Polycystic ovary syndrome is the single most common endocrine abnormality of women of reproductive age and is a leading cause of female infertility. Common clinical features include hirsutism, various ovarian abnormalities, obesity, and insulin resistance. Expert consensus recommendations on diagnostic criteria vary, but the most recent focus on the presence of clinical features of hyperandrogenism, hyperandrogenemia, polycystic ovaries, and ovulatory and menstrual dysfunction to the exclusion of alternative diagnoses. In adolescence, diagnosis is more difficult because of the frequent presence of individual clinical findings in otherwise "normal" individuals. Laboratory tests and pelvic ultrasound are necessary to confirm polycystic ovary syndrome and exclude other disorders that may mimic this syndrome. Treatment is centered on the clinical manifestations and should be initiated early to prevent/limit long-term complications, including the metabolic syndrome, diabetes, endometrial carcinoma, and infertility.

Ishida, A, Travis, SK, Draper, G, White, JB, and Stone, MH. Player position affects relationship between internal and external training loads during Division I collegiate female soccer season. J Strength Cond Res 36(2): 513-517, 2022-The purpose of this study was to investigate how competition phase and player position affect the relationship between internal and external training loads (ITL and ETL, respectively) in collegiate female soccer. Seventeen players participated (21.8 ± 1.7 years; 165.1 ± 6.2 cm; and 63.7 ± 7.9 kg). Nineteen match-plays (10 nonconference and 9 conference) were completed during the 2019 competitive season, including 270 observations of 17 players (defenders = 5, midfielders = 9, and forwards = 3). Internal training load was assessed using session rating of perceived exertion (sRPE). External training load included total distance and high-speed running (HSR) distance. A linear mixed model was compiled with fixed effects of total distance, HSR, competition phase, and player position (defenders, midfielders, and forwards) and random effects of player. There were statistically significant main effects for total distance (p < 0.001), HSR (p = 0.047) and player position (p = 0.045) on the prediction model of sRPE. However, the main effect of competition phase did not statistically contribute to the prediction model of sRPE (p = 0.38). In the final model, total distance (p < 0.001) and player position for forwards (p = 0.008) were significant predictors of sRPE. However, there was no statistically significant fixed effect of HSR on sRPE (p = 0.15). The final model explained 60.6% of the variance in sRPE (R2 = 0.60), whereas the random effect also explained 6.1% of the variance (R2 = 0.06). Our findings indicated that total distance and player position were strong predictors of sRPE. The relationship between ITL and ETL should be monitored by player position in female soccer players.

INTRODUCTION: For persons with diabetes, surgery is fraught with complications; of primary concern is postoperative infection. A postoperative infection rate of up to 13% has been noted in patients with diabetes undergoing elective surgical procedures compared with less than 3% in nondiabetic populations. OBJECTIVE: The objective of this study was to provide preliminary evaluation of the efficacy of a novel bioresorbable microfilm matrix (20 µm thick) containing very low amounts of silver (0.16 mg/in²) in preventing surgical site infections when placed at the level of subcutaneous tissue and dermis prior to primary closure in the patient with diabetes undergoing elective surgery. MATERIALS AND METHODS: Twenty-two patients with diabetes undergoing nonemergent or elective foot or ankle surgery and who met at least 1 of the following 6 criteria were included in the study: neuropathy, infection, open wound, history of recurrent infection, nonhealing wound, or peripheral vascular disease. Patients underwent amputation, removal of exostosis, midfoot bone removal, Achilles tendon repair, bunionectomy, or an elevating osteotomy with primary closure of the wound. After hemostasis was obtained and subcutaneous closure achieved, if applicable, the bioresorbable microfilm matrix was applied just deep to the incision at the level of subcutaneous tissue and dermis, and the incision primarily closed. A nonadherent cover dressing was applied over the suture line, and routine follow-up was scheduled for 3 to 5 days later. RESULTS: No patient exhibited signs of infection at initial follow-up, and all adherent patients achieved complete healing during the 3-month follow-up period. Eighteen patients healed at a rate typical for the respective procedure. In 2 patients, time to healing was delayed secondary to weight-bearing dehiscence. Two patients were not included in the results secondary to multiple infractions of nonadherence with the postoperative protocol. CONCLUSIONS: The application of microfilm matrix in surgical incisions at the level of subcutaneous tissue and dermis prior to primary closure is safe for and has the potential to prevent postoperative surgical site infections in at-risk patients with diabetes..

OBJECTIVE: The effects of a computer-assisted instruction (CAI) tutorial program on learning clinical reasoning skills were compared in undergraduate dietetics students. DESIGN: A drill-and-practice program to control for time on task, and tutorial program, and a simulation program, as the test vehicle, were developed. The tutorial and simulation programs presented data on a patient with cardiovascular disease. SETTING: Subjects were tested in 30 undergraduate dietetics programs. SUBJECTS: Participants were 413 undergraduate diet therapy students enrolled in a coordinated program in dietetics (CPD) or a didactic program in dietetics (DPD). INTERVENTION: After completion of lectures on cardiovascular disease, subjects were given the drill-and-practice program plus a simulation test (group 1), the tutorial plus a simulation test (group 2), or the simulation test only (group 3). MAIN OUTCOME MEASURES: Scores on the simulation test were compared. Variables included type of CAI, dietetics program, year in school, computer experience, and experience using a medical chart. Mastery of objectives related to lower- and higher-level clinical reasoning skills introduced in the tutorial program was computed. STATISTICAL ANALYSIS: One-way analysis of variance and Student-Newman Keuls tests were conducted to determine any differences among the three groups. Reliability was determined using the Kuder-Richardson Formula 20. RESULTS: The reliability coefficient of the stimulation test was 0.93. Group 2 higher on the simulation test than group 1 or group 3. As a group, the CPD students scored higher than the DPD students. When CPD and DPD students were divided into the three experimental groups, there was no significant difference between the CPD and DPD student simulation scores. Group 2 mastered all objectives for lower-level reasoning skills and the higher-level decision-making objective better than groups 1 and 3. APPLICATIONS/CONCLUSIONS: A computer tutorial program enhanced clinical reasoning skills in undergraduate dietetics students. This type of program could be used to supplement many topics taught in diet therapy and provide DPD students with experimental learning before their clinical intern practicums.

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This policy paper reviews the history, use and significance of telehealth in primary care. The emergence of telehealth as a primary strategy to continue to deliver value based, timely primary care during COVID-19 is discussed with recommendations for future applications, payment and preparation of providers to continue to provide quality care of clients in the future using telehealth.

No / This volume presents state-of-the-art research from a wide area of subjects brought about by the digital convergence of computing, television, telecommunications and the World-Wide Web. It represents a unique snapshot of trends across a wide range of subjects including virtual environments; virtual reality; telepresence; human-computer interface design; interactivity; avatars; and the Internet. Both researchers and practitioners will find it an invaluable source of reference.

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Menopause is characterized by prolonged lifespan beyond the point of reproductive cessation. Defined so that at least 25% of adulthood is nonreproductive, humans and some toothed whale species are the only groups that have been found to exhibit menopause. Menopause is a puzzling trait that seems to contradict classical evolutionary theory that equates selection operating on reproduction to selection operating on survival. I created two computational models to gain better understanding of the evolution of menopause. The first model explored why menopause is not observed in elephants despite their being characterized by key features in common with menopausal species, specifically offspring care from older females and longevity. Simulations allowed testing the effects of varying age at reproductive cessation and levels of offspring care, modeled by decreases in interbirth intervals. I found that hypothetical populations with greatest post-reproductive lifespans, characterized by longer interbirth intervals and earlier reproductive cessation, were most likely to be out-competed by contemporary elephants. Conversely, hypothetical populations that were most reproductively competitive, those with shorter interbirth intervals and older ages of reproductive cessation, returned post-reproductive lifespans that failed to meet the 25% post-reproductive lifespan criterion for menopause. I identified a small region in the parameter space where populations that were both menopausal and reproductively competitive evolved, but the majority of that region corresponds to biologically unrealistic scenarios. The scenario that is most feasible involves an interbirth interval of 4 years and an age at reproductive cessation of 40 years. The second model studied how menopause might have evolved in humans through a behavioural strategy of ending reproduction early to avoid risk of aneuploidy later in life and diverting resources toward extant kin. I found that populations that ceased reproduction earlier and exhibited greater post-reproductive lifespan returned lower reproductive success. The model also demonstrated that the aneuploidy avoidance behaviour is most successful when reproduction ends at approximately age 50. These concepts have never been explored computationally before, so these experiments contribute a novel simulation-based perspective to the growing body of knowledge surrounding the origin and evolution of menopause. / Thesis / Master of Science (MSc) / Menopause can be defined generally for a group as a life history characterized by prolonged post-reproductive lifespan. Defined specifically so that at least 25% of adulthood is nonreproductive, menopause has been recorded in only humans and some species of toothed whales. This trait presents an evolutionary puzzle, as it appears to contradict classical evolutionary theory, which suggests that reproduction should continue until the end of life. In this thesis, I use computational modeling to explore why elephants have not evolved menopause despite sharing key features with menopausal species and how aneuploidy might have contributed to the evolution of menopause in humans.