Rehabilitation among individuals with traumatic brain injury who intersect with the criminal justice system: A scoping review

Traumatic brain injury (TBI), a leading cause of morbidity and mortality globally, is highly prevalent among individuals who intersect with the criminal justice system (CJS). It is well-established that TBI negatively impacts individuals' interactions both within the CJS and upon release and is associated with serious disciplinary charges and higher recidivism rates. Although rehabilitation is fundamental to TBI recovery, it is not known to what extent rehabilitation is available to, or used by, individuals who intersect with the CJS. This scoping review explores the availability and extent of rehabilitation for individuals with TBI who intersect with the CJS, based on available literature. A systematic search of electronic databases (MEDLINE, Embase, Cochrane CENTRAL Register of Clinical Trials, CINAHL, APA PsycINFO, Applied Social Sciences Index and Abstracts, and Proquest Nursing and Allied Health), relevant organizations' websites, and reference lists of eligible articles identified 22 peer-reviewed articles and 2 gray literature reports that met predetermined eligibility criteria. Extracted data were synthesized through a descriptive numerical summary and qualitative content analysis. This review provides evidence that existing rehabilitation interventions are already serving individuals with TBI with a history of CJS involvement; however, they rarely consider or acknowledge TBI or CJS in their interventions. Findings also suggest opportunities to integrate rehabilitation for individuals with TBI who intersect with the CJS through TBI screening, education on TBI within CJS settings, and linkages to the community to facilitate continuity of care. This review also highlights significant gaps in knowledge regarding sex, gender, and other intersecting factors. Research to understand how these experiences impact the rehabilitation process throughout the CJS is urgently needed to enable timely and appropriate rehabilitation and continuity of care for diverse individuals with TBI who intersect with the CJS

Gas hydrate formation in Gulf of Mexico sediments

Gas hydrate formation was studied in Gulf of Mexico (GOM) sediments. Sediments studied were from six-meter long cores from Mississippi Canyon Block 118 and a 27-meter core from a cruise in 2002 of the Marion Dufresne. These sediments retained their in situ seawater before testing. Hydrate formation rate and induction times were measured. The hydrate memory effect was studied in GOM sediments with and without in situ seawater. Hydrate induction time was short when in situ seawater was present. Bioproducts adsorbed on particles in the sediments are postulated to shorten the induction times by maintaining seawater structuring around coated particles. Hydrate nucleation was studied by Dynamic Light Scattering and Scanning Electron Microscopy. Particles around 50 to 100 nm nucleated hydrate formation. These small nucleating particles appeared to be clays or surfactant molecules and interactions thereof. Hydrate capillaries were studied and found to be at least 100 nm in diameter because the sediment nucleating particles with bioproducts diffused through the hydrate capillaries. Large complexes of nontronite smectite clay and Emulsan, an anionic biosurfactant, were found to facilitate hydrate formation. It was determined that Emulsan entered the interlayer of nontronite. The clay contents of the GOM sediments were determined. All sediments contained smectite, illite, chlorite, and kaolinite in different proportions. The study gave new insight into the gas hydrate formation mechanism in seafloor sediments

Enhancement of gas hydrate formation in Gulf of Mexico sediments

Gas hydrate induction times and formation rates in seawater-saturated sand/clay packs are catalyzed in the laboratory by a few ppm of biosurfactants. To determine if biosurfactants are indigenous to sediments near Gulf of Mexico gas-hydrates, such sediment samples were analyzed for catalytic effects on hydrate formation. This paper addresses the relationships of biosurfactants, sand, and clays with gas hydrate formation rates, induction times, and form (dispersed, nodular, stratified, massive), relating these factors to gas hydrate occurrence in GOM sediments

Interprofessional Collaborative Practice to Improve Patient Outcomes: A Pilot Study

This project focused on a pilot project implemented during the 2013-2014 academic year. The overall purpose was to facilitate interprofessional collaborative practice innovations through the development of leadership, core competencies, and the use of technology, especially among nurses. Nursing, medicine, and physician assistant students were educated on the IOM competencies for interprofessional teams and the core competencies identified by the Interprofessional Education Collaborative Expert Panel [1] to develop knowledge, skills, and attitudes needed to practice in the collaborative practice environments. The project addressed four goals: Develop faculty expertise and leadership in interprofessional collaborative practice to provide a current, high quality education to nursing, physician assistant, and medical students; Implement a culturally responsive and respectful collaborative interprofessional practice curriculum to prepare nurses, physician assistants, and medical students to deliver high quality, efficient, team-based care in a dynamically evolving environment; Focus interprofessional collaborative practice education on models and practices that lead to improvement in patient outcomes; and Evaluate the program and disseminate best practices. Findings from this pilot include strategies to engage different health professions' students and faculty, partnering with community agencies, building an effective interprofessional team to guide the project, and seeking funding for extension and expansion of the offerings

How well does objective examination of professionalism discriminate medical students practice commensurate with regulatory expectations?

Background: The development and attainment of professional identity includes the need to meet the standards of the professional regulator, in the UK this is the General Medical Council’s Good Medical Practice (GMP)1. Whilst it can be challenging to integrate this reality of medical practice into curricular and assessment methodologies2 various multi-dimensional, multiparadigmatic approaches to assess professionalism have been described3,4 including simulated situations5. Within an Objective Structured Clinical Examination (OSCE) we aimed to design and assess the performance of a station using GMP as the assessment framework for professionalism6. Its developmental emphasis was formative, with verbal and written feedback and access to learning resources. Methodology: Using an iterative approach, we constructed an OSCE station with student and actor as foundation year 1 doctors, where a medical peer appears not fit for work due to health problems. The station assessed knowledge, skills and attitude, including the duty to raise appropriate concern about a colleague, inter-professional communication and protecting patients. After the 2016 iteration, performance data, examiner and student feedback were used to improve the assessment for 2017. Subsequent examiner feedback and a student focus group were used to understand the station’s educational impact. Performance data were analysed using regression analysis, measuring reliability with Cronbach’s alpha. Results: Examiners and students felt the station worked well but students confused a private conversation with a colleague with the duty of confidentiality for patients, as well as the need to act promptly. Students were uncertain as to whom they should escalate concerns. Within focus groups students spoke in terms of what they “should have” done suggesting the emergence of greater insight. However, only one looked at GMP after the assessment. In 2016 examiners found the binary assessment ‘check-list’ failed to discriminate students with partial insight from those with none, thus in 2017 a qualitative global rating scale was used. In 2016 station fail rate was 34%, R2 was 0.86 with 56% variance related to the circuit and 0.02 Alpha difference on deletion. Whereas in 2017 the fail rate was 24%, R2 was 0.80 with 20% variance related to the circuit and -0.06 Alpha difference on deletion. The inter-circuit variation in the 2016 iteration although not ideal is difficult to interpret as there were only small numbers of students; a maximum of 6 per circuit and 8 circuits in total. The professionalism station contributed to overall OSCE reliability in 2016 as Cronbach’s alpha went down on deletion but not in 2017. The correlation between marks and overall rating of performance was very good for both iterations, slightly stronger for the 2016 ‘check list’ mark scheme. Discrimination was also good for both stations, again better in 2016, 14.6% and 10.6% respectively. Discrimination between borderline and clearly passing students was less clear with a global rating scale but clearly failing or very good students were distinct. Examiner narrative supported the 2017 iteration’s ability to identify students who had clearly recognized the fundamental actions required. Discussion: The OSCE model can use a professional framework, in this case GMP, in the assessment of professionalism in the context of a situational judgement with reasonable discrimination of student performance. OSCE station design and marking should to be linked to students’ prior contextual experience where global ratings and examiner narrative appear to better assess performance. However a binary mark scheme discriminates well, but when used performance expectations need to reflect learner context. Although more work is needed to understand the impact of this approach on professional practice, graduates may benefit from revisiting these scenarios as they may feel more ‘real’ or relevant which may help to reinforce what was previously learned. References: 1. GMC (2013), Good Medical Practice. 2. O’Sulivan, H. et al (2012) Integrating professionalism into the curriculum: AMEE Guide No.61, Medical Teacher, 34:2, e64-e77 3. Hodges, B. et al (2011) Assessment of professionalism: Recommendations from the Ottawa 2010 Conference, Medical Teacher, 33:5, 354-363. 4. Goldie, J. (2013) Assessment of professionalism: A consolidation of current thinking, Medical Teacher, 35:2, e952-e956 5. van Zanten, M. et al (2005) Using a standardised patient assessment to measure professional attributes, Medical Education, 39: 20-29. 6. GMC (2016) Achieving good medical practice: guidance for medical students

Attenuated PGI2 synthesis in obese Zucker rats

In obesity, skeletal muscle blood flow during exercise (functional hyperemia) is impaired. We have indirectly demonstrated that an altered arachidonic acid metabolism is responsible for the impaired functional vasodilation in the obese Zucker rat (OZR), a model of obesity. In this study, we tested the hypothesis that there is an impaired release of PGI2 due to a nitration of PGI2 synthase (PGIS), which is associated with a decreased prostanoid receptor expression. PGI2, PGE2, and thromboxane A2 (TXA2) release were determined in vitro using ELISA under basal conditions and in response to arachidonic acid (AA) administration (50 μM). Immunofluorescence of PGI2 and TXA2 receptors (IP and TP, respectively) was determined in dispersed vascular smooth muscle cells (VSMCs). Nitration of tyrosine residues of the PGIS enzyme was determined using immunoprecipitation and Western blot analysis. Following AA administration, PGI2 and PGE2 release were attenuated in OZR compared with lean Zucker rats (LZR; controls). Basal and AA-induced TXA2 release were not significantly different between groups. IP and TP immunofluorescence were not significantly different between OZR and LZR groups. OZR exhibited elevated nitration of tyrosine residues of PGIS compared with LZR. These results suggest that alterations in the PGI2 pathway (attenuated PGI2 synthesis), and not the TXA2 pathway (normal TXA2 synthesis/no change in TP receptor expression), underlie the attenuated functional hyperemia in the OZR