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Background: Insufficient evidence exists to support the recommendation for coordinated, multidisciplinary care for the outpatient treatment of patients with anorexia nervosa. The objective of this study was to conduct a pragmatic assessment of care delivered through a retrospective comparative examination of patients who received a coordinated, multidisciplinary approach (medical provider, registered dietitian, and mental health professional collaborating to coordinate patient care) on clinical outcomes for treatment of anorexia nervosa (AN). Methods: Historical electronic medical record data on patients aged 6 to 80 years diagnosed with AN seen in a healthcare system between 2007 and 2017 were stratified, according to services received, into three groups: Group A (n = 48) received hospital-based services; Group B (n = 290) saw one or two provider types; Group C (n = 26) received outpatient coordinated multidisciplinary care from three provider types. Clinical outcomes (body mass index for adults, body mass index percentile for pediatric patients) defined AN severity and weight restoration. Electronic medical record data were analyzed using a generalized mixed-effects model and a Markov Transition model to examine the odds of weight restoration and the change in odds of weight restoration across the number of provider visits, respectively. Results: Patients receiving coordinated multidisciplinary care had significantly higher odds of weight restoration compared with patients receiving hospital-based services only (OR = 3.76, 95% CI [1.04, 13.54], p = 0.042). Additionally, patients receiving care from 1-2 providers (OR = 1.006, 95% CI [1.003, 1.010], p = 0.001) or receiving coordinated multidisciplinary care (OR = 1.005, 95% CI [1.001, 1.011], p = 0.021) had significantly higher odds of weight restoration per provider visit day. Conclusions: This retrospective chart review supports the coordinated, multidisciplinary care model for the outpatient treatment of AN.

The objective of this research is to obtain empirical evidence about the influence of liquidity, leverage, dividend policy, firm size, profitability, institutional ownership, and managerial ownership as independent variables to firm value as dependent variable in Indonesia non-financial companies. The research used companies listed in non-financial sectors in Indonesia Stock Exchange on 2018-2020. There are 103 companies meet the criteria by using purposive sampling method. The research uses multiple regression method for data analysis. The result shows that leverage and profitability have influence to firm value, while other independent variables such as liquidity, dividend policy, firm size, institutional ownership and managerial ownership have no influence towards firm value in the company.

Athletes are vulnerable to sexual violence. Perpetrators of sexual violence may be a trusted coach, a member of the health care team, or a peer. The consequences of sexual violence are wide ranging, resulting in immediate and long-term physical and mental health outcomes that require recognition and comprehensive, multidisciplinary care. Sports medicine providers need to have specific knowledge and skill to care for athletes who experience sexual violence. Several sports organizations (e.g., International Olympic Committee, United States Olympic and Paralympic Committee, the National Collegiate Athletic Association, and the National Athletic Trainers' Association) have developed policies and procedures to prevent sexual violence and help sports medicine specialists provide care and services for athletes affected by sexual violence. Nevertheless, there remains a need for clinical guidelines, screening tools, and education, as well as clinical best practices to address sexual violence in sports medicine.

This study aims to describe indigenous peoples’ use of social media. There are 110 ethno-linguistic groups in the Philippines who comprise nearly 15 percent of total population. Majority of indigenous peoples live in the island of Mindanao. Phenomenology was used for this study in explaining the experiences and perspectives of the Blaan students in using social media. Twenty-five Blaan students from Matanao, Davao del Sur were selected through purposive sampling. Through in-depth interviews and focus group discussion it was revealed that entertainment and leisure, emotional trauma and discrimination, research and educational purposes, and communication and socialization were the issues related to the Blaan students’ experiences on using social media. As regards insights in using social media, they identified time management, stand against discrimination, staying hopeful and positive, respecting and promoting culture, and prioritizing education. This study has significance not only in but also in the indigenous peoples’ cultural community in terms of promoting and preserving culture in the digital age.

This study aimed to determine the mediating effect of wellbeing on the relationship between financial literacy and professional commitment of public school teachers. Stratified random sampling technique was used which included 300 public school teachers as respondents. Through non-experimental quantitative mediation test, validated questionnaire, mean and per-son, results showed significant relationships between financial literacy of teachers, professional commitment and wellbeing. However, there was no mediation on the effect of wellbeing on the relationship between financial literacy and professional commitment of teachers. Furthermore, to improve the level of wellbeing of the public school teachers, the mediating model can be tested keeping in view the socio demographics for better results as the scope of this research required testing of the model. The attitudinal variable of financial literacy relies on many factors as well and to get a holistic picture of what exact source of financial literacy.

The Male Athlete Triad is a medical syndrome most common in adolescent and young adult male athletes in sports that emphasize a lean physique, especially endurance and weight-class athletes. The 3 interrelated conditions of the Male Athlete Triad occur on spectrums of energy deficiency/low energy availability (EA), suppression of the hypothalamic-pituitary-gonadal axis, and impaired bone health, ranging from optimal health to clinically relevant outcomes of energy deficiency/low EA with or without disordered eating or eating disorder, functional hypogonadotropic hypogonadism, and osteoporosis or low bone mineral density with or without bone stress injury (BSI). Because of the importance of bone mass acquisition and health concerns in adolescence, screening is recommended during this time period in the at-risk male athlete. Diagnosis of the Male Athlete Triad is best accomplished by a multidisciplinary medical team. Clearance and return-to-play guidelines are recommended to optimize prevention and treatment. Evidence-based risk assessment protocols for the male athlete at risk for the Male Athlete Triad have been shown to be predictive for BSI and impaired bone health and should be encouraged. Improving energetic status through optimal fueling is the mainstay of treatment. A Roundtable on the Male Athlete Triad was convened by the Female and Male Athlete Triad Coalition in conjunction with the 64th Annual Meeting of the American College of Sports Medicine in Denver, Colorado, in May of 2017. In this second article, the latest clinical research to support current models of screening, diagnosis, and management for at-risk male athlete is reviewed with evidence-based recommendations.

The purpose of this study was to determine the domain in servant leadership that significantly influenced organizational citizenship behavior. The researcher employed quantitative research design utilizing the non-experimental, co-relational method of research as the data collection instrument. Specifically, it determined if servant leadership significantly influenced organizational citizenship behavior. The instrument used was the Or-ganizational Citizenship Behavior Questionnaire (OCBQ) to measure the dependent variable and Servant Leader-ship Scale to measure the independent variable and was validated by experts. The respondents of the study were the public elementary school teachers. Findings reveal that among the level of servant leadership, organizational stewardship was very high and when it comes to organizational citizenship behavior, only sportsmanship was moderate. There is a significant relationship between servant leadership and organizational citizenship behavior and among the domains of servant leadership, emotional healing, wisdom and organizational stewardship significantly influenced the organizational citizenship of school heads.

Background: Approximately 30 million Americans currently suffer from diabetes, and nearly 55 million people will be impacted by 2030. Continuous glucose monitoring (CGM) systems help patients manage their care with real-time data. Although approximately 95% of those with diabetes suffer from type 2, few studies have measured CGM’s clinical impact for this segment within an integrated healthcare system. Methods: A parallel randomized, multisite prospective trial was conducted using a new CGM device (Dexcom G6) compared to a standard of care finger stick glucometer (FSG) (Contour Next One). All participants received usual care in primary care clinics for six consecutive months while using these devices. Data were collected via electronic medical records, device outputs, exit surveys, and insurance company (SelectHealth) claims in accordance with institutional review board approval. Results: Ninety-nine patients were randomized for analysis ( n = 50 CGM and n = 49 FSG). CGM patients significantly decreased hemoglobin A1c ( p = .001), total visits ( p = .009), emergency department encounters ( p = .018), and labs ordered ( p = .001). Among SelectHealth non-Medicare Advantage patients, per member per month savings were $417 for CGM compared to FSG, but $9 more for Medicare Advantage. Seventy percent of CGM users reported that the technology helped them better understand daily activity and diet compared to only 16% for FSG. Discussion: Participants using CGM devices had meaningful improvements in clinical outcomes, costs, and self-reported measures compared to the FSG group. Although a larger study is necessary to confirm these results, CGM devices appear to improve patient outcomes while making treatment more affordable.

The purpose of this phenomenological qualitative study was to give light to the experiences of working women and women leaders who are also victims of domestic violence. This study may inspire women from all walks of life and to give voice to the abused women to stand for their rights in advancing gender equality and development. Five informants from Matanao, Davao del Sur were selected through purposive sampling on February 18, 2017, for an in-depth interview. The research design employed in this study was phenomenology as it explained well the experiences and perspectives of women leaders on domestic violence. The results of the interview were transcribed, translated, and coded to produce themes. Several issues escalated as regards to the narratives of working women leaders who are abused at home, the following were the themes: anxiety and signs of depression, prejudice, low self-esteem, and poor disposition, and resilience. As to their insights that they can share with other women and to the academe: disputing chauvinism, the optimistic outlook in life, faith in God, tenets on leadership, and gender distinctions.

Assessing physical activity is an opportunity to encourage lifestyle-based tactics for reducing cardiovascular risk. These handy tables serve as practical guides.

Approximately 1 in 3 American adults has prediabetes, a condition characterized by blood glucose levels that are above normal, not in the type 2 diabetes ranges, and that increases the risk of developing type 2 diabetes. Evidence-based treatments can be used to prevent or delay type 2 diabetes in adults with prediabetes. The American Medical Association (AMA) has collaborated with health care organizations across the country to build sustainable diabetes prevention strategies. In 2017, the AMA formed the Diabetes Prevention Best Practices Workgroup (DPBP) with representatives from 6 health care organizations actively implementing diabetes prevention. Each organization had a unique strategy, but all included the National Diabetes Prevention Program lifestyle change program as a core evidence-based intervention. DPBP established the goal of disseminating best practices to guide other health care organizations in implementing diabetes prevention and identifying and managing patients with prediabetes. Workgroup members recognized similarities in some of their basic steps and considerations and synthesized their practices to develop best practice recommendations for 3 strategy maturity phases. Recommendations for each maturity phase are classified into 6 categories: (1) organizational support; (2) workforce and funding; (3) promotion and dissemination; (4) clinical integration and support; (5) evaluation and outcomes; (6) and program. As the burden of chronic disease grows, prevention must be prioritized and integrated into health care. These maturity phases and best practice recommendations can be used by any health care organization committed to diabetes prevention. Further research is suggested to assess the impact and adoption of diabetes prevention best practices.

ObjectivesTo describe the characteristics and outcomes of hospitalised patients with COVID-19 from UK in the highest decile of health and gross regional products per capita.DesignProspective cohort study.SettingRecruited all adult inpatients with laboratory-confirmed COVID-19 symptoms admitted to a single Surrey centre between March and April 2020. Extensive demographic details were documented.Outcome measureCOVID-19 status of alive/dead and intensive care unit (ICU) status of yes/no.ParticipantsPatients with COVID-19 from Surrey centre UK (n=429).Results429 adult inpatients (mean age 70±18 years; men 56.4%) were included in this study, of whom, 19.1% required admission to ICU and 31.9% died. Adverse outcomes were associated with age (OR with each decade of years: 1.78, 95% CI 1.53 to 2.11, pConclusionsDespite reports of worse outcomes in deprived regions, we show similar complication and mortality rates due to COVID-19 in an affluent and high life expectancy region.

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a position statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the position statement. The objective of this position statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.

The daily evolution of the nursing profession has charged nurse educators to be innovative and creative in their teaching strategies, with the goal of engaging and motivating students and promoting lifelong learning. Educational escape rooms use multiple teaching/learning strategies, such as problem-based learning, flipping the classroom, and gamification, to engage learners and promote active learning. The educational escape room experience provides a way to engage and empower nursing students and assist in meeting learning objectives. This article describes an interactive educational escape activity for hematologic disorders.

Background: Alcohol induced health problems have tormented the world population since time immemorial. This research work was done to study the therapeutic role of Tylophora indica ethanolic extract on alcohol induced anxiety in Wistar albino rats. Method: Wistar albino rats were administered 20% alcohol, orally twice a day for 30 days. The protective role of Tylophora indica ethanolic extract was evaluated by administering it at a dose of 100 mg/kg body weight orally in alcohol treated animals for 30 days. Anxiety was assessed by elevated plus maze and light dark arena tests. After that, animals were sacrificed and brains were dissected out, to measure the levels of dopamine. To pinpoint the active constituent responsible for the anxiolytic activity, Tylophora indica ethanolic extract was subjected to HPLC-LCMS analysis. Results: Elevated plus maze and light dark arena tests showed that alcohol induced anxiety can be prevented by Tylophora indica ethanolic extract in Wistar albino rats. There was a significant increase in the levels of Dopamine in the brains of rats, which received Tylophora indica . From the HPLC-LCMS analysis report it is postulated that Tylophorinidine is the active constituent responsible for the anxiolytic activity of Tylophora indica ethanolic extract. Conclusion: Tylophora indica can mitigate the deleterious effect of alcohol in CNS. Key words : Alcohol, Wistar rats, Anxiety, Tylophora indica , Antianxiety, Tylophorinidine.

Eating disorders, such as anorexia nervosa and bulimia nervosa, can have devastating effects on both the health and performance of athletes. Compared to non-athletes, both female and male athletes are at higher risk of developing an eating disorder. This is especially true for athletes participating in sports where low body weight or leanness confers a competitive advantage. Screening for disordered eating behaviours, eating disorders and for related health consequences should be a standard component of preparticipation examinations, and team physicians should be knowledgeable of the updated diagnostic criteria for eating disorders in the Diagnostic and Statistical Manual-V. Athletes with eating disorders should undergo thorough evaluation and treatment by an experienced multidisciplinary team. Team physicians play a critical role in decision-making on clearance for participation and return to play. Using evidence-based guidelines for clearance and return to play encourages transparency and accountability between the sports medicine care team and the athlete. Efforts to prevent eating disorders should be aimed at athletes, coaches, parents and athletic administrators, and focused on expanding knowledge of healthy nutrition in support of sport performance and health.

The U.S. population is plagued by physical inactivity, lack of cardiorespiratory fitness, and sedentary lifestyles, all of which are strongly associated with the emerging epidemic of chronic disease. The time is right to incorporate physical activity assessment and promotion into health care in a manner that engages clinicians and patients. In April 2015, the American College of Sports Medicine and Kaiser Permanente convened a joint consensus meeting of subject matter experts from stakeholder organizations to discuss the development and implementation of a physical activity vital sign (PAVS) to be obtained and recorded at every medical visit for every patient. This statement represents a summary of the discussion, recommendations, and next steps developed during the consensus meeting. Foremost, it is a "call to action" for current and future clinicians and the health care community to implement a PAVS in daily practice with every patient.

Introduction Exercise is Medicine (EIM) is an initiative that seeks to integrate physical activity assessment, prescription, and patient referral as a standard in patient care. Methods to assess this integration have lagged behind its implementation. Purpose and objectives The purpose of this work is to provide a pragmatic framework to guide health care systems in assessing the implementation and impact of EIM. Evaluation methods A working group of experts from health care, public health, and implementation science convened to develop an evaluation model based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. The working group aimed to provide pragmatic guidance on operationalizing EIM across the different RE-AIM dimensions based on data typically available in health care settings. Results The Reach of EIM can be determined by the number and proportion of patients that were screened for physical inactivity, received brief counseling and/or a physical activity prescription, and were referred to physical activity resources. Effectiveness can be assessed through self-reported changes in physical activity, cardiometabolic biometric factors, incidence/burden of chronic disease, as well as health care utilization and costs. Adoption includes assessing the number and representativeness of health care settings that adopt any component of EIM, and Implementation involves assessing the extent to which health care teams implement EIM in their clinic. Finally, Maintenance involves assessing the long-term effectiveness (patient level) and sustained implementation (clinic level) of EIM in a given health care setting. Implications for public health The availability of a standardized, pragmatic, evaluation framework is critical in determining the impact of implementing EIM as a standard of care across health care systems.

El estudio de la ciencia es un asunto fundamental en el mundo de hoy, ya que ayuda a solucionar problemas y a hacer avanzar nuestra sociedad. La comunicación científica es la herramienta utilizada para transmitir el conocimiento, siendo esta imprescindible para que los conocimientos y descubrimientos sigan perpetuándose. Pero aún más importante es la divulgación científica, para que la sociedad llegue a conocer y entender la importancia de las investigaciones llevadas a cabo en ciencia. El presente trabajo investiga acerca de la estrategia de comunicación y divulgación científica en los grupos de investigación de Ciencias de la Salud, e Ingeniería Civil y Arquitectura en la Universidad de Alicante; a través de un estudio exploratorio, se analiza la gestión comunicativa y comunicación online de los grupos de investigación.

The Female Athlete Triad (Triad) was first defined by a group of clinical and scientific experts in 1992 (28). Since then, two American College of Sports Medicine (ACSM) Position Stands have been published (1997, 2007) (21,22), and more recently, the Female Athlete Triad Coalition Consensus on Clear

Kimberly D Brunisholz,1,2,* Pascal Briot,1,2,* Sharon Hamilton,1 Elizabeth A Joy,3 Michael Lomax,2 Nathan Barton,2 Ruthann Cunningham,3 Lucy A Savitz,2 Wayne Cannon1 1Primary Care Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA; 2Institute for Healthcare Delivery, Intermountain Healthcare, Salt Lake City, UT, USA; 3Office of Research, Intermountain Healthcare, Salt Lake City, UT, USA*Joint first authors Purpose: The purpose of this study was to determine the impact of diabetes self-management education (DSME) in improving processes and outcomes of diabetes care as measured by a five component diabetes bundle and HbA1c, in individuals with type 2 diabetes mellitus (T2DM). Methods: A retrospective analysis was performed for adult T2DM patients who received DSME training in 2011–2012 from an accredited American Diabetes Association center at Intermountain Healthcare (IH) and had an HbA1c measurement within the prior 3 months and 2–6 months after completing their first DSME visit. Control patients were selected from the same clinics as case-patients using random number generator to achieve a 1 to 4 ratio. Case and control patients were included if 1) pre-education HbA1c was between 6.0%–14.0%; 2) their main provider was a primary care physician; 3) they met the national Healthcare Effectiveness Data and Information Set criteria for inclusion in the IH diabetes registry. The IH diabetes bundle includes retinal eye exam, nephropathy screening or prescription of angiotensin converting enzyme or angiotensin receptor blocker; blood pressure

Denali (Mt. McKinley) is the tallest mountain in North America and a popular climbing destination for high altitude mountaineering expeditions. National Park Service (NPS) personnel care for and manage medical incidences and traumatic injuries for mountaineers each year. We retrospectively examined NPS medical reports from the climbing seasons of 1992-2011. Medical complaints, diagnoses, treatment, provider training, and overall numbers of injuries and illness were analyzed. Fatalities were included only if they were cared for by NPS medical personnel prior to death. Of the 24,079 climbers on Denali during this period, 831 (3.5%) required medical assistance from the NPS. There were 819 diagnoses; 502 were due to medical illness and 317 were traumatic injuries. Patient encounters occurred most frequently (71%) at the 4328 m camp. Frostbite was the most common individual diagnosis (18.1%), while altitude-related syndromes were the most common illness category (29%). Most patients (84%) were treated and released to descend without additional intervention, whereas 11% needed air evacuation, and 4% needed another type of NPS assistance to descend. The only fatality in this series was caused by traumatic brain injury due to a climbing fall. A broad variety of medical complaints were evaluated and treated by NPS personnel, most commonly altitude related problems and frostbite. The results of the study will enhance the awareness of potential illness and injuries encountered by medical providers participating in high altitude mountaineering expeditions. Additionally, providers responsible for evaluating mountaineers prior to their expeditions can educate them on the spectrum of physical and environmental conditions that increase the chances of illness or injury. This ideally will decrease the incidence of morbidity on both Denali and other high altitude mountaineering destinations.

Treatment as prevention® (TasP®) proposes a new way to end AIDS by requiring people living with HIV/AIDS (PWAs) to strictly adhere to lifelong HIV treatment, effectively making them non-infectious. Essentially, TasP attempts to stop the spread of HIV at the source. Yet, this radical prevention intervention is not without individual and collective repercussions. With an eye to the growing physical, moral, legal, and political costs of HIV treatment on adherence, this study seeks to describe how adherence has changed throughout the AIDS epidemic in order to understand its function in this present time and place of TasP in Vancouver. Through a Foucauldian genealogy, this dissertation examines how TasP adherence practices re-asserts colonial hierarchies. Guided by critical race and postcolonial theories, I argue that race and racism distinguish those who are made to live from those left to die in this new war on AIDS, a war against PWAs. Using biopower as an analytical framework, I emphasize the continued role of sovereign power, a repressive power alongside productive power. To examine adherence, I investigate specific moments in time and across place to ground Vancouver’s current TasP rationale and practices, beginning with the scientific role and methods of late 19th century colonial medicine through to present day TasP. I delve into TasP’s scientific rationale by analyzing the first uses of antiretroviral treatment for HIV prevention. Next, I outline the changes in British Columbia’s public health law along with Vancouver’s clinical guidelines and protocols. Then, I position artwork produced by PWAs as important sites of knowledge, providing insight into the multiple effects of antiretroviral therapy. To conclude, I argue that TasP works as an imperial formation as it uses force in the construction of its subjects. I suggest TasP pushes us to confront this ethical question: to what end and at whose expense are we willing to end AIDS? At its most basic level, this project seeks to disrupt the seemingly neutral scientific language of TasP by showing how scientific knowledge regarding adherence practices draw from histories relying on, recuperating, and revising the interlocking structures of colonialism, racism, sexism, poverty, and sexuality.

Participation in regular physical activity is associated with a multitude of benefits including a reduction in chronic disease and premature mortality, and improved quality of life. All segments of society need to collaborate with one another in an effort to promote active lives. The Israeli “Gymnasium Law” requires pre-exercise evaluation prior to exercise participation in a health club. Recently that law was modified to allow for participant pre-screening with the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+). This change reflects the evidence that the risk of catastrophic events (e.g. heart attack) during moderate intensity physical activity is low, and the likelihood of detecting heart disease in asymptomatic adults is low. This change will likely reduce the number of individuals who require physician evaluation. The American College of Sports Medicine (ACSM) recently updated their recommendations for pre-exercise evaluation. The ACSM guidelines have replaced risk factor assessment, with an algorithm that first stratifies based on current physical activity level, then by the presence of chronic disease, and/or signs and symptoms of chronic disease, and last by desired exercise intensity. The goal of these efforts is to reduce barriers to regular physical activity, by eliminating unnecessary medical evaluations. All adults should be encouraged to be physically active.