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.

Response of Chiropractic Organizations to the COVID-19 Pandemic: A Descriptive Report.

Objective: The purpose of this report is to describe actions by chiropractic entities during the early stages of the coronavirus disease 2019 (COVID-19) pandemic. Methods: Large entities that support chiropractic education or practice were invited to participate in this report. Leaders of various entities were emailed an invitation. A designee who was assigned by the leader provided a brief synopsis of actions the entity had taken in response to the COVID-19 pandemic. Only entities that responded are included in this report. Results: Five entities agreed to participate: The Council on Chiropractic Education, Association of Chiropractic Colleges, Federation of Chiropractic Licensing Boards, National Board of Chiropractic Examiners, and the National Chiropractic Mutual Insurance Company. Common themes included (1) recognizing the crisis and taking action, (2) establishing a safe working environment for staff so that services could continue, (3) delivering communications to stakeholders (chiropractic students, practitioners, licensing boards, and others) to guide decisions and direct actions, and (4) continuing to monitor the situation and respond as new information becomes available. Conclusion: These entities serve a large portion of the chiropractic profession. They have been quick to respond in a responsible, compassionate, and supportive manner to assist chiropractic licensing boards, practitioners, and students during the COVID-19 pandemic. These findings are encouraging as the chiropractic profession looks to the future as it navigates changes in education and the health care environment in the months and years ahead.

Revised methodology for the examinations of the National Board of Chiropractic Examiners: Impact on institutions, faculty, and students.

For over 50 years, the National Board of Chiropractic Examiners (NBCE) has administered pre-licensure examinations to chiropractic students and graduates. During this time, the testing process has been continually refined and improved, consistent with the evolving science and practices of standardized testing. NBCE test results are provided to chiropractic program leaders who use these data to improve their curricula as part of their own ongoing efforts to refine and improve the academic programs. Finally, the Council on Chiropractic Education (CCE) requires accredited chiropractic programs to report their NBCE scores to ensure that benchmarks set by the CCE are met. With this symbiotic relationship between the NBCE, CCE, and chiropractic programs (as well as state licensing authorities), it is very important that these groups collaborate and communicate with transparency and diplomacy. In particular, the chiropractic program leaders-and their students as the end users-are vitally interested in monitoring changes at the NBCE and CCE levels that may impact their programs. Recent changes in testing methodology for the NBCE examinations need to be understood and monitored to ensure that they result in their intended outcome, which is greater validity of the testing process. This commentary reflects the views and concerns of 3 chiropractic educational leaders and is intended to facilitate further discussion among chiropractic program leaders toward strengthening the aforementioned symbiotic relationship.

Health Physics Society Comments to U.S. Environmental Protection Agency Regulatory Reform Task Force.

The Health Physics Society (HPS) provided comment to the U.S. Environmental Protection Agency (EPA) on options to consider when developing an action plan for President Trump's Executive Order to evaluate regulations for repeal, replacement, or modification. The HPS recommended that the EPA reconsider their adherence to the linear no-threshold (LNT) model for radiation risk calculations and improve several documents by better addressing uncertainties in low-dose, low dose-rate (LDDR) radiation exposure environments. The authors point out that use of the LNT model near background levels cannot provide reliable risk projections, use of the LNT model and collective-dose calculations in some EPA documents is inconsistent with the recommendations of international organizations, and some EPA documents have not been exposed to the public comment rule-making process. To assist in establishing a better scientific basis for the risks of low dose rate and low dose radiation exposure, the EPA should continue to support the "Million Worker Study," led by the National Council on Radiation Protection and Measurement.

Fronto-striatal correlates of impaired implicit sequence learning in major depression: an fMRI study.

BACKGROUND: Neural network models of major depression (MD) suggest that the striatum is involved in the pathophysiology and is linked to key cognitive and clinical features. However, functional imaging studies have largely assessed the prefrontal cortex and have utilised emotional paradigms. This study sought to probe the integrity of fronto-striatal circuits using functional magnetic resonance imaging (fMRI) in conjunction with a theoretically-driven motor sequencing implicit learning (IL) task. METHODS: Nineteen patients with MD (mean age=56.1 years, sd=9.8) and 20 control participants (mean age=50.6 years, sd=11.9) participated. A blocked fMRI paradigm was used in association with a motor sequencing task which included an IL and random sequence (baseline) condition. Although the study was hypothesis driven, within and between groups whole-brain analysis was used to examine fMRI patterns in the IL compared to BL condition. RESULTS: While both groups activated the striatum, there was no significant difference between patients and controls in striatal activation. Instead, control subjects showed significantly greater activity in the middle frontal gyrus whereas the patients exhibited greater activity in the superior temporal gyrus and cerebellum. LIMITATIONS: Most patients were receiving antidepressant medication when assessed. An event-related fMRI design would have enabled more fine-grained temporal analysis of IL related activation. CONCLUSIONS: IL deficits in MD are not due primarily to striatal dysfunction. IL performance may depend on more specific sub-components of the striatum or a more distributed neural network involving frontal, temporal and cerebellar regions.

Psychomotor slowing in older patients with major depression: Relationships with blood flow in the caudate nucleus and white matter lesions.

[corrected] Selected structural and functional neuroimaging correlates of psychomotor slowing were examined [corrected] in older persons with depression. Clinical, neuropsychological, magnetic resonance imaging (MRI) and single photon emission computerized tomography (SPECT) data were obtained for 32 persons with depression (mean age=55.5) and 17 controls (mean age = 55.4). Psychomotor slowing was measured by simple (SRT) and choice (CRT) reaction times. White matter lesions (WMLs) were visually rated and caudate nucleus regional cerebral blood flow (rCBF) was obtained through the co-registration of MRI and SPECT data. Two SPECT scans were performed (corresponding to the SRT and CRT tasks) and a percentage change score in rCBF (%rCBF) due to the increasing complexity of the second task was calculated. Persons with depression and controls did not differ with respect to %rCBF or frequency of WMLs. In persons with depression, reduced %rCBF was associated with slower CRT. For all subjects, WMLs predicted 14% of the variance in %rCBF. Although CRT was predicted by a combination of older age, WMLs and %rCBF, the diagnosis of depression still predicted a further 25% of the variance. Reduced %rCBF is associated with demonstrable psychomotor slowing and presence of WMLs. While psychomotor slowing is determined in part by subcortical changes, other cortical and illness-dependent factors are likely to be relevant.

Impaired implicit sequence learning in depression: a probe for frontostriatal dysfunction?

BACKGROUND: Implicit learning through motor sequencing tasks is sensitive to basal ganglia dysfunction. Consequently, it is ideally suited for testing elements of the frontostriatal model of major depression and performance can be related to key clinical, neuropsychological, vascular and biochemical data. METHOD: Twenty-one subjects with moderate to severe unipolar depression and 21 age-, sex- and education-matched controls were recruited. Clinical, vascular and biochemical data were recorded. Subjects were administered a battery of neuropsychological tests that assessed speed of processing, working memory, learning, memory, language, perceptual organization and executive functioning. Additionally, subjects were administered a motor sequencing implicit learning task. Implicit learning is assumed when reaction times improve during the sequenced condition as compared to the pseudo-random baseline condition. RESULTS: The rate of implicit learning in persons with depression was only half that of control subjects (3.6% v. 7.3%). Lower rates of implicit learning in patients were associated with poorer performance on neuropsychological tests of visuomotor speed and mental flexibility, longer duration of depressive episode and severity of acute stress. In a small number of subjects, poorer performance was also related to past suicide attempt. CONCLUSIONS: Impaired implicit learning in persons with depression is consistent with frontostriatal dysfunction. Performance is related to some clinical characteristics and to neuropsychological functioning on tests of visuomotor speed and mental flexibility.

Neuropsychological performance in patients with depression is associated with clinical, etiological and genetic risk factors.

The present study explores neuropsychological functioning in patients with depression with reference to key clinical, etiological and genetic features. In comparison to healthy volunteers, patients with severe depression demonstrated poorer performance on all neuropsychological tests except for WAIS-R Vocabulary and a 64-item computerized version of the Wisconsin Card Sorting Test. On average, patients exhibited significant impairments (greater than -2 standard deviation units) on tests of simple reaction time, Part B of the Trail Making Test and Raven's Colored Progressive Matrices. When performance decrements were analyzed with reference to key clinical features, patients with melancholia performed more poorly on WAIS-R Vocabulary, semantic fluency and choice reaction time than those with nonmelancholic depression. After controlling for age, those patients with late-onset depression (i.e., age of onset > or =50 years) exhibited poorer performance on a computerized version of the Tower of London test in comparison to those with an early onset. While there was no relationship between neuropsychological test scores and summed vascular risk factors or apolipoprotein E genotypes, presence of the methylenetetrahydrofolate reductase gene mutation was associated with slowed reaction time. The differential relationships between clinical, etiological and genetic risks and neuropsychological performance supports the presence of unique pathophysiological mechanisms in distinct subgroups of patients. These findings underscore the need to consider subtypes when investigating neuropsychological deficits in patients with depression.

Caudate nucleus volumes and genetic determinants of homocysteine metabolism in the prediction of psychomotor speed in older persons with depression.

OBJECTIVE: The authors sought to determine whether caudate nucleus volumes or specific genotypes predict psychomotor slowing in older persons with depression. METHOD: Forty-seven persons with depression (mean age=51.8 years, SD=12.4) and 20 healthy volunteers (mean age=56.1 years, SD=9.8) underwent clinical assessments, a neuropsychological test of psychomotor speed (part A of the Trail Making Test), high-resolution magnetic resonance imaging scans, and genotyping for the apolipoprotein E epsilon4 allele and a mutation of the methylenetetrahydrofolate reductase enzyme. RESULTS: Multivariate analyses revealed that psychomotor speed was uniquely predicted by age, a diagnosis of depression, right caudate nucleus volume, and mutation of the methylenetetrahydrofolate reductase enzyme. CONCLUSIONS: Psychomotor slowing, a key clinical and cognitive phenomenon in older persons with depression, is predicted by reduced caudate nucleus volumes and genetic determinants of homocysteine metabolism.