We present confirmation of HD 143811 AB b, a substellar companion to spectroscopic binary HD 143811 AB through direct imaging with the Gemini Planet Imager (GPI) and Keck NIRC2. HD 143811 AB was observed as a part of the GPI Exoplanet Survey in 2016 and 2019 and is a member of the Sco-Cen star formation region. The exoplanet is detected ∼430 mas from the host star by GPI. With two GPI epochs and one from Keck/NIRC2 in 2022, we confirm through common proper motion analysis that the object is bound to its host star. We derive an orbit with a semimajor axis of 6 4 − 14 + 32 au and eccentricity 0.23 − 0.16 + 0.24 . Spectral analysis of the GPI H -band spectrum and NIRC2 L′ photometry provides additional proof that this object is a substellar companion. We compare the spectrum of HD 143811 AB b to PHOENIX stellar models and Exo-Radioactive-Convective Equilibrium Model (REM) exoplanet atmosphere models and find that Exo-REM models provide the best fits to the data. From the Exo-REM models, we derive an effective temperature of 104 2 − 132 + 178 K for the planet and translate the derived luminosity of the planet to a mass of 5.6 ± 1.1 M Jup assuming hot-start evolutionary models. HD 143811 AB b is the first directly imaged planet around a binary that is not on an ultrawide orbit. Future characterization of this object will shed light on the formation of planets around binary star systems.

HD 143811 AB is the host star to the directly imaged planet HD 143811 AB b, which was recently discovered using data from the Gemini Planet Imager and Keck NIRC2. A member of the Sco-Cen star-forming region with an age of 13 ± 4 Myr, HD 143811 AB is somewhat rare among hosts of directly imaged planets, as it is a close stellar binary, with an ∼18-day period. Accurate values for the orbital and stellar parameters of this binary are needed to understand the formation and evolutionary history of the planet in orbit. We utilize archival high-resolution spectroscopy from FEROS on the MPG/ESO 2.2 m telescope to fit the orbit of the binary, and we combine with unresolved photometry to derive the basic stellar properties of the system. From the orbit, we derive precise values of orbital period of 18.59090 ± 0.00007 days and mass ratio of 0.886 ± 0.003. When combined with stellar evolutionary models, we find masses of both components of M A = 1.3 0 − 0.05 + 0.03 M ⊙ and M B = 1.1 5 − 0.04 + 0.03 M ⊙ . While the current data are consistent with the planet and stellar orbits being coplanar, the 3D orientations of both systems are currently poorly constrained, with additional observations required to more rigorously test for coplanarity.

Research ObjectivesTo establish indices of responsiveness on the Coma Recovery Scale - Revised (CRS-R) for patients with disorders of consciousness (DoC): (1) minimal detectable change with 95% confidence interval (MDC95), (2) conditional MDC95 (cMDC), and (3) distribution-based minimally clinically important difference (MCID). To compare participants’ change in CRS-R scores between the control and placebo group of the Amantadine Trial.DesignRetrospective analysis of data collected during a randomized, placebo-controlled clinical trial of participants with DoC.SettingInpatient rehabilitation facilities.Participants180 adult participants with DoC resulting from traumatic brain injury (age: mean=36.4 years, SD=15.3; gender: 130 males, 50 females ; condition: 92 Amantadine, 88 placebo).InterventionsAmantadine or placebo was administered to patients for four weeks.Main Outcome MeasuresCRS-R was administered to patients at baseline and four weeks later. We transformed CRS-R total raw scores (0 to 23) to a 10-unit equal-interval scale using Rasch analysis. All responsiveness indices are in CRS-R units.ResultsFor the full sample, MDC95=11, cMDC 95 range=11-42, MCID: .20SD=4, .33SD=6, .50SD=9. Experimental group: Mean CRS-R change (20.4 units) exceeded all MCID values. 63 (68.5%) participants improved beyond MDC 95; 53 (57.6%) participants improved beyond cMDC 95. Control group: Mean CRS-R change (16.8 units) exceeded all MCID values. 54 (61.4%) participants improved beyond MDC 95; 42 (48.9%) participants improved beyond cMDC 95. The experimental group made a mean CRS-R change that was nearly 4 units greater than the control group.ConclusionsThe MDC95 and MCID statistics account for differences over the four weeks between the two CRS-R administrations. The cMDC95 accounts for measurement error in change scores on a pair-wise basis and thus provides a more precise index to identify individual patients who are likely to have truly changed. Participants in the amantadine group improved, on average, nearly CRS-R 4 units greater than the control group which represents a small (.20SD) important difference. As none of the distribution-based MCIDs exceed the MDC95 or cMDC95 values, MCIDs should not be applied to interpret individual patient change.Author(s) DisclosuresN/A.

Objective: To investigate whether the relationships between acute care occupational therapy (OT) and physical therapy (PT) utilization and community discharge are moderated by functional or physical performance at discharge among individuals hospitalized with traumatic brain injury (TBI). Setting: 14 acute care hospitals in the state of Colorado. Participants: We studied 5599 adults hospitalized with TBI between June 2018 and April 2021. Design: In a secondary analysis of de-identified electronic health record (EHR) data, multivariable moderation logistic regression models were performed to calculate odds ratios (ORs) for the likelihood of community discharge among patients who utilized OT/PT services. Main Measures: Functional (activities of daily living [ADL]) and physical (mobility) performance at discharge, OT and PT utilization, and community discharge status. Results: Overall, 67% of patients discharged to the community. The mean age of the sample was 55 years (SD = 20 years). Most participants were male (64%) and non-Hispanic White (72%). Mean hospital length of stay was 6 days (SD = 6 days). Both OT and PT utilization (OT: OR = 1.21, 95% CI [1.11, 1.33]; PT: OR = 1.22, 95% CI [1.14, 1.30]) and discharge ADL and mobility scores (ADL: OR = 1.34, 95% CI [1.30, 1.39]; mobility: OR = 1.38, 95% CI [1.33, 1.42]) were significantly and positively associated with community discharge. The OT and PT utilization-by-discharge ADL and mobility interaction terms yielded slightly negative, but statistically significant moderation effects in both models (ORs = 0.99, 95% CIs [0.98, 1.00]); indicating the magnitude of the OT and PT utilization effect diminished as ADL and mobility scores increased. Several sociodemographic characteristics and clinical factors were also independently associated with community discharge in both models (p-values < 0.001–0.04). Conclusions: Greater OT and PT utilization was associated with increased odds of community discharge. Similarly, higher ADL and mobility scores at discharge were associated with increased odds of community discharge. The small, but statistically significant negative interaction terms in both models indicated that the magnitude of the OT and PT utilization effect diminished as ADL and mobility scores increased. This study’s findings can guide occupational and physical therapists in their efforts to facilitate a safe transition to the community for patients with TBI.

Date Presented 03/21/24 Results indicated that only insurance type was significantly associated with 30-day readmission. Our results inform OTs about which patient factors may contribute to a higher risk of readmission for patients hospitalized with traumatic brain injury (TBI). Primary Author and Speaker: Rayyan Bukhari Contributing Authors: Jessica Edelstein, Jennifer Weaver, Amanda L. Hoffman, Deana Davalos, Julia Sharp, James Graham

The purpose of this study was to differentiate clinically meaningful improvement or deterioration from normal fluctuations in patients with disorders of consciousness (DoC) following severe brain injury. We computed indices of responsiveness for the Coma Recovery Scale-Revised (CRS-R) using data from a clinical trial of 180 participants with DoC. We used CRS-R scores from baseline (enrollment in a clinical trial) and a 4-week follow-up assessment period for these calculations. To improve precision, we transformed ordinal CRS-R total scores (0-23 points) to equal-interval measures on a 0-100 unit scale using Rasch Measurement theory. Using the 0-100 unit total Rasch measures, we calculated distribution-based 0.5 standard deviation (SD) minimal clinically important difference, minimal detectable change using 95% confidence intervals, and conditional minimal detectable change using 95% confidence intervals. The distribution-based minimal clinically important difference evaluates group-level changes, whereas the minimal detectable change values evaluate individual-level changes. The minimal clinically important difference and minimal detectable change are derived using the overall variability across total measures at baseline and 4 weeks. The conditional minimal detectable change is generated for each possible pair of CRS-R Rasch person measures and accounts for variation in standard error across the scale. We applied these indices to determine the proportions of participants who made a change beyond measurement error within each of the two subgroups, based on treatment arm (amantadine hydrochloride or placebo) or categorization of baseline Rasch person measure to states of consciousness (i.e., unresponsive wakefulness syndrome and minimally conscious state). We compared the proportion of participants in each treatment arm who made a change according to the minimal detectable change and determined whether they also changed to another state of consciousness. CRS-R indices of responsiveness (using the 0-100 transformed scale) were as follows: 0.5SD minimal clinically important difference = 9 units, minimal detectable change = 11 units, and the conditional minimal detectable change ranged from 11 to 42 units. For the amantadine and placebo groups, 70% and 58% of participants showed change beyond measurement error using the minimal detectable change, respectively. For the unresponsive wakefulness syndrome and minimally conscious state groups, 54% and 69% of participants changed beyond measurement error using the minimal detectable change, respectively. Among 115 participants (64% of the total sample) who made a change beyond measurement error, 29 participants (25%) did not change state of consciousness. CRS-R indices of responsiveness can support clinicians and researchers in discerning when behavioral changes in patients with DoC exceed measurement error. Notably, the minimal detectable change can support the detection of patients who make a "true" change within or across states of consciousness. Our findings highlight that the continued use of ordinal scores may result in incorrect inferences about the degree and relevance of a change score.

Occupational therapy has been identified as a required service in the neuro critical care unit (NCCU), however who receives occupational therapy services and what services they receive are not well understood. We sought to determine if arousal deficits impacted patients' likelihood to receive an occupational therapy evaluation or specific types of occupational therapy interventions in the NCCU. When compared to patients without arousal deficits, patients who were experiencing agitation or light sedation, but not deep sedation, were more likely to receive occupational therapy interventions in the therapeutic activities category. Arousal deficits were not associated with receipt of occupational therapy services or occupational therapy interventions in the self-care or therapeutic exercise categories. Determining predictors of occupational therapy services will help ensure the timely delivery of services by improving the allocation of resources and identifying potential gaps in care.

The HR 2562 system is a rare case where a brown dwarf companion resides in a cleared inner hole of a debris disk, offering invaluable opportunities to study the dynamical interaction between a substellar companion and a dusty disk. We present the first ALMA observation of the system as well as the continued Gemini Planet Imager monitoring of the companion’s orbit with six new epochs from 2016 to 2018. We update the orbital fit, and in combination with absolute astrometry from GAIA, place a 3 σ upper limit of 18.5 M J on the companion’s mass. To interpret the ALMA observations, we used radiative transfer modeling to determine the disk properties. We find that the disk is well resolved and nearly edge-on. While the misalignment angle between the disk and the orbit is weakly constrained, due to the short orbital arc available, the data strongly support a (near) coplanar geometry for the system. Furthermore, we find that the models that describe the ALMA data best have inner radii that are close to the companion’s semimajor axis. Including a posteriori knowledge of the system’s SED further narrows the constraints on the disk’s inner radius and places it at a location that is in reasonable agreement with (possibly interior to) predictions from existing dynamical models of disk truncation by an interior substellar companion. HR 2562 has the potential over the next few years to become a new test bed for dynamical interaction between a debris disk and a substellar companion.

Chaotic embryos have copy number variations in 6 or more chromosomes and subsequent transfer is typically not recommended. Yet, recent reports detail a healthy live birth following chaotic embryo transfer (1) and demonstrate that 40% of re-biopsies resulted euploid following initial ‘chaotic’ biopsy result (2). The objective of this study is to assess chromosome concordance in embryos found to be ‘chaotic’ on repeated biopsy. Secondary outcome was to evaluate for associations with maternal age and/or day of blastocyst biopsy. This repeated measures study compared the initial and the repeat biopsy results analyzed by Next Generation Sequencing (NGS) at the same reference laboratory. Analysis of concordance between first and second biopsies was stratified by patient age and day of blastocyst biopsy. Concordance was defined as a re-biopsy result of either chaotic (“concordantly chaotic”) or aneuploid. For embryos with concordantly chaotic results on both biopsies, per pair chromosome concordance was assessed. Non-random associations were assessed by Fisher’s Exact Test. A total of 64 embryos initially reported as chaotic were re-biopsied. Overall concordance was 67% (44% concordantly chaotic,23% aneuploid) (Table). A total of 11 embryos were reclassified as euploid on repeat biopsy (17%) (Table). While chaotic embryos biopsied on day 7 were more likely than day 5 or 6 chaotic embryos to be concordant this did not achieve statistical significance (P=0.067). Further, concordance in chaotic embryo diagnosis was not associated with maternal age. Concordantly chaotic embryos (n=28) showed a Median of 100% (IQR 96-100%) of having the same aneuploidy per pair of 23 chromosomes. In our hypothesis-generating observational study, 17% of chaotic embryos were reclassified as euploid at re-biopsy. A trend toward higher likelihood of concordantly chaotic result was observed among late-developing embryos. Interestingly, concordantly chaotic embryos demonstrated copy number variations in the same chromosomes in nearly every instance. Additional study will lend credence to observations and allow for insight into the clinical relevance of findings presented herein.

Objective: To examine the impact of community-level social determinants of health (SDoH) on the onset of occupational therapy (OT) and physical therapy (PT) services among individuals hospitalized for traumatic brain injury (TBI). Setting: 14 acute care hospitals in the state of Colorado. Participants: We studied 5825 adults with TBI. Design: In a secondary analysis of de-identified electronic health record data, we performed multivariable logistic and linear regressions to calculate odds ratios (ORs) and 95% CIs for the likelihood of receiving services and duration to initiation of services among those who received them. Main Measures: Community-level SDoH, receipt of rehabilitation services, and onset of rehabilitation services. Results: Multivariable logistic and linear regressions revealed that those in top quartiles for community income were associated with duration to OT services, ranging from OR = 0.33 [05% CI, 0.07, 0.60] for quartile 2 to 0.76 [0.44, 1.08] for quartile 4 compared with those with the lowest quartile. Only the top quartile differed significantly for duration to PT services (0.63 [0.28, 0.98]). Relative to those with below the median community percentage of high school degree, those with above the median were associated with duration to PT services only (−0.32 [−0.60, −0.04]). Neither community percentage with bachelor's degree nor rural-urban designation was associated with duration to either therapy service. Conclusion: Further research is needed to determine whether our SDoH variables were too diffuse to capture individual experiences and impacts on care or whether community-level education and income, and rurality, truly do not influence time to therapy for patients hospitalized with TBI. Other, individual-level variables, such as age, comorbidity burden, and TBI severity, demonstrated clear relationships with therapy onset. These findings may help therapists evaluate and standardize equitable access to timely rehabilitation services.

OBJECTIVE:The aims of this study were to identify disability subgroups among patients hospitalized for ischemic stroke and to determine the predictors and distal outcomes for the disability subgroups.METHODS:A retrospective, cross-sectional study design was used. Data on patients after ischemic stroke were collected from the electronic health records at 5 hospitals within a single health system. Covariates included social and demographic factors. Disability was characterized according to the Activity Measure for Post-Acute Care assessment. Distal outcomes were physical therapist treatment use, occupational therapist treatment use, and discharge disposition. Latent class analysis was used to identify disability subgroups of patients hospitalized for ischemic stroke.RESULTS:A total of 1549 patients were included in the analyses. Five disability subgroups were identified and labeled as follows: globally impaired (subgroup 1), impaired dynamic balance (subgroup 2), impaired self-care (subgroup 3), impaired mobility (subgroup 4), and independent (subgroup 5). Physical therapist treatment use (χ24 = 113.21 [P < .001]) and occupational therapist treatment use (χ24 = 122.97 [P < .001]) varied significantly across the disability subgroups. The globally impaired group had the highest probability of physical and occupational therapist treatment use. Similarly, discharge disposition varied across the subgroups (for home without services, χ24 = 246.61 [P < .001]; for home with home health care, χ24 = 35.49 [P < .001]; for institutional discharge, χ24 = 237.18 [P < .001]). The independent subgroup had the highest probability of discharge to home without services.CONCLUSION:Five disability subgroups were identified for patients after ischemic stroke. The disability subgroups provide a common language for clinicians to organize the heterogeneity of disability after stroke.IMPACT:Using the disability subgroups, the multidisciplinary team might be able to improve the accuracy and efficiency of care decisions. The number of current rehabilitation interventions is indeterminable; these subgroups may help to guide clinicians in selecting the most beneficial interventions for patients based on subgroup membership.

The POLISH2 optical polarimeter has been in operation at the Lick Observatory 3 m Shane telescope since 2011, and it was commissioned at the Gemini North 8 m in 2016. This instrument primarily targets exoplanets, asteroids, and the Crab Pulsar, but it has also been used for a wide variety of planetary, galactic, and supernova science. POLISH2's photoelastic modulators, employed instead of rotating wave plates or ferroelectric liquid crystal modulators, offer the unprecedented ability to achieve sensitivity and accuracy of order 1 ppm (0.0001%), which are difficult to obtain with conventional polarimeters. Additionally, POLISH2 simultaneously measures the intensity (Stokes I), linear polarization (Stokes Q and U), and circular polarization (Stokes V), which fully describe the polarization state of incident light. We document our laboratory and on-sky calibration methodology and our archival on-sky database, and we demonstrate the conclusive detection of circular polarization of certain objects.

IMPORTANCE:Occupational therapy in the neurological critical care unit (NCCU) may enable safe community discharge by restoring functional ability. However, the influence of patient characteristics and NCCU occupational therapy on discharge disposition is largely unknown. OBJECTIVE:To examine how patient factors and receipt of occupational therapy predict discharge disposition for NCCU patients. DESIGN:Retrospective cross-sectional cohort study of electronic health records data from adults admitted to the NCCU between May 2013 and September 30, 2015. SETTING:NCCU in a large urban academic hospital. PARTICIPANTS:Adults age 18 yr or older (N = 1,134) admitted to the NCCU. Outcomes and Measures: Using logistic regression with discharge disposition as the dependent variable, we entered sex, age, length of stay (LOS), baseline Glasgow Coma Scale score, Elixhauser Comorbidity Index, and receipt of occupational therapy services as predictor variables. RESULTS:Of NCCU patients, 39% received occupational therapy. Younger age, shorter LOS, lower comorbidity burden, and not receiving occupational therapy services increased the likelihood of discharge to the community. Men who received occupational therapy were less likely to be discharged to the community than men who did not receive occupational therapy. As age increased, differences in the probability of community discharge decreased between recipients and nonrecipients of occupational therapy services. CONCLUSIONS AND RELEVANCE:Our results suggest that patients receiving occupational therapy services in the NCCU may have a lower likelihood of community discharge. However, these findings may result from therapist's consideration of the safest discharge location to ensure the greatest balance between independence and support. What This Article Adds: This study's findings suggest that receipt of occupational therapy in the NCCU is associated with higher likelihood for noncommunity discharge (i.e., to inpatient rehabilitation, skilled nursing, or long-term care). However, activity limitations and comorbidity burden may be greater for recipients of occupational therapy, and these NCCU patients are presumably less prepared for community discharge.

Date Presented 04/01/2022 Functional impairments after stroke are heterogeneous. Standardized clinical assessments may not effectively capture the different functional subgroups of individuals after stroke. Using latent class analysis, five functional subgroups were identified within a sample of individuals hospitalized for ischemic stroke. The following outcomes varied across the functional subgroups: OT utilization, physical therapy utilization, and discharge disposition. Primary Author and Speaker: Jessica Edelstein Additional Authors and Speakers: Adam Kinney, Matthew Malcolm Contributing Authors: James Graham, Tamera Keeney, Amanda L. Hoffman

IMPORTANCE Hospitalized patients who have difficulty performing activities of daily living (ADLs) benefit from occupational therapy services; however, disparities in access to such services are understudied. OBJECTIVE To investigate whether need (i.e., limited ADL performance) predicts acute care occupational therapy utilization and whether this relationship differs across sociodemographic factors and insurance type. DESIGN A secondary analysis of electronic health records data. Logistic regression models were specified to determine whether ADL performance predicted use of occupational therapy treatment. Interactions were included to investigate whether the relationship between ADL performance and occupational therapy utilization varied across sociodemographic factors (e.g., age) and insurance type. PARTICIPANTS A total of 56,022 adults admitted to five regional hospitals between 2014 and 2018 who received an occupational therapy evaluation. INTERVENTION None. Outcomes and Measures: Occupational therapy service utilization, Activity Measure for Post-Acute Care "6-Clicks" measure of daily activity. RESULTS Forty-four percent of the patients evaluated for occupational therapy received treatment. Patients with lower ADL performance were more likely to receive occupational therapy treatment; however, interaction terms indicated that, among patients with low ADL performance, those who were younger, were White and non-Hispanic, had significant others, and had private insurance (vs. public) were more likely to receive treatment. These differences were smaller among patients with greater ADL performance. CONCLUSIONS AND RELEVANCE Greater need was positively associated with receiving occupational therapy services, but this relationship was moderated by age, minoritized status, significant other status, and insurance type. The findings provide direction for exploring determinants of disparities in occupational therapy utilization. What This Article Adds: Acute care occupational therapy utilization is driven partly by patient need, but potential disparities in access to beneficial services may exist across sociodemographic characteristics and insurance type. Identifying potential determinants of disparities in acute care occupational therapy utilization is the first step in developing strategies to reduce barriers for those in need.

Employment is a common, yet often elusive goal for adults with intellectual and developmental disabilities (IDD). There is growing interest in inclusive higher education opportunities as a means to improve employment success for people with IDD. This chapter reviews the current knowledge base regarding a promising type of post-secondary experience, career and technical education (CTE), and examines its utility for expanding inclusive higher education pathways that lead to employment for this population. Evidence-based recommendations are presented for implementing novel CTE programs for people with IDD, along with a proposed model of partnerships at land-grant universities in the United States that are uniquely positioned to train adults with IDD for careers in agricultural settings.

We present new near-infrared Gemini Planet Imager (GPI) spectroscopy of HD 206893 B, a substellar companion orbiting within the debris disk of its F5V star. The J , H , K1 , and K2 spectra from GPI demonstrate the extraordinarily red colors of the object, confirming it as the reddest substellar object observed to date. The significant flux increase throughout the infrared presents a challenging atmosphere to model with existing grids. Best-fit values vary from 1200 to 1800 K for effective temperature and from 3.0 to 5.0 for log( g ), depending on which individual wavelength band is fit and which model suite is applied. The extreme redness of the companion can be partially reconciled by invoking a high-altitude layer of submicron dust particles, similar to dereddening approaches applied to the peculiar red field L dwarf population. However, reconciling the HD 206893 B spectra with even those of the reddest low-gravity L dwarf spectra still requires the contribution of additional atmospheric dust, potentially due to the debris disk environment in which the companion resides. Orbit fitting from 4 yr of astrometric monitoring is consistent with a ∼30 yr period, an orbital inclination of 147°, and a semimajor axis of 10 au, well within the estimated disk inner radius of ∼50 au. As one of a very few substellar companions imaged interior to a circumstellar disk, the properties of this system offer important dynamical constraints on companion–disk interaction and provide a benchmark for substellar and planetary atmospheric study.