Impact of Post-Acute Sequelae of COVID-19 on Lives of Patients Post ICU Discharge: A Cross-Sectional Study.

OBJECTIVES: Post-acute sequelae of SARS-CoV-2 (PASC) are known for their prolonged and persistent effects on patients. This study aimed to investigate the impact of the PASC on the quality of life (QOL) of patients, their levels of activity participation, and satisfaction with these levels, in addition to exploring whether the duration of post-intensive care unit (ICU) discharge is associated with the effects of PASC. SUBJECT AND METHODS: This cross-sectional study included 134 patients with COVID-19 discharged from an ICU in Kuwait. Data were collected using two validated questionnaires: the World Health Organization Quality of Life-Brief (WHOQOL-BREF) and Satisfaction with Daily Occupations. Additionally, demographic information was collected, and 11 categories of related symptoms were investigated. RESULTS: Most patients reported health issues post-ICU discharge. Furthermore, most PASC-related symptoms decreased over time, whereas a few increased. Notably, we observed a negative association between post-discharge duration and overall improvement in level of participation in activities of daily living. However, patients discharged from the ICU for more than 6 months demonstrated higher satisfaction with functional performance and improved QOL. Additionally, patients who received rehabilitation, and were vaccinated were less likely to have poor QOL. No significant sex differences were observed in the WHOQOL-BREF score. CONCLUSION: PASC adversely affected the daily functioning of patients, especially in leisure, social, and religious aspects. However, these effects lessened over time, with corresponding improvement in QOL. Additionally, patient satisfaction with functional performance increased over time. These findings shed light on the rehabilitation needs of patients with COVID-19.

Perceptions of diversity, equity, and inclusion within undergraduate curriculum and university: A qualitative study.

OBJECTIVE: Diversity, equity, and inclusion (DEI) efforts are important at university campuses, especially preparing students for the workforce. This study aimed to identify perceptions of DEI among seniors related to their major curriculum and at the university. PARTICIPANTS: In Spring 2021, 101 graduating seniors, who are future health professionals, completed an online survey. METHODS: Open-ended and multiple-choice survey items were analyzed. Thematic coding for open-ended questions and SPSS was used for the quantitative analysis. RESULTS: Analyses revealed the university kept students informed of DEI activities; however, more could be done. In the department, participants reported that classes focused on DEI activities; however, some faculty entered classrooms without evaluating their own implicit biases. Future suggestions include creating a DEI-focused course and increasing faculty and student representation from underrepresented backgrounds. CONCLUSIONS: Findings from this study can be used to inform DEI-related courses as well as faculty hiring and student recruitment guidelines.

Visualizing the chaperone-mediated folding trajectory of the G protein ß5 ß-propeller.

The Chaperonin Containing Tailless polypeptide 1 (CCT) complex is an essential protein folding machine with a diverse clientele of substrates, including many proteins with ß-propeller domains. Here, we determine the structures of human CCT in complex with its accessory co-chaperone, phosducin-like protein 1 (PhLP1), in the process of folding Gß5, a component of Regulator of G protein Signaling (RGS) complexes. Cryoelectron microscopy (cryo-EM) and image processing reveal an ensemble of distinct snapshots that represent the folding trajectory of Gß5 from an unfolded molten globule to a fully folded ß-propeller. These structures reveal the mechanism by which CCT directs Gß5 folding through initiating specific intermolecular contacts that facilitate the sequential folding of individual ß sheets until the propeller closes into its native structure. This work directly visualizes chaperone-mediated protein folding and establishes that CCT orchestrates folding by stabilizing intermediates through interactions with surface residues that permit the hydrophobic core to coalesce into its folded state.

Visualizing the chaperone-mediated folding trajectory of the G protein ß5 ß-propeller.

The cytosolic Chaperonin Containing Tailless polypeptide 1 (CCT) complex is an essential protein folding machine with a diverse clientele of substrates, including many proteins with ß-propeller domains. Here, we determined structures of CCT in complex with its accessory co-chaperone, phosducin-like protein 1 (PhLP1), in the process of folding Gß5, a component of Regulator of G protein Signaling (RGS) complexes. Cryo-EM and image processing revealed an ensemble of distinct snapshots that represent the folding trajectory of Gß5 from an unfolded molten globule to a fully folded ß-propeller. These structures reveal the mechanism by which CCT directs Gß5 folding through initiating specific intermolecular contacts that facilitate the sequential folding of individual ß-sheets until the propeller closes into its native structure. This work directly visualizes chaperone-mediated protein folding and establishes that CCT directs folding by stabilizing intermediates through interactions with surface residues that permit the hydrophobic core to coalesce into its folded state.

Validity and Reliability of the Turkish Version of the Revised Low Vision Independence Measure (LVIM-R).

IMPORTANCE: Few tools are available for assessing the activity performance of people with low vision. Additional practical instruments are required for occupational therapy evaluation. OBJECTIVE: To evaluate the validity and reliability of the Turkish version of the Revised Low Vision Independence Measure (LVIM-R). DESIGN: We analyzed Turkish LVIM-R items using confirmatory factor analysis with parceling. Test-retest reliability was measured using the intraclass correlation coefficient (ICC). The study was conducted between April 2020 and July 2021. SETTING: Ophthalmology clinic. PARTICIPANTS: The study included 89 people with low vision who applied to an ophthalmology training and research clinic. Participants were age ≥18 yr, had visual acuity of 0.5 to 1.3 logarithms of the minimum angle of resolution, and consented to participate. INTERVENTION: Not applicable. OUTCOMES AND MEASURES: Turkish version of the LVIM-R, a self-report measure of activity performance for people with low vision. RESULTS: In the principal-components analysis, the highest eigenvalue was Armor's θ = .966. ICCs were .995 for Visual Field or Scotoma, .997 for Visual Acuity, and .997 for Total score. Other results included χ2 = 9.566 (p = .297), comparative fit index = .998, Tucker-Lewis Index = .996, and root mean square error of approximation = .047. Goodness-of-fit indices support the structural validity of the two-factor model. CONCLUSION: The Turkish version of the LVIM-R is a valid and reliable assessment tool for occupational therapy practice in low vision rehabilitation. What This Article Adds: The Turkish LVIM-R is a valid and reliable assessment for use in low vision rehabilitation.

Mechanistic insights into protein folding by the eukaryotic chaperonin complex CCT.

The cytosolic chaperonin CCT is indispensable to eukaryotic life, folding the cytoskeletal proteins actin and tubulin along with an estimated 10% of the remaining proteome. However, it also participates in human diseases such as cancer and viral infections, rendering it valuable as a potential therapeutic target. CCT consists of two stacked rings, each comprised of eight homologous but distinct subunits, that assists the folding of a remarkable substrate clientele that exhibits both broad diversity and specificity. Much of the work in recent years has been aimed at understanding the mechanisms of CCT substrate recognition and folding. These studies have revealed new binding sites and mechanisms by which CCT uses its distinctive subunit arrangement to fold structurally unrelated substrates. Here, we review recent structural insights into CCT-substrate interactions and place them into the broader context of CCT function and its implications for human health.

Reasons Affecting the Choice of Patient-Identified Goals Set by Occupational Therapists in Low Vision Rehabilitation.

Background: Goal setting is done in collaboration with the patient, but patient identified (PID) goals are not always addressed. The purpose of this study was to determine reasons PID goals are not set in low vision rehabilitation and for which tasks. Methods: Occupational therapists completed an individualized survey to determine from 15 probable reasons why they did not set a PID for specific tasks. Results and Conclusion: PID goals were not set for 3 ADL, 13 IADL, 4 Social Participation, and 10 Leisure tasks. Further research is needed to understand how prioritization of PID goals differ between therapist and patient.

Comparison of a standard computer-assisted cognitive training program to a music enhanced program: A mixed methods study.

BACKGROUND: Between 17 and 75% of breast cancer survivors (BCS) experience long-term cognitive deficits such as deficits in memory, attention, processing speed, and executive function. AIMS: This study aimed to (a) compare effects of a standard computer-assisted cognitive training (CACT) program to a CACT program enhanced with music (CACT+A) to improve focus and concentration on BCS' memory, cognition, quality of life (QOL), and participation in everyday activities; and (b) garner participants' perspectives of effects of the programs to determine best practice. METHODS: An embedded design was employed in this mixed methods study. Participants who reported cognitive problems were recruited through breast cancer support groups. Four pre and post-tests were used followed by a qualitative interview. RESULTS: Twenty-five BCS, ages 31 to 72 years participated. The CACT group demonstrated significantly improved pre to post-test scores for working memory, QOL, and three subscales of the Model of Human Occupation Screening Tool (MOHOST) measuring participation in everyday activities. The CACT+A group had significant improvement for four FACT-Cog cognitive function subscales and the total score. Five themes emerged from the interview: Cognitive skill, Strategy learned, No change, QOL factors, and Participation in everyday activities. The CACT+A group expressed experiencing a larger ratio of improvements, most notably for memory and QOL factors. CONCLUSION: CACT+A is an auspicious intervention option for BCS who self-report cognitive issues. It is convenient to participate in at home and allows BCS to safely self-isolate if need be. This study is a registered clinical trial protocol: TexasWU record 19 959.

Responsiveness of the Revised Low Vision Independence Measure (LVIM-R).

IMPORTANCE: The Low Vision Independence Measure (LVIM) was designed to measure the effectiveness of occupational therapy to improve visual ability in low vision rehabilitation. OBJECTIVE: To validate the Revised LVIM (LVIM-R) as an outcome measure by determining its sensitivity to visual ability changes after occupational therapy. DESIGN: In this observational study, LVIM-R scores were collected before and after customary low vision intervention. SETTING: Home health agency or outpatient facility. PARTICIPANTS: Forty-four participants with a mean age of 80.2 yr (standard deviation = 11.2) and an average length of visual impairment of 6.2 yr. Twenty-three participants (52.3%) were treated in an outpatient setting, and 21 (47.7%) were treated in the home. The majority of participants were non-Hispanic White (92.8%) and had macular degeneration (54.5%). INTERVENTION: Customary low vision intervention by occupational therapists. OUTCOMES AND MEASURES: LVIM-R scores were collected before and after intervention, and participants' pre- and posttest scores were anchored into Rasch-calibrated item parameters. RESULTS: Paired t tests demonstrated significant increases in person measures with large effect sizes for both constructs of the LVIM-R, the visual field or scotoma (t[43] = 6.46, p < .0001; Cohen's d = 0.92) and visual acuity (t[43] = 9.08, p < .0001; Cohen's d = 1.14) constructs. CONCLUSIONS AND RELEVANCE: The LVIM-R is sensitive to changes in visual ability in clients who have good rehabilitation potential and can be used to examine the effectiveness of occupational therapy for low vision. WHAT THIS ARTICLE ADDS: The LVIM-R is useful for measuring occupational therapy outcomes in low vision rehabilitation in the home or in outpatient settings.

Measurement Validity of the Low Vision Independence Measure (LVIM).

OBJECTIVE: This study's objective was to test the psychometrics of Smith's (2013) Low Vision Independence Measure (LVIM) using the Rasch model. METHOD: A cohort design was used with 93 participants receiving occupational therapy for low vision. Confirmatory factor analysis (CFA) with a parceling approach was used to test the LVIM factors and Rasch analysis to examine item-level psychometrics. RESULTS: Participants' average age was 78.9 yr (standard deviation = 12.1), and the majority were female (72.8%) with macular degeneration (62.3%). The CFA revealed two measurement factors: visual field or scotoma (n = 28) and visual acuity (n = 24). We removed six misfitting items, and the two factors of the revised LVIM demonstrated good rating scale function, good internal consistency (person reliability: visual field, .87; visual acuity, .90), good precision (person strata: visual field, 3.91; visual acuity, 4.40), no ceiling or floor effects, and no differential item functioning. CONCLUSION: The revised LVIM demonstrates good psychometrics on the Rasch model and can be used as a valid outcome measure in low vision rehabilitation.

Stroke Survivor and Caregiver Perspectives on Post-Stroke Visual Concerns and Long-Term Consequences.

Approximately 800,000 people in the United States have a stroke annually. Up to two thirds of stroke survivors have some visual problems, which result in disability and can affect survivors' overall rehabilitation outcomes. Although some post-stroke visual impairments can be corrected and respond well to intervention, ocular signs can be subtle and may not be recognized or reported by the stroke survivor but rather by a vigilant caregiver. The purpose of this study was to explore the post-stroke visual concerns and consequences expressed by stroke survivors and caregivers. This study employed a qualitative design using semistructured interviews conducted with a convenience sample of stroke survivors and caregivers recruited from either a community support group or skilled nursing and long-term care facilities. Interviews were recorded and transcribed verbatim. Comparative content analysis was used to identify vision-related themes by two independent coders. All research team members completed quality checking of coding. Twenty participants (11 stroke survivors and 9 caregivers) expressed visual concerns or consequences following stroke: (1) eye movement problems, (2) perceptual issues, and (3) consequences of vision problems or issues, which affected their daily life/quality of life. Stroke survivors and caregivers reported receiving vision care from (1) eye doctors, (2) occupational therapists, and (3) other healthcare professionals. All vision care providers need to be observant of potential post-stroke visual concerns. Stroke survivors should have a thorough vision evaluation to optimize their independence in everyday activities and quality of life.

Alcohol, drugs, and links to sexual risk behaviors among a sample of Virginia college students.

This project was significant in that it administered the National College Health Risk Behavior Survey (NCHRBS), a health risk assessment, to a sample of students at three public universities in Virginia. Virginia was never included in the original or subsequent nationwide assessments using this instrument. This health risk assessment is comprehensive, easy to administer, and free. The NCHRBS assesses risk behaviors in six categories including: (1) behaviors that contribute to unintentional and intentional injuries; (2) tobacco use; (3) alcohol and other drug use; (4) sexual behaviors that contribute to unintended pregnancy and STDs, including the HIV infection; (5) unhealthy dietary behaviors; and (6) physical inactivity. This article focuses on student responses to questions about alcohol and other drugs and sexual behaviors linked to the use of these substances. It provided baseline data on health risk behaviors of college students which can help determine wellness/health education course objectives and health promotion programming and services provided to the students within the universities. In addition, this project provided protocol to expand use of the survey statewide.

Identification of mild cognitive impairments in cancer survivors.

ABSTRACT Changes in cognitive functioning are a frequent complaint of persons diagnosed and treated for cancer. The purposes of this study were to explore the feasibility of the use of the Montreal Cognitive Assessment (MoCA) for identifying mild cognitive impairment in persons who are cancer survivors as well as begin to identify the prevalence of mild cognitive impairment in cancer survivors as identified by the MoCA. Thirty-eight cancer survivors participated in this study, and 14 scored below the cutoff score of 26 on the MoCA, which indicated mild cognitive impairment. These results indicate assessment of cognitive changes in cancer patients and survivors should be part of the occupational therapy evaluation and that the MoCA is a feasible tool for such use.

Effects of Level II Fieldwork on Clinical Reasoning in Occupational Therapy.

SUMMARY Objective. Fieldwork has been described as an educational method that enhances clinical reasoning skills. The purpose of this study was to determine the effects of Level II fieldwork on the development of clinical reasoning skills of undergraduate occupational therapy students. Method. A quasi-experimental pretest-posttest design was used with a convenience sample of 48 undergraduate seniors. All students participated in two 12-week, full-time rotations of Level II fieldwork. The Self-Assessment of Clinical Reflection and Reasoning (SACRR) developed by Royeen, Mu, Barrett and Luebben (2000) was administered the week before the students left for fieldwork and the first day after they returned from fieldwork. Results. Paired t-tests revealed statistically significant differences in pretest and posttest scores for 13 of 26 items on the SACRR. In addition, the overall total score increased from 102.55 to 108.41 (p <. 01). Conclusion. The results suggest 24 weeks of full-time fieldwork experience, in the senior year of an undergraduate occupational therapy curriculum, can significantly facilitate the development of students' clinical reasoning skills.