Beef color and tenderness response to production systems utilizing additive combinations of growth-promotant technologies.

The objective of this study was to compare the influence of beef production systems using additive combinations of growth-promotant technologies on meat quality. Steer calves (n = 120) were assigned to 1 of 4 treatments: 1) no technology (NT; control), 2) antibiotic treated (ANT; NT plus therapeutic antibiotics, monensin, and tylosin), 3) implant treated (IMP; ANT plus a series of three implants), and 4) beta-agonist treated (BA; IMP plus ractopamine-HCl). Muscle biopsy samples from the longissimus lumborum were extracted from a subset (n = 4 per treatment) of steers to evaluate expression of calpain-1, calpain-2, and calpastatin using real-time RT-PCR. Following carcass chilling, objective color (L*, a*, and b*) was evaluated. The right strip loin was removed from each carcass, portioned into 2.54-cm steaks, and designated to 7, 14, or 21 d postmortem aging periods for analysis of cook loss and Warner-Bratzler shear force (WBSF). The anterior face of each strip loin was used for analysis of crude fat and moisture. Treatment influenced (P < 0.001) L*, a*, and b*. The NT and IMP treatments had greater (P < 0.01) L* values, ANT was intermediate, and BA had the lowest (P < 0.01) L* values. The NT and IMP treatments had higher (P < 0.01) a* and b* values compared with ANT, which were higher (P < 0.01) than BA. Steaks from implanted steers (IMP and BA) tended (P ≤ 0.067) to exhibit higher a* and b* than steaks from nonimplanted steers. Cattle in the NT and ANT treatments produced steaks with increased (P < 0.01) crude fat percentage compared with the IMP and BA treatments, which were similar (P > 0.05). Percent moisture of NT steaks was lower (P < 0.01) than all other treatments, ANT was intermediate, and IMP and BA were similar (P > 0.05) and had the highest (P < 0.01) moisture content. Cook loss tended to be greater (P = 0.088) for implanted steers (IMP and BA) compared to nonimplanted steers (NT and ANT). Steaks from NT and ANT treatments were more tender (P < 0.05) than IMP and BA, which were similar (P > 0.05). Thus, WBSF was lower (P < 0.001) in nonimplanted than implanted steaks. Expression of calpastatin was increased (P ≤ 0.025) in ANT and BA treatments, and there was a tendency for expression of calpain-2 to be increased (P = 0.081) in ANT compared to NT. These results suggest that production systems with limited use of growth promoting technology produced strip loins with more crude fat, less moisture and cook loss, and improved tenderness.

Equitable and timely access to outpatient COVID-19 treatment: A review of centralized workflow implementation at an integrated health system.

BACKGROUND: During the evolution of the COVID-19 pandemic, health care entities had to adapt to rapidly changing research and best practices in disease prevention and treatment to maintain the delivery of high-quality patient care. Prompt interdisciplinary efforts amongst physician, pharmacist, nursing, and information technology teammates are needed to develop robust centralized strategies to allocate and administer COVID-19 therapies in the ambulatory setting. OBJECTIVE: The objective of this analysis is to demonstrate the impact of a system-wide, centralized workflow on referral times and treatment outcomes for COVID-19 infected patients in the ambulatory setting. METHODS: Upon release of monoclonal antibodies for the treatment of COVID-19, a centralized approach for patient treatment referrals to the University of North Carolina Health Virtual Practice team was developed due to the limited supply. Collaboration with infectious disease colleagues played a pivotal role in the rapid application of therapeutic guidance and creation of treatment prioritization levels. RESULTS: From November 2020 through February 2022, the centralized workflow team facilitated the administration of over 17,000 COVID-19 treatment infusions. The median time from treatment referral to infusion was 2 days from a positive COVID-19 test result. From January through February 2022, 514 oral COVID-19 treatment courses were dispensed from the health system's outpatient pharmacies. The median time from referral to treatment was 1 day from diagnosis. CONCLUSION: Given the ongoing strain and demand of COVID-19 on the health care system, a centralized, multidisciplinary team of experts allowed for efficient delivery of COVID-19 therapies through one provider touchpoint. The collaboration between outpatient pharmacies, infusion sites, and Virtual Practice culminated in a sustainable, centralized treatment approach that supported widespread reach, and equitable dose distribution, to the most vulnerable patient populations.

Deconstructing Differential Drug Coverage within a Malaysian Media Source.

Many researchers have noted that media coverage of drugs can be sensationalized and/or have questionable accuracy. Additionally, it has been alleged that the media often treats all drugs as harmful and can fail to differentiate between different types of drugs. Within this context, the researchers sought to deconstruct how media coverage was similar and/or different according to drug type within a national media outlet in Malaysia. Our sample comprised 487 news articles published over a two-year period. Articles were coded to reflect thematic differences in drug framing. We focus on five drugs widely used in Malaysia (amphetamines, opiates, cannabis, cocaine, and kratom) and assess the most frequent themes, crimes, and locations mentioned in reference to each drug. All drugs were primarily covered in a criminal justice context, and articles highlighted concern about the spread of these drugs and their abuse. Drug coverage varied, particularly in association with violent crimes, specific regions, and discussion of legality. We find evidence of both similarities and differences in how drugs were covered. Variation in coverage demonstrated that certain drugs were deemed a heightened threat, as well as reflected broader social/political processes shaping ongoing debates over treatment approaches and legality.

CE: Pain and Mental Health Symptoms After Traumatic Orthopedic Injury.

ABSTRACT: This article highlights the need to screen survivors of traumatic orthopedic injuries for postinjury symptoms associated with stressor-related disorders such as acute stress disorder and posttraumatic stress disorder, including pain, sleep disturbances, anxiety, and depression. The authors discuss the presentation of these postinjury symptoms, the instruments used to screen for each, the various pharmacological and nonpharmacological treatments, and the nursing implications for managing postinjury symptoms in traumatic orthopedic injury survivors.

Rumination and Activity Patterns in Angus and Angus-Cross Beef Calves: Influences of Sex, Breed, and Backgrounding Diet.

The objectives of this study were to evaluate the influences of sex, breed, and backgrounding diet on rumination and activity patterns in Angus and Angus-cross beef calves; and the daily variations in rumination and activity in Angus and Angus-cross beef calves under different backgrounding systems. A total of 62 freshly weaned calves were vaccinated and randomly stratified by sex (heifers and steers), breed (Angus and Angus × Simmental cross), and assigned randomly to 3 backgrounding treatments for 55 days. The peak values for rumination and activity in heifers, steers, Angus, and Angus × Simmental cross occurred during the dark and light phases of the dark/light cycle, respectively. Beef calves backgrounded on cover crops had higher (p < 0.05) rumination (45.33 ± 1.57 min) compared with calves backgrounded on a perennial pasture (43.96 ± 1.47 min) diet. Similarly, drylot calves (24.16 ± 0.68 min) had higher (p < 0.05) activity compared to perennial pasture (23.49 ± 0.72 min). The results showed that sex and breed did not influence rumination and activity of Angus and Angus-cross beef calves during the study period. We concluded that the time of the day and backgrounding diet influenced rumination and activity patterns of Angus and Angus-cross beef calves.

A Culture of Health and Alcohol-Permitted Events at a U.S. University.

We examined event organizers' understandings and management of alcohol-related risk and accommodation of people in recovery from substance use disorders and other non-drinkers, when organizing alcohol-permitted events that primarily involved faculty, staff, and graduate students. We interviewed 31 event organizers at a large, public university in California. Organizers were most concerned about avoiding legal liabilities, were less concerned about promoting responsible drinking among drinkers, and often failed to consider the needs of non-drinkers. Their actions were informed by problematic beliefs about alcohol (e.g., people need alcohol to relax and socialize), drinkers (e.g., only undergraduate students engage in risky alcohol consumption), and people in recovery (e.g., they lack self-control). Organizers over-relied on informal control to shape attendees' behavior, failing to acknowledge contextual factors. They need education on how they can shape the event context to better promote healthy behaviors, avoid exclusively focusing on informal control and prevention of unhealthy behaviors, and promote better inclusion of people who do not drink alcohol. There is fertile ground for infusing a culture of health into events in higher education.

Influence of Maternal Protein Restriction in Primiparous Beef Heifers during Mid- and/or Late-Gestation on Progeny Feedlot Performance and Carcass Characteristics.

This study investigated the impacts of metabolizable protein (MP) restriction in primiparous heifers during mid- and/or late-gestation on progeny performance and carcass characteristics. Heifers were allocated to 12 pens in a randomized complete block design. The factorial treatment structure included two stages of gestation (mid- and late-) and two levels of dietary protein (control (CON); ~101% of MP requirements and restricted (RES); ~80% of MP requirements). Half of the pens on each treatment were randomly reassigned to the other treatment at the end of mid-gestation. Progeny were finished in a GrowSafe feeding system and carcass measurements were collected. Gestation treatment x time interactions indicated that MP restriction negatively influenced heifer body weight (BW), body condition score, and longissimus muscle (LM) area (p < 0.05), but not fat thickness (p > 0.05). Treatment did not affect the feeding period, initial or final BW, dry matter intake, or average daily gain of progeny (p > 0.05). The progeny of dams on the RES treatment in late gestation had a greater LM area (p = 0.04), but not when adjusted on a hot carcass weight basis (p > 0.10). Minimal differences in the animal performance and carcass characteristics suggest that the level of MP restriction imposed during mid- and late-gestation in this study did not have a significant developmental programming effect.

Microbiome network traits in the rumen predict average daily gain in beef cattle under different backgrounding systems.

BACKGROUND: Backgrounding (BKG), the stage between weaning and finishing, significantly impacts feedlot performance in beef cattle; however, the contributions of the rumen microbiome to this growth stage remain unexplored. A longitudinal study was designed to assess how BKG affects rumen bacterial communities and average daily gain (ADG) in beef cattle. At weaning, 38 calves were randomly assigned to three BKG systems for 55 days (d): a high roughage diet within a dry lot (DL, n = 13); annual cover crop within a strip plot (CC, n = 13); and perennial pasture vegetation within rotational paddocks (PP, n = 12), as before weaning. After BKG, all calves were placed in a feedlot for 142 d and finished with a high energy ration. Calves were weighed periodically from weaning to finishing to determine ADG. Rumen bacterial communities were profiled by collecting fluid samples via oral probe and sequencing the V4 region of the 16S rRNA bacterial gene, at weaning, during BKG and finishing. RESULTS: Rumen bacterial communities diverged drastically among calves once they were placed in each BKG system, including sharp decreases in alpha diversity for CC and DL calves only (P < 0.001). During BKG, DL calves showed a substantial increase of Proteobacteria (Succinivibrionaceae family) (P < 0.001), which also corresponded with greater ADG (P < 0.05). At the finishing stage, Proteobacteria bloomed for all calves, with no previous alpha or beta diversity differences being retained between groups. However, at finishing, PP calves showed a compensatory ADG, particularly greater than that in calves coming from DL BKG (P = 0.02). Microbiome network traits such as lower average shortest path length, and increased neighbor connectivity, degree, number and strength of bacterial interactions between rumen bacteria better predicted ADG during BKG and finishing than variation in specific taxonomic profiles. CONCLUSIONS: Bacterial co-abundance interactions, as measured by network theory approaches, better predicted growth performance in beef cattle during BKG and finishing, than the abundance of specific taxa. These findings underscore the importance of early post weaning stages as potential targets for feeding interventions that can enhance metabolic interactions between rumen bacteria, to increase productive performance in beef cattle.

Perceived ethnic discrimination, ethnic-racial socialization, and substance use among ethnic minority adolescents.

Perceived discrimination is a significant problem among ethnic minority adolescents and has been consistently linked to negative outcomes, including substance use, although few studies examine this relation with more than one time point. The present study adds to the literature by examining whether ethnic-racial socialization moderates the effects of perceived discrimination at time 1 on recent substance use six months later in a sample of ethnic minority, public high school students in Southern California. The results from analyses of survey data showed that perceived discrimination did not predict the likelihood of the outcomes, and they suggest that discrimination based on attributes other than ethnicity, such as immigration or documentation status, may be operating in the sample. Future research should simultaneously analyze effects of discrimination by type of attribute as well as level (e.g., intragroup, intergroup, and structural). With regard to ethnic-racial socialization in the multivariate models, cultural socialization was negatively related to the likelihood of the outcomes. Preparation for bias was positively related to the likelihood of the outcomes. Promotion of mistrust was not statistically significantly related to the likelihood of the outcomes. Although the socialization variables did not moderate the effect of perceived discrimination, they were clearly related to substance use in multiple ways, suggesting that future research continue to distinguish the effects of socialization by type to better understand how they can be addressed to optimize youth outcomes.

Age-related differences in resting state functional connectivity in pediatric migraine.

BACKGROUND: Migraine affects roughly 10% of youth aged 5-15 years, however the underlying mechanisms of migraine in youth are poorly understood. Multiple structural and functional alterations have been shown in the brains of adult migraine sufferers. This study aims to investigate the effects of migraine on resting-state functional connectivity during the period of transition from childhood to adolescence, a critical period of brain development and the time when rates of pediatric chronic pain spikes. METHODS: Using independent component analysis, we compared resting state network spatial maps and power spectra between youth with migraine aged 7-15 and age-matched controls. Statistical comparisons were conducted using a MANCOVA analysis. RESULTS: We show (1) group by age interaction effects on connectivity in the visual and salience networks, group by sex interaction effects on connectivity in the default mode network and group by pubertal status interaction effects on connectivity in visual and frontal parietal networks, and (2) relationships between connectivity in the visual networks and the migraine cycle, and age by cycle interaction effects on connectivity in the visual, default mode and sensorimotor networks. CONCLUSIONS: We demonstrate that brain alterations begin early in youth with migraine and are modulated by development. This highlights the need for further study into the neural mechanisms of migraine in youth specifically, to aid in the development of more effective treatments.

Impact of antithrombin III and enoxaparin dosage adjustment on prophylactic anti-Xa concentrations in trauma patients at high risk for venous thromboembolism: a randomized pilot trial.

The impact of antithrombin III activity (AT-III) on prophylactic enoxaparin anti-factor Xa concentration (anti-Xa) is unknown in high-risk trauma patients. So too is the optimal anti-Xa-adjusted enoxaparin dosage. This prospective, randomized, pilot study sought to explore the association between AT-III and anti-Xa goal attainment and to preliminarily evaluate two enoxaparin dosage adjustment strategies in patients with subprophylactic anti-Xa. Adult trauma patients with Risk Assessment Profile (RAP) ≥ 5 prescribed enoxaparin 30 mg subcutaneously every 12 h were eligible. AT-III and anti-Xa were drawn 8 h after the third enoxaparin dose and compared between patients with anti-Xa ≥ 0.1 IU/mL (goal; control group) or anti-Xa < 0.1 IU/mL (subprophylactic; intervention group). The primary outcome was difference in baseline AT-III. Subsequently, intervention group patients underwent 1:1 randomization to either enoxaparin 40 mg every 12 h (up to 50 mg every 12 h if repeat anti-Xa < 0.1 IU/mL) (enox12) or enoxaparin 30 mg every 8 h (enox8) with repeat anti-Xa assessments. The proportion of patients achieving goal anti-Xa after dosage adjustment were compared. A total of 103 patients were included. Anti-Xa was subprophylactic in 50.5%. Baseline AT-III (median [IQR]) was 87% [80-98%] in control patients versus 82% [71-96%] in intervention patients (p = 0.092). Goal trough anti-Xa was achieved on first assessment in 38.1% enox12 versus 50% enox8 patients (p = 0.67), 84.6% versus 53.3% on second assessment (p = 0.11), and 100% vs. 54.5% on third trough assessment (p = 0.045). AT-III activity did not differ between high-risk trauma patients with goal and subprophylactic enoxaparin anti-Xa concentrations, although future investigation is warranted. Enoxaparin dose adjustment rather than frequency adjustment may be associated with a higher proportion of patients achieving goal anti-Xa over time.

GABA and glutamate in pediatric migraine.

Migraine is one of the top 5 most prevalent childhood diseases; however, effective treatment strategies for pediatric migraine are limited. For example, standard adult pharmaceutical therapies are less effective in children and can carry undesirable side effects. To develop more effective treatments, improved knowledge of the biology underlying pediatric migraine is necessary. One theory is that migraine results from an imbalance in cortical excitability. Magnetic resonance spectroscopy (MRS) studies show changes in GABA and glutamate levels (the primary inhibitory and excitatory neurotransmitters in the brain, respectively) in multiple brain regions in adults with migraine; however, they have yet to be assessed in children with migraine. Using MRS and GABA-edited MRS, we show that children (7-13 years) with migraine and aura had significantly lower glutamate levels in the visual cortex compared to controls, the opposite to results seen in adults. In addition, we found significant correlations between metabolite levels and migraine characteristics; higher GABA levels were associated with higher migraine burden. We also found that higher glutamate in the thalamus and higher GABA/Glx ratios in the sensorimotor cortex were associated with duration since diagnosis, i.e., having migraines longer. Lower GABA levels in the sensorimotor cortex were associated with being closer to their next migraine attack. Together, this indicates that GABA and glutamate disturbances occur early in migraine pathophysiology and emphasizes that evidence from adults with migraine cannot be immediately translated to pediatric sufferers. This highlights the need for further mechanistic studies of migraine in children, to aid in development of more effective treatments.

Forage quality and beef cow preference is affected by wrap type of conventional and reduced-lignin alfalfa round bales stored outdoors.

Storing hay outdoors can result in detrimental changes in forage quality. Additionally, alfalfa (Medicago sativa L.) cultivar may influence dry matter intake (DMI) and hay waste when feeding livestock. The objectives were to determine the effects of conventional or reduced-lignin alfalfa round bales stored outdoors and wrapped with plastic twine, net wrap, or B-Wrap on forage quality, beef cow preference, and hay waste. Round bales made from reduced-lignin (n = 12) or conventional (n = 12) alfalfa cultivars were baled and stored outdoors for 16 mo. Within each cultivar, four bale replicates were bound with plastic twine, net wrap, or B-Wrap. After storage, bales were fed in a switchback design with period confounded with alfalfa cultivar to 18 lactating Angus cows (Bos Taurus L.). The pairs had ad libitum access to three round-bale feeders where bales of each wrap type were placed for eight 48 h periods. Position of round bale wrap type was rotated according to a Latin Square arrangement. Bales were weighed and waste surrounding each feeder was collected at 24 and 48 h to calculate DMI and hay waste. Statistical significance was set at P < 0.05. Alfalfa cultivar did not impact any of the response variables (P > 0.05). At feeding, round bales wrapped in net wrap had greater (P < 0.015) moisture content (16.4%) compared with those wrapped with B-Wrap (12.8%). Neutral detergent fiber was lower (P = 0.03) in bales wrapped in B-Wrap (46%) compared with twine-tied bales (49%) while net wrapped bales were not different. Total digestible nutrients (P = 0.02), and relative feed value (P = 0.04) were lower in twine-tied bales compared with B-Wrap while net wrapped bales were not different. Twine (7.1 × 106 colony forming units [CFU]/g) and net wrap (4.7 × 106 CFU/g) bales had greater (P < 0.0001) mold counts than B-Wrap bales (4.8 × 104 CFU/g), while concentrations of other forage components and yeast counts were not different among wrap types (P > 0.05). Total DMI, and DMI during the first 24 h, were greater (P ≤ 0.032) for B-Wrap bales compared to twine-tied bales indicating preference for hay wrapped in B-Wrap; net wrapped bales were not different. Dry matter intake in the first 24 h was negatively associated with the mold count (r = -0.52; P = 0.02), and hay waste was not affected by wrap type (P > 0.05). These results confirm that wrap type affected forage quality and mold counts, which in turn influenced beef cattle preference of round bales stored outdoors.

Cattle and carcass performance, and life cycle assessment of production systems utilizing additive combinations of growth promotant technologies.

The objective of this study was to determine the impact of beef production systems utilizing additive combinations of growth promotant technologies on animal and carcass performance and environmental outcomes. Crossbred steer calves (n =120) were stratified by birth date, birth weight, and dam age and assigned randomly to one of four treatments: 1) no technology (NT; control), 2) antibiotic treated (ANT; NT plus therapeutic antibiotics and monensin and tylosin), 3) implant treated (IMP; ANT plus a series of 3 implants, and 4) beta-agonist treated (BA; IMP plus ractopamine-HCl for the last 30 d prior to harvest). Weaned steers were fed in confinement (dry lot) and finished in an individual feeding system to collect performance data. At harvest, standard carcass measures were collected and the United States Department of Agriculture (USDA) Yield Grade and Quality Grade were determined. Information from the cow-calf, growing, and finishing phases were used to simulate production systems using the USDA Integrated Farm System Model, which included a partial life cycle assessment of cattle production for greenhouse gas (GHG) emissions, fossil energy use, water use, and reactive N loss. Body weight in suckling, growing, and finishing phases as well as hot carcass weight was greater (P < 0.05) for steers that received implants (IMP and BA) than non-implanted steers (NT and ANT). The average daily gain was greater (P < 0.05) for steers that received implants (IMP and BA) than non-implanted steers during the suckling and finishing phases, but no difference (P = 0.232) was detected during the growing phase. Dry matter intake and gain:feed were greater (P < 0.05) for steers that received implants than non-implanted steers during the finishing phase. Steers that received implants responded (P < 0.05) with a larger loin muscle area, less kidney pelvic and heart fat, advanced carcass maturity, reduced marbling scores, and a greater percentage of carcasses in the lower third of the USDA Choice grade. This was offset by a lower percentage of USDA Prime grading carcasses compared with steers receiving no implants. Treatments did not influence (P > 0.05) USDA Yield grade. The life cycle assessment revealed that IMP and BA treatments reduced GHG emissions, energy use, water use, and reactive nitrogen loss compared to NT and ANT. These data indicate that growth promoting technologies increase carcass yield while concomitantly reducing carcass quality and environmental impacts.

Magnetic Resonance Imaging in Pediatric Migraine.

This literature review provides an overview of the research using magnetic resonance imaging (MRI) in pediatric migraine and compares findings with the adult migraine literature. A literature search using PubMed was conducted using all relevant sources up to February 2019. Using MRI methods to categorize and explain pediatric migraine in comparison with adult migraine is important, in order to recognize and appreciate the differences between the two entities, both clinically and physiologically. We aim to demonstrate the differences and similarities between pediatric and adult migraine using data from white matter and gray matter structural studies, cerebral perfusion, metabolites, and functional MRI (fMRI) studies, including task-based and resting-state blood oxygen level-dependent studies. By doing this we identify areas that need further research, as well as possible areas where intervention could alter outcomes.

Utiliser des examens d'IRM dans le cas de jeunes patients souffrant de migraine. Cette revue de littérature entend fournir un survol des travaux de recherche explorant l'utilisation d'examens d'IRM dans le cas de jeunes patients souffrant de migraine. Elle vise aussi à comparer nos observations à celles que l'on trouve dans la littérature portant sur les cas de migraine chez les adultes. Au moyen de PubMed, nous avons effectué une recherche bibliographique pour ensuite utiliser toutes les références jugées pertinentes et publiées avant février 2019. Le fait d'utiliser des méthodes d'imagerie afin de catégoriser et d'expliquer les cas de migraine chez les enfants, et ce, en comparaison avec les cas de migraine chez l'adulte, est important afin de pouvoir reconnaître et d'identifier les différences tant sur le plan clinique que physiologique. Notre intention est ici de faire ressortir ces différences (mais aussi des similitudes) au moyen de données obtenues dans le cadre d'études structurales de la matière blanche et de la matière grise et d'études portant sur la perfusion cérébrale, les métabolites et les IRM fonctionnelles, ce qui inclut le signal BOLD (blood oxygen level dependent) à l'état de repos ou lors de l'exécution de tâches. En procédant à cette étude, nous voulons identifier les domaines qui devraient être explorés davantage de même que les domaines où des interventions pourraient modifier l'évolution de l'état de santé des patients.

Narrative identity, rationality, and microdosing classic psychedelics.

BACKGROUND: Microdosing involves ingesting a small dose of a classic psychedelic (e.g., LSD and psilocybin) at regular intervals for prolonged periods. The practice is said to reduce anxiety, improve mood, and offer several creative and practical benefits to users. Using the narrative identity theoretical framework, our aim was to explore the experiences of those who microdosed classic psychedelics. Specifically, we sought to understand how and why they began microdosing and how they made sense of their actions in the context of their conventional lives. METHODS: To understand the experiences of those who microdose classic psychedelics, we rely on data collected from semi-structured interviews with 30 people who had microdosed. RESULTS: Participants saw themselves as conventional citizens who microdosed for rational and instrumental purposes. They emphasized the rationality of microdosing by discussing (1) the practicality of their procurement and administration processes, (2) the connection between their microdosing practice and their general awareness in health and wellness, and (3) the benefits of the practice. CONCLUSION: Participants described their microdosing in the context of embracing traditional middle-class values. This created social distance between themselves and those who use drugs recreationally. While people who use drugs recreationally typically construct boundaries by distancing themselves from symbolic others (i.e., "crackheads," "meth heads," "junkies"), microdosers constructed boundaries by emphasizing connections to conventional citizens who embrace middle-class values. This connection to conventional citizens allows them to normalize their drug use and facilitates persistence.

Gait quality and velocity influences activity tracker accuracy in individuals post-stroke.

Objective: Fitbit Zip™ (FBZ) is a low-cost user-friendly device that could help motivate individuals post-stroke to increase their physical activity. However, inaccuracy in step counts from altered gait variables could cause dissatisfaction and reduce compliance. The aim of this study was to determine the influence of gait variables on the concurrent validity of the FBZ. Method: In a cross-sectional study, 19 community-dwelling stroke survivors (mean 66 (SD 8) years)  wore a FBZ at the non-paretic hip, and were videoed completing a six minute walk test (6MWT). Steps recorded by the FBZ were compared against the criterion standard of manually counted steps from video-recordings. Spatio-temporal gait parameters were calculated, and gait quality was assessed using the Wisconsin Gait Analysis (WGA) tool. Concurrent validity of FBZ was determined using Kendall's Tau correlation coefficient. Linear regression analysis determined the association between gait parameters, quality, and FBZ accuracy. Results: A very strong correlation was observed between the FBZ steps and manual counting (τ = 0.80, p < .001). Step difference demonstrated significant negative association with gait velocity (R2 = 0.35, B = -59.94, p = .007), and positive association with WGA score (R2 = 0.69, B = 4.59, p < .001), indicating poor FBZ accuracy in participants with lower speed (≤0.8m/s) and poor gait quality (WGA score>16). Conclusions: FBZ is an accurate measure of step activity in independent ambulators with stroke walking at speeds > 0.8m/s, but accuracy can be compromised with lower speed and poor gait quality. Clinicians should consider gait velocity and quality before advising FBZ as a motivational tool to increase physical activity in individuals post-stroke.

Ketamine versus hydromorphone patient-controlled analgesia for acute pain in trauma patients.

BACKGROUND: It is unknown whether ketamine administered via patient-controlled analgesia (PCA) provides adequate analgesia while reducing opioid consumption in the traumatically injured patient. Differences in opioid consumption, pain scores, and adverse effects between ketamine and hydromorphone PCA were studied. MATERIALS AND METHODS: This is an investigator-initiated, single-center, double-blinded, randomized, pilot trial conducted from 2014 to 2016 at a level 1 trauma center. Nonintubated trauma patients in intensive care, who were receiving PCA, were randomized to ketamine or hydromorphone PCA plus opioid analgesics for breakthrough pain. RESULTS: Twenty subjects were randomized. There was no difference in median daily breakthrough opioid use (10 [0.63-19.38] mg versus 10 [4.38-22.5] mg, P = 0.55). Subjects in the ketamine group had lower median cumulative opioid use on therapy day 1 than the hydromorphone group (4.6 [2.5-15] mg versus 41.8 [31.8-50] mg, P < 0.001), as well as in the first 48 h (10 [3.3-15] mg versus 48.5 [32.1-67.5] mg, P < 0.001) and first 72 h (10 [4.2-15] mg versus 42.5 [31.7-65.2] mg, P < 0.001) of therapy. Daily oxygen supplementation requirements were lower in the ketamine group (0.5 [0-1.5] L/min versus 2 [0.5-3] L/min, P = 0.020). Hallucinations occurred more frequently in the ketamine group (40% versus 0%, P = 0.090). CONCLUSIONS: Ketamine PCA led to lower cumulative opioid consumption and lower oxygen supplementation requirements, though hallucinations occurred more frequently with use of ketamine. Additional studies are needed to investigate the tolerability of ketamine as an alternative to traditional opioid-based PCA.

The Scheduling of Kratom and Selective Use of Data.

Kratom is a traditional drug from Southeast Asia that has been an emerging new substance in the United States. On August 30, 2016, the DEA announced the intention to emergency schedule kratom into Schedule I. To support this decision, the DEA cited an increase in drug seizures of kratom and an increase in calls to poison control concerning kratom. However, a short time later, on October 12, 2016, the DEA withdrew the intent to schedule kratom after public and congressional backlash. The withdrawal by the DEA was somewhat unprecedented. To better understand both decisions, the current article examines the evidence the DEA cited to support their decision to emergency schedule kratom and the degree and type of media coverage of kratom to determine if a media-driven drug panic occurred.

Metagenomic characterization of the effect of feed additives on the gut microbiome and antibiotic resistome of feedlot cattle.

In North America, antibiotic feed additives such as monensin and tylosin are added to the finishing diets of feedlot cattle to counter the ill-effects of feeding diets with rapidly digestible carbohydrates. While these feed additives have been proven to improve feed efficiency and reduce liver abscess incidence, how these products impact the gastrointestinal microbiota is not completely understood. In this study, we analyzed the impact of providing antibiotic feed additives to feedlot cattle using metagenome sequencing of treated and control animals. Our results indicate that use of antibiotic feed additives does not produce discernable changes at the phylum level. However, treated cattle had reduced abundance of gram-positive bacteria at the genus level. The abundance of Ruminococcus, Erysipelotrichaceae and Lachnospiraceae in the gut of treated steers was reduced. Functional analysis of the data indicates that there was only minimal impact due to the treatment in the rumen. Genes involved in detoxification were significantly increased in the rumen of AB steers. But the relative abundance of these genes was < 0.3%. However, our results did not show any correlation between the presence of antimicrobial resistance genes in the gut microbiota and the administration of antibiotic feed additives.