Citations

Abstract Magee, MK, Fields, JB, Jagim, A, Lockard, B, Miller, A, Stroiney, D, and Jones, MT. Estimation of whole-body bone mineral density through air displacement plethysmography in a large sample of elite athletes. J Strength Cond Res 39(4): 427–432, 2025—Dual-energy x-ray absorptiometry (DXA) is used to determine bone mineral density (BMD) and body composition. Regulations and cost may limit DXA's utility in some athletic settings. Air displacement plethysmography (ADP), while able to measure body composition, does not measure BMD. The purpose was to evaluate the influence of body composition parameters obtained from ADP on BMD. Collegiate athletes (males, n = 153; females, n = 208) underwent ADP and DXA assessments. For ADP testing, the Brozek equation was used to estimate body fat percent (BF%) and fat-free mass (FFM) from body density. Dual-energy x-ray absorptiometry tests were completed to obtain BMD using the whole-body scan mode. Stepwise regression was conducted using age, body mass, height, sex, race, FFM (ADP), BF% (ADP), and sport type as independent variables. Total BMD (DXA) was the dependent variable. Accuracy and precision of the final equation were evaluated through Bland–Altman and linear regression. The final regression equation yielded an R 2 of 0.691 with race, mass, BF%, age, and sport type as significant predictors ( p < 0.05) of BMD. Bland–Altman and linear regression showed systematic {95% confidence interval [CI] (−0.619 to −0.360)} and proportional bias (95% CI [0.173–0.374]). Although an ADP-derived regression equation may not provide a precise prediction of BMD, it may be useful to establish risk for low BMD if DXA is unavailable. Dual-energy x-ray absorptiometry may not be feasible for some athletic programs; therefore, an estimation equation for BMD derived from ADP values is advantageous for practitioners. This equation may assist in screening athletes for risk of low BMD.

Abstract Kuhlman, NM, Jagim, AR, Jones, MT, Feit, MK, and Fields, JB. A comparison of match external load demands across women’s collegiate field sports. J Strength Cond Res 39(2): 234–241, 2025—Historically, soccer (SOC), lacrosse (LAX), and field hockey (FH) have been grouped together as “field sports” due to their intermittent nature of match play and similar physiological demands. However, questions have emerged regarding potential variations in demands between sports. The purpose of this study was to compare external match workloads between collegiate women's SOC, LAX, and FH, and examine within-sport positional differences. Athletes (SOC: n = 15; LAX: n = 15; FH: n = 14) wore a global positioning system device during all matches throughout a competitive season. External load metrics included in the analysis were total distance (TD), sprint distance (SD), accelerations (>3 m·s −2 ), sprint efforts (SE), player load (PL), PL per minute (PL/min), top speed (m·s −1 ), and distances covered in select speed zones. Soccer performed higher external load volumes (TD, PL) ( p ≤ 0.025) but incurred lower intensities (SD, SE, accelerations) ( p < 0.001) compared with LAX and FH. Within-sport positional differences were apparent in SOC ( p < 0.001–0.018), LAX ( p < 0.001–0.045), and FH ( p < 0.001–0.004). However, FH exhibited more positional variance in external load metrics compared with SOC or LAX. Field hockey midfielders covered greater volumes (TD, PL) compared with attackers and defenders ( p < 0.001), while attackers sustained greater intensities (SD, SE, top speed) compared with midfielders and defenders ( p < 0.004). Results indicate that there are significant differences in external workload parameters between sports and across positions. Practitioners should tailor sport-specific and position-specific programs to match demands, and future research should explore the proposed categorizations of LAX as a “fast collision invasion sport,” FH as a “fast contact invasion sport,” and SOC as a “slow contact invasion sport.”

Background Coronavirus Disease 2019 (COVID-19) has led to dramatic changes including social distancing, closure of schools, travel bans, and issues of stay-at-home orders. The health-care field has been transformed with elective procedures and on-site visits being deferred. Telemedicine has emerged as a novel mechanism to continue to provide care. However, there remains a paucity of data regarding its efficacy in nutrition support, especially in patients with chronic intestinal failure (CIF). Objective Describe the utilization of telehealth in the routine management of CIF, particularly in the initiation and training of home parenteral nutrition (HPN). Methods A case series presenting our experience with the use of telemedicine to provide training for HPN for three patients. The manuscript describes the utility of telehealth in providing remote and adequate training for patients commenced on HPN during COVID-19 pandemic. Results Since the onset of the COVID-19 pandemic, we have successfully provided virtual training to three patients, including two who were noted to be severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive and one patient who could not be transferred to our facility for training. For SARS-CoV-2 positive patients, the risk of transmission to nursing staff with 8–10 h of face-to-face training in two cases was felt to be too significant for in-person training. We determined that the best option would be to stabilize parenteral nutrition in the hospital and perform virtual training. Although virtual training was successfully performed, it was felt that training in this manner took much longer, required frequent adjustment of the tablet device to ensure patient remained in field of view, and made it difficult to connect with the patient emotionally. Conclusions Telemedicine has significantly improved care provided during COVID-19 as a modality for effective training on HPN, while in-person communication was significantly limited due to the pandemic. However, when possible, it should be used in a manner that complements but does not supplant standard care.

Importance Multiparametric magnetic resonance imaging (MRI), with or without prostate biopsy, has become the standard of care for diagnosing clinically significant prostate cancer. Resource capacity limits widespread adoption. Biparametric MRI, which omits the gadolinium contrast sequence, is a shorter and cheaper alternative offering time-saving capacity gains for health systems globally. Objective To assess whether biparametric MRI is noninferior to multiparametric MRI for diagnosis of clinically significant prostate cancer. Design, Setting, and Participants A prospective, multicenter, within-patient, noninferiority trial of biopsy-naive men from 22 centers (12 countries) with clinical suspicion of prostate cancer (elevated prostate-specific antigen [PSA] level and/or abnormal digital rectal examination findings) from April 2022 to September 2023, with the last follow-up conducted on December 3, 2024. Interventions Participants underwent multiparametric MRI, comprising T2-weighted, diffusion-weighted, and dynamic contrast–enhanced (DCE) sequences. Radiologists reported abbreviated biparametric MRI first (T2-weighted and diffusion-weighted), blinded to the DCE sequence. After unblinding, radiologists reported the full multiparametric MRI. Patients underwent a targeted biopsy with or without systematic biopsy if either biparametric MRI or multiparametric MRI was suggestive of clinically significant prostate cancer. Main outcomes and measures The primary outcome was the proportion of men with clinically significant prostate cancer. Secondary outcomes included the proportion of men with clinically insignificant cancer. The noninferiority margin was 5%. Results Of 555 men recruited, 490 were included for primary outcome analysis. Median age was 65 (IQR, 59-70) years and median PSA level was 5.6 (IQR, 4.4-8.0) ng/mL. The proportion of patients with abnormal digital rectal examination findings was 12.7%. Biparametric MRI was noninferior to multiparametric MRI, detecting clinically significant prostate cancer in 143 of 490 men (29.2%), compared with 145 of 490 men (29.6%) (difference, −0.4 [95% CI, −1.2 to 0.4] percentage points; P = .50). Biparametric MRI detected clinically insignificant cancer in 45 of 490 men (9.2%), compared with 47 of 490 men (9.6%) with the use of multiparametric MRI (difference, −0.4 [95% CI, −1.2 to 0.4] percentage points). Central quality control demonstrated that 99% of scans were of adequate diagnostic quality. Conclusion and relevance In men with suspected prostate cancer, provided image quality is adequate, an abbreviated biparametric MRI scan, with or without targeted biopsy, could become the new standard of care for prostate cancer diagnosis. With approximately 4 million prostate MRIs performed globally annually, adopting biparametric MRI could substantially increase scanner throughput and reduce costs worldwide. Trial registration ClinicalTrials.gov Identifier: NCT04571840

OBJECTIVES: Many PICU admissions start with presentation in the emergency department (ED). However, we do not know whether there are any ED-related factors associated with the subsequent development of pediatric delirium (PD) within 24 hours of PICU admission. DESIGN: Retrospective cohort study. SETTING: Single-center ED and PICU serving a quaternary referral center in the United States. PATIENTS: Children younger than 18 years old presenting to the ED between January 2022 and December 2023 who required direct admission to the PICU, and who had at least one positive delirium screening within 24 hours of the admission. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The presence of delirium in the PICU was defined as a Cornell Assessment of Pediatric Delirium (CAPD) score of 9 and higher. We identified 138 patients for the final analysis. Overall, 51 of 138 patients (37%) developed PD within 24 hours of admission. The majority of delirium cases were classified as hypoactive (53%, 27/51) and mixed (31%, 16/51) subtypes, while only 16% (8/51) were identified as hyperactive delirium. Factors associated with greater odds (95% CI) of delirium in the PICU in multivariable analysis were use of mechanical ventilation (odds ratio [OR], 3.42 [95% CI, 1.09–10.78]; p = 0.04) and intermittent urinary catheterization (OR, 3.7 [95% CI, 1.21–11.30]; p = 0.02). Initial CAPD score positively correlated with PICU length of stay (LOS; r = 0.32; p < 0.01), Pediatric Index of Mortality 3 (PIM 3) score ( r = 0.26; p < 0.01), and negatively correlated with emergency severity index (ESI) in the ED ( r = –0.35; p < 0.01). CONCLUSIONS: Mechanical ventilation and intermittent urinary catheterization in the ED are associated with greater odds of PD within 24 hours of PICU admission. CAPD at admission positively correlates with PICU LOS, PIM 3 scores, and negatively correlates with ESI in the ED.

ABSTRACT Aims Sarcoid myopathy (SaM) is characterised by granulomatous myositis (GM) and can overlap with inclusion body myositis (IBM), a late‐onset chronic idiopathic inflammatory myopathy with a still enigmatic pathogenesis. As GM can occur in different clinical contexts, we aimed to examine the histomorphologic features and gene expression profiles in cases of definite SaM that may inform diagnostic and therapeutic considerations. Methods We performed a multidimensional characterisation of muscle biopsy specimens from patients with ‘pure SaM’ (n=17), SaM with concomitant IBM (SaM‐IBM) (n=2), including histopathologic and ultrastructural analysis in addition to quantitative real‐time polymerase chain reaction. Additionally, bulk RNA sequencing was performed on 38 muscle biopsy specimens from patients with SaM (including SaM‐IBM) (n=30) and NGI (n=8). Results Histopathological analysis revealed a pattern of endomysial and perimysial granulomatous inflammation frequently extending to the fascia, endomysial fibrosis, muscle fibre atrophy, variation in muscle fibre size and capillary thickening. Findings from immunohistochemical studies established Chitinase 1 as a pure giant cell marker in SaM. On a subcellular level, ‘pure SaM’ was characterised by focal accumulation of large swollen mitochondria with rare cristae but an absence of irregular cristae. Transcriptomic analysis of patients with SaM confirmed markedly elevated expression of both type 1 and type 2 human leukocyte antigen molecules. Macrophage activity markers were highly elevated. Consistent with histologic findings, CHIT1 was specifically overexpressed in SaM samples but not in ‘pure IBM’ muscle biopsy specimens. Conclusions SaM is characterised by a stereotypical appearance at the histopathologic level and disease‐specific immune dysregulation that involves macrophage function and maturation. SaM‐IBM represents a noteworthy overlap syndrome that shares multiple dysregulated immune pathways with ‘pure SaM’.

Wastewater treatment is evolving rapidly with the advent of advanced deep-learning AI, graph-based, and physics-informed approaches. This study integrates graph neural networks, physics-informed neural networks, and multi-agent reinforcement learning within a hybrid digital-twin framework, evaluated on multi-scale real-world datasets. The developed models achieved over 90% dissolved organic carbon removal and reduced aeration energy by up to 22% while maintaining process stability. The results demonstrate that graph–physics synergies not only boost operational efficiency but also reveal critical trade-offs between energy savings and hydraulic performance. Our findings establish a new benchmark for resilient, low-carbon wastewater treatment, highlighting the transformative role of data-driven system design.

The NCCN Guidelines for Biliary Tract Cancers (BTCs) provide recommendations for the evaluation and comprehensive care of patients with gallbladder cancer, intrahepatic cholangiocarcinoma, and extrahepatic cholangiocarcinoma. The multidisciplinary panel of experts is convened at least once annually to review requests from internal and external entities as well as to evaluate new data on current and emerging therapies. This manuscript focuses on the adjuvant chemotherapy and chemoradiation treatment options for BTCs as well as the systemic treatment recommendations for patients with advanced BTCs.