Positive Postsecondary Education Outcomes: It Is More Than Intervention

The National Longitudinal Transition Study–2 (NLTS–2) reports that 19% of students with disabilities will enter postsecondary education programs. However, The United States Department of Labor, U.S. Bureau of Labor Statistics (BLS) (2015) reported that 16.8% of individuals with disabilities obtain a bachelor’s degree compared to 34.6% of individuals without a disability (BLS, 2015). Though students with disabilities aspire to continue their education, they are not as successful as their peers without disabilities. They are at risk for health disparities, lower earning potential, and stability in their community (Department of Health and Human Services [HHS], 2020a). Occupational therapy is beginning to play a role in supporting students to achieve the skills needed for positive postsecondary education outcomes. However, the interventions do not discuss their effectiveness using an evidence-based practice approach. The research found that four overarching themes impact positive postsecondary education outcomes: self-determination, disability identity, relationships, and accessibility. This doctoral project aims to bring awareness to themes impacting intervention, provide interventions by pairing these themes with the American Occupational Therapy Associations (AOTA) Occupational Practice Framework–4th edition, and advocate for our place in supporting transition planning to postsecondary education. The three knowledge translation (KT) projects served to address this purpose. The first KT project served to educate on this topic using a systematic evidence-based practice approach for practitioners and students on this topic.This project was a continuing education webinar sponsored by the Minnesota Occupational Therapy Association (MOTA). The second KT project focused on one of the themes: disability identity and its importance when using a strength-based approach. This project was an article for the Children and Youth Special Interest Section Quarterly Connections. The third KT project served to provide practitioners knowledge and opportunities to identify interventions within the four themes. It also served to provide the foundation for practitioners to successfully advocate for occupational therapy’s role in positive postsecondary education outcomes. These projects support occupational therapy’s potential to impact positive postsecondary education outcomes. However, students with disabilities who are slated to attend postsecondary education are not the primary focus of transition planning, which puts them at risk for health disparities and lower socioeconomic opportunities. Also, accessibility needs to be broadened in its definition to address occupational therapy’s ability to provide occupational justice to all students. Future research should include the application of these themes outside of an urban school setting and the effectiveness of building a specialized transition team focusing on students with high incidence disabilities

Avoiding allogenic blood transfusions in endoscopic angiofibroma surgery

BackgroundSurgical approaches for many tumours are often limited by blood loss, exposure and risk to vital anatomical structures. Therefore, the standard of care for certain skull base tumours has become endoscopic transnasal resection. Other surgical disciplines often use cell salvage techniques, but review of the otolaryngology literature revealed very few case reports. This study investigated the value and safety of salvage-type autologous blood transfusion during the endoscopic resection of juvenile nasopharyngeal angiofibromas (JNA).MethodsJNA is a rare vascular nasal tumour and the study extended over a 3-year period to obtain adequate patient numbers. All patients undergoing endoscopic resection during this period were included in the population sample. Ten patients with JNA were identified and underwent embolization prior to the endoscopic resection. In all cases the intraoperative blood salvage apparatus was used. Close post-operative monitoring was performed.ResultsHomologous blood transfusion could be avoided in all cases. Postoperative monitoring revealed transient bacteraemia in two cases where the leukocyte filter was not used, but no evidence of septicaemia.ConclusionsPerioperative cell saver and autologous blood transfusion in endonasal JNA surgery is safe. Homologous blood transfusion can be avoided by using this technique. The use of cell salvage allows for single stage surgery without the need to abandon surgery due to excessive blood loss and its future use is promising

Proprioceptive Neuromuscular Facilitation of the Wrist Flexors

The present study examined a wrist extension-to-flexion contraction pattern that was theorized to result in proprioceptive neuromuscular facilitation. However, the “reversal of antagonists” contraction pattern may have, alternatively, interfered with motor learning-related increases in strength. Participants (N=24) were matched on predicted strength and randomly assigned to either the control or experimental group. Training occurred during three test sessions within a one-week period. Retention and transfer (crossed-condition) tests were administered during a fourth test session two- weeks later. Both groups exhibited comparable increases in strength (20.2%) and decreases in muscle coactivation (35.2%), which were retained and transferred. Decreases in error and variability of the torque traces were associated with parallel decreases in variability of muscle activity. The reversal of antagonists technique did not interfere with motor learning-related increases in strength and decreases in variability. However, the more complex contraction pattern failed to result in proprioceptive neuromuscular facilitation of strength

Assessment of Kinematics and Electromyography Following Arthroscopic Single-Tendon Rotator Cuff Repair

Background The increasing demand for rotator cuff (RC) repair patients to return to work as soon as they are physically able has led to exploration of when this is feasible. Current guidelines from our orthopedic surgery clinic recommend a return to work at 9 weeks postoperation. To more fully define capacity to return to work, the current study was conducted using a unique series of quantitative tools. To date, no study has combined 3-dimensional (3D) motion analysis with electromyography (EMG) assessment during activities of daily living (ADLs), including desk tasks, and commonly prescribed rehabilitation exercise. Objective To apply a quantitative, validated upper extremity model to assess the kinematics and muscle activity of the shoulder following repair of the supraspinatus RC tendon compared to that in healthy shoulders. Design A prospective, cross-sectional comparison study. Setting All participants were evaluated during a single session at the Medical College of Wisconsin Department of Orthopaedic Surgery\u27s Motion Analysis Laboratory. Participants Ten participants who were 9-12 weeks post–operative repair of a supraspinatus RC tendon tear and 10 participants with healthy shoulders (HS) were evaluated. Methods All participants were evaluated with 3D motion analysis using a validated upper extremity model and synchronized EMG. Data from the 2 groups were compared using multivariate Hotelling T2 tests with post hoc analyses based on Welch t-tests. Main Outcome Measurements Participants\u27 thoracic and thoracohumeral joint kinematics, temporal-spatial parameters, and RC muscle activity were measured by applying a quantitative upper extremity model during 10 activities of daily living and 3 rehabilitation exercises. These included tasks of hair combing, drinking, writing, computer mouse use, typing, calling, reaching to back pocket, pushing a door open, pulling a door closed, external rotation, internal rotation, and rowing. Results There were significant differences of the thoracohumeral joint motion in only a few of the tested tasks: comb maximal flexion angle (P = .004), pull door internal/external rotation range of motion (P = .020), reach abduction/adduction range of motion (P = .001), reach flexion/extension range of motion (P = .001), reach extension minimal angle (P = .025), active external rotation maximal angle (P = .012), and active external rotation minimal angle (P = .004). The thorax showed significantly different kinematics of maximal flexion angle during the call (P = .011), mouse (P = .007), and drink tasks (P = .005) between the 2 groups. The EMG data analysis showed significantly increased subscapularis activity in the RC repair group during active external rotation. Conclusions Although limited abduction was expected due to repair of the supraspinatus tendon, only a single ADL (reaching to back pocket) had a significantly reduced abduction range of motion. Thoracic motion was shown to be used as a compensatory strategy during seated ADLs. Less flexion of the thorax may create passive shoulder flexion at the thoracohumeral joint in efforts to avoid active flexion. The RC repair group participants were able to accomplish the ADLs within the same time frame and through thoracohumeral joint kinematics similar to those in the healthy shoulder group participants. In summary, this study presents a quantification of the effects of RC repair and rehabilitation on the ability to perform ADLs. It may also point to a need for increased rehabilitation focus on either regaining external rotation strength or range of motion following RC repair to enhance recovery and return to the workforce

Estimating Northern Bobwhite Density in Privately-Owned Forests Across the Southeast

Rigorous density estimates can inform management, conservation planning, and policy decisions. Northern bobwhite (Colinus virginianus; hereafter, bobwhite) populations are declining throughout their range, including the southeastern United States. Numerous private land conservation initiatives are underway to restore bobwhite populations in these areas, but baseline estimates of density spanning privately owned forests are sparse. This information gap makes it difficult to evaluate the population-level effects of these conservation programs or develop expectations for timelines to reach population targets. We sought to understand baseline densities across privately owned pine forests in the southeastern United States in areas targeted for bobwhite conservation. We sampled 138 pine stands a total of 286 times across Alabama, Florida, Georgia, North Carolina, and South Carolina from 2018 to 2020 using autumn distance sampling point counts. We sampled 110 stands that were either planned or applied U.S. Department of Agriculture, Natural Resources Conservation Service (NRCS) management contracts, specifically Working Lands for Wildlife (WLFW) Northern Bobwhite partnerships or similar Environmental Quality Incentives Program contracts. The WLFW contracts were solely in focal counties identified in the National Bobwhite Conservation Initiative 2.0 plan and by cooperating state wildlife agencies. Contracts were on average 17.4 ha (SD = 27.0). We also sampled 28 areas with extensive (\u3e200 ha) and intensive (e.g., at least every 3 years for the last ~10 years) habitat management for bobwhite. We used a hierarchical distance sampling model to estimate density. Density was lowest in North Carolina and South Carolina. Densities in Alabama were slightly greater, and greatest densities were in Georgia and Florida. However, the majority of observed densities were 2 coveys/40 ha or below, and all were below 4 coveys/40 ha. Large and intensively managed sites on average had 4 times greater density compared to smaller contracts. Specific densities will be reported in the future. Our sampling efforts fill an important information gap regarding densities throughout private lands in the southeastern United States. Our models indicate that bobwhite densities are generally low in pine forests of the Southeast even in counties identified as having the greatest conservation potential. The relatively greater densities at large and intensively managed sites illustrate the need for more intensive landscape-scale planning when implementing private land conservation. Pending research will compare densities at planned and applied NRCS contracts in the context of landscape-scale habitat amount

REVIEW OF DEER KED (LIPOPTENA CERVI) ON MOOSE IN SCANDINAVIA WITH IMPLICATIONS FOR NORTH AMERICA

The deer ked (Lipoptena cervi) is an Old World dipteran ectoparasite of moose (Alces alces) and other Cervidae. It has undergone significant expansion in distribution on moose of Scandinavia in recent decades. This has been accompanied by much published research dealing with the range expansion and possible factors involved, problems for moose, exposure of northern populations of reindeer (Rangifer rangifer tarandus), and public health issues. Apparently, Lipoptena cervi was introduced into northeastern United States in the late 1800s, presumably on an unknown species of European deer, and it soon spread to white-tailed deer (Odocoileus virginianus). We review the current situation in Scandinavia and North America and document the first record of L. cervi on moose in northeastern United States

Annotated Bibliography: Literature Review Of Causative And Non-Causative Risk Factors For Breast Cancer-Related Lymphedema

Annotated bibliography derived from a review of literature concerning causative and non-causative risk factors for breast cancer-related lymphedema. This document was created by UNE Doctor of Physical Therapy students to establish a knowledge base for clinicians to better understand, diagnose, and educate patients.https://dune.une.edu/lrr/1000/thumbnail.jp

Poster: Literature Review Of Causative And Non-Causative Risk Factors For Breast Cancer-Related Lymphedema

Poster outlining results of a review of literature concerning causative and non-causative risk factors for breast cancer-related lymphedema. This document was created by UNE Doctor of Physical Therapy students to establish a knowledge base for clinicians to better understand, diagnose, and educate patients.https://dune.une.edu/lrr/1001/thumbnail.jp

Supporting the development of a health benefits package in Malawi

Malawi, like many low-income and middle-income countries, has used health benefits packages (HBPs) to allocate scarce resources to key healthcare interventions. With no widely accepted method for their development, HBPs often promise more than can be delivered, given available resources. An analytical framework is developed to guide the design of HBPs that can identify the potential value of including and implementing different interventions. It provides a basis for informing meaningful discussions between governments, donors and other stakeholders around the trade-offs implicit in package design. Metrics of value, founded on an understanding of the health opportunity costs of the choices faced, are used to quantify the scale of the potential net health impact (net disability adjusted life years averted) or the amount of additional healthcare resources that would be required to deliver similar net health impacts with existing interventions (the financial value to the healthcare system). The framework can be applied to answer key questions around, for example: the appropriate scale of the HBP; which interventions represent 'best buys' and should be prioritised; where investments in scaling up interventions and health system strengthening should be made; whether the package should be expanded; costs of the conditionalities of donor funding and how objectives beyond improving population health can be considered. This is illustrated using data from Malawi. The framework was successfully applied to inform the HBP in Malawi, as a core component of the country's Health Sector Strategic Plan II 2017-2022

Evaluating the Patient-Reported Outcomes Measurement Information System scales in acute intermittent porphyria.

PurposeAcute intermittent porphyria (AIP) is a rare inborn error of heme biosynthesis characterized by life-threatening acute attacks. Few studies have assessed quality of life (QoL) in AIP and those that have had small sample sizes and used tools that may not have captured important domains.MethodsBaseline data from the Porphyrias Consortium's Longitudinal Study were obtained for 259 patients, including detailed disease and medical history data, and the following Patient-Reported Outcomes Measurement Information System (PROMIS) scales: anxiety, depression, pain interference, fatigue, sleep disturbance, physical function, and satisfaction with social roles. Relationships between PROMIS scores and clinical and biochemical AIP features were explored.ResultsPROMIS scores were significantly worse than the general population across all domains, except depression. Each domain discriminated well between asymptomatic and symptomatic patients with symptomatic patients having worse scores. Many important clinical variables like symptom frequency were significantly associated with domain scores in univariate analyses, showing responsiveness of the scales, specifically pain interference and fatigue. However, most regression models only explained ~20% of the variability observed in domain scores.ConclusionPain interference and fatigue were the most responsive scales in measuring QoL in this AIP cohort. Future studies should assess whether these scales capture longitudinal disease progression and treatment response