Female National Collegiate Athletic Association Division-I Athlete Injury Prediction by Vertical Countermovement Jump Force-Time Metrics.

ABSTRACT: Merrigan, JJ, Stone, JD, Kraemer, WJ, Vatne, EA, Onate, J, and Hagen, JA. Female National Collegiate Athletic Association Division-I athlete injury prediction by vertical countermovement jump force-time metrics. J Strength Cond Res 38(4): 783-786, 2024-Vertical countermovement jump (CMJ) assessments on force plates have been purported to screen for musculoskeletal injury risk (MSKI) but with little scientific support. Thus, this study aimed to identify associations and noncontact lower-body injury predictability with CMJ force-time metrics in female athletes. The study entailed a retrospective analysis of routine injury and performance monitoring from 155 female National Collegiate Athletics Association Division I athletes. Noncontact lower-body injuries included in analysis were confirmed by medical staff, occurred during competition or training, resulted in time loss from training, and occurred within 3 months following CMJ testing (2 maximal effort, no arm swing, jumps on dual force plates). A total of 44 injuries occurred within 3 months following CMJ baseline testing and resulted in an average of 24.5 missed days from training. Those who sustained an injury were more likely to sustain another injury (15 of 44 injuries [33.1%]; odds ratio = 3.05 [95% CI = 1.31-6.99]). For every 1-unit increase from the mean in eccentric mean power and minimum eccentric force, there was a decrease in odds of sustaining a MSKI. Despite high overall model accuracy (85.6%), the receiving operating characteristic area under the curve (65.9%) was unacceptable and the true positive rate (recall) was 0.0%. Thus, no injuries in the testing data set were correctly classified by the logistic regression model with CMJ force-time metrics as predictors. Baseline CMJ assessment may not be useful for noncontact lower-body musculoskeletal injury screening or predictability in National Collegiate Athletics Association female athletes.

Analysis of Sleep, Nocturnal Physiology, and Physical Demands of NCAA Women's Ice Hockey Across a Championship Season.

ABSTRACT: Merrigan, JJ, Stone, JD, Kraemer, WJ, Friend, C, Lennon, K, Vatne, EA, and Hagen, JA. Analysis of sleep, nocturnal physiology, and physical demands of NCAA women's ice hockey across a championship season. J Strength Cond Res 38(4): 694-703, 2024-The aims of this study were to evaluate the (a) relationships between daily physical demands and nighttime sleep, heart rate (HR), and heart rate variability (HRV); (b) weekly changes in physical demands and sleep; and (c) differences among positions and between training and competition during a competitive season in National Collegiate Athletic Association (NCAA) women's ice hockey. Twenty-five NCAA Division I women's ice hockey athletes wore a sensor at night to monitor sleep quantity or quality (e.g., time asleep and sleep efficiency) and physiology (e.g., HR and HRV). During training and competitions (31 regular season and 7 postseason), athletes wore performance monitoring systems to assess workload demands (e.g., training impulse and TRIMP). As internal workload (TRIMP, Time >80% of HRmax, Average HR) during training or competition increased, nocturnal HRV decreased, HR increased, and Sleep Duration, Sleep Score, and Readiness Score decreased that night. Across the season, athletes experienced lower HRV, but exhibited longer sleep durations. Training Distance, Duration, Time >80% HRmax, Average HR, and TRIMP decreased, whereas competition Total Distance, Duration, and TRIMP increased across weeks throughout the season. There were differences across positions and season blocks when evaluating these data at the mesocycle level. Athletes slept longer before competition compared with training, but physiological data did not differ. Competitions had greater physiological demands than training. We speculate that the increased focus on sleep hygiene, as evidenced by the increase in sleep over the season, may have served as a recovery aid to combat physiological stress of accumulated demands of competitions that increased over time into postseason tournaments.

Whole-body photobiomodulation improves post-exercise recovery but does not affect performance or physiological response during maximal anaerobic cycling.

This study aims to examine the effects of acute whole-body photobiomodulation (wbPBM), applied pre-exercise, on bouts of anaerobic cycling (Wingate) performances. Forty-eight healthy, active males and females participated in this single-blind, randomized, crossover study. Participants visited the laboratory three times to complete repeat (4 ×) Wingate testing, with one week between each visit. All participants completed baseline testing during their first visit and randomly received either the wbPBM or placebo condition before testing on the second visit, followed by the opposite condition on the third visit. There were no significant condition × time interactions for any variable (peak power, average power, power decrement, lactate, heart rate, ratings of perceived exertion, heart rate variability (HRV), root-mean square of differences between R-R intervals (rMSSD), power in the high-frequency range (HF) average, power in the low-frequency range (LF) average, total power, LF/HF, or power in the very-low-frequency range average). A main condition effect was only noted for heart rate, where peak heart rate was significantly higher for wbPBM (145, 141-148 bpm) than placebo (143, 139-146 bpm; p = 0.006) and baseline testing (143, 140-146; p = 0.049) throughout the entire testing session (i.e., collapsed across all timepoints). Furthermore, HRV (rMSSD) the following morning after testing was significantly higher for the wbPBM session compared to placebo (p = 0.043). There were no differences in perceived recovery (p = 0.713) or stress (p = 0.978) scores between wbPBM and placebo. Implementing 20 min of wbPBM immediately prior to maximal bouts of anaerobic cycling did not improve performance (i.e., power output) or physiological responses (e.g., lactate). However, wbPBM elicited the ability to work at a higher heart rate throughout testing and seemed to enhance recovery through improved HRV the following morning.

Analyzing Force-Time Curves: Comparison of Commercially Available Automated Software and Custom MATLAB Analyses.

ABSTRACT: Merrigan, JJ, Stone, JD, Galster, SM, and Hagen, JA. Analyzing force-time curves: Comparison of commercially available automated software and custom MATLAB analyses. J Strength Cond Res 36(9): 2387-2402, 2022-With the growing prevalence of commercial force plate solutions providing automated force-time curve analysis, it is critical to understand the level of agreement across techniques. Thus, this study directly compared commercial and custom software analyses across force-time curves. Twenty-four male and female subjects completed 6 trials of countermovement, squat, and drop jumps, and isometric mid-thigh pulls on the same force plate. Vertical ground reaction forces were analyzed by automated software from Vald Performance, Hawkin Dynamics, and custom MATLAB scripts. Trials were visually assessed to verify proper landmark identifications. Systematic and proportional bias among analyses were compared via least products regressions, Bland-Altman plots, and percent error. Hawkin Dynamics had subtle differences in analysis procedures and demonstrated low percent errors across all tests (<3% error), despite demonstrating systematic and proportional bias for several metrics. ForceDecks demonstrated larger percent differences and greater biases for several metrics. These errors likely result from different identification of movement initiation, system weight, and integration techniques, which causes error to subsequent landmark identifications (e.g., braking/propulsive phases) and respective force-time metrics. Many metrics were in agreement between devices, such as isometric mid-thigh pull peak force consistently within 1 N across analyses, but some metrics are difficult and incomparable across software analyses (i.e., rate of force development). Overall, many metrics were in agreement across each commercial software and custom MATLAB analyses after visually confirming landmarks. However, because of inconsistencies, it is important to only compare metrics that are in agreement across software analyses when absolutely necessary.

Using Random Forest Regression to Determine Influential Force-Time Metrics for Countermovement Jump Height: A Technical Report.

ABSTRACT: Merrigan, JJ, Stone, JD, Wagle, JP, Hornsby, WG, Ramadan, J, Joseph, M, and Hagen, JA. Using random forest regression to determine influential force-time metrics for countermovement jump height: a technical report. J Strength Cond Res 36(1): 277-283, 2022-The purpose of this study was to indicate the most influential force-time metrics on countermovement jump (CMJ) height using multiple statistical procedures. Eighty-two National Collegiate Athletic Association Division I American football players performed 2 maximal-effort, no arm-swing, CMJs on force plates. The average absolute and relative (i.e., power/body mass) metrics were included as predictor variables, whereas jump height was the dependent variable within regression models (p < 0.05). Best subsets regression (8 metrics, R2 = 0.95) included less metrics compared with stepwise regression (18 metrics, R2 = 0.96), while explaining similar overall variance in jump height (p = 0.083). Random forest regression (RFR) models included 8 metrics, explained ∼93% of jump height variance, and were not significantly different than best subsets regression models (p > 0.05). Players achieved higher CMJs by attaining a deeper, faster, and more forceful countermovement with lower eccentric-to-concentric force ratios. An additional RFR was conducted on metrics scaled to body mass and revealed relative mean and peak concentric power to be the most influential. For exploratory purposes, additional RFR were run for each positional group and suggested that the most influential variables may differ across positions. Thus, developing power output capabilities and providing coaching to improve technique during the countermovement may maximize jump height capabilities. Scientists and practitioners may use best subsets or RFR analyses to help identify which force-time metrics are of interest to reduce the selectable number of multicollinear force-time metrics to monitor. These results may inform their training programs to maximize individual performance capabilities.

Comparisons of Countermovement Jump Force-Time Characteristics Among National Collegiate Athletic Association Division I American Football Athletes: Use of Principal Component Analysis.

ABSTRACT: Merrigan, JJ, Rentz, LE, Hornsby, WG, Wagle, JP, Stone, JD, Smith, HT, Galster, SM, Joseph, M, and Hagen, JA. Comparisons of countermovement jump force-time characteristics among NCAA Division I American football athletes: use of principal component analysis. J Strength Cond Res 36(2): 411-419, 2022-This study aimed to reduce the dimensionality of countermovement jump (CMJ) force-time characteristics and evaluate differences among positional groups (skills, hybrid, linemen, and specialists) within National Collegiate Athletic Association (NCAA) division I American football. Eighty-two football athletes performed 2 maximal effort, no arm-swing, CMJs on force plates. The average absolute and relative (e.g., power/body mass) metrics were analyzed using analysis of variance and principal component analysis procedures (p < 0.05). Linemen had the heaviest body mass and produced greater absolute forces than hybrid and skills but had lower propulsive abilities demonstrated by longer propulsive phase durations and greater eccentric to concentric mean force ratios. Skills and hybrid produced the most relative concentric and eccentric forces and power, as well as modified reactive strength indexes (RSIMOD). Skills (46.7 ± 4.6 cm) achieved the highest jump height compared with hybrid (42.8 ± 5.5 cm), specialists (38.7 ± 4.0 cm), and linemen (34.1 ± 5.3 cm). Four principal components explained 89.5% of the variance in force-time metrics. Dimensions were described as the (a) explosive transferability to concentric power (RSIMOD, concentric power, and eccentric to concentric forces) (b) powerful eccentric loading (eccentric power and velocity), (c) countermovement strategy (depth and duration), and (d) jump height and power. The many positional differences in CMJ force-time characteristics may inform strength and conditioning program designs tailored to each position and identify important explanatory metrics to routinely monitor by position. The overwhelming number of force-time metrics to select from may be reduced using principal component analysis methods, although practitioners should still consider the various metric's applicability and reliability.

An analysis of antibiotic prescribing practices for enteric bacterial infections within FoodNet Canada sentinel sites.

OBJECTIVES: Understanding the current state of antibiotic treatment guidelines and prescribing practices for bacterial enteric infections is critical to inform antibiotic stewardship initiatives. This study aims to add to the current understanding through three objectives: (i) to identify and summarize published treatment guidelines for bacterial enteric infections; (ii) to describe observed antibiotic prescribing practices for bacterial enteric infections across three sentinel sites in Canada; and (iii) to assess concordance between observed antibiotic prescribing and treatment guidelines. METHODS: An environmental scan of treatment guidelines for bacterial enteric infections was conducted and recommendations were collated. A descriptive analysis of cases of bacterial enteric illnesses captured in FoodNet Canada's sentinel site surveillance system between 2010 and 2018 was performed. Antibiotic-use data were self-reported by cases via an enhanced questionnaire. RESULTS: Ten treatment guidelines were identified in the environmental scan. There was substantial variation between guidelines for both when to prescribe antibiotics and which antibiotics were recommended. Of the 5877 cases of laboratory-confirmed bacterial enteric illness in the three sites, 49% of cases reported having received an antibiotic prescription. Of particular significance was the finding that 21% of verotoxigenic Escherichia coli cases received a prescription. Of the 17 antibiotics recommended in the guidelines, 14 were used in practice. In addition to these, 18 other antibiotics not included in any of the guidelines reviewed were also prescribed. CONCLUSIONS: Our study suggests that a substantial proportion of enteric bacterial infections in Canada are prescribed antibiotics. These findings highlight the need to standardize treatment guidelines for enteric illnesses and could be used to inform future stewardship programme development.

Spontaneous Regression and Resolution of Breast Implant-Associated Anaplastic Large Cell Lymphoma: Implications for Research, Diagnosis and Clinical Management.

BACKGROUND: First described in 1997, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) was recognised by the World Health Organisation in 2016 as a specific disease. It typically presents as a late seromacontaining atypical, monoclonal T cells which are CD30+ and anaplastic lymphoma kinase negative. Until recently, it was thought that the disease was very rare. However, it is being diagnosed increasingly frequently with 56 cases confirmed in Australia by September 2017 and the estimated incidence revised from 1 in 300,000 to between 1 in 1000 and 1 in 10,000 patients with bilateral implants. There is debate about the spectrum of BIA-ALCL. According to the current WHO classification, BIA-ALCL is a cancer in all cases. Treatment guidelines require that it is treated urgently with a minimum of bilateral removal of implants and capsulectomies. Whilst acknowledging the disease has been under diagnosed in the past, with some notable exceptions the BIA-ALCL literature has given scant attention to the epidemiological evidence. Now that it is known that the disease may occur in up to 1 in 1000 patients with a median of 7.5 years from implantation to diagnosis, understanding it in its epidemiological context is imperative. The epidemiology of cancer and lymphoma in women with breast implants strongly suggests that most patients do not have a cancer that will inevitably progress without treatment but instead a self-limiting lympho-proliferative disorder. Although the possibility of spontaneous regression has been raised and the observation made that treatment delay did not seem to increase the risk of spread, the main objection to the lympho-proliferative hypothesis has been the lack of documented cases of spontaneous regression or resolution. Because all cases currently are considered malignant and treated urgently, only case report evidence, interpreted in the proper epidemiological context, is likely to be available to challenge this thinking. METHODS AND RESULTS: New observations and interpretation of the epidemiology of BIA-ALCL are made. These are supported by the presentation of two cases, which to the best of our knowledge comprise the first documented evidence of spontaneous regression and spontaneous resolution of confirmed BIA-ALCL. CONCLUSIONS: The epidemiology of the disease strongly suggests that the vast majority of cases are not a cancer that will inevitably progress without treatment. The findings presented in the manuscript provide supportive clinical evidence. Consequently, an alternative view of BIA-ALCL with implications for research, diagnosis and clinical management needs to be considered. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Changes in Creatine Kinase and Hormones Over the Course of an American Football Season.

Stone, JD, Kreutzer, A, Mata, JD, Nystrom, MG, Jagim, AR, Jones, MT, and Oliver, JM. Changes in creatine kinase and hormones over the course of an American Football Season. J Strength Cond Res 33(9): 2481-2487, 2019-The purpose of this study was to examine changes in creatine kinase and hormones over the course of an entire season of American football. A secondary purpose was to determine differences between starters and nonstarters. Fasting blood samples were obtained from 19 National Collegiate Athletic Association Division I (n = 19; 20 ± 1 years) football athletes over the course of a season beginning before the start of summer off-season conditioning (T1), before (T2) and after preseason (T3) football camp, with remaining samples taken throughout the competitive season (T4-T8). A magnitude-based inference approach was used to define outcomes. Testosterone was higher in starters before the start of the season (T1, Effect Size [ES] = 0.8) and during preconference (T4; ES = 0.7). Postcamp (T3) testosterone was lower in all players, though greater in starters (starters, 0.0%/0.3%/99.7%; nonstarters, 0.2%/2.9%/96.9%). An increase cortisol relative to baseline (T1) was observed in starters early in season (T4, ES = 0.7; T5, ES = 0.5). Creatine kinase was elevated at all time points in all athletes, with starters having higher circulating levels throughout season. These data demonstrate that changes in hormonal markers may be experienced over a season of football and differ by playing status. Differences between starters and nonstarters may be indicative of greater damage and stress experienced by starters, which may result from a greater number of repetitions.

Effect of ACTN3 Polymorphism on Self-reported Running Times.

Kreutzer, A, Martinez, CA, Kreutzer, M, Stone, JD, Mitchell, JB, and Oliver, JM. Effect of ACTN3 polymorphism on self-reported running times. J Strength Cond Res 33(1): 80-88, 2019-This investigation examined the effect of ACTN3 genotype on self-reported distance running personal records (PRs). Of 94 (n = 94) recreationally active men and women, 82 (f = 42, m = 40; age: 22.6 ± 4.5 years; body mass index [BMI]: 23.5 ± 3.4 kg·m) reported 1-mile running PRs, whereas 57 (f = 33, m = 24; age: 23.4 ± 5.3 years; BMI: 22.9 ± 9.3 kg·m) reported 5K running PRs. Subjects were grouped by the presence (ACTN3) or absence (ACTN3) of α-actinin-3, as well as by individual genotype (RR, RX, and XX). Among female participants, ACTN3 reported 64.5 seconds faster (p = 0.048) 1-mile PRs compared with their ACTN3 counterparts. No differences were observed when comparing 5K PRs between genotypes. Two one-sided test equivalence testing revealed that none of the effects observed when comparing ACTN3 and ACTN3 were equivalent to zero. Our study confirms a reportedly greater prevalence of XX benefits for endurance performance in females when compared with males but fails to strongly link ACTN3 genotype to endurance performance. Practitioners should continue to be cautious when using genetic information for talent identification and sport selection.

Effect of Strength on Velocity and Power During Back Squat Exercise in Resistance-Trained Men and Women.

Askow, AT, Merrigan, JJ, Neddo, JM, Oliver, JM, Stone, JD, Jagim, AR, and Jones, MT. Effect of strength on velocity and power during back squat exercise in resistance-trained men and women. J Strength Cond Res 33(1): 1-7, 2019-The purpose was to examine load-velocity and load-power relationships of back squat in resistance-trained men (n = 20, 21.3 ± 1.4 years, 183.0 ± 8.0 cm, 82.6 ± 8.0 kg, 11.5 ± 5.0% total body fat) and women (n = 18; 20.0 ± 1.0 years; 166.5 ± 6.9 cm; 63.9 ± 7.9 kg, 20.3 ± 5.0% body fat). Body composition testing was performed followed by determination of back squat 1 repetition maximum (1RM). After at least 72 hours of recovery, subjects returned to the laboratory and completed 2 repetitions at each of 7 separate loads (30, 40, 50, 60, 70, 80, and 90% 1RM) in a random order. During each repetition, peak and average velocity and power were quantified using a commercially available linear position transducer. Men produced higher absolute peak and average power and velocity at all loads. When power output was normalized for body mass, significant differences remained. However, when normalizing for strength, no significant differences were observed between sexes. Furthermore, when subjects were subdivided into strong and weak groups, those above the median 1RM produced higher peak power, but only at loads greater than 60% 1RM. It was concluded that differences between men and women may be a result of strength rather than biological sex. Furthermore, training for maximal strength may be an appropriate method to augment maximal power output in those athletes who exhibit low levels of strength.

Differences in elbow extensor muscle characteristics between resistance-trained men and women.

PURPOSE: Muscular strength is suggested to be dependent upon muscle characteristics. Yet, sex-specific relationships of muscle characteristics to strength in the resistance-trained require investigation. Therefore, the purpose was to evaluate sex differences in muscle characteristics and isometric strength in the elbow extensors, as well as their respective associations. METHODS: Resistance-trained men (n = 15, mean ± SD 22 ± 4 years, 87.5 ± 12.8 kg, 16.9 ± 2.9% body fat) and women (n = 15, mean ± SD 25 ± 5 years, 59.3 ± 7.3 kg, 22.4 ± 4.2% body fat) were tested. B-mode ultrasound images assessed muscle thickness, pennation angle, and echo intensity. Muscle volume and fascicle length were estimated from previously validated equations. Maximal voluntary isometric contraction measured elbow extensors isometric strength. Independent samples t-tests and Fisher's r-to-z test examined differences between sexes. RESULTS: Sex differences existed in all muscle characteristics (p < 0.05). Men's absolute strength (27.86 ± 3.55 kg) was significantly greater than women (16.15 ± 3.15 kg), but no differences were noted when controlling for muscle volume (men 0.069 ± 0.017, women 0.077 ± 0.022 kg/cm3). Sex differences did not exist in the relationships of muscle characteristics to strength with muscle size having the largest correlations. However, the relationship between echo intensity and body fat was different in men (r = - 0.311) and women (r = 0.541, p = 0.0143). CONCLUSIONS: Sex differences in isometric elbow extensor strength are eliminated when expressed relative to muscle volume. Relationships of echo intensity and body fat were different between men and women and may be indicative of greater adipose infiltration in women.

Outbreak of Vibrio parahaemolyticus Associated with Consumption of Raw Oysters in Canada, 2015.

There has been a steady increase in illness incidence of Vibrio parahaemolyticus (Vp). The majority of illnesses are associated with consumption of raw oysters. In the summer of 2015, Canada experienced the largest outbreak associated with the consumption of raw oysters harvested from British Columbia (BC) coastal waters. Case investigation of laboratory-confirmed cases was conducted to collect information on exposures and to assist traceback. Investigations at processors and oyster sampling were conducted. Eighty-two laboratory-confirmed cases of Vp infection were reported between January 1 and October 26, 2015. The majority of the cases were reported in BC, associated with consumption of raw BC oysters in restaurants. Sea surface temperatures were above the historical levels in 2015. This outbreak identified the need to improve surveillance and response to increases in human cases of Vp. This is of particular importance due to the potential for increasing water temperatures and the likelihood of additional outbreaks of Vibrio.

Spontaneous Regression and Resolution of Breast Implant-Associated Anaplastic Large Cell Lymphoma: Implications for Research, Diagnosis and Clinical Management.

BACKGROUND: First described in 1997, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) was recognised by the World Health Organisation in 2016 as a specific disease. It typically presents as a late seroma-containing atypical, monoclonal T cells which are CD30+ and anaplastic lymphoma kinase negative. Until recently, it was thought that the disease was very rare. However, it is being diagnosed increasingly frequently with 56 cases confirmed in Australia by September 2017 and the estimated incidence revised from 1 in 300,000 to between 1 in 1000 and 1 in 10,000 patients with bilateral implants. There is debate about the spectrum of BIA-ALCL. According to the current WHO classification, BIA-ALCL is a cancer in all cases. Treatment guidelines require that it is treated urgently with a minimum of bilateral removal of implants and capsulectomies. Whilst acknowledging the disease has been under diagnosed in the past, with some notable exceptions the BIA-ALCL literature has given scant attention to the epidemiological evidence. Now that it is known that the disease may occur in up to 1 in 1000 patients with a median of 7.5 years from implantation to diagnosis, understanding it in its epidemiological context is imperative. The epidemiology of cancer and lymphoma in women with breast implants strongly suggests that most patients do not have a cancer that will inevitably progress without treatment but instead a self-limiting lympho-proliferative disorder. Although the possibility of spontaneous regression has been raised and the observation made that treatment delay did not seem to increase the risk of spread, the main objection to the lympho-proliferative hypothesis has been the lack of documented cases of spontaneous regression or resolution. Because all cases currently are considered malignant and treated urgently, only case report evidence, interpreted in the proper epidemiological context, is likely to be available to challenge this thinking. METHODS AND RESULTS: New observations and interpretation of the epidemiology of BIA-ALCL are made. These are supported by the presentation of two cases, which to the best of our knowledge comprise the first documented evidence of spontaneous regression and spontaneous resolution of confirmed BIA-ALCL. CONCLUSIONS: The epidemiology of the disease strongly suggests that the vast majority of cases are not a cancer that will inevitably progress without treatment. The findings presented in the manuscript provide supportive clinical evidence. Consequently, an alternative view of BIA-ALCL with implications for research, diagnosis and clinical management needs to be considered. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Intracardiac Leiomyomatosis - an Unusual Cause of Syncope in a Middle-Aged Woman.

Intracardiac leiomyomatosis is a rare complication that occurs when a uterine leiomyoma (fibroid) undergoes vascular invasion and propagates within the inferior vena cava to reach the right atrium. This article describes a case of intracardiac leiomyomatosis in a middle-aged woman, exploring the presentation, diagnosis and surgical management of this condition. In this case the presenting complaints were syncope and atrial fibrillation, illustrating the importance of performing a transthoracic echocardiogram in patients presenting with their first episode of atrial fibrillation. Clinicians should consider intracardiac leiomyomatosis when evaluating women with right heart masses, especially those with a history of uterine leiomyomas.

Evaluating the Timeliness of Enteric Disease Surveillance in British Columbia, Canada, 2012-13.

Timely surveillance of enteric diseases is necessary to identify and control cases and outbreaks. Our objective was to evaluate the timeliness of enteric disease surveillance in British Columbia, Canada, compare these results to other settings, and recommend improvements. In 2012 and 2013, information was collected from case report forms and laboratory information systems on 2615 Salmonella, shigatoxin-producing E. coli, Shigella, and Listeria infections. Twelve date variables representing the surveillance process from onset of symptoms to case interview and final laboratory results were collected, and intervals were measured. The median time from onset of symptoms to reporting subtyping results to BC epidemiologists was 26-36 days and from onset of symptoms to case interview was 12-14 days. Our findings were comparable to the international literature except for a longer time (up to 29 day difference) to reporting of PFGE results to epidemiologists in BC. Such a delay may impact our ability to identify and solve outbreaks. Several process and system changes were implemented which should improve the timeliness of enteric disease surveillance.

Using environmental health officers' opinions to inform the source attribution of enteric disease: further analysis of the "most likely source of infection".

BACKGROUND: Policies and programs are needed to mitigate the burden of enteric disease in Canada. Source attribution, a goal of FoodNet Canada, can inform such strategies and can be accomplished with the information provided by expert opinion. This includes environmental health officers' (EHOs) opinions on the "most likely source of infection" (MLSI) of confirmed cases of enteric disease that are investigated by the Fraser Health Authority in British Columbia, FoodNet Canada's second sentinel site. METHODS: Exposure data from the MLSI were categorized into ten groups and summarized for five enteric disease groups using endemic cases in the first analysis, and a combination of endemic and international travel cases for the second analysis. An exploratory analysis was also conducted on risk setting information in the MLSI. The final analysis involved using a logistic regression model (Wald test) to describe the inherent biases in the data. RESULTS: Exposure proportions, by disease group, were similar to those of an analysis of MLSI data from FoodNet Canada's Ontario sentinel site. Food exposure represented the greatest proportion of overall enteric disease (32.0%), as well as for salmonellosis (45.0%), verotoxigenic E. coli (VTEC) infection (38.1%), and campylobacteriosis (30.0%) cases. The majority of parasitic diseases (41.2%) were attributed to water exposure. Food safety practices and consuming unpasteurized products were more frequently reported for campylobacteriosis (19.7% and 5.4%, respectively) compared to other enteric diseases. More VTEC infection was attributed to domestic travel (4.8%) than the other enteric diseases. Among endemic and international travel-related cases combined, VTEC infection was attributed more to endemic food exposure (35.5%) than international travel (16.1%), but similar proportions of campylobacteriosis were attributed to endemic food exposure (25.1%) and international travel (25.1%). Variations existed in the exposure and risk setting information that EHOs included in the MLSI, and in their propensity to enter food sources over other types of exposures. CONCLUSIONS: Results from the MLSI analysis for exposure, risk setting, and EHO bias, are valid contributions for informing source attribution. Important considerations from this work, including strategies to standardize and improve the quality of MLSI data, will enhance source attribution hypotheses.

Distinct mesenchymal cell states mediate prostate cancer progression.

In the complex tumor microenvironment (TME), mesenchymal cells are key players, yet their specific roles in prostate cancer (PCa) progression remain to be fully deciphered. This study employs single-cell RNA sequencing to delineate molecular changes in tumor stroma that influence PCa progression and metastasis. Analyzing mesenchymal cells from four genetically engineered mouse models (GEMMs) and correlating these findings with human tumors, we identify eight stromal cell populations with distinct transcriptional identities consistent across both species. Notably, stromal signatures in advanced mouse disease reflect those in human bone metastases, highlighting periostin's role in invasion and differentiation. From these insights, we derive a gene signature that predicts metastatic progression in localized disease beyond traditional Gleason scores. Our results illuminate the critical influence of stromal dynamics on PCa progression, suggesting new prognostic tools and therapeutic targets.

Outbreak of Diarrhetic Shellfish Poisoning associated with mussels, British Columbia, Canada.

In 2011, a Diarrhetic Shellfish Poisoning (DSP) outbreak occurred in British Columbia (BC), Canada that was associated with cooked mussel consumption. This is the first reported DSP outbreak in BC. Investigation of ill individuals, traceback of product and laboratory testing for toxins were used in this investigation. Sixty-two illnesses were reported. Public health and food safety investigation identified a common food source and harvest area. Public health and regulatory agencies took actions to recall product and notify the public. Shellfish monitoring program changes were implemented after the outbreak. Improved response and understanding of toxin production will improve management of future DSP outbreaks.