Shoulder Arthroscopy After a Proximal Humeral Fracture Malunion: Athlete Care and Clinical Medicine in Middle-Aged Athletes

Malunion of the proximal humerus is operationally defined as healing of the fractured bone in a non-anatomical position, resulting in a painful and disabling deformity (e.g., a bone being shorter than normal, twisted or rotated in a bad position, or bent), which affects the range of motion (ROM) and functional movement. A correction and functional restoration are often needed in athletes, since their profession requires superior physical functioning. Shoulder arthroscopy has evolved dramatically over the past 15 years and has been used in cases of malunion of the humerus in athletes. However, there is a scarcity of evidence concerning middle-aged athletes. PURPOSE: To examine the benefits of shoulder arthroscopy after a proximal humeral fracture unified in malposition in middle-aged athletes. METHODS: Physical examination and imaging evaluation using 3D Computed Tomography(3D-CT), Magnetic Resonance Imaging (MRI), and shoulder radiographs (anteroposterior, internal rotation, and lateral scapular view) were used to evaluate shoulder dysfunction after proximal humeral fracture in malposition. Fourteen athletes (9 males, 5 females; Mage = 43.1, SD = 3.5) were included in this research. According to Neer classification before surgery, 11 (78%) had one part displaced and the rest three (22%) had two parts displaced. Post-operative clinical results were evaluated with self-reported pain score (1-10), UCLA scores, and shoulder abduction ROM measured with a goniometer. RESULTS: There was significant difference in pain scores (Mbefore = 8, Range: 6-9; Mafter = 4, Range: 2-6; p \u3c .001), in UCLA scores (Mbefore = 12, Range: 9-16; Mafter = 28, Range: 20-31; p \u3c .01), and in shoulder abduction ROM (Mbefore = 80, Range: 70-100; Mafter = 135, Range: 120-150; p \u3c .05). CONCLUSION: Our research provides evidence for clinical translation in improving health outcomes in middle-aged athletes with a history of proximal humeral fracture union in malposition: shoulder arthroscopy can be simultaneously beneficial in terms of decreasing pain level, increasing ROM, and restoring limb function

Gender Differences Concerning Physical Activity Beliefs and Practices among Fourth and Fifth Graders in Rural Virginia

Cardiovascular disease is the leading cause of death in the United States. Physical activity (PA) is a known preventative factor. It is recommended that children participate in 60 minutes of PA daily, but most do not meet these guidelines. Further, boys, aged 8-17 years, spend more time in PA than girls of the same age. The purposes of this study were to identify gender differences in PA beliefs and practices among fourth and fifth graders and to determine when gender disparities in self-confidence regarding PA and fitness occur.  Subjects were 41 fourth (19 boys; 22 girls) and 33 fifth (16 boys; 17 girls) graders in a public elementary school in the rural northwest. They participated in the FitnessGram, a nationwide assessment of flexibility, aerobic capacity, and muscular strength and endurance, and a proctored survey about their PA beliefs, self-confidence, and participation. There were no differences in FitnessGram data between boys and girls for aerobic capacity or muscular strength and endurance, but girls had increased flexibility when compared to boys in both grades. Importantly, survey results showed fifth grade girls had less confidence they could improve their physical fitness (p = 0.002) or their overall health (p = 0.004) when compared to fourth grade girls. Research is needed to determine how these changes in self-confidence contribute to the gender gap in time spent in PA. We recommend physical education programs throughout all grades teach healthy behaviors, including time spent in PA, and work to build and maintain self-confidence in girls

R|S Atlas: Identifying Existing Cohort Study Data Resources to Accelerate Epidemiological Research on the Influence of Religion and Spirituality on Human Health

OBJECTIVE: Many studies have documented significant associations between religion and spirituality (R/S) and health, but relatively few prospective analyses exist that can support causal inferences. To date, there has been no systematic analysis of R/S survey items collected in US cohort studies. We conducted a systematic content analysis of all surveys ever fielded in 20 diverse US cohort studies funded by the National Institutes of Health (NIH) to identify all R/S-related items collected from each cohort\u27s baseline survey through 2014. DESIGN: An R|S Ontology was developed from our systematic content analysis to categorise all R/S survey items identified into key conceptual categories. A systematic literature review was completed for each R/S item to identify any cohort publications involving these items through 2018. RESULTS: Our content analysis identified 319 R/S survey items, reflecting 213 unique R/S constructs and 50 R|S Ontology categories. 193 of the 319 extant R/S survey items had been analysed in at least one published paper. Using these data, we created the R|S Atlas (https://atlas.mgh.harvard.edu/), a publicly available, online relational database that allows investigators to identify R/S survey items that have been collected by US cohorts, and to further refine searches by other key data available in cohorts that may be necessary for a given study (eg, race/ethnicity, availability of DNA or geocoded data). CONCLUSIONS: R|S Atlas not only allows researchers to identify available sources of R/S data in cohort studies but will also assist in identifying novel research questions that have yet to be explored within the context of US cohort studies

Trends in Use of Medication to Treat Opioid Use Disorder During the COVID-19 Pandemic in 10 State Medicaid Programs

Federal and state agencies granted temporary regulatory waivers to prevent disruptions in access to medication for opioid use disorder (MOUD) during the COVID-19 pandemic, including expanding access to telehealth for MOUD. Little is known about changes in MOUD receipt and initiation among Medicaid enrollees during the pandemic.To examine changes in receipt of any MOUD, initiation of MOUD (in-person vs telehealth), and the proportion of days covered (PDC) with MOUD after initiation from before to after declaration of the COVID-19 public health emergency (PHE).This serial cross-sectional study included Medicaid enrollees aged 18 to 64 years in 10 states from May 2019 through December 2020. Analyses were conducted from January through March 2022.Ten months before the COVID-19 PHE (May 2019 through February 2020) vs 10 months after the PHE was declared (March through December 2020).Primary outcomes included receipt of any MOUD and outpatient initiation of MOUD via prescriptions and office- or facility-based administrations. Secondary outcomes included in-person vs telehealth MOUD initiation and PDC with MOUD after initiation.Among a total of 8 167 497 Medicaid enrollees before the PHE and 8 181 144 after the PHE, 58.6% were female in both periods and most enrollees were aged 21 to 34 years (40.1% before the PHE; 40.7% after the PHE). Monthly rates of MOUD initiation, representing 7% to 10% of all MOUD receipt, decreased immediately after the PHE primarily due to reductions in in-person initiations (from 231.3 per 100 000 enrollees in March 2020 to 171.8 per 100 000 enrollees in April 2020) that were partially offset by increases in telehealth initiations (from 5.6 per 100 000 enrollees in March 2020 to 21.1 per 100 000 enrollees in April 2020). Mean monthly PDC with MOUD in the 90 days after initiation decreased after the PHE (from 64.5% in March 2020 to 59.5% in September 2020). In adjusted analyses, there was no immediate change (odds ratio [OR], 1.01; 95% CI, 1.00-1.01) or change in the trend (OR, 1.00; 95% CI, 1.00-1.01) in the likelihood of receipt of any MOUD after the PHE compared with before the PHE. There was an immediate decrease in the likelihood of outpatient MOUD initiation (OR, 0.90; 95% CI, 0.85-0.96) and no change in the trend in the likelihood of outpatient MOUD initiation (OR, 0.99; 95% CI, 0.98-1.00) after the PHE compared with before the PHE.In this cross-sectional study of Medicaid enrollees, the likelihood of receipt of any MOUD was stable from May 2019 through December 2020 despite concerns about potential COVID-19 pandemic–related disruptions in care. However, immediately after the PHE was declared, there was a reduction in overall MOUD initiations, including a reduction in in-person MOUD initiations that was only partially offset by increased use of telehealth

Recombinant Protein Production Using the Baculovirus Expression Vector System (BEVS)

The baculovirus expression vector system (BEVS) is one of the most popular eukaryotic systems for recombinant protein production. The focus of our protein production platform is the provision of recombinant proteins for research use, where generally only small quantities are required, in the range of tens of micrograms to a few hundred milligrams. Here, we present methods that reflect our standard operating procedures and setup to be able to frequently, and often repeatedly, produce many different types of proteins

An environmental justice analysis of air pollution emissions in the United States from 1970 to 2010

Over the last decades, air pollution emissions have decreased substantially; however, inequities in air pollution persist. We evaluate county-level racial/ethnic and socioeconomic disparities in emissions changes from six air pollution source sectors (industry [SO2], energy [SO2, NOx], agriculture [NH3], commercial [NOx], residential [particulate organic carbon], and on-road transportation [NOx]) in the contiguous United States during the 40 years following the Clean Air Act (CAA) enactment (1970-2010). We calculate relative emission changes and examine the differential changes given county demographics using hierarchical nested models. The results show racial/ethnic disparities, particularly in the industry and energy generation source sectors. We also find that median family income is a driver of variation in relative emissions changes in all sectors-counties with median family income >$75 K vs. less generally experience larger relative declines in industry, energy, transportation, residential, and commercial-related emissions. Emissions from most air pollution source sectors have, on a national level, decreased following the United States CAA. In this work, we show that the relative reductions in emissions varied across racial/ethnic and socioeconomic groups