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BACKGROUND: Literature supports the need for improved techniques to achieve spinopelvic alignment and reduce complication rates in patients with adult spinal deformity (ASD). Personalized interbody devices were developed to address this need and are under evaluation in the multicenter Clinical Outcome Measures in Personalized aprevo (circle R superscript) Spine Surgery (COMPASS (TM suprascript) registry. This report presents interim COMPASS pre- and postoperative sagittal alignment results and complication rates for a subcohort of COMPASS patients diagnosed and surgically treated for spinal deformity. METHODS: COMPASS is a postmarket observational registry of patients enrolled either before or after index surgery and then followed prospectively for 24 months. Sagittal alignment was assessed with SRS-Schwab modifiers for pelvic incidence minus lumbar lordosis, pelvic tilt, and T1 pelvic angle. Summed SRS-Schwab modifiers were utilized to assign overall deformity status as mild, moderate, or severe. Complications were extracted from patient medical records. RESULTS: The study included 67 patients from 9 centers. Preoperative severe deformity was observed in 66% of patients. Index surgeries included implantation of a median of 2 personalized interbody devices by anterior, lateral, or transforaminal approaches and with a median of 8 posteriorly instrumented levels. Overall postoperative sagittal alignment improved with a significant decrease in the mean sum of SRS-Schwab modifiers that correlated strongly to improvements in pelvic incidence minus lumbar lordosis. Among 44 patients with preoperative severe overall deformity, 16 improved to moderate and 9 to mild deformity. Complications occurred for 13 patients (19.4%), including 1 mechanical complication requiring revision 9 months after surgery and none related to personalized interbody devices. CONCLUSIONS: This study demonstrates that ASD patients whose treatment included personalized interbody devices can obtain favorable postoperative alignment status comparable to published results and with no complications related to the personalized interbody devices. CLINICAL RELEVANCE: This study contributes to growing evidence that personalized interbody devices contribute to improved sagittal alignment in ASD patients by directly adjusting the orientation of adjacent vertebra.

BACKGROUND: Lumbar lordosis distribution has become a pivotal factor in re-establishing the foundational alignment of the lumbar spine. This can directly influence overall sagittal alignment, leading to improved long-term outcomes for patients. Despite the wide availability of hyperlordotic stock cages intended to achieve optimal postoperative alignment, there is a lack of correlation between the lordotic shape of a cage and the resultant intervertebral alignment. Recently, personalized spine surgery has witnessed significant advancements, including 3D-printed personalized interbody implants, which are customized to the surgeons treatment and alignment goals. This study evaluates the reliability of 3D-printed patient-specific interbody implants to achieve the planned postoperative intervertebral alignment. METHODS: This is a retrospective study of 217 patients with spinal deformity or degenerative conditions. Patients were included if they received 3D-printed personalized interbody implants. The desired intervertebral lordosis (IVL) angle was prescribed into the device design for each personalized interbody (IVL goal). Standing postoperative radiographs were measured, and the IVL offset was calculated as IVL achieved minus IVL goal. RESULTS: In this patient population, 365 personalized interbodies were implanted, including 145 anterior lumbar interbody fusions (ALIFs), 99 lateral lumbar interbody fusions (LLIFs), and 121 transforaminal lumbar interbody fusions. Among the 365 treated levels, IVL offset was 1.1° ± 4.4° (mean ± SD). IVL was achieved within 5° of the plan in 299 levels (81.9%). IVL offset depended on the approach of the lumbar interbody fusion and was achieved within 5° for 85.9% of LLIF, 82.6% of transforaminal lumbar interbody fusions and 78.6% of ALIFs. Ten levels (2.7%) missed the planned IVL by >10°. ALIF and LLIF levels in which the plan was missed by more than 5° tended to be overcorrected. CONCLUSIONS: This study supports the use of 3D-printed personalized interbody implants to achieve planned sagittal intervertebral alignment. CLINICAL RELEVANCE: Personalized interbody implants can consistently achieve IVL goals and potentially impact foundational lumbar alignment.

BackgroundDespite suicide being the leading cause of death among emerging adult Asian American women (AAW), little is known about the risk factors.AimWe tested whether gendered racial microaggressions stress (GRMS) would be associated with AAW's suicidal ideation, and whether internalized racism (self-negativity, IRSN; weakness stereotypes, IRWS; and appearance bias, IRAB) would exacerbate this link based on self-devaluating implications of internalized racism.MethodUsing a sample of 309 AAW (Mage = 20.00, SD = 6.26), we conducted a moderated logistic regression with GRMS predicting suicidal ideation (endorsement or no endorsement) and the three internalized racism factors (IRSN, IRWS, and IRAB) as moderators.ResultsGRMS significantly predicted suicidal ideation with a threefold increase in the odds of suicidal ideation. Only IRSN significantly exacerbated this link at low to mean levels.ConclusionGendered racial microaggressions is likely a risk factor for suicidal ideation among AAW, particularly for those who internalize negative images of themselves as Asian individuals.

Presently, over 700,000 Californian workers — primarily immigrant women and women of color — provide homecare for nearly three million older adults and people with disabilities. Researchers examined homecare in California by surveying 500 workers and 103 consumers, conducting in-depth interviews with workers and consumers, and reviewing homecare agencies and residential facilities for the elderly.Lives & Livelihoods: California’s Private Homecare Industry in Crisis finds that the California homecare industry is facing critical issues that strain workers and consumers alike, amid growing demand that further intensified during the COVID-19 pandemic. Among other findings, the report notes how the lack of infrastructure in homecare leaves both consumers and workers struggling. Over half of consumers determined employment terms on their own or turned to their friends and family for guidance. Only 22% of workers reported ever taking paid sick leave. Nearly two-thirds of homecare workers did not earn enough to cover their daily expenses and 74% reported they did not have any type of personal retirement savings.Many families need financial support through public investment in order to pay their homecare workers a living wage. Three quarters of consumers stated they would like to pay higher wages and 85% of consumers strongly supported a universal long-term care insurance program in California.Meaningful and timely public investment in the state’s homecare workforce and infrastructure is imperative to the sustainability of the industry over the next decade and beyond. Report authors provide the following recommendations: 1) Make it easier for consumers to find care and workers to find fair employers 2) Formalize the industry and make workers rights real through education, tools, and increased enforcement efforts 3) Address the crisis of low wages, and 4) Increase public investment in long-term care to help consumers access and afford homecare and other long-term care.

The COVID-19 pandemic has had a profound and disparate impact on the lives of millions of people. In Los Angeles County, college campuses remained closed for more than a full academic year. Workers and learners juggled academic demands with the need to work for an income. As the pandemic persisted and colleges across the country continued to modify their reopening plans, the researchers of this study recognized the urgency of investigating the possible effects the crisis may have on workers’ and learners’ academic and job experiences. This study builds on existing knowledge concerning workers and learners by documenting how their education, employment, and life experiences inform their concerns and expectations for the return to campus and work. Developed by the 2021 Labor Summer Research Program student research teams, the research is based on 128 surveys and 29 interviews collected from Los Angeles public colleges and universities students in August 2021.The study found that nearly all students agreed that flexibility in deadlines, office hours, and attendance should remain as they return to campus. They also wanted to see the practice of recorded class lectures continue. While schedule flexibility helped some students balance school and work, many were still forced to prioritize either school or work. Most students reported that their campus had a vaccine requirement and mask mandate—preventive measures that they were overall in favor of. In contrast, workers and learners reported that their workplaces had fewer safety requirements. Further, workers and learners faced barriers to financial stability and well-being. Returning to normal after a global pandemic will be a process filled with challenges, and report authors provide specific recommendations for improving conditions in the report.

Domestic work is an indispensable part of American life. Domestic workers provide childcare, homecare, and housecleaning services to support families, individuals, older adults, and people with illnesses or disabilities. Essential to the functioning of our economy and a more caring and sustainable future, domestic workers ensure our children, aging grandparents, and loved ones who are managing chronic illnesses or disabilities receive the assistance they need to live healthy and dignified lives. However, this work remains largely excluded from basic employment protections and benefits that can ensure the health and safety of domestic workers.This report is part of a series of UCLA Labor Center studies that capture the experience of workers and employers in the domestic work sector. This industry lacks the structure common to others, and the resulting absence of regular and predictable practices leads to wide variations in work and pay arrangements. Studies have shown that domestic workers also experience wage theft, health and safety violations, and harassment. A recent survey of domestic workers found workplace risks similar to those of nurses in hospital or cleaners in commercial buildings. Unlike other low-wage industries, domestic work is hidden behind closed doors and lacks government oversight or support. In addition, household employers often do not consider themselves as such or see their homes as workplaces.Based on our analysis of government data from the most recent 5-year sample (2014– 2018) of the American Community Survey (ACS), this research brief provides a profile of domestic workers in California—who they are, where they live and work, and the economic vulnerabilities they face due to their employment status, low wages, and lack of benefits.

Because of the COVID-19 pandemic, colleges have rapidly transitioned from in-person classes to remote learning, dramatically changing the way students receive instruction. At the same time, students who work are also facing unemployment or reduced hours. Most of those who were not laid off are working in frontline positions in essential services. Compounding those challenges are government policies that prohibit many college students and certain low-wage workers from accessing economic relief benefits. Based on 138 surveys and 25 interviews collected from Los Angeles public colleges and universities, this study builds on existing knowledge concerning the experiences of workers and learners by documenting how their academic, employment, and life experiences have changed since the onset of the global health crisis.

Because of the COVID-19 pandemic, colleges have rapidly transitioned from in-person classes to remote learning, dramatically changing the way students receive instruction. At the same time, students who work are also facing unemployment or reduced hours. Most of those who were not laid off are working in frontline positions in essential services. Compounding those challenges are government policies that prohibit many college students and certain lowwage workers from accessing economic relief benefits.This study supplements the report Unseen Costs: The Experiences of Workers and Learners in Los Angeles County with new data on the effects of the pandemic on this population. Based on 236 surveys collected from Los Angeles public colleges and universities in April and May 2020, this study builds on existing knowledge concerning the experiences of workers and learners by documenting how their academic, employment, and life experiences have changed since the onset of the global health crisis.

Today, over half of college students work. Their experiences as workers and learners are impacted by increasing college costs and often exorbitant living expenses, and compounded by low wages. Meanwhile, state funding for public institutions has decreased dramatically: in 2017, it was nearly $9 billion less than in 2008. Tuition and fees have increased across every institution of public higher education in California. Financial aid rarely covers the educational expenses of workers and learners, and students generally face an acute funding gap. Workers and learners are concentrated in the low-wage service economy, and nine out of 10 worked more than 15 hours a week. Many simply lack the resources to pay for their tuition and fees, books, other necessary supplies, housing, and utilities.Yet this emerging reality has not produced a systematic infrastructure that might provide support and necessary accommodations for workers and learners. In fact, their schoolwork and engagement with academic opportunities suffers for their work commitments, and they are often penalized at work for attempting to meet their scholarly obligations and schedules.This report explores how workers and learners in Los Angeles’ public colleges and universities experience the competing demands of school and the workplace as they prepare for careers. We used a participatory and research justice approach, and worked with students, workers, and community partners to collect and analyze the data.

Objectives:Understanding how phenotypic traits vary has been a longstanding goal of evolutionary biologists. When examining antibiotic-resistance in bacteria, it is generally understood that the minimum inhibitory concentration (MIC) has minimal variation specific to each bacterial strain-antibiotic combination. However, there is a less studied resistance trait, the mutant prevention concentration (MPC), which measures the MIC of the most resistant sub-population. Whether and how MPC varies has been poorly understood. Here, we ask a simple, yet important question: How much does the MPC vary, within a single strain-antibiotic association? Using a Staphylococcus species and five antibiotics from five different antibiotic classes-ciprofloxacin, doxycycline, gentamicin, nitrofurantoin, and oxacillin-we examined the frequency of resistance for a wide range of concentrations per antibiotic, and measured the repeatability of the MPC, the lowest amount of antibiotic that would ensure no surviving cells in a 1010 population of bacteria. Results: We found a wide variation within the MPC and distributions that were rarely normal. When antibiotic resistance evolved, the distribution of the MPC changed, with all distributions becoming wider and some multi-modal. Conclusion: Unlike the MIC, there is high variability in the MPC for a given bacterial strain-antibiotic combination.

Background: Emerging data have highlighted the significance of planning and aligning total and segmental lumbar lordosis with pelvic morphology when performing short-segment fusion with the goal of reducing the risk of adjacent segment disease while also decreasing spine-related disability. This study evaluates the impact of personalized interbody implants in restoring pelvic incidence-lumbar lordosis (PI-LL) mismatch compared with a similar study using stock interbody implants. Methods: This multicenter retrospective analysis assessed radiographic pre- and postoperative spinopelvic alignment (PI-LL) in patients who underwent 1- or 2-level lumbar fusions with personalized interbody implants for degenerative (nondeformity) indications. The aim was to assess the incidence of malalignment (PI-LL = 10°) both before and after fusion surgery and to determine the rate of alignment preservation and/or correction in this population. Results: There were 135 patients included in this study. Of 83 patients who were aligned preoperatively, alignment was preserved in 76 (91.6%) and worsened in 7 (8.4%). Among the 52 preoperatively malaligned patients, alignment was restored in 23 (44.2%), and 29 (55.8%) were not fully corrected. Among patients who were preoperatively aligned, there was no statistically significant difference in either the "preserved" or "worsened" groups between stock devices and personalized interbody devices. In contrast, among patients who were preoperatively malaligned, there was a statistically significant increase in the "restored" group (P = 0.046) and a statistically significant decrease in the "worsened" groups in patients with personalized interbodies compared with historical stock device data (P < 0.05). Conclusions: Compared with a historical cohort with stock implants, personalized interbody implants in short-segment fusions have shown a statistically significant improvement in restoring patients to normative PI-LL. Using 3-dimensional preoperative planning combined with personalized implants provides an important tool for planning and achieving improvement in spinopelvic parameters. [ABSTRACT FROM AUTHOR]

BackgroundOne potential mechanism for early superficial cartilage wear in normal joints is alteration of the lubricant content and quality of synovial fluid. The purpose of this study was to determine if the concentration and quality of the lubricant, hyaluronan, in synovial fluid: (1) was similar in left and right knees; (2) exhibited similar age-associated trends, whether collected postmortem or antemortem; and (3) varied with age and grade of joint degeneration.MethodsHuman synovial fluid of donors (23-91 years) without osteoarthritis was analyzed for the concentrations of protein, hyaluronan, and hyaluronan in the molecular weight ranges of 2.5-7 MDa, 1-2.5 MDa, 0.5-1 MDa, and 0.03-0.5 MDa. Similarity of data between left and right knees was assessed by reduced major axis regression, paired t-test, and Bland-Altman analysis. The effect of antemortem versus postmortem collection on biochemical properties was assessed for age-matched samples by unpaired t-test. The relationships between age, joint grade, and each biochemical component were assessed by regression analysis.ResultsJoint grade and the concentrations of protein, hyaluronan, and hyaluronan in the molecular weight ranges of 2.5-7 MDa, 1-2.5 MDa, and 0.5-1 MDa in human synovial fluid showed good agreement between left and right knees and were similar between age-matched patient and cadaver knee joints. There was an age-associated decrease in overall joint grade (-15 %/decade) and concentrations of hyaluronan (-10.5 %/decade), and hyaluronan in the molecular weight ranges of 2.5-7 MDa (-9.4 %/decade), 1-2.5 MDa (-11.3 %/decade), 0.5-1 MDa (-12.5 %/decade), and 0.03-0.5 MDa (-13.0 %/decade). Hyaluronan concentration and quality was more strongly associated with age than with joint grade.ConclusionsThe age-related increase in cartilage wear in non-osteoarthritic joints may be related to the altered hyaluronan content and quality of synovial fluid.

With the everyday influence of social media and online platforms, racially minoritized individuals face the risk of experiencing racial discrimination in both offline and online contexts. Yet, there is scant research on how online and offline racism could jointly impact the mental health of racially minoritized individuals. Thus, the study examined online racism as a moderator in the link between offline racism and mental health issues. Using data from 651 racially minoritized emerging adults (M age = 22.15, SD = 3.39), a moderation analysis was conducted using the PROCESS macro with bias-corrected bootstrapping (10,000 resamples). Experiencing more offline racism was significantly associated with greater mental health issues. Online racism was a significant moderator in the link between offline racism and mental health issues. The link between offline racism and mental health issues was not significant at low levels of online racism. However, the link was significant and strengthened at mean to high levels of online racism. The results suggest complex interactions in understanding the compounding impact of online and offline racism on mental health costs among racially minoritized individuals. Implications for future research on understanding the interplay between online and offline racism are discussed. [ABSTRACT FROM AUTHOR]

We tested whether a digital storytelling video on anti-Black racism could improve empathic reactions to anti-Black racism and decrease fear of Black individuals (FBI) among Asian American emerging adults, and whether these changes were associated with greater anti-racism advocacy intentions. Asian American emerging adults (M age = 19.92; N = 205) were randomly assigned to view either storytelling or informational online videos. Data was collected before and after viewing the videos. The changes in empathic reactions and fear were analyzed using polynomial regression with response surface analysis. Those who viewed the storytelling video significantly increased their empathy and this change was significantly associated with greater individual anti-racism advocacy (IndAdv) and institutional anti-racism advocacy (IntAdv). Reductions in fear were not associated with greater advocacy. The informational video did not improve empathy but did decrease fear, which was associated with greater IndAdv. Therefore, digital storytelling videos may be a useful tool to promote advocacy against anti-Black racism. [ABSTRACT FROM AUTHOR]

Extant literature suggests that racism is associated with difficult emotional reactions and feelings of social disconnect among White individuals. These feelings of social disconnect may be particularly salient in today's digital era in which racism against racial minority individuals is conveniently and frequently witnessed via online platforms. Thus, we examined whether witnessing racism online may be associated with feelings of loneliness among White emerging adults. We also tested whether anti‐racism advocacy buffered loneliness given its potential for relationship building and community organizing to promote racial justice and equity. Using data from 227 White emerging adults (Mage = 20.86, SD = 4.82), we conducted a latent moderated structural equation modeling to test individual and institutional anti‐racism advocacy as moderators in the link between witnessing racism online (racial victimization of racial minority individuals in online interactions and online content on cultural devaluation/systemic racism against racial minority individuals) and loneliness. Greater exposure to online content on systemic racism and cultural devaluation of racial minority groups significantly predicted greater loneliness. Engagement in individual anti‐racism advocacy (mean to high levels) buffered this link. White allies must engage in anti‐racism practice to address racism in our society, and our findings advance our understanding of the associated psychosocial costs. Implications for research and practice are discussed. [ABSTRACT FROM AUTHOR]

Although prior research suggests Asian Americans experience physical health advantages relative to other racial/ethnic groups, increasing evidence points to health inequalities within Asian American subgroups. Disparities are especially pronounced among middle-aged Asian American women, who remain an understudied population, despite studies showing that midlife corresponds with distinct social stressors and changes in the availability of protective resources, such as social support. Thus, the purpose of the study was to examine racial/ethnic differences in social support and self-rated health (SRH) among middle-aged women. With data from the Study of Women's Health Across the Nation (SWAN; N = 1258), we used modified Poisson regression models to estimate incidence rate ratios (IRR), examining how social support shaped the risk of fair-to-poor SRH by race/ethnicity. We tested interactions between perceived stress, social support and race/ethnicity to determine whether the stress-buffering role of social support varies by group. Results demonstrate racial/ethnic differences in SRH. Higher levels of social support were linked to higher fair-to-poor SRH among Chinese American women (IRR = 1.24; 95% CI [1.02, 1.52]); while greater social support conferred lower risk among White women. Interaction analyses revealed additional nuances in the stress-buffering effects of social support among Chinese American women, such that the health benefits of social support depended on levels of perceived stress (IRR = 0.75; 95% CI [0.57, 1.00]). These findings highlight important distinctions in the ways that psychosocial factors shape health across racial/ethnic groups. In particular, this study helps advance our understanding of important subgroup differences in the stress-buffering role of social support for Asian American midlife women. Interventions should focus on identifying sources of social strain among Asian American women that can increase the risk for poor health and identify alternative sources of support that mitigate stressors to improve health. [ABSTRACT FROM AUTHOR]