Exploring Sleep Health Among Occupational Therapy Students

A substantial number of health-professional graduate students do not follow the national recommendation of obtaining at least seven hours of sleep per day. Decreased sleep duration and quality are strongly associated with daytime sleepiness and dysfunction, academic burnout, low academic performance, and mental health symptoms and disorders. However, limited research exists on sleep health among occupational therapy (OT) graduate students. Thus, the purpose of this study was to explore OT graduate student perspectives on sleep and to measure their sleep duration, quality, and practices to inform sleep promotion strategies for increased student well-being. A mixed-method study with a cross-sectional design was conducted. Occupational therapy graduate student participants engaged in a focus group and completed the Sleep Practices and Attitudes Questionnaire (SPAQ) along with a survey of demographic characteristics. Nineteen participants completed all aspects of the study. Participants slept an average of 6.75 hours per weekday night and rated their sleep quality an average of 3.47 out of 5 on a Likert scale (1: restless; 5: restful). The majority of participants (68.4%; n=13) reported feeling unrefreshed upon waking, and 78.9% (n=15) reported tiredness during the day. Three major themes emerged from the focus group data: 1) sleep prioritization and practice, 2) sleep knowledge versus action, and 3) occupational balance. This study is one of the first to assess sleep health among OT graduate students. Findings contribute to sleep health literature and may guide programming in sleep health promotion and graduate student well-being

THE EFFECTS OF CLEAT LOCATION ON MUSCLE RECRUITMENT STRATEGIES OF CYCLING

Foot placement may play an important role in muscle recruitment patterns and affect cycling performance. The purpose of this study was to determine if magnitude of activation increased in more proximal muscles when a more posterior compared to standard cleat location is used. Surface electromyography (8 muscles) and kinematics were collected from 11 experienced cyclists pedalling at 80 rpm rate during standard and posterior cleat location conditions. Root mean square (RMS) EMG were analyzed using paired t-tests. Peak RMS magnitude and crank angle of peak RMS were affected by cleat conditions. Posterior cleat locations alter the magnitude and muscular recruitment strategies of seated cycling when compared to neutral cleat placement

The Development of a Well-Being Program for Occupational Therapy Graduate Students

High levels of stress among occupational therapy graduate students have led to the adoption of unhealthy coping habits such as poor nutrition, little exercise, and disrupted sleep. In response, many institutions have explored programming and even curricular changes to support student well-being. However, very few are built upon a strong theoretical foundation to address holistic well-being. Therefore, this paper describes how logic modeling was used to develop a student well-being program based on Facilitating Learning and Occupational Well-Being Using Research-Based Initiatives for Student Health (FLOURISH), a theoretical approach rooted in the Person-Environment-Occupation Performance Model. A well-being program delivered via a virtual community of practice for entry-level students at a Midwestern occupational therapy program was created to decrease stress and enhance overall well-being for the performance of learning. The program consisted of eight 50-minute sessions that met once per week and included topics of physical, mental, sociocultural, environmental, and occupational well-being. The student well-being program is one viable option that shows promise to empower students with a theoretical approach to address personal and professional well-being, which has the potential to translate into professional practice. In this article, we describe the well-being program and the theoretical approach in detail and illustrate how it can be used to improve occupational therapy student well-being

The Development of a Well-Being Program for Occupational Therapy Graduate Students

High levels of stress among occupational therapy graduate students have led to the adoption of unhealthy coping habits such as poor nutrition, little exercise, and disrupted sleep. In response, many institutions have explored programming and even curricular changes to support student well-being. However, very few are built upon a strong theoretical foundation to address holistic well-being. Therefore, this paper describes how logic modeling was used to develop a student well-being program based on Facilitating Learning and Occupational Well-Being Using Research-Based Initiatives for Student Health (FLOURISH), a theoretical approach rooted in the Person-Environment-Occupation Performance Model. A well-being program delivered via a virtual community of practice for entry-level students at a Midwestern occupational therapy program was created to decrease stress and enhance overall well-being for the performance of learning. The program consisted of eight 50-minute sessions that met once per week and included topics of physical, mental, sociocultural, environmental, and occupational well-being. The student well-being program is one viable option that shows promise to empower students with a theoretical approach to address personal and professional well-being, which has the potential to translate into professional practice. In this article, we describe the well-being program and the theoretical approach in detail and illustrate how it can be used to improve occupational therapy student well-being

Xylem surfactants introduce a new element to the cohesion-tension theory

Vascular plants transport water under negative pressure without constantly creating gas bubbles that would disable their hydraulic systems. Attempts to replicate this feat in artificial systems almost invariably result in bubble formation, except under highly controlled conditions with pure water and only hydrophilic surfaces present. In theory, conditions in the xylem should favor bubble nucleation even more: there are millions of conduits with at least some hydrophobic surfaces, and xylem sap is saturated or sometimes supersaturated with atmospheric gas and may contain surface-active molecules that can lower surface tension. So how do plants transport water under negative pressure? Here, we show that angiosperm xylem contains abundant hydrophobic surfaces as well as insoluble lipid surfactants, including phospholipids, and proteins, a composition similar to pulmonary surfactants. Lipid surfactants were found in xylem sap and as nanoparticles under transmission electron microscopy in pores of intervessel pit membranes and deposited on vessel wall surfaces. Nanoparticles observed in xylem sap via nanoparticle-tracking analysis included surfactant-coated nanobubbles when examined by freeze-fracture electron microscopy. Based on their fracture behavior, this technique is able to distinguish between dense-core particles, liquid-filled, bilayer-coated vesicles/liposomes, and gas-filled bubbles. Xylem surfactants showed strong surface activity that reduces surface tension to low values when concentrated as they are in pit membrane pores. We hypothesize that xylem surfactants support water transport under negative pressure as explained by the cohesion-tension theory by coating hydrophobic surfaces and nanobubbles, thereby keeping the latter below the critical size at which bubbles would expand to form embolisms

Does interlimb knee symmetry exist after unicompartmental knee arthroplasty? Knee

BACKGROUND: Unicompartmental knee arthroplasty (UKA) has long been a treatment option for patients with disease limited primarily to one compartment with small, correctable deformities. However, some surgeons presume that normal kinematics of a lateral compartment UKA are difficult to achieve. Furthermore, it is unclear whether UKA restores normal knee kinematics and interlimb symmetry. QUESTIONS/PURPOSES: We determined knee kinematics exhibited during stair ascent by patients with medial- (MED-UKA) or lateral-UKA (LAT-UKA) and if the knee kinematics of the operated and nonoperated limbs were symmetrical. METHODS: Participants were 17 individuals with MED-UKA and nine with LAT-UKA, all with nondiseased contralateral limbs. For each limb, participants walked up four stairs for five trials while a motion-capture system obtained reflective marker locations. Temporal events were determined by force platform signals. Interlimb symmetry was classified for temporal gait and knee angular kinematics by comparing observed interlimb differences with clinically meaningful differences set at 5% of stride time for temporal variables and 5° for angular variables. The minimum postoperative followup was 6 months (median, 24 months; range, 6-53 months). RESULTS: Neither group demonstrated clinically meaningful mean interlimb differences. However, approximately half of participants of each UKA group displayed asymmetry favoring the operative or nonoperative limb with similar frequency. CONCLUSIONS: Many patients undergoing UKA demonstrate kinematic interlimb symmetry during stair ascent. Interlimb asymmetry may be affected by a variety of factors unrelated to the UKA. CLINICAL RELEVANCE: A MED- or LAT-UKA can potentially restore normal knee function for a demanding task of daily life

Routine Pediatric Enterovirus 71 Vaccination in China: a Cost-Effectiveness Analysis.

BACKGROUND: China accounted for 87% (9.8 million/11.3 million) of all hand, foot, and mouth disease (HFMD) cases reported to WHO during 2010-2014. Enterovirus 71 (EV71) is responsible for most of the severe HFMD cases. Three EV71 vaccines recently demonstrated good efficacy in children aged 6-71 mo. Here we assessed the cost-effectiveness of routine pediatric EV71 vaccination in China. METHODS AND FINDINGS: We characterized the economic and health burden of EV71-associated HFMD (EV71-HFMD) in China using (i) the national surveillance database, (ii) virological surveillance records from all provinces, and (iii) a caregiver survey on the household costs and health utility loss for 1,787 laboratory-confirmed pediatric cases. Using a static model parameterized with these data, we estimated the effective vaccine cost (EVC, defined as cost/efficacy or simply the cost of a 100% efficacious vaccine) below which routine pediatric vaccination would be considered cost-effective. We performed the base-case analysis from the societal perspective with a willingness-to-pay threshold of one times the gross domestic product per capita (GDPpc) and an annual discount rate of 3%. We performed uncertainty analysis by (i) accounting for the uncertainty in the risk of EV71-HFMD due to missing laboratory data in the national database, (ii) excluding productivity loss of parents and caregivers, (iii) increasing the willingness-to-pay threshold to three times GDPpc, (iv) increasing the discount rate to 6%, and (v) accounting for the proportion of EV71-HFMD cases not registered by national surveillance. In each of these scenarios, we performed probabilistic sensitivity analysis to account for parametric uncertainty in our estimates of the risk of EV71-HFMD and the expected costs and health utility loss due to EV71-HFMD. Routine pediatric EV71 vaccination would be cost-saving if the all-inclusive EVC is below US$10.6 (95$9.7-US$11.5) and would remain cost-effective if EVC is below US$17.9 (95% CI US$16.9-US$18.8) in the base case, but these ceilings could be up to 66% higher if all the test-negative cases with missing laboratory data are EV71-HFMD. The EVC ceiling is (i) 10%-14% lower if productivity loss of parents/caregivers is excluded, (ii) 58%-84% higher if the willingness-to-pay threshold is increased to three times GDPpc, (iii) 14%-19% lower if the discount rate is increased to 6%, and (iv) 36% (95% CI 23%-50%) higher if the proportion of EV71-HFMD registered by national surveillance is the same as that observed in the three EV71 vaccine phase III trials. The validity of our results relies on the following assumptions: (i) self-reported hospital charges are a good proxy for the opportunity cost of care, (ii) the cost and health utility loss estimates based on laboratory-confirmed EV71-HFMD cases are representative of all EV71-HFMD cases, and (iii) the long-term average risk of EV71-HFMD in the future is similar to that registered by national surveillance during 2010-2013. CONCLUSIONS: Compared to no vaccination, routine pediatric EV71 vaccination would be very cost-effective in China if the cost of immunization (including all logistical, procurement, and administration costs needed to confer 5 y of vaccine protection) is below US$12.0-US$18.3, depending on the choice of vaccine among the three candidates. Given that the annual number of births in China has been around 16 million in recent years, the annual costs for routine pediatric EV71 vaccination at this cost range should not exceed US$192-US$293 million. Our results can be used to determine the optimal vaccine when the prices of the three vaccines are known

Knee moments after unicompartmental knee arthroplasty during stair ascent knee

BACKGROUND: For unicompartmental knee arthroplasty (UKA), abnormal loading on the tibiofemoral joint could exacerbate knee osteoarthritis or implant wear. Joint moments are an indirect measure of such loading. However, little is known about knee moments of patients with UKA, tempering enthusiasm for its use. QUESTIONS/PURPOSES: In patients with UKAs performing stair ascent, we (1) determined whether interlimb differences for knee moments are demonstrated, (2) described the knee kinetics of patients with medial and lateral UKAs, and (3) investigated possible factors that might influence the knee abductor moments. METHODS: In our cross-sectional study, we recruited 26 patients with UKA with nondiseased contralateral limbs who performed stair ascent. Seventeen patients had medial UKAs and nine had lateral UKAs. Paired t-tests and CIs were applied to determine interlimb differences within each UKA group for peak knee moments and times to peak moments. RESULTS: During stair ascent, the medial UKA group displayed greater peak extensor moments for the nondiseased compared to the UKA limb (p = 0.030), whereas the lateral UKA group did not (p = 0.087). For both medial and lateral UKA groups, the UKA limb demonstrated greater internal peak abductor moments (p = 0.005 and 0.013, respectively). Both UKA groups exhibited knee moments similar to those in the literature. Limb dominance and postoperative time were correlated for both UKA groups. CONCLUSIONS: Reduced knee extensor moments of limbs with UKA displayed by some participants may indicate less compressive loading on the tibiofemoral joint surfaces, whereas the increased abductor moments suggest increased compression on the medial compartment. These findings suggest UKA knees may not be subjected to excessive loads regardless of the side reconstructed

Cisplatin +/− rucaparib after preoperative chemotherapy in patients with triple-negative or BRCA mutated breast cancer

Patients with triple-negative breast cancer (TNBC) who have residual disease after neoadjuvant therapy have a high risk of recurrence. We tested the impact of DNA-damaging chemotherapy alone or with PARP inhibition in this high-risk population. Patients with TNBC or deleterious BRCA mutation (TNBC/BRCAmut) who had >2 cm of invasive disease in the breast or persistent lymph node (LN) involvement after neoadjuvant therapy were assigned 1:1 to cisplatin alone or with rucaparib. Germline mutations were identified with BROCA analysis. The primary endpoint was 2-year disease-free survival (DFS) with 80% power to detect an HR 0.5. From Feb 2010 to May 2013, 128 patients were enrolled. Median tumor size at surgery was 1.9 cm (0-11.5 cm) with 1 (0-38) involved LN; median Residual Cancer Burden (RCB) score was 2.6. Six patients had known deleterious BRCA1 or BRCA2 mutations at study entry, but BROCA identified deleterious mutations in 22% of patients with available samples. Toxicity was similar in both arms. Despite frequent dose reductions (21% of patients) and delays (43.8% of patients), 73% of patients completed planned cisplatin. Rucaparib exposure was limited with median concentration 275 (82-4694) ng/mL post-infusion on day 3. The addition of rucaparib to cisplatin did not increase 2-year DFS (54.2% cisplatin vs. 64.1% cisplatin + rucaparib; P = 0.29). In the high-risk post preoperative TNBC/BRCAmut setting, the addition of low-dose rucaparib did not improve 2-year DFS or increase the toxicity of cisplatin. Genetic testing was underutilized in this high-risk population