Engaging with First Responders to Prevent Falls in Older Adults

In order to further explore the circumstances of falls in the City of Novato’s older adults age 60 and over Novato Fire Protection District (NFPD) partnered with Dominican University Occupational Therapy Department to conduct a study with the support of County of Marin Mental Health Services Act funds. The following were the goals of this study: Identify fall risk factors in community-dwelling older adults. Understand the experiences of older adults who have fallen. Determine whether there is a relationship between falls and depression in older adults. Examine first responder experiences with fall-related calls in older adults. Identify approaches to prevent falls in older adults. Data sources included Patient Care Reports (PCRs) completed by EMS first responders with narratives coded by the researchers, two focus groups conducted with older adults living in adult care facilities, telephone interviews with four older adults residing at home in the community and a focus group with NFPD first responders

Domesticated dogs’ (Canis familiaris) use of the solidity principle

Shannon M. A. Kundey, Chelsea Taglang, Ayelet Baruch, and Rebecca German, Department of Psychology, Hood College; Andres De Los Reyes, Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland at College Park. We would like to thank Jessica Arbuthnot, Rebecca Allen, Ariel Coshun, Erica Royer, Sherry McClurkin, Sabrina Molina, and Robin Reutten for their assistance in data collection and participant recruitment for this study.Organisms must often make predictions about the trajectories of moving objects. However, often these objects become hidden. To later locate such objects, the organism must maintain a representation of the object in memory and generate an expectation about where it will later appear. We explored adult dogs’ knowledge and use of the solidity principle (that one solid object cannot pass through another solid object) by evaluating search behavior. Subjects watched as a treat rolled down an inclined tube into a box. The box either did or did not contain a solid wall dividing it in half. To find the treat, subjects had to modify their search behavior based on the presence or absence of the wall, which either did or did not block the treat’s trajectory. Dogs correctly searched the near location when the barrier was present and the far location when the barrier was absent. They displayed this behavior from the first trial, as well as performed correctly when trial types were intermingled. These results suggest that dogs direct their searches in accordance with the solidity principle

A Literature Review of Current Treatments for the Hypermobility Subtype of Ehlers-Danlos Syndrome

Purpose: The purpose of this study is to compare pharmacologic intervention, neurocognitive therapy, physical therapy, and orthotics in treating the hypermobility subtype of Ehlers-Danlos Syndrome (hEDS) and determine which has the most positive effect on symptoms. Introduction: Ehlers-Danlos Syndrome is an inheritable connective tissue disorder which results from a genetic mutation that alters the body’s ability to produce collagen. The most common subtype of Ehlers-Danlos Syndrome is hEDS, which leads to hypermobility and hyperextensibility and can cause frequent joint dislocations. Methods: A review of literature was performed to compare each treatment based on reported results. The types of studies reviewed include systematic reviews, randomized clinical trials, review articles, cross sectional studies, and longitudinal studies. This study includes patients diagnosed with hEDS. Results: Data was analyzed from different studies and presented using various figures and tables to compare the effectiveness of each treatment modality. Discussion: Pain medications such as opioids and NSAIDs are the most commonly used treatment option, but they carry the risk of addiction and other side effects. Use of orthotics was the most successful treatment option in alleviating symptoms of hEDS. Conclusion: Pharmacologic intervention, neurocognitive therapy, physical therapy, and orthotics each have their own benefits in treating hEDS. Therefore, a combination of each therapy should be used to ensure the greatest positive effect on the symptoms of hEDS. Future research should focus on more direct comparisons of each treatment method to identify which modality consistently yields the best results

Longitudinal Assessments Using Validated Instruments In Myasthenia Gravis Outpatients Receiving Long-Term Therapeutic Plasma Exchange

Purpose: In the most recent American Society for Apheresis Guidelines on the Use of Therapeutic Apheresis in Clinical Practice, employing therapeutic plasma exchange (TPE) for long-term treatment of myasthenia gravis (MG) patients is a new indication and carries a category II, grade 2B recommendation. As data for this indication is evolving and subjective assessments of these patients are often uninformative, we sought to better characterize the impacts of long-term TPE in these MG patients using validated instruments. Methods: In this prospective observational study, we used a combination of validated instruments and openended questions clarifying concerns that are routinely applied to MG patients. The two validated instruments were the MG Activities of Daily Living (MG-ADL) and MG Quality of Life 15 (MG-QoL15r) profiles. Based on previous literature, a 2-point change in the MG-ADL and a 10-point change in the MGQoL15r indicates significant improvement or worsening. Over a 3-month period, MG patients receiving long-term TPE were assessed using a single-form questionnaire that integrated all of the MG-ADL and MG-QoL15r elements and was completed at every visit. Patients unable to complete the survey due to their medical condition were exempted. Results: In total, 9 patients were eligible and received long-term TPE at frequencies from 3 times per week to 1 time per month. Five patients (56%) were female, 6 (67%) were white, and mean age was 54 years. Active pharmacotherapy included prednisone, azathioprine, mycophenolate, rituximab, and pyridostigmine. All patients reported that lengthening the interval between successive TPE treatments, even by a few days, resulted in noticeable MG changes. Five patients (56%) were clinically stable during the study period and had no significant changes in MG-ADL or MG-QoL15r profiles, though these patients still documented issues with sight, speech, muscular weakness, and fatigue. During the study period, 4 patients (44%) had significant changes identified by the MG-ADL, a mean of 5.5 times per patient (range 2-8) and 2 (22%) had significant changes identified by the MG-QoL15r, a mean of 2 times per patient (range 1-3). MG-ADL appeared to be more sensitive in correlating with patient-reported clinical changes, with clinical improvements identified a mean of 3.2 times per patient and clinical deteriorations identified a mean of 2.3 times per patient (compared to 1.5 and 1 times per patient, respectively, for the MG-QoL15r; p=0.03 for interaction effect). In the 4 patients with significant changes in profile scores, associated clinical changes in breathing, swallowing, sight, speech, muscular strength, and fatigue were reported. Importantly, for all of 4 of these patients, subjective clinical deteriorations in conjunction with objectively worsening MG-ADL scores were used as evidence to medically justify intensification of TPE therapy. Conclusions: Objective longitudinal assessments in MG patients receiving long-term TPE may be helpful for accurate disease monitoring. A subset of MG patients receiving long-term TPE still has dynamic changes in disease status as assessed by clinical history and two different validated instruments. In all patients with stable MG, both the MD-ADL and MG-QoL15r accurately indicated no significant changes. However, in those with fluctuating disease status, MG-ADL was more sensitive to both clinical improvement and worsening. These findings need to be validated in larger studies

Analysis of Hendra Virus Fusion Protein N-Terminal Transmembrane Residues

Hendra virus (HeV) is a zoonotic enveloped member of the family Paramyoxviridae. To successfully infect a host cell, HeV utilizes two surface glycoproteins: the attachment (G) protein to bind, and the trimeric fusion (F) protein to merge the viral envelope with the membrane of the host cell. The transmembrane (TM) region of HeV F has been shown to have roles in F protein stability and the overall trimeric association of F. Previously, alanine scanning mutagenesis has been performed on the C-terminal end of the protein, revealing the importance of β-branched residues in this region. Additionally, residues S490 and Y498 have been demonstrated to be important for F protein endocytosis, needed for the proteolytic processing of F required for fusion. To complete the analysis of the HeV F TM, we performed alanine scanning mutagenesis to explore the residues in the N-terminus of this region (residues 487–506). In addition to confirming the critical roles for S490 and Y498, we demonstrate that mutations at residues M491 and L492 alter F protein function, suggesting a role for these residues in the fusion process

Case report: Abomasal ulcer secondary to congenital pyloric and duodenal stenosis in a 3-day-old heifer

Abomasal ulcers, an economic concern for all calf-raising farms, are usually silent until perforation occurs, at which time management is complicated and often unrewarding. This case study describes perforating ulcer in a 3-day-old Brahman heifer, occurring secondary to a congenital narrowing of the pylorus and proximal duodenum and leading to marked abomasal distention, leakage, and eventual peritonitis and sepsis

Learners Engaging with Hispanic Communities to address COVID19 Inequities by Developing a Cultural Competence Guide for Public Health Messaging

Introduction: The Rio Grande Valley (RGV) has the highest rates of obesity and diabetes nationwide which have compounded the impact of COVID-19. We propose addressing underlying mistrust and systemic racism through a resident-and-student-learner-led, community-engaged, educational public health campaign targeting the Hispanic community in the RGV. Methods: Twelve students were provided interdisciplinary leadership skills in a community-engaged public messaging campaign covering issues of COVID-19 inequities. Learners used these skills to engage with clinic community partners in qualitative interviews regarding the patient population to guide the creation of a culturally competent public health messaging rubric for the Hispanic community. Results: Pre-intervention survey results showed that the patient population was 97% Hispanic/Latino with a 73% language preference for Spanish and a 98% uninsured status. Clinic leaders described 67% of their patient population as being high risk for COVID-19 with multiple underlying risk factors, including obesity, hypertension, and diabetes. Surveyed clinic leaders selected that PSAs need to have clarity of the message and availability in the patient’s preferred language. Our team created two focused, culturally competent rubrics for the Hispanic community. Discussion: This research has shown that it is imperative to be able to evaluate which PSAs are effective in delivering their intended message as well as being able to monitor the effects on their target audience. The Hispanic and Spanish-speaking communities needs more effective public health messaging to decrease testing fears, improve contact tracing, motivate individuals to seek medical care, and to ultimately address the rampant COVID-19 inequities that exist

Osteo-Chondroprogenitor–Specific Deletion of the Selenocysteine tRNA Gene, Trsp, Leads to Chondronecrosis and Abnormal Skeletal Development: A Putative Model for Kashin-Beck Disease

Kashin-Beck disease, a syndrome characterized by short stature, skeletal deformities, and arthropathy of multiple joints, is highly prevalent in specific regions of Asia. The disease has been postulated to result from a combination of different environmental factors, including contamination of barley by mold mycotoxins, iodine deficiency, presence of humic substances in drinking water, and, importantly, deficiency of selenium. This multifunctional trace element, in the form of selenocysteine, is essential for normal selenoprotein function, including attenuation of excessive oxidative stress, and for the control of redox-sensitive molecules involved in cell growth and differentiation. To investigate the effects of skeletal selenoprotein deficiency, a Cre recombinase transgenic mouse line was used to trigger Trsp gene deletions in osteo-chondroprogenitors. Trsp encodes selenocysteine tRNA[Ser]Sec, required for the incorporation of selenocysteine residues into selenoproteins. The mutant mice exhibited growth retardation, epiphyseal growth plate abnormalities, and delayed skeletal ossification, as well as marked chondronecrosis of articular, auricular, and tracheal cartilages. Phenotypically, the mice thus replicated a number of the pathological features of Kashin-Beck disease, supporting the notion that selenium deficiency is important to the development of this syndrome