Older Adult Injury Risk Assessment in the Driving and Occupational Environments

Thesis (Ph.D.)--University of Washington, 2016-08

Live Work: The Impact of Direct Encounters in Statutory Child and Family Social Wor

The aim of this research project was to examine the impact of direct work on practitioners in the field of statutory child protection. The author’s premise was that this work was anything but straightforward and that surprisingly, given the intense scrutiny on Children’s Services following a child death, there was little research into the day-to-day practice of front line staff. The aim was to explore whether psychoanalytic theory could be useful in understanding and making sense of the social work task. Data was collected through observation and semi-structured interviews in one Local Authority Child in Need team over a period of six months. The findings indicated that practitioners experienced direct work with some individuals and families as profoundly disturbing and that this affected them physiologically as well as psychologically. These effects persisted over time and appeared very difficult for the workers to process or articulate. This could be expressed through embodied or non-verbal communication in the interview. Practitioners appeared to be ‘inhabited’ by particular clients, suggesting phenomena such as projective identification were in operation. The intensity and persistence of the impact on the practitioners appears to be directly related to the quality, nature and intensity of the psychic defences functioning for the particular client. Significantly, the research indicated that when practitioners were dealing with the negative and disturbing projections from the (adult) clients it seemed from the data that the focus on the child would slip so that the child appeared to recede from view. Symptoms experienced by the practitioners were akin to trauma and research and theory on primary and secondary trauma were considered. Other issues raised included shame, which affects the clients, practitioners and the organisation and the meaning and implications of this are explored. Links between neuroscience and projective identification are addressed as well as the role of the organisation, particularly as a container for these toxic and disturbing encounters.

Dependent Adult Abuse A Guide for Mandatory Reporters, July 2009

“Dependent adult” abuse allegations involve people who are aged 18 or over and are incapable of adequate self care due to physical or mental conditions and require assistance from other people. Dependent adults may be elderly or may have diminished physical or mental capacities that prevent them from meeting their own needs adequately. Researchers estimate that only 1 in 14 incidents of elder abuse actually come to the attention of law enforcement or human service agencies. Elder abuse is one of the most under-recognized and under-reported social problems in the United States. It is far less likely to be reported than child abuse because of the lack of public awareness. Nationally, it is estimated that over 55% of elder abuse is due to self-neglect. Such abuse can happen anywhere … in private homes, at health care facilities and in the community at large. Iowa has an increasing proportion of people who are aged 60 or over. The number of persons 80 or over is increasing more rapidly than any other age group. Iowa’s proportion of older adults in the population exceeds that of the United States as a whole.

Impact of parenteral nutrition standardization on costs and quality in adult patients

Background: Parenteral nutrition (PN) is a costly therapy that can also be associated with serious complications. Therefore, efforts are focusing on reducing rate of complications, and costs related to PN. Objective: The aim was to analyze the effect of the implementation of PN standardization on costs and quality criteria. Secondary aim was to assess the use of individualized PN based on patient's clinical condition. Methods: We compare the use of PN before and after the implementation of PN standardization. Demographic, clinical and PN characteristics were collected. Costs analysis was performed to study the costs associated to the two different periods. Quality criteria included were: 1) PN administration; 2) nutrition assessment (energy intake between 20-35 kcal/kg/day; protein contribution according to nitrogen balance); 3) safety and complications (hyperglycemia, hypertriglyceridemia, hepatic complications, catheter-related infection); 4) global efficacy (as serum albumin increase). Chi-square test was used to compare percentages; logistic regression analysis was performed to evaluate the use of customized PN. Results: 296 patients were included with a total of 3,167 PN compounded. During the first period standardized PN use was 47.5% vs 85.7% within the second period (p < 0.05). No differences were found in the quality criteria tested. Use of individualized PN was related to critical care patients, hypertriglyceridemia, renal damage, and long-term PN. Mean costs of the PN decreased a 19.5%. Annual costs savings would be € 86,700. Conclusions: The use of customized or standard PN has shown to be efficient and flexible to specific demands; however customized PN was significantly more expensive.

Pharmacokinetic and pharmacodynamic responses in adult patients with Chagas disease treated with a new formulation of benznidazole

controversial in chronically infected adults. We report the pharmacokinetics and pharmacodynamics in six adult patients with Chagas disease treated with the new BNZ formulation (ABARAX®) in doses between 2.5-5.5 mg/Kg/ day. All but one patient had plasmatic BNZ concentrations within the expected range. All patients finalised treatment with nondetectable Trypanosoma cruzi quantitative polymerase chain reaction, which remained nondetectable at the six month follow-up. Our data suggests parasitological responses with the new BNZ and supports the hypothesis that treatment protocols with lower BNZ doses may be effective.

Propofol causes neuronal degeneration in neonatal mice and long-term neurocognitive consequences in adult mice

Purpose: To investigate the effect of propofol on brain development in neonatal mice and long-term neurocognitive impact in adult mice. Method: The offspring of female C57Bl/6 and male CD-1 mice were administered propofol at concentrations of 2.5 and 5.0 mg/kg (treatment group) or normal saline (control) on postnatal day 7. Thereafter, histological and immunohistochemical examinations were performed on the mice brain. Apoptotic assay, neuronal nuclei antigen immunohistochemistry (to assess neuron density), and behavioral and neurocognitive tests were conducted on the adult mice. Results: Propofol induced cellular degeneration and apoptosis in the brains of neonatal mice. It also modulated physiological parameters (pH, PO2, glucose and lactate), among which decreased blood glucose might be associated with cellular degeneration in the brain. Propofol also caused long-term neuronal deficits in adults, which showed impaired neurocognitive functions. Upon reaching adulthood, propofol-treated mice showed slow learning response and poor memory compared to controls. Conclusion: Propofol causes neurodegeneration in neonatal mice and has long-term neurocognitive consequences in adults, indicating that the use of propofol anesthetics in neonates requires careful consideration.

Caffeine Intake and its Association with Disease Progression, Sleep Quality and Anxiety Symptoms and Nutritional Alterations in People Living with HIV in the Miami Adult Studies on HIV Cohort

Miami-Dade County has approximately 27,000 people living with HIV (PLWH), and the highest HIV incidence in the nation. PLWH have reported several types of sleep disturbances. Caffeine is an anorexic and lipolytic stimulant that may adversely affect sleep patterns, dietary intakes and body composition. High caffeine consumption (>250 mg. per day or the equivalent of >4 cups of brewed coffee) may also affect general functionality, adherence to antiretroviral treatment (ART) and HIV care. This study assess the relationship of high caffeine intake with markers of disease progression, sleep quality, insomnia, anxiety, nutritional intakes and body composition. A convenience sample of 130 PLWH on stable ART were recruited from the Miami Adult Studies on HIV (MASH) cohort, and followed for three months. After consenting, questionnaires on Modified Caffeine Consumption (MCCQ), Pittsburg Insomnia Rating Scale (PIRS), Pittsburg Sleep Quality Index (PSQI), Generalized Anxiety Disorder-7 (GAD-7), socio-demographics, drug and medication use were completed. CD4 count, HIV viral load, anthropometries, and body composition measures were obtained. Mean age was 47.89±6.37 years, 60.8% were male and 75.4% were African-Americans. Mean caffeine intake at baseline was 337.63 ± 304.97 mg/day (Range: 0-1498 mg/day) and did not change significantly at 3 months. In linear regression, high caffeine consumption was associated with higher CD4 cell count (β=1.532, P=0.049), lower HIV viral load (β=-1.067, P=0.048), higher global PIRS (β=1.776, P=0.046), global PSQI (β=2.587, P=0.038), and GAD-7 scores (β=1.674, P=0.027), and with lower fat mass (β=-0.994, P=0.042), energy intakes (β=-1.643, P=0.042) and fat consumption (β=-1.902, P=0.044), adjusting for relevant socioeconomic and disease progression variables. Over three months, these associations remained significant. The association of high caffeine with lower BMI weakened when excluding users of other anorexic and stimulant drugs such as cocaine and methamphetamine, suggesting that caffeine in combination, but not alone, may worsen their action. In summary, high caffeine consumption was associated with better measures of disease progression; but was also detrimental on sleep quality, nutritional intakes, BMI and body composition and associated with insomnia and anxiety. Large scale studies for longer time are needed to elucidate the contribution of caffeine to the well-being of PLWH.

Developmental, relational and situational characteristics of maritally abusive men

Rapport de stage présenté à la Faculté des Arts et Sciences en vue de l’obtention du grade de Maître des Sciences (M. Sc.) en Criminologie, Option Stage en Intervention

Routines in a European aquaculture company and the development of a Flavobacterium psychrophilum dose response pre-model in adult Rainbow Trout

An internship in a European company dealing with aquaculture and biotechnology - AquaBioTech Group, Malta - was undertaken to complete the Master Degree of Science in Aquaculture of the School of Tourism and Maritime Technology of the Polytechnic Institute of Leiria. Biotechnology and aquaculture are two areas that have been synergistically used to contribute for the progress and improvement of fish production. The AquaBioTech Group is an example of a company able to integrate these areas to maximizing their services. Located in Mosta (Malta) the company operates in a sustainable way using Recirculation Aquaculture Systems (RAS) to maintain aquaculture species. In collaboration with several companies and institutions, the AquaBioTech Group is involved and supports the development of important international research projects. The present report focuses on two important parts of the internship performed during 6 months. Initially, it will cover the operation and constitution of the company, describing the routines and techniques acquired. Then, it will describe a pathology trial that forms the practical and scientific component of this report. Despite the limitation to describe some confidential assays, this trial consisted in the infection of Rainbow Trout (Oncorhynchus mykiss) with the bacterium Flavobacterium psychrophilum in order to evaluate the mortality rates over time. The internship served to solidify theoretical knowledge acquired during the academic training, develop professional skills and provide an understanding of jobs available on the market.

Developmental, relational and situational characteristics of maritally abusive men

Rapport de stage présenté à la Faculté des Arts et Sciences en vue de l’obtention du grade de Maître des Sciences (M. Sc.) en Criminologie, Option Stage en Intervention

2007-2008 Juvenile Court Services School Liaison Program Data, July 2008

Data are provided to CJJP through statistical summary forms completed by the JCSLs. Because forms are completed only when meaningful contact between a student and a liaison takes place, only a portion of the total population served is reported. Meaningful contact is defined as having at least five contacts within a 60-day period (at any point during the academic year) regarding at least one of the referral reasons supplied on the form. Data are entered into a web-based application by the liaisons and retrieved electronically by CJJP via the internet. Service information is submitted and uploaded only at the end of the academic year.

2010-2011 Juvenile Court Services School Liaison Program Data, July 2011

Data are provided to CJJP through statistical summary forms completed by the JCSLs. Because forms are completed only when meaningful contact between a student and a liaison takes place, only a portion of the total population served is reported. Meaningful contact is defined as having at least five contacts within a 60-day period (at any point during the academic year) regarding at least one of the referral reasons supplied on the form. Data are entered into a web-based application by the liaisons and retrieved electronically by CJJP via the internet. Service information is submitted and uploaded only at the end of the academic year.

2012-2013 Juvenile Court Services School Liaison Program Data, July 2013

Data are provided to CJJP through statistical summary forms completed by the JCSLs. Because forms are completed only when meaningful contact between a student and a liaison takes place, only a portion of the total population served is reported. Meaningful contact is defined as having at least five contacts within a 60-day period (at any point during the academic year) regarding at least one of the referral reasons supplied on the form. Data are entered into a web-based application by the liaisons and retrieved electronically by CJJP via the internet. Service information is submitted and uploaded only at the end of the academic year.