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Objective: The purpose of this review is to systematically assess primary research publications on known genetic variants, which modify the risk for symptoms or dysfunction persisting 30 days or more following mild traumatic brain injury (mTBI). Summary of Review: A search of PubMed and Embase from inception through June 2022 identified 42 studies that associated genetic variants with the presence of symptoms or cognitive dysfunction 30 days or more following mTBI. Risk of bias was assessed for each publication using the Newcastle Ottawa Scale (NOS). Fifteen of the 22 studies evaluating apolipoprotein E (APOE) ɛ4 concluded that it was associated with worse outcomes and 4 of the 8 studies investigating the brain-derived neurotrophic factor (BDNF) reported the Val66Met allele was associated with poorer outcomes. The review also identified 12 studies associating 28 additional variants with mTBI outcomes. Of these, 8 references associated specific variants with poorer outcomes. Aside from analyses comparing carriers and noncarriers of APOE ɛ4 and BDNF Val66Met, most of the reviewed studies were too dissimilar, particularly in terms of specific outcome measures but also in genes examined, to allow for direct comparisons of their findings. Moreover, these investigations were observational and subject to varying degrees of bias. Conclusions: The most consistent finding across articles was that APOE ɛ4 is associated with persistent post-mTBI impairment (symptoms or cognitive dysfunction) more than 30 days after mTBI. The sparsity of other well-established and consistent findings in the mTBI literature should motivate larger, prospective studies, which characterize the risk for persistent impairment with standardized outcomes in mTBI posed by other genetic variants influencing mTBI recovery. [ABSTRACT FROM AUTHOR]

Background: Advanced antiretroviral treatment has led to a growing population of older persons with HIV. To understand the characteristics of persons aging with HIV, this analysis examines epidemiological profiles of persons with diagnosed HIV through 2021 aged 50 years and older in New York State. Methods: Persons diagnosed with HIV and reported to the NYS HIV registry by December 31, 2021, were included in the analysis. Characteristics of persons aged 50 years and older were compared with persons younger than 50 years. Results: Persons diagnosed with HIV and aged 50 years and older more often reported heterosexual transmission risk and were more often females than individuals diagnosed with HIV younger than 50 years. Among new diagnoses in 2021, persons aged 50 years and older were more likely to have a stage 3 HIV diagnosis. By the end of 2021, 57% of persons living with diagnosed HIV were aged 50 years and older. There was an upward trend of deaths with cardiovascular disease as an underlying cause of death among persons aged 50 years and older. Conclusions: More females diagnosed with HIV and a higher percentage of persons who reported heterosexual transmission risk among persons aged 50 years and older suggest a need for enhanced clinician education and sexual health discussions with this adult population. A greater rate of stage 3 HIV diagnoses in persons aged 50 years and older emphasizes the need for specialized HIV testing and treatment, care for comorbidities, and social supports for this aging population. [ABSTRACT FROM AUTHOR]

Background: Optic disc edema is a feature of many ophthalmic and neurologic conditions. It remains an underappreciated feature of birdshot chorioretinitis (BSCR), leading to delay in diagnosis and treatment. The purpose of our study was to identify clinical features that are concomitant with optic disc edema and suggest a diagnosis of BSCR. Methods: Retrospective multicenter case series of 29 patients who were referred to a neuro-ophthalmologist or uveitis specialist for evaluation of disc edema and were ultimately diagnosed with BSCR. Results: Fifty-four eyes of 30 patients, from the practices of 15 uveitis specialists, met the eligibility criteria. In addition to disc edema, concomitant features in all patients included vitritis, chorioretinal lesions, and retinal vasculitis. Visual recovery to 20/40 or better occurred in 26 of 29 patients. Visual acuity remained 20/100 or worse in 2 patients previously diagnosed with idiopathic intracranial hypertension, 1 patient previously diagnosed with optic neuritis, and 1 patient for whom treatment was delayed for years, leading to optic disc atrophy. Conclusions: Optic disc edema is a presenting feature in some cases of BSCR. A diagnosis of BSCR should be considered when disc edema occurs with vitritis, chorioretinal inflammation, and retinal vasculitis. Patients should be referred to a uveitis specialist for treatment. [ABSTRACT FROM AUTHOR]

Although survivors of childhood cancer are at an increased risk, little is known about the prevalence of chronic pain, associated interference, and daily pain experiences. Survivors (N 5 233; mean age 5 40.8 years, range 22-64 years; mean time since diagnosis 5 32.7 years) from the Childhood Cancer Survivor Study completed pain and psychosocial measures. Survivors with chronic pain completed 2-week, daily measures assessing pain and psychological symptoms using mHealth-based ecological momentary assessment. Multivariable-modified Poisson and linear regression models estimated prevalence ratio estimates (PR) and mean effects with 95% confidence intervals (CI) for associations of key risk factors with chronic pain and pain interference, respectively. Multilevel mixed models examined outcomes of daily pain and pain interference with prior day symptoms. Ninety-six survivors (41%) reported chronic pain, of whom 23 (24%) had severe interference. Chronic pain was associated with previous intravenous methotrexate treatment (PR 5 1.6, 95% CI 1.1-2.3), respiratory (PR 5 1.8, 95% CI 1.2-2.5), gastrointestinal (PR 5 1.6, 95% CI 11.0-2.3), and neurological (PR 5 1.5, 95% CI 1.0-2.1) chronic health conditions, unemployment (PR 5 1.4, 95% CI 1.0-1.9) and clinically significant depression and anxiety (PR 5 2.9, 95% CI 2.0-4.2), as well as a diagnosis of childhood Ewing sarcoma or osteosarcoma (PR 5 1.9, 95% CI 1.0-3.5). Higher pain interference was associated with cardiovascular and neurological conditions, unemployment and clinical levels of depression and/or anxiety, and fear of cancer recurrence. For male, but not female survivors, low sleep quality, elevated anxiety, and elevated depression predicted high pain intensity and interference the next day. A substantial proportion of childhood cancer survivors experience chronic pain and significant associated interference. Chronic pain should be routinely evaluated, and interventions are needed. [ABSTRACT FROM AUTHOR]

Approximately two-thirds of pregnancy-related deaths in the United States occur during the postpartum period, yet there is minimal research focusing on the postpartum hospital stay, a critical point of contact between women and the health care system and an important opportunity for intervention. A new approach to postpartum care is needed. "Woman-centered" postpartum care is recommended to improve maternal outcomes, but the concept of woman-centered care is not well-defined. Using Walker & Avant's method of concept analysis, we identified four defining attributes of woman-centered care in the literature: 1) choice, control, and involvement in decision-making ; 2) communication and collaboration in the caregiver–woman relationship ; 3) individualized and holistic care ; and 4) continuity of care. Using these findings, we offer a conceptual definition of woman-centered care and apply the attributes to the postpartum hospitalization in the model and contrary cases. We discuss the potential of the concept to improve maternal health care during this critical period. There is minimal research focusing on the postpartum hospital stay, a critical point of contact between women and the health care system and an important opportunity for intervention. "Woman-centered" postpartum care is recommended to improve maternal outcomes, but the concept of woman-centered care is not well-defined. In this concept analysis, women-centered care is evaluated and recommendations for postpartum care are offered based on the findings. [ABSTRACT FROM AUTHOR]

Compared to their sedentary peers, older track athletes demonstrate a superior ability to negate the normal age-related changes in gait mechanics known to attenuate maximal walking speed performance with age. Sports-specific exercises commonly utilized to affect this end may be appropriately scaled to benefit a wider subset of older adults. Optimal dosing of resistance training to maximize gluteus maximus functional fitness, accompanied by gait reeducation to augment motor patterns facilitating optimal peak trailing leg extension and push-off intensity, create a redundancy in walking capacity likely to prolong functional independence for beneficiaries of this targeted intervention. [ABSTRACT FROM AUTHOR]

The article introduces the Leadership and Education for Advanced Practice Provider (LEAPP) fellowship, an innovative postgraduate program designed to address the shortage of qualified cystic fibrosis (CF) providers by offering specialized training across various CF care centers. Topics include the program's unique blended learning approach, its focus on leadership and quality improvement, and its potential application to other complex conditions requiring specialized care.

Introduction: This study aimed to explore the potential impact of incorporating blood flow restriction (BFR) training within a training block characterized by minimal high-intensity work on 2000-m rowing ergometer time trial (TT) performance in elite/world-class rowers. Physiological markers often associated with endurance performance (maximal aerobic capacity, ... blood lactate thresholds and hemoglobin mass, Hbmass) were measured to determine whether changes are related to an improvement in performance. Methods: Using a quasi-experimental, observational study design (no control group), 2000-m TT performance, ..., submaximal work rates eliciting blood lactate concentrations of ~2 and ~4mmol⋅L-1, and Hbmass were measured before and after 4 wk of noncompetitive season training, which included BFR rowing. BFR training consisted of 11 sessions of 2 x 10 min of BFR rowing at a workload equating to blood lactate concentrations of ~2 mmol⋅L-1. Paired t-tests were used to compare pre-/postvalues, and Pearson correlation was used to examine whether physiological changes were associated with changes to TT performance. Results: TT performance improved in both female (1.09% ± 1.2%, ~4.6 ± 5.2 s; P < 0.01) and male (1.17% ± 0.48%, ~4.5 ± 1.9 s; P < 0.001) athletes. ... increased in female rowers only (P < 0.01), but both sexes had an increase in work rates eliciting blood lactate concentrations of 2 mmol⋅L-1 (female: 184 ± 16 to 195 ± 15 W, P < 0.01;male: 288 ± 23 to 317 ± 26W, P = 0.04) and 4 mmol⋅L-1 (female: 217 ± 13 to 227 ± 14 W, P = 0.02;male: 339 ± 43 to 364 ± 39W, P < 0.01). No changes in Hbmass (both sexes, P = 0.8) were observed. Improvements in TT performance were not related to physiological changes (all correlations P ≥ 0.2). Conclusions: After 4 wk of training with BFR, the improvement in TT performance was greater than what is typical for this population. Physiological variables improved during this training block but did not explain improved TT performance. [ABSTRACT FROM AUTHOR]

Patient-selected music during cataract surgery was a safe and effective method to reduce anxiety, fear, nervousness, and confusion perioperatively. This inexpensive, low-risk method directly impacted patient experience during surgery. Purpose: To determine the effect of playing patient-selected music intraoperatively on patient self-reported anxiety and the amount of sedative administered during cataract surgery. Setting: Yale New Haven Hospital health system, New Haven, Connecticut. Design: Prospective, randomized, controlled clinical trial. Methods: Patients were randomized to either a music group or a control group, which had no music played. Patients were blinded to the purpose of the study. On postoperative day 1, patients were consented to participate in the study and asked to complete a 6-question Likert-style survey (modified from the State-Trait Anxiety Inventory) assessing anxiety at baseline and during surgery. Patients' intraoperative and postoperative vitals were recorded. The medication, dosage, and number of sedative injections given were also recorded. Paired t tests were used to assess for significant differences between the 2 groups. Results: 107 patients (mean age 71.2 years) were enrolled in the study. There was no significant difference in baseline anxiety between the 2 groups. Patients randomized to the music group had significantly lower total self-reported anxiety (mean 5.98) than the control group (mean 7.13, P =.006). Moreover, patients exposed to music felt significantly less frightened, nervous, and confused during surgery (P =.002,.007, and 0.017, respectively). There was no significant difference between the groups in number and dosage of sedatives given. Conclusions: Playing patient-selected music during cataract surgery is an effective way to decrease anxiety. Music directly affects patient experience and is an inexpensive, low-risk method of reducing patient anxiety during surgery. [ABSTRACT FROM AUTHOR]