Search

Teachers at a, mostly white, independent school met monthly for a year, discussing how to talk with children from pre-K through eighth grade about race. They looked at interactions that aro...

Stroke remains a leading cause of disability, with survivors experiencing long-term decrements in independence and quality of life. Occupational therapists (OTs) employ numerous neurorehabilitative treatment approaches to remediate impairments that are impeding performance. OTs also use physical agent modalities to facilitate increased participation and success in therapy. One such modality is transcranial direct current stimulation (tDCS), a form a noninvasive brain stimulation that can be overlaid onto task practice and delivers a constant, low intensity current into the brain. tDCS is safe, portable, and efficacious in remediating a variety of deficits, yet is not consistently incorporated into clinical practice. The authors discuss the mechanisms, safety, evidence, and potential applications of tDCS to enhance outcomes for this growing population.

Stroke remains a leading cause of death, with most survivors experiencing long-term deficits in motor function. Upper extremity (UE) hemiparesis constitutes one of the most common and disabling poststroke impairments. Many contemporary rehabilitative methods target reacquisition of UE motor skills. One such intervention is mental practice (MP), which involves mental rehearsal without physical execution of the movement. MP has not been consistently integrated into clinical environments. This article discusses the scientific rationale for MPs, highlights evidence supporting their use, discusses components of the repetitive task-specific practice regimens accompanying MP, and discusses possible augmentative strategies and areas for research.

Background The National Institutes of Health Stroke Scale (NIHSS) is purported to be associated with long-term outcomes. This study determined the concurrent validity of the NIHSS with the Stroke Impact Scale (SIS), a previously validated measure of health status in chronic stroke survivors. Methods The NIHSS and the SIS were administered to 147 subjects before participation in a multicenter, randomized, controlled trial. A Spearman's rho was used to determine correlations between NIHSS total score and (1) SIS physical dimension scores, (2) SIS overall perception of recovery scores, and (3) the SIS activities and independent activities of daily living (ADL/IADL) scores. SIS score variation and medians between subjects who scored a zero versus a nonzero on the NIHSS was also assessed. Results There was no association between total NIHSS scores and SIS physical dimension scores, SIS overall perception of recovery scores, and SIS ADL/IADL scores ( P = −.036, P = .782; P = −.039, P = .640; P = −.054, P = .520; respectively). Lastly, significant variation and similar median scores on the SIS were found between those scoring a zero on the NIHSS versus those who did not score a zero. Conclusions The NIHSS has no association with health status in chronic stroke and lacks association with measures of impairment and functional limitation. From these findings, we conclude that the NIHSS has poor validity to discern long-term poststroke outcomes and is not associated with health status. Because of possible limitation in the NIHSS's ability to accurately determine outcomes in this population, we recommend restriction of its use to the acute stage of recovery.

OBJECTIVE. To determine the impact of transcranial direct current stimulation (tDCS) combined with repetitive, task-specific training (RTP) on upper-extremity (UE) impairment in a chronic stroke survivor with moderate impairment. METHOD. The participant was a 54-yr-old woman with chronic, moderate UE hemiparesis after a single stroke that had occurred 10 yr before study enrollment. She participated in 45-min RTP sessions 3 days/wk for 8 wk. tDCS was administered concurrent to the first 20 min of each RTP session. RESULTS. Immediately after intervention, the participant demonstrated marked score increases on the UE section of the Fugl–Meyer Scale and the Motor Activity Log (on both the Amount of Use and the Quality of Movement subscales). CONCLUSION. These data support the use of tDCS combined with RTP to decrease impairment and increase UE use in chronic stroke patients with moderate impairment. This finding is crucial, given the paucity of efficacious treatment approaches in this impairment level.

The vast majority of stroke survivors exhibit residual impairments,1,2 with most reporting-associated quality of life decrements.3,4 The prevalence of these poststroke motor deficits and the overall burden of stroke are likely to rise exponentially attributable to an aging population and increases in the prevalence of many risk factors (eg, obesity, diabetes mellitus, smoking).5,6 In light of these trends, several promising motor interventions have been introduced, with many targeting upper extremity (UE) hemiparesis, given its widely appreciated impact. Yet, although several of these approaches appear efficacious, few therapeutic approaches showing promise in animal or early human trials are fully translated to regular clinical practice.7 Consistently, many contemporary motor rehabilitation strategies require high duration contact time8 and costly equipment,9 preventing their widespread clinical application, except among specialized rehabilitation and academic medical centers. Mental practice involves repetitive cognitive rehearsal of physical movements in the absence of physical, voluntary attempts. From a practical perspective, mental practice constitutes an attractive alternative to other rehabilitative approaches because it does not require physical rehearsal, can be performed without direct supervision, and requires minimal expense and equipment, facilitating ease of use. The brain’s ability to respond to repetitive, learning-based strategies even years after injury and well into adulthood also makes mental practice a favorable match for stroke, which tends to be a disease of the aged and because survivors frequently exhibit residual impairments for years postictus. We speculated that repetitive mental practice use, shown to trigger the same neural areas and musculature as physical practice of the same tasks,10–14 would cause substantive neural and motor changes in stroke survivors with UE deficits. Although used for decades in sport and exercise settings, this laboratory was the first to apply mental practice to increase learning …

Stroke remains a leading cause of disability, with those affected usually experiencing long-term motor deficits. The National Institutes of Health Stroke Scale (NIHSS) is commonly used to measure acute neurological status, but recently is being deployed in at least 29 chronic stroke trials as a secondary UE motor outcome despite a lack of evidence surrounding its validity in chronic stroke. The purpose of this secondary, retrospective analysis of randomized controlled, multicenter, trial data was to (a) determine the NIHSS’s association with the Stroke Impact Scale (SIS), a poststroke health status measurement, the upper extremity Fugl Meyer (UEFM) and the Arm Motor Ability Test (AMAT), measures of upper extremity (UE) impairment and functional limitation and (b) determine the NIHSS’s sensitivity to UE motor change over time . There was no association between total NIHSS scores and SIS physical dimension, overall perception of recovery, activity of daily living scores ( P = -.036, P = .782; P = -.039, P = .640; P = -.054, P 5.520, respectively) or functional limitation ( P; = –0.141; P; = 0.089 ). NIHSS and UE impairment associations were significant ( P; = –0.204; P; = 0.014 ) but explained less than 4% of the variance among UEFM scores. Subjects scoring a “zero” on the NIHSS exhibited discernible UE motor deficits and varied scores on the UEFM, AMAT, and SIS. A statistically significant sensitivity to change was found for the UEFM ( χ 2 (3) = 10.783, p = 0.013 ), but not for NIHSS ( X 2 (3) = 1.250, p = 0.741 ) or either AMAT functional ability or quality of movement scores ( χ 2 (3) = 3.953, p = 0.267; χ 2 (3) = 4.199, p = 0.241, respectively ). There was a significant weak, negative correlation between the NIHSS and UEFM ( r s (47) = -.325, p = .026 ), but nonsignificant weak, negative correlations between the NIHSS and either AMAT scores ( r s (47) = -.051, p = .740; r s (47) = -.103, p = .489, respectively ). While being increasingly used in postacute trials, the NIHSS’s weak correlation with measures of motor impairment, functional limitation, and health status measurements as well as its insensitivity to change suggest that its use be reserved to acute bedside status. Its utility as a predictor of real world UE motor outcomes has been purported and is currently under investigation as a next step.

Objectives. (a) To determine associations among motor evoked potential (MEP) amplitude, MEP latency, lower extremity (LE) impairment, and gait velocity and (b) determine the association between the presence of a detectable MEP signal with LE impairment and with gait velocity.Method. 35 subjects with chronic, stable LE hemiparesis were undergone TMS, the LE section of the Fugl-Meyer Impairment Scale (LE FM), and 10-meter walk test. We recorded presence, amplitude, and latency of MEPs in the affected tibialis anterior (TA) and soleus (SO).Results. MEP presence was associated with higher LEFM scores in both the TA and SO. MEP latency was larger in subjects with lower LEFM and difficulty walking.Conclusion. MEP latency appears to be an indicator of LE impairment and gait.Significance. Our results support the precept of using TMS, particularly MEP latency, as an adjunctive LE outcome measurement and prognostic technique.

Objective To determine the immediate effect of a portable, myoelectric elbow-wrist-hand orthosis on paretic upper extremity (UE) impairment in chronic, stable, moderately impaired stroke survivors. Design Observational cohort study. Setting Outpatient rehabilitation clinic. Participants Participants exhibiting chronic, moderate, stable, poststroke, UE hemiparesis (N=18). Interventions Subjects were administered a battery of measures testing UE impairment and function. They then donned a fabricated myoelectric elbow-wrist-hand orthosis and were again tested on the same battery of measures while wearing the device. Main Outcome Measures The primary outcome measure was the UE Section of the Fugl-Meyer Scale. Subjects were also administered a battery of functional tasks and the Box and Block (BB) test. Results Subjects exhibited significantly reduced UE impairment while wearing the myoelectric elbow-wrist-hand orthosis (FM: t 17 =8.56, P z =2.251, P =.024; feeding [elbow]: z =2.966, P =.003; drinking [grasp]: z =3.187, P =.001). Additionally, subjects showed significant decreases in time taken to grasp a cup ( z =1.286, P =.016) and increased gross manual dexterity while wearing a myoelectric elbow-wrist-hand orthosis (BB test: z =3.42, P Conclusions Results suggest that UE impairment, as measured by the Fugl-Meyer Scale, is significantly reduced when donning a myoelectric elbow-wrist-hand orthosis, and these changes exceeded the Fugl-Meyer Scale's clinically important difference threshold. Further, utilization of a myoelectric elbow-wrist-hand orthosis significantly increased gross manual dexterity and performance of certain functional tasks. Future work will integrate education sessions to increase subjects' ability to perform multijoint functional movements and attain consistent functional changes.

Stroke remains a leading cause of disability worldwide, with a majority of survivors experiencing long term decrements in motor function that severely undermine quality of life. While many treatment approaches and adjunctive strategies exist to remediate motor impairment, many are only efficacious or feasible for survivors with active hand and wrist function, a population who constitute only a minority of stroke survivors. Transcranial direct current stimulation (tDCS), a type of non-invasive brain stimulation, has been increasingly utilized to increase motor function following stroke as it is able to be used with stroke survivors of varying impairment levels, is portable, is relatively inexpensive and has few side effects and contraindications. Accordingly, in recent years the number of studies investigating its efficacy when utilized as an adjunct to motor rehabilitation regimens has drastically increased. While many of these trials have reported positive and promising efficacy, methodologies vary greatly between studies, including differences in stimulation parameters, outcome measures and the nature of physical practice. As such, an urgent need remains, centering on the need to investigate these methodological differences and synthesize the most current evidence surrounding the application of tDCS for post-stroke motor rehabilitation. Accordingly, the purpose of this paper is to provide a detailed overview of the most recent tDCS literature (published 2014-2015), while highlighting these variations in methodological approach, as well to elucidate the mechanisms associated with tDCS and post-stroke motor re-learning and neuroplasticity.

Guided by Colella, Paetzold, and Belliveau (2004), we surveyed 305 employees on their reactions towards coworkers with mental illness. Co-workers were less likely to view longer/more frequent work breaks as appropriate accommodations for the mentally ill relative to fl exible hours, banking of overtime hours, and counselling. Moreover, employees who believed that co-workers with mental illness were being equitably (or fairly) treated at work were more likely to report that they would selfdisclose—and seek assistance for—a mental illness. Finally, employees with workplace contact with the mentally ill were more likely to support hiring people with mental illness. Copyright © 2009 ASAC. Published by John Wiley & Sons, Ltd. JEL classifi cation: J71

Social work and other professions struggle with the roles of knowledge and values in the study of society and human lives, and in professional practice. Discussions of this topic range from those who see relatively clear distinctions between these concepts and those for whom the lines between the concepts are blurred. For those who separate theory and knowledge from values and ethics there is further discussion in the literature on which is the appropriate foundation for social work practice. The following discussion examines two arguments: firstly, that these concepts, and the two camps they can be placed into, are distinct and should be kept separate; and secondly, the alternative perspective that the concepts overlap and that the separation into two camps is false. The analysis here outlines these perspectives and suggests reasons why shades of both are necessary to fully understand and participate in the reality of social work as a profession and an academic discipline.

Discusses problems in teaching social policy courses which students often view as not necessary for practice. Documents teaching of critical social policy to Canadian students and identifies a number of problems in making it interesting, such as the abstract nature of the content, general lack of understanding of the importance of policy analysis, and fear of an unknown subject. Highlights key teaching strategies and assessment methods and notes constraints, successes and failures in teaching the subject.

English The dominant economic philosophy, heavily influenced by neoliberalism, is antagonistic to state intervention. Drawing on the case of Canada, we argue that women's groups could resort to international advocacy to combat neoliberal social policy. Such advocacy has a number of potentials as discussed, including fostering a rights-based discourse. French Fortement influencée par le néolibéralisme, la philosophie économique dominante est antagoniste à l'intervention étatique. Nous référant à l'expérience canadienne, nous soutenons que les groupes de femmes pourraient faire appel à des organismes internationaux d'appui et de défense des droits pour combattre les politiques néolibérales sociales. De tels défenseurs peuvent plaider en faveur des femmes des façons suivantes: cette inclus promouvoir un discours fondé sur les droits. Spanish La filosofía económica dominante que ha sido influida profundamente por el neo-liberalismo, es contraria a la intervención del estado. Basado en el caso de Canadá, argüimos que los grupos representando a las mujeres recuren a la abogacía internacional para combatir las políticas neo-liberales sociales. Tal forma de abogacía tiene las siguientes características: presiona a los gobiernos a que abandonen políticas contra las mujeres; fomenta un discurso basado en los derechos; y actúa como catalizador para los esfuerzos de implementación a nivel domestico y nacional.

Enterovirus (EV) 68 was originally isolated in California in 1962 from four children with respiratory illness. Since that time, reports of EV68 isolation have been very uncommon. Between 1989 and 2003, 12 additional EV68 clinical isolates were identified and characterized, all of which were obtained from respiratory specimens of patients with respiratory tract illnesses. No EV68 isolates from enteric specimens have been identified from these same laboratories. These recent isolates, as well as the original California strains and human rhinovirus (HRV) 87 (recently shown to be an isolate of EV68 and distinct from the other human rhinoviruses), were compared by partial nucleotide sequencing in three genomic regions (partial sequencing of the 5'-non-translated region and 3D polymerase gene, and complete sequencing of the VP1 capsid gene). The EV68 isolates, including HRV87, were monophyletic in all three regions of the genome. EV68 isolates and HRV87 grew poorly at 37 degrees C relative to growth at 33 degrees C and their titres were reduced by incubation at pH 3.0, whereas the control enterovirus, echovirus 11, grew equally well at 33 and 37 degrees C and its titre was not affected by treatment at pH 3.0. Acid lability and a lower optimum growth temperature are characteristic features of the human rhinoviruses. It is concluded that EV68 is primarily an agent of respiratory disease and that it shares important biological and molecular properties with both the enteroviruses and the rhinoviruses.

While enteroviruses have been the most commonly identified cause of aseptic meningitis in the United States, the role of the emerging, neurotropic West Nile virus (WNV) is not clear. In summer 2001, an aseptic meningitis epidemic occurring in an area of a WNV epizootic in Baltimore, Maryland, was investigated to determine the relative contributions of WNV and enteroviruses. A total of 113 aseptic meningitis cases with onsets from June 1 to September 30, 2001, were identified at six hospitals. WNV immunoglobulin M tests were negative for 69 patients with available specimens; however, 43 (61%) of 70 patients tested enterovirus-positive by viral culture or polymerase chain reaction. Most (76%) of the serotyped enteroviruses were echoviruses 13 and 18. Enteroviruses, including previously rarely detected echoviruses, likely caused most aseptic meningitis cases in this epidemic. No WNV meningitis cases were identified. Even in areas of WNV epizootics, enteroviruses continue to be important causative agents of aseptic meningitis.

Between November 1998 and December 2000, the Centers for Disease Control and Prevention screened samples from 263 outbreaks of gastroenteritis in the United States and identified 3 that were associated with rotavirus among adults. Rotaviruses from each outbreak were further characterized by reverse-transcription polymerase chain reaction. Surprisingly, all specimens were of serotype G2, a strain that is, as determined by high-stringency hybridization analysis, genetically distinct in all 11 gene segments from the other common rotavirus strains in circulation. The unusual coincidence of identification of only G2 strains in these 3 outbreaks of rotavirus gastroenteritis among adults is similar to results from other studies, in which G2 strains were found in association with more-severe disease in children than other rotavirus serotypes and in association with outbreaks of diarrhea among adults in Japan. Although rotavirus infections in adults are relatively uncommon, which indicates that good overall protective immunity exists, the predominance of G2 strains in outbreaks that have occurred in adults suggests that natural immunity to more common strains does not always provide adequate heterotypic immunity to G2 strains. For the rotavirus vaccines under development, special attention may need to be paid to protection against G2 strains.

Objectives. We evaluated the implementation of three commericially available neuraminidase inhibition assays in a public health laboratory (PHL) setting. We also described the drug susceptibility patterns of human influenza A and B circulating in Maryland during the 2011–2012 influenza season. Methods. From January to May 2012, 169 influenza virus isolates were tested for phenotypic susceptibility to oseltamivir, zanamivir, and peramivir using NA-Fluor™, NA-Star®, and NA-XTD™ concurrently. A 50% neuraminidase inhibitory concentration (IC50) value was calculated to determine drug susceptibility. We used the standard deviation based on the median absolute deviation of the median analysis to determine the potential for reduced drug susceptibility. We evaluated each assay for the use of resources in high- and low-volume testing scenarios. Results. One of the 25 2009 influenza A (H1N1) pandemic isolates tested was resistant to oseltamivir and peramivir, and sensitive to zanamivir, on all three platforms. Eighty-two influenza A (H3N2) and 62 B isolates were sensitive to all three drugs in all three assays. For a low-volume scenario, NA-Star and NA-XTD took 120 minutes to complete, while NA-Fluor required 300 minutes to complete. The lowest relative cost favored NA-Star. In a high-volume scenario, NA-Fluor had the highest throughput. Reagent use was most efficient when maximizing throughput. Cost efficiency from low- to high-volume testing improved the most for NA-Star. Conclusions. Our evaluation showed that both chemiluminescent and fluorescent neuraminidase inhibition assays can be successfully implemented in a PHL setting to screen circulating influenza strains for neuraminidase inhibitor resistance. For improved PHL influenza surveillance, it may be essential to develop guidelines for phenotypic drug-resistance testing that take into consideration a PHL's workload and available resources.

Objectives. (a) To determine associations among motor evoked potential (MEP) amplitude, MEP latency, lower extremity (LE) impairment, and gait velocity and (b) determine the association between the presence of a detectable MEP signal with LE impairment and with gait velocity. Method. 35 subjects with chronic, stable LE hemiparesis were undergone TMS, the LE section of the Fugl-Meyer Impairment Scale (LE FM), and 10-meter walk test. We recorded presence, amplitude, and latency of MEPs in the affected tibialis anterior (TA) and soleus (SO). Results. MEP presence was associated with higher LEFM scores in both the TA and SO. MEP latency was larger in subjects with lower LEFM and difficulty walking. Conclusion. MEP latency appears to be an indicator of LE impairment and gait. Significance. Our results support the precept of using TMS, particularly MEP latency, as an adjunctive LE outcome measurement and prognostic technique.

Date Presented 4/8/2016 Mental practice (MP) increases upper-extremity function poststroke. However, whether there is a MP practice effect is unknown. In our study, one group underwent a massed MP intervention, and the second group underwent distributed MP. Results indicate that distributed MP may be more efficacious than massed practice. Primary Author and Speaker: Heather Peters Contributing Authors: Stephen J. Page, Erinn M. Hade, Juan Pang

Date Presented 4/9/2016 The National Institutes of Health Stroke Scale (NIHSS) is an acutely based measure purported to be associated with long-term outcomes and is increasingly being used in chronic trials. The study objective was to determine the concurrent validity of the NIHSS with the Stroke Impact Scale, a previously validated measure in chronic stroke. Primary Author and Speaker: Heather Peters Contributing Authors: Susan E. White and Stephen J. Page

Member of the Autism Genome Project Consortium: Astrid M. Vicente Although autism is a highly heritable neurodevelopmental disorder, attempts to identify specific susceptibility genes have thus far met with limited success. Genome-wide association studies using half a million or more markers, particularly those with very large sample sizes achieved through meta-analysis, have shown great success in mapping genes for other complex genetic traits. Consequently, we initiated a linkage and association mapping study using half a million genome-wide single nucleotide polymorphisms (SNPs) in a common set of 1,031 multiplex autism families (1,553 affected offspring). We identified regions of suggestive and significant linkage on chromosomes 6q27 and 20p13, respectively. Initial analysis did not yield genome-wide significant associations; however, genotyping of top hits in additional families revealed an SNP on chromosome 5p15 (between SEMA5A and TAS2R1) that was significantly associated with autism (P = 2 x 10(-7)). We also demonstrated that expression of SEMA5A is reduced in brains from autistic patients, further implicating SEMA5A as an autism susceptibility gene. The linkage regions reported here provide targets for rare variation screening whereas the discovery of a single novel association demonstrates the action of common variants.

A street nurse position in the rural and small-town interior of British Columbia has been addressing the needs of street-involved or otherwise marginalized client populations by bringing healthcare services to wherever those clients are, rather than waiting for the clients to seek care. The primary reason for a street outreach approach is that marginalized populations face a variety of barriers to accessing traditional healthcare services--barriers such as homelessness, mental health problems, criminal involvement, lack of transportation, lack of ability to pay for prescriptions, lack of specialized or knowledgeable providers and provider discrimination. In the rural street nurse program, the target population includes the usual street nurse populations of illegal drug users and sex trade workers, which are more hidden in small communities than in larger urban centres, creating the community denial that is a barrier to healthcare access. Yet another barrier is the co-locaton of services common in small communities, where public health clinics might share a building with police services, making marginalized clients reluctant to attend clinics. The rural street nurse collaborates with public health nurses and other care providers (mental health workers, social workers, etc) with collegial advice and support, making and receiving referrals, and generally assisting one another--the street nurse through his rapport with the marginalized individuals and the others with their specialized knowledge. Rural street services are delivered whereverthe clientsfeel comfortable: a school, a drop-in centre, a mall, a youth centre or simplythe street. Services provided include sexually transmitted infection testing, chlamydia treatments, pregnancy testing emergency contraception pills and assistance with filling out forms for financial support. Accordingly, the street nurse's truck is equipped as a mobile treatment centre and office, with a cellphone and a stock of testing and treatment supplies.

This study examines relationships between an intensive care unit and the general practitioners within a local health authority in respect of bereavement care. A questionnaire to all 113 local general practitioners generated a response from 67 (59.3%). While about two-fifths of respondents reported at least one of their patients dying on the intensive care unit, half said that they were often first informed by relatives. Although four-fifths of inner city general practitioners offered some form of bereavement service, it ranked lowest in terms of priority on time, and a further one-seventh provided no service at all. Half the respondents thought that hospital staff could do more to help. The implications for practice are discussed.

Marijuana was the drug of the 1960s and heroin the drug of the 1970s. Cocaine was the popular drug of the 1980s, and cocaine's popularity appears to have continued into the 1990s. Cocaine use increased dramatically between 1974 and 1985. This article reviews the trends of cocaine use, fetal and maternal pharmacodynamics of cocaine, intrauterine effects of cocaine on the fetus, and the neonatal manifestations of cocaine exposure.