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We retrospectively reviewed the records of 136 veterans with a penicillin allergy label during a quality improvement initiative. We identified 82 inpatients eligible for removal of penicillin allergy by oral amoxicillin challenge, including 40 out of 82 (48%) still eligible after accounting for other limiting factors.

ABSTRACT: Background: High-grade isthmic spondylolisthesis poses a clinical challenge in the pediatric and adolescent population. Current surgical management using posterior-based approaches may lead to incomplete reduction and restoration of listhesis, disc height, and lordosis. Combined anterior and posterior approach addresses these issues but has been infrequently reported, mainly in the treatment of low-grade isthmic spondylolisthesis. Neither offers good disc space visualization and control of spinal alignment during reduction. Case Description: A healthy 17-year-old female presented with 9 months of progressively worsening lower back pain radiating down the left lower extremity and 3 inches of height loss. Diagnosis of grade IV L5–S1 spondylolisthesis was made using plain radiographs, CT, and MRI. Management with combined anterior and posterior fusion, involving the manual manipulation of segments using an anterior pedicle screw joystick, was pursued. Outcome: Satisfactory alignment, solid arthrodesis, no complications, and improved patient reported outcomes. Conclusions: Combined anterior and posterior fusion with anterior joystick manipulation allowed for full reduction of grade IV spondylolisthesis and restoration of disc/foraminal height and L5–S1 segmental lordosis without neurological complication. Although less commonly performed in children and adolescents, this surgical approach can assist in restoring optimal alignment in isthmic spondylolisthesis.

Background: An uncommon complication of anterior cervical discectomy and fusion (ACDF) is dura tear, which may be further complicated by cerebral spinal fluid (CSF) leak. Dural tears with CSF leak can lead to catastrophic neurologic outcomes and should be recognized early. Case Description: This case report describes a 43-year-old female patient with history of Ehlers-Danlos syndrome who presented 1-year post-ACDF with positional headaches and lightheadedness. Imaging revealed ACDF plate subsidence and CSF leak with inferior displacement of the cerebellar tonsils. Outcome: The patient underwent a revision procedure with removal of index screws and CSF repair using epidural blood patch, fat graft, and Tisseel. The original bicortical screws were replaced with shorter larger diameter unicortical screws. Post-operative imaging at 2 and 6 weeks confirmed resolution of CSF leak. Conclusions: Healthcare professionals and patients undergoing spinal surgery should be aware of late presentation CSF leaks which can represent gradual decline in neurological function. Surgical candidates at risk to develop CSF leaks should be counseled about possible complications in preoperative planning.

BackgroundAs telemedicine plays an increasing role in health care delivery, providers are expected to receive adequate training to effectively communicate with patients during telemedicine encounters. Teach-back is an approach that verifies patients’ understanding of the health care information provided by health care professionals. Including patients in the design and development of teach-back training content for providers can result in more relevant training content. However, only a limited number of studies embrace patient engagement in this capacity, and none for remote care settings. ObjectiveWe aimed to design and evaluate the feasibility of patient-centered, telehealth-focused teach-back training for family medicine residents to promote the use of teach-back during remote visits. MethodsWe codeveloped the POTENTIAL (Platform to Enhance Teach-Back Methods in Virtual Care Visits) curriculum for medical residents to promote teach-back during remote visits. A patient participated in the development of the workshop’s videos and in a patient-provider panel about teach-back. We conducted a pilot, 2-arm cluster, nonrandomized controlled trial. Family medicine residents at the intervention site (n=12) received didactic and simulation-based training in addition to weekly cues-to-action. Assessment included pre- and postsurveys, observations of residents, and interviews with patients and providers. To assess differences between pre- and postintervention scores among the intervention group, chi-square and 1-tailed t tests were used. A total of 4 difference-in-difference models were constructed to evaluate prepost differences between intervention and control groups for each of the following outcomes: familiarity with teach-back, importance of teach-back, confidence in teach-back ability, and ease of use of teach-back. ResultsMedical residents highly rated their experience of the teach-back training sessions (mean 8.6/10). Most residents (9/12, 75%) used plain language during training simulations, and over half asked the role-playing patient to use their own words to explain what they were told during the encounter. Postintervention, there was an increase in residents’ confidence in their ability to use teach-back (mean 7.33 vs 7.83; P=.04), but there was no statistically significant difference in familiarity with, perception of importance, or ease of use of teach-back. None of the difference-in-difference models were statistically significant. The main barrier to practicing teach-back was time constraints. ConclusionsThis study highlights ways to effectively integrate best-practice training in telehealth teach-back skills into a medical residency program. At the same time, this pilot study points to important opportunities for improvement for similar interventions in future larger-scale implementation efforts, as well as ways to mitigate providers’ concerns or barriers to incorporating teach-back in their practice. Teach-back can impact remote practice by increasing providers’ ability to actively engage and empower patients by using the features (whiteboards, chat rooms, and mini-views) of their remote platform.

IntroductionAnterior cruciate ligament reconstruction (ACLR) is characterized by persistent involved limb functional deficits that persist for years despite rehabilitation. Previous research provides evidence of both peripheral and central nervous system adaptations following ACLR. However, no study has compared functional organization of the brain for involved limb motor control relative to the uninvolved limb and healthy controls. The purpose of this study was to examine sensorimotor cortex and cerebellar functional activity overlap and non-overlap during a knee motor control task between groups (ACLR and control), and to determine cortical organization of involved and uninvolved limb movement between groups.MethodsEighteen participants with left knee ACLR and 18 control participants performed a knee flexion/extension motor control task during functional magnetic resonance imaging (fMRI). A conjunction analysis was conducted to determine the degree of overlap in brain activity for involved and uninvolved limb knee motor control between groups.ResultsThe ACLR group had a statistically higher mean percent signal change in the sensorimotor cortex for the involved > uninvolved contrast compared to the control group. Brain activity between groups statistically overlapped in sensorimotor regions of the cortex and cerebellum for both group contrasts: involved > uninvolved and uninvolved > involved. Relative to the control group, the ACLR group uniquely activated superior parietal regions (precuneus, lateral occipital cortex) for involved limb motor control. Additionally, for involved limb motor control, the ACLR group displayed a medial and superior shift in peak voxel location in frontal regions; for parietal regions, the ACLR group had a more posterior and superior peak voxel location relative to the control group.ConclusionACLR may result in unique activation of the sensorimotor cortex via a cortically driven sensory integration strategy to maintain involved limb motor control. The ACLR group's unique brain activity was independent of strength, self-reported knee function, and time from surgery.

Background: Anecdotal reports suggest a rise in anti-Asian racial attitudes and discrimination in response to COVID-19. Racism can have significant social, economic, and health impacts, but there has been little systematic investigation of increases in anti-Asian prejudice. Methods: We utilized Twitter's Streaming Application Programming Interface (API) to collect 3,377,295 U.S. race-related tweets from November 2019-June 2020. Sentiment analysis was performed using support vector machine (SVM), a supervised machine learning model. Accuracy for identifying negative sentiments, comparing the machine learning model to manually labeled tweets was 91%. We investigated changes in racial sentiment before and following the emergence of COVID-19. Results: The proportion of negative tweets referencing Asians increased by 68.4% (from 9.79% in November to 16.49% in March). In contrast, the proportion of negative tweets referencing other racial/ethnic minorities (Blacks and Latinx) remained relatively stable during this time period, declining less than 1% for tweets referencing Blacks and increasing by 2% for tweets referencing Latinx. Common themes that emerged during the content analysis of a random subsample of 3300 tweets included: racism and blame (20%), anti-racism (20%), and daily life impact (27%). Conclusion: Social media data can be used to provide timely information to investigate shifts in area-level racial sentiment.

Recess represents a rich opportunity for social development, but students with intellectual and developmental disabilities (IDD) often do not fully realize these benefits. In this systematic review, we review 37 experimental studies in which students with IDD received interventions designed to improve social outcomes at recess. Overall, these studies provide strong scientific evidence that focused intervention can produce medium to large effects on peer interaction and peer play. A subset of studies reported effects on social skills and social status, although the presence and magnitude of effects was variable. Studies tended to focus on students with autism who did not have intellectual disability and involved a combination of classroom-based social skills instruction and support on the playground from peers or adults. We recommend that special educators deliver this combination of strategies to students with autism. Further research is needed for students with intellectual disability or multiple disabilities.

Background: Though rare, pathologic extramedullary hematopoiesis (EMH) can occur in response to myeloproliferative disorders and may present as paravertebral masses. Case Description: We describe a 63-year-old female with unspecified thalassemia, hemochromatosis, and known asymptomatic extramedullary hematopoiesis of the thoracic spine who acutely developed severe spinal cord compression and a T9 vacuum phenomenon fracture 7 months after her initial diagnosis. Outcome: The patient was treated with urgent decompression and T9 kyphoplasty, which resulted in complete resolution of her neurological deficits. Conclusions: The timeline of symptomatology in the case suggests that asymptomatic patients with T-spine extramedullary hematopoiesis can develop progressive neurologic deterioration and atraumatic compression fractures culminating in acute spinal cord injury. While it may be appropriate to treat asymptomatic patients conservatively, surgical decompression must always remain a consideration.

ABSTRACT: Background: Severe positive sagittal malalignment can potentially lead to shortening and contracture of the psoas and joint capsule in a flexed spinopelvic position. The utilization of bilateral psoas release to supplement sagittal spinal deformity correction in the same hospitalization was not reported in the literature. Case presentation: A 66-year-old patient presented with a 5-year history of severe global spinal deformity (sagittal vertical axis 220 mm, 60° spinopelvic mismatch) that did not improve on supine radiographs, and a modified Thomas test with more than 30° flexion contracture of bilateral hips. A 3-stage operation utilizing posterior spinal column osteotomies, anterior lumbar interbody fusion, and bilateral psoas releases was performed. Outcome: Her postoperative alignment significantly improved and she was pleased with her new posture and the ability to stand up straight. Conclusions: This report is the first to demonstrate safe and substantial correction of severe spinal deformities associated with bilateral hip flexion contracture in 1 hospitalization.

The alarming rise of antibiotic resistance and the emergence of new vaccine technologies have increased the focus on vaccination to control gonorrhea. Neisseria gonorrhoeae strains FA1090 and MS11 have been used in challenge studies in human males. We used negative-ion MALDI-TOF MS to profile intact lipooligosaccharide (LOS) from strains MS11mkA, MS11mkC, FA1090 A23a, and FA1090 1-81-S2. The MS11mkC and 1-81-S2 variants were isolated from male volunteers infected with MS11mkA and A23a, respectively. LOS profiles were obtained after purification using the classical phenol water extraction method and by microwave-enhanced enzymatic digestion, which is more amenable for small-scale work. Despite detecting some differences in the LOS profiles, the same major species were observed, indicating that microwave-enhanced enzymatic digestion is appropriate for MS studies. The compositions determined for MS11mkA and mkC LOS were consistent with previous reports. FA1090 is strongly recognized by mAb 2C7, an antibody-binding LOS with both α- and β-chains if the latter is a lactosyl group. The spectra of the A23a and 1-81-S2 FA1090 LOS were similar to each other and consistent with the expression of α-chain lacto-N-neotetraose and β-chain lactosyl moieties that can both be acceptor sites for sialic acid substitution. 1-81-S2 LOS was analyzed after culture with and without media supplemented with cytidine-5'-monophosphate N-acetylneuraminic acid (CMP-Neu5Ac), which N. gonorrhoeae needs to sialylate its LOS. LOS sialylation reduces the infectivity of gonococci in men, although it induces serum resistance in serum-sensitive strains and reduces killing by neutrophils and antimicrobial peptides. The infectivity of FA1090 in men is much lower than that of MS11mkC, but the reason for this difference is unclear. Interestingly, some peaks in the spectra of 1-81-S2 LOS after bacterial culture with CMP-Neu5Ac were consistent with disialylation of the LOS, which could be relevant to the reduced infectivity of FA1090 in men and could have implications regarding the phase variation of the LOS and the natural history of infection.

The high costs of cancer treatment and the lack of investment in health care are significant barriers to public health on the African continent. The objective of this study was to investigate the financial cost of children cancer treating in sub-Saharan Africa. We systematically searched PubMed, Cochrane, and Google Scholar to identify relevant studies between March 2000 and December 2022. We selected articles that specifically addressed the US dollar financial costs of childhood cancer in African countries. Medians and interquartile ranges (IQR) were calculated. We also calculated the economic burden of childhood cancer at the individual level, by dividing the direct costs of cancer per patient by the GDP per capita, PPP of the country studied. The quality of economic studies was assessed using the CHEERS (2022) 28-point checklist. A total of 17 studies met our eligibility criteria. The median (IQR) of total childhood cancer costs by region was $909.5 ($455.3–$1,765) and ranged from $88803.10 for neuroblastoma to $163.80 for lymphoma. No significant differences (p

ABSTRACT The ability of bacterial pathogens to metabolically adapt to the environmental conditions of their hosts is critical to both colonization and invasive disease. Infection with Neisseria gonorrhoeae (the gonococcus, Gc) is characterized by the influx of neutrophils [polymorphonuclear leukocytes (PMNs)], which fail to clear the bacteria and make antimicrobial products that can exacerbate tissue damage. The inability of the human host to clear Gc infection is particularly concerning in light of the emergence of strains that are resistant to all clinically recommended antibiotics. Bacterial metabolism represents a promising target for the development of new therapeutics against Gc. Here, we generated a curated genome-scale metabolic network reconstruction (GENRE) of Gc strain FA1090. This GENRE links genetic information to metabolic phenotypes and predicts Gc biomass synthesis and energy consumption. We validated this model with published data and in new results reported here. Contextualization of this model using the transcriptional profile of Gc exposed to PMNs revealed substantial rearrangements of Gc central metabolism and induction of Gc nutrient acquisition strategies for alternate carbon source use. These features enhanced the growth of Gc in the presence of neutrophils. From these results, we conclude that the metabolic interplay between Gc and PMNs helps define infection outcomes. The use of transcriptional profiling and metabolic modeling to reveal new mechanisms by which Gc persists in the presence of PMNs uncovers unique aspects of metabolism in this fastidious bacterium, which could be targeted to block infection and thereby reduce the burden of gonorrhea in the human population. IMPORTANCE The World Health Organization designated Gc as a high-priority pathogen for research and development of new antimicrobials. Bacterial metabolism is a promising target for new antimicrobials, as metabolic enzymes are widely conserved among bacterial strains and are critical for nutrient acquisition and survival within the human host. Here we used genome-scale metabolic modeling to characterize the core metabolic pathways of this fastidious bacterium and to uncover the pathways used by Gc during culture with primary human immune cells. These analyses revealed that Gc relies on different metabolic pathways during co-culture with human neutrophils than in rich media. Conditionally essential genes emerging from these analyses were validated experimentally. These results show that metabolic adaptation in the context of innate immunity is important to Gc pathogenesis. Identifying the metabolic pathways used by Gc during infection can highlight new therapeutic targets for drug-resistant gonorrhea.

Students with emotional or behavioral disorders (EBD) perform academically below their peers. One area of particular challenge is written expression. Using a multiple-probe design across participants, this study evaluated the effects of GO 4 IT . . . NOW! strategy instruction on the writing skills of three students with EBD, ages 11-14. The researchers used GO 4 IT . . . NOW strategy instruction to teach students to write paragraphs in the context of their individualized education programs; in particular, students learned to write goals and objectives related to their self-identified academic and nonacademic needs. Researchers taught 19 GO 4 IT . . . NOW! lessons in a one-on-one format; lessons included explicit strategy instruction, feedback, self-evaluation, and practice with revising paragraphs. Results indicate a functional relation between GO 4 IT . . . NOW! strategy instruction and improved expository and IEP goal paragraphs. Students maintained gains into the following school year. Social validity, limitations, and future directions are discussed.

Although national and EU policies and recommendations encourage varied language learning, English has ruled as the most studied foreign language, while other languages are decreasingly being studied in basic and upper secondary education in Finland. The purpose of this paper is to examine the implications of this development in practice. Interviews with Finnish foreign language and mother tongue teachers revealed issues with enrolment in language courses, resulting in decreased pay for teachers of languages other than the national languages and English. To boost enrolment or to ensure courses run, the participants reported having to make adjustments to course expectations, content, accept pay cuts, and 'market' languages to students, essentially creating a market in which languages are sold and consumed. In terms of policies, it is argued that ensuring successful learning outcomes in foreign languages is thus heavily dependent on the teachers' willingness to exert their own resources, agency, and commitment to the institution and their students.

The target article on robust modeling (Lee et al. in review) generated a lot of commentary. In this reply, we discuss some of the common themes in the commentaries; some are simple points of agreement while others are extensions of a practical or abstract nature. We also address a small number of disagreements or confusions.

Objective: Describe variation in sentiment of tweets using race-related terms and identify themes characterizing the social climate related to race. Methods: We applied a Stochastic Gradient Descent Classifier to conduct sentiment analysis of 1,249,653 US tweets using race-related terms from 2015-2016. To evaluate accuracy, manual labels were compared against computer labels for a random subset of 6600 tweets. We conducted qualitative content analysis on a random sample of 2100 tweets. Results: Agreement between computer labels and manual labels was 74%. Tweets referencing Middle Eastern groups (12.5%) or Blacks (13.8%) had the lowest positive sentiment compared to tweets referencing Asians (17.7%) and Hispanics (17.5%). Qualitative content analysis revealed most tweets were represented by the categories: negative sentiment (45%), positive sentiment such as pride in culture (25%), and navigating relationships (15%). While all tweets use one or more race-related terms, negative sentiment tweets which were not derogatory or whose central topic was not about race were common. Conclusion: This study harnesses relatively untapped social media data to develop a novel area-level measure of social context (sentiment scores) and highlights some of the challenges in doing this work. New approaches to measuring the social environment may enhance research on social context and health.

IntroductionThe purpose of this investigation was to examine the influence of supportive parent-adolescent relationships on adolescent adjustment (i.e., prosocial behavior, aggression, depressive symptoms) both directly and indirectly (via adolescent emotion regulation). Scholars have posited that adolescent emotion regulation (ER) may serve as an underlying mechanism in the link between parenting and adolescent adjustment. Supportive parent-adolescent relationships (i.e., openness, acceptance, emotional responsiveness) may be a key emotion socialization mechanism influencing adolescent ER.MethodsThe sample included 206 adolescents (Age Range= 10–18years; 51% female; 70.4% ethnic minorities) and one primary caregiver (83.3% biological mothers, 38.7% single parents). Structural equation modeling (SEM) was implemented to investigate the direct and indirect (via adolescent ER) effects of supportive parent-adolescent relationships on adolescent adjustment. We also explored whether these indirect and direct effects varied by adolescent sex and age.ResultsResults suggested direct and indirect (via adolescent ER) links between supportive parent-adolescent relationships and adolescent prosocial behavior, aggressive behavior, and depressive symptoms. Moreover, evidence indicated that many of these pathways were significant for boys but not girls. No evidence of youth age as a moderator was found.DiscussionThese findings highlight the important role supportive parent-adolescent relationships play in adolescent emotional and behavioral adjustment. Parenting programs could focus on facilitating a mutually responsive parent-adolescent relationship with a specific focus on the dynamic nature of emotion socialization during adolescence.

Endothelial cells (ECs) normally form an anticoagulant surface under physiological conditions, but switch to support coagulation following pathogenic stimuli. This switch promotes thrombotic cardiovascular disease. To generate thrombin at physiologic rates, coagulation proteins assemble on a membrane containing anionic phospholipid, most notably phosphatidylserine (PS). PS can be rapidly externalized to the outer cell membrane leaflet by phospholipid “scramblases,” such as TMEM16F. TMEM16F-dependent PS externalization is well characterized in platelets. In contrast, how ECs externalize phospholipids to support coagulation is not understood. We employed a focused genetic screen to evaluate the contribution of transmembrane phospholipid transport on EC procoagulant activity. We identified 2 TMEM16 family members, TMEM16F and its closest paralog, TMEM16E, which were both required to support coagulation on ECs via PS externalization. Applying an intravital laser-injury model of thrombosis, we observed, unexpectedly, that PS externalization was concentrated at the vessel wall, not on platelets. TMEM16E-null mice demonstrated reduced vessel-wall–dependent fibrin formation. The TMEM16 inhibitor benzbromarone prevented PS externalization and EC procoagulant activity and protected mice from thrombosis without increasing bleeding following tail transection. These findings indicate the activated endothelial surface is a source of procoagulant phospholipid contributing to thrombus formation. TMEM16 phospholipid scramblases may be a therapeutic target for thrombotic cardiovascular disease.

La subfamilia Polistinae (Hymenoptera: Vespidae) es un grupo común de la fauna neotropical, caracterizados en su mayoría por su comportamiento social. En Manu Learning Centre, dentro de la Reserva de Biosfera del Manu, se han colectado dichos organismos empleando trampas Malaise, de caída y bandejas amarillas durante los meses de mayo a diciembre del 2021. Se encontraron diecisiete especies de la subfamilia Polistinae, de las cuales catorce se reportan por primera vez para el departamento de Madre de Dios (Perú). El género mejor representado es Polybia Lepeletier, 1836, con 7 especies.

Se registra una nueva localidad de distribución para el ciempiés Scolopendra galapagoensis (Bollman) en la Reserva de la Biosfera del Manu en el sureste de Perú. El ámbito geográfico de la especie se amplía significativamente hacia el este de la cordillera de los Andes, en la provincia biogeográfica de la Rondonia.

Background: Athletes at risk for anterior cruciate ligament (ACL) injury have concurrent deficits in visuocognitive function and sensorimotor brain functional connectivity. Purpose: This study aimed to determine whether visual perturbation neuromuscular training (VPNT, using stroboscopic glasses and external visual focus feedback) increases physical and cognitive training demand, improves landing mechanics, and reduces neural activity for knee motor control. Design: Controlled laboratory study. Methods: Eight right leg dominant healthy female athletes (20.4±1.1yrs; 1.6±0.1m; 64.4±7.0kg) participated in four VPNT sessions. Before and after VPNT, real-time landing mechanics were assessed with the Landing Error Scoring System (LESS) and neural activity was assessed with functional magnetic resonance imaging during a unilateral right knee flexion/extension task. Physical and cognitive demand after each VPNT session was assessed with Borg's Rating of Perceived Exertion (RPE) for both physical and cognitive perceived exertion and the NASA Task Load Index. Descriptives and effect sizes were calculated. Results: Following VPNT, LESS scores decreased by 1.5 ± 1.69 errors with a large effect size (0.78), indicating improved mechanics, and reductions in BOLD signal were observed in two clusters: 1) left supramarginal gyrus, inferior parietal lobule, secondary somatosensory cortex (p=.012, z=4.5); 2) right superior frontal gyrus, supplementary motor cortex (p<.01, z=5.3). There was a moderate magnitude increase of cognitive RPE between the first and last VPNT sessions. Conclusion: VPNT provides a clinically feasible means to perturbate visual processing during training that improves athletes' real-time landing mechanics and promotes neural efficiency for lower extremity movement, providing the exploratory groundwork for future randomized controlled trials. Level of evidence: Level 3 [ABSTRACT FROM AUTHOR]

Background/Objectives: Early studies have suggested that the SARS-CoV-2 virus has a deleterious effect on bone mineral density and may increase the risk of pathological fractures. This study characterized vertebral compression fractures in patients with and without a prior diagnosis of COVID-19. Methods: Using a nationwide claims database, this retrospective study used ICD-10 billing codes to identify patients with a diagnosis of vertebral compression fracture from January 2020 to April 2022. Two cohorts were created based on whether the patients had a concurrent diagnosis of COVID-19. Patient demographics, comorbidities, and outcome measures were characterized by descriptive analysis. Results: In total, 413,425 patients met the inclusion criteria. Among them, a total of 23,148 patients (5.60%) had a diagnosis of COVID-19 at the time of their compression fracture. Among the COVID-19 patients, the incidences of vertebral compression fracture were 0.42% in 2020 and 0.33% in 2021, in comparison to the historical average yearly incidence of 0.17% across all patients. The patients with COVID-19 at the time of compression fracture diagnosis had a higher rate of vitamin D deficiency (OR: 1.25) and a lower rate of routine healing (OR: 0.61). The patients without COVID-19 were more likely to be osteoporotic (OR: 0.88), experience additional compression fractures (OR: 0.38), and have kyphoplasty or vertebroplasty (OR: 0.73). Conclusions: Despite lower rates of osteoporosis, patients with a concomitant COVID-19 diagnosis exhibited a higher incidence of compression fractures. Although more research is needed, these results support increasing bone health surveillance in patients with a history of COVID-19 infection. [ABSTRACT FROM AUTHOR]

Background: Degenerative cervical myelopathy is a progressive neurological disorder that is commonly encountered in clinical practice and its incidence is expected to increase alongside the aging population. Given the importance of early and accurate diagnosis in this patient population, this narrative review aims to provide a repository of up-to-date information regarding pertinent patient history, physical exam findings, and potential alternate diagnoses. Methods: The PubMed database was queried for publications from 1 January 2019 to 19 March 2024. The search terms utilized are as follows: cervical myelopathy", "cervical spondylotic myelopathy", "degenerative cervical myelopathy", "epidemiology", "prevalence", "incidence", "etiology", "diagnosis", "differential", "symptoms", "clinical presentation", and "atypical symptoms". The resultant articles were reviewed for relevance and redundancy and are presented within the following categories: Natural History, Epidemiology, Clinical Presentation, Diagnosis, and Management. Results: Myelopathy patients often present with subtle and non-specific symptoms such as sleep disturbances, increased falls, and difficulty driving, which can lead to underdiagnosis and misdiagnosis. Failing to diagnose degenerative cervical myelopathy in a timely manner can result in progressive and irreparable neurological damage. Although many nonoperative treatment modalities are available, surgical decompression is ultimately recommended in most cases to limit further deterioration in neurological function and optimize long-term patient outcomes. Conclusions: A thorough clinical history and physical examination remain the most important diagnostic tools to avoid misdiagnosis and implement early treatment in this patient population. [ABSTRACT FROM AUTHOR]

Background: Vertebral fractures are associated with enduring back pain, diminished quality of life, as well as increased morbidity and mortality. Existing epidemiological data for cervical and thoracic vertebral fractures are limited by insufficiently powered studies and a failure to evaluate the mechanism of injury. Question/purpose: What are the temporal trends in incidence, patient characteristics, and injury mechanisms of cervical and thoracic vertebral fractures in the United States from 2003 to 2021? Methods: The United States National Electronic Injury Surveillance System–All Injury Program (NEISS-AIP) database collects data on all nonfatal injuries treated in US hospital emergency departments and is well suited to capture epidemiological trends in vertebral fractures. As such, the NEISS-AIP was queried from 2003 to 2021 for cervical and thoracic fractures. The initial search by upper trunk fractures yielded 156,669 injuries; 6% (9900) of injuries, with a weighted frequency of 638,999 patients, met the inclusion criteria. The mean age was 62 ± 25 years and 52% (334,746 of 638,999) of patients were females. Descriptive statistics were obtained. Segmented regression analysis, accounting for the year before or after 2019 when the NEISS sampling methodology was changed, was performed to assess yearly injury trends. Multivariable logistic regression models with age and sex as covariates were performed to predict injury location, mechanism, and disposition. Results: The incidence of cervical and thoracic fractures increased from 2.0 (95% CI 1.4 to 2.7) and 3.6 (95% CI 2.4 to 4.7) per 10,000 person-years in 2003 to 14.5 (95% CI 10.9 to 18.2) and 19.9 (95% CI 14.5 to 25.3) in 2021, respectively. Incidence rates of cervical and thoracic fractures increased for all age groups from 2003 to 2021, with peak incidence and the highest rate of change in individuals 80 years or older. Most injuries occurred at home (median 69%), which were more likely to impact older individuals (median [range] age 75 [2 to 106] years) and females (median 61% of home injuries); injuries at recreation/sports facilities impacted younger individuals (median 32 [3 to 96] years) and male patients (median 76% of sports facility injuries). Falls were the most common injury mechanism across all years, with females more likely to be impacted than males. The proportion of admissions increased from 33% in 2003 to 50% in 2021, while the proportion of treated and released patients decreased from 53% to 35% in the same period. Conclusion: This epidemiological study identified a disproportionate increase in cervical and thoracic fracture incidence rates in patients older than 50 years from 2003 to 2021. Furthermore, high hospital admission rates were also noted resulting from these fractures. These findings indicate that current osteoporosis screening guidelines may be insufficient to capture the true population at risk of osteoporotic fractures, and they highlight the need to initiate screening at an earlier age. Level of Evidence: Level III, prognostic study. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the link between parent-emerging adult relationship quality and emerging adult physical health outcomes. In addition, mediators and moderators of these links were explored. The sample consisted of 869 college students (ages 18–25 years) who completed online anonymous surveys. Results indicated that high levels of parent-emerging adult openness were significantly related to low levels of emerging adult health problems. In addition, parental involvement was negatively and significantly related to emerging adult body mass index and health problems. Mediation analyses conducted through structural equation modeling demonstrated that parent-emerging adult relationship quality was indirectly (but not directly) related to youth health outcomes via emerging adult internalizing symptoms (but not via emotion regulation). Moreover, there was no evidence for significant gender differences, therefore the overall pattern of findings were similar for women and men. Implications for interventions focusing on parent-emerging adult relationships and emotion regulation were discussed. [ABSTRACT FROM AUTHOR]

Australia lags behind other linguistic and culturally diverse countries in policy direction and approaches to early multilingual education, despite well-established research documenting the intellectual, linguistic, sociocultural, familial and economic benefits of multilingualism in the early years. This is evidenced by the absence of a national policy framework that addresses early multilingual education in Australia, and the relatively limited attention given to research on the role of early childhood education in supporting and extending children's home languages. Within this context, using data from a larger study on early multilingual education, this article builds on empirical data from interviews with four educators representing two early childhood education settings. This article aims to examine the educators' perspectives of their settings' policy and practice, in the absence of broader curriculum frameworks, regarding their role in extending children's home languages. Despite this policy gap, the authors explore how these settings facilitated the diverse linguistic and cultural assets of children and families by supporting and extending children's home languages. Drawing on Bourdieu's framework of social practice, they examine various pedagogical approaches implemented at the settings that validated children's multilingualism, and explore the range of opportunities afforded to multilingual children in using their home languages at the settings. The findings reveal that despite the educators' well-developed understandings of the benefits of early multilingualism, there is some confusion regarding appropriate pedagogical approaches for multilingual support in early childhood education. [ABSTRACT FROM AUTHOR]

Background: Lumbar spine fractures are common injuries associated with substantial morbidity for patients and socioeconomic burden. This study sought to epidemiologically analyze lumbar spine fractures by mechanism of injury and identify temporal trends in patient demographics and disposition, which few studies have previously evaluated. Materials and Methods: A retrospective analysis was done of the US National Electronic Injury Surveillance System (NEISS) database between 2003 and 2022. The sample contained all patients 2 to 101 years old with product-related lumbar fractures presenting to participating institutions' emergency departments. A total of 15,196 unweighted injuries (642,979 weighted injuries) were recorded. Results: Overall, there was a 20-year incidence rate of 10.14 cases per 100,000 person-years with a 2-fold increase in fracture incidence. Females were more prone to lumbar fracture than males (P=.032). Injuries primarily stemmed from a fall (76.6%). The incidence of lumbar fracture increased most significantly in older patients, with patients 80 years and older showing the greatest annual increase (β=8.771, R2=0.7439, P<.001) and patients 60 to 69 years showing the greatest percent increase with a 3.24-fold increase in incidence. Most (58.9%) of the fractures occurred at home. Females were more often injured at home compared with males (P<.001), who more often sustained lumbar fractures during recreational or athletic activity (P<.001). All patients older than 40 years showed at least a doubling in incidence rate of lumbar fracture between 2003 and 2022. Conclusion: These data demonstrate the pressing need to address poor bone health in the aging population, shown here to have an increasing fracture burden. [Orthopedics. 2024;47(6):e297–e302.] [ABSTRACT FROM AUTHOR]

Background: University wellness education can have a long-term impact on the health-related knowledge and behaviors of individuals. Moreover, individual perceptions influence the likelihood of participation in health-promoting behaviors. Therefore, understanding college students' health-related priorities and perceptions may increase the effectiveness of wellness education in university settings. Purpose: The purpose of this study was to assess the health-related priorities, perceptions, and values of college students in the context of wellness-oriented education. Methods: Surveys were administered to undergraduate students enrolled in wellness courses at a liberal arts university. Measures included Multidimensional Health Locus of Control, Perceived Health Competence, Health Values, health priorities, and health behaviors. Results: Students identified stress and mental health as their primary health concerns, over other chronic and infectious diseases. Health was second to happiness among student-identified life values, but increased in relative importance during the semester (P =0.03). Students ranking health high in importance were more likely to accomplish personal wellness goals than those who ranked health lower (P =0.01). Discussion: Considering the association between values and behaviors, value- and priority-informed wellness education may have an increased impact on health-related behavioral outcomes. Translation to Health Education Practice: College wellness education may benefit from incorporating student-identified health priorities and values into curricula.

Although research has demonstrated that both parents and peers influence adolescent development, it is not clear whether these relationships also serve as contexts for emotion socialization. In the current longitudinal study, we investigated whether maternal and peer emotion socialization were related to adolescent girls' daily emotions, emotion regulation, and social and emotional adjustment. The sample included 160 adolescent girls from low-income families followed across 2 years. At Time 1 (T1), girls reported on maternal and peer emotion socialization practices during laboratory visits. At Time 2 (T2), girls reported on daily negative and positive affect using ecological momentary assessment across 2 weeks. Emotion regulation, internalizing problems, and prosocial behavior were assessed during laboratory visits at both T1 and 2 years later (Time 3 [T3]). Results demonstrated that higher levels of maternal and peer emotionally supportive socialization practices were associated with lower levels of girls' daily negative affect. Mothers' supportive practices also predicted increases in girls' emotion regulation over time. Both maternal and peer unsupportive practices predicted more internalizing problems, and peer unsupportive practices predicted less prosocial behavior over time. This study supports and expands Eisenberg's heuristic model by demonstrating that both maternal and peer emotion socialization are associated with adolescent girls' emotional and behavioral outcomes, and maternal and peer emotion socialization have differential effects.