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Background Police constitute a structural determinant of health and HIV risk of people who inject drugs (PWID), and negative encounters with law enforcement present significant barriers to PWID access to harm reduction services. Conversely, police may facilitate access via officer-led referrals, potentiating prevention of HIV, overdose, and drug-related harms. We aimed to identify police characteristics associated with support for officer-led referrals to addiction treatment services and syringe service programs (SSP). We hypothesized that officers who believe harm reduction services are contradictory to policing priorities in terms of safety and crime reduction will be less likely to support police referrals. Methods Between January and June 2018, police officers (n = 305) in Tijuana, Mexico, completed self-administered surveys about referrals to harm reduction services during the 24-month follow-up visit as part of the SHIELD police training and longitudinal cohort study. Log-binomial regression was used to estimate adjusted prevalence ratios and model policing characteristics and attitudes related to officers’ support for including addiction treatment and SSP in referrals. Results Respondents were primarily male (89%), patrol officers (86%) with a median age of 38 years (IQR 33–43). Overall, 89% endorsed referral to addiction services, whereas 53% endorsed SSP as acceptable targets of referrals. Officers endorsing addiction services were less likely to be assigned to high drug use districts (adjusted prevalence ratio [APR] = 0.50, 95% CI 0.24, 1.08) and more likely to agree that methadone programs reduce crime (APR = 4.66, 95% CI 2.05, 9.18) than officers who did not support addiction services. Officers endorsing SSPs were younger (adjusted prevalence ratio [APR] = 0.96 95% CI 0.93, 0.98), less likely to be assigned to high drug use districts (APR = 0.50, 95% CI 0.29, 0.87), more likely to believe that methadone programs reduce crime (APR = 2.43, 95% CI 1.30, 4.55), and less likely to believe that SSPs increase risk of needlestick injury for police (APR = 0.44, 0.27, 0.71). Conclusions Beliefs related to the occupational impact of harm reduction services in terms of officer safety and crime reduction are associated with support for referral to related harm reduction services. Efforts to deflect PWID from carceral systems toward harm reduction by frontline police should include measures to improve officer knowledge and attitudes about harm reduction services as they relate to occupational safety and law enforcement priorities. Trial Registration: NCT02444403.

There is still a lack of understanding of H2S formation in agricultural waste, which leads to poor odour prevention and control. Microbial sulfate reduction is a major process contributing to sulfide formation in natural and technogenic environments with high sulfate and low oxygen concentration. Agricultural waste can be considered a low-sulfate system with no obvious input of oxidised sulfur compounds. The purpose of this study was to characterise a microbial community participating in H2S production and estimate the microbial sulfate reduction rate (SRR) in manure slurry from a large-scale swine finishing facility in Western Siberia. In a series of manure slurry microcosms, we identified bacterial consortia by 16S rRNA gene profiling and metagenomic analysis and revealed that sulfate-reducing Desulfovibrio were key players responsible for H2S production. The SRR measured with radioactive sulfate in manure slurry was high and comprised 7.25 nmol S cm−3 day−1. Gypsum may be used as a solid-phase electron acceptor for sulfate reduction. Another plausible source of sulfate is a swine diet, which often contains supplements in the form of sulfates, including lysine sulfate. Low-sulfur diet, manure treatment with iron salts, and avoiding gypsum bedding are possible ways to mitigate H2S emissions from swine manure.

Hypothesis The purpose of this study was to perform a systematic review to identify cost-analysis studies pertaining to shoulder arthroplasty, provide a comprehensive review of published studies, and critically evaluate the quality of the available literature using the Quality of Health Economic Studies (QHES) instrument. Methods A systematic review of the literature was performed to identify cost analyses examining shoulder arthroplasty. The inclusion criteria included studies pertaining to either shoulder hemiarthroplasty (HA), total shoulder arthroplasty (TSA), or reverse TSA. Articles were excluded based on the following: nonoperative studies, nonclinical studies, studies not based in the United States, and studies in which no cost analysis was performed. The quality of studies was assessed using the QHES instrument. One-sided Fisher exact testing was performed to identify predictors of both low-quality (ie, QHES score 75th percentile) cost analyses based on items within the QHES checklist. Results Of the 196 studies screened, 9 were included. Seven studies conducted cost analyses comparing reverse TSA vs. arthroscopic rotator cuff repair, HA, or total hip arthroplasty, and 2 studies examined TSA vs. HA for primary glenohumeral arthritis. The average QHES score among all studies was 86.22 ± 13.39 points. Failure to include an annual cost discounting rate was associated with a low-quality QHES score (P = .03). In addition, including a discussion of the magnitude and direction of potential biases was associated with a high-quality score (P = .03). Conclusions Shoulder arthroplasty is a cost-effective procedure when used to treat a multitude of shoulder pathologies. The overall quality of cost analysis in shoulder arthroplasty is relatively good, with an average QHES score of 86.22 points. Studies failing to include an annual cost discounting rate are more likely to score below the 25th percentile, whereas those including a discussion of the magnitude and direction of potential biases are more likely to achieve a score in excess of the 75th percentile.

Background and aims Syringe-sharing among people who inject drugs, which can occur during incarceration and post-release, has been linked with increased risk of blood-borne infections. We aimed to investigate the cumulative effect of repeated incarceration and the post-release period on receptive syringe-sharing. Design Ongoing community-based cohort, recruited through targeted sampling between 2011 and 2012 with 6-month follow-ups. Setting Tijuana, Mexico. Participants Sample of 185 participants (median age 35 years; 67% female) with no history of incarceration at study entry, followed to 2017. Measurements Cumulative incarceration and post-release period were constructed from incarceration events reported in the past 6 months for each study visit. Receptive syringe-sharing in the past 6 months was assessed as a binary variable. We used logistic regression with generalized estimating equations to examine the association between cumulative incarceration events and the post-release period with receptive syringe-sharing over time. Missing data were handled through multiple imputation. Findings At baseline, 65% of participants engaged in receptive syringe-sharing in the prior 6 months. At follow-up, 150 (81%) participants experienced a total of 358 incarceration events [median = 2, interquartile range (IQR) = 1-3]. The risk of receptive syringe-sharing increased with the number of repeated incarcerations. Compared with never incarcerated, those with one incarceration had 1.28 [95% confidence interval (CI) = 0.97-1.68] higher adjusted odds of syringe-sharing; two to three incarcerations, 1.42 (95% CI = 1.02-1.99) and more than three incarcerations, 2.10 (95% CI = 1.15-3.85). Participants released within the past 6 months had 1.53 (95% CI = 1.14-2.05) higher odds of sharing syringes compared with those never incarcerated. This post-release risk continued up to 1.5 years post-incarceration (adjusted odds ratio = 1.41, 95% CI = 1.04-1.91), but then waned. Conclusions A longitudinal community cohort study among people who inject drugs suggested that the effects of incarceration on increased injecting risk, measured through syringe-sharing, are cumulative and persist during the post-release period.

GLI1 is one of three GLI family transcription factors that mediate Sonic Hedgehog signaling, which plays a role in development and cell differentiation. GLI1 forms a positive feedback loop with GLI2 and likely with itself. To determine the impact of GLI1 and its intronic regulatory locus on this transcriptional loop and human stem cell differentiation, we deleted the region containing six GLI binding sites in the human GLI1 intron using CRISPR/Cas9 editing to produce H1 human embryonic stem cell (hESC) GLI1‐edited clones. Editing out this intronic region, without removing the entire GLI1 gene, allowed us to study the effects of this highly complex region, which binds transcription factors in a variety of cells. The roles of GLI1 in human ESC differentiation were investigated by comparing RNA sequencing, quantitative‐real time PCR (q‐rtPCR), and functional assays. Editing this region resulted in GLI1 transcriptional knockdown, delayed neural commitment, and inhibition of endodermal and mesodermal differentiation during spontaneous and directed differentiation experiments. We found a delay in the onset of early osteogenic markers, a reduction in the hematopoietic potential to form granulocyte units, and a decrease in cancer‐related gene expression. Furthermore, inhibition of GLI1 via antagonist GANT‐61 had similar in vitro effects. These results indicate that the GLI1 intronic region is critical for the feedback loop and that GLI1 has lineage‐specific effects on hESC differentiation. Our work is the first study to document the extent of GLI1 abrogation on early stages of human development and to show that GLI1 transcription can be altered in a therapeutically useful way., CRISPR/Cas9 genomic editing was used to delete the first intronic region containing six highly conserved GLl1 binding sites. The decreased GLl1 gene expression impacted GLl1 regulatory capacity within the Sonic Hedgehog signaling pathway. The result was a reduced transcriptional activation of upstream and downstream GLl1 targets, which ultimately impacted endodermal, mesodermal, and ectodermal differentiation via downregulation of key genes.

Patient postoperative pain is an important consideration following biceps tenodesis. The visual analog scale (VAS) for pain is one of the most commonly used measures for perioperative pain assessment. Currently, there is limited understanding of clinically significant improvement in VAS pain.To define the substantial clinical benefit (SCB), patient acceptable symptomatic state (PASS), and minimal clinically important difference (MCID) for the VAS pain score in patients undergoing open subpectoral (OSPBT) or arthroscopic suprapectoral biceps tenodesis (ASPBT) at 1 year from surgery; and to identify preoperative predictors of achieving each outcome end point.Data from consecutive patients who underwent isolated biceps tenodesis between January 2014 and March 2017 were collected and analyzed. Baseline data and postoperative patient-reported outcome (PRO) scores were recorded at 1 year postoperatively. In order to quantify the clinical significance of outcome achievement for the VAS pain score, the MCID, PASS, and SCB were calculated.A total of 165 patients were included in the final analysis. The VAS pain score threshold for achieving MCID was defined as a decrease of 12.9 (0-100). PASS was defined as achieving a 2-year postoperative score of 27.4 points (0-100), and SCB was defined as a decrease of 25.1 (0-100) at 1-year follow-up. The rates of achieving MCID, PASS, and SCB were 73.3%, 52.8%, and 45.9%, respectively. Multivariate regression analysis demonstrated that ASPBT (P = .01) and a lower preoperative Constant-Murley score were predictive of achieving the MCID (P = .01). In contrast, a lower preoperative score on the SF-12 Physical Component Summary (P = .01) and a higher score on the preoperative American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (P.001) were predictive of achieving the SCB and PASS, respectively. Preoperative duration of symptoms6 months was predictive of a reduced likelihood to achieve PASS.This study identified scores for VAS pain that can be used to define clinically significant outcome after biceps tenodesis. Specifically, a decrease in pain score of 12.9 was a clinically important improvement in VAS pain, whereas a decrease of 25.1 represented the upper threshold of VAS pain improvement. Additionally, there were both modifiable and nonmodifiable factors that predicted achieving clinically significant levels of postoperative pain improvement.

Relevance of research. The reform of higher education in Ukraine is to create a system to ensure and constantly improve its quality, which meets the recommendations and standards of the European Higher Education Area (EHEA), takes into account international best practices and provides for the development of a new generation standards based on a competent approach. Objective of research. It is necessary to create a substantiated system of competencies and training program results, combining a scientific and methodological approach that takes into account the needs of stakeholders: higher education applicants, employers, society and the state. Methods and techniques of research. Approbation of the training of applicants for the first (bachelor) level of higher education according to the formed list of training program results on a specialty is conducted in National University of Water and Environmental Engineering, according to the corresponding educational and professional program, which has been certified for the first time in 2020. Results of research and conclusions. On the example of the formation of training program results of the applicants for the first (bachelor) level of higher education on the specialty 194 "Hydraulic Engineering, Water Engineering and Water Technology", we tried to show how to take into account the suitability of graduates for the employment by the professional titles of jobs corresponding to the level of "Specialists" in National Classification of Jobs (DK 003: 2010). The correspondence of professional titles of jobs and professions according to DK 003: 2010 to the International Standard Classification of Jobs (ISCO-08) is given. The article evaluates the suitability of a university graduate to perform professional tasks and responsibilities defined in the qualification characteristics and job descriptions of specialists in the field of water management, in comparison with the program results of higher education received by the graduate. In continuation of the discussion on the search for perspective approaches to the formation of a modern technical specialist, we consider that one of the important mechanisms is the production practice and personalized implementation of course design and bachelor's project. All that will form the necessary program results of the graduate's education, develop the personality of the young specialist and allow him to socialize successfully, conduct professional and / or further educational activities. Prospects. The comparison given in the article shows the importance of the formation of training program results in the standards of higher education, taking into account the requirements of the specific profession for which the higher education applicant is preparing. These requirements are defined in the qualifications and job descriptions. A high school graduate, having got the first job, must demonstrate training program results that will allow him to perform tasks and responsibilities in accordance with job descriptions.

BackgroundRegional anesthetic techniques have become increasingly used for the purpose of pain management following mastectomy. Although a variety of beneficial techniques have been described, the delivery of regional anesthesia following mastectomy has yet to be examined for racial or ethnic disparities. We aimed to examine the association of race and ethnicity on the delivery of regional anesthesia in patients undergoing surgical mastectomy using a large national database.MethodsWe used the American College of Surgeons–National Surgical Quality Improvement Program database to identify adult patients aged ≥18 years old who underwent mastectomy from 2014 to 2016. We reported unadjusted estimates of regional anesthesia accordingly to race and ethnicity and examined differences in sociodemographic characteristics and health status. Multivariable logistic regression was used to report the association of race and ethnicity with use of regional anesthesia.ResultsA total of 81 345 patients who underwent mastectomy were included, 14 887 (18.3%) of whom underwent regional anesthesia. The unadjusted rate of use of regional anesthesia was 18.9% for white patients, 16.8% for black patients, 15.6% for Asian patients, 16.5% for Native Hawaiian/Pacific Islander patients, 17.8% for American Indian or Alaska Native and 17.4% for unknown race (pConclusionBlack and Asian patients had lower odds of undergoing regional anesthesia following mastectomy compared with white counterparts. In addition, Hispanic patients had lower odds of undergoing regional anesthesia than non-Hispanic counterparts. These differences underlie the importance of working to deliver equitable healthcare irrespective of race or ethnicity.

Trisomy 21 (T21), known as Down syndrome (DS), is a widely studied chromosomal abnormality. Previous studies have shown that DS individuals have a unique cancer profile. While exhibiting low solid tumor prevalence, DS patients are at risk for hematologic cancers, such as acute megakaryocytic leukemia and acute lymphoblastic leukemia. We speculated that endothelial cells are active players in this clinical background. To this end, we hypothesized that impaired DS endothelial development and functionality, impacted by genome-wide T21 alterations, potentially results in a suboptimal endothelial microenvironment with the capability to prevent solid tumor growth. To test this hypothesis, we assessed molecular and phenotypic differences of endothelial cells differentiated from Down syndrome and euploid iPS cells. Microarray, RNA-Seq, and bioinformatic analyses revealed that most significantly expressed genes belong to angiogenic, cytoskeletal rearrangement, extracellular matrix remodeling, and inflammatory pathways. Interestingly, the majority of these genes are not located on Chromosome 21. To substantiate these findings, we carried out functional assays. The obtained phenotypic results correlated with the molecular data and showed that Down syndrome endothelial cells exhibit decreased proliferation, reduced migration, and a weak TNF-α inflammatory response. Based on this data, we provide a set of genes potentially associated with Down syndrome's elevated leukemic incidence and its unfavorable solid tumor microenvironment-highlighting the potential use of these genes as therapeutic targets in translational cancer research.

The composition of the microbiome of acid drainage water of a quarry used for the mining of brown coal was studied. The water had a pH of 5.15 and contained 1.4 g/L of sulfate. Unlike acid mine drainage associated with mining of sulfide ores, the content of iron and heavy metals was low. Molecular analysis of the microbial community was performed by high-throughput sequencing of the 18S and 16S rRNA gene fragments. Most eukaryotic sequences belonged to the fungal phylum Basidiomycota; members of the Chytridiomycota were also found. Basidiomycetes of the family Sporidiobolaceae were the predominant group, as was previously reported for acid mine drainage waters. Among the minor groups, protozoa (Alveolata and Amoebozoa) and green algae (Chlamydomonas) were found. The dominant group of prokaryotes was the genus Acidiphilium (Alphaproteobacteria); betaproteobacteria of the genera Sulfuriferula and Thiomonas were also found.

Policy Points This article reconceptualizes our understanding of the opioid epidemic and proposes six strategies that address the epidemic's social roots. In order to successfully reduce drug-related mortality over the long term, policymakers and public health leaders should develop partnerships with people who use drugs, incorporate harm reduction interventions, and reverse decades of drug criminalization policies. Context Drug overdose is the leading cause of injury-related death in the United States. Synthetic opioids, predominantly illicit fentanyl and its analogs, surpassed prescription opioids and heroin in associated mortality rates in 2016. Unfortunately, interventions fail to fully address the current wave of the opioid epidemic and often omit the voices of people with lived experiences regarding drug use. Every overdose death is a culmination of a long series of policy failures and lost opportunities for harm reduction. Methods In this article, we conducted a scoping review of the opioid literature to propose a novel framework designed to foreground social determinants more directly into our understanding of this national emergency. The "continuum of overdose risk" framework is our synthesis of the global evidence base and is grounded in contemporary theories, models, and policies that have been successfully applied both domestically and internationally. Findings De-escalating overdose risk in the long term will require scaling up innovative and comprehensive solutions that have been designed through partnerships with people who use drugs and are rooted in harm reduction. Conclusions Without recognizing the full drug-use continuum and the role of social determinants, the current responses to drug overdose will continue to aggravate the problem they are trying to solve.

BackgroundRegional anesthesia is becoming increasingly used for analgesia in clavicular surgery. The purpose of the study is to examine same-day discharge and readmissions in patients with clavicular fractures receiving open reduction and internal fixation, comparing those who received regional anesthesia to those that did not.MethodsThe National Surgical Quality Improvement Program registry was used to build a retrospective cohort with the primary and secondary outcomes of same-day discharge and readmission rates, respectively. The independent variable was type of anesthesia (ie, regional vs general). Unadjusted univariable followed by multivariable logistic regression analysis for the association of each covariate with the primary and secondary outcome was performed. A pResultsA total of 2300 patients were included, in which 346 (15.0%) of received a nerve block. The only factor associated with same-day discharge on crude analysis was the use of a nerve block (OR 1.70, 95% CI 1.21 to 2.40, pConclusionRegional anesthesia use in patients with clavicular fractures is associated with higher odds for same-day discharge. There is no significant difference in the rates of hospital readmission within a 30-day period.Level of EvidenceIV, retrospective case series.

Purpose To compare knotted and knotless transosseous equivalent (TOE) rotator cuff repair (RCR) techniques and evaluate their imaging-diagnosed retear rates. Methods The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (2008 to 2019), EMBASE (2008 to 2019), and Medline (2008 to 2019) were used to perform a systematic review and meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, with the following search terms: rotator cuff repair AND (knotless OR knotted) AND transosseous; rotator cuff repair AND (knotless OR knotted or transosseous); rotator cuff repair AND (“suture bridge” OR “suture bridging”). Data pertaining to demographic characteristics, surgical techniques, retears, and patient-reported outcomes were extracted from each study. Rates and locations of retear were reported using ranges, and risks of bias and heterogeneity for each study were assessed. Results A total of 7 studies (552 shoulders) were included. Patients had a weighted mean (± standard deviation) age of 60.5 ± 2.4 years with 27.8 ± 7.9-month follow-up. The incidence of retears ranged from 5.1% to 33.3% in patients treated with knotless TOE RCR, and the incidence for patients treated with knotted TOE RCR ranged from 7.5% to 25%. The incidence of type I retears ranged from 42.9% to 100% for patients treated with knotless TOE RCR and 20% to 100% for patients treated with knotted TOE RCR. The incidence of type II retears ranged from 0% to 57.1% in patients treated with knotless TOE RCR and 0% to 100% in patients treated with knotted TOE RCR. Conclusions The incidence and location of retears after knotless and knotted TOE RCR appear to be similar.

Purpose To define the psychometric properties of the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), Pain Interference (PI), and Depression computer adaptive tests (CATs) in patients undergoing knee cartilage surgical procedures. Methods The PROMIS PF, PI, and Depression CATs were administered preoperatively and at 6 months alongside legacy knee patient-reported outcome measures (PROMs) in patients undergoing knee cartilage surgical procedures. Statistical analysis consisted of the time to completion, psychometric analysis for correlative strengths, absolute and relative floor and ceiling effects, and Cohen effect size. Results Our study included 250 patients (57.2% male patients), averaging 1.87, 1.53, and 1.91 minutes for completion of the PF, PI, and Depression CATs, respectively. Preoperatively, the PROMIS PF and PI CATs showed wide ranges of correlation coefficients with respect to function (r = 0.14-0.72 and r = 0.29-0.77, respectively) and health-related quality-of-life PROMs (r = 0.64-0.70). At 6 months, the PROMIS PF CAT (r = 0.82-0.93) and PI CAT (r = 0.77-0.93) both exhibited excellent correlations with respect to legacy function and health-related quality-of-life PROMs except for the Marx Activity Rating Scale (r = 0.36-0.44). None of the PROMIS instruments exhibited any significant floor or ceiling effects. Conclusions The PROMIS PF, PI, and Depression CATs performed better with respect to legacy PROMs in the postoperative period than the preoperative period. In addition, the PROMIS PF and PI measures performed best with respect to the International Knee Documentation Committee questionnaire, and no floor or ceiling effects were identified for the PROMIS instruments. The PROMIS instruments may be more suited to track outcomes postoperatively than to establish preoperative baselines in cartilage surgery patients. Level of Evidence Level IV, retrospective case series.

Purpose To determine the influence of corticosteroid injections (CSIs) before or after primary rotator cuff repair (RCR) on the risk of (1) revision RCR, (2) retears, and (3) infections. Methods The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PubMed, Embase, and MEDLINE databases were queried in accordance with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Data pertaining to the use of CSIs before or after primary RCR and adverse events were extracted. A subjective synthesis of these outcomes and bias was performed. Results A total of 10 studies including 240,976 patients were identified; 20.0% received a perioperative CSI. Of the 48,235 patients who received a CSI, 66.2% did so preoperatively whereas 33.8% did so postoperatively. A total of 78 patients received both preoperative and postoperative CSIs. Three studies examined the influence of preoperative CSIs on revision RCR; the incidence ranged from 3.8% to 10.5% with preoperative CSIs and from 3.2% to 3.4% for controls. Two of these studies analyzed outcomes of patients from the same databases over the same period. Five studies examined the influence of postoperative CSI use on retears; the incidence ranged from 5.7% to 19.0% in patients who received postoperative CSIs and from 10.0% to 18.4% for controls. Three studies examined the influence of CSI use on infection; 2 studies examined the risk of infection after postoperative CSI use, which ranged from 0.0% to 6.7% with CSIs and from 0.0% to 0.5% for controls. Conclusions The use of preoperative CSIs could be associated with an increased risk of revision RCR. There were no conclusive data to suggest an increased risk of retear or infection with CSI use based on a subjective synthesis of ranges. There is currently poor-quality literature surrounding this topic. Given that the current literature is limited and heterogeneous, no definitive recommendations can be made on perioperative CSI use for RCR. Level of Evidence Level III, systematic review of Level I and III studies.

The complete genome sequence of a thermotolerant obligate methanotroph Methylococcus sp. Concept-8 was determined and analyzed. This strain was obtained by long-term storage, selection, and purification of an industrial culture of Methylococcus capsulatus BSV-874, which was used for methane-based protein biosynthesis in the Soviet Union. The size of the Concept-8 genome is 3.46 Mb. Genome annotation identified 3266 open reading frames that encode proteins. The closest phylogenetic relative of strain Concept-8 is Methylococcus capsulatus Bath (98.7% identity of 16S rRNA gene sequences). Comparison of the genomic sequences of these methanotrophs revealed 88.39% average nucleotide sequence identity, indicating that Concept-8 represents a novel species of the genus Methylococcus. The genomes of the strains Bath and Concept-8 both contain two copies of rRNA operons and pmoBAC operons for particulate methane monooxygenase, as well as a single copy of the soluble methane monooxygenase operon mmoXYBZDC. Growth on methanol was possible due to the presence of two complementary methanol dehydrogenases: MxaFJGIRACKLD and XoxF. The two methanotrophs also possess highly similar sets of genes encoding enzymes of the major pathways of the metabolism of C1 compounds. The genome of Methylococcus sp. Concept-8 was found to contain two regions associated with prophages of the family Siphoviridae. The prophage regions detected in the genome of Mc. capsulatus Bath are also homologous to viral sequences of the family Siphoviridae but differ from those identified in the genome of Concept-8.

The candidate phylum Riflebacteria was described based on analysis of genomes assembled from the metagenomes of various anaerobic ecosystems; however, to date, no member of Riflebacteria has been isolated in a pure culture. In this work, the genome of a new member of Riflebacteria was obtained from the metagenome of the microbial community of a deep subsurface thermal aquifer in Western Siberia. Phylogenetic analysis indicates that this bacterium, designated Ch46, represents a new genus of the phylum Riflebacteria, distinct from the previously described Candidatus Ozemobacter. The genome of Ch46 was found to encode putatively secreted alpha-amylases and various sugar and peptide transporters. Reconstruction of central metabolic pathways suggests that Ch46 is an anaerobic organotroph capable of fermenting sugars and proteinaceous substrates. The bacterium lacks the genes of the known pathways of autotrophic carbon fixation, as well as the aerobic respiratory chain. The transmembrane ion gradient can be generated by an Rnf complex, as well as by a sodium-transporting NADH‒quinone oxidoreductase. The presence of multiheme c-type cytochromes indicates the possibility of dissimilatory Fe(III) reduction. The pathways of dissimilatory reduction of sulfate, nitrate, nitrite, arsenate, and sulfur were not detected. In the subsurface aquifer, Riflebacteria probably utilize starch and similar polysaccharides, as well as low-molecular-weight organic compounds. Based on the results of phylogenetic and genomic analysis, it is proposed to classify the novel bacterium as ‘Candidatus Rifleibacterium amylolyticum.’

Purpose To evaluate outcomes of screw-type and coil-type open-architecture suture anchors with respect to bony ingrowth, release of biological markers, and patient-reported outcome measures when used in rotator cuff repair (RCR). Methods Forty patients undergoing arthroscopic RCR for full-thickness rotator cuff tears were enrolled and prospectively randomized to receive a screw-type (19 patients) or coil-type (21 patients) suture anchor for the medial row during repair. All repairs used a transosseous-equivalent configuration with footprint anchors laterally. Marrow elements released during surgery were evaluated for 9 cytokine markers (insulin-like growth factor 1, fibroblast growth factor 2, bone morphogenetic proteins 7 and 2, platelet-derived growth factors AA and BB, epidermal growth factor, transforming growth factor beta1, and vascular endothelial growth factor). Postoperative computed tomography scans were performed at 6 months. Range of motion, strength, and validated patient-reported outcome measures (Simple Shoulder Test, Single Assessment Numeric Evaluation, visual analog scale, and American Shoulder and Elbow Surgeons scores) were gathered before the operation and at 6 months and 1 year postoperatively. Results Bone mineral density surrounding the coil-type anchor was significantly greater than that surrounding the screw-type anchor (P = .005). Bone mineral density values within the coil-type and screw-type anchors were comparable (P = .527); however, a larger amount of total bone mineral mass (in milligrams) was shown within the coil-type anchor owing to its larger volume (P .05). Postoperatively, no statistically significant difference was found between groups for clinical outcome measures at 6 months or 1 year. Retear and complication rates were similar between groups (P > .05). Conclusions Both the coil-type and screw-type anchors can be reliably used for RCR and produce similar clinical outcomes. The coil-type anchor resulted in superior bony growth surrounding the anchor and a larger total bone mineral mass within the anchor owing to its larger volume. Level of Evidence Level II, randomized prospective comparative study.

To quantify the cost of resident involvement in academic sports medicine by examining differences in operative time, relative value units (RVUs) per case, and RVUs per hour between attending-only cases and cases with resident involvement.A retrospective analysis of common sports medicine procedures identified by Current Procedural Terminology code was performed using data from the American College of Surgeons National Surgical Quality Improvement Program database from 2006 to 2015. Matched cohorts were generated based on demographic variables, comorbidities, preoperative laboratory values, and surgical procedures. Bivariate analysis examined mean differences in operative time, RVUs per case, and RVUs per hour between attending-only cases and cases with resident involvement. A cost analysis was performed to quantify differences in RVUs generated per hour in terms of dollars per case.A total of 14,840 attending-only cases and 2,230 resident-involved cases were used to generate 2 matched cohorts (N = 4,460). Resident cases had greater mean operative times than attending-only cases, with operative time increasing as residents became more senior (P.01). Residents participated in cases with larger mean RVUs per case (P.01). Cases with lone attendings showed greater RVUs per hour (P.01). The cost of resident involvement increased nearly 8-fold from postgraduate year 1 to postgraduate year 6 residents ($25.70 vs $200.07).In academic sports medicine, the involvement of resident physicians increases operative time. The associated decrease in attending physician efficiency in RVUs per hour equates to an average cost per case of $159.18, with costs increasing as residents become more senior.Level III, retrospective comparative trial.

Background: Several studies have investigated failure rates and magnitude of improvement in patient-reported outcome measures after microfracture surgery for focal chondral defects of the knee; however; what constitutes clinically significant improvement in this patient population is poorly understood. Purpose: To (1) establish the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds for microfracture surgery including the time-dependent nature of these thresholds and (2) identify predictors of achieving the MCID and PASS in patients specifically undergoing microfracture of the knee. Study Design: Case series; Level of evidence, 4. Methods: A secure institutional cartilage preservation repository was queried for all patients who underwent microfracture between 2004 and 2017. The distribution method was used to calculate MCID thresholds for the International Knee Documentation Committee (IKDC) score and the Knee injury and Osteoarthritis Outcome Score (KOOS), whereas an anchor-based method was used for the PASS. Multivariate logistic regressions were constructed to determine predictors of achieving the MCID and PASS. Results: A total of 206 patients with a mean ± SD age of 33.7 ± 13.2 years and body mass index of 26.9 ± 5.3 kg/m2 were included. All thresholds for the MCID and PASS increased over time except for the MCID thresholds for the KOOS Sports and Symptoms subscales. The proportion of patients who achieved the MCID (6 months, 78.4%; 12 months, 83.9%; 24 months, 88.6%) and PASS (6 months, 67.7%; 12 months, 79.2%; 24 months, 76.1%) generally increased over time. Older age and larger lesion size were negative independent predictors of MCID achievement. Older age was also a negative predictor of the PASS, whereas male sex and higher preoperative KOOS Symptoms and Pain scores were positive independent predictors of the PASS. Conclusion: The MCID and PASS thresholds for the IKDC and KOOS in patients undergoing microfracture of the knee are dynamic, with an increasing number of patients achieving the MCID over time. The percentage achieving the PASS increased between 6 and 12 months and then declined slightly at 24 months. Independent predictors of achieving the MCID were lesion size and age at surgery, whereas predictors of achieving the PASS included lesion size, male sex, and greater preoperative KOOS Symptoms and Pain scores.

A novel actinobacterium, strain K3-2T, was isolated in pure culture from a thawing ancient ice wedge at Mammoth Mountain (Eastern Siberia, Russia). Colonies of strain K3-2T were yellowish orange; cells had the fine structure typical of Gram-positive bacteria, were non-motile short rods and were non-spore-forming. Strain K3-2T was mesophilic (optimum growth at 28 °С), but capable of growing at 4 °С. The cell-wall peptidoglycan of strain K3-2T contained lysine (the diagnostic diamino acid), glutamic acid, alanine, ornithine, glycine and serine. The polar lipids were phosphatidylglycerol, lysophosphatidylserine, three unidentified phospholipids and glycolipids. The major fatty acids were anteiso-C15 : 0 and C16 : 0. The only menaquinone detected was MK-8(H4). 16S rRNA gene analysis indicated that strain K3-2T belongs to the genus Serinibacter . The closest taxonomically described relatives were Serinibacter salmoneus Kis4-28T and Serinibacter tropicus PS-14-7T, with 97.20 and 97.20 % 16 s rRNA gene sequence similarity, respectively. The average nucleotide identity value of the whole genome sequence between strain K3-2T and S. salmoneus Kis4-28T was 78.9 %. DNA–DNA relatedness values between strain K3-2T and S. salmoneus DSM 21801T (=Kis4-28T) and S. tropicus VKPM Ac 2044T (=PS-14-7T) were 41 and 47 %. Thus, strain K3-2T represents a novel species of the genus Serinibacter for which the name Serinibacter arcticus sp. nov. is proposed. The type strain is K3-2T (DSM 103859T=VKM Ас−2719T).

—Biotechnologies involving phosphate-accumulating organisms, which collect inorganic phosphates from the medium as polyphosphates during cyclic growth under aerobic and anaerobic conditions, are presently applied for phosphorus removal from wastewater. Betaproteobacteria of the candidate genus ‘Candidatus Accumulibacter’ carry out phosphate accumulation in most systems for wastewater treatment. However, no member of ‘Ca. Accumulibacter’ has been isolated in pure culture. Metagenomic analysis of the microbial consortium formed in a laboratory setup for phosphate removal from wastewater and removing up to 80% phosphorus from the medium was carried out. Members of the phyla Proteobacteria (82.5%), Bacteroidetes (10.5%), and Chloroflexi (1.6%) predominated in the community. Among the proteobacteria, Betaproteobacteria were revealed, among which ‘Ca. Accumulibacter’ predominated, as well as Gammaproteobacteria (26.8%), which mainly belonged to the family ‘Ca. Competibacteraceae.’ Metagenomic data were used to obtain the genome of the dominant phosphate-accumulating bacterium, which belonged to a new ‘Ca. Accumulibacter’ species. The studied community was promising both for further basic research on metabolism of phosphate-accumulating organisms and for improvement of existing biotechnologies for phosphorus removal from wastewater.

espanolIntroduccion En la frontera norte de Mexico hay niveles altos de consumo de heroina. Durante mas de 10 anos, el pais ha implementado diversas intervenciones de reduccion de danos para minimizar los riesgos asociados con el uso de sustancias. Los sitios de consumo seguro (SCS) se deben considerar como una opcion que brinde servicios a poblaciones vulnerables para mejorar su salud. Objetivo Este reporte mide y compara actitudes entre policias y personas con experiencia vivida (PEV) en uso de heroina en Tijuana, relacionadas con una posible implementacion de SCS en la ciudad. Metodo Dos estudios paralelos sobre practicas policiales y experiencias cotidianas de usuarios de heroina en Tijuana incluyeron preguntas similares sobre actitudes hacia los SCS y su implementacion en la ciudad. Se realizaron 771 entrevistas cuantitativas con oficiales de policia y 200 con PEV internadas en centros de rehabilitacion. Resultados Ambos grupos mostraron un alto apoyo hacia los SCS cercano al 82% y un exito percibido en implementacion del 80%. Los oficiales reportaron 58.9% de apoyo entre pares a las SCS y del 79% entre PEV. Un 76% en ambos grupos coincidieron que un SCS ayudaria a mejorar su salud personal. Finalmente, el 86.2% de los oficiales referirian hacia un SCS, mientras que 62.5% de PEV las usarian. Discusion y conclusiones Las actitudes hacia los SCS indican una posible implementacion exitosa de SCS en la ciudad. Esta intervencion representaria una forma innovadora de disminuir el acoso y victimizacion policial hacia las PEV, reduciendo los factores de riesgo de VIH y VHC, mejorando la salud comunitaria. EnglishIntroduction: Mexico northern border has high levels of heroin use. For more than 10 years, the country has implemented several harm reduction interventions to reduce the risks associated with drug use. New strategies such as Safe Consumption Sites (SCS) must be considered as a next step to service vulnerable populations and increase their health outcomes. Objective: this report seeks to measure and compare attitudes on a potential SCS intervention in Tijuana among police and people with lived experience (PLE) in heroin use in the city. Method: two parallel studies on police practices and everyday experiences of heroin users in Tijuana were able to ask similar questions about attitudes toward SCS and its implementation in the city. They conducted quantitative interviews with 771 active police officers and 200 PLE while in rehabilitation services. Results: both groups showed a high personal support for SCS of nearly 82% and a perceived implementation success around 80%. Officers reported 58.9% peer support for SCS while PLE 79%. Around 76% of both groups agreed that a SCS would help to improve their personal health. Finally, 86.2% of the officers would refer people to a SCS while 62.5% of PLE would use the service. Discussion and conclusions: the strong positive attitudes from police officers and PLE towards SCS in the city of Tijuana reported in both studies indicate the possibility of a successful implementation of a SCS. This intervention would represent an innovative way to protect PLE from police harassment and victimization, helping reduce HIV and HCV risk behaviors while improving community health.

BACKGROUND: The importance of creating an anatomic anterior cruciate ligament (ACL) reconstruction has been receiving significant attention. The best technique by which to achieve this anatomic reconstruction continues to be debated. The two most common methods are the transtibial (TT) and anteromedial (AM) techniques. Each has its advantages and disadvantages, and the literature comparing the two remains uncertain. QUESTIONS/PURPOSES: In this prospective comparative study, we aimed to compare the ACL graft and tunnel angles achieved using the anatomic transtibial (TT) and anteromedial (AM) techniques; compare the ACL graft and tunnel angles in knees that have undergone ACL reconstruction and knees with intact ACLs; and determine whether differences in the graft or tunnel angle produce differences in clinical outcomes, as measured using both physical exam and patient-reported outcomes, after ACL reconstruction. METHODS: Patients who underwent primary ACL reconstruction with bone–tendon–bone grafts using a TT or AM technique were included. Femoral graft angle (FGA), tibial graft angle (TGA), and sagittal orientation of the reconstructed ACL and contralateral native ACL were measured on post-operative magnetic resonance imaging. Post-operatively, patients underwent measurement of knee stability and completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) survey. RESULTS: Twenty-nine patients were enrolled (AM group, 14; TT group, 15); at follow-up, KOOS data were available for 26 patients (13 in each group). There were no differences in sagittal ACL graft angle between groups or in comparison with the normal knee. The FGA was more vertical after TT reconstructions; the TGA was comparable between groups. There were no significant differences in 2-year post-operative physical exam measurements or in KOOS scores. CONCLUSION: Anatomic ACL angle was restored after reconstruction with both the TT and AM techniques, despite different FGAs. No significant differences in clinical outcome were noted between groups on physical exam or KOOS at 2 years after surgery. These results suggest that TT reconstruction results in a graft position similar to that seen in AM reconstruction and that the location of the intra-articular tunnel aperture matters more than the orientation of the tunnel.

Although arctic and subarctic lakes are important sources of methane, the emission of which will increase due to the melting of permafrost, the processes related to the methane cycle in such environments are far from being comprehensively understood. Here we studied the microbial communities in the near-bottom water layer and sediments of the meromictic subarctic Lake Svetloe using high-throughput sequencing of the 16S rRNA and methyl coenzyme M reductase subunit A genes. Hydrogenotrophic methanogens of the order Methanomicrobiales were abundant, both in the water column and in sediments, while the share of acetoclastic Methanosaetaceae decreased with the depth of sediments. Members of the Methanomassiliicoccales order were absent in the water but abundant in the deep sediments. Archaea known to perform anaerobic oxidation of methane were not found. The bacterial component of the microbial community in the bottom water layer included oxygenic (Cyanobacteria) and anoxygenic (Chlorobi) phototrophs, aerobic Type I methanotrophs, methylotrophs, syntrophs, and various organotrophs. In deeper sediments the diversity of the microbial community decreased, and it became dominated by methanogenic archaea and the members of the Bathyarchaeota, Chloroflexi and Deltaproteobacteria. This study shows that the sediments of a subarctic meromictic lake contain a taxonomically and metabolically diverse community potentially capable of complete mineralization of organic matter.

Background As overdose deaths have increased in the United States, some lawmakers have explored punitive, “supply-side” interventions aimed at reducing the supply of fentanyl. While a rationale of seeking to protect people who use drugs is often given to justify harsh sentences for fentanyl distribution, there is no research to our knowledge on perceptions of the effect of drug-induced homicide laws among people who use drugs. Methods We conducted semi-structured, qualitative interviews with 40 people with opioid use disorder (OUD) who were enrolled in a medication for addiction treatment (MAT) program in a unified jail and prison system in Rhode Island on attitudes surrounding increased sentences for distribution of fentanyl, including recently enacted drug-induced homicide laws. Codes were developed using a generalized, inductive method and interviews analyzed in NVivo 12 after being coded by two coders. Results Most participants stated that drug-induced homicide laws would not be an effective strategy to stem the overdose crisis. We identified key themes, including discussions surrounding the autonomy of people who use drugs, widespread fentanyl prevalence as a barrier to implementation of drug-induced homicide laws, discussions of mass incarceration as ineffective for addressing substance use disorders, feelings that further criminalization could lead to violence, criminalization as a justification for interpersonal loss, and intention as meaningful to categorizing an act as homicide. Conclusions Findings highlight the importance of centering the experiences of people with OUD in creating policies surrounding the overdose epidemic, potential unintended health consequences of drug-induced homicides laws such as deterrence from calling 911 and increased violence, and how drug-induced homicide laws may undermine advances made in expanding access to OUD treatment for people who are criminal justice-involved.

Bacteria of the candidate phylum Bipolaricaulota, previously known as OP1 and Acetothermia, have been identified in various terrestrial and marine ecosystems as a result of molecular analysis of microbial communities. To date, none of the members of Bipolaricaulota has been isolated in a pure culture. We assembled the complete closed genome sequence of the bacterium of this phylum from the metagenome of a subsurface thermal aquifer and used the genomic data to analyze the phylogenetic position and metabolic potential of this bacterium. Analysis of the genome of this bacterium, designated Ch78, revealed various transporters of sugars and peptides and limited capacities for the extracellular hydrolysis of polysaccharides. Reconstruction of the central metabolic pathways suggested that the bacterium Ch78 is an anaerobic organotroph capable of fermenting sugars and proteinaceous substrates. Known pathways of aerobic and anaerobic respiration, as well as of autotrophic carbon fixation, were not found in the Ch78 genome. In the subsurface aquifer Bipolaricaulota probably consume low-molecular weight organic compounds and produce hydrogen and acetate. Based on the results of phylogenetic and genomic analysis, classification of the novel bacterium as “Candidatus Bipolaricaulis sibiricus” is proposed.

Transcriptome analysis of leaf and pitcher at different developmental stages in the carnivorous plant Nepenthes sp. identified 20 cDNAs of the SWEET gene family encoding sugar uniporters of classes I–IV. The structure of NSWEET proteins generally corresponded to the 3-1-3 scheme typical of SWEET proteins in eukaryotes. The variability in the expression of NSWEET genes in the mature leaf and in the three stages of pitcher development indicates the possible functional diversity of these genes. It has been suggested that class I transporters (NSWEET2d, 2f, and 2h) may participate in export of sugars from the leaf to the site of pitcher meristem initiation, while proteins NSWEET1, 2a, 2k (class I), 4a, 4b, 4d (II), and 12c (III) may participate in the delivery of sugars for the primary development of the pitcher. In subsequent stages, they can be replaced by NSWEET2b, 2c, 2e, 2i, 2j (class I), 4c (II), and 12b (III), delivering hexoses and sucrose to the growing pitcher. In the fully formed pitcher, proteins NSWEET12a (III), 2g (I), and 16 (IV) can export sugars from the digestive fluid to the leaf.

The Latarjet coracoid transfer is a key procedure for reducing anterior shoulder instability in patients with glenoid bone loss. New evidence suggests that subcritical glenoid bone loss, particularly in revision situations, portends an increased risk of recurrent instability. High recurrent instability rates associated with nonoperative management and revision soft tissue stabilization make the Latarjet and other bony stability procedures a must in an orthopaedic surgeons repertoire of recurrent anterior instability management. The long-term outcomes of the Latarjet surpass revision stabilization by soft-tissue correction in those with significant glenoid loss. Despite the promising outcomes of the Latarjet, the complication rate remains high. We present a practical guide to the open Latarjet procedure, addressing many of technical challenges to aid the reader in future decision-making regarding indications, approach, exposure, surgical technique, and rehabilitation.

High concentrations of ethanol and oxidative stress can cause a mutagenic effect on mitochondrial genomes (mtDNAs) of flor yeasts. We performed a comparative analysis of mtDNAs of wine yeast strains and three sequenced flor yeast strains. mtDNAs of flor strains are characterized by high conservation of nucleotide sequences and the structure. The numbers of destabilizing elements of mtDNA (GC clusters, short repeats, active ori sequences) in flor strains are generally lower than that in wine yeasts. The mtDNA conservation of flor strains can be determined by both bottleneck effects in the course of evolution and mechanisms aimed at maintaining the genetic stability. In general, the data obtained do not confirm the hypothesis of increased genetic variability of the mitochondrial genomes of flor yeast strains.

Methanogenesis is the main source of biogenic methane in the atmosphere and therefore plays an important role in climate change. While all methanogens known until recently belonged to the phylum Euryarchaeota, potential methanogens were recently found among two uncultured archaeal phyla, Bathyarchaeota and Verstraetearchaeota. Analysis of the genomes of several members of Verstraetearchaeota revealed their ability to use methylated compounds for methanogenesis; however, all these genomes were incomplete, which prevents an unequivocal reconstruction of their metabolic pathways. The present work reports the complete genome of a new member of Verstraetearchaeota from the metagenome of the microbial community of a deep subsurface reservoir of thermal waters in Western Siberia. Phylogenetic analysis revealed the new archaeon to belong to a new species of the genus ‘Candidatus Methanosuratus’, for which the name ‘Candidatus Methanosuratus subterraneum’ was proposed. The possibility of methyl-reducing methanogenesis was indicated by the presence of the methyl coenzyme M reductase complex and of the genes required for methane production using methanol as the methyl group donor, while the genes required for the oxidation of methyl group to CO2 were missing. Genome analysis showed that ‘Ca. Methanosuratus subterraneum’ has the metabolic pathways required for growth by fermentation of proteinaceous substrates. Analysis of the global distribution of ‘Ca. Methanosuratus’ revealed the 16S rRNA gene sequences assigned to this genus in hot springs, underground waters, and oil reservoirs, which makes it possible to consider this genus as a representative of the subsurface biosphere.

PURPOSE For many types of surgical cases, there is an increase in length with the participation of a resident physician. The lost operative time productivity is not necessarily mitigated in any fashion other than to benefit the experience of the trainee. Moreover, increasing pressures to maximize productivity, coupled with diminishing reimbursements serve to disincentive resident involvement. The aim of this study was to examine the opportunity cost in the academic setting for intraoperative resident participation during specific hand surgery cases. METHODS Retrospective analysis was performed on the American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database from 2006 to 2015. Cases were identified by Current Procedural Terminology code to isolate distal radius fracture repairs, carpal tunnel releases, scaphoid fractures repairs, and metacarpal fracture repairs. Variables collected included operation time, presence or absence of resident physician, and postgraduate year level. Statistical analysis was performed using the statistical computing software R 3.4.2 (R Foundation for Statistical Computing, Vienna, Austria). Cost analysis was performed to quantify the effect of operative times in terms of relative value units (RVUs) lost. RESULTS A total of 3727 cases were identified. Of those, 1264 cases were performed with a resident present. Residents participated in cases with higher total RVU (14.91 vs 13.16, P < 0.001). There was a statistically significant increase of 24.3 minutes (P < 0.001) in the mean operation time with a resident present as compared with those without. Moreover, RVU per hour in resident cases was significantly lower by 2.97 RVU per hour or 21% (P < 0.001). Using the late 2018 Medicare physician conversion factor of US $33.9996, the opportunity cost to attending physicians is US $159.20 per case. CONCLUSIONS Resident participation in surgical cases is paramount to the education of future trainees, particularly in the era of trainee duty hour reform. Because residents are participating in higher total RVU cases, this selection bias may be playing a role in explaining our result. Nonetheless, resident involvement for certain procedures comes at an opportunity cost to faculty surgeons. How to balance the cost to train residents in the emerging value-based health systems will prove to be challenging but requires consideration.

An enigmatic uncultured member of Firmicutes, Candidatus Desulforudis audaxviator (CDA), is known by its genome retrieved from the deep gold mine in South Africa, where it formed a single-species ecosystem fuelled by hydrogen from water radiolysis. It was believed that in situ conditions CDA relied on scarce energy supply and did not divide for hundreds to thousand years. We have isolated CDA strain BYF from a 2-km-deep aquifer in Western Siberia and obtained a laboratory culture growing with a doubling time of 28.5 h. BYF uses not only H(2) but also various organic electron donors for sulfate respiration. Growth required elemental iron, and ferrous iron did not substitute for it. A complex intracellular organization included gas vesicles, internal membranes, and electron-dense structures enriched in phosphorus, iron, and calcium. Genome comparison of BYF with the South African CDA revealed minimal differences mostly related to mobile elements and prophage insertions. Two genomes harbored

Most microorganisms from deep terrestrial subsurface remain yet uncultured. Recent achievements in recovery of metagenome-assembled genomes (MAG) provide clues for improving cultivation via metabolic reconstructions and other genomic characteristics. Here we report the isolation in pure culture of a thermophilic spirochete with the use of MAGs binned from metagenomes of the deep (>2 km) aquifers broached by two artesian boreholes in Western Siberia. The organism constitutes a minor share in the aquifer microbial community and could not be cultivated by traditional techniques. The obtained two pure culture isolates along with three bacteria identified by MAGs represent a novel family-level lineage in the order Brevinematales. Based on genomic and phenotypic characteristics the novel spirochete is proposed to be classified as Longinema margulisiae gen. nov., sp. nov. within a novel family, Longinemaceae fam. nov. Both cultivated strains, NST and N5R, are anaerobic hemoorganoheterotrophes growing by fermentation of starch and a few sugars. They can form recalcitrant round bodies under unfavourable growth conditions, which survive up to 15 min at 95°C and can revert to the original helical cells. We suggest that the round bodies may facilitate global distribution of this lineage, detected from molecular signaturesand colonization of subsurface environments.

Bacillus velezensis strain BZR 277 is a rhizobacterium isolated from the rhizoplane of a winter oilseed rape plant from the Krasnodar region in Russia. This study presents the genome sequence of the rhizobacterium Bacillus velezensis BZR 277, which exhibited high antagonistic activity against the root-knot nematode Meloidogyne incognita Kof., Bacillus velezensis strain BZR 277 is a rhizobacterium isolated from the rhizoplane of a winter oilseed rape plant from the Krasnodar region in Russia. This study presents the genome sequence of the rhizobacterium Bacillus velezensis BZR 277, which exhibited high antagonistic activity against the root-knot nematode Meloidogyne incognita Kof. The data on the genome sequence can help to identify pathways for the biosynthesis of metabolites responsible for nematicidal activity in order to improve crop protection against plant-parasitic nematodes.

ObjectiveAt a time of unprecedented attention to the public health impact of policing, it is imperative to understand the role of occupational safety in shaping officer behaviours. We assessed the longitudinal impact of police training in a quasi-experimental hybrid type-1 trial to reduce syringe-related occupational risk, while realigning police practices with public health prevention among people who inject drugs (PWID).SettingTijuana, Mexico.ParticipantsOf 1806 Tijuana municipal police trainees, 771 reporting previous exposure to syringes were randomly selected for follow-up. All participants completed at least one follow-up visit; attrition at 24 months was 8%.InterventionBetween 2015 and 2016, officers received a training intervention (Safety and Health Integration in the Enforcement of Laws on Drugs, SHIELD) bundling occupational needle stick injury (NSI) prevention with health promotion among PWID.Outcome measuresLongitudinal analysis with generalised linear mixed models to evaluate training impact on occupational NSI risk via NSI incidence and prevalidated Syringe Threat and Injury Correlates (STIC) score. This composite indicator integrates five self-reported risky syringe-handling practices (eg, syringe confiscation, breaking) and was used as a proxy for NSI risk due to reporting bias and concerns about reliability of NSI incidence reports.ResultsNo change in self-reported NSI incidence was observed, but significant reductions in risk (16.2% decrease in STIC score) occurred at 3 months, with a sustained decrease of 17.8% through 24 months, compared with pretraining (pConclusionsSHIELD is the first intervention to be associated with significant sustained changes in police practices that pose risk for both occupational and the public’s health. Integrating occupational safety and public health education should inform other interventions to mitigate the community health detriments of policing behaviours.Trial registration numberNCT02444403.

Thermal ecosystems associated with areas of underground burning coal seams are rare and poorly understood in comparison with geothermal objects. We studied the microbial communities associated with gas vents from the coal-fire in the mining wastes in the Kemerovo region of the Russian Federation. The temperature of the ground heated by the hot coal gases and steam coming out to the surface was 58 °C. Analysis of the composition of microbial communities revealed the dominance of Ktedonobacteria (the phylum Chloroflexi), known to be capable of oxidizing hydrogen and carbon monoxide. Thermophilic hydrogenotrophic Firmicutes constituted a minor part of the community. Among the well-known thermophiles, members of the phyla Aquificae, Deinococcus-Thermus and Bacteroidetes were also found. In the upper ground layer, Acidobacteria, Verrucomicrobia, Actinobacteria, Planctomycetes, as well as Proteobacteria of the alpha and gamma classes, typical of soils, were detected, their relative abundancies decreased with depth. The phylum Verrucomicrobia was dominated by Candidatus Udaeobacter, aerobic heterotrophs capable of generating energy through the oxidation of hydrogen present in the atmosphere in trace amounts. Archaea made up a small part of the communities and were represented by thermophilic ammonium-oxidizers. Overall, the community was dominated by bacteria, whose cultivated relatives are able to obtain energy through the oxidation of the main components of coal gases, hydrogen and carbon monoxide, under aerobic conditions.

Two metagenome-assembled genomes (MAGs), obtained from laboratory-scale enhanced biological phosphorus removal bioreactors, were analyzed. The values of 16S rRNA gene sequence identity, average nucleotide identity, and average amino acid identity indicated that these genomes, designated as RT and SSD2, represented two novel species within the genus Thiothrix, &lsquo, Candidatus Thiothrix moscowensis&rsquo, and &lsquo, Candidatus Thiothrix singaporensis&rsquo, A complete set of genes for the tricarboxylic acid cycle and electron transport chain indicates a respiratory type of metabolism. A notable feature of RT and SSD2, as well as other Thiothrix species, is the presence of a flavin adenine dinucleotide (FAD)-dependent malate:quinone oxidoreductase instead of nicotinamide adenine dinucleotide (NAD)-dependent malate dehydrogenase. Both MAGs contained genes for CO2 assimilation through the Calvin&ndash, Benson&ndash, Bassam cycle, sulfide oxidation (sqr, fccAB), sulfur oxidation (rDsr complex), direct (soeABC) and indirect (aprBA, sat) sulfite oxidation, and the branched Sox pathway (SoxAXBYZ) of thiosulfate oxidation to sulfur and sulfate. All these features indicate a chemoorganoheterotrophic, chemolithoautotrophic, and chemolithoheterotrophic lifestyle. Both MAGs comprise genes for nitrate reductase and NO-reductase, while SSD2 also contains genes for nitrite reductase. The presence of polyphosphate kinase and exopolyphosphatase suggests that RT and SSD2 could accumulate and degrade polyhosphates during the oxic-anoxic growth cycle in the bioreactors, such as typical phosphate-accumulating microorganisms.

Phycisphaera-like WD2101 'soil group' is one of the as-yet-uncultivated phylogenetic clades within the phylum Planctomycetes. Members of this clade are commonly detected in various terrestrial habitats. This study shows that WD2101 represented one of the major planctomycete groups in 10 boreal peatlands, comprising up to 76% and 36% of all Planctomycetes-affiliated 16S rRNA gene reads in raised bogs and eutrophic fens respectively. These types of peatlands displayed clearly distinct intra-group diversity of WD2101-affiliated planctomycetes. The first isolate of this enigmatic planctomycete group, strain M1803, was obtained from a humic lake surrounded by Sphagnum peat bogs. Strain M1803 displayed 89.2% 16S rRNA gene similarity to Tepidisphaera mucosa and was represented by motile cocci that divided by binary fission and grew under micro-oxic conditions. The complete 7.19 Mb genome of strain M1803 contained an array of genes encoding Planctomycetal type bacterial microcompartment organelle likely involved in l-rhamnose metabolism, suggesting participation of M1803-like planctomycetes in polysaccharide degradation in peatlands. The corresponding cellular microcompartments were revealed in ultrathin cell sections. Strain M1803 was classified as a novel genus and species, Humisphaera borealis gen. nov., sp. nov., affiliated with the formerly recognized WD2101 'soil group'.

Bacteria of the genus Acinetobacter, with their numerous species common in various habitats, play a significant role as pathogens. Their ability to adapt to different living conditions is largely due to the presence of numerous plasmids containing the necessary adaptive genes. At the same time the diversity of Acinetobacter plasmids and their evolutionary dynamics have not been sufficiently studied. Here, we characterized 44 plasmids isolated from five permafrost Acinetobacter lwoffii strains, examined their relationship with plasmids of modern Acinetobacter strains and identified groups of related plasmids. For this purpose, we have developed a combined approach for classifying all known Acinetobacter plasmids. The classification took into account the size of plasmids, the presence and structure of the rep and mob genes, as well as the structure of their backbone and accessory regions. Based on the analysis, 19 major groups (lineages) of plasmids were identified, of which more than half were small plasmids. The plasmids of each group have common features of the organization of the backbone region with a DNA identity level of at least 80%. In addition, plasmids of the same group have similarities in the organization of accessory regions. We also described a number of plasmids with a unique structure. The presence of plasmids in clinical strains that are closely related to those of environmental permafrost strains provides evidence of the origin of the former from the latter.

Acidophilic archaea of the archaeal Richmond Mine acidophilic nanoorganisms (ARMAN) group from the uncultured candidate phylum “Candidatus Micrarchaeota” have small genomes and cell sizes and are known to be metabolically dependent and physically associated with their Thermoplasmatales hosts. However, phylogenetically diverse “Ca. Micrarchaeota” are widely distributed in various nonacidic environments, and it remains uncertain because of the lack of complete genomes whether they are also devoted to a partner-dependent lifestyle. Here, we obtained nine metagenome-assembled genomes of “Ca. Micrarchaeota” from the sediments of a meromictic freshwater lake, including a complete, closed 1.2 Mbp genome of “Ca. Micrarchaeota” Sv326, an archaeon phylogenetically distant from the ARMAN lineage. Genome analysis revealed that, contrary to ARMAN “Ca. Micrarchaeota,” the Sv326 archaeon has complete glycolytic pathways and ATP generation mechanisms in substrate phosphorylation reactions, the capacities to utilize some sugars and amino acids as substrates, and pathways for de novo nucleotide biosynthesis but lacked an aerobic respiratory chain. We suppose that Sv326 is a free-living scavenger rather than an obligate parasite/symbiont. Comparative analysis of “Ca. Micrarchaeota” genomes representing different order-level divisions indicated that evolution of the “Ca. Micrarchaeota” from a free-living “Candidatus Diapherotrites”-like ancestor involved losses of important metabolic pathways in different lineages and gains of specific functions in the course of adaptation to a partner-dependent lifestyle and specific environmental conditions. The ARMAN group represents the most pronounced case of genome reduction and gene loss, while the Sv326 lineage appeared to be rather close to the ancestral state of the “Ca. Micrarchaeota” in terms of metabolic potential. IMPORTANCE The recently described superphylum DPANN includes several phyla of uncultivated archaea with small cell sizes, reduced genomes, and limited metabolic capabilities. One of these phyla, “Ca. Micrarchaeota,” comprises an enigmatic group of archaea found in acid mine drainage environments, the archaeal Richmond Mine acidophilic nanoorganisms (ARMAN) group. Analysis of their reduced genomes revealed the absence of key metabolic pathways consistent with their partner-associated lifestyle, and physical associations of ARMAN cells with their hosts were documented. However, “Ca. Micrarchaeota” include several lineages besides the ARMAN group found in nonacidic environments, and none of them have been characterized. Here, we report a complete genome of “Ca. Micrarchaeota” from a non-ARMAN lineage. Analysis of this genome revealed the presence of metabolic capacities lost in ARMAN genomes that could enable a free-living lifestyle. These results expand our understanding of genetic diversity, lifestyle, and evolution of “Ca. Micrarchaeota.”

Background As a response to mounting overdose fatalities, cross-agency outreach efforts have emerged to reduce future risk among overdose survivors. We aimed to characterize such programs in Massachusetts, with focus on team composition, approach, services provided, and funding. Methods We conducted a two-phase cross-sectional survey of public health and safety providers in Massachusetts. Providers in all 351 municipalities received a screening survey. Those with programs received a second, detailed survey. We analyzed responses using descriptive statistics. Results As of July 2019, 44 % (156/351) of Massachusetts municipalities reported post-overdose outreach programs, with 75 % (104/138) formed between 2016−2019. Teams conducted home-based outreach 1–3 days following overdose events. Police departments typically supplied location information on overdose events (99 %, 136/138) and commonly participated in outreach visits (86 %, 118/138) alongside public health personnel, usually from community-based organizations. Teams provided or made referrals to services including inpatient addiction treatment, recovery support, outpatient medication, overdose prevention education, and naloxone. Some programs deployed law enforcement tools, including pre-visit warrant queries (57 %, 79/138), which occasionally led to arrest (11 %, 9/79). Many programs (81 %, 112/138) assisted families with involuntary commitment to treatment – although this was usually considered an option of last resort. Most programs were grant-funded (76 %, 104/136) and engaged in cross-municipal collaboration (94 %, 130/138). Conclusions Post-overdose outreach programs have expanded, typically as collaborations between police and public health. Further research is needed to better understand the implications of involving police and to determine best practices for increasing engagement in treatment and harm reduction services and reduce subsequent overdose.

Background: Recent literature has focused on correlating statistically significant changes in outcome measures with clinically significant outcomes (CSOs). CSO benchmarks are being established for arthroscopic rotator cuff repair (RCR), but more remains to be defined about them. Purpose: To define the time-dependent nature of the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptomatic State (PASS) after RCR and to define what factors affect this time to CSO achievement. Study Design: Case series; Level of evidence, 4. Methods: An institutional registry was queried for patients who underwent arthroscopic RCR between 2014 and 2016 and completed preoperative, 6-month, 1-year, and 2-year patient-reported outcome measures (PROMs). Threshold values for MCID, SCB, and PASS were obtained from previous literature for the American Shoulder and Elbow Surgeons score (ASES), Single Assessment Numeric Evaluation (SANE), and subjective Constant score. The time in which patients achieved MCID, SCB, and PASS was calculated using Kaplan-Meier analysis. A Cox multivariate regression model was used to identify variables correlated with earlier or later achievement of CSOs. Results: A total of 203 patients with an average age of 56.19 ± 9.96 years and average body mass index was 30.29 ± 6.49 were included. The time of mean achievement of MCID, SCB, and PASS for ASES was 5.77 ± 1.79 months, 6.22 ± 2.85 months, and 7.23 ± 3.81 months, respectively. The time of mean achievement of MCID, SCB, and PASS for SANE was 6.25 ± 2.42 months, 7.05 ± 4.10 months, and 9.26 ± 5.89 months, respectively. The time of mean achievement of MCID, SCB, and PASS for Constant was 6.94 ± 3.85 months, 7.13 ± 4.13 months, and 8.66 ± 5.46 months, respectively. Patients with dominant-sided surgery (hazard ratio [HR], 1.363; 95% CI, 1.065-1.745; P = .014) achieved CSOs earlier on ASES, while patients with workers’ compensation status (HR, 0.752; 95% CI, 0.592-0.955; P = .019), who were current smokers (HR, 0.323; 95% CI, 0.119-0.882; P = .028), and with concomitant biceps tenodesis (HR, 0.763; 95% CI, 0.607-0.959; P = .021) achieved CSOs on ASES at later timepoints. Patients with distal clavicle excision (HR, 1.484; 95% CI, 1.028-2.143; P = .035) achieved CSOs earlier on SANE. Patients with distal clavicle excision (HR, 1.689; 95% CI, 1.183-2.411, P = .004) achieved CSOs earlier on Constant, while patients with workers’ compensation insurance status (HR, 0.671; 95% CI, 0.506-0.891; P = .006) and partial-thickness tears (HR, 0.410; 95% CI, 0.250-0.671; P < .001) achieved CSOs later on Constant. Greater preoperative score was associated with delayed achievement of CSOs for ASES, SANE (HR, 0.993; 95% CI, 0.987-0.999; P = .020), and Constant (HR, 0.941; 95% CI, 0.928-0.962; P < .001). Conclusion: A majority of patients achieved MCID by 6 months after surgery. Dominant-sided surgery and concomitant distal clavicle excision resulted in faster CSO achievement, while workers’ compensation status, concomitant biceps tenodesis, current smoking, partial-thickness rotator cuff tears, and higher preoperative PROMs resulted in delayed CSO achievement.

Objectives The authors hypothesized that monitored anesthesia care (MAC)—either by local sedation or regional anesthesia (RA)—compared with general anesthesia (GA), would be associated with lower odds of significant 30-day postoperative complications and mortality in patients undergoing an ankle amputation. Design Retrospective cohort study. Setting Inpatient. Participants The authors used data from patients who underwent ankle amputation from the American College of Surgeons National Surgical Quality Improvement Program registry. Intervention RA as primary anesthetic. Measurements and Main Results A multivariate logistic regression was used to evaluate the association of primary anesthesia type with the outcomes. The regression analysis included all covariates to test the association of the primary exposure variable (anesthesia type) with each outcome of interest. The odds ratio (OR), with associated 95% confidence interval (CI), was reported for each covariate. There were a total of 3,368 patients undergoing guillotine amputation through the tibia/fibula (n = 2,935) or ankle disarticulation (n = 433). Among these patients, 15.5% (n = 491) received MAC as their primary anesthetic. Among all patients, 11.4% (n = 363) experienced a significant postoperative complication. On multivariate logistic regression, MAC was found to decrease odds of postoperative complications (OR 0.57, 95% CI 0.40-0.82, p = 0.002), but not mortality (OR 1.26, 95% CI 0.87-1.84, p = 0.22). Conclusion This study showed that MAC was associated with improved outcomes, as opposed to GA, as the primary anesthetic in ankle amputations.

To get insights into microbial diversity and biogeochemical processes in the terrestrial deep subsurface aquifer, we sequenced the metagenome of artesian water collected at a 2.8 km deep oil exploration borehole 5P in Western Siberia, Russia. We obtained 71 metagenome-assembled genomes (MAGs), altogether comprising 93% of the metagenome. Methanogenic archaea accounted for about 20% of the community and mostly belonged to hydrogenotrophic Methanobacteriaceae; acetoclastic and methylotrophic lineages were less abundant. ANME archaea were not found. The most numerous bacteria were the Firmicutes, Ignavibacteriae, Deltaproteobacteria, Chloroflexi, and Armatimonadetes. Most of the community was composed of anaerobic heterotrophs. Only six MAGs belonged to sulfate reducers. These MAGs accounted for 5% of the metagenome and were assigned to the Firmicutes, Deltaproteobacteria, Candidatus Kapabacteria, and Nitrospirae. Organotrophic bacteria carrying cytochrome c oxidase genes and presumably capable of aerobic respiration mostly belonged to the Chloroflexi, Ignavibacteriae, and Armatimonadetes. They accounted for 13% of the community. The first complete closed genomes were obtained for members of the Ignavibacteriae SJA-28 lineage and the candidate phylum Kapabacteria. Metabolic reconstruction of the SJA-28 bacterium, designated Candidatus Tepidiaquacella proteinivora, predicted that it is an anaerobe growing on proteinaceous substrates by fermentation or anaerobic respiration. The Ca. Kapabacteria genome contained both the sulfate reduction pathway and cytochrome c oxidase. Presumably, the availability of buried organic matter of Mesozoic marine sediments, long-term recharge of the aquifer with meteoric waters and its spatial heterogeneity provided the conditions for the development of microbial communities, taxonomically and functionally more diverse than those found in oligotrophic underground ecosystems.

Mud volcanoes are prominent geological structures where fluids and gases from the deep subsurface are discharged along a fracture network in tectonically active regions. Microbial communities responsible for sulfur and methane cycling and organic transformation in terrestrial mud volcanoes remain poorly characterized. Using a metagenomics approach, we analyzed the microbial community of bubbling fluids retrieved from an active mud volcano in eastern Crimea. The microbial community was dominated by chemolithoautotrophic Campylobacterota and Gammaproteobacteria, which are capable of sulfur oxidation coupled to aerobic and anaerobic respiration. Methane oxidation could be enabled by aerobic Methylococcales bacteria and anaerobic methanotrophic archaea (ANME), while methanogens were nearly absent. The ANME community was dominated by a novel species of Ca. Methanoperedenaceae that lacked nitrate reductase and probably couple methane oxidation to the reduction of metal oxides. Analysis of two Ca. Bathyarchaeota genomes revealed the lack of mcr genes and predicted that they could grow on fatty acids, sugars, and proteinaceous substrates performing fermentation. Thermophilic sulfate reducers indigenous to the deep subsurface, Thermodesulfovibrionales (Nitrospirae) and Ca. Desulforudis (Firmicutes), were found in minor amounts. Overall, the results obtained suggest that reduced compounds delivered from the deep subsurface support the development of autotrophic microorganisms using various electron acceptors for respiration.

A massive, irreparable rotator cuff tear represents a challenging treatment scenario with respect to surgical intervention. Traditionally, surgical options have included reverse total shoulder arthroplasty, hemiarthroplasty, or rotator cuff repair; however, these techniques may not necessarily restore proper anatomy to the superior capsule, a structure implicated in the maintenance of subacromial contact pressures and the prevention of superior glenohumeral translation. Indications for arthroscopic superior capsular reconstruction include massive, irreparable supraspinatus and/or infraspinatus tears and failure of conservative treatment beyond subjective pain thresholds and dysfunction tolerability. Adequate latissimus dorsi, pectoralis major, and deltoid function helps to ensure the appropriate level of shoulder stability and the ability to complete the necessary rehabilitation protocol. The current surgical guide details the clinical evaluation, surgical technique, and rehabilitation protocol for patients undergoing arthroscopic superior capsular reconstruction for a massive, irreparable rotator cuff tear involving the subscapularis, supraspinatus, and infraspinatus. The procedure is performed arthroscopically with the patient in a beach-chair position, starting first with anterior and lateral portal placement for comprehensive diagnostic shoulder arthroscopy assessing rotator cuff damage. Single-row suture repair of the subscapularis and infraspinatus is performed, followed by concomitant subacromial bursectomy, decompression, and coracoplasty to aid in visualization, avoid graft abrasion, and provide access to marrow elements. Suture anchor placement, allograft fixation, and appropriate suture management are highlighted, as well as rehabilitation timelines, complications, and clinical pearls.

Microbiological, molecular ecological, biogeochemical, and isotope geochemical research was carried out at the polar Lake Bol'shie Khruslomeny at the coast of the Kandalaksha Bay, White Sea in March and September 2017. The uppermost mixolimnion was oxic, with low salinity (3-5%). The lower chemocline layer was brown-green colored, with very high content of particulate organic matter (up to 11.8 mg C L-1). The lowermost monimolimnion had marine salinity (22-24%) and very high concentrations of sulfide (up to 18 mmol L-1) and CH4 (up to 1.8 mmol L-1). In the chemocline, total microbial abundance and the rate of anoxygenic photosynthesis were 8.8 × 106 cells mL-1 and 34.4 μmol C L-1 day-1, respectively. Both in March and September, sulfate reduction rate increased with depth, peaking (up to 0.6-1.1 μmol S L-1 day-1) in the lower chemocline. Methane oxidation rates in the chemocline were up to 85 and 180 nmol CH4 L-1 day-1 in March and September, respectively; stimulation of this process by light was observed in September. The percentages of cyanobacteria and methanotrophs in the layer where light-induced methane oxidation occurred were similar, ∼2.5% of the microbial community. Light did not stimulate methane oxidation in deeper layers. The carbon isotope composition of particulate organic matter (δ13C-Corg), dissolved carbonates (δ13C-DIC), and methane (δ13C- CH4) indicated high microbial activity in the chemocline. Analysis of the 16S rRNA gene sequences revealed predominance of Cyanobium cyanobacteria (order Synechococcales) in the mixolimnion. Green sulfur bacteria Chlorobium phaeovibrioides capable of anoxygenic photosynthesis constituted ∼20% of the chemocline community both in March and in September. Methyloprofundus gammaptoteobacteria (family Methylomonaceae) were present in the upper chemocline, where active methane oxidation occurred. During winter, cyanobacteria were less abundant in the chemocline, while methanotrophs occurred in higher horizons, including the under-ice layer. Chemolithotrophic gammaproteobacteria of the genus Thiomicrorhabdus, oxidizing reduced sulfur compounds at low oxygen concentrations, were revealed in the chemocline in March. Both in March and September archaea constituted up to 50% of all microorganisms in the hypolimnion. The percentage of putative methanogens in the archaeal community was low, and they occurred mainly in near-bottom horizons.

Before COVID-19 pandemic, advocates had long urged drug policy reforms based on health, security, civil rights, racial justice, fiscal stewardship, and other considerations. In the United States, such calls went largely unanswered. In response to COVID-19, public health and occupational safety concerns have rapidly transformed some drug policies, along with their enforcement. Almost contemporaneously, nationwide protests against violence and racism by militarized police have highlighted the enduring legacy of the Drug War in fueling carceral systems. Disruption from these historical events provides a once-in-a-century opportunity to reconsider the legal architecture of drug policy and policing-both in the U.S. and elsewhere. Rather than returning to a fundamentally broken and inequitable status quo, we urge envisioning a new drug policy in service to life, liberty, and the pursuit of happiness.

Background We aimed to examine the preoperative performance of Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE, versions 1.2 and 2.0), Pain Interference (PI, version 1.1), and Depression (version 1.0) testing across multiple orthopedic procedures for the upper extremity and define its susceptibility to preoperative floor and ceiling effects. Methods We conducted a retrospective analysis of prospectively collected patient-reported outcome measures using an electronic outcome registry for procedures performed between May 2017 and April 2019. Current Procedural Terminology (CPT) codes were used to examine cohorts for 2 upper-extremity orthopedic procedures: Bankart repair and arthroscopic rotator cuff repair (ARCR). Shapiro-Wilk normality testing was used to assess score distributions for normalcy; given non-normal score distributions, Spearman correlation coefficients were calculated for preoperative patient-reported outcome scores. Absolute floor and ceiling effects were calculated for preoperative time points based on CPT code. Results A total of 488 patients were included across the Bankart repair cohort (n = 109; mean age, 29.3 ± 12.5 years) and ARCR cohort (n = 379; mean age, 57.5 ± 9.5 years). In the Bankart repair cohort, the PROMIS PI score demonstrated strong correlations with the American Shoulder and Elbow Surgeons score (r = −0.63), Constant score (r = −0.75), PROMIS UE score (r = −0.75), and Veterans RAND-6 Domain score (r = −0.61). The PROMIS Depression score (r = 0.23 and r = 0.17, respectively), Short Form 12 Mental Composite Scale score (r = 0.34 and r = 0.11, respectively), and Veterans RAND 12-item health survey Mental Composite Scale score (r = 0.44 and r = 0.15, respectively) exhibited poor correlations with the PROMIS PI and UE scores. In the ARCR cohort, the PROMIS PI score demonstrated a good correlation with the PROMIS UE score (r = 0.61). The Constant score (r = 0.58 and r = 0.67, respectively), Veterans RAND 12-item health survey Physical Composite Scale score (r = 0.58 and r = 0.47, respectively), and Veterans RAND-6 Domain score (r = 0.67 and r = 0.53, respectively) exhibited good correlations with the PROMIS PI and UE measures. No significant absolute floor or ceiling effects were observed for the PROMIS instruments except the PROMIS Depression measure: An absolute floor effect was noted for both the Bankart repair (n = 12, 30%) and ARCR (n = 38, 14.7%) groups. Conclusion The PROMIS PI and UE instruments perform favorably compared with legacy outcome instruments in patients receiving Bankart repair, as well as those undergoing ARCR. Furthermore, in both populations, the PROMIS Depression instrument exhibits absolute floor effects whereas the PROMIS PI and UE instruments fail to demonstrate any absolute floor or ceiling effects.