Adolescent Cannabis Use and Perceived Social Norm Trends Pre- and Post-Implementation of Washington State's Liberalized Recreational Cannabis Policy: Healthy Youth Survey, 2008-2018.

This study examined trends in adolescent perceptions of social norms pertaining to adolescent cannabis use, in relation to past 30-day adolescent cannabis use, and was interpreted in light of Washington State's liberalized recreational cannabis policy (LRCP: 2012). Data come from Washington's Healthy Youth Survey (HYS), collected during even-numbered years between 2008 and 2018, with methods-stabilized surveys of school-attending youths in grades 8, 10, and 12. This study used an aggregate state census sample of n = 325,723. Year-specific social norms and cannabis use proportions were estimated, stratified by grade. Regression analyses assessed associations between social norms and recent cannabis use. The proportion of recent adolescent cannabis use during the initial years post-LRCP in Washington State remained relatively stable or trended downward slightly; however, 2018 data may indicate a slight upward trend for 10th and 8th graders. Cannabis use by a close friend consistently paralleled adolescent cannabis use trends. The proportion of youth reporting parental acceptance of, and overall community acceptance of, adolescent cannabis use trended slightly upward in 2014 (post-LRCP implementation) but, since, has remained stable or declined slightly. Adolescent self-acceptance of youth cannabis use increased steadily for high school students between 2008 and 2014, edged downward in 2016, and then trended back upward for 8th and 10th graders in 2018. Perceived parental acceptance remained statistically associated with adolescent cannabis use across grades and years, with the strength of associations edging up. Ongoing monitoring of substance use and related risk factor trends will be needed to understand the impacts of LRCPs.

Workplace Racial Discrimination, Negative Emotions Based on Treatment Due to Race, and Substance Use.

BACKGROUND: Experiencing racial discrimination may be associated with poor health outcomes including negative emotional states and substance use. The workplace is a setting where people may experience discriminatory treatment. Objectives: This study examined associations, between negative emotions due to treatment based on race (NE), workplace racial discrimination (WRD), and substance use outcomes (drinking and smoking), stratified by race. Methods: Data from the cross-sectional 2014 Behavioral Risk Factor Surveillance System (BRFSS), Minnesota and New Mexico sub-samples, were analyzed. This study excluded non-Hispanic white participants, resulting in a sample of n = 3098 adult, U.S. residents. Multivariable logistic regression models were utilized to examine the associations, and possible interactions, between WRD, NE, and substance use (alcohol and tobacco). Results: Prior to stratification, WRD was not associated with drinking or smoking after controlling for NE and other sociodemographic variables, however, NE was associated with heavy drinking. NE appeared to account for some of the observed bivariate associations between WRD and heavy drinking and daily smoking. Post-stratification, WRD was associated with heavy drinking for non-Hispanic other respondents, even after controlling for NE. For non-Hispanic black participants, NE was associated with smoking after controlling for WRD. A stratified interaction analysis of WRD*NE revealed that there was only an association between NE and heavy drinking for Hispanic participants who did not experience WRD. Conclusions: The relationship between WRD and substance use may be in part accounted for by NE. Further exploration is needed to more fully understand why associations exist for some race/ethnicity groups but not others.

The Effect of Neuraxial Anesthesia on Postoperative Outcomes in Total Joint Arthroplasty With Rapid Recovery Protocols.

BACKGROUND: Compared to general anesthesia (GA), neuraxial anesthesia (NA) has been associated with improved outcomes after total joint arthroplasty (TJA). We examined the impact of NA on patient outcomes in an institution with an established rapid recovery protocol. METHODS: This is a single-institution retrospective analysis of 5914 consecutive primary TJA performed from July 2015 to June 2018. Univariate tests and multivariate regression compared length of stay (LOS), transfusion rates, hematocrit levels, discharge disposition, and emergency room returns between patients receiving GA and NA. RESULTS: Patients receiving NA had a significantly shorter LOS (total hip arthroplasty [THA]: GA 1.74 vs NA 1.36 days, P < .001; total knee arthroplasty [TKA]: GA 1.77 vs NA 1.64 days, P < .001). Both THA and TKA patients receiving NA were less likely to require transfusion (THA: GA 5.8% vs NA 1.6%, P < .001; TKA: GA 2.5% vs NA 0.5%, P < .001) and had a higher postoperative hematocrit (THA: GA 32.50% vs NA 33.22%, P < .001; TKA GA 33.57 vs NA 34.50%, P < .001). Patients receiving NA were more likely to discharge home (THA: GA 83.4% vs NA 92.3%, P < .001; TKA: GA 83.3% vs NA 86.3%, P = .010) (THA: NA adjusted OR [aOR] 2.04, P < .001; TKA: NA aOR 1.23, P = .048) and had significantly lower rates of 90-day emergency room visits (THA: NA aOR 0.61, P = .005; TKA: NA aOR 0.74, P = .034). CONCLUSION: NA appears to contribute to decreased LOS, short-term complications, and transfusions while facilitating home discharge following TKA and THA. These trends are consistent when controlling for patient-specific risk factors, suggesting NA may enhance outcomes for patients with increased age, body mass index, and comorbidities. LEVEL OF EVIDENCE: Level III Retrospective Cohort Study.

Outpatient, Home-Based Physical Therapy Promotes Decreased Length of Stay and Post-Acute Resource Utilization After Total Joint Arthroplasty.

BACKGROUND: Patients and healthcare systems are increasingly focused on evaluating interventions that increase the value of care delivered. Our objective of this study is to evaluate early post-operative outcomes among those patients who underwent total joint arthroplasty with and without the participation in our piloted Outpatient Physical Therapy Home Visits (OPTHV) program. METHODS: A retrospective analysis of patients undergoing total hip arthroplasty and total knee arthroplasty at a single institution from July 2016 to September 2017 was performed. Matched cohorts were compared according to OPTHV enrollment status. RESULTS: In total, 1729 patients were included in this study. Two hundred ninety-three patients were enrolled in OPTHV, while 1436 patients received institutional standard care. Patients were matched by gender (56.7% vs 57.7% female, P = .751), age (67.75 vs 66.95 years, P = .167), body mass index (30.18 vs 30.12 kg/m2, P = .859), and average American Society of Anesthesiologists score (2.31 vs 2.36, P = .131). OPTHV patients had a shorter length of stay (1.39 vs 1.64 days, P < .001) and were more likely to discharge to home (89.8% vs 74.7%, P < .001). Ninety-day re-admissions (2.7% vs 2.6%, P = .880) and emergency room visits (4.1% vs 4.3%, P = .864) were equivalent. CONCLUSION: OPTHV is a novel program that facilitates discharge home and decreased length of stay after total joint arthroplasty without increasing re-admissions or emergency room visits. Utilization of OPTHV may contribute toward reducing the episode of care costs by reducing utilization of skilled nursing facility and home health services. Further prospective studies are needed to evaluate the effect of OPTHV on the total cost of care and functional outcomes.

Opioid Use Patterns After Total Joint Arthroplasty.

The incidence of new persistent opioid use following elective total joint arthroplasty (TJA) hasnt been well documented; with this study we aim to further characterize opioid use following TJA, specifically focusing on those patients still requiring opioid prescriptions 6 months postoperatively. Retrospective review of a consecutive series of 977 primary TJA performed from June 2016May 2017. Opioid prescriptions verified in Surescripts database; 3.7% (29) opioid nave patients and 18.0% (35) opioid nonnave patients received fills at 6 months. Opioid nave patients requiring fills at 6 months had more fills from 12 months onward. Opioid nonnave patients requiring fills at 6 months had more preoperative fills than those that werent filling opioid prescriptions (5.49 vs. 2.52 fills). Most patients in this study ceased opioid use by 3 months postoperatively. More preoperative fills in the opioid nonnave population and continuing to fill prescriptions after 23 months were associated with continued opioid use. (Journal of Surgical Orthopaedic Advances 29(1):1317, 2020).

The Effect of Psychiatric Diagnosis and Psychotropic Medication on Outcomes Following Total Hip and Total Knee Arthroplasty.

BACKGROUND: Nearly 20% of the US adult population lives with mental illness, and less than 50% of these receive treatment. Preoperative mental health may affect postoperative outcomes in patients undergoing total joint arthroplasty (TJA), yet is rarely addressed; poor outcomes increase the cost of care and burden on the healthcare system. This study examines the influence of patients with psychiatric diagnosis (PD) and taking psychotropic medication (PM) on emergency room visits, readmissions, and discharge disposition following TJA. METHODS: Single institution retrospective analysis of a consecutive series of 3020 primary TJA performed between January 2017 and June 2018. Chi-squared, t-tests, and analysis of variance were used to quantify differences between groups. RESULTS: Nine hundred seventy-six (32.3%) patients had a PD, most had depression (10.1%), anxiety (8.6%), or both (8.4%); 808 (26.8%) patients were on PM. Patients with PD were more likely to experience emergency room visits (6.3% vs 10.0%, P = .034) and skilled nursing facility discharge (11.6% vs 17.9%, P = .005). Patients taking PM were more likely to experience skilled nursing facility discharge (12.4 vs 17.1, P = .047); those taking >2 PM had the highest rate (21.6%). CONCLUSION: Patients with PD on or off PM may experience increased healthcare utilization in the postoperative period. Increased patient education and support may reduce these discrepancies. PD is not a deterrent for TJA, but targeted interventions should be developed to provide additional support where needed and avoid unnecessary utilization of resources.

Differences in Perioperative Outcomes and Complications Between African American and White Patients After Total Joint Arthroplasty.

BACKGROUND: Racial disparities in healthcare utilization and outcomes have been reported and have wide-reaching implications for individual patient and healthcare system; as providers we bear an ethical burden to address this disparity and provide culturally competent care. This study will examine the influence of race on length of stay, discharge disposition, and complications requiring reoperation following total joint arthroplasty (TJA). METHODS: Single institution retrospective analysis of a consecutive series of 7208 primary TJA procedures performed between July 2013 and June 2017 was conducted. Chi-squared and t-tests were used to quantify differences between the groups and multiple logistic regression was used to identify race as an independent risk factor. RESULTS: In total, 6182 (84.3%) white and 1026 (14.0%) African American (AA) patients were included. AA patients were younger (63.62 vs 66.84 years, P < .001), more likely female (68.8% vs 57.0%, P < .001), had a longer length of stay (2.19 vs 2.00 days, P < .001), more likely to experience septic complications (1.3% vs 0.5%, P = .002) and manipulation under anesthesia (3.9% vs 1.8%, P < .001), and less likely to discharge home (67.1% vs 81.1%, P < .001). Multiple logistic regression showed that AA patients were more likely to discharge to a facility (adjusted odds ratio 2.63, 95% confidence interval 2.19-3.16, P < .001) and experience a manipulation under anesthesia (adjusted odds ratio 1.90, 95% confidence interval 1.26-2.85, P = .002). CONCLUSION: AA patients undergoing TJA were younger with longer length of stay and a higher rate of nonhome discharge; AA race was identified as an independent risk factor. Further study is required to understand the differences identified in this study. Targeted interventions should be developed to attempt to eliminate the disparity.

Protein quality and physicochemical properties of commercial cricket and mealworm powders.

The pressing need for protein supply growth gives rise to alternative protein sources, such as insect proteins. Commercial cricket and mealworm powders were examined for their protein quality, surface charge and functional attributes. Both insect powders had similar proximate compositions with protein and ash contents of ~ 66% db (dry weight basis) and 5% db, respectively, however cricket powder contained more lipid (16.1%, db) than mealworm powder (13.7%, db). Mealworm protein had an amino acid score of 0.71 and was first limiting in lysine, whereas cricket protein was first limiting in tryptophan with an amino acid score of 0.85. In vitro protein digestibility values of 75.7% and 76.2%, and in vitro protein digestibility corrected amino acid scores of 0.54 and 0.65, were obtained for mealworm and cricket powders, respectively. Zeta potential measurements gave isoelectric points near pH 3.9 for both insect powders. Mealworm and cricket powders had water hydration capacities of 1.62 g/g and 1.76 g/g, respectively, and oil holding capacities of 1.58 g/g and 1.42 g/g, respectively. Both insect proteins had low solubility (22-30%) at all pHs (3.0, 5.0, and 7.0) measured. Cricket powder had a foaming capacity of 82% and foam stability of 86%, whereas mealworm powder was non-foaming. Values for commercial pea and faba bean protein concentrates were reported for comparative purposes. The insect proteins had similar protein quality as the pulse proteins and had higher solubility at pH 5.0 but were much less soluble at pH 7.0.

Reducing Length of Stay Does Not Increase Emergency Room Visits or Readmissions in Patients Undergoing Primary Hip and Knee Arthroplasties.

BACKGROUND: Total hip and total knee arthroplasty (total joint arthroplasty [TJA]) are 2 of the most common elective surgeries. Identifying which patients are at highest risk for emergency room (ER) visits or readmissions within 90 days of surgery and the reasons for return are crucial to formulate ways to decrease these visits and improve patient outcomes. METHODS: This is a retrospective review of a consecutive series of 7466 unilateral primary TJA performed from July 2013 to June 2017; any patients who had an ER visit or readmission in the first 90 days after surgery were identified, and a detailed chart review was performed. Patients discharged home or to rehab were analyzed separately. RESULTS: Three hundred thirty-six (4.5%) patients had 380 ER visits and 250 (3.3%) patients had 291 readmissions in the first 90 days after TJA. Patients returning to the ER were equivalent to those who did not. Patients who went to a rehab facility on discharge were significantly more likely to be readmitted (P = .000). Patients who were readmitted had a higher American Society of Anesthesiologists score (P = .000). Length of stay decreased over the study period from 2.66 days to 1.63 days, while the number of unplanned interventions remained steady. Pain and swelling was the most common reason for return for ER visits (33.2%) and readmissions (14.1%). CONCLUSION: The overall number of unplanned interventions after TJA in this population was low and remained consistent over time despite decreasing length of stay. Patients who went to rehab were more likely to experience readmission. The majority of unplanned interventions occurred in the first 4 weeks after surgery.

Evaluation of the Learning Curve When Transitioning From Posterolateral to Direct Anterior Hip Arthroplasty: A Consecutive Series of 1000 Cases.

BACKGROUND: The direct anterior approach (DAA) for primary hip replacement has been gaining more attention and widespread use in recent years. There are a number of published studies evaluating the learning curve when a surgeon changes technique; these studies typically look at complications during the initial cases. This study examines procedure and total operating room (OR) time along with all complications for a surgeon transitioning from the posterolateral approach (PA) to DAA. METHODS: A retrospective review of a single surgeon series of 1000 initial DAA procedures. Total OR time, procedure time, and complications were collected and analyzed. One-way analysis of variance and post hoc least significant difference tests were used for statistical analysis. RESULTS: There was an initial increase in both procedure and OR times compared with the mature PA, by 34% and 30%, respectively. The procedure time became statistically equivalent to the mature PA time after the 400th DAA case, and significantly shorter after the 850th case. The total OR time became statistically equivalent after the 900th DAA case. There were 18 early (<90 days) and 18 late reoperations performed in this series with a nonsignificant trend toward femoral complications occurring early in the series. Minimum follow-up time was 2 years. CONCLUSION: There was an initial increase in both total OR time and procedure time when an experienced surgeon introduced the DAA. By the end of the series, procedure time was significantly shorter and total OR time was equivalent. Complications overall were low and femoral complications decreased with time.

Functional Outcomes and Accuracy of Patient-Specific Instruments for Total Knee Arthroplasty.

BACKGROUND: Patient-specific instruments (PSIs) were developed to improve mechanical axis alignment for patients undergoing total knee arthroplasty (TKA) as neutral alignment (180°) is a predictor of long-term success. This study examines alignment accuracy and functional outcomes of PSI as compared with standard instruments (SIs). METHODS: We retrospectively reviewed a consecutive series of TKA procedures using PSI. A total of 85 PSI procedures were identified, and these were compared with a matched cohort of 85 TKAs using SI. Intraoperative decision-making, estimated blood loss, efficiency, Knee Society Scores, and postoperative radiographs were evaluated. RESULTS: One hundred and seventy patients with comparable patient demographics were reviewed. Eighty-one percent of the PSI procedures were within target (180 ± 3°) mechanical alignment, while the SI group had 70% of cases within the target plane ( P = .132). Mean target alignment (2.0° PSI vs 2.2° SI, P = .477) was similar between groups. Twenty-seven percent of patients in the PSI group had surgeon-directed intraoperative recuts to improve the perceived coronal alignment. The change in hematocrit was reduced in the PSI group (8.89 vs 7.21, P = .000). Procedure time and total operating room time were equivalent. Knee Society Scores did not differ between groups at 6 months or at 1 year. CONCLUSION: Patient-specific instrumentation decreased change in hematocrit, though coronal alignment and efficiency were equivalent between groups. Surgeons must evaluate cuts intraoperatively to confirm alignment. Functional outcomes are equivalent for PSI and SI groups.

Effect of Lactobacillus plantarum Fermentation on the Surface and Functional Properties of Pea Protein-Enriched Flour.

The effect of Lactobacillus plantarum fermentation on the functional and physicochemical properties of pea protein-enriched flour (PPF) was investigated. Over the course of the fermentation the extent of hydrolysis increased continuously until reaching a maximum degree of hydrolysis of 13.5% after 11 h. The resulting fermented flour was then adjusted to either pH=4 or 7 prior to measuring the surface and functional attributes as a function of fermentation time. At pH=4 surface charge, as measured by zeta potential, initially increased from +14 to +27 mV after 1 h of fermentation, and then decreased to +10 mV after 11 h; whereas at pH=7 the charge gradually increased from -37 to -27 mV over the entire fermentation time. Surface hydrophobicity significantly increased at pH=4 as a function of fermentation time, whereas at pH=7 fermentation induced only a slight decrease in PPF surface hydrophobicity. Foam capacity was highest at pH=4 using PPF fermented for 5 h whereas foam stability was low at both pH values for all samples. Emulsifying activity sharply decreased after 5 h of fermentation at pH=4. Emulsion stability improved at pH=7 after 5 h of fermentation as compared to the control. Oil-holding capacity improved from 1.8 g/g at time 0 to 3.5 g/g by the end of 11 h of fermentation, whereas water hydration capacity decreased after 5 h, then increased after 9 h of fermentation. These results indicate that the fermentation of PPF can modify its properties, which can lead towards its utilization as a functional food ingredient.

Effect of Fermentation on the Protein Digestibility and Levels of Non-Nutritive Compounds of Pea Protein Concentrate.

In order to determine the impact of fermentation on protein quality, pea protein concentrate (PPC) was fermented with Lactobacillus plantarum for 11 h and total phenol and tannin contents, protease inhibitor activity, amino acid composition and in vitro protein digestibility were analyzed. Phenol levels, expressed as catechin equivalents (CE), increased on dry mass basis from 2.5 at 0 h to 4.9 mg CE per 1 g of PPC at 11 h. Tannin content rose from 0.14 at 0 h to a maximum of 0.96 mg CE per 1 g of PPC after 5 h, and thereafter declined to 0.79 mg/g after 11 h. After 9 h of fermentation trypsin inhibitor activity decreased, however, at all other fermentation times similar levels to the PPC at time 0 h were produced. Chymotrypsin inhibitor activity decreased from 3.7 to 1.1 chymotrypsin inhibitory units (CIU) per mg following 11 h of fermentation. Protein digestibility reached a maximum (87.4%) after 5 h of fermentation, however, the sulfur amino acid score was reduced from 0.84 at 0 h to 0.66 at 11 h. This reduction in sulfur content altered the in vitro protein digestibility-corrected amino acid score from 67.0% at 0 h to 54.6% at 11 h. These data suggest that while fermentation is a viable method of reducing certain non-nutritive compounds in pea protein concentrate, selection of an alternative bacterium which metabolises sulfur amino acids to a lesser extent than L. plantarum should be considered.

Racial bullying and adolescent substance use: An examination of school-attending young adolescents in the United States.

This article examines the association between race and racial bullying (bullying due to one's race), in relation to youth substance use in school attending young adolescents in the United States. Weighted unadjusted and adjusted logistic regression models were run to assess if racial bullying involvement was associated with youth substance use. Data for this study come from the Health Behaviors in School-Aged Children survey (n = 7,585). An association between racial bullying status (not involve, bullying victim, bullying perpetrator, or mixed bullying victim/perpetrator) and youth substance was identified in this study. Racial bully perpetrators were most likely to have used cigarettes, alcohol, and marijuana, followed by youth in the mixed victim/perpetrator group. When analyses were stratified by race, non-Hispanic White and Hispanic youth experienced an increased risk of cigarette, alcohol, and marijuana use if in the perpetrator or mixed group (compared to those not involved with racial bullying). Non-Hispanic White and Asian youth were also more likely to report marijuana use if in the victim group. Non-Hispanic Black youth were more likely to use alcohol and marijuana if they were a perpetrator or in the mixed group, but they were not more likely to use cigarettes. Differences appear to exist in relation to racial bullying experience and substance across racial/ethnic group among youth in grades 7-10. Implications for prevention and educational professionals are discussed.

Submerged fermentation of lentil protein isolate and its impact on protein functionality, nutrition, and volatile profiles.

Fermentation of pulses as a clean processing technique has been reported to have a favorable impact on the functional and nutritional quality of the starting materials. Compared to commonly fermented pulses such as peas and chickpeas, limited information is available on the effect of fermentation on lentils, especially when using a high protein isolate (>80% protein) as compared to seeds or flours. Therefore, in the present work, lentil protein isolate was used as a feedstock for submerged fermentation with Aspergillus niger, Aspergillus oryzae, or Lactobacillus plantarum. After 48 h, the samples showed increased protein content with enhanced solubility and oil-holding capacity. Controlled fermentation, as opposed to spontaneous fermentation, maintained the high foaming capacity; however, all fermented samples had lower foam and emulsion stabilizing properties and reduced water-holding capacity compared to the control. The fermented proteins were also less digestible, possibly due to an increase in phenolics and saponins. New volatile compounds were identified in fermented samples that show promise for improved sensory attributes. Significant differences were observed in specific quality attributes depending on the microbial strain used. Further research is required to better understand the fermentative metabolism of microbial communities when provided high-protein lentil ingredients as growth substrates. PRACTICAL APPLICATION: Fermented lentil protein isolate has promising flavor profiles that may improve its sensory properties for food application.

Facilitating exit from encampments: combining low-barrier transitional housing with stabilizing treatment for substance related problems.

BACKGROUND: Tent encampments in the neighborhood surrounding Boston Medical Center (BMC) grew to include 336 individuals at points between 2019 and 21, prompting public health concerns. BMC, the City of Boston, and Commonwealth of Massachusetts partnered in 2/2022 to offer low-barrier transitional housing to encampment residents and provide co-located clinical stabilization services for community members with substance use disorders (SUDs) experiencing homelessness. METHODS: To meet the needs of some of the people who had been living in encampments, BMC established in a former hotel: 60 beds of transitional housing, not contingent upon sobriety; and a low-barrier SUD-focused clinic for both housing residents and community members, offering walk-in urgent care, SUD medications, and infection screening/prevention; and a 24/7 short-stay stabilization unit to manage over-intoxication, withdrawal, and complications of substance use (e.g., abscesses, HIV risk, psychosis). A secure medication-dispensing cabinet allows methadone administration for withdrawal management. Housing program key metrics include retention in housing, transition to permanent housing, and engagement in SUD treatment and case management. Clinical program key metrics include patient volume, and rates of initiation of medication for opioid use disorder. RESULTS: Housing: Between 2/1/22-1/31/2023, 100 people entered the low-barrier transitional housing (new residents admitted as people transitioned out); 50 former encampment residents and 50 unhoused people referred by Boston Public Health Commission. Twenty-five residents transferred to permanent housing, eight administratively discharged, four incarcerated, and four died (two overdoses, two other substance-related). The remaining 59 residents remain housed; none voluntarily returned to homelessness. One hundred residents (100%) engaged with case management, and 49 engaged with SUD treatment. CLINICAL: In the first 12 months, 1722 patients (drawn from both the housing program and community) had 7468 clinical visits. The most common SUDs were opioid (84%), cocaine (54%) and alcohol (47%) and 61% of patients had a co-occurring mental health diagnosis in the preceding 24-months. 566 (33%) patients were started on methadone and accepted at an Opioid Treatment Program (OTP). CONCLUSIONS: During the 1st year of operation, low-barrier transitional housing plus clinical stabilization care was a feasible and acceptable model for former encampment residents, 49% of whom engaged with SUD treatment, and 25% of whom transitioned to permanent housing.

Food cue reactivity in successful laparoscopic gastric banding: A sham-deflation-controlled pilot study.

Laparoscopic adjustable gastric banding (LAGB) offers a unique opportunity to examine the underlying neuronal mechanisms of surgically assisted weight loss due to its instant, non-invasive, adjustable nature. Six participants with stable excess weight loss (%EWL ≥ 45) completed 2 days of fMRI scanning 1.5-5 years after LAGB surgery. In a within-subject randomized sham-controlled design, participants underwent (sham) removal of ∼ 50% of the band's fluid. Compared to sham-deflation (i.e., normal band constriction) of the band, in the deflation condition (i.e., decreasing restriction) participants showed significantly lower activation in the anterior (para)cingulate, angular gyrus, lateral occipital cortex, and frontal cortex in response to food images (p < 0.05, whole brain TFCE-based FWE corrected). Higher activation in the deflation condition was seen in the fusiform gyrus, inferior temporal gyrus, lingual gyrus, lateral occipital cortex. The findings of this within-subject randomized controlled pilot study suggest that constriction of the stomach through LAGB may indirectly alter brain activation in response to food cues. These neuronal changes may underlie changes in food craving and food preference that support sustained post-surgical weight-loss. Despite the small sample size, this is in agreement with and adds to the growing literature of post-bariatric surgery changes in behavior and control regions.

Effect of different levels of esterification and blockiness of pectin on the functional behaviour of pea protein isolate-pectin complexes.

This research examines changes to the functional (solubility, emulsifying and foaming) properties of pea protein isolate when complexed with commercial citrus pectin of different structural attributes. Specifically, a high methoxy (P90; degree of esterification: 90.0%; degree of blockiness: 64.5%; galacturonic acid content 11.4%) and low methoxy (P29; degree of esterification: 28.6%; degree of blockiness: 31.1%; galacturonic acid: 70%) pectin at their optimum mixing ratios with pea protein isolate (4:1 pea protein isolate to P90; 10:1 pea protein isolate to P29) were assessed at the pHs associated with critical structure forming events during the complexation process (soluble complexation (pHc), pH 6.7 and 6.1; insoluble complex formation (pHϕ1), pH 4.0 and 5.0; maximum complexation (pHopt), pH 3.5 and 3.8; dissolution of complexes, pH 2.4 and 2.1; for admixtures of pea protein isolate-P90 and pea protein isolate-P29, respectively). Pea protein isolate solubility was improved from 41 to 73% by the presence of P90 at pH 6.0 and was also moderately increased at pH 4.0 and pH 5.0 by P90 and P29, respectively. The emulsion stability of both pea protein isolate-pectin complexes was higher than the homogeneous pea protein isolate at all critical pHs except pHopt as well as pHc for pea protein isolate-P29 only. P90, with the higher level blockiness and esterification, displayed better foaming properties at the maximal complexation pH when complexed with pea protein isolate than pea protein isolate-P29 or pea protein isolate alone. However at pHϕ2, pea protein isolate-P29 admixtures produced foams with 100% stability, increasing pea protein isolate foam stability by 85%. The enhanced functionality of pea protein isolate-pectin complexes based on the type of pectin used at critical pHs indicates they may be useful biopolymer ingredients in plant protein applications.

Reasons for Revision: Primary Total Hip Arthroplasty Mechanisms of Failure.

BACKGROUND: This study aimed to examine the major reasons for total hip arthroplasty (THA) failure and temporal patterns in THA revisions. METHODS: A retrospective chart review was conducted on 535 revisions performed on 444 THAs from January 2010 to May 2019 at our institution. RESULTS: The average time to revision THA was 8.51 ± 8.38 years, with 136 cases (30.9%) occurring within 2 years after primary THA. The major mechanisms of failure that resulted in revision surgery were mechanical failure (162, 36.5%), metallosis (95, 21.4%), dislocation or instability (65, 14.6%), periprosthetic fracture (46, 10.4%), infection (44, 9.9%), hematoma or poor wound healing (15, 3.4%), and pain or other (17, 3.8%). CONCLUSION: Based on our institutional experience over the past decade, mechanical failure without dislocation, metallosis, dislocation, periprosthetic fracture, and infection are typical reasons patients present for primary THA revision. Revisions within 2 years after primary THA are more likely to be the result of infection and periprosthetic fracture. Mechanical failure is the most common reason for revision THA overall, and mechanical failure and metallosis are more likely to be the reason revision is necessary 2 or more years after primary THA.

Effect of roasting pulse seeds at different tempering moisture on the flour functional properties and nutritional quality.

Knowledge on the functional and nutritional properties of wet roasted pulses can increase the utilization of processed pulses as ingredients in food products. This study investigated the effects of tempering different pulse [chickpea (CP), green lentil (GL), navy bean (NB) and yellow pea (YP)] seeds to 20 or 30% moisture prior to roasting (160℃ for 30 min) on the functional properties and nutritional quality of their resulting flours. The surface charge of each pulse remained the same (p > 0.05) after wet roasting and there were no significant (p > 0.05) differences between the different raw pulse flours. The oil holding capacity (OHC) of GL (~2 g/g) was not improved by wet roasting (p > 0.05) whereas the other pulses generally had better OHC for one or both of the tempering moistures used prior to roasting. Foaming properties of all pulses decreased after heat treatment with the exception of both foaming capacity (107%) and stability (~71%) for GL tempered to 20% moisture prior to roasting (p > 0.05). Raw GL had inferior foaming properties compared to the other raw pulse flours (p < 0.001). Emulsion properties of the wet roasted pulses were similar to those of the control (raw flour) for each pulse. Solubility decreased with roasting regardless of the tempering moisture (p < 0.05) whereas in general the in vitro protein digestibility increased. Small improvements (2.4-6.9% increase) in the in vitro protein digestibility-corrected amino acid score were found for GL and NB tempered to 20% moisture before roasting and roasted YP at either moisture content (p < 0.05). Wet roasting increased (p < 0.05) the rapidly digestible starch content, more so with a tempering moisture of 30%. Overall the results from this study will allow for the utilization of wet roasted pulses as ingredients based on their functional properties and protein quality.