Outcomes of International Service Learning (ISL): Alumni Perspectives

Service learning is an active method that combines academic knowledge and hands-on experience while serving a community. Service learning is well established within occupational therapy (OT) and allied health education, as many institutions have organized both domestic and international service learning experiences. Literature supports student benefits of participation in international service learning (ISL), but limited literature exists on the long-term impact of participation in ISL throughout allied health education. Many OT students participate in ISL during their education, but there is limited literature on the impact of an ISL experience on participants’ careers in OT. In this qualitative study, an online survey was distributed to past participants of an ISL trip of an OT program in the Midwest. Of the 100 subjects, 30 completed the survey. Researchers used conventional content analysis to extract themes from the data. Two themes were identified: (1) evolving professional self and (2) transformative personal experience. Subthemes of the evolving professional self theme included: (1) desire to work with vulnerable populations, (2) professional soft skill development, and (3) acquisition of knowledge and skills. Results indicate that benefits are maintained after graduation signifying that participation in ISL may have a sustained, lasting influence on OT practitioners. ISL supports the values of OT education by shaping professional identity through active, diverse learning and self-reflection to promote lifelong learning. Results broaden the profession’s understanding of the outcomes of ISL post-graduation and inform ISL best practice standards within OT education

Severe rhabdomyolysis in homozygote carnitine palmitoyltransferase II deficiency

Carnitine palmitoyltransferase II (CPT II) deficiency represents an inherited defect in mitochondrial long-chain fatty acid oxidation. Rhabdomyolysis with necrosis of muscle is caused by the destruction of skeletal muscle and leads to systemic, multiorgan complications due to the release of intracellular muscle components. Severe rhabdomyolysis may be triggered by combination of a genetic predisposition, including CPT II deficiency, with additionally acting causes. Generally, patients with CPT II deficiency are rarely clinical recognized and reported. We describe a patient presenting severe rhabdomyolysis due to urosepsis, who, in genetic testing, demonstrated the homozygous CPT II deficiency (c.338C>T, p.Ser113Leu) mutation. The diagnosis of CPT II deficiency helped this patient to put the symptoms into context, and this reduced myopathy and the risk of recurring rhabdomyolysis. We report on this patient to increase awareness of diagnostic and medical management in CPT II deficiency

Food malabsorption/intolerance complaints triggered by primary epiploic appendagitis

Primary epiploic appendagitis (PEA) is an uncommon and self-limiting cause of acute or subacute abdominal complaints. The diagnosis of PEA, with its characteristic appearance, is made with computed tomography (CT). This report describes a patient seven months after a CT-confirmed diagnosis of PEA. Because of persistent and recurring, functional, non-specific abdominal complaints, food intolerance/malabsorption was investigated. Fructose malabsorption combined with histamine intolerance was found. A registered dietician helped develop an individually-tailored diet to address the problem. Within four days of beginning the fructose-free and histamine-reduced diet, the patient’s complaints resolved. In conclusion, abdominal symptoms caused by fructose malabsorption and histamine intolerance may have been triggered by PAE in this patient

Long time blood-transfusion trend in a European general hospital

Reports about long-time transfusion trends in Austrian hospitals are rare. In our hospital, we implemented an algorithm of preoperative anemia management as part of a patient blood management (PBM) program in October 2011. Anemic individuals with elective surgery underwent an adequate preoperative anemia classification and treatment with erythropoietin and intravenous iron. The aim of this study was to assess red blood cell (RBC), platelet and plasma transfusions before and after implementation of an anemia management program in a general hospital in Austria. This retrospective study evaluated a 12-year trend (2006 – 2017) of RBC, platelet and plasma transfusions in an Austrian general hospital comprising a 6-year period before (2006 – 2011) and a 6-year period after (2012 – 2017) the implementation of an algorithm-guided anemia management. From overall 49,142 transfused RBC units between 2006 - 2017, 22,745 units were transfused in the post-implementation period compared to 26,397 units before PBM initiation (-13.8 %). The plasma unit use decreased also distinctly (787 vs. 1065 units, - 26.1 %) in the period after PBM implementation, whereas a slight decrease of platelet concentration use (807 vs. 843 units, - 4.3 %) was observed, only. This study demonstrates a 12-year pattern of blood use in an Austrian hospital with a distinct decreasing trend of transfused RBC and plasma units during this period. The implementation of PBM activities decreased the need of blood utilization at our institution. Further initiatives are needed to continue this trend in the next years

TRACING ORIGIN AND COLLAPSE OF HOLOCENE BENTHIC BASELINE COMMUNITIES IN THE NORTHERN ADRIATIC SEA

The shallow northern Adriatic Sea has a long history of anthropogenic impacts that reaches back many centuries. While the effects of eutrophication, overfishing, pollution, and trawling over recent decades have been extensively studied, the major ecological turnovers during the Holocene as a whole remain poorly explored. In this study, we reconstruct ecological baselines defining benthic ecosystem composition prior to major anthropogenic changes at four stations characterized by low sedimentation and millennial-scale time averaging of molluscan assemblages. We discriminate between natural and anthropogenic drivers based on (1) stratigraphic changes in the composition of molluscan communities observed in sediment cores and (2) changes in concentrations of heavy metals, pollutants, and organic enrichment. The four 1.5-m long sediment cores reach back to the Pleistocene–Holocene boundary, allowing for a stratigraphic distinction of the major sea-level phases of the Holocene. During the transgressive phase and maximum flooding, sea-level and establishment of the modern circulation pattern determined the development of benthic communities in shallow-water, vegetated habitats with epifaunal biostromes and, in deeper waters, with bryozoan meadows. After sea-level stabilization, the composition of these baseline communities remained relatively uniform and started to change markedly only with the intensification of human impacts in the late highstand, leading to a dominance of infauna and a decline of epifauna at all sites. This profound ecological change reduced species richness, increased the abundance of infaunal suspension feeders, and led to a decline of grazers and deposit feeders. We suggest that modern soft-bottom benthic communities in the northern Adriatic Sea today do not show the high geographic heterogeneity in composition characteristic of benthos prior to anthropogenic influences

Interleukin-6 is associated with tryptophan metabolism and signs of depression in individuals with carbohydrate malabsorption

The aim of the present study was to investigate possible associations between interleukin-6 (IL-6), interferon-gamma (INF-γ), tumor necrosis factor-alpha (TNF-α), lactoferrin and lipopolysaccharide binding protein (LBP) with TRP metabolism and signs of depression in a large cohort of outpatients referred for carbohydrate malabsorption testing. Serum concentrations of IL-6, INF-γ, TNF-α, lactoferrin, LBP, tryptophan (TRP), kynurenine (KYN) and kynuric acid were determined in 250 adults referred for lactose and fructose malabsorption testing. All participants filled out the Beck Depression Inventory (BDI). Serum IL-6 levels were positively correlated with the BDI score (p = 0.001, ρ = 0.205) and indicators of TRP metabolism (KYN/TRP ratio, KYN) (P-values 13 showed significantly higher IL-6 serum levels (1.7 [1.0 – 2.8] vs. 1.1 [0.8 – 1.7] pg/mL, p < 0.001) compared to 115 individuals with a BDI score ≤ 13. LBP showed a positive correlation with the KYN/TRP ratio (p = 0.005, ρ = 0.177). IL-6 and LBP were associated with indicators of TRP metabolism. IL-6 was found to be linked to signs of depression. Individuals with the presence of depressive symptoms showed higher serum IL-6 levels compared to individuals without depressive symptoms

Assessment of trimethylamine-N-oxide at the blood-cerebrospinal fluid barrier

Recently, the microbiome-derived trimethylamine-N-oxide (TMAO) was shown to be present in human cerebrospinal fluid (CSF). However, data on the potential of TMAO crossing the blood-CSF barrier are still lacking. This retrospective study aimed at investigating possible associations between the CSF/serum albumin (QALB) and TMAO (QTMAO) quotient and evaluating QTMAO values in individuals with and without blood-CSF barrier dysfunction. A total of 290 patients, who underwent diagnostic lumbar puncture with QALB and QTMAO determination, were evaluated. Serum and CSF TMAO measurements were performed on a tandem mass spectrometry SCIEX QTRAP 4500 (Applied Biosystems, Framingham, MA, USA) coupled with an Agilent 1260 Infinity HPLC system (Agilent Technologies Santa Clara, CA, USA). Serum and CSF albumin were measured on the Atellica® NEPH 630 system (Siemens Healthineers, Erlangen, Germany). CSF TMAO levels were positively correlated with serum TMAO levels (ρ = 0.709, p < 0.001). The QALB was significantly associated with the QTMAO (ß-coefficient = 0.312; p < 0.001). A total of 117 patients with blood-CSF barrier dysfunction had significantly higher median (Q1 – Q3) QTMAO values (4.7 (2.8 – 7.5) vs. 3.8 (2.5 – 5.7) x 10-1, p = 0.002) compared to 173 individuals with normal blood-CSF barrier function. CSF and serum TMAO concentrations were significantly associated in 290 CSF/serum pairs from lumbar punctures of clinical routine. QALB showed a relevant influence on QTMAO. Present results indicate that TMAO may cross the blood-CSF barrier

A Measure of Obesity: BMI versus Subcutaneous Fat Patterns in Young Athletes and Nonathletes

Although the body mass index (BMI, kg/m2) is widely used as a surrogate measure of adiposity, it is a measure of excess weight, rather than excess body fat, relative to height. The BMI classification system is derived from cut points obtained from the general population. The influence of large muscle mass on BMI in athletes and young adults may misclassify these individuals as overweight and obese. Therefore, the use of subcutaneous adipose tissue topography (SAT-Top) may be more effective than BMI in assessing obesity in physically active people and young adults. The purposes of this study were 1) to describe the relationship between the BMI and SAT-Top of young athletes and nonathletes, and 2) to determine the accuracy of the BMI as a measure of overweight. Height, weight, BMI and SAT-Top were determined in 64 males (25.0±6.7) and 42 females (24.8±7.0), who were subsequently separated into two even groups (athletes and nonathletes). The optical Lipometer device was applied to measure the thickness of subcutaneous adipose tissue (SAT).While BMI was similar, male athletes showed a 50.3% lower total SAT thickness compared to their male nonathlete controls. Even though female athletes had significantly higher BMI and weight scores, their total SAT thickness was 34.9% lower than their nonathlete controls. These results suggest subcutaneous fat patterns are a better screening tool to characterize fatness in physically active young people

Subcutaneous Fat Patterns in Type-2 Diabetic Men and Healthy Controls

The optical device LIPOMETER enables the non-invasive, quick, and save determination of the thickness of subcutaneous adipose tissue layers at any given site of the human body. The specification of 15 evenly distributed body sites allows the precise measurement of subcutaneous body fat distribution, so-called subcutaneous adipose tissue topography (SAT-Top). In the present paper we focus on SAT-Top of male type-2 diabetes patients (N=21), describing very precisely their special SAT development and their SAT-Top deviation from a healthy control group (N=111), applying factor analysis and ROC curves. Factor analysis revealed three independent subcutaneous body fat compartments, which can be summarised as »upper body«, »lower trunk« and »legs«. The upper body SAT-Top is much more pronounced in diabetic men compared to their healthy controls (p<0.001). Furthermore, high diagnostic power by ROC curve analysis was achieved by different measurement sites of the upper body and summary measures of upper body obesity (sum2, which is the sum of neck and biceps, provides: area index = 0.86, sensitivity = 81 %, specificity = 90.1 %, at an optimal cutoff value of 18.8 mm), ascribing a higher diabetes probability to subjects with a more upper body SAT-Top pattern. Calculating new ROC curves for diabetic patients with HBA1C values >8 (N=17) and their healthy controls (N=111) we received improved discrimination power for several SAT-Top body sites, especially for sum2, showing an area index of 0.91, a sensitivity of 94.1 %, and a specificity of 90.1 % at the optimal cutoff value of 18.8 mm. Concluding, the exact and complete description of the especial type 2 diabetic SAT pattern, which differs strongly from the SAT-Top of healthy controls, suggests the LIPOMETER technique combined with advanced statistical methods such as factor analysis and ROC curve analysis as a possible detecting tool for this disease