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Background Biomechanical muscle stiffness has been linked to musculoskeletal disorders. Assessing changes in muscle stiffness following DN may help elucidate a physiologic mechanism of DN. This study characterizes the effects of dry needling (DN) to the infraspinatus, erector spinae, and gastrocnemius muscles on biomechanical muscle stiffness. Method 60 healthy participants were randomized into infraspinatus, erector spinae, or gastrocnemius groups. One session of DN was applied to the muscle in standardized location. Stiffness was assessed using a MyotonPRO at baseline, immediately post DN, and 24 h later. The presence of a localized twitch response (LTR) during DN was used to subgroup participants. Results A statistically significant decrease in stiffness was observed in the gastrocnemius, the LTR gastrocnemius, and the LTR erector spinae group immediately following DN treatment. However, stiffness increased after 24 h. No significant change was found in the infraspinatus group. Conclusions DN may cause an immediate, yet transitory change in local muscle stiffness. It is unknown whether these effects are present in a symptomatic population or related to improvements in clinical outcomes. Future studies are necessary to determine if a decrease in biomechanical stiffness is related to improvement in symptomatic individuals.

PurposeThe purpose of this study was to examine the organizational context that may support learning and change readiness climates that previous research has found to be conducive to implementing evidence-based interventions.Design/methodology/approachAn exploratory, mixed method evaluation that included 15 rheumatology clinics throughout the United States was performed. Quantitative data were collected using a web-based survey completed by 135 clinic members. Qualitative data were collected via semi-structured interviews with 88 clinic members.FindingsIn general, clinics reported strong, positive learning and change readiness climates. More complex organizations (e.g. multispecialty, academic medical centers) with rational/hierarchical cultures and members with longer tenure were associated with less supportive learning and change readiness climates. The authors’ findings highlight opportunities for organizational leaders and evidence-based intervention sponsors to focus their attention and allocate resources to settings that may be most susceptible to implementation challenges.Originality/valueFirst, the authors address a deficit in previous research by describing both the level and strength of the learning and change readiness climates for implementing an evidence-based shared decision-making aid (SDMA) and examine how these vary as a function of the organizational context. Second, the study examines a broader set of factors to assess the organizational context (e.g. organizational culture, organizational structure, ownership) than previous research, which may be especially salient for shaping the climate in smaller specialty clinics like those we study. Third, the authors utilize a mixed methods analysis to provide greater insights into questions of how and why organizational factors such as size and structure may influence the learning and change readiness climate.

Protected areas (PAs) are the cornerstones of global biodiversity conservation efforts, but to fulfil this role they must be effective at conserving the ecosystems and species that occur within their boundaries. Adequate monitoring datasets that allow comparing biodiversity between protected and unprotected sites are lacking in tropical regions. Here we use the largest citizen science biodiversity dataset – eBird – to quantify the extent to which protected areas in eight tropical forest biodiversity hotspots are effective at retaining bird diversity. We find generally positive effects of protection on the diversity of bird species that are forest-dependent, endemic to the hotspots, or threatened or Near Threatened, but not on overall bird species richness. Furthermore, we show that in most of the hotspots examined this benefit is driven by protected areas preventing both forest loss and degradation. Our results provide evidence that, on average, protected areas contribute measurably to conserving bird species in some of the world’s most diverse and threatened terrestrial ecosystems., Assessing the effectiveness of protected areas requires sufficient monitoring data inside and outside of protected areas; such data are lacking in many tropical regions. Here the authors use robust citizen science data on bird occupancy to show that protected areas are effective in maintaining bird species diversity across eight tropical biodiversity hotspots.

Background Persons living with traumatic Spinal Cord Injury (SCI) face challenges when returning to their communities. The Spain Rehabilitation Center at the University of Alabama at Birmingham is developing a continuum of care for SCI patients. The perspectives of individuals with SCI are critical to designing a person-centered approach to the continuum. Objective This study sought to explore the lived experiences of individuals with SCI after their injury, as well as obtain the perspectives of therapists working with SCI patients. Methods Ten persons ranging in age from 23 to 65 years old and living with SCI were recruited to participate in in-depth interviews. We utilized a grounded theory approach to develop descriptive codes and themes. Results Our analysis highlighted domains that are critical to the lives of individuals with SCI including: planning for life after SCI, intrinsic motivation, environmental barriers, financial barriers, role of family, friends, and social networks, and relationships with medical providers. A key theme was the need for more information about how to manage their health condition, including the development of plans that are tailored to their specific needs. Conclusions Individuals with an SCI need access to a continuum of care that addresses both medical and social needs.

Burnout among behavioral health care providers and employees is associated with poor patient and provider outcomes. Leadership style has generally been identified as a means of reducing burnout, yet it is unclear whether some leadership styles are more effective than others at mitigating burnout. Additionally, behavioral health care is provided in a variety of contexts and a leadership style employed in one context may not be effective in another. The purpose of this paper was to review the literature on leadership style and burnout in behavioral health care contexts to identify the different leadership styles and contexts in which the relationship between the two constructs was studied. Studies were categorized based on the leadership style, study design, research methods, and study context. Findings of this review provide insights into potential approaches to prevent employee burnout and its attending costs, as well as ways to improve future research in this critical area.

This study identified and characterized the rates of documentation and guideline-based management of overweight and obese children within an academic pediatric clinic through a retrospective electronic medical record review of 7422 well-child visits in 2016. Diagnosis and treatment were analyzed by patient’s weight diagnosis, sex, age, and provider training level. The percentages of correctly identified severely obese (90.2%), obese (77.0%), and overweight (42.0%) children were much higher than in previous retrospective chart reviews; however, less than 30% of children were referred for more intensive weight management to a dietitian or pediatric obesity weight management program. Increased provider training level was associated with a lower adherence to pediatric obesity guidelines. Strategic modifications to electronic medical records that automatically offer body mass index–associated weight diagnoses with a link to treatment pathways and resources are needed to facilitate improved compliance with current pediatric obesity guidelines in the primary care setting.

The aim of this study was to compare measurement methods of tissue stiffness using ultrasound shear wave elastography (SWE) and superficial mechanical deformation (MyotonPRO) in the infraspinatus, erector spinae, and gastrocnemius muscles. Thirty healthy volunteers were assessed during rest, 40% and 80% maximum voluntary isometric contraction (MVIC). Correlation of the two methods in the three muscle regions was significant (r = 0.23-0.71, p .05), and strongest in the gastrocnemius. MyotonPRO reliability was excellent (ICC 0.93), and demonstrated ability to discriminate between the three levels of muscle contraction. SWE demonstrated good reliability in the resting condition (ICC 0.88), but lower during the 2 MVIC conditions. The utility of SWE during isometric contraction may be limited due to the inability to discriminate between 40% and 80% MVIC.

The purpose of this study was to examine whether cerebral activation in response to noxious mechanical stimuli varies with thrust manipulation (TM) when compared with sham manipulation (SM) as measured by blood oxygenation level-dependent functional magnetic resonance imaging.Twenty-four volunteers (67% female) with complaints of acute or subacute mechanical (nontraumatic) neck pain satisfied eligibility requirements and agreed to participate. Participants were randomized to receive TM to the thoracic spine or SM, and then underwent functional magnetic resonance scanning while receiving noxious stimuli before and after TM or SM. An 11-point numeric pain rating scale was administered pre- and postmanipulation for neck pain and to determine perceptions of pain intensity with respect to neck pain and mechanical stimuli. Blood oxygenation level-dependent functional magnetic resonance imaging recorded the cerebral hemodynamic response to the mechanical stimuli.Imaging revealed significant group differences, with those individuals in the manipulation group exhibiting increased areas of activation (postmanipulation) in the insular and somatosensory cortices and individuals in the sham group exhibiting greater areas of activation in the precentral gyrus, supplementary motor area, and cingulate cortices (P.05). However, between-group differences on the numeric pain rating scale for mechanical stimuli and for self-reported neck pain were not statistically significant.This study provides preliminary level 2b evidence suggesting cortical responses in patients with nontraumatic neck pain may vary between thoracic TM and a sham comparator.

Background The oral microbiota has been implicated in the pathogenesis of rheumatoid arthritis through activation of mucosal immunity. This study tested for associations between oral health, microbial communities and juvenile idiopathic arthritis (JIA). Methods A cross-sectional exploratory study of subjects aged 10–18 years with oligoarticular, extended oligoarticular and polyarticular JIA was conducted. Control groups included pediatric dental clinic patients and healthy volunteers. The primary aim was to test for an association between dental health indices and JIA; the secondary aim was to characterize the microbial profile of supragingival plaque using 16S rRNA gene sequencing. Results The study included 85 patients with JIA, 62 dental patients and 11 healthy child controls. JIA patients overall had significantly more gingival inflammation compared to dental patients, as evidenced by bleeding on probing of the gingiva, the most specific sign of active inflammation (p = 0.02). Overall, however, there was a trend towards better dental hygiene in the JIA patients compared to dental patients, based on indices for plaque, decay, and periodontitis. In the JIA patients, plaque microbiota analysis revealed bacteria belonging to genera Haemophilus or Kingella elevated, and Corynebacterium underrepresented. In poly JIA, bacteria belonging to the genus Porphyromonas was overrepresented and Prevotella was underrepresented. Conclusion Increased gingival inflammation in JIA was independent of general oral health, and thus cannot be attributed to poor dental hygiene secondary to disability. The variation of microbial profile in JIA patients could indicate a possible link between gingivitis and synovial inflammation.

Background and purpose As childhood obesity is a concern in many communities, this study investigated outpatient evaluation and initial management of overweight and obese pediatric patients in U.S. military medical treatment facilities (MTFs). Methods Samples of 579 overweight and 341 obese patients (as determined by body mass index [BMI]) aged 3–17 years were drawn from MTFs. All available FY2011 outpatient records were searched for documentation of BMI assessment, overweight/obesity diagnosis, and counseling. Administrative data for these patients were merged to assess coded diagnostic and counseling rates and receipt of recommended laboratory screenings. Conclusions Generic BMI documentation was high, but BMI percentile assessments were found among fewer than half the patients. Diagnostic recording or recognition totaled 10.9% of overweight and 32.0% of obese. Counseling rates were higher, with 46.4% and 61.0% of overweight and obese patients, respectively, receiving weight related counseling. Among patients 10 years of age or older, rates of recommended lab screenings for diabetes, liver abnormality, and dyslipidemia were not greater than 33%. BMI percentile recording was strongly associated with diagnostic recording, and diagnostic recording was strongly associated with counseling. Implications for practice Improvements to electronic health records or implementation of local procedures to facilitate better diagnostic recording would likely improve adherence to clinical practice guidelines.

[Image: see text] The emergence and evolution of new immunological cancer therapies has sparked a rapidly growing interest in discovering novel pathways to treat cancer. Toward this aim, a novel series of pyrrolidine derivatives (compound 5) were identified as potent inhibitors of ERK1/2 with excellent kinase selectivity and dual mechanism of action but suffered from poor pharmacokinetics (PK). The challenge of PK was overcome by the discovery of a novel 3(S)-thiomethyl pyrrolidine analog 7. Lead optimization through focused structure–activity relationship led to the discovery of a clinical candidate MK-8353 suitable for twice daily oral dosing as a potential new cancer therapeutic.