Postoperative implant-associated spine infection remains poorly understood. Currently there is no large animal model using biofilm as initial inocula to study this challenging clinical entity. The ...purpose of the present study was to develop a sheep model for implant-associated spine infection using clinically relevant biofilm inocula and to assess the in vivo utility of methylene blue (MB) for visualizing infected tissues and guiding debridement. This 28-day study used five adult female Rambouillet sheep, each with two non-contiguous surgical sites– in the lumbar and thoracic regions– comprising randomized positive and negative infection control sites. A standard mini-open approach to the spine was performed to place sterile pedicle screws and Staphylococcus aureus biofilm-covered (positive control), or sterile (negative control) spinal fusion rods. Surgical site bioburden was quantified at the terminal procedure. Negative and positive control sites were stained with MB and staining intensity quantified from photographs. Specimens were analyzed with x-ray, micro-CT and histologically. Inoculation rods contained ∼10.44 log10 colony forming units per rod (CFU/rod). Biofilm inocula persisted on positive-control rod explants with ∼6.16 log10 CFU/rod. There was ∼6.35 log10 CFU/g of tissue in the positive controls versus no identifiable bioburden in the negative controls. Positive controls displayed hallmarks of deep spine infection and osteomyelitis, with robust local tissue response, bone resorption, and demineralization. MB staining was more intense in infected, positive control sites. This work presents an animal-efficient sheep model displaying clinically relevant implant-associated deep spine infection.
•Biofilm inocula reliably produces implant-associated deep spine infection in an ovine model.•Positive control sites displayed hallmarks of deep spine infection within the 28-day study window.•Hematogenous spread was not observed from positive to negative controls sites.
This Indigenous-led project aims to better understand historical and contemporary ways in which Alaska Native Peoples steward salmon and the values connected to salmon stewardship. Indigenous Peoples ...have stewarded Alaska lands and waters for thousands of years yet have been largely excluded from western science and management systems. In this project, we utilize a participatory approach that allows for the equitable valuing of ideas and knowledges to document the breadth and depth of Yup'ik and Athabascan knowledge and governance systems in southwestern Alaska. We reshape research methodologies by centering Indigenous frameworks and methodologies, including circle dialogues and multi-generational interviews led by Indigenous scholars and students in their home communities and regions. In this paper, we share the Yup'ik and Athabascan values, knowledge, management, and governance mechanisms that can improve the long-term sustainability and equity of Alaska salmon systems. This research elevates the voices of Alaska Native salmon stewards and experts from the Kuskokwim Bay and the Kuskokwim River. We elaborate on five key themes that emerged from this research, including traditional Indigenous ways of life, Indigenous stewardship, self-determination, food and livelihood sovereignty, and ecosystem changes, and identify a more equitable and sustainable path forward for salmon and people in Alaska.
To describe protocol adaptations to the Fibromyalgia Integrative Training for Teens (FIT Teens) randomized controlled trial in response to the COVID-19 pandemic. The overarching aims of the FIT Teens ...multi-site 3-arm comparative effectiveness trial are to assess whether a specialized neuromuscular exercise training intervention combined with cognitive-behavioral therapy (CBT) is superior to CBT alone or graded aerobic exercise alone.
The trial was originally designed as an in-person, group-based treatment with assessments at baseline, mid- and post-treatment, and four follow-up time points. The original study design and methodology was maintained with specific modifications to screening, consenting, assessments, and group-based treatments to be delivered in remote (telehealth) format in response to COVID-19 restrictions.
Study enrollment was paused in March 2020 for five months to revise operations manuals, pilot remote treatment sessions for accuracy and fidelity, complete programming of REDCap assent/consent and assessment materials, train study staff for new procedures and obtain regulatory approvals. The trial was relaunched and has been successfully implemented in remote format since July 2020. Trial metrics thus far demonstrate a consistent rate of enrollment, strong attendance at remote treatment sessions, high retention rates and high treatment fidelity after protocol adaptations were implemented.
Preliminary findings indicate that FIT Teens protocol adaptations from in-person to remote are feasible and allowed for sustained enrollment, retention, and treatment fidelity comparable to the in-person format. Methodologic and statistical considerations resulting from the adaptations are discussed as well as implications for interpretation of results upon completion of the trial.
NCT 03268421.
We sought to identify trends and characteristics associated with the availability of tailored mental health services for individuals involved in the criminal justice system and ordered to treatment ...by a court, nationally in the US and by state.
We used National Mental Health Services Survey to identify outpatient mental health treatment facilities in the US (2016 n = 4744; 2018 n = 4626; 2020 n = 4869). We used clustered multiple logistic regression to identify changes over time as well as facility- and state-level factors associated with the availability of specialty court-ordered services.
Slightly more than half of the outpatient mental health treatment facilities offered specialized services for individuals ordered to treatment by a court, with wide variation between states. Nationally, there was a significant increase in the odds of offering court-ordered treatment in 2020 compared to 2016 (aOR = 1.16, 95% CI = 1.06-1.27, p < 0.01). Notable associations included offering integrated substance use treatment (versus none, aOR = 2.95, 95% CI = 2.70-3.22, p < 0.0001) and offering trauma therapy (versus none, aOR = 2.05, 95% CI = 1.85-2.27, p < 0.0001).
The availability of mental health services for individuals ordered to treatment by a court is growing nationally but several states are lagging behind. Court ordered treatment is a promising strategy to improve health and reduce reliance on the carceral system as a healthcare provider. At the same time, we express caution around disparities within behavioral health courts and advocate for equity in access to incarceration alternatives.
The majority of known tetratricopeptide repeat (TPR) domains consist of three copies of the helix-turn-helix TPR motif, together with a seventh C-terminal helix. TPR domains function as ...protein–protein recognition modules in intracellular signalling. This function is exemplified by the TPR domain of protein phosphatase 5 (PP5), which binds to the C terminus of the chaperone protein Hsp90. Here, we report NMR and CD spectroscopic studies that reveal that this domain is largely unfolded at physiological temperatures, and that interaction with an MEEVD pentapeptide derived from Hsp90 stabilises a folded structure. This complex, coupled folding-binding mechanism is characterised further by its observed enthalpy change on binding (determined by isothermal titration calorimetry), which displays a markedly non-linear relationship with temperature. A nested Gibbs–Helmholtz model is used in a novel combined analysis of the CD and ITC data to determine separately the thermodynamic contributions of the intrinsic folding and binding events to the overall coupled process. The analysis shows that, despite the expected large entropic opposition to the folding process, a nearly equal favourable folding enthalpy means the net effect of coupled folding on the observed affinity is small across a broad range of temperature. We hypothesise that a coupled folding-binding mechanism is common in this class of domains.
Violence against women (VAW) is a significant public health and human rights issue, with an estimated 736 million women globally experiencing VAW. Consistent evidence demonstrates that substance use ...is associated with VAW and that participation in substance use treatment programs is associated with reduction in substance use-related violence. While evidence demonstrates the ability to address VAW through substance use treatment programs, less attention has been paid to geographic access to substance use programs. If these programs are geographically inaccessible, particularly to marginalized populations, many people will not get the help they need. This study seeks to explore the relationship between geographic access to substance use treatment programs on VAW. Using data from the HIV Prevention Trials Network (HPTN) 064 study, longitudinal multilevel models were used to assess the relationship between neighborhood-level social determinants, with a specific focus on geographic access to Substance Abuse and Mental Health Services Administration (SAMHSA) certified drug and alcohol treatment programs and VAW. The study included 1910 women, ages 18 to 44, living in select geographic areas with high-ranked prevalence of HIV and poverty. The findings of this study indicate that among women who reside in census tracts with high prevalence rates of HIV: (1) substance use increases VAW; (2) VAW decreases as geographic access to SAMHSA-certified drug and alcohol treatment facilities increases; and (3) when looking at specific types of VAW, emotional and physical abuse decreases as geographic access to substance use treatment increases. Policies and programs to increase access to substance use treatment should be explored and evaluated, and more programs are needed that address the intersectionality of substance use and VAW.
Background
Transition from pediatric to adult care is a period of high risk for loss to follow‐up, morbidity, and mortality in adolescents and young adults (AYA) with hemoglobinopathies. The purpose ...of this study was to determine whether a transition program with transition navigator (TN) reduced loss to follow‐up and hospitalizations and improved medication adherence and appointment attendance compared with an unstructured transfer.
Procedure
A retrospective observational study compared all AYA with hemoglobinopathies who turned 18 one year prior to (n = 51) and one year after (n = 61) the initiation of the transition program. Data from one year prior to last pediatric appointment and one year following first adult appointment were collected from each patient.
Results
The transition program with TN reduced loss to follow‐up from 29% to 7% (P = 0.034). A greater proportion of patients in the transition cohort maintained or improved adherence to hydroxyurea or iron chelation to ≥4 days/week; exposure to the program was independently associated with such improvement (P = 0.047). A trend toward improvement or maintenance of ≥90% attendance to appointments was observed (P = 0.096). Frequency of hospitalization was not significantly different between the two cohorts (P = 0.985).
Conclusions
A transition program with TN significantly reduced loss to follow‐up, and significantly improved and maintained fair to good medication adherence. Further analysis of economic benefit and patient satisfaction will be conducted.
Habitat complexity and connectivity can influence the number of species and their diversity across a landscape. For the surf zones of ocean-exposed beaches, globally one of the longest habitat ...interfaces, the assumed low structural complexity, and apparent homogeneity, of the sandy seafloor habitats predicts low taxonomic and functional diversity. Here, we assessed how the configuration of the seascape and the context of different beach structure functional diversity and functional niche space of fish assemblages in surf zones. We expected that beaches that were well connected with highly productive and complex estuarine and reef habitats would support a greater level of functional diversity, and a greater degree of functional complementarity within different niches. We sampled surf zones at twenty-five beaches along 50 km of coastline in southeast Queensland, Australia. We calculated functional diversity and functional niche space using variation in the functional traits of fish assemblages. We found that increased proximity with nearby subtidal rocky reefs was the key feature of the coastline shaping functional diversity and functional niche space in surf zone fishes. These effects resulted in increased functional complementarity within a number of fish functional group niches when rocky reefs were nearby. We provide empirical evidence that habitat proximity can structure functional diversity and complementarity in the surf zones of ocean beaches, a system traditionally viewed as having low habitat heterogeneity. Our results highlight the focus management must take in conserving these highly connected ecosystems to avoid negative functional consequences.
PDF