Adult Specialists Research Articles

Specialism for larval and adult consumer resources among British butterflies: Implications for conservation

Specialism is a key issue in conserving organisms. Using a new database of consumer resources we investigate specialism among British butterflies. Different measures for the range of sources exploited by adults are compared. As number of nectar sources correlates closely with number of records, new measures of specialism based on the residuals from this relationship are developed as well as a measure generated using a Monte Carlo procedure. Clear evidence for specialism in adult feeding emerges. A number of species depend heavily on alternative substrates to nectar flowers and others on flowers which are also larval host plants. Though many species have varied nectar sources, there is confirmation of the tendency of larval host plant specialists to be adult feeding specialists. Rarity, distribution losses and conservation status are associated with nectar specialism. We suggest that habitat fragmentation and regional extinctions are exacerbating resource (nectar and host plant) specialism. We draw attention to the importance of resource databases; there is clear indication now which nectar plants are more or less suitable for different butterfly species. Nevertheless, despite the current database comprising 10,539 records, it is deficient for 29 species (<50 records each). For conservation, site-specific data obtained according to strict survey protocols are required for determining ecological relationships and to direct site management.

Adolescent urology: A challenge for adult urologists

The medical care of adolescents has become a growth area in many disciplines. There are two major aspects. Firstly, adolescents have specific medical and emotional needs which are not fulfilled either by paediatric or by adult specialists. Secondly, some childhood problems, particularly the congenital deformities, have no equivalent in adult life and so lifelong care is mandatory. Renal damage, especially dysplasia and scarring, leads to a substantial risk of early onset hypertension and, occasionally, to renal failure. Bladder outlet obstruction in utero, such as from a posterior urethral valve, causes irreversible changes to the wall that will act adversely on the kidneys in adolescence or early adulthood. The incidence of renal failure in early adulthood is about 36%. Bladder reconstruction with bowel has been very beneficial in preventing renal failure and improving continence. Life long follow-up is needed because of the high incidence of complications. These include stones, hyperchloraemic acidosis, perforation, anastomotic stenosis and, possibly, cancer. Patients have a normal expectation of sexuality and fertility. Their desires cannot always be achieved but they require considerable emotional and surgical support.

Cancer adolescent pathway in France between 1988 and 1997

We report an adolescent cancer pathway from referral, through diagnosis and treatment, to follow-up in France. All cases of cancer among 15-19 years, diagnosed from 1988 to 1997, recorded by nine French population-based cancer registries (10% of French population) were included. The management of adolescent cancer by paediatricians was rare. An adolescents' pathway through cancer care can be summarized as first visit to general practitioner, referral to adult oncologist for haematological malignancy and medical or surgical specialists for solid tumours, treatment in adult unit, and follow-up by adult oncologist, adult medical or surgical specialist, or general practitioner. Only 9% of the 15-19 years are entered into a clinical trial (respectively 6% and 3% into adult and paediatric clinical trial). The inclusion rate changes according to the diagnosis, higher for acute lymphoblastic leukaemia (39%), non-Hodgkin's lymphomas (NHL) (27%), and acute non-lymphoblastic leukaemia (20%). Only 4% of adolescent cancers were managed on shared adult/paediatric departments, especially for soft-tissue sarcomas (14.9%), malignant bone tumours (13.4), central nervous system tumours (6.2%), and NHL (4.4%). Whatever the reasons for lack of participation in clinical trials, an ideal model requiring communication and cooperation between all adult and paediatric specialists involved in adolescent cancer treatment should reduce the large gap in access to cooperative groups.

La continuité de prise en charge lors de la transition des soins de l'enfant à l'adulte handicapé

Most children born with a chronic health condition or disability are expected to live more than 20 years. Health care is provided for these children in paediatric units until they are 18 years old, and the transition to the adult health care system is difficult because of poor collaboration between specialists and families who sometimes wonder if the adult specialist will be competent, although young disabled people need specialised follow-up. This report discusses U.S. and English models in the transition in health care. Coordination between paediatricians and adult services is necessary. The neuromuscular disorders clinic is cited as an example.

A Proposed Classification of Supracondylar Femur Fractures Above Total Knee Arthroplasties

A new classification system is proposed for supracondylar femur fractures above total knee arthroplasties based on fracture location relative to the femoral component. Radiographs of 28 cases were evaluated and classified according to the proposed system by 12 physicians: 3 trauma specialists, 3 adult reconstruction specialists, 3 musculoskeletal radiologists, and 3 orthopaedic residents. The same 12 physicians reevaluated the same 28 cases 3 months later. The mean reliability coefficient for all observers was 0.74 (substantial agreement). The coefficient for reproducibility after 3 months was 0.85 (almost perfect). The power of the study was 80%. The proposed classification system is easy to use and has good interobserver reliability among orthopaedic residents, orthopaedic attendings—trauma and reconstruction—and radiologists. Intraobserver reliability was also excellent at 3 months.

LES is more: [When evaluating training

Performance ImprovementVolume 45, Issue 8 p. 8-13 Research Article LES is more: [When evaluating training] Sarah Ward, Sarah Ward Sarah Ward: is an adult learning specialist who focuses on using e-learning technology to improve and measure performance. Through her company, ALTER Inc., she has consulted with the world's largest distance learning system, Ford Motor Company's FORDSTAR, and the world's largest repository of knowledge, the Library of Congress. She uses the latest in learning technology to increase workforce productivity, through strategic planning of organizational learning, developing e-learning models, consolidating education and training efforts into corporate universities, and creating full spectrum evaluation systems. Sarah may be reached at sward@alter-inc.com.Search for more papers by this authorGodfrey Parkin, Godfrey Parkin Godfrey Parkin: , originally a South African marketing professional, has a global perspective. He spent many years in Switzerland running A. C. Nielsen's international management services operation, training marketing consultants and implementing OD initiatives worldwide. He headed a Zurich-based consulting company specializing in marketing and sales team transformation and culture change. He bootstrapped a technology company in the United Kingdom to build and market innovative simulation products, computer games, and animation properties. In 1998, he started a successful project management e-learning company in Washington, D.C,, and founded MindRise, his consulting company, soon afterward. Godfrey may be reached at gparkin@mindrise.com.Search for more papers by this authorKaren Medsker, Karen Medsker Karen Medsker: is an owner and principal consultant of Human Performance Systems, Inc., a small firm that helps organizations improve performance, primarily through developing custom training programs. For 17 years, Karen taught instructional design, performance improvement, and evaluation at Marymount University, where she is now Professor Emerita. She is the author of two books on instructional design as well as a variety of book chapters and journal articles. She is coeditor (with Michael Cassidy) of Performance Improvement Quarterly. Karen may be reached at hpsi@adelphia.net.Search for more papers by this author Sarah Ward, Sarah Ward Sarah Ward: is an adult learning specialist who focuses on using e-learning technology to improve and measure performance. Through her company, ALTER Inc., she has consulted with the world's largest distance learning system, Ford Motor Company's FORDSTAR, and the world's largest repository of knowledge, the Library of Congress. She uses the latest in learning technology to increase workforce productivity, through strategic planning of organizational learning, developing e-learning models, consolidating education and training efforts into corporate universities, and creating full spectrum evaluation systems. Sarah may be reached at sward@alter-inc.com.Search for more papers by this authorGodfrey Parkin, Godfrey Parkin Godfrey Parkin: , originally a South African marketing professional, has a global perspective. He spent many years in Switzerland running A. C. Nielsen's international management services operation, training marketing consultants and implementing OD initiatives worldwide. He headed a Zurich-based consulting company specializing in marketing and sales team transformation and culture change. He bootstrapped a technology company in the United Kingdom to build and market innovative simulation products, computer games, and animation properties. In 1998, he started a successful project management e-learning company in Washington, D.C,, and founded MindRise, his consulting company, soon afterward. Godfrey may be reached at gparkin@mindrise.com.Search for more papers by this authorKaren Medsker, Karen Medsker Karen Medsker: is an owner and principal consultant of Human Performance Systems, Inc., a small firm that helps organizations improve performance, primarily through developing custom training programs. For 17 years, Karen taught instructional design, performance improvement, and evaluation at Marymount University, where she is now Professor Emerita. She is the author of two books on instructional design as well as a variety of book chapters and journal articles. She is coeditor (with Michael Cassidy) of Performance Improvement Quarterly. Karen may be reached at hpsi@adelphia.net.Search for more papers by this author First published: 13 October 2006 https://doi.org/10.1002/pfi.4930450803Citations: 2 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume45, Issue8September 2006Pages 8-13 RelatedInformation

Eosinophilic esophagitis

Previously perceived as an anomaly, eosinophilic esophagitis is now frequently diagnosed by both pediatric and adult specialists including gastroenterologists, allergists, pathologists, and otolaryngologists. Research efforts initially focused on characterization of the clinical, endoscopic, and histologic features of this disorder. In the last 3 years, the research focus has evolved into understanding its immunologic and demographic features as well as the development of efficacious therapies. Population-based demographic studies have documented the unique epidemiologic parameters of eosinophilic esophagitis, some of its natural history, and its increasing frequency. Basic research efforts have identified cytokines relevant toward development of eosinophilic esophagitis, including interleukin-5 and interleukin-13. Clinical efforts have established the efficacy of dietary and medical treatments. Some treatments result in symptomatic improvement with ongoing inflammation, so a debate is ensuing over the long-term effect of asymptomatic esophageal inflammation. Understanding of eosinophilic esophagitis has evolved to a point at which patients can be appropriately diagnosed and initially treated; however, a paucity of long-term outcome data prevents the creation of uniform recommendations for the clinical care of patients with eosinophilic esophagitis.

Outcome in congenital heart disease

<h2>Summary</h2> Largely as a result of advances in cardiac surgery, at least 85% of children with children with congenital heart disease can expect to survive to adult life. As a consequence, there will soon be more adults than children with congenital heart disease in the United Kingdom. Although most of this group are well, a significant number will require long-term follow-up including re-operation and treatment for cardiac arrhythmias. Many will also have significant co-morbidity including learning difficulties. This is a highly specialized field that has led to the development of a new specialty—adult congenital heart disease. Close cooperation is essential between paediatric and adult congenital heart specialists and carefully planned transition to adult follow-up is essential.

The Tension between Mainstream Competence and Specialization in Adult Protection: An Evaluation of the Role of the Adult Protection Co-ordinator

With the implementation of No Secrets (Department of Health, 2000), the question of how far to specialize in adult protection has been raised for social services departments. Related issues include the extent of specialization within the vulnerable adult client groups as well as between adult protection specialists and other workers. This paper draws on an evaluation of the role of the adult protection co-ordinator across two local authority social services departments (the case study) who share adult protection policies, protocols and procedures but where the specialist role has only partially been implemented and has evolved in different ways. It identifies a number of critical considerations for the local implementation of national policy, including the particular model for adult protection specialization, working relationships with district management and care management, decision making and accountability, adult protection case management and the development of mainstream competence in adult protection.

Transition from Pediatric to Adult Medical Care

Because of recent medical advances, the number of children with chronic medical conditions who survive into adulthood has increased. The transition of care from pediatric to adult specialists and subspecialists has been rarely studied, yet it is an important aspect of care. To define issues in the pediatric patients at the University of Virginia, survey data was collected from adult nephrologists in the state. A total of 105 surveys were mailed to adult providers in Virginia. From 62 responses, 60% of adult providers did not feel completely comfortable caring for a patient with a pediatric-specific diagnosis. To efficiently receive information on new patients, adult providers preferred an abbreviated medical summary or phone call from pediatric providers. Additionally, interviews were conducted with 6 pediatric patients and their families. Patients reported a good grasp of their diagnosis and treatment, expressed an interest in learning chronic-illness coping strategies, and expressed interest in obtaining community-resource information. This study reiterated the need for additional insurance options for this at-risk population. Development of individualized transition plans and transition services are recommended to support young adult patients with chronic medical conditions as they transition into adulthood.

A Course on the Transition to Adult Care of Patients with Childhood-Onset Chronic Illnesses

Children with special health care needs born today have a 90% chance of surviving into adulthood, making their transition to adult systems of care an issue that will affect almost all physicians. However, many adult generalists and specialists are not familiar with the management of chronic diseases that begin in childhood. While the public health system has made transition to appropriate adult care a priority, and many specialty organizations have endorsed this concept, there are no published studies addressing how the concept of transition can be taught to medical students or residents. The authors describe a one-week course for medical students, begun in 2001 at their institution, that addresses the transition for youth with special health care needs, emphasizing patient and family-centered care, cultural competence, and decision making in end-of-life issues. Cystic fibrosis, a common genetic disease with increasing life expectancy, is used as the model for the course. Involvement of interdisciplinary faculty, interviews with youth with special health care needs and family caregivers, readings from academic and nonacademic literature, and group discussions are presented as teaching methods. Key insights based on experience with the course are the need to include the voices of patients and families, the use of faculty from various professions and specialties to model interdisciplinary care, and the insight that problems specific to transition offer into contemporary health care financing. Future studies should measure the impact of such courses on students' knowledge of transition issues, and determine essential information required for physicians in practice.

Joint outpatient clinics for the adult with congenital heart disease at the district general hospital: an alternative model of care

Congenital heart disease (CHD) affects approximately 250,000 adults in the UK. Most of these patients would benefit from specialized follow-up. However, there is at present a significant shortfall of specialized tertiary care expertise and facilities for this growing cardiovascular field in the UK and around the world. We aimed to report our experience with a joint adult CHD clinic run in a district general hospital with regular input from the local cardiology team and a visiting adult CHD specialist. In total, 148 patients aged 33.6+/−14.1 years were seen once or more in 12 clinics over the study period (September 1999 to January 2003). Diagnostic case mix consisted of 2.9% complex, 67.9% moderate and 29.2% minor cases of CHD. Twenty percent of patients visited the counterpart tertiary center for additional investigations (mostly MRI) and 8% for intervention (with no operative mortality). There was one death during the study period giving an overall mortality of 0.2%/year. Patients were referred to the clinic from tertiary centres, the local cardiology and paediatric clinics and with time from obstetric and community sources. Nonattendance rates were relatively low, comparing favourably with tertiary care. This model of joint care for the adult CHD patient at a general district hospital with regular onsite specialized input appears to be effective and highlights the need for additional resource allocation to provide optimal care for these patients. Our data may be useful in future planning for CHD services.

Advancing the Field of Elder Mistreatment: A New Model for Integration of Social and Medical Services

The purpose of this work is to describe the development and operation of a new model for integration of medical and social services. The Vulnerable Adult Specialist Team (VAST) provides Adult Protective Services (APS) and criminal justice agencies with access to medical experts who examine medical and psychological injuries of victims of elder abuse. This retrospective, descriptive analysis included community-dwelling elders and adults with disabilities who were reported for mistreatment and referred to VAST (n = 269). Most cases came from APS for mental status and physical examination for evidence of abuse. Cases referred to a medical response team (n = 269) were significantly different from cases that were not referred (n = 9,505). Ninety-seven percent of those who referred cases to VAST indicated that the team was helpful in confirming abuse, documenting impaired capacity, reviewing medications and medical conditions, facilitating the conservatorship process, persuading the client or family to take action, and supporting the need for law enforcement involvement. As a result, VAST has become institutionalized in our county. Amenable to replication, medical response teams for elder abuse may be useful in other counties across the nation.

The needs of physically disabled young people during transition to adult services.

The needs and provisions for health service and housing adaptation of a cohort of school leavers with physical disabilities in two inner city London health districts are described in this cross-sectional study. Fourteen young people were assessed by two consultant community paediatricians during their last year at school, using a structured proforma that includes the British Association of Community Child Health standards of functional levels. Great difficulty was encountered in identifying the subjects, partly because of inadequate information systems. Only 16 were identified out of over 12 000 school leavers. Important discrepancies were found between the needs assessed and the services provided. For the total sample, the need for 49 potential referrals to adult specialist services was identified, but 17 were not made as such services did not exist, in contrast to what had been available within paediatric services. Adult physiotherapy and occupational therapy services were particularly under-provided for young people with physical disabilities. Only a minority were eligible for housing adaptations. Suggestions are made for improvements in information systems, the transition process, revised provision of services and closer involvement of general practitioners.

Building an Adult Workplace Literacy Program for Spanish-Speaking Carpenters

In the last 15 years, adult literacy educators have witnessed an important change in how the curriculum of adult workplace literacy programs is structured. The functional approach, a method of developing curriculum which is heavily skills-based, to developing workplace literacy curriculum has dominated the adult workplace literacy research until the end of the 1990s when it fell out of favor with researchers who began to question its narrow conception of literacy and program development practices which excluded the students from participation (Bailey, 1997; Bell, 2000; Lankshear & Gee, 1997; Sticht, 1997). The social practice definition of literacy, a philosophy of curriculum development and literacy which examines the multiple ways that literacy is used in individuals' lives, emerged as an alternative and called for increased involvement of students in the development process and a wider definition of literacy and goals which reflect the students' interests and needs. Despite the promise a social practices definition of literacy holds for adult workplace literacy, discussions of how to develop and implement an adult workplace literacy program within a social practices definition have not been forthcoming. This article answers that need by providing a field-based account of how to develop and implement an adult workplace literacy program for English as a Second Language (ESL) students based upon the principles of a social practices definition of literacy, A literacy course for ESL students is slightly different from traditional ESL courses. In a traditional class, students develop all four skills: reading, writing, listening and speaking. Within an ESL literacy course, speaking and listening are not ignored but the focus is on developing reading and writing skills. The purpose of the program is to provide basic literacy instruction for the growing population of Spanish-speaking apprentice carpenters in northern Nevada. The following parties participated in the development of the program (Pseudonyms are used in place of actual names.): a college professor of English as a second language and his graduate students at the University of Nevada, Reno (UNR); the Joint Apprentice Training Committee (JATC), a union school of carpentry in northern Nevada; Spanish-speaking apprentice carpenters attending the JATC, and representatives of various construction companies. This article details the development of a curriculum for the UNR/JATC workplace ESL literacy program, with a particular emphasis on the role that the socio-cultural definition of literacy played in the development of the curriculum. The audience is adult literacy workplace specialists or business leaders interested in developing a curriculum for a similar program. After a discussion of the context for the UNR/JATC workplace ESL literacy program, we detail the steps taken in developing the curriculum. Context The JATC, located in Reno, Nevada, is one of two schools in Nevada responsible for the training of apprentice carpenters. The program is staffed by a coordinator, Sam, a full-time instructor, Brad, and a number of part-time instructors. At present, there are approximately 300 apprentices enrolled. Forty identify themselves as Spanish speakers. Entrance into a union school of carpentry requires that the applicant secure a job with a construction company, pass an exam in basic mathematics, join the union and hold a high school diploma. Apprentice carpenters are given a week off every three months to attend one in a sequence of sixteen developmentally-based classes in topics ranging from the operation of simple hand-tools in the beginning classes to complex cabinetry construction techniques at the end. Step 1: Selecting a Literacy Perspective Consistent with Richards (2001), we began the curriculum development process with a careful reading of contemporary research on literacy and curriculum development. The purpose was to find a contemporary theory of literacy which would build upon the Spanish-speaking apprentices' knowledge of carpentry and value the ways that literacy is used across multiple settings. …

Langerhans cell histiocytosis in adults: more questions than answers?

Langerhans cell histiocytosis (LCH) may affect patients of any age but in adults the features of this disease are still poorly defined. Most reports are based on single-specialty experience and there are only a few describing relatively large series of patients. Although child and adult patients share several features of the disease, and may either have localised or disseminated disease, the proportion of cases with lung involvement is much higher in adults and is partly explained by cigarette smoking. Persisting uncertainty about the pathogenesis of LCH has certainly limited current treatment alternatives. In particular, no clinical trial has been conducted in adults so far and most information derives from description of one or a few cases, often reported retrospectively. On the basis of the background provided by the data collected in its International Registry, the Histiocyte Society is about to start the first prospective, cooperative adult LCH study, aimed at: (a) establishing a common platform for clinical evaluation; (b) testing in adult patients the efficacy of the best standard chemotherapy regimen for children—a combination of prednisone and vinblastine—developed by the Society's trials; (c) describing the natural history of the disease, the impact of cigarette smoking withdrawal and the efficacy of steroid monotherapy in pulmonary LCH. Research studies, ancillary to this trial, offer unique opportunities of addressing some of the open questions in LCH including: the genetic component of the disease as supported by evidence of familial clustering and chromosomal instability, the issue of ‘LCH cells’ clonality, the relation between pulmonary disease, cigarette smoking, and immune system polymorphisms that might increase individual susceptibility to LCH. A concerted joint effort between paediatricians and adult specialists could be the key to the development of insights into LCH in all age groups affected by this distressing and often debilitating condition.

Development of pediatric pulmonology in the United Kingdom, Europe, and Australasia.

The organization of medicine in Europe, the UK and the Commonwealth countries was always much less formal than in the USA for many years and pediatricians interested in pediatric lung disease and asthma often started off as adult internists or specialists in adult pulmonary medicine. The early leaders in developing a special interest in the breathing of children during the 1940s and 1950s were predominantly physiologists and clinicians who began to apply physiological techniques to the study lung function in healthy and sick infants and children. A major contribution to our understanding of the epidemiology of wheezing in children was the early establishment of a cohort study in Australia which is still yielding important information. It was during the early 1970s that pediatric pulmonary "politics" began to emerge in the UK when pediatricians interested in lung diseases began to arrange an informal society and meet regularly under the auspices of the British Paediatric Association. In fairly characteristic fashion, pulmonology in Europe was represented for a while by several different societies but due to the efforts of some dedicated enthusiasts there finally emerged the Paediatric Assembly of the European Respiratory Society (ERS) and its first Head, Max Zach, went to become President of the ERS itself. Despite some early doubts abut the future for pediatric pulmonology as a specialty in Europe and Australasia it is clearly flourishing as shown by the rising membership of the professional societies and the constant stream of high quality basic science and clinical publications.

Better safe than sorry: a survey of safety awareness and safety provisions in the workplace among specialist registrars in the South West

Aims and MethodA questionnaire was sent to all general adult psychiatry specialist registrars (SpRs, n=33) on the largest rotation in the South West to survey their safety awareness and provision for safety in their workplace.ResultsThe response rate was 82%. Most SpRs had received training, but less than half within the previous 2 years. Only 44% had been given induction to their job and only 37% reported inclusion in local safety procedures. More than half felt they had to interview in unsuitable rooms and sometimes felt vulnerable or fearful at work. No personal involvement in violent incidents during SpR training was reported.Clinical ImplicationsImportant gaps in workplace safety provision for SpRs persist and should be addressed.

Better safe than sorry: a survey of safety awareness and safety provisions in the workplace among specialist registrars in the South West

Aims and Method A questionnaire was sent to all general adult psychiatry specialist registrars (SpRs, n=33) on the largest rotation in the South West to survey their safety awareness and provision for safety in their workplace. Results The response rate was 82%. Most SpRs had received training, but less than half within the previous 2 years. Only 44% had been given induction to their job and only 37% reported inclusion in local safety procedures. More than half felt they had to interview in unsuitable rooms and sometimes felt vulnerable or fearful at work. No personal involvement in violent incidents during SpR training was reported. Clinical Implications Important gaps in workplace safety provision for SpRs persist and should be addressed.

The patient population and requirements for optimal care

Increasing numbers of individuals born with congenital cardiac defects are surviving to adulthood. Although estimates of the size of this population vary, it seems likely that the number of adults with congenital heart disease will increase each year, and will soon exceed the number of children with congenital heart disease. Many adults with congenital heart disease have simple defects and may require minimal specialized cardiac care, but at least half of the adult population have conditions of moderate or severe complexity. There are few trained subspecialists to care for this unique group of patients, and there are no established pathways for the training of adult congenital heart disease specialists. Most will come from programs that combine training in internal medicine, cardiology and pediatric cardiology. The increased number of adults with congenital heart disease will also demand more formal training in congenital heart disease during cardiology fellowship. The low prevalence and high complexity of congenital heart disease lends itself to a model in which a local caregiver or center is supported by a regional specialized center. A regional adult congenital heart disease center is directed by an adult congenital heart disease cardiologist supported by a multidisciplinary team, and provides a variety of services including comprehensive diagnosis, management planning and patient counseling. It is proposed that improved education and training of adult congenital heart disease specialists and regionalization of care will improve access to and quality of care for this population.