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Context Preceptors play an integral role in training athletic training students (ATSs). Balancing roles as health care providers and educators can often be challenging. Role strain is a documented concern for the preceptor, yet limited information is available regarding other issues faced while supervising ATSs. Objective To explore preceptor challenges. Design Qualitative study. Setting Athletic training programs. Patients or Other Participants A total of 41 preceptors from 2 different data collection procedures (cohorts) participated in the study. Preceptors had an average of 6 ± 2 years (cohort 1) and 5 ± 3 (cohort 2) years of experience as clinical educators, respectively. The preceptors were distributed between college (25) and secondary school (16) settings. Data Collection and Analysis Data were collected via telephone interviews (cohort 1) and asynchronous online interviews using Question Pro (cohort 2). We used a combination of grounded theory and inductive procedures for data analysis. Credibility of the data was established by investigator and data analyst triangulation in addition to peer review. Results Role strain was reported by preceptors as they attempted to balance their responsibilities as health care providers and clinical educators. Working conditions characterized by long hours, high patient volumes, and inadequate compensation hindered preceptors' ability to foster a positive learning environment. Because of contrasting personalities and different expectations, some preceptors experienced challenges interacting with students. Conclusions The preceptor position involves meeting the high standards for education and health care simultaneously. Preceptor training does not often address the challenges of balancing multiple roles. It therefore becomes important for ATSs and preceptors to develop strong lines of communication and determine an appropriate schedule for educational activities. Clinical coordinators should consider both the personalities of preceptors and ATSs and the workload of the preceptor when determining clinical assignments.

Context Colleges and universities are implementing new academic and social programs to retain students. One possible program is a residential living community (RLC) devoted to a content area. Objective To understand the perceptions of athletic training students involved in an RLC. Design Qualitative study. Setting Athletic training program. Patients or Other Participants Ten athletic training students (8 female, 2 male; average age = 19.50 ± 0.97 years) who participated in an RLC during their first year in college volunteered to participate. Data Collection and Analysis We used QuestionPro to complete in-depth interviews by having the participants journal their responses to open-ended questions. We used grounded theory to uncover the dominant themes and negotiated over the coding scheme, completed member checks, and performed a peer review to establish trustworthiness. Results The overall theme of our data pertained to the supportive nature of the RLC allowing for early socialization. Specifically, we uncovered 3 subthemes. The participants found study opportunities common because they lived in close proximity to peers in the same classes. Our participants believed the RLC provided a supportive environment by fostering a support network with classmates navigating similar challenges. Students also enjoyed early socialization by having a resident assistant who was an upper-level athletic training student. The final theme emerged from the unintended consequences of the RLC. Finding a quiet area in which to study became difficult and students often had trouble making personal connections outside of athletic training. Conclusions The RLC promoted first-year student success by fostering relationships and providing early socialization to the demands of the athletic training program. Some negative aspects did occur; however, these can be remedied by having quiet study spaces available and providing students with sufficient time outside of athletic training to pursue extracurricular endeavors.

Context Student motivation has been linked to persistence until graduation for athletic training students. There is little research, however on ways athletic training programs (ATPs) foster student motivation. Objective To expand upon the existing literature regarding retention of students in ATPs, specifically examining the concept of student motivation to complete degree requirements from the perspective of the program director (PD). Design Qualitative study. Setting One-on-one telephone interviews. Patients or Other Participants Eight PDs from professional master's and 16 PDs from undergraduate ATPs. Data Collection and Analysis We asked PDs to participate in a tape-recorded semistructured telephone interview. We analyzed data using a general inductive approach and secured credibility by utilizing member checks, multiple analyst triangulation, and peer review. Results Motivation for degree completion, as evaluated by the PD, is fostered by internal motivation, program pride and continued tradition of program success, and accomplishment of the personal goal to become an athletic trainer. Conversely, 1 major theme, disinterest or dissatisfaction with a career in athletic training, evolved as a reason to not remain motivated to complete the degree requirements for athletic training. Conclusions Program directors reported that internal drive and the achievement of personal goals influence the persistence of students in their ATPs. Students are also motivated by the successes of previous students in the program and feel a responsibility to uphold the legacy.

Context Preceptors play a vital role in athletic training education as they mentor and socialize athletic training students into their professional role. Exploring the benefits to serving as a preceptor is important to secure appropriate professional role models for students. Objective To determine the benefits of serving as an athletic training preceptor. Design Qualitative study. Setting Undergraduate athletic training programs (ATPs). Patients or Other Participants Twenty-four preceptors (average age = 32 ± 7 years, 11 male, 13 female, average clinical experience = 9 ± 6 years, average preceptor experience = 5 ± 3 years) volunteered to participate in our study. Participants represented 7 undergraduate Commission on Accreditation of Athletic Training Education–accredited ATPs from the east coast. Data Collection and Analysis We asked participants to journal responses to open-ended questions through a QuestionPro online survey. We analyzed data using a general inductive approach. We secured credibility by using consistency and stakeholder checks and by having a peer review our work. Results Three main themes emerged from the data. Preceptors enjoy the personal relationships they build with students. The challenging atmosphere of supervising students while they gain knowledge to improve their skills also came through as a major benefit to serving as a preceptor. Finally, our participants enjoy teaching and mentoring the future members of the athletic training profession. Conclusions Our participants listed the relationships they build with students as rewarding, potentially leading to an improved professional commitment. Reciprocal learning between the preceptors and the students allows for a stimulating environment and has the potential to improve patient care. The enjoyment of teaching and mentoring students may aid in providing a dynamic atmosphere for students to learn.

The cytoplasmic lipid droplet (CLD) protein perilipin-2 (Plin2) is expressed in multiple nonadipose tissues, where it is thought to play a role in regulating their lipid storage properties. However, the extent to which Plin2 functions in nutrient utilization and metabolism, or how it influences the consequences of over-feeding, remains unclear. In this study, we demonstrate that the absence of Plin2 prevents high-fat diet(HFD)-induced obesity in male and female mice. This response is associated with increased formation of subcutaneous beige adipocyte cells with uncoupling protein 1 expression, and amelioration of inflammatory foci formation in white adipose tissue and steatosis in the liver. Experiments demonstrate that Plin2 loss results in reduced energy intake and increased physical activity in response to HFD feeding. Our study provides the first evidence that Plin2 contributes to HFD-induced obesity by modulating food intake, and that its absence prevents obesity-associated adipose tissue inflammatory foci and liver steatosis.

Impairment of insulin clearance is being increasingly recognized as a critical step in the development of insulin resistance and metabolic disease. The carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) promotes insulin clearance. Null deletion or liver-specific inactivation of Ceacam1 in mice causes a defect in insulin clearance, insulin resistance, steatohepatitis, and visceral obesity. Immunohistological analysis revealed reduction of hepatic CEACAM1 in obese subjects with fatty liver disease. Thus, we aimed to determine whether this occurs at the hepatocyte level in response to systemic extrahepatic factors and whether this holds across species. Northern and Western blot analyses demonstrate that CEACAM1 mRNA and protein levels are reduced in liver tissues of obese individuals compared to their lean age-matched counterparts. Furthermore, Western analysis reveals a comparable reduction of CEACAM1 protein in primary hepatocytes derived from the same obese subjects. Similar to humans, Ceacam1 mRNA level, assessed by quantitative RT-PCR analysis, is significantly reduced in the livers of obese Zucker (fa/fa, ZDF), and Koletsky (f/f) rats relative to their age-matched lean counterparts. These studies demonstrate that the reduction of hepatic CEACAM1 in obesity occurs at the level of hepatocytes and identify the reduction of hepatic CEACAM1 as a common denominator of obesity across multiple species.

The carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) promotes insulin clearance. Mice with global null mutation (Cc1 −/−) or with liver-specific inactivation (L-SACC1) of Cc1 (also known as Ceacam1) gene display hyperinsulinaemia resulting from impaired insulin clearance, insulin resistance, steatohepatitis and obesity. Because increased lipolysis contributes to the metabolic phenotype caused by transgenic inactivation of CEACAM1 in the liver, we aimed to further investigate the primary role of hepatic CEACAM1-dependent insulin clearance in insulin and lipid homeostasis. To this end, we examined whether transgenic reconstitution of CEACAM1 in the liver of global Cc1 −/− mutant mice reverses their abnormal metabolic phenotype. Insulin response was assessed by hyperinsulinaemic–euglycaemic clamp analysis and energy balance was analysed by indirect calorimetry. Mice were overnight-fasted and refed for 7 h to assess fatty acid synthase activity in the liver and the hypothalamus in response to insulin release during refeeding. Liver-based rescuing of CEACAM1 restored insulin clearance, plasma insulin level, insulin sensitivity and steatohepatitis caused by global deletion of Cc1. It also reversed the gain in body weight and total fat mass observed with Cc1 deletion, in parallel to normalising energy balance. Mechanistically, reversal of hyperphagia appeared to result from reducing fatty acid synthase activity and restoring insulin signalling in the hypothalamus. Despite the potential confounding effects of deleting Cc1 from extrahepatic tissues, liver-based rescuing of CEACAM1 resulted in full normalisation of the metabolic phenotype, underscoring the key role that CEACAM1-dependent hepatic insulin clearance pathways play in regulating systemic insulin sensitivity, lipid homeostasis and energy balance.

The pathogenesis of human non-alcoholic fatty liver disease (NAFLD) remains unclear, in particular in the context of its relationship to insulin resistance and visceral obesity. Work on the carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) in mice has resolved some of the related questions. CEACAM1 promotes insulin clearance by enhancing the rate of uptake of the insulin-receptor complex. It also mediates a negative acute effect of insulin on fatty acid synthase activity. This positions CEACAM1 to coordinate the regulation of insulin and lipid metabolism. Fed a regular chow diet, global null mutation of Ceacam1 manifest hyperinsulinemia, insulin resistance, obesity, and steatohepatitis. They also develop spontaneous chicken-wire fibrosis, characteristic of non-alcoholic steatohepatitis. Reduction of hepatic CEACAM1 expression plays a significant role in the pathogenesis of diet-induced metabolic abnormalities, as bolstered by the protective effect of hepatic CEACAM1 gain-of-function against the metabolic response to dietary fat. Together, this emphasizes that loss of hepatic CEACAM1 links NAFLD to insulin resistance and obesity.

Purpose: Evidence suggested that athletic training doctoral candidates are being socialized through a variety of formal and informal experiences to prepare them for roles in higher education. It is unclear, however, if they are aware of the expectations associated with tenure and/or promotion which are necessary for transition into higher education. Perceptions of tenure and promotion among doctoral students preparing to enter the athletic training professoriate were investigated. Methods: Twenty-four students (16=females, 8=males, average age=28±3 years) completed one-on-one telephone interviews. Data were analyzed using a general inductive approach, with a peer review and multiple analyst triangulation completed for rigor. Results: Four primary themes emerged from the data: 1) there is a limited understanding of the guidelines and criteria for tenure and promotion, 2) knowledge of guidelines and criteria is perpetuated by mentoring, 3) research/scholarship is perceived as paramount for success, and 4) the belief that skills gained, regardless of the domain of tenure, can facilitate success in others. Conclusions: The findings suggest that doctoral students in athletic training are partially aware of the guidelines for tenure, but could benefit from additional mentoring.

Context Although previous researchers have begun to identify sources of athletic training student stress, the specific reasons for student frustrations are not yet fully understood. It is important for athletic training administrators to understand sources of student frustration to provide a supportive learning environment. Objective To determine the factors that lead to feelings of frustration while completing a professional athletic training education program (ATEP). Design Qualitative study. Setting National Athletic Trainers' Association (NATA) accredited postprofessional education program. Patients or Other Participants Fourteen successful graduates (12 women, 2 men) of accredited professional undergraduate ATEPs enrolled in an NATA-accredited postprofessional education program. Data Collection and Analysis We conducted semistructured interviews and analyzed data with a grounded theory approach using open, axial, and selective coding procedures. We negotiated over the coding scheme and performed peer debriefings and member checks to ensure trustworthiness of the results. Results Four themes emerged from the data: (1) Athletic training student frustrations appear to stem from the amount of stress involved in completing an ATEP, leading to anxiety and feelings of being overwhelmed. (2) The interactions students have with classmates, faculty, and preceptors can also be a source of frustration for athletic training students. (3) Monotonous clinical experiences often left students feeling disengaged. (4) Students questioned entering the athletic training profession because of the fear of work-life balance problems and low compensation. Conclusions In order to reduce frustration, athletic training education programs should validate students' decisions to pursue athletic training and validate their contributions to the ATEP; provide clinical education experiences with graded autonomy; encourage positive personal interactions between students, faculty, and preceptors; and successfully model the benefits of a career in athletic training.

Although the National Operating Committee on Standards for Athletic Equipment (NOCSAE) standards are similar for football and lacrosse helmets, it remains unknown how helmets for each sport compare on drop tests. Due to the increased concern over head injury in sport and the rapid growth in lacrosse participation, it is useful to compare the performance of various football and lacrosse helmets. Therefore, the goal of this study was to document the impact attenuation properties of football and lacrosse helmets and to identify the relative performance between helmets for the two sports. Six models of football and six models of lacrosse helmets were tested using a drop tower at three prescribed velocities and six locations on the helmets. A repeated measures ANOVA was conducted to determine the effect of sport on Gadd Severity Index (GSI) scores and linear accelerations. The interaction between location and sport was significant at the low (F2.64,89.71=7.68, P

Context: Clinical education is critical to athletic training students' professional development. Instructional style can vary between preceptors, and little information is available regarding popular methods used by athletic trainers serving as preceptors. Objective: To uncover the common instructional styles used by athletic trainers supervising athletic training students in the clinical setting. Design: Qualitative study. Setting: Online interviewing via Question Pro™. Patients or Other Participants: Twenty-four athletic training preceptors with an average age of 32±7 years (11 male, 13 female) volunteered for the study. On average, the preceptors had 9±6 years of clinical experience, and had served an average of 5±3 years as preceptors. The preceptors were employed in the collegiate (n=12) and secondary school settings (n=12). Data Collection and Analysis: We completed a general inductive study using online, asynchronous in-depth interviewing via Question Pro™. Credibility was secured using peer review, intercoder agreement, and member checks. Data was analyzed inductively to uncover the dominant themes, and recruitment was guided by data redundancy. Results: Three dominant themes emerged from the data: First, preceptors engaged athletic training students through discussions and questioning to facilitate learning and critical application; second, they provided athletic training students with the independence and autonomy to develop their own clinical style and abilities by providing an authentic experience; and finally, preceptors fostered a learning environment that allowed athletic training students to feel their preceptor was approachable. Conclusions: Preceptors promoted learning by mentoring students through a professional relationship and by creating an authentic learning experience that challenged the student to think, apply their knowledge, and gain confidence by being an active learner.

Context: Previous researchers have indicated that athletic training education programs (ATEPs) appear to retain students who are motivated and well integrated into their education programs. However, no researchers have examined the factors leading to successful persistence to graduation of recent graduates from ATEPs.Objective: To determine the factors that led students enrolled in a postprofessional education program accredited by the National Athletic Trainers' Association (NATA) to persist to graduation from accredited undergraduate ATEPs.Design: Qualitative study.Setting: Postprofessional education program accredited by the NATA.Patients or Other Participants: Fourteen graduates (12 women, 2 men) of accredited undergraduate entry-level ATEPs who were enrolled in an NATA-accredited postprofessional education program volunteered to participate.Data Collection and Analysis: We conducted semistructured interviews and analyzed data through a grounded theory approach. We used open, axial, and selective coding procedures. To ensure trustworthiness, 2 independent coders analyzed the data. The researchers then negotiated over the coding categories until they reached 100% agreement. We also performed member checks and peer debriefing.Results: Four themes emerged from the data. Decisions to persist to graduation from ATEPs appeared to be influenced by students' positive interactions with faculty, clinical instructors, and peers. The environment of the ATEPs also affected their persistence. Participants thought they learned much in both the clinic and the classroom, and this learning motivated them to persist. Finally, participants could see themselves practicing athletic training as a career, and this greatly influenced their eventual persistence.Conclusions: Our study gives athletic training educators insight into the reasons students persist to graduation from ATEPs. Specifically, athletic training programs should strive to develop close-knit learning communities that stress positive interactions between students and instructors. Athletic training educators also must work to present the athletic training field as exciting and dynamic.

Context: Immediate feedback has been shown to improve student learning more efficiently than delayed feedback in lower-level general education courses. No research exists examining the effects of immediate feedback on learning in higher-level athletic training coursework. Objective: To determine if using the Immediate Feedback Assessment Technique (IF-AT) improves retention of information taught in upper-level athletic training courses better than traditional multiple choice (TMC) exams. The second purpose of this research was to determine students' perceptions of the IF-AT. Design: 2 x 2 randomized, crossover experimental design. Setting: A standard higher education classroom. Patients or Other Participants: A convenience sample of 23 students enrolled in an upper-level athletic training course. Interventions: Examination type (IF-AT and TMC) and examination session (initial and follow-up). Main Outcome Measures: Examination scores of the students on the initial examinations and the follow-up examinations. Results: The interaction between examination type and examination session was not significant; F(1,44) = .154, P = .696, 1-β = .067, ω2 = .015. Students did prefer the IF-AT over traditional multiple choice as evidenced by the survey. Conclusions: Using the IF-AT on the initial examination did not significantly improve students' scores on the follow-up examination compared to using the TMC format. However, students gave the IF-AT high scores on the satisfaction survey.

Aims: Examine the incidence of clinical events after utilization of the TAXUS® Express® paclitaxel-eluting stent (PES) in multivessel and bifurcation coronary stenting in an unselected patient population. Methods and Results: The ARRIVE Program compiled data on 7,492 patients receiving ≥1 TAXUS Express PES, including patients with multivessel stenting (MVS; n = 1,208) and bifurcation stenting (n = 575). Patients were enrolled at procedure start with no mandated inclusion/exclusion criteria; all cardiac events were monitored with independent adjudication of end-points. Compared to simple use (single vessel/single stent) patients undergoing native intervention (N = 2,698), MVS patients had significantly more baseline comorbidities. Both groups had higher 2-year rates of mortality (7.3%[MVS] and 7.5%[bifurcation] vs. 4.2%[simple-use], P < 0.001), myocardial infarction (5.5% and 4.6% vs. 2.2%, P < 0.001 and P = 0.002), target vessel revascularization (15.5% and 14.8% vs. 7.7%, P < 0.001), and Academic Research Consortium definite/probable stent thrombosis (4.3% and 4.4% vs. 1.4%, P < 0.001) than the simple-use group. Conclusions: ARRIVE multivessel and bifurcation stenting patients have significantly higher clinical risk through 2 years compared to simple-use patients. In the absence of large randomized controlled trials in these populations, ARRIVE provides important insight into clinical outcomes over an extended period of time. (J Interven Cardiol 2011;24:342–350)

Aims: To examine the incidence of clinical events after implantation of the TAXUS Express paclitaxel-eluting stent (PES) in chronic total occlusions (CTO) in an unselected patient population. Methods and Results: The TAXUS ARRIVE registries compiled data on 7,492 patients, including 113 patients with CTO (TIMI flow 0). Patients enrolled at procedure start with no mandated inclusion/exclusion criteria; all cardiac events were monitored with independent end-point adjudication. Two-year follow-up was 89% (101/113) for CTO patients who had significantly more baseline comorbidities/complex disease than simple-use patients undergoing native coronary intervention (N = 2,698) and significantly longer lesions/smaller vessels than other expanded-use patients (N = 4,681 without CTO). Among CTO patients the rate of 2-year major cardiac events (MCE, including cardiac death, myocardial infarction, and target vessel revascularization) was 22.3%, significantly higher than in simple-use patients (10.3%, P < 0.001). CTO MCE was similar to that for other expanded-use patients (16.5%, P = 0.14) but target lesion revascularization was significantly higher in year 2 (6.9% vs. 2.7%, P = 0.02). Academic Research Consortium definite/probable stent thrombosis through 2 years was 5.7%, significantly higher than simple-use patients but similar to other expanded-use cases. Conclusion: In a “real-world” setting, PES use in CTO was associated with increased MCE compared to simple- use patients, but achieved long-term outcomes similar to that observed in other complex patient/lesion cases. (J Interven Cardiol 2011;24:232–240)

Five species of subterranean asellid are known from Maryland: Caecidotea pricei, C. franzi, C. holsingeri, C. mausi and C. vandeli. Caecidotea nordeni, n. sp. is a subterranean species described from Washington Co., Maryland and assigned to the hobbsi Group. A new locality for C. franzi in Kentucky is presented. This species was previously known from two caves in Maryland and Pennsylvania. The newly discovered population represents a range extension of over 400 km. The male pleopod 2 morphology of specimens from a Maryland population of the subterranean asellid C. holsingeri is compared with populations from three caves in West Virginia. The range of C. holsingeri extends from eastern West Virginia and adjacent Virginia to Garrett Co., Maryland.

Objectives The aim of this study was to examine the incidence of clinical events after implantation of the TAXUS Express (Boston Scientific Corporation, Natick, Massachusetts) paclitaxel-eluting stent in saphenous vein graft (SVG) lesions in an unselected patient population. Background Saphenous vein grafts have 1-year occlusion rates of 12% to 20%, with >50% failure by 7 to 10 years. Many diseased SVGs are treated by percutaneous coronary intervention to avoid higher-risk reoperation, but bare-metal stents have 35% to 40% historical SVG restenosis rates by 18 months. Reported outcomes of drug-eluting stents in SVG lesions are limited and mainly retrospective. Methods The ARRIVE (TAXUS Peri-Approval Registry: A Multicenter Safety Surveillance) program compiled data on 7,492 patients receiving ≥1 TAXUS Express (Boston Scientific) stent, including 474 patients with SVG. All cardiac events were monitored with independent adjudication of end points. Patients enrolled at procedure start with no mandated inclusion/exclusion criteria. Results The ARRIVE SVG patient 2-year follow-up was 96% complete (457 of 474). The SVG patients had significantly more baseline comorbidities/complex disease than simple-use patients (n = 2,698) undergoing native coronary intervention or other expanded-use patients (n = 4,320 without SVG patients). They had higher 2-year rates of mortality (10.9% vs. 4.2%, p Conclusions The ARRIVE SVG patients have significantly different baseline risk and higher clinical risk through 2 years than simple-use and other expanded-use patients. Nonetheless, compared with historical SVG revascularization rates, treatment with paclitaxel-eluting stent seems to offer a reasonable therapeutic option in this high-risk group. (TAXUS ARRIVE: TAXUS Peri-Approval Registry: A Multicenter Safety Surveillance Program; NCT00569491 ) and (TAXUS ARRIVE 2: A Multicenter Safety Surveillance Program; NCT00569751 )

Although FK506-binding protein 52 (FKBP52) is an established positive regulator of glucocorticoid receptor (GR) activity, an in vivo role for FKBP52 in glucocorticoid control of metabolism has not been reported. To address this question, FKBP52(+/-) mice were placed on a high-fat (HF) diet known to induce obesity, hepatic steatosis, and insulin resistance. Tissue profiling of wild-type mice showed high levels of FKBP52 in the liver but little to no expression in muscle or adipose tissue, predicting a restricted pattern of FKBP52 effects on metabolism. In response to HF, FKBP52(+/-) mice demonstrated a susceptibility to hyperglycemia and hyperinsulinemia that correlated with reduced insulin clearance and reduced expression of hepatic CEACAM1 (carcinoembryonic antigen-related cell adhesion molecule 1), a mediator of clearance. Livers of HF-fed mutant mice had high lipid content and elevated expression of lipogenic genes (peroxisome proliferator-activated receptor gamma, fatty acid synthase, and sterol regulatory element-binding protein 1c) and inflammatory markers (TNFalpha). Interestingly, mutant mice under HF showed elevated serum corticosterone, but their steatotic livers had reduced expression of gluconeogenic genes (phosphoenolpyruvate carboxy kinase, glucose 6 phosphatase, and pyruvate dehydrogenase kinase 4), whereas muscle and adipose expressed normal to elevated levels of glucocorticoid markers. These data suggest a state of glucocorticoid resistance arising from liver-specific loss of GR activity. Consistent with this hypothesis, reduced expression of gluconeogenic genes and CEACAM1 was observed in dexamethasone-treated FKBP52-deficient mouse embryonic fibroblast cells. We propose a model in which FKBP52 loss reduces GR control of gluconeogenesis, predisposing the liver to steatosis under HF-diet conditions attributable to a shunting of metabolism from glucose production to lipogenesis.

Objective Physical activity has been associated with lower diabetes risk, but several prospective studies among women found that activity only slightly attenuated the diabetes risk associated with high body mass index (BMI). We investigated the independent and joint associations between vigorous activity and BMI on diabetes risk in men. Methods This was a prospective cohort design within the Physicians' Health Study, using Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident diabetes in 20,757 men without diabetes at baseline. Models were based on self-reported BMI and exercise frequency at baseline, first separately and then with a 6-category joint variable combining World Health Organization BMI category (normal/overweight/obese) with activity status (active/inactive) using weekly vigorous activity as the threshold. Results After a median follow-up of 23.1 years, there were 1836 cases of incident diabetes. Compared with active participants with normal BMIs, active but overweight and obese men had multivariable-adjusted HRs of 2.39 (95% CI, 2.11-2.71) and 6.22 (95% CI, 5.12-7.56). Inactive men with normal, overweight, or obese BMIs had multivariable-adjusted HRs of 1.41 (95% CI, 1.19-1.67), 3.14 (95% CI, 2.73-3.62), and 6.57 (95% CI, 5.25-8.21). Conclusion Active men with normal and overweight BMIs had lower diabetes hazards than their inactive counterparts, but no difference by weekly activity was seen in obese men. Elevated BMI is a key driver of diabetes risk, with relatively modest attenuation by activity.

Objectives The pivotal TAXUS IV (TAXUS IV-SR: Treatment of De Novo Coronary Disease Using a Single Paclitaxel-Eluting Stent) trial evaluated the long-term safety and effectiveness of the paclitaxel-eluting stent (PES) compared with an otherwise identical bare-metal stent (BMS) in a relatively uncomplicated population of patients with a single de novo lesion in a native coronary vessel, treated between March and July 2002. Background Long-term follow-up is required to determine whether the early safety and efficacy of drug-eluting stents are maintained. Methods The primary end point of this prospective, randomized, double-blind trial was 9-month ischemia-driven target vessel revascularization (TVR) for PES versus the BMS control. Follow-up was complete in 1,230 (95.1%) of 1,294 randomized evaluable patients at 5 years. Results Compared with BMS, PES significantly reduced TVR at 9 months (12.1% vs. 4.7%; p Conclusions These 5-year results demonstrate the long-term safety and sustained efficacy of PES compared with BMS in patients with noncomplex lesions. (TAXUS IV-SR: Treatment of De Novo Coronary Disease Using a Single Paclitaxel-Eluting Stent; NCT00292474 )

The association between change in high-density lipoprotein cholesterol (HDL-C) and risk of subsequent coronary heart disease (CHD) remains unclear. We calculated the change in HDL-C in a prospective cohort of 4501 male physicians enrolled in the Physician's Health Study I (PHS I) who had HDL-C levels measured in 1982-1983 and again approximately 14 years later. Subjects were divided into categories: those with a decrease (of -2.5 mg/dL or more), those with no change in HDL-C (change between -2.5 mg/dL and 2.5 mg/dL), those with a small increase in HDL-C of 2.5 to 12.5 mg/dL, and those with a large increase in HDL-C of ≥12.5 mg/dL. We used Cox proportional hazards to examine the association between change in HDL-C and incident CHD (confirmed acute myocardial infarction or cardiac death). Hazard ratios were adjusted for age, initial HDL-C level, diabetes mellitus, hypertension, non-HDL cholesterol, and history of cholesterol medication. Compared to subjects with a decrease in HDL-C, multivariable-adjusted hazard ratios (HR, 95% confidence interval, CI) for CHD were 0.66(0.40-1.09) in subjects with no change in HDL-C, 0.56 (0.35-0.89) for subjects with an increase in HDL-C between 2.5 mg/dL and 12.5 mg/dL, and 0.43 (0.23-0.83) for subjects with HDL-C increase of ≥12.5 mg/dL. In conclusion, our findings are consistent with an inverse, graded relation between 14-year increase in HDL-C and risk of subsequent CHD.

OBJECTIVE—Liver-specific inactivation of carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) by a dominant-negative transgene (l-SACC1 mice) impaired insulin clearance, caused insulin resistance, and increased hepatic lipogenesis. To discern whether this phenotype reflects a physiological function of CEACAM1 rather than the effect of the dominant-negative transgene, we characterized the metabolic phenotype of mice with null mutation of the Ceacam1 gene (Cc1−/−). RESEARCH DESIGN AND METHODS—Mice were originally generated on a mixed C57BL/6x129sv genetic background and then backcrossed 12 times onto the C57BL/6 background. More than 70 male mice of each of the Cc1−/− and wild-type Cc1+/+ groups were subjected to metabolic analyses, including insulin tolerance, hyperinsulinemic-euglycemic clamp studies, insulin secretion in response to glucose, and determination of fasting serum insulin, C-peptide, triglyceride, and free fatty acid levels. RESULTS—Like l-SACC1, Cc1−/− mice exhibited impairment of insulin clearance and hyperinsulinemia, which caused insulin resistance beginning at 2 months of age, when the mutation was maintained on a mixed C57BL/6x129sv background, but not until 5–6 months of age on a homogeneous inbred C57BL/6 genetic background. Hyperinsulinemic-euglycemic clamp studies revealed that the inbred Cc1−/− mice developed insulin resistance primarily in liver. Despite substantial expression of CEACAM1 in pancreatic β-cells, insulin secretion in response to glucose in vivo and in isolated islets was normal in Cc1−/− mice (inbred and outbred strains). CONCLUSIONS—Intact insulin secretion in response to glucose and impairment of insulin clearance in l-SACC1 and Cc1−/− mice suggest that the principal role of CEACAM1 in insulin action is to mediate insulin clearance in liver.

Objective:To present the case of an 18-year-old collegiate decathlete with a Salter-Harris type I epiphyseal plate fracture of the proximal humerus.Background:A collegiate decathlete was playing flag football and fell on an outstretched arm. He was taken to the emergency room and diagnosed with a type I epiphyseal plate fracture.Differential Diagnosis:AC sprain, dislocation or subluxation, rotator cuff tear, labral tear.Treatment:Active and passive range of motion exercises were completed after two days of immobilization. He then started strengthening exercises and returned to competitive activity in 10 weeks.Uniqueness:Proximal humeral epiphyseal plate fractures are uncommon injuries, especially in athletes over the age of 15.Conclusions:If an accurate diagnosis is made, an appropriate conservative rehabilitation program can be implemented to safely return an athlete to participation without permanent deformity following a type I Salter-Harris fracture.

Acquisition of 3D seismic surveys in urban areas is one of many obstacles explorationists face when exploring rapidly expanding plays such as the Barnett Shale of the Fort Worth Basin in Texas. To compensate for limited lease sizes, drilling deadlines, and cultural growth, we have been forced to revisit 3D seismic acquisition technologies and examine all factors considered key to designing minimum-size 3D seismic surveys. With small urban lease sizes, explorationists are forced to limit their work to a few hundred acres—an approach we like to call “surgical” 3D surveys. Although these may seem too small and appear to violate current thinking on acquisition parameters and design criteria, there are potential applications for this approach that are beneficial and important to prospect development and play enhancement. In our initial tests, small surgical 3D surveys proved adequate in imaging the particular targets of interest and the limited survey size turned out not to be an issue. The processed seismic i...

Background. High blood pressure (BP) has been associated with a decrease in kidney function. However, it remains unclear which BP measure best predicts impaired kidney function. Methods. We compared systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP) and mean arterial pressure (MAP) in predicting risk of chronic kidney disease (CKD). We prospectively followed 8093 male participants in the Physicians' Health Study, without a known history of kidney disease at baseline, who provided BP values on the baseline and 24-month questionnaires, and for whom we had creatinine measures after 14 years of follow-up. Reported BP was averaged from both questionnaires. The main outcome was CKD, defined as an estimated glomerular filtration rate

Context The debate over what the entry-level degree should be for athletic training has heightened. A comparison of retention and career-placement rates between bachelor's and master's degree professional athletic training programs may inform the debate. Objective To compare the retention rates and career-placement rates of students in bachelor's and master's degree professional programs. Design Cross-sectional study. Setting Web-based survey. Patients or Other Participants A total of 192 program directors (PDs) from bachelor's degree (n = 177) and master's degree (n = 15) professional programs. Intervention(s) The PDs completed a Web-based survey. Main Outcome Measure(s) We instructed the PDs to provide a retention rate and career-placement rate for the students in the programs they lead for each of the past 5 years. We also asked the PDs if they thought retention of students was a problem currently facing athletic training education. We used independent t tests to compare the responses between bachelor's and master's degree professional programs. Results We found a higher retention rate for professional master's degree students (88.70% ± 9.02%, 95% confidence interval [CI] = 83.71, 93.69) than bachelor's degree students (80.98% ± 17.86%, 95% CI = 78.30, 83.66) (t25 = −2.86, P = .008, d = 0.55). Similarly, PDs from professional master's degree programs reported higher career-placement percentages (88.50% ± 10.68%, 95% CI = 82.33, 94.67) than bachelor's degree professional PDs (71.32% ± 18.47%, 95% CI = 68.54, 74.10) (t20 = −5.40, P < .001, d = 1.14). Finally, we observed no difference between groups regarding whether retention is a problem facing athletic training (χ21 = 0.720, P = .40, Φ = .061). Conclusions Professional master's degree education appears to facilitate higher retention rates and greater career-placement rates in athletic training than bachelor's degree education. Professional socialization, program selectivity, and student commitment and motivation levels may help to explain the differences noted.

Context The decision has been made to move away from the traditional bachelor's degree professional program to a master's degree professional program. Little is known about the perceptions about this transition from those involved with education.Objective To examine multiple stakeholders' perspectives within athletic training education on the effect that a change to graduate-level education could have on the profession and the educational and professional development of the athletic trainer.Design Qualitative study.Setting Web-based survey.Patients or Other Participants A total of 18 athletic training students (6 men, 12 women; age = 24 ± 5 years), 17 athletic training faculty (6 men, 9 women, 2 unspecified; 7 program directors, 5 faculty members, 3 clinical coordinators, 2 unidentified; age = 45 ± 8 years), and 15 preceptors (7 men, 7 women, 1 unspecified; age = 34 ± 7 years) completed the study.Data Collection and Analysis Participants completed a structured Web-based questionnaire. Each cohort responded to questions matching their roles within an athletic training program. Data were analyzed following a general inductive process. Member checks, multiple-analyst triangulation, and peer review established credibility.Results Thirty-one (62%) participants supported the transition, 14 (28%) were opposed, and 5 (10%) were neutral or undecided. Advantages of and support for transitioning and disadvantages of and against transitioning emerged. The first higher-order theme, advantages, revealed 4 benefits: (1) alignment of athletic training with other health care professions, (2) advanced coursework and curriculum delivery, (3) improved student and professional retention, and (4) student maturity. The second higher-order theme, disadvantages, was defined by 3 factors: (1) limited time for autonomous practice, (2) financial concerns, and (3) lack of evidence for the transition.Conclusions Athletic training students, faculty, and preceptors demonstrated moderate support for a transition to the graduate-level model. Factors supporting the move were comparable with those detailed in a recent document on professional education in athletic training presented to the National Athletic Trainers' Association Board of Directors. The concerns about and reasons against a move have been discussed by those in the profession.

CEACAM1 promotes insulin extraction, an event that occurs mainly in liver. Phenocopying global Ceacam1 null mice (Cc1–/–), C57/BL6J mice fed a high-fat diet exhibited reduced hepatic CEACAM1 levels and impaired insulin clearance, followed by hyperinsulinemia, insulin resistance and visceral obesity. Conversely, forced liver-specific expression of CEACAM1 protected insulin sensitivity and energy expenditure, and limited gain in total fat mass by high-fat diet in L-CC1 mice. Because CEACAM1 protein is barely detectable in white adipose tissue, we herein investigated whether hepatic CEACAM1-dependent insulin clearance pathways regulate adipose tissue biology in response to dietary fat. While high-fat diet caused a similar body weight gain in L-CC1, this effect was delayed and less intense relative to wild-type mice. Histological examination revealed less expansion of adipocytes in L-CC1 than wild-type by high-fat intake. Immunofluorescence analysis demonstrated a more limited recruitment of crown-like structures and qRT-PCR analysis showed no significant rise in TNFα mRNA levels in response to high-fat intake in L-CC1 than wild-type mice. Unlike wild-type, high-fat diet did not activate TGF-β in white adipose tissue of L-CC1 mice, as assessed by Western analysis of Smad2/3 phosphorylation. Consistently, high-fat diet caused relatively less collagen deposition in L-CC1 than wild-type mice, as shown by Trichome staining. Coupled with reduced lipid redistribution from liver to visceral fat, lower inflammation and fibrosis could contribute to protected energy expenditure against high-fat diet in L-CC1 mice. The data underscore the important role of hepatic insulin clearance in the regulation of adipose tissue inflammation and fibrosis.

Obesity is a risk factor for colorectal cancer (CRC), and alterations in the colonic microbiome and metabolome may be mechanistically involved in this relationship. The relative contribution of diet and obesity per se are unclear. We compared the effect of diet- and genetically-induced obesity on the intestinal microbiome and metabolome in a mouse model of CRC. Apc1638N mice were made obese by either high fat (HF) feeding or the presence of the Leprdb/db (DbDb) mutation. Intestinal tumors were quantified and stool microbiome and metabolome were profiled. Genetic obesity, and to a lesser extent HF feeding, promoted intestinal tumorigenesis. Each induced distinct microbial patterns: taxa enriched in HF were mostly Firmicutes (6 of 8) while those enriched in DbDb were split between Firmicutes (7 of 12) and Proteobacteria (5 of 12). Parabecteroides distasonis was lower in tumor-bearing mice and its abundance was inversely associated with colonic Il1b production (p

Objective: To evaluate which blood pressure measure is the best predictor of risk of total, ischemic, and hemorrhagic stroke. Methods: The authors used a prospective cohort study among 11,466 men followed for incident stroke during a median of 19.4 years in the Physicians9 Health Study. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were self-reported. They calculated relative risks (RRs) and 95% CIs for total, ischemic, and hemorrhagic stroke using Cox proportional hazards models. Model fit was compared using the χ 2 test statistic from likelihood ratio tests. Results: During follow-up, 508 strokes occurred (411 ischemic, 89 hemorrhagic, and eight of unknown etiology). For each 10-mm Hg increase in SBP, the multivariable RRs were 1.31 (95% CI: 1.20 to 1.42) for total stroke, 1.28 (95% CI: 1.16 to 1.40) for ischemic stroke, and 1.38 (95% CI: 1.13 to 1.68) for hemorrhagic stroke. Although DBP, pulse pressure, and mean arterial pressure were all significant predictors of stroke risk, none was a significantly better predictor than SBP alone. Adding DBP did not significantly improve the model fit of SBP alone for any stroke type. Conclusion: In this large cohort of initially healthy men, systolic blood pressure was a consistent and significant predictor of total, ischemic, and hemorrhagic stroke. Systolic blood pressure alone was the only measure necessary to predict risk of total stroke or its major subtypes.

In cross-sectional studies, elevated homocysteine levels are associated with higher blood pressure, but it remains unclear whether plasma homocysteine is a risk factor for hypertension. In a prospective nested case-control study, participants who developed hypertension (n=396) had significantly higher levels of baseline plasma homocysteine (12.6 mol/l) than matched controls (11.8 mol/l, P=0.03); compared to those in the lowest quintile, those in the highest quintile had a crude relative risk (RR) of 1.56 (95% confidence interval (CI), 0.98-2.48; P for trend=0.10) and a multivariable RR of 1.63 (95% CI, 0.97-2.74; P for trend=0.13). Higher plasma homocysteine levels at baseline were associated with an increased but non-significant risk of incident hypertension that was minimally affected by multivariable adjustment.

Background and Purpose— Large epidemiological studies have not established cholesterol levels as a risk factor for ischemic stroke, but recent clinical trials have demonstrated a reduction in the ischemic stroke rate for patients taking HMG-CoA reductase inhibitors (“statins”). The goal of this study was to evaluate whether total cholesterol (TC), high-density lipoprotein (HDL), triglycerides, and the TC:HDL ratio are risk factors for ischemic stroke in apparently healthy men enrolled in the Physicians’ Health Study. Methods— We used a nested case-control study design and matched 296 ischemic stroke cases with an equal number of controls on age, tobacco use, and follow-up time. At baseline, TC, HDL, and triglyceride levels were measured. We calculated odds ratios (ORs) and their 95% confidence intervals (CIs) using conditional logistic regression, adjusting for major risk factors for ischemic stroke. Results— Compared with the reference lowest quartile, the highest quartile for TC had an adjusted OR of 1.56 (95% CI, 0.84 to 2.92), the highest quartile of HDL had an adjusted OR of 0.75 (95% CI, 0.43 to 1.30), and the highest quartile of triglycerides had an adjusted OR of 1.07 (95% CI, 0.63 to 1.82). Although the highest quartile of the TC:HDL ratio had an adjusted OR of 1.62 (95% CI, 0.93 to 2.82), the risk of ischemic stroke was not a linear relationship. Conclusions— After adjustment, TC, HDL, and triglycerides were not significantly associated with ischemic stroke risk, and for the TC:HDL ratio, a suggestion of increased risk of ischemic stroke was limited to those with the highest levels.

The purpose of this study, which involved two dermatology clinics and two podiatric medical clinics, was to determine whether a difference exists in patient-reported satisfaction and compliance between continuous terbinafine therapy and pulse-dose itraconazole therapy for the treatment of toenail onychomycosis. Patients in this multicenter, open-label, cross-sectional study had previously completed treatment with either oral terbinafine or oral itraconazole for toenail onychomycosis. Patients were interviewed by telephone to assess clinical outcomes, compliance, and satisfaction with treatment; clinical data were collected by medical chart review. Patients reported significantly greater ease and convenience of treatment and higher overall satisfaction with continuous terbinafine therapy compared with pulse-dose itraconazole therapy. (J Am Podiatr Med Assoc 93(5): 373-379, 2003)

Purpose: College students are at a risk for increased levels of stress and burnout, and those enrolled in healthcare degree programs are more likely to experience higher levels due to balancing demanding roles. Our purpose was to assess sources of stress, burnout, and/or frustration in athletic training students (ATSs) of different academic standings. Methods: Data were collected through the use of an original, 33-question questionnaire. An inductive approach was used to analyze the data and multiple analyst triangulation and interpretive member checks were used to secure credibility. Results: 27 male and female ATSs from freshman, sophomore, junior, and senior classes from one institution voluntarily participated within this study. We were able to identify distinct themes of stress and burnout for each class of ATSs. Freshman reported concern for the time demand from the major and a desire to have more hands-on activity involved with their clinical education experiences. The sophomores reported feeling stressed regarding the expectation to retain information and the expectations to perform hands-on duties, as well as their ability to balance academic and clinical responsibilities. Challenging coursework, pressure during clinical experiences, and social conflicts appeared as themes for the junior ATSs. Finally, the seniors stated a fear of not achieving professional proficiency was a source of frustration. Conclusions and Recommendations: Based on our findings, efforts should be made to assist student time management practices, improve communication between preceptors and students, and make expectations of the athletic training program (ATP) faculty and preceptors clear. Such measures could help influence other positive changes within ATPs to improve the learning environment for ATSs.

Objective For both subconcussive impacts and traditionally-defined concussion, neither the number of head impacts nor the magnitude has had a strong correlation to the incidence or severity of injury. Recent modelling work has suggested that impulse may be an important biomechanical factor, and therefore it is hypothesised that it may be a good predictor of subconcussive neurophysiological changes. Design Observational study. Setting American high school football team. Participants Nine male high school football athletes (mean age=16.4, range=15–17) volunteered. All participants were enrolled with parental consent. Assessment of risk factors Head impacts were monitored at all practices and games with the Head Impact Telemetry System. Baseline neurophysiology was measured prior to contact activity using a functional magnetic resonance imaging (fMRI) visual n-back task protocol. Subjects returned throughout the season and were re-evaluated according to the same protocol. Outcome measures Kinematic impulse was computed from head impact telemetry. Changes in neurophysiology were determined as the difference in the 2 vs. 1-back contrast. This contrast was determined for 116 anatomically defined regions of interest (ROI). Main results Stepwise regressions (P=0.05) relating kinematic impulse to ROI-specific changes in neurophysiology yielded significant correlations for 57/116 ROIs. 22/116 ROIs had an R2 value greater than 0.70. Correlations were found bilaterally for 16 anatomical ROIs, including the executive pre-frontal regions, basal ganglia, and thalamus. Conclusions The relationship between kinematic impulse and fMRI changes reported here are the strongest correlations to subconcussive changes reported to date. Correlations were observed bilaterally in regions associated with concussion symptoms. Competing interests None.

Objective Neurocognitive changes have been found in football players without documented concussion raising concerns regarding the long term consequences of subconcussive head impacts in sport. It remains unknown if similar neurocognitive changes are found in female soccer athletes without concussion. Females have been found to have higher concussion rates compared to males and soccer is the most popular sport internationally providing a compelling area of study. Design Observational study. Setting American collegiate women’s soccer team. Participants 16 National Collegiate Athletic Association Division III women’s soccer athletes (19.88±1.1 years old, 163.7±4.9 cm, 61.2±4.9 kg) volunteered and provided consent for the study. Assessment of risk factors We measured head impacts during practices and games throughout the 15 week season with the xPatch (X2 Biosystems, Seattle, WA, USA). All participants completed ImPACT and the Sport Concussion Assessment Tool – 3rd Edition (SCAT3) prior to the season’s start and at the end of the season. Outcome measures The xPatch stored location, frequency, and magnitude (linear and rotational accelerations) of head impacts. Event film was used to verify each head impact. Changes in neurocognitive function were determined by comparing the baseline ImPACT and SCAT3 scores with the post-season scores. Main results A stepwise regression found a significant relationship between weekly head impact frequency during practices and the ImPACT measures of Visual Motor Speed (P=0.03) and Symptom Score (P=0.03). Conclusions Soccer activity may lead to lower visual motor speed and higher symptom scores. Future studies should use additional screening tools to verify these preliminary findings. Competing interests None.

In response to adrenergic stimulation, adipocytes undergo protein kinase A (PKA)‐stimulated lipolysis. A key PKA target in this context is perilipin 1, a major regulator of lipolysis on lipid droplets (LDs). A study published in this issue of The EMBO Journal (Pidoux et al , 2011) identifies optic atrophy 1 (OPA1), a protein that regulates mitochondrial dynamics, as perilipin 1 interaction partner and the A‐kinase anchoring protein (AKAP) on LDs that is involved in the induction of stimulated lipolysis.

Context: The average retention rate for students enrolled in undergraduate athletic training programs (ATPs) nationwide has been reported to be 81%, and slightly more than half of program directors (PDs) have indicated that retention of athletic training students (ATSs) is a problem. However, why PDs do or do not believe ATS retention is problematic is unknown. Objective: To determine why PDs do or do not believe ATS retention is problematic. Design: Qualitative study. Setting: Undergraduate ATPs. Patients or Other Participants: We obtained responses from 177 of the 343 PDs (51.6%). Using data saturation as a guide, we randomly selected 16 PDs from the survey responses to participate in follow-up telephone interviews; 8 believed retention was a problem and 8 did not. Data Collection and Analysis: During audio-recorded telephone interviews, we asked PDs why they thought retention was or was not a problem for athletic training education. Following verbatim transcription, we used grounded theory to analyze the interview data and maintained trustworthiness by using intercoder agreement, member checks, and peer review. Results: Program directors believed that retaining ATSs was a problem because students lack information regarding athletic training and the rigor of the ATP. Program directors were consistent in their perception that ATPs do not have a retention challenge because of the use of a secondary admissions process. This finding was likely based on personal use of a secondary admissions process in the ATPs these PDs lead. Conclusions: Program directors who lead ATPs that struggle to retain ATSs should consider using a secondary admissions process. During the preprofessional phase of the ATP, faculty and staff should work to socialize students to the demands of the ATP and the professional lives of athletic trainers.

Context:The role of the preceptor requires the athletic trainer to be versed in effective instructional techniques, supervisory skills, and communication skills beyond his or her competence as an athletic trainer, but many have not received formal training in educational techniques.Objective:To gain a better understanding about the professional socialization process for the athletic trainer assuming the role of the preceptor.Design:Qualitative study.Setting:Athletic training education programs.Patients or Other Participants:Twenty-four preceptors (11 men, 13 women; age = 32 ± 7 years, clinical experience = 9 ± 6 years, preceptor experience = 5 ± 3 years) employed in the collegiate (n = 12) or secondary school (n = 12) setting.Data Collection and Analysis:We gathered data using asynchronous, in-depth interviewing via QuestionPro. We analyzed data using a general inductive approach to uncover the dominant themes. Credibility was secured by using consistency and stakeholder checks and a peer review.Results:We identified 2 main themes by which preceptors develop in their roles as clinical instructors: formal processes and informal processes. The participants used observations, previous experiences or interactions with role models, and self-reflection and evaluation as informal socialization processes. Formal socialization processes included preceptor training/workshops, professional development, and formal teacher certification.Conclusions:Athletic trainers who serve as preceptors learned their roles by a combination of informal and formal processes. Preceptor training sessions appeared to be effective in initially helping preceptors learn their responsibilities, whereby more informal processes seemed to help them refine their skills. Furthermore, one socialization strategy did not appear to dominate role learning; rather, a combination of several processes fostered an understanding.

Context Facemask removal (FMR) is required to access the airway of a catastrophically injured football or ice hockey athlete. However, the best method of caring for the helmeted lacrosse athlete with suspected catastrophic injury remains unclear. Objective To evaluate the effects of sex and grip strength on the speed and ease of use of various FMR methods across different lacrosse helmet types. Design Cross-sectional study. Setting Athletic training laboratory. Patients or Other Participants Fourteen athletic trainers (7 men, 7 women). Intervention(s) Removal method (cordless screwdriver [CSD], Face Mask Extractor 2 [FMX], pruner, Trainer's Angel [TA]), helmet type (Cascade CPX, Cascade Pro7, Riddell Revolution, Brine Triumph, Warrior Venom), and sex. Main Outcome Measure(s) Facemask removal time and participant-reported ease of use of the removal method (6-point Likert scale). Results We found a 2-way interaction for removal method and sex only for the ease-of-use scores (F3,246 = 4.67, P = .01). A main effect for removal method for time (F3,200 = 19.41, P < .001) and ease of use (F3,200 = 53.78, P < .001) was seen. The fastest times (32.32 ± 11.70 seconds) and highest ease-of-use scores (4.94 ± 0.30) were recorded for the CSD. We noted a main effect for helmet type only for time (F4,200 = 5.34, P < .001), with the fastest removal times (72.75 ± 74.67 seconds) recorded for the CPX. We discovered a main effect for sex only for time (F1,200 = 17.57, P < .001), with slower times recorded for women (115.51 ± 110.80 seconds) than men (75.71 ± 83.87 seconds). We found correlations between FMR time and grip strength only when using the FMX (r = −0.40, P = .001), pruner (r = −0.26, P = .04), and TA (r = −0.26, P = .047). Conclusions Based on our results, FMR of lacrosse helmets should be attempted with a CSD. We recommend carrying a pruner as a backup cutting tool in case the CSD fails, practicing FMR regularly, and inspecting helmets for faulty hardware to reduce the chance of CSD failure.

An efficient discontinuous molecular dynamics simulation algorithm is developed to simulate hydrogen-bonding systems. The efficiency of CPU time in the order of N log 2 N is stressed by comparisons to several other methods and algorithms. To evaluate this algorithm, special attention is given to the simulation of thermodynamic and transport properties as well as oligomer distribution of the hydrogen-bonding water system by use of DMD-1B and -4B site models. The results are compared to the results of Monte Carlo simulations and Wertheim's first-order theory. The overall agreement is satisfactory within a standard deviation

Background Observational studies of new coronary stents are necessary to assess performance in a variety of complex patient and lesion types. Furthermore, the optimal dose and duration of thienopyridine treatment is unclear, particularly in patients with complex clinical conditions. The TAXUS Libertē Post-Approval Study is designed to provide 5-year data on the TAXUS Liberte paclitaxel-eluting stent with concomitant prasugrel therapy in routine clinical practice and to contribute data to the DAPT study. Study Design The TAXUS Libertē Post-Approval Study is a prospective, multicenter, observational study. Enrollment of approximately 4,200 patients receiving ≥1 TAXUS Liberte stents is planned. All patients without a contraindication will be prescribed prasugrel plus aspirin for 1 year. The 12-month primary end point of cardiac death or myocardial infarction in on-label stent patients will be compared with historical TAXUS Express stent data from the TAXUS ATLAS and TAXUS ARRIVE studies. Secondary clinical end points include stent thrombosis, all-cause death, stroke, revascularization, and bleeding in all patients. In addition, this study will be the first to evaluate prasugrel use in a routine practice setting (including 5 and 10 mg daily doses) and will contribute data to the DAPT Study, comparing 12 versus 30 months of dual antiplatelet therapy after drug-eluting stent placement. Summary The TAXUS Libertē Post-Approval Study will be the first to provide long-term real-world data on use of the TAXUS Liberte Stent with prasugrel treatment. The study is currently enrolling, and primary end point data are expected in mid 2013.