Level I Fieldwork: Could Simulation be the Answer? A Descriptive Study

This article describes the creation and outcomes of simulation as Level I Fieldwork for entry level graduate occupational therapy students. The simulations were created by a team of interprofessional educators following the International Nursing Association for Clinical Simulation and Learning best practices. Additionally, the simulations were designed to meet the student learning outcomes of Level I Fieldwork. Students participated in eight high-fidelity simulations and were evaluated with self-ratings, peer ratings, and faculty ratings. Each student completed a student evaluation of the fieldwork experience, with rating scales and open-ended questions to understand student perceptions of the experience. The vast majority of students met or exceeded expectations on all rating scales. Faculty ratings on student performance were consistently higher than peer ratings and self-ratings. Student perceptions of their experiences were mostly positive, and the majority of students reported meeting the student learning outcomes. The results of this study indicate that Level I Fieldwork with well-designed simulation can result in positive student perceptions, achievement of student learning outcomes, and a consistent student experience

A Comparison of Level II Fieldwork Outcomes: Preparation with Simulation vs Community and Clinical Level I Fieldwork Experiences

Occupational therapy programs can use a variety of delivery modes for Level I fieldwork. All experiences aim to contribute to the clinical and professional preparation for Level II fieldwork. This study compared the Level II fieldwork outcomes for two cohorts of students, one that participated in simulation-based Level I fieldwork and one that completed community and clinic-based Level I fieldwork. The student outcomes on the American Occupational Therapy Association AOTA Fieldwork Performance Evaluation (FWPE) for the Occupational Therapy Student were used for comparative data. The results indicated no statistically significant difference in the two cohorts’ midterm score ratings. Statistically significant differences with higher performance for the cohort that participated in simulation-based Level I fieldwork were noted in the areas of safety and use of occupation-based interventions. The results of this study support the effective use of high-fidelity simulation in preparing students for success on Level II fieldwork

Developing Critical Thinking in OT Education: Effectiveness of a Fishbowl Approach

This paper explores the effectiveness of peer assisted learning on developing critical thinking skills in an occupational therapy graduate course. The use of peer teaching strategies, including a Fishbowl discussion and case-based problem solving, were compared to a faculty-led lecture approach to determine which approach best prepared student critical thinking. Participants included 115 first year graduate occupational therapy students. No statistically significant differences were noted in student ability to express knowledge, comprehension, and application of information. However, statistically significant differences were noted on graduate student ability to analyze, synthesize, and evaluate using newly learned information when peer teaching strategies were used in the classroom. Therefore, the authors concluded peer assisted learning approaches may support better integration of knowledge at higher levels of Bloom’s knowledge for critical thinking than traditional faculty-led teaching approaches

Providing Oral Health Education to Underserved Children and Families within an Interdisciplinary Team

This paper outlines the background literature, needs assessment process, and project activities of a master’s project focused on oral health outcomes through use of an interprofessional team. The project activities were based on recommendations from current literatures, including interprofessional education and teaming, as well as family-centered education to promote positive oral health outcomes for young children and their families. Recommendations for future collaborations and the occupational therapy role within interprofessional oral health care teams are shared

Encouraging Entrepreneurship: Microfinance, Knowledge Support, and the Costs of Operating in Institutional Voids

This study focuses on the supplemented strategies of microfinance institutions (MFIs), in which the MFI offers nonfinancial services, such as entrepreneurship related knowledge, in addition to financial services to impoverished borrowers at the bottom of the pyramid (BoP). We examine two contextual factors–foreign direct investment (FDI) and loan defaults–to better understand the relationship between providing knowledge support to encourage entrepreneurship and costs of operating at the BoP for MFIs. In contexts where FDI is low and loan defaults are high, providing knowledge support to encourage entrepreneurship aggravates the MFI\u27s costs of operating at the BoP. However, in contexts where FDI is high and loan defaults are low, providing knowledge support to encourage entrepreneurship among impoverished borrowers does not aggravate the MFI\u27s costs of operating at the BoP. Hence, in emerging markets where governments welcome FDI and curb loan defaults, MFIs can viably support entrepreneurship among the poor

Stochastic Differential Systems with Memory: Theory, Examples and Applications

The purpose of this article is to introduce the reader to certain aspects of stochastic differential systems, whose evolution depends on the past history of the state. Chapter I begins with simple motivating examples. These include the noisy feedback loop, the logistic time-lag model with Gaussian noise , and the classical ``heat-bath model of R. Kubo , modeling the motion of a ``large molecule in a viscous fluid. These examples are embedded in a general class of stochastic functional differential equations (sfde\u27s). We then establish pathwise existence and uniqueness of solutions to these classes of sfde\u27s under local Lipschitz and linear growth hypotheses on the coefficients. It is interesting to note that the above class of sfde\u27s is not covered by classical results of Protter, Metivier and Pellaumail and Doleans-Dade. In Chapter II, we prove that the Markov (Feller) property holds for the trajectory random field of a sfde. The trajectory Markov semigroup is not strongly continuous for positive delays, and its domain of strong continuity does not contain tame (or cylinder) functions with evaluations away from zero. To overcome this difficulty, we introduce a class of quasitame functions. These belong to the domain of the weak infinitesimal generator, are weakly dense in the underlying space of continuous functions and generate the Borel $\sigma$-algebra of the state space. This chapter also contains a derivation of a formula for the weak infinitesimal generator of the semigroup for sufficiently regular functions, and for a large class of quasitame functions. In Chapter III, we study pathwise regularity of the trajectory random field in the time variable and in the initial path. Of note here is the non-existence of the stochastic flow for the singular sdde $dx(t)= x(t-r) dW(t)$ and a breakdown of linearity and local boundedness. This phenomenon is peculiar to stochastic delay equations. It leads naturally to a classification of sfde\u27s into regular and singular types. Necessary and sufficient conditions for regularity are not known. The rest of Chapter III is devoted to results on sufficient conditions for regularity of linear systems driven by white noise or semimartingales, and Sussman-Doss type nonlinear sfde\u27s. Building on the existence of a compacting stochastic flow, we develop a multiplicative ergodic theory for regular linear sfde\u27s driven by white noise, or general helix semimartingales (Chapter IV). In particular, we prove a Stable Manifold Theorem for such systems. In Chapter V, we seek asymptotic stability for various examples of one-dimensional linear sfde\u27s. Our approach is to obtain upper and lower estimates for the top Lyapunov exponent. Several topics are discussed in Chapter VI. These include the existence of smooth densities for solutions of sfde\u27s using the Malliavin calculus, an approximation technique for multidimensional diffusions using sdde\u27s with small delays, and affine sfde\u27s

Manganese Superoxide Dismutase: Guardian of the Powerhouse

The mitochondrion is vital for many metabolic pathways in the cell, contributing all or important constituent enzymes for diverse functions such as β-oxidation of fatty acids, the urea cycle, the citric acid cycle, and ATP synthesis. The mitochondrion is also a major site of reactive oxygen species (ROS) production in the cell. Aberrant production of mitochondrial ROS can have dramatic effects on cellular function, in part, due to oxidative modification of key metabolic proteins localized in the mitochondrion. The cell is equipped with myriad antioxidant enzyme systems to combat deleterious ROS production in mitochondria, with the mitochondrial antioxidant enzyme manganese superoxide dismutase (MnSOD) acting as the chief ROS scavenging enzyme in the cell. Factors that affect the expression and/or the activity of MnSOD, resulting in diminished antioxidant capacity of the cell, can have extraordinary consequences on the overall health of the cell by altering mitochondrial metabolic function, leading to the development and progression of numerous diseases. A better understanding of the mechanisms by which MnSOD protects cells from the harmful effects of overproduction of ROS, in particular, the effects of ROS on mitochondrial metabolic enzymes, may contribute to the development of novel treatments for various diseases in which ROS are an important component

Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial

Background: The safety, effectiveness, and cost-effectiveness of molnupiravir, an oral antiviral medication for SARS-CoV-2, has not been established in vaccinated patients in the community at increased risk of morbidity and mortality from COVID-19. We aimed to establish whether the addition of molnupiravir to usual care reduced hospital admissions and deaths associated with COVID-19 in this population. Methods: PANORAMIC was a UK-based, national, multicentre, open-label, multigroup, prospective, platform adaptive randomised controlled trial. Eligible participants were aged 50 years or older—or aged 18 years or older with relevant comorbidities—and had been unwell with confirmed COVID-19 for 5 days or fewer in the community. Participants were randomly assigned (1:1) to receive 800 mg molnupiravir twice daily for 5 days plus usual care or usual care only. A secure, web-based system (Spinnaker) was used for randomisation, which was stratified by age (<50 years vs ≥50 years) and vaccination status (yes vs no). COVID-19 outcomes were tracked via a self-completed online daily diary for 28 days after randomisation. The primary outcome was all-cause hospitalisation or death within 28 days of randomisation, which was analysed using Bayesian models in all eligible participants who were randomly assigned. This trial is registered with ISRCTN, number 30448031. Findings: Between Dec 8, 2021, and April 27, 2022, 26 411 participants were randomly assigned, 12 821 to molnupiravir plus usual care, 12 962 to usual care alone, and 628 to other treatment groups (which will be reported separately). 12 529 participants from the molnupiravir plus usual care group, and 12 525 from the usual care group were included in the primary analysis population. The mean age of the population was 56·6 years (SD 12·6), and 24 290 (94%) of 25 708 participants had had at least three doses of a SARS-CoV-2 vaccine. Hospitalisations or deaths were recorded in 105 (1%) of 12 529 participants in the molnupiravir plus usual care group versus 98 (1%) of 12 525 in the usual care group (adjusted odds ratio 1·06 [95% Bayesian credible interval 0·81–1·41]; probability of superiority 0·33). There was no evidence of treatment interaction between subgroups. Serious adverse events were recorded for 50 (0·4%) of 12 774 participants in the molnupiravir plus usual care group and for 45 (0·3%) of 12 934 in the usual care group. None of these events were judged to be related to molnupiravir. Interpretation: Molnupiravir did not reduce the frequency of COVID-19-associated hospitalisations or death among high-risk vaccinated adults in the community

Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial

BackgroundThe safety, effectiveness, and cost-effectiveness of molnupiravir, an oral antiviral medication for SARS-CoV-2, has not been established in vaccinated patients in the community at increased risk of morbidity and mortality from COVID-19. We aimed to establish whether the addition of molnupiravir to usual care reduced hospital admissions and deaths associated with COVID-19 in this population.MethodsPANORAMIC was a UK-based, national, multicentre, open-label, multigroup, prospective, platform adaptive randomised controlled trial. Eligible participants were aged 50 years or older—or aged 18 years or older with relevant comorbidities—and had been unwell with confirmed COVID-19 for 5 days or fewer in the community. Participants were randomly assigned (1:1) to receive 800 mg molnupiravir twice daily for 5 days plus usual care or usual care only. A secure, web-based system (Spinnaker) was used for randomisation, which was stratified by age (<50 years vs ≥50 years) and vaccination status (yes vs no). COVID-19 outcomes were tracked via a self-completed online daily diary for 28 days after randomisation. The primary outcome was all-cause hospitalisation or death within 28 days of randomisation, which was analysed using Bayesian models in all eligible participants who were randomly assigned. This trial is registered with ISRCTN, number 30448031.FindingsBetween Dec 8, 2021, and April 27, 2022, 26 411 participants were randomly assigned, 12 821 to molnupiravir plus usual care, 12 962 to usual care alone, and 628 to other treatment groups (which will be reported separately). 12 529 participants from the molnupiravir plus usual care group, and 12 525 from the usual care group were included in the primary analysis population. The mean age of the population was 56·6 years (SD 12·6), and 24 290 (94%) of 25 708 participants had had at least three doses of a SARS-CoV-2 vaccine. Hospitalisations or deaths were recorded in 105 (1%) of 12 529 participants in the molnupiravir plus usual care group versus 98 (1%) of 12 525 in the usual care group (adjusted odds ratio 1·06 [95% Bayesian credible interval 0·81–1·41]; probability of superiority 0·33). There was no evidence of treatment interaction between subgroups. Serious adverse events were recorded for 50 (0·4%) of 12 774 participants in the molnupiravir plus usual care group and for 45 (0·3%) of 12 934 in the usual care group. None of these events were judged to be related to molnupiravir.InterpretationMolnupiravir did not reduce the frequency of COVID-19-associated hospitalisations or death among high-risk vaccinated adults in the community