The effect of knee replacement on outcomes throughout the disablement model

The annual incidence of knee replacement (KR) procedures in the United States is predicted to reach over 3.5 million by the year 2030. KR is the current definitive treatment for debilitating knee osteoarthritis (KOA). There has yet to be substantial research regarding the impact of KR on participation in community activities and quality of life. The hypotheses evaluated in this dissertation were that persons following KR will have 1) faster gait speed and 2) lower risk of participation restrictions than persons without KR; and 3) a decreased risk of all-cause mortality compared to persons without KR. To address the first two hypotheses, we collected data from subjects with KOA from the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative, large cohorts of older adults with or at risk of KOA at the time of enrollment. In the first study, KR did not have an effect on gait speed overall and among most subgroups, however subjects with a slow gait speed prior to KR did have an 80% increased risk (RR 1.8, 95% CI 1.1, 3.0) of having a healthy gait speed compared with non-KR subjects. In the second study, KR was associated with a small decreased risk of having participation restriction (RR 0.82, 95% CI 0.67, 0.99). The third study used data on patients with KOA from the Clinical Practice Research Datalink, a database of clinical information on > 8 million people throughout the United Kingdom. There was a decrease in the death rate among KOA subjects who had a KR compared to those who did not, and the hazard of death was reduced by over one half in the first five years after the procedure (HR 0.46 (95% CI 0.43, 0.51). For most subjects, this benefit did not extend longer than five years, and patients least likely to have KR (due to clinical and medical presentation) showed an increased hazard of death compared to the non-KR subjects. In conclusion, the results of this dissertation support the hypotheses that KR confers a positive benefit to activity and participation related pursuits which may extend to survival in the short term for some people

Historically Black Colleges and University Graduates Transitioning to Predominantly White Institutions for Graduate School: A Phenomenological Study

The purpose of this phenomenological study was to explore the perceptions of recent Black, Historically Black Colleges and University graduates who chose to transition to a PWI for graduate school. The theory guiding this study was the self-determination theory of motivation developed by psychologists Ryan and Deci. This theory explains how intrinsic and extrinsic motivations and the fulfillment of autonomy, competence, and relatedness impacts human functioning and decisions. This theory was used to determine what motivational factors influenced Black, HBCU graduates to transition to PWIs for graduate school. The research design was a phenomenological approach exploring the perceptions of a group of Black students lived experiences within an HBCU that motivated them transition to a PWI for graduate school. The participants graduated from one of the 101 HBCUs and transitioned to a PWI for a graduate degree. The study focused on 10 Black, graduate students currently attending a PWI or recently graduate a PWI for graduate school. Semi-structured interviews, a focus group, and graduate student video of advice to undergraduate HBCU students was implemented to gain the perspectives from the HBCU graduates. Data analysis identified three major themes: institutional offerings, programmatic academic offerings, and social relationships and interactions

Ergonomics Within the Workplace: an Occupation Based Injury Prevention Program for Computer Users

An ergonomic intervention increased computer workers’ knowledge of ergonomics, and improved their work station, thereby reducing risk for injury. Occupational therapy’s ability to implement ergonomic training programs for computer workers is an effective way to improve worker safety

The Dental Hygienist’s Role in Management in Oral Lichen Planus.

PosterObjective: To understand the dental hygienist’s role in the management of patients with oral lichen planus (OLP). Signs of OLP are clinically seen as lacy white, raised patches of tissue and/or as red, swollen, tender patches of tissue. These lesions are most commonly visible on the buccal mucosa; other common locations are the gingiva, tongue, alveolar mucosa, and the palate. Patients with OLP typically experience a burning sensation or pain in the area. Our patient presented with generalized slight to moderate plaque induced and localized non-plaque induced gingivitis evidenced by hypersensitivity involving the papilla, white and pale pink gingiva, blunted, and sloughing papilla. Raised white patches were clinically noted on the left buccal alveolar mucosa, the left buccal mucosa, and with similar but fewer patches on the right buccal tissues. Patient indicated being more symptomatic a couple weeks prior to her visit, but she was unsure why. She expressed that the inside of her cheeks felt very painful and these symptoms “come and go.” Patient reported no history of medication. Her oral hygiene habits consist of brushing once a day with an electric tooth brush, flossing once a day, and using Listerine mouth rinse once a day. While there is no cure for OLP, current treatment includes systemic and topical corticosteroids. Palliative care during a dental hygiene appointment would include the use of topical and local anesthetics. When treating a patient with OLP, it is important that the dental hygienist recognizes the signs and symptoms in order to determine an appropriate care plan while keeping pain and discomfort to a minimum; and to provide the patient with the knowledge to care for lichen planus at home

Episode 6 - Honest Repentance and the Law

In this week’s episode we talk with Dr. David Maxwell, professor of systematic theology at Concordia Seminary, St Louis. Maxwell recently wrote a series of sermons exploring the ways in which our understanding of the law, faith, and salvation influence our ability to repent. This episode explores the first concept in the series, titled LAW. “The image is that the Bible’s like an anvil on your chest that crushes the life out of you…this is the kind of thing that I think makes people want to hide.” Dr. Maxwel

Anxiety in Children with Intellectual Disability: the Role of Intolerance of Uncertainty

DClinPsych ThesisApproximately 2-3% of children worldwide are living with an Intellectual Disability (ID). Anxiety is prevalent in children with ID and can cause considerable distress for the child and wider family. Anxiety in children has been reported to have significant social and emotional impact and has a long-term effect, being predictive of mental health and economic status in adulthood. Despite this, the evidence base is limited with regard to psychological interventions for mental health difficulties in individuals with ID. More specifically, there is a clear gap in the literature pertaining to the evidence for the implementation of psychological interventions for alleviating anxiety in children with ID. A systematic review was undertaken to evaluate the quality of literature on psychological interventions for anxiety in children with ID. 17 papers were eligible for inclusion and reported on a range of interventions, including a behavioural approach for specific phobias, and CBT based interventions for generalised symptoms of anxiety. The evidence was highly variable in quality, and when aggregated, no intervention had sufficient empirical support to be considered current or promising evidence-based practice. Further research is therefore suggested in order to develop a strong evidence base from which clinicians can select effective interventions for this population. This research should additionally be clear and transparent in its conceptualisation, measurement and reporting of both anxiety and Intellectual Disability, in order to support the development of the field. There is a robust body of evidence that the transdiagnostic construct of Intolerance of Uncertainty (IU) plays a key role in a range of anxiety disorders in the typically developing population. Recent research suggests that IU may be particularly elevated in children with Autism Spectrum Disorder (ASD), and that this may account for the increased difficulties with anxiety experienced by this population. IU has therefore been proposed as a potential target for intervention in managing anxiety in children with ASD, and interventions such as CUES (Coping with Uncertainty in Everyday Situations) have begun to be successfully implemented to this end. However, a large proportion of children with ASD have a co-occurring ID, and the role of IU in the understanding and management of anxiety in this population had not been explored to date. An investigation was undertaken to address this gap. The study aimed to explore the relationships between IU, anxiety and repetitive behaviours (RRBs) in children with ASD and ID, and consider whether CUES can be adapted so that it is suitable for this population. Within the study, parents/carers of children with ASD and/or ID completed measures of anxiety, IU and RRBs online. In this sample, IU was significantly higher in children with ASD and ID than children with ASD only, however there was no difference in anxiety levels between these groups. In children with ASD (both with and without ID), it was observed that IU significantly positively correlated with anxiety and RRBs, and that IU, but not ID-status, was a significant predictor of anxiety. The CUES parent group intervention was then adapted and implemented with parents of five children with ASD and co-occurring ID and was reported to be acceptable and helpful for parents in managing IU in their children. Therefore, findings suggest that IU plays a role in anxiety in children with ASD and ID and may be an appropriate target for intervention for this group