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Objectives: This study aimed to assess the impact of a telehealth rotation on the perceived benefits and challenges of telehealth use among third‐year dental students at the Columbia University College of Dental Medicine (CDM). Methods: A newly implemented weeklong telehealth rotation at CDM engaged all 95 third‐year dental students from the 2022 graduating class through assigned readings and virtual interaction with patients. The telehealth rotation involves virtual visits with patients for screening and triage. An ongoing retrospective assessment of the students' post‐rotation evaluation was analyzed qualitatively to identify emerging themes and was coded to describe students' attitudes and beliefs about telehealth. Results: Students reported that the greatest benefit of telehealth is logistical convenience, while the greatest challenge to telehealth is related to the use of technology. After the telehealth rotation, students reported improvement in their clinically relevant skills and knowledge, including patient education, facilitating access to care, and communication skills. Conclusions: The skills reported by students as the most important learning takeaway from the telehealth rotation are applicable to many aspects of care delivery, beyond the scope of telehealth. The incorporation of telehealth education into dental curricula allows students to improve essential clinically relevant skills and knowledge beyond the procedural skills emphasized during in‐person patient appointments. [ABSTRACT FROM AUTHOR]

Objective: The potential influence (i.e., impact rate) of catch‐and‐release fisheries on wild steelhead Oncorhynchus mykiss is poorly understood and is a function of the abundance of wild fish, how many fish are encountered by anglers (i.e., encounter rate), and the mortality of fish that are caught and released. In Idaho, estimates of wild steelhead encounter rates have been derived using the number of wild and hatchery steelhead passing Lower Granite Dam, the number of hatchery steelhead harvested, and the number of hatchery steelhead caught and released. The method includes assumptions that hatchery and wild steelhead have equal encounter rates and catch‐and‐release mortality is 5% for wild steelhead. Here, we investigated wild and hatchery steelhead encounter rates by anglers, estimated catch‐and‐release mortality, and concatenated both aspects to examine how existing recreational steelhead fisheries influence wild steelhead mortality. Methods: We sampled, tagged, and released 1,251 spawn‐year 2020 (SY2020) and 1,956 spawn‐year 2021 (SY2021) adult steelhead at Lower Granite Dam with T‐bar anchor tags and passive integrated transponder (PIT) tags to estimate steelhead encounter rates and catch‐and‐release mortality. Differences in survival of caught steelhead and those not reported as caught were evaluated using detections at various locations (e.g., PIT arrays, weirs). Result: Estimated encounter rates were 43.7% (95% credible interval; 28.2%, 100.0%) for wild fish and 46.7% (29.6%, 100.0%) for adipose‐clipped fish in SY2020. In SY2021, encounter rates were 47.2% (32.4%, 100.0%) for wild fish and 52.3% (37.1%, 100.0%) for adipose‐clipped fish. Based on detections of caught fish and those not reported as caught, catch‐and‐release mortality of wild steelhead was estimated to be 1.6% (0.0%, 5.2%). Wild steelhead impact rates were 0.7% (0.0%, 2.7%) in SY2020 and 0.7% (0.0%, 2.8%) in SY2021. Conclusion: Estimated rates of impact on wild steelhead were consistent and low across years despite major differences in the structure of the fisheries. Our results suggest assuming that encounter rates are equal between hatchery and wild steelhead, and that steelhead catch‐and‐release mortality is 5%, will likely lead to a conservative estimate of the wild steelhead impact occurring from catch‐and‐release fisheries. Impact statementWith wild steelhead numbers declining in many parts of North America, a dilemma between providing angling opportunity and wild steelhead conservation can develop. We show that encounter rate plays a larger role than mortality regarding catch‐and‐release angling on overall impact rates. Our method provides a direct, reliable estimate of encounter rates across multiple scales. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) is the most common type of dementia which results in debilitating memory loss as the disease advances. However, among older adults with AD, some may experience rapid cognitive decline while others may maintain a stable cognitive status for years. In addition to the amyloid plaques, tau tangles, and neuronal inflammation characteristic of AD, there is strong evidence of dysregulation in the peripheral immune system, including decreased naïve T cells and increased memory T cells among older adults with AD. It is currently unknown what underlies dysfunction in the peripheral immune system or whether changes in peripheral immune cells are associated with cognitive decline. Method: We have performed unbiased metabolomics and characterized stool metabolites present in 35 AD versus 35 propensity matched healthy controls. In our ongoing work, we are longitudinally characterizing resting peripheral immune cell populations by flow cytometry and gut microbiome composition by metagenomic sequencing. Result: We have identified an increase in the metabolites methionine sulfone (1.46 fold, p<0.05), homocysteine (1.67 fold, p<0.05), and cysteine (1.33 fold, p<0.05) in the stool of older adults with AD compared to controls. Among the population of AD patients experiencing cognitive decline, determined by increasing ADAS‐Cog score >6 points over one year (n = 7 declining vs n = 8 stable cognition), we have identified increases in the bacterial genes responsible for methionine production at the point of cognitive decline compared to previous timepoints and between patients with decline versus stable cognition. In accordance with the role of methionine in promoting immune cell proliferation and differentiation, we have compared the composition of peripheral immune cells among adults with declining versus stable cognition and identified a decrease in CD4+/CD62L+ naïve T cells (percent of CD4+ lymphocytes, stable 0.3055 vs declining 0.0955, p = 0.0042) and increased effector memory CD4+ T cells (percent of CD4+ lymphocytes, stable = 0.2375 vs declining = 0.4164, p = 0.0225). Conclusion: This longitudinal clinical study identifies changes in stool metabolites and resting peripheral T cell populations in AD patients and among AD patients with cognitive decline. We propose that gut bacterial produced methionine acts to promote peripheral immune differentiation and dysfunction, leading to cognitive decline in AD. [ABSTRACT FROM AUTHOR]

Background: In Alzheimer's disease (AD), changes in intestinal microbiota and systemic inflammation are concomitant with neuroinflammation and cognitive decline. This has led to the theory of microbial communities or infections as being causative in the development of neuroinflammation and immunosenescence seen in AD. Our research has demonstrated a decreased taxonomic diversity and an increased abundance of pathobionts in the gut of AD patients (Haran, mBio 2019), which is sufficient to promote amyloid and tau deposition in a mouse model (Chen, Gut 2023). It is unclear, however, if effects from the AD microbiome on the central nervous system can be mitigated. Here, we propose a protective mechanism where bacterial metabolites influence cognition via estrogen signaling. Method: We have performed gut microbiome profiling on a cohort of 178 nursing home residents and used in vitro models to quantify the effects of AD‐associated bacteria and bacterial products on inflammation. Result: We have identified a commensal bacterium, Adlercreutzia equolifaciens, to be depleted in our cohort of older adults with AD and further depleted in adults with progressive versus stable AD. A. equolifaciens metabolizes dietary isoflavones to produce (s)‐equol, a bacterial metabolite which binds to estrogen receptors. We treated cells expressing estrogen receptor beta, which is predominately expressed along the intestinal epithelium, with (s)‐equol and demonstrated (s)‐equol induces transcription of host genomic estrogen response genes (Vehicle normalized luciferase = 0.007, estradiol = 1.04, (s)‐equol = 1.23, p<0.0001). We have further demonstrated that treatment of intestinal epithelial cells with 17β‐estradiol induced the transcription of regulators of the innate immune response in an ERβ dependent manner (Vehicle RQ = 0.88, estradiol = 1.84, p<0.05). Finally, we have discovered that colonization with A. equolifaciens in the gut of older adults is associated with lower rates of colonization by the intestinal pathobiont Escherichia (Estimation of regression β‐coefficient = ‐1.422, p<0.05). Conclusion: Adlercreutzia equolifaciens and similar phytoestrogen‐metabolizing bacteria may protect the intestinal epithelium against bacterial invasion and subsequent systemic inflammation, thereby preventing cognitive decline. Our continuing work aims to further establish the connection between AD related neurocognitive decline, the microbiome, and immune system. A. equolifaciens is therefore a strong candidate as a microbiome‐based therapeutic acting along the gut‐brain axis in AD. [ABSTRACT FROM AUTHOR]

Objective: State‐space models are a flexible modeling approach and are often fit to ecological time series data exhibiting temporal autocorrelation. Traditionally, angler effort data collected using on‐site creel surveys are analyzed using design‐based methods. With some exceptions, state‐space models are rarely used to model creel survey data that are also generally a time series of temporally autocorrelated counts. Methods: In this study, we demonstrated how to fit state‐space models to a time series of angler counts in 11 sections of three trout fisheries in Idaho. The basic model was extended to make inference about processes that may regulate angling dynamics, such as "population growth rate" of angling effort and recreational carrying capacity. Result: Estimated angling effort varied from 21,179 h in the lowermost section of the Henrys Fork Snake River to 199,457 h in the uppermost section of the South Fork Snake River. The finite population growth rate of angling effort was 1.82 when transitioning from a weekday to a weekend, suggesting that angling effort was 1.82 times greater, on average, on Saturdays than on Fridays, and the population growth rate was 0.38 (i.e., 0.38 times smaller) when transitioning from a Sunday to a Monday. Estimated carrying capacity among fishery sections varied from 129 daily hours of angling effort on the Big Lost River to 693 h on the middle section of the South Fork Snake River. Carrying capacity was 1.88 times higher on fishery sections that had ≥0.5 access points/km than on sections with <0.5 access points/km. Conclusion: The state‐space models used in this study can be modified or extended to fit a variety of data types or can be used to evaluate additional hypotheses regarding the angling process. Impact statementState‐space models are a flexible modeling approach that are rarely applied to angling effort data. Here we demonstrated how to fit various types of state‐space models to angling effort data and evaluated hypotheses regarding angling effort. Catch rates had little effect on recreational carrying capacity, but carrying capacity was 1.88 times higher in fishery sections with high access compared to low access. [ABSTRACT FROM AUTHOR]

Neutrophils are an essential component of the innate immune system; however, uncontrolled neutrophil activity can lead to inflammation and tissue damage in acute and chronic diseases. Despite inclusion of neutrophil presence and activity in clinical evaluations of inflammatory diseases, the neutrophil has been an overlooked therapeutic target. The goal of this program was to design a small molecule regulator of neutrophil trafficking and activity that fulfilled the following criteria: (a) modulates neutrophil epithelial transmigration and activation, (b) lacks systemic exposure, (c) preserves protective host immunity, and (d) is administered orally. The result of this discovery program was ADS051 (also known as BT051), a low permeability, small molecule modulator of neutrophil trafficking and activity via blockade of multidrug resistance protein 2 (MRP2)‐ and formyl peptide receptor 1 (FPR1)‐mediated mechanisms. ADS051, based on a modified scaffold derived from cyclosporine A (CsA), was designed to have reduced affinity for calcineurin with low cell permeability and, thus, a greatly reduced ability to inhibit T‐cell function. In cell‐based assays, ADS051 did not inhibit cytokine secretion from activated human T cells. Furthermore, in preclinical models, ADS051 showed limited systemic absorption (<1% of total dose) after oral administration, and assessment of ADS051 in human, cell‐based systems demonstrated inhibition of neutrophil epithelial transmigration. In addition, preclinical toxicology studies in rats and monkeys receiving daily oral doses of ADS051 for 28 days did not reveal safety risks or ADS051‐related toxicity. Our results to date support the clinical development of ADS051 in patients with neutrophil‐mediated inflammatory diseases. [ABSTRACT FROM AUTHOR]

Restoration in dryland ecosystems often has poor success due to low and variable water availability, degraded soil conditions, and slow plant community recovery rates. Restoration treatments can mitigate these constraints but, because treatments and subsequent monitoring are typically limited in space and time, our understanding of their applicability across broader environmental gradients remains limited. To address this limitation, we implemented and monitored a standardized set of seeding and soil surface treatments (pits, mulch, and ConMod artificial nurse plants) designed to enhance soil moisture and seedling establishment across RestoreNet, a growing network of 21 diverse dryland restoration sites in the southwestern USA over 3 years. Generally, we found that the timing of precipitation relative to seeding and the use of soil surface treatments were more important in determining seeded species emergence, survival, and growth than site‐specific characteristics. Using soil surface treatments in tandem with seeding promoted up to 3× greater seedling emergence densities compared with seeding alone. The positive effect of soil surface treatments became more prominent with increased cumulative precipitation since seeding. The seed mix type with species currently found within or near a site and adapted to the historical climate promoted greater seedling emergence densities compared with the seed mix type with species from warmer, drier conditions expected to perform well under climate change. Seed mix and soil surface treatments had a diminishing effect as plants developed beyond the first season of establishment. However, we found strong effects of the initial period seeded and of the precipitation leading up to each monitoring date on seedling survival over time, especially for annual and perennial forbs. The presence of exotic species exerted a negative influence on seedling survival and growth, but not initial emergence. Our findings suggest that seeded species recruitment across drylands can generally be promoted, regardless of location, by (1) incorporation of soil surface treatments, (2) employment of near‐term seasonal climate forecasts, (3) suppression of exotic species, and (4) seeding at multiple times. Taken together, these results point to a multifaceted approach to ameliorate harsh environmental conditions for improved seeding success in drylands, both now and under expected aridification. [ABSTRACT FROM AUTHOR]

Many population metrics for wild steelhead Oncorhynchus mykiss are unquantified due to complex early life history strategies and a lack of juvenile age data. Juvenile steelhead can rear in freshwater systems for up to 7 years, with overlapping size distributions among age‐classes. As logistics for sampling and aging fish can be challenging, there are benefits to utilizing age–length keys (ALKs). We examined the potential benefits of applying ALKs to unaged juvenile steelhead from a rotary screw trap and to determine whether stratifying trapping data by season could improve accuracy in assigning ages to unaged fish. Additionally, we examined the effects of reducing samples of aged fish using a uniform sampling design in which there was a fixed number of aged fish across all length intervals of the size distributions. Using a leave‐one‐out cross validation method with aged fish, we found that ALKs assigned unbiased ages to unaged fish. When including fish with assigned ages from ALKs, results of mean length‐at‐age and brood year abundance estimates between using proportional‐sampled aged fish and uniform‐sampled aged fish were comparable. Typically, absolute differences in estimated brood year abundances were improved if age‐assigned fish were included, and mean absolute error did not exceed 0.4 years for any of the methods examined. Although seasons had a significant effect on mean length at age, overall brood year estimates of juvenile abundance derived from stratifying data by season did not notably differ from pooling summer and fall seasons together, likely because there was a higher portion of juveniles emigrating in the fall compared to the summer. Age–length keys can benefit trapping operations and aid in filling data gaps in age‐based movement and survival for steelhead by being able to accurately assign ages to unaged fish and include more data for population analyses. [ABSTRACT FROM AUTHOR]

Pest control methods that can target pest species with limited environmental impacts are a conservation and economic priority. Species‐specific pest control using RNA interference is a challenging but promising avenue in developing the next generation of pest management. We investigate the feasibility of manipulating a biological invader's immune system using double‐stranded RNA (dsRNA) in order to increase susceptibility to naturally occurring pathogens. We used the invasive Argentine ant as a model, targeting the immunity‐associated genes Spaetzle and Dicer‐1 with dsRNA. We show that feeding with Spaetzle dsRNA can result in partial target gene silencing for up to 28 days in the laboratory and 5 days in the field. Dicer‐1 dsRNA only resulted in partial gene knockdown after 2 days in the laboratory. Double‐stranded RNA treatments were associated with significant gene expression disruptions across immune pathways in the laboratory and to a lower extent in the field. In total, 12 viruses and four bacteria were found in these ant populations. Some changes in viral loads in dsRNA‐treated groups were observed. For example, Linepithema humile Polycipivirus 2 (LhuPCV2) loads increased after 2 days of treatment with Spaetzle and Dicer‐1 dsRNA treatments in the laboratory. After treatment with the dsRNA in the field, after 5 days the virus Linepithema humile toti‐like virus 1 (LhuTLV1) was significantly more abundant. However, immune pathway disruption did not result in a consistent increase in microbial infections, nor did it alter ant abundance in the field. Some viruses even declined in abundance after dsRNA treatment. Our study explored the feasibility of lowering a pest's immunity as a control tool. We demonstrate that it is possible to alter immune gene expression of pest species and pathogen loads, although in our specific system the affected pathogens did not appear to influence pest abundance. We provide suggestions on future directions for dsRNA‐mediated immune disruption in pest species, including potential avenues to improve dsRNA delivery as well as the importance of pest and pathogen biology. Double‐stranded RNA targeting immune function might be especially useful for pest control in systems in which viruses or other microorganisms are prevalent and have the potential to be pathogenic. [ABSTRACT FROM AUTHOR]

Residual limb pain (RLP) and phantom limb pain (PLP) profoundly affect the lives of many individuals who have undergone lower- or upper-extremity amputation. Despite the considerable impact of RLP/PLP on quality of life in persons with amputation, there have been few attempts to evaluate the efficacy of percutaneous interventions in the treatment of RLP and/or PLP. This narrative review evaluates the effectiveness of percutaneous treatments for RLP and/or PLP in patients after lower-extremity amputation. Peripheral nerve stimulation, alcohol neurolysis, conventional thermal radiofrequency ablation, perineural corticosteroid injection, botulinum toxin injection, and etanercept injection were associated with varying success rates. Wide confidence intervals and small treatment cohorts impede assessments of overall success. High-quality studies of nonsurgical, percutaneous treatments for RLP and/or PLP are lacking. Welldesigned randomized controlled trials and large cohort studies with comparison groups using validated outcomes are needed to determine the effectiveness of nonsurgical interventions for the treatment of RLP and PLP. [ABSTRACT FROM AUTHOR]

Henrys Lake, Idaho, supports a popular fishery for Yellowstone Cutthroat Trout Oncorhynchus clarkii bouvieri and Yellowstone Cutthroat Trout × Rainbow Trout O. mykiss hybrids. A majority of the adult population of fish in Henrys Lake are of hatchery origin that were stocked as fingerlings. The fishery is closed to angling during the late winter and spring months, but fisheries managers are considering opening the fishery year‐round with catch‐and‐release‐only regulations or with a two‐fish bag limit during the extended season. However, there is concern that the proposed management actions may negatively affect the current fishery. Therefore, we developed an integrated catch‐at‐age model to estimate population parameters for trout in Henrys Lake and used a simulation model to evaluate alternative management actions. Results of this study suggest that catch and release of both Yellowstone Cutthroat Trout and hybrids would increase and that abundance of trout in the spring (i.e., the start of the traditional season) would decrease under both proposed bag limits. Losses in abundance can be mitigated by stocking additional fish as long as no more than approximately 1,520,000 Yellowstone Cutthroat Trout are stocked annually. If catch‐and‐release‐only regulations are implemented during the newly proposed season, total harvest is expected to decrease compared to the current fishery due to additional catch‐and‐release mortality. Ultimately, managers will need to prioritize harvest or catch‐and‐release opportunity, both of which provide additional utility to anglers, when choosing how to proceed with bag limit regulations. [ABSTRACT FROM AUTHOR]

The AT(N) research framework categorizes eight biomarker profiles using amyloid (A), tauopathy (T), and neurodegeneration (N), regardless of dementia status. We evaluated associations with dementia risk in a community‐based cohort by approximating AT(N) profiles using autopsy‐based neuropathology correlates, and considered cost implications for clinical trials for secondary prevention of dementia based on AT(N) profiles. We used Consortium to Establish a Registry for Alzheimer's Disease (moderate/frequent) to approximate A+, Braak stage (IV‐VI) for T+, and temporal pole lateral ventricular dilation for (N)+. Outcomes included dementia prevalence at death and incidence in the last 5 years of life. A+T+(N)+ was the most common profile (31%). Dementia prevalence ranged from 14% (A–T–[N]–) to 79% (A+T+[N]+). Between 8% (A+T–[N]–) and 68% (A+T+[N]–) of decedents developed incident dementia in the last 5 years of life. Clinical trials would incur substantial expense to characterize AT(N). Many people with biomarker‐defined preclinical Alzheimer's disease will never develop clinical dementia during life, highlighting resilience to clinical expression of AD neuropathologic changes and the need for improved tools for prediction beyond current AT(N) biomarkers. [ABSTRACT FROM AUTHOR]

Summary: Rectal bleeding occurs in about 40% of pregnant women, and is predominantly attributed to benign perianal pathology (haemorrhoids or anal fissures).More sinister causes of rectal bleeding may be heralded by key red flag clinical and biochemical features. These features should be evaluated in all women with rectal bleeding. Imaging investigations or flexible sigmoidoscopy may be warranted. The latter can be performed safely by experienced operators in pregnant women.Women with evidence of haemodynamic compromise, elevated inflammatory markers, significant anaemia, signs of intestinal obstruction or compromise to the fetus should be evaluated urgently. Providers must be mindful of the changes in normal ranges for common haematological and biochemical parameters in pregnancy compared with the non‐pregnant state.Faecal calprotectin is an established tool for identification of intestinal inflammation and is valid in pregnancy. An elevated faecal calprotectin level (≥ 50 µg/g) signifies a need for further diagnostic evaluation.Inflammatory bowel disease may present initially, or with worsening disease activity, in pregnancy. Expedient diagnosis with the use of faecal calprotectin, sigmoidoscopy with or without intestinal ultrasound, exclusion of alternative or compounding infective aetiologies, and institution of appropriate therapy are critical. Medical therapies for management of inflammatory bowel disease can be safely instituted in pregnancy.Colorectal cancer incidence is increasing in younger age groups, but fortunately remains rare. When diagnosed in pregnancy, colorectal cancer can be successfully and safely managed with a collaborative multidisciplinary team approach. Early diagnosis is key to optimising outcomes. [ABSTRACT FROM AUTHOR]

Recent declines in abundance of Yellowstone Cutthroat Trout Oncorhynchus clarkii bouvieri in the upper Blackfoot River drainage in Idaho coincided with establishment of a nearby nesting colony and increased abundance of American white pelicans Pelecanus erythrorhynchos (hereafter, "pelicans"). Published pelican predation rates have been estimated to be as high as 70% on Yellowstone Cutthroat Trout in the Blackfoot River. Consequently, the Idaho Department of Fish and Game established management objectives for pelicans of less than 350 breeding pairs or 700 adults. However, a thorough assessment has not been conducted to evaluate if the pelican abundance objective would reduce predation to an extent that would allow Yellowstone Cutthroat Trout to recover to levels that meet minimum objectives for abundance. A Bayesian state‐space model that integrated survival and abundance data was used in this study to evaluate the effects of local pelican abundance on survival, abundance, and population growth rate of Yellowstone Cutthroat Trout. Survival of both juvenile and adfluvial adult Yellowstone Cutthroat Trout decreased as pelican abundance increased, and there was a positive relationship between survival of both life stages and population growth rate. If the current management objective for abundance of 700 breeding pelicans was met, the probability of meeting or exceeding the Yellowstone Cutthroat Trout objective was 0.44 and declined substantially as simulated pelican abundance increased beyond 700. Results of this study suggest that if pelican abundance can be maintained at or below the current management objective, there is a reasonable chance of meeting the management objective for Yellowstone Cutthroat Trout. [ABSTRACT FROM AUTHOR]

Background: Physician decision‐making surrounding choices for large joint and bursa injections is poorly defined, yet influences patient safety and treatment effectiveness. Objective: To identify practice patterns and rationale related to injectate choices for large joint and bursal injections performed by physician members of the American Medical Society for Sports Medicine (AMSSM). Design: An electronic survey was sent to 3400 members of the AMSSM. Demographic variables were collected: primary specialty (residency), training location, practice location, years of clinical experience, current practice type, and rationale for choosing an injectate. Participants: A total of 674 physicians responded (minimum response rate of 20%). Intervention: Not applicable. Main Outcome Measures: Outcomes of interest included corticosteroid type and dose, local anesthetic type, and total injectate volume for each large joint or bursa (hip, knee, and shoulder). Results: Most respondents used triamcinolone (50% to 56% of physicians, depending on injection location) or methylprednisolone (25% to 29% of physicians), 21 to 40 mg (53% to 60% of physicians), diluted with lidocaine (79% to 87%) for all large joint or bursa injections. It was noted that 36.2% (244/674) of respondents reported using >40 mg for at least one injection type. Most (90.5%, 610/674) reported using an anesthetic other than ropivacaine for at least one type of joint or bursa injection. Physicians who reported lidocaine use were less likely to report that their injectate choice was based on the literature that they reviewed (odds ratio [OR] 0.41 [0.27‐0.62], P <.001). Respondents predominantly used 5 to 7 mL of total injectate for all large joints or bursae (45% to 54% of respondents), except for the pes anserine bursa, where 3‐4 mL was more common (51% of physicians). Conclusions: It appears that triamcinolone and methylprednisolone are the most commonly used corticosteroids for sports medicine physicians; most physicians use 21 to 40 mg of corticosteroid for all injections, and lidocaine is the most‐often used local anesthetic; very few use ropivacaine. Over one‐third of respondents used high‐dose (>40 mg triamcinolone or methylprednisolone) for at least one joint or bursa. [ABSTRACT FROM AUTHOR]

Key Takeaways: So that employees are empowered to assess workplace issues and implement a continuous‐improvement framework, Denver Water adopted the Lean methodology in 2011. With its goal of renewing or replacing aging infrastructure, Denver Water designed Northwater Treatment Plant as a key element in its North System Renewal Program. Denver Water held Lean‐supported workshops to glean input from its key stakeholders, including several of its operational departments. Lean workshops led to rightsizing of treatment plant capacity and multiple improvements in operational and management strategies for enhanced system resilience. [ABSTRACT FROM AUTHOR]

Managing fisheries for species of conservation concern, such as steelhead Oncorhynchus mykiss fisheries in Idaho where wild steelhead are incidentally caught and released, requires a tradeoff between providing opportunity for anglers to fish for hatchery‐origin steelhead and managing conservation risk for wild steelhead. Understanding population‐level effects of catch‐and‐release fishing is critical for effectively balancing this tradeoff. We used an integrated population model to evaluate population‐level effects of incidental catch‐and‐release mortality on steelhead in Idaho and assessed the effectiveness of alternative management strategies for meeting fishery and population objectives. When simulated catch‐and‐release mortality or encounter rates were low, fishery, abundance, and conservation risk objectives were easily met by implementing fisheries annually, regardless of adult abundance. However, when simulated catch‐and‐release mortality rates were high, management strategies that required the population to surpass minimum thresholds for pre‐season abundance were more likely to meet goals for minimizing conservation risk but limited fishing opportunity substantially. Results of this study provide managers with a framework that can be used to manage fisheries to meet fishery goals in the form of hatchery steelhead harvest while maintaining sustainable populations and minimizing risk to wild steelhead. The results also suggest that when implemented properly, it is possible to meet fisheries and conservation objectives simultaneously. [ABSTRACT FROM AUTHOR]

The introduction and subsequent spread of Common Carp Cyprinus carpio throughout the world represent one of the most destructive and pervasive forces impacting aquatic ecosystems. Herein we use computer simulations to predict if stocking YY male carp in conjunction with manual netting or piscicide use could eradicate invasive Common Carp populations. Two forms of YY males were evaluated, including sperm‐producing (MYY) and egg‐producing (FYY) fish. A stochastic individual‐based population model was used to evaluate the effects of simulated management actions on both the abundance and extirpation probabilities of high‐ and low‐density populations. Results predicted that some YY male stocking scenarios alone could eradicate carp populations. For example, when stocking FYY carp into low‐density populations, predicted extirpation probabilities exceeded 0.87 when stocking at least 50 carp/ha was maintained for at least 10 years. Additionally, a one‐time use of rotenone (to reduce the virtual population by 90%) plus stocking at least 50 FYY carp/ha for at least 5 years into low‐density populations resulted in predicted extirpation probabilities exceeding 0.88. Favorable extirpation probabilities were also obtained by combining YY male stocking and either selective (i.e., no culling of stocked YY males) or non‐selective annual suppression. For example, FYY stocking with only 10% sustained, non‐selective suppression yielded extinction probabilities exceeding 95% in 15 years, while increasing suppression levels to 50% resulted in extirpation probabilities over 95% within 5 years. Without exception, MYY stocking functioned far less efficiently in simulations than FYY stocking, but MYY carp did work in a small subset of low‐density scenarios and may also have prophylactic utility where prior eradication has occurred and where there is a high risk of re‐invasion. We conclude that stocking of YY male Common Carp is worthy of field testing, but additional simulations are needed to explore other questions not addressed in this study. [ABSTRACT FROM AUTHOR]

The South Fork Snake River supports one of the few remaining robust populations of fluvial Yellowstone Cutthroat Trout Oncorhynchus clarkii bouvieri in Idaho. Since the early to mid‐2000s, salmonid populations on the South Fork Snake River have been intensively monitored and managed to limit the abundance of introduced Rainbow Trout O. mykiss, which have been increasing in abundance relative to Yellowstone Cutthroat Trout. Integrated population models (IPMs) were built using multiple data sets (abundance, survival, and fecundity data) to evaluate the effectiveness of management actions. Modeling results suggested that Yellowstone Cutthroat Trout survival at ages 0 and 2 was influenced by inter‐ and intracohort competition with both adult Rainbow Trout and adult Yellowstone Cutthroat Trout. Decreasing minimum winter discharge from Palisades Reservoir appeared to negatively affect the population growth rate of Yellowstone Cutthroat Trout; however, the effect on survival of individual life stages was minimal. Use of the IPM allowed for evaluation of life‐stage‐specific dynamics that would be lacking when using alternative analytical methods. It is apparent from the results of this study that the population bottlenecks for Yellowstone Cutthroat Trout in the South Fork Snake River occurred at ages 0 and 2 as a result of inter‐ and intraspecific density‐dependent mechanisms. Thus, management actions that target these life stages should be continued or expanded. [ABSTRACT FROM AUTHOR]

Background: Epidural steroid injections (ESI) are commonly used to treat refractory radicular spinal pain. Although evidence suggests that an increasing cumulative dose of exogenous corticosteroid may be harmful, knowledge of current practice patterns is limited regarding the choice of dose and frequency of epidural steroid injections (ESIs).Objective: Describe current practice trends in the dose selection and frequency of administration of transforaminal ESIs (TFESIs) and interlaminar ESIs (ILESIs).Design: Cross-sectional survey study.Setting: Not applicable.Participants: Three hundred fourteen physician members of the Spine Intervention Society (SIS). From May to June 2018, an online survey was distributed to 5907 physician members of the SIS.Interventions: Not applicable.Main Outcome Measures: Corticosteroid dose used by practitioners and the number of annual ESIs administered per patient.Results: Three hundred fourteen physicians responded to the survey. For single cervical or lumbar injections of dexamethasone, most physicians (56.0%) reported using 10 mg; 17% of physicians reported use of doses greater than 10 mg, with 6% using a dose of 20 mg per injection level. The most common particulate corticosteroid dose used during both cervical and lumbar ILESIs was 80 mg (cervical = 55.4%, lumbar = 54.7%). During cervical and lumbar ILESIs, 17% and 12.7% of physicians reported using doses greater than 80 mg, respectively. Almost 10% of physicians reported performing cervical TFESIs with particulate steroids. Forty percent of physicians reported allowing four ESIs at a given spinal segmental level per year (cervical/thoracic/lumbosacral). A small percentage of physicians reported allowing more than six ESIs annually (6%) and >10 injections annually (1%).Conclusions: There is considerable variability among this large cohort of interventionists with regard to corticosteroid dose selection and epidural steroid injection frequency. A small proportion of respondents reported Mulitsociety Pain Workgroup guideline-discordant use of particulate steroids during cervical TFESIs. These findings demonstrate a need for additional research regarding both the reasons for such variation in care and the reasons for guideline-discordant practice in a subset of physicians.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Steelhead Oncorhynchus mykiss exhibit significant variation in life histories. Dworshak National Fish Hatchery (NFH)‐stock steelhead exhibit a life history that is unique compared to other Columbia River basin hatchery summer steelhead stocks, as it is dominated by older and larger‐length fish relative to conspecifics. We evaluated changes within the Dworshak NFH stock's ocean age composition and length at age from run years 1978 to 2016 using samples collected from the commercial gill‐net fishery, the sport fishery, and the hatchery trap. In addition, we analyzed the genetic composition of the stock by comparing samples collected in 1969 from the wild founding stock to samples from recent returns. We found that Dworshak NFH steelhead became younger across the study, with fewer of the oldest, three‐ocean fish (i.e., rearing in the ocean for 3 years) and increases in the proportion of the population returning as one‐ocean fish (i.e., rearing in the ocean for 1 year). Length at ocean age decreased for all ocean ages; however, the decrease was not significant in one‐ocean fish. In general, samples collected from gill nets and the sport fishery contained fish with older ocean ages and larger sizes at age compared to samples collected from the hatchery trap. Neutral genetic diversity, as measured from a panel of single‐nucleotide polymorphic markers, showed no changes between the sample of fish representing the original founders and the present‐day population. Life history shifts observed in Dworshak NFH‐stock steelhead were likely influenced by a variety of factors, including gear selectivity and changing ocean conditions. Decreases in ocean age composition and length at age have implications for both fishery and broodstock management as well as generating concern that similar trends may be occurring within wild steelhead stocks. [ABSTRACT FROM AUTHOR]

Early evidence from clinical trials suggests effectiveness of fluoroscopically guided genicular nerve radiofrequency ablation (RFA) for the treatment of chronic knee pain due to osteoarthritis.[1] One small sham-controlled study has demonstrated efficacy of this procedure.[2] Additionally, there is interest in the use of genicular RFA for the treatment of persistent chronic knee pain after total knee arthroplasty, though efficacy has yet to be demonstrated.[3] This procedure is indicated for patients with symptoms recalcitrant to conservative treatments including physical therapy, bracing, intra-articular injections of corticosteroid, or viscosupplement injection, and when arthroplasty has failed, is contraindicated, or is undesired. In fact, it is likely that pes anserine tendon ablation may be an underrecognized complication of cooled genicular nerve RFA, potentially mistaken for standard postprocedure pain and stiffness. This is a novel report of pes anserine tendon damage resulting from a cooled genicular nerve RFA performed according to a commonly used procedure protocol. [Extracted from the article]

Removing this hair from the skin prior to EDP placement may have prevented the burn, as the EDP would have more likely adhered uniformly to the skin, which increases contact surface area and disperses heat more effectively. The individual removing the EDP should survey the skin under the EDP and communicate abnormal skin findings to ensure early skin burn care if necessary. Until now and despite frequent use of RFN for the treatment of chronic pain conditions, skin burns at the site of the EDP have been theoretical. This novel case provides evidence that such skin burns are possible during common pain management RFN procedures and highlights the importance of utilizing risk-mitigation strategies to prevent this complication. [Extracted from the article]

Radiofrequency ablation (RFA) of the sacral lateral branches targets the innervation of the posterior sacroiliac ligaments and posterior portion of the sacroiliac joint, also referred to as the posterior sacroiliac joint complex. This review assesses the published evidence on local anesthetic blocks for the diagnosis of posterior sacroiliac joint complex pain and the efficacy of RFA of the sacral lateral branches as a treatment. The current evidence suggests that RFA can provide relief of pain that originates from the posterior sacroiliac joint complex, but interpretation of this literature is limited by variability in patient selection criteria, the specific nerves targeted for ablation, and the types of RFA technology and technique utilized. [ABSTRACT FROM AUTHOR]

Injections into the intraarticular sacroiliac joint (SIJ) are commonly done for both diagnostic and therapeutic reasons. Injection of an anesthetic can aid in the diagnosis of SIJ pain. Corticosteroids can be administered with the goal of providing a therapeutic effect. This article summarizes the literature regarding the diagnostic and therapeutic effects of these injections. It includes a review of the various imaging modalities including fluoroscopy, ultrasound, and computed tomography guidance, as well as a discussion on the prevalence data and other variables that may affect the reported outcomes. [ABSTRACT FROM AUTHOR]

Accurate diagnosis of sacroiliac joint (SIJ) pain is challenging. Diagnosis can be aided by pain referral patterns, historical features, physical examination maneuvers, and imaging. However, all of these diagnostic tools have limitations. The most reliable clinical tools may be a combination of three or more positive physical exam maneuvers, although the evidence is inconsistent even for this strategy. Intra-articular diagnostic SIJ injections are often used as the reference standard for "true" sacroiliac pain. However, such injections do not consider extra-articular sources of pain that may also exist as part of the sacroiliac joint complex. Research has established the posterior sacral ligaments as a possible source of pain, and the innervation of these ligaments has been anatomically defined. It is possible that by expanding our focus from the articular portion of the sacroiliac complex structure to both the joint and extra-capsular ligaments, advancements in clinical diagnosis and treatment will be possible. [ABSTRACT FROM AUTHOR]

The physiological challenge for anadromous fish to migrate upriver is influenced by river temperature, but the impacts of river temperature can be difficult to predict due to an incomplete understanding of how temperature influences migration costs, especially in high‐latitude (>60°N) ecosystems. To assess temperature influences on migrating Pacific salmon Oncorhynchus spp., we measured heat shock protein 70 (HSP70), as an indicator of cellular stress, and energy content of Sockeye Salmon Oncorhynchus nerka throughout their upriver migration in the Pilgrim River, Alaska. Although HSP70 was elevated as fish moved to the spawning grounds and was higher in fish with low energy content, HSP70 did not increase with warmer river temperatures. We verified in an experiment that HSP70 abundance in Sockeye Salmon does respond to temperatures above 20.5°C. Over the 4 years of sampling, energy content decreased at similar rates as Sockeye Salmon moved upstream. We expected Sockeye Salmon energy levels would be lower when migrating in warmer river temperatures; however, we found higher energy levels occurred with higher temperatures in the Pilgrim River. We hypothesize that the relationship between temperature and energy content is due to river temperatures often occurring below optimal temperatures for migration. Lower temperatures could be energetically costly or reduce migration rates, both of which would result in lower energy content with cooler temperature. Understanding interactions between environmental drivers and physiological responses will help managers anticipate future changes for Sockeye Salmon at the northern edge of their distribution. [ABSTRACT FROM AUTHOR]

Objective: To systematically evaluate the scientific literature examining the effect of corticosteroid type, dose, and volume of small- and intermediate-size joint injections on pain and function. TYPE: Narrative review.Literature Survey: Medline (PubMed), Cochrane Central Register of Controlled Trial, and SportDiscus databases were searched.Methodology: Inclusion criteria included prospective studies evaluating pain- and/or function-related improvements following a corticosteroid injection of a small- or intermediate-size joint.Synthesis: A total of 28 articles were included, all studying patients with osteoarthritis and/or rheumatoid arthritis. Eleven studies were randomized-controlled trials comparing corticosteroid injections to a control treatment and three were randomized trials comparing corticosteroid dose or type; the rest were prospective case series without a control. Most studies used 10 to 20 mg of methylprednisolone or triamcinolone for small joints and 20 to 40 mg for intermediate joints; wrist joints were the only joint studied that directly compared doses-20 mg was noninferior to 40 mg. Triamcinolone hexacetonide was found to be superior to methylprednisolone in the interphalangeal finger joints in a single randomized-controlled trial; no other studies compared steroid types in any joint. No studies evaluated the effect of volume on clinical outcomes.Conclusions: Very few studies directly examine the effect of corticosteroid type, corticosteroid dose, or injectate volume on clinical outcomes for small- or intermediate-size joint arthralgia. Future studies are needed to better elucidate the most effective treatment protocols.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

In recent years, increased scrutiny has been placed on the physiological effects of exhaustive exercise and air exposure on caught‐and‐released fish. Steelhead Oncorhynchus mykiss broodstock in the South Fork Clearwater River, Idaho, were collected by anglers during a winter fishery (water temperatures of 2–5°C); this enabled fight and air exposure times to be recorded to determine their influence on prespawn survival and progeny survival to the fry stage in the hatchery. The average fight time during angling was 164 s. Air exposure was measured when anglers landed fish and again during fish transport from the river to the hatchery vehicle; the longest interval of air exposure averaged 23 s during angling and 28 s during transport. Three‐year average prespawn survival was 97.0% for 1,148 angler‐caught fish, compared to 91.9% for 3,325 swim‐in broodstock collected at the hatchery. The top mixed‐effects logistic regression model estimated that the odds of progeny survival increased by 1.027 times with each additional day of the year until an adult fish spawned; this was likely a reflection of peak spawn time in the hatchery. Fight time and air exposure time did not influence progeny survival or prespawn mortality of adult steelhead captured by anglers. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) is a progressive neurocognitive disease characterized by amyloid beta plaques and neurofibrillary tangles in the brain along with inflammation both in the brain and systemically. This has led to the theory of microbial communities or infections as being causative in the development of neuroinflammation as well as immunosenescence and inflamm‐aging seen in AD. Our own research has demonstrated a decreased abundance of anti‐inflammatory taxa and an increased abundance of pro‐inflammatory taxa in the gut microbiome of AD patients. However, it is unclear how the AD microbiome exerts effects on the central nervous system. Method: We have performed gut microbiome profiling, analysis of immune cell populations in serum, blood cytokine profiling, and cognitive assessments of AD older adults at 90‐day intervals. Result: In our early data collected from this ongoing study we have observed changes in B‐cell populations with an increased abundance of class‐switched B‐cells in older adults with greater levels of cognitive impairment (Spearman R = 0.33, p = 0.001). We have further demonstrated that fecal transfer of the microbiome of older adults with AD into mice promotes B‐cell class‐switching when compared with cognitively impaired older adults without AD (Percent total B‐cells, AD 75.12 (SD 10.41) vs ND 50.02 (SD 11.90) p<0.016). Additionally, we have discovered a loss of phytoestrogen‐metabolizing bacteria such as Adlercreutzia equolifaciens among AD older adults with rapidly progressing dementia. Phytoestrogens have been previously identified in protecting the intestinal epithelium from oxidative stress and epithelial permeability. Our work suggests that that the phytoestrogen (s)‐equol, produced by A. equolifaciens, confers resistance to epithelial damage in the setting of oxidative stress and bacterial lipopolysaccharide. Conclusion: We propose that Adlercreutzia equolifaciens and similar phytoestrogen‐metabolizing bacteria will better maintain epithelial homeostasis in the setting of inflammation while a gain of pro‐inflammatory taxa in AD leads to intestinal barrier disruption. This leads to increased antigen presentation, immune cell dysregulation, and ultimately cognitive decline. This continuing work aims to further establish the connection between AD related neurocognitive decline, the microbiome, and immune system. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) is the most common type of dementia which results in debilitating memory loss as the disease advances. In addition to the amyloid plaques, tau tangles, and neuronal inflammation characteristic of AD, there is strong evidence of dysregulation in the peripheral immune system, including decreased naïve T cells and increased memory T cells among older adults with AD. However, the involvement of the peripheral immune system in the neurodegenerative cascade leading to AD is poorly understood. Furthermore, among older adults with AD, some may experience rapid cognitive decline while others may maintain a stable cognitive status for years. It is currently unknown whether dysfunction in the peripheral immune system is associated with neuronal inflammation and cognitive decline. Method: In our ongoing work, we are longitudinally characterizing resting peripheral immune system cells by flow cytometry and here present data from a subset of those with AD (n = 19) or no dementia (ND, n = 93) whom we have followed for >1 year. Result: We have identified an increase in B cells (percent all lymphocytes, AD 6.4 (SD 8.6) vs ND 4.0 (SD 2.4) p = 0.031) and CD4+/CD62L+ naïve T cells (percent CD4+ lymphocytes, AD 33.4 (SD 18.4) vs ND 25.4 (SD 14.1) p = 0.034) among AD patients. Among the population of AD patients experiencing cognitive decline (n = 4) determined by increasing ADAS‐Cog score >6 points over one year compared to stable scores (n = 11), we have discovered a decrease in CD4+/CD62L+ naïve T cells (percent CD4+ lymphocytes, stable 33.9 (SD 14.5) vs declining 20.5 (SD 16.1) p = 0.049), increase in effector memory CD4+ T cells (percent CD4+ lymphocytes, stable 28.2 (SD 4.8) vs declining 47.0 (SD 6.5) p<0.001), and increase in B cells (percent all lymphocytes, stable 2.6 (SD 1.5) vs declining 5.3 (SD 1.8) p = 0.010), when compared to older adults with AD and stable cognitive status. Conclusion: This longitudinal clinical study identifies changes in resting peripheral B and T cell populations in AD patients and among AD patients with cognitive decline. [ABSTRACT FROM AUTHOR]

Background: The relation between chronic musculoskeletal pain and joint hypermobility in a small percentage of the pediatric population is well described. However, literature discussing the treatment of chronic pain associated with joint hypermobility in pediatrics is limited. The present study examines the impact of interdisciplinary treatment on chronic pain in pediatrics with joint hypermobility syndrome.Objective: To determine if pediatric patients with chronic pain related to joint hypermobility can be effectively treated with an intensive, interdisciplinary pain management program, as measured by changes in pain, psychosocial and physical functioning, as well as parental coping.Design: Retrospective cohort study.Setting: Urban academic tertiary intensive outpatient interdisciplinary pain management clinic.Participants: The study involved 30 patients who met the criteria for a diagnosis of joint hypermobility and chronic pain and completed an interdisciplinary pain management program.Intervention: All patients were treated in an intensive pediatric interdisciplinary pain management program for a duration of 6 to 8 weeks. The program provided physical therapy, occupational therapy, psychological counseling, and weekly pediatric rehabilitation medicine follow-up.Main Outcome Measures: Outcome measures included numeric rating scale pain scores, the Bath Adolescent Pain Questionnaire, and the Bath Adolescent Pain-Parent Impact Questionnaire. Changes from pre- to post-treatment were analyzed using paired-samples t tests.Results: Patients endorsed pre- to post-treatment improvements in pain, depression, general anxiety, pain-related anxiety, social functioning, and physical functioning (P < .05). The patients' parents showed significant improvements in depression, anxiety, catastrophic thinking, self-blame and helplessness, leisure functioning, and parental behavior (P < .05).Conclusion: The present findings suggest that an intensive interdisciplinary rehabilitation pain management program yields short-term improvements in pain, emotional and physical function, and daily activity in a pediatric population diagnosed with joint hypermobility. Parents also experienced benefits from the program. A larger prospective study with longer-term follow-up is needed.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Introduction: Identifying ophthalmic diseases associated with increased risk of Alzheimer's disease (AD) may enable better screening and understanding of those at risk of AD. Methods: Diagnoses of glaucoma, age‐related macular degeneration (AMD), and diabetic retinopathy (DR) were based on International Classification of Diseases, 9th revision, codes for 3877 participants from the Adult Changes in Thought study. The adjusted hazard ratio for developing probable or possible AD for recent (within 5 years) and established (>5 years) diagnoses were assessed. Results: Over 31,142 person‐years of follow‐up, 792 AD cases occurred. The recent and established hazard ratio were 1.46 (P =.01) and 0.87 (P =.19) for glaucoma, 1.20 (P =.12) and 1.50 (P <.001) for AMD, and 1.50 (P =.045) and 1.50 (P =.03) for DR. Discussion: Increased AD risk was found for recent glaucoma diagnoses, established AMD diagnoses, and both recent and established DR. People with certain ophthalmic conditions may have increased AD risk. [ABSTRACT FROM AUTHOR]

Corticosteroid injections are commonly used in the treatment of disorders of the large joints. This review assimilates the available literature on corticosteroid injections into the glenohumeral joint, subacromial space, hip joint, and knee joint. A systematic method to review available literature revealed 84 articles that fit the inclusion criteria. For each injection location, four items were examined: overall efficacy of injection, superior type of steroid, superior dose of steroid, and superior volume of injectate. Most research demonstrates positive short-term outcomes in pain and function for corticosteroid injections of the large joints. Methylprednisolone and triamcinolone seem similar in efficacy, with minor differences seen in specific studies. Larger doses may last longer, but need to be balanced with the systemic effects from higher doses. Volume has not been studied extensively. Due to heterogeneity in study types, subject populations, and outcomes, it is not possible to identify a single defining trend for a superior type, dose, or volume of steroid. Future prospective studies examining these factors may better reveal the optimum regimen for each injection location.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Abstract: The objective of this study was to evaluate the sensitivity of exploitation estimates to tag loss estimation methods for six species of sport fish in Idaho. A discrete tag loss model and four instantaneous tag loss models were evaluated using both empirical data and a simulation approach. Empirical exploitation estimates were similar for most species when using the discrete model and all four forms of instantaneous tag loss model. Maximum differences among estimators were less than 2% for five species; however, exploitation estimates differed by as much as 17% for Walleyes Sander vitreus depending on the choice of the tag loss model. The discrete estimator of tag loss, which was computationally much easier to implement than the instantaneous models, resulted in exploitation estimates that were similar to or more accurate than the instantaneous models in the simulation. Exploitation in the simulation was underestimated by more than 1% at a minimum and by greater than 14% at maximum when tag loss was not accounted for. These results suggest that regardless of the choice of tag loss estimator, an attempt should be made to account for tag loss even for species that are expected to have a relatively short average time at liberty and relatively low tag loss over the duration of a study. [ABSTRACT FROM AUTHOR]

Introduction There may be biologically relevant heterogeneity within typical late-onset Alzheimer's dementia. Methods We analyzed cognitive data from people with incident late-onset Alzheimer's dementia from a prospective cohort study. We determined individual averages across memory, visuospatial functioning, language, and executive functioning. We identified domains with substantial impairments relative to that average. We compared demographic, neuropathology, and genetic findings across groups defined by relative impairments. Results During 32,286 person-years of follow-up, 869 people developed Alzheimer's dementia. There were 393 (48%) with no domain with substantial relative impairments. Some participants had isolated relative impairments in memory (148, 18%), visuospatial functioning (117, 14%), language (71, 9%), and executive functioning (66, 8%). The group with isolated relative memory impairments had higher proportions with ≥ APOE ε4 allele, more extensive Alzheimer's-related neuropathology, and higher proportions with other Alzheimer's dementia genetic risk variants. Discussion A cognitive subgrouping strategy may identify biologically distinct subsets of people with Alzheimer's dementia. [ABSTRACT FROM AUTHOR]

Conducting sample size analysis is important to ensure that sample sizes are adequate to meet objectives for precision but not so large that valuable resources are wasted. When simple survey designs are used, sample size analysis is straightforward. However, creel surveys often follow complex designs that can make sample size estimation difficult. The objectives of this study were to provide sample size estimators for commonly used creel survey designs and investigate sample size requirements to achieve varying levels of precision. For estimates of angling effort, the average sample size among fisheries required to achieve relative 95% confidence intervals of 40% (i.e., coefficient of variation of approximately 0.2) was 16 d (range = 7–40 d). To estimate mean catch rate with the same level of precision, 43 survey days (range = 8–95 d) were required when the daily catch rate estimator was used, and 11 d (range = 3–30 d) were required when the multi-day estimator was used. Fifty-five days (range = 14–89 d) and 57 d (range = 19–140 d) were required to estimate total catch with relative 95% confidence intervals of 40% when the daily and multi-day estimators were used, respectively. Although absolute precision will vary among fisheries, our results suggest that approximately 30 d of surveying may serve as a reasonable starting point for planning creel surveys when no prior information is available on expected sample variance, as relatively large increases in sample size beyond 30 d were needed to achieve relatively small increases in precision. Received February 14, 2017; accepted June 9, 2017 Published online August 4, 2017 [ABSTRACT FROM AUTHOR]

Background: Patients have expressed concern about undergoing procedures involving trainees, even with direct attending physician supervision. Little literature has examined the effect of trainee involvement on patient outcomes.Objective: We aimed to evaluate the effect of trainee involvement on patient complications, immediate pain reduction, and fluoroscopic time for different fluoroscopic injection types.Design: Retrospective review.Setting: Four academic outpatient institutions with Accreditation Council for Graduate Medical Education (ACGME)-accredited residency (physical medicine and rehabilitation, or anesthesiology) or fellowship (sports medicine or pain medicine) programs from 2000 to 2015.Patients: All patients receiving fluoroscopically guided hip (HI), sacroiliac joint (SIJI), transforaminal epidural (TFEI), and/or interlaminar epidural injections (ILEI, performed at only 1 institution).Methods: Outcome measures were examined based on the presence or absence of a trainee during the procedure.Main Outcome Measurements: The primary outcome was the number of immediate complications, with secondary outcomes being fluoroscopic time per injection (FTPI) and immediate numeric rating scale percentage improvement.Results: Trainees were involved in 67.0% of all injections (N = 7,833). Complication rates or improvements in numeric rating scale scores showed no significant differences with trainee involvement for any injection type (P > .05). Trainee involvement was associated with increased FTPI for ILEIs (18.2 ± 10.1 seconds with trainees versus 15.1 ± 8.5 seconds without trainees, P < .001), but not for HIs (P = .60) or SIJIs (P = .51). Trainee involvement with TFEIs was dependent on institution for outcome with respect to FTPI (P < .001), with 28.1 ± 17.9 seconds with trainees and 32.1 ± 22.1 seconds without trainees (P = 0.51).Conclusions: This large multicenter study of academic institutions demonstrates that trainee involvement in fluoroscopically guided injections does not affect immediate patient complications or pain improvement. Trainee involvement does not increase fluoroscopic time for most injections, although there is an institutional difference seen. This study supports the notion that appropriate trainee supervision likely does not compromise patient safety for fluoroscopically guided injections.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]

Introduction Findings for genetic correlates of late-onset Alzheimer's disease (LOAD) in studies that rely solely on clinic visits may differ from those with capacity to follow participants unable to attend clinic visits. Methods We evaluated previously identified LOAD-risk single nucleotide variants in the prospective Adult Changes in Thought study, comparing hazard ratios (HRs) estimated using the full data set of both in-home and clinic visits ( n = 1697) to HRs estimated using only data that were obtained from clinic visits ( n = 1308). Models were adjusted for age, sex, principal components to account for ancestry, and additional health indicators. Results LOAD associations nominally differed for 4 of 21 variants; CR1 and APOE variants were significant after Bonferroni correction. Discussion Estimates of genetic associations may differ for studies limited to clinic-only designs. Home visit capacity should be explored as a possible source of heterogeneity and potential bias in genetic studies. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate behavior and survival of radio-tagged wild and hatchery-reared landlocked Atlantic SalmonSalmo salarsmolts as they migrated past three hydropower dams equipped with fish bypass solutions in the Winooski River, Vermont. Among hatchery-reared smolts, those released early were more likely to initiate migration and did so after less delay than those released late. Once migration was initiated, however, the late-released hatchery smolts migrated at greater speeds. Throughout the river system, hatchery-reared fish performed similarly to wild fish. Dam passage rates varied between the three dams and was highest at the dam where unusually high spill levels occurred throughout the study period. Of the 50 fish that did migrate downstream, only 10% managed to reach the lake. Migration success was low despite the presence of bypass solutions, underscoring the need for evaluations of remedial measures; simply constructing a fishway is not synonymous with providing fish passage. Received July 8, 2016; accepted April 29, 2017 Published online June 30, 2017 [ABSTRACT FROM PUBLISHER]

Objective: To analyze the literature to determine whether controlled studies on percutaneous tenotomy have been published, and if so, to systematically assess the efficacy of percutaneous tenotomy for the treatment of tendinosis at the lateral epicondyle of the elbow.Design: Systematic review of the available literature.Methods: Cochrane Controlled Trials Register (CENTRAL), MEDLINE, EMBASE, CINAHL, and Web of Science databases were searched in November 2015, unrestricted by date. After the initial search, we excluded conference proceedings, theses, reviews, expert opinions, and publications written in languages other than English. Next, 2 independent reviewers screened all of the remaining records with regard to their titles and abstracts, and subsequently, the full texts of identified publications potentially relevant to the present study.Results: Six articles focused on percutaneous tenotomy, none of which were controlled against a placebo or conservative treatment group. The absence of true randomized controlled trials created a great deal of heterogeneity between the studies; thus we could not include any of our studies in the intended final quantitative analysis with meta-analysis tools. We describe all 6 studies identified by this systematic review with a detailed analysis of the procedural methods, outcome measures, and conclusions of each study.Conclusions: Percutaneous tenotomy presents an alternative to surgical release of the common extensor tendon for the treatment of chronic tendinosis at the lateral epicondyle of the elbow. Current research supporting the efficacy of this procedure, however, is of low quality (level II to level IV).Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Background: Intrathecal baclofen (ITB) often is used to treat severe spasticity of cerebral origin. Although literature exists regarding the efficacy of ITB, there has been minimal investigation related to dosing in the adult-acquired brain injury population, particularly at long-term duration.Objective: To investigate long-term dosing of ITB in adult patients with spasticity of cerebral origin due traumatic brain injury (TBI), stroke, and hypoxic-ischemic encephalopathy (HIE).Design: Retrospective cohort study.Setting: An academic outpatient rehabilitation clinic.Patients: Forty-two adult patients with spasticity secondary to TBI, stroke, or HIE treated with ITB for greater than 3 years.Methods: Medical records and device manufacturer records of included patients were reviewed to obtain demographic data, dosing information, dates of pump and catheter placements, and revisions.Main Outcome Measure: Average daily ITB doses and mean change in ITB dose over 1, 2, and 3 years. Goal of ITB treatment (active function versus comfort/care/positioning) also was compared.Results: Of 42 total patients, spasticity was attributed to either TBI (n = 19), stroke (n = 11), or HIE (n = 12). The mean (standard deviation) age was 35.21 (10.17), 56.7 (13.1), and 35.1 (12.4) years for the TBI, stroke, and HIE groups, respectively (P < .001). There was a significant difference in the goal of therapy with "improving functional independence," accounting for 27.8%, 72.8%, and 0% in the TBI, stroke, and HIE groups, respectively (P = .002). The mean duration of ITB therapy was 8.5 (5.0), 7.8 (3.4), and 9.1 (4.6) years in the TBI, stroke, and HIE groups, respectively (P = .79). The mean daily ITB dose was 596.9 (322.8) μg/d, 513.2 (405.7) μg/d, and 705.2 (271.7) μg/d for the TBI, stroke, and HIE groups, respectively (P = .39). In the subset of the cohort with ITB therapy for more than 5 years, the mean percent change in daily ITB dose between time of chart review and 1, 2, and 3 years previously was 7.3% (13.6), 12.7% (16), and 24.7% (50.3), respectively. A complex dosing pattern was used more frequently in those with stroke (36.4%) compared with the TBI and HIE (9.7%) groups (P = .04).Conclusion: Despite the long-term use of ITB therapy in this cohort, the mean daily dose of ITB continued to require adjustments. There was no significant difference in the mean daily dose between patients with a diagnosis of TBI, stroke, or HIE. A complex dosing pattern was used more frequently in patients with stroke.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Chinook SalmonOncorhynchus tshawytschaharvest in Oregon is currently estimated using voluntary returns of angler harvest permits. However, estimates are potentially biased due to nonresponse. The objective of this study was to evaluate the utility of a new method for estimating harvest in which anglers were given the option to record harvest on a smartphone application in addition to traditional paper harvest permits. Estimates were evaluated via simulation using eight basins along the mid- and north coast of Oregon as a theoretical case study. Simulated harvest was estimated using data from supplemental on-site surveys in conjunction with hypothetical harvest data recorded on smartphones. Confidence intervals varied from 1.2% to 24.7% of actual harvest at the aggregate scale and from 2.6% to 104.1% at the individual-fishery scale when smartphone recording rates were consistent among fisheries. Precision increased as the percentage of anglers recording harvest on a smartphone increased. Based on the simulation results, it is expected that harvest estimates relying on smartphones would have a precision up to 3.0 times greater than that of traditional creel survey estimates. Although the methods described in this study will likely need further evaluation when implemented in practice, they have the potential to provide cost-effective harvest estimates compared with those of the techniques that are currently being applied. Received March 25, 2016; accepted July 30, 2016 Published online December 20, 2016 [ABSTRACT FROM AUTHOR]

Background: The corticosteroid choice for a lumbar transforaminal epidural steroid injection (TFESI) remains controversial. Whether to utilize particulate or nonparticulate steroid preparations for these injections remains an unanswered question in the literature.Objective: To determine if a particulate or nonparticulate steroid is more effective in the treatment of electromyography (EMG)-confirmed lumbosacral radiculopathy.Design: Multicenter retrospective cohort study.Setting: Two tertiary academic spine centers.Patients: Consecutive patients, aged 18 years or older, with EMG-confirmed lumbosacral radiculopathy.Interventions: TFESI with a particulate or nonparticulate steroid to treat radicular pain within 6 months of EMG.Main Outcome Measures: The primary outcome was the proportion of patients with ≥50% pain reduction on the numerical rating scale after TFESI. Secondary outcomes included mean numerical rating scale score reduction and number of repeat TFESIs. Short-term (<30 days) and intermediate (≥30 days) outcomes were compared between patients who received a TFESI with a particulate versus nonparticulate steroid.Results: Seventy-eight patients, with an age ± standard deviation of 56 ± 16 years and a mean symptom duration of 49 ± 71 months, were included. Forty-one patients (52%) received dexamethasone, 23 (30%) received triamcinolone, and 14 (18%) received betamethasone. There was no statistically significant difference in the proportion of patients who reported ≥50% pain reduction between the particulate and nonparticulate groups at short-term follow-up (35%; 95% confidence interval [CI], 21-51 versus 28%; 95% CI, 13-43) or at intermediate follow-up (40%; 95% CI, 21-59 versus 39%; 95% CI, 19-59). There was no difference in the mean number of injections administered between groups at intermediate follow-up (P = .26).Conclusions: This study demonstrates no significant differences in pain reduction or the number of repeat injections with particulate compared with nonparticulate transforaminal epidural steroid injection in patients with EMG-confirmed painful lumbosacral radiculopathy. These findings suggest a new population for whom nonparticulate steroid appears to be an appropriate first-line therapy, although confirmation with a randomized study is needed.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Background: Intra-articular hip injections are commonly performed for both diagnostic and therapeutic interventions. Because of the risk of damage to neurovascular structures, fluoroscopic guidance with injection of contrast material has been established as the gold standard to ensure proper needle placement into the intra-articular space. However, fluoroscopically guided intra-articular hip injections put patients at risk due to radiation exposure.Objective: To examine the relationship between body mass index (BMI) and fluoroscopy time and radiation dose during intra-articular hip injections.Design: Retrospective study.Setting: The study was conducted at an academic orthopedic center. All procedures were performed by physicians board-certified in PM&R and/or with subspecialty certification in sports medicine, or by a trainee under close supervision from an attending physician.Participants: All patients who underwent fluoroscopically guided intra-articular hip injections between the years 2003-2014 with a documented height/weight, fluoroscopy time, and radiation dose.Interventions: All patients received unilateral or bilateral intra-articular hip injections with fluoroscopic guidance. Fluoroscopy time and dose were recorded.Main Outcome Measures: The main outcome measures were fluoroscopy time and radiation dose. A Bonferroni correction was implemented for multiple comparisons, defining statistical significance at P < .01.Results: A total of 438 subjects (446 injections) were included. Mean fluoroscopy times were 17.4 ± 9.9, 17.5 ± 11.4, and 19.1 ± 13.4 seconds for normal, overweight, and obese body mass (BMI) index groups, respectively, with no significant difference between groups (P = .148). The mean radiation doses were 601 ± 690, 678 ± 558, and 1049 ± 812 mGy-cm(2), respectively (P < .001, r = 0.29). There was no association of age (P = .03), needle length (P = .34) or trainee involvement (P = .159) with fluoroscopy time.Conclusion: This study demonstrates that increasing BMI leads to elevated radiation dose during fluoroscopically guided intra-articular hip injections. The increased radiation experienced by patients with a larger BMI, however, is likely negligible. [ABSTRACT FROM AUTHOR]

Redd abundance for steelheadOncorhynchus mykissis frequently estimated using design-based redd surveys. Redd abundance estimates may be biased low because redds may not be distinguishable prior to or in between sampling events (i.e., removal bias). Removal bias is typically mitigated by increasing temporal sampling intensity, thereby potentially reducing the level of spatial replication. In this study a model-assisted estimation technique to correct for removal bias was described and evaluated. Parametric survival time models were fit to redd data to estimate redd longevity and parameterize a simulation to evaluate the model-assisted estimation approach. The simulation showed increasing negative bias in redd counts not adjusted for removal bias as redd longevity decreased and as sampling intervals increased. Average bias among simulated datasets was as high as 43% using raw counts when redd longevity was relatively short at a 25-d sampling interval. Average bias was reduced to as low 1.3% using the model-assisted approach. Relative benefits of the model-assisted approach compared with traditional estimates decreased as redd longevity increased, and the accuracy of model-assisted estimates were sensitive to the function used to estimate redd longevity. The results of this study suggest that commonly used sampling intervals can potentially be increased with no appreciable increase in bias when using model-assisted estimation techniques. Received October 7, 2015; accepted March 21, 2016 Published online July 20, 2016 [ABSTRACT FROM AUTHOR]

Background: Sacroiliac joint (SIJ) injections are commonly performed under fluoroscopic guidance. Radiation exposure to patients and providers has not been comprehensively studied, particularly the effect of body mass index (BMI).Objective: To identify whether patients with a larger BMI require longer fluoroscopy time or a larger radiation dose during performance of an SIJ injection.Design: Retrospective study of an academic institution database.Setting: Academic outpatient musculoskeletal clinic.Patients: All patients who underwent SIJ injections during a 10-year period.Main Outcome Measurements: Machine-reported fluoroscopic time and machine-reported radiation dose. A Bonferroni correction was implemented with P ≤ .01 as statistically significant.Results: A total of 453 SIJ injections were performed in 359 patients. No statistically significant differences in fluoroscopy time were found between patients with BMI scores identified as normal, overweight, and obese (P = .054). However, the radiation doses were significantly greater for patients with higher BMI scores (χ(2) [2, n = 441] = 62.4, P < .001); the median (interquartile range) doses were 1210 (839), 1671 (1240), and 2090 (2170) mGy-cm(2) for normal weight, overweight, and obese patients, respectively. Although longer needles were used more often in obese patients (χ(2) [2, n = 452] = 31.5, P < .001), fluoroscopy time was not associated with needle length (P = .162). No relationships were identified between fluoroscopy time and first-time (as opposed to repeat) injection (P = .123), trainee involvement (χ(2) [1, n = 698] = 3.9, P = .049), or age (P = .337).Conclusions: Patients with an elevated BMI score who are undergoing SIJ injection receive an increased radiation dose despite equivalent fluoroscopic time. This finding suggests that the increased dose is likely due to x-ray output from the fluoroscope traversing a greater tissue mass, as opposed to the physician requiring more fluoroscopic images for proper needle placement. Fortunately, the increased radiation dose delivered to patients with a larger BMI score likely has negligible effects. [ABSTRACT FROM AUTHOR]