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Background:After officer-involved shootings (OIS), rapid delivery of emergency medical care is critical but may be delayed due to scene safety concerns. The purpose of this study was to describe medical care rendered by law enforcement officers (LEOs) after lethal force incidents.Methods:Retrospective analysis of open-source video footage of OIS occurring from February 15, 2013 through December 31, 2020. Frequency and nature of care provided, time until LEO and Emergency Medical Services (EMS) care, and mortality outcomes were evaluated. The study was deemed exempt by the Mayo Clinic Institutional Review Board.Results:Three hundred forty-two (342) videos were included in the final analysis; LEOs rendered care in 172 (50.3%) incidents. Average elapsed time from time-of-injury (TOI) to LEO-provided care was 155.8 (SD = 198.8) seconds. Hemorrhage control was the most common intervention performed. An average of 214.2 seconds elapsed between LEO care and EMS arrival. No mortality difference was identified between LEO versus EMS care (P = .1631). Subjects with truncal wounds were more likely to die than those with extremity wounds (P < .00001).Conclusions:It was found that LEOs rendered medical care in one-half of all OIS incidents, initiating care on average 3.5 minutes prior to EMS arrival. Although no significant mortality difference was noted for LEO versus EMS care, this finding must be interpreted cautiously, as specific interventions, such as extremity hemorrhage control, may have impacted select patients. Future studies are needed to determine optimal LEO care for these patients.

Breast cancer (BC) is the most diagnosed cancer in women worldwide. In estrogen receptor (ER)-positive disease, anti-estrogens and aromatase inhibitors (AI) improve patient survival; however, many patients develop resistance. Dysregulation of apoptosis is a common resistance mechanism; thus, agents that can reinstate the activity of apoptotic pathways represent promising therapeutics for advanced drug-resistant disease. Emerging targets in this scenario include microRNAs (miRs). To identify miRs modulating apoptosis in drug-responsive and -resistant BC, a high-throughput miR inhibitor screen was performed, followed by high-content screening microscopy for apoptotic markers. Validation demonstrated that miR-361-3p inhibitor significantly increases early apoptosis and reduces proliferation of drug-responsive (MCF7), plus AI-/antiestrogen-resistant derivatives (LTED, TamR, FulvR), and ER- cells (MDA-MB-231). Importantly, proliferation-inhibitory effects were observed in vivo in a xenograft model, indicating the potential clinical application of miR-361-3p inhibition. RNA-seq of tumour xenografts identified FANCA as a direct miR-361-3p target, and validation suggested miR-361-3p inhibitor effects might be mediated in part through FANCA modulation. Moreover, miR-361-3p inhibition resulted in p53-mediated G1 cell cycle arrest through activation of p21 and reduced BC invasion. Analysis of publicly available datasets showed miR-361-3p expression is significantly higher in primary breast tumours vspaired normal tissue and is associated with decreased overall survival. In addition, miR-361-3p inhibitor treatment of BC patient explants decreased levels of miR-361-3p and proliferation marker, Ki67. Finally, miR-361-3p inhibitor showed synergistic effects on BC growth when combined with PARP inhibitor, Olaparib. Together, these studies identify miR-361-3p inhibitor as a potential new treatment for drug-responsive and -resistant advanced BC.

Objectives Controversy remains regarding surgical managements of sylvian fissure arachnoid cyst (SFAC). This review presents our experience in the microsurgical fenestration of pediatric patients with SFAC to define surgical indication, and risks and benefits with special emphasis on postoperative subdural fluid collection (SDFC) and cyst size reduction. Methods Thirty-four children with SFAC who underwent microsurgical cyst fenestration at a single institution over a 10-year period were retrospectively reviewed for their clinical presentation, neuroimaging findings, and postsurgical course. The SFACs were classified by a novel grading system based on the degree of arachnoid cyst extension from the sylvian fissure to the insular cistern shown on MR images: grade 0 — little or no prominence of sylvian fissure, grade I — SFAC confined to the sylvian fissure, grade II — SFAC partially extending to the insular cistern, grade III — SFAC extending to the entire insular cistern. Results There were 26 males and 8 females. SFAC was present in the left side in 24. Twelve patients presented with cyst rupturing to the subdural space. Cyst grading did not show significant difference compared with rupture status (p > 0.9). All patients underwent microsurgical cyst fenestration. Postoperative SDFC is common but often resolved overtime in two-thirds of the cases with the mean average of 6 months. However, 3 patients had symptomatic postoperative SDFC and needed reoperation shortly after the first operation. Microsurgical cyst fenestrations for SFAC effectively resolved the presenting symptoms and often showed restorations of intracranial structures on follow-up imaging. Cyst resolution or reduction greater than 75% was noted in 61.8% of the patients postoperatively which was noted in a half of the SFAC of children even with age of 11 years or older. During the follow-up, no cyst recurrence or SDFC was noted. Patients with greater surgical reduction of cyst size tended to occur in younger children, and those with lower MR grade. Conclusion Our results showed a high reduction rate of SFAC and brain re-expansion after microsurgical fenestration together with symptomatic improvements regardless the patient’s age. Considering the developing CNS during childhood, reductions of a large space-occupying lesion followed by restorations of the structural integrity of the developing brain are very desirable. However, a multi-center cooperative prospective longitudinal study on long-term comparative data of those treated and untreated of neuro-psychological outcome and cyst rupture incidence is needed.

Introduction Clinical knowledge surrounding functional outcomes of a powered knee–ankle (PKA) device is limited, particularly among younger and active populations with limb loss. Here, three service members (SM) with unilateral transfemoral limb loss received an optimally tuned PKA prosthesis and device-specific training. Materials and Methods Once proficiency with the PKA device was demonstrated on benchmark activities, and outcomes with the PKA and standard-of-care (SoC) prostheses were obtained via a modified graded treadmill test, 6-minute walk test, and overground gait assessment. Results All SM demonstrated proficiency with the PKA prosthesis within the minimum three training sessions. With the PKA versus SoC prosthesis, cost of transport during the modified graded treadmill test was 4.0% ± 5.2% lower at slower speeds (i.e., 0.6-1.2 m/s), but 7.0% ± 5.1% greater at the faster walking speeds (i.e., ≥1.4 m/s). For the 6-minute walk test, SM walked 83.9 ± 13.2 m shorter with the PKA versus SoC prosthesis. From the overground gait assessment, SM walked with 20.6% ± 10.5% greater trunk lateral flexion and 31.8% ± 12.8% greater trunk axial rotation ranges of motion, with the PKA versus SoC prosthesis. Conclusions Compared to prior work with the PKA in a civilian cohort, although SM demonstrated faster device proficiency (3 versus 12 sessions), SM walked with greater compensatory motions compared to their SoC prostheses (contrary to the civilian cohort). As such, it is important to understand patient-specific factors among various populations with limb loss for optimizing device-specific training and setting functional goals for occupational and/or community reintegration, as well as reducing the risk for secondary complications over the long term.

Violence in the emergency department (ED) remains underreported. Patient factors are often cited as a source of confusion in determining the culpability of perpetrators and whether to proceed with incident reporting. This study’s objective was to determine how ED staff at one academic medical center perceive certain clinical scenarios and how this compares to local law enforcement officers (LEO). An anonymous survey with 4 scenarios was sent to multidisciplinary ED staff at our academic medical center, as well as local LEO and inquired whether respondents considered any of the scenarios to be reportable as a crime. Chi-square analysis was used for comparison. The study was deemed exempt by the Institutional Review Board. A total of 261 ED staff and 77 LEO completed the survey. Both groups were equally likely to believe that a reportable crime occurred in Scenario 1, where a patient with dementia punches a nurse (LEO: 26.0% vs. ED: 31.4%, p = 0.44), and in Scenario 2, where an intoxicated patient spits at a phlebotomist (LEO: 97.4% vs. ED: 95.0%, p = 0.56). However, the two groups differed in Scenario 3, in which a patient with delirium makes verbal threats to a doctor (LEO: 20.8% vs. ED: 42.9%, p < 0.001), and Scenario 4, in which a patient’s parent throws a chair at a medical student (LEO: 66.2% vs. ED: 81.2%, p = 0.009). As health systems seek to improve workplace safety, it is important to consider the barriers to reporting violent incidents, including staff’s understanding of what acts may constitute reportable violence, as well as LEO understanding of the unique ED environment and patient responsibilities.

The purpose of this research was to develop a better understanding of the underlying mechanisms that shape athletes’ perceptions and experiences of subgroups, with the purview of advancing a sport ...

Although extensive sport research has been dedicated to understanding coach effectiveness, this work has largely explored how coaches’ behaviours influence individual athletes rather than consideri...

Despite the importance of teamwork in the operating room (OR), teamwork can often be conflated with teamwork components (e.g., communication, cooperation). We reviewed the existing literature pertaining to OR teamwork to understand which teamwork components have been assessed. Following PRISMA guidelines for scoping reviews, 4,233 peer-reviewed studies were identified using MEDLINE and Embase. Eighty-seven studies were included for synthesis and analysis. Using the episodic model of teamwork as an organizing framework, studies were grouped into the following teamwork categories: (a) transition processes (e.g., goal specification), (b) action processes (e.g., coordination), (c) interpersonal processes (e.g., conflict management), (d) emergent states (e.g., psychological safety), or (e) omnibus topics (a combination of higher-order teamwork processes). Results demonstrated that action processes were most frequently explored, followed by transition processes, omnibus topics, emergent states, and interpersonal processes. Although all studies were framed as investigations of teamwork, it is important to highlight that most explored only one or a few constructs under the overarching umbrella of teamwork. We advocate for enhanced specificity with descriptions of OR teamwork, reporting practices pertaining to interprofessional demographics and outcomes, and increased diversity in study design and surgery type to advance understanding of teamwork and its implications.

The purpose of this study was to determine whether the relationship between coach leadership and athlete motivation was moderated by age, gender, competition level, and seasons spent with a coach. This study involved data from two previous studies that explored this relationship yet provides a novel perspective through the lens of important moderators. Three-hundred and three athletes (

Background: Cervical arterial dissection accounts for 2-3% of all ischemic strokes. The pathophysiologic mechanism of the ensuing neurological sequelae is largely attributed to embolic phenomenon. The degree to which the dissection may limit cerebral blood flow and its relationship to symptoms is currently not well characterized. This study is the first to evaluate and quantify blood flow using quantitative magnetic resonance angiography (QMRA) in this patient population. Methods: A retrospective chart review was completed in patients at this institution with cervical arterial dissection between August 31, 2009, to September 1, 2019. Inclusion criteria were adults (≥18 years) with diagnosis of dissection of the common carotid artery, internal carotid artery, or vertebral artery, who received QMRA neuroimaging. The cases were reviewed for clinical presentation, diagnosis, management strategy, and radiologic imaging finding. Flow index was calculated using the ipsilateral vessel flow divided by the contralateral flow. Statistical analyses were completed using SPSS software (Version 27, IBM Corporation, Armonk, NY). Results: A total of 41 patients were included in this study, 53.7% male and 46.3% female, with mean age 46.0 +/- 11.9 years. Twenty-one patients (51.2%) had ICA dissections while 19 patients (46.3%) had VA dissections, and 1 patient had both ICA and VA vessels affected. Patients with ischemia on MRI demonstrated lower flow in the ipsilateral vessel when compared to those patients without ischemia on MRI at diagnosis and follow-up (p=0.003). Although flow improved over time, patients continued to remain stratified: patients with the lowest index on presentation tended to continue to have low flow in the ipsilateral vessel (p=0.000). Using the flow index in ROC analysis to predict ischemia on MRI yielded an area under the curve of 0.833 (p=0.002); ROC analysis of the percent of total flow for ischemia on MRI found an AUC of 0.895 (p=0.000). Conclusion: This study represents the first to assess vessel flow in patients with cervical arterial dissection using QMRA. Patients with lower flow as a result of dissection appear to be at higher risk of ischemia on presentation, emphasizing the role of hemodynamics in the underlying pathophysiology.

Effective onboarding practices benefit both the incoming members and the organization as a whole. However, to date, existing onboarding literature has focused exclusively on the incoming members, with little attention to those in their social network, such as family members (e.g., partners, parents/guardians). The purpose of this study was to explore onboarding practices within a professional sport context (i.e., National Basketball Association), with a specific emphasis on understanding the experiences of family members involved in the transition process with an athlete. A qualitative approach was undertaken, involving semi-structured interviews with people who facilitated or had undergone onboarding: organizational representatives (n = 11), athletes (n = 5), and family members (n = 6). Findings demonstrated the importance of resource and information sharing, valuing family members, and developing social capital for successful onboarding, and identified several considerations (e.g., timing, acquisition type) and barriers (e.g., member turnover, status hierarchy). Ultimately, although organizations acknowledged the importance of purposefully onboarding family members, none prioritized the task or had a systematic process in place. These findings reinforce the importance of considering significant others when onboarding professional athletes and provide suggestions for future research directions and practical advancements within the elite sport context. Lay summary: Family members, such as partners and parents/guardians, play an important role in assisting professional athletes through career transitions. While family members experience similar stressors during transition periods, they are often not considered in the onboarding process. Results highlight that family members require purposeful onboarding from sporting organizations to be successfully integrated into a new environment.IMPLICATIONS FOR PRACTICEThe current findings emphasize the importance of being purposeful and prioritizing family members during the onboarding process of professional athletes.For successful onboarding to occur, organizations should know who will be onboarded and subsequently, provide tailored resources to ensure they feel informed and valued.It is integral that systematic and formal mentoring efforts (e.g., forming a mentoring network) are put in place to foster a sense of connection amongst family members within an organization. The current findings emphasize the importance of being purposeful and prioritizing family members during the onboarding process of professional athletes. For successful onboarding to occur, organizations should know who will be onboarded and subsequently, provide tailored resources to ensure they feel informed and valued. It is integral that systematic and formal mentoring efforts (e.g., forming a mentoring network) are put in place to foster a sense of connection amongst family members within an organization.

Objective:Performance feedback on clinical care and patient outcomes is a cornerstone of medical education, yet it remains lacking in the prehospital environment. Research seeking to establish the quantity of feedback provided to Emergency Medical Services (EMS) has been limited and studies focused on complimentary feedback or how feedback relates to EMS job satisfaction are lacking. The objectives of this study were to measure the frequency and nature of feedback received by EMS agencies and to identify the importance of receiving feedback as it relates to EMS job satisfaction.Methods:This was an anonymous, survey-based study of twenty-nine Basic Life Support (BLS) and fifteen Advanced Life Support (ALS) agencies located in Southeastern Minnesota (USA). Descriptive statistics and Fisher exact tests were used. The study was deemed exempt by the Mayo Clinic Institutional Review Board.Results:Ninety-four responses were included from nineteen different EMS agencies, including sixty-one (64.9%) paramedics and thirty-three (35.1%) emergency medical technicians (EMTs). One-half of all respondents reported that they had not received any type of feedback in the past 30 days, while another 43.6% of respondents indicated that they had only received feedback one to three times in the same time period. Twenty (60.6%) EMTs reported receiving no feedback in the past 30 days, compared with twenty-seven (44.3%) paramedics (P = .123). Of respondents receiving feedback, 65.9% reported never or rarely receiving positive reinforcing feedback and 60.6% reported never or rarely receiving constructive criticism or feedback regarding something that did not go well with patient care or transport. The majority of respondents were dissatisfied with the quantity (86.1%) and quality (73.4%) of feedback received. An overwhelming majority (93.6%) indicated that feedback on patient care or outcomes was important in influencing their overall job satisfaction. This high importance was maintained across all demographic groups.Conclusion:Within the cohort of survey respondents, a paucity of feedback received by EMS personnel is a source of dissatisfaction for EMS providers. Feedback on patient care strongly relates to overall job satisfaction. These findings suggest system-wide opportunities for structured feedback processes, focusing upon both quality and quantity of delivered feedback, to improve both patient care and staff satisfaction.

Author(s): McGuire, Sarayna S.; Mullan, Aidan F.; Clements, Casey M. | Abstract: Introduction: Workplace violence in the emergency department (ED) is a serious threat to staff and is likely to go unreported. We sought to identify the incidence of violence among staff at our academic ED over a six-month period.Methods: An anonymous survey was sent to all ED staff, asking whether respondents had experienced verbal abuse or physical assault over the prior six months and whether they had reported it. Those working in the department l6 months were excluded from analysis. We used chi-squared comparison to analyze the results.n Results: We analyzed 242 responses. Overall, 208 (86%) respondents indicated being verbally abused in the preceding six months, and 90 (37%) indicated being physically assaulted. Security officers had the highest incidence of verbal abuse (98%), followed by nursing (95%), patient care assistants (PCA) (90%) and clinicians (90%), phlebotomists (75%), care team assistants (73%), registration staff (50%) and electrocardiogram (ECG)/radiology technicians (50%). Security also had the highest incidence of physical assault (73%), followed by nursing (49%), PCAs (30%), clinicians (24%), phlebotomists (17%), and ECG/radiology technicians (13%). A total of 140 (69%) non-security personnel indicated that they never report incidents of violence.Conclusion: Our results indicate that violence in the ED affects more than just nurses and doctors. As health systems seek to improve the safety of their employees in violence-prone areas, it is imperative that they direct initiatives to the entire healthcare team as no one group is immune.

Neural network-based language models such as BERT (Bidirectional Encoder Representations from Transformers) use attention mechanisms to create contextualized representations of inputs, conceptually analogous to humans reading words in context. For the task of classifying the sentiment of texts, we ask whether BERT’s attention can be informed by human cognitive data. During training, we supervise attention with eye-tracking and/or brain imaging data and combine binary sentiment classification loss with these attention losses. We find that attention supervision can be used to manipulate BERT attention to be more similar to the ground truth human data, but that there are no significant differences in sentiment classification accuracy. However, models with cognitive attention supervision more frequently misclassify different samples from the baseline models–they more often make different errors–and the errors from models with supervised attention have a higher ratio of false negatives.

IntroductionDirect-to-family clinical trials efficiently provide data while reducing the participation burden for children and their families. Although these trials can offer significant advantages over traditional clinical trials, the process of designing and implementing direct-to-family studies is poorly defined, especially in children with rheumatic disease. This paper provides lessons learnt from the design and implementation of a self-controlled, direct-to-family pilot trial aimed to evaluate the effects of a medication management device on adherence to hydroxychloroquine in paediatric SLE.MethodsSeveral design features accommodate a direct-to-family approach. Participants meeting eligibility criteria from across the USA were identified a priori through a disease registry, and all outcome data are collected remotely. The primary outcome (medication adherence) is evaluated using electronic medication event-monitoring, plasma drug levels, patient questionnaires and pill counts. Secondary and exploratory endpoints include (1) lupus disease activity measured by a remote SLE Disease Activity Index examination and the Systemic Lupus Activity Questionnaire; and (2) hydroxychloroquine pharmacokinetics and pharmacodynamics. Recruitment of the initial target of 20 participants was achieved within 10 days. Due to initial recruitment success, enrolment was increased to 26 participants. Additional participants who were interested were placed on a waiting list in case of dropouts during the study.Discussion and disseminationDirect-to-family trials offer several advantages but present unique challenges. Lessons learnt from the protocol development, design, and implementation of this trial will inform future direct-to-family trials for children and adults with rheumatic diseases. Additionally, the data collected remotely in this trial will provide critical information regarding the accuracy of teleresearch in lupus, the impact of adherence to hydroxychloroquine on disease activity and a pharmacokinetic analysis to inform paediatric-specific dosing of hydroxychloroquine.Trial registration numberClinicalTrials.gov Registry (NCT04358302).

Many current language models such as BERT utilize attention mechanisms to transform sequence representations. We ask whether we can influence BERT’s attention with human reading patterns by using eye-tracking and brain imaging data. We fine-tune BERT for relation extraction with auxiliary attention supervision in which BERT’s attention weights are supervised by cognitive data. Through a variety of metrics we find that this attention supervision can be used to increase similarity between model attention distributions over sequences and the cognitive data without significantly affecting classification performance while making unique errors from the baseline. In particular, models with cognitive attention supervision more often correctly classified samples misclassified by the baseline.

STUDY OBJECTIVES: COVID-19 brought unique challenges; however, it remains unclear what effect the pandemic had on violence in healthcare. The objective of this study was to identify the impact of the pandemic on workplace violence at an academic emergency department (ED). METHODS: This mixed-methods study involved a prospective descriptive survey study and electronic medical record review. Within our hospital referral region (HRR), the first COVID-19 case was documented on 3/11/2020 and cases peaked in mid-November 2020. We compared the monthly HRR COVID-19 case rate per 100,000 people to the rate of violent incidents per 1000 ED visits. Multidisciplinary ED staff were surveyed both pre/early-pandemic (April 2020) and mid/late-pandemic (December 2020) regarding workplace violence experienced over the prior 6-months. The study was deemed exempt by the Mayo Clinic Institutional Review Board. RESULTS: There was a positive association between the monthly HRR COVID-19 case rate and rate of violent ED incidents (r = 0.24). Violent incidents increased overall during the pandemic (2.53 incidents per 1000 visits) compared to the 3 months prior (1.13 incidents per 1000 visits, p

Study Objectives: Violence in the emergency department (ED) is a common and longstanding threat to staff. The COVID-19 pandemic brought unique challenges;however, it remains unclear what effect the pandemic had on violence in health care. The objective of this study was to identify the impact of the pandemic on workplace violence at an academic emergency department in the Midwest. Methods: The hospital referral region (HRR) COVID-19 case rate per 100,000 people was obtained from March through December 2020. Monthly incidents of ED violence were obtained from the Office of Security and included both physical assault and verbal threats where security officers were notified to respond. These incidents were combined with monthly reports of violent flags added to patient charts within the electronic medical record. Overlapping data from both sources were counted only once. Monthly ED patient volume was obtained to calculate a rate of violent incidents per 1,000 ED visits. Two anonymous surveys were sent to all multidisciplinary ED staff both pre/early-pandemic (April 2020) and mid/late-pandemic (December 2020) and surveyed respondents regarding the incidence of verbal abuse and physical assault experienced over the prior 6-months (November 2019-April 2020 and July 2020-December 2020). Chi-squared tests and Fisher’s exact tests were used for comparison. The study was deemed exempt by the Mayo Clinic Institutional Review Board. Results: There was a positive association between the HRR rate and rate of violent ED incidents (r = 0.24;Figure 1). There was also an increase in overall violent workplace incidents per ED volume during the pandemic compared to the months leading up to it. A total of 259 responses were received for the initial pre/early-pandemic survey and 259 responses received for the mid/late-pandemic survey. The reported level of safety perceived by staff remained the same, as did the overall percentage of respondents indicating any verbal abuse or physical assault in the prior 6-months. The frequency of verbal abuse experienced by staff did increase during the pandemic, with 6.2% of respondents pre/early-pandemic indicating verbal abuse by patients or their visitors every day or two, compared to 10.8% mid/late-pandemic (p =.029). Conclusion: Despite our findings of a positive association between the COVID-19 case rate and rate of violent ED incidents, the percentage of our survey respondents indicating verbal abuse or physical assault experienced in a 6-month time period remained unchanged between the pre/early-pandemic and mid/late-pandemic periods, as did staff perception of workplace safety. This difference in documented and self-reported/perceived violence may be attributable to staff prioritizing other personal safety concerns throughout the pandemic. This positive association could be due to significant fear and stress experienced by the general public, or worsening substance abuse or mental health state during the pandemic. [Formula presented]

BackgroundBirds show adaptations in limb bone shape that are associated with resisting locomotor loads. Whether comparable adaptations occur in the microstructure of avian cortical bone is less clear. One proposed microstructural adaptation is laminar bone in which the proportion of circumferentially-oriented vascular canals (i.e., laminarity) is large. Previous work on adult birds shows elevated laminarity in specific limb elements of some taxa, presumably to resist torsion-induced shear strain during locomotion. However, more recent analyses using improved measurements in adult birds and bats reveal lower laminarity than expected in bones associated with torsional loading. Even so, there may still be support for the resistance hypothesis if laminarity increases with growth and locomotor maturation.MethodsHere, we tested that hypothesis using a growth series of 17 homing pigeons (15–563 g). Torsional rigidity and laminarity of limb bones were measured from histological sections sampled from midshaft. Ontogenetic trends in laminarity were assessed using principal component analysis to reduce dimensionality followed by beta regression with a logit link function.ResultsWe found that torsional rigidity of limb bones increases disproportionately with growth, consistent with rapid structural compensation associated with locomotor maturation. However, laminarity decreases with maturity, weakening the hypothesis that high laminarity is a flight adaptation at least in the pigeon. Instead, the histological results suggest that low laminarity, specifically the relative proportion of longitudinal canals aligned with peak principal strains, may better reflect the loading history of a bone.

Subgroups represent any discernible grouping of individuals that emerge from within a superordinate group (e.g., a sport team). Recent sport research suggests the inevitability of their presence, necessitating a greater understanding of why or how these groupings develop, and to what extent they impact the athletes and teams involved. Within this chapter, we provide readers with a general account of the conceptual background and key literature pertaining to subgroups generally, and in relation to sport. Our aim is to emphasize the need for a nuanced approach to their investigation, while highlighting the wide range of outcomes emanating from their presence. We also situate this topic as an important consideration pertaining to youth development and propose exciting opportunities for future research. It is our hope that this chapter instigates research interest in this topic.