Administration of Low-dose Hyperbaric Bupivacaine for Spinal Anesthesia in the Setting of Outpatient Arthroplasty.

INTRODUCTION: With the rise of ambulatory surgery centers (ASCs), rapid motor and sensory recovery after anesthesia is crucial. The purpose of this study was to evaluate the safety and efficacy of low-dose single-shot hyperbaric bupivacaine for spinal anesthesia (SA) for patients undergoing outpatient arthroplasty. METHODS: Data were reviewed from a single ASC from 2018 to 2020 for two arthroplasty-trained surgeons for all patients with primary arthroplasties that had administration of low-dose hyperbaric bupivacaine. Data collected from the ASC records were then further evaluated for total spinal block time, length of blockade, time to discharge criteria, visual analog scale (VAS) scores, and time to discharge. RESULTS: Two hundred twenty-seven patients undergoing 244 primary arthroplasties received SA with low-dose hyperbaric bupivacaine. The volume of 0.75% bupivacaine varied: 115 patients received 0.8 mL (6 mg), 111 patients received 1.0 mL (7.5 mg), and 17 patients received 1.2 mL (9 mg). Total SA time averaged 144 minutes with a mean of 30 minutes from post anesthesia care unit arrival to motor recovery. The mean time from post anesthesia care unit arrival to discharge criteria was 89 minutes. The average VAS at discharge was 1.44; the average VAS on POD1 was 3.0. No episodes of urinary retention and no reports of transient neurologic symptoms were noted in the study population. CONCLUSION: Low-dose, single-shot hyperbaric bupivacaine SA is an effective option in the ASC for arthroplasty, providing a fast return of motor function, facilitating rapid discharge, and is safe with a relatively low-risk profile.

Nudging to Change: Using Behavioral Economics Theory to Move People and Their Health Care Partners Toward Effective Type 2 Diabetes Prevention.

IN BRIEF In 2017, 30 million Americans had diabetes, and 84 million had prediabetes. In this article, the authors focus on the journey people at risk for type 2 diabetes take when they become fully engaged in an evidence-based type 2 diabetes prevention program. They highlight potential drop-off points along the journey, using behavioral economics theory to provide possible reasons for most of the drop-off points, and propose solutions to move people toward making healthy decisions.

Science That Matters: The Importance of a Cultural Connection in Underrepresented Students' Science Pursuit.

Recent research suggests that underrepresented minority (URM) college students, and especially first-generation URMs, may lose motivation to persist if they see science careers as unable to fulfill culturally relevant career goals. In the present study, we used a mixed-methods approach to explore patterns of motivation to pursue physical and life sciences across ethnic groups of freshman college students, as moderated by generational status. Results from a longitudinal survey (N = 249) demonstrated that freshman URM students who enter with a greater belief that science can be used to help their communities identified as scientists more strongly over time, but only among first-generation college students. Analysis of the survey data were consistent with content analysis of 11 transcripts from simultaneously conducted focus groups (N = 67); together, these studies reveal important differences in motivational characteristics both across and within ethnicity across educational generation status. First-generation URM students held the strongest prosocial values for pursuing a science major (e.g., giving back to the community). URM students broadly reported additional motivation to increase the status of their family (e.g., fulfilling aspirations for a better life). These findings demonstrate the importance of culturally connected career motives and for examining intersectional identities to understand science education choices and inform efforts to broaden participation.

The what, when, and why of implementation frameworks for evidence-based practices in child welfare and child mental health service systems.

It is widely recognized that children in the child welfare system are particularly vulnerable to the adverse health and mental effects associated with exposure to abuse and neglect, making it imperative to have broad-based availability of evidence-based practices (EBPs) that can prevent child maltreatment and reduce the negative mental health outcomes for youth who are victims. A variety of EBPs exist for reducing child maltreatment risk and addressing the associated negative mental health outcomes, but the reach of these practices is limited. An emerging literature documents factors that can enhance or inhibit the success of EBP implementation in community service agencies, including how the selection of a theory-driven conceptual framework, or model, might facilitate implementation planning by providing guidance for best practices during implementation phases. However, limited research is available to guide decision makers in the selection of implementation frameworks that can boost implementation success for EBPs that focus on preventing child welfare recidivism and serving the mental health needs of maltreated youth. The aims of this conceptual paper are to (1) provide an overview of existing implementation frameworks, beginning with a discussion of definitional issues and the selection criteria for frameworks included in the review; and (2) offer recommendations for practice and policy as applicable for professionals and systems serving victims of child maltreatment and their families.

Towards standardization of the nomenclature of resistance training exercises.

There is a disagreement surrounding the names of resistance training exercises. The purpose of this study was to survey different professionals regarding the nomenclature of resistance training exercises. Two hundred five participants volunteered for the study, of which, 64.9 % were male. Participants self-identified as either certified athletic trainer (22.4%), academic (18.5%), strength and conditioning coach (25.9%), personal trainer (15.6%), or clinician (17.6%). Participants were asked to name 10 resistance training exercises as depicted by pictures. A χ2 for exercise name by current profession analysis was used to analyze frequency differences. All exercises in the survey yielded inconsistent terminology primarily related to the responders' profession and 3 items in their naming patterns as follows: specification, equipment, and exercise. These results reveal a need to establish consistent naming pattern guidelines for resistance training exercises. The use of a consistent naming pattern may provide direction and clarity when working with athletes and clients in a strength training environment. We suggest a "specification, equipment, exercise" (e.g., 1 arm dumbbell row) naming pattern be used when naming resistance training exercises.

Adults with RRM2B-related mitochondrial disease have distinct clinical and molecular characteristics.

Mutations in the nuclear-encoded mitochondrial maintenance gene RRM2B are an important cause of familial mitochondrial disease in both adults and children and represent the third most common cause of multiple mitochondrial DNA deletions in adults, following POLG [polymerase (DNA directed), gamma] and PEO1 (now called C10ORF2, encoding the Twinkle helicase) mutations. However, the clinico-pathological and molecular features of adults with RRM2B-related disease have not been clearly defined. In this multicentre study of 26 adult patients from 22 independent families, including five additional cases published in the literature, we show that extra-ocular neurological complications are common in adults with genetically confirmed RRM2B mutations. We also demonstrate a clear correlation between the clinical phenotype and the underlying genetic defect. Myopathy was a prominent manifestation, followed by bulbar dysfunction and fatigue. Sensorineural hearing loss and gastrointestinal disturbance were also important findings. Severe multisystem neurological disease was associated with recessively inherited compound heterozygous mutations with a mean age of disease onset at 7 years. Dominantly inherited heterozygous mutations were associated with a milder predominantly myopathic phenotype with a later mean age of disease onset at 46 years. Skeletal muscle biopsies revealed subsarcolemmal accumulation of mitochondria and/or cytochrome c oxidase-deficient fibres. Multiple mitochondrial DNA deletions were universally present in patients who underwent a muscle biopsy. We identified 18 different heterozygous RRM2B mutations within our cohort of patients, including five novel mutations that have not previously been reported. Despite marked clinical overlap between the mitochondrial maintenance genes, key clinical features such as bulbar dysfunction, hearing loss and gastrointestinal disturbance should help prioritize genetic testing towards RRM2B analysis, and sequencing of the gene may preclude performance of a muscle biopsy.

Inhibition of Francisella tularensis LVS infection of macrophages results in a reduced inflammatory response: evaluation of a therapeutic strategy for intracellular bacteria.

Francisella tularensis is an intracellular pathogen and is able to invade several different cell types, in particular macrophages, most commonly through phagocytosis. A flow cytometric assay was developed to measure bacterial uptake, using a fluorescein isothiocyanate-labelled anti-F. tularensis lipopolysaccharide antibody in conjunction with antibodies to cell surface markers, in order to determine the specific cell phenotypes that were positive for the bacteria. Several phagocytic inhibitors were evaluated in macrophage cell lines and a lung homogenate assay to determine whether the uptake of F. tularensis strain LVS could be altered. Our data show that cytochalasin B, LY294002, wortmannin, nocodazole, MG132 and XVA143 inhibitors reduced LVS uptake by >50% in these assays without having significant cytotoxic effects. Furthermore, a reduction in the inflammatory cytokines monocyte chemoattractant protein-1, interleukin-6 and tumour necrosis factor-α was found in the supernatant of lung tissue infected with LVS when the inhibitory compounds were present. Similarly, there was an alteration in bacterial uptake and a reduction in the inflammatory cytokine response following the administration of wortmannin to LVS-infected mice. Although wortmannin treatment alone did not correlate with the enhanced survival of LVS-infected mice, these inhibitors may have utility in combination therapeutic approaches or against other intracellular pathogens that use phagocytic mechanisms to enter their optimal niche.

Racial/Ethnic Differences in Bone Mineral Density of Young Adults.

An estimated 1.5 million people suffer a bone disease-related fracture every year. Most work investigating bone mineral density (BMD) focuses on post-menopausal females but a report from the Surgeon General in 2004 stated that of particular concern are men, racial and ethnic minorities, poor individuals, individuals with disabilities, and individuals living in rural areas. The purpose of this study was to examine the racial/ethnic differences in bone mineral density of young adults and to investigate any correlations with variables suggested to influence BMD. BMD was assessed at a younger age than most studies based on the assumption that osteoporosis is a pediatric disorder that manifests in old age. Whole-body BMD, percent body fat (BF), fat mass (FM), and lean mass (LM) of 103 college-aged Blacks, Whites, and Hispanics (18 - 34 years of age) were measured using a Lunar Prodigy Dual Energy X-ray Absorptiometry (DEXA). Blacks and Whites were taller than Hispanics. Blacks had higher BMD than Whites and Hispanics. Blacks and Whites had higher t-scores than Hispanics. Weight and LM correlated with BMD for all three groups. Height correlated with BMD for Blacks only. FM correlated with BMD for Hispanics only. In conclusion, BMD is suggested to be higher in Blacks than Whites and Hispanics. LM is suggested to be an important component of bone health. It is important to stress resistance training for building and maintaining bone health throughout life.

Critical role of type 1 cytokines in controlling initial infection with Burkholderia mallei.

Burkholderia mallei is a gram-negative bacterium which causes the potentially fatal disease glanders in humans; however, there is little information concerning cell-mediated immunity to this pathogen. The role of gamma interferon (IFN-gamma) during B. mallei infection was investigated using a disease model in which infected BALB/c mice normally die between 40 and 60 days postinfection. IFN-gamma knockout mice infected with B. mallei died within 2 to 3 days after infection, and there was uncontrolled bacterial replication in several organs, demonstrating the essential role of IFN-gamma in the innate immune response to this pathogen. Increased levels of IFN-gamma, interleukin-6 (IL-6), and monocyte chemoattractant protein 1 were detected in the sera of immunocompetent mice in response to infection, and splenic mRNA expression of IFN-gamma, IL-6, IL-12p35, and IL-27 was elevated 24 h postinfection. The effects of IL-18, IL-27, and IL-12 on stimulation of the rapid IFN-gamma production were investigated in vitro by analyzing IFN-gamma production in the presence of heat-killed B. mallei. IL-12 was essential for IFN-gamma production in vitro; IL-18 was also involved in induction of IFN-gamma, but IL-27 was not required for IFN-gamma production in response to heat-killed B. mallei. The main cellular sources of IFN-gamma were identified in vitro as NK cells, CD8+ T cells, and TCRgammadelta T cells. Our data show that B. mallei is susceptible to cell-mediated immune responses which promote expression of type 1 cytokines. This suggests that development of effective vaccines against glanders should target the production of IFN-gamma.