Applying Statewide Innovation Through Infrastructure and Partnership

The art and practice of health care necessitates the continued exploration and acquisition of medical knowledge. Although healthcare professionals complete years of formal training, healthcare is an evolving field with continuous advances and quality refinements that must be incorporated into healthcare processes. Without effective systems of education, the advances in health care derived from research would likely “die on the vine” (Bachmann, Cantoni, Coyne, Mazzola, & McLaughlin, 2010)

Muscle loading effects on bone parameters in the oim mouse model [abstract]

Faculty Mentor: Dr. Charlotte Phillips, BiochemistryAbstract only availablePrevious studies have shown that mechanical loading on the skeleton acts as an anabolic stimulus, inducing changes in bone geometry, bone mineral density, and mechanical properties. Increases in these properties may improve bone quality as seen by increased bone density following sustained physical activity, and the increase may be due to increased muscle contraction. Much data exists on the effects of unloading on the skeleton, but data regarding the effects of loading is limited. This study is aimed at examining the effects of loading on the skeleton of the oim mouse model. The oim mouse model produces defective type I collagen, the most abundant structural protein in the body. The oim mouse has a phenotype similar to human type III human osteogenesis imperfecta (OI), including fractures, cortical thinning, and bowing of long bones. Current therapies for OI have been marginally successful and can be painful and invasive with significant recovery times. Data from this study may aid in development of non-invasive treatments via target exercise and muscle training for OI, and other bone diseases such as osteoporosis. This project served as a pilot study to determine if current methods are sensitive enough to detect changes that occur due to muscle loading. Mice were anesthetized and the gastrocnemius muscle removed to impose mechanical overload on the plantaris and soleus muscles. The mice resumed activity for three weeks before being euthanized and the leg bones removed. The bones were subject to microCT to obtain geometric parameters before undergoing torsional loading to failure to assess bone biomechanics. The remaining muscles were examined for histological differences, and their collagen content determined using a hydroxyproline assay. Data thus far confirms that our methodology will detect changes in both muscle and bone, and future work will determine if muscle loading improves bone quality

Prevalence of Epilepsy in Iran: A Meta-Analysis and Systematic Review

How to Cite This Article: Sayemiri K, Tavan H, Sayemiri F, Mohammadi I, Carson KV. Prevalence of Epilepsy in Iran : A Meta-Analysis and Systematic Review. Iran J Child Neurol. 2014 Autumn; 8(4):9-17.AbstractObjectiveEpilepsy is one of the most common diseases in Iran contributing to an array of health problems. In light of this, the aim of the present study is to examine the prevalence of epilepsy in Iran through a systematic review and meta-analysis.Materials & MethodsA systematic search of several databases including PubMed, scientific information databases, Google, Google scholar, Elsevier and Scopus was conducted in June 2013. Observational studies were considered for inclusion ifthey were published in Iranian and examined epilepsy prevalence and/or related risk factors. Meta-analysis was conducted using a random effect model with the DerSimonian/Laird method. Heterogeneity was examined using the Breslow- Day test and inconsistency using the I2 statistic.ResultsA total of 45 studies were identified from the search strategy. Of these, nine published manuscripts with a total of 7,723 participants were included within the review. The pooled prevalence of epilepsy in Iran was estimated to be around 5% (95% confident interval (CI) 2 to 8). For each region the prevalence of epilepsy in central, northern and eastern Iran were 5% (95%CI 2 to 8), 1% (95%CI -1 to 3) and 4% (95%CI 3 to 11) respectively. The most common risk factors in order of prevalence were somatic diseases 39% (95%CI 15 to 62),convulsion 38% (95%CI 11 to 65), mental diseases 36% (95%CI 15 to 95) and hereditary development 26% (95%CI 9 to 42). A meta-regression model identified a declining trend in the prevalence of epilepsy within Iran for the last decade.ConclusionPooled analyses from the nine included publications in this review estimate the prevalence of epilepsy in Iran to be around 5%. Although this result is much higher than rates in other countries, a declining trend in prevalence over the pastdecade was also identified. References1. Valizadeh L, Barzegar M, Akbarbegloo M, ZamanzadehV, Rahiminia E, Ferguson CF. The relationship between psychosocial care and attitudes toward illness in adolescents with epilepsy. Epilepsy and Behavior 2013;27: 267–271.2. Widera E, LikusW, Kazek B, Niemiec P, Balcerzyk A,Aleksander L, Siero N, gak I. CYP3A5 * 3 and C3435TMDR1 Polymorphisms in Prognostication of Drug-Resistant Epilepsy in Children and Adolescents. Hindawi Publishing Corporation Biomed Research International 2013;12: 7 -10.3. Koochaki E, Daneshvar R. Evaluation of Seizure Attacksin Patients with Cerebrovascular Accident. Zahedan J ResMed Sci 2013; 15: 29-32.4. Asadi-PooyaA, Sharifzade M. Lennox–Gastaut syndrome in south Iran: Electro-clinical manifestations. Seizure 2012; 21: 760-763.5. Motamedi M, Sahraian M, Moshirzadeh S. A Cross Sectional Study Evaluating Perceived Impact of Epilepsy on Aspects of Life. Zahedan J Res Med Sci 2012; 14: 33-366. Scott RA, Lhatoo SD, Sander J. The treatment of epilepsy in developing countries: where do we go from here? Bull WHO 2001;79:344–345.7. Bharucha, N.E. Epidemiology of epilepsy in India. Epilepsia 2003;44: 9-11.8. Ronnie D. Horner.Racial/ethnic disparities in the treatment of epilepsy: What do we know? What do we need to know? Epilepsy & Behavior 2006; 9: 243–264.9. Nachvak M, Haghighat HR, Rezaei M. Prevalence and monitoring of retarded Childs in Tehran at 2002. Quarterly of science-research journal of Kermanshah University of Medical Sciences.2004; 3: 34-42.10. Etemadifar M, Mirabdolbaghe P. Demographic and clinical characteristics of young epilepsy mortalities in Isfahan. Two quarterly of south pediatric, Persian golf center of health researches in Boushehr University of Medical Sciences. 2005; 2: 160-164.11. Najafi MR, Rezaei F, Vakili Zarch N, Dehghani F, Barakatein M. Survey of pattern of personality and psychopathology in patients with Grandmal and complexpartial epilepsy and comparison with control group. Journal of Shaheed Sadoughi University of Medical Sciences. 2010; 2:84-91.12. Pashapour A, Sadrodini A. Grandmal epilepsy and EEG variations in primary school children at Tabriz. MedicalJournal of Tabriz University of Medical Sciences. 2001; 50: 23- 27.13. Mohammadi M, Ghanizadeh A, Davidian H, MohammadiM, Norouzian M. Prevalence of epilepsy and co morbidity of psychiatric disorders in Iran. Seizure. 2006; 15: 476-482.14. Nasehi M.M, Mahvalati Shamsabadi F, Ghofrani M. Associated Factors in Response to Treatment in Childrenwith Refractory Epilepsy. J Babol University Med Sci (4):2010; 12: 61-66.15. Kaheni S, Riyasi HR, Rezvani Kharashad MR, Sharifzadeh Gh, Nakhaei S. Prevalence of epilepsy in children at primary schools and awareness of teachers about epilepsy at primary schools of Birjand at 2010. Novel cares, Quarterly of science journal of nursing and midwifery in Birjand University of Medical Sciences. 2011; 3:135-142.16. Rezaei AK, Saeidi Sh. Survey of starting age and genderof epilepsy and effective parameters on the Sina and Ghaem hospitals patients at 1989 till 1995. Rehabilitation magazine. 2000; 2: 52-57.

Smoking cessation and tobacco prevention in Indigenous populations

This article systematically reviews 91 smoking cessation and tobacco prevention studies tailored for Indigenous populations around the world, with a particular focus on Aboriginal and Torres Strait Islander populations in Australia. We identified several components of effective interventions, including the use of multifaceted programs that simultaneously address the behavioural, psychological and biochemical aspects of addiction, using resources culturally tailored for the needs of individual Indigenous populations. Pharmacotherapy for smoking cessation was effective when combined with culturally tailored behavioural interventions and health professional support, though it is generally underused in clinical practice. From a policy perspective, interventions of greater intensity, with more components, were more likely to be effective than those of lower intensity and shorter duration. For any new policy it is important to consider community capacity building, development of knowledge, and sustainability of the policy beyond guided implementation. Future research should address how the intervention can be supported into standard practice, policy, or translation into the front-line of clinical care. Investigations are also required to determine the efficacy of emerging therapies (such as e-cigarettes and the use of social media to tackle youth smoking), and under-researched interventions that hold promise based on non-Indigenous studies, such as the use of Champix. We conclude that more methodologically rigorous investigations are required to determine components of the less-successful interventions to aid future policy, practice and research initiatives. Evidence Base, issue 3, 201

Safety and efficacy of umbilical cord-derived Wharton\u27s jelly compared to hyaluronic acid and saline for knee osteoarthritis: Study protocol for a randomized, controlled, single-blind, multi-center trial

BACKGROUND: Osteoarthritis (OA) is the most common joint disorder in the United States of America (USA) with a fast-rising prevalence. Current treatment modalities are limited, and total knee replacement surgeries have shown disadvantages, especially for grade II/III OA. The interest in the use of biologics, including umbilical cord (UC)-derived Wharton\u27s jelly (WJ), has grown in recent years. The results from a preliminary study demonstrated the presence of essential components of regenerative medicine, namely growth factors, cytokines, hyaluronic acid (HA), and extracellular vesicles, including exosomes, in WJ. The proposed study aims to evaluate the safety and efficacy of intra-articular injection of UC-derived WJ for the treatment of knee OA symptoms. METHODS: A randomized, controlled, single-blind, multi-center, prospective study will be conducted in which the safety and efficacy of intra-articular administration of UC-derived WJ are compared to HA (control) and saline (placebo control) in patients suffering from grade II/III knee OA. A total of 168 participants with grade II or III knee OA on the KL scale will be recruited across 53 sites in the USA with 56 participants in each arm and followed for 1 year post-injection. Patient satisfaction, Numeric Pain Rating Scale, Knee Injury and Osteoarthritis Outcome Score, 36-Item Short Form Survey (SF-36), and 7-point Likert Scale will be used to assess the participants. Physical exams, X-rays, and MRI with Magnetic Resonance Observation of Cartilage Repair Tissue score will be used to assess improvement in associated anatomy. DISCUSSION: The study results will provide valuable information into the safety and efficacy of intra-articular administration of Wharton\u27s jelly for grade II/III knee osteoarthritis. The results of this study will also add to the treatment options available for grade II/III OA as well as help facilitate the development of a more focused treatment strategy for patients. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04711304 . Registered on January 15, 2021

Identifying critical features of type two diabetes prevention interventions: A Delphi study with key stakeholders

Aims This study aims to identify critically important features of digital type two diabetes mellitus (T2DM) prevention interventions. Methods A stakeholder mapping exercise was undertaken to identify key end-user and professional stakeholders, followed by a three-round Delphi procedure to generate and evaluate evidence statements related to the critical elements of digital T2DM prevention interventions in terms of product (intervention), price (funding models/financial cost), place (distribution/delivery channels), and promotion (target audiences). Results End-user (n = 38) and professional (n = 38) stakeholders including patients, dietitians, credentialed diabetes educators, nurses, medical doctors, research scientists, and exercise physiologists participated in the Delphi study. Fifty-two critical intervention characteristics were identified. Future interventions should address diet, physical activity, mental health (e.g. stress, diabetes-related distress), and functional health literacy, while advancing behaviour change support. Programs should be delivered digitally or used multiple delivery modes, target a range of population subgroups including children, and be based on collaborative efforts between national and local and government and non-government funded organisations. Conclusions Our findings highlight strong support for digital health to address T2DM in Australia and identify future directions for T2DM prevention interventions. The study also demonstrates the feasibility and value of stakeholder-led intervention development processes

Short-acting bronchodilators for the management of acute exacerbations of chronic obstructive pulmonary disease in the hospital setting: systematic review

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Currently, there is a lack of guidelines for the use of short-acting bronchodilators (SABD) in people admitted to hospital for acute exacerbation of chronic obstructive pulmonary disease (AECOPD), despite routine use in practice and risk of cardiac adverse events. Aim: To review the evidence that underpins use and optimal dose, in terms of risk versus benefit, of SABD for inpatient management of AECOPD and collate the results for future guidelines. Methods: Medline, Embase, the Cochrane Central Register of Controlled Trials, clinicaltrials.gov and International Clinical Trials Registry Platform were searched (inception to November 2017) for published and ongoing studies. Included studies were randomised controlled trials or controlled clinical trials investigating the effect of SABD (β2-agonist and/or ipratropium) on inpatients with a diagnosis of AECOPD. This review was undertaken in accordance with PRISMA guidelines and a pre-defined protocol. Due to heterogeneous methodologies, meta-analysis was not possible so the results were synthesised qualitatively. Results: Of 1378 studies identified, 10 met inclusion criteria. Narrative synthesis of 10 studies revealed no significant differences in most outcomes of interest relative to dose, delivery via inhaler or nebuliser, and type of B2-agonist used. However, some evidence demonstrated significantly increased cardiac side effects with increased dosage of B2-agonist (45% versus 24%), P<0.05). Conclusion: This review identified a paucity of methodologically rigorous evidence evaluating use of SABD among AECOPD. The available evidence did not identify any additional benefits for participants receiving higher doses of short-acting B2-agonists compared to lower doses, or based on type of delivery method or B2-agonists used. However, there was a small increase in some adverse events for participants using higher doses of B2-agonists

Consumer guidelines for chronic disease management (Protocol)

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of consumer guidelines for people with chronic illnesses, on health outcomes

BRAIN Initiative: Cutting-Edge Tools and Resources for the Community.

The overarching goal of the NIH BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative is to advance the understanding of healthy and diseased brain circuit function through technological innovation. Core principles for this goal include the validation and dissemination of the myriad innovative technologies, tools, methods, and resources emerging from BRAIN-funded research. Innovators, BRAIN funding agencies, and non-Federal partners are working together to develop strategies for making these products usable, available, and accessible to the scientific community. Here, we describe several early strategies for supporting the dissemination of BRAIN technologies. We aim to invigorate a dialogue with the neuroscience research and funding community, interdisciplinary collaborators, and trainees about the existing and future opportunities for cultivating groundbreaking research products into mature, integrated, and adaptable research systems. Along with the accompanying Society for Neuroscience 2019 Mini-Symposium, "BRAIN Initiative: Cutting-Edge Tools and Resources for the Community," we spotlight the work of several BRAIN investigator teams who are making progress toward providing tools, technologies, and services for the neuroscience community. These tools access neural circuits at multiple levels of analysis, from subcellular composition to brain-wide network connectivity, including the following: integrated systems for EM- and florescence-based connectomics, advances in immunolabeling capabilities, and resources for recording and analyzing functional connectivity. Investigators describe how the resources they provide to the community will contribute to achieving the goals of the NIH BRAIN Initiative. Finally, in addition to celebrating the contributions of these BRAIN-funded investigators, the Mini-Symposium will illustrate the broader diversity of BRAIN Initiative investments in cutting-edge technologies and resources