Feasibility of regional center telehealth visits utilizing a rural research network in people with Parkinson's disease.

Background: Impaired motor and cognitive function can make travel cumbersome for People with Parkinson's disease (PwPD). Over 50% of PwPD cared for at the University of Arkansas for Medical Sciences (UAMS) Movement Disorders Clinic reside over 30 miles from Little Rock. Improving access to clinical care for PwPD is needed. Objective: To explore the feasibility of remote clinic-to-clinic telehealth research visits for evaluation of multi-modal function in PwPD. Methods: PwPD residing within 30 miles of a UAMS Regional health center were enrolled and clinic-to-clinic telehealth visits were performed. Motor and non-motor disease assessments were administered and quantified. Results were compared to participants who performed at-home telehealth visits using the same protocols during the height of the COVID pandemic. Results: Compared to the at-home telehealth visit group (n = 50), the participants from regional centers (n = 13) had similar age and disease duration, but greater disease severity with higher total Unified Parkinson's disease rating scale scores (Z = -2.218, p = 0.027) and lower Montreal Cognitive Assessment scores (Z = -3.350, p < 0.001). Regional center participants had lower incomes (Pearson's chi = 21.3, p < 0.001), higher costs to attend visits (Pearson's chi = 16.1, p = 0.003), and lived in more socioeconomically disadvantaged neighborhoods (Z = -3.120, p = 0.002). Prior research participation was lower in the regional center group (Pearson's chi = 4.5, p = 0.034) but both groups indicated interest in future research participation. Conclusions: Regional center research visits in PwPD in medically underserved areas are feasible and could help improve access to care and research participation in these traditionally underrepresented populations.

Sociodemographic Factors are Associated with Care Delivery and Outcomes in Pediatric Severe Sepsis.

IMPORTANCE: Sepsis is a leading cause of morbidity and mortality in the United States and disparate outcomes exist between racial/ethnic groups despite improvements in sepsis management. These observed differences are often related to social determinants of health (SDoH). Little is known about the role of SDoH on outcomes in pediatric sepsis. OBJECTIVE: This study examined the differences in care delivery and outcomes in children with severe sepsis based on race/ethnicity and neighborhood context (as measured by the social vulnerability index). DESIGN SETTING AND PARTICIPANTS: This retrospective, cross-sectional study was completed in a quaternary care children's hospital. Patients 18 years old or younger who were admitted between May 1, 2018, and February 28, 2022, met the improving pediatric sepsis outcomes (IPSO) collaborative definition for severe sepsis. Composite measures of social vulnerability, care delivery, and clinical outcomes were stratified by race/ethnicity. MAIN OUTCOMES AND MEASURES: The primary outcome of interest was admission to the PICU. Secondary outcomes were sepsis recognition and early goal-directed therapy (EGDT). RESULTS: A total of 967 children met the criteria for IPSO-defined severe sepsis, of whom 53.4% were White/non-Hispanic. Nearly half of the cohort (48.7%) required PICU admission. There was no difference in illness severity at PICU admission by race (1.01 vs. 1.1, p = 0.18). Non-White race/Hispanic ethnicity was independently associated with PICU admission (odds ratio [OR] 1.35 [1.01-1.8], p = 0.04). Although social vulnerability was not independently associated with PICU admission (OR 0.95 [0.59-1.53], p = 0.83), non-White children were significantly more likely to reside in vulnerable neighborhoods (0.66 vs. 0.38, p < 0.001). Non-White race was associated with lower sepsis recognition (87.8% vs. 93.6%, p = 0.002) and less EGDT compliance (35.7% vs. 42.8%, p = 0.024). CONCLUSIONS AND RELEVANCE: Non-White race/ethnicity was independently associated with PICU admission. Differences in care delivery were also identified. Prospective studies are needed to further investigate these findings.

Efficacy and safety of Felpreva®, a spot-on formulation for cats containing emodepside, praziquantel and tigolaner against experimental infestation with the Australian paralysis tick Ixodes holocyclus.

The Australian paralysis tick Ixodes holocyclus continues to be a serious threat to companion animals along Australia's east coast. The tick produces a potent neurotoxin which causes a rapidly ascending flaccid paralysis, which if left untreated, can result in the death of the animal. There is currently only a limited number of products registered in Australia for the treatment and control of paralysis ticks in cats. Felpreva® is an effective spot-on combination containing emodepside, praziquantel and tigolaner. To investigate the therapeutic and long-term persistent efficacy of Felpreva® (2.04% w/v emodepside, 8.14% w/v praziquantel and 9.79% w/v tigolaner) against experimental infestation with I. holocyclus in cats, two studies were undertaken. Fifty cats were included in the studies on study Day -17. These cats were immunized against paralysis tick holocyclotoxin prior to the study commencing. Immunity to holocyclotoxin was confirmed with a tick carrying capacity (TCC) test conducted prior to treatment. Cats were treated once on Day 0. Group 1 cats were treated with the placebo formulation and Group 2 cats were treated with Felpreva®. Cats were infested on Days -14 (tick carrying capacity test), 0, 28, 56, 70, 84 and 91 (weeks 4, 8, 10, 12 and 13). Ticks were counted on cats 24 h, 48 h and 72 â€‹h post-treatment and infestation, except during the tick carrying capacity test when they were counted approximately 72 â€‹h post-infestation only. The 24-h and 48-h assessments were conducted without removing the ticks. The ticks were assessed, removed and discarded at the 72-h assessment time-points. Significant differences in total live tick counts at ∼24 h, ∼48 h and ∼72 â€‹h post-infestation were observed between the treatment and control group. Differences were significant (P â€‹< â€‹0.05 to â€‹< â€‹0.001) in all instances. Treatment efficacies of 98.1-100% were observed ∼72 â€‹h post-infestation through to 13 weeks (94 days) post-treatment. These results show that a single application of Felpreva® provides effective treatment and control against induced infestation with paralysis ticks for 13 weeks.

Rural Research Network to engage rural and minority community members in translational research.

Background: To address the high prevalence of health disparities and lack of research opportunities among rural and minority communities, the University of Arkansas for Medical Sciences (UAMS) developed the Rural Research Network in January 2020. Aim: The aim of this report is to describe our process and progress in developing a rural research network. The Rural Research Network provides a platform to expand research participation opportunities to rural Arkansans, many of whom are older adults, low-income individuals, and underrepresented minority populations. Methods: The Rural Research Network leverages existing UAMS Regional Programs family medicine residency clinics within an academic medical center. Results: Since the inception of the Rural Research Network, research infrastructure and processes have been built within the regional sites. Twelve diverse studies have been implemented with recruitment and data collection from 9248 participants, and 32 manuscripts have been published with residents and faculty from the regional sites. Most studies were able to recruit Black/African American participants at or above a representative sample. Conclusions: As the Rural Research Network matures, the types of research will expand in parallel with the health priorities of Arkansas. Relevance to Patients: The Rural Research Network demonstrates how Cancer Institutes and sites funded by a Clinical and Translational Science Award can collaborate to expand research capacity and increase opportunities for research among rural and minority communities.

Survey on national practices regarding iodine thyroid blocking in 2016-2017.

Severe nuclear accidents may lead to a release of radioactivity, including radioactive iodine, into the environment. The thyroid gland in the human body needs natural or stable iodine to function properly and this iodine is normally absorbed in small quantities from food. Following a release of radioactive iodine from a nuclear or radiological accident, the body will absorb and accumulate the radioactive iodine in the thyroid gland. This increases the risk of thyroid cancer, especially in children. Since the thyroid gland cannot distinguish between radioactive and stable iodine, stable iodine can be taken to prevent the absorption of radioiodine by the thyroid in the event of a nuclear emergency. This is referred to as Iodine Thyroid Blocking (ITB). In 2017, the World Health Organization published revised guidelines entitled 'Iodine Thyroid Blocking: guidelines for use in planning for and responding to radiological and nuclear emergencies'. The purpose of these guidelines is to support Member States in planning for and implementation of ITB before and during a radiation emergency. To enable the monitoring and measurement of the impact of a specific recommended intervention, a baseline should be established against which the impact will be measured over a certain period of time. With that in mind, a global WHO survey of national policies on ITB was carried out in 2016-2017. Here, an overview of some core findings of this survey is provided.

A Randomized, Community-Based Feasibility Trial of Modified ESDM for Toddlers with Suspected Autism.

A randomized feasibility trial of a parent coaching (PC) intervention was conducted across 16 community agencies in a Canadian province. Parents of toddlers with suspected autism were assigned to either a PC group (n = 24) or an enhanced community treatment (ECT) group (n = 25). PC participants received 24 weeks of coaching support from community service providers trained in the project. Children in both groups also received available community services and supplementary materials. PC children made significantly greater gains in word understanding and PC parents had significantly higher quality of life, satisfaction, and self-efficacy scores. Results are discussed in terms of the challenges of conducting feasibility studies in community settings and the lessons learned in the project.

Learning through technology in middle school classrooms: Students' perceptions of their self-directed and collaborative learning with and without technology.

In the present study, students' perceptions of their self-directed and collaborative learning with and without technology were examined in ICT-supported middle school classrooms. Three hundred and twenty middle school students from eight schools across Alberta, Canada participated in the study by completing a questionnaire. Descriptive statistics, independent sample t-test, one-way ANOVA and correlational analysis were used to analyse the questionnaire responses. Descriptive statistics revealed that middle school students perceive themselves as readily engaging in self-directed and collaborative learning within their classrooms. Students' self-directed learning with and without technology was significantly related to the instructional quality in their classroom with lower instructional quality classrooms having a significant small effect on self-directed learning. Gender was also found to have a small effect, with girls more readily engaging in self-directed learning, although this difference was not sustained when using technology. When learning with technology, while indicating that they engage in self-directed learning within their classrooms, students reported less engagement in collaborative activities with their peers, particularly in earlier middle school grades. Students may benefit from additional support to engage in collaborative activities while using technology. Likewise, teachers may benefit from professional development to support their facilitation of self-directed learning and collaborative learning as well as implementation of technology within the classroom.

Comparison of free-living physical activity data obtained from a Fitbit Zip, the Apple iPhone Health app and a modified Bouchard Activity Record.

ISSUE ADDRESSED: Physical activity tracking devices have potential to improve public health, but their data needs to be reliable. No study has compared movement data between the Fitbit Zip, Apple iPhone Health app and physical activity records in a community setting over 10 days. METHODS: University students aged 18+ years wore both a Fitbit Zip and an iPhone at/near their right waist and completed a modified Bouchard Activity Record (BAR) for 10 days in a free-living setting. Comparisons were made between the Fitbit Zip and iPhone for the number of steps and the distance travelled and between the Fitbit Zip and BAR for the minutes of activity in three different intensities. RESULTS: Eighteen students provided sufficient data for inclusion. There were strong correlations between steps per day (r = .87) and distance travelled (r = .88) between the Fitbit Zips and iPhones. However, the Fitbit Zip measured significantly more steps per day (mean 8437 vs 7303; P ≤ .001) and greater distances (mean 5.9 vs 4.9; P ≤ .001) than the iPhone. Correlations between the Fitbit Zips and the BARs were moderate for minutes of total (r = .51) and light (r = .40) activity and weak for moderate/fairly active (r = .20) and vigorous/very active (r = .25). CONCLUSIONS: There were strong correlations between the physical activity data measured by Fitbit Zips and iPhones, but the iPhone Health app significantly underestimated the number of steps per day taken and the distance travelled when compared to the Fitbit Zip. SO WHAT?: Understanding the comparability of accelerometer devices provides useful information for future pragmatic physical activity measurement.

Enhanced recognition of emotional images is not affected by post-exposure exercise-induced arousal.

Research suggests that aerobic exercise (i.e., exercise aiming to improve cardiovascular fitness) promotes cognition, but the impact on memory specifically, is unclear. There is some evidence to suggest that as little as one session of post-learning exercise benefits memory consolidation. Furthermore, memory may be particularly facilitated by exercise when the individual is emotionally aroused while encoding stimuli. The current study tested whether exercise after exposure to neutral and emotional images improved memory consolidation of the items among university students. Ninety-nine students were randomly instructed to either exercise or not exercise after viewing a set of images that were positive, neutral, and negative in valence, and they were later tested on their memory. Although emotional images were remembered better than non-emotional images, the results suggested that exercise did not influence this effect or enhance consolidation of the items overall. Explanations and implications for these findings are discussed.

Training Coaches in Community Agencies to Support Parents of Children with Suspected Autism: Outcomes, Facilitators, and Barriers.

This study evaluated the fidelity and effectiveness of a parent coach training program for toddlers at risk for autism spectrum disorder and identified factors required for successful training implementation under real-world conditions. Training addressed four tiers of clinical competence and was delivered to early intervention providers across 23 partner agencies in a large Canadian province. Results indicated that mean trainee fidelity scores were within the range reported in previous community-based training studies but there was considerable variability across trainees. Implementation facilitators included agency learning climate, leadership support, and trainee readiness for change. Implementation barriers included time/caseload demands and challenges related to technology learning and infrastructure. Results have implications for parent coach training in community settings.

Escape Room: Innovative Teaching Strategy to Stimulate Critical Thinking/Judgment in Nursing Students.

ABSTRACT: The Escape Room, an innovative teaching strategy, can be customized to various nursing scenarios. Student teams complete puzzles and tasks to reach designated goals and objectives within a limited time frame. Escape Rooms were designed as a clinical make-up day for 10 first-year, second-semester associate degree nursing students. Using activity theory to create a constructivist learning environment, scenarios were designed to focus on diabetic ketoacidosis and safety/environmental factors associated with aspiration pneumonia and wound dehiscence. This student sample evaluated the Escape Room experiences as an effective method for content retention and clinical thinking/judgment.

Microresearch: Promoting Scholarly Activity That Addresses Health Disparities in Rural Health Professional Education Programs.

Microresearch is an innovative, mentored research experience, originally developed in Africa and adapted for U.S. health professional trainees preparing for rural primary care practice. This report describes program elements (funding, mentorship, and peer support) that others may replicate to develop research and leadership skills through community engagement to address health disparities.

Use of nalbuphine as a substitute for butorphanol in combination with dexmedetomidine and tiletamine/zolazepam: a randomized non-inferiority trial.

OBJECTIVES: The goal of this study was to determine whether a drug combination using nalbuphine with dexmedetomidine and tiletamine/zolazepam is non-inferior to one that uses butorphanol. METHODS: All healthy cats presenting solely for gonadectomy to two trap-neuter-return mobile clinic days were randomly assigned to induction with a combination of tiletamine/zolazepam 3 mg/kg, dexmedetomidine 7.5 µg/kg and either butorphanol or nalbuphine at 0.15 mg/kg. All participants were blinded to the identity of the combinations. The primary endpoint was clinician satisfaction, comprised of the mean of four satisfaction ratings on a 7-point Likert scale (highly dissatisfied through to highly satisfied) recorded for induction, maintenance of anesthesia, surgery and recovery. Exploratory endpoints included each individual score, number of injections, duration of induction, duration of recovery and need for reversal agent. To assess non-inferiority for the primary endpoint and individual scores, the difference and 95% confidence intervals (CIs) of the difference between the mean clinical scores for the nalbuphine and butorphanol-based combinations were calculated and compared with a prespecified non-inferiority margin of 20% (1.4 points). RESULTS: Seventy-two cats were enrolled, 36 in each group. The mean ± SD composite score for the combination with nalbuphine was 6.06 ± 0.59 (95% CI 5.86-6.25) points, while the combination with butorphanol was 6.22 ± 0.62 (95% CI 6.01-6.43). The difference between mean scores was 0.17 (-0.12 to 0.45), which did not exceed the prespecified boundary of 1.4, establishing the non-inferiority of nalbuphine. No individual clinical score for nalbuphine was inferior to butorphanol, and there were no significant differences for any secondary endpoints. CONCLUSIONS AND RELEVANCE: The clinical experience of the nalbuphine-based combination was non-inferior to the butorphanol-based combination. Nalbuphine is an effective substitute for butorphanol, providing another option if butorphanol is unavailable due to shortage, controlled status or cost, without requiring a change in anesthetic workflow.

Fundamental Studies of New Ionization Technologies and Insights from IMS-MS.

Exceptional ion mobility spectrometry mass spectrometry (IMS-MS) developments by von Helden, Jarrold, and Clemmer provided technology that gives a view of chemical/biological compositions previously not achievable. The ionization method of choice used with IMS-MS has been electrospray ionization (ESI). In this special issue contribution, we focus on fundamentals of heretofore unprecedented means for transferring volatile and nonvolatile compounds into gas-phase ions singly and multiply charged. These newer ionization processes frequently lead to different selectivity relative to ESI and, together with IMS-MS, may provide a more comprehensive view of chemical compositions directly from their original environment such as surfaces, e.g., tissue. Similarities of results using solvent- and matrix-assisted ionization are highlighted, as are differences between ESI and the inlet ionization methods, especially with mixtures such as bacterial extracts. Selectivity using different matrices is discussed, as are results which add to our fundamental knowledge of inlet ionization as well as pose additional avenues for inquiry. IMS-MS provides an opportunity for comparison studies relative to ESI and will prove valuable using the new ionization technologies for direct analyses. Our hypothesis is that some ESI-IMS-MS applications will be replaced by the new ionization processes and by understanding mechanistic aspects to aid enhanced source and method developments this will be hastened.

Less Binge Eating and Loss of Control over Eating Are Associated with Greater Levels of Mindfulness: Identifying Patterns in Postmenopausal Women with Obesity.

Obesity is a public health concern resulting in widespread personal, social, and economic burden. Many individuals with obesity report feeling unable to stop eating or to control their food intake (i.e., a loss of control over eating) despite their best efforts. Experiencing loss of control over eating predicts further eating pathology and is a key feature of binge eating. Mindfulness (i.e., awareness and acceptance of current thoughts, feelings, sensations, and surrounding events) has emerged as a potential strategy to treat such eating disorder behaviors, but it is not known whether there is merit in investigating this strategy to address binge eating in postmenopausal women with obesity. Thus, this study aimed to examine the relationships between binge eating and mindfulness in postmenopausal women with obesity seeking weight loss treatment. Participants (n = 101) were assessed with the Eating Disorder Examination Questionnaire, the Loss of Control over Eating Scale, the Five-Facet Mindfulness Questionnaire, and the Langer Mindfulness Scale. Participants´ overall scores on both mindfulness scales were significantly and negatively correlated with binge eating frequency or the severity of loss of control over eating. Moreover, participants who reported fewer binge eating episodes were significantly more mindful than those who reported greater frequencies of binge eating episodes within the past 28 days. These findings suggest a merit in investigating the use of mindfulness-based therapies to treat binge eating in postmenopausal women with obesity.

Efficacy and feasibility of HIIT training for university students: The Uni-HIIT RCT.

OBJECTIVES: The primary aim of this study was to evaluate the preliminary efficacy and feasibility of an 8-week high-intensity interval training program (Uni-HIIT) for young adult students in a university setting. DESIGN: Randomised controlled trial. METHOD: Uni-HIIT was conducted at the University of Newcastle, Australia (February-June, 2017). Participants were university students 18-25yrs (n=53; 20.38±1.88yrs) randomized into the Uni HIIT program (n=26) or wait-list control (n=27) condition. Participants were required to attend up to three HIIT sessions/week for 8-weeks which included a variety of aerobic and muscular fitness exercise combinations lasting 8-12minutes (using 30:30sec rest:work intervals). The primary outcome was cardio-respiratory fitness (CRF) (20mSRT), and secondary outcomes included muscular fitness (standing jump, push-ups), body composition (InBody), executive function (Trail Making Test), anxiety levels (State Trait Anxiety Inventory) and perceived stress (Perceived Stress Scale). Linear mixed models were used to analyse outcomes and Cohen's d effect sizes were calculated. Process evaluation measures of recruitment, retention, attendance and satisfaction were conducted. RESULTS: A large significant group-by-time effect resulted for CRF [8.4 shuttles (95% CI(2.9-13.9), P=0.004,d=1.08] and muscular fitness [4.0 repetitions (95% CI(1.2-6.8), P=0.006,d=0.99], and moderate effect size was observed for Trail B [-5.9seconds (95% CI(-11.8-0.1.0), P=0.052, d=0.63]. No significant intervention effects were found for body composition, standing jump, anxiety or perceived stress (P >0.05). High ratings of participant satisfaction (4.73), enjoyment (4.54) and perceived value (4.54) were observed. CONCLUSION: This study demonstrates the efficacy and feasibility of delivering a novel HIIT program in the university setting.

Autoimmune Granulomatous Inflammation of Lacrimal Glands and Axonal Neuritis Following Treatment With Ipilimumab and Radiation Therapy.

Immune checkpoint inhibitors such as anti-CTLA-4 (cytotoxic T-lymphocyte-associated protein 4), anti PD-1 (programmed cell death protein 1) and PD-L1 (programmed cell death protein-ligand 1) monoclonal antibodies are emerging as standard oncology treatments in various tumor types. The indications will expand as immunotherapies are being investigated in various tumors with promising results. Currently, there is inadequate identification of predictive biomarkers of response or toxicity. Unique response patterns include pseudoprogression and delayed response. The use of immune checkpoint inhibitors exhibit an unique toxicity profile, the immune-related adverse events (irAEs). The most notable immune reactions are noted in skin (rash), gastrointestinal track (colitis, hepatitis, pancreatitis), lung (pneumonitis), heart (myocarditis), and endocrine system (thyroiditis, hypophysitis). We present a patient with metastatic adenoid cystic carcinoma of the left submandibular gland with granulomatous inflammation of the lacrimal glands and axonal neuritis of the cervical and paraspinal nerves following treatment with ipilimumab and radiation therapy.

Equine-Assisted Occupational Therapy: Increasing Engagement for Children With Autism Spectrum Disorder.

Engagement in meaningful activities is essential to development and is often reduced in children with autism spectrum disorder (ASD) who have limited engagement in activities or relationships. A multiple-baseline design was used with 7 children with ASD ages 4-8 yr to assess the effect of including a horse in occupational therapy intervention on task engagement. The children showed improvements in engagement. Including horses in occupational therapy sessions may be a valuable addition to conventional treatments to increase task engagement of children with ASD. Factors related to the environment, therapeutic strategies, and individual participation need to be considered in understanding why this intervention may be effective and developing a theoretical basis for implementation.

Interaction between community pharmacists and community nurses in dementia care.

There has been little research that explores the interaction between community pharmacists and community nurses and how this interaction could benefit people affected by dementia. Using information taken from a larger study, this article presents the views of community pharmacists and one community nurse on how their communication, information sharing and team integration may improve care for this patient group. The community pharmacists reported positive attitudes to supporting people affected by dementia, but they highlighted barriers to integrated team working. In contrast, the community nurse conveyed the belief that the community pharmacist was an integrated member of the community health team. Community pharmacists and community nurses are keen to interact with each other to support people affected by dementia, but this interaction stops short of collaborative, integrated team working. Further research is needed to address this issue.