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Background: Most studies regarding medial meniscus posterior root tear (MMPRT) report total Knee injury and Osteoarthritis Outcome Score (KOOS) subscale values as important patient-reported outcomes, but there are few symptom-specific characterizations of patients with MMPRT. Purpose/Hypothesis: The purpose of this study was to characterize the prevalence and severity of symptoms and functional limitations among patients with MMPRT based on item-level KOOS responses. It was hypothesized that patients with MMPRT would show similar symptoms to those of other meniscal tear types, with items from the KOOS pain subscale forming a majority of the most severe and prevalent symptoms. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The records of 1466 patients with medial meniscus root tear between January 2017 and December 2021 at a single institution were reviewed. KOOS subscale scores and item-specific responses from initial evaluation were collected for each patient. Each KOOS item was scored on a scale from 1 (none/least severe) to 5 (extreme/most severe). Median and mean item-level responses were calculated and ranked in order of most to least severe. For statistical analysis, item-level prevalence rates were calculated as the proportion of patients reporting at least mild symptoms and ranked from most to least prevalent. Results: Included were 61 patients with MMPRT verified on magnetic resonance imaging (MRI). The most severe items according to item-level KOOS response were as follows: awareness of knee problem (mean, 4.62 [95% CI, 4.47-4.78]), difficulty jumping (mean, 4.06 [95% CI, 3.73-4.39]), difficulty twisting or pivoting (mean, 4.04 [95% CI, 3.76-4.32]), difficulty kneeling (mean, 3.98 [95% CI, 3.65-4.31]), and modification of lifestyle (mean, 3.94 [95% CI, 3.69-4.20]). The most prevalent items were knee stiffness later in the day, pain going up- or downstairs, difficulty ascending stairs, difficulty getting in and out of the car, difficulty twisting or pivoting, awareness of knee problem, and modification of lifestyle, with all patients reporting at least mild symptoms for each. Of the 11 most severe and prevalent symptoms, 8 came from the KOOS-Pain item-specific responses. Conclusion: Pain-related items made up a majority of the most severe and most prevalent symptoms as identified by the item-specific KOOS responses. However, meniscal symptoms commonly seen in other tear types, such as clicking and knee stiffness, were still quite prevalent in patients with MMPRT. [ABSTRACT FROM AUTHOR]

This article investigates the dependence of G10 countries' equity markets on the US market, particularly when the US experiences upturns or downturns in the market. If indeed the dependence is high in the downturn market, then investors will not benefit from international diversification when it is mostly needed. Using daily returns on the stock markets of G11 countries, this study estimates Pearson and rank correlations of G10 markets conditional on the US market falling below and rising above certain levels. The rank correlation is robust to outliers and hence provides stronger evidence than its counterpart. When the US market falls, the dependence between the US market and G10 countries has become notably stronger than that during bull markets, except for Sweden. The observed higher dependence in the bear market is of concern for investors, because it erodes the benefit of international diversification. [ABSTRACT FROM AUTHOR]

This paper presents a modeling approach based on a geographic information system (GIS) to estimate the variability of on-ground nitrogen loading and the corresponding nitrate leaching to ground water. The methodology integrates all point and nonpoint sources of nitrogen, the national land cover database, soil nitrogen transformations, and the uncertainty of key soil and land use-related parameters to predict the nitrate mass leaching to ground water. The analysis considered 21 different land use classes with information derived from nitrogen sources such as fertilizer and dairy manure applications, dairy lagoons, septic systems, and dry and wet depositions. Simulations were performed at a temporal resolution of one month to capture seasonal trends. The model was applied to a large aquifer of 376 square miles in Washington State that serves more than 100,000 residents with drinking water. The results showed that dairy manure is the main source of nitrogen in the area followed by fertilizers. It was also seen that nitrate leaching is controlled by the recharge rate, and there can be a substantial buildup of soil nitrogen over long periods of time. Uncertainty analysis showed that denitrification rate is the most influential parameter on nitrate leaching. The results showed that combining management alternatives is a successful strategy, especially with the use of nitrification inhibitors. Also, change in the land use pattern has a noticeable impact on nitrate leaching. [ABSTRACT FROM AUTHOR]

The American Public Health Association (APHA) has long advocated the development of a system of universal health care for all US residents. APHA has adopted several policies on this topic that stress the financing of the system of universal health care under a single-payer mechanism. However, this approach has never been adopted by US policymakers. The need for universal health coverage in the United States is growing more acute, and failure to provide such coverage threatens the health status of the public. I propose an alternative approach to the single-payer system that is based on incremental extension of existing coverage mechanisms, accompanied by fundamental reform of the health care delivery system. This approach is in keeping with the traditional methods of policy development in the United States, and I urge APHA to assume leadership in advocating it. (Am J Public Health. 2003; 93:99-101) [ABSTRACT FROM AUTHOR]

This article examines the role of public health professionals in the U.S. Despite the fact that public health can take credit for 80 percent of improved longevity and health, the story is simply not known to many people in the country. Investments in public health have decreased from 3 percent of health spending in the country to 0.9 percent. Local health budgets and staff are being reduced and their responsibilities transferred elsewhere. In addition, most public health employees are undervalued and underpaid. Hence, the Association of Schools of Public Health and the American Public Health Association, stated that one important factor affecting public health spending is the absence of discernible, visible, organized professionalism.

Comments on the attempts of lawmakers in the United States to come up with a national comprehensive tobacco control legislation. Negotiation between the tobacco industry and state attorneys on compensation for those afflicted with tobacco-related diseases; Reasons for the failure of proposals to be passed in the U.S. Congress; Response of the public health community on the proposed tobacco control legislation.

Objective: To determine the number of prior concussions associated with increased incidence of persistent postconcussive symptoms (PPCS) in a cohort of acutely concussed pediatric patients. Design: Prospective observational cohort study. Setting: Three university-affiliated concussion clinics. Participants: Two hundred seventy participants (14.9 ± 1.9 years, 62% male, 54% with prior concussion) were assessed within 14 days of concussion and followed to clinical recovery. Participants with a second head injury before clinical recovery were excluded. Measures: and Main Outcome: Concussion history, current injury characteristics, recovery time, and risk for prolonged recovery from current concussion. Results: There was no statistically significant change in PPCS risk for participants with 0, 1 or 2 prior concussions; however, participants with 3 or more prior concussions had a significantly greater risk of PPCS. Twelve participants sustained a subsequent concussion after clinical recovery from their first injury and were treated as a separate cohort. Our secondary analysis found that these participants took longer to recover and had a greater incidence of PPCS during recovery from their latest concussion. Conclusion: Pediatric patients with a history of 3 or more concussions are at greater risk of PPCS than those with fewer than 3 prior concussions. [ABSTRACT FROM AUTHOR]

Foodborne infections with antimicrobial-resistant Campylobacter spp. remain an important public health concern. Publicly available data collected by the National Antimicrobial Resistance Monitoring System for Enteric Bacteria related to antimicrobial resistance (AMR) in Campylobacter spp. isolated from broiler chickens and turkeys at the slaughterhouse level across the United States between 2013 and 2021 were analysed. A total of 1,899 chicken-origin (1,031 Campylobacter coli (C. coli) and 868 Campylobacter jejuni (C. jejuni) ) and 798 turkey-origin (673 C. coli and 123 C. jejuni ) isolates were assessed. Chicken isolates exhibited high resistance to tetracycline (43.65%), moderate resistance to ciprofloxacin (19.5%), and low resistance to clindamycin (4.32%) and azithromycin (3.84%). Turkey isolates exhibited very high resistance to tetracycline (69%) and high resistance to ciprofloxacin (39%). The probability of resistance to all tested antimicrobials, except for tetracycline, significantly decreased during the latter part of the study period. Turkey-origin Campylobacter isolates had higher odds of resistance to all antimicrobials than isolates from chickens. Compared to C. jejuni isolates, C. coli isolates had higher odds of resistance to all antimicrobials, except for ciprofloxacin. The study findings emphasize the need for poultry-type-specific strategies to address differences in AMR among Campylobacter isolates.

To strengthen the quality of HIV care and achieve improved clinical outcomes, payers, providers, and policymakers should encourage the use of patient-centered medical homes (PCMHs), building on the Ryan White CARE Act Program established in the 1990s. The rationale for a PCMH with HIV-specific expertise is rooted in clinical complexity, HIV's social context, and ongoing gaps in HIV care. Existing Ryan White HIV/AIDS Program clinicians are prime candidates to serve HIV PCMHs, and HIV-experienced community-based organizations can play an important role. Increasingly, state Medicaid programs are adopting a PCMH care model to improve access and quality to care. Stakeholders should consider several important areas for future action and research with regard to development of the HIV PCMH.

The aging of the population in the United States along with the high prevalence of chronic diseases among them requires that a system of care be developed that will permit seniors to age gracefully in place even when in ill health. Such a system will encourage healthy lifestyles, provide expert coordination of care, involve friends and family, and make seniors informed and active participants in decisions about their health care. Overcoming the barriers to the establishment of such a system is a challenge for the 21st century.