Promoting Participant and Community Participation at Saddle Up!

This capstone project was completed through partnership with Saddle Up!, in Franklin, Tennessee. Saddle Up! is a nonprofit adaptive barn providing children and youth with disabilities the opportunity to grow and develop through therapeutic, educational, and recreational activities with horses. The primary focus of this project was to create a volunteer training manual for operating the mechanical lift. The deliverable was a PowerPoint which bridged the gap between instructor and volunteer knowledge. It included step by step instructions, as well as education on how to best support participants during the lift process. The secondary focus of the project was educating local organizations that serve children and youth with disabilities on Saddle Up’s Equine Assisted Learning (EAL) program. Education was provided to advocate for the EAL program, and how it benefits children and youth and with disabilities. The final focus of the project was to adapt and refurbish gait trainers for participant use to promote participation. After researching and consulting with experts, it was determined it was not best practice to utilize one gait trainer for multiple children. The deliverable included a resource to educate the staff of Saddle Up! on the purpose of gait trainers, and energy conservation techniques in order to promote participant participation

Use of a 3-item short-form version of the Barthel Index for use in stroke: systematic review and external validation

Background and Purpose—There may be a potential to reduce the number of items assessed in the Barthel Index (BI), and shortened versions of the BI have been described. We sought to collate all existing short-form BI (SF-BI) and perform a comparative validation using clinical trial data. Methods—We performed a systematic review across multidisciplinary electronic databases to find all published SF-BI. Our validation used the VISTA (Virtual International Stroke Trials Archive) resource. We describe concurrent validity (agreement of each SF-BI with BI), convergent and divergent validity (agreement of each SF-BI with other outcome measures available in the data set), predictive validity (association of prognostic factors with SF-BI outcomes), and content validity (item correlation and exploratory factor analyses). Results—From 3546 titles, we found 8 articles describing 6 differing SF-BI. Using acute trial data (n=8852), internal reliability suggested redundancy in BI (Cronbach α, 0.96). Each SF-BI demonstrated a strong correlation with BI, modified Rankin Scale, National Institutes of Health Stroke Scale (all ρ≥0.83; P<0.001). Using rehabilitation trial data (n=332), SF-BI demonstrated modest correlation with quality of life measures Stroke Impact Scale and 5 domain EuroQOL (ρ≥0.50, P<0.001). Prespecified prognostic factors were associated with SF-BI outcomes (all P<0.001). Our factor analysis described a 3 factor structure, and item reduction suggested an optimal 3-item SF-BI comprising bladder control, transfer, and mobility items in keeping with 1 of the 3-item SF-BI previously described in the literature. Conclusions—There is redundancy in the original BI; we have demonstrated internal and external validity of a 3-item SF-BI that should be simple to use

Nonalbuminuric Renal Impairment in Type 2 Diabetic Patients and in the General Population (National Evaluation of the Frequency of Renal Impairment cO-existing with NIDDM [NEFRON] 11)

OBJECTIVE Most diabetic patients with impaired renal function have a urinary albumin excretion rate in the normal range. In these patients, the etiology of renal impairment is unclear, and it is also unclear whether this nonalbumunuric renal impairment is unique to diabetes. RESEARCH DESIGN AND METHODS In this study, we examined the frequency and predictors of nonalbumunuric renal impairment (estimated glomerular filtration rate [eGFR] <60 ml/min per 1.73 m(2)) in a nationally representative cohort of 3,893 patients with type 2 diabetes and compared our findings with rates observed in the general population from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) survey (n = 11,247). RESULTS Of the 23.1% of individuals with type 2 diabetes who had eGFR <60 ml/min per 1.73 m(2) (95% CI 21.8-24.5%), more than half (55%) had a urinary albumin excretion rate that was persistently in the normal range. This rate of renal impairment was predictably higher than that observed in the general population (adjusted odds ratio 1.3, 95% CI 1.1-1.5, P < 0.01) but was solely due to chronic kidney disease associated with albuminuria. In contrast, renal impairment in the absence of albuminuria was less common in those with diabetes than in the general population, independent of sex, ethnicity, and duration of diabetes (0.6, 0.5-0.7, P < 0.001). CONCLUSIONS Nonalbuminuric renal impairment is not more common in those with diabetes. However, its impact may be more significant. New studies are required to address the pathogenesis, prevention, and treatment of nonalbuminuric renal disease

The biological embedding of early-life socioeconomic status and family adversity in children's genome-wide DNA methylation.

AimTo examine variation in child DNA methylation to assess its potential as a pathway for effects of childhood social adversity on health across the life course.Materials &amp; methodsIn a diverse, prospective community sample of 178 kindergarten children, associations between three types of social experience and DNA methylation within buccal epithelial cells later in childhood were examined.ResultsFamily income, parental education and family psychosocial adversity each associated with increased or decreased DNA methylation (488, 354 and 102 sites, respectively) within a unique set of genomic CpG sites. Gene ontology analyses pointed to genes serving immune and developmental regulation functions.ConclusionFindings provided support for DNA methylation as a biomarker linking early-life social experiences with later life health in humans

On the context-dependent scaling of consumer feeding rates

This is the final version. Available from Wiley via the DOI in this record.The stability of consumer–resource systems can depend on the form of feeding interactions (i.e.functional responses). Size-based models predict interactions–and thus stability–based on con-sumer–resource size ratios. However, little is known about how interaction contexts (e.g. simpleor complex habitats) might alter scaling relationships. Addressing this, we experimentally mea-sured interactions between a large size range of aquatic predators (4–6400 mg over 1347 feedingtrials) and an invasive prey that transitions among habitats: from the water column (3D interac-tions) to simple and complex benthic substrates (2D interactions). Simple and complex substratesmediated successive reductions in capture rates–particularly around the unimodal optimum–and promoted prey population stability in model simulations. Many real consumer–resource sys-tems transition between 2D and 3D interactions, and along complexity gradients. Thus, Context-Dependent Scaling (CDS) of feeding interactions could represent an unrecognised aspect of foodwebs, and quantifying the extent of CDS might enhance predictive ecology

Assemblage structure: an overlooked component of human-mediated species movements among freshwater ecosystems

The spread and impact of alien species among freshwater ecosystems has increased with global trade and human movement; therefore, quantifying the role of anthropogenic and ecological factors that increase the risk of invasion is an important conservation goal. Two factors considered as null models when assessing the potential for invasion are colonization pressure (i.e., the number of species introduced) and propagule pressure [i.e., the number (propagule size), and frequency (propagule number), of individuals of each species introduced]. We translate the terminology of species abundance distributions to the invasion terminology of propagule size and colonization size (PS and CS, respectively). We conduct hypothesis testing to determine the underlying statistical species abundance distribution for zooplankton assemblages transported between freshwater ecosystems; and, on the basis of a lognormal distribution, construct four hypothetical assemblages spanning assemblage structure, rank-abundance gradient (e.g., even vs uneven), total abundance (of all species combined), and relative contribution of PS vs CS. For a given CS, many combinations of PS and total abundance can occur when transported assemblages conform to a lognormal species abundance distribution; therefore, for a given transportation event, many combinations of CS and PS are possible with potentially different ecological outcomes. An assemblage exhibiting high PS but low CS (species poor, but highly abundant) may overcome demographic barriers to establishment, but with lower certainty of amenable environmental conditions in the recipient region; whereas, the opposite extreme, high CS and low PS (species rich, but low abundance per species) may provide multiple opportunities for one of n arriving species to circumvent environmental barriers, albeit with lower potential to overcome demographic constraints. Species abundance distributions and the corresponding influence of CS and PS are some of many influential factors (e.g., demographic and genetic stochasticity, environmental variability, composition of recipient ecosystems) that will help refine an understanding of establishment risk following the human-mediated movement of species

Modeling sampling strategies for determination of zooplankton abundance in ballast water

Ballast water has been a major source of non-indigenous species introductions. The International Maritime Organization has proposed performance standard that will establish an upper limit for viable organisms in discharged ballast. Here we test different sampling efforts for zooplankton in ballast water on a commercial vessel. We fit different probability density functions to find the most representative and evaluated sampling efforts necessary to achieve error rates (α, β) of \u3c 0.05. Our tests encompassed four seasonal trials and five sample volumes. To estimate error rates, we performed simulations which drew from 1 to 30 replicates of each volume (0.10–3.00m3) for mean densities ranging between 1 and 20 organisms m− 3. Fieldwork and simulations suggested that \u3e 0.5 m3samples had the best accuracy and precision, and that the Poisson distribution fit these communities best. This study provides the first field test of a sampling strategy to assess compliance with the future IMO standard for large vessels. © 2016 Elsevier Lt

Clinical selection strategies to identify ischemic stroke patients with large anterior vessel occlusion: results from SITS-ISTR (Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry)

Background and Purpose—The National Institutes of Health Stroke Scale (NIHSS) correlates with presence of large anterior vessel occlusion (LAVO). However, the application of the full NIHSS in the prehospital setting to select patients eligible for treatment with thrombectomy is limited. Therefore, we aimed to evaluate the prognostic value of simple clinical selection strategies. Methods—Data from the Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry (January 2012–May 2014) were analyzed retrospectively. Patients with complete breakdown of NIHSS scores and documented vessel status were included. We assessed the association of prehospital stroke scales and NIHSS symptom profiles with LAVO (internal carotid artery, carotid-terminus or M1-segment of the middle cerebral artery). Results—Among 3505 patients, 23.6% (n=827) had LAVO. Pathological finding on the NIHSS item best gaze was strongly associated with LAVO (adjusted odds ratio 4.5, 95% confidence interval 3.8–5.3). All 3 face–arm–speech–time test (FAST) items identified LAVO with high sensitivity. Addition of the item gaze to the original FAST score (G-FAST) or high scores on other simplified stroke scales increased specificity. The NIHSS symptom profiles representing total anterior syndromes showed a 10-fold increased likelihood for LAVO compared with a nonspecific clinical profile. If compared with an NIHSS threshold of ≥6, the prehospital stroke scales performed similarly or even better without losing sensitivity. Conclusions—Simple modification of the face–arm–speech–time score or evaluating the NIHSS symptom profile may help to stratify patients’ risk of LAVO and to identify individuals who deserve rapid transfer to comprehensive stroke centers. Prospective validation in the prehospital setting is required

Coagulation and fibrinolytic activity of tenecteplase and alteplase in acute ischemic stroke

Background and Purpose—We compared the fibrinolytic activity of tenecteplase and alteplase in patients with acute ischemic stroke, and explored the association between hypofibrinogenaemia and intracerebral hemorrhage. Methods—Venous blood samples from a subgroup of participants in the Alteplase–Tenecteplase Trial Evaluation for Stroke Thrombolysis (ATTEST) study were obtained at pretreatment, 3 to 12 hours, and 24±3 hours post-intravenous thrombolysis for analyses of plasminogen, plasminogen activator inhibitor-1, D-dimer, factor V, fibrinogen, and fibrin(ogen) degradation products, in addition to routine coagulation assays. Related sample Wilcoxon signed-rank tests were used to test the within-group changes, and independent Mann–Whitney tests for between-group differences. Results—Thirty patients were included (alteplase=14 and tenecteplase=16) with similar baseline demographics. Compared with baseline, alteplase caused significant hypofibrinogenaemia (P=0.002), prolonged prothrombin time (P=0.011), hypoplasminogenaemia (P=0.001), and lower factor V (P=0.002) at 3 to 12 hours after administration with persistent hypofibrinogenaemia at 24 hours (P=0.011), whereas only minor hypoplasminogenaemia (P=0.029) was seen in the tenecteplase group. Tenecteplase consumed less plasminogen (P&lt;0.001) and fibrinogen (P=0.002) compared with alteplase. Conclusions—In patients with acute ischemic stroke, alteplase 0.9 mg/kg caused significant disruption of the fibrinolytic system, whereas tenecteplase 0.25 mg/kg did not, consistent with the trend toward lower intracerebral hemorrhage incidence with tenecteplase in the ATTEST study

Speed impairs attending on the left: comparing attentional asymmetries for neglect patients in speeded and unspeeded cueing tasks

Visuospatial neglect after stroke is often characterized by a disengage deficit on a cued orienting task, in which individuals are disproportionately slower to respond to targets presented on the contralesional side of space following an ispilesional cue as compared to the reverse. The purpose of this study was to investigate the generality of the finding of a disengage deficit on another measure of cued attention, the temporal order judgment (TOJ) task, that does not depend upon speeded manual responses. Individuals with right hemisphere stroke with and without spatial neglect and older healthy controls (OHC) were tested with both a speeded RT cueing task and an unspeeded TOJ-with-cuing task. All stroke patients evidenced a disengage deficit on the speeded RT cueing task, although the size and direction of the bias was not associated with the severity of neglect. In contrast, few neglect patients showed a disengage deficit on the TOJ task. This discrepancy suggests that the disengage deficit may be related to task demands, rather than solely due to impaired attentional mechanisms per se. Further, the results of our study show that the disengage deficit is neither necessary nor sufficient for neglect to manifest