Occupational Therapy Group Programming for Adolescents with Developmental and Learning Disabilities: A Retrospective Documentation Review

Background: Individuals with learning disabilities have higher rates of unemployment, are less likely to live independently, and have lower rates of college graduation. Occupational therapists who serve this population need to capture outcomes for programming effectively to determine best practice to address these needs. A retrospective documentation review of occupational therapy transition group programming was completed to identify themes and to assess fieldwork student documentation clarity. Method: Analysis of 162 de-identified treatment notes from the years 2014–2018 was completed for six high school students (HSS) (13 to 20 years of age) who previously participated in a high school transition program for adolescents with disabilities. A five-phase analysis process consisted of: (a) review of all treatment notes to determine common areas of intervention; (b) provision of an initial peer debriefing session with one transition program licensed occupational therapist to confirm identified themes; (c) synthesis of HSS strengths/weaknesses; (d) analysis of the fieldwork students’ (FWS) documentation to determine clinical reasoning and clarity; and (e) follow-up peer debriefing with two transition program licensed occupational therapists to re-confirm all findings. Results: Analysis suggested group transition programming was used to facilitate HSS development in the following areas: attention and group participation, social behaviors, abilities to serve as a leader, participation in group discussion, adherence to group rules, fine motor skills, bilateral coordination skills, and hand strength. Conclusion: This retrospective analysis provides evidence that occupational therapy transition group programming is designed to facilitate smoother transitions for adolescents with disabilities in areas unique to occupational therapy practice. Analysis highlighted the need for more standardized methods of documentation for FWS and transition program occupational therapists

Aktive Medienarbeit als Vorbild. Handlungsorientierte Ansätze zur Förderung einer um digitaltechnische Dimensionen erweiterten Medienbildung

Wie Medien auch, ist (digitale) Technik dank ihrer prinzipiellen Offenheit und Plastizität grundsätzlich gestaltbar und bietet daher erfahrungs- und handlungsorientierte Zugänge geradezu an. Die Ansätze des produktiven Technikhandelns wie der des medienpädagogischen Makings ermöglichen aber nicht nur den kreativen Umgang mit digitalen Tools und Werkstoffen, sondern auch die kritische Reflexion des dabei Erlebten. Im Beitrag führen die Autor*innen konzeptionell in das produktive Medien- und Technikhandeln ein und begründen anhand exemplarischer Einblicke in eine laufende qualitative Studie, warum diese von der Aktiven Medienarbeit inspirierten pädagogischen Ansätze die praktische Förderung einer um digitaltechnische Dimensionen erweiterten Medienbildung ermöglichen können. (DIPF/Orig.

Reflexion durch Aktion – Ansätze zur handlungsorientierten Förderung einer um digitaltechnische Dimensionen erweiterten Medienbildung

Ziel des in der Medienpädagogik etablierten Ansatzes der Aktiven Medienarbeit ist es, einen erfahrungs- und handlungsorientierten Zugang anzubieten und damit mediale Kommunikations-, Kritik- und Gestaltungsfähigkeiten zu stärken. In einer digital geprägten Gesellschaft ist dieses Ziel aktueller denn je, denn aufgrund der digitalen Basis aktueller Medien ‚kommunizieren‘ technologische Prinzipien und Muster sowie in digitale Technik eingeschriebene Werte und Normen stets mit. Was bedeutet dieses ‚Mit-kommunizieren‘ sowie die Erkenntnis, dass auch menschliche Kommunikation nicht mehr nur zwischen Menschen stattfindet, für das gesellschaftliche Miteinander, für Persönlichkeitsentwicklung und Bildungsprozesse? Wie Medien auch, ist (digitale) Technik dank ihrer prinzipiellen Offenheit und Plastizität grundsätzlich gestaltbar und bietet daher erfahrungs- und handlungsorientierte Zugänge geradezu an. Die Ansätze des produktiven Technikhandelns wie der des medienpädagogischen Makings ermöglichen aber nicht nur den kreativen Umgang mit digitalen Tools und Werkstoffen, sondern auch die kritische Reflexion des dabei Erlebten. In unserem Beitrag führen wir konzeptionell in das produktive Medien- und Technikhandeln ein und begründen anhand exemplarischer Einblicke in eine laufende qualitative Studie, warum diese von der Aktiven Medienarbeit inspirierten pädagogischen Ansätze die praktische Förderung einer um digitaltechnische Dimensionen erweiterten Medienbildung ermöglichen können. (DIPF/Orig.

Reduced level of arousal and increased mortality in adult acute medical admissions: a systematic review and meta-analysis

Abstract Background Reduced level of arousal is commonly observed in medical admissions and may predict in-hospital mortality. Delirium and reduced level of arousal are closely related. We systematically reviewed and conducted a meta-analysis of studies in adult acute medical patients of the relationship between reduced level of arousal on admission and in-hospital mortality. Methods We conducted a systematic review (PROSPERO: CRD42016022048), searching MEDLINE and EMBASE. We included studies of adult patients admitted with acute medical illness with level of arousal assessed on admission and mortality rates reported. We performed meta-analysis using a random effects model. Results From 23,941 studies we included 21 with 14 included in the meta-analysis. Mean age range was 33.4 - 83.8 years. Studies considered unselected general medical admissions (8 studies, n=13,039) or specific medical conditions (13 studies, n=38,882). Methods of evaluating level of arousal varied. The prevalence of reduced level of arousal was 3.1%-76.9% (median 13.5%). Mortality rates were 1.7%-58% (median 15.9%). Reduced level of arousal was associated with higher in-hospital mortality (pooled OR 5.71; 95% CI 4.21-7.74; low quality evidence: high risk of bias, clinical heterogeneity and possible publication bias). Conclusions Reduced level of arousal on hospital admission may be a strong predictor of in-hospital mortality. Most evidence was of low quality. Reduced level of arousal is highly specific to delirium, better formal detection of hypoactive delirium and implementation of care pathways may improve outcomes. Future studies to assess the impact of interventions on in-hospital mortality should use validated assessments of both level of arousal and delirium

Copy number variant discrepancy resolution using the ClinGen dosage sensitivity map results in updated clinical interpretations in ClinVar

Conflict resolution in genomic variant interpretation is a critical step toward improving patient care. Evaluating interpretation discrepancies in copy number variants (CNVs) typically involves assessing overlapping genomic content with focus on genes/regions that may be subject to dosage sensitivity (haploinsufficiency (HI) and/or triplosensitivity (TS)). CNVs containing dosage sensitive genes/regions are generally interpreted as â likely pathogenicâ (LP) or â pathogenicâ (P), and CNVs involving the same known dosage sensitive gene(s) should receive the same clinical interpretation. We compared the Clinical Genome Resource (ClinGen) Dosage Map, a publicly available resource documenting known HI and TS genes/regions, against germline, clinical CNV interpretations within the ClinVar database. We identified 251 CNVs overlapping known dosage sensitive genes/regions but not classified as LP or P; these were sent back to their original submitting laboratories for reâ evaluation. Of 246 CNVs reâ evaluated, an updated clinical classification was warranted in 157 cases (63.8%); no change was made to the current classification in 79 cases (32.1%); and 10 cases (4.1%) resulted in other types of updates to ClinVar records. This effort will add curated interpretation data into the public domain and allow laboratories to focus attention on more complex discrepancies.The ClinGen Dosage Sensitivity (DS) Map provides evidenceâ based assessments of the haploinsufficiency and triplosensitivity of genes/genomic regions. We identified 251 clinical copy number variants (CNVs) in ClinVar that overlapped known DS genes/regions but were not interpreted as â likely pathogenicâ or â pathogenic;â these were sent back to their original laboratories for reâ evaluation. Of the 246 that were reâ evaluated, 63.0% resulted in updated classifications, showing that the ClinGen DS Map can be an effective initial step in CNV classification discrepancy resolution.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146425/1/humu23610_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146425/2/humu23610.pd

N. elongata Produces Type IV Pili That Mediate Interspecies Gene Transfer with N. gonorrhoeae

The genus Neisseria contains at least eight commensal and two pathogenic species. According to the Neisseria phylogenetic tree, commensals are basal to the pathogens. N. elongata, which is at the opposite end of the tree from N. gonorrhoeae, has been observed to be fimbriated, and these fimbriae are correlated with genetic competence in this organism. We tested the hypothesis that the fimbriae of N. elongata are Type IV pili (Tfp), and that Tfp functions in genetic competence. We provide evidence that the N. elongata fimbriae are indeed Tfp. Tfp, as well as the DNA Uptake Sequence (DUS), greatly enhance N. elongata DNA transformation. Tfp allows N. elongata to make intimate contact with N. gonorrhoeae and to mediate the transfer of antibiotic resistance markers between these two species. We conclude that Tfp functional for genetic competence is a trait of a commensal member of the Neisseria genus. Our findings provide a mechanism for the horizontal gene transfer that has been observed among Neisseria species

Emergence and Modular Evolution of a Novel Motility Machinery in Bacteria

Bacteria glide across solid surfaces by mechanisms that have remained largely mysterious despite decades of research. In the deltaproteobacterium Myxococcus xanthus, this locomotion allows the formation stress-resistant fruiting bodies where sporulation takes place. However, despite the large number of genes identified as important for gliding, no specific machinery has been identified so far, hampering in-depth investigations. Based on the premise that components of the gliding machinery must have co-evolved and encode both envelope-spanning proteins and a molecular motor, we re-annotated known gliding motility genes and examined their taxonomic distribution, genomic localization, and phylogeny. We successfully delineated three functionally related genetic clusters, which we proved experimentally carry genes encoding the basal gliding machinery in M. xanthus, using genetic and localization techniques. For the first time, this study identifies structural gliding motility genes in the Myxobacteria and opens new perspectives to study the motility mechanism. Furthermore, phylogenomics provide insight into how this machinery emerged from an ancestral conserved core of genes of unknown function that evolved to gliding by the recruitment of functional modules in Myxococcales. Surprisingly, this motility machinery appears to be highly related to a sporulation system, underscoring unsuspected common mechanisms in these apparently distinct morphogenic phenomena

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

The Expert Panel was charged with using data from randomized controlled trials (RCTs) and systematic reviews and meta-analyses of RCTs to update the clinical practice recommendations for the treatment of blood cholesterol levels to reduce ASCVD risk. For this guideline, ASCVD includes coronary heart disease (CHD), stroke, and peripheral arterial disease, all of presumed atherosclerotic origin. These recommendations are intended to provide a strong, evidence-based foundation for the treatment of cholesterol for the primary and secondary prevention of ASCVD in women and men

One year soy protein supplementation has positive effects on bone formation markers but not bone density in postmenopausal women

BACKGROUND: Although soy protein and its isoflavones have been reported to reduce the risk of osteoporosis in peri- and post-menopausal women, most of these studies are of short duration (i.e. six months). The objective of this study was to examine if one year consumption of soy-containing foods (providing 25 g protein and 60 mg isoflavones) exerts beneficial effects on bone in postmenopausal women. METHODS: Eighty-seven eligible postmenopausal women were randomly assigned to consume soy or control foods daily for one year. Bone mineral density (BMD) and bone mineral content (BMC) of the whole body, lumbar (L1-L4), and total hip were measured using dual energy x-ray absorptiometry at baseline and after one year. Blood and urine markers of bone metabolism were also assessed. RESULTS AND DISCUSSION: Sixty-two subjects completed the one-year long study. Whole body and lumbar BMD and BMC were significantly decreased in both the soy and control groups. However, there were no significant changes in total hip BMD and BMC irrespective of treatment. Both treatments positively affected markers of bone formation as indicated by increased serum bone-specific alkaline phosphatase (BSAP) activity, insulin-like growth factor-I (IGF-I), and osteocalcin (BSAP: 27.8 and 25.8%, IGF-I: 12.8 and 26.3%, osteocalcin: 95.2 and 103.4% for control and soy groups, respectively). Neither of the protein supplements had any effect on urinary deoxypyridinoline excretion, a marker of bone resorption. CONCLUSION: Our findings suggest that although one year supplementation of 25 g protein per se positively modulated markers of bone formation, this amount of protein was unable to prevent lumbar and whole body bone loss in postmenopausal women

Country Concepts and the Rational Actor Trap: Limitations to Strategic Management of International NGOs

Growing criticism of inefficient development aid demanded new planning instruments of donors, including international NGOs (INGOs). A reorientation from isolated project-planning towards holistic country concepts and the increasing rationality of a result-orientated planning process were seen as answer. However, whether these country concepts - newly introduced by major INGOs too - have increased the efficiency of development cooperation is open to question. Firstly, there have been counteracting external factors, like the globalization of the aid business, that demanded structural changes in the composition of INGO portfolios towards growing short-term humanitarian aid; this was hardly compatible with the requirements of medium-term country planning. Secondly, the underlying vision of rationality as a remedy for the major ills of development aid was in itself a fallacy. A major change in the methodology of planning, closely connected with a shift of emphasis in the approach to development cooperation, away from project planning and service delivery, towards supporting the socio-cultural and political environment of the recipient communities, demands a reorientation of aid management: The most urgent change needed is by donors, away from the blinkers of result-orientated planning towards participative organizational cultures of learning.Des critiques croissantes de l'aide au développement inefficace exigent de nouveaux instruments de planification des bailleurs de fonds, y compris les ONG internationales (ONGI). Une réorientation de la planification des projets isolés vers des concepts holistiques de la planification de l’aide par pays ainsi que la rationalité croissante d'un processus de planification orientée vers les résultats ont été considérés comme réponse. Toutefois, si ces concepts de pays - nouvellement introduites par les grandes OING eux aussi - ont augmenté l'efficacité de la coopération au développement est ouvert à la question. Tout d'abord, il y a eu l’impact des facteurs externes, comme la mondialisation de l'entreprise de l'aide, qui a exigé des changements structurels dans la composition des portefeuilles des OING vers la croissance de l'aide humanitaire à court terme. Cela était difficilement compatible avec les exigences de l'aménagement du territoire à moyen terme. Deuxièmement, la vision sous-jacente de la rationalité accrue de la planification, concentré sur les resultats, comme un remède pour les grands maux de l'aide au développement était en soi une erreur. Un changement majeur dans la méthodologie de la planification, étroitement liée à un changement d'orientation dans l'approche de la coopération au développement, qui n’est pas concentrer sur planification du projet et la prestation de services, mais qui soutienne l'environnement socio-culturel et politique des communautés bénéficiaires, exige une réorientation de la gestion de l’aide: Le changement le plus urgent est un changement par les donateurs eux-mêmes, qui devrait implanter des cultures de collaboration étroit avec les partenaires et la population locale