Preparing adults with intellectual disabilities for their future: How do support services staff view their role?

BACKGROUND: Person-centred service delivery underpins current approaches to working with individuals with intellectual disabilities. We investigated views of staff from a service organisation regarding their roles in creating desired futures for adults with intellectual disabilities. METHODS: Data were gathered from staff of a large organisation that provided a range of services to adults with intellectual disabilities. Respondents were asked to describe their role in assisting an individual with intellectual disability to meet their goals for the future. Responses were analysed using a text analysis programme. RESULTS: Two major themes were identified: 'Support for self-determination' and 'Business-as-usual'. These themes were not entirely separate but had some overlap. There were indications that staff experienced competing demands in their role(s). CONCLUSION: Although central to person-centred planning, staff who work with adults with intellectual disabilities may not see support of self-determination as a key factor in creating a desired future.

Management of the intraoperative loss of microsurgical needles: A literature review and clinical survey.

Data on the incidence, management, and consequences of retained microsurgical needles in plastic and reconstructive surgery remains sparse. Research suggests that a mobile C-arm x-ray has a low detection rate for needles of size 8-0 or smaller. By means of a literature review, and survey, we aimed to investigate the current practice employed in the event of the intraoperative loss of a microsurgical needle. A literature review was conducted investigating the incidence, current management strategies, and consequences of retained microsurgical needles. This informed the questions included in a survey investigating management strategies employed in the intra-operative loss of a microsurgical needle. Results from the literature review show an overall low detection rate of microsurgical needles on imaging. Of the forty responders who completed the survey, 80% did not use a mobile C-arm x-ray to locate a missing microsurgical needle. Of the 20% that had done so, x-ray had been unsuccessful in locating the needle in all cases. Portable x-ray has a definite role to play in locating needles of size 7-0 or larger. This study suggests that suture needles of size 8-0 or smaller cannot be reliably detected on x-ray. Regarding management of this event, one should consider the risk of harm to the patient if retained, against the risk of searching for the needle. Based on the results of this work as well as existing published data, we advise against obtaining intra-operative x-rays in the event of a lost needle size 8-0 and above. Appropriate documentation should be completed.

Retro-Antegrade Technique in the Management of Severely Angulated Fourth and Fifth Metacarpal Neck Fractures: A Case Series.

Background: This study introduces a novel method for the management of closed metacarpal neck fractures. Kirschner wires (K-wire) are introduced in a retrograde and the wires withdrawn through skin proximally at the base of the metacarpal. The fracture is reduced using traction and the reduction is maintained by antegrade advancement of the K-wires. The aim of this study is to report the outcomes of this technique. Methods: A total of 36 patients with severely angulated closed metacarpal neck fractures underwent reduction and fixation using this novel method from January 2017 to December 2020 in centres in Ireland and Saudi Arabia. We performed a retrospective review of these patients' clinical data examining their outcomes. Results: Six months postoperatively, all fractures demonstrated bony union and correction of angulation. All patients exhibited excellent range of motion (ROM) with no significant impairment of hand function. Conclusions: The method detailed here is a simple, minimally invasive and reliable technique that has not previously been described. It is suitable for use in the management of closed metacarpal neck fractures of the fourth and fifth metacarpal, with dorsal angulation greater than 60°. Level of Evidence: Level IV (Therapeutic).

Beyond job placement: careers for refugees.

In this article, we highlight the Australian country context to advocate for career support that extends beyond initial job placement in a segmented labor market to strengthen refugees' skills and knowledge and future career development. We address systemic barriers while advocating for access to skilled career development practitioners, whose important expertise as members of multidisciplinary teams could enhance resettlement assistance. Strengthening the preparation of career development practitioners is essential for providing career support to refugees and for building capacity in the provision of resettlement services. We encourage debate within and between country contexts about ways to enhance refugees' career development.

Au-delà du placement: Carrières pour les réfugiés. Dans cet article, nous mettons en avant le contexte du pays australien pour plaider en faveur d'un soutien de carrière qui va au-delà l'insertion professionnelle initiale dans un marché du travail segmenté, afin de renforcer les compétences et les connaissances des réfugiées et leur futur développement de carrière. Nous abordons les obstacles systémiques tout en plaidant pour l'accès à des praticiennes qualifiées en développement de carrière, dont l'expertise importante en tant que membres d'équipes multidisciplinaires pourrait améliorer l'aide à la réinsertion. Le renforcement de la préparation des praticiennes en développement de carrière est essentiel pour fournir un soutien professionnel aux réfugiées et pour renforcer les capacités de prestation de services de réinsertion. Nous encourageons le débat au sein des contextes nationaux et entre eux sur les moyens d'améliorer le développement de carrière des réfugiées.

Más allá de la colocación: Carreras para refugiados. En este artículo destacamos el contexto del país australiano para abogar por un apoyo a la carrera profesional que vaya más allá de la colocación inicial en un mercado laboral segmentado para reforzar las habilidades y conocimientos de los refugiados y su futuro desarrollo profesional. Abordamos las barreras sistémicas a la vez que abogamos por el acceso a profesionales cualificados en desarrollo profesional, cuya importante experiencia como miembros de equipos multidisciplinares podría mejorar la asistencia al reasentamiento. Reforzar la preparación de los profesionales del desarrollo profesional es esencial para proporcionar apoyo profesional a los refugiados y para crear capacidad en la prestación de servicios de reasentamiento. Alentamos el debate dentro y entre los contextos nacionales sobre las formas de mejorar el desarrollo profesional de los refugiados.

Gross motor function prediction using natural language processing in cerebral palsy.

AIM: To predict ambulatory status and Gross Motor Function Classification System (GMFCS) levels in patients with cerebral palsy (CP) by applying natural language processing (NLP) to electronic health record (EHR) clinical notes. METHOD: Individuals aged 8 to 26 years with a diagnosis of CP in the EHR between January 2009 and November 2020 (~12 years of data) were included in a cross-sectional retrospective cohort of 2483 patients. The cohort was divided into train-test and validation groups. Positive predictive value, sensitivity, specificity, and area under the receiver operating curve (AUC) were calculated for prediction of ambulatory status and GMFCS levels. RESULTS: The median age was 15 years (interquartile range 10-20 years) for the total cohort, with 56% being male and 75% White. The validation group resulted in 70% sensitivity, 88% specificity, 81% positive predictive value, and 0.89 AUC for predicting ambulatory status. NLP applied to the EHR differentiated between GMFCS levels I-II and III (15% sensitivity, 96% specificity, 46% positive predictive value, and 0.71 AUC); and IV and V (81% sensitivity, 51% specificity, 70% positive predictive value, and 0.75 AUC). INTERPRETATION: NLP applied to the EHR demonstrated excellent differentiation between ambulatory and non-ambulatory status, and good differentiation between GMFCS levels I-II and III, and IV and V. Clinical use of NLP may help to individualize functional characterization and management. WHAT THIS PAPER ADDS: Natural language processing (NLP) applied to the electronic health record (EHR) can predict ambulatory status in children with cerebral palsy (CP). NLP provides good prediction of Gross Motor Function Classification System level in children with CP using the EHR. NLP methods described could be integrated in an EHR system to provide real-time information.

The intersections of migration, app-based gig work, and career development: implications for career practice and research.

The incidence of app-based gig work is expanding rapidly in developed global north countries. Many app-based gig workers are migrants from developing global south countries searching for a better life in their resettlement countries. App-based gig work, however, is insecure, irregular and potentially precarious. Access to decent work is vital for migrants' integration after resettlement and also their career development. In the context of the decent work agenda, this article explores the intersections of migration, app-based gig work, and southern migrants' career development in the global north and considers the implications for career practice and research.

Las intersecciones de la migración, los conciertos basados en apps y el desarrollo de la carrera : implicaicones para la práctica de la carrera y la investigación. La incidencia de el trabajo musical basado en apps se está expandiendo rápidamente en los países del norte global desarrollado. Muchos migrantes músicos que trabajan a partir de las apps desde países del sur global en dsarrollo, buscando una vida mejor en los países de reasentamiento. El trabajo musical basado en apps es inseguro, irregular y potencialmente precario. El acceso al. Trabajo digno es vital para la integración de los migrantes tras su reasentameinteo y también para su desarrrollo de la carrera. En el contexto de la agenda sobre el trabajo digno, este artículo explora las intersecciones del trabajo musical basado en apps y el desarrollo de la carrera de los migrantes del sur en el norte global y considera las implicacions para la práctica de la carrera y la investigación.

Les intersections entre la migration, le travail de plateforme basé sur des applications et le développement de carrière: Implications pour la pratique et la recherche en matière de carrière. L'incidence des emplois de plateforme basés sur des applications se développe rapidement dans les pays développés du Nord. De nombreux travailleurs de ce type sont des migrants originaires de pays en développement du Sud à la recherche d'une vie meilleure dans leur pays de réinstallation. Cependant, le travail de plateforme basé sur des applications est peu sûr, irrégulier et potentiellement précaire. L'accès à un travail décent est vital pour l'intégration des migrants après leur réinstallation et pour le développement de leur carrière. Dans le contexte de l'agenda pour le travail décent, cet article explore les intersections entre la migration, le travail de plateforme basé sur les applications et l'évolution de carrière des migrants du Sud dans le Nord et examine les implications pour la pratique et la recherche en matière de carrière.

The naked truth: a comprehensive clarification and classification of current 'myths' in naked mole-rat biology.

The naked mole-rat (Heterocephalus glaber) has fascinated zoologists for at least half a century. It has also generated considerable biomedical interest not only because of its extraordinary longevity, but also because of unusual protective features (e.g. its tolerance of variable oxygen availability), which may be pertinent to several human disease states, including ischemia/reperfusion injury and neurodegeneration. A recent article entitled 'Surprisingly long survival of premature conclusions about naked mole-rat biology' described 28 'myths' which, those authors claimed, are a 'perpetuation of beautiful, but falsified, hypotheses' and impede our understanding of this enigmatic mammal. Here, we re-examine each of these 'myths' based on evidence published in the scientific literature. Following Braude et al., we argue that these 'myths' fall into four main categories: (i) 'myths' that would be better described as oversimplifications, some of which persist solely in the popular press; (ii) 'myths' that are based on incomplete understanding, where more evidence is clearly needed; (iii) 'myths' where the accumulation of evidence over the years has led to a revision in interpretation, but where there is no significant disagreement among scientists currently working in the field; (iv) 'myths' where there is a genuine difference in opinion among active researchers, based on alternative interpretations of the available evidence. The term 'myth' is particularly inappropriate when applied to competing, evidence-based hypotheses, which form part of the normal evolution of scientific knowledge. Here, we provide a comprehensive critical review of naked mole-rat biology and attempt to clarify some of these misconceptions.

Insights into the Molecular Basis of Genome Stability and Pristine Proteostasis in Naked Mole-Rats.

The naked mole-rat (Heterocephalus glaber) is the longest-lived rodent, with a maximal reported lifespan of 37 years. In addition to its long lifespan - which is much greater than predicted based on its small body size (longevity quotient of ~4.2) - naked mole-rats are also remarkably healthy well into old age. This is reflected in a striking resistance to tumorigenesis and minimal declines in cardiovascular, neurological and reproductive function in older animals. Over the past two decades, researchers have been investigating the molecular mechanisms regulating the extended life- and health- span of this animal, and since the sequencing and assembly of the naked mole-rat genome in 2011, progress has been rapid. Here, we summarize findings from published studies exploring the unique molecular biology of the naked mole-rat, with a focus on mechanisms and pathways contributing to genome stability and maintenance of proteostasis during aging. We also present new data from our laboratory relevant to the topic and discuss our findings in the context of the published literature.

Electronic health record and patterns of care for children with cerebral palsy.

AIM: To characterize the patterns of care of children with cerebral palsy (CP) in a tertiary healthcare system. METHOD: Electronic health record data from 2009 to 2019 were extracted for children with CP. Machine learning hierarchical clustering was used to identify clusters of care. The ratio of in-person to care coordination visits was calculated for each specialty. RESULTS: The sample included 6369 children with CP (55.7% males, 44.3% females, 76.2% white, 94.7% non-Hispanic; with a mean age of 8y 2mo [SD 5y 10mo; range 0-21y; median 7y 1mo]) at the time of diagnosis. A total of 3.7 million in-person visits and care coordination notes were identified across 34 specialties. The duration of care averaged 5 years 5 months with five specialty interactions and 21.8 in-person visits per year per child. Seven clusters of care were identified, including: musculoskeletal and function; neurological; high-frequency/urgent care services; procedures; comorbid diagnoses; development and behavioral; and primary care. Network analysis showed shared membership among several clusters. INTERPRETATION: Coordination of care is a central element for children with CP. Medical informatics, machine learning, and big data approaches provide unique insights into care delivery to inform approaches to improve outcomes for children with CP. What this paper adds Seven primary clusters of care were identified: musculoskeletal and function; neurological; high-frequency/urgent care services; procedures; comorbid diagnoses; development and behavioral; and primary care. The in-person to care coordination visit ratio was 1:5 overall for healthcare encounters. Most interactions with care teams occur outside of in-person visits. The ratio of in-person to care coordination activities differ by specialty.