A Non-Pharmaceutical Approach to Chronic Pain: An OT’s Perspective

The following project was created for advocacy and education of occupational therapy\u27s role in chronic pain management. This project focuses on occupational therapist\u27s ability to utilize non-pharmaceutical interventions to manage chronic pain symptoms. The capstone outlines fitness-based exercises, aquatic therapy, ergonomics, adaptive equipment, and adaptive strategies by supporting their efficacy in recent literature. Occupational therapists possess invaluable skills that can impact the chronic pain community for the better. They can aid in the reduction of pain while increasing overall quality of life and independence. Occupational therapists are a much needed resource in chronic pain management.https://soar.usa.edu/otdcapstonespring2020/1012/thumbnail.jp

A Study of Ligand Coordination at Lanthanide and Group 4 Metal Centers by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry

Reactions of lanthanide amide reagents Ln{N(SiMe3)2}3 (where Ln = Sm, Gd, Ho, or Yb) with amine-bis(phenol) ligands were probed using inert atmosphere matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) (anthracene matrix); the technique rapidly confirms ligand coordination, giving excellent agreement with theoretical isotope patterns for lanthanide(amine-phenolate) fragments. Spectra on isolated lanthanide amine-bis(phenolate) amido complexes are similar to those seen from small scale parallel reactions of metal amides and protonated ligands. Although in all cases molecular ion peaks are not observed, peaks for lanthanide arene complexes, [M + arene]+•, formed in situ, are seen. The lack of molecular ion peak is due to difficulties in ionizing Ln3+ complexes by charge transfer. However, if Nujol is used to disperse the analyte and matrix prior to analysis rather than toluene, arene adducts are not observed. Similar phenol-derived ligands can be reacted with diamagnetic M(NMe2)4 (where M = Ti or Zr), and amine-phenolate complex formation is again confirmed easily by MALDI-TOF MS or LDI-TOF MS (no matrix). These complexes were also characterized by NMR spectroscopy and elemental analysis on isolated samples

Effects of GSK3-β Inhibitors on Wnt Signaling in Zebrafish Fin Regeneration: Chemical Biology

In order to develop beneficial drugs for osteoporosis it is important to understand the molecular mechanisms of bone regeneration and define specific regulatory factors. Zebrafish can regenerate damaged tissues, and they prove to be a good model to study bone growth and repair. Previous research showed that GSK3β inhibitor compound at various concentrations and for different treatment periods effectively stimulated fin regeneration. Conducted experiments identified temporal and spatial fluctuations on individual gene markers after GSK3β inhibitor treatment at various concentrations. Recent analyzed data uses the Lilly Research Labs experimental compound LSN 2105786 at 3 nM and 5 nM to stimulate tissue regeneration to determine whether activating Wnt signaling produces cell proliferation and β-catenin translocation to the nucleus for zebrafish bone regeneration. This research has potential to identify mechanism of bone growth and repair, leading to more suitable drugs for patients suffering with osteoporosis.This work was supported by a research grant from Lilly Research Labs. Angelica Brannick and Jennifer Mahin were supported by the IUPUI UROP/CRL program

Many Labs 5:Testing pre-data collection peer review as an intervention to increase replicability

Replication studies in psychological science sometimes fail to reproduce prior findings. If these studies use methods that are unfaithful to the original study or ineffective in eliciting the phenomenon of interest, then a failure to replicate may be a failure of the protocol rather than a challenge to the original finding. Formal pre-data-collection peer review by experts may address shortcomings and increase replicability rates. We selected 10 replication studies from the Reproducibility Project: Psychology (RP:P; Open Science Collaboration, 2015) for which the original authors had expressed concerns about the replication designs before data collection; only one of these studies had yielded a statistically significant effect (p < .05). Commenters suggested that lack of adherence to expert review and low-powered tests were the reasons that most of these RP:P studies failed to replicate the original effects. We revised the replication protocols and received formal peer review prior to conducting new replication studies. We administered the RP:P and revised protocols in multiple laboratories (median number of laboratories per original study = 6.5, range = 3?9; median total sample = 1,279.5, range = 276?3,512) for high-powered tests of each original finding with both protocols. Overall, following the preregistered analysis plan, we found that the revised protocols produced effect sizes similar to those of the RP:P protocols (?r = .002 or .014, depending on analytic approach). The median effect size for the revised protocols (r = .05) was similar to that of the RP:P protocols (r = .04) and the original RP:P replications (r = .11), and smaller than that of the original studies (r = .37). Analysis of the cumulative evidence across the original studies and the corresponding three replication attempts provided very precise estimates of the 10 tested effects and indicated that their effect sizes (median r = .07, range = .00?.15) were 78% smaller, on average, than the original effect sizes (median r = .37, range = .19?.50)

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Proceedings of the Thirteenth International Society of Sports Nutrition (ISSN) Conference and Expo

Meeting Abstracts: Proceedings of the Thirteenth International Society of Sports Nutrition (ISSN) Conference and Expo Clearwater Beach, FL, USA. 9-11 June 201

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Synthesis of amine-phenol ligands in water – a simple demonstration of a hydrophobic effect

The synthesis in water of a series of tetradentate amine-phenol ligands derived from formaldehyde, 2,4-disubstituted phenols and amines is presented. These molecules, which are used in catalyst development, include 4,6-di-alkyl-2-bis(2-methoxyethyl)aminomethylphenols and 4,6-di-tert-amyl-2-bis(3-(dimethylamino)propyl)aminomethylphenols. Yields were generally greater than reactions performed in methanol and near quantitative for hydrophobic phenols

Medication use evaluation of intravenous promethazine

Introduction: Intravenous (IV) promethazine is FDA approved for treatment, prevention, and control of nausea and vomiting. It is a vesicant. Some complications of administration can include burning, erythema, tissue necrosis, and gangrene. Some cases require surgical intervention. The manufacturer recommends concentrations no greater than 25 mg/ml and infusing no faster than 25 mg/minute. In September 2009, the FDA required manufacturers add black box warning for the risk of IV promethazine administration causing serious tissue injury. In 2007, IV promethazine was added to ISMP List of High Alert Medications in Acute Settings, and in 2018-2019 ISMP Best practice recommends to remove all injectable promethazine from the hospital and to classify as non-formulary. ASHP issues policy position IV promethazine may used when clinically warranted, despite recognized risks. Research Question or Hypothesis: When dosed and administered as recommended, IV promethazine has reduced risk for infusion-related adverse effects. The primary endpoint is the frequency of adverse reactions with IV promethazine. Study Design: Retrospective chart review using descriptive statistics for results. Methods: Subjects at Emory Saint Joseph\u27s Hospital were randomly selected from a promethazine drug utilization report from January 1st to December 31 st of 2017. Data collected includes patient age, gender, weight, dose and indication for promethazine, date and time administered, administration site, infusion duration, additional antiemetics, antiemetic allergies, length of stay, adverse reactions, and outcome of adverse reaction. Results: 157 patients were randomly selected for analysis from 848 patients. 987 doses were analyzed for these patients, promethazine was the second antiemetic administered for 123 Of 157 patients analyzed. One patient had an adverse drug reaction with a possible link to intravenous promethazine (\u3c1%). The reaction was edema and erythema at the site of injection, which subsided without further incident after the site of injection was changed. Conclusion: IV promethazine is a reasonable alternative for preventing or managing nausea and vomiting