Combining qualitative and quantitative data collection and analysis methods in understanding multiple sclerosis fatigue management

Combining qualitative inquiry with quantitative frequency data in a mixed methods research approach was valuable in understanding the strategies that people with Multiple Sclerosis (MS) used to manage their fatigue. Understanding its management is important because fatigue is often described by people with MS as their most disabling symptom and can pervade all aspects of a person’s life. This research aimed to identify how often people used particular fatigue management strategies and the factors that influenced their use in the context of daily life. The methodology was Qualitative Description with phenomenological overtones using convenience sampling, interviews with semi-structured and structured components, and frequencies combined with typology development. Thirty-one people with MS from Chicago, Ill and Brisbane, Queensland in Australia who experienced fatigue were interviewed and asked to sort 15 cards with common fatigue management strategies into 3 categories, indicating whether they used them regularly, sometimes or never. Frequency counts were used to identify the number of participants who placed a specific strategy in a particular category. Frequencies were used to develop a typology with which to code the qualitative data. The strategies placed most frequently in each category were: Plan / organize the day used regularly, Ask someone for help used sometimes, and Use mobility devices never used. Mixed methods research techniques enabled us to explore the participants’ fatigue management in greater depth. Each data type (i.e., qualitative and quantitative data) complemented the other and led to a richer understanding than either could provide in isolation

Chedoke Arm and Hand Activity Inventory-9 (CAHAI-9): Perceived clinical utility within 14 days of stroke

Purpose: The Chedoke Arm and Hand Activity Inventory-9 (CAHAI-9) is an activity-based assessment developed to include relevant functional tasks and to be sensitive to clinically important changes in upper limb function. The aim of this study was to explore both therapists' and clients' views on the clinical utility of CAHAI-9 within 14 days of stroke. Method: Twenty-one occupational therapists actively working in stroke settings were recruited by convenience sampling from 8 hospitals and participated in semistructured focus groups. Five clients within 14 days of stroke were recruited by consecutive sampling from 1 metropolitan hospital and participated in structured individual interviews. The transcripts were analyzed thematically. Results: Six themes emerged from the focus groups and interviews: collecting information, decisions regarding client suitability, administration and scoring, organizational demands, raising awareness, and clients' perceptions of CAHAI-9 utility. All therapists agreed CAHAI-9 was suited for the stroke population and assisted identification of client abilities or difficulties within functional contexts. Opinions varied as to whether CAHAI-9 should be routinely administered with clients who had mild and severe upper limb deficits, but therapists agreed it was appropriate for clients with moderate deficits. Therapists made suggestions regarding refinement of the scoring and training to increase utility. All clients with stroke felt that the assessment provided reassurance regarding their recovery. Conclusion: The findings indicate that CAHAI-9 shows promise as an upper limb ability assessment for clients within 14 days of stroke

Mechanistic interplay between ceramide and insulin resistance

Recent research adds to a growing body of literature on the essential role of ceramides in glucose homeostasis and insulin signaling, while the mechanistic interplay between various components of ceramide metabolism remains to be quantified. We present an extended model of C16:0 ceramide production through both the de novo synthesis and the salvage pathways. We verify our model with a combination of published models and independent experimental data. In silico experiments of the behavior of ceramide and related bioactive lipids in accordance with the observed transcriptomic changes in obese/diabetic murine macrophages at 5 and 16 weeks support the observation of insulin resistance only at the later phase. Our analysis suggests the pivotal role of ceramide synthase, serine palmitoyltransferase and dihydroceramide desaturase involved in the de novo synthesis and the salvage pathways in influencing insulin resistance versus its regulation

Sphingolipids as critical players in retinal physiology and pathology

Sphingolipids have emerged as bioactive lipids involved in the regulation of many physiological and pathological processes. In the retina, they have been established toparticipate in numerousprocesses, suchas neuronal survival and death, proliferation and migration of neuronal and vascular cells, inflammation, and neovascularization. Dysregulation of sphingolipids is therefore crucial in the onset and progression of retinal diseases. This review examines the involvement of sphingolipids in retinal physiology and diseases. Ceramide (Cer) has emerged as a common mediator of inflammation and death of neuronal and retinal pigment epithelium cells in animal models of retinopathies such as glaucoma, age-related macular degeneration (AMD), and retinitis pigmentosa. Sphingosine- 1-phosphate (S1P) has opposite roles, preventing photoreceptor and ganglion cell degeneration but also promoting inflammation, fibrosis, and neovascularization in AMD, glaucoma, and pro-fibrotic disorders. Alterations in Cer, S1P, and ceramide 1- phosphate may also contribute to uveitis. Notably, use of inhibitors that either prevent Cer increase or modulate S1P signaling, such as Myriocin, desipramine, and Fingolimod (FTY720), preserves neuronal viability and retinal function. These findings underscore the relevance of alterations in the sphingolipid metabolic network in the etiology of multiple retinopathies and highlight the potential of modulating their metabolism for the design of novel therapeutic approaches.Fil: Simon, Maria Victoria. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Instituto de Investigaciones Bioquímicas de Bahía Blanca. Universidad Nacional del Sur. Instituto de Investigaciones Bioquímicas de Bahía Blanca; Argentina. Universidad Nacional del Sur. Departamento de Biología, Bioquímica y Farmacia; ArgentinaFil: Basu, Sandip K.. University of Tennessee; Estados UnidosFil: Qaladize, Bano. University of Tennessee; Estados UnidosFil: Grambergs, Richards. University of Tennessee; Estados UnidosFil: Rotstein, Nora Patricia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Instituto de Investigaciones Bioquímicas de Bahía Blanca. Universidad Nacional del Sur. Instituto de Investigaciones Bioquímicas de Bahía Blanca; Argentina. Universidad Nacional del Sur. Departamento de Biología, Bioquímica y Farmacia; ArgentinaFil: Mandal, Nawajes .A.. University of Tennessee; Estados Unido

The issue is....Recovery of our phenomenological knowledge in occupational therapy

Many definitions of occupational therapy include reference to both art and science. Kielhofner (1997) identified balancing art and science as a value of the emerging paradigm in occupational therapy. In this article, I argue that valuing an art-science balance reflects the pluralistic nature of occupational therapy and that recovering our phenomenological knowledge is a key to achieving this balance. I present two aspects of phenomenology. The first relates to the way occupational therapists strategically use an understanding of the constructed nature of experience to bring about therapeutic outcomes. The second is reflected in a call for occupational therapists to adopt a critical perspective on their own practice. Finally, I briefly discuss art and science with reference to the work of the philosopher Paul Ricoeur

Using threshold concepts to transform entry level curricula

Academics at The University of Queensland undertook an extensive curriculum reform leading to changes in both the undergraduate and masters entry occupational therapy curricula. We explored a number of theories to assist with determining an educational philosophy to underpin our curricula. Threshold concepts (Meyer & Land, 2005) provided us with a transformative and integrative way forward. In this paper we describe our experiences of using threshold concepts as a mechanism for engaging in transformative curriculum renewal and planning. We compiled a list of 20 pieces of troublesome knowledge, namely aspects of each course that were difficult for students to grasp (Perkins, 2006). Using thematic analysis we reduced this list further to 8 items and then subjected these to rigorous questioning to determine whether they were threshold concepts. We asked whether each potential concept was transformative, irreversible, integrative, bounded and troublesome. Threshold concepts were identified if they met all of these characteristics. This generative process revealed five threshold concepts:1)purposeful and meaningful occupation, 2) client centred practice, 3)integral nature of occupational therapy theory and practice, 4) identity as an occupational therapist, and 5)thinking critically, reasoning and reflecting. We also reflected on Barnett and Coate’s (2005) key features of professional programmes - knowing, doing/action and being. We made these concepts explicit to staff as well as students and have used these to underpin our new curricula. This shared language has contributed to staff ownership of the curricula