The Role of Patient and Rehabilitation Factors in the Recovery of Home and Family Work Roles Following Distal Radius Fracture

Background: Distal radius fracture (DRF) is a common upper extremity fracture that causes significant impairment and leads to difficulties in fulfilling important life roles such as indoor and outdoor cleaning, meal preparation, grocery shopping, caring for others, and earning and managing family income. However, clinicians do not routinely address home and family life roles after a DRF. Patient and rehabilitation factors are crucial in addressing home and family work roles (HFWRs). The HFWR questionnaire consists of tasks that are typically performed at home. Objective: The overarching objective of this thesis is to explore the role of patient and rehabilitation factors in the recovery of HFWRs following DRF. Methods: The first manuscript was an exploratory factor analysis (EFA) of the HFWR questionnaire to determine the structural validity in the DRF population and compare the HFWR by gender. The second manuscript was an observational longitudinal cohort study that explored HFWRs performed one week before (retrospective rating) and recovery of those roles three months after fracture. The third manuscript was a qualitative study that explored patients\u27 and clinicians’ perceptions of integrating HFWRs into rehabilitation. Results: An EFA of 115 participants (women 73%; men 27%; mean age = 56 years; 18 to 89 years) yielded a three-factor solution, namely: traditionally masculine roles, traditionally feminine roles, and caregiving roles. Men performed a greater proportion of items 2, 5, 6, and 12 (outdoor cleaning, home repairs, yard work, and maintaining vehicles), and women performed a greater proportion of item 3 (laundry). The second study showed that the proportion of HFWR performed decreased significantly one week after the fracture (n = 115) and returned to pre-fracture level at three months (n = 50). Marital and employment status had a significant influence on HFWRs. Finally, the semi-structured interview of eighteen patients and eleven clinicians provided an in-depth understanding of patients’ and clinicians’ perceptions of integrating HFWRs into rehabilitation. The patient interview yielded five themes: (ⅰ) a positive rehabilitation experience (ⅱ) a predetermined expectation of rehabilitation; (ⅲ) varying patient needs for addressing HFWRs; (ⅳ) the determination to return to valued activities driving behavioural choices; and (ⅴ) incorporating HFWRs into rehabilitation is perceived as beneficial. The clinician interview yielded five themes: (ⅰ) there are challenges in integrating HFWR into rehabilitation; (ⅱ) HFWR is addressed when brought up by a patient; (ⅲ) working context and referral sources influence the rehabilitation plan; (ⅳ) rehabilitation is not explicitly tailored according to sex and gender, and (ⅴ) utilizing HFWR as a rehabilitation strategy is perceived as beneficial. Conclusions: The HFWR questionnaire has demonstrated three-factor structure validity in the DRF population. DRF has a significant short-term impact on HFWR and recovers in three months. Clinicians and patients acknowledge that integrating HFWR into rehabilitation is beneficial but was not a major focus for either the clinician or the expectation of the patients. However, there are challenges in integrating HFWRs into rehabilitation due to the unfavourable working environment, the financial constraints of the patient, and limited time. Keywords: activities of daily living, function, clinicians, distal radius fracture, sex, gender, factor analysis, life roles

Patterns of Telehealth Usage at a Medical School Ambulatory Practice Before and During the COVID-19 Pandemic

What might the attendee be able to do after being in your session? The attendee may be able to better organize their practice in anticipation of future issues that may affect patients’ ability to present to clinic. Furthermore, the attendee may be able to better accommodate patients and provide a higher quality of care via delivery through different healthcare access modes. Description of Problem or Gap Although Telehealth use had been on a slow rise for many years, it significantly increased with the onset of the COVID-19 crisis. The stay at home orders and isolation procedures dramatically changed the way patients could access healthcare and Telehealth became a valuable tool to facilitate contactless access. The objective of this study is to elucidate how patients’ access to health care changed during the pandemic and determine if different access methods (i.e., audio-only, audio with video, or face-to-face visits) were associated with specific diagnoses or patient populations. Methods: This study is a retrospective, cross-sectional study of clinic EHR (Epic) data from the Western Michigan University Homer Stryker, M.D., School of Medicine (WMed)’s ambulatory clinic from 1/2/20-12/30/21. Microsoft Excel/Python were utilized to tabulate descriptive statistics. Results: Usage of Telehealth peaked in April 2020 at the onset of the pandemic with Audio and Video visits reaching 45.8% and 18.07% of total visits, respectively. The next three months showed Audio and Video visits decline to a steady average of 12.47% and 3.58%, respectively. Fluctuations closely followed local COVID-19 case trends. Adult Video visits were most associated with psychiatric diagnoses, while video visits were most associated with the pediatric diagnoses of developmental delay and dermatitis. While White Americans and African Americans made up 62.2% and 22% of total Office visits, respectively, Video visit proportions shifted to 73.3% for White Americans and 11.8% for Black Americans. Discussion of Results: Audio and Video visits remain as continuously utilized methods of receiving healthcare even after COVID-19 mandatory closures with increases in usage predictable during worsening public health situations. Furthermore, different healthcare modalities were utilized heavily for specific diseases. Lastly, Telehealth did show differences in usage between racial/ethnic groups indicating variation in access to healthcare. Conclusion: Telehealth has become integrated into our healthcare system, remaining a viable avenue for accessing care. Differing access patterns by different patient groups and for different predominant diagnoses suggest Telehealth carries varying value propositions in a healthcare landscape marked by inequities in access to care. Attendee’s Take-away Tool: The take-away tool is the strategy for organizing a medical practice to provide improved healthcar

Fast, scalable, Bayesian spike identification for multi-electrode arrays

We present an algorithm to identify individual neural spikes observed on high-density multi-electrode arrays (MEAs). Our method can distinguish large numbers of distinct neural units, even when spikes overlap, and accounts for intrinsic variability of spikes from each unit. As MEAs grow larger, it is important to find spike-identification methods that are scalable, that is, the computational cost of spike fitting should scale well with the number of units observed. Our algorithm accomplishes this goal, and is fast, because it exploits the spatial locality of each unit and the basic biophysics of extracellular signal propagation. Human intervention is minimized and streamlined via a graphical interface. We illustrate our method on data from a mammalian retina preparation and document its performance on simulated data consisting of spikes added to experimentally measured background noise. The algorithm is highly accurate

Addressing the contribution of previously described genetic and epidemiological risk factors associated with increased prostate cancer risk and aggressive disease within men from South Africa

BACKGROUND: Although African ancestry represents a significant risk factor for prostate cancer, few studies have investigated the significance of prostate cancer and relevance of previously defined genetic and epidemiological prostate cancer risk factors within Africa. We recently established the Southern African Prostate Cancer Study (SAPCS), a resource for epidemiological and genetic analysis of prostate cancer risk and outcomes in Black men from South Africa. Biased towards highly aggressive prostate cancer disease, this is the first reported data analysis. METHODS: The SAPCS is an ongoing population-based study of Black men with or without prostate cancer. Pilot analysis was performed for the first 837 participants, 522 cases and 315 controls. We investigate 46 pre-defined prostate cancer risk alleles and up to 24 epidemiological measures including demographic, lifestyle and environmental factors, for power to predict disease status and to drive on-going SAPCS recruitment, sampling procedures and research direction. RESULTS: Preliminary results suggest that no previously defined risk alleles significantly predict prostate cancer occurrence within the SAPCS. Furthermore, genetic risk profiles did not enhance the predictive power of prostate specific antigen (PSA) testing. Our study supports several lifestyle/environmental factors contributing to prostate cancer risk including a family history of cancer, diabetes, current sexual activity and erectile dysfunction, balding pattern, frequent aspirin usage and high PSA levels. CONCLUSIONS: Despite a clear increased prostate cancer risk associated with an African ancestry, experimental data is lacking within Africa. This pilot study is therefore a significant contribution to the field. While genetic risk factors (largely European-defined) show no evidence for disease prediction in the SAPCS, several epidemiological factors were associated with prostate cancer status. We call for improved study power by building on the SAPCS resource, further validation of associated factors in independent African-based resources, and genome-wide approaches to define African-specific risk alleles

Heralded generation of entangled photon pairs

Entangled photons are a crucial resource for quantum communication and linear optical quantum computation. Unfortunately, the applicability of many photon-based schemes is limited due to the stochastic character of the photon sources. Therefore, a worldwide effort has focused in overcoming the limitation of probabilistic emission by generating two-photon entangled states conditioned on the detection of auxiliary photons. Here we present the first heralded generation of photon states that are maximally entangled in polarization with linear optics and standard photon detection from spontaneous parametric down-conversion. We utilize the down-conversion state corresponding to the generation of three photon pairs, where the coincident detection of four auxiliary photons unambiguously heralds the successful preparation of the entangled state. This controlled generation of entangled photon states is a significant step towards the applicability of a linear optics quantum network, in particular for entanglement swapping, quantum teleportation, quantum cryptography and scalable approaches towards photonics-based quantum computing

Using small molecules to facilitate exchange of bicarbonate and chloride anions across liposomal membranes

Bicarbonate is involved in a wide range of biological processes, which include respiration, regulation of intracellular pH and fertilization. In this study we use a combination of NMR spectroscopy and ion-selective electrode techniques to show that the natural product prodigiosin, a tripyrrolic molecule produced by microorganisms such as Streptomyces and Serratia, facilitates chloride/bicarbonate exchange (antiport) across liposomal membranes. Higher concentrations of simple synthetic molecules based on a 4,6-dihydroxyisophthalamide core are also shown to facilitate this antiport process. Although it is well known that proteins regulate Cl-/HCO3- exchange in cells, these results suggest that small molecules may also be able to regulate the concentration of these anions in biological systems

Sequential occurrence of thrombotic thrombocytopenic purpura, essential thrombocythemia, and idiopathic thrombocytopenic purpura in a 42-year-old African-American woman: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Thrombotic thrombocytopenic purpura and idiopathic thrombocytopenic purpura are two well recognized syndromes that are characterized by low platelet counts. In contrast, essential thrombocythemia is a myeloproliferative disease characterized by abnormally high platelet numbers.</p> <p>The coexistence of thrombotic thrombocytopenic purpura and idiopathic thrombocytopenic purpura in a single patient has been reported in the literature on a few occasions. However, having essential thrombocythemia complicating the picture has never been reported before.</p> <p>Case presentation</p> <p>We present a case where thrombotic thrombocytopenic purpura, essential thrombocythemia, and idiopathic thrombocytopenic purpura were diagnosed in a 42-year-old African-American woman in the space of a few years; we are reporting this case with the aim of drawing attention to this undocumented occurrence, which remains under investigation.</p> <p>Conclusions</p> <p>As the three conditions have different natural histories and require different treatment modalities, it is important to recognize that these diseases may be seen sequentially. This case emphasizes the importance of reviewing peripheral blood smears for evaluation of thrombocytopenia and bone marrow aspirations for diagnosis of thrombocythemia in order to reach an accurate diagnosis and tailor therapy accordingly. Moreover, this case demonstrates the variability and complexity of platelet disorders. This occurrence of three different types of platelet disorders in one patient remains a pure observation on our part; regardless, this does raise the possibility of a common underlying, as yet undiscovered, pathophysiology that could explain the phenomenon.</p

Association of the 894G>T polymorphism in the endothelial nitric oxide synthase gene with risk of acute myocardial infarction

Background: This study was designed to investigate the association of the 894G>T polymorphism in the eNOS gene with risk of acute myocardial infarction (AMI), extent of coronary artery disease (CAD) on coronary angiography, and in-hospital mortality after AMI. Methods: We studied 1602 consecutive patients who were enrolled in the GEMIG study. The control group was comprised by 727 individuals, who were randomly selected from the general adult population. Results: The prevalence of the Asp298 variant of eNOS was not found to be significantly and independently associated with risk of AMI (RR = 1.08, 95%CI = 0.77–1.51, P = 0.663), extent of CAD on angiography (OR = 1.18, 95%CI = 0.63–2.23, P = 0.605) and in-hospital mortality (RR = 1.08, 95%CI = 0.29–4.04, P = 0.908). Conclusion: In contrast to previous reports, homozygosity for the Asp298 variant of the 894G>T polymorphism in the eNOS gene was not found to be associated with risk of AMI, extent of CAD and in-hospital mortality after AM

Identification and Typing of Human Enterovirus: A Genomic Barcode Approach

Identification and typing of human enterovirus (HEVs) are important to pathogen detection and therapy. Previous phylogeny-based typing methods are mainly based on multiple sequence alignments of specific genes in the HEVs, but the results are not stable with respect to different choices of genes. Here we report a novel method for identification and typing of HEVs based on information derived from their whole genomes. Specifically, we calculate the k-mer based barcode image for each genome, HEV or other human viruses, for a fixed k, 1<k<7, where a genome barcode is defined in terms of the k-mer frequency distribution across the whole genome for all combinations of k-mers. A phylogenetic tree is constructed using a barcode-based distance and a neighbor-joining method among a set of 443 representative non-HEV human viruses and 395 HEV sequences. The tree shows a clear separation of the HEV viruses from all the non-HEV viruses with 100% accuracy and a separation of the HEVs into four distinct clads with 93.4% consistency with a multiple sequence alignment-based phylogeny. Our detailed analyses of the HEVs having different typing results by the two methods indicate that our results are in better agreement with known information about the HEVs