Occupational Therapy: The Supports and Barriers to Practice

Background: The United States population is aging due to advances in healthcare and the aging of the “baby boomers generation” and the rate of aging is set to be the next public health challenge (Quarterman, 2017). Purpose: To address the unique nature of providing skilled therapy services in rural communities. To gain insight into the recruitment and retention of occupational therapists to rural communities. Theoretical Framework: The Model of Human Occupation (MOHO) (Kielhofner,2008) theory explains how occupations motivate participants in their environments supported by habits and roles in which they engage. Methods: Quantitative design using a descriptive method research approach for understanding the reasons occupational therapists choose to work in rural communities by identifying meaningful concrete relations to describe the original experience (Taylor, 2017). Results: A total of 151 therapists completed the online survey in full or in part through Google forms. The participants worked in a variety of rural community settings and were well-educated therapists. Conclusions: The findings of this research gives insight into the unique needs of rural occupational therapy practitioners. Rural practice has been described as a specialty practice requiring a great deal of knowledge on a variety of patient conditions and patient ages

A preliminary investigation of adult defence style and physiological reactivity to infant distress signals

Species whose offspring require extended care-giving ought to be predisposed to being biologically responsive to their infant\u27s signalling. This paper examined the interplay between biological and psychological aspects of adult response to an infant\u27s distress. HR (heart rate) and GSR (galvanic skin response) were recorded continuously, while 50 adults listened to white noise and an infant cry audio recording. Participants completed the defence style questionnaire and the state trait anxiety inventory. HR acceleration occurred in response to the control sound, while HR decelerated in response to the infant cry. GSR responsiveness was positively correlated with immature and neurotic defence styles. When controlling for other variables, immature defence was a unique and independent predictor of GSR change in response to infant distress. Defence demonstrated a stronger relationship than self-reported anxiety, than that with physiological responsiveness. Employing defence mechanisms appears to reduce an individual\u27s perceived anxiety, though it has little effect on physiological arousal levels

In vitro/in vivo assessment of novel 99mTc-bombesin conjugates in human cancer tissue [abstract]

Abstract only availableReceptor-specific, radiolabeled peptides are becoming increasingly popular as targeting vectors for the development of new diagnostic radiopharmaceuticals. The over-expression of certain receptors such as the gastrin releasing peptide receptor (GRPr) on human cancer cells makes this method of drug development a viable tool for tumor targeting in vivo. Breast, pancreatic, prostate, gastric, colon, and small-cell lung cancer have demonstrated GRPr expression. In this project, we have conjugated a diaminoproionic acid (DPR) bifunctional chelator to bombesin (BBN) peptide targeting vector by solid phase peptide synthesis. BBN is an analogue of human gastrin releasing peptide (GRP) that binds to the GRPr with high affinity and specificity. Conjugates of the general structure [DPR-(X)-BBN(7-14)NH2] (X = a series of amino acid pharmacokinetic modifiers) were purified by reverse-phase high-performance liquid chromatography and characterized by electrospray-ionization mass spectrometry. Radiolabeling investigations of with fac-[99mTc(CO)3(H2O)3]+ (Isolink®) provided for metallated conjugates of the following general structure: [99mTc(CO)3-DPR-(X)-BBN(7-14)NH2]. These new conjugates demonstrated the ability to target specific human tumors in rodent models. Subsequent radiolabeling studies of [DPR-(X)-BBN(7-14)NH2] with fac-[188Re(CO)3(H2O)3]+, the therapeutic surrogate precursor of Tc-99m, have given us the potential to treat specific human tumors via these new targeting vectors. Detailed radiolabeling protocols, in vitro cell binding studies, and in vivo biodistribution assays will be reported.Harry S. Truman Memorial VA Hospita

HIV-associated neurocognitive disorder in Australia: a case of a high-functioning and optimally treated cohort and implications for international neuroHIV research

Abstract The Australian HIV-infected (HIV+) population is largely comprised of high-functioning men who have sex with men (MSM). Like other English-speaking countries, Australia mostly relies on US neuropsychological normative standards to detect and determine the prevalence of neurological disorders. Whether the US neuropsychological (NP) normative standards are appropriate in Australian HIV+ MSM has not been established. Ninety virally suppressed HIV+ and 49 HIV-uninfected (HIV−) men (respectively 86 and 85 % self-reported MSM; mean age 54 and 56 years, mean premorbid verbal IQ estimate 110 and 111) undertook standard NP testing. The raw neuropsychological data were transformed using the following: (1) US standards as uncorrected scaled scores and demographically corrected T scores (US norms); and (2) z scores (without demographic corrections) derived from Australian comparison group scaled scores (local norms). To determine HIV-associated neurocognitive disorder prevalence, we used a standard definition of impairment based upon a battery-wide summary score: the global deficit score (GDS). Impairment classification (GDS≥0.5) based on the local norms was best at discriminating between the two groups (HIV− = 14.3 % vs. HIV+ = 53.3 %; p<0.0001). This definition was significantly associated with age. Impairment classification based on the US norms yielded much lower impairment rate regardless of the HIV status (HIV−=4.1 % vs. HIV+=14.7 %; p= 0.05), but was associated with historical AIDS, and not age. Both types of summary scores were associated with reduced independence in activities of daily living (p≤ 0.03). Accurate neuropsychological classifications of high (or low) functioning individuals may need country-specific norms that correct for performancebased (e.g., reading) estimates of premorbid cognition in addition to the traditional demographic factors

Too Stressed to Persist to Graduation: Accessing Financial Aid at a Historically Black University (HBU) in Texas

Abstract Inadequate financial aid adversely affects students’ persistence through college graduation. This qualitative study at a Historically Black University (HBU) in the Southwestern region employed purposive sampling to examine 10 former students’ perception of financial aid accessibility and its impact on their non-persistence status. Barriers impeding financial aid accessibility and persistence to graduation are shared.  Data collection consisted of recorded responses from open-end questions. A thorough analysis of participant interviews and findings confirmed the existence of barriers obstructing financial aid accessibility and contribute to the phenomena of non-persistence.  The emergent themes significantly contribute to research that informs higher education practitioners and policy makers. In particular, this study serves as a stimulus for dialogue about the need to implement systems and strategies that ensure financial aid support to persistence through graduation at historically Black colleges and universities. Keywords: financial aid packages, non-persistence, barriers, need-based and merit-based financial aid, loan debt, allocation formulas, HBCUs, PWI

Preliminary evidence of emotional processing impairment in HIV infected individuals

1 page(s

Management issues in HIV-associated neurocognitive disorders

The incidence of human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) decreased with the introduction of combined antiretroviral therapy (cART), but there is now evidence that HAND is persisting and developing despite effective HIV suppression and the absence of other confounds. HAND in the cART era is different. The main issues are: (1) HIV disease is now a chronic disorder spanning decades. While acute and subacute presentations of HAND still occur, there is mounting evidence that it is based on cumulative brain damage. Furthermore, the pathogenetic significance of continuing HIV replication as the main factor in such brain damage is still unclear. (2) As HIV disease is a chronic disorder with increased life expectancy, the effects of aging are now becoming important. Their impact and significance on the pathogenesis of HAND are only beginning to be grasped. (3) In addition to aging, there is the increased risk of the effects of comorbid conditions (eg, cardiovascular and kidney diseases). The optimal treatment of HAND in the context of cART has not yet been established with any certainty. As a general principle, systemic HIV disease must be well controlled. There is increasing evidence that central nervous system disease should also be well controlled and may require specific antiretroviral drugs that have the ability to effectively penetrate the central nervous system. The role of adjunctive therapies remains hypothetical. Research to date has shown that all adjunctive therapies have thus far failed to show any significant benefit. In this paper, we provide an updated review of the clinical presentation and neuropsychological profile in the cART era. We also review the current HAND diagnostic nomenclature in respect to both its recommendations and limitations. This is followed by discussion of the main management issues for persisting HAND, including screening algorithms and optimal therapeutic options. Finally, we explore the use of everyday life assessment methods and recommendations.11 page(s

Facial emotional processing in HIV infection : relation to neurocognitive and neuropsychiatric status

Objective: To examine facial emotional processing in HIV+ individuals and its relation to neurocognitive performance, neuropsychiatric symptomatology and immune status. Method: Participants included 85 HIV+ individuals (83 males, 2 females) and 25 age-comparable HIV- individuals (22 males, 3 females). Participants underwent The University of Pennsylvania computerized neuropsychological facial emotion test battery, standardized neuropsychological testing, neurobehavioral questionnaires, a semistructured psychiatric interview, and an assessment of independence in activities of daily living. Results: Relative to HIV- controls, HIV+ individuals showed a mild difference for recognition of sadness (p = .02, d = 0.43), discrimination of happiness (p = .02, d = 0.52), and speed of recognition for fear (p = .04, d = 0.37). HIV+ individuals with HIV-associated neurocognitive disorder (HAND; 20%) had abnormal emotional facial recognition (p = .04; d = .59), and slower recognition of negative facial expressions (p < .01; d = .63-.83), as well as poorer discrimination of happy facial expressions (p < .003, d = .83). Apathy, depression, reduced independence in activities of daily living, and HIV biomarkers were not associated with reduced facial emotion recognition in the HIV+ group. Conclusions: Clinically stable HIV+ individuals show a mild level of emotional processing reduction that is dissociated from neuropsychiatric complaints. Individuals with HAND showed moderate to large emotional processing abnormalities, particularly for the timely recognition of negative expressions (fear, sadness, and anger). These findings warrant a more comprehensive and dynamic evaluation of emotional processing in HIV infection and an investigation of the integrity of the fronto-basal-amygdala circuits.10 page(s

Glutamate excitotoxicity, cortical and subcortical neuronal damage as potential markers of HIV-associated neurocognitive disorder (HAND) : a 1H-MRS and neuropsychological study

Background: Chronic brain HIV infection and aging may lead to new europathological processes. Methods: 54 HIV+ adults aged 54 ± 7 on HAART (Plasma and CSF (N = 26) HIV RNA < 50 cp/mL in 96%; median CD4 = 526) and 11 demographically-comparable controls underwent neuropsychological testing, mood examination, blood tests, and single voxel 1H-MRS at 3T: Right frontal white matter (FWM), posterior cingulate cortex (PCC) and right caudate area (Caud) metabolites were quantified using jMRUI with baseline and water corrections. Regression models investigated factors associated with brain metabolites: 1. Neurocognitive model; 2. HIV biomarker model, 3. Cardiovascular model, 4. Multivariate model combining factors at p < .10. Overall neurocognitive impairment was defined by the Global Deficit Score. Results: Relative to controls, HIV+ individuals demonstrated significantly increased FWM glutamine/glutamate (Glx) (d = .64; p < .04); decreased PCC N-Acetylaspartate (NAA) (d = .50; p = .07), and PCC increased myo-Inositol/Creatine (mIo/Cr) (d= .57; p < .16); and decreased Caud NAA (d = .59; p < .02). Higher FWM Glx was associated with lower PCC NAA (r = -.33; p < .02). 20% of the HIV+ group were classified as neurocognitively impaired versus 0% in the HIV- group; p < .05. Caud NAA was decreased in the impaired HIV+ group (d = .50; p < .20). Memory performance; serum b2-microglobulin, HIV duration and Framingham cardio-vascular risk were retained in the multivariate model and showed: b2-microglobulin negatively correlated with FWM Glx (p < .02), but positively with PCC mIo/Cr (p < .05). Lower memory performance (p = .05) was associated with lower PCC NAA. Cardio-vascular risks were associated with lower PCC NAA and lower memory performance only in initial models (p < .05). In the HIV+ group, higher depressive, and apathy complaints were associated with lower Caud NAA (p < .05). Conclusion: Ongoing excitotoxicity despite viral suppression was found in areas of the brain that have been classically involved in HIV infection, linked to injury in new areas. This suggests a hybrid development: classical HAND plus new pathological process involving posterior cortical areas.2 page(s

HIV, vascular and aging injuries in the brain of clinically stable HIV-infected adults : a ¹H MRS study

BACKGROUND: Cardiovascular disease (CVD) and premature aging have been hypothesized as new risk factors for HIV associated neurocognitive disorders (HAND) in adults with virally-suppressed HIV infection. Moreover, their significance and relation to more classical HAND biomarkers remain unclear. METHODS: 92 HIV- infected (HIV+) adults stable on combined antiretroviral therapy (cART) and 30 age-comparable HIV-negative (HIV-) subjects underwent ¹H Magnetic Resonance Spectroscopy (MRS) of the frontal white matter (targeting HIV, normal aging or CVD-related neurochemical injury), caudate nucleus (targeting HIV neurochemical injury), and posterior cingulate cortex (targeting normal/pathological aging, CVD-related neurochemical changes). All also underwent standard neuropsychological (NP) testing. CVD risk scores were calculated. HIV disease biomarkers were collected and cerebrospinal fluid (CSF) neuroinflammation biomarkers were obtained in 38 HIV+ individuals. RESULTS: Relative to HIV- individuals, HIV+ individuals presented mild MRS alterations: in the frontal white matter: lower N-Acetyl-Aspartate (NAA) (p<.04) and higher myo-inositol (mIo) (p<.04); in the caudate: lower NAA (p = .01); and in the posterior cingulate cortex: higher mIo (p<.008- also significant when Holm-Sidak corrected) and higher Choline/NAA (p<.04). Regression models showed that an HIV*age interaction was associated with lower frontal white matter NAA. CVD risk factors were associated with lower posterior cingulate cortex and caudate NAA in both groups. Past acute CVD events in the HIV+ group were associated with increased mIo in the posterior cingulate cortex. HIV duration was associated with lower caudate NAA; greater CNS cART penetration was associated with lower mIo in the posterior cingulate cortex and the degree of immune recovery on cART was associated with higher NAA in the frontal white matter. CSF neopterin was associated with higher mIo in the posterior cingulate cortex and frontal white matter. CONCLUSIONS: In chronically HIV+ adults with long-term viral suppression, current CVD risk, past CVD and age are independent factors for neuronal injury and inflammation. This suggests a tripartite model of HIV, CVD and age likely driven by chronic inflammation.12 page(s