Interoception Toolkit: A Resource For Occupational Therapy Practitioners To Use With Children And Their Families

Purpose: Interoception refers to one’s ability to sense the internal condition of the body, including sensory messages from body parts and internal organs (Craig, 2002). In the past 30 years, scientists and researchers have discovered a powerful connection between interoceptive appraisal skills and self-regulation, emotional identification, emotional regulation, social skills, and nearly every task in daily life (Mahler, 2017). The purpose of this project is to provide practitioners with an educational platform that describes the sensorimotor skill of interoception applied throughout the occupational therapy process. Methods: The development of this product was initiated with a thorough review of literature to identify areas of need. Types of sources included online databases such as CINAHL, Pubmed, Google Scholar, and the University of North Dakota Scholarly Commons. Key resources that informed the project discussed the neuroscience of interoception (Critchley et al., 2014; Stern et al., 2017; Quadt, Critchley, & Garfinkel, 2018), interoception and self-regulation, (Füstös et al., 2012; Mahler, 2017), interoception and emotion (Mahler, 2017; Nummenmaa et al., 2014; Herbert et al., 2011; Mahler 2019), interoception and occupations/tasks (Williams & Shellenberger, 1996), and the relationship between interoception and contextual factors (Dean et al., 2010; Zhou et al., 2021; Stern et al., 2017). After careful review of theories and models, the Ecological Model of Human Performance (EHP) was chosen to guide the development and content within the product. EHP emphasizes the dynamic, interdependent relationship between a person’s skills/abilities and the contexts in which they are embedded in (Dunn, 2017). Results: An interoception toolkit and manual for practitioners was created. This toolkit and manual has six sections: Introduction to the Manual, Introduction to Interoception, Evaluation/Assessment of Interoception, Interoception Intervention Framework, Documentation and Outcomes, and Opportunities for Specialized Interoception Programming. Conclusion: This educational platform was created to increase awareness of, and increase the use of interoception-based practices in pediatric occupational therapy. It is anticipated that this product will address a need for innovative, evidence-based occupational therapy interventions that target self-regulation, emotional regulation, social skills, and self-care skills for children

Occupational therapy intervention approaches for successful employment outcomes for individuals with an intellectual disability

“Disability is an umbrella term, covering impairments, activity limitations, and participation restrictions. Disability is thus not just a health problem. It is a complex phenomenon, reflecting the interaction between features of a person’s body and features of the society in which he or she lives” (Boyt Schell & Gillen, 2019, pp. 1196). Disability is a natural part of the human experience, and does not inhibit an individual’s ability to successfully contribute to society. “Intellectual disability is a developmental disability that is diagnosed before the age of 18 and expected to last throughout life. It involves significant limitations in intellectual functioning and adaptive behavior” (Johnson & Blaskowtiz, 2017, p. 3). According to the US Bureau of Labor Statistics, persons with a disability have significantly lower employment rates than persons without a disability (2020). Disability is a natural part of the human experience, and does not inhibit an individual’s ability to successfully contribute to society. “The unemployment rate for adults with intellectual disability is more than twice as high as those without disabilities, with only 44% of adults with intellectual disability aged 21 to 64 years participating in the labor force (Johnson & Blaskowtiz, 2017, p.4). Legislation has been implemented to support individuals with intellectual disabilities including American Disability Act (ADA), Individuals with Disabilities Education Act (IDEA), and Workforce Innovation and Opportunity Act (WIOA) (Cleary & Persch, 2020)

Hospital staff, volunteers’ and patients’ perceptions of barriers and facilitators to communication following stroke in an acute and a rehabilitation private hospital ward: A qualitative description study

Objectives To explore barriers and facilitators to patient communication in an acute and rehabilitation ward setting from the perspectives of hospital staff, volunteers and patients following stroke. Design A qualitative descriptive study as part of a larger study which aimed to develop and test a Communication Enhanced Environment model in an acute and a rehabilitation ward. Setting A metropolitan Australian private hospital. Participants Focus groups with acute and rehabilitation doctors, nurses, allied health staff and volunteers (n=51), and interviews with patients following stroke (n=7), including three with aphasia, were conducted. Results The key themes related to barriers and facilitators to communication, contained subcategories related to hospital, staff and patient factors. Hospital-related barriers to communication were private rooms, mixed wards, the physical hospital environment, hospital policies, the power imbalance between staff and patients, and task-specific communication. Staff-related barriers to communication were staff perception of time pressures, underutilisation of available resources, staff individual factors such as personality, role perception and lack of knowledge and skills regarding communication strategies. The patient-related barrier to communication involved patients’ functional and medical status. Hospital-related facilitators to communication were shared rooms/co-location of patients, visitors and volunteers. Staff-related facilitators to communication were utilisation of resources, speech pathology support, staff knowledge and utilisation of communication strategies, and individual staff factors such as personality. No patient-related facilitators to communication were reported by staff, volunteers or patients. Conclusion Barriers and facilitators to communication appeared to interconnect with potential to influence one another. This suggests communication access may vary between patients within the same setting. Practical changes may promote communication opportunities for patients in hospital early after stroke such as access to areas for patient co-location as well as areas for privacy, encouraging visitors, enhancing patient autonomy, and providing communication-trained health staff and volunteers

What is the effect of interrupting prolonged sitting with frequent bouts of physical activity or standing on first or recurrent stroke risk factors? A scoping review

The objective of this review was to ascertain the scope of the available literature on the effects of interrupting prolonged sitting time with frequent bouts of physical activity or standing on stroke and recurrent stroke risk factors. Databases Medline, Embase, AMED, CINAHL and Cochrane library were comprehensively searched from inception until 21st February 2018. Experimental trials which interrupted sitting time with frequent bouts of physical activity or standing in adults (≥ 18 years) were included. Comparison to a bout of prolonged sitting and a measure of at least one first or recurrent stroke risk factor was required to be included. Overall, 30 trials (35 articles) were identified to meet the inclusion criteria. Fifteen trials were completed in participants at an increased risk of having a first stroke and one trial in participants at risk of a recurrent stroke. Outcomes of hypertension and dysglycemia were found to be more favourable following predominately light- to moderate-intensity bouts of physical activity or standing compared to sitting in the majority of trials in participants at risk of having a first stroke. In the one trial of stroke survivors, only outcomes of hypertension were significantly improved. These findings are of significant importance taking into consideration hypertension is the leading risk factor for first and recurrent stroke. However, trials primarily focused on measuring outcomes of dysglycemia and without assessing a dose-response effect. Additional research is required on the dose-response effect of interrupting sitting with frequent bouts of physical activity or standing on first and recurrent stroke risk factors, in those high risk population groups

Study Design and Evaluation of Risk Minimization Measures: A Review of Studies Submitted to the European Medicines Agency for Cardiovascular, Endocrinology, and Metabolic Drugs

Introduction: Studies measuring the effectiveness of risk minimization measures (RMMs) submitted by pharmaceutical companies to the European Medicines Agency are part of the post-authorization regulatory requirements and represent an important source of data covering a range of medicinal products and safety-related issues. Their objectives, design, and the associated regulatory outcomes were reviewed, and conclusions were drawn that may support future progress in risk minimization evaluation. Methods: Information was obtained from risk management plans, study protocols, clinical study reports, and assessment reports of 157 medicinal products authorized for cardiovascular, endocrinology, and metabolic indications. We selected observational studies measuring, as outcomes o

Seasonal and Nonseasonal Longitudinal Variation of Immune Function

Different components of the immune response show large variability between individuals, but they also vary within the same individual because of host and environmental factors. In this study, we report an extensive analysis of the immune characteristics of 56 individuals over four timepoints in 1 single year as part of the Human Functional Genomics Project. We characterized 102 cell subsets using flow cytometry; quantified production of eight cytokines and two chemokines in response to 20 metabolic, bacterial, fungal, and viral stimuli; and measured circulating markers of inflammation. Taking advantage of the longitudinal sampling, both seasonal and nonseasonal sources of variability were studied. The circulating markers of inflammation IL-18, IL-18 binding protein, and resistin displayed clear seasonal variability, whereas the strongest effect was observed for alpha-1 antitrypsin. Cytokine production capacity also showed strong seasonal changes, especially after stimulation with the influenza virus, Borrelia burgdorferi, and Escherichia coli. Furthermore, we observed moderate seasonality effects on immune cell counts, especially in several CD4(+)/CD8(+) T cell subpopulations. Age of the volunteers was an important factor influencing IFN-gamma and IL-22 production, which matched the strong impact of age on several T cell subsets. Finally, on average, genetics accounted for almost 50% of the interindividual variance not already explained by age, sex, and body mass index, although this varies strongly for different parameters. In conclusion, seasonality is an important environmental factor that influences immune responses, in addition to specific genetic and nongenetic host factors, and this may well explain the seasonal variation in the incidence and severity of immune-mediated diseases

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts

Pan-cancer Alterations of the MYC Oncogene and Its Proximal Network across the Cancer Genome Atlas

Although theMYConcogene has been implicated incancer, a systematic assessment of alterations ofMYC, related transcription factors, and co-regulatoryproteins, forming the proximal MYC network (PMN),across human cancers is lacking. Using computa-tional approaches, we define genomic and proteo-mic features associated with MYC and the PMNacross the 33 cancers of The Cancer Genome Atlas.Pan-cancer, 28% of all samples had at least one ofthe MYC paralogs amplified. In contrast, the MYCantagonists MGA and MNT were the most frequentlymutated or deleted members, proposing a roleas tumor suppressors.MYCalterations were mutu-ally exclusive withPIK3CA,PTEN,APC,orBRAFalterations, suggesting that MYC is a distinct onco-genic driver. Expression analysis revealed MYC-associated pathways in tumor subtypes, such asimmune response and growth factor signaling; chro-matin, translation, and DNA replication/repair wereconserved pan-cancer. This analysis reveals insightsinto MYC biology and is a reference for biomarkersand therapeutics for cancers with alterations ofMYC or the PMN

Genomic, Pathway Network, and Immunologic Features Distinguishing Squamous Carcinomas

This integrated, multiplatform PanCancer Atlas study co-mapped and identified distinguishing molecular features of squamous cell carcinomas (SCCs) from five sites associated with smokin

Spatial Organization and Molecular Correlation of Tumor-Infiltrating Lymphocytes Using Deep Learning on Pathology Images

Beyond sample curation and basic pathologic characterization, the digitized H&E-stained images of TCGA samples remain underutilized. To highlight this resource, we present mappings of tumorinfiltrating lymphocytes (TILs) based on H&E images from 13 TCGA tumor types. These TIL maps are derived through computational staining using a convolutional neural network trained to classify patches of images. Affinity propagation revealed local spatial structure in TIL patterns and correlation with overall survival. TIL map structural patterns were grouped using standard histopathological parameters. These patterns are enriched in particular T cell subpopulations derived from molecular measures. TIL densities and spatial structure were differentially enriched among tumor types, immune subtypes, and tumor molecular subtypes, implying that spatial infiltrate state could reflect particular tumor cell aberration states. Obtaining spatial lymphocytic patterns linked to the rich genomic characterization of TCGA samples demonstrates one use for the TCGA image archives with insights into the tumor-immune microenvironment