Coronavirus Disease 2019 (COVID-19) in Americans Aboard the Diamond Princess Cruise Ship.

BACKGROUND: The Diamond Princess cruise ship was the site of a large outbreak of coronavirus disease 2019 (COVID-19). Of 437 Americans and their travel companions on the ship, 114 (26%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We interviewed 229 American passengers and crew after disembarkation following a ship-based quarantine to identify risk factors for infection and characterize transmission onboard the ship. RESULTS: The attack rate for passengers in single-person cabins or without infected cabinmates was 18% (58/329), compared with 63% (27/43) for those sharing a cabin with an asymptomatic infected cabinmate, and 81% (25/31) for those with a symptomatic infected cabinmate. Whole genome sequences from specimens from passengers who shared cabins clustered together. Of 66 SARS-CoV-2-positive American travelers with complete symptom information, 14 (21%) were asymptomatic while on the ship. Among SARS-CoV-2-positive Americans, 10 (9%) required intensive care, of whom 7 were ≥70 years. CONCLUSIONS: Our findings highlight the high risk of SARS-CoV-2 transmission on cruise ships. High rates of SARS-CoV-2 positivity in cabinmates of individuals with asymptomatic infections suggest that triage by symptom status in shared quarters is insufficient to halt transmission. A high rate of intensive care unit admission among older individuals complicates the prospect of future cruise travel during the pandemic, given typical cruise passenger demographics. The magnitude and severe outcomes of this outbreak were major factors contributing to the Centers for Disease Control and Prevention's decision to halt cruise ship travel in US waters in March 2020.

Understanding willingness to access and experiences of NHS Stop Smoking Services: a qualitative systematic review with meta-aggregation synthesis.

OBJECTIVES: NHS Stop Smoking Services (NHS-SSS) have been available in the United Kingdom (UK) since 2000. The service has proven to be effective, however uptake remains below aspirations. Understanding people's willingness and reasons for accessing and engaging with NHS-SSS is, therefore, important. The aim of this systematic review is to summarise the findings from qualitative research to understand people's views, perceptions and willingness to access NHS-SSS. STUDY DESIGN: Qualitative systematic review with meta-aggregation synthesis. METHODS: Four electronic databases were searched for published qualitative studies, from Jan 2000 to Jan 2020. Following the screening, data extraction and quality assessment, data synthesis was conducted using meta-aggregation based on a patient-centred theoretical framework. We explored five 'demand-side' dimensions of service accessibility: the ability to perceive, seek, reach, pay and engage. Confidence in the synthesised findings relating to dependability and credibility was established using CONQual. RESULTS: Seventeen studies were included in the review. Twelve categories emerged, contributing to five synthesised statements, all with a CONQual rating of moderate confidence. Access and willingness to use NHS-SSS were found to be related to an individual's readiness to perceive that smoking is a problem for which a solution should be sought, their ability to seek a perceived effective treatment, to conveniently reach NHS-SSS, their perceptions around associated costs and tailoring care to improve engagement with individuals. CONCLUSIONS: By using a theoretical framework incorporating healthcare access, this study provides policymakers valuable insights into people's willingness to access these services. Willingness to access NHS-SSS is multifaceted, nuanced and complex. Strategies to promote NHS-SSS uptake should include making services more attractive, relevant and responsive to individual perceptions around smoking and health. Given the higher prevalence of smoking in less affluent socioeconomic groups and in some ethnic minority groups, the importance of having a comprehensive and inclusive tobacco control policy, one that is linguistically and culturally sensitive, cannot be overstated.

Public Health Responses to COVID-19 Outbreaks on Cruise Ships - Worldwide, February-March 2020.

An estimated 30 million passengers are transported on 272 cruise ships worldwide each year* (1). Cruise ships bring diverse populations into proximity for many days, facilitating transmission of respiratory illness (2). SARS-CoV-2, the virus that causes coronavirus disease (COVID-19) was first identified in Wuhan, China, in December 2019 and has since spread worldwide to at least 187 countries and territories. Widespread COVID-19 transmission on cruise ships has been reported as well (3). Passengers on certain cruise ship voyages might be aged ≥65 years, which places them at greater risk for severe consequences of SARS-CoV-2 infection (4). During February-March 2020, COVID-19 outbreaks associated with three cruise ship voyages have caused more than 800 laboratory-confirmed cases among passengers and crew, including 10 deaths. Transmission occurred across multiple voyages of several ships. This report describes public health responses to COVID-19 outbreaks on these ships. COVID-19 on cruise ships poses a risk for rapid spread of disease, causing outbreaks in a vulnerable population, and aggressive efforts are required to contain spread. All persons should defer all cruise travel worldwide during the COVID-19 pandemic.

Standing low-field MRI of the equine proximal metacarpal/metatarsal region is considered useful for diagnosing primary bone pathology and makes a positive contribution to case management: A prospective survey study.

High-field MRI of the proximal metacarpal/metatarsal region has been associated with great diagnostic potential and clinical reports of standing low-field MRI of the forelimb suggest the same. To better understand diagnostic outcomes with standing low-field MRI of the proximal suspensory region, a prospective survey study was conducted and users of a widely available system questioned on their experience, operating procedures, and interpretation of standing low-field MRI findings. Response data included scores on a modified Likert scale from which weighted ratings were calculated for statistical analyses. Depending on the question, responses were obtained from 17 to 29 of the 38 invited facilities. Users indicated that standing low-field MRI was most frequently performed in the face of equivocal diagnostic findings; compared to Sports horses, general purpose riding horses were thought less likely to have detectable abnormalities and standing low-field MRI was rated most useful for the detection of primary bone pathology in the proximal metacarpal region. Standing low-field MRI signal change involving both the suspensory ligament and adjacent bone concurrently was rated most relevant and abnormalities solely affecting the muscle/adipose tissue bundles least relevant for diagnosing suspensory ligament injury. Transverse scans and in decreasing order T1-weighted gradient echo, short-tau inversion recovery FSE, T2*-weighted gradient echo, and T2-weighted FSE sequences were most frequently acquired and judged most useful by the majority of users experienced in imaging of the target area. This survey supports the relevant impact of standing low-field MRI on clinical case management, particularly in the context of imaging the proximal metacarpal region.

Computed tomographic dimensions of the normal adult equine eye.

There are limited data on whether the dimensions of the equine eye and its internal structures change with bodyweight in horses. The aim of this study was to identify whether the size of the equine eye and its individual structures varied in a predictable manner with bodyweight, and to examine the reliability of computed tomography (CT) scans in the measurement of the equine eye. Ninety horses which had undergone CT examination of the head for non-ocular disease were included. All measurements of the eye were performed twice on all eyes by the same operator to quantify intra-operator agreement, and in 10 cases were also performed by a second operator to quantify inter-operator agreement. Agreement was excellent for all but the rostrocaudal measurement of the anterior chamber, which was fair. The following variables correlated significantly with bodyweight: anterior-posterior size of the globe (correlation coefficient: 0.586) and posterior segment (correlation coefficient: 0.554); the latero-medial size of the globe (correlation coefficient: 0.452), anterior chamber (correlation coefficient: 0.504) and posterior segment (correlation coefficient: 0.455); and the orbital fossa diameter (correlation coefficient: 0.219). The lens size and anterior-posterior distance of the anterior chamber did not correlate significantly with bodyweight. These results suggest that overall eye size and the size of the orbital fossa change with the bodyweight of the horse, but lens size remains consistent, and that CT measurements of the internal structures of the eye are repeatable and reproducible. This information aids in interventional procedures for ocular pathology and assessment of normal anatomy.

Assessing Community Health: An Innovative Tool for Measuring Height and Length.

Anthropometric measurements, including height and length, are routinely needed for health research worldwide. Measurement boards are the current gold standard for obtaining the height and length of children. In community-based research, however, the size and weight of the measurement boards make them difficult and cumbersome to carry in the field. In addition, children and infants may express an unwillingness to be placed onto the measurement board. Electronic measuring tools commonly used in industry and contracting work are precise and portable. This study piloted a protocol to use an adapted laser measurement tool, the anthropometric measurement assist (AMA), to obtain height and recumbent length in children in Western Kenya. Intra- and inter-observer variability were determined and compared with measurement board measurements. Results of this initial pilot indicated that the AMA may be a viable alternative to measurement boards. The AMA can measure height/length accurately and reliably, is portable and is equivalent in price to measuring boards, making it a viable option for fieldwork in low-resourced countries.

Mindfulness-based interventions for youth in the criminal justice system: a review of the research-based literature.

Mindfulness is a technique and sense of being present in the moment that incorporates aspects of acceptance, openness and meditation with the ultimate intention of improving well-being. Research indicates that mindfulness can significantly improve negative personality traits, reduce stress, increase attention, alleviate chronic pain and enhance mental health. Mindfulness-based interventions in correctional facilities have resulted in reduced hostility and improved self-esteem for adults, but less is known about its applicability amongst youth. This article reviews the research-based literature on the use of mindfulness-based interventions for youths (aged 13 to 24 years) involved in the justice system. A total of ten studies were located and synthesised into four themes of stress reduction, self-regulation, anger management and acceptance. The article concludes by considering the methodological rigour of the reviewed studies, providing recommendations for future research and contemplating the positive impact that mindfulness interventions might have on youth in the criminal justice system.

MAGNETIC RESONANCE IMAGING, GROSS POSTMORTEM, AND HISTOLOGICAL FINDINGS FOR SOFT TISSUES OF THE PLANTAR ASPECT OF THE TARSUS AND PROXIMAL METATARSAL REGION IN NON-LAME HORSES.

Injuries of the plantar soft tissues of the tarsus and proximal metatarsus can be a source of lameness in horses, however published information is lacking on high field MRI characteristics of these tissues. Objectives of the current anatomic study were to (1) describe high-field MRI features of the plantar tarsal and proximal metatarsal soft tissues; and (2) compare MRI findings with gross and histological appearances of selected structures for a sample of cadaver limbs from non-lame horses. Single hindlimbs for 42 horses, and right and left hindlimbs for eight horses were scanned using high-field MRI. The MRI findings were described for the 50 single limbs; and the MRI, gross postmortem and histological findings were compared for the eight pairs of hindlimbs. The superficial digital flexor tendon had uniform low signal intensity, surrounded by the flexor retinaculum of intermediate to high signal intensity on all sequences. The lateral digital flexor tendon had slightly higher signal intensity, enclosed on the plantaromedial aspects by the low signal intensity metatarsocalcaneal ligament. The accessory ligament of the deep digital flexor tendon varied in size and signal intensity. The proximal and distal plantar ligaments, accessory ligament of the suspensory ligament, and calcaneoquartal ligament had low signal intensity. The long plantar ligament comprised a number of related parts, separated by lines of high signal intensity corresponding with fibrous septae seen in gross anatomical specimens. The plantar aspect of the ligament had uniform low signal intensity in all sequences, but the dorsal half was more heterogeneous with multifocal spots or lines of higher signal intensity.

Nitrous oxide fluxes in estuarine environments: response to global change.

Nitrous oxide is a powerful, long-lived greenhouse gas, but we know little about the role of estuarine areas in the global N2 O budget. This review summarizes 56 studies of N2 O fluxes and associated biogeochemical controlling factors in estuarine open waters, salt marshes, mangroves, and intertidal sediments. The majority of in situ N2 O production occurs as a result of sediment denitrification, although the water column contributes N2 O through nitrification in suspended particles. The most important factors controlling N2 O fluxes seem to be dissolved inorganic nitrogen (DIN) and oxygen availability, which in turn are affected by tidal cycles, groundwater inputs, and macrophyte density. The heterogeneity of coastal environments leads to a high variability in observations, but on average estuarine open water, intertidal and vegetated environments are sites of a small positive N2 O flux to the atmosphere (range 0.15-0.91; median 0.31; Tg N2 O-N yr(-1) ). Global changes in macrophyte distribution and anthropogenic nitrogen loading are expected to increase N2 O emissions from estuaries. We estimate that a doubling of current median NO3 (-) concentrations would increase the global estuary water-air N2 O flux by about 0.45 Tg N2 O-N yr(-1) or about 190%. A loss of 50% of mangrove habitat, being converted to unvegetated intertidal area, would result in a net decrease in N2 O emissions of 0.002 Tg N2 O-N yr(-1) . In contrast, conversion of 50% of salt marsh to unvegetated area would result in a net increase of 0.001 Tg N2 O-N yr(-1) . Decreased oxygen concentrations may inhibit production of N2 O by nitrification; however, sediment denitrification and the associated ratio of N2 O:N2 is expected to increase.

Comparison of cone-beam and fan-beam computed tomography and low-field magnetic resonance imaging for detection of proximal phalanx dorsoproximal osteochondral defects.

BACKGROUND: Dorsoproximal osteochondral defects commonly affect the proximal phalanx, but information about diagnosis on computed tomography (CT) and magnetic resonance imaging (MRI) is limited. OBJECTIVES: To assess CT and MRI diagnoses of osteochondral defects, describe the lesions and compare sensitivity and specificity of the modalities using macroscopic pathology as gold standard. STUDY DESIGN: Cross-sectional study. METHODS: Thirty-five equine cadaver limbs underwent standing cone-beam CT (CBCT), fan-beam CT (FBCT), low-field MRI and pathological examination. CT and MR images were examined for proximal phalanx dorsomedial and dorsolateral eminence osteochondral defects. Defect dimensions were measured. Imaging diagnoses and measurements were compared with macroscopic examination. RESULTS: Fifty-six defects were seen over 70 potential locations. On CBCT and FBCT, osteochondral defects appeared as subchondral irregularity/saucer-shaped defects. On MRI, osteochondral defects were a combination of articular cartilage defect on dorsal images and subchondral flattening/irregularity on sagittal images. Subchondral thickening and osseous short tau inversion recovery hyperintensity were found concurrent with osteochondral defects. Compared with pathological examination, the sensitivity and specificity of diagnosis were 86% (95% confidence interval [95% CI] 75%-93%) and 64% (95% CI 38%-85%) for FBCT; 64% (95% CI 51%-76%) and 71% (95% CI 46%-90%) for CBCT; and 52% (95% CI 39%-65%) and 71% (95% CI 46%-90%) for MRI. Sensitivity of all modalities increased with defect size. Macroscopic defect dimensions were strongly correlated with CBCT (r = 0.76, p < 0.001) and moderately correlated with FBCT and MRI (r = 0.65, p < 0.001). Macroscopic measurements were significantly greater than all imaging modality dimensions (p < 0.001), potentially because macroscopy included articular cartilage pathology. MAIN LIMITATIONS: Influence of motion artefact could not be assessed. CONCLUSIONS: Osteochondral defects could be visualised using both CT and MRI with sensitivity increasing with defect size. Diagnostic performance was best using FBCT, followed by CBCT then MRI, but CBCT-measured defect size best correlated with macroscopic examination. MRI provided useful information on fluid signal associated with defects, which could represent active pathology.

Citrate occurs widely in healthy and pathological apatitic biomineral: mineralized articular cartilage, and intimal atherosclerotic plaque and apatitic kidney stones.

There is continuing debate about whether abundant citrate plays an active role in biomineralization of bone. Using solid state NMR dipolar dephasing, we examined another normally mineralized hard tissue, mineralized articular cartilage, as well as biocalcifications arising in pathological conditions, mineralized intimal atherosclerotic vascular plaque, and apatitic uroliths (urinary stones). Residual nondephasing ¹³C NMR signal at 76 ppm in the spectra of mineralized cartilage and vascular plaque indicates that a quaternary carbon atom resonates at this frequency, consistent with the presence of citrate. The presence, and as yet unproven possible mechanistic involvement, of citrate in tissue mineralization extends the compositional, structural, biogenetic, and cytological similarities between these tissues and bone itself. Out of 10 apatitic kidney stones, five contained NMR-detectable citrate. Finding citrate in a high proportion of uroliths may be significant in view of the use of citrate in urolithiasis therapy and prophylaxis. Citrate may be essential for normal biomineralization (e.g., of cartilage), play a modulatory role in vascular calcification which could be a target for therapeutic intervention, and drive the formation of apatitic rather than other calcific uroliths, including more therapeutically intractable forms of calcium phosphate.

Saddle Thigh Block Design Can Influence Rider and Horse Biomechanics.

The association between rider-saddle interaction and horse kinematics has been little studied. It was hypothesized that differences in a thigh block design would influence (a) rider-saddle interface pressures, (b) rider kinematics, and (c) equine limb/spinal kinematics. Eighteen elite sport horses/riders were trotted using correctly fitted dressage saddles with thigh blocks S (vertical face) and F (deformable face). Contact area, mean, and peak pressure between rider and saddle were determined using an on-saddle pressure mat. Spherical markers allowed for the measurement of horse/rider kinematics using two-dimensional video analysis. The kinematics of the equine thoracolumbosacral spine were obtained using skin-mounted inertial measuring units. Results were compared between thigh blocks (paired t-test p ≤ 0.05). With F, the contact area, mean, and peak pressure between rider and saddle were significantly higher (p = 0.0001), and the rider trunk anterior tilt was reduced, indicating altered rider-saddle interaction. The horse thoracic axial rotation and flexion/extension were reduced (p = 0.01-0.03), caudal thoracic and lumbar lateral bend was increased (p = 0.02-0.04), and carpal flexion increased (p = 0.01-0.05) with F compared to S. During straight-line locomotion when in sitting trot, thigh block F was associated with altered rider-saddle interaction and rider and equine kinematics, leading to a more consistent rider-saddle interface, a more upright rider trunk during stance, an increased horse thoracic stability and lumbar lateral bend, and forelimb flexion, supporting the importance of optimising rider-saddle-horse interaction.

Equine Behavioural and Physiological Responses to Auditory Stimuli in the Presence and Absence of Noise-Damping Ear Covers.

Despite numerous studies investigating responses to visual perception, there is limited research into how horses respond to different auditory stimuli. Although 'noise-damping' ear covers are frequently used on sport horses to minimise distraction from external auditory stimuli, the effectiveness of ear covers has not been established. This study aimed to (i) investigate the responses of horses to different sounds commonly present in a competition environment, and (ii) compare these responses in the presence and absence of ear covers. A total of 18 horses were presented with 5 sounds commonly heard in competition or stable environments both with and without ear covers, in a randomised order crossover design. Behavioural and heart rate responses were recorded. Responses were compared between sounds and with/without ear covers. Differences in physiological and behavioural responses to different complex auditory stimuli were shown. An overall difference in physiological and behavioural responses with and without ear covers was detected, although the only difference in heart rate between ear covers and no ear covers that individually achieved significance was the feed sound. These findings suggest that horses can discriminate sounds and alter their responses based on the individual stimulus, and these responses are reduced when wearing ear covers with varying effectiveness for different sounds.

Comparison of cone-beam and fan-beam computed tomography and low-field magnetic resonance imaging for detection of palmar/plantar osteochondral disease in Thoroughbred horses.

BACKGROUND: Palmar/plantar osteochondral disease (POD) of the metacarpal/tarsal condyles is a common pathological finding in racehorses. OBJECTIVE: To compare diagnoses, imaging details, and measurements of POD lesions between cone-beam computed tomography CT (CBCT), fan-beam CT (FBCT), and low-field magnetic resonance imaging (MRI) using macroscopic pathology as a gold standard. STUDY DESIGN: Cross-sectional study. METHODS: Thirty-five cadaver limbs from 10 horses underwent CBCT, FBCT, MRI, and macroscopic examination. CT and MR images were examined for presence of POD, imaging details of POD, and measurements of POD dimensions and areas. Imaging diagnoses, details, and measurements were compared with macroscopic examination and between modalities. RESULTS: Forty-eight POD lesions were seen over 70 condyles. Compared with macroscopic examination the sensitivity and specificity of diagnosis were 95.8% (CI95 = 88%-99%) and 63.6% (CI95 = 43%-81%) for FBCT, 85.4% (CI95 = 74%-94%) and 81.8% (CI95 = 63%-94%) for CBCT, and 69.0% (CI95 = 54%-82%) and 71.4% (CI95 = 46%-90%) for MRI. Inter-modality agreement on diagnosis was moderate between CBCT and FBCT (κ = 0.56, p < 0.001). POD was identified on CT as hypoattenuating lesions with surrounding hyperattenuation and on MRI as either T1W, T2*W, T2W, and STIR hyperintense lesions or T1W and T2*W heterogeneous hypointense lesions with surrounding hypointensity. Agreement on imaging details between CBCT and FBCT was substantial for subchondral irregularity (κ = 0.61, p < 0.001). Macroscopic POD width strongly correlated with MRI (r = 0.81, p < 0.001) and CBCT (r = 0.79, p < 0.001) and moderately correlated with FBCT (r = 0.69, p < 0.001). Macroscopic POD width was greater than all imaging modality (p < 0.001). MAIN LIMITATIONS: Effect of motion artefact in live horse imaging could not be assessed. CONCLUSIONS: All imaging modalities were able to detect POD lesions, but underestimated lesion size. The CT systems were more sensitive, but the differing patterns of signal intensity may suggest that MRI can detect changes associated with POD pathological status or severity. The image features observed by CBCT and FBCT were similar.

Three-Dimensional Imaging and Histopathological Features of Third Metacarpal/Tarsal Parasagittal Groove and Proximal Phalanx Sagittal Groove Fissures in Thoroughbred Horses.

Fissure in the third metacarpal/tarsal parasagittal groove and proximal phalanx sagittal groove is a potential prodromal pathology of fracture; therefore, early identification and characterisation of fissures using non-invasive imaging could be of clinical value. Thirty-three equine cadaver limbs underwent standing cone-beam (CB) computed tomography (CT), fan-beam (FB) CT, low-field magnetic resonance imaging (MRI), and macro/histo-pathological examination. Imaging diagnoses of fissures were compared to microscopic examination. Imaging features of fissures were described. Histopathological findings were scored and compared between locations with and without fissures on CT. Microscopic examination identified 114/291 locations with fissures. The diagnostic sensitivity and specificity were 88.5% and 61.3% for CBCT, 84.1% and 72.3% for FBCT, and 43.6% and 85.2% for MRI. Four types of imaging features of fissures were characterised on CT: (1) CBCT/FBCT hypoattenuating linear defects, (2) CBCT/FBCT striated hypoattenuated lines, (3) CBCT/FBCT subchondral irregularity, and (4) CBCT striated hypoattenuating lines and FBCT subchondral irregularity. Fissures on MRI appeared as subchondral bone hypo-/hyperintense defects. Microscopic scores of subchondral bone sclerosis, microcracks, and collapse were significantly higher in locations with CT-identified fissures. All imaging modalities were able to identify fissures. Fissures identified on CT were associated with histopathology of fatigue injuries.

Identification of Heterotopic Mineralization and Adjacent Pathology in the Equine Fetlock Region by Low-Field Magnetic Resonance Imaging, Cone-Beam and Fan-Beam Computed Tomography.

Heterotopic mineralization in equine distal limbs has been considered an incidental finding and little is known about its imaging features. The study aimed to identify heterotopic mineralization and adjacent pathology in the fetlock region with cone-beam (CB) computed tomography (CT), fan-beam (FB) CT, and low-field magnetic resonance imaging (MRI). Images from 12 equine cadaver limbs were examined for heterotopic mineralization and adjacent pathology and verified by macro-examination. Retrospective review of the CBCT/MR images from 2 standing horses was also included. CBCT and FBCT identified twelve mineralization's with homogeneous hyperattenuation: oblique-sesamoidean-ligament (5) without macroscopic abnormality; deep-digital-flexor-tendon (1) and suspensory-branch (6) with macroscopic abnormalities. MRI failed to identify all mineralization's, but detected suspensory branch splitting, and T2 and STIR hyperintensity in 4 suspensory-branches and 3 oblique-sesamoidean-ligaments. Macro-examination found corresponding disruption/splitting and discoloration. All modalities identified 7 ossified fragments showing cortical/trabecular pattern: capsular (1), palmar sagittal ridge (1), proximal phalanx (2) without macroscopic abnormality, and proximal sesamoid bones (3). On MRI, fragments were most identifiable on T1 images. All abaxial avulsions had suspensory-branch splitting on T1 images with T2 and STIR hyperintensity. Macro-examination showed ligament disruption/splitting and discoloration. Suspensory-branch/intersesamoidean ligament mineralization's were identified by CBCT in standing cases; 1 had associated T2 hyperintensity. Both CT systems were generally superior in identifying heterotopic mineralization's than MRI, while MRI provided information on soft tissue pathology related to the lesions, which may be important for management.

Lipids in biocalcification: contrasts and similarities between intimal and medial vascular calcification and bone by NMR.

Pathomechanisms underlying vascular calcification biogenesis are still incompletely understood. Biomineral from human atherosclerotic intimal plaques; human, equine, and bovine medial vascular calcifications; and human and equine bone was released from collagenous organic matrix by sodium hydroxide/sodium hypochlorite digestion. Solid-state (13)C NMR of intimal plaque mineral shows signals from cholesterol/cholesteryl esters and fatty acids. In contrast, in mineral from pure medial calcifications and bone mineral, fatty acid signals predominate. Refluxing (chloroform/methanol) intimal plaque calcifications removes the cholesterylic but not the fatty acyl signals. The lipid composition of this refluxed mineral now closely resembles that of the medial and bone mineral, which is unchanged by reflux. Thus, intimal and medial vascular calcifications and bone mineral have in common a pool of occluded mineral-entrained fatty acyl-rich lipids. This population of fatty acid may contain methyl-branched fatty acids, possibly representing lipoprotein particle remnants. Cell signaling and mechanistic parallels between physiological (orthotopic) and pathological (ectopic) calcification are also reflected thus in the NMR spectroscopic fingerprints of mineral-associated and mineral-entrained lipids. Additionally the atherosclerotic plaque mineral alone shows a significant independent pool of cholesterylic lipids. Colocalization of mineral and lipid may be coincidental, but it could also reflect an essential mechanistic component of biomineralization.

Effect of Ground and Raised Poles on Kinematics of the Walk.

Walking over poles is a commonly employed training and rehabilitation tool and it is crucial to understand its effect on equine locomotion, particularly joint range of motion (ROM). The study aimed to compare the effect of ground poles (GP) and raised poles (RP) on limb kinematics and poll, wither and pelvic ROM at walk. It was hypothesized that walking over poles would increase joint ROM but have no effect on poll, wither and pelvic ROM compared to no poles (NP). Forty-one horses were walked in-hand over NP, GP (10 cm) and RP (26 cm) in a crossover design. Limb kinematics were determined via two-dimensional motion capture (240 Hz). Poll, wither, tubera sacrale, and left/right tuber coxae ROM were determined by inertial motion units (100 Hz). Multivariable mixed effects linear regression analyses were carried out. Walking over poles increased limb joint ROM, through increased swing flexion, compared to NP. There was a greater effect over RP compared to GP. Significant reductions in craniocaudal ROM of the wither, tuber coxae and tuber sacrale were observed over GP and RP. Mediolateral ROM of tuber coxae and tuber sacrale increased over GP and RP and was greatest over RP. Wither ROM was increased over RP only. Set-up and height of the poles used here may not extrapolate to other scenarios. Walking over poles appears to be effective at increasing joint ROM via an increase in mid swing flexion, without vertical excursion of the trunk, compared to normal locomotion, which supports the use of poles for rehabilitation.

Effect of Water Depth on Limb and Back Kinematics in Horses Walking on a Water Treadmill.

Water treadmill (WT) exercise is frequently used for training/rehabilitation of horses. There is limited study into the effect of water depth on limb/back kinematics warranting investigation. The objective was to determine the effect of walking in different water depths, at the same speed, on limb/back kinematics measured simultaneously in a group of horses. Six horses (age:15 ± 6.5 years) completed a standardized WT exercise session (19 minutes duration; speed:1.6 m/s; water depths: 0.0/7.5/21.0/32.0/47.0 cm). Ten waterproof light-emitting-diode tea-light-markers and reflective-spheres were affixed to the skin at predetermined locations; inertial-measurement-units were fixed to the poll/withers/left and right tubera coxae (TC)/sacrum to determine range-of-motion (ROM) changes of these locations. Univariable-mixed-effects-linear-regression-analyses were carried out, with a significance value of P ≤ .05. At maximum carpal/tarsal flexion during swing, regression analyses showed a clear and consistent nonlinear increase in carpal and tarsal flexion at increasing water depths (P < 0.0001 for both variables). As water depth increased there was a significant increase in thoracic spine flexion-extension ROM (P < 0.0001 at all thoracic sites) and increased dorsoventral and mediolateral ROM of the sacrum/left and right TC (P < 0.001 for all variables) as water depth increased. Results suggest that horses responded to an increase in water depth until a threshold depth was reached when the biomechanical response levelled off, and there was increased pelvic roll. In conclusion, changes in limb kinematics brought about by relatively modest increases in water depth at walking speed of 1.6 m/s are sufficient to induce significant changes in back/pelvic movement highlighting key issues with relevance for WT program design.

Social determinants of health screening and intervention: A cystic fibrosis quality improvement process.

INTRODUCTION: Lower socioeconomic status is associated with significantly poorer outcomes in weight, lung function, and pulmonary exacerbation rates in people with cystic fibrosis (PwCF). GLOBAL AIM: We aim to reduce health disparities and inequities faced by PwCF by screening for and addressing unmet social needs. SPECIFIC AIMS: We aimed to increase routine social determinants of health (SDoH) screening of eligible PwCF from 0% to 95% and follow-up within 2 weeks for those PwCF who screened positive and requested assistance from 0% to 95% by December 31, 2021. METHODS: The Model for Improvement methodology was used. A process map and a simplified failure mode effects analysis chart were created for the screening and SDoH follow-up process. For those who screened positive for SDoH and requested assistance, follow-up contact was made to offer intervention. INTERVENTION: Adult PwCF who had at least one UVA Clinic encounter in 2021 were screened for SDoH. The SDoH screening tool included eight domains: housing, food, transportation, utilities, health-care access, medication access, income/employment, and education. Follow-up was completed with all PwCF who screened positive for SDoH. RESULTS: A total of 132 of 142 (93.0%) PwCF eligible for screening completed the SDoH screening. Of the PwCF who completed screening, 56 (42.4%) screened positive for SDoH. A follow-up rate of 100% was achieved in June 2021 and maintained through December 2021. CONCLUSION: Implementing screening for SDOH and follow-up to mitigate social difficulties in adult PwCF at UVA was successful and could be reproduced at other CF care centers.