The Impact of Education on Implementation of Mirror Box Therapy Across Occupational Therapy Practice Settings

Mirror box therapy has been found to be effective in changing motor and sensory outcomes in patients with cerebrovascular accident (CVA). It has many benefits to use for occupational therapists such as ease of use, ease of transportation, capability to be used across practice settings, and ability to be incorporated into conventional therapy treatment. However, therapists included in this study may not have been using the intervention due to lack of knowledge or availability of the intervention equipment. The purpose of this capstone project was to determine the impact education would have on occupational therapists’ attitudes and behaviors towards the use of mirror box therapy. It also served to determine the impact the use of mirror box therapy would have on changing functional outcomes individuals recovering from across occupational therapy practice settings. This study utilized a mixed methods approach and was divided in to two parts. Part A utilized a two-part educational series for occupational therapists analyzed by a quantitative pre-test/post-test assessment of learning. This was followed by a qualitative focus group to determine impression of the learning. Part B included using mirror box therapy with seven patients with acute CVA during admission stays over the course of four weeks to collect pre-test/post-test data on changes in range of motion, muscle strength, sensation of the affected limb, and Functional Independence Measure (FIM) levels. This was followed by a qualitative focus group for therapists who had implemented mirror box therapy. Part A of this study found significant changes in learning about mirror box therapy by occupational therapists. Through the educational series, they identified how they learned, what motivates them to learn, barriers to job performance due to the environment, and overall excitement to learn. Part B of this study found changes in occupational performance for all seven patients with acute CVA. Patients identified sensory changes throughout the use of the mirror box and presented with changes in motor function resulting in improvements in FIM scores. Using mirror box therapy with patients with CVA facilitated growth by the therapists in their confidence to use, motivation to use to continue to help patients, evolution of becoming leaders in their respective practice settings, motivation to utilize evidence-based practice and critical thinking about changes in their environment that would be needed to successfully incorporate mirror box therapy into daily practice. Education that addresses preferences in learning, motivates the therapist to want to learn, and provides support for adaptation of the person, the environment, and the occupation can be successful in creating changes in occupational performance of occupational therapists. Learning to use mirror box therapy by incorporation into practice increased confidence of use in occupational therapists. As confidence improved, the therapists evolved into leaders in their practice settings by modeling the use of the mirror box and sharing an understanding of the benefits to use of the intervention with their peers. Utilizing mirror box therapy also changed impressions of use of evidence-based practice with demonstrated future desire to use and support treatment. Using mirror box therapy with patients with acute CVA can lead to changes in functional outcomes by improving motor function and sensory awareness resulting in improved occupational performance. Short periods of use of the intervention can be effective throughout occupational practice settings to initiate recovery of the affected limb

Circadian Genes Are Expressed during Early Development in Xenopus laevis

Circadian oscillators are endogenous time-keeping mechanisms that drive twenty four hour rhythmic changes in gene expression, metabolism, hormone levels, and physical activity. We have examined the developmental expression of genes known to regulate circadian rhythms in order to better understand the ontogeny of the circadian clock in a vertebrate.In this study, genes known to function together in part of the core circadian oscillator mechanism (xPeriod1, xPeriod2, and xBmal1) as well as a rhythmic, clock-controlled gene (xNocturnin) were analyzed using in situ hybridization in embryos from neurula to late tailbud stages. Each transcript was present in the developing nervous system in the brain, eye, olfactory pit, otic vesicle and at lower levels in the spinal cord. These genes were also expressed in the developing somites and heart, but at different developmental times in peripheral tissues (pronephros, cement gland, and posterior mesoderm). No difference was observed in transcript levels or localization when similarly staged embryos maintained in cyclic light were compared at two times of day (dawn and dusk) by in situ hybridization. Quantitation of xBmal1 expression in embryonic eyes was also performed using qRT-PCR. Eyes were isolated at dawn, midday, dusk, and midnight (cylic light). No difference in expression level between time-points was found in stage 31 eyes (p = 0.176) but stage 40 eyes showed significantly increased levels of xBmal1 expression at midnight (RQ = 1.98+/-0.094) when compared to dawn (RQ = 1+/-0.133; p = 0.0004).We hypothesize that when circadian genes are not co-expressed in the same tissue during development that it may indicate pleiotropic functions of these genes that are separate from the timing of circadian rhythm. Our results show that all circadian genes analyzed thus far are present during early brain and eye development, but rhythmic gene expression in the eye is not observed until after stage 31 of development

The Rho-Rock-Myosin Signaling Axis Determines Cell-Cell Integrity of Self-Renewing Pluripotent Stem Cells

Background: Embryonic stem (ES) cells self-renew as coherent colonies in which cells maintain tight cell-cell contact. Although intercellular communications are essential to establish the basis of cell-specific identity, molecular mechanisms underlying intrinsic cell-cell interactions in ES cells at the signaling level remain underexplored. Methodology/Principal Findings: Here we show that endogenous Rho signaling is required for the maintenance of cell-cell contacts in ES cells. siRNA-mediated loss of function experiments demonstrated that Rock, a major effector kinase downstream of Rho, played a key role in the formation of cell-cell junctional assemblies through regulation of myosin II by controlling a myosin light chain phosphatase. Chemical engineering of this signaling axis by a Rock-specific inhibitor revealed that cell-cell adhesion was reversibly controllable and dispensable for self-renewal of mouse ES cells as confirmed by chimera assay. Furthermore, a novel culture system combining a single synthetic matrix, defined medium, and the Rock inhibitor fully warranted human ES cell self-renewal independent of animal-derived matrices, tight cell contacts, or fibroblastic niche-forming cells as determined by teratoma formation assay. Conclusions/Significance: These findings demonstrate an essential role of the Rho-Rock-Myosin signaling axis for the regulation of basic cell-cell communications in both mouse and human ES cells, and would contribute to advance i

Improving metabolic health in obese male mice via diet and exercise restores embryo development and fetal growth

Paternal obesity is now clearly associated with or causal of impaired embryo and fetal development and reduced pregnancy rates in humans and rodents. This appears to be a result of reduced blastocyst potential. Whether these adverse embryo and fetal outcomes can be ameliorated by interventions to reduce paternal obesity has not been established. Here, male mice fed a high fat diet (HFD) to induce obesity were used, to determine if early embryo and fetal development is improved by interventions of diet (CD) and/or exercise to reduce adiposity and improve metabolism. Exercise and to a lesser extent CD in obese males improved embryo development rates, with increased cell to cell contacts in the compacting embryo measured by E-cadherin in exercise interventions and subsequently, increased blastocyst trophectoderm (TE), inner cell mass (ICM) and epiblast cell numbers. Implantation rates and fetal development from resulting blastocysts were also improved by exercise in obese males. Additionally, all interventions to obese males increased fetal weight, with CD alone and exercise alone, also increasing fetal crown-rump length. Measures of embryo and fetal development correlated with paternal measures of glycaemia, insulin action and serum lipids regardless of paternal adiposity or intervention, suggesting a link between paternal metabolic health and subsequent embryo and fetal development. This is the first study to show that improvements to metabolic health of obese males through diet and exercise can improve embryo and fetal development, suggesting such interventions are likely to improve offspring health.Nicole O. McPherson, Hassan W. Bakos, Julie A. Owens, Brian P. Setchell, Michelle Lan

HLA class I and II diversity contributes to the etiologic heterogeneity of non-Hodgkin lymphoma subtypes

A growing number of loci within the human leukocyte antigen (HLA) region have been implicated in non-Hodgkin lymphoma (NHL) etiology. Here, we test a complementary hypothesis of "heterozygote advantage" regarding the role of HLA and NHL, whereby HLA diversity is beneficial and homozygous HLA loci are associated with increased disease risk. HLA alleles at class I and II loci were imputed from genome-wide association studies (GWAS) using SNP2HLA for: 3,617 diffuse large B-cell lymphomas (DLBCL), 2,686 follicular lymphomas (FL), 2,878 chronic lymphocytic leukemia/small lymphocytic lymphomas (CLL/SLL), 741 marginal zone lymphomas (MZL), and 8,753 controls of European descent. Both DLBCL and MZL risk were elevated with homozygosity at class I HLA-B and -C loci (OR DLBCL=1.31, 95% CI=1.06-1.60; OR MZL=1.45, 95% CI=1.12-1.89) and class II HLA-DRB1 locus (OR DLBCL=2.10, 95% CI=1.24-3.55; OR MZL= 2.10, 95% CI=0.99-4.45). Increased FL risk was observed with the overall increase in number of homozygous HLA class II loci (p-trend<0.0001, FDR=0.0005). These results support a role for HLA zygosity in NHL etiology and suggests that distinct immune pathways may underly the etiology of the different NHL subtypes

Vascular and blood-brain barrier-related changes underlie stress responses and resilience in female mice and depression in human tissue

Prevalence, symptoms, and treatment of depression suggest that major depressive disorders (MDD) present sex differences. Social stress-induced neurovascular pathology is associated with depressive symptoms in male mice; however, this association is unclear in females. Here, we report that chronic social and subchronic variable stress promotes blood-brain barrier (BBB) alterations in mood-related brain regions of female mice. Targeted disruption of the BBB in the female prefrontal cortex (PFC) induces anxiety- and depression-like behaviours. By comparing the endothelium cell-specific transcriptomic profiling of the mouse male and female PFC, we identify several pathways and genes involved in maladaptive stress responses and resilience to stress. Furthermore, we confirm that the BBB in the PFC of stressed female mice is leaky. Then, we identify circulating vascular biomarkers of chronic stress, such as soluble E-selectin. Similar changes in circulating soluble E-selectin, BBB gene expression and morphology can be found in blood serum and postmortem brain samples from women diagnosed with MDD. Altogether, we propose that BBB dysfunction plays an important role in modulating stress responses in female mice and possibly MDD

A national study of organizational features of inpatient medicine and the association with aggressiveness of care near the end of life

Thesis (M.S.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at [email protected]. Thank you.Background: Patients with advanced cancer are receiving increasingly aggressive care near the end of life, but it is not known to what degree acute care organizational characteristics may influence the intensity of care provided. Objective: To characterize the organizational features of acute care VA Medical Centers (VAMCs) which predict the delivery of aggressive end-of-life care in a cohort of patients with advanced malignancy. Research Design: Two forms of study design were used in our data collection. A cross-sectional descriptive study was performed to assess the current state of inpatient medicine services across the VHA nationally. Surveys were administered to chiefs of medicine and medicaiiCU directors at all of the 124 currently existing acute care VAMCs. A retrospective administrative data analysis was performed on a specified cohort of 9700 patients with advanced malignancies, who were admitted to one of the VAMCs in the last year of life. Based on the survey completion rate, our final analytic sample included 7105 patients across 74 different facilities. The final analysis employed generalized linear mixed-effect models to account for the clustering of patients at the facility level. Measures: Independent organizational variables of interest included the presence and number of academic teaching teams, use of hospitalists, ICU structure and staffing and integration of non-physician providers. Primary outcome measures were previously defined administrative data indicators of aggressiveness of care near the end of life, including: 1) ICU admission within the last 30 days of life, 2) >1 ER visit in the last 30 days of life and 3) chemotherapy administration within the last 2 weeks of life. The patient characteristics of age, gender, marital status, percent service connected, cancer diagnosis, and number of hospital days in the last six months and year of life were controlled for in all of the analyses. [TRUNCATED

Understanding visitor happiness in museums

Thesis (Master's)--University of Washington, 2018As museums begin to focus on the importance of visitor happiness and well-being, a growing number of studies have been conducted on how the museum environment can impact well-being. However, there has been limited research into how visitors are experiencing happiness in these settings. The purpose of this study was to explore how and in what ways museum visitors experience momentary happiness. The study was structured as a mixed-methods descriptive survey to understand what happiness means to museum visitors, in what circumstances they experienced momentary happiness, and how they express momentary happiness in a museum environment. Interviews were completed with 180 visitors and 75 visitor observations were collected across three Seattle-area museums. It was found that all visitors in this study experienced some level of momentary happiness during their museum visit. Visitors were most likely to experience momentary happiness throughout their visit, followed by a specific exhibit or activity and they most often expressed momentary happiness through physically or verbally engaging with their surroundings. This study provides evidence of momentary happiness in museums and could inform the design of future museum programs containing happiness enhancing aspects as well as facets of visitor satisfaction