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Zusammenfassung Einleitung Für eine Verbesserung der Patientenversorgung und die Erhöhung der Lebensmittelsicherheit im Sinne von One Health wurden im Rahmen des Projekts „Integrierte Genomische Surveillance von Zoonoseerregern (IGS-Zoo)“ Konzepte für eine sektorübergreifende genomische Surveillance von Shiga Toxin(Stx)-bildenden bzw. enterohämorrhagischen Escherichia coli (STEC/EHEC) in Deutschland entwickelt. Methoden Mittels Onlineumfrage erfolgte zunächst eine Bestandsaufnahme der aktuell in den Laboratorien im Bereich der staatlichen Untersuchungsämter im Veterinärwesen, der Lebensmittelüberwachung und des Öffentlichen Gesundheitsdienstes der Länder verfügbaren und der tatsächlich angewandten Typisierungsmethoden für diese Erreger. Ergebnisse Von 33 Teilnehmenden konnten 26 Fragebögen hinsichtlich STEC/EHEC ausgewertet werden. Pro Jahr werden in den Laboratorien zwischen 10 und 3500 Proben bearbeitet, daraus werden zwischen 3 und 1000 Erregerisolate gewonnen. Die aktuell am häufigsten verwendete Typisierungsmethode ist dabei die Bestimmung der Stx- und Intimin-kodierenden Gene mittels Polymerase-Kettenreaktion (PCR). Genomsequenzierung (Whole Genome Sequencing, WGS) ist in 8 staatlichen Laboratorien der Länder etabliert und zusätzlich in 9 Einrichtungen geplant. Als häufigstes Hindernis für eine weiterführende STEC/EHEC-Typisierung wurde angeführt, dass auch bei eindeutigem Nachweis des stx-Gens mittels PCR eine Isolierung aus Probenmaterial oftmals nicht erfolgreich ist. Diskussion Die Ergebnisse der Befragung sollen dazu beitragen, die im Projekt entwickelten Analyseverfahren bei der Zielgruppe zu integrieren, und zudem aufzeigen, wo Schwerpunkte bei der bedarfsgerechten Entwicklung von entsprechenden Schulungskonzepten gesetzt werden sollen.

The care of older adults with complex medical conditions requires effective team-based care.Nursing and social work students need a curriculum that provides them with immersive experiences in geriatrics to prepare them for competent practice.This Geriatric Workforce Enhancement Program supported 5 advanced practice nursing (APN) and 5 master of social work (MSW) student fellows in a 2-semester program, with 3 cohorts completing the fellowship over 3 years (N = 30).By the completion of the fellowship, students had (1) demonstrated increased knowledge of age-related changes and health problems experienced by older adults, (2) developed clinical competencies in providing patient-centered health care for older adults, and (3) assessed the fellowship as helpful in preparing for interprofessional team care.An interprofessional gerontology fellowship for APN and MSW students can develop knowledge and skills in team-based care for older adults. Recommendations for creating a fellowship curriculum are provided.

Background and Objective: In 2018, 51% of the 63 pregnancy-associated deaths of women in Indiana were attributed to substance use disorder (SUD), with Black women being disproportionately affected. To address the need for more effective SUD treatment interventions, the community-based addiction reduction (CARE) program connects women of child-bearing ages with SUD with addiction recovery coaches (ARCs) to provide personalized supports throughout recovery. To identify program characteristics that influence the retention of women of color in the program, quantitative analysis of CARE survey data and qualitative analysis of CARE ARC narrative entries of participant encounters were performed. Project Methods: 251 women were enrolled in the CARE program. Chi-square/T-tests compared survey responses by race for treatment status, treatment motivation scales, and retention in the program at intake, 2-, 6-, 9-, and 12-month follow ups. Qualitative analysis of ARC narrative entries was conducted following thematic analysis and crystallization immersion analytic methods based on the grounded theory. Results: Statistical analyses revealed White compared with Black women in the CARE program were significantly more likely to be in treatment at intake (p

The objective of this study was to increase screening for falls and dementia by improving interprofessional (IP) providers' and staffs' knowledge and attitudes toward the care of older patients and team-based care. An intervention, including education about screening and an electronic health record (EHR) flowsheet, was rolled-out across eight Federally Qualified Health Centers (FQHC). Participants were 262 IP health providers who served 6670 patients ≥ age 65 > age 65 . An EHR flowsheet with two-item screeners for falls and dementia triggered automatically for patients ≥ age 65. Documentation of screening for falls and dementia was abstracted from the EHR for the year prior to and the year after the interventions began. Baseline screening rates for falls and dementia were flat; from the start of education intervention until EHR live date, screening rates increased significantly; after EHR live date, the screening rates continued increasing significantly. A combined education-system intervention can improve screening for falls and dementia in FQHC.

The purpose of the program WeCare was to provide a personalized approach to addressing the wide array of psycho-social-cultural-fiscal needs to reduce risk factors for infant mortality (IM) by supporting maternal and infant health through health coaching by community health workers (CHWs). A prospective cohort study of 1,513 women from highest risk ZIP codes for IM in central Indiana were followed over three years. The WeCare program focused on training and deploying CHWs to provide evidence-based, patient-centered social care and support to pregnant and postpartum women and tracked outcomes in health risk categories (mental health, nutrition, safe sleep, breastfeeding) targeted for behavioral change. The low birth weight rate among program participants was lower (8.9%) than Marion County's rate (10%) (p=0.23) with statistically significant improvement in many risk behaviors. Despite limitations, the personalized coaching provided by the CHWs provided an effective, practical approach to maternal and child health disparities.

In order to improve patient care and to increase food safety within the framework of One Health, the project "Integrated Genomic Surveillance of Zoonotic Agents (IGS-Zoo)" aims to develop concepts for a genomic surveillance of Shiga toxin(Stx)-producing and enterohemorrhagic Escherichia coli (STEC/EHEC) in Germany.An online survey was conducted to assess the currently available and applied STEC/EHEC typing methods in the federal laboratories of veterinary regulation, food control, and public health service.Twenty-six questionnaires from 33 participants were evaluated with regard to STEC/EHEC. The number of STEC/EHEC-suspected samples that the laboratories process per year ranges between 10 and 3500, and out of these they obtain between 3 and 1000 pathogenic isolates. Currently the most frequently used typing method is the determination of Stx- and intimin-coding genes using polymerase chain reaction (PCR). Whole genome sequencing (WGS) is currently used by eight federal state laboratories, and nine are planning to implement it in the future. The most common obstacle for further typing of STEC/EHEC is that isolation from sample material is often unsuccessful despite apparent PCR detection of the stx genes.The results of the survey should facilitate the integration of the analysis methods developed in the project and emphasize the target groups' individual needs for corresponding training concepts.EINLEITUNG: Für eine Verbesserung der Patientenversorgung und die Erhöhung der Lebensmittelsicherheit im Sinne von One Health wurden im Rahmen des Projekts „Integrierte Genomische Surveillance von Zoonoseerregern (IGS-Zoo)“ Konzepte für eine sektorübergreifende genomische Surveillance von Shiga Toxin(Stx)-bildenden bzw. enterohämorrhagischen Escherichia coli (STEC/EHEC) in Deutschland entwickelt.Mittels Onlineumfrage erfolgte zunächst eine Bestandsaufnahme der aktuell in den Laboratorien im Bereich der staatlichen Untersuchungsämter im Veterinärwesen, der Lebensmittelüberwachung und des Öffentlichen Gesundheitsdienstes der Länder verfügbaren und der tatsächlich angewandten Typisierungsmethoden für diese Erreger.Von 33 Teilnehmenden konnten 26 Fragebögen hinsichtlich STEC/EHEC ausgewertet werden. Pro Jahr werden in den Laboratorien zwischen 10 und 3500 Proben bearbeitet, daraus werden zwischen 3 und 1000 Erregerisolate gewonnen. Die aktuell am häufigsten verwendete Typisierungsmethode ist dabei die Bestimmung der Stx- und Intimin-kodierenden Gene mittels Polymerase-Kettenreaktion (PCR). Genomsequenzierung (Whole Genome Sequencing, WGS) ist in 8 staatlichen Laboratorien der Länder etabliert und zusätzlich in 9 Einrichtungen geplant. Als häufigstes Hindernis für eine weiterführende STEC/EHEC-Typisierung wurde angeführt, dass auch bei eindeutigem Nachweis des stx-Gens mittels PCR eine Isolierung aus Probenmaterial oftmals nicht erfolgreich ist.Die Ergebnisse der Befragung sollen dazu beitragen, die im Projekt entwickelten Analyseverfahren bei der Zielgruppe zu integrieren, und zudem aufzeigen, wo Schwerpunkte bei der bedarfsgerechten Entwicklung von entsprechenden Schulungskonzepten gesetzt werden sollen.

Sacroiliac joint (SIJ) pain is a common etiology of chronic lower back pain. Treatment of persistent sacroiliac joint pain may entail intraarticular steroid injections and lateral branch radiofrequency neurotomy.This study evaluates the efficacy of SIJ intervention treatments by comparing intraarticular steroid injections with lateral branch radiofrequency neurotomy.Retrospective cohort study.We reviewed electronic medical records of patients with SIJ pain at Massachusetts General Hospital from 2006 through 2016 and identified 354 patients who received 930 SIJ intraarticular injections and 19 patients who received 41 SIJ lateral branch radiofrequency neurotomies.The Numeric Rating Scale (NRS) score for pain and the Eastern Cooperative Oncology Group (ECOG) Performance Status were measured prior to intervention and on follow-up. A mixed effects model was used to evaluate the duration of treatment effect.Patients who received an SIJ intraarticular steroid injection reported lower pain scores following treatment with a mean (standard deviation) NRS reduction from 6.77 (2.25) to 2.72 (2.81). SIJ lateral branch radiofrequency neurotomy resulted in NRS reduction from 5.96 (2.39) to 3.54 (3.14). A linear mixed model analysis suggests SIJ intraarticular steroid injections provided an estimated mean (CI 95%) of 38 (30-46.3) days of pain relief. Lateral branch radiofrequency neurotomy provided 82 (39.4-124.8) days of pain relief. The mean preprocedure ECOG score was 1.22 for both interventions and trended toward improvement with a post SIJ intraarticular injection score of 1.05 and SIJ lateral branch radiofrequency neurotomy score of 1.03.There was variable follow-up reporting among patients. The small size of the lateral branch radiofrequency cohort limited intergroup comparisons.Both SIJ intraarticular steroid injections and SIJ lateral branch radiofrequency neurotomy demonstrated significant pain relief for patients with SIJ pain. SIJ lateral branch radiofrequency neurotomy provided a longer duration of pain relief (82 days) versus SIJ intraarticular steroid injection (38 days).

PURPOSE: Although children with autism spectrum disorder (ASD) often display motor deficits, the nature of these motor deficits remains unspecified. The purpose of this study was to establish a robust motor profile in children with ASD across a wider range of motor skills by using two professionally administered standardized motor assessments alongside a parent report measure to capture a comprehensive view of motor performance compared to a group of neurotypical peers. METHODS: Complex motor skills, balance and global motor performance were compared in twenty-four children, between the ages of 5–12 years, split into two groups: ASD and typically developing. The Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) and the Movement Assessment Battery for Children, Second Edition (MABC-2) were used to examine skill performance. Motor proficiency was also collected using the parent/caregiver form of the Vineland Adaptive Behavior Scales, 3(rd) edition (Vineland-3). RESULTS: Children with ASD presented with significant differences in complex motor skills, balance skills, and global motor performance when compared to their neurotypical peers across all three measures. CONCLUSION: This preliminary study indicated that the children with ASD had greater difficulty with global motor performance, including more difficulty performing complex motor tasks and balance tasks compared to their neurotypical peers. The parents of the children with ASD reported decreased proficiency of motor skills. Overall, the children with ASD demonstrated deficits performing tasks that targeted strength, speed, agility, coordination and both static and dynamic balance. While manifestations of motor skill deficits specific to the ASD population are variable, physical therapists should be included in the ongoing assessment and implementation of comprehensive therapeutic plans for children with ASD.

Background: We examined whether the effect of true electroacupuncture on pain and functionality in chronic pain participants can be differentiated from that of medication (gabapentin) by analyzing quantitative sensory testing (QST). Methods: We recruited chronic back and neck pain participants who received six sessions (twice weekly) of true electroacupuncture versus sham electroacupuncture or 3 weeks of gabapentin versus placebo treatment. QST profiles, pain scores, and functionality profile were obtained at baseline (visit 1) and after three sessions (visit 4) or six sessions (visit 7) of acupuncture or 3 weeks of gabapentin or placebo. Results: A total of 50 participants were analyzed. We found no differences in QST profile changes (p = 0.892), pain reduction (p = 0.222), or functionality (p = 0.254) between the four groups. A major limitation of this pilot study was the limited number of study participants in each group. Conclusion: This pilot study suggests that a large-scale clinical study with an adequate sample size would be warranted to compare acupuncture and medication therapy for chronic pain management. Trial registration number: NCT01678586 (ClinicalTrials.gov).

DNA methylation is one of the most important epigenetic modifications and is closely related with several biological processes such as regulation of gene transcription and the development of non-malignant diseases. The prevailing dogma states that DNA methylation in eukaryotes occurs essentially through 5-methylcytosine (5mC) but recently adenine methylation was also found to be present in eukaryotes. In mouse embryonic stem cells, 6-methyladenine (6mA) was associated with the repression and silencing of genes, particularly in the X-chromosome, known to play an important role in cell fate determination. Here, we have demonstrated that 6mA is a ubiquitous eukaryotic epigenetic modification that is put in place during epigenetically sensitive periods such as embryogenesis and fetal development. In somatic cells there are clear tissue specificity in 6mA levels, with the highest 6mA levels being observed in the brain. In zebrafish, during the first 120 h of embryo development, from a single pluripotent cell to an almost fully formed individual, 6mA levels steadily increase. An identical pattern was observed over embryonic days 7-21 in the mouse. Furthermore, exposure to a neurotoxic environmental pollutant during the same early life period may led to a decrease in the levels of this modification in female rats. The identification of the periods during which 6mA epigenetic marks are put in place increases our understanding of this mammalian epigenetic modification, and raises the possibility that it may be associated with developmental processes. ispartof: FRONTIERS IN GENETICS vol:12 ispartof: location:Switzerland status: published

Health outcomes for complex older adults are enhanced by interprofessional collaboration. Funded by a Geriatrics Workforce Enhancement Program (GWEP), an interprofessional team of educators developed a short-term geriatrics experience, including four hours of pre-clinical education and 12-20 hours of immersion in team-based care for advanced learners in nursing (n = 70 APN), social work (n = 48 MSW), and medicine (n = 122 medical students). Content focused on five areas: medication management, dementia, depression, falls, and myths about aging. Learners completed pre/post surveys measuring knowledge of geriatrics, attitudes toward geriatric patients and team care, and post-surveys regarding perceptions of the overall clinical experience. Results showed significant improvement in knowledge and attitudes toward older adults and interprofessional (IP) team practice. Qualitative comments reflected increased empathy toward and enthusiasm for working with older adults, valuing IP teams, and a desire for geriatrics content earlier in their respective curricula.

Numerous preclinical studies support the role of spinal neuroimmune activation in the pathogenesis of chronic pain, and targeting glia (eg, microglia/astrocyte)- or macrophage-mediated neuroinflammatory responses effectively prevents or reverses the establishment of persistent nocifensive behaviors in laboratory animals. However, thus far, the translation of those findings into novel treatments for clinical use has been hindered by the scarcity of data supporting the role of neuroinflammation in human pain. Here, we show that patients suffering from a common chronic pain disorder (lumbar radiculopathy), compared with healthy volunteers, exhibit elevated levels of the neuroinflammation marker 18 kDa translocator protein, in both the neuroforamina (containing dorsal root ganglion and nerve roots) and spinal cord. These elevations demonstrated a pattern of spatial specificity correlating with the patients' clinical presentation, as they were observed in the neuroforamen ipsilateral to the symptomatic leg (compared with both contralateral neuroforamen in the same patients as well as to healthy controls) and in the most caudal spinal cord segments, which are known to process sensory information from the lumbosacral nerve roots affected in these patients (compared with more superior segments). Furthermore, the neuroforaminal translocator protein signal was associated with responses to fluoroscopy-guided epidural steroid injections, supporting its role as an imaging marker of neuroinflammation, and highlighting the clinical significance of these observations. These results implicate immunoactivation at multiple levels of the nervous system as a potentially important and clinically relevant mechanism in human radicular pain, and suggest that therapies targeting immune cell activation may be beneficial for chronic pain patients.

Author(s): Chung, Arlene S.; Smart, Jon; Zdradzinski, Michael; Roth, Sarah; Gende, Alecia; Conroy, Kylie; Battaglioli, Nicole | Abstract: Introduction: Burnout, depression, and suicidality among residents of all specialties have become a critical focus of attention for the medical education community. Methods: As part of the 2017 Resident Wellness Consensus Summit in Las Vegas, Nevada, resident participants from 31 programs collaborated in the Educator Toolkit workgroup. Over a seven-month period leading up to the summit, this workgroup convened virtually in the Wellness Think Tank, an online resident community, to perform a literature review and draft curricular plans on three core wellness topics. These topics were second victim syndrome, mindfulness and meditation, and positive psychology. At the live summit event, the workgroup expanded to include residents outside the Wellness Think Tank to obtain a broader consensus of the evidence-based toolkits for these three topics. Results: Three educator toolkits were developed. The second victim syndrome toolkit has four modules, each with a pre-reading material and a leader (educator) guide. In the mindfulness and meditation toolkit, there are three modules with a leader guide in addition to a longitudinal, guided meditation plan. The positive psychology toolkit has two modules, each with a leader guide and a PowerPoint slide set. These toolkits provide educators the necessary resources, reading materials, and lesson plans to implement didactic sessions in their residency curriculum. Conclusion: Residents from across the world collaborated and convened to reach a consensus on high-yield—and potentially high-impact—lesson plans that programs can use to promote and improve resident wellness. These lesson plans may stand alone or be incorporated into a larger wellness curriculum.

Background: Although spinal cord stimulation (SCS) therapy has been shown to be efficacious in various pain conditions, the ability for SCS therapy to maintain long-term efficacy has been questioned. Objective: The purpose of this study was to investigate whether a loss of efficacy (LOE) phenomenon exists with SCS therapy and to investigate if this phenomenon is more apparent in any specific patient population. Study Design: A retrospective, observation chart review was conducted to evaluate the patient response to SCS therapy over time. Setting: Massachusetts General Hospital, Boston, Massachusetts. Methods: Patients who received a SCS at the Massachusetts General Hospital, between January 1, 2002 and December 31, 2012, were invited to participate. A total of 62 patients were included in this study. Various models were created to analyze pain score changes over time using 2-tailed statistical analysis. Additionally, one-way ANOVA and Pearson’s chi-square tests were used to determine if certain patient characteristics were associated with LOE. Results: Compared to the visual analog scale (VAS) score at one month after device implantation, pain scores increased 1.95 points after 2 years (95% CI: 1.06 to 2.84, P = < 0.001). There were no significant differences in baseline characteristics between the groups of patients who did and did not lose efficacy of their therapy. However, those who experienced LOE had a baseline SCS therapy VAS score 3.09 points lower than those who did not (95% CI: 1.69 to 4.48, P = < 0.001). Limitations: This study had several limitations including the retrospective nature of its design, confounders to VAS scores, small sample size, missing data points, and the evaluation of only conventional, low-frequency SCS therapy. Conclusions: Patients who received a SCS had a significant increase in VAS scores over time. Our data did not show any baseline patient characteristic that helped predict LOE. However, patients who have significant baseline response to therapy may be more likely to experience LOE. Key words: Spinal cord stimulation, chronic pain, retrospective study, low frequency electrical stimulation, efficacy, chronic pain therapy

Background and Hypothesis: Marion County suffers from stark racial disparities in infant mortality rate (IMR) with black babies experiencing an IMR of 11.6 and white babies 4.5, to culminate at a state average of 7.3. Since 2016, WeCare Indiana has worked to reduce the IMR in Central Indiana by connecting pregnant, post-partum, and childbearing age women with Community Health Workers (CHW) and community organizations that help with areas including but not limited to baby supplies, housing, and food insecurity. The goal of this research was to identify factors that promote changes in behaviors in WeCare clients as well as barriers to behavior modification in relation to the five pillars of the WeCare program: food insecurity, mental health, smoking, breastfeeding, and safe sleep. Experimental Design or Project Methods: Qualitative analysis of unstructured CHW follow-up notes from 2016 to 2018 of 1775 WeCare clients from mostly 13 highest risk zip codes for IM in Central Indiana was completed using keyword searches and clustering narrative entries into themes associated with the apriori areas of behavioral change. Results: Several key influencers of behavioral change were identified: (1) CHW dissemination of eligibility information about WIC, (2) CHW referral of clients to behavioral health resources, and (3) Pack n Play resources bundled with Safe Sleep class. Persistent barriers to positive behavioral change included: (1) lack of transportation to food resources, (2) unmanaged stress propagating substance use and smoking, (3) employment interfering with breastfeeding, and (4) lack of Safe Sleep education for all caretakers. Conclusion and Potential Impact: Next steps include sharing qualitative findings with CHW to reinforce positive behavioral change as well as investigating solutions for the barriers that prevent change within the five pillars of WeCare Indiana. Data from this study will be used to help interpret the calculated behavioral change scores relative to baseline measures that were found from quantitative analysis.

Cortical neuronal circuits along the sensorimotor pathways are shaped by experience during critical periods of heightened plasticity in early postnatal development. After closure of critical periods, measured histologically by the formation and maintenance of extracellular matrix structures called perineuronal nets (PNNs), the adult mouse brain exhibits restricted plasticity and maturity. Mature PNNs are typically considered to be stable structures that restrict synaptic plasticity on cortical parvalbumin+ (PV+) GABAergic neurons. Changes in environment (i.e., novel behavioral training) or social contexts (i.e., motherhood) are known to elicit synaptic plasticity in relevant neural circuitry. However, little is known about concomitant changes in the PNNs surrounding the cortical PV+ GABAergic neurons. Here, we show novel changes in PNN density in the primary somatosensory cortex (SS1) of adult female mice after maternal experience [called surrogate (Sur)], using systematic microscopy analysis of a whole brain region. On average, PNNs were increased in the right barrel field and decreased in the left forelimb regions. Individual mice had left hemisphere dominance in PNN density. Using adult female mice deficient in methyl-CpG-binding protein 2 (MECP2), an epigenetic regulator involved in regulating experience-dependent plasticity, we found that MECP2 is critical for this precise and dynamic expression of PNN. Adult naiveMecp2-heterozygous (Het) females had increased PNN density in specific subregions in both hemispheres before maternal experience, compared with wild-type (WT) littermate controls. The laterality in PNN expression seen in naive Het (NH) was lost after maternal experience in Sur Het (SH) mice, suggesting possible intact mechanisms for plasticity. Together, our results identify subregion and hemisphere-specific alterations in PNN expression in adult females, suggesting extracellular matrix plasticity as a possible neurobiological mechanism for adult behaviors in rodents.

In this randomized clinical trial, we examined whether the effect of true acupuncture can be differentiated from sham acupuncture (pain and functionality) by analyzing quantitative sensory testing (QST) profiles in chronic pain participants. We recruited 254 healthy or chronic back and neck pain participants. Healthy subjects were included to control for a possible effect of acupuncture on baseline QST changes. Study participants received 6 sessions (twice weekly) of true acupuncture, sham acupuncture, or no acupuncture treatment (routine care). Quantitative sensory testing profiles, pain scores, and functionality profile were obtained at baseline (visit 1) and after 3 (visit 4) or 6 sessions (visit 7). A total of 204 participants were analyzed. We found no QST profile changes among 3 groups (P = 0.533 and P = 0.549, likelihood ratio tests) in either healthy or chronic pain participants. In chronic back and neck pain participants, true acupuncture reduced pain (visit 4: difference in mean [DIM] = -0.8, 95% confidence interval [CI]: -1.4 to -0.1, adjusted P = 0.168; visit 7: DIM = -1.0, 95% CI: -1.7 to -0.3, adjusted P = 0.021) and improved functional status including physical functioning (DIM = 14.21, 95% CI: 5.84-22.58, adjusted P = 0.003) and energy/fatigue (DIM = 12.28, 95% CI: 3.46-21.11, adjusted P = 0.021) as compared to routine care. Our results indicate that QST was not helpful to differentiate between true acupuncture and sham acupuncture (primary outcome) in this study, although true acupuncture reduced pain and improved functionality (secondary outcomes) when compared with routine care.

A thorough understanding of the physiological processes that underlie muscle tension is foundational to any discussion on environments and substances that alter such a process. The fascial web, an interconnection of the various fascia, extends throughout the entire body and acts to link every area of the body together and connect external and internal structures. It is the fascial tissue that transmits forces locally (i.e., between muscle and bone or between muscle and ligament) and distally, thereby creating muscle contraction in interconnected but distant areas of the body. Fascia is composed of various cell types, fibers (elastin, collagen, and reticular), and a fluid-like ground substance that is rich in proteoglycans. Fascial tissue responds both acutely and chronically to its environment via adaptations in both collagen and proteoglycan structure. Acutely, this results in the normal contraction of muscles and resultant movement, such as looking down at one's feet while walking, but chronically it can result in chronic pain syndromes, including tension headaches, due to tensegrity (tensional integrity) changes in the fascial framework. This can occur as a response to repetitive strain or acute injury. The purpose of this discussion is to provide an overview of some of the many influences on muscle tension from the perspective of a naturopathic doctor. I will use tension headaches as an example, though the principles discussed here may be extended to many different chronic pain syndromes.

We introduce a concurrent solver for the periodic event scheduling problem (PESP). It combines mixed integer programming techniques, the modulo network simplex method, satisfiability approaches, and a new heuristic based on maximum cuts. Running these components in parallel speeds up the overall solution process. This enables us to significantly improve the current upper and lower bounds for all benchmark instances of the library PESPlib.

ObjectiveCorrelation between radiologic structural abnormalities and clinical symptoms in low back pain patients is poor. There is an unmet clinical need to image inflammation in pain conditions to aid diagnosis and guide treatment. Ferumoxytol, an ultrasmall superparamagnetic iron oxide (USPIO) nanoparticle, is clinically used to treat iron deficiency anemia and showed promise in imaging tissue inflammation in human. We explored whether ferumoxytol can be used to identify tissue and nerve inflammation in pain conditions in animals and humans.MethodsComplete Freud’s adjuvant (CFA) or saline was injected into mice hind paws to establish an inflammatory pain model. Ferumoxytol (20 mg/kg) was injected intravenously. Magnetic resonance imaging (MRI) was performed prior to injection and 72 hours postinjection. The changes in the transverse relaxation time (T2) before and after ferumoxytol injection were compared between mice that received CFA vs saline injection. In the human study, we administered ferumoxytol (4 mg/kg) to a human subject with clinical symptoms of lumbar radiculopathy and compared the patient with a healthy subject.ResultsMice that received CFA exhibited tissue inflammation and pain behaviors. The changes in T2 before and after ferumoxytol injection were significantly higher in mice that received CFA vs saline (20.8 ± 3.6 vs 2.2 ± 2.5, P = 0.005). In the human study, ferumoxytol-enhanced MRI identified the nerve root corresponding to the patient’s symptoms, but the nerve root was not impinged by structural abnormalities, suggesting the potential superiority of this approach over conventional structural imaging techniques.ConclusionsFerumoxytol-enhanced MRI can identify tissue and nerve inflammation and may provide a promising diagnostic tool in assessing pain conditions in humans.

Background Childhood obesity has increased dramatically over several decades, and the American Academy of Pediatrics has recommended primary care practices as ideal sites for the identification, education, and implementation of therapeutic interventions. The objective of this study was to describe the implementation and results for the Fit Family Challenge (FFC), a primary care-based childhood obesity intervention. Methods A single-intervention pilot project that trains primary care practices on childhood obesity guidelines and implementation of a family-focused behavior modification curriculum. A total of 29 family medicine and pediatric community practices in Colorado participated. Participants included 290 patients, aged 6 to 12 years, with a body mass index (BMI) above the 85th percentile. The main outcome measure included the feasibility of implementation of a childhood obesity program in primary care; secondary outcomes were changes in BMI percentile, BMI z-scores, blood pressure, and changes in lifestyle factors related to childhood obesity. Results Implementation of FFC is feasible, statically significant changes were seen for decreases in BMI percentile and BMI z-scores for participants who completed 9 to 15 months of follow-up; lifestyle factors related to childhood obesity in proved Spanish-speaking families and food insecurity were associated with less follow-up time (P Conclusions A primary care-based childhood obesity intervention may result in significant clinical and lifestyle changes.

Studies from behavioral genetics have demonstrated the high heritability of intelligence. However, the endeavor to detect the genes forming the molecular basis of intelligence has been rather unsuccessful until now. Pharmacological studies have demonstrated the influence of the dopaminergic (DA) and the serotonergic (5-HT) system on subcomponents of cognitive functioning, and first studies from molecular genetics have demonstrated that genes related to the DA metabolism are associated with mental abilities. However, candidate genes for creativity have not been identified so far. Therefore, the influence of the catechol-O-methyltransferase (locus: COMT VAL158MET) gene and the dopamine D2 receptor gene (locus: DRD2 TAQ IA) on creativity was tested in addition to a serotonergic gene, TPH1 (locus: TPH-A779C), in a sample of N = 92 healthy Caucasian subjects while controlling for intelligence. Results showed that the DRD2 gene and the TPH gene were both associated with total creativity, explaining 9% of the variance, while COMT was not related to creativity at all. With respect to the subcomponents, the A1+ allele of DRD2 was related to higher verbal creativity as compared to the A1- allele, and carriers of the A allele of TPH1 showed significantly higher scores in figural and in numeric creativity, indicating that the two gene loci discriminate between higher cortical functions according to the organization of cognitive functions in the respective hemispheres.