搜索结果：Away

To characterize the composition and specialty training of sideline medical providers present during National Collegiate Athletic Association (NCAA) Division I (Power 5) college football games. Cross-sectional survey study. Power 5 NCAA Division I football programs during the 2023 to 2024 season. Head team physicians from 69 institutions were contacted; 53 (76.8%) completed the survey.Intervention: A 25-question REDCap survey assessing on-site personnel during home and away football games, including physician specialties, emergency coverage, imaging availability, emergency medicines, and athletic training support. Presence, specialty training, and roles of medical providers on the sideline during football games. All responding programs had orthopedic surgeons (OS) on-site at home games, and all but 1 had a primary care sports medicine physician (SMP). SMPs most commonly trained in family medicine (54.2%), followed by emergency medicine (13.5%) and pediatrics (11.9%). OSs were most frequently fellowship-trained in sports medicine (68.6%). Emergency/airway management physicians were present at 37.7% of schools; neurotrauma-specific providers were present at 15.1%. Away game coverage was reduced, with fewer SMPs and OSs traveling. Athletic trainer coverage remained consistent. Only a minority of schools traveled with additional medical specialists. There is significant variability in sideline medical staffing across Power 5 college football programs. While all schools met or exceeded NCAA minimums, these findings highlight opportunities for standardization and alignment with professional sports models to optimize athlete safety.

Alzheimer's disease (AD) is characterized by the accumulation of amyloid-β (Aβ), yet the specific link between plaque burden and cognitive decline remains a subject of intense investigation. This paper presents a mathematical model that simulates the coupled dynamics of Aβ monomers, soluble oligomers, and fibrillar species in the brain tissue. By modifying existing governing equations to include a dedicated conservation equation for Aβ monomers, the model explores how various microscopic processes, such as primary nucleation, surface-catalyzed secondary nucleation, fibril elongation, and fragmentation, contribute to macroscopic disease progression. Central to this study is the concept of "accumulated neurotoxicity" as a surrogate marker of biological age, defined as the time-integrated concentration of soluble Aβ oligomers. Unlike plaque burden, accumulated neurotoxicity cannot be reversed, and the harm it causes depends critically on the sequence of events that produced it. Numerical results demonstrate that while plaque burden and neurotoxicity both increase over time, their relationship is non-linear and highly sensitive to the efficiency of protein degradation machinery. Specifically, impaired degradation causes biological age, defined in terms of accumulated neurotoxicity, to advance considerably faster than calendar age. The model further identifies oligomer dissociation and fibril fragmentation as potential protective mechanisms that can counterintuitively reduce neurotoxic burden by diverting monomers away from the soluble oligomer pool. These findings provide a quantitative basis for understanding why individuals with similar plaque burdens may experience vastly different cognitive outcomes, underscoring the importance of targeting soluble oligomers early in therapeutic interventions.

In 2016, France reformed its health system by requiring public hospitals to form territorial groups. Policymakers, following experiences with integrated care provision in the United States and NHS-type networks in Italy and England, expected these groups to improve coordination and system efficiency. However, it remains unclear whether such administrative integration creates new care pathways within groups or substitutes for existing referral relationships with external providers. We analyzed national hospital administrative data from 2013 to 2021. Changes in inter-facility transfer rates were estimated using a synthetic difference-in-differences approach. The main outcome was the annual percentage of patients transferred to another hospital, overall and within the same group. Following group formation, smaller local hospitals experienced an average increase of 1.25 percentage points in transfers to hospitals within their group. Transfers to hospitals outside the group remained broadly stable, suggesting limited substitution away from pre-existing referral channels. Territorial grouping are associated with an increase in internal patient mobility, particularly among local hospitals, without reducing exchanges with external providers. These findings suggest that administrative integration may have layered new coordination arrangements onto existing care pathways and reinforced patterns of functional specialization. The results contribute to understanding how network-based integration reshapes organizational behaviour and patient mobility in regulated health systems.

The impact of target prevalence (the proportion of trials in which a target appears) has been widely studied within visual search. The low prevalence effect is the finding that rare targets are often missed. Mind wandering, where one's attention drifts away from a primary goal, impairs performance across various tasks, but its influence in low-prevalence search remains unclear. We recruited 60 participants from the general population and examined their mind-wandering rates as they searched for either low- (10%) or high- (50%) prevalence targets. When participants were engaged in mind wandering, response accuracy was reduced and target-absent response times increased. Low-prevalence targets were missed more than high-prevalence targets, but to our surprise, we discovered that most of the low-prevalence effect could be attributed to mind wandering in the majority our analyses. This marks a substantial shift in our understanding of the prevalence effect.

In this study, we explored the psychotherapeutic process for autistic adult clients without intellectual impairment with comorbid psychological disorders, drawing on the perspectives of highly specialized psychotherapists with extensive clinical experience in autism-focused practice. Within the context of the ongoing shift from deficit-based interventions toward neurodiversity-affirming approaches, we investigated how therapists conceptualize comorbidities in autism and how this conceptualization informs their therapeutic work. We employed a qualitative research design and collected data through semistructured interviews with 10 psychotherapists specialized in autism. We analyzed the data using a sequential combination of deductive and inductive thematic analysis. We identified five main themes (comprising a total of 22 subthemes): (a) development of comorbidity as an interactional vulnerability process; (b) change as a reorganization of self-understanding, regulation, and relational engagement; (c) helpful aspects of psychotherapy as needs-adapted, autism-informed relational practice; (d) therapeutic misfit as misattunement, overload, and contextual constraint; and (e) managing therapeutic misfit through adaptation, reattunement, and containment. Therapists viewed comorbid symptoms as arising from an interaction between autistic traits and environmental mismatches, rather than autism itself. Psychotherapy was conceived as prioritizing reducing comorbid symptoms, fostering self-acceptance, and mitigating social camouflaging. Therapists emphasized a flexible, integrative approach tailored to individual needs, supported by a strong therapeutic alliance. The accounts of specialized psychotherapists suggest a shift away from interventions targeting core autistic traits, with greater emphasis on promoting well-being and psychological health. The therapists aligned with neurodiversity principles, advocating for autism-specific expertise, individualized strategies, and systemic efforts to enhance social acceptance. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Despite national primary prevention strategies, rural mothers face a higher risk of stillbirth compared to metropolitan mothers. One prevention strategy involves recommending women seek care for reduced fetal movement (RFM), yet limited research has explored rural mothers' understanding of RFM or their experiences of accessing maternity care. To explore factors influencing access to maternity care for rural and remote mothers experiencing RFM. A qualitative phenomenological approach was employed. Ten women were recruited and interviewed, with transcripts analysed using Braun and Clarke's thematic analysis framework. Three key themes were identified: 1) How concerned am I? 2) Is this concern real? and 3) What kind of help is available locally? Together, these themes capture the complex health-seeking journeys of rural mothers when experiencing RFM. The rural maternity services were often described as inaccessible due to limited staffing and resources leaving women to shoulder the burden of deciding whether to seek care away from home. This burden was compounded by poor external validation from professionals and support networks, and a prevailing 'deficit' discourse towards rural healthcare. These findings highlight the need for a more nuanced implementation of national stillbirth prevention strategies that account for contextual barriers in rural settings, including the potential role of innovative fetal monitoring technologies. Rural mothers experiencing RFM face distinct challenges in accessing maternity care. Tailoring national stillbirth prevention strategies to the realities of rural healthcare access is essential to improve equity and outcomes for rural mothers.

To evaluate the recent literature on differential exposure to and health risks from wildfire smoke across subpopulations, whether wildfire-derived PM2.5 affects health differently from non-wildfire-derived PM2.5, and how wildfire smoke composition affects health. We found inconsistent evidence of differential exposure to and health risks from wildfire PM2.5 by population subgroups. This could be due to variation in wildfire PM2.5 infiltration into buildings and ability to take individual protective actions, both of which have been noted to be related to socio-economic status in the recent scientific literature. Respiratory health endpoints have been the most consistent and commonly evaluated health outcome in studies of wildfire smoke; additional research is needed to resolve conflicting findings for non-respiratory health outcomes (e.g., cardiovascular disease). Although some recent studies have documented larger health risks from wildfire-derived as compared to non-wildfire-derived PM2.5, we document how further research could evaluate whether these findings are confounded by type of fuel burned, due to methodological concerns, or are true. We also conclude that more research is necessary to elucidate potential differences in health risks of constituents of wildfire smoke other than PM2.5 or from burning of different fuels. Wildfire smoke is projected to continue to increase. We encourage future research to move away from further documentation of respiratory health impacts of wildfire smoke, which has been very well established, into studies of other health endpoints that have been less well studied to date, more exploration into health effects from wildfire smoke constituents other than PM2.5 and from different types of fires (i.e., wildland urban interface (WUI) fires versus wildland fires), and additional exploration of remaining uncertainties with a goal of further supporting public health protection from wildfire smoke.

Organic molecular oxidation reactions are ideally regarded to be energy-saving alternative to replace oxygen evolution reaction (OER) for lowering the oxidation overpotential during green hydrogen production. However, the vast scale of hydrogen production is far beyond the fine chemical processes, inevitably resulting in substantial oxygen release. Here, we propose another type of coupled oxidation reactions to stably accommodate with high-current density hydrogen production, accompanied by easy separation. As taking benzylamine oxidation reaction (BOR) as a probe without other side reactions, we propose a bubble-assisted strategy by activating OER and utilizing the generated oxygen bubbles to timely take the insoluble product benzonitrile away from electrode surface, and effectively overcome the electrode poisoning issue. The assembled prototype water electrolyzer achieves a typical current density of 200 mA/cm2 and faradaic efficiency of 55% at 1.65 V for over 40 hours, diversify high-value chemical outputs. Such hybrid electrolysis within bubble-assisted strategy endows system flexibility for next-generation integrated electrochemical energy platforms.

Sleep profoundly alters large-scale brain dynamics, yet its impact on the cortex's macroscale functional hierarchy remains incompletely understood. We analyzed transitions from wakefulness to nonrapid eye movement (NREM) 1 and NREM2 sleep in a simultaneous electroencephalography-functional MRI (EEG-fMRI) dataset of 33 healthy adults, deriving cortical gradients and local and global functional connectivity density (lFCD, gFCD) from stage-specific fMRI time series. Cortical gradients remained highly correlated across states (R > 0.92), indicating preservation of the overall hierarchical scaffold, yet both principal and secondary gradients showed progressive compression during NREM2, with prominent posterior/visual involvement. lFCD increased within unimodal regions and closely tracked gradient position, whereas gFCD showed broader, less spatially specific increases, consistent with altered low-frequency synchronization and network integration during early sleep. Complementary analysis of an independent eyes-open/eyes-closed dataset revealed milder, more localized gradient changes during eyes-closed wakefulness, suggesting that early NREM sleep may involve broader sensory disengagement than eye closure alone. Together, these results indicate that early NREM sleep preserves large-scale cortical topology while reducing differentiation along its principal axes and strengthening local connectivity within sensory systems, marking a shift toward more internally dominated cortical dynamics as the brain transitions away from external input.

Plant pathogens pose a critical threat to global agriculture by significantly reducing crop productivity through the negative impact on plant physiology and associated microbial communities. Grapevines (Vitis vinifera), a high-value crop worldwide, are highly susceptible to a range of bacterial and fungal vascular pathogens. In this study, we investigated the effects of five major grapevine pathogens-Diplodia seriata, Eutypa lata, Neofusicoccum parvum, Phaeoacremonium minimum, and Xylella fastidiosa-on host microbiome composition and phenolic secondary metabolite profiles across multiple plant tissues. For grapevines infected with each of the five pathogens, a combination of 16S rRNA and Internal Transcribed Spacer (ITS) sequencing was performed alongside high-performance liquid chromatography analysis. Generated data were compared to observe if changes in host chemistry caused by infection from one of the pathogens could be associated with shifts in microbial communities both around and away from the initial infection sites. We found that pathogen infection induced significant pathogen-specific alterations in both bacterial and fungal communities, predominantly at the inoculation site. Additionally, infections triggered localized changes in phenolic compounds, especially stilbenoids, consistent with host defense responses. Notably, fungal pathogens broadly disrupted bacterial communities, while X. fastidiosa had a more limited and distal effect. Our findings highlight distinct microbiome and metabolic signatures associated with each pathogen and underscore the importance of examining different host tissues in studying plant-microbiome-pathogen interactions. These insights contribute to a systems-level understanding of grapevine disease ecology and may inform future strategies for monitoring and controlling pathogen spread in perennial crops such as grapevines.

Solid-binding peptides (SBPs) are versatile molecules that can control a range of atomic-scale interfacial processes, but they remain challenging to discover. Current approaches for discovery rely on directed evolution, which samples only a small fraction of possible sequences. Data-driven methods for therapeutic peptides are also not applicable as they rely on crystal structures whereas peptides adopt varied conformations at solid surfaces. To address this challenge, we recently combined biophysical modeling and machine learning to design plastic-binding peptides that were predicted to have strong adsorption enthalpies. Here, we evaluate these designs using steered molecular dynamics and single-molecule force measurements and identify de novo designed peptides that bind strongly to polyethylene. Experimental adhesion forces exceed those previously reported for SBPs, and adsorption free energies from metadynamics simulations support strong binding. Analysis of the designed peptides reveals blocks of non-polar and charged residues, which enables them to adopt conformations that segregate non-polar amino acids to the plastic surfaces (generating hydrophobic interactions) and charged amino acids away from the surfaces. The contact patterns within the non-polar blocks depend on sequence context and polyolefin type. Overall, we validate a general approach for de novo SBP discovery that has broad scientific and engineering applications.

Preadipocyte commitment to the adipogenic lineage declines markedly with advancing age, while triglyceride accumulation in hypertrophied existing adipocytes persists or expands. This creates a dissociation between adipogenic capacity and lipid-buffering demand, progressively weakening depot metabolic competence and contributing to systemic insulin resistance. This review examines the molecular mechanisms linking impaired adipose tissue plasticity during ageing to metabolic decline, and appraises therapeutic strategies that may restore adipose progenitor competence or limit downstream metabolic dysfunction. Ageing adipose tissue is characterized by four interlocking defects. First, transcriptional reprogramming, including induction of the inhibitory CCAAT/enhancer-binding protein β-LIP isoform through CUG triplet repeat-binding protein 1, together with reduced C/EBPα and peroxisome proliferator-activated receptor γ activity, shifts progenitors away from differentiation and toward hypertrophic lipid storage. Second, SIRT7 opposes SIRT1 in regulating adipogenic commitment, implicating sirtuin and NAD+ dysregulation in the age-related adipogenic deficit. Third, nuclear lamina remodelling restricts chromatin accessibility at adipogenic loci. Fourth, senescent cells accumulate in ageing depots and generate a senescence-associated secretory phenotype enriched in interleukin-6, tumour necrosis factor-α, and matrix metalloproteinases, sustaining local inflammation and inhibiting preadipocyte differentiation. These changes occur alongside redistribution of fat from subcutaneous depots toward visceral, hepatic, muscular, and perivascular compartments, accelerating insulin resistance, Type 2 diabetes, and cardiovascular disease. Sex-specific depot trajectories diverge, and rodent models reproduce these patterns only partly. Senolytics, NAD+ precursors, and incretin-based agents, including GLP-1 and dual GIP/GLP-1 receptor agonists, are reviewed together with still-preclinical stem cell and CRISPR approaches, ranked by translational readiness. Restoring adipose progenitor competence while preserving depot-specific metabolic identity may help slow age-related metabolic deterioration and prolong healthspan.

Clitoromegaly in a newborn with otherwise typically appearing female genitalia indicates exposure to excess androgens in fetal life. Congenital Adrenal Hyperplasia (CAH) is the most common cause of virilization at birth and empiric treatment is often pursued due to the risk of life-threatening adrenal crisis. Turner syndrome (TS) does not usually present with atypical genital appearance or other signs of hyperandrogenism, unless Y chromosome material is present. In this report, we describe a newborn who was noted to have clitoromegaly soon after birth with an otherwise normal exam and no syndromic features. Empiric treatment with hydrocortisone and fludrocortisone was started while initial laboratory results were pending. However, prior to receiving CAH hormonal panel results, karyotype testing returned as [45,XO(3)/46,XX(17)], consistent with mosaic TS. Testing for Y chromosome material, pursued as a potential cause of clitoromegaly, was negative. To add to the diagnostic dilemma, newborn screening for CAH was also negative. Results from the CAH panel done soon after birth eventually returned and revealed an elevated 17-hydroxyprogesterone level (17-OHP) of 1540 ng/dl, which is more congruent with non-classical CAH and does not typically result in clitoromegaly at birth. To clarify the diagnosis, a 250 mcg cosyntropin stimulation test was performed after holding steroids for a week. Post-stimulation 17-OHP of 82334 ng/dL confirmed classical CAH secondary to 21-hydroxylase deficiency and genetic analysis identified biallelic pathogenic deletions of CYP21A2 gene. Current TS guidelines recommend testing for Y chromosome material if masculinizing features develop. This case underlines the value of including CAH in the differential diagnosis as another potential cause of virilization in patients with TS. The concurrence of CAH and TS poses added complexity for clinical management due to their overlapping impacts on linear growth, puberty, reproductive function, bone density and metabolic health. This report describes a newborn girl who had an enlarged clitoris at birth, which can be a sign of exposure to high levels of male hormones before birth. The most common cause of this is Congenital Adrenal Hyperplasia (CAH), where the adrenal glands cannot make enough cortisol and instead produce excess male hormones. Absence of cortisol can result in a life-threatening condition called adrenal or salt wasting crisis, so treatment for suspected CAH is often started right away while awaiting test results. While CAH testing results were still pending, genetic testing revealed the baby had Turner Syndrome (TS), a condition where girls are missing all or part of one X chromosome. TS does not usually cause masculinization unless they also have Y chromosome material in their cells, but testing for Y material was negative in this baby. Adding to the puzzle, the newborn screening test for CAH also came back negative. However, more detailed blood tests, including a “stimulation test” showed elevated hormone levels consistent with CAH due to 21-hydroxylase deficiency, the most common enzyme deficiency causing CAH. Genetic testing found that both copies of the responsible gene had deleted sections. This is a rare case of a baby having both TS and CAH at the same time. Current guidelines recommend testing for Y chromosome material when girls with TS show masculine features. This case suggests that CAH should also be considered as a potential cause of hyperandrogenism. Managing both conditions together can be challenging because they both affect growth, puberty, fertility, bone health and metabolism.

Determining the optimal dosage of oncology drugs is a critical component of drug development, as many anticancer agents are associated with high toxicity. With the emergence of targeted therapies and immunotherapies, the conventional concept that "more is better" may not apply, as higher doses do not necessarily yield greater efficacy and may compromise tolerability. In response to repeated post-approval dosage modifications, the U.S. Food and Drug Administration (FDA) launched Project Optimus in 2021 to promote data-driven, patient-centered dosage optimization. Despite the release of the finalized FDA Guidance for Industry on Oncology Dosage Optimization in 2024, sponsors continue to face challenges in translating these recommendations into practice, due to the complexity in the development process of oncology drugs and the limitations of early-phase trials. To gain insight into current practices and challenges, the DahShu Innovative Designs Scientific Working Group (IDSWG) conducted an industry-wide survey among oncology statisticians in biopharmaceutical companies. The survey revealed a shift away from reliance on the maximum tolerated dose toward integrated strategies balancing efficacy, safety, pharmacokinetics, and patient experience. This paper summarizes the findings from that survey and offers practical recommendations emphasizing cross-functional collaboration between statisticians and other functional members in early phase trials, adoption of innovative trial designs, and proactive regulatory engagement regarding dosage optimization strategies in clinical development.

The prolonged waiting times for hip and knee arthroplasty have resulted in numerous negative effects for patients being reported, with none more important than increasing opioid reliance due to chronic musculoskeletal pain. Opioid use prior to surgery is a factor associated with prolonged use postoperatively, and while opioids remain a valuable resource in the management of acute surgical pain, ongoing use carries substantial clinical, psychological, and societal risks. Recent Medicines and Healthcare products Regulatory Agency (MHRA) guidance and the 2024 UK consensus statement have resulted in a shift for perioperative pain management, moving away from routine modified release opioid use towards individualized care. To address these issues and changes, interventions need to be focused both preoperatively and postoperatively using improved risk stratification, patient education, and community engagement. This annotation discusses these issues and emphasizes the importance of opioid stewardship as a unifying framework to embed principles across the arthroplasty pathway, with the aims of reducing harm, improving outcomes, and supporting safer sustainable care.

This review describes surgical interventions that address structural and anatomical changes in younger patients with the aim of delaying traditional rejuvenating or corrective surgery in an operative setting. Traditionally, surgical procedures like submentoplasty and rhytidectomy are used to rejuvenate and/or correct anatomical, structural, and/or age-related defects in patients with advanced aging. For appropriate younger patients, we describe a shift away from cutaneous, surface-level changes to procedures aimed to correct structural changes resulting from aging, trauma, or genetic manifestation, specifically addressing submental fat, plastysmal diastasis, jowling, and periorbital dermatochalasis. Candidates are younger patients with high skin elasticity and mild structural changes. Targeted procedures include submentoplasty, mini-facelift, and preservation-focused upper and lower blepharoplasty performed in the office, under local anesthesia for younger patients. Emphasis is placed on compression, cold therapy, and supplements to minimize downtime and swelling. In appropriate patients, the surgical, structural prejuvenation techniques described herein offer a proactive, durable result from procedures performed entirely in-office.