Effect of Occupational Therapy in Promoting Medication Adherence in Primary Care: A Randomized Controlled Trial.

IMPORTANCE: The Integrative Medication Self-Management Intervention (IMedS) is a manualized occupational therapy intervention designed to improve adherence to medications. The intervention influences medication adherence and facilitates new medication habits and routines; however, it has not been tested in a community clinical setting. OBJECTIVE: To test the efficacy of the IMedS to address medication adherence rates among community-dwelling adults with hypertension (HTN), Type 2 diabetes mellitus (T2DM), or both. DESIGN: Randomized controlled trial using a pretest-posttest control group design. SETTING: Primary care clinic in a large federally qualified health center. PARTICIPANTS: Adults with uncontrolled HTN, T2DM, or both. INTERVENTION: Participants were divided into two groups: The control group received treatment as usual (TAU) per the primary care protocol, and the intervention IMedS group received TAU and the IMedS intervention. OUTCOMES AND MEASURES: Primary outcome: seven-item version of the Adherence to Refills and Medication Scale (ARMS-7), pill count, blood pressure, hemoglobin A1c, or all of these. RESULTS: The proportion of adherent participants increased in both groups, but between groups, changes were not statistically significant. Post hoc comparisons of the results of a mixed analysis of variance for ARMS-7 measurements indicated that the occupational therapy intervention had a unique effect, compared with that for the TAU control group (dc = 0.65). Effect scores for pill count (d = 0.55) also suggested that the occupational therapy intervention positively affected adherence. CONCLUSIONS AND RELEVANCE: Occupational therapists can provide assessment and intervention to positively influence medication adherence in a primary care setting. What This Article Adds: This article provides a better understanding of the occupational therapist's role in addressing medication management and adherence on the interdisciplinary primary care medical team.

Exploring the Impact of the Occupational Therapy Health and Wellness Program (OT-HAWP) on Performance and the Health-Related Quality of Life of Cancer Survivors.

Creating innovative community-based programs for those living with and beyond cancer has the potential to improve outcomes; however, little has been done to explore these programs with participants that have various cancer diagnoses. We evaluated the impact of a 4-week community Occupational Therapy Health and Wellness Program (OT-HAWP) on self-perceived satisfaction and performance of daily activities, health-related quality of life, sleep quality, and fatigue among adults living with and beyond various cancer diagnoses. An uncontrolled, prospective, one-group pretest-posttest design was used. Participants completed patient reported measures of occupational performance and satisfaction (Canadian Occupational Performance Measure [COPM]), global health related quality of life (Patient-Reported Outcomes Measurement Information System-Global Health [PROMIS® Global Health]), sleep quality (Pittsburgh Sleep Quality Index [PSQI]), and the effect of fatigue on activities (Multidimensional Assessment of Fatigue [MAF]) before and after the program completion. Data was fully collected on 34 participants with various cancer diagnoses. For all outcomes, there was a statistically significant improvement after participating in the OT-HAWP program. Effect sizes range from small (0.46) to large (1.28). The OT-HAWP has the potential to improve self-reported occupational performance and satisfaction, global health-related quality of life, sleep quality, and fatigue in adults living with and beyond cancer in the community. Efficacy studies exploring community-based interventions are warranted to support legislation for improved access to care.

Hepatocyte p53 ablation induces metabolic dysregulation that is corrected by food restriction and vertical sleeve gastrectomy in mice.

P53 has been implicated in the pathogenesis of obesity and diabetes; however, the mechanisms and tissue sites of action are incompletely defined. Therefore, we investigated the role of hepatocyte p53 in metabolic homeostasis using a hepatocyte-specific p53 knockout mouse model. To gain further mechanistic insight, we studied mice under two complementary conditions of restricted weight gain: vertical sleeve gastrectomy (VSG) or food restriction. VSG or sham surgery was performed in high-fat diet-fed male hepatocyte-specific p53 wild-type and knockout littermates. Sham-operated mice were fed ad libitum or food restricted to match their body weight to VSG-operated mice. Hepatocyte-specific p53 ablation in sham-operated ad libitum-fed mice impaired glucose homeostasis, increased body weight, and decreased energy expenditure without changing food intake. The metabolic deficits induced by hepatocyte-specific p53 ablation were corrected, in part by food restriction, and completely by VSG. Unlike food restriction, VSG corrected the effect of hepatocyte p53 ablation to lower energy expenditure, resulting in a greater improvement in glucose homeostasis compared with food restricted mice. These data reveal an important new role for hepatocyte p53 in the regulation of energy expenditure and body weight and suggest that VSG can improve alterations in energetics associated with p53 dysregulation.

Interprofessional Education Week: the impact of active and passive learning activities on students' perceptions of interprofessional education.

Healthcare professions faculty at a private Midwestern university designed an Interprofessional Education (IPE) Week, consisting of 12 different interprofessional learning activities over the span of one week. The purpose of the study was to determine students' perceptions toward interprofessional healthcare, as measured by the Student Perceptions of Interprofessional Clinical Education-Revised (SPICE-R), one week before and one week after the events to determine if the type of learning activity - more passive, didactic-type events or active learning events - impacted outcomes. Of the over 400 students representing predominantly athletic training, nursing, occupational therapy, and physical therapy programs who attended IPE Week, a total of 190 health professions students completed the pre- and post-IPE Week SPICE-R. Students who attended an active learning activity had a statistically significant increase in all three factors of the tool (interprofessional teamwork and team-based practice, roles/responsibilities for collaborative practice, and patient outcomes from collaborative practice) while students who attended more passive didactic type events only showed a statistically significant increase in roles/responsibilities and patient outcomes. This study demonstrates the utility of an IPE Week on student perceptions and highlights the potential importance of active interprofessional learning offerings.

Sex-specific hepatic lipid and bile acid metabolism alterations in Fancd2-deficient mice following dietary challenge.

Defects in the Fanconi anemia (FA) DNA damage-response pathway result in genomic instability, developmental defects, hematopoietic failure, cancer predisposition, and metabolic disorders. The endogenous sources of damage contributing to FA phenotypes and the links between FA and metabolic disease remain poorly understood. Here, using mice lacking the Fancd2 gene, encoding a central FA pathway component, we investigated whether the FA pathway protects against metabolic challenges. Fancd2-/- and wildtype (WT) mice were fed a standard diet (SD), a diet enriched in fat, cholesterol, and cholic acid (Paigen diet), or a diet enriched in lipid alone (high-fat diet (HFD)). Fancd2-/- mice developed hepatobiliary disease and exhibited decreased survival when fed a Paigen diet but not a HFD. Male Paigen diet-fed mice lacking Fancd2 had significant biliary hyperplasia, increased serum bile acid concentration, and increased hepatic pathology. In contrast, female mice were similarly impacted by Paigen diet feeding regardless of Fancd2 status. Upon Paigen diet challenge, male Fancd2-/- mice had altered expression of genes encoding hepatic bile acid transporters and cholesterol and fatty acid metabolism proteins, including Scp2/x, Abcg5/8, Abca1, Ldlr, Srebf1, and Scd-1 Untargeted lipidomic profiling in liver tissue revealed 132 lipid species, including sphingolipids, glycerophospholipids, and glycerolipids, that differed significantly in abundance depending on Fancd2 status in male mice. We conclude that the FA pathway has sex-specific impacts on hepatic lipid and bile acid metabolism, findings that expand the known functions of the FA pathway and may provide mechanistic insight into the metabolic disease predisposition in individuals with FA.

Does a Sway-Based Mobile Application Predict Future Falls in People With Parkinson Disease?

OBJECTIVE: To determine whether Sway, a sway-based mobile application, predicts falls and to evaluate its discriminatory sensitivity and specificity relative to other clinical measures in identifying fallers in individuals with Parkinson disease (PD). DESIGN: Observational cross-sectional study. SETTING: Community. PARTICIPANTS: A convenience sample of subjects with idiopathic PD in Hoehn and Yahr levels I-III (N=59). INTERVENTIONS: Participants completed a balance assessment using Sway, the Movement Disorders Systems-Unified PD Rating Scale motor examination, Mini-BESTest, Activities-specific Balance Confidence (ABC) Scale, and reported 6-month fall history. Participants also reported falls for each of the following 6 months. Binomial logistic regression was used to identify significant predictors of future fall status. Cutoff scores, sensitivity, and specificity were based on receiver operating characteristic plots. MAIN OUTCOME MEASURES: Sway score. RESULTS: The most predictive logistic regression model included fall history, ABC Scale, and Sway (P<.001). This model explained 61% (Nagelkerke R2) of the variance in fall prediction and correctly classified 85% of fallers. However, only fall history and ABC Scale were statistically significant (P<.02). Participants were 32 times more likely to fall in the future if they fell in the past. The ABC Scale and Mini Balance Evaluation Systems Test (Mini-BESTest) demonstrated greater accuracy than Sway (area under the curve=0.76, 0.72, and 0.65, respectively). Cutoff scores to identify fallers were 85% for the ABC Scale and 21 of 28 for the Mini-BESTest. CONCLUSION: Sway did not improve the accuracy of predicting future fallers beyond common clinical measures and fall history.

Body Mass Index at 3 Years of Age: Cascading Effects of Prenatal Maternal Depression and Mother-Infant Dynamics.

OBJECTIVE: To investigate the effects of mothers' prenatal depression on parenting during infancy, ensuing childhood regulation, and body mass index (BMI) at age 3 years. STUDY DESIGN: The sample (N = 284) included teen mothers (n = 157), adult mothers with low education (n = 69), and adult mothers with high education (n = 58), and their first-born children. Maternal depressive symptoms were assessed prenatally through self-report; observational methods and self-report were used to assess mothers' parenting at 4, 6, and 8 months and children's regulation at 18, 24, and 30 months of age. Child BMI was measured at 36 months of age in the laboratory. RESULTS: Structural equation modeling supported mediating processes such that mothers who reported more depressive symptoms prenatally exhibited less positive parenting during infancy. In turn, less positive parenting predicted lower levels of child regulation during toddlerhood, which predicted higher child BMIs at 36 months of age, even after controlling for infant birth weight and concurrent maternal BMI. Models comparing groups (teen mothers, adult low-educated mothers, and adult-high educated mothers) indicated mean differences in maternal depression, parenting, and child regulation, but similar patterns of prediction across groups. CONCLUSIONS: The present study provides evidence of cascading psychosocial processes beginning prenatally and continuing through infancy, toddlerhood, and into early childhood. Results have implications for family-wide intervention strategies to help lower the risk for early onset obesity in children.

Hand-Assisted Robotic Surgery for Staging of Ovarian Cancer and Uterine Cancers With High Risk of Peritoneal Spread: A Retrospective Cohort Study.

OBJECTIVE: This study aimed to determine surgical outcomes related to hand-assisted robotic surgery (HARS) for staging of ovarian cancer and uterine cancers with high risk of peritoneal spread and compare them to laparotomy and standard robotic-assisted surgery. METHODS: A retrospective cohort study of women undergoing staging for uterine and ovarian cancer between January 2011 and July 2013 at a major metropolitan teaching hospital was reviewed. Patients undergoing HARS were matched with patients undergoing staging laparotomy [exploratory laparotomy (XLAP)] for the same indications and with patients undergoing traditional robotic surgery (RS) for staging of endometrioid endometrial cancer. In HARS, a longer incision is used to allow palpation of the peritoneal surfaces, to exteriorize the small bowel, to examine the mesentery, and to perform omentectomy. RESULTS: One hundred five patients were analyzed (15 HARS, 45 RS, 45 XLAP). Compared with XLAP, HARS was associated with decreased blood loss (200 vs 400 mL, P = 0.011) and shorter hospital stay (1 vs 4 days, P < 0.001). Patients who had undergone HARS had fewer major complications, but those results did not reach statistical significance (0% vs 27%, P = 0.063). Hand-assisted robotic surgery was associated with higher blood loss and length of stay as compared to robotic staging of endometrioid endometrial cancer (RS). Minor wound complications were also more common (27% vs 2%, P = 0.012). CONCLUSIONS: Hand-assisted robotic surgery allows for thorough visual and tactile assessment of peritoneal surfaces. It represents a safe alternative to laparotomy for staging of ovarian and uterine cancers with high risk of peritoneal spread. Long-term follow-up study is needed to determine oncologic adequacy of HARS.

Retrospective evaluation of methotrexate elimination when co-administered with proton pump inhibitors.

AIMS: The aim was to assess potential interaction between methotrexate (MTX) and proton pump inhibitors (PPIs) in patients receiving high-dose MTX. METHODS: Records of 56 adults receiving 201 cycles of MTX were reviewed to determine effects of PPI administration on MTX elimination. Repeated-measures logistic regressions and Cox regressions were performed to evaluate the possible drug interaction. RESULTS: Despite a significant difference between those receiving a PPI and not receiving a PPI in median MTX levels at 24 (8.0 vs. 3.9 µmol l(-1) , respectively, P = 0.013) and 72 h after MTX administration (0.08 vs. 0.05 µmol l(-1) , respectively, P = 0.037), there was no difference between those receiving a PPI and not receiving a PPI in the proportion of patients experiencing delayed elimination at 24 (19.2% vs. 20.2%, respectively, P = 1.000) and 72 h (36.2% vs. 33.7%, respectively, P = 0.765). When data were analysed using Cox regression, controlling for multiple cycles of MTX per patient, PPI use was not a significant predictor of time to MTX < 0.1 µmol l(-1) . When the clustering effect of multiple cycles of MTX per patient was controlled for, co-administration of PPIs was not a significant predictor of MTX level (P = 0.969). A comparison of patients with delayed elimination at any time point and those without delayed elimination indicated that PPI use was not a significant predictor of delayed elimination (P = 0.607). CONCLUSIONS: This study does not support previous findings of a significant interaction between PPIs and MTX. Based on these results, the clinical significance of any potential interaction is likely to be small.

Venipuncture Site Influences Blood-drop Volume in C57BL/6 Mice.

Many experiments require the collection of serial blood samples from mice. However, the size of mice limits the volume of blood that can be safely collected as a survival procedure. In IACUC protocols, investigators may report the amount of blood they collect from mice as a number of drops. Many institutions, including ours, use an anecdotal conversion factor (1drop of mouse blood = 25µL) to ensure that blood-collection volumes are compliant with institutional guidelines. To our knowledge, previous work has not experimentally determined the volume of a drop of mouse blood. In this 10-wk crossover experiment, 2 phlebotomists bled 30 C57BL/6J mice from 3 sites (facial, saphenous, and tail) using one or 2 different needle gauge sizes per site. Male and female mice were weighed weekly and divided among 5 groups (n = 6): left and right tail vein, left and right saphenous vein, and facial vein. A single blood drop from each site was weighed, and the volume of each drop was calculated using the average blood density determined from 8 mice terminally bled at the end of the study. Venipuncture site and side significantly influenced blood-drop weight and thus calculated volume. Facial vein puncture produced the largest drop volume (mean: 21.7µL), followed by the saphenous vein (mean: 9.97µL) and tail vein (mean: 4.96µL). Collection from the facial vein was associated with more hemorrhage and morbidity. Left-sided venipuncture was associated with slightly larger-volume blood drops, though the effect size of side was small. The results of this study may be useful in more accurately estimating blood loss via conversion of drops to volume. Our data indicate that blood collection from saphenous and tail veins minimizes blood loss relative to facial vein puncture and may optimize both serial collection of small-volume blood samples and animal welfare.

A backward cycling programme for people with Parkinson's disease: a feasibility and preliminary results study.

OBJECTIVE: To assess the feasibility of backward cycling for people with Parkinson's disease. Secondary objectives were to assess changes in gait and balance following a 6-week program. DESIGN: A single-group prospective pre-test, post-test study with 1-month follow-up. SUBJECTS/PATIENTS: Twenty-six people with Parkinson's disease (mean age: 69 (7.74) years, gender: 83% males, time since diagnosis: 6 (4.44) years). METHODS: Participants pedaled backward on a stationary bicycle for 30 minutes at moderate intensity twice a week for 6 weeks. Feasibility was assessed by acceptability, suitability, and burden. Data collected at pre- and post-intervention with 1-month follow-up included backward stepping response variables, forward/backward gait variables, Mini-Balance Evaluation Systems Test (MBT), and 6 Minute Walk Test. RESULTS: There was a high retention rate (95.8%) and adherence rate (100%) with one adverse event and minimal burden. Significant improvements were seen in step count and excursion distance during backward stepping responses, forward and backward gait velocity, forward step length, and the Mini-BESTest. CONCLUSION: Backward cycling was a feasible intervention for people with Parkinson's disease, demonstrating low burden with high retention and adherence rates, and it is a safe exercise with the potential for benefits in gait and balance variables.

Relation over time between facial measurements and cognitive outcomes in fetal alcohol-exposed children.

BACKGROUND: The identification of individuals exposed prenatally to alcohol can be challenging, with only those having the characteristic pattern of facial features, central nervous system abnormality, and growth retardation receiving a clinical diagnosis of fetal alcohol syndrome (FAS). METHODS: Seventeen anthropometric measurements were obtained at 5 and 9 years from 125 Cape Town, South African children, studied since birth. The children were divided into 3 groups: FAS or partial FAS (PFAS), heavily exposed nonsyndromal (HE), and non-alcohol-exposed controls (C). Anthropometric measurements were evaluated for mean group differences. Logistic regression models were used to identify the subset of anthropometric measures that best predicted group membership. Anthropometric measurements were examined at the 2 ages in relation to prenatal alcohol exposure obtained prospectively from the mothers during pregnancy. Correlation of these facial measurements with key neurobehavioral outcomes including Wechsler Intelligence Scales for Children-IV IQ and eyeblink conditioning was used to assess their utility as indicators of alcohol-related central nervous system impairment. RESULTS: Significant group differences were found for the majority of the anthropometric measures, with means of these measures smaller in the FAS/PFAS compared with HE or C. Upper facial widths, ear length, lower facial depth, and eye widths were consistent predictors distinguishing those exposed to alcohol from those who were not. Using longitudinal data, unique measures were identified that predicted facial anomalies at one age but not the other, suggesting the face changes as the individual matures. And 41% of the FAS/PFAS group met criteria for microtia at both ages. Three of the predictive anthropometric measures were negatively related to measures of prenatal alcohol consumption, and all were positively related to at least 1 neurobehavioral outcome. CONCLUSIONS: The analysis of longitudinal data identified a common set of predictors, as well as some that are unique at each age. Prenatal alcohol exposure appears to have its primary effect on brain growth, reflected by smaller forehead widths, and may suppress neural crest migration to the branchial arches, reflected by deficits in ear length and mandibular dimensions. These results may improve diagnostic resolution and enhance our understanding of the relation between the face and the neuropsychological deficits that occur.

Assessing reliability and validity of a functional outcome measure for adolescents with hypermobility spectrum disorder.

PURPOSE: To determine the reliability and validity of the upper extremity function and pain scales of the Pediatric Outcomes Data Collecton Instrument (PODCI UEF and PODCI P) as an outcome measure in adolescents with Hypermobility Spectrum Disorder (HSDs). MATERIALS AND METHODS: An observational study using a cross-section design was conducted. A convenience sample of 83 adolescents (age 11-18 years) with HSDs were recruited. Test-retest reliability of the PODCI UEF and PODCI P was examined using Lin's concordance correlation coefficient (ρc). Concurrent validity was established by comparing the PODCI UEF to the PROMIS Pediatric Upper Extremity-Short Form (PROMIS PUE-SF) and comparing the PODCI P to Numeric Rating Scale (NRS) using Spearman rho correlations. RESULTS: There was high test-retest reliability for the PODCI UEF, ρc = 0.81 (p < 0.001) and moderate test-retest reliability for the PODCI P, ρc = 0.68 (p < 0.001). There was a strong correlation between the PODCI UEF and the PROMIS PUE-SF, rs = 0.80 (p < 0.001) and a moderate inverse relationship rs = -0.73 (p < 0.001) between PODCI P and NRS scores (n = 150). CONCLUSION: The PODCI UEF and PODCI P may be a valid and reliable outcome measure in adolescents with HSDs.Implications for rehabilitationAdolescents with joint hypermobility can have chronic pain, fatigue, and decreased participation in daily activities.Clinical use of valid and reliable outcome measures to measure change may assist in planning care and identifying best practice for the management of HSDs.The PODCI was designed to be used as an outcome measure for chronic musculoskeletal conditions and has demonstrated test-retest reliability, validity, and responsiveness to change in other pediatric populations.The PODCI may be a valid and reliable outcome measure in adolescents with HSDs.

Effects of Trigger Point Dry Needling on Strength Measurements and Activation Levels of the Gluteus Medius: A Quasi-Experimental Randomized Control Study.

Background: Latent trigger points have been identified as a source of impaired muscle function giving rise to a reduction in force production and alterations in muscle activation patterns and movement efficiency. There is limited investigation into the effectiveness of a treatment in reducing these clinical manifestations. Purpose: To investigate whether the application of trigger point dry needling (TDN) to latent trigger points within the gluteus medius musculature affected strength measurements and muscle activation levels immediately following intervention. Design: Quasi experimental, single group, pretest-posttest, randomized control study. Methods: A control and an intervention side were randomly assigned for each participant (N = 39). Hand held dynamometer (HHD) force measurements and raw surface electromyography (sEMG) amplitude readings were recorded during maximal volitional isometric contractions of the gluteus medius in two separate positions before and after application of TDN. Comparison of within and between group data were conducted. Results: A statistically significant interaction between time (pre-TDN to post-TDN) and groups (intervention side and control side), p < 0.001 was found for HHD measurements in both positions. Post hoc analysis revealed a statistically significant difference (p < 0.001) for all comparisons in the side lying neutral (SL0) position, while statistically significant differences (p < 0.001) were found for pre and post-TDN measurements within intervention side as well as between the intervention and control side for post-TDN measurements in the side lying internal rotation (SLIR) position. For sEMG amplitude measurements, statistically significant differences were found only in the SL0 position for within group comparisons on the intervention side (p = 0.009) and for between group comparisons for post-TDN measurements (p = 0.002). Conclusion: Application of TDN to latent trigger points within the gluteus medius can significantly increase gluteus muscle force production immediately following intervention while reducing the level of muscle activation required during contraction. Level of Evidence: Level 2.

Targeting Cancer Stem Cells with Differentiation Agents as an Alternative to Genotoxic Chemotherapy for the Treatment of Malignant Testicular Germ Cell Tumors.

Testicular germ cell tumors (TGCTs) are exceptionally sensitive to genotoxic chemotherapy, resulting in a high cure rate for the young men presenting with these malignancies. However, this treatment is associated with significant toxicity, and a subset of malignant TGCTs demonstrate chemoresistance. Mixed nonseminomas often contain pluripotent embryonal carcinoma (EC) cells, the cancer stem cells (CSCs) of these tumors. We hypothesized that differentiation therapy, a treatment strategy which aims to induce differentiation of tumor-propagating CSCs to slow tumor growth, could effectively treat mixed nonseminomas without significant toxicity. The FDA-approved antipsychotic thioridazine and the agricultural antibiotic salinomycin are two drugs previously found to selectively target CSCs, and here we report that these agents differentiate EC cells in vitro and greatly reduce their tumorigenic potential in vivo. Using a novel transformed induced pluripotent stem cell allograft model and a human xenograft model, we show that thioridazine extends the survival of tumor-bearing mice and can reduce the number of pluripotent EC cells within tumors. These results suggest that thioridazine could be repurposed as an alternative TGCT treatment that avoids the toxicity of conventional chemotherapeutics.

Predictors of outcomes in exercisers with Parkinson disease: A two-year longitudinal cohort study.

BACKGROUND: Exercise may modify disease progression in persons with Parkinson disease (PD). OBJECTIVE: The purpose of this longitudinal cohort study was to determine factors that predict motor, activity, and participation-based outcomes over two years in exercisers with PD. METHODS: A convenience sample with idiopathic PD was included in the analysis [n = 74; mean age 66.7(8.4) years; male 54%; median months post diagnosis 69.0(76.0), median Hoehn and Yahr score 1.0(2.0)]. Exercise behaviors (minutes of exercise/week, peak rate of perceived exertion (RPE) and mode of exercise) and outcomes of impairment [grip strength], activity [10-meter walk test, functional reach test, activity specific balance confidence scale] and participation [Parkinson Disease Questionnaire-39] were assessed at baseline, 6, 12, 18 and 24 months. RESULTS: Using generalized estimating equations at least one exercise behavior was a significant predictor across most of the models (p≤0.026), with higher RPE predicting better outcomes in all activity and participation domains. Younger age, male gender and lower disease severity also significantly predicted better outcomes over time (p≤0.041). CONCLUSIONS: Exercise behaviors contributed to activity and participation-based outcomes over two years in exercisers with PD. Participation in high-intensity exercise programs may enhance maintenance of health and function over time in individuals with PD.

Rate of Progression in Activity and Participation Outcomes in Exercisers with Parkinson's Disease: A Five-Year Prospective Longitudinal Study.

BACKGROUND: Rates of progression of motor symptoms and physical performance show declines between 2% and 7% annually in community samples with Parkinson's disease (PD). However, the effects of ongoing exercise behaviors on progression rates have not been considered. OBJECTIVE: The primary purpose of this prospective, longitudinal study was to examine the annual rates of progression in activity and participation measures over five years in community-based exercisers with PD. METHODS: A cohort of 55 regular exercisers with idiopathic PD was assessed at baseline and 1, 2, and 5 years. Regular exercise was defined as scores of 4-5 on the Stages for Readiness to Exercise Scale and a self-reported average of at least 60 minutes of exercise/week within six months of each testing session. Unadjusted and adjusted annual progression rates for activity and participation measures were calculated with a standardized equation of change from baseline. A linear mixed model with covariates of age at PD diagnosis and PD subtype was used to determine adjusted change scores. RESULTS: Annual progression rates for unadjusted and adjusted variables were similar, and none exceeded 1.7% across time points for this group of exercisers with PD. Older age at PD diagnosis significantly contributed to faster progression of walking and balance functions. A nonlinear trajectory of the PD progression was demonstrated across most activity and participation outcomes. CONCLUSIONS: Annual progression rates demonstrated by this sample of exercisers were lower than those previously reported for motor decline in general samples with PD. Assessing activity and participation outcomes longitudinally at interim time points was important for understanding the trajectory of change over time. The lower rates of progression in this study warrant further investigation into the long-term effects of exercise in PD.

Influence of the position of charcoal air-filtration canisters on the efficacy of waste isoflurane scavenging as assessed in a randomized experiment.

OBJECTIVE To determine whether the position or elevation of charcoal air-filtration canisters would impact efficacy of waste anesthetic gas (WAG) scavenging. DESIGN Randomized experiment. SAMPLE 2 types of bottom-vented and 1 type of top-vented charcoal air-filtration canisters (n = 8 of each canister type/evaluation session). PROCEDURES Canisters were evaluated in a vertical or horizontal position at both low and high isoflurane gas flow rates in a modified Bain nonrebreathing circuit. Waste anesthetic gas concentrations were measured 2.54 cm from canister exhaust ports with an ambient air analyzer every 30 seconds for a maximum of 15 min/experimental condition. One type of bottom-vented canister was tested in a vertical position elevated above or suspended below the vaporizer at a high isoflurane flow rate and then a standard maintenance flow rate. RESULTS Position had no significant effect on WAG emission by any canister type at low isoflurane flow rates. Horizontally positioned bottom-vented canisters at the high isoflurane flow rate emitted significantly more WAG than vertically positioned canisters. Horizontally positioned top-vented canisters at high flow rates emitted significantly more WAG than vertically positioned canisters at the final 15-minute time point only. Cannister types differed significantly in intercanister variability. Canister elevation relative to the vaporizer had no impact on WAG scavenging efficacy. CONCLUSIONS AND CLINICAL RELEVANCE Findings suggested that charcoal air-filtration canisters should be used in a vertical position when anesthetizing animals with the anesthetic delivery system used in this study.

Interprofessional Healthcare Students' Perceptions of a Simulation-Based Learning Experience.

Academic healthcare programs are incorporating interprofessional education (IPE) into students' learning experiences in order to prepare students for optimal clinical practice. This paper describes a simulation-based learning experience (SBLE) designed to encourage students (n = 130) from six healthcare professions to learn more about interprofessional communication, roles and responsibilities of the healthcare team, and knowledge of interprofessional collaborative practice. Data analysis showed statistically significant differences in participants' perceptions of roles/responsibilities for collaborative practice (p = 0.001) and the patient outcomes from collaborative practice (p = 0.002). Additionally, participants identified the importance of holistic, patient-centered care, a greater understanding of the roles and responsibilities of healthcare team members, and a greater desire to participate in IPE activities. Utilizing SBLE with students in athletic training, nursing, occupational therapy, physical therapy, social work, and psychology led to positive perceptions of IPE and collaborative practice.