Exploring Hospital Transfers for Long-Stay Nursing Home Residents With End-Stage Renal Disease.

Background: Nursing home residents with end-stage renal disease (ESRD) are an understudied, yet growing population within nursing homes.

Purpose: To describe hospital transfers for nursing home residents diagnosed with ESRD and receiving hemodialysis.

Methods: Data were analyzed for residents with ESRD transferred to the hospital between October 2016 and September 2020 (n = 219).

Repeat hospital transfers among long stay nursing home residents: a mixed methods analysis of age, race, code status and clinical complexity.

Background: Nursing home residents are at increased risk for hospital transfers resulting in emergency department visits, observation stays, and hospital admissions; transfers that can also result in adverse resident outcomes. Many nursing home to hospital transfers are potentially avoidable. Residents who experience repeat transfers are particularly vulnerable to adverse outcomes, yet characteristics of nursing home residents who experience repeat transfers are poorly understood.

A Comparison of Models Predicting One-Year Mortality at Time of Admission.

Context: Hospitalization provides an opportunity to address end-of-life care (EoLC) preferences if patients at risk of death can be accurately identified while in the hospital. The modified Hospital One-Year Mortality Risk (mHOMR) uses demographic and admission data in a logistic regression algorithm to identify patients at risk of death one year from admission.

Objectives: This project sought to validate mHOMR and identify superior models.

Global Rehabilitation Health Worker Certification: Global Agenda, Local Imperative.

Rehabilitation, seen as a disability-specific service needed only by few of the world's population, has not been prioritized in countries and is under-resourced. A rehabilitation-ready health workforce is potentially the most important resource for improving functioning and the quality of life for the 2.41 billion people worldwide needing this care.

Integrating the Lived Experience Conditions and Care in the ECHO Model.

Show Me ECHO has introduced a 'lived experience' role by including patients and caregivers into some of its ECHO Hub Teams. Grounded in the patient-centered care model, this role provides insights into the lived experience of patients and caregivers experiencing chronic conditions. The goals are to improve patient outcomes, strengthen authentic communication and partnership between providers, patients, and patients' support systems, and to enhance local communities' ability to support its members dealing with chronic conditions.

Building Regional Expertise: Perspectives from Show-Me ECHO Participants.

This article highlights four primary care providers that practice in underserved areas in Missouri. Show-Me ECHO (Extension for Community Healthcare Outcomes) provides colleagues opportunities for consultation and Continuing Medical Education (CME) around particular conditions. Through their participation, these providers have 1) enhanced their comfort and skill in diagnosis and treatment, 2) become important regional resources for patients and other providers, and 3) improved access to specialty services in their community.

Embracing the Power of Show-Me ECHO Learning Communities to Transform Clinical Practice in Missouri.

Show-Me ECHO, a state-funded project, provides access to education within a community of learners in order to optimize healthcare for the citizens of Missouri. Through videoconferencing and case-based review, ECHO shifts professional development from learning about medical problems in isolation to experiential learning as part of a multidisciplinary team. The establishment of a statewide COVID-19 ECHO is allowing a rapid response to this novel, unprecedented, and unanticipated health care crisis.

Ethical considerations for allocation of scarce resources and alterations in surgical care during a pandemic.

The COVID-19 pandemic caused by SARS-CoV-2 is unprecedented in modern history. Its effects on social behavior and health care delivery have been dramatic. The resultant burden of disease and critical illness has outpaced the diagnostic, therapeutic, and health care professional resources of many clinics and hospitals.

Occupational therapy students' perspectives of ethics in two countries: South Africa and the United States of America.

Objectives: Worldwide, health-care students, including occupational therapy students undergo ethics training. Ethics training facilitates students' critical thinking, objective analysis and clinical reasoning skills to promote impartiality and minimize bias in decision-making. The aim of the study was to explore and describe similarities and differences in occupational therapy students' perceptions and experiences of an ethical dilemma.

HIV-Specific CD8+ T Cell-Mediated Viral Suppression Correlates With the Expression of CD57.

Background: Virus-specific CD8(+) T-cell responses are believed to play an important role in the control of HIV-1 infection; however, what constitutes an effective HIV-1 CD8(+) T-cell response remains a topic of debate. The ex vivo viral suppressive capacity was measured of CD8(+) T cells from 44 HIV-1-positive individuals. The phenotypic and cytokine profiles, and also the specificity of the CD8(+) T cells, were correlated with the suppression of HIV-1 replication.

From collaboration to cause: breaking rural poverty cycles through educational partnerships.

The Missouri Health Professions Consortium (MHPC) Occupational Therapy Assistant Program is an innovative educational model that was specifically designed to address needs unique to rural communities. The model takes into account not only the distinctiveness of rural practice environments but also the educational barriers unique to rural student populations. The MHPC Occupational Therapy Assistant Program addresses the needs of these communities by providing educational opportunities to rural, place-bound students.

Fidelity to the healing relationship: a medical student's challenge to contemporary bioethics and prescription for medical practice.

As a medical  student, I observed that different physicians had strikingly different attitudes and approaches when caring for patients. The care of one patient in particular continues to challenge my understanding of illness and moral responsibility in the practice of medicine. In this paper, I illustrate the care of this patient in order to evaluate the dominant ethics I was taught in medical school, in theory and in practice, and argue neither principlism nor the ethics of care fully captures the moral responsibility of physicians.

Broadening of the T-cell repertoire to HIV-1 Gag p24 by vaccination of HLA-A2/DR transgenic mice with overlapping peptides in the CAF05 adjuvant.

Induction of broad T-cell immune responses is regarded as critical for vaccines against the human immunodeficiency virus type 1 (HIV-1) which exhibit high diversity and, therefore, focus has been on inducing cytotoxic CD8 T-cell responses against the more conserved parts of the virus, such as the Gag protein. Herein, we have used the p24 protein which contains a range of conserved T-cell epitopes. We demonstrate that a vaccine of HIV-1 subtype B consensus group-specific antigen (Gag) p24 protein with the CD8-inducing liposomal cationic adjuvant formulation (CAF) 05, induces both CD4 and CD8 T-cell responses in CB6F1 mice.

HIV-1-infected individuals in antiretroviral therapy react specifically with polyfunctional T-cell responses to Gag p24.

Background: Still no effective HIV-1 prophylactic or therapeutic vaccines are available. However, as the proportion of HIV-1-infected individuals on antiretroviral treatment is increasing, knowledge about the residual immune response is important for the possible development of an HIV-1 vaccine.

Methods: In this study, the magnitude, breadth, and quality of the HIV-1-specific T-cell response in HIV-1-infected viremic individuals (n = 19) and individuals on highly active antiretroviral treatment (HAART) (n = 14) using multicolor flow cytometry were determined.

Adjuvanted HLA-supertype restricted subdominant peptides induce new T-cell immunity during untreated HIV-1-infection.

We investigated the potential of inducing additional T-cell immunity during chronic HIV-1 infection directed to subdominant HIV-1 epitopes from common HLA-supertypes. Ten treatment-naïve HIV-1-infected individuals were immunized with peptides in the adjuvant CAF01. One individual received placebo.

Changes in 1,25-dihydroxyvitamin D and 25-hydroxyvitamin D are associated with maturation of regulatory T lymphocytes in patients with chronic pancreatitis: a randomized controlled trial.

Objectives: We studied the impact of changes in 25-hydroxyvitamin D (25OHD) and 1,25-dihydroxyvitamin D (1,25(OH)(2)D) on regulatory T lymphocytes (Tregs) in patients with chronic pancreatitis (CP) and fat malabsorption in a prospective clinical trial.

Methods: The patients were randomized to 1 of 3 treatments during 10 weeks: weekly UV-B in a tanning bed (group A), 1520-IU/d vitamin D supplement (group B), or placebo (group C). A placebo tanning bed was used in groups B and C.

Low level of regulatory T cells and maintenance of balance between regulatory T cells and TH17 cells in HIV-1-infected elite controllers.

Background: A subgroup of HIV-1-infected individuals, elite controllers, have spontaneous viral control and offer an exceptional opportunity to study virological and immunolocigal factors of possible involvement in control of HIV-1 infection.

Methods: The frequencies of Tregs and TH17 cells was evaluated and correlated to markers of disease progression in peripheral blood mononuclear cells from 3 different groups of individuals infected with HIV-1: treatment-naive viremic individuals, individuals on successful highly active antiretroviral therapy, and elite controllers. In addition, a group of HIV-1-negative individuals were included.