Analysis of a model for pediatric physical therapy and clinical education via telehealth.

A novel entry-level collaborative clinical learning experience (CLE) in pediatric physical therapy (PT) delivered via telehealth was implemented involving 12 families, 54 DPT students, and 12 clinical instructors (CIs). Children of various ages, a wide range of home environments, and diagnoses received individualized PT via telehealth during a four-week CLE. Retrospective quantitative and qualitative analyses of student documentation, video recordings of sessions, and CI, student, and caregiver survey responses were performed. All children demonstrated qualitative improvements and 73% demonstrated quantitative improvements. CIs, students, and caregivers believed the children benefited from the experience and 98% believed the children were able to work toward their goals. Most students (95%) and CIs (100%) felt that it was a valuable and effective learning experience. Most (>71%) CIs and students believed students were able to learn in all relevant domains of the clinical performance instrument. This model provides a unique CLE for students in both pediatric PT and telehealth.

Amyloid-ß alters the DNA methylation status of cell-fate genes in an Alzheimer's disease model.

Alzheimer's disease (AD) is characterized by neurofibrillary tangles and extracellular amyloid-ß plaques (Aß). Despite ongoing research, some ambiguity remains surrounding the role of Aß in the pathogenesis of this neurodegenerative disease. While several studies have focused on the mutations associated with AD, our understanding of the epigenetic contributions to the disease remains less clear. To that end, we determined the changes in DNA methylation in differentiated human neurons with and without Aß treatment. DNA was isolated from neurons treated with Aß or vehicle, and the two samples were digested with either a methylation-sensitive (HpaII) or a methylation-insensitive (MspI) restriction endonuclease. The fragments were amplified and co-hybridized to a commercial promoter microarray. Data analysis revealed a subset of genomic loci that shows a significant change in DNA methylation following Aß treatment in comparison to the control group. After mapping these loci to nearby genes, we discovered high enrichment for cell-fate genes that control apoptosis and neuronal differentiation. Finally, we incorporated three of those genes in a possible model suggesting the means by which Aß contributes to the brain shrinkage and memory loss seen in AD.

The dopamine D4/D2 receptor antagonist affinity ratio as a predictor of anti-aggression medication efficacy.

Aggression is a major clinical problem that spans multiple medical and psychiatric diagnoses. The etiology of aggression is complex, comprising social, psychological, and biological factors. Treatment of aggression is equally heterogeneous with structural (environmental), behavioral, and pharmacologic approaches. Among medications, mood stabilizers and antipsychotics are usually considered first line. Antidepressants are frequently recommended but their anti-aggression effect is limited. Within the available limited data, clozapine stands out as more effective than other antipsychotic medications. One of the prominent differences between clozapine and less effective medications is that the affinity of the compound to the dopamine D4 receptor is quite high and significantly greater than to the D2 receptor (defined as a ratio that is >1). Medications that inhibit both receptors equally, e.g., haloperidol, have anti-aggression properties that are less than seen with clozapine. A specific variant of the D4 receptor with an expansion of the third cytoplasmic loop, which interacts with the G protein second messenger system, has been implicated in the etiology of aggression. The proposal is put forward that blockade of the D4 receptor, without concomitant significant blockade of D2, increases the anti-aggression effect of the medication. This hypothesis can be tested using a new antipsychotic, asenapine, which is the only other antipsychotic with antagonistic affinity ratio of D4/D2>1.

Recurrent subcutaneous emphysema as a consequence of bulimia nervosa.

OBJECTIVE: Pneumomediastinum is a rare complication of increased intrathoracic pressure. It is more likely to occur in individuals with nutritional deficiencies. Pneumomediastinum has been reported in some individuals with anorexia nervosa. METHOD: Case report. RESULTS: Recurrent subcutaneous emphysema is probably secondary to recurrent pneumomediastinum in a woman with bulimia nervosa. DISCUSSION: It is believed that increased intrathoracic pressure and nutritional deficiency associated with repeated induced vomiting contributed to this complication. This is the only case of recurrent subcutaneous emphysema. While in this case, and in most cases, the course was benign with eventual reabsorption of the subcutaneous air, pneumomediastinum can be a life-threatening complication of bulimia nervosa.

Protection of Salmonella by ampicillin-resistant Escherichia coli in the presence of otherwise lethal drug concentrations.

Microbial systems have become the preferred testing grounds for experimental work on the evolution of traits that benefit other group members. This work, based on conceptual and theoretical models of frequency-dependent selection within populations, has proven fruitful in terms of understanding the dynamics of group beneficial or 'public goods' traits within species. Here, we expand the scope of microbial work on the evolution of group-beneficial traits to the case of multi-species communities, particularly those that affect human health. We examined whether beta-lactamase-producing Escherichia coli could protect ampicillin-sensitive cohorts of other species, particularly species that could cause human disease. Both beta-lactamase-secreting E. coli and, surprisingly, those engineered to retain it, allowed for survival of a large number of ampicillin-sensitive cohorts of Salmonella enterica serovar Typhimurium, including both laboratory and clinical isolates. The Salmonella survivors, however, remained sensitive to ampicillin when re-plated onto solid medium and there was no evidence of gene transfer. Salmonella survival did not even require direct physical contact with the resistant E. coli. The observed phenomenon appears to involve increased release of beta-lactamase from the E. coli when present with S. enterica. Significantly, these findings imply that resistant E. coli, that are not themselves pathogenic, may be exploited, even when they are normally selfish with respect to other E. coli. Thus, Salmonella can gain protection against antibiotics from E. coli without gene transfer, a phenomenon not previously known. As a consequence, antibiotic-resistant E. coli can play a decisive role in the survival of a species that causes disease and may thereby interfere with successful treatment.

Bimodal association of a bis-1,2,3-dithiazolyl radical.

The N-ethyl pyrazine-bridged bis-1,2,3-dithiazolyl radical (R(1) = Et) associates at room temperature as a C-C bonded sigma-dimer which, on heating, converts to a laterally S-S sigma-bonded structure.