Long-term outcomes of intrathecal baclofen in ambulatory multiple sclerosis patients: A single-center experience.

BACKGROUND: Intrathecal baclofen (ITB) is traditionally reserved for non-ambulatory patients. OBJECTIVE: To investigate outcomes of ITB in ambulatory multiple sclerosis (MS) patients. METHODS: Changes in outcome measures were estimated by a mixed effect model, while the complication rate was calculated using a logistic regression. Predictors of non-ambulatory status were identified by Cox model. RESULTS: In all, 256 patients received an ITB test injection and 170 underwent ITB surgery. Aggregate Modified Ashworth Scale (MAS) scores for the ambulatory ITB cohort decreased from 13.5 ± 6.96 to 4.54 ± 4.18 at 5 years (p < 0.001). There was no significant change in walking speed 1 year post ITB surgery (0.45 m/second ± 0.30 vs 0.38 m/second ± 0.39, p = 0.80) with 77.8% of patients remaining ambulatory which decreased to 41.7% at year 5. Longer MS disease duration (hazard ratio (HR): 1.04; 95% confidence interval (CI): 1.01-1.07; p = 0.018) and lower hip flexor strength (HR: 0.40; 95% CI: 0.27-0.57; p < 0.001) predicted non-ambulatory status after surgery. Complications were more likely in the ambulatory cohort (odds ratio (OR): 3.30, 95% CI: 2.17-5.02; p = 0.017). CONCLUSION: ITB is effective for ambulatory MS patients without compromising short-term walking speed, although a higher complication rate was observed in this cohort.

Self-Measured vs Professionally Measured Waist Circumference.

PURPOSE: Although waist circumference can provide important metabolic risk information, logistic issues inhibit its routine use in outpatient practice settings. We assessed whether self-measured waist circumference is sufficiently accurate to replace professionally measured waist circumference for identifying high-risk patients. METHODS: Medical outpatients and research participants self-measured their waist circumference at the same visit during which a professionally measured waist circumference was obtained. Participants were provided with standardized pictorial instructions on how to measure their waist circumference, and professionals underwent standard training. RESULTS: Self- and professionally measured waist circumference data were collected for 585 women (mean ± SD age = 40 ± 14 years, mean ± SD body mass index = 27.7 ± 6.0 kg/m(2)) and 165 men (mean ± SD age = 41 ± 14 years, mean ± SD body mass index = 29.3 ± 4.6 kg/m(2)). Although self- and professionally measured waist circumference did not differ significantly, we found a clinically important false-negative rate for the self-measurements. Eleven percent of normal-weight and 52% of overweight women had a professionally measured waist circumference putting them in a high-risk category for metabolic syndrome (ie, greater than 88 cm); however, 57% and 18% of these women, respectively, undermeasured their waist circumference as falling below that cutoff. Fifteen percent and 84% of overweight and class I obese men, respectively, had a professionally measured waist circumference putting them in the high-risk category (ie, greater than 102 cm); however, 23% and 16% of these men, respectively, undermeasured their waist circumference as falling below that cutoff. CONCLUSIONS: Despite standardized pictorial instructions for self-measured waist circumference, the false-negative rate of self-measurements approached or exceeded 20% for some groups at high risk for poor health outcomes.

Seeking Justice: How VAWA Reduced the Stronghold Over American Indian and Alaska Native Women.

The Violence Against Women Act (VAWA), originally passed in 1994, was successfully reauthorized in 2000, 2005, and 2013. Over time, VAWA altered the environment for many victims who had previously suffered in silence. This article focuses on how VAWA impacted American Indian (AI) and Alaska Native (AN) victims of dating and domestic violence. AI and AN women experience these crimes at a rate higher than the national average, yet they are often denied justice due to the interplay of federal and state laws and tribal sovereignty. VAWA affirmed tribes' sovereign authority to exercise criminal jurisdiction over non-Indians who commit crimes against AI and AN victims on tribal lands. This article also discusses future steps to enhance justice reforms.

Assessment of Stress and Quality of Life in Non-native and Native English-speaking Pharmacy Students.

Objective. To evaluate the stress and health-related quality of life experienced by native and non-native English-speaking students enrolled in a Doctor of Pharmacy (PharmD) program.Methods. This study assessed PharmD students at a single institution using a self-administered online questionnaire. The primary outcome of the study was a comparison of Perceived Stress Scale (PSS) scores. Secondary outcomes were the Medical Outcome Study SF-12 Health Questionnaire scores. An independent samples t test was conducted to compare differences between non-native and native English speakers for both primary and secondary outcomes.Results. The following three criteria were used to evaluate the language status of a student: whether the student preferred to speak English (91/113 participants), whether their primary caregiver as a child spoke English at home (63/113 participants), and whether the student usually thought in English (90/113 participants). Evaluation of the primary outcome of PSS score and secondary outcome of SF-12 mental and physical health revealed no significant differences between native and non-native English speakers based on the three language-related criteria.Conclusion. The results of this study showed that the native language spoken by a pharmacy student was not directly associated with an increase in stress or decrease in quality of life for students in a PharmD program. However, the survey results did indicate that experiencing more stress correlated with a decrease in students' mental health-related quality of life, which indicates the need for further research to identify students at risk for a decrease in mental health-related quality of life during pharmacy education.

Providing Person-Centered Care via Telemedicine in the Era of COVID-19 in Multiple Sclerosis.

The coronavirus disease 2019 (COVID-19) pandemic has catalyzed the rapid adoption of telemedicine which encompasses synchronous and asynchronous interactions between patients and providers. In order to facilitate this rapid deployment, there has been numerous regulatory changes to ensure caregivers can effectively communicate with patients during this time. We illustrate a model where people, processes, and technology work together to address the comprehensive needs of multiple sclerosis (MS) patients. We provide a template for how multidisciplinary, academic practices can implement a rapid shift to virtual management during the pandemic using existing infrastructure that can be widely adopted to care for patients with chronic diseases. Telemedicine was incorporated into our entire practice, which encompasses neurology, rehabilitation, advanced practice providers, fellows, social work, and behavioral medicine. Our patient satisfaction results remained stable across almost all domains when compared to survey results from our typical, in-office visits. Our experience demonstrates telemedicine's transformative potential in successfully managing a multidisciplinary MS clinic during the time of a pandemic and outlines a potential path for other practices to follow.

Predicted distribution of a rare and understudied forest carnivore: Humboldt marten (Martes caurina humboldtensis).

BACKGROUND: Many mammalian species have experienced range contractions. Following a reduction in distribution that has resulted in apparently small and disjunct populations, the Humboldt marten (Martes caurina humboldtensis) was recently designated as federally Threatened and state Endangered. This subspecies of Pacific marten occurring in coastal Oregon and northern California, also known as coastal martens, appear unlike martens that occur in snow-associated regions in that vegetation associations appear to differ widely between Humboldt marten populations. We expected current distributions represent realized niches, but estimating factors associated with long-term occurrence was challenging for this rare and little-known species. Here, we assessed the predicted contemporary distribution of Humboldt martens and interpret our findings as hypotheses correlated with the subspecies' niche to inform strategic conservation actions. METHODS: We modeled Humboldt marten distribution using a maximum entropy (Maxent) approach. We spatially-thinned 10,229 marten locations collected from 1996-2020 by applying a minimum distance of 500-m between locations, resulting in 384 locations used to assess correlations of marten occurrence with biotic and abiotic variables. We independently optimized the spatial scale of each variable and focused development of model variables on biotic associations (e.g., hypothesized relationships with forest conditions), given that abiotic factors such as precipitation are largely static and not alterable within a management context. RESULTS: Humboldt marten locations were positively associated with increased shrub cover (salal (Gautheria shallon)), mast producing trees (e.g., tanoak, Notholithocarpus densiflorus), increased pine (Pinus sp.) proportion of total basal area, annual precipitation at home-range spatial scales, low and high amounts of canopy cover and slope, and cooler August temperatures. Unlike other recent literature, we found little evidence that Humboldt martens were associated with old-growth structural indices. This case study provides an example of how limited information on rare or lesser-known species can lead to differing interpretations, emphasizing the need for study-level replication in ecology. Humboldt marten conservation would benefit from continued survey effort to clarify range extent, population sizes, and fine-scale habitat use.

Assessing the impact of faculty research profile videos on students' perceptions towards research at a school of pharmacy.

BACKGROUND AND PURPOSE: Innovative delivery of research education and training in pharmacy education improves student perception of, and involvement in, professional pharmacy research. The purpose of this project was to utilize a flipped-classroom video technology approach to introduce our Capstone research experience and to assess the impact of the video technology on student's perceptions of pharmacy research. EDUCATIONAL ACTIVITY AND SETTING: Faculty recorded one-min videos that provided an overview of current research. Each video included a research introduction, explanation of student incorporation into research, and impact of research on the field of expertise. Students were assigned to review faculty videos. To assess impact of the videos on students' perceptions of research, t-tests compared five variables before and after students watched the videos. These variables included research curiosity, research interest, research inspiration, research motivation, and pharmacy research interest. FINDINGS: Across all students, no differences were detected. A statistically significant interaction emerged that suggested prior pharmacy experience may impact research curiosity, interest, and inspiration. SUMMARY: Findings demonstrated that the impact of research videos on pharmacy students' attitudes and perceptions towards research may depend on students' past experiences in a pharmacy setting. Further research is needed to identify factors that impact students' perceptions of pharmacy research. The information from this study provided our faculty members with valuable insights that can be used to better prepare students in the laboratory, classroom, and beyond.

Exploring the gender differences in protective factors: implications for understanding resiliency.

Understanding the causes of why individuals desist from or are resilient to delinquency and drug use has become a salient social concern. Much research has centered on the effects that protective factors possess in fostering resiliency but that research has not fully explored how the effects of protective factors might vary across gender. Using a sample of 711 individuals from the National Longitudinal Survey of Youth, Child-Mother data set, the authors investigate how individual protective factors vary across gender on two measures of resiliency that document the lack of involvement in serious delinquency and drug use. They also examine whether the accumulation of protective factors varies across gender in fostering resiliency. The findings suggest that although males and females rely on different individual protective factors to foster resiliency, the accumulation of protective factors appears to be equally important for males and females in promoting resiliency. The authors discuss theoretical and policy implications.

Occlusion of the Ascenda Catheter in a Patient with Pump Twiddler's Sydrome: A Case Report.

INTRODUCTION: Intrathecal baclofen (ITB) therapy is an effective way to manage spasticity in numerous conditions, including multiple sclerosis, stroke, and cerebral palsy. While pump failure is a common complication of ITB, improvements in device design have led to reduction of complications. In particular, the Ascenda catheter from Medtronic, Inc. was designed to resist kinking and associated complications; indeed, no incidences of catheter twisting or occlusion have been reported in literature prior to this case. CASE REPORT: We report a case of a 32-year old gentleman who presented to the clinic with symptoms of baclofen withdrawal 19 months after he had a programmable pump implanted for spasticity. During the diagnostic evaluation it was discovered that the patients pump had flipped in his abdominal pocket. He was taken to surgery to reorient the pump, during which time it was noted the catheter was tightly coiled on itself occluding flow. The twisted catheter was excised and replaced with a new segment.His symptoms subsequently resolved. CONCLUSIONS: Although catheter occlusions have subsided since the approval of the Ascenda catheter, pump twiddler's syndrome remains a risk factor for this complication. This is the first report describing this syndrome in a patient with the Ascenda catheter.

On the Association Between Repeat Bully Victimizations and Carrying a Firearm: Evidence in a National Sample.

Bullying is a significant public concern. The purpose of the present study is to investigate whether being repeatedly victimized by a bully during childhood and adolescence is associated with gun carrying in adolescence and adulthood. Using data from the National Longitudinal Survey of Youth 1997, we found that just over one fourth of the respondents reported carrying a gun at some point in their lifetime. Respondents experiencing repeat bully victimizations reported higher rates of gun carrying during the last 12 months and the last 30 days. No support was found for the association of repeat bully victimizations and carrying a gun to school. Individuals victimized during childhood (before the age of 12) and during adolescence were found to be at risk of carrying a gun later in the life course. Repeat bully victimizations should be considered a marker for gun-carrying behaviors in adolescence and adulthood.

A novel doxycycline-inducible system for the transgenic analysis of mammary gland biology.

Normal developmental events such as puberty, pregnancy, and parity influence the susceptibility of the mammary gland to tumorigenesis in both humans and rodent model systems. Unfortunately, constitutive transgenic mouse models that rely on mammary-specific promoters to control transgene expression have limited utility for studying the effect of developmental events on breast cancer risk since the hormonal signals governing these events also markedly influence transgene expression levels. A novel transgenic mouse system is described that uses the MMTV-LTR to drive expression of the reverse tetracycline-dependent transactivator rtTA. Transgenic mice expressing rtTA in the mammary epithelium were crossed with reporter lines bearing tet operator-controlled transgenes. We tested the ability to spatially, temporally, and quantitatively control reporter gene expression after administration of doxycycline to bitransgenic mice. Transgene expression using this system can be rapidly induced and deinduced, is highly mammary specific, can be reproducibly titrated over a wide range of expression levels, and is essentially undetectable in the uninduced state. Homogeneous transgene expression throughout the mammary epithelium can be achieved. This system permits transgene expression to be restricted to any desired stage of postnatal mammary gland development. We have developed a mammary-specific, doxycycline-inducible transgenic mouse model for studying the effect of mammary gland development on transgene-mediated phenotypes. Unlike other mammary-specific, transgenic systems that have been described, this system combines spatially homogeneous transgene expression in the mammary epithelium during puberty, pregnancy, lactation, and involution with the use of an orally administered, inexpensive, and widely available inducing agent. This system offers new opportunities for the transgenic analysis of mammary gland biology in vivo.

Persistent parity-induced changes in growth factors, TGF-beta3, and differentiation in the rodent mammary gland.

Epidemiological studies have repeatedly demonstrated that women who undergo an early first full-term pregnancy have a significantly reduced lifetime risk of breast cancer. Similarly, rodents that have previously undergone a full-term pregnancy are highly resistant to carcinogen-induced breast cancer compared with age-matched nulliparous controls. Little progress has been made, however, toward understanding the biological basis of this phenomenon. We have used DNA microarrays to identify a panel of 38 differentially expressed genes that reproducibly distinguishes, in a blinded manner, between the nulliparous and parous states of the mammary gland in multiple strains of mice and rats. We find that parity results in the persistent down-regulation of multiple genes encoding growth factors, such as amphiregulin, pleiotrophin, and IGF-1, as well as the persistent up-regulation of the growth-inhibitory molecule, TGF-beta3, and several of its transcriptional targets. Our studies further indicate that parity results in a persistent increase in the differentiated state of the mammary gland as well as lifelong changes in the hematopoietic cell types resident within the gland. These findings define a developmental state of the mammary gland that is refractory to carcinogenesis and suggest novel hypotheses for the mechanisms by which parity may modulate breast cancer risk.

Functional microarray analysis of mammary organogenesis reveals a developmental role in adaptive thermogenesis.

The use of DNA microarrays to study vertebrate organogenesis presents unique analytical challenges compared with expression profiling of homogeneous cell populations. We have used a general approach that permits the automated, unbiased identification of biologically relevant patterns of gene expression to study murine mammary gland development. Our studies confirm the utility of this approach by demonstrating the ready identification of cellular processes and pathways of known functional importance in mammary development. Additionally, this approach permitted the identification of genetic pathways with unpredicted patterns of developmental regulation, including those involved in angiogenesis, extracellular matrix synthesis, and the beta-oxidation of fatty acids. Surprisingly, our findings demonstrate that the coordinate regulation of genes involved in the beta-oxidation of fatty acids reflects the presence of an abundant, yet previously unrecognized stromal compartment within the mammary gland that is composed of brown adipose tissue. Our data demonstrate that the amount of brown adipose tissue present in the mammary gland is developmentally regulated; that PPARalpha, Ucp1, and genes involved in fatty acid oxidation are spatially and temporally coregulated during development; that the mammary gland plays a functional role in adaptive thermogenesis; and that the transcriptional control of this adaptive response to cold is itself developmentally regulated.

Poly-Victimization Risk in Prison: The Influence of Individual and Institutional Factors.

Victimization research suggests that individuals who either witness or are direct victims of violence are substantially more likely to experience long-term negative outcomes. Although recent studies identifying factors associated with prison victimization are emerging, the risk factors predicting inmate's experience of multiple types of victimization, called poly-victimization, remain unknown. Utilizing a lifestyles model that incorporates the importation/deprivation framework, the current study examines whether certain features of the prison environment or individual characteristics predict who is most likely to experience victimization. Data from more than 1,600 recently released inmates confirm that the environmental and individual-level factors are related to poly-victimization in prison. The findings from the study have implications for policy and practice.

Linking pediatric primary care obesity management to community programs.

Guidelines for obesity management in primary care call for linking to community services. The Promoting Health Project (PHP) was a multi-component, practice-based intervention aimed at improving care of obese children, including referrals to community services. Promoting Health Project staff identified and interviewed representatives of 40 nutrition or physical activity services/programs. Quality improvement (QI) teams at three practices worked to improve overweight/obesity identification and care and implement practice-to-community connections that used the information gathered from the programs/ services. A practice community coordinator (PCC) facilitated interactions between practices, community programs and families. Researchers tracked patients referred, PCC to family interactions, and time spent. They surveyed parents of referred patients and interviewed key clinicians. Forty-six patients participated in programs. Substantial efforts were necessary to create smooth referral systems. Family motivation was perceived as a limiting factor in program attendance. Clinicians were satisfied with systems established. Effectively linking practitioners to community programs requires the use of additional resources.

Using detection dogs to conduct simultaneous surveys of northern spotted (Strix occidentalis caurina) and barred owls (Strix varia).

State and federal actions to conserve northern spotted owl (Strix occidentalis caurina) habitat are largely initiated by establishing habitat occupancy. Northern spotted owl occupancy is typically assessed by eliciting their response to simulated conspecific vocalizations. However, proximity of barred owls (Strix varia)-a significant threat to northern spotted owls-can suppress northern spotted owl responsiveness to vocalization surveys and hence their probability of detection. We developed a survey method to simultaneously detect both species that does not require vocalization. Detection dogs (Canis familiaris) located owl pellets accumulated under roost sites, within search areas selected using habitat association maps. We compared success of detection dog surveys to vocalization surveys slightly modified from the U.S. Fish and Wildlife Service's Draft 2010 Survey Protocol. Seventeen 2 km × 2 km polygons were each surveyed multiple times in an area where northern spotted owls were known to nest prior to 1997 and barred owl density was thought to be low. Mitochondrial DNA was used to confirm species from pellets detected by dogs. Spotted owl and barred owl detection probabilities were significantly higher for dog than vocalization surveys. For spotted owls, this difference increased with number of site visits. Cumulative detection probabilities of northern spotted owls were 29% after session 1, 62% after session 2, and 87% after session 3 for dog surveys, compared to 25% after session 1, increasing to 59% by session 6 for vocalization surveys. Mean detection probability for barred owls was 20.1% for dog surveys and 7.3% for vocal surveys. Results suggest that detection dog surveys can complement vocalization surveys by providing a reliable method for establishing occupancy of both northern spotted and barred owl without requiring owl vocalization. This helps meet objectives of Recovery Actions 24 and 25 of the Revised Recovery Plan for the Northern Spotted Owl.

Outcomes among drug court participants: does drug of choice matter?

The link between drug and alcohol abuse and criminal behavior is clearly illustrated in the literature. The options of how to respond to these offenders, however, has widely fluctuated over time. Currently, many states have reconsidered their "get tough" approach to one that is more rehabilitative in nature. One particular community-based intervention that has gained in popularity is the drug court model. The literature on drug courts is generally supportive; however, there is a need to examine effectiveness by target population. The purpose of this study is to explore recidivism rates of drug court clients by drug of choice. Using a 2-year follow-up period, this study finds that drug of choice does not significantly influence either successful graduation or arrest. Policy implications are discussed.