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Scaling up the use of evidence-based practice (EBP) for autism across service sectors and regions has presented a considerable challenge indicating a clear need for continued development. The California Autism Professional Training and Information Network (CAPTAIN) integrates implementation drivers into specific procedures and methodology as an implementation strategy to support statewide scale up. The current study was designed to evaluate the impact of CAPTAIN on provider-level outcomes including attitude toward, and knowledge, fidelity and use of autism EBPs, and overall classroom quality. Overall, results indicated variability across measures, with some significant differences between CAPTAIN-trained and non-CAPTAIN-trained providers. CAPTAIN-trained providers reported more openness to EBP. Significantly more CAPTAIN-trained direct service providers reported collecting fidelity of implementation data (X[superscript 2](2, N = 1515) = 10.95, p = 0.004), collecting student data (X[superscript 2](2, N = 1509) = 14.19, p = 0.001), and reported using their primary EBP with "most or all students" (X[superscript 2](2, N = 1514) = 11.41, p = 0.003) than providers not trained by CAPTAIN. In summary, these preliminary findings show promise for the efficacy of the CAPTAIN model to increase dissemination and implementation of EBP at the classroom level.

Andrea Ticinesi,1–3 Claudio Tana,2 Antonio Nouvenne,2,3 Beatrice Prati,2 Fulvio Lauretani,2 Tiziana Meschi1–3 1Department of Medicine and Surgery, University of Parma, Parma, Italy; 2Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy; 3Microbiome Research Hub, University of Parma, Parma, Italy Abstract: Cognitive frailty, defined as the coexistence of mild cognitive impairment symptoms and physical frailty phenotype in older persons, is increasingly considered the main geriatric condition predisposing to dementia. Recent studies have demonstrated that gut microbiota may be involved in frailty physiopathology by promoting chronic inflammation and anabolic resistance. The contribution of gut microbiota to the development of cognitive impairment and dementia is less defined, even though the concept of “gut–brain axis” has been well demonstrated for other neuropsychiatric disorders. The aim of this systematic review was to summarize the current state-of-the-art literature on the gut microbiota alterations associated with cognitive frailty, mild cognitive impairment and dementia and elucidate the effects of pre- or probiotic administration on cognitive symptom modulation in animal models of aging and human beings. We identified 47 papers with original data (31 from animal studies and 16 from human studies) suitable for inclusion according to our aims. We concluded that several observational and intervention studies performed in animal models of dementia (mainly Alzheimer’s disease) support the concept of a gut–brain regulation of cognitive symptoms. Modulation of vagal activity and bacterial synthesis of substances active on host neural metabolism, inflammation and amyloid deposition are the main mechanisms involved in this physiopathologic link. Conversely, there is a substantial lack of human data, both from observational and intervention studies, preventing to formulate any clinical recommendation on this topic. Gut microbiota modulation of cognitive function represents, however, a promising area of research for identifying novel preventive and treatment strategies against dementia. Keywords: microbiome, Alzheimer’s disease, vascular dementia, mild cognitive impairment, dysbiosis

Fulvio Lauretani,1,2 Marcello Maggio,1,2 Andrea Ticinesi,1,2 Claudio Tana,1,2 Beatrice Prati,1,2 Luciano Gionti,1,2 Antonio Nouvenne,1,2 Tiziana Meschi1,2 1Department of Medicine and Surgery, University of Parma, Parma, Italy; 2Internal Medicine and Critical Subacute Care Unit, Geriatric Rehabilitation Department, University Hospital of Parma, Parma, Italy Background: The determinants of altered balance in older subjects and, particularly, the contribution of muscle strength and cognitive impairment are still uncertain. We hypothesized that both these conditions and their interactions could affect balance in older persons. To address this hypothesis, we studied the cross-sectional association between handgrip strength and balance performance in subjects with and without cognitive impairment. Methods: Two hundred and sixty-three elderly outpatients (104 men and 159 women, aged 81.44 ± 7.36 years) were evaluated for the comprehensive geriatric assessment. The patients were enrolled from the cross-sectional observational Traumatic Risk Identikit Parma study that was aimed at identifying risk factors for falling in older outpatients. Results: Balance deficit, defined as an inability to maintain tandem position for at least 10 seconds, was present in 185 patients (70.34%). The mean mini-mental state examination score was 20.79 ± 6.5, the median short physical performance battery score was 5.0 and the mean grip strength was 18.54 ± 9.14 kg. After dividing the subjects into four categories according to the presence of low grip strength and/or cognitive impairment, we found that the mini nutritional assessment short-form scale score was negatively and independently (β: -0.02 ± 0.01; p=0.04) associated with balance deficit in the group with low grip strength and cognitive impairment. In the other three categories, grip strength was negatively and significantly associated with balance deficit. Conclusion: The loss of muscle strength, presence of cognitive impairment and their interaction, influenced probably by malnutrition, could affect balance in older persons. Keywords: muscle strength, cognitive impairment, balance, malnutrition, older persons

Understanding therapy providers' experiences with cognitive screening, assessment, and documentation can provide guidance on improving care quality. Semi-structured interviews (n = 18) were conducted with therapy providers across disciplines and post-acute settings. Thematic analysis was used to identify themes. Six over-arching themes emerged pertaining to cognitive screening and assessment. (1) Therapists routinely conducted screening through task performance and informal observation. (2) Documentation habits varied due to multiple conflicting goals and lack of guidelines. (3) Therapists' approach was honed on the job through clinical experience and trial and error. (4) Patient diagnosis, emerging medical conditions, and goals most strongly influenced therapists' approach. (5) Roles and responsibilities were implicit. (6) The end goal was determining patient safety. All therapy providers frequently screened for cognition, yet documentation varied widely. To increase consistent delivery and documentation of cognitive screening and assessment, future studies can examine strategies to streamline electronic health record platforms. [ABSTRACT FROM AUTHOR]

In the last decade, scientists have accumulated increasing evidence showing that the human gut microbiota, i.e. the ensemble of bacteria symbiotically living in the intestinal lumen of every individual, is involved in many aspects of human physiology and, possibly, disease. In fact, specific alterations of the gut microbiota, generally referred with the term of dysbiosis, have been detected in a large number of acute and chronic diseases, not involving only gastroenteric system. The microbiota may exert its influence on distant organs with multiple mechanisms, involving modulation of inflammation, anabolism, insulin sensitivity, bioavailability of nutrients, release of toxins, and metabolically active mediators. In this short review, we summarize the basis of the gut-muscle axis hypothesis, that is, the possible influence exerted by gut microbiota composition on skeletal muscle metabolism and function. This hypothesis is particularly focused on the pathophysiology of sarcopenia, the age-related loss of muscle mass and function associated with a large number of adverse outcomes in older people. Although no human studies support the possible involvement of gut microbiota in the onset of sarcopenia, some studies performed on mouse models seem to support the assumption that the age-related decline in muscle mass and function is associated with a distinct gut microbiota composition towards dysbiosis. More studies should thus investigate the possible connections between gut microbiota and muscle health. KEY WORDS: Microbiota, Sarcopenia, Mobility Limitations, Aging, Inflammation, Muscle Mass, Muscle Function

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The simplified point mass, flail-space model was introduced in 1981 and is currently used in the United States, Canadian, Australian, and New Zealand road safety barrier and fixtures standards as a method of assessing vehicle occupant injury risk in certification crash tests when an instrumented anthropomorphic crash test dummy is not used. Maximum and preferred flail-space threshold impact velocities and accelerations of an unrestrained occupant are specified for longitudinal (frontal) and lateral (side) impact in the standards. The longitudinal impact velocity component of the flail-space model has been compared with impact velocities from real-world frontal crash data. However, the lateral velocity component has yet to be compared with impact velocities from any side impact tests or real-world injury crash data. This current study assesses the relationship between injury severity and impact velocities from cadaveric lateral thoracic impact tests and relates this to the maximum and preferred lateral velocities as recommended in the flail-space model. The following data from previous thoracic lateral impact cadaver tests were collated: impact velocity, cadaver age, cadaver mass, impact wall padding thickness, impact test method, and resultant Abbreviated Injury Scale (AIS) level. Multiple logistic regression analysis was used to determine the significant variables in predicting AIS 3+ and AIS 4+ injuries. Single variable regression analysis was then performed to determine a relationship between lateral impact velocity and AIS 3+ and AIS 4+ injury level. From the results, the current flail-space model's preferred lateral velocity used in the road safety barrier standards was found to be high and a lower preferred threshold of 6.4 m s−1is proposed. [ABSTRACT FROM PUBLISHER]

Aims: This article reports current evidence on the association between Lp(a) and cardiovascular (CV) disease and on pathophysiological mechanisms. The available information on therapy for reduction of lipoprotein(a) is also discussed.Data Synthesis: Although some evidence is conflicting, Lp(a) seems to increase CV risk through stimulation of platelet aggregation, inhibition of tissue factor pathway inhibitor, alteration of fibrin clot structure and promotion of endothelial dysfunction and phospholipid oxidation. Lp(a) 3.5-fold higher than normal increases the risk of coronary heart disease and general CV events, particularly in those with LDL cholesterol ≥ 130 mg/dl. High Lp(a) values represent also an independent risk factor for ischemic stroke (more relevant in young stroke patients), peripheral artery disease (PAD) and aortic and mitral stenosis. Furthermore, high Lp(a) levels seem to be associated with increased risk of cardiovascular events in patients with chronic kidney disease, particularly in those undergoing percutaneous coronary intervention.Conclusions: Lipoprotein (a) (Lp[a]) seems to significantly influence the risk of cardiovascular events. The effects of statins and fibrates on Lp(a) are limited and extremely variable. Nicotinic acid was shown effective in reducing Lp(a) but, due to its side effects and serious adverse events during clinical trials, it is no longer considered a possible option for treatment. To date, the treatment of choice for high levels of Lp(a) in high CV risk patients is represented by LDL-Apheresis. Thanks to innovative technologies, new selectively inhibiting LPA drugs are being developed and tested. [ABSTRACT FROM AUTHOR]

The aim of this case–control study was to determine if there is an association between vehicle panel damage and AIS3+ thoracic injuries. NASS CDS data from 2001 to 2012 was examined for single vehicle rollover crashes with occupants receiving serious thoracic injuries (cases) and those without thoracic injuries (controls). Vehicle panel damage for cases and controls were coded and logistic regression performed to determine if there is an association between serious thoracic injury and vehicle panel damage. Furthermore, an investigation into the differences in injury sources and injury outcomes between front-seated near- and far-side occupants was performed with the data. There were two main findings from this study. First, there is an association between the rear left segment, front left upper-half door, and front right upper-half door damage and serious thoracic injury. Second, the sources of thoracic injuries and the thoracic viscera injured are different for near-side and far-side occupants. [ABSTRACT FROM AUTHOR]

The article discusses a study of the effect of the 5-HT4 receptor, mosapride citrate, on rectosigmoid motility and perception in patients with irritable bowel syndrome (IBS). The authors recruited 37 patients with IBS and 18 healthy subjects to undergo a rectosigmoid barostat test and measured pain perception to intraluminal distention and resting smooth muscle motility for 20-minutes in the fasting state. They found that mosapride reduced the mean bag volume and improved the mean number of contractions but did not affect perception.