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Objective. The objective of this study was to examine the associations between active, passive, and manual therapy interventions with the escalation-of-care events following physical therapist care for veterans with low back pain (LBP). Methods. A retrospective cohort study was conducted in 3618 veterans who received physical therapist care for LBP between January 1, 2015 and January 1, 2018. The Department of Veterans Affairs (VA) Corporate Data Warehouse was utilized to identify LBP-related physical therapist visits and procedures, as well as opioid prescription and non-physical therapy clinic encounters. The association between physical therapist interventions with 1-year escalation-of-care events were assessed using adjusted odds ratios from logistic regression. Results. Nearly all veterans (98%) received active interventions, but only a minority (31%) received manual therapy. In the 1-year follow-up period, the odds of receiving an opioid prescription were 30% lower for those who received manual therapy in addition to active interventions, as compared with patients who received only active interventions. Moreover, the odds of receiving primary care, specialty care, and diagnostic testing were 30% to 130% higher for patients who received electrical stimulation or more than 1 passive intervention in addition to active treatments, as compared with patients who received only active interventions. Conclusion. The use of manual therapy along with active interventions was associated with reduced prescription of opioids, while utilization of specific passive interventions such as electrical stimulation or multiple modalities in conjunction with active interventions resulted in increased escalation-of-care events. Impact. The use of active interventions, which is supported by most clinical practice guidelines, was the cornerstone of physical therapist care for veterans with LBP. However, the use of clinical practice guideline-recommended manual therapy interventions was low but associated with reduced opioid prescriptions. The use of 2 or more different passive interventions along with active interventions was common (34%) and associated with less-than-optimal escalation-of-care outcomes. Keywords: Exercise Therapy, Guideline Adherence, Low Back Pain, Manual Therapy, Veterans, Introduction Low back pain (LBP) is a large burden for individual sufferers and societies around the world. (1-3) Regardless of age, gender, occupation, socioeconomic indicators, and various comor-bidities, LBP is [...]

Battalion mortar platoons and company mortar sections provide the most responsive fire assets for maneuver formations at the battalion level and below. Force design updates align direct support field artillery [...]

Objectives. Mental health disorders are increasing among health profession students. Compounding this, students from underrepresented backgrounds may face additional stressors and challenges. The aims of this study were to: (1) assess the extent to which burnout, exhaustion, experiences of discrimination, and stress exist among students in dentistry, nursing, occupational therapy, pharmacy, and physical therapist professional education programs; (2) determine if there are significant differences by key demographic characteristics (those who are first-generation college students [FGCSs], a member of an underrepresented minority [URM] group, or both); and (3) highlight strategies and solutions to alleviate these challenges identified by students. Methods. Cross-sectional survey using a mix of question types of a sample of graduate students from dentistry, nursing, occupational therapy, pharmacy, and physical therapy programs from February to June 2020. Utilizing the Maslach Burnout Inventory Student Survey and campus climate and stress survey, mean subscale scores were calculated for the following outcomes of interest: MBI-SS burnout, dimensions of stress, and observed racism. Logistic regressions examined student factors that may help explain these outcomes. Content analysis examined participants' responses to open-ended questions. Results. There were 611 individuals who completed all survey questions. FGCSs were significantly more likely than non-FGCSs to report exhaustion (adjusted odds ratio [aOR]: 1.50; 95% CI = 1.04-2.16), family stress (aOR: 3.11; 95% CI = 2.13-4.55), and financial stress (aOR: 1.74; 95% CI = 1.21-2.50). URM students reported not feeling supported in their program and mentioned needing additional support, particularly for well-being, from staff and faculty. Conclusion. Findings from this study are consistent with literature that FGCSs experience additional stressors that may lead to burnout and exhaustion. URM students reported not feeling supported in their programs. This study's findings point to the need for leadership and faculty of health professional schools to implement or strengthen current policies, practices, and strategies that support URM students and FGCSs. Impact. Research demonstrates that a diverse student body and faculty enhances the educational experience for health professional students, and that diversity strengthens the learning environment and improves learning outcomes, preparing students to care for an increasingly diverse population. However, this study finds that students from underrepresented backgrounds may still experience more burnout, exhaustion, discrimination, and stress than their peers. Programs and policies to support URM students and FGCSs throughout their academic careers can help improve graduation and retention rates, leading to improved workforce diversity. Keywords: Burnout, First Generation College Students, Health Professional Students, Stress, URM Students, Workforce Diversity, Introduction A growing body of evidence demonstrates that mental health disorders are increasing in both frequency and severity among students in higher education to which burnout and stress may be [...]

Even before Hurricane Helene made landfall on September 26, faithbased disaster groups were on the move. Disaster relief staff from the Southern Baptist Convention, for example, shipped food and other [...]

Objective. The aim of this study was to explore associations between the utilization of active, passive, and manual therapy interventions for low back pain (LBP) with 1-year escalation-of-care events, including opioid prescriptions, spinal injections, specialty care visits, and hospitalizations. Methods. This was a retrospective cohort study of 4827 patients identified via the Military Health System Data Repository who received physical therapist care for LBP in 4 outpatient clinics between January 1, 2015 and January 1, 2018. One-year escalation-of-care events were evaluated based on type of physical therapist interventions (ie, active, passive, or manual therapy) received using adjusted odds ratios. Results. Most patients (89.9%) received active interventions. Patients with 10% higher proportion of visits that included at least 1 passive intervention had a 3% to 6% higher likelihood of 1-year escalation-of-care events. Similarly, with 10% higher proportion of passive to active interventions used during the course of care, there was a 5% to 11% higher likelihood of 1-year escalation-of-care events. When compared to patients who received active interventions only, the likelihood of incurring 1-year escalation-of-care events was 50% to 220% higher for those who received mechanical traction and 2 or more different passive interventions, but lower by 50% for patients who received manual therapy. Conclusion. Greater use of passive interventions for LBP was associated with elevated odds of 1-year escalation-of-care events. In addition, the use of specific passive interventions such as mechanical traction in conjunction with active interventions resulted in suboptimal escalation-of-care events, while the use of manual therapy was associated with more favorable downstream health care outcomes. Impact. Physical therapists should be judicious in the use of passive interventions for the management of LBP as they are associated with greater likelihood of receiving opioid prescriptions, spinal injections, and specialty care visits. Keywords: Electric Stimulation Therapy, Exercise, Hot/Cold Pack, Low Back Pain, Manual Therapy, Needle Therapy, Traction, Introduction Low back pain (LBP) is one of the leading causes of disability in the USA. (1, 2) The prevalence of LBP has continued to increase each year, as has [...]

David A. Patterson reflects on his career as a computer scientist thus far and provides sixteen life lessons in two areas, people-focused and career-focused. His people-focused life lessons include putting family first and seeking out honest feedback. While his career-focused lessons deal with topics such as urgent vs. important and leading by example.

Patients at the end of life may experience dyspnea but be unable to report symptoms. The Respiratory Distress Observation Scale measures respiratory distress in patients who are unable to self-report and helps decrease any hesitation nurses may have about administering opioids to a patient who is dying. Keywords: dypnea, respiratory distress, cancer, end of life, Respiratory Distress Observation Scale, Patients with cancer frequently experience distressing symptoms at end of life. Nurses are responsible for assessing and treating uncomfortable symptoms such as dyspnea. Patients who cannot self-report their symptoms may [...]

From the Great Lakes to the Atlantic Ocean, water has shaped the land and life of Indigenous Peoples inhabiting New York State since time immemorial. It is no surprise that [...]

Introduction By Alexa Gonzalez and Nora Kelly This article provides summaries and context for 31 changes to family law that were enacted in 2023 by legislatures in 26 states and [...]

More than 50 participants from six annual conferences in the United Methodist Church convened in October to network and learn about the issues around mass incarceration at the biennial National [...]

Objective: To determine the distinct influences of rural background and rural residency training on rural practice choice among family physicians. Data Sources and Study Setting: We used a subset of The RTT Collaborative rural residency list and longitudinal data on family physicians from the American Board of Family Medicine National Graduate Survey (NGS; three cohorts, 2016-2018) and American Medical College Application Service (AMCAS). Study Design: We conducted a logistic regression, computing predictive marginals to assess associations of background and residency location with physician practice location 3 years post-residency. Data Collection/Extraction Methods: We merged NGS data with residency type-rural or urban-and practice location with AMCAS data on rural background. Principal Findings: Family physicians from a rural background were more likely to choose rural practice (39.2%, 95% CI = 35.8, 42.5) than those from an urban background (13.8%, 95% CI = 12.5,15.0); 50.9% (95% CI = 43.0, 58.8) of trainees in rural residencies chose rural practice, compared with 18.0% (95% CI = 16.8,19.2) of urban trainees. Conclusions: Increasing rural programs for training residents from both rural and urban backgrounds, as well as recruiting more rural students to medical education, could increase the number of rural family physicians. KEYWORDS health equity, health policy/politics/law/regulation, health workforce, primary care, rural health What is known on this topic * Geographic maldistribution of the health care workforce in favor of urban areas threatens access to care in rural communities, where low supply is associated with poor health outcomes. * Factors associated with choosing rural practice include having a rural background and participating in clinical training in a rural place. * Past research on rural practice choice has not adequately distinguished the discrete and interactive effects of rural background and rural training experiences. What this study adds * Using data from a recent national, longitudinal cohort, we found that both rural background and rural residency training are strong, independent predictors of rural practice among family physicians. * Rural residency training is more strongly associated with rural practice than rural background. Individuals from a rural background who trained in a rural residency were the most likely to choose rural practice. * In addition to recruiting more rural students to undertake medical education, increasing opportunities for training residents from both rural and urban backgrounds in rural programs could greatly increase the number of family physicians entering rural practice., 1 | INTRODUCTION The geographic maldistribution of the health workforce is associated with negative rural population health outcomes, including excess mortality. (1,2) Rural communities frequently struggle to attract and retain [...]

TNF inhibitors, which are used to treat inflammatory conditions such as rheumatoid arthritis, modify an individual's immune response and can increase susceptibility to serious and potentially life-threatening infections. Nurses must have a good understanding of these medications to monitor patients safely during treatment. Keywords: rheumatoid arthritis, tumor necrosis factor, TNF, TNF inhibitor, diseasemodifying antirheumatic drugs, DMARDs, Learning Outcome: After completing this education activity, the learner will report increased knowledge of TNF inhibitors to be able to monitor patients safely during treatment. Rheumatoid arthritis (RA) is a [...]

The National Book Festival, sponsored by the Library of Congress, will celebrate its 23rd year with a daylong event held on Aug. 24 at the Walter E. Washington Convention Center [...]

The day before a ribbon cutting for a new student lounge at Gammon Theological Seminary in Atlanta, the rest of the building was still a work in progress. Brown builder's [...]

The association between Jesus and longtime FBI chief J. Edgar Hoover comes up frequently at Capitol Hill United Methodist Church in Washington, DC. There's a huge stained-glass window of Jesus [...]

This article provides an overview of the scientific awards given by the Association of Computing Machinery (ACM) and the nomination process with the goal of encouraging diverse nominees. The article points out the diversity discrepancy in ACM membership compared to award winners as well as impact on future computing professionals when awards are given to diverse individuals. Topics include the role of special interest groups, a description of each of the ACM awards, as well as tips on how to submit an effective nomination.

The evolution of server technology has shifted from faster central processing units (CPUs) to those with more cores, resulting in minimal performance improvements and lengthened replacement cycles from three years to six to eight years. As benchmarks fail to predict real-world performance effectively, a new focus on metrics such as workload goodput, operational efficiency, and environmental impact is essential for optimizing artificial intelligence and cloud computing infrastructures. The introduction of these metrics aims to enhance the total cost of ownership and carbon footprint assessments, guiding the information technology sector toward more sustainable practices.

As Naval Information Warfare Center (NIWC) Atlantic closes out its Women's History Month celebration, the command honors an employee from its Defense Health Information Technology (DHIT) division who was recently [...]

Clinical practice guidelines based on scientific evidence from testing and therapeutic interventions are needed to improve control of asthma. The latest asthma treatment paradigm shift is discussed as presented in recent guidelines from the Global Initiative for Asthma and the National Asthma Education and Prevention Program. Keywords Asthma, airway disease, pharmacotherapeutic management, bronchodilator, corticosteroid, clinical practice guidelines, evidence-based care, medication management, assessment of body systems, Asthma is a chronic airway disease that affects children and adults worldwide and requires ongoing medical care (Pate et al., 2021; World Health Organization [WHO], 2022). A great deal of [...]

This year marks the 50th year the Krone Company has been providing hay and forage equipment to dealers and customers in North America. Starting out from humble beginnings in 1973--with [...]

* DEB CALETTI, Deb. Plan A. 416p. Random/Labyrinth Road. Oct. 2023. Tr $18.99. ISBN 9780593485545. Gr 9 Up--Sixteen-year-old Ivy DeVries has a plan. She is Assistant Manager of Euwing's Drugs, [...]

Suicide education for nurses is critical amidst the current impact that suicide has on a global, national, and individual level. In Australia, there are 3,000 people per year who die [...]

* MCMANUS, Karen M. Such Charming Liars. 400p. Delacorte. Jul. 2024. Tr $20.99. ISBN 9780593485057. Gr 9 Up--Kat and Liam haven't seen each other for 12 years, not since their [...]

Objective: To describe the implementation of the age-friendly health systems (AFHS) 4Ms Framework, an evidence-based framework to assess and act on 'What Matters, Medication, Mentation and Mobility to deliver Age-Friendly health care for patients 65 and older', to achieve the Institute for Health care Improvement (IHI) Committed to Care Excellence recognition in a convenient care health system and test two novel implementation strategies. Setting: The study was conducted in over 1100 convenient care clinics in 35 states and DC. MinuteClinics are located in community-based retail pharmacies in rural, suburban, and urban areas and staffed with approximately 3300 nurse practitioners and physician associates. Design: In Year 1, the project used a quality improvement design, and in Year 2, a quasiexperimental implementation research design to pilot two strategies at the provider level (Virtual Clinic and Plan-Do-Study-Act (PDSA)). Statistical process control charts were used to assess changes in 4Ms documentation over time. Mixed-effects Poisson regression was used to assess the effectiveness of the pilot studies. Data Collection: The electronic health record (EHR) was enhanced to capture documentation of the AFHS 4Ms assessments and actions. A learning platform was created to teach and evaluate provider 4Ms competency, and the two data sources were merged into a registry. A formative evaluation was conducted using Tableau and reporting dashboards. Findings: After 18 months and the implementation of 20 strategies to improve the uptake of the 4Ms, MinuteClinic achieved the IHI Committed to Care Excellence recognition. A significant increase over time in the reliable delivery of all 4Ms and each M component individually was found. For the research, there were significant improvements in the mean number of Ms delivered per visit (M-Score) in the Virtual Clinic (Incident Rate Ratio [IRR]: 2.47, p = 0.001) and PDSA (IRR: 3.08, p = 0.002) strategy intervention groups when compared to controls. Conclusions: Application of quality improvement and implementation methodologies contributed to the success of implementing age-friendly 4Ms evidence-based practice. KEYWORDS age-friendly, convenient care, evidence-based practice, implementation, older adult, quality improvement, reliability What is known on this topic? * There is little evidence that older adults receive age-friendly care in community-based convenience care clinics despite the prevalent use of services. What does the study add? * The integration of age-friendly 4Ms 'What Matters, Medication, Mentation, Mobility' in convenient care clinic settings highlights the unique opportunity to provide health promotion and spread evidence-based geriatric care. * The use of quality improvement and implementation science methods and implementation strategies contributes to the reliable integration of age-friendly health systems and evidencebased 4Ms care., 1 | INTRODUCTION By 2034, there will be over 77 million adults in the United States over the age of 65, (1,2) and with this unprecedented aging of the population, [...]

Since the publication of Patrick Deneen's Why Liberalism Failed in 2018, a small but growing number of religious conservatives have been reevaluating the place of classical liberalism in America's political [...]

FIRST OFF, PLEASE TELL US A LITTLE BIT ABOUT YOURSELF --YOUR BACKGROUND, YOUR PASSIONS, AND YOUR CAREER. Personally I'm a mom, a daughter, a sister, an aunt, a cousin, and [...]

State and regional chapters of SFMA are the true lifeblood of our association. SFMA affiliated its first chapter more than 25 years ago, and now has 34 chapters throughout the [...]

Pattern litigation conies in many forms: multidistrict litigation, class actions, or simply common allegations arising in individual cases around the country. The latter comes with some standard characteristics: a volume [...]

A Google case study finds ML training in the cloud can reduce CO2e emissions up to 100×. [ABSTRACT FROM AUTHOR]

The article from PCWorld highlights the exciting tech innovations showcased at CES 2025, ranging from powerful GPUs like the NVIDIA GeForce RTX 5090 to innovative products like the Lenovo Legion Go S powered by SteamOS. Other notable mentions include the Alienware Area-51 gaming laptop, Lenovo IdeaCentre Mini X with Snapdragon, and the ASUS ROG XG Mobile eGPU. The article also covers unique offerings such as Razer's Project Arielle gaming chair, Lenovo ThinkBook Plus Gen 6 Rollable, and the Pawport Smart Pet Door, providing a comprehensive overview of the cutting-edge technology presented at the event. [Extracted from the article]

Glomeruli filter blood through the coordination of podocytes, mesangial cells, fenestrated endothelial cells, and the glomerular basement membrane. Cellular changes, such as podocyte loss, are associated with pathologies like diabetic kidney disease. However, little is known regarding the in situmolecular profiles of specific cell types and how these profiles change with disease. Matrix-assisted laser desorption/ionization imaging mass spectrometry (MALDI IMS) is well-suited for untargeted tissue mapping of a wide range of molecular classes. Importantly, additional imaging modalities can be integrated with MALDI IMS to associate these biomolecular distributions to specific cell types. Here, we integrated workflow combining MALDI IMS and multiplexed immunofluorescence (MxIF) microscopy. High spatial resolution MALDI IMS (5 μm) was used to determine lipid distributions within human glomeruli from a normal portion of fresh-frozen kidney cancer nephrectomy tissue revealing intra-glomerular lipid heterogeneity. Mass spectrometric data were linked to specific glomerular cell types and substructures through new methods that enable MxIF microscopy to be performed on the same tissue section following MALDI IMS, without sacrificing signal quality from either modality. Machine learning approaches were combined enabling cell type segmentation and identification based on MxIF data. This was followed by mining of cell type or cluster-associated MALDI IMS signatures using classification and interpretable machine learning. This allowed automated discovery of spatially specific molecular markers for glomerular cell types and substructures as well as lipids correlated to deep and superficial glomeruli. Overall, our work establishes a toolbox for probing molecular signatures of glomerular cell types and substructures within tissue microenvironments providing a framework applicable to other kidney tissue features and organ systems.

Purpose: The purpose of this conceptual paper is to demonstrate how memes perpetuate trauma with a schematic. This conceptual paper uses the "begin with the end in mind" meme to format the presentation of the necessary components for the schematic of how trauma persists across generations. It is the third paper in a series of applications of the recursive, test-operate-test schematic to the systemic effects of the information processes involved in trauma. The schematic presented permits evaluations of solutions to interrupt the generational trauma cycle. Design/methodology/approach: The required schematic components are described. Trauma (actual or perceived threat to survival) will be briefly discussed. Evolutionary processes that create the psychophysiology necessary to support nominal social expectations (NSEs) memes and metaphors will be summarized. The development of NSEs will be discussed. Metaphors and memes necessary for the creation of the schematic and esoteric events at level Learning IV will be briefly described. Finally, Figure 3, which illustrates the maintenance of NSEs and attempts to prevent their violation, will be explained. Findings: It is asserted that functional human social behavior requires NSEs. Trauma is found to persist through the presence of anti-nominal NSE memes that are transduced by the individual into anti-nominal metaphors, which then damage grid, place and dentate gyrus cell (GPDG) neurophysiology. The damaged neurocircuits allow the use of anti-nominal NSE metaphors within our individual neurophysiology. Furthermore, anti-NSE memes interfere with the self-organized criticalities (SOCs) of genetic-epigenetic processes necessary for the intergenerational transfer of functional social behavior. When anti-NSE nominal metaphors are transduced back into anti-NSEs, social niche memes, the trauma process is reiterated. Anti-NSE memes and metaphors are found to be inappropriate criteria central to the maintenance of persistent trauma. Therefore, anti-NSE memes have hijacked our epigenetics and our social niches. Solutions are available because during our evolution, the Homo clade developed esoteric capabilities and the ability to bring back what information we can from those encounters. This physiology operates around the 5HT2A neural receptors that process hallucinogens, such as psilocybin. Accessing this resource system, either through naturally occurring altered states of consciousness or through micro-dose pharmaceutical psilocybin and related neurotransmitters, produces a significant structural change in the GPDG system to reset the NSE system illustrated in the schematic to its nominal status so that we can maintain nominal NSE relationships within our meme niche(s). Research limitations/implications: The source of persistent trauma in our social niche(s), the means by which the trauma is maintained and the means to mitigate and perhaps eliminate persistent trauma are identified. Based on these three conclusions, it is difficult to make decisions regarding corrective actions because of ubiquitous anti-NSE memes and because of the limitations of our ordinary consciousness. Practical implications: If we wish to survive as a species, we will need to discover the criteria necessary to maintain our niche(s) congruent SOCs and use them instead of tyrannical memes described by Dawkins (1989) to make decisions about ourselves and our niche(s). Social implications: Significant courage is required to identify the memes that maintain trauma because many of them are culturally sacred cows. Unfortunately, we have known since Bremner's (1995) MRI study of posttraumatic stress disorder that trauma causes brain damage. Fortunately, our NSE genes compel us to pursue restitution of the memes that maintain our trauma-inducing cultures. Originality/value: Several original assertions are presented. While the Homo clade ancestors began the creation of the social niche(s) that led to Homo sapiens sapiens, it is asserted that the australopiths created the NSE memes which are the foundation behaviors that permit our social niche(s). Furthermore, NSEs were produced by enhanced intentionality skills and NSEs were created by both genetic and memetic processes. The evolution of intentionality-NSE neural networks is asserted as the source of intentional material manipulation. While anti-NSE memes are claimed as the source of persistent trauma, the practice of esoteric technologies is presented as a solution to persistent trauma. [ABSTRACT FROM AUTHOR]

Introduction: Recent research has raised questions about potential unintended consequences of the Inflation Reduction Act’s Drug Price Negotiation Program (DPNP), suggesting that the timelines introduced by the law may reduce manufacturer incentives to invest in post-approval research towards additional indications. Given the role of multiple indications in expanding treatment options in patients with cancer, IRA-related changes to development incentives are especially relevant in oncology. This study aimed to describe heterogeneous drug-level trajectories and timelines of subsequent indications in a cohort of recently approved, multi-indication oncology drugs, including overall, across subgroups of drugs characterized by the timing and pace of additional indications, and by drug type (i.e., small molecule vs. biologic). Methods: This cross-sectional study evaluated oncology drugs first approved by the FDA from 2008 to 2018 and later approved for one or more additional indications. Numbers, types, and approval timelines of subsequent indications were recorded at the drug level, with drugs grouped by quartile based on the pacing of post-approval development (i.e., “rapid pace” to “measured pace”). Results: Multi-indication oncology drugs (N= 56/86, 65.1%) had one or more subsequent indication approved in a new: cancer type (60.7%), line of treatment (50.0%), combination (41.1%), mutation (32.1%), or stage (28.6%). The median time between FDA approvals for indications increased from 0.6 years (IQR: 0.48, 0.74) in the “rapid pace” group to 1.6 years (IQR: 1.32, 1.66), 2.4 years (IQR: 2.29, 2.61), and 4.9 years (IQR: 3.43, 6.23) in the “moderate,” “measured-moderate,” and “measured” pace groups, respectively. Drugs in the “rapid pace” group often received their first subsequent indication approval within 9 months of initial approval (median: 0.7 years; IQR: 0.54, 1.59), whereas the “measured pace” group took a median of 5.7 years (IQR: 3.43, 6.98). Across all multi-indication drugs, the median time to the most recent approval for a subsequent indication was 5.5 years (IQR: 3.18, 7.95). One quarter (25%) of drugs were approved for their most recent subsequent indication after the time at which they would be DPNP-eligible. Conclusion: Approval histories of new oncology drugs demonstrate the role of post-approval indications in expanding treatment options towards new cancer types, stages, lines, combinations, and mutations. Heterogeneous clinical development pathways provide insights into potential unintended consequences of IRA-related changes surrounding post-approval research and development.

Background: Active transportation is a form of physical activity that enables mobility in one’s community. Current data indicate that the most frequent users of active transportation in high-income countries are predominantly white men of higher socioeconomic status. Aim: The purpose of this study was to understand the barriers and facilitators to active transportation among adults from three equity-deserving groups – people of color, people with disabilities, and people from the queer community. Methods: A systematic search of the literature was conducted using five databases: Ovid MEDLINE(R) ALL, EBSCOHost Sport Discus, ProQuest Sociological Abstracts, ProQuest Dissertations & Theses Global, and SCOPUS. Only studies conducted in Canada, the USA, Australia, New Zealand, and the UK were included given the distinct environment and culture of active transportation compared to other countries and continents. Results: After removing duplicates, 704 articles were identified. Of these, seven met our inclusion criteria. Three papers focused on people of color and four papers focused on people with disabilities; no papers focused on the queer community. In people of color, a unique barrier to active transportation that was identified was English language proficiency. Among people with disabilities, a unique barrier to engaging in active transportation related to navigating shared zones in intersections. Conclusion: This review found that walkability, density, points of interest, and English proficiency are important factors that influence active transportation among people of color, while the physical environment and safety are important factors that affect active transportation among people with disabilities.

Bleeding is common in patients with haematological malignancies undergoing intensive therapy. We aimed to assess the effect of tranexamic acid on preventing bleeding and the need for platelet transfusions.

BackgroundSignificant controversy exists about the management of unruptured cerebral arteriovenous malformations (AVMs). Results from A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) suggested that intervention increases the risk of stroke/death compared with medical management. However, numerous study limitations raised concerns about the trial’s generalizability.ObjectiveTo assess the rate of stroke/death and functional outcomes in ARUBA-eligible patients from a multicenter database, the Neurovascular Quality Initiative-Quality Outcomes Database (NVQI-QOD).MethodsWe performed a retrospective analysis of prospectively collected data of ARUBA-eligible patients who underwent intervention at 18 participating centers. The primary endpoint was stroke/death from any cause. Secondary endpoints included neurologic, systemic, radiographic, and functional outcomes.Results173 ARUBA-eligible patients underwent intervention with median follow-up of 269 (25–722.5) days. Seventy-five patients received microsurgery±embolization, 37 received radiosurgery, and 61 received embolization. Baseline demographics, risk factors, and general AVM characteristics were similar between groups. A total of 15 (8.7%) patients experienced stroke/death with no significant difference in primary outcome between treatment modalities. Microsurgery±embolization was more likely to achieve AVM obliteration (P<0.001). Kaplan-Meier survival curves demonstrated no difference in overall death/stroke outcomes between the different treatment modalities' 5-year period (P=0.087). Additionally, when compared with the ARUBA interventional arm, our patients were significantly less likely to experience death/stroke (8.7% vs 30.7%; P<0.001) and functional impairment (mRS score ≥2 25.4% vs 46.2%; P<0.01).ConclusionOur results suggest that intervention for unruptured brain AVMs at comprehensive stroke centers across the United States is safe.

Background: The US Centers for Medicare and Medicaid Services (CMS) held patient-focused listening sessions in Fall 2023 for each of the first ten drugs selected for the Inflation Reduction Act’s (IRA) Drug Price Negotiation Program (DPNP). This study aimed to quantitatively describe speaker input at the sessions, including the absolute and relative time allocated to key areas of interest for the DPNP. Methods: In this descriptive analysis of speaker remarks from ten CMS-hosted patient-focused listening sessions, speaker demographics were examined using video streams, time-stamped transcripts, public data, contextual clues, validated tools, and visual assessment when necessary. Audio recordings were transcribed using a speech-to-text application programming interface, followed by human review for accuracy. Transcripts included speaker identification and sentence-level timestamping. Two researchers coded each sentence into predefined categories on the basis of CMS’s optional discussion topics, DPNP goals, and potential unintended consequences of the IRA: speaker background, evidence about selected drugs or therapeutic alternatives, drug prices, patient access/benefit design, therapeutic advancements, and other. The total and proportion of time spent by category were calculated per speaker. Results: Out of an anticipated 200 speaker slots, 106 total speakers (median per session: 10; range 5–17) and 70 unique speakers participated, most of whom were patients (n= 38, 54.2%), female (n= 40, 57.1%), and below Medicare age (n= 40, 57.1%). The most popular categories discussed included evidence about the selected drug or therapeutic alternatives (median per slot: 36.5% of time; range 0–93.0%) and patient access/benefit design (median per slot: 12.1%; range 0–75.5%). CMS received a median of 12.3 total minutes of evidence about selected drugs or therapeutic alternatives per listening session across all speakers (range per session 3.9–22.6 minutes). Conclusions: The first listening sessions provided an important, but limited, first step toward patient engagement with the DPNP. Speaker demographics suggest the sessions fell short of capturing the voices of diverse and Medicare-representative patient populations. While speakers often focused their time on patient experience and evidence, CMS received less than 15 minutes of patient-focused evidence about therapeutic alternatives for more than half of the drug listening sessions. CMS has indicated its intent to improve upon the design of the patient-focused listening sessions for drugs selected in the second round of the DPNP. Future iterations should prioritize robust, two-way dialogue, transparency surrounding the impact of patient input on CMS’s price determination process, and improvements to event logistics and outreach that facilitate the participation of diverse patients and stakeholders.

Similar to other additive manufacturing processes, material extrusion is a thermal energy driven process, and the quality of the bonding, stability of the structure, deformation of the part during deposition as well as after detachment, and also in addition, microstructure of the part relies on the heat supplied by the nozzle. Short fiber addition is a recent technique to enhance the heat transfer process for better quality parts. This paper focuses on the review of the thermal characterization and thermophysical property measurements of the additively manufactured parts, and furthermore, it covers the thermal simulation techniques applied in the area. In addition, the paper discusses the thermal anisotropy of the composite materials inherent to the manufacturing technique itself. Future directions and challenges related to the current materials and technology are also illustrated and discussed in detail.

Objectives Heavy alcohol and drug use is reported by a substantial number of Canadians; yet, only a minority of those experiencing substance use difficulties access specialized services. Computer-Based Training for Cognitive Behavioural Therapy (CBT4CBT) offers a low-cost method to deliver accessible and high-quality CBT for substance use difficulties. To date, CBT4CBT has primarily been evaluated in terms of quantitative outcomes within substance use disorder (SUD) samples in the United States. A comparison between CBT4CBT versus standard care for SUDs in a Canadian sample is critical to evaluate its potential for health services in Canada. We conducted a randomized controlled trial of CBT4CBT versus standard care for SUD.Methods Adults seeking outpatient treatment for SUD (N= 50) were randomly assigned to receive either CBT4CBT or treatment-as-usual (TAU) for 8 weeks. Measures of substance use and associated harms and quality of life were completed before and after treatment and at 6-month follow-up. Qualitative interviews were administered after treatment and at follow-up, and healthcare utilization and costs were extracted for the entire study period.Results Participants exhibited improvements on the primary outcome as well as several secondary outcomes; however, there were no differences between groups. A cost-effectiveness analysis found lower healthcare costs in CBT4CBT versus TAU in a subsample analysis, but more days of substance use in CBT4CBT. Qualitative analyses highlighted the benefits and challenges of CBT4CBT.Discussion Findings supported an overall improvement in clinical outcomes. Further investigation is warranted to identify opportunities for implementation of CBT4CBT in tertiary care settings. Trial Registration:https://clinicaltrials.gov/ct2/show/NCT03767907

The piezoresistive response of specimens made by electrically conductive polylactic acid (PLA) under monotonic and cyclic flexural loading was experimentally investigated. A material extrusion process was utilized to 3D print the conductive PLA/carbon black nanocomposite samples using three infill patterns and three infill ratios. Then three-point bending tests, and electrical resistance measurements, were simultaneously conducted on beam-type specimens. The results of the electromechanical tests demonstrated that the 3D printed samples show outstanding piezoresistive sensing characteristics with excellent cyclic stability and reproducibility suitable for in-situ damage detection and strain monitoring through their electrical resistance change. Determination of gauge factors of specimens with different infill ratios and patterns exhibited a significant sensitivity even at low infill ratio. The potential of the piezoresistive property of conductive PLA/carbon black nanocomposite was examined by proposing 3D printed sensors for strain monitoring. The results demonstrated that conductive feedstock can be successfully processed by this material extrusion technique to develop advanced 3D printing sensing solutions. The applicability of the piezoresistive property of conductive cellular structures 3D printed with PLA/carbon black feedstock as a suitable technique for structural health monitoring was demonstrated.

Polymer design requires fine control over syntheses and a thorough understanding of their macromolecular structure. Herein, near-atomic level imaging of polymers is achieved, enabling the precise determination of one of the most important macromolecular characteristics: molecular weight. By judiciously designing and synthesizing different linear metal(loid)-rich homopolymers, subnanoscale polymer imaging is achieved through annular dark field-scanning transmission electron microscopy (ADF-STEM), owing to the incorporation of high Zatoms in the side chain of the monomeric units. The molecular weight of these polymers can be precisely determined by detecting and counting their metal(loid) atoms upon ADF-STEM imaging, at sample concentrations as low as 10 μg·mL–1. Notably, a commonly used C, H, and O-containing polymer (i.e., poly(methyl acrylate)) that was thus far inaccessible at the atomic scale is derivatized to allow for subnano-level imaging, thus expanding the scope of our approach toward the atomic-level visualization of commodity polymers.

Purpose: Although health research in Canada is primarily conducted in academic hospitals, most patients receive their care in community hospitals. The benefits of increasing research capacity in community hospitals include improved study recruitment, increased generalizability of results, broader patient access to novel therapies, better patient outcomes, enhanced staff satisfaction, and improved organizational efficiency. Nevertheless, building research programs in community hospitals remains challenging because of a lack of support and expertise. To address this gap, we developed a toolkit to help community hospital professionals build and sustain their community hospital research programs. Source: The toolkit was developed by the Canadian Community Intensive Care Unit Research Network (CCIRNet), a group of clinician-researchers and research staff from community hospitals across Canada who have experience building community hospital research programs. Feedback from a concurrent qualitative study of Canadian community critical care professionals informed the toolkit’s design. Principal findings: The CCIRNet toolkit outlines five stages of community hospital clinical research program development: 1) building a research team and gaining support, 2) developing a new research program, 3) choosing a first research study, 4) getting the study up and running, and 5) sustaining a research program. Feedback from qualitative interviews emphasized the need for a step-by-step approach, frequently asked questions, and essential resources. Accordingly, each stage is structured in a question-and-answer format and includes relevant resources for each section. Conclusion: The CCIRNet toolkit is a practical resource for establishing research programs in community hospitals. The toolkit may increase research participation and support clinical research capacity building in community hospitals.

The pervasive contamination of the environment with microplastics (MPs) poses a significant threat to food safety as MPs enter and move up the food chain. Understanding the exposure route via foodstuffs is essential. In this study, we analyzed MP contamination in commonly available brands of crystal and iodized powder salts from India and Sri Lanka. MPs were isolated and identified using digestion, filtration, microscopy, and Attenuated Total Reflectance-Fourier Transform Infrared (ATR-FTIR) spectroscopy. MPs were more abundant in Indian salt (17.16 ± 8.81 MPs/kg) than in Sri Lankan salt (7.9 ± 6.2 MPs/kg), with crystal salt showing higher MP levels than iodized salt in both countries. Fiber-shaped black and white MPs (< 1 mm) were the most common. ATR-FTIR analysis confirmed the polymer composition, predominantly polypropylene and polyethylene, in both Indian (56%, 24%) and Sri Lankan (42%, 28%) samples. Based on polymer hazard scores, the chemical risk of salts was categorized as level II (Sri Lanka) and IV (India). If a person consumes 5 g of salt per day (World Health Organization), Indians would ingest 0.085 MPs/day (31.025 MPs/year), and Sri Lankans would consume 0.0395 MPs/day (14.4175 MPs/year). The presence of MPs in salts is likely due to the use of contaminated water in production and specific manufacturing processes. Ingesting MPs through daily salt consumption poses a risk to human health, highlighting the need for measures to protect salt sources and improve production processes.

The Equus journal offers expert advice on equine health, care, and training through its Consultants department. Topics covered include the recovery process of a horse with a bowed tendon, the occurrence of internal cancers in horses, the heritability of colic in horses, and solutions for firming up a horse's manure. The articles provide insights from professionals in the field and offer practical recommendations for horse owners seeking guidance on these specific issues. [Extracted from the article]