Zhang, Yue

Background: The Spinal Cord Injury Model Systems (SCIMS) began studying traumatic SCI (TSCI) in 1970. The National Institute of Disability, Independent Living and Rehabilitation Research (NIDILRR) provided pilot funding during the 2021-2026 SCIMS funding cycle to perform an initial study of individuals with nontraumatic spinal cord injury (NTSCI). Objectives: To describe the demographic and etiological profiles and inpatient rehabilitation outcomes of the SCIMS NTSCI pilot cohort. Methods: This was a descriptive study of adults with NTSCI admitted to SCIMS centers who consented to medical records abstraction and completed survey questionnaires near the completion of inpatient rehabilitation. Results: One hundred eighty-seven people with NTSCI consented to participate and provided data. The etiology of patients’ NTSCI was degenerative vertebral causes ( n = 67), tumor-malignant ( n = 29), tumor-benign/unknown ( n = 16), vascular ( n = 28), infection ( n = 26), and other NTSCI causes ( n = 21). The average age was 59.2 years. Over 40% of the population was age 60-74 years. The population was 35% female, 59.5% non-Hispanic White, 21.6% non-Hispanic Black, and 11.4% Hispanic. Age, sex, race, and ethnicity distributions did not differ significantly across etiology groups. Only symptom onset time ( P = .002) and marital status ( P = .005) were significantly different between groups. Vascular disorders onset was less than a day in 60% of cases. Greater than 60% of tumor-malignant, vascular, and other NTSCI individuals were married or living with a partner. Conclusion: The US SCIMS program can recruit a population of NTSCI research participants that is consistent with previously published results. Ongoing study of NTSCI through the US SCIMS could provide important data akin to that available regarding TSCI.

Abstract Background The advancement of knowledge about control of antibiotic resistance depends on the rigorous evaluation of alternative intervention strategies. The STAR*ICU trial examined the effects of active surveillance and expanded barrier precautions on acquisition of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) in intensive care units. We report a reanalyses of the STAR*ICU trial using a Bayesian transmission modeling framework. Methods The data included admission and discharge times and surveillance test times and results. Markov chain Monte Carlo stochastic integration was used to estimate the transmission rate, importation, false negativity, and clearance separately for MRSA and VRE. The primary outcome was the intervention effect, which when less than (or greater than) zero, indicated a decreased (or increased) transmission rate attributable to the intervention. Results The transmission rate increased in both arms from pre- to postintervention (by 20% and 26% for MRSA and VRE). The estimated intervention effect was 0.00 (95% confidence interval [CI], −0.57 to 0.56) for MRSA and 0.05 (95% CI, −0.39 to 0.48) for VRE. Compared with MRSA, VRE had a higher transmission rate (preintervention, 0.0069 vs 0.0039; postintervention, 0.0087 vs 0.0046), higher importation probability (0.22 vs 0.17), and a lower clearance rate per colonized patient-day (0.016 vs 0.035). Conclusions Transmission rates in the 2 treatment arms were statistically indistinguishable from the pre- to postintervention phase, consistent with the original analysis of the STAR*ICU trial. Our statistical framework was able to disentangle transmission from importation and account for imperfect testing. Epidemiological differences between VRE and MRSA were revealed.