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Recent studies have validated the efficacy of point-of-care ultrasound (POCUS) as an alternative diagnostic imaging approach to computed tomography (CT) for patients with suspected acute diverticulitis. This study aimed to quantify the national impact of this approach in cost savings, ED length-of-stay (LOS), and radiation risk mitigation using a POCUS-first approach for acute diverticulitis in the emergency department (ED). Using published data, we constructed a Monte Carlo simulation model to compare two POCUS-first strategies (nonselective and selective approaches) for evaluating patients with suspected acute diverticulitis in the ED. Primary outcomes were cost savings, reduction in ED LOS, and radiation risk mitigation. In our simulation model, both nonselective and selective POCUS-first strategies showed substantial potential reductions in the annual number of CTs. Notably, the selective approach led to significantly fewer estimated POCUS examinations (433,847 ± 45,103 exams vs 720,048 ± 55,815 exams, p < 0.001) resulting in greater cost savings ($94,620,235 ± $10,090,807 vs $70,017,473 ± $11,583,911, p < 0.001) and greater reductions in ED LOS (508,569 ± 640,048 bed-hours vs 332,518 ± 774,485 bed-hours, p < 0.001). Reduction in radiation exposure was comparable between the two approaches (8,779,414 ± 2,389,982 mSv vs 8,846,058 ± 2,420,185 mSv, p = 0.536). Both POCUS-first models can achieve substantial national annual cost savings, ED LOS reduction, and decreases in radiation exposure compared to the traditional CT-first approach. POCUS should be strongly considered as a first-line imaging modality for acute diverticulitis especially among low-risk patients. [ABSTRACT FROM AUTHOR]

Objectives: To identify predictors of moderate to vigorous physical activity (MVPA) at 12-months post–moderate-severe traumatic brain injury (TBI). Setting: Four inpatient rehabilitation centers. Participants: Individuals enrolled in the TBI Model Systems with moderate to severe TBI, admitted to inpatient rehabilitation, and able to ambulate without physical assistance from another person. Design: Prospective longitudinal cohort study. MVPA was measured by having participants wear an ActiGraph GT3X on their wrist for 7 consecutive days. Main Analyses: We used multivariate regression to predict minutes per week of MVPA at 12 months after TBI. Three classes of predictors were entered hierarchically—demographic and clinical variables (age, sex, body mass index, education, TBI severity, neighborhood walkability score, and self-reported preinjury physical activity [PA] level), baseline TBI-related comorbid conditions (eg, measures of sleep, pain, mood, fatigue, and cognition), and intention to exercise and exercise self-efficacy assessed approximately 1 week after discharge from inpatient rehabilitation. Results: 180 participants (ages 17.7–90.3 years) were enrolled, and 102 provided at least 5 days of valid accelerometer data at 12 months. At 12 months, participants recorded an average of 703 (587) minutes per week of MVPA. In univariate and multivariate analyses, age was the only significant predictor of 12-month MVPA (r = −0.52). A sharp decline in MVPA was observed in the tertile of participants who were over the age of 61. Conclusions: Older adults with TBI are at elevated risk of being physically inactive. Assuming PA may enhance health after TBI, older adults are a logical target for prevention or early intervention studies. Studies with longer outcomes are needed to understand the trajectory of PA levels after TBI. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Blood‐based biomarkers offer a promising approach for the detection of neuropathologies from repetitive head impacts (RHI). We evaluated plasma biomarkers of amyloid, tau, neurodegeneration, and inflammation in former football players. METHODS: The sample included 180 former football players and 60 asymptomatic, unexposed male participants (aged 45–74). Plasma assays were conducted for beta‐amyloid (Aβ) 40, Aβ42, hyper‐phosphorylated tau (p‐tau) 181+231, total tau (t‐tau), neurofilament light (NfL), glial fibrillary acidic protein (GFAP), interleukin‐6 (IL‐6), Aβ42/p‐tau181 and Aβ42/Aβ40 ratios. We evaluated their ability to differentiate the groups and associations with RHI proxies and traumatic encephalopathy syndrome (TES). RESULTS: P‐tau181 and p‐tau231(padj = 0.016) were higher and Aβ42/p‐tau181 was lower(padj = 0.004) in football players compared to controls. Discrimination accuracy for p‐tau was modest (area under the curve [AUC] = 0.742). Effects were not attributable to AD‐related pathology. Younger age of first exposure (AFE) correlated with higher NfL (padj = 0.03) and GFAP (padj = 0.033). Plasma GFAP was higher in TES‐chronic traumatic encephalopathy (TES‐CTE) Possible/Probable (padj = 0.008). DISCUSSION: Plasma p‐tau181 and p‐tau231, GFAP, and NfL may offer some usefulness for the characterization of RHI‐related neuropathologies. Highlights: Former football players had higher plasma p‐tau181 and p‐tau231 and lower Aβ42/ptau‐181 compared to asymptomatic, unexposed men.Younger age of first exposure was associated with increased plasma NfL and GFAP in older but not younger participants.Plasma GFAP was higher in participants with TES‐CTE possible/probable compared to TES‐CTE no/suggestive. [ABSTRACT FROM AUTHOR]

Informed by Minority Stress Theory, to investigate disparities in pain intensity, interference, and care in patients with spinal cord injuries (SCI) based on demographic features. Cross-sectional survey. Outpatient SCI clinics in 2 academic medical centers in the northwestern United States. Sample of 242 SCI clinic patients who endorsed SCI-related pain, were ≥18-years-of-age, English-fluent, not diagnosed with bipolar or psychotic disorders, and able to make their own medical decisions. Participants were 74.8% men, an average of 48.5 years (range 18.1-89.8 years), 76.2% White, 31.9% privately insured, and 64.7% making <$50,000 per year. Not applicable. Exploratory analyses of screening data from a randomized controlled trial for pain treatment. Primary outcomes included pain intensity, pain interference, and the patient report of recommended pain treatments by a medical provider, tried by the patient, or that the patient would be willing to try. More treatments recommended was associated with younger age (ρ=−0.14, 95% confidence interval [CI]: −0.01 to −0.27, P =.03) and private insurance (ρ=-0.15, 95% CI: 0.02-0.27, P =.03), whereas more treatments tried was associated with private insurance alone (ρ=0.20, 95% CI: 0.07-0.32, P =.003). Number of treatments willing to be tried was associated with lower income (ρ=−0.15, 95% CI: −0.02 to −0.28, P =.03). SCI patients of color (PoC) reported higher pain intensity (Cohen's d =0.41, 95% CI: 0.11-0.71) and greater odds of receiving psychotherapy for pain (odds ratio: 7.12, 95% CI: 1.25-40.46) than their White peers. These exploratory findings indicate differences in SCI-related pain intensity based on identifying as PoC, and differences in SCI-related pain treatment modalities based on identifying as PoC, age, insurance type, and income. Further work exploring differences in SCI-related pain care based on patient social identities is warranted. [ABSTRACT FROM AUTHOR]

The aim of this systematic review update was to determine the average effect of massage for adults with neck pain (NP) contrasted against another standard treatment. Randomised controlled trials comparing massage to standard treatments were included; placebo/no treatment comparisons were excluded. Databases were searched (CENTRAL, MEDLINE, EMBASE, CINAHL, ICL, trial registries) from inception to Oct-1-2023. We used the standard Cochrane methodological procedures: rated Risk of Bias 1.0, abstracted mean differences (MD), meta-analysed data, and rated the level of certainty (GRADE). We included 42 studies (2656 participants; 67% high RoB) contrasted against 10 unique treatments. Trials studied ages 18–70, 70% female, and mean pain severity 52 Visual Analogue Scale (VAS). Very-low to moderate-certainty evidence for pain (MD VAS 0–100, 95% CI) at ≤12 weeks follow-up follows. The pre-stated minimal important difference margin was 10 VAS points. Massage was 1. Favoured over an education-booklet (MD -4.80, −9.17 to −0.43), traction (MD -19.10, −31.07 to −7.13), and higher over lower dose (MD -17.40, −25.40 to −9.40). 2. Likely comparable to acupuncture (MD 2.09, −1.13 to 5.30), exercise (MD -2.50, −6.41 to 1.41), and ultrasound (MD -12.80, −26.43 to 0.83). 3. Not favoured (less effective) when compared to kinesiotaping (MD 9.59, 0.68 to 18.51), manipulation-mobilisation (MD 7.93, 0.01 to 15.85), and mobilisation-plus-exercise (not reported). Massage may not increase risks of minor adverse events: RR 0.37 (95% CI 0.22 to 0.61). For subacute-chronic NP, pain reduction varied by comparison. The evidence was limited by imprecision and high RoB. Focused planning for adequately dosed longer-term trials is needed. [ABSTRACT FROM AUTHOR]

Purpose: Anterior urethral stricture disease (aUSD) is a complex, heterogeneous condition that is idiopathic in origin for most men. This gap in knowledge rarely affects the current management strategy for aUSD, as urethroplasty does not generally consider etiology. However, as we transition towards personalized, minimally invasive treatments for aUSD and begin to consider aUSD prevention strategies, disease pathophysiology will become increasingly important. The purpose of this study was to perform a deep phenotype of men undergoing anterior urethroplasty for aUSD. We hypothesized that unique biologic signatures and potential targets for intervention would emerge based on stricture presence/absence, stricture etiology, and the presence/absence of stricture inflammation. Materials and Methods: Men with aUSD undergoing urethroplasty were recruited from one of 5 participating centers. Enrollees provided urethral stricture tissue and blood/serum on the day of surgery and completed patient-reported outcome measure questionnaires both pre- and postoperatively. The initial study had 3 aims: (1) to determine pediatric and adult subacute and repeated perineal trauma (SRPT) exposures using a study-specific SRPT questionnaire, (2) to determine the degree of inflammation and fibrosis in aUSD and peri-aUSD (normal urethra) tissue, and (3) to determine levels of systemic inflammatory and fibrotic cytokines. Two controls groups provided serum (normal vasectomy patients) and urethral tissue (autopsy patients). Cohorts were based on the presence/absence of stricture, by presumed stricture etiology (idiopathic, traumatic/iatrogenic, lichen sclerosus [LS]), and by the presence/absence of stricture inflammation. Results: Of 138 enrolled men (120 tissue/serum; 18 stricture tissue only), 78 had idiopathic strictures, 33 had trauma-related strictures, and 27 had LS-related strictures. BMI, stricture length, and stricture location significantly differed between cohorts (P <.001 for each). The highest BMIs and the longest strictures were observed in the LS cohort. SRPT exposures did not significantly differ between etiology cohorts, with > 60% of each reporting low/mild risk. Stricture inflammation significantly differed between cohorts, with mild to severe inflammation present in 27% of trauma-related strictures, 54% of idiopathic strictures, and 48% of LS strictures (P =.036). Stricture fibrosis did not significantly differ between cohorts (P =.7). Three serum cytokines were significantly higher in patients with strictures compared to stricture-free controls: interleukin-9 (IL-9; P =.001), platelet-derived growth factor–BB (P =.004), and CCL5 (P =.01). No differences were observed in the levels of these cytokines based on stricture etiology. However, IL-9 levels were significantly higher in patients with inflamed strictures than in patients with strictures lacking inflammation (P =.019). Degree of stricture inflammation positively correlated with serum levels of IL-9 (Spearman's rho 0.224, P =.014). Conclusions: The most common aUSD etiology is idiopathic. Though convention has implicated SRPT as causative for idiopathic strictures, here we found that patients with idiopathic strictures had low SRPT rates that were similar to rates in patients with a known stricture etiology. Stricture and stricture-adjacent inflammation in idiopathic stricture were similar to LS strictures, suggesting shared pathophysiologic mechanisms. IL-9, platelet-derived growth factor–BB, and CCL5, which were elevated in patients with strictures, have been implicated in fibrotic conditions elsewhere in the body. Further work will be required to determine if this shared biologic signature represents a potential mechanism for an aUSD predisposition. [ABSTRACT FROM AUTHOR]

Key to addressing persistent opportunity gaps in education is preparing teachers who are committed to disrupting the status quo. In recent years, teacher education research and scholarship have increasingly focused attention on the learning and development of preservice teachers with respect to issues of race, equity, and justice. However, less attention has been paid to the learning and development of teacher educators – those entrusted to design and implement justice-oriented learning for preservice and inservice teachers. Teacher educators are often thrust into their roles without the knowledge needed to support the justice-oriented learning of the students. To date, few graduate programs have provided comprehensive preparation for teacher educators, particularly regarding issues of race, equity, and justice. Beyond this, we know little about the justice-oriented learning that TEs have access to and the outcomes of this learning. In this article, we examine the small body of literature reporting on TEs' justiceoriented learning and consider the affordances when TEs' learning is grounded in robust conceptions of justice. History Matters, Race Matters, Justice Matters, and Language Matters (Annamma & Winn, 2019). We offer implications for the teacher educator learning and possibilities for narrowing opportunity gaps through increased investments in the development of teacher educators. [ABSTRACT FROM AUTHOR]

To identify variables independently associated with moderate to high loneliness in individuals living with Spinal Cord Injuries or Disorders (SCI/D). A cross-sectional, national survey of a random sample of community-dwelling Veterans with SCI/D in the United States. Survey methodology was used to collect data on demographic and injury characteristics, general health, chronic and SCI-secondary conditions, and loneliness. The VHA SCI/D System of Care including 25 regional SCI/D Centers (or Hubs). Among 2466 Veterans with SCI/D, 592 completed surveys (24%). Most participants were men (91%), white (81%), not currently married (42%), had tetraplegia (33%), and on average injured for 18 years at the time of data collection (N=562). Not applicable. The dependent variable, loneliness, was collected using the UCLA-3 instrument. Loneliness was dichotomized into never/low loneliness and moderate/high loneliness (UCLA score ≥ 4). Bivariate analyses assessed unadjusted associations in demographics, injury characteristics, chronic disease, and SCI-secondary conditions. Multivariable logistic regression was used to identify factors independently associated with moderate/high loneliness. Participants had a mean loneliness score of 5.04, SD=1.99. The point prevalence of moderate to high loneliness was 66%. Lower duration of injury, paraplegia, being unmarried, being in fair/poor general health, having dysfunctional sleep, and having a diagnosis of bowel dysfunction were each independently associated with greater odds of moderate/high loneliness. Findings suggest that interventions to reduce/manage loneliness in the Veteran SCI/D population should focus on those who are more newly injured, have paraplegia, currently unmarried, have bowel problems, and experience dysfunctional sleep. [ABSTRACT FROM AUTHOR]

We conducted an annual late-summer raptor survey along a 53-km route around Henrys Lake Flats, Idaho, from 1994 to 2022, and pooled the resulting data with similar published information collected from 1974 to 1993. A mean of 36 Red-tailed Hawks (Buteo jamaicensis), 13 Ferruginous Hawks (Buteo regalis), and 16 Swainson's Hawks (Buteo swainsoni) were observed each year along this route. The counts of Ferruginous Hawks declined significantly (P < 0.001) over the combined study period and were almost 10 times lower from 2013–2022 compared to 1974–1983. The counts of Red-tailed Hawks also declined significantly (P = 0.04), whereas no significant variation was evident for Swainson's Hawks over the combined 49-yr study period. Summer precipitation levels and hawk numbers were not correlated. The observed numbers of Ferruginous Hawks and Red-tailed Hawks were correlated throughout the study period, suggesting similar responses to local environmental and/or land-use factors. Obvious changes in the study area during the corresponding 49 yr include conversion of some pastures to center-pivot-irrigated agriculture and a substantial expansion of all-terrain vehicle trails and recreational activity. Because 88% of Ferruginous Hawks breeding in the Columbia Basin funnel through the upper Snake River Plain and adjacent areas on their way to post-breeding ranges in the Great Plains, expanded surveys in these areas in late August/early September could effectively monitor this intermountain population. Realizamos un censo anual de rapaces en el final del verano a lo largo de una ruta de 53 km alrededor de las planicies del Lago Henrys, Idaho, desde 1994 hasta 2022, y combinamos los datos obtenidos con información similar publicada colectada entre 1974 y 1993. Se observó un promedio de 36 individuos de Buteo jamaicensis, 13 de B. regalis y 16 de B. swainsoni cada año a lo largo de esta ruta. Los conteos de B. regalis disminuyeron significativamente (P < 0.001) durante el período de estudio combinado y fueron casi 10 veces más bajos entre 2013–2022 en comparación con 1974–1983. Los conteos de B. jamaicensis también disminuyeron significativamente (P = 0.04), mientras que no se observó variación significativa en el caso de B. swainsoni durante el período de estudio combinado de 49 años. Los niveles de precipitación en verano y el número de individuos de Buteo no estuvieron correlacionados. Los números observados de B. regalis y B. jamaicensis estuvieron correlacionados durante todo el período de estudio, lo que sugiere respuestas similares a factores locales ambientales y/o de uso del suelo. Los cambios evidentes en el área de estudio durante los 49 años analizados incluyen la conversión de algunos pastizales a agricultura con sistemas de riego de pivote central y una expansión sustancial de caminos para vehículos todo terreno y actividad recreativa. Dado que el 88% de los individuos de B. regalis que se reproducen en la Cuenca de Columbia pasan por la parte alta de la planicie del Río Snake y áreas adyacentes en su camino a las áreas post reproductivas en las Grandes Llanuras, la ampliación de los censos en estas áreas a finales de agosto/principios de septiembre podrían permitir un seguimiento efectivo de esta población inter-montana. [Traducción del equipo editorial] [ABSTRACT FROM AUTHOR]

To determine the cross-sectional and temporal relationships between minutes per week of moderate to vigorous physical activity (MVPA) as measured by a wrist-worn accelerometer and secondary conditions in the first year after moderate to severe traumatic brain injury (TBI). Prospective longitudinal cohort study. Four inpatient rehabilitation centers. Individuals (N = 180) with moderate-severe TBI enrolled in the TBI Model Systems Study. Participants wore a wrist accelerometer for 7 days immediately post discharge, and for 7 consecutive days at 6- and 12-months post injury. Minutes per week of MVPA from daily averages based on wrist worn accelerometer. Secondary conditions included depression (Patient Health Questionnaire-9), fatigue (PROMIS Fatigue), Pain (Numeric Rating Scale), Sleep (Pittsburgh Sleep Quality Index), and cognition (Brief Test of Adult Cognition by Telephone). At baseline, 6 and 12 months, 61%, 70% and 79% of the sample achieved at least 150 minutes per week of MVPA. The correlations between minutes of MVPA between baseline, 6 and 12 months were significant (r = 0.53-0.73), as were secondary conditions over these time points. However, no significant correlations were observed between minutes of MVPA and any secondary outcomes cross-sectionally or longitudinally at any time point. Given the robust relationships physical activity has with outcomes in the general population, further research is needed to understand the effect of physical activity in individuals with moderate-severe TBI. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Tau is a key pathology in chronic traumatic encephalopathy (CTE). Here, we report our findings in tau positron emission tomography (PET) measurements from the DIAGNOSE CTE Research Project. METHOD: We compare flortaucipir PET measures from 104 former professional players (PRO), 58 former college football players (COL), and 56 same‐age men without exposure to repetitive head impacts (RHI) or traumatic brain injury (unexposed [UE]); characterize their associations with RHI exposure; and compare players who did or did not meet diagnostic criteria for traumatic encephalopathy syndrome (TES). RESULTS: Significantly elevated flortaucipir uptake was observed in former football players (PRO+COL) in prespecified regions (p < 0.05). Association between regional flortaucipir uptake and estimated cumulative head impact exposure was only observed in the superior frontal region in former players over 60 years old. Flortaucipir PET was not able to differentiate TES groups. DISCUSSION: Additional studies are needed to further understand tau pathology in CTE and other individuals with a history of RHI. [ABSTRACT FROM AUTHOR]

Burton and Welty Peachey (2013) proposed a call for implementing servant leadership in intercollegiate athletics to better empower athletes in sport. Through the lens of empowerment, servant leadership also appears to have connection with spirituality and religiosity (Sendjaya et al., 2008; Greenleaf, 1970). Thus, the purpose of this study was to make meaning of one Christian college head baseball coach's servant leadership behaviors and examine his perception of coaching effectiveness. By way of thematic analysis, a qualitative case study was used to examine one baseball coach and his program with the following themes identified: 1) external issues/dynamics, 2)love, 3) internal dynamics. The findings highlighted the participant integrated the concepts of love, development, and the implementation of religious gospel principles with his athletes. Additionally, the participant's perception of coaching effectiveness was not related to winning, but on "what the kids do after" playing baseball in his program. [ABSTRACT FROM AUTHOR]

Falls are the leading cause of injuries in the US for older adults. Follow-up after an ED-related fall visit is essential to initiate preventive strategies in these patients who are at very high risk for recurrent falls. It is currently unclear how frequently follow-up occurs and whether preventive strategies are implemented. Our objective is to determine the rate of follow-up by older adults who sustain a fall related head injury resulting in an ED visit, the rate and type of risk assessment and adoption of preventive strategies. This 1-year prospective observational study was conducted at two South Florida hospitals. All older ED patients with an acute head injury due to a fall were identified. Telephone surveys were conducted 14 days after ED presentation asking about PCP follow-up and adoption of fall prevention strategies. Clinical and demographic characteristics were compared between patients with and without follow up. Of 4951 patients with a head injury from a fall, 1527 met inclusion criteria. 905 reported follow-up with their PCP. Of these, 72% reported receiving a fall assessment and 56% adopted a fall prevention strategy. Participants with PCP follow-up were significantly more likely to have a history of cancer or hypertension. Only 60% of ED patients with fall-related head injury follow-up with their PCP. Further, 72% received a fall assessment and only 56% adopted a fall prevention strategy. These data indicate an urgent need to promote PCP fall assessment and adoption of prevention strategies in these patients. • Older ED patients who have sustained a fall-related injury have a very high risk for recurrent fall and injury. • After the ED visit, the primary care follow-up is an opportunity to address recurrent fall risk and fall prevention. • Unfortunately, older ED head injury patients who are discharged often do not follow-up with a primary care physician. • When follow-up does occur, fall-risk assessment and fall prevention strategies are infrequently performed and adopted. [ABSTRACT FROM AUTHOR]

(1) Adapt evidence-based hypnosis-enhanced cognitive therapy (HYP-CT) for inpatient rehabilitation setting; and (2) determine feasibility of a clinical trial evaluating the effectiveness of HYP-CT intervention for pain after spinal cord injury (SCI). Pilot non-randomized controlled trial. Inpatient rehabilitation unit. English-speaking patients admitted to inpatient rehabilitation after SCI reporting current pain of at least 3 on a 0-10 scale. Persons with severe psychiatric illness, recent suicide attempt or elevated risk, or significant cognitive impairment were excluded. Consecutive sample of 53 patients with SCI-related pain enrolled, representing 82% of eligible patients. Up to 4 sessions of HYP-CT Intervention, each 30-60 minutes long. Participants were assessed at baseline and given the choice to receive HYP-CT or Usual Care. Participant enrollment and participation and acceptability of intervention. Exploratory analyses examined the effect of intervention on pain and cognitive appraisals of pain. In the HYP-CT group, 71% completed at least 3 treatment sessions and reported treatment benefit and satisfaction with the treatment; no adverse events were reported. Exploratory analyses of effectiveness found pre-post treatment pain reductions after HYP-CT with large effect (P <.001; β=-1.64). While the study was not powered to detect significant between-group differences at discharge, effect sizes revealed decreases in average pain (Cohen's d =-0.13), pain interference (d =-0.10), and pain catastrophizing (d =-0.20) in the HYP-CT group relative to control and increases in self-efficacy (d =0.27) and pain acceptance (d =0.15). It is feasible to provide HYP-CT to inpatients with SCI, and HYP-CT results in substantial reductions in SCI pain. The study is the first to show a psychological-based nonpharmacologic intervention that may reduce SCI pain during inpatient rehabilitation. A definitive efficacy trial is warranted. [ABSTRACT FROM AUTHOR]

• Neurogenic bladder dysfunction negatively impacts quality of life in children with SCI. • Strengthening spared neurocircuitry through activity-dependent plasticity. • Children with SCI may experience improved bladder and bowel function through ABR-LT. • Implications of enhanced bladder and bowel control include reduced medication dependence. Bladder dysfunction and associated complications of the urinary system negatively impact the quality of life in children living with spinal cord injury (SCI). Pediatric lower urinary tract deficits include bladder over-activity, inefficient emptying, decreased compliance, and incontinence. Recent evidence in adults with SCI indicates significant improvements in bladder capacity and detrusor pressure following participation in an activity-based recovery locomotor training (ABR-LT) rehabilitative program. Additionally, anecdotal self-reports from parents in our Pediatric NeuroRecovery Program reference changes in bladder function, ranging from awareness of bladder fullness to gains in voluntary control while undergoing ABR-LT. In a within-subjects repeated measures study, we investigated the effect of ABR-LT on bladder function in three children (ages: 2.5, 3, and 6 years) who sustained upper motor neuron SCI. Each child received at least 60 sessions of ABR-LT (5x/week) for 12–14 weeks. Bladder function was assessed via urodynamics and the Common Data Elements questionnaires. Awareness of bladder filling during cystometry was present in all children and detrusor leak point pressure (LPP) was reduced post-ABR-LT relative to pre-training. A decrease in LPP after locomotor training was observed in all three participants. One out of the three participants had substantial improvements in bladder capacity post-ABR-LT and experienced less bowel incontinence following training. Like our evidence in adults, the changes in bladder function suggest an interaction between lumbosacral networks regulating spinal reflex control of bladder filling, voiding, and afferent input (including potential descending supraspinal commands) and those activated by ABR-LT. Locomotor training may be associated with increased bladder capacity, enhanced perception of bladder filling, and decreased LPP as well as improvements in bowel control in pediatric SCI. This research suggests that children and adolescents with traumatic SCI could experience dynamic improvements in bladder and bowel function with the aid of various therapies. Studies assessing the durability of training on the recovery of bladder and bowel dysfunction in children with SCI are needed. [ABSTRACT FROM AUTHOR]

To describe cangrelor use in patients on concurrent mechanical circulatory support who underwent postpercutaneous coronary intervention. A single-center, retrospective, cohort study. At a quaternary teaching hospital. Included patients were ≥18 years old, admitted to the intensive care unit, underwent percutaneous coronary intervention with stent placement, initiated on mechanical circulatory support, and received cangrelor in the postpercutaneous coronary intervention period. Retrospectively analyzed cangrelor use in patients on mechanical circulatory support. The primary outcome was the incidence of thrombosis and bleeding events during cangrelor administration. Additional outcomes included initial cangrelor dose, number of cangrelor dose adjustments per patient, survival from mechanical circulatory support, and mortality within 30 days. Overall, 19 patients were included in this study. In total, 14 patients (74%) experienced a bleeding event; however, 93% were classified as a minor bleed. There was 1 major bleeding event. There were no thrombotic events observed during cangrelor administration. The median initial cangrelor dose was 0.5 µg/kg/min. There were 10 patients who underwent dose adjustment, with the majority being dose reductions based on antiplatelet monitoring (VerifyNow assay). Survival from mechanical circulatory support occurred in 17 patients (89%), and 30-day mortality occurred in 8 patients (42%). For patients receiving cangrelor as a bridge to oral P2Y12 inhibitor therapy on mechanical circulatory support, the authors observed a low rate of major bleeding and no episodes of thrombosis. Lower starting doses appear feasible with no observed increased risk of thrombotic complications. Future studies are needed to confirm these observations. [ABSTRACT FROM AUTHOR]

Non-contrast computed tomography (NCCT) is the gold standard for nephrolithiasis evaluation in the emergency department (ED). However, Choosing Wisely guidelines recommend against ordering NCCT for patients with suspected nephrolithiasis who are <50 years old with a history of kidney stones. Our primary objective was to estimate the national annual cost savings from using a point-of-care ultrasound (POCUS)-first approach for patients with suspected nephrolithiasis meeting Choosing Wisely criteria. Our secondary objectives were to estimate reductions in ED length of stay (LOS) and preventable radiation exposure. We created a Monte Carlo simulation using available estimates for the frequency of ED visits for nephrolithiasis and eligibility for a POCUS-first approach. The study population included all ED patients diagnosed with nephrolithiasis. Based on 1000 trials of our simulation, we estimated national cost savings in averted advanced imaging from this strategy. We applied the same model to estimate the reduction in ED LOS and preventable radiation exposure. Using this model, we estimate a POCUS-first approach for evaluating nephrolithiasis meeting Choosing Wisely guidelines to save a mean (±SD) of $16.5 million (±$2.1 million) by avoiding 159,000 (±18,000) NCCT scans annually. This resulted in a national cumulative decrease of 166,000 (±165,000) annual bed-hours in ED LOS. Additionally, this resulted in a national cumulative reduction in radiation exposure of 1.9 million person-mSv, which could potentially prevent 232 (±81) excess cancer cases and 118 (±43) excess cancer deaths annually. If adopted widely, a POCUS-first approach for suspected nephrolithiasis in patients meeting Choosing Wisely criteria could yield significant national cost savings and a reduction in ED LOS and preventable radiation exposure. Further research is needed to explore the barriers to widespread adoption of this clinical workflow as well as the benefits of a POCUS-first approach in other patient populations. [ABSTRACT FROM AUTHOR]

Objective: To examine the safety and efficacy of iltamiocel, an investigational cellular therapy of autologous muscle-derived cells, as a treatment for fecal incontinence (FI) in adults. Background: Limited therapeutic options are available for patients with FI refractory to conservative treatments. Cell therapy using autologous muscle-derived cells represents a promising, minimally invasive approach for restoring anal sphincter function. Methods: In this multicenter, prospective, non-randomized study, 48 participants were treated with a single iltamiocel dose of 250x106 cells. The primary outcome was the incidence of product or procedure-related adverse events (AEs) and serious AEs. Secondary outcomes were changes in the number of FI episodes, Cleveland Clinic Incontinence Score, Fecal Incontinence Quality of Life, and anorectal manometry at 3, 6, and 12 months compared to baseline. Results: No serious AEs and only one product-related AE of inflammation at the injection site were reported. At 12 months, there was a reduction in median FI episodes (-6.0; 95% confidence interval (CI): -10.0, -1.0) and days with episodes (-4.0; 95% CI: -8.0, -1.0). A ≥ 50% reduction in FI episodes was observed in 53.7% of participants, and 24.4% had complete restoration of continence. Symptom severity and quality of life improved with mean Cleveland Clinic Incontinence Score reduction (-2.9; 95% CI: -3.7, -2.1), and Fecal Incontinence Quality of Life increased (2.2; 95% CI:1.4, 2.9). No significant changes were detected in anorectal manometry measurements. A history of episiotomy was significantly associated with treatment response in multivariate analysis. Conclusion: The administration of iltamiocel cellular therapy is safe. Iltamiocel shows promise for significantly improving fecal incontinence symptoms and quality of life. [ABSTRACT FROM AUTHOR]