Rural medical workforce pathways: exploring the importance of postgraduation rural training time.

BACKGROUND: Inadequate distribution of the medical workforce in rural regions remains a key global challenge. Evidence of the importance of postgraduation (after medical school) rural immersion time and subsequent rural practice, particularly after accounting for other key factors, remains limited. This study investigated the combined impact of three key training pathway factors: (1) rural background, (2) medical school rural immersion, and (3) postgraduation rural immersion, and duration time of each immersion factor on working rurally. METHODS: Data from a cross-sectional national survey and a single university survey of Australian doctors who graduated between 2000 to 2018, were utilised. Key pathway factors were similarly measured. Postgraduation rural training time was both broad (first 10 years after medical school, national study) and specific (prevocational period, single university). This was firstly tested as the dependent variable (stage 1), then matched against rural practice (stage 2) amongst consultant doctors (national study, n = 1651) or vocational training doctors with consultants (single university, n = 478). RESULTS: Stage 1 modelling found rural background, > 1 year medical school rural training, being rural bonded, male and later choosing general practice were associated with spending a higher proportion (> 40%) of their postgraduation training time in a rural location. Stage 2 modelling revealed the dominant impact of postgraduation rural time on subsequent rural work for both General Practitioners (GPs) (OR 45, 95% CI 24 to 84) and other specialists (OR 11, 95% CI 5-22) based on the national dataset. Similar trends for both GPs (OR 3.8, 95% CI 1.6-9.1) and other specialists (OR 2.8, 95% CI 1.3-6.4) were observed based on prevocational time only (single university). CONCLUSIONS: This study provides new evidence of the importance of postgraduation rural training time on subsequent rural practice, after accounting for key factors across the entire training pathway. It highlights that developing rural doctors aligns with two distinct career periods; stage 1-up to completing medical school; stage 2-after medical school. This evidence supports the need for strengthened rural training pathways after medical school, given its strong association with longer-term decisions to work rurally.

Experiences of Rural and Metropolitan Background Applicants in Preparing for and Completing a Regionally Focused Multiple Mini-interview for Admission into a Regional Medical Program.

BACKGROUND: To better target rural background and rurally interested applicants during medical school admission, it is increasingly common for rural medical programs to include multiple mini-interview (MMI) scenarios designed to screen for rural interest. It remains unclear whether the inclusion of regionally/rurally focused MMI scenarios positively impacts the selection of rural background applicants and evidence is limited regarding why rural background applicants may perform worse on the MMI. Therefore, this study explored how rural and metropolitan applicants prepare for and perceive the MMI for admission to a regional medical pathway. METHODS: A mixed-methods survey was sent to provisional entry regional pathway medical school applicants who had completed an MMI. The survey was distributed before any offers of admission had been released. RESULTS: Rural applicants spent less time and money preparing for the MMI and felt less prepared (P < 0.05). However, time and money spent, and resources used to prepare were not associated with feeling more prepared (all P > 0.05). Respondents mostly felt that the MMI process aligned with their expectations (83%), is fair (64%), and helps a rural program select the most suitable applicants (61%). Rural applicants generally felt that they had an advantage over other applicants (61%) while most metropolitan applicants did not (23%; P = 0.002). DISCUSSION: Applicants to a regional medical pathway are generally supportive of the MMI process. It appears valuable for applicants to prepare for the MMI by understanding the format and requirements; however, investing substantial time and money does not underpin feeling better prepared. MMI scenarios which include a regional focus are perceived to advantage rural applicants.

Medical student interest and participation in research at one rural clinical school: Insights from the last six years.

INTRODUCTION: Limited evidence is currently available relating to research acitivity of medical students training in regional or rural areas. OBJECTIVE: To describe medical student interest and participation in research at The University of Queensland Rural Clinical School (UQRCS). DESIGN: Annual student expression of interest surveys were collated with records of student research participation maintained at UQRCS from 2017-2022. Additionally, a systematic search was conducted to identify student outputs not captured in internal records. Frequencies and proportions were calculated for all descriptive data along with proportions of students who engaged with a project, and projects that led to a peer-reviewed publication. FINDINGS: At UQRCS commencement, 55% of research-interested students reported having basic research skills. Thirty-nine percent of research-interested students engaged with a project, most commonly literature reviews (47%) or audits (29%). Thirty-three percent of completed projects led to a peer-reviewed manuscript. DISCUSSION: Students who engage with a project are unlikely to receive a project in their preferred clinical area and should be informed about the transferrability of research skills. Most students have basic research skills when commencing a project and therefore require ongoing support and mentorship from staff/supervisors. CONCLUSION: Publication rates of medical students in regional/rural areas are comparable to those reported by metropolitan medical schools (~30%).

Nature and extent of disruptions to staff clinical supervision practices in health care settings due to COVID-19: A survey study.

OBJECTIVE: To investigate the impact of the COVID-19 pandemic on clinical supervision practices of health care workers in health care settings in one Australian state. METHOD: A bespoke survey was developed and administered online using Qualtrics™. The survey consisted of Likert scale and closed questions, with options for free text comments. Numerical data were analysed descriptively and using Chi-Square tests. Textual data were analysed through content analysis. RESULTS: Of the 178 survey respondents, 42% were from allied health disciplines, 39% from nursing and midwifery, and 19% from medicine. The type and mode (i.e., face-to-face, telesupervision) of clinical supervision prior to the pandemic and at the time of survey completion (i.e., July-August 2021) were similar. Eighteen percent of respondents had a change in supervision arrangements but only 5% had a change in supervisor. For the 37% who changed roles due to COVID-19, 81% felt their current supervisor was still able to support them, 69% were still having their supervisory needs met. Analyses of textual data resulted in the development of two categories: Supervision deteriorating, and some clinical supervision functions (i.e., formative and restorative) being more impacted than others (i.e., normative). CONCLUSION: There were substantial disruptions to several parameters of clinical supervision due to COVID-19, that may pose a threat to high quality supervision. Health care workers reported pandemic-induced stress and mental health challenges that were not always addressed by effective restorative supervision practices.

Short-term medical student placements completed consecutively at a rural general practice positively impact chronic disease management.

INTRODUCTION: Little is known about how medical school placements in rural areas impact key stakeholders such as patients, host organisations and the wider rural community. With engagement from rural communities crucial to the success of rural medical training, this case study sought to demonstrate the benefit that rural clinical placements can have on rural general practices (systems) and likely impacts on communities (health outcomes). Specifically, we describe how a series of consecutive short-term student placements in a single rural practice were the drivers of a series of clinical audits and interventions resulting in improved management of chronic disease. METHODS: Data for this project were obtained from student research reports completed as part of a rural and remote medicine rotation at an Australian medical school. For this series of projects, eight consecutive students were based at the same rural medical centre, with each attending for 6 weeks across a 15-month period, completing a report for a quality improvement activity and evaluating the outcomes. Each project related to chronic kidney disease (CKD), with CKD chosen based on the needs of the medical centre and the higher burden of this disease in rural areas. Each project was developed and delivered in consultation with the practice, taking into account student interest and skills, and related projects completed prior or concurrently. Projects were related to database management (n=2), alignment between CKD management and best-practice guidelines (n=3), patient health literacy (n=3), and a summary and staff perceptions of the preceding quality improvement activities (n=1). RESULTS: The combination of student projects led to tangible improvements in CKD management at a rural general practice. All doctors at the medical centre (n=4) reported using the database management tools implemented by the students and felt the interventions were sustainable, long-term solutions for ensuring clinical investigations are not being delayed or missed. Following the various interventions completed by the students, clinician knowledge and implementation of best-practice CKD management increased, and some patients became more aware of their condition and how to manage it. CONCLUSION: This case study provides evidence that short-term rural clinical placements for medical students have the potential to greatly improve health care and clinical practice in rural and remote communities, when designed around a consistent topic within a medical practice. Outcomes of the student projects in combination demonstrate that addressing CKD management longitudinally led to improvements in administrative processes, clinical practices, and patient awareness and accountability, despite each student only being at the medical centre for a short period of time. Similar approaches to structuring rural clinical placements and defining community projects for medical students should be considered more broadly.

Impact of the COVID-19 pandemic on student experiences during rural placements in Australia: findings from a national multi-centre survey.

BACKGROUND: The aim of this national study was to explore the learning experiences of Australia's medical students who trained rurally during the COVID-19 pandemic in 2020. METHODS: A cross-sectional, national multi-centre survey was conducted in 2020, through the Federation of Rural Australian Medical Educators (FRAME). Participants were medical students who had completed an extended Rural Clinical School (RCS) training placement (≥ 12 months). A bespoke set of COVID-19 impact questions were incorporated into the annual FRAME survey, to capture COVID-19-related student experiences in 2020. Pre-pandemic (2019 FRAME survey data) comparisons were also explored. RESULTS: FRAME survey data were obtained from 464 students in 2020 (51.7% response rate), compared with available data from 668 students in 2019 (75.6% response rate). Most students expressed concern regarding the pandemic's impact on the quality of their learning (80%) or missed clinical learning (58%); however, students reported being well-supported by the various learning and support strategies implemented by the RCSs across Australia. Notably, comparisons to pre-pandemic (2019) participants of the general RCS experience found higher levels of student support (strongly agree 58.9% vs 42.4%, p < 0.001) and wellbeing (strongly agree 49.6% vs 42.4%, p = 0.008) amongst the 2020 participants. Students with more than one year of RCS experience compared to one RCS year felt better supported with clinical skills learning opportunities (p = 0.015) and less affected by COVID-19 in their exam performance (p = 0.009). CONCLUSIONS: This study has provided evidence of both the level of concern relating to learning quality as well as the positive impact of the various learning and support strategies implemented by the RCSs during the pandemic in 2020. RCSs should further evaluate the strategies implemented to identify those that are worth sustaining into the post-pandemic period.

The Effect of Game-Related Contextual Factors on Sleep in Basketball Players.

ABSTRACT: Fox, JL, Scanlan, AT, Stanton, R, and Sargent, C. The effect of game-related contextual factors on sleep in basketball players. J Strength Cond Res 36(10): 2942-2945, 2022-The purpose of this study was to determine whether contextual factors including game location, game outcome, and score-line margin influence subsequent nightly sleep duration and quality in basketball players. Seven semiprofessional, male basketball players were monitored across one competitive season using self-reported sleep diaries and activity monitors. Linear mixed models and effect sizes (ESs) were used to compare sleep duration and quality following games based on game location (played at home or away venues), game outcome (win or loss), and score-line margin (balanced [≤ 8-point margin] or unbalanced [≥ 9-point margin]). Sleep onset was later following away games (ES = 0.79 ± 0.86 [ moderate ], p = 0.12), losses (ES = 0.63 ± 0.79 [ moderate ], p = 0.18), and unbalanced games (ES = 1.36 ± 0.90 [ large ], p = 0.01). Wake time was later following losses (ES = 1.14 ± 0.85 [ moderate ], p = 0.02). Sleep fragmentation was higher following wins (ES = 0.65 ± 0.74 [ moderate ], p = 0.17). Sleep efficiency was higher following losses (ES = 0.70 ± 0.80 [ moderate ], p = 0.14). All other differences in sleep variables yielded trivial - small ESs ( p > 0.05). Because of the later sleep onset times of players, basketball practitioners should consider avoiding early morning travel or training sessions following away games, losses, and unbalanced games, to maintain similar nightly sleep durations in light of the contextual factors encountered. Basketball practitioners may also need to ensure player sleep is optimized following wins compared with losses given the lower quality observed.

Impact of the COVID-19 pandemic on medical student placements in rural Queensland: A survey study.

OBJECTIVE: The COVID-19 pandemic has adversely impacted medical students' learning experiences. Students in one Australian Rural Clinical School were surveyed to investigate the impact of disruptions to clinical placements and satisfaction with educational changes implemented as a result of the pandemic. DESIGN: Cross-sectional survey. SETTING: The University of Queensland Rural Clinical School. METHODS: Students undertaking one or two years of study at the participating Rural Clinical School in November 2020. MAIN OUTCOME MEASURE: A 20-item anonymised survey with questions on personal health and safety, quality of clinical training experience, response to changes in learning and student environment, and progression to completion of the medical degree. RESULTS: The survey was completed by 124 students (76% response rate). Students were satisfied with the changes made to their learning to accommodate the disruptions to health service delivery and placements. Final year students were more satisfied with their learning experiences compared to their third-year counterparts. CONCLUSIONS: The Rural Clinical School implemented a range of academic and psychological support strategies which appear to have helped with mitigating mental health concerns experienced by students completing rural placements, who are already prone to experiencing social isolation. Strengthening communication between the academic and health service sectors can improve the quality of learning for medical students on placements.

Are acute player workloads associated with in-game performance in basketball?

To investigate associations between acute workload and in-game performance in basketball. Eight semi-professional, male basketball players were monitored during all training sessions (N = 28) and games (N = 18) across the season. External workload was determined using absolute (arbitrary units[AU]) and relative (AU·min-1) PlayerLoadTM (PL), and absolute (count) and relative (count·min-1) low-intensity, medium-intensity, high-intensity, and total Inertial Movement Analysis (IMA) events (accelerations, decelerations, changes-of-direction, and jumps). Internal workload was determined using absolute and relative Summated-Heart-Rate-Zones workload, session-rating of perceived exertion, rating of perceived exertion, and time (min) spent working > 90% of maximal heart rate. In-game performance was indicated by the player efficiency statistic. Repeated measures correlations were used to determine associations between acute workload variables (across the previous 7 days) and player efficiency. Relative PL (r = 0.13, small) and high-intensity IMA events (r = 0.13, small) possessed the strongest associations with player efficiency of the investigated workload variables (P > 0.05). All other associations were trivial in magnitude (P > 0.05). Given the trivial-small associations between all external and internal workload variables and player efficiency, basketball practitioners should not rely solely on monitoring acute workloads to determine performance potential in players.

The Application of Accelerometer-Derived Moving Averages to Quantify Peak Demands in Basketball: A Comparison of Sample Duration, Playing Role, and Session Type.

ABSTRACT: Fox, JL, Conte, D, Stanton, R, McLean, B, and Scanlan, AT. The application of accelerometer-derived moving averages to quantify peak demands in basketball: A comparison of sample duration, playing role, and session type. J Strength Cond Res 35(12S): S58-S63, 2021-The purpose of this was to study compare peak external workload intensities in basketball using accelerometer-derived moving averages between different sample durations (0.5-5 minutes), session types (training vs. game-play), and playing roles (starting vs. bench players). Five starting and 3 bench players were monitored over a 15-week competitive season using accelerometers. For all training sessions and games, peak external workload intensities were determined using accelerometer-derived moving averages for PlayerLoad per minute (PL·min-1) across sample durations of 0.5, 1, 2, 3, 4, and 5 minutes. Linear mixed-models and effect sizes (ESs) were used to compare peak PL·min-1 between sample durations, session type, and playing role. Peak PL·min-1 was significantly different between all sample durations (p < 0.05; ES = 0.88-5.45), with higher intensities evident across shorter sample durations. In starting players, peak intensities were significantly higher during games compared with training for all sample durations (p < 0.05; ES = 0.69-0.93). Peak game intensities were higher in starting players using all sample durations (p > 0.05; ES = 0.69-1.43) compared with bench players. Shorter sample durations produced higher peak PL·min-1. Peak intensities were higher during games than training in starting players, indicating training may not adequately prepare players for the most demanding passages of game-play.

Individualized and Fixed Thresholds to Demarcate PlayerLoad Intensity Zones Produce Different Outcomes.

ABSTRACT: Scanlan, AT, Fox, JL, Milanovic, Z, Stojanovic, E, Stanton, R, and Dalbo, VJ. Individualized and fixed thresholds to demarcate PlayerLoad intensity zones produce different outcomes. J Strength Cond Res 35(7): 2046-2052, 2021-Individualized approaches to derive intensity zones are yet to be examined using microsensor metrics in basketball. The purpose of this study was to quantify and compare the time spent in different PlayerLoad intensity zones using individualized and fixed approaches during basketball training. Thirteen semiprofessional, male basketball players were monitored across the preparatory training phase. Microsensors recorded the time spent in 6 PlayerLoad intensity zones using individualized and fixed approaches. Individualized zones were calculated relative to the peak instantaneous PlayerLoad response observed in each player across training. Fixed zones were determined following predefined cut-points set in proprietary software. The majority of training time was spent in zones 1-2 (98-99%), with a low proportion of time detected in zones 3-6 (1-2%) across approaches. The fixed approach produced greater training time in zones 2 (11.9 ± 1.2 vs. 9.3 ± 2.4 minutes; very likely large) and 3 (1.7 ± 0.8 vs. 0.8 ± 0.9 minutes; very likely moderate), was an unclear small increase in time spent in zone 1 were apparent using individualized thresholds (76.5 ± 11.2 vs. 72.9 ± 9.6 minutes). Almost certain similar time was spent in zones 4-6 across approaches. Individual analyses showed deviations across players; however, fixed PlayerLoad thresholds produced higher training time in zones 2 (moderate to very large), 3 (moderate to very large), 4 (moderate to large), and 5 (moderate) than the individualized approach in most players. Variations in outcomes between individualized and fixed approaches must be considered when quantifying the time spent working in PlayerLoad intensity zones.

Game schedule congestion affects weekly workloads but not individual game demands in semi-professional basketball.

To quantify and compare workloads encountered by basketball players during individual games played across 1-, 2-, and 3-day periods in the same week, and during weeks where 1, 2, and 3 games are scheduled. Eight semi-professional male players were monitored. External workload was determined as absolute and relative (·min-1) PlayerLoad (PL), and total and high-intensity jumps, accelerations, decelerations, and changes of direction (COD). Internal workload was determined as absolute and relative summated heart rate zones (SHRZ), session-rating of perceived exertion (sRPE), and RPE. Game workloads were tabulated considering the order in which they were scheduled weekly (game 1, 2, or 3), and each week considering the number of games scheduled (1, 2, or 3 games). Analysing weekly workloads, duration was higher during 3-game than 1- and 2-game weeks (P <0.05, ES = 6.65-18.19). High-intensity decelerations and COD were higher during 3-game than 1-game weeks (P <0.05, ES = 1.26-1.55). Absolute PL, jumps, accelerations, decelerations, COD, and high-intensity jumps and accelerations were higher during 3-game than 1- and 2-game weeks (P <0.05, ES = 0.69-2.63). Absolute SHRZ and sRPE were higher during 3-game than 1- and 2-game weeks (P <0.05, ES = 0.86-2.43). Players completed similar individual game workloads regardless of the number of games played on consecutive days in the week. Workloads were similar during 1- and 2-game weeks, while the addition of a third game significantly increased the overall weekly workloads encountered.

Decrements in knee extensor and flexor strength are associated with performance fatigue during simulated basketball game-play in adolescent, male players.

This study quantified lower-limb strength decrements and assessed the relationships between strength decrements and performance fatigue during simulated basketball. Ten adolescent, male basketball players completed a circuit-based, basketball simulation. Sprint and jump performance were assessed during each circuit, with knee flexion and extension peak concentric torques measured at baseline, half-time, and full-time. Decrement scores were calculated for all measures. Mean knee flexor strength decrement was significantly (P < 0.05) related to sprint fatigue in the first half (R = 0.65), with dominant knee flexor strength (R = 0.67) and dominant flexor:extensor strength ratio (R = 0.77) decrement significantly (P < 0.05) associated with sprint decrement across the entire game. Mean knee extensor strength (R = 0.71), dominant knee flexor strength (R = 0.80), non-dominant knee flexor strength (R = 0.75), mean knee flexor strength (R = 0.81), non-dominant flexor:extensor strength ratio (R = 0.71), and mean flexor:extensor strength ratio (R = 0.70) decrement measures significantly (P < 0.05) influenced jump fatigue during the entire game. Lower-limb strength decrements may exert an important influence on performance fatigue during basketball activity in adolescent, male players. Consequently, training plans should aim to mitigate lower-limb fatigue to optimise sprint and jump performance during game-play.

Influence of Different Methods to Determine Maximum Heart Rate on Training Load Outcomes in Basketball Players.

Berkelmans, DM, Dalbo, VJ, Fox, JL, Stanton, R, Kean, CO, Giamarelos, KE, Teramoto, M, and Scanlan, AT. Influence of different methods to determine maximum heart rate on training load outcomes in basketball players. J Strength Cond Res 32(11): 3177-3185, 2018-The summated-heart-rate-zones (SHRZ) approach uses heart rate (HR) responses relative to maximum HR (HRmax) to calculate the internal training load (TL). Age-predicted, test-derived, and session-based approaches have all been used to determine HRmax in team sports. The purpose of this study was to determine the effects of using age-predicted, test-derived, and session-based HRmax responses on SHRZ TL in basketball players. Semiprofessional, male basketball players (N = 6) were analyzed during the preparatory training phase. Six age-based approaches were used to predict HRmax including Fox (220 - age); Hossack (206 - [0.567 × age]); Tanaka (208 - [0.7 × age]); Nikolaidis (223 - [1.44 × age]); Nes (211 - [0.64 × age]); and Faff (209.9 - [0.73 × age]). Test-derived HRmax was taken as the highest HR during the Yo-Yo intermittent recovery test (Yo-Yo IRT), whereas session-based HRmax was taken as the higher HR seen during the Yo-Yo IRT or training sessions. Comparisons in SHRZ TL were made at group and individual levels. No significant group differences were evident between SHRZ approaches. Effect size analyses revealed moderate (d = 0.60-0.79) differences between age-predicted, test-derived, and session-based methods across the group and individually in 2 players. The moderate differences between approaches suggest age-predicted, test-derived, and session-based methods to determine HRmax are not interchangeable when calculating SHRZ. Basketball practitioners are encouraged to use individualized HRmax directly measured during field-based tests supplemented with higher HR responses evident during training sessions and games when calculating the SHRZ TL to ensure greatest accuracy.

A Review of Player Monitoring Approaches in Basketball: Current Trends and Future Directions.

Fox, JL, Scanlan, AT, and Stanton, R. A review of player monitoring approaches in basketball: current trends and future directions. J Strength Cond Res 31(7): 2021-2029, 2017-Effective monitoring of players in team sports such as basketball requires an understanding of the external demands and internal responses, as they relate to training phases and competition. Monitoring of external demands and internal responses allows coaching staff to determine the dose-response associated with the imposed training load (TL), and subsequently, if players are adequately prepared for competition. This review discusses measures reported in the literature for monitoring the external demands and internal responses of basketball players during training and competition. The external demands of training and competition were primarily monitored using time-motion analysis, with limited use of microtechnology being reported. Internal responses during training were typically measured using hematological markers, heart rate, various TL models, and perceptual responses such as rating of perceived exertion (RPE). Heart rate was the most commonly reported indicator of internal responses during competition with limited reporting of hematological markers or RPE. These findings show a large discrepancy between the reporting of external and internal measures and training and competition demands. Microsensors, however, may be a practical and convenient method of player monitoring in basketball to overcome the limitations associated with current approaches while allowing for external demands and internal responses to be recorded simultaneously. The triaxial accelerometers of microsensors seem well suited for basketball and warrant validation to definitively determine their place in the monitoring of basketball players. Coaching staff should make use of this technology by tracking individual player responses across the annual plan and using real-time monitoring to minimize factors such as fatigue and injury risk.

A preference-based value framework to assess healthcare provision in an oil and gas industry.

ObjectivesThe aim of this study was to develop the Remote Health Value Framework to evaluate the models of healthcare provision for workers in the oil and gas sector, predominantly situated in rural and remote areas.MethodsThe framework was co-designed with the leadership team in one global oil and gas company using a multi-criteria decision analysis approach with a conjoint analysis component. This was used to elicit and understand preferences and trade-offs among different value domains that were important to the stakeholders with respect to the provision of healthcare for its workers. Preference elicitation and interviews were conducted with a mix of health, safety, and environment (HSE) team and non-HSE managers and leaders.ResultsOut of five presented value domains, participants considered the attribute 'Improving health outcomes of employees' the most important aspect for the model of healthcare which accounted for 37.3% of the total utility score. Alternatively, the 'Program cost' attribute was least important to the participants, accounting for only 11.0% of the total utility score. The marginal willingness-to-pay analysis found that participants would be willing to pay A$9090 per utile for an improvement in a particular value attribute.ConclusionsThis is the first value framework for healthcare delivery in the oil and gas industry, contextualised by its delivery within rural and remote locations. It provides a systematic and transparent method for creating value-based healthcare models. This approach facilitates the evaluation of healthcare investments, ensuring they align with value domains prioritised by the HSE and leadership teams.

RPA and Rad27 limit templated and inverted insertions at DNA breaks.

Formation of templated insertions at DNA double-strand breaks (DSBs) is very common in cancer cells. The mechanisms and enzymes regulating these events are largely unknown. Here, we investigated templated insertions in yeast at DSBs using amplicon sequencing across a repaired locus. We document very short (most ∼5-34 bp), templated inverted duplications at DSBs. They are generated through a foldback mechanism that utilizes microhomologies adjacent to the DSB. Enzymatic requirements suggest a hybrid mechanism wherein one end requires Polδ-mediated synthesis while the other end is captured by nonhomologous end joining (NHEJ). This process is exacerbated in mutants with low levels or mutated RPA ( rtt105 Δ; rfa1 -t33) or extensive resection mutant ( sgs1 Δ exo1 Δ). Templated insertions from various distant genomic locations also increase in these mutants as well as in rad27 Δ and originate from fragile regions of the genome. Among complex insertions, common events are insertions of two sequences, originating from the same locus and with inverted orientation. We propose that these inversions are also formed by microhomology-mediated template switching. Taken together, we propose that a shortage of RPA typical in cancer cells is one possible factor stimulating the formation of templated insertions.

Waking Up to the Issue! Research Inattention and Sex-Related Differences Warrant More Sleep Studies in Female Athletes.

Understanding sleep patterns and behaviors of athletes is essential for developing targeted sleep-based interventions for implementation in practice. However, more than double the number of sleep studies have examined male athletes compared with female athletes, making the current understanding of sleep patterns, behaviors, and interventions among athletes disproportionately indicative of men. Consequently, this review demonstrates the need for more female-specific sleep data among athlete populations due to research inattention and sex-related differences. Specifically, this review identifies variations in sleep patterns and behaviors between male and female athletes, as well as physiological and lifestyle factors that potentially affect sleep patterns and behaviors across the lifespan, specifically in female athletes. In this regard, evidence suggests some female athletes experience longer sleep durations and better objective sleep quality, but similar or worse subjective sleep quality compared with male athletes. Additionally, scheduling training in the morning or throughout the day may benefit sleep in some female athletes. Considering sleep disorders, women may be at greater risk for insomnia and restless legs syndrome compared with men, which may be attributed to pregnancy, as well as a higher prevalence of anxiety and depressive symptoms, iron deficiency without anemia, and use of psychotropic medication among women. Finally, the menstrual cycle, menstrual disorders, oral contraceptive use, and the postpartum period have been shown to exert detrimental effects on sleep patterns and behaviors and should theoretically be considered when monitoring and managing sleep in female athletes.

Can digital innovation transform rural primary health care? A systematic review protocol.

INTRODUCTION: Digital technology is increasingly being adopted within primary healthcare services to improve service delivery and health outcomes; however, the scope for digital innovation within primary care services in rural areas is currently unknown. This systematic review aims to synthesise existing research on the use and integration of digital health technology within primary care services for rural populations across the world. METHODS AND ANALYSIS: A systematic approach to the search strategy will be conducted. Relevant medical and healthcare-focused electronic databases will be searched using key search terms between January 2013 and December 2023. Searches will be conducted using specific inclusion and exclusion criteria. A systematic study selection and data extraction process will be implemented, using standardised templates. Outcomes will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses- Protocol statement guidelines. Quality assessment and risk of bias appraisal will be conducted using the Mixed Methods Appraisal Tool. ETHICS AND DISSEMINATION: Ethical approval will not be required because there is no individual patient data collected or reviewed. The finding of this review will be disseminated through peer-reviewed publications and conference presentations. Outcomes will help to understand existing knowledge and identify gaps in delivering digital healthcare services, while also providing potential future practice and policy recommendations. PROSPERO REGISTRATION NUMBER: CRD42023477233.

Yeast EndoG prevents genome instability by degrading cytoplasmic DNA.

In metazoans release of mitochondrial DNA or retrotransposon cDNA to cytoplasm can cause sterile inflammation and disease 1. Cytoplasmic nucleases degrade these DNA species to limit inflammation 2,3. It remains unknown whether degradation these DNA also prevents nuclear genome instability. To address this question, we decided to identify the nuclease regulating transfer of these cytoplasmic DNA species to the nucleus. We used an amplicon sequencing-based method in yeast enabling analysis of millions of DSB repair products. Nuclear mtDNA (NUMTs) and retrotransposon cDNA insertions increase dramatically in nondividing stationary phase cells. Yeast EndoG (Nuc1) nuclease limits insertions of cDNA and transfer of very long mtDNA (>10 kb) that forms unstable circles or rarely insert in the genome, but it promotes formation of short NUMTs (~45-200 bp). Nuc1 also regulates transfer of cytoplasmic DNA to nucleus in aging or during meiosis. We propose that Nuc1 preserves genome stability by degrading retrotransposon cDNA and long mtDNA, while short NUMTs can originate from incompletely degraded mtDNA. This work suggests that nucleases eliminating cytoplasmic DNA play a role in preserving genome stability.