Collaboration between Public Health and Schools: An Example of an Integrated Community Social Care Model

Introduction

There is a need to improve public health interventions to promote youth social and emotional development in close collaboration with schools, families and local communities. A close intersectoral collaboration between the regional public health, schools and school boards was established to co-construct and implement "Positive Intervention (PI)" in the Eastern Townships region (Quebec, Canada). This paper describes its implementation according to the "Integrated Community Care (ICC)" framework.

Description

PI is a collaborative and personalized intervention leaning toward an integrated community social care model. In fact, PI relies on the close proximity between Public Health and their educational counterpart as well as their individual temporality. However, PI offered mainly social services and its relationships with Primary Care services was not yet a priority.

Discussion

The results show that it is possible to develop and implement an intervention promoting positive mental health in children, with and for local organisations. The level of integration between schools and Public Health services achieved after only 6 months of implementation is encouraging.

Conclusion

More research is needed to thoroughly document the implementation, social validity, and effects of such an intervention by taking in the point of view of all stakeholders.

[Description of a Pilot Project for Pediatric Occupational Therapy in Daycare and Community Settings]

Background. Occupational therapy interventions that promote and prevent children's health and well-being aim to reduce health inequalities and foster protective factors. The purpose of this study is to describe a pilot community-based occupational therapy project for preschoolers in partnership with community organizations and childcare services. Method. A participatory action research approach was implemented with support from an advisory committee. An occupational therapist provided community-based occupational therapy services in a tiered organization model over one year. Findings. Services were offered in three tiers: 7 awareness workshops for parents and caregivers (Tier 1), 57 visits and 27 consultations in 8 community agencies (Tier 2), and 23 individual follow-ups (Tier 3). Implications. There is an opportunity to implement with community agencies and daycare settings an occupational therapy service based on community-based rehabilitation for children under 5 years of age.

Training Intervention and Program of Support (TIPS) for fostering adoption of family-centred telehealth in pediatric rehabilitation: Protocol for a multi-method, prospective hybrid type 3 implementation-effectiveness study (Preprint)

Background

Children with disability face long wait times for rehabilitation services. Before the COVID-19 pandemic, telehealth adoption was low across pediatric rehabilitation. Owing to the COVID-19 pandemic restrictions, pediatric therapists were asked to rapidly shift to telehealth, often with minimal training. To facilitate the behavior changes necessary for telehealth adoption, provision of appropriate evidence-based training and support is required. However, evidence to support the effective implementation of such training is lacking. The successful real-world implementation of a training intervention and program of support (TIPS) targeting pediatric therapists to enhance the adoption of family-centered telerehabilitation (FCT) requires the evaluation of both implementation and effectiveness.

Objective

This study aimed to evaluate TIPS implementation in different pediatric rehabilitation settings and assess TIPS effectiveness, as it relates to therapists’ adoption, service wait times, families’ perception of service quality, and costs.

Methods

This 4-year, pan-Canadian study involves managers, pediatric occupational therapists, physiotherapists, speech-language pathologists, and families from 20 sites in 8 provincial jurisdictions. It will use a multimethod, prospective, hybrid type 3 implementation-effectiveness design. An interrupted time series will assess TIPS implementation. TIPS will comprise a 1-month training intervention with self-paced learning modules and a webinar, followed by an 11-month support program, including monthly site meetings and access to a virtual community of practice. Longitudinal mixed modeling will be used to analyze indicators of therapists’ adoption of and fidelity to FCT collected at 10 time points. To identify barriers and facilitators to adoption and fidelity, qualitative data will be collected during implementation and analyzed using a deductive-inductive thematic approach. To evaluate effectiveness, a quasi-experimental pretest-posttest design will use questionnaires to evaluate TIPS effectiveness at service, therapist, and family levels. Generalized linear mixed effects models will be used in data analysis. Manager, therapist, and family interviews will be conducted after implementation and analyzed using reflective thematic analysis. Finally, cost data will be gathered to calculate public system and societal costs.

Results

Ethics approval has been obtained from 2 jurisdictions (February 2022 and July 2022); approval is pending in the others. In total, 20 sites have been recruited, and data collection is anticipated to start in September 2022 and is projected to be completed by September 2024. Data analysis will occur concurrently with data collection, with results disseminated throughout the study period.

Conclusions

This study will generate knowledge about the effectiveness of TIPS targeting pediatric therapists to enhance FCT adoption in pediatric rehabilitation settings, identify facilitators for and barriers to adoption, and document the impact of telehealth adoption on therapists, services, and families. The study knowledge gained will refine the training intervention, enhance intervention uptake, and support the integration of telehealth as a consistent pediatric rehabilitation service option for families of children with disabilities.

Trial Registration

ClinicalTrials.gov NCT05312827; https://clinicaltrials.gov/ct2/show/NCT05312827

International Registered Report Identifier (IRRID)

PRR1-10.2196/40218

Case study assessing the feasibility of using a wearable haptic device or humanoid robot to facilitate transitions in occupational therapy sessions for children with autism spectrum disorder

Introduction

Some children with autism spectrum disorder (ASD) have difficulties with transitions that may lead to problem behaviours. Although the use of technologies with children with ASD is receiving increasing attention, no study has looked at their effect on transitions in activities of daily living. This study aimed to document the feasibility of (1) using two intervention technologies (NAO humanoid robot or wearable haptic device) separately to facilitate transitions in occupational therapy sessions for children with ASD and (2) the method used to document changes.

Methods

Using a single case reversal (ABA) design, two children with ASD were randomly assigned to one of the intervention technologies (humanoid robot or haptic bracelet). Each technology was used as an antecedent to stimulate the start of transitions in eight intervention sessions at a private occupational therapy clinic. Data concerning the time required for transitions, child's behaviours during transitions at the clinic and mother's perception of the child's performance in transitions at home were analysed graphically.

Results

When using technology, both children's behaviours were appropriate, quick and relatively stable. Also, both mothers reported improved perceptions of their child's performance in transitions.

Conclusions

This exploratory study suggests no detrimental effect of using these technologies.

Intermittent plasticity in individual grains: A study using high energy x-ray diffraction

Long-standing evidence suggests that plasticity in metals may proceed in an intermittent fashion. While the documentation of intermittency in plastically deforming materials has been achieved in several experimental settings, efforts to draw connections from dislocation motion and structure development to stress relaxation have been limited, especially in the bulk of deforming polycrystals. This work uses high energy x-ray diffraction measurements to build these links by characterizing plastic deformation events inside individual deforming grains in both the titanium alloy, Ti-7Al, and the magnesium alloy, AZ31. This analysis is performed by combining macroscopic stress relaxation data, complete grain stress states found using far-field high energy diffraction microscopy, and rapid x-ray diffraction spot measurements made using a Mixed-Mode Pixel Array Detector. Changes in the dislocation content within the deforming grains are monitored using the evolution of the full 3-D shapes of the diffraction spot intensity distributions in reciprocal space. The results for the Ti-7Al alloy show the presence of large stress fluctuations in contrast to AZ31, which shows a lesser degree of intermittent plastic flow.

Effects of size on the dynamics of dislocations in ice single crystals

Single crystals of ice subjected to primary creep in torsion exhibit a softening behavior: the plastic strain rate increases with time. In a cylindrical sample, the size of the radius affects this response. The smaller the radius of the sample becomes while keeping constant the average shear stress across a section, the softer the response. The size-dependent behavior is interpreted by using a field dislocation theory, in terms of the coupled dynamics of excess screw dislocations gliding in basal planes and statistical dislocations developed through cross slip occurring in prismatic planes. The differences in the results caused by sample height effects and variations in the initial dislocation microstructure are discussed.

Quantification of the passive mechanical properties of the resting platelet

Sudden coronary artery occlusion is one of the leading causes of death. Several in vitro models have been used to study the relationship between hemodynamic forces and platelet function. However, very few in vivo studies exist that fully explore this relationship due to the lack of rheologic data for the platelet. For this purpose, micropipette aspiration techniques were used in the present study to determine the mechanical properties of platelets. The data were analyzed by two mathematical models: (1) an erythrocyte-type membrane model which yielded a platelet shear modulus of 0.03+/-0.01 dyn cm[-1] (mean+/-SD) and a viscous modulus of 0.12+/-0.04 dyn s cm[-1]. (2) An endothelial-type cell model which approximated the platelet Young's modulus to be 1.7+/-0.6 x 10(3) dyn cm(-2) with a viscous modulus of 1.0+/-0.5 x 10(4) dyn s cm(-2). The endothelial-type cell model more accurately describes the mechanics occurring at the micropipette tip and permits more appropriate assumptions to be made in quantifying the rheologic properties of a platelet. Results from this study can be integrated into numerical models of blood flow in stenosed coronary arteries to elucidate the impact of local hemodynamics on platelets and thrombus formation in coronary artery disease.

A comparison of femoral neck fixation with the reconstruction nail versus cancellous screws in anatomic specimens

Femoral neck fixation techniques were applied to five matched pairs of autopsy specimens to evaluate the fixation of the Russell-Taylor femoral nail in ipsilateral neck and shaft fractures of the femur. Reconstruction nail fixation of the femoral neck was compared with that of three parallel screws. The intact and postfixation femora were subjected to an applied bending moment in 0 degrees, 30 degrees, and 90 degrees of simulated hip flexion. The bending stiffness was determined from the load deformation data for each intact femur and then after the appropriate fixation. The fatigue response of the fixation, presence of osteopenia, degree of fracture reduction, and device alignment showed that the stiffness ratio (fixed to normal) of the nail was greater in most specimens. There was no statistical difference in retained stiffness after cyclic loading between the nail and cancellous screw fixations. The ultimate strength of the nail was 2.5 times the strength of the screw fixation of the femoral neck. Thus, the nail provided biomechanically sound fixation of the femoral neck.

Finite-element modelling of femoral shaft fracture fixation techniques post total hip arthroplasty

The presence of a femoral prosthesis superior to a shaft fracture severely complicates fixation and treatment. This study uses two-dimensional, multithickness, plane stress finite-element models of a femur with prosthesis to investigate the stresses developed with the application of three popular fixation techniques: revision to a long stem prosthesis, lateral plating with a cortical bone allograft strut and cerclage wires, and custom plate application with proximal Parham band fixation with distal cortical screws (Ogden plate). The plate and bone contact as well as the fracture site contact were modelled by using orthotropic elements with custom-fit moduli so that only the normal stress to the interface was significant. A thermal analogy was used to model the cerclage and Parham band preloads so that representative preloads in the proximal fixation of the two types of plate treatments could be modelled. A parametric study was performed with the long-prosthesis model to show variations in stem lengths of one, two and three femoral diameters distal to the fracture site. The Ogden plate model showed a transfer of tensile stress near the proximal-most band, with the highest tensile stress being at the fracture site with evidence of stress shielding of the proximal lateral cortex. The cortical bone strut model showed a transfer of tensile stress to the bone strut but showed less shielding of the proximal cortex. The cerclage wires at the base of the bone strut showed the highest changes in load with the distalmost wire increasing to almost four times its original preload.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of isolated talocalcaneal fusion on contact in the ankle and talonavicular joints

A cadaveric model was developed to establish the articular contact area and load distribution in the ankle joint, posterior facet of the talocalcaneal joint, and talonavicular joint using pressure sensitive film. Positions of dorsiflexion, neutral, and plantarflexion were evaluated. This model was further used to determine the effect of talocalcaneal fusion on the articular contact area in the talonavicular and ankle joints. Alteration of articular contact was most pronounced in the talonavicular joint. There, a statistically significant reduction in contact area postfusion was noted when the foot was in the plantarflexed position. Reductions in ankle joint articular contact area were observed in the dorsiflexed and plantarflexed positions in the majority of specimens. Lateral displacement of the region of articular contact was noted in some specimens. A pressure-weighted centroid calculation was performed to provide a quantitative measure of the shift of the contact region.

Finite element modelling of polymethylmethacrylate flow through cancellous bone

A mathematical model based on the Finite Element Method is developed to simulate the non-linear flow of acrylic bone cement through cancellous bone. The cancellous bone bed is modelled as a bed of parallel capillaries filled with equal spaced toroidal trabeculae. By manipulating the relative size of the torus and the capillary, the flow within bone of varying porosity is simulated. An apparent permeability based on the volume weighted average viscosity and Darcy's law is developed to describe the flow of the acrylic through the cancellous bone bed. The model predicts a cancellous bone permeability of 5.6 x 10(-9)-8.3 x 10(-9) m2 for linear flow. The non-linear behavior of the acrylic cement results in an increase of apparent permeability when compared to the permeability computed for linear flow. Estimates of penetration are achieved by running the model in a quasi-steady state fashion with pressure applied over a fixed time increment. Close agreement is shown between model predictions of penetration depth and experimental results available in the literature.

Use of high-energy shock waves for bone cement removal

The revision rate of total hip arthroplasty has increased dramatically over recent years, leading to different methods of extraction of the femoral cement mantle to reduce operative time and surgical risks. The use of high-energy shock waves produced by the Dornier HM.3 Lithotripter to interrupt the cement-bone interface and to reduce the material properties of the cement is investigated. Tests were conducted to measure the pull-out strength of cemented treated rods versus untreated rods, from the medullary canal of canine femurs. The treated femurs showed an average reduction in pull-out strength of 43%. An investigation involving the material properties of acrylic bone cement was also conducted. The properties tested were the compressive modulus of elasticity, the ultimate compressive strength, the ultimate tensile strength, and fracture toughness. The scanning electron microscope aided in determining whether microfractures in the cement resulted from the shock wave treatment. A theoretical study utilizing the finite element method was used to investigate areas of select shock wave treatment about the femoral prosthesis. Analysis of the results showed that the lithotripter treatment had no significant effect on the compressive properties but reduced the tensile properties and fracture toughness significantly. Scanning electron microscopy uncovered definite areas of induced microfractures not present in the control specimens. This study supports the concept of clinically noninvasive, preoperative shock wave treatment prior to total hip revision.

Mechanical properties and material characteristics of orthopaedic casting material

In this study, two types of orthopaedic casting materials were evaluated: the Johnson & Johnson Specialist plaster bandage and the 3M Scotch-cast Plus fiber glass bandage. The materials were evaluated using tensile tests to determine the elastic modulus, yield strength, and ultimate tensile strength. To determine the structural characteristics and stiffness of a cylindrical cast, each material was formed around a foam cylinder core and tested in a four-point bend jig. A computer-based model using the finite element method (FEM) was developed for a cylindrical cast of both types and compared with the experimental findings. A second FEM model with loads applied at the periphery was performed to simulate the clinical observations of plaster bandage breakdown at the ends of a cast. It is with these tests that the two bandage materials were compared and evaluated. It was concluded that the plaster bandage, while initially stiffer than the fiber glass bandage, had much lower yield stress. This implies that the plaster cast may break down under loads that would leave the fiber glass cast intact. It was also determined that the plaster bandage load displacement curve is bilinear. The bilinear characteristic of the plaster bandage explains its breakdown at the ends of a cast.