Shared Vision for Improving Outcomes for Serious Fungal Diseases: Report of a Patient, Caregiver, and Clinician Summit.

Background: Recently, increasing focus on patient input into research and healthcare improvements has fostered expanded patient-centered advocacy efforts. This first pan-fungal disease summit, part of the MYCology Advocacy, Research, & Education effort, brought together patients, caregivers, and mycology experts to better document patient experiences with invasive fungal disease (IFD) and establish priorities for mycology education, advocacy, and research. Methods: Patients who had suffered from IFD, their caregivers, clinicians, industry representatives, government officials, and patient advocacy professionals were invited. Patients and caregivers shared their stories and struggles with IFD. Breakout sessions separated mycology experts from patients and caregivers for further discussions to identify commonalities and perceived gaps and to formulate recommendations. The 2 groups then reconvened to develop consensus recommendations. Results: IFD patients and their caregivers shared experiences reflecting the typically lengthy prediagnosis, acute treatment, long-term treatment, and posttreatment recovery stages of IFD. They reported substantial physical, psychological, and financial burdens associated with the IFD experience, particularly related to delayed diagnoses. They reaffirmed a need for coordinated patient-centered education, peer support, and advocacy to document the burden of serious fungal infections. Mycology experts discussed strategies to address gaps in the mycology field, such as insufficient training, inadequate workforce support, and a need to partner more with patient groups. Conclusions: A summit involving patients with IFD, family caregivers, and mycology experts identified a substantial nonclinical burden of disease associated with IFD. Patients and mycology experts prioritized several goals for education, advocacy, and research to raise awareness of IFD and improve outcomes.

Global liberalism, emerging illiberalism, and human rights, 1980 to 2018.

The international institutions established after 1945 enshrine and expand human rights norms. Recently, the global liberal order has been challenged by a variety of illiberal oppositions. We discuss how the trajectories of global liberalism and illiberal challenges may affect country human rights practices in both direct and diffuse ways. Hybrid panel regression models of human rights scores for 158 countries from 1980 to 2018 evaluate our arguments. We observe direct effects of global liberalism: countries linked to liberal organizations in world society have higher scores on measures of human rights practices. The growth of global liberalism also explains a great deal of within-country variation in human rights practices over time. However, recent illiberal challenges have the opposite effect. Countries linked to illiberal intergovernmental organizations are less respectful of human rights, and the global rise of illiberalism undermines human rights. We conclude with reflections on the importance of the global institutional and normative context for sustaining (and eroding) human rights.

The impact of Demodex blepharitis on patient symptoms and daily life.

SIGNIFICANCE: Patients with Demodex blepharitis have a considerable symptomatic burden that negatively impacts their daily activities and well-being. Despite chronic manifestations of and problems associated with blepharitis that resulted in multiple visits to eye care providers, Demodex blepharitis remained underdiagnosed or misdiagnosed. PURPOSE: This study aimed to evaluate the effect of Demodex blepharitis on patients' daily activities and well-being. METHODS: This prospective, multicenter, observational study recruited 524 patients with Demodex blepharitis from 20 U.S. ophthalmology and optometry practices. Demodex blepharitis was diagnosed based on the presence of the following clinical manifestations in at least one eye: >10 collarettes on the upper lashes, at least mild lid margin erythema of the upper eyelid, and mite density of ≥1.0 mite/lash (upper and lower combined). Patients were asked to complete a questionnaire related to their symptoms, daily activities, and management approaches. RESULTS: The proportion of patients who experienced blepharitis symptoms for ≥2 years was 67.8%, and for ≥4 years, it was 46.5%. The three most bothersome symptoms ranked were "itchy eyes," "dry eyes," and "foreign body sensation." Overall, 77.4% of patients reported that Demodex blepharitis negatively affected their daily life. One-third (32.3%) of patients had visited a doctor for blepharitis at least two times, including 19.6% who visited at least four times. Despite having clinical manifestations of Demodex blepharitis confirmed by an eye care provider, 58.7% had never been diagnosed with blepharitis. Commonly used management approaches were artificial tears, warm compresses, and lid wipes. Among those who discontinued their regimen, 45.9% had discontinued because of either tolerability issues or lack of effectiveness. Among contact lens wearers, 64.3% of the patients either were uncomfortable wearing contact lenses or experienced vision changes "sometimes" or "frequently." CONCLUSION: Demodex blepharitis results in a significant negative impact on daily activities, creating a psychosocial and symptomatic burden on patients.

Long-Term Outcomes of 6-Week Treatment of Lotilaner Ophthalmic Solution, 0.25%, for Demodex Blepharitis: A Noninterventional Extension Study.

PURPOSE: The aim of this study was to evaluate the long-term outcomes of lotilaner ophthalmic solution, 0.25%, in the treatment of Demodex blepharitis. METHODS: This observational, extension study included patients with Demodex blepharitis (N = 239) who completed the Saturn-1 study and presented for the day 180 visit. All participants were assessed at days 180 and 365 after the initiation of 6-week treatment with the study drug or its vehicle. RESULTS: The proportion of patients with 0 to 2 collarettes (grade 0) was significantly higher in the study group (N = 128 patients) than in the control group (N = 111 patients) (39.8% vs. 2.7% at day 180 and 23.5% vs. 2.9% at day 365; P < 0.0001). Similarly, the proportion of patients with ≤10 collarettes (collarette grade 0-1) in the study group was significantly higher than in the control group (70.3% vs. 18.0% at day 180 and 62.6% vs. 21.9% at day 365; P < 0.0001). In the study group, erythema continued to improve even after completion of the 6-week lotilaner treatment. No serious ocular adverse events were observed in the study group, and there was 1 treatment-related ocular adverse event in the study group, which was considered mild. CONCLUSIONS: After 6-week treatment with lotilaner ophthalmic solution, 0.25%, for Demodex blepharitis, no long-term concerns were observed during 1 year of follow-up. A high proportion of patients with 0 to 2 collarettes (grade 0) or ≤10 collarettes (collarette grade of 0 or 1) was observed throughout 1 year of follow-up, indicating that the efficacy of lotilaner ophthalmic solution, 0.25%, against Demodex blepharitis may last well after completion of therapy.

Perceptions of Job Hazards and Requests for Accommodation Among Pregnant Women in a Large Urban Hospital System.

BACKGROUND: Many pregnant women remain uninformed about job accommodation options or have not been empowered to ask their employers. METHODS: A cross-sectional survey of a sample base of pregnant women from late first through third trimester was conducted. Associations between job perception variables, work characteristics, race/ethnicity, and income were assessed using binary logistic regression. RESULTS: Workers in service/support occupations were twice as likely as those in management to perceive need for job duty change and to request job accommodation. Perception of needed job change was higher when jobs had high physical demands and low substantive complexity. CONCLUSIONS: We found positive relationships between highly physical work, perception of harm, and need for job change in pregnancy. Further research could explore worker/employer characteristics explaining why these perceptions did not translate into requesting and receiving job accommodation during pregnancy.

Lotilaner Ophthalmic Solution 0.25% for Demodex Blepharitis: Randomized, Vehicle-Controlled, Multicenter, Phase 3 Trial (Saturn-2).

PURPOSE: To evaluate the safety and efficacy of lotilaner ophthalmic solution 0.25% compared with vehicle for the treatment of Demodex blepharitis. DESIGN: Prospective, randomized, double-masked, vehicle-controlled, multicenter, phase 3 clinical trial. PARTICIPANTS: Four hundred twelve patients with Demodex blepharitis were assigned randomly in a 1:1 ratio to receive either lotilaner ophthalmic solution 0.25% (study group) or vehicle without lotilaner (control group). METHODS: Patients with Demodex blepharitis treated at 21 United States clinical sites were assigned either to the study group (n = 203) to receive lotilaner ophthalmic solution 0.25% or to the control group (n = 209) to receive vehicle without lotilaner bilaterally twice daily for 6 weeks. Collarettes and erythema were graded for each eyelid at screening and at all visits after baseline. At screening and on days 15, 22, and 43, 4 or more eyelashes were epilated from each eye, and the number of Demodex mites present on the lashes was counted with a microscope. Mite density was calculated as the number of mites per lash. MAIN OUTCOME MEASURES: Outcome measures included collarette cure (collarette grade 0), clinically meaningful collarette reduction to 10 collarettes or fewer (grade 0 or 1), mite eradication (0 mites/lash), erythema cure (grade 0), composite cure (grade 0 for collarettes as well as erythema), compliance with the drop regimen, drop comfort, and adverse events. RESULTS: At day 43, the study group achieved a statistically significant (P < 0.0001) higher proportion of patients with collarette cure (56.0% vs. 12.5%), clinically meaningful collarette reduction to 10 collarettes or fewer (89.1% vs. 33.0%), mite eradication (51.8% vs. 14.6%), erythema cure (31.1% vs. 9.0%), and composite cure (19.2% vs. 4.0%) than the control group. High compliance with the drop regimen (mean ± standard deviation, 98.7 ± 5.3%) in the study group was observed, and 90.7% of patients found the drops to be neutral to very comfortable. CONCLUSIONS: Twice-daily treatment with lotilaner ophthalmic solution 0.25% for 6 weeks generally was safe and well tolerated and met the primary end point and all secondary end points for the treatment of Demodex blepharitis compared with vehicle control. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Radiation osteitis: incidence and clinical impact in the setting of radiation treatment for soft tissue sarcoma.

OBJECTIVE: Radiotherapy is an important component of soft tissue sarcoma management. Radiation osteitis is a common radiographic finding identified in the setting of radiotherapy on magnetic resonance imaging (MRI). This study aims to identify the incidence of radiation osteitis in patients who received radiotherapy for soft tissue sarcoma and if a further workup, including a biopsy, was performed for concerning MRI findings. MATERIALS AND METHODS: Medical records of patients with soft tissue sarcoma who received radiotherapy from 2008 to 2020 were retrospectively reviewed. Patients with at least one MRI of the sarcoma site following radiotherapy and information regarding radiotherapy treatments were included. MRIs of these patients were reviewed for the presence of radiation osteitis by two musculoskeletal radiologists. The clinical course of these patients including biopsy for concerning MRI findings, local recurrence, and metastasis was recorded. RESULTS: Thirty soft tissue sarcoma patients who received radiation for soft tissue sarcoma were included. Radiation osteitis was present in 18 patients. The time to osteitis present on MRI following radiotherapy completion was a median of 4.5 months. Biopsy for concerning MRI findings was performed in eight patients, five for local recurrence, and three for regional osseous metastasis. Three patients had confirmed osseous metastases. CONCLUSION: Although radiation osteitis is often a benign imaging finding, it can be difficult to discern these lesions from potentially malignant sites of disease. We recommend multidisciplinary management of soft tissue sarcoma at sarcoma centers to appropriately identify benign from malignant lesions and decide the necessity of a biopsy.

Testing the Nonlinearity Assumption Underlying the Use of Reverse-Keyed Items: A Logical Response Perspective.

Researchers often assume a strong, linear relationship between regular- and reverse-keyed items, with responses on regular-keyed items (e.g., agree) perfectly mirroring those on reverse-keyed items (e.g., disagree). The current research challenges this received view and propounds a possible nonlinear relationship, partly due to the logical tendency of midlevel respondents to disagree with both types of items. In four examples (reported human height, job satisfaction, positive-negative affect, and self-esteem; total N = 50,544), a nonlinear model consistently explained additional item variance beyond a linear model. We further demonstrate that this relationship is moderated by item characteristics such as item extremity (job satisfaction) and item softening (self-esteem). Suboptimal modeling of the relationship may result in the apparent bidmensionality of a construct that characterizes regular- and reverse-keyed items as separate factors. User-friendly syntax for the examination of nonlinearity is provided to enhance the accessibility of the procedure.

Vasoactive Intestinal Peptide-Secreting Pheochromocytoma: A Case Report and Review of Literature.

Objective: To describe a case of composite vasoactive intestinal peptide (VIP)-secreting pheochromocytoma and review literature to provide insight into the various presentations and potential management of these rare tumors. Case Report: A 64-year-old male patient presented with hypertensive emergency and coronary demand ischemia with development of watery diarrhea, hypokalemia, and achlorhydria syndrome. Serum and urine studies demonstrated elevated metanephrine and VIP levels. Definitive surgical resection resolved symptoms and normalized laboratory values. Pathologic examination of the specimen revealed pheochromocytoma with a Pheochromocytoma of the Adrenal gland Scaled Score of 4 and patchy expression of VIP. Discussion: Given the different actions of hormones that can be secreted by these composite tumors, we suggest that pheochromocytomas with diversified secretory capabilities may be an underrecognized clinical entity. Localized disease is often amenable to surgical resection, although management of metastatic disease is not well established due to the rarity of these tumors and lack of randomized trials. Conclusion: In patients presenting with diarrhea of unclear etiology or the suggestion of secondary hypertension, assessment for a possible neuroendocrine tumor may be prudent. If an adrenal mass is discovered but the patient exhibits atypical symptoms of catecholamine excess, a diagnosis of composite pheochromocytoma with multisecretory properties should be considered.

Occupation and Semen Parameters in a Cohort of Fertile Men.

OBJECTIVE: We examined associations between occupation and semen parameters in demonstrably fertile men in the Study for Future Families. METHODS: Associations of occupation and workplace exposures with semen volume, sperm concentration, motility, and morphology were assessed using generalized linear modeling. RESULTS: Lower sperm concentration and motility were seen in installation, maintenance, and repair occupations. Higher exposure to lead, and to other toxicants, was seen in occupations with lower mean sperm concentrations (prevalence ratio for lead: 4.1; pesticides/insecticides: 1.6; solvents: 1.4). Working with lead for more than 3 months was associated with lower sperm concentration, as was lead exposure outside of work. CONCLUSIONS: We found evidence in demonstrably fertile men for reduced sperm quality with lead, pesticide/herbicide, and solvent exposure. These results may identify occupations where protective measures against male reproductive toxicity might be warranted.

Magnetic Resonance Imaging Findings of the Asymptomatic Shoulder May Impact Performance, Not Future Injury List Placement in Major League Baseball Pitchers.

Purpose: To evaluate preseason shoulder magnetic resonance images (MRIs) obtained from pitchers entering either major or minor league baseball (MLB) and correlate findings with subsequent injury, operative repair, and placement on the injured list (IL). Methods: Preseason-MRI of the throwing shoulders of professional-level baseball pitchers, taken during routine evaluations at a single organization (2004-2017) were retrospectively reviewed. Publicly available databases were queried to exclude pitchers with known injuries prior to pre-signing imaging. Three blinded reviewers reviewed all MRI scans independently to evaluate for the presence of abnormalities in the rotator cuff (RTC), labrum, capsule, long-head of the biceps tendon (LHBT), and humeral head. Binary imaging findings were correlated to future placement on the IL for subsequent shoulder complaints. Bivariate statistics using Student's t-tests and Fisher exact tests (both α = .05) were used in this study. Results: A total of 38 asymptomatic pitchers with shoulder MRIs were included. Pitchers had a mean (±SD) age of 28.2 ± 4.9 and had pitched an average of 119.6 ± 143.8 career games. Pitchers with partial articular-sided RTC tears (P = .04) or intra-articular BT hyperintensity (P = .04) on preseason MRI demonstrated an association with the need for future surgery. Pitchers with evidence of labral heterogeneity demonstrated greater total career pitch counts (10,034.1 vs 2,465.3; P = .04). Evidence of a posterior-superior humeral cyst was associated with decreased strikeouts per 9 innings (6.1 vs 8.0; P = .039) and total strikeout percentage (16.1% vs 23.2%; P = .04). Conclusion: Although there was a significant difference in the percent of various radiographic findings between the injured and healthy cohort, no MRI findings were predictive of future IL placement or duration of placement. The presence of a posterior superior humeral cyst was associated with decreased strikeout rates at 2 and 3 years, the presence of a labral tear was associated with decreased earned run average (ERA) at 3 years and decreased career strikeout percentages, and increased capsular signal was associated with decreased 5-year ERA. Level of Evidence: Level IV, retrospective study.

Development and evolution of commitment profiles among military recruits: Implications for turnover intention and well-being.

We investigate the development and consequences of commitment profiles among Canadian Armed Forces (CAF) recruits who completed surveys at the end of basic training (N = 3998) and three (N = 636) and nine (N = 612) months later. The surveys included measures of affective, normative, and continuance commitment as well as measures developed by the CAF to assess recruits' experiences, career intentions, and well-being. Latent profile analyses of commitment at the end of basic training revealed four quantitatively distinct profiles (i.e., profiles differing in elevation but not shape). Strength of commitment related positively with perceived values fit, support from instructors and fellow recruits, and well-being, and negatively with turnover intention. Analyses of longitudinal data obtained following basic training revealed a stable and more differentiated 6-profile structure reflecting weak, exchange-based (continuance-dominant) and value-based (strong affective alone or in combination with strong normative and continuance) commitment. Value-based profiles were associated with greater perceived values fit, supervisor support, and well-being, and lower turnover intentions. The relative advantages of identifying the more nuanced commitment mind-sets reflected in commitment profiles is discussed along with the relevance of early onboarding experiences for the development of value-based commitment and retention.

Return-to-Sport Criteria After Upper Extremity Surgery in Athletes-A Scoping Review, Part 2: Ulnar Collateral Ligament of the Elbow Procedures.

BACKGROUND: There is a lack of consensus to guide patient return to sport (RTS) after elbow ulnar collateral ligament surgery (eUCLS). PURPOSE: To describe the reported RTS criteria after eUCLS in the athletic population. STUDY DESIGN: Scoping review; Level of evidence, 4. METHODS: This scoping review was performed by adhering to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review) guidelines. We searched 5 electronic databases (MEDLINE, Scopus, SPORTDiscus, Embase, Google Scholar Advanced) and the gray literature for English-language studies that reported at least 1 RTS criterion in athletes after eUCLS. Data were extracted and summarized as frequencies or arithmetic mean and standard deviation. RESULTS: Included were 14 studies and 1335 athletes with a mean age of 21.4 ± 1.1 years. Time from surgery (range, 6-16 months) was the most common RTS criterion used, and it was reported by all 14 of the included articles. RTS criteria reported less often were pain (3/14; 21%), successful completion of a throwing program (3/14; 21%), muscle strength of the forearm muscles (1/14; 7%), and "normal" range of motion and muscle strength of the elbow and shoulder joints on the operated upper extremity (1/14; 7%). All studies used 1 to 5 of the above RTS criteria. CONCLUSION: Only 14 studies reported 1 or more RTS criteria after eUCLS in athletes, and time was the most common RTS criterion used. Our results highlight the need for a coordinated effort among surgeons, physical therapists, and athletic trainers in order to establish evidence-based RTS criteria after eUCLS in athletes so athletes can safely to sport and prolong their athletic careers.

Return-to-Sport Criteria After Upper Extremity Surgery in Athletes-A Scoping Review, Part 1: Rotator Cuff and Shoulder Stabilization Procedures.

BACKGROUND: Standardized criteria are lacking to guide patient return to sport (RTS) after rotator cuff surgery (RCS) or shoulder stabilization surgery (SSS). PURPOSE: To describe RTS criteria used after RCS and SSS in athletic populations. STUDY DESIGN: Scoping review; Level of evidence, 4. METHODS: This scoping review was based on the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review) guidelines. A total of 5 electronic databases (MEDLINE, Scopus, SPORTDiscus, Embase, Google Scholar Advanced search) and the gray literature were searched for English-language studies that reported at least 1 RTS criterion in athletes after shoulder surgery. Studies were assigned to the RCS or SSS subgroup based on the primary procedure performed. Data were extracted and summarized as frequencies or arithmetic mean and standard deviation. RESULTS: Included were 52 studies and 2706 athletes (2206 male, 500 female, with a mean age of 28.8 ± 1.8 years). The RCS group consisted of 14 studies and the SSS group consisted of 38 studies. Time from surgery was the most common RTS criterion reported overall (37/52 studies; 71%) as well as within the RCS (93%) and SSS (63%) subgroups. Muscle strength (25/52 studies; 48%) and range of motion (23/52; 44%) were used by almost half of the included articles. RTS criteria reported less often were absence of pain, successful completion of sport-specific or position-specific test, proprioception, radiographic evaluation, patient-surgeon agreement, minimum time required to participate in pain-free throwing, and satisfactory scapulothoracic mechanics. All studies used 1 to 3 of the above RTS criteria; however, the definition of each criterion differed among the included articles. CONCLUSION: Time from surgery was the most commonly reported RTS criterion after RCS or SSS in athletes, whereas muscle strength and range of motion were used by almost half of the articles. There was high heterogeneity in the definition of each RTS criterion used among the included studies, which also used different combinations of 1 to 3 RTS criteria. These results suggest the need to better define quantitative and qualitative RTS criteria in athletes undergoing rotator cuff and shoulder stabilization procedures in order to safely return athletes to sport.

Paramedic students' confidence and satisfaction with clinical simulations of an emergency medical care programme in South Africa: A cross-sectional study.

BACKGROUND: There has been an increase in the use of clinical simulations as instructional tools in healthcare education. This is because of their role in ensuring patients' safety and quality-care provision. AIM: This study investigated the paramedic students' satisfaction and self-confidence in the clinical simulation of an emergency medical care programme. SETTING: The study was conducted at the Durban University of Technology in the KwaZulu-Natal Province of South Africa. The paramedic students' satisfaction and self-confidence in the clinical simulation of an emergency medical care programme were the focus of the study. METHODS: The study used a cross-sectional research design. A convenience sampling method was used to select the 83-paramedic students who participated in the study. Data were collected between July and September 2017 using a structured questionnaire. Descriptive statistics (frequencies and percentages and Spearman's rank-order correlation coefficient) and an inferential test, ordinal logistic regression analysis, were used for data analysis. RESULTS: High levels of paramedic students' satisfaction and self-confidence in simulation activities were reported. Generally, the paramedic students' demographics were associated with the satisfaction and self-confidence variables with p-values ≤ 0.04. Emergency medical care training undertaken by the paramedic students was significantly associated with self-confidence (p = 0.00). CONCLUSION: Clinical simulation can bridge the theory-practice gap for paramedic students. It is a hands-on approach that promotes students learning of clinical skills through reflection.

Why Do People Agree With Both Regular and Reversed Items? A Logical Response Perspective.

The current research challenges the received view that misresponses to reversed items are the result of participants' irrational behavior. On the contrary, for participants at a midpoint level of a trait, it is perfectly logical to agree and disagree with seemingly equivalent statements (e.g., I'm not tall, but neither am I short). For this reason, regular and reversed items for a unidimensional construct were predicted to load on separate factors. Two types of reversed items-polar opposites and negated regular items-were also predicted to load on separate factors, as they are qualitatively different. An empirical study supported this explanation. Differential responding was found to be highest for participants at the mid-level of a trait and diminished toward the ends, revealing a quadratic relationship and a trait × method interaction. Thus, our findings demonstrate that the logical response pattern of individuals at the mid-level of a trait is another previously unrecognized explanation for why the inclusion of regular and reverse-keyed items can contribute to the apparent bi-dimensionality of unidimensional constructs (for data analysis results, see https://osf.io/krh2w/).

Clinically Significant Outcomes Following the Treatment of Focal Cartilage Defects of the Knee With Microfracture Augmentation Using Cartilage Allograft Extracellular Matrix: A Multicenter Prospective Study.

PURPOSE: To determine the short-term outcomes following microfracture augmented with cartilage allograft extracellular matrix for the treatment of symptomatic focal cartilage defects of the adult knee. METHODS: Forty-eight patients enrolled by 8 surgeons from 8 separate institutions were included in this study. Patients underwent microfracture augmented by cartilage allograft extracellular matrix (BioCartilage; Arthrex, Naples, FL) and were followed at designated time points (3, 6, 12, and 24 months) to assess patient-reported outcomes (PROs), clinically significant outcomes (CSOs), and failure and complication rates. Magnetic resonance imaging (MRI) was offered at 2 years postoperatively regardless of symptomatology, and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score was documented. RESULTS: PRO compliance was 81.3% at 6 months, 72.9% at 12 months, and 47.9% at 2 years. All joint-specific and function-related PROs significantly improved compared to baseline at 3, 6, 12, 18, and 24 months of follow-up (P < .01), apart from Marx activity scale, which demonstrated a significant decline in postoperative scores at 2 years (P = .034). The percentage of patients achieving CSOs (as defined for microfracture) at 2 years was 90% for minimal clinically important difference and 85% for patient acceptable symptomatic state. Patient factors including age, sex, body mass index, symptoms duration, smoking, presence of a meniscal tear, lesion size, and location were not associated with CSO achievement at 2 years. One patient (2.1%) failed treatment 9.5 months postoperatively due to graft delamination and required a reoperation consisting of arthroscopic debridement. One complication (2.1%) consisting of complaints of clicking, grinding, and crepitus 15 months following the index procedure was reported. Two-year postoperative MRI demonstrated a mean 40.5 ± 22.9 MOCART 2.0 score. CONCLUSIONS: In this preliminary study, we found cartilage allograft extracellular matrix to be associated with improvement in functional outcomes, high rates of CSO achievement, and low failure and complication rates at 2-year follow-up. LEVEL OF EVIDENCE: Level III, prospective multicenter cohort study.

Establishing the structure and replicability of personality profiles using the HEXACO-PI-R.

Previous attempts to identify personality profiles in the five-factor and HEXACO models of personality have produced inconsistent results. Here, using data from four independent samples, each with approximately 90,000 international respondents to the 100-item HEXACO Personality Inventory-Revised (HEXACO-PI-R), we demonstrated that a five-profile solution fit the data well. Exploratory analyses suggested that this solution was also consistent across gender and age groups. The five-profile structure replicated well with larger subsamples, but could not be reproduced consistently with samples of fewer than 500 individuals. However, even with small samples, the five-profile structure could be applied using the parameters obtained with the larger samples. We used HEXACO theory along with agency-communion and attachment theories to offer preliminary explanations and labels for the five profiles. We discuss how these theories, combined with parameter estimates provided by our research, can be used to generate and test hypotheses to validate the five-profile structure and evaluate its utility for personality research and other applications.

A new framework for small drinking water plant sustainability support and decision-making.

Public drinking water system decisions about treatment processes are becoming more challenging, especially as regulations become more stringent and source water quality degrades. For small systems that serve <10,000 people, treatment decisions are particularly difficult due to limited resources and because they do not currently have resources to help them make informed and sustainable decisions using environmental, social, and economic criteria. Therefore, a user-friendly sustainability assessment framework, which compares treatment processes relevant to a wide variety of small drinking water systems, was constructed. In summary, the framework uses life cycle assessment and multiple-criteria decision analysis to comprehensively evaluate twelve decision criteria, developed specific to small drinking water systems; the framework then uses an aggregation approach to identify and navigate multiple trade-offs and make a final recommendation based on stakeholder values. Four hypothetical scenarios were examined to show the framework's applicability to diverse small systems, ability to help stakeholders navigate trade-offs, and engineering relevance. The framework is universal in its capacity to evaluate systems with different design parameters, source waters, treatment criteria, and stakeholder preferences.