Evaluation of a cross-sectoral care intervention for families with psychosocial burden: a study protocol of a controlled trial.

BACKGROUND: Family risk factors, e.g. low socioeconomic status or parental mental health disorders, can affect children's health and development. Thus, targeted preventive services for families with psychosocial burden are crucial. The German Early Childhood Intervention (ECI) program is a preventive approach that aims to strengthen parent's resources by supportive services. However, research has revealed that only a proportion of the families considered to have substantial risk factors access the ECI program. To increase pediatricians' skills in identifying risk factors, and to improve the cross-sectoral collaboration between relevant professionals and the referral of families to supportive services, the PATH-intervention (Pediatric Attention To Help) was developed. The PATH-intervention includes interprofessional quality circles and a one-day training program for the pediatricians. This study aims to evaluate this complex cross-sectoral care intervention for families with psychosocial burden. METHODS: Using a prospective quasi-experimental, controlled (matched-pair), longitudinal mixed-method design, we will compare families under treatment of pediatricians trained in the PATH-intervention with families under treatment of a control group of pediatricians. Participating families are asked to complete online-surveys. As a primary outcome, we will examine the use of supportive services of the ECI by burdened families. Secondary outcomes are the proportion of correctly identified families with psychosocial burden by the pediatricians, as well as information provision and motivation of the families to use the supportive services. Additionally, the cost-effectiveness ratio will be investigated. In the process evaluation, we will qualitatively explore the acceptance of the PATH-intervention of all involved stakeholders and the treatment fidelity of the trained pediatricians. DISCUSSION: This study will determine whether the PATH-intervention enables the pediatricians to identify and recommend supportive services to burdened families, as well as the families' use of the supportive services of the ECI. Qualitative data will give insight into the acceptance of the intervention from the perspective of all stakeholders and the treatment fidelity. Results of this study could be the starting point for the broader implementation of the PATH-intervention as standard care. TRIAL REGISTRATION: German Clinical Trials Register (DRKS): DRKS00023461 (3rd December 2020); WHO UTN: U1111- 260-6575.

Non-linear association of efficiency of practice of adult elite athletes with their youth multi-sport practice.

We explored associations of elite athletes' multi-year efficiency of practice and improvement of performance with their current and earlier participation patterns. Participants were 80 adult German track-and-field national-squad athletes. Performance improvement was measured as development of athletes' highest track-and-field championship level and placing from 19 to 25 years (t1-t2). Practice efficiency was defined as performance improvement per amount of coach-led athletics practice from t1 to t2. Participation variables included amounts of coach-led practice and peer-led play in athletics and other sports through t1 and t1-t2. Analyses involved an advanced machine learning procedure, XGBoost, allowing non-linear, multivariate exploration. We computed two models, one for performance improvement ("good" discriminative performance, AUC = 0.82) and one for practice efficiency ("fair", AUC = 0.73). Four central findings emerged: 1. Childhood/adolescent coach-led multi-sport practice was a critical discriminator of adult practice efficiency and performance improvement. 2. Associations were non-linear, displaying a saturation pattern. 3. The likelihood of achieving high adult practice efficiency was greatest when combining ~1,000-2,500 track-and-field practice hours until t1 with ~1,250 other-sports practice hours until t1. 4. Peer-led engagement in any sport had negligible effects. Childhood/adolescent multi-sport coach-led practice apparently facilitated long-term sustainability of athletes' development of adult practice efficiency and performance improvement in athletics.

Retirement of professional soccer players - A systematic review from social sciences perspectives.

Retiring professional athletes face multifaceted changes and potential issues of adjustment, occupational development, and well-being, which raises concerns around the world. The study systematically reviewed the available research investigating professional soccer players' sport retirement from social sciences perspectives. The literature search in electronic databases and a "snowballing" procedure yielded 17 eligible studies investigating > 2,200 retired professional soccer players. The review followed the PRISMA statement. Nine studies focused on an early transition phase to retirement period; four studies investigated later periods of ten years or longer after retirement. Around half of the players reported involuntary retirement, often associated with declining performance and/or injury. Studies suggest issues of adjustment and mental health during early years after retirement, while psychological issues had apparently declined around 1-2 decades after retirement. However, available studies had notable limitations including lack of evidenced representative samples, report of measures' reliability, and control for confounders. Furthermore, while theoretical models emphasise a holistic perspective, quantitative research often took a narrow rather than holistic perspective. In summary, available knowledge is fraught with some uncertainty regarding reliability and representativeness of the population of retired professional soccer players. We offer future directions to advance the development of a theory of sport retirement.

Spin Relaxation in s-Wave Superconductors in the Presence of Resonant Spin-Flip Scatterers.

Employing analytical methods and quantum transport simulations we investigate the relaxation of quasiparticle spins in graphene proximitized by an s-wave superconductor in the presence of resonant magnetic and spin-orbit active impurities. Off resonance, the relaxation increases with decreasing temperature when electrons scatter off magnetic impurities-the Hebel-Slichter effect-and decreases when impurities have spin-orbit coupling. This distinct temperature dependence (not present in the normal state) uniquely discriminates between the two scattering mechanisms. However, we show that the Hebel-Slichter picture breaks down at resonances. The emergence of Yu-Shiba-Rusinov bound states within the superconducting gap redistributes the spectral weight away from magnetic resonances. The result is opposite to the Hebel-Slichter expectation: the spin relaxation decreases with decreasing temperature. Our findings hold for generic s-wave superconductors with resonant magnetic impurities, but also, as we show, for resonant magnetic Josephson junctions.

Acute on-snow severe injury events in elite alpine ski racing from 1997 to 2019: the Injury Surveillance System of the Austrian Ski Federation.

OBJECTIVES: The study aimed to (1) determine the incidence and gender-specific risk ratio of acute on-snow severe injury events (SIE) in elite alpine ski racing, (2) examine the development of SIE over 22 seasons, and (3) analyse SIE with respect to the severely injured body parts and structures. METHODS: Data recorded in the Austrian Ski Federation's Injury Surveillance System over 22 seasons were analysed. The Austrian Ski Team consists of four groups: Team National (n=477), Team A (n=444), Team B (n=696) and Team C (n=608). Team National and Team A comprised World Cup, Team B European Cup and Team C junior alpine ski racers. Simple and multiple Poisson regressions were calculated. RESULTS: The SIE incidence was 15.7 (95% CI 14.2 to 17.5) per 100 skier seasons. ACL injury events accounted for 70.8% of severe knee injury events and 48.6% of SIE. The incidence of severe ACL injury events was 7.6 (95% CI 6.6 to 8.9). Female World Cup alpine ski racers had a 1.65 times (95% CI 1.02 to 2.69) higher risk of severe ACL injury events than their male counterparts. CONCLUSION: The incidence of acute on-snow SIE in World Cup alpine ski racing was higher than previously reported. Despite various prevention efforts, the average seasonal incidence of SIE in World and European Cup alpine ski racers has grown from approximately 11 in 1997 to 23 in 2019; thus with roughly one more injured athlete every second season.

[Access to Early Childhood Interventions in Children̛s Hospital: Screening as Clinical Routine Procedure - Exploration and Transfer by a Specialized Team]. / Zugang zu Frühen Hilfen in der Kinderklinik: Belastungsscreening als klinische Routine ­ differenzierte Exploration und Vermittlung durch das Fachteam.

BACKGROUND: In order to prevent risks associated with insufficient family care, it is mandatory to provide early childhood interventions for parents unable to cope with their young children in best time. Children̛s hospitals represent one pillar that hasn´t been fully explored yet. METHODS: As a proof-of-concept, we performed a study to determine the feasibility of a standardized risk assessment tool during routine work of doctors and nurses in a university department. RESULTS: Our data indicate that a standardized screen to assess stress is powerful in identifying stressed parents, especially those with children under the age of one year. In this context, psychosocial stress in families with newborns was most frequently indicated. The placement rates into early childhood interventions (8.5%) and youth welfare services (11.3%) correspond to the literature. DISCUSSION AND CONCLUSION: The standardized risk assessment tool can be used as a "call button" and delivers a basis for further differentiated exploration of the families by a specialized team and might be used to deliver services for these families. In summary children's hospitals might be useful to provide a low-threshold access into early childhood interventions.

Efficacy of selective serotonin reuptake inhibitors and adverse events: meta-regression and mediation analysis of placebo-controlled trials.

BACKGROUND: It has been suggested that the efficacy of antidepressants has been overestimated in clinical trials owing to unblinding of drug treatments by adverse events. AIMS: To investigate the association between adverse events and the efficacy of selective serotonin reuptake inhibitors (SSRIs). METHOD: The literature was searched to identify randomised, double-blind, placebo-controlled trials of SSRIs in the treatment of major depression. Efficacy outcomes were response to treatment and change in depressive symptoms. Reporting of adverse events was used as an indicator of tolerability. Random effects meta-analyses were used to calculate pooled estimates. Meta-regression analyses were performed to investigate the association between adverse events and efficacy. Potential mediation was investigated with the Baron & Kenny approach. RESULTS: A total of 68 trials (n = 17 646) were included in the analyses. In meta-analysis SSRIs were superior to placebo in terms of efficacy (odds ratio, OR = 1.62, 95% CI 1.51-1.72). More patients allocated to SSRIs reported adverse events than did patients receiving placebo (OR = 1.73, 95% CI 1.58-1.89). Meta-regression analyses did not find an association between adverse events and efficacy (P = 0.439). There was no indication of adverse events mediating the effect of SSRI treatment. CONCLUSIONS: Our results do not support, but also do not unequivocally disprove, the hypothesis that adverse events lead to an overestimation of the effect of SSRIs over placebo.

[Pediatrician-parent interaction and early prevention : A review about the limits in addressing psychosocial risks during well-child visits]. / Das pädiatrische Elterngespräch und Frühe Hilfen : Eine Übersicht über Grenzen der Belastungsansprache in Früherkennungsuntersuchungen.

BACKGROUND: Pediatricians can be a door opener to early prevention for families at risk. The German well-child program is well-established, but there is a gap between the structural possibilities and the observed placements. OBJECTIVE: The aim of this review is to show how pediatricians and parents talk about psychosocial risks under the very structured conditions of well-child visits. The challenges and traps of the framed interactions will be described and options for early prevention will be shown. METHODS: The review is primarily based on the work of conversational and ethnomethodological studies reconstructing the pediatrician's discussion with parents about psychosocial issues in the family. RESULTS: Well-child visits are a highly routinized practice. Talking about family issues for both partners is a difficult task. Discussions about psychosocial issues are seldom and vague . Predominantly, they work cooperatively on reciprocal normalization of the child's development. Based on this shared orientation, pediatricians make an early, mostly general, prescription of parental tasks, supporting the child in the next developmental step. This kind of routine anticipatory counselling puts some pressure on the parents. Parents under unknown stress could be overburdened with this advice. CONCLUSION: In the script of well-child visits, there are no slots that indicate to pediatricians and parents when, which, how and for what purpose psychosocial issues can be discussed and negotiated. For implementing such slots in well-child visits, three steps are necessary: a structured and regular assessment of psychosocial issues, a trained pediatrician in motivational interviewing and a social worker guiding the family in the network of early prevention.

[Case finding in early prevention networks - a heuristic for ambulatory care settings]. / Fallfindung im Netzwerk Frühe Hilfen - eine Heuristik für die ambulante Versorgung.

BACKGROUND: One goal of early prevention is the support of families with small children up to three years who are exposed to psychosocial risks. The identification of these cases is often complex and not well-directed, especially in the ambulatory care setting. OBJECTIVE: Development of a model of a feasible and empirical based strategy for case finding in ambulatory care. METHODS: Based on the risk factors of postpartal depression, lack of maternal responsiveness, parental stress with regulation disorders and poverty a lexicographic and non-compensatory heuristic model with simple decision rules, will be constructed and empirically tested. Therefore the original data set from an evaluation of the pediatric documentary form on psychosocial issues of families with small children in well-child visits will be used and reanalyzed. RESULTS: The first diagnostic step in the non-compensatory and hierarchical classification process is the assessment of postpartal depression followed by maternal responsiveness, parental stress and poverty. The classification model identifies 89.0 % cases from the original study. Compared to the original study the decision process becomes clearer and more concise. CONCLUSIONS: The evidence-based and data-driven model exemplifies a strategy for the assessment of psychosocial risk factors in ambulatory care settings. It is based on four evidence-based risk factors and offers a quick and reliable classification. A further advantage of this model is that after a risk factor is identified the diagnostic procedure will be stopped and the counselling process can commence. For further validation of the model studies, in well suited early prevention networks are needed.

Effects of Early Talent Promotion on Junior and Senior Performance: A Systematic Review and Meta-Analysis.

BACKGROUND: Does younger involvement in talent promotion programs (TPPs) facilitate the attainment of higher performance levels? This question is the subject of the present meta-analysis. Many national sport systems have established TPPs such as federations' junior squads (including under-age selection teams) and youth sport academies, and many are making expanding investments in TPPs. TPPs seek to select the most advanced youth high performers at young ages, around puberty or younger, and then strive to further accelerate their performance development. However, studies show 25-55% annual athlete turnover within TPPs. In this context, accelerated biological maturation (puberty, growth spurt), high relative age within one's birth year, and intensified sport-specific childhood/adolescent practice may boost rapid junior performance, but the effects diminish or are reversed by adulthood. Moreover, expanded opportunity costs and risks (time demands, injury, burnout) imposed on young TPP participants may impair their long-term development and even prematurely terminate their career. OBJECTIVE: We aimed to provide robust and generalizable evidence on the effects of early talent promotion on junior and senior performance through a systematic review and meta-analysis. METHODS: A systematic literature search was conducted 18/03-03/04/2023 in SPORTDiscus, ProQuest, PsycINFO, PubMed, Scopus, WorldCat, and Google Scholar. We searched for original studies that compared athletes across defined higher and lower performance levels within defined types of sports, age categories, and sexes, regarding their age at commencement of TPP involvement and reported effect sizes or data needed to compute effects sizes. Mean meta-analytic Cohen's d ¯ was computed separately for junior and senior athletes. Quality of evidence was evaluated using the mixed-methods appraisal tool. RESULTS: The search yielded k = 51 effect sizes from N = 6233 athletes from a wide range of countries and sports, 82% male and 18% female, from 2009 to 2022. The central finding is that effects on short-term junior performance versus long-term senior performance are opposite, whereby higher-performing junior athletes began TPP involvement at younger ages than lower-performing junior athletes, d ¯ = - 0.53. In contrast, higher-performing senior athletes began TPP involvement at older ages than lower-performing senior athletes, d ¯ = 0.56. The findings are robust across different TPPs (federation's junior squad/selection team, youth academy), individual and team sports, and performance levels compared (international, national, regional). The quality of primary studies was high. DISCUSSION: The findings are consistent with recent meta-analytic evidence that participation patterns predicting early junior success versus long-term senior success are opposite (starting age, main-sport and other-sports practice amounts, age to reach performance 'milestones'). We discuss theoretical and practical implications of potential selection and 'treatment' effects of TPPs. CONCLUSIONS: Consistent across different populations, early TPP involvement is positively correlated with short-term junior performance but is negatively correlated with long-term senior performance.

Quantifying the Extent to Which Junior Performance Predicts Senior Performance in Olympic Sports: A Systematic Review and Meta-analysis.

BACKGROUND: To what extent does junior athletic performance predict senior athletic performance (i.e., in the highest, open-age category)? This question is the subject of a lively debate in the literature. Following traditional theories of giftedness and expertise, some researchers and practitioners have proposed that a high level of junior performance is a prerequisite for the development of a high level of later senior performance. Sceptics of this view hold that junior performance has limited predictive value for later senior performance, pointing to empirical evidence indicating that predictors (e.g., participation patterns) of junior performance and of senior performance differ. The straightforward way to resolve this controversy empirically is to test the correlation between junior and senior performance. OBJECTIVE: To provide robust and generalizable evidence on this issue, we performed a systematic review and meta-analysis of relevant studies. The aim was to quantify the overall correlation between junior and senior performance and then test whether correlations vary across junior age categories and subsamples (e.g., types of sports). METHODS: A systematic literature search was conducted in SPORTDiscus, Eric, ProQuest, PsychInfo, PubMed, Scopus, WorldCat, and Google Scholar from 27 January through 30 April 2022. We searched for original studies that recorded athletes' junior and senior performance longitudinally and included measures of association between junior and senior performance. Quality of evidence was evaluated using the Mixed Methods Appraisal Tool version for nonrandomized studies. RESULTS: The search yielded k = 129 effect sizes from N = 13,392 athletes from a wide range of Olympic sports, 62% male and 38% female, from 2006 to 2021. Four central findings emerged: (1) Overall, the meta-analytic pooled correlation between junior and senior performance was [Formula: see text] = 0.148. That is, junior performance explained only 2.2% of the reliable variance in senior performance. (2) The finding was robust across types of sports, sexes, wider or narrower performance ranges, national or international samples, and binary or continuous performance measures. (3) Effects varied across junior age categories: the younger the junior age category, the lower the correlation between junior and senior performance, with [Formula: see text] ranging from [Formula: see text] = - 0.052 to [Formula: see text] = 0.215. That is, across junior age categories, junior performance explained 0-4.6% of the reliable variance in senior performance. (4) The quality of primary studies was high. DISCUSSION: The results suggest that junior performance has very little, if any, predictive value for senior performance. The findings run counter to claims from traditional theories of both giftedness and expertise. From an applied perspective, talent selection typically begins around puberty or younger-age ranges where youth performance is uncorrelated or negatively correlated with later senior performance. The evidence presented here raises serious questions about the use of junior performance for talent selection purposes. A PRISMA-P protocol was registered at https://osf.io/gck4a/ .

Perceived social support and characteristics of social networks of families with children with special healthcare needs following the COVID-19 pandemic.

Background: Children with special healthcare needs (CSHCN) require more support than the average of their peers. Support systems for CSHCN were particularly affected by pandemic control measures. Perceived social support is a resource for health and wellbeing for CSHCN and their families. Associations of social support, mental health and socioeconomic status (SES) have been described. This study aims to (1) assess perceived social support in families with and without CSHCN; (2) describe structure and types of social networks of families with and without CSHCN; and (3) explore associations between perceived social support, disease complexity, child and caregiver mental health, and SES. Methods: This is the third of a sequential series of cross-sectional online surveys conducted among caregivers of children ≤ 18 years in Germany since the beginning of the COVID-19 pandemic, administered between 1st December 2022 and 10 March 2023. The Brief Social Support Scale (BS6) assessed perceived social support. Child and parental mental health were assessed using the Strengths and Difficulties Questionnaire (SDQ) and WHO-5 Wellbeing index. The CSHCN-Screener identified CSHCN. Descriptive statistics and linear regression modeling assessed associations between perceived social support, parent-reported child mental health problems, disease complexity, caregiver mental wellbeing and SES. Results: The final sample included 381 participants, among them 76.6% (n = 292) CSHCN. 46.2% (n = 176) of caregivers reported moderate, i.e., at least occasional social support. Social support was largely provided by informal social networks consisting of partners, relatives and neighbors/friends. Linear regression modeling revealed associations of lower perceived social support with higher disease complexity of the child, lower caregiver mental wellbeing, lower SES and increasing caregiver age. Conclusion: The results of this study describe inequalities in perceived social support according to disease complexity of the child, caregiver mental health and socioeconomic status. They highlight the importance of social support and support networks as a resource for wellbeing of caregivers and CSHCN. Moving on from the COVID-19 pandemic, recovery strategies should focus on low-threshold interventions based in the community to improve social support for families with CSHCN and actively involve caregivers in identifying needs and co-creating new approaches.

Biocontrol potential of entomopathogenic nematodes against the grey maize weevil Tanymecus dilaticollis (Coleoptera: Curculionidae) adults.

The grey maize weevil, Tanymecus dilaticollis, is a polyphagous species, which is among the most important pests of maize in Southeastern Europe. The efficacy of commercial products with two species of entomopathogenic nematodes (EPNs), Steinernema carpocapsae and Heterorhabditis bacteriophora, was investigated against adults of the grey maize weevil under laboratory conditions. Nemastar®, containing S. carpocapsae was more effective on T. dilaticollis adults than Nematop® containing H. bacteriophora, when applied uniformly to the surface of the soil, on Petri dishes containing T. dilaticollis adults. Results showed that S. carpocapsae rates of 83-333 infective juveniles/adult caused > 94% mortality in T. dilaticollis adults, whereas H. bacteriophora caused 27-61%, adult mortality, after exposure of insects to the commercial products of EPNs for 15 days. The infection rates of EPNs increased with concentration applied and ranged from 70-83% and 19-64% for Nemastar® and Nematop®, respectively. Subsequent field and semi-field tests were conducted with Nemastar® (application rate of 50 million S. carpocapsae per 100 m2) in maize crops with biological (mycoinsecticide Naturalis®, biofungicides and fertilizers) and chemical seed treatment (Gaucho® FS 600; active ingredient: imidacloprid) in Knezha, Bulgaria. Nematodes were found only in the dead specimens, in open plots and cages sprayed with the commercial nematode product. Nematode sprayings contributed for higher maize yields in the open maize plots in the fields with different seed treatments. We suggest that the use of powder formulation of S. carpocapsae in combination with biologically treated maize seeds can contribute to minimize the use of chemical insecticides against the grey maize weevil. The results obtained can be used as a base to further tests to ascertain the efficacy of EPNs products before they can be recommended for use in the integrated approach to T. dilaticollis management.

COVID-19 and spinal cord injury: clinical presentation, clinical course, and clinical outcomes of people hospitalised.

STUDY DESIGN: Retrospective study OBJECTIVES: To describe the presenting symptoms/signs, clinical course and outcomes in hospitalised people with spinal cord injury (SCI) and symptomatic COVID-19 infections. SETTING: One university hospital and two SCI centres in Switzerland. METHODS: Descriptive analysis of symptoms/signs, clinical course and outcomes of people with SCI with symptomatic COVID-19 infections and need for hospitalisation. RESULTS: Twenty-two people with SCI were included, 15 (68%) were male, median age 64.5 years (interquartile range, IQR, 52-73 years). Nine (41%) had tetraplegia, and eight (36%) were classified with motor-complete lesions. Frequent clinical symptoms were fever (59%), coughing (54%), fatigue (50%), and dyspnoea (27%). Most frequent complications were bacterial pulmonary superinfection (18%), and acute respiratory distress syndrome (18%). Fifteen persons (68%) needed oxygen therapy during the course of hospitalisation, and 7 (32%) people were ventilated. Median length of stay (LOS) was 23 days (IQR 15-35), varying by age for people under 60 years with a median LOS of 9 days (IQR 8-27), and for those older than 60 years with a median of 34 days (IQR 17-39), respectively. In total, 3 persons (14%) died during hospitalisation, all older with paraplegia. CONCLUSIONS: Typical symptoms like fever and coughing were not present in all people. People with tetraplegia did not demonstrate worse outcomes, on the contrary, they had shorter LOS, no difference in ventilation needs, and no higher mortality compared to people with paraplegia. Older people showed longer LOS. This study recommends close supervision of the SCI population to detect early signs and symptoms of COVID-19 infection.

Participation patterns in talent development in youth sports.

There has been a longstanding debate about the question: What amounts of what types of youth sport activities optimally facilitate later athletic excellence? This article provides a review of relevant research. We first evaluate popular conceptualizations of participation patterns-early specialization, deliberate practice, and deliberate play. Then, we review the available evidence on associations between performance and individual participation variables. The review reveals conceptual, definitional, and empirical flaws of the conceptions of early specialization, deliberate practice, and deliberate play. These approaches thus possess limited usefulness for empirical research. A review of studies considering individual, clearly defined participation variables provides a differentiated pattern of findings: Predictors of rapid junior performance and of long-term senior performance are opposite. Higher-performing juniors, compared to lower-performing peers, started playing their main sport, began involvement in talent promotion programs, and reached developmental performance milestones at younger ages, while accumulating larger amounts of coach-led main-sport practice, but less other-sports practice. In contrast, senior world-class athletes, compared to less-accomplished national-class peers, started playing their main sport, began involvement in talent promotion programs, and achieved performance milestones at older ages, while accumulating less coach-led main-sport practice, but more other-sports practice. We discuss implications for theory, practice, and future research.

Quantifying the Extent to Which Successful Juniors and Successful Seniors are Two Disparate Populations: A Systematic Review and Synthesis of Findings.

BACKGROUND: To what extent does the pathway to senior elite success build on junior elite success? Evidence from longitudinal studies investigating athletes' junior-to-senior performance development is mixed; prospective studies have reported percentages of juniors who achieved an equivalent competition level at senior age (e.g., international championships at both times) ranging from 0 to 68%. Likewise, retrospective studies have reported percentages of senior athletes who had achieved an equivalent competition level at junior age ranging from 2 to 100%. However, samples have been heterogeneous in terms of junior age categories, competition levels, sex, sports, and sample sizes. OBJECTIVE: This study aimed to establish more robust and generalizable findings via a systematic review and synthesis of findings. We considered three competition levels-competing at a national championship level, competing at an international championship level, and winning international medals-and addressed three questions: (1) How many junior athletes reach an equivalent competition level when they are senior athletes? (2) How many senior athletes reached an equivalent competition level when they were junior athletes? The answers to these questions provide an answer to Question (3): To what extent are successful juniors and successful seniors one identical population or two disparate populations? METHODS: We conducted a systematic literature search in SPORTDiscus, ERIC, ProQuest, PsychInfo, PubMed, Scopus, WorldCat, and Google Scholar until 15 March 2022. Percentages of juniors who achieved an equivalent competition level at senior age (prospective studies) and of senior athletes who had achieved an equivalent competition level at junior age (retrospective studies) were aggregated across studies to establish these percentages for all athletes, separately for prospective and retrospective studies, junior age categories, and competition levels. Quality of evidence was evaluated using the Mixed Methods Appraisal Tool (MMAT) version for descriptive quantitative studies. RESULTS: Prospective studies included 110 samples with 38,383 junior athletes. Retrospective studies included 79 samples with 22,961 senior athletes. The following findings emerged: (1) Few elite juniors later achieved an equivalent competition level at senior age, and few elite seniors had previously achieved an equivalent competition level at junior age. For example, 89.2% of international-level U17/18 juniors failed to reach international level as seniors and 82.0% of international-level seniors had not reached international level as U17/18 juniors. (2) Successful juniors and successful seniors are largely two disparate populations. For example, international-level U17/18 juniors and international-level seniors were 7.2% identical and 92.8% disparate. (3) Percentages of athletes achieving equivalent junior and senior competition levels were the smallest among the highest competition levels and the youngest junior age categories. (4) The quality of evidence was generally high. DISCUSSION: The findings question the tenets of traditional theories of giftedness and expertise as well as current practices of talent selection and talent promotion. A PRISMA-P protocol was registered at https://osf.io/gck4a/ .

Laboratory Findings, Medical Imaging, and Clinical Outcome in Children with Cerebral Sinus Venous Thrombosis.

INTRODUCTION: Cerebral sinus venous thrombosis (CSVT) is a rare disease, especially in children. Therefore, thrombophilia markers, risk factors, treatment strategy, and MRI, as well as clinical outcome need further investigation to support future diagnostic and therapeutic guidelines for children. METHODS: We retrospectively identified all children with CSVT treated in our center between January 1, 2000, and December 31, 2015. Risk factors and laboratory findings were investigated. Furthermore, outcome and treatment satisfaction were evaluated using magnetic resonance imaging (MRI) analyses and a modified questionnaire. RESULTS: All 43 patients, who agreed to participate, were treated with therapeutic levels of heparin; 86% of children had an increased risk for thromboembolic events upon onset of CSVT (acute disease: 58.1%, perinatal risk factors: 9.3%, medical intervention/immobility: 14%, chronic disease: 16.3%). Thrombophilia markers showed positive results (e.g., reduced values for protein C/S, factor-V-Leiden mutation) in 58% of children at the time of CSVT diagnosis but dropping to 20.9% over the course of the disease. Forty-two of 43 patients received MRI follow-ups and the outcome showed complete recanalization in 69% of the patients and partial recanalization in 31%. At the onset of CSVT, 88% of patients reported restrictions in everyday life due to CSVT; at follow-up this percentage declined to 18%. Satisfaction with the outcome among parents/patients according to the questionnaire was high with 1.7 (German school grades from 1 to 6). CONCLUSIONS: All 42 children with MRI follow-up demonstrated complete or partial recanalization under anticoagulation. This positive result underlines the need for future studies on anticoagulation to optimize therapy regimens of pediatric CSVT.

Birth of monozygotic dichorionic twins after a single blastocyst embryo transfer: a case report of genetic determination of zygosity.

Objective: To report a case of monozygotic dichorionic (DC) twins after a single cryopreserved blastocyst embryo transfer followed by genetic determination of zygosity postpartum. Design: Case report. Setting: University hospital. Patients: A 26-year-old woman with polycystic ovary syndrome and her 36-year-old male partner with severe oligozoospermia, resulting in a 1.5-year history of primary infertility. Interventions: Controlled ovarian stimulation and intracytoplasmic sperm injection treatment with single cryopreserved embryo transfer at blastocyst stage. Main Outcome Measures: Ultrasound images of the fetuses and short tandem repeat genotyping postpartum. Results: A DC twin pregnancy following a single cryopreserved blastocyst embryo transfer was confirmed at the first trimester screening. Confirmatory testing performed postpartum included short tandem repeat analysis determining monozygosity and pathology examination reporting DC placental configuration. Conclusions: Dichorionic monozygotic twins are thought to arise from the splitting of an embryo before the blastocyst stage. This case suggests that placental configuration of monozygotic twins may not strictly depend on timing of embryo division. Genetic analysis is the only tool to confirm the zygosity.

Cardiovascular risk in pediatric type 1 diabetes: sex-specific intima-media thickening verified by automatic contour identification and analyzing systems.

OBJECTIVES: To improve screening and quantification of subclinical atherosclerosis in children and adolescents with type 1 diabetes (T1D), we investigated the distribution of cardiovascular risk factors (cRFs) and carotid intima-media thickness (cIMT) percentiles with regard to sex-specific differences. METHODS: This cross-sectional analysis included clinical parameters, blood lipids, and B-mode ultrasound examination of the bilateral mean cIMT using an automatic contour identification procedure combined with computerized analysis. RESULTS: A total of 270 patients were eligible for evaluation (126 females, mean age 13.7 yr; 144 males, mean age 13.8 yr). In the total group, cIMT was significantly related to sex and diabetes duration but not to age. In males, cIMT was significantly higher than in females and sex-specific cIMT percentiles were calculated. Both pulse pressure and diabetes duration in boys and low-density lipoprotein (LDL)-cholesterol, hemoglobin A1c (HbA1c), and diabetes duration in girls showed a significant association with cIMT. CONCLUSIONS: On the basis of sex differences of cRFs and cIMT in pediatric T1D, the assessment of sex-specific IMT percentiles facilitates a differentiated interpretation of subclinical atherosclerosis. The underlying diabetes and additional cRFs seem to be more important determinants of intima-media thickening than age. To improve the comparability of IMT measurements of relevant studies, the international harmonization of IMT measurements should be aimed for.

Predictors of Junior Versus Senior Elite Performance are Opposite: A Systematic Review and Meta-Analysis of Participation Patterns.

BACKGROUND: Does early specialization facilitate later athletic excellence, or is early diversification better? This is a longstanding theoretical controversy in sports science and medicine. Evidence from studies investigating athletes' starting age, childhood/adolescent progress, and amounts of coach-led practice and peer-led play in their main sport and in other sports has been mixed. Each participation variable was positively correlated with performance in some studies but uncorrelated or negatively correlated with performance in others. However, samples were heterogeneous in age, sports, and performance levels. OBJECTIVE: This study aimed to establish robust, generalizable findings through a systematic review and meta-analysis. We investigated three questions: (1) did higher- and lower-performing athletes differ in childhood/adolescent progress, starting age, or amounts of main-sport or other-sports practice or play; (2) do effects differ between junior and adult athletes, compared performance levels, or types of sports; and (3) are effect sizes from different predictors associated with one another? METHODS: We conducted a systematic literature search in SPORTDiscus, ERIC, ProQuest, PsycINFO, PubMed, Scopus, WorldCat, and Google Scholar until 28 February 2021. Selection criteria included original research studies comparing higher- versus lower-performing athletes regarding one or more of our predictor variables within defined age categories, sports, and sex, and reporting effect sizes or data needed to compute effects sizes. Mean meta-analytic Cohen's d was calculated for each predictor. Quality of evidence was evaluated using GRADE. RESULTS: In total, 71 study reports met all eligibility criteria and included 262 international athlete samples, 685 effect sizes, and a total sample size of 9241 athletes from local to Olympic competition level and from diverse sports. The following findings emerged. (1) Compared with their national-class counterparts, adult world-class athletes had more childhood/adolescent multi-sport coach-led practice, a later main-sport start, less main-sport practice, and slower initial progress (|0.23|< [Formula: see text]<|0.50|; all p < 0.001). (2) The opposite was true for predictors of junior-age performance: higher-performing juniors had an earlier main-sport start, more main-sport practice, less other-sports practice, and faster initial progress (|0.23|< [Formula: see text]< |0.61|; all p < 0.001). (3) Main-sport or other-sports peer-led play had negligible effects (all p > 0.05). (4) Results were robust across types of sports. (5) Effect sizes from different predictors were associated with one another (|0.64|< r <|0.79|). A GRADE assessment revealed a low quality of evidence for peer-led play but a moderate to high quality of evidence for all other predictors. DISCUSSION: Excess childhood/adolescent specialized practice may hinder athletes' long-term development through overuse injury, burnout, suboptimal athlete-sport match, and limiting long-term learning capital. By contrast, adult world-class athletes' childhood/adolescent multi-sport practice with reduced main-sport practice implied a relatively resource-preserving, cost-reducing, and risk-buffering pattern that yielded greater long-term sustainability and practice efficiency.