Injury incidence and prevalence in elite short-course triathletes: a 4-year prospective study.

OBJECTIVE: To characterise the prevalence, incidence rate (IR) and burden of injuries in elite short-course triathletes over a 4-year training and competition period. METHODS: Fifty elite Australian triathletes were prospectively monitored for injury during four consecutive seasons (2018-2021). Injuries requiring medical attention were prospectively recorded and further subcategorised according to time loss. The IR and burden (injury IR×mean injury severity) were calculated per 365 athlete days, with sex differences in IR compared using IR ratios (IRR) from negative binomial regression models. RESULTS: Two hundred and sixty-six injuries were reported in 46 (92.0%) athletes, of which 67.3% resulted in time loss. The injury IR was 1.87 injuries per 365 athlete days (95% CI 1.70 to 2.80), and comparable between sexes (IRR 0.82, 95% CI 0.64 to 1.04, p=0.109). Most injuries (70.7%) were training related. The most frequently injured body sites were the ankle (15.8%), foot (12.4%) and lower leg (12.0%). Bone stress injuries (BSIs) were the most burdensome injury type with 31.38 days of time loss per 365 days (95% CI 24.42 to 38.34). Twenty athletes (40.0%) reported at least one bone stress injury (BSI) (range 0-3). The rate of BSIs in female athletes was three times greater compared with male athletes (IRR 2.99, 95% CI 1.26 to 7.07, p=0.013). CONCLUSION: Two-thirds of injuries reported in elite short-course triathletes resulted in time loss, with the majority occurring during training activities. Foot, ankle and other lower leg injuries had the highest incidence, with BSIs carrying the highest injury burden. The considerably higher rate of BSI observed in female athletes warrants consideration for future prevention strategies in female triathletes.

Improved fertilization, degeneration, and embryo quality rates with PIEZO-intracytoplasmic sperm injection compared with conventional intracytoplasmic sperm injection: a sibling oocyte split multicenter trial.

OBJECTIVE: To investigate whether PIEZO-intracytoplasmic sperm injection (PIEZO-ICSI) increases the fertilization rate, decreases the degeneration rate, and increases the utilization rate per oocyte injected compared with conventional intracytoplasmic sperm injection (ICSI). DESIGN: Sibling oocyte split multicenter trial. SETTING: Fertility clinics. PATIENTS: Women with a diagnosis of infertility who used ICSI as their method of insemination and had ≥6 mature oocytes for injection. INTERVENTIONS: Participants had their mature oocyte cohort divided, where half were injected using conventional ICSI and the other half were injected using PIEZO-ICSI. For patients with an uneven oocyte number, the extra oocyte was injected using conventional ICSI. The injection technique used first was also randomized to ensure that there was no bias due to order of injection. MAIN OUTCOME MEASURE: The primary outcome measure was the fertilization rate after injection. RESULTS: A total of 108 patients underwent a sibling split use of conventional ICSI and PIEZO-ICSI. The fertilization rate was 71.6% in PIEZO-ICSI, which significantly increased compared with that in conventional ICSI 65.6%. In addition, the oocyte degeneration rate decreased in PIEZO-ICSI compared with that in conventional ICSI (6.3% vs. 12.1% respectively), and the blastocyst quality increased, as measured by the number of grade A and B quality blastocysts present on day 5 of development (33.3% vs. 27.5%). No significant differences in the aneuploidy or utilization rate, clinical pregnancy, or live birth outcome after single embryo transfer were noted between the two injection techniques. CONCLUSIONS: This trial supports the possibility that PIEZO-ICSI increases the fertilization rates, decreases the oocyte degeneration rates, and increases the blastocyst quality compared with conventional ICSI; however, it does not appear to influence the clinical pregnancy or live birth rate per transfer. CLINICIAN TRIAL REGISTRATION NUMBER: Australian and New Zealand Clinical Trial Registry ACTRN12620000407998.

How school policies, strategies, and relational factors contribute to teacher victimization and school safety.

In this study, we examined how school policies and strategies (i.e., positive discipline, hardening strategies, and positive behavioral strategies) affect teacher relational factors and teacher reports of victimization and safety. Specifically, we examined the mediational roles of teacher support of student learning, maltreatment of students by teachers, and teachers' differential treatment of students in schools. Using a sample of 6643 pre-K-12th-grade teachers, path analysis results revealed that positive behavior strategies, hardening strategies, and positive discipline were indirectly associated with teacher victimization and sense of safety. Additionally, teachers' perceptions of other teachers maltreating students had the greatest contributions to their sense of safety and victimization by students. Positive discipline was directly and indirectly associated with teacher victimization and safety. Implications and directions for future studies are discussed.

A Dual Inertial Measurement Unit System for Classifying Standard Overhead Drill Movements in Elite Women's Water Polo.

INTRODUCTION: Water polo upper limb external load monitoring cannot be currently measured accurately because of technological and methodological challenges. This is problematic as large fluctuations in overhead movement volume and intensity may affect performance and alter injury risk. Inertial measurement units (IMU) and machine learning techniques have been shown to accurately classify overhead movements in other sports. We investigated the model accuracy and class precision, sensitivity, and specificity of IMU and machine learning techniques to classify standard overhead drill movements in elite women's water polo. METHODS: Ten women's water polo players performed standard drills of swimming, blocking, low-intensity throwing and high-intensity throwing under training conditions. Athletes wore two IMU: one on the upper back and the other on the distal forearm. Each movement was videoed and coded to a standard overhead drill movement. IMU and coded video data were merged to verify the IMU-detected activity classification of each movement to that of the video. Data were partitioned into a training and a test set and used to form a decision tree algorithm. Model accuracy and class precision, sensitivity, and specificity were assessed. RESULTS: IMU resultant acceleration and angular velocity values displayed drill-specific values. A total of 194 activities were identified by the model in the test set, with 8 activities being incorrectly classified. Model accuracy was 95.88%. Percentage class precision, sensitivity, and specificity were as follows: blocking (96.15, 86.21, 99.39), high-intensity throwing (100, 100, 100), low-intensity throwing (93.48, 93.48, 97.97), and swimming (94.81, 98.65, 96.67). CONCLUSIONS: IMU and machine learning techniques can accurately classify standard overhead drill movements in elite women's water polo.

Throwing in the deep end: athletes, coaches and support staff experiences, perceptions and beliefs of upper limb injuries and training load in elite women's water polo.

To understand elite athlete, coach and support staff experiences, perceptions and beliefs in women's water polo with managing upper limb injuries and monitoring training loads. Inductive qualitative design. Twenty athletes, coaches and support staff were purposively recruited and participated in semistructured interviews. Participants either had experienced an upper limb injury or had experience managing athletes with upper limb injuries. Interviews were conducted in-person or virtually, audio-recorded, deidentified, transcribed verbatim and cleaned to ensure accuracy. Data were thematically analysed. Analysis identified five cohesive themes: (1) upper limb injury management is adequate-but prevention, communication and knowledge need improving, (2) current training load monitoring generates uncertainty and lack of consistency of processes-due to reliance on internal, and lack of external load monitoring, (3) optimal training load monitoring requires objective measurement of training load-that accurately measures the external load of athletes' upper limbs, (4) athlete-centred philosophy matters-including athlete-centred care to facilitate individually tailored rehabilitation programmes and their inclusion in management decisions, (5) mental, social and emotional aspects of upper limb injury management matter-acknowledging feelings of loss of team inclusion, fear of missing out and frustration felt by athletes as well as the emotional labour felt by coaches when supporting athletes with an upper limb injury. Upper limb injury management and training load monitoring are evolving areas where objective measurement of training load may assist in increasing consistency of communication, collaboration and coordination between all stakeholders, and to address uncertainty. Stakeholders placed value in intangible qualities such as trust and care in their relationships with other collaborators-facilitating athlete physical, mental and emotional recovery following upper limb injuries.

"We Need to Address the Trauma": School Social Workers' Views About Student and Staff Mental Health During COVID-19.

The COVID-19 pandemic and subsequent school disruptions shined a spotlight on the mental health needs of young people, and the importance of schools and school social workers (SSWs) in attending to those needs. This study sought to understand SSWs' views about mental health and trauma in relation to the pandemic and schools reopening. Data came from written responses to open-ended questions on a national survey of SSWs during June-July 2020 (Kelly et al., 2021; Watson et al., 2022). In the national survey, 450 SSWs responded to open-ended questions, providing 115 single-spaced pages of detailed qualitative comments. A unified conceptual model for a trauma-informed school was created by integrating components suggested within the literature. This conceptual model was then used to generate a theory-based coding schema. Responses mapped well onto the conceptual model. Major themes included recognition of COVID-19 and 2020 social unrest as a unique period and potentially traumatic experience; the need for a trauma-informed school response; the challenges of addressing all facets of safety during the pandemic; and the essentiality and difficulty of maintaining school-based relationships during school closures and remote learning. Results demonstrated that SSWs used and discussed key components of a trauma-informed approach. Respondents offered several recommendations for implementing trauma-informed approaches during and after the pandemic, many of which required collaboration from other school staff. Findings provide empirical support for a unified school model that integrates components of a trauma-informed approach found in the literature. We make recommendations for interpersonal, organizational, and policy adaptations schools can take to become more trauma informed.

Morphometric and morphokinetic differences in the sperm- and oocyte-originated pronuclei of male and female human zygotes: a time-lapse study.

PURPOSE: To study the morphometric and morphokinetic profiles of pronuclei (PN) between male and female human zygotes. METHOD(S): This retrospective cohort study included 94 consecutive autologous single day 5 transfer cycles leading to a singleton live birth. All oocytes were placed in the EmbryoScope + incubator post-sperm injection with all annotations performed retrospectively by one embryologist (L-SO). Timing parameters included 2nd polar body extrusion (tPB2), sperm-originated PN (tSPNa) or oocyte-originated PN (tOPNa) appearance, and PN fading (tPNF). Morphometrics were evaluated at 8 (stage 1), 4 (stage 2), and 0 h before PNF (stage 3), measuring PN area (um2), PN juxtaposition, and nucleolar precursor bodies (NPB) arrangement. RESULTS: Male zygotes had longer time intervals of tPB2_tSPNa than female zygotes (4.8 ± 0.2 vs 4.2 ± 0.1 h, OR = 1.442, 95% CI 1.009-2.061, p = 0.044). SPN increased in size from stage 1 through 2 to 3 (435.3 ± 7.2, 506.7 ± 8.0, and 556.3 ± 8.9 um2, p = 0.000) and OPN did similarly (399.0 ± 6.1, 464.3 ± 6.7, and 513.8 ± 6.5 um2, p = 0.000), with SPN being significantly larger than OPN at each stage (p < 0.05 respectively). More male than female zygotes reached central PN juxtaposition at stage 1 (76.7% vs 51.0%, p = 0.010), stage 2 (97.7% vs 86.3%, p = 0.048), and stage 3 (97.7% vs 86.3%, p = 0.048). More OPN showed aligned NPBs than in SPN at stage 1 only (44.7% vs 28.7%, p = 0.023). CONCLUSION(S): Embryos with different sexes display different morphokinetic and morphometric features at the zygotic stage. Embryo selection using such parameters may lead to unbalanced sex ratio in resulting offspring.

Trunk muscle size and function in volleyball players with and without injuries to the head, neck and upper limb.

OBJECTIVE: To investigate trunk muscle size and function in elite and community volleyball players with and without a history of head, neck or upper limb injury. DESIGN: Cross-sectional observational study. SETTING: Volleyball training camp or training sessions. PARTICIPANTS: 86 volleyball players (elite = 29; community = 57). MAIN OUTCOME MEASURES: Information regarding history of head, neck or upper limb injuries was collected by self-report questionnaires. Trunk muscle size (multifidus, transversus abdominis, internal oblique and quadratus lumborum) and voluntary contraction (multifidus, transversus abdominis, internal oblique) were assessed using ultrasound imaging. RESULTS: For trunk muscle size, no significant differences were found between elite and community volleyball players with and without a history of injury (all p > 0.05). A significant difference was found for voluntary contraction of the multifidus and transversus abdominis muscles for elite and community volleyball players with and without a history of injury (all p < 0.05). CONCLUSION: A difference in trunk muscle contraction but no change in trunk muscle size in players with a history of head, neck or upper limb injuries may represent an altered muscle recruitment pattern rather than a deficiency in trunk muscle strength. Prospective studies are required to determine if these adaptations are compensatory (and protective) or predispose players to further injuries.

School Social Worker Voice during COVID-19 School Disruptions: A National Qualitative Analysis.

The novel coronavirus (COVID-19) pandemic has created unprecedented impacts on our schools and society, requiring school social workers (SSWs) to attend to layered and cascading effects for students and their families. This study presents rich qualitative data from a national survey of SSWs about their personal and professional roles supporting students, families, and staff members as schools shifted to remote instruction. Findings indicate that SSWs are highly concerned about a lack of basic needs resources, including food, housing, and mental health support for students and families. SSWs highlighted the unequal effects of school closures for families without technology and Internet access as well as the difficulties providing services during the pandemic. Recovery policies should target resources to schools with the highest needs while prioritizing food, housing, mental health, and access to tools for online learning. SSWs also need additional and refined professional support to overcome their isolated roles in schools and bolster their ability to deliver online services effectively.

Needs of Children and Families during Spring 2020 COVID-19 School Closures: Findings from a National Survey.

Despite extensive reports during the COVID-19 pandemic of the academic challenges facing students, and the effects of online learning on academic achievements, we have little information regarding the needs and difficulties of K-12 students and their families from a social work perspective. The present article shares findings from a nationwide survey of 1,275 school social workers (SSWs) reporting on their clients-schools, children, and families-during the spring 2020 COVID-19 school closures. SSWs indicated that the children and families they served had significant unmet basic needs, including for food, healthcare, and housing. Poverty and mental health compounded pandemic difficulties, which were associated with the sociodemographic makeup of schools. Student engagement in social work services during the closures was significantly lower than prepandemic levels, generally due to unmet material needs. Several policy and practice implications arise from these findings, including a need for additional services for students and families, a plan to address structural inequities in our schools and communities, coordinated outreach to reengage missing students, and recognition of the strong work being done by school staff coupled with a need for additional supports and resources to combat persistent inequality.

Live birth in a complete zona-free patient: a case report.

OBJECTIVE: To report a live birth from a patient with complete zona-free oocytes due to abnormal zona production and to reveal full time-lapse blastocyst development footage of its originating embryo. METHODS: A 34-year-old woman presented with a history of failed fertilization via standard in vitro fertilization insemination and a potential absence of zona pellucida. A total of 3 intracytoplasmic sperm injection cycles were undertaken with all oocytes collected being zona-free. Embryos created in the initial 2 cycles were cultured in the G1+/G2+ sequential media in a benchtop incubator. During the final successful cycle, the culture strategy was shifted to single step media (G-TL) in an Embryoscope+ incubator. RESULTS: The first 2 attempts led to a biochemical pregnancy or no blastocyst available for transfer. In the third cycle, 13 out of 24 collected oocytes were subjected to injection, with 4 being normally fertilized. Two blastocysts were subsequently formed, in which one was cryopreserved and the other transferred. A live baby girl (1570g) was subsequently delivered at 34 weeks of gestation by cesarean section. CONCLUSION: Live birth can be achieved for patients with zona production deficiency. Adjustment in ovarian stimulation and subsequent embryo culture strategies may have potentially contributed to the success of the 3rd cycle.

Preparation for certain and uncertain future outcomes in young children and three species of monkey.

This study examined 3-year old children and monkeys' capacities to prepare for immediate future events. In Study 1, children were presented with several tube apparatuses with two exits. When targets were certain to emerge from both, children tended to prepare to catch them by covering each exit. When it was uncertain where targets would emerge, however, they tended to prepare for only one possibility. These results substantiate the claim that simultaneous preparation for mutually exclusive possibilities develops relatively late. Study 2 found no evidence for such a capacity in monkeys (Ateles geoffroyi, Cebus apella, Papio hamadryas) given the same tasks.

Hyperosmolar reconstituted lyophilized plasma is an effective low-volume hemostatic resuscitation fluid for trauma.

BACKGROUND: We performed this study to optimize reconstituted lyophilized plasma (LP) into a minimal volume fluid that provides effective hemostatic resuscitation for trauma while minimizing logistical limitations. METHODS: We performed a prospective, blinded animal study. Plasma was lyophilized following whole blood collection from anesthetized swine. The minimal volume needed for reconstitution was determined, and this solution was evaluated for safe infusion into the swine. Reconstituted LP was analyzed for electrolyte content, osmolarity, and coagulation factor activity. Twenty swine were anesthetized and subjected to a validated model of polytrauma and hemorrhagic shock (including a Grade V liver injury), then randomized to resuscitation with LP reconstituted to either 100% of the original plasma volume (100%LP) or the minimal volume LP fluid. Physiologic data were monitored, and blood loss and hematocrit were measured. Coagulation status was evaluated using thrombelastography. RESULTS: The minimal volume of reconstituted LP safe for infusion in swine was 50% of the original plasma volume (50%LP). The 50%LP had higher electrolyte concentrations, osmolarity, and increased coagulation factor activity levels by volume compared with 100%LP (p < 0.05). Blood loss, hematocrit, mean arterial pressure, and heart rate did not differ between animals receiving 100%LP (n = 10) or 50%LP (n = 10) at any time point (p > 0.05). International normalized ratio and thrombelastography parameters were not different between groups (R time, α angle, or maximal amplitude, p > 0.05). CONCLUSION: Resuscitation with 50%LP fluid was well tolerated and equally effective compared with 100%LP, with respect to physiologic and hemostatic properties. The smaller volume of fluid necessary to reconstitute hypertonic LP makes it logistically superior to 100%LP for first responders and may reduce adverse effects of large-volume resuscitation.

The use of lyophilized plasma in a severe multi-injury pig model.

BACKGROUND: Shock and severe tissue injury lead to an endogenous coagulopathy mediated by activation of Protein C and hyperfibrinolysis known as acute traumatic coagulopathy. Together, hemodilution, acidosis, inflammation, and hypothermia result in a global trauma-induced coagulopathy. Coagulopathy in trauma is associated with mortality. Early and effective hemostatic resuscitation is critical in restoring perfusion, correcting coagulopathy, and saving lives in exsanguinating trauma. Lyophilized plasma (LP) provides a logistically superior alternative to fresh frozen plasma (FFP). STUDY DESIGN AND METHODS: Plasma was lyophilized following whole blood collection from anesthetized swine. A series of studies were performed using anesthetized swine subjected to a validated model of polytrauma and hemorrhagic shock including a Grade V liver injury. Animals were randomized to resuscitation using reconstituted LP fluids. Physiologic data and blood loss were measured. Coagulation status and inflammatory mediators were evaluated. RESULTS: Full volume reconstituted LP (100%LP) retains on average 86% coagulation factor activity compared to fresh plasma and when used in 1:1 ratios with red blood cells demonstrated superior hemostatic efficacy compared to FFP. Hypertonic LP reconstituted using 50% of the original plasma volume (50%LP) had higher coagulation factor concentrations, was well tolerated in swine, and equally effective compared to 100%LP with respect to physiologic and hemostatic properties. Buffering with ascorbic acid resulted in significant reductions in serum levels of tumor necrosis factor alpha and interleukin-6. CONCLUSION: By minimizing the volume of reconstituted LP and optimizing its anti-inflammatory properties, an LP resuscitation fluid may be created to provide effective hemostatic resuscitation with superior logistical properties.

The public health role in the primary prevention of diabetes: recommendations from the chronic disease directors' project.

AIM: The article reports on the recommendations from the Diabetes Primary Prevention Project that was initiated and funded by the Division of Diabetes Translation, Centers for Disease Control and Prevention, and developed by the National Association of Chronic Disease Directors. METHOD: Essential components of statewide programs are delineated for effective interventions for diabetes primary prevention. The recommendations were derived from a structured process that is detailed on the basis of a cross-comparison of state-level diabetes prevention initiatives in six states where such programs were most developed. RESULTS: The recommendations focus on state-level partnerships, statewide program planning, required resources, policies, benchmarks for progress, and data collection. CONCLUSION: Illustrations are provided regarding how the project influenced the six participating states in further developing their programs for the primary prevention of diabetes.

Preoperative fasting: we need a new consensus.

Fasting before surgery is necessary to avoid the risk of regurgitation and vomiting; it is also a legal requirement. But the current practice of fasting overnight or up to eight hours before surgery can cause dehydration, electrolyte imbalance, malnutrition and general malaise. Evidence shows that patients can benefit from receiving clear liquids up to three hours before surgery. Health care professionals need to be brought up to date with the latest evidence-based practice; national introduction of clear guidelines would help in this respect.