Deaf role-models for Deaf children in hearing families: a scoping review.

The use of Deaf role-models (DRMs) with Deaf children born into hearing families is a practice aimed at improving outcomes for Deaf children, yet there is little peer-reviewed research available to influence future direction of such. This scoping review directs attention to available research on DRMs as a socio-linguistic and cultural viewpoint for balancing a predominantly audiological approach for early intervention for Deaf children. Systematic database searches initially yielded 132 records, of which seven articles were included in this scoping review. Findings are presented as five themes: 'Deaf Gain' and associated cultural capital, effective communication, developmental influences, family (or caregiver) attitudes to Deafness, and administration of DRM programs. Few formalized DRM programs were identified within the literature. The review concludes with recommendations for further exploration of the DRM experiences of Deaf people and their families within Australia.

Curriculum effectiveness for secondary-aged students with severe intellectual disabilities or profound and multiple learning difficulties in Australia: Teacher perspectives.

The active inclusion of students within education systems relies on a curriculum that caters to all. This article presents partial findings from Australian mixed methods research examining 46 teacher perspectives on the curriculum and its ability to support their practice in supporting students aged 12-19 years with severe intellectual disability or profound and multiple learning difficulties who attend specialist school settings. Results reveal that Australian teachers see the current curriculum as insufficient in its design and content and unable to cater to their students educational and social capacities or needs. Strengths essential to the reform process are highlighted, emergent challenges discussed and recommendations for future action are presented.

Social Capital, Loneliness, and Peer Relationships of Adolescents who are Deaf or Hard of Hearing.

There are many documented benefits of social capital to adolescents in general, and for young people who are deaf or hard of hearing social capital can potentially have a buffering effect against adverse life outcomes. Using the Loneliness and Social Dissatisfaction Questionnaire ( Asher et al., 1984; Cassidy & Asher, 1992) and the Looman Social Capital Scale ( Looman, 2006), this research investigated changes in levels of social capital and loneliness and peer relationships of deaf or hard of hearing adolescents before attending a residential camp and then three, six- and 12-months post-camp. The camp was specifically for DHH adolescents whose primary communication mode was spoken language. The study also investigated associations between social capital and adolescents' perceptions of loneliness and peer relationships. Results indicated no statistically significant change in social capital and loneliness and peer relations over the four-time points. There was a significant association between one social capital scale, common good, and loneliness. Implications of these findings are discussed, and recommendations are made for enhancing social capital development within a residential camp experience.

Increasing the Rate of Documentation of Security Interventions in the Emergency Department: Big Orange Security Sticker (BOSS) Project.

BACKGROUND: Security interventions in aggressive and violent patients in the emergency department (ED) are not always documented in the clinical record, which can compromise the effectiveness of communication, and increase clinical risks. LOCAL PROBLEM: Fewer than half of all security interventions are documented in the clinical record. METHODS: The study had a pre- and posttest design including a retrospective audit of patient medical records and a staff survey. INTERVENTION: A dedicated sticker, to be completed by nursing and security staff, was placed into the clinical notes as a record of the security intervention. RESULTS: From 1 month before to 1 month after implementation, the rate of documentation of security interventions in clinical notes increased from 43.3% to 68.8% (P = .01), and was maintained for 3 months after implementation. CONCLUSIONS: The rate of documentation of ED security interventions in clinical notes can be increased by encouraging clinicians and security staff to collaborate and share documentation responsibilities.

Services for children with hearing loss in urban and rural Australia.

OBJECTIVE: To report satisfaction with services for children with hearing loss in urban and rural Australia. DESIGN: Mixed-method approach using surveys and semi-structured interviews. SETTING: Australian organisations that serve children with hearing loss. PARTICIPANTS: One hundred parents of children with hearing loss and 91 professionals that serve children with hearing loss completed surveys. Seven parents and eight professionals were interviewed. MAIN OUTCOME MEASURES: Comparison of satisfaction with services in rural and urban areas. RESULTS: Timing of initial hearing services was similar in rural and urban areas. Children with hearing loss in rural areas had less satisfaction with services than children in urban areas. Parents of children with hearing loss in rural areas had higher costs, mainly linked to travel, than parents in urban areas. Parents and professionals were concerned that advantaged parents received more services for their child than disadvantaged parents. Parents and professionals in urban and rural areas were satisfied with mainstream education, but less satisfied with education for children with hearing loss and additional disability. Professional satisfaction was lower in rural areas than urban areas. CONCLUSIONS: This small-scale study adds to research citing reduced services in rural areas. An exception is the newborn hearing screening program, with the limited data presented indicating the program is effectively overcoming the barrier of distance. However, children with hearing loss in rural areas have reduced access to ongoing services.

Systematic Review of Literature: Social Capital and Adolescents who are Deaf or Hard of Hearing.

Outcomes have improved for adolescents who are deaf or hard of hearing (DHH) in recent years in areas such as language and speech; however, outcomes such as pragmatic and psychosocial development are still not equal to adolescents with typical hearing. This systematic review of literature explored recent research as it pertains to social capital and adolescents who are DHH. The inclusion criteria were extended to include other populations who are DHH and adolescents with other disabilities to identify future research directions. Themes identified in the reviewed literature viewed through social capital theory included psychosocial outcomes; the importance of language; the benefit of online social networking sites; the role of the family; the role of the school; inclusion and identity; role models; and post-school transition. Results demonstrated that social capital is an area with much promise as it relates to buffering outcomes for adolescents who are DHH. More empirical evidence is required in the form of quantitative research using validated social capital instruments and qualitative research that gives a voice to adolescents who are DHH. The role of social capital in facilitating inclusion, identity, and friendships, were identified as possible future research directions.

A Systematic Review of Services to DHH Children in Rural and Remote Regions.

Children in regional, rural and remote areas have less access to services than those living in urban areas. Practitioners serving children with a hearing loss have attempted to address this gap, however there are few studies investigating service access and experiences of non-metropolitan families and professionals. This systematic review evaluates the literature on service provision to children with a hearing loss living in regional, rural and remote areas of Australia. A search of five databases, the gray literature and a prominent author located 37 relevant documents. The journal articles were rated for quality and the findings of all documents were themed. The evidence from this review indicates that children with a hearing loss living in regional, rural and remote Australia experience reduced quality and frequency of service. Further investigation is needed to identify the accessibility and suitability of services for children with a hearing loss in non-metropolitan areas.

Voices of Young Deaf Adults: Supporting Adolescent Social Capital Development.

For most young people, social capital plays an important role in transitioning to postsecondary education and employment. For youth who are deaf or hard of hearing (DHH), social capital can mitigate negative effects of challenges they will likely encounter after high school. In phase 2 of a two-phase qualitative study in Australia, we investigated DHH young adults' perspectives on how DHH adolescents could best be supported to develop and use social capital to benefit their postschool transition. Nine university students whose primary communication mode was spoken language participated in semistructured interviews, discussing practical ways educators and families could assist DHH high school students. We close by recommending ways schools and families can facilitate social capital development of DHH adolescents in preparation for postsecondary education and employment. Importantly, this research gives voice to young DHH adults with the objective of improving DHH adolescents' outcomes.

The Role of Social Capital in the Transition to Postsecondary Education of Students Who Are Deaf or Hard of Hearing.

Social capital can positively influence students' postsecondary aspirations and their postschool transitions to higher education and employment. Educators, families, and young people themselves can play an active role in generating and developing adolescents' social capital. A targeted focus on developing robust social capital could play an important role in the transition planning and support provided to secondary students who are deaf or hard of hearing (DHH) and contribute to their success in postsecondary education and employment. A qualitative study gaining the perspectives of DHH young adults attending universities in Australia investigated the role of social capital in assisting DHH students in their attainment of postsecondary education. Ten DHH university students who communicated primarily through spoken English participated in semistructured interviews. Thematic analysis identified social capital facilitator themes on four levels: community, school, family, and individual. In addition, two barrier themes were identified.

Decision-Making Processes of Caregivers Choosing an Educational Setting for Children Who Are Deaf or Hard of Hearing.

Deciding on an educational setting for children who are deaf or hard of hearing (DHH) is a complex process that is not well understood. In the present study, the researchers' objective was to understand the factors caregivers consider when choosing a school for their child. Six caregivers of children who were DHH participated in semistructured interviews, which were coded into three themes (Child-Centered, Familial, School) and five subthemes (Inclusion, Additional Needs and Well-Being, Complex Process, Information Input and Flow, School Systems and Personnel). An unexpected theme (On Reflection) and three additional subthemes (Caregiver Perceptions of Education, School Character, No Regrets) were also identified. A highlighted finding is that when choosing an educational setting, caregivers of children who are DHH use decision-making processes that are complex and multifaceted. Practical implications for professionals supporting caregivers through decision-making processes are outlined, and applications for practice are suggested.

The profile, clinical characteristics, and outcomes of alcohol- and non-alcohol-related patient presentations to Queensland emergency departments: a multi-site observational study.

Objective The harmful use of alcohol is a global issue. This study aimed to describe and compare the profiles, emergency department (ED) clinical characteristics, and outcomes of alcohol-related ED presentations (ARPs) and non-alcohol-related ED presentations (NARPs). Methods A multi-site observational study of all presentations to four EDs between 4 April 2016 and 31 August 2017, was conducted. Routinely collected ED clinical, administrative and costings data were used. Classification of ARPs were prospectively recorded by clinicians. Analysis was performed at the presentation, rather than person level. Univariate tests were undertaken to compare demographics, ED clinical characteristics and outcomes between ARPs and NARPs. Results A total of 418 051 ED presentations occurred within the 17-month study period; 5% (n = 19 875) were ARPs. Presentations made by people classified as ARPs were younger, more likely to be male, present on weekends or at night, and arrive by ambulance or police compared to NARPs. Compared with NARPs, ARPs had a longer median ED length of stay of over 20 min (95% CI 18-22, median 196 min vs 177 min, P < 0.001), a 5.5% (95% CI 4.9-5.3) lower admission rate (36% vs 42%, P < 0.001), and a AUD69 (95% CI 64-75) more expensive ED episode-of-care (AUD689 vs AUD622, P < 0.001). Conclusion Clinically meaningful differences were noted between alcohol-related and non-alcohol-related ED presentations. The higher cost of care for ARPs likely reflects their longer time in the ED. The healthcare and economic implications of incidents of alcohol-related harm extend beyond the ED, with ARPs having higher rates of ambulance and police use than NARPs.

Evolving Identities of Adolescents Who Are Deaf or Hard of Hearing: A Scoping Review.

The authors employed a scoping review to examine peer-reviewed journal articles published 2002-2020 focusing on adolescents who are deaf or hard of hearing and their self-reported identities. d/Deaf identity theory was explored in light of recent advances in developed countries, e.g., universal newborn hearing screening, increased access to mainstream school placements, and rising rates of cochlear implantation. Key themes were explored, including deafness acculturation, competing and complementary identities, and flexibility and fluidity. The results demonstrated that the way adolescents perceive their identity is evolving, in what is often a flexible and fluid process dependent on the adolescents' context. Other identities, such as those relating to ethnicity and culture, were often seen as equal in importance to one's d/Deaf identity. These findings are contrasted with those of wider research on d/Deaf identity, and further research investigating adolescents' perceptions of themselves is recommended.

Service accessibility for children with hearing loss in rural areas of the United States and Canada.

OBJECTIVES: Children in rural areas have difficulty accessing the same services as their urban peers, which is a particular challenge in large countries such as the U.S. and Canada. Despite known problems providing services in rural areas, there is limited research investigating services for children with hearing loss living in rural areas. This scoping review examines the accessibility of services for children with hearing loss in rural U.S. and Canada. METHODS: The search strategy included four databases and gray literature from 2008-2018. Eight government documents and 16 articles met the inclusion criteria and the main findings in the literature were themed. RESULTS: Children with hearing loss, experienced difficulties accessing specialized services which influenced the timing of diagnosis of hearing loss, receiving hearing technology and accessing ongoing support. Families in rural areas also had access to less information about hearing loss than urban families. Managing funding and health insurance was also a challenge for families in rural areas. CONCLUSION: The limited research in this area indicates that children with hearing loss in rural areas can experience barriers when accessing the same services as their urban peers. Limited service provision can negatively influence outcomes for children with hearing loss. Alternate service delivery such as teleintervention and visiting specialists can improve service provision in rural areas. Comprehensive research of the experience of children with hearing loss across states, provinces and territories would guide improvements to services for children with hearing loss in rural areas of the U.S. and Canada.

Security interventions are frequently undocumented in emergency department clinical notes.

OBJECTIVE: To compare the documentation of security interventions in ED presentations between clinical notes and security records. METHODS: Presentations (n = 680) were randomly selected from all ED presentations to a public tertiary referral hospital in Queensland, Australia between April 2016 and August 2017 that were perceived by the treating clinician as alcohol-related. Retrospective data, manually extracted from clinical notes and the security service database, were compared for the documentation of any security interventions. Security interventions were defined as observation without physical contact, verbal de-escalation or physical restraint by security officers. RESULTS: Forty-one presentations had security interventions documented in the security services database and, of those, 20 (48.8%) had documentation in the clinical notes. Patients who required security interventions were admitted to hospital in higher proportions compared with those who did not (73.2% vs 26.8%, respectively, P < 0.0001). CONCLUSION: The rate of documentation of security interventions in clinical notes was less than 50%. Documentation of critical information, including alerts and risks, in the clinical notes is an essential component of communication that the multi-disciplinary team use to ensure patient safety. Strategies aimed at improving the documentation of security interventions in clinical notes will help to optimise risk management and the safety of patients, staff and visitors along the continuum of care.

Exploring the Social Capital of Adolescents Who Are Deaf or Hard of Hearing and Their Parents: A Preliminary Investigation.

The study explored the social capital of Australian adolescents who were deaf or hard of hearing (DHH) and their parents, and investigated the relationship between social capital and individual characteristics, language, literacy, and psychosocial outcomes. Sixteen adolescents (ages 11-14 years) and 24 parents enrolled in the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study completed an online questionnaire on social capital and psychosocial outcomes. Information about demographics, language, and literacy was retrieved from the LOCHI study database. On average, parent-rated social capital was positively related to adolescent-rated social capital, but not to child outcomes. Aspects of adolescent-reported social capital were significantly related to the adolescents' language and reading skills, but not to psychosocial outcomes. This study gives support to the promotion of social capital in adolescents who are DHH and their families, and considers how social capital promotion could be applied in interventions.

DNA microarray analysis of gene expression in human optic nerve head astrocytes in response to hydrostatic pressure.

There is clinical and experimental evidence that elevated intraocular pressure (IOP), a mechanical stress, is involved in the pathogenesis of glaucomatous optic neuropathy. The mechanism by which astrocytes in the optic nerve head (ONH) respond to changes in IOP is under study. Gene transcription by ONH astrocytes exposed either to 60 mmHg hydrostatic pressure (HP) or control ambient pressure (CP) for 6, 24, and 48 h was compared using Affymetrix GeneChip microarrays to identify HP-responsive genes. Data were normalized across arrays within each gene. A linear regression model applied to test effect of time and HP on changes in expression level identified 596 genes affected by HP over time. Using GeneSpring analysis we selected genes whose average expression level increased or decreased more than 1.5-fold at 6, 24, or 48 h. Expression of selected genes was confirmed by real-time RT-PCR; protein levels were detected by Western blot. Among the genes highly responsive to HP were those involved in signal transduction, such as Rho nucleotide exchange factors, Ras p21 protein activator, tyrosine kinases and serine threonine kinases, and genes involved in transcriptional regulation, such as c-Fos, Egr2, and Smad3. Other genes that increased expression included ATP-binding cassettes, solute carriers, and genes associated with lipid metabolism. Among the genes that decreased expression under HP were genes encoding for dual activity phosphatases, transcription factors, and enzymes involved in protein degradation. These HP-responsive genes may be important in the establishment and maintenance of the ONH astrocyte phenotype under conditions of elevated IOP in glaucoma.

Use of pharmacogenetics and clinical factors to predict the maintenance dose of warfarin.

Knowledge of pharmacogenetics may help clinicians predict their patients' therapeutic dose of warfarin, thereby decreasing the risk of bleeding during warfarin initiation. Our goal was to use pharmacogenetics to develop an algorithm that uses genetic, clinical, and demographic factors to estimate the warfarin dose a priori. We collected a blood sample, demographic variables, laboratory values, smoking status, names of medications, and dietary history from 369 patients who were taking a maintenance dose of warfarin. Using polymerase chain reaction, we genotyped each participant for the presence of 8 polymorphisms in the cytochrome P450 2C9 system. Using multiple regression, we quantified the association between warfarin dose and all factors. Advanced age, lower body surface area (BSA), and the presence of cytochrome P450 2C9 *2 or *3 single nucleotide polymorphisms were strongly associated (P < 0.001) with lower warfarin dose: the maintenance dose decreased by 8% per decade of age, by 13% per standard deviation decrease in BSA, by 19% per 2C9*2 allele, and by 30% per 2C9*3 allele. Warfarin doses were 29% lower in patients who took amiodarone, 12% lower in patients who took simvastatin, 21% lower in patients whose target INR was 2.5 rather than 3.0, and 11% lower in white rather than African-American participants (P < 0.05 for these comparisons). An algorithm that included these factors and one of borderline significance (sex), explained 39% of the variance in the maintenance warfarin dose. Use of this pharmacogenetic model had potential to prevent patients from being overdosed when initiating warfarin: we estimate that only 24 (6.5%) patients would have been over- dosed by >2 mg/day with pharmacogenetic dosing compared to 59 (16%) patients who would have been overdosed if they had been prescribed the empirical dose of 5 mg/day (P < 0.001). In conclusion, the maintenance warfarin dose can be estimated from demographic, clinical, and pharmacogenetic factors that can be obtained at the time of warfarin initiation.

Analyzing microarray data using cluster analysis.

As pharmacogenetics researchers gather more detailed and complex data on gene polymorphisms that effect drug metabolizing enzymes, drug target receptors and drug transporters, they will need access to advanced statistical tools to mine that data. These tools include approaches from classical biostatistics, such as logistic regression or linear discriminant analysis, and supervised learning methods from computer science, such as support vector machines and artificial neural networks. In this review, we present an overview of another class of models, cluster analysis, which will likely be less familiar to pharmacogenetics researchers. Cluster analysis is used to analyze data that is not a priori known to contain any specific subgroups. The goal is to use the data itself to identify meaningful or informative subgroups. Specifically, we will focus on demonstrating the use of distance-based methods of hierarchical clustering to analyze gene expression data.

Promoting higher blood pressure targets for frail older adults: a consensus guideline from Canada.

The authors, who are members of the Dalhousie Academic Detailing Service and the Palliative and Therapeutic Harmonization program, recommend that antihypertensive treatment be less intense in elderly patients who are frail. This paper reviews their recommendations and the evidence behind them.