Objective: To investigate the prevalence of rotator cuff and long head of the biceps pathologies in manual wheelchair (MWC) users with spinal cord injury (SCI). Design: Cross-sectional study. Setting: Outpatient clinic at a tertiary medical center. Participants: Forty-four adult MWC users with SCI (36 men and 8 women) with an average age (SD) of 42 (13) years. SCI levels ranged from C6 to L1; complete and incomplete SCI. Outcome Measures: Participants’ demographic and anthropometric information, presence of shoulder pain, Wheelchair User’s Pain Index (WUSPI) scores, and magnetic resonance imaging findings of shoulder pathologies including tendinopathy, tendon tears, and muscle atrophy. Results: Fifty-nine percent of the participants reported some shoulder pain. The prevalence of any tendinopathy across the rotator cuff and the long head of biceps tendon was 98%. The prevalence of tendinopathy in the supraspinatus was 86%, infraspinatus was 91%, subscapularis was 75%, and biceps was 57%. The majority of tendinopathies had mild or moderate severity. The prevalence of any tears was 68%. The prevalence of tendon tears in the supraspinatus was 48%, infraspinatus was 36%, subscapularis was 43%, and biceps was 12%. The majority of the tears were partial-thickness tears. Participants without tendon tears were significantly younger (P < 0.001) and had been wheelchair user for a significantly shorter time (P = 0.005) than those with tendon tears. Conclusion: Mild and moderate shoulder tendinopathy and partial-thickness tendon tears were highly prevalent in MWC users with SCI. Additionally, the findings of this study suggest that strategies for monitoring shoulder pathologies in this population should not be overly reliant on patient-reported pain, but perhaps more concerned with years of wheelchair use and age.

Background Limited recent data exist on prescribing patterns and patient characteristics for glucagon-like peptide 1 receptor agonists (GLP-1 RAs), an important drug class used as anti-diabetic medication (ADM) for patients with type 2 diabetes mellitus (T2D) and/or anti-obesity medication (AOM) in patients with overweight or obesity. For brevity, we use the term GLP-1 RA to refer to both GLP-1 RA and dual GLP-1 RA/GIP medications. Objective To describe recent trends in prescribing and dispensing of GLP-1-based medications in the US Methods Using a subset of real-world electronic health record (EHR) data from Truveta, a growing collective of health systems that provide more than 18% of all daily clinical care in the US, we identified people who were prescribed a GLP-1-based medication between January 01, 2018 and December 31, 2023. We describe prescribing volumes and patient characteristics over time, by medication, and by FDA- labeled use. Among the subset of patients for whom post-prescription dispensing data is available, we describe the proportion and characteristics of patients who were and were not dispensed a GLP-1 RA following their prescription. Results 1,063,200 patients were prescribed a GLP-1 RA between January 2018 and December 2023, with 4,213,888 total prescriptions during this period. Among first-time prescriptions for which use could be established, ADMs accounted for 86.6% and AOMs accounted for 13.4%. The most common first-time medication was semaglutide (n = 559,880). Among those with available data, 71.5% of first-time ADM prescriptions overall and 74.9% in September 2023 had a fill within 60 days. By comparison, 45.6% of first-time AOM prescriptions overall and 32.1% in September 2023 had a fill within 60 days.

Pressure injuries for individuals with spinal cord injuries (SCI) are correlated with mortality and are a leading cause for rehospitalizations. The Assisted Weight Shift (AW-Shift©) is a mobile pressure mapping application designed to provide users with a live map view and reminders to perform weight shifts. Novel visualization techniques were used to understand daily distributions of user interaction wit h AW-Shift©. The date and time of system interactions were recorded for six participants with SCI over 7 days (five males/one female, five manual users/one power user, 55.3 ± 17.3 years old, 10.6 ± 6.5 years since injury). Circular frequency plots were created to visualize the time and frequency participants brought the app to the foreground of their phone and received alerts and reminders to complete weight shifts. While some participants used the system regularly throughout the day, others primarily used it before 8am; highlighting the system’s importance for regular spot checks and morning wheelchair setup. Participant adherence to weight shift reminders was low suggesting the live pressure map may be more useful. Circular frequency plots can be used by clinicians to more easily review large amounts of patient data. Future work will investigate raw pressure mat data and create a closed-loop weight shift detection algorithm.

Syphilis incidence has increased significantly in the US, raising concerns about onward transmission. Using near-real-time data, this study examined monthly trends in syphilis incidence among US adults from January 2017 to October 2024, focusing on overall patterns and stratifying by demographic and clinical characteristics. Using Truveta Data - a large, diverse database of electronic health records from US healthcare systems - monthly syphilis incidence from January 2017 to October 2024 was calculated. Poisson regression models were used to assess trends, with adjustments for the early COVID-19 pandemic period. The analysis included 56,980,788 adults and 21,180 first-time syphilis cases, with a cumulative incidence of 35.9 per 100,000 person-years. Overall, incidence increased from 1.26 per 100,000 person-years in January 2017 to 4.88 in July 2022, then plateaued and declined to 2.47 by October 2024. The decline was larger among populations with high syphilis burdens, including men, younger adults, individuals identifying as American Indian/Alaskan Native or Native Hawaiian/Pacific Islander, those with behaviors associated with STI acquisition, those using Pre-exposure prophylaxis (PrEP) for HIV prevention, and individuals living with HIV. Conversely, incidence rose among populations with lower burdens: those without behaviors associated with STI acquisition, PrEP use, or living with HIV - implying a shift in the transmission dynamics. The findings highlight recent declines in syphilis incidence, primarily among high-burden groups, while syphilis incidence is rising in low-burden populations. These findings underscore the need to address factors contributing to syphilis transmission in diverse populations, including those that may not perceive themselves as vulnerable.

Shoulder pain and pathology are extremely common for individuals with spinal cord injuries (SCI) who use manual wheelchairs (MWC). Although risky humeral kinematics have been measured during wheelchair-based activities performed in the lab, little is known about arm kinematics in the free-living environment. The purpose of this study was to measure the humeral elevation workspace throughout a typical day for individuals with SCI who use a MWC and matched able-bodied controls. Thirty-four individuals with SCI who use a MWC (42.7±12.7 years of age, 28 males/6 females, C6-L1) and 34 age-and sex-matched controls were enrolled. Participants wore three inertial measurement units (IMU) on their upper arms and torso for one to two days. Humeral elevation angles were estimated and the percentage of time individuals spent in five elevation bins (0–30°, 30–60°, 60–90°, 90–120°, and 120–180°) were calculated. For both arms, the SCI cohort spent a significantly lower percentage of the day in 0–30° of humeral elevation (Dominant: SCI = 15.7±12.6%, Control = 32.1±15.6%, p<0.0001; Non-Dominant: SCI = 21.9±17.8%, Control = 34.3±15.5%, p = 0.001) and a significantly higher percentage of time in elevations associated with tendon compression (30–60° of humeral elevation, Dominant: SCI = 62.8±14.4%, Control = 49.9.1±13.0%, p<0.0001; Non-Dominant: SCI = 58.8±14.9%, Control = 48.3±13.6%, p = 0.003) than controls. The increased percentage of time individuals with SCI spent in elevations associated with tendon compression may contribute to increased shoulder pathology. Characterizing the humeral elevation workspace utilized throughout a typical day may help in understanding the increased prevalence of shoulder pain and pathology in individuals with SCI who use MWCs.

Arm use in manual wheelchair (MWC) users is characterized by a combination of overuse and a sedentary lifestyle. This study aimed to describe the percentage of daily time MWC users and able-bodied individuals spend in each arm use intensity level utilizing accelerometers. Arm use intensity levels of the upper arms were defined as stationary, low, mid, and high from the signal magnitude area (SMA) of the segment accelerations based on in-lab MWC activities performed by eight MWC users. Accelerometry data were collected in the free-living environments from forty MWC users and 40 sex- and age-matched able-bodied individuals. The SMA intensity levels were applied to the free-living data and the percentage of time spent in each level was calculated. The SMA intensity levels were defined as, stationary: ≤0.67 g, low: 0.671–3.27 g, mid: 3.27–5.87 g, and high: >5.871 g. The dominant arm of both MWC users and able-bodied individuals was stationary for most of the day and less than one percent of the day was spent in high intensity arm activities. Increased MWC user age correlated with increased stationary arm time (R = 0.368, p = 0.019). Five and eight days of data are needed from MWC users and able-bodied individuals, respectively, to achieve reliable representation of their daily arm use intensities.