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Secondary inorganic aerosols (sulfate, nitrate, and ammonium, SNA) are major contributors to fine particulate matter. Predicting concentrations of these species is complicated by the cascade of processes that control their abundance, including emissions, chemistry, thermodynamic partitioning, and removal. In this study, we use 11 flight campaigns to evaluate the GEOS-Chem model performance for SNA. Across all the campaigns, the model performance is best for sulfate (R2 = 0.51; normalized mean bias (NMB) = 0.11) and worst for nitrate (R2=0.22; NMB = 1.76), indicating substantive model deficiencies in the nitrate simulation. Thermodynamic partitioning reproduces the total particulate nitrate well (R2=0.79; NMB = 0.09), but actual partitioning (i.e., ε(NO3-)= NO3- / TNO3) is challenging to assess given the limited sets of full gas- and particle-phase observations needed for ISORROPIA II. In particular, ammonia observations are not often included in aircraft campaigns, and more routine measurements would help constrain sources of SNA model bias. Model performance is sensitive to changes in emissions and dry and wet deposition, with modest improvements associated with the inclusion of different chemical loss and production pathways (i.e., acid uptake on dust, N2O5 uptake, and NO3- photolysis). However, these sensitivity tests show only modest reduction in the nitrate bias, with no improvement to the model skill (i.e., R2), implying that more work is needed to improve the description of loss and production of nitrate and SNA as a whole.

Background: The aim of this study was to determine whether body mass index (BMI) plays a role in overall morbidity following shoulder instability surgery and whether some surgical techniques are BMI-sensitive. Methods: A prospective, multicenter database was created that included the following three surgical techniques: arthroscopic Bankart (AB), arthroscopic Bankart with remplissage (ABR), and Open Latarjet (OL). Patient data (demographic, strength, laxity and functional outcomes (Disability of the Arm, Shoulder, and Hand [QuickDASH]; Western Ontario Shoulder Instability Index; and QuickDASH Pain subscore) were compared at enrollment and last postoperative follow-up. Functional outcomes, complications, and postoperative outcomes were compared between the different groups and then subdivided by BMI. Follow-up radiographs were evaluated for graft position and complications for all patients who underwent OL. Results: A total of 227 patients (164 men, 63 women) were included with at least 1-year follow-up (3.3y AB (n = 126), 4.5y ABR (n = 34), and 3y OL (n = 62)). At baseline, patients with high BMI (37(17%)) had significantly worse QuickDASH Pain subscores (2.9 ± 1.0, P value

Current diversity and sexual harassment trainings often take an informative approach that results in a gap between theoretical knowledge and practical resolutions of ethical dilemmas. Available research suggests that diversity training programs often elicit the greatest amount of change among people with a minority identity and can result in hostility from majority group members. To better prepare all engineering students for modern-day organizations, it's imperative that universities develop effective approaches at the student level to mitigate these discrepancies. We propose that our novel ethics-based training will elicit positive diversity-related outcomes overall. We inductively explore the differential impact of diversity training across majority and minority identities. Longitudinal quantitative data were collected to examine changes in participant attitudes and behaviors in response to the diversity module. Undergraduate engineering students enrolled in an introductory engineering ethics course at a large Southwestern university were presented with a week-long teaching module on diversity. Survey results were evaluated to measure differences in effectiveness among majority and minority students. The diversity training successfully decreased levels of sexism, acceptance of sexual harassment myths, and increased intentions to confront discrimination. Differences in outcome variables between majority and minority members were found with regard to political orientation, race, and physical and mental disability status. Overall, this study presents a promising new avenue for diversity training scholarship. Specifically, we find that an ethics-based approach to diversity training may be particularly effective for majority group students.

Vaishnavi L Gopaul,* Lacey Winstone,* Beatrice G Gatien,* Braydon D Nault, Sujit Maiti, Reid M Opperman, Mousumi Majumder Department of Biology, Brandon University, Brandon, MB, Canada*These authors contributed equally to this workCorrespondence: Mousumi Majumder, Email majumderm@brandonu.caBackground: YWHAB (14-3-3 Beta) was found in the secretome of miR-526b and miR-655 overexpressed breast cancer (BRCA) cell lines. The potential of YWHAB as a therapeutic target or biomarker for BRCA is investigated here.Methods: After YWHAB was knocked down with siRNA, BRCA cell lines were used for in vitro assays (proliferation, migration, epithelial-to-mesenchymal transition). In silico analysis and in situ validation with BRCA plasma and biopsy tissues were used to test YWHAB’s biomarker potential.Results: YWHAB RNA and protein expression are elevated in aggressive BRCA cell lines, and the knockdown of YWHAB inhibited cell migration, proliferation, and EMT in all subtypes of tumour cell lines. YWHAB expression is significantly higher in BRCA biopsy tissue and blood plasma compared to control tissues and benign plasmas. YWHAB is expressed in all hormonal subtypes of BRCA tumours and has shown increased expression in advanced tumour stages. Its high expression is linked to poor patient survival. YWHAB is a sensitivity tumour marker (AUC of 0.7340, p = 0.0012) but is not a promising blood biomarker. Nevertheless, combined with pri-miR-526b, YWHAB mRNA expression shows potential as a BRCA blood biomarker (AUC of 0.711, p = 0.032), which must be validated in a larger sample set.Conclusion: We elucidate the novel role of YWHAB as a therapeutic target in BRCA, given that its inhibition mitigated aggressive phenotypes across all tumour subtypes, including triple-negative breast cancer. Furthermore, YWHAB emerges as a potential tumour marker, exhibiting high expression in metastatic BRCA and correlating with poor patient survival; however, it is not a sensitive blood biomarker. Keywords: breast cancer, microRNA, miRNA, miR-526b, miR-655, YWHAB, 14-3-3 Beta, biomarker, migration, epithelial to mesenchymal transition, proliferation

Abstract In the last three decades, ablation of atrial fibrillation (AF) has become an evidence‐based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society

As part of the summer 2022 NYC-METS (New York City metropolitan Measurements of Emissions and TransformationS) campaign and the ASCENT (Atmospheric Science and Chemistry mEasurement NeTwork) observational network, speciated particulate matter was measured in real time in Manhattan and Queens, NY, with additional gas-phase measurements. Largely due to observed reductions in inorganic sulfate aerosol components over the 21st century, summertime aerosol composition in NYC has become predominantly organic (80-83%). Organic aerosol source apportionment via positive matrix factorization showed that this is dominated by secondary production as oxygenated organic aerosol (OOA) source factors comprised 73-76% of OA. Primary factors, including cooking-related organic aerosol (COA) and hydrocarbon-like organic aerosol (HOA) comprised minor fractions of OA, only 13-15% and 10-11%, respectively. The two sites presented considerable spatiotemporal variations in OA source factor concentrations despite similar average PM2.5 concentrations. The less- and more-oxidized OOA factors exhibited clear temperature dependences at both sites with increased concentrations and greater degrees of oxidation at higher temperatures, including during a heatwave. With strong temperature sensitivity and minimal changes in summertime concentrations since 2001, secondary OA poses a particular challenge for air quality policy in NYC that will very likely be exacerbated by continued climate change and extreme heat events.

Introduction: Being named as a defendant in a malpractice lawsuit is known to be a particularly high-stress and vulnerable time for a physician. Medical malpractice stress syndrome (MMSS) is a consequence of being named as a physician defendant in a malpractice lawsuit. Symptoms include depression, anxiety, and insomnia, which may lead to burnout, loss of confidence in clinical decision-making, substance abuse, strain on personal and professional relationships, and suicidal ideation. Although the legal process requires strict confidentiality regarding the specific details of the legal case, discussing the emotional impact of the case is not prohibited. Given that physicians often do not choose formalized therapy with a licensed professional, there is a recognized need to provide physicians with options to support their wellness during a lawsuit.Methods: The peer support model is a promising option to address the negative impacts to wellness that physician defendants face during medical malpractice lawsuits. We developed and implemented a peer support program to provide a safe, protected space for discussion of the personal impact of a lawsuit and to normalize this experience among peer physicians.Results: Physicians were receptive to joining a peer support group to discuss the personal impacts of being named in a medical malpractice lawsuit. Participants in this novel group-based program found it helpful and would unanimously recommend it to others who are being sued.Conclusion: To our knowledge, this pilot study is the first to implement and assess a facilitated, group-based peer support model for emergency physicians who are named as defendants in malpractice lawsuits. While group discussions demonstrated that symptoms of acute distress and MMSS were prevalent among physicians who were being sued, in this study physicians were receptive to and felt better after peer support sessions. Despite increasing burnout in the specialty of emergency medicine (EM) during the study time frame, burnout did not worsen in participants. Extrapolating from this pilot program, we hypothesize that formal peer support offered by EM groups can be an effective option to normalize the experience of being sued, promote wellness, and benefit physicians who endure the often long and stressful process of a medical malpractice lawsuit.

Opportunities exist to improve patient experience in the emergency department for low-risk (ie, non-cardiac) chest pain patients with anxiety and panic as the underlying cause of symptoms. Referral to internet-based cognitive behavioral therapy (iCBT) with guided support is a scalable, evidence-based option that is underused, particularly among non-white patients. In collaboration with a diverse group of patient and community partners, we co-developed and tested an existing iCBT course for generalized anxiety disorder with delivery of guided support by a peer recovery specialist with concordant lived experience. We analyzed patient partner feedback from debriefing sessions during the testing phase using conventional content analysis. Results revealed overall positive experiences with both iCBT lessons and peer support calls. Key points derived from qualitative findings include: (1) iCBT lesson content resonated reasonably well with the diverse group of patient partners, (2) the peer relationship was key to individualizing application of content to various lived experiences, and (3) the guided discussion should be participant-driven and based on content that resonates most with the participant. In conclusion, iCBT with guided peer support was acceptable to patient partners involved in co-development and testing who were representative of a diverse patient population.

The fraction of urban volatile organic compound (VOC) emissions attributable to fossil fuel combustion has been declining in many parts of the world, resulting in a need to better constrain other anthropogenic sources of these emissions. During the National Institute of Environmental Research (NIER) and National Aeronautics and Space Administration (NASA) Korea-United States Air Quality (KORUS-AQ) field study in Seoul, South Korea, during May–June 2016, air quality models underestimated ozone, formaldehyde, and peroxyacetyl nitrate (PAN), indicating an underestimate of VOCs in the emissions inventory. Here, we use aircraft observations interpreted with the GEOS-Chem chemical transport model (version 13.4.0) to assess the need for increases in VOC emissions and for a revised chemical mechanism to improve treatment of VOC speciation and chemistry. We find that the largest needed VOC emissions increases are attributable to compounds associated with volatile chemical products, liquefied petroleum gas (LPG) and natural gas emissions, and long-range transport. Revising model chemistry to better match observed VOC speciation together with increasing model emissions of underestimated VOC species increased calculated OH reactivity by +2 s−1 and ozone production by +2 ppb h−1. Ozone increased by +6 ppb below 2 km and +9 ppb at the surface, and formaldehyde and acetaldehyde increased by +30 % and +120 % aloft, respectively, all in better agreement with observations. The larger increase in acetaldehyde was attributed to ethanol emissions, which we found to be as important for ozone production as isoprene or alkenes. The increased acetaldehyde significantly reduced the model PAN bias. The need for additional unmeasured VOCs, however, was indicated by a remaining model bias of −0.8 ppb in formaldehyde and a −57 % and −52 % underestimate in higher peroxynitrates (PNs) and alkyl nitrates (ANs), respectively. We added additional chemistry to the model to represent an additional six PNs from observed VOCs but were unable to account for the majority of missing PNs. However, four of these PNs were modeled at concentrations similar to other commonly measured PNs (> 2 % of PAN) indicating that these should be measured in future campaigns and considered from other VOC emission sources (e.g., fires). We hypothesize that emissions of oxygenated VOCs (OVOCs) such as ≥ C5 aldehydes from cooking and/or alkenes associated with volatile chemical products could produce both PNs and ANs and improve remaining model biases. Emerging research on the emissions and chemistry of these species will soon allow for modeling of their impact on local and regional photochemistry.

Ozone (O3) is an important secondary pollutant that impacts air quality and human health. Eastern Asia has high regional O3 background due to the numerous sources and increasing and rapid industrial growth, which also impacts the Seoul Metropolitan Area (SMA). However, the SMA has also been experiencing increasing O3 driven by decreasing NOx emissions, highlighting the role of the local in situ O3 production on the SMA. Here, comprehensive gas-phase measurements collected on the NASA DC-8 during the National Institute of Environmental Research (NIER)/NASA Korea–United States Air Quality (KORUS-AQ) study are used to constrain the instantaneous O3 production rate over the SMA. The observed NOx oxidized products support the importance of non-measured peroxy nitrates (PNs) in the O3 chemistry in the SMA, as they accounted for ∼49 % of the total PNs. Using the total measured PNs (ΣPNs) and alkyl and multifunctional nitrates (ΣANs), unmeasured volatile organic compound (VOC) reactivity (R(VOC)) is constrained and found to range from 1.4–2.1 s−1. Combining the observationally constrained R(VOC) with the other measurements on the DC-8, the instantaneous net O3 production rate, which is as high as ∼10 ppbv h−1, along with the important sinks of O3 and radical chemistry, is constrained. This analysis shows that ΣPNs play an important role in both the sinks of O3 and radical chemistry. Since ΣPNs are assumed to be in a steady state, the results here highlight the role that ΣPNs play in urban environments in altering the net O3 production, but ΣPNs can potentially lead to increased net O3 production downwind due to their short lifetime (∼1 h). The results provide guidance for future measurements to identify the missing R(VOCs) and ΣPN production.

Origami-inspired metamaterials have gained significant attention for their ability to mimic the complex mechanical behavior of biological tissues and their potential applications in advanced surgical treatments. Inspired by Kresling origami, we introduced a metamaterial capable of large recoverable deformations. A parametric design explored the effects of changing geometrical parameters on the mechanical properties of the metamaterial. Eighteen designs were fabricated and mechanically tested for practicability assessment and validation purposes. Non-linear finite element method was leveraged to test the entire design space of the metamaterial. Using Bayesian machine learning, the sensitivity of surface to volume ratio, porosity, elastic modulus, strain energy density, and maximum local strain to the design inputs was assessed and their corresponding predictive models were created. The fabricated designs could withstand 80 % and up to 70 % recoverable strain in quasi static and cyclic loading, respectively, while exhibiting a wide range of structural and mechanical properties. From predictive models, elastic modulus of 0.1 Pa to 1.8 KPa was attainable, while having porosities from 49.7 % to 99.9 %. This study demonstrated the feasibility of the design and manufacturing of an origami-inspired super deformable metamaterial with highly-tunable structural and mechanical properties, which can be used for various tissue engineering applications.

Metabolic reprogramming by the pyruvate kinase M2 isoform is associated with cell proliferation and reactive oxygen species (ROS) defenses. 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD), an environmental contaminant that induces ROS and hepatotoxicity, dose-dependently induces pyruvate kinase muscle isoform M2 (PKM2) in the liver. To further investigate its role in combating TCDD hepatotoxicity, a PkmΔDRE mouse was constructed lacking the dioxin response element mediating aryl hydrocarbon receptor (AHR) induction. TCDD failed to induce hepatic PKM2 in PkmΔDRE mice and in primary hepatocytes isolated from an AHR knockout model (AHRV375Afl/flAlb-CreERT2), demonstrating induction is AHR dependent. Both wild-type (WT) and PkmΔDRE mice exhibited dose-dependent increases in liver weight after treatment with TCDD every 4 days for 28 days. Glutathione (GSH) levels increased in WT mice while oxidized glutathione (GSSG) levels increased in both models with a 24-fold decrease in the GSH/GSSG ratio in PkmΔDRE mice suggesting lower antioxidant and recycling capacity. Moreover, TCDD-induced fibrosis was more severe in PkmΔDRE mice while PkmΔDRE hepatocytes exhibited greater cytotoxicity following co-treatment with TCDD and hydrogen peroxide. TCDD also induced PKM2 in human HepaRG™ cells with AHR enrichment at a conserved DRE core within the locus. These results suggest AHR-mediated PKM2 induction is a novel antioxidant response to TCDD.

Background & Aims: Safety data for patients with hepatocellular carcinoma (HCC) treated with atezolizumab-bevacizumab in the real-world setting remain uncertain. Thus, the aim of this study was to evaluate the incidence of adverse events (AEs) in patients with HCC treated with atezolizumab-bevacizumab in the literature. Methods: In this systematic review and meta-analysis, we searched PubMed for original studies reporting percentages of AEs in patients with HCC receiving atezolizumab-bevacizumab between 2020 to 2023, using the search terms “Atezolizumab/Bevacizumab”, “HCC” and “Adverse events”. We summarized the incidence of AEs and performed a meta-analysis in order to evaluate the incidence of AEs reported in the literature. Results: A total of 30 studies (3,867 patients) were included. The analysis revealed heterogeneity in AE reporting, with arterial hypertension, proteinuria, and fatigue being the most frequently reported AEs whereas incidence of bleeding was reported in 66.7% of the studies and rare immune-related AEs were reported in 26.7% of the studies. The meta-analysis revealed pooled incidence rates of 79% for any grade AEs: 56% for grade 1/2 and 30% for grade ≥3. While the pooled rates of hypertension, anorexia, bleeding, pruritus, rash, and thyroid dysfunction were similar to those reported in the IMbrave150 trial, higher rates were observed in the literature for proteinuria, fatigue, ALT and AST elevations and gastrointestinal perforation. For grade ≥3 AEs, the percentages were consistent with the IMbrave150 trial, except for lower incidences of arterial hypertension and thrombosis in the literature. The exposure-adjusted incidence rates for proteinuria (55.7%), hypertension (45.3%) and fatigue (33.6%) were high. Heterogeneity was observed in the analysis of AEs across articles within the same cohorts of patients. Conclusion: We observed a significant variability in AE reporting for atezolizumab-bevacizumab treatment in HCC in the literature, underscoring the need for standardized reporting practices. Impact and implications: Considering the demonstrated safety of atezolizumab-bevacizumab in randomized-controlled trials, this meta-analysis offers valuable insights into reported occurrences of adverse events. Our study highlights significant heterogeneity among studies, underscoring the need to improve adverse event recording. Understanding the incidence and severity of treatment-related adverse events beyond clinical trials is essential for prompt intervention and may help in preventing treatment discontinuation and complications, potentially leading to better outcomes without significantly compromising quality of life due to adverse events.

Background & Aims: We aimed to explore patient expectations regarding their treatments and prognosis in comparison to physicians' assessments in patients with advanced hepatocellular carcinoma (HCC) receiving systemic treatments. Methods: We prospectively enrolled 205 patients in France and Belgium with Barcelona Clinic Liver Cancer (BCLC) stage B/C HCC receiving systemic treatment (NCT04823754). Patients completed a 28-question survey and the hospital anxiety and depression scale (HADS), while physicians filled a 17-question survey after the initial consultation. Univariate and multivariate models were used to assess factors associated with concordant patient-physician responses, HADS, as well as predicted (by physicians) and observed overall survival. Results: Patients had a median age of 68 years with 75% having BCLC C HCC; 86.3% received atezolizumab/bevacizumab. 60% of patients did not discuss life expectancy with the physician. 63% of the patients believed they had a life expectancy >5 years. Among shared questions between patients and physicians, 36.4% concordance was observed; major differences centered on life expectancy with patients more optimistic than physicians. A lower patient-physician concordance was seen with shorter-consultations (p = 0.003), female physicians (p = 0.02), BCLC C (p = 0.03) and >100 HCC patients/year per physician (p = 0.008). Compared to France, patients from Belgium were more likely to be satisfied with the consultation (p

Range disjunctions appear to be common in nature, although they may be caused by various factors. They may simply be an artefact of inadequate sampling. If real, they may be the result of colonization events or habitat change. With natural habitats showing increasing fragmentation because of human activity, understanding the cause of a disjunction can have important conservation implications. We investigate the geographical range of the Plains spadefoot toad, Spea bombifrons, a widely distributed species in the midwestern and southwestern United States, with a putative disjunct population in southern Texas. We combine GIS mapping, species distribution modeling, and population genetic analysis to investigate this putative disjunction. We establish that this southern Texas population is truly geographically disjunct and genetically distinct. Further, using climate projections we show that this unique population is at high risk of local extinction.

Adeno-associated virus (AAV) is the most widely used vector for in vivo gene transfer. A major limitation of capsid engineering is the incomplete understanding of the consequences of multiple amino acid variations on AAV capsid stability resulting in high frequency of non-viable capsids. In this context, the study of natural AAV variants can provide valuable insights into capsid regions that exhibit greater tolerance to mutations. Here, the characterization of AAV2 variants and the analysis of two public capsid libraries highlighted common features associated with deleterious mutations, suggesting that the impact of mutations on capsid viability is strictly dependent on their 3D location within the capsid structure. We developed a novel prediction method to infer the fitness of AAV2 variants containing multiple amino acid variations with 98% sensitivity, 98% accuracy, and 95% specificity. This novel approach might streamline the development of AAV vector libraries enriched in viable capsids, thus accelerating the identification of therapeutic candidates among engineered capsids.

Objective and Approach The study investigates attitudes of Red River Métis (RRM) Citizens towards existing mental health services to assess satisfaction levels and enhance support and accessibility. Employing a Community-Based Participatory Research and Collective Consensual Data Analytic Procedure (CBPR/CCDAP) framework, a survey was conducted during health consultations in 2022 and 2023. It explored participant perspectives on existing programming, service availability, and future needs. Analysis of participant responses, stratified by demographics, offers insights into mental health attitudes among the RRM Community. Results A total of 144 RRM Citizens participated in the survey, reporting "addiction," "trauma," and "stress" as primary causes of mental health issues. Presently, only 20% (n = 29) utilize mental health services, with over 40% (n = 58) expressing dissatisfaction with available services. Moreover, more than 90% (n = 130) of Citizens emphasized “an urgent need for additional mental health services tailored to the RRM Community”. Common barriers to accessing mental health services included lack of awareness and financial constraints. Conclusion The study highlights RRM Citizens’ dissatisfaction with existing services and inadequate awareness of available mental health services and their protocols, presenting significant barriers to accessing services. Further investigations are warranted to determine whether these challenges stem from communication discrepancies, service inadequacies, or a combination of both factors. Implications Findings from the study inform the development of distinctions-based mental health services for the Red River Métis Community, enhancing access, engagement, and policy development to address mental health disparities.

Objective and Approach To address the opioid crisis within the Red River Métis (RRM) Community, understanding opioid use is crucial to empower regional health authorities to adapt health programs, services, and policies to meet their unique needs effectively. The investigation utilized focus groups with a Community-Based Participatory Research and Collective Consensual Data Analytics Procedure (CBPR/CCDAP) approach. Additionally, a population-based retrospective cross-sectional study for fiscal years 2006/07–2018/19 was conducted using administrative data from a population research data repository. Rates of prescription opioid dispensing (RPOD) and mean morphine equivalents (MEQ) were compared between RRM and all other Manitobans (AOM) aged 10 years or older. Results The rate of prescription opioid dispensing and MEQ/person were found to be consistently higher among RRM compared to AOM in each study year (p < 0.001). While the RPOD declined among AOM over the study period, it did not change among RRM. Key findings revealed RRM were concerned about how opioids impacted their communities, and felt the need for increased addiction treatment resources, including Red River Métis culture-specific programs. Conclusion The evidence demonstrates higher RPOD and MEQ among RRM compared to AOM, suggesting elevated risk of opioid-related harms. Focus group feedback reinforces the need for tailored interventions. Implications Future policies and programs targeting the opioid crisis should prioritize the unique needs of populations like the RRM, requiring tailored, culturally appropriate interventions for effective crisis management.

Foot strike patterns influence vertical loading rates during running. Running retraining interventions often include switching to a new foot strike pattern. Sudden changes in the foot strike pattern may be uncomfortable and may lead to higher step-to-step variability. This study evaluated the effects of running with an imposed and usual foot strike on vertical loading rate variability and amplitude. Twenty-seven participants (16 men and 11 women; age range: 18–30 years) ran on an instrumented treadmill with their usual foot strike for 10 min. Then, the participants were instructed to run with an unusual foot strike for 6 min. We calculated the vertical instantaneous and vertical average loading rates and their variances over 200 steps to quantify vertical loading rate variability. We also calculated the amplitude and variability of the shank acceleration peak using an inertial measurement unit. The vertical loading rate and shank acceleration peak amplitudes were higher when running with a rearfoot strike, regardless of the foot strike conditions (i.e., usual or imposed). The vertical loading rate and shank acceleration peak variability were higher when running with an imposed rearfoot strike than when running with a usual forefoot strike. No differences were found in the vertical loading rate and shank acceleration peak variabilities between the imposed forefoot strike and usual rearfoot strike conditions. This study offers compelling evidence that adopting an imposed (i.e., unusual) rearfoot strike amplifies loading rate and shank acceleration peak variabilities.