Drake University

IntroductionCardiac implantable electronic devices (CIEDs), including permanent pacemakers and implantable cardioverter-defibrillators (ICDs), are widely used in the management of bradyarrhythmias, tachyarrhythmias, and conduction disorders. Although implantation techniques and device technology have advanced substantially, mechanical complications remain clinically relevant. Lead displacement continues to represent an important cause of device malfunction and may present with a broad spectrum of clinical manifestations.¹Twiddler syndrome is a well-recognized but uncommon mechanical complication first described by Bayliss and colleagues in 1968, in which rotation of the pulse generator within its subcutaneous pocket results in lead coiling, retraction, and eventual loss of effective myocardial contact.² Variants such as Reel and Ratchet syndromes have since been described, differing primarily in the direction and mechanism of generator manipulation.³⁻⁴ Although the overall incidence is low, reported between 0.07% and 7%,⁵ presentations range from asymptomatic loss of capture to inappropriate ICD shocks and rare cases of sudden cardiac death.⁶⁻⁷When lead migration occurs proximally into the superior vena cava (SVC) or right atrium, pacing impulses may stimulate adjacent extracardiac structures, most notably the phrenic nerve, resulting in rhythmic diaphragmatic or abdominal wall contractions. These symptoms may be misinterpreted as arrhythmia, neuromuscular disease, or anxiety, leading to diagnostic delay.⁸ We report an early post-implantation presentation of right hemidiaphragmatic twitching due to ventricular lead migration into the SVC and highlight diagnostic and management considerations.

Understanding that excess body weight can increase disability and limit daily occupations, occupational therapists must consider how to support patients with weight management within a larger health care system. To develop a clinical tool for health care professionals to (a) support referrals to occupational therapists to address weight management and (b) assess priorities for weight management interventions. This research utilized a co-design process with six occupational therapists from primary care to design a screening tool prototype. The design process revealed three challenges to supporting patients with excess body weight that were addressed through the design elements of the screening tool: (a) weight is a "sticky" topic, (b) negative messaging around weight can adversely impact patient care, and (c) occupational therapy involvement in weight management is impacted by a lack of referrals. This design process yielded the Occupational Therapy Health Routines Screening Tool prototype.

We introduce a concept of a $\Lambda$-derivative operator, which is a certain generalization of hypersingular integral operators, which in turn are used in the definitions of the Marchaud and the Riesz fractional derivatives. We study the problem of sharp Kolmogorov-type inequalities in spaces of continuous bounded functions equipped with a seminorm defined by a certain modulus of continuity for such kind of operators. We also consider an application of the obtained Kolmogorov-type inequality to the Stechkin problem about the best approximation of an operator by bounded ones.

Rigorous academic preparation in high school is a strong predictor of postsecondary success. The College Board's Advanced Placement (AP) program allows students to earn college credit while in high school; however, disparities in equitable participation remain a persistent concern. This qualitative multiple-case study explored equity-focused AP program implementation in two urban school districts in the Midwest. From interviews with 29 school leaders, the study examined participants’ beliefs, leadership practices, and reflections on equitable AP access. Findings highlight examples of community-engaged, social justice leadership that promote inclusive participation in AP coursework.

Background Recidivism presents significant barriers to occupational performance and community reintegration. Individuals transitioning from incarceration often face structural stigma, limited access to meaningful occupation, and disrupted occupational identity. These challenges fall within the scope of occupational therapy, yet the profession’s role in reentry remains underexplored in the literature. Objective In this study, we set out to explore the lived experiences of formerly incarcerated individuals and examine how recidivism affects occupational performance and community participation. Methods This qualitative study used a phenomenological design with in-depth, semi-structured interviews conducted with nine formerly incarcerated individuals. Data were analyzed thematically using an inductive approach, with rigor supported by bracketing, member checking, and peer debriefing. Results Five central themes emerged, (1) occupational disengagement and mental health barriers; (2) environmental barriers and systemic stigma; (3) structured occupational engagement as a protective factor; (4) the role of social support and mentorship; and (5) the need for individualized rehabilitation approaches. In addition, one intersecting theme was identified across all narratives: the scarcity of resources and support systems post-release. Participants described diverse reentry experiences but consistently emphasized systemic and occupational barriers to reintegration. Conclusion Occupational therapy has the potential to play a critical role in supporting reentry through trauma-informed, identity-driven, and community-integrated interventions. Addressing structural stigma and building therapeutic alliances may be essential strategies for both practice and advocacy.

<bold>Background:</bold> Demographic projections predict an increasing number of elderly people living with chronic conditions. Making the future healthcare system sustainable necessitate adopting innovative pathways to healthcare delivery. The Norwegian Directorate of Health commissioned pilot projects testing digital remote care in 2018. The purpose was to acquire sufficient knowledge and experience on digital remote care to provide national recommendations for implementation. We describe the development of a collaborative service model implementing digital remote care for patients with chronic obstructive pulmonary disease (COPD). <bold>Methods:</bold> The “Mitt liv, mitt ansvar” (MILA) project was developed in an iterative process of workshops, network meetings, profit planning, active user participation assessing quantitative and qualitative evaluations, adjustments and revisions. A research and development agreement with Siemens Healthineers was undertaken to customize digital tools. Representatives of the municipal health services, general practitioners and hospital specialists participated in the model development. <bold>Results:</bold> The MILA model recruits COPD-patients from primary and secondary healthcare. It utilizes multicomponent interventions through a joint digital platform solution. Key elements include digital home monitoring of symptoms and vital signs, digital self-management plans based on stoplight tool, remote follow-up by regional response centre and cross-disciplinary meetings between healthcare providers. <bold>Conclusion:</bold> The MILA model is implemented in regular healthcare by January 2025. Further qualitative data analysis is necessary to evaluate the impact on patient safety, quality of life and self-management.