Peer-led stay interviews to connect employees and develop retention strategies.

ABSTRACT: Stay interviews can strengthen employee engagement and increase retention. This quality improvement project aimed to determine nurses' motivations for staying on their current unit by conducting peer-led stay interviews. Participants responded positively to the stay interview process.

The frequency and presentation of upper thoracic spinous process deviations, their relationship to articular morphology, and the potential influence on static palpation techniques.

BACKGROUND: Static palpation of vertebral spinous process deviations from the midline are often utilized by manual therapists as a means to determine area for treatment of manipulable lesions. Previous research has discussed the diagnostic validity of this technique, but no correlation to vertebral morphology has been presented. AIM: To evaluate the frequency and presentation of vertebral spinous process deviations and their relationship with articular morphology, and the impact this may have in terms of static palpation techniques in the upper thoracic spine. SETTING: This study was conducted on human T1-T6 vertebrae. METHOD: A skeletal sample consisting of 58 humans T1-T6 vertebrae were photographed and linear and angular measurements taken utilizing ImageJ software and non-metric visual observations. RESULTS: Spinous process deviations in the entire sample group (n = 348) were found to occur in a frequency ranging from 19% (n = 11) at T1 to 41.4% (n = 24) at T3. However, when evaluated in terms of frequency within an individual's T1-T6, 83.3% (n = 25) of males and 67.86% (n = 19) of females demonstrated this feature, with an overall incidence of 77.59% (n = 45). Age of individuals did not show an increase in frequency, and no clear pattern could be identified regarding metric measurements and its presence. CONCLUSION: Spinous process deviations in the upper thoracic spine are most probably the result of random normal variations between individuals and are more frequent in males. Static palpation without pain criteria is not a reliable diagnostic technique to determine areas needing manual treatment, as these may be considered normal osseous anatomical variations.

Chiropractic Day 2023: A Report and Qualitative Analysis of How Thought Leaders Celebrate the Present and Envision the Future of Chiropractic.

Objective: This study aimed to (1) collect and analyze statements about how to celebrate chiropractic in the present and roles that chiropractors may fulfill in the future, (2) identify if there was congruence among the themes between present and future statements, and (3) offer a model about the chiropractic profession that captures its complex relationships that encompass its interactions within microsystem, mesosystem, exosystem, and macrosystem levels. Methods: For this qualitative analysis, we used pattern and grounded theory approaches. A purposive sample of thought leaders in the chiropractic profession were invited to answer the following 2 open-ended questions: (1) envision the chiropractor of the future, and (2) recommendations on how to celebrate chiropractic. Information was collected during April 2023 using Survey Monkey. The information was entered into a spreadsheet and analyzed for topic clusters, which resulted in matching concepts with social-ecological themes. The themes between the responses to the 2 questions were analyzed for congruence. We used the Standards for Reporting Qualitative Research to report our findings. Results: Of the 54 experts invited, 32 (59%) participated. Authors represented 7 countries and have a median of 32 years of chiropractic experience, with a range of 5 to 51 years. Nineteen major topics in the future statements and 23 major topics in statements about celebrating chiropractic were combined in a model. The topics were presented using the 4 levels of the social-ecological framework. Individual (microsystem): chiropractors are competent, well-educated experts in spine and musculoskeletal care who apply evidence-based practices, which is a combination of the best available evidence, clinical expertise, and patient values. Interpersonal relationships (mesosystem): chiropractors serve the best interests of their patients, provide person-centered care, embrace diversity, equity, and inclusion, consider specific health needs and the health of the whole person. Community (exosystem): chiropractors provide care within integrated health care environments and in private practices, serve the best interests of the public through participation in their communities, participate through multidisciplinary collaboration with and within the health care system, and work together as a profession with a strong professional identity. Societal (macrosystem): chiropractors contribute to the greater good of society and participate on a global level in policy, leadership, and research. There was concordance between both the future envisioning statements and the present celebration recommendations, which suggest logical validity based on the congruence of these concepts. Conclusion: A sample of independent views, including the perceptions from a broad range of chiropractic thought leaders from various backgrounds, philosophies, diversity characteristics, and world regions, were assembled to create a comprehensive model of the chiropractic profession. The resulting model shows an array of intrinsic values and provides the roles that chiropractors may provide to serve patients and the public. This study offers insights into the roles that future chiropractors may fulfill and how these are congruent with present-day values. These core concepts and this novel model may have utility during dialogs about identity, applications regarding chiropractic in policy, practice, education, and research, and building positive relationships and collaborations.

Long-Term Follow-Up of Non-Enhancing Renal Masses on CEUS.

PURPOSE: To determine the natural history and necessity of long-term follow-up of renal masses that do not demonstrate enhancement on contrast-enhanced ultrasound (CEUS). METHODS: This retrospective single-center study was approved by our local IRB and is HIPAA compliant. Exactly 405 patients with 620 non-enhancing renal masses on CEUS from a previously reported study were followed for up to 10 years. Techniques and equipment are described in the original manuscript. Patient charts and imaging studies were reviewed for the change in features. There were 117 (18.6%) patients lost to follow-up leading to 341 patients with 512 lesions. The lesion size, patient age, number of lesions per patient, and Bosniak class assigned at the initial examination was recorded. RESULTS: Mean patient age was 66 ± 12.6 years (range 17-95 years). Average time of follow-up was 58.9 ± 41.7 months (range 1-207 months). There was a mean of 1.5 ± 1.0 lesions per patient (range 1-7 lesions). Lesion size was 24.9 ± 18.2 mm (range 3-161 mm). There were 276 (53.9%) patients with >5-year follow-up and 78 (15.2%) patients with >10-year follow-up. The probability of change within 5 years was 0% (95% CI: 0-0.37 per 100PY) and 10 years 0% (95% CI: 0.0-0.18 per 100PY). Two lesions (0.4%) resolved by 60 months. Five lesions (1.0%) decreased in size. Four lesions (0.8%) increased in size >20% during the follow-up period but remained benign on subsequent imaging. CONCLUSION: Any non-enhancing renal mass on CEUS can be classified as benign.

Depression, Anxiety, and Stress Among Chiropractors in South Africa During the Early COVID-19 Pandemic.

Objective: The purpose of this study was to assess the self-reported depression, anxiety, and stress responses of chiropractors in South Africa during the first year of the COVID-19 pandemic. Methods: This was an explorative cross-sectional survey. The survey was distributed to 884 chiropractors through the membership databases of the Chiropractic Association of South Africa and the Allied Health Professions Council of South Africa from July 9, 2020, until August 4, 2020. The study was conducted through Google Forms and included the Depression, Anxiety, and Stress Scale questionnaire. Data were analyzed using the Kolmogorov-Smirnov and Shapiro-Wilk tests and comparatively using the Mann-Whitney U and Kruskal-Wallis tests. Results: The response rate was 17%. The chiropractor scores for depression, anxiety, and stress were within the normal range (7.35, 5.42, and 11.58, respectively). Female chiropractors under the age of 40 years old were found to be affected to a greater degree than the other participants in this study (9.87, 7.56, and 14.14). Conclusion: Self-reported levels for stress, anxiety, and depression among chiropractors in South Africa were found to be within normal limits during the initial phase of the COVID-19 pandemic.

The positive and negative impacts of the COVID-19 pandemic on the European Council on Chiropractic Education accredited programs: A mixed methods audit and thematic analysis.

OBJECTIVE: The objectives of this study were to: (1) determine the impact of COVID-19 on the operations within the 9 sections of the European Council on Chiropractic Education (ECCE) 'Standards'; (2) identify specific rapid changes to the programs; and (3) identify positive changes that will continue post-pandemic. METHODS: This was a mixed methods audit and thematic analysis of data from interviews conducted via a cloud-based video conferencing tool with program leaders of the ECCE accredited institutions. A validated questionnaire designed around ECCE's "Standards" was used, consisting of 3 sections: (1) Severity of the COVID-19 impact on each ECCE Standard section; (2) Description of program changes made for each section; (3) Identification of positive changes continuing post-pandemic. Descriptive statistics were calculated for Part 1 and compared for significant differences via the Kruskal-Wallis test. Verbal responses to Parts 2 and 3 were evaluated independently by 3 researchers using a modified "thematic analysis" approach. Final thematic categories and themes were agreed upon by the researchers. RESULTS: There was a 100% response rate. Outpatient teaching clinics were most severely affected, followed by teaching chiropractic technique courses. Curricular structure and duration and program management were least affected (p =.033). Four thematic categories were identified: Extreme Stress, Courses Most Severely Affected, Integrity of Examinations and Assessments, and Positive Changes That Will Continue. CONCLUSION: Final-year students were most negatively impacted due to restricted opportunities in outpatient clinics. Integrity of examinations was also a problem. Positive, innovative teaching materials and methods were quickly developed and should continue.

The Councils on Chiropractic Education International Mapping Project: Comparison of Member Organizations' Educational Standards to the Councils on Chiropractic Education International Framework Document.

Objective: The purpose of this project was to investigate how well each member agency's standards complied with the Councils on Chiropractic Education International (CCEI) framework standards. Methods: Each of the CCEI member agencies were provided with a mapping template that was approved by all representatives. A representative from each agency independently mapped their agency's standards to the CCEI framework standards using the template document. Discrepancies were explored and discussed among members. Member agencies discussed with their constituents the omissions and areas that did not comply or adequately match the CCEI document. Changes or additions to member agency standards were made, and updated versions of the mapping were agreed by all CCEI representatives. Results: There were 12 sections containing 30 standards within the CCEI framework standards. The Council of Chiropractic Education Australasia and Council on Chiropractic Education Canada reported relevant standards for all 30 CCEI standards. The European Council on Chiropractic Education had 29 of 30 relevant standards, with no direct standard for service. The products that were created were an executive summary of our findings and a detailed map showing similarities for each of the member agencies. Conclusion: This mapping project demonstrated the similarities of the CCEI member agency standards and that these standards focused on outcomes-based chiropractic education. This quality improvement project resulted in useful dialogue among the member agencies during this project, which clarified areas of difference.

Differences in Practice Characteristics Between Male and Female Chiropractors in South Africa: Secondary Analysis of Data From Scope of Practice Survey 2015.

OBJECTIVE: The aim of the study was to determine whether there were differences in practice characteristics between male and female chiropractors working in South Africa. METHODS: A secondary analysis of data from the online survey "The Analysis of the Scope of Chiropractic Practice in South Africa in 2015" was performed, relating to demographic data, work environment, patient data, chief complaint, treatment techniques, and conditions treated. The original survey yielded a 30% response rate (n = 214), of which 212 responses to the question relating to sex, indicated 56.13% (n = 119) male respondents and 43.87% (n = 93) female respondents. Using the X2 test, differences in practice characteristics between male and female chiropractors were compared. RESULTS: Significant differences were noted for South African female chiropractors reporting that they spent more time with patients during initial (P = .028) and subsequent (P = .0001) visits and more time on direct patient care (P = .0001). South African male chiropractors showed significant differences in being in practice for longer (P = .002), treating more patients per week (P = .0001), number of new patients seen per week (P = .0001), and spending more time working in their practice per week. CONCLUSION: We found differences between self-reported male and female chiropractors in their practice characteristics, particularly in the number of patients seen per week and hours worked per week. These factors may need to be considered in the profession as the number of female chiropractors increases.

Limited prognostic value of pain duration in non-specific neck pain patients seeking chiropractic care.

BACKGROUND: Pain chronicity is considered an important prognostic factor for outcome. Here, it was investigated whether pain duration influences outcome when only chronic patients (pain >3 months) are considered. Secondary aims were to determine, in patients of any pain duration, how much variance in outcome is explained by pain duration and whether pain duration truly predicts outcomes, that is out-of-sample prediction in independent data. METHODS: Secondary analysis of a cohort study of neck pain patients. Patients were assessed before start of treatment and at 1-week, 1-, 3-, 6- and 12-month follow-up. Outcomes were patient global impression of change (PGIC) and percent change in patients' perceived pain intensity, rated on a numerical rating scale (NRS). Regression analyses (linear and logistic) and supervised machine learning were used to test the influence of pain duration on PGIC and percent NRS change at 1-week, 1-, 3-, 6- and 12-month follow-up within sample and out-of-sample. Separate analyses were performed for the full sample (n = 720) and for chronic patients (n = 238) only. RESULTS: No relationship between pain duration and outcome was found for chronic patients only. For the full sample, statistical relationships between pain duration and outcomes were observed at all tested follow-up time points. However, the amount of variance in outcome explained by pain duration was low and no out-of-sample prediction was possible. CONCLUSIONS: Pain duration did not emerge as an important predictor of outcome in this database of 720 neck pain patients receiving chiropractic treatment. SIGNIFICANCE STATEMENT: The relatively large dataset of neck pain patients challenges the widely accepted wisdom that pain duration is an important predictor of pain outcomes and that very chronic patients might only have a small likelihood of getting better. It is postulated that these results are important for the attitude of the first encounter between healthcare professionals and chronic patients.

Attitudes towards limited drug prescription rights: A survey of South African chiropractors.

Background: Several surveys that have been published show opinions regarding a change in the scope of chiropractic practice to include prescription rights. Currently, research into the attitudes of South African chiropractors towards having this right is non-existent. Aim: To ascertain the attitudes of South African chiropractors towards the inclusion of drug prescription rights in their scope of practice. Setting: The study was conducted on chiropractors registered with the Allied Health Professions Council of South Africa and members of the Chiropractic Association of South Africa. Method: A self-administrative online questionnaire was developed, and sent via email to all registered chiropractors in South Africa in February 2020. Descriptive statistics were used to analyse the data. Results: The response rate for this study was 15.9% (n = 138). 84% (n =105) were in favour of limited prescription rights for over-the-counter medication. However, 79.6% (n = 98) did not agree to full prescriptions rights for non-musculoskeletal drugs. A total of 33.6% (n = 42) rarely recommended OTC and prescription-based analgesics, muscle relaxants and non-steroidal anti-inflammatory drugs (NSAIDs) to their acute patients and 37.9% (n = 52) rarely recommended these drugs to chronic patients. 68.8% (n = 86) were confident in their knowledge of musculoskeletal drugs and 91.2% (n = 112) agreed on further education and training in pharmacology for those practitioners seeking limited medication prescription rights. Conclusion: The majority of South African chiropractor respondents indicated an interest in expanding their scope of practice to include limited prescription rights. Contribution: These findings could indicate a shift in the attitudes of chiropractors towards drug prescription rights within the profession.

Assessing attitudes of patient-centered care among chiropractic students at a South African university.

OBJECTIVE: Patient-centered care (PCC) is acknowledged globally as a foundation of quality patient care and key to doctor-patient rapport. Student attitudes toward PCC have been assessed in some health professions and some international chiropractic institutions but is lacking in the South African chiropractic student context. This study explores this concept and compares these attitudes to other student groups. METHODS: A cross-sectional survey was conducted on chiropractic students (years 1, 3, 5, and 6) at a South African institution. The 18-item Patient-Practitioner Orientation Scale (PPOS), with scoring 1-6 on a Likert scale, was used to evaluate the attitude toward PCC by students. Higher scores were representative of more patient-centeredness. Variables were analyzed to assess for associations between variables. Mean PPOS scores were calculated, and reliability and validity were tested using Cronbach α and factor analysis. RESULTS: There were 100 respondents (68% response rate). The PPOS showed unsatisfactory reliability in our sample. The mean scores for the overall PPOS were 3.64 (SD = 0.46), the sharing subscale was 2.99 (SD = 0.61), and the caring subscale was 4.29 (SD = 0.58). There were small but suggestive trends noticed in PPOS scores based on age, sex, and year of study. CONCLUSIONS: Chiropractic students from our university showed a general positive tendency toward PCC with no association between age and year of study. Sex showed some suggestive descriptive trends contrary to findings in other studies. The PPOS showed poor reliability in this study, warranting consideration with its use in similar contexts.

Reasons why referring doctors order renal ultrasound contrast studies.

PURPOSE: To determine the indications for CEUS for renal mass evaluation. METHODS: This retrospective, single-center, IRB-approved, HIPAA compliant study analyzed data from 303 consecutive patients scheduled for a renal CEUS to determine the indications for the examination. A chart review was performed from 05/01/2020 through 05/31/2021 on all patients who received a renal CEUS. The patient demographics were extracted as well as the motivating factor for ordering the examination. RESULTS: From the 303 patients, 114 were referred because of an indeterminate mass seen on CT and 28 were referred for long-term follow-up of a mass defined as benign or malignant was identified on CT. 9 patients were referred for a CEUS follow-up due to an indeterminate mass on MRI and 6 patients were referred for long-term follow-up of a mass defined as benign or malignant on MRI. 34 patients were referred for follow-up for characterization of a lesion seen on unenhanced ultrasound. 48 patients and 21 patients were referred for long-term follow-up of a previously observed benign or malignant lesion, respectively, seen on CEUS. CEUS was ordered in 21 patients to follow-up a partial nephrectomy and 5 patients for follow-up of a thermal ablation. 7 patients were referred because of a clinical finding. CONCLUSION: The main reason for a renal CEUS referral is to characterize a mass which could not be characterized on CT or MRI. Another main indication is for long-term follow-up of lesions to decrease radiation dose. Referrals due to inability to receive CT or MRI contrast or renal insufficiency were minor indications.

Perceptions and attitudes of University of Johannesburg chiropractic students toward a blended learning approach and a shift to an e-learning approach necessitated by the COVID-19 pandemic.

OBJECTIVE: This study aimed to explore and compare the perceptions and attitudes of chiropractic students on a blended learning offering in 2019 and a subsequent shift to an e-learning approach in 2020 owing to the COVID-19 pandemic. METHODS: This was an exploratory descriptive study of 4th-year BHSc chiropractic students enrolled in the Clinical and Applied Biomechanics IV module in 2019 (n = 31) and 2020 (n = 33). The survey used close-ended Likert scale questions collected from 29 July to 14 August 2020. Data were analyzed using frequencies and descriptions, exploratory factor analysis, and reliability. Trends and interrelationships of and between student attitude, satisfaction, social influences, ease of use, accessibility, and effectivity were investigated for each year and compared between successive years' cohorts. RESULTS: Students were mostly female (76.6%), aged 20 to 24 years (84.4%). Although both cohorts showed similar positive attitudes, accessibility, and satisfaction levels, the e-learning group showed increased effectivity (p = .016) and ease of use (p = .038) compared with the blended learning cohort. Face-to-face time with the lecturer was shown to be more important to the blended learning cohort (p = .006). Strong correlations were demonstrated in both cohorts between accessibility and satisfaction with attitude, effectivity, and ease of use. CONCLUSION: Findings suggest that students were more receptive to an e-learning approach than they may have been in the past. This may be as a direct consequence of the response to COVID-19, and the adapted offerings of the curriculum.

Factors Associated With Pain Medication Use and the Relationship to Chiropractic Treatment Outcomes for Patients With Low Back and Neck Pain: A Cross-Sectional Study.

OBJECTIVE: The study objectives were to identify baseline factors associated with pain medication use and determine any differences in chiropractic treatment outcomes in patients with low back pain (LBP) and neck pain (NP) depending on their use of pain medication. METHODS: This cross-sectional, prospective outcomes study included 1077 adults with acute or chronic LBP and 845 adults with acute or chronic NP recruited from Swiss chiropractors in their offices within 4 years. Demographic data and the responses to the Patient's Global Impression of Change scale collected at 1 week, 1 month, 3 months, 6 months, and 1 year were analyzed with the χ2 test. Baseline pain and disability levels were measured using the numeric rating scale (NRS), Oswestry questionnaire for LBP, and Bournemouth questionnaire for patients with NP and analyzed with the Mann-Whitney U test between the 2 groups. To detect significant predictors of medication use at baseline, logistic regression analysis was performed. RESULTS: Patients with acute LBP and NP were more likely than those with chronic pain to take pain medication (P < .001 LBP; P = .003 NP). Medication use was more likely with patients with radiculopathy (P < .001 LBP; P = .05 NP) who were smokers (P = .008 LBP; P = .024 NP) and those reporting below-average general health (P < .001 LBP and NP). Pain medication users had higher baseline pain (P < .001 LBP and NP) and disability (P < .001 LBP and NP) scores. CONCLUSION: Patients with LBP and NP had significantly higher pain and disability levels at baseline, tended to have radiculopathy and poor health, were smokers, and presented during the acute phase. However, for this sample of patients, there were no differences in subjective improvement between users and non-users of pain medication for any data collection time point, which has management implications.

Determinants of Sleep-Disordered Breathing During the Mixed Dentition: Development of a Functional Airway Evaluation Screening Tool (FAIREST-6).

Purpose: The purpose of this study was to identify patterns of functional, extraoral, and intraoral examination characteristics that correlate with increased risk of sleep disturbances and develop a functional airway screening tool to help clinicians for early diagnosis of pediatric sleep-disordered breathing. Methods: From March 2018 until March 2019, a cross-sectional study was conducted of 96 mixed dentition children during dental examinations at the UCLA pediatric dental clinic. Outcome measures included a sleep index score by the Sleep Disturbance Scale for Children (SDSC) completed by parents. Clinical assessment tool measurements assessing functional, extraoral, intraoral soft tissue, and intraoral hard tissue determinants were recorded during a routine dental examination by pediatric dental residents. Results: The mean age was 8.9 years (±1.9 years standard deviation), with 46 males and 50 females participating. Mouth-breathing (functional), mentalis strain (extra-oral), tonsillar hypertrophy and ankyloglossia (intraoral soft tissue), dental wear, and narrow palate (intraoral hard tissue) were found to be the most clinically deterministic of higher SDSC scores (P<0.01). A clinical assessment tool for sleep-disordered breathing in pediatric dental patients (FAIREST-6) was developed, comprising these six clinical factors. Conclusions: The FAIREST-6 is a concise and validated clinical assessment tool that may aid in early diagnosis and intervention of pediatric sleep-disordered breathing.

Chiropractic program changes facilitated by the European Council on Chiropractic Education Accreditation reports.

OBJECTIVE: The European Council on Chiropractic Education (ECCE) currently accredits 10 programs throughout Europe and South Africa. It is assumed that ECCE evaluation activities lead to changes to the chiropractic programs but no systematic evaluation as to whether this is true, and the extent of changes has previously been done. The purpose of this study was to obtain feedback from program heads as to whether ECCE evaluation reports facilitated changes/improvements to their programs and to identify their reported changes. METHODS: This was a mixed methods audit study using questionnaires with 2 sections. Closed statements requesting the degree of change to each section of the "Standards" based on ECCE evaluation reports (substantial, some, none) were analyzed using frequencies. Written responses identifying the specific changes made based on previous evaluation reports were evaluated independently by 3 researchers using a modified "thematic analysis" approach. RESULTS: All 10 accredited programs responded. Seven of the 10 programs (70%) reported "some" or "substantial" changes to ≥ 6 sections of the ECCE Standards. The most common section with reported changes was "Educational Program" (8 of 10). "Educational Resources" had the largest number of programs reporting "substantial changes" (4) and was the second most common section to have reported changes. The main themes identified emphasized changes in "infrastructure, equipment and faculty," "increasing evidence-based practice," and "instilling a research culture in faculty and students." CONCLUSION: ECCE accreditation processes facilitate changes to the chiropractic programs, particularly in the areas of improved infrastructure and faculty, research, and evidence-based practice.

Assessment of posterior tongue mobility using lingual-palatal suction: Progress towards a functional definition of ankyloglossia.

BACKGROUND: A functional definition of ankyloglossia has been based on assessment of tongue mobility using the tongue range of motion ratio (TRMR) with the tongue tip extended towards the incisive papilla (TIP). Whereas this measurement has been helpful in assessing for variations in the mobility of the anterior one-third of the tongue (tongue tip and apex), it may be insufficient to adequately assess the mobility of the posterior two-thirds body of the tongue. A commonly used modification is to assess TRMR while the tongue is held in suction against the roof of the mouth in lingual-palatal suction (LPS). OBJECTIVE: This study aims to explore the utility and normative values of TRMR-LPS as an adjunct to functional assessment of tongue mobility using TRMR-TIP. STUDY DESIGN: Cross-sectional cohort study of 611 subjects (ages: 3-83 years) from the general population. METHODS: Measurements of tongue mobility using TRMR were performed with TIP and LPS functional movements. Objective TRMR measurements were compared with subjective self-assessment of resting tongue position, ease or difficulty elevating the tongue tip to the palate, and ease or difficulty elevating the tongue body to the palate. RESULTS: There was a statistically significant association between the objective measures of TRMR-TIP and TRMR-LPS and subjective reports of tongue mobility. LPS measurements were much more highly correlated with differences in elevating the posterior body of the tongue as compared to TIP measurements (R2 0.31 vs 0.05, P < .0001). CONCLUSIONS: This study validates the TRMR-LPS as a useful functional metric for assessment of posterior tongue mobility.

Dissecting molecular details and functional effects of the high-affinity copper binding site in plasminogen activator Inhibitor-1.

Plasminogen activator inhibitor-1 (PAI-1) is the primary inhibitor for plasminogen activators, tissue-type plasminogen activator (tPA) and urokinase-type plasminogen activator (uPA). As a unique member in the serine protease inhibitor (serpin) family, PAI-1 is metastable and converts to an inactive, latent structure with a half-life of 1-2 hr under physiological conditions. Unusual effects of metals on the rate of the latency conversion are incompletely understood. Previous work has identified two residues near the N-terminus, H2 and H3, which reside in a high-affinity copper-binding site in PAI-1 [Bucci JC, McClintock CS, Chu Y, Ware GL, McConnell KD, Emerson JP, Peterson CB (2017) J Biol Inorg Chem 22:1123-1,135]. In this study, neighboring residues, H10, E81, and H364, were tested as possible sites that participate in Cu(II) coordination at the high-affinity site. Kinetic methods, gel sensitivity assays, and isothermal titration calorimetry (ITC) revealed that E81 and H364 have different roles in coordinating metal and mediating the stability of PAI-1. H364 provides a third histidine in the metal-coordination sphere with H2 and H3. In contrast, E81 does not appear to be required for metal ligation along with histidines; contacts made by the side-chain carboxylate upon metal binding are perturbed and, in turn, influence dynamic fluctuations within the region encompassing helices D, E, and F and the W86 loop that are important in the pathway for the PAI-1 latency conversion. This investigation underscores a prominent role of protein dynamics, noncovalent bonding networks and ligand binding in controlling the stability of the active form of PAI-1.

Determinants of probable sleep bruxism in a pediatric mixed dentition population: a multivariate analysis of mouth vs. nasal breathing, tongue mobility, and tonsil size.

OBJECTIVES: This study aims to identify structural and functional craniofacial characteristics that correlate with higher incidence of 'probable' sleep bruxism in children. METHODS: From March 2018 until March 2019, a cross-sectional clinical study was performed with ninety-six healthy children ages 6-12 years who presented for routine dental examination at the UCLA pediatric dental clinic. Variables of interest included: (1) assessment of probable bruxism based on parental awareness on the frequency of tooth grinding during sleep and clinical signs of bruxism based on tooth wear; (2) parental reports of mouth breathing while awake and asleep, snoring during sleep, difficulty breathing and/or gasping for air during sleep; (3) parental reports of psychosocial distress; (4) assessment of tonsil hypertrophy, tongue mobility, and nasal obstruction. Three pediatric dental residents were calibrated to perform the clinical data collection. All dental residents were graduated dentists with licensure and at least one year of experience examining children. The methodology to take the specific measurements administered in the manuscript were calibrated between the data-collectors under the supervision of a board-certified pediatric dentist and orthodontist (AY). RESULTS: The mean age of individuals was 8.9 (SD = 1.9) years with a gender distribution of 46 males and 50 females. There were 23 out of the 96 (24%) individuals who met the diagnostic criteria for probable sleep bruxism (PSB). Sleep Disturbance Scale for Children (SDSC) scores were significantly elevated among children positive for PSB, indicating that they are at higher risk for sleep disturbances (PSB-positive: 45.1 ± 13.0, PSB-negative: 34.8 ± 5.5; p < 0.0001). Impaired nasal breathing, parental reports of mouth breathing when awake or asleep, restricted tongue mobility, and tonsillar hypertrophy were found to be significant risk factors for PSB. Exploratory analysis further suggests a synergistic effect between tonsil hypertrophy, restricted tongue mobility, and nasal obstruction. The incidence of probable sleep bruxism among individuals without any of the exam findings of tonsillar hypertrophy, restricted tongue mobility, and nasal obstruction was 5/58 (8.6%), whereas the incidence of PSB among individuals with all three exam findings was 10/11 (90.9%), p < 0.0001. Among the 23 individuals with PSB, however, there were n = 5 (21.7%) who did not have any of the three exam findings, suggesting an additional role of psychosocial distress, postural maladaptation, malocclusion, or other factors in the etiology of sleep bruxism. CONCLUSION: This study shows that tonsil hypertrophy, restricted tongue mobility, and nasal obstruction may have a synergistic association on the presentation of PSB. Dentists should evaluate for tonsillar hypertrophy, restricted tongue mobility, and nasal obstruction in the evaluation of PSB, as these exam findings are highly prevalent in the majority of cases.

Characteristics of chiropractic patients treated at the University of Johannesburg chiropractic student clinic and relevance to the educational process.

OBJECTIVE: This study aimed to analyze the demographic and descriptive information of new patients presenting to an educational institution-based chiropractic student clinic in South Africa that could then be used to draw comparisons to other international chiropractic student clinics and local practices. METHODS: We conducted a retrospective descriptive study of all new patient files from January 1, 2016, to July 31, 2016. The variables extracted were age, health profiles, number of musculoskeletal complaints, treatment protocol, and number of treatments that patients received for the initial complaint. Data were analyzed using cross-tabulations and multidimensional χ2 tests. RESULTS: There were 865 files reviewed. Most patients were aged between 20 and 24 years. Lumbar and pelvic complaints were most common (42.2%), followed by the cervical spine (28%). Lumbar (18.8%) and cervical (16.8%) biomechanical conditions, followed by lumbar myofascial pain syndrome (7.6%), were the most common problems. Musculoskeletal conditions were reported in 99% of cases. The majority (80%) of patients received 9 or fewer treatments for their initial complaint. Manipulation was used in 93.9% of cases, followed by mobilization (8.8%), interferential current (23.5%), and dry needling (19.1%). CONCLUSIONS: Data gathered suggest that there are some general similarities with international training institutions. There are also differences between the study sample and international institutions and South African private chiropractic practice. The dissimilarities were a younger patient population, a lower number of treatment visits, and low exposure to nonmusculoskeletal conditions. These differences may affect the breadth of student education and require further investigation.