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Carpenter ants in the genus Camponotus are large, conspicuous ants that are abundant and ecologically influential in many terrestrial ecosystems. The bicolored carpenter ant, Camponotus vicinus Mayr, is distributed across a wide range of elevations and latitudes in western North America, where it is a prominent scavenger and predator. Here, we present a high-quality genome assembly of C. vicinus from a sample collected in Sonoma County, California, near the type locality of the species. This genome assembly consists of 38 scaffolds spanning 302.74 Mb, with contig N50 of 15.9 Mb, scaffold N50 of 19.9 Mb, and BUSCO completeness of 99.2%. This genome sequence will be a valuable resource for exploring the evolutionary ecology of C. vicinus and carpenter ants generally. It also provides an important tool for clarifying cryptic diversity within the C. vicinus species complex, a genetically diverse set of populations, some of which are quite localized and of conservation interest.

Dercas nina Mell 1913 (Pieridae) is a little-studied butterfly species endemic to China that flies primarily in the forest canopy. Genome skimming by Illumina sequencing allowed assembly of 146,702 reads for complete 1471.3-fold mean coverage of the circular 15,264 bp mitogenome from D. nina consisting of 82.1% AT nucleotides. A gene order typical of butterflies was recovered consisting of 13 protein-coding genes, 22 tRNAs, two rRNAs, and a predicted control region. The Dercas nina COX1 open reading frame begins with atypical start codon CGA. Six protein-coding genes (COX1, COX2, ND2, ND3, ND4, ND5) with single-nucleotide (T) stop codons, and two protein-coding genes (ATP6, ATP8) with two-nucleotide (TA) stop codons encoded in the DNA were inferred to be completed by adenine nucleotides from the Poly-A tail of the mRNA. Bayesian’s phylogenetic reconstruction places the D. nina and D. lycorias mitogenomes as sister clades. Dercas mitogenomes were sister to those from genus Colias in the monophyletic subfamily Coliadinae. The mitogenome phylogeny is consistent with previous molecular phylogenetic hypotheses based on other markers, but differs somewhat from a morphology-based hypothesis that suggested that Dercas was more closely related to genus Gonepteryx. This may falsify the hypothesis or may instead reflect mitochondrial-nuclear phylogenetic discordance.

Abstract Seeding activities of disease-associated α-synuclein aggregates (αSynD), a hallmark of Parkinson’s disease (PD), are detectable by seed amplification assay (αSyn-SAA) and being developed as a diagnostic biomarker for PD. Sensitive and accurate αSyn-SAA for blood or saliva would greatly facilitate PD diagnosis. This prospective diagnostic study conducted αSyn-SAA analyses on serum and saliva samples collected from patients clinically diagnosed with PD or healthy controls (HC). 124 subjects (82 PD, 42 HC) donated blood and had extensive clinical assessments, of whom 74 subjects (48 PD, 26 HC) also donated saliva at the same visits. An additional 57 subjects (35 PD, 22 HC) donated saliva and had more limited clinical assessments. The mean ages were 69.21, 66.55, 69.58, and 64.71 years for PD serum donors, HC serum donors, PD saliva donors, and HC saliva donors, respectively. αSynD seeding activities in either sample type alone or both sample types together were evaluated for PD diagnosis. Serum αSyn-SAA data from 124 subjects showed 80.49% sensitivity, 90.48% specificity, and 0.9006 accuracy (AUC of ROC); saliva αSyn-SAA data from 131 subjects attained 74.70% sensitivity, 97.92% specificity, and 0.8966 accuracy. Remarkably, the combined serum and saliva αSyn-SAA from 74 subjects with both sample types achieved better diagnostic performance: 95.83% sensitivity, 96.15% specificity, and 0.98 accuracy. In addition, serum αSynD seeding activities correlated inversely with Montreal Cognitive Assessment in males and positively with Hamilton Depression Rating Scale in females and in the

Abstract Background Douglas-fir (Pseudotsuga menziesii [Mirb.] Franco) plays a critical role in the ecology and economy of Western North America. This conifer species comprises two distinct varieties: the coastal variety (var. menziesii) along the Pacific coast, and the interior variety (var. glauca) spanning the Rocky Mountains into Mexico, with instances of inter-varietal hybridization in Washington and British Columbia. Recent investigations have focused on assessing environmental pressures shaping Douglas-fir’s genomic variation for a better understanding of its evolutionary and adaptive responses. Here, we characterize range-wide population structure, estimate inter-varietal hybridization levels, identify candidate loci for climate adaptation, and forecast shifts in species and variety distribution under future climates. Results Using a custom SNP-array, we genotyped 540 trees revealing four distinct clusters with asymmetric admixture patterns in the hybridization zone. Higher genetic diversity observed in coastal and hybrid populations contrasts with lower diversity in inland populations of the southern Rockies and Mexico, exhibiting a significant isolation by distance pattern, with less marked but still significant isolation by environment. For both varieties, we identified candidate loci associated with local adaptation, with hundreds of genes linked to processes such as stimulus response, reactions to chemical compounds, and metabolic functions. Ecological niche modeling revealed contrasting potential distribution shifts among the varieties in the coming decades, with interior populations projected to lose habitat and become more vulnerable, while coastal populations are expected to gain suitable areas. Conclusions Overall, our findings provide crucial insights into the population structure and adaptive potential of Douglas-fir, with the coastal variety being the most likely to preserve its evolutionary path throughout the present century, which carry implications for the conservation and management of this species across their range.

For the marine industry biofouling has a negative reputation. On ship hulls, the accumulation of these unwanted plants and animals can lead to increased drag, fuel consumption, and greenhouse gas emissions. Offshore platforms are also subject to biofouling which can result in corrosion and hydrodynamic loading, thus shortening their lifespan. While the harmful impacts of biofouling are commonly reported throughout the literature, biofouling can also benefit both aquatic and human populations. Common biofouling organisms act as natural filtration systems, thus improving water quality. Many of the same flora and fauna serve as a food source, and structures could be designed to lessen the impacts of fouling on hydrodynamic forces. In addition, microfouling species commonly found in biofilms have the potential to be harnessed as biofuel sources and can be a component of the carbon cycle. The following review discusses the benefits of biofouling and why ecological engineering initiatives may aid in ecosystem restoration versus the use of antifouling techniques for preventative growth.

Multitudes of epidemiological factors contribute to the resultant effects in the mental health of adolescents, defined by the World Health Organization as between ages of 10 to 19. Presently, both prevailing aspects, including the occuring Covid-19 pandemic and the subsequent social lockdown, and inherent social determinants like certain academic environments, poverty, chronic loneliness, and lack of available treatment or research influence the state of adolescent mental health. This literature review seeks to identify critical determinants of adolescent mental health and study their long term influence on mental health epidemiology as a whole. By compiling a plethora of various case studies from publications on PubMed and MEDLINE, APA PsycInfo, and PLOS One along with data from important surveys such as Youth Self Report, Adult Self Report, and TRacking Adolescents’ Individual Lives Survey, this study generates a comprehensive overview of facets underlying the current trends in specifically adolescent mental health. Through the review of critical results extracted from these sources, this paper displays the causal relationship with Covid-19’s social disruptions, especially quarantine, on Vitamin D deficiency and in academic contexts. Furthermore, this paper explores the generalized risk factors associated with mental illness onset in the context of adolescent development along with an evaluation of current trends in mental health research.

Background: Many patients with cellulitis are treated with oral antibiotics as outpatients, but some require hospital admission for intravenous antibiotics. During the coronavirus disease 2019 pandemic, Betsi Cadwaladr University Health Board in Wales approved use of dalbavancin as first-line intravenous antibiotic from April to December 2020 to facilitate early discharge and prevent hospital admission. Objectives: To report cost savings and admission avoidance through first-line intravenous use of dalbavancin for cellulitis in one health board in Wales. Patients and methods: Patients with cellulitis who presented to the emergency department or medical assessment unit at Betsi Cadwaladr University Health Board's two hospitals between April and December 2020 were identified for treatment with dalbavancin, because they had not responded to oral antibiotics or their initial presentation warranted intravenous antibiotics. Patients received 1500 mg dalbavancin by intravenous infusion according to prescribing information and were sent home without being admitted. Outcomes were admission within 30 d of dalbavancin and cost savings from avoiding admission. Results: 31 patients were treated with dalbavancin for cellulitis in the emergency department or medical assessment unit. No patient was admitted within 30 d of receiving dalbavancin. Use of dalbavancin is estimated to have saved 248 bed-days over the study period, with an estimated saving of $120,444.23 based on avoidance of admission. The cost of dalbavancin for these 31 patients was $69,959.08, giving an overall cost saving of $50,485.15 ($1529.95 per patient). Conclusions: Prescribing dalbavancin as first-line intravenous antibiotic for cellulitis prevents admission, saving bed-days and admission-related costs.

Purpose: The purpose of this study was to evaluate the process and overall feasibility of a doula grant program for expectant families from economically vulnerable backgrounds. Design: A mixed-methods process evaluation framework was utilized to examine program feasibility and focused on constructs related to fidelity, dose delivered/dose received, reach, program satisfaction, and limited efficacy testing. Measures: Evaluation constructs were measured using a program tracking document. Program satisfaction and efficacy were examined through a mixed methodology approach utilizing doula surveys and birthing parent interviews. Analysis: Related to survey data, analysis focused on presenting descriptive counts and percentages related to the number of doulas that participated and clients served. Continuous variables were calculated as means and standard deviations and categorical data as counts and percentages. Qualitative data analyses were conducted using a structured deductive thematic approach. Results: The grant program was successfully implemented over an 18-month period, and the program had a high rate of fidelity to the grant processes developed by a Midwestern-based nonprofit organization. The program was satisfactory to doulas and parents, and the largest barrier was communication. A high incidence of prenatal anxiety among the birthing parents was reported. Thematic findings from the birthing parent interviews included the following: the grant application process was effective and easy, birth doulas were greatly valued, and a financial burden was lifted. Conclusion: This grant process can be replicated by other organizations seeking to fill a gap between doula services and the economically vulnerable.

Abstract Objective The objective of this scoping review is to identify and understand the available evidence on the delivery of dietary messages to patients with type 2 diabetes in a dental setting. The outcome of a scoping review in this area will inform the development of a clinical intervention for dietary counseling at the chairside. Introduction Diabetics are at a higher risk for developing periodontal disease, and the severity of periodontal disease can impact the ability to control glucose levels. Considering the prevalence of diabetes within the community, dental practitioners are well placed to provide dietary messages to support this cohort during the management of periodontal disease. Inclusion Criteria Studies that consider the population affected by type 2 diabetes and a dietary intervention in the context of a dental setting will be included. Methods The databases selected for sources of studies are MEDLINE, EMBASE, CINAHL and SCOPUS. The scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. Only English language studies are eligible for inclusion in this review. Terms relating to dietary advice, diabetes, dental practitioner and health education will be used to search for related studies. Screening based on abstract, and titles will be followed by full text screening with results supplied in PRISMA‐SCR diagram. A data extraction tool will be used to chart the details of selected studies then presented in a venn diagram and word map along with a narrative synthesis of results.

Six refugee screening sites collaborated to estimate the prevalence of hepatitis C virus (HCV) antibodies among newly arrived refugees in the United States from 2010 to 2017, identify demographic characteristics associated with HCV antibody positivity, and estimate missed HCV antibody-positive adults among unscreened refugees. We utilized a cross-sectional study to examine HCV prevalence among refugees (N = 144,752). A predictive logistic regression model was constructed to determine the effectiveness of current screening practices at identifying cases. The prevalence of HCV antibodies among the 64,703 refugees screened was 1.6%. Refugees from Burundi (5.4%), Moldova (3.8%), Democratic Republic of Congo (3.2%), Burma (2.8%), and Ukraine (2.0%) had the highest positivity among refugee arrivals. An estimated 498 (0.7%) cases of HCV antibody positivity were missed among 67,787 unscreened adults. The domestic medical examination represents an opportunity to screen all adult refugees for HCV to ensure timely diagnosis and treatment.

Autistic meltdowns have been explored from the perspectives of parents, but there is a paucity of research on the experience of meltdowns from the autistic perspective. Little is known about how adults experience these events. In this descriptive phenomenological study, we conducted online interviews with 32 autistic adults on the experience of having a meltdown. Data were analyzed using Colaizzi's seven-step method. Six themes emerged from data that captured the essence of meltdowns, including "feeling overwhelmed" by informational, sensory, social, or emotional stressors; "experiencing extreme emotions," such as anger, sadness, and fear; "losing logic," including challenges with thinking and memory; "grasping for self-control," in which participants felt out of touch with themselves; "finding a release" for emotions, often described as an "explosion" of external behaviors or self-harm; and "minimizing social, emotional, or physical harm" by avoiding triggers or self-isolating when possible. Findings highlight the painful and distressing internalized experience of meltdowns beyond behavioral characteristics. Participants shared examples of internal meltdowns, in which external characteristics of meltdowns were camouflaged. Participants also suggested that meltdowns may serve a functional role in regulating emotions and making one's voice heard. Meltdowns are diverse experiences that hold different meaning to different people.

While the number of immunocompromised (IC) individuals continues to rise, the existing literature on influenza vaccine effectiveness (VE) in IC populations is limited. Understanding the vaccine effectiveness (VE) of the seasonal influenza vaccines in immunocompromised (IC) populations remains paramount. Using 2017–2018 US Flu VE Network data, we examined the VE of the 2017–2018 seasonal influenza vaccine against symptomatic influenza in outpatient settings among IC adults. We used logistic regression and adjusted for enrollment site, race, self-reported general health status, age, and onset date of symptoms. The VE among non-IC was 31% (95% CI: 22, 39) and among IC participants was −4% (95% CI: −66, 35), though the difference was not statistically significant. This study demonstrates the capacity to study a large IC population using an existing influenza VE network and contributes to the literature to support large, multicenter VE studies for IC populations.

Exosomes are extracellular vesicles that modulate essential physiological and pathological signals. Communication between cancer cells that express the von Hippel-Lindau (VHL) tumor suppressor gene and those that do not is instrumental to distant metastasis in renal cell carcinoma (RCC). In a novel metastasis model, VHL(-) cancer cells are the metastatic driver, while VHL(+) cells receive metastatic signals from VHL(-) cells and undergo aggressive transformation. This study investigates whether exosomes could be mediating metastatic crosstalk. Exosomes isolated from paired VHL(+) and VHL(-) cancer cell lines were assessed for physical, biochemical, and biological characteristics. Compared to the VHL(+) cells, VHL(-) cells produce significantly more exosomes that augment epithelial-to-mesenchymal transition (EMT) and migration of VHL(+) cells. Using a Cre-loxP exosome reporter system, the fluorescent color conversion and migration were correlated with dose-dependent delivery of VHL(-) exosomes. VHL(-) exosomes even induced a complete cascade of distant metastasis when added to VHL(+) tumor xenografts in a duck chorioallantoic membrane (dCAM) model, while VHL(+) exosomes did not. Therefore, this study supports that exosomes from VHL(-) cells could mediate critical cell-to-cell crosstalk to promote metastasis in RCC.

Parents of children with Down syndrome (DS) were interviewed about if their experiences raising their children matched their initial assumptions about parenting a child with DS. A dominant narrative was identified, wherein most parents described initially having negative assumptions, which did not come to fruition; parenting their child was not very different from parenting a typical child. There was also a sub-group of participants who disputed the dominant narrative; parenting their child was challenging and the dominant narrative marginalizes that experience. The findings indicate that although for many parents, having a child with DS is like "taking the scenic route" (i.e., it involves a few more hurdles, but often more rewards), this framing is not always applicable. Therefore, health care providers and support organizations should promote a narrative that encompasses the diversity of parenting a child with DS.

Christopher Martin argues that an interest in strong autonomy supports a right to debt-free higher education and that making tuition free is the best way of enacting that right. We argue that making higher education tuition free would, in the absence of other countervailing measure, maldistribute strong autonomy, even in ideal conditions. We also argue that even if Martin is right that higher education should be tuition-free in ideal circumstances, it does not follow that in prevailing, non-ideal, conditions higher education should be tuition-free.

BackgroundThe COVID-19 pandemic highlighted the importance of telemedicine in health care. However, video telemedicine requires adequate broadband internet speeds. As video-based telemedicine grows, variations in broadband access must be accurately measured and characterized. ObjectiveThis study aims to compare the Federal Communications Commission (FCC) and Microsoft US broadband use data sources to measure county-level broadband access among veterans receiving mental health care from the Veterans Health Administration (VHA). MethodsRetrospective observational cohort study using administrative data to identify mental health visits from January 1, 2019, to December 31, 2020, among 1161 VHA mental health clinics. The exposure is county-level broadband percentages calculated as the percentage of the county population with access to adequate broadband speeds (ie, download >25 megabits per second) as measured by the FCC and Microsoft. All veterans receiving VHA mental health services during the study period were included and categorized based on their use of video mental health visits. Broadband access was compared between and within data sources, stratified by video versus no video telemedicine use. ResultsOver the 2-year study period, 1,474,024 veterans with VHA mental health visits were identified. Average broadband percentages varied by source (FCC mean 91.3%, SD 12.5% vs Microsoft mean 48.2%, SD 18.1%; P

ObjectivesBlood transfusion is an important mode of infectious disease transmission in low- and middle-income countries (LMICs). This study describes a model to determine the prevalence of transfusion-transmitted infections (TTIs) and the associated burden of disease.MethodsA five-step model was developed to determine the TTI-related burden of disease measured by disability-adjusted life years (DALYs). Uganda was selected as the study country.ResultsApproximately 298,266 units of blood were transfused in Uganda in 2019, yielding an estimated TTI incidence of 6,858 new TTIs (2.3% of transfused units) and prevalence of 19,141 TTIs (6.4% of transfused units). The total burden of disease is 2,903 DALYs, consisting of approximately 2,590 years of life lost (YLLs), and 313 years lived with disability (YLDs).ConclusionThe incidence and prevalence of TTIs and the associated burden of disease can be calculated on a local and national level. The model can be applied by health ministries to estimate the impact of TTIs in order to develop blood safety strategies to reduce the burden of disease.

As a result of the United States withdrawal from Afghanistan in fall 2021, 1,260 Afghan evacuees arrived in Minnesota between October 2021 and February 2022. Several contextual factors including an overtaxed health system under duress from COVID-19 and uncertain benefit eligibility prompted a coordinated public health response to appropriately address the acute and pressing medical concerns of our new neighbors. This community case study describes the State of Minnesota's cross-sectoral response that created a welcoming environment, identified public health concerns, and addressed acute medical needs. Medical volunteers provided an initial health and safety check for Afghan families upon arrival. Volunteers also offered onsite culturally and linguistically appropriate mental health assessments, group therapy, women's clinics, vaccine clinics, medication refills, and ongoing walk-in primary care. Care coordinators facilitated primary care and specialty care referrals. The majority (96%) of eligible arrivals were screened as part of this response and the median time between arrival to Minnesota and initial health screening was 2 days. Half of all arrivals screened reported at least one health concern and 56% were referred to a specialty for further evaluation. Almost one in four adults (24%) reported mental health concerns. Existing partnerships across local sectors can be leveraged to provide comprehensive physical and mental health services to newcomers in an emergency response.

Background: Past research indicates that young adult cigarette smokers are at risk of engaging in maladaptive eating behaviors (MEBs); however, whether this relationship extends to nicotine vaping is unclear. The current study assessed bidirectional associations between four types of MEBs and nicotine vaping among young adults. Methods: 1,303 young adults (20.5 ± 2.3 years; 63 % female) from a public, urban university were recruited and completed online surveys at six-month intervals from spring 2021 (W1) to spring 2023 (W5). Past 30-day nicotine vaping and four types of MEBs (susceptibility to external cues, emotional eating, routine restraint, and compensatory restraint) were evaluated. Results: Longitudinal cross-lagged models examined the bidirectional relationships between past 30-day nicotine vaping and each type of MEB across five waves. Nicotine vaping predicted both susceptibility to external cues (β = 0.10, p

Perceived sense of belonging and positive social climate on campus are crucial elements for post-secondary students, as they contribute to academic achievement, positive mental health, and help-seeking. Few studies have explored post-secondary students' sense of belonging and perceptions of social climate in an official language minority campus, which attract Canadian-born francophones, anglophones who pursue higher education in their second language, and francophone international students. With declining student mental health and greater ethnolinguistic diversity of post-secondary students on Canadian campuses, this important study aims to explore francophone students' perceived sense of belonging and social climate on campus. In total, 35 students from different ethnolinguistic backgrounds took part in focus groups or individual interviews. Domestic students with French as their first language more often reported positive social climate on campus and a sense of belonging, in contrast to international students and students with French as a second language. A common obstacle to connecting with others was language insecurity in one of the official languages, as both are currently used on campus. Universities hosting students of multiple linguistic diversities should provide courses and campus events to stimulate intercultural knowledge and dialogue. [Note: The issue number (3) shown in the footer of the first page of the PDF is incorrect. The correct issue number is 4.]

Sarcoidosis is a granulomatous disease of indeterminate etiology. Women are more commonly affected than men at nearly twice the incidence with black women most commonly afflicted in the United States. Osseous spinal sarcoidosis (SS) is thought to be uncommon. Such lesions are often mistaken for metastatic disease, multiple myeloma, or disseminated fungal/granulomatous infection complicating the diagnosis, clinical course, and treatment. Patients presenting with clinical and imaging features of sarcoidosis may have normal serum laboratory values further complicating diagnosis. We present the case of a 61-year-old African American female with a diagnosis of osseous spinal sarcoidosis and normal calcium and ACE levels. Her initial presentation began with an incidentally discovered pulmonary nodule and was subsequently discovered to have multiple enlarging pulmonary nodules and widespread sclerotic lesions throughout her spine. This imaging presentation occurred before development of hilar adenopathy and cutaneous manifestations of sarcoidosis. Here, we describe her clinical course, exclusion of metastatic disease, and other confounders to arrive at the correct diagnosis.

Exercise performance tends to suffer during the morning compared to the evening, which may decrease potential training adaptations. Currently, it is unclear how nutritional interventions may affect this phenomenon and whether supplementation may allow for the attainment of optimal performance regardless of the time of day. The purpose of this study was to investigate the effects of acute yohimbine ingestion on morning-associated decrements in performance and psychophysiological responses to exercise. Physically active females (n = 16) were recruited to participate in three total visits, each with a different treatment: (1) placebo-morning (PL-AM), (2) yohimbine-morning (YHM-AM; oral 2.5 mg), and (3) placebo-afternoon (PM). The morning and afternoon visits occurred between 7:00–8:00 h and 16:00–17:00 h, respectively. The experimental treatments in the morning were ingested 20 min prior to capillary blood collection, which was completed pre- and post-exercise. Following a warm-up, participants completed a 2000 m time trial on a rowing ergometer. Power output, heart rate (HR), and rating of perceived exertion (RPE) were recorded every minute. Time to competition (TTC) and subjective energy, focus, and alertness were documented post-exercise. Pre- and post-exercise blood lactate (La) and plasma hypoxanthine (HX) levels were also assessed. The trials were separated by a 48 h washout period. The results showed that power output (p = 0.010) was lower and TTC (p = 0.003) was significantly slower with PL-AM compared to PM. Furthermore, YHM-AM resulted in higher power output (p = 0.035) and faster TTC (p = 0.007) compared to PL-AM, with no differences compared to PM (p > 0.05). Post-exercise La was significantly lower with YHM-AM compared to PL-AM (p = 0.046) and PM (p = 0.001). Pre-exercise plasma HX, as measured via conversion to xanthine, was significantly higher with PM (p = 0.039), while the levels trended higher with YHM-AM (p = 0.060) compared to PL-AM. Subjective energy was higher with YHM-AM (p = 0.045) and PM (p = 0.009) compared to PL-AM, while alertness was only higher for YHM-AM compared to PL-AM (p = 0.045). No statistical differences between the treatments were found for RPE or HR (p > 0.05). These findings indicate that YHM ingestion attenuates performance decrements in the morning. Improvements in performance may be underpinned by improved feelings of energy and alterations in metabolism. Practically, YHM may represent an effective ergogenic aid to combat a lack of energy and low performance during the morning.

Background: Corticosteroid injections (CSIs) can be an effective nonsurgical treatment for patients with rotator cuff tears. Recent large database studies have raised concern that CSI may result in a higher reoperation rate, increased infection risk, and worse outcome after arthroscopic rotator cuff repair (ARCR). The purpose of this study was to evaluate the reoperation rate, incidence of postoperative infection, and two-year outcomes of patients undergoing ARCR with and without the use of preoperative CSI. Methods: An institutional database generated from fellowship-trained orthopedic sports surgeons was retrospectively queried for patients who underwent ARCR with a minimum of two-year follow-up. Inclusion criteria consisted of 1) primary full-thickness rotator cuff tear and 2) preoperative and minimum two-year patient-reported outcome measures (PROMs). Of the 219 patients identified, 134 patients had preoperative subacromial CSI administered within one year of ARCR. Reoperation rate, number of injections, Visual Analog Scale, American Shoulder and Elbow Surgeons Score, Single Assessment Numeric Evaluation, and Veterans Rand 12-Item Health Survey Physical Component Score/Mental Component Score were compared between groups at six months, one year, and two years. Chi-square and t-tests were used to compare baseline differences, postoperative infections, and reoperations. A repeated measures Analyses of Covariance was used to measure differences between PROMs at each time point. Simple Analyses of Covariance were used for the two-year sub-analyses for patients receiving CSI within 90 days of surgery and if multiple preoperative CSI had been given (α ≤ 0.05). Results: There were no significant demographic differences between groups (P > .05). Preoperative use of subacromial CSI within one year prior to ARCR did not increase reoperation rate (P = .85) or impact PROMs at any timepoint. There were two reoperations during the study period in the CSI group (2 lysis of adhesions). No infections occurred in either cohort. No differences were found if injections were performed within 90 days of surgery or if more than one CSI was administered within the year prior to surgery (P > .05). Conclusion: Our results show that preoperative CSI prior to primary ARCR did not increase risk of reoperation, infection, or influence PROMs with a minimum follow-up of 2 years.

Advocates of tuition-free four-year public college make the argument for it too easy by asserting that it would be paid for out of taxes on the wealthy. Other uses of the revenues are possible. In this paper, Harry Brighouse and Kailey Mullane establish two criteria for comparing different uses of the revenues: the first criterion is, will the policy increase the overall level of educational goods?, and the second is, will the policy reduce inequalities of educational goods? Here, Brighouse and Mullane compare tuition-free four-year public college with two alternatives: (1) spending the revenues in pre-K and K-12; and (2) spending them on expanding the Pell Grant Program. Both alternatives are superior with respect to reducing inequalities, and spending in pre-K and K-12 is superior with respect to increasing the overall level of educational goods. While on some assumptions tuition-free four-year public college might prove better than expanding Pell Grants at increasing the overall level of educational goods, there are good reasons, nevertheless, to prefer expanding Pell Grants.

Objective: Previous studies identified Snapchat as the most likely social media platform for depictions of excessive drinking and consequences. We sought to further examine this relationship and the possible protective impact of trait mindfulness. Method: A sample of 838 college students completed a survey assessing self-reported alcohol use, alcohol-related consequences, trait mindfulness, and individual and peer alcohol-related Snapchat posts. Results: Viewing more peer's Snapchats was associated with increased alcohol-related consequences, except at high levels of trait mindfulness. When controlling for the individual's Snapchat posts, the significant relationship between peer's Snapchats and consequences remained at low levels of trait mindfulness but not for moderate levels. The protective effect of high levels of trait mindfulness endured. Conclusion: Increasing trait mindfulness may help buffer the negative influence of viewing peer's alcohol-related Snapchats on alcohol-related consequences. Further examining how trait mindfulness interacts with peer norms offers important avenues for future research.

BackgroundThere is a sparsity of literature on treatment outcomes for patients with non-muscle invasive bladder cancer (NMIBC) who received neoadjuvant chemotherapy (NAC). We aim to analyze the outcomes associated with the use of NAC prior to radical cystectomy for NMIBC utilizing the National Cancer Database.Materials/MethodsThe National Cancer Database bladder dataset was evaluated for patients with NMIBC and known pT staging undergoing RC from 2006–2016. The primary outcome was the utilization of NAC. The secondary outcomes were pathologic down staging to pT0, positive surgical margins, 30-day readmission, and overall survival.ResultsThe proportion of patients receiving NAC prior to radical cystectomy for NMIBC increased from 8.6% in 2006 to 14.8% in 2016. Those who received NAC had significantly higher tumor stages (cT1 vs cTa/is) with 85.7% of patients receiving NAC presenting with cT1 as opposed to only 82% in those not receiving NAC (p < 0.001). Similarly, there were significantly more patients who were cN+ in the NAC group as compared to those who did not receive NAC (5.5% vs. 1.1%, p < 0.001). For patients who received NAC, the rate of downstaging to pT0 was 12.7% as compared to only 3.3% in patients who did not receive NAC (p < 0.001). There was no significant difference comparing the rates of positive margins or 30-day readmissions between groups. On multivariable logistic regression for pathologic downstaging, NAC was significant (OR 4.1, p < 0.05). There was no significant difference in overall survival between patients treated with or without NAC.ConclusionNAC prior to RC in patients with NMIBC has increased in recent years and correlates with tumor downstaging. Further research is requisite to identify patients who obtain the greatest benefit of NAC in the NMIBC setting.

Intracellular bacterial pathogens have evolved to be adept at manipulating host cellular function for the benefit of the pathogen, often by means of secreted virulence factors that target host pathways for modulation. The lysosomal pathway is an essential cellular response pathway to intracellular pathogens and, as such, represents a common target for bacterial-mediated evasion. Here, we describe a method to quantitatively assess bacterial pathogen–mediated suppression of host cell trafficking to lysosomes, using Salmonella enterica serovar Typhimurium infection of epithelial cells as a model. This live-cell imaging assay involves the use of a BODIPY TR-X conjugate of BSA (DQ-Red BSA) that traffics to and fluoresces in functional lysosomes. This method can be adapted to study infection with a broad array of pathogens in diverse host cell types. It is capable of being applied to identify secreted virulence factors responsible for a phenotype of interest as well as domains within the bacterial protein that are important for mediating the phenotype. Collectively, these tools can provide invaluable insight into the mechanisms of pathogenesis of a diverse array of pathogenic bacteria, with the potential to uncover virulence factors that may be suitable targets for therapeutic intervention.Key features• Infection-based analysis of bacterial-mediated suppression of host trafficking to lysosomes, using Salmonella enterica serovar Typhimurium infection of human epithelial cells as a model.• Live microscopy–based analysis allows for the visualization of individually infected host cells and is amenable to phenotype quantification.• Assay can be adapted to a broad array of pathogens and diverse host cell types.• Assay can identify virulence factors mediating a phenotype and protein domains that mediate a phenotype.

ABSTRACT Enterococcus faecium is a member of the human gastrointestinal (GI) microbiota but can also cause invasive infections, especially in immunocompromised hosts. Enterococci display intrinsic resistance to many antibiotics, and most clinical E. faecium isolates have acquired vancomycin resistance, leaving clinicians with a limited repertoire of effective antibiotics. As such, vancomycin-resistant E. faecium (VREfm) has become an increasingly difficult to treat nosocomial pathogen that is often associated with treatment failure and recurrent infections. We followed a patient with recurrent E. faecium bloodstream infections (BSIs) of increasing severity, which ultimately became unresponsive to antibiotic combination therapy over the course of 7 years. Whole-genome sequencing (WGS) showed that the patient was colonized with closely related E. faecium strains for at least 2 years and that invasive isolates likely emerged from a large E. faecium population in the patient’s gastrointestinal (GI) tract. The addition of bacteriophage (phage) therapy to the patient’s antimicrobial regimen was associated with several months of clinical improvement and reduced intestinal burden of VRE and E. faecium. In vitro analysis showed that antibiotic and phage combination therapy improved bacterial growth suppression compared to therapy with either alone. Eventual E. faecium BSI recurrence was not associated with the development of antibiotic or phage resistance in post-treatment isolates. However, an anti-phage-neutralizing antibody response occurred that coincided with an increased relative abundance of VRE in the GI tract, both of which may have contributed to clinical failure. Taken together, these findings highlight the potential utility and limitations of phage therapy to treat antibiotic-resistant enterococcal infections.IMPORTANCEPhage therapy is an emerging therapeutic approach for treating bacterial infections that do not respond to traditional antibiotics. The addition of phage therapy to systemic antibiotics to treat a patient with recurrent E. faecium infections that were non-responsive to antibiotics alone resulted in fewer hospitalizations and improved the patient's quality of life. Combination phage and antibiotic therapy reduced E. faecium and VRE abundance in the patient's stool. Eventually, an anti-phage antibody response emerged that was able to neutralize phage activity, which may have limited clinical efficacy. This study demonstrates the potential of phages as an additional option in the antimicrobial toolbox for treating invasive enterococcal infections and highlights the need for further investigation to ensure phage therapy can be deployed for maximum clinical benefit.

Transit agencies are looking for ways to save costs and improve transit rider experiences. One strategy to accomplish this is to replace legacy payment systems that accept cash and in-network agency-issued tickets or cards with fully digital open-loop payments systems, which accept all debit, credit, and mobile payments and are more readily interoperable between different transit agencies and shared mobility operators. This transition will not come without confronting a number of equity and logistical challenges to ensure all riders benefit from this transition. The state of California’s California Integrated Travel Project (Cal-ITP) aims to help transit agencies make this digital payment transition. Researchers at UC Davis partnered with Cal-ITP to explore this question: how can California transit agencies modernize fare payment while ensuring transit systems are open and accessible to un-and underbanked riders? Researchers collected 200+ intercept surveys in the Davis-Sacramento-Woodland area of California to assess the potential for un-and underbanked passengers to use digital payment tools, such as contactless cards, and smartphone-based apps. This research finds that among unbanked riders who typically pay with cash, more than half of respondents would be open to paying with a prepaid debit card or a prepaid government-issued debit card, and about a third are open to paying with a mobile phone.View the NCST Project Webpage