The impact of individual and organisational factors on engagement of individuals with intellectual disability living in community group homes: a multilevel model.

BACKGROUND: Being engaged in daily activities is a strong indicator of quality of life for individuals with intellectual disability (ID) who live in small community group homes. This study aimed to identify individual and organisational factors that predict high levels of engagement. METHOD: Individuals with ID (n = 78), direct support professionals (DSPs; n = 174) and supervisors (n = 21) from 21 US group homes participated in the study. For each individual with ID, we conducted 80 min of observation at the person's residence. Information was also gathered regarding demographic characteristics, DSP competence, supervisor years of experience and management practices. Data were analysed using multilevel modelling. RESULTS: On average, individuals were engaged in social activities 12% of observed time and non-social activities 35% of the time. Individuals with greater adaptive skills who were supported by more competent staff showed significantly higher levels of social engagement. Individuals with less severe deficits in adaptive behaviours and less challenging behaviour showed higher levels of non-social engagement. Although none of the factors related to group homes were significant, 24% of the variance in non-social engagement existed among group homes. CONCLUSION: These results suggested that engagement is a dynamic construct. The extent to which an individual with ID is engaged in daily life is a result of interplay between the individual's characteristics and the group home environment. Future research is needed to investigate the influence of variables specific to the group home on the engagement level of individuals with disabilities.

Evil animes and Honorable Ruptures: Reading Gabriel García Márquez's Love in the Time of Cholera through a Public Health Humanities Lens.

Extent health humanities readings of Gabriel García Márquez's Love in the Time of Cholera have focused on the doctor-patient relationship, the physician-scientist as a model for aspiring practitioners, and how individuals relate to the novel's health themes of death, disease, and disability. However, such medicine-focused readings neglect the population-level public health concerns of the novel as they relate to contagion, community, and quarantine. This paper contributes to the growing field of public health humanities by using a close reading method to explore how the competing endemic and epidemic public health issues shape the plot and metaphors of the novel.

SEIS: Insight's Seismic Experiment for Internal Structure of Mars.

By the end of 2018, 42 years after the landing of the two Viking seismometers on Mars, InSight will deploy onto Mars' surface the SEIS (Seismic Experiment for Internal Structure) instrument; a six-axes seismometer equipped with both a long-period three-axes Very Broad Band (VBB) instrument and a three-axes short-period (SP) instrument. These six sensors will cover a broad range of the seismic bandwidth, from 0.01 Hz to 50 Hz, with possible extension to longer periods. Data will be transmitted in the form of three continuous VBB components at 2 sample per second (sps), an estimation of the short period energy content from the SP at 1 sps and a continuous compound VBB/SP vertical axis at 10 sps. The continuous streams will be augmented by requested event data with sample rates from 20 to 100 sps. SEIS will improve upon the existing resolution of Viking's Mars seismic monitoring by a factor of ∼ 2500 at 1 Hz and ∼ 200 000 at 0.1 Hz. An additional major improvement is that, contrary to Viking, the seismometers will be deployed via a robotic arm directly onto Mars' surface and will be protected against temperature and wind by highly efficient thermal and wind shielding. Based on existing knowledge of Mars, it is reasonable to infer a moment magnitude detection threshold of M w ∼ 3 at 40 ∘ epicentral distance and a potential to detect several tens of quakes and about five impacts per year. In this paper, we first describe the science goals of the experiment and the rationale used to define its requirements. We then provide a detailed description of the hardware, from the sensors to the deployment system and associated performance, including transfer functions of the seismic sensors and temperature sensors. We conclude by describing the experiment ground segment, including data processing services, outreach and education networks and provide a description of the format to be used for future data distribution. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11214-018-0574-6) contains supplementary material, which is available to authorized users.

Printing Parasites: Hookworm and Public Health Narratives in Southern Fiction.

During the early twentieth century, public health campaigns taught Americans from all strata of society to recognize that a great threat to the health and prosperity of the South was not an enemy abroad, but rather a bloodsucking parasite living underfoot in Southern soil: hookworm. According to the information widely disseminated by these campaigns, hookworm infection was responsible for the physical "backwardness" of Southern men, women, and children. By linking physical and cognitive symptoms to a parasitic source, the public health campaign introduced a new literary tool for constructing characters who are not "quite right" that continues to be employed in contemporary fiction. This paper focuses on the so-called "lazy man's disease" (hookworm) and takes the work of William Faulkner as a case study to demonstrate how authors deployed a figurative form of hookworm to construct disabled, poor, and degenerate characters.

Depression and alcohol withdrawal syndrome: is antidepressant therapy associated with lower rates of hospital readmission?

BACKGROUND: Alcohol withdrawal syndrome (AWS) is a frequent cause of admission to acute care hospitals and many of these patients have a history of depression. AIM: Our objective was to determine if antidepressant use in patients with a history of depression is associated with lower rates of hospital readmission for AWS. METHODS: A retrospective study was performed of patients admitted with AWS between January 1, 2006 and December 31, 2008 to an academic tertiary referral hospital. RESULTS: Three hundred and twenty-two patients were admitted with AWS during the study period. One hundred and sixty-one patients (50 %) had no history of depression, 111 patients (34 %) had a history of depression and antidepressant use, and 50 patients (16 %) had a history of depression and no antidepressant use. There was no significant difference in the number of hospitalizations for AWS between these three groups. Patients with a history of depression on antidepressant medication were more likely to be retired or work disabled compared to the other two groups (p < 0.05). The antidepressant class most commonly used was SSRI (63 %). CONCLUSION: Our study highlights the high frequency of depression and antidepressant use in patients admitted with AWS to an acute care hospital. As alcohol withdrawal is associated with increased morbidity and mortality and depression is common in those with alcohol use disorder, further research is necessary to clarify the optimal treatment of comorbid depression and alcohol use disorder in reducing these revolving door admissions.

Outpatient management of uncomplicated lower-extremity infections in diabetic patients.

Most diabetic foot infections are believed to be caused by both aerobic and anaerobic bacteria and to require hospitalization and parenteral antimicrobial therapy. We prospectively evaluated diabetic patients with non-limb-threatening lower-extremity infections not yet treated with antibiotics. The patients were randomized to outpatient treatment with oral clindamycin hydrochloride or cephalexin for 2 weeks and evaluated every 3 to 7 days. In 56 assessable patients, curettage yielded a mean of 2.1 microorganisms. Aerobic gram-positive cocci were isolated in 50 cases (89%), and were the sole pathogen in 21 (42%) of these. Aerobic gram-negative bacilli and anaerobes were isolated in 20 (36%) and 7 (13%) cases, respectively, and almost always in polymicrobial infections. Fifty-one infections (91%) were eradicated, 42 (75%) after 2 weeks of treatment; only 5 (9%) were initially treatment failures, and 3 (5%) were subsequently cured with further outpatient oral antibiotic treatment. After a mean follow-up of 15 months, no further treatment was required in 43 (84%) of the cured patients. Previously untreated lower-extremity infections in diabetic patients are usually caused by aerobic gram-positive cocci, and generally respond well to outpatient management with oral antibiotic therapy.

Thermodynamic propensities of amino acids in the native state ensemble: implications for fold recognition.

An amino acid sequence, in the context of the solvent environment, contains all of the thermodynamic information necessary to encode a three-dimensional protein structure. To investigate the relationship between an amino acid sequence and its corresponding protein fold, a database of thermodynamic stability information was assembled that spanned 2951 residues from 44 nonhomologous proteins. This information was obtained using the COREX algorithm, which computes an ensemble-based description of the native state of a protein. It was observed that amino acid types partitioned unequally into high, medium, and low thermodynamic stability environments. Furthermore, these distributions were reproducible and were significantly different than those expected from random partitioning. To assess the structural importance of the distributions, simple fold-recognition experiments were performed based on a 3D-1D scoring matrix containing only COREX residue stability information. This procedure was able to recover amino acid sequences corresponding to correct target structures more effectively than scoring matrices derived from randomized data. High-scoring sequences were often aligned correctly with their corresponding target profiles, suggesting that calculated thermodynamic stability profiles have the potential to encode sequence information. As a control, identical fold-recognition experiments were performed on the same database of proteins using DSSP secondary structure information in the scoring matrix, instead of COREX residue stability information. The comparable performance of both approaches suggested that COREX residue stability information and secondary structure information could be of equivalent utility in more sophisticated fold-recognition techniques. The results of this work are a consequence of the idea that amino acid sequences fold not into single, rigidly stable structures but rather into thermodynamic ensembles best represented by a time-averaged structure.

Prevalence of mental retardation and developmental disabilities: estimates from the 1994/1995 National Health Interview Survey Disability Supplements.

In 1994 and 1995, the National Health Interview Survey included a Disability Supplement (NHIS-D) to collect extensive information about disabilities among individuals sampled as part of annual census-based household interview surveys. Here we describe the development and application of operational definitions of mental retardation and developmental disabilities to items in the NHIS-D to estimate prevalence. In our analyses, we estimate the prevalence of mental retardation in the noninstitutionalized population of the United States to be 7.8 people per thousand (.78%); of developmental disabilities, 11.3 people per thousand (1.13%); and the combined prevalence of mental retardation and/or developmental disabilities to be 14.9 per thousand (1.49%). Differences in prevalence estimates for mental retardation and developmental disabilities and among people of various ages are explored.

Prevalence of mental retardation and developmental disabilities: estimates from the 1994/1995 national health interview survey disability supplements.

In 1994 and 1995, the National Health Interview Survey included a Disability Supplement (NHIS-D) to collect extensive information about disabilities among individuals sampled as part of annual census-based household interview surveys. Here we describe the development and application of operational definitions of mental retardation and developmental disabilities to items in the NHIS-D to estimate prevalence. In our analyses, we estimate the prevalence of mental retardation in the noninstitutionalized population of the United States to be 7.8 people per thousand (.78%); of developmental disabilities, 11.3 people per thousand (1.13%); and the combined prevalence of mental retardation and/or developmental disabilities to be 14.9 per thousand (1.49%). Differences in prevalence estimates for mental retardation and developmental disabilities and among people of various ages are explored.

Sexual assault victims find care, support at Center.

In 1983 St. Catherine's Hospital, Kenosha, WI, began a Sexual Assault Treatment Program and Center to serve Kenosha County. The program's goals were the following: To provide medical, emotional, and spiritual care to sexual assault victim via a multidisciplinary treatment team approach. To provide emergency and ongoing counseling to sexual assault victims and their families and friends. To provide legal system advocacy and support for the victims. To educate children and adults about the prevention, recognition, and treatment of sexual assault. The center provides a 24-hour Crisis Line and a sexual assault treatment team made up of a physician, nurse, and counselor. Counselors work with the victims throughout the legal process and help them in dealing with police, the district attorney's office, and social service agencies.

Direct-care staff stability in a national sample of small group homes.

In this national study of direct-care staff members working in 101 small (6 or fewer residents) community homes, we examined staff stability in terms of turnover, staff members' perceptions of turnover problems, and their intentions to remain a careprovider. The annual turnover rate for the facilities sampled was 57.0%. Staff members indicated that they planned to remain a care provider for an average of 5.4 years (SD = 5.9). One multiple regression analysis revealed two variables that accounted for 7% of the variability in facility turnover rates. Another multiple regression analysis revealed three employee and five employer variables that accounted for 53% of the variability in intended length of stay for individual staff members. The findings confirm the importance of individual staff member characteristics to staff members' stability.

Longitudinal study of recruitment and retention in small community homes supporting persons with developmental disabilities.

Variables associated with turnover in 110 small Minnesota group homes supporting people with developmental disabilities between December 1993 and December 1996 were examined. Common staffing problems included recruiting qualified workers (reported by 57% of supervisors) and staff turnover (44%). Turnover for direct support professionals was 46%. Of workers who left, 45% left within 6 months of hire, and another 23%, between 6 and 12 months. A multiple regression analysis (with 11 variables) accounted for 34% of the variability in facility turnover rates. Variables contributing significantly to the prediction of higher turnover included greater support needs of residents, lower starting pay, less tenured supervisors, and fewer direct support professionals eligible for paid leave. Implications for practice, research, and policy were discussed.

Staff recruitment challenges and interventions in agencies supporting people with developmental disabilities.

Recruitment challenges and costs were identified by administrators from 129 randomly selected agencies that provide residential, vocational, and other services to persons with developmental disabilities in Minnesota. Finding qualified applicants was the most difficult staffing problem reported. Common recruitment incentives included providing competitive benefits, allowing time off without pay, and offering paid leave time. Relatively few agencies used innovative strategies (e.g., bonuses for employees who recruit new workers). The average agency had vacancy rates of 6% in direct-support positions and 4% in first-line supervisor positions. On the basis of these findings, one could determine that the cost of advertising and overtime for vacant positions in Minnesota could approach $6.7 million per year.

Deletion of 11q: report of two cases and a review.

A terminal deletion of the long arm of chromosome 11 is compatible with life, and the affected child uniformly shows growth and mental retardation and telecanthus. However, no clear-cut, distinctive clinical syndrome is apparent. Mental and growth retardation alone may be the sole indications for chromosome analysis, as the virtual absence of dysmorphic features in some cases (Case 2) is noteworthy. Other appropriate family members should be evaluated to determine whether there is a familial balanced reciprocal translocation present and proper genetic counseling provided.

Significant relationships and social supports of injecting drug users and their implications for HIV/AIDS services.

Strong social support networks have been associated with positive outcomes for health and well-being throughout the life-cycle. This paper investigates the structural and functional nature of social support networks of 100 injecting drug users (IDUs) in Sydney and the implications for HIV/AIDS services. Using a modified ISEL respondents saw support in terms of its tangibility of people and support, in terms of an appraisal of having friends, and as a self-esteem measure. We found the majority of respondents 'hung around' with other IDUs, lived with other IDUs, and were satisfied with the support they received from their friends. Friends appeared to be a more important source of social support than biological families and if respondents were to become HIV infected they would be more open about their status with friends than family. Where family was involved in support it was likely to be provided by mothers and siblings who were also the family members who knew about the respondent's drug use. There was no relationship between numbers of supports and satisfaction of support, suggesting quality and quantity of support were independent. Non-social supports were conceptualized primarily in terms of medical services.