Using active learning strategies to teach DPT students how to assertively address inappropriate patient sexual behavior (IPSB)

PURPOSE/HYPOTHESIS Inappropriate sexual behavior is defined as a “verbal or physical act of an explicit, or perceived, sexual nature, which is unacceptable within the social context in which it is carried out.” In a survey of U.S. PTs, 86% of the respondents reported experiencing at least one type of IPSB. PT education programs are required to teach concepts of professional duty, communication skills, and cultural competency, however, management techniques of IPSB in the clinic are not uniformly taught in schools. The use of active learning methods such as role play simulation and small group discussion has been successful with other healthcare professionals allowing students to practice behaviors in a safe place. The aim of this study was to use flipped and active learning methods to effectively teach DPT students assertive approaches to managing IPSB. This study describes the effects on students’ knowledge and attitudes pre- and post-instruction. NUMBER OF SUBJECTS Forty-five first-year DPT students participated as part of a course on psychosocial issues. MATERIALS/METHODS Faculty developed eight case scenarios for the in-class discussion and role play. Students completed pre- and post-class paper surveys about their beliefs and knowledge on IPSB. The flipped model involved reading an assigned article on the topic prior to the class, brief instruction by faculty, interactive small-group discussion, role play, and a large group debrief in class. RESULTS: Forty-three students reported reading the preparatory article prior to class. Significant improvements were observed in students’ perceptions including: 1) the ability to address sexuality with young patients (p CONCLUSIONS The students responded well to the learning experience and believed they improved their ability to address IPSB. There was an interaction between males and females on the self-efficacy question. Females perceived their abilities to be lower than the males initially, but they scored higher post-instruction. While both groups’ perceptions changed, we observed that the females gained more from the experience. We recommend using the flipped classroom model and simulation methods to instruct DPT students in assertive behaviors. CLINICAL RELEVANCE PT’s may encounter IPSB in the clinic. Practicing strategies for these situations could lead to more appropriate therapist-patient interactions and fewer adverse effects. FUNDING SOURCE UNMC Division of Physical Therapy Educatio

Fluid administration rate for uncontrolled intraabdominal hemorrhage in swine

Background We hypothesized that slow crystalloid resuscitation would result in less blood loss and a smaller hemoglobin decrease compared to a rapid resuscitation during uncontrolled hemorrhage. Methods Anesthetized, splenectomized domestic swine underwent hepatic lobar hemitransection. Lactated Ringers was given at 150 or 20 mL/min IV (rapid vs. slow, respectively, N = 12 per group; limit of 100 mL/kg). Primary endpoints were blood loss and serum hemoglobin; secondary endpoints included survival, vital signs, coagulation parameters, and blood gases. Results The slow group had a less blood loss (1.6 vs. 2.7 L, respectively) and a higher final hemoglobin concentration (6.0 vs. 3.4 g/dL). Conclusions Using a fixed volume of crystalloid resuscitation in this porcine model of uncontrolled intraabdominal hemorrhage, a slow IV infusion rate produced less blood loss and a smaller hemoglobin decrease compared to rapid infusion

Issues in accelerometer methodology: the role of epoch length on estimates of physical activity and relationships with health outcomes in overweight, post-menopausal women

<p>Abstract</p> <p>Background</p> <p>Current accelerometer technology allows for data collection using brief time sampling intervals (i.e., epochs). The study aims were to examine the role of epoch length on physical activity estimates and subsequent relationships with clinically-meaningful health outcomes in post-menopausal women.</p> <p>Methods</p> <p>Data was obtained from the Woman On the Move through Activity and Nutrition Study (n = 102). Differences in activity estimates presented as 60s and 10s epochs were evaluated using paired t-tests. Relationships with health outcomes were examined using correlational and regression analyses to evaluate differences by epoch length.</p> <p>Results</p> <p>Inactivity, moderate- and vigorous-intensity activity (MVPA) were significantly higher and light-intensity activity was significantly lower (all <it>P </it>< 0.001) when presented as 10s epochs. The correlation between inactivity and self-reported physical activity was stronger with 10s estimates (<it>P </it>< 0.03); however, the regression slopes were not significantly different. Conversely, relationships between MVPA and body weight, BMI, whole body and trunk lean and fat mass, and femoral neck bone mineral density was stronger with 60s estimates (all <it>P </it>< 0.05); however, regression slopes were similar.</p> <p>Conclusion</p> <p>These findings suggest that although the use of a shorter time sampling interval may suggestively reduce misclassification error of physical activity estimates, associations with health outcomes did not yield strikingly different results. Additional studies are needed to further our understanding of the ways in which epoch length contributes to the ascertainment of physical activity in research studies.</p> <p>Trial Registration</p> <p>Clinical Trials Identifier: NCT00023543</p

Targeted Transthoracic Acoustic Activation of Systemically Administered Nanodroplets to Detect Myocardial Perfusion AbnormalitiesCLINICAL PERSPECTIVE

Liquid core nanodroplets containing condensed gaseous fluorocarbons can be vaporized at clinically relevant acoustic energies, and have been hypothesized as an alternative ultrasound contrast agent instead of gas-core agents. The potential for targeted activation and imaging of these agents was tested with droplets formulated from liquid octafluorpropane (C3) and 1:1 mixtures of C3 with liquid decafluorobutane (C3C4)

ARFI Ultrasound Monitoring of Hemorrhage and Hemostasis In Vivo in Canine Von Willebrand Disease and Hemophilia

A validated method for assessing hemostasis in vivo is critical for testing the hemostatic efficacy of therapeutic agents designed for patients with bleeding disorders such as von Willebrand disease (VWD) and hemophilia A. We hypothesize that rate of bleeding and time to hemostasis can be monitored in vivo by acoustic radiation force impulse (ARFI) ultrasound. We performed ARFI imaging following 12-gauge needle puncture of hind limb muscle encompassing an ~2mm vein in six normal, eight naïve hemophilia A before and after infusing canine factor VIII, three hemophilia A expressing canine factor VIIa following gene transfer, and two naïve VWD dogs. Serial data sets were processed with custom software to (1) estimate the rate of hemorrhage and (2) estimate the time of hemostasis onset. The rate of hemorrhage during the first 30 min following puncture was markedly increased in the VWD dogs relative to normal but was not significantly different between normal, naïve hemophilia A or hemophilia A expressing cFVIIa. ARFI-derived times to hemostasis were significantly longer in naïve hemophilia A dogs than in normal dogs and were shortened by canine coagulation factors VIII and VIIa. These data support our hypothesis that rate of hemorrhage and time to hemostasis in vivo in response to a standardized hemostatic challenge can be detected by ARFI ultrasound in canine models of VWD and hemophilia. These data also suggest that the ARFI-monitored hemostatic challenge is relevant for in vivo testing of the hemostatic efficacy of therapeutic clotting factor replacement products used to treat inherited bleeding disorders

Metabolic Rewiring by Loss of Sirt5 Promotes Kras-induced Pancreatic Cancer Progression.

BACKGROUND & AIMS: SIRT5 plays pleiotropic roles via post-translational modifications, serving as a tumor suppressor, or an oncogene, in different tumors. However, the role SIRT5 plays in the initiation and progression of pancreatic ductal adenocarcinoma (PDAC) remains unknown. METHODS: Published datasets and tissue arrays with SIRT5 staining were used to investigate the clinical relevance of SIRT5 in PDAC. Furthermore, to define the role of SIRT5 in the carcinogenesis of PDAC, we generated autochthonous mouse models with conditional Sirt5 knockout. Moreover, to examine the mechanistic role of SIRT5 in PDAC carcinogenesis, SIRT5 was knocked down in PDAC cell lines and organoids, followed by metabolomics and proteomics studies. A novel SIRT5 activator was utilized for therapeutic studies in organoids and patient-derived xenografts. RESULTS: SIRT5 expression negatively regulated tumor cell proliferation and correlated with a favorable prognosis in PDAC patients. Genetic ablation of Sirt5 in PDAC mouse models promoted acinar-to-ductal metaplasia, precursor lesions, and pancreatic tumorigenesis, resulting in poor survival. Mechanistically, SIRT5 loss enhanced glutamine and glutathione metabolism via acetylation-mediated activation of GOT1. A selective SIRT5 activator, MC3138, phenocopied the effects of SIRT5 overexpression and exhibited anti-tumor effects on human PDAC cells. MC3138 also diminished nucleotide pools, sensitizing human PDAC cell lines, organoids, and patient-derived xenografts to gemcitabine. CONCLUSIONS: Collectively, we identify SIRT5 as a key tumor suppressor in PDAC, whose loss promotes tumorigenesis through increased non-canonical utilization of glutamine via GOT1, and that SIRT5 activation is a novel therapeutic strategy to target PDAC