Occupational Therapy\u27s Role in Adapting Residential Youth Camps for Increased Inclusion

Each year, summer camps serve more than 11 million youth in the United States (US) (Wilson, Sibthorp, & Brusseau, 2017). Summer camps provide children with new experiences and give them opportunities to build confidence, social skills, and peer relationships (Wilson et al., 2017). Occupational therapy (OT) is an emerging area of practice throughout summer camps in the US (Hanscom & Schoen, 2014). Hanscom and Schoen (2014) recommend strategically combining OT with traditional camp programming to create an emotionally, physically, and spiritually safe environment that promotes optimal attending and task follow through. Summer camp has been shown to enhance positive youth development, as it meets motivational needs and promotes intrinsic engagement (Halsall, Kendellen, Bean, & Forneris, 2016). However, not all youth have an equal opportunity to partake in the experience (Shefter, Uhrman, Tobin, & Kress, 2017). McCarthy (2015) states that two percent of American Camp Association camps exclusively serve youth with special medical needs. Further, only seven percent are inclusive (Hall, Dunlap, Causton-Theoharis, & Theohari, 2019). The purpose of this capstone project is to explore the populations served within a residential youth camp, identify barriers to participation, and recommend adaptations to the environment to promote a more inclusive setting

Occupational Therapy’s Role in Adapting Residential Youth Camps for Increased Inclusion

Each year, summer camps serve more than 11 million youth in the United States (US) (Wilson, Sibthorp, & Brusseau, 2017). Summer camps provide children with new experiences and give them opportunities to build confidence, social skills, and peer relationships (Wilson et al., 2017). Occupational therapy (OT) is an emerging area of practice throughout summer camps in the US (Hanscom & Schoen, 2014). Hanscom and Schoen (2014) recommend strategically combining OT with traditional camp programming to create an emotionally, physically, and spiritually safe environment that promotes optimal attending and task follow through. Summer camp has been shown to enhance positive youth development, as it meets motivational needs and promotes intrinsic engagement (Halsall, Kendellen, Bean, & Forneris, 2016). However, not all youth have an equal opportunity to partake in the experience (Shefter, Uhrman, Tobin, & Kress, 2017). McCarthy (2015) states that two percent of American Camp Association camps exclusively serve youth with special medical needs. Further, only seven percent are inclusive (Hall, Dunlap, Causton-Theoharis, & Theohari, 2019). The purpose of this capstone project is to explore the populations served within a residential youth camp, identify barriers to participation, and recommend adaptations to the environment to promote a more inclusive setting.https://soar.usa.edu/otdcapstonespring2020/1002/thumbnail.jp

The Oral Bacterial Communities of Children with Well-Controlled HIV Infection and without HIV Infection.

The oral microbial community (microbiota) plays a critical role in human health and disease. Alterations in the oral microbiota may be associated with disorders such as gingivitis, periodontitis, childhood caries, alveolar osteitis, oral candidiasis and endodontic infections. In the immunosuppressed population, the spectrum of potential oral disease is even broader, encompassing candidiasis, necrotizing gingivitis, parotid gland enlargement, Kaposi\u27s sarcoma, oral warts and other diseases. Here, we used 454 pyrosequencing of bacterial 16S rRNA genes to examine the oral microbiome of saliva, mucosal and tooth samples from HIV-positive and negative children. Patient demographics and clinical characteristics were collected from a cross-section of patients undergoing routine dental care. Multiple specimens from different sampling sites in the mouth were collected for each patient. The goal of the study was to observe the potential diversity of the oral microbiota among individual patients, sample locations, HIV status and various dental characteristics. We found that there were significant differences in the microbiome among the enrolled patients, and between sampling locations. The analysis was complicated by uneven enrollment in the patient cohorts, with only five HIV-negative patients enrolled in the study and by the rapid improvement in the health of HIV-infected children between the time the study was conceived and completed. The generally good oral health of the HIV-negative patients limited the number of dental plaque samples that could be collected. We did not identify significant differences between well-controlled HIV-positive patients and HIV-negative controls, suggesting that well-controlled HIV-positive patients essentially harbor similar oral flora compared to patients without HIV. Nor were significant differences in the oral microbiota identified between different teeth or with different dental characteristics. Additional studies are needed to better characterize the oral microbiome in children and those with poorly-controlled HIV infections

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

NMDS Coordinate Plots.

<p>NMDS plots were generated using OTU abundance data using the Vegan package in R. Panel A and B contain coordinates labeled by HIV status and sample location respectively, while Panel C and D contain coordinates labeled by dentition status and patient ID.</p

Principle Coordinate Plots.

<p>Principle coordinate plots were generated from OTU abundance data using the Vegan package in R. Panel A demonstrates coordiates from samples labeled by the HIV status. Panel B contains coordinates from samples labeled by the sample location. Panels C and D depict coordinates from samples labeled by dentition status and patient ID respectively.</p

Shannon Diversity Scores.

<p>Boxplots were generated from Shannon diversity scores with quartiles represented in whisker plots and the mean identified by the central point. The Shannon score, which is a measure of species diversity within a sample, is compared between sample locations in Panel A. All Shannon scores for each location, patient or HIV-status are contained in the individual boxplots. Panel B demonstrates that minimal differences were observed between the HIV positive and HIV negative patients. The range of Shannon scores between patients is shown in Panel C. Most patients had scores greater than 5.6. The sole exception was patient 12, who was the only patient under age five. All tooth samples from patient 12 were from primary teeth, and her average shannon score was decreased relative to the other patients with a value of 5.0. All tooth samples are supragingival.</p

Most abundant OTUs.

<p>Relative OTU abundance was summed for primary versus permanent teeth and plaque score. Multiple OTUs may be generated for the same genera, due to the clustering method employed by QIIME. Unique genera consist of OTUs with identical genera assignments, which were summed for each patient group to provide a total abundance for each unique genus. The abundance data was normalized and ranked to identify the ten most abundant genera for each group. Genera identified in only primary or permanent teeth were present in both patient groups, but at lower relative abundance.</p

Patient Demographics^a.

<p>^a<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0131615#pone.0131615.t001" target="_blank">Table 1</a> contains demographic information for all patients with sequenced samples. No additional treatment information was available for patient 8. Ages, viral loads and CD4 values were rounded to two significant digits to maintain patient privacy.</p><p>3TC–lamivudine, ABC–abacavir, AZT—d4T = stavudine, ddI–didanosine, EFV–efavirenz, FTC–emtricitabine, LPV/r–lopinavir/ritonavir, NFV–nelfinavir, NVP–nevirapine, TDF–tenofovir, ZDV–zidovudine, SMZ-TMP–sulfamethoxazole and trimethoprim, LGE–linear gingival erythema.</p><p>Patient Demographics<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0131615#t001fn001" target="_blank">^a</a>.</p

Diversity and Richness Estimators^a.

<p>^a Mean values of Chao1, Shannon and Simpson diversity indexes are shown for all samples with at least one OTU in greater than 25% of all samples and with an n of greater than 4. Standard deviation is shown in parentheses. Total number of samples and OTUs for each site is displayed.</p><p>Diversity and Richness Estimators<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0131615#t004fn001" target="_blank">^a</a>.</p