Influence of Muscle Strength on Mobility in Critically Ill Adult Patients on Mechanical Ventilation

Patients in the intensive care unit (ICU) setting are prone to develop muscle weakness and the causes are multi-factorial. Muscle strength in adult, critically ill patients on mechanical ventilation decreases with immobility. The influence of muscle strength on different muscle groups and its influence on progressive mobility in the adult, critically ill patient on mechanical ventilation has not been examined. Identifying muscle strength in this patient population can benefit overall muscle health and minimize muscle deconditioning through a progressive mobility plan. The objective of this dissertation was to describe muscle strength in different muscle groups and to describe the influence of muscle strength on mobility in critically ill adult patients on mechanical ventilation (MV). Fifty ICU patients were enrolled in this descriptive, cross sectional study. Abdominal core, bilateral hand grip and extremity strength was measured using three measurement tools. Mobility was measured using the following scale: 0=lying in bed; 1=sitting on edge of bed; 2=sitting on edge of bed to standing; 3=walking to bedside chair and 4=walking \u3e7 feet from the standing position. Predictors of mobility were examined using stepwise regression. Abdominal core, bilateral hand grip and extremity strength demonstrated statistically significant relationships with all variables. Extremity strength accounted for 82% of the variance in mobility and was the sole predictor (β=0.903; F=212.9; p=0.000). Future research addressing the outcomes of implementing a mobility protocol in this patient population and prioritizing when such a protocol should be implemented would be beneficial to ongoing plans to decrease MV, ICU and hospital days. Muscle strength tests implemented at the bedside are crucial to implementing a progressive mobility plan for critically ill adults while they are on MV therapy

Patterns of interaction in peer response: the relationship between pair dynamics and revision outcomes

Sociocultural researchers in SLA consider the interface between the social dynamics of pair interactions and language learning. Using Storch’s (2002) patterns of interaction coding scheme, studies have found that students who adopt a collaborative pattern are more successful in using language as a learning tool. SLA theorists, however, have suggested research projects that further analyze peer interaction and learning outcomes, including writing development, in ecologically valid settings (Swain, 2002; Ortega, 2012). Peer response is a pedagogical practice where focus on pair dynamics in relation to learning is particularly relevant. Despite its popularity and the theoretical argument for peer response, not all peer response is successful, and Ferris (2003) called for projects that consider both characteristics and outcomes of peer response. This study bridges the gap in these two related research areas, L2 writing and SLA, examining patterns of interaction during peer response, and considering associations between these and revision outcomes. Five pairs of non-native English speaking undergraduates were recording during peer response sessions three times, and also contributed first and second drafts of the papers they discussed. Peer response conversations were coded as exhibiting one of the four patterns (collaborative, expert/novice, dominant/dominant, and dominant/passive) identified by Storch (2002), which was enhanced by students’ perceptions of the peer response sessions that they provided in interviews. Second drafts were analyzed for improvement, and these gains were compared by pattern of interaction. Results show that two patterns (collaborative and expert/novice) are indeed associated with better revision outcomes. What is more, stimulated recall interviews with these students revealed that they become more successful at peer response when they attend to not only the task, but the interpersonal relationship. Overall, results provide classroom-based evidence on the relationship between peer-peer interaction and writing acquisition. These findings complement SLA interaction studies conducted in more experimental settings, as well as contribute to the peer response research in L2 writing by describing in detail students’ social interactions. This study also provides valuable pedagogical implications about training and pairing students for peer response. Finally, this study contributes to the emerging research trend of interfaces between SLA and L2 writing (Ortega, 2012)

Topical Rapamycin Therapy to Alleviate the Cutaneous Manifestations of Tuberous Sclerosis Complex

Background and Objectives: Facial angiofibromas are disfiguring facial lesions, present in up to 80% of patients with tuberous sclerosis complex. Recent elucidation of the complex cell signaling pathways that are disrupted in tuberous sclerosis indicates that rapamycin may be successful in alleviating the appearance of these lesions. The objectives of the current study were to evaluate the safety of topically applied rapamycin in patients with tuberous sclerosis complex and to determine its potential effectiveness in treatment of facial angiofibromas. Patients and Methods: The study was a prospective, randomized, double-blind, placebo-controlled study performed at the University of Texas Health Science Center at Houston. Study subjects were recruited from the patient populations at the University of Texas Tuberous Sclerosis Center of Excellence. All subjects were over the age of 13 years and had a diagnosis of tuberous sclerosis complex. Subjects were excluded if they were using any form of rapamycin or if they were pregnant. Study subjects applied the study product to their facial angiofibromas nightly for a duration of 6 months. The investigational product contained one of three doses of rapamycin compounded with Skincerity®: (i) no rapamycin; (ii) 1 mg of rapamycin per 30 cc (0.003%); or (iii) 5 mg of rapamycin per 30 cc (0.015%). Plasma rapamycin concentrations were measured monthly to test for systemic absorption. Complete blood counts were performed monthly to test for anemia, neutropenia, or thrombocytopenia. Upon completion of the trial, subjects were asked if the formulation had improved the appearance of their facial angiofibromas. Results: Twenty-three subjects completed the study. There was no detectable systemic absorption of rapamycin (all blood concentrations were <1.0 ng/mL). There were no significant changes in white blood cell, red blood cell, or platelet counts. Seventy-three percent of subjects in the treatment arms versus 38% of subjects in the placebo arm reported a subjective improvement in the appearance of their facial angiofibromas. Conclusion: The application of low-dose topical rapamycin (0.003–0.015%) to the face can safely decrease the appearance of facial angiofibromas in patients with tuberous sclerosis complex

Self-appraisal and perceptions of the appraisal discussion: A field experiment

Performance evaluation based on self-appraisal has been widely advocated because of its potential for increasing the effectiveness of the performance appraisal discussion. A field experiment was conducted to assess the effects of a formal \u27both-rate\u27 self appraisal (where both manager and subordinate independently complete appraisals before the discussion) on perceptions of ratee and rater behaviors and outcomes. One hundred fifty-one ratees and 81 raters randomly assigned to self-appraisal and control groups participated in the study. Results indicated that the self-appraisal treatment had no main effects on ratee perceptions of their contributions to the discussion or satisfaction with the appraisal. Self-appraising ratees perceived less influence over the appraisal discussion, and less agreement with their manager\u27s rating than did non-self appraisers. However, informal self-appraisal behavior was significantly and positively correlated with most dependent variables. Results suggest major differences between formal and informal self-appraisal which warrant future research

Genetic and Environmental Contributions of Negative Valence Systems to Internalizing Pathways

The genetic and environmental contributions of negative valence systems (NVS) to internalizing pathways study (also referred to as the Adolescent and Young Adult Twin Study) was designed to examine varying constructs of the NVS as they relate to the development of internalizing disorders from a genetically informed perspective. The goal of this study was to evaluate genetic and environmental contributions to potential psychiatric endophenotypes that contribute to internalizing psychopathology by studying adolescent and young adult twins longitudinally over a 2-year period. This report details the sample characteristics, study design, and methodology of this study. The first wave of data collection (i.e., time 1) is complete; the 2-year follow-up (i.e., time 2) is currently underway. A total of 430 twin pairs (N = 860 individual twins; 166 monozygotic pairs; 57.2% female) and 422 parents or legal guardians participated at time 1. Twin participants completed self-report surveys and participated in experimental paradigms to assess processes within the NVS. Additionally, parents completed surveys to report on themselves and their twin children. Findings from this study will help clarify the genetic and environmental influences of the NVS and their association with internalizing risk. The goal of this line of research is to develop methods for early internalizing disorder risk detection