Influence of Bone Cement Augmentation on Complications in Cephalomedullary Nail Fixation of Geriatric Intertrochanteric Hip Fractures.

Introduction: The purpose of this study was to determine if augmentation of the helical blade with polymethylmethacrylate bone cement decreases the rates of varus cut-out and medial perforation in geriatric intertrochanteric hip fracture fixation. Methods: This was a retrospective comparative cohort study at two urban Level I trauma centers. Patients with an intertrochanteric hip fracture (classified as AO 31A1-3) who were treated with the TFN-Advanced Proximal Femoral Nailing System (TFNA) from 2018 to 2021 were eligible for the study. Medical records and post-operative radiographs were reviewed to determine procedure complications and reoperations. Results: Of the 179 patients studied, cement augmentation (CA) was used in 93 patients (52%) and no cement augmentation (NCA) was used in 86 (48%). There were no significant differences between group demographics and fracture reduction grades. Varus cut-out occurred three times in the CA group and five times in the NCA group (p = 0.48). Medial perforation occurred three times, all in the NCA group (p = 0.11). The most frequent complication was symptomatic blade lateralization from fracture collapse, with eight occurrences in the CA group compared with two in the NCA group (p = 0.10). There were 10 reoperations in the CA group and 9 in the NCA group (p = 0.99). The most common reason for reoperation was varus cut-out and the most common revision procedure was hip arthroplasty. Conclusions: Intertrochanteric hip fractures treated with the TFNA fixation system with and without cement augmentation have similar complication profiles and reoperation rates.

Online Nucleotide Mapping of mRNAs.

Messenger RNA (mRNA) can be sequenced via indirect approaches such as Sanger sequencing and next generation sequencing (NGS), or direct approaches like bottom-up mass spectrometry (MS). Direct sequencing allows the confirmation of RNA modifications. However, the conventional bottom-up MS approach involves time-consuming in-solution digestions that require a large amount of sample, and can lead to the RNase contamination of the LC-MS system and column. Here, we describe a platform that enables online nucleotide mapping of mRNAs via the use of immobilized RNase cartridges and 2D-LC-MS instrumentation. The online approach was compared to conventional offline digestion protocols adapted from two published studies. For this purpose, five model mRNAs of varying lengths (996-4521 nucleotides) and chemistries (unmodified uridine vs 5-methoxyuridine (5moU)) were analyzed. The profiles and sequence coverages obtained after RNase T1 digestion were discussed. The online nucleotide mapping achieved comparable or slightly greater sequence coverage for the 5 mRNAs (5.8-51.5%) in comparison to offline approaches (3.7-50.4%). The sequence coverage was increased to 65.6-85.6 and 69.7-85.0% when accounting for the presence of nonunique digestion products generated by the RNase T1 and A, respectively. The online nucleotide mapping significantly reduced the digestion time (from 15 to <5 min), increased the signal intensity by more than 10-fold in comparison to offline approaches.

Biobehavior Life Regulation (BLR) scale for living well in chronic pain: Preliminary scale development and validation.

Currently available pain assessment scales focus on pain-related symptoms and limitations imposed by pain. Validated assessment tools that measure how pain is regulated by those who live well with pain are missing. This study seeks to fill this gap by describing the development and preliminary validation of the Biobehavior Life Regulation (BLR) scale. The BLR scale assesses engagement, social relatedness, and self-growth in the presence of chronic pain and the unpredictability of chronic pain. Sources for items included survivor strategies, patient experiences, existing scales, and unpredictable pain research. Review for suitability yielded 52 items. Validation measures were identified for engagement, social relatedness, self-growth, and unpredictability of pain. The study sample (n = 202) represented patients treated in the Phoenix VA Health Care System (n = 112) and two community clinics (n = 90). Demographic characteristics included average age of 52.5, heterogeneous in ethnicity and race at the VA, mainly Non-Hispanic White at the community clinics, 14 years of education, and pain duration of 18 years for the VA and 15.4 years for community clinics. Exploratory factor analysis using Oblimin rotation in the VA sample (n = 112) yielded a two-factor solution that accounted for 48.23% of the total variance. Confirmatory factor analysis (CFA) in the same sample showed high correlations among items in Factor 1, indicating redundancy and the need to further reduce items. The final CFA indicated a 2-factor solution with adequate fit to the data. The 2-factor CFA was replicated in Sample 2 from the community clinics (n = 90) with similarly adequate fit to the data. Factor 1, Pain Regulation, covered 8 items of engagement, social relatedness, and self-growth while Factor 2, Pain Unpredictability, covered 6 items related to the experience of unpredictable pain. Construct validity showed moderate to higher Pearson correlations between BLR subscales and relevant well-established constructs that were consistent across VA and community samples. The BLR scale assesses adaptive regulation strategies in unpredictable pain as a potential tool for evaluating regulation resources and pain unpredictability.

Pressurizing or encouraging: Health behaviors among long-distance couples.

Couples in long-distance relationships face unique challenges that affect their health outcomes and relationship dynamics in ways that are different from couples in close proximal relationships (PR). The results of previous literature analyzing health outcomes for long-distance relationship (LDR) couples have been mixed, and factors such as couple satisfaction and gender of the individuals contribute to the variance. This study examined the good health practices of couples in LDRs, the ways in which partners influence each other's health, and the health outcomes of these couples as compared to couples in PRs. Multilevel multivariate analysis showed that couples in LDRs had better health practices than those in PRs, and men overall had poorer health practices than women. There was no main effect seen for LDRs when we examined strategies used for influencing health. There was a main effect for gender, though, and we found that women tend to use more collaborative and pressurizing strategies for influencing their partner's health. On health indices, we found that LDR couples tended to have lower levels of fatigue and sleep disturbance as compared to PR couples. In the adjusted model with covariates, which included age, income, couple satisfaction, and married or unmarried couples, we found that lower couple satisfaction and lower income significantly predicted poorer health on all health indices. These results are discussed in light of unequal gender roles, social control, and positive aspects of LDRs on health in an attempt to understand LDRs better and destigmatize the narrative of these relationships as 'less than' PRs. Implications for health and mental health practitioners are also discussed.

Antibody surface mobility amplifies FcγR signaling via Arp2/3 during phagocytosis.

We report herein that the anti-CD20 therapeutic antibody, rituximab, is rearranged into microclusters within the phagocytic synapse by macrophage Fcγ receptors (FcγR) during antibody-dependent cellular phagocytosis. These microclusters were observed to potently recruit Syk and to undergo rearrangements that were limited by the cytoskeleton of the target cell, with depolymerization of target-cell actin filaments leading to modest increases in phagocytic efficiency. Total internal reflection fluorescence analysis revealed that FcγR total phosphorylation, Syk phosphorylation, and Syk recruitment were enhanced when IgG-FcγR microclustering was enabled on fluid bilayers relative to immobile bilayers in a process that required Arp2/3. We conclude that on fluid surfaces, IgG-FcγR microclustering promotes signaling through Syk that is amplified by Arp2/3-driven actin rearrangements. Thus, the surface mobility of antigens bound by IgG shapes the signaling of FcγR with an unrecognized complexity beyond the zipper and trigger models of phagocytosis.

Erratum: Pharmacist interventions for appropriate COVID-19 antiviral therapy in long-term care facilities: A public health initiative - ERRATUM.

[This corrects the article DOI: 10.1017/ash.2023.246.].

Development and adaptation of the Emotion Regulation Skills Questionnaire for adolescents.

INTRODUCTION: The ability to effectively regulate one's emotions is important for adolescent mental health. However, extant assessments of how adolescents regulate their emotions can be expanded upon in several ways, including incorporating more strategies (e.g., cultural and spiritual) and positive emotions, and being informed by adolescents and expert consultation during the development process. Thus, our study aimed to improve the construct validity of an emotion regulation measure by adapting and refining the Emotion Regulation Skills Questionnaire (ERSQ) into an adolescent self-report. METHODS: We recruited 24 13-17-year-olds (12 males; 11 females; 1 gender fluid) via social media advertisement in the United States in 2020. We used an iterative qualitative approach in which we combined expert consultation, cognitive interviewing with adolescents, and top-down and bottom-up coding to review and provide feedback on the ERSQ. RESULTS: Findings of thematic analysis showed that a need for clarity in wording and inclusion of strategy examples across all sections of the ERSQ was needed. Adolescents also identified the need to replace the Silly/Excited section with a more age-appropriate positive emotion section. CONCLUSION: Findings indicate cognitive interviewing can be successfully completed in a virtual format when necessary, youth utilize a wider range of strategies to maintain or upregulate positive emotions than what is represented in current measures, and use of qualitative methods may have reduced construct underrepresentation and construct-irrelevant variance in the adapted ERSQ.

"Following the Breath:" A Trauma-Informed Intervention for Educator Wellness in Rural Montana.

Given the prevalence of mental health issues for both educators and adolescents in rural Montana, this project is designed to help mitigate the impact of stressors by providing coping strategies linked to improvements in overall mental health outcomes for teachers, which may ultimately lead to improved co-regulation of students and classroom climate. The immediate goal of this pilot study was to measure physical and mental health outcomes of educators resulting from a remotely-delivered trauma-informed yoga intervention. Findings suggest improvements in participants' depression and anxiety levels, trauma symptoms, sleep quality, and non-significant changes in heart rate variability and cortisol levels.

Characterization of antisense oligonucleotide and guide ribonucleic acid diastereomers by hydrophilic interaction liquid chromatography coupled to mass spectrometry.

Oligonucleotides have become an essential modality for a variety of therapeutic approaches, including cell and gene therapies. Rapid progress in the field has attracted significant research in designing novel oligonucleotide chemistries and structures. Beyond their polar nature, the length of large RNAs and presence of numerous diastereomers for phosphorothioate (PS)-modified RNAs pose heightened challenges for their characterization. In this study, the stereochemistry of a fully-modified antisense oligonucleotide (ASO) and partially-modified guide RNAs (gRNAs) was investigated using HILIC and orthogonal techniques. The profiles of three lots of a fully-modified ASO with PS linkages were compared using ion-pairing RPLC (IPRP) and HILIC. Interestingly, three isomer peaks were partially resolved by HILIC for two lots while only one peak was observed on the IPRP profile. Model oligonucleotides having the same sequence of the five nucleotides incorporated to the 3'-end of the gRNA but differing in their number and position of PS linkages were investigated by HILIC, IPRP, ion mobility spectrometry-mass spectrometry (IM-MS) and nuclear magnetic resonance (NMR). An strategy was ultimately designed to aid in the characterization of gRNA stereochemistry. Ribonuclease (RNase) T1 digestion enabled the characterization of gRNA diastereomers by reducing their number from 32 at the gRNA intact level to 4 or 8 at the fragment level. To our knowledge, this is the first time that HILIC has successfully been utilized for the profiling of diastereomers for various oligonucleotide formats and chemical modifications.

Pediatric Chest Compression Improvement Via Augmented Reality Cardiopulmonary Resuscitation Feedback in Community General Emergency Departments: A Mixed-Methods Simulation-Based Pilot Study.

BACKGROUND: Yearly, more than 20,000 children experience a cardiac arrest. High-quality pediatric cardiopulmonary resuscitation (CPR) is generally challenging for community hospital teams, where pediatric cardiac arrest is infrequent. Current feedback systems are insufficient. Therefore, we developed an augmented reality (AR) CPR feedback system for use in many settings. OBJECTIVE: We aimed to evaluate whether AR-CPR improves chest compression (CC) performance in non-pediatric-specialized community emergency departments (EDs). METHODS: We performed an unblinded, randomized, crossover simulation-based study. A convenience sample of community ED nonpediatric nurses and technicians were included. Each participant performed three 2-min cycles of CC during a simulated pediatric cardiac arrest. Participants were randomized to use AR-CPR in one of three CC cycles. Afterward, participants participated in a qualitative interview to inquire about their experience with AR-CPR. RESULTS: Of 36 participants, 18 were randomized to AR-CPR in cycle 2 (group A) and 18 were randomized to AR-CPR in cycle 3 (group B). When using AR-CPR, 87-90% (SD 12-13%) of all CCs were in goal range, analyzed as 1-min intervals, compared with 18-21% (SD 30-33%) without feedback (p < 0.001). Analysis of qualitative themes revealed that AR-CPR may be usable without a device orientation, be effective at cognitive offloading, and reduce anxiety around and enhance confidence in the CC delivered. CONCLUSIONS: The novel CPR feedback system, AR-CPR, significantly changed the CC performance in community hospital non-pediatric-specialized general EDs from 18-21% to 87-90% of CC epochs at goal. This study offers preliminary evidence suggesting AR-CPR improves CC quality in community hospital settings.

What Program Characteristics Are Associated with Resident Racial Diversity in Orthopaedic Surgery? An Analysis of Association of American Medical Colleges Data.

In orthopaedic surgery, there are fewer Black or African American (4%) and Hispanic or Latino (4%) residents compared with general surgery, internal medicine, family medicine, and pediatrics (5%-7% Black residents and 7%-9% Hispanic/Latino residents, respectively). There are also fewer underrepresented in medicine minority (URiM) faculty in orthopaedic surgery (6.1%) compared with general surgery (8.9%), otolaryngology (7.8%), internal medicine (9.7%), and obstetrics and gynecology (15.6%). Identifying program characteristics that are associated with the percentage of URiM residents could reveal strategies for improving diversity. Methods: Using Association of American Medical Colleges orthopaedic resident and faculty race/ethnicity data from 2007 to 2016, we analyzed the racial diversity of 166 of 207 residency programs. The primary outcome was program racial diversity, measured as the percentage of URiM residents per program. The top quartile of programs was compared with the other quartiles. Characteristics analyzed included percentage of URiM faculty, affiliation with a university/top 40 medical school/top 40 orthopaedic hospital, geographic region, city type, and city size. We used a multivariable linear regression model to evaluate program characteristics associated with diversity and a linear mixed-effects model with program-specific random effects to evaluate time trends. Results: The mean percentage of URiM residents per program was 9.3% (SD = 10.5%). In the top quartile of programs, URiM residents composed 20.7% ± 2.5% of the program compared with 5.8% ± 0.3% in other quartiles (p < 0.001). After adjusting for program and faculty size, the only factor associated with the number of URiM residents per program was the number of URiM faculty. For every 5 additional URiM faculty members, there was an associated increase in the number of URiM residents per program by 3.6 (95% confidence interval [CI]: 2.3-5.0). There was a small but statistically significant annual increase in the percentage of URiM residents per program of 0.207 (95% CI: 0.112-0.302) percentage points during the study period. Conclusion: URiM representation remains low among orthopaedic residents. Efforts to increase the URiM faculty base represent a potential strategy for programs to increase URiM representation among residents by attracting more diverse applicants.

Anxiety and Depression in Northern Plains American Indian Youth: Evidence for Resilience and Risk.

Developing research collaborations with Indigenous communities to understand the expression and experience of anxiety and depression in American Indian (AI) youth and identifying protective and risk factors may be an important first step toward addressing AI health inequities. We used a community-based participatory research (CBPR) approach to investigate anxiety and depressive disorder symptoms among AI youth living on a Northern Plains reservation. Moreover, we examined whether symptoms were related to two potential protective and risk factors, anxiety control beliefs and rumination. Our tribal research team collected multi-reporter survey data from 71 AI 3rd-6th graders (8-13-years-old; 62.3% female) attending a tribal school, their caregivers, and teachers. Results pointed toward resilience in this sample with 7.3% and 8.7% of AI youth reporting clinical levels of anxiety and depressive disorder symptoms, respectively, and on average experiencing symptoms "Sometimes." There were moderate correlations between youth- and teacher-reported anxiety and depressive disorder symptoms, but no correlation with caregivers. Anxiety control beliefs were lower in older compared to younger AI youth and negatively related to youth-reported anxiety and depressive disorder symptoms, while rumination was positively related to youth-reported anxiety and depressive disorder symptoms and teacher-reported anxiety disorder symptoms. Age moderated relations between anxiety control beliefs and both youth-reported anxiety and depressive disorder symptoms with only significant relations found for older youth. Our findings are consistent with research showing resilience to internalizing problems in AI youth living on a reservation, but replication of their relations to anxiety control beliefs and rumination in other Indigenous peoples is warranted.

Paediatric chest compression performance improves via novel augmented-reality cardiopulmonary resuscitation feedback system: A mixed-methods pilot study in a simulation-based setting.

Aim: More than 20,000 children experience a cardiac arrest event each year in the United States. Most children do not survive. High-quality cardiopulmonary resuscitation (CPR) has been associated with improved outcomes yet adherence to guidelines is poor. We developed and tested an augmented reality head mounted display chest compression (CC) feedback system (AR-CPR) designed to provide real-time CC feedback and guidance. Methods: We conducted an unblinded randomized crossover simulation-based study to determine whether AR-CPR changes a user's CC performance. A convenience sample of healthcare providers who perform CC on children were included. Subjects performed three two-minute cycles of CC during a simulated 18-minute paediatric cardiac arrest. Subjects were randomized to utilize AR-CPR in the second or third CC cycle. After, subjects participated in a qualitative portion to inquire about their experience with AR-CPR and offer criticisms and suggestions for future development. Results: There were 34 subjects recruited. Sixteen subjects were randomly assigned to have AR-CPR in cycle two (Group A) and 18 subjects were randomized to have AR-CPR in cycle three (Group B). There were no differences between groups CC performance in cycle one (baseline). In cycle two, subjects in Group A had 73% (SD 18%) perfect CC epochs compared to 17% (SD 26%) in Group B (p < 0.001). Overall, subjects enjoyed using AR-CPR and felt it improved their CC performance. Conclusion: This novel AR-CPR feedback system showed significant CC performance change closer to CC guidelines. Numerous hardware, software, and user interface improvements were made during this pilot study.

Analysis of pharmaceutical drug oligomers by selective comprehensive two-dimensional liquid chromatography-high resolution mass spectrometry.

The presence of oligomeric impurities in drugs is often overlooked and less studied due to conventional small molecule analytical methods which are often not capable of capturing these oligomers. In the present work, the oligomer species of a lipophilic active pharmaceutical ingredient (API) containing an azetidine ring was investigated. No separation was observed by reversed-phase liquid chromatography (RPLC) methods, and only a partial separation of oligomer peaks was achieved by a size exclusion chromatography (SEC) method. To improve the resolution of the different oligomers species and understand the root cause of the formation of the oligomers, a selective comprehensive two-dimensional liquid chromatography (2D-LC) method was developed by coupling SEC to RPLC. The selective comprehensive SEC × RPLC method allowed the separation of 16 species and evidenced four main groups of oligomer impurities. The contour plots of 3 API lots helped to visualize the oligomer profiles and quickly compare the difference between these lots. Finally, the oligomer peaks separated by 2D-LC were identified by high-resolution mass spectrometry (HRMS) using a Q Exactive mass spectrometer. The developed 2D-LC/HRMS workflow provides a fast and generic screening approach to quickly examine and visualize the oligomeric impurities in API materials, and direct the impurity control strategy during process development.

On-line Sequencing of CRISPR Guide RNAs and Their Impurities via the Use of Immobilized Ribonuclease Cartridges Attached to a 2D/3D-LC-MS System.

In this study, for the first time, the automated digestion and sequencing of an RNA molecule via the use of immobilized RNase cartridges attached to a multidimensional liquid chromatography (LC)-mass spectrometry (MS) system are presented. We first developed an on-line digestion-HILIC two-dimensional (2D)-LC-MS method in order to sequence CRISPR guide RNAs for gene editing. Three RNases (T1, A, and U2) were immobilized on polyetheretherketone cartridges, and their performance was evaluated. Ultrafast digestions were performed within 2.3 min with the on-line approach versus 30 min via the conventional off-line approach. The higher sequence coverage was achieved by the RNase T1 (71%), which is the same as the off-line mode. A 20-fold reduction in the gRNA sample amount was achieved with the on-line digestion approach (6.5 µg) in comparison to that with the off-line approach (130 µg). In the second step, a three-dimensional (3D)-LC-MS method was developed for the sequencing of fractions collected on-line across the main peak and the partially separated tail by the reference ion-pairing RPLC method. Additional insights were gained in order to better understand the cause of the main peak tailing.

Capturing what matters: A retrospective observational study of advance care planning documentation at an academic medical center during the COVID-19 pandemic.

BACKGROUND: Advance care planning allows patients to share their preferences for medical care with the aim of ensuring goal-concordant care in times of serious illness. The morbidity and mortality of the COVID-19 pandemic has increased the importance and public visibility of advance care planning. However, little is known about the frequency and quality of advance care planning documentation during the pandemic. AIM: This study examined the frequency, quality, and predictors of advance care planning documentation among hospitalized medical patients with and without COVID-19. DESIGN: This retrospective cohort analysis used multivariate logistic regression to identify factors associated with advance care planning documentation. SETTING/PARTICIPANTS: This study included all adult patients tested for COVID-19 and admitted to a tertiary medical center in San Francisco, CA during March 2020. RESULTS: Among 262 patients, 31 (11.8%) tested positive and 231 (88.2%) tested negative for SARS-CoV-2. The rate of advance care planning documentation was 38.7% in patients with COVID-19 and 46.8% in patients without COVID-19 (p = 0.45). Documentation consistently addressed code status (100% and 94.4% for COVID-positive and COVID-negative, respectively), but less often named a surrogate decision maker, discussed prognosis, or elaborated on other wishes for care. Palliative care consultation was associated with increased advance care planning documentation (OR: 6.93, p = 0.004). CONCLUSION: This study found low rates of advance care planning documentation for patients both with and without COVID-19 during an evolving global pandemic. Advance care planning documentation was associated with palliative care consultation, highlighting the importance of such consultation to ensure timely, patient-centered advance care planning.

Psychometric properties of the 7-item version of the Concise Health Risk Tracking Self-Report Scale for rural adults enrolled in an Internet-delivered self-help program for depression.

PURPOSE: Monitoring suicide risk in clinical practice requires valid and reliable assessment instruments. This study evaluated the psychometric properties of the 7-item version of the Concise Health Risk Tracking Self-Report, CHRT-SR7 in a primarily rural population. METHODS: The sample comprised 788 participants (81.7% female) of an effectiveness trial of an internet-based self-help intervention for depression. Participants completed self-report questionnaires, including the CHRT-SR7 , Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Work and Social Adjustment Scale, Connor-Davidson Resilience Scale-10, and Barriers to Seeking Mental Health Care. Four-week test-retest reliability was calculated for a subsample of 147 participants randomized to a waitlist control group. FINDINGS: The CHRT-SR7 internal consistency was α = 0.80 (total sample), α = 0.80 (women), and α = 0.83 (men). The 4-week test-retest reliability was strong for women (r = 0.78) and moderate for men (r = 0.66). Confirmatory factor analysis supported the original 3-factor solution: Hopelessness (2 items), Perceived Lack of Social Support (2 items), and Current Suicidal Thoughts and Plans (3 items), which was invariant across gender and rural status. Convergent and divergent validity was supported as reflected in significant correlations of the CHRT-SR7 and its subscales with measures of depression, anxiety, adjustment, and resilience. Limitations include the limited demographic diversity (mostly non-Hispanic White women) and reliance on self-report data. CONCLUSIONS: Our findings complement those reported in prior studies of patients with severe depression and support the use of the CHRT-SR7 for measuring suicide risk in rural adults; future studies should further test the instrument's psychometric properties in racial or ethnic minority rural residents.