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Built Environment Implementation Strategies to Promote Physical Activity: Expert Consensus for Local Implementation of Physical Activity Policy, Systems, and Environment (ECLIPPSE)
No full textContext: Despite evidence supporting the role of the built environment in promoting physical activity, there is limited guidance on how to implement recommended built environment changes at the local level.
Objectives: The objective of this project was to develop a compilation of implementation strategies that hold promise for aiding communities in implementing built environment changes that support active transportation and leisure-time physical activity, titled "Expert Consensus for Local Implementation of Physical Activity Policy, Systems, and Environment (ECLIPPSE)."
Design: A modified Delphi Technique using 3 web-based survey rounds was conducted from 2024 to 2025.
Setting: A multidisciplinary national expert panel was recruited to participate in this online panel.
Participants: The panel consisted of 23 professionals with expertise in the implementation of built environment changes to support physical activity at the local level.
Main outcome measure: The Round 1 and 2 surveys utilized a rating process to establish a compilation of potentially promising strategies for aiding communities in implementing physical activity-supportive built environment changes. The Round 3 survey involved rating these strategies on potential feasibility and impact and endorsing the final compilation.
Results: Fifty-five strategies emerged in 2 broad domains. The first domain, "Get Ready," included 4 categories: (1) Partnerships and collaboration (5 strategies); (2) staffing (5 strategies); (3) training and education (4 strategies), and (4) interactive assistance (2 strategies). The second domain, "Take Action," included 6 categories: (1) Data and community informed prioritization (6 strategies); (2) evaluative (8 strategies); (3) community awareness and demand (8 strategies); (4) engagement with decision-making processes (5 strategies); (5) funding (7 strategies); and (6) pilots or demonstration projects (5 strategies). The final compilation was endorsed by 95% of respondents.
Conclusions: The ECLIPPSE strategies can be used to aid implementation of built environment changes at the local level to support physical activity.No embarg
Meniscal degeneration among knees without radiographic osteoarthritis correlates with changes in disease activity and subsequent cumulative damage: Data from the Osteoarthritis Initiative
Get PDFObjective: To explore the relationship between meniscal degeneration (intrameniscal signal alteration without a tear) and future osteoarthritis pathology measured by composite scores based on magnetic resonance imaging (MRI): disease activity (bone marrow lesion and effusion-synovitis volumes) and cumulative damage (articular cartilage damage).
Design: This analysis involved 225 participants from the Osteoarthritis Initiative with intact menisci (defined as normal or meniscal degeneration without tear) on MRI and no radiographic knee osteoarthritis at baseline. We used longitudinal MRIs from an existing study to calculate disease activity and cumulative damage. We used robust regression models to assess the association between baseline meniscal degeneration (exposure) and disease activity or cumulative damage at baseline and four annual follow-up visits (outcomes), adjusting for gender, race, age, static alignment, and body mass index.
Results: Our sample included 110 participants with normal menisci (77% Female, 55 [SD 7] average years of age) and 115 with meniscal degeneration (60% Female, 61 [SD 9] average years of age). Knees with meniscal degeneration were more likely to have, on average, 0.21 greater disease activity at 12 months than knees with normal menisci (parameter estimate=0.21, 95% CI=0.09, 0.33); this association persisted over time. In contrast, the association between meniscal degeneration and cumulative damage only became statistically significant at the 48-month visit (parameter estimate=0.74, 95% CI=0.18, 1.31).
Conclusions: Meniscal degeneration related to worsening disease activity earlier than articular cartilage damage among knees without radiographic osteoarthritis. Meniscal degeneration and disease activity are promising biomarkers for early detection, monitoring osteoarthritis, and informing potential early intervention strategies.No embarg
miR-124 acts During Drosophila Development to Determine the Phase of Adult Circadian Behavior
No full textThe circadian clock enables organisms to optimize their metabolism, physiology, and behavior with the time-of-day. However, circadian rhythms benefit organisms only if they are properly synchronized with the day/night cycle; circadian misalignment can have detrimental effects on animals' wellbeing and survival. We previously showed that in , loss of the microRNA advances the phase of circadian evening locomotor activity by several hours under constant darkness conditions. Interestingly, we now report that loss of also delays morning activity under a light/dark cycle with a short photoperiod. We recapitulated these opposite phase phenotypes by eliminating during larval development, but not when this microRNA is lost during pupation to adulthood. The loss of results in significant miswiring within the circadian neural network and severely alters neural activity rhythms in the ventral Lateral Neurons (s-LNvs) and the posterior Dorsal Neurons 1 (DN1ps), which control the timing of morning and evening activity. Silencing the s-LNvs in mutant flies restores the phase of evening activity, while activating the DN1ps rescues the phases of both morning and evening activities. Our findings thus reveal the pivotal role of in sculpting the circadian neural network during development and its long-lasting impact on circuit activity and adult circadian behavior.No embarg
Publisher preferences for a journal transparency tool: A modified three-round Delphi study
No full textBACKGROUND: We propose the creation of a journal transparency tool (JTT), which will allow users to obtain information about a given scholarly journal's operations and policies. We are obtaining preferences from different stakeholders to inform the development of this tool. This study aimed to identify the publishing community's preferences for the JTT.
METHODS: We conducted a modified three-round Delphi survey. Representatives from publishing houses and journal publishers were recruited through purposeful and snowball sampling. The first two Delphi rounds involved an online survey with items about JTT metrics and user features. During the third round, participants discussed and voted on JTT metric items that did not reach consensus after round 2 within a virtual consensus meeting. We defined consensus as 80% agreement to include or exclude an item in the JTT.
RESULTS: Eighty-six participants completed the round 1 survey, and 43 participants (50% of round 1) completed the round 2 survey. In both rounds, respondents voted on JTT user feature and JTT metric item preferences and answered open-ended survey questions regarding the JTT. In round 3, a total of 21 participants discussed and voted on JTT metric items that did not reach consensus after round 2 during an online consensus group meeting. Fifteen out of 30 JTT metric items and none of the four JTT user feature items reached the 80% consensus threshold after all rounds of voting. Analysis of the round 3 online consensus group transcript resulted in two themes: 'factors impacting support for JTT metrics' and 'suggestions for user clarity.'
CONCLUSIONS: Participants suggested that the publishing community's primary concerns for a JTT are to ensure that the tool is relevant, user-friendly, accessible, and equitable. The outcomes of this research will contribute to developing and refining the tool in accordance with publishing preferences.No embarg
COVID-19 test positivity, vaccine uptake, and mortality among Veterans with SCI/D
No full textBACKGROUND: Between January 2020 and December 2023, the United States reported over 103 million COVID-19 cases and 1.1 million related deaths. Veterans with spinal cord injuries and disorders (VSCI/D) are particularly vulnerable due to chronic health conditions and comorbidities, which increases COVID-19 infection and mortality risk from exposure to others who they depend on for care. This manuscript highlights factors associated with COVID-19 vaccine uptake in VSCI/D.
OBJECTIVE: This study aimed to explore Veteran demographic and clinical factors associated with COVID-19 test positivity, vaccine uptake, and COVID-19-related mortality among VSCI/D in the 2-year period following the start of the pandemic.
METHODS: This observational cohort study used the Veterans Health Administration's (VHA) Spinal Cord Injuries and Disorders Registry to identify VSCI/D alive on March 20, 2020. Outcome measures included COVID-19 test positivity, vaccine uptake, and mortality within 30 days of a positive test over a 2-year period.
RESULTS: Among 17,522 VSCI/D, 12% had a positive COVID-19 test at least once in the two-year period following March 20, 2020, 73% received at least one COVID-19 vaccine dose in the 2-year period, and 47% received at least three doses. COVID-related mortality occurred in 67 (0.4%; 67/17,522) VSCI/D in the first year of the pandemic and 46 in the second year (0.6% two-year mortality; 113/17,522).
CONCLUSION: Less than half of VSCI/D received three COVID-19 vaccine doses, suggesting opportunities for quality improvement efforts. Peer support services may help improve vaccine uptake among VSCI/D in the future.No embarg
Brain dynamics reflecting an intra-network brain state is associated with increased posttraumatic stress symptoms in the early aftermath of trauma
No full textPost-traumatic stress (PTS) encompasses a range of psychological responses following trauma, which may lead to more severe outcomes such as post-traumatic stress disorder (PTSD). Identifying early neuroimaging biomarkers that link brain function to PTS outcomes is critical for understanding PTSD risk. This longitudinal study examines the association between brain dynamic functional network connectivity (dFNC) and current/future PTS symptom severity, and the impact of sex on this relationship. By analyzing 275 participants' dFNC data obtained ~2 weeks after trauma exposure, we noted that brain dynamics of an inter-network brain state link negatively with current (=-0.197, = 0.0079) and future (=-0.176, = 0.0176) PTS symptom severity. Also, dynamics of an intra-network brain state correlated with future symptom intensity ( = 0.205, = 0.0079). We additionally observed that the association between the network dynamics of the inter-network and intra-network brain state with symptom severity is more pronounced in female group. Our findings highlight a potential link between brain network dynamics in the aftermath of trauma with current and future PTSD outcomes, with a stronger effect in female group, underscoring the importance of sex differences.No embarg
VPS13D mutations affect mitochondrial homeostasis and locomotion in Caenorhabditis elegans [preprint]
No full textThis article is a preprint. Preprints are preliminary reports of work that have not been certified by peer review.Mitochondria control cellular metabolism, serve as hubs for signaling and organelle communication, and are important for the health and survival of cells. encodes a cytoplasmic lipid transfer protein that regulates mitochondrial morphology, mitochondria and endoplasmic reticulum (ER) contact, quality control of mitochondria. mutations have been reported in patients displaying ataxic and spastic gait disorders with variable age of onset. Here we used CRISPR/Cas9 gene editing to create related-spinocerebellar ataxia-4 (SCAR4) missense mutations and C-terminal deletion in 's orthologue in . Consistent with SCAR4 patient movement disorders and mitochondrial dysfunction, mutant worms exhibit locomotion defects and abnormal mitochondrial morphology. Importantly, animals with a deletion or a N3017I missense mutation exhibited an increase in mitochondrial unfolded protein response (UPR ). The cellular and behavioral changes caused by mutations in advance the development of animal models that are needed to study SCAR4 pathogenesis
Intervention Stage Completion and Behavioral Health Outcomes: An Integrated Behavioral Health and Primary Care Randomized Pragmatic Trial
No full textPurpose: We performed a pragmatic, cluster randomized controlled trial of a comprehensive practice-level, multistage practice transformation intervention aiming to increase behavioral health integration in primary care practices and improve patient outcomes. We examined associations between completion of intervention stages and patient outcomes across a heterogeneous national sample of primary care practices.
Methods: Forty-two primary care practices across the United States with colocated behavioral health and 2,945 patients with multiple chronic medical and behavioral health conditions completed surveys at baseline, midpoint, and 2-year follow-up. We examined effects of intervention on patient health and primary care integration outcomes using multilevel mixed-effects models, controlling for baseline outcome measurements.
Results: No differences were found associated with the number of intervention stages completed and patient health outcomes including depression, anxiety, fatigue, sleep disturbance, pain, pain interference, social participation, and physical function. However, the completion of each intervention stage was associated with increases in Practice Integration Profile domain scores and confirmed with modeling using multiple imputation for the following: workflow 3.5 (95% CI, 0.9 to 6.1), integration methods 4.6 (95% CI, 1.5 to 7.6), patient identification 2.9 (95% CI, 0.9 to 5.0), and total integration 2.7 (95% CI, 0.7 to 4.7).
Conclusion: A practice-centric flexible practice transformation intervention improved integration of behavioral health in primary care across heterogeneous primary care practices treating patients with multiple chronic conditions when accounting for completion of intervention stages. Interventions that allow practices to flexibly improve care have the potential to help complex patient populations. Future research is needed to determine how to best target patient health outcomes at the population level.No embarg
Petechial hemorrhage in mechanical thrombectomy for distal and medium-vessel occlusions: technical considerations and outcomes
No full textObjective: Mechanical thrombectomy (MT) is well established for large-vessel occlusion (LVO) strokes, but its safety in distal and medium-vessel occlusions (DMVOs) requires further investigation. This study analyzed the relationship between procedural approaches, petechial hemorrhage (PetH), and clinical outcomes in DMVO thrombectomy, with particular attention to technical considerations and the complex interplay between tissue injury and hemorrhagic complications.
Methods: A retrospective cohort study was conducted on DMVO stroke patients treated with MT at 37 stroke centers worldwide from 2016 to 2024. Patients were categorized based on follow-up imaging into those with or without PetH. Four logistic regression models analyzed the association of PetH with favorable functional outcomes (modified Rankin Scale score ≤ 2) at 90 days, early neurological improvement (≥ 4-point National Institutes of Health Stroke Scale score decrease at 24 hours), all-cause mortality, and independent determinants of PetH. Adjusted odds ratios (aORs), 95% confidence intervals, and p values were reported.
Results: Of 1428 patients, 439 (30.7%) developed PetH. Factors independently associated with PetH were multiple thrombectomy passes (aOR 1.58, 95% CI 1.21-2.06; p = 0.001), IV thrombolysis (aOR 1.31, 95% CI 1.01-1.69; p = 0.04), and the combined use of a stent retriever with aspiration as the first-line method compared with aspiration alone (aOR 1.66, 95% CI 1.15-2.38; p = 0.007). Conversely, general anesthesia (aOR 0.55, 95% CI 0.40-0.77; p < 0.001), higher Alberta Stroke Program Early CT Scores (aOR 0.76, 95% CI 0.69-0.83; p < 0.001), and successful recanalization (aOR 0.56, 95% CI 0.39-0.80; p = 0.002) were significantly associated with a lower odds of PetH. PetH was associated with a decreased odds of favorable functional outcomes (aOR 0.51, 95% CI 0.36-0.73; p < 0.001), reduced early neurological improvement (aOR 0.59, 95% CI 0.44-0.79; p < 0.001), and increased all-cause mortality (aOR 1.84, 95% CI 1.23-2.76; p < 0.001).
Conclusions: PetH is a frequent sequela following MT in DMVO strokes and is associated with poorer outcomes, likely reflecting underlying ischemic injury rather than direct causation. Procedural factors influence PetH risk, suggesting medical treatment as first-line therapy for DMVOs, with MT reserved for refractory cases using less aggressive approaches.No embarg
Testing a Machine Learning-Based Adaptive Motivational System for Socioeconomically Disadvantaged Smokers (Adapt2Quit): Protocol for a Randomized Controlled Trial
Get PDFBackground: Individuals who are socioeconomically disadvantaged have high smoking rates and face barriers to participating in smoking cessation interventions. Computer-tailored health communication, which is focused on finding the most relevant messages for an individual, has been shown to promote behavior change. We developed a machine learning approach (the Adapt2Quit recommender system), and our pilot work demonstrated the potential to increase message relevance and smoking cessation effectiveness among individuals who are socioeconomically disadvantaged.
Objective: This study protocol describes our randomized controlled trial to test whether the Adapt2Quit recommender system will increase smoking cessation among individuals from socioeconomically disadvantaged backgrounds who smoke.
Methods: Individuals from socioeconomically disadvantaged backgrounds who smoke were identified based on insurance tied to low income or from clinical settings (eg, community health centers) that provide care for low-income patients. They received text messages from the Adapt2Quit recommender system for 6 months. Participants received daily text messages for the first 30 days and every 14 days until the end of the study. Intervention participants also received biweekly texting facilitation messages, that is, text messages asking participants to respond (yes or no) if they were interested in being referred to the quitline. Interested participants were then actively referred to the quitline by study staff. Intervention participants also received biweekly text messages assessing their current smoking status. Control participants did not receive the recommender messages but received the biweekly texting facilitation and smoking status assessment messages. Our primary outcome is the 7-day point-prevalence smoking cessation at 6 months, verified by carbon monoxide testing. We will use an inverse probability weighting approach to test our primary outcome. This involves using a logistic regression model to predict nonmissingness, calculating the inverse probability of nonmissingness, and using it as a weight in a logistic regression model to compare cessation rates between the two groups.
Results: The Adapt2Quit study was funded in April 2020 and is still ongoing. We have completed the recruitment of individuals (N=757 participants). The 6-month follow-up of all participants was completed in November 2024. The sample consists of 64% (486/757) female participants, 35% (265/757) Black or African American individuals, 51.1% (387/757) White individuals, and 16% (121/757) Hispanic or Latino individuals. In total, 52.6% (398/757) of participants reported having a high school education or being a high school graduate; 70% (529/757) smoked their first cigarette within 30 minutes of waking, and half (379/757, 50%) had stopped smoking for at least one day in the past year. Moreover, 16.6% (126/757) had called the quitline before study participation.
Conclusions: We have recruited a diverse sample of individuals who are socioeconomically disadvantaged and designed a rigorous protocol to evaluate the Adapt2Quit recommender system. Future papers will present our main analysis of the trial.
Trial registration: ClinicalTrials.gov NCT04720625; https://clinicaltrials.gov/study/NCT04720625.
International registered report identifier (irrid): DERR1-10.2196/63693.No embarg