Planning and Implementation of Physical Therapy Services in an Athletic Training Pro-Bono Clinic: An Administrative Case Report

Background & Purpose Athletic Training and Physical Therapy students have overlapping, yet unique aspects of clinical competencies and scopes of practice, offering rich potential for interprofessional partnership. University of Nebraska Medical Center (UNMC) Doctor or Physical Therapy Education expanded its program to the University of Nebraska-Kearney (UNK) campus, which boasts a Division II athletic training (AT) program. To create meaningful IPE experiences for both programs (1,2), campus leaders from the UNMC College of Allied Health Professions and UNK sought to create an interprofessional clinic by adding PT care to an existing AT-led pro-bono clinic serving the University intramural recreation community. This project describes the process of integrating services with a focus on educating students in a team-based care model. Methods An administrative case report framework allows description of the development phases of the collaborative clinic. Details including AT and PT scope of practice, supervision requirements, liability coverage, and clinic resource needs are addressed. Operational considerations regarding student orientation, scheduling and programmatic outcomes assessment are also described. Results & Outcomes The outcomes of this clinic partnership are categorized in three key areas. Clarification of roles and responsibilities occurs as students work side-by-side to reach patient goals and lead different aspects of care. Relationships between clinicians, students and referral sources (in and out of clinic) build trust necessary for effective team function, improved communication and patient care. Relationship-building is key for continued clinic success and viability, simultaneously providing a springboard for both programs to meet the IPEC Core Competencies (3). Continued development of assessment of student learning is ongoing. Impressively, the clinic has experienced 157% growth in patient visits and an unexpected impact, reaching students representing ethnic minorities and a student population that is transitioning from school-based IEPs – and is underserved in this region and across the US (4). Conclusion Clinic growth and legal practice standards have highlighted the need to implement several new policies and procedures for clinic operations. Scheduling preferences for AT:PT ratios and pairing of Year 1/2 PT students are recommended to establish mentoring relationships and teaching opportunities for upper-level students. Developing a student board will help with scheduling, standardization of documentation and communication between disciplines to ensure well-rounded coverage, facilitating hand-offs and continuity of care. Providing students with ownership of clinic operations may enhance professional responsibility and learning (5)

Length-weight relationships of the Emerald Shiner (Notropis atherinoides - Rafinesque, 1818) in the Western Basin of Lake Erie

Total length and standard length (mm) were compared to weight (mg) in the Emerald Shiner (Notropis atherinoides - Rafinesque, 1818) in the western basin of Lake Erie. Length and weight relationship (n = 400), length-frequency distribution, and sex ratios were evaluated for  coastal and tributary habitats and compared to open water habitats. A strong positive correlation was observed between length and weight for both males and females. For males (n = 195) there was a significant positive relationship between standard length (SL) and weight (F = 935.64, d.f = 195; R2 = 0.989) and between total length (TL) and weight (F = 918.75, d.f. = 195; R2 = 0.991). In females (n = 205), there was also a strong positive correlation between SL and weight (F = 1108.18, d.f. = 204; R2 = 0.976) and between TL and weight (F = 1208.86, d.f. = 204; R2 = 0.983). This same positive relationship between SL and weight (F = 1909.58, d.f. = 399; R2 = 0.984,) and between TL and weight (F = 1960.07, d.f. = 399; R2 = 0.988) that was found for  the individual sexes was present in the combined data for the two sexes. Length-weight relationship patterns in Emerald Shiner were significantly influenced by sex (ANCOVA, F= 313.03, p < 0.01) and habitat (ANCOVA, F = 6.693, p = 0.013).  Three separate age classes were distinguished in the data. Age 0 males ranged from 15-33 mm TL, while age 0 females ranged from 18-30 mm TL. Age I males ranged from 39-78 mm TL and Age I females ranged from 42-78 mm TL. Age II+ males ranged from 78-111 mm TL and Age II+ females ranged from 81-108 mm TL. Emerald Shiner exhibit indeterminate growth and sex influenced growth patterns based on the von Bertalanffy growth model

Antibody-based detection of protein phosphorylation status to track the efficacy of novel therapies using nanogram protein quantities from stem cells and cell lines

This protocol describes a highly reproducible antibody-based method that provides protein level and phosphorylation status information from nanogram quantities of protein cell lysate. Nanocapillary isoelectric focusing (cIEF) combines with UV-activated linking chemistry to detect changes in phosphorylation status. As an example application, we describe how to detect changes in response to tyrosine kinase inhibitors (TKIs) in the phosphorylation status of the adaptor protein ​CrkL, a major substrate of the oncogenic tyrosine kinase ​BCR-​ABL in chronic myeloid leukemia (CML), using highly enriched CML stem cells and mature cell populations in vitro. This protocol provides a 2.5 pg/nl limit of protein detection (<0.2% of a stem cell sample containing <104 cells). Additional assays are described for phosphorylated tyrosine 207 (pTyr207)-​CrkL and the protein tyrosine phosphatase ​PTPRC/​CD45; these assays were developed using this protocol and applied to CML patient samples. This method is of high throughput, and it can act as a screen for in vitro cancer stem cell response to drugs and novel agents

Regenerative capacity in the lamprey spinal cord is not altered after a repeated transection

© The Author(s), 2019. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in PLoS One 14(1), (2019):e0204193, doi: 10.1371/journal.pone.0204193.The resilience of regeneration in vertebrates is not very well understood. Yet understanding if tissues can regenerate after repeated insults, and identifying limitations, is important for elucidating the underlying mechanisms of tissue plasticity. This is particularly challenging in tissues, such as the nervous system, which possess a large number of terminally differentiated cells and often exhibit limited regeneration in the first place. However, unlike mammals, which exhibit very limited regeneration of spinal cord tissues, many non-mammalian vertebrates, including lampreys, bony fishes, amphibians, and reptiles, regenerate their spinal cords and functionally recover even after a complete spinal cord transection. It is well established that lampreys undergo full functional recovery of swimming behaviors after a single spinal cord transection, which is accompanied by tissue repair at the lesion site, as well as axon and synapse regeneration. Here we begin to explore the resilience of spinal cord regeneration in lampreys after a second spinal transection (re-transection). We report that by all functional and anatomical measures tested, lampreys regenerate after spinal re-transection just as robustly as after single transections. Recovery of swimming, synapse and cytoskeletal distributions, axon regeneration, and neuronal survival were nearly identical after spinal transection or re-transection. Only minor differences in tissue repair at the lesion site were observed in re-transected spinal cords. Thus, regenerative potential in the lamprey spinal cord is largely unaffected by spinal re-transection, indicating a greater persistent regenerative potential than exists in some other highly regenerative models. These findings establish a new path for uncovering pro-regenerative targets that could be deployed in non-regenerative conditions.The authors would like to thank Dr. Cristina Roman-Vendrell and Louie Kerr, Director of the Central Microscopy Facility at the MBL, for technical support. We also thank Dr. Juan Diaz-Quiroz for helpful comments on the manuscript. EG was supported in part by an NSF REU Award (#1659604: Biological Discovery in Woods Hole at the Marine Biological Laboratory)

Small Group Learning is Associated with Reduced Salivary Cortisol and Testosterone in Undergraduate Students

Small group learning activities have been shown to improve student academic performance and educational outcomes. Yet, we have an imperfect understanding of the mechanisms by which this occurs. Group learning may mediate student stress by placing learning in a context where students have both social support and greater control over their learning. We hypothesize that one of the methods by which small group activities improve learning is by mitigating student stress. To test this, we collected physiological measures of stress and self-reported perceived stress from 26 students in two undergraduate classes. Salivary cortisol and testosterone were measured within students across five contexts: a) pre-instructional baseline, b) following a traditional lecture, c) after participating in a structured small group learning activity, d) following completion of multiple choice, and e) essay sections of an exam. Results indicate students have lower salivary cortisol after small group learning activities, as compared to traditional lectures. Further, there is no evidence of a relationship between physiological measures of stress and self-reported perceived stress levels. We discuss how structured small group activities may be beneficial for reducing stress and improving student-learning outcomes

Towards an Understanding of Changing-Look Quasars: An Archival Spectroscopic Search in SDSS

The uncertain origin of the recently-discovered `changing-looking' quasar phenomenon -- in which a luminous quasar dims significantly to a quiescent state in repeat spectroscopy over ~10 year timescales -- may present unexpected challenges to our understanding of quasar accretion. To better understand this phenomenon, we take a first step to building a sample of changing-look quasars with a systematic but simple archival search for these objects in the Sloan Digital Sky Survey Data Release 12. By leveraging the >10 year baselines for objects with repeat spectroscopy, we uncover two new changing-look quasars, and a third discovered previously. Decomposition of the multi-epoch spectra and analysis of the broad emission lines suggest that the quasar accretion disk emission dims due to rapidly decreasing accretion rates (by factors of >2.5), while disfavoring changes in intrinsic dust extinction for the two objects where these analyses are possible. Broad emission line energetics also support intrinsic dimming of quasar emission as the origin for this phenomenon rather than transient tidal disruption events or supernovae. Although our search criteria included quasars at all redshifts and transitions from either quasar-like to galaxy-like states or the reverse, all of the clear cases of changing-look quasars discovered were at relatively low-redshift (z ~ 0.2 - 0.3) and only exhibit quasar-like to galaxy-like transitions.Comment: 15 pages, 8 figures. Updated to accepted versio

Influence of age on the clinical outcomes of coronary revascularisation for the treatment of patients with multivessel de novo coronary artery lesions: sirolimus-eluting stent vs. coronary artery bypass surgery and bare metal stent, insight from the multicentre randomised Arterial Revascularisation Therapy Study Part I (ARTS-I) and Part II (ARTS-II)

peer reviewedAims: We sought to evaluate the prognostic impact of age on the procedural results and subsequent clinical outcomes in patients with multivessel disease (MVD) treated either by coronary artery bypass surgery (CABG) or by percutaneous coronary intervention (PCI) with or without drug eluting stents, based on data of the Arterial Revascularisation Therapies Study (ARTS) part I and part II. The potential influence of age in determining the most appropriate revascularisation strategy for patients with MVD is largely unknown. Methods and results: Three year clinical outcome of ARTS I patients randomised to PCI with bare metal stent (BMS) (n= 600) or CABG (n= 605), and matched patients treated by PCI with sirolimus-eluting stents (SES) in ARTS II (n= 607) were reviewed according to four age quartiles. Endpoints were measured in terms of major adverse cardiac and cerebrovascular events MACCE) during hospital stay and up to three years. The frequency of female, diabetes, hypertension, peripheral vascular disease, pulmonary disease, as well as lesion complexity increased with age. At three years, MACCE free survival was comparable between patients treated by CABG or SES PCI, regardless of age quartile. The incidence of MACCE was higher among ARTS I BMS treated patients in all but the second age quartile. This was primarily related to a higher need for repeat revascularisation among BMS treated patients. However, age, which emerged as a strong independent predictor of MACCE following CABG (p<0.005), was not predictive of adverse events following PCI. Conversely, diabetes was the strongest independent predictor of MACCE among PCI treated patients (p<0.02), but didn’t affect three-year outcomes following CABG. Conclusions: Age seems to influence the CABG outcome in-hospital but not PCI. PCI-SES could offer lower immediate risk in patients with MVD and comparable long-term outcome as CABG especially in older patients. The worst outcome of PCI-BMS group is primarily related to the need for repeat revascularisation. Diabetes is the most important predictor of MACCE following PCI