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Background: Within the hip joint, the anatomy of the acetabulum and cotyloid fossa is well established. There is little literature describing the association between the size of the cotyloid fossa relative to the acetabulum and characteristics of patients with femoroacetabular impingement (FAI). Purpose/Hypothesis: The purpose was to calculate the cotyloid fossa coverage percentage in the acetabulum and determine its association with patient characteristics, radiographic parameters, intra-articular findings, and preoperative patient-reported outcomes in patients with FAI. We hypothesized there is an association between the cotyloid fossa coverage percentage of the acetabulum and characteristics of patients with FAI. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients were included who underwent standard clinical 3-T magnetic resonance imaging of the hip and primary arthroscopic FAI correction surgery during 2015 and 2016. Exclusion criteria were age 40 years, osteoarthritis, labral reconstruction, previous ipsilateral hip surgery, and hip dysplasia. Measurements of the cotyloid fossa and surrounding lunate cartilage were performed to calculate cotyloid fossa width (CFW) and cotyloid fossa height (CFH) coverage percentages. The relationships between coverage percentages and patient characteristics and intraoperative findings were assessed using independent t tests or Pearson correlations. Results: An overall 146 patients were included. Alpha angle negatively correlated with CFH coverage percentage ( r = −0.19; P = .03) and positively correlated with labral tear size ( r = 0.28; P < .01). CFH coverage percentage was negatively correlated with labral tear size ( r = −0.24; P < .01). Among patients with degenerative tears, CFH was negatively correlated with labral tear size ( r = −0.31; P < .01). However, this association was no longer significant after adjusting for sex (partial r = −0.10; P = .39). Cotyloid fossa coverage was not associated with the condition of the cotyloid fossa synovium (synovitis vs no synovitis). CFW coverage percentage was negatively correlated with the 12-Item Short Form Health Survey (SF-12) physical component summary score ( r = −0.23; P < .01). Conclusion: The CFW and CFH coverage percentages may be associated with alpha angle, labral tear size, and SF-12 physical component summary score in patients with FAI. We may be able to predict the labral condition based on preoperative measurements of CFH and CFW coverage percentages.

This study compared pre-treatment distress and the changes in that distress over the course of therapy between sexual trauma clients and non-sexual trauma clients. Reasons for therapy ending were a...

Objective The purpose of this work was to compare measurements of talar cartilage thickness and cartilage and bone surface geometry from clinically feasible magnetic resonance imaging (MRI) against high-accuracy laser scan models. Measurement of talar bone and cartilage geometry from MRI would provide useful information for evaluating cartilage changes, selecting osteochondral graft sources or creating patient-specific joint models. Design Three-dimensional (3D) bone and cartilage models of 7 cadaver tali were created using (1) manual segmentation of high-resolution volumetric sequence 3T MR images and (2) laser scans. Talar cartilage thickness was compared between the laser scan– and MRI-based models for the dorsal, medial, and lateral surfaces. The laser scan– and MRI-based cartilage and bone surface models were compared using model-to-model distance. Results Average cartilage thickness within the dorsal, medial, and lateral surfaces were 0.89 to 1.05 mm measured with laser scanning, and 1.10 to 1.22 mm measured with MRI. MRI-based thickness was 0.16 to 0.32 mm higher on average in each region. The average absolute surface-to-surface differences between laser scan– and MRI-based bone and cartilage models ranged from 0.16 to 0.22 mm for bone (MRI bone models smaller than laser scan models) and 0.35 to 0.38 mm for cartilage (MRI bone models larger than laser scan models). Conclusions This study demonstrated that cartilage and bone 3D modeling and measurement of average cartilage thickness on the dorsal, medial, and lateral talar surfaces using MRI were feasible and provided similar model geometry and thickness values to ground-truth laser scan–based measurements.

Six ruminally cannulated steers (average BW = 791 + 71 kg) were used in a replicated 3 × 3 Latin square experiment to determine the effects of roughage type on rumination, fiber mat characteristics, and rumen fermentation variables. Three roughages were included at 7% (DM basis) in a steam flaked corn-based diet; cotton burrs (CB), wheat silage (WS), or corn stalks (CS). Steers were fitted with a sensory collar to record rumination behaviors in 2-h intervals at the beginning of the experiment. Each 30-d period consisted of a 7-d of recovery, 14-d of diet adaptation, 7-d of rumination data collection (daily and bi-hourly average rumination), 1-d of rumen fluid collection, and 1-d of rumen evacuations. In situ degradation of individual roughages was determined for 4-d after period 3 evacuations. During rumen evacuations, ruminal contents were removed; the rumen fiber mat (RF) was separated from the liquid portion with a 2 mm sieve, weighed, and a subsample was dried. Data were analyzed using the MIXED procedure of SAS with steer as the experimental unit and roughage (CB, WS, and CS) as the main effect. Dry matter intake (DMI) was not different for CB and WS (P = 0.25) and greatest for steers consuming CS diet (P < 0.01). Roughage type did not influence the weight of the RF dry matter (%; DM; P = 0.92), RF weight (P = 0.69), or RF:DMI ratio (P = 0.29). Daily rumination (min/d) did not differ among roughages (P = 0.40), but min of rumination/kg of DMI was greatest for CS (18.0 min), min/kg of NDF was greatest for WS (89.8 min; P = 0.02), and min/kg of peNDF was greatest for CS (132.4 min; P < 0.01). Wheat silage had the greatest percentage of soluble DM and CB-R and CS-R (P < 0.01) had the greatest ruminal degraded DM fraction. Rumen fiber mat did not differ for roughages, although rumination min/kg of DMI and peNDF was greatest for steers consuming CS and WS. In situ degradation determined that CB-R and CS-R had the greatest percentage of ruminal degraded DM. Based on the objective of the experiment, roughage type did not influence daily rumination or fiber mat characteristics.

Growth-promoting technologies such as implants, ionophores, and β-agonists improve feedlot performance, efficiency, and carcass characteristics of cattle. The objective of this experiment was to determine the effects of dose and duration of ractopamine hydrochloride (RH) on feedlot performance and carcass characteristics when fed to Holstein steers. A randomized complete block design was used with a 3 × 3 factorial arrangement of treatments with 3 RH doses (0, 300, or 400 mg∙steer−1∙d−1) fed for 3 durations (28, 35, or 42 d). Holstein steers (n = 855; initial body weight [BW] = 448 ± 37 kg) were blocked by BW and randomly allocated to 1 of 9 pens (15 blocks; 9 dose × duration treatment combinations) approximately 72 d before harvest. Weekly pen weights, chute temperament scores, and animal mobility were determined during the RH feeding period. At harvest, carcass data were collected on all steers, and tenderness was measured on steaks from 3 or 4 randomly selected steers from each pen and slice shear force (SSF) was determined on one steak selected from each side of the carcass after aging for 14 or 21 d. For feedlot performance, carcass characteristics, and SSF, no dose × duration interactions were observed (P ≥ 0.11). With increasing RH dose, average daily gain (ADG) and gain-to-feed ratio (G:F) increased linearly (P ≤ 0.01), whereas BW gain increased linearly with RH dose and duration (P ≤ 0.01). Hot carcass weight (P = 0.02) and longissimus muscle (LM) area (P ≤ 0.01) increased linearly with increasing RH dose. The percentage of carcasses in the USDA Yield Grade 2 category increased linearly (P ≤ 0.01) and percentage of carcasses in the USDA Yield Grade 4 category tended (P = 0.08) to decrease linearly as RH dose increased. In the 14-d aged steaks, the percentage of steaks with SSF ≤ 15.3 kg decreased linearly (P ≤ 0.01), whereas the percentage of steaks with ≥20.0 kg SSF increased linearly (P ≤ 0.01) with increasing RH dose. After 21-d aging, there was a tendency (P = 0.06) for a greater percentage of steaks from steers fed RH to have SSF ≥ 20.0 kg (2% of total steaks), but no difference (P ≥ 0.12) in the percentage of steaks with SSF ≤ 19.9 kg. Final chute temperament (P ≥ 0.45) and animal mobility (P ≥ 0.67) scores were not affected by feeding RH. Increasing the dose of RH (300 or 400 mg∙steer−1∙d−1) fed for 28 to 42 d before harvest increased ADG, G:F, hot carcass weight, and LM area when fed to Holstein steers with no negative effects on behavior or mobility. The percentage of steaks classified as not tender improved when steaks were aged for 21 d from steers treated with RH.

Background: Ventricular assist device (VAD) patients are at high risk for morbidities and mortality. One potentially beneficial component of the Joint Commission VAD Certification process is the requirement that individual VAD programs select 4 performance measures to improve and optimize patients’ clinical outcomes. Problem Statement: Review of patient data after our program’s first certification visit in 2008 showed that, compared to national recommendations and published reports, our patients had suboptimal outcomes in 4 areas after device implantation: length of hospital stay, receipt of early (Methods: Plan-Do-Study-Act processes were implemented to shorten length of stay, increase patient receipt of early physical therapy, decrease driveline infection incidence, and improve nutritional status. With 2008 as our baseline, we deployed interventions for each outcome area across 2009 to 2017. Performance improvement activities included staff, patient, and family didactic, one-on-one, and hands-on education; procedural changes; and outcomes monitoring with feedback to staff on progress. Descriptive and inferential statistics were examined to document change in the outcomes. Outcomes: Across the performance improvement period, length of stay decreased from 40 to 23 days; physical therapy consults increased from 87% to 100% of patients; 1-year driveline infection incidence went from 38% to 23.5%; and the percentage of patients with prealbumin within the normal range increased from 84% to 90%. Implications: Performance improvement interventions may enhance ventricular assist device patient outcomes. Interventions’ sustainability should be evaluated to ensure that gains are not lost over time.

Objective The objective of this experiment was to measure feedlot performance, rumination, ruminal pH, and carcass characteristics of cattle consuming a finishing diet with increasing levels of corn stalks (CS). Materials and Methods Fifty cross-bred steers (initial BW = 302 ± 27 kg) were randomly allocated to 1 of 3 dietary treatments: 5% (5CS; n = 17), 10% (10CS; n = 17), or 15% (15CS; n = 16) CS in a finishing diet based on steam-flaked corn. Experimental design was a randomized complete block, and data were analyzed using generalized random coefficients models. Rumination (min/d) was recorded from all the steers, and half of the steers (n = 27) received an indwelling rumen bolus to monitor pH. Results As CS inclusion rate increased, ADG and G:F decreased (P ≤ 0.05) linearly, whereas DMI of cattle consuming 10CS and 15CS was greater (P ≤ 0.05) than those consuming 5CS. Ruminal pH tended (P Applications Results of this study indicate that optimal dietary roughage inclusion of CS should be between 5 and 10% to optimize feedlot performance while maintaining rumination and ruminal pH.

Background Psychosocial evaluations are required for long-term mechanical circulatory support (MCS) candidates, no matter whether MCS will be destination therapy (DT) or a bridge to heart transplantation. Although guidelines specify psychosocial contraindications to MCS, there is no comprehensive examination of which psychosocial evaluation domains are most prognostic for clinical outcomes. We evaluated whether overall psychosocial risk, determined across all psychosocial domains, predicted outcomes, and which specific domains appeared responsible for any effects. Methods A single-site retrospective analysis was performed for adults receiving MCS between April 2004 and December 2017. Using an established rating system, we coded psychosocial evaluations to identify patients at low, moderate, or high overall risk. We similarly determined risk within each of 10 individual psychosocial domains. Multivariable analyses evaluated whether psychosocial risk predicted clinical decisions about MCS use (DT versus bridge), and postimplantation mortality, transplantation, rehospitalization, MCS pump exchange, and standardly defined adverse medical events (AEs). Results In 241 MCS recipients, greater overall psychosocial risk increased the likelihood of a DT decision (odds ratio, 1.76; P = 0.017); and postimplantation pump exchange and occurrence of AEs (hazard ratios [HRs] ≥ 1.25; P ≤ 0.042). The individual AEs most strongly predicted were cardiac arrhythmias and device malfunctions (HRs ≥ 1.39; P ≤ 0.032). The specific psychosocial domains predicting at least 1 study outcome were mental health problem severity, poorer medical adherence, and substance use (odds ratios and HRs ≥ 1.32; P ≤ 0.010). Conclusions The psychosocial evaluation predicts not only clinical decisions about MCS use (DT versus bridge) but important postimplantation outcomes. Strategies to address psychosocial risk factors before or soon after implantation may help to reduce postimplantation clinical risks.

Purpose Kentucky experiences a disproportionate burden of substance use disorder (SUD), particularly in rural areas of the state. Multiple factors increase vulnerability to SUD and limit access to services in rural communities. However, the recent implementation and expansion of syringe service programs (SSPs) in rural Kentucky may provide a leverage point to reach at-risk people who inject drugs (PWID). Methods Data were collected as part of an ongoing NIDA-funded study designed to examine uptake of SSPs among PWID in Appalachian Kentucky. Using Respondent Driven Sampling (RDS), the study enrolled a sample of 186 PWID SSP attenders across 3 rural Appalachian Kentucky counties and conducted face-to-face interviews regarding health behaviors, injecting practices, SSP utilization, and treatment services. Using logistic regression analyses, we examined consistent SSP use, as well as importance and confidence to reduce substance use as predictors of current treatment participation. Findings For the prior 6 months, 44.6% of the sample reported consistent SSP use. Consistent use of SSPs was associated with treatment participation in the unadjusted logistic regression models. Significant predictors of treatment participation in the adjusted model included high confidence to reduce substance use, and not reporting primary methamphetamine injection. Conclusions Rurally located SSPs may play an important role in supporting confidence and motivation to change substance use behaviors among PWID impacted by SUD. SSPs may be critical venues for integration and expansion of prevention, health promotion, and treatment linkage services for this underserved population.

Young Black men who have sex with men (YBMSM) bear a disproportionate burden of HIV, and HIV pre-exposure prophylaxis (PrEP) uptake has been slow. Decisions regarding PrEP initiation change in different life contexts over time. Our YBMSM cohort study found about 1/3 of those who initially declined PrEP subsequently changed and initiated PrEP care. This study explores the process of their PrEP decision changes. The study interviewed participants who initially voiced strong and clear reservations about PrEP, but subsequently started PrEP 1-14 months later. In "review/renew" follow-up interviews, participants reviewed their past statements from a time they declined PrEP, and renew their understanding regarding perspective and behavioral change. Analyzing the data with a positive deviance framework, we found that shifting the decisional balance in favor of PrEP initiation only required change in some areas. There were not consistent factors that prevented or facilitated PrEP uptake. Instead, YBMSM initiated PrEP while maintaining an array of substantial reservations. PrEP initiation discussions should be viewed by health practitioners as a longitudinal process, and routine PrEP offers should be made over time. To optimally facilitate PrEP use among YBMSM, the diverse benefits of PrEP should be emphasized rather than focusing on allaying all concerns.

Key Points Question Can a multifaceted approach lead to control of COVID-19 transmission and spread on an urban campus? Findings In this case series including more than 500 000 COVID-19 tests and 719 individuals with COVID-19 at Boston University, active surveillance of campus populations, isolation of individuals with SARS-CoV-2 infection, early and vigorous contact tracing and quarantine, regular communication, robust data systems, and strong leadership were associated with minimal transmission of SARS-CoV-2. Most transmission occurred off campus, and there was no evidence of classroom transmission. Meaning These findings suggest that using frequent testing, vigorous contact tracing, rapid isolation and quarantine, and a strong leadership structure to ensure rapid decision-making and adaption to emerging data, controlling the spread of SARS-CoV-2 on an urban campus was feasible despite worsening local transmission during the semester., This case series describes the use of a multifaceted COVID-19 control plan to reduce spread of SARS-CoV-2 at a large urban university during the second wave of the pandemic., Importance The COVID-19 pandemic has severely disrupted US educational institutions. Given potential adverse financial and psychosocial effects of campus closures, many institutions developed strategies to reopen campuses in the fall 2020 semester despite the ongoing threat of COVID-19. However, many institutions opted to have limited campus reopening to minimize potential risk of spread of SARS-CoV-2. Objective To analyze how Boston University (BU) fully reopened its campus in the fall of 2020 and controlled COVID-19 transmission despite worsening transmission in Boston, Massachusetts. Design, Setting, and Participants This multifaceted intervention case series was conducted at a large urban university campus in Boston, Massachusetts, during the fall 2020 semester. The BU response included a high-throughput SARS-CoV-2 polymerase chain reaction testing facility with capacity to deliver results in less than 24 hours; routine asymptomatic screening for COVID-19; daily health attestations; adherence monitoring and feedback; robust contact tracing, quarantine, and isolation in on-campus facilities; face mask use; enhanced hand hygiene; social distancing recommendations; dedensification of classrooms and public places; and enhancement of all building air systems. Data were analyzed from December 20, 2020, to January 31, 2021. Main Outcomes and Measures SARS-CoV-2 diagnosis confirmed by reverse transcription–polymerase chain reaction of anterior nares specimens and sources of transmission, as determined through contact tracing. Results Between August and December 2020, BU conducted more than 500 000 COVID-19 tests and identified 719 individuals with COVID-19, including 496 students (69.0%), 11 faculty (1.5%), and 212 staff (29.5%). Overall, 718 individuals, or 1.8% of the BU community, had test results positive for SARS-CoV-2. Of 837 close contacts traced, 86 individuals (10.3%) had test results positive for COVID-19. BU contact tracers identified a source of transmission for 370 individuals (51.5%), with 206 individuals (55.7%) identifying a non-BU source. Among 5 faculty and 84 staff with SARS-CoV-2 with a known source of infection, most reported a transmission source outside of BU (all 5 faculty members [100%] and 67 staff members [79.8%]). A BU source was identified by 108 of 183 undergraduate students with SARS-CoV-2 (59.0%) and 39 of 98 graduate students with SARS-CoV-2 (39.8%); notably, no transmission was traced to a classroom setting. Conclusions and Relevance In this case series of COVID-19 transmission, BU used a coordinated strategy of testing, contact tracing, isolation, and quarantine, with robust management and oversight, to control COVID-19 transmission in an urban university setting.

Whole Body Vibration (WBV) is an innovative therapy that may be effective for reducing chronic pain associated with diabetic peripheral neuropathy (DPN), Current treatments for DPN pain have demonstrated questionable efficacy and significant risk of adverse events. Preliminary research has indicated that WBV may be effective for controlling chronic pain symptoms of DPN. METHODS: 20 participants (9 male, 11 female), 58.51 ± 10.69 years old, and BMI of 33.60 ± 8.20 kg/m2 were randomly assigned to a sham-treatment (n = 8) or WBV treatment (n = 12) group in a pre-post design. Pain was assessed with a 10-point verbal analog pain scale (VAS). Treatment consisted of three sessions/week with at least one day between sessions, 12 min/session (four bouts of 3 min), for four weeks. Control was established with a sham vibration protocol for two weeks in which the participants were blinded to the treatment. RESULTS: VAS scores of the treatment group decreased significantly at both 2 and 4 weeks (p = 0.019). The treatment group was found to have a significantly lower VAS score than the controls at two weeks (p = 0.033). After cessation of WBV vibration treatment, participants reported reduced DPN-related pain from 1 to 5 weeks later. Conclusion WBV is effective for reducing DPN-associated pain over a two- and four-week interval. This was the first study to demonstrate this using a sham vibration control. We further saw a persistence in pain reduction beyond the day of treatment, indicating a potential chronic effect of WBV treatment.

The objective of this trial was to investigate the effects of using meloxicam as a pretransport or on arrival therapeutic on disease outcomes of bovine respiratory disease (BRD), biomarker outcomes associated with BRD, performance characteristics over the first 42 d on feed, and carcass traits at harvest in cross bred beef cattle. Multisourced, crossbred steer calves (n = 168) consisting of mainly British and British-Continental breeds were purchased from an auction market in central Missouri. Calves were processed prior to transportation and again upon feedlot arrival. Animals were randomized to 3 separate treatments: pretransport meloxicam (PMEL), arrival meloxicam (AMEL), and a control group receiving inactive excipient (CONT). Dosing at 1 mg/kg on weighted averaged administered per os. Animals were weighed and blood was collected pre- and post-transport. Haptoglobin (Hp)-matrix metaloproteinase (MMP)-9 complex, cortisol, and substance P were quantified. Weights were taken again at 42 d and at harvest. Clinical signs of BRD were monitored using indicators of depression, appetite, respiration, and temperature that qualified the animals for treatment. Harvest parameters were collected using a standardized United States Department of Agriculture grading system for quality grade and yield grade. Meloxicam did not have a significant effect on BRD morbidity over the course of the study and there was no significant effect on performance characteristics at 42 d (P > 0.10). Of the calves that did succumb to BRD, no significant differences were found in severity of disease (P > 0.10). Concentrations of substance P and Hp- MMP-9, were increased on arrival (P ≤ 0.05) however no significant treatment effect or interaction were found between AMEL, PMEL, CONT, or across different levels of biomarkers (P > 0.10). Meloxicam use prior to or on arrival does not mitigate disease or improve performance during the feeding period.

The purpose of this study was to compare the reliability and accuracy of existing computed tomography (CT) methods for measuring the distal tibiofibular syndesmosis in uninjured, paired cadaveric specimens and in simulated malreduction models. It was hypothesized that a repeatable set of measurements exists to accurately and quantitatively describe the typical forms of syndesmotic malreduction using contralateral ankle comparison. Twelve cadaveric lower-leg specimen pairs were imaged with CT to generate models for this study. Thirty-five measurements were performed on each native model. Next, four distinct fibular malreductions were produced via digital simulation and all measurements were repeated for each state: (1) 2-mm lateral translation; (2) 2-mm posterior translation; (3) 7-degree external rotation; (4) the previous three states combined. The modified standardized response mean (mSRM) was calculated for each measurement. To assess rater reliability and side-to-side agreements of the native state measurements, intraclass correlation coefficients (ICC) and Pearson correlation coefficients (PCC) were calculated, respectively. The most responsive measurements for detecting isolated malreduction were the Leporjarvi clear space for lateral translation, the Nault anterior tibiofibular distance for posterior translation, and the Nault talar dome angle for external rotation of the fibula. These measurements demonstrated fair to excellent inter-rater ICCs (0.64–0.76) and variable side-to-side PCCs (0.14–0.47). The most reliable method to assess the syndesmosis on CT was to compare side-to-side differences using three distinct measurements, one for each type of fibular malreduction, allowing assessment of the magnitude and directionality of syndesmosis malreduction. Reliable evaluation is essential for assessing subtle syndesmosis injuries, malreduction and surgical planning.

To develop a method for T2 mapping of the entire tibiotalar/hindfoot articular surfaces and to examine regional T2 variation in asymptomatic volunteers, establishing necessary methods for future T2 mapping work in patients with ankle/hindfoot injury.Twenty-six asymptomatic volunteers (11 female/13 male, aged 23-64 years in final analysis) underwent sagittal T2 mapping. Tibiotalar and hindfoot cartilage surfaces were segmented by two raters. The tibiotalar joint cartilage was divided into subregions to assess T2 variation across the joint. The articular surface and subregion mean T2 values were compared using Tukey post hoc pairwise comparisons to test for statistical significance.Mean ankle/hindfoot cartilage T2 ranged from 37 ± 3 to 47 ± 7 ms. Tibial plafond mean T2 was significantly different from the middle and posterior subtalar cartilage T2 (both articular surface comparisons resulted in P .05). Talar dome mean T2 was significantly different from the posterior calcaneal-side and talar-side subtalar cartilage, and middle calcaneal-side subtalar cartilage (P .05 for all comparisons). Tibial plafond middle versus lateral, anterior versus middle, middle versus posterior, and anterior versus posterior subregion T2 values were significantly different (P .05 for all comparisons). Talar dome medial versus middle, middle versus lateral, anterior versus middle, and middle versus posterior subregion T2 values were significantly different (P .05 for all comparisons). Ankle/hindfoot joint cartilage T2 mapping and segmentation was found to be feasible for all cartilage surfaces except the anterior subtalar joint facet. Mean T2 differed significantly between ankle/hindfoot joint and subregion cartilage in asymptomatic volunteers.

Background: The purposes of this study were to determine (1) if cartilage thicknesses on the talar dome and medial/lateral surfaces of the talus were similar, (2) whether there was sufficient donor cartilage surface area on the medial and lateral talar surfaces to repair talar dome cartilage injuries of the talus, and (3) whether the cartilage surface could be increased following anterior talofibular ligament (ATFL) and sectioning of the tibionavicular and tibiospring portion of the anterior deltoid. Methods: Medial and lateral approaches were utilized in 8 cadaveric ankles to identify the accessible medial, lateral, and talar dome cartilage surfaces in 3 conditions: (1) intact, (2) ATFL release, and (3) superficial anterior deltoid ligament release. The talus was explanted, and the cartilage areas were digitized with a coordinate measuring machine. Cartilage thickness was quantified using a laser scanner. Results: The mean cartilage thickness was 1.0 ± 0.1 mm in all areas tested. In intact ankles, the medial side of the talus showed a larger total area of available cartilage than the lateral side (152 mm2 vs 133 mm2). ATFL release increased the available cartilage area on the medial and lateral sides to 167 mm2 and 194 mm2, respectively. However, only the lateral talar surface had sufficient circular graft donor cartilage available for autologous osteochondral transplantation (AOT) procedures of the talus. After ATFL and deltoid sectioning, there was an increase in available graft donor cartilage available for AOT procedures. Conclusion: The thickness of the medial and lateral talar cartilage surfaces is very similar to that of the talar dome cartilage surface, which provides evidence that the medial and lateral surfaces may serve as acceptable AOT donor cartilage. The surface area available for AOT donor site grafting was sufficient in the intact state; however, sectioning the ATFL and superficial anterior deltoid ligament increased the overall lateral talar surface area available for circular grafting for an AOT procedure that requires a larger graft. These results support the idea that lateral surfaces of the talus may be used as donor cartilage for an AOT procedure since donor and recipient sites are similar in cartilage thickness, and there is sufficient cartilage surface area available for common lesion sizes in the foot and ankle. Clinical Relevance: This anatomical study investigates the feasibility of talar osteochondral autografts from the medial or lateral talar surfaces exposed with standard approaches. It confirms the similar cartilage thickness of the talar dome and the ability to access up to an 8- to 10-mm donor graft from the lateral side of the talus after ligament release. This knowledge may allow better operative planning for use of these surfaces for osteochondral lesions within the foot and ankle, particularly in certain circumstances of a revision microfracture.

We hypothesized that roughage source would not impact rumination time and growth performance if the different sources provided a similar concentration of dietary neutral detergent fiber (NDF) and physically effective NDF (peNDF). This experiment’s objective was to evaluate rumination time, and growth performance steers consuming finishing diets with differing roughage sources (corn stalks, cotton burrs, or wheat silage). Beef steers (n = 49; BW = 317 + 5.6 kg) were used in a completely randomized design with 3 dietary treatments. Steers consumed a steam-flaked corn-based diet containing corn stalks (CS), cotton burrs (CB), or wheat silage (WS) included at 7% (DM basis). Dietary NDF was similar (P = 0.36) across treatments. Each steer was fitted with a sensory collar to record daily rumination. Weekly ingredient and dietary samples were estimated for physically effective NDF (epeNDF) using the Penn State Particle Separator. Actual physically effective NDF (apeNDF) was calculated based upon rumination time. Neither initial nor final body weight (BW) differed between treatments (P > 0.52); nor did average daily gain (ADG), dry matter intake or carcass adjusted variables of FBW, ADG, empty BW, or empty body fat (P > 0.31). However, gain to feed (G:F) tended to differ (P = 0.06) between treatments. The CS diet had the greatest G:F with no difference (P = 0.75) between CB and WS. Dietary NDF and epeNDF were similar (P > 0.35) among roughage sources; however, CB had the least apeNDF, consistent with lower rumination time (P < 0.01). When energy values were calculated from animal performance, the CS diet had the greatest observed energy values, followed by WS and CB having the least. These results indicate roughage source impacted rumination time, although steers were fed a steam-flaked corn-based finishing diet with similar dietary roughage and NDF inclusions.

ImportanceThe coronavirus disease 2019 (COVID-19) pandemic has severely disrupted United States educational institutions. Given potential adverse financial psychosocial effects of campus closures, many institutions developed strategies to reopen campuses in the fall despite the ongoing threat of COVID-19. Many however opted to have limited campus re-opening in order to minimize potential risk of spread of SARS-CoV-2.ObjectiveTo analyze how Boston University (BU) fully reopened its campus in the fall of 2020 and controlled COVID-19 transmission despite worsening transmission in the city of Boston.DesignMulti-faceted intervention case study.SettingLarge urban university campus.InterventionsThe BU response included a high-throughput SARS-CoV-2 PCR testing facility with capacity to delivery results in less than 24 hours; routine asymptomatic screening for COVID-19; daily health attestations; compliance monitoring and feedback; robust contact tracing, quarantine and isolation in on campus facilities; face mask use; enhanced hand hygiene; social distancing recommendations; de-densification of classrooms and public places; and enhancement of all building air systems.Main Outcomes and MeasuresBetween August and December 2020, BU conducted >500,000 COVID-19 tests and identified 719 individuals with COVID-19: 496 (69.0%) students, 11 (1.5%) faculty, and 212 (29.5%) staff. Overall, about 1.8% of the BU community tested positive. Of 837 close contacts traced, 86 (10.3%) tested positive for COVID-19. BU contact tracers identified a source of transmission for 51.5% of cases with 55.7% identifying a source outside of BU. Among infected faculty and staff with a known source of infection, the majority reported a transmission source outside of BU (100% for faculty and 79.8% for staff). A BU source was identified by 59.2% of undergraduate students and 39.8% of graduate students; notably no transmission was traced to a classroom setting.Conclusions and RelevanceBU was successful in containing COVID-19 transmission on campus while minimizing off campus acquisition of COVID-19 from the greater Boston area. A coordinated strategy of testing, contact tracing, isolation and quarantine, with robust management and oversight, can control COVID-19 transmission, even in an urban university setting.Key PointsQuestionCan a multi-faceted approach lead to control of COVID-19 transmission and spread on an urban campus?FindingsDespite a second wave of SARS-CoV-2 in the greater Boston area, Boston University was able to minimize outbreaks by means of active surveillance of campus populations, isolation of infected individuals, early, effective contact tracing and quarantine, regular communication, excellent data systems, and strong leadership. Most transmission appeared to occur off campus and there was no evidence of classroom transmission.MeaningUsing the main axioms of infection control including frequent testing, vigorous contact tracing, and rapid isolation and quarantine, and a strong leadership structure to ensure nimble decision-making and rapid adaption to emerging data, controlling the transmission and spread of SARS-CoV-2 on an urban campus was feasible despite worsening local transmission during the course of the semester.

Background Magnetic resonance (MR) T2 and T2* mapping sequences allow in vivo quantification of biochemical characteristics within joint cartilage of relevance to clinical assessment of conditions such as hip osteoarthritis (OA). Purpose To evaluate an automated immediate reliability analysis of T2 and T2* mapping from MR examinations of hip joint cartilage using a bone and cartilage segmentation pipeline based around focused shape modelling. Study type Technical validation. Subjects 17 asymptomatic volunteers (M: F 7:10, aged 22–47 years, mass 50–90 kg, height 163-189 cm) underwent unilateral hip joint MR examinations. Automated analysis of cartilage T2 and T2* data immediate reliability was evaluated in 9 subjects (M: F 4: 5) for each sequence. Field strength/sequence A 3 T MR system with a body matrix flex-coil was used to acquire images with the following sequences: T2 weighted 3D-trueFast Imaging with Steady-State Precession (water excitation; 10.18 ms repetition time (TR); 4.3 ms echo time (TE); Voxel Size (VS): 0.625 × 0.625 × 0.65 mm; 160 mm field of view (FOV); Flip Angle (FA): 30 degrees; Pixel Bandwidth (PB): 140 Hz/pixel); a multi-echo spin echo (MESE) T2 mapping sequence (TR/TE: 2080/18–90 ms (5 echoes); VS: 4 × 0.78 × 0.78 mm; FOV: 200 mm; FA: 180 degrees; PB: 230 Hz/pixel) and a MESE T2* mapping sequence (TR/TE: 873/3.82–19.1 ms (5 echoes); VS: 3 × 0.625 × 0.625 mm; FOV: 160 mm; FA: 25 degrees; PB: 250 Hz/pixel). Assessment Automated cartilage segmentation and quantitative analysis provided T2 and T2* data from test-retest MR examinations to assess immediate reliability. Statistical tests Coefficient of variation (CV) and intraclass correlations (ICC2, 1) to analyse automated T2 and T2* mapping reliability focusing on the clinically important superior cartilage regions of the hip joint. Results Comparisons between test-retest T2 and (T2*) data revealed mean CV's of 3.385% (1.25%), mean ICC2, 1′s of 0.871 (0.984) and median mean differences of −1.139ms (+0.195ms). Conclusion The T2 and T2* times from automated analyses of hip cartilage from test-retest MR examinations had high (T2) and excellent (T2*) immediate reliability.

BACKGROUND: Despite evidence of effectiveness, most US hospitals do not deliver hospital-based addictions care. ECHO (Extension for Community Healthcare Outcomes) is a telementoring model for providers across diverse geographic areas. We developed and implemented a substance use disorder (SUD) in hospital care ECHO to support statewide dissemination of best practices in hospital-based addictions care. OBJECTIVES: Assess the feasibility, acceptability, and effects of ECHO and explore lessons learned and implications for the spread of hospital-based addictions care. DESIGN: Mixed-methods study with a pre-/post-intervention design. PARTICIPANTS: Interprofessional hospital providers and administrators across Oregon. INTERVENTION: A 10–12-week ECHO that included participant case presentations and brief didactics delivered by an interprofessional faculty, including peers with lived experience in recovery. APPROACH: To assess feasibility and acceptability, we collected enrollment, attendance, and participant feedback data. To evaluate ECHO effects, we used pre-/post-ECHO assessments and performed a thematic analysis of open-ended survey responses and participant focus groups. KEY RESULTS: We recruited 143 registrants to three cohorts between January and September 2019, drawing from 32 of Oregon’s 62 hospitals and one southwest Washington hospital. Ninety-six (67.1%) attended at least half of ECHO sessions. Participants were highly satisfied with ECHO. After ECHO, participants were more prepared to treat SUD; however, prescribing did not change. Participants identified substantial gains in knowledge and skills, particularly regarding the use of medications for opioid use disorder; patient-centered communication with people who use drugs; and understanding harm reduction as a valid treatment approach. ECHO built a community of practice and reduced provider isolation. Participants recognized the need for supportive hospital leadership, policies, and SUD resources to fully implement and adopt hospital-based SUD care. CONCLUSIONS: A statewide, interprofessional SUD hospital care ECHO was feasible and acceptable. Findings may be useful to health systems, states, and regions looking to expand hospital-based addictions care. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11606-020-06175-5) contains supplementary material, which is available to authorized users.

Hearing loss is the third most common chronic health condition in the United States and largely results from damage to sensory hair cells. Major causes of hair cell damage include aging, noise exposure, and medications such as aminoglycoside antibiotics. Due to their potent antibacterial properties and low cost, aminoglycosides are often used for the treatment of gram-negative bacterial infections, surpassing expensive antibiotics with fewer harmful side effects. However, their use is coupled with permanent hearing loss in over 20% of patients requiring these life-sustaining antibiotics. There are currently no FDA-approved drugs that prevent hearing loss from aminoglycosides. A previous study by our group identified the plant alkaloid berbamine as a strong protectant of zebrafish lateral line hair cells from aminoglycoside damage. This effect is likely due to a block of the mechanotransduction channel, thereby reducing aminoglycoside entry into hair cells. The present study builds on this previous work, investigating 16 synthetic berbamine analogs to determine the core structure underlying their protective mechanisms. We demonstrate that nearly all of these berbamine analogs robustly protect lateral line hair cells from ototoxic damage, with ED50 values nearing 20 nM for the most potent analogs. Of the 16 analogs tested, nine strongly protected hair cells from both neomycin and gentamicin damage, while one conferred strong protection only from gentamicin. These data are consistent with prior research demonstrating that different aminoglycosides activate somewhat distinct mechanisms of damage. Regardless of the mechanism, protection required the entire berbamine scaffold. Phenolic alkylation or acylation with lipophilic groups appeared to improve protection compared to berbamine, implying that these structures may be responsible for mitigating damage. While the majority of analogs confer protection by blocking aminoglycoside uptake, 18% of our analogs also confer protection via an uptake-independent mechanism; these analogs exhibited protection when delivered after aminoglycoside removal. Based on our studies, berbamine analogs represent a promising tool to further understand the pathology of aminoglycoside-induced hearing loss and can serve as lead compounds to develop otoprotective drugs.

Purpose: To determine whether adherence to a repeating 30-d non-linear diet intervention while participating in a supervised exercise program that includes resistance-exercise would promote weight and fat loss without weight loss plateau and whether alterations in carbohydrate and protein intake may influence results. Methods: Fifty sedentary and obese pre-menopausal females (35.2±7.6 years; 88.7±18 kg, 32.6±6 kg/m2, 42.5±4.2% fat) were randomly assigned to an exercise-only (EX) or EX plus diets containing higher proportions of carbohydrate or protein. Diets were hypoenergetic for 30-d (7-d at 1,200 kcals/d, 21-d at 1,500 kcal/d), more isoenergetic for 30-d (2,200 kcals/d), and repeated three times during a 24-wk intervention. Diets were either 45:30:24 (HCD) or 30:45:25 (HPD) carbohydate:protein:fat. All participants performed 30-min resistance exercise (3 d/wk) and a brisk walking program (3 d/wk). Data were analyzed by general linear model (GLM) statistics with repeated measures and presented as mean changes from baseline (mean [UL, LL]). Results: Participants experienced a significant and reduction in body weight (EX -2.24 [-6.5, 2.0], EX+HCD -6.99 [-9.4, -4.5], EX+HPD -4.49 [-7.1, -1.8] %), fat mass (EX -3.45 [-10.9, 4.03], EX+HCD -12.15 [-16.4, -7.9], EX+HPD -8.54 [-13.2, -3.9] %), and percent body fat (EX -1.30 [-5.6, 3.0], EX+HCD -5.91 [-8.3, -3.5], EX+HPD -4.31 [-7.0, -1.6] %) with those in the EX+HCD experiencing a more linear response. Participants in the EX and EX+HCD groups maintained fat-free mass to a better degree (EX -0.89 [-4.0, 2.2], EX+HCD -3.21 [-5.0, -1.2], EX+HPD -1.92 [-3.8, 0.002] %). Participants dieting generally experiencing greater benefit with some evidence that those in the EX+HPD experienced greater changes in blood lipids. Conclusion: A 30-day repeated non-linear diet can promote fat and weight loss without a plateau. Consuming a HPD may help maintain fat-free mass during weight loss and improve some markers of health compared to HCD interventions.

Driveline infection (DLI) is a cause of morbidity and mortality in patients with continuous-flow left ventricular assist devices (CF-LVADs). We hypothesized that an alternate dressing protocol would decrease the rate of DLIs.A retrospective review of CF-LVAD implants at a single institution from January 2010 to October 2015 was conducted. Patients were divided into implants before (group 1) and after (group 2) the introduction of the new protocol on September 1, 2012. Patients were followed until death, transplantation, change in dressing type, or 2 years. 153 patients were included: 61 in group 1 and 92 in group 2. Group 1 had fewer HVADs than group 2 (27.9% vs 71.7%; P.001) and more destination therapy, although the latter was not statistically significant (50.8% vs 34.8%; P = .118). At 24 months, the freedom from DLI was 53% in group 1 and 89% in group 2 (P = .01). Group 1 had a significantly greater risk of DLI than group 2 (incident rate ratio 3.18, 95% confidence interval 1.23-8.18; P = .016).Dramatic improvement in freedom from DLI at 2 years was achieved with a new driveline dressing protocol. This demonstrates that DLI rates can be improved with alternate percutaneous site care techniques in CF-LVAD patients.

OBJECTIVE Mixed methods can foster depth and breadth in psychological research. However, its use remains in development in psychotherapy research. Our purpose was to review the use of mixed methods in psychotherapy research. METHOD Thirty-one studies were identified via the PRISMA systematic review method. Using Creswell & Plano Clark's typologies to identify design characteristics, we assessed each study for rigor and how each used mixed methods. RESULTS Key features of mixed methods designs and these common patterns were identified: (a) integration of clients' perceptions via mixing; (b) understanding group psychotherapy; (c) integrating methods with cases and small samples; (d) analyzing clinical data as qualitative data; and (e) exploring cultural identities in psychotherapy through mixed methods. CONCLUSION The review is discussed with respect to the value of integrating multiple data in single studies to enhance psychotherapy research.

Leishmania infantum causes visceral leishmaniasis (VL) in Brazil. We previously observed that VL is more common in males than females living in endemic neighborhoods, despite similar exposure. Using a larger sample, we document that VL is more common in males than females, but only after puberty. BALB/c and C57BL/6 mouse models confirmed that there is a biological basis for male susceptibility to symptomatic VL, showing higher parasite burdens in males than females. Female C57BL/6 mice generated more antigen-induced cytokines associated with curative responses (interferon-γ, interleukin [IL]-1β). Males expressed higher levels of IL-10 and tumor necrosis factor, which are linked to exacerbated disease. Different parasite lines entered or survived at a higher rate in macrophages of male- than female-origin. These results suggest that males are inherently more susceptible to L. infantum than females and that mice are a valid model to study this sex-dependent difference.

This study was realized to evaluate the effects of a yeast-based additive complex (AC) on animal performance, heat stress behaviors, and carcass characteristics of beef of finishing beef steers fed during a period of thermal heat stress. Black-hided beef steers (n = 192; initial live weight = 403 ± 24.5 kg) were used in a randomized complete block design experiment with 2 treatments; a steam flaked corn-based diet with AC (fed at 0.14 kg∙hd−1∙d−1) and a diet without AC (CON). Steers were stratified by live weight to 1 of 2 weight blocks and randomly allocated to an experimental treatment within block. Experimental supplementation was fed through d 75. Steers were fitted with an ear tag that recorded rumination and activity in 2-h intervals; whereas heat stress behaviors were recorded in 1-min intervals. Pen was used as the experimental unit for animal performance, carcass characteristics, and rumination, and animal was used for heat stress behaviors, while day was used as repeated measure for the analysis of heat stress behaviors and rumination. Data were analyzed using the MIXED procedure of SAS. Final live weight (LW), average daily gain (ADG), dry matter intake (DMI), and gain:feed (G:F) were not affected (P > 0.38) by treatment (d 1–76). Time spent ruminating (min/d) were not affected by AC supplementation (P ≥ 0.21). Treatment did not influence (P > 0.13) time spent panting, resting, or eating. Supplementation of AC did not impact (P ≥ 0.22) HCW, fat thickness, Longissimus area, or marbling score . Dressing percentage was decreased (P = 0.02) with AC addition (60.4% ± 0.6) compared to CON (61.0% ± 0.6) and calculated yield grade tended (P = 0.09) to increase with AC (2.51 ± 0.16) compared to CON (2.37 ± 0.16). Overall, feedlot performance, efficiency and carcass characteristics were not influenced by the supplementation of AC. Supplementing cattle exposed to thermal heat stress with AC did not impact rumination or panting behaviors.

Despite growing evidence that a greater number of students are seeking counseling in college and university counseling centers throughout the United States, there is a dearth of empirical information about (a) the presenting concerns for which students seek treatment and (b) how these concerns differ according to client demographic factors. The purpose of this descriptive and exploratory study was to explore how counseling center clinicians categorize client presenting concerns, and how these concerns vary according to client demographics. Given the importance of client suicide within the field of college counseling, the frequency of suicidality as an identified presenting concern was also explored. A sample of 1,308 clinicians from 84 counseling centers rated the presenting concerns of 53,194 clients using the Clinician Index of Client Concerns (CLICC) after an initial consultation. Results of descriptive and nonparametric analyses indicated that the most prevalent concerns were anxiety, depression, stress, family, and academic performance, and that clients who belong to different demographic groups frequently present to counseling with broadly similar types of concerns. Furthermore, suicidality represented an area of concern for 8.4% of all clients, and it ranked 20 of 44 as a clinician-rated concern. Comparable rates emerged across the range of client demographic groups examined, although rates were notably higher for a handful of groups. The findings offer one of the largest and most generalizable descriptions of why college students seek counseling services, as determined by clinicians' evaluations of presenting concerns. Implications for research and clinical applications of the findings are discussed. (PsycINFO Database Record

Background: Reports of left ventricular assist device (LVAD) malfunction have focused on pump thrombosis. However, the device consists of the pump, driveline, and peripherals, all of which are potentially subject to failure. Methods: Prospectively collected data were reviewed for all LVAD device malfunctions (DMs) occurring in rotary LVADs implanted at a single center between April 2004 and May 2016. Durable LVADs included 108 Heartmate II (HM II) and 105 HeartWare VAD (HVAD). DM data were categorized according to device type and into categories related to the component that failed: (1) controller, (2) peripheral components, and (3) implantable blood pump or its integral electric driveline. Pump-related events were analyzed as pump-specific (suspected or confirmed thrombosis) or nonpump-specific (driveline failure). DM rates were reported as events per 1000 patient-days, and Cox proportional hazard models were used for time-to-event analyses. Cumulative rates of malfunction were examined for the main components of each type of LVAD. Results: Types of DM included controller failure (30%), battery failure (19%), or patient cable failure (14%), whereas only 13% were because of pump failure. DMs were more common in the HM II device (3.73 per 1000 patient-days versus 3.06 per 1000 patient-days for the HVAD, P P P P P Conclusions: Device malfunction is much broader than pump failure alone and occurs for different components at different rates based on the type of LVAD.

While commercial dietary weight-loss programs typically advise exercise, few provide actual programing. The goal of this study was to compare the Curves Complete 90-day Challenge (CC, n = 29), which incorporates exercising and diet, to programs advocating exercise (Weight Watchers Points Plus (WW, n = 29), Jenny Craig At Home (JC, n = 27), and Nutrisystem Advance Select (NS, n = 28)) or control (n = 20) on metabolic syndrome (MetS) and weight loss. We randomized 133 sedentary, overweight women (age, 47 ± 11 years; body mass, 86 ± 14 kg; body mass index, 35 ± 6 kg/m2) into respective treatment groups for 12 weeks. Data were analyzed using chi square and general linear models adjusted for age and respective baseline measures. Data are means ± SD or mean change ± 95% confidence intervals (CIs). We observed a significant trend for a reduction in energy intake for all treatment groups and significant weight loss for all groups except control: CC (−4.32 kg; 95% CI, −5.75, −2.88), WW (−4.31 kg; 95% CI, −5.82, −2.96), JC (−5.34 kg; 95% CI, −6.86, −3.90), NS (−5.03 kg; 95% CI, −6.49, −3.56), and control (0.16 kg, 95% CI, −1.56, 1.89). Reduced MetS prevalence was observed at follow-up for CC (35% vs. 14%, adjusted standardized residuals (adjres.) = 3.1), but not WW (31% vs. 28% adjres. = 0.5), JC (37% vs. 42%, adjres. = −0.7), NS (39% vs. 50% adjres. = −1.5), or control (45% vs. 55% adjres. = −1.7). While all groups improved relative fitness (mL·kg−1·min−1) because of weight loss, only the CC group improved absolute fitness (L/min). In conclusion, commercial programs offering concurrent diet and exercise programming appear to offer greater improvements in MetS prevalence and cardiovascular function after 12 weeks of intervention.

This year nearly 86,000 persons in the US will be diagnosed with a primary brain tumor. Glioblastoma (GBM) is the deadliest and most common of these tumors in adults with overall survival around 15mos. Disease progression is inevitable, and effective second-line therapies are few. Delays in identifying progressed GBM risks neurologic decline, continuation of ineffective therapies, and increased tumor-mutational-burden, potentially rendering treatment less-effective. Brain tumor imaging can be ambiguous and is an active topic in neuro-oncology as there are currently no validated approaches to assessment of tumor treatment response. We present a single institution database including 622 gross-totally-resected GBMs (2006–2018) to evaluate changes in T2/FLAIR signal intensity (T2FSI), diffusion restriction, and contrast enhancement both in and around the resection cavity (RC) to determine earliest indicators of tumor progression. Analysis of NANO score was completed to correlate with predicted tumor progression. This is an early data release of an ongoing two-phased retrospective/prospective study with findings that support a novel integration of radiographic sequences and NANO to supplement established RANO criteria in earlier detection of GBM progression. Of 622 confirmed GBMs, 158 fit the rigorous criteria – included here are 58 cases. We report 70% (n=41) of patients show RC T2FSI correlating with restricted diffusion and increasing NANO score (0.5–1.4) as early as 3.8mos prior to and at time of radiographic progression, respectively. Previous studies have reported similar T2FSI but without associated NANO, less rigid inclusion criteria, and limited MRI sequences. We also report imaging phenomena, not previously described, such as FLAIR migration and FLAIR coring timed closely with progression. The proposed technique uses routine MRI, therefore readily standardized in clinical practice. With further validation, this novel integration of imaging and neurologic assessment might serve to supplement existing response criteria in GBM and improve clinician confidence in earlier detection of progression.

Objective:Early detection of tibialis posterior tendon changes and appropriate intervention is necessary to prevent disease progression to flat-foot deformity and foot/ankle dysfunction, and the need for operative treatment. Currently, differentiating between early-stage tibialis posterior tendon deficiency patients who will benefit from conservative vs more aggressive treatment is challenging. The objective of this work was to establish a quantitative MRI T2* mapping method and subregion baseline values in the tibialis posterior tendon in asymptomatic ankles for future clinical application in detecting tendon degeneration.Methods:26 asymptomatic volunteers underwent T2* mapping. The tendon was divided axially into seven subregions. Summary statistics for T2* within each subregion were calculated and compared using Tukey post-hoc pairwise comparisons.Results:Results are reported for 24 subjects. The mean tibialis posterior tendon T2* was 7 ± 1 ms. Subregion values ranged from 6 ± 1 to 9 ± 2 ms with significant between-region differences in T2*. Inter- and intrarater absolute agreement intraclass correlation coefficient (ICC) values were all "excellent" (0.75 < ICC=1.00) except for regions 5 through 7, which had "fair to good" interrater and/or and intrarater ICC values (0.4 < ICC=0.75).Conclusion:A tibialis posterior tendon T2* mapping protocol, subregion division method, and baseline T2* values for clinically relevant regions were established. Significant differences in T2* were observed along the tendon length.Advances in knowledge:This work demonstrates that regional variation exists and should be considered for future T2*-based research on posterior tibias tendon degeneration and when using T2* mapping to evaluate for potential tibialis posterior tendon degeneration.

Buprenorphine is an opioid partial agonist used to treat opioid use disorder. While several policy changes have attempted to increase buprenorphine availability, access remains well below optimal levels. This study characterized how buprenorphine utilization in the United States has changed over time and whether there are regional disparities in distribution of the medication.The amount of buprenorphine distributed from 2007 to 2017 was obtained from the Drug Enforcement Administration's Automated Reports and Consolidated Ordering System. Data were expressed as the percent change and milligrams per person in each state. The formulations and cost for prescriptions covered by Medicaid (2008 to 2018) were also examined.Buprenorphine distributed to pharmacies increased about 7-fold (476.8 to 3179.9 kg) while the quantities distributed to hospitals grew 5-fold (18.6 to 97.6 kg) nationally from 2007 to 2017. Buprenorphine distribution per person was almost 20-fold higher in Vermont (40.4 mg/person) relative to South Dakota (2.1 mg/person). There was a strong association between the number of physicians authorized to prescribe buprenorphine and distribution per state (r[49] = +0.94, P .0005). The buprenorphine/naloxone sublingual film (Suboxone) was the predominant formulation (92.6% of 0.31 million Medicaid prescriptions) in 2008 but accounted for less than three-fifth (57.3% of 6.56 million prescriptions) in 2018.Although buprenorphine availability has substantially increased over the last decade, distribution was very nonhomogeneous across the United States.

AimsBuprenorphine is an opioid partial-agonist used to treat Opioid Use Disorders (OUD). While several state and federal policy changes have attempted to increase buprenorphine availability, access remains well below optimal levels. This study characterized how buprenorphine utilization in the United States has changed over time and whether there are regional disparities in distribution.MeasurementsBuprenorphine weights distributed from 2007 to 2017 were obtained from the Drug Enforcement Administration. Data was expressed as the percent change and as the mg per person in each state. Separately, the formulations for prescriptions covered by Medicaid (2008 to 2018) were examined.FindingsBuprenorphine distributed to pharmacies increased about seven-fold (476.8 to 3,179.9 kg) while the quantities distributed to hospitals grew five-fold (18.6 to 97.6 kg) nationally from 2007 to 2017. Buprenorphine distribution per person was almost 20-fold higher in Vermont (40.4 mg/person) relative to South Dakota (2.1 mg/person). There was a strong association between the number of waivered physicians per 100K population and distribution per state (r(49) = +0.76, p < .0005). The buprenorphine/naloxone sublingual film (Suboxone) was the predominant formulation (92.6% of 0.31 million Medicaid prescriptions) in 2008 but this accounted for less than three-fifths (57.3% of 6.56 million prescriptions) in 2018.ConclusionsAlthough buprenorphine availability has substantially increased over the last decade, distribution was very non-homogenous across the US.

Auction-derived steers (n = 36; initial BW = 284 ± 11 kg) were received to compare performance, rumination characteristics, and rumen pH differences due to alternative ration energy densities and feed management strategies during a 56 d receiving study. Cattle were weighed on day -1 and randomized to 1 of 3 treatments. Time spent ruminating was quantified with a three-axis accelerometer ear-tag. Rumen pH and temperature were logged in a random subset (n = 6 per treatment) by a ruminal bolus. Cattle were processed identically and housed in individual pens. The modified-live virus respiratory vaccination was delayed until day 28. The finisher (FIN) cattle were provided their daily feed as a high energy density (1.39 Mcal NEg/kg) diet. The finisher + hay (FIN+H) cattle were provided the same diet but were also offered 0.5% BW DM as coastal Bermudagrass hay on days 1, 4, 7, 10, 13, 16, 19, 22, 25, and 28. The control (CON) cattle were fed a low energy density (0.93 Mcal NEg/kg) diet from day 0 to 7, then transitioned to the FIN diet by replacing an additional 25% of the daily feed call with FIN every 7 d until 100% of the diet was FIN on day 29. Feed offering for CON was increased more aggressively (0.45 kg DM daily for days 1 to 7, every other day for day 8 to 14) than FIN and FIN+H (0.45 kg DM every other day for days 1 to 7, daily for days 8 to 14). Performance and DMI were analyzed using PROC MIXED in SAS with treatment as a fixed effect. Rumination, pH, and temperature models included repeated measures. There was no treatment difference observed for BW, average daily gain (ADG), or G:F (P ≥ 0.12). There was a treatment × day interaction (P = 0.06) for rumen temperature, where FIN increased more rapidly following vaccination on day 28 compared to CON (P ≤ 0.04). Daily rumination minutes were greater (P < 0.01) for CON than FIN from days 7 to 22. Additionally, CON had the greatest (P < 0.01) hourly rumination from 2000 to 0800 hours. Lower minimum daily rumen pH occurred in FIN+H (P ≤ 0.06) on weeks 1, 2 and 6 to 8 compared to CON. There were minimal statistical differences in area under the curve or time below pH thresholds, probably due to large animal-to-animal variation. Hourly rumen pH was reduced (P ≤ 0.05) for FIN vs. FIN+H and CON during the initial 28 d, but greater (P = 0.05) for FIN and FIN+H during the final 28 d. When cattle are individually fed, greater energy density rations can be fed initially without compromising performance, but this needs to be evaluated in group pens where greater DMI variation is probable.

Background The diagnosis of incomplete acute and chronic posterior cruciate ligament (PCL) tears can be challenging with conventional magnetic resonance (MR) imaging, particularly for injuries in which the ligament appears continuous as occurs with chronic PCL tears that have scarred in continuity. Quantitative mapping from MR imaging may provide additional useful diagnostic information in these cases. The purpose of this study was to assess the feasibility of quantifying transverse relaxation time (T2) mapping values at 3 Tesla (T) in a prospectively enrolled patient cohort with chronic PCL tears. Methods Twelve subjects with acute or chronic functionally torn PCL, confirmed on clinical exam and posterior knee stress radiographs (with 8 mm or more of increased posterior tibial translation), were enrolled prospectively over a span of 4 years (age: 28–52 years, injury occurred 2 weeks to 15 years prior). Unilateral knee MR images were acquired at 3 T, including a multi-echo spin-echo T2 mapping scan in the sagittal plane. For the six subjects with a continuous PCL on MR imaging the PCL was manually segmented and divided into proximal, mid and distal thirds. Summary statistics for T2 values in each third of the ligament were compiled. Results Across the six patient subjects with a continuous ligament, the mean T2 for the entire PCL was 36 ± 9 ms, with the highest T2 values found in the proximal third (proximal: 41 ms, mid 30 ms, distal 37 ms). The T2 values for the entire PCL and for the proximal third subregion were higher than those recently published for asymptomatic volunteers (entire posterior cruciate ligament: 31 ± 5 ms, proximal: 30 ms, mid: 29 ms, distal: 37 ms) with similar methodology. Conclusion Mean T2 values were quantified for acute and chronic PCL tears in this prospectively enrolled patient cohort and were higher than those reported for asymptomatic volunteers. This novel approach of using quantitative mapping to highlight injured areas of the posterior cruciate ligament has potential to provide additional diagnostic information in the challenging case of a suspected posterior cruciate ligament tear which appears continuous, including chronic tears that have scarred in continuity and may appear intact on conventional magnetic resonance imaging.

In the Caribbean region, HIV prevalence is high among key population (KP) groups, such as sex workers and men who have sex with men. However, there is a lack of high-quality, population-level data estimating HIV prevalence and population sizes of KPs. The President's Emergency Plan for AIDS Relief has funded and completed five bio-behavioral surveillance (BBS) surveys using respondent-driven sampling methodology to target KP in the English-speaking Caribbean region. We describe the experience of implementing bio-behavioral surveys in the Caribbean region and document the context, processes, successes, and challenges, and make recommendations for future survey implementation. Successes include the provision of estimates of nationally representative HIV data and KP size estimates to improve HIV programming and provision of tools for routinization of BBS. Challenges include small KP sizes, the legal context, and the cost and speed of implementation. Future bio-behavioral surveys should include well-planned formative assessments and stakeholder involvement.

Despite high HIV incidence among young black men who have sex with men (YBMSM), pre-exposure prophylaxis (PrEP) uptake in this group is low. In a cohort of HIV-negative YBMSM in Atlanta, GA, all participants were offered PrEP as standard of care with free clinician visits and laboratory testing. We explored self-perceived need for PrEP among 29 in-depth interview participants by asking about reasons for PrEP uptake or refusal and factors that may lead to future reconsideration. Self-perceived need was compared to US Center for Disease Control and Prevention guidance for clinical PrEP indication using behavioral data and laboratory testing data. Self-perceived need for PrEP consistently underestimated clinical indication, primarily due to optimism for choosing other HIV prevention strategies, such as condom use, abstinence, or monogamy. Many participants cited consistent condom use and lack of sexual activity as reasons for not starting PrEP; however, follow-up survey data frequently demonstrated low condom use and high levels of sexual activity in the period after the interview. Study participants endorsed perceptions that PrEP is only for people with very high levels of sexual activity. Only one participant perceived incident sexually transmitted infection (STI) to be an indication for PrEP, despite the fact that several of the participants had a history of an STI diagnosis. These findings point to an opportunity for clinician intervention at diagnosis. Disconnect between self-perceived and guidance-based PrEP indications, as well as other factors such as medical mistrust or difficulty with access, may contribute to low PrEP uptake among YBMSM. A better understanding of the ways in which these issues manifest may be one tool for clinicians to support PrEP uptake.

Worldwide, an estimated 12 million people are infected with Leishmania spp. and an additional 350 million are at risk of infection. Leishmania are intracellular parasites that cause disease by suppressing macrophage microbicidal responses. Infection can remain asymptomatic or lead to a spectrum of diseases including cutaneous, mucocutaneous, and visceral leishmaniasis. Ultimately, the combination of both pathogen and host factors determines the outcome of infection. Leishmaniasis, as well as numerous other infectious diseases, exhibits sex-related differences that cannot be explained solely in terms of environmental exposure or healthcare access. Furthermore, transcriptomic evidence is revealing that biological sex is a variable impacting physiology, immune response, drug metabolism, and consequently, the progression of disease. Herein, we review the distribution, morbidity, and mortality among male and female leishmaniasis patients. Additionally, we discuss experimental findings and new avenues of research concerning sex-specific responses in cutaneous and visceral leishmaniasis. The limitations of current therapies and the emergence of drug-resistant parasites underscore the need for new treatments that could harness the host immune response. As such, understanding the mechanisms driving the differential immune response and disease outcome of males versus females is a necessary step in the development of safer and more effective treatments against leishmaniasis.

The targeted development of neuroprotective therapies for retinitis pigmentosa (RP) depends upon a better understanding of the mechanisms of photoreceptor cell death. Nucleotide metabolite-associated photoreceptor cell death is an emerging area of research that is important in multiple models of RP, yet the exact pathophysiology remains to be elucidated. One common pathway of photoreceptor cell death in RP is cGMP dysregulation, which is underscored by its potential to be relevant in up to 30% of patients with RP. Optimizing tools for detecting and quantifying nucleotide metabolites in the retina is vital to expanding this area of research. Immunohistochemistry is useful for localizing abnormally high levels of cGMP in a cell-specific manner, while enzyme-linked immunosorbent assay and liquid chromatography-mass spectrometry are quantitative and more sensitive. These techniques can form the basis for more sophisticated experiments to elucidate upstream events in photoreceptor cell death, which will hopefully lead to the development of novel therapies for patients with RP.

Following the rising crisis of COVID-19 and the Oregon governor's stay-at-home orders, members of the Oregon Health and Science University (OHSU) inpatient addiction consult service recognized that local addiction treatment and recovery organizations were operating at limited capacity. As a result, discharge planning, patient access to local community-based treatment, and safety-net programming were affected. Given structural and intersectional risk vulnerabilities of people with substance use disorders (SUDs), the OHSU members felt that COVID-19 would disproportionately impact chronically marginalized members of our community. These inequities inspired the formation of the Oregon substance use disorder resources collaborative (ORSUD) led by four medical students. ORSUD's mission is to support the efforts of local safety-net organizations that and front-line providers who serve chronically marginalized community members in the midst of the global pandemic. We operationalized our mission through: 1) collecting and disseminating operational and capacity changes in local addiction and harm reduction services to the broader treatment community, and 2) identifying and addressing immediate resource needs for local safety-net programs. Our program uses a real-time public-facing document to collate local programmatic updates and general community resources. COVID-19 disproportionately burdens people with SUDs; thus, ORSUD exists to support programs serving people with SUDs and will continue to evolve to meet their needs and the needs of those who serve them.

Highlights • Glenohumeral cartilage T2 values were correlated to increasing rotator cuff pathology severity. • Massive tear versus lesser injury differences were most evident in superior humeral cartilage. • Sagittal T2 mapping best captures superior humeral head cartilage change in massive tear patients., Purpose To examine the relationship between glenohumeral cartilage T2 mapping values and rotator cuff pathology. Method Fifty-nine subjects (age 48.2 ± 13.5 years, 15 asymptomatic volunteers and 10 tendinosis, 13 partial-thickness tear, 8 full-thickness tear, and 13 massive tear patients) underwent glenohumeral cartilage T2 mapping. The humeral head cartilage was segmented in the sagittal and coronal planes. The glenoid cartilage was segmented in the coronal plane. Group means for each region were calculated and compared between the groups. Results Massive tear group T2 values were significantly higher than the asymptomatic group values for the humeral head cartilage included in the sagittal (45 ± 7 versus 32 ± 4 ms, p

(1) Background: Limited information exists on the prevalence of low energy availability (LEA) in collegiate team sports. The purpose of this study was to examine the prevalence of LEA in collegiate women soccer players. (2) Methods: Collegiate women soccer athletes (n = 18, height: 1.67 &plusmn, 0.05 m, body mass: 65.3 &plusmn, 7.9 kg, body fat %: 24.9 &plusmn, 5.6%) had their body composition and sport nutrition knowledge assessed in the pre-season. Energy availability was assessed mid-season using a 4-day dietary log and activity energy expenditure values from a team-based monitoring system. A validated screening tool was used to screen for LEA. (3) Results: The screening tool classified 56.3% of athletes as at risk of LEA (&lt, 30 kcal/kg of FFM), however, the actual dietary intake identified 67% as LEA. Athletes identified as non-LEA consumed significantly more absolute (p = 0.040) and relative (p = 0.004) energy than LEA athletes. (4) Conclusions: There was a high prevalence of LEA among collegiate women soccer athletes. Although previously validated in women endurance athletes, the LEA screening tool was not effective in identifying those at risk of LEA in this sample of athletes.

To examine the effect of protein-focused (PRO, 1.14 g/kg/day) and carbohydrate-focused (CHO, ∼2.2 g/kg/day) diets (∼1600 kcals) combined with 10 weeks of circuit exercise training in sedentary overweight/obese women (N = 661, age 46 ± 11 years) on metabolic syndrome (MetS).We retrospectively analyzed eight exercise training studies performed from 2002-2014. Primary (MetS), secondary (MetS z-scores and individual MetS components), and tertiary outcomes [body mass index (BMI) by WHO cut points] were analyzed using chi-square, GLM, and McNemar's tests.Both groups experienced significant weight loss, improvements in fitness, and reductions in MetS prevalence from baseline to follow-up (PRO: 49% to 42%, CHO: 42% to 36%, both P 0.01). MetS z-score improvement (∼66.5%) was similar for both groups with no significant between-group differences noted. There were also no significant differences for individual component features between groups for the following: waist circumference (-0.28 ± 0.02 vs. -0.28 ± 0.025 cm, P = 0.97), glucose (-0.07 ± 0.03 vs. -0.08 ± 0.04 mM, P = 0.87), triglycerides (-0.16 ± 0.04 vs. -0.09 ± 0.04 mM, P = 0.20), high-density lipoprotein cholesterol (-0.21 ± 0.03 vs. -0.19 ± 0.04 mM, P = 0.68), and systolic BP (-0.16 ± 0.4 vs. -0.24 ± 0.05 mmHg, P = 0.26). Diastolic BP showed a minor advantage for the PRO group (-0.14 ± 0.05 vs. -0.30 ± 0.05 mmHg P = 0.02). When stratified by BMI, those with morbid obesity did not show a significant improvement in MetS while following a PRO-focused diet; however, caution is warranted given the exploratory nature of this analysis.Our findings suggest that a low-moderate calorie diet partitioned for CHO and PRO preference is equally effective when combined with a structured exercise program for reducing the prevalence of MetS prevalence in overweight/obese women.

Interest has been growing in the mental health benefits of self-compassion. Whereas, most research on this topic has been conducted with the 26-item Self-Compassion Scale (SCS), a briefer 12-item version of the instrument, the Self-Compassion Scale-Short Form (SCS-SF), also exists. The SCS-SF has demonstrated good validity and reliability in non-clinical samples, but it has not been used often in research with psychotherapy clients. This study was designed to examine the factor structure and construct validity of the SCS-SF in a clinical population. Data for this study were collected from 1609 college students receiving services at 10 campus counseling centers. The previously proposed factor structure of the SCS-SF was not supported. Instead, analyses revealed two factors, Self Care and Self Disparagement. Evidence for the construct validity of these factors was found via expected relationships with indices of depression, anxiety, social anxiety, hostility, academic distress, eating concerns, family distr...

Introduction: Couples’ voluntary HIV counseling and testing (CHTC) is an HIV risk reduction strategy not widely available in the US. Methods: We assessed willingness to participate in CHTC among US HIV-infected clinic patients via tablet-based survey and among HIV-negative persons with HIV-infected partners in care via mixed-method phone interviews. Results: Most of the N=64 HIV-infected partners surveyed were men (89%), on antiretroviral treatment (ART) (92%), and many self-identified homosexual (62%). We observed high levels of willingness to participate in CHTC (64%) among HIV-infected partners. Reasons for not wanting to participate included perceived lack of need (26%), desire to self-disclose their status (26%), and fear of being asked sensitive questions with their partner present (17%). HIV-infected partners were interested in discussing ART (48%), other sexually transmitted infections (STIs) (44%), and relationship agreements like monogamy (31%) during CHTC sessions. All N=15 HIV-negative partners interviewed were men, most identified as homosexual (73%), and about half (54%) reported consistent condom use with HIV-infected partners. We observed high levels of willingness to participate in CHTC (87%) among HIV-negative partners, who were also interested in discussing ART (47%), other STIs (47%), mental health services (40%), and relationship agreements (33%). Most negative partners (93%) indicated that they believed their HIV-infected partner was virally suppressed, but in the event that they were not, many (73%) were willing to take pre-exposure prophylaxis (PrEP). Conclusion: These results indicate that CHTC for serodiscordant couples is acceptable and should emphasize aspects most pertinent to these couples, such as discussion of ART/PrEP, STIs, and relationship agreements.

Purpose To determine the effect of mycophenolate mofetil (MMF) on retinal degeneration on two mouse models of retinitis pigmentosa. Methods Intraperitoneal injections of MMF were administered daily in rd10 and c57 mice starting at postoperative day 12 (P12) and rd1 mice starting at P8. The effect of MMF was assessed with optical coherence tomography, immunohistochemistry, electroretinography, and OptoMotry. Whole retinal cyclic guanosine monophosphate (cGMP) and mycophenolic acid levels were quantified with mass spectrometry. Photoreceptor cGMP cytotoxicity was evaluated with cell counts of cGMP immunostaining. Results MMF treatment significantly delays the onset of retinal degeneration and cGMP-dependent photoreceptor cytotoxicity in rd10 and rd1 mice, albeit a more modest effect in the latter. In rd10 mice, treatment with MMF showed robust preservation of the photoreceptors up to P22 with associated suppression of cGMP immunostaining and microglial activation; The neuroprotective effect diminished after P22, but outer retinal thickness was still significantly thicker by P35 and OptoMotry response was significantly better up to P60. Whereas cGMP immunostaining of the photoreceptors were present in rd10 and rd1 mice, hyperphysiological whole retinal cGMP levels were observed only in rd1 mice. Conclusions Early treatment with MMF confers potent neuroprotection in two animal models of RP by suppressing the cGMP-dependent common pathway for photoreceptor cell death. The neuroprotective effect of MMF on cGMP-dependent cytotoxicity occurs independently of the presence of hyperphysiological whole retinal cGMP levels. Thus our data suggest that MMF may be an important new class of neuroprotective agent that could be useful in the treatment of patients with RP.