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Occupational therapy practitioners address pain management across settings, populations, and the lifespan. Occupational therapy practitioners offer unique contributions to pain management through biopsychosocial approaches, targeting supported self-management and occupational engagement. Comprehensive pain education is necessary to prepare entry-level occupational therapy practitioners to address pain in practice, yet no standards exist in entry-level occupational therapy education. This survey describes the status of pain-related education in entry-level occupational therapy programs across the United States. A total of 41 entry-level occupational therapy programs completed the survey. Total instructional time for pain content was reported to be an average of 9.68 hours, ranging from 1 to 30 hours, indicating significant variability. Average lecture (4.88 hours) and lab-based (5.05 hours) time devoted to pain content were similar. More time was devoted to teaching pain interventions (4.91 hours) than pain assessments (2.82 hours). Most programs integrated pain content throughout the curriculum (73%). One program utilized a standardized pain curriculum (International Association for the Study of Pain Occupational Therapy Curriculum). Open-ended questions revealed a breadth of evidence-based resources, pain assessments, and interventions covering all domains of the biopsychosocial model of pain. The majority of faculty (61%) felt their current amount of pain education was insufficient, citing the need for increased time and educational activities for pain education across all program years. Given the essential and unique role of occupational therapy practitioners in pain management, improving pain education and practitioner competence is an important consideration across entry-level occupational therapy education. Further discussion is needed regarding educational standards and entry-level occupational therapy curricula relating to pain management.

The use of high-fidelity simulation and standardized patients (SPs) in occupational therapy (OT) education is expanding. However, the implementation of simulation varies across programs, leading to inconsistent outcomes and research limitations. Furthermore, details on SP use and training are lacking in OT literature. This article aims to provide OT educators with considerations for improving simulation fidelity by effectively using highly trained SPs. For example, recruiting SPs from diverse backgrounds is necessary to improve sociological fidelity, and proper training of SPs is required to ensure psychological fidelity. This article also emphasizes the need for standardized training for SPs and recommends following the Association of Standardized Patient Educators (ASPE) guidelines to ensure best practices in OT education. Adequate SP training and ongoing professional development are essential for maintaining simulation fidelity during SP experiences and optimizing student learning outcomes. Implementing SP experiences within the OT curriculum, SP recruitment and training, case development, pre-briefing, and debriefing processes are discussed, with recommendations from current evidence and the authors' experience at an institution accredited by the Society for Simulation in Healthcare. Trained SPs can enhance simulation fidelity and provide students with realistic and compelling learning experiences, better preparing them for fieldwork and clinical practice. While further research is needed to explore the efficacy of SP encounters in OT education and the student experience, this article reinforces the need to standardize the use and training of SPs to enhance simulation fidelity and support the reliability and validity of future research efforts surrounding the use of SPs.

This research was performed to investigate the hypothesis that dietary mono-component protease (PRO) might improve growth performance, nutrient digestibility, and carcass characteristics of growing-finishing pigs. A total of eighty-four pigs [Duroc × (Landrace × Yorkshire), 25.3 ± 2.16 kg initial body weight] were randomly assigned to three dietary treatments (7 replicates/treatment; 2 barrows and 2 gilts/replicate) in a randomized complete block design (block = sex). The dietary treatments were prepared as follows; (1) a positive control (PC) as a typical growing-finishing diet based on corn and soybean meal, (2) PC added with 0.015% of PRO (PCPRO), and (3) a negative control (NC) added with 0.015% of PRO (NCPRO). The NC had a lower concentration of crude protein (CP) compared with PC. The PRO was a commercial product that contained 75,000 protease units/g and derived from Nocardiopsis prasina produced in Bacillus licheniformis. Dietary treatments were offered to pigs during growing and finishing periods. Measurements were growth performance, apparent total tract digestibility (ATTD) of nutrients, and carcass characteristics. The PCPRO and/or NCPRO increased average daily gain (ADG) and gain to feed ratio (G:F) during growing (p < 0.10), finishing (p < 0.05), and growing-finishing periods (p < 0.10) compared with PC. Furthermore, pigs fed PCPRO and NCPRO had higher (p < 0.05) ATTD of CP and energy during growing and/or finishing periods than those fed PC. In conclusion, the supplementation of PRO in diets improved growth performance and protein digestibility of growing-finishing pigs.

This experiment was conducted to investigate effects of dietary protease on immune responses of weaned pigs. Weaned pigs (n = 75; 7.06 ± 0.18 kg BW; 28 d old) were randomly assigned to 3 treatments (5 pigs/pen; 5 pens/treatment). Dietary treatments were positive control, a diet with required protein level (PC), negative control, a diet with lower protein level than PC (NC), and NC + 0.02% dietary protease (PRO). The dietary protease used in this experiment was a commercial product containing 75,000 protease units/g derived from Nocardiopsis prasina produced in Bacillus licheniformis. The dietary treatments did not contain any ingredients or additives that may provide antibacterial or physiological effects. Pigs were fed respective dietary treatments for 6 weeks. Blood was collected from randomly selected 2 pigs in each pen on d 1, 3, 7, and 14 after weaning. Measurements were number of white blood cells (WBC), tumor necrosis factor-α (TNF-α), transforming growth factor-β1 (TGF-β1), and C-reactive protein (CRP). Pigs fed PRO had lower WBC on d 7 (14.84 vs 20.42 × 103/μL; p < 0.05) and TNF-α on d 7 (618 vs 889 pg/mL; p = 0.085) and 14 (437 vs 576 pg/mL; p = 0.069) than those fed NC, but there were no differences on WBC and TNF-α between PC and PRO. Pigs fed PRO had lower TGF-β1 on d 3 (630 vs. 1,588 and 1,396 pg/mL; p < 0.05) than those fed PC and NC. However, no differences were found on CRP among dietary treatments. In conclusion, addition of dietary protease reduced inflammatory immune responses of weaned pigs.

This study was conducted to evaluate effects of dietary protease (PR) on growth performance, nutrient digestibility, and intestinal morphology of weaned pigs. A total of 75 weaned pigs [7.06 ± 0.18 kg of average body weight (BW); 28 day old] were randomly allotted to 3 dietary treatments in a randomized complete block design (blocks = BW and sex): a diet based on corn and soybean meal to meet the requirement of crude protein (CP) as a positive control (PC; CP = 24.49%), a low protein diet as a negative control (NC; CP = 22.51%), and NC + 0.02% PR. The PR used in this study was a commercial product containing 75,000 protease units/g derived from Nocardiopsis prasina produced in Bacillus licheniformis. Pigs were fed the dietary treatments for 6 weeks and the diets containing 0.2% chromic oxide for the last week of this study. Blood, feces, ileal digesta, and ileum samples were collected from randomly selected two pigs in each pen on respective time points. Measurements were growth performance, apparent ileal digestibility (AID) and apparent total tract digestibility (ATTD) of dry matter (DM), CP, and energy, frequency of diarrhea, packed cell volume (PCV), and ileal morphology of weaned pigs. Pigs fed PC and PR had higher (p < 0.05) final BW, average daily gain (ADG), and gain to feed ratio (G:F) during overall experimental period than those fed NC. Pigs fed PC and PR had higher (p < 0.05) AID or ATTD of DM, CP, or energy than those fed NC. Moreover, pigs fed PR had higher ratio between villus height and crypt depth (p < 0.05) and number of goblet cells (p < 0.05) than those fed NC. Addition of PR decreased (p < 0.05) frequency of diarrhea for the first two weeks after weaning compared with PC and NC. In addition, pigs fed PR had lower (p < 0.05) PCV on d 14 after weaning than those fed PC and NC. In conclusion, addition of PR in nursery diets with a low protein level significantly improved growth performance, nutrient digestibility, and intestinal morphology of weaned pigs.

The case report of a patient is described who, 7 years after carrying out a partial falectomy with inguinal superficial lymphadenectomy and chemotherapy (cisplatin 150) due to an squamous cell carcinoma of the penis, he went to the Urology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba presenting a giant scrotal lymphedema, of lymphatic obstructive origin, with marked repercussion on the biped position and during walking. The surgical procedure (Homans technique with modifications) was carried out and the patient had a satisfactory clinical course. Then after 2 years of surgery, he was discharged from the out-patient service, because it was considered that he had recovered the physical motor skills and his self-esteem.

Introduction: Optimizing the performance of emergency department (ED) teams impacts patient care, but the utility of current, team-based performance assessment tools to comprehensively measure this impact is underexplored. In this study we aimed to 1) evaluate ED team performance using current team-based assessment tools during an interprofessional in situ simulation and 2) identify characteristics of effective ED teams.Methods: This mixed-methods study employed case study methodology based on a constructivist paradigm. Sixty-three eligible nurses, technicians, pharmacists, and postgraduate year 2–4 emergency medicine residents at a tertiary academic ED participated in a 10-minute in situ simulation of a critically ill patient. Participants self-rated performance using the Team Performance Observation Tool (TPOT) 2.0 and completed a brief demographic form. Two raters independently reviewed simulation videos and rated performance using the TPOT 2.0, Team Emergency Assessment Measure (TEAM), and Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS). Following simulations, we conducted semi-structured interviews and focus groups with in situ participants. Transcripts were analyzed using thematic analysis.Results: Eighteen team-based simulations took place between January–April 2021. Raters’ scores were on the upper end of the tools for the TPOT 2.0 (R1 4.90, SD 0.17; R2 4.53, SD 0.27, IRR [inter-rater reliability] 0.47), TEAM (R1 3.89, SD 0.19; R2 3.58, SD 0.39, IRR 0.73), and Ottawa GRS (R1 6.6, SD 0.56; R2 6.2, SD 0.54, IRR 0.68). We identified six themes from our interview data: team member entrustment; interdependent energy; leadership tone; optimal communication; strategic staffing; and simulation empowering team performance.Conclusion: Current team performance assessment tools insufficiently discriminate among high performing teams in the ED. Emergency department-specific assessments that capture features of entrustability, interdependent energy, and leadership tone may offer a more comprehensive way to assess an individual’s contribution to a team’s performance.

The aim of this study was to determine how participation in a community service project impacts entry-level OT doctoral (OTD) students at different time points in their education. This study employed a mixed-method, prospective cohort design. The Community Service Attitudes Scale (CSAS) is an instrument to measure college students' attitudes about community service. Open-ended questions were asked after participation in the experience in addition to the CSAS to gather a deeper reflection of the S-L experience. A total of 62 OTD students participated in the study. There was no statistically significant difference between the CSAS scores between the OTD first-year and third-year students. Students reported that they gained knowledge regarding occupational justice and community-based interventions, how to establish a therapeutic relationship, and the impact of occupation-based interventions when asked what they learned from the experience. Through the participation in a S-L experience, the students gained knowledge regarding occupational justice and community-based interventions, how to establish a therapeutic relationship, and an awareness of the impact of occupation-based interventions on clients. S-L enables OT educators to provide opportunities for students to gain critical skills that will translate into clinical practice.

Candida auris is considered a nosocomial pathogen of high concern and is currently spreading across the United States. Infection control measures for C. auris focus mainly on healthcare facilities, yet transmission levels may already be significant in the community before outbreaks are detected in healthcare settings. Wastewater-based epidemiology (culture, quantitative PCR, and whole-genome sequencing) can potentially gauge pathogen transmission in the general population and lead to early detection of C. auris before it is detected in clinical cases. To learn more about the sensitivity and limitations of wastewater-based surveillance, we used wastewater-based methods to detect C. auris in a southern Utah jurisdiction with no known clinical cases before and after the documented transfer of colonized patients from bordering Nevada. Our study illustrates the potential of wastewater-based surveillance for being sufficiently sensitive to detect C. auris transmission during the early stages of introduction into a community.

Abstract Aims The trials upon which recommendations for the use of cardiac resynchronization therapy (CRT) in heart failure used optimal medical therapy (OMT) before sodium‐glucose co‐transporter 2 inhibitors (SGLT2i). Moreover, the SGLT2i heart failure trials included only a small proportion of participants with CRT, and therefore, it remains uncertain whether SGLT2i should be considered part of OMT prior to CRT. Methods and results We compared electrocardiogram (ECG) and echocardiographic responses to CRT as well as hospitalization and mortality rates in consecutive patients undergoing implantation at a large tertiary centre between January 2019 to June 2022 with and without SGLT2i treatment. Three hundred seventy‐four participants were included aged 74.0 ± 11.5 years (mean ± standard deviation), with a left ventricular ejection fraction (LVEF) of 31.8 ± 9.9% and QRS duration of 161 ± 29 ms. The majority had non‐ischaemic cardiomyopathy (58%) and were in NYHA Class II/III (83.6%). These characteristics were similar between patients with (n = 66) and without (n = 308) prior SGLT2i treatment. Both groups demonstrated similar evidence of response to CRT in terms of QRS duration shortening, and improvements in LVEF, left ventricular end‐diastolic inner‐dimension (LVIDd) and diastolic function (E/A and e/e′). While there was no difference in rates of hospitalization (for heart failure or overall), mortality was significantly lower in patients treated with SGLT2i compared with those who were not (6.5 vs. 16.6%, P = 0.049). Conclusions We observed an improvement in mortality in patients undergoing CRT prescribed SGLT2i compared with those not prescribed SGLT2i, despite similar degrees of reverse remodelling. The authors recommend starting SGLT2i prior to CRT implantation, where it does not delay implantation.

This article describes a collaboration between an urban school board and a faculty of education aimed at supporting Indigenous youth transitions to post-secondary education. Drawing upon strengths-based approaches including wise practices, we offer a model for how postsecondary transition events can illuminate pathways for young people to see that they belong in higher education. We highlight the importance of connecting with Elders, hearing from successful Indigenous speakers, and seeing campus. The theme of our event reiterates to Indigenous youth that they have a story and that they can take the next steps to a new beginning in post-secondary education.

Abstract Background Supervised consumption sites (SCS) and overdose prevention sites (OPS) have been implemented across Canada to mitigate harms associated with illicit substance use. Despite their successes, they still contend with challenges that limit their accessibility and uptake. Overdose response hotlines and apps are novel virtual technologies reminiscent of informal “spotting” methods that may address some of the limitations. Here, we strove to qualitatively examine the factors that may encourage or deter utilization of these virtual services and SCS. Methods A total of 52 participants across Canada were recruited using convenience and snowball sampling methods. These included people with lived and living experience of substance use, family members of people with lived experience, healthcare providers, community harm reduction workers, and virtual harm reduction operators. Semi-structured telephone interviews were conducted and inductive thematic analysis was performed to identify the themes pertaining to SCS and virtual harm reduction. Results Participants viewed overdose response hotline and apps as an opportunity to consume substances without being hindered by logistical barriers (e.g., wait times), fear of law enforcement, invasion of privacy, and more. They also noted that these virtual services provided more flexibility for clients who opt for routes of consumption that are not supported by SCS, such as smoking. Overall, SCS was perceived to be better than virtual services at facilitating social connection, providing additional resources/referrals, as well as prompt response to overdose. Conclusion In sum, participants viewed SCS and virtual services as filling different needs and gaps. This study adds to a growing body of literature which informs how virtual harm reduction services can serve as useful adjunct to more standard harm reduction methods.

Abstract Juvenile dermatomyositis (JDM) is a rare immune-mediated disease of childhood with putative links to microbial exposures. In this multi-center, prospective, observational cohort study, we evaluated whether JDM is associated with discrete oral and gut microbiome signatures. We generated 16S rRNA sequencing data from fecal, saliva, supragingival, and subgingival plaque samples from JDM probands (n = 28). To control for genetic and environmental determinants of microbiome community structure, we also profiled microbiomes of unaffected family members (n = 27 siblings, n = 26 mothers, and n = 17 fathers). Sample type (oral-vs-fecal) and nuclear family unit were the predominant variables explaining variance in microbiome diversity, more so than having a diagnosis of JDM. The oral and gut microbiomes of JDM probands were more similar to their own unaffected siblings than they were to the microbiomes of other JDM probands. In a sibling-paired within-family analysis, several potentially immunomodulatory bacterial taxa were differentially abundant in the microbiomes of JDM probands compared to their unaffected siblings, including Faecalibacterium (gut) and Streptococcus (oral cavity). While microbiome features of JDM are often shared by unaffected family members, the loss or gain of specific fecal and oral bacteria may play a role in disease pathogenesis or be secondary to immune dysfunction in susceptible individuals.

Abstract Humans constantly interact with their environment, with other humans, as well as natural and artificial non-human agents. Nevertheless, our somatosensory system limits the diversity of our ways of communicating. Such organisms as plants thus escape our notice, blending into the landscape. This phenomenon is called Plant blindness. This leads not only to indifference and lack of empathy towards plants among ordinary people but also to a deficit in funding plant conservation. We believe that it is important to develop connections and also rethink the relationship between humans and flora. This paper examines the Plant turn in the context of an art-science project titled Plantoverse. The scientific part of the project is based on a study of plant epidermis cells, which possess optical properties and function as a “lens”. The data acquired via confocal microscopy was used to construct a mathematical model of these lenses which in turn formed the basis of the artistic work. It is a representation of the plant epidermis in a digital environment. The work allows us to look at ourselves through “plant optics'' and find new tools for interacting with the vegetal world. This interdisciplinary approach can help transfer knowledge about flora from the professional environment to lay society and form a new, more empathetic view toward plants.

Introduction: Optimizing the performance of emergency department (ED) teams impacts patient care, but the utility of current, team-based performance assessment tools to comprehensively measure this impact is underexplored. In this study we aimed to 1) evaluate ED team performance using current team-based assessment tools during an interprofessional in situ simulation and 2) identify characteristics of effective ED teams. Methods: This mixed-methods study employed case study methodology based on a constructivist paradigm. Sixty-three eligible nurses, technicians, pharmacists, and postgraduate year 2–4 emergency medicine residents at a tertiary academic ED participated in a 10-minute in situ simulation of a critically ill patient. Participants self-rated performance using the Team Performance Observation Tool (TPOT) 2.0 and completed a brief demographic form. Two raters independently reviewed simulation videos and rated performance using the TPOT 2.0, Team Emergency Assessment Measure (TEAM), and Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS). Following simulations, we conducted semi-structured interviews and focus groups with in situ participants. Transcripts were analyzed using thematic analysis. Results: Eighteen team-based simulations took place between January–April 2021. Raters’ scores were on the upper end of the tools for the TPOT 2.0 (R1 4.90, SD 0.17; R2 4.53, SD 0.27, IRR [inter-rater reliability] 0.47), TEAM (R1 3.89, SD 0.19; R2 3.58, SD 0.39, IRR 0.73), and Ottawa GRS (R1 6.6, SD 0.56; R2 6.2, SD 0.54, IRR 0.68). We identified six themes from our interview data: team member entrustment; interdependent energy; leadership tone; optimal communication; strategic staffing; and simulation empowering team performance. Conclusion: Current team performance assessment tools insufficiently discriminate among high performing teams in the ED. Emergency department-specific assessments that capture features of entrustability, interdependent energy, and leadership tone may offer a more comprehensive way to assess an individual’s contribution to a team’s performance.

We developed a mathematical model to simulate dynamics associated with the proliferation of Geobacter and ultimately optimize cellular operation by analyzing the interaction of its components. The model comprises two segments: an initial part comprising a logistic form and a subsequent segment that incorporates acetate oxidation as a saturation term for the microbial nutrient medium. Given that four parameters can be obtained by minimizing the square root of the mean square error between experimental Geobacter growth and the mathematical model, the model underscores the importance of incorporating nonlinear terms. The determined parameter values closely align with experimental data, providing insights into the mechanisms that govern Geobacter proliferation. Furthermore, the model has been transformed into a scaleless equation with only two parameters to simplify the exploration of qualitative properties. This allowed us to conduct stability analysis of the fixed point and construct a co-dimension two bifurcation diagram.

School systems are often not set up to support transgender and gender diverse (TGD) students, which results in unsafe and unsupportive environments and other institutional barriers to helping TGD students thrive. An important factor to students' feeling safe and supported in schools may be their relationship with school nurses. The purpose of this study was to describe school nurses' experiences working with TGD students and their parents/guardians, their role in working with this community, and the challenges nurses face when trying to serve TGD students. Semistructured interviews were conducted with 23 school nurses across a Midwestern state. Thematic analysis was used to identify themes: gender-affirming education and interpersonal collaboration, bridging the gap between TGD youth and parents/guardians, gender-affirming care and confidentiality, and navigating parental acceptance and gender-affirmation. School nurses expressed a strong desire to support TGD students but lack the structure and training within schools.