Exploring downstream effects of gender roles in healthcare decision-making and relationships within systems: A cross-sectional analysis of openness to treatment in pediatric headache.

OBJECTIVE: Socio-culturally defined identity factors present significant and often understudied influences on the experience, management, and treatment of chronic pain. For instance, there exist societal narratives about how males and females are expected to experience and express pain. Such gender roles may impact youth and caregiver openness to individual multidisciplinary treatments for pediatric headache. METHODS: In this cross-sectional study, participants (N = 1087 youth/caregiver dyads, Mage = 14.5 years, 71% female, 97% cisgender, 77% White) completed a series of questionnaires, including Openness to Headache Treatment (OHT), upon presenting for initial multidisciplinary evaluation of chronic headache. Pearson correlations, independent samples t-tests and hierarchical regressions were used to analyze potential gender differences in youth and caregiver openness, as well as its relationships with pain-related and psychological factors. RESULTS: Overall, female youth and their caregivers were more open to headache treatment, broadly and for individual interventions, when compared to male counterparts. Caregiver distress related to their child's headaches (i.e., fear and avoidance) was significantly correlated with openness in female youth and their caregivers, but not males. CONCLUSION: Gendered patterns in healthcare decision-making in youth and caregivers provide insight on individual, societal, and systemic gender bias.

Disparities in access but not outcomes: Medicaid versus non-Medicaid patients in multidisciplinary chronic pain rehabilitation.

Purpose: There are known disparities in chronic pain severity, treatment, and opioid-related risks amongst individuals from lower socioeconomic status, including Medicaid beneficiaries, but little is known about whether Medicaid beneficiaries benefit in a similar way from multidisciplinary chronic pain rehabilitation. This study investigated differences in clinical outcomes between Medicaid and non-Medicaid beneficiaries who completed a 3-week multidisciplinary chronic pain rehabilitation program.Methods: Participants (N = 131) completed a broad range of clinical measures pre- and post-treatment including pain severity, pain interference, depression, anxiety, objective physical functioning, and opioid misuse risk. Patients with Medicaid were compared with non-Medicaid patients in terms of baseline characteristics and rate of change, utilizing two-factor repeated measures analyses of variance.Results: There were baseline characteristic differences, with Medicaid beneficiaries being more likely to be African American, have higher rates of pain, worse physical functioning, and lower rates of opioid use. Despite baseline differences, both groups demonstrated significantly improved outcomes across all measures (p<.001) and no significant difference in rate of improvement.Conclusions: Results suggest that pain rehabilitation is as effective for Medicaid recipients as non-Medicaid recipients. Patients with Medicaid are particularly vulnerable to disparities in treatment, so efforts to expand access to multidisciplinary pain treatments are warranted.

Medicaid beneficiaries, who tend to be from lower socioeconomic status (SES), with chronic pain have poorer baseline functioning compared to non-Medicaid beneficiaries, including worse pain severity, poorer physical functioning, and higher levels of anxiety.Medicaid beneficiaries appear to benefit significantly and in a similar way to non-Medicaid individuals from participating in multidisciplinary, non-pharmacological chronic pain rehabilitation.Expanding access to evidence-based chronic pain rehabilitation, including nonopioid and multidisciplinary treatments, is a key component to address the chronic pain and opioid crises that differentially impact individuals from lower SES.

Engaging the Lower Extremity via Active Therapy Early (ELEVATE) Is Feasible and May Improve Gross Motor Function in Children with Spastic Bilateral Cerebral Palsy: A Case Series.

Purpose: The feasibility of ELEVATE with respect to adherence and preliminary efficacy was determined for children with spastic bilateral cerebral palsy (CP) from encephalopathy of prematurity. Methods: A case series was used. Participants were randomized to receive ELEVATE immediately or delay the intervention by 3 months before receiving the intervention. The outcomes included feasibility measures of (1) number of children recruited, (2) percentage of sessions attended, (3) stride counts during the intervention, and preliminary efficacy measures of change over the intervention period in (4) Gross Motor Function Measure-66 (GMFM-66), and (5) kinematics and weight-bearing during treadmill walking. Results: Four boys under 3 years of age participated. All participants tolerated 60-minute intervention sessions four times/week for 12 weeks, and attended 75%-94% (min-max) of the targeted sessions. The median step count per session ranged from 833 to 2484 steps (min-max) during the final week of training. Participants showed an increase in GMFM-66 score of 2.4-7.5 points (min-max) over the 3-month intervention phase, as compared to a decrease of 1.7 for one participant and an increase of 1.3 for another over the delay period. Three participants demonstrated small improvements in their gait with the intervention. Conclusions: Engaging young children with bilateral CP in intensive rehabilitation targeting gross motor function was feasible and demonstrated preliminary efficacy. The results have guided the design of a larger clinical trial to assess efficacy of early, active interventions for children with spastic bilateral CP.

Objectif: les chercheurs ont déterminé la faisabilité d'ELEVATE en matière d'adhésion et d'efficacité préliminaire chez des enfants ayant une paralysie cérébrale spastique bilatérale (PC) causée par une encéphalopathie de la prématurité. Méthodologie: série de cas. Les participants ont été choisis au hasard entre l'utilisation immédiate d'ELEVATE ou son report de trois mois. Les résultats incluaient des mesures de fiabilité, soit 1) le nombre d'enfants recrutés, 2) le pourcentage de séances suivies, 3) le compte des foulées pendant l'intervention et les mesures d'efficacité préliminaire pendant la période de l'intervention sur le plan de 4) la mesure de la fonction motrice globale 66 (GMFM-66) et de 5) la cinématique et la mise en charge pendant la marche sur tapis roulant. Résultats: quatre garçons de moins de trois ans ont participé. Tous ont toléré des séances d'intervention de 60 minutes quatre fois par semaine pendant 12 semaines et ont assisté à 75 % à 94 % (minimum-maximum) des séances ciblées. Le compte médian de foulées par séance se situait entre 833 et 2 484 foulées (minimum­maximum) lors de la dernière semaine d'entraînement. Les participants ont présenté une augmentation de 2,4 à 7,5 points (minimum-maximum) au score du GMFM-66 pendant les trois mois de la phase d'intervention, par rapport à une diminution de 1,7 point chez un participant et à une augmentation de 1,3 point chez un autre pendant la période de report. Trois participants ont démonté de légères améliorations de leur démarche grâce à l'intervention. Conclusions: il est faisable de faire participer des jeunes enfants ayant une PC bilatérale à une réadaptation intensive visant la fonction motrice globale, et cette intervention a une efficacité préliminaire démontrée. Les résultats ont entraîné la conception d'une étude clinique plus vaste pour évaluer l'efficacité d'interventions précoces actives chez les enfants ayant une PC bilatérale spastique.

Behavior Management in Young Children Exposed to Trauma: A Case Study of Three Evidence-Based Treatments.

Young children are particularly vulnerable to traumatic events and the development of posttraumatic stress symptoms, including comorbid disruptive behaviors. Fortunately, several evidence-based interventions have been shown to be effective at decreasing both posttraumatic stress symptoms and disruptive behaviors in young children. This paper provides an overview of three such interventions-Child-Parent Psychotherapy (CPP), Parent-Child Interaction Therapy (PCIT), and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). An illustrative case study is used to compare how each intervention addresses disruptive behaviors, with a focus on theoretical underpinnings, model similarities, and model differences. The models each have empirical evidence for the treatment of disruptive behavior in young children, and therefore, may be appropriate for treating children with a history of trauma exposure and comorbid disruptive behaviors. Child, caregiver, and environmental factors are essential to consider when identifying an evidence-based intervention for this population.

Eating Disorder Risk and Pathogenic Behaviors Among Collegiate Student-Athletes.

CONTEXT: Eating disorders (EDs) are a cluster of behavioral conditions characterized by uneasy thoughts and behaviors that grow into severe or persistent eating disturbances. The demands on student-athletes may create mental and physical stressors that increase the likelihood of EDs and disordered eating. OBJECTIVE: To examine the ED risk through eating attitudes and behaviors in male and female student-athletes and across various sport types (endurance, aesthetic, power, ball or team, or technical sports). DESIGN: Cross-sectional study. SETTING: Collegiate athletics. PATIENTS OR OTHER PARTICIPANTS: National Collegiate Athletic Association Division I and II student-athletes (n = 2054; males = 631; females = 1423) from 40 institutions. MAIN OUTCOME MEASURE(S): Participants completed a web-based demographic survey and the Eating Attitudes Test-26 (EAT-26). Multiple χ2 analyses examined participants classified as at risk for EDs. Independent-samples t tests and a 1-way analyses of variance compared sex and sport type across EAT-26 totals and subscale (Dieting, Bulimia, and Oral Control) scores. RESULTS: Overall, 25.3% (n = 520/2054) of student-athletes were classified as at risk for EDs. Differences were found between sex and ED risk (χ21,2054 = 32.9, P ≤ .01; 17.3% [n = 109/631] males, 28.9% [n = 411/1423] females) and across ED risk and sport type (χ24,2054 = 13.4, P = .01). When examining females only, we observed differences across ED risk and sport type (χ24,1423 = 13.4, P ≤ .01). No differences were evident across ED risk and sport type for males. Differences were seen between sex and binge eating (χ21,2054 = 6.8, P = .009), sex and diet pill use (χ21,2054 = 19.6, P ≤ .01), and sport type and diet pill use (χ24,2054= 12.2, P = .016), excessive exercise (χ24,2054 = 32.1, P ≤ .01), and losing more than 20 lb (9 kg) in the last 6 months (χ24,2054 = 10.2, P ≤ .037). CONCLUSIONS: Student-athletes in the collegiate setting are at risk for EDs. Medical professionals, such as athletic trainers, need to be educated on the potential risk factors that may lead to EDs. Protocols for prevention, screening and recognition, and referral should be developed for student-athletes at risk for EDs.

The Telehealth Tradeoff: A Multimethod Study of the Benefits and Challenges Associated With Maintaining Treatment Outcomes Using a Hybrid Model of Pediatric Intensive Interdisciplinary Pain Treatment.

OBJECTIVES: The COVID-19 pandemic required intensive interdisciplinary pain treatment (IIPT) programs to shift to virtual models of care. This study used a multimethod approach to examine outcomes of a pediatric hybrid IIPT program (50% in-person treatment and 50% synchronous video-based telehealth) and assessed staff experiences while treating within this model. MATERIALS AND METHODS: Patients (M=14.73, SD=2.04; 79% female) reported pain intensity, functional disability, and psychological factors (anxiety, depressive symptoms, fear of pain, pain catastrophizing, social functioning) at admission, discharge, and short-term follow-up. Differences in treatment outcomes at discharge and short-term follow-up between patients who participated in the hybrid IIPT model (n=42) during the pandemic and those who participated in the traditional in-person model before the pandemic (n=42) were examined. Quantitative assessments of staff burnout and perceived effort and qualitative assessments exploring staff perspectives about the challenges and advantages of the hybrid IIPT model were gathered. RESULTS: Youth in both groups made significant improvements across the majority of treatment outcomes; however, the hybrid group reported higher levels of pain at discharge and anxiety at follow-up. The majority of IIPT staff reported moderate to high levels of overall burnout, and almost half reported high levels of emotional exhaustion. Staff highlighted various challenges and benefits associated with treating within the hybrid model. DISCUSSION: When considering telehealth as a treatment tool for youth with complex chronic pain, it is crucial to leverage its benefits while addressing its challenges for patients and providers.

OnabotulinumtoxinA for Pediatric Migraine.

BACKGROUND: Migraine is a painful, prevalent, and problematic condition among children. Children need access to safe and effective treatment options to alleviate the impact of this chronic condition on their wellbeing. CLINICAL IMPLICATIONS: Nurses have a crucial role in supporting patient access to BTX-A. Given the results of this and other studies demonstrating the safety and efficacy of BTX-A in children, nurses can support policy change for health plans to fund this intervention for pediatric migraineurs. Allowing children to receive the safe and effective BTX-A injections will lessen the already significant impact of chronic migraine on their physical, emotional and mental health. Nurses can also play a key role in providing education to patients regarding safe administration of BTX-A for migraine. AIM: The objective of this study was to define the experiences, effects, and clinical response of children to onabotulinumtoxinA (BTX-A) for migraine prevention. METHODS: Clinical documentation for patients aged 13-17 years presenting for BTX-A treatment for chronic migraine between 2016-2022 in a community-based specialty clinic within a large, urban, pediatric academic medical center were included. A series of one-way repeated measures (analysis of variance [ANOVA]) were conducted to compare headache frequency, severity, and duration at baseline, and following first and second injections of BTX-A. RESULTS: Of 32 eligible participants, administration of BTX-A demonstrated a decrease in headache frequency and severity. Participants reported nearly seven fewer headache days per month. Participants reported neck stiffness, fever or flu-like symptoms, fatigue, and worsening pain following BTX-A administration. CONCLUSIONS: Pediatric migraineurs need therapies that are safe, effective, and accessible. BTX-A was a safe and effective treatment for migraine among the children included in this study.

Associations of bedroom PM2.5, CO2, temperature, humidity, and noise with sleep: An observational actigraphy study.

OBJECTIVE: Climate change and urbanization increasingly cause extreme conditions hazardous to health. The bedroom environment plays a key role for high-quality sleep. Studies objectively assessing multiple descriptors of the bedroom environment as well as sleep are scarce. METHODS: Particulate matter with a particle size <2.5 µm (PM2.5), temperature, humidity, carbon dioxide (CO2), barometric pressure, and noise levels were continuously measured for 14 consecutive days in the bedroom of 62 participants (62.9% female, mean ± SD age: 47.7 ± 13.2 years) who wore a wrist actigraph and completed daily morning surveys and sleep logs. RESULTS: In a hierarchical mixed effect model that included all environmental variables and adjusted for elapsed sleep time and multiple demographic and behavioral variables, sleep efficiency calculated for consecutive 1-hour periods decreased in a dose-dependent manner with increasing levels of PM2.5, temperature, CO2, and noise. Sleep efficiency in the highest exposure quintiles was 3.2% (PM2.5, p < .05), 3.4% (temperature, p < .05), 4.0% (CO2, p < .01), and 4.7% (noise, p < .0001) lower compared to the lowest exposure quintiles (all p-values adjusted for multiple testing). Barometric pressure and humidity were not associated with sleep efficiency. Bedroom humidity was associated with subjectively assessed sleepiness and poor sleep quality (both p < .05), but otherwise environmental variables were not statistically significantly associated with actigraphically assessed total sleep time and wake after sleep onset or with subjectively assessed sleep onset latency, sleep quality, and sleepiness. Assessments of bedroom comfort suggest subjective habituation irrespective of exposure levels. CONCLUSIONS: These findings add to a growing body of evidence highlighting the importance of the bedroom environment-beyond the mattress-for high-quality sleep.

Energy Availability, Mental Health, and Sleep Patterns of Athletic Trainers.

CONTEXT: Engaging in exercise and appropriate nutritional intake improves mental health by reducing anxiety, depression, and sleep disturbances. However, few researchers have examined energy availability (EA), mental health, and sleep patterns in athletic trainers (ATs). OBJECTIVE: To examine ATs' EA, mental health risk (ie, depression, anxiety), and sleep disturbances by sex (male, female), job status (part time [PT AT], full time [FT AT]), and occupational setting (college or university, high school, or nontraditional). DESIGN: Cross-sectional study. SETTING: Free living in occupational settings. PATIENTS OR OTHER PARTICIPANTS: A total of 47 ATs (male PT ATs = 12, male FT ATs = 12; female PT ATs = 11, female FT ATs = 12) in the southeastern United States. MAIN OUTCOME MEASURE(S): Anthropometric measurements consisted of age, height, weight, and body composition. Energy availability was measured through energy intake and exercise energy expenditure. We used surveys to assess the depression risk, anxiety (state or trait) risk, and sleep quality. RESULTS: Thirty-nine ATs engaged in exercise, and 8 did not exercise. Overall, 61.5% (n = 24/39) reported low EA (LEA); 14.9% (n = 7/47) displayed a risk for depression; 25.5% (n = 12/47) indicated a high risk for state anxiety; 25.5% (n = 12/47) were at high risk for trait anxiety, and 89.4% (n = 42/47) described sleep disturbances. No differences were found by sex and job status for LEA, depression risk, state or trait anxiety, or sleep disturbances. Those ATs not engaged in exercise had a greater risk for depression (risk ratio [RR] = 1.950), state anxiety (RR = 2.438), trait anxiety (RR = 1.625), and sleep disturbances (RR = 1.147), whereas ATs with LEA had an RR of 0.156 for depression, 0.375 for state anxiety, 0.500 for trait anxiety, and 1.146 for sleep disturbances. CONCLUSIONS: Although most ATs engaged in exercise, their dietary intake was inadequate, they were at increased risk for depression and anxiety, and they experienced sleep disturbances. Those who did not exercise were at an increased risk for depression and anxiety. Energy availability, mental health, and sleep affect overall quality of life and can affect ATs' ability to provide optimal health care.

Effects of Swaddling During Bottle Feeding in Preterm Infants.

BACKGROUND: Preterm infants have immature oral feeding skills, affecting length of hospital stay and long-term feeding outcomes. Swaddling has positive effects on pain and stress responses, state regulation, and physiological stability in preterm infants in the neonatal intensive care unit (NICU). Swaddling during bottle feeding may support preterm infant behavioral organization and oral feeding skills. Swaddling is used inconsistently during feeding in the NICU and has not been critically examined for effects on bottle feeding performance in preterm infants. PURPOSE: To examine the effects of swaddling on bottle feeding quality and efficiency in preterm infants. METHODS: A convenience sample of 30 infants born before 34 weeks of gestation was selected in an urban level IV NICU. Using an experimental, randomized crossover design, each infant was swaddled for one feeding and unswaddled for one feeding. Feeding efficiency was measured by rate and volume consumed. Feeding quality was examined by the Early Feeding Skills Assessment and frequency of physiological changes. Data were analyzed using dependent t tests and Wilcoxon signed rank test. RESULTS: When swaddled, participants demonstrated significantly better scores on all related subtests of the Early Feeding Skills Assessment ( P ≤ .001). Infants demonstrated no difference in frequency of bradycardia or oxygen desaturations greater than 4 seconds. No significant differences were found in feeding efficiency outcomes. IMPLICATIONS FOR PRACTICE AND RESEARCH: Swaddling can be used in the NICU to improve bottle feeding quality in preterm infants. Future investigation is needed on long-term effects of swaddling during bottle feeding on feeding performance, weight gain, and length of stay.

An immunization quality improvement learning collaborative in the college health setting.

OBJECTIVE: To increase administration of influenza (flu), human papillomavirus (HPV) and meningococcal serogroup B (MenB) vaccinations to students at college student health centers (SHCs). PARTICIPANTS: Improvement teams from 45 US-based SHCs. METHODS: Teams participated in a 7-month virtual learning collaborative to implement immunization delivery best practices at their SHCs. A pre-post-intervention design was used to compare vaccination coverage in May 2017 to May 2018 among students who were unvaccinated at the start of the academic year. RESULTS: Data were compared from 29 SHCs and 152,648 students (2017) and from 18 SHCs and 122,315 students (2018). Percent of newly vaccinated students increased for ≥1 dose of flu vaccine by 14.3 percentage points to 32.3% (p < .01), ≥1 dose of HPV vaccine by 3.9 points to 7.8% (p < .05) and ≥3 doses of HPV vaccine by 0.7 points to 1.5% (p < .05). CONCLUSIONS: Participating in a learning collaborative may help SHCs improve vaccination delivery.

Keys to embracing aging: A healthy aging intervention.

Keys to Embracing Aging (KTEA) is a community-based educational program that introduces and reinforces health behaviors that promote healthy aging. Data from 12 distinct KTEA lessons delivered by 42 Cooperative Extension educators to 764 unique participants across one year were examined to determine the program's impact on attitude, diet, physical activity, brain health, belonging, staying up-to-date, safety, health, stress, finances, sleep, and self-care. The most frequent immediate behavior changes occurred in practicing self-care, developing a positive attitude, and making safe choices. And longer-term behavior change was reported in the areas of maintaining a positive attitude, brain health, and healthy eating. Participants discussed challenges related to time, commitment, and maintaining a habitual routine of healthy behaviors. KTEA outcomes indicated a promising community-based educational program and supported continued investigation and development in health promotion within Cooperative Extension. Future research is needed to examine the versatility and long-term effects of the KTEA intervention.

Aligning with Patients and Families: Exploring Youth and Caregiver Openness to Pediatric Headache Interventions.

Primary headache disorders are common yet underestimated in youth, resulting in functional disability, decreased quality of life, and caregiver burden. Despite the ubiquity of options, adherence remains challenging for families. One potential factor impacting willingness to engage in recommended treatments is openness. This study explored openness to multidisciplinary headache interventions and the relationships with demographic, pain-related, and psychological variables, among youth and their caregivers. Participants (n = 1087) were youth/caregiver dyads presenting for initial headache evaluation. They completed assessments of openness to headache treatments, medical information, functional disability, and pain-related distress. Overall openness was moderately high for youth and caregivers, and highly correlated between them (r = 0.70). Relationships between youth/caregiver openness to specific interventions were moderate-high (r = 0.42-0.73). These were stronger for interventional techniques but weaker for lifestyle changes. In hierarchical regression models predicting youth and caregiver openness, we found that counterpart openness accounted for the largest portion of variance in their own openness (31-32%), beyond demographic (3%), pain-related (10%), and psychological variables (2-3%). Our findings highlight the importance of involving caregivers in pediatric headache management, given their influence on youth openness and potential involvement in adherence. Awareness of youth/caregiver openness may guide clinicians providing recommendations.

Promoting readiness and engagement in pain rehabilitation for youth and families: Developing a pediatric telehealth motivational interviewing protocol.

Objective: Intensive interdisciplinary pain treatment (IIPT) is a promising approach for youth with complex, disabling, refractory pain conditions. However, youth and families who initiate IIPT without sufficient acceptance of its focus on functional rehabilitation or readiness to adopt a self-management approach to their pain may face challenges in IIPT and/or experience suboptimal outcomes. Motivational interviewing (MI) techniques have been shown to enhance readiness to make a number of health behavior changes for adults and youth, but it has not been systematically examined in the context of pediatric IIPT. The authors developed an MI telehealth intervention protocol explicitly designed to prepare youth and families for admission to IIPT. Method: The protocol development process is detailed here, including influential models, expert consultation, and feedback from IIPT clinical experts. The intervention protocol was then piloted with a group of eligible families to elicit feedback and prompt further refining. Feasibility and acceptability were explored through measures of treatment engagement and satisfaction. Results: The Promoting Readiness and Engagement in Pain Rehabilitation (PREPaRe) intervention protocol contains four modules aimed to enhance youth and parent readiness to adopt a self-management approach to persistent pain, through a motivational interviewing approach. Initial responses from the test group suggested high levels of treatment engagement and treatment satisfaction with PREPaRe. Conclusions: PREPaRe appears feasible to administer and acceptable to families of youth with persistent pain seeking IIPT. Implications for implementation are discussed. Further study via randomized control trial is warranted. Trial registration: ClinicalTrials.gov identifier: NCT04093921.

Will This Treatment Help My Child?: How Parent/Caregiver Treatment Expectations Relate to Intensive Pain Rehabilitation Outcomes for Youth With Chronic Pain.

OBJECTIVE: An extensive body of research has highlighted the impact that parent/caregiver factors have on functioning and treatment outcomes among youth with chronic pain. However, parent/caregiver expectations in pain treatment have been largely understudied, despite strong evidence that treatment expectations are associated with treatment engagement and overall outcomes in nonpain populations. Accordingly, the primary aim of this investigation was to preliminarily examine the manifestation and measurement of parent/caregiver treatment expectations in an intensive interdisciplinary pediatric pain treatment (IIPT) setting. METHODS: Participants in this study (N=328) included children and adolescents who attended an IIPT program for chronic pain between August 2013 and March 2020 and their parent/caregiver(s). Outcomes examined include parent/caregiver self-report of treatment expectations for their child upon admission to the IIPT in addition to pain-related and psychosocial factors at admission and discharge. RESULTS: Findings revealed a high level of expectations (ie, belief that the treatment will be helpful) on average, with higher parent/caregiver expectations associated with poorer functioning at admission to and discharge from the IIPT program. CONCLUSION: Extremely high treatment expectations among parents of more disabled youth may be indicative of unrealistic hopes or the "need" for IIPT to help their child; tempering parental expectations with psychoeducation about IIPT goals and realistic outcomes may indirectly improve treatment outcomes for their children. Future research should examine the potentially unique and important role that treatment expectations, of both parent/caregivers and their children, may have in overall IIPT outcomes.

Correlating Thermodynamic and Kinetic Hydricities of Rhenium Hydrides.

The kinetics of hydride transfer from Re(Rbpy)(CO)3H (bpy = 4,4'-R-2,2'-bipyridine; R = OMe, tBu, Me, H, Br, COOMe, CF3) to CO2 and seven different cationic N-heterocycles were determined. Additionally, the thermodynamic hydricities of complexes of the type Re(Rbpy)(CO)3H were established primarily using computational methods. Linear free-energy relationships (LFERs) derived by correlating thermodynamic and kinetic hydricities indicate that, in general, the rate of hydride transfer increases as the thermodynamic driving force for the reaction increases. Kinetic isotope effects range from inverse for hydride transfer reactions with a small driving force to normal for reactions with a large driving force. Hammett analysis indicates that hydride transfer reactions with greater thermodynamic driving force are less sensitive to changes in the electronic properties of the metal hydride, presumably because there is less buildup of charge in the increasingly early transition state. Bronsted α values were obtained for a range of hydride transfer reactions and along with DFT calculations suggest the reactions are concerted, which enables the use of Marcus theory to analyze hydride transfer reactions involving transition metal hydrides. It is notable, however, that even slight perturbations in the steric properties of the Re hydride or the hydride acceptor result in large deviations in the predicted rate of hydride transfer based on thermodynamic driving forces. This indicates that thermodynamic considerations alone cannot be used to predict the rate of hydride transfer, which has implications for catalyst design.

The regional whole blood program in San Antonio, TX: A 3-year update on prehospital and in-hospital transfusion practices for traumatic and non-traumatic hemorrhage.

Low titer type O Rh-D + whole blood (LTO + WB) has become a first-line resuscitation medium for hemorrhagic shock in many centers around the World. Showing early effectiveness on the battlefield, LTO + WB is used in both the pre-hospital and in-hospital settings for traumatic and non-traumatic hemorrhage resuscitation. Starting in 2018, the San Antonio Whole Blood Collaborative has worked to provide LTO + WB across Southwest Texas, initially in the form of remote damage control resuscitation followed by in-hospital trauma resuscitation. This program has since expanded to include pediatric trauma resuscitation, obstetric hemorrhage, females of childbearing potential, and non-traumatic hemorrhage. The objective of this manuscript is to provide a three-year update on the successes and expansion of this system and outline resuscitation challenges in special populations.

In-vivo platelet activation and aggregation during and after acute atherothrombotic myocardial infarction in patients with and without Type-2 diabetes mellitus treated with ticagrelor.

INTRODUCTION: Patients with type-2 diabetes are twice as likely to suffer from acute myocardial infarction (AMI) and have a higher incidence of recurrent events than their non-diabetic counterparts. Ticagrelor is a platelet inhibitor known to reduce major adverse cardiovascular events (MACE) in AMI patients. This study measures the level and change in platelet activation and aggregation at the time of and following an AMI in patients with and without diabetes treated with ticagrelor. MATERIALS/METHODS: P2Y12 receptor inhibitor naïve patients presenting with AMI were prospectively enrolled. Blood collection occurred before coronary angiography (baseline: T0), 2, 4, 24, 48 h after baseline, and at a three-month follow-up. Ticagrelor was administered within five minutes of T0. We assessed platelet activation via measurements of surface P-selectin and platelet activated glycoprotein IIb/IIIa-1 (PAC-1) and assessed platelet aggregation via monocyte, lymphocyte, and granulocyte aggregates. We hypothesize that platelet activation and aggregation will be proportionally impacted to the same degree by ticagrelor, regardless of diabetes status. RESULTS: Ninety-seven patients were prospectively enrolled (diabetes, N = 33; no diabetes, N = 64). No difference was observed in the expression of P-selectin and PAC-1 at any given point between diabetes and non-diabetes groups (p > 0.05). No difference was observed in the percentage of platelet bound to leukocytes at any measured timepoint between patients with and without diabetes (p > 0.05). Platelet leukocyte aggregation was suppressed during the acute phase compared to quiescence equally among both groups. DISCUSSION: Ticagrelor demonstrated similar in-vivo effects on platelet activation and aggregation regardless of diabetes status in patients presenting with AMI.

Early, Intensive, Lower Extremity Rehabilitation Shows Preliminary Efficacy After Perinatal Stroke: Results of a Pilot Randomized Controlled Trial.

BACKGROUND: Perinatal stroke injures motor regions of the brain, compromising movement for life. Early, intensive, active interventions for the upper extremity are efficacious, but interventions for the lower extremity remain understudied. OBJECTIVE: To determine the feasibility and potential efficacy of ELEVATE-Engaging the Lower Extremity Via Active Therapy Early-on gross motor function. METHODS: We conducted a single-blind, two-arm, randomized controlled trial (RCT), with the Immediate Group receiving the intervention while the Delay Group served as a 3-month waitlist control. A separate cohort living beyond commuting distance was trained by their parents with guidance from physical therapists. Participants were 8 months to 3 years old, with MRI-confirmed perinatal ischemic stroke and early signs of hemiparesis. The intervention was play-based, focused on weight-bearing, balance and walking for 1 hour/day, 4 days/week for 12 weeks. The primary outcome was the Gross Motor Function Measure-66 (GMFM-66). Secondary outcomes included steps and gait analyses. Final follow-up occurred at age 4. RESULTS: Thirty-four children participated (25 RCT, 9 Parent-trained). The improvement in GMFM-66 over 12 weeks was greater for the Immediate than the Delay Group in the RCT (average change 3.4 units higher) and greater in younger children. Average step counts reached 1370-3750 steps/session in the last week of training for all children. Parent-trained children also improved but with greater variability. CONCLUSIONS: Early, activity-intensive lower extremity therapy for young children with perinatal stroke is feasible and improves gross motor function in the short term. Longer term improvement may require additional bouts of intervention. CLINICAL TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov (NCT01773369).