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Context: Despite the routine use of prophylactic systemic antibiotics, sternal wound infection still occurs in 5% or more of cardiac surgical patients and is associated with significant excess morbidity, mortality, and cost. The gentamicin-collagen sponge, a surgically implantable topical antibiotic, is currently approved in 54 countries. A large, 2-center, randomized trial in Sweden reported in 2005 that the sponge reduced surgical site infection by 50% in cardiac patients.Objective: To test the hypothesis that the sponge prevents infection in cardiac surgical patients at increased risk for sternal wound infection.Design, Setting, and Participants: Phase 3 single-blind, prospective randomized controlled trial, 1502 cardiac surgical patients at high risk for sternal wound infection (diabetes, body mass index >30, or both) were enrolled at 48 US sites between December 21, 2007, and March 11, 2009.Intervention: Single-blind randomization to insertion of 2 gentamicin-collagen sponges (total gentamicin of 260 mg) between the sternal halves at surgical closure (n = 753) vs no intervention (control group: n = 749). All patients received standardized care including prophylactic systemic antibiotics and rigid sternal fixation.Main Outcome Measures: The primary end point was sternal wound infection occurring through 90 days postoperatively as adjudicated by a clinical events classification committee blinded to study treatment group. The primary study comparison was done in the intent-to-treat population. Secondary outcomes included (1) superficial wound infection (involving subcutaneous tissue but not extending down to sternal fixation wires), (2) deep wound infection (involving the sternal wires, sternal bone, and/or mediastinum), and (3) score for additional treatment, presence of serous discharge, erythema, purulent exudate, separation of the deep tissues, isolation of bacteria, and duration of inpatient stay (ASEPSIS; minimum score of 0 with no theoretical maximum).Results: Of 1502 patients, 1006 had diabetes (67%) and 1137 were obese (body mass index >30) (76%). In the primary analysis, there was no significant difference in sternal wound infection in 63 of 753 patients randomized to the gentamicin-collagen sponge group (8.4%) compared with 65 of 749 patients randomized to the control group (8.7%) (P = .83). No significant differences were observed between the gentamicin-collagen sponge group and the control group, respectively, in superficial sternal wound infection (49/753 [6.5%] vs 46/749 [6.1%]; P = .77), deep sternal wound infection (14/753 [1.9%] vs 19/749 [2.5%]; P = .37), ASEPSIS score (mean [SD], 1.9 [6.4] vs 2.0 [7.2]; P = .67), or rehospitalization for sternal wound infection (23/753 [3.1%] vs 24/749 [3.2%]; P = .87).Conclusion: Among US patients with diabetes, high body mass index, or both undergoing cardiac surgery, the use of 2 gentamicin-collagen sponges compared with no intervention did not reduce the 90-day sternal wound infection rate.Trial Registration: clinicaltrials.gov Identifier: NCT00600483. [ABSTRACT FROM AUTHOR]

This article examines the role of the African American uncle as a vital yet overlooked form of social support and social capital in the lives of adolescent African American male sons living in single-female-headed households. Research rarely examines the affective roles and functions of men in Black families; moreover, poor urban Black male youth are typically portrayed as a monolithic and homogeneous group who lack positive relationships with their biological fathers. The absence of these relationships has been correlated to numerous social problems for Black male youthDLspecifically, delinquency and violent behavior. Although much of the work on African American fatherhood has focused on the role of the biological father (and, to some extent, the stepfather), minimal attention has been given to men within extended familial networks and their impact on successful adolescent development among young African American males. [ABSTRACT FROM AUTHOR]

Background: Illinois experienced a historic firearm violence surge in 2016 with a decline to baseline rates in 2018. This study aimed to understand this 2016 surge through the direct accounts of violence prevention community-based organisations (CBOs) in Illinois., Methods: We conducted semistructured interviews with 20 representatives from 13 CBOs from the south and west sides of greater Chicago metropolitan area. Interviews were audio recorded, coded and analysed thematically., Results: We identified lack of government-derived infrastructure and systemic poverty as the central themes of Illinois's 2016 firearm violence surge. Participants highlighted the Illinois Budget Impasse halted funding for violence prevention efforts, leading to 2016's violence. This occurred in the context of a strained relationship with the criminal justice system, where disengagement from police and mistrust in the justice system led victims and families to seek justice outside of the judicial system. Participants emphasised that systemic poverty and the obliteration of community support structures led to overwhelming desperation, which, in turn, increased risky behaviours perceived as necessary for survival. Participants disproportionately identified that this impacted the young people in their communities., Conclusions: Lack of government-derived infrastructure and systemic poverty were the central themes of the 2016 firearm violence surge. The insights gained from the 2016 surge are applicable to understanding both current and future surges. CBOs focused on violence prevention offer insights into the context and conditions fuelling surges in the epidemic of violence., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Japanese encephalitis is a disease caused by the Japanese encephalitis virus (JEV) and is a concern for U.S. military personnel stationed in the Republic of Korea (ROK). The recent literature reports a potential shift from GI to GV as the dominant genotype circulating in east Asia. In the ROK, GV has been reported in a few Culex spp., but not in the main JEV vector, Cx . tritaeniorhynchus . The goal of this surveillance was to shed light on the current knowledge of the epidemiology of JEV in the ROK by analyzing mosquito collection data from three consecutive years, 2021-2023, and molecularly detecting and genotyping JEV in all Culex spp. collected in several military locations across the ROK. In this study, we detected only JEV GI in Cx . tritaeniorhynchus in 2021 samples. In contrast, all 2022 and 2023 positive samples were GV and detected in Cx . bitaeniorhynchus , Cx . orientalis , and Cx . pipiens . Results support a shift in JEV genotype in the ROK and suggest that for GV, Culex spp. other than Cx . tritaeniorhynchus may be playing an important role.

We present a machine learning method to directly estimate viscoelastic moduli from displacement time-series profiles generated by viscoelastic response (VisR) ultrasound excitations. VisR uses two colocalized acoustic radiation force (ARF) pushes to approximate tissue viscoelastic creep response and tracks displacements on-axis to measure the material relaxation. A fully connected neural network is trained to learn a nonlinear mapping from VisR displacements, the push focal depth, and the measurement axial depth to the material elastic and viscous moduli. In this work, we assess the validity of quantitative VisR (QVisR) in simulated materials, propose a method of domain adaption to phantom VisR displacements, and show in vivo estimates from a clinically acquired dataset.

Two clinically important subspecies, Francisella tularensis subsp. tularensis (type A) and F. tularensis subsp. holarctica (type B) are responsible for most tularaemia cases, but these isolates typically form a weak biofilm under in vitro conditions. Phase variation of the F. tularensis lipopolysaccharide (LPS) has been reported in these subspecies, but the role of variation is unclear as LPS is crucial for virulence. We previously demonstrated that a subpopulation of LPS variants can constitutively form a robust biofilm in vitro, but it is unclear whether virulence was affected. In this study, we show that biofilm-forming variants of both fully virulent F. tularensis subspecies were highly attenuated in the murine tularaemia model by multiple challenge routes. Genomic sequencing was performed on these strains, which revealed that all biofilm-forming variants contained a lesion within the wbtJ gene, a formyltransferase involved in O-antigen synthesis. A Δ wbtJ deletion mutant recapitulated the biofilm, O-antigen and virulence phenotypes observed in natural variants and could be rescued through complementation with a functional wbtJ gene. Since the spontaneously derived biofilm-forming isolates in this study were a subpopulation of natural variants, reversion events to the wbtJ gene were detected that eliminated the phenotypes associated with biofilm variants and restored virulence. These results demonstrate a role for WbtJ in biofilm formation, LPS variation and virulence of F. tularensis .

Foraging for edible and medicinal mushrooms is a cultural and social practice both globally and in the United States. Determining the toxic and nutrient element concentrations of edible and medicinal mushrooms is needed to ensure the safe consumption of this food source. Our research examined wild, foraged mushrooms in New England, USA to assess nutrient (Ca, K, Mg, P) and toxic (As, Hg, Pb, Cd) element relationships between mushrooms, substrates, and soils. We examined a gradient in nutrient and toxic elements from more rural Mountain and Hill Zones in Massachusetts, Vermont, and New Hampshire to more developed and urban Valley and Coastal Zones in Connecticut. Substrates and mineral soils were moderate to weak predictors of mushroom tissue concentrations. We found significant differences in nutrient and toxic element concentration among the five common genera: Ganoderma, Megacollybia, Pluteus, Pleurotus, and Russula. In particular, Pluteus had consistently higher toxic element concentrations while Pleurotus and Russula had the highest Bioaccumulation Factors (BAFs). We found that the urban areas of the Valley and Coastal zones of Connecticut had Cd Target Hazard Quotient (THQ) values and ΣTHQ values > 1.0, indicating potential non-carcinogenic health hazard. However, the trend was largely driven by the > 2.0 Cd THQ for Pluteus. Our results suggest that foraging in more urban areas can still yield mushrooms with safe concentrations of toxic elements and abundant nutrients. Further research of this kind needs to be conducted within this region and globally to ensure humans are consuming safe, foraged mushrooms., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

European oyster (Ostrea edulis) can be used for biological monitoring of water and sediment quality and serve as a conduit of trace elements to humans via consumption. Trace element concentrations in seawater, sediment, O. edulis edible tissues and shells from Boston Harbor were studied and found to be elevated relative to comparative studies in native ecosystems in the Adriatic Sea and Bay of Biscay. Average edible oyster tissues concentrations (mg/kg) were: arsenic 6, cadmium 1.7, cobalt 3.1, chromium 1.9, copper 153, mercury 0.265, nickel 1.8, lead 3.3, and zinc 2390. Arsenic was elevated in seawater and oyster shells. Mercury was elevated in sediments and oyster tissues. Lead was elevated in suspended sediments. Total Hazard Quotient (THQ) was < 1 but when summed across trace elements, THQ was nominally > 1 for all sites. Further study is warranted to determine mechanisms and spatial extent of bioaccumulation., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Understanding drivers of nutrient and pollutant elements (NPEs) in soils, sediments, and river water is important for protecting water resources and aquatic ecosystems. The objectives of this study were to quantify accumulation and transport of NPEs (P, As, Cd, Cu, Ni, Pb, and Zn) in riparian soils, sediments, river water, and watershed-scale exports within seven post-industrial subwatersheds of the Thames River, Connecticut, USA. Suspended sediments and river water samples were collected from February 2019 to January 2020. Arsenic concentrations in soil (6 to 18 mg kg -1 ) and sediments (8 to 85 mg kg -1 ) generally exceeded state and federal EPA quality targets but not river water. Elevated Pb 'hot spots' occurred in some riparian soils (>2000 mg kg -1 ) and sediments (>200 mg kg -1 ), but the other NPEs concentrations were below toxic thresholds. Riparian soil concentrations and watershed land cover were generally weak predictors for NPE concentrations in bottom sediments, suspended sediments, and river water. DOC, Mn, and Fe concentrations were important predictors for area-normalized dissolved and sediment-bound export of NPEs across the seven watersheds. Dissolved export was greater than sediment export for Mn, P, As, Cd, Cu, and Ni but not for Fe, Pb, and Zn. Watersheds with higher farmland had higher P river water concentrations, but the larger, more urbanized watershed had the highest total and area-normalized P export. An estuarine sediment core that captures sediment from the whole watershed and spans pre-industrial conditions through present shows that export of most NPEs has decreased since its peak, but all remain above baseline throughout the Thames River watershed. Future constraints on surface soil-river exchange and erosion inputs are needed to investigate rates of NPE sourcing to the watersheds., Competing Interests: Declaration of competing interest The authors state that work was conducted without any personal, professional, or financial relationships that could potentially be construed as a conflict of interest. This study was funded by the College of Natural Sciences at the University of Massachusetts Amherst., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Urban forest soils perform important ecosystem services, such as the sequestration of potentially toxic elements, but some can serve as a source for human exposure if ingested or eroded by wind. Assessment of trace elements in urban soils through traditional methods is costly but portable X-ray fluorescence (pXRF) can allow for rapid screening for hazardous concentrations. Our objectives were (1) evaluate trace elements (As, Cd, Cr, Cu, Pb, and Zn) at 460 locations in and around urban forests across three town and cities in New England and across multiple land-uses, (2) evaluate accuracy and precision of pXRF compared with traditional digestion-inductively coupled plasma analyses, (3) determine if pXRF measurements are improved by processing the soil (oven drying, rock fragment removal, and organic matter (OM) removal). Our findings show that urban forest soils have extensive Pb accumulations (42 out of 460 with >200 mg/kg), while As and Zn exceeded regulatory limits in limited outlier samples. Urban forest soils adjacent to multi-family residences have higher Pb and Zn concentrations than recreational and open lots. Fortunately, Cd, Cr, and Cu were far below hazardous concentrations. Our comparisons suggest pXRF measurements of Cu, Pb, and Zn can be considered accurate while Cd and Cr may be screened by pXRF. However, As should not be considered qualitative nor quantitative due to 70% type 1 (false positive) error on samples. While the accuracy and precision were nominally improved through soil drying, removal of rock fragments, and removal of OM (<5% decrease in relative error), our results show processing soil samples is likely not needed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Sulfidic schists are important rock formations due to their trace metal and metalloid (TMM) content and carry the potential for pyrite and pyrrhotite to hydrate and oxidize leading to acid-enhanced chemical weathering. The objectives of this study were to compare TMMs in sulfidic schists to other co-occurring bedrock, evaluate conditions that optimize TMM rock weathering, and examine streamwater TMMs in relation to bedrock lithology and human development in eleven streams across central Massachusetts. Sulfidic schists samples had the highest As (72 ± 46 mg kg -1 ), Cu (63 ± 21 mg kg -1 ), and Pb (63 ± 33 mg kg -1 ) concentrations. Electron Probe Microanalysis (EPMA) images show As and Pb were widely distributed across silicate and sulfide minerals in both the mica schist and sulfidic schists, not exclusively hosted in sulfide minerals as hypothesized. Batch reactors had TMM dissolution rates an order of magnitude higher for sulfidic schists than granite and mica schists. Furthermore, TMM dissolution was greatest under pH 9 than pH 7 or pH 5 and dissolution rates were two times greater under anoxic conditions compared to oxic conditions. Streamwater concentrations of As (0.01 to 10.3 μg L -1 ), Cu (0.2 to 206 μg L -1 ), and Pb (0.001 to 8.3 μg L -1 ) were below Massachusetts Surface Water Quality Standards. Across the eleven watersheds, % sulfidic schists were positively correlated with mean streamwater S and Cu concentrations and area-normalized annual export. Streamwater As and Pb concentrations were significantly correlated with %Developed land and %Mica schist, which strongly covaried. Our study confirmed the elevated abundance of TMMs in sulfidic schists but laboratory experiments suggest the precipitation of amorphous Fe oxyhydroxide phases decreased dissolved TMMs during oxic weathering. Future work will need to incorporate groundwater and stable isotope systems to separate anthropogenic and geogenic analyses., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Challenges in participant recruitment and retention limit the effectiveness of hospital-based violence intervention programs (HVIPs). This study aimed to determine if an outpatient violence intervention program (VIP) could be integrated into a trauma clinic and increase uptake of violence prevention services. Patients previously hospitalized for intent-to-harm being seen for outpatient follow-up were eligible. VIP counselors met with participants during their clinic visit, administered the survey, and offered violence prevention services (April to June 2019). Patients were followed for 6 months to assess involvement. The primary outcome of interest was long-term participation in the VIP, defined as uptake of services at 6 months, in comparison to inpatient recruitment. Out of 76 patients, 34 (44.7%) did not appear for their appointment. The remainder (n = 42) were offered participation in the study, of which 32 (76.2%) completed the survey. From the group offered VIP services, 57.1% expressed interest, and 5 (20.8%) ultimately took part yielding an overall participation rate of 11.9% at 6 months. The inpatient recruitment rate in 2019 was 2.4%. An outpatient VIP program can be integrated into a clinic setting but suffers from the same challenges faced by inpatient programs resulting in low rates of long-term participation in services. Although a high proportion of participants reported interest, actual engagement at 6 months was low. Reasons behind low participation in VIP services must be investigated., (© 2022. Society for Prevention Research.)

Objective: To examine repair tissue formed approximately 15 months after a chondral harvest in the human knee., Design: Sixteen individuals (12 males, 4 females, mean age 36 ± 9 years) underwent a chondral harvest in the trochlea as a pre-requisite for autologous chondrocyte implantation (ACI) treatment. The harvest site was assessed via MRI at 14.3 ± 3.2 months and arthroscopy at 15 ± 3.5 months (using the Oswestry Arthroscopy Score [O-AS] and the International Cartilage Repair Society Arthroscopy Score [ICRS-AS]). Core biopsies (1.8 mm diameter, n = 16) of repair tissue obtained at arthroscopy were assessed histologically (using the ICRS II and OsScore histology scores) and examined via immunohistochemistry for the presence of collagen types I and II., Results: The mean O-AS and ICRS-AS of the repaired harvest sites were 7.2 ± 3.2 and 10.1 ± 3.5, respectively, with 80.3% ± 26% repair fill depth on MRI. The histological quality of the repair tissue formed was variable, with some hyaline cartilage present in 50% of the biopsies; where this occurred, it was associated with a significantly higher ICRS-AS than those with no hyaline cartilage present (median 11 vs. 7.5, P = 0.049). Collagen types I and II were detected in 12/14 and 10/13 biopsies, respectively., Conclusions: We demonstrate good-quality structural repair tissue formed following cartilage harvest in ACI, suggesting this site can be useful to study endogenous cartilage repair in humans. The trochlea is less commonly affected by osteoarthritis; therefore, location may be critical for spontaneous repair. Understanding the mechanisms and factors influencing this could improve future treatments for cartilage defects.