Expanding Rehabilitation Beyond the Clinic—Strategies to Increase Total Restorative Therapy Time for Adults with Hemiplegia

Background: Positive neuroplastic changes involving cortical reorganization after stroke are experience dependent and are facilitated more effectively when rehabilitation occurs with high volume. Structured experiences to promote adaptive changes can be implemented during scheduled therapies in any rehabilitation setting. However, time spent in supervised restorative therapy is limited regardless of setting. Time spent in therapeutic activity can be extended by a variety of options that patients can engage in independently, that are low-cost, and that have evidence to support their use as a supplement to physical and occupational therapy. Purpose: The purpose of this paper is to present four such options for supplemental therapeutic activities to support restorative rehabilitation, including mental practice, mirror therapy, low cost virtual reality, and community group exercise classes. A sample of the evidence supporting their feasibility and effectiveness is presented. Practical guidelines for implementation are provided based on the evidence. Recommendations: Evidence based interventions can be used to extend total restorative rehabilitation time as an extension of therapy activities performed in the clinic. They are feasible and effective and can support positive neuroplastic changes in individuals with hemiplegia. These strategies can and should be implemented across practice settings by physical therapists, occupational therapists, and speech language pathologists

Exploring the Use of Video-Recorded Practical Examination Performance to Enhance Student Self-Assessment

ABSTRACT Purpose: The purposes of this study were to explore the ability of doctor of physical therapy students to self-assess performance during a video-recorded practical examination, to evaluate student perceptions of the experience, and to determine their perception of their ability to self-assess. Method: A cross-sectional design with students from 2 consecutive cohorts was utilized. Participants worked in groups of three conducting a video-recorded gait training session. Students graded their own performance immediately upon completing the practical examination. Students then regraded their performance from the video recording. The instructor graded each student’s video-recorded performance using the same rubric as the students. Following the experience, students completed a 7-question survey administered via Survey Monkey. Data were analyzed using Friedman’s ANOVA with post-hoc Wilcoxon signed-rank test to compare median scores. Cohen’s Kappa and percent agreement calculations assessed inter- and intra-rater reliability. Student perception data were analyzed using descriptive statistics and non-parametric Wilcoxon signed-rank test. Results: The only significant difference in scores was between student-live and faculty examiner assessments for Cohort 2. Inter-rater reliability (.09-.17) and percent agreement (20.7%-26.3%) were low across all comparisons. Intra-rater reliability (.12-.23) and percent agreement (23.7%-34.5%) were also low for both cohorts. Students rated their ability to self-assess from the video-recorded performance significantly higher than from the live performance (pConclusions:Students’ ability to self-assess performance does not appear to be well developed in the early stages of physical therapy education. The use of video-recorded performance, in conjunction with instructor feedback, could enhance this ability, ideally leading to independent and effective self-assessment as students proceed through the curriculum

Rethinking Work and Family Policy: The Making and Taking of Parental Leave in Australia

Despite the continued increase in female participation rates, Australia remains one of only two developed nations in the world without a paid maternity leave scheme. While research interest and public policy debate about paid maternity leave entitlements continues, little is known about the actual utilization of the 52 weeks unpaid parental leave that is currently available to all employees. Moreover, research and policy debate on the availability and provision of paid paternity leave has only just begun. This paper argues that, given the gendered nature of employee entitlements, it is time to re-evaluate all aspects of parental leave policy in Australia. Using unique data from a national survey of Australian employees, the paper provides a statistical analysis of the use of unpaid parental leave and the availability of paid maternity leave. The paper models the availability of paid maternity leave to Australian employees as a function of demographic and organizational characteristics, including annual income, union status, and establishment size. A parallel analysis of the likelihood that an individual has used the unpaid parental leave provision is also provided. The results show that the existing unpaid parental leave provision is rarely used and that the current availability of paid maternity leave is inequitable. The paper discusses the conceptual and policy implications of these results and concludes that a re-thinking of parental leave policy in Australia is essential if gender inequities at work and in society are to be addressed

Sub-dekahertz ultraviolet spectroscopy of 199Hg+

Using a laser that is frequency-locked to a Fabry-Perot etalon of high finesse and stability, we probe the 5d10 6s 2S_1/2 (F=0) - 5d9 6s 2D_5/2 (F=2) Delta-m_F = 0 electric-quadrupole transition of a single laser-cooled 199Hg+ ion stored in a cryogenic radio-frequency ion trap. We observe Fourier-transform limited linewidths as narrow as 6.7 Hz at 282 nm (1.06 X 10^15 Hz), yielding a line Q = 1.6 X 10^14. We perform a preliminary measurement of the 5d9 6s2 2D_5/2 electric-quadrupole shift due to interaction with the static fields of the trap, and discuss the implications for future trapped-ion optical frequency standards.Comment: 4 pages, 4 figures, submitted for publicatio

Keeping Steady as She Goes: A Negotiated Order Perspective on Technological Evolution

A central idea in the theory of technology cycles is that social and political mechanisms are most important during the selection of a dominant design, and that eras of incremental change are socially uninteresting periods in which innovation is driven by technological momentum and elaboration of the dominant design. In this essay, we overturn the ontological assumption that social order is inherently stable, drawing on Anselm Strauss's concept of negotiated order to analyze the persistence of a dominant design as a social accomplishment: an outcome of ongoing processes that reinforce or challenge a socially negotiated order. Thus, we shift focus from battles over standards to periods of normal innovation. We extend the technology cycles model to explain social dynamics in periods of incremental change, and to make predictions specifying how contextual conditions in standards-setting organizations affect social interaction, leading to reinforcement or challenge to a socio-technical order

Pelvic actinomycosis presenting as a malignant pelvic mass: a case report

<p>Abstract</p> <p>Introduction</p> <p>Pelvic actinomycosis constitutes 3% of all human actinomycosis infections. It is usually insidious, and is often mistaken for other conditions such as diverticulitis, abscesses, inflammatory bowel disease and malignant tumors, presenting a diagnostic challenge pre-operatively; it is identified post-operatively in most cases. Here we present a case that presented as pelvic malignancy and was diagnosed as pelvic actinomycosis post-operatively.</p> <p>Case presentation</p> <p>A 48-year-old Caucasian Turkish woman presented to our clinic with a three-month history of abdominal pain, weight loss and difficulty in defecation. She had used an intra-uterine device for 16 years, however it had recently been removed. The rectosigmoidoscopy revealed narrowing of the lumen at 12 cm due to a mass lesion either in the wall or due to an extrinsic lesion that prevented the passage of the endoscope. On examination, there was no gynecological pathology. Magnetic resonance imaging showed a mass, measuring 5.5 × 4 cm attached to the rectum posterior to the uterus. The ureter on that side was dilated. Surgically there was a pelvic mass adhered to the rectum and uterine adnexes, measuring 10 × 12 cm. It originated from uterine adnexes, particularly ones from the left side and formed a conglomerated mass with the uterus and nearby organs; the left ureter was also dilated due to the pelvic mass. Because of concomitant tubal abscess formation and difficulty in dissection planes, total abdominal hysterectomy and bilateral salphingo-oophorectomy was performed (our patient was 48 years old and had completed her childbearing period). The cytology revealed inflammatory cells with aggregates of <it>Actinomyces</it>. Penicillin therapy was given for six months without any complication.</p> <p>Conclusions</p> <p>Pelvic actinomycosis should always be considered in patients with a pelvic mass especially in ones using intra-uterine devices, and who have a history of appendectomy, tonsillectomy or dental infection. Surgeons should be aware of this infection in order to avoid excessive surgical procedures.</p

Fresh-blood-free diet for rearing malaria mosquito vectors

Mosquito breeding depends on the supply of fresh vertebrate blood, a major bottleneck for large-scale production of Anopheles spp. Feeding alternatives to fresh blood are thus a priority for research, outdoor large-cage trials and control interventions. Several artificial meal compositions were tested and Anopheles oogenesis, egg laying and development into the next generation of adult mosquitoes were followed. We identified blood-substitute-diets that supported ovarian development, egg maturation and fertility as well as, low progeny larval mortality, and normal development of offspring into adult mosquitoes. The formulated diet is an effective artificial meal, free of fresh blood that mimics a vertebrate blood meal and represents an important advance for the sustainability of Anopheles mosquito rearing in captivity.Agência financiadora / Número do subsídio Bill and Melinda Gates Foundation OPP1138841 Fundacao para a Ciencia e Tecnologia GHTM - UID/Multi/04413/201 CCMAR - UID/Multi/04326/2013 UID/Multi/04326/2013 RF SFRH/BPD/89811/2012 FAPEAM, Brazil 19716.UNI472.2459.20022014info:eu-repo/semantics/publishedVersio

Health Care Provider Knowledge and Practices Regarding Folic Acid, United States, 2002–2003

Objective: To assess health care providers (HCP) knowledge and practices regarding folic acid (FA) use for neural tube defect (NTD) prevention. Methods: Two identical surveys were conducted among 611 obstetricians/gynecologists (OB/GYNs) and family/general physicians (FAM/GENs) (2002), and 500 physician assistants (PAs), nurse practitioners (NPs), certified nurse midwives (CNMs), and registered nurses (2003) to ascertain knowledge and practices regarding FA. For analysis, T-tests, univariate and multivariate logistic regression modeling were used. Results: Universally, providers knew that FA prevents birth defects. Over 88% knew when a woman should start taking folic acid for the prevention of NTDs; and over 85% knew FA supplementation beyond what is available in the diet is necessary. However, only half knew that 50% of all pregnancies in the United States are unplanned. Women heard information about multivitamins or FA most often during well woman visits in obstetrical/gynecology (ob/gyn) practice settings (65%), and about 50% of the time during well woman visits in family/general (fam/gen) practice settings and 50% of the time at gynecology visits (both settings). Among all providers, 42% did not know the correct FA dosage (400 μg daily). HCPs taking multivitamins were more than twice as likely to recommend multivitamins to their patients (Odds Ratio [OR] 2.27 95%, Confidence Interval [CI] 1.75–2.94). HCPs with lower income clients (OR 1.49, CI 1.22–1.81) and HCPs with practices having more than 10% minorities (OR 1.46, CI 1.11–1.92) were more likely to recommend supplements. NPs in ob/gyn settings were most likely and FAM/GENs were least likely to recommend supplements (OR 3.06, CL 1.36–6.90 and OR 0.64, CL 0.45–0.90 respectively). Conclusions: Knowledge about birth defects and the necessity of supplemental FA was high. Increasing knowledge about unintended pregnancy rates and correct dosages of FA is needed. The strongest predictor for recommending the use of FA supplements was whether the provider took a multivitamin

Modern management of pyogenic hepatic abscess: a case series and review of the literature

<p>Abstract</p> <p>Background</p> <p>Pyogenic hepatic abscesses are relatively rare, though untreated are uniformly fatal. A recent paradigm shift in the management of liver abscesses, facilitated by advances in diagnostic and interventional radiology, has decreased mortality rates. The aim of this study was to review our experience in managing pyogenic liver abscess, review the literature in this field, and propose guidelines to aid in the current management of this complex disease.</p> <p>Methods</p> <p>Demographic and clinical details of all patients admitted to a single institution with liver abscess over a 5 year period were reviewed. Clinical presentation, aetiology, diagnostic work-up, treatment, morbidity and mortality data were collated.</p> <p>Results</p> <p>Over a 5 year period 11 patients presented to a single institution with pyogenic hepatic abscess (55% males, mean age 60.3 years). Common clinical features at presentation were non-specific constitutional symptoms and signs. Aetiology was predominantly gallstones (45%) or diverticular disease (27%). In addition to empiric antimicrobial therapy, all patients underwent radiologically guided percutaneous drainage of the liver abscess at diagnosis and only 2 patients required surgical intervention, including one 16-year old female who underwent hemi-hepatectomy for a complex and rare Actinomycotic abscess. There were no mortalities after minimum follow-up of one year.</p> <p>Conclusions</p> <p>Pyogenic liver abscesses are uncommon, and mortality has decreased over the last two decades. Antimicrobial therapy and radiological intervention form the mainstay of modern treatment. Surgical intervention should be considered for patients with large, complex, septated or multiple abscesses, underlying disease or in whom percutaneous drainage has failed.</p