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Measurement-based care is designed to track symptom levels during treatment and leverage clinically significant change benchmarks to improve quality and outcomes. Though the Veterans Health Administration promotes monitoring progress within posttraumatic stress disorder (PTSD) clinical teams, actionability of data is diminished by a lack of population-based benchmarks for clinically significant change. We reported the state of repeated measurement within PTSD clinical teams, generated benchmarks, and examined outcomes based on these benchmarks.PTSD Checklist forBoth the number of repeated measurements and the cases who had multisession care in the Corporate Data Warehouse were very low. Clinically significant change benchmarks were similar across locality levels. The modal cohort had worse outcomes than the EOC cohort.National benchmarks for clinically significant change could improve the actionability of assessment data for measurement-based care. Benchmarks created using data from Veterans who received multisession care had better outcomes than those receiving sporadic care. Measurement-based care in PTSD clinical teams is hampered by low rates of repeated assessments of outcome. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

LAY SUMMARY Both moral injury (MI) and posttraumatic stress disorder (PTSD) can result from adverse experiences (potentially morally injurious events [PMIEs] for the former and Criterion A events for the latter) and may lead to similar symptoms. Thus, debate is ongoing as to whether MI and PTSD are distinct. Depressive symptoms can also follow these events and may also overlap with symptoms of MI and PTSD. This study investigated how distinct MI is from PTSD and depression by examining networks composed of MI-related outcomes (trust violation, shame, functioning), PTSD symptom clusters, and depression for participants who reported experiencing a PMIE and those who did not. This study is the first of its kind to use MI outcomes with PTSD and depression in a network analysis. The results suggest that MI, PTSD, and depression are distinct but related phenomena, with more connections between these phenomena present particularly among those who experienced a PMIE. Moreover, the negative alterations in cognition and mood cluster of PTSD and MI-related functioning appears to explain some of the co-occurrence among constructs.

Seagrass meadows provide greater predator refuge and resource availability than unvegetated habitats and generally improve the survival and growth rates of associated animals. Few studies, however, have examined how these relationships might vary at a region-wide spatial scale. The blue crab Callinectes sapidus is a commercially important species that uses turtlegrass Thalassia testudinum habitats, but it is unclear if blue crab use of seagrass habitats varies across the northern Gulf of Mexico (GOM), USA. We conducted synoptic predation and growth experiments at 6 turtlegrass-dominated estuaries in the northern GOM to evaluate the role of seagrass structural complexity on juvenile (9.7-44 mm carapace width) blue crab mortality due to predation and growth. Relationships of blue crab predation and growth rate with seagrass shoot density, canopy height, temperature, and seagrass leaf area index (LAI) were evaluated using linear and generalized linear mixed effects models. Mortality rates due to predation (50 ± 9.6% [mean ± SD] crabs eaten, n = 286) showed negative relationships with LAI across the northern GOM. Conversely, mean crab growth rate (0.513 ± 0.317 mm d-1) varied across the northern GOM but was independent of seagrass shoot density or canopy height. We found that: (1) turtlegrass-dominated beds with a greater seagrass LAI provided more effective cover for juvenile blue crabs across the northern GOM, (2) blue crabs across multiple GOM estuaries responded similarly to changes in LAI, and (3) blue crab growth varied across the northern GOM and was likely dependent on regional factors unrelated to structural complexity. This study illustrates the value of conducting synchronous field-based experiments across broad spatial scales to identify regional patterns and the influence of regional versus local drivers.

Clinical guidelines do not recommend long-term anticoagulation in non-cirrhotic splanchnic vein thrombosis (NC-SVT) without underlying thrombophilia because it is assumed that there is a very low risk of recurrent thrombosis (RT). Our first aim was to describe the incidence of RT in people with NC-SVT without an indication for long-term anticoagulation. The second aim was to identify RT risk factors and afterwards verify them in a validation cohort.This is a multicentre, retrospective observational study evaluating risk factors for RT in 64 people with NC-SVT of idiopathic/local factor aetiology. In a subgroup of 48 individuals, the potential value of additional thrombophilic parameters to predict RT was analysed. Findings were validated in 70 individuals with idiopathic/local factor NC-SVT.Of the 64 participants in the training cohort, 17 (26%) presented splanchnic and/or extrasplanchnic RT (overall-RT) during follow-up (cumulative incidence: 2, 10, 19, and 34% at 1, 2, 5, and 10 years, respectively). In addition, 53% of people with splanchnic RT were asymptomatic. No clinical or biochemical parameters predicted overall-RT. However, in the 48 people with an additional comprehensive thrombophilic study, factor VIII ≥150% was the only independent factor predicting overall-RT (hazard ratio 7.10, 95% CI 2.17-23.17, p0.01). In the validation cohort, 19 individuals (27%) presented overall-RT, and it was also independently predicted by factor VIII150% (hazard ratio 3.71, 95% CI 1.31-10.5, p0.01). The predictive value of factor VIII was confirmed in both people with idiopathic/local factor aetiology associated NC-SVT.People with idiopathic/local factor NC-SVT are at risk of overall-RT. Splanchnic RT can be asymptomatic and requires screening for its detection. Values of factor VIII ≥150% may help identify individuals at high risk of overall-RT who could benefit from long-term anticoagulation.People with idiopathic/isolated local factor non-cirrhotic portal vein thrombosis were previously thought to be at minimal risk of re-thrombosis and therefore did not receive scheduled follow-up. The results of this study are of special interest for hepatologists treating people with non-cirrhotic splanchnic thrombosis, as they show a 25% incidence of re-thrombosis and support the close follow-up of people with factor VIII150% to ensure the early identification of new thrombotic events.

OBJECTIVE Extension fractures in the setting of diffuse idiopathic skeletal hyperostosis (DISH) represent highly unstable injuries. As a result, these fractures are most frequently treated with immediate surgical fixation to limit any potential risk of associated neurological injury. Although this represents the standard of care, patients with significant comorbidities, advanced age, or medical instability may not be surgical candidates. In this paper, the authors evaluated a series of patients with extension DISH fractures who were treated with orthosis alone and evaluated their outcomes. METHODS A retrospective review from 2015 to 2022 was conducted at a large level 1 trauma center. Patients with extension-type DISH fractures without neurological deficits were identified. All patients were treated conservatively with orthosis alone. Baseline patient characteristics and adverse outcomes are reported. RESULTS Twenty-seven patients were identified as presenting with extension fractures associated with DISH without neurological deficit. Of these, 22 patients had complete follow-up on final chart review. Of these 22 patients, 21 (95.5%) were treated successfully with external orthosis. One patient (4.5%) who was noncompliant with the brace had an acute spinal cord injury 1 month after presentation, requiring immediate surgical fixation and decompression. No other complications, including skin breakdown or pressure ulcers related to bracing, were reported. CONCLUSIONS Treatment of extension-type DISH fractures may be a reasonable option for patients who are not candidates for safe surgical intervention; however, a risk of neurological injury secondary to delayed instability remains, particularly if patients are noncompliant with the bracing regimen. This risk should be balanced against the high complication rate and potential mortality associated with surgical intervention in this patient population.

The reinstatement of pavement markings after resurfacing will typically entail like-for-like re-marking of the resealed road sections. However, there are cases where sections in between planned reseal (infills) may be left untouched or are not required in the renewal contract irrespective of the service life and condition of the infill markings. This gives room for poor marking continuity and reduction of the markings service level. As the asset management of long-life high-performance markings includes a duty of care around cost-effectively realising value from planned maintenance, there is a need to consider infills when reinstating long-life markings on resurfaced road sections. This paper presents a method for determining infill sites for cost-effective renewal to forestall returning to the same road in the future, thereby managing customer delay and realising cost savings without compromising road safety. The method considers tactical assessment merits and life-cycle costs to demonstrate its suitability to solving the problem. Various marking reinstatement cases were investigated where the results showed method applicability and highlighted sensitivities to re-mark length and installation time. The method supports the asset owner/manager to plan pavement markings renewals at the tactical/section level and could benefit from further studies that consider more complex scenarios, extended variables and uncertainties.

Dual-energy x-ray absorptiometry (DXA) is considered to have high accuracy in estimating fat mass; however, DXA is not always available. We hypothesized that the equations most commonly used for predicting body fat percentage (BF%) using skinfold thickness agree with direct measures of BF% obtained by DXA scan in African American (AA) and Caucasian American (CA) women. Data from 42 women from Alabama who were 21 to 45 years of age, who self-identify as AA (n = 20) or CA (n = 22) were included. BF% was estimated using DXA scan and through 6 different skinfold thickness equations. Agreement between DXA-BF% and BF% based on the skinfold thickness equations was assessed following the Bland-Altman method (bias and agreement limits). Agreement analysis showed in both AA and CA women that the BF%-Siri equation reflects better agreement and lower mean differences (bias) with BF%-DXA than the BF%-Brozek equation after applying 4 body density (BD) equations. Limits showed that BF%-Siri and BF%-Brozek predictive equations overestimate BF% compared with DXA-BF% in both AA and CA women. In AAs, equations that overestimated less were Wilmore and Behnke-Siri (by 1.81%) and Durnin and Womersley-Siri (by 2.5%) equations. Regarding CAs, equations that overestimated less were Durnin and Womersley-Siri (by 2.74%) and Wilmore and Behnke-Siri (by 3.11%) equations. The results of this study show that the BF%-Siri equation is a more accurate alternative than the BF%-Brozek equation for the calculation of BF%. In the calculation of BD, the Wilmore and Behnke equation in AA women and Durnin and Womersley in CA women were those that overestimated BF% to a lesser degree.

Sport for Development and Peace (SDP) has transformed from what some termed a “social movement” to an institutionalized sector with numerous organizations and practitioners involved, resulting in trends that point toward SDP becoming a recognized category of work through professional training. The purpose of this paper is to utilize theories of professions and institutional isomorphism to advance the significance and importance of thinking about SDP as a profession. Three emerging trends that point to the professionalization of SDP are reviewed: (a) increasing opportunities to attain SDP certifications and training, (b) the growing number of SDP-specific academic degrees, and (c) the creation of a SDP knowledge base, particularly in relation to monitoring and evaluation. To conclude, theoretical and practical implications of the professionalization of SDP are discussed and a research agenda is outlined for future research on the continued institutionalization, and professionalization, of the SDP sector.

Background The aim of the study was to analyze the association between the liver uptake of Gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA) in the hepatobiliary phase (HBP) in cirrhotic patients and the presence of clinically significant portal hypertension (CSPH), and how these features impact on hepatocellular carcinoma (HCC) detection in the HBP. Patients and methods Post-hoc analysis of a prospective cohort of 62 cirrhotic patients with newly US-detected nodule between 1–2 cm (study group). Twenty healthy subjects were used as control group. Qualitative and quantitative analysis of the liver contrast uptake in the HBP assessed by Relative Liver-Enhancement (RLE), Liver-Spleen (LSCR), Liver-Muscle (LMCR), and Liver-Kidney Contrast-Ratio (LKCR), Contrast Enhancement Index (CEI), and Hepatic Uptake (HUI), and biliary excretion, were registered. CSPH was confirmed invasively (HVPG > 10 mmHg) or by indirect parameters. The appearance of HCC at the HBP was analyzed. Results Nineteen patients (30.6%) did not have CSPH. In 41 patients (66.1%) the final diagnosis was HCC. All indices were significantly higher in the control group, indicating a more intense HBP liver signal intensity compared to patients with cirrhosis, even if the comparison was restricted to patients with no CSPH. CSPH was associated to a lower rate of HCC hypointensity in the HBP (51.9% vs. 85.7% without CSPH, p = 0.004). Conclusions Liver uptake of Gd-EOB-DTPA at the HBP is decreased in cirrhosis even if the liver function is minimally impaired and it falls down significantly in patients with CSPH compromising the recognition of hypointense lesions. This fact may represent a limitation for the detection of small HCC in patients with cirrhosis and CSPH.

Nucleotide metabolism supports RNA synthesis and DNA replication to enable cell growth and division. Nucleotide depletion can inhibit cell growth and proliferation, but how cells sense and respond to changes in the relative levels of individual nucleotides is unclear. Moreover, the nucleotide requirement for biomass production changes over the course of the cell cycle, and how cells coordinate differential nucleotide demands with cell cycle progression is not well understood. Here we find that excess levels of individual nucleotides can inhibit proliferation by disrupting the relative levels of nucleotide bases needed for DNA replication and impeding DNA replication. The resulting purine and pyrimidine imbalances are not sensed by canonical growth regulatory pathways like mTORC1, Akt and AMPK signalling cascades, causing excessive cell growth despite inhibited proliferation. Instead, cells rely on replication stress signalling to survive during, and recover from, nucleotide imbalance during S phase. We find that ATR-dependent replication stress signalling is activated during unperturbed S phases and promotes nucleotide availability to support DNA replication. Together, these data reveal that imbalanced nucleotide levels are not detected until S phase, rendering cells reliant on replication stress signalling to cope with this metabolic problem and disrupting the coordination of cell growth and division.

The purpose of this study was to adapt and pilot-test an employment support, primary HIV intervention tailored to the needs of adolescent men who have sex with men and adolescent transgender women of color.The intervention was implemented in 2 settings: controlled environment (Phase 1) and real-world community-based (Phase 2) setting in Chicago, IL.Eighty-seven adolescent men who have sex with men and adolescent transgender women of color ages 16-24 participated in Work2Prevent , a 4-session employment and HIV prevention intervention, designed to increase job-readiness and reduce HIV risk. Intervention sessions consisted of group activities: educational games, roleplaying/modeling behavior, and self-regulation exercises. Participants were assessed at baseline, postintervention, and 8-month (Phase 1) or 3-month follow-up (Phase 2).Participants evaluated Work2Prevent as feasible and acceptable, rating intervention quality, usefulness, and satisfaction highly. Overall, 59.6% (Phase 1) and 85.0% (Phase 2) participants attended 2 or more sessions. At 8 months, Phase 1 participants reported a mean increase of 11.4 hours worked per week. Phase 2 participants reported a mean increase of 5.2 hours worked per week and an increase in job-seeking self-efficacy. Phase 2 participants also reported a decrease in transactional sex work.Work2Prevent is one of the first structural primary HIV interventions to specifically focus on adolescent employment readiness. Findings suggest Work2Prevent is feasible and acceptable, improved adolescent employment outcomes, and reduced HIV risk associated with transactional sex work. Our study underscores the need for alternative pathways, such as addressing socioeconomic determinants, to prevent adolescent HIV infection.

Critical illness-related cardiac arrest (CIRCA) as a distinct entity is not well described epidemiologically. There is currently a knowledge gap regarding how many occur in the UK or the impact on patient outcome. The CIRCA study is a prospective multi-centre observational cohort study of patients in the United Kingdom experiencing a cardiac arrest while in a Critical Care Unit embedded in the Case Mix Programme and National Cardiac Arrest Audit. The duration of data collection is 12 months, with surviving patients and family members receiving questionnaire follow-up at 90 days, 180 days and 12 months. This paper describes the protocol for the CIRCA study which received favourable ethical opinion from South Central – Berkshire Research Ethics Committee and approval from the Health Research Authority. Study registration is on clinicaltrials.gov (NCT04219384).

Introduction: Currently, there are no non-surgical FDA-approved biological approaches to accelerate fracture repair. Injectable therapies designed to stimulate bone healing represent an exciting alternative to surgically implanted biologics, however, the translation of effective osteoinductive therapies remains challenging due to the need for safe and effective drug delivery. Hydrogel-based microparticle platforms may be a clinically relevant solution to create controlled and localized drug delivery to treat bone fractures. Here, we describe poly (ethylene glycol) dimethacrylate (PEGDMA)-based microparticles, in the shape of microrods, loaded with beta nerve growth factor (β-NGF) for the purpose of promoting fracture repair.Methods: Herein, PEGDMA microrods were fabricated through photolithography. PEGDMA microrods were loaded with β-NGF and in vitro release was examined. Subsequently, bioactivity assays were evaluated in vitro using the TF-1 tyrosine receptor kinase A (Trk-A) expressing cell line. Finally, in vivo studies using our well-established murine tibia fracture model were performed and a single injection of the β-NGF loaded PEGDMA microrods, non-loaded PEGDMA microrods, or soluble β-NGF was administered to assess the extent of fracture healing using Micro-computed tomography (µCT) and histomorphometry.Results:In vitro release studies showed there is significant retention of protein within the polymer matrix over 168 hours through physiochemical interactions. Bioactivity of protein post-loading was confirmed with the TF-1 cell line. In vivo studies using our murine tibia fracture model show that PEGDMA microrods injected at the site of fracture remained adjacent to the callus for over 7 days. Importantly, a single injection of β-NGF loaded PEGDMA microrods resulted in improved fracture healing as indicated by a significant increase in the percent bone in the fracture callus, trabecular connective density, and bone mineral density relative to soluble β-NGF control indicating improved drug retention within the tissue. The concomitant decrease in cartilage fraction supports our prior work showing that β-NGF promotes endochondral conversion of cartilage to bone to accelerate healing.Discussion: We demonstrate a novel and translational method wherein β-NGF can be encapsulated within PEGDMA microrods for local delivery and that β-NGF bioactivity is maintained resulting in improved bone fracture repair.

Objective: A novel MRI radio-frequency coil design, termed an integrated RF/wireless (iRFW) coil design, can simultaneously perform MRI signal reception and far-field wireless data transfer with the same coil conductors between the coil in the scanner bore and an access point (AP) on the scanner room wall. The objective of this work is to optimize the design inside the scanner bore to provide a link budget between the coil and the AP for the wireless transmission of MRI data. Approach: Electromagnetic simulations were performed at the Larmor frequency of a 3T scanner and in a WiFi wireless communication band to optimize the radius and position of an iRFW coil located near the head of a human model inside the scanner bore, which were validated by performing both imaging and wireless experiments. Main Results: The simulated iRFW coil with a 40-mm radius positioned near the model forehead provided: a signal-to-noise ratio (SNR) comparable to that of a traditional RF coil with the same radius and position, a power absorbed by the human model within regulatory limits, and a gain pattern in the scanner bore resulting in a link budget of 51.1 dB between the coil and an AP located behind the scanner 3 m from the isocenter, which would be sufficient to wirelessly transfer MRI data acquired with a 16-channel coil array. Significance: The MRI coil array cable assembly connected to the scanner increases patient setup time, can present a burn risk to patients and is an obstacle to the development of lightweight, flexible, or wearable coil arrays that provide an improved coil sensitivity. Significantly, the RF coaxial cables and corresponding receive chain electronics can be removed from within the scanner by integrating the iRFW coil design into an array for the wireless transmission of MRI data outside of the bore.

BACKGROUND Depression and anxiety are common among people living with HIV (PLWH) and contribute to adverse health outcomes. Conducting population-level depression and anxiety screening via the patient portal is a promising intervention and has not been studied in HIV care settings. OBJECTIVE To explore facilitators and barriers to implementing population-level portal-based depression and anxiety screening for PLWH. METHODS Semi-structured hour-long qualitative interviews were conducted with staff at an HIV clinic using the Consolidated Framework of Implementation Research. RESULTS Ten clinicians participated in interviews. Facilitators included (1) respect for patient privacy, (2) interest in evidence-based practices and lessons learned from prior implementation, (3) normalizing mental health screening, and (4) compatibility with clinic culture, workflows, and systems. Barriers included (1) limited availability of mental health services,(2) impersonal approach to sensitive topics, and (3) limited capacity to address mental health during HIV visits. CONCLUSIONS Strategies are needed for facilitating the implementation of population-level portal-based mental health screening for PLWH

Most cells in eukaryotic species—from yeast to humans—possess histone proteins that pack and unpack DNA in response to environmental cues. These essential proteins regulate genes necessary for important cellular processes, including development and stress protection.

Fetal brain development in early gestation can be impacted by transplacental infection, altered metabolites from the maternal microbiome, or maternal immune activation. It is less well understood how maternal microbial subcomponents that cross the placenta, such as bacterial cell wall (BCW), directly interact with fetal neural progenitors and neurons and affect development.

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The tumor suppressor retinoblastoma protein (Rb) plays a pivotal role in the regulation of cell proliferation and sensitivity to apoptosis through binding to E2F transcription factors. Loss of Rb in response to genotoxic stress or inflammatory cytokines can enhance cell death, in part, by eliminating Rb-mediated repression of proapoptotic gene transcription. Here we show that calpain cleavage of Rb facilitates Rb loss by proteasome degradation and that this may occur during tumor necrosis factor α–induced apoptosis. The cytoprotective, Rb-binding protein SerpinB2 (plasminogen activator inhibitor type 2) protects Rb from calpain cleavage, increasing Rb levels and enhancing cell survival. Chromatin immunoprecipitation assays show that the increased Rb levels selectively enhance Rb repression of proapoptotic gene transcription. This cytoprotective role of SerpinB2 is illustrated by reduced susceptibility of SerpinB2-deficient mice to multistage skin carcinogenesis, where Rb-dependent cell proliferation competes with apoptosis during initiation of papilloma development. These data identify SerpinB2 as a cell survival factor that modulates Rb repression of proapoptotic signal transduction and define a new posttranslational mechanism for selective regulation of the intracellular levels of Rb. [Cancer Res 2008;68(14):5648–57]

Supplementary Materials, Figure 1 from SerpinB2 Protection of Retinoblastoma Protein from Calpain Enhances Tumor Cell Survival

Small variations in environmental parameters can substantially alter species composition, but the extent to which different species respond to these changes remains obscure. A synoptic survey of seagrass-associated faunal communities was performed across the Gulf of Mexico using otter trawls coupled with seagrass and water quality assessments. The abundance of eight central seagrass inhabitants, representing a range of functional groups, were quantified to identify factors that best predicted their prevalence across environmental gradients and the consistency of these ecological relationships. Seagrass density and drift algal biomass generally had the strongest influence on animal abundance (40–67%), although relationships with drift algae were species specific and seemingly related to faunal size and mobility. Abundances of free-swimming pinfish, pigfish, and silver perch were negatively related to drift algae biomass (0.7, 0.7, and 1.0% Δ per 1 g·m−2 drift algae, respectively), whereas the abundance of pipefish (Syngnathus spp.) and brown/pink shrimp (Penaeus spp.) tended to be positively related to algal biomass (0.8 and 1.6% Δ per 1 g·m−2 drift algae). Shrimp abundances increased by 3.6% per 1% increase in light attenuation while the abundance of a higher-order visual predator, silver perch, negatively responded to light attenuation (1.1% Δ per 1% Δ vertical light attenuation). Additionally, bivariate plots of organismal abundance and salinity or canopy height indicated a unimodal relationship with peaks in abundance associated with intermediate values for several species. This study explored the extent species and functional groups responded to variation in key elements of the abiotic and biotic environment, providing insight into community development and offering resource managers quantitative targets for aspects of habitat quality.

Mechanisms regulating meiotic progression in mammals are poorly understood. The N6-methyladenosine (m6A) reader and 3′ → 5′ RNA helicase YTHDC2 switches cells from mitotic to meiotic gene expression programs and is essential for meiotic entry, but how this critical cell fate change is accomplished is unknown. Here, we provide insight into its mechanism and implicate YTHDC2 in having a broad role in gene regulation during multiple meiotic stages. Unexpectedly, mutation of the m6A-binding pocket of YTHDC2 had no detectable effect on gametogenesis and mouse fertility, suggesting that YTHDC2 function is m6A-independent. Supporting this conclusion, CLIP data defined YTHDC2-binding sites on mRNA as U-rich and UG-rich motif-containing regions within 3′ UTRs and coding sequences, distinct from the sites that contain m6A during spermatogenesis. Complete loss of YTHDC2 during meiotic entry did not substantially alter translation of its mRNA binding targets in whole-testis ribosome profiling assays but did modestly affect their steady-state levels. Mutation of the ATPase motif in the helicase domain of YTHDC2 did not affect meiotic entry, but it blocked meiotic prophase I progression, causing sterility. Our findings inform a model in which YTHDC2 binds transcripts independent of m6A status and regulates gene expression during multiple stages of meiosis by distinct mechanisms.