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Abstract INTRODUCTION We examined the relationship between sedentary behavior (SB), moderate‐to‐vigorous physical activity (MVPA), and white matter hyperintensity (WMH) volumes, a common magnetic resonance imaging (MRI) marker associated with risk of neurodegenerative disease in middle‐aged to older adults. METHODS We used data from the UK Biobank (n = 14,415; 45 to 81 years) that included accelerometer‐derived measures of SB and MVPA, and WMH volumes from MRI. RESULTS Both MVPA and SB were associated with WMH volumes (βMVPA = −0.03 [−0.04, −0.01], p

Purpose: To identify motivational determinants explaining Physical Education teachers' behaviors promoting students' physical activity (PA) amidst the COVID-19 pandemic. Method: Nine hundred thirty-one Italian and French teachers completed a questionnaire assessing motivational determinants (self-determined motivation, self-efficacy, perceived ease and usefulness toward digital technologies, engagement at work), their intention and behaviors promoting PA, in reference to before and during the pandemic. Path analyses tested the associations of changes in motivational determinants with changes in intention and behaviors. Results: Increases in autonomous, controlled motivation, self-efficacy, and perceived usefulness toward digital technologies, and a decrease in amotivation were associated with an increase in the intention to promote PA. In turn, an increase in intention, but also in self-efficacy, autonomous motivation, and perceived usefulness toward digital technologies were paired with an increase in behaviors promoting PA. Conclusion: Implications regarding the commitment of Physical Education teachers to challenging pedagogical situations, such as promoting PA amidst the COVID-19 pandemic, are discussed.

Aim: This prospective randomized clinical trial aimed at analyzing the skeletal effects of this modified acrylic splint palatal expander (MASPE) used for maxillary transversal deficiency treatment in mixed dentition. Methods: Eligibility criteria included maxillary transverse deficiencies in children between 7 and 10 years of age. Eighteen individuals who met the inclusion criteria and reached the end of treatment were evaluated (mean age of 8.66 years old) and randomly assigned to be submitted to rapid maxillary expansion with either the MASPE experimental device or a well-known tooth-borne expander (control group). CBCT scans taken before expansion and at the end of the retention period were evaluated. The palatal area was calculated, and the length of expansion was measured. Treatment changes were analyzed using paired t-tests, whereas independent t-tests were used to compare the two groups. Results: There were statistically significant (p

Background: A new access technique was developed to reduce postoperative adverse events after the extraction of impacted maxillary wisdom teeth. Hence, this study aimed to assess the occurrence of adverse events after the extraction of maxillary impacted wisdom teeth using a traditional access (TA) or a new technique (NT). Methods: Two different surgical incision designs were used for bilateral wisdom tooth extractions in 30 patients. The traditional incision was performed distal to the second molar in the center of the tuberosity, followed by a buccal releasing incision. After the tooth extraction, the wound was secured by sutures. The new technique consists of an oblique incision from the distal palatal aspect of the tuberosity towards the buccal aspect of the second molar. After the tooth extraction, cyanoacrylate glue was used on the wound. Results: Lower pain was reported by patients at the site treated with the new technique (p < 0.01). Edema, postsurgical bleeding, and hematoma were similar in both groups. The surgical time was shorter for the new technique (p < 0.01). Conclusions: The new technique applied for the extraction of impacted maxillary wisdom teeth reduced postsurgical pain and the duration of surgery.

ABSTRACTPre-clerkship curricula of most Liaison Committee on Medical Education (LCME)-accredited medical schools are divided into blocks by organ system, leaving a significant amount of information susceptible to loss due to prolonged nonuse. We describe the implementation of a formal Spiral Curriculum that periodically revisits material from previous blocks. Learners were surveyed on receptivity to the curriculum across three graduating classes at a single medical school. Medical school graduate classes of 2020, 2021, and 2022 were surveyed at the end of their pre-clerkship years (2018–2020). The class of 2022 actually received the Spiraled Curriculum intervention, for which the authors created 500 board exam style multiple-choice questions, periodically administered via mandatory in-class sessions ranging from 10 to 20 questions reviewing content from previous blocks with designated expert faculty. Response rates were 36% (n = 46), 45% (n = 52), and 32% (n = 40) for classes of 2020, 2021, and 2022, respectively. On a Likert scale (1 = strongly disagree, 5 = neutral, 10 = strongly agree), the classes of 2020, 2021, and 2022 provided statistically significant differences in their belief that a Spiraled Curriculum would/did help them retain information as 8.2 (SD 1.7), 8.2 (SD 2.2), and 5.0 (SD 3.0) (n < 0.05). All classes endorsed neutral confidence in the existing pre-clerkship curriculum in themselves to prepare for United Stated Medical Licensing Examination (USMLE) Step 1, and in their retention of previous block material with no statistically significant differences between classes. USMLE Step 1 scores did not differ significantly between classes (n = 0.21). Those who did not receive the Spiral Curriculum were highly receptive to it in theory, while those who actually received the intervention gave a neutral rating. Per survey comments, implementation of a Spiraling Curriculum would ideally be administered as either team-based or self-directed activities, and a Spiraling Curriculum may be difficult to implement in accelerated (18 month) pre-clerkship formats.Practice points Question: What is the receptivity of medical students to a formal Spiral curriculum that uses time-spaced repetition sessions of board exam style questions to revisit previous block content of their pre-clerkship years?Findings: In this single-center, quasi-experimental study, the two control group medical school classes had very positive theoretical reception to a Spiral curriculum proposal (rated 8 out of 10) while the class who actually received the Spiral curriculum provided a statistically significant lower neutral rating (rated 5 out of 10), citing preference for a team-based or self-directed format.Meaning: Medical students are strongly in favor of structured time-spaced repetition with board exam style questions to revisit previous material but prefer a format that does not interfere with time to personalize their medical school experience.

Individuals identified as Aricidea assimilis Tebble, 1959 were collected from ten localities across the Mediterranean Sea from 0.5 to 225 m depth in order to have a wide coverage of the species habitats and geographic range and to assess the effects of environmental factors and biogeographical barriers on molecular and morphological diversity. Two mitochondrial and one nuclear markers were used to reconstruct phylogenetic relationships and test the occurrence of cryptic species. We observed two highly divergent lineages, one including all individuals from shallow, sandy environments (

Objective: We sought to several develop parsimonious machine learning models to predict resource utilization and clinical outcomes following cardiac operations using only preoperative factors. Methods: All patients undergoing coronary artery bypass grafting and/or valve operations were identified in the 2015-2021 University of California Cardiac Surgery Consortium repository. The primary end point of the study was length of stay (LOS). Secondary endpoints included 30-day mortality, acute kidney injury, reoperation, postoperative blood transfusion and duration of intensive care unit admission (ICU LOS). Linear regression, gradient boosted machines, random forest, extreme gradient boosting predictive models were developed. The coefficient of determination and area under the receiver operating characteristic (AUC) were used to compare models. Important predictors of increased resource use were identified using SHapley summary plots. Results: Compared with all other modeling strategies, gradient boosted machines demonstrated the greatest performance in the prediction of LOS (coefficient of determination, 0.42), ICU LOS (coefficient of determination, 0.23) and 30-day mortality (AUC, 0.69). Advancing age, reduced hematocrit, and multiple-valve procedures were associated with increased LOS and ICU LOS. Furthermore, the gradient boosted machine model best predicted acute kidney injury (AUC, 0.76), whereas random forest exhibited greatest discrimination in the prediction of postoperative transfusion (AUC, 0.73). We observed no difference in performance between modeling strategies for reoperation (AUC, 0.80). Conclusions: Our findings affirm the utility of machine learning in the estimation of resource use and clinical outcomes following cardiac operations. We identified several risk factors associated with increased resource use, which may be used to guide case scheduling in times of limited hospital capacity.

The phylogenetic relationships among black-tailed rattlesnakes remain poorly understood and some authors indicated that the diversity of this group has been underestimated and additional analyses are required to clarify the biogeographic patterns throughout its distribution in Mexico. Therefore, the aim of this study was to elucidate the phylogenetic relationships among black-tailed rattlesnakes across their range, identifying relative divergence times among the main clades and reconstructing the biogeographical history of the group. Three partial mitochondrial genes (ND4, cytb and ATPase6) and one nuclear gene (RAG1) were sequenced to infer the phylogenetic relationships, through the maximum likelihood and Bayesian inference-based methods; demographic history reconstruction was investigated through Bayesian Skyline plot analysis and the ancestral area reconstruction was carried out considering a Bayesian framework. We found strong evidence that the black-tailed rattlesnakes’ group is composed of six clades, which is in agreement with subspecies previously reported. Divergence time estimation indicated that the origin of the C. molossus group could be traced to the middle of the Miocene (~7.71 Mya). Ancestral area reconstruction indicated that early divergence events occurred in Central Mexico, probably related to the geological dynamics of the Trans-Mexican Volcanic Belt. The lineage C. m. oaxacus is the basal member of the C. molossus group. Furthermore, the combination of geological events and changes in Quaternary vegetation may have contributed to the divergence of C. molossus clades. Our results suggest several clades within C. molossus complex could be potentially recognized as separate species.