A family systems perspective on supporting self-determination in young adults with intellectual and developmental disabilities.

BACKGROUND: This study explored the way families support self-determination in young adults with intellectual and developmental disabilities (IDD) during life transitions. METHOD: Qualitative case studies were conducted with two Canadian families who participated in semi-structured interviews and ethnographic observations every quarter for one year. Analyses were informed by family systems theory and self-determination theory. FINDINGS: Families considered the needs and preferences of the young adults with IDD, suggesting individualized approaches for balancing independence and protection. Families set short-term and long-term goals for increased independence, scaffolded the learning of new skills and collaborated on important choices. Collaboration occurred to the extent that all family members perceived agency in planning and implementing transitions. CONCLUSIONS: Families supported the young adults with IDD in their psychological needs for competence, relatedness and autonomy, which allowed them to experience self-determination. Findings have implications for supporting self-determination and transition planning in the family system.

Thromboelastography after Cardiopulmonary Bypass: Does it Save Blood Products?

INTRODUCTION: This study aimed to determine if thromboelastography (TEG) is associated with reduced blood product use and surgical reintervention following cardiopulmonary bypass (CPB) compared to traditional coagulation tests. METHODS: A retrospective review was conducted of 698 patients who underwent CPB at a tertiary-care, community-based, university-affiliated hospital from February 16, 2014 to February 16, 2015 (Period I) and from May 16, 2015 to May 16, 2016 (Period II). Traditional coagulation tests guided transfusion during Period I and TEG guided transfusion during Period II. Intraoperative and postoperative administration of blood products (red blood cells, fresh frozen plasma, platelets, and cryoprecipitate), reoperation for hemorrhage or graft occlusion, duration of mechanical ventilation, hospital length of stay, and mortality were recorded. RESULTS: Use of a TEG-directed algorithm was associated with a 13.5% absolute reduction in percentage of patients requiring blood products intraoperatively (48.2% vs. 34.7%, p < 0.001). TEG resulted in a 64.3% and 43.1% reduction in proportion of patients receiving fresh frozen plasma (FFP) and platelets, respectively, with a 50% reduction in volume of FFP administered (0.3 vs. 0.6 units, p < 0.001). Use of TEG was not observed to decrease postoperative blood product usage or mortality significantly. The median length of hospital stay was reduced by one day after TEG guided transfusion was implemented (nine days vs. eight days, p = 0.01). CONCLUSIONS: Use of TEG-directed transfusion of blood products following CPB appeared to decrease the need for intraoperative transfusions, but the effect on clinical outcomes has yet to be clearly determined.

The Effect of Duration of Individual Housing on Social Behavior of Adult Male Bonnet Macaques (Macaca radiata).

Project constraints often require social primates, such as macaques, to be housed individually. However, we believed the amount of time spent housed alone prior to renewed social exposure would effect an animal's behavior. We observed the behavior of adult male bonnet macaques (Macaca radiata) during time spent in an exercise pen with other adult males. We studied 2 groups (n = 3 males/group). Group one (group LT) was composed of males that had been housed alone for 24 months prior to the study, and the other group (group ST) consisted of male macaques that had been housed alone for 1 month prior to the study. One day each week for 8 weeks, members of each group were placed in an exercise pen containing items that would encourage foraging and object exploration. Seven 5-min focal observations were recorded for macaques during each session. The 2 most notable differences in social behavior were that macaques of group LT spent significantly (P = 0.003) more time alone than did macaques of group ST, whereas macaques of group ST spent significantly (P = 0.002) more time involved in social grooming than did macaques of group LT. Thus, prior duration of prior individual housing appeared to significantly affect social behavior.