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To determine whether the prone or lateral position is associated with post-operative sciatic nerve palsy in posterior acetabular fracture fixation.Retrospective cohort study.Three Level I trauma centers.Patients with acetabular fractures treated with a posterior approach (n=1045).Posterior acetabular fixation in the prone or lateral positions.The primary outcome was the prevalence of post-operative sciatic nerve palsy by position. Secondary outcomes were risk factors for nerve palsy, using multiple regression analysis and propensity scoring.The rate of post-operative sciatic nerve palsy was 9.5% (43/455) in the prone position and 1.5% (9/590) in the lateral position (p0.001). Intraoperative blood loss and surgical duration were significantly higher for patients who developed a post-operative sciatic nerve palsy. Subgroup analysis showed that position did not influence palsy prevalence in posterior wall fractures. For other fracture patterns, propensity score analysis demonstrated a significantly increased odds ratio of palsy in the prone position (aOR 7.14 (2.22, 23.00); p=0.001).With the exception of posterior wall fracture patterns, the results of this study suggest that factors associated with increased risk for post-operative sciatic nerve palsy following a posterior approach are: fractures treated in the prone position, increased blood loss, and prolonged operative duration. These risks should be considered alongside the other goals (e.g., reduction quality) of acetabular fracture surgery when choosing surgical positioning.Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

To compare a large panel of plasma protein inflammatory biomarkers and mid-infrared (MIR) spectral patterns in patients with confirmed fracture-related infections (FRIs) with those in controls without infection.Prospective case-control study.Academic, Level 1 trauma center.Thirteen patients meeting confirmatory FRI criteria were matched to 13 controls based on age, time after surgery, and fracture region.Plasma levels of 49 proteins were measured using enzyme-linked immunosorbent assay techniques. Fourier transform infrared spectroscopy of dried films was used to obtain MIR spectra of plasma samples.The main outcome measurements included plasma protein levels and MIR spectra of samples.Multivariate analysis-based predictive model developed using enzyme-linked immunosorbent assay-based biomarkers had sensitivity, specificity, and accuracy of 69.2% ± 0.0%, 99.9% ± 1.0%, and 84.5% ± 0.6%, respectively, with platelet-derived growth factor-AB/BB, C-reactive protein, and MIG selected as the minimum number of variables explaining group differences ( Plt; 0.05). Sensitivity, specificity, and accuracy of the predictive model based on MIR spectra were 69.9% ± 6.2%, 71.9% ± 5.9%, and 70.9% ± 4.8%, respectively, with 6 wavenumbers as explanatory variables ( Plt; 0.05).This pilot study demonstrates the feasibility of using a select panel of plasma proteins and Fourier transform infrared spectroscopy to diagnose FRIs. Preliminary data suggest that the measurement of these select proteins and MIR spectra may be potential clinical tools to detect FRIs. Further investigation of these biomarkers in a larger cohort of patients is warranted.Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Background/objective The aim of this study was to identify psychological factors that influence moderate-vigorous physical activity (MVPA) participation in patients with fibromyalgia. Methods In this secondary data analysis, 170 patients received personalized exercise plans and completed baseline and follow-up assessments of self-reported physical activity at weeks 12, 24, and 36. Structural equation modeling was used to examine the predictive strengths of psychological factors (exercise self-efficacy, perceived barriers, and intention) on MVPA participation. Results Using a threshold increase in MVPA of 10 or greater metabolic equivalent hours per week (MET h/wk), 3 groups were defined based on subjects who achieved a minimum increase of 10 MET h/wk that was sustained for at least 12 weeks (SUS-PA), achieved an increase of 10 MET h/wk that was not sustained for at least 12 weeks (UNSUS-PA), and did not achieve an increase of 10 MET h/wk (LO-PA). Increases in exercise self-efficacy and intention and reductions in perceived barriers were associated with increased volume of PA, showing the greatest change in the SUS-PA, followed by UNSUS-PA. For the LO-PA group, there was no change in exercise self-efficacy, a decrease in intention, and an increase in barriers. Using path analysis, exercise self-efficacy and perceived barriers were associated with higher volumes of physical activity via greater intention to engage in MVPA. Conclusions For patients with fibromyalgia, exercise self-efficacy, perceived barriers, and intention to exercise are important constructs for increasing physical activity. Our findings provide guidance for practitioners who seek to promote physical activity in fibromyalgia and suggestions for researchers aiming to improve prediction models.

BACKGROUND Late preterm infants (born 34-36 weeks gestation) without cystic fibrosis (CF) are at risk for growth failure during the first 2 years of life. Infants with CF are at risk of being born premature, and thus at risk for growth failure. The aim for this study was to assess weight-for-length (WFL) at 2 years of age for late preterm infants compared with term infants with CF. METHODS Data were collected from the US CF Foundation Patient Registry. We compared growth parameters between late preterm and term infants with CF born from 2010 to 2013. Our primary outcome was WFL

Heightened systemic inflammation contributes to cardiovascular (CVD) events in people living with HIV (PLWH), although not all PLWH develop CVD, thus suggesting a genetic modifying role. We examined GCH1 polymorphisms, which have been associated with reduced endothelial function in European populations with CVD and increased inflammation, in a racially diverse cohort of US PLWH initiating antiretroviral therapy (ART). GCH1 polymorphisms differed by race and were not associated with flow-mediated dilation or carotid intima-media thickness before or after 48 weeks of ART.

Obesity is a common comorbid condition among patients with fibromyalgia (FM). Our objective was to assess if obesity moderates the treatment benefits of exercise-based motivational interviewing (MI) for FM.This is a secondary data analysis of a completed clinical trial of 198 FM patients who were randomized to receive either MI or attention control (AC). Using body mass index (BMI) to divide participants into obese (BMI≥30 kg/m) and nonobese (BMI30 kg m) groups, mixed linear models were used to determine interaction between treatment arms and obesity status with regards to the primary outcome of global FM symptom severity (Fibromyalgia Impact Questionnaire, FIQ). Secondary measures included pain intensity (Brief Pain Inventory), 6-Minute Walk Test, and self-reported physical activity (Community Health Activities Model Program for Seniors).Of the 198 participants, 91 (46%) were nonobese and 107 (54%) were obese. On global FM symptom severity (FIQ), the interaction between treatment arms and obesity status was significant (P=0.02). In the nonobese group, MI was associated with a greater improvement in FIQ than AC. In the obese group, MI participants reported less improvement in FIQ compared with AC. The interaction analysis was also significant for Brief Pain Inventory pain intensity (P=0.01), but not for the walk test and self-reported physical activity.This is the first study to show that obesity negatively affects the treatment efficacy of MI in patients with FM. Our findings suggest that exercise-based MI may be more effective if initiated after weight loss is achieved.

To investigate the effect of meal intake on liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) in patients with biopsy-proven nonalcoholic fatty liver disease undergoing vibration-controlled transient elastography.LSM and CAP were assessed at baseline and serially for 6 hours after meal intake in 24 patients.A significant increase in LSM was seen up to the 2-hour time point (26 ± 25%, P = 0.02). The CAP scores changed minimally with a maximal change of 3% (P0.1).Three hours of fasting is necessary before evaluation with vibration-controlled transient elastography.

Given the lack of patient-centered, self-care programs after stroke, we designed a stroke self-management program based upon social cognitive theory and stakeholder input. Objectives: We conducted a randomized controlled trial to evaluate the effectiveness of the program after stroke on stroke specific, quality of life, SSQOL, and maintenance at 1 year. Methods: We enrolled 258 participants within 90 days of a stroke, on average, stratified by stroke, n=218, or TIA, n=40, and by VA and nonVA healthcare systems. The program included telephone case management, support groups, and booster calls. Outcomes of SSQoL, PHQ9, self-efficacy were assessed at 0, 3, 6, and 12 months. We compared the intervention to usual care using linear mixed effects modeling. Results: We delivered the program with high fidelity: 16/19 elements were delivered to > 90%. Our sample included 19% women with an average age of 61.7 years with an average NIHSS=3. At 3 months, the groups did not differ. However, at 6 months, we report an adjusted intervention effect on mean change in total SSQoL, m=0.30, compared to usual care m=0.16, p< 0.05. We found a significant interaction effect, p Conclusions: A stroke self-management program is effective for improving the health-related quality of life, self-efficacy to manage health and physical functioning of patients after an acute stroke during the first six months post discharge. Long term maintenance may need additional support and resources. Finally, our results remained significant after adjusting for the healthcare system, patient demographics and whether the acute event was a stroke or TIA. Thus, healthcare systems may consider implementing such programs as patients transition after the acute health event.

Objective: To determine if single nucleotide polymorphisms (SNPs) in interleukin (IL) IL-1A, IL-1B, IL-1RN, IL-2, IL-9, and IL-9R were associated with chronic beryllium disease (CBD) and beryllium sensitization (BeS). Methods: Forty SNPs in six IL genes were evaluated in 85 individuals with CBD, 61 individuals with BeS, and 730 individuals without BeS or CBD (nonsensitized) using a 5' nuclease polymerase chain reaction assay. Logistic regression was used to evaluate the association between IL SNPs, CBD, and BeS, adjusting for plant-site and HLA-DPB1 Glu69 in additive, dominant, and recessive inheritance models. Results: IL-1A-1142, IL-1A-3769, and IL-1A-4697 were significantly associated with CBD in both the additive and dominant models compared to individuals with BeS or the nonsensitized. Conclusions: These results indicate that genetic variations in the IL-1A gene may play a role in the development of CBD but not BeS.

Background: Despite advances in stroke care, many patients do not receive recommended care processes. Quality indicator (QI) reporting programs, like GWTG-Stroke, have been shown to improve care. We sought to determine whether training plus QI feedback was more effective than QI feedback alone in improving two stroke QIs. Methods: We conducted a cluster randomized trial in 11 VA hospitals. Sites were randomized to a quality improvement training program plus QI feedback vs. QI feedback alone to improve DVT prophylaxis and dysphagia screening. Intervention sites received face-to-face training, developed individualized improvement plans, and had 6 months of post-training facilitation. Both groups received monthly QI feedback. Eligibility and passing for the two stroke QIs, plus nine other stroke QIs, was determined by centralized chart review. We compared pre-intervention (pre-I) to post-intervention (post-I) performance on the two stroke QIs and on defect-free care (DF, a binary patient-level variable including all QIs) in intervention vs. control sites. We constructed logistic models of the two QIs and DF care, adjusting for patient variables, time, intervention group, and time-group interaction. Results: The five intervention sites had 1147 admissions and the six control sites had 1017 admissions during the study period. DVT prophylaxis was similar pre-I (85% vs. 90%) and improved in both groups (post-I rates 90% intervention and 94% control, ratio of ORs 0.89, p = 0.75). Dysphagia screening was higher pre-I in intervention sites (51% vs. 37%), and improved more in the control sites (post-I 56% and 52%, ratio of ORs 0.67, p=0.04). In logistic models, DVT, Dysphagia, and DF performance were associated with baseline performance and post-I time. Dysphagia performance was also associated with NIHSS and time-group interaction, and DF care was also associated with the presence of a baseline data collection program. Conclusion: Quality improvement training did not add to the impact of data feedback in sites already motivated to participate in QI initiatives. Defect-free stroke care is associated with an ongoing stroke data collection program, emphasizing the importance of audit and feedback to achieve the highest quality stroke care.