German translation and validation of the Interprofessional Facilitation Scale.

We identified evidence from item response theory (IRT) to examine a German translation of the Interprofessional Facilitation Scale (IPFS). The IPFS was administered to n = 130 mixed-health profession participants in a post-interprofessional education practicum questionnaire. We used IRT analyses to examine the following three aspects of the IPFS: (a) general factor strength, (b) subscale usability, and (c) item bias. First, findings indicate a strong, general factor underlying the IPFS that supports unidimensional interpretations. Second, findings supported IPFS overall reliability, but failed to support subscale reliabilities. Third, item bias assessment using a comparator-French sample (n = 89) indicated insubstantial differences across German and French samples. Taken together, we find sufficient evidence to support the IPFS-German translation's application in IPE contexts and unidimensional interpretations. Subscores are not advisable for interpretation, and future researchers should aim to further inspect potential item bias.

N-acetylglucosamine inhibits inflammation and neurodegeneration markers in multiple sclerosis: a mechanistic trial.

BACKGROUND: In the demyelinating disease multiple sclerosis (MS), chronic-active brain inflammation, remyelination failure and neurodegeneration remain major issues despite immunotherapy. While B cell depletion and blockade/sequestration of T and B cells potently reduces episodic relapses, they act peripherally to allow persistence of chronic-active brain inflammation and progressive neurological dysfunction. N-acetyglucosamine (GlcNAc) is a triple modulator of inflammation, myelination and neurodegeneration. GlcNAc promotes biosynthesis of Asn (N)-linked-glycans, which interact with galectins to co-regulate the clustering/signaling/endocytosis of multiple glycoproteins simultaneously. In mice, GlcNAc crosses the blood brain barrier to raise N-glycan branching, suppress inflammatory demyelination by T and B cells and trigger stem/progenitor cell mediated myelin repair. MS clinical severity, demyelination lesion size and neurodegeneration inversely associate with a marker of endogenous GlcNAc, while in healthy humans, age-associated increases in endogenous GlcNAc promote T cell senescence. OBJECTIVES AND METHODS: An open label dose-escalation mechanistic trial of oral GlcNAc at 6 g (n = 18) and 12 g (n = 16) for 4 weeks was performed in MS patients on glatiramer acetate and not in relapse from March 2016 to December 2019 to assess changes in serum GlcNAc, lymphocyte N-glycosylation and inflammatory markers. Post-hoc analysis examined changes in serum neurofilament light chain (sNfL) as well as neurological disability via the Expanded Disability Status Scale (EDSS). RESULTS: Prior to GlcNAc therapy, high serum levels of the inflammatory cytokines IFNγ, IL-17 and IL-6 associated with reduced baseline levels of a marker of endogenous serum GlcNAc. Oral GlcNAc therapy was safe, raised serum levels and modulated N-glycan branching in lymphocytes. Glatiramer acetate reduces TH1, TH17 and B cell activity as well as sNfL, yet the addition of oral GlcNAc dose-dependently lowered serum IFNγ, IL-17, IL-6 and NfL. Oral GlcANc also dose-dependently reduced serum levels of the anti-inflammatory cytokine IL-10, which is increased in the brain of MS patients. 30% of treated patients displayed confirmed improvement in neurological disability, with an average EDSS score decrease of 0.52 points. CONCLUSIONS: Oral GlcNAc inhibits inflammation and neurodegeneration markers in MS patients despite concurrent immunomodulation by glatiramer acetate. Blinded studies are required to investigate GlcNAc's potential to control residual brain inflammation, myelin repair and neurodegeneration in MS.

Autologous hematopoietic stem cell transplantation for a patient with multiple autoimmune diseases.

Level of autoantibodies after autologous hematopoietic stem cell transplantation. AGA, antigliadin antibody; AHSCT, autologous hematopoietic stem cell transplantation; Anti-GAD65, Ab anti-glutamic acid decarboxylase epitope 65 antibody; Anti-TPO, anti-thyroid peroxidase antibody; CU, chemiluminescent unit.

Sociomaterial perspective as applied in interprofessional education and collaborative practice: a scoping review.

Learning and working together towards better health outcomes today have become more complex requiring an investigation on how interprofessional education (IPE) and interprofessional collaboration (IPC) practices could be sustained and further developed. Through a sociomaterial perspective, we can better understand IPE and IPC practices by foregrounding the material aspect of learning and working together and examining its relationship with humans and their interactions. This article aimed to examine existing literature that discusses the application of sociomaterial perspectives in IPE and IPC. A scoping review was conducted following Arksey and O'Malley's framework to explore the extent within the current body of knowledge that discuss how sociomaterial perspective is applied in IPE and IPC practices. A systematic database search was performed in September 2021 to retrieve literature published from 2007 onwards, with forty-three papers meeting the inclusion criteria. These papers included research articles, book chapters, conference papers and commentaries, with the majority originating from Europe. The thematic analysis revealed the following themes: (1) power as a sociomaterial entity shaping IPE and IPC; (2) inclusion of non-health professionals in reimagining IPE and IPC practices, and (3) the critical understanding of sociomateriality. The findings suggest that a sociomaterial perspective can allow for the reimagination of the contemporary and future practices of interprofessionalism.

Attitudes of Filipino health profession students toward interprofessional education: a descriptive study.

The thrust of interprofessional education is to prepare health professions students to deliberately learn and work together with a common goal of providing better and safer care for service users. This study sought to describe the attitudes of health profession students toward interprofessional education and to identify which among the variables (i.e., sex, programme, year level, prior clinical and interprofessional education experiences, and level of moral development) are determinants of their attitudes toward interprofessional education. A total of 485 participants were surveyed using a validated, three-part Interprofessional Education-Attitude Scale (IPE-AS). No statistically significant difference was found between the attitudes toward interprofessional education and variables such as sex, prior clinical and interprofessional education experiences among medical, nursing, and pharmacy students. Our findings found that those with more agreeable attitudes toward interprofessional education were students in the medical programme, those from the lower year levels and those with higher stages of morality (based on Kohlberg's stages of moral development). This suggests that IPE must be introduced across health science curricula with an intentional profiling of students about their experiences related to learning and working with students from different programmes. Moral development, as a variable in the study, also provides information as to how it can improve IPE programmes, competencies, and experiences of students in the fields of health sciences.

N-acetylglucosamine drives myelination by triggering oligodendrocyte precursor cell differentiation.

Myelination plays an important role in cognitive development and in demyelinating diseases like multiple sclerosis (MS), where failure of remyelination promotes permanent neuro-axonal damage. Modification of cell surface receptors with branched N-glycans coordinates cell growth and differentiation by controlling glycoprotein clustering, signaling, and endocytosis. GlcNAc is a rate-limiting metabolite for N-glycan branching. Here we report that GlcNAc and N-glycan branching trigger oligodendrogenesis from precursor cells by inhibiting platelet-derived growth factor receptor-α cell endocytosis. Supplying oral GlcNAc to lactating mice drives primary myelination in newborn pups via secretion in breast milk, whereas genetically blocking N-glycan branching markedly inhibits primary myelination. In adult mice with toxin (cuprizone)-induced demyelination, oral GlcNAc prevents neuro-axonal damage by driving myelin repair. In MS patients, endogenous serum GlcNAc levels inversely correlated with imaging measures of demyelination and microstructural damage. Our data identify N-glycan branching and GlcNAc as critical regulators of primary myelination and myelin repair and suggest that oral GlcNAc may be neuroprotective in demyelinating diseases like MS.

Top tips for interprofessional education and collaborative practice research: a guide for students and early career researchers.

Interprofessional research within the contexts of education and health and social care practice has grown exponentially within the past three decades. To maintain the momentum of high-quality research, it is important that early career researchers embarking on their first research journey and new to interprofessional education or interprofessional collaborative practice feel supported in making their contribution to the field. This guide, developed by the Center for the Advancement of Interprofessional Education (CAIPE) Research Group, has been written with these groups in mind who are embarking on their first research journey, and new to the interprofessional field. It aims to raise awareness of academic resources and share practical advice from those who have previously experienced problems when undertaking interprofessional research in education or health and social care practice.

Doing interprofessional research in the COVID-19 era: a discussion paper.

The COVID-19 pandemic, and ensuing physical distancing measures, poses challenges for researchers in the field of interprofessional care. Pandemic management has highlighted the centrality of interprofessional working to effective healthcare delivery during crises. It is essential to find ways to maintain interprofessional research that has commenced, while also designing research to capture important learning from pandemic management and response. However, it also creates opportunities for new research projects and novel research designs. This discussion paper explores ways of adapting existing research methodologies and outlines potential avenues for new research. Specifically, considerations to bear in mind when designing interprofessional research during the pandemic include research ethics and integrity, research design, data collection methods, research opportunities, implications and limitations. Interprofessional research can continue to make a valuable contribution in informing global responses to COVID-19 and in planning for future global health crises. We call for, insofar as possible, for interprofessional research to continue to be developed during this time.

Long-term plasma exchange as maintenance therapy for cerebellar-type Hashimoto's encephalopathy, a case report.

Hashimoto's encephalopathy (HE) is a presumed autoimmune disorder associated with anti-thyroid autoantibodies and signs and symptoms of encephalopathy. A sub-type of HE is associated with cerebellar dysfunction and ataxia. Immunosuppressive therapy, particularly corticosteroid treatment, is utilized in the majority of cases. Short-term apheresis has been reported with variable patient responses. Here we report the case of a 72 year-old female with an ∼15 year history of cerebellar type HE that had profound improvement in symptoms after long-term apheresis treatment over an ∼2 year period. Following an induction phase, twice-weekly maintenance apheresis of 1 plasma volume reversed long-standing severe gait ataxia that had required a walker, as well as mild cognitive symptoms. This paralleled reductions in anti-thyroid antibody levels. Holidays from apheresis lasting several weeks and/or reductions in maintenance apheresis frequency to once per-week resulted in re-expression of ataxia and cognitive impairments along with a rise in anti-thyroid antibody levels. An apheresis dose-effect was observed whereby parallel rise and fall in both symptomatology and antibody levels would mirror duration between apheresis intervals. To our knowledge, this is the first report of profound therapeutic benefit and a dose-response relationship to long-term apheresis in cerebellar-type HE. This case suggests that maintenance apheresis be considered in responsive patients, particularly in those with contraindications to medical immunosuppression.

Filipino therapists' experiences and attitudes of interprofessional education and collaboration: A cross-sectional survey.

For the past more than 50 years, the World Health Organisation has acknowledged through empirical findings that health workers that learn together work together effectively to provide the best care for their patients. This study aimed to: (1) describe the perceived extent of interprofessional education (IPE) experience among Filipino occupational therapists (OTs), physical therapists (PTs), and speech-language-pathologists (SLPs); (2) identify their attitudes towards interprofessional collaboration (IPC); and (3) compare their attitudes towards IPC according to: prior IPE experience, classification of IPE experience, profession, years of practice, and practice setting. Using a cross-sectional survey design, a two-part questionnaire was sent to Filipino OTs, PTs, and SLPs working in the Philippines via an online survey application. The first part of the survey contained eight items of demographic information and the second part contained the 14-item Attitudes Towards Health Care Teams Scale (ATHCTS). Findings revealed that among the Filipino OT, PT and SLP respondents (n = 189), 70.9% had prior experience on IPE. Moreover, the three most commonly used IPE teaching-learning strategies were case discussion (clinical setting), small group discussion, didactics, and case discussion (community setting), while the use of didactics and case discussion (community setting) yielded more agreeable attitudes towards IPC. Among the 14 items in the ATHCTS, 11 were rated with agreeability and three items with neutrality. For professional variables, only the practice setting variable yielded a statistically significant finding confirming those working in the academia to be more agreeable towards IPC compared to other settings. However, years of practice and professional background variables both yielded no statistically significant difference implying no association between years of practice and attitude towards IPC and a homogenous composition among respondents, respectively. The results of this research are to springboard IPE initiatives within Philippine higher education institutions to enable evidence-based IPC approaches in clinical practice.

Technology Use for Home-Based Stroke Rehabilitation in Switzerland From the Perspectives of Persons Living With Stroke, Informal Caregivers, and Therapists: Qualitative Interview and Focus Group Study.

BACKGROUND: Stroke is a leading cause for long-term disability, requiring both inpatient and outpatient rehabilitation and self-training in the home environment. Technology-based tools are gradually gaining acceptance as additional and suitable options for extending the rehabilitation process. While the experiences of persons living with stroke, therapists, and informal caregivers with respect to technology use have already been investigated in other countries, this topic is underexplored in the Swiss context. OBJECTIVE: We aimed to explore the experiences and needs of persons living with stroke, informal caregivers, and therapists in using technology-based tools in a home environment for stroke rehabilitation in Switzerland. METHODS: This study followed a qualitative descriptive methodology, including semistructured interviews and focus group discussions. We applied a deductive template analysis alongside the accessibility, adaptability, accountability, and engagement framework to analyze the qualitative data sets for technology-assisted solutions for poststroke rehabilitation. RESULTS: We collected the experiences and needs of persons living with stroke (7/23, 30%), informal caregivers (4/23, 17%), and therapists (occupational and physical therapists; 12/23, 52%). The 4 categories we used to organize the analysis and results were accessibility to quality rehabilitation, adaptability to patient differences, accountability or compliance with rehabilitation, and engagement with rehabilitation. Persons living with stroke stated that they use various tools within their rehabilitation process depending on their specific needs. They felt that there is a plethora of tools available but sometimes felt overwhelmed with the selection process. Informal caregivers indicated that they generally felt underserved and insufficiently informed throughout the rehabilitation process. They reported that they use technology-based tools to support their relatives affected by stroke in becoming more independent. Therapists appreciate the numerous possible applications of technology-based tools in rehabilitation. At the same time, however, they express dissatisfaction with the lack of clarity in Switzerland regarding cost coverage, recommendations, and training opportunities. CONCLUSIONS: Persons living with stroke, informal caregivers, and therapists in Switzerland reported varied and unique experiences and needs with the use of technology-based tools in outpatient stroke rehabilitation. Written recommendations, the assumption of financial costs, and the provision of information and education could foster increased confidence in the use of technology-based tools for patients and therapists.

Erratum: 541 A Framework for Multicultural and Multidisciplinary Near-Peer Mentoring for Artificial Intelligence in Healthcare Education: A University of Florida Friend Group - CORRIGENDUM.

[This corrects the article DOI: 10.1017/cts.2024.462.].

Potential roles of occupational therapists in urban planning for age-friendly environments: A Q-methodology.

BACKGROUND: Urban planning for age-friendly environments is an important issue, and occupational therapists and occupational scientists could contribute to planning such environments; however, knowledge of the potential roles of occupational therapists is limited. AIM: To explore the potential roles of occupational therapists in urban planning for age-friendly environments in Japan from the perspectives of occupational therapists and stakeholders. MATERIALS AND METHODS: A Q-methodology study was conducted to gain viewpoints from occupational therapists and stakeholders regarding their roles in the urban planning of age-friendly environments for older people in Japan. Participants included eight occupational therapists and seven stakeholders who completed the Q-sorting process. RESULTS: Three viewpoints emerged which are interpreted as roles of occupational therapists: (1) Promote older people's participation in everyday activities in their communities, (2) Advocate for older people towards policy-making to reflect their occupational needs or perspectives, and (3) Arrange neighbourhood environments towards enhancing participation in occupation through adjustments to compensate for functional limitations. CONCLUSION AND SIGNIFICANCE: Results reveal the potential roles of occupational therapists in urban planning for age-friendly environments in Japan. These roles can be a guide in the continuing professional development of occupational therapists in the fields of urban planning for older people.

Case report: Approaches to treatment-refractory and super-refractory glutamic acid decarboxylase antibody-spectrum disorders.

Background: Glutamic acid decarboxylase antibody-spectrum disorders (GAD-SDs) include a group of autoimmune neurological diseases associated with neuronal excitability, most noticeably stiff person syndrome. Immune modulators are the mainstay of treatment, but a significant number of patients remain refractory. Methods: We present our single-center experience of eight cases of GAD-SD, two of which were refractory to immune modulatory treatments. Results: Of the two cases that were refractory to immunomodulation, one showed significant improvement with bilateral globus pallidus interna deep brain stimulation (GPi DBS) placement, and the other showed significant improvement with autologous hematopoietic stem cell transplant (aHSCT). Discussion: To our knowledge, this is the first instance of GPi DBS placement being noted to improve GAD-SD movements.

Unraveling the "Greener Pastures" Concept: The Phenomenology of Internationally Educated Occupational Therapists.

The Philippines is one of the major labor exporters for health care workers in the world and occupational therapists are the second most likely professionals behind nurses to work in "greener pastures" overseas. This phenomenological study describes the migration experiences of Philippine-trained occupational therapists working in high-income, Anglophone countries. Researchers conducted online interview for 15 participants who were previously/currently unemployed/underemployed. Following an inductive approach to qualitative data analysis, themes were drawn from the migrant therapists' lived experiences. Four themes describe the migration experiences of Filipino occupational therapists: (a) realities of being an occupational therapist in the Philippines, (b) contradictions faced by Filipino occupational therapists upon migration, (c) when the pastures overseas are not greener, and (d) when the pastures overseas are indeed greener. The study contributes to the labor migration discourse in occupational therapy and the critical examination of the idea of "greener pastures."

The Migration and Deskilling of Filipino Occupational TherapistsThis study provides stories of Filipino occupational therapists who were underemployed as they migrated to developed and English-speaking countries. We interviewed 15 people online to explore their experiences of migration, being underemployed, and working in a foreign country with a different culture of working. Results of the study revealed four ideas: (a) reality of being an occupational therapist in the Philippines, (b) contradictions faced by Filipino occupational therapists upon migration, (c) barriers faced by migrant occupational therapists, and (d) successes experienced by migrant occupational therapists. This study contributes to the ongoing research on occupational therapy, labor migration, and overseas Filipino workers.

Inflammation induced by infection potentiates tau pathological features in transgenic mice.

Comorbidities that promote the progression of Alzheimer's disease (AD) remain to be uncovered and evaluated in animal models. Because elderly individuals are vulnerable to viral and bacterial infections, these microbial agents may be considered important comorbidities that could potentiate an already existing and tenuous inflammatory condition in the brain, accelerating cognitive decline, particularly if the cellular and molecular mechanisms can be defined. Researchers have recently demonstrated that triggering inflammation in the brain exacerbates tau pathological characteristics in animal models. Herein, we explore whether inflammation induced via viral infection, compared with inflammation induced via bacterial lipopolysaccharide, modulates AD-like pathological features in the 3xTg-AD mouse model and provide evidence to support the hypothesis that infectious agents may act as a comorbidity for AD. Our study shows that infection-induced acute or chronic inflammation significantly exacerbates tau pathological characteristics, with chronic inflammation leading to impairments in spatial memory. Tau phosphorylation was increased via a glycogen synthase kinase-3ß-dependent mechanism, and there was a prominent shift of tau from the detergent-soluble to the detergent-insoluble fraction. During chronic inflammation, we found that inhibiting glycogen synthase kinase-3ß activity with lithium reduced tau phosphorylation and the accumulation of insoluble tau and reversed memory impairments. Taken together, infectious agents that trigger central nervous system inflammation may serve as a comorbidity for AD, leading to cognitive impairments by a mechanism that involves exacerbation of tau pathological characteristics.

A Rapid Review of the Factors That Influence Service User Involvement in Interprofessional Education, Practice, and Research.

Service user involvement in interprofessional education and collaborative practice remains limited despite the increasing push for this by governments and grant funding bodies. This rapid review investigated service user involvement in interprofessional education, practice, and research to determine factors that enable or hinder such involvement. Following the Cochrane and the World Health Organization's rapid review guidelines, a targeted search was undertaken in four databases. Subsequent to the screening processes, included papers were critically appraised, and extracted data were synthesized narratively. Sixteen studies met inclusion criteria. Most studies were related to interprofessional collaborative practice, as opposed to education and research. Service user involvement was more in the form of consultation and collaboration, as opposed to consumer-led partnerships. Enablers and barriers to service user involvement in IPECP were identified. Enablers included structure, the valuing of different perspectives, and relationships. Barriers included time and resources, undesirable characteristics, and relationships. This rapid review has added evidence to a swiftly expanding field, providing timely guidance. Healthcare workers can benefit from targeted training. Policy makers, healthcare organizations, and governments can investigate strategies to mitigate the time and resource challenges that impede service user involvement in IPECP.

ßIV-Spectrin Autoantibodies in 2 Individuals With Neuropathy of Possible Paraneoplastic Origin: A Case Series.

OBJECTIVE: To identify the autoantigen in 2 individuals with possible seronegative paraneoplastic neuropathy. METHODS: Serum and CSF were screened by tissue-based assay and panned for candidate autoantibodies by phage display immunoprecipitation sequencing (PhIP-Seq). The candidate antigen was validated by immunostaining knockout tissue and HEK 293T cell-based assay. RESULTS: Case 1 presented with gait instability, distal lower extremity numbness, and paresthesias after a recent diagnosis of serous uterine and fallopian carcinoma. Case 2 had a remote history of breast adenocarcinoma and presented with gait instability, distal lower extremity numbness, and paresthesias that progressed to generalized weakness. CSF and serum from both patients immunostained the axon initial segment (AIS) and node of Ranvier (NoR) of mice and enriched ßIV-spectrin by PhIP-Seq. Patient CSF and serum failed to immunostain NoRs in dorsal root sensory neurons from ßI/ßIV-deficient mice. ßIV-spectrin autoantibodies were confirmed by overexpression of AIS and nodal ßIV-spectrin isoforms Σ1 and Σ6 by a cell-based assay. ßIV-spectrin was not enriched in a combined 4,815 PhIP-Seq screens of healthy and other neurologic disease patients. DISCUSSION: Therefore, ßIV-spectrin autoantibodies may be a marker of paraneoplastic neuropathy. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that ßIV-spectrin antibodies are specific autoantibody biomarkers for paraneoplastic neuropathy.

The dark side of occupation within the context of modern-day beauty pageants.

BACKGROUND: The desire to be physically beautiful is inherent among human beings. In particular, some women who participate in modern-day beauty pageants tend to spend more time, energy, money and emotional resources to alter their natural body and looks to fit socially and culturally constructed standards of beauty. OBJECTIVE: The authors frame beauty pageants as the context where diverse occupations are at play with the purpose of becoming a 'beauty queen'. This commentary aims to discuss the origins and culture of beauty pageants, the different perspectives on pageantry work, and essential and hidden occupations performed within the context of this form of performing art. APPROACH: Using the conceptual lens of the dark side of occupation, hidden occupations are characterised by the doings of pageant hopefuls that are less explored and acknowledged because they are perceived as health-compromising, risky, dishonest, illicit, and socially or personally undesirable. CONCLUSION: Furthermore, this commentary calls for the exploration of occupations beyond the conventional scope of its understanding and the acknowledgment of hidden occupations intertwined into people's everyday doings specifically in the context of desiring to be 'beautiful'.

Uncovering the lived experiences of Filipino drug recoverees towards occupational participation and justice through an interpretative phenomenological analysis.

BACKGROUND: The drug using crisis entails participation and justice issues making it a pressing health and social concern in the Philippines today. AIM: This study explored the lived experiences of Filipinos recovering from drug addiction and sought to understand the occupational justice determinants of drug addiction to better develop substance addiction rehabilitation programs in the Philippines. METHOD: Using a qualitative approach, we conducted in-depth interviews guided by the Occupational Justice Health Questionnaire to 24 participants. Data were analyzed using interpretative phenomenological analysis. RESULTS: We found four emerging themes: living with drugs, living around rules, living for the future, and living amidst the war on drugs. Each theme represented a "period of participation" exposing occupational injustices that activated the first enablement skill "raise consciousness of occupational injustice" from the Participatory Occupational Justice Framework. CONCLUSION AND SIGNIFICANCE: Understanding the participants' lived experiences raised consciousness of the injustices that exist before and during rehabilitation which uncovered pointers to improve local substance addiction rehabilitation programs: use of occupation-based social participation interventions, limitation of occupational therapy services due to lack of human resources reinforcing interprofessional collaboration, a participatory approach is essential in discussing and addressing injustices, and deliberate use of political activities of daily living.