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Children with autism spectrum have immediate and long-term benefits from therapeutic horseback riding, researchers show

In the first large, randomized study of its kind, researchers at the University of Colorado Anschutz Medical Campus have shown a lasting reduction in irritability and other positive social and communication impacts on children with autism spectrum through therapeutic horse riding.

“There is growing evidence that human-animal interventions can improve emotional health and social wellness in youth, particularly those with autism spectrum disorder,” said the study’s principal investigator and lead author Robin Gabriels, PsyD, professor of psychiatry at the University of Colorado School of Medicine. “Our study was rigorous and the findings remarkable.”

The initial report of the researchers’ randomized study of therapeutic horseback riding (THR) with 127 children ages 6 to 16 years was published in the Journal of the American Academy of Child & Adolescent Psychiatry in 2015. It was the first to show that participating in 10-weeks of THR resulted in significant improvements in irritability, hyperactivity, social skills and word fluency compared to a barn activity control group that met at the riding center to learn about horses, but had no direct interaction with horses.

The researchers then did a 6-month follow-up of 44% of the participants from that initial study, published in a recent special issue of Frontiers in Veterinary Science. The study was the first to demonstrate that the initial benefits of 10-weeks of THR in this same population can have lasting benefits.

Reductions in irritability

Specifically, this follow-up study revealed that the THR group maintained their reductions in irritability, but not hyperactivity compared to the children who just learned about horses at the riding center. At the same time, when examining just the THR group, the results indicated that children sustained their initial significant improvements in social communication and word fluency.

The research provides evidence to show that THR may be an intervention that leads to the longer-term maintenance of initial benefits gained from equine therapy.

Yet the physiological mechanisms behind this remain to be discovered.

Some theorize that children diagnosed with autism spectrum might gravitate toward horseback riding because they are more comfortable with familiar routines.

“Horses are known to prefer the same routine, the same stall, the same path or route, and the same habits, similar to children with autism,” wrote L. Eugene Arnold, MD, MEd, of The Ohio State University in an editorial in the Journal of the American Academy of Child & Adolescent Psychiatry about Gabriels’ 2015 study. “More importantly, horses are content to be guided by nonverbal communication but are amenable to verbal instruction, allowing children to experience and practice the power of communication by controlling a much stronger force than themselves in ways within their repertoire.”

Calming gait

He also noted that a horse’s rhythmic stride can have a calming effect on the brain.

The study reflects that human interaction with animals can be beneficial on a number of levels.

“Most pet owners are only too aware of the ‘feel-good factor’ associated with pets in their lives. The important thing is that there is also a growing body of measurable scientific evidence showing the emotional, social and psychological benefits of interacting with animals,” said Dr. Darren Logan, Head of Research at the WALTHAM Centre for Pet Nutrition, a division of Mars Petcare that has partnered with the National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) for the past 10 years to study human-animal interaction. “This impressive study, part of our partnership with NICHD, adds to this evidence and provides a positive indicator of how animal-assisted therapy can play a role in improving the developmental outcomes of children and youth in the future.”

Dr. Gabriels, a licensed clinical psychologist who practices at Children’s Hospital Colorado, said that based on these findings, THR might be a safe and effective adjunct intervention for treating children with autism, and one that might help reduce the need for higher medication doses to address symptoms of irritability within this population.

“This is just the beginning,” she said. “We hope to conduct additional studies aimed at getting a better understanding of how exactly this form of therapy seems to benefit those with autism.”

The study can be found here: https://www.frontiersin.org/articles/10.3389/fvets.2018.00156/full

The study’s co-authors include: Zhaoxing Pan; Noemie A. Guerin; Briar Dechant and Gary Mesibov.

 

 

 

 

 

 

 

 

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Why we do what we do: State of the Campus 2018

Behind every diagnosis at the University of Colorado Anschutz Medical Campus is a patient, their loved ones and an extraordinary medical team that strives to restore their good health.

 

Discover the journey of Karen Possehl and Richard Schulick, MD, at Chancellor Don Elliman’s State of the Campus Address on Tuesday, Oct. 30, at 4 p.m. MDT. The chancellor will discuss our remarkable progress to date, and the vision, talent and innovation that powers our future. 
Onward!

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Researchers provide resource for patient care in chemical and biological attacks

The neurologic effects and treatment options for exposure to biologic and chemical agents are outlined in a newly published article by neurologists from the University of Colorado School of Medicine who collaborated on the article with military physicians.

“We wrote this article to help neurohospitalists and other health care providers identify unusual neurologic illnesses that could result from potential biological or chemical attacks,” said senior author Daniel M. Pastula, MD, MHS. “While we hope such attacks never happen, our goal is to provide a resource for health care providers so that we can all be prepared in an emergency.”

Pastula is an assistant professor in the CU School of Medicine’s Department of Neurology and in the Department of Medicine’s Division of Infectious Diseases, and an assistant professor of epidemiology at the Colorado School of Public Health.

The article, “Neuroterrorism Preparedness for the Neurohospitalist,” published Oct. 21 in the journal The Neurohospitalist, provides an overview of biological and chemical agents that might be used in potential terror attacks. Such agents can affect the nervous system and lead to paralysis, respiratory failure, and/or encephalopathy.

Daniel Pastula, MD, MHS
Daniel Pastula, MD, MHS

In the article, the authors describe how to recognize, diagnose, treat, and report exposures to anthrax, botulism, brucella, plague, smallpox, organophosphates, nerve agents, cyanide, or carfentanil.

“Our goal is to better prepare health care providers to clinically recognize and help manage potential effects of such agents. Additionally, we stress the importance of collaborating with state and local health departments when use of such agents is suspected.” Pastula said.

In addition to Pastula, CU faculty who contributed to the article are Daniel Vela-Duarte, MD, assistant professor of neurology, and Karen D. Orjuela, MD, assistant professor of neurology. Collaborating co-authors were Maj. Samuel A. Ralston, DO, and Maj. Brian P. Murray, DO.

Guest contributor: CU School of Medicine

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Evalina Burger named chair of Orthopedics

Evalina Burger, MB ChB, MMed, an expert spine surgeon and accomplished administrative leader, has been named chair of the Department of Orthopedics at the University of Colorado School of Medicine, effective Nov. 1, 2018.

Evalina Burger, Orthopedics chair
Evalina Burger, MB ChB, MMed, chair of the Department of Orthopedics

Burger, who joined the CU School of Medicine faculty in 2006, is a successful and highly productive surgeon who has been recognized frequently by her peers as one of the best physicians in the country. In addition to her clinical work, Burger has been an active investigator and educator working to find new metal-alloy compositions to improve orthopedic implants.

She has written more than 60 peer-reviewed publications and several book chapters. She also serves on editorial boards of scholarly journals and has co-edited two textbooks on spine surgery. She has actively participated in FDA clinical trials for spine implants and has received several grants to support her work.

‘Global destination’

“Through innovation, infrastructure and inclusion, I see the Department of Orthopedics becoming a leader and an integral part of healthcare delivery on a national level,” Burger said. “With a diverse faculty, I hope to grow the department into a global destination for healthcare excellence.”

Burger was selected after a national search to succeed Robert D’Ambrosia, MD, who joined the CU School of Medicine in 2002 and who has been a catalyst for growth and an inspirational champion of the university’s diversity efforts. When D’Ambrosia joined CU, there were six faculty members in the department and there are now more than 110.

Burger has also been a key administrative leader in the Department of Orthopedics, serving as vice chair of clinical affairs since 2008. In her leadership role, she led efforts in clinical service development and reorganization and strategic business planning. She has also helped improve workflows to enhance quality patient care in a teaching environment.

‘Talented surgeon’

“Dr. Burger is a talented surgeon and a dedicated colleague,” said John J. Reilly, Jr., MD, dean of the CU School of Medicine. “She articulated an ambitious vision for the department, building upon the foundation established by Dr. D’Ambrosia, and clearly recognizes the importance of all of our missions. She successfully treats patients from all walks of life while efficiently managing the need for high-quality and efficient care in an academic setting. We are fortunate to have her on our faculty and I look forward to working with her in her new role as the chair of a growing department.”

Burger graduated with a medical degree, MB ChB, from the University of the Orange Free State in South Africa in 1984. She also earned a graduate degree, an MMed, from the University of Pretoria in 1993. In 2000, she became the first female orthopedic surgeon from South Africa and only the third woman ever to receive the American-British-Canadian Traveling Fellowship, which is awarded to highly accomplished young surgeons from English-speaking countries.

Prior to joining CU, Burger was an associate professor at Louisiana State University Health Sciences Center in New Orleans from 2001 to 2006. While there, she helped establish the first fully functional orthopedic clinic after Hurricane Katrina.

Guest contributor: CU School of Medicine

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Researchers find gene that makes some susceptible to middle ear infections

Researchers at the University of Colorado Anschutz Medical Campus have found multiple genetic variants within the FUT2 gene that makes some people especially susceptible to middle ear infections.

“Middle ear infections are very common in kids,” said the study’s lead author, Regie Santos-Cortez, MD, PhD, associate professor of Otolaryngology at the University of Colorado School of Medicine. “By the time they are 1-year-old around half have fever, ear pain or pus/fluid in the middle ear due to infection. Some of these infections may recur or become chronic thus requiring surgery.”

The FUT2 gene is expressed in the salivary gland, colon and lungs but its expression in the middle ear has not been described previously.

Santos-Cortez and her colleagues discovered the role the gene played in middle ear infections or otitis media by initially examining DNA samples from 609 multi-ethnic families with the condition.

The study was published online today in the American Journal of Human Genetics.

The researchers found common variants of the gene in Filipinos and South Asians and a rarer variant associated with recurrent middle ear infections in European-American children. The most common variant occurs in 30-50% of individuals in almost all population groups except East Asians.

Regie Santos-Cortez, MD, PhD, associate professor of Otolaryngology at the University of Colorado School of Medicine
Regie Santos-Cortez, MD, PhD, associate professor of Otolaryngology at the University of Colorado School of Medicine

“A number of things predispose people to getting these infections including a lack of vaccinations, lack of breastfeeding and being around smoking caregivers,” said Santos-Cortez, who is also with the Center for Children’s Surgery at Children’s Hospital Colorado.  “But even in the best case scenario, recurrent or chronic middle ear infections still happen in some kids, which may be due to genetic predisposition.”

Those who possessed the genetic variants had a much higher chance of getting the infection. The researchers believe the gene modifies the microbiome of the middle ear in a way that makes it more susceptible to infection by specific bacteria.

“If you have these mutations, you will have a slightly different microbiota which could elevate the risk of disease,” Santos-Cortez said.

The finding could eventually lead to new ways of determining who is likely to get the infection.

The study confirmed expression of FUT2 in the middle ear which is spiked within 24 hours of bacterial infection. But the FUT2 genetic variants decrease presentation of A antigen used by bacteria to gain access to the middle ear lining.

That causes a decrease in some bacteria while boosting the numbers of bacteria known to play a role in chronic or recurrent disease.

“The frequency of population-specific FUT2 variants makes this gene a potential target for preventative screening and future treatments for otitis media, including modulation of the middle ear microbiome,” the study said.

The study was performed in collaboration with 60 co-authors including 21 faculty and staff from the Departments of Otolaryngology and Medicine on the Anschutz Medical Campus, including Daniel Frank, Melissa Scholes, Norman Friedman, Todd Wine, Samuel Gubbels, Stephen Cass, Jeremy Prager, Patricia Yoon, Sven-Olrik Streubel, Herman Jenkins and Kenny Chan. Lead collaborators from other universities within the US, Europe and Asia are: Charlotte Chiong (U Philippines Manila); Allen Ryan (UCSD); Nanette Lee (U San Carlos); Michael Bamshad and Debbie Nickerson (U Washington); Karen Mohlke (U North Carolina); Suzanne Leal (Baylor College of Med); Lena Hafrén (U Helsinki); Tasnee Chonmaitree (UTMB); Michele Sale (U Virginia); and Zubair Ahmed (U Maryland).

 

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Down syndrome event raises $2.4 million toward research at CU Anschutz

Down syndrome researchers at the University of Colorado Anschutz Medical Campus joined with Hollywood celebrities, Denver Broncos and foundation advocates to raise $2.4 million for the Global Down Syndrome Foundation on Saturday.

The Be Beautiful Be Yourself Fashion Show (BBBY) took place in the Sheraton Denver Downtown Hotel. The event celebrated its 10th anniversary raising money to support the Linda Crnic Institute for Down Syndrome on the Anschutz Medical Campus and the Sie Center for Down Syndrome at Children’s Hospital Colorado.

‘Epicenter of research’

CU School of Medicine researchers taking part in the festivities included Joaquin Espinosa, PhD, professor of pharmacology, executive director of the Linda Crnic Institute for Down Syndrome; Huntington Potter, PhD, professor of neurology, director of the Crnic Institute’s Alzheimer’s Disease Program; and Francis Hickey, MD, FAAP, associate professor of pediatrics-Linda Crnic Institute for Down Syndrome.

Joaquin Espinosa, PhD
Joaquin Espinosa, PhD

Espinosa calls the BBBY Fashion Show, which included actors Heather Graham, Jamie Foxx, Jeremy Renner, Colin Farrell and Dakota Johnson, an inspiring event. “Every year we look forward to this event, not only because it is the major fundraiser for research on Down syndrome, but also because it energizes us scientists to work harder in search of tangible outcomes that will improve the lives of people with Down syndrome.” He said the Crnic Institute has become the “epicenter of Down syndrome research in the world,” with more than 42 teams and more than 200 scientists involved in research over the last five years.

Crowning achievement

“Perhaps the crowning achievement of these efforts is the Human Trisome Project, arguably the most comprehensive cohort study of people with Down syndrome to date, being run by a multidisciplinary team of clinicians and scientists at the Anschutz Medical Campus,” Espinosa added.

Potter said the 10th anniversary edition of the BBBY Fashion Show was the best ever. “It was heartwarming to see all the dedicated families working to support research on Down syndrome and all of its related disabilities, including Alzheimer’s disease,” said Potter, also director of the Rocky Mountain Alzheimer’s Disease Center at CU Anschutz.

Down syndrome and Alzheimer’s disease

Huntington Potter, PhD
Huntington Potter, PhD

Explaining the scientific relationship between Down syndrome and other medical conditions, Potter said, “people with Down syndrome offer us a wonderful opportunity to study some of these questions. For example, they almost never develop solid cancerous tumors, but they are very prone to developing Alzheimer’s disease, and we want to know why this is.”

He said scientists working on these and other questions will see their research move forward faster thanks to the fundraising of the Global Down Syndrome Foundation, which is led by president and CEO Michelle Sie Whitten.

Denver Broncos players at the BBBY event included Phillip Lindsay, Case Keenum, Von Miller, and Justin Simmons. One of the night’s highlights occurred when Foxx auctioned off Miller’s suit jacket to Keenum for $65,000.

Here is a sampling of coverage in the media:

https://denver.cbslocal.com/2018/10/21/global-down-syndrome-foundation-denver/

https://kdvr.com/2018/10/22/be-beautiful-be-yourself-recap/

https://people.com/movies/jamie-foxx-sister-deondra-down-syndrome-foundation-event/

Editor’s note: Helen Gray, communications coordinator for the Rocky Mountain Alzheimer’s Disease Center, contributed to this report.

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Study: Home care for knee replacement patients aids in recovery

A team of physical therapy researchers from the University of Colorado School of Medicine have conducted one of the first full-scale studies to assess the effectiveness of in-home physical therapy care for patients who have had knee replacement surgery.

The study analyzes Medicare home health care claims for patients treated with total knee arthroplasty in 2012 who received home health care services for their post-operation rehabilitation.

Generally, patients who received more physical therapy visits at home were able to recover better from the surgery. The optimal number of home-care visits by physical therapists was six to nine. Researchers also found that patients living in a rural area or having other complex medical conditions were associated with fewer, not more, home health care visits.

Jason Falvey, PhD
Jason Falvey, PhD, research physical therapist, CU School of Medicine’s Physical Therapy Program

“This study is important because some people have recommended saving money by curtailing the use of physical therapists for in-home care for patients who receive total knee arthroplasty,” said lead author Jason R. Falvey, PhD, research physical therapist with the CU School of Medicine’s Physical Therapy Program. “But those recommendations are based on a lack of research. Our study shows that patients recover better when they receive appropriate care.”

Based on a review of 5,967 Medicare beneficiaries, those who received fewer than five home health care visits by a physical therapist were associated with greater difficulty returning to activities of daily living. The survey of cases covered urban and rural locations across the United States. About 68 percent of the patients were women. Eighty-nine percent were Caucasian.

“This is one of the most commonly performed surgeries in the United States,” Falvey said, noting that more than 700,000 total knee replacements are performed each year. The number of cases is expected to increase to 3.5 million annually by 2030.

The cost of the procedure averages $23,000 to $27,000, according to the Centers for Medicare & Medicaid Services (CMS), with post-acute care responsible for a substantial portion of that cost. CMS has introduced a bundle payment model that combines the costs of hospital, post-acute-care and outpatient costs associated with total joint replacement. The bundles have the effect of incentivizing the discharge of patients from hospital to home.

“Our study may help care providers prescribe more optimal dosages of at-home physical therapy for these patients who are discharged,” said Falvey. “Low users of at-home physical therapy often had less social support and more complex medical conditions. Patients who don’t get the home health care visits they need can end up needing future hospitalization or institutionalization. The risks of not providing the appropriate level home health care may result in higher overall healthcare costs in the long term.”

The results of the study are published in the current issue of the Journal of Bone and Joint Surgery. Funding to support the study came from a scholarship from the Foundation for Physical Therapy and from grants from the National Institute on Aging, the American Physical Therapy Association Home Health Section, the Foundation for Physical Therapy, and the Center on Health Services Training and Research. Statistical resources were provided by the VA informatics and Computing Infrastructure.

Falvey’s academic appointment is in the School of Medicine’s Department of Physical Medicine and Rehabilitation. There are seven authors on the paper, including senior author Jennifer E. Stevens-Lapsley, PhD, professor in the CU Physical Therapy Program, director of the Rehabilitation Science PhD Program, and member of the Veterans Affairs Geriatric Research Education and Clinical Center.

Guest contributor: CU School of Medicine

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Researchers find common genetic link in lung ailments

An international research team led by members of the University of Colorado School of Medicine faculty has identified a genetic connection between rheumatoid arthritis-associated interstitial lung disease and idiopathic pulmonary fibrosis.

The findings are published in the current issue of the New England Journal of Medicine.

Joyce Lee, MD, associate professor in the Department of Medicine
Joyce Lee, MD, associate professor, Department of Medicine

“By uncovering this link in the genetic background between these conditions, we now know that rheumatoid arthritis associated-interstitial lung disease and idiopathic pulmonary fibrosis have similar causes and may prove to have similar treatments,” said first author Joyce Lee, MD, Associate Professor in the Department of Medicine.

Rheumatoid arthritis (RA) is an inflammatory and autoimmune disease that affects about 1 percent of the population. While it is commonly associated with progressive impairment, systemic complications and increased mortality, up to 60 percent of the patients with rheumatoid arthritis suffer from pulmonary conditions known as interstitial lung disease, which causes progressive scarring of lung tissue, lung impairment, and death.  Interstitial lung disease is a leading cause of morbidity and mortality in patients with RA.

Idiopathic pulmonary fibrosis (IPF) is the most common type of progressive lung fibrosis. Over time, the scarring gets worse and it becomes hard to take in a deep breath and the lungs cannot take in enough oxygen.  The average length of survival of patients with IPF is three to five years, and a critical unmet need is to identify patients before the lung is scarred irreversibly.

The investigators on the current study in the New England Journal hypothesized that there might be a common element in the genetics of RA-interstitial lung disease and IPF, so they studied a diverse population of patients with RA, including those who had and those who did not have interstitial lung disease. The study collected cases of patients from France, China, Greece, Japan, Mexico, the Netherlands and the United States. The number of study subjects totaled more than 6,000.

The investigators found that a specific genetic characteristic, known as the MUC5B promoter variant rs35705950, which results in a marked increase production of mucus in the lung and is the strongest genetic risk factor for idiopathic pulmonary fibrosis, is also the strongest risk factor for RA-interstitial lung disease.

“These findings will enable us to identify those with rheumatoid arthritis who are at risk of pulmonary fibrosis and design interventions to potentially prevent patients with rheumatoid arthritis from developing progressive pulmonary fibrosis,” said senior and corresponding author David Schwartz, MD, Chair of the Department of Medicine at the CU School of Medicine.

The research in the study was supported by grants from Société Française de Rhumatologie; the Fondation Arthritis Recherche & Rhumatismes; DHU FIRE; the National Heart, Lung and Blood Institute; the National Institute of Arthritis and Musculoskeletal and Skin Diseases (K23-AR051046); U.S. Department of Defense; the National Center for Advancing Translational Science; the Nina Ireland Program for Lung Health; Intramural Research Programs of the National Institute on Aging (NIA), part of the National Institutes of Health, Department of Health and Human Services.

Guest contributor: CU School of Medicine

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Celebrating public health scholars

Scholarship recipients recognized at the Hoffmans’ home

On October 11, the annual Hoffman Scholarship Reception was held at the home of benefactors Richard Hoffman, MD, MPH, and Molly Hoffman, bringing them together with public health students and faculty.

Richard and Molly Hoffman are avid supporters of the success of future public health leaders. Dr. Hoffman, in particular, is a longtime benefactor and early advocate of the Colorado School of Public Health (ColoradoSPH), and holds a position there as an adjunct associate professor of epidemiology.

A decade ago, Dr. Hoffman helped set the stage for ColoradoSPH by providing initial philanthropic funding for the school. More recently, he responded to a need for student support by establishing a scholarship with three areas of interest, one of which is the Hamman-Hoffman Award in Epidemiology, named in honor of founding dean Richard Hamman, MD, DrPH. The scholarship fund also supports masters and doctoral students showing high potential to excel in public health careers, including communicable disease control.

The scholarship reception is an opportunity for top public health students to express gratitude and share their backgrounds with the Hoffmans.

Jonny Williams is one of the recipients of the Hoffmans’ generosity. Williams knew he wanted to pursue public health after witnessing the devastating health effects of the Flint, Michigan, water crisis. With his education, he plans to create public health programs that will empower sustainability in underserved communities like Flint.

Williams, who will graduate in May 2019 with a master’s degree in health systems, management and policy, is grateful for his scholarship. “As an out-of-state student, the extra support allowed me to focus on studying and improving the field of public health,” he said. “I’m incredibly grateful for what my scholarship has allowed me to achieve.”

Also in attendance was the current dean of ColoradoSPH, Jonathan Samet, MD, MS, who took the helm of the school last year. Dean Samet said, “We are grateful for our partnership with the Hoffmans. They have not only provided valuable resources to some of our brightest and most talented students, but helped ensure the long-term success of our school.”

Dr. Hamman also expressed gratitude for the Hoffmans’ generosity. “By investing in public health leaders, the Hoffmans are investing in the next generation of new ideas that will address public health disparities of the future. I am thankful for their philanthropic leadership and vision.”

It is private support from benefactors like the Hoffmans that is essential to student success at ColoradoSPH. Scholarships attract highly qualified applicants, and ensure that students have the resources they need to make the most of their education and graduate ready to join the workforce as highly capable leaders.

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Our experts weigh in on acute flaccid myelitis cases

Several University of Colorado School of Medicine experts on acute flaccid myelitis (AFM) have been interviewed in recent news reports about an increase in AFM cases nationwide, including in Colorado.

AFM is a devastating polio-like virus that strikes children, causing weakness in the limbs and other muscle groups. In the most severe cases it can cause respiratory failure.

This week, outlets including CNN, U.S. News & World Report, Science and Wyoming Public Media quoted Samuel Dominguez, MD, PhD, associate professor, pediatrics-infectious diseases; Kenneth Tyler, MD, Louise Baum Endowed Professor and Chair of the Department of Neurology; and Kevin Messacar, MD, assistant professor, pediatrics-pediatric hospital medicine.

According to the U.S. Centers for Disease Control and Prevention, there have been 38 confirmed cases of AFM in 16 states as of Sept. 30. The numbers of cases appear to be climbing, with several additional cases being reported in Colorado, Illinois, Washington and Minnesota.

Here are a few of the recent stories:

Wyoming Public Media, Oct. 17

Colorado is home to mysterious neurological disease, and researchers tracking it

U.S. News & World Report, Oct. 16

CDC warns of polio-like virus striking more U.S. kids

Science, Oct. 16

United States reports new cases of puzzling, polio-like disease that strikes children

CNN, Oct. 13

Young survivor of rare polio-like illness now thriving

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