The Prevalence of Cognitive Impairment and Dementia in Incarcerated Older Adults.

OBJECTIVES: In view of the growing number of older incarcerated persons in the United States, cognitive impairment represents one of the most challenging and costly health care issues facing the U.S. correctional system. This study examined the prevalence and correlates of this growing public health issue in the nation's largest prison system. METHODS: In this study of a random sample of 143 older (≥55 years) adults incarcerated in the Texas prison system, we assessed-using the Montreal Cognitive Assessment (MoCA)-the percentage of inmates who met the MoCA thresholds for mild cognitive impairment (MCI; <23) and dementia (<18). Due to sample size limitations, our multivariable analysis assessed the binary outcome, MoCA <23. RESULTS: Overall, 35.0% of our random sample of incarcerated older adults in Texas met the threshold for MCI and 9.1% met the threshold for dementia. After adjusting for covariates, study participants who were Black (odds ratio [OR] = 4.12, 95% confidence interval [CI] = 1.57-10.82), Hispanic (OR = 4.34, 95% CI = 1.46-12.93), and those with a diagnosis of major depressive disorder (8.56, 95% CI = 1.21-60.72) all had higher prevalence of a positive screen for MCI or dementia. Dementia was underdiagnosed in our study sample of incarcerated adults, with 15.4% of MoCA-diagnosed dementia patients having a dementia diagnosis documented in their medical records. DISCUSSION: Future studies of cognitive impairment in prisons and jails can inform health care planning and resource allocation, such as expansion of access to palliative care, advance care planning, and targeted cognitive screening in older age groups.

Health and Safety in Correctional Facilities: A Framework for Action to Overcome Obstacles.

An overwhelming number of justice-involved individuals arrive in correctional settings with many complex physical and mental health conditions. Consequently, health care interventions are needed to stabilize and prevent further deterioration of these conditions. This opinion article discusses the significance of nursing care in correctional settings. The goal is to raise awareness and convince readers that this is an important issue to address. The article presents evidence from practice, court cases, and published research that supports the arguments and facts, with focus on the overarching correctional goals of public safety and rehabilitation, and the role of nurses in the achievement of those goals. Corrections and health care administrators must engage in meaningful and compromising ways to attain the correctional goals for the benefit of justice-involved individuals and the community at large.

From Institutions to Inclusion: How Children with Disabilities Gained Educational Rights in the U.S.

Children with disabilities or specialized healthcare needs were legally excluded from U.S. public education for decades, but in the last 45 years, they have gained tremendous ground in receiving comparable educational opportunities as their non-disabled peers. The purpose of this article is to provide a historical review of the educational laws which affect children with disabilities, so that school nurses who work with these children understand the impact of these laws and the resulting changes in school nursing practice. Review of the United States' educational history provides school nurses the working background necessary to recognize their key role to support the education of children with disabilities and to advocate for these children's educational rights with their parents, school officials and policy makers.

Photolytic, thermal, addition, and cycloaddition reactions of 2-diazo-5,6- and -3,8-disubstituted acenaphthenones.

Preparation and varied thermal and photolytic reactions of 2-diazo-5,6-(disubstituted)acenaphthenones (11a-d) and 2-diazo-3,8-dimethoxyacenaphthenone (12) are reported. Alcohols react thermally and photolytically with 11a-c with losses of N(2) to yield 2-alkoxynaphthenones (24a,band 47a,b) and acenaphthenones (25 and 48a,b). Aniline and diphenylamine are converted by 11a-c at 180 degrees C to acenaph[1,2-b]indoles (29a,b and 53a,b). Thermolyses of 11a-c at approximately 450 degrees C (0.15 mmHg) yield reduction products 25 and 48a,b, respectively. Wolff rearrangements to 1,8-naphthyleneketenes (15a-d) and/or their derivatives are not observed in the above experiments. Oxygen converts 11a-c thermally to acenaphthenequinones (19a-c) and/or 1,8-naphthalic anhydrides. Insertion, addition, substitution, and/or isomerization reactions occur upon irradiation of 2-diazoacenaphthenones in cyclohexane, benzene, and tetrahydrofuran. Photolysis of 11d in benzene in the presence of O(2) yields the insertion-oxidation product 2-hydroxy-5,6-dinitro-2-phenylacenaphthenone (60). Photolyses of 11a-c in nitriles result in N(2) evolution and dipolar cycloaddition to give acenaph[1,2-d]oxazoles (41 and 61a,b). Acetylenes undergo thermal and photolytic cycloaddition/1,5-sigmatropic rearrangement reactions with 11a-d with N(2) retention to give pyrazolo[5,1-a]quinolin-7-ones (69f-j). 2-Diazoacenaphthenones 1a and 11a react thermally and photolytically with electronegatively-substituted olefins with N(2) expulsion to yield (E)- and (Z)-2-oxospiro[acenaphthylene-1(2H),1'cyclopropanes] 73a-c and 74a-c, respectively. The mechanisms of the reactions of 1a, 11a-d, and 12 reported are discussed.

Determine your scope of practice.

Assignments involving large numbers of high-acuity patients often impede competent nursing care. Questioning whether assignments are within a nurse's scope of practice protects patients' safety and well-being.