External cephalic version was attempted in 684 women (53.8%), with a success rate of 61.5%. External cephalic version succeeded in 19.6% of those with persistent breech presentation (44/224) compared with 82.0% (377/460) of those without persistent breech presentation (P<.001). Ultimately, women with persistent breech presentation and successful ECV experienced a lower rate of vaginal delivery (27.3% vs 79%, P<.001), and a higher rate of instrumental (29% vs 13%, P<.001) and cesarean deliveries (43% vs 7%, P<.001) compared with the nonpersistent breech presentation group. The rate of noninstrumental vaginal delivery among women with persistent breech presentation, regardless of ECV, was 5.4%.
 
  Women with persistent breech presentation experienced a high rate of ECV failure and a low rate of spontaneous vaginal delivery.
 Women with persistent breech presentation experienced a high rate of ECV failure and a low rate of spontaneous vaginal delivery.Advances in genetic technology have allowed for the development of multiplex panels that can test for hundreds of genetic disorders at the same time; these large panels are referred to as expanded carrier screening. This process can screen couples for far more conditions than the gene-by-gene approach used with traditional carrier screening; however, although expanded carrier screening has been promoted as an efficient means of detecting many more disorders, the complexities of genetic sequencing raise substantial challenges and concerns. In our practice, we have seen a number of complex cases in which only attention to detail on the part of thorough genetic counselors allowed identification of misclassified variants that could have resulted in significant patient harm. We raise issues that require urgent attention by professional societies, including whether to endorse testing that uses sequencing compared with genotyping; required components of pretest and posttest counseling; reclassification of variants; whether obstetric health care professionals have a responsibility to assure that patients understand the iterative process of variant interpretation and how it relates to carrier screening results; and the question of rescreening in subsequent pregnancies. Implementation of expanded carrier screening needs to be considered thoughtfully in light of the complexity of genetic sequencing and limited knowledge of genetics of most front-line obstetric health care professionals.The evidence of racial health disparities is profound. Much attention has been given to the disparity in maternal morbidity and mortality experienced by Black mothers. The disparity in Black lives lost from coronavirus disease 2019 (COVID-19) has further highlighted the disparity in health outcomes for Black people. Although COVID-19 is a new disease, the reason for the health disparity is the same as in maternal morbidity and mortality implicit bias and structural racism. Implicit bias among health care professionals leads to disparities in how health care is delivered. Generations of structural racism perpetuated through racial residential segregation, economic suppression, and health care inequality have normalized the poorer health outcomes for Black Americans. It is easy to dismiss these issues as someone else's problem, because health care professionals often fail to acknowledge the effect of implicit bias in their own practices. We all need to be highly critical of our own practices and look introspectively for implicit bias to find the cure.  https://www.selleckchem.com/Bcl-2.html  Health care organizations must invest time and resources into investigating the structural racism that exists within our own walls.
  This study aimed to assess and compare the systemic response of oxygen uptake kinetics and muscle deoxygenation between a 30-min rest protocol and a multivisit protocol on the parameters of the power-duration relationship (i.e., critical power [CP] and W').
 
  Nine endurance-trained triathletes reported to the laboratory on five occasions a preliminary graded exercise test and a familiarization, a 30-min single-visit protocol (time trials of 10, 5, and 2 min in that order interspersed with 30 min rest), and a multivisit protocol (time trials of 10, 5, and 2 min in randomized order interspersed by >24 h rest). Heart rate (HR) was recorded continuously, respiratory gases were measured breath by breath, and deoxygenation was recorded at 10 Hz using near-infrared spectroscopy (NIRS) during all tests. Blood lactate (BLa-) concentration was measured before all time trials. Maximal HR (HRmax), oxygen uptake (V˙O2) during the first 2 min (V˙O2onset), mean response time, end-exercise V˙O2 (V˙O2peak), V˙O2 amplitude (amplV˙O2), O2 deficit, NIRS τ, amplitude (amplNIRS), and time delay were assessed. To compare the two protocols and to assess the differences in W' and CP, a paired sample t-test was used as well as a two-way ANOVA to assess the differences between trials and/or protocols, including trial-protocol interactions.
 
  No significant differences, and trivial effect sizes, were found for W' and CP between protocols (P = 0.106-0.114, d < 0.01-0.08). Furthermore, no significant differences between protocols were found for all parameters, except for [BLa-]. Significant differences between trials were found for V˙O2ampl, V˙O2onset, NIRS τ, amplNIRS, [BLa-], and HRmax.
 
  Results suggest that W' and CP can be determined using the 30-min rest protocol without confounding effects of previous severe exercise compared with the multivisit protocol.
 Results suggest that W' and CP can be determined using the 30-min rest protocol without confounding effects of previous severe exercise compared with the multivisit protocol.
  This study aimed to evaluate the relationship between race car cockpit temperature and thermal strain indicators among race car drivers.
 
  Four male racing drivers' heart rate (HR), skin temperature (Tskin), and core temperature (Tcore) were measured continuously using the Equivital Life Monitor bio harness, and physiological strain index (PSI) was calculated during a hot (ambient temperature of 34.1°C ± 2.8°C) 6-h endurance race. Only data collected during green flag racing laps were analyzed.
 
  Cross-sectional analyses showed that cockpit temperature did not have a significant relationship with percent of HRmax, Tskin, Tcore, or PSI (P > 0.05) during the race. Cockpit temperature decreased during driving time, whereas percent of HRmax, Tskin, Tcore, and PSI increased (P < 0.05).
 
  Cockpit temperature does not correlate with measures of race car driver thermal strain. Therefore, metrics to determine driver thermal strain should include direct monitoring of the race car driver.
 Cockpit temperature does not correlate with measures of race car driver thermal strain.