The Ethical Obligations, Barriers, and Solutions for Interprofessional Collaboration in the Treatment of Autistic Individuals.

With an estimated 1 in 44 children having been diagnosed with autism and given the variety of types of service providers that treat autism, collaboration among these professionals is a necessary part of the overall treatment package for an autistic individual. However, like with any professional skill, competence in collaborating effectively must be developed, especially because behavior analysts have been criticized for being resistant to collaboration. Competence with collaboration may be developed through coursework, professional development opportunities, and supervision by someone who has demonstrated competence with collaboration. With the 2020 update to the Ethics Code for Behavior Analysts, the behavior analyst's role in collaborating with other professionals has been clarified by several expectations. Current literature also provides additional guidance on the potential barriers to collaboration as well as recommendations for how to support a collaborative team. In order to facilitate successful collaboration, it is also important to evaluate the effectiveness of the collaborative team and to take advantage of opportunities to learn about the methodologies and perspectives of the other professionals to ensure that the client's best interests are met.

A high prevalence of manual wheelchair rear-wheel misalignment could be leading to increased risk of repetitive strain injuries.

PURPOSE: To determine the prevalence and severity of manual wheelchair rear wheel misalignment in community-dwelling manual wheelchair users and estimate the associated increases in rolling resistance (RR) and risk of repetitive strain injuries (RSIs). MATERIALS AND METHODS: Data were collected in an outpatient rehabilitation clinic, a university research laboratory, and at adaptive sporting events in the United States. Two hundred active, self-propelling manual wheelchair users were recruited. Angular misalignment (referred to as toe angle) while the wheelchair was loaded with the user, and the difference between the maximum and minimum toe angle (referred to as slop) with the wheelchair unloaded. RESULTS: Average results for toe angle and slop (movement in the rear wheels) were 0.92 and 0.61 degrees, respectively. Using a lab-based testing method, we quantified the impact of increased RR forces due to misalignment in increased RR forces. Our results indicate that the average toe angle while under load and slop, without loading, measured in the community increase required propulsion force by 3.0 N. Combined toe angle and slop (i.e., the worst-case scenario) added increased propulsion force by 3.9 N. CONCLUSIONS: We found that rear-wheel misalignment was prevalent and severe enough that it may increase the risk for RSIs and decrease participation. To mitigate this issue, future work should focus on reducing misalignment through improved maintenance interventions and increased manufacturing quality through more stringent standards.Implications for RehabilitationThe work reveals a previously unknown and significant contributor to RR that could have health implications for users who self-propel.Maintenance and repairs should be adjusted to help reduce the impact of misalignment.Our results suggests that WC designers should take additional care to designs wheels and frames to minimize misalignment.Service providers setting up wheelchairs should take additional care to make sure the wheels are aligned.Users should monitor misalignment and prioritize maintaining or having their chair repaired when misalignment occurs.

Effect of three n-acetylamino acids on N-(3,5-dichlorophenyl)succinimide (NDPS) and ndps metabolite nephrotoxicity in Fischer 344 rats.

The agricultural fungicide N-(3,5-dichlorophenyl)succinimide (NDPS) induces nephrotoxicity in mammals characterized as polyuric renal failure and proximal tubular necrosis. Recent studies have suggested that NDPS-induced nephrotoxicity may be mediated by metabolites arising from the nephrotoxic NDPS metabolites N-(3,5-dichlorophenyl)-2-hydroxysuccinimide (NDHS) and/or N-(3,5-dichlorophenyl)-2-succinamic acid (2-NDHSA). The purpose of this study was to examine the effects of N-acetylcysteine (NAC), a nucleophilic agent, and two nonnucleophilic N-acetylamino acids, N-acetylserine (NAS) and N-acetylalanine (NAA), on NDPS and NDPS metabolite-induced nephrotoxicity. Male Fischer 344 rats (4-8/group) were administered intraperitoneally (ip) an N-acetylamino acid (1 mmol/kg) 2 h before an ip injection of NDPS (0.4 mmol/kg), NDHS (0.1 mmol/kg), 2-NDHSA (0.1 mmol/kg), or vehicle. Renal function was then monitored at 24 and 48 h. NAC pretreatment markedly attenuated NDPS-, NDHS-, and 2-NDHSA-mediated nephrotoxicity. The nonnucleophilic N-acetylamino acids (NAS, NAA) only partly reduced NDPS and NDHS nephrotoxicity, and they had little effect on 2-NDHSA nephrotoxicity. These results suggest that reactive NDPS metabolites may be formed from NDHS and 2-NDHSA and that nucleophilic substrates (e.g., NAC) may offer protection from NDPS-induced nephrotoxicity. However, mechanisms other than chemical neutralization of reactive NDPS metabolites may also be contributing to the attenuation of NDPS nephrotoxicity, since nonnucleophilic N-acetylamino acids (e.g., NAA) also provided some protection against NDPS and NDHS nephrotoxicity.