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IntroductionSprinting ability and anaerobic capacities are the determinant variables of the performance of ice hockey players. Recent research in sprinting showed the existence of distinct force–velocity (F–V) profiles, but the link between these profiles and anaerobic capacities remains unclear. This study explores the associations between F–V variables and anaerobic capacities among cohorts of highly trained adolescent ice hockey players.MethodsData from 36 men (age, 15.1 ± 0.2 years) and 34 women (age, 16.5 ± 0.7 years) were collected during off-season camps. All athletes completed a 30-m sprint test, a Wingate anaerobic test (WAnT), and a repeated-sprint anaerobic (RSA) test. F–V variables were calculated from the 30-m sprint test. Partial Pearson correlation coefficients for pooled data and Pearson correlation coefficients for individual male and female datasets were calculated.ResultsAmong the F–V variables, maximal theoretical velocity and power were moderately to largely associated with WAnT and RSA performance (|r| = 0.30–0.70). Maximal theoretical force was moderately associated with the RSA (r = −0.32 to −0.33).DiscussionThe results indicate the importance for highly trained adolescent players to be able to apply force at high velocities to maximize anaerobic capacities. Important differences between male and female players suggest training priorities may differ according to sex.

Abstract Introduction The optimal management of rectal cancer with synchronous liver metastases remains debatable. Thus, we propose an optimised liver-first (OLF) strategy that combines concomitant pelvic irradiation with hepatic management. This study aimed to evaluate the feasibility and oncological quality of the OLF strategy. Materials and methods Patients underwent systemic neoadjuvant chemotherapy followed by preoperative radiotherapy. Liver resection was performed in one step (between radiotherapy and rectal surgery) or in two steps (before and after radiotherapy). The data were collected prospectively and analysed retrospectively as intent to treat. Results Between 2008 and 2018, 24 patients underwent the OLF strategy. The rate of treatment completion was 87.5%. Three patients (12.5%) did not proceed to the planned second-stage liver and rectal surgery because of progressive disease. The postoperative mortality rate was 0%, and the overall morbidity rates after liver and rectal surgeries were 21% and 28.6%, respectively. Only two patients developed severe complications. Liver and rectal complete resection was performed in 100% and 84.6%, respectively. A rectal-sparing strategy was performed in 6 patients who underwent local excision (n = 4) or a watch and wait strategy (n = 2). Among patients who completed treatment, the median overall and disease-free survivals were 60 months (range 12–139 months) and 40 months (range 10–139 months), respectively. Eleven patients (47.6%) developed recurrence, among whom five underwent further treatment with curative intent. Conclusion The OLF approach is feasible, relevant, and safe. Organ preservation was feasible for a quarter of patients and may be associated with reduced morbidity.

Controlling the COVID-19 outbreak remains a challenge for Cameroon, as it is for many other countries worldwide. The number of confirmed cases reported by health authorities in Cameroon is based on observational data, which is not nationally representative. The actual extent of the outbreak from the time when the first case was reported in the country to now remains unclear. This study aimed to estimate and model the actual trend in the number of COVID -19 new infections in Cameroon from March 05, 2020 to May 31, 2021 based on an observed disaggregated dataset. We used a large disaggregated dataset, and multilevel regression and poststratification model was applied prospectively for COVID-19 cases trend estimation in Cameroon from March 05, 2020 to May 31, 2021. Subsequently, seasonal autoregressive integrated moving average (SARIMA) modeling was used for forecasting purposes. Based on the prospective MRP modeling findings, a total of about 7450935 (30%) of COVID-19 cases was estimated from March 05, 2020 to May 31, 2021 in Cameroon. Generally, the reported number of COVID-19 infection cases in Cameroon during this period underestimated the estimated actual number by about 94 times. The forecasting indicated a succession of two waves of the outbreak in the next two years following May 31, 2021. If no action is taken, there could be many waves of the outbreak in the future. To avoid such situations which could be a threat to global health, public health authorities should effectively monitor compliance with preventive measures in the population and implement strategies to increase vaccination coverage in the population.

Heterozygous variants in the Poly(U) Binding Splicing Factor 60kDa gene (PUF60) have been associated with Verheij syndrome, which has the key features of coloboma, short stature, skeletal abnormalities, developmental delay, palatal abnormalities, and congenital heart and kidney defects. Here, we report five novel patients from unrelated families with PUF60-related disorders exhibiting novel genetic and clinical findings with three truncating variants, one splice-site variant with likely reduced protein expression, and one missense variant. Protein modeling of the patient’s missense variant in the PUF60 AlphaFold structure revealed a loss of polar bonds to the surrounding residues. Neurodevelopmental disorders were present in all patients, with variability in speech, motor, cognitive, social-emotional and behavioral features. Novel phenotypic expansions included movement disorders as well as immunological findings with recurrent respiratory, urinary and ear infections, atopic diseases, and skin abnormalities. We discuss the role of PUF60 in immunity with and without infection based on recent organismic and cellular studies. As our five patients showed less-severe phenotypes than classical Verheij syndrome, particularly with the absence of key features such as coloboma or palatal abnormalities, we propose a reclassification as PUF60-related neurodevelopmental disorders with multi-system involvement. These findings will aid in the genetic counseling of patients and families.

Introduction Investigating elective and emergency caesarean section (CS) separately is important for a better understanding of birth delivery modes in the sub-Saharan Africa (SSA) region and identifying bottlenecks that prevent favourable childbirth outcomes in SSA. This study aimed at evaluating the prevalences of both CS types, determining their associated socioeconomic factors and their association with early neonatal mortality in SSA.Methods SSA countries Demographic and Health Surveys data that had collected information on the CS’ timing were included in our study. A total of 21 countries were included in this study, with a total of 155 172 institutional live births. Prevalences of both CS types were estimated at the countries’ level using household sampling weights. Multilevel models were fitted to identify associated socioeconomic factors of both CS types and their associations with early neonatal mortality.Results The emergency CS prevalence in SSA countries was estimated at 4.6% (95% CI 4.4–4.7) and was higher than the elective CS prevalence estimated at 3.4% (95% CI 3.3–3.6). Private health facilities’ elective CS prevalence was estimated at 10.2% (95% CI 9.3–11.2) which was higher than the emergency CS prevalence estimated at 7.7% (95% CI 7.0–8.5). Conversely, in public health facilities, the emergency CS prevalence was estimated at 4.0% (95% CI 3.8–4.2) was higher than the elective CS prevalence estimated at 2.7% (95% CI 2.6–2.8). The richest women were more likely to have birth delivery by both CS types than normal vaginal delivery. Emergency CS was positively associated with early neonatal mortality (adjusted OR=2.37, 95% CI 1.64–3.41), while no association was found with elective CS.Conclusions Findings suggest shortcomings in pregnancy monitoring, delivery preparation and postnatal care. Beyond antenatal care (ANC) coverage, more attention should be put on quality of ANC, postnatal care, emergency obstetric and newborn care for favourable birth delivery outcomes in SSA.

PurposeTo independently evaluate the impact of axillary surgery type and regional lymph node radiation (RLNR) on breast cancer-related lymphedema (BCRL) rates in patients with breast cancer.Patients and methodsFrom 2005 to 2018, 1,815 patients with invasive breast cancer were enrolled in a lymphedema screening trial. Patients were divided into the following 4 groups according to axillary surgery approach: sentinel lymph node biopsy (SLNB) alone, SLNB+RLNR, axillary lymph node dissection (ALND) alone, and ALND+RLNR. A perometer was used to objectively assess limb volume. All patients received baseline preoperative and follow-up measurements after treatment. Lymphedema was defined as a ≥ 10% relative increase in arm volume arising > 3 months postoperatively. The primary end point was the BCRL rate across the groups. Secondary end points were 5-year locoregional control and disease-free-survival.ResultsThe cohort included 1,340 patients with SLNB alone, 121 with SLNB+RLNR, 91 with ALND alone, and 263 with ALND+RLNR. The overall median follow-up time after diagnosis was 52.7 months for the entire cohort. The 5-year cumulative incidence rates of BCRL were 30.1%, 24.9%, 10.7%, and 8.0% for ALND+RLNR, ALND alone, SLNB+RLNR, and SLNB alone, respectively. Multivariable Cox models adjusted for age, body mass index, surgery, and reconstruction type showed that the ALND-alone group had a significantly higher BCRL risk (hazard ratio [HR], 2.66; P = .02) compared with the SLNB+RLNR group. There was no significant difference in BCRL risk between the ALND+RLNR and ALND-alone groups (HR, 1.20; P = .49) and between the SLNB-alone and SLNB+RLNR groups (HR, 1.33; P = .44). The 5-year locoregional control rates were similar for the ALND+RLNR, ALND-alone, SLNB+RLNR, and SLNB-alone groups (2.8%, 3.8%, 0%, and 2.3%, respectively).ConclusionAlthough RLNR adds to the risk of lymphedema, the main risk factor is the type of axillary surgery used.

ObjectivesTo identify the association between cording and breast cancer-related lymphedema (BCRL); describe time course, location, symptoms and functional impairments.MethodsA total of 1181 patients were prospectively screened for BCRL after breast cancer (BC) surgery, including patient-reported outcome measures (4193) and perometric arm volume measurements (BCRL defined as relative or weight-adjusted volume change [RVC or WAC] ≥10% ≥3 months postoperatively).ResultsA total of 374/1181 patients (31.7%) reported cording first a median of 4.5 months postoperatively, and were more likely to: have body mass index less than 30 kg/m2 ; be less than 55 years of age; have had mastectomy, axillary lymph node dissection, regional lymph node radiation, neoadjuvant chemotherapy (all P

Abstract Synthetic Nitrogen (N) usage in agriculture has greatly increased food supply over the past century. However, the intensive use of N fertilizer is nevertheless the source of numerous environmental issues and remains a major challenge for policymakers to understand, measure, and quantify the interactions and trade-offs between ecosystem carbon and terrestrial biodiversity loss. In this study, we investigate the impacts of a public policy scenario that aims to halve N fertilizer application across European Union (EU) agriculture on both carbon (C) sequestration and biodiversity changes. We quantify the impacts by integrating two economic models with an agricultural land surface model and a terrestrial biodiversity model (that uses data from a range of taxonomic groups, including plants, fungi, vertebrates and invertebrates). Here, we show that the two economic scenarios lead to different outcomes in terms of C sequestration potential and biodiversity. Land abandonment associated with increased fertilizer price scenario facilitates higher C sequestration in soils (+ 1014 MtC) and similar species richness levels (+ 1.9%) at the EU scale. On the other hand, the more extensive crop production scenario is associated with lower C sequestration potential in soils (− 97 MtC) and similar species richness levels (− 0.4%) because of a lower area of grazing land. Our results therefore highlight the complexity of the environmental consequences of a nitrogen reduction policy, which will depend fundamentally on how the economic models used to project consequences.

RÉSUMÉLes dernières saisons d’étiage ont été intenses et durables en Île-de-France. Cet enjeu majeur en métropole devient de plus en plus problématique au fil des ans. Cela a amené l’Unité Hydrométrie (UH) d’Île-de-France à de multiples réflexions autour de la communication et de la qualification annuelle des étiages. Le suivi de l’étiage consiste dans la production d’un bulletin toutes les deux semaines et d’un tableau de synthèse intermédiaire. Ils intègrent un résumé des observations induisant un passage des seuils d’étiage, un indice de confiance sur les données publiées et une analyse synthétique de la situation. Cependant, un besoin d’analyses approfondies s’est fait sentir et des bilans interannuels sont produits sur la base des statistiques : Q3JN annuel (moyenne glissante sur 3 jours consécutifs du débit journalier la plus basse de l’année), durée en dessous des seuils d’étiage pour caractériser le stress hydrique. Ainsi, l’UH a travaillé sur un nouvel indicateur, la sévérité. Cet indicateur agrège l’intensité et la durée sous un seuil : il rapporte la moyenne des écarts du QJ (débit journalier) à ce seuil avec la durée cumulée en dessous de ce seuil. La représentation graphique de ces trois grandeurs (durée de l’étiage, intensité et sévérité) permet de caractériser et comparer les étiages d’une année à l’autre. Cela fournit de nouveaux outils, notamment visuels, pour mieux gérer et communiquer sur les étiages. De nouvelles évolutions sont encore envisagées concernant l’anticipation de l’étiage, la notion de seuil d’étiage, le retour des utilisateurs des données …

Abstract Background In the Republic of the Congo, malaria represents a major public health problem affecting all age groups. A regular surveillance of the current efficacy of first-line anti-malarial drugs is required in the face of possible emergence and spread of artemisinin-resistant Plasmodium falciparum strains in Africa. The purpose of this study was to determine the prevalence of malaria among febrile patients of all ages and assess the efficacy of artemether-lumefantrine (AL) and artesunate-amodiaquine (ASAQ) in Congolese children. Methods Febrile patients of all ages were initially screened for malaria by both rapid diagnostic test (RDT) and microscopy. Patients less than 12 years of age, with parasitaemia ≥ 1000 asexual parasites of P. falciparum/µL of blood, without any signs of severity, were enrolled in a therapeutic efficacy study and treated after obtaining their parents' (or legal guardian’s) informed consent in two health centres in Dolisie. The patients were followed for 28 days in accordance with the 2009 World Health Organization standard protocol. If parasitaemia reappeared on or after day 7, the genetic profiles (genes expressing merozoite surface protein-1 [msp1], merozoite surface protein-2 [msp2], and glutamine-rich protein [glurp]) of pre-treatment and post-treatment isolates were compared by nested polymerase chain reaction (PCR) followed by capillary electrophoresis to make a distinction between recrudescence and re-infection. The clinical and parasitological outcome was analysed by the per-protocol method and Kaplan–Meier survival curves. Results A total of 994 febrile patients of all ages were screened by RDT and microscopy. Of 994 patients, 323 (32.5%) presented a positive RDT, and 266 (26.8%) were microscopy-positive. Based on microscopy as the reference diagnostic method, the sensitivity and the specificity of the RDT were 98.9 and 91.8%, respectively. The Cohen’s kappa coefficient was 0.86. A total of 121 children aged less than 12 years (61 in AL treatment group and 60 in ASAQ treatment group) were included in therapeutic efficacy study. Before PCR correction, the proportions of adequate clinical and parasitological response were 96.6% for AL and 86.0% for ASAQ in the per-protocol population (P 0.05). Both treatments were well tolerated. Conclusions AL and ASAQ remain highly effective for the first-line treatment of uncomplicated P. falciparum malaria in Dolisie. Despite high efficacy of first- and second-line treatment, there is a continuing need to scale up effective malaria preventive interventions and vector control strategies in the country. Trial Registration Number: ACTRN12616001422415.

Abstract Background Personalized diet counselling, as part of lifestyle change programs for cardiometabolic risk conditions (combinations of prediabetes or type 2 diabetes, hypertension, dyslipidemia and high waist circumference) has been shown to reduce progression to type 2 diabetes overall. To identify key process of care measures that could be linked to changes in diet, we undertook a secondary analysis of a Canadian pre-post study of lifestyle treatment of metabolic syndrome (MetS). Diet counselling process measures were documented and association with diet quality changes after 3 months were assessed. Results of the primary study showed 19% reversal of MetS after 1 year. Methods Registered dietitians (RDs) reported on contact time, specific food behaviour goals (FBG), behaviour change techniques (BCT; adapted from the Michie CALO-RE taxonomy) and teaching resources at each contact. Diet quality was measured by 2005 Canadian Healthy Eating Index (HEI-C) and assessed for possible associations with individual BCT and FBG. Results Food behaviour goals associated with improved HEI-C at 3 months were: poultry more than red meat, increased plant protein, increased fish, increased olive oil, increased fruits and vegetables, eating breakfast, increased milk and alternatives, healthier fats, healthier snacks and increased nuts, with an adverse association noted for more use (> 2 times/ 3 months) of the balanced meal concept (F test; p 3 times/3 months) was associated with poorer HEI-C at 3 months (F test; p = 0.007). Only self-monitoring, feedback on performance and focus on past success were associated with improved HEI-C. Conclusions These results identify key aspects of process that impact diet quality. Documentation of both FBG and BCT is highly relevant in diet counselling and a summary diet quality score is a promising target for assessing short-term counselling success.

Background The goal of this study was to determine whether an awake prone position (aPP) reduces the global inhomogeneity (GI) index of ventilation measured by electrical impedance tomography (EIT) in COVID-19 patients with acute respiratory failure (ARF). Methods This prospective crossover study included COVID-19 patients with COVID-19 and ARF defined by arterial oxygen tension:inspiratory oxygen fraction (PaO2:FIO2) of 100–300 mmHg. After baseline evaluation and 30-min EIT recording in the supine position (SP), patients were randomised into one of two sequences: SP-aPP or aPP-SP. At the end of each 2-h step, oxygenation, respiratory rate, Borg scale and 30-min EIT were recorded. Results 10 patients were randomised in each group. The GI index did not change in the SP-aPP group (baseline 74±20%, end of SP 78±23% and end of aPP 72±20%, p=0.85) or in the aPP-SP group (baseline 59±14%, end of aPP 59±15% and end of SP 54±13%, p=0.67). In the whole cohort, PaO2:FIO2 increased from 133±44 mmHg at baseline to 183±66 mmHg in aPP (p=0.003) and decreased to 129±49 mmHg in SP (p=0.03). Conclusion In spontaneously breathing nonintubated COVID-19 patients with ARF, aPP was not associated with a decrease of lung ventilation inhomogeneity assessed by EIT, despite an improvement in oxygenation.

While it is well recognized that gambling behaviours are shaped by the contexts in which they occur, less research has investigated the relationship between poker and substance use (i.e., alcohol and other drugs). The current study explores poker players’ perceptions of the relationship between substance use and gambling. This qualitative descriptive study is a secondary data analysis of 25 interviews with poker players conducted as part of a broader prospective cohort project. From the thematic analysis, players described how specific contextual factors, such as social setting and location (e.g., bars, casinos) influenced their substance use. Poker players reported a relationship between substance use and gambling practices. However, players differed greatly in their decisions about whether, and how much, to use alcohol and other drugs, with individuals’ choices depending heavily on contexts (e.g., more inclined to partake when alcohol was available) and motivations (e.g., remaining sober to remain sharp and not impair their intellectual capacity). For those players who considered poker earnings to be their main source of income, increased use of alcohol, tobacco and cannabis were reported as a way of dealing with stress, anxiety and a lack of motivation related to their play.

IntroductionClimate change is impacting forest-based agricultural systems with implications for producer decision-making and livelihoods. This article presents a case study on the observations, perceptions, knowledge, and adaptation strategies of maple syrup producers in the United States to climate change.MethodsWe carried out two semi-structured surveys with maple producers on: (1) climate change and its impacts on the maple system (n = 106 participants); and (2) responses to climate adaptation scenarios (n = 98 participants). Additionally, we carried out two focus groups and key informant interviews (n = 70+) to understand barriers and opportunities for climate adaptation. One of these focus groups and follow up key informant interviews was with tribally affiliated community members with the intention to acknowledge Indigenous Peoples’ voices, history, and relationships to the land.ResultsFindings highlight that most of the surveyed producers (89%) have experienced the negative impacts of climate on maple syrup production. While 40% of participants feel concerned regarding the future of the maple system, 39% feel hopeful, with significant differences based on the age of the surveyed producers. The majority of producers have adapted their harvesting practices to climate effects. Producers shared knowledge of multiple adaptation strategies in response to climate scenarios comprised of: (1) stand management practices such as diversification of sap species tapped; (2) harvesting practices such as changing the type and number of taps; (3) sap processing practices focused on the integration of technology such as the use of an evaporator and reverse osmosis; and (4) marketing practices such as innovation of products and marketing different maple syrup characteristics. Responses shared by tribally affiliated producers highlight knowledge of multiple adaptation strategies that focus on long-term ecological management of forests rather than technological solutions.DiscussionOverall, findings emphasize the importance of cooperation and diversification at every level and dimension of the maple system for its long-term resilience.