“Putting on our people lens”: Lived Experience as Pedagogy

In the professional education of mental health practitioners, including occupational therapists, there has been a lack of meaningful inclusion of people labeled with mental illness into curricula, beyond guest speaker panels and presentations. This study explored the experiences of students, faculty, and ‘Experts by Experience’ within a mental health occupational therapy course that incorporated Experts with lived experience as co-facilitators of weekly fieldwork debriefs. The study utilized focus groups and interviews to understand the experiences of students, mental health faculty, and ‘Experts by Experience’. Key themes that emerged from the qualitative data analysis were organized under three broad categories: 1) Students experienced powerful insights, 2) Experts conveyed the complexity of the work, and 3) Faculty grew from co-creating learning experiences with the Experts. This research makes a significant contribution to occupational therapy education by shifting the Expert’s role beyond traditional speaker panels or storytelling. This broader responsibility elevated experiential knowledge into the realm of practice in clinical reasoning by shifting the context of the knowledge from storytelling to support practice reasoning. While this created significant learning opportunities for the students, it also did appear to cause emotional risk for the ‘Experts by Experience’. It is important that efforts to include ‘Experts by Experience’ in curriculum also include sources of support and financial remuneration

Self-selected Foot Strike Patterns in Runners when Transitioning from the Shod to Barefoot Condition: A Systematic Review of the Literature

Purpose and Background: Recent research has begun to focus on foot strike patterns as they relate to injuries in runners. Runners who employ a rear-foot strike (RFS) pattern (in which the heel lands before the ball of the foot) are more likely to experience repetitive stress injuries such as tibial stress fractures, patellofemoral pain syndrome (PFPS), and plantar fasciitis. Conversely, runners demonstrating a forefoot strike (FFS) pattern (defined as the ball of the foot-usually the 4th and 5th metatarsal heads-landing before the heel) are more susceptible to Achilles tendon, plantarflexor, and metatarsal injuries. Several systematic studies have concluded that barefoot runners employed a FFS pattern while shod runners used a RFS pattern. The purpose of this systematic review was to determine the effects of transitioning from traditionally shod running to barefoot running on self-selected initial contact patterns in long distance runners.https://jdc.jefferson.edu/dptcapstones/1010/thumbnail.jp

Low-Intrusion Techniques and Sensitive Information Management for Warhead Counting and Verification: FY2012 Annual Report

Progress in the second year of this project is described by the series of technical reports and manuscripts that make up the content of this report. These documents summarize successes in our goals to develop our robust image-hash templating and material-discrimination techniques and apply them to test image data

Imaging for dismantlement verification: information management and analysis algorithms

The level of detail discernible in imaging techniques has generally excluded them from consideration as verification tools in inspection regimes. An image will almost certainly contain highly sensitive information, and storing a comparison image will almost certainly violate a cardinal principle of information barriers: that no sensitive information be stored in the system. To overcome this problem, some features of the image might be reduced to a few parameters suitable for definition as an attribute. However, this process must be performed with care. Computing the perimeter, area, and intensity of an object, for example, might reveal sensitive information relating to shape, size, and material composition. This paper presents three analysis algorithms that reduce full image information to non-sensitive feature information. Ultimately, the algorithms are intended to provide only a yes/no response verifying the presence of features in the image. We evaluate the algorithms on both their technical performance in image analysis, and their application with and without an explicitly constructed information barrier. The underlying images can be highly detailed, since they are dynamically generated behind the information barrier. We consider the use of active (conventional) radiography alone and in tandem with passive (auto) radiography

Intra-Accumbens Injection of a Dopamine Aptamer Abates MK-801-Induced Cognitive Dysfunction in a Model of Schizophrenia

Systemic administration of the noncompetitive NMDA-receptor antagonist, MK-801, has been proposed to model cognitive deficits similar to those seen in patients with schizophrenia. The present work investigated the ability of a dopamine-binding DNA aptamer to regulate these MK-801-induced cognitive deficits when injected into the nucleus accumbens. Rats were trained to bar press for chocolate pellet rewards then randomly assigned to receive an intra-accumbens injection of a DNA aptamer (200 nM; n = 7), tris buffer (n = 6) or a randomized DNA oligonucleotide (n = 7). Animals were then treated systemically with MK-801 (0.1 mg/kg) and tested for their ability to extinguish their bar pressing response. Two control groups were also included that did not receive MK-801. Data revealed that injection of Tris buffer or the random oligonucleotide sequence into the nucleus accumbens prior to treatment with MK-801 did not reduce the MK-801-induced extinction deficit. Animals continued to press at a high rate over the entire course of the extinction session. Injection of the dopamine aptamer reversed this MK-801-induced elevation in lever pressing to levels as seen in rats not treated with MK-801. Tests for activity showed that the aptamer did not impair locomotor activity. Results demonstrate the in vivo utility of DNA aptamers as tools to investigate neurobiological processes in preclinical animal models of mental health disease

Polygenic prediction of educational attainment within and between families from genome-wide association analyses in 3 million individuals

We conduct a genome-wide association study (GWAS) of educational attainment (EA) in a sample of ~3 million individuals and identify 3,952 approximately uncorrelated genome-wide-significant single-nucleotide polymorphisms (SNPs). A genome-wide polygenic predictor, or polygenic index (PGI), explains 12-16% of EA variance and contributes to risk prediction for ten diseases. Direct effects (i.e., controlling for parental PGIs) explain roughly half the PGI's magnitude of association with EA and other phenotypes. The correlation between mate-pair PGIs is far too large to be consistent with phenotypic assortment alone, implying additional assortment on PGI-associated factors. In an additional GWAS of dominance deviations from the additive model, we identify no genome-wide-significant SNPs, and a separate X-chromosome additive GWAS identifies 57

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Association of whole-genome and NETRIN1 signaling pathway-derived polygenic risk scores for Major Depressive Disorder and white matter microstructure in UK Biobank

Background: Major depressive disorder is a clinically heterogeneous psychiatric disorder with a polygenic architecture. Genome-wide association studies have identified a number of risk-associated variants across the genome and have reported growing evidence of NETRIN1 pathway involvement. Stratifying disease risk by genetic variation within the NETRIN1 pathway may provide important routes for identification of disease mechanisms by focusing on a specific process, excluding heterogeneous risk-associated variation in other pathways. Here, we sought to investigate whether major depressive disorder polygenic risk scores derived from the NETRIN1 signaling pathway (NETRIN1-PRSs) and the whole genome, excluding NETRIN1 pathway genes (genomic-PRSs), were associated with white matter microstructure. Methods: We used two diffusion tensor imaging measures, fractional anisotropy (FA) and mean diffusivity (MD), in the most up-to-date UK Biobank neuroimaging data release (FA: n = 6401; MD: n = 6390). Results: We found significantly lower FA in the superior longitudinal fasciculus (β = −.035, p =.029) and significantly higher MD in a global measure of thalamic radiations (β =.029, p =.021), as well as higher MD in the superior (β =.034, p =.039) and inferior (β =.029, p =.043) longitudinal fasciculus and in the anterior (β =.025, p =.046) and superior (β =.027, p =.043) thalamic radiation associated with NETRIN1-PRS. Genomic-PRS was also associated with lower FA and higher MD in several tracts. Conclusions: Our findings indicate that variation in the NETRIN1 signaling pathway may confer risk for major depressive disorder through effects on a number of white matter tracts

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

Effects of the Insect Growth Regulator, Novaluron on Immature Alfalfa Leafcutting Bees, Megachile rotundata

Alfalfa leafcutting bees, Megachile rotundata F. (Hymenoptera: Megachilidae), are the most common pollinators of alfalfa in the Pacific Northwest. Reports from users of M. rotundata in Idaho, Utah and Colorado have indicated exceptionally poor bee return from fields treated with novaluron to control Lygus spp. Our goal was to evaluate novaluron toxicity to immature M. rotundata using two different possible mechanisms of exposure. One goal was to assess immature mortality via treating nectar-pollen provisions and adults with novaluron. Immature M. rotundata mortality in all novaluron provision dosing treatments was significantly higher than the water or blank controls, providing evidence that novaluron is toxic to progeny in nest cells. The mean cumulative frequency showed that more eggs and 1st–2nd instars died compared to older instars. Female M. rotundata nested similarly in field cages during the field cage experiment; however, there was greater immature mortality in cages where females were fed sugar-water + novaluron compared to sugar-water only. Although females provided adequate provisions, there was a low percentage of egg hatch and larval development when females ingested novaluron before mating and nesting. Novaluron was also present in egg provision of bees collecting resources from novaluron-sprayed plants. At least 84% of progeny died when the females were allowed to mate and nest 24 hours after a novaluron application. Novaluron could be contributing to poor bee return in alfalfa grown for seed. Timely insecticide applications to suppress Lygus spp. is an important consideration to improve ongoing bee health.This article is from The Journal of Insect Science 11 (2011): 1–10, doi:10.1673/031.011.0143.</p