Effect of Stroke on Fall Rate, Location and Predictors: A Prospective Comparison of Older Adults with and without Stroke

BACKGROUND: The literature suggests that stroke is a major risk factor for falls, but there is a lack of prospective, controlled studies which quantify fall-risk after stroke. The purpose of this study was to compare the rates, location and predictors among individuals recently discharged home from stroke rehabilitation to age and sex matched controls. METHODOLOGY/PRINCIPAL FINDINGS: A sample of 80 people with stroke and 90 controls received baseline assessments of balance, mobility and balance confidence. Falls were recorded prospectively over 13 months for both groups. Group differences in fall rates and contribution of clinical measures to falls were determined using negative binomial regression. Fall location was compared between groups using χ(2) statistics. The rate of falls for individuals with stroke was 1.77 times the rate for the control group. People with stroke were more likely to fall at home. Poorer balance (Berg Balance Scale) was associated with greater falls for both stroke and control groups (incidence rate ratio [IRR]: 0.908 and IRR: 0.877 respectively). A faster Timed Up and Go Test was associated with greater falls for the stroke group (IRR: 0.955) while better walking endurance (Six Minute Walk Test) was associated with greater falls for the controls (IRR: 1.004). Balance confidence was not an independent predictor in either group. CONCLUSIONS: Individuals recently discharged home are at greater risk of falling than individuals without stroke. Attention to home environment is warranted. Balance function can predict falls for both people with stroke and age and sex matched controls. Increased mobility may increase exposure to fall opportunities

Interprofessional Education: A Curricular Gap Analysis

The goal of Interprofessional education (IPE) is to create a new health care workforce that is prepared to function as a deliberative culturally competent team, providing patient centered care that optimizes health and quality of life for individuals with multiple chronic conditions. The purpose of an IPE curricular gap analysis is to determine if IPE and key concepts related to chronic disease self-management are integrated into course descriptions, objectives, didactic, activities and evaluated. The baseline results can be an effective tool to initiate an institutional cultural change promoting curricular revision. Key concept terminology, interprofessional, chronic disease self-management, motivational interviewing, and culture and diversity were reviewed in graduate syllabi from the Colleges of Nursing, Medicine, and Allied Health Sciences. The terms were tallied in course content areas (course descriptions, objectives, content didactic, learning activities, and evaluation). Exemplary syllabi included 4 out of the 5 key concept terms listed above. Courses with key concepts in 3 out of 5 content areas were defined as meeting minimum expectations. A total of 457 courses were reviewed across the three graduate colleges. Ten exemplary courses were found with key term concepts threaded throughout the syllabi: 4 with motivational interviewing (MI), 3 with culture and diversity (C&D) and 3 with interprofessional (IP) concepts. Eighteen courses met minimum expectations: 7 courses with MI, 6 with IP and 5 with C&D. The other key concept, chronic disease self-management (CDSM) was notably lacking in all courses from all colleges. A curricular gap analysis is an effective tool to initiate an institutional cultural change to include IPE and related concepts. It can create awareness and commitment from administration, deans, faculty, and students. Champions can be identified from each college, spearheading action plans for changes in syllabi, there by promoting curricular revision in key content areas. Objectives: 1. Discuss the common definition of interprofessional education, chronic disease self-management, motivational interviewing, culture and diversity. 2. Identify a method to examine one’s own curriculum for a gap in IPE. 3. Discuss the use of a curricular gap analysis to create awareness, commitment to facilitate cultural and curricular change within a University

Immortalization of mouse myogenic cells can occur without loss of p16(INK4a), p19(ARF), or p53 and is accelerated by inactivation of Bax

BACKGROUND: Upon serial passaging of mouse skeletal muscle cells, a small number of cells will spontaneously develop the ability to proliferate indefinitely while retaining the ability to differentiate into multinucleate myotubes. Possible gene changes that could underlie myogenic cell immortalization and their possible effects on myogenesis had not been examined. RESULTS: We found that immortalization occurred earlier and more frequently when the myogenic cells lacked the pro-apoptotic protein Bax. Furthermore, myogenesis was altered by Bax inactivation as Bax-null cells produced muscle colonies with more nuclei than wild-type cells, though a lower percentage of the Bax-null nuclei were incorporated into multinucleate myotubes. In vivo, both the fast and slow myofibers in Bax-null muscles had smaller cross-sectional areas than those in wild-type muscles. After immortalization, both Bax-null and Bax-positive myogenic cells expressed desmin, retained the capacity to form multinucleate myotubes, expressed p19(ARF )protein, and retained p53 functions. Expression of p16(INK4a), however, was found in only about half of the immortalized myogenic cell lines. CONCLUSIONS: Mouse myogenic cells can undergo spontaneous immortalization via a mechanism that can include, but does not require, loss of p16(INK4a), and also does not require inactivation of p19(ARF )or p53. Furthermore, loss of Bax, which appears to be a downstream effector of p53, accelerates immortalization of myogenic cells and alters myogenesis

Parasympathetic functions in children with sensory processing disorder.

The overall goal of this study was to determine if parasympathetic nervous system (PsNS) activity is a significant biomarker of sensory processing difficulties in children. Several studies have demonstrated that PsNS activity is an important regulator of reactivity in children, and thus, it is of interest to study whether PsNS activity is related to sensory reactivity in children who have a type of condition associated with sensory processing disorders termed sensory modulation dysfunction (SMD). If so, this will have important implications for understanding the mechanisms underlying sensory processing problems of children and for developing intervention strategies to address them. The primary aims of this project were: (1) to evaluate PsNS activity in children with SMD compared to typically developing (TYP) children, and (2) to determine if PsNS activity is a significant predictor of sensory behaviors and adaptive functions among children with SMD. We examine PsNS activity during the Sensory Challenge Protocol; which includes baseline, the administration of eight sequential stimuli in five sensory domains, recovery, and also evaluate response to a prolonged auditory stimulus. As a secondary aim we examined whether subgroups of children with specific physiological and behavioral sensory reactivity profiles can be identified. Results indicate that as a total group the children with severe SMD demonstrated a trend for low baseline PsNS activity, compared to TYP children, suggesting this may be a biomarker for SMD. In addition, children with SMD as a total group demonstrated significantly poorer adaptive behavior in the communication and daily living subdomains and in the overall Adaptive Behavior Composite of the Vineland than TYP children. Using latent class analysis, the subjects were grouped by severity and the severe SMD group had significantly lower PsNS activity at baseline, tones and prolonged auditory. These results provide preliminary evidence that children who demonstrate severe SMD may have physiological activity that is different from children without SMD, and that these physiological and behavioral manifestations of SMD may affect a child\u27s ability to engage in everyday social, communication, and daily living skills

Ultrasonographic assessment of costochondral cartilage for microtia reconstruction

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149363/1/lary27390_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149363/2/lary27390.pd