Effective Pain Assessment Conducted by Nursing for Developmentally Disabled Clients: An Integrative Literature Review

Background: Individuals with intellectual and developmental disabilities (IDD) cannot be cared for in the same way that typically developed individuals are cared for, especially when it comes to pain assessment. Self-report is currently the gold standard for pain assessment, making it difficult for nurses to manage the pain of individuals who cannot self-report. Techniques and strategies must be altered to provide effective care for developmentally impaired individuals to ensure their pain is not left untreated. Objectives: To examine current methods of pain assessment for clients with cognitive and developmental disabilities in the hospital setting. This will help determine promising methods of pain assessment that nurses can conduct for individuals who cannot self-report pain. Methods: This integrative literature review was conducted using the keywords “pain assessment”, “pain measurement”, and “developmental disabilities”. Articles included were all in English, peer reviewed and a full-text version was available on either the DePaul University database system or the Rosalind Franklin University database system. The databases used for this literature search were the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychInfo, and PubMed databases. Results: After reviewing 15 articles for this study, three techniques were identified as useful to accurately assess pain in individuals with IDD: (1) caregiver reports, (2) behavioral pain checklists/assessment tools and pain scales, (3) a clinical pain nurse expert [also called a pain resource nurse]. These findings provide important implications for clinical practice. Conclusions:This literature review identified techniques for effective pain assessment in individuals with developmental disabilities, so their pain no longer goes unnoticed and undertreated. Those techniques include the use of caregiver and proxy reports, the use of pain assessment tools and scales, and the addition of pain nurse experts to hospital staff. These strategies for pain measurement, used separately or in concert, have the potential to reduce the presence of severe pain in individuals with IDD. Key words: pain assessment, pain measurement and developmental disabilitie

Explorations of Classroom Talk and Links to Reading Achievement in Upper Elementary Classroo

The current study reports on a large-scale quantitative analysis of classroom talk practices and links to different measures of reading achievement within upper elementary classrooms. Data involving 745 fourth- and fifth-grade teachers and 18,844 students from the Measures of Effective Teaching (MET) study were used. Talk was quantified via various talk-related indicators from 2 observation protocols and a student survey. Dimensionality analyses suggest these indicators represent 4 factors consisting of teacher explaining, questioning, encouraging of student talk, and big-picture communicating. Links to 2 different standardized reading achievement measures were also modeled with improved ratings of teacher explanations and questioning predicting higher standardized reading scores. Relationships varied, though, by different measures of classroom talk (i.e., observational protocols vs. student surveys) and levels of analysis (i.e., the student, class period, or school level). Students’ but not observers’ ratings of talk practices linked to standardized reading at the class period level, whereas observers’ ratings related to standardized reading performance at the school level. Interpretations, implications for future research, and connections to educational practice are conveyed

Legal and Policy Best Practices in Response to the Substance Abuse Crisis: A Preliminary Report

In 2017, Indiana University, in cooperation with Indiana Governor Eric Holcomb and community partners, launched the Grand Challenge: Responding to the Addictions Crisis initiative, a university-wide effort to advance interdisciplinary research and interventions in response to the substance abuse crisis affecting Indiana and the nation. The “Legal and Policy Best Practices in Response to the Substance Abuse Crisis” project is one of sixteen funded under Phase 1 of the Grand Challenge. This preliminary report outlines the initial findings of the project

Establishing broad generality of DNA catalysts for site-specific hydrolysis of single-stranded DNA

We recently reported that a DNA catalyst (deoxyribozyme) can site-specifically hydrolyze DNA on the minutes time scale. Sequence specificity is provided by Watson-Crick base pairing between the DNA substrate and two oligonucleotide binding arms that flank the 40-nt catalytic region of the deoxyribozyme. The DNA catalyst from our recent in vitro selection effort, 10MD5, can cleave a single-stranded DNA substrate sequence with the aid of Zn2+ and Mn2+ cofactors, as long as the substrate cleavage site encompasses the four particular nucleotides ATG^T. Thus, 10MD5 can cleave only 1 out of every 256 (44) arbitrarily chosen DNA sites, which is rather poor substrate sequence tolerance. In this study, we demonstrated substantially broader generality of deoxyribozymes for site-specific DNA hydrolysis. New selection experiments were performed, revealing the optimality of presenting only one or two unpaired DNA substrate nucleotides to the N40 DNA catalytic region. Comprehensive selections were then performed, including in some cases a key selection pressure to cleave the substrate at a predetermined site. These efforts led to identification of numerous new DNA-hydrolyzing deoxyribozymes, many of which require merely two particular nucleotide identities at the cleavage site (e.g. T^G), while retaining Watson-Crick sequence generality beyond those nucleotides along with useful cleavage rates. These findings establish experimentally that broadly sequence-tolerant and site-specific deoxyribozymes are readily identified for hydrolysis of single-stranded DNA

The Diesel Exhaust in Miners Study: II. Exposure Monitoring Surveys and Development of Exposure Groups

Air monitoring surveys were conducted between 1998 and 2001 at seven non-metal mining facilities to assess exposure to respirable elemental carbon (REC), a component of diesel exhaust (DE), for an epidemiologic study of miners exposed to DE. Personal exposure measurements were taken on workers in a cross-section of jobs located underground and on the surface. Air samples taken to measure REC were also analyzed for respirable organic carbon (ROC). Concurrent measurements to assess exposure to nitric oxide (NO) and nitrogen dioxide (NO2), two gaseous components of DE, were also taken. The REC measurements were used to develop quantitative estimates of average exposure levels by facility, department, and job title for the epidemiologic analysis. Each underground job was assigned to one of three sets of exposure groups from specific to general: (i) standardized job titles, (ii) groups of standardized job titles combined based on the percentage of time in the major underground areas, and (iii) larger groups based on similar area carbon monoxide (CO) air concentrations. Surface jobs were categorized based on their use of diesel equipment and proximity to DE. A total of 779 full-shift personal measurements were taken underground. The average REC exposure levels for underground jobs with five or more measurements ranged from 31 to 58 μg m−3 at the facility with the lowest average exposure levels and from 313 to 488 μg m−3 at the facility with the highest average exposure levels. The average REC exposure levels for surface workers ranged from 2 to 6 μg m−3 across the seven facilities. There was much less contrast in the ROC compared with REC exposure levels measured between surface and underground workers within each facility, as well as across the facilities. The average ROC levels underground ranged from 64 to 195 μg m−3, while on the surface, the average ROC levels ranged from 38 to 71 μg m−3 by facility, an ∼2- to 3-fold difference. The average NO and NO2 levels underground ranged from 0.20 to 1.49 parts per million (ppm) and from 0.10 to 0.60 ppm, respectively, and were ∼10 times higher than levels on the surface, which ranged from 0.02 to 0.11 ppm and from 0.01 to 0.06 ppm, respectively. The ROC, NO, and NO2 concentrations underground were correlated with the REC levels (r = 0.62, 0.71, and 0.62, respectively). A total of 80% of the underground jobs were assigned an exposure estimate based on measurements taken for the specific job title or for other jobs with a similar percentage of time spent in the major underground work areas. The average REC exposure levels by facility were from 15 to 64 times higher underground than on the surface. The large contrast in exposure levels measured underground versus on the surface, along with the differences between the mining facilities and between underground jobs within the facilities resulted in a wide distribution in the exposure estimates for evaluation of exposure–response relationships in the epidemiologic analyses

Associations of hemoglobin A1c with cognition reduced for long diabetes duration

IntroductionAssociations of some risk factors with poor cognition, identified prior to age 75, are reduced or reversed in very old age. The Protected Survivor Model predicts this interaction due to enhanced survival of those with extended risk factor duration. In a younger sample, this study examines the association of cognition with the mean hemoglobin A1c risk factor over the time at risk, according to its duration.MethodsThe interaction of mean hemoglobin A1c (averageâ =â 9.8%), evaluated over duration (averageâ =â 116.8â months), was examined for overall cognition and three cognitive domains in a sample of 150 â youngâ oldâ veterans (mean ageâ =â 70) with type 2 diabetes.ResultsThe predicted interactions were significant for overall cognition and attention, but not executive functions/language and memory.DiscussionFindings extend the Protected Survivor Model to a â youngâ oldâ sample, from the very old. This model suggests focusing on individuals with good cognition despite prolonged high risk when seeking protective factors.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152553/1/trc2jtrci201911009.pd

Discovery of Precursor LBV Outbursts in Two Recent Optical Transients: The Fitfully Variable Missing Links UGC 2773-OT and SN 2009ip

We present progenitor-star detections, light curves, and optical spectra of SN2009ip and the 2009 optical transient in UGC2773 (U2773-OT), which were not genuine SNe. Precursor variability in the decade before outburst indicates that both of the progenitor stars were LBVs. Their pre-outburst light curves resemble the S Doradus phases that preceded giant eruptions of eta Carinae and SN1954J (V12 in NGC2403), with intermediate progenitor luminosities. HST detections a decade before discovery indicate that the SN2009ip and U2773-OT progenitors were supergiants with likely initial masses of 50-80 Msun and \ga20 Msun, respectively. Both outbursts had spectra befitting known LBVs, although in different physical states. SN 2009ip exhibited a hot LBV spectrum with characteristic speeds of 550 km/s, plus faster material up to 5000 km/s, resembling the slow Homunculus and fast blast wave of eta Carinae. U2773-OT shows a forest of narrow absorption and emission lines comparable to that of S Dor in its cool state, plus [CaII] emission and an IR excess indicative of dust, similar to SN2008S and N300-OT. [CaII] emission is probably tied to a dusty pre-outburst environment, and not the outburst mechanism. SN2009ip and U2773-OT may provide a critical link between historical LBV eruptions, while U2773-OT may provide a link between LBVs and SN2008S and N300-OT. Future searches will uncover more examples of precursor LBV variability of this kind, providing key clues that may help unravel the instability driving LBVs.Comment: 18 pages, 13 Figures, accepted AJ. added significant material while revising after referee repor

A video-based educational intervention for providers regarding colorectal cancer screening

Methods: Email sent to providers asking them to complete a 7 question survey regarding knowledge and self-reported comfort in screening for colorectal cancer using a shared decision-making approach.https://jdc.jefferson.edu/patientsafetyposters/1045/thumbnail.jp

The trouble with temporary : impacts and pitfalls of a meanwhile community garden in Wythenshawe, South Manchester

The rise of Urban Agriculture projects across the UK has led to a surge of interest in their efficacy and resulting social impacts. Real Food Wythenshawe is a Lottery-funded urban food project in the UK that aims to teach the population of Wythenshawe to grow their own food and to cook from scratch. The area, popularly referred to as 'Europe's largest council estate', suffers from high levels of deprivation and has been described as a 'food desert' due to a perceived lack of access to fresh fruit and vegetables (Small World Consulting, 2013). In order to encourage Wythenshawe residents to grow their own food and to increase access to fresh fruit and vegetables, Real Food Wythenshawe aims to transform unused areas of land into growing spaces, such as allotments and community gardens. This paper focuses on research conducted at a community garden in Wythenshawe, established by Real Food Wythenshawe as an example of a 'meanwhile' or temporary growing site for people affected by cancer. The research investigated the impact of the growing activities on community garden participants through a series of observations and interviews. The findings suggest that the benefits of the space were multiple and diverse, ranging from increased growing knowledge to therapeutic effects, whilst there has been minimal effect on participants' dietary behaviour. The organisation of the community garden also raises questions over some of the practicalities of temporary urban growing sites and highlights the tensions that can arise between small community growing groups and larger institutions with control over land use. These findings add to a growing body of research that considers the value of growing in the city and reflects on the role of community gardening in deprived urban areas of the UK