Identification and support of autistic individuals within the UK Criminal Justice System: a practical approach based upon professional consensus with input from lived experience

Background: Autism spectrum disorder (hereafter referred to as autism) is characterised by difficulties with (i) social communication, social interaction, and (ii) restricted and repetitive interests and behaviours. Estimates of autism prevalence within the criminal justice system (CJS) vary considerably, but there is evidence to suggest that the condition can be missed or misidentified within this population. Autism has implications for an individual’s journey through the CJS, from police questioning and engagement in court proceedings through to risk assessment, formulation, therapeutic approaches, engagement with support services, and long-term social and legal outcomes. Methods: This consensus based on professional opinion with input from lived experience aims to provide general principles for consideration by United Kingdom (UK) CJS personnel when working with autistic individuals, focusing on autistic offenders and those suspected of offences. Principles may be transferable to countries beyond the UK. Multidisciplinary professionals and two service users were approached for their input to address the effective identification and support strategies for autistic individuals within the CJS. Results: The authors provide a consensus statement including recommendations on the general principles of effective identification, and support strategies for autistic individuals across different levels of the CJS. Conclusion: Greater attention needs to be given to this population as they navigate the CJS.Acknowledgements: We are grateful to the assistance of SW and MK, two service users who reviewed and contributed to the manuscript

Identification and support of autistic individuals within the UK Criminal Justice System: a practical approach based upon professional consensus with input from lived experience

Background: Autism spectrum disorder (hereafter referred to as autism) is characterised by difficulties with (i) social communication, social interaction, and (ii) restricted and repetitive interests and behaviours. Estimates of autism prevalence within the criminal justice system (CJS) vary considerably, but there is evidence to suggest that the condition can be missed or misidentified within this population. Autism has implications for an individual’s journey through the CJS, from police questioning and engagement in court proceedings through to risk assessment, formulation, therapeutic approaches, engagement with support services, and long-term social and legal outcomes. Methods: This consensus based on professional opinion with input from lived experience aims to provide general principles for consideration by United Kingdom (UK) CJS personnel when working with autistic individuals, focusing on autistic offenders and those suspected of offences. Principles may be transferable to countries beyond the UK. Multidisciplinary professionals and two service users were approached for their input to address the effective identification and support strategies for autistic individuals within the CJS. Results: The authors provide a consensus statement including recommendations on the general principles of effective identification, and support strategies for autistic individuals across different levels of the CJS. Conclusion: Greater attention needs to be given to this population as they navigate the CJS

A Technique for the Effective Removal of Air from a Hollow Fiber Membrane Oxygenator Circuit

This paper describes some of the ways unwanted air can be introduced into a cardiopulmonary bypass circuit and a technique which has been shown to significantly decrease the resultant bubble counts. In this study air was introduced into a circuit (Hct. 20%) containing a Hollow Fiber Membrane Oxygenator (HFMO). Conventional techniques of recirculation (3 L/min.) and vigorous agitation/percussion were compared to recirculation with vacuum (gas phase of HFMO) for efficiency in reducing bubble counts measured after three minutes by a microbubble counter. Conventional methods were ineffective after three minutes while vacuum for 3 minutes significantly (p = .001) reduced bubble counts (bubbles > 100 microns). The microporous membrane allows efficient air removal with vacuum while recirculation/percussion did little to remove air which, in a blood perfusate, was not visible to the naked eye. The application of vacuum not only increases safety but convenience when used in the priming and de bubbling of a circuit in routine and emergency case

Perfusion Error Cause Removal: The Perfusion Case Conference

Prevention of accidents is one of the fundamental elements of perfusion quality. Unfortunately, errors and accidents frequently occur during cardiopulmonary bypass. A recent retrospective survey of perfusionists identified some common accidents. We have previously reported a method of developing protocols to prevent and treat the ten most common perfusion related problems. Until we reach the day when perfusion accidents no longer occur, we need to be able to systematically evaluate failures and prevent their recurrence. We have developed a non-judgmental forum to discuss, analyze, and prevent variances or unusual circumstances that occur during cardiopulmonary bypass. We hold a monthly case conference where we discuss all cases from which we can learn something–interesting cases and cases during which there was a departure from protocol. The purpose of this paper is to discuss the development of a case conference and to outline the format and benefits of such an Error Cause Removal program

The Biomedical Technology/Information Explosion: Find Yourself A Foxhole

Approximately 5500 biomedical papers are published every day and the half-life of this information is currently only 3-4 years. Therefore, it is not only important but nearly impossible to keep up-to-date on the literature relating to one's field. This paper will propose a Journal Club (JC) format designed for perfusionists. Our experience with JC the last three years encourages us to share what we have learned about design, scheduling, benefits, pitfalls, and the evolution of a JC. We will suggest a list of 50+ journals that represent a cross section of the literature from disciplines affecting perfusionists. We will discuss techniques for surveying the literature, reporting at JC, recording participation, and creating a database for reference. JC is the best way to stay current with new information in our field and the benefits justify the effort required

An In Vitro Comparison of Micro Air Passage in the Venous Reservoir Bag

The increasing use of membrane oxygenators and collapsable venous reservoir bags (VRB) imposes a concern not associated with bubble oxygenators: Venous line air. Since no defoamer is present, a VRB must rely on flow characteristics or a barrier to remove air from the venous return. The purpose of this study is to determine the air removal efficiency of seven commercially available VRBs. Seven VRBs with clear crystaloid solution were tested for microbubble passage using an ultrasonic bubble detector at the outlet. At 5 LPM flow, 50cc of air was injected into a stopcock in the venous line. Microbubble counts were taken in six trials of each bag, and divided into three size ranges: 10–50µ, 50–100µ, and >100µ. The means and standard deviations are presented below. VR

An Experimental Evaluation of the Capiox 1.6 and 5.4M

Membrane oxygenators do not create bubbles but most will transmit the bubbles which are common in venous reservoir bags. We previously reported the elimination of arterial micro-air in the 0.8m2 Capiox when operated in the inverted position with an open purge line. This same lung failed to eliminate micro-air when operated in the conventional orientation. The purpose of this study was to test the effectiveness of the Capiox as a bubble trap in lungs with a larger surface area (subgroup a-1.6m2) (subgroup b-5.4m2) and at higher flows. Two test circuits were constructed for each size lung (Group 1—conventional orientation) (Group 11—inverted). The circuits were primed with dilute, outdated human blood (Hct. 20 ± 2%). Ten injections of air (5ml) were done for each lung in both test positions. A bubble counter on the outlet side of the lung was used to count bubbles passed through the membrane oxygenator following the air challenge. Thirty second counts were significantly higher (p<.001) in Group I than in Group II for both size lungs. The counts for both groups were: Group I(alb

A Double-Lumen Cannula for Cardioplegia Delivery and/or Air Aspiration from the Aorta during Cardiopulmonary Bypass

This paper reports the use of a double-lumen cannula designed to deliver cardioplegic solution, decompress the left heart during ischemic arrest, and aspirate air from the aorta before cardioplegic delivery and after the aortic cross-damp is removed. The unique feature of this cannula is its doublelumen design which allows air to be aspirated from the aorta prior to, and concurrent with, the beginning of the delivery of cardioplegic solution, to prevent the introduction of air into the coronary arteries. We will outline the unrecognized sources of this air and why it is advantageous to evacuate it before a subsequent infusion of cardioplegia

Is Your Oxygenator Failing? Diagnosis and Suggested Treatment

(J. Extra-Corpor. Technol. 19[3] p. 330-337 Fall 1987, 3 ref.) Oxygenator failure during open heart surgery can be a serious complication but one with which perfusionists should be prepared to deal. We hypothesize that oxygenators are often replaced unnecessarily and when they are performing within the manufacturers' specifications. This suspicion was confirmed by surveying several oxygenator manufacturers. Discriminating between oxygenator and nonoxygenator problems is critical. In the face of the correct diagnosis of oxygenator failure a simple, safe, expedient, and familiar method of replacement is needed. By using the gas transfer equations one can determine if the oxygenator is transfering adequate gas, after other associated problems are considered and ruled out. After oxygenator failure has been diagnosed, a plan for replacement which has previously been established and practiced should be implemented. We studied 2 techniques for hollow fiber membrane oxygenation (HFMO) replacement and found the risk of micro-air, as a result of the changeout procedure, decreased when the new oxygenator was vacuumed. The purpose of this paper is to help identify when/if an oxygenator is failing and suggest a planned replacement drill to help minimize confusion, delay and possible complications. We will also present a technique for decreasing the risk of micro-air which may result from a quick oxygenator changeout

Micro-Prime Circuit Facilitating Minimal Blood Use during Infant Perfusion

(J. Extra-Corpor. Technol. 19[3] p. 352-357 Fall 1987, 24 ref.) There is considerable concern about the use of blood products during cardiac surgery on the part of adult patients and the parents of pediatric patients. It has been fairly easy to eliminate blood usage in most adult patients but difficult to impossible in infants and small children. Most infant perfusion circuits require a priming volume of 500-850cc which may be cut to 400cc with substantial effort. These volumes are far in excess of the blood volume of most newborns requiring cardiac surgery. We have developed and refined a circuit using commonly available components that can be primed with as little as 265cc. The circuit consists of a Capiox II 0.8m2 lung, with a Terumo 1 OOcc venous reservoir bag and 1/4″ lines. It incorporates a level sensor, bubble detector, recirculation line, arterial GasSTAT™ sensor, and sampling and pressure monitoring lines. A priming volume this low facilitates minimal blood usage in even the smallest infants. This circuit is especially applicable for use with children of Jehovah's Witness parents. It is unique from a safety standpoint in that it not only allows level sensing and bubble detection, but the lung is inverted so the inlet is at the top and the outlet is at the bottom. This configuration causes the lung to act as a bubble trap which may decrease gaseous microemboli. We will describe this “microprime” circuit allowing minimal or no blood usage in this age group, including a review of the literature concerning the safe limits of hemodilution