Standardized administration and scoring guidelines for the Spinal Cord Independence Measure Version 3.0 (SCIM-III).

STUDY DESIGN: Qualitative studies. OBJECTIVE: To develop clear and specific administration and scoring procedures for the Spinal Cord Independence Measure Version 3.0 as a performance-based and interview assessment. SETTING: Research lab. METHODS: Modified Delphi Technique survey methods were used in this study. Previously developed SCIM-III administration and scoring procedures for performance-based and interview versions were presented to clinicians experienced in SCI and SCIM-III using the Qualtrix (Qualtrics, Provo, UT) online survey platform. Summary and descriptive statistics were used to assess the percent agreement survey responses. RESULTS: Three survey rounds were necessary to achieve 80% agreement or above for the performance-based version. Two survey rounds were necessary to achieve 80% agreement or above on the interview version. CONCLUSIONS: This study describes the development of standardized administration and scoring procedures for the self-care and mobility sub-scales of the SCIM-III as a performance-based and interview version.

Promoting community engagement in spinal cord injury research: a case example.

Community engagement is an important method of knowledge translation in spinal cord injury (SCI) research where researchers collaborate with people with lived experience, care partners, and other research users to improve the quality of research. This perspective article aims to promote community engagement in SCI research by describing useful resources for its implementation and providing an example project using the North American Spinal Cord Injury Consortium (NASCIC) process for such partnerships. Researchers from the Jefferson College of Rehabilitation Sciences' (JCRS) Center for Outcomes and Measurement engaged NASCIC to create an advisory committee composed of four people living with SCI to make recommendations for the methods of a large-scale study to develop a clinical outcome assessment. The advisory committee made usable recommendations for enhancing recruitment methods and reducing burden and barriers to participation. The successful partnership between NASCIC and JCRS shows the feasibility and value of SCI community engagement in research.

Elucidating the neurological mechanism of the FLASH effect in juvenile mice exposed to hypofractionated radiotherapy.

BACKGROUND: Ultrahigh dose-rate radiotherapy (FLASH-RT) affords improvements in the therapeutic index by minimizing normal tissue toxicities without compromising antitumor efficacy compared to conventional dose-rate radiotherapy (CONV-RT). To investigate the translational potential of FLASH-RT to a human pediatric medulloblastoma brain tumor, we used a radiosensitive juvenile mouse model to assess adverse long-term neurological outcomes. METHODS: Cohorts of 3-week-old male and female C57Bl/6 mice exposed to hypofractionated (2 × 10 Gy, FLASH-RT or CONV-RT) whole brain irradiation and unirradiated controls underwent behavioral testing to ascertain cognitive status four months posttreatment. Animals were sacrificed 6 months post-irradiation and tissues were analyzed for neurological and cerebrovascular decrements. RESULTS: The neurological impact of FLASH-RT was analyzed over a 6-month follow-up. FLASH-RT ameliorated neurocognitive decrements induced by CONV-RT and preserved synaptic plasticity and integrity at the electrophysiological (long-term potentiation), molecular (synaptophysin), and structural (Bassoon/Homer-1 bouton) levels in multiple brain regions. The benefits of FLASH-RT were also linked to reduced neuroinflammation (activated microglia) and the preservation of the cerebrovascular structure, by maintaining aquaporin-4 levels and minimizing microglia colocalized to vessels. CONCLUSIONS: Hypofractionated FLASH-RT affords significant and long-term normal tissue protection in the radiosensitive juvenile mouse brain when compared to CONV-RT. The capability of FLASH-RT to preserve critical cognitive outcomes and electrophysiological properties over 6-months is noteworthy and highlights its potential for resolving long-standing complications faced by pediatric brain tumor survivors. While care must be exercised before clinical translation is realized, present findings document the marked benefits of FLASH-RT that extend from synapse to cognition and the microvasculature.

Modular epitope binding predicts influenza quasispecies dominance and vaccine effectiveness: Application to 2018/19 season.

The modular binding sites on the influenza A(H3N2) hemagglutinin protein are under significant pressure to acquire mutations in order to evade human antibody recognition. Analysis of these hemagglutinin epitopes in the strains circulating during 2017/18 and early 2018/19 identified the emergence of a new antigenic cluster that has grown from 4% of circulating strains to 11%. We regressed our module-based antigenic distance, pepitope, with A(H3N2) vaccine effectiveness from recent studies conducted by the US Centers for Disease Control and Prevention (r2 = 0.92), and we used this to estimate that the 2018/19 vaccines will protect against most circulating A(H3N2) strains. The pEpitope model is useful for A(H3N2) influenza vaccine virus selection and development, and it has the potential to aid national or regional regulatory authorities in making geographically localized decisions.