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As the baby boomers move into retirement and later stages of life, gerontology and geriatrics have begun to receive much more attention. Changing Aging, Changing Family Therapy explores the ways in which family therapists’ expertise in systems theory makes them uniquely qualified to take a leading role in helping families and individuals cope with the challenges and changed circumstances that aging brings. Clinicians will find detailed coverage and practical guidelines on a wealth of vital topics, including coping with the illness of a parent or partner, working past retirement age, outliving one’s savings, preserving physical and mental well-being over time, and more. Paul R. Peluso, PhD, is an associate professor of mental health counseling in the department of counselor education at Florida Atlantic University in Boca Raton, Florida. He is a licensed mental health counselor and marriage and family therapist and is the author of several books and journal articles on infidelity, counselor training, and couples therapy. Richard E. Watts, PhD, is distinguished professor of counseling and director of the Center for Research and Doctoral Studies in Counselor Education in the Department of Educational Leadership and Counseling at Sam Houston State University in Huntsville, Texas. He has published several books and numerous journal articles. Mindy Parsons is a licensed mental health counselor with a successful private practice in Delray Beach, Florida. She is a doctoral candidate at Florida Atlantic University and resides in southern Palm Beach County with her husband and their two children. \"This beautifully constructed book identifies the key issues we must address in our work to help aging individuals and their families. Filled with compassion and insight, this wonderful volume examines aging from a family-systems perspective, discussing the shifting life challenges that the elderly encounter and the ways in which those challenges affect older men, women, and their loved ones. Changing Aging, Changing Family Therapy is one of those special books that practitioners will want to have at their fingertips to guide them as they help older clients and their families to manage and enjoy the latter stages of their lives.\" —Mark Kiselica, PhD, dean of education and professor of counselor education at the College of New Jersey \"This book is what baby boomers have been waiting for. It is a timely assessment of the realities inherent in aging, and it is skillful in the way it equips therapists to work with clients both directly and indirectly affected by aging. Changing Aging, Changing Family Therapy is a must for practitioners, students, and professors.\" — Rita Chi-Ying Chung, PhD, author of Social Justice Counseling: The Next Steps Beyond Multiculturalism \"What an outstanding group of authors! From finance to health and from work to intimacy (including same-sex couples), this book covers the many critical aspects of what happens as we age and how this affects our relationships. Changing Aging, Changing Family Therapy is more than a book for professionals in the fields of gerontology or marriage and family therapy. Anyone who is in a relationship and is aging will gain critically important knowledge from this book.\" — Mark Pope, EdD, professor of counseling and family therapy at the University of Missouri–Saint Louis and past president of the American Counseling Association \"This book does an exceptional job presenting what no one has done: acclimatizing family therapy to the baby boomer population. The in-depth interviews with four of the family therapy masters are a rich addition to the book. This is a must read for family therapists our changing times.\" — Fred Bemak, EdD, professor and director of the Diversity Research and Action Center, George Mason University \"In general, the book educates family therapists and other counseling professionals on the many different factors to be considered in dealing with aging family systems… The overall strength of the book is that it is a very useful guide for any clinician, counselor, or related professional assisting aging clients and/or their family members. Changing Aging, Changing Family Therapy: Practicing With 21st Century Realities is a very useful resource for professionals working with clients in response to the normative stressor of aging and associated family system changes over time.\" — Lisa Hollis-Sawyer, PhD, Activities, Adaptation & Aging, Volume 38 , Issue 2 , 2014 Introduction. Peluso, Watts, Parsons, Grandparents Raising Grandchildren. Fruhauf, Lambert, Narrative Approaches to Working with Older Clients. Peluso, Watts, Parsons, Elderly Parents. Qualls, Caregiver Family Therapy for Families Dealing with Dementia. Peluso, Watts, Parsons, Physical Health. Moll, Leisure and Sexuality in Older Clients. Peluso, Watts, Parsons, Psychopathology in Older Couples. Stein, Working with \"Older Old\" Couples. Peluso, Watts, Parsons, Financial Issues, Work and Retirement. Blando, Transforming Your Practice to Work with Older Clients. Peluso, Watts, Parsons, Spirituality and Death. Interview with John Gottman. Interview with Gus Napier. Interview with Monica McGoldrick. Interview with Jon Carlson. Peluso, Watts, Parsons, Summary.

This qualitative case study investigated the impact of sand tray on individuals diagnosed with Alzheimer’s and other forms of dementia. Four participants successfully completed the creation of sand trays while the researcher observed, interviewed, and documented the individual sand trays. The intervention established that sand tray allows the dementia patient to kinesthetically connect to their inner cognitions through the intentional symbolic expression offered by this unique therapeutic medium. Using a series of eight sand trays of varying thematic concepts, the participants were offered a modality to facilitate a synthesization of their continued individuation, presenting a possible neural pathway to connect and express thoughts, feelings, emotions, concerns, challenges, and fears. The findings of this study include the fact that all trays were classified as “empty” and that the majority of the participants placed objects almost exclusively on the right side of the tray, which is commonly associated with the concrete or conscious side. The use of sand tray allowed each individual the opportunity to create autobiographies in the sand and literally navigate through time – past, present, and future, confronting fears, expressing hope and possibilities. The results of the research study offer insight into the psychotherapeutic effects of using sand tray with dementia patients, as well as a better understanding of the cognitive and expressive abilities and limitations of an individual with impaired memory. The results also offer insight into the difficulties with short-term memory in this population and possibly indicate a potential means for monitoring cognitive decline. Keywords: Neurocognitive disorder, Alzheimer’s, dementia, sand tray, play therapy.

Benthic dinoflagellates in the genus Gambierdiscus produce the ciguatoxin precursors responsible for the occurrence of ciguatera toxicity. The prevalence of ciguatera toxins in fish has been linked to the presence and distribution of toxin-producing species in coral reef ecosystems, which is largely determined by the presence of suitable benthic habitat and environmental conditions favorable for growth. Here using single factor experiments, we examined the effects of salinity, irradiance, and temperature on growth of 17 strains of Gambierdiscus representing eight species/phylotypes (G. belizeanus, G. caribaeus, G. carolinianus, G. carpenteri, G. pacificus, G. silvae, Gambierdiscus sp. type 4-5), most of which were established from either Marakei Island, Republic of Kiribati, or St. Thomas, United States Virgin Island (USVI). Comparable to prior studies, growth rates fell within the range of 0-0.48 divisions day(-1). In the salinity and temperature studies, Gambierdiscus responded in a near Gaussian, non-linear manner typical for such studies, with optimal and suboptimal growth occurring in the range of salinities of 25 and 45 and 21.0 and 32.5°C. In the irradiance experiment, no mortality was observed; however, growth rates at 55 μmol photons · m(-2) · s(-1) were lower than those at 110-400 μmol photons · m(-2) · s(-1). At the extremes of the environmental conditions tested, growth rates were highly variable, evidenced by large coefficients of variability. However, significant differences in intraspecific growth rates were typically found only at optimal or near-optimal growth conditions. Polynomial regression analyses showed that maximum growth occurred at salinity and temperature levels of 30.1-38.5 and 23.8-29.2°C, respectively. Gambierdiscus growth patterns varied among species, and within individual species: G. belizeanus, G. caribaeus, G. carpenteri, and G. pacificus generally exhibited a wider range of tolerance to environmental conditions, which may explain their broad geographic distribution. In contrast, G. silvae and Gambierdiscus sp. types 4-5 all displayed a comparatively narrow range of tolerance to temperature, salinity, and irradiance.

Purpose To investigate associations of sociodemographic factors—race/ethnicity, neighborhood socioeconomic status (SES), and health insurance—with survival for adolescents and young adults (AYAs) with invasive cancer. Methods Data on 80,855 AYAs with invasive cancer diagnosed in California 2001–2011 were obtained from the California Cancer Registry. We used multivariable Cox proportional hazards regression to estimate overall survival. Results Associations of public or no insurance with greater risk of death were observed for 11 of 12 AYA cancers examined. Compared to Whites, Blacks experienced greater risk of death, regardless of age or insurance, while greater risk of death among Hispanics and Asians was more apparent for younger AYAs and for those with private/military insurance. More pronounced neighborhood SES disparities in survival were observed among AYAs with private/military insurance, especially among younger AYAs. Conclusions Lacking or having public insurance was consistently associated with shorter survival, while disparities according to race/ethnicity and neighborhood SES were greater among AYAs with private/military insurance. While health insurance coverage associates with survival, remaining racial/ethnic and socioeconomic disparities among AYAs with cancer suggest additional social factors also need consideration in intervention and policy development.

Background: In June of 2024 the Cincinnati Health Department Communicable Disease Prevention and Control Unit investigated an outbreak of Carbapenemase-resistant Pseudomonas aeruginosa (CRPA) Verona Integron-encoded Metallo-beta-lactamase (VIM) infections at a local hospital after whole genomic sequencing (WGS) performed by the Centers for Disease Control (CDC) determined two patients had closely related infections. At the time CDC was using WGS to link CRPA infections to the multi-state outbreak associated with artificial tears. CRPA is classified as a Carbapenemase-producing organism (CPO) by the Ohio Department of Health (ODH) and is a Class B reportable disease. According to the ODH Infectious Disease Control Manual, the CPO reportable condition targets organisms that have acquired mobile genetic elements, or plasmids, carrying carbapenemase-producing genes that can be transmitted to other bacteria. CDC’s WGS technology enables faster detection of healthcare-associated infection outbreaks by determining how closely the organisms are related genetically, which facilitates a faster public health response. Method: A line list was used to collect data extracted from the patients’ medical records. The hospital was requested to forward all CRPA isolates to the state laboratory for further analysis including WGS at CDC. The facility was provided with cleaning and disinfection guidance and transmission based precaution guidance specific to CRPA. The hospital was also advised to screen roommates of the patients and those who had units in common with the patients. Result: Four patients, having a number of other health conditions, with ages ranging from 30-38 (median 35.5) who were hospitalized at the same facility between March and September of 2024 were determined to have closely related CRPA VIM infections through WGS. Their infections were not closely related to the artificial tears-associated outbreak. There were procedural, staff, and potential equipment overlaps found between cases 1 and 2 including Ultrasound-guided ART line and midline performed on consecutive days, and Echo/TTE performed on the same day by the same provider. Cases 3 and 4 had hospital units in common with cases 1 and 2. 50% of cases had gaps in transmission-based precautions. 50% of patients died. One patient was homeless. The hospital did not perform the recommended screenings. Conclusion: The detection of two closely related CRPA VIM cases in a hospital through WGS allowed public health responders to quickly identify an outbreak and work closely with the facility in order to implement organism specific infection control measures that helped contain the spread of an insidious healthcare-associated infection to a total of four cases over six months. The outbreak was determined to be over when no new infections were detected for a period of four weeks.

Purpose Adolescent and young adult (AYA) cancer survivors experience barriers to utilizing healthcare, but the determinants of cancer-related medical care of AYAs has not been fully explored. Methods We studied factors associated with medical care utilization among 465 AYA cancer survivors in the AYA Health Outcomes and Patient Experience Study, a cohort of 15 to 39 year olds recently diagnosed with germ cell cancer, lymphoma, sarcoma, or acute lymphocytic leukemia. Descriptive statistics and multivariate logistic regression methods were used. Results Most AYA cancer survivors (95 %), who were 15–35 months post diagnosis, received medical care in the past 12 months and 17 % were undergoing cancer treatment. In multivariate analyses, compared with AYAs with no cancer-related medical visits in the previous year, AYAs receiving cancer-related care were more likely to currently have health insurance (odds ratio (OR) = 4.9; 95 % confidence interval (CI) = 1.7–13.8) or have had health insurance in the past year (OR = 4.0; 95 % CI = 0.99–16.3). Cancer recurrence, lacking employment, and negative changes in self-reported general health were associated with ongoing cancer treatment versus other cancer-related medical care. Eleven percent of all AYAs and 25 % of AYAs who did not receive medical care in the past 12 months lost health insurance between the initial and follow-up surveys. Conclusion AYA cancer survivors with health insurance were much more likely to receive cancer-related medical care than those without insurance. Implications for Cancer Survivors Despite the need for post-treatment medical care, lacking health insurance is a barrier to receiving any medical care among AYAs.

Background: During the COVID-19 pandemic, rates of central line bloodstream infections (CLABSI) increased nationally. Studies pre-pandemic showed improved CLABSI rates with implementation of a standardized vascular access team (VAT).[PL1] [PL2] [mi3] Varying VAT resources and coverage existed in our 10 acute care facilities (ACF) prior to and during the pandemic. VAT scope also varied in 1) process for line selection during initial placement, 2) ability to place a peripherally inserted central catheter (PICC), midline or ultrasound-guided peripheral IV in patients with difficult vascular access, 3) ownership of daily assessment of central line (CL) necessity, and 4) routine CL dressing changes. We aimed to define and implement the ideal VAT structure and evaluate the impact on CLABSI standardized infection ratios (SIR) and rates prior to and during the pandemic. Methods: A multidisciplinary workgroup including representatives from nursing, infection prevention, and vascular access was formed to understand the current state of VAT responsibilities across all ACFs. The group identified key responsibilities a VAT should conduct to aid in CLABSI prevention. Complete VAT coverage[mi4] was defined as the ability to conduct the identified responsibilities daily. We compared the SIR and CLABSI rates between hospitals who had complete VAT (CVAT) coverage to hospitals with incomplete VAT (IVAT) coverage. Given this work occurred during the pandemic, we further stratified our analysis based on a time frame prior to the pandemic (1/2015 – 12/2019) and intra-pandemic (1/2020 - 12/2022). Results: The multidisciplinary team identified 6 key components of complete VAT coverage: Assessment for appropriate line selection prior to insertion, ability to insert PICC and midlines, daily CL and midline care and maintenance assessments, daily assessment of necessity for CL, and weekly dressing changes for CL and midlines[NA5] . A cross walk of VAT scope (Figure 1) was performed in October 2022 which revealed two facilities (A and E) which met CVAT criteria. Pre-pandemic, while IVAT CLABSI rates and SIR were higher than in CVAT units, the difference was not statistically significant. During the pandemic, however, CLABSI rates and SIR were 40-50% higher in IVAT compared to CVAT facilities (Incident Rate Ratio 1.5, 95% CI 1.1-2.0 and SIR Relative Ratio 1.4, 95% CI1.1-1.9 respectively) (Table 1). Conclusions: CLABSI rates were lower in facilities with complete VAT coverage prior to and during the COVID-19 pandemic suggesting a highly functioning VAT can aid in preventing CLABSIs, especially when a healthcare system is stressed and resources are limited.