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Background Critical thinking is key for responsible occupational therapy practice. However, the degree to which educators understand critical thinking and the conceptualizations of such concept in teaching remains unclear.Aim This study aimed to describe occupational therapy educators’ perceptions and experiences of teaching critical thinking.Material and Methods Social constructivism underpins the study. Eight participants were included in three online synchronous focus groups. One participant was interviewed in person due to time constraints. Data were analysed using content analysis.Results This study reveals a considerable diversity of perceptions and experiences of ambiguity regarding educators’ perceptions of what they know about and how to teach critical thinking. Most educators interpret critical thinking in ways that differs from their colleagues. Furthermore, educators encounter divergent expectations pertaining to their role as educators and the readiness of their students.Conclusions This study reveal a paradox within the occupational therapy profession, where critical thinking is highly valued yet educators experience ambiguity, differing expectations of their role, time constraints, and lack of formal education to support students’ development of critical thinking.Significance This study provides the foundation for further inquiry into the invisible effects and benefits of different understandings of critical thinking on occupational therapy practice.

Abstract Current NCCN guidelines for second‐line therapy in recurrent or metastatic esophago‐gastric cancers recommend the use of VEGF inhibitors such as ramucirumab. VEGF inhibitors have been shown to be associated with gastrointestinal perforation in clinical trials and late colorectal anastomotic leaks in a few case reports. Here, we present a case of late esophageal anastomotic leak in a patient receiving ramucirumab. Case information was obtained from our institution's electronic medical records. The patient was found to have T4N1M0, poorly differentiated invasive adenocarcinoma and subsequently received neoadjuvant chemoradiation followed by hybrid Ivor‐Lewis esophagectomy 6 weeks later. He recovered well with no leak or perioperative complications. The patient had disease progression 9 months postoperatively on CT and PET imaging. Sixteen months after surgery he began paclitaxel and ramucirumab and 16 weeks after ramucirumab initiation, he was found to have an esophago‐pulmonary fistula in the region of the anastomosis. Biopsies were negative for recurrence at the anastomosis. He died one week later from progressive pneumonia despite stenting. In conclusion, this is the only known report of delayed esophageal anastomotic complication associated with ramucirumab. VEGF inhibitor therapies such as bevacizumab have been associated with late (greater than 3 months postoperative) colorectal anastomotic complications including fistulas and leaks. Risk factors that have been associated are perioperative radiotherapy and history of early postoperative leak. These findings raise concern whether VEGF inhibitor therapy should be used in post‐esophagectomy patients with recurrence if these rare but catastrophic events are likely to be terminal.

Os estudos sobre ocupação têm informado parte da área de Terapia Ocupacional, notadamente no contexto anglo-saxão e, muitas vezes, tidos como diretrizes em nível mundial. Contudo, há um aumento dos debates em torno da diversidade teórico-metodológica radicada localmente, o que envolve histórias, culturas e vocabulários próprios. Objetiva-se apresentar e discutir conceitos que se relacionam ao lócus da ação terapêutico-ocupacional: atividade humana, ocupação, cotidiano e modos de vida, assim como aqueles relacionados à finalidade da atuação profissional: engajamento ocupacional, inserção/inclusão social, emancipação/autonomia e participação social, a partir da realidade brasileira. Postula-se a defesa de que parte destes conceitos auxilia a centralização das ações terapêutico-ocupacionais, tomando-se os sujeitos e a vida social. Por sua vez, a Ciência Ocupacional tem desenvolvido pesquisas sobre a relevância do social em seus referenciais. Questiona-se, então, a possibilidade de diálogos entre Terapia Ocupacional e Ciência Ocupacional, na composição do campo científico da área. Defende-se que é preciso que se reconheça a pluralidade de vocabulários, histórias e culturas em curso, inclusive rediscutindo-se o próprio conceito de ocupação. Intenciona-se contribuir com diálogos horizontais, com vistas a ampliar a produção de conhecimentos e a valorizar diferentes perspectivas teóricas e assistenciais que informam a Terapia Ocupacional.

Background: Critical thinking is key for responsible occupational therapy practice. However, the degree to which educators understand critical thinking and the conceptualizations of such concept in teaching remains unclear. Aim: This study aimed to describe occupational therapy educators' perceptions and experiences of teaching critical thinking. Material and Methods: Social constructivism underpins the study. Eight participants were included in three online synchronous focus groups. One participant was interviewed in person due to time constraints. Data were analysed using content analysis. Results: This study reveals a considerable diversity of perceptions and experiences of ambiguity regarding educators' perceptions of what they know about and how to teach critical thinking. Most educators interpret critical thinking in ways that differs from their colleagues. Furthermore, educators encounter divergent expectations pertaining to their role as educators and the readiness of their students. Conclusions: This study reveal a paradox within the occupational therapy profession, where critical thinking is highly valued yet educators experience ambiguity, differing expectations of their role, time constraints, and lack of formal education to support students' development of critical thinking. Significance: This study provides the foundation for further inquiry into the invisible effects and benefits of different understandings of critical thinking on occupational therapy practice. [ABSTRACT FROM AUTHOR]

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It is well known that cardiometabolic dysfunction gradually increases after menopause, and the sedentary lifestyle can aggravate this condition. Therefore, we compared the effects of aerobic exercise training during the premenopausal period and after ovariectomy (OVX) on metabolic, hemodynamic, and autonomic parameters in an experimental rat model of menopause. The female rats were divided into four groups: control (C), sedentary OVX (SO), trained OVX (TO), and previously trained OVX (PTO). The PTO group was trained for 4 weeks prior to+8 weeks after OVX, and the TO group trained only after OVX on a motor treadmill. Autonomic modulation was evaluated, white adipose tissue (WAT) was removed and weighed, and lipolysis was assessed. The citrate synthase activity in the soleus muscle was analyzed. The trained groups prevented the impairment of baroreceptor reflex sensitivity in relation to SO; however, only PTO reduced the low-frequency band of the pulse interval compared to SO. PTO reduced the weight of WAT compared to the other groups; lipolysis in PTO was similar to that in C. PTO preserved muscle metabolic injury in all types of fibers analyzed. In conclusion, this study suggests that exercise training should be recommended in a premenopausal model to prevent cardiometabolic and autonomic menopause-induced deleterious effects. [ABSTRACT FROM AUTHOR]

PURPOSEDespite advances in palliative care in Uganda, there has been relatively little recent patient-centered research investigating end-of-life outcomes in this region. We assessed the quality of dying and death of patients with cancer in hospice care in Uganda.METHODSBereaved caregivers of patients who received hospice care in Uganda and died 2-12 months earlier (N = 201) completed the Quality of Dying and Death Questionnaire, which includes 31 items and single-item ratings of overall quality of dying and moment of death, and the FAMCARE measure of family satisfaction with cancer care.RESULTSCaregivers reported low-intermediate overall quality of dying (mean [M] standard deviation [SD], 3.25 [2.98]) and overall quality of moment of death (M [SD], 3.59 [3.51]), with 47.0% of the ratings of these two outcomes in the poor range, but the mean family satisfaction with care was high (M [SD], 77.75 [10.26]). Most Quality of Dying and Death Questionnaire items (74.2%) were rated within the intermediate range. Items rated within the good range were religious-spiritual, interpersonal, and personal facets; two items within the poor range reflected physical functioning. Overall quality of dying was most strongly correlated with pain control (Spearman's rho [rs] = 0.45, P < .001), and overall quality of moment of death with state of consciousness before death and being unafraid of dying (rs = 0.42, P < .001). The FAMCARE score was not correlated with overall quality of dying or moment of death (P = .576-.813). Only one FAMCARE item, information on managing patient's pain, was correlated with overall quality of moment of death (rs = –0.19, P = .008).CONCLUSIONEnd-of-life care in hospices in Uganda requires further improvement, particularly with regard to symptom control. Patient-centered data could bolster advocacy efforts to support quality improvement of palliative care in this and other countries.

Introduction The diagnosis, progression or recurrence of cancer is often highly traumatic for family caregivers (FCs), but systematic assessments of distress and approaches for its prevention and treatment are lacking. Acute leukaemia (AL) is a life-threatening cancer of the blood, which most often presents acutely, requires intensive treatment and is associated with severe physical symptoms. Consequently, traumatic stress may be common in the FCs of patients with AL. We aim to determine the prevalence, severity, longitudinal course and predictors of traumatic stress symptoms in FCs of patients with AL in the first year after diagnosis, and to understand their lived experience of traumatic stress and perceived support needs.Methods and analysis This two-site longitudinal, observational, mixed methods study will recruit 223 adult FCs of paediatric or adult patients newly diagnosed with AL from two tertiary care centres. Quantitative data will be collected from self-report questionnaires at enrolment, and 1, 3, 6, 9 and 12 months after admission to hospital for initial treatment. Quantitative data will be analysed using descriptive and machine learning approaches and a multilevel modelling (MLM) approach will be used to confirm machine learning findings. Semi-structured qualitative interviews will be conducted at 3, 6 and 12 months and analysed using a grounded theory approach.Ethics and dissemination This study is funded by the Canadian Institutes of Health Research (CIHR number PJT 173255) and has received ethical approval from the Ontario Cancer Research Ethics Board (CTO Project ID: 2104). The data generated have the potential to inform the development of targeted psychosocial interventions for traumatic stress, which is a public health priority for high-risk populations such as FCs of patients with haematological malignancies. An integrated and end-of-study knowledge translation strategy that involves FCs and other stakeholders will be used to interpret and disseminate study results.

A matéria orgânica do solo (MOS) exerce papel fundamental para a sustentabilidade de ecossistemas florestais. O estudo das frações da MOS possibilita avaliar a qualidade do solo sob florestas nativas ou plantadas. O objetivo dessa pesquisa foi comparar o carbono orgânico sob mata nativa e florestas plantadas, em longo prazo. Foram avaliados os estoques de carbono orgânico total (COT), as frações leve (COL) e pesada (COP) e o índice de manejo do carbono (IMC) da camada superficial de Latossolo Vermelho distroférrico, sob plantios de quatro espécies de eucaliptos australianos - Eucalyptus grandis, E. pilularis, E. cloeziana e Corymbia maculata - e Pinus caribaea var. hondurensis, com 40 anos de idade, e sob Floresta Estacional Semidecidual. C. maculata manteve estoques de COT, COP e de COL e o IMC em níveis similares aos encontrados sob a mata nativa, sendo considerada a espécie mais eficiente na ciclagem e estocagem de carbono no solo, seguida por E. cloeziana. E. pilularis e o pinus apresentaram os menores estoques de carbono e IMC.

BackgroundThymic epithelial tumors (TETs) are frequently accompanied by Good Syndrome (GS), a rare immunodeficiency, characterized by hypogammaglobulinemia and peripheral B cell lymphopenia. TETs can be also associated to other immunological disorders, both immunodeficiency and autoimmunity.MethodsIn this study, we enrolled TET patients with GS to address differences between patients with or without associated autoimmune diseases (AD). We analyzed the immunophenotype from peripheral blood of these patients focusing on selected immune cell subsets (CD4+T cells, CD8+T cells, T regulatory cells, NK cells, B-cells, monocytes, eosinophils, basophils, neutrophils) and serum levels of cytokines, chemokines and growth factors.ResultsWe observed higher number of leucocytes, in particular lymphocytes, B lymphopenia and lower number of T regulatory cells in TET patients with associated AD compared to TET patients without AD. In the group of TET patients with AD, we also observed increased serum levels of IL-15, VEGF, IP-10, GM-CSF, IL-6, and MIP-1α. Thus, we identified considerable differences in the lymphocyte profiles of TET patients with and without ADs, in particular a reduction in the numbers of B lymphocytes and T-regulatory cells in the former, as well as differences in the serum levels of various immune modulators.ConclusionsAlthough the pathogenic mechanisms are still unclear, our results add new knowledge to better understand the disease, suggesting the need of surveilling the immunophenotype of TET patients to ameliorate their clinical management.

Abstract We present the first records of insect visitors and pollinators of Bertholletia excelsa (Lecythidaceae) in a 25 years plantation outside the Amazon biome, flowering and producing Brazil nuts. We installed a platform to observe and photograph the insects. The collected insects were stored, mounted, and identified by specialists. Six species were observed, three of them classified as potential pollinators (Centris lutea, Eulaema nigrita, Eulaema cingulata). The species E. nigrita and E. cingulata were already reported as a pollinators of Brazil nut in Amazon. This is the first record of C. lutea as potential pollinators for B. excelsa.

The purpose of this study was to look at teachers' perceptions of challenging behaviors in the classroom, including students who had emotional or behavioral disorders and students who were at-risk for developing these problems. In the format of the survey, teachers were asked to consider the behaviors of their students in respect to gender. For male externalized behaviors, the strongest support was for students who lose their tempers during the school day. Regarding internalized behaviors, a majority of participants believed that both males and females seem to be withdrawn during lessons and activities. Teachers were asked to reflect on the screening and identification process as well as on ways to accommodate students. Based on the participants' responses, there was support for reexamining how students were identified, revealing the necessity for gender-based procedures. The survey also suggested that there was a need for gender-based considerations for working with students.

Italy has been one of the first-hit and most affected countries worldwide by the coronavirus disease 2019 (COVID-19) outbreak, and Lombardy accounts for almost half of all Italian cases. Vulnerable population is the one suffering the most from the current epidemic, without guaranteed access to basic needs. This aspect becomes critical for people experiencing disability, either due or not to COVID-19. To face the pandemic, all the regional health system services, rehabilitation ones included, were forced to radically adapt their operating paradigm and even sometimes to leave their intrinsic mission. The Italian Society of Physical and Rehabilitation Medicine (SIMFER) since the beginning of the outbreak was profoundly involved in the clinical and organizational response to COVID-19. The Lombardy regional group cooperated strictly and continuously with the national group to coordinate rehabilitation processes region wide. The paper presents a brief report of our field experience describing the phases faced since the beginning of the pandemic and suggesting the organizational strategies that could be useful in rehabilitation services for both inpatients and outpatients. Springing from literature and the experience of the Lombardy section of SIMFER, this paper should help clinicians to respond to the need of the disabled patient facing the new COVID-19 outbreak.

Abstract Background Disabled people are particularly exposed to the risks of COVID-19, as well as to the measures taken to address it, and their impact. The aim of the study was to examine the disability-inclusiveness of government responses to COVID-19 in four South American Countries: Argentina, Brazil, Chile, and Peru. Methods We conducted documentary research, using framework analysis to analyse reports, legislation, decrees, and other official documents that communicated measures taken in response to the pandemic, published from February 1st until May 22nd, 2020. We included documents reporting measures that affected disabled people either directly (measures specifically designed for disabled people) or indirectly (measures for the general population). We developed an analytical framework based on recommendations for disability-inclusive response to COVID-19 published by the Economic Commission for Latin America and the Carribean, the World Health Organisation, and other international organisations. Results We analysed 72 documents. The findings highlight that while some positive measures were taken, the needs of disabled people were not fully considered. Several countries published recommendations for a disability-inclusive response to COVID-19, without ensuring their translation to practice. All countries took at least some steps to ensure access to financial support, health, and education for disabled people, but at the same time they also implemented policies that had a detrimental impact on disabled people. The populations that are most exposed to the impacts of COVID-19, including disabled people living in institutional care, were protected in several cases only by recommendations rather by legislation. Conclusions This study illustrates how the official government responses taken by four countries in the region – while positive, in several aspects – do not fully address the needs of disabled people, thus further disadvantaging them. In order to ensure response to COVID − 19 is disability inclusive, it is necessary to translate recommendations to practice, consider disabled people both in mainstream policy and in disability-specific measures, and focus on the long-term reconstruction phase.

Although rare, central post-stroke pain remains one of the most refractory forms of neuropathic pain. Repetitive transcranial magnetic stimulation (rTMS) has been reported to be effective in chronic cases. However, there are no data on the effects in the acute and subacute phases after stroke. In this study, we present a case of a patient with thalamic stroke with acute onset of pain and paresthesia who was responsive to rTMS. After a right thalamic stroke, a 32-year-old woman presented with drug-resistant pain and paresthesia on the left side of the body. There were no motor or sensory deficits, except for blunted thermal sensation and allodynia on light touch. Ten daily sessions were performed, where 10 Hz rTMS was applied to the hand area of the right primary motor cortex, 40 days after stroke. Before rTMS treatment (T0), immediately after treatment conclusion (T1), and 1 month after treatment (T2), three pain questionnaires were administered, and cortical responses to single and paired-pulse TMS were assessed. Eight healthy participants served as controls. At T0, when the patient was experiencing the worst pain, the excitability of the ipsilesional motor cortex was reduced. At T1 and T2, the pain scores and paresthesia' spread decreased. The clinical improvement was paralleled by the recovery in motor cortex excitability of the affected hemisphere, in terms of both intra- and inter-hemispheric connections. In this subacute central post-stroke pain case, rTMS treatment was associated with decreased pain and motor cortex excitability changes.

São tecidas neste texto algumas reflexões em torno das respostas que têm sido empreendidas pelos setores da saúde, previdência social e assistência social, que compõem a seguridade social no Brasil, tomando-se a sua centralidade, que deveria ser assumida para o enfrentamento da pandemia causada pelo SARS-Cov-2. Com essa leitura de contexto e com o pressuposto de uma ação profissional para a participação social com autonomia, partilham-se experiências de intervenção em Terapia Ocupacional Social com jovens que vivem em periferias urbanas e, certamente, pobres para o mercado/consumo, mas ricos de vida, na pandemia de Covid-19. O intuito foi produzir um cuidado que se coaduna com a proteção social e se direciona, na defesa do valor inegociável de cada vida e do seu pulsar, para a promoção de uma circulação emancipatória, questão agravada, mas anterior à pandemia e sempre presente entre esses jovens.

PURPOSE: A culturally appropriate, patient-centered measure of the quality of dying and death is needed to advance palliative care in Africa. We therefore evaluated the Quality of Dying and Death Questionnaire (QODD) in a Kenyan hospice sample and compared item ratings with those from a Canadian advanced-cancer sample. METHODS: Caregivers of deceased patients from three Kenyan hospices completed the QODD. Their QODD item ratings were compared with those from 602 caregivers of deceased patients with advanced cancer in Ontario, Canada, and were correlated with overall quality of dying and death ratings. RESULTS: Compared with the Ontario sample, outcomes in the Kenyan sample (N = 127; mean age, 48.21 years; standard deviation, 13.57 years) were worse on 14 QODD concerns and on overall quality of dying and death (P values ≤ .001) but better on five concerns, including interpersonal and religious/spiritual concerns (P values ≤ .005). Overall quality of dying was associated with better patient experiences with Symptoms and Personal Care, interpersonal, and religious/spiritual concerns (P values < .01). Preparation for Death, Treatment Preferences, and Moment of Death items showed the most omitted ratings. CONCLUSION: The quality of dying and death in Kenya is worse than in a setting with greater PC access, except in interpersonal and religious/spiritual domains. Cultural differences in perceptions of a good death and the acceptability of death-related discussions may affect ratings on the QODD. This measure requires revision and validation for use in African settings, but evidence from such patient-centered assessment tools can advance palliative care in this region.

G-quadruplexes (G4s) are nucleic secondary structures characterized by G-tetrads. G4 motif stabilization induces DNA damage and cancer cell death; therefore, G4-targeting small molecules are the focus of clinical investigation. DNA destabilization induced by G4 ligands might potentiate the anticancer activity of agents targeting DNA or inhibiting its repair such as oncolytic viruses. This study represents the first approach combining G4 ligands, BRACO-19 (B19), pyridostatin (PDS), and the adenovirus dl922-947 in breast cancer cells. We demonstrated that G4 binders and dl922-947 induce cytotoxicity in breast cancer cells (MDA-MB-231 and MCF-7) and at higher doses in other neoplastic cell lines of thyroid (BHT-101 cells) and prostate (PC3 cells). G4 binders induce G4 motifs distributed in the S and G2/M phases in MCF-7 cells. G4 binder/dl922-947 combination increases cell cytotoxicity and the accumulation in subG0/G1. Indeed, G4 binders favor viral entry and replication with no effect on coxsackie and adenovirus receptor. Notably, dl922-947 induces G4 motifs and its combination with PDS potentiates this effect in MCF-7 cells. The agents alone or in combination similarly enhanced cell senescence. Additionally, PDS/dl922-947 combination inactivates STING signaling in MDA-MB-231 cells. Our results suggest that G4 binder/virotherapy combination may represent a novel therapeutic anticancer approach.

El artículo aborda el desarrollo teórico-práctico de los conceptos territorio y comunidad en la Terapia Ocupacional colombiana. El objetivo fue comprender el uso y la elaboración de tales conceptos e identificar cómo se expresan en la práctica. La recolección de datos se realizó en dos etapas: primera, revisión conceptual de la literatura publicada entre 1990 y 2020 en revistas y libros de amplia circulación en América Latina, así como entrevistas a dos autoras recurrentes en las publicaciones seleccionadas; segunda, observación participante de una pasantía profesional orientada a estudiantes de pregrado en Terapia Ocupacional de una universidad colombiana y entrevistas a actores sociales involucrados en esa práctica. Se identifica que los términos territorio y comunidad conforman el vocabulario técnico de las y los terapeutas ocupacionales en Colombia; se refieren históricamente a prácticas realizadas en contextos de pobreza, y adquirieron mayor relevancia con el desarrollo de políticas públicas. Se evidencia, además, una actuación territorial-comunitaria relacionada con el modo de vida comunitario y con la apropiación de los recursos materiales, sociales, culturales y relacionales del territorio, desde una perspectiva colectiva de la vida. Se reitera la necesidad de superar el uso de estos conceptos solo como espacios físicos de actuación profesional.