Emergency and Scheduled Respite Care for Caregivers of Persons with Dementia: A Proposed Program

Introduction: Respite care is defined as providing the primary caregiver with relief or a reprieve from care commitments on a short-term or emergency basis. Despite a demonstrated interest in and need for respite care programs, our research has shown that scarce resources exist via a statewide dementia respite program administered by Vermont’s five Area Agencies on Aging. Grants are small and many families do not fall within the eligibility requirements. In FY2010, only 290 families across the state met eligibility requirements (physicians’ diagnosis of dementia, income less than 300% of poverty line, unpaid caregiver, primary residence in VT) and were awarded limited funding for the provision of outside care (up to $750.00 each). For many of these families, this money is typically used to provide substitute care when the primary caregiver is not available. To date, there is no true emergency respite program in place for caregivers. This has placed a strain on families and day facilities, particularly when situations arise in which a caregiver is unable to pick up their family member due to an emergency situation. Our goal was to demonstrate the feasibility of a respite program to address this need.https://scholarworks.uvm.edu/comphp_gallery/1061/thumbnail.jp

Assessment of a Novel Pediatric Resident Simulation Curriculum

Aim: To assess the efficacy of a newly implemented resident simulation curriculum at a medium sized pediatric residency program. Background: Many pediatric residency programs incorporate high-fidelity simulation into their curriculum, but there is limited data discussing the utility/educational impacts of a longitudinal/standardized/multimodal simulation curriculum. Several studies of simulation-based training have employed “self-efficacy” as a barometer for trainee education and performance 1,2,. The level of a person’s self-efficacy can influence their behavior and may be a pivotal factor in performance. We have implemented a newly devised standardized, multimodal resident simulation curriculum and used resident self-efficacy to assess its effectiveness. Methods: Participants were UMass Pediatric and Med/Peds residents. Implementation of our curriculum occurred at the start of the 2016-2017 academic year. Surveys were administered to all residents prior to curriculum implementation and at 6 months post-implementation. They assessed resident self-efficacy with regards to specific technical/procedural skills (i.e. running a code, performing intubation, etc.) and resident confidence in their ability to identify/manage specific pediatric disease presentations (i.e. respiratory failure, tachyarrhythmia, etc.). Data was pooled and averaged for each resident class separately. We predetermined a 10% change in self-efficacy to be a clinically significant difference. Results: 36 of 40 residents completed the initial survey and 31 completed the 6-month follow-up. PGY1 residents reported improved self-efficacy for 4 PALS-related skills and 8 pediatric case presentations. Similarly, PGY2 residents reported improved self-efficacy for 3 PALS-related skills and 6 pediatric case presentations. Conversely, PGY3/4 residents reported no significant change in self-efficacy for any survey question. Conclusions: These results suggest that our newly implemented longitudinal, standardized, multidisciplinary, multi-modal simulation curriculum has significantly improved resident self-efficacy related to core Pediatric Advanced Life-Support (PALS) skills/topics, with the greatest impact affecting our PGY1 class. Further study and curriculum development will attempt to address this issue

Human Cytomegalovirus Fcγ Binding Proteins gp34 and gp68 Antagonize Fcγ Receptors I, II and III

Human cytomegalovirus (HCMV) establishes lifelong infection with recurrent episodes of virus production and shedding despite the presence of adaptive immunological memory responses including HCMV immune immunoglobulin G (IgG). Very little is known how HCMV evades from humoral and cellular IgG-dependent immune responses, the latter being executed by cells expressing surface receptors for the Fc domain of IgG (FcγRs). Remarkably, HCMV expresses the RL11-encoded gp34 and UL119-118-encoded gp68 type I transmembrane glycoproteins which bind Fcγ with nanomolar affinity. Using a newly developed FcγR activation assay, we tested if the HCMV-encoded Fcγ binding proteins (HCMV FcγRs) interfere with individual host FcγRs. In absence of gp34 or/and gp68, HCMV elicited a much stronger activation of FcγRIIIA/CD16, FcγRIIA/CD32A and FcγRI/CD64 by polyclonal HCMV-immune IgG as compared to wildtype HCMV. gp34 and gp68 co-expression culminates in the late phase of HCMV replication coinciding with the emergence of surface HCMV antigens triggering FcγRIII/CD16 responses by polyclonal HCMV-immune IgG. The gp34- and gp68-dependent inhibition of HCMV immune IgG was fully reproduced when testing the activation of primary human NK cells. Their broad antagonistic function towards FcγRIIIA, FcγRIIA and FcγRI activation was also recapitulated in a gain-of-function approach based on humanized monoclonal antibodies (trastuzumab, rituximab) and isotypes of different IgG subclasses. Surface immune-precipitation showed that both HCMV-encoded Fcγ binding proteins have the capacity to bind trastuzumab antibody-HER2 antigen complexes demonstrating simultaneous linkage of immune IgG with antigen and the HCMV inhibitors on the plasma membrane. Our studies reveal a novel strategy by which viral FcγRs can compete for immune complexes against various Fc receptors on immune cells, dampening their activation and antiviral immunity.DFG grant He 2526/6-2.European Commission grants QLRT-2001-01112 and MRTN-CT-2005-019248.Helmholtz Association through VISTRIE VH-VI-242.UCR::Vicerrectoría de Docencia::Salud::Facultad de Microbiologí