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Current primary care models are inadequate for adults on the autism spectrum. The Center for Autism Services and Transition (CAST) clinic was developed in 2014 using feedback from parents of adults on the autism spectrum and patient-centered medical home principles. We evaluated the reach of CAST's services. As of January 2021, 858 patients were seen in CAST. Many continue to receive primary care from the CAST clinic. The program has undergone staffing changes but continues to accept new patients. We have added services such as "happy visits," pre-procedure videos, and telehealth visits. CAST provides one example of how to improve primary care for adults on the autism spectrum. More research is needed to assess the effectiveness of the CAST model.

POINTS CLES En 2016, au Canada (a l’exclusion du Quebec), 270 204 personnes ont ete admises a l’hopital pour un trouble cardiaque, un accident vasculaire cerebral (AVC) ou un deficit cognitif d’origine vasculaire; de ce nombre, 107 391 etaient des femmes, 162 813 etaient des hommes

KEY POINTS In 2016, 270 204 people in Canada (excluding Quebec) were admitted to hospital for heart conditions, stroke and vascular cognitive impairment, including 107 391 women and 162 813 men, of whom 91 524 died.[1][1] This equates to 1 out of every 3 deaths in Canada and outpaces other diseases

Psychobiography is best understood as a branch of applied personality science in which experimental findings are used to explore the lives and personalities of public figures, from artists to politicians. This article introduces the field, addresses questions commonly raised about it, and explores, among other subjects, what psychobiographical research might offer to the field of psychology. Two recent model psychobiographies are described in detail-McAdams's (2010) profile of George W. Bush and Kasser's (2013) analysis of John Lennon-both of which are oriented scientifically and rooted in experimentally derived concepts. Lastly, criteria for evaluating psychobiographical studies are summarized, as well as attributes of effective psychobiography that tend to include the components of fact, fit, and function. (PsycINFO Database Record

District Nurses have been delivering care at home for over 150 years. Their role is appreciated by colleagues, patients and carers alike and can often make the difference between remaining in a preferred location of care or a preferred place of death. \ud \ud The role has changed considerably over this time: patients are living longer with increasingly more complex conditions; earlier discharges from secondary care are common with more acute patients returning to be cared for at home and comorbid mental health conditions are often the norm for people. \ud \ud However, against this backdrop, District Nurse numbers are falling, and are expected to continue to fall, due, in part, to an ageing workforce but also a reduction in training, both places and funding, which is potentially putting the future of the District Nurse in jeopardy.\ud \ud Urgent action is required to avoid losing this cornerstone of ‘care closer to home’.

This chapter summarizes the transition of medical care from pediatric to adult providers for adolescents and young adults with type 1 diabetes mellitus. The chapter includes a patient case, case discussion, and a complete didactic section that covers the definition and epidemiology of the disease and potential microvascular and macrovascular complications of uncontrolled diabetes and their recommended screening. Furthermore, the chapter highlights several common coexisting conditions in emerging adults with diabetes, including mood disorders, disordered eating, and other accompanying autoimmune diseases. Critical issues in caring for emerging adults with diabetes are also discussed, including substance use, sexual health and preconception planning, financial barriers to transition and health insurance, preparation for changing living situations, and entering the work force or college. The chapter also provides multiple resources for the pediatric and adult health care team as well as the patient and family to help prepare and empower the emerging adult with diabetes for the transition to adult medical care.

This research theorizes a model for unauthorized border crosser (UBC) behavior when crossing the Mexico/U.S. border into Arizona. The manifold model developed here is a modified funneling effect of multiple trails converging together at nodes that separate into multiple exit points. Using hydrological metaphors, we quantify deathsheds into trails by using the remains of UBCs as trail markers and then compare the trails produced from three geostatistical research methods. The results may be used in designing search-and-rescue locations.

Good hospital hygiene is integral to the prevention of healthcare associated infections (HCAI). Clinical evidence suggests a link between poor environmental hygiene and healthcare associated infections. A qualitative design, using focus group interviews, was used to explore cleaners’ perceptions of their role in the prevention of HCAI. Focus group interviews were conducted with cleaners in two large hospitals in the Republic of Ireland. Data were analysed using thematic content analysis and four themes emerged. These were supervision and communication; roles and task allocations; workload and staffing levels; and education. Findings suggest that cleaners feel they have a role in the prevention of HCAI. However, this role is often undervalued due to the perceived low status of cleaners. Problems of communication in the workplace frequently interfere with work organisation. Furthermore, blurring of role boundaries between cleaners and healthcare assistants can create additional difficulties.

The purpose of this study was to describe the pre-retirement and related services offered to service-users with intellectual disability in Ireland. Increasing numbers of service-users with an intellectual disability are living into older adulthood, creating important challenges for services providers. The National Intellectual Disability Database 2007 (NIDD) suggests that the population of service-users with an intellectual disability in the Republic of Ireland is an ageing population. Significant ongoing demands for new retirement-related intellectual disability services and enhancement of existing services are indicated. It is unknown how to support the development of a retirement policy to meet this growing need. The findings of this survey study indicate that there is, in general, recognition among Ireland's service providers of the need for retirement options for this population, although little attention has been directed towards formalizing these services through policy-making. There are few retirement policies in place, limiting the implementation of comprehensive services to meet the changing needs of ageing adults with an intellectual disability.

The subtype-selectivity of racemic [(3)H]CP-101,606, a novel high-affinity NMDA receptor radioligand was determined using defined recombinant NMDA receptor subunits expressed in HEK 293 cells. [(3)H]CP-101,606 binds to adult rodent forebrain and NR1/NR2B receptors expressed in HEK 293 cells with K(D)=4.2 nM and 6.0 nM, respectively. In contrast, no high affinity specific binding was detected to NR1, NR2A, NR2B subunits expressed alone or NR1/NR2A receptors. HEK 293 cells were transfected with NR1, NR2A and NR2B receptor subunits and complexes comprising all three subunits were isolated by anti-NR2A immunoaffinity chromatography. Based on immunoblotting with subunit-selective antibodies, the immunopurified material contained all three NMDA receptor subunit polypeptides. However, in contrast to parallel studies in which high affinity [(3)H]Ro-25,6981 binding activity was observed, no high affinity [(3)H]CP-101,606 binding sites were detected to the immunopurified material. This study provides further evidence for two distinct classes of NR2B-directed NMDA receptor antagonists, one which binds with high affinity irrespective whether another NR2 subunit type is present (Ro-25,6981) and a second class which is affected significantly by the presence of another NR2 subunit type within the receptor complex, exemplified by CP-101,606.

Human aging is associated with heightened risk of diabetes and cardiovascular disease. Increased fat mass may contribute to age-related diseases by harboring inflammatory macrophages that produce metabolically important proteins such as plasminogen activator inhibitor-1 (PAI-1). Elevated PAI-1 concentrations have been implicated in the pathogenesis of such aging-related conditions as insulin resistance, obesity, and atherosclerosis. We have previously reported that increased plasma free fatty acid (FFA) concentrations augment both circulating PAI-1 concentrations and PAI-1 production by adipose tissue macrophages (ATMs).Because increasing age is associated with increased infiltration and reactivity of adipose macrophages, we performed euglycemic-hyperinsulinemic clamp studies and adipose tissue biopsies with and without elevated FFA concentrations in 31 nondiabetic participants stratified by age, to determine whether middle-aged individuals manifest heightened insulin resistance and PAI-1 production by ATMs in response to elevated nutrient signals relative to their young adult peers.We observed that elevating FFA concentrations under euglycemic-hyperinsulinemic clamp conditions induced the same degree of insulin resistance in both middle-aged and younger body mass index-matched adults, whereas systemic PAI-1 concentrations were significantly increased in the middle-aged group. Likewise, elevated FFA and insulin concentrations induced larger increases in PAI-1 gene expression in the whole fat and ATMs of middle-aged compared with younger adult participants.These studies reveal a heightened adipose inflammatory response to increased FFA and insulin availability in middle-aged individuals relative to younger adults, suggesting that increased susceptibility to the effects of fatty acid excess may contribute to the pathogenesis of age-related diseases.

Background: Although it is common for central line catheters to develop a thrombotic occlusion, pediatric patients are at especially high risk of occlusion due to smaller vessels, smaller-gauge catheters, and slower rates of infusion. Mitigating catheter occlusions is costly, requiring tissue plasminogen activator, supplies, and nursing time. Our facility tested a novel neutral displacement needle-free valve designed to reduce occlusion. Methodology: The organization determined a baseline occlusion rate for Hickman/Broviac catheters, in our 38-bed inpatient hematology/oncology department and our outpatient hematology/oncology clinic from August 2010 through October 2010. In 2011, a premarket test of the Neutron device (ICU Medical, San Clemente, CA) was conducted on the units. Based on the positive trial results, it was decided to implement the device housewide in December 2012. Results: A comparison of baseline central line complete occlusion rates from August to October 2010 with Neutron trial data from July to October 2011. This pilot project demonstrated a 74.3% reduction (from a rate of 3.82 to a rate of 0.98) in all hematology/oncology department Hickman and Broviac complete catheter occlusions. Subsequently, comparing 5 months of housewide occlusion data from June through October 2012 to 2013, complete occlusions fell by 32.1% (from a rate of 1.56 to a rate of 1.06). Conclusions: The use of the Neutron needle-free catheter patency device was associated with a reduction in complete occlusions. The corresponding reduction in treatment delays, nursing time spent managing occluded catheters, and fewer needlesticks to patients likely translates to financial benefit for the organization and improved patient and family satisfaction.

ANPs are making visits to nursing homes and acting as a first port of call for urgent issues, explains Stephanie Lawrence

Although morale in the NHS is generally low, industrial action is not the answer (news August 9). Nurses should lobby their MPs and pressure the government over job cuts. If nurses opt for industrial action, it will alienate the public, who mostly support nurses.