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ObjectiveThe study objective was to determine the relationship of magnetic resonance imaging (MRI)-detected features of patellofemoral joint osteoarthritis to pain and functional outcomes.MethodsWe sampled 1,099 participants from the 60-month visit of the Multicenter Osteoarthritis Study (mean ± SD age: 66.8 ± 7.5 years; body mass index: 29.6 ± 4.8; 65% female). We determined the prevalence of MRI-detected features of patellofemoral joint osteoarthritis (eg, cartilage damage, bone marrow lesions, and osteophytes) and assessed the relationship between these features and knee pain severity, knee pain on stairs, chair stand time, and walking less than 6,000 steps per day. We evaluated the relationship of MRI features to each outcome using logistic and linear regression, adjusting for potential covariates.ResultsParticipants with cartilage damage in 3-4 subregions had the highest mean pain severity (22.0/100; 95% confidence interval [CI]: 17.6-26.4 mm). They also showed higher odds of having at least mild pain on stairs (odds ratio [OR]: 3.3; 95% CI: 1.7-6.5) and of walking less than 6,000 steps per day (OR: 2.3; 95% CI: 1.1-4.4) compared with those without cartilage damage. Participants with bone marrow lesions in 3-4 subregions had higher odds of at least mild pain on stairs than those without (OR: 3.3; 95% CI: 2.2-5.2). Participants with osteophytes in 3-4 subregions also had higher odds of walking less than 6,000 steps/day (OR 2.1, 95% CI: 1.3-3.5, respectively).ConclusionMRI-detected features of osteoarthritis of the patellofemoral joint are related to pain and functional performance. This knowledge highlights the need to develop treatments for those with patellofemoral joint osteoarthritis to improve pain and maximize function.

MY THIRD-GRADE teacher asked what we wanted to do when we grew up. 'Don't just tell me what you want to be; show me,' she said. Under her guidance, we [...]

In many areas of Northern and Western Alaska, small streams and shallow lakes serve as community raw water supplies. These water supplies freeze completely during winter. In order to supply drinking water during the 6-9 month winter, communities store water that was treated during summer. A chlorine residual is maintained in the stored water. Raw water sources derived from surface water may be heavily laden with dissolved organic matter. At utilities where organic matter escapes treatment, the potential for accumulation of disinfection by-products (DBPs) during storage is a significant health concern. The following study was performed to evaluate this potential threat. Water was collected from five operating utilities, four that normally store water for 6-9 months and one that produces drinking water year-round. Raw, filtered (i.e., unchlorinated) and 'finished' (i.e., filtered and chlorinated) water samples were collected during the summer pumping season and stored in the laboratory for 8 months. In order to mimic practice in the field, the chlorine residual was maintained in the finished water for the full storage period. While the concentration of DBPs in the finished water varied over the study period, there was not a statistically significant trend from the third to the eighth month of storage. The observed DBP values were strongly a function of the type of treatment system used. Those systems passing more organic matter had higher DBP values throughout the storage period. The ultraviolet absorbance at 254 nanometers ([UV.sub.254]) decreased continuously in the finished water coincident with chlorine consumption. [UV.sub.254], often used as a surrogate for DBPs, remained constant during the entire storage period in raw and filtered water samples. Filtered water that was stored prior to chlorination accumulated fewer DBPs than finished water that was continuously chlorinated during the storage period. This result suggests that storing filtered water instead of finished water for long periods would limit DBP exposure to consumers. This conclusion was based on a comparison of DBP formation potentials (i.e., raw and filtered water) to DBPs (i.e., finished water). It is important to note that DBP formation potentials are based on a 24 hchlorine contact time. If long term storage were provided for filtered water, a smaller volume of secondary storage would still be needed to provide contact time for disinfection. CE Database subject headings: Water pollution; Alaska; Disinfection; Water supply.

As pharmacists become established in their roles within Primary Care Network (PCN) multidisciplinary teams, it is important that their wellbeing and self‐care needs are supported. Here, the authors describe how the process of 'restorative clinical supervision', which they reframe as 'professional self‐care', brings pharmacists together to help them manage the complex professional and personal challenges they are now faced with. [ABSTRACT FROM AUTHOR]

Background. The increasing incidence of multidrug-resistant Gram negatives, such as carbapenem-resistant Enterobacteriaceae (CRE), has resulted in a critical need for new antimicrobials. Most studies of new antimicrobials have been performed in patients with nondrug-resistant pathogens. We performed a retrospective analysis of patients with CRE infections to inform the design of phase 3 clinical trials. Methods. This was a retrospective study at 22 centers in 4 countries. Baseline data, treatment, and outcomes were collected in patients with complicated urinary tract infection (cUTI)/acute pyelonephritis (AP), hospital-acquired bacterial pneumonia (HABP), ventilator-associated bacterial pneumonia (VABP), and bacteremia due to CRE. Results. Two hundred fifty-six cases of CRE infection were identified: 75 cUTI/AP, 21 HABP, 20 VABP, and 140 bacteremia. The patient population had significant comorbidities: 32.8% had chronic renal insufficiency, and 26.2% were immunocompromised. Illness severity at presentation was high: 29.3% presented with septic shock. Treatment regimens varied widely; however, a majority of patients received combination therapy. Outcomes were universally poor (28-day mortality was 28.1%) across all sites of infection, particularly in dialysis patients and those with sepsis. Conclusions. The CRE infections occured in patients with substantial comorbidities and were associated with high mortality and low rates of clinical cure with available antibiotics. Patients with these comorbidities are often excluded from enrollment in clinical trials for registration of new drugs. These results led to changes in the inclusion/exclusion criteria of a phase 3 trial to better represent the patient population with CRE infections and enable enrollment. Observational studies may become increasingly important to guide clinical trial design, inform on the existing standard of care, and provide an external control for subsequent trials. [ABSTRACT FROM AUTHOR]

The article focuses on risks and costs, and the immigration process with the guidelines H-1B visa for foreign nationals in the U.S. It mentions that the U.S. Citizenship and Immigration Services (USCIS) will nevertheless require that the transfer petition contain complete documentation of eligibility for both the company and the transferee. It also mentions that challenges in front of systems engineering student and STEM graduate for employment.

Cardiovascular disease remains the leading cause of death worldwide compared with any other clinical condition, and improving medication adherence contributes to better outcomes. There is no single predictor of good or poor adherence. Patient beliefs about their illness can affect willingness to adhere to medicines. A health coaching approach can support medication adherence by raising the patient's awareness of their issue or problem and increasing their responsibility for managing their condition. This ultimately supports patients to be their own problem solvers. Cognitive behavioural therapy (CBT) can be used to support adherence where the patient works collaboratively with a therapist to identify and re-evaluate the content and effects of their thoughts, beliefs and emotional states that affect adherence. Both health coaching and cognitive behavioural change techniques have been used successfully in routine medicinesrelated consultations including use of the Four Es (explore, educate, empower, enable) framework to support adherence. Use of cognitive behavioural change techniques, including health coaching and CBT, can support patients to better engage with their medicines-related activity to improve health outcomes. [ABSTRACT FROM AUTHOR]

This article draws lessons from ACDI/VOCA, CARE, and World Vision-implemented food security programmes to answer three questions: how can push/pull activities better integrate the extremely poor into 1) output and 2) input markets? And 3) how can push/ pull programme activities help improve intra-household gender dynamics and financial decision-making to improve the food and nutrition security of household members? In output markets the lessons include: 1) that market development and savings group interventions can be implemented by the same officer; and 2) projects should move early to have a private sector provider take over the village savings and loan associations. While there are constraints in the input markets, there are also push strategies for increasing production, including direct delivery of inputs to farmers, vouchers to increase demand, and Farmer Business Group development to increase collective input buying and pull strategies such as linkages with buyers for the selling of products and tapering down subsidies. Intrahousehold gender equitable decision-making can positively impact the food security of the household members. Mixed gender Village Economic and Social Associations are efficient in tackling intra-household decision-making. This allows the provision of flexible and efficient financial services as well as an opportunity to engage husbands and wives in gender-related dialogues. [ABSTRACT FROM AUTHOR]

Just like urban residents, rural citizens want educational, cultural, and technological resources delivered in an affordable manner appropriate to their locale. Rural communities and elected officials strive to leverage their limited resources to meet critical needs, provide services, and improve their quality of life. The Rural Library Project, a small nonprofit in Georgia, is working with rural communities to organize and engage talent, gather resources, and value the public library as a center for lifelong learning and community development. [ABSTRACT FROM PUBLISHER]

BackgroundPhysical distancing measures taken to contain COVID-19 transmission may substantially reduce physical activity levels and cause individuals to adopt a more sedentary lifestyle. ObjectiveThe objective of this study is to determine if there was any change in daily steps, an important component of daily physical activity, and examine risk factors for frequent low daily steps during the COVID-19 epidemic. MethodsWe used data collected from the Step Study, a population-based longitudinal study of walking activity among residents aged ≥40 years in Changsha, China. Daily steps were collected via a smartphone linked to WeChat, a social networking platform. We plotted mean daily steps and the prevalence of low daily steps (≤1500 steps/day) 30 days before (reference period) and 30 days after (epidemic period) January 21, 2020 (date of the first COVID-19 case diagnosed in Changsha), and compared it with the same corresponding period from 2019. We examined the association of risk factors with the prevalence of frequent low daily steps (≤1500 steps/day for ≥14 days) using logistic regression. ResultsAmong 3544 participants (mean age 51.6 years; n=1226 females, 34.6%), mean daily steps dropped from 8097 to 5440 and the prevalence of low daily steps increased from 3% (2287/76,136 person-day) to 18.5% (12,951/70,183 person-day) during the reference and epidemic periods, respectively. No such phenomenon was observed during the corresponding period in 2019. Older age (P for interaction=.001) and female sex (P for interaction

The article focuses on a range of challenges discerned by the Day of Discernment process associated with the evangelising mission of the Catholic Church within the context of the Archdiocese of Hobart in Tasmania. It mentions the relativity between the struggling medieval city of Venice and Catholic Education. It reflects on the necessity and capacity of Catholic schools to respond to a growing awareness that Catholics have moved into a phase of new evengelisation within many Catholic communities across Australia. It also explores the emerging policy initiatives and strategies being formulated in response to the challenges associated with the identity and mission of Catholic schools.

The article presents a commentary about the recent ocean energy in the U. S. It provides information on the current state of technology specifically needed in the research for energy sourced from the oceans which also be a viable source of water and hydrogen fuel. Factors driving and affecting the implementation of ocean energy technology in the U. S. are discussed more.

The article offers information about different visa categories made available to U. S. employers who wish to hire a foreign national. Visa categories include the H-1B "Specialty Occupation" visa, the Tennessee "Professional Work" permit, the L "Intra-Company" visa, the E "Treaty" visa, the J-1 Exchange Visitors, and the E-3 "Specialty Occupation" visa designed specially for Australians. These visas, with the exception of the H-1B visa, have allegedly no U.S. Citizenship and Immigration Services.

The article recommends several picture books that address serious subjects for older readers. "Smoky Night," by Eve Bunting exemplifies the values of interacting with others no matter what their background or nationality. "So Far From the Sea," by Bunting depicts the forced relocation of Japanese-Americans during World War II. "Major Taylor, Champion Cyclist," by Lesa Cline-Ransome introduces readers to the life of the African-American bicycle racer who won the 1899 World Championship title. "The Cats in Krasinski Square," by Karen Hesse represents the difficulties and efforts of two Jewish sisters to survive from the Warsaw ghetto.