Impact of the HOP-UP-PT program on older adults at risk to fall: a randomized controlled trial

BACKGROUND: Reduced falls and fall risks have been observed among older adults referred to the HOP-UP-PT (Home-based Older Persons Upstreaming Prevention-Physical Therapy) program. The purpose of this study was to describe outcomes of HOP-UP-PT program participants and then to compare these outcomes to non-participants. METHODS: Six Michigan senior centers referred adults ≥65 years who were at-risk for functional decline or falls. 144 participants (n = 72 per group) were randomized to either the experimental group (EG) or the control group (CG). Physical therapists (PTs) delivered physical, environmental, and health interventions to the EG over nine encounters (six in-person, three telerehabilitation) spanning seven months. The CG participants were told to continue their usual physical activity routines during the same time frame. Baseline and re-assessments were conducted at 0-, 3-, and 7-months in both groups. Descriptions and comparisons from each assessment encounter were analyzed. RESULTS: Participants ages were: EG = 76.6 (7.0) years and CG = 77.2 (8.2). Baseline measures were not significantly different apart from the Short Physical Performance Battery (SPPB) which favored the EG (P = 0.02). While no significant differences were identified in the survey outcomes or home environment assessments, significant differences in favor of the EG were identified in common fall risk indicators including the Timed Up and Go (P = 0.04), Four Test Balance Scale (P = 0.01), and the modified SPPB (P = 0.02) at the 3-month assessment visit. However, these differences were not sustained at the 7-month assessment as, notably, both groups demonstrated positive improvements in the Four Test Balance Score and SPPB. For individuals at a moderate/high fall risk at baseline, 47.8% of CG reported falling at seven months; whereas, only 6.3% of EG participants meeting the same criteria reported a fall after HOP-UP-PT participation. CONCLUSIONS: A prevention-focused multimodal program provided by PTs in older adults\u27 homes proved beneficial and those with the highest fall risk demonstrated a significant decrease in falls. A collaboration between PTs and community senior centers resulted in upstreaming care delivery that may reduce both the financial and personal burdens associated with falls in an older adult population. TRIAL REGISTRATION: This study was retrospective registered at Clinical Trials.gov , TRN: NCT04814459 on 24/03/2021

Cephalexin: In Vitro and in Vivo Studies

Cephalexin, a derivative of cephalosporin C, produces high serum and urine concentrations after oral administration. In addition, it shows good activity in vitro against most gram-positive and some gram-negative organisms. This study reports the in vitro susceptibility to cephalexin of a series of clinical isolates, the serum levels and urine concentrations in human volunteers and the results of its use in infections due to susceptible organisms. Results of in vitro susceptibility testing reveal that cephalexin was effective against most strains of the gram-positive organisms tested — group A streptococci, pneumococci, and staphylococci — although the MIC\u27s are higher than those found for cephaloridine and ampicillin, with the one exception being penicillinase producing staphylococcus against which ampicillin is ineffective. Cephalexin is effective against most strains of indole-negative proteus, Klebsiella and E. coli, but all strains of enterobacter show resistance. Forty-seven patients with a variety of clinical illnesses were treated with cephalexin. Five of 14 patients with urinary tract infections were cured and nine had a remission followed by a bacteriologic relapse. All patients with soft tissue infection were cured as were nine of 12 patients with pneumonia. Of the three patients with pneumonia who were not cured, one improved, while two were classified as treatment failures. Similarly, 11 of 12 patients with streptococcal pharyngitis had a clinical remission, although in three, the organism was isolated after therapy. One patient with an associated coagulase-positive staphylococci cultured from the pharynx failed to respond to treatment

Hyperparathyroidism subsequent to radioactive iodine therapy for Graves\u27 disease

BACKGROUND: The development of primary hyperparathyroidism (PHPT) after radioactive iodine (RAI) treatment for thyroid disease is poorly characterized. The current study is the largest reported cohort and assesses the disease characteristics of patients treated for PHPT with a history of RAI exposure. METHODS: A retrospective analysis comparing patients, with and without a history of RAI treatment, who underwent surgery for PHPT. RESULTS: Twenty-eight of the 469 patients had a history of RAI treatment, all for Graves\u27 disease. Patients with a history of RAI exposure had similar disease characteristics compared to control; however, patients with a history of RAI treatment had a higher rate of recurrence (7.4% vs 1.2%, p = 0.012). CONCLUSION: PHPT in patients with a history of RAI treatment can be approached in the same manner as RAI naive PHPT patients; however, the risk of recurrence of PHPT in RAI exposed patients may be higher

Preparing for Climatic Change: The Water, Salmon, and Forests of the Pacific Northwest

The impacts of year-to-year and decade-to-decade climatic variations on some of the Pacific Northwest’s key natural resources can be quantified to estimate sensitivity to regional climatic changes expected as part of anthropogenic global climatic change. Warmer, drier years, often associated with El Niño events and/or the warm phase of the Pacific Decadal Oscillation, tend to be associated with below-average snowpack, streamflow, and flood risk, below-average salmon survival, below-average forest growth, and above-average risk of forest fire. During the 20th century, the region experienced a warming of 0.8 ◦C. Using output from eight climate models, we project a further warming of 0.5–2.5 ◦C (central estimate 1.5 ◦C) by the 2020s, 1.5–3.2 ◦C (2.3◦C) by the 2040s, and an increase in precipitation except in summer. The foremost impact of a warming climate will be the reduction of regional snowpack, which presently supplies water for ecosystems and human uses during the dry summers. Our understanding of past climate also illustrates the responses of human management systems to climatic stresses, and suggests that a warming of the rate projected would pose significant challenges to the management of natural resources. Resource managers and planners currently have few plans for adapting to or mitigating the ecological and economic effects of climatic change

Preparing for Climatic Change: The Water, Salmon, and Forests of the Pacific Northwest

The impacts of year-to-year and decade-to-decade climatic variations on some of the Pacific Northwest’s key natural resources can be quantified to estimate sensitivity to regional climatic changes expected as part of anthropogenic global climatic change. Warmer, drier years, often associated with El Niño events and/or the warm phase of the Pacific Decadal Oscillation, tend to be associated with below-average snowpack, streamflow, and flood risk, below-average salmon survival, below-average forest growth, and above-average risk of forest fire. During the 20th century, the region experienced a warming of 0.8 ◦C. Using output from eight climate models, we project a further warming of 0.5–2.5 ◦C (central estimate 1.5 ◦C) by the 2020s, 1.5–3.2 ◦C (2.3◦C) by the 2040s, and an increase in precipitation except in summer. The foremost impact of a warming climate will be the reduction of regional snowpack, which presently supplies water for ecosystems and human uses during the dry summers. Our understanding of past climate also illustrates the responses of human management systems to climatic stresses, and suggests that a warming of the rate projected would pose significant challenges to the management of natural resources. Resource managers and planners currently have few plans for adapting to or mitigating the ecological and economic effects of climatic change

Impact of a specialty trained billing team on an academic otolaryngology practice

PURPOSE: To determine how the incorporation of specialty specific training for coders within a focused billing team affected revenue, efficiency, time to reimbursement, and physician satisfaction in an academic otolaryngology practice. MATERIALS AND METHODS: Our academic otolaryngology department recently implemented a new billing system, which incorporated additional training in otolaryngology surgical procedures for medical coders. A mixed model analysis of variance was used to compare billing outcomes for the 6 months before and 6 months after this new approach was initiated. The following metrics were analyzed: Current Procedural Terminology codes, total charges, time between services rendered and billing submission, and time to reimbursement. A survey of department physicians assessing satisfaction with the system was reviewed. RESULTS: There were 4087 Current Procedural Terminology codes included in the analysis. In comparing the periods before and after implementation of the new system, statistically significant decreases were found in the mean number of days to coding completion (19.3 to 12.0, respectively, p \u3c 0.001), days to posting of charges (27.0 to 15.2, p \u3c 0.001), days to final reimbursement (54.5 to 27.2, p \u3c 0.001), and days to closure of form (179.2 to 76.6, p \u3c 0.001). Physician satisfaction with communication and coder feedback increased from 36% to 64% after initiation of the new program. CONCLUSIONS: The implementation of additional specialty training for medical coders in the otolaryngology department of a large medical system was associated with improved revenue cycle efficiency. Additionally, this model appears to improve physician satisfaction and confidence with the coding system

Early smoking initiation and nicotine dependence in a cohort of young adults

We examined the extent to which nicotine dependence and daily smoking might vary by age at first cigarette. The potential confounding effects of sex, race and history of childhood behaviour problems were examined as well. A sample of 1200 was randomly selected from the subset of 21-30-year-old members of a large HMO in the Detroit SMSA; 1007 (84%) agreed to participate. Personal interviews were conducted in respondents' homes, using the NIMH-DIS to elicit information on DSM-III-R diagnoses, including nicotine dependence. Controlling for sex and race, persons who smoked their first cigarette at 14 to 16 years of age were 1.6 times more likely to become dependent than those who initiated smoking at an older age (P = 0.03). The association was unchanged when history of childhood behaviour problems was also controlled. Smoking initiation before age 14 was not associated with increased probability of dependence. Persons who initiated smoking before age 14 had a longer lag time to daily smoking and a lower likelihood of progressing to daily smoking, compared to persons who initiated smoking later on. The findings suggest that, among persons who have ever smoked, there might be two distinct groups in whom the chances of developing dependence are considerably reduced. The first comprises persons who delayed first use until age 17. The second comprises persons who smoked their first cigarette before age 14, a group in whom the progression to daily smoking might be markedly slower than in persons who initiated smoking when they were older.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30589/1/0000226.pd

VALIDATION OF POLYGENIC SCORE FOR BETA-BLOCKER SURVIVAL BENEFIT IN HEART FAILURE USING THE UNITED KINGDOM BIOBANK

Background: A novel polygenic response predictor (PRP) for beta blocker (BB) survival benefit in heart failure (HF) was recently described which separated European ancestry BB responders from non-responders using a score derived from 44 genetic loci. We tested whether this would replicate in the United Kingdom Biobank (UKB) dataset. Methods: UKB data pull identified patients with a HF diagnosis, genetic data and prescription data. Ejection fraction (EF) data was not available. BB exposure was quantified using BB dose and prescription frequency. The PRP was calculated using the genetic loci, weights, and cutoff value from the original description. Cox models were constructed of time to all-cause mortality adjusted for clinical risk (MAGGIC score), BB propensity score, BB exposure and BB exposure*PRP interaction. Results: Among 7502 HF patients included, 34% were women, 54% had coronary disease, 33% atrial fibrillation, 51% baseline BB usage, and 22% (n=1651) were PRP-predicted responders. Patients in the PRP responder group had strong survival benefit associated with BB exposure (HR=0.55, p=0.016), while PRP non-responders showed little BB effect (HR=0.92, p=0.466) and this difference was significant (p-interaction =0.051). Survival curves by PRP group and dichotomized BB exposure (high vs. low) are shown in the figure. Conclusion: The polygenic BB response predictor replicated in HF patients from the UKB regardless of EF. This innovative genomic medicine tool requires testing in a clinical trial