Charles House-Yorktown Eldercare Home: A Program and Evaluation Plan

With the aging of the American population and the rising prevalence of chronic disease and disability, there will be increasing numbers of older Americans in need of long-term care in the coming decades. Unfortunately, many current models of residential long-term care are associated with suboptimal quality of life for residents and high levels of caregiver burden among their family caregivers. The Charles House-Yorktown Eldercare Home is a small care home that was started in 2011 in Chapel Hill, North Carolina in response to the need for holistic residential eldercare expressed by local families caring for elder relatives in the community, and its overarching goal is to provide high quality residential elder care in a community context. The program provides person-centered residential care to 6 elders in a small, home-like setting in a suburban neighborhood and purposefully involves family caregivers in care and household life. As a next step in community involvement, the Eldercare Home plans to reach out to neighbors and other stakeholders to learn how it might better support and enhance the neighborhood and its needs. The purpose of the following program and evaluation plan is to outline the program's development to date and its future directions, formally articulate its goals, and plan for evaluation, towards program improvement and dissemination. The program's logic model provides a framework for linking goals and activities, and is accompanied by a detailed implementation plan. A mini-systematic literature review provides insight into evaluation methods reported in the literature by similar programs. The focus of evaluation plans is elucidated through consideration of resources and rationale for undertaking evaluation. Evaluation planning tables provide a framework for an observational mixed-methods approach, and dissemination plans for evaluation findings are also outlined. The Charles House-Yorktown Eldercare Home program represents a novel strategy for improving the quality of life of elders who require residential care as well as that of their family caregivers, while engaging the surrounding neighborhood in mutually beneficial ways.Master of Public Healt

Btk Mutations Selectively Regulate Btk Expression And Upregulate Monocyte Xbp1 Mrna In Xla Patients.

Mutations in the Bruton agammaglobulinemia tyrosine kinase (BTK) gene are responsible for X-linked agammaglobulinemia (XLA). Unfolded or misfolded proteins can trigger stress pathways in the endoplasmic reticulum (ER), known as unfolded protein response (UPR). The aim was to clarify the involvement of UPR in XLA pathophysiology. By reverse transcription-quantitative PCR, we evaluated the expression of BTK and 12 UPR-related genes in eight patients. Moreover, we assessed the BTK protein expression and pattern in the patients' monocytes by flow cytometry and fluorescence immunocytochemistry. We found a reduced BTK expression in patients with stop codon mutations (P < 0.02). However, missense mutations did not affect BTK expression. Flow cytometry showed a reduction of BTK in patients which was corroborated by an absent or nonfunctional protein synthesis revealed by immunocytochemistry. In contrast with the other UPR-related genes, X-box binding protein 1 (XBP1) was markedly upregulated in the patients (P < 0.01), suggesting Toll-like receptor (TLR) activation since BTK directly interacts with TLRs as a negative regulator and XBP1 can be activated in direct response to TLR ligation. Different BTK mutations can be identified by the BTK expression. Inasmuch as UPR-related genes were downregulated or unaltered in patients, we speculate the involvement of the TLRs-XBP1 axis in the XLA pathophysiology. Such data could be the basis for further studies of this novel pathomechanism concerning XLA.3171-18

A retrospective case note review of young people in transition from adolescent medium secure units to adult services

Purpose There is substantial evidence that young people moving from child and adolescent mental health services to adult services are more likely to experience poor transitions. However, little is known about the care pathways of young people transitioning from forensic services. This retrospective case note review sought to examine the clinical characteristics, transition pathways and psychosocial indicators of transition outcomes amongst young people in forensic medium secure services discharged to adult services. Design/methodology/approach The electronic records of 32 young people, who transitioned from six adolescent medium secure units in England to adult services between May 2015 and June 2016, were examined. Findings Approximately 65% of young people were between 18 and 19 years at the time of transition and the average waiting time from referral to discharge was six months. A total of 63% young people transitioned to community placements and adult medium secure services. Four pathways describing the journey into and out of adolescent medium secure services were identified in a subsample of 12 young people. A total of 25% young people with neurodevelopmental problems moved to specialist services. Practical implications The results suggest that diagnosis, severity of offence and clinical background are associated with transition pathway. Promoting a person-centred approach and gradual independence of the young person may improve current practice. Originality/value These results inform existing policy and clinical practice in an effort to reform transition guidelines around young people’s needs during transition times. Further studies in adolescent forensic services are needed to understand complex neurodevelopmental problems and comorbidities

Challenges and facilitators during transitions from adolescent medium secure units to adult services in England : interviews with mental healthcare professionals

Young people moving from child and adolescent secure hospitals present with complex needs and vulnerabilities and are more likely to experience poor transition outcomes. Previous research has indicated the presence of several risk factors in periods of transition, such as poor liaison among services, lack of proper planning, shortage of beds in adult services, multiple transitions and lack of emotional readiness. However, little evidence exists about the processes and outcomes of transitions from adolescent secure services to adult settings. This study aims to bridge the gap in the existing literature by exploring the views and experiences of key professionals involved in the transition process from six adolescent medium secure units to nine adult secure and community services in England. Thirty-four key workers from 15 child and adolescent (N = 21) and adult (N = 13) forensic hospitals were interviewed to provide information about potential barriers and facilitators to transitions. Face-to-face semi-structured interviews were conducted between January 2016 and December 2017. Thematic analysis was used to identify challenges and facilitators to transitions. Three primary themes were identified: (1) transition processes and preparation; (2) transition barriers and challenges; (3) success factors to transition. Key differences in adult and adolescent service care-models and lack of emotional and developmental readiness to moving onto adult-oriented settings constitute major barriers to positive transition outcomes. Practice and policy implications are considered to address the need for service transformations

Quantitative Changes In Human Epithelial Cancers And Osteogenesis Imperfecta Disease Detected Using Nonlinear Multicontrast Microscopy.

We show that combined multimodal nonlinear optical (NLO) microscopies, including two-photon excitation fluorescence, second-harmonic generation (SHG), third harmonic generation, and fluorescence lifetime imaging microscopy (FLIM) can be used to detect morphological and metabolic changes associated with stroma and epithelial transformation during the progression of cancer and osteogenesis imperfecta (OI) disease. NLO microscopes provide complementary information about tissue microstructure, showing distinctive patterns for different types of human breast cancer, mucinous ovarian tumors, and skin dermis of patients with OI. Using a set of scoring methods (anisotropy, correlation, uniformity, entropy, and lifetime components), we found significant differences in the content, distribution and organization of collagen fibrils in the stroma of breast and ovary as well as in the dermis of skin. We suggest that our results provide a framework for using NLO techniques as a clinical diagnostic tool for human cancer and OI. We further suggest that the SHG and FLIM metrics described could be applied to other connective or epithelial tissue disorders that are characterized by abnormal cells proliferation and collagen assembly.17081407-

Incidence rates of dilated cardiomyopathy in adult first-degree relatives versus matched controls

BACKGROUND: The incidence rates and importance of traditional risk factors in dilated cardiomyopathy among first-degree relatives are unknown. METHODS AND RESULTS: We identified all probands with dilated cardiomyopathy (n = 13,714, mean age at diagnosis 63 years) from the Danish nationwide registries between 1994 and 2017. Incidence rates among first-degree relatives (n = 29,671, mean age 38 years) and for up to 10 age- and sex-matched controls were calculated. Totally 233 (0.8%) first-degree relatives and 285 (0.1%) controls developed dilated cardiomyopathy during a median follow-up of 8.2 (Q1-Q3 4.4–13.3) years. Incidence rates (per 100,000 person-years) were 86.4 (95% confidence interval 73.9–101.0) and 111.1 (79.4–128.7) for first-degree relatives aged < 50 and ≥ 50 years, respectively, versus 7.5 (6.4–8.9) and 19.7 (16.8–23.2) for controls. Atrial fibrillation, diabetes, ischemic heart disease, and hypertension were associated with increased risks of developing dilated cardiomyopathy both in first-degree relatives and controls. Population attributable fractions for the 4 risk factors were 27.7% for first-degree relatives and 37.3% for controls aged < 50 years, and 46.4% versus 58.4% for first-degree relatives and controls among people aged ≥ 50 years, respectively. CONCLUSIONS: The absolute incidence rates of dilated cardiomyopathy in first-degree relatives to patients with dilated cardiomyopathy were low, but significantly higher than in matched controls and elevated by the presence of additional risk factors, especially atrial fibrillation. Additional investigations are warranted to assess whether aggressive treatment of risk factors translates into a reduction of dilated cardiomyopathy in first-degree relatives

EU POSSO, VOCÊ PODE, EU POSSO MAIS: NARCISISMO E PODER

Objetivo: A relação entre narcisismo e poder é analisada com estudantes de administração de uma universidade estadual na Bahia. Método: Adotou-se a abordagem teórico-empírica, à luz da Teoria do Alto Escalão. Um questionário autorrelato foi aplicado com 161 estudantes do 7º e 8º semestres. Utilizou-se a Estatística descritiva, Testes Mann-Whitney e Kruskal-Wallis, Correlação e Regressão logística. Resultados: As evidências apontaram menor concordância dos estudantes com traços narcisistas, embora tenham demonstrado alta concordância para autossuficiência, autoridade, exploração e vaidade. Sobre a busca por poder, os estudantes também apresentaram menor motivação, embora tenham evidenciado atitudes de persistência, autoconfiança e independência. Quanto mais altos os níveis de Narcisismo, maior a busca pelo poder, mesmo que os meios utilizados para essa busca não contemplem o benefício comum para a empresa e para os colegas de trabalho. O sexo masculino apresentou alta motivação para o poder. Contribuição: Esses achados suscitam no meio acadêmico, a discussão entre poder e Narcisismo, permitindo a compreensão sobre as implicações das temáticas ainda no ambiente de ensino da área de negócios, tornando possível a interferência na formação de futuros gestores, haja vista que as decisões destes, refletirão nos relatórios contábeis e impactarão os usuários dessas informações

Avaliação metabólica em mulheres jovens com hiperplasia adrenal congênita

OBJECTIVE: To evaluate insulin resistance and lipid profile in women with congenital adrenal hyperplasia (CAH) caused by classical 21-hydroxylase deficiency (21OHD), and their association with body mass index (BMI) and corticosteroid dosage. SUBJECTS AND METHODS: We assessed BMI, waist circumference, current glucocorticoid dosage, glucose, insulin and lipid profile in eighteen young women (mean ± SD, 19.3 ± 3.0 years) with 21OHD CAH. RESULTS: BMI was normal in 12 patients, 5 of them were overweight, and 1 was obese. Waist circumference was high in 7 patients. Fasting insulin and HOMA-IR were elevated in seven and eight patients, respectively. Total cholesterol and triglycerides were high in only two patients, and HDL-cholesterol was low in four. Insulin resistance was not associated with BMI, waist circumference or glucocorticoid dose. CONCLUSIONS: Young women with 21OHD CAH had infrequent dyslipidemia, but had a higher prevalence of insulin resistance and central obesity, that were independent of BMI or corticosteroid dosage.OBJETIVO: Avaliar a presença de resistência insulínica e dislipidemia em mulheres com hiperplasia adrenal congênita (HAC) por deficiência da 21-hidroxilase (21OHD) e investigar a associação com índice de massa corporal (IMC) e dose de glicocorticoide prescrita. PACIENTES E MÉTODOS: Em 18 mulheres jovens (média ± DP, 19,3 ± 3,0 anos), avaliamos IMC, circunferência abdominal, dose de glicocorticoide, glicemia, insulinemia e perfil lipídico. RESULTADOS: O IMC foi normal em 12 pacientes; 5 apresentavam sobrepeso e 1 apresentou obesidade. Circunferência abdominal estava aumentada em 7 pacientes. Insulinemia de jejum e HOMA-IR estavam elevados em 7 e 8 pacientes, respectivamente. Apenas 2 pacientes apresentaram aumento de colesterol total ou de triglicérides e 4, diminuição dos níveis de HDL-colesterol. Resistência insulínica não apresentou associação com IMC, circunferência abdominal ou dose de glicocorticoide prescrita. CONCLUSÃO: Mulheres jovens com CAH 21OHD apresentaram pouca dislipidemia, mas tiveram alta prevalência de resistência insulínica e obesidade central, independentemente do IMC e da dose de glicocorticoide prescrita.64665