Sports Medicine Physicians Comfort and Competence in Caring for Transgender and Gender Nonconforming Patients and Athletes.

OBJECTIVE: The purpose of this study was to explore primary care sports medicine physicians' comfort, competence, education, and scope of training in caring for transgender and gender nonconforming (TGNC) patients/athletes. DESIGN: Mixed-methods, cross-sectional survey. SETTING: Online. PATIENTS OR PARTICIPANTS: In total, 4300 e-mails were successfully sent with 252 eligible responses received from the American Medical Society for Sports Medicine members. INDEPENDENT VARIABLES: Previous relationships with TGNC persons; previous relationships with TGNC patients/athletes; frequency of care for TGNC patients/athletes. MAIN OUTCOME MEASURES: The participants completed a 38-item tool used to assess perceived comfort and competence treating TGNC patients/athletes. Physicians defined "transgender" and described their thoughts on unfair competitive advantage of transgender athletes. RESULTS: Most participants had worked with a TGNC patient (70.2%, n = 177), but far fewer worked with a TGNC athlete (n = 26.6%, n = 67). Among the participants who provided a definition of transgender (n = 183), only 28.4% (n = 52) of participants were able to correctly define the term, whereas most were able to partially (57.9%, n = 106) characterize the term. The most common mechanisms identified for learning about TGNC patients were reading peer-reviewed journal articles (44.8%, n = 113) and CME (41.3%, n = 104). Those with previous TGNC friend/family, patient, and athlete relationships had a significantly different level of comfort and competence treating TGNC patients/athletes. CONCLUSIONS: Previous care relationships with TGNC strongly influences comfort and perceived competence of primary care sports medicine physicians. Training, from unbiased peer-reviewed sources of data, is critical to improve care for TGNC patients/athletes.

Environment and genotype predict the genomic nature of domestication of salmonids as revealed by gene expression.

Billions of salmonids are produced annually by artificial reproduction for harvest and conservation. Morphologically, behaviourally and physiologically these fish differ from wild-born fish, including in ways consistent with domestication. Unlike most studied domesticates, which diverged from wild ancestors millennia ago, salmonids offer a tractable model for early-stage domestication. Here, we review a fundamental mechanism for domestication-driven differences in early-stage domestication, differentially expressed genes (DEGs), in salmonids. We found 34 publications examining DEGs under domestication driven by environment and genotype, covering six species, over a range of life-history stages and tissues. Three trends emerged. First, domesticated genotypes have increased expression of growth hormone and related metabolic genes, with differences magnified under artificial environments with increased food. Regulatory consequences of these DEGs potentially drive overall DEG patterns. Second, immune genes are often DEGs under domestication and not simply owing to release from growth-immune trade-offs under increased food. Third, domesticated genotypes exhibit reduced gene expression plasticity, with plasticity further reduced in low-complexity environments typical of production systems. Recommendations for experimental design improvements, coupled with tissue-specific expression and emerging analytical approaches for DEGs present tractable avenues to understand the evolution of domestication in salmonids and other species.

Neutral and adaptive drivers of genomic change in introduced brook trout (Salvelinus fontinalis) populations revealed by pooled sequencing.

Understanding the drivers of successful species invasions is important for conserving native biodiversity and for mitigating the economic impacts of introduced species. However, whole-genome resolution investigations of the underlying contributions of neutral and adaptive genetic variation in successful introductions are rare. Increased propagule pressure should result in greater neutral genetic variation, while environmental differences should elicit selective pressures on introduced populations, leading to adaptive differentiation. We investigated neutral and adaptive variation among nine introduced brook trout (Salvelinus fontinalis) populations using whole-genome pooled sequencing. The populations inhabit isolated alpine lakes in western Canada and descend from a common source, with an average of ~19 (range of 7-41) generations since introduction. We found some evidence of bottlenecks without recovery, no strong evidence of purifying selection, and little support that varying propagule pressure or differences in local environments shaped observed neutral genetic variation differences. Putative adaptive loci analysis revealed nonconvergent patterns of adaptive differentiation among lakes with minimal putatively adaptive loci (0.001%-0.15%) that did not correspond with tested environmental variables. Our results suggest that (i) introduction success is not always strongly influenced by genetic load; (ii) observed differentiation among introduced populations can be idiosyncratic, population-specific, or stochastic; and (iii) conservatively, in some introduced species, colonization barriers may be overcome by support through one aspect of propagule pressure or benign environmental conditions.

Evolution of thermal physiology alters the projected range of threespine stickleback under climate change.

Species distribution models (SDMs) are widely used to predict range shifts but could be unreliable under climate change scenarios because they do not account for evolution. The thermal physiology of a species is a key determinant of its range and thus incorporating thermal trait evolution into SDMs might be expected to alter projected ranges. We identified a genetic basis for physiological and behavioural traits that evolve in response to temperature change in natural populations of threespine stickleback (Gasterosteus aculeatus). Using these data, we created geographical range projections using a mechanistic niche area approach under two climate change scenarios. Under both scenarios, trait data were either static ("no evolution" models), allowed to evolve at observed evolutionary rates ("evolution" models) or allowed to evolve at a rate of evolution scaled by the trait variance that is explained by quantitative trait loci (QTL; "scaled evolution" models). We show that incorporating these traits and their evolution substantially altered the projected ranges for a widespread panmictic marine population, with over 7-fold increases in area under climate change projections when traits are allowed to evolve. Evolution-informed SDMs should improve the precision of forecasting range dynamics under climate change, and aid in their application to management and the protection of biodiversity.

Gait Adaptations to Physical Fatigue During the Negotiation of Variable and Unexpected Obstacles.

OBJECTIVE: The purpose of this study was to investigate how physical fatigue impacts one's ability to negotiate unexpected and randomly located obstacles during locomotion. BACKGROUND: Physically demanding occupations place workers at risk of trips and falls-a major health and financial burden. How worker physical fatigue and fitness impacts their ability to navigate through unpredictable environments is not thoroughly explored in current literature. In this exploratory study, we further examine these relationships. METHODS: Twenty-one young, physically fit participants completed a series of obstacle negotiation trials in the dark, where an obstacle would suddenly be illuminated as they reached it. Participants then engaged in a fatigue protocol, before repeating a series of the same negotiation trials. RESULTS: When fatigued, participants exhibited a significant decrease in leading toe and trailing toe clearance, as well as a significant increase in leading heel clearance. Moreover, participants stepped closer to the obstacle with their both feet on the step prior to negotiation. Participants also walked at a faster velocity. Regression analyses revealed that participants' VO2max and height were significant predictors of foot placement metrics. CONCLUSION: Results indicate that physical fatigue negatively impacts crossing mechanics of young, healthy individuals, and that a higher level of VO2 capacity may reduce the occurrences of altered crossing behavior that coincide with physical fatigue. APPLICATION: These results highlight the effect of fatigue on worker safety during performance of job-related duties and are of interest to professionals seeking to reduce the incidence of slips, trips, and falls in the workplace.

Altered Spatiotemporal Gaze Dynamics During Unexpected Obstacle Negotiation in a Fatigued State.

Humans use their peripheral vision during locomotion to perceive an approaching obstacle in their path, while also focusing central gaze on steps ahead of them. However, certain physiological and psychological factors may change this strategy, such as when a walker is physically fatigued. In this study, 21 healthy participants walked through a dark room while wearing eye tracking glasses before and following intense exercise. Obstacles were placed in random locations along their path and became illuminated when participants approached them. Results indicate that, when fatigued, participants had altered spatial gaze strategies, including more frequent use of central gaze to perceive obstacles and an increased gaze angular displacement. However, there were no changes in temporal gaze strategies following exercise. These findings reveal how physical fatigue alters one's visual perception of their environment during locomotion, and may partially explain why people are at greater risk of trips and falls while fatigued.

Mitochondrial volume density and evidence for its role in adaptive divergence in response to thermal tolerance in threespine stickleback.

Phenotypic plasticity is predicted to permit persistence in new environments, and may subsequently evolve to enhance fitness. Colonizing environments with lower winter temperatures can lead to the evolution of lower critical thermal minima; the corresponding physiological traits associated with temperature tolerance are predicted to involve mitochondrial function. Threespine stickleback (Gasterosteus aculeatus) have colonized freshwater lakes along the Pacific Northwest. These freshwater populations are known to exhibit cold-induced increases in mitochondrial volume density in pectoral muscle, but whether such plasticity evolved before or after colonization is uncertain. Here, we measure critical thermal minima (CTmin) in one marine and one freshwater population of threespine stickleback, and mitochondrial volume density in pectoral and cardiac tissue of both populations acclimated to different temperature treatments (6.2, 14.5 and 20.6 â„ƒ). Mitochondrial volume density increased with cold acclimation in pectoral muscle; cardiac muscle was non-plastic but had elevated mitochondrial volume densities compared to pectoral muscle across all temperature treatments. There were no differences in the levels of plasticity between marine and freshwater stickleback, but neither were there differences in CTmin. Importantly, marine stickleback exhibited plasticity under low-salinity conditions, suggesting that marine stickleback had at least one necessary phenotype for persistence in freshwater environments before colonization occurred.

Heritability of DNA methylation in threespine stickleback (Gasterosteus aculeatus).

Epigenetic mechanisms underlying phenotypic change are hypothesized to contribute to population persistence and adaptation in the face of environmental change. To date, few studies have explored the heritability of intergenerationally stable methylation levels in natural populations, and little is known about the relative contribution of cis- and trans-regulatory changes to methylation variation. Here, we explore the heritability of DNA methylation, and conduct methylation quantitative trait loci (meQTLs) analysis to investigate the genetic architecture underlying methylation variation between marine and freshwater ecotypes of threespine stickleback (Gasterosteus aculeatus). We quantitatively measured genome-wide DNA methylation in fin tissue using reduced representation bisulfite sequencing of F1 and F2 crosses, and their marine and freshwater source populations. We identified cytosines (CpG sites) that exhibited stable methylation levels across generations. We found that additive genetic variance explained an average of 24-35% of the methylation variance, with a number of CpG sites possibly autonomous from genetic control. We also detected both cis- and trans-meQTLs, with only trans-meQTLs overlapping with previously identified genomic regions of high differentiation between marine and freshwater ecotypes. Finally, we identified the genetic architecture underlying two key CpG sites that were differentially methylated between ecotypes. These findings demonstrate a potential role for DNA methylation in facilitating adaptation to divergent environments and improve our understanding of the heritable basis of population epigenomic variation.

Athletic Trainers' Competence, Education, and Perceptions Regarding Transgender Student-Athlete Patient Care.

CONTEXT: Transgender student-athletes are increasingly participating in sport, requiring athletic trainer (AT) preparedness to care for their needs. OBJECTIVE: To measure ATs' (1) perceived definition of transgender, (2) comfort and competence working with transgender student-athletes, (3) sources of education, (4) perceived legal concerns, and (5) perception of competitive advantage. DESIGN: Cross-sectional study. SETTING: Mixed-methods survey. PATIENTS OR OTHER PARTICIPANTS: Collegiate or university ATs (n = 5537) received an email invitation to participate; the data of 667 ATs were included in the analysis. MAIN OUTCOME MEASURE(S): A multipart 43-item questionnaire addressing the primary objectives of the study, with other factors that were explored in relation to these objectives to uncover potential influences on their responses. We calculated descriptive statistics, and for open-ended responses, we used the consensual qualitative research tradition. RESULTS: About half (48.1%, n = 321) of the participants agreed they were competent in treating transgender patients, but only 36.0% (n = 240) believed they were competent in practicing collaboratively with an endocrinologist in the drug-screening processes. Fewer than half (45.6%, n = 304) of participants felt they were competent in using appropriate terminology relating to transgender patients. The ATs disagreed when asked if they were competent regarding counseling transgender patients about the effects of hormone replacement therapy on sport participation (48.1%, n = 321) or on mental health concerns (40.3%, n = 269). Participants learned most frequently from media outlets (35.2%, n = 235) or personal experiences with family, friends, or themselves (33.7%, n = 225), yet 35.1% (n = 243) received no education in caring for transgender patients. Many ATs (41.2%, n = 278) believed that transgender female student-athletes had a competitive advantage. In contrast, 6.6% (n = 44) of participants indicated that transgender male student-athletes had a competitive advantage. CONCLUSIONS: Although collegiate ATs generally felt competent in treating transgender patients, they did not feel capable of addressing specific aspects of transgender patients' health care needs. Regardless of the resulting perceived unfair advantage, ATs must be aware of the regulations and therapeutic effects associated with hormone-related therapy for transgender student-athletes.

The power and limitations of gene expression pathway analyses toward predicting population response to environmental stressors.

Rapid environmental changes impact the global distribution and abundance of species, highlighting the urgency to understand and predict how populations will respond. The analysis of differentially expressed genes has elucidated areas of the genome involved in adaptive divergence to past and present environmental change. Such studies however have been hampered by large numbers of differentially expressed genes and limited knowledge of how these genes work in conjunction with each other. Recent methods (broadly termed "pathway analyses") have emerged that aim to group genes that behave in a coordinated fashion to a factor of interest. These methods aid in functional annotation and uncovering biological pathways, thereby collapsing complex datasets into more manageable units, providing more nuanced understandings of both the organism-level effects of modified gene expression, and the targets of adaptive divergence. Here, we reanalyze a dataset that investigated temperature-induced changes in gene expression in marine-adapted and freshwater-adapted threespine stickleback (Gasterosteus aculeatus), using Weighted Gene Co-expression Network Analysis (WGCNA) with PANTHER Gene Ontology (GO)-Slim overrepresentation and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. Six modules exhibited a conserved response and six a divergent response between marine and freshwater stickleback when acclimated to 7°C or 22°C. One divergent module showed freshwater-specific response to temperature, and the remaining divergent modules showed differences in height of reaction norms. PPARAa, a transcription factor that regulates fatty acid metabolism and has been implicated in adaptive divergence, was located in a module that had higher expression at 7°C and in freshwater stickleback. This updated methodology revealed patterns that were not found in the original publication. Although such methods hold promise toward predicting population response to environmental stressors, many limitations remain, particularly with regard to module expression representation, database resources, and cross-database integration.

Predicting the fate of eDNA in the environment and implications for studying biodiversity.

Environmental DNA (eDNA) applications are transforming the standard of characterizing aquatic biodiversity via the presence, location and abundance of DNA collected from environmental samples. As eDNA studies use DNA fragments as a proxy for the presence of organisms, the ecological properties of the complex and dynamic environments from which eDNA is sampled need to be considered for accurate biological interpretation. In this review, we discuss the role that differing environments play on the major processes that eDNA undergoes between organism and collection, including shedding, decay and transport. We focus on a mechanistic understanding of these processes and highlight how decay and transport models are being developed towards more accurate and robust predictions of the fate of eDNA. We conclude with five recommendations for eDNA researchers and practitioners, to advance current best practices, as well as to support a future model of eDNA spatio-temporal persistence.

Triple Hop for Distance as a Predictor of Lower Extremity Performance in Firefighter Equipment.

The objective of this study was to examine the predictive value of the Triple Hop for Distance (THD) physical performance test to assess lower extremity (LE) strength and power in individuals donning firefighter personal protective equipment (PPE). Thirty-one healthy participants completed the THD in firefighter PPE on both the dominant and non-dominant limb. Dependent variables included LE power (vertical jump height [cm]) on a jump mat, and LE strength of the quadriceps and hamstrings (peak torque [Nm]) on an isokinetic dynamometer. THD was a strong predictor of LE power on the dominant (p<0.01) and non-dominant (p<0.01) limbs. THD was also a moderate predictor of LE strength on both the dominant limb (Ham60 [p<0.01]), Quad60 [p<0.01]), and the non-dominant limb (Ham60 [p<0.01]), (Quad60 [p<0.01]). The THD was found to be a strong and valid predictor for clinical measures of LE power and strength in firefighter PPE.

The effect of structural firefighter protective clothing systems on single-legged functional hop test scores.

BACKGROUND: Firefighters must complete a physical ability test to assess work readiness. There is a lack of understanding of how personal protective clothing (PPC) affects functional performance tests for work readiness, e.g. Triple Hop for Distance (THD) and Triple Hop for Work (THW). OBJECTIVE: To examine firefighter PPC's effect on the THD and THW measures. METHODS: Thirty-one healthy, untrained participants (male = 20, female = 11; age = 23±3 years; height = 175.30± 11.12 cm; mass = 77.94±14.24 kg; mass in PPC = 89.14±14.68 kg) completed three successful trials of the THD on their dominant and non-dominant leg, with and without PPC. The main outcome measures included maximum and mean distances on the THD with and without PPC and THW. RESULTS: We identified a significant decrease in THD measures (mean difference = 97.83 cm; p <  0.001) and THW measures (mean difference = -326.61J; p <  0.001) when donning PPC in the dominant leg. We identified a significant decrease in THD (mean difference = 121.48 cm; p <  0.001) and THW (mean difference = 493.15J; p <  0.001) for females, and a significant difference for THD (mean difference = 84.83 cm; p <  0.001) for males when donning PPC. CONCLUSIONS: The addition of PPC decreased the THD and THW measures. The additional mass of the PPC required the more energy to move the same distance without the PPC.

Lesbian, Gay, Bisexual, Transgender, and Queer Patients: Collegiate Athletic Trainers' Perceptions.

CONTEXT: Research suggests that patients who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) are at risk for certain conditions and denied equal access to health care in physician offices compared with their heterosexual counterparts. However, little evidence exists regarding the treatment of LGBTQ student-athlete patients in the athletic training clinic and the role the athletic trainer (AT) plays in these health care experiences. OBJECTIVE: To explore the perceptions of ATs treating LGBTQ student-athlete patients. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 1077 collegiate and university ATs completed the survey (5685 e-mails distributed, 1214 surveys started, access rate = 21.4%, completion rate = 88.7%). MAIN OUTCOME MEASURE(S): Demographic information and level of agreement in 3 areas (approach, quality of care, and comfort) were obtained on a 5-point Likert scale. We asked ATs their likeliness of providing guidance to student-athletes about navigating their sexuality generally and as it related to athletic participation, if they thought they provided equal health care to a student-athlete who identified as LGBTQ, how comfortable they were treating LGBTQ student-athlete patients, and how comfortable they thought student-athlete patients would be seeking care from them or from providers in their clinic. RESULTS: Overall, we found differences among groups for sexual orientation, gender, religion, and the existence of interpersonal contact with LGBTQ friends or family for approach, quality of care, and comfort. We also identified 2 main themes indicating ATs' desire for more training and education, specifically in caring for transgender student-athletes and providing patient-centered care with professionalism, regardless of gender identity or sexual orientation. CONCLUSIONS: Although differences existed among demographic groups, ATs had a generally positive view of treating LGBTQ student-athlete patients and wanted more training and education on the specific needs of this population.

Heterozygosity and asymmetry: Ectodysplasin as a form of genetic stress in marine threespine stickleback.

Genome-wide heterozygosity has long been hypothesized to play a role in buffering organisms against developmental perturbations, potentially resulting in increased symmetry. If true, this could in part explain the maintenance of standing genetic variation in wild populations. Marine threespine sticklebacks (Gasterosteus aculeatus) were sampled across their eastern Pacific coastal distribution from Alaska to California and variations in asymmetry for both structural and nonstructural armor traits (lateral plates) were assessed. Structural plates consistently showed less asymmetry than nonstructural plates, but standardized measures of heterozygosity were not correlated with the extent of asymmetry expressed by a fish. Fish that were heterozygous for the major-effect gene controlling lateral plate variation (Ectodysplasin) had higher occurrences of asymmetry, even when the individuals were phenotypically fully plated. Collectively, this suggests that heterozygosity at a major-effect locus can have a greater impact on asymmetry than heterozygosity sampled across the genome.

Lesbian, Gay, Bisexual, Transgender, and Queer Athletic Trainers: Collegiate Student-Athletes' Perceptions.

CONTEXT: Lesbian, gay, bisexual, transgender, and queer (LGBTQ) athletic trainers (ATs) face uncertain acceptance in the workplace. OBJECTIVE: To examine the perceptions of National Collegiate Athletic Association (NCAA) student-athletes toward ATs who identified as LGBTQ. DESIGN: Cross-sectional design. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 623 (males = 212, females = 403, other = 8; age = 19.7 ± 1.4 years) NCAA student-athletes completed the survey. MAIN OUTCOME MEASURE(S): Participants completed a 19-item survey to assess their perceptions about the appropriateness of, quality of care from, and comfort with ATs who identified as LGBTQ. We asked 10 demographic questions and 2 questions regarding the student-athlete's exposure to individuals who identified as LGBTQ. Five matrix questions had 5 stems each to represent LGBTQ individuals on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree) and 2 open-ended questions elicited qualitative data. We analyzed characteristics of central tendency to evaluate the level of appropriateness, quality of care, and level of comfort perceived by student-athletes of ATs who identified as LGBTQ. We used Mann-Whitney U and Kruskal-Wallis tests for post hoc analyses where appropriate. We used grounded theory to identify themes in the answers to the open-ended questions. RESULTS: Participants indicated they would seek health care and would feel comfortable approaching an AT who identified as LGBTQ. Participants agreed it was appropriate for an LGBTQ AT to work with both male and female sports and did not agree that health care provided by heterosexual and LGBTQ ATs differed. The open-ended responses revealed 4 themes: professionalism, upbringing, situational concerns, and concerns about specific populations that affected their perceptions. CONCLUSIONS: In general, the NCAA student-athletes had positive perceptions of ATs who identified as LGBTQ.

Angling-induced injuries have a negative impact on suction feeding performance and hydrodynamics in marine shiner perch, Cymatogaster aggregata.

Fishing is a popular and lucrative sport around the world and, in some cases, may contribute to declining fish stocks. To mediate this problem and maintain fish biomass in aquatic ecosystems, catch-and-release fishing, whereby a fish is caught and immediately released, has been implemented in many countries. It is unclear whether the injuries to the mouth that are caused by the hook have an impact on feeding performance of fishes. Using high-speed video and computational fluid dynamics (CFD), we asked whether injuries around the mouth caused by fishing hooks have a negative impact on suction feeding performance (measured as maximum prey velocity) of the commonly angled marine shiner perch (Cymatogaster aggregata). We hypothesized that fish with mouth injuries would exhibit decreased feeding performance compared with controls. Ten shiner perch were caught using scientific angling and 10 were caught using a seine net. Feeding events were then recorded at 500 frames per second using a high-speed camera. Compared with the control group, maximum prey velocity was significantly lower in the injured group (P<0.01). Maximum gape, time to peak gape, maximum jaw protrusion and predator-prey distance were comparable between the control and injured groups, leading us to conclude that the injury-induced hole in the buccal cavity wall reduced the pressure gradient during mouth expansion, thereby reducing the velocity of water entering the fish's mouth. This was confirmed with our CFD modelling. Fishing injuries in nature are likely to depress feeding performance of fish after they have been released, although it is currently unclear whether this has a significant impact on survival.