Search

The prevalence of diagnosed cumulative trauma disorders (CTD) within the workforce comes at a high price for employers burdened with financial losses from missed work and worker's compensation costs. Research has focused primarily on the impact of CTD on the worker role within the workplace, overlooking the impact on roles across multiple environments [24,35,54]. Furthermore, the influence of CTD on life roles of a spouse has not been examined. This single case study illustrated the experience of CTD within a marital relationship through the use of grounded theory. Results indicated that adaptations to CTD symptoms were least altering to the established routines and roles of the couple. With progression of symptoms, the spouse without symptoms was relied on more heavily for adaptations to manage pain. The results of this study indicate that occupational therapists must examine the client's valued roles and incorporate the family into intervention strategies. [ABSTRACT FROM AUTHOR]

Although effective in treating actinic damage, topical photodynamic therapy (PDT) has been shown to be immunosuppressive through unknown mechanisms, which could potentially limit its effectiveness. Multiple types of environmental stressors, including PDT, can produce the immunosuppressive lipid mediator platelet-activating factor (PAF). Because PAF can produce subcellular microvesicle particles (MVPs), these studies tested whether PDT can generate PAF and MVP release and whether these are involved in PDT-induced immunosuppression. Previously, topical PDT using blue light and 5-aminolevulinic acid was found to be a potent stimulus for PAF production in mice and human skin explants and human patients, and we show that experimental PDT also generates high levels of MVP. PDT-generated MVPs were independent of the PAF receptor but were dependent on the MVP-generating enzyme acid sphingomyelinase. Patients undergoing topical PDT treatment to at least 10% of body surface area showed local and systemic immunosuppression as measured by inhibition of delayed-type hypersensitivity reactions. Finally, using a murine model of contact hypersensitivity, PDT immunosuppression was blocked by genetic and pharmacologic inhibition of acid sphingomyelinase and genetic inhibition of PAF receptor signaling. These studies describe a mechanism involving MVP through which PDT exerts immunomodulatory effects, providing a potential target to improve its effectiveness., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Group A strep tests in patients aged below 3 years are not recommended unless the patient has appropriate symptoms and a positive contact or signs of complications. The purpose of this quality improvement project was to increase the percentage of appropriately ordered strep tests among providers. Data were collected retrospectively and prospectively from 1163 patient visits. Providers were exposed to educational interventions, an electronic medical record order change, and provider feedback. Proportional control charts characterized the providers' behaviors and determined significant improvement among testing. The result was an increase in appropriate tests (13.7% to 37.8%), and the control charts showed sustainable results over time. This project demonstrates the efficacy of these methods to encourage antibiotic stewardship among providers. Furthermore, the interventions used here can be applied to other areas with low-value diagnostic testing. Future studies should investigate whether parental anxiety and educational programs influence testing and evaluate the efficacy of certain strategies.

Abstract: This article describes a teenager who developed anisocoria with no obvious neurologic deficits or decline after a motor vehicle accident. The condition resolved over several hours before reappearing in the opposite eye 2 days later. Again no clinical neurologic deficits were noted and the condition resolved after several hours. The patient's asymptomatic anisocoria was finally determined to be secondary to aerosolized ipratropium treatments and an ill-fitting mask., (Copyright © 2023 American Academy of Physician Associates.)

Recognition and support for young carers has improved steadily in the past two decades; with stronger legislation and more visibility and awareness of the challenges that many of the YC face, especially with respect to their education. Recent UK-based initiatives providing toolkits and guidance for school staff have provided much needed direction for schools, to support the loosely defined statutory requirements. The aim of the current research was to hear from school staff about their experiences in identifying and supporting young carers, to better understand any enablers and barriers. The thematic analysis of the interview data from 18 school staff was organized into two main themes: perceptions regarding the characteristics of young carers; and perceptions regarding the importance of home-school communication. Each superordinate theme contained several sub-themes. Overall, the teachers perceived many difficulties identifying young carers who did not volunteer this information and felt that the main enabler of identification was the trust relationships between the school and the pupil and parents. Once identified, the schools perceived the main areas of need that they could provide support for were the emotional wellbeing of the pupils and additional academic opportunities. They spoke too of the difficulties balancing the provision of this extra support within the constraints of the school context, both in terms of the school day, and the competing priorities relating to academic and social-emotional needs. School staff recognized that extra time outside of school was difficult for young carers to attend. Other subthemes are discussed with consideration to enablers and barriers. The implications for the dissemination of good practice, and addressing policy are considered., Competing Interests: The authors declare no conflict of interest.

Photodynamic therapy (PDT) is a treatment option for tumors and pre-cancerous lesions, but it has immunosuppressive side effects that limit its effectiveness. Recent studies suggest that PDT-mediated immunosuppression occurs through a cyclooxygenase type 2 (COX-2) mediated pathway that leads to increases in regulatory T cells (Tregs) and myeloid-derived suppressor cells (MDSCs), which act as negative regulators of immune responses. Given this pathway, there are three main methods to block immunosuppression: i) Inhibiting the proliferation of Tregs, which can be achieved with the administration of cyclophosphamide or inhibitors of indoleamine 2,3-dioxygenase 1, an activator of Tregs; ii) inhibiting MDSCs by reducing hypoxia around the tumor to create an unfavorable environment or administering all-trans-retinoic acid, which converts MDSCs to a non-immunosuppressive state; and iii) inhibiting COX-2 through selective or non-selective COX-inhibitors. In the present review article, strategies that have shown increased efficacy of PDT in treating tumors and pre-cancerous lesions by blocking the immunosuppressive side effects are outlined and discussed., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Bayless et al.)

Background: Sex is recognized as a significant determinant of outcome among glioblastoma patients, but the relative prognostic importance of glioblastoma features has not been thoroughly explored for sex differences., Methods: Combining multi-modal MR images, biomathematical models, and patient clinical information, this investigation assesses which pretreatment variables have a sex-specific impact on the survival of glioblastoma patients (299 males and 195 females)., Results: Among males, tumor (T1Gd) radius was a predictor of overall survival (HR = 1.027, p = 0.044). Among females, higher tumor cell net invasion rate was a significant detriment to overall survival (HR = 1.011, p < 0.001). Female extreme survivors had significantly smaller tumors (T1Gd) (p = 0.010 t-test), but tumor size was not correlated with female overall survival (p = 0.955 CPH). Both male and female extreme survivors had significantly lower tumor cell net proliferation rates than other patients (M p = 0.004, F p = 0.001, t-test)., Conclusion: Despite similar distributions of the MR imaging parameters between males and females, there was a sex-specific difference in how these parameters related to outcomes.

Ethnic-racial identity formation represents a key developmental task that is especially salient during adolescence and has been associated with many indices of positive adjustment. The Identity Project intervention, which targeted ethnic-racial identity exploration and resolution, was designed based on the theory that program-induced changes in ethnic-racial identity would lead to better psychosocial adjustment (e.g., global identity cohesion, self-esteem, mental health, academic achievement). Adolescents (N =215; Mage =15.02, SD =.68; 50% female) participated in a small-scale randomized control trial with an attention control group. A cascading mediation model was tested using pre-test and three follow-up assessments (12, 18, and 67 weeks after baseline). The program led to increases in exploration, subsequent increases in resolution and, in turn, higher global identity cohesion, higher self-esteem, lower depressive symptoms, and better grades. Results support the notion that increasing adolescents' ethnic-racial identity can promote positive psychosocial functioning among youth.

Aim: To investigate the impact of caring for a parent on the psychosocial development of the young person., Methods: A total of 20 young carers and 20 non-caregiving peers, aged 11-18 years, were compared on self-report measures of life satisfaction, self-esteem, and behavioural strengths and difficulties. Parental reports on their child's behaviour were obtained and measured., Results: Young carers reported lower life satisfaction and self-esteem compared with non-caregiving peers, and their parents rated them as having more difficulties with peer relationships and more emotional symptoms. There was no evidence of more pro-social behaviour on the part of young carers., Conclusions: Caregiving has a negative effect on young people overall; improved support of and more research around young carers are required.

Face recognition is a complex cognitive task that involves a distributed network of neural sources. While some components of this network have been identified, the temporal sequence of these components is not well understood. Magnetoencephalography (MEG), analyzed with a spatial filtering source localisation algorithm, was used to determine frontal contributions to face recognition. We tested 22 adults (mean age 26.3 years; 10 females). Upright and inverted faces were presented in counter-balanced blocks and subjects identified repetitions in a 1-back protocol. MEG data were recorded continuously from a 151 channel CTF machine and source localised to each participant's MRI. The classic face components, M100 and M170, were seen for upright and inverted faces with M100 localizing to bilateral occipital areas and M170 to bilateral fusiform areas. A third component, M240, showed high global field power to correctly recognised repeated faces and localised to right middle frontal and insula sources at 240 ms for upright faces and bilateral mid-frontal sources for inverted faces. The effect of repetition was examined and a source identified at 250 ms in the cingulate, for inverted faces. These results provide timing information on frontal lobe activation, seen reliably in fMRI memory studies; the immediate recognition of repeated faces activates the right frontal sources at 240-250 ms, with bilateral activation to repeated inverted faces, perhaps due to increased task difficulty., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Background: School-age preterm children are at risk for cognitive difficulties including Executive Dysfunction and low average IQ., Aim: The aim of this study was to determine the performance of very preterm, school-age children on three components of Executive Function (EF), two components of Executive Attention and a measure of IQ., Study Design: Cross-sectional, independent samples comparison., Methods: A UK sample of 40 very preterm (<32 weeks gestational age, Mean 28.43, SD 2.41) children and 41 term born control children aged between 6 and 12 years (mean ages 8 years 5 months in both groups) was assessed on IQ, EF (inhibition, working memory and set shifting) and attention (sustained and selective). Between group comparisons were made using multivariate analysis of variance and covariance., Results: Multivariate analyses indicated that preterm children scored significantly lower than their term born peers across Executive Function and executive attention tasks. As expected, the preterm group achieved IQ scores at the low end of the average range. Univariate analyses indicated some difficulties with shifting and inhibition components of EF, although covariate analysis revealed that only shifting was independent of IQ., Conclusions: Preterm children showed mild executive function and executive attention difficulties in the context of average IQ scores. The findings highlight the benefit of using multivariate assessments of executive skills rather than general intellectual outcome alone, to obtain a better distinction of the specific cognitive weaknesses associated with preterm birth.