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BACKGROUND: The opioid epidemic in the United States has devastated the lives of individuals and imposed decades-long opportunity costs on the community. METHODS: We analyzed Emergency Medical Services (EMS) data from the Maryland Department of Health installation of the Electronic Surveillance System for Early Notification of Community-Based Epidemics (ESSENCE) to assess the impact of COVID-19 on EMS call volume and how COVID-19 impacted patients' decisions whether to accept transport to a hospital following an EMS call. RESULTS: The rate of patients accepting transportation via EMS to a hospital emergency department (ED) declined for both opioid-related and non-opioid-related calls from prepandemic (before April 2020) to mid-pandemic (mid-March 2020 to mid-April 2020). The opioid-related call volume increased more from pre- to mid-pandemic for male patients than for female patients, and this "gender gap" had not returned to prepandemic levels by April 2021. CONCLUSION: Consistent with reports from other states, the pandemic worsened the opioid crisis in Maryland, impacting some populations more than others while also decreasing the likelihood that individuals experiencing an opioid-related overdose would seek further medical care following an EMS call.

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Overdose mortality in the United States continues to climb, with Maryland being one of the hardest hit states. We summarized implementation of overdose prevention and response programs in Maryland and identified associations between opioid overdose deaths by jurisdiction in 2019 and implementation of overdose programs by 2021. Data on program implementation are from Maryland's Opioid Operational Command Center (OOCC) Program Inventory. OOCC coordinates the state's response to overdose, and their Program Inventory tracks implementation of 145 programs across 12 domains (e.g., public health, education, and judiciary), including 10 programs designed to broaden naloxone access. The level of program implementation was dichotomized as substantial implementation versus other levels (i.e., partial, planned, and none). We estimated associations between per capita opioid overdose deaths and substantial implementation of: all 145 programs in the Inventory, programs within each of 12 domains, and 10 naloxone programs. Data on program implementation and overdose mortality are summarized at the jurisdiction level. Across jurisdictions, the median proportion of programs with substantial implementation was 51% across all programs and 70% among naloxone programs. Overdose mortality was associated with subsequent substantial implementation of programs within the public health domain (p = .04), but not in the other 11 domains. We did not find evidence that per capita overdose deaths in 2019 spurred overdose program implementation by 2021, with the exception of public health programs. The OOCC Program Inventory is a novel way to track implementation across jurisdictions. Findings can inform the implementation and evaluation of overdose programs in other jurisdictions across the United States.

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This paper details Von Lüttichau's relationship with Carl Jung and Bill Wilson, co-founder of Alcoholics Anonymous (AA), and her role as intermediary in the relationship between the two men. Her contribution within this mediator role has not been previously recognized but is an important factor in explaining how Jung became introduced to the AA 12-step format and validated the effectiveness of group work. After the Second World War, Von Lüttichau travelled between America and Switzerland and introduced the writings and ideas of Wilson and Jung to each other and acted as an intermediary between both titans. Jung gave Von Lüttichau extraordinarily detailed instructions on how the 12-step programme of AA could be applied to 'general neurotics'. Von Lüttichau's private papers provide a bridge between Jung and Wilson's correspondence and help to piece together gaps in both Jungian and AA history.

Cet article précise la relation entre Carl Jung et Bill Wilson, le co-fondateur d'Alcooliques anonymes (AA), et son rôle en tant qu'intermédiaire dans la relation entre les deux hommes. Sa contribution dans un rôle de médiatrice n'a pas été reconnue jusqu'ici. C'est pourtant un facteur important pour expliquer comment Jung a été introduit au programme en 12 étapes d'AA, et a validé l'efficacité du travail de groupe. Après la deuxième guerre mondiale, Von Lüttichau a voyagé entre l'Amérique et la Suisse et a permis à chacun des deux hommes de découvrir les idées et les écrits de l'autre, agissant en tant qu'intermédiaire entre les deux Titans. Jung a donné à Von Lüttichau des instructions extraordinairement détaillées sur comment le programme en 12 étapes d'AA pouvait être appliqué aux « simples névrosés ¼. Les écrits personnels de Von Lüttichau offrent une passerelle pour éclairer la correspondance entre Jung et Wilson, et aident à remplir les blancs dans l'histoire commune entre la psychologie analytique et AA.

El presente artículo detalla la relación de Von Lüttichau con Carl Jung and Bill Wilson, co-fundador de Alcohólicos Anónimos (AA), y su rol como intermediaria en la relación entre los dos hombres. Su contribución como mediadora no ha sido previamente reconocido pero es un factor importante para explicar cómo Jung fue introducido al formato de los 12-pasos de AA y validó la efectividad del trabajo grupal. Luego de la Segunda Guerra Mundial, Von Lüttichau viajó entre América y Suiza, e introdujo los escritos e ideas de Wilson y Jung, mutuamente, y actuó como intermediaria entre ambos Titanes. Jung le dio a Von Lüttichau instrucciones extraordinariamente detalladas sobre cómo el programa de 12-pasos de AA podría ser aplicado al 'neurótico general'. Los escritos privados de Von Lüttichau ofrecen un puente entre la correspondencia de Jung y Wilson, y ayudó a llenar vacíos en ambas historias, la Junguiana, y la de AA.

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Leaves and cotyledons of the terrestrial C4 plants, Bienertia cycloptera Bunge ex Boiss. and Suaeda aralocaspica (Bunge) Freitag & Schütze (Chenopodiaceae), accomplish C4 photosynthesis within individual chlorenchyma cells: each species having a unique means of intracellular spatial partitioning of biochemistry and organelles. In this study the chlorenchyma tissue in flowers and stems of these species was investigated. Flowers have an outer whorl of green tepals with a layer of chlorenchyma cells, which are located on the abaxial side, exposed to the atmosphere. Anatomical, immunocytochemical, western blots and starch analyses show that the chlorenchyma cells in tepals are specialised for performance of single-cell C4 photosynthesis like that in leaves. In the tepals of B. cycloptera, chlorenchyma cells have a distinctive central cytoplasmic compartment, with chloroplasts which contain Rubisco, separated by cytoplasmic channels from a peripheral chloroplast-containing compartment, with phosphoenolpyruvate carboxylase (PEPC) distributed throughout the cytoplasm. In the tepals of S. aralocaspica, chlorenchyma cells have chloroplasts polarised towards opposite ends of the cells. Rubisco is found in chloroplasts towards the proximal end of the cell and PEPC is found throughout the cytoplasm. Also, green stems of B. cycloptera have a single layer of the specialised C4 type chlorenchyma cells beneath the epidermis, and in stems of S. aralocaspica, chlorenchyma cells are scattered throughout the cortical tissue with chloroplasts around their periphery, typical of C3 type chlorenchyma. During reproductive development, green flowers become very conspicuous, and their photosynthesis is suggested to be important in completion of the life cycle of these single-cell C4 functioning species.

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OBJECTIVE: This study seeks to show that in the case of a patient not responding to nonoperative measures for the treatment of anterior knee pain, arthroscopic release of a symptomatic infrapatellar plica can successfully resolve the disability. DESIGN: We report a retrospective study of 12 cases of anterior knee pain not responding to nonoperative treatment that underwent isolated infrapatellar plica resection without other noted knee pathology. SETTING: Patients were evaluated and treated in an outpatient orthopedic sports medicine clinic. PARTICIPANTS: Any patient who presented with anterior knee pain, underwent subsequent arthroscopy, and was treated by isolated resection of the infrapatellar plica was included in the study. INTERVENTION: The surgical procedure involved arthroscopic division of the infrapatellar plica at its attachment on the superior intercondylar notch of the femur. MAIN OUTCOME MEASUREMENTS: Patients were reviewed at least 12 months following the date of surgery. Two subjective knee scales were used to assess knee function. RESULTS: A subjective scale used in prior studies assessing symptomatic medial plica demonstrated 91% percent (11 of 12) excellent (6) or good (5) outcomes at follow-up greater than 1 year. The Knee Injury and Osteoarthritis Outcome Scores of knee function on the subscales of pain, symptoms, activities of daily living, sports activity, and quality of life were 97, 96, 99, 99, and 87, respectively. CONCLUSIONS: These cases demonstrate a potential role for the infrapatellar plica as a cause of anterior knee pain. A prospective study is warranted to measure causality.

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We describe the case of a 10-day-old boy who was brought to the hospital with stridor and respiratory distress. He was diagnosed with stenosis caused by a subglottic cyst. After the cyst was removed endoscopically, the patient's symptoms resolved. Pathology identified the cyst as ectopic thymic tissue. This case is noteworthy because we believe it represents the first reported instance of ectopic thymic tissue in the subglottis.

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