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Introduction: With increased access to commercial spaceflight and space tourism, plus a push for longer duration spaceflights, it is especially important to understand the impact of spaceflight on musculoskeletal health. Upper extremity injuries are the most common musculoskeletal injuries in spaceflight. It is, therefore, vital to determine the changes to the upper extremities during spaceflight. The purpose of this study was to examine the state of knowledge on the impact of spaceflight on upper extremity orthopedic health, and to identify knowledge gaps and future areas of research., Methods: A literature review was performed and studies and reports that amassed data on shoulder, elbow, wrist, and hand health were included., Results: Spaceflight decreases bone mineral density in the upper extremities and increases risk of fracture, especially upon return to gravitational environments. Spaceflight does not uniformly affect all muscles; in the shoulder, the various muscles crossing the joint appear to be variably affected: the deltoid experiences a greater degree of atrophy than the rotator cuff muscles. Spaceflight additionally affects the peripheral nervous system, with astronauts experiencing hand numbness and loss of manual dexterity but cause of these symptoms is undetermined. Spacesuits have also been implicated in causing upper extremity injury, especially while training for or performing extravehicular activities., Discussion: While upper extremity orthopedic health in spaceflight is incompletely understood, known adaptations increase risk for weakening and injury. Existing research provides valuable information for best practices, but there is still much to be discovered to optimize upper extremity health in spaceflight. Fiedler B, Jami M, Rakauskas T, Ahmed AS. Impact of spaceflight on upper extremity orthopedic health. Aerosp Med Hum Perform. 2024; 95(10):777-783.

Normal cells coordinate proliferation and differentiation by precise tuning of gene expression based on the dynamic shifts of the epigenome throughout the developmental timeline. Although non-mutational epigenetic reprogramming is an emerging hallmark of cancer, the epigenomic shifts that occur during the transition from normal to malignant cells remain elusive. Here, we capture the epigenomic changes that occur during tumorigenesis in a prototypic embryonal brain tumor, medulloblastoma. By comparing the epigenomes of the different stages of transforming cells in mice, we identify nuclear factor I family of transcription factors, known to be cell fate determinants in development, as oncogenic regulators in the epigenomes of precancerous and cancerous cells. Furthermore, genetic and pharmacological inhibition of NFIB validated a crucial role of this transcription factor by disrupting the cancer epigenome in medulloblastoma. Thus, this study exemplifies how epigenomic changes contribute to tumorigenesis via non-mutational mechanisms involving developmental transcription factors., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The unique needs of first-generation immigrants and their families have not been prioritized in mental healthcare. Cultural tailoring of child services requires valid, reliable, and efficient assessments of family cultural identity. The Abbreviated Multidimension Acculturation Scale (AMAS) is a self-report of acculturation and enculturation that has been evaluated in community, but not clinical, samples. We offer the first AMAS psychometric evaluation in a treatment-seeking sample of first-generation immigrant caregivers presenting for children's mental healthcare (N = 219). Analyses examined the internal consistency, concurrent validity, and factor structures of the long-form AMAS (42 items, six subscales), AMAS-10 (10 items, four subscales), and AMAS-14 (14 items, six subscales). Findings provide support for the AMAS-10 and AMAS-14, but not the full-length AMAS, in the present sample. Given urgent needs for culturally responsive care for first-generation populations, the AMAS-10 and AMAS-14 can be used in clinical settings to support cultural assessment, case conceptualization, and treatment planning., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Clinical presentations of selective mutism (SM) vary widely across affected youth. Although studies have explored general externalizing problems in youth with SM, research has not specifically examined patterns of irritability. Relatedly, research has not considered how affected families differentially accommodate the anxiety of youth with SM as a function of the child's temper outbursts (i.e., phasic irritability) and general angry mood (i.e., tonic irritability). Data were drawn from a sample of treatment-seeking children and adolescents with a primary diagnosis of selective mutism (N = 152; Mean age = 6.12 years; 67.11% female), and their caregivers. Latent profile analysis (LPA) was used to identify distinct profiles in SM youth that were characterized by varying levels of phasic and/or tonic irritability. Analyses further examined whether these different profiles were associated with different levels of family accommodation and global impairment. LPA identified 5 profiles: SM with No irritability, SM with Low Phasic Irritability, SM with High Phasic Irritability, SM with High Phasic and Moderate Tonic Irritability, and SM with High Phasic and High Tonic Irritability. Patterns of family accommodation and global impairment were highest among youth belonging to profiles characterized by high phasic irritability. Findings highlight separable patterns of irritability across youth with SM, with phasic irritability (i.e., temper outbursts) appearing particularly linked with increased family accommodation and overall global impairment. Assessing phasic irritability is critical for optimizing treatment in youth with SM and can be useful for flagging possible patterns of family accommodation contributing to overall impairment., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Primary Achilles tendon repair (ATR) can be performed in ambulatory surgery centers (ASCs) or hospitals. We compared costs and complication rates of ATR performed in these settings., Methods: We retrospectively queried the electronic medical record of our academic health system and identified 97 adults who underwent primary ATR from 2015 to 2021. Variables were compared between patients treated at ASCs vs those treated in hospitals. We compared continuous variables with Wilcoxon rank-sum tests and categorical variables with χ 2 tests. We used an α of 0.05. Multivariable logistic regression was performed to determine associations between surgical setting and costs. Linear regression was performed between each charge subtype and total cost to identify which charge subtypes were most associated with total cost., Results: Patients who underwent ATR in hospitals had a higher rate of unanticipated postoperative hospital admission (13%) than those treated in ASCs (0%) ( P  = .01). We found no differences with regard to postoperative complications, emergency department visits, readmission, rerupture, reoperation/revision, or death. Patients treated in hospitals had a higher mean (±SD) implant cost ($664 ± $810) than those treated in ASCs ($175 ± $585) ( P  < .01). We found no differences between settings with regard to total cost, supply costs, operating room charges, or anesthesia charges. Higher implant cost was associated with hospital setting (odds ratio = 16 [95% CI: 1.7-157]) and body mass index > 25 (odds ratio = 1.2 [95% CI: 1.0-1.5]). Operating room costs were strongly correlated with total costs ( R 2  = .94)., Conclusion: The overall cost and complication rate of ATRs were not significantly different between ASCs and hospitals. ATRs performed in hospitals had higher implant costs and higher rates of postoperative admission than those performed in ASCs., Level of Evidence: Level III, retrospective comparative study., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Rachel S. Bronheim, MD, reports grants or contracts from any entity: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) of the National Institutes of Health, T32 AR07708-08. ICMJE forms for all authors are available online., (© The Author(s) 2023.)

Real-time prediction of human location combined with the capability to perceive obstacles is crucial for socially-aware navigation in robotics. Our work focuses on localizing humans in the world and predicting the free space around them by incorporating other static and dynamic obstacles. We propose a multi-task learning strategy to handle both tasks, achieving this goal with minimal computational demands. We use a dataset captured in a typical warehouse environment by mounting a perception module consisting of a Jetson Xavier AGX and an Intel L515 LiDAR camera on a MiR100 mobile robot. Our method, which is built upon prior works in the field of human detection and localization demonstrates improved results in difficult cases that are not tackled in other works, such as human instances at a close distance or at the limits of the field of view of the capturing sensor. We further extend this work by using a lightweight network structure and integrating a free space segmentation branch that can independently segment the floor space without any prior maps or 3D data, relying instead on the characteristics of the floor. In conclusion, our method presents a lightweight and efficient solution for predicting human 3D location and segmenting the floor space for low-energy consumption platforms, tested in an industrial environment., Competing Interests: Authors DA and MJ were employed by Novo Nordisk A/S. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Arapis, Jami and Nalpantidis.)

Our primary objective was to identify if fasciotomy was associated with increased mortality in patients who developed acute compartment syndrome (ACS) on extracorporeal cardiopulmonary resuscitation (ECPR). Additionally, we sought to identify any additional risk factors for mortality in these patients and report the amputation-free survival following fasciotomy. We retrospectively reviewed adult ECPR patients from the Extracorporeal Life Support Organization registry who were diagnosed with ACS between 2013 and 2021. Of 764 ECPR patients with limb complications, 127 patients (17%) with ACS were identified, of which 78 (63%) had fasciotomies, and 14 (11%) had amputations. Fasciotomy was associated with a 23% rate of amputation-free survival. There were no significant differences in demographics or baseline laboratory values between those with and without fasciotomy. Overall, 88 of 127 (69%) patients with ACS died. With or without fasciotomy, the mortality of ACS patients was similar, 68% vs. 71%. Multivariable logistic regression demonstrated that body mass index (BMI; adjusted odds ratio [aOR] = 1.22, 95% confidence interval [CI] = 1.01-1.48) and 24 hour mean blood pressure (BP; aOR = 0.93, 95% CI = 0.88-0.99) were independently associated with mortality. Fasciotomy was not an independent risk factor for mortality (aOR = 0.24, 95% CI = 0.03-1.88). The results of this study may help guide surgical decision-making for patients who develop ACS after ECPR. However, the retrospective nature of this study does not preclude selection bias in patients who have received fasciotomy. Thus, prospective studies are necessary to confirm these findings., Competing Interests: Disclosure: B.S. is a paid consultant for Bone Foam Inc., Smith & Nephew, and DePuy Synthes. He is on the editorial board for Frontiers in Surgery , Orthopedic Surgery , and is a Board/committee member for the Orthopaedic Trauma Association. He also receives research support from DePuy Synthes. The other authors have no conflicts of interest to report., (Copyright © ASAIO 2023.)

Neurodegenerative diseases are a major cause of disability in the world, but their etiologies largely remain elusive. Genetic factors can only account for a minority of risk for most of these disorders, suggesting environmental factors play a significant role in the development of these diseases. Prolonged exposure to air pollution has recently been identified to increase the risk of Alzheimer's and Parkinson's diseases, but the molecular mechanisms by which it acts are not well understood. Zebrafish embryos exposed to diesel exhaust particle extract (DEPe) lead to dysfunctional autophagy and neuronal loss. Here, we exposed zebrafish embryos to DEPe and performed high throughput proteomic and transcriptomic expression analyses from their brains to identify pathogenic pathways induced by air pollution. DEPe treatment altered several biological processes and signaling pathways relevant to neurodegenerative processes, including xenobiotic metabolism, phagosome maturation, and amyloid processing. The biggest induction of gene expression in brains was in Cyp1A (over 30-fold). The relevance of this expression change was confirmed by blocking induction using CRISPR/Cas9, which resulted in a dramatic increase in sensitivity to DEPe toxicity, confirming that Cyp1A induction was a compensatory protective mechanism. These studies identified disrupted molecular pathways that may contribute to the pathogenesis of neurodegenerative disorders. Ultimately, determining the molecular basis of how air pollution increases the risk of neurodegeneration will help in the development of disease-modifying therapies., (© 2021. The Author(s).)

Study Design: Retrospective cohort., Objective: The objective was to determine if sarcopenia is an independent risk factor for complications in adult spinal deformity (ASD) patients undergoing pedicle subtraction osteotomy (PSO) and define categories of complication risk by sarcopenia severity., Summary of Background Data: Sarcopenia is linked to morbidity and mortality in several orthopedic procedures. Data concerning sarcopenia in ASD surgery is limited, particularly with respect to complex techniques performed such as PSO. With the high surgical burden of PSOs, appropriate patient selection is critical for minimizing complications., Methods: We identified 73 ASD patients with lumbar CT/MRI scans who underwent PSO with spinal fusion ≥5 levels at a tertiary care center from 2005 to 2014. Sarcopenia was assessed by the psoas-lumbar vertebral index (PLVI). Using stratum-specific likelihood ratio analysis, patients were separated into 3 sarcopenia groups by complication risk. The primary outcome measure was any 2-year complication. Secondary outcome measures included intraoperative blood loss and length of stay., Results: The mean PLVI was 0.84±0.28, with 47% of patients having complications. Patients with a complication had a 27% lower PLVI on average than those without complications (0.76 vs. 0.91, P=0.021). Stratum-specific likelihood ratio analysis produced 3 complication categories: 32% complication rate for PLVI ≥ 0.81; 61% for PLVI 0.60-0.80; and 69% for PLVI < 0.60. Relative to patients with PLVI ≥ 0.81, those with PLVI 0.60-0.80 and PLVI < 0.60 had 3.2× and 4.3× greater odds of developing a complication (P<0.05). For individual complications, patients with PLVI < 1.0 had a significantly higher risk of proximal junctional kyphosis (34% vs. 0%, P=0.022), while patients with PLVI < 0.8 had a significantly higher risk of wound infection (12% vs. 0%, P=0.028) and dural tear (14% vs. 0%, P=0.019). There were no significant associations between sarcopenia, intraoperative blood loss, and length of stay., Conclusions: The increasing severity of sarcopenia is associated with a significantly and incrementally increased risk of complications following ASD surgery that require PSO., Level of Evidence: Level III., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Although obesity has been shown to increase the risk of short-term medical complications following total shoulder arthroplasty (TSA), evidence is lacking on the influence of obesity on longer-term surgical complications such as revision. The purpose of this study was to assess the association of increasing obesity with 2- and 5-year all-cause revision, periprosthetic joint infection (PJI), aseptic loosening, and manipulation under anesthesia (MUA) among patients undergoing reverse total shoulder arthroplasty (RTSA) or TSA., Methods: Patients who underwent RTSA or TSA with a minimum 5-year follow-up were identified in a national claims database (PearlDiver Technologies). Patients with obesity (body mass index [BMI] ≥30) were compared to patients who are normal or overweight (18.5 ≤ BMI < 30). Those with obesity were further stratified to those with class I or II obesity (30 ≤ BMI < 40) and those with class III obesity (BMI ≥ 40). Outcomes for comparison included all-cause revision, PJI, aseptic loosening, and MUA within 2 or 5 years. These cohorts were compared using univariate and multivariable analysis., Results: Patients with obesity had no significant difference in any surgical complication within 2 or 5 years for both those who underwent TSA or RTSA. After stratifying by class I or II obesity and class III obesity, there was still no significant difference in surgical complications with 2 or 5 years for both TSA patients and RTSA patients., Discussion: Obesity, when other major comorbidities are controlled for, was not associated with increased risk of long-term surgical complications after shoulder replacement surgery., (Copyright © 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

There is tremendous need for brief and supported, non-commercial youth- and caregiver-report questionnaires of youth anxiety. The pediatric and parent proxy short forms of the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety scale (8a v2.0) are free, brief, publicly accessible measures of youth- and caregiver-reported anxiety in children and adolescents. Despite increased use of the PROMIS, no study has evaluated performance of its anxiety scales in a sample of treatment-engaged anxious youth. Analyses were conducted on baseline data from the first 265 families (child M Age =11.14 years, 70% racial/ethnic minoritized youth) to enroll in the Kids FACE FEARS trial, a multisite comparative effectiveness trial of therapist-led vs. self-administered treatment for elevated youth anxiety. Confirmatory factor analysis (CFA) examined factor structure; omega coefficients and regression models examined internal consistency, convergent validity, and cross-informant reliability. CFA supported adjusted single-factor solutions across youth and caregiver reports, and internal consistency was high. Convergent validity was supported by medium-to-large associations with anxiety-related impairment and severity. Moderate cross-informant reliability between reports was found. Results showcase the first psychometric study of the PROMIS Anxiety scale short forms among treatment-engaged youth with elevated anxiety. Findings highlight the PROMIS Anxiety scale's utility in typical care settings for youth anxiety., (Published by Elsevier Ltd.)

Selective mutism (SM) is a relatively rare, but highly interfering, child anxiety disorder characterized by a consistent failure to speak in certain situations, despite demonstrating fluent speech in other contexts. Exposure-based cognitive behavioral therapy and Parent-Child Interaction Therapy adapted for SM can be effective, but the broad availability and accessibility of such specialty care options remains limited. Stay-at-home guidelines to mitigate the spread of COVID-19 further limited the accessibility of office-based specialty care for SM. Building on separate lines of research supporting intensive treatments and telehealth service delivery models, this paper is the first to describe the development, preliminary feasibility, acceptability, and efficacy of a Remote Intensive Group Behavioral Treatment (IGBT) for families of young children with SM ( N =9). Treatment leveraged videoconferencing technology to deliver caregiver training sessions, lead-in sessions, 5 consecutive daily IGBT sessions, and an individualized caregiver coaching session. Remote IGBT was found to be both feasible and acceptable. All families (100%) completed diagnostic assessments and caregiver-report questionnaires at four major study timepoints (i.e., intake, pre-treatment, post-treatment, 4-month follow-up) and participated in all treatment components. Caregivers reported high treatment satisfaction at post-treatment and 4-month follow-up and low levels of burden associated with treatment participation at post-treatment. Approximately half of participating children were classified as treatment responders by independent evaluators at post-treatment and 4-month follow-up. Although these pilot results should be interpreted with caution, the present work underscores the potential utility of using videoconferencing to remotely deliver IGBT to families in their natural environments.

Caveolae, specialized plasma membrane invaginations present in most cell types, play important roles in multiple cellular processes including cell signaling, lipid uptake and metabolism, endocytosis and mechanotransduction. They are found in almost all cell types but most abundant in endothelial cells, adipocytes and fibroblasts. Caveolin-1 (Cav1), the signature structural protein of caveolae was the first protein associated with caveolae, and in association with Cavin1/PTRF is required for caveolae formation. Genetic ablation of either Cav1 or Cavin1/PTRF downregulates expression of the other resulting in loss of caveolae. Studies using Cav1-deficient mouse models have implicated caveolae with human diseases such as cardiomyopathies, lipodystrophies, diabetes and muscular dystrophies. While caveolins and caveolae are extensively studied in extra-ocular settings, their contributions to ocular function and disease pathogenesis are just beginning to be appreciated. Several putative caveolin/caveolae functions are relevant to the eye and Cav1 is highly expressed in retinal vascular and choroidal endothelium, Müller glia, the retinal pigment epithelium (RPE), and the Schlemm's canal endothelium and trabecular meshwork cells. Variants at the CAV1/2 gene locus are associated with risk of primary open angle glaucoma and the high risk HTRA1 variant for age-related macular degeneration is thought to exert its effect through regulation of Cav1 expression. Caveolins also play important roles in modulating retinal neuroinflammation and blood retinal barrier permeability. In this article, we describe the current state of caveolin/caveolae research in the context of ocular function and pathophysiology. Finally, we discuss new evidence showing that retinal Cav1 exists and functions outside caveolae., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Periprosthetic infections after total shoulder arthroplasty (TSA) are associated with devastating complications and prolonged treatment. Patients with identified antibiotic allergy (ABX) may be at increased risk for complications because of suboptimal preincisional prophylaxis. This study aims to quantify the risk of postoperative outcomes and complications for patients undergoing TSA with a history of ABX., Methods: Retrospective cohort analysis of patient data was conducted using the PearlDiver Patient Records Database. Patients who underwent TSA for osteoarthritis were identified using Current Procedural Terminology and International Classification of Diseases codes and were stratified based on self-reported (1) penicillin, (2) sulfonamide, or (3) other antibiotic allergies. We analyzed patient demographics, comorbidities, 90-day medical complications, and rate of revision at 30 days, 90 days, 1 year, and 2 years., Results: In total, 85,606 patients who underwent TSA for osteoarthritis from 2010 to 2018 were identified, of whom 7,836 (9.15%) had a reported ABX. Univariate analysis found the ABX cohort was younger (67.5 versus 67.7 year; P = 0.042), more often female (67.57% versus 54.79%; P < 0.001), and more likely to have Elixhauser comorbidities than nonallergic control subjects. Multivariate analysis found patients who reported ABX had increased likelihood of periprosthetic joint infection (PJI) within 30 days (odds ratio [OR]: 3.129), 1 year (OR: 2.016), and 2 years of surgery (OR: 2.221). Patients with reported ABX had increased likelihood of postoperative anemia (OR: 1.126), blood transfusion (OR: 1.238), and readmission (OR: 1.585) within 90 days of surgery. Patients with penicillin allergy had a greater incidence of revision due to PJI at 30 days (OR: 4.811), 90 days (OR: 2.91), 1 year (OR: 2.105), and 2 years (OR: 2.72). Rates of reported ABX increased from 2010 to 2018 (8.60% to 10.91%; P = 0.001) in patients undergoing TSA., Conclusion: Patients undergoing TSA with a history of ABX had a higher risk of readmission, postoperative anemia, blood transfusions, and PJI. These findings support critical assessment and clarification of reported allergies before TSA and possibly the use of preoperative allergy testing., Level of Evidence: Level 3 therapeutic study., Competing Interests: Best or an immediate family member has received educational support from Arthrex, Smith and Nephew, and Stryker outside the submitted work. Srikumaran or an immediate family member has received grants and personal fees from Arthrex, grants and personal fees from Depuy, personal fees from Fx Shoulder, personal fees from Orthofix, other from Quantum OPS, other from ROM3, grants from Smith and Nephew, other from Sonogen, personal fees from Stryker, personal fees from Thieme, personal fees and other from Tigon Medical, grants and personal fees from Wright Medical Technology, outside the submitted work; has received a patent Conventus pending, a patent Fx Shoulder pending, and a patent Tigon Medical issued. The other authors certify that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Bahoravitch, Jami, Nayar, Agarwal, and Kreulen., (Copyright © 2022 by the American Academy of Orthopaedic Surgeons.)

Aims: Due to the recent rapid expansion of scooter sharing companies, there has been a dramatic increase in the number of electric scooter (e-scooter) injuries. Our purpose was to conduct a systematic review to characterize the demographic characteristics, most common injuries, and management of patients injured from electric scooters., Methods: We searched PubMed, EMBASE, Scopus, and Web of Science databases using variations of the term "electric scooter". We excluded studies conducted prior to 2015, studies with a population of less than 50, case reports, and studies not focused on electric scooters. Data were analyzed using t -tests and p-values < 0.05 were considered significant., Results: We studied 5,705 patients from 34 studies. The mean age was 33.3 years (SD 3.5), and 58.3% (n = 3,325) were male. The leading mechanism of injury was falling (n = 3,595, 74.4%). Injured patients were more likely to not wear a helmet (n = 2,114; 68.1%; p < 0.001). The most common type of injury incurred was bony injuries (n = 2,761, 39.2%), of which upper limb fractures dominated (n = 1,236, 44.8%). Head and neck injuries composed 22.2% (n = 1,565) of the reported injuries, including traumatic brain injuries (n = 455; 2.5%), lacerations/abrasions/contusions (n = 500; 7.1%), intracerebral brain haemorrhages (n = 131; 1.9%), and concussions (n = 255; 3.2%). Standard radiographs comprised most images (n = 2,153; 57.7%). Most patients were treated and released without admission (n = 2,895; 54.5%), and 17.2% (n = 911) of injured patients required surgery. Qualitative analyses of the cost of injury revealed that any intoxication was associated with higher billing costs., Conclusion: The leading injuries from e-scooters are upper limb fractures. Falling was the leading mechanism of injury, and most patients did not wear a helmet. Future research should focus on injury characterization, treatment, and cost.Cite this article: Bone Jt Open  2022;3(9):674-683.

Background Despite progress in youth anxiety assessment, there is need for a measure that is simultaneously (a) free, (b) brief, (c) focused broadly on anxiety and avoidance severity, frequency, and interference, and (d) concerned with the past week. The adult overall anxiety severity and impairment scale (OASIS) was adapted to yield a caregiver-report of past week youth anxiety and interference (OASIS-Y). Methods In a sample of diverse youth seeking anxiety services (N = 132; 67% racial/ethnic minority) and their caregivers, analyses examined the OASIS-Y factor structure, internal consistency, and convergent and divergent validity. Hierarchical linear modeling in a participant subset examined OASIS-Y sensitivity to treatment-related change. Results OASIS-Y internal consistency was high and confirmatory factor analysis supported a single-factor structure similar to that found in adults. OASIS-Y convergent validity was supported by a medium-sized association with an established, commercially available measure of youth anxiety, and divergent validity was supported by the absence of unique associations with measures of youth attention and externalizing problems. In a sample subset, session-by-session OASIS-Y scores significantly declined across treatment, and declined at a steeper rate among treatment "responders" versus "non-responders," providing evidence of OASIS-Y sensitivity to treatment-related change. Limitations This study focused on a clinical sample and cannot speak to OASIS-Y performance in community settings. Shared method-variance may have also influenced findings. Conclusions This study offers the first psychometric evaluation of the OASIS-Y, and underscores the promising clinical utility of the measure for assessing past week youth anxiety and impairment and for supporting routine outcome monitoring., (Copyright © 2021. Published by Elsevier B.V.)

Introduction The COVID-19 pandemic resulted in a transition to a virtual format for all medical residency and fellowship application processes. Previous studies have discussed the successful implementation of virtual interviews, but a deep analysis of how the application process has changed for orthopedic surgery fellowship programs during the pandemic is lacking. The purpose of this study was to assess how COVID-19 impacted the orthopedic spine fellowship application and selection process. Methods A web-based survey was administered to the program directors of all 75 U.S. orthopedic surgery spine fellowship programs, which often can accept both orthopedic surgery and neurosurgery trained graduates. Questions focused on the changes from the 2019-2020 application cycle to the 2020-2021 cycle. We collected data on connecting with potential applicants, the general application process, and interviews offered by programs. Univariate analyses were used to compare data from the 2020-2021 cycle with the prior 2019-2020 cycle. Results Twenty-five of the 75 contacted program directors responded to our survey (33% response rate). The percentage of programs that offered virtual open houses/meet-and-greets increased from 20% in 2019-2020 to 52% in 2020-2021 (p=0.018). Social media use was unchanged (0.0% vs. 4.0%, p>0.05). Compared to the prior year, the number of interviews offered by programs increased by 1.5 (32.7 vs. 21.9 interviews, p=0.024). There were no significant differences in the numbers of applications received by programs, interview dates available, or separate interviews each candidate completed during an interview day (p>0.05 for all). The in-person interview was the most important factor in 2019-2020 for selecting applicants, whereas the virtual interview, letters of recommendation (LOR), and research were equally ranked as the most important factors in 2020-2021. Regarding interviews, 50% of respondents would "likely" consider virtual interviews as an option in addition to in-person interviews in the future, but most (55%) answered that it was "unlikely" that virtual interviews would entirely replace in-person interviews. Conclusion Spine fellowship programs were more likely to use virtual social events to recruit potential applicants, send out more interview invitations, and equally consider LOR and research with interview performance during an entirely virtual application cycle. Half of the program directors would consider offering virtual interviews as an option for future application cycles, which may help reduce costs associated with the process., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Jami et al.)

Purpose: To compare 90-day postoperative complications, health care use, 2-year and 5-year rates of reoperation and manipulation under anesthesia, and costs at the 30-day, 90-day, and 1-year postoperative intervals following open and arthroscopic rotator cuff repair (RCR)., Methods: Patients who underwent an open or arthroscopic RCR with minimum 5-year follow-up were identified in a national database (PearlDiver Technologies) using Common Procedural Terminology and International Classification of Diseases codes. These patients were then stratified into 2 cohorts: open RCRs and arthroscopic RCRs. These cohorts were propensity-matched based on age, sex, Charlson Comorbidity Index, smoking status, and obesity (body mass index>30). 90-day medical complications, 2-year and 5-year surgical complications, and reimbursements at the 30-day, 90-day and 1-year postoperative intervals were assessed. Bivariate statistics were performed using χ 2 tests, Fisher exact tests, and Student t tests where appropriate. Reimbursements included the reimbursement for the index surgery as well as any reimbursements during the specified postoperative interval related to the index surgery., Results: In total, 3,266 patients who underwent open RCR were matched with 3,266 patients who underwent arthroscopic RCR. Compared with patients who underwent arthroscopic RCR, patients who underwent open RCR were at significantly increased risk of 90-day surgical-site infection (0.89% vs 0.34%, P  = .004), undergoing manipulation under anesthesia (MUA) within 2 years of surgery (1.65% vs 0.95%, P  = .012), and undergoing MUA within 5 years of surgery (1.75% vs 1.10%, P  = .028). There were no significant differences in any other postoperative complications, reoperation rates, or reimbursements between open RCR and arthroscopic RCR (all, P > .05)., Conclusions: Patients undergoing open RCR were at increased risk of 90-day surgical-site infection and MUA both within 2 years and within 5 years of surgery in this study cohort., Level of Evidence: Level III, retrospective cohort study., (© 2021 The Authors.)

Background: Patients with Coronavirus disease 2019 (COVID-19)-related acute respiratory disease (ARDS) increasingly receive extracorporeal membrane oxygenation (ECMO) support. While ECMO has been shown to increase risk of stroke, few studies have examined this association in COVID-19 patients., Objective: We conducted a systematic review to characterise neurological events during ECMO support in COVID-19 patients., Design: Systematic review of cohort and large case series of COVID-19 patients who received ECMO support., Data Sources: Studies retrieved from PubMed, EMBASE, Cochrane, Cochrane COVID-19 Study Register, Web of Science, Scopus, Clinicaltrials.gov, and medRχiv from inception to November 11, 2020., Eligibility Criteria: Inclusion criteria were a) Adult population (>18 year old); b) Positive PCR test for SARS-CoV-2 with active COVID-19 disease; c) ECMO therapy due to COVID-19 ARDS; and d) Neurological events and outcome described while on ECMO support. We excluded articles when no details of neurologic events were available., Results: 1,322 patients from 12 case series and retrospective cohort studies were included in our study. The median age was 49.2, and 75% (n=985) of the patients were male. Diabetes mellitus and dyslipidaemia were the most common comorbidities (24% and 20%, respectively). Most (95%, n=1,241) patients were on venovenous ECMO with a median P:F ratio at the time of ECMO cannulation of 69.1. The prevalence of intracranial haemorrhage (ICH), ischaemic stroke, and hypoxic ischaemic brain injury (HIBI) was 5.9% (n=78), 1.1% (n=15), and 0.3% (n=4), respectively. The overall mortality of the 1,296 ECMO patients in the 10 studies that reported death was 36% (n=477), and the mortality of the subset of patients who had a neurological event was 92%., Conclusions: Neurological injury is a concern for COVID-19 patients who receive ECMO. Further research is required to explore how neuromonitoring protocols can inform tailored anticoagulation management and improve survival in COVID-19 patients with ECMO support., (Copyright © 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Introduction: The goal of this study was to assess the influence of the coronavirus disease 2019 pandemic on the orthopaedic surgery residency application process in the 2020 to 2021 application cycle., Methods: A survey was administered to the program directors of 152 Accreditation Council for Graduate Medical Education-accredited orthopaedic surgery residency programs. The following questions were assessed: virtual rotations, open houses/meet and greet events, social media, the selection criteria of applicants, the number of applications received by programs, and the number of interviews offered by programs., Results: Seventy-eight (51%) orthopaedic residency programs responded to the survey. Of those, 25 (32%) offered a virtual away rotation, and 57 (75%) held virtual open houses or meet and greet events. Thirteen of these programs (52%) reported virtual rotations as either "extremely important" or "very important." A 355% increase was observed in social media utilization by residency programs between the 2019 to 2020 and 2020 to 2021 application cycles, with more programs finding social media to be "extremely helpful" or "very helpful" for recruiting applicants in 2020 to 2021 compared with the previous year (39% versus 10%, P < 0.001)., Conclusion: Although many of the changes seen in the 2020 to 2021 application cycle were implemented by necessity, some of these changes were beneficial and may continue to be used in future application cycles., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Background: To provide prevention programs and educate drug users (DUs), the estimation of their population is necessary. This study aimed to estimate the population size of this hidden group in Isfahan city as a metropolitan in Iran using the network scale-up ýmethod (NSUM)., Methods: This cross-sectional study was performed in summer 2018 on 1000 people selected through a multistage sampling method based on 14 region of the municipality of Isfahan. The data collection tool was a questionnaire that was previously used in Dr. Banshi's national plan without any changes. The Cronbach's alpha value of the questionnaire was 0.826. Using correction factors such as transparency of response and the ratio of social network size used in previous national studies, the number of people with high-risk behaviors was estimated. The results were analyzed through NSUM based on survey analysis., Findings: Among all kinds of DUs, men were the largest consumers. The prevalence of use of opium, cannabis, heroin/crack, stimulants, ecstasy, hallucinogens, tramadol, zolpidem, tobacco, and drug injection was 2983, 2342, 613, 766, 86, 268, 1185, 213, 5869, 135 in 100000 people, among individuals of over 18 years of age. In both sexes, the prevalence of using opium and its nectar and illegal treatment with methadone and buprenorphine was higher in people of over 30 years of age, while the prevalence of consuming cannabis, ecstasy, tramadol, tobacco products, and stimulants was higher in the age group of 18 to 30 years., Conclusion: The results indicated that the prevalence of different DUs in Isfahan city, especially among men was higher than the reported average (especially in young men of 18-30 years of age). Since the prevalence of drug use varies based on the type of substance used among age groups, targeted preventive planning based on the type of drug used and age group is recommended., (©2021 Kerman University of Medical Sciences.)

Background: Video telehealth is an important tool for health care delivery during the COVID-19 pandemic. Given physical distancing recommendations, access to traditional in-person telehealth training for providers has been limited. Telesimulation is an alternative to in-person telehealth training. Telesimulation training with both remote participants and facilitators using telehealth software has not been described. Objective: We investigated the feasibility of a large group telesimulation provider training of telehealth software for remote team leadership skills with common neonatal cases and procedures. Methods: We conducted a 90-min telesimulation session with a combination of InTouch™ provider access software and Zoom™ teleconferencing software. Zoom facilitators activated InTouch software and devices and shared their screen with remote participants. Participants rotated through skill stations and case scenarios through Zoom and directed bedside facilitators to perform simulated tasks using the shared screen and audio connection. Participants engaged in a debrief and a pre- and postsurvey assessing participants' comfort and readiness to use telemedicine. Data were analyzed using descriptive statistics and paired t tests. Results: Twenty ( n  = 20) participants, five Zoom and eight bedside facilitators participated. Twenty-one (21) pre- and 16 postsurveys were completed. Most participants were attending neonatologists who rarely used telemedicine software. Postsession, participants reported increased comfort with some advanced InTouch features, including taking and sharing pictures with the patient ( p < 0.01) and drawing on the shared image ( p < 0.05), but less comfort with troubleshooting technical issues, including audio and stethoscope ( p < 0.01). Frequently stated concerns were troubleshooting technical issues during a call (75%, n  = 16) and personal discomfort with telemedicine applications and technology (56%, n  = 16). Conclusion: Large group telesimulation is a feasible way to offer telehealth training for physicians and can increase provider comfort with telehealth software.

Background: Autoimmune thyroid diseases are the most frequent autoimmune disorders, with a global prevalence of about 10%. Several mechanisms have been proposed to induce autoimmune thyroid responses by infectious agents. In this study, we aimed to evaluate the association between parvovirus B19 infection and autoimmune thyroid disorders., Methods: Adult patients with newly diagnosed Graves' disease (GD) and Hashimoto's thyroiditis (HT) and healthy euthyroid controls were recruited. Various clinical and biochemical parameters, including thyroid function tests and serum parvovirus B19 antibody level (IgG), were assessed and compared between the groups., Results: In this study, data from 404 cases with HT, 248 cases with GD, and 480 healthy individuals as a control group were analyzed. The prevalence of parvovirus B19 infection in patients with HT and GD and controls was 61.1%, 58.9%, and 47.1%, respectively. In the group of patients with HT, there was a significant positive correlation between the B19 IgG and TPOAb (r = 0.764, P < 0.001) and TgAb (r = 0.533, P < 0.001). Also, in patients with GD, the B19 IgG had a significant positive correlation with TPOAb (r = 0.779, P < 0.001) and TgAb (r = 0.467, P < 0.001)., Conclusions: Parvovirus B19 infection is commonly seen in patients with autoimmune thyroid disorders., Competing Interests: Conflict of Interests: The authors of this article state that there are no potential conflicts of interest in conducting this research and its publication., (Copyright © 2021, International Journal of Endocrinology and Metabolism.)

Despite recent advances in the treatment of early child social anxiety, the broad accessibility of brick-and-mortar services has been limited by traditional barriers to care, and more recently by new obstacles related to efforts to slow the spread of COVID-19. The present waitlist-controlled trial examined the preliminary efficacy of a family-based behavioral parenting intervention (i.e., the iCALM Telehealth Program) that draws on Parent-Child Interaction Therapy and videoconferencing to remotely deliver clinician-led care for anxiety in early childhood. Young children (3-8 years) with a diagnosis of social anxiety disorder (N = 40; 65% from ethnic/racial minority backgrounds) were randomly assigned to iCALM or waitlist. Intent-to-treat analyses found that at post, independent evaluators classified roughly half of the iCALM-treated children, but only 6% of waitlist children, as "Responders" (Wald test = 4.51; p = .03). By Post, iCALM led to significantly greater reductions than waitlist in child anxiety symptoms, fear, discomfort, and anxiety-related social impairment, and also led to greater improvements in child soothability. By 6-month follow-up, the percentage of iCALM-treated children classified as "Responders" rose to roughly 60%. Exploratory moderation tests found iCALM was particularly effective in reducing life impairments and parental distress among families presenting with higher, relative to lower, levels of baseline parental accommodation. The present findings add to a growing body of research supporting the promise of technology-based strategies for broadening the portfolio of options for delivering clinician-led mental health services., (Copyright © 2021 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. All rights reserved.)

Uncontrolled inflammation is associated with neurodegenerative conditions in central nervous system tissues, including the retina and brain. We previously found that the neural retina (NR) plays an important role in retinal immunity. Tumor necrosis factor Receptor-Associated Factor 3 (TRAF3) is a known immune regulator expressed in the retina; however, whether TRAF3 regulates retinal immunity is unknown. We have generated the first conditional NR- Traf3 knockout mouse model ( Chx10 -Cre/ Traf3 f/f ) to enable studies of neuronal TRAF3 function. Here, we evaluated NR- Traf3 depletion effects on whole retinal TRAF3 protein expression, visual acuity, and retinal structure and function. Additionally, to determine if NR- Traf3 plays a role in retinal immune regulation, we used flow cytometry to assess immune cell infiltration following acute local lipopolysaccharide (LPS) administration. Our results show that TRAF3 protein is highly expressed in the NR and establish that NR- Traf3 depletion does not affect basal retinal structure or function. Importantly, NR- Traf3 promoted LPS-stimulated retinal immune infiltration. Thus, our findings propose NR- Traf3 as a positive regulator of retinal immunity. Further, the NR- Traf3 mouse provides a tool for investigations of neuronal TRAF3 as a novel potential target for therapeutic interventions aimed at suppressing retinal inflammatory disease and may also inform treatment approaches for inflammatory neurodegenerative brain conditions.

Research has examined suicide-related behaviors following exposure to suicide news articles, yet only a handful of studies utilized experimental designs. We aimed to address the limitations of these prior experimental studies by utilizing more realistic suicide articles and more empirically sound measures. 420 participants were randomly assigned to read a series of either suicide-related or neutral news articles, then complete a battery of questionnaires and the Death/Suicide Implicit Association Task. Overall, no significant differences between groups were observed, nor did we observe any moderation effect of individual vulnerabilities (e.g., lifetime suicidal ideation/behavior). We did not observe any immediate effects of exposure to suicide news articles. Further research examining potential mechanisms for imitative effects remains critically needed.

Objective: Neck pain is a leading cause of years lived with disability and is often managed with opioid medications in primary care settings, though this is contraindicated by national guidelines. The aim of this study was to determine the prevalence of opioid prescription for neck pain at a primary care visit and to analyze the geographic variation and trends in opioid prescriptions between 2011 and 2017., Methods: Using a prescription drug claims database, we identified 591,961 adult patients who presented for neck pain in primary care settings between 2011 and 2017. Patients who had outpatient specialty visits within 1 year before presentation, a concomitant diagnosis of a non-musculoskeletal cause of neck pain, or preexisting chronic opioid use were excluded., Results: The mean age of the patients was 45 ± 12 years, and 64% were female. Fifteen percent of patients were prescribed opioids within 30 days of their encounter. Eleven percent of patients were prescribed moderate- to high-dose opioids (>20 morphine milligram equivalents). From 2011-2017, the proportion of both overall opioid prescriptions and moderate- to high-dose prescriptions given to first time presenters to an outpatient clinic for neck pain was highest in Mississippi (20%) and lowest in New Mexico (6%) (P < 0.001). In 2017, the proportion of both overall opioid prescriptions and moderate- to high-dose prescriptions was highest in the Midwest (10.4%) and lowest in the Northeast (4.9%). The proportion of patients with filled opioid prescriptions declined between 2011 (19%) and 2017 (13%) (P < 0.001), and the proportion of patients with moderate- to high-dose prescriptions declined from 2011 (13%) to 2017 (8%) (P < 0.001). first-time presenters of neck pain to an outpatient clinic., Conclusions: Opioid medication use for neck pain in the primary care setting is significant. Although opioid prescriptions are declining, there remains a need for further standardization in prescription practices., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

In this study, physically cross-linked hydrogels were developed by freezing-thawing method while different concentrations of honey were included into the hydrogels for accelerated wound healing. The hydrogel was composed of chitosan, polyvinyl alcohol (PVA), and gelatin with the ratio of 2:1:1 (v/v), respectively. Further, the effect of honey concentrations on antibacterial properties, and cell behavior was investigated. In vivo studies, including wound healing mechanism using rat model and histological analysis of section tissue samples were performed. The results illustrated that the incorporation of honey in hydrogels increased the ultimate strain of hydrogels approximately two times, while reduced the ultimate tensile strength and elastic modulus of hydrogels. Moreover, the antibacterial activities of samples were increased by increasing the concentration of honey. Regarding MTT assay, as the concentration of honey increased, the cell viability of hydrogels was enhanced until an optimal amount of honey. Further, the integration of honey into the hydrogel matrix results in the maintenance of a well-structured layer of epidermis containing mature collagen and accelerates the rate of wound healing. The 3D Chitosan/PVA/Gelatin hydrogel containing honey with appropriate mechanical, antibacterial activity, and biocompatibility could be a promising approach for wound healing., (Copyright © 2020 Elsevier B.V. All rights reserved.)

During the progression of ocular diseases such as retinopathy of prematurity and diabetic retinopathy, overgrowth of retinal blood vessels results in the formation of pathological neovascular tufts that impair vision. Current therapeutic options for treating these diseases include antiangiogenic strategies that can lead to the undesirable inhibition of normal vascular development. Therefore, strategies that eliminate pathological neovascular tufts while sparing normal blood vessels are needed. In this study we exploited the hyaloid vascular network in murine eyes, which naturally undergoes regression after birth, to gain mechanistic insights that could be therapeutically adapted for driving neovessel regression in ocular diseases. We found that endothelial cells of regressing hyaloid vessels underwent down-regulation of two structurally related E-26 transformation-specific (ETS) transcription factors, ETS-related gene (ERG) and Friend leukemia integration 1 (FLI1), prior to apoptosis. Moreover, the small molecule YK-4-279, which inhibits the transcriptional and biological activity of ETS factors, enhanced hyaloid regression in vivo and drove Human Umbilical Vein Endothelial Cells (HUVEC) tube regression and apoptosis in vitro. Importantly, exposure of HUVECs to sheer stress inhibited YK-4-279-induced apoptosis, indicating that low-flow vessels may be uniquely susceptible to YK-4-279-mediated regression. We tested this hypothesis by administering YK-4-279 to mice in an oxygen-induced retinopathy model that generates disorganized and poorly perfused neovascular tufts that mimic human ocular diseases. YK-4-279 treatment significantly reduced neovascular tufts while sparing healthy retinal vessels, thereby demonstrating the therapeutic potential of this inhibitor., Competing Interests: The authors declare no competing interest.

Purpose: The immune-privileged environment and complex organization of retinal tissue support the retina's essential role in visual function, yet confound inquiries into cell-specific inflammatory effects that lead to dysfunction and degeneration. Caveolin-1 (Cav1) is an integral membrane protein expressed in several retinal cell types and is implicated in immune regulation. However, whether Cav1 promotes or inhibits inflammatory processes in the retina (as well as in other tissues) remains unclear. Previously, we showed that global-Cav1 depletion resulted in reduced retinal inflammatory cytokine production but paradoxically elevated retinal immune cell infiltration. We hypothesized that these disparate responses are the result of differential cell-specific Cav1 functions in the retina., Methods: We used Cre/lox technology to deplete Cav1 specifically in the neural retinal (NR) compartment to clarify the role NR-specific Cav1 (NR-Cav1) in the retinal immune response to intravitreal inflammatory challenge induced by activation of Toll-like receptor-4 (TLR4). We used multiplex protein suspension array and flow cytometry to evaluate innate immune activation. Additionally, we used bioinformatics assessment of differentially expressed membrane-associated proteins to infer relationships between NR-Cav1 and immune response pathways., Results: NR-Cav1 depletion, which primarily affects Müller glia Cav1 expression, significantly altered immune response pathway regulators, decreased retinal inflammatory cytokine production, and reduced retinal immune cell infiltration in response to LPS-stimulated inflammatory induction., Conclusions: Cav1 expression in the NR compartment promotes the innate TLR4-mediated retinal tissue immune response. Additionally, we have identified novel potential immune modulators differentially expressed with NR-Cav1 depletion. This study further clarifies the role of NR-Cav1 in retinal inflammation.

Purpose: Polymorphisms at the caveolin-1/2 locus are associated with glaucoma and IOP risk and deletion of caveolin-1 (Cav1) in mice elevates IOP and reduces outflow facility. However, the specific location/cell type responsible for Cav1-dependent regulation of IOP is unclear. We hypothesized that endothelial Cav1 in the conventional outflow (CO) pathway regulate IOP via endothelial nitric oxide synthase (eNOS) signaling., Methods: We created a mouse with targeted deletion of Cav1 in endothelial cells (Cav1ΔEC) and evaluated IOP, outflow facility, outflow pathway distal vascular morphology, eNOS phosphorylation, and tyrosine nitration of iridocorneal angle tissues by Western blotting., Results: Endothelial deletion of Cav1 resulted in significantly elevated IOP versus wild-type mice but not a concomitant decrease in outflow facility. Endothelial Cav1 deficiency did not alter the trabecular meshwork or Schlemm's canal morphology, suggesting that the effects observed were not due to developmental deformities. Endothelial Cav1 deletion resulted in eNOS hyperactivity, modestly increased protein nitration, and significant enlargement of the drainage vessels distal to Schlemm's canal. L-Nitro-arginine methyl ester treatment reduced outflow in Cav1ΔEC but not wild-type mice and had no effect on the size of drainage vessels. Endothelin-1 treatment decrease the outflow and drainage vessel size in both wild-type and Cav1ΔEC mice., Conclusions: Our results suggest that hyperactive eNOS signaling in the CO pathway of both Cav1ΔEC and global Cav1 knockout mice results in chronic dilation of distal CO vessels and protein nitration, but that Cav1 expression in the trabecular meshwork is sufficient to rescue CO defects reported in global Cav1 knockout mice.

Recent efforts to improve access to evidence-based parent training programs using online delivery have largely neglected findings that young children with callous-unemotional (CU)-type conduct problems receive less benefit from parent training than children with conduct problems alone. The current study aimed to examine the moderating effect of child CU traits on efficacy and engagement outcomes associated with Internet-delivered Parent-Child Interaction Therapy (iPCIT) versus standard, clinic-based PCIT. Forty families (57.6% non-Hispanic Caucasian) with a 3-5 year-old (M = 3.95 years, SD = 0.9; 83.5% boys) child with a disruptive behavior disorder were randomized to either iPCIT or clinic-based PCIT. Families participated in four assessments across time; child conduct problems, global functioning and treatment responder status, and parent-rated treatment satisfaction were measured. Analyses revealed that the negative influence of CU traits on functional gains was not uniform across treatment formats. Specifically, the detrimental effect of CU traits on functional gains was significantly more pronounced among children treated with iPCIT than clinic-based PCIT. CU traits also predicted lower parental treatment satisfaction across delivery formats, but this effect was more pronounced among iPCIT parents. In contrast, CU traits did not moderate differential effects across iPCIT and clinic-based PCIT for conduct problem severity or treatment response status. Findings suggest that iPCIT is a promising treatment option for early conduct problems, particularly when access-to-care barriers exist, but that further research is needed to determine whether strategic adaptations to online programs can more optimally address the distinct needs of children with clinically significant CU traits.

We discuss quantum annealing of the two-dimensional transverse-field Ising model on a D-Wave device, encoded on L×L lattices with L≤32. Analyzing the residual energy and deviation from maximal magnetization in the final classical state, we find an optimal L dependent annealing rate v for which the two quantities are minimized. The results are well described by a phenomenological model with two powers of v and L-dependent prefactors to describe the competing effects of reduced quantum fluctuations (for which we see evidence of the Kibble-Zurek mechanism) and increasing noise impact when v is lowered. The same scaling form also describes results of numerical solutions of a transverse-field Ising model with the spins coupled to noise sources. We explain why the optimal annealing time is much longer than the coherence time of the individual qubits.

Background Context: Although prescribing opioid medication on a limited basis for postoperative pain control is common practice, few studies have focused on chronic opioid use following anterior cervical discectomy and fusion (ACDF)., Purpose: To determine the prevalence of and risk factors for chronic opioid use following one and two-level ACDF for degenerative cervical pathology., Design: Retrospective cohort., Patient Sample: Using an insurance claims database, we identified patients aged 18-64 who underwent one or two-level primary ACDF from 2010 to 2015 for degenerative cervical pathology., Outcome Measures: Opioid prescription strength at various timepoints pre- and postoperatively and development of chronic postoperative opioid use., Methods: Prescription opioid use was examined during the following periods: 90 days before 7 days preceding surgery (preoperative), 6 days preceding surgery to 90 days following surgery (perioperative) and from 91 to 365 days following surgery (postoperative). The primary outcome was chronic postoperative opioid use, defined as ≥120 days' supply of opioid prescriptions filled or ≥10 opioid prescriptions between 3 and 12 months postoperatively. Secondary outcomes were high-dose (>90 morphine milligram equivalents [MME]/day) and very high-dose (>200 MME/day) opioid prescriptions. A multivariate logistic model (area under the ROC curve 0.75, p<.001) was built to predict long-term opioid use., Results: Among 28,813 patients who underwent ACDF, most were female (55%) and underwent single-level ACDF (68%), with mean age of 50±8.0 years. Fifty-two percent of patients filled an opioid prescription in the preoperative period, 95% of patients filled a prescription in the perioperative period, and 39% of patients filled a prescription in the postoperative period. High-dose and very high-dose opioid prescriptions in the perioperative period were identified in 45% and 24% of patients, respectively, whereas 17% met criteria for chronic postoperative opioid use. The odds of chronic opioid use were highest in the Western US (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.3, 1.6). Duration of opioids prescribed was also highest in the Western US (median 111 days, interquartile range 11-336), p<.001. Factors associated with the highest risk for chronic opioid use were preoperative opioid use (OR 5.7, 95% CI 5.3, 56.2), drug abuse (OR 3.5, 95% CI 2.6, 4.5), depression (OR 1.7, 95% CI 1.6, 1.9), anxiety (OR 1.5, 95% CI 1.4, 1.6), and surgery in the western region of the United States (OR 1.5, 95% CI 1.3, 1.6)., Conclusions: Patients undergoing ACDF commonly receive high-dose opioid prescriptions after surgery, and certain patient factors increase risk for chronic opioid use following ACDF. Intervention focusing on patients with these factors is essential to reduce long-term use of prescription opioids and postoperative care., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Cancer is considered as the most lethal disease for human beings, and up to now many attempts were failed for prevention and treatment of this tremendous health problem. Consequently, this study purpose was to investigate novel therapeutic methods for cancer. The bacterial toxin can result in cell death throughout the induction of apoptosis in cancer cell lines. We evaluated apoptosis and the expression levels of long non-coding RNAs (lncRNAs) in PC3, ACHN and HDF cell lines that were transfected with pCDNA3.1(+)- seh and empty plasmid. pCDNA3.1(+)- seh treatment showed overexpression of GAS5 ( p = 0.0033 and p = 0.0033) in PC3 and ACHN cells, down regulation of PCA3 and NEAT1 ( p = 0.0092 and p = 0.0097) in the PC3 cells, and down regulation of PVT1 and MALAT1 ( p = 0.0239 and p = 0.0133) in the ACHN cells in comparison with the empty plasmid, but there was no significant effect on HDF normal cells. Additionally, this study data demonstrated that the cell adhesion was down regulated. The flow cytometry data showed transfection by pCDNA3.1 (+)- seh could elevate PC3 and ACHN cell apoptosis levels in comparison with empty plasmid. This study findings propose that SEH toxin of S. aureus could be a useful candidate for therapeutic researches in cancer vaccine development., Competing Interests: The authors declare that they have no conflict of interest. This article does not contain any studies involving animals or human participants performed by any of the authors., (© Allerton Press, Inc. 2020, ISSN 0891-4168, Molecular Genetics, Microbiology and Virology, 2020, Vol. 35, No. 3, pp. 180–188. © Allerton Press, Inc., 2020.)

Drinking to cope is associated with suicide ideation and attempts. Event-based research shows drinking, particularly when alcohol is consumed in large quantities, increases the intensity of suicidal thoughts and immediate risk for attempt. Such findings suggest those who typically drink to cope may be especially likely to drink heavily in the hours preceding a suicide attempt. In the first examination of the association between regular use of alcohol as a coping strategy and acute alcohol consumption prior to a suicide attempt, participants included 130 patients hospitalized for a recent attempt. The number of drinks consumed in the acute period preceding the attempt, as well as past-year heavy drinking frequency, typical drinking motives, and depressive symptoms were assessed. The unique impacts of coping motives on odds of consuming any alcohol, and of using specific amounts of alcohol in the acute period, were determined through binary and multinomial logistic regressions. Results demonstrated that commonly drinking for coping motives increased the odds of heavy drinking - but not of using alcohol at low levels - during the acute period. Results held after adjusting for relevant covariates. Clinicians should assess drinking motives and prioritize prevention of drinking to cope to reduce risk of alcohol-related suicide attempts., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Given the substantial heterogeneity of both impulsivity and suicidality, increased specificity in studying relations between these variables is needed. One aspect of suicidality that may be especially important for predicting future risk among those with a recent suicide attempt is self-perceived likelihood of making a future attempt (suicide likelihood). Presently, little is known about the extent to which impulsivity is related to this important aspect of suicidality. We examined whether three distinct impulsivity facets (i.e., deficits in conscientiousness, negative urgency, and sensation seeking) would differentially predict suicide likelihood., Methods: Participants included 155 psychiatric inpatients who presented to a Level-1 trauma hospital after a recent suicide attempt. Structural Equation Modeling (SEM), in which demographic and clinical covariates were controlled, was conducted to examine whether each impulsivity facet would uniquely predict suicide likelihood., Results: Deficits in conscientiousness was the only robust predictor of suicide likelihood, with an association that persisted after accounting for demographic and clinical covariates., Limitations: The cross-sectional design and unknown predictive validity of suicide likelihood are study limitations., Conclusion: This was a preliminary investigation of impulsivity facets with suicide likelihood. Clinical implications of this study suggest that deficits in conscientiousness and suicide likelihood may be important factors to consider when identifying and intervening with patients at high-risk for suicide., (Copyright © 2019. Published by Elsevier B.V.)

Sphingosine-1-phosphate (S1P) produced by sphingosine kinases (SPHK1 and SPHK2) is a signaling molecule involved in cell proliferation and formation of cellular junctions. In this study, we characterized the retinas of Sphk1 knockout (KO) mice by electron microscopy and immunocytochemistry. We also tested cultured Müller glia for their response to S1P. We found that S1P plays an important role in retinal and retinal pigment epithelial (RPE) structural integrity in aging mice. Ultrastructural analysis of Sphk1 KO mouse retinas aged to 15 months or raised with moderate light stress revealed a degenerated outer limiting membrane (OLM). This membrane is formed by adherens junctions between neighboring Müller glia and photoreceptor cells. We also show that Sphk1 KO mice have reduced retinal function in mice raised with moderate light stress. In vitro assays revealed that exogenous S1P modulated cytoskeletal rearrangement and increased N-cadherin production in human Müller glia cells. Aged mice also had morphological degeneration of the RPE, as well as increased lipid storage vacuoles and undigested phagosomes reminiscent of RPE in age-related macular degeneration. These findings show that SPHK1 and S1P play a vital role in the structural maintenance of the mammalian retina and retinal pigmented epithelium by supporting the formation of adherens junctions.

Objective: Very few controlled trials have evaluated targeted treatment methods for childhood selective mutism (SM); the availability of evidence-based services remains limited. This study is the first controlled trial to evaluate an intensive group behavioral treatment (IGBT) for children with SM., Method: Twenty-nine children with SM (5-9 years; 76% female; 35% ethnic minority) were randomized to immediate SM 5-day IGBT or to a 4-week waitlist with psychoeducational resources (WLP), and were assessed at Week 4 and again 8 weeks into the following school year., Results: IGBT was associated with high satisfaction and low perceived barriers to treatment participation. At Week 4, 50% of the immediate IGBT condition and 0% of the WLP condition were classified as "clinical responders." Further, Time × Condition interactions were significant for social anxiety severity, verbal behavior in social situations, and global functioning (but not for SM severity, verbal behavior in home settings, or overall anxiety). School-year follow-up assessments revealed significant improvements across all outcomes. Eight weeks into the following school year, 46% of IGBT-treated children were free of an SM diagnosis. In addition, teachers in the post-IGBT school year rated less school impairment and more classroom verbal behavior relative to teachers in the pre-IGBT school year., Conclusions: Findings provide the first empirical support for the efficacy and acceptability of IGBT for SM. Further study is needed to examine mechanisms of IGBT response, and other effective SM treatment methods, in order to clarify which treatment formats work best for which affected children. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Online courses and programs in higher education, including nursing education, continue to multiply exponentially in the United States. In order to meet accreditation standards and build internal standards of quality in online course delivery, nursing administrators and faculty must keep abreast of evidence and best practice in online course design. Awareness and adoption of online standards of excellence may be a departure from standard operating procedure with faculty adept at creating face-to-face courses and mavericks self-taught in online course development. The Plan-Do-Study-Act process for improvement is a viable and scalable method to achieve national certification of online course quality, improving ability to compete in a dynamic online education environment. Considerations of infrastructure and multiple stakeholder groups are critical to successful implementation. The case of one nursing program that used faculty development, team building, and continuous quality improvement to successfully reach national online quality benchmarks is presented.

Although peer support in response to online disclosures of suicidality may be imperative for suicide prevention efforts, little is known as to how often support is provided or what predicts giving support. This study addresses this issue by investigating the odds of providing peer support in response to simulated online disclosures of suicidality. While interacting with a simulated Facebook newsfeed, participants (N = 690, M age  = 20.24, 527 female) were given the opportunity to leave comments on two posts disclosing low, moderate, or severe risk for suicide. Participants also completed questionnaires on their symptoms of depression and anxiety, experience with a loved one's suicidality, and Facebook use strategies. Only 33.6% of participants left a positive, supportive comment on at least one of the two suicide posts. Content severity, experience with a loved one's suicide attempts, and use of Facebook to meet people were predictive of providing positive comments. These findings suggest that young adults vary in their propensity to provide support after encountering a suicide disclosure online and that giving support is driven by a combination of contextual and intrapersonal factors., (© 2018 The American Association of Suicidology.)

Background: Through evaluations of training programs, systematic reviews, and meta-analyses, advances in identifying best practices for disseminating motivational interviewing (MI) have emerged. To advance this work further, inclusion of thorough descriptions of the following is needed in research publications: study (design, trainee characteristics, setting characteristics), training and coaching methods (if applicable), trainer qualifications, and evaluation of MI skills. Methods: The purpose of this study was to systematically evaluate the research on MI training of substance use treatment professionals for the inclusion of such descriptions. Twenty-five studies were reviewed using a scoring rubric developed by the authors. Results: Just over two thirds of the studies (68%) were randomized controlled trials of MI training. The majority of studies provided information about (a) trainee characteristics (professional background = 76%, education = 60%, experience = 56%); (b) setting characteristics (80%); (c) training methods (format = 96%, length = 92%); (d) coaching (76%); and (e) evaluation of MI skills (92%). Conclusion: Findings suggest advancements in MI training studies since previous reviews, especially in regards to the inclusion of feedback and coaching. However, this review also found that inconsistencies in methods and reporting of training characteristics, as well as limited follow-up assessment of trainees' skill, continue to limit knowledge of effective training methods.

Although the retina resides within the immune-protected ocular environment, inflammatory processes mounted in the eye can lead to retinal damage. Unchecked chronic ocular inflammation leads to retinal damage. Thus, retinal degenerative diseases that result in chronic inflammation accelerate retinal tissue destruction and vision loss. Treatments for chronic retinal inflammation involve corticosteroid administration, which has been associated with glaucoma and cataract formation. Therefore, we must consider novel, alternative treatments. Here, we provide a brief review of our current understanding of chronic innate inflammatory processes in retinal degeneration and the complex role of a putative inflammatory regulator, Caveolin-1 (Cav1). Furthermore, we suggest that the complex role of Cav1 in retinal inflammatory modulation is likely dictated by cell type-specific subcellular localization.

Background: To improve the quality of patient care, the Institute of Medicine has called for eliminating barriers to academic progression for nurses. Despite this call, nurses who matriculate from institutions that lack national nursing-specific accreditation are denied admission to advanced degree programs., Method: Within an online RN-to-baccalaureate nursing (BSN) program, the performance of students who matriculated from institutions lacking discipline-specific accreditation was compared with student performance representative of programs holding discipline-specific accreditation. The bases for comparison were grade point average (GPA), on-time completion rate, and academic withdrawal., Results: Students admitted from institutions lacking national nursing accreditation had a higher on-time completion rate and a lower GPA than comparison groups. Differences in GPA were statistically insignificant (p > .05). Evidence regarding withdrawals was insufficient for adequate comparisons., Conclusion: Admission policies that deny education opportunities to candidates from institutions lacking national nursing accreditation may create unwarranted barriers to educational advancement. [J Contin Educ Nurs. 2019;50(1):15-19.]., (Copyright 2019, SLACK Incorporated.)

Progress in evidence-based treatments for child anxiety has been hampered by limited accessibility of quality care. This study utilized a multiple baseline design to evaluate the pilot feasibility, acceptability, and preliminary efficacy of real-time, Internet-delivered, family-based cognitive-behavioral therapy for child anxiety delivered to the home setting via videoconferencing. Participants included 13 anxious youth (mean age = 9.85) with a primary/co-primary anxiety disorder diagnosis. Eleven participants (84.6%) completed treatment and all study procedures. Consistent with hypotheses, the intervention was feasible and acceptable to families (i.e., high treatment retention, high client satisfaction, strong therapeutic alliance, and low barriers to participation). Moreover, the novel videoconferencing treatment format showed preliminary efficacy: 76.9% of the intention-to-treat (ITT) sample and 90.9% of treatment completers were treatment responders (i.e., Clinical Global Impressions-Improvement Scale = 1 or 2 at posttreatment), and 69.2% of the ITT sample and 81.8% of treatment completers were diagnostic responders (as per the Anxiety Disorders Interview for Children). Gains were largely maintained at 3-month follow-up evaluation. Outcome patterns within and across subjects are discussed, as well as limitations and the need for further controlled evaluations. With continued support, videoconferencing treatment formats may serve to meaningfully broaden the reach of quality care for youth anxiety disorders., (Copyright © 2018. Published by Elsevier Ltd.)

A major limitation of research on attitudes toward suicide is that most measures lack evidence of a stable factor structure. To investigate the structure of recently developed stigma of suicide scale-short form (SOSS-SF), we conducted an exploratory factor analysis in a sample of 499 undergraduates. Results revealed a three-factor structure: Stigma, Isolation/Depression, and Glorification/Normalization. We also identified good convergent and discriminant validity between the SOSS-SF and related constructs. In a separate sample of 570 undergraduates, a confirmatory factor analysis (CFA) demonstrated adequate fit for the three-factor model. In addition, a multiple-group CFA demonstrated invariance across gender.

Objective: Our primary objective was to determine the potency of externalizing psychopathology as a risk factor for suicidal thoughts and behaviors (STBs)., Method: We conducted a random effects meta-analysis of 174 prospective studies (839 unique statistical tests) examining externalizing psychopathology and suicidal thoughts and behaviors (STBs) published prior to December 8, 2017. The weighted mean odds ratios for the overall relationship between externalizing psychopathology and STBs were below 2.00 in magnitude, and all risk factor subcategories were also fairly modest predictors of STBs. Taking publication bias into account reduced the magnitude of these associations, particularly for death. Although externalizing psychopathology modestly predicts STBs, this may be due to design limitations of existing studies. Future research should employ shorter follow-up periods, consider risk factors in combination, and focus on forms of externalizing psychopathology that have not been studied extensively., Results: The weighted mean odds ratios for the overall relationship between externalizing psychopathology and STBs were below 2.00 in magnitude, and all risk factor subcategories were also fairly modest predictors of STBs. Taking publication bias into account reduced the magnitude of these associations, particularly for death. Additionally, our results were mostly consistent regardless of sample age, sample severity, follow-up length, and predictor scale., Conclusions: Although externalizing psychopathology modestly predicts STBs, this may be due to design limitations of existing studies. Future research should employ shorter follow-up periods, consider risk factors in combination, and focus on forms of externalizing psychopathology that have not been studied extensively., (© 2018 Wiley Periodicals, Inc.)

The Interpersonal Psychological Theory of Suicide (IPTS) proposes that to attempt suicide one must not only desire death, but must also have acquired the capability to act on that desire. The IPTS states capability for suicide can be acquired through exposure to painful and provocative events, with events most closely related to suicide (e.g., non-fatal attempt) having the strongest effects on capability. We tested the effects of two aspects of suicide attempt history-number and violence of methods-on acquired capability, operationalized as both fearlessness about death and fearlessness of suicide, in a sample of psychiatric inpatients with a history of multiple suicide attempts. Results from three separate models suggest that number of methods and number of violent methods, but not history of ever using a violent method, are associated with increased fearlessness of suicide, even after accounting for hopelessness, general painful and provocative events, NSSI, and number of attempts. Few variables were associated with fearlessness about death. Our results raise the possibility that fearlessness of death and suicide may not be synonymous constructs. They also indicate that number of methods, and/or number of violent methods, may be important markers of fearlessness of suicide among those at high risk., (Copyright © 2018 Elsevier B.V. All rights reserved.)