Association of MOUD ECHO Participation on Expansion of Buprenorphine Prescribing in Rural Primary Care.

BACKGROUND: Lack of access to buprenorphine to treat Opioid Use Disorder is profound in rural areas where over half of small and remote rural counties have no buprenorphine prescriber. To increase prescribing, an online, Medication of Opioid Use Disorder (MOUD) Extensions for Community Healthcare Outcomes (ECHO) was developed that addressed known barriers to the startup and expansion of treatment. The objective of the present study was to determine the relationship between participating in MOUD ECHO sessions and prescribing of buprenorphine for OUD in rural primary care. METHODS: Using non-random, rolling-recruitment from Feb 2018 to October of 2021, all rural primary care clinics in New Mexico were contacted via phone call and fax to recruit providers (Physicians, Nurse Practitioners, and Physician Assistants) who had no or limited buprenorphine experience to enroll in this study. Participation in the MOUD ECHO was tracked across the 12 week series. Start-up and expansion of buprenorphine treatment was measured every 3 months for up to 2 years using 5 implementation benchmarks spanning training completion, obtaining licensure, prescribing and adding patients. Using a dose-response intention to treat type analysis, associations between number of sessions and benchmark achievement were analyzed using logistic regression. RESULTS: Eighty providers were enrolled, mostly female (66%) white (82%), non-Hispanic (82%), and mostly nurse practitioners (51%) or MDs (38%). Achievement of prescribing benchmarks at 6 months was significantly increased by attendance at MOUD ECHO sessions including obtaining training and licensure Odds Ratio (OR = 1.24; P = .001); starting to prescribe (OR = 1.31; P = .004), and adding patients (OR = 1.14; P = .025). CONCLUSIONS: This study provides compelling evidence that MOUD ECHO participation may significantly increase the number of providers implementing this treatment and adding patients onto their panels. The dose-response approach helps address current gaps in ECHO research that call for more rigorous examination of the ECHO model's impact on provider practice improvements.

Hypernatremia in Hospitalized Patients: A Large Population-Based Study.

Background: Hypernatremia is a frequently encountered electrolyte disorder in hospitalized patients. Controversies still exist over the relationship between hypernatremia and its outcomes in hospitalized patients. This study examines the relationship of hypernatremia to outcomes among hospitalized patients and the extent to which this relationship varies by kidney function and age. Methods: We conducted an observational study to investigate the association between hypernatremia, eGFR, and age at hospital admission and in-hospital mortality, and discharge dispositions. We analyzed the data of 1.9 million patients extracted from the Cerner Health Facts databases (2000-2018). Adjusted multinomial regression models were used to estimate the relationship of hypernatremia to outcomes of hospitalized patients. Results: Of all hospitalized patients, 3% had serum sodium (Na) >145 mEq/L at hospital admission. Incidence of in-hospital mortality was 12% and 2% in hyper- and normonatremic patients, respectively. The risk of all outcomes increased significantly for Na >155 mEq/L compared with the reference interval of Na=135-145 mEq/L. Odds ratios (95% confidence intervals) for in-hospital mortality and discharge to a hospice or nursing facility were 34.41 (30.59-38.71), 21.14 (17.53-25.5), and 12.21 (10.95-13.61), respectively (all P<0.001). In adjusted models, we found that the association between Na and disposition was modified by eGFR (P<0.001) and by age (P<0.001). Sensitivity analyses were performed using the eGFR equation without race as a covariate, and the inferences did not substantially change. In all hypernatremic groups, patients aged 76-89 and ≥90 had higher odds of in-hospital mortality compared with younger patients (all P<0.001). Conclusions: Hypernatremia was significantly associated with in-hospital mortality and discharge to a hospice or nursing facility. The risk of in-hospital mortality and other outcomes was highest among those with Na >155 mEq/L. This work demonstrates that hypernatremia is an important factor related to discharge disposition and supports the need to study whether protocolized treatment of hypernatremia improves outcomes.

The parietal notch (Brammer's pointer): Accuracy of a surface landmark for temporal bone surgery.

Hypothesis: The parietal notch is a reliable surface landmark of the sigmoid sinus at the sinodural angle. Background: Currently no surface landmark approximates the anterior border of the sigmoid sinus. Additionally, the temporal line may not accurately identify the tegmen near the sinodural angle. This study examines the reliability of the parietal notch as a surface landmark of the sigmoid sinus at the sinodural angle. Methods: Forty-seven cadaveric temporal bones were used to identify the parietal notch by two observers. The parietal notch and sinodural angle were labeled with radiopaque markers, mounted on foam, and CT imaged in the axial plane. The horizontal and vertical distances between the labeled landmarks were measured using PACS software. Results: The parietal notch location was identified in 43/47 specimens. The notch was posterior to the sinodural angle in 90.6% and superior in 65% of the specimens. The average horizontal and vertical distance between the two landmarks was 6.1 mm (SD = 5.4) and 0.8 mm (SD = 8.7), respectively. In 60% of the specimens the parietal notch was within 6 mm of the sinodural angle in the horizontal dimension. Conclusions: The parietal notch is identified in most temporal bones. It also approximates the anterior boarder of the sigmoid sinus and level of the tegmen due to its proximity to the sinodural angle. The parietal notch helps to define the posterosuperior margins of a mastoid dissection and may assist surgeons during mastoid surgery.

A Comprehensive COVID-19 Daily News and Medical Literature Briefing to Inform Health Care and Policy in New Mexico: Implementation Study.

BACKGROUND: On March 11, 2020, the New Mexico Governor declared a public health emergency in response to the COVID-19 pandemic. The New Mexico medical advisory team contacted University of New Mexico (UNM) faculty to form a team to consolidate growing information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its disease to facilitate New Mexico's pandemic management. Thus, faculty, physicians, staff, graduate students, and medical students created the "UNM Global Health COVID-19 Intelligence Briefing." OBJECTIVE: In this paper, we sought to (1) share how to create an informative briefing to guide public policy and medical practice and manage information overload with rapidly evolving scientific evidence; (2) determine the qualitative usefulness of the briefing to its readers; and (3) determine the qualitative effect this project has had on virtual medical education. METHODS: Microsoft Teams was used for manual and automated capture of COVID-19 articles and composition of briefings. Multilevel triaging saved impactful articles to be reviewed, and priority was placed on randomized controlled studies, meta-analyses, systematic reviews, practice guidelines, and information on health care and policy response to COVID-19. The finalized briefing was disseminated by email, a listserv, and posted on the UNM digital repository. A survey was sent to readers to determine briefing usefulness and whether it led to policy or medical practice changes. Medical students, unable to partake in direct patient care, proposed to the School of Medicine that involvement in the briefing should count as course credit, which was approved. The maintenance of medical student involvement in the briefings as well as this publication was led by medical students. RESULTS: An average of 456 articles were assessed daily. The briefings reached approximately 1000 people by email and listserv directly, with an unknown amount of forwarding. Digital repository tracking showed 5047 downloads across 116 countries as of July 5, 2020. The survey found 108 (95%) of 114 participants gained relevant knowledge, 90 (79%) believed it decreased misinformation, 27 (24%) used the briefing as their primary source of information, and 90 (79%) forwarded it to colleagues. Specific and impactful public policy decisions were informed based on the briefing. Medical students reported that the project allowed them to improve on their scientific literature assessment, stay current on the pandemic, and serve their community. CONCLUSIONS: The COVID-19 briefings succeeded in informing and guiding New Mexico policy and clinical practice. The project received positive feedback from the community and was shown to decrease information burden and misinformation. The virtual platforms allowed for the continuation of medical education. Variability in subject matter expertise was addressed with training, standardized article selection criteria, and collaborative editing led by faculty.

Use of a Benchmark Tracking Assessment to Support Expansion of Buprenorphine for Treatment of Opioid Use Disorder in Primary Care.

INTRODUCTION: Barriers to the expansion of opioid use disorder (OUD) treatment in primary care using buprenorphine are well documented. Providers require support along a continuum. A systematic tracking framework to enhance provider progress along this continuum is lacking. METHODS: We developed a benchmark tracking assessment (BTA) as part of data collection in a 5-year study to examine the impact of provider participation in an online intervention to support expansion of buprenorphine treatment for OUD in rural primary care. Providers were contacted via phone every 3 months for up to 2 years to track their advancement along the 5 identified key benchmarks and were offered support for any barriers encountered. RESULTS: Forty-one providers enrolled in the study. Almost half (49%) did not experience a barrier that prevented them from accomplishing their next benchmark. Of the remaining 51% of providers, the majority (75%) experienced barriers early in the training and licensure phases, with most citing lack of time as the main reason. CONCLUSION: The BTA offers a feasible approach to identifying challenges along the training to prescription continuum and facilitated targeted support to address barriers. This framework has the potential, with locally contextual adaptations, to guide medication-assisted treatment implementation and training efforts.

A Population-Based Feasibility Study of Occupation and Thoracic Malignancies in New Mexico.

BACKGROUND: Occupational exposures in mining and oil/gas extraction are known risk factors for thoracic malignancies (TMs). Given the relatively high proportion of these industries in New Mexico (NM), we conducted a feasibility study of adult lifetime occupational history among TM cases. We hypothesized a higher proportion of occupational TM in NM relative to the estimated national average of 10-14%. METHODS: We identified incident TM cases through the population-based New Mexico Tumor Registry (NMTR), from 2017-2018. Cases completed a telephone interview. An adjudication panel reviewed case histories and classified cancers as probable, possible, or non-occupational related, taking into account the presence, duration, and latency of exposures. We characterized recruitment and describe job titles and exposures among those with occupational TMs. We also compared the distributions of industry between those with and without occupational TM. RESULTS: The NMTR identified 400 eligible TM cases, 290 of which were available to be recruited (n=285 lung/bronchial cancer; n=5 mesotheliomas). Of the latter, 60% refused and 18% were deceased, 9% had invalid addresses, 11% were unable to be reached by telephone, and 3% were too ill to participate. The 43 cases who completed an interview held 236 jobs. A total of 33% of cases were classified as probable occupational TM and 5% as possible occupational TM. CONCLUSIONS: High rates of early mortality and refusals were significant barriers to study participation. Nonetheless, the proportion of probable occupational TMs greatly exceeded the estimated national average, highlighting the need for further study of occupational TM in the state.

Continent-wide tree fecundity driven by indirect climate effects.

Indirect climate effects on tree fecundity that come through variation in size and growth (climate-condition interactions) are not currently part of models used to predict future forests. Trends in species abundances predicted from meta-analyses and species distribution models will be misleading if they depend on the conditions of individuals. Here we find from a synthesis of tree species in North America that climate-condition interactions dominate responses through two pathways, i) effects of growth that depend on climate, and ii) effects of climate that depend on tree size. Because tree fecundity first increases and then declines with size, climate change that stimulates growth promotes a shift of small trees to more fecund sizes, but the opposite can be true for large sizes. Change the depresses growth also affects fecundity. We find a biogeographic divide, with these interactions reducing fecundity in the West and increasing it in the East. Continental-scale responses of these forests are thus driven largely by indirect effects, recommending management for climate change that considers multiple demographic rates.

Feasibility and acceptability of an online ECHO intervention to expand access to medications for treatment of opioid use disorder, psychosocial treatments and supports.

Background: Buprenorphine combined with psychosocial support is the standard of care for treatment of opioid use disorder (OUD) in office-based primary care settings. However, uptake of this treatment has been slow due to a number of addressable barriers including providers' lack of training, staffing concerns, stigma and the need for ongoing support and consultation. This study examined acceptability and feasibility of an online Extensions for Community Healthcare Outcomes (ECHO) model intervention developed to support rural primary care clinics to expand treatment and is part of a larger study tracking the impact of participation in this ECHO on expansion of MOUD in rural primary care. Methods: We developed a comprehensive, 12-week online education and mentorship intervention using ECHO aimed at supporting the entire primary care clinic to start or expand treatment using MOUD, psychosocial treatments and recovery supports. We tracked participation and collected feedback using qualitative interviews and post-session questionnaires. Results: Sixty-seven primary care staff across 27 rural clinics in New Mexico participated in the study including 32 prescribers and 35 clinic support staff. Average participation was 4/12 sessions. Post-session questionnaires showed positive feedback, including that 95% or more respondents agreed or strongly agreed that the sessions were relevant and improved their confidence. Qualitative interview themes included strong endorsement of the ECHO curriculum. Clinical duties were the most common barrier to attending sessions. Conclusions: Engagement of 27 clinics, the range of staff and providers who participated, and positive feedback gathered through survey and qualitative interviews provide evidence of feasibility and acceptability of MOUD ECHO to support expansion of this treatment. However, barriers to participation present an important threat to feasibility. Understanding feasibility and acceptability is an important component of research on the impact of ECHO to expand MOUD treatment.

Pulse oximetry screening for detection of congenital heart defects at 1646 m in Albuquerque, New Mexico.

AIM: To determine the false-positive rate of pulse oximetry screening at moderate altitude, presumed to be elevated compared with sea level values and assess change in false-positive rate with time. METHODS: We retrospectively analysed 3548 infants in the newborn nursery in Albuquerque, New Mexico, (elevation 5400 ft) from July 2012 to October 2013. Universal pulse oximetry screening guidelines were employed after 24 hours of life but before discharge. Newborn babies between 36 and 36 6/7 weeks of gestation, weighing >2 kg and babies >37 weeks weighing >1.7 kg were included in the study. Log-binomial regression was used to assess change in the probability of false positives over time. RESULTS: Of the 3548 patients analysed, there was one true positive with a posteriorly-malaligned ventricular septal defect and an interrupted aortic arch. Of the 93 false positives, the mean pre- and post-ductal saturations were lower, 92 and 90%, respectively. The false-positive rate before April 2013 was 3.5% and after April 2013, decreased to 1.5%. There was a significant decrease in false-positive rate (p = 0.003, slope coefficient = -0.082, standard error of coefficient = 0.023) with the relative risk of a false positive decreasing at 0.92 (95% CI 0.88-0.97) per month. CONCLUSION: This is the first study in Albuquerque, New Mexico, reporting a high false-positive rate of 1.5% at moderate altitude at the end of the study in comparison to the false-positive rate of 0.035% at sea level. Implementation of the nationally recommended universal pulse oximetry screening was associated with a high false-positive rate in the initial period, thought to be from the combination of both learning curve and altitude. After the initial decline, it remained steadily elevated above sea level, indicating the dominant effect of moderate altitude.

Long term sexual function following rectal cancer treatment.

INTRODUCTION: Rectal cancer treatment can lead to sexual dysfunction. METHODS: We designed a retrospective survey-based study to quantify rates of sexual dysfunction in rectal cancer survivors. Patients that underwent surgery for rectal cancer between 2005 and 2016 at our institution were identified, and the following were distributed: Quality of Life measure for oncology (QoL-30), Female Sexual Function Index (FSFI), and International Index of Erectile Function (IIEF). RESULTS: Survey response rate was 21%, 17 females and 30 males (n = 47). 50% of males recalled a physician asking about sexual function during or after treatments, compared to 18% of females (p = 0.034). More than 50% of those surveyed wished one of their physicians had discussed the possibility of sexual dysfunction. In men, the QoL-30 significantly correlated with IIEF orgasmic function (r = 0.50, p = 0.004) and IIEF overall satisfaction (r = 0.60, p < 0.001). CONCLUSIONS: Our findings demonstrate that rectal cancer patients experience posttreatment sexual dysfunction, desire discussion with their physicians on this topic, and that there are gender differences in how providers approach counseling regarding posttreatment sexual dysfunction.

Measuring organizational mentoring climate: Importance and availability scales.

INTRODUCTION: Although organizational climate may affect faculty's mentoring behaviors, there has not been any way to measure that climate. The purpose of this study was to test the reliability and validity of two novel scales to measure organizational mentoring climate importance and availability at two public research universities. METHODS: We developed 36 content-valid mentoring climate items in four dimensions: Structure, Programs/Activities, Policies/Guidelines, and Values. In total, 355 faculty completed an anonymous, structured, online survey asking about the importance (very important to very unimportant) and availability (no, don't know, yes) of each of the items. We conducted reliability analyses and construct validity testing using exploratory common factor analysis, principal axis factoring, and oblique rotation. RESULTS: The majority of the predominantly female, White non-Hispanic, senior, tenure-track faculty were not currently mentoring another faculty or being mentored. Analyses demonstrated a 15-item solution for both the Organizational Mentoring Climate Importance (OMCI) and the Availability (OMCA) Scales, with three factors each: Organizational Expectations, Mentor-Mentee Relationships, and Resources. Standardized Cronbach alphas ranged from 0.74 to 0.90 for the subscales, and 0.94 (OMCI) and 0.87 (OMCA) for the full scales. Faculty rated all items as somewhat to very important; however, perceived availability was very low ranging from mentor training programs (40%) to guidelines for evaluating mentoring success or managing conflict (2.5%). CONCLUSIONS: The scales will allow studying of how organizational climate may affect mentoring behavior and whether climate can be changed to improve faculty mentoring outcomes. We provide recommendations for furthering the science of organizational mentoring climate and culture.

Critical Evaluation of the Methodologic Quality of the Top 50 Cited Articles Relating to Knee Dislocation and Multiligamentous Knee Injury.

BACKGROUND: Many studies have evaluated the management of knee dislocations (KDs) and multiligamentous knee injuries (MLKIs). However, no study to date has analyzed the quality of the most cited articles in this literature. HYPOTHESIS: There is a positive correlation between the number of article citations in the KD and MLKI literature and their methodologic quality. STUDY DESIGN: Systematic review. METHODS: The Web of Science online database was searched to identify the top 50 cited articles in KD and MLKI care. Demographic data were recorded for each study. The Modified Coleman Methodology Score (MCMS) and the Methodological Index for Non-randomized Studies (MINORS) were used to analyze the methodological quality of each article. Spearman correlation coefficients (r s) were then calculated. RESULTS: The articles identified were published between 1958 and 2015 in a wide variety of peer-reviewed journals (n = 16). The majority of study level of evidence (LOE) was of low quality (level 5, 16%; level 4, 54%; level 3, 16%; level 2, 14%). There were no studies of level 1 evidence. The mean MCMS and MINORS scores were 29.0 (SD, 19.1; range, 3-72) and 6.1 (SD, 3.7; range, 0-14), respectively. No significant correlation was identified between the number of citations and the publication year, LOE, MCMS, or MINORS (r s = 0.123 [P = .396]; r s = 0.125 [P = .389]; r s = 0.182 [P = .204]; and r s = 0.175 [P = .224], respectively). Positive correlations were observed between improved MCMS and MINORS scores and more recent year of publication (r s = 0.43 [P = .002]; r s = 0.32 [P = .022]) as well as improved study LOE (r s = 0.65 [P < .001]; r s = 0.67 [P < .001]). CONCLUSION: The top 50 cited articles on KD and MLKI care consisted of low LOE and methodological quality, with no existing level 1 articles. There was no significant correlation between the number of citations and publication year, LOE, or study methodological quality. Positive correlations were observed between later publication date and improved methodological quality.

Greater Odds for Angina in Uranium Miners Than Nonuranium Miners in New Mexico.

OBJECTIVE: The aim of this study was to test the hypothesis that uranium miners in New Mexico (NM) have a greater prevalence of cardiovascular disease than miners who extracted the nonuranium ore. METHODS: NM-based current and former uranium miners were compared with nonuranium miners by using cross-sectional standardized questionnaire data from the Mining Dust in the United States (MiDUS) study from 1989 to 2016. RESULTS: Of the 7215 eligible miners, most were men (96.3%). Uranium miners (n = 3151, 43.7%) were older and diabetic, but less likely to currently smoke or use snuff (P ≤ 0.001 for all). After adjustment for covariates, uranium miners were more likely to report angina (odds ratio 1.51, 95% confidence interval 1.23 to 1.85) than nonuranium miners. CONCLUSION: Our data suggest that along with screening for pulmonary diseases, uranium industry workers should be screened for cardiovascular diseases.

An assessment of chlorine stain and collegiate swimmers.

Background: Swimming is known worldwide as one of the healthiest, low-impact forms of exercise that promotes a strong body, heart, and mind. However, several studies have suggested that swimming pool chlorination is responsible for dental erosion, calculus formation, and stain in competitive and recreational swimmers, a phenomenon known as swimmer's mouth. The purpose of this observational study was to assess chlorine stain on the dentition of competitive female swimmers and divers from a university team and to determine if dental preventive practices affected chlorine stains. Methods: Swimmers were recruited from the University of New Mexico Swimming and Diving Team for this IRB-approved study (#17-481). Participants completed a questionnaire regarding individual oral habits and frequency of preventive visits. Following the questionnaire, an oral screening was completed to evaluate for stain. Fisher exact tests, nonparametric Wilcoxon tests, and descriptive statistics were used to analyse the data. Additionally, a cross-sectional analysis was used to compare the chlorine stain between divers and swimmers. Results: Twenty-one females, with a mean age of 20.5 years, participated in the study. One hundred percent of these subjects had staining of the teeth, despite the fact that 85% of them reported brushing their teeth 2 to 3 times per day, and 81% reported receiving regular dental prophylaxis. All participants swam 5 or more times every week, with practice length ranging from 1 to 2 hours. There were no differences in stain between collegiate swimmers and divers. Conclusion: Within this study sample, extrinsic staining of the teeth was identified on all swimmers and divers and the presence of stain was not prevented by the frequency of tooth brushing or professional stain removal. Additional oral hygiene regimens should be explored to facilitate the prevention or complete removal of swimmer stain.

Contexte: La natation est reconnue partout dans le monde comme l'une des formes d'exercice physique les plus saines et ayant le moins d'impact, qui renforce le corps, le coeur et l'esprit. Cependant, plusieurs études ont suggéré que la chloration des piscines cause l'érosion dentaire et la formation de tartre et de taches chez les nageurs compétitifs et récréatifs; un phénomène appelé la bouche de nageur. L'objectif de cette étude d'observation était d'évaluer les taches de chlore sur la dentition de nageuses et de plongeuses de compétition d'une équipe universitaire et de déterminer si les habitudes dentaires en matière de prévention influençaient les taches de chlore. Méthodologie: Les nageuses ont été recrutées de l'équipe de natation et de plongeon de l'Université du Nouveau-Mexique pour effectuer cette étude approuvée par le comité d'éthique médicale (#17-481). Les participantes ont répondu à un questionnaire à l'égard des habitudes buccodentaires personnelles et de la fréquence de leurs visites dentaires préventives. À la suite du questionnaire, un dépistage buccal a été effectué pour évaluer les taches. Les tests exacts de probabilité de Fisher, les tests non paramétriques de Wilcoxon et les statistiques descriptives ont été employées pour analyser les données. De plus, une analyse en coupe a servi à comparer les taches de chlore chez les plongeuses et les nageuses. Résultats: Vingt-et-une femmes âgées en moyenne de 20,5 ans ont participé à l'étude. La totalité des sujets avait des taches sur les dents, malgré le fait que 85 % d'entre elles ont signalé avoir brossé leurs dents 2 à 3 fois par jour et 81 % d'entre elles ont rapporté recevoir régulièrement des prophylaxies dentaires. Toutes les participantes ont nagé 5 fois ou plus par semaine et la durée de leur entraînement variait d'une à deux heures. Les nageuses et les plongeuses universitaires n'ont démontré aucune différence dans leur taux de taches. Conclusion: Parmi cet échantillon de l'étude, des taches extrinsèques ont été décelées sur les dents de toutes les nageuses et plongeuses, et la fréquence du brossage de dents ou l'élimination professionnelle des taches n'a pas empêché la présence de taches. Des mesures supplémentaires d'hygiène buccodentaire devraient être explorées afin de faciliter la prévention ou l'élimination complète des taches chez les nageurs.

The value of using seasonality and meteorological variables to model intra-urban PM2.5 variation.

A yearlong air monitoring campaign was conducted to assess the impact of local temperature, relative humidity, and wind speed on the temporal and spatial variability of PM2.5 in El Paso, Texas. Monitoring was conducted at four sites purposely selected to capture the local traffic variability. Effects of meteorological events on seasonal PM2.5 variability were identified. For instance, in winter low-wind and low-temperature conditions were associated with high PM2.5 events that contributed to elevated seasonal PM2.5 levels. Similarly, in spring, high PM2.5 events were associated with high-wind and low-relative humidity conditions. Correlation coefficients between meteorological variables and PM2.5 fluctuated drastically across seasons. Specifically, it was observed that for most sites correlations between PM2.5 and meteorological variables either changed from positive to negative or dissolved depending on the season. Overall, the results suggest that mixed effects analysis with season and site as fixed factors and meteorological variables as covariates could increase the explanatory value of LUR models for PM2.5.

Damage in a Distal Radius Fracture Model Treated With Locked Volar Plating After Simulated Postoperative Loading.

PURPOSE: "Damage" is an engineering term defining a period between a state of material perfection and the onset of crack initiation. Clinically, it is a loss of fixation due to microstructural breakdown, indirectly measured as a reduction of stiffness of the bone-implant construct, normalized by the cross-sectional area and length of the bone. The purpose of this study was to characterize damage in a cadaver model of extra-articular distal radius fracture with dorsal comminution treated using 2-column volar distal radius plates. METHODS: Ten matched distal radii were randomly divided into 2 groups: group I specimens were treated with a volar distal radius plate with an independent, 2-tiered scaffold design; group II specimens (contralateral limbs) were treated with a volar plate with a single-head design for enhanced ulnar buttressing. Specimens were cyclically loaded to simulate a 6-month postoperative load-bearing period. We report damage after a defined protocol of cyclical loading and load to failure simulating a fall on an outstretched hand. RESULTS: Group II specimens experienced more damage under cyclic loading conditions than group I specimens. Group I specimens were stiffer than group II specimens under load-to-failure conditions. Ultimate force at failure in group I and group II specimens was not different. Specimens failed by plate bending (group I, n = 6/10; group II, n = 2/10) and fracture of the lunate facet (group I, n = 4/10; group II, n = 8/10). CONCLUSIONS: Group I specimens had less screw cutout at the lunate facet than group II specimens under cyclic loading as indicated by lower damage measures and fewer facet fractures during load-to-failure testing. The overall strength of the construct is not affected by plate design. CLINICAL RELEVANCE: Microstructural damage or a loss of fixation due to an overly rigid volar plate design may cause malunion or nonunion of fracture fragments and lead to bone-implant instability.

A Cardiovascular Health Intervention for Spanish Speakers: The Health Literacy and ESL Curriculum.

Spanish speakers in the United States are in need of effective interventions that address both cardiovascular disease (CVD) and health literacy. However, the literature lacks interventions that have used and evaluated a strategies that focus on both, particularly at the community level. The aim of this study was to explore the effect of a health literacy curriculum on cardiovascular health behavior among Spanish speaking adults. It used a randomized controlled pre-posttest design. Participants included Hispanic adults with a low-to-intermediate level of English proficiency. The intervention group received the health literacy and English as a second language (ESL) Curriculum with CVD specific content, while the control group received a conventional ESL curriculum. Tools included the Spanish Cardiovascular Health Questionnaire (CSC), the test of functional health literacy in adults (TOFHLA), and the Combined English Language Skills Assessment. Analysis of change scores included independent sample t test and multiple linear regression. A total of 155 participants completed the study. There was a significant greater improvement for the intervention group in change of CSC score from pretest to posttest (P = 0.049) compared to controls. The study also found significantly improved TOFHLA (P = 0.011), however it did not find a relationship between changes in CVD behavior and health literacy or English proficiency. The Health Literacy and ESL Curriculum constitutes a valuable resource for addressing the cardiovascular health, literacy, and language needs of Spanish-speaking adults. Interventions that take a multilevel education and health approach may be more effective in addressing the needs of immigrants. Research should further explore the interactions between CVD behavior, health literacy, and English proficiency.

A Comparative Analysis of the ADOS-G and ADOS-2 Algorithms: Preliminary Findings.

The Autism Diagnostic Observation Schedule (ADOS) is a widely utilized observational assessment tool for diagnosis of autism spectrum disorders. The original ADOS was succeeded by the ADOS-G with noted improvements. More recently, the ADOS-2 was introduced to further increase its diagnostic accuracy. Studies examining the validity of the ADOS have produced mixed findings, and pooled relationship trends between the algorithm versions are yet to be analyzed. The current review seeks to compare the relative merits of the ADOS-G and ADOS-2 algorithms, Modules 1-3. Eight studies met inclusion criteria for the review, and six were selected for paired comparisons of the sensitivity and specificity of the ADOS. Results indicate several contradictory findings, underscoring the importance of further study.

The piloting of a culturally centered American Indian family prevention program: a CBPR partnership between Mescalero Apache and the University of New Mexico.

The Mescalero Apache Family Listening Program (MAFLP) is a culturally centered family prevention program with third, fourth, and fifth graders; a parent/caregiver; and a family elder. The program follows a positive youth development model to develop stronger communication and shared cultural practices between elders, parents, and youth in the tribe to reduce substance initiation of use among the youth. The MAFLP was created using a community-based participatory research (CBPR) approach in partnership with the University of New Mexico. The research focus of MAFLP is centered on the adaptation of a family curriculum from a Navajo and Pueblo version of the Family Listening Program to an Apache version, the establishment of a (Apache) Tribal Research Team, and the piloting of the curriculum with Apache families. MAFLP was piloted twice, and evaluation measures were collected focused on formative and impact evaluation. This article provides a background on Mescalero Apache then introduces the Navajo and Pueblo version of a Family Listening and Family Circle Program, respectively, next, the CBPR research partnership between Mescalero Apache and the University of New Mexico and the creation of a Mescalero Apache Tribal Research Team followed by the development and adaptation of a Mescalero Apache Family Listening Program including implementation and evaluation, and concluding with preliminary findings.