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A recent national survey of bereaved partners found high levels of complicated grief and psychological distress, with evidence that loneliness and isolation may contribute to these outcomes. However, the mechanisms of action for this have not been explored. To advance grief theory this paper reports analysis of the survey free-text data to examine the relationship between social support and emotional responses to bereavement. Individuals bereaved of a civil partner or spouse 6-10 months previously were identified through death registration data. 569/1945 (29 %) completed surveys were received. Of those, 311 participants (55 %) provided responses to two free-text questions which asked about their 'feelings since the death of their partner or spouse', and 'about the support around' them. Data were analysed using corpus-assisted discourse analysis and the discourse dynamics approach for figurative language. Participants described diverse emotional responses to the bereavement (e.g. sadness, anger, denial, acceptance), and the value of formal and informal bereavement support. Although many of the experiences described are accounted for in existing grief theory, some participants described a liminal experience not recognised within these theories. They felt trapped, unable to engage with loss or restoration, and unable to move forward as their planned future no longer existed. They sought out 'communitas' (solidarity in experiences), but often found support from their social networks had diminished. Metaphors were used to describe this liminality, with partner grief expressed as a dark agentic force, a monster, an abyss, and as water. The findings of this study offer original insights into experiences and trajectories of bereavement, and our understandings of prolonged or complicated grief. A novel model 'Between Loss and Restoration' is presented to include these experiences. Recognition of the place for liminality within the spectrum of grief experiences could enhance grief literacy and improve formal and informal bereavement support provision., Competing Interests: Declaration of competing interest The authors report there are no competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Polar monomer-induced β-H elimination is a key elementary step in polar polyolefin synthesis by coordination polymerization but remains underexplored. Herein, we show that a bulky neutral Ni catalyst, 1 Ph , is not only a high-performance catalyst in ethylene/acrylate copolymerization (activity up to ∼37,000 kg/(mol·h) at 130 °C in a batch reactor, mol % tBA ∼ 0.3) but also a suitable platform for investigation of acrylate-induced β-H elimination. 4 Ph- t Bu , a novel Ni alkyl complex generated after acrylate-induced β-H elimination and subsequent acrylate insertion, was identified and characterized by crystallography. A combination of catalysis and mechanistic studies reveals effects of the acrylate monomer, bidentate ligand, and the labile ligand (e.g., pyridine) on the kinetics of β-H elimination, the role of β-H elimination in copolymerization catalysis as a chain-termination pathway, and its potential in controlling the polymer microstructure in polar polyolefin synthesis.

Background: Data suggest poorer bereavement outcomes for lesbian, gay and bisexual people, but this has not been estimated in population-based research. This study compared bereavement outcomes for partners of same-gender and different-gender decedents., Methods: In this population-based, cross-sectional survey of people bereaved of a civil partner or spouse 6-10 months previously, we used adjusted logistic and linear regression to investigate outcomes of interest: (1) positive screen on Inventory of Complicated Grief (ICG), (2) positive screen on General Health Questionnaire (GHQ), (3) grief intensity (ICG) and (4) psychiatric symptoms (GHQ-12)., Results: Among 233 same-gender partners and 329 of different-gender partners, 66.1% [95% confidence interval (CI) 60.0-72.2] and 59.2% [95% CI (53.9-64.6)] respectively screened positive for complicated grief on the ICG, whilst 76.0% [95% CI (70.5-81.5)] and 69.3% [95% CI (64.3-74.3)] respectively screened positive on the GHQ-12. Same-gender bereaved partners were not significantly more likely to screen positive for complicated grief than different-gender partners [adjusted odds ratio (aOR) 1.56, 95% CI (0.98-2.47)], p = 0.059, but same-gender bereaved partners were significantly more likely to screen for psychiatric caseness [aOR 1.67 (1.02, 2.71) p = 0.043]. We similarly found no significant association of partner gender with grief intensity [ B = 1.86, 95% CI (-0.91to 4.63), p = 0.188], but significantly greater psychological distress for same-gender partners [ B = 1.54, 95% CI (-0.69-2.40), p < 0.001]., Conclusions: Same-gender bereaved partners report significantly more psychological distress. In view of their poorer sub-clinical mental health, clinical and bereavement services should refine screening processes to identify those at risk of poor mental health outcomes.

Background: Support from social networks is vital after the death of a partner. Lesbian, gay, bisexual and/or transgender (LGBT+) people can face disenfranchisement and isolation in bereavement. The Acceptance-Disclosure Model (of LGBT+ bereavement) posits that experiences are shaped by the extent to which individuals feel able to disclose their bereavement to others, and whether that loss is acknowledged appropriately., Aim: To explore LGBT+ specific experiences of partner bereavement; determine decision-making processes regarding disclosure of relationships/identities; and appraise the Acceptance-Disclosure Model using primary qualitative data., Design: Exploratory in-depth qualitative interview study positioned within a social constructivist paradigm. Data were analysed using inductive and deductive reflexive thematic analysis., Setting/participants: 21 LGBT+ people from across England bereaved of their civil partner/spouse., Results: Participants described LGBT+ specific stressors in bereavement: lack of recognition of their loss; inappropriate questioning; unwanted disclosure of gender history; and fears of discrimination when accessing support. Disclosure of LGBT+ identities varied across social networks. Some participants described hiding their identities and bereavement to preserve relationships, and challenging intersections between LGBT+ identities and other aspects of culture or self. These findings provide primary evidence to support the Acceptance-Disclosure Model., Conclusions: LGBT+ people face additional stressors in bereavement. Not all LGBT+ people want to talk directly about their relationships/identities. Sensitive exploration of support needs, aligned with preferences around disclosure of identities, can help foster trust. Five recommendations for inclusive practice are presented. Further research should consider whether the Acceptance-Disclosure Model has utility to explain bereavement experiences for other isolated or disenfranchised groups.

Background: Healthcare organisations have legal and ethical duties to reduce inequalities in access to healthcare services and related outcomes. However, lesbian, gay, bisexual and/or transgender (LGBT+) people continue to experience and anticipate discrimination in health and social care. Skilled communication is vital for quality person-centred care, but there is inconsistent provision of evidence-based clinician education on health needs and experiences of LGBT+ people to support this. This study aimed to identify key stakeholders' experiences, preferences and best practices for communication regarding sexual orientation, gender identity and gender history in order to reduce inequalities in healthcare., Methods: Semistructured qualitative interviews with LGBT+ patients with serious illness, significant others and clinicians, recruited via UK-wide LGBT+ groups, two hospitals and one hospice in England. We analysed the interview data using reflexive thematic analysis., Results: 74 stakeholders participated: 34 LGBT+ patients with serious illness, 13 significant others and 27 multiprofessional clinicians. Participants described key communication strategies to promote inclusive practice across three domains: (1) 'Creating positive first impressions and building rapport' were central to relationship building and enacted through routine use of inclusive language, avoiding potentially negative non-verbal signals and echoing terminology used by patients and caregivers; (2) 'Enhancing care by actively exploring and explaining the relevance of sexual orientation and gender identity', participants described the benefits of clinicians initiating these discussions, pursuing topics guided by the patient's response or expressed preferences for disclosure. Active involvement of significant others was encouraged to demonstrate recognition of the relationship; these individual level actions are underpinned by a foundation of (3) 'visible and consistent LGBT+ inclusiveness in care systems'. Although participants expressed hesitance talking about LGBT+ identities with individuals from some sociocultural and religious backgrounds, there was widespread support for institutions to adopt a standardised, LGBT+ inclusive, visibly supportive approach., Conclusions: Person-centred care can be enhanced by incorporating discussions about sexual orientation and gender identity into routine clinical practice. Inclusive language and sensitive exploration of relationships and identities are core activities. Institutions need to support clinicians through provision of adequate training, resources, inclusive monitoring systems, policies and structures. Ten inclusive communication recommendations are made based on the data., Competing Interests: Competing interests: KB, SM, KJ and RH have received funding from the NIHR for other research work, and DB, KB, PC, RH and LT are members of the EAPC task force on improving palliative and end-of-life care for LGBT+ people., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Background: The voices of children and adolescents have historically been substituted by the perspective of adults. There is growing recognition that children (<18 years old) are able to participate in research and appreciate the opportunity to participate in studies., Aim: To share the strategies employed by two research teams from USA and UK, who have successfully recruited children living with parental life-limiting illness as research participants., Findings: The researchers overcame common challenges when negotiating ethics committees by anticipating the IRB/REC concerns, providing the committees with detailed applications including distress protocols, and offering resources to their ethics committee to learn about conducting research with this population. The researchers navigated recruitment and gatekeeping by clinicians and parents by partnering with clinical agencies and nurturing relationships with practitioners who are supportive of the research, offering to present the findings of the study with continuing education credits, and developing children's, adolescents' and parents' project advisory groups to support recruitment, data collection and analysis., Conclusions: Simple strategies can be used to overcome barriers to recruitment, providing opportunities for children to be research participants and for their unique perspectives to be heard in palliative care research.

Head impact measurement devices enable opportunities to collect impact data directly from humans to study topics like concussion biomechanics, head impact exposure and its effects, and concussion risk reduction techniques in sports when paired with other relevant data. With recent advances in head impact measurement devices and cost-effective price points, more and more investigators are using them to study brain health questions. However, as the field's literature grows, the variance in study quality is apparent. This brief paper aims to provide a high-level set of key considerations for the design and analysis of head impact measurement studies that can help avoid flaws introduced by sampling biases, false data, missing data, and confounding factors. We discuss key points through four overarching themes: study design, operational management, data quality, and data analysis., (© 2022. The Author(s).)

Background: Healthcare professionals report challenges in supporting dying patients who have dependent children. These parents are often uncertain how to meet the needs of their children and require appropriate support from professionals. There is limited evidence based guidance for professionals around this issue, which is informed by the views and experiences of children themselves., Aim: To develop an understanding of the perspective of children on living with parental life-limiting illness and inform recommendations for healthcare professionals., Design: Qualitative semi-structured interviews were conducted, with thematic analysis of the data., Setting/participants: A diverse sample of 32 children aged 6-17, whose parent was living with life-limiting illness, were recruited from across the United Kingdom., Results: Despite the challenges of living with a parent with a life-limiting illness, the children display agency in their response. The children: feel a responsibility to look after their family; negotiate a relationship with healthcare; employ strategies to maintain some normality; and ensure that the inevitable sadness does not become overwhelming., Conclusions: Five recommendations for healthcare professionals were developed from the findings. Clinicians should encourage dying parents to: (1) acknowledge the agency of children; (2) recognise children's caregiving roles; (3) engender children's trust in healthcare; (4) maintain some normality; and (5) discuss emotions with their children. Implementing these recommendations will assist parents with a life-limiting illness to provide evidence-based support to their dependent children.

Bacterial infections routinely cause inflammation and thereby impair osseointegration of orthopedic implants. Acinetobacter spp., which cause osteomyelitis following trauma, on or off the battlefield, were, however, reported to cause neither osteomyelitis nor osteolysis in rodents. We therefore compared the effects of Acinetobacter strain M2 to those of Staphylococcus aureus in a murine implant infection model. Sterile implants and implants with adherent bacteria were inserted in the femur of mice. Bacterial burden, levels of proinflammatory cytokines, and osseointegration were measured. All infections were localized to the implant site. Infection with either S. aureus or Acinetobacter strain M2 increased the levels of proinflammatory cytokines and the chemokine CCL2 in the surrounding femurs, inhibited bone formation around the implant, and caused loss of the surrounding cortical bone, leading to decreases in both histomorphometric and biomechanical measures of osseointegration. Genetic deletion of TLR2 and TLR4 from the mice partially reduced the effects of Acinetobacter strain M2 on osseointegration but did not alter the effects of S. aureus. This is the first report that Acinetobacter spp. impair osseointegration of orthopedic implants in mice, and the murine model developed for this study will be useful for future efforts to clarify the mechanism of implant failure due to Acinetobacter spp. and to assess novel diagnostic tools or therapeutic agents.

Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a global threat. We therefore analysed the bacterial characteristics of CRKP infections and the clinical outcomes of patients with CRKP infections across different countries., Methods: In this prospective, multicentre, cohort study (CRACKLE-2), hospitalised patients with cultures positive for CRKP were recruited from 71 hospitals in Argentina, Australia, Chile, China, Colombia, Lebanon, Singapore, and the USA. The first culture positive for CRKP was included for each unique patient. Clinical data on post-hospitalisation death and readmission were collected from health records, and whole genome sequencing was done on all isolates. The primary outcome was a desirability of outcome ranking at 30 days after the index culture, and, along with bacterial characteristics and 30-day all-cause mortality (a key secondary outcome), was compared between patients from China, South America, and the USA. The desirability of outcome ranking was adjusted for location before admission, Charlson comorbidity index, age at culture, Pitt bacteremia score, and anatomical culture source through inverse probability weighting; mortality was adjusted for the same confounders, plus region where relevant, through multivariable logistic regression. This study is registered at ClinicalTrials.gov, NCT03646227, and is complete., Findings: Between June 13, 2017, and Nov 30, 2018, 991 patients were enrolled, of whom 502 (51%) met the criteria for CRKP infection and 489 (49%) had positive cultures that were considered colonisation. We observed little intra-country genetic variation in CRKP. Infected patients from the USA were more acutely ill than were patients from China or South America (median Pitt bacteremia score 3 [IQR 2-6] vs 2 [0-4] vs 2 [0-4]) and had more comorbidities (median Charlson comorbidity index 3 [IQR 2-5] vs 1 [0-3] vs 1 [0-2]). Adjusted desirability of outcome ranking outcomes were similar in infected patients from China (n=246), South America (n=109), and the USA (n=130); the estimates were 53% (95% CI 42-65) for China versus South America, 50% (41-61) for the USA versus China, and 53% (41-66) for the USA versus South America. In patients with CRKP infections, unadjusted 30-day mortality was lower in China (12%, 95% CI 8-16; 29 of 246) than in the USA (23%, 16-30; 30 of 130) and South America (28%, 20-37; 31 of 109). Adjusted 30-day all-cause mortality was higher in South America than in China (adjusted odds ratio [aOR] 4·82, 95% CI 2·22-10·50) and the USA (aOR 3·34, 1·50-7·47), with the mortality difference between the USA and China no longer being significant (aOR 1·44, 0·70-2·96)., Interpretation: Global CRKP epidemics have important regional differences in patients' baseline characteristics and clinical outcomes, and in bacterial characteristics. Research findings from one region might not be generalisable to other regions., Funding: The National Institutes of Health., Competing Interests: Declaration of interests MW, ME, LC, YY, ZL, SS, EC, LL, SSK, HG, KM, LK, SDR, SHM, CM, JR, MVV, CH, RA, KB, BCF, BNK, and RAB report funding support from the ARLG of the National Institutes of Health (NIH) and the National Institute of Allergy and Infectious Diseases (NIAID; UM1AI104681) during the conduct of this study. BMH reports funding support from the ARLG of the NIH and the NIAID (UM1AI104681), during the conduct of this study, and a grants from the NIH and the NIAID (K01AI148593–01), outside the submitted work. JMM reports funding support from the ALRG of the NIH and the NIAID (UM1AI104681) during the conduct of this study and grants from Pfizer, MSD, and bioMerieux, outside the submitted work. KO reports funding support from the ALRG of the NIH and the NIAID (UM1AI104681) during the conduct of this study; payments for educational events and presentations from Pfizer, MSD, AstraZeneca, and Farma de Colombia; and meeting support from Pfizer, MSD, and Gilead, outside the submitted work. GW reports funding support from the ARLG of the NIH and the NIAID (UM1AI104681), and from Allergan. MJS reports funding support from the ARLG of the NIH and the NIAID (UM1AI104681) during the conduct of this study; contracts payments, to his institution, from Merck, Allergan, BioFire Diagnostics, and Affinity Biosensors; personal consulting fees from Achaogen and Shionogi; and board participation for Spero Therapeutics, outside the submitted work. SLV-B reports funding support from the ARLG of the NIH and the NIAID (UM1AI104681) during the conduct of this study and personal fees from MSD and Biotoscana, outside the submitted work. MES reports grants from the NIH during the conduct of the study; speaker fees from Pfizer (Argentina); advisory board participation for Wockhardt; and consultancy for Basilea, outside the submitted work. CL reports funding support from the ARLG of the NIH and the NIAID (UM1AI104681) during the conduct of this study and salary support from the National Institute of General Medical Sciences of the NIH (award number T32GM086330) outside the submitted work. DLP reports funding support from the ARLG of the NIH and the NIAID (UM1AI104681) during the conduct of this study; grants and contracts with MERCK, Pfizer, and Shionogi; consulting fees from Merck, Shionogi, and Qpex; payments and financial support from Sumitomo, Merck, Pfizer, bioMerieux, and Shionogi; and board participation for Symvivo, outside the submitted work. SE reports grants from the NIAID and the NIH and Degruter (Editor in Chief for Statistical Communications in Infectious Diseases); royalties from Taylor & Francis; consulting fees from Genentech, AstraZeneca, Cardinal Health, Microbiotix, Stryker, Atricure, Roivant, Neovasc, Nobel Pharma, Horizon, the International Drug Development Institute, and SVB Leerink; payments from Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks, Osaka University, and the National Cerebral and Cardiovascular Center of Japan; meeting support from the US Food and Drug Administration, the Deming Conference on Applied Statistics, the Clinical Trial Transformation Initiative, the Council for International Organizations of Medical Sciences, and the Antimicrobial Resistance and Stewardship Conference; and board member participation for the NIH, the Breast International Group, the University of Pennsylvania, Duke University, Roche, Pfizer, Takeda, Novartis, Amgen, Teva, Vir, Shire, Alexion, Gilead, Tracon, Rakuten, Abbvie, Nuvelution, Clover, FHI Clinical, Lung Biotech, SAB Biopharm, Advantagene, the American Statistical Association, the Society for Clinical Trials, and the Frontier Science Foundation, outside the submitted work. YD reports funding support from the ARLG of the NIH and the NIAID (UM1AI104681) during the conduct of this study; grants from Janssen, Pfizer, MSD, Shionogi, Astellas, and Kanto Chemical, outside the submitted work; and personal fees from Janssen, MSD, Entasis, VenatoRx, AstraZeneca, Gilead, FUJIFILM Toyama Chemical, bioMerieux, and Meiji Seika Pharma, outside the submitted work. RP reports funding support from the ARLG of the NIH and the NIAID (UM1AI104681) during the conduct of this study; reports grants from Merck, ContraFect, TenNor Therapeutics, and Shionogi; is a consultant to Curetis, Specific Technologies, Next Gen Diagnostics, PathoQuest, Selux Diagnostics, 1928 Diagnostics, PhAST, and Qvella, for which monies are paid to Mayo Clinic; is a consultant to Netflix; has a patent on Bordetella pertussis (parapertussis) PCR issued, a patent on a device and method for sonication (with royalties paid by Samsung to Mayo Clinic), and a patent on an anti-biofilm substance issued; receives an editor's stipend from the Infectious Diseases Society of America; and receives honoraria from the National Board of Medical Examiners, UpToDate, and the Infectious Diseases Board Review Course, outside the submitted work. HFC reports funding support from the ARLG of the NIH and the NIAID (UM1AI104681) during the conduct of this study; personal fees from Merck; and stock ownership from Moderna, outside the submitted work. VGF reports personal Fees from Novartis, Novadigm, Durata, Debiopharm, Genentech, Achaogen, Affinium, Medicines, Cerexa, Tetraphase, Trius, MedImmune, Bayer, Theravance, Basilea, Affinergy, Janssen, xBiotech, Contrafect, Regeneron, Basilea, Destiny, Amphliphi Biosciences, Integrated Biotherapeutics, C3J, Armata, Valanbio, Akagera, and Aridis; grants to his institution from the NIH, MedImmune, Allergan, Pfizer, Advanced Liquid Logics, Theravance, Novartis, Merck, Medical Biosurfaces, Locus, Affinergy, Contrafect, Karius, Genentech, Regeneron, Basilea, and Janssen; educational fees from Green Cross, Cubist, Cerexa, Durata, Theravance, and Debiopharm; royalties from UpToDate; and stock options in Valanbio. CAA is employed at the University of Texas Health Science Center in Houston, TX, USA; declares money paid to the University of Texas as part of a grant from Merck, MeMed Diagnostics, Entasis Therapeutics, and the ARLG of the NIH and the NIAID (UM1AI104681); reports royalties paid as personal fees from UptoDate (Harrison Principles of Internal Medicine and Mandell Principles and Practice of Infectious Diseases); reports personal fees from the NIH and the NIAID for being a study section member and grant reviewer; reports an editor-in-chief stipend from the American Society for Microbiology for Antimicrobial Agents and Chemotherapy; reports reimbursement for travel to Infectious Disease Week and Infectious Disease programme committee meetings as Infectious Disease chair from the Infectious Disease Society of America; and reports reimbursement for traveling to the American Society for Microbiology Microbe conference from the American Society for Microbiology. DvD reports funding support from the ARLG of the NIH and the NIAID (UM1AI104681) during the conduct of this study; is a consultant for Actavis, Tetraphase, Sanofi Pasteur, MedImmune, Astellas, Merck, Allergan, T2Biosystems, Roche, Achaogen, Neumedicine, Shionogi, Pfizer, Entasis, QPex, Wellspring, Karius, and Utility; receives an editor's stipend from the British Society for Antimicrobial Chemotherapy; and reports grants from the NIH, outside the submitted work., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Despite the recent emergence of plasmid-mediated colistin resistance, the epidemiology and mechanisms of colistin-resistant Enterobacterales (CORE) infections remain poorly understood., Methods: A case-case-control study was conducted utilizing routine clinical isolates obtained at a single tertiary health system in Ann Arbor, Michigan. Patients with CORE isolates from January 1, 2016, to March 31, 2017, were matched 1:1 with patients with colistin-susceptible Enterobacterales (COSE) and uninfected controls. Multivariable logistic regression was used to compare clinical and microbiologic features of patients with CORE and COSE to controls. A subset of available CORE isolates underwent whole-genome sequencing to identify putative colistin resistance genes., Results: Of 16 373 tested clinical isolates, 166 (0.99%) were colistin-resistant, representing 103 unique patients. Among 103 CORE isolates, 103 COSE isolates, and 102 uninfected controls, antibiotic exposure in the antecedent 90 days and age >55 years were predictors of both CORE and COSE. Of 33 isolates that underwent whole-genome sequencing, a large variety of mutations associated with colistin resistance were identified, including 4 mcr -1/ mcr -1.1 genes and 4 pmrA/B mutations among 9 Escherichia coli isolates and 5 mgrB and 3 PmrA mutations among 8 Klebsiella pneumoniae isolates. Genetic mutations found in Enterobacter species were not associated with known phenotypic colistin resistance., Conclusions: Increased age and prior antibiotic receipt were associated with increased risk for patients with CORE and for patients with COSE. Mcr -1, pmrA/B , and mgrB were the predominant colistin resistance-associated mutations identified among E. coli and K. pneumoniae, respectively. Mechanisms of colistin resistance among Enterobacter species could not be determined., (© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Background: The importance of actively involving patient and public members throughout the different stages of palliative care and health research projects is widely acknowledged, however patient and public involvement work rarely considers insight from children and young people. Although this is becoming increasingly recognised in other areas of research, there is currently no structured guidance on how to best involve children and young people in palliative care research., Aim: To plan and deliver a Young People's Advisory Group in palliative care and health research at a secondary school., Findings: Attending an after-school 'Health and Social Research Methods Club' for 11 weeks benefitted children and researchers. Children were taught about data collection methods, data analysis and ethics in health research and used these skills to provide valuable feedback which has been implemented in current palliative care research projects. Children took part in considered discussions around palliative care topics and enjoyed attending the group., Conclusion: This project has equipped researchers with skills and provided a structured template for future Young People's Advisory Groups, ensuring the unique voices of children and young people are considered and valued in future palliative care research.

Background: Although the death of a parent during childhood is relatively commonplace, the voices of children affected by parental life-limiting illness are under-represented in research evidence. Guidance for healthcare professionals is largely based upon professional opinion rather than the experience of children themselves., Aim: To synthesise and appraise the literature from primary research with children about their experience of having a parent with a life-limiting illness., Design: Integrative review and thematic synthesis. Registered on PROSPERO (CRD42019094581)., Data Sources: PsychINFO, Medline, Embase, Scopus and Web of Science were searched, supplemented by searches of grey literature and systematic reviews. There were no restrictions on publication date, and study quality was appraised using the Hawker checklist. Studies reporting the findings of primary research with participants under 18, whose parent has a life-limiting illness, were eligible for inclusion., Results: Twenty-one papers met the inclusion criteria ( n = 13 qualitative; n = 8 quantitative), reporting on n = 18 studies from high-income countries. Findings reveal that throughout parental life-limiting illness, children strive for agency, but are often shielded and excluded by adults. The experience of living with a dying parent is emotionally demanding for children and involves significant caregiving responsibilities. However these children are not passive, developing strategies to cope with the situation and wanting to be involved., Conclusions: The review has enabled the voices of children affected by parental life-limiting illness to be heard and will inform the development of guidance for parents and professionals.

Deaths due to COVID-19 are associated with risk factors which can lead to prolonged grief disorder, post-traumatic stress, and other poor bereavement outcomes among relatives, as well as moral injury and distress in frontline staff. Here we review relevant research evidence and provide evidence-based recommendations and resources for hospital clinicians to mitigate poor bereavement outcomes and support staff. For relatives, bereavement risk factors include dying in an intensive care unit, severe breathlessness, patient isolation or restricted access, significant patient and family emotional distress, and disruption to relatives' social support networks. Recommendations include advance care planning; proactive, sensitive, and regular communication with family members alongside accurate information provision; enabling family members to say goodbye in person where possible; supporting virtual communication; providing excellent symptom management and emotional and spiritual support; and providing and/or sign-posting to bereavement services. To mitigate effects of this emotionally challenging work on staff, we recommend an organizational and systemic approach which includes access to informal and professional support., (Copyright © 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Law enforcement traffic stops are one of the most common entryways to the US justice system. Conventional frameworks suggest traffic stops promote public safety by reducing dangerous driving practices and non-vehicular crime. Law enforcement agencies have wide latitude in enforcement, including prioritization of stop types: (1) safety (e.g. moving violation) stops, (2) investigatory stops, or (3) economic (regulatory and equipment) stops. In order to prevent traffic crash fatalities and reduce racial disparities, the police department of Fayetteville, North Carolina significantly re-prioritized safety stops., Methods: Annual traffic stop, motor vehicle crash, and crime data from 2002 to 2016 were combined to examine intervention (2013-2016) effects. Fayetteville was compared against synthetic control agencies built from 8 similar North Carolina agencies by weighted matching on pre-intervention period trends and comparison against post-intervention trends., Results: On average over the intervention period as compared to synthetic controls, Fayetteville increased both the number of safety stops + 121% (95% confidence interval + 17%, + 318%) and the relative proportion of safety stops (+ 47%). Traffic crash and injury outcomes were reduced, including traffic fatalities - 28% (- 64%, + 43%), injurious crashes - 23% (- 49%, + 16%), and total crashes - 13% (- 48%, + 21%). Disparity measures were reduced, including Black percent of traffic stops - 7% (- 9%, - 5%) and Black vs. White traffic stop rate ratio - 21% (- 29%, - 13%). In contrast to the Ferguson Effect hypothesis, the relative de-prioritization of investigatory stops was not associated with an increase in non-traffic crime outcomes, which were reduced or unchanged, including index crimes - 10% (- 25%, + 8%) and violent crimes - 2% (- 33%, + 43%). Confidence intervals were estimated using a different technique and, given small samples, may be asymmetrical., Conclusions: The re-prioritization of traffic stop types by law enforcement agencies may have positive public health consequences both for motor vehicle injury and racial disparity outcomes while having little impact on non-traffic crime.

Recent decades have witnessed intense research efforts aimed at developing new homogeneous olefin polymerization catalysts, with a primary focus on metal-Cl or metal-hydrocarbyl precursors. Curiously, metal-NR 2 precursors have received far less attention. In this contribution, the Zr-amido complex FI 2 ZrX 2 (FI = 2,4-di- tert-butyl-6-((isobutylimino)methyl)phenolate, X = NMe 2 ) is found to exhibit high ethylene polymerization activity and relatively high 1-octene coenchainment selectivity (up to 7.2 mol%) after sequential activation with trimethylaluminum, then Ph 3 C + B(C 6 F 5 ) 4 - . In sharp contrast, catalysts with traditional hydrocarbyl ligands such as benzyl and methyl give low 1-octene incorporation (0-1.0 mol%). This unexpected selectivity persists under scaled/industrial operating conditions and was previously inaccessible with traditional metal-Cl or -hydrocarbyl precursors. NMR, X-ray diffraction, and catalytic control experiments indicate that in this case an FI ligand is abstracted from FI 2 Zr(NMe 2 ) 2 by trimethylaluminum in the activation process to yield a catalytically active cationic mono-FIZr species. Heretofore this process was believed to serve only as a major catalyst deactivation pathway to be avoided. This work demonstrates the importance of investigating diverse precatalyst monodentate σ-ligands in developing new catalyst systems, especially for group 4 olefin polymerization catalysts.

Background/objectives: A lower risk of falls is commonly cited as a reason to treat hypertension conservatively in older individuals. We examined the effect of hypertension treatment and control status and measured blood pressure (BP) level on the risk of falls in older women., Design/setting: Prospective cohort study., Participants: A total of 5971 women (mean age 79 years; 50.4% white, 33.1% black, 16.5% Hispanic/Latina) enrolled in the Women's Health Initiative and Objective Physical Activity and Cardiovascular Health study., Measurements: BP was measured by trained nurses, and hypertension treatment was assessed by medication inventory. Participants mailed in monthly calendars to self-report falls for 1 year., Results: Overall, 70% of women had hypertension at baseline (53% treated and controlled, 12% treated and uncontrolled, 5% untreated). There were 2582 women (43%) who reported falls in the 1 year of surveillance. Compared with nonhypertensive women, when adjusted for fall risk factors and lower limb physical function, the incidence rate ratio (IRR) for falls was 0.82 (confidence interval [CI] = 0.74-0.92) in women with treated controlled hypertension (p = .0008) and 0.73 (CI = 0.62-0.87) in women with treated uncontrolled hypertension (p = .0004). Neither measured systolic nor diastolic BP was associated with falls in the overall cohort. In women treated with antihypertensive medication, higher diastolic BP was associated with a lower risk of falls in a model adjusted for fall risk factors (IRR = 0.993 per mm Hg; 95% CI = 0.987-1.000; p = .04). The only class of antihypertensive medication associated with an increased risk of falls compared with all other types of antihypertensive drugs was β-blockers., Conclusion: Women in this long-term research study with treated hypertension had a lower risk of falls compared with nonhypertensive women. Diastolic BP (but not systolic BP) is weakly associated with fall risk in women on antihypertensive treatment (<1% decrease in risk per mm Hg increase). J Am Geriatr Soc, 2019. J Am Geriatr Soc 67:726-733, 2019., (© 2019 The American Geriatrics Society.)

Multidrug-resistant (MDR) Acinetobacter spp. poses a significant therapeutic challenge in part due to the presence of chromosomally encoded β-lactamases, including class C Acinetobacter -derived cephalosporinases (ADC) and class D oxacillinases (OXA), as well as plasmid-mediated class A β-lactamases. Importantly, OXA-like β-lactamases represent a gap in the spectrum of inhibition by recently approved β-lactamase inhibitors such as avibactam and vaborbactam. ETX2514 is a novel, rationally designed, diazabicyclooctenone inhibitor that effectively targets class A, C, and D β-lactamases. We show that addition of ETX2514 significantly increased the susceptibility of clinical Acinetobacter baumannii isolates to sulbactam. AdeB and AdeJ were identified to be key efflux constituents for ETX2514 in A. baumannii The combination of sulbactam and ETX2514 was efficacious against A. baumannii carrying bla TEM-1 , bla ADC-82 , bla OXA-23 , and bla OXA-66 in a neutropenic murine thigh infection model. We also show that, in vitro , ETX2514 inhibited ADC-7 ( k 2 / K i 1.0 ± 0.1 × 10 6 M -1 s -1 ) and OXA-58 ( k 2 / K i 2.5 ± 0.3 × 10 5 M -1 s -1 ). Cocrystallization of ETX2514 with OXA-24/40 revealed hydrogen bonding interactions between ETX2514 and residues R261, S219, and S128 of OXA-24/40 in addition to a chloride ion occupied in the active site. Further, the C3 methyl group of ETX2514 shifts the position of M223. In conclusion, the sulbactam-ETX2514 combination possesses a broadened inhibitory range to include class D β-lactamases as well as class A and C β-lactamases and is a promising therapeutic candidate for infections caused by MDR Acinetobacter spp. IMPORTANCE The number and diversity of β-lactamases are steadily increasing. The emergence of β-lactamases that hydrolyze carbapenems poses a significant threat to our antibiotic armamentarium. The explosion of OXA enzymes that are carbapenem hydrolyzers is a major challenge (carbapenem-hydrolyzing class D [CHD]). An urgent need exists to discover β-lactamase inhibitors with class D activity. The sulbactam-ETX2514 combination demonstrates the potential to become a treatment regimen of choice for Acinetobacter spp. producing class D β-lactamases.

Purpose: The concept of liminality has been applied to both the experience of adolescence and to the experience of a cancer diagnosis. The aim of this study was to explore how the concept of liminality can be applied to a cohort of patients experiencing both adolescence and cancer concurrently., Methods: Thematic analysis was applied to data from interviews with 17 participants who had been treated for cancer between the ages of 15 and 24 in an adult hospital. As the analysis developed, it became apparent that liminality was a useful conceptual framework to be applied to the data., Results: Participants experienced the liminality of both adolescence and cancer. Four subthemes revealed the interaction of these two liminal states: an oscillation between childhood and adulthood; a disassociation from noncancer peers; a strong connection with other adolescents and young adults (AYAs) with cancer; and a lack of connection with older cancer peers., Conclusion: A model of dual liminality provides a unique conceptualization of the AYA cancer experience. Cancer in the AYA years is depicted as a navigation of two compounding transitional periods. Adolescence and cancer exacerbate one another and impede the AYA's ability to progress through either. It is this compounding of two transitional periods that makes the model of dual liminality valuable to an understanding of AYAs with cancer.

The purpose of this review is to explore the literature on the experience of adolescents and young adults (AYAs) having cancer treatment in an adult setting, rather than on a specialist adolescent cancer unit. The integrative review method was used to explore the current literature. Primary research on the topic was located systematically and then synthesized into a thematic narrative. The experience of AYAs undergoing treatment in an adult setting was generally negative. This can be attributed to three themes: feeling isolated in the adult setting; the lack of empathy from staff working in the adult setting; and the inappropriateness of the adult environment for this age group. As many AYAs with cancer will continue to have treatment in adult settings, staff working in this environment should be aware of the negative experience of this cohort and the impact this can have on a vulnerable group of patients. Staff could consider simple ways of improving the AYA experience, such as connecting AYA patients with their peers to reduce isolation; adapting their approach to take account of the unique emotional needs of this age group; and considering ways of making the environment more welcoming and age-appropriate.

Colistin and polymyxin B MICs were determined for 106 carbapenem-resistant Klebsiella pneumoniae (CR-Kp) isolates using Sensititre Research Use Only GNX2F plates (Thermo Fisher) and compared to CLSI broth macrodilution (BMD) as the reference method. For colistin, EUCAST breakpoints were applied and testing of isolates with very major (VM) errors was repeated in duplicate by both methods to determine a majority result. Essential agreement (MIC ± one dilution) of GNX2F with the reference method was 97.1% for polymyxin B and 92.5% for colistin (7 VM errors, 22.6%). After discrepancy testing, there were 28 colistin resistant isolates by BMD and essential agreement was 94.3% with 4 VM errors (14.3%). Colistin and polymyxin B GNX2F results showed acceptable essential agreement with BMD for MICS without interpretation. Colistin VM errors with EUCAST breakpoints were due to MIC variability in the 2 to 4 μg/mL range that could be addressed by establishing an intermediate category., (Copyright © 2018. Published by Elsevier Inc.)

Purpose: Although the UK has pioneered the development of specialist adolescent cancer units, the majority of teenagers and young adults (TYAs) continue to be treated at their local hospital or at a cancer centre alongside adults of all ages. This study aimed to elicit young people's views on this experience of having cancer treatment in an adult setting., Methods: Seventeen participants who had been treated for cancer in an adult hospital between the ages of 15 and 24 were recruited via cancer charities and social media. Telephone interviews were conducted with the participants and the resulting data were analysed using thematic analysis., Results: Already feeling out of sync as a TYA with cancer, participants felt out of place in the adult setting. Four factors contributed to this negative experience: a lack of affinity with older patients; the challenging issues in the adult setting; the absence of empathy towards TYAs by staff; and the unsuitability of the environment for adolescents., Conclusion: Staff working with TYAs with cancer in the adult setting should be aware of the potentially detrimental impact of this environment on this cohort of patients, and consider ways of adapting and modifying their approach., (Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.)

Background: Lower proteoglycan density (PGD) of the articular cartilage may be an early marker of osteoarthritis following anterior cruciate ligament (ACL) reconstruction (ACL-R). The purpose this study was to determine associations between the Knee Injury and Osteoarthritis Outcomes Score (KOOS) and PGD of the articular cartilage in the femur and tibia 12-months following ACL-R., Methods: We evaluated KOOS pain, symptoms, function in activities of daily living (ADL), function in sport and recreation (Sport), and quality of life (QOL), as well as PGD using T1rho magnetic resonance imaging in 18 individuals 12.50±0.70months (these are all mean±standard deviation) following unilateral ACL-R (10 females, eight males; 22.39±4.19years; Marx Score=10.93±3.33). Medial and lateral load-bearing portions of the femoral and tibial condyles were sectioned into three (anterior, central and posterior) regions of interest (ROIs). T1rho relaxation times in the ACL-R knee were normalized to the same regions of interest in the non-surgical knees. Alpha levels were set at P≤0.05., Results: Worse KOOS outcomes were significantly associated with greater T1rho relaxation time ratios in the posterior-lateral femoral condyle [pain (r=-0.54), ADL (r=-0.56), Sport (r=-0.62) and QOL (r=-0.59)] central-lateral femoral condyle [Sport (r=-0.48) and QOL (r=-0.42)], and the anterior-medial femoral condyle [Sport (r=-0.46) and QOL (r=-0.40)]. There were no significant associations between the KOOS and T1rho outcomes for tibial ROI., Conclusions: Lower PGD of the femoral cartilage in the ACL-R knees was associated with worse patient-reported outcomes., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: This study was performed to characterize the epidemiology, management, and outcomes of skin and soft tissue infection (SSTI) and colonization due to carbapenem-resistant Enterobacteriaceae (CRE)., Methods: Patients from the Consortium on Resistance Against Carbapenem in Klebsiella and Other Enterobacteriaceae (CRACKLE-1) from December 24, 2011 to October 1, 2014 with wound cultures positive for CRE were included in the study. Predictors of surgical intervention were analyzed. Molecular typing of isolates was performed using repetitive extragenic palindromic polymerase chain reaction (PCR). Carbapenemase genes were detected using PCR., Results: One hundred forty-two patients were included: 62 had SSTI (44%) and 56% were colonized. Mean age was 61 years, and 48% were male: median Charlson score was 3 (interquartile range, 1-5). Forty-eight percent of patients were admitted from long-term care facilities (LTCFs), and 31% were from the community. Two strain types (ST258A and ST258B) were identified (73% of 45 tested). Carbapenemase genes were detected in 40 of 45 isolates ( bla KPC-3 [47%], bla KPC-2 [42%]). Sixty-eight patients (48%) underwent surgical intervention, 63% of whom had SSTI. Patients admitted from LTCFs were less likely to undergo surgical intervention (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.18-0.71). In multivariable analysis, among patients with SSTI, those admitted from LTCFs were less likely to undergo debridement (OR, 0.18; 95% CI, 0.04-0.93)., Conclusions: Patients admitted from LTCFs with CRE SSTI were less likely to undergo surgical intervention. Sixteen percent of the patients died, and approximately 50% of survivors required more intensive care upon discharge. These findings suggest a unique, impactful syndrome within the CRE infection spectrum. Further studies are needed to assess the role of surgical debridement in management of CRE-SSTI, particularly among LTCF residents.

Background: Polymyxins including colistin are an important "last-line" treatment for infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKp). Increasing use of colistin has led to resistance to this cationic antimicrobial peptide., Methods: A cohort nested within the Consortium on Resistance against Carbapenems in Klebsiella pneumoniae (CRACKLE) was constructed of patients with infection, or colonization with CRKp isolates tested for colistin susceptibility during the study period of December, 2011 to October, 2014. Reference colistin resistance determination as performed by broth macrodilution was compared to results from clinical microbiology laboratories (Etest) and to polymyxin resistance testing. Each patient was included once, at the time of their first colistin-tested CRKp positive culture. Time to 30-day in-hospital all-cause mortality was evaluated by Kaplan-Meier curves and Cox proportional hazard modeling., Results: In 246 patients with CRKp, 13% possessed ColR CRKp. ColR was underestimated by Etest (very major error rate = 35%, major error rate = 0.4%). A variety of rep-PCR strain types were encountered in both the ColS and the ColR groups. Carbapenem resistance was mediated primarily by blaKPC-2 (46%) and blaKPC-3 (50%). ColR was associated with increased hazard for in-hospital mortality (aHR 3.48; 95% confidence interval, 1.73-6.57; P < .001). The plasmid-associated ColR genes, mcr-1 and mcr-2 were not detected in any of the ColR CRKp., Conclusions: In this cohort, 13% of patients with CRKp presented with ColR CRKp. The apparent polyclonal nature of the isolates suggests de novo emergence of ColR in this cohort as the primary factor driving ColR. Importantly, mortality was increased in patients with ColR isolates., (© The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com)

Background: Limited evidence exists to inform physical activity (PA) and sedentary behavior guidelines for older people, especially women. Rigorous evidence on the amounts, intensities, and movement patterns associated with better health in later life is needed., Methods/design: The Objective PA and Cardiovascular Health (OPACH) Study is an ancillary study to the Women's Health Initiative (WHI) Program that examines associations of accelerometer-assessed PA and sedentary behavior with cardiovascular and fall events. Between 2012 and 2014, 7048 women aged 63-99 were provided with an ActiGraph GT3X+ (Pensacola, Florida) triaxial accelerometer, a sleep log, and an OPACH PA Questionnaire; 6489 have accelerometer data. Most women were in their 70s (40%) or 80s (46%), while approximately 10% were in their 60s and 4% were age 90 years or older. Non-Hispanic Black or Hispanic/Latina women comprise half of the cohort. Follow-up includes 1-year of falls surveillance with monthly calendars and telephone interviews of fallers, and annual follow-up for outcomes with adjudication of incident cardiovascular disease (CVD) events through 2020. Over 63,600 months of calendar pages were returned by 5,776 women, who reported 5,980 falls. Telephone interviews were completed for 1,492 women to ascertain the circumstances, injuries and medical care associated with falling. The dataset contains extensive information on phenotypes related to healthy aging, including inflammatory and CVD biomarkers, breast and colon cancer, hip and other fractures, diabetes, and physical disability., Discussion: This paper describes the study design, methods, and baseline data for a diverse cohort of postmenopausal women who wore accelerometers under free-living conditions as part of the OPACH Study. By using accelerometers to collect more precise and complete data on PA and sedentary behavior in a large cohort of older women, this study will contribute crucial new evidence about how much, how vigorous, and what patterns of PA are necessary to maintain optimal cardiovascular health and to avoid falls in later life., Clinical Trials Registration: ClinicalTrials.gov identifier NCT00000611 . Registered 27 October 1999.

Background: Socially excluded populations have poorer access to care; however, little attention has been paid to lesbian, gay, bisexual and/or trans* people. Lesbian, gay, bisexual and/or trans* people are at increased risk of certain life-limiting illnesses and may not receive the care and support they need at the end of life and into bereavement., Aim: To identify and appraise the evidence of the bereavement experiences of lesbian, gay, bisexual and/or trans* people who have lost a partner and develop an explanatory model of lesbian, gay, bisexual and/or trans* partner bereavement., Design: Systematic review (in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines) and thematic synthesis with assessment of reporting and rigour. Quantitative or qualitative articles reporting bereavement experiences of lesbian, gay, bisexual and/or trans* partners were included, excluding articles reporting multiple losses in the context of HIV or AIDS., Data Sources: PsycINFO, MEDLINE, Web of Science, Scopus, Cochrane Library. Inclusion dates: database inception - 30 April 2015., Results: A total of 23 articles reporting on 13 studies were identified. Studies described universal experiences of the pain of losing a partner; however, additional barriers and stressors were reported for lesbian, gay, bisexual and/or trans* people, including homophobia, failure to acknowledge the relationship, additional legal and financial issues and the 'shadow' of HIV or AIDS. A novel model was developed to explain how the experience for lesbian, gay, bisexual and/or trans* people is shaped by whether the relationship was disclosed and acknowledged in life and into bereavement and how this impacts upon needs and access to care., Conclusion: There is a need for healthcare providers to avoid hetero-normative assumptions; be mindful of additional stressors in bereavement for lesbian, gay, bisexual and/or trans* people; and consider additional sources of support to deliver individualised holistic care., (© The Author(s) 2016.)

Objective: Previous studies examining opioid dose and overdose risk provide limited granularity by milligram strength and instead rely on thresholds. We quantify dose-dependent overdose mortality over a large spectrum of clinically common doses. We also examine the contributions of benzodiazepines and extended release opioid formulations to mortality., Design: Prospective observational cohort with one year follow-up., Setting: One year in one state (NC) using a controlled substances prescription monitoring program, with name-linked mortality data., Subjects: Residential population of North Carolina (n = 9,560,234), with 2,182,374 opioid analgesic patients., Methods: Exposure was dispensed prescriptions of solid oral and transdermal opioid analgesics; person-years calculated using intent-to-treat principles. Outcome was overdose deaths involving opioid analgesics in a primary or additive role. Poisson models were created, implemented using generalized estimating equations., Results: Opioid analgesics were dispensed to 22.8% of residents. Among licensed clinicians, 89.6% prescribed opioid analgesics, and 40.0% prescribed ER formulations. There were 629 overdose deaths, half of which had an opioid analgesic prescription active on the day of death. Of 2,182,374 patients prescribed opioids, 478 overdose deaths were reported (0.022% per year). Mortality rates increased gradually across the range of average daily milligrams of morphine equivalents. 80.0% of opioid analgesic patients also received benzodiazepines. Rates of overdose death among those co-dispensed benzodiazepines and opioid analgesics were ten times higher (7.0 per 10,000 person-years, 95 percent CI: 6.3, 7.8) than opioid analgesics alone (0.7 per 10,000 person years, 95 percent CI: 0.6, 0.9)., Conclusions: Dose-dependent opioid overdose risk among patients increased gradually and did not show evidence of a distinct risk threshold. There is urgent need for guidance about combined classes of medicines to facilitate a better balance between pain relief and overdose risk., (Published by Oxford University Press on behalf of the American Academy of Pain Medicine. 2016. This work is written by US Government employees and is in the public domain in the US.)

Objectives: A thorough understanding of influence of maxillary growth on patterns of mandibular rotation during development is important with regard to the treatment of skeletal discrepancies. In the present study, we examined whether experimentally altered maxillary position has a significant influence on patterns of mandibular rotation in a pig model., Design: Maxillary growth was altered in a sample of n=10 domestic pigs via surgical fixation of the circummaxillary sutures. We compared the experimental group to control and surgical sham samples and assessed the effects of altered maxillary growth on mandibular form using geometric morphometric techniques. We tested for significant differences in mandibular shape between our samples and examined axes of morphological variation. Additionally, we examined whether altered mandibular shape resulting from altered maxillary position was predictably associated with morphological changes to the condylar region., Results: There was a statistically significant difference in mandibular shape between the experimental and control/sham groups. As a result of vertical displacement of the snout, mandibles in the experimental sample resulted in greater anterior rotation when compared to the control/sham pigs. Variation in rotation was correlated with morphological changes in the condyle including the shape of the articular surface and condylar orientation indicative of greater anterior mandibular rotation., Conclusions: Vertical displacement of the maxilla had a significant effect on mandibular shape by encouraging anterior mandibular rotation. This result has important implications for understanding the effects of altered mandibular posture on condylar remodeling the treatment of skeletal discrepancies such as the correction of hyperdivegent mandibular growth., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Drywall installers are at high-risk of work-related injury. Comprehensive descriptive epidemiology of injuries among drywall installers, particularly over time, is lacking., Methods: We identified worker-hours and reported and accepted workers' compensation (WC) claims for a 20-year (1989-2008) cohort of 24,830 Washington State union carpenters. Stratified by predominant type of work (drywall installation, other carpentry), work-related injury rates were examined over calendar time and by worker characteristics. Expert interviews provided contextual details., Results: Drywall installers' injury rates, higher than those of other carpenters, declined substantially over this period by 73.6%. Common injury mechanisms were struck by/against, overexertion and falls. Drywall material was considered a contributing factor in 19.7% of injuries. One-third of these drywall material-related injuries resulted in paid lost time, compared to 19.4% of injuries from other sources. Rates of injury were particularly high among workers with 2 to <4 years in the union. Notable declines over time in rates of overexertion injury in which drywall material was a contributing factor were still observed after controlling for secular temporal trends. Experts highlighted changes over the past 20 years that improved both work safety and, in some cases, production., Conclusions: Declines in drywall installers' injury rates over time likely reflect, in part, enhanced workplace safety, including efforts to reduce overexertion hazards associated with handling drywall. Continued injury prevention efforts are needed, particularly for less tenured workers. Given the potential for under-reporting to WC, additional sources of health outcomes data may provide a more complete picture of workers' health., (Copyright © 2013 Wiley Periodicals, Inc.)

Introduction: The primary stability of orthodontic anchorage miniscrews is believed to result from mechanical interlock, with success based upon a number of variables, including screw diameter, angle of placement, monocortical vs bicortical placement, placement through attached or unattached soft tissue, presence or absence of a pilot hole, periscrew inflammation, and maximum placement torque. The purpose of this ex-vivo study was to further explore the relationship between maximum placement torque during miniscrew placement and miniscrew resistance to movement under load., Methods: Ninety-six titanium screws were placed into 24 hemi-maxillae and 24 hemi-mandibles from cadavers between the first and second premolars by using a digital torque screwdriver. All screws were subjected to a force parallel to the occlusal plane, pulling mesially until the miniscrews were displaced by 0.6 mm. The Spearman rank correlation test was used to evaluate whether there was an increasing or a decreasing relationship between maximum placement torque of the screws, miniscrew resistance to movement, and bone thickness. A paired-sample t test and the nonparametric Wilcoxon signed rank test were used to compare maximum placement torque, bone thickness, and miniscrew resistance to movement between coronally positioned and apically positioned screws in the maxilla and the mandible, and between screws placed in the maxilla vs screws placed in the mandible. Additionally, 1-way analysis of variance (ANOVA) with the post-hoc Tukey-Kramer test was used to determine whether there was a significant difference in miniscrew resistance to movement for screws placed with maximum torque of <5 Ncm, 5 to 10 Ncm, and >10 Ncm., Results: The mean difference in miniscrew resistance to movement between maximum placement torque groupings, <5 Ncm, 5 to 10 Ncm, and >10 Ncm, increased throughout the deflection range of 0.0 to 0.6 mm. As deflection increased to 0.12 to 0.33 mm, the mean resistance to movement for miniscrews with maximum placement torque of 5 to 10 Ncm was statistically greater than for screws with maximum placement torque <5 Ncm (P <0.05). As deflection increased to 0.34 to 0.60 mm, the mean resistance to movement for miniscrews with maximum placement torque of 5 to 10 Ncm and >10 Ncm was significantly greater than for screws with maximum placement torque <5 Ncm (P <0.05). At no deflection was there a significant difference in resistance to movement between the 2 miniscrew groups with higher placement torque values of 5 to 10 Ncm and >10 Ncm., Conclusions: Ex vivo, the mean resistance to movement of miniscrews with higher maximum placement torque was greater than the resistance to movement of those with lower maximum placement torque., (Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Introduction: Even though the use of titanium miniscrews to provide orthodontic anchorage has become increasingly popular, there is no universally accepted screw-placement protocol. Variables include the presence or absence of a pilot hole, placement through attached or unattached soft tissue, and angle of placement. The purpose of this in-vitro study was to test the hypothesis that screw angulation affects screw-anchorage resistance., Methods: Three-dimensional finite element models were created to represent screw-placement orientations of 30°, 60°, and 90°, while the screw was displaced to 0.6 mm at a distance of 2.0 mm from the bone surface. In a parallel cadaver study, 96 titanium alloy screws were placed into 24 hemi-sected maxillary and 24 hemi-sected mandibular specimens between the first and second premolars. The specimens were randomly and evenly divided into 3 groups according to screw angulation (relative to the bone surface): 90° vs 30° screw pairs, 90° vs 60° screw pairs, and 30° vs 60° screw pairs. All screws were subjected to increasing forces parallel to the occlusal plane, pulling mesially until the miniscrews were displaced by 0.6 mm. A paired-samples t test was used to assess the significance of differences between 2 samples consisting of matched pairs of subjects, with matched pairs of subjects including 2 measurements taken on the same subject. One-way analysis of variance (ANOVA) with the post-hoc Tukey studentized range test was conducted to determine whether there were significant differences, and the order of those differences, in anchorage resistance values among the 3 screw angulations at maxillary and mandibular sites., Results: The finite element analysis showed that 90° screw placement provided greater anchorage resistance than 60° and 30° placements. In the cadaver study, although the maximum anchorage resistance provided by screws placed at 90° to the cadaver bone surface exceeded, on average, the anchorage resistance of the screws placed at 60°, which likewise exceeded the anchorage resistance of screws placed at 30°, these differences were not statistically significant., Conclusions: Placing orthodontic miniscrews at angles less than 90° to the alveolar process bone surface does not offer force anchorage resistance advantages., (Copyright © 2011 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

This case report describes the treatment of a 25-year-old woman with a Class II malocclusion, secondary to mandibular skeletal deficiency, and mild overclosure. Inferior surgical repositioning of the maxilla is often the treatment of choice for patients with maxillary vertical deficiency; however, this patient had borderline vertical deficiency that was treated with a mandibular "tripod" advancement (leveling of the mandibular arch after surgery) coupled with a setback and down-grafting genioplasty. The surgical-orthodontic treatment plan, combined with cosmetic dentistry, resulted in dramatically improved facial esthetics and occlusal relationships.

Introduction: Many case reports have documented the successful use of titanium miniscrews for orthodontic anchorage. However, the literature lacks a well-controlled study examining the effect of miniscrew diameter on anchorage force resistance. The purpose of this in-vitro study was to compare the force resistance of larger-diameter monocortical miniscrews to smaller-diameter monocortical miniscrews; and to compare the force resistance of larger-diameter monocortical miniscrews to smaller-diameter bicortical miniscrews., Methods: Ninety-six titanium alloy screws were placed into 24 hemisected maxillary and 24 hemisected mandibular specimens between the first and second premolars. Specimens were randomly and evenly divided into 2 groups. In the first group, 24 large-diameter screws (2.5 x 17 mm) and with 24 small-diameter screws (1.5 x 15 mm) were placed monocortically. In the second group, 24 large-diameter screws (2.5 x 17 mm) were placed monocortically and 24 small-diameter screws (1.5 x 15 mm) were placed bicortically. All screws were subjected to tangential force loading perpendicular to the miniscrew with lateral displacement of 0.6 mm. Statistical analyses, including the paired-samples t test and the 2-samples t test, were used to quantify screw force-deflection characteristics. One-way analysis of variance (ANOVA) with the post-hoc Tukey studentized range test was used to determine any significant differences, and the order of those differences, in force anchorage values among the 3 screw types at maxillary and mandibular sites., Results: Mean mandibular and maxillary anchorage force values of the 2.5-mm monocortical screws were significantly greater than those of the 1.5-mm monocortical screws (P <0.01). No statistically significant differences in mean mandibular anchorage force values were found between the 2.5-mm monocortical screws and the 1.5-mm bicortical screws. However, mean maxillary anchorage force values of the 1.5-mm bicortical screws were significantly greater than those of the 2.5-mm monocortical screws (P <0.01). Data analyzed with 1-way ANOVA with the post-hoc Tukey studentized range tests indicated that the mean mandibular and maxillary force values of the 2.5-mm monocortical screws and the 1.5-mm bicortical screws were significantly greater than those of the 1.5-mm monocortical screws (P <0.01). Based on the 2-samples t test, mean anchorage force values at mandibular sites were significantly greater than at maxillary sites for the 2.5-mm monocortical screws and the 1.5-mm monocortical screws. There were no statistically significant differences in mean anchorage force values between maxillary and mandibular sites for the 1.5-mm bicortical screws., Conclusions: In vitro, larger-diameter (2.5 mm) monocortical screws provide greater anchorage force resistance than do smaller-diameter (1.5 mm) monocortical screws in both the mandible and the maxilla. Smaller-diameter (1.5 mm) bicortical screws provide anchorage force resistance at least equal to larger-diameter (2.5 mm) monocortical screws. An alternative to placing a larger-diameter miniscrew for additional anchorage is a narrower bicortical screw.

Recent studies of beach sand fecal contamination have triggered interest among scientists and in the media. Although evidence shows that beach sand can harbor high concentrations of fecal indicator organisms, as well as fecal pathogens, illness risk associated with beach sand contact is not well understood. Beach visitors at 7 US beaches were enrolled in the National Epidemiological and Environmental Assessment of Recreational Water (NEEAR) Study during 2003-2005 and 2007 and asked about sand contact on the day of their visit to the beach (digging in the sand, body buried in the sand). Then, 10-12 days after their visit, participants were telephoned to answer questions about any health symptoms experienced since the visit. The authors completed 27,365 interviews. Digging in the sand was positively associated with gastrointestinal illness (adjusted incidence proportion ratio (aIPR) = 1.13, 95% confidence interval (CI): 1.02, 1.25) and diarrhea (aIPR = 1.20, 95% CI: 1.05, 1.36). The association was stronger between those buried in the sand and gastrointestinal illness (aIPR = 1.23, 95% CI: 1.05, 1.43) and diarrhea (aIPR = 1.24, 95% CI: 1.01, 1.52). Nonenteric illnesses did not show a consistent association with sand contact activities. Sand contact activities were associated with enteric illness at beach sites. Variation in beach-specific results suggests that site-specific factors may be important in the risk of illness following sand exposure.

Objectives: (1) To examine the reliability of a new clinical measure of simultaneous walking with performance of a working memory task, the Walking and Remembering Test (WART). (2) To compare older adult to younger adult WART performance to illustrate preliminary validity., Subjects: Convenience sample of 25 young adults (ages 22-35) and 25 older adults (ages 65-86) performed the WART twice., Methods: Subjects walked 6.1 meters at their fastest safe speed along a path requiring a narrowed base of support in both single and dual-task (with simultaneous digit span task) conditions. Reductions in walking and cognitive performance were examined in the dual-task condition for older adults as compared to younger adults., Main Outcome Measures: Walking time, step accuracy, digit span memory accuracy, and dual-task costs for walking and cognitive tasks., Results: Inter-rater reliability ICC (2,1) values were > or = .97 for walking time and digit span accuracy. Rater agreement of steps off the path was excellent (93%) for young adults and good (76%) for older adults. Test-retest reliability ICC (2,1) values for walking time were > or = .79. Older adults were slower and remembered shorter digit spans, and demonstrated greater dual-task costs for digit span accuracy and steps off the path than younger adults, but relative dual-task costs for walking time were not significantly different between groups., Conclusions: The WART is a reliable clinical measure of dual-task memory and walking that can be administered safely with community-dwelling older adults. Expected greater dual-task costs for older adults were observed, but not as strongly as anticipated in this group of very active subjects. The WART provides information that may be useful in targeting patients for intervention to reduce risk of falls in dual-task conditions, but needs validation with older adults across a greater range of walking ability.

Introduction: Case reports have documented the use of titanium miniscrews in providing skeletal anchorage for orthodontic tooth movement. Success rates as low as 50% have been reported for screw retention in either the facial or the lingual cortical plates (monocortical placement). The purpose of this in-vitro study was to test the hypothesis that bicortical miniscrew placement (across the entire width of the alveolus) gives the orthodontist superior force resistance and stability (anchorage) compared with monocortical placement., Methods: Forty-four titanium alloy screws, 1.5 x 15.0 mm, were placed in 22 hemi-sected maxillae and mandibular specimens between the first and second premolars. Half were placed monocortically, half were placed bicortically, and all were subjected to tangential force loading perpendicular to the miniscrew through a lateral displacement of 1.5 mm. Bone samples were sectioned and bone thickness at the screw sites measured. Statistical analyses, consisting of paired samples t tests, 2-samples t tests, Spearman rank correlation tests, and Fisher exact tests, were used to compare monocortical with bicortical screw force-deflection characteristics and stability. Additionally, 2-dimensional plane-stress finite-element models of bicortical and monocortical screw placement subjected to similar loading were analyzed., Results: As hypothesized, deflection force values were significantly greater for bicortical screws than for monocortical screws placed in both the maxilla and the mandible (P <0.01 in each instance). Furthermore, force values at mandibular sites were significantly greater than those at maxillary sites for both types of screws. No significant differences in deflection force values were found between the right and left sides of the jaws, or between coronal and apical alveolar-process screw positions. A significant increasing relationship was found between mandibular buccal bone thickness and deflection force for monocortical screws only, and no relationship was found between maxillary bone thickness and deflection force for monocortical or bicortical screws. Monocortical screws were significantly more mobile after force application than bicortical screws. Finite-element analysis indicated lower cortical bone stresses with bicortical placement than with monocortical placement, and these results were consistent with in-vitro experimental findings., Conclusions: Bicortical miniscrews provide the orthodontist superior anchorage resistance, reduced cortical bone stress, and superior stability compared with monocortical screws.

Background: Lower plasma adiponectin levels are related to dyslipidaemia and components of the metabolic syndrome. It is not clear whether adiponectin levels are independently related to hypertension. Also, previous studies that examined the putative adiponectin-hypertension association studied only men. We examined the relationship between plasma adiponectin and hypertension after controlling for important confounding factors and also performed separate analyses among men and women., Methods: Cross-sectional study of 664 participants (mean age: 52.5 years, 50.3% men). Main outcome-of-interest was presence of hypertension (systolic blood pressure (BP) > or = 140 mmHg, diastolic > or = 90 mmHg, or combination of self-reported hypertension diagnosis and antihypertensive medication use)., Results: Lower plasma adiponectin levels were found to be positively associated with hypertension. Multivariable odds ratio (OR) (95% confidence intervals [CI]) comparing gender-specific tertile I of plasma adiponectin to tertile 3 (referent) was 3.40 (2.04-5.68), P-trend < 0.0001. This association was consistently present in separate analyses among men (P-trend < 0.0001) and women (P-trend = 0.01)., Conclusions: These data provide new evidence clarifying the putative relation between plasma adiponectin and hypertension, suggesting that this association is independent of traditional cardiovascular factors, including dyslipidaemia and renal function and present in both men and women.

Introduction: Previous authors have suggested that transverse facial skeletal growth is completed before either anteroposterior or vertical growth and that anteroposterior growth is completed before vertical growth. Our purpose in this study was to examine this concept., Methods: Twenty-four subjects (11 male, 13 female) who had annual lateral and posteroanterior cephalograms up to and including age 17 or 18 and again at age 25 or older were identified from the Iowa Facial Growth Study. Transverse, anteroposterior, and vertical facial dimensions were measured longitudinally into adulthood by using key skeletal landmarks. Descriptive statistics were calculated, and nonparametric Wilcoxon signed rank tests were performed separately for the sexes to determine the age at which each anteroposterior, vertical, and transverse growth variable reached adult size., Results: For both sexes, an overlap exists at any age in the amount of growth completed for the various measurements in the transverse, anteroposterior, and vertical dimensions. Although some transverse measures (cranial width and interjugal width) attain adult size before any anteroposterior or vertical ones, there is evidence of continued growth for other transverse parameters (interzygomatic width and intergonial width). A similar overlap is seen in the anteroposterior and vertical dimensions., Conclusions: A distinct separation, by time and dimension, is not seen in the amount of facial growth completed during development. Instead, a dramatic spread and an overlap of growth curves are observed throughout the developing years.

Conventional wisdom suggests that orthodontists must apply added force to overcome friction during canine retraction (sliding mechanics), the result of which can be increased anchorage loading and anchorage loss. However, for a frictional force to be exerted mesially by the archwire against a canine during retraction, the archwire must be compressed between the canine and the anchor molar, and an equal but opposite force must be applied distally against the molar by the archwire. In other words, the frictional force that reduces the force of retraction on the canine must also reduce the protraction force on the molar. Emphasis on employing reduced-friction (eg, self-ligating) brackets during sliding mechanics to prevent added posterior anchorage loading is unwarranted and based more on bracket salesmanship than on orthodontic biomechanics.

Background: Laboratory animal allergy is a common illness among workers exposed to laboratory animals and can progress to symptoms of asthma., Objectives: This study evaluates the continuum of disease from allergy symptoms to asthma symptoms in a dynamic cohort of workers exposed to animals in a pharmaceutical company., Methods: Data arose from annual questionnaires administered to workers in a surveillance program established to monitor exposure to animals and the development of allergy. The life-table method was used to compare asthma-free survival between workers with and without symptoms of allergy. A Cox proportional hazards model was used to examine the effects of covariates on the development of asthma., Results: A total of 603 workers contributed 2527.4 person-years to the study over the 12.3-year period. The probabilities of experiencing asthma symptoms by the 11th year of follow-up were 0.367 for workers with allergy symptoms and 0.052 for those without allergy symptoms. The hazard ratio for asthma symptoms when comparing workers with and without allergy symptoms was 7.39 (95% CI, 3.29-16.60) after adjustment for sex and family history of allergy. Female subjects developed asthma at a rate 3.4 times that of male subjects., Conclusions: This study supports the hypothesis that laboratory animal allergy symptoms are a major risk factor for the development of asthma. It also suggests a heightened risk of asthma for women who work with laboratory animals, a finding that has not been previously reported.

Background: Occupational fatal injury rate studies are often based upon uncertain and variable data. The numerator in rate calculations is often obtained from surveillance systems that can understate the true number of deaths. Worker-years, the denominator in many occupational rate calculations, are frequently estimated from sources that exhibit different amounts of variability., Methods: Effects of these data limitations on analyses of trends in occupational fatal injuries were studied using computer simulation. Fatality counts were generated assuming an undercount. Employment estimates were produced using two different strategies, reflecting either frequent but variable measurements or infrequent, precise estimates with interpolated estimates for intervening years. Poisson regression models were fit to the generated data. A range of empirically motivated fatality rate and employment parameters were studied., Results: Undercounting fatalities resulted in biased estimation of the intercept in the Poisson regression model. Relative bias in the trend estimate was near zero for most situations, but increased when a change in fatality undercounting over time was present. Biases for both the intercept and trend were larger when small employment populations were present. Denominator options resulted in similar rate and trend estimates, except where the interpolated method did not capture true trends in employment., Conclusions: Data quality issues such as consistency of conditions throughout the study period and the size of population being studied affect the size of the bias in parameter estimation.

The purpose of this study was to evaluate changes in molar crown torque and intermolar arch width from the time of permanent first molar eruption to early adulthood. Molar crown torque and intermolar arch width were measured in 36 untreated subjects with Class I occlusion from the Iowa Facial Growth Study at approximate ages 7.5, 10.3, 12.9, 16.5, and 26.4 years. On average, the mandibular first and second molars uprighted buccally by 5.0 degrees and 7.5 degrees, respectively. Mandibular first and second molar intermolar width increased by 2.2 and 0.78 mm, respectively. On average, maxillary first and second molars uprighted lingually by 3.3 degrees and 5.9 degrees, respectively. Maxillary first and second intermolar width increased by 2.8 and 2.0 mm, respectively. Results of statistical analysis by the Wilcoxon signed rank test indicate that (1) maxillary molars erupt with buccal crown torque and upright with age, whereas mandibular molars erupt with lingual crown torque and upright with age (P <.01), and (2) molar crown torque changes are accompanied by concurrent increases in maxillary and mandibular intermolar width (P <.01).

In vitro linezolid resistance was selected at a higher frequency in Enterococcus faecalis JH2-2 than in recombination-deficient E. faecalis UV202. Resistance in JH2-2 was related to accumulated G2576T mutations in 23S rRNA genes, with the least resistance conferred by mutations in two of four copies. UV202 resistance was associated with a G2505A mutation present in a single copy in mutants with different MICs.