IntroductionApproximately 50 % of residents in long-term care facilities fall yearly and orthostatic hypotension accounts for a significant portion of them. Neurogenic orthostatic hypotension - a subtype of orthostatic hypotension – is important to be recognized as its management is far more complex; undertreatment of these older adults can lead to recurrent falls, high healthcare cost burden, and increased morbidity and mortality. The primary purpose of our study was to describe the rate of neurogenic orthostatic hypotension in older adults in a long-term care facility, with a secondary purpose to describe risk factors for neurogenic orthostatic hypotension in this population. MethodsWe conducted a retrospective case-control study of residents with recurrent falls at the Dayton Veteran's Affairs long-term care facility. Charts were manually reviewed. Inclusion criterion was three or more falls and age 65 or greater; we did not have exclusion criteria.ICD10 codes and most recent primary care physician notes were used to identify comorbidity diagnoses. Recent orthostatic vitals were used to assess orthostatic hypotension or neurogenic orthostatic hypotension diagnoses. ResultsOf our sample of 224 residents, we observed a prevalence of 20.5 % for neurogenic orthostatic hypotension and 32.1 % for orthostatic hypotension. Neither of them had diagnosis of neurogenic orthostatic hypotension documented. Parkinson's disease was associated with neurogenic orthostatic hypotension (OR-4.3; p = 0.002). Hypertension was prevalent in 69.6 % of residents with orthostatic vitals suggestive of neurogenic orthostatic hypotension. ConclusionOlder adults with recurrent falls at a long-term care facility meet criteria for neurogenic orthostatic hypotension diagnosis far more often than is documented. Common comorbidities associated with neurogenic orthostatic hypotension in this population include Parkinson's disease.

355 Background: Nearly two-thirds (62%) of people with cancer want to know about non-tumor directed therapies such as exercise, nutrition counseling, massage, and meditation before starting conventional treatment, but only 33% of oncologists agree with that timeline, according to a 2022 online survey . In 2021-2022, Samueli Integrative Health Programs (now Healing Works Foundation) funded a two-year integrative oncology leadership collaborative (IOLC) with a goal to further whole person cancer care, also called integrative oncology. The IOLC adapted a new patient reported outcome (PRO), and patient education and workflow resources used in whole person primary care for use in cancer care. The Personal Health Inventory (PHI), a person-focused PRO intake tool to elicit “what matters”, was made oncology-specific and deployed at several centers including a VA Medical Center. The IOLC created or adapted additional resources, resulting in a set of open-source tools for use in mainstream oncology practice. Methods: 13 cancer care organizations met monthly in 90-min virtual format from April-Dec 2021. From Jan-Dec 2022 sessions were held twice monthly over 1-hr. Year One allowed group cohesion in discussion-based review of the current state of whole person cancer care and covered foundational topics to include guideline-based supportive care and group medical visits. IOLC members suggested changes to the primary care PHI along with development of new oncology-specific whole person care resources. In Year Two, IOLC members were encouraged to beta test the PHI and related-resources in their practice settings and a Patient Empowerment and Advocacy Collaborative (PAEC) was developed as part of the group to bring in direct patient experience. The oncology-specific PHI was trialed within the Dayton VA Whole Health Oncology clinic from Oct 2021-June 2023. It proved feasible for use at any stage of the cancer care experience in 25 intake encounters. Results: PHI oncology-specific adaptations included replacing “Healthy Days” with FACT-G7 and the Patient Dignity Question (PDQ). Nineteen “pocket guides” were created and posted free online to support whole person cancer care. The patient voice was expanded through the formation of the PAEC in Year Two, and the group led two joint sessions where advocates provided input on IOLC tools’ development. Conclusions: A group of cancer care professionals and patients, working together in a sponsored community of practice, created no-cost resources, including a new PRO called the PHI, to further whole person integrative cancer care. The PHI demonstrated feasibility in a veteran population with cancer and can be offered at any time in the oncology trajectory, from diagnosis to end of life, surviving to thriving. Next steps are to formally test these tools in various oncology practice settings.

Ionizing radiation (IR) exerts both tissue and systemic effects. However, the exact mechanism by which radiation therapy to skin results in local and systemic effects is incompletely defined. Previously our group has reported that IR of tumors results in the generation of the lipid mediator Platelet-activating factor (PAF) which resulted in systemic immunosuppressive effects via activation of regulatory T cells. Since PAF acting on the PAF receptor (PAFR) has been demonstrated to generate high levels of subcellular microvesicle particles (100-1000nm; MVP), and MVP are known to be able to signal systemically, the current studies seek to define whether IR of keratinocyte cells generates MVP, and to define the role of the PAFR in this process. Thus, we examine MVP release in the human keratinocyte cell line HaCaT. Moreover, the PAFR-dependency of IR-generated MVP is assessed by use of PAFR-positive KBP and PAFR-negative KBM cells. HaCaT cells (human keratinocytes), KBM cells (PAFR-negative), and KBP cells (PAFR-positive) were grown in 10cm dishes and treated with IR at either no treatment 0 Gy (NT), 4 Gy and 10 Gy. IR was delivered utilizing a technology company's medical linear accelerator radiotherapy system set up with dosimetry verified by nanodot optical stimulated luminescence (Landauer, Glenwood, IL). Some cell lines were treated with PAFR agonist N-methyl carbamoyl PAF (CPAF) and a phorbol ester TPA, known inducers of MVP release. A set of cells were treated with only 90% DMSO/10% ethanol vehicle in HBSS with BSA. After treatments, cells were incubated for 4 hours prior to extraction of MVPs. MVPs were isolated through centrifuging at 2000G for 20, supernatant was collected, transferred into different tubes, and centrifuged at 20,000 G for 70 mins. MVP was detected using a NanoSight NS300 instrument. MVP concentrations were recorded, and the data was statistically analyzed using Student's t-test (JMP, Cary, NC). IR treatment of HaCaT cells at various fluences exhibited statistically significant increases in MVP generation when compared to NT. Of note, 4 Gy resulted in the most fluence for MVP release but was not significant. IR treatment of KB cells resulted in MVP release in both KBM and KBP cells at both 4 and 10Gy. Augmented levels of MVP release were noted in KBP over KBM cells with any IR dose suggesting that the presence of the PAFR is involved in MVP release. Testing of inhibitors of the MVP generating enzyme acid sphingomyelinase (aSMase) also revealed involvement of this lipid metabolizing enzyme. The present studies indicate that RT can generates MVP production in epithelial cells. The mechanism for IR-generated MVP appears to involve aSMase and the PAFR. Target cell MVP release may provide a mechanism for RT effects, including the release of cytokines that influence systemic and local inflammation. Elucidation of this novel pathway may provide insights into IR effects on skin along with new therapeutic strategies.

This study analyzed genetic risk assessments in patients undergoing bariatric surgery to serve as a predictive factor for weight loss parameters 1 year after the operation. Thirty (30) patients were assessed for Genetic Addiction Risk Severity (GARS), which analyzes neurogenetic polymorphisms involved in addiction and reward deficiency. Genetic and psychosocial data collected before the operation were correlated with weight loss data, including changes in weight, body mass index (BMI), and percent of expected weight loss (%EWL). Results examined correlations between individual gene risk alleles, 1-year body weight data, and psychosocial trait scores. Spearman's correlations revealed that the OPRM1 (rs1799971) gene polymorphism had significant negative correlation with 1-year weight (rs = -0.4477, p < 0.01) and BMI (rs = -0.4477, p < 0.05). In addition, the DRD2 risk allele (rs1800497) was correlated negatively with BMI at 1 year (rs = -0.4927, p < 0.05), indicating that one risk allele copy was associated with lower BMI. However, this allele was positively correlated with both ∆Weight (rs = 0.4077, p < 0.05) and %EWL (rs = 0.5521, p < 0.05) at 1 year post-surgery. Moreover, the overall GARS score was correlated with %EWL (rs = 0.4236, p < 0.05), ∆Weight (rs = 0.3971, p < 0.05) and ∆BMI (rs = 0.3778, p < 0.05). Lastly, Food Cravings Questionnaire (FCQ) scores were negatively correlated with %EWL (rs = -0.4320, p < 0.05) and ∆Weight at 1 year post-surgery (rs = -0.4294, p < 0.05). This suggests that individuals with a higher genetic addiction risk are more responsive to weight loss treatment, especially in the case of the DRD2 polymorphism. These results should translate clinically to improve positivity and attitude related to weight management by those individuals born with the risk alleles (rs1800497; rs1799971).

To measure the impact of an automated hand hygiene monitoring system (AHHMS) and an intervention program of complementary strategies on hand hygiene (HH) performance in both acute-care and long-term care (LTC) units. Prospective, nonrandomized, before-and-after intervention study. Single Veterans Affairs Medical Center (VAMC), with 2 acute-care units and 6 LTC units. An AHHMS that provides group HH performance rates was implemented on 8 units at a VAMC from March 2021 through April 2022. After a 4-week baseline period and 2.5-week washout period, the 52-week intervention period included multiple evidence-based components designed to improve HH compliance. Unit HH performance rates were expressed as the number of dispenses (events) divided by the number of patient room entries and exits (opportunities) × 100. Statistical analysis was performed with a Poisson general additive mixed model. During the 4-week baseline period, the median HH performance rate was 18.6 (95% CI, 16.5-21.0) for all 8 units. During the intervention period, the median HH rate increased to 21.6 (95% CI, 19.1-24.4; P < .0001), and during the last 4 weeks of the intervention period (exactly 1 year after baseline), the 8 units exhibited a median HH rate of 25.1 (95% CI, 22.2-28.4; P < .0001). The median HH rate increased from 17.5 to 20.0 (P < .0001) in LTC units and from 22.9 to 27.2 (P < .0001) in acute-care units. The intervention was associated with increased HH performance rates for all units. The performance of acute-care units was consistently higher than LTC units, which have more visitors and more mobile veterans.

Abdominal aortic aneurysm (AAA) repair is commonly treated via endovascular aneurysm repair (EVAR). A known complication of EVAR is an endoleak: types I to IV. Type III endoleaks have been shown to have a relative risk of 8.95 for late rupture requiring prompt treatment. These endoleaks have been found to be caused by over dilation of the main body causing graft fabric distortion, fractures of metallic struts, fabric wear from chronic micromotion, fabric tears, and suture breakage. We present a case of traumatic EVAR fracture with subsequent type IIIb endoleak after blunt abdominal trauma. This highlights the need for close evaluation of endografts after abdominal trauma. These traumatic events can lead to traumatic fracture of endografts creating endoleaks that if not treated promptly can lead to rupture.

Jensen, AE, Bernards, JR, Hamilton, JA, Markwald, RR, Kelly, KR, and Biggs, AT. Do not shoot me: potential consequences of force-on-force training modulate the human stress response. J Strength Cond Res 37(9): 1761-1769, 2023-Close-quarters combat (CQC) engagements trigger the "fight-or-flight" response, activating the sympathetic nervous system and hypothalamic-pituitary-adrenal axis in response to perceived threats. However, it has yet to be shown if a force-on-force (FoF) CQC training environment will lead to adaptations in the physiological stress response or performance. United States Marines and Army infantry personnel participated in a 15-day CQC training program. The CQC program focused heavily on FoF training with the use of nonlethal training ammunition (NLTA). Data collections occurred on training days 1 and 15, during a simulated FoF-hostage rescue (HR) scenario and photorealistic target drill. For the FoF-HR, subjects were instructed to clear the shoot house, rescue the hostage, and only shoot hostile threat(s) with NLTA. The photorealistic target drills were similar, but replaced the role players in the FoF-HR with paper targets. Salivary alpha-amylase (sAA) and salivary cortisol were obtained immediately before entering and exiting the shoot house. Time to completion significantly decreased, between days 1 and 15, for both the FoF-HR and the photorealistic drills by 67.7 and 54.4%, respectively ( p < 0.05). Analyses revealed that the change in sAA, nonsignificantly, doubled from day 1 to 15 during FoF-HR ( p > 0.05), whereas the change in sAA decreased during the photorealistic drills across days ( p < 0.05). Cortisol was significantly higher during the FoF-HR in comparison to the photorealistic drills ( p < 0.05). These data suggest that potential consequences of FoF training heighten the stress response in conjunction with enhanced performance.