Associations Between Race & Socioeconomic Status, Lower Extremity Strength, and Patient Reported Outcomes Following Anterior Cruciate Ligament Reconstruction.

CONTEXT: There are significant disparities in access to health care, but there are limited data about the impact of race and socioeconomic status (SES) on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction (ACLR) surgery. OBJECTIVE: To identify associations between area deprivation index (ADI), strength measures and patient-reported outcomes (PROs) following ACLR as well as to examine differences in outcomes between race, sex, and race. DESIGN: Case control study in a single hospital setting. SETTING: Database secondary analysis. PATIENTS OR OTHER PARTICIPANTS: Data was collected from 340 patients who underwent primary, isolated, unilateral ACLR. MAIN OUTCOME MEASURES: Strength measures and PROs were obtained at patients' postoperative assessments at approximately six months post-surgery. Area Deprivation Index values were calculated on each patient's census tract, determined through medical records review. Correlations were conducted to determine the relationship between ADI and KOOS measures, IKDC, and limb symmetry on strength measurements. The racial composition of the sample was heavily skewed and was excluded from statistical analyses. RESULTS: ADI was weakly correlated with IKDC (ρ=0.11, p=0.04) outcomes, with more disadvantaged patients reporting better quality of life and knee function. ADI was not correlated with other outcomes of interest. The median ADI value of the sample was 32 (range 1-86 [IQR 19-47]). CONCLUSIONS: Our study revealed a weak correlation between higher levels of socioeconomic disadvantage as measured by ADI and improved subjective assessment of knee function and quality of life as measured by IKDC. These findings are contrary to what other studies on this subject have found and highlight the importance of further research into the impact of SES and other social determinants of health on post ACLR outcomes.

The effect of factors from different time points on psychological readiness following ACL reconstruction.

OBJECTIVE: The purpose of this study was to examine factors correlated with psychological readiness to return to activity after ACLR. DESIGN: cross sectional study. SETTING: controlled laboratory. PARTICIPANTS: 164 patients (82 M/82 F, 22.5 ± 8.9yr, 171.6 ± 11.0 cm, 77.4 ± 18.6 kg, 8.6 ± 3.4 months post-ACLR) participated in this study after a primary, isolated, and uncomplicated ACLR. MAIN OUTCOME MEASURES: ACL Return to Sport Index (ACL-RSI). RESULTS: ACL-RSI scores demonstrated a weak positive correlation with activity level at the time of injury and a fair positive correlation with activity level at the time of post-operative testing (p-values: 0.004, <0.001). ACL-RSI scores showed a statistically significant fair negative correlation with pain and a moderate negative correlation with kinesiophobia during rehabilitation (p-values: <0.001, <0.001). There was no statistical significance between ACL-RSI and the surgical variables (p-value range: 0.10-0.61). CONCLUSIONS: Outcomes from testing during postoperative rehabilitation were most correlated with psychological readiness to return to activity after ACLR. Increased pain and kinesiophobia were associated with a decreased psychological readiness. Increased activity level prior to injury and activity level at the time of testing during rehabilitation were both correlated with increased psychological readiness. Psychological readiness to return to activity may need to be customized based on potentially modifiable patient-specific factors during the post-operative rehabilitation.

Comparison of Limb Loading Characteristics and Subjective Functional Outcomes Between Sexes Following ACLR.

CONTEXT: ACL reconstruction (ACLR) patients commonly adopt poor movement patterns that potentially place them at an increased risk for reinjury if untreated. Limb loading characteristics during functional tasks can highlight movement compensations. OBJECTIVE: Examine loading symmetry during a bilateral bodyweight squatting task between sexes, compare loading metrics between limbs and sexes, and describe the relationship between loading metrics and patient reported outcomes (PROs) following ACLR. DESIGN: Cross-Sectional Study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: 142 patients (71M/71F, 24.4±11.10yrs) with a primary, unilateral, uncomplicated ACLR completed a squatting assessment and PROs at approximately 5.2 months post-ACLR. MAIN OUTCOME MEASURE(S): Normalized limb loading peak force (N/kg) and unilateral cumulative load (%) were collected bilaterally during the squatting task. Limb symmetry index (%) was calculated for normalized peak force. Our first objective compared limb loading symmetry (%) between sexes using independent samples t-test. Our second objective assessed differences in limb loading metrics between limbs and sexes were analyzed via an analysis of covariance. Our third objective was assessed using Spearman Rho correlations to determine the relationship between limb loading metrics and PROs. RESULTS: The majority of individuals (91/142, 64.1%) offloaded their ACLR limb (ACLR: 6.6±1.56 N/kg; contralateral: 7.3±1.61 N/kg, p<0.001). Females significantly offloaded their ACLR limb (ACLR: 6.3±1.38 N/kg; contralateral: 7.2±1.62 N/kg, p<0.001) where males did not significantly offload their ACLR limb (ACLR 6.98±1.65 N/kg; contralateral: 7.4±1.60, p=0.07). Weak relationships were observed (ρ-value range: -0.23 to 0.19) across limb loading metrics and PROs. CONCLUSION: Individuals approximately five months following ACLR, on average, offloaded their ACLR limb compared to the contralateral limb. Patients' tendency to offload their weight during a squat was influenced by sex. Relationships between limb loading metrics and PROs indicate patients who load their limbs disproportionately have a lower perception in their capability to complete activities of daily living and lower subjective knee function.

Transference of outdoor gait-training to treadmill running biomechanics and strength measures: A randomized controlled trial.

Outdoor gait-training has been successful in improving pain and reducing contact time during outdoor running for runners with exercise-related lower leg pain (ERLLP). However, it is unclear if these adaptations translate to gold standard treadmill running and clinical strength assessments. The study purpose was to assess the influence of a 4-week outdoor gait-training intervention with home exercises (FBHE) on treadmill running biomechanics and lower extremity strength compared to home exercises alone (HE) among runners with ERLLP. Seventeen runners with ERLLP were randomly allocated to FBHE and HE groups (FBHE: 3 M, 6F, 23 ± 4 years, 22.0 ± 4.6 kg/m2; HE: 3 M, 5F, 25 ± 5 years, 24.0 ± 4.0 kg/m2). Both groups completed eight sessions of home exercises over 4 weeks. The FBHE group received gait-training through wearable sensors to reduce contact time. Treadmill running gait and clinical strength assessments were conducted at baseline and 4-weeks. Multivariate repeated measures analyses of variance were used to assess the influence of group and timepoint for all outcomes. The FBHE group demonstrated significantly decreased contact time at 4-weeks compared to baseline and the HE group (Mean Difference [MD] range: -42 ms - -39 ms; p-range: <0.001-0.02). The FBHE group had significantly increased cadence (MD: +21 steps/min; p = 0.003) and decreased loading impulse (MD: -51, p < 0.001) during treadmill running at 4-weeks compared to the HE group. Strength did not significantly differ adjusting for multiple comparisons (p > 0.007). The outdoor FBHE intervention transferred to favorable changes in treadmill running biomechanics. Clinicians treating runners with ERLLP patients should implement data-driven outdoor gait-training to maximize patient benefits across running locations.

Prediction of properties of boron [Formula: see text]-icosahedral nanosheet by bond-addictive [Formula: see text]-polynomial.

Nanosheets with boron elements have excellent characteristics which makes the boron polymorphs unique and super hard. A boron [Formula: see text]-icosahedral nanosheet in crystalline form has superconductivity and thermal electronic properties. In theoretical chemistry and QSPR/QSAR study, a topological descriptor is an important analytical tool. It helps to analyse the structure and its properties and also correlates the with numerical expressions. The valence-based M-polynomial provides quantitative measures of molecular properties based on their geometric, electrostatic, and quantum chemical characteristics. In this article, the QSPR/QSAR analysis is performed for this nanosheet and the analytical expressions are validated with original synthesized data, and received excellent correlation values of 0.9835 and 0.9932. The mathematical expression of the structure is analysed and the indices are compared graphically and numerically.

A randomized controlled trial evaluating a theory driven, complex intervention centered on task sharing and mobile health to improve selfcare and outcomes in heart failure - The PANACEA-HF RCT: Design and rationale.

Background: We developed a three-pronged complex intervention to improve selfcare and deliver whole person care for patients with heart failure, underpinned by the 'extant cycle' theory - a theory based on our formative work. Methods: This is a 3 centre, 2-arm, 1:1, open, adaptive stratified, randomized controlled trial. We included patients aged ≥ 18 years with heart failure, taking any of the key guideline directed medical treatments, with a history of or currently on a high ceiling diuretic. We excluded end stage renal disease, clinically diagnosed severe mental illness or cognitive dysfunction and having no caregivers. Interventions included, (i) trained hospital based lay health worker mediated assessment of patients' current selfcare behaviour, documenting barriers and facilitators and implementing a plan to 'transition' the patient toward optimal selfcare. (ii) m-health mediated remote monitoring and (iii) dose optimization through a 'physician supervisor'. Results: We recruited 301 patients between Jan 2021 and Jan 2022. Mean age was 59.8 (±11.7) years, with 195 (64.8 %) from rural or semi-urban areas and 67.1 % having intermediate to low health literacy. 190 (63.1 %) had an underlying ischemic cardiomyopathy. In the intervention arm, 142 (94.1 %) had a Selfcare in Heart Failure Index (SCHFI) score of ≤70, with significant barriers being 'lack of knowledge' 105 (34.5 %) and 'behavioural passivity' 23 (7.5 %). Conclusion: This is the first South Asian trial evaluating a complex intervention underpinned by behaviour change theory for whole person heart failure care. These learnings can be applied to heart failure patient care in other resource constrained health systems.

In vitro quorum quenching activity of eleusine indica crude ethanolic extract against pseudomonas aeruginosa and serratia marcescens

@#<p style="text-align: justify;"><strong>Introduction:</strong> Nosocomial contaminants such as Pseudomonas aeruginosa and Serratia marcescens are increasingly developing resistance to many antibiotics. One of the promising alternatives that may complement, if not substitute, the use of antibiotics is quorum quenching, the process of interfering with chemical signals that mediate communication between microorganisms. Eleusine indica, a ubiquitous grass used traditionally to treat infections, has been shown to contain metabolites, such as fatty acid derivatives and p-coumaric acid, capable of quorum quenching. To date, there has been no study on the quorum quenching activity of E. indica.</p><p style="text-align: justify;"><strong>Objectives:</strong> This study aimed to determine the in vitro activity of crude ethanolic extract of E. indica leaves against selected quorum-sensing regulated virulence factors of P. aeruginosa and S. marcescens.</p><p style="text-align: justify;"><strong>Methodology:</strong> E. indica leaves were collected, washed, air-dried, and homogenized. Following ethanolic extraction and rotary evaporation, the extract was screened for antimicrobial activity through disk diffusion test and broth microdilution assay. The quorum quenching activity of the extract against P. aeruginosa was measured through swarming motility assay, while the activity against S. marcescens was measured through swarming motility and pigment inhibition assays. The quorum quenching assays were conducted in triplicates, and analysis of variance (ANOVA) was performed to identify differences among the treatment groups.</p><p style="text-align: justify;"><strong>Results:</strong> Disk diffusion test revealed that no zones of inhibition formed against both P. aeruginosa and S. marcescens for varying concentrations of up to 200 mg/mL of the crude extract. Likewise, the MIC of the extract against both P. aeruginosa and S. marcescens was determined to be >200 mg/mL. However, it was shown that the extract, at 50 mg/mL, has statistically significant activity (p<0.05) against the swarming motility of P. aeruginosa, and it is 71.6% as effective in reducing the swarming area of the bacteria compared to cinnamaldehyde. This was not observed when the extract was tested against the swarming motility of and pigment production by S. marcescens.</p><p style="text-align: justify;"><strong>Conclusion:</strong> In this study, the quorum quenching activity of the crude ethanolic extract of E. indica leaves was found to be effective against P. aeruginosa but not against S. marcescens. The compounds that will be identified by further studies may conceivably be used as an adjunct therapy in P. aeruginosa infections and as coating agents in medical devices.</p>

Application of the "real options theory" method to the production systems used in dairy cattle farming / [Aplicação do método "Teoria das Opções Reais" nos sistemas de produção utilizados na bovinocultura leiteira]

The objective of this study was to analyze applications of real options theory for increasing the productivity of Mantiqueira ecotype dairy cows kept in guinea grass pastures with different sources of bulky supplementation (black oats, fodder cane, or sorghum silage), because the traditional methodologies do not consider the uncertainties related to this activity. Real options theory, an investment evaluation method, fills this gap as its most significant feature is its flexibility to act on uncertain events. Based on the results obtained for two economic indicators, the net present value and internal rate of return, and considering the production items identified in the sensitivity analysis, this study evaluated the expansion flexibility of each system using the real options theory methodology in discrete time as proposed by Copeland and Antikarov (2001). The analysis of the expansion options showed that the values of the production systems increased by 6.73%, 1.21%, and 19.49% for the systems supplemented with sorghum silage, black oats, and fodder cane, respectively. The expanded net present values were R$ 141,642.39, R$ 64,211.08, and R$ 58,013.07 for the systems that adopted bulky supplementation with black oats, fodder cane, and sorghum silage, respectively.(AU)

Objetivou-se analisar a aplicação da Teoria das Opções Reais para expansão da produtividade de vacas leiteiras do ecótipo Mantiqueira, mantidas em pastagem de capim-Mombaça com fornecimento de diferentes fontes de suplementação volumosa (aveia-preta, cana-forrageira ou silagem de sorgo), uma vez que as metodologias tradicionais não consideram as incertezas presentes na atividade. A Teoria de Opções Reais é um método de avaliação de investimento que possui como maior característica a valoração da flexibilidade de agir a eventos incertos, preenchendo, assim, a lacuna deixada pelo método tradicional. A partir dos resultados obtidos pelos indicadores econômicos valor presente líquido e taxa interna de retorno, em conjunto com os itens de produção identificados na análise de sensibilidade, foi possível avaliar o valor da flexibilidade de expansão que cada sistema apresentou. A flexibilidade de expansão foi avaliada utilizando-se a metodologia Teoria das Opções Reais, proposta por Copeland e Antikarov (2001), em tempo discreto. O resultado da análise da opção de expansão apresentou aumento nos valores dos sistemas de produção, na ordem de 6,73%, 1,21% e 19,49%, para os sistemas suplementados com silagem de sorgo, aveia-preta e cana-forrageira, respectivamente. Os resultados obtidos para os valores presentes líquidos expandidos foram de R$ 141.642,39, R$ 64.211,08 e R$ 58.013,07, para os sistemas que adotaram a suplementação volumosa com aveia-preta, cana-forrageira e silagem de sorgo, respectivamente.(AU)

Novel approaches in primary cardiovascular disease prevention: the HOPE-3 trial rationale, design, and participants' baseline characteristics

AbstractBACKGROUND:Cholesterol and blood pressure (BP) can be effectively and safely lowered with statin drugs and BP-lowering drugs, reducing major cardiovascular (CV) events by 20%-30% within 5 years in high-risk individuals. However, there are limited data in lower-risk populations. The Heart Outcomes Prevention Evaluation-3 (HOPE-3) trial is evaluating whether cholesterol lowering with a statin drug, BP lowering with low doses of 2 antihypertensive agents, and their combination safely reduce major CV events in individuals at intermediate risk who have had no previous vascular events and have average cholesterol and BP levels.METHODS:A total of 12,705 women 65 years or older and men 55 years or older with at least 1 CV risk factor, no known CV disease, and without any clear indication or contraindication to the study drugs were randomized to rosuvastatin 10 mg/d or placebo and to candesartan/hydrochlorothiazide 16/12.5 mg/d or placebo (2 × 2 factorial design) and will be followed for a mean of 5.8 years. The coprimary study outcomes are the composite of CV death, nonfatal myocardial infarction (MI), and nonfatal stroke and the composite of CV death, nonfatal MI, nonfatal stroke, resuscitated cardiac arrest, heart failure, and arterial revascularization.RESULTS:Participants were recruited from 21 countries in North America, South America, Europe, Asia, and Australia. Mean age at randomization was 66 years and 46% were women.CONCLUSIONS:The HOPE-3 trial will provide new information on cholesterol and BP lowering in intermediate-risk populations with average cholesterol and BP levels and is expected to inform approaches to primary prevention worldwide (HOPE-3 ClinicalTrials.govNCT00468923).

Listeria monocytogenes, E. coli O157, Salmonella spp. e microrganismos indicadores em carcaças bovinas para exportação / Listeria monocytogenes, E. coli O157, Salmonella spp., micro-organism indicators in export cattle carcasses

Foram colhidas amostras de 100 carcaças em um frigorífico exportador, localizado no interior do estado de São Paulo, amostradas ao longo de um ano, por meio do método de esponjas, aplicado na região do peito do animal. As amostras foram colhidas em três pontos, denominados A, B e C, sendo cada carcaça amostrada nos três pontos, localizados nas etapas: pós-sangria (A); pós-esfola (B) e pós-lavagem (C). Foram realizadas pesquisas de Listeria sp., E. coli O157, Salmonella spp. e microrganismos indicadores (Petrifilms® AC, EC e EB). Não foram isolados Listeria ou E. coli O157 em nenhuma das 300 amostras. Salmonella spp. foi isolada em nove, sendo oito no ponto A e uma no ponto B. Para mesófilos, as contagens variaram de 0 a 6,8 log UFC/cm², para coliformes totais, de 0 a 4,57 log UFC/cm², e para E. coli, de 0 a 4,38 log UFC/cm². Diante dos resultados obtidos e em comparação com a literatura, conclui-se que o estabelecimento estudado apresenta qualidade, tanto sanitária (devido às baixas prevalências dos patógenos) quanto higiênica (devido à acentuada diminuição da carga microbiana de indicadores ao longo da linha).

Samples were collected from 100 carcasses in a slaughterhouse exporter, located within the State of São Paulo, sampled over a year through the sponge method, applied to the chest of the animal. Samples were taken at three points, denominated A, B and C, each carcass sampled at three points located in the following steps: after bleeding (A) after skinning (B) and after washing (C). Research was conducted for Listeria sp., E. coli O157, Salmonella spp. and Micro-organism (Petrifilms ® AC, EC and EB). Listeria or E. coli O157 were not isolated in any of the 300 samples. Salmonella spp. was isolated in nine, eight at point A and one at point B. For Mesophiles, scores ranged from 0 to 6.8 log UFC/cm²; for Total coliforms, 0 to 4.57 log UFC/cm² and E. coli from 0 to 4.38 log UFC/cm². With the results obtained and compared with the literature, it is concluded that the establishment in this study has both sanitary quality (due to the low prevalence of pathogens) and hygienic quality (due to the sharp decrease in the microbial load of indicators along the line.

The role of plant type and salinity in the selection for the denitrifying community structure in the rhizosphere of wetland vegetation

Coastal wetlands, as transient links from terrestrial to marine environments, are important for nitrogen removal by denitrification. Denitrification strongly depends on both the presence of emergent plants and the denitrifier communities selected by different plant species. In this study, the effects of vegetation and habitat heterogeneity on the community of denitrifying bacteria were investigated in nine coastal wetlands in two preserved areas of Spain. Sampling locations were selected to cover a range of salinity (0.81 to 31.3 mS/cm) and nitrate concentrations (0.1 to 303 μM NO3-), allowing the evaluation of environmental variables that select for denitrifier communities in the rhizosphere of Phragmites sp., Ruppia sp., and Paspalum sp. Potential nitrate reduction rates were found to be dependent on the sampling time and plant species and related to the denitrifier community structure, which was assessed by terminal restriction fragment length polymorphism analysis of the functional genes nirS, nirK and nosZ. The results showed that denitrifier community structure was also governed by plant species and salinity, with significant influences of other variables, such as sampling time and location. Ruppia sp. and Phragmites sp. selected for certain communities, whereas this was not the case for Paspalum sp. The plant species effect was strongest on nirK-type denitrifiers, whereas water carbon content was a significant factor defining the structure of the nosZ-harboring community. The differences recognized using the three functional gene markers indicated that different drivers act on denitrifying populations capable of complete denitrification, compared to the overall denitrifier community. This finding may have implications for emissions of the greenhouse gas nitrous oxide (AU)

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Prevalência de enterococos isolados de frangos caipiras em diferentes regiões do Distrito Federal / Prevalence of Enterococcus spp. isolated from free-range chickens in different regions of Distrito Federal, Brazil

It was studied whether vancomycin-resistant enterococci (VRE) colonize poultry raised without receiving antimicrobial growth promoters (AGP), in non-intensive production systems. A total of 200 cloacal swabs were colleted in farms (n=40) of eight different regions of the Distrito Federal. After selective isolation, the typical enterococcal colonies were submitted to the multiplex PCR to identify enterococcal species (E. faecalis, E. faecium, E. gallinarum, and E. casseliflavus), and genes coding for high-level vancomycin resistance phenotypes. No VRE were found in the examined samples. The prevalence rates were higher for E. gallinarum (n=26; 13.0 percent) and E. casseliflavus (n=11; 5.5 percent). It was found remarkable differences in the prevalence of E. gallinarum and E. casseliflavus among the poultry farms and studied regions, and it seems that poultry raised in non-intensive production systems in the Distrito Federal of Brazil are not reservoirs of VRE.

Leite humano - estudo das imunoglobulinas no colostro de maes de prematuros e de maes de criancas a termo. / Human milk - study of immunoglobulins in the colostrum of mothers of premature and full term infants

A composicao proteica e imunologica do colostro humano foi analisada em termos comparativos entre as maes de recem-nascidos prematuros e recem-nascidos a termo. Nenhuma diferenca estatisticamente significativa foi encontrada em termos de imunoglobulinas e proteinas