Telerehabilitation Policy Report: Interprofessional Policy Principles and Priorities

The American Occupational Therapy Association, the American Physical Therapy Association, the American Speech-Language-Hearing Association and the American Telemedicine Association are collaborating to advance telehealth and ensure sustainability of virtual care services beyond the COVID-19 pandemic. These professional associations represent the interests of more than 888,000 rehabilitation services professionals. This paper summarizes the current state of telehealth policy principles and priorities for rehabilitation services. The report outlines key considerations when advocating with policymakers to avoid the “Telehealth Cliff” for audiology and therapy services and to facilitate the continued advancement of telehealth innovation and transformation by rehabilitation services professionals

Rolling Deck to Repository: Supporting the marine science community with data management services from academic research expeditions

Direct observations of the oceans acquired on oceanographic research ships operated across the international community support fundamental research into the many disciplines of ocean science and provide essential information for monitoring the health of the oceans. A comprehensive knowledge base is needed to support the responsible stewardship of the oceans with easy access to all data acquired globally. In the United States, the multidisciplinary shipboard sensor data routinely acquired each year on the fleet of coastal, regional and global ranging vessels supporting academic marine research are managed by the Rolling Deck to Repository (R2R, rvdata.us) program. With over a decade of operations, the R2R program has developed a robust routinized system to transform diverse data contributions from different marine data providers into a standardized and comprehensive collection of global-ranging observations of marine atmosphere, ocean, seafloor and subseafloor properties that is openly available to the international research community. In this article we describe the elements and framework of the R2R program and the services provided. To manage all expeditions conducted annually, a fleet-wide approach has been developed using data distributions submitted from marine operators with a data management workflow designed to maximize automation of data curation. Other design goals are to improve the completeness and consistency of the data and metadata archived, to support data citability, provenance tracking and interoperable data access aligned with FAIR (findable, accessible, interoperable, reusable) recommendations, and to facilitate delivery of data from the fleet for global data syntheses. Findings from a collection-level review of changes in data acquisition practices and quality over the past decade are presented. Lessons learned from R2R operations are also discussed including the benefits of designing data curation around the routine practices of data providers, approaches for ensuring preservation of a more complete data collection with a high level of FAIRness, and the opportunities for homogenization of datasets from the fleet so that they can support the broadest re-use of data across a diverse user community

Sans titres: Anthologie collective Français 335 (automne 2011)

http://deepblue.lib.umich.edu/bitstream/2027.42/89432/1/sans_titres.pd

Thrive: Success Strategies for the Modern-Day Faculty Member

The THRIVE collection is intended to help faculty thrive in their roles as educators, scholars, researchers, and clinicians. Each section contains a variety of thought-provoking topics that are designed to be easily digested, guide personal reflection, and put into action. Please use the THRIVE collection to help: Individuals study topics on their own, whenever and wherever they want Peer-mentoring or other learning communities study topics in small groups Leaders and planners strategically insert faculty development into existing meetings Faculty identify campus experts for additional learning, grand rounds, etc. If you have questions or want additional information on a topic, simply contact the article author or email [email protected]://digitalcommons.unmc.edu/facdev_books/1000/thumbnail.jp

Actin Nemaline Myopathy Mouse Reproduces Disease, Suggests Other Actin Disease Phenotypes and Provides Cautionary Note on Muscle Transgene Expression

Mutations in the skeletal muscle α-actin gene (ACTA1) cause congenital myopathies including nemaline myopathy, actin aggregate myopathy and rod-core disease. The majority of patients with ACTA1 mutations have severe hypotonia and do not survive beyond the age of one. A transgenic mouse model was generated expressing an autosomal dominant mutant (D286G) of ACTA1 (identified in a severe nemaline myopathy patient) fused with EGFP. Nemaline bodies were observed in multiple skeletal muscles, with serial sections showing these correlated to aggregates of the mutant skeletal muscle α-actin-EGFP. Isolated extensor digitorum longus and soleus muscles were significantly weaker than wild-type (WT) muscle at 4 weeks of age, coinciding with the peak in structural lesions. These 4 week-old mice were ∼30% less active on voluntary running wheels than WT mice. The α-actin-EGFP protein clearly demonstrated that the transgene was expressed equally in all myosin heavy chain (MHC) fibre types during the early postnatal period, but subsequently became largely confined to MHCIIB fibres. Ringbinden fibres, internal nuclei and myofibrillar myopathy pathologies, not typical features in nemaline myopathy or patients with ACTA1 mutations, were frequently observed. Ringbinden were found in fast fibre predominant muscles of adult mice and were exclusively MHCIIB-positive fibres. Thus, this mouse model presents a reliable model for the investigation of the pathobiology of nemaline body formation and muscle weakness and for evaluation of potential therapeutic interventions. The occurrence of core-like regions, internal nuclei and ringbinden will allow analysis of the mechanisms underlying these lesions. The occurrence of ringbinden and features of myofibrillar myopathy in this mouse model of ACTA1 disease suggests that patients with these pathologies and no genetic explanation should be screened for ACTA1 mutations

Nurses\u27 perceptions of patient rounding

Objective: This descriptive pilot study explored hospital staff nurses\u27 perceptions toward the practice of patient rounding. Background: Rounding has re-emerged as a standard practice initiative among nurses in hospitals and has been associated with a decrease in call lights and falls, increased patient satisfaction and safety, and quieter nursing units. Regardless of these outcomes, controversy exists among nurses regarding rounding. Methods: The Nurses\u27 Perception of Patient Rounding Scale (K. Neville, unpublished manuscript, 2010) was developed to gain an understanding of nurses\u27 perceptions of rounding. Results: Nurses identified rounding as valuable and perceived hourly rounding to be beneficial to patients and families but significantly less beneficial to their own professional practice. Challenges to rounding as a practice include issues of documentation, patient ratios, and skill mix. Conclusion: Findings support the need for further research to address the challenges of patient rounding for nursing. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams &Wilkins

Hyponatraemia and ADH secretion during intravenous fluid therapy in children

Antidiuretic hormone (ADH) is a fundamental regulator of fluid and electrolyte homeostasis. Osmotically unregulated ADH secretion during intravenous fluid therapy has been implicated in the development of iatrogenic hyponatraemia. The case report and 3 prospective studies of this thesis provide evidence for this and examine the relative contributions of salinity versus infusion rate of intravenous fluids to the development of hyponatraemia. Two studies of plasma and urinary electrolytes and osmolality during intravenous rehydration of children with gastroenteritis were performed. The first, an observational study of 52 children receiving 0.45% (N/2) saline documented persistently raised plasma ADH concentrations independent of plasma sodium. In both studies, plasma and urinary biochemistry suggested osmotically unregulated ADH action. When N/2 and NS were compared in a randomised study of 102 children, NS emerged as superior in the prevention and correction of hyponatraemia, independent of infusion rate. In the third study, 124 pre-operative children were randomised to receive N/2 or NS intravenously at 100% or 50% of maintenance rates post-operatively. Plasma ADH concentrations increased in all groups, and the plasma and urinary biochemistry indicated persistent non-osmotic ADH activity in some children for up to 24 hours. Baseline urinary tonicity approximated NS. Comparison of urinary tonicity with the infused fluid largely explained changes observed in plasma sodium. The risk of hyponatraemia was decreased by isotonic saline but not fluid restriction; however plasma sodium concentration decreased in the NS 100% group between 8 and 24 hours, suggesting that a decreased rate should be considered during prolonged intravenous fluid administration. Fourteen (23%; 7NS) of those on 50% maintenance were assessed as dehydrated, with hypernatraemia in 3 receiving NS50%. The chloride load associated with NS in the second and third studies was not associated with the development of acidosis. The studies also showed that 2.5% dextrose resolved and prevented hypoglycaemia in children with gastroenteritis but was inadequate to prevent hypoglycaemia and/or ketosis in 38% of children under 6 years when infused at maintenance rates. Non-osmotically regulated ADH activity in hospitalised children is common, in the face of which, isotonic is superior to hypotonic saline in decreasing the risk of hyponatraemia

Acute illness in children with secondary adrenal insufficiency

Objective and background: Secondary adrenal insufficiency (SAI) is a rare conditioning childhood which can be associated with high levels of morbidity in some patients. The causes of increased levels of illness are not well defined and warrant further investigation. Methods: A retrospective cohort of patients with SAI was constructed by examining records of all attendances for acute illness by SAI patients at the emergency department of the two specialist paediatric hospitals in Sydney, Australia between 2004and 2016. Demographic, clinical, and physiological characteristics together with pre-hospital illness management strategies were assessed. Results: There were 168 presentations for an acute illness by 47 children with SAI. Comorbid diabetes insipidus (DI) was present in 46.8% (n = 22), 77.3% (n = 17) of whom were male (P \u3c .05). Patients with comorbid DI were more likely to be admit-ted (86.7%, n = 65 vs 60.2%, n = 56 for non-DI, P \u3c .01); had a longer hospital stay(6.5 (8.7) vs 2.5 (2.6) days, P \u3c .001); and higher rates of IV HC administration (56.0%,n = 42 vs 35.5%, n = 33), P \u3c .01). The medically-diagnosed adrenal crisis (AC) rate was3.68 ACs/100PY. Stress dose use was reported by fewer DI patients (58.7%, n = 44)than non-DI patients (78.5%, n = 73, P \u3c .01). Previous attendance at hospital was positively associated with stress dose use (OR = 1.08, 95% CI 1.00, 1.16). Conclusion: Secondary adrenal insufficiency can cause significant morbidity in children. Comorbid DI is associated with higher levels of hospitalisation, longer hospital stays and lower levels of pre-emergent stress dose use. Educational interventions in this subgroup of SAI patients may reduce the burden of morbidit