Effect of distance caregiver coaching on functional skills of a child with traumatic brain injury

Brain injury is a major public health concern affecting nearly 5 million Americans annually with a cost exceeding $60 billion in the United States. Acquired and traumatic brain injuries cause physical, cognitive and social deficits resulting in behavioral, affective, cognitive, and physical changes. Though the biomechanical injury may be the initial source of the behavioral changes, environmental factors frequently contribute to maintaining maladaptive behaviors. Behavioral and affective changes in the person with a brain injury are frequently cited as the most distressing issues for caregivers, and their need for education and training is well documented. Interactions between caregivers and persons with brain injury may play a critical role in the rehabilitation process, and coaching caregivers may decrease unwanted behaviors exhibited by the person with the brain injury and foster more positive functional outcomes for the individual. This study utilized a multiple probe, multiple baseline across behaviors, single-case research design and examined the effects of caregiver behaviors on skill acquisition by a child with a traumatic brain injury. The caregiver-client dyad in this study was a mother and her 10-year-old adopted child. The researcher coached the caregiver using distance technology. Coaching consisted of in vivo feedback on the caregiver’s use of general behavior analytic skills, such as use of effective prompting and positive social consequences, while engaging with the child with a brain injury. Improvements in the client’s independent task completion across three functional tasks were observed, which correlated with changes in the caregiver’s skills following distance coaching

Thematic Analysis of Third-Year Medical Student Reflections on Social Determinants of Health During Their Pediatric Clerkship: Emergent Themes and Topic Interconnectedness

Background. Social determinants of health (SDOH), as defined by the World Health Organization, are the “non-medical factors that influence health outcomes… the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” Studies have estimated that SDOH account for 30-55% of health outcomes. Understanding the impact of SDOH can be integrated into medical education in different formats, here we explore student reflections. Methods. In the 2021-2022 academic year, third-year medical students at a midwestern medical school submitted discussion board reflections on their experiences with SDOH during their 8-week pediatric clerkship. We analyzed de-identified posts to look for emergent themes that showcase the experiences and perceptions of medical students as they care for patients and learn about the socio-environmental factors in the community. Initial coding was built on a preliminary codebook drafted based on the medical school’s SDOH curriculum. Utilizing a grounded theory approach, we added new codes as novel topics and themes emerged. We then examined the relationships between the codes and SDOH categories outlined in the US Department of Health and Human Services Healthy People 2030 objectives. Results. Ninety-seven student discussion posts were analyzed. Our preliminary results demonstrate the two most common themes, social support and communication, together represented approximately 50% of all student responses. With the addition of the next two most frequently discussed topics, healthcare access and diet/nutrition, this set of themes comprises over 75% of student responses. Student responses also demonstrated the interconnectedness of SDOH categories through frequent overlap of categories during coding and analysis. Conclusion. Our study demonstrates the most common SDOH themes students identified during the pediatric clerkship involve social support, communication, access to care, and diet/nutrition. We found a multifactorial, connected nature of those themes as they impact patient health. This study validates the need for explicit education on SDOH topics during medical school so that future physicians are well-equipped to intervene or accommodate these factors throughout their careers. Future directions include comparing our results to preexisting social and educational frameworks and future cohort comparisons as curriculum evolves.https://digitalcommons.unmc.edu/chri_forum/1065/thumbnail.jp

Force Characterization and Manufacturing of a Dynamic Unilateral Clubfoot Brace

Clubfoot is a musculoskeletal birth defect characterized by an inward twisting of an infant’s feet. Currently, a series of casts are used to correct the clubfoot, and a boots-and-bar brace is used to maintain the correction. However, this method has concerns with compliance, comfort, and social stigma. Hope Walks and their clinic in Kijabe, Kenya are interested in implementing a new maintenance brace that addresses these concerns. Mr. Jerald Cunningham, CPO, designed and is utilizing a unilateral clubfoot maintenance brace called the Cunningham Clubfoot Brace. He asserts his brace reduces treatment time, lessens social stigma, and increases child mobility. However, to date, there is not enough published research on its biomechanics and patient success rates to confirm his findings. The Cunningham Clubfoot Brace Collaboratory project seeks to validate the effectiveness of the Cunningham design through biomedical testing and increase brace availability through sustainable manufacturing. To do this, the team is measuring the biomechanical forces applied by the brace with multiple force sensor systems and an infant foot model. The team is assisting Mr. Cunningham in his plans to use injection molding to increase brace production by scanning and creating CAD files of the brace. The team is also completing a failure and reuse analysis of the Cunningham Brace for the clinic in Kijabe. Furthermore, the ongoing clinical study at CURE International\u27s hospital in Kijabe, Kenya, and Dr. Emily Farrar’s research paper will provide greater insight into the effectiveness of the Cunningham Brace. These collaborative efforts will allow for further understanding of the effectiveness of the Cunningham Brace and its acceptance as an alternative clubfoot maintenance brace.https://mosaic.messiah.edu/engr2021/1001/thumbnail.jp

Sphingosine-1-Phosphate Modulates the Effect of Estrogen in Human Osteoblasts

Production of sphingosine‐1‐phosphate (S1P) is linked to 17β‐estradiol (E2) activity in many estrogen‐responsive cells; in bone development, the role of S1P is unclear. We studied effects of S1P on proliferation and differentiation of human osteoblasts (hOB). Ten nM E2, 1 μM S1P, or 1 μM of the S1P receptor 1 (S1PR1) agonist SEW2871 increased hOB proliferation at 24 hours. S1PR 1, 2, and 3 mRNAs are expressed by hOB but not S1PR4 or S1PR5. Expression of S1PR2 was increased at 7 and 14 days of differentiation, in correspondence with osteoblast‐related mRNAs. Expression of S1PR1 was increased by E2 or S1P in proliferating hOB, whereas S1PR2 mRNA was unaffected in proliferating cells; S1PR3 was not affected by E2 or S1P. Inhibiting sphingosine kinase (SPHK) activity with sphingosine kinase inhibitor (Ski) greatly reduced the E2 proliferative effect. Both E2 and S1P increased SPHK mRNA at 24 hours in hOB. S1P promoted osteoblast proliferation via activating MAP kinase activity. Either E2 or S1P increased S1P synthesis in a fluorescent S1P assay. Interaction of E2 and S1P signaling was indicated by upregulation of E2 receptor mRNA after S1P treatment. E2 and S1P also promoted alkaline phosphatase expression. During osteoblast differentiation, S1P increased bone‐specific mRNAs, similarly to the effects of E2. However, E2 and S1P showed differences in the activation of some osteoblast pathways. Pathway analysis by gene expression arrays was consistent with regulation of pathways of osteoblast differentiation; collagen and cell adhesion proteins centered on Rho/Rac small GTPase signaling and Map kinase or signal transducer and activator of transcription (Stat) intermediates. Transcriptional activation also included significant increases in superoxide dismutase 1 and 2 transcription by either S1P or E2. We demonstrate that the SPHK system is a co‐mediator for osteoblast proliferation and differentiation, which is mainly, but not entirely, complementary to E2, whose effects are mediated by S1PR1 and S1PR2. © 2018 The Authors JBMR Plus is published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research

Novel rat tail discitis model using bioluminescent Staphylococcus aureus

Management of spondylodiscitis is a challenging clinical problem requiring medical and surgical treatment strategies. The purpose of this study was to establish a rat model of spondylodiscitis that utilizes bioluminescent Staphylococcus aureus, thus permitting in-vivo surveillance of infection intensity. Inocula of the bioluminescent S. aureus strain XEN36 were created in concentrations of 102 CFU/0.1 mL, 104 CFU/0.1 mL, and 106 CFU/0.1 mL. Three groups of rats were injected with the bacteria in the most proximal intervertebral tail segment. The third most proximal tail segment was injected with saline as a control. Bioluminescence was measured at baseline, 3 days, and weekly for a total of 6 weeks. Detected bioluminescence for each group peaked at day three and returned to baseline at 21 days. The average intensity was highest for the experimental group injected with the most concentrated bacterial solution (106 CFU/0.1 mL). Radiographic analysis revealed loss of intervertebral disc space and evidence of osseous bridging. Saline injected spaces exhibited no decrease in intervertebral spacing as compared to distal sites. Histologic analysis revealed neutrophilic infiltrates, destruction of the annulus fibrosus and nucleus pulposus, destruction of vertebral endplates, and osseous bridging. Saline injected discs exhibited preserved annulus fibrosus and nucleus pulposus on histology. This study demonstrates that injection of bioluminescent S. aureus into the intervertebral disc of a rat tail is a viable animal model for spondylodiscitis research. This model allows for real-time, in-vivo quantification of infection intensity, which may decrease the number of animals required for infection studies of the intervertebral disc

Force Characterization and Manufacturing of a Dynamic Unilateral Clubfoot Brace

Clubfoot is a musculoskeletal birth defect that is characterized by an inward twisting of an infant’s feet. The current method for correction involves several casts and a bilateral boots-and-bar maintenance brace. This method of maintenance requires 5 years of bracing and has issues with compliance, comfort, and social stigma. CURE International in Kijabe, Kenya is currently using the boots-and-bar brace but is interested in implementing a design that reduces these concerns. Mr. Jerald Cunningham, CPO, designed and is utilizing a unilateral clubfoot maintenance brace, the Cunningham Brace, which he expects will reduce treatment time to 2-3 years, lessen the social stigma, and increase the child’s mobility. However, there is not enough published research on its biomechanics and patient success rates to confirm his findings. The Collaboratory Cunningham Clubfoot Brace project seeks to validate the effectiveness of this design and increase accessibility through force testing and standardized manufacturing. We are working on measuring the biomechanical forces created and applied by the brace with a series of force sensors that are attached to the child’s brace. In addition, a new wrapping process for manufacturing the Cunningham Brace is being developed to increase the productivity and reproducibility of brace manufacturing in Kenya. Along with a clinical study that was started in Kenya, this testing and manufacturing will allow for further understanding of the effectiveness of the Cunningham Brace and provide more research for the medical community for it to potentially be accepted as an alternative clubfoot maintenance brace.https://mosaic.messiah.edu/engr2020/1014/thumbnail.jp

Associations between nutritional properties of food and consumer perceptions related to weight management

Consumer perceptions of food (for example, how filling or healthy) influence eating behaviour and appetite control. Therefore approaches to understand the global nutritional attributes of foods that predict the strength of consumer perceptions are of academic and commercial interest. The current research describes the development of a flexible platform for systematically mapping the global nutritional attributes of foods (both objective and perceived) to consumer perceptions of those foods. The platform consists of a database of standardised UK food images (currently n= 300), linked to a catalogue of detailed perceptual, nutritional, sensory, cost, and psychological information ('nutritional attributes'). The platform also incorporates demographic and psychometric questionnaires to examine the importance of nutritional attributes on consumer perceptions within or between relevant target groups. In the current study, the platform was applied to a sample of dieting and non-dieting British men and women (n= 887) to examine the global attributes of a subset of foods (n= 75) and their association with successful weight management (i.e. supportive of weight loss, weight loss maintenance or prevention of weight gain). Generalised linear models identified energy density, cost (£/kcal), perceived energy content and satiating capacity as the main nutritional attributes underlying dieters' and non-dieters' perception of successful weight management food. Additionally, pleasantness, and desire not to (over) eat were uniquely associated with dieters' perception of food as good for weight management; pleasantness was positively associated with weight management and desire to eat was negatively associated with weight management. Therefore, global nutritional attributes of foods can predict and distinguish the extent consumers' perceive a food to be related to successful weight management. This platform will be extended to increase the variety of foods and specificity of nutritional attributes in the database suitable for a range of commercial, academic or clinical research applications

Ventilatory muscle strength, diaphragm thickness and pulmonary function in world-class powerlifters.

Resistance training activates the ventilatory muscles providing a stimulus similar to ventilatory muscle training. We examined the effects of elite powerlifting training upon ventilatory muscle strength, pulmonary function and diaphragm thickness in world-class powerlifters (POWER) and a control group (CON) with no history of endurance or resistance training, matched for age, height and body mass

Human papillomavirus, high-grade intraepithelial neoplasia and killer immunoglogulin-like receptors: a Western Australian cohort study

Background: Human papillomavirus (HPV) is the causative agent in cervical cancer and HPV genotypes 16 and 18 cause the majority of these cancers. Natural killer (NK) cells destroy virally infected and tumour cells via killer immunoglobulin-like receptors (KIR) that recognize decreased MHC class I expression. These NK cells may contribute to clearance of HPV infected and/or dysplastic cells, however since KIR controls NK cell activity, KIR gene variation may determine outcome of infection.Methods: KIR gene frequencies were compared between 147 patients with a history of high-grade cervical intraepithelial neoplasia (CIN) and a control population of 187, to determine if any KIR genes are associated with high-grade CIN. In addition a comparison was also made between cases of high grade CIN derived from 30 patients infected with HPV 16/18 and 29 patients infected with non-16/18 HPV to determine if KIR variation contributes to the disproportional carcinogenesis derived from HPV 16/18 infection.Results: High-grade CIN was weakly associated with the absence of KIR2DL2 and KIR2DS2 (p = 0.046 and 0.049 respectively, OR 0.6; 95% CI 0.4 – 0.9) but this association was lost after correction for multi-gene statistical analysis.No difference in KIR gene frequencies was found between high-grade CIN caused by HPV 16/18 and non-16/18.Conclusion: No strong association between KIR genes, high-grade CIN and HPV genotype was found in the Western Australian population

Characterization of twenty-five ovarian tumour cell lines that phenocopy primary tumours

Currently available human tumour cell line panels consist of a small number of lines in each lineage that generally fail to retain the phenotype of the original patient tumour. Here we develop a cell culture medium that enables us to routinely establish cell lines from diverse subtypes of human ovarian cancers with >95% efficiency. Importantly, the 25 new ovarian tumour cell lines described here retain the genomic landscape, histopathology and molecular features of the original tumours. Furthermore, the molecular profile and drug response of these cell lines correlate with distinct groups of primary tumours with different outcomes. Thus, tumour cell lines derived using this methodology represent a significantly improved platform to study human tumour pathophysiology and response to therapy