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Discordance between the genetic sex and phenotype seen on ultrasound can identify disorders of sexual development (DSD) that previously escaped detection until puberty. We describe a 46, XY disorder of sexual differentiation caused by a rare mutation in the SF1 gene (OMIM]184757, (NR5A1). The mutation (NR5A1)-c.205C > G (p. Arg69Gly) was discovered after a phenotype-genotype discrepancy was encountered during prenatal care. The baby with 46, XY DSD has female external genitalia but evidence of Y chromosome-related regression of Müllerian structures and the absence of palpable gonads. We discussed the literature on phenotype-genotype discrepancy and the importance of care coordination between the antenatal and postnatal teams to ensure a timely diagnosis of DSD.
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PROBLEM: UK midwives report high work-related stress, which can negatively impact their health and wellbeing, with many considering leaving the profession. BACKGROUND: An occupational stress audit guides the implementation of stress management intervention, by identifying which stressors have the most negative impact and why, and highlighting "at risk" groups. AIM: To conduct a concurrent mixed-methods stress audit with UK midwives in an NHS Trust. METHODS: Seventy-one midwives (Mage= 39 years, SD = 11) completed a survey assessing stressors (e.g., relationships), stress appraisals (i.e., challenge vs. threat), coping strategies (e.g., avoidance-focused), and outcomes (i.e., mental health, performance, and intention to leave). Ten midwives (Mage = 42 years, SD = 10) participated in semi-structured interviews. FINDINGS: Quantitative data revealed that more work-related demands, poorer peer support and relationships, and threat appraisals predicted worse mental health. Moreover, less control and more work-related demands predicted poorer performance, while less control, poorer manager support, more change-related demands, and threat appraisals predicted greater intention to leave. Qualitative data generated three themes: organisational pressures exacerbated by unexpected changes; individualised responses but largely debilitative emotions; and personal coping and power of social support. DISCUSSION AND CONCLUSION: This study offered a comprehensive and novel insight into the stress experiences of UK midwives, highlighting targets for future stress management interventions, including key stressors (e.g., manager support), underlying mechanisms (e.g., stress appraisals), and "at-risk" groups (e.g., night shift workers). Practical recommendations are provided for stakeholders operating at multiple levels (e.g., midwife, trust, policy) to better support midwives with work-related stress.
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Adaptação Psicológica , Tocologia , Estresse Ocupacional , Humanos , Feminino , Reino Unido , Adulto , Estresse Ocupacional/psicologia , Inquéritos e Questionários , Pessoa de Meia-Idade , Enfermeiros Obstétricos/psicologia , Pesquisa Qualitativa , Satisfação no Emprego , Estresse Psicológico/psicologia , Local de Trabalho/psicologia , Saúde Mental , Gravidez , Carga de Trabalho/psicologia , Apoio SocialRESUMO
Although greater lifetime stressor exposure has been associated with physical and mental health issues in the general population, relatively little is known about how lifetime stressors impact the physical and mental health of elite athletes or the factors moderating this association. Given that many elite athletes show signs of perfectionism, and that this trait has been linked with ill-health, it is possible that perfectionism may moderate the lifetime stressor-health relationship. To test this possibility, we examined how cumulative lifetime stressor exposure was associated with general mental and physical health complaints in elite athletes, and the extent to which these associations were moderated by perfectionism. Participants were 110 elite athletes (64 female; M age = 29.98 years, SD = 10.54) who completed assessments of lifetime stressor exposure, physical health, psychological distress, and perfectionism. As hypothesised, hierarchical regression analyses revealed that experiencing more severe lifetime stressors was related to poorer physical and mental health. Furthermore, self-oriented perfectionism moderated the association between lifetime stressor count and severity and physical health, but not mental health. Overall, these data demonstrate stressor-specific effects among elite athletes and highlight the potential importance of assessing lifetime stressor exposure and perfectionistic tendencies in order to improve athlete health and well-being.
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BACKGROUND: Work-related stress is high in midwifery with negative implications for midwives' health and performance. This systematic review therefore examined which stress management interventions (SMIs) are most effective at reducing occupational stress and improving midwives' health and well-being, performance, and job satisfaction. METHODS: A systematic review included studies if they were: investigating midwives or student midwives; examining an individual- or organisation-level intervention; reporting the intervention effects on at least one outcome (e.g., job performance); peer-reviewed; and published in English. Methodological quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was conducted and data were presented by SMI level (i.e., individual vs. organisation) and modality type (e.g., mindfulness, care model). Sum codes were used to compare the effects of individual- and organisation-level SMIs on outcomes. FINDINGS: From 2605 studies identified, 30 were eligible (18 individual- and 12 organisation-level SMIs). Eight studies were deemed low quality. While individual- and organisation-level SMIs were equally effective in improving job satisfaction and performance, there was a trend for organisation-level SMIs more effectively reducing work stress and improving health and well-being. Specific individual- (i.e., mindfulness, simulation training) and organisation-level (i.e., reflective groups, midwifery care models) SMIs were most beneficial. CONCLUSION: It is recommended that health practitioners and policy makers implement interventions that target both individual- and organisation-levels to optimally support midwives' work stress, health, well-being, and performance. Notwithstanding these findings and implications, some studies had poor methodological quality; thus, future research should better follow intervention reporting guidelines.
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Satisfação no Emprego , Tocologia , Enfermeiros Obstétricos , Estresse Ocupacional , Humanos , Estresse Ocupacional/psicologia , Estresse Ocupacional/prevenção & controle , Feminino , Enfermeiros Obstétricos/psicologia , Atenção Plena/métodosRESUMO
BACKGROUND AND OBJECTIVES: Recent research has shown that lifetime stressor exposure can negatively impact sport performers. However, this work has predominantly relied on quantitative methods, which has provided limited information regarding how stressors occurring over the life course affect health, well-being, and performance. This study aimed to explore how relatively high levels of lifetime (non-sport and sport-specific) stressor exposure influenced sport performers' health, well-being, and performance. METHODS AND DESIGN: To identify participants who had experienced high lifetime (non-sport and sport-specific) stressors, we used criterion-based purposeful sampling from a prior study. Subsequently, semi-structured interviews, complemented by timelining, were conducted with 22 sport performers (17 female; Mage = 25.89, SD = 10.20). RESULTS: We used reflexive thematic analysis to develop three overarching themes that illustrate how high lifetime (non-sport and sport-specific) stressor exposure influences sport performers' health, well-being, and performance. These were: psychological (e.g., maladaptive coping strategies), social (e.g., difficulties in building relationships), and behavioral (e.g., risky behaviors) factors. CONCLUSIONS: These findings can help practitioners identify sport performers at risk of developing stress-related health, well-being, and performance problems, and may aid the development of effective interventions.
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Esportes , Estresse Psicológico , Humanos , Feminino , Adulto , Esportes/psicologia , Assunção de Riscos , Capacidades de Enfrentamento , Acontecimentos que Mudam a VidaRESUMO
It has been argued that habitually appraising stressful events as more of a threat (i.e., situational demands exceed personal coping resources) may increase one's risk of ill-health (e.g., depression). However, while first theorized 15 years ago, little research has tested this assertion. Thus, this study offered a novel test of the associations between trait challenge and threat appraisals and health-related outcomes (i.e., mental health symptomology, psychological well-being, and physical health complaints). Three hundred and ninety-five participants (251 female, 144 male; Mage = 22.50 years, SD = 5.33) completed valid and reliable measures of trait challenge and threat appraisals, mental health (i.e., symptoms of depression and anxiety), well-being (e.g., subjective vitality), and physical health complaints (e.g., respiratory illnesses). Regression analyses revealed that trait challenge and threat appraisals accounted for a significant proportion of variance in all outcomes after controlling for age and gender, with a tendency to appraise stressful events as more of a threat associated with poorer mental health (i.e., greater depression symptomology), well-being (e.g., lower vitality), and physical health (e.g., more respiratory illnesses). Taken together, the findings highlight the importance of trait challenge and threat appraisals for health, although further research is needed using stronger designs (e.g., longitudinal) to enable a more causal understanding.
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Ansiedade , Depressão , Estresse Psicológico , Humanos , Feminino , Masculino , Adulto , Estresse Psicológico/psicologia , Adulto Jovem , Depressão/psicologia , Ansiedade/psicologia , Nível de Saúde , Adaptação Psicológica , Saúde Mental , Adolescente , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Experiencing psychological stress may affect clinician performance in acute emergencies. While simulation is used extensively in healthcare education, it is unknown whether simulation effectively replicates the psychophysiological stress of real-world conditions. Thus, this study explored whether measurable differences exist in psychophysiological responses to acute stress in simulated compared with real-world clinical practice. METHODS: In this within-subjects observational study, stress appraisals, state anxiety and heart rate variability (HRV) were recorded during simulated and real-world emergencies in a 6-month training placement in neonatal medicine. Eleven postgraduate trainees and one advanced neonatal nurse practitioner participated. Mean (SD) participant age was 33 (8) years; and eight participants (67%) were female. Data were collected at rest and immediately before, during and 20 min after simulated and real-world neonatal emergencies. In situ simulation scenarios were modelled on those used in accredited neonatal basic life support training. Stress appraisals and state anxiety were assessed using Demand Resource Evaluation Scores and the short State-Trait Anxiety Inventory, respectively. High-frequency power, a component of HRV associated with parasympathetic tone, was derived from electrocardiogram recordings. RESULTS: Simulation was associated with greater likelihood of threat appraisal and higher state anxiety. High-frequency HRV reduced from baseline in simulated and real-world emergencies but recovered further towards baseline 20 min after simulated events. Possible explanations for the observed differences between conditions include participants' previous experiences and expectations of simulation and the effect of post-simulation debrief and feedback. DISCUSSION: This study identifies important differences in psychophysiological stress responses to simulated and real-world emergencies. Threat appraisals, state anxiety and parasympathetic withdrawal are educationally and clinically significant, given their known associations with performance, social functioning and health regulation. While simulation may facilitate interventions aimed at optimising clinicians' stress responses, it is vital to confirm that outcomes transfer to real-world clinical practice.
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Emergências , Estresse Psicológico , Recém-Nascido , Humanos , Feminino , Adulto , Masculino , Estresse Psicológico/psicologia , Ansiedade , Competência ClínicaRESUMO
OBJECTIVE: The aim of this study was to investigate whether risk estimates for childhood acute lymphoblastic leukemia change when restricting model comparison groups to "nonpesticide exposure" (NPE10) households. METHODS: Cases ( n = 1810) 15 years or younger were identified through Children's Cancer Group institutions between 1989 and 1993 and age-/sex-matched to controls ( n = 1951). Household pesticide use during pregnancy/month prior was collected via telephone. NPE10 comparison group reporting no parental exposure to 10 pesticide classes was identified. RESULTS: Adjusted odds ratios increased from 15% to 49% when limiting the comparison to NPE10. Maternal termite insecticide exposure was associated with greatest risk (adjusted odds ratio, 4.21; 95% confidence interval, 2.00-8.88). There was minimal evidence of interaction by child sex or occupational pesticide exposure, and no monotonic dose-response pattern with frequency of use (times per year). CONCLUSIONS: Elevated risks are consistent with published pooled-/meta-analyses and DNA damage. The consistency and magnitude of these associations warrant product labeling, exposure reduction interventions, or both.
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Praguicidas , Leucemia-Linfoma Linfoblástico de Células Precursoras , Efeitos Tardios da Exposição Pré-Natal , Criança , Masculino , Gravidez , Feminino , Humanos , Lactente , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Praguicidas/toxicidade , Fatores de Risco , Exposição Paterna/efeitos adversos , Exposição Materna/efeitos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/induzido quimicamente , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Estudos de Casos e ControlesRESUMO
This study addressed whether lifetime stressor exposure was associated with psychophysiological reactivity and habituation to a novel laboratory-based stressor. Eighty-six participants (Mage = 23.31 years, SD = 4.94) reported their exposure to lifetime non-sport and sport-specific stressors before completing two consecutive trials of the Trier Social Stress Test, while cardiovascular (i.e., heart rate) and endocrine (i.e., salivary cortisol) data were recorded. Exposure to a moderate number of lifetime non-sport and sport-specific stressors was associated with adaptive cardiovascular reactivity, whereas very low or very high stressor exposure was related to maladaptive reactivity. Moreover, experiencing a very low number of lifetime non-sport (but not sport-specific) stressors was associated with poorer habituation. In contrast, lifetime stressor severity was unrelated to cardiovascular reactivity. Finally, greater lifetime non-sport and sport-specific stressor counts were associated with blunted cortisol reactivity and poorer habituation. These results suggest that lifetime stressor exposure may influence sport performers' acute stress responses.
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Habituação Psicofisiológica , Esportes , Humanos , Hidrocortisona , Frequência CardíacaRESUMO
This study examined the effect of slow diaphragmatic breathing on psychophysiological stress responses and pressurized performance. Sixty-seven participants (40 female; Mage = 20.17 ± 2.77 years) were randomly assigned to either a diaphragmatic-breathing, paced-breathing, or control group. Participants completed a nonpressurized shooting task and then received instructions about a pressurized version. Next, the diaphragmatic group was told to breathe at 6 breaths/min, the paced group at 12 breaths/min, and the control group received no instructions. Following a 5-min intervention period, participants completed the pressurized task while performance was assessed. Psychophysiological stress responses (e.g., cognitive anxiety, heart rate) were recorded throughout. Results revealed that diaphragmatic breathing had mixed effects on stress responses, with some unaffected (e.g., heart rate) and others reduced (e.g., cognitive anxiety), and little effect on performance. Findings suggested that slow diaphragmatic breathing might not aid pressurized performance but could benefit psychological stress responses.
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Estresse Psicológico , Feminino , Frequência Cardíaca/fisiologia , HumanosRESUMO
PURPOSE: To report a case of atypical infectious crystalline keratopathy-like stromal infection secondary to microsporidia wherein diagnosis of the causative organism was aided by use of the Center for Disease Control (CDC) DPDx program. METHODS: We report the case of a 73-year-old woman who presented with atypical infectious crystalline keratopathy-like corneal infection without previous surgical history. RESULTS: The patient had previously been treated for recalcitrant corneal infection with topical antibiotics and steroids at an outside provider before referral. Further treatment with topical fortified antibiotics failed to improve the infection. Corneal biopsy was performed and sent to the CDC DPDx for diagnostic confirmation for presumptive microsporidia. The patient underwent therapeutic penetrating keratoplasty without recurrence of ocular infection. CONCLUSIONS: Utilization of the DPDx resource may help guide appropriate and timely diagnosis and management strategies in atypical presentations of infectious keratitis.
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Centers for Disease Control and Prevention, U.S./estatística & dados numéricos , Córnea/patologia , Infecções Oculares Bacterianas/diagnóstico , Ceratite/diagnóstico , Microsporídios/isolamento & purificação , Microsporidiose/diagnóstico , Idoso , Córnea/microbiologia , Infecções Oculares Bacterianas/microbiologia , Feminino , Humanos , Ceratite/microbiologia , Microsporidiose/microbiologia , Estados UnidosRESUMO
OBJECTIVE: To understand the specific ways in which champions lead efforts to obtain and sustain buy-in for immediate postpartum long-acting reversible contraception (LARC) programs. METHODS: We conducted a qualitative study with 60 semistructured interviews at 3 teaching hospitals in Texas with physicians, nurses, administrators and other staff who participated in the implementation of immediate postpartum LARC. Physicians self-identified as champions and identified other champion physicians and administrators. Two researchers analyzed and coded interview transcripts for content and themes. RESULTS: We found that champions draw on institutional knowledge and relationships to build awareness and support for immediate postpartum LARC implementation. To obtain buy-in, champions needed to demonstrate financial sustainability, engage key stakeholders from multiple departments, and obtain nurse buy-in. Champions also created buy-in by communicating goals for the service that focused on expanding reproductive autonomy, improving maternal health, and improving access to postpartum contraception. Some staff, especially nurses, identified reasons for the program that run counter to reproductive justice principles: reducing birth rates, poverty, and/or unplanned pregnancy among young women and high-parity women. Respondents at 2 hospitals noted that not all women had equitable access to immediate postpartum LARC. CONCLUSION: Physician and non-physician champions must secure long-term support across multiple hospital departments to successfully implement an immediate postpartum LARC program. For programs to equitably serve all women in need of postpartum contraceptive care, champions and other program leaders need to implement strategies to address access issues. They should also explicitly focus on reproductive justice principles during program introduction and training. IMPLICATIONS: Successfully implementing immediate postpartum long-acting reversible contraception programs requires champions with institutional networking connections, administrative and nursing support, and clearly communicated goals. Champions need to address access issues and focus on reproductive justice principles during program introduction and training to equitably serve all women in need of postpartum contraceptive care.
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Contracepção Reversível de Longo Prazo , Anticoncepção , Anticoncepcionais , Feminino , Hospitais , Humanos , Período Pós-Parto , Gravidez , TexasRESUMO
Research has found that greater lifetime stressor exposure increases the risk for mental and physical health problems. Despite this, few studies have examined how stressors occurring over the entire lifespan affect sport performers' health, well-being, and performance, partly due to the difficulty of assessing lifetime stressor exposure. To address this issue, we developed a sport-specific stress assessment module (Sport SAM) for the Stress and Adversity Inventory (STRAIN) and then analyzed the instrument's usability, acceptability, validity, and test-retest reliability. Furthermore, we examined whether trait-like tendencies to appraise stressful situations as a challenge or threat mediated the association between lifetime stressor exposure and health, well-being, and performance. Participants were 395 sport performers (Mage = 22.50 years, SD = 5.33) who completed an online survey. Results revealed that the Sport SAM demonstrated good usability and acceptability, good concurrent validity in relation to the Adult STRAIN (rs = 0.23 to 0.29), and very good test-retest reliability (r icc = 0.87 to 0.89). Furthermore, the Sport SAM was significantly associated with symptoms of depression (ß = 0.21 to 0.24, ps ≤ .001) and anxiety (ß = 0.13 to 0.19, ps ≤ .012), and general physical (ß = 0.24 to 0.27, ps = ≤ 0.001) and mental (ß = 0.23 to 0.32, p ≤ .001) health complaints. Finally, we found that associations between total lifetime non-sport and sport-specific stressor severity and health were mediated by trait stress appraisals. Consequently, these findings may help practitioners better identify sport performers who are at risk of developing stress-related health problems.
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PURPOSE: To determine whether higher coffee intake may reduce the risk of renal cell cancer (RCC) associated with lead (Pb) and other heavy metals with known renal toxicity. METHODS: We conducted a nested case-control study of male smokers (136 RCC cases and 304 controls) within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Cases diagnosed with RCC at 5 or more years following cohort enrollment were matched to controls on age (± 7 years) and whole blood draw date (± 30 days). Conditional logistic regression (using two-sided tests) was used to test for main effects and additive models of effect modification. RESULTS: After a mean follow-up of 16.3 years, coffee consumption was not significantly associated with renal cell cancer risk, when adjusting for blood concentrations of Cd, Hg, and Pb and RCC risk factors (age, smoking, BMI, and systolic blood pressure) (p-trend, 0.134). The association with above median blood Pb and RCC (HR = 1.69, 95% CI 1.06, 2.85) appeared to be modified by coffee consumption, such that RCC risk among individuals with both increased coffee intake and higher blood lead concentration were more than threefold higher RCC risk (HR = 3.40, 95% CI 1.62, 7.13; p-trend, 0.003). CONCLUSION: Contrary to our initial hypothesis, this study suggests that heavy coffee consumption may increase the previously identified association between higher circulating lead (Pb) concentrations and increased RCC risk. Improved assessment of exposure, including potential trace element contaminants in coffee, is needed.
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Carcinoma de Células Renais , Neoplasias Renais , Oligoelementos , Carcinoma de Células Renais/epidemiologia , Carcinoma de Células Renais/etiologia , Estudos de Casos e Controles , Café/efeitos adversos , Humanos , Neoplasias Renais/epidemiologia , Neoplasias Renais/etiologia , Masculino , Fatores de Risco , FumantesRESUMO
The ccA and ccB molecular subtypes of clear cell renal cell carcinoma (ccRCC) have well-characterized prognostic relevance. However, it is not known whether they possess distinct etiologies. We investigated the relationships between these subtypes and RCC risk factors within a case-control study conducted in Eastern Europe. We analyzed risk factor data for ccA (n = 144) and ccB (n = 106) cases and 1476 controls through case-only and case-control comparisons to assess risk factor differences across subtypes using logistic and polytomous regression models. We also performed a meta-analysis summarizing case-only results from our study and three patient cohorts. Patients with ccB tumors had poorer survival than those with ccA tumors and were more likely to be male (case-only odds ratio [OR] 2.68, 95% confidence interval [CI] 1.43-5.03). In case-control analyses, body mass index was significantly associated with ccA tumors (OR 2.45, 95% CI 1.18-5.10 for ≥35 vs <25 kg/m2 ) but not with ccB tumors (1.52, 0.56-4.12), while trichloroethylene was associated with ccB but not ccA (OR 3.09, 95% CI 1.11-8.65 and 1.25, 0.36-4.39 respectively for ≥1.58 ppm-years vs unexposed). A polygenic risk score of genetic variants identified from genome-wide association studies was associated with both ccA and, in particular, ccB (OR 1.82, 1.11-2.99 and 2.87, 95% CI 1.64-5.01 respectively for 90th vs 10th percentile). In a meta-analysis of case-only results including three patient cohorts, we still observed the ccB excess for male sex and the ccA excess for obesity. In conclusion, our findings suggest the existence of etiologic heterogeneity across ccRCC molecular subtypes for several risk factors.
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Carcinoma de Células Renais/patologia , Neoplasias Renais/patologia , Idoso , Carcinoma de Células Renais/classificação , Carcinoma de Células Renais/etiologia , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Neoplasias Renais/classificação , Neoplasias Renais/etiologia , Masculino , Metanálise como Assunto , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Taxa de SobrevidaRESUMO
PURPOSE: Exome- and whole-genome sequencing of muscle-invasive bladder cancer has revealed important insights into the molecular landscape; however, there are few studies of non-muscle-invasive bladder cancer with detailed risk factor information. EXPERIMENTAL DESIGN: We examined the relationship between smoking and other bladder cancer risk factors and somatic mutations and mutational signatures in bladder tumors. Targeted sequencing of frequently mutated genes in bladder cancer was conducted in 322 formalin-fixed paraffin-embedded bladder tumors from a population-based case-control study. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI), evaluating mutations and risk factors. We used SignatureEstimation to extract four known single base substitution mutational signatures and Poisson regression to calculate risk ratios (RR) and 95% CIs, evaluating signatures and risk factors. RESULTS: Non-silent KDM6A mutations were more common in females than males (OR = 1.83; 95% CI, 1.05-3.19). There was striking heterogeneity in the relationship between smoking status and established single base substitution signatures: current smoking status was associated with greater ERCC2-Signature mutations compared with former (P = 0.024) and never smoking (RR = 1.40; 95% CI, 1.09-1.80; P = 0.008), former smoking was associated with greater APOBEC-Signature13 mutations (P = 0.05), and never smoking was associated with greater APOBEC-Signature2 mutations (RR = 1.54; 95% CI, 1.17-2.01; P = 0.002). There was evidence that smoking duration (the component most strongly associated with bladder cancer risk) was associated with ERCC2-Signature mutations and APOBEC-Signature13 mutations among current (P trend = 0.005) and former smokers (P = 0.0004), respectively. CONCLUSIONS: These data quantify the contribution of bladder cancer risk factors to mutational burden and suggest different signature enrichments among never, former, and current smokers.
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Genes Neoplásicos/genética , Sequenciamento de Nucleotídeos em Larga Escala , Mutação , Neoplasias da Bexiga Urinária/epidemiologia , Neoplasias da Bexiga Urinária/genética , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
The enumeration of circulating tumor cells (CTCs) in the peripheral bloodstream of metastatic cancer patients has contributed to improvements in prognosis and therapeutics. There have been numerous approaches to capture and counting of CTCs. However, CTCs have potential information beyond simple enumeration and hold promise as a liquid biopsy for cancer and a pathway for personalized cancer therapy by detecting the subset of CTCs having the highest metastatic potential. There is evidence that epithelial cell adhesion molecule (EpCAM) expression level distinguishes these highly metastatic CTCs. The few previous approaches to selective CTC capture according to EpCAM expression level are reviewed. A new two-stage microfluidic device for separation, enrichment and release of CTCs into subpopulations sorted by EpCAM expression level is presented here. It relies upon immunospecific magnetic nanoparticle labeling of CTCs followed by their field- and flow-based separation in the first stage and capture as discrete subpopulations in the second stage. To fine tune the separation, the magnetic field profile across the first stage microfluidic channel may be modified by bonding small Vanadium Permendur strips to its outer walls. Mathematical modeling of magnetic fields and fluid flows supports the soundness of the design.
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Separação Celular/instrumentação , Molécula de Adesão da Célula Epitelial/metabolismo , Dispositivos Lab-On-A-Chip , Magnetismo/instrumentação , Células Neoplásicas Circulantes , Linhagem Celular Tumoral , Humanos , Análise de Sequência com Séries de Oligonucleotídeos , Ligação ProteicaRESUMO
ABSTRACT: Sant'Anna, RT, Roberts, SP, Moore, LJ, and Stokes, KA. Physical demands of refereeing rugby sevens matches at different competitive levels. J Strength Cond Res 35(11): 3164-3169, 2021-The aim of this study was to compare the physical demands of officiating across different competitive levels in rugby sevens. An observational design was used involving 27 referees (26 men and 1 woman, age: 27 ± 6 years, body mass [mean ± SD]: 78.5 ± 9.3 kg, and height: 179 ± 5 cm). Global Navigation Satellite Systems data were collected across a total of 114 matches during 5 separate rugby sevens tournaments played in England-between May and July 2018-categorized into 4 competitive levels: (a) international, (b) professional, (c) semiprofessional, and (d) amateur. Compared with referees officiating at the international, professional, and semiprofessional levels, referees officiating at the amateur level covered less total (p < 0.001) and relative distance (p < 0.001). In addition, these referees covered more distance walking and jogging (p < 0.001). Amateur referees also completed fewer sprints (p = 0.006), repeated high-intensity efforts (RHIEs) per game (p < 0.001), and spent longer between RHIEs (p = 0.015). Finally, for the amateur referees, the duration of the longest repeated high-intensity bout (i.e., worst case scenario) was lower (p < 0.001), with less distance covered (p < 0.001) and fewer high-intensity accelerations (p < 0.001). Refereeing rugby sevens is therefore more physically demanding at higher competitive levels, particularly in terms of high-intensity efforts. The results provide vital information for practitioners involved in the physical preparation of rugby sevens referees.
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Rugby , Corrida , Adulto , Feminino , Sistemas de Informação Geográfica , Humanos , Masculino , Caminhada , Adulto JovemRESUMO
BACKGROUND: The purpose of this study was to compare the match demands of officiating 15-a-side rugby union at different competitive levels. METHODS: Data was collected using Global Navigation Satellite Systems from 21 referees during 82 competitive rugby union matches across three different competitive levels: 1) professional; 2) semi-professional; 3) amateur. RESULTS: Compared with referees at the professional and semi-professional levels, referees at the amateur level covered less total distance (P=0.005). Additionally, these referees covered less distance jogging, and at low and medium intensity (all P<0.05), and had less time between repeated high-intensity efforts (P<0.001). Furthermore, compared with referees at the semi-professional and amateur levels, referees at the professional level had a higher sprint duration and covered more distance sprinting (all P<0.05), and achieved a higher maximal speed during the longest repeated high-intensity effort or "worst-case scenario" (P=0.026). The professional level referees also displayed a lower average heart rate (P<0.001), spent a higher percentage of time at <60% HR
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Futebol Americano/classificação , Corrida/fisiologia , Adulto , Treino Aeróbico/educação , Futebol Americano/fisiologia , Frequência Cardíaca , Humanos , MasculinoRESUMO
PURPOSE: To develop a more efficient and less traumatic method of Descemet membrane removal in endothelial surgery. METHODS: A novel, vertically oriented, reverse-grasping microforceps (named the Rabiyah Descemet Membrane Removal Microforceps) were created to facilitate grasping and extraction of a host Descemet membrane. RESULTS: This new instrument has been used successfully and safely in more than 85 endothelial keratoplasty cases among 4 surgeons. CONCLUSIONS: The Rabiyah Descemet Membrane Removal Microforceps provides surgeons with a safe and an efficient option to remove Descemet membrane in endothelial surgical procedures.