Preparing Those with Developmental Disabilities for Adulthood and Work: Parent Perspectives on Support Services Available in Washington State

Services designed to support the transition periods for individuals with special needs from high school to employment vary throughout the state of Washington. There is little information available regarding the opinions of parents and their experiences while navigating supports available in their area, and recommendations for system improvements. This paper derived from an in-depth study regarding these experiences and questions how the Diffusion of Innovation theory could be used to impact public policy, leading to improvements in high school to employment supports for individuals with special needs. This study presents the findings of a survey sent to parents of children with special needs throughout the state of Washington. The results of this survey will reveal parent perspectives regarding high school transition programs, and compare them to those of teachers. The study also discusses what parents value the most in a post-secondary setting, the importance of job coaching and promoting the will to work. The use of change agents as described in the Diffusion of Innovation theory is explored, which discovers that parents view other parents of children with special needs as their most trusted source of information. This implies that the strongest change agents regarding system improvements in a community should be the parents themselves. Future research should include a closer look at communication gaps between schools and families and how community engagement can enhance programs already in place. Future research should also include an in depth-study of the differences between rural and urban communities, focusing on culture, resource funding and availability

Harley-Davidson reaction to changes in the consumer population and marketplace competition

The Harley-Davidson Motor Company manufactures quality motorcycles, related parts and accessories. Harley-Davidson currently controls 68.5% of the motorized recreational vehicle market share. Forecasts predict that sales, presently the highest in Harley-Davidson history, will begin a slow downward trend over the next three to ten years. There are two specific areas influencing this trend. The first is the aging of the current population. The second is verified evidence that a major competitor intends to increase their market share by initiating a floor plan program and offering guaranteed financing to new product buyers. Maintaining market share is vital to maintaining projected revenues. It is important that a proactive strategic response be developed to cope with these new demands. The news that the aging population and newly introduced competitor actions are affecting market share requires adjustments be made to future strategic planning

Investigation and Evaluation of a Computer Program to Minimize VFR Flight Planning Errors

The purpose of this study was to investigate the effect of computer aided flight planning on flight planning errors. Subjects were selected from the introductory flight courses at Embry-Riddle Aeronautical University. After the subjects completed a conventional VFR navigation log, they were asked to plan the return trip of the flight using a computer aided flight plan. It was initially expected that the computer aided flight plans would have fewer flight planning errors than those calculated using conventional methods. The results supported the hypothesis that flight planning errors are greatly reduced when computer aided flight planning techniques are used

Phase 1 Safety and Tolerability Study of BMP-7 in Symptomatic Knee Osteoarthritis

BACKGROUND: There are no proven therapies that modify the structural changes associated with osteoarthritis (OA). Preclinical data suggests that intra-articular recombinant human BMP-7 (bone morphogenetic protein-7) has reparative effects on cartilage, as well as on symptoms of joint pain. The objective of this study was to determine the safety and tolerability as well as dose-limiting toxicity and maximal tolerated dose of intra-articular BMP-7. The secondary objectives were to determine the effect on symptomatic responses through 24 weeks. METHODS: This was a Phase 1, double-blind, randomized, multi-center, placebo-controlled, single-dose escalation safety study consisting of 4 dosing cohorts in participants with knee OA. Each cohort was to consist of 8 treated participants, with treatment allocation in a 3:1 active (intra-articular BMP-7) to placebo ratio. Eligible participants were persons with symptomatic radiographic knee OA over the age of 40. The primary objective of this study was to determine the safety and tolerability of BMP-7 including laboratory assessments, immunogenicity data and radiographic assessments. Secondary objectives were to determine the proportion of participants with a 20%, 50%, and 70% improvement in the WOMAC pain and function subscales at 4, 8, 12, and 24 weeks. Other secondary outcomes included the change from baseline to 4, 8, 12, and 24 weeks for the OARSI responder criteria. RESULTS: The mean age of participants was 60 years and 73% were female. All 33 participants who were enrolled completed the study and most adverse events were mild or moderate and were similar in placebo and BMP-7 groups. The 1 mg BMP-7 group showed a higher frequency of injection site pain and there was no ectopic bone formation seen on plain x-rays. By week 12, most participants in both the BMP-7 and placebo groups experienced a 20% improvement in pain and overall the BMP-7 group was similar to placebo with regard to this measurement. In the participants who received 0.1 mg and 0.3 mg BMP-7, there was a trend toward greater symptomatic improvement than placebo. The other secondary endpoints showed similar trends including the OARSI responder criteria for which the BMP-7 groups had more responders than placebo. CONCLUSIONS: There was no dose limiting toxicity identified in this study. The suggestion of a symptom response, together with the lack of dose limiting toxicity provide further support for the continued development of this product for the treatment of osteoarthritis.ARC Future Fellowship; Stryker Biotec

The Utility of Capsule Endoscopy in Patients under 50 Years of Age with Recurrent Iron Deficiency Anaemia: Is the Juice Worth the Squeeze?

Background and Aims. The role of capsule endoscopy (CE) in the <50 years of age patients with iron deficiency anaemia (IDA) remains unclear. We aim to assess its utility in this cohort. Methods. All patients referred for CE for recurrent IDA were included retrospectively. Patients were divided into Group 1 (<50 years) and Group 2 (≥50 years). Results. There were 971 patients with recurrent IDA and 28% belonged to Group 1. The mean age was 40 years in this group with a DY of 28% (). Significant diagnoses included erosions and ulcers (26%; ), small bowel (SB) angioectasia (AE) (10%; ), SB tumours (3%; ), Crohn’s disease (3%; ), SB bowel strictures (1%; ), and SB varices (1%; ). On logistic regression, the presence of diabetes () and the use of warfarin () was associated with increased DY. The DY in Group 2 was 38% which was significantly higher than in Group 1 (). While SB tumours were equally common in both groups, AE was commoner in Group 2 (). Conclusion. A significant proportion of patients <50 years are referred for CE. Although the DY is lower compared to those ≥50 years, significant pathology is found in this age group. CE is advisable in patients <50 years old with recurrent IDA and negative bidirectional endoscopies

Effects of glucosamine sulfate on the use of rescue non-steroidal anti-inflammatory drugs in knee osteoarthritis: Results from the Pharmaco-Epidemiology of GonArthroSis (PEGASus) study

AbstractBackground and objectiveThe use of Symptomatic Slow-Acting Drugs in Osteoarthritis (SYSADOAs) may be expected to decrease the use of concomitant medications for rescue analgesia, including non-steroidal anti-inflammatory drugs (NSAIDs). The Pharmaco-Epidemiology of GonArthroSis (PEGASus) study was designed to assess this possibility.MethodsPEGASus was a cohort study of continuous recruitment of patients with “dynamic” exposure to the investigated SYSADOA (crystalline glucosamine sulfate, glucosamine hydrochloride, chondroitin sulfate, diacerein, and avocado–soybean unsaponifiables, all at approved dosages). Investigators were rheumatologists or general practitioners randomly selected from French telephone lists. Patients diagnosed with knee osteoarthritis (OA) were recruited when consulting an investigator for a symptom flare and were prescribed, or not, one of the SYSADOAs as per clinical judgment. Follow-up visits were as per routine medical practice in the 12 months following enrollment, with telephone interviews after 1 month and at 4-month intervals thereafter up to 24 months. Use of NSAIDs was recorded, as well as the dynamism of treatment exposure consisting of continuing the prescribed SYSADOA, switching, discontinuation or initiation of a SYSADOA. Patient exposure was expressed in 2-month time units, with any NSAID use as Yes/No binary outcome during each unit. Odds ratios [OR and 95% confidence interval (CI)] of NSAID use were calculated for periods of exposure to each SYSADOA, by multivariate logistic regression for an 80% power and 95% confidence to see a decrease of at least 15%.ResultsThis report consists of the full data pertaining to crystalline glucosamine sulfate, while results of other SYSADOAs were summarized as available from the French Health Authority (HAS) website (www.has-sante.fr). Of 6451 patients in the PEGASus cohort, 315 patients received crystalline glucosamine sulfate, they were exposed for 481 2-month time units and had an incident use of NSAIDs of 18.7%. In the control cohort (9237 time units) NSAID incident use was 23.8%. Crystalline glucosamine sulfate significantly decreased the risk of NSAID consumption by up to 36% (OR = 0.64; 95% CI: 0.45–0.92) in the primary analysis foreseen by the protocol; OR was 0.74 (95% CI: 0.54–1.01), i.e. at the very limit of significance, in a sensitivity analysis accounting for an extension of the study and of the control cohort. None of the other SYSADOAs showed any hint of a decrease in the use of NSAIDs.ConclusionCrystalline glucosamine sulfate was the only SYSADOA that decreased the use of NSAIDs in this pharmaco-epidemiology study in patients with knee OA