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Long-duration spaceflight missions are on the rise. However, recent literature suggests that prolonged and deep-space exposure is likely to introduce increased risks for brain health and consequent detriments to performance and well-being. Given up-to-date evidence, we argue that transcranial magnetic stimulation (TMS) is a promising solution for mitigating behavioral and neurocognitive risks associated with long-duration and deep-space missions. We provide support from recent Earth-based applications of TMS and review several advantages it holds over current treatment approaches. Lastly, we highlight some of the needs in the process of applying such technology to the spaceflight environment.

Background: Anterior shoulder instability is a common problem around the world, with a high risk for recurrence following the index dislocation. Surgical stabilization is commonly indicated for persistent instability, particularly in patients at high risk for recurrence, to minimize the risk of further labral injury and glenoid bone loss. However, there is little known about global geographic differences in the surgical management of anterior shoulder instability. As such, the purpose of this study was to evaluate and systematically review regional differences in the surgical treatment of anterior shoulder instability, particularly the indications for and outcomes from bony stabilization procedures compared to soft tissue procedures. Methods: A systematic review, in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was performed. Inclusion criteria consisted of level I and II evidence studies evaluating indications, techniques, and outcomes following operative management of anterior shoulder instability published from January 2000 to September 2021. Studies meeting inclusion criteria were grouped into four global regions (Asia, Europe, North America, South America) based on primary study location. Patient demographics, procedural details, patient reported outcomes, and complications (recurrence and reoperation rates) were compared between regions. Results: Sixty (n = 60) studies (5480 patients) were identified. Eighty-six percent of all patients were male, with a mean age of 26.7 years. There was no difference in mean patient age, though patients undergoing bony stabilization procedures were older than those undergoing soft-tissue stabilization procedures (P = .0002) in all regions. The proportion of bony versus soft-tissue procedure groups did not differ significantly among regions. The indications for bony stabilization procedures varied significantly. Mean final follow-up was 3.5 years. Recurrent instability was 5.0% and did not vary across regions. However, recurrent instability occurred more frequently following soft-tissue compared to bony stabilization procedures (P = .017). South American studies utilized fewer anchors during soft tissue stabilization (P < .0001) and reported a higher reoperation rate compared to other regions (P = .009). Conclusion: There is global variation in the reporting of outcomes following surgery for anterior shoulder instability. The proportion of bony and soft-tissue procedures is similar, irrespective of geographic region. Recurrent instability does not vary by region but occurs more frequently following soft-tissue compared to bony stabilization procedures. There are a number of potential medical and nonmedical factors that may affect global variation in the surgical treatment of anterior shoulder instability.

Purpose: To perform a systematic review on clinical and radiologic outcomes for meniscus tears treated nonoperatively with platelet-rich plasma (PRP). Methods: A literature search was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using keywords and Boolean operators in SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials in April 2023. Inclusion criteria were limited to Level I to IV human studies reporting on outcomes of meniscus tears treated nonoperatively with PRP. Results: A total of 6 studies, consisting of 184 patients, were identified. There was 1 Level I study and 5 Level IV studies. Mean patient age was 47.8 ± 7.9 years, with 62% (n = 114/184) being female. The medial meniscus was treated in 95.7% (n = 157/164) of patients. Mean follow-up ranged from 75.9 days to 31.9 months. Meniscus tears were generally described as chronic, degenerative, or intrasubstance. In 4 studies, magnetic resonance imaging revealed variable improvement in meniscus grade with complete healing in 0% to 44% of patients and partial healing in 0% to 40% of patients. Four of 5 studies reported significant statistical improvement in pain from baseline to final follow-up. Studies reporting on clinical outcomes showed significant improvements Lysholm score (2 studies), Knee injury and Osteoarthritis Outcome Score total score (2 studies), and Tegner score (1 study). Successful return to sport occurred in 60% to 100% of patients. Two studies reported that most patients were either very satisfied or satisfied following treatment. Conclusions: The use of PRP injections for the treatment of meniscus tears led to variable results based on postoperative magnetic resonance evaluation and improvements in clinical outcomes, although the clinical significance remains unclear. The heterogeneity of PRP protocols, short-term follow-up, and lack of comparative studies limit findings. Level of Evidence: Level IV, systematic review of Level I to IV studies.

Appropriate management of radial meniscal tears is complex, with continued efforts focused on optimizing diagnostic methods for identification to help dictate treatment, especially as surgical indications for repair have expanded, coupled with improvements in surgical techniques and instrumentation. Currently, no standardized classification system for radial meniscal tears exists, limiting the ability to accurately characterize injury patterns and guide surgical decision-making.

Abstract The evolution of secondary sex-specific traits of dioecious species under abiotic stress conditions has received limited research, especially in the case of Amaranthus palmeri, a fast adapting and highly competing plant. Here, we have examined the interactive effects of abiotic stress on mineral accumulation, chlorophyll a and b content, and the operating capacity of Photosystem II (PSII) in both male and female A. palmeri plants grown under three different intensities of white light, and under N, K or P deficiency. Mineral profiling of the leaves and stems (with inflorescence) highlighted intra- and intersexual differences in their accumulation pattern and mineral associations. Chlorophyll a and chlorophyll b were different between the male and the female plants, being slightly lower in the latter, at high light intensity towards maturity, or under K or P deficiency. Further, slight, although statistically significant differences were recorded in the chlorophyll a/b ratio, which was lower at the higher light intensity in the female, over that in the male, plants towards maturity. Chlorophyll fluorescence parameters, i.e., steady state and maximum fluorescence increased under high light intensity, whereas the PSII operating efficiency decreased in the female plants, indicating reduced PSII capacity. Sex-specific differences in A. palmeri showed a differential response to stressful conditions because of differences in their ontogeny and physiology, and possibly due to the cost of reproduction. We suggest that the breeding system of dioecious species has weaknesses that can be used for the ecological management of dioecious weeds without relying on the use of herbicides.

Black Americans suffer lower life expectancy and show signs of accelerated aging compared to other Americans. While previous studies observe these differences in children and populations with chronic illness, whether these pathologic processes exist or how these pathologic processes progress has yet to be explored prior to the onset of significant chronic illness, within a young adult population. Therefore, we investigated race-related differences in epigenetic age in a cross-sectional sample of young putatively healthy adults and assessed whether lifetime stress and/or trauma mediate those differences. Biological and psychological data were collected from self-reported healthy adult volunteers within the local New Haven area (399 volunteers, 19.8% Black, mean age: 29.28). Stress and trauma data was collected using the Cumulative Adversity Inventory (CAI) interview, which assessed specific types of stressors, including major life events, traumatic events, work, financial, relationship and chronic stressors cumulatively over time. GrimAge Acceleration (GAA), determined from whole blood collected from participants, measured epigenetic age. In order to understand the impact of stress and trauma on GAA, exploratory mediation analyses were then used. We found cumulative stressors across all types of events (mean difference of 6.9 p = 2.14e-4) and GAA (β = 2.29 years [1.57–3.01, p = 9.70e-10] for race, partial η2 = 0.091, model adjusted R2 = 0.242) were significantly greater in Black compared to White participants. Critically, CAI total score (proportion mediated: 0.185 [0.073–0.34, p = 6e-4]) significantly mediated the relationship between race and GAA. Further analysis attributed this difference to more traumatic events, particularly assaultive traumas and death of loved ones. Our results suggest that, prior to development of significant chronic disease, Black individuals have increased epigenetic age compared to White participants and that increased cumulative stress and traumatic events may contribute significantly to this epigenetic aging difference.

Purpose: To investigate the association between changes in individual (anterior, lateral, and posterior) and overall deltoid compartment pressures and postoperative opioid consumption up to 14 days after primary double-row arthroscopic rotator cuff repair (ARCR). Methods: In 113 consecutive patients undergoing primary double-row ARCR, anterior, lateral, and posterior deltoid compartment pressures were measured prior to incision and immediately after closure with a manometer. Postoperatively, all patients were provided with an identical rehabilitation protocol, quantity and dose of opioid tablets, and pain journal in which to record daily opioid consumption and visual analog scale pain scores for 14 days after surgery. The pain journals were collected at the first postoperative visit, and opioid consumption was calculated based on morphine equivalents. Statistical analysis was performed to determine the association between deltoid compartment pressures and opioid consumption postoperatively. Results: Sixty-nine percent of patients who met the inclusion criteria (74 of 107) returned the pain journals. The mean age at the time of surgery was 57.4 ± 8.8 years (range, 30-75 years), with female patients being significantly older (P = .03). The mean length of surgery was 71.7 ± 16.3 minutes. No significant association between increase in individual (anterior, lateral, or posterior) or mean overall compartment pressures and morphine equivalents of opioid consumption was appreciated on any postoperative day. Conclusions: No significant correlation between increase in individual or overall deltoid compartment pressures after ARCR and postoperative opioid consumption in the immediate postoperative period was found in this study. Level of Evidence: Level II, prospective cohort study.

Purpose: To systematically examine the effects of radiofrequency (RF) ablation or coblation (controlled ablation) on chondrocyte viability following knee chondroplasty in preclinical literature to determine the effectiveness and safety of RF-based techniques. Methods: A literature search was performed in September 2022 using PubMed and Scopus using the following search terms combined with Boolean operators: “chondroplasty,” “radiofrequency,” “thermal,” “knee,” “chondral defect,” “articular cartilage,” and “cartilage.” The inclusion criteria consisted of preclinical studies examining the effect of RF ablation or coblation on chondrocytes during knee chondroplasty. Exclusion criteria consisted of studies reporting chondroplasty in joints other than the knee, clinical studies, in vitro studies using animal models, case reports, non–full-text articles, letters to editors, surveys, review articles, and abstracts. The following data were extracted from the included articles: author, year of publication, chondral defect location within the knee and chondral characteristics, RF probe characteristics, cartilage macroscopic description, microscopic chondrocyte description, and extracellular matrix characteristics. Results: A total of 17 articles, consisting of 811 cartilage specimens, were identified. The mean specimen age was 63.4 ± 6.0 (range, 37-89) years. Five studies used monopolar RF devices, 7 studies used bipolar RF devices, whereas 4 studies used both monopolar and bipolar RF devices. Time until cell death during ablation at any power was reported in 5 studies (n = 351 specimens), with a mean time to cell death of 54.4 seconds (mean range, 23.1-64) for bipolar RF and 56.3 seconds (mean range, 12.5-64) for monopolar RF devices. Chondrocyte cell death increased with increased wattage, while treatment time was positively correlated with deeper cell death. Conclusions: In this systematic review, histologic analysis demonstrated that RF-based chondroplasty creates a precise area of targeted chondrocyte death, with minimal evidence of necrosis outside the target zone. Caution must be exercised when performing RF-based chondroplasty due to the risk of cell death with increased application time and wattage. Clinical Relevance: Although RF ablation has demonstrated favorable results in preliminary trials, including smoother cartilage and less damage to the surrounding healthy tissue, the risks versus benefits of the procedure are largely unknown. Caution must be exercised when performing RF-based chondroplasty in the clinical setting due to the risk of cell death with increased application time and wattage.

The landscape of psychiatry is ever evolving and has recently begun to be influenced more heavily by new technologies. One novel technology which may have particular application to psychiatry is the metaverse, a three-dimensional digital social platform accessed via augmented, virtual, and mixed reality (AR/VR/MR). The metaverse allows the interaction of users in a virtual world which can be measured and manipulated, posing at once exciting new possibilities and significant potential challenges and risks. While the final form of the nascent metaverse is not yet clear, the immersive simulation and holographic mixed reality-based worlds made possible by the metaverse have the potential to redefine neuropsychiatric care for both patients and their providers. While a number of applications for this technology can be envisioned, this article will focus on leveraging the metaverse in three specific domains: medical education, brain stimulation, and biofeedback. Within medical education, the metaverse could allow for more precise feedback to students performing patient interviews as well as the ability to more easily disseminate highly specialized technical skills, such as those used in advanced neurostimulation paradigms. Examples of potential applications in brain stimulation and biofeedback range from using AR to improve precision targeting of non-invasive neuromodulation modalities to more innovative practices, such as using physiological and behavioral measures derived from interactions in VR environments to directly inform and personalize treatment parameters for patients. Along with promising future applications, we also discuss ethical implications and data security concerns that arise when considering the introduction of the metaverse and related AR/VR technologies to psychiatric research and care.

Purpose: To evaluate the influence of spinopelvic parameters on short-term postoperative patient-reported outcomes (PROs) following primary hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS). Methods: Patients undergoing primary hip arthroscopy between January 2012 and December 2015 were retrospectively reviewed. Hip Outcome Score – Activities of Daily Living, Hip Outcome Score – Sports-Specific Subscale, modified Harris Hip Score, International Hip Outcome Tool-12, and visual analog scale pain were recorded preoperatively and at final follow-up. Lumbar lordosis (LL), pelvic tilt (PT), sacral slope, and pelvic incidence (PI) were measured on lateral radiographs in standing position. Patients were split into subgroups for individual analyses based on previous literature cutoffs: |PI-LL|> or or 65°. PROs and rate of achievement of patient acceptable symptom state (PASS) were compared between subgroups at final follow-up. Results: Sixty-one patients who underwent unilateral hip arthroscopy were included in the analysis, and 66% of patients were female. Mean patient age was 37.6 ± 11.3 years, whereas mean body mass index was 25.0 ± 5.7. Mean follow-up time was 27.6 ± 9.0 months. No significant difference in preoperative nor postoperative PROs were appreciated in patients with spinopelvic mismatch (|PI-LL| >10°) versus those without, whereas patients with mismatch achieved PASS according to the modified Harris Hip Score (P = .037) and International Hip Outcome Tool-12 (P = .030) at greater rates. When we compared patients with a PT ≥20° versus PT 65°, no significant differences in 2-year PROs or rates of PASS achievement for any PRO were appreciated (P > .05 for all). Conclusions: In this study, spinopelvic parameters and traditional measures of sagittal imbalance did not influence PROs in patients undergoing primary hip arthroscopy for FAIS. Patients with sagittal imbalance (|PI-LL|> 10° or PT >20°) achieved a greater rate of PASS. Level of Evidence: IV; Prognostic case series.

Abstract Land use/cover (LULC) and climate are significant environmental factors that influence watershed hydrology across the globe. The present study attempts to understand the consequences of existing changing patterns of climate and LULC on the hydrology of the Usri watershed. Different water balance components were simulated using a semi-distributed Soil and Water Assessment Tool (SWAT) model. Sixteen scenarios were generated using combinations of four periods of climatic data (1974–84; 1985–1995; 1996–2006 and 2007–2016) and four sets of land use maps (1976; 1989; 2000 and 2014). The SWAT model performed well for monthly stream flows during calibration and validation. The study finds that the individual impact of LULC change contributes to increase in the streamflow and decrease in evapotranspiration (ET) primarily due to increase in urbanization and decrease in water bodies, forest cover and barren land of Usri watershed. The combined impact of climatic variations and land use change reveals complex interactions. The study provides insight into hydrological response to variations in climate and land use changes in Usri watershed in recent decades. The results of this study can be beneficial to the authorities, decision-makers, water resource engineers and planners for the best water resource management approaches in the perspective of climate change and LULC transformation of similar ecological regions as that of Usri.

Introduction: Meniscal injuries represent the most common pathology affecting the knee, often limiting return to sporting activities secondary to pain and disability. In meniscal deficient patients, meniscal allograft transplantation (MAT) procedure may be considered. Return to sport (RTS) rate, predictors of successful RTS, and patient-reported outcomes in athletic patients undergoing MAT are largely unknown. Objectives: To review the literature on RTS rates, predictors of RTS success or failure, and patient-reported outcomes following MAT in athletic patients. Methods: PubMed, Cochrane, and Scopus databases were reviewed for relevant literature using the following keywords: “meniscal allograft transplantation,” “meniscal transplant,” “meniscus transplant,” “return to sport,” “return to play,” and “patient-reported outcomes.” Results: RTS rates following MAT are generally favorable in the athletic population. Appropriate graft sizing, secure graft fixation, younger age, and the absence of articular cartilage injury are associated with improved RTS success. Meanwhile, the presence of focal chondral defects, osteoarthritic changes, limb malalignment, concomitant procedures performed at the time of MAT, and ligamentous instability are associated with failed RTS. Significant improvements in patient-reported outcomes were appreciated when compared to pre-operative values. Conclusions: MAT is a viable treatment option for athletic, meniscal deficient patients. Future investigations of high methodologic quality that evaluate long-term outcomes, graft survivorship, and athletic performance following MAT are warranted to better understand the influence and efficacy of MAT in athletic patients.

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique with substantial evidence for its safety and tolerability in adults. However, less than 5% of published tDCS research is in pediatrics. Our primary objective was to investigate tDCS safety, tolerability, and acceptability in a sample of children and adults. We hypothesized that children and adults would be equal with regard to tDCS safety, tolerability, and acceptability. We tested this hypothesis using a Bayesian approach. Sixty participants aged 6–45 (balanced for sex) participated in a randomized double-blind controlled trial. They were randomly assigned to two ten-minute tDCS sessions with varying amperages and electrode locations. The primary outcome measure of this study was the intensity of 13 potential side effects evaluated at six different time points spanning two weeks. Independent sample Bayes factor tests were conducted between children/adults, males/females, clinical/healthy, and low/high amperage groups. As predicted, there was moderate support for the null hypothesis in all between-group analyses. There were no serious adverse events or dropouts, and the number needed to treat for an additional harmful outcome was 23. This study provided evidence supporting the overall short-term safety, tolerability, and acceptability of tDCS including amperages up to 2 mA and different electrode placements.

Contemporary research indicates that Black American men encounter multiple obstacles in higher education settings. Understanding the complexities of how Black men perceive and make sense of academic environments requires addressing a number of elements that influence their academic success. The purpose of this study is to investigate the academic advising challenges faced in virtual environments by Black men during the COVID-19 pandemic. This qualitative case study provides detailed accounts of ten Black men navigating academic advising practices in a virtual setting at large research one historically white institution using focus groups as a method of data collection. Implications and suggestions for future research highlight the significance of supporting Black men in virtual academic advising spaces to create equitable and sustainable practices.

Background: As a degenerative condition, symptomatic rotator cuff disease is frequently seen in the aging population, often requiring arthroscopic repair to eliminate pain and restore function. Repair integrity remains a concern in both short- and long-term postoperative periods due to high rates of primary repair failures, leading to increased interest in biologic patch augmentation to improve healing. Indications: Patch augmentation during rotator cuff repair is indicated in patients at high risk for repair failure or incomplete healing, including patients with poor quality, degenerative tendon tissue, those undergoing revision repair, and patients with large or massive rotator cuff tears. Technique Description: Standard arthroscopic portals are established and following diagnostic arthroscopy, the rotator cuff tear is identified, mobilized, and the humeral head gently debrided to a bleeding surface. Medial row suture anchors are placed, and following suture passage through the rotator cuff, the medial row sutures are tied. A bioinductive augmentation patch is introduced and provisionally secured medial to the enthesis utilizing spinal needles. Sutures are shuttled over the patch and incorporated into the lateral row repair utilizing 2 knotless suture anchors, effectively securing the patch over the bone-tendon interface. Results: Utilization of the described patch augmentation technique may improve repair healing by stimulating collagen formation and tissue vascularity, while providing structural support during the immediate postoperative period, effectively facilitating new tissue formation. Discussion/Conclusion: Incorporation of the bioinductive patch into the lateral row suture repair, directly over the tendon-bone interface, may assist in repair healing and decrease issues related to patch migration, while minimizing operative time and materials cost.

Background: Root tears are functionally compromising injuries that require an anatomic repair for functional restoration of native joint mechanics. Posterior root tears of the lateral meniscus are commonly associated with anterior cruciate ligament (ACL) ruptures as lateral root tears contribute to anterolateral rotational instability. Two-tunnel transtibial root repair allows for root repair with superior pullout strength and can be combined with ACL reconstruction to treat this injury pattern. Indications: Two-tunnel transtibial root repair is indicated in active patients with meniscal root tears that have low-grade chondromalacia (grade II or less). It is contraindicated in patients with advanced degenerative changes (grade III-IV), severe mal-alignment, and extrusion related to advanced degenerative changes; those who cannot complete postoperative rehabilitation; and patients with significant medical comorbidities. Technique Description: After repairing a vertical horn tear of the posterior medial meniscus, a vertical tear of the posterior root of the lateral meniscus was observed. Following preparation of the anatomic footprint, 2 transtibial tunnels were drilled and sutures were passed and secured using a surgical button over the anterior tibial cortex. Horizontal repair of the tear was then performed using 2 all-inside devices. Subsequently, an ACL reconstruction was performed. Results: At 11 months postoperative, the patient has continued to progress as expected. She was able to ambulate without pain, had a symmetric and balanced gait, and was able to return to running. Discussion/Conclusion: Lateral meniscal root repairs using 2 transtibial tunnels and concomitant ACL reconstruction have yielded good and reliable clinical outcomes with low failure rates and low rates of revision surgery.

Abstract Purpose In the setting of persistent instability or failed non‐operative management, surgical reconstruction is commonly recommended for isolated posterior cruciate ligament (PCL) tears. The purpose of this study was to systematically review published studies to evaluate regional variation in the epidemiology of and surgical approaches to primary, isolated PCL reconstruction. Methods A systematic review was performed in June 2022 to identify studies examining operative techniques during primary, isolated PCL reconstruction. Collected variables consisted of reconstruction technique, graft type, graft source, tibial reconstruction technique, femoral and tibial drilling and fixation methods, and whether the remnant PCL was preserved or debrided. Studies were classified into four global regions: Asia, Europe, North America, and South America. Results Forty‐five studies, consisting of 1461 total patients, were identified. Most of the included studies were from Asia (69%, n = 31/45). Single bundle reconstruction was more commonly reported in studies out of Asia, Europe, and North America. Hamstring autografts were utilized in 51.7% (n = 611/1181) of patients from Asia and 60.8% (n = 124/204) of patients from Europe. Trans‐tibial drilling and outside‐in femoral drilling were commonly reported in all global regions. The PCL remnant was generally debrided, while remnant preservation was commonly reported in studies from Asia. Conclusion Surgical treatment of isolated PCL injuries varies by region, with the majority of published studies coming from Asia. Single‐bundle reconstruction with hamstring autograft through a trans‐tibial approach is the most commonly reported technique in the literature, with males reported to undergo isolated reconstruction more often than females. Level of Evidence Systematic review, Level IV.

Background During shoulder arthroplasty with substantial bone and soft tissue loss, reverse shoulder arthroplasty (RSA) with a tumor prosthesis may restore function, reduce pain, and improve implant fixation. Methods Thirteen adult patients undergoing RSA using a tumor prosthesis system were retrospectively reviewed. Preoperative visual analog score (VAS), single assessment numeric evaluation (SANE), American Shoulder and Elbow Surgeons (ASES) score, simple shoulder test (SST), and forward flexion were compared to latest follow up. Postoperative radiographs and complications were recorded. Results Mean age at surgery was 68.4 years. Eight patients had undergone at least 1 prior operation on the indicated shoulder. Six patients required wide excision of proximal humerus tumor. At mean of 34 months postoperatively, significant improvements were noted in VAS ( P = .03) and ASES score ( P = .04). Active forward elevation was 81.1 degrees. For all patients, postoperative radiographs demonstrated satisfactory alignment. Complications occurred in 38% of patients, with 31% requiring reoperation. Conclusion In cases of failed shoulder arthroplasty with excessive bone and soft tissue loss or substantial tumor burden, RSA with a tumor prosthesis can reduce pain levels and improve functional outcomes. However, forward elevation remains limited, and postoperative complications are a concern.

Achievement of appropriate mechanical knee alignment is crucial to ensure optimal clinical outcomes following osteotomy procedures about the knee. The use of patient-specific instrumentation (PSI) to assist in preoperative planning and intraoperative realignment has gained increasing popularity. The purpose of this article is to describe a surgical technique involving a medial closing wedge high tibial osteotomy performed using three-dimensional (3D) PSI and cutting guide to revise residual valgus deformity following failed distal femoral osteotomy. The correction angle, 3D position of the hinge and wedge, as well as final plate and screw position are planned preoperatively using virtual software and computed tomography imaging to allow precise surgical execution.

Background: Trochlear dysplasia represents one of the main anatomic risk factors for patellar instability, with risk of failure and unfavorable clinical outcomes in patients with unaddressed dysplasia undergoing patellar stabilization. Indications: Patients with trochlear dysplasia characterized by supratrochlear prominence (DeJour B or D) and recurrent patellar instability, especially following failed soft tissue or bony stabilization. This technique addresses an anterior trochlea without pathologic convexity, as convexity may require conversion to other techniques for groove deepening (eg, DeJour “thick flap” or Schottle “thin flap”). Technique Description: A 6-cm lateral parapatellar arthrotomy is created. A marking pen is used to identify the native center of the trochlea, as well as the location of the planned resection and bony hinge point laterally. An osteotome is used to remove a wedge of bone proximally, such that the posterior aspect of the osteotomy is in line with the anterior femoral cortex. A resection guide is then used to perforate the lateral cortex, with care to avoid damaging the cartilage, and carried laterally and distally to ensure the bony cuts are connected, creating the bony flap. To ensure that all bony bridges are eliminated, the arthroscope is placed into the osteotomy to visualize reduction of the trochlea with manual pressure. A knotless PEEK anchor loaded with 8 loaded sutures is then placed on the roof of the trochlear notch. Sutures are then secured using anchors placed at the center of the trochlea, at the superolateral corner and far lateral edge of the trochlea to reduce the osteotomy, with 2 to 3 sutures placed in each anchor depending on surgeon preference. Results: Trochleoplasty has been reported to decrease the rate of recurrent patellar dislocation while improving mean Kujala score and knee function. Benefits of trochleoplasty must be balanced against the high rate of potential complications, primarily pain and decreased knee range of motion, secondary to the technical challenges and steep learning curve inherent to effectively performing the procedure. Discussion/Conclusion: Patients with recurrent patellar instability with trochlear dysplasia and failed prior stabilization may experience improved stability and outcomes following trochleoplasty.

A variety of genetic techniques have been devised to determine cell lineage relationships during tissue development. Some of these systems monitor cell lineages spatially and/or temporally without regard to gene expression by the cells, whereas others correlate gene expression with the lineage under study. The GAL4 Technique for Real-time and Clonal Expression (G-TRACE) system allows for rapid, fluorescent protein-based visualization of both current and past GAL4 expression patterns and is therefore amenable to genome-wide expression-based lineage screens. Here we describe the results from such a screen, performed by undergraduate students of the University of California, Los Angeles (UCLA) Undergraduate Research Consortium for Functional Genomics (URCFG) and high school summer scholars as part of a discovery-based education program. The results of the screen, which reveal novel expression-based lineage patterns within the brain, the imaginal disc epithelia, and the hematopoietic lymph gland, have been compiled into the G-TRACE Expression Database (GED), an online resource for use by the Drosophila research community. The impact of this discovery-based research experience on student learning gains was assessed independently and shown to be greater than that of similar programs conducted elsewhere. Furthermore, students participating in the URCFG showed considerably higher STEM retention rates than UCLA STEM students that did not participate in the URCFG, as well as STEM students nationwide.

Purpose: To establish a better understanding of the variations in pain management protocols and prescribing patterns for pediatric patients undergoing anterior cruciate ligament (ACL) reconstruction or repair. Methods: A 20-question multiple-choice survey was distributed to 3 professional orthopaedic societies to assess the pre-emptive and postoperative pain management prescribing patterns for pediatric patients undergoing ACL reconstruction or repair. Clinical agreement (defined as agreement between >80% of participants) and general agreement (defined as agreement between >60% of participants) were calculated based on responses as previously reported. Results: Clinical agreement was observed among the 68 respondents in use of a single shot nerve block before induction of anesthesia versus continuous use when a peripheral nerve block was used, “always” counseling patients on postoperative pain control, the prescribing of opioids postoperatively, and a lack of change in postoperative protocol when concomitant meniscal repair or meniscectomy was performed. General agreement was observed in the use of a peripheral nerve block, some pre-emptive analgesia practices, and the lack of counseling patients with regard to disposal of unused opioid pain medication postoperatively. Opioids were prescribed by 88% of participants postoperatively, with 48% prescribing 11 to 19 pills and 15% prescribing ≥20 pills. Conclusions: While pain management practices before and following ACL reconstruction and repair in the pediatric population remain varied, opioids are frequently prescribed postoperatively with many providers neglecting to provide instruction on excess opioid disposal. Clinical Relevance: ACL reconstruction and repair is becoming increasingly common in the pediatric population. Clinical guidelines that establish pre-emptive and postoperative pain-control protocols should be considered to determine safe and optimal pain control throughout the duration of care while minimizing opioid prescribing and consumption.

Introduction: The influence of patient demographic factors in predicting the success and failure of HTO remains largely unknown. Objectives: To determine factors associated with success or failure after high tibial osteotomy (HTO) for unicompartmental knee pain with varus deformity at a minimum of 2-year follow-up. Methods: A prospectively collected HTO outcomes registry was queried for patients undergoing HTO. Demographic, preoperative, intraoperative, radiographic, and postoperative data were collected. Patient factors were analyzed for their association with HTO failure, which was defined as conversion to uni- or total knee arthroplasty. Results: Seventy-five patients were identified (n = 58 males; n = 17 females) with a mean age of 37.3 ± 8.7 years at surgery and average follow-up of 5.5 ± 3.8 years. Forty-eight percent (n = 36) of patients underwent reoperation, 28% (n = 21) underwent hardware removal, and 17% (n = 13) converted to arthroplasty. Increased body mass index (BMI) (> 30 kg/m2) (P = .025) and age > 45 years (P = .020) were associated with HTO failure, while performance of concomitant procedures decreased failure probabilities (P = .008). Conclusion: s: High tibial osteotomy is an effective procedure for symptomatic patients with varus deformity, associated with a significant improvement in PROs, a moderate complication rate, and a high survival rate. Reoperation rates remain common, while failure rates requiring conversion to arthroplasty necessitate HTO be performed in appropriately selected patients. Performance of concomitant joint preservation procedures at the time of HTO was protective against HTO failure, while greater patient age and BMI were associated with HTO failures. Level of Evidence: Level 4, Case series

Instability of the long head of the biceps brachii tendon is a recognized source of shoulder pain. However, this diagnosis is usually associated with concomitant pathology including subscapularis tendon tears. The appropriate diagnosis of biceps incarceration or instability remains challenging, with failure to address instability being likely to result in persistent pain and disability despite arthroscopic management of concomitant shoulder pathology. The objective of this article is to (1) describe a dynamic test performed both preoperatively and intraoperatively, termed the “biceps incarceration maneuver,” to help identify biceps instability; (2) reinforce the concept that biceps instability must be ruled out in young patients presenting with anterior shoulder pain; and (3) report that with proper diagnosis and treatment, patients with biceps instability will experience rapid symptomatic resolution after management.

Embryonal tumor with multilayered rosettes (ETMR) are rare pediatric brain tumors with increased malignant potential. Despite the advances in multimodal treatment schemes the overall 5-year event free survival rates for ETMR are not favorable. Further, therapeutic regimes are limited to a case by case basis due to the limited amount of literature and guidelines available for treating childhood ETMR. We report one patient with refractory ETMR who was successfully treated by implementing a molecular profiling approach which identified the tyrosine kinase inhibitor dasatinib as a viable therapy. Our results suggest that utilizing this precision medicine approach might prove useful in treating patients with refractory ETMR.

Acetaminophen is a common analgesic, but its potential effects on early embryonic development are not well understood. Previous studies using zebrafish (Danio rerio) have described the effects of acetaminophen on liver development and physiology, and a few have described gross physiological and morphological defects. Using a high but non-embryonic lethal dose of acetaminophen, we probed for defects in zebrafish craniofacial cartilage development. Strikingly, acetaminophen treatment caused severe craniofacial cartilage defects, primarily affecting both the presence and morphology of pharyngeal arch-derived cartilages of the viscerocranium. Delaying acetaminophen treatment restored developing cartilages in an order correlated with their corresponding pharyngeal arches, suggesting that acetaminophen may target pharyngeal arch development. Craniofacial cartilages are derived from cranial neural crest cells; however, many neural crest cells were still seen along their expected migration paths, and most remaining cartilage precursors expressed the neural crest markers sox9a and sox10, then eventually col2a1 (type II collagen). Therefore, the defects are not primarily due to an early breakdown of neural crest or cartilage differentiation. Instead, apoptosis is increased around the developing pharyngeal arches prior to chondrogenesis, further suggesting that acetaminophen may target pharyngeal arch development. Many craniofacial muscles, which develop in close proximity to the affected cartilages, were also absent in treated larvae. Taken together, these results suggest that high amounts of acetaminophen can disrupt multiple aspects of craniofacial development in zebrafish.

Purpose: Subspine impingement occurs due to a morphologically abnormal anterior inferior iliac spine (AIIS), capable of causing impingement against the distal femoral neck. The purpose of this investigation was to determine the prevalence of AIIS dysmorphism based on specimen sex, race, and age, while introducing a novel anatomic-based classification system.Methods: A total of 1,797 adult cadaveric specimens (n = 3,594 hemipelvises) were analyzed. AIIS with the potential for subspine impingement (SSI) was recorded in each specimen by two independent authors. Specimens with AIIS dysmorphism were then reexamined to determine SSI subtype using a novel descriptive anatomic classification system.Results: AIIS dysmorphism was present in 6.4% (n = 115 of 1,797 specimens) of specimens and 5.2% (n = 186 of 3,594) of hemipelvises. Dysmorphism was significantly more common in male specimens (p = 0.04) and African–American specimens (p = 0.04). No significant overall difference in prevalence was appreciated based on specimen age (p = 0.89). Subtype classification found that 67% of hemipelvises possessed a columnar type AIIS, 30% were bulbous and 3% hook type. Males possessed a significantly higher prevalence of columnar type AIIS dysmorphism (p < 0.001). No significant overall differences in anatomic classification were appreciated based on race (p = 0.12) or when analyzed based on age (p = 0.34).Conclusion: AIIS dysmorphism was present in 6.4% of the 1,797 cadaveric specimens evaluated. African-American and male specimens possessed significantly higher prevalence of AIIS dysmorphism, with no significant difference based on specimen age. Columnar type AIIS dysmorphism was most common. Anatomic classification was not significantly different based on specimen race or age.Level of Evidence: Case Series, Level IV.

A significant number of proteins possess sizable intrinsically disordered regions (IDRs). Due to the dynamic nature of IDRs, NMR spectroscopy is often the tool of choice for characterizing these segments. However, the application of NMR to IDRs is often hindered by their instability, spectral overlap and resonance assignment difficulties. Notably, these challenges increase considerably with the size of the IDR. In response to these issues, here we report the use of sortase-mediated ligation (SML) for segmental isotopic labeling of IDR-containing samples. Specifically, we have developed a ligation strategy involving a key segment of the large IDR and adjacent folded headpiece domain comprising the C-terminus of A. thaliana villin 4 (AtVLN4). This procedure significantly reduces the complexity of NMR spectra and enables group identification of signals arising from the labeled IDR fragment, a process we refer to as segmental assignment. The validity of our segmental assignment approach is corroborated by backbone residue-specific assignment of the IDR using a minimal set of standard heteronuclear NMR methods. Using segmental assignment, we further demonstrate that the IDR region adjacent to the headpiece exhibits nonuniform spectral alterations in response to temperature. Subsequent residue-specific characterization revealed two segments within the IDR that responded to temperature in markedly different ways. Overall, this study represents an important step toward the selective labeling and probing of target segments within much larger IDR contexts. Additionally, the approach described offers significant savings in NMR recording time, a valuable advantage for the study of unstable IDRs, their binding interfaces, and functional mechanisms.

Solid polymer electrolytes (SPEs) are promising for the next-generation all-solid-state lithium metal battery (LMB) applications. The effect of semicrystalline structure on ion transport is two-fold: the crystalline domains provide a tortuous diffusion pathway (structural effect) while the tethered chains can cause sluggish ion diffusion (dynamic effect). These two effects are intertwining in a bulk semicrystalline SPE system. In this work, we fabricate a series of polymer single crystal (PSC)-based SPEs by infiltrating lithium bis(trifluoromethylsulfonyl) imide (LiTFSI) into poly(ethylene oxide) (PEO) PSC films. The obtained SPE films show anisotropic conducting behavior with the in-plane conductivity being one to three orders of magnitudes greater than the through-plane conductivity, which can be attributed to the PSC-guided ion transport. The room temperature in-plane conductivity of the PSC SPE can be comparable to its amorphous counterpart, indicating that the tortuosity effect plays a major role in the reduced ionic conductivity of semicrystalline SPEs. PSC-LiTFSI superstructure is observed in the PSC SPEs due to selective perforation of the crystalline PEO lamellae by LiTFSI salts. This work demonstrates the importance of the crystalline morphology on the ion transport in semicrystalline SPEs.

Purpose: To systematically review the literature to better understand the technique, outcomes, and complications after percutaneous superficial medial collateral ligament (sMCL) lengthening during knee arthroscopy to address isolated medial meniscal pathology. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using a PRISMA checklist. The inclusion criteria consisted of English-language articles or articles with English-language translations documenting the use of percutaneous sMCL lengthening during arthroscopic knee surgery to treat isolated meniscal pathology (repair vs meniscectomy) with reported postoperative outcomes and complications. Results: Four studies met the inclusion criteria, consisting of a total of 192 patients undergoing percutaneous sMCL lengthening. No perioperative complications related to iatrogenic chondral damage, fracture, or additional meniscal injury were reported. Mild postoperative pain at the medial needle tract site lasting up to 15 days after surgery was reported in 52% of patients (46 of 88). At final follow-up, laxity on valgus stress testing showed a range from 0 to 1.1 mm with a range from –0.3° to 0.9° of radiographic medial joint space widening compared with preoperative radiographs. The length of follow-up ranged from 1.5 to 24 months. Conclusions: The percutaneous “pie-crusting” technique remains the most commonly reported technique to lengthen the sMCL during arthroscopic meniscal surgery. Percutaneous lengthening represents a safe and effective method of increasing medial joint space visualization, with no reported perioperative or postoperative complications and with minimal, likely clinically insignificant residual joint laxity after surgery on valgus stress testing at final follow-up compared with preoperative values. Level of Evidence: Level IV, systematic review of Level IV studies.

Abstract. Objectives:. To assess complications and secondary operations in patients treated with either open reduction and internal fixation (ORIF) versus percutaneous fixation of displaced intra-articular calcaneus fractures. Design:. Retrospective comparative study. Setting:. Level 1 trauma center. Patients/Participants:. Ninety-three adult patients with 111 fractures treated by a single orthopaedic traumatologist between 2001 and 2014. Intervention:. ORIF through an extensile lateral approach or percutaneous reduction and internal fixation. Main Outcome Measurements:. Wound-healing complications, infections, posttraumatic arthrosis (PTOA), and secondary procedures. Results:. Fifty patients with 58 fractures underwent ORIF, and 43 patients with 53 fractures had percutaneous fixation. Mean age was 43 years, and 80% were male. Open fractures and two-part fractures were more often treated percutaneously (26% vs 8%, P = 0.03) and (49% vs 31%, P = 0.02), respectively. Patients undergoing percutaneous fixation were more often tobacco users (58% vs 36%, P = 0.04) and with history of alcohol and other substance abuse. Twenty-seven patients (29%) had 28 complications, including 21% with PTOA, with no differences based on type of treatment. Six patients had secondary procedures, with no difference based on type of treatment. Patients with open fractures (P = 0.001) or tobacco abuse (P = 0.005) were more likely to experience complications. Conclusions:. No differences in complication rates were found for ORIF versus percutaneous fixation. Regardless of fixation technique, patients with open fractures or history of tobacco abuse were more likely to develop complications. Percutaneous reduction and fixation represents an alternative to extensile ORIF in terms of similar early and late complications, particularly in high risk patients. Level of Evidence:. Therapeutic Level III

Introduction: Distal tibial osteotomy is commonly used for surgically correcting tibial torsion. While the effect of purposeful oblique osteotomies are well described, minimal data exists regarding how variation of distal tibial osteotomy cut angle may inadvertently affect final ankle alignment. Aim: To assess changes in orientation of the cut angle in distal tibial osteotomies on ankle alignment in specimens with existing rotational deformities. Materials and Methods: Using preserved human tibia specimens; we identified ten specimens with the greatest degree of rotational deformity. Surface scanning produced a three-dimensional image of each tibia. Digitally, we created transverse and 10° angled cuts, five centimeters above the distal tibial articular surface. Specimens were three-dimensionally printed and cross-pinned at 0°, 20° and 40° of internal or external rotation. Anterior-posterior and lateral radiographs were obtained at each degree of rotation and the Anterior Distal Tibial Angle (ADTA) and Lateral Distal Tibial Angle (LDTA) were calculated. Results: No significant differences in LDTA or ADTA measurements was found based on degree of rotation in internally and externally rotated specimens using a transverse osteotomy. In angled osteotomies, LDTA and ADTA measurements were significantly different based on the degree of angulation in internally rotated (p=0.02, p=0.007; respectively), but not externally rotated (p=0.74, p=0.40; respectively) specimens. Conclusion: Distal tibia osteotomy cuts parallel to the distal joint surface can result in unanticipated coronal and sagittal plane deformity particularly with correction of internal tibial torsion. Osteotomies made perpendicular to the axis of the tibial shaft maintain native ankle alignment.

Heat stress constitutes a major threat to crop production, and according to climatic projections, night temperatures are expected to increase faster and to a greater extent compared to day temperatures. While extensive research has been dedicated to the effects of higher than optimum day temperatures on cotton physiology, metabolism, and yield, and while heat-tolerant cotton cultivars have been introduced, the responses of such heat-tolerant cultivars to high night temperatures have not been evaluated. The objective of this study was to assess the efficiency of heat-tolerant cultivars to high night temperatures stress by monitoring the physiological and biochemical responses of two cotton cultivars, differing in thermotolerance, subjected to higher than optimum night temperatures, during anthesis. To that end, growth chamber experiments were conducted using two cotton cultivars differing in thermotolerance, namely ST5288B2RF (thermosensitive) and VH260 (thermotolerant). Treatments consisted of normal day/night temperatures (32/24 °C) and high night temperatures (32/30 °C) for 2 weeks at flowering (approximately 8 eight weeks after planting). The results indicated that VH260 was more thermotolerant than ST5288 even under conditions of high night temperature stress, as it managed to maintain its net photosynthetic rates, cell membrane integrity, as well as pistil carbohydrate contents and ultimately achieved higher total reproductive weight. It was concluded that heat tolerance of thermotolerant cultivars selected under conditions of high day temperatures is also conserved under high night temperatures, while net photosynthetic rates and cell membrane integrity can be utilized as selection traits for heat tolerance under either high day or night temperatures.

PurposeTo purpose of this study was to compare arthroscopic anterior cruciate ligament (ACL) reconstruction femoral tunnel length measurements from the anterolateral portal between the standard notch view using a 30° arthroscope versus a “top-down” view utilizing a 70° arthroscope to visual the far side of the femoral tunnel aperture.MethodsArthroscopic femoral tunnel length measurements using calibrated reamers from the standard notch versus the “top-down” view were obtained and reviewed in 54 skeletally mature patients undergoing ACL reconstruction with no prior bony knee surgery. Patient age, height, weight, sex, and surgery laterality were also recorded. Measurements of femoral tunnel length were repeated using both views for inter-observer and intra-observer correlation.ResultsInter-observer and intra-observer intra-class correlation coefficients for the standard notch view and “top-down” views were excellent, with higher reliability values appreciated using the “top down” view. Mean overall femoral tunnel length measurements obtained using the standard notch view were significantly longer than measurements from the “top-down” view (p < 0.001).ConclusionsThe standard notch view provides significantly longer femoral tunnel length measurements in comparison to the “top-down” view.

Cholesterol crystals form within hepatocyte lipid droplets in human and experimental nonalcoholic steatohepatitis (NASH) and are the focus of crown-like structures (CLSs) of activated Kupffer cells (KCs). Obese, diabetic Alms1 mutant (foz/foz) mice were a fed high-fat (23%) diet containing 0.2% cholesterol for 16 weeks and then assigned to four intervention groups for 8 weeks: a) vehicle control, b) ezetimibe (5 mg/kg/day), c) atorvastatin (20 mg/kg/day), or d) ezetimibe and atorvastatin. Livers of vehicle-treated mice developed fibrosing NASH with abundant cholesterol crystallization within lipid droplets calculated to extend over 3.3% (SD, 2.2%) of liver surface area. Hepatocyte lipid droplets with prominent cholesterol crystallization were surrounded by TNFα-positive (activated) KCs forming CLSs (≥3 per high-power field). KCs that formed CLSs stained positive for NLRP3, implicating activation of the NLRP3 inflammasome in response to cholesterol crystals. In contrast, foz/foz mice treated with ezetimibe and atorvastatin showed near-complete resolution of cholesterol crystals [0.01% (SD, 0.02%) of surface area] and CLSs (0 per high-power field), with amelioration of fibrotic NASH. Ezetimibe or atorvastatin alone had intermediate effects on cholesterol crystallization, CLSs, and NASH. These findings are consistent with a causative link between exposure of hepatocytes and KCs to cholesterol crystals and with the development of NASH possibly mediated by NLRP3 activation.

Platinum coated by silver nanoparticles was synthesized, which displays a unique structure where polycrystalline platinum particles are completely encapsulated in continuous monocrystalline silver shells. These particles display accentuated electronic properties, where the silver shells gain electron density from the platinum cores, imparting enhanced properties such as oxidation resistance. This electron transfer phenomenon is highly interfacial in nature, and the degree of electron transfer decreases as the thickness of silver shell increases. The nanoparticle structure and electronic properties are studied and the implication to creating sensing probes with enhanced robustness, sensitivity and controllable plasmonic properties is discussed.

Gibberellin inhibitor growth regulators are used for cotton (Gossypium hirsutum L.) canopy manipulation to avoid excess growth and yield losses. However, under temperatures below or over the optimum for cotton production the effect of mepiquat chloride (MC) has not always been significant. In this experiment, cotton plants were grown in growth chambers to study the response to MC as affected by temperature and to determine if an increase in dose could overcome the temperature effects. Mepiquat chloride was applied at rates of 0, 15 and 30 g ai ha-1 at the pinhead square stage. Plants were then grown under three temperature regimes: 25/15 °C, 32/22 °C, and 39/29 °C (day/night temperatures) for 51 days. Higher temperatures increased plant height, reproductive branches, fruit number, fruit abscission, and photosynthesis per unit area, but decreased leaf area and chlorophyll. The largest effect of MC on plant height was observed when the daily temperature was 32 °C, with nights of 22 °C, which was also best for plant growth. High temperatures not only decreased the effectiveness of MC on plant height control, but also caused lower dry matter and fruit number per plant. Low temperatures (25/15 ºC) decreased cotton growth and fruit retention, but a higher concentration of MC was required per unit of growth reduction as compared with 32/22 ºC. At high temperatures, the rate of MC to be applied must be disproportionately increased, because either plant growth is impaired by high temperature lessening the effect of MC, or degradation of MC within the plant is too rapid.

The primary goal of the eighth industrial fluid properties simulation challenge was to test the ability of molecular simulation methods to predict the adsorption of organic adsorbates in activated carbon materials. The challenge focused on the adsorption of perfluorohexane in the activated carbon standard BAM-P109. Entrants were challenged to predict the adsorption of perfluorohexane in the activated carbon at a temperature of 273 K and at relative pressures of 0.1, 0.3, and 0.6. The relative pressure (P/P o ) is defined as that relative to the bulk saturation pressure predicted by the fluid model at a given temperature (273 K in this case). The predictions were judged by comparison to a set of experimentally determined values, which are published here for the first time and were not disclosed to the entrants prior to the challenge. Benchmark experimental studies, described herein, were also carried out and provided to entrants in order to aid in the development of new force fields and simulation methods to be employed in the challenge. These studies included argon, carbon dioxide, and water adsorption in the BAM-P109 activated carbon as well as X-ray diffraction, X-ray microtomography, photoelectron spectroscopy, and atomic emission spectroscopy studies of BAM-P109. Several concurrent studies were carried out for the BAM-P108 activated carbon. These are included in the current manuscript for comparison.

Since 2000, scientists and students from the greater Rocky Mountain region, along with invited speakers, both national and international, have gathered at the Mountain Campus of Colorado State University to discuss their area of study, present recent findings, establish or strengthen collaborations, and mentor the next generation of virologists and prionologists through formal presentations and informal discussions concerning science, grantsmanship and network development. This year, approximately 100 people attended the 17th annual Rocky Mountain Virology Association meeting, that began with a keynote presentation, and featured 29 oral and 35 poster presentations covering RNA and DNA viruses, prions, virus-host interactions and guides to successful mentorship. Since the keynote address focused on the structure and function of Zika and related flaviviruses, a special session was held to discuss RNA control. The secluded meeting at the foot of the Colorado Rocky Mountains gave ample time for in-depth discussions amid the peak of fall colors in the aspen groves while the random bear provided excitement. On behalf of the Rocky Mountain Virology Association, this report summarizes the >50 reports.