Enhancing resilience through seed system plurality and diversity: challenges and barriers to seed sourcing during (and in spite of) a global pandemic.

The effects of the COVID-19 pandemic have rippled across the United States' (US) agri-food system, illuminating considerable issues. US seed systems, which form the foundation of food production, were particularly marked by panic-buying and heightened safety precautions in seed fulfillment facilities which precipitated a commercial seed sector overwhelmed and unprepared to meet consumer demand for seed, especially for non-commercial growers. In response, prominent scholars have emphasized the need to support both formal (commercial) and informal (farmer- and gardener-managed) seed systems to holistically aid growers across various contexts.

Perspectives of internal medicine residency clinics: A national survey of US medical directors.

Background: Ambulatory training is an integral component of internal medicine residency programs, yet details regarding operational processes in resident continuity clinics remain limited.

Methods: We surveyed a convenience sample of medical directors of residency practices between 2015 and 2019 (n = 222) to describe and share operational and scheduling processes in internal medicine resident continuity clinics in the US.

Results: Among residency practices, support for the medical director role ranged substantially, but was most commonly reported at 11%-20% full-time-equivalent support.

Novel biomechanical injury risk score demonstrates correlation with lower limb posterior chain injury in 50 elite-level rugby union athletes.

Objectives: Lower limb posterior chain injury (PCI) is common among athletic populations, with multifactorial risk factors including age, previous injury, strength measurements, range of motion and training load. Biomechanics are commonly considered in the prevention and rehabilitation of PCI by performance staff. However, there is no documented testing method to assess for associations between biomechanics and PCI.

Opioids for chronic pain management in patients with dialysis-dependent kidney failure.

Chronic pain is highly prevalent among adults treated with maintenance haemodialysis (HD) and has profound negative effects. Over four decades, research has demonstrated that 50-80% of adult patients treated with HD report having pain. Half of patients with HD-dependent kidney failure (HDKF) have chronic moderate-to-severe pain, which is similar to the burden of pain in patients with cancer.

The day the residents left: lessons learnt from COVID-19 for ambulatory clinics.

As the COVID-19 pandemic began, the residents from our ambulatory clinics were pulled to cover the increasing numbers of hospitalised patients. To provide care for our 40 000 patients, without resident support, we needed to develop quickly a new culture of communication and innovation. We accomplished this by regular, transparent meetings with senior leadership and key stakeholders who were empowered to make rapid decisions.

Physicians Should Play a Role in Ensuring Safe Firearm Ownership.

The USA is unique among industrialized nations in its dramatic rate of firearm violence. Unfortunately, firearm-related issues in America are politically divisive and fraught with controversy, thus impeding the study and implementation of safety strategies. Despite the lack of consensus, there is agreement that firearms should be kept away from individuals with criminal intent and those who are dangerous due to medical impairment.

Pain and Addiction in Specialty and Primary Care: The Bookends of a Crisis.

Specialists and primary care physicians play an integral role in treating the twin epidemics of pain and addiction. But inadequate access to specialists causes much of the treatment burden to fall on primary physicians. This article chronicles the differences between treatment contexts for both pain and addiction - in the specialty and primary care contexts - and derives a series of reforms that would empower primary care physicians and better leverage specialists.

Pharmacotherapy for Alcohol Use Disorder.

Alcohol use disorder is a common, destructive, and undertreated disease. As understanding of alcohol use disorder has evolved, so has our ability to manage patients with pharmacotherapeutic agents in addition to nondrug therapy, including various counseling strategies. Providers now have a myriad of medications, both approved and not approved by the US Food and Drug Administration, to choose from and can personalize care based on treatment goals, comorbidities, drug interactions, and drug availability.

The worst case scenario: Locomotor and collision demands of the longest periods of gameplay in professional rugby union.

A number of studies have used global positioning systems (GPS) to report on positional differences in the physical game demands of rugby union both on an average and singular bout basis. However, the ability of these studies to report quantitative data is limited by a lack of validation of certain aspects of measurement by GPS micro-technology. Furthermore no study has analyzed the positional physical demands of the longest bouts of ball-in-play time in rugby union.

Collision count in rugby union: A comparison of micro-technology and video analysis methods.

The aim of our study was to determine if there is a role for manipulation of g force thresholds acquired via micro-technology for accurately detecting collisions in rugby union. In total, 36 players were recruited from an elite Guinness Pro12 rugby union team. Player movement profiles and collisions were acquired via individual global positioning system (GPS) micro-technology units.

Breaking the pain contract: A better controlled-substance agreement for patients on chronic opioid therapy.

"Pain contracts" for patients receiving long-term opioid therapy, though well-intentioned, often stigmatize the patient and erode trust between patient and physician. This article discusses how to improve these agreements to promote adherence, safety, trust, and shared decision-making.

Modifying the Primary Care Exception Rule to Require Competency-Based Assessment.

Teaching residents to practice independently is a core objective of graduate medical education (GME). However, billing rules established by the Centers for Medicare and Medicaid Services (CMS) require that teaching physicians physically be present in the examination room for the care they bill, unless the training program qualifies for the Primary Care Exception Rule (PCER). Teaching physicians in programs that use this exception can bill for indirectly supervised ambulatory care once the resident who provides that care has completed six months of training.

Prescribing opioids in primary care: Safely starting, monitoring, and stopping.

Chronic noncancer pain is common and often managed in the outpatient setting with chronic opioid therapy, even though the efficacy of this approach is uncertain and adverse effects are common. Some patients report meaningful benefit from opioids, but prescription drug abuse has reached epidemic proportions, and many suffer harm from opioid misuse, abuse, and diversion. Primary care providers and their care teams often struggle to balance these risks and benefits with little outside support.

Implementing the patient-centered medical home in residency education.

Background: In recent years, physician groups, government agencies and third party payers in the United States of America have promoted a Patient-centered Medical Home (PCMH) model that fosters a team-based approach to primary care. Advocates highlight the model's collaborative approach where physicians, mid-level providers, nurses and other health care personnel coordinate their efforts with an aim for high-quality, efficient care. Early studies show improvement in quality measures, reduction in emergency room visits and cost savings.

Application of Individualized Speed Thresholds to Interpret Position Specific Running Demands in Elite Professional Rugby Union: A GPS Study.

A number of studies have used GPS technology to categorise rugby union locomotive demands. However, the utility of the results of these studies is confounded by small sample sizes, sub-elite player status and the global application of absolute speed thresholds to all player positions. Furthermore, many of these studies have used GPS units with low sampling frequencies.

Optimal loading range for the development of peak power output in the hexagonal barbell jump squat.

Recent studies indicate that the utilization of the hexagonal barbell jump squat (HBJS) compared with the traditional barbell jump squat may offer a superior method of developing peak power. The notion that a single optimal load may be prescribed in training programs aiming to develop peak power is subject to debate. The purpose of this study was to identify the optimal load corresponding with peak power output during the HBJS in professional rugby union players.

Peak power in the hexagonal barbell jump squat and its relationship to jump performance and acceleration in elite rugby union players.

Recent research suggests that jump squats with a loaded hexagonal barbell are superior for peak power production to comparable loads in a traditional barbell loaded jump squat. The aim of this study was to investigate the relationship between relative peak power output during performance of the hexagonal barbell jump squat (HBJS), countermovement jump (CMJ) height, and linear acceleration speed in rugby union players. Seventeen professional rugby union players performed 10- and 20-m sprints, followed by a set of 3 unloaded CMJs and a set of 3 HBJS at a previously determined optimal load corresponding with peak power output.

The acute effect of a plyometric stimulus on jump performance in professional rugby players.

Post-activation potentiation (PAP) is the elevation of motor performance to a higher level in response to a conditioning stimulus. Extensive research exists examining the PAP effect after a heavy resistance exercise. However, there is limited research examining the PAP effect after a plyometric stimulus.