Professional Behaviors and Fieldwork: A Curriculum Based Model in Occupational Therapy

Professional behaviors have been identified as imperative for fieldwork success in occupational therapy, and are held to high expectations by fieldwork educators. This study consisted of three phases. Phase one was a retrospective analysis of past Fieldwork Performance Evaluations (FWPE; n=319). Phase two consisted of the development of a curricular model and Level I Fieldwork Seminar with a focus on low-scoring professional behaviors on the FWPEs, which included verbal/ non-verbal communication, written communication, professional responsibility, work behaviors, and time management. Finally, phase three was a review of the course by the Philadelphia Region Fieldwork Consortium and edits to the seminar based on their feedback. Two theories, situated cognition and self-directed learning, were used to guide the curriculum development

Placental Structure in Preterm Birth Among HIV-Positive Versus HIV-Negative Women in Kenya.

BackgroundPreterm birth (PTB) is a major cause of infant morbidity and mortality in developing countries. Recent data suggest that in addition to Human Immunodeficiency Virus (HIV) infection, use of antiretroviral therapy (ART) increases the risk of PTB. As the mechanisms remain unexplored, we conducted this study to determine whether HIV and ART were associated with placental changes that could contribute to PTB.SettingWe collected and evaluated placentas from 38 HIV-positive women on ART and 43 HIV-negative women who had preterm deliveries in Nairobi, Kenya.MethodsAnatomical features of the placentas were examined at gross and microscopic levels. Cases were matched for gestational age and compared by the investigators who were blinded to maternal HIV serostatus.ResultsAmong preterm placentas, HIV infection was significantly associated with thrombosis (P = 0.001), infarction (P = 0.032), anomalies in cord insertion (P = 0.02), gross evidence of membrane infection (P = 0.043), and reduced placental thickness (P = 0.010). Overall, preterm placentas in both groups were associated with immature villi, syncytial knotting, villitis, and deciduitis. Features of HIV-positive versus HIV-negative placentas included significant fibrinoid deposition with villus degeneration, syncytiotrophoblast delamination, red blood cell adhesion, hypervascularity, and reduction in both surface area and perimeter of the terminal villi.ConclusionsThese results imply that HIV infection and/or ART are associated with morphological changes in preterm placentas that contribute to delivery before 37 weeks. Hypervascularity suggests that the observed pathologies may be attributable, in part, to hypoxia. Further research to explore potential mechanisms will help elucidate the pathways that are involved perhaps pointing to interventions for decreasing the risk of prematurity among HIV-positive women

Predicting death over 8 years in a prospective cohort of HIV-infected women: the Women's Interagency HIV Study.

ObjectivesPredicting mortality in middle-aged HIV-infected (HIV+) women on antiretroviral therapies (ART) is important for understanding the impact of HIV infection. Several health indices have been used to predict mortality in women with HIV infection. We evaluated: (1) an HIV biological index, Veterans Aging Cohort Study (VACS); (2) a physical index, Fried Frailty Index (FFI); and (3) a mental health index, Center for Epidemiologic Studies-Depression (CES-D). Proportional hazards regression analyses were used to predict death and included relevant covariates.DesignProspective, observational cohort.SettingMulticentre, across six sites in the USA.Participants1385 multirace/ethnic ART-experienced HIV+ women in 2005.Primary and secondary outcomesAll deaths, AIDS deaths and non-AIDS deaths up to ~8 years from baseline.ResultsIncluded together in one model, VACS Index was the dominant, significant independent predictor of all deaths within 3 years (HR=2.20, 95% CI 1.83, 2.65, χ2=69.04, p<0.0001), and later than 3 years (HR=1.55, 95% CI 1.30, 1.84, χ2=23.88, p<0.0001); followed by FFI within 3 years (HR=2.06, 95% CI 1.19, 3.57, χ2=6.73, p=0.01) and later than 3 years (HR=2.43, 95% CI 1.58, 3.75, χ2=16.18, p=0.0001). CES-D score was not independently associated with mortality.Conclusions and relevanceThis is the first simultaneous evaluation of three common health indices in HIV+ adults. Indices reflecting physical and biological ageing were associated with death

Becoming College-Ready: Early Findings From a CUNY Start Evaluation

CUNY Start, a pre-matriculation program developed by the City University of New York, seeks to help the lowest placed developmental education students become college ready in just one semester. The program targets incoming students who are assessed as needing remediation in math, reading, and writing by providing intensive instruction for one semester while students delay enrollment in college. It uses a conceptual student-centered curriculum and instructional delivery method and provides a robust approach to staffing and training that allows instructors to learn to implement these strategies while under the tutelage of experienced teachers. It also provides advising, tutoring, and a weekly seminar that teaches students skills they need to succeed in college. Students pay only $75 for the program and do not use financial aid. This report describes the early findings of a random assignment evaluation and implementation study of CUNY Start by CCRC, MDRC, and CUNY. After following CUNY Start and control group students for three semesters, the researchers found: CUNY Start was implemented as it was designed, and the contrast between the program and the colleges’ standard developmental courses and services was substantial. During the first semester in the study, program group students made substantially more progress through developmental education than control group students. Control group students earned more college credits than program group students, as predicted by CUNY Start’s designers. During the second semester, program group students enrolled at CUNY colleges either in CUNY Start or in non-CUNY Start courses at a higher rate than control group students. A final report will look at CUNY Start students’ persistence in college, college credit accumulation, and graduation rates. Another paper will detail CUNY Start’s math curriculum and pedagogy, and a brief will focus on CUNY Start’s staff recruitment, induction, and professional development. CUNY will also create a CUNY Start “Practice Guide.

Synchronous genitourinary lichen sclerosus signals a distinct urinary microbiome profile in men with urethral stricture disease.

PurposeAlterations in the urinary microbiome have been associated with urological diseases. The microbiome of patients with urethral stricture disease (USD) remains unknown. Our objective is to examine the microbiome of USD with a focus on inflammatory USD caused by lichen sclerosus (LS).MethodsWe collected mid-stream urine samples from men with LS-USD (cases; n = 22) and non-LS USD (controls; n = 76). DNA extraction, PCR amplification of the V4 hypervariable region of the 16S rRNA gene, and sequencing was done on the samples. Operational taxonomic units (OTUs) were defined using a > 97% sequence similarity threshold. Alpha diversity measurements of diversity, including microbiome richness (number of different OTUs) and evenness (distribution of OTUs) were calculated and compared. Microbiome beta diversity (difference between microbial communities) relationships with cases and controls were also assessed.ResultsFifty specimens (13 cases and 37 controls) produced a 16S rRNA amplicon. Mean sample richness was 25.9 vs. 16.8 (p = 0.076) for LS-USD vs. non-LS USD, respectively. LS-USD had a unique profile of bacteria by taxonomic order including Bacillales, Bacteroidales and Pasteurellales enriched urine. The beta variation of observed bacterial communities was best explained by the richness.ConclusionsMen with LS-USD may have a unique microbiologic richness, specifically inclusive of Bacillales, Bacteroidales and Pasteurellales enriched urine compared to those with non-LS USD. Further work will be required to elucidate the clinical relevance of these variations in the urinary microbiome

Introduction to IPE: A School-Wide Orientation Initiative

Session Objectives: Present an innovative approach to orienting new students from various healthcare disciplines on Interprofessional Educa(on (IPE). Discuss strategies to shape incoming students’ attitudes toward working in teams. Discuss challenges and opportunities in coordinating a large-­‐scale IPE event. Synopsis Interprofessional experiences are a vital part of healthcare education, and early introduction can positively impact students’ attitudes and knowledge about their team members’ roles. While students at academic health centers (AHC’s) have opportunites to engage in IPE, such opportunites can be overwhelming given significant challenges to coordination and implementation. Addressing these challenges, an interprofessional team at Jefferson School of Health Professions in Philadelphia developed a large-­‐scale event where students could meet other healthcare students and be oriented to IPE as a community. This session discusses the pragmatic and conceptual challenges of the two month planning process of the orientation event, its implementation, and outcomes

The Pic Protease of Enteroaggregative \u3cem\u3eEscherichia coli\u3c/em\u3e Promotes Intestinal Colonization and Growth in the Presence of Mucin

Enteroaggregative Escherichia coli (EAEC) is increasingly being recognized as a cause of diarrheal disease in diverse populations. No small animal model is currently available to study this pathogen. We report here that conventional mice orally inoculated with prototype EAEC strain 042 generally became colonized, though the abundance of organisms cultured from their stool varied substantially among individual animals. In contrast, mice whose water contained 5 g/liter streptomycin consistently became colonized at high levels (ca. 108 CFU/g of stool). Neither conventional nor streptomycin-treated mice developed clinical signs or histopathologic abnormalities. Using specific mutants in competition with the wild-type strain, we evaluated the contribution of several putative EAEC virulence factors to colonization of streptomycin-treated mice. Our data suggest that the dispersin surface protein and Pic, a serine protease autotransporter secreted by EAEC and Shigella flexneri, promote colonization of the mouse. In contrast, we found no role for the aggregative adherence fimbriae, the transcriptional activator AggR, or the surface factor termed Air (enteroaggregative immunoglobulin repeat protein). To study Pic further, we constructed a single nucleotide mutation in strain 042 which altered only the Pic catalytic serine (strain 042PicS258A). Fractionation of the tissue at 24 h and 3 days demonstrated an approximate 3-log10 difference between 042 and 042PicS258A in the lumen and mucus layer and adherent to tissue. Strains 042 and 042PicS258A adhered similarly to mouse tissue ex vivo. While no growth differences were observed in a continuous-flow anaerobic intestinal simulator system, the wild-type strain exhibited a growth advantage over 042PicS258A in a culture of cecal mucus and in cecal contents in vitro; this difference was manifest only after 6 h of growth. Moreover, enhanced growth of the wild type was observed in comparison with that of the mutant in minimal medium containing mucin but not in the absence of mucin. The data suggest a novel metabolic role for the Pic mucinase in EAEC colonization

Pharmacokinetics and Safety of Micafungin in Infants Supported With Extracorporeal Membrane Oxygenation

Candida is a leading cause of infection in infants on extracorporeal membrane oxygenation (ECMO). Optimal micafungin dosing is unknown in this population because ECMO can alter drug pharmacokinetics (PK)

Decoding Continuous Variables from Neuroimaging Data: Basic and Clinical Applications

The application of statistical machine learning techniques to neuroimaging data has allowed researchers to decode the cognitive and disease states of participants. The majority of studies using these techniques have focused on pattern classification to decode the type of object a participant is viewing, the type of cognitive task a participant is completing, or the disease state of a participant's brain. However, an emerging body of literature is extending these classification studies to the decoding of values of continuous variables (such as age, cognitive characteristics, or neuropsychological state) using high-dimensional regression methods. This review details the methods used in such analyses and describes recent results. We provide specific examples of studies which have used this approach to answer novel questions about age and cognitive and disease states. We conclude that while there is still much to learn about these methods, they provide useful information about the relationship between neural activity and age, cognitive state, and disease state, which could not have been obtained using traditional univariate analytical methods