Using Practice-Based Inquiry to Enact Occupation-Centered, Justice-Oriented Practice in an Acute Mental Health Setting.

IMPORTANCE: Occupational therapy practitioners working in mental health settings in the United States are faced with challenges and barriers to implementing justice-oriented, occupation-centered practice. Research situated in the practice context with practitioners as coresearchers may provide an avenue for changing practice. OBJECTIVE: To describe the reconceptualization and redesign of occupational therapy services by a community of occupational therapy practitioners in an acute mental health setting in the United States. DESIGN: Practice-based inquiry, a form of practitioner-generated action research with a community of practice scholars (CoPS), guided the redesign of practice. SETTING: Acute mental health service in a large teaching hospital system. PARTICIPANTS: Nine occupational therapists comprised a CoPS and served as coresearchers and participants in the study. DATA COLLECTION AND ANALYSIS: Practitioner scholars' experiences of daily practice captured in individual reflections and collective research discussions were the source of data. Data collection, analysis, and action was an iterative process. Coresearchers coded and categorized findings and then developed themes reflecting changes enacted in practice. FINDINGS: The data analysis resulted in two themes characterizing how the CoPS reconceptualized and redesigned practice to reflect their commitment to occupation-centered and justice-focused occupational therapy: (1) occupational opportunities through direct services and (2) occupational opportunities through system-level change. CONCLUSIONS AND RELEVANCE: For this CoPS, engaging in a practice-based inquiry facilitated a reconceptualization of their practice and widened their occupational lens, thus strengthening their identity as occupational therapists. Given the barriers to demonstrating occupational therapy's unique contribution to mental health practice, this research provides a valuable tool for practitioners. What This Article Adds: Occupational therapy practitioners who engage in context-specific, action-oriented research experience a transformative process that empowers them to address barriers often encountered in mental health practice and enact occupation-centered and justice-focused practice.

Management of contaminated open fractures: a comparison of two types of irrigation in a porcine model.

BACKGROUND: Treatment of open fractures demands rapid intervention consisting of intravenous antibiotics, aggressive debridement, fracture immobilization, and soft tissue management including additional debridements and soft tissue coverage. Despite this approach, infection, particularly osteomyelitis, after open fracture continues to be a source of significant morbidity. Recent literature has provided several studies that performed clinical trials in superficial wounds. These investigations compared sterile solutions with tap water for wound decontamination. The results suggest that tap water washouts are cost-effective for these specific wounds. MATERIAL: An established protocol using sterile porcine hind limb tibias, as reported by Bhandari et al., was applied with modification. There were then 15 specimens and 5 controls (no irrigation) for each condition. The conditions were potable water and sterile water. A representative bacterium of gram-positive, Staphylococcus aureus, or gram-negative, Escherichia coli, acted as the contaminant. Sectioned, sterile porcine hind limb tibias were inoculated with 1 mL of a known concentration (1 × 10(10)) of bacterium and incubated. Each specimen was then irrigated, with bulb irrigation at a standardized distance of 15 cm, with 500 mL of irrigation. The specimen, along with 0.5 mL of wash (irrigant collected after it was placed over the specimen), was placed in 5 mL of Brain Heart Infusion broth. All specimens were incubated in this broth at 37°C for 2 hours. At 2 hours, a 100-µL supernatant was plated on blood agar plates and incubated for 24 hours. Colony counts for each specimen and controls were then performed. RESULTS: The number of colony forming units (CFUs) for each type of bacterium was different. The average CFUs from bone samples contaminated with E. coli was 5.18 × 10(8) after irrigation with sterile water and 6.24 × 10(8) after irrigation with tap water. The average CFUs from bone samples contaminated with S. aureus was 18 × 10(6) after irrigation with sterile water and 12 × 10(6) after irrigation with tap water. The average CFUs from the irrigation samples from E. coli contamination treated with sterile water was 1.3 × 10(6) and the CFUs from E. coli contamination treated with tap water was 2.2 × 10(6). The average CFUs from the irrigation samples from S. aureus contamination treated with sterile water was 1.57 × 10(6) and the CFUs from S. aureus contamination treated with tap water was 1.56 × 10(6). CONCLUSION: There was no significant difference between the CFUs for the sterile and potable water (p = 0.201) for each bacterium (p = 0.871).

Molecular analysis of herbivore-induced condensed tannin synthesis: cloning and expression of dihydroflavonol reductase from trembling aspen (Populus tremuloides).

In order to study condensed tannin synthesis and its induction by herbivory, a dihydroflavonol reductase (DFR) cDNA was isolated from trembling aspen (Populus tremuloides). Bacterial overexpression demonstrated that this cDNA encodes a functional DFR enzyme, and Southern analysis revealed that DFR likely is a single-copy gene in the aspen genome. Aspen plants that were mechanically wounded showed a dramatic increase in DFR expression after 24 h in both wounded leaves and unwounded leaves on wounded trees. Feeding by forest tent caterpillar (Malacosoma disstria) and satin moth (Leucoma salicis) larvae, and treatment with methyl jasmonate, all strongly induced DFR expression. DFR enzyme activity was also induced in wounded aspen leaves, and phytochemical assays revealed that condensed tannin concentrations significantly increased in wounded and systemic leaves. The expression of other genes involved in the phenylpropanoid pathway were also induced by wounding. Our findings suggest that the induction of condensed tannins, compounds known to be important for defense against herbivores, is mediated by increased expression of DFR and other phenylpropanoid genes.