Organ Donation Organization Architecture: Recommendations From an International Consensus Forum.

This report contains recommendations from 1 of 7 domains of the International Donation and Transplantation Legislative and Policy Forum (the Forum). The purpose is to provide expert guidance on the structure and function of Organ and Tissue Donation and Transplantation (OTDT) systems. The intended audience is OTDT stakeholders working to establish or improve existing systems. Methods: The Forum was initiated by Transplant Québec and co-hosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. This domain group included administrative, clinical, and academic experts in OTDT systems and 3 patient, family, and donor partners. We identified topic areas and recommendations through consensus, using the nominal group technique. Selected topics were informed by narrative literature reviews and vetted by the Forum's scientific committee. We presented these recommendations publicly, with delegate feedback being incorporated into the final report. Results: This report has 33 recommendations grouped into 10 topic areas. Topic areas include the need for public and professional education, processes to assure timely referral of patients who are potential donors, and processes to ensure that standards are properly enforced. Conclusions: The recommendations encompass the multiple roles organ donation organizations play in the donation and transplantation process. We recognize the diversity of local conditions but believe that they could be adapted and applied by organ donation organizations across the world to accomplish their fundamental objectives of assuring that everyone who desires to become an organ donor is given that opportunity in a safe, equitable, and transparent manner.

Exploratory Evaluation and Initial Adaptation of a Parent Training Program for Hispanic Families of Children with Autism.

The present paper takes a translational approach in applying the themes of the current special section to prevention and intervention science in Latino families. The paper reviews the current literature on cultural processes in prevention and intervention research with Latino families. Overall, many prevention and intervention programs have either been developed specifically for Latino families or have been modified for Latino families with great attention paid to the socio-cultural needs of these families. Nevertheless, few studies have tested the role of cultural values or acculturation processes on outcomes. We make recommendations based on findings within basic science and in particular this special section on the incorporation of these values and processes into prevention and intervention science with Latino families.

Class-Wide Function-Related Intervention Teams "CW-FIT" Efficacy Trial Outcomes.

The purpose of the study was to determine the efficacy of the Class-wide Function-related Intervention Teams (CW-FIT) program for improving students' on-task behavior, and increasing teacher recognition of appropriate behavior. The intervention is a group contingency classroom management program consisting of teaching and reinforcing appropriate behaviors (i.e., getting the teacher's attention, following directions, and ignoring inappropriate behaviors of peers). Seventeen elementary schools, the majority in urban and culturally diverse communities, participated in a randomized trial with 86 teachers (classrooms) assigned to CW-FIT, and 73 teachers (classrooms) assigned to the comparison group. Class-wide student on-task behavior improved over baseline levels in the intervention classes. Teachers were able to implement the intervention with high fidelity overall, as observed in adherence to 96% of the fidelity criteria on average. Teacher praise and attention to appropriate behaviors increased, and reprimands decreased. These effects were replicated in new classrooms each of the 4 years of the study, and for all years combined.

A comprehensive peer network intervention to improve social communication of children with autism spectrum disorders: a randomized trial in kindergarten and first grade.

The purpose of this randomized control group study was to examine the effects of a peer network intervention that included peer mediation and direct instruction for Kindergarten and First-grade children with autism spectrum disorders. Trained school staff members provided direct instruction for 56 children in the intervention group, and 39 children participated in a comparison group. Results showed children in the intervention group displayed significantly more initiations to peers than did the comparison group during non-treatment social probes and generalization probes. Treatment session data showed significant growth for total communications over baseline levels. Children in treatment also showed more growth in language and adaptive communication. Finally, teachers' ratings of prosocial skills revealed significantly greater improvements for the intervention group.

Social Communication Effects of Peer-Mediated Recess Intervention for Children with Autism.

Children with ASD face enormous challenges in the area of social functioning. Research has shown that impairments in social functioning distinguish this population from both typically developing children and children with disabilities. This study incorporated several evidence-based social skills-teaching procedures (i.e., direct instruction, priming, prompting, peer-mediation, contingent reinforcement, and token economies) directly in the recess setting to increase appropriate social behaviors for four children with ASD (ages 6-8). Elements of Peer Networks and Pivotal Response Training (two types of social skills intervention packages in the literature) were included. Results showed significant increases in social communication between focus children and their peers, as well as generalization of skills to non-intervention recesses.

Family-based risk reduction of obesity and metabolic syndrome: an overview and outcomes of the Idaho Partnership for Hispanic Health.

Mexican American women have the highest incidence of metabolic syndrome among all U.S. demographic groups. This paper details an innovative approach to reducing the risks for metabolic syndrome among Hispanic families in rural Idaho. Compañeros en Salud (CeS) is a promotora-led wellness program and community-based participatory research project from the Idaho Partnership for Hispanic Health. As behavior change is the first line of prevention and treatment of obesity and metabolic syndrome, the program aimed to improve nutrition and physical activity behaviors as well as increase community support and infrastructure for healthy living. CeS has demonstrated substantial improvement in health outcomes, with statistically significant reductions in weight, BMI, metabolic syndrome risk, A1c, glucose, blood pressure, and cholesterol, from pre-intervention to post-intervention and/or pre-intervention to one-year follow-up. These outcomes suggest the CeS model as a promising best practice for effecting individual and family-level physiologic and behavioral outcomes for obesity prevention.

Gastrointestinal flora and gastrointestinal status in children with autism--comparisons to typical children and correlation with autism severity.

BACKGROUND: Children with autism have often been reported to have gastrointestinal problems that are more frequent and more severe than in children from the general population. METHODS: Gastrointestinal flora and gastrointestinal status were assessed from stool samples of 58 children with Autism Spectrum Disorders (ASD) and 39 healthy typical children of similar ages. Stool testing included bacterial and yeast culture tests, lysozyme, lactoferrin, secretory IgA, elastase, digestion markers, short chain fatty acids (SCFA's), pH, and blood presence. Gastrointestinal symptoms were assessed with a modified six-item GI Severity Index (6-GSI) questionnaire, and autistic symptoms were assessed with the Autism Treatment Evaluation Checklist (ATEC). RESULTS: Gastrointestinal symptoms (assessed by the 6-GSI) were strongly correlated with the severity of autism (assessed by the ATEC), (r = 0.59, p < 0.001). Children with 6-GSI scores above 3 had much higher ATEC Total scores than those with 6-GSI-scores of 3 or lower (81.5 +/- 28 vs. 49.0 +/- 21, p = 0.00002).Children with autism had much lower levels of total short chain fatty acids (-27%, p = 0.00002), including lower levels of acetate, proprionate, and valerate; this difference was greater in the children with autism taking probiotics, but also significant in those not taking probiotics. Children with autism had lower levels of species of Bifidobacter (-43%, p = 0.002) and higher levels of species of Lactobacillus (+100%, p = 0.00002), but similar levels of other bacteria and yeast using standard culture growth-based techniques. Lysozyme was somewhat lower in children with autism (-27%, p = 0.04), possibly associated with probiotic usage. Other markers of digestive function were similar in both groups. CONCLUSIONS: The strong correlation of gastrointestinal symptoms with autism severity indicates that children with more severe autism are likely to have more severe gastrointestinal symptoms and vice versa. It is possible that autism symptoms are exacerbated or even partially due to the underlying gastrointestinal problems. The low level of SCFA's was partly associated with increased probiotic use, and probably partly due to either lower production (less sacchrolytic fermentation by beneficial bacteria and/or lower intake of soluble fiber) and/or greater absorption into the body (due to longer transit time and/or increased gut permeability).

A retrospective immunohistochemical study reveals atypical scrapie has existed in the United Kingdom since at least 1987.

Atypical scrapie is a relatively recent discovery, and it was unknown whether it was a new phenomenon or whether it had existed undetected in the United Kingdom national flock. Before 1998, the routine statutory diagnosis of transmissible spongiform encephalopathy (TSE) in sheep relied on the presence of TSE vacuolation in the brainstem. This method would not have been effective for the detection of atypical scrapie. Currently, immunohistochemistry (IHC) and Western blot are commonly used for the differential diagnosis of classical and atypical scrapie. The IHC pattern of PrPd deposition in atypical scrapie is very different from that in classical scrapie using the same antibody. It is thus possible that because of a lack of suitable diagnostic techniques and awareness of this form of the disease, historic cases of atypical scrapie remain undiagnosed. Immunohistochemistry was performed on selected formalin-fixed, paraffin-embedded (FFPE) blocks of ovine brain from the Veterinary Laboratories Agency archives that were submitted for various reasons, including suspect neurological disorders, between 1980 and 1989. It was found that PrPd deposits in a single case were consistent with atypical scrapie. A method was developed to obtain a PrP genotype from FFPE tissues and was applied to material from this single case, which was shown to be AHQ/AHQ. This animal was a scrapie suspect from 1987, but diagnosis was not confirmed by the available techniques at that time.

Mobile interprofessional wellness care of rural older adults.

This article describes the outcomes of an innovative program developed to deliver mobile health and wellness services to older adults residing in rural Idaho. The Senior HealthMobile project had been implemented based on a framework of interprofessional practice, with faculty and students from varied health professions providing wellness care to rural older adults. Students had participated in the community-based experience to improve access to interdisciplinary wellness care and enhance existing services. Outcomes are shared as they relate to the experience of the students over the initial 6-year implementation of the project, with future perspectives and opportunities also presented.

Rates of ethanol metabolism decrease in sons of alcoholics following a priming dose of ethanol.

Rapid changes in rates of ethanol metabolism in response to acute ethanol administration have been observed in animals and humans. To examine whether this phenomenon might vary by risk for alcoholism, 23 young men with a positive family history of alcoholism (family history positive [FHP]) were compared to 15 young men without a family history of alcoholism (family history negative [FHN]). Rates of ethanol metabolism were measured in all subjects first after an initial ethanol dose (0.85 g/kg) and then, several hours later, a second dose (0.3 g/kg), and the two rates were compared. The two groups of subjects were similar in their histories of ethanol consumption. FHP subjects demonstrated faster initial rates of ethanol metabolism, 148+/-36 mg/kg/h, compared to FHN subjects, 124+/-18 mg/kg/h, P=.01. However, FHN subjects increased their rate of metabolism by 10+/-27% compared to a decrease of -15+/-24% in FHP subjects, P=.007. Fifty-two percent of the FHP and none of the FHN subjects exhibited a decline in metabolic rate of 20% or more, P=.0008. Since a significant proportion of FHP subjects exhibited a decrease in the second rate of ethanol metabolism, these preliminary data might help to partly explain why FHP individuals differ in their sensitivity to ethanol and are more likely to develop alcohol dependence.

Changes in students' perceptions of interdisciplinary practice reaching the older adult through mobile service delivery.

This study examined students' perceptions of interdisciplinary health care practice in a facilitated, community-based practicum experience. Students' perceptions of interdisciplinary practice relative to their own profession and other health disciplines were examined before and after involvement in mobile service delivery to the older adult in a collaborative team approach. The Interdisciplinary Education Perception Scale was used to collect data before and after planned and facilitated interdisciplinary experiences of students enrolled in health professional programs (nursing, dietetics, physical therapy, occupational therapy, pharmacy, health education, social work, and physician assistant). Univariate repeated-measures analysis of variance revealed significant pretest to posttest and discipline effects following the interdisciplinary interaction of students in the practicum experience. Univariate analysis revealed a significant change in students' perceptions of professional competence and autonomy, actual cooperation and resource sharing within and across professions, and understanding of the value and contributions of other professionals from pretest to posttest. The findings support the need for educators to facilitate communication through innovative interdisciplinary clinical opportunities for health professions students to influence perceptions that promote active participation in a team approach to care delivery in an increasingly complex health care system.

The quest for an efficacious antiviral for respiratory syncytial virus.

Respiratory syncytial virus (RSV) continues as an emerging infectious disease not only among infants and children, but also for the immune-suppressed, hospitalized and the elderly. To date, ribavirin (Virazole) remains the only therapeutic agent approved for the treatment of RSV. The prophylactic administration of palivizumab is problematic and costly. The quest for an efficacious RSV antiviral has produced a greater understanding of the viral fusion process, a new hypothesis for the mechanism of action of ribavirin, and a promising antisense strategy combining the 2'-5' oligoadenylate antisense (2-5A-antisense) approach and RSV genomics.