A New Motif in Halogen Bonding: Cooperative Intermolecular S-Br⋠⋠⋠O, O⋠⋠⋠F, and F⋠⋠⋠F Associations in the Crystal Packing of α,ω-Di(sulfonyl bromide) Perfluoroalkanes.

We recently reported the first examples of S-Cl⋅⋅⋅O halogen bonding complemented by short F⋅⋅⋅F contacts between neighboring chains that resulted in stabilized crystals of ClSO2 (CF2 )4 SO2 Cl and ClSO2 (CF2 )6 SO2 Cl. More recently, other researchers studied our crystallographic data further using an Independent Gradient Model (IGM), and they suggested if one goes beyond IUPAC's proposed 'less than the sum of the van der Waals radii' criterion that even more noncovalent interactions between fluorine atoms on neighboring chains as well as Cl⋅⋅⋅Cl, Cl⋅⋅⋅S, O⋅⋅⋅F, and O⋅⋅⋅S attractive interactions can be found. With that said, we have prepared samples of the related BrSO2 (CF2 )n SO2 Br derivatives (where n=4, 6, 8, and others), which give rise to even stronger S-Br⋅⋅⋅O halogen bonding interactions complemented minimally by O⋅⋅⋅F and F⋅⋅⋅F intermolecular interactions as shown by X-ray crystallography and computational chemistry using IGM isosurface plots. Additional spectroscopic characterization (multinuclear NMR, FT-IR, and MS) of the disulfonyl bromide derivatives BrSO2 (CF2 )4 SO2 Br, BrSO2 (CF2 )6 SO2 Br, and BrSO2 (CF2 )8 SO2 Br has also been obtained as well as some preliminary spectroscopic evidence for BrSO2 (CF2 )2 SO2 Br and BrSO2 CF2 O(CF2 )2 OCF2 SO2 Br. The implication of these results toward the preparation of the corresponding disulfonyl iodides is discussed.

A Grassroots Approach to Addressing the MCH Workforce Crisis.

Following predictions of a dramatic drop in the developmental-behavioral healthcare workforce by 2023 due to retirement and/or burnout, much has been written about ways to replenish or sustain needed personnel. To date, we continue to have a crisis of not enough new clinicians being attracted to the field to replenish the third of the workforce that is expected to retire. Recent concerns about increased clinician mental health problems and burnout in the wake of COVID-19 and other societal stressors add further complexity and urgency. This crisis will not be solved solely by a top-down focus on intensive graduate training or marketing to newly licensed professionals. Through the lived experience of three fellows from the Leadership Education in Neurodevelopmental and related Disabilities (LEND) program, this paper offers a "grassroots" approach to supporting people with disabilities (PWD) to weather this rebuilding period by increasing (a) their material wealth through entrepreneurship and (b) capacities for self-determination through thoughtful mentorship and considered changes in institutional culture.

"Physician's prescriptions accurately prepared" - The Mid-Nineteenth-Century Prescription Books of Four Gloucester Chemists.

Britain's mid-nineteenth-century healthcare economy has often been described as a "medical marketplace" in which struggling doctors faced intense competition from a range of unqualified rivals. Chemists and druggists, who proliferated in industrial cities and supposedly prospered by exploiting the poor and the gullible, are widely regarded as having presented a serious threat to medical livelihoods. However, the activities of four Gloucester chemists show how the dispensing of medical prescriptions brought individual chemists and doctors closer together. Competition between chemists and druggists for this trade was intense and it was instrumental in establishing them as trusted community pharmacists and giving impetus to the process of professionalization. Prescription books, an under-represented source in the literature, also show that customers for prescription medicines were surprisingly socially diverse and that most prescriptions were collected by women, with significant variation in dispensing activity through the week. This, and the volume of prescriptions being dispensed, suggest prescription medicines were regularly being used to treat chronic and less serious ailments, where collection could await normal shopping days. Significantly, prescriptions were the property of the patients and could be re-presented whenever they thought fit. For some patients, it thus effectively became an instrument of self-medication.

Association of Borderline Intellectual Functioning and Adverse Childhood Experience with adult psychiatric morbidity. Findings from a British birth cohort.

BACKGROUND: To examine whether Borderline Intellectual Functioning (BIF) and Adverse Childhood Experiences independently predict adult psychiatric morbidity. METHODS: We performed a secondary analysis of longitudinal data derived from the 1970 British Birth Cohort Study to examine whether BIF and Adverse Childhood Experiences independently predict adult mental distress as measured by the Malaise Inventory. Factor analysis was used to derive a proxy measure of IQ from cognitive testing at age 10 or 5. Variables that could be indicators of exposure to Adverse Childhood Experiences were identified and grouped into health related and socio-economic related adversity. RESULTS: Children with BIF were significantly more likely than their peers to have been exposed to Adverse Childhood Experiences (BIF mean 5.90, non-BIF mean 3.19; Mann-Whitney z = 31.74, p < 0.001). As adults, participants with BIF were significantly more likely to score above the cut-off on the Malaise Inventory. We found statistically significant relationships between the number of socio-economic Adverse Childhood Experiences and poorer adult psychiatric morbidity (r range 0.104-0.141, all p < 001). At all ages the indirect mediating effects of Adverse Childhood Experiences were significantly related to adult psychiatric morbidity. CONCLUSIONS: The relationship between BIF and adult psychiatric morbidity appears to be partially mediated by exposure to Adverse Childhood Experiences. Where possible, targeting Adverse Childhood Experiences through early detection, prevention and interventions may improve psychiatric morbidity in this population group.

Converse theorems and the local Langlands correspondence in families.

We prove a descent criterion for certain families of smooth representations of GL n ( F ) (F a p-adic field) in terms of the γ -factors of pairs constructed in Moss (Int Math Res Not 2016(16):4903-4936, 2016). We then use this descent criterion, together with a theory of γ -factors for families of representations of the Weil group W F  (Helm and Moss in Deligne-Langlands gamma factors in families, arXiv:1510.08743v3, 2015), to prove a series of conjectures, due to the first author, that give a complete description of the center of the category of smooth W ( k ) [ GL n ( F ) ] -modules (the so-called "integral Bernstein center") in terms of Galois theory and the local Langlands correspondence. An immediate consequence is the conjectural "local Langlands correspondence in families" of Emerton and Helm (Ann Sci Éc Norm Supér (4) 47(4):655-722, 2014).

End-of-life care policies and practices in pediatric skilled nursing facilities.

Although most children with intellectual and developmental disabilities reside in the community, a subset of children with severe intellectual disability and complex medical needs reside in pediatric skilled nursing facilities. These children have elevated mortality with end-of-life care (EOLC) routinely provided. The present study explored policies and practice in such settings by surveying administrators, nursing directors, and medical directors in facilities across the United States. In addition to EOLC policies and practices, staff reported on their understanding of definitions of do-not-resuscitate orders, family involvement in EOLC planning, and the availability of in-service training. The presence of an official EOLC policy was associated with higher ratings of perception of effectiveness among staff. Staff felt more prepared and comfortable providing EOLC when in-service training was provided.

Unique and universal barriers: hospice care for aging adults with intellectual disability.

As life expectancy of people with intellectual disability (ID) has increased, there has been a concurrent increase in age-related illnesses and conditions similar to that of the general population. These circumstances result in people with ID dying from typical life-ending conditions, and thus, they require similar end-of-life services such as palliative and hospice care. Although there are notable barriers to hospice for all, people with ID face additional challenges in accessing the benefits of these services. This article presents a review of the literature on these issues, underscoring the multiple challenges and the importance of a more collaborative approach between hospice and palliative care workers with people with ID, their families, and other important stakeholders.

Health information management and perceptions of the quality of care for children with tracheotomy: a qualitative study.

BACKGROUND: Children with tracheotomy receive health care from an array of providers within various hospital and community health system sectors. Previous studies have highlighted substandard health information exchange between families and these sectors. The aim of this study was to investigate the perceptions and experiences of parents and providers with regard to health information management, care plan development and coordination for children with tracheotomy, and strategies to improve health information management for these children. METHODS: Individual and group interviews were performed with eight parents and fifteen healthcare (primary and specialty care, nursing, therapist, equipment) providers of children with tracheotomy. The primary tracheotomy-associated diagnoses for the children were neuromuscular impairment (n = 3), airway anomaly (n = 2) and chronic lung disease (n = 3). Two independent reviewers conducted deep reading and line-by-line coding of all transcribed interviews to discover themes associated with the objectives. RESULTS: Children with tracheotomy in this study had healthcare providers with poorly defined roles and responsibilities who did not actively communicate with one another. Providers were often unsure where to find documentation relating to a child's tracheotomy equipment settings and home nursing orders, and perceived that these situations contributed to medical errors and delayed equipment needs. Parents created a home record that was shared with multiple providers to track the care that their children received but many considered this a burden better suited to providers. Providers benefited from the parent records, but questioned their accuracy regarding critical tracheotomy care plan information such as ventilator settings. Parents and providers endorsed potential improvement in this environment such as a comprehensive internet-based health record that could be shared among parents and providers, and between various clinical sites. CONCLUSIONS: Participants described disorganized tracheotomy care and health information mismanagement that could help guide future investigations into the impact of improved health information systems for children with tracheotomy. Strategies with the potential to improve tracheotomy care delivery could include defined roles and responsibilities for tracheotomy providers, and improved organization and parent support for maintenance of home-based tracheotomy records with web-based software applications, personal health record platforms and health record data authentication techniques.

Setting up a support group for children and their well carers who have a significant adult with a life-threatening illness.

St Richard's Hospice provides care and support for adults with a life-threatening illness and their families. Children and adolescents who are facing the loss of a significant adult are often encountered as part of its work. Whereas in the past children and young people have been supported primarily through one-to-one interactions after the adult has died, the expansion of the hospice's facilities has recently enabled it to provide an increasing amount of pre-death support, including the launch of a pre-death child and family support group. This article reflects on the benefits and challenges of setting up and running such a group and the journey the hospice has gone through so far. It is hoped that by sharing experiences, some of the benefits of group work for children and adolescents facing the loss of a significant adult can be demonstrated, and that others in the worldwide palliative care community who are considering running or are already providing such a service will be encouraged.

Efficient and effective compound management to support lead optimization.

The introduction of lean thinking and Six Sigma methodologies into the drug discovery process has become an important approach for ensuring efficient workflows while containing costs. For the compound management department at Bristol-Myers Squibb, this has resulted in a partnership with the research community to evaluate and streamline processes to enable cost-disciplined science. The authors describe the results of Lean Six Sigma approaches in the automation and informatics environment that have been optimized to support parallel processing of compounds. This new platform facilitates the rapid and simultaneous data generation from structure activity and structure liability assays. As a result of these compound management improvements, reduction of timelines and quicker decision making has been achieved in the lead optimization process.