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Introduction: Nucleic acid tests for blood donor screening have improved the safety of the blood supply; however, increasing numbers of emerging pathogen tests are burdensome. Multiplex testing platforms are a potential solution.Methods: The Blood Borne Pathogen Resequencing Microarray Expanded (BBP-RMAv.2) can perform multiplex detection and identification of 80 viruses, bacteria and parasites. This study evaluated pathogen detection in human blood or plasma. Samples spiked with selected pathogens, each with one of 6 viruses, 2 bacteria and 5 protozoans were tested on this platform. The nucleic acids were extracted, amplified using multiplexed sets of primers, and hybridized to a microarray. The reported sequences were aligned to a database to identify the pathogen. To directly compare the microarray to an emerging molecular approach, the amplified nucleic acids were also submitted to nanopore next generation sequencing (NGS).Results: The BBP-RMAv.2 detected viral pathogens at a concentration as low as 100 copies/ml and a range of concentrations from 1,000 to 100,000 copies/ml for all the spiked pathogens. Coded specimens were identified correctly demonstrating the effectiveness of the platform. The nanopore sequencing correctly identified most samples and the results of the two platforms were compared.Discussion: These results indicated that the BBP-RMAv.2 could be employed for multiplex detection with potential for use in blood safety or disease diagnosis. The NGS was nearly as effective at identifying pathogens in blood and performed better than BBP-RMAv.2 at identifying pathogen-negative samples.

Itylos titicaca (Weyner 1890) has been reported to have a narrow distribution range associated with Andean wetlands called “bofedales” in Peru, Bolivia, northeast Chile and northwest Argentina. In Chile its distribution is between the upper Puna and lower Alpine belts, recorded from 3800 to 4900 m. This study reports a new elevation record of I. titicaca above 5200 m at Sora Pata Lake, northeast of Caquena in the highlands of the Chilean altiplano. Furthermore, this finding establishes the highest report for the genus Itylos, and one of the highest reports for the family Lycaenidae, with several records of individuals breeding in extreme elevations. Further data, principally from Himalayas and other high mountain ranges, is needed to confirm whether this could be the highest record for the family Lycaenidae.

Identifying suitable animal models and standardizing preclinical methods are important for the generation, characterization, and development of new vaccines, including those against Francisella tularensis. Non-human primates represent an important animal model to evaluate tularemia vaccine efficacy, and the use of correlates of vaccine-induced protection may facilitate bridging immune responses from non-human primates to people. However, among small animals, Fischer 344 rats represent a valuable resource for initial studies to evaluate immune responses, to identify correlates of protection, and to screen novel vaccines. In this study, we performed a comparative analysis of three Fischer rat substrains to determine potential differences in immune responses, to evaluate methods used to quantify potential correlates of protection, and to evaluate protection after vaccination. To this end, we took advantage of data previously generated using one of the rat substrains by evaluating two live vaccines, LVS and F. tularensis SchuS4-ΔclpB (ΔclpB). We compared immune responses after primary vaccination, adaptive immune responses upon re-stimulation of leukocytes in vitro, and sensitivity to aerosol challenge. Despite some detectable differences, the results highlight the similarity of immune responses to tularemia vaccines and challenge outcomes between the three substrains, indicating that all offer acceptable and comparable approaches as animal models to study Francisella infection and immunity.

Abstract Reactive nitrogen (Nr) concentrations are higher than expected for mountain lakes in Rocky Mountain National Park, and for many years, high Nr concentrations have been attributed to atmospheric Nr deposition from regional and more distant emission sources, including combustion of fossil fuels and agricultural activities. Here, we estimated the contribution from a very local source, that of human urine, related to intensive use by visitors in Loch Vale Watershed (LVWS). Not only does urine convey hormones, pharmaceuticals, antibiotic‐resistant bacteria, and antibiotic‐resistant genes to the environment, but it also contributes Nr, which contributes to loss of biodiversity and eutrophication. Using caffeine as a specific marker for human urine, we compared the calculated maximum potential input of urine with that from wet atmospheric Nr deposition. The maximum potential input is a worst‐case scenario. Nearly 30,000 and 45,000 people hiked the 4.0 km to the Loch, the lowest lake in LVWS, in June–September 2019 and 2020, respectively. Informal trails and informal latrine sites were mapped, and the contribution of human urine was calculated based on several assumptions, including that each visitor voided their bladder on the ground once per visit somewhere in Loch Vale. The resulting Nr input from urine in Loch Vale for the summer months of June through September was 0.02 kg Nr ha−1, and prorated to a full year, the 2019 potential contribution of human waste was 0.06 kg ha−1 year−1. These values are compared with June–September 1.2 kg Nr ha−1 from wet atmospheric deposition or annual measured 2019 deposition of 2.5 kg Nr ha−1 year−1, to indicate a contribution of 2% Nr to the waters of Loch Vale from local human urine. Most Nr in this alpine and subalpine watershed is still attributable to emissions and subsequent wet atmospheric deposition, but a 2% contribution from human waste is not insignificant. In the very broadest sense, our results document an ecological disturbance from an unprecedented level of human activity in a protected and designated wilderness area. Local solutions to this local problem could include greater outreach to visitors of public lands about the consequences of their activities and installation of latrines.

Background: The most common complication following ileal pouch-anal anastomosis (IPAA) in patients with ulcerative colitis (UC) is pouchitis. Our study aimed to investigate the relationship between histopathologic findings of ileitis, granuloma, or transmural inflammation on the colectomy specimen of patients with clinically and endoscopically diagnosed UC and the development of pouchitis within the first 2 years after IPAA. Methods: We performed a retrospective cohort study evaluating patients undergoing colectomy with IPAA for UC between January 1, 2004 and December 31, 2016. Bivariate analyses were conducted to evaluate the relationship between clinical factors and the development of pouchitis. We performed multivariate logistic regression to evaluate the relationship between histologic, clinical, and demographic factors at the time of colectomy and subsequent development of pouchitis. Results: Among 626 patients, pouchitis occurred in 246 (39%). Patients with primary sclerosing cholangitis were more likely to develop pouchitis (adjusted odds ratio [aOR] 2.81, 95% confidence interval [CI] 1.02–7.72), as were patients with a family history of inflammatory bowel disease (aOR 1.75, 95% CI 1.11–2.77). Histologic findings of ileitis, granuloma, or transmural inflammation were not associated with an increased odds of developing pouchitis (aOR 0.70, 95% CI 0.45–1.08). Discussion/Conclusion: Patients with ileitis, granulomas, or transmural inflammation at the time of colectomy were not at greater risk for development of pouchitis in the 2 years after IPAA. These pathological findings should not preclude IPAA for UC.

Su Chul Jang et al. develop exoSTING, consisting of an engineered extracellular vesicle loaded with a potent cyclic dinucleotide (CDN) agonist of the STING pathway. They find that exoSTING shows more than 100-fold increased potency in in vivo tumor models and has increased tumor retention and lower levels of systemic inflammatory cytokine production as compared to free CDN.

Background: The Patient Reported Outcomes Measurement Information System (PROMIS) Computerized Adaptive Test (CAT) physical function rapidly assesses self-reported function capability. The Timed Up and Go (TUG) test is often used in clinical practice, but administration may be impeded by space and patient limitations. PROMIS CAT can potentially address these limitations, but we lack evidence if TUG and health indicators are predictors of PROMIS CAT. This study assessed whether TUG, body mass index (BMI), numeric pain rating scale (NPRS), and smoking status were predictors of PROMIS CAT in total knee arthroplasty (TKA) candidates. Methods: Sixty-five TKA candidates completed the PROMIS CAT physical function test using an iPad application. TUG, NPRS, BMI, and smoking status were obtained at the clinic visit or from medical records. Univariate and multiple regression analyses identified the strongest predictors of PROMIS CAT. Results: TUG was the best predictor of PROMIS CAT physical function based on simple regression (r = −0.43, 95% CI = −0.62 to −0.20) or multiple regression (βˆ = −0.45, 95% CI = −0.73 to −0.17) analyses. BMI and NPRS did not incrementally help predict the PROMIS score beyond TUG. Smoking status did not contribute to the prediction of the PROMIS CAT score. Conclusions: The findings suggest that the PROMIS CAT physical function is not a surrogate for the TUG performance-based measure in candidates for TKA. However, TUG was the best predictor of PROMIS physical function compared with BMI, NPRS, and smoking status. Clinicians should consider both patient-reported and performance-based measures when evaluating function for TKA outcomes. Keywords: Prediction, Osteoarthritis, Outcomes, Self-report, Performance-based

ABSTRACT Glena mielkei Vargas, 2010 (Lepidoptera: Geometridae: Ennominae: Boarmiini) is a Neotropical geometrid moth native to the Atacama Desert of northern Chile whose larvae are folivorous on the shrub Trixis cacalioides (Asteraecae). The last instar and pupa are described and illustrated, and DNA barcode sequences are provided for the first time for G. mielkei. Descriptions are made based on larvae collected in the type locality. Comparisons with the available descriptions of congeneric species suggest that the chaetotaxy of the SV group of the abdominal segment and the morphology of the cremaster could be useful tools to species identification based on last instar and pupa, respectively. A search in BOLD (Barcode of Life Data System) showed that the only DNA barcode haplotype found in the two specimens sequenced was closest to Physocleora Warren, 1897 than Glena Hulst, 1896. These results coincide with the morphological peculiarities of the genitalia highlighted in the original description of G. mielkei, suggesting that a definitive assessment of the generic status of this geometrid moth deserves further integrative studies.

This department, sponsored by the Council on Graduate Education for Administration in Nursing (CGEAN), provides information updates to nurse leaders on educational trends, issues, and research important for effective health system administration. The CGEAN Web site can be accessed at http://www.ibiblio.org/cgean/. In this article, the authors share the CGEAN members' reactions to the American Nurses Association's draft of 'Nursing Administration: Scope and Standards of Practice.' [ABSTRACT FROM AUTHOR]

Providing nursing administrators with excellent educational programming is imperative for the profession. The author analyzes trends in nursing administration education in the United States and how they compare with standards and future recommendations for graduate curricula. The degrees conferred, curricula, hours of study, and educational modalities are examined in 57 master's degrees in nursing programs with concentrations in administration. [ABSTRACT FROM AUTHOR]

Eugnosta azapaensis Vargas and Moreira, 2015 (Lepidoptera: Tortricidae) is a micromoth native to the Atacama Desert whose larvae induce fusiform galls in shoots of Baccharis salicifolia (Ruiz & Pav.) Pers. (Asteraceae). The presence of this cecidogenous tortricid was previously recorded only from the type locality, the Azapa Valley, Arica Province, northern Chile. However, fusiform galls on shoots of B. salicifolia were recently found in Chaca, another coastal valley of the Atacama Desert. The adults obtained from these galls were preliminarily identified as E. azapaensis based on morphology. Subsequently, to assess an additional source of evidence for the taxonomic identification of E. azapaensis in this new locality, sequences of the DNA barcode fragment of the cytochrome oxidase subunit I mitochondrial gene from the two localities were analyzed. Four haplotypes were detected, two restricted to Azapa and two restricted to Chaca. The genetic divergence (K2P) between haplotypes of each locality was 0.2–0.8%, while it was 1.1–1.4% between haplotypes of different localities, and 8.7–13.5% between the Chilean haplotypes and other species of Eugnosta Hübner, 1825. In addition, all the sequences of Azapa and Chaca were clustered in a well-supported group in a Maximum Likelihood (ML) analysis. Accordingly, divergence and ML analyses support the morphological identification of E. azapaensis in the Chaca Valley. Furthermore, although preliminary, the analyses suggest that the genetic variation of the populations of this insect could be geographically structured, a pattern that must be assessed in further studies. Keywords: Asteraceae, Baccharis salicifolia, Chile, DNA barcodes

An 11-year-old male German Shepherd dog presented for inappetence and weight loss. Physical examination and initial bloodwork revealed palpable abdominal masses, mild non-regenerative anemia and thrombocytopenia. Survey radiography and abdominal ultrasonography confirmed the presence of bilateral abdominal masses and lymphadenopathy. Contrast-enhanced computed tomography (CT) was performed in order to further investigate the origin of the intraabdominal masses, confirming two enlarged cryptorchid testes, one of which had an associated CT whirl sign. Histopathology of the testes and lymph nodes revealed bilateral malignant Sertoli cell tumors and seminomas with lymph node metastasis of both neoplasms. The purpose of this case report is to discuss the benefits of CT in the diagnosis of cryptorchid testes and describe an additional organ that may display CT whirl sign.

Marine ecologists and managers need to know the spatial extent of at-sea areas most frequented by the groups of wildlife they study or manage. Defining group-specific ranges and distributions (i.e. space use at the level of species, population, age-class, etc.) can help to identify the source or severity of common or distinct threats among different at-risk groups. In biologging studies, this is accomplished by estimating the space use of a group based on a sample of tracked individuals. A major assumption of these studies is consistency in individual movements among members of a group. The implications of scaling up individual-level tracking data to infer higher-level spatial patterns for groups (i.e. size and extent of areas used, overlap or segregation among groups) is not well documented for wide-ranging pelagic species with high potential for individual variation in space use. We present a case study exploring the effects of sampling (i.e. number and identity of individuals contributing to an analysis) on defining group-specific space use with year-round multi-colony tracking data from two highly vagile species, Laysan (Phoebastria immutabilis) and black-footed (P. nigripes) albatrosses. The results clearly demonstrate that caution is warranted when defining space use for a specific species-colony-period group based on datasets of small, intermediate, or relatively large sample sizes (ranging from n=3-42 tracked individuals) due to a high degree of individual-level variation in movements. Overall, we provide further support to the recommendation that biologging studies aiming to define higher-level patterns in space use exercise restraint in the scope of inference, particularly when pooled Kernel Density Estimation techniques are applied to small datasets for wide-ranging species. Transparent reporting in respect to the potential limitations of the data can in turn better inform both biological interpretations and science-based management decisions.

Sodium nitroprusside (SNP) has been widely used to control blood pressure in infants and children. The goals of this analysis were to develop models that describe the hemodynamic response to SNP dosing in pediatric patients; examine sources of variation in dose-response, defining age and size dependencies; and determine vulnerable populations or patient subtypes that may elicit dosing modifications. A multi-center, randomized, double-blinded, parallel-group, dose-ranging, effect-controlled study, followed by an open-label dose titration of an intravenous infusion of SNP was undertaken in 203 pediatric subjects, who required deliberate hypotension or controlled normotension during anesthesia. A total of 3,464 MAP measurements collected from 202 patients during the study’s blinded phase, including baseline measurements up to 6 min prior to the blinded were available for analysis. A population K-PD model was developed with a one-compartment model assumed for SNP. Size differences in CL and V of the effect compartment were described using theory-based allometry. An inhibitory sigmoidal Emax model was used to describe the effect of SNP. A power function of age was used to describe age-related differences in baseline MAP. A mixture model of two groups with low and high EC50 was used to explain variability in MAP response. Change in MAP was characterized by a linear disease progression slope during the blinded phase. In the final population model, CL and V increased with weight, and baseline MAP increased with age. The effect compartment half-life of SNP was 13.4 min. The infusion rate producing 50% of Emax (ER50) at steady state for high EC50, was 0.34 µg/kg/min and for low EC50 0.103 µg/kg/min. The K-PD model well describes initial dosing of SNP under controlled circumstances; model-based dosing guidance agrees with current practice. An initial titration strategy supported via algorithm-based feedback should improve maintenance of target MAP.

Purpose. (1) To define the onset and offset of the blood-pressure-lowering effects of sodium nitroprusside (SNP) for use in developing instructions for dose titration in children undergoing a surgical or medical procedure, and (2) to assess the safety of SNP administration in pediatric patients requiring controlled reduction of blood pressure.Methods. We conducted a randomized, double-blind, parallel-group, dose-ranging, effect-controlled, multicenter study of intravenous (IV) infusions of SNP in pediatric patients

Processing of sensory information relies on interacting mechanisms of sustained attention and attentional capture, both of which operate in space and on object features. While evidence indicates that exogenous attentional capture, a mechanism previously understood to be automatic, can be eliminated while concurrently performing a demanding task, we reframe this phenomena within the theoretical framework of the ‘attention set’ (Most et al., 2005). Consequently, the specific prediction that cuing effects should reappear when feature dimensions of the cue overlap with those in the attention set (i.e., elements of the demanding task) was empirically tested and confirmed using a dual-task paradigm involving both sustained attention and attentional capture, adapted from Santangelo et al. (2007). Participants were required to either detect a centrally presented target presented in a stream of distractors (the primary task), or respond to a spatially cued target (the secondary task). Importantly, the spatial cue could either share features with the target in the centrally presented primary task, or not share any features. Overall, results supported the attention set hypothesis showing that a spatial cuing effect was only observed when the peripheral cue shared a feature with objects that were already in the attention set (i.e., the primary task). However, this finding was accompanied by differential attentional orienting dependent on the different types of objects within the attention set, with feature-based orienting occurring for target-related objects, and additional spatial-based orienting for distractor-related objects.

Lignin is a ubiquitous polymer present in cell walls of all vascular plants, where it rigidifies and strengthens the cell wall structure through covalent cross-linkages to cell wall polysaccharides. The presence of lignin makes the cell wall recalcitrant to conversion into fermentable sugars for bioenergy uses. Therefore, reducing lignin content and modifying its linkages have become major targets for bioenergy feedstock development through either biotechnology or traditional plant breeding. In addition, lignin synthesis has long been implicated as an important plant defense mechanism against pathogens, because lignin synthesis is often induced at the site of pathogen attack. This article explores the impact of lignin modifications on the susceptibility of a range of plant species to their associated pathogens, and the implications for development of feedstocks for the second-generation biofuels industry. Surprisingly, there are some instances where plants modified in lignin synthesis may display increased resistance to associated pathogens, which is explored in this article.

While modulating neural activity through stimulation is an effective treatment for neurological diseases such as Parkinson’s disease and essential tremor, an opportunity for improving neuromodulation therapy remains in automatically adjusting therapy to continuously optimize patient outcomes. Practical issues associated with achieving this include the paucity of human data related to disease states, poorly validated estimators of patient state, and unknown dynamic mappings of optimal stimulation parameters based on estimated states. To overcome these challenges, we present an investigational platform including: an implanted sensing and stimulation device to collect data and run automated closed-loop algorithms; an external tool to prototype classifier and control-policy algorithms; and real-time telemetry to update the implanted device firmware and monitor its state. The prototyping system was demonstrated in a chronic large animal model studying hippocampal dynamics. We used the platform to find biomarkers of the observed states and transfer functions of different stimulation amplitudes. Data showed that moderate levels of stimulation suppress hippocampal beta activity, while high levels of stimulation produce seizure-like after-discharge activity. The biomarker and transfer function observations were mapped into classifier and control-policy algorithms, which were downloaded to the implanted device to continuously titrate stimulation amplitude for the desired network effect. The platform is designed to be a flexible prototyping tool and could be used to develop improved mechanistic models and automated closed-loop systems for a variety of neurological disorders.

Rapidly evolving research examining the extended role of human beta-defensins (hBDs) in chemoattraction, innate immune-mediated response and promotion of angiogenesis suggest that the collective effects of hBDs extend well beyond their antimicrobial mechanism(s). Indeed, the numerous basic cellular functions associated with hBDs demonstrate that these peptides have dual impact on health, as they may be advantageous under certain conditions, but potentially detrimental in others. The consequences of these functions are reflected in the overexpression of hBDs in diseases, such as psoriasis, and recently the association of hBDs with pro-tumoral signaling. The mechanisms regulating hBD response in health and disease are still being elucidated. Clearly the spectrum of function now attributed to hBD regulation identifies these molecules as important cellular regulators, whose appropriate expression is critical for proper immune surveillance; i.e., expression of hBDs in proximity to areas of cellular dysregulation may inadvertently exacerbate disease progression. Understanding the mechanism(s) that regulate contextual signaling of hBDs is an important area of concentration in our laboratories. Using a combination of immunologic, biochemical and molecular biologic approaches, we have identified signaling pathways associated with hBD promotion of immune homeostasis and have begun to dissect the inappropriate role that beta-defensins may assume in disease.

Abstract Eugnosta azapaensis Vargas and Moreira, 2015 (Lepidoptera: Tortricidae) is a micromoth native to the Atacama Desert whose larvae induce fusiform galls in shoots of Baccharis salicifolia (Ruiz & Pav.) Pers. (Asteraceae). The presence of this cecidogenous tortricid was previously recorded only from the type locality, the Azapa Valley, Arica Province, northern Chile. However, fusiform galls on shoots of B. salicifolia were recently found in Chaca, another coastal valley of the Atacama Desert. The adults obtained from these galls were preliminarily identified as E. azapaensis based on morphology. Subsequently, to assess an additional source of evidence for the taxonomic identification of E. azapaensis in this new locality, sequences of the DNA barcode fragment of the cytochrome oxidase subunit I mitochondrial gene from the two localities were analyzed. Four haplotypes were detected, two restricted to Azapa and two restricted to Chaca. The genetic divergence (K2P) between haplotypes of each locality was 0.2-0.8%, while it was 1.1-1.4% between haplotypes of different localities, and 8.7-13.5% between the Chilean haplotypes and other species of Eugnosta Hübner, 1825. In addition, all the sequences of Azapa and Chaca were clustered in a well-supported group in a Maximum Likelihood (ML) analysis. Accordingly, divergence and ML analyses support the morphological identification of E. azapaensis in the Chaca Valley. Furthermore, although preliminary, the analyses suggest that the genetic variation of the populations of this insect could be geographically structured, a pattern that must be assessed in further studies.

Members of The Church of Jesus Christ of Latter-day Saints (frequently referred to as Latter-day Saints or Mormons) share with other faiths a desire to celebrate sites significant to their founding. By memorialising religious sacred space, the Church of Jesus Christ has created a desire among many of its more than sixteen million members to retrace the steps of their early faith leaders as pilgrims. As with other religious sites around the world, Latter-day Saint pilgrimage destinations have also become scenes of contestation. Churches that divided from the original movement offer rival interpretations of the its history and beliefs, leading at times to division and discord. Additionally, many of the sites central to the church’s founding are small towns today, magnifying the impact of tens of thousands of seasonal pilgrims on rural communities whose residents often do not share in the story nor want their towns to be transformed by religious tourists. Latter-day Saint pilgrimage has reshaped the identity of these communities as rival faiths and local residents vie over interpretation.Chief among Latter-day Saint early pilgrimage sites is Nauvoo, Illinois, the faith’s headquarters in the 1840s, burial site of its founder, Joseph Smith, and most visited of these communities as rival faiths and local residents vie over interpretation.Chief among Latter-day Saint early pilgrimage sites is Nauvoo, Illinois, the faith’s headquarters in the 1840s, burial site of its founder, Joseph Smith, and most visited early historic site. Throughout the twentieth century, the church purchased approximately half of the town, restoring and rebuilding it into a Latter-day Saint version of America’s Colonial Williamsburg. Visitors enter homes, shops, and public buildings, learning from costumed representatives of the church about religious life in a nineteenth-century-themed religious community. Meanwhile, local residents grapple with the influx of thousands of pilgrims and the challenges created by a pilgrimage destination not of their making. This paper serves as a case-study in shared sacred space, exploring the contestation and cooperation that go into the creating of a pilgrimage destination.

Herein, we present a simplified approach to prehospital mass casualty event (MASCAL) management called "Move, Treat, and Transport." Prior publications demonstrate a disconnect between MASCAL response training and actions taken during real-world incidents. Overly complex algorithms, infrequent training on their use, and chaotic events all contribute to the low utilization of formal triage systems in the real world. A review of published studies on prehospital MASCAL management and a recent series of military prehospital MASCAL responses highlight the need for an intuitive MASCAL management system that accounts for expected resource limitations and tactical constraints. "Move, Treat, and Transport" is a simple and pragmatic approach that emphasizes speed and efficiency of response; considers time, tactics, and scale of the event; and focuses on interventions and evacuation to definitive care if needed., Competing Interests: The authors have indicated they have no financial relationships relevant to this article to disclose., (2024.)

Introduction: Mass casualty events (MASCALs) in the combat environment, which involve large numbers of casualties that overwhelm immediately available resources, are fundamentally chaotic and dynamic and inherently dangerous. Formal triage systems use diagnostic algorithms, colored markers, and four or more named categories. We hypothesized that formal triage systems are inadequately trained and practiced and too complex to successfully implement in true MASCAL events. This retrospective analysis evaluates the real-world application of triage systems in prehospital military MASCALs and other aspects of MASCAL management., Methods: We surveyed Special Operations Forces (SOF) medics known to us who have participated in military prehospital MASCALs and analyzed them. Aggregated data describing the scope of the incidents, the use of formal triage algorithms and colored markers, the number of categories, and the interventions on scene were analyzed using descriptive statistics, and lessons learned were consolidated., Results: From 1996 to 2022 we identified 29 MASCALs that were managed by military medics in the prehospital setting. There was a median of three providers (range 1-85) and 15 casualties (range 6-519) per event. Four or more formal triage categories were used in only one event. Colored markers and formal algorithms were not used. Life-saving interventions were performed in 27 of 29 (93%) missions and blood transfusions were performed in four (17%) MASCALs. The top lessons learned were: 1) security and accountability are cornerstones of MASCAL management; 2) casualty movement is a priority; 3) intuitive triage categories are the default; 4) life-saving interventions are performed as time and tactics permit., Conclusion: Formal triage systems requiring the use ofdiagnostic algorithms, colored tags, and four or five categories are seldom implemented in real-world military prehospital MASCAL management. The training of field triage should be simplified and pragmatic, as exemplified by these instances., Competing Interests: None of the authors have any financial conflicts of interest or pertinent disclosures., (2024.)

Competency-based teasing has been identified as a risk factor for children's depressive symptoms. However, the specific psychological mechanisms mediating this relationship are not well understood, especially in the context of Chinese culture. This study examined the relationship between competency-based teasing, subsequent depressive symptoms, and the possible mediating role of positivity in Chinese children by using parallel process latent growth curve modelling. Gender differences were also explored. A sample of 4376 Chinese children (55.1% boys; age: M = 9.98 years, SD = 0.88) completed measurements of the relevant constructs on five occasions across 2 years, using half-year intervals. The findings revealed that competency-based teasing was significantly positively associated with subsequent depressive symptoms in Chinese children. Furthermore, positivity mediated this relationship in girls, but not in boys. The results suggest that positivity-cultivating and gender-specific interventions may be effective to reduce the risk of depressive symptoms in Chinese children., (© 2024 John Wiley & Sons Ltd.)

Introduction: The current study aimed to examine the longitudinal associations among basic psychological need satisfaction at school (BPNSS), self-esteem, and suicidal ideation (SI), including whether self-esteem functioned as a mediator of the relations between BPNSS and SI at the within-person level after disentangling between- and within-person associations encompassing middle childhood to early adolescence., Methods: A total of 650 Chinese students (53.54% boys, M age  = 9.95, SD = 0.75 at Time 1) completed measures on four occasions across 1.5 years, using 6-month intervals. Random intercept cross-lagged panel models were applied to disaggregate between- and within-person effects, thus providing greater confidence in elucidating the causal relations among study variables., Results: The results showed that at the within-person level: (a) BPNSS negatively predicted SI; (b) BPNSS positively predicted self-esteem; (c) Self-esteem negatively predicted SI; and (d) BPNSS indirectly predicted SI via self-esteem., Conclusion: These findings advanced the literature by demonstrating longitudinal associations among BPNSS, self-esteem, and SI at the within-person level, and highlighting the significance of distinguishing between- and within-person effects in developing prevention and intervention programs aimed at reducing SI over time from middle childhood to early adolescence., (© 2024 Foundation for Professionals in Services to Adolescents.)

Background: Racial and ethnic health disparities are important factors that contribute to outcomes in orthopedic surgery. With the increasing rates of common shoulder surgeries being performed, understanding all factors that contribute to patient outcomes is essential. There are several key socioeconomic and demographic factors, including insurance status, ethnicity, and Race, which have been implicated to impact both access to high-quality shoulder and elbow care and outcomes following shoulder and elbow surgery. In this review article, we seek to highlight the literature pertaining to social and demographic disparities in shoulder and elbow surgery for the purpose of providing policy makers and clinicians key information to optimize the equitable delivery of high-quality medical care to patients of all socioeconomic backgrounds., Methods: A literature review of PubMed was conducted using several keywords with defined inclusion and exclusion criteria., Results: A total of 22 articles were included across shoulder arthroplasty, rotator cuff repair, shoulder instability, and elbow arthroplasty. Multiple disparities were identified in the literature across Race, ethnicity, insurance status, and social determinants of health., Conclusions: Our search of the literature demonstrated significant disparities in shoulder and elbow surgeries, showing that racial, ethnic, and socioeconomic factors adversely affect patient outcomes due to decreased access quality care. To improve equity, recommendations include shifting care to high-volume and outpatient centers and increasing geographical diversity and access to surgical and rehabilitative care., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: This cross-sectional study aims to understand the relationship between responses on the Anxiety/Depression (A/D) dimension of the EQ-5D-5L and symptoms of anxiety and depression on the GAD-7 and PHQ-9 instruments. In doing so, we investigate the comparative performance of the dimension between diagnostic groups (i.e. anxiety (GAD-7); depression (PHQ-9); anxiety & depression versus none). We additionally investigate the discriminatory performance between sub-populations based on gender, age, education and self-reported chronic conditions., Methods: 19,902 general population participants completed a health survey in May/June 2020, from five European countries and the United States. Performance of A/D was calculated using the Area Under the Receiver Operating Characteristic curve (AUROC), and was compared to having anxiety (GAD-7 ≥ 8), depression (PHQ-9 ≥ 10) and both versus none for the total population and sub-populations. Several additional sensitivity analyses were conducted, including calculations of the optimal A/D cut-off., Results: The performance in the total sample was good (AUROC > 0.8) and did not differ significantly between diagnostic groups. The performance differed significantly between the age groups, with worse performance in the younger groups, and differed between those with a singular chronic condition, with worse performance in those indicating having an anxiety or depression disorder. The performance did not differ significantly by gender, education, nor total chronic conditions., Conclusion: The A/D dimension captures symptoms of anxiety, depression or both equally well. Performance is worse in the younger population. Interpretation in those with a self-reported anxiety or depression disorder should be further investigated. This is the first-of-its-kind large population sample performance analysis, where we present evidence that the performance of the A/D dimension differs between ages, and thus intra-age comparative results may be flawed., (© 2024. The Author(s).)

Background: KRAS is frequently mutated in the tumors of patients with metastatic colorectal cancer (mCRC) and thus represents a valid target for therapy. However, the strategies of targeting KRAS directly and targeting the downstream effector mitogen-activated protein kinase kinase (MEK) via monotherapies have shown limited efficacy. Thus, there is a strong need for novel, effective combination therapies to improve MEK-inhibitor efficacy in patients with KRAS -mutated mCRC., Objective: Our objective was to identify novel drug combinations that enhance MEK-inhibitor efficacy in patients with KRAS -mutated mCRC., Design: In this study, we performed unbiased high-throughput screening (HTS) to identify drugs that enhance the efficacy of MEK inhibitors in vitro , and we validated the efficacy of the drugs in vivo ., Methods: HTS was performed using 3-dimensional CRC spheroids. Trametinib, the anchor drug, was probed with 2 clinically ready libraries of 252 drugs to identify effective drug combinations. The effects of the drug combinations on CRC cell proliferation and apoptosis were further validated using cell growth assays, flow cytometry, and biochemical assays. Proteomic and immunostaining studies were performed to determine the effects of the drugs on molecular signaling and cell division. The effects of the drug combinations were examined in vivo using CRC patient-derived xenografts., Results: HTS identified paclitaxel as being synergistic with trametinib. In vitro validation showed that, compared with monotherapies, this drug combination demonstrated strong inhibition of cell growth, reduced colony formation, and enhanced apoptosis in multiple KRAS -mutated CRC cell lines. Mechanistically, combining trametinib with paclitaxel led to alterations in signaling mediators that block cell cycle progression and increases in microtubule stability that resulted in significantly higher defects in the mitosis. Finally, the combination of trametinib with paclitaxel exhibited significant inhibition of tumor growth in several KRAS -mutant patient-derived xenograft mouse models., Conclusion: Our data provide evidence supporting clinical trials of trametinib with paclitaxel as a novel therapeutic option for patients with KRAS -mutated, metastatic CRC.

Background: This study aimed to identify the developmental trajectories of loneliness in Chinese children and examine the predictive roles of domain-specific environmental factors (i.e., family dysfunction and satisfaction of relatedness needs at school), personality factors (i.e., neuroticism and extraversion), and their interactions in these developmental trajectories., Methods: A total of 702 Chinese children (M age  = 8.95, SD = 0.76; 54.1 % boys) participated in assessments at six time points over three years at six-month intervals. Growth mixture modeling (GMM) was used to estimate trajectory classes for loneliness, followed by multivariate logistic regression analyses exploring associations between these classes and predictors., Results: GMM analyses identified three distinct trajectories of loneliness: "low-stable" (81.5 %), "moderate-increasing" (9.4 %), and "high-decreasing" (9.1 %). Multivariate logistic regression analyses revealed that family dysfunction and neuroticism served as risk factors for adverse loneliness trajectories, while satisfaction of relatedness needs at school and extraversion acted as protective factors. Furthermore, the interaction between family dysfunction and extraversion indicated that extraversion did not mitigate the adverse effects of high family dysfunction on children's loneliness, emphasizing the vital need to support positive family functioning among all children., Limitations: This study did not incorporate biological variables (e.g., genetics), which are crucial in the evolutionary theory of loneliness., Conclusions: The identification of three distinct trajectory groups of children's loneliness, along with key environmental and personality predictors, suggests that interventions should be tailored to each group's unique characteristics., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Intestinal failure-associated liver disease (IFALD) is a complication of long-term PN use, attributed to the use of ω-6 injectable lipid emulsions (ILE). Fish oil (FO) ILE have been successful in reversing liver injury in neonates. Evidence for pure FO ILE use in adult patients is limited., Methods: Case series of the use of FO lipid emulsions in adults with IFALD from the University of Chicago PN registry. Analysis of medical charts and PN formulations was performed., Results: Three cases of IFALD treated with FO ILE were identified. The first case was a 30-year-old man with short bowel syndrome (SBS), hyperbilirubinemia, and biopsy-proven IFALD. Following a change from a soy lipid emulsion to FO lipid emulsion, his liver tests rapidly improved and remained stable over 202 weeks of use. The second case was a 76-year-old woman with intestinal failure (IF) due to a frozen bowel. A change from a soy ILE to a composite lipid and later to a pure FO ILE did not result in improvement in her liver tests. The third case was a 28-year-old man with SBS and biopsy-proven IFALD. Change to a composite ILE and subsequently FO lipid emulsion resulted in a gradual improvement in liver tests. No clinical essential fatty acid (EFA) deficiencies were identified during treatment., Conclusion: FO ILE may be effective in the treatment of adult patients with cholestatic IFALD. Use is safe with no EFA deficiencies detected in up to 4 years of use., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Purpose: To determine whether (1) healthcare access at onset of the pandemic and (2) age, gender, socioeconomic status (SES), and pre-existing health status were associated with change in health-related quality-of-life (HRQoL) during the COVID-19 pandemic. The study includes a general population sample of five countries., Methods: An online questionnaire was administered to respondents from Greece, Italy, the Netherlands, the UK, and the US at the onset of the COVID-19 pandemic between April 22nd and May 5th of 2020, and 1 year later between May 23rd and June 29th of 2021. The questionnaire included questions on demographic background, health status, and HRQoL. The primary outcome was change in HRQoL as measured by the EQ-5D-5L instrument. Specifically, the EQ-5D-5L index and EQ VAS were used. Healthcare access was quantified with regard to the respondent's ease of getting an appointment, waiting time, and opportunity to contact the provider and during analysis dichotomized into "sufficient" versus "insufficient". Linear regression analysis was performed with change in HRQoL as dependent variable and background variables as independent variables., Results: In total, 6,765 respondents completed the second questionnaire. 19.8% of total respondents reported insufficient healthcare access. Respondents with insufficient healthcare had both more improved and deteriorated HRQoL compared to respondents with sufficient healthcare, whose HRQoL remained unchanged. We did not find significant interactions between age, gender, SES and/or chronic disease status with healthcare access at onset of the COVID-19 pandemic., Conclusion: Healthcare access was not associated with cumulative differences in change in HRQoL over a 1-year period in strata of age, gender, SES, and chronic disease status., (© 2024. The Author(s).)

We utilized city-scale simulations to quantitatively compare the diverse urban overheating mitigation strategies, specifically tied to social vulnerability and their cooling efficacies during heatwaves. We enhanced the Weather Research and Forecasting model to encompass the urban tree effect and calculate the Universal Thermal Climate Index for assessing thermal comfort. Taking Houston, Texas, and United States as an example, the study reveals that equitably mitigating urban overheat is achievable by considering the city's demographic composition and physical structure. The study results show that while urban trees may yield less cooling impact (0.27 K of Universal Thermal Climate Index in daytime) relative to cool roofs (0.30 K), the urban trees strategy can emerge as an effective approach for enhancing community resilience in heat stress-related outcomes. Social vulnerability-based heat mitigation was reviewed as vulnerability-weighted daily cumulative heat stress change. The results underscore: (i) importance of considering the community resilience when evaluating heat mitigation impact and (ii) the need to assess planting spaces for urban trees, rooftop areas, and neighborhood vulnerability when designing community-oriented urban overheating mitigation strategies., (© The Author(s) 2024. Published by Oxford University Press on behalf of National Academy of Sciences.)

Case: A 58-year-old, very active man sustained bilateral isolated teres major (TM) tendon tears when his arms were forcefully elevated overhead while wakeboarding. Staged surgical repair was performed. A progressive rehabilitation protocol was followed, and he returned to high-level activities 7 months postoperatively. At 1-year follow-up, outcome measures for bilateral shoulders were DASH 0, SST 12, ASES 100, and EQ-5D 1.0., Conclusion: Despite literature supporting conservative treatment, this case demonstrates that operative treatment of acute, isolated TM tears can result in highly successful outcomes for motivated active patients., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C386)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Purpose: With a lack of standardization among outcome measures in fracture literature, cross-study comparisons remain limited. This systematic review aimed to identify trends in outcome measures reported by studies of the treatment of humeral shaft fractures., Methods: A systematic review was performed of studies reporting clinical outcomes of humeral shaft fractures indexed in PubMed. Extracted data included demographics, fracture characteristics, treatment modalities, outcomes, patient reported outcome measures (PROMs), and journal characteristics. Cochran-Armitage tests and linear regressions were used to identify data trends. Pearson chi-square and Kruskal-Wallis tests were used for comparisons between studies., Results: This review included 197 studies with outcomes of 15,445 humeral shaft fractures. 126 studies reported PROMs and 37 different PROMs were used. The Constant Score was most commonly reported (34% of studies), followed by ASES Score (21%), MEPS (21%), and DASH Score (20%). There was a significant increase in PROM usage over time (p = 0.016) and in articles using three or more PROMs (p = 0.005). The number of PROMs were significantly greater in prospective cohort studies and RCTs (p = 0.012) compared to retrospective cohort studies and case series (p = 0.044 for both). Post-treatment shoulder motion was reported in 43% of studies and 34% reported elbow motion. 86% of studies reported complications as an outcome parameter. Time to union and nonunion rate were published in 69% and 88% of studies, respectively., Conclusion: This study identified increasing PROM usage over time and disparities in the reporting of outcomes in humeral shaft fracture literature requiring further validation and standardization of available outcome measures., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Advances in arthroscopy have contributed toward improved understanding and management of diverse pathological conditions in the shoulder. As a result, arthroscopy is often preferred by both patients and surgeons. However, surgery can be complicated by limited visualization. Techniques to improve visualization include patient and portal positioning, mechanical débridement, radiofrequency ablation, epinephrine added to irrigation fluid, tranexamic acid administration, and controlled hypotensive anesthesia. Despite published literature on each, a thorough understanding of the evidence supporting these techniques and adjuvants is essential to interpret the clinical utility of each., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)

Background: Psychological maltreatment by teachers and peer victimization are significant public health issues among youth. However, few studies have verified transactional associations between psychological maltreatment by teachers and peer victimization at the within-person level and the mediating roles of depression and aggression have yet to be fully evaluated., Objective: This study examined the transactional associations between psychological maltreatment by teachers and peer victimization from middle childhood to early adolescence, separating within- and between-person variation. The study also examined whether youth's depression and aggression mediated the associations., Participants and Setting: A total of 4945 Chinese youth (M age  = 9.92 years, SD = 0.73 53 % boys) completed a packet of measures on five occasions at 6-month intervals from May of 2017 to May of 2019., Methods: Random Intercept Cross-Lagged Panel Models (RI-CLPMs) were used to distinguish between- and within-person effects., Results: The results indicated that: (a) Psychological maltreatment by teachers predicted peer victimization, and vice versa; (b) Depression (but not aggression) mediated the associations from peer victimization to psychological maltreatment by teachers., Conclusions: The findings supported bidirectional spillover effects between adverse teacher-student and peer interactions and demonstrated at the within-person level that such effects were transmitted indirectly via youth's depression., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: In this multi-informant, 3-year longitudinal study, the bidirectional relations between externalizing and internalizing problems were investigated, along with whether peer victimization and academic achievement mediated their relations after separating between-person effects from within-person effects., Method: A sample of 3238 Chinese children (55.02% boys; M age T1 = 9.89 years) reported semiannually on peer victimization and both externalizing and internalizing problems, and parents reported on their children's externalizing and internalizing problems. Students' objective academic achievement data (i.e. final exam scores) were obtained from school records., Results: Random intercepts cross-lagged panel modeling (RI-CLPM) revealed that neither academic achievement nor peer victimization mediated the relations between externalizing and internalizing problems in both self and parent reports at the within-person level. The cross-lagged panel models (CLPM) results supported that peer victimization (but not academic achievement) mediated the relations from internalizing to externalizing problems or externalizing to internalizing problems, whether self-reported or parent-reported. This study also identified meaningful sex differences in focal relations among children., Conclusions: Findings illustrate the importance of distinguishing within-person and between- person associations, with within- person findings failing to support the hypothesized mediating pathways of the Dual Failure or Acting Out Models among children.

Objectives: While cytokine response patterns are pivotal in mediating immune responses, they are also often dysregulated in sepsis and critical illness. We hypothesized that these immunological deficits, quantifiable through ex vivo whole blood stimulation assays, may be indicative of subsequent organ dysfunction., Design: In a prospective observational study, adult septic patients and critically ill but nonseptic controls were identified within 48 hours of critical illness onset. Using a rapid, ex vivo assay based on responses to lipopolysaccharide (LPS), anti-CD3/anti-CD28 antibodies, and phorbol 12-myristate 13-acetate with ionomycin, cytokine responses to immune stimulants were quantified. The primary outcome was the relationship between early cytokine production and subsequent organ dysfunction, as measured by the Sequential Organ Failure Assessment score on day 3 of illness (SOFAd3)., Setting: Patients were recruited in an academic medical center and data processing and analysis were done in an academic laboratory setting., Patients: Ninety-six adult septic and critically ill nonseptic patients were enrolled., Interventions: None., Measurements and Main Results: Elevated levels of tumor necrosis factor and interleukin-6 post-endotoxin challenge were inversely correlated with SOFAd3. Interferon-gamma production per lymphocyte was inversely related to organ dysfunction at day 3 and differed between septic and nonseptic patients. Clustering analysis revealed two distinct immune phenotypes, represented by differential responses to 18 hours of LPS stimulation and 4 hours of anti-CD3/anti-CD28 stimulation., Conclusions: Our rapid immune profiling technique offers a promising tool for early prediction and management of organ dysfunction in critically ill patients. This information could be pivotal for early intervention and for preventing irreversible organ damage during the acute phase of critical illness., Competing Interests: Dr. Halstead is a speaker for Swedish Orphan Biovitrum pharmaceuticals and lectures specifically about the disease process and therapeutic strategies for hemophagocytic lymphohistiocytosis. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)

Recent literature reports highlight the importance of the renal outer medullary potassium (ROMK) channel in renal sodium and potassium homeostasis and emphasize the potential impact that ROMK inhibitors could have as a novel mechanism diuretic in heart failure patients. A series of piperazine-based ROMK inhibitors were designed and optimized to achieve excellent ROMK potency, hERG selectivity, and ADME properties, which led to the identification of compound 28 (BMS-986308). BMS-986308 demonstrated efficacy in the volume-loaded rat diuresis model as well as promising in vitro and in vivo profiles and was therefore advanced to clinical development.

Previous research has shown a strong link between deviant peer affiliation (DPA) and externalizing problems (EXT) among children and adolescents. Little is known about how DPA and EXT develop jointly over time or possible sex differences in their development. This longitudinal study identified sex-specific joint trajectories of DPA and EXT from middle childhood to early adolescence and investigated the predictive role of family maltreatment experiences in joint trajectories of DPA and EXT. A total of 3622 Chinese elementary school students in grades 3 and 4 (M age  = 10, SD = 0.53; 46.5% girls) comprised the sample. Assessments were conducted every six months on five occasions across 2.5 years. Parallel process latent class growth modeling (PP-LCGM) was used to explore the joint trajectories of DPA and EXT for boys and girls separately. The PP-LCGM identified four trajectories for boys: "congruent-low" (78.2%), "congruent-high" (12.40%), "deviant peer affiliation increasing" (6.5%), and "congruent late increasing" (2.9%). Four trajectories were identified for girls: "congruent-low" (82.5%), "slowly increasing" (10.2%), and "deviant peer affiliation desisting" (5.6%), and "congruent late increasing" (1.7%). After controlling for socioeconomic status (SES), the results showed that compared to the congruent-low group, more severe family maltreatment predicted the high and high-start trajectories for boys. The findings highlighted the joint development of DPA and EXT and the sex differences associated with their development. Findings also shed light on the importance of sex in developmental responses to family maltreatment., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: Previous cross-sectional and unidirectional longitudinal studies have identified positive associations between childhood victimization and neuroticism in children. However, these studies have not simultaneously examined multiple common sources of childhood victimization (family abuse, teacher abuse, and peer victimization) in relation to neuroticism nor have they distinguished between- and within-person effects. Moreover, the moderating role of child sex in their associations has yet to be fully evaluated., Objective: This study examined the within-person longitudinal associations between three common sources of childhood victimization and neuroticism in Chinese children and whether these effects differed between boys and girls., Participants and Setting: The sample included 4315 children (55.1 % boys) with an average age of 9.93 (SD = 0.73) years from a large city in China., Methods: Participants completed self-report measures on five occasions across two years, employing six-month intervals. Random Intercept Cross-Lagged Panel Models (RI-CLPMs) were used to distinguish between-person and within-person effects., Results: Results included: (a) Family abuse (excluding sexual abuse) and peer victimization directly predicted subsequent increases in neuroticism at the within-person level and vice versa, whereas teacher abuse and neuroticism did not reveal significant longitudinal relations at the within-person level; (b) The effect of family abuse on neuroticism at the within-person level was stronger in boys, while the effect of peer victimization on neuroticism at the within-person level was stronger in girls., Conclusions: Prevention and intervention strategies targeting high neuroticism and childhood victimization should consider the roles of both family and peer systems., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Case: A 71-year-old woman presented with post-traumatic arthritis 11 months after open reduction and internal fixation for a left proximal humerus fracture (PHF) dislocation. After revision to reverse total shoulder arthroplasty (rTSA), the patient's left upper extremity was found to be avascular. An emergent thrombectomy was performed with restoration of arterial flow after removal of an acute-on-chronic axillary artery thrombus., Conclusion: Although rare, as rTSA becomes more common for management of PHF, incidence of associated vascular injuries is likely to rise. Screening methods and clinical vigilance in diagnosis are advised for patients with anterior PHF dislocations and arterial injury risk factors., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C346)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: Cervical spine degenerative disease (CSD) can cause shoulder pain, potentially confounding the management of patients with rotator cuff tears. This study aimed to investigate the relationships between CSD and rotator cuff repair (RCR)., Methods: A national administrative database (PearlDiver) was used to study 4 patient cohorts: (1) RCR only (RCRo), (2) RCR with concurrent CSD (RCRC), (3) RCR after a cervical spine procedure (RCRA), and (4) RCR before a cervical spine procedure (RCRB). The outcomes of RCR were compared using multivariable logistic regression, controlling for age, sex, and Elixhauser Comorbidity Index, as well as preoperative opioid utilization in the analysis of opioid use., Results: Between 2010 and 2021, a total of 889,977 patients underwent RCR. Of these patients, 784,230 (88%) underwent RCRo whereas 105,747 (12%) underwent RCRC, of whom 21,585 (2.4%) underwent cervical spine procedures (RCRA in 9670 [1.1%] and RCRB in 11,915 [1.3%]). At 2 years after RCR, compared with RCRo patients, RCRC patients had an increased risk of surgical-site infection (adjusted odds ratio [aOR] = 1.25, P = .0004), deep vein thrombosis (aOR = 1.17, P = .0002), respiratory complications (aOR = 1.19, P = .0164), and ipsilateral shoulder reoperations (débridement [aOR = 1.66, P < .0001], manipulation under anesthesia or arthroscopic lysis of adhesions [aOR = 1.23, P < .0001], distal clavicle excision [aOR = 1.78, P < .0001], subacromial decompression [aOR = 1.72, P < .0001], biceps tenodesis [aOR = 1.76, P < .0001], incision and drainage [aOR = 1.34, P = .0020], synovectomy [aOR = 1.48, P = .0136], conversion to shoulder arthroplasty [aOR = 1.62, P < .0001], revision RCR [aOR = 1.77, P < .0001], and subsequent contralateral RCR [aOR = 1.71, P < .0001]). At 2 years, compared with RCRC patients who did not undergo cervical spine procedures, RCRC patients who underwent cervical spine procedures had an increased risk of incision and drainage (aOR = 1.50, P = .0255), conversion to arthroplasty (aOR = 1.40, P < .0001), and revision RCR (aOR = 1.11, P = .0374), as well as a lower risk of contralateral RCR (aOR = 0.89, P = .0469). The sequence of cervical spine procedures did not affect the risk of shoulder reoperations. At 1 year, the risk of opioid use after RCR was less for RCRA patients compared with RCRB patients (aOR = 1.71 [95% confidence interval, 1.61-1.80; P < .0001] vs. aOR = 2.01 [95% confidence interval, 1.92-2.12; P < .0001])., Conclusion: Concurrent CSD has significant detrimental effects on RCR outcomes. Patients with concurrent CSD undergoing cervical spine procedures have a greater risk of ipsilateral shoulder reoperations but a decreased risk of contralateral RCR. The risk of prolonged opioid use was lower if RCR followed a cervical spine procedure. Concurrent CSD must be considered and possibly treated to optimize the outcomes of RCR., (Copyright © 2024. Published by Elsevier Inc.)