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This article explores CityHealth, an initiative of the de Beaumont Foundation and Kaiser Permanente, as a model collaboration between attorneys, public health groups and city leaders that advances a package of 12 evidence-based policies addressing key social determinants of health and centering equity.
The effects of carbohydrate (CHO) intake on substrate metabolism, exercise capacity, and exercise performance have been studied for >100 y. From a metabolic perspective, the ergogenic effect of CHO intake is likely mediated by liver (and potentially muscle) glycogen sparing, maintenance of plasma glucose concentrations, and whole-body CHO oxidation rates, such that the required exercise intensity can be sustained for a longer duration thereby delaying fatigue. Accordingly, the 2016 sport nutrition guidelines from the American College of Sports Medicine recommend CHO intakes ≤90 g/h (from multiple-transportable CHOs, e.g., glucose/fructose mixtures), as targeted to exercise that is >2.5-3 h in duration. Although field observations report a trend for endurance athletes to consume (and experiment with) higher rates of CHO ingestion during training and racing (i.e., 120-200 g/h), the efficacy of such doses is not yet substantiated by current scientific research. Rather, contemporary research suggests that the upper limit of CHO intake could increase from 90 to 120 g/h (at least for trained participants), considering that both exogenous and whole-body rates of CHO oxidation can be increased with these higher ingestion rates. Such absolute doses may also modulate important physiological determinants of performance (e.g., durability and economy) across cycling, marathon running, and ultraendurance exercise. As such, the present paper provides a contemporary review of CHO metabolism during exercise, factors affecting exogenous CHO oxidation rates (i.e., CHO blend, ratio, format, environmental considerations, etc.) and sport-specific research (alongside personal author insights from practice), before presenting an updated and more nuanced model to guide CHO personalization strategies for endurance athletes. Directions for future research are also discussed, emphasizing the need for collaborative research to study both male and female athletes during ecologically valid exercise protocols that better address the real-world fueling challenges faced by elite athletes.
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Despite decades of research into the phenomena of athletic retirement, many modern athletes continue to report difficulties in adjusting to life beyond sport. As a result, the issue of athletic retirement has become a significant concern for those working within high-performance settings. However, there remains a distinct lack of critical attention regarding how key actors within athletes' lives (e.g., coaches) shape and impact upon their capacities to adjust to post-sport life. In this paper, we address this gap in research by presenting qualitative data from interviews with eight coaches working in the context of Olympic sport in the United Kingdom to examine their perspectives regarding the athlete retirement process. Drawing upon Foucault's conceptualization of disciplinary power-knowledge, our analysis illustrates how Olympic coaches' perspectives and experiences of athletic retirement can be linked to the modernist logic and normalizing pressures that characterize Olympic level coaching environments.
This study aimed to identify the Greatest of All Time (GOAT) athlete in running events held at the Olympic Games and World Athletics championships. The achievements of 1294 men and 824 women who won at least one medal in any sprint, hurdles, or distance event at major global championships since 1896, or set a World Record (WR) since 1912, were collated. A scoring system was used to award points, with Olympic gold medals and WRs ranked joint highest. Fewer points were awarded for Olympic silver and bronze medals and for medals in World Championships (outdoor, indoor, and cross-country). Bonus points were awarded for WR longevity and the setting of WRs during Olympic finals. Athletes were also ranked by event and within historical eras. As of March 2026, Usain Bolt (Jamaica) was ranked as the male GOAT, and the highest-scoring woman was Faith Kipyegon (Kenya). Both athletes notably won "doubles" during their careers (over 100/200 m and 1500 m/5000 m, respectively) and set WRs over both distances. Marathon, steeplechase, and hurdle specialists usually competed in one event only. In an earlier era, Paavo Nurmi (Finland) had the highest combined Olympic Games/WR score across a range of distances. Athletes who successfully competed over physiologically and tactically similar events ("doubles"), such as Bolt and Kipyegon, had a greater opportunity to become the GOAT. An increase in global competition since 1972 meant greater opportunities for winning medals, especially for women. This study provides a foundation on which future performances could be evaluated.
Haugen, T, Sandbakk, Ø, Bucher Sandbakk, S, and Tønnessen, E. Strength and speed training practices for Olympic endurance sports: Insights from world-class coaches. J Strength Cond Res 40(8): 1003-1012, 2026-This study aimed to identify common features and sport-specific variations in strength and speed training practices in Olympic endurance sports as described by world-class Norwegian coaches. A multiple case study design was used, and 12 successful male Norwegian coaches served as key informants. Together, they were responsible for athletes winning ∼400 international medals, representing long-distance running, biathlon, rowing, cross-country skiing, speed skating, road cycling, swimming, and triathlon. Data collection was based on a pragmatic 4-step procedure involving questionnaires, training logs, in-depth and semistructured interviews, followed by negotiation among researchers and coaches to assure our interpretations. The present coaches implemented strength and speed training to reduce injury risk, enhance work economy, finish/acceleration capacity, and skeletal health. The total volume of such training ranged from 20 to 200 hours·year -1 , depending on sport and contextual factors. The highest volumes and resistance loads were reached during preparation phases, and the strength and speed training were implemented at varying stages of the weekly cycle. Strength sessions typically consisted of 4-8 exercises, 2-4 sets per exercise, 5-10 repetitions per set, and up to 10 repetitions in reserve. The speed training was completed in sport-specific modality with an intensity >90% of maximal velocity. The coaches emphasized strength and speed training as supportive yet secondary to endurance development, often delegating its implementation to the athletes themselves or to specialized staff. The present insights offer valuable contributions to strength and speed training practices in endurance sports and lay the groundwork for future research exploring the effectiveness of these strategies.
This study describes the long-term development of training characteristics and physiological performance-determining variables among six world-class (Tier 5) female cross-country skiers across three decades, collectively holding 61 Olympic/World Championship medals. The skiers were divided into two groups: three world-leading (Tier 5+) athletes with ≥ 8 medals in international championships and three Tier 5 athletes with ≤ 4 medals. Self-reported training characteristics, as well as peak oxygen uptake ([Formula: see text]) and submaximal lactate threshold tests from junior to senior age were collected and analyzed retrospectively. Training was categorized into endurance, strength and speed training, with endurance training systemized using a five-zone intensity scale. While athletes exhibited individual patterns in the development of training volume from junior to senior, the increase in training volume was primarily driven by a rise in low-intensity endurance training. There was a noticeable trend that Tier 5+ athletes had a longer, more consistent increase in training volume compared to Tier 5. Among Tier 5+ athletes, [Formula: see text] values showed a positive progression from junior to senior level, whereas only one of the Tier 5 showed the same pattern. Additionally, Tier 5+ demonstrated larger improvements in speeds at a given blood lactate and heart rate level than Tier 5 throughout the investigated period (e.g., mean increase in speed at estimated lactate threshold: ~14% for Tier 5+ vs. ~ 7% for Tier 5). Keeping in mind the limitations associated with the small sample size, the development pathways to becoming a Tier 5+ skier tended to involve longer, more consistent, increases in training volume, resulting in greater improvements in both [Formula: see text] and submaximal physiological determinants than Tier 5 skiers.
The step-up effect of great coaches on Olympic performance has been widely recognized, but its dynamic influence mechanism and quantitative evaluation remain methodological challenges. This study proposes a Change-Point Driven Difference-in-Differences with Decay Model ([Formula: see text]), which integrates the CUSUM algorithm, dynamic difference method (DID), and exponential decay function. The Great Coach effect's nonlinear characteristics and time attenuation rule were analyzed systematically. First, based on the improved CUSUM algorithm to detect the abrupt points of performance, the dual test mechanism of medal continuity and competition size stability was introduced to filter the pseudo-abrupt signals (such as the host effect and short-term strategic interference). Secondly, a hierarchical DID model was used to quantify the net effect of heterogeneous coach turnover events to solve the problem of traditional methods ignoring the dynamic confounding bias and run-in period. Finally, the sustainability difference of the coaching effects is revealed by the half-life model. Empirical studies show that the effect half-life of a systematic coaching system (such as Zhou Jihong coaching the Chinese diving team) is more than 20 years, while the technology-driven intervention (such as the AI tactical optimization for Japanese judo) has a half-life of only 5.3 years. The model predicts that in the 2028 Los Angeles Olympics, the introduction of great coaches will enable the Brazilian swimming team to achieve a breakthrough from 0 to 5 medals (95% CI: 4.7-6.3). This study provides an explainable and predictive framework for the allocation of coaching resources in Olympic strategy, and its methodology can be extended to dynamic causal inference in policy evaluation and organizational management.
This study examined the relationship between start order and competition outcomes in men's artistic gymnastics apparatus finals. Competition outcomes from three Olympic Games and nine World Championships were analyzed. Ordinal-based analyses, including Spearman's rank-order correlation and Kendall's tau-b, were conducted to examine the relationship between start order and final rankings. Logistic regression was used to assess the association between start order and medal attainment. In addition, Mann-Whitney U tests were used to compare final rankings between start-order groups; independent-samples t-tests were used to assess differences in Difficulty (D) scores, Execution (E) scores, and total scores; and Chi-square tests were used to evaluate associations between start-order grouping, medal attainment, and continental affiliation. Ordinal correlation and logistic regression analyses showed no significant associations between start order and final rankings or medal attainment across apparatuses. Start-order grouping had limited influence on final rankings across most apparatuses. A significant effect was observed only in the pommel horse, where second-half gymnasts achieved higher E-scores and won more medals. Medal distributions between European and non-European athletes were similar across apparatuses and start-order groupings. Overall, start-order grouping had minimal effects. However, pommel horse results highlight the importance of execution stability. The findings support the general fairness of the current judging system and Code of Points. Future research should examine warm-up procedures under revised FIG regulations and extend analyses to women's artistic gymnastics.
The Genetics Society of America Medal honors an individual member of the Society for their contributions to the field of genetics at the midcareer level (up to 15 years since starting an independent position). The society established the GSA Medal in 1981 to recognize members who exemplify the ingenuity of the GSA membership through elegant and highly meaningful contributions to modern genetics. Joseph Schacherer is being recognized for his impactful contributions to the field through the study of population genomics in the model Saccharomyces cerevisiae and other less well-studied species, the genetic basis and architecture of complex traits, and mitochondrial genome evolution in yeast. This award also celebrates Schacherer's work leading the 1000 Yeast Genomes Project, which has provided a reference framework for studying genetic diversity and domestication, and efforts to train and support a diverse group of early career scientists.
To assess the effectiveness of a swimming and education programme compared with education alone for patients with chronic low back pain. Adults with chronic, non-specific low back pain were randomised to a swimming and education (intervention) group or an education alone (control) group (1:1). The intervention group received an individualised swimming and education programme facilitated by four physiotherapy telehealth sessions delivered over 8 weeks. The control group received up to two telehealth sessions with a physiotherapist covering the same educational content as the intervention group. The primary outcome was disability (Roland Morris Disability Questionnaire, (RMDQ)) at 8 weeks. Secondary outcomes included pain intensity, patient-specific functional limitation, pain self-efficacy, fear of movement, patient-perceived global improvement and adverse events. Linear mixed models were used to assess intervention effects. 76 participants were randomised (39 to intervention and 37 to control). Swimming and education together was more effective than education alone for disability at 8 weeks (RMDQ mean difference (MD) -2.5, 95% CI -4.5 to -0.5), but this between-group difference was not sustained at 52 weeks. For pain intensity, the intervention showed a small benefit at 8 weeks that may not be clinically significant (MD -0.7, 95% CI -1.5 to 0.0). All other secondary outcomes showed a pattern of better outcomes in the intervention group early, which typically reduced over time. The intervention group had more adverse events, although almost all were non-serious. A swimming and education programme was more effective than education alone for short-term improvement of chronic low back pain. ACTRN12624000263594.
The China Youth May Fourth Medal serves as a state-endorsed mechanism for modeling positive youth development (PYD). This study aims to decode the archetype of exemplary youth constructed by this socio-legal institution within China's unique context, moving beyond a direct application of Western PYD models. We conducted a socio-legal inquiry employing mixed-methods analysis. A dataset of 1,219 Medal recipients (1997-2023) was examined, focusing on demographic data, career paths, and commendation texts. The study also integrated analysis of extreme counter-examples involving revoked honors. Three distinct state-facilitated growth pathways were delineated: Ladder-shaped, Folded-ladder, and Inverted-ladder. An interaction-driven model predominated (64.76%), highlighting a core mechanism of "strategic alignment" between individual agency and state-facilitated opportunity structures. A significant geographical imbalance was identified, with awardee distribution showing a moderate positive correlation with provincial population but pronounced over-representation of major municipalities. The celebrated virtues, such as Dedication and Patriotism, represent a fusion of universal PYD constructs with collectivist values. This study foregrounds the institutional construction of exemplary youth. It contributes to a more culturally contextualized and theoretically robust understanding of PYD. The findings offer evidence-based insights for youth policy and the dynamic governance of state recognition systems, while critically engaging with the sustainability of state-sponsored exemplarity.
A long-standing goal of artificial intelligence (AI) is to build systems capable of complex reasoning in vast domains, a task epitomized by mathematics with its boundless concepts and demand for rigorous proof. Recent AI systems, often reliant on human data, typically lack the formal verification necessary to guarantee correctness. By contrast, formal languages such as Lean1 offer an interactive environment that grounds reasoning, and reinforcement learning (RL) provides a mechanism for learning in such environments. Here we present AlphaProof, an AlphaZero-inspired2 agent that learns to find formal proofs through RL by training on millions of auto-formalized problems. For the most difficult problems, it uses test-time RL, a method of generating and learning from millions of related problem variants at inference time to enable deep, problem-specific adaptation. AlphaProof substantially improves state-of-the-art results on historical mathematics competition problems. At the 2024 International Mathematical Olympiad competition, our AI system, with AlphaProof as its core reasoning engine, solved three out of the five non-geometry problems, including the competition's most difficult problem. Combined with AlphaGeometry 23, this performance, achieved with multi-day computation, resulted in reaching a score equivalent to that of a silver medallist, marking the first time an AI system achieved any medal-level performance, to our knowledge. Our work demonstrates that learning at scale from grounded experience produces agents with complex mathematical reasoning strategies, paving the way for a reliable AI tool in complex mathematical problem solving.
Hydrogels are of great interest for the delivery of protein therapeutics as they obviate the denaturing shear forces and/or organic solvents common to other delivery systems. Dextrin, a polysaccharide derived from starch, has been largely ignored in the design of hydrogels, yet is biodegradable and can be modified to allow in situ gelation after injection by click-crosslinking. Herein, dextrin is modified with either ketone or aldehyde moieties and then click-crosslinked with poly(ethylene glycol)-tetraoxyamine to form dextrin-oxime (dexime) hydrogels. The rheological and mechanical properties are tunable by changing formulation parameters such as total dextrin weight percentage (wt.%) and pH. The hydrogels are injectable through a 30G needle, selectively degradable via α-amylase, yet stable and minimally swelling in the presence of other enzymes, including hyaluronidase and chondroitinase ABC (ChASE). The presence of low amounts of α-amylase in many fluids and tissues of the body allow for the slow degradation of dexime with minimal swelling. Dexime is particularly useful for local delivery of ChASE: an enzyme that degrades the aggregate scar formed after injury in the central nervous system. Dexime is cytocompatible and releases active ChASE both in vitro and in vivo as evidenced by chondroitin sulphate proteoglycan degradation in the spinal cord.
Despite a growing proportion of women in surgery, there is a significant underrepresentation in clinical and academic leadership positions. The mechanisms are still poorly understood. The German Congress of Visceral Medicine, as the largest interdisciplinary medical congress in German-speaking countries, provides a suitable platform for investigating gender-specific representation patterns. The aim of this study was to analyze the gender distribution in various congress functions between 2013 and 2024 in order to identify potential structural inequalities. The gender distribution of speakers and chairs at the German Congress of Visceral Medicine from 2013 to 2024 was analyzed based on the official congress programs. After excluding gastroenterological, endoscopic and interdisciplinary sessions, the visceral surgery sessions were analyzed in the categories of abstract sessions, plenary sessions and industry symposia. The analysis revealed a significant increase in the number of female speakers (r2 = 0.585; p = 0.006) and chairs (r2 = 0.777; p < 0.001). The proportion of female speakers significantly increased in both plenary sessions (r2 = 0.600, p = 0.005) and abstract sessions (r2 = 0.445, p = 0.025). An increase in the number of female chairs was also observed for plenary sessions (r2 = 0.796; p < 0.001) and abstract sessions (r2 = 0.678; p = 0.002). Parity could not be achieved except for chairs of abstract sessions. At industry symposia, speakers were male in 88-100%, and chairs were male in 100% of all cases. The congress presidency was held by men in 10 out of 11 years (92%). The Walter Kausch Medal and the Rudolf Pichlmayr Medal went exclusively to men (100%). The analysis reveals a persistent underrepresentation of female surgeons in prestigious conference roles. Women were predominantly represented in less visible formats, indicating structural barriers. Following the introduction of transparent selection procedures and gender parity requirements, a significant increase in female participation was observed. These results suggest that targeted institutional measures are suitable for promoting the representation of women in academic surgery and reducing existing imbalances. HINTERGRUND UND FRAGESTELLUNG: Trotz steigenden Frauenanteils sind Chirurginnen in klinischen und akademischen Führungspositionen weiterhin unterrepräsentiert. Der Viszeralmedizin-Kongress als größter deutschsprachiger Fachkongress ermöglicht die Untersuchung geschlechtsspezifischer Repräsentationsmuster. Ziel der Studie war die Analyse der Geschlechterverteilung in Kongressfunktionen 2013 bis 2024 zur Identifikation möglicher struktureller Barrieren. Die Geschlechterverteilung von Vortragenden und Vorsitzenden wurde anhand der Kongress Programme 2013 bis 2024 erfasst. Nach Ausschluss gastroenterologischer, endoskopischer und interdisziplinärer Sitzungen wurden ausschließlich viszeralchirurgische Beiträge ausgewertet. Es zeigte sich ein signifikanter Anstieg weiblicher Vortragender (r2 = 0,585; p = 0,006) und Vorsitzender (r2 = 0,777; p < 0,001). Zunahmen fanden sich in Plenarsitzungen (Vortragende r2 = 0,600, p = 0,005; Vorsitze r2 = 0,796, p < 0,001) und Abstractsitzungen (Vortragende r2 = 0,445, p = 0,025; Vorsitze r2 = 0,678, p = 0,002). Parität wurde nur bei Abstractvorsitzen stellenweise erreicht. In Industriesymposien waren 88–100 % der Vortragenden und 100 % der Vorsitzenden männlich. Von 2013 bis 2024 waren 92 % der Kongresspräsident*innen männlich. Auch bei den Auszeichnungen dominierten Männer: 66,6–80 % der Preisträger und 87,5–100 % der Medaillenempfänger waren männlich. Chirurginnen bleiben damit in prestigeträchtigen Kongressfunktionen deutlich unterrepräsentiert und erscheinen überwiegend in weniger sichtbaren Formaten, was strukturelle Barrieren nahelegt. Paritätische Vorgaben führten zu einem signifikanten Anstieg weiblicher Beteiligung. Institutionelle Maßnahmen können die Repräsentation von Frauen in der akademischen Chirurgie verbessern und bestehende Ungleichgewichte reduzieren.
This study explores the use of advanced synchrotron radiation (SR)-based imaging and spectroscopic techniques to investigate the distribution and nature of mercury (Hg) in numismatic artifacts, with a particular focus on its role in historical counterfeiting practices. A selection of medieval silver coins exhibiting anomalous surface Hg signals, initially identified through portable energy-dispersive X-ray fluorescence (ED-XRF) and laser-induced breakdown spectroscopy, were further examined using high-resolution synchrotron X-ray micro-computed tomography (SR-µCT), micro-X-ray spectroscopy (SR-µXRF) and micro-X-ray diffraction (SR-µXRD) at the PSICHÉ beamline of the SOLEIL Synchrotron. Comparative analyses were conducted on coins produced by an unofficial mint at the Castle of Godano (La Spezia, Italy) and on verified genuine specimens. The results provide evidence for the use of Hg-Ag amalgam, indicative of fraudulent minting practices. This research highlights the methodological strength of integrating multiple non-destructive techniques. Portable ED-XRF demonstrates significant utility as a preliminary screening tool for detecting Hg in medieval and Renaissance coins, supporting the identification of potential forgeries. The combined use of SR-µCT, SR-µXRF and SR-µXRD offers a comprehensive framework for probing internal microstructures and elemental compositions of metal archaeological objects, advancing our understanding of both ancient coinage and fraudulent processes.
This article comparatively analyzes public policies for the promotion of Paralympic sport in ten Latin American countries with outstanding results in the Paralympic medal table during the last Olympic cycle: Brazil, Colombia, Mexico, Argentina, Cuba, Venezuela, Costa Rica, Chile, Peru, and Ecuador. From a social study of disability perspective, it examines how these countries have incorporated sport practiced by persons with disabilities into their regulatory frameworks, what support instruments they have developed, and to what extent they have built institutional mechanisms to foster access, retention, and athletic development. The study is based on a comparative documentary analysis of laws, regulations, programs, institutional plans, and official documents. The results show that most countries have advanced formal recognition of the right to sport for persons with disabilities and in the creation of support instruments, especially scholarships and awards associated with high performance. However, these mechanisms are mainly concentrated on rewarding achievements already attained rather than correcting structural inequalities in access. The main gaps appear in talent identification, in the articulation of pathways for athletic progression, and in the incorporation of gender- and territory-based approaches. The article concludes that the region has made greater progress in normative recognition and performance incentives than in consolidating comprehensive, accessible, and equitable systems. The main public policy challenge is to strengthen stable conditions for the training, continuity, and development of athletic trajectories.
Mandibular fractures in high-performance athletes challenge both structural stability and the rapid restoration of sport-specific function. Standard rehabilitation following open reduction and internal fixation (ORIF) often overlooks neuromuscular re-education, cervical-mandibular coordination, and the demands of elite athletic return. A 23-year-old elite judoka from the Romanian National Team sustained a right mandibular angle fracture during training. ORIF was performed using titanium miniplates. At week 3 post-surgery, she presented with severe trismus (maximum interincisal opening [MIO] 15 mm) and significant pain (Visual Analog Scale [VAS] 8/10). A 12-week multimodal rehabilitation program was initiated, combining ultrasound-guided dry needling (masseter, temporalis, pterygoids, suprahyoids, sternocleidomastoid, and suboccipitals), temporomandibular joint (TMJ) manual therapy, and a structured digital home-based program (Healthy TMJ, 20 min daily). Early Transfer of Energy Capacitive and Resistive therapy induced swelling and was discontinued. By week 8, her MIO improved to 43 mm and VAS to 2-3, enabling return to competitive training and a Gold Medal at the Romanian National University Championship. At week 12, MIO reached 55 mm, VAS 1, and full functional recovery was achieved, culminating in a Bronze Medal at the FISU World University Championships. This case demonstrates that a multimodal, ultrasound-guided rehabilitation approach can promote faster recovery, improve mandibular kinematics, and enable safe early return to elite competition following mandibular ORIF.
The submission is a brief communication outlining and celebrating the career of Dr. Debbie Monticciolo, in recognition of receiving the 2026 ACR Gold Medal Award. The piece outlines her early education, pathway to Radiology, research and advocacy accomplishments, and her impact on patients and the wider field of Breast Imaging. The piece clearly demonstrates, and lauds, Dr. Monticciolo's impact on the science of screening and on the administration of specialty and subspecialty organizations. Trainees and junior faculty will gain an important perspective about the potential impact of their careers by following Dr. Monticciolo's example.