The Occupation-Centered Intervention Assessment: Bridging Theory and Practice in Fieldwork Education

Occupational therapy’s identity is grounded in occupation-centered care. However, evidence suggests external factors in the healthcare system burden practitioners’ time and resources, reducing attention directed toward occupation-centered practice and student learning and transfer of theoretically grounded knowledge. The departure from theory-based practice can threaten the identity and viability of the profession. The Occupation-Centered Intervention Assessment (OCIA) was designed for practitioners or students to self-rate the degree to which interventions are occupation-based or occupation-focused, creating an occupation-centered framework. In this pilot explanatory sequential mixed methods study, Level II fieldwork educators and fieldwork students in Alaska completed OCIA training and utilized the tool. A pre- and post-survey identified attitudes toward theory application, feedback, confidence, developing and understanding occupation-centered perspectives, and the OCIA. Additionally, focus group participants discussed using the OCIA during Level II fieldwork and the impact on development, understanding, and communicating using an occupation-centered perspective. Results of the survey revealed preliminary receptivity to the tool as a communication aid and as a theoretical framework for an occupation-centered perspective. The focus group highlighted the “common language” provided by the tool and drew attention to contextual factors influencing the transfer of knowledge and use of the OCIA in practice. Further research is needed to understand the potential of the OCIA as a resource for facilitating student learning with a grounded, occupation-centered perspective

Elastin-like Polypeptide (ELP) Charge Influences Self-Assembly of ELP–mCherry Fusion Proteins

Self-assembly of protein–polymer bioconjugates presents an elegant strategy for controlling nanostructure and orientation of globular proteins in functional materials. Recent work has shown that genetic fusion of globular protein mCherry to an elastin-like polypeptide (ELP) yields similar self-assembly behavior to these protein–polymer bioconjugates. In the context of studying protein–polymer bioconjugate self-assembly, the mutability of the ELP sequence allows several different properties of the ELP block to be tuned orthogonally while maintaining consistent polypeptide backbone chemistry. This work uses this ELP sequence tunability in combination with the precise control offered by genetic engineering of an amino acid sequence to generate a library of four novel ELP sequences that are used to study the combined effect of charge and hydrophobicity on ELP–mCherry fusion protein self-assembly. Concentrated solution self-assembly is studied by small-angle X-ray scattering (SAXS) and depolarized light scattering (DPLS). These experiments show that fusions containing a negatively charged ELP block do not assemble at all, and fusions with a charge balanced ELP block exhibit a weak propensity for assembly. By comparison, the fusion containing an uncharged ELP block starts to order at 40 wt % in solution and at all concentrations measured has sharper, more intense SAXS peaks than other fusion proteins. These experiments show that charge character of the ELP block is a stronger predictor of self-assembly behavior than the hydrophobicity of the ELP block. Dilute solution small-angle neutron scattering (SANS) on the ELPs alone suggests that all ELPs used in this study (including the uncharged ELP) adopt dilute solution conformations similar to those of traditional polymers, including polyampholytes and polyelectrolytes. Finally, dynamic light scattering studies on ELP–mCherry blends shows that there is no significant complexation between the charged ELPs and mCherry. Therefore, it is proposed that the superior self-assembly of fusion proteins containing uncharged ELP block is due to effective repulsions between charged and uncharged blocks due to local charge correlation effects and, in the case of anionic ELPs, repulsion between like charges within the ELP block

SHANK1 Deletions in Males with Autism Spectrum Disorder.

International audienceRecent studies have highlighted the involvement of rare (15,000 controls (p = 0.009). The discovery of apparent reduced penetrance of ASD in females bearing inherited autosomal SHANK1 deletions provides a possible contributory model for the male gender bias in autism. The data are also informative for clinical-genetics interpretations of both inherited and sporadic forms of ASD involving SHANK1

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

©2019American Society for Bone andMineral Research. Osteoporosis-related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fractureamong people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, andsubcutaneous pharmacotherapies are efficaciousandcanreduce risk of future fracture.Patientsneededucation,however, about thebenefitsandrisks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first-line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive butmay be beneficial for selected patients at high risk.Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the earlypost-fractureperiod,prompt treatment is recommended.Adequate dietary or supplemental vitaminDand calciumintake shouldbe assured. Individuals beingtreatedfor osteoporosis shouldbe reevaluated for fracture risk routinely, includingvia patienteducationabout osteoporosisandfracturesandmonitoringfor adverse treatment effects.Patients shouldbestronglyencouraged to avoid tobacco, consume alcohol inmoderation atmost, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease)