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IntroductionRegular physical activity is associated with a wide range of health benefits in youth. While previous studies have identified disparities in physical activity among youth by gender identity and sexual attraction, these have seldom been explored in Canadian youth. MethodsData from the 2019 Canadian Health Survey on Children and Youth were used to assess prevalence of and time spent in organized sports participation, total physical activity and active transportation by gender identity (non-cisgender vs. cisgender) among youth aged 12 to 17, and by sexual attraction (nonheterosexual attraction vs. heterosexual attraction) among youth aged 15 to 17. ResultsThere was no difference in average minutes of total physical activity per week between non-cisgender and cisgender Canadian youth. Non-cisgender youth (which represent 0.5% of the population) averaged significantly fewer minutes of organized sports per week than their cisgender counterparts. There was some evidence of increased active transportation to school among non-cisgender youth, but insufficient power to detect significant differences. Canadian youth reporting any nonheterosexual attraction (which represent 21.2% of the population, including mostly heterosexual youth) were less likely to be regularly physically active and participate in organized sports than youth reporting exclusive heterosexual attraction. Differences were larger among males than females. Males reporting nonheterosexual attraction were more likely to use active transportation to get to school than their heterosexual counterparts. ConclusionNon-cisgender youth and youth reporting nonheterosexual attraction tended to participate less in organized sports than their counterparts, but may have engaged in more active transportation. Mitigating the barriers associated with sport participation could increase physical activity among these groups.

IntroductionLa pratique régulière d’activité physique est associée à un grand nombre d’avantages pour la santé chez les jeunes. Bien que des études antérieures aient fait ressortir des différences dans la pratique de l’activité physique chez les jeunes selon l’identité de genre et l’orientation sexuelle, ces facteurs ont été peu étudiés chez les adolescents canadiens. MéthodologieLes données de l’Enquête canadienne sur la santé des enfants et des jeunes de 2019 ont été utilisées pour évaluer la prévalence de la participation à des sports organisés, le temps passé à pratiquer des sports organisés, l’activité physique totale et l’utilisation du transport actif pour se rendre à l’école en fonction de l’identité de genre (cisgenre ou non cisgenre) chez les adolescents de 12 à 17 ans et de l’attirance sexuelle (hétérosexuelle ou non hétérosexuelle) chez les adolescents de 15 à 17 ans. RésultatsAucune différence n’a été constatée entre les adolescents canadiens cisgenres et non cisgenres sur le plan du nombre moyen de minutes d’activité physique totale par semaine. Le nombre hebdomadaire moyen de minutes passées à pratiquer des sports organisés était nettement plus faible chez les adolescents non cisgenres (qui représentent 0,5 % de la population) que chez les adolescents cisgenres. Certaines données indiquent que les adolescents non cisgenres étaient plus nombreux que les autres adolescents à utiliser le transport actif pour se rendre à l’école, mais leur puissance statistique est insuffisante pour faire ressortir des différences significatives. Les adolescents canadiens ayant déclaré tout type d’attirance non hétérosexuelle (et qui représentent 21,2 % de la population, incluant les jeunes avec une attirance principalement hétérosexuelle) étaient moins nombreux que les adolescents ayant déclaré une attirance exclusivement hétérosexuelle à faire de l’activité physique régulièrement et à participer à des sports organisés. Les écarts étaient plus marqués chez les garçons que chez les filles. Les garçons ayant déclaré une attirance non hétérosexuelle étaient plus nombreux que ceux ayant déclaré une attirance hétérosexuelle à utiliser le transport actif pour se rendre à l’école. ConclusionLes adolescents non cisgenres et les adolescents ayant déclaré une attirance non hétérosexuelle participaient moins que les autres adolescents à des sports organisés, mais ils semblent être plus nombreux à utiliser le transport actif. L’atténuation des barrières à la pratique de sports organisés pourrait accroître l’activité physique dans ces groupes.

Aging leads to a general decline in protective immunity. The most common age-associated effects are in seen T-cell mediated immune function. Adult mice whose immune systems show only moderate changes in T-cell subsets tend to live longer than age-matched siblings that display extensive T-cell subset aging. Importantly, at the time of reproductive decline, the increase in disease risks in women significantly outpace those of men. In female mice, there is a significant decline in central and peripheral naïve T-cell subsets at the time of reproductive failure. Available evidence indicates that this naïve T-cell decline is sensitive to ovarian function and can be reversed in post-reproductive females by transplantation of young ovaries. The restoration of naïve T-cell subsets due to ovarian transplantation was impressive compared with post-reproductive control mice, but represented only a partial recovery of what was lost from 6 months of age. Apparently, the influence of ovarian function on immune function may be an indirect effect, likely moderated by other physiological functions. Estradiol is significantly reduced in post-reproductive females, but was not increased in post-reproductive females that received new ovaries, suggesting an estradiol-independent, but ovarian-dependent influence on immune function. Further evidence for an estradiol-independent influence includes the restoration of immune function through the transplantation of young ovaries depleted of follicles and through the injection of isolated ovarian somatic cells into the senescent ovaries of old mice. While the restoration of naïve T-cell populations represents only a small part of the immune system, the ability to reverse this important functional parameter independent of estradiol may hold promise for the improvement of post-reproductive female immune health. Further studies of the non-reproductive influence of the ovary will be needed to elucidate the mechanisms of the relationship between the ovary and health.

Recruiting companies recommend elite female soccer players be ≥165 cm (5′5″) in stature. This study investigated if stature limits match-playing time and performance in elite World Cup soccer among players, positions, and countries. We hypothesized stature would not affect match-playing time or performance. Descriptive data were collected on 552 players from 2019 FIFA Women's World Cup. Odds ratios determined likelihood of starting for players 0.05), or between countries (p > 0.05). Taller mid-fielders exhibited greater performance in goals, assists, attempts, shots blocked, and defending blocks (MD [95%CI] ES; assists, −0.44[−0.76,−0.11]0.59, p = 0.009; goals, −0.35[−0.69,−0.01]0.44, p = 0.047); attempts, 3.14[1.38, 4.90]0.80, p = 0.001; corners, 2.04[0.12, 3.95]0.48, p = 0.037; shots blocked, 0.96[0.40, 1.51]0.75, p = 0.001; defending blocks, 0.43[0.32,0.82]0.48, p = 0.035), however, actual differences were minimal. Our findings indicate stature does not inhibit playing and performing elite women's soccer, as nearly one-third of players were

Background: The role of video-assisted Thoracoscopic Surgery (VATS) is still being defined in the management of thoracic trauma. We report our trauma cases managed by VATS and review the role of VATS in the management of thoracic trauma. Materials and Methods: All the trauma patients who underwent VATS from 2000 to 2007 at Cedars-Sinai Medical Center were retrospectively studied. Results: Twenty-three trauma patients underwent 25 cases of VATS. The most common indication for VATS was retained haemothorax. Thoracotomy was avoided in 21 patients. VATS failed in two cases. On an average VATS was performed on trauma day seven (range 1-26) and the length of hospital stay was 20 days (range 3-58). There was no mortality. VATS was performed in an emergency (day 1-2), or in the early (day 2-7) or late (after day 7) phases of trauma. Conclusion: VATS can be performed safely for the management of thoracic traumas. VATS can be performed before or after thoracotomy and at any stage of trauma. The use of VATS in trauma has a trimodal distribution (emergent, early, late), each with different indications.

Hospital quality-improvement initiatives that focus on diagnosis are challenging because clinicians who make the initial diagnosis are often not involved in deciding subsequent management and are unaware of the discharge diagnosis. A large Veterans Affairs study used natural language processing and diagnosis codes to determine the frequency of discordant diagnoses and to describe variables associated with discordance. Visual Abstract. Diagnostic Discordance, Uncertainty, and Treatment Ambiguity in Community-Acquired Pneumonia: Hospital quality-improvement initiatives that focus on diagnosis are challenging because clinicians who make the initial diagnosis are often not involved in deciding subsequent management and are unaware of the discharge diagnosis. A large Veterans Affairs study used natural language processing and diagnosis codes to determine the frequency of discordant diagnoses and to describe variables associated with discordance. Background: Evidence-based practice in community-acquired pneumonia often assumes an accurate initial diagnosis. Objective: To examine the evolution of pneumonia diagnoses among patients hospitalized from the emergency department (ED). Design: Retrospective nationwide cohort. Setting: 118 U.S. Veterans Affairs medical centers. Patients: Aged 18 years or older and hospitalized from the ED between 1 January 2015 and 31 January 2022. Measurements: Discordances between initial pneumonia diagnosis, discharge diagnosis, and radiographic diagnosis identified by natural language processing of clinician text, diagnostic coding, and antimicrobial treatment. Expressions of uncertainty in clinical notes, patient illness severity, treatments, and outcomes were compared. Results: Among 2   383   899 hospitalizations, 13.3% received an initial or discharge diagnosis and treatment of pneumonia: 9.1% received an initial diagnosis and 10.0% received a discharge diagnosis. Discordances between initial and discharge occurred in 57%. Among patients discharged with a pneumonia diagnosis and positive initial chest image, 33% lacked an initial diagnosis. Among patients diagnosed initially, 36% lacked a discharge diagnosis and 21% lacked positive initial chest imaging. Uncertainty was frequently expressed in clinical notes (58% in ED; 48% at discharge); 27% received diuretics, 36% received corticosteroids, and 10% received antibiotics, corticosteroids, and diuretics within 24 hours. Patients with discordant diagnoses had greater uncertainty and received more additional treatments, but only patients lacking an initial pneumonia diagnosis had higher 30-day mortality than concordant patients (14.4% [95% CI, 14.1% to 14.7%] vs. 10.6% [CI, 10.4% to 10.7%]). Patients with diagnostic discordance were more likely to present to high-complexity facilities with high ED patient load and inpatient census. Limitation: Retrospective analysis; did not examine causal relationships. Conclusion: More than half of all patients hospitalized and treated for pneumonia had discordant diagnoses from initial presentation to discharge. Treatments for other diagnoses and expressions of uncertainty were common. These findings highlight the need to recognize diagnostic uncertainty and treatment ambiguity in research and practice of pneumonia-related care. Primary Funding Source: The Gordon and Betty Moore Foundation. [ABSTRACT FROM AUTHOR]

Patron-driven acquisition has been an important, if contentious, topic for decades, with numerous programs having been piloted, adopted, and reported on, largely favorably, in the library literature. Still, questions and doubts persist for academic libraries, especially where the composition of vendor plans and packages and the judgment of patrons are concerned. Past literature has approached the assessment of patron-driven acquisition by analyzing circulation/usage, comparing peer-library holdings, seeking patrons' or librarians' judgments of utility and suitability, looking for evidence of collection imbalances, and testing for overlap in patrons' and librarians' purchases. To contribute to this literature, this study addresses scholarly impact and examines whose selections--approval plans', librarians', or patrons'--have been most heavily cited. For the social sciences, the sciences, and the humanities, the authors gathered topic-matched random samples of books acquired via approval plans and librarian orders during the first five years of operation of their institutions' interlibrary loan purchase-on-demand patrondriven acquisition program and compared their citation counts to the counts of books acquired via the program. Google Scholar was employed to tally citations.

Lung volume reduction surgery (LVRS) has shown promising results in severe emphysema. However, intraoperative indicators are needed to define optimal resection volumes. Diffusing capacity (DLCO) worsens with larger LVRS and may correlate with pulmonary artery (PA) pressure. We hypothesized that there would be a greater increase in PA pressures with larger volume LVRS in an inhaled elastase animal emphysema model. Twenty-one rabbits were induced with 15,000 units of elastase via an endotracheal tube. Four weeks later, bilateral LVRS was performed through a median sternotomy using an endoscopic stapler. PA pressures were measured prior to LVRS, immediately after LVRS, and at sacrifice. Single-breath DLCO, static pressure-volume relationships, and forced expiratory flows were measured prior to induction and at corresponding times to PA pressures. Systolic PA pressures increased in both groups immediately after LVRS (small: 2. 67 +/- 9.2 mm Hg, ANOVA, P = 0.023; large: 3.8 +/- 8.5 mm Hg, P = 0. 002), and then decreased at time of sacrifice 1 week later (small: 9. 43 +/- 4.8 mm Hg, ANOVA, P = 0.053; large: 5.2 +/- 7.3 mm Hg, P = 0. 552). The decrease, at sacrifice, in PA pressures was greater for small LVRS animals than large LVRS animals. The mortality rate (MR) for the small resection group was 0%, whereas that for the large resection group was 24%. The MR associated with larger LVRS was appreciably greater than that associated with small LVRS. These studies suggest that PA pressures may prove to be a useful intraoperative indicator for limits of resection.

ObjectiveThe purpose of this study was to investigate in an elastase-induced emphysema rabbit model the effects of increasing resection volumes during lung volume reduction surgery on pulmonary compliance, forced expiratory air flow, and diffusing capacity to assess factors limiting optimal resection.MethodsEmphysema was induced in 68 New Zealand White rabbits with 15,000 units of aerosolized elastase. Static respiratory system compliance, forced expiratory flow, and single-breath diffusing capacity were measured before the induction of emphysema, after the induction of emphysema, and 1 week after a bilateral upper and middle lobe lung volume reduction operation.ResultsStatic respiratory system compliance with 60 mL insufflation above functional residual capacity increased with emphysema induction and then decreased progressively with resection of larger volumes of lung tissue (P =.001 by analysis of variance). Expiratory flow improved after lung resection in the rabbits with large resection volumes. In contrast, diffusing capacity tended to deteriorate with larger resection volumes (P =. 18).ConclusionImprovements in respiratory system compliance and forced expiratory flow after lung volume reduction operations may account for the improvements seen clinically. Declines in diffusing capacity with extensive lung reduction may limit the clinical benefits associated with greater tissue resection volumes. Future investigations with animal models may reveal other physiologic parameters that may further guide optimal lung volume reduction procedures.