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Sleep has an essential role in the health, wellbeing, and ability to learn of undergraduate college and university students (UCUS). Due to high credit loads, the music curriculum, and music therapy competencies, music therapy students may experience difficulties obtaining adequate sleep. Therefore, the purpose of this study was to understand factors that enable or inhibit sleep in undergraduate music therapy students. We conducted semi-structured interviews with 14 junior and senior level music therapy UCUS at public institutions in the United States. We used an inductive approach to thematic analysis to analyze data and incorporated member checking and trustworthiness to clarify and verify the results. We identified three themes (supported by seven subthemes) as factors that impacted the sleep of undergraduate music therapy students: (a) academic schedule and expected time commitment; (b) intrinsic motivation to become better student music therapists; and (c) wellness-based education and personal factors. The results of this study provide insight into the various factors that might adversely affect sleep in undergraduate music therapy students and have consequences on their health, wellbeing, and learning. Implications for students and educators, limitations of the study, and suggestions for future research are provided.

Although changing industries is common for many professionals, there is a lack of research regarding why music therapists have left the profession. The purpose of this phenomenological investigation was to explore why music therapists in the United States left the profession and understand how music therapy academic and clinical training might be applied across a range of occupational opportunities. We interviewed eight music therapists who had worked in and left the profession for employment in other industries. We used interpretative phenomenological analysis to analyze transcripts and incorporated member checking and trustworthiness to verify our findings. The first theme described how there were multiple factors that contributed to the decision to leave the music therapy profession. The second theme described how participants grappled with the decision to leave the music therapy profession. Regarding why music therapists left the profession and how their education and training were related to their new industry, we used a modified social ecological model to depict four superordinate themes (supported by 11 themes) that described (1) individual and interpersonal factors contributing to the need for occupational change; (2) music therapy skills that facilitated occupational change; (3) unmet professional expectations that contributed to occupational change; and (4) desired changes to the music therapy curriculum for greater career flexibility. Constituting an idiosyncratic process for each participant, leaving the music therapy profession was a complex and multifaceted phenomenon. Implications for education and greater career flexibility, limitations of the study, and suggestions for future research are provided.

Background Patients resuscitated from cardiac arrest are routinely sedated during targeted temperature management, while the effects of sedation on cerebral physiology and outcomes after cardiac arrest remain to be determined. The authors hypothesized that sedation would improve survival and neurologic outcomes in mice after cardiac arrest. Methods Adult C57BL/6J mice of both sexes were subjected to potassium chloride–induced cardiac arrest and cardiopulmonary resuscitation. Starting at the return of spontaneous circulation or at 60 min after return of spontaneous circulation, mice received intravenous infusion of propofol at 40 mg · kg–1 · h–1, dexmedetomidine at 1 µg · kg–1 · h–1, or normal saline for 2 h. Body temperature was lowered and maintained at 33°C during sedation. Cerebral blood flow was measured for 4 h postresuscitation. Telemetric electroencephalogram (EEG) was recorded in freely moving mice from 3 days before up to 7 days after cardiac arrest. Results Sedation with propofol or dexmedetomidine starting at return of spontaneous circulation improved survival in hypothermia-treated mice (propofol [13 of 16, 81%] vs. no sedation [4 of 16, 25%], P = 0.008; dexmedetomidine [14 of 16, 88%] vs. no sedation [4 of 16, 25%], P = 0.002). Mice receiving no sedation exhibited cerebral hyperemia immediately after resuscitation and EEG power remained less than 30% of the baseline in the first 6 h postresuscitation. Administration of propofol or dexmedetomidine starting at return of spontaneous circulation attenuated cerebral hyperemia and increased EEG slow oscillation power during and early after sedation (40 to 80% of the baseline). In contrast, delayed sedation failed to improve outcomes, without attenuating cerebral hyperemia and inducing slow-wave activity. Conclusions Early administration of sedation with propofol or dexmedetomidine improved survival and neurologic outcomes in mice resuscitated from cardiac arrest and treated with hypothermia. The beneficial effects of sedation were accompanied by attenuation of the cerebral hyperemic response and enhancement of electroencephalographic slow-wave activity. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

The ability of most patients with selective immunoglobulin A (IgA) deficiency (SIgAD) to remain apparently healthy has been a persistent clinical conundrum. Compensatory mechanisms, including IgM, have been proposed, yet it remains unclear how secretory IgA and IgM work together in the mucosal system and, on a larger scale, whether the systemic and mucosal anti-commensal responses are redundant or have unique features. To address this gap in knowledge, we developed an integrated host-commensal approach combining microbial flow cytometry and metagenomic sequencing (mFLOW-Seq) to comprehensively define which microbes induce mucosal and systemic antibodies. We coupled this approach with high-dimensional immune profiling to study a cohort of pediatric patients with SIgAD and household control siblings. We found that mucosal and systemic antibody networks cooperate to maintain homeostasis by targeting a common subset of commensal microbes. In IgA-deficiency, we find increased translocation of specific bacterial taxa associated with elevated levels of systemic IgG targeting fecal microbiota. Associated features of immune system dysregulation in IgA-deficient mice and humans included elevated levels of inflammatory cytokines, enhanced follicular CD4 T helper cell frequency and activation, and an altered CD8 T cell activation state. Although SIgAD is clinically defined by the absence of serum IgA, the symptomatology and immune dysregulation were concentrated in the SIgAD participants who were also fecal IgA deficient. These findings reveal that mucosal IgA deficiency leads to aberrant systemic exposures and immune responses to commensal microbes, which increase the likelihood of humoral and cellular immune dysregulation and symptomatic disease in patients with IgA deficiency.

Music therapists may have strategic advantages for collaborative and interdisciplinary research. As such, there is a need to analyze authorship teams as well as funding in the premiere United States-based music therapy research journal. The purpose of this descriptive study was to analyze independent, collaborative, interdisciplinary, and funded research in the Journal of Music Therapy (JMT) from 1998 to 2021. We built a database of JMT articles from 1998 to 2021 and (1) counted the number of authors contributing to articles, (2) categorized articles as independent, collaborative, or interdisciplinary, and (3) counted the number of articles that received funding. From 1998 to 2021, there were 423 total articles that met our inclusion criteria published in JMT. Although two or more authors contributed to most papers, a high percentage of articles were published by single authors (n = 185, 43.74%). More articles were interdisciplinary (n = 162, 38.30%) than collaborative (n = 90, 21.28%). There was a trend for fewer independent articles in more recent years. Although most articles were not funded (n = 312, 73.76%), interdisciplinary articles were most likely to be funded (n = 72, 64.86% of funded articles) while independent articles were least likely to be funded (n = 17, 15.32% of funded articles). General trends indicate higher frequencies of funded papers in more recent years. Research articles published in JMT have become increasingly team-based, interdisciplinary, and funded. Implications regarding the future of music therapy research, Music Therapy Research 2025, limitations of the study, and suggestions for future research are provided.

People in rural communities often encounter unique circumstances when accessing healthcare services and there is a lack of literature investigating music therapy in rural areas. Since nearly 20% of the United States population lives in rural areas, it is imperative to understand not only barriers in providing and accessing music therapy but potential solutions to these challenges. Therefore, the purpose of this exploratory interpretivist study was to identify barriers and potential solutions to improve music therapy access in rural communities within the United States. We conducted semi-structured interviews with five board-certified music therapists with experience working in rural communities. We used an inductive approach to thematic analysis to analyze data and incorporated member checking and trustworthiness to clarify and verify results. We identified five themes (supported by 13 subthemes): (1) General differences between rural and urban communities; (2) Factors potentially increasing therapist burnout; (3) Factors inhibiting service user access to music therapy; (4) Potential solutions to increase access; and (5) Methods to reduce therapist burnout. The emerging themes and subthemes describe insights into the experiences of music therapists working in rural communities and identify unique challenges as well as potential methods to mitigate barriers. Implications for clinical practice, limitations, and suggestions for future research are provided.

The A3 adenosine receptor (A3AR) is over-expressed in human hepatocellular carcinoma (HCC) cells. Namodenoson, an A3AR agonist, induces de-regulation of the Wnt and NF-kB signaling pathways resulting in apoptosis of HCC cells. In a phase I healthy volunteer study and in a phase I/II study in patients with advanced HCC, namodenoson was safe and well tolerated. Preliminary evidence of antitumor activity was observed in the phase I/II trial in a subset of patients with advanced disease, namely patients with Child–Pugh B (CPB) hepatic dysfunction, whose median overall survival (OS) on namodenoson was 8.1 months. A phase II blinded, randomized, placebo-controlled trial was subsequently conducted in patients with advanced HCC and CPB cirrhosis. The primary endpoint of OS superiority over placebo was not met. However, subgroup analysis of CPB7 patients (34 namodenoson-treated, 22 placebo-treated) showed nonsignificant differences in OS/progression-free survival and a significant difference in 12-month OS (44% vs 18%, p = 0.028). Partial response was achieved in 9% of namodenoson-treated patients vs 0% in placebo-treated patients. Based on the positive efficacy signal in HCC CPB7 patients and the favorable safety profile of namodenoson, a phase III study is underway.

Purpose statement: The purpose of this critical interpretive synthesis is to 1) identify the existing music-based health and wellbeing psychometric assessment inventories and then to 2) identify their strengths and limitations.

Antibody-based assays have been a cornerstone of infectious disease diagnostics for over 100 years [1]. These assays rely on the exquisite sensitivity and specificity of humoral response to almost all infections. While next-generation sequencing (NGS) has tremendous potential to improve diagnostics and uncover host-microbial relationships by directly identifying nucleic acids from infectious microbes, challenges and opportunities for new approaches remain. Here, we review a group of cutting-edge techniques that couple antibody responses with flow cytometry of antibody tagged microbes and NGS. These studies are bringing into focus the dynamic relationship between our immune systems and endogenous microbial communities, which are an important source of pathogens. For simplicity, we use the umbrella term mFLOW-Seq (microbial flow cytometry coupled to NGS) to describe these approaches.

Background Neurostimulants (NS) can be used to treat patients with a traumatic brain injury (TBI) with altered levels of consciousness. We sought to determine if amantadine alone (monotherapy) versus amantadine + methylphenidate (dual therapy) would correlate with better neurorecovery (NR) among acutely hospitalized patients with a severe TBI. Methods We performed a retrospective review of adult patients admitted to our level I trauma center from 2016-2019 with a severe TBI. NR was calculated by dividing the difference between admission and discharge Glasgow Coma Scale (GCS) scores by 12. Resulting ratios were used to divide the cohort into two groups: excellent NR (1) and non–excellent NR ( Results A total of 76 patients comprised the cohort; 19.7% (n = 15) had excellent NR. The excellent NR group had a larger proportion of patients receiving dual therapy compared to the non–excellent group (86.7% versus 59%, P = 0.04). In monotherapy (n = 27), amantadine was initiated 13 (8-20) d following injury and treatment lasted 7 (2-16) d. In dual therapy (n = 49), amantadine was initiated 12 (6-19) d following injury and continued for 9 (4-25.5) d. Methylphenidate was initiated 15 (7-20.5) d following injury and continued for 5 (2-13.5) d. After adjusting for confounders, dual versus monotherapy predicted excellent NR (OR 5.4, 95% CI 1.2 - 38.9, P = 0.03). Conclusions During the acute hospitalization for a severe TBI, dual NS therapy compared to monotherapy is associated with an increased likelihood of excellent NR. Larger prospective trials are warranted to validate these findings.

According to the Stress Vulnerability Model, affect regulation is crucial to manage stressors and promote recovery for adults with mental health conditions. Education regarding music-based affect regulation can be delivered in group formats using a transdiagnostic approach to increase access to services and vicarious learning. Therefore, the purpose of this study was to determine if there were between-diagnosis and between-substance differences in music-based affect regulation via the Brief Music in Mood Regulation Scale (B-MMR) and Healthy-Unhealthy Music Scale (HUMS) subscales in adults with mental health and substance use conditions. Adults with mental health ( n = 147) and substance use ( n = 221) conditions completed the B-MMR and HUMS. Analyses of variance were conducted with participants’ mental health diagnosis or primary substance as independent variables and the B-MMR and HUMS subscales as dependent variables. There were only significant between-substance differences in revival and discharge subscales, with participants addicted to heroin having higher mean scores than participants addicted to alcohol. No other result was significant. Due to an overall lack of between-group differences in diagnoses and substances, transdiagnostic theory has applications for educating adults with mental health and substance use conditions about music-based affect regulation in group formats.

Background Namodenoson, an A3 adenosine receptor (A3AR) agonist, improved liver function/pathology in non-alcoholic steatohepatitis (NASH) preclinical models. Aim To evaluate the efficacy and safety of namodenoson for the treatment of non-alcoholic fatty liver disease (NAFLD) with or without NASH METHODS: This phase 2 study included 60 patients with NAFLD (ALT ≥60 IU/L) who were randomised (1:1:1) to oral namodenoson 12.5 mg b.d. (n = 21), 25 mg b.d. (n = 19), or placebo (n = 20) for 12 weeks (total follow-up: 16 weeks). The main efficacy endpoint involved serum ALT after 12 weeks of treatment. Results Serum ALT decreased over time with namodenoson in a dose-dependent manner. The difference between change from baseline (CFB) for ALT in the namodenoson 25 mg b.d. arm vs placebo trended towards significance at 12 weeks (P = 0.066). Serum AST levels also decreased with namodenoson in a dose-dependent manner; at 12 weeks, the CFB for 25 mg b.d. vs placebo was significant (P = 0.03). At Week 12, 31.6% in the namodenoson 25 mg b.d. arm and 20.0% in the placebo arm achieved ALT normalisation (P = 0.405). At week 16, the respective rates were 36.8% and 10.0% (P = 0.038). A3AR expression levels were stable over time across study arms. Both doses of namodenoson were well tolerated with no drug-emergent severe adverse events, drug-drug interactions, hepatotoxicity, or deaths. Three adverse events were considered possibly related to study treatment: myalgia (12.5 mg b.d. arm), muscular weakness (25 mg b.d. arm), and headache (25 mg b.d. arm). Conclusion A3AR is a valid target; namodenoson 25 mg b.d. was safe and demonstrated efficacy signals (ClinicalTrials.gov #NCT02927314).

Enteric pathogens are exposed to a dynamic polymicrobial environment in the gastrointestinal tract(1). This microbial community has been shown to be important during infection, but there are few examples illustrating how microbial interactions can influence virulence of invading pathogens(2). Here, we show that expansion of a group of antibiotic-resistant, opportunistic pathogens in the gut, the enterococci, enhances fitness and pathogenesis of C. difficile. Through a parallel process of nutrient restriction and cross-feeding, enterococci shape the metabolic environment in the gut and reprogram C. difficile metabolism. Enterococci provide fermentable amino acids, including leucine and ornithine, which increase C. difficile fitness in the antibiotic perturbed gut. Parallel depletion of arginine by enterococci through arginine catabolism provides a metabolic cue for C. difficile that facilitates increased virulence. Evidence of microbial interaction between these two pathogenic organisms is observed in multiple mouse models of infection and C. difficile-infected patients. These findings provide mechanistic insights into the role that pathogenic microbiota have in susceptibility to and severity of C. difficile infection.

Strategies to modify the gut microbiome in cancer patients using fecal microbiota transplantation (FMT) have gained momentum as a therapeutic intervention. However, how FMT impacts innate-like, antimicrobial T lymphocytes is unclear. In this study, we assessed peripheral blood (PB) mucosa-associated invariant T (MAIT) cell frequencies and functions in patients with metastatic renal cell carcinoma (mRCC) before and seven days after they received FMT as part of a clinical trial. We found comparable MAIT cell frequencies in healthy controls and mRCC patients. In contrast, γδ T cells exhibited a numerical decline in mRCC, which was partially reversed by FMT. We also found a significant increase in the PB CD4

Background: Microtubule stabilizing drugs, commonly used as anti-cancer therapeutics, have been proposed for treatment of Alzheimer’s disease (AD); however, many do not cross the blood-brain barrier. Objective: This research investigated if paclitaxel (PTX) delivered via the intranasal (IN) route could alter the phenotypic progression of AD in 3xTg-AD mice. Methods: We administered intranasal PTX in 3XTg-AD mice (3xTg-AD n = 15, 10 weeks and n = 10, 44 weeks, PTX: 0.6 mg/kg or 0.9%saline (SAL)) at 2-week intervals. After treatment, 3XTg-AD mice underwent manganese-enhanced magnetic resonance imaging to measure in vivo axonal transport. In a separate 3XTg-AD cohort, PTX-treated mice were tested in a radial water tread maze at 52 weeks of age after four treatments, and at 72 weeks of age, anxiety was assessed by an elevated-plus maze after 14 total treatments. Results: PTX increased axonal transport rates in treated 3XTg-AD compared to controls (p≤0.003). Further investigation using an in vitro neuron model of Aβ-induced axonal transport disruption confirmed PTX prevented axonal transport deficits. Confocal microscopy after treatment found fewer phospho-tau containing neurons (5.25±3.8 versus 8.33±2.5, p

Background: Conditioning- and cue-induced craving theories indicate that music has the potential to induce substance craving. A better understanding of this phenomenon could enhance treatment and prevent misuse, relapse, and overdose. Objective: The purpose of this systematic review was to locate and examine studies using music to induce substance craving in humans. We sought to discover if music can induce substance craving as well as specific aspects of the music and how it was used. Method: Adhering to the PRISMA Statement and Checklist, we conducted a systematic review of literature on music-induced substance craving in nine databases. We extracted data from studies meeting our inclusion criteria, which related to substance craving induced by music and data based on music intervention reporting guidelines. Results: We reviewed 751 research outputs. A total of 33 articles meeting the inclusion criteria were found, indicating that various types of music can induce alcohol, cannabis, nicotine, and general substance craving. In most of the studies, music was used as a component of a mood induction technique or in a virtual reality setting that led to craving. There tended to be a lack of detail about the music itself and most authors did not adhere to music intervention reporting guidelines. In the majority of studies, the researchers selected the music to induce negative mood states so as to elicit craving. Conclusion: Music has the potential to induce substance craving. While the music used in studies varied considerably and tended to be well controlled from a research design perspective, the music was not based on the music psychology literature, and authors did not adequately report essential aspects of the music. Implications for clinical practice, limitations, and suggestions for future research are provided.

Music therapy can decrease illness- and treatment-related symptoms for adults in medical settings. In these environments, service users often decide to accept or decline music therapy after a brief introduction by the music therapist. As there is limited literature exploring the challenges related to these introductions, the purpose of this interpretivist study was to describe how music therapists introduce music therapy in the form of patient-preferred live music (MT-PPLM) in adult medical settings to augment the likelihood of patients accepting treatment. We conducted semi-structured interviews with nine participants who had experience providing MT-PPLM in adult medical settings. In this exploratory interpretivist study, we used an inductive approach to thematic analysis and incorporated member-checking to augment trustworthiness and credibility of the results. We identified three themes (supported by eight subthemes depicted in parentheses): (A) Offer patient a unique interaction through verbal and nonverbal techniques (Provide opportunities for patient control; Engage patient through nonmedical dialogue; and Use affect and body language to convey a different demeanor); (B) Clarify expectations related to patient and session (Avoid the word “therapy”; Use the music to explain the intervention; and Mention clinical benefits to describe what the patient can expect from the session); and (C) Respond to patient’s verbal and nonverbal communication (Assess patient and adapt introduction; and Validate patient’s response). The findings offer introductory techniques for music therapists that may increase the likelihood of adults in medical settings accepting MT-PPLM. Implications for clinical practice, ethical considerations, limitations, and suggestions for future research are provided.

While many individuals affected by blindness or low vision utilize accessibility applications on iPhone and iPad devices, few receive professional training on application use. Determining the impact of a smartphone and tablet-based curriculum at a Blind Rehabilitation Center (BRC) on functionality and independence can help patients and physicians understand the value of these training programs. Between January 2015 and December 2019, a pre–post initiative evaluated patient functionality and independence scores before and after exposure to a technology educational curriculum at the West Palm Beach Veteran Affairs BRC. A total of 337 patients with impaired vision or complete blindness participated in a 1-month, 35-hr iPhone and iPad learning course. This course was led by technology instructors trained in working with patients with low vision or blindness. The level of function and independence was determined before and after the educational curriculum using a modified Functional Independence Measurement (FIM) Scale from 1 to 7, with 1 indicating no independent functionality and 7 indicating complete independence. After completion of the course, patients were stratified by age, gender, ethnicity, and eye-related diagnosis. All demographic groups noted an increase in FIM score, with average improvement of 3.75 points. A factorial analysis of variance (ANOVA) revealed that younger age groups displayed a statistically significant improvement in FIM score compared to older groups with an F ratio of F(3, 295) = 4.503, p = .004. Eye diagnosis did not have an impact on FIM score change. These results suggest any patient may benefit from professional training in the use of iPhone and iPad applications with younger patients showing greater rates of initial improvement. The authors recommend increased utilization of smartphone and tablet training programs at BRCs by all individuals with low vision or blindness.

Reduction of Clostridioides difficile infection (CDI) recurrence is an essential endpoint for CDI-directed antibiotic development that is often not evaluated until Phase III trials. The purpose of this project was to use a functional and metagenomic approach to predict the potential anti-CDI recurrence effect of ibezapolstat, a DNA polymerase IIIC inhibitor, in clinical development for CDI. As part of the Phase I ibezapolstat clinical study, stool samples were collected from 22 healthy volunteers, who were given either ibezapolstat or vancomycin. Stool samples were evaluated for microbiome changes and bile acid concentrations. Ibezapolstat 450 mg and vancomycin, but not ibezapolstat 300 mg, showed statistically significant changes in alpha diversity over time compared to that of a placebo. Beta diversity changes confirmed that microbiota were significantly different between study groups. Vancomycin had a more wide-ranging effect on the microbiome, characterized by an increased proportion of Gammaproteobacteria. Ibezapolstat demonstrated an increased proportion of Actinobacteria, including the Bifidobacteriaceae family. Using a linear regression analysis, vancomycin was associated with significant increases in primary bile acids as well as primary:secondary bile acid ratios. An overabundance of Enterobacteriaceae was most highly correlated with primary bile acid concentrations (

Population-based data are needed to inform the safe prescribing of fluoroquinolone antibiotics to patients with advanced chronic kidney disease (CKD).To quantify the 14-day risk of a hospital visit with nervous system and/or psychiatric disorders, hypoglycemia, or a collagen-associated event in patients with advanced CKD newly prescribed a fluoroquinolone at a higher vs a lower dose.This population-based cohort study in Ontario, Canada (January 1, 2008, to March 17, 2020) used linked health care data to identify new users of fluoroquinolone antibiotics. Participants included adults 66 years or older with advanced CKD (an estimated glomerular filtration rate [eGFR]30 mL/min/1.73 m2 but not receiving dialysis). Data analysis was performed from January 1 to April 30, 2021.A new prescription for a higher-dose fluoroquinolone (ciprofloxacin, 501-1000 mg/d; levofloxacin, 501-750 mg/d; or norfloxacin, 401-800 mg/d) vs a lower-dose fluoroquinolone (ciprofloxacin, 500 mg/d; levofloxacin, 250-500 mg/d; or norfloxacin, 400 mg/d).The primary outcome was the 14-day risk of a hospital visit with nervous system and/or psychiatric disorders, hypoglycemia, or a collagen-associated event. Secondary outcomes included a hospital visit with sepsis, retinal detachment or other tendinopathies, all-cause hospitalization, all-cause mortality, and sudden cardiac death. Inverse probability of treatment weighting on the propensity score was used to balance comparison groups on baseline health. Weighted risk ratios and risk differences were obtained using modified Poisson regression and binomial regression, respectively.Of 11 917 patients (median age, 83 years [IQR, 77-89 years]; 7438 women [62.4%]; median eGFR, 25 [IQR, 21-28] mL/min/1.73 m2) included in the analysis, 5482 (46.0%) received a higher-dose and 6435 (54.0%) received a lower-dose fluoroquinolone. After weighting, the primary composite outcome-a hospital visit with nervous system and/or psychiatric disorders, hypoglycemia, or a collagen-associated event-occurred in 68 of 5482 patients (1.2%) treated with a higher-dose fluoroquinolone and in 47 of 5516 (0.9%) treated with a lower-dose fluoroquinolone (weighted risk ratio, 1.45 [95% CI, 1.01-2.08]; weighted risk difference, 0.39% [95% CI, 0.01%-0.76%]). The risk of sepsis, retinal detachment, all-cause hospitalization, all-cause mortality, and sudden cardiac death did not differ significantly between groups.These findings suggest that older patients with advanced CKD who were prescribed a fluoroquinolone at a higher-than-recommended dose were significantly more likely to experience the composite outcome of a hospital visit with nervous system and/or psychiatric disorders, hypoglycemia, or a collagen-associated event, although the absolute risk of these events was less than 2%.

to describe the clinical and safety outcomes between andexanet alfa (AA) and 4-factor prothrombin complex concentrate (4F-PCC) for the reversal of apixaban or rivaroxaban in the setting of an intracranial hemorrhage (ICH).A retrospective, multicentered descriptive study was conducted in hospitalized patients 18 years of age or older from June 2018 to October 2019 who received AA or 4F-PCC for the reversal of apixaban or rivaroxaban in the setting of ICH. Patients were excluded if they had received 4F-PCC prior to AA after its addition to the institution wide formulary. Other exclusion criteria were history or presence of heparin-induced thrombocytopenia or disseminated intravascular coagulation, estimated hematoma volume of60 mL, Glasgow Coma Scores7, or no repeat CT head scan. Information was collected from the electronic medical records. The primary outcome was the achievement of excellent or good hemostatic efficacy upon the repeat computer tomography (CT) scan performed after the infusion of study drugs. Secondary outcomes included disposition, survival to hospital discharge, 30-day readmission, length of hospital stay, length of ICU stay, incidence of thromboembolic events.A total of 24 patients were included in the study, of which 9 received AA and 15 received 4F-PCC. The achievement of excellent or good hemostatic efficacy upon repeat CT scan occurred in 7 (77.8%) patients in the AA group and in 14 (93.3%) patients in the 4-F PCC group. All patients in the AA group survived to hospital discharge with no 30-day morality and 86.7% patients in the 4F-PCC group.This study suggests that real-world clinical and safety outcomes between andexanet alfa and 4F-PCC for the reversal of factor Xa inhibitors in the setting of ICH are similar to ones reported in clinical trials.

The long-term consequences of the COVID-19 pandemic on college students' mental health remains unknown. The current study explored self-reported Obsessive-Compulsive symptomatology among college student cohorts from pre-, peak-, and later-pandemic time points.Undergraduate college students (N = 524) who volunteered for course credit.Self-report responses on the Dimensional Obsessive-Compulsive Scale (DOCS), which includes subscales for contamination, unacceptable thoughts, harm responsibility, and symmetry, were collected from November 29, 2016 through April 27, 2021 and assessed for differences between the pre-, peak-, and later-pandemic cohorts.Peak-pandemic responders reported higher symptomatology for contamination and unacceptable thoughts compared to pre-pandemic responders (and for pre- vs. later-pandemic for contamination), with no significant effects for symmetry or harm responsibility.Although the longer-term consequences of the COVID-19 pandemic on students remains unknown, a greater shift in college mental health services from prevention to assessing and addressing more immediate challenges may be necessary.

Addressing "total pain" is a concept commonly practiced in palliative care. Spiritual healing in a Navy Veteran led to a significant improvement in pain allowing a voluntary taper of opioid medication. The Veteran was able to reconcile his faith in God and participated in several spiritual practices daily. The palliative care pharmacist assisted the team in developing an opioid taper process per Veteran's request as he had a strong conviction that he was spiritually healed. A reduction in opioid morphine equivalent daily doses (MEDD) were 87.5% without any symptoms from the clinical opioid withdrawal scale (COWS). The Veteran died peacefully during an opioid taper in hospice care.

Autistic children (AC) can demonstrate varying abilities of comprehending spoken and written information. Although information is often paired with music to facilitate recall and learning, there is limited research investigating if sung short stories influence the listening and reading comprehension (LRC) of AC. The purpose of this study was to compare the LRC of information paired with (1) familiar melodies, (2) unfamiliar melodies, and (3) spoken information in AC. Participants ( N = 59) received three different short stories presented live that were sung paired with a familiar melody, sung paired with an unfamiliar melody, and spoken. Both music conditions had guitar accompaniment. After presentation of each condition, participants answered five close-ended questions to measure LRC. There was no significant within-group LRC difference between the familiar melody, unfamiliar melody, or spoken conditions. Descriptive statistics indicated that both music conditions yielded slightly higher mean LRC scores than the spoken condition with slightly higher mean LRC during the familiar melody condition than the unfamiliar melody condition. Given the differences in the means, future researchers should be mindful of the possibility of a type II error. Implications for classroom and clinical work, limitations of the study, and suggestions for future research are provided.

Background: Motivation represents a core concept in substance use disorder (SUD) treatment while commitment constitutes a compelling construct lacking empirical investigation. Although music therap...

Background: Although coronavirus disease 2019 (COVID-19) has impacted on a global scale, the knowledge, attitudes, and beliefs of the health care workers who provide the care at the end of life have not been evaluated. Objectives: To assess and understand palliative medicine and hospice care health care workers' knowledge, attitudes, and beliefs related to COVID-19. Design: A web-based survey was created. Primary outcomes included attitudes, beliefs, and knowledge. Secondary outcomes included comparison in between health care workers who described themselves at high risk versus not at high risk of complications related to COVID-19 infection. Setting/Subjects: In total, 1262 adult hospice workers in the United States were invited. Results: A total of 348 workers completed the survey. Of them, 321 were analyzed, 54.52% were over the age of 50 years, 84.74% were females, 41.75% were nurses, 29.6% were administrative staff, and 6.54% were physicians. Of these workers, 39.56% considered themselves at high risk to develop complications related to COVID-19 infection, 74.46% felt neutral to uncomfortable treating these patients, 77.57% believed that the recommended personal protective equipment (PPE) was adequate, 89.41% supported the risk-reduction strategies, 84.73% obtained information from health authorities, 25.55% from social media, 31.46% believed COVID-19 was likely created in a laboratory or intentionally, and 66.14% of hospice workers who considered themselves at high risk of complications felt available PPE was adequate to protect them compared with 85.05% of responders who did not consider themselves at high risk (p

In an era when numerous disease-associated genes have been identified, determining the molecular mechanisms of complex diseases is still difficult. The CELF1 region was identified by genome-wide association studies as an Alzheimer’s disease (AD) risk locus. Using transcriptomics and cross-linking and immunoprecipitation sequencing (CLIP-seq), we found that CELF1, an RNA-binding protein, binds to KLC1 RNA and regulates its splicing. Analysis of two brain banks revealed that CELF1 expression is correlated with inclusion of KLC1 exons downstream of the CELF1-binding region identified by CLIP-seq. In AD, low CELF1 levels result in high levels of KLC1 splice variant E (KLC1_vE), an amyloid-β (Aβ) pathology-driving gene product. Cell culture experiments confirmed regulation of KLC1_vE by CELF1. Analysis of mouse strains with different propensities for Aβ accumulation confirmed that Klc1_vE drives Aβ pathology. Using omics methods, we revealedthe molecular pathway of a complex disease supported by human and mouse genetics.

Cancer-related fatigue (CRF) is the most persistent and commonly occurring side effect of cancer and its treatments. CRF can negatively impact recovery and there is a lack of music intervention research addressing CRF. The purpose of this randomized study was to determine the effects of a single patient-preferred live music (PPLM) session on fatigue, energy, and pain in adults on a medical oncology/hematology unit. Participants ( N = 36) were randomly assigned to experimental or wait-list control conditions and completed measures at pre- and posttest. Experimental participants received an individual PPLM session. Participants were provided with a 35-song menu consisting of music from a variety of genres. The results indicated significant between-group differences in posttest fatigue ( p = .004) and pain ( p = .027) with experimental participants having more favorable means. Although the between-group difference in posttest energy was not significant, the experimental group had a greater increase in energy from pre- to posttest than the control group. As CRF is common and the existing literature indicates that adults in medical settings tend to prefer receptive interventions, PPLM may represent a practical and effective intervention to address fatigue and pain for adults on a medical oncology/hematology unit. Limitations, implications for clinical practice, and suggestions for further research are provided.

The existing literature indicates that motivation is an important predictor of treatment outcome for people with substance use disorders (SUD). Although researchers have found that music therapy can positively impact motivation for people with SUD, the music therapy and SUD literature base lack a theoretical understanding of motivation. Vroom’s expectancy theory of motivation (ETM) is an established theoretical framework positing that motivation depends on three relationships: expectancy, instrumentality, and valence. These relationships consist of four variables: effort, performance, reward, and preference. Based on these four variables, motivation depends on the expectation that an increase in effort will lead to improved performance, thus leading to a reward aligned with an individual’s preferences. The purpose of this paper is to apply Vroom’s ETM to music therapy and SUD clinical practice and research. We reviewed the existing literature addressing Vroom’s ETM within SUD treatment and created a model to depict how to apply Vroom’s ETM to music therapy clinical practice for people with SUD. Application of Vroom’s ETM may help music therapists understand and augment motivation for people with SUD, potentially leading to relapse prevention and recovery. Implications for clinical practice, limitations, and suggestions for future research are provided.

BackgroundClostridioides difficile infection is the most common cause of healthcare-associated infections in the USA, with limited treatment options. Ibezapolstat is a novel DNA polymerase IIIC inhibitor with in vitro activity against C. difficile.Objectives and methodsRandomized, double-blind, placebo-controlled study to assess the safety, tolerability and pharmacokinetics of ibezapolstat in healthy volunteers. Microbiome changes associated with ibezapolstat were compared with vancomycin over a 10 day course using shotgun metagenomics.ResultsA total of 62 subjects aged 31 ± 7 years (45% female; average BMI: 25 ± 3 kg/m2) were randomized. Ibezapolstat was well tolerated with a safety signal similar to placebo. Ibezapolstat had minimal systemic absorption with the majority of plasma concentrations less than 1 µg/mL. In the multiday, ascending dose study, ibezapolstat concentrations of 2000 µg/g of stool were observed by Day 2 and for the remainder of the dosing time period. In the multiday, multiple-dose arm, baseline microbiota was comparable between subjects that received ibezapolstat compared with vancomycin. At Day 10 of dosing, differential abundance analysis and β-diversity demonstrated a distinct difference between the microbiome in subjects given vancomycin compared with either dose of ibezapolstat (P = 0.006). α-Diversity changes were characterized as an increase in the Actinobacteria phylum in subjects that received ibezapolstat and an increase in Proteobacteria in subjects given vancomycin.ConclusionsIbezapolstat was shown to be safe and well tolerated, with minimal systemic exposure, high stool concentrations and a distinct microbiome profile compared with oral vancomycin. These results support further clinical development of ibezapolstat for patients with C. difficile infection.

Although patient-preferred live music (PPLM) can be an effective music therapy intervention for addressing cancer-related fatigue (CRF) in adult oncology patients, there is a gap in the literature specific to patients’ experiences of how PPLM impacts CRF. The primary purpose of this interpretivist study was to understand the mechanisms by which PPLM impacts CRF from the patients’ perspectives. The secondary purpose was to gain insight into patients’ song choice rationales and their ensuing function within PPLM. We provided PPLM and conducted semi-structured interviews with adult oncology patients ( N = 5) on a blood and marrow transplant unit. We used an inductive approach to thematic analysis to analyze interview transcripts and achieved trustworthiness through independent analyses of transcripts as well as peer review of codes and themes. Participants described how PPLM provided CRF symptomatic relief by facilitating emotional release and being an aesthetically pleasing distraction. Participants noted they chose songs because of memorable experiences and for musical elements and components, while explaining that PPLM facilitated reminiscence, promoted relaxation and restful states, and encouraged reflection through the lyrics. Results provide an initial patient-centric understanding of how and why PPLM might impact CRF. Implications for clinical practice, limitations, and suggestions for future research are provided.

Background: Although people self-administer music for affect enhancement and self-regulation, there is a dearth of empirical inquiry investigating whether music-based regulatory factors and healthy and unhealthy music use explain coping strategies in adults hospitalized with cancer. Purpose: The purpose of this study was to determine whether music-based affect regulation and healthy and unhealthy music use explain coping strategies in adults hospitalized with cancer. Method: Participants ( N = 139) were adults hospitalized on oncology units at a large teaching hospital. Participants completed the Brief Music in Mood Regulation scale, the Healthy-Unhealthy Music Scale, and the Brief COPE. Correlational and ensuing multiple regression analyses were conducted to determine whether music-based affect regulation factors and healthy and unhealthy music use explained coping strategies. Results: Regression results indicated that discharge explained humor and religion. Unhealthy music use explained self-distraction, denial, behavioral disengagement, venting, and self-blame. Healthy music use explained active coping, instrumental support, positive reframing, planning, and acceptance. Conclusions: Music use can explain both adaptive and maladaptive coping strategies for adults with cancer. Education may enable people with cancer to make effective self-administered music listening choices that augment mood, quality of life, and recovery. Implications, limitations, and suggestions for future research are provided.