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Virtual reality (VR) technology holds significant potential for chronic pain management in children and adolescents by providing an alternative and complementary approach to traditional methods of alleviating pain and improving quality of life. Parents play an important role in the successful adoption of VR technologies for children, influencing how children accept, use, and benefit from it. However, little is known about parents' views on integrating VR technology into pediatric and adolescent chronic pain management. This study aimed to better our understanding of parents' perspectives regarding the integration of VR technology into pediatric and adolescent chronic pain management-including barriers, facilitators, and recommendations for future VR technologies. Semistructured interviews were conducted with parents of children with chronic pain between March and November 2024. Key aspects of the discussion centered on the acceptability, barriers, and enablers of integrating VR technology into pediatric and adolescent chronic pain management. Interviews were audio-recorded, transcribed, and analyzed through inductive thematic analysis. We conducted 12 interviews. We identified four broad themes from the interview data: (1) views toward integrating VR technology into chronic pain management (perceived benefits, distraction, and redirection); (2) barriers to using VR technology for chronic pain management (accessibility, complexity, discomfort, and symptom exacerbation); (3) facilitators of integrating VR technology into chronic pain management (addressing financial barriers, integrating VR technology into clinical care, establishing evidence of effectiveness and showcasing positive patient experiences); and (4) recommendations for program content and features (relaxation and mindfulness, physical activity, customization, and social connection). Our findings underscore the perceived benefits of integrating VR technology into pediatric and adolescent chronic pain management to enhance physical, social, and mental health and well-being. However, there are several potential challenges that need to be addressed to improve the accessibility of VR technology for use in pediatric and adolescent chronic pain management. Our findings yielded several practical suggestions to guide the development of effective and equitable VR technology for chronic pain management in children and adolescents.

Background Existing studies analyzing the impact of state concussion laws have found an increase in concussion-related medical encounters post-law, in some instances, such increases were observed during the pre-law period due to a potential “spillover” effect. This study assessed the effects of Ohio’s concussion law, while accounting for such a “spillover” effect, on the trends in monthly rates of concussion-related medical encounters in Medicaid insured children using autoregressive integrated moving average (ARIMA) analysis. Methods We analyzed claim data obtained from the Partners For Kids database, a pediatric accountable care organization in Ohio. Concussion-related medical encounters for Medicaid-insured children (ages 0–18 years) treated between April 1, 2008 to December 31, 2016 were selected and analyzed. We assessed pre- and post-law trends in concussion-related medical encounters using an ARIMA intervention model. We also used traditional regression methods to validate the study results. Results A total of 16,943 concussion-related medical encounters sustained by 15,545 unique patients were included. Monthly rates of concussion-related medical encounters significantly increased from 4.64 per 10,000 member months during the pre-law period to 6.69 per 10,000 member months in the post-law period ( P  < 0.0001). Three upward breaks in the monthly rates of concussion-related medical encounters were observed between 2009 and 2016, with two breaks observed during the pre-law period. Specifically, the increased breakpoint observed in July 2011 ( P  = 0.0186) was significantly associated with an estimated 7.3% increase (95% CI: 1.1–13.7) in the rate of concussion-related medical encounters. This finding was confirmed in the Poisson regression and curve fitting models. Furthermore, a seasonal trend in concussion-related medical encounters was observed with the highest rates in September and October of each year. Conclusions Two of the three upward breaks identified in the monthly rate of concussion-related medical encounters occurred before the enactment of Ohio’s concussion law, suggesting a potential “spillover” effect. Further research is needed to confirm such an effect in children with other types of medical insurance.

Background Literature indicates that poor psychological wellbeing can have a negative impact on outcomes following hip surgery. However, limited information is available on psychological interventions for adults with a planned hip surgery. This study describes and synthesizes existing interventions to improve psychological wellbeing in hip surgery patients. Methods We conducted a search of articles using seven electronic databases: CINAHL, Cochrane Library, Embase, PubMed, PsycINFO, SPORTDiscus, and Web of Science. We included all original studies ( n  = 12) investigating psychological interventions for adults with a planned hip surgery or recovering from hip surgery. Results Most articles focused on adults aged > 60 and individuals recovering from total hip arthroplasty ( n  = 7). The interventions varied in approach, dose, delivery methods, and timing. The most used approach was self-efficacy enhancing interventions ( n  = 5) followed by patient education ( n  = 2) and motivation-based interventions ( n  = 2). Most interventions ( n  = 9) were delivered post-operatively either in-person or through a combination of in-person and telephone delivery. Two-thirds of the articles ( n  = 8) evaluated the effectiveness of the intervention in a randomized controlled trial, with studies varying in sample size and outcome measures. In general, results indicated that psychological interventions positively influenced patient-reported outcomes, including functional status and health-related quality of life, following hip surgery. Conclusion Psychological interventions were generally found to be helpful in improving psychological wellbeing and patient-reported outcomes, such as functional status and health-related quality of life, following hip surgery. Several gaps in the literature were identified, highlighting the need for further research to strengthen the evidence base for psychological interventions in this population.

During the novel coronavirus (COVID-19) pandemic, physical activity (PA) behaviors were altered worldwide due to public health measures such as “lockdown.” This study described PA among adults residing in 11 countries during COVID-19 lockdown and examined factors associated with PA engagement. We conducted a cross-sectional anonymous survey among adults (≥18 years old) in 11 countries (Brazil, Bulgaria, China, India, Ireland, Malaysia, North Macedonia, Singapore, Spain, Turkey, United States). Of 11,775 participants, 63.7% were female and 52.8% were 18–34 years old. More than 40% of participants were insufficiently active (43.9%) and reported a decrease in their PA during lockdown (44.8%). Statistically significant differences were observed in (1) proportions of participants being insufficiently active, (2) level of PA, and (3) decrease in PA across the 11 countries. More stringent governmental policy responses were associated with greater likelihood of being insufficiently active during lockdown (adjusted odds ratio = 1.22, 95% confidence interval = 1.03, 1.45). Higher depression or anxiety scores were associated with greater likelihood of decreased level of PA during lockdown.We found substantial reductions in PA levels during COVID-19 lockdown across countries. Country-specific PA promotion interventions are needed during this and similar global emergencies.

Ionizing radiation, from both space and radiation therapy, is known to affect bone health. While there have been studies investigating changes in bone density and microstructure from radiation exposure, the effects of radiation on material properties are unknown. The current study addresses this gap by assessing bone material property changes in rats exposed to helium-4 radiation through spherical micro-indentation. Rats were exposed to a single dose of 0, 5, and 25 cGy whole body helium-4 radiation. Animals were euthanized at 7, 30, 90, or 180-days after exposure. Spherical micro-indentation was performed on axial cross sections of the femur cortical bone to determine instantaneous and relaxed shear moduli. At 90-days after exposure, the 25 cGy exposure caused a significant decline in shear modulus compared to control and 5 cGy groups. The instantaneous modulus decreased 33% and the relaxed modulus decreased 32% as compared to the sham group. This decline was followed by a recovery of both moduli, which was observed by 180-days after exposure; at 180 days, the moduli were no longer statistically different from those at 7 or 30 days. The observed decrease at 90 days, followed by recovery to baseline levels, can be attributed to the biological mechanisms involved in bone formation that were affected by radiation, bone turnover, and systemic changes in hormones due to radiation exposure. Continued assessment of the mechanisms that drive such a response in material properties may enable identification of pathways for therapeutic countermeasures against radiation exposure.

Radiation therapy and estrogen deficiency can damage healthy bone and lead to an increased fracture risk. The goal of this study is to develop a mouse model for radiation therapy using a fractionated biologically equivalent dose for cervical cancer treatment in both pre- and postmenopausal women. Thirty-two female C57BL/6 mice 13 weeks of age were divided into four groups: Sham + non-irradiated (SHAM + NR), Sham + irradiated (SHAM + IRR), ovariectomy + non-irradiated (OVX + NR) and ovariectomy + irradiated (OVX + IRR). The irradiated mice received a 6 Gy dose of X-rays to the hindlimbs at Day 2, Day 4 and Day 7 (18 Gy total). Tissues were collected at Day 35. DEXA, microCT analysis and FEA were used to quantify structural and functional changes at the proximal tibia, midshaft femur, proximal femur and L1 vertebra. There was a significant ( p  < 0.05) decline in proximal tibia trabecular BV/TV from (1) IRR compared to NR mice within Sham (− 46%) and OVX (− 41%); (2) OVX versus Sham within NR mice (− 36%) and IRR mice (− 30%). With homogenous material properties applied to the proximal tibia mesh using FEA, there was (1) an increase in whole bone (trabecular + cortical) structural stiffness from IRR compared to NR mice within Sham (+ 10%) and OVX (+ 15%); (2) a decrease in stiffness from OVX versus Sham within NR mice (− 18%) and IRR mice (− 14%). Fractionated irradiation and ovariectomy both had a negative effect on skeletal microarchitecture. Ovariectomy had a systemic effect, while skeletal radiation damage was largely specific to trabecular bone within the X-ray field.

Background Despite the increasing rate of hip arthroscopy for femoroacetabular impingement syndrome (FAIS), very little research has examined the lived experiences of individuals scheduled to undergo hip arthroscopy for FAIS. This study aimed to understand the experiences of individuals aged 18 and older with a planned hip arthroscopy for FAIS and to present the findings through their voices. Understanding the lived experiences of patients with FAIS may inform the development of preoperative preparation programs that meet the needs of this growing population. Methods We conducted 12 semi-structured telephone interviews with individuals aged 18 and older with FAIS (women = 9, men = 3, age = 39 ± 18.8 years). All participants were scheduled for a hip arthroscopy for FAIS within 30 days of the interview. Interviews were conducted between March 2023 and February 2024. Data were analyzed using the methods of open coding, axial coding, and selective coding. Results We identified eight themes during data analysis, which we divided into three categories: impact of hip condition (chronic pain, emotional and mental well-being, activities of daily living), views toward surgery and the rehabilitation process (optimism, pessimism), and perceived facilitators to recovery following hip arthroscopy (information gathering, preparation for surgery, social support). Conclusions Our results support the need for interventions that promote social, emotional, and mental well-being in individuals with a planned hip arthroscopy for FAIS. Preoperative preparation programs that seek to provide comprehensive emotional and cognitive preparation for hip arthroscopy for FAIS and recovery from surgery may be warranted.

In most aquatic ecosystems, copepod nauplii outnumber all other mesozooplankton. Although thousands of studies have examined feeding by later life history stages, the feeding habits of nauplii are poorly known. We offered conspecific adult and naupliar stages of the current-feeding calanoid copepod Pseudodiaptomus marinus and the ambush-feeding cyclopoid copepod Oithona davisae 14 species of phytoplankton from various functional and taxonomic groups that spanned a wide size range. Using a novel epifluorescence microscopy method, we calculated an index of gut pigment for copepods fed each phytoplankton species. We also measured adult and naupliar feeding rates on three species of phytoplankton: the cryptomonad Rhodomonas salina, the prasinophyte Tetraselmis suecica, and the diatom Thalassiosira pseudonana, by an improved gut fluorescence method using a microplate reader. Despite their smaller size, weaker swimming and sensory capabilities, and rudimentary feeding apparatus, nauplii fed on a large range of cell sizes and were capable of consuming many of the same phytoplankton as adults.

Understanding the experiences of parents of adolescents with chronic pain is crucial in creating a better experience for all involved throughout the adolescent's chronic pain journey. However, limited qualitative research has explored the experiences of parents of adolescents with chronic pain. This qualitative study explored the lived experiences of parents of adolescents with chronic pain, with a focus on the impact of chronic pain on their child and family life. Methods: We conducted 12 semi-structured interviews with parents of adolescents with chronic pain receiving care through a pain management program. Data were transcribed and analyzed using inductive thematic analysis. Seven key themes were generated and divided into two groups: (1) adolescent and (2) family (including both parents and siblings). Groups were determined based on whether the theme referred to the effect of chronic pain on the adolescent or the caregiver or family. The adolescent group included four themes: (1) physical, (2) psychological, (3) social interaction, and (4) school functioning. The family group included three themes: (1) disruption to daily life, (2) emotional, and (3) relationship dynamics. This study provides a deeper understanding of the negative effect chronic pain can have on adolescents and family life. Our findings call for interventions to mitigate the physical, psychological, and social impact of chronic pain on adolescents. Family level interventions are also needed to support families of adolescents with chronic pain. More research is needed to explore adolescents' own views of their experiences with chronic pain.

Understanding the conditions that drive variation in recruitment of key estuarine species can be important for effective conservation and management of their populations. The Olympia oyster (Ostrea lurida) is native to the Pacific coast of North America and has been a target of conservation efforts, though relatively little information on larval recruitment exists across much of its range. This study examined the recruitment of Olympia oysters at biweekly to monthly intervals at four sites in northern San Francisco Bay from 2010 to 2015 (except 2013). Mean monthly temperatures warmed at all sites during the study, while winter (January-April) mean monthly salinity decreased significantly during a wet year (2011), but otherwise remained high as a result of a drought. A recurring peak in oyster recruitment was identified in midestuary, in conditions corresponding to a salinity range of 2530 and >16 °C at the time of settlement (April-November). Higher average salinities and temperatures were positively correlated with greater peak recruitment. Interannual variation in the timing of favorable conditions for recruitment at each site appears to explain geographic and temporal variation in recruitment onset. Higher winter/spring salinities and warmer temperatures at the time of recruitment corresponded with earlier recruitment onset within individual sites. Across all sites, higher winter/spring salinities were also correlated with earlier onset and earlier peak recruitment. Lower winter salinities during 2011 also resulted in a downstream shift in the location of peak recruitment.