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Background: Living arrangements is an essential component of the social environments for autistic adults. The need to understanding the status and experience of living arrangements has been highlighted. Aim: This study examined living arrangements and satisfaction with current arrangements of autistic adults reported by autistic adults or caregivers of autistic adults. Methods: This study used data from a statewide survey of autistic adults or caregivers. Results: Older autistic adults and those employed and had higher financial resources were more likely to live alone or with a roommate or spouse than to live with family or in a supervised setting. Correlates of greater satisfaction included being young, either men or women (vs. non-binary adults), public insurance, fewer service needs, no or one mental health diagnosis (vs. two or more), no psychiatric emergency room or hospitalisation history, and living with a roommate or spouse (vs. living with family). Conclusion: This cross-sectional study adds to the literature on the status of living arrangements and satisfaction with living arrangements among autistic adults. Future research is needed to investigate contributing factors to the satisfaction of living arrangements and quality of life among autistic adults.

This study investigates a crucial aspect of inventory management, which is the process of replacing failed items. In dynamic commercial environments, it is essential to efficiently and strategically replace failed items to maintain operational efficiency and ensure profitability. We consider a two-commodity retrial queueing-inventory system with vacation interruption. Upon purchasing the first commodity, the second commodity is provided as a complimentary item. In contrast, no item is given as a complimentary for the purchase of the second item. Only the first commodity is stored in a dedicated pooled storage for replacement when it fails. The (s,Q) policy governs replenishing the first commodity while the second is replenished through instantaneous ordering. The model considers the multi-component demand rate for customer arrivals. Server vacations are initiated during customer absence in waiting hall or when the first commodity is unavailable. We formulate a level-dependent quasi-birth-and-death process, and its steady-state probability vector is computed using Neuts and Rao's truncation method. The stability condition for the system is derived, and various system performance measures, including expected total cost, number of replaceable items, and customers in the waiting hall and orbit, are established. The comparative analysis between the system with replacement is done with the regular model without replacement, which revealed the efficiency of replacement. The analysis of multi-component demand towards homogeneous arrival highlights the impact of multi-component demand on boosting customer arrival. Also, parametric sensitivity analysis has been conducted numerically over total cost, mean number of failed items for replacement, and mean number of customers in the waiting hall and orbit.

Purpose: In patients with locally advanced, unresectable non-small cell lung cancer (NSCLC), the standard of care is concurrent chemoradiation (CRT) followed by consolidative immunotherapy with durvalumab. Pneumonitis is a known adverse event of both radiation therapy and immune checkpoint inhibitors such as durvalumab. We sought to characterize pneumonitis rates and dosimetric predictors of pneumonitis in a real-world population of patients with NSCLC treated with definitive CRT followed by consolidative durvalumab. Methods and Materials: Patients with NSCLC from a single institution who were treated with definitive CRT followed by consolidative durvalumab were identified. Outcomes of interest included pneumonitis incidence, type of pneumonitis, progression-free survival, and overall survival. Results: Sixty-two patients were included in our data set treated from 2018 to 2021 with a median follow-up of 17 months. The rate of grade 2+ pneumonitis in our cohort was 32.3%, and the rate of grade 3+ pneumonitis was 9.7%. Lung dosimetry parameters including V20 ≥30% and mean lung dose (MLD) >18 Gy were found to be correlated with increased rates of grade 2+ and grade 3+ pneumonitis. Patients with a lung V20 ≥30% had a grade 2+ pneumonitis rate at 1 year of 49.8% compared with 17.8% in patients with a lung V20 18 Gy had a grade 2+ pneumonitis rate at 1 year of 52.4% compared with 25.8% in patients with an MLD ≤18 Gy (P = .01). Moreover, heart dosimetry parameters including mean heart dose ≥10 Gy were found to be correlated with increased rates of grade 2+ pneumonitis. The estimated 1-year overall survival and progression-free survival of our cohort were 86.8% and 64.1%, respectively. Conclusions: The modern management of locally advanced, unresectable NSCLC involves definitive chemoradiation followed by consolidative durvalumab. Pneumonitis rates were higher than expected in this cohort, particularly for patients with a lung V20 ≥30%, MLD >18 Gy, and mean heart dose ≥10 Gy, suggesting that more stringent radiation planning dose constraints may be needed.

ObjectivesThis study examined age-related cross-sectional and longitudinal associations between activity diversity and four dimensions of well-being: psychological well-being, depression, positive affect, and negative affect.MethodActivity diversity was defined as the breadth and evenness of participation in seven daily activities including paid work, time with children, doing chores, leisure, physical activities, formal volunteering, and giving informal help to others. Participants from the National Survey of Daily Experiences (N = 793, Mage = 46.71, SDag = 12.48) provided data during two 8-day measurement bursts approximately 10 years apart.ResultsOlder adults (age = 60-74 years) who engaged in more diverse activities reported higher psychological well-being than older adults who engaged in less diverse activities; an association not significant among middle-aged adults (age = 35-59 years), and in the opposite direction for younger individuals (age = 24-34 years). Longitudinally, increased activity diversity over 10 years was marginally associated with increases in positive affect. Compared with younger individuals who increased activity diversity, older adults who increased activity diversity reported smaller decreases in psychological well-being, greater increases in positive affect, and greater decreases in negative affect.DiscussionOur findings suggest that activity diversity may play an important role in older adults' concurrent well-being and also in their long-term longitudinal improvements of well-being.

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University-based retirement communities (UBRCs) are a relatively recent addition to housing options for older adults. The case example of a new UBRC, Mirabella at Arizona State University (ASU), is presented within the context of Age-Friendly University (AFU) principles and New American University design aspirations. We provide an overview of the planning process, describe initial collaborations between Mirabella and research faculty, and outline areas of overlap and distinction between Mirabella's approach and other UBRCs, AFU principles, and the design aspirations of the New American University model. Empirical investigations are needed to identify key characteristics of UBRCs that facilitate university integration and how those characteristics impact individual, community, and university level outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Survival for patients with extensive-stage small cell lung cancer (ES-SCLC) remains poor. Consolidative thoracic radiation therapy (cTRT) and upfront immunotherapy with chemotherapy have each incrementally improved patient outcomes, but have not yet been combined in clinical trials. We sought to characterize outcomes and toxicities after first-line chemotherapy and immunotherapy followed by cTRT. Methods and Materials: Patients with ES-SCLC who were treated with first-line chemotherapy and immunotherapy followed by cTRT were identified at 2 institutions. Patient outcomes including overall survival (OS), progression-free survival, local progression-free survival, distant progression free-survival, and toxicity were assessed. Results: Twenty patients were included in our data set treated from 2018 to 2021 with a median follow-up of 12 months. Median OS in this cohort was 16 months with 6-month OS of 94.7% and 12-month OS of 77.5% (comparable to historical controls). There were also low rates of toxicity, including 0% grade 3+ toxicity, 0% grade 2 pneumonitis, and 5% grade 2 esophagitis. Conclusions: Treatment of ES-SCLC with first-line chemoimmunotherapy followed by cTRT appears to be safe and to have outcomes comparable to published modern clinical trials. Further studies are warranted to determine the therapeutic effect of cTRT after chemoimmunotherapy.

A growing number of individuals with autism spectrum disorder are aging into adulthood. In the United States, Medicaid is the primary payer for services for adults with autism spectrum disorder, yet there are few funded programs that provide dedicated supports to this population. This study examined the experiences of adults with autism spectrum disorder in two Medicaid-funded programs in Pennsylvania through focus groups. Researchers conducted 20 focus groups with a total of 36 adults with autism spectrum disorder, 32 family members, 32 direct care staff, and 20 program administrators. Using thematic analysis, we identified three themes: training needs, community engagement and socialization, and employment. There was a need for additional training to meet the varying needs of program participants including co-occurring diagnoses, sexuality, and long-term planning. Adults with autism spectrum disorder prioritized more individualized community activities based on their interests. Finally, barriers to and strategies for successful employment were discussed. It will be crucial for policy makers to utilize the findings to inform program improvement and development based on the experiences of individuals impacted by these services and systems directly. Additionally, researchers should use the findings from this study to design interventions for adults with autism spectrum disorder as it includes their voices.

Background Despite the epidemiological associations between psychological stress, depression, and increased cardiovascular disease risk, no studies have examined the relation between naturally occurring psychosocial stressors and directly measured microvascular function in adults with major depressive disorder (MDD). We tested the hypothesis that young adults with MDD exposed to everyday psychosocial stressors would exhibit more severe impairments in endothelium‐dependent dilation (EDD) compared with: (1) healthy nondepressed adults (HCs); and (2) adults with MDD without acute psychosocial stress exposure. Methods and Results Twenty HCs (22±1 years) and 23 otherwise healthy adults with MDD (20±0.3 years) participated in the study. Participants completed a psychosocial experiences survey to document their exposure to any of 6 stressors over the preceding 24 hours (eg, arguments, work stressors). Red cell flux (laser Doppler flowmetry) was measured during graded intradermal microdialysis perfusion of acetylcholine (10−10 to 10−1mol/L). EDD was expressed as a percentage of maximum vascular conductance (flux/mm Hg). Multiple linear regression was used to determine the associations between stress, EDD, and MDD. Adults with MDD reported a greater number and severity of psychosocial stressors compared with HCs (all P