Assessing disease activity and response to treatment in axial spondyloarthritis: The unmet clinical need and potential role for quantitative imaging

BACKGROUND: Objective assessments of disease activity and response to treatment in axial spondyloarthritis (axSpA) remain an area of unmet clinical need. Quantitative magnetic resonance imaging (qMRI) offers potential for more accurate measures of disease activity and therapeutic response. PURPOSE: To critically appraise current methods of disease activity in axSpA and determine the responsiveness and validity of quantitative imaging biomarkers (QIBs) in patients with axSpA undergoing biologic therapy. METHODS: An observational cohort study was carried out to assess the specificity of our current disease activity measure on patients with axSpA. A systematic literature review was performed to assess the use of MRI in the assessment of axSpA. A prospective cohort study was carried out on 30 patients with axSpA undergoing biologic therapy or switching biologic therapy. Conventional and qMRI scans, including diffusion-weighted imaging (DWI) and chemical shift-encoded imaging (CSI) were carried out at baseline and after 12-16 weeks of treatment. Apparent diffusion coefficient (ADC) and proton density fat fraction (PDFF) maps were analysed using the partially-automated Bone Edema and Adiposity Characterisation with Histograms (BEACH) tool, which derives a series of quantitative imaging biomarkers (QIBs) for both ADC and PDFF. Conventional MR images were assessed using established visual scoring methods. QIBs were assessed in terms of change after treatment and correlation with clinical and conventional MRI measures of disease activity. RESULTS: Current disease activity measures are not specific to axSpA and can be increased in a number of other spinal pathologies. ADC biomarkers are sensitive to changes in inflammation and show significant reductions following biologic therapy, while PDFF-based QIBs showed nonsignificant reductions. Responsiveness to therapy was moderate for ADC based biomarkers and small for conventional scoring systems. ADC and PDFF correlated well with conventional MRI scoring methods. CONCLUSION: Quantitative MRI offers promise for a more accurate assessment of disease activity in axSpA

From Covenants to Classrooms: Uncovering the Impact of Racial Segregation on Education in St. Paul, Minneapolis, and Duluth

Minnesota\u27s history contains a narrative of segregation that not only shaped the physical landscape of its cities but also entrenched disparities in education and fractured communities. The racial covenants that first emerged in 1910 built the bedrock of housing segregation that led to segregated neighborhoods. The consequences of this systemic segregation extended beyond residential boundaries and infiltrated the corridors of education, where the harsh realities of racial imbalance often betrayed the promise of equal opportunity. By examining the interconnectedness of housing policies, school integration efforts, and community development, this study uncovers the roots of inequality and proves how Minnesota failed students of color in its attempt to address the schools and race challenge. This dissertation contends that the racial covenants that forced African Americans to live in select neighborhoods caused segregated schools, which the government neglected at both a state and local level. By the time the government began to address de facto segregation in the 1960s and 1970s, simply establishing a minority enrollment percentage for schools to meet was not enough. Central to this argument were the integration efforts of these decades, which, while aiming to dismantle the barriers of segregation, inadvertently burdened Black students with the responsibility of integration. Forced busing policies, coupled with the closure of predominantly Black schools, disrupted communities and exacerbated educational disparities. Furthermore, the construction of freeways, ostensibly for connectivity, disproportionately targeted Black neighborhoods, severing vital ties and deepening the wounds of segregation

Subsidization of race entry fees lowers barriers to participation in 5K races in children 14 and under

Background: Numerous studies have highlighted the physical health benefits of children's participation in sports and more recently, a body of research is growing that details the mental health benefits. Despite these benefits, children are leading increasingly sedentary lifestyles and this puts them at greater risk of chronic disease, obesity, and poor school performance. The key barriers to participation in sport for children have been identified by researchers as 'cost' and 'time'. One way to reduce the cost barrier is to subsidize race entry fees for 5K races.Methods: Data for national averages was retrieved from a public database (meteor.run), which calculates statistics for the aggregate of all 5K events in the system. Data from selected races where fee waivers are available was retrieved from public databases containing specific event information (oksportsandfitness.com and tatur.org). Male and female participation in the age group of 1-14 years was analyzed.Results: Nationally, in races where fees are not subsidized, participation by children aged 1-14 is 7.0% in females and 10.5% in males. In selected races where fee-subsidization is offered, participation by children is much greater. Over the course of five years (2015-2019) in the Cherokee National Holiday 5K, average participation by females aged 1-14 years is 14.3% and males is 21.3%. In the 2019 Redbird 5K, female participation in the 1-14 age group was 16% and the male rate was 26.8%. The 2019 Beat the Heat 5K had 15.4% female participation in the 1-14 years age group and 21.5% male participation. The Isaiah Sapp 2019 5K was 17.8% females aged 1-14 and 28.2% males. The Huckleberry 5K 2019 was 12.5% females aged 1-14 and 21.3% males. The Mayes Co HOPE 2019 5K had 14.3% participation from females aged 1- 14 and 20.1% participation from males aged 1-14.Conclusions: The races where fee waivers were available took place at different times during the school year and summer (the Holiday 5K was calculated over a five-year period). These races took place during differing weather conditions and in different cities around northeastern Oklahoma. There is a commitment necessary by parents to enroll the children into the wellness program in order to receive the race fee waivers and there is a requirement to attend the races once registered. However, despite the membership, registration, and attendance requirements, children are still motivated to train for and participate in the races at a greater rate if their fees are paid. Policy makers, parents, and teachers should be aware that 'cost' and 'time' are key barriers to participation in sport for children. More opportunities are needed where costs are reduced and this provides one example of an effective cost-reducing method for increasing participation in running

Improving Patient Outcomes by Preventing Airway Injuries Associated with Video Laryngoscopes

Video laryngoscopy poses a higher risk of airway injury than direct laryngoscopy when used for difficult intubations in the operating room. Education related to manufacturer guidelines, in addition to, routine simulation practice are vital to improving efficacy and patient safety when using video laryngoscopes. The purpose of this project was to provide education to anesthesia providers regarding the potential risk of airway injury through a presentation and mid-fidelity simulation experience. An in-person PowerPoint presentation was delivered to anesthesia providers, along with a simulation experience using an intubation trainer manikin to demonstrate the proper technique when using the GlideScope and McGRATH MAC Video Laryngoscope. A pocket reference tool was also created and distributed to all participants after the presentation. The participants completed a 10-question pre-test before the presentation and a 10-question post-test immediately following the presentation and simulation experience. The results from both tests were evaluated to determine the overall impact and effectiveness of the presentation and simulation experience. A post-implementation survey was also utilized, which consisted of an 11-question Likert Scale Survey with two open-ended questions. This was used to collect participant perceptions on how well the material was presented and the usefulness of the educational tools provided. The results of this quality improvement project implied there was an immediate impact on the participants’ level of knowledge related to the proper use of video laryngoscopes to avoid injury to the patient. The survey results suggested that the participants had an increase in confidence of video laryngoscope use when presented with a difficult intubation, along with the reinforcement of accurate use according to manufacturer guidelines. Recommendations of this project would be to continue to provide awareness to anesthesia providers of the potential airway injury risk associated with video laryngoscopy with further education and simulation experiences

Culturally Responsive Teaching: Inclusive, Engaging, and Effective Instructional Strategies

Illinois’ Culturally Responsive Teaching and Leading Standards, approved by the Illinois State Board of Education in March 2021, will be part of teacher education programs throughout the state by the end of the 2022-2023 school year. To this end, we want to provide practical strategies for reflecting on teacher preparation coursework and incorporating the CRTLS in our work with preservice teachers. We will provide a quick review of the content within the standards, but most of the time will be spent on specific examples of what teacher education classrooms might look like with the CRTLS embedded

Spirituality and Religiosity in Adolescents Living with Sickle Cell Disease

This study purports to address paucity in the literature regarding how adolescents with sickle cell disease (SCD) describe and experience spirituality and religiosity (S/R). This was a qualitative descriptive study. Two semi-structured interviews were conducted with nine adolescents (Mage = 16.2 years). Data were analyzed using a template analysis style and a concurrent analysis process of data reduction. Three major themes encompassed the participants’ descriptions of the relationships between S/R, health and illness in their lives including S/R as sources for coping, influence of S/R beliefs on health and illness, and sharing S/R with Health Care Providers (HCPs). S/R as coping mechanisms included six threads: interconnecting with God, interconnecting with others, interconnecting with creative arts, scriptural metanarratives, transcendent experiences, and acceptance and finding meaning. Expectations of health providers included two threads: Religiosity is private/personal and sharing spiritual and religious beliefs is risky. S/R are particularly salient for adolescents with SCD