COVID-19-Positive Testing in Minnesota High School Fall and Winter Sports: A Guide for Sports Risk.

OBJECTIVE: To assess the effectiveness of coronavirus disease 2019 (COVID-19) prevention strategies used during sports participation. DESIGN: To analyze prospective reports of student-athletes with COVID-19-positive tests to assess prevention strategies and risk factors by sports and seasons. SETTING: Minnesota high schools. PARTICIPANTS: Fall 2020 (August 24-October 30) and winter 2021 (January 2-March 12) student-athletes. ASSESSMENT OF RISK FACTORS: Sports, indoor location, mask use, physical distancing, and season. MAIN OUTCOME MEASURES: COVID-19-positive test rates. METHODS: Self-selected schools voluntarily reported, in 2-week intervals, the number of student-athletes with COVID-19-positive tests in each sport and the number of athletes participating in each sport during the fall and winter sports seasons. The positive testing rates per 100 000 athletes were calculated for participants in each sport and compared by sports type and risk variables. RESULTS: The high school age community-positive testing rate was 1298 per 100 000 students in the fall and 2396 in the winter. The student-athlete positive testing rate was 1500 per 100 000 athletes during the fall and 2800 during the winter (χ2 = 1.98, df = 1, P = 0.350). Positive tests per 100 000 athletes ranged from 197 (girls alpine skiing) to 4151 (wrestling). The incidence rates comparing indoor with outdoor sports (P = 0.001) and close-contact with physically distanced sports (P = 0.023) were significantly different, but the incidence rates comparing indoor masked with unmasked sports (P = ns) were not different. CONCLUSION: Athletes competing in outdoor individual sports have less risk of a COVID-19-positive test compared with age-matched individuals in the community and indoor sports participants either wearing or not wearing masks during competition. Unmasked athletes in close proximity have the highest positive test rates, and unenforced masking is not associated with lower positive testing rates. More study is needed to understand mask effectiveness.

Functional Genomic Analysis of Candida albicans Adherence Reveals a Key Role for the Arp2/3 Complex in Cell Wall Remodelling and Biofilm Formation.

Fungal biofilms are complex, structured communities that can form on surfaces such as catheters and other indwelling medical devices. Biofilms are of particular concern with Candida albicans, one of the leading opportunistic fungal pathogens of humans. C. albicans biofilms include yeast and filamentous cells that are surrounded by an extracellular matrix, and they are intrinsically resistant to antifungal drugs such that resolving biofilm infections often requires surgery to remove the contaminated device. C. albicans biofilms form through a regulated process of adhesion to surfaces, filamentation, maturation, and ultimately dispersion. To uncover new strategies to block the initial stages of biofilm formation, we utilized a functional genomic approach to identify genes that modulate C. albicans adherence. We screened a library of 1,481 double barcoded doxycycline-repressible conditional gene expression strains covering ~25% of the C. albicans genome. We identified five genes for which transcriptional repression impaired adherence, including: ARC18, PMT1, MNN9, SPT7, and orf19.831. The most severe adherence defect was observed upon transcriptional repression of ARC18, which encodes a member of the Arp2/3 complex that is involved in regulation of the actin cytoskeleton and endocytosis. Depletion of components of the Arp2/3 complex not only impaired adherence, but also caused reduced biofilm formation, increased cell surface hydrophobicity, and increased exposure of cell wall chitin and ß-glucans. Reduced function of the Arp2/3 complex led to impaired cell wall integrity and activation of Rho1-mediated cell wall stress responses, thereby causing cell wall remodelling and reduced adherence. Thus, we identify important functional relationships between cell wall stress responses and a novel mechanism that controls adherence and biofilm formation, thereby illuminating novel strategies to cripple a leading fungal pathogen of humans.

Quality of Care for Chronic Conditions Among Disabled Medicaid Enrollees: An Evaluation of a 1915 (b) and (c) Waiver Program.

IMPORTANCE: Examining the impact of Medicaid-managed care home-based and community-based service (HCBS) alternatives to institutional care is critical given the recent rapid expansion of these models nationally. OBJECTIVE: We analyzed the effects of STAR+PLUS, a Texas Medicaid-managed care HCBS waiver program for adults with disabilities on the quality of chronic disease care. DESIGN, SETTING, AND PARTICIPANTS: We compared quality before and after a mandatory transition of disabled Medicaid enrollees older than 21 years from fee-for-service (FFS) or primary care case management (PCCM) to STAR+PLUS in 28 counties, relative to enrollees in counties remaining in the FFS or PCCM models. MEASURES AND ANALYSIS: Person-level claims and encounter data for 2006-2010 were used to compute adherence to 6 quality measures. With county as the independent sampling unit, we employed a longitudinal linear mixed-model analysis accounting for administrative clustering and geographic and individual factors. RESULTS: Although quality was similar among programs at baseline, STAR+PLUS enrollees experienced large and sustained improvements in use of ß-blockers after discharge for heart attack (49% vs. 81% adherence posttransition; P<0.01) and appropriate use of systemic corticosteroids and bronchodilators after a chronic obstructive pulmonary disease event (39% vs. 68% adherence posttransition; P<0.0001) compared with FFS/PCCM enrollees. No statistically significant effects were identified for quality measures for asthma, diabetes, or cardiovascular disease. CONCLUSION: In 1 large Medicaid-managed care HCBS program, the quality of chronic disease care linked to acute events improved while that provided during routine encounters appeared unaffected.

The Telemedicine Musculoskeletal Examination.

Telemedicine uses modern telecommunication technology to exchange medical information and provide clinical care to individuals at a distance. Initially intended to improve health care for patients in remote settings, telemedicine now has a broad clinical scope with the general purpose of providing convenient, safe, and time- and cost-efficient care. The coronavirus disease 2019 pandemic has created marked nationwide changes in health care access and delivery. Elective appointments and procedures have been canceled or delayed, and multiple states still have some degree of shelter-in-place orders. Many institutions are now relying more heavily on telehealth services to continue to provide medical care to individuals while also preserving the safety of health care professionals and patients. Telemedicine can also help reduce the surge in health care needs and visits as restrictions are lifted. In recent weeks, there has been a significant amount of information and advice on how to best approach telemedicine visits. Given the frequent presentation of individuals with musculoskeletal complaints to the medical practitioner, it is important to have a framework for the virtual musculoskeletal physical examination. This will be of importance as telemedicine continues to evolve, even after coronavirus disease 2019 restrictions are lifted. This article will provide the medical practitioner performing a virtual musculoskeletal examination with a specific set of guidelines, both written and visual, to enhance the information obtained when evaluating the shoulder, hip, knee, ankle, and cervical and lumbar spine. In addition to photographs, accompanying videos are included to facilitate and demonstrate specific physical examination techniques that the patient can self-perform.

Preparation of an Aurylated Alkylthiophene Monomer via C-H Activation for Use in Pd-PEPPSI-iPr Catalyzed-Controlled Chain Growth Polymerization.

In the search for new synthetic routes toward greener and more facile syntheses of conjugated polymers, C-H functionalization provides a promising solution by minimizing the production and processing of aryl halide monomer precursors used in traditional organometallic coupling reactions. In this paper, we investigate the use of Au(I) and its ability to directly C-H activate 2-bromo-3-hexylthiophene to form a reactive monomer species, bypassing the typical Grignard monomer formation from a dihalogenated thiophene. Addition of Pd-PEPPSI-iPr as a palladium catalyst source in the presence of the resultant aurylated thiophene monomer yielded poly(3-hexylthiophene) as observed by both NMR and GPC. Studies on the growth of these polymers show linear dependence between Mn and monomer conversion, low dispersities, as well as Mn predicted by catalyst loading, which is supportive of a living-type chain growth mechanism. This Au-Pd system represents a novel methodology for incorporating C-H activation into the synthesis of P3HT with control over Mn.

C-H Arylation in the Synthesis of π-Conjugated Polymers.

C-H activation reactions have allowed us to react traditionally chemically inert bonds in molecules to develop new methods for cross-coupling reactions. This type of reactivity can be applied to conjugated polymer materials in an effort to improve existing synthetic difficulties including harsh reaction conditions, multiple monomer functionalization steps, and organometallic reagent waste. In this Viewpoint, we highlight some of the encouraging advances in direct arylation polymerization (DArP) as well as ongoing challenges for future improvement and utility.

The effects of surgical factors on postoperative astigmatism in patients enrolled in the Infant Aphakia Treatment Study (IATS).

PURPOSE: To evaluate the effect of surgical factors on postoperative astigmatism in infants undergoing cataract extraction with or without intraocular lens (IOL) implantation. METHODS: The Infant Aphakia Treatment Study is a multicenter clinical trial in which 114 infants with unilateral congenital cataracts were randomized to undergo cataract extraction with IOL placement or contact lens aphakic correction. Surgical videos were reviewed with regard to incision type and location, whether the incision was extended, the number of sutures placed, and technique of closure. Corneal astigmatism was measured using a handheld keratometer prior to surgery and at 1 year of age. RESULTS: Corneal astigmatism decreased from a mean of 1.92 D at baseline to 1.62 D at age 1 year in the contact lens group but remained almost unchanged from 2.00 D to 2.09 D in the IOL group (P = 0.023). There was no statistical difference between the amount of corneal astigmatism with regard to incision type (P = 0.214) and no increase in astigmatism with extension of the incision to facilitate IOL placement (P = 0.849) at 1 year. The number of sutures and technique of closure did not influence the amount of astigmatism at 1 year. CONCLUSIONS: At the age of 1 year following cataract extraction in infants, contact lens correction and the lack of IOL placement are associated with a significant decrease in postoperative corneal astigmatism compared to IOL placement. No other surgical factors considered in this study had a statistically significant effect on corneal astigmatism.