Narratives of therapeutic art-making in the context of marital breakdown: Older women reflect on a significant mid-life experience

This paper explores the narratives of three women aged 65-72 years. They reflected on an episode of therapeutic art-making in midlife, which addressed depression associated with marital crisis and breakdown. The narrative analysis focused upon on the ways in which participants narrated the events leading up to their participation in therapeutic art-making; the aspects of therapeutic art-making that continued to be given significance; the characters given primacy in the stories they told about their journey through therapy and marital breakdown; meanings, symbolic and otherwise, that participants ascribed to their artwork made during this turning point in their lives; and aspects of the narratives that conveyed present-day identities and artistic endeavors. The narratives revealed the complexity of the journey through marital breakdown and depression into health, and showed that therapeutic art-making could best be understood, not as a stand-alone experience, but as given meaning within the context of wider personal and social resources. Participants looked back on therapeutic art-making that occurred two decades earlier and still described this as a significant turning point in their personal development. Art as an adjunct to counselling/therapy was not only symbolically self-expressive but provided opportunity for decision-making, agency and a reformulated self-image

IDEA Requirements for Use of PBS: Guidelines for Responsible Agencies

Positive behavioral interventions and supports (PBS) is the federal law's preferred strategy for dealing with challenging behaviors of students with disabilities. The Individuals with Disabilities Education Act (IDEA) requires PBS to be considered in all cases of students whose behavior impedes their learning or the learning of others, reflecting IDEA's preference for use of state-of-the-art technology in special education. This article explains the legal ramifications of these requirements for responsible agencies, including schools, school boards, other local educational agencies, and state educational agencies

Matrix of Federal Statutes and Federal and State Court Decisions Reflecting the Core Concepts of Disability Policy

This article sets out the 18 core concepts of policy affecting families who have children with disabilities. It defines each concept, provides a reference to the constitutional principle(s) that undergird the core concept, cites the federal statutes that reflect the core concept, and references the decisions of the United States Supreme Court and other courts interpreting or defining the core concept

Public Policy Foundations for Positive Behavioral Interventions, Strategies, and Supports

This article examines precedents that justify Congress in creating a preference for positive behavioral interventions, strategies, and supports over other interventions in the 1997 Amendments to the Individuals with Disabilities Education Act (IDEA). The authors concluded that the IDEA 1997 provisions are warranted by several well-established precedents based in constitutional law, in the right to treatment and the right to education cases, in moral philosophy, and in democratic-government philosophy

SER-109: An Oral Investigational Microbiome Therapeutic for Patients with Recurrent Clostridioides difficile Infection (rCDI)

Clostridioides difficile infection (CDI) is classified as an urgent health threat by the Centers for Disease Control and Prevention (CDC), and affects nearly 500,000 Americans annually. Approximately 20–25% of patients with a primary infection experience a recurrence, and the risk of recurrence increases with subsequent episodes to greater than 40%. The leading risk factor for CDI is broad-spectrum antibiotics, which leads to a loss of microbial diversity and impaired colonization resistance. Current FDA-approved CDI treatment strategies target toxin or toxin-producing bacteria, but do not address microbiome disruption, which is key to the pathogenesis of recurrent CDI. Fecal microbiota transplantation (FMT) reduces the risk of recurrent CDI through the restoration of microbial diversity. However, FDA safety alerts describing hospitalizations and deaths related to pathogen transmission have raised safety concerns with the use of unregulated and unstandardized donor-derived products. SER-109 is an investigational oral microbiome therapeutic composed of purified spore-forming Firmicutes. SER-109 was superior to a placebo in reducing CDI recurrence at Week 8 (12% vs. 40%, respectively; p \u3c 0.001) in adults with a history of recurrent CDI with a favorable observed safety profile. Here, we discuss the role of the microbiome in CDI pathogenesis and the clinical development of SER-109, including its rigorous manufacturing process, which mitigates the risk of pathogen transmission. Additionally, we discuss compositional and functional changes in the gastrointestinal microbiome in patients with recurrent CDI following treatment with SER-109 that are critical to a sustained clinical response

Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure

Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of hospitalization for heart failure or death from cardiovascular causes among patients with stable heart failure. However, the safety and efficacy of SGLT2 inhibitors when initiated soon after an episode of decompensated heart failure are unknown

Effect of Sotagliflozin on Total Hospitalizations in Patients With Type 2 Diabetes and Worsening Heart Failure A Randomized Trial

In the SOLOIST-WHF (Effect of Sotagliflozin on Cardiovascular Events in Patients With Type 2 Diabetes Post Worsening Heart Failure) trial, sotagliflozin, a sodium-glucose cotransporter-1 and sodium-glucose cotransporter-2 inhibitor, reduced total occurrences of cardiovascular deaths, hospitalizations for heart failure, and urgent visits for heart failure relative to placebo by 33%

Effect of Sotagliflozin on Early Mortality and Heart Failure-Related Events:A Post Hoc Analysis of SOLOIST-WHF

Background: Approximately 25% of patients admitted to hospitals for worsening heart failure (WHF) are readmitted within 30 days. Objectives: The authors conducted a post hoc analysis of the SOLOIST-WHF (Effect of Sotagliflozin on Cardiovascular Events in Patients With Type 2 Diabetes Post-WHF) trial to evaluate the efficacy of sotagliflozin versus placebo to decrease mortality and HF-related events among patients who began study treatment on or before discharge from their index hospitalization. Methods: The main endpoint of interest was cardiovascular death or HF-related event (HF hospitalization or urgent care visit) occurring within 90 and 30 days after discharge for the index WHF hospitalization. Treatment comparisons were by proportional hazards models, generating HRs, 95% CIs, and P values. Results: Of 1,222 randomized patients, 596 received study drug on or before their date of discharge. Sotagliflozin reduced the main endpoint at 90 days after discharge (HR: 0.54 [95% CI: 0.35-0.82]; P = 0.004) and at 30 days (HR: 0.49 [95% CI: 0.27-0.91]; P = 0.023) and all-cause mortality at 90 days (HR: 0.39 [95% CI: 0.17-0.88]; P = 0.024). In subgroup analyses, sotagliflozin reduced the 90-day main endpoint regardless of sex, age, estimated glomerular filtration rate, N-terminal pro-B-type natriuretic peptide, left ventricular ejection fraction, or mineralocorticoid receptor agonist use. Sotagliflozin was well-tolerated but with slightly higher rates of diarrhea and volume-related events than placebo. Conclusions: Starting sotagliflozin before discharge in patients with type 2 diabetes hospitalized for WHF significantly decreased cardiovascular deaths and HF events through 30 and 90 days after discharge, emphasizing the importance of beginning sodium glucose cotransporter treatment before discharge.</p

Precision medicine in cats:novel niemann-pick type C1 diagnosed by whole-genome sequencing

State-of-the-art health care includes genome sequencing of the patient to identify genetic variants that contribute to either the cause of their malady or variants that can be targeted to improve treatment. The goal was to introduce state-of-the-art health care to cats using genomics and a precision medicine approach. To test the feasibility of a precision medicine approach in domestic cats, a single cat that presented to the University of Missouri, Veterinary Health Center with an undiagnosed neurologic disease was whole-genome sequenced. The DNA variants from the cat were compared to the DNA variant database produced by the 99 Lives Cat Genome Sequencing Consortium. Approximately 25× genomic coverage was produced for the cat. A predicted p.H441P missense mutation was identified in NPC1, the gene causing Niemann-Pick type C1 on cat chromosome D3.47456793 caused by an adenine-to-cytosine transversion, c.1322A>C. The cat was homozygous for the variant. The variant was not identified in any other 73 domestic and 9 wild felids in the sequence database or 190 additionally genotyped cats of various breeds. The successful effort suggested precision medicine is feasible for cats and other undiagnosed cats may benefit from a genomic analysis approach. The 99 Lives DNA variant database was sufficient but would benefit from additional cat sequences. Other cats with the mutation may be identified and could be introduced as a new biomedical model for NPC1. A genetic test could eliminate the disease variant from the population