Rehabilitation practices during hematopoietic stem cell transplantation: An international survey.

BACKGROUND AND OBJECTIVE: Rehabilitation therapy plays an important role in treating physical and functional impairments observed in individuals undergoing hematopoietic stem cell transplants (HSCT). This study assessed the rehabilitation practices implemented in the HSCT population internationally. MATERIALS AND METHODS: A 48-question online survey comprising questions soliciting information regarding patient characteristics, therapy details (timing, indication, and administering providers), outcome measures, and precautions were developed by an international group of cancer rehabilitation physicians. As reported by European registries, surveys were administered to personnel providing care to patients receiving HSCT at cancer centers, which comprised the top 10% of HSCT volume. In addition, emails were sent to National Medical Societies and registries in the Latin America, Asia, and Pacific regions. RESULTS: Forty-three institutions from 18 countries responded to the survey. Half of the centers provided referrals for rehabilitation therapy at the time of admission. Referrals were provided for functional decline (84.5%), risk of falls (53.3%), and discharge planning (42.2%). Rehabilitation therapies were administered by physical therapists (93.0%), occupational therapists (34.9%), therapy aides (14.0%), and speech-language pathologists (11.6%). Approximately 95% of the surveyed centers used objective functional measures such as sit-to-stand (46.5%), grip strength (46.5%), and 6-min walk/gait speed (both 34.9%). The blood counts were monitored to determine the appropriateness of the therapy modalities. CONCLUSION: Rehabilitation practices varied internationally; however, most centers provided skilled therapy during hospitalization for HSCT, utilized objective and patient-reported outcomes, and monitored blood counts to determine the safety of administering therapy.

Assessment of rehabilitation practices during hematopoietic stem cell transplantation in the United States: a survey.

Background: Rehabilitation therapy is important to treat physical and functional impairments that may occur in individuals receiving physically taxing, yet potentially curative hematopoietic stem cell transplants (HSCT). However, there is scarce data on how rehabilitation is delivered during HSCT in real-life setting. Our objective is to assess the rehabilitation practices for adult patients hospitalized for HSCT in the United States. Methods: A 48-question online survey with cancer centers with the top 10% HSCT volumes (per American registries). We obtained data on patient characteristics, rehabilitation therapy details (timing, indication, administering providers), physical function objective and subjective outcome measures, and therapy activity precautions. Results: Fourteen (out of 21) institutions were included. Rehabilitation therapy referrals occurred at admission for all patients at 35.7% of the centers for: functional decline (92.9%), fall risk (71.4%), and discharge planning (71.4%). Participating institutions had physical therapists (92.9%), occupational therapists (85.7%), speech language pathologists (64.3%) and therapy aides (35.7%) in their rehabilitation team. Approximately 71% of centers used objective functional measures including sit-to-stand tests (50.0%), balance measures (42.9%), and six-minute walk/gait speed (both 35.7%). Monitoring of blood counts to determine therapy modalities frequently occurred and therapies held for low platelet or hemoglobin values; but absolute neutrophil values were not a barrier to participate in resistance or aerobic therapies (42.9%). Discussion: Rehabilitation practices during HSCT varied among the largest volume cancer centers in the United States, but most centers provided skilled therapy, utilized objective, clinician and patient reported outcomes, and monitored blood counts for safety of therapy administration.

A Comparison of Haitian and American Bachelor of Science in Nursing Students' Perceptions of Cigarette Smoking and E-Cigarette Use.

ABSTRACT: Cigarette smoking is a global health epidemic, and smoking along with electronic nicotine delivery systems use or vaping are on the rise. Despite the effectiveness of smoking cessation strategies, healthcare providers and nursing students do not routinely recommend these strategies for patients who are smokers. This study compares the perceptions of smoking and vaping between two groups of baccalaureate degree nursing students from Haiti and the United States. The study was influenced by contemporary and past studies showing that more young people are drawn into smoking and vaping despite the prevalence of antismoking policies and awareness campaigns. In this descriptive study, surveys were used to collect data to determine the differences between the two country's nursing students on their perception of smoking and vaping. The findings indicated that, despite greater usage, the students from the United States had a higher perception of the health implications of cigarette smoking and vaping compared with those from Haiti. On the basis of the findings of this study, collaborative pedagogical research opportunities among international nursing education programs can further curriculum development to foster growth and development of future global health practitioners.

A comparative study of AumRhn (4 ≤ m + n ≤ 6) clusters in the gas phase versus those deposited on (100) MgO.

A comparative theoretical study has been performed of the gas phase and deposited AumRhn (4 ≤ m + n ≤ 6) clusters. The combined use of a genetic algorithm and Density Functional Theory (DFT) calculations allows us to explore the potential energy surface and, therefore, find efficiently and automatically the global minimum configuration for each composition. Our results show interesting effects on the geometries of the clusters on deposition. This occurs because the rhodium atoms (electronically) prefer to be in contact with the MgO surface, sometimes promoting planar clusters to become three-dimensional when deposited, and three-dimensional clusters in the gas phase to become two-dimensional. Together with the change in geometries, the magnetic moment is reduced from the gas phase, as the electrons rearrange themselves when the cluster interacts with the substrate.

Gelatinous fibers and variant secondary growth related to stem undulation and contraction in a monkey ladder vine, Bauhinia glabra (Fabaceae).

PREMISE OF THE STUDY: Some of the most striking stem shapes occur in species of Bauhinia (Fabaceae) known as monkey ladder vines. Their mature stems are flattened and develop regular undulations. Although stems have variant (anomalous) secondary growth, the mechanism causing the undulations is unknown. METHODS: We measured stem segments over time (20 mo), described stem development using light microscopy, and correlated the changes in stem shape with anatomy. KEY RESULTS: Growing stems are initially straight and bear tendrils on short axillary branches. The inner secondary xylem has narrow vessels and lignified fibers. As stems age, they become flattened and increasingly undulated with the production of two lobes of outer secondary xylem (OX) with wide vessels and only gelatinous fibers (G-fibers). Similar G-fibers are present in the secondary phloem and the cortical sclerified layer. In transverse sections, the concave side of each undulation has a greater area and quantity of G-fibers than the opposite convex side. Some older stems are not undulated and have less lobing of OX. Undulation causes a shortening of the stem segments: up to 28% of the original length. CONCLUSIONS: Uneven distribution of G-fibers produces tensions that are involved in the protracted development of undulations. While young extending shoots attach by lateral branch tendrils, older stems may maintain their position in the canopy using undulations and persistent branch bases as gripping devices. Flattened and undulated stems with G-fibers produce flexible woody stems.

Paracoccidioides brasiliensis in a liquid-based Papanicolaou test from a pregnant woman: report of a case.

With the exception of Candida species, fungal organisms are rarely encountered in the Papanicolaou test and, when encountered, usually represent contaminants rather then infections. We present the case of a healthy 29-year-old pregnant female, gravida 1, para 0, who presented for her first prenatal visit at 12-week gestation and had many large fungal-like elements with a distinct budding pattern of multiple narrow-based buds resembling a "ship's-wheel" identified in her routine liquid-based Papanicolaou test. Based on its characteristic appearance in the Papanicolaou test and the hematoxylin and eosin, periodic acid Schiff and Gomori's methenamine silver stains performed on the cell block made from the residual sample, the fungus was diagnosed as "consistent with Paracoccidioides." This is the second reported case of Paracoccidioides presenting in a Papanicolaou test and shows that this organism may rarely involve the uterine cervix in the absence of clinical systemic disease.

Venezuelan kindreds reveal that genetic and environmental factors modulate Huntington's disease age of onset.

Huntington's disease (HD) is an autosomal dominant neurodegenerative disease caused by a triplet (CAG) expansion mutation. The length of the triplet repeat is the most important factor in determining age of onset of HD, although substantial variability remains after controlling for repeat length. The Venezuelan HD kindreds encompass 18,149 individuals spanning 10 generations, 15,409 of whom are living. Of the 4,384 immortalized lymphocyte lines collected, 3,989 DNAs were genotyped for their HD alleles, representing a subset of the population at greatest genetic risk. There are 938 heterozygotes, 80 people with variably penetrant alleles, and 18 homozygotes. Analysis of the 83 kindreds that comprise the Venezuelan HD kindreds demonstrates that residual variability in age of onset has both genetic and environmental components. We created a residual age of onset phenotype from a regression analysis of the log of age of onset on repeat length. Familial correlations (correlation +/- SE) were estimated for sibling (0.40 +/- 0.09), parent-offspring (0.10 +/- 0.11), avuncular (0.07 +/- 0.11), and cousin (0.15 +/- 0.10) pairs, suggesting a familial origin for the residual variance in onset. By using a variance-components approach with all available familial relationships, the additive genetic heritability of this residual age of onset trait is 38%. A model, including shared sibling environmental effects, estimated the components of additive genetic (0.37), shared environment (0.22), and nonshared environment (0.41) variances, confirming that approximately 40% of the variance remaining in onset age is attributable to genes other than the HD gene and 60% is environmental.

An island-wide epidemic of salmonellosis in Trinidad traced to contaminated powdered milk

Between March 1 and November 30, 1973, an epidemic of salmonella derby gastroenteritis occurred in Trinidad. Approximately 3,000 people were affected. Cases occurred throughout the island roughly in proportion to the population, but most were in infants and small children. Household surveys of cases and a sample survey of controls indicated that the consumption of powdered milk was significantly associated with illness. Further studies showed that 7 different brands of imported powdered milk packaged at a single processing plant near Port-of-Spain were, as a group, significantly associated with salmonellosis. Investigations at the implicated processing plant disclosed several packaging procedures that could have permitted contamination during canning, but the specific mode of contamination could be demonstrated (AU)