“Tears in My Eyes ’Cause Somebody Finally Understood”: Client Perceptions of Practitioners Following Brain Injury

Objective: The purpose of this study was to identify practitioner qualities and traits that clients with brain injury see as important. Method: An opportunistic sample of 51 participants with brain injury was interviewed about perceptions of service access and effectiveness. An interview guide was used to gather data for this phenomenological qualitative study. Four interviewers individually conducted audiotaped interviews, which were then transcribed. Coding and theme development were completed using HyperRESEARCH™ software. Results: Three themes regarding practitioner qualities emerged from the data: (a) roles of the provider, (b) perceived helpfulness of services, and (c) personal characteristics of the providers. Beneficial provider roles included advocate, friend, mentor, and team member. Perceptions of helpfulness of the services included relevance, meaningfulness, practical application, skill development potential, and whether periodic feedback on progress was provided. Personal characteristics of the provider valued by the participants were clear and honest communicator, supportive, respectful, good listener, and understanding. Conclusions: Practitioners need to pay increased attention to the perceptions of care and services of clients with brain injury. The current study closely supports previous research related to quality of care in the medical and community arenas and offers some additional suggestions to professionals who work with persons with brain injury, including learning how to time giving information to clients and how to understand client concerns without being prescriptive. Future research in this area needs to focus on and describe providers who demonstrate an ability—through their willingness to don a variety of roles, their helpful services, and their personal characteristics—to meet the unique needs of clients with brain injury

Advancing the Entry-Level Practitioner: A Curricular Model of the Professional Occupational Therapy Doctoral Degree

The recent growth of entry-level occupational therapy doctoral (EL-OTD) programs has been met with mixed opinions from both occupational therapy educators and practitioners. These opinions occasionally have been accompanied by uncertainty about the specific curricular components that differentiate the EL-OTD from the entry-level master’s degree. In an effort to address this uncertainty, the purpose of this article is to present one example of an EL-OTD curricular model and describe its distinct educational components. This curricular model integrates recommendations for doctoral education originally proposed by Case-Smith et al. (2014) and is characterized by the following three components: 1) Advanced Coursework; 2) the Doctoral Capstone Project; and 3) the Doctoral Capstone Experience. We share the lessons learned after matriculating three cohorts of EL-OTD students and describe influences from the field of implementation science that have informed the development of our curriculum

Development and Validation of a 28-gene Hypoxia-related Prognostic Signature for Localized Prostate Cancer.

BACKGROUND: Hypoxia is associated with a poor prognosis in prostate cancer. This work aimed to derive and validate a hypoxia-related mRNA signature for localized prostate cancer. METHOD: Hypoxia genes were identified in vitro via RNA-sequencing and combined with in vivo gene co-expression analysis to generate a signature. The signature was independently validated in eleven prostate cancer cohorts and a bladder cancer phase III randomized trial of radiotherapy alone or with carbogen and nicotinamide (CON). RESULTS: A 28-gene signature was derived. Patients with high signature scores had poorer biochemical recurrence free survivals in six of eight independent cohorts of prostatectomy-treated patients (Log rank test P \u3c .05), with borderline significances achieved in the other two (P \u3c .1). The signature also predicted biochemical recurrence in patients receiving post-prostatectomy radiotherapy (n = 130, P = .007) or definitive radiotherapy alone (n = 248, P = .035). Lastly, the signature predicted metastasis events in a pooled cohort (n = 631, P = .002). Prognostic significance remained after adjusting for clinic-pathological factors and commercially available prognostic signatures. The signature predicted benefit from hypoxia-modifying therapy in bladder cancer patients (intervention-by-signature interaction test P = .0026), where carbogen and nicotinamide was associated with improved survival only in hypoxic tumours. CONCLUSION: A 28-gene hypoxia signature has strong and independent prognostic value for prostate cancer patients

Effectiveness of the HomeSafe Pilot Program in Reducing Injury Rates Among Residential Construction Workers, 1994-1998

Background: The construction industry typically has one of the highest fatal and non-fatal injury rates compared with other industries. Residential construction workers are at particular risk of injury (work is in remote sites with small crews, there are often many subcontractors, and they have limited access to safety programs). Difficulty accessing information specific to this group has made research more challenging, therefore, there are few studies. This study evaluated the effectiveness of the HomeSafe Pilot Program, a safety education and training program designed to reduce injuries among residential construction workers. Methods: Researchers evaluated whether overall and severe injury incidence rates declined during the intervention period. Data were analyzed using incidence rates and Poisson regression to control for the effect of antecedent secular trend. Results: Injury incidence rates declined significantly following HomeSafe; however, this effect was not statistically significant once temporal variation was controlled. Conclusions: The decline in injury rates following HomeSafe cannot be attributed solely to HomeSafe, however, programmatic and methodologic limitations contributed to the inconclusive results. Further research into the hazards faced by residential construction workers is needed

Safe-Patient-Handling Equipment in Therapy Practice: Implications for Rehabilitation

OBJECTIVE. To determine how safe-patient-handling (SPH) equipment is used in rehabilitation and how it affects therapists, patients, and therapy practice. METHOD. We used a qualitative, instrumental case study design. Thirty-five occupational and physical therapist practitioners from three facilities participated in the study. RESULTS. Therapists reported a broad range of applications for equipment (e.g., functional mobility and neuromusculoskeletal function). They reported that SPH equipment increased treatment options for therapists and increased participation options for patients, although equipment limitations exist. Three themes emerged from the analysis: choice, potential, and safety. CONCLUSION. SPH equipment has therapeutic applications in rehabilitation, especially for medically complex or bariatric patients. Therapists in this study engaged in a highly individualized, complex process of decision making when selecting and using SPH devices in rehabilitation. More research to refine and test therapeutic uses is necessary

Machine Learning-Based Single Cell and Integrative Analysis Reveals That Baseline mDC Predisposition Correlates With Hepatitis B Vaccine Antibody Response

Vaccination to prevent infectious disease is one of the most successful public health interventions ever developed. And yet, variability in individual vaccine effectiveness suggests that a better mechanistic understanding of vaccine-induced immune responses could improve vaccine design and efficacy. We have previously shown that protective antibody levels could be elicited in a subset of recipients with only a single dose of the hepatitis B virus (HBV) vaccine and that a wide range of antibody levels were elicited after three doses. The immune mechanisms responsible for this vaccine response variability is unclear. Using single cell RNA sequencing of sorted innate immune cell subsets, we identified two distinct myeloid dendritic cell subsets (NDRG1-expressing mDC2 and CDKN1C-expressing mDC4), the ratio of which at baseline (pre-vaccination) correlated with the immune response to a single dose of HBV vaccine. Our results suggest that the participants in our vaccine study were in one of two different dendritic cell dispositional states at baseline - an NDRG2-mDC2 state in which the vaccine elicited an antibody response after a single immunization or a CDKN1C-mDC4 state in which the vaccine required two or three doses for induction of antibody responses. To explore this correlation further, genes expressed in these mDC subsets were used for feature selection prior to the construction of predictive models using supervised canonical correlation machine learning. The resulting models showed an improved correlation with serum antibody titers in response to full vaccination. Taken together, these results suggest that the propensity of circulating dendritic cells toward either activation or suppression, their "dispositional endotype" at pre-vaccination baseline, could dictate response to vaccination