A Scoping Review of Occupational Therapy Approaches to Enable Occupations for People Living with Behavioral Disturbance as a Result of Acquired Brain Injury

Background: Behavioral disturbance impacts almost 50% of people living with acquired brain injury (ABI) and severely impedes occupational participation. Occupational therapists are appropriately qualified and well placed to address behavioral disturbance. This scoping review analyzes the literature to ascertain approaches used by occupational therapists to treat behavioral disturbance. Method: A literature search of three databases revealed 379 papers for consideration, five of which met inclusion criteria. The Critical Appraisal Skills Programme (CASP) checklists were used for the analysis. This paper employs the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) framework. Results: Sensory modulation interventions, community-based interventions, behavior therapy, and neurofunctional activity of daily living (ADL) retraining were identified as approaches that could be used by occupational therapists to promote participation for people living with behavioral disturbance after an ABI. Conclusion: According to current occupational therapy literature, evidenced-based behavioral interventions to enable participation for almost half of people living with an ABI are lacking. To promote the occupational therapy role in this area of rehabilitation, further empirical research is needed

Efferocytosis is an innate antibacterial mechanism

Mycobacterium tuberculosis persists within macrophages in an arrested phagosome and depends upon necrosis to elude immunity and disseminate. Although apoptosis of M. tuberculosis-infected macrophages is associated with reduced bacterial growth, the bacteria are relatively resistant to other forms of death, leaving the mechanism underlying this observation unresolved. We find that after apoptosis, M. tuberculosis-infected macrophages are rapidly taken up by uninfected macrophages through efferocytosis, a dedicated apoptotic cell engulfment process. Efferocytosis of M. tuberculosis sequestered within an apoptotic macrophage further compartmentalizes the bacterium and delivers it along with the apoptotic cell debris to the lysosomal compartment. M. tuberculosis is killed only after efferocytosis, indicating that apoptosis itself is not intrinsically bactericidal but requires subsequent phagocytic uptake and lysosomal fusion of the apoptotic body harboring the bacterium. While efferocytosis is recognized as a constitutive housekeeping function of macrophages, these data indicate that it can also function as an antimicrobial effector mechanism.Behar, Fortune, and Remold labs for reagents, helpful discussion, and insights. TIM4-blocking antibodies were a generous gift of Vijay Kuchroo. Members of the Harvard Electron Microscopy Core Facility helped in the preparation, staining, and operation of the electron microscope. The Small Animal Biocontainment (ABC) Suite is supported by CFAR 5P30AI060354. T.R.R and S.M.F were supported by CFAR 5P30AI060354, DP2-0d001378, and T32-AI07387. C.N.A. is the recipient of a fellowship from FCT. S.M.B and H.G.R. were supported by R56AI084161 and R01AI072143

Validation of the Body Concealment Scale for Scleroderma (BCSS): Replication in the Scleroderma Patient-centered Intervention Network (SPIN) Cohort

© 2016 Elsevier Ltd Body concealment is an important component of appearance distress for individuals with disfiguring conditions, including scleroderma. The objective was to replicate the validation study of the Body Concealment Scale for Scleroderma (BCSS) among 897 scleroderma patients. The factor structure of the BCSS was evaluated using confirmatory factor analysis and the Multiple-Indicator Multiple-Cause model examined differential item functioning of SWAP items for sex and age. Internal consistency reliability was assessed via Cronbach's alpha. Construct validity was assessed by comparing the BCSS with a measure of body image distress and measures of mental health and pain intensity. Results replicated the original validation study, where a bifactor model provided the best fit. The BCSS demonstrated strong internal consistency reliability and construct validity. Findings further support the BCSS as a valid measure of body concealment in scleroderma and provide new evidence that scores can be compared and combined across sexes and ages

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

Applying an occupational lens to thinking about and addressing sexuality

A person’s sexuality exerts a powerful influence on their needs, desires, roles, social relationships and personal identity. This study, explored occupational therapists’ reasoning and practice in relation to the work they do (or do not do) with clients for whom sexual expression has become problematic. The lens used to explore reasoning and practice was a key conceptual framework adopted by occupational therapists, the occupational perspective of health, which considers humans need to do, be, become and belong. Using a qualitative, phenomenographic approach, 16 occupational therapists from across Australia were interviewed to understand the qualitatively variable ways in which they reasoned about practice in relation to the sexual needs of their clients. Four related, layers of ‘conception’ are presented. At a foundational level, we describe how participants conceived of their practice role in relation to assisting people in the doing aspect of sex(uality). At the next, more complex level, participants appeared to conceive of practice in relation to their clients’ being as a sexual person. The next conception related to how therapists think about their clients in their becoming as a sexual being and finally, in their belonging as a sexual being. These conceptual categories, derived both theoretically and empirically are presented as a hierarchically aligned framework, the occupational perspective of sexuality (OPS). While generated from a study of occupational therapists’ reasoning, the OPS has potential to enable a broader, more holistic consideration of sexuality, assisting health care professionals and educators to better understand the ways in which they may address their clients’ needs to do, be, become and belong to their sexuality

Being and becoming a professional : restoring history to the education of health professions

The conveners of this conference have challenged participants to consider whether the University still acts as an environment for developing engaged, disciplined citizens. In this presentation we interrogate student learning in the health professions and a tendency of educators and students to favor ‘forward thinking’ technical rationality, where the history of the discipline and its past ways are considered irrelevant. We contend that a pragmatic, forward thinking approach to learning how to ‘do’ or become ‘competent’ to practise may stand in the way of becoming critically reflective professionals. As Schon (1983) stated “many [professional] practitioners, locked into a view of themselves as technical experts, find nothing in the world of practice to occasion reflection. They become too skillful at techniques of selective inattention, junk categories, and situational control, techniques which they use to preserve the constancy of their knowledge-in-practice” (p.69). How have some health professions come to be framed in such a way that the histories of their emergence have largely been erased from university curricula, and what are the consequences for how students learn to become professional

Bridging identity chasms: Occupational therapy academics' reflections on the journey towards scholarship

The performative context of higher education demands that practice-oriented academics shift their priorities from preparing practitioners for the profession, towards ‘productive’ scholarship. We present narratives from occupational therapy academics at the end of a year-long journey through an action research project focussed on academic identity and scholarly growth. Our analysis captures subtle and striking shifts in being and becoming, doing and belonging. The findings, re-presented as an adapted Hero’s Journey, also reveal the powerful impacts on identity and practice that are enabled when academics have the opportunity to create spaces for scholarship that are experienced as caring, collaborative and collegial

Returning history to the educational formation of health professionals in Australia

History has practically vanished from allied health professional education. We ask, what kind of problem does a ‘history of the professions’ pose for health sciences curriculum? What are the implications of graduates being unschooled in the history of their profession? Literature on knowledge in the curriculum, is used to interrogate how historical knowledge has come to be constituted in professional education fields. We develop a sketch of two particular health professions – occupational therapy and physiotherapy – and ask why it might be difficult to include a history of the profession in these curricula. Our view is that by helping students to cultivate an historical imagination, they can see how their experiences are framed by a fascinating collision of ideas, politics and practices. Furthermore, attention to history can help students better situate their own uncertainties about transitioning to practice enabling them to tackle professional quandaries with hindsight, foresight and insight