Search

Jay M Margolis,1 Paul Juneau,1 Alesia Sadosky,2 Joseph C Cappelleri,3 Thomas N Bryce,4 Edward C Nieshoff5 1Truven Health Analytics, Bethesda, MD, USA; 2Pfizer Inc., New York, NY, USA; 3Pfizer Inc., Groton, CT, USA; 4Department of Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA; 5Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA Background: The study aimed to evaluate health care resource utilization (HRU) and costs for neuropathic pain (NeP) secondary to spinal cord injury (SCI) among Medicaid beneficiaries. Methods: The retrospective longitudinal cohort study used Medicaid beneficiary claims with SCI and evidence of NeP (SCI-NeP cohort) matched with a cohort without NeP (SCI-only cohort). Patients had continuous Medicaid eligibility 6 months pre- and 12 months postindex, defined by either a diagnosis of central NeP (ICD-9-CM code 338.0x) or a pharmacy claim for an NeP-related antiepileptic or antidepressant drug within 12 months following first SCI diagnosis. Demographics, clinical characteristics, HRU, and expenditures were compared between cohorts. Results: Propensity score-matched cohorts each consisted of 546 patients. Postindex percentages of patients with physician office visits, emergency department visits, SCI- and pain-related procedures, and outpatient prescription utilization were all significantly higher for SCI-NeP (P

Average American students are seldom aware of child and human rights principles and their impact globally and locally. School counselors are one logical group of school specialists skilled to facilitate school-based, rights-based (i.e., child and human rights) initiatives to promote students' awareness. Moving beyond their professional comfort zones, school counselors have: (1) training in leadership, systemic change, advocacy, and collaboration; and (2) requisite skills to facilitate students' development of a rights-based foundation to become engaged and responsible global citizens with a mature rights-based lens. Rights-based resources are offered for guidance lessons, academic lessons, and extra-curricular programs.

Being a social worker requires facing many social upheavals, juggling with organizational changes, and working with various populations with increasing complex social issues. Future social workers must quickly familiarize themselves with the conditions of the practice. In order to do so, it is essential to provide students with multiple opportunities to integrate theory and practice throughout the school curriculum through educational activities that are as close as possible to professional practise. This article shows the results of a qualitative study that compares the comments of two groups of students, one exposed to an experiential pedagogy and the other not, in order to better understand the benefits of pedagogy for the integration of theory into practice. One of the principal results of this study shows that putting students in situations similar to practice environments makes the learning meaningful, promotes the integration of theory and practice, and strengthens professional identity.

Canada faces an increasingly difficult international environment. The to-do list is extensive: decades of neglect and underinvestment mean that every instrument of national power - diplomacy, defence, development, intelligence, national security, law enforcement - all suffer from chronic under-investment. Perhaps most strikingly, Canada has also not produced a comprehensive national security policy since 2004. These vulnerabilities are being increasingly discussed publicly. There is, however, one persistent problem that underlies these vulnerabilities and systematically fails to receive the attention it deserves, both in public debates and inside government: human resources. [ABSTRACT FROM AUTHOR]

The impact, incidence, prevalence, and severity of violence and trauma adversely affect students academically, behaviorally, emotionally, and socially. For students residing in geographically isolated or self-sequestered communities, trauma may be exacerbated when school counselors may be unprepared to respond effectively and timely because prevention and intervention options might be limited. Barriers to preparedness may be related to geographic, financial, cultural, religious, psychological, or linguistic reasons. This paper describes how a free, online repository of pre-screened crisis-specific counseling and guidance resources could be useful in supporting students' resiliency in geographically isolated or self-sequestered communities.

INTRODUCTION: Animal research has shown that tau pathology in the locus coeruleus (LC) is associated with reduced norepinephrine signaling, lower projection density to the medial temporal lobe (MTL), atrophy, and cognitive impairment. We investigated the contribution of LC‐MTL functional connectivity (FCLC‐MTL) on cortical atrophy across Braak stage regions and its impact on cognition. METHODS: We analyzed functional magnetic resonance imaging and amyloid beta (Aβ) positron emission tomography data from 128 cognitively normal participants, associating novelty‐related FCLC‐MTL with longitudinal atrophy and cognition with and without Aβ moderation. RESULTS: Cross‐sectionally, lower FCLC‐MTL was associated with atrophy in Braak stage II regions. Longitudinally, atrophy in Braak stage 2 to 4 regions related to lower baseline FCLC‐MTL at elevated levels of Aβ, but not to other regions. Atrophy in Braak stage 2 regions mediated the relation between FCLC‐MTL and subsequent cognitive decline. DISCUSSION: FCLC‐MTL is implicated in Aβ‐related cortical atrophy, suggesting that LC‐MTL connectivity could confer neuroprotective effects in preclinical AD. Highlights: Novelty‐related functional magnetic resonance imaging (fMRI) LC‐medial temporal lobe (MTL) connectivity links to longitudinal Aβ‐dependent atrophy.This relationship extended to higher Braak stage regions with increasing Aβ burden.Longitudinal MTL atrophy mediated the LC‐MTL connectivity–cognition relationship.Our findings mirror the animal data on MTL atrophy following NE signal dysfunction. [ABSTRACT FROM AUTHOR]

Background Isokinetic dynamometers are widely used when assessing neuromuscular function including knee extension kinetics. However, these dynamometers are often prohibitively expensive and are not portable. Thus strain-gauge technology has grown in popularity. Purpose The purpose of this study was to compare kinetic data captured via an isokinetic dynamometer against an affordable and portable strain-gauge with a treatment plinth during maximal isometric knee extensions. Study Design Cross-sectional study. Methods Healthy participants (8 males and 6 females; age 30.2±7.1 years) volunteered and performed knee extensions at a 90° knee angle on a dynamometer and a treatment plinth with a portable strain-gauge. Peak force (PF), peak rate of force development (PRFD), rate of force development (RFD2080) and impulse (IMP2080) from 20-80% of onset to peak force were assessed using both strain-gauge and isokinetic dynamometer. Between-device differences were evaluated by the Wilcoxon signed-rank test, Cohen's d effect sizes (ES), Pearson's correlation coefficients (r), and Bland-Altman plots. Results No significant or meaningful differences were identified between isokinetic and strain-gauge devices (all p≥0.268, ES≤0.35). However, slightly greater (2.5-9.5%) outputs were observed with the isokinetic dynamometer. Very large significant between-device correlations were found for PF (r=0.77, p=0.001) and PRFD (r=0.73, p=0.003), while small and moderate non-significant between-device correlations were found for RFD2080 (r=0.48, p=0.079) and IMP2080 (r=0.59, p=0.060). Bland-Altman plots did not reveal apparent biases from high to low performers. Conclusions These results indicate that the strain-gauge device can produce valid maximal and rapid force expression measurements. Similar results, such as those quantified via an isokinetic device, can be obtained without extreme rigour and constraint. The study's findings support using the practically relevant treatment plinth and strain-gauge combination as a suitable alternative to the isokinetic dynamometry for measuring PF and PRFD. Therefore, more rehabilitation and sports performance practitioners can confidently assess knee extension kinetics. Level of Evidence 3 [ABSTRACT FROM AUTHOR]

Coronary computed tomography angiography (CCTA) is an important non-invasive tool for the assessment of coronary artery disease and the delivery of information incremental to coronary anatomy. CCTA measured left ventricular (LV) mid-diastolic volume (LV MDV) and LV mass (LV Mass) have important prognostic information but the utility of prospectively ECG-triggered CCTA to predict reduced left ventricular ejection fraction (LVEF) is unknown. The objective of this study was to determine if indexed LV MDV (LV MDVi) and the LV MDV :LV Mass ratio on CCTA can identify patients with reduced LVEF. 8179 patients with prospectively ECG-triggered CCTA between November 2014 and December 2019 were reviewed. A subset derivation cohort of 4352 healthy patients was used to define normal LV MDVi and LV MDV :LV Mass. Sex-specific thresholds were tested in a validation cohort of 1783 patients, excluded from the derivation cohort, with cardiac disease and known LVEF. The operating characteristics for 1 SD above the mean were tested for the identification of abnormal LVEF, LVEF≤35 ​% and ≤30 ​%. The derivation cohort had a mean LV MDVi of 61.0 ​± ​13.7 ​mL/m2 and LV MDV :LV Mass of 1.11 ​± ​0.24 ​mL/g. LV MDVi and LV MDV :LV Mass were both higher in patients with reduced LVEF than those with normal LVEF (98.8 ​± ​40.8 ​mL/m2 vs. 63.3 ​± ​19.7 ​mL/m2, p ​< ​0.001, and 1.32 ​± ​0.44 ​mL/g vs. 1.05 ​± ​0.28 ​mL/g, p ​< ​0.001). Both mean LV MDVi and LV MDV :LV Mass increased with the severity of LVEF reduction. Sex-specific LV MDVi thresholds were 79 ​% and 80 ​% specific for identifying abnormal LVEF in females (LV MDVi ​≥ ​69.9 ​mL/m2) and males (LV MDVi ​≥ ​78.8 ​mL/m2), respectively. LV MDV :LV Mass thresholds had high specificity (87 ​%) in both females (LV MDVi :LV Mass ​≥ ​1.39 ​mL/g) and males (LV MDVi :LV Mass ​≥ ​1.30 ​mL/g). Our study provides reference thresholds for LV MDVi and LV MDV :LV Mass on prospectively ECG-triggered CCTA, which may identify patients who require further LV function assessment. [ABSTRACT FROM AUTHOR]