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Background: Despite increased awareness for promoting diversity, orthopaedics remains one of the least diverse specialties. Studying health care providers in women’s professional sports provides a unique opportunity to analyze gender and racial diversity. Hypotheses: There would be low female and minority representation across the various women’s professional sports leagues. There would be an increased number of female head certified athletic trainers (ATCs) when compared with head team physicians (HTPs). Study Design: Cross-sectional study. Methods: We evaluated the perceived race and sex of designated HTPs and ATCs in the Women’s National Basketball Association, National Women’s Soccer League, and National Women’s Hockey League. Type of doctorate degree, specialty, and years in practice were also collected. Kappa (κ) coefficient measurements were used to determine interobserver agreement on race. Categorical and continuous variables were analyzed using chi-square and t tests, respectively. Results: There were significantly more female ATCs than female HTPs (74.1% vs 37.5%; P = .01). Minority representation between HTPs and ATCs was not significantly different (20.8% vs 40.7%; P = .13). Black HTPs (12.5%) and Black ATCs (22.2%) composed the largest proportion among the minority groups. There was high interobserver agreement of perceived race across HTPs (κ = 1.0) and ATCs (κ = 0.95). Conclusion: Although there were more female ATCs than HTPs in women’s professional sports leagues, both cohorts lack perceived racial diversity. These data suggest an opportunity for diversification in medical and training staff of women’s professional sports.

Acinetobacter baumannii causes multi-system diseases in both nosocomial settings and a pre-disposed general population. The bacterium is not only desiccation-resistant but also notoriously resistant to multiple antibiotics and drugs of last resort including carbapenem, colistin, and sulbactam. The World Health Organization has categorized carbapenem-resistant A. baumannii at the top of its critical pathogen list in a bid to direct urgent countermeasure development. Several early-stage vaccines have shown a range of efficacies in healthy mice, but no vaccine candidates have advanced into clinical trials. Herein, we report our findings that both an ionizing γ-radiation-inactivated and a non-ionizing ultraviolet C-inactivated whole-cell vaccine candidate protects neutropenic mice from pulmonary challenge with virulent AB5075, a particularly pathogenic isolate. In addition, we demonstrate that a humoral response is sufficient for this protection via the passive immunization of neutropenic mice.

Additional co-authors: Ivan Ropovik, Balazs Aczel, Lena F. Aeschbach, Luca Andrighetto, Jack D. Arnal, Holly Arrow, Peter Babincak, Bence E. Bakos, Gabriel Banik, Ernest Baskin, Radomir Belopavlovic, Michael H. Bernstein, Michal Bialek, Nicholas G. Bloxsom, Bojana Bodroža, Diane B. V. Bonfiglio, Leanne Boucher, Florian Bruhlmann, Claudia C. Brumbaugh, Erica Casini, Yiling Chen, Carlo Chiorri, William J. Chopik, Oliver Christ, Antonia M. Ciunci, Heather M. Claypool, Sean Coary, Marija V. Cˇolic, W. Matthew Collins, Paul G. Curran, Chris R. Day, Anna Dreber, John E. Edlund, Filipe Falcao, Anna Fedor, Lily Feinberg, Ian R. Ferguson, Maire Ford, Michael C. Frank, Emily Fryberger, Alexander Garinther, Katarzyna Gawryluk, Kayla Ashbaugh, Mauro Giacomantonio, Steffen R. Giessner, Jon E. Grahe, Rosanna E. Guadagno, Ewa Halasa, Rias A. Hilliard, Joachim Huffmeier, Sean Hughes, Katarzyna Idzikowska, Michael Inzlicht, Alan Jern, William Jimenez-Leal, Magnus Johannesson, Jennifer A. Joy-Gaba, Mathias Kauff, Danielle J. Kellier, Grecia Kessinger, Mallory C. Kidwell, Amanda M. Kimbrough, Josiah P. J. King, Vanessa S. Kolb, Sabina Kolodziej, Marton Kovacs, Karolina Krasuska, Sue Kraus, Lacy E. Krueger, Katarzyna Kuchno, Caio Ambrosio Lage, Eleanor V. Langford, Carmel A. Levitan, Tiago Jesse Souza de Lima, Hause Lin, Samuel Lins, Jia E. Loy, Dylan Manfredi, Łukasz Markiewicz, Madhavi Menon, Brett Mercier, Mitchell Metzger, Venus Meyet, Jeremy K. Miller, Andres Montealegre, Don A. Moore, Rafal Muda, Gideon Nave, Austin Lee Nichols, Sarah A. Novak, Christian Nunnally, Ana Orlic, Anna Palinkas, Angelo Panno, Kimberly P. Parks, Ivana Pedovic, Emilian Pekala, Matthew R. Penner, Sebastiaan Pessers, Boban Petrovic, Thomas Pfeiffer, Damian Pienkosz, Emanuele Preti, Danka Puric, Tiago Ramos, Jonathan Ravid, Timothy S. Razza, Katrin Rentzsch, Juliette Richetin, Sean C. Rife, Anna Dalla Rosa, Kaylis Hase Rudy, Janos Salamon, Blair Saunders, Przemyslaw Sawicki, Kathleen Schmidt, Kurt Schuepfer, Thomas Schultze, Stefan Schulz-Hardt, Astrid Schutz, Ani N. Shabazian, Rachel L. Shubella, Adam Siegel, Ruben Silva, Barbara Sioma, Lauren Skorb, Luana Elayne Cunha de Souza, Sara Steegen, L. A. R. Stein, R. Weylin Sternglanz, Darko Stojilovic, Daniel Storage, Gavin Brent Sullivan, Barnabas Szaszi, Peter Szecsi, Orsolya Szoke, Attila Szuts, Manuela Thomae, Natasha D. Tidwell, Carly Tocco, Ann-Kathrin Torka, Francis Tuerlinckx, Wolf Vanpaemel, Leigh Ann Vaughn, Michelangelo Vianello, Domenico Viganola, Maria Vlachou, Ryan J. Walker, Sophia C. Weissgerber, Aaron L. Wichman, Bradford J. Wiggins, Daniel Wolf, Michael J. Wood, David Zealley, Iris Žeželj, Mark Zrubka, and Brian A. Nosek

Medical device infections are costly, while preclinical assessment of antimicrobial properties for new materials is time intensive and imperfect at capturing the interrelated aspects of infection response and wound resolution. Herein, we developed an in vivo model for quantification of inflammatory and biocompatibility responses in the presence of a sustained implant-associated infection. The antimicrobial effectiveness of commercially available polymer materials was compared to that of thermoplastic polyurethane (TPU) materials modified with putative antimicrobial strategies as example test materials. Materials were incubated with bioluminescent Escherichia coli prior to implantation in a dorsal subcutaneous pocket in rats with an additional intraluminal bolus of bacteria. Infection kinetics were monitored with bioluminescence, and inflammatory infiltrate and fibrous capsule thickness were determined from stained histological sections. Our model resulted in a persistent infection, sensitive to antimicrobial effects, as the materials modified with a putative antimicrobial surface were able to significantly reduce the level of infection in animals at day 4 postimplantation with efficacy similar to that of commercially available antimicrobial drug-eluting polymers (positive controls). At day 30 postimplantation, the antimicrobial surface modified TPU tubing was found to promote complete elimination of intraluminal bacteria in the absence of antibiotics. Differences were also measurable in acute inflammation, as Wright-Giemsa staining demonstrated reduced inflammatory cell infiltration at day 4 postimplantation for antimicrobial TPU materials. Additionally, antimicrobial materials exhibited reduced fibrous capsule thickness coinciding with infection resolution, as compared to unmodified TPU controls. The developed model can be utilized for testing antimicrobial polymers in the context of a prolonged infection while also revealing concurrent differences in the infiltrating immune cell profiles and fibrous capsule thickness, thus improving the relevance of preclinical medical device material testing.

A 65-year-old man with diabetes, end-stage renal disease on hemodialysis, coronary artery disease, and a prosthetic aortic valve. He presented to the emergency department with hypothermia (96.6°F), several weeks of anorexia and chills, and bilateral lower extremity tissue necrosis with erythema and edema (Figure 1A). He had a peripherally inserted central catheter (PICC) line 8 weeks prior placed at another hospital for treatment of cellulitis. Laboratory results revealed anemia, azotemia, and leukocytosis (19,200 WBCs/mm

The extent to which physical therapy (PT) is used after meniscectomy is unknown. The objective of this study was to estimate the extent to which PT is implemented after meniscectomy and to identify factors associated with its utilization.The Mariner PearlDiver database was queried to identify patients who underwent uncomplicated meniscectomy. The number of PT visits for each patient was tabulated. Logistic regressions were used to compare demographic factors associated with no use of PT and use of nine or more PT visits.In total, 92,291 patients met inclusion criteria. Of these patients, 72.21% did not use PT and 27.8% used 1 or more PT visits. Of the patients who used PT, 19.76% had 1 to 8 PT visits and 8.03% had 9 or more PT visits. Older age and noncommercial insurance types were associated with no PT use. Male sex, Medicaid, and Medicare were associated with markedly lower odds of increased PT utilization.PT is used in the minority of the time after meniscectomy. Among patients who do use PT, however, notable variation exists in the amount of PT visits used. Patient age, sex, insurance status, and geographic variables were independently associated with PT utilization.

Antibody-secreting cells (ASC) or plasma cells secrete antibodies and form a cornerstone of humoral immunity. B cells that receive activation signals in the presence or absence of T cells initiate a differentiation program that requires epigenetic and transcriptional reprogramming in order to ultimately form ASC. Reprogramming is accomplished through the interplay of transcription factors that initiate gene expression programs and epigenetic mechanisms that maintain these programs and cell fates. An important consideration is that all of these factors are operating in the context of cell division. Recent technical advances now allow mechanistic studies to move beyond genetic studies to identify the promoters and enhancer repertoires that are regulated by epigenetic mechanisms and transcription factors in rare cell types and differentiation stages in vivo. This review will detail efforts to integrate transcriptional and epigenetic changes during B cell differentiation with cell division in vivo. What has emerged is a multi-phased differentiation model that requires distinct transcription factors and epigenetic programs at each step. The identification of markers that define each phase will help facilitate the manipulation of B cell differentiation for vaccine development or to treat diseases where antibodies are a component.

Albarracín et al. (2008, Experiment 7) tested whether priming action or inaction goals (vs. no goal) and then satisfying those goals (vs. not satisfying them) would be associated with subsequent cognitive responding. They hypothesized and found that priming action or inaction goals that were not satisfied resulted in greater or lesser responding, respectively, compared with not priming goals ( N = 98). Sonnleitner and Voracek (2015) attempted to directly replicate Albarracín et al.’s (2008) study with German participants ( N = 105). They did not find evidence for the 3 × 2 interaction or the expected main effect of task type. The current study attempted to directly replicate Albarracín et al. (2008), Experiment 7, with a larger sample of participants ( N = 1,690) from seven colleges and universities in the United States. We also extended the study design by using a scrambled-sentence task to prime goals instead of the original task of completing word fragments, allowing us to test whether study protocol moderated any effects of interest. We did not detect moderation by protocol in the full 3 × 2 × 2 design (pseudo- r2 = 0.05%). Results for both protocols were largely consistent with Sonnleitner and Voracek’s findings (pseudo- r2s = 0.14% and 0.50%). We consider these results in light of recent findings concerning priming methods and discuss the robustness of action-/inaction-goal priming to the implementation of different protocols in this particular context.

Phaf suggests that, in order to address overpublication, academics should read more and publish less. Although many academics would like to take this advice, doing so is complicated by the audit culture that marketizes and metricizes everything they do. Working from the evolutionary metaphor introduced by Phaf, we argue that the evolution of science consists not simply in adapting theory to the demands of empirical investigation, but also in adapting scientific traditions and communities to the political and institutional forces that shape them. We point specifically to the generalized metrics (e.g., impact factors) that, in audit environments, arbitrate resources, in the process engineering professional precarity and overdetermining theory building. We argue that hyper-production can be understood as an adaptation to such an audit environment. We briefly discuss some suggestions for approaching the audit through relational accounting practices that disrupt and re-inscribe calculative audits, thus creating opportunities to read more and publish less.

Background Memorial University Medical Center conducts opt-out HIV screening in the Emergency Department (ED) for patients aged ≥ 13. After gaining consent, an electronic algorithm automatically orders an HIV test with the diagnostic evaluation for patients who meet CDC guidelines for HIV screening. Unfortunately, no pediatric patient aged 13–18 received HIV screening despite our out-opt testing protocol being in place since 2016. Approach Through a systematic analysis, implicit bias to gain consent was repeatedly identified as the most common barrier to HIV screening in this population. Pediatric leadership developed strategies to improve HIV screening, including education of parents and staff, on-site support for staff and parents/guardians, pediatric patient counseling, and adding HIV screening to syphilis tests. Despite these interventions, HIV screening in the pediatric population only improved about 37% from January 2017 through November 2020. As a final strategy HIV screening was added to the sexually transmitted infection (STI) order set for patients who met CDC guidelines for STI. Pediatric ED HIV education to clinical staff continued, specifically emphasizing the high prevalence of HIV in our community. Outcomes Persistence to drive change increased HIV screening by 61% from July 2020 to December 2020. Strategies producing the greatest impact were the inclusion of HIV testing in the standard STI panel and focused pediatric ED nurse education/support. As a result, current HIV screening in our pediatric patients aged 13–18 is now 88% of those who meet CDC guidelines to be screened. Significance Up to 20% of HIV diagnoses occur during adolescence making screening in this age group imperative. Removing implicit bias from HIV screening is difficult. However, continued persistence and automated testing protocols can lead to increases in pediatric ED HIV screening. Because of our high HIV screening rate, many pediatric patients will have early identification of HIV and linkage to care.

Psychology is in a replication crisis that has brought about a period of self-reflection and reform. Yet this reform appears in many ways to focus primarily on methodological and statistical practices, with little consideration for the foundational issues that concern many theoretical and philosophical psychologists and that may provide a richer account of the crisis. In this paper we offer an overview of the history of the replication crisis, the critiques and reforms at the heart of the crisis, and several points of intersection between the reform movement and broader theoretical and philosophical issues. We argue that the problems of the replication crisis and the concerns of the reform movement in fact provide various points of entry for theoretical and philosophical psychologists to collaborate with reformers in providing a more deeply philosophical critique and reform.

Sternal cleft (SC) is a rare congenital anomaly, occurring with associated developmental anomalies or in isolation. Surgery to reconstruct the sternum is indicated to protect the visceral organs from trauma, to ensure healthy cardiopulmonary function and growth, and to reconstruct the anterior chest wall. Although infection recognized as a postoperative complication following chest wall reconstruction, spontaneous mediastinal infection is rare. To the authors' knowledge, there is only 1 reported case of spontaneous mediastinal infection with concomitant SC in the literature. Here, the authors present a unique case of a medically complicated infant with a SC who presented with a spontaneous mediastinal abscess.

Multispectral imaging is increasingly used in specialty crops, but its benefits in assessment of disease severity and improvements in conventional scouting practice are unknown. Multispectral imaging was conducted using an unmanned aerial vehicle (UAV), and data were analyzed for five flights from Florida and Georgia commercial watermelon fields in 2017. The fields were rated for disease incidence and severity by extension agents and plant pathologists at randomized locations (i.e., conventional scouting) followed by ratings at locations that were identified by differences in normalized difference vegetation index (NDVI) and stress index (i.e., UAV-assisted scouting). Diseases identified by the scouts included gummy stem blight, anthracnose, Fusarium wilt, Phytophthora fruit rot, Alternaria leaf spot, and cucurbit leaf crumple disease. Disease incidence and severity ratings were significantly different between conventional and UAV-assisted scouting (P < 0.01, Bhapkar/exact test). Higher severity ratings of 4 and 5 on a scale of 1 to 5 from no disease to complete loss of the canopy were more consistent after the scouts used the multispectral images in determining sampling locations. The UAV-assisted scouting locations had significantly lower green, red, and red edge NDVI values and higher stress index values than the conventional scouting areas (P < 0.05, ANOVA/Tukey), and this corresponded to areas with higher disease severity. Conventional scouting involving human evaluation remains necessary for disease validation. Multispectral imagery improved watermelon field scouting owing to increased ability to identify disease foci and areas of concern more rapidly than conventional scouting practices with early detection of diseases 20% more often using UAV-assisted scouting.

Background: Discrepancies in race, ethnicity, and sex among health care providers and their patients have been shown to affect the patient-provider relationship as well as the quality of care. Currently, minority and female representation among orthopaedic surgeons remains low. Given the large proportion of minority athletes and their degree of public visibility, professional sports serves as an important arena within which to analyze the diversity of health care providers. Purpose: To describe and evaluate the current level of diversity of head team physicians (HTPs) and head athletic trainers (ATCs), primarily in terms of race and sex, within men’s professional sports leagues in the United States. Study Design: Cross-sectional study. Methods: Five major US professional sports leagues were evaluated: National Basketball Association, National Football League, National Hockey League, Major League Soccer, and Major League Baseball. Publicly available data were collected to identify the HTPs and head ATCs for each team within these leagues. Two independent observers analyzed photographs and names of these individuals to determine his or her perceived race and sex, with disagreements being resolved by a third independent observer. Other physician data collected included graduate degree(s), specialty, and number of years in practice. Kappa coefficients (κ) were employed to evaluate interobserver reliability. Chi-square, Fisher exact, and t tests were used for statistical comparisons across leagues. Results: The κ values for perceived race were 0.85 for HTPs and 0.89 for head ATCs, representing near-perfect interobserver agreement. Minorities comprised 15.5% of HTPs and 20.7% of ATCs ( P = .24). Women comprised 3.9% of HTPs and 1.3% of head ATCs ( P = .017). The majority of HTPs were orthopaedic surgeons with medical doctorates. Female HTPs had significantly fewer years in practice compared with male HTPs (15.0 ± 4.9 vs 23.1 ± 9.6; P = .04). Conclusion: The lead physicians and athletic training providers for men’s professional sports teams demonstrated low rates of minority and female representation, denoting a highly visible area for discussing the role of increased diversity in health care.

Many flatfish species utilize coastal areas during at least one of their life-history stages. Estuaries on the eastern US Atlantic coast provide important settlement and nursery habitat for flatfishes. Small tidal creeks serve as transition zones between upland and estuarine environments and are a consistent settlement and nursery habitat for flatfish. Flatfish habitat use in Wylly Creek, a southeastern US tidal creek, was examined to determine whether assemblage composition has changed over a decadal time period (2004–2007 vs. 2016–2019). In addition, the potential effect of cold winters on juvenile flatfish recruitment and subsequent spring flatfish assemblage composition were examined. Flatfish assemblages have undergone subtle shifts in composition between initial and recent time periods, with decreases (5–16-fold) in abundance occurring for ocellated flounder Ancylopsetta quadrocellata, summer flounder Paralichthys dentatus, and southern flounder Paralichthys lethostigma, while abundances of more common species, bay whiff Citharichthys spilopterus and blackcheek tonguefish Symphurus plagiusa, remained relatively consistent. Bay whiff recruitment into the creek occurred in early spring, but was delayed in most years with colder winters. Minimum residency for bay whiff within an approximately 350 m stretch of creek was estimated to be approximately 5–10 days. Flatfish habitat use in this small tidal creek adjacent to a relatively undeveloped coastal area may reflect a shifting baseline against which potential assemblage shifts in developed areas can be assessed.

The development of vaccinations changed the face of medicine starting in the late 1700s with the introduction of the vaccine that led to the eradication of smallpox, by providing active and passive immunity against infectious diseases that had plagued many generations. The result by the beginning of the twenty-first century was the near eradication of these morbid illnesses in the western world, including measles, rubella, and varicella-zoster viruses. Recent developments in the anti-vaccination movement have led to widespread refusal of vaccinations, subsequently resurrecting many viruses that have not been battled for centuries. Outbreaks, seen throughout the world, have seen high mortality rates in immunocompetent and immunocompromised individuals, alike. Those who have survived the illnesses have suffered severe complications, especially since treatment for these viruses is limited. In this chapter, we review reemerging viral infections with primary and secondary cutaneous manifestations. We also discuss the factors spurring the anti-vaccination movement and the obstacles healthcare faces in abating its consequences.

Acinetobacter baumannii is a bacterial pathogen that is often multidrug-resistant (MDR) and causes a range of life-threatening illnesses, including pneumonia, septicemia, and wound infections. Some antibiotic treatments can reduce mortality if dosed early enough before an infection progresses, but there are few other treatment options when it comes to MDR-infection. Although several prophylactic strategies have been assessed, no vaccine candidates have advanced to clinical trials or have been approved. Herein, we rapidly produced protective whole-cell immunogens from planktonic and biofilm-like cultures of A. baumannii, strain AB5075 grown using a variety of methods. After selecting a panel of five cultures based on distinct protein profiles, replicative activity was extinguished by exposure to 10 kGy gamma radiation in the presence of a Deinococcus antioxidant complex composed of manganous (Mn2+) ions, a decapeptide, and orthophosphate. Mn2+ antioxidants prevent hydroxylation and carbonylation of irradiated proteins, but do not protect nucleic acids, yielding replication-deficient immunogenic A. baumannii vaccine candidates. Mice were immunized and boosted twice with 1.0 × 107 irradiated bacterial cells and then challenged intranasally with AB5075 using two mouse models. Planktonic cultures grown for 16 h in rich media and biofilm cultures grown in static cultures underneath minimal (M9) media stimulated immunity that led to 80–100% protection.

Background Epithelioid hemangioma is a rare, benign vascular lesion classically presenting with painless nodules in the head and neck region. Hemangioma lesions are typically small, located within the dermis and subcutaneous tissue, and rarely exceed 10 cm in size. Complete surgical excision, with negative margins, is the recommended treatment as local recurrence is common. We describe an unusual presentation of epithelioid hemangioma that, to our knowledge, has not been previously described in the literature, epithelioid. Case presentation We report an atypical case of a large epithelioid hemangioma lesion with deep intramuscular involvement in a 16-year-old male. Ultrasound and MRI showed a hypervascular mass on the patient’s left upper back, and biopsy confirmed the diagnosis. Treatment consisted of preoperative embolization followed by excision and local tissue rearrangement. Conclusions Epithelioid hemangiomas are considered uncommon in the pediatric population. Moreover, it is challenging to diagnose these lesions due to their similarities to other vascular anomalies. We aim to increase awareness of this condition and obtain more precision in diagnosis, thus standardizing the approach for those treating individuals with vascular anomalies.

Memory B cells (MBC) are a heterogenous population that consist of immunoglobin class switched and non-class switched MBC, and these populations can arise via germinal center dependent or independent mechanisms. The timing of MBC development influences the fate outcome of MBC populations. These different populations of MBC are regulated by cell signaling, but it is not clearly defined what epigenetic factors influence MBC differentiation. EZH2 is an important histone methyltransferase that catalyzes H3K27me3 resulting in gene repression. EZH2 has been shown to regulate B cell differentiation into germinal centers and plasma cells; however, it is unknown if EZH2 regulates MBC development. To address this, a knockout model has been established where EZH2 is conditionally deleted using the CD19 and AICDA driven CRE expression. Here we used the influenza PR8 model to ascertain the kinetics of MBC differentiation and formation in the spleen, dLN, and lungs following a live infection in wild-type and EZH2-KO cohorts. Using B cell tetramers, antigen-specific MBC will be analyzed to define the kinetics of MBC development and determine the similarities and differences between the different populations of MBC. Overall, these data define the early kinetics of MBC establishment and the developmental timing that EZH2-dependent H3K27me3 remodeling is required for MBC formation. Supported by NIH/NIAID to CDS (R01 AI148471)

About 70% of the world's main crops depend on insect pollination. Climate change is already affecting the abundance and distribution of insects, which could cause geographical mismatches between crops and their pollinators. Crops that rely primarily on wild pollinators (e.g., crops that cannot be effectively pollinated by commercial colonies of honey bees) could be particularly in jeopardy. However, limited information on plant-pollinator associations and pollinator distributions complicate the assessment of climate change impacts on specific crops. To study the potential impacts of climate change on pollination of a specific crop in North America, we use the case of open-field tomato crops, which rely on buzz pollinators (species that use vibration to release pollen, such as bumble bees) to increase their production. We aimed to (1) assess potential changes in buzz pollinator distribution and richness, and (2) evaluate the overlap between areas with high densities of tomato crops and high potential decrease in richness. We used baseline (1961-1990) climate and future (2050s and 2080s) climatic projections in ecological niche models fitted with occurrences of wild bees, documented in the literature as pollinators of tomatoes, to estimate the baseline and future potential distribution of suitable climatic conditions of targeted species and to create maps of richness change across North America. We obtained reliable models for 15 species and found important potential decreases in the distribution of some pollinators (e.g., Lasioglossum pectorale and Augochlorella aurata). We observed geographical discrepancies in the projected change in species richness across North America, detecting important declines in the eastern United States (up to 11 species decrease for 2050s). After overlapping the maps of species richness change with a tomato crop map for the United States, we found spatial correspondence between richness declines and areas with high concentration of tomato crops. Disparities in the effects of climate change on the potential future distribution of different wild pollinators and geographical variation in richness highlight the importance of crop-specific studies. Our study also emphasizes the challenges of compiling and modeling crop-specific pollinator data and the need to improve our understanding of current distribution of pollinators and their community dynamics under climate change.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is an infectious disease of recent origin with high transmissibility and mortality. The resulting COVID-19 pandemic has impacted the United States the most, in terms of the number of confirmed cases and fatalities. How other aspects of public health will be impacted by this disease has yet to be fully realized. Sexually transmitted diseases (STDs), already a major public health crisis, will likely be significantly affected by this pandemic. We address some of the potential implications for STDs in the setting of widespread COVID-19, discussing the sexual transmission of COVID-19 itself, STD co-infection with COVID-19, and changes in STD prevalence secondary to COVID-19. (

Bacterial infections still present a significant concern in orthopedic and dental implant failure. Previous investigations have focused on modifying the surface texture, roughness, or coating implants with antibiotics to provide enhanced anti-bacterial properties. However, they have demonstrated limited success. In this study, we attempted to engineer the titanium (Ti) alloy surface biomimetically at the nano level using alkaline hydrothermal treatment (AHT) inspired by cicada's wing structure. Two modified surfaces of Ti plates were developed using 4 and 8-hr AHT at 230°C. We found that the control plates showed a relatively smooth surface, with little artifacts on the surface. In contrast, 4-hr AHT and 8-hr AHT plates showed nano-spikes of heights around 250-350 and 100-1,250 nm, respectively, that were distributed randomly all over the surface. We found a statistically significant (p < 0.05) number of non-viable cells for both S. aureus and P. aeruginosa bacterial strains when incubated for 1 hr in a dynamic environment when compared with the control group. The 8-hr AHT groups killed 38.97% more S. aureus in static culture and 11.27% in a dynamic environment than the 4-hr AHT. Overall, the findings indicate that the nanostructures generated on titanium by the AHT showed significant bactericidal properties. We, therefore, recommend conducting alkaline hydrothermal treatment on the surfaces for future orthopedic and dental metallic implants.

Masks are coverings of the face that serve a variety of purposes. Throughout history, they have been used for religious ceremonies, theatric entertainment, protection of identity, and as a tool to limit the spread of infectious diseases. The development of masks in the medical setting has evolved along with our understanding of the mode of disease transmission, material science, and population health dynamics. The simple barrier face mask, surgical mask, and filtering facepiece respirator are each appropriate in different settings. Establishing evidence-based guidance behind the use of masks is essential, particularly in public health crises.

Background: Patients often have quadriceps or hamstring weakness after anterior cruciate ligament reconstruction (ACLR), despite postoperative physical therapy regimens; however, little evidence exists connecting nerve blocks and ACLR outcomes. Purpose: To compare muscle strength at return to play in patients who received a nerve block with ACLR and determine whether a specific block type affected subjective knee function. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were recruited 5 to 7 months after primary, isolated ACLR and completed bilateral isokinetic strength tests of the knee extensor/flexor groups as a single-session return-to-sport test. Subjective outcomes were assessed with the International Knee Documentation Committee (IKDC) score. Strength was expressed as torque normalized to mass (N·m/kg) and limb symmetry index as involved/uninvolved torque. Chart review was used to determine the type of nerve block and graft used. Nerve block types were classified as knee extensor motor (femoral nerve), knee flexor motor (sciatic nerve), or isolated sensory (adductor canal block/saphenous nerve). A 1-way analysis of covariance controlling for graft type was used. Results: A total of 169 patients were included. Graft type distribution consisted of 102 (60.4%) ipsilateral bone–patellar tendon–bone (BTB) and 67 (39.6%) ipsilateral hamstring tendon. Nerve block type distribution consisted of 38 (22.5%) femoral, 25 (14.8%) saphenous, 45 (26.6%) femoral and sciatic, and 61 (36.1%) saphenous and sciatic. No significant difference was found in knee extensor strength ( P = .113) or symmetry ( P = .860) between patients with knee extensor motor blocks (1.57 ± 0.45 N·m/kg; 70.1% ± 15.3%) and those without (1.47 ± 0.47 N·m/kg; 69.6% ± 18.8%). A significant difference was found between patients with knee flexor motor blocks (0.83 ± 0.26 N·m/kg) and those without (0.92 ± 0.27 N·m/kg) for normalized knee flexor strength ( P = .21) but not knee flexor symmetry ( P = .592). Controlling for graft type, there were no differences in subjective knee function (IKDC score) between all nerve block groups ( P = .57). Conclusion: Our data showed that use of a sciatic nerve block with ACLR in patients with hamstring and BTB grafts influences persistent knee flexor strength deficits at time of return to sports. Although the cause of postoperative muscular weakness is multifactorial, this study adds to the growing body of evidence suggesting that perioperative nerve blocks affect muscle strength and functional rehabilitation after ACLR.

Estimating invasion dynamic is important to the management of invasive species, and geopolitical-unit level data are usually the most abundant and available records of invasive species. Here, for the first time we evaluated performances and similarities of eight common methods to estimate spread pattern and spread dynamic of invasive species with geopolitical-unit level data, and assessed impacts of variations in geopolitical-units on each method using simulated spread data. We also formulated a concave hull boundary displacement method (i.e., CEB) and an area-based regression method (i.e., AER) for estimating spread with geopolitical-unit data. Three regions with different sized counties in the United States (U.S.) were selected to conduct simulations and three spread scenarios were simulated. R2 and root mean square error were used to evaluate the abilities of all methods to estimate spread. Correlation coefficients were used to assess the similarity pattern of all methods. Finally, kudzu bug Megacopta cribraria, an invasive insect in the U.S., was used as a case study to test the generality of some results concluded from the simulated research. We found the CEB and two regression methods consistently estimated the right expansion patterns. Two boundary displacement and two area-based regression methods estimated highly correlated spread and were the best four methods, among which CEB had the best estimation. Distance-based regression methods are sensitive to irregularity and stochasticity in spread, and the minimum spread distance method had low ability to estimate spread. The case study showed consistent results with the simulated research. Both regression and boundary displacement methods can estimate spread patterns, overall rate, and spread dynamics of invasive species. Boundary displacement methods best estimate spread rates and dynamics; however, for spread without clear infestation outlines, area-based regression methods can be good alternatives.

Magnetic resonance imaging (MRI) is a cornerstone in multiple sclerosis (MS) diagnostics and monitoring. Ultra-high field (UHF) MRI is being increasingly used and becoming more accessible. Due to the small diameter and mobility of the spinal cord, imaging this structure at ultra-high fields poses additional challenges compared to brain imaging. Here we review the potential benefits for the MS field by providing a literature overview of the use UHF spinal cord MRI in MS research and we elaborate on the challenges that are faced. Benefits include increased signal- and contrast-to-noise, enabling for higher spatial resolutions, which can improve MS lesion sensitivity in both the spinal white matter as well as grey matter. Additionally, these benefits can aid imaging of microstructural abnormalities in the spinal cord in MS using advanced MRI techniques like functional imaging, MR spectroscopy and diffusion-based techniques. Technical challenges include increased magnetic field inhomogeneities, distortions from physiological motion and optimalisation of sequences. Approaches including parallel imaging techniques, real time shimming and retrospective compensation of physiological motion are making it increasingly possible to unravel the potential of spinal cord UHF MRI in the context of MS research.

Transferability of species distribution models (SDMs) is key to predicting invasion patterns and can be challenged if niche shift occurs in the invaded range. When using native occurrences to estimate potential invasions with presence-only modeling methods, it is important to constrain the pseudo-absence (PA) sampling to the species’ native range. However, some studies including highly cited ones, do not follow this approach to selecting PA samples. In this research, we addressed two questions using an invasive species in the United States (U.S.), kudzu bug (Megacopta cribraria): 1) is model transferability challenged by a non-adaptive niche shift? and 2) is model performance affected by use of PA samples from outside the native range of the species? Kudzu bug is native to Asia, with recently observed non-adaptive niche shift in the U.S. To answer the first question, we quantified the environmental space anisotropy and non-adaptive niche change, and then evaluated the performances of seven SDMs. To answer the second question, we further compared the interpolation and transferability of seven SDMs trained with PAs from the native range and from both native and invaded ranges. We confirmed that the environmental space anisotropy (P = 0.01) and non-adaptive niche change (P = 0.01) are both statistically significant. Of the seven SDMs used, four models had transferability indices higher than 0.9. Boosted regression tree and random forests both had good interpolation and transferability (AUC>0.80 and kappa>0.60), whereas three other models showed good interpolation and fair transferability (AUC>0.70 and kappa>0.40). Inclusion of pseudo-absences from the invaded range significantly increased the interpolation (P

BACKGROUND: Medial epicondylitis (ME), or “golfer’s elbow,” is often treated initially by conservative means. Up to 15% of recalcitrant cases require surgical intervention, according to small sample populations, but no national study has determined the incidence of the diagnosis or corroborated the rate of surgical intervention. PURPOSE/QUESTION: We sought to review the annual incidence of ME, surgical rates, and health care costs in a population setting. METHODS: A national database was queried for ME from 2007 to 2014. Annual rates and the percentage of diagnosed cases subjected to surgical intervention were recorded. Epidemiologic data was reported with descriptive statistics, and the significant trends over time were analyzed using linear regression. RESULTS: We identified 19,856 cases of ME in the study period. There was a significant increase in the annual incidence and overall incidence per 10,000 patients. The proportion of diagnoses in patients under 65 years of age decreased significantly, while the proportion in those 65 years of age or older significantly increased. The annual number of surgical interventions significantly increased over the study period, although the annual proportion of diagnosed cases proceeding to surgery remained constant. The proportion of patients 65 years of age or older undergoing surgery significantly increased. Total reimbursement for the management of ME during the study period was $1,877,189. While there was a significant increase in the total annual reimbursement, annual per-patient reimbursement did not change significantly. CONCLUSIONS: While the annual incidence of ME and surgical treatment of ME increased significantly from 2007 to 2014, the proportion of cases treated surgically did not. Notably, the proportion of patients 65 years of age or older diagnosed with and being surgically treated for ME has increased in recent years. Total reimbursement for ME has steadily risen, although per-patient reimbursement rates have not significantly changed.

Biological invasions have long placed challenges on ecosystems, agricultural production, and human health. Modeling potential invasion of an introduced organism becomes a critical tool for early management of damaging species, such as kudzu bug, Megacopta cribraria (F.) (Hemiptera:Heteroptera:Plataspidae). Since it was first found in the United States in 2009, kudzu bug has spread rapidly, economically impacted agricultural production, and became a household pest. To better predict the potential invasion of kudzu bug in North and South America, we used the species distribution models Genetic Algorithm for Rule-set Production (GARP) and Maximum Entropy (Maxent). We used the D metric to test for niche equivalency and similarity between native and invaded populations of kudzu bug. We found that kudzu bugs currently occupied unequal environmental space between the two ranges. Therefore, distribution models using GARP and Maxent were constructed using occurrences in both native and invaded ranges. Area under the curve (AUC), true skill statistics (TSS), and omission rate (OR) were used to evaluate and compare the models. Results indicated both models had good performance, but Maxent (AUC = 0.971, TSS = 0.946, OR = 0.019) performed better than GARP (AUC = 0.922, TSS = 0.860, OR = 0.037). This research confirmed the effectiveness of using occurrence data in both ranges to predict potential invasions. Kudzu bugs prefer warm (annual mean temperature around 15 °C) and humid (annual mean precipitation around 1300 mm) regions. Distribution models generated by both methods indicated similar regions with high invasion risk. Management programs that include quarantine and prevention measures are suggested for these regions to avoid outbreaks of kudzu bug.

We argue that academic life is increasingly giving way to forces of industrialization and that many of the problems confronting higher education arise within this transformation. We discuss how a culture of standardization has led to academic monocultures; how faculty autonomy has been subverted by topdown management structures; how locally based academic communities have been dispersed by mission creep and institutional isomorphism; and how many institutions have grown unsustainably, even in the midst of austerity. Drawing inspiration from sustainability discourses, we propose that the individuals and communities that make up higher education seek out and nourish practices that permit organic (local, slow) institutional development and relationally structured cultures of care and responsibility.

A 66-year-old man with a recent history of herpes zoster in the second division of the trigeminal nerve presented with hyperkeratotic plaques along his left cheek and temple. A shave biopsy was found to be consistent with postherpetic hyperkeratosis. This case represents a unique presentation of Wolf’s postherpetic isotopic response: a new skin disorder emerging at the site of a previously healed herpetic, predominantly zoster, infection. We aim to increase awareness of an unusual complication of herpes zoster and the importance of appropriate vaccination to help protect patients from these potential postinfection effects.