Defense Equal Opportunity Management Institute

UNLABELLED: The Eastern woodchuck (Marmota monax) is naturally infected with woodchuck hepatitis virus (WHV), a hepadnavirus closely related to the human hepatitis B virus (HBV). The woodchuck is used as an animal model for studying chronic hepatitis B (CHB) and HBV-associated hepatocellular carcinoma (HCC) in humans, but the lack of sequence information has hitherto precluded functional genomics analysis. To address this major limitation of the model, we report here the sequencing, assembly, and annotation of the woodchuck transcriptome, together with the generation of custom woodchuck microarrays. Using this new platform, we characterized the transcriptional response to persistent WHV infection and WHV-induced HCC. This revealed that chronic WHV infection, like HBV, is associated with (1) a limited intrahepatic type I interferon response; (2) intrahepatic induction of markers associated with T cell exhaustion; (3) elevated levels of suppressor of cytokine signaling 3 (SOCS3) in the liver; and (4) intrahepatic accumulation of neutrophils. Underscoring the translational value of the woodchuck model, this study also determined that WHV-induced HCC shares molecular characteristics with a subtype of human HCC with poor prognosis. CONCLUSION: Our data establish the translational value of the woodchuck model and provide new insight into immune pathways which may play a role either in the persistence of HBV infection or the sequelae of CHB.

The present study extends knowledge of the performance consequences of workgroup diversity climate. Building upon Kopelman, Brief, and Guzzo's ( ) climate model of productivity, we introduce workgroup discrimination as a behavioral mediator that explains the positive effects of diversity climate on workgroup performance. In addition, we investigate group size as a moderator upon which this mediated relationship depends. We test these moderated‐mediated propositions using a split‐sample design and data from 248 military workgroups comprising 8,707 respondents. Findings from structural equation modeling reveal that diversity climate is consistently positively related to workgroup performance and that this relationship is mediated by discrimination. Results yield a pattern of moderated mediation, in that the indirect relationship between workgroup diversity climate (through perceptions of workgroup discrimination) and group performance was more pronounced in larger than in smaller workgroups. These results illustrate that discrimination and group size represent key factors in determining how a diversity climate is associated with group performance and, thus, have significant implications for research and practice. © 2014 Wiley Periodicals, Inc.

Diversity in group membership can present both advantages and disadvantages for group performance. The authors examined how different percentages in workgroup diversity categories (gender, minority, and persons with disabilities) affected measures of group effectiveness (commitment, overall effectiveness, satisfaction, cohesion, trust, equal opportunity climate, and quality) taken from the Military Equal Opportunity Climate Survey Test Version 3.1 (Talking Paper, 1998). The gender and minority, but not persons with disabilities, categories showed increases in perceived work-group effectiveness at the 11–30% diversity level. Results are discussed in terms of possible optimum diversity levels, expanded measures of diversity, and team development of diverse work groups.

The American Academy of Periodontology (AAP) recently embarked on a Best Evidence Consensus (BEC) model of scientific inquiry to address questions of clinical importance in the treatment of periodontal and peri-implant diseases. For each focused question addressed below, there is a critical mass of evidence. However, by itself, that evidence is, in the judgment of the expert panel convened by the AAP, insufficient to support broad conclusions and/or clinical practice guidelines. The members of the expert panel have extensive knowledge of laser therapy and experience using lasers in a broad range of clinical scenarios relevant to the management of periodontitis and peri-implant diseases. The panel performed systematic reviews on the subject, debated the merits of published data and experiential information, developed a consensus report, and provided “clinical bottom lines” based on the best evidence available. The panel recognizes the limitations imposed on assessing the potential clinical applications of laser-assisted therapy in the treatment of periodontitis and peri-implant diseases. The challenge in analyzing current evidence in these two clinical areas stems from several factors, including the diversity of lasers, the variety of energy settings employed, and the differing modes of delivery, which together create many combinations of factors that can result in differing clinical outcomes for patients. The expert panel looks forward to future clinical studies that will provide unequivocal answers to the role that the various available lasers can play in treating periodontitis and peri-implant diseases. In patients with moderate to severe periodontitis, do lasers used alone or as an adjunct to conventional forms of periodontal therapy provide better clinical outcomes than scaling and root planing alone? A literature search for randomized controlled clinical trials (RCTs) evaluating scaling and root planing versus laser therapy alone or laser therapy plus scaling and root planning, with or without surgical access, in the treatment of patients with moderate to severe periodontitis was conducted using the MEDLINE, EMBASE, and CENTRAL databases. A total of 475 articles published through March 2016 were identified. Of these, 28 met the selection criteria for review. These criteria required human clinical trials of ≥3 months’ duration, with at least 10 adult subjects presenting, with mean probing depth ≥5 mm. (See Chambrone, Ramos, Reynolds1 2018 for detailed information on the literature review and results.) Current evidence suggests that, as an adjunct to conventional periodontal therapy, appropriate laser therapy may provide a modest additional benefit (< 1 mm) in clinical improvement in probing depth and clinical attachment level (CAL) compared with traditional forms of periodontal therapy in the treatment of moderate to severe chronic and aggressive forms of periodontitis. Although not conclusive, some evidence suggests that adjunctive use of Er:YAG or Nd:YAG lasers was superior to conventional periodontal therapy alone in deep periodontal pockets with probing depth ≥7 mm. At the same time, current evidence is inadequate to conclude that laser therapy alone is either superior or comparable to conventional periodontal therapy in terms of clinical improvement in probing depth and CAL in the treatment of moderate to severe chronic and aggressive forms of periodontitis. For residual probing depths ≥5 mm following conventional active periodontitis therapy and regular periodontal maintenance care for at least one year, current evidence is inadequate to conclude that laser therapy as an adjunct or alone provides any additional improvement in probing depth or clinical attachment level compared with conventional periodontal therapy.1 In patients with peri-implant mucositis or peri-implantitis, do lasers used alone or as an adjunct to conventional forms of therapy provide better clinical outcomes than scaling and root planing alone? A literature search for prospective and retrospective human case series, controlled clinical trials, or RCTs was conducted using three electronic databases and a hand search of peer-reviewed journals for relevant articles published in English between January 1980 and June 2016. Human clinical trials of ≥10 patients with peri-implant disease, treated with surgical/non-surgical approaches and laser therapy, and with a follow-up period of ≥6 months were included. The search yielded 237 articles for evaluation, and a total of 22 articles were selected, 13 with lasers used as an adjunct to non-surgical intervention and nine with lasers used with surgery. Among the selected 22 studies, only three included patients with peri-implant mucositis; the other 19 included patients with peri-implantitis. The outcomes of using laser as the sole method of therapy could not be evaluated because no controlled studies were identified. Therefore, all results represented outcomes of applying lasers as an adjunct to surgical/non-surgical treatment. (See Lin, López del Amo, Wang4 2018 for detailed information on the literature review and results.) Data on adjunctive laser treatment for peri-implant mucositis are scarce. No substantial current evidence conclusively supports their use in the treatment of peri-implant mucositis. Some evidence suggests clinical benefits with adjunctive laser use in the non-surgical treatment of peri-implantitis in the short term. However, no substantial evidence suggests long-term benefits. Such evidence includes successfully reaching certain definitive endpoints of care, such as bleeding on probing reduction, while failing to alter others, such as pocket depth reduction or gain in attachment or radiographic improvement. Limited evidence presented benefits that could be arguable (i.e., potential bacteria reduction) for adjunctive laser use with surgical treatment of peri-implantitis. However, no long-term benefits of adjunctive laser therapy for peri-implantitis have been reported, and long-term benefits must be interpreted with caution due to the critical role of maintenance care on long-term treatment outcomes for peri-implantitis. In patients with moderate to severe periodontitis or peri-implantitis, does antimicrobial photodynamic therapy (aPDT) as an adjunct to conventional forms of therapy provide better clinical outcomes than scaling and root planing alone? MEDLINE, EMBASE, and CENTRAL databases were searched for articles published up to and including March 2017. Articles that presented original data from RCTs, with a follow-up duration ≥3 months that evaluated scaling and root planing or implant surface scaling versus scaling and root planning, or implant surface scaling plus aPDT for the treatment of adult patients (≥18 years) with moderate to severe chronic/aggressive periodontitis or peri-implantitis were considered eligible for inclusion.5 A total of 730 articles published through March 2017 was identified and 28 were selected for review based on their meeting the selection criteria. (See Chambrone, Wang, Romanos5 2018 for detailed information on the literature review and results.) Antimicrobial photodynamic therapy is laser treatment used in conjunction with a photosensitizer and is intended to reduce periodontal pathogenic bacteria. Current evidence demonstrates that appropriate antimicrobial photodynamic therapy as an adjunct to conventional therapy may provide modest (< 1 mm) improvements in probing depths and clinical attachment levels when compared to conventional periodontal therapy for periodontitis. However, the difference in clinical outcomes suggested by the current evidence does not support clinical relevance for the combined therapy. More information is needed to provide a reliable estimate of the effect on clinical outcomes. Insufficient evidence was available to draw conclusions relative to the adjunctive effect of aPDT in the treatment of peri-implantitis. The BEC panel on laser therapy acknowledges the difficulty in drawing specific conclusions from the data of the RCTs referenced in the systematic reviews it considered. This difficulty is due to several factors, including the heterogeneity among studies, potential for study bias, and wide diversity in the types of lasers, energy settings, and modes of delivery utilized among the studies reviewed. The panel further recognizes there are several applications of laser therapy for which there is limited, and/or controversial, and/or contradictory evidence. As a result, the panel spent considerable time in discussion to arrive at a consensus on the current status of laser therapy, as well as recommendations for future research and training. The following sections summarize the consensus of the expert opinion of the panel. The American Academy of Periodontology Best Evidence Consensus meeting on lasers was sponsored by J. Morita USA (Irvine, California). Participants filed detailed disclosure of potential conflicts of interest relevant to the meeting topic, and these are kept on file. The authors receive, or have received, research funding, consultant fees, and/or lecture compensation from the following companies: BIOLASE (Irvine, California), J. Morita USA, and Millennium Dental Technologies (Cerritos, California).

OBJECTIVE: To evaluate prospectively the efficacy and safety of almotriptan 12.5 mg as compared to placebo when administered within 1 hour of headache pain onset for the acute treatment of 3 migraine headaches. BACKGROUND: Although clinical trials have reported improved outcomes when triptans were used early or to treat mild pain, acceptance of this treatment strategy has been hampered by both efficacy and tolerability issues. METHODS: In this multicenter, double-blind, placebo-controlled, parallel-group trial, patients with IHS-migraine were randomized in a 1:1 ratio to treat 3 consecutive migraine attacks with either almotriptan 12.5 mg or placebo. Patients were instructed to take their study medication at the first sign of headache pain of any intensity, within 1 hour of onset, and to record their symptoms at multiple time points during their headaches using a personal digital assistant. Clinical trial efficacy results for the first study headache and safety data for the entire study are presented. RESULTS: A total of 378 patients were randomized, 189 to each group; 162 almotriptan-treated patients, and 155 placebo-treated patients were evaluable for efficacy. Almotriptan treatment, compared to placebo, resulted in a significantly greater proportion of patients achieving 2-hour pain free (37.0% vs 23.9%, P= .010), 2-hour pain relief (72.3% vs 48.4%, P < .001) and sustained pain free (24.7% vs 16.1%, P= .040). Significant differences in pain free (P= .026) and pain relief (P= .019) between almotriptan and placebo also were observed at 1 hour. At 2 to 4 hours and 4 to 24 hours after treatment, the mean intensity of phonophobia and photophobia were significantly lower in the patients treated with almotriptan compared to the placebo-treated patients. A greater proportion of patients treating with almotriptan versus placebo reported normal functionality within 2 hours postdose (54.4% vs 38.1%, P= .007) and 4 hours postdose (74.5% vs 54.3%, P < .001). The percentage of patients experiencing 1 or more treatment-emergent adverse events (AE) was 9.8% for almotriptan and 6.4% for placebo. The only treatment-emergent AEs that occurred with a frequency of at least 1% (equivalent to 2 or more patients) in the almotriptan and placebo groups, respectively, were somnolence (1.1% and 2.3%), nausea (1.1% and 1.7%), vomiting (1.1% and 0.6%), and fatigue (1.1% and 0%). CONCLUSION: Treatment with almotriptan within 1 hour of migraine onset resulted in significantly better clinical outcomes than placebo and tolerability similar to placebo. Acute medications, such as almotriptan, that are both effective and well tolerated may encourage patients to access acute treatment earlier.

Abstract Sexual harassment is hurtful for victims, observers, and the organizations that employ them. Although previous studies have identified numerous gender‐specific antecedents such as sex similarity and climate for sexual harassment, the present study considers the role of a more general contextual construct—organizational justice climate. Beyond examining justice climate as a predictor of sexual harassment, we also assess its potential moderation of well‐established relationships between antecedents (i.e., climate for sexual harassment and sex similarity) and sexual harassment at both the individual and unit levels. In two large military samples ( N s = 26,018 and 8,197), we found that psychological and collective justice climates (a) related negatively to sexual harassment and (b) moderated the effects of sex similarity and sexual harassment climate on sexual harassment. These findings indicate that harassment is less prevalent and established antecedents are less impactful when greater value is perceived to be placed on fairness. Moreover, the attenuating effects of justice climate appear interchangeable with those of harassment climate or sex similarity, suggesting that managing justice climate effectively generally helps to deter sexual harassment.

the Department of Anesthesiology, Wilford Hall USAF Medical Center, Lackland AFB, Texas. Address correspondence to Joseph V. Mirenda, Major, USAF, MC, Department of Anesthesiology, Wilford Hall USAF Medical Center, Lackland AFB, TX 78236. The opinions or assertions expressed herein are those of the authors and are not to be construed as official or as reflecting the views of the United States Air Force or the Department of Defense. The authors thank Dr. Edward D. Miller, Jr., of the Department of Anesthesiology (College of Physicians and Surgeons of Columbia University) for his support in preparation of this manuscript. Accepted for publication November 26, 1990.

Background: Myofascial pain is defined as pain that originates from myofascial trigger points in skeletal muscle. It is prevalent in regional musculoskeletal pain syndromes, either alone or in combination with other pain generators. The myofascial pain syndrome is one of the largest groups of under diagnosed and under treated medical problems encountered in clinical practice. Trigger points are commonly seen in patients with myofascial pain which is responsible for localized pain in the affected muscles as well as referred pain patterns. Correct needle placement in a myofascial trigger point is vital to prevent complications and improve efficacy of the trigger point injection to help reduce or relieve myofascial pain. In obese patients, these injections may not reach the target tissue. In the cervicothoracic spine, a misguided or misplaced injection can result in a pneumothorax. Here, we describe an ultrasound-guided trigger point injection technique to avoid this potential pitfall. Office based ultrasound-guided injection techniques for musculoskeletal disorders have been described in the literature with regard to tendon, bursa, cystic, and joint pathologies. For the interventionalist, utilizing ultrasound yields multiple advantages technically and practically, including observation of needle placement in real-time, ability to perform dynamic studies, the possibility of diagnosing musculoskeletal pathologies, avoidance of radiation exposure, reduced overall cost, and portability of equipment within the office setting. To our knowledge, the use of ultrasound guidance in performing trigger point injection in the cervicothoracic area, particularly in obese patients, has not been previously reported. Methods: A palpable trigger point in the cervicothoracic musculature was localized and marked by indenting the skin with the tip of a plastic needle cover. The skin was then sterile prepped. Then, using an ultrasound machine with sterile coupling gel and a sterile latex free transducer cover, the musculature in the cervicothoracic spine where the palpable trigger point was detected was visualized. Then utilizing direct live ultrasound guidance, a 25-gauge 1.5 inch needle connected to a 3 mL syringe was placed into the muscle at the exact location of the presumed trigger point. This guidance helps confirm needle placement in muscle tissue and not in an adipose tissue or any other non-musculature structure. Results: The technique is simple to be performed by a pain management specialist who has ultrasound system training. Conclusion: Ultrasound-guided trigger point injections may help confirm proper needle placement within the cervicothoracic musculature. The use of ultrasound-guided trigger point injections in the cervicothoracic musculature may also reduce the potential for a pneumothorax by an improperly placed injection. Key words: Trigger point injection, myofascial pain, ultrasound

Purpose: Sexual harassment remains a persistent problem in the U.S. military despite extensive research and policy initiatives. Theoretical explanations identify individual circumstances (e.g., power differentials) and organizational factors (e.g., climate, culture). However, data constraints limit the capacity to link individual contexts with independent measures of environments. Data/Methods: A unique Defense Equality Opportunity Climate Survey allows assessment of organizational climates and individual experiences with multilevel analyses. Results: Sexist environmental context increases the likelihood of personal harassment experiences after controlling for individual-level variables. However, unit-level climate, group cohesion, and job satisfaction are not significant. Conclusion: Both individual and organizational factors are important. However, the organizational context has less to do with culture or unit cohesion and more to do with tolerance of sexism. Focusing on problem units may be effective for reducing the prevalence and persistence of sexual harassment.

To date, minimal work has explored associations between equal opportunity (EO) climate and employee work attitudes, and no known research has investigated the effects of EO climate beyond the individual level. We address these gaps in the literature by testing a multilevel structural equation model in which effects of EO climate are considered at both the individual and unit levels. At the individual level, we predicted that psychological EO climate would be directly associated with job stress and job satisfaction, as well as indirectly related to job satisfaction via stress. In addition, cross-level associations between unit EO climate and job stress and job satisfaction were hypothesized to be mediated by cohesion. Findings supported the proposed model; hypothesized relations were supported at both levels of analysis. We conclude with a discussion of the findings, study limitations, and directions for future EO climate research.

During the 2003 severe acute respiratory syndrome (SARS) outbreak, a real-time quantitative polymerase chain reaction, which targets the nucleocapsid gene at the 3' end of the viral genome, was established to detect and identify the SARS-associated coronavirus. We describe the use of this assay to screen >700 clinical samples.

Summary Our research examined how team age diversity can be either detrimental or beneficial for team performance depending on team agreeableness minimum. In age diverse teams, a disagreeable teammate may trigger age‐based stereotypes about his/her social group, thereby activating social categorization. This would result in decreased relational team functioning and worsened team performance. When the least agreeable member scores high on agreeableness, negative social categorization processes may not be triggered in age diverse teams. They may focus on informational diversity with beneficial effects for team relational processes and team performance. We tested our model in three samples (Study 1: k = 81, N = 254; Study 2: k = 109, N = 434; Study 3: k = 195, N = 1784) wherein performance was measured both objectively (Studies 1 and 2) and subjectively (Study 3). In both Studies 1 and 2, team age diversity was positively related to team performance when team agreeableness minimum was high. In Study 2, when the least agreeable person scored low on agreeableness, greater age diversity resulted in lower performance, and this relationship was mediated by higher interpersonal conflict. In Study 3, these interactive effects transpire via reduced team cohesion—another aspect of relational team functioning.

OBJECTIVE: To investigate the clinical features of patients who had two demonstrated coronavirus disease 2019 (COVID-19) episodes. METHODS: Data of patients with both COVID-19 episodes were recruited from 22 March to 27 December 2020. The following outcomes were studied: epidemiological, comorbidities, prevalence and severity of general and otolaryngological symptom, olfactory, aroma, and gustatory dysfunctions. A comparison between first and second episodes was performed. RESULTS: Forty-five patients reported having two confirmed COVID-19 episodes. The majority of patients had mild infections in both episodes. The second clinical episode was significantly similar to the first. The symptom duration of the second episode was shorter than the first. The occurrence of loss of smell was unpredictable from the first to the second episode. CONCLUSION: The recurrence of COVID-19 symptoms is associated with a similar clinical picture than the first episode in patients with initial mild-to-moderate COVID episode. The pathophysiological mechanisms underlying the development of second episode remain uncertain and may involve either true reinfection or virus reactivation from sanctuaries.

Recent analyses of the perceptions of equal opportunity (EO) climate in the military highlight differences among various demographic subgroups. Prior research (CitationDansby, 1994) indicates minority female officers have the least favorable views of EO climate in military organizations when contrasted to comparable demographic subgroups (i.e., Caucasian male officers, etc.). Differences based on race, gender, and representation index (number in the subgroup divided by the total unit population) are explored in a sample of 190 U.S. Army units (N = 47,823) that conducted the Military Equal Opportunity Climate Survey between 1990 and 1995. As predicted, minority female officers’ perceptions of the favorability of the EO climate improved as their representation in the organization increased (p < .05). Contrary to the expected negative relation, higher educational attainment positively correlated with improved perceptions of EO climate. The findings are interpreted as supporting consideration of representation issues as a means to improving perceived EO climate.

From the United States Army Institute of Surgical Research (B.A.P.), Joint Base Fort Sam Houston, Texas; the United States Combat Casualty Care Research Program (T.E.R.), Fort Detrick, Maryland; and the Norman M. Rich Department of Surgery, The Uniformed Services University of the Health Sciences (B.A.P., T.E.R.), Bethesda, Maryland. Disclaimer: The views expressed in this manuscript are those of the authors and do not reflect official position or policy of the United States Air Force, United States Army or the Department of Defense. Address for reprints: Todd E. Rasmussen, MD, FACS, Colonel USAF MC, Director, US Combat Casualty Care Research Program, 722 Doughten Street, Room 3, Fort Detrick, MD 21702–5012; email: [email protected].

Cultural competence is a vital component of many missions in today's military. Cultural competence enables one to further a mission, save resources, and save lives. Conversely, a lack of cultural competence may bring about challenges to mission completion, requirement for more resources, waste of resources, and destruction of lives. Cultural competence involves many components. One particular component is cultural heritage awareness and protection of cultural property. This study sought to assess current understanding of cultural property protection and determine the effectiveness of a training aimed at increasing cultural property protection awareness, knowledge, and comfort within the military setting. It was hypothesized that participants would vary in their level of awareness, knowledge, and comfort of cultural property protection, and that all would show a significant improvement in knowledge scores post training. Factors such as deployment experience were examined for potential correlation with measures such as awareness. A 14 question pre-read survey was developed to assess participants' demographics, awareness, knowledge, and comfort with cultural property protection. Awareness included value, laws, and procedures while knowledge examined "know how" such as how to bed down in a protected structure or communicate information about the structure. Comfort assessed one's comfort with engaging in the knowledge based tasks. A 24 question post read survey was administered to assess awareness, knowledge, and comfort, and to solicit additional feedback on the manual itself. The survey utilized a 1-5 rating scale with 1 representing no awareness, knowledge, or comfort and 5 representing absolute awareness, knowledge, and comfort with different aspects of cultural property protection. Cultural property protection value was highest pre and post training while knowledge regarding recovery of property was rated lowest pre and post training. Results are encouraging for the pursuit of cultural property education. Further studies should include knowledge assessment versus self rating as well as tracking of incidents and outcomes in the field. Implications for mission readiness and success are discussed.

Situational judgment tests (SJTs) are well suited for training evaluation, especially when measures of on-the-job behaviors/performances are unavailable. Yet, SJTs are underutilized in the training evaluation context. This research details the development and use of an SJT to evaluate equal opportunity/diversity training in the military. We focus on issues that differentiate the development of SJTs for training evaluation from the development of SJTs for selection. Finally, results are presented for two cycles of training evaluation using an SJT, and the strengths and limitations of using SJTs in the training context are discussed.

BACKGROUND: Myofascial pain is defined as pain that originates from myofascial trigger points in skeletal muscle. It is prevalent in regional musculoskeletal pain syndromes, either alone or in combination with other pain generators. The myofascial pain syndrome is one of the largest groups of under-diagnosed and under-treated medical problems encountered in clinical practice. Trigger points are commonly seen in patients with myofascial pain that can be responsible for localized pain in the affected muscles as well as referred pain patterns. Correct needle placement in a myofascial trigger point is vital to prevent complications and improve efficacy of the trigger point injection to help reduce or relieve myofascial pain. In the obese patients, these injections may not reach the target tissue. In the cervicothoracic spine, a misguided or misplaced injection can result in a pneumothorax. Here, we review an electromyographically guided trigger point injection technique to avoid this potential pitfall. METHODS: Using a disposable Teflon coated hypodermic injection needle attached to an electromyography (EMG) machine, a trigger point injection can be performed utilizing electromyographic guidance. This guidance by observing motor unit action potentials (MUAPs) on the EMG screen helps confirm the needle placement to be within the muscle tissue and not in an adipose tissue or any other non-musculature structure. RESULTS: The technique is simple when performed by a pain management specialist who has electromyographic training. CONCLUSION: This technique helps confirm proper needle placement within the cervicothoracic musculature in an obese patient in whom the musculature is not readily palpated. This, thus, reduces the potential for a pneumothorax by an improperly placed injection.

Chronic ulcerations are a physical and financial burden to the health and economic establishment in the United States and Worldwide. Improvements in biotechnology and knowledge in stem cell applications have progressed and basic science results are making their way slowly into the clinical arena. Chronic wounds and diabetic bone healing are the key components in the limb salvage of the common diabetic foot. We have examined the current available literature and present the latest on stem cells applications as a novel clinical technique in the treatment of chronic wound and diabetic bone healing and their impact in the treatment paradigm of patients.

= 8,196 employees in 546 work units). Results generally show that bystanders who are women or similar in gender to the target of mistreatment reported different levels of emotional and cognitive identity threat that related to psychological gender mistreatment climate and workplace injustice following the incident as compared to men and those not similar in gender to the target. Overall, by integrating and extending bystander theory and dual-process models of injustice perceptions, through this work, we provide a potentially overlooked reason why negative behaviors like incivility, ostracism, and discrimination continue to occur in organizations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).