Toward Competitive Employment for Persons with Intellectual and Developmental Disabilities: What Progress Have We Made and Where Do We Need to Go

Progress toward competitive integrated employment (CIE) for people with intellectual and developmental disabilities (IDD) over the last 40 years has been mixed. Despite evidence showing that supported employment interventions can enable adults with IDD to effectively get and keep jobs, national rates of integrated employment remain below a third of the working-age population. Progress is being made to improve these outcomes. Pathways have been identified that lead to CIE through supported employment, customized employment, internship experiences, and postsecondary education. The recent passage of the Workforce Innovation and Opportunity Act (WIOA) has created fresh momentum and increased the onus on interagency collaboration. This article examines what is known about promoting CIE through these pathways and highlights recommendations for future research and policy change. Recommendations for the future provide direction toward positive change for CIE into the 21st century

Aortic Dissection and Renal Failure in a Patient with Severe Hypothyroidism

Acute aortic dissection (AAD) is a life-threatening condition associated with high morbidity and mortality. The most important recognized acquired cause that leads to dissection is chronic arterial hypertension. With respect to the anuria and renal failure, aortic dissection is not something that is always considered and is still not a very common presentation unless both renal arteries come off the false lumen of the dissection. However, when present, preoperative renal failure in patients with acute type B dissection has been noted to be an independent predictor of mortality. Early recognition and diagnosis is the key and as noted by previous studies as well, almost a third of these patients are initially worked up for other causes until later when they are diagnosed with aortic dissection. Here we present a case of a patient presenting with severe hypothyroidism, long-standing hypertension, and anuria. Through the case, we highlight the importance of having aortic dissection as an important differential in patients presenting with anuria who have a long standing history of uncontrolled hypertension. Pathophysiology relating to severe hypothyroidism-induced renal dysfunction is also discussed

Exploring Nursing Students\u27 Perceptions of Electronic Fetal Monitoring App

Within the healthcare realm, innovative technology has become an integral part of teaching in today’s nursing education, specifically computer-generated teaching applications. A new application that combines both nursing simulation and teaching methods regarding electronic fetal monitoring and fetal heart rhythms was developed at the University of Tennessee in fall 2014.This application was created in collaboration with both the College of Engineering and the College of Nursing. The Electronic Fetal Monitoring App displays instructor-created fetal heart rate (FHR) and maternal contraction patterns to simulate a monitor enabling live- feed interpretation in the classroom or simulation setting. It also has the potential to be saved and recreated for further simulated learning experiences. With current nursing education using processes such as application involvement and simulation in the clinical environment, the evolvement and merger of simulation and technology applications has the potential to exponentially benefit patient outcomes. Therefore, with the creation of a novel simulation application incorporated into the classroom setting, the purpose of this qualitative descriptive study is to explore nursing students’ learning experiences, attitudes, perceptions, and opinions regarding a fluid, dynamic, instructor-manipulated EFM application

Intention Attribution and the Development of Moral Evaluation

Research with infants and toddlers suggests that even early in development, humans evaluate others by considering the outcome of an action in relation to the intention underlying it. When someone tries but fails to do a good deed, for example, it seems that it is “the thought that counts.” However, research with slightly older children in the preschool years has produced mixed results: in some cases, children are solely considering the positive or negative outcome of an action when evaluating others, while in others, intention attributions are integrated. Such contradictory findings have prompted debate about the development of moral reasoning. Here, we examine extant research on early moral evaluation and propose that differences in the way that task procedures present intention and outcome information can (1) support or preclude young children’s intention attribution and (2) alter the relative saliency or predominance of each kind of information. In turn, these differences would influence the frequency and degree to which young children generate intention-oriented moral evaluations

Age-Related Success with Elective Single versus Double Blastocyst Transfer

Background. Although the optimal outcome of assisted reproductive technology (ART) is a healthy singleton pregnancy, the rate of twin gestation from ART in women over the age of 35 is persistently high. Methods/Findings. We compared clinical pregnancy rates (PRs), ongoing pregnancy/live birth rates, and multiple gestation rates (MGRs) in 108 women who chose elective single blastocyst transfer (eSBT) to 415 women who chose elective double blastocyst transfer (eDBT) at a hospital-based IVF center. There was no significant difference in PR between eSBT and eDBT (57.4% versus 50.2%, P = 0.47) nor between eSBT and eDBT within each age group: <35, 35–37, 38–40, and >40. The risk of multiple gestations, however, was greatly increased between eSBT and eDBT (1.6 versus 32.4%, P < 0.00005), and this difference did not vary across age groups. Conclusion(s). Women undergoing eDBT are at uniformly high risk of multiple gestation regardless of age. eSBT appears to significantly lower the risk of multiple gestation without compromising PR

Washington Park Main Street Plan

There is an immense variety of privately owned businesses. They will be stakeholders because their businesses are located there, but they will also be assets in themselves in drawing people to the area. There is basically everything anyone could possible want or need in this area. There are two gas stations, a Family Dollar, a liquor store, a few sit down restaurants, numerous places where one can get a quick bite to eat, a frame shop, a clothing store, a pawn shop, a store with fresh produce (which is hard to find in urban areas), a store that sells sports uniforms, a frame shop, a lawyerʼs office, an animal hospital, two Laundromats, a record shop, a health food store, two cell phone stores, an automotive shop, and a karate school with an afterschool program. With such variety, it will draw people to the area and then give them other reasons to keep coming back

Metal-Free Room-Temperature Vulcanization of Silicones via Borane Hydrosilylation

Vulcanization of silicone networks from commercially available linear poly(dimethyl-co-methylhydro)siloxane (PMHS) and α-diketones was achieved using metal-free borane hydrosilylation at room temperature. The Lewis acid catalyst, tris(pentafluorophenyl)borane (B(C_6F_5)_3), efficiently cross-linked PMHS at minimal catalyst loadings (200–1000 ppm) to produce polymer networks with mechanical properties, thermal stability, and optical clarity rivaling that achieved from traditional platinum catalysis. Variation of the starting PMHS structure is shown to influence the final characteristics of the network. Increasing molar mass of the PMHS chain results in a higher thermal decomposition temperature, while increasing mole fractions of Si–H moieties along the backbone increase the cross-linking density and the attendant Shore hardness. The degradation behavior of the networks was investigated, with the borane-vulcanized samples showing rapid dissolution upon exposure to acid and high stability to neutral and basic conditions. Functional networks bearing halide and vinyl groups could also be prepared via a preliminary reaction of PMHS with an appropriate monoketone, providing a general and versatile strategy for network derivatization with the potential for postvulcanization functionalization being subsequently demonstrated via thiol–ene click chemistry