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Purpose: This study tested a bone-tendon allograft versus human dermis patch for reconstructing chronic rotator cuff repair by use of a canine model. Methods: Mature research dogs (N = 15) were used. Radiopaque wire was placed in the infraspinatus tendon (IST) before its transection. Three weeks later, radiographs showed IST retraction. Each dog then underwent 1 IST treatment: debridement (D), direct repair of IST to bone with a suture bridge and human dermis patch augmentation (GJ), or bone-tendon allograft (BT) reconstruction. Outcome measures included lameness grading, radiographs, and ultrasonographic assessment. Dogs were killed 6 months after surgery and both shoulders assessed biomechanically and histologically. Results: BT dogs were significantly (P = .01) less lame than the other groups. BT dogs had superior bone-tendon, tendon, and tendon-muscle integrity compared with D and GJ dogs. Biomechanical testing showed that the D group had significantly (P = .05) more elongation than the other groups whereas BT had stiffness and elongation characteristics that most closely matched normal controls. Radiographically, D and GJ dogs showed significantly more retraction than BT dogs (P = .003 and P = .045, respectively) Histologically, GJ dogs had lymphoplasmacytic infiltrates, tendon degeneration and hypocellularity, and poor tendon-bone integration. BT dogs showed complete incorporation of allograft bone into host bone, normal bone-tendon junctions, and well-integrated allograft tendon. Conclusions: The bone-tendon allograft technique re-establishes a functional IST bone-tendon-muscle unit and maintains integrity of repair in this model. Clinical Relevance: Clinical trials using this bone-tendon allograft technique are warranted. [ABSTRACT FROM AUTHOR]

Positive behavior support (PBS) plans are required practice for students whose behaviors impede their learning or that of others. Educators of children and youth with autism and other developmental disorders represent a subgroup of special educators who are frequently involved in the development of PBS plans. The goal of this research was to assess the effect of a specific, brief training delivered to improve the substantive, evidence-based quality of PBS plans developed by autism educators in a graduate-level university program. Intra-individual tests of significance revealed that the training significantly improved the quality of PBS plans. The plan components with the highest ratings were predictors of problem behavior and bahavioral definition, whereas the components with the lowest ratings were behavioral goals/objectives and team communication. The implications for delivering brief trainings to improve evidence-based practice, as well as limitations and future directions, are discussed. [ABSTRACT FROM AUTHOR]

More than 70 million adults in the United States are impacted by osteoarthritis (OA). Symptomatic articular cartilage loss that progresses to debilitating OA is being diagnosed more frequently and earlier in life, such that a growing number of active patients are faced with life-altering health care decisions at increasingly younger ages. Joint replacement surgeries, in the form of various artificial arthroplasties, are reliable operations, especially for older (≥65 years), more sedentary patients with end-stage OA, but have major limitations for younger, more active patients. For younger adults and those who wish to remain highly active, artificial arthroplasties are associated with significantly higher levels of pain, complications, morbidity, dysfunction, and likelihood of revision. Unfortunately, non-surgical management strategies and surgical treatment options other than joint replacement are often not indicated and have not proven to be consistently successful for this large and growing population of patients. As such, these patients are often relegated to postpone surgery, take medications including opioids, profoundly alter their lifestyle, and live with pain and disability until artificial arthroplasty is more likely to meet their functional demands without high risk for early revision. As such, our research team set out to develop, test, and validate biologic joint restoration strategies that could provide consistently successful options for young and active patients with joint disorders who were not considered ideal candidates for artificial arthroplasty. In pursuit of this goal, we implemented a targeted bedside-to-bench-to-bedside translational approach to hypothesis-driven studies designed to address this major unmet need in orthopaedics by identifying and overcoming key clinical limitations and obstacles faced by health care teams and patients in realizing optimal outcomes after biologic joint restoration. The objective of this article is to condense more than two decades of rigorous patient-centered research aimed at optimizing osteochondral and meniscus allograft transplantation toward more consistently successful management of complex joint problems in young and active patients., Competing Interests: Authors report the following disclosures: C.B. has no conflicts to report. C.R.C. reports the following:Arthrex, Inc: IP royalties; Paid consultant Paid presenter or speaker; Research support; Collagen Matrix Inc: IP royalties; Paid consultant; Paid presenter or speaker; Research support; Musculoskeletal Transplant Foundation: IP royalties; Paid consultant; Paid presenter or speaker; Research support. C.C. has no conflicts to report. B.D.C. reports the following:AO Trauma North America: Board or committee member; Arthrex, Inc: Other financial or material support; Curvafix: Paid consultant; Paid presenter or speaker; DePuy, A Johnson & Johnson Company: Paid presenter or speaker; Fragility Fracture Network--USA: Board or committee member; Globus Medical: IP royalties; International Geriatric Fracture Society: Board or committee member; Journal of Hip Preservation: Editorial or governing board; Journal of Orthopaedic Trauma: Editorial or governing board; KCI: Paid consultant; Paid presenter or speaker; Orthopaedic Trauma Association: Board or committee member; Osteocentric: Unpaid consultant; RomTech: Stock or stock Options; SLACK Incorporated: Editorial or governing board; Synthes: Paid consultant; Research support; Urgo Medical: Unpaid consultant. S.D.F. reports the following:AO North America: Other Professional Activities; Stryker Corporation: Other Professional Activities. C.H. reports the following:Allosource (license): IP royalties; Journal of Orthopaedic Research: Editorial or governing board; Publishing royalties, financial or material support; Musculoskeletal Transplant Foundation: Research support; Orthopedic Research & Reviews: Editorial or governing board. *J.L.C. reports the following:AANA: Research support; AO Trauma: Research support; Advanced Research Projects Agency for Health: Research support; Arthrex, Inc: IP royalties; Paid consultant; Research support; Boehringer Ingelheim: Paid consultant; Collagen Matrix Inc: Paid consultant; Research support; GE Healthcare: Research support; Journal of Knee Surgery: Editorial or governing board; Midwest Transplant Network: Board or committee member; Musculoskeletal Transplant Foundation/MTF Biologics: Board or committee member; IP royalties; Research support; National Institutes of Health (NIAMS & NICHD): Research support; OREF: Research support; PCORI: Research support; Thieme: Publishing royalties, financial or material support; Trupanion: Paid consultant; U.S. Department of Defense: Research support. K.K. has no conflicts to report. M.J.S. reports the following:American Shoulder and Elbow Surgeons: Board or committee member; Current Orthopedic Practice: Editorial or governing board; DePuy, A Johnson & Johnson Company: IP royalties; Paid consultant; Paid presenter or speaker; Ignite Orthopedics: IP royalties; Stock or stock Options. C.N. reports the following:AAOS: Board or committee member; American Orthopaedic Society for Sports Medicine: Board or committee member; AO Foundation: Other financial or material support; Arthrex, Inc: Paid presenter or speaker; Arthroscopy: Editorial or governing board; Publishing royalties, financial or material support; Arthroscopy Association of North America: Board or committee member; Guidepoint Consulting: Paid consultant; Vericel, Inc.: Paid presenter or speaker. L.R. has no conflicts to report. K.R. reports the following:National Institutes of Health: Other Professional Activities; Advanced Research Projects Agency for Health: Other Professional Activities. K.S. reports the following:AAOS: Board or committee member; AO North America: Board or committee member Arthrex, Inc: Paid presenter or speaker; Research support; CarboFix: Stock or stock Options; Johnson & Johnson: Paid consultant; Paid presenter or speaker; ODi: IP royalties; Orthopaedic Trauma Association: Board or committee member. J.P.S. reports the following:Arthrex, Inc: Paid consultant; Research support, DePuy, A Johnson & Johnson Company: Paid consultant; Journal of Knee Surgery: Editorial or governing board; National Institutes of Health (NIAMS & NICHD): Research support; Orthopedic Designs North America: Paid consultant; Smith & Nephew: Paid consultant; Thieme: Publishing royalties, financial or material support; U.S. Department of Defense: Research support. A.M.S. reports the following:IP royalties from the Musculoskeletal Transplant Foundation. R.S. has no conflicts to report. *Note: Authors James L. Cook and Cristi R. Cook are husband and wife., (Thieme. All rights reserved.)

Based on recent evidence-based advances in meniscus allograft transplantation (MAT), fresh (viable) meniscus allografts have potential for mitigating key risk factors associated with MAT failure, and preclinical and clinical data have verified the safety of fresh meniscus allografts as well as possible efficacy advantages compared with fresh-frozen meniscus allografts. The objective of this study was to prospectively assess clinical outcomes for the initial cohort of patients undergoing MAT using fresh meniscus allografts at our center. Patients who were prospectively enrolled in a dedicated registry were included for analyses when they had undergone primary MAT using a fresh meniscus allograft for treatment of medial and/or lateral meniscus deficiency with at least 1-year follow-up data recorded. Forty-five patients with a mean final follow-up of 47.8 months (range = 12-90 months) were analyzed. The mean patient age was 30.7 years (range = 15-60 years), mean body mass index (BMI) was 29.7 kg/m 2 (range = 19-48 kg/m 2 ), and 14 patients (31%) were females. In total, 28 medial, 13 lateral, and 4 combined medial and lateral MATs with 23 concurrent ligament reconstructions and 2 concurrent osteotomies were included. No local or systemic adverse events or complications related to MAT were reported for any patient in the study. Treatment success rate for all patients combined was 91.1% with three patients requiring MAT revision and one patient requiring arthroplasty. Treatment failures occurred 8 to 34 months after MAT and all involved the medial meniscus. None of the variables assessed were significantly different between treatment success and treatment failure cohorts. Taken together, the data suggest that the use of fresh (viable) meniscus allografts can be considered a safe and effective option for medial and lateral MAT. When transplanted using double bone plug suspensory fixation with meniscotibial ligament reconstruction, fresh MATs were associated with a 91% success rate, absence of local or systemic adverse events or complications, and statistically significant and clinically meaningful improvements in patient-reported measures of pain and function at a mean of 4 years postoperatively., Competing Interests: The authors report the following conflicts:J.L.C. reports the following: AANA: Research support; AO Trauma: Research support; Advanced Research Projects Agency for Health: Research support; Arthrex, Inc: IP royalties; Paid consultant; Research support; Boehringer Ingelheim: Paid consultant; Collagen Matrix Inc: Paid consultant; Research support; GE Healthcare: Research support; Journal of Knee Surgery: Editorial or governing board; Midwest Transplant Network: Board or committee member; Musculoskeletal Transplant Foundation/MTF Biologics: Board or committee member; IP royalties; Research support; National Institutes of Health (NIAMS & NICHD): Research support; OREF: Research support; PCORI: Research support; Thieme: Publishing royalties, financial or material support; Trupanion: Paid consultant; U.S. Department of Defense: Research support.J.P.S. reports the following: Arthrex, Inc: Paid consultant; Research support, DePuy, A Johnson & Johnson Company: Paid consultant; Journal of Knee Surgery: Editorial or governing board; National Institutes of Health (NIAMS & NICHD): Research support; Orthopedic Designs North America: Paid consultant; Smith & Nephew: Paid consultant; Thieme: Publishing royalties, financial or material support; U.S. Department of Defense: Research support.K.R. has no conflicts to report.C.N. reports the following: AAOS: Board or committee member; American Orthopaedic Society for Sports Medicine: Board or committee member; AO Foundation: Other financial or material support; Arthrex, Inc: Paid presenter or speaker; Arthroscopy: Editorial or governing board; Publishing royalties, financial or material support; Arthroscopy Association of North America: Board or committee member; Guidepoint Consulting: Paid consultant; Vericel, Inc.: Paid presenter or speaker.C.C. has no conflicts to report.C.R.C. reports the following: Arthrex, Inc.: research support, consulting fees and royalties; Zimmer; nonconsulting fees from Arthrex, CONMED Linvatec, and Musculoskeletal Transplant Foundation; and royalties from CONMED Linvatec and Musculoskeletal Transplant Foundation.R.M. reports the following: AAOS: Board or committee member; American College of Sports Medicine: Board or committee member; American Orthopaedic Association: Board or committee member; American Orthopaedic Society for Sports Medicine: Board or committee member; Arthroscopy Association of North America: Board or committee member; Cartiheal: Research support.Johnson & Johnson: Paid consultant; Journal of Bone and Joint Surgery – American: Editorial or governing board; Moximed: Research support; Novocart: Research support; Rugby Research Injury Prevention Group: Board or committee member., (Thieme. All rights reserved.)

Fracture-related infections (FRIs) are a challenging complication in orthopaedics. Standard of care management for FRIs typically involves prolonged antibiotic therapies, irrigation and debridement (I&D) of the fracture site, and retention of fracture-fixation implants with or without exchange. Unfortunately, this treatment regimen is associated with treatment failure rates of up to 38 %, such that improved preventive and therapeutic interventions are needed. To test and develop these interventions, clinically relevant preclinical animal models are required. The purpose of this study was to develop and validate a canine model for early onset (<2 weeks) FRI that replicates its clinical, radiographic, bacteriologic, and histologic features. In this model, bilateral proximal fibular 1-cm ostectomies were created to mimic an open fracture, which was then stabilized using a plate and screws pre-incubated in methicillin-resistant Staphylococcus aureus (MRSA). After 7 days, I&D was performed and twice-daily systemic antibiotics were administered until the 17-day endpoint. This model consistently resulted in clinical signs of local infection, compromised wound healing, radiographic evidence for delayed bone healing and implant loosening, and implant-associated biofilm formation. Importantly, MRSA was isolated from deep tissue cultures in all dogs, and histological assessments detected bacteria and bacterial biofilms associated with all fracture-fixation implants at the study endpoint. These clinical, radiographic, bacteriologic, and histologic outcomes in conjunction with the capabilities for standard of care interventions, such as antibiotic treatment and I&D, verify that this preclinical canine model for early onset FRI effectively replicated the pathology associated with this commonly encountered complication of orthopaedic trauma., Competing Interests: Declaration of competing interest • Aaron M. Stoker receives IP royalties from Musculoskeletal Transplant Foundation. • Cristi R. Cook receives IP royalties, is a paid consultant, paid presenter or speaker, and receives research support from Arthrex, Inc; receives IP royalties, is a paid consultant, paid presenter or speaker, and receives research support from Collagen Matrix Inc; receives IP royalties, is a paid consultant, paid presenter or speaker, and receives research support from Musculoskeletal Transplant Foundation. • James P Stannard is a paid consultant and receives research support from Arthrex, Inc; is a paid consultant for DePuy, A Johnson & Johnson Company; is on the editorial or governing board for the Journal of Knee Surgery; receives research support from National Institutes of Health (NIAMS & NICHD); is a paid consultant for Orthopedic Designs North America; is a paid consultant for Smith & Nephew; receives publishing royalties, financial or material support from Thieme; and receives research support from the U.S. Department of Defense. • James L. Cook receives research support from AANA; receives research support from AO Trauma; receives IP royalties, is a paid consultant and receives research support from Arthrex, Inc; is a paid consultant for Bioventus; is a paid consultant for Boehringer Ingelheim; is a paid consultant and receives research support from Collagen Matrix Inc; receives research support from GE Healthcare; is on the editorial or governing board for the Journal of Knee Surgery; is a board or committee member for Midwest Transplant Network; is a board or committee member, receives IP royalties and research support from Musculoskeletal Transplant Foundation; receives research support from the National Institutes of Health (NIAMS & NICHD); receives research support from OREF; receives research support from Orthopaedic Trauma Association; receives research support from PCORI; receives research support from Regenosine; receives research support from SITES Medical; receives publishing royalties, financial or material support from Thieme; is a paid consultant for Trupanion; and receives research support from U.S. Department of Defense. • Bryce W. Rigden, Chantelle C. Bozynski, Keiichi Kuroki, Tamara Gull have no conflicts of interest to disclose., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: Osteochondral allograft transplantation (OCAT) can be a successful joint restoration treatment option for large post-traumatic articular defects but is still associated with significant revision and failure rates. Despite recent advances that have improved OCAT success, insufficient osteochondral allograft (OCA) osseointegration remains a major cause of failure. Deferoxamine (DFO) is an effective angiogenic and osteo-anabolic iron chelator that consistently promotes bone neovascularization and regeneration. This study was designed to investigate local delivery of DFO for augmenting OCA osseointegration using a preclinical canine model for OCAT in the knee and hip as commonly affected joints., Methods: On Institutional Animal Care and Use Committee (IACUC) approval, 12 purpose-bred dogs underwent OCAT of the femoral head or femoral condyles with DFO or DFO-free (controls) microspheres in recipient sites. OCA revascularization, cellular repopulation, and integration were evaluated based on functional, diagnostic imaging, microcomputed tomography, histology, and immunohistochemistry outcome measures., Results: Local delivery of DFO into OCAT recipient sites was associated with maintained or improved joint function, superior radiographic appearance, significantly greater trabecular thickness, higher bone volume, and new bone ingrowth compared with DFO-free controls., Conclusion: OCA osseointegration is dependent on cellular repopulation and neovascularization, resulting in new bone ingrowth through creeping substitution, and insufficient osseointegration with resorption and subsidence of the OCA remains a major cause of failure after transplantation. The results of this study suggest that local delivery of DFO using a controlled microsphere release system may reduce resorption and improve revascularization and cellular repopulation to increase new bone ingrowth, potentially expediting OCA osseointegration after transplantation., Competing Interests: J. L. Cook receives research support from AANA; receives research support from AO Trauma; receives IP royalties, is a paid consultant, and receives research support from Arthrex, Inc, Naples, FL; is a paid consultant for Bioventus; is a paid consultant for Boehringer Ingelheim; is a paid consultant and receives research support from Collagen Matrix Inc; receives research support from GE Healthcare; is on the editorial or governing board for the Journal of Knee Surgery; is a board or committee member for Midwest Transplant Network; is a board or committee member, receives IP royalties and research support for Musculoskeletal Transplant Foundation; receives research support from National Institutes of Health (NIAMS and NICHD); receives research support from OREF; receives research support from Orthopaedic Trauma Association; receives research support from PCORI; receives research support from Regenosine; receives research support from SITES Medical; receives publishing royalties, financial or material support from Thieme; is a paid consultant for Trupanion; and receives research support from US Department of Defense. A. M. Stoker receives IP royalties from Musculoskeletal Transplant Foundation. J. P. Stannard is a board or committee member for American Orthopaedic Association; is a board or committee member for AO Foundation; is a board or committee member for AO North America; is a paid consultant and research support from Arthrex, Inc; is a paid consultant for DePuy, A Johnson & Johnson Company; is on the editorial or governing board for Journal of Knee Surgery; is a board or committee member of Mid-America Orthopaedic Association; receives research support from National Institutes of Health (NIAMS and NICHD); is a paid consultant for Orthopedic Designs North America; is a paid consultant for Smith & Nephew; receives publishing royalties, financial or material support from Thieme; and receives research support from US Department of Defense. C. R. Cook receives IP royalties, is a paid consultant, paid presenter or speaker and receives research support from Arthrex, Inc; receives IP royalties, is a paid consultant, paid presenter or speaker, and receives research support from Collagen Matrix Inc; receives IP royalties, is a paid consultant, paid presenter or speaker and receives research support from Musculoskeletal Transplant Foundation. B. D. Crist is a board or committee member for AO Trauma North America; is a paid consultant for Curvafix; receives IP royalties for Globus Medical; is a board or committee member for International Geriatric Fracture Society; is on the editorial or governing board for the Journal of Hip Preservation; is on the editorial or governing board for the Journal of Orthopaedic Trauma; is a paid consultant, presenter or speaker for KCI; has stock or stock options for the Orthopaedic Implant Company; is a board or committee member for Orthopaedic Trauma Association; is an unpaid consultant for Osteocentric; has stock or stock options from RomTech; is on the editorial or governing board for SLACK Incorporated; is a paid consultant and receives research support from Synthes. The remaining authors report no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Telomeres are a protective cap that prevents chromosome ends from being recognized as double-stranded breaks. In somatic cells, telomeres shorten with each cell division due to the end replication problem, which eventually leads to senescence, a checkpoint proposed to prevent uncontrolled cell growth. Tumor cells avoid telomere shortening by activating one of two telomere maintenance mechanisms (TMMs): telomerase reactivation or alternative lengthening of telomeres (ALT). TMMs are a viable target for cancer treatment as they are not active in normal, differentiated cells. Whereas there is a telomerase inhibitor currently undergoing clinical trials, there are no known ALT inhibitors in development, partially because the complex ALT pathway is still poorly understood. For cancers such as neuroblastoma and osteosarcoma, the ALT-positive status is associated with an aggressive phenotype and few therapeutic options. Thus, methods that characterize the key biological pathways driving ALT will provide important mechanistic insight. We have developed a first-in-class phenotypic high-throughput screen to identify small-molecule inhibitors of ALT. Our screen measures relative C-circle level, an ALT-specific biomarker, to detect changes in ALT activity induced by compound treatment. To investigate epigenetic mechanisms that contribute to ALT, we screened osteosarcoma and neuroblastoma cells against an epigenetic-targeted compound library. Hits included compounds that target chromatin-regulating proteins and DNA damage repair pathways. Overall, the high-throughput C-circle assay will help expand the repertoire of potential ALT-specific therapeutic targets and increase our understanding of ALT biology., Competing Interests: The authors declare no competing financial interest., (© 2024 American Chemical Society.)

Background: Socket-tunnel overlap during meniscal allograft transplantation (MAT) combined with anterior cruciate ligament reconstruction (ACLR) may compromise graft integrity and lead to impaired fixation and treatment failure., Purpose/hypothesis: The purpose of this study was to determine optimal socket-tunnel drilling parameters for medial and lateral MAT with concurrent ACLR using artificial tibias and computed tomography (CT) scans for 3-dimensional (3D) modeling. It was hypothesized that clinically relevant socket tunnels could be created to allow for concurrent medial or lateral MAT and ACLR without significant risk for overlap at varying tunnel guide angles., Study Design: Descriptive laboratory study., Methods: A total of 27 artificial right tibias (3 per subgroup) were allocated to 9 experimental groups based on the inclination of the socket tunnels (55°, 60°, and 65°) created for simulating medial and lateral MAT and ACLR. Five standardized socket tunnels were created for each tibia using arthroscopic guides: one for the ACL tibial insertion and one for each meniscus root insertion. CT scans were performed for all specimens and sequentially processed using computer software to produce 3D models for quantitative assessment of socket-tunnel overlap risk. Statistical analysis was performed with Kruskal-Wallis and Mann-Whitney U tests., Results: No subgroup consistently presented significantly safer distances than other subgroups for all distances measured. Three cases (11%) and 24 cases (~90%) of tunnel overlap occurred between the ACL tunnel and tunnels for medial and lateral MAT, respectively. Most socket-tunnel overlap (25 of 27; 92.6%) occurred between sockets at depths ranging between 6.3 and 10 mm from the articular surface. For ACLR and posterior root of the lateral meniscus setting, the guide set at 65° increased socket-tunnel distances., Conclusion: When combined ACLR and MAT using socket tunnels for graft fixation is performed, the highest risk for tibial socket-tunnel overlap involves the ACLR tibial socket and the lateral meniscus anterior root socket at a depth of 6 to 10 mm from the tibial articular surface., Clinical Relevance: Setting tibial guides at 65° to the tibial articular surface with the tunnel entry point anteromedial and socket aperture location within the designated anatomic "footprint" will minimize the risk for socket-tunnel overlap., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: S.D. has received research support from Arthrex; education payments from Arthrex, Encore Medical, Smith+Nephew, Medical Device Business Services, and Zimmer Biomet; nonconsulting fees from DJO and Synthes; honoraria from Encore Medical; and hospitality payments from Stryker. C.R.C. has received research support from Arthrex and Zimmer; consulting fees from Arthrex and CONMED Linvatec; nonconsulting fees from Arthrex, CONMED Linvatec, and Musculoskeletal Transplant Foundation; and royalties from Arthrex, CONMED Linvatec, and Musculoskeletal Transplant Foundation. C.W.N. has received education payments from Arthrex and Encore Orthopedics, consulting fees from Guidepoint Consulting and Arthrex, nonconsulting fees from Arthrex and Vericel, hospitality payments from Synthes GmbH, and other financial or material support from the AO Foundation. J.P.S. has received research support from Arthrex; education payments from Elite Orthopedics; consulting fees from Arthrex, DePuy Synthes/Medical Device Business Services, Orthopedic Designs North America, and Smith+Nephew; nonconsulting fees from Synthes and Medical Device Business Services; and royalties from Thieme. J.L.C. has received research support from AO Trauma, Arthrex, Collagen Matrix, DePuy Synthes, Musculoskeletal Transplant Foundation, Purina, Regenosine, and Sites Medical; consulting fees from Arthrex and Trupanion; royalties from Arthrex, Musculoskeletal Transplant Foundation, and Thieme; and was a board or committee member for the Musculoskeletal Transplant Foundation. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2024.)

Objective: To compare the bone healing effects of percutaneously delivered bone marrow aspirate concentrate (BMC) versus reamer irrigator aspirator (RIA) suspension in a validated preclinical canine ulnar nonunion model. We hypothesized that BMC would be superior to RIA in inducing bone formation across a nonunion site after percutaneous application. The null hypothesis was that BMC and RIA would be equivalent., Methods: A bilateral ulnar nonunion model (n= 6; 3 matched pairs) was created. Eight weeks after segmental ulnar ostectomy, RIA from the ipsilateral femur and BMC from the proximal humerus were harvested and percutaneously administered into either the left or right ulnar defect. The same volume (3 ml) of RIA suspension and BMC were applied on each side. Eight weeks after treatment, the dogs were euthanized, and the nonunions were evaluated using radiographic, biomechanical, and histologic assessments., Results: All dogs survived for the intended study duration, formed radiographic nonunions 8 weeks after segmental ulnar ostectomy, and underwent the assigned percutaneous treatment. Radiographic and macroscopic assessments of bone healing at the defect sites revealed superior bridging-callous formation in BMC-treated nonunions. Histologic analyses revealed greater amount of bony bridging and callous formation in the BMC group. Biomechanical testing of the treated nonunions did not reveal any significant differences., Conclusion: Bone marrow aspirate concentrate (BMC) had important advantages over Reamer Irrigator Aspirator (RIA) suspension for percutaneous augmentation of bone healing in a validated preclinical canine ulnar nonunion model based on clinically relevant radiographic and histologic measures of bone formation., Competing Interests: Declaration of competing interest Cristi R. Cook receives IP royalties, is a paid consultant, a paid presenter or speaker and receives research support from Arthrex, Inc; receives IP royalties, is a paid consultant, paid presenter or speaker and receives research support from Collagen Matrix Inc; receives IP royalties, is a paid consultant, is a paid presenter or speaker and receives research support from Musculoskeletal Transplant Foundation. Brett D. Crist is a board or committee member fromAO Trauma North America; receives other financial or material support from Arthrex, Inc; is a paid consultant, paid presenter or speaker from Curvafix; is a paid presenter or speaker for DePuy, A Johnson & Johnson Company; is a board or committee member for Fragility Fracture Network—USA; receives IP royalties from Globus Medical; is a board or committee member for International Geriatric Fracture Society; is on the editorial or governing board for the Journal of Hip Preservation; is on the editorial or governing board from Journal of Orthopaedic Trauma; is a paid consultant, paid presenter or speaker for KCI; is a board or committee member for Orthopaedic Trauma Association; is an unpaid consultant for Osteocentric; has stock or stock options for RomTech; is on the editorial or governing board for SLACK Incorporated; is a paid consultant or receives research support for Synthes; and is unpaid consultant for Urgo Medical. James L. Cook receives research support from AANA; receives research support from AO Trauma; receives IP royalties, is a paid consultant and receives research support from Arthrex, Inc; is a paid consultant from Bioventus; is a paid consultant for Boehringer Ingelheim; is a paid consultant and receives research support from Collagen Matrix Inc; receives research support from GE Healthcare; is on the editorial or governing board for the Journal of Knee Surgery; is a board or committee member for Midwest Transplant Network; is a board or committee member, receives IP royalties and research support from Musculoskeletal Transplant Foundation; receives research support from the National Institutes of Health (NIAMS & NICHD); receives research support from OREF; receives research support from Orthopaedic Trauma Association; receives research support from PCORI; receives research support from Regenosine; receives research support from SITES Medical; receives publishing royalties, financial or material support from Thieme; is a paid consultant for Trupanion; receives research support from the U.S. Department of Defense. Kenrick Lam, Chantelle Bozynski, Kei Kuroki and Will Bezold have no conflicts of interest to disclose., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Integrated care involves care provided by a team of professionals, often in non-traditional settings. A common example worldwide is integrated school-based mental health (SBMH), which involves externally employed clinicians providing care at schools. Integrated mental healthcare can improve the accessibility and efficiency of evidence-based practices (EBPs) for vulnerable populations suffering from fragmented traditional care. However, integration can complicate EBP implementation due to overlapping organizational contexts, diminishing the public health impact. Emerging literature suggests that EBP implementation may benefit from the similarities in the implementation context factors between the different organizations in integrated care, which we termed inter-organizational alignment (IOA). This study quantitatively explored whether and how IOA in general and implementation context factors are associated with implementation outcomes in integrated SBMH., Methods: SBMH clinicians from community-based organizations (CBOs; n clinician  = 27) and their proximal student-support school staff (n school  = 99) rated their schools and CBOs (clinician only) regarding general (organizational culture and molar climate) and implementation context factors (Implementation Climate and Leadership), and nine common implementation outcomes (e.g., treatment integrity, service access, acceptability). The levels of IOA were estimated by intra-class correlations (ICCs). We fitted multilevel models to estimate the standalone effects of context factors from CBOs and schools on implementation outcomes. We also estimated the 2-way interaction effects between CBO and school context factors (i.e., between-setting interdependence) on implementation outcomes., Results: The IOA in general context factors exceeded those of implementation context factors. The standalone effects of implementation context factors on most implementation outcomes were larger than those of general context factors. Similarly, implementation context factors between CBOs and schools showed larger 2-way interaction effects on implementation outcomes than general context factors., Conclusions: This study preliminarily supported the importance of IOA in context factors for integrated SBMH. The findings shed light on how IOA in implementation and general context factors may be differentially associated with implementation outcomes across a broad array of integrated mental healthcare settings., (© 2024. The Author(s).)

Existing literature has established the effectiveness of school-wide positive behavioral interventions and supports (SWPBIS) for improving school-level student behavioral and academic outcomes. Implementation of SWPBIS in uncontrolled settings is often suboptimal, leading to lackluster outcomes. Researchers have developed and validated several implementation strategies to improve individual-level implementation determinants (e.g., educators' supportive beliefs) to promote the successful delivery of universal programs (e.g., SWPBIS). However, empirical studies are needed to explore the mechanisms of change through which school-level educators' beliefs influence their delivery of SWPBIS. This school-level quasi-experimental study tested a mediational mechanism of change where changes in educators' beliefs work through their intervention fidelity of SWPBIS to influence student outcomes. We delivered the Supportive Belief Intervention (a school-wide implementation strategy used before training to promote educators' supportive beliefs about SWPBIS) and then Tier 1 SWPBIS training to 81 elementary schools serving diverse student populations. At the start of the academic year, school-level educators' beliefs were assessed before the Supportive Belief Intervention. At the end of the academic year, educators' beliefs, intervention fidelity, and rates of student reading proficiency and suspension were assessed. Conditional process analyses with nonparametric bootstrapping (mediational and first stage moderated mediational models) revealed that, at the school level, a larger increase in educators' supportive beliefs was associated with enhanced SWPBIS fidelity and better corollary student outcomes (increased reading proficiency and reduced suspension), while student socioeconomic status moderated the size of the mediation effect. Implications for research and practices about the implementation of SWPBIS and school context were discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Few "intervention agnostic" strategies have been developed that can be applied to the broad array of evidence-based practices (EBPs) in schools. This paper describes two studies that reflect the initial iterative redesign phases of an effective leadership-focused implementation strategy-Leadership and Organizational Change for Implementation (LOCI)-to ensure its acceptability, feasibility, contextual appropriateness, and usability when used in elementary schools. Our redesigned strategy-Helping Educational Leaders Mobilize Evidence (HELM)-is designed to improve principals' use of strategic implementation leadership to support the adoption and high-fidelity delivery of a universal EBP to improve student outcomes., Method: In Study 1, focus groups were conducted ( n  = 6) with 54 district administrators, principals, and teachers. Stakeholders provided input on the appropriateness of original LOCI components to maximize relevance and utility in schools. Transcripts were coded using conventional content analysis. Key themes referencing low appropriateness were summarized to inform LOCI adaptations. We then held a National Expert Summit (Study 2) with 15 research and practice experts. Participants provided feedback via a nominal group process (NGP; n  = 6 groups) and hackathon ( n  = 4 groups). The research team rated each NGP suggestion for how actionable, impactful/effective, and feasible it was. We also coded hackathon notes for novel ideas or alignment with LOCI components., Results: Study 1 suggestions included modifications to LOCI content and delivery. Study 2's NGP results revealed most recommendations to be actionable, impactful/effective, and feasible. Hackathon results surfaced two novel ideas (distributed leadership teams and leaders' knowledge to support educators EBP use) and several areas of alignment with LOCI components., Conclusion: Use of these iterative methods informed the redesign of LOCI and the development of HELM. Because it was collaboratively constructed, HELM has the potential to be an effective implementation strategy to support the use of universal EBP in schools., Competing Interests: Dr. Lyon is an Associate Editor for Implementation Research and Practice. As such, he had no part in the peer review process. All other authors declare that there is no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Purpose: To assess the risk of socket-tunnel overlap for posterior medial or lateral meniscal root repair combined with anterior cruciate ligament reconstruction (ACLR) using artificial tibias and computed tomography scans for 3-dimensional modeling., Methods: Artificial tibias (n = 27; n = 3/subgroup) were allocated to groups based on inclination of socket-tunnels (55°, 60°, 65°) created for posterior root of the medial meniscus (MMPR) and lateral meniscus posterior root (LMPR) repair, and ACLR. Three standardized socket-tunnels were created: one for the ACL and one for each posterior meniscal root insertion. Computed tomography scans were performed and sequentially processed using computer software to produce 3-dimensional models for assessment of socket-tunnel overlap. Statistical analysis was performed with Kruskal-Wallis and Mann-Whitney U tests. Significance was set at P < .05., Results: The present study found no significant risk of tunnel overlap when drilling for combined ACLR and MMPR repair, whereas 7 cases of tunnel overlap occurred between ACL tunnels and LMPR (25.9% of cases). No subgroup or specific pattern of angulation consistently presented significantly safer distances than other subgroups for all distances measured., Conclusions: This study demonstrated 25.9% rate of overlap for combined LMPR repair and ACLR, compared with 0% for MMPR repair with ACLR. Lower ACL drilling angle (55 or 60°) combined with greater lateral meniscus drilling angle (65°) produced no socket-tunnel overlap., Clinical Relevance: Socket-tunnel overlap during meniscal root repair combined with ACLR may compromise graft integrity and lead to impaired fixation and treatment failure of either the ACL, the meniscus, or both. Despite this, risk for socket-tunnel overlap has not been well characterized., Competing Interests: The authors report the following potential conflicts of interest or sources of funding: S.D. reports grants from Arthrex and board member/owner/officer/committee appointments from American Orthopaedic Society for Sports Medicine, Arthroscopy, and AANA. C.R.C. reports grants and royalties or licenses from, and payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events from Arthrex, Collagen Matrix, and the Musculoskeletal Transplant Foundation. C.W.N. reports royalties or licenses from Arthroscopy, consulting fees from Guidepoint Counseling, and payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events from Arthrex and Vericel, leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid: American Academy of Orthopaedic Surgeons, AANA, American Orthopaedic Society for Sports Medicine, and Arthroscopy; and other financial or nonfinancial interests from the AO Foundation. J.P.S. reports grants or contracts from Arthrex, 10.13039/100000002National Institutes of Health (National Institute of Arthritis and Musculoskeletal and Skin Diseases and Eunice Kennedy Shriver 10.13039/100000071National Institute of Child Health and Human Development), and 10.13039/100000005U.S. Department of Defense; royalties or licenses from Thieme; consulting fees from 10.13039/100007307Arthrex, DePuy, A Johnson & Johnson Company, Orthopedic Designs North America, and Smith & Nephew; and leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid: 10.13039/100005382American Orthopaedic Association, Journal of Knee Surgery, AO Foundation, Mid-America Orthopaedic Association, and AO North America. J.L.C. reports grants from AO Trauma, DePuy, A 10.13039/100004331Johnson & Johnson Company, Arthrex, the Musculoskeletal Transplant Foundation, Collagen Matrix, National Institutes of Health (National Institute of Arthritis and Musculoskeletal and Skin Diseases and Eunice Kennedy Shriver National Institute of Child Health and Human Development), Orthopaedic Trauma Association, SITES Medical, Purina, U.S. Department of Defense, and Regenosine; royalties or licenses from Arthrex, the Musculoskeletal Transplant Foundation, and Thieme; and consulting fees from Arthrex and Trupanion; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid: Midwest Transplant Network and Musculoskeletal Transplant Foundation. All other authors (J.B.d.A., W.B.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (© 2024 The Authors.)

The inhibition of ataxia-telangiectasia mutated (ATM) has been shown to chemo- and radio-sensitize human glioma cells in vitro and therefore might provide an exciting new paradigm in the treatment of glioblastoma multiforme (GBM). The effective treatment of GBM will likely require a compound with the potential to efficiently cross the blood-brain barrier (BBB). Starting from clinical candidate AZD0156, 4 , we investigated the imidazoquinolin-2-one scaffold with the goal of improving likely CNS exposure in humans. Strategies aimed at reducing hydrogen bonding, basicity, and flexibility of the molecule were explored alongside modulating lipophilicity. These studies identified compound 24 (AZD1390) as an exceptionally potent and selective inhibitor of ATM with a good preclinical pharmacokinetic profile. 24 showed an absence of human transporter efflux in MDCKII-MDR1-BCRP studies (efflux ratio <2), significant BBB penetrance in nonhuman primate PET studies ( K p,uu 0.33) and was deemed suitable for development as a clinical candidate to explore the radiosensitizing effects of ATM in intracranial malignancies.

Background: For approximately one in five children who have social, emotional, and behavioral (SEB) challenges, accessible evidence-based prevention practices (EBPPs) are critical. In the USA, schools are the primary setting for children's SEB service delivery. Still, EBPPs are rarely adopted and implemented by front-line educators (e.g., teachers) with sufficient fidelity to see effects. Given that individual behavior change is ultimately required for successful implementation, focusing on individual-level processes holds promise as a parsimonious approach to enhance impact. Beliefs and Attitudes for Successful Implementation in Schools for Teachers (BASIS-T) is a pragmatic, multifaceted pre-implementation strategy targeting volitional and motivational mechanisms of educators' behavior change to enhance implementation and student SEB outcomes. This study protocol describes a hybrid type 3 effectiveness-implementation trial designed to evaluate the main effects, mediators, and moderators of the BASIS-T implementation strategy as applied to Positive Greetings at the Door, a universal school-based EBPP previously demonstrated to reduce student disruptive behavior and increase academic engagement., Methods: This project uses a blocked randomized cohort design with an active comparison control (ACC) condition. We will recruit and include approximately 276 teachers from 46 schools randomly assigned to BASIS-T or ACC conditions. Aim 1 will evaluate the main effects of BASIS-T on proximal implementation mechanisms (attitudes, subjective norms, self-efficacy, intentions to implement, and maintenance self-efficacy), implementation outcomes (adoption, reach, fidelity, and sustainment), and child outcomes (SEB, attendance, discipline, achievement). Aim 2 will examine how, for whom, under what conditions, and how efficiently BASIS-T works, specifically by testing whether the effects of BASIS-T on child outcomes are (a) mediated via its putative mechanisms of behavior change, (b) moderated by teacher factors or school contextual factors, and (c) cost-effective., Discussion: This study will provide a rigorous test of BASIS-T-a pragmatic, theory-driven, and generalizable implementation strategy designed to target theoretically-derived motivational mechanisms-to increase the yield of standard EBPP training and support strategies., Trial Registration: ClinicalTrials.gov ID: NCT05989568. Registered on May 30, 2023., (© 2023. The Author(s).)

Previous studies have evaluated method performance for quantifying and characterizing microplastics in clean water, but little is known about the efficacy of procedures used to extract microplastics from complex matrices. Here we provided 15 laboratories with samples representing four matrices (i.e., drinking water, fish tissue, sediment, and surface water) each spiked with a known number of microplastic particles spanning a variety of polymers, morphologies, colors, and sizes. Percent recovery (i.e., accuracy) in complex matrices was particle size dependent, with ∼60-70% recovery for particles >212 μm, but as little as 2% recovery for particles <20 μm. Extraction from sediment was most problematic, with recoveries reduced by at least one-third relative to drinking water. Though accuracy was low, the extraction procedures had no observed effect on precision or chemical identification using spectroscopy. Extraction procedures greatly increased sample processing times for all matrices with the extraction of sediment, tissue, and surface water taking approximately 16, 9, and 4 times longer than drinking water, respectively. Overall, our findings indicate that increasing accuracy and reducing sample processing times present the greatest opportunities for method improvement rather than particle identification and characterization., Competing Interests: Declaration of competing interest Leah M. Thornton Hampton, Hannah De Frond, Kristine Gesulga, Syd Kotar, Wenjian Lao, Cindy Matuch, Stephen B. Weisberg, Charles S. Wong, Susanne Brander, Silke Christansen, Cayla R. Cook, Fangni Du, Sutapa Ghosal, Andrew B. Gray, Jeanne Hankett, Paul A. Helm, Kay T. Ho, Timnit Kefela, Gwendolyn Lattin, Amy Lusher, Lei Mai, Rachel E. McNeish, Odette Mina, Elizabeth C. Minor, Sebastian Primpke, Keith Rickabaugh, Violet C. Renick, Samiksha Singh, Bert van Bavel, Florian Vollnhals, and Chelsea M. Rochman declare having no known competing financial interests or professional relationships that could have appeared to influence the work reported in this manuscript., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Introduction: Treatment monitoring after meniscus allograft transplantation (MAT) is challenging. Ultrasonographic (US) imaging has been proposed as a modality that may allow for treatment monitoring after MAT, but has yet to be clinically validated for this purpose. The objective of this study was to assess the capabilities for serial US imaging during the first year after surgery to predict short-term MAT failure., Methods: Patients who had undergone Meniscus-only or Meniscus-Tibia MAT for treatment of medial or lateral meniscus deficiency were prospectively evaluated by US imaging at various time points after transplantation. Each meniscus was evaluated for abnormalities in echogenicity, shape, associated effusion, extrusion and extrusion with weightbearing (WB)., Results: Data from 31 patients with a mean follow-up of 32 ± 16 (range, 12-55) months were analysed. MAT failure occurred in 6 patients (19.4%) at a median time point of 20 (range, 14-28) months with 4 (12.9%) converted to total knee arthroplasty. US imaging was effective for assessing MAT extrusion and imaging with WB demonstrated dynamic changes in MAT extrusion. US characteristics that were significantly associated with higher likelihood for MAT failure included abnormal echogenicity, localised effusion, extrusion with WB at 6 months, and localised effusion and extrusion with WB at 1 year., Conclusions: US assessments of meniscus allografts at 6 months after transplantation can effectively determine risk for short-term failure. Abnormal meniscus echogenicity, persistent localised effusion and extrusion with weightbearing were associated with 8-15 times higher odds for failure, which occurred at a median of 20 months post-transplantation., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: James L. Cook has Research support from AO Trauma; receives IP royalties; Paid consultant; Research support from Arthrex, Inc.; receives research support from Collagen Matrix Inc.; receives research support from DePuy, A Johnson & Johnson Company; is on the editorial or governing board for Journal of Knee Surgery; is a board or committee member for Midwest Transplant Network; is a board or committee member; IP royalties; Research support for Musculoskeletal Transplant Foundation; receives research support from National Institutes of Health (NIAMS & NICHD); receives research support from Orthopaedic Trauma Association; receives research support from Purina; receives research support from Regenosine; receives research support from SITES Medical; receives publishing royalties, financial or material support from Thieme; is a paid consultant for Trupanion; and receives research support from US Department of Defense. Cristi Cook receives IP royalties; Paid consultant; Paid presenter or speaker; Research support from Arthrex, Inc.; receives IP royalties; Paid consultant; Paid presenter or speaker for CONMED Linvatec; receives IP royalties; Paid presenter or speaker from Musculoskeletal Transplant Foundation; and receives research support from Zimmer. James P. Stannard is a Board or committee member for American Orthopaedic Association, AO Foundation and AO North America; receives research support and is a paid consultant from Arthrex, Inc.; is a paid consultant for DePuy, A Johnson & Johnson Company; is on the editorial or governing board for Journal of Knee Surgery; is a board or committee member for Mid-America Orthopaedic Association; receives research support from National Institutes of Health (NIAMS & NICHD); is a paid consultant for Orthopedic Designs North America; is a paid consultant for Smith & Nephew; received publishing royalties, financial or material support from Thieme; and receives research support from US Department of Defense. Kylee Rucinski has no conflicts of interest to disclose., (© The Author(s) 2022.)

As the most common setting where youth access behavioral healthcare, the education sector frequently employs training and follow-up consultation as cornerstone implementation strategies to promote the implementation of evidence-based practices (EBPs). However, these strategies alone are not sufficient to promote desirable implementation (e.g., intervention fidelity) and youth behavioral outcomes (e.g., mitigated externalizing behaviors). Theory-informed pragmatic pre-implementation enhancement strategies (PIES) are needed to prevent the lackluster outcomes of training and consultation. Specifically, social cognitive theory explicates principles that inform the design of PIES content and specify mechanisms of behavior change (e.g., "intentions to implement" (ITI)) to target increasing providers' responsiveness to training and consultation. This triple-blind parallel randomized controlled trial preliminarily examined the efficacy of a pragmatic PIES based on social cognitive theories (SC-PIES) to improve implementation and youth behavioral outcomes from universal preventive EBPs in the education sector. Teachers from a diverse urban district were recruited and randomly assigned to the treatment (SC-PIES; n treatment  = 22) or active control condition (administrative meeting; n control  = 21). Based on the condition assigned, teachers received the SC-PIES or met with administrators before their EBP training. We assessed teachers' ITI, intervention fidelity, and youth behavioral outcome (academic engagement as an incompatible behavior to externalizing disorders) at baseline, immediately after training, and 6 weeks afterward. A series of ANCOVAs detected sizeable effects of SC-PIES, where teachers who received SC-PIES demonstrated significantly larger improvement in their ITI, intervention fidelity, and youth behaviors as compared to the control. Conditional analyses indicated that teachers' ITI partially mediated the effect of SC-PIES on intervention fidelity, which in turn led to improved youth behaviors. Findings suggest that theory-informed pragmatic PIES targeting providers' ITI can boost their responsiveness to implementation strategies, as reflected in improved implementation behaviors and youth behavioral outcomes. The results have implications for targeting motivational mechanisms of behavior change and situating preventive implementation strategies at the intersection between the preparation and active implementation stages of an implementation process. Limitations and implications for research and practice are discussed. Clinicaltrials.gov: NCT05240222. Registered on: 2/14/2022. Retrospectively registered.  https://clinicaltrials.gov/show/NCT05240222., (© 2022. Society for Prevention Research.)

Background: The Evidence-Based Practice Attitudes Scale (EBPAS) is widely used in implementation research, but it has not been adapted and validated for use among general education teachers, who are most likely to deliver evidence-based prevention programs in schools, the most common setting where youth access social, emotional, and behavioral health services., Method: School-based stakeholders and a research team comprised of experts in the implementation of evidence-based practices in schools adapted the EBPAS for teachers (the S-EBPAS). The adapted instrument was administered to a representative sample ( n  = 441) of general education teachers (grades K-5) to assess the reliability and internal consistency via factor analyses. The S-EBPAS included two forms (i.e., EBP-agnostic and EBP-specific item referents), therefore, a multiple-group confirmatory factor analysis (CFA) was also performed to establish measurement invariance between the two forms., Results: After adaptation and refinement, a 9-item, 3-factor structure was confirmed, with the final model supporting three first-order factors that load onto a second-order factor capturing attitudes toward adopting evidence-based practices. Multiple-group CFA analyses of measurement invariance indicated there were no significant differences between the two forms., Conclusions: Overall, this study provides a brief, flexible instrument capturing attitudes toward adopting EBPs that has high reliability and internal consistency, which support its use among general education teachers in school settings implementing evidence-based practices., Plain Language Summary: The Evidence-Based Practice Attitudes Scale (EBPAS) is a popular instrument for measuring attitudes toward evidence-based practices (EBPs). This instrument provides valuable information during implementation initiatives, such as whether providers or front-line implementers have favorable attitudes toward a given practice. The EBPAS has been used in many different settings, such as in community-based mental health clinics, medical hospitals, and in child welfare. However, it's use in schools has been limited, and it has not yet been tested with general education teachers, who are key implementers of evidence-based practices in schools. In order to trust that the scores from an instrument are accurate, it needs to be evaluated when scaling it out to new populations and settings. One popular method to determine this is to use factor analysis, which was employed in this study. This study fills the identified gap by assessing the reliability (i.e., accuracy) and internal consistency of the EBPAS among a representative sample of general education teachers. Findings from this study indicate that the school-adapted EBPAS (S-EBPAS) is a brief, nine-item instrument that provides a reliable estimate of teachers' attitudes toward evidence-based practices. Our results also provide evidence that the S-EBPAS can be used to capture attitudes toward specific EBPs as well as attitudes toward EBP -agnostic. This study provides a flexible instrument that can be used by school-based implementation researchers, practitioners, and intermediaries at multiple phases of implementation projects, such as when exploring a new EBP to adopt., Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Lyon is an associate editor at Implementation Research and Practice, but he had no role in the review or editorial decision making of this paper., (© The Author(s) 2023.)

Due to increased reliance on glycolysis, which produces lactate, monocarboxylate transporters (MCTs) are often upregulated in cancer. MCT4 is associated with the export of lactic acid from cancer cells under hypoxia, so inhibition of MCT4 may lead to cytotoxic levels of intracellular lactate. In addition, tumor-derived lactate is known to be immunosuppressive, so MCT4 inhibition may be of interest for immuno-oncology. At the outset, no potent and selective MCT4 inhibitors had been reported, but a screen identified a triazolopyrimidine hit, with no close structural analogues. Minor modifications to the triazolopyrimidine were made, alongside design of a constrained linker and broad SAR exploration of the biaryl tail to improve potency, physical properties, PK, and hERG. The resulting clinical candidate 15 (AZD0095) has excellent potency (1.3 nM), MCT1 selectivity (>1000×), secondary pharmacology, clean mechanism of action, suitable properties for oral administration in the clinic, and good preclinical efficacy in combination with cediranib.

Although evidence-based practices can enhance educational outcomes, a persistent gap exists between research and practice. Advancing the understanding and use of implementation science among educational researchers has potential to close this gap. This study uses person-centered approaches to identify profiles of educational researchers (N = 140) according to interest, knowledge, and use of four implementation science constructs (determinants, strategies, outcomes, theories). We examined whether profile membership was predicted by researcher career level/type and project topic and type. Participants were moderately to very interested to learn more about implementation constructs, but were only a little to somewhat likely to be knowledgeable about them or incorporate them into their research. Three profiles were identified: High Knowledge/High Use/High Interest, Low Knowledge/Low Use/High Interest, and Low Knowledge/Low Use/Low Interest. Profile membership was not predicted by project type, topic area, or career level. Implications for enhancing implementation science training for educational researchers are discussed., Competing Interests: Conflicts of interest: None

Group-based didactic training is a cornerstone implementation strategy used to support the adoption and delivery of evidence-based prevention programs (EBPP) by teachers in schools, but it is often insufficient to drive successful implementation. Beliefs and Attitudes for Successful Implementation in Schools for Teachers (BASIS-T) is a theory-based, motivational implementation strategy designed to increase the yield of EBPP training and consultation. The purpose of this study was to examine the longitudinal effects of BASIS-T on hypothesized mechanisms of behavior change (e.g., attitudes toward EBPP, self-efficacy, intentions to implement) and implementation and student outcomes associated with a well-established universal prevention program-the good behavior game (GBG). This pilot trial included 82 elementary school teachers from nine public elementary schools who were randomly assigned at the school-level to the BASIS-T ( n  = 43) or active comparison ( n  = 39) condition, with both conditions receiving training and consultation of the good behavior game by a third-party purveyor. Analyses included mixed-effects and multilevel growth modeling of adoption, mechanisms of behavior change, and student behavior outcomes. Meaningful effects were found favoring BASIS-T on immediate adoption of the GBG within the first month of school (74% vs. 40%) and self-efficacy ( p  < 0.05). These findings advance our understanding of the type of implementation strategies that complement pre-implementation training and post-training consultation in schools by identifying the importance of task self-efficacy as a mechanism of behavior change related to adoption for prevention programming., Supplementary Information: The online version contains supplementary material available at 10.1007/s12310-022-09536-z., Competing Interests: Conflict of interestThe authors have no conflicts of interest to declare. Institutional Review Board approval was obtained by the university human subjects committee and the school district research department, and all procedures complied with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Prior informed consent was obtained for all participants involved., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022, Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Objectives: We conducted a mixed-method focus group study to (a) assess the appropriateness and likely effectiveness of strategies that target individual behavior change mechanisms associated with perceived barriers of lack of time and unsupportive leadership and (b) identify recommendations regarding strategies for overcoming the barriers., Method: Sample included 39 school-based staff (80% female, 77% White) across two districts in the Midwest. Mixed methods included a simultaneous approach., Results: Lack of time and supportive leadership continue to pervade school-based implementation efforts. Recommendations centered around the need for school leaders to give teachers the power to re-prioritize how they spend their time as well as providing protected, facilitated time for teachers to collaborate and learn practical skills targeting self-advocacy., Conclusion: Our findings provide compelling evidence for the use of implementation methodology to strategically target mechanisms of individual behavior change during the process of incorporating new and innovative practices in schools., Competing Interests: The authors declare no conflicts of interest associated with this manuscript.

Background: Implementation climate is an organizational construct theorized to facilitate the adoption and delivery of evidence-based practices. Within schools, teachers often are tasked with implementing universal prevention programs. Therefore, they are ideal informants when assessing school implementation climate for initial and continuous implementation improvement efforts. The purpose of this study was to examine the construct validity (i.e., factor structure and convergent/divergent validity) of a school-adapted measure of strategic implementation climate called the School Implementation Climate Scale (SICS)., Methods: Confirmatory factor analyses of SICS data, collected from 441 teachers in 52 schools, were used to compare uncorrelated and correlated first-order factor models and a second-order hierarchical model. Correlations with other school measures were examined to assess SICS convergent and divergent validities., Results: Results demonstrated acceptable internal consistency for each SICS subscale ( α s > 0.80 for all subscales) and construct validity of the hypothesized factor structure of the SICS with three new scales. The hierarchical second-order factor structure with eight first-order factors was found to best model the SICS data. Correlations with other school measures were in the expected direction and magnitude., Conclusions: Results from this study provide psychometric evidence that supports the use of the SICS to inform the implementation research and practice in schools., Plain Language Summary: Schools are busy trying to implement various universal programs and systems to help support kids in their growth. Beginning and sustaining these efforts is quite challenging, and there is need for tools and ideas to help those implementation efforts. One concept is implementation climate, which is broadly the school staff's perception of the implementation support for a given practice. However, no measure currently exists to help schools assess their implementation climate. The goal of our study was to adapt a measure of implementation climate used in other settings to the school environment. We used feedback from educational experts to make changes and used various analyses to determine if the newly adapted measure was psychometrically sound. Findings suggest the new measure is usable to guide implementation efforts in schools., Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Aaron Lyon is an Associate Editor of Implementation Research and Practice, and thus Dr. Lyon was not involved in any aspect of the peer review process for this manuscript., (© The Author(s) 2022.)

Effective mental health services require accurate assessment of psychosocial impairments linked to mental health concerns. Youth who experience these impairments do so within and across various contexts (e.g., school, home). Youth may display symptoms of mental health concerns without co-occurring impairments, and vice versa. Yet, nearly all impairment measures presume that those assessed display mental health concerns. Consequently, we recently developed youth and parent versions of a five-item measure of youth psychosocial impairments (i.e., Work and Social Adjustment Scale for Youth [WSASY]), structured to assess any youth, regardless of mental health status. Across two studies, we developed and tested a WSASY teacher version, in a large sample of 382 student teacher reports (Study 1), and a subsample of 66 youth who, along with their parents and teachers, completed the WSASY and a series of school- and home-based behavioral tasks (Study 2). In Study 1, WSASY teacher reports demonstrated excellent internal consistency and unique relations with teacher reports on well-established measures of psychosocial strengths and difficulties. In Study 2, teacher, youth, and parent WSASY reports demonstrated low correspondence with each other and context-specific relations with criterion variables. This low correspondence allowed us to capitalize on an integrative approach designed to optimize informant-specific variance. Integrative scores demonstrated robust, large-magnitude relations with criterion variables across multiple information sources. These findings provide important psychometric support for use of WSASY teacher reports, and pave the way toward integrating WSASY reports from multiple informants who observe youth psychosocial impairments within different contexts and from different perspectives. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Background: Strategic implementation leadership is a critical determinant of successful implementation, hypothesized to create a more supportive implementation climate conducive to the adoption and use of evidence-based practices. Implementation leadership behaviors may vary significantly across contexts, necessitating studies that examine the validity of established measurement tools in novel health service delivery sectors. The education sector is the most common site for delivering mental health services to children and adolescents in the USA, but research focused on implementation leadership in schools is in the early phases, and there is a need for adaptation and expansion of instruments in order to tailor to the school context. The current study adapted and validated the School Implementation Leadership Scale (SILS) (based on the Implementation Leadership Scale) in a sample of elementary school personnel from six school districts who were implementing one of two well-established prevention programs for supporting children's mental health., Methods: Participants were 441 public school teachers from 52 elementary schools in the Midwest and West Coast of the USA. Participants completed a survey that contained: (1) an adapted and expanded version of the SILS with additional items generated for four existing subscales as well as three new subscales (communication, vision/mission, and availability), and (2) additional tools to evaluate convergent and divergent validity (i.e., measures of general/molar leadership and teaching attitudes). Data underwent (1) examination of item characteristic curves to reduce items and ensure a pragmatic instrument, (2) confirmatory factor analyses to establish structural validity, and (3) evaluation of convergent and divergent validity., Results: Item reduction analyses resulted in seven subscales of three items each. Results indicated acceptable fit for a seven-factor structural model (CFI = .995, TLI = .99, RMSEA = .07, SRMR = 0.02). Second-order factor loadings were high (λ = .89 to .96), suggesting that the SILS subscales comprise a higher-order implementation leadership factor. All subscales demonstrated good inter-item reliability (α = .91-.96). Convergent and divergent validity results were generally as hypothesized, with moderate to high correlations between SILS subscales and general leadership, moderate correlations with teaching attitudes, and low correlations with school demographics., Conclusions: Overall, results provided strong structural, convergent, and divergent validity evidence for the 21-item, 7-factor SILS instrument. Implications for the measurement of implementation leadership in schools are discussed, as well as strategies to support leaders to enhance their strategic behaviors related to the implementation of mental health prevention programs (e.g., adaptation of existing leadership-focused implementation strategies)., (© 2022. The Author(s).)

A 10-y-old, castrated male Boxer dog that was born and had lived in Missouri without any travel history to other states, except for a few trips to Kansas, was presented with a distended abdomen and declined health. Ultrasonographic examination revealed a large hepatic mass, and the dog was euthanized. A postmortem examination revealed that the left liver lobes were largely replaced by a white-to-tan multilobular mass with a cobblestone surface. The lesion also involved the diaphragm. Histologically, hepatic architecture was effaced by large areas of necrosis with numerous, ≤0.2-cm, cystic structures that stained positively with periodic acid-Schiff stain and contained calcareous corpuscles. Gross and microscopic hepatic lesions were compatible with alveolar echinococcosis (AE) caused by Echinococcus multilocularis . PCR examination confirmed E. multilocularis , and results from genotyping were consistent with the E4 haplotype. To our knowledge, this is only the second canine AE case and the third pet dog that has been confirmed to be infected by E. multilocularis in the contiguous United States. E. multilocularis is a serious health risk for both pet dogs and humans.

Background: Lateral meniscal oblique radial tears (LMORTs) affect joint and meniscal stability in anterior cruciate ligament (ACL)-deficient knees., Purpose: To determine the clinically relevant kinematics associated with the most common posterior horn LMORT lesion types, types 3 (LMORT3) and 4 (LMORT4), untreated versus arthroscopic repair versus partial meniscectomy in combination with ACL reconstruction (ACLR)., Study: Controlled laboratory study., Methods: Sixteen cadaveric knees underwent robotic testing for anterior drawer and pivot-shift simulations at multiple knee flexion angles in ACL-intact and ACL-deficient states, followed by sequential testing of arthroscopic ACLR, LMORT3 lesion, LMORT3 repair, and partial meniscectomy (n = 8). The same testing sequence was performed for LMORT4 lesions (n = 8)., Results: ACLR restored kinematics in ACL-deficient knees to intact levels for all metrics tested. For anterior drawer, ACLR + LMORT3 tear and partial meniscectomy resulted in significantly greater anterior translation compared with ACL-intact at all angles ( P < .05) and compared with ACLR at 60° and 90° ( P < .014). For pivot shift, compared with ACL-intact knees, ACLR + LMORT3 tear resulted in significantly more anterior translation at 15° ( P = .041); and for ACLR + partial meniscectomy, at both 0° and 15° ( P < .03). ACLR + LMORT4 tear and partial meniscectomy resulted in significantly greater anterior translation for anterior drawer ( P < .04) and pivot-shift testing ( P < .05) compared with intact and ACLR knees at all angles tested. ACLR + LMORT3 repair and ACLR + LMORT4 repair restored kinematics to ACLR and intact levels at all angles tested. ACLR + LMORT3 tear ( P < .008) and both LMORT4 tear and partial meniscectomy ( P < .05) resulted in increased meniscal extrusion compared with intact and ACLR statuses at all tested angles for anterior drawer and pivot shift, while repairs restored meniscal stability to ACLR and intact levels., Conclusion: Untreated LMORT tears increased anterior translation, pivot shift, and meniscal extrusion after ACLR, while partial meniscectomy further exacerbated these detrimental effects in this cadaveric model. In contrast, arthroscopic side-to-side repair of LMORT lesions effectively restored measured knee kinematics., Clinical Relevance: LMORT lesions are common with ACL tears and adversely affect joint stability and meniscal extrusion. This study highlights the importance of repair of LMORT 3 and 4 lesions at the time of ACLR.

Educational researchers have produced a variety of evidence-based practices (EBP) to address social, emotional, and behavioral (SEB) needs among students. Yet, these practices are often insufficiently adopted and implemented with fidelity by teachers to produce the beneficial outcomes associated with the EBP, leaving students at risk for developing SEB problems. If ignored, SEB problems can lead to other negative outcomes, such as academic failure. Therefore, implementation strategies (i.e., methods and procedures designed to promote implementation outcomes) are needed to improve teachers' uptake and delivery of EBPs with fidelity. This meta-analysis sought to examine the types and magnitude of effect of implementation strategies that have been designed and tested to improve teacher adherence to SEB EBPs. Included studies (a) used single case experimental designs, (b) employed at least one implementation strategy, (c) targeted general education teachers, and (d) evaluated adherence as a core dimension of fidelity related to the delivery of EBPs. In total, this study included 28 articles and evaluated 122 effect sizes. A total of 15 unique implementation strategies were categorized. Results indicated that, on average, implementation strategies were associated with increases in teacher adherence to EBPs above baseline and group-based pre-implementation trainings alone (g = 2.32, tau = 0.77). Moderator analysis also indicated that larger effects were associated with implementation strategies that used a greater number of unique behavior change techniques (p < .001). Implications and future directions for research and practice regarding use of implementation strategies for general education teachers are discussed., (Published by Elsevier Ltd.)

Treatment options that result in consistently successful outcomes for young and active patients with joint disorders are needed. This article summarizes two decades of rigorous research using a bedside-to-bench- to-bedside translational approach based on the One Health - One Medicine concept that culminated in successful clinical use of biologic joint restoration options for treatment of knee, hip, ankle, and shoulder problems in this growing patient population., Competing Interests: Disclosure JLC: Arthrex: paid consultant, presenter or speaker, and research support; Bioventus: paid consultant; Coulter Foundation and DePuy: research grants, GE Healthcare: research support; Journal of Knee Surgery: rditorial or governing board; Merial: research support; Midwest Transplant Network: board or committee member; Musculoskeletal Transplant Foundation: board or committee member, IP royalties and research support; National Institutes of Health (NIAMS and NICHD): research support; Purina: research support; Thieme: publishing royalties, financial or material support; Trupanion: paid consultant; and U.S. Department of Defense: research support. JPS: DePuy, Orthopedica Designs North America, and Smith and Nephew: paid consultant; National Institutes of Health: research grant; American Orthopaedic Association: board or committee member; AO Foundation: board or committee member; AO North America: board or committee member; Journal of Knee Surgery: editorial or governing board; Mid-America Orthopaedic Association: board or committee member; Thieme: publishing royalties, financial, or material support; and U.S. Department of Defense: research support. MJS: Arthrex, Inc. and Wright Medical Technology: research grants; DePuy: paid presenter; Ignite Orthopedics: IP royalties, and stock/stock option. AMS: Musculoskeletal Transplant Foundation: IP royalties. CC: Arthrex, Inc., CONMED Linvatec, and the Musculoskeletal Transplant Foundation: paid consultant; Zimmer: research grant. BDC: KCI: paid consultant; Orthopaedic Implant Company and RomTech: stock/stock options; Springer: publishing royalties, financial, or material support; AO Trauma North America: board or committee member; Globus Medical: IP royalties; International Geriatric Fracture Society: board or committee member; Journal of Hip Preservation: editorial or governing board; Journal of Orthopaedic Trauma: editorial or governing board; Orthopaedic Trauma Association: board or committee member; Osteocentric: unpaid consultant; SLACK Incorporated: editorial or governing board; Synthes: paid consultant; research support., (Copyright 2022 by the Missouri State Medical Association.)

Over 60 years of research reveal that informants who observe youth in clinically relevant contexts (e.g., home, school)-typically parents, teachers, and youth clients themselves-often hold discrepant views about that client's needs for mental health services (i.e., informant discrepancies). The last 10 years of research reveal that these discrepancies reflect the reality that (a) youth clients' needs may vary within and across contexts and (b) informants may vary in their expertise for observing youth clients within specific contexts. Accordingly, collecting and interpreting multi-informant data comprise "best practices" in research and clinical care. Yet, professionals across settings (e.g., health, mental health, school) vary in their use of multi-informant data. Specifically, professionals differ in how or to what degree they leverage multi-informant data to determine the goals of services designed to meet youth clients' needs. Further, even when professionals have access to multiple informants' reports, their clinical decisions often signal reliance on one informant's report, thereby omitting reports from other informants. Together, these issues highlight an understudied research-to-practice gap that limits the quality of services for youth. We advance a framework-the Needs-to-Goals Gap-to characterize the role of informant discrepancies in identifying youth clients' needs and the goals of services to meet those needs. This framework connects the utility of multi-informant data with the reality that services often target an array of needs within and across contexts, and that making decisions without accurately integrating multiple informants' reports may result in suboptimal care. We review evidence supporting the framework and outline directions for future research., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Multiligament knee injury (MLKI) typically requires surgical reconstruction to achieve the optimal outcomes for patients. Revision and failure rates after surgical reconstruction for MLKI can be as high as 40%, suggesting the need for improvements in graft constructs and implantation techniques. This study assessed novel graft constructs and surgical implantation and fixation techniques for anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), posterior medial corner (PMC), and posterior lateral corner (PLC) reconstruction. Study objectives were (1) to describe each construct and technique in detail, and (2) to optimize MLKI reconstruction surgical techniques using these constructs so as to consistently implant grafts in correct anatomical locations while preserving bone stock and minimizing overlap. Cadaveric knees ( n  = 3) were instrumented to perform arthroscopic-assisted and open surgical creation of sockets and tunnels for all components of MLKI reconstruction using our novel techniques. Sockets and tunnels with potential for overlap were identified and assessed to measure the minimum distances between them using gross, computed tomographic, and finite element analysis-based measurements. Percentage of bone volume spared for each knee was also calculated. Femoral PLC-lateral collateral ligament and femoral PMC sockets, as well as tibial PCL and tibial PMC posterior oblique ligament sockets, were at high risk for overlap. Femoral ACL and femoral PLC lateral collateral ligament sockets and tibial popliteal tendon and tibial posterior oblique ligament sockets were at moderate risk for overlap. However, with careful planning based on awareness of at-risk MLKI graft combinations in conjunction with protection of the socket/tunnel and trajectory adjustment using fluoroscopic guidance, the novel constructs and techniques allow for consistent surgical reconstruction of all major ligaments in MLKIs such that socket and tunnel overlap can be consistently avoided. As such, the potential advantages of the constructs, including improved graft-to-bone integration, capabilities for sequential tensioning of the graft, and bone sparing effects, can be implemented., Competing Interests: J.P.S. reports grants and personal fees from Arthrex, Inc., grants from DePuy Synthes, other from Journal of Knee Surgery, grants from National Institutes of Health (NIAMS & NICHD), personal fees and other from Thieme, grants from U.S. Department of Defense, other from AO Foundation, other from American Orthopaedic Association, other from AO North America, grants from Coulter Foundation, other from Mid-America Orthopaedic Association, personal fees from Orthopedic Designs North America, personal fees from Smith & Nephew, outside the submitted work. Authors J.L.C. and C.R.C. are husband and wife. J.L.C. reports grants and personal fees from Arthrex, Inc., personal fees from CONMED Linvatec, grants, personal fees and other from Musculoskeletal Transplant Foundation, grants from Zimmer-Biomet, outside the submitted work. All the other authors report no conflict of interest., (Thieme. All rights reserved.)

In-service training is a critical and frequently utilized implementation strategy to support the adoption and delivery of evidence-based practice (EBP) across service settings, but is characteristically ineffective in producing provider behavior changes, particularly when delivered in single exposure didactic events. EBP trainers are in a strategic position to leverage their trainee-perceived characteristics to influence trainees' attitudes, motivation, and intentions to implement, and ultimately increase the likelihood of successful uptake of skills. The purpose of this study was to extend research on the measure of effective attributes of trainers (MEAT) by examining its underlying factor structure and reliability in the context of in-service EBP training for teachers (i.e., structural validity). This study also examined the predictive validity of the MEAT by examining relationships with a measure of teacher intentions to implement EBPs following a standardized training experience (i.e., predictive validity). An exploratory factor analysis (EFA) was employed to determine the latent factors (i.e., subscales of characteristics) that underlie the data. Additionally, a forward selection, stepwise regression was conducted to determine the extent to which trainer attributes could explain variance in intentions to implement. Results indicated that the MEAT was a valid and reliable measure to examine trainer attributes in school settings. Moreover, findings suggested that trainer attributes, particularly those related to trainee perceptions of the trainers' welcoming disposition (i.e., related to trainers' warm, positive temperament and internal character traits), were significantly associated with trainees' intentions to implement the trained upon EBP., Competing Interests: Conflict of interestMadeline Larson declares that she has no conflict of interest. Clayton R. Cook declares that he has no conflict of interest. Margaret M. Sullivan declares that she has no conflict of interest. Aaron R. Lyon declares that he has no conflict of interest. Cara C. Lewis declares that he has no conflict of interest., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022.)

Check-in/Check-out (CICO) is a widely implemented evidence-based program for supporting students with at-risk levels of social and emotional behavior concerns. It is comprised of several core features described in the previous literature, including practice elements , which are the specific actions that are delivered directly to students, and implementation components, which are actions that support the implementation by adults. Practice elements and implementation components are both important to implementation but have been combined and conflated in descriptions of CICO implementation. Well-defined and differentiated practice elements could provide improved clarity in communicating implementation expectations to front-line implementers as well as support future research into essential active ingredients and measures of front-line intervention fidelity. The purpose of the present study was to distill, differentiate, and operationally define the student-facing practice elements of CICO. A panel of research experts and practice experts participated in a three-round modified e-Delphi process that led to the identification and operational definition of 19 discreet practice elements organized into five domains. Results are discussed in terms in implications for future development of measures of commitment and intervention fidelity, future research into active ingredients of CICO, and in terms of how well-defined practice elements can improve communication of implementation expectations for front-line implementers of CICO such as teachers., Supplementary Information: The online version contains supplementary material available at 10.1007/s12310-021-09495-x., Competing Interests: Conflicts of InterestThe authors declare that they have no conflict of interest., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021, corrected publication 2022.)

Student-teacher relationships are important to student outcomes and may be especially pivotal at the high school transition and for minoritized racial/ethnic groups. Although interventions exist to improve student-teacher relationships, none have been shown to be effective among high school students or in narrowing racial/ethnic disparities in student outcomes. This study was conducted to examine the effects of an equity-explicit student-teacher relationship intervention (Equity-Explicit Establish Maintain Restore, or E-EMR) for high school teachers and students. A cluster-randomized pilot trial was conducted with 94 ninth grade teachers and 417 ninth grade students in six high schools. Teachers in three schools were randomized to receive E-EMR training and follow-up supports for one year. Teachers in three control schools conducted business as usual. Student-teacher relationships, sense of school belonging, academic motivation, and academic engagement were collected via student self-report in September and January of their ninth-grade year. Longitudinal models revealed non-significant main effects of E-EMR. However, there were targeted benefits for students who started with low scores at baseline, for Asian, Latinx, multicultural, and (to a lesser extent) Black students. We also found some unexpected effects, where high-performing and/or advantaged groups in the E-EMR condition had less favorable outcomes at post, compared to those in the control group, which may be a result of the equity-explicit focus of E-EMR. Implications and directions for future research are discussed., Competing Interests: Conflict of interestThe last author receives compensation for providing training on EMR., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022.)

Background: Lateral meniscal oblique radial tears (LMORT) occur frequently in conjunction with anterior cruciate ligament (ACL) disruption and are anatomically distinct from meniscus root tears., Hypothesis/purpose: The purpose of this study was to characterize the effects of LMORT types 3 (LMORT3) and 4 (LMORT4) lesions on joint stability and meniscal extrusion in ACL-deficient knees. Our hypothesis was that both lesions would promote significant increases in anterior translation and meniscal extrusion, with the LMORT4 lesion having a greater effect., Study Design: Controlled laboratory study., Methods: Two matched pairs of cadaveric knees (n = 4) were used to optimize the testing sequence. Additional cadaveric knees with LMORT3 (n = 8) and LMORT4 (n = 8) lesions created after ACL transection underwent robotic kinematic testing for anterior drawer and pivot-shift simulations with associated ultrasound-measured meniscal extrusion at clinically relevant knee flexion angles., Results: Optimization testing showed no differences on the effect of LMORT4 lesions for anterior translation and lateral meniscal extrusion with ACL-intact versus ACL-deficient knees. ACL deficiency and LMORT3 and LMORT4 lesions with ACL deficiency were associated with significantly greater anterior translation compared with ACL-intact state for both anterior drawer and pivot-shift testing at all flexion angles ( P < .001). ACL deficiency with either LMORT3 or LMORT4 lesion was associated with significantly greater anterior translation than was ACL deficiency only ( P < .005) for anterior drawer testing at 90° of flexion. Meniscal extrusion was greater with LMORT3 and LMORT4 lesions compared with ACL deficiency only ( P < .05) for anterior drawer at 60° of flexion and for pivot shift at 15° of flexion. The LMORT4 lesion demonstrated increased anterior translation for anterior drawer ( P = .003) at 60° of flexion (12%) as well as for pivot shift at 15° of flexion (7%) and 30° of flexion (13%) ( P < .005) compared with ACL deficiency only., Conclusion: In this cadaveric model, the addition of an LMORT3 or LMORT4 lesion increased anterior laxity for both the anterior drawer and the pivot shift when compared with an isolated ACL tear. Lateral meniscal extrusion was also exacerbated by these LMORT lesions., Clinical Relevance: LMORT lesions, distinct from meniscus root tears, occur frequently in conjunction with ACL tears. This study characterized the biomechanical consequences of LMORT3 and LMORT4 lesions on joint stability and meniscal function, highlighting the importance of diagnosing and treating LMORT lesions at the time of ACL reconstruction.

Training and consultation are core implementation strategies used to support the adoption and delivery of evidence-based prevention programs (EBPPs), but are often insufficient alone to effect teacher behavior change. Motivational interviewing (MI) and related behavior change techniques (e.g., strategic education, social influence, implementation planning) delivered in a group format offer promising supplements to training and consultation to improve EBPP implementation. Beliefs and Attitudes for Successful Implementation in Schools for Teachers (BASIS-T) is a theoretically informed, motivational implementation strategy delivered in a group format prior to and immediately after EBPP training. The purpose of this study was to examine the proximal effects of BASIS-T on hypothesized mechanisms of behavior change (e.g., attitudes, subjective norms, intentions to implement) in the context of teachers receiving training and consultation to implement the Good Behavior Game. As part of a pilot trial, 83 elementary school teachers from 9 public elementary schools were randomly assigned (at the school-level to reduce contamination across participants) to a BASIS-T (n = 44) or active comparison control (n = 39) condition, with both conditions receiving Good Behavior Game (GBG) training and consultation. A series of mixed effects models revealed meaningful effects favoring BASIS-T on a number of hypothesized mechanisms of behavior change leading to increased motivation to implement GBG. The implications, limitations, and directions for future research on the use of MI with groups of individuals and other behavior change techniques to increase the yield of training and consultation are discussed., (© 2020. Society for Prevention Research.)

Osteochondral allograft (OCA) transplantation can restore large articular defects in the knee. Bipolar OCA transplantations for partial and whole joint resurfacing often have less favorable results than single-surface transplants. This study was designed to use a large animal model to test the hypothesis that unicompartmental bipolar osteochondral and meniscal allograft transplantation (BioJoint) would be as or more effective for treatment of medial compartment osteoarthritis (OA) compared to standard-of-care nonoperative treatment. OA was induced in one knee of each research hound (n = 8) using a meniscal release model and pretreatment assessments were performed. After 3 months, dogs were randomly assigned to either the control group (n = 4, no surgical intervention, daily nonsteroidal antiinflammatory drugs [NSAIDs]) or the BioJoint group (n = 4). Clinical, radiographic, and arthroscopic assessments were performed longitudinally and histopathology was evaluated at the 6-month endpoint. At study endpoint, functional, pain, and total pressure index measures, as well as radiographic and arthroscopic grading of graft appearance and joint health, demonstrated superior outcomes for BioJoints compared to NSAID controls. Furthermore, histologic assessments showed that osteochondral and meniscal transplants maintain integrity and integrated into host tissues. Clinical significance: The results support the safety and efficacy of unicompartmental bipolar osteochondral and meniscal allograft transplantation in a preclinical model with highly functional outcomes without early OA progression., (© 2020 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.)

Posterior cruciate ligament (PCL) injuries can often be missed on physical examination, especially in multiligament knee injuries. Therefore, a comprehensive approach to imaging the PCL should be implemented whenever history and examination findings indicate relative risk. Radiography, including a posterior-stress view, and magnetic resonance imaging, when available, provide consistently accurate diagnosis of PCL pathology and common knee comorbidities. Computed tomography and ultrasonography can be useful modalities with potential advantages with respect to availability and access, specific comorbidities, and/or cost-effectiveness., Competing Interests: None declared., (Thieme. All rights reserved.)

Purpose: To evaluate functional, symptomatic, and diagnostic imaging outcomes after arthroscopic superior capsular reconstruction (SCR) using dermal allograft in patients with massive irreparable rotator cuff tears., Methods: From 2015 to 2017, this multicenter study retrospectively evaluated patients undergoing arthroscopic SCR for treatment of symptomatic massive rotator cuff tears. Study criteria included the presence of a massive irreparable rotator cuff tear with retraction to the glenoid without diffuse bipolar cartilage loss, Grade 4 or 5 Hamada classification, and subscapularis pathology that could not be addressed. All SCR procedures were performed with neutral abduction of the arm at the time of implantation. Outcome measures included visual analog pain scale (VAS) score, the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, and active forward elevation (FE) through 2 years postoperatively. Imaging analyses included radiographs, ultrasound, and magnetic resonance imaging at 6 months and 1 year., Results: Fourteen patients met all study criteria including required follow-up. There were statistically significant improvements in VAS pain (3.3-0.6, P = .001), ASES (55.0-86.5, P < .0001), SANE (33.1-71.5, P < .0001), and active FE (128-172, P = .0005) with mean follow-up of 2.1 years. Twelve patients (86%) met the minimum clinically important difference in VAS pain, ASES, and SANE. Thirteen grafts (93%) had ultrasonographic evidence for vascularity by 1 year postoperatively. There were 2 graft complications (14%) with one (7%) requiring revision to reverse total shoulder arthroplasty., Conclusions: Arthroscopic SCR using dermal allograft can be a safe and effective treatment option for patients with massive irreparable rotator cuff tears with statistically significant improvements in VAS pain, ASES, SANE, and active FE at 2-years postoperatively, with 93% of grafts demonstrating vascularity at 1-year postoperatively. Neutral abduction of the arm at the time of implantation resulted in positive clinical outcomes and may decrease graft failure rate., Level of Evidence: Level IV, case series., (Copyright © 2020 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: More than two-thirds of youth experience trauma during childhood, and up to 1 in 5 of these youth develops posttraumatic stress symptoms that significantly impair their functioning. Although trauma-focused cognitive behavior therapy (TF-CBT) has a strong evidence base, it is rarely adopted, delivered with adequate fidelity, or evaluated in the most common setting where youth access mental health services-schools. Given that individual behavior change is ultimately required for successful implementation, even when organizational factors are firmly in place, focusing on individual-level processes represents a potentially parsimonious approach. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a pragmatic, motivationally focused multifaceted strategy that augments training and consultation and is designed to target precise mechanisms of behavior change to produce enhanced implementation and youth clinical outcomes. This study protocol describes a hybrid type 2 effectiveness-implementation trial designed to concurrently evaluate the main effects, mediators, and moderators of both the BASIS implementation strategy on implementation outcomes and TF-CBT on youth mental health outcomes., Methods: Using a cluster randomized controlled design, this trial will assign school-based mental health (SMH) clinicians and schools to one of three study arms: (a) enhanced treatment-as-usual (TAU), (b) attention control plus TF-CBT, or (c) BASIS+TF-CBT. With a proposed sample of 120 SMH clinicians who will each recruit 4-6 youth with a history of trauma (480 children), this project will gather data across 12 different time points to address two project aims. Aim 1 will evaluate, relative to an enhanced TAU condition, the effects of TF-CBT on identified mechanisms of change, youth mental health outcomes, and intervention costs and cost-effectiveness. Aim 2 will compare the effects of BASIS against an attention control plus TF-CBT condition on theoretical mechanisms of clinician behavior change and implementation outcomes, as well as examine costs and cost-effectiveness., Discussion: This study will generate critical knowledge about the effectiveness and cost-effectiveness of BASIS-a pragmatic, theory-driven, and generalizable implementation strategy designed to enhance motivation-to increase the yield of evidence-based practice training and consultation, as well as the effectiveness of TF-CBT in a novel service setting., Trial Registration: ClinicalTrials.gov registration number NCT04451161 . Registered on June 30, 2020.

Meniscal allograft transplantation (MAT) can be a safe, effective treatment for meniscal deficiency resulting in knee dysfunction, leading to osteoarthritis (OA) without proper treatment with 5-year functional success rates (75%-90%). While different grafts and techniques have generally proven safe and effective, complications include shrinkage, extrusion, progression of joint pathology, and failure. The objective of this study was to assess the functional outcomes after MAT using three different clinically-relevant methods in a preclinical canine model. The study was designed to test the hypothesis that fresh meniscal-osteochondral allograft transplantation would be associated with significantly better function and joint health compared with fresh-viable or fresh-frozen meniscus-only allograft transplantations. Three months after meniscal release to induce meniscus-deficient medial compartment disease, research hounds (n = 12) underwent MAT using meniscus allografts harvested from matched dogs. Three MAT conditions (n = 4 each) were compared: frozen meniscus-fresh-frozen meniscal allograft with menisco-capsular suture repair; fresh meniscus-fresh viable meniscal allograft (Missouri Osteochondral Preservation System (MOPS)-preservation for 30 days) with menisco-tibial ligament repair; fresh menisco-tibial-fresh, viable meniscal-tibial-osteochondral allografts (MOPS-preservation for 30 days) with menisco-tibial ligament preservation and autogenous bone marrow aspirate concentrate on OCA bone. Assessment was performed up to 6 months after MAT. Pain, comfortable range of motion, imaging, and arthroscopic scores as well histological and cell viability findings were superior (P < .05) for the fresh menisco-tibial group compared with the two other groups. Novel meniscal preservation and implantation techniques with fresh, MOPS-preserved, viable meniscal-osteochondral allografts with menisco-tibial ligament preservation appears to be safe and effective for restoring knee function and joint health in this preclinical model. This has the potential to significantly improve outcomes after MAT., (© 2020 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.)

There has been an increase in school mental health research aimed at producing generalizable knowledge to address longstanding science-to-practice gaps to increase children's access to evidence-based mental health services. Successful dissemination and implementation are both important pieces to address science-to-practice gaps, but there is conceptual and semantic imprecision that creates confusion regarding where dissemination ends and implementation begins, as well as an imbalanced focus in research on implementation relative to dissemination. In this paper, we provide an enhanced operational definition of dissemination; offer a conceptual model that outlines elements of effective dissemination that can produce changes in awareness, knowledge, perceptions, and motivation across different stakeholder groups; and delineate guiding principles that can inform dissemination science and practice. The overarching goal of this paper is to stimulate future research that aims to advance dissemination science and practice in school mental health., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021.)