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Background/Objectives: This study aimed to develop a novel nanotechnological slow-release drug delivery platform based on hyaluronic acid Microsponge (MSP) for the subcutaneous administration of methotrexate (MTX) in the treatment of rheumatoid arthritis (RA). RA is a chronic autoimmune disease characterized by joint inflammation and damage, while MTX is a common disease-modifying antirheumatic drug (DMARD), the conventional use of which is limited by adverse effects and the lack of release control. Methods: MSP were synthesized as freeze-dried powder to increase their stability and allow for a facile reconstitution prior to administration and precise MTX dosing. Results: A highly stable and rounded-shaped micrometric MSP, characterized by an open porosity inner structure, achieved both a high MTX loading efficiency and a slow release of MTX after injection. Our drug release assays indeed demonstrated a characteristic drug release profile consisting of a very limited burst release in the first few hours, followed by a slow release of MTX sustained for over a month. By means of a preclinical rat model of RA, the administration of MTX-loaded MSP proved to nearly double the therapeutic efficacy compared to sole MTX, according to a steep reduction in arthritic score compared to control groups. The preclinical study was replicated twice to confirm this improvement in performance and the safety profile of the MSP. Conclusions: This study suggests that the MSP drug delivery platform holds significant potential for clinical use in improving RA therapy by enabling the sustained slow release of MTX, thereby enhancing therapeutic outcomes and minimizing side effects associated with conventional burst-release drug administration. [ABSTRACT FROM AUTHOR]

Background: In Italy, knee osteoarthritis (KOA) accounts for over 5 million prevalent cases and requires long-term multidisciplinary management. The most frequent KOA symptom is pain. The aim of the survey is to provide a national overview of the current management of moderate-to-severe pain associated with KOA from both clinicians' and patients' perspectives. Methods: An exploratory qualitative survey was conducted in Italy between July and October 2023. The survey participants were members of four national scientific societies and two patient associations who were invited to participate via email and given an online questionnaire. Questions included a mix of single and multiple responses and scalar items. Results: In total, 1473 clinicians and 150 patients with KOA completed the questionnaire. Patients rated knee pain as both the most burdensome symptom and the most frequent reason for treatment dissatisfaction and seeking consultation. One in two patients declared that they were unsatisfied/little satisfied with the current prescribed analgesic treatments. The clinicians surveyed preferentially prescribed intra-articular hyaluronic acid, oral non-steroidal anti-inflammatory drugs/paracetamol, non-pharmacological intervention, and intra-articular corticosteroids. The clinicians' selection of analgesic therapy often failed to adequately meet patients' expectations for pain relief. Conclusions: Our findings highlight the current unmet needs of patients with KOA in Italy and call for new approaches to effectively optimize the management of KOA-associated pain. [ABSTRACT FROM AUTHOR]

The global cases of knee osteoarthritis (KOA) are projected to increase by 74.9% by 2050. Currently, over half of patients remain dissatisfied with their pain relief. This review addresses unmet needs for moderate-to-severe KOA pain; it offers evidence and insights for improved management. Italian experts from the fields of rheumatology, physical medicine and rehabilitation, orthopedics, primary care, and pain therapy have identified several key issues. They emphasized the need for standardized care protocols to address inconsistencies in patient management across different specialties. Early diagnosis is crucial, as cartilage responds better to early protective and structural therapies. Faster access to physiatrist evaluation and reimbursement for physical, rehabilitative, and pharmacological treatments, including intra-articular (IA) therapy, could reduce access disparities. Concerns surround the adverse effects of oral pharmacological treatments, highlighting the need for safer alternatives. Patient satisfaction with corticosteroids and hyaluronic acid-based IA therapies reduces over time and there is no consensus on the optimal IA therapy protocol. Surgery should be reserved for severe symptoms and radiographic KOA evidence, as chronic pain post-surgery poses significant societal and economic burdens. The experts advocate for a multidisciplinary approach, promoting interaction and collaboration between specialists and general practitioners, to enhance KOA care and treatment consistency in Italy. [ABSTRACT FROM AUTHOR]

Interviews with 16 employment consultants--triangulated with job seekers, family members, and supervisors--revealed a model of employment supports aligned with the elements described in the literature, although with an added emphasis on (a) building trust as a key element starting from day one; (b) a circular process converging on the job match; (c) and flexible intensity of supports. The model can be used for improving clarity in communication with employment consultants about effective employment support practices for assisting job seekers with intellectual and developmental disabilities., Employment rates for individuals with cognitive disabilities remain low at 24%, compared to 78% for people without disabilities. Moreover, workers with cognitive disabilities typically work limited work hours and earn [...]

Background: Intra-articular hyaluronic acid (IAHA) products are often used in the treatment of adults with mild-to-moderate knee osteoarthritis (KOA). The International Symposium on Intra-Articular Treatment (ISIAT) convened a multidisciplinary technical expert panel to define characteristics for an innovative IAHA product that should answer unmet needs in the clinical management of adults with mild-to-moderate KOA. Methods: An initial set of evidence-based statements was developed based on data extracted from articles identified through a comprehensive literature search. A Delphi panel comprising 19 experts in KOA voted in 3 rounds to rate their degree of agreement with accepted statements. Results: The final set of 13 accepted statements focus on the effect of an innovative IAHA across 5 key domains of nociceptive pain, joint function, quality of life, joint structure and integrity, and adverse effects. The statements set thresholds for clinically meaningful improvements that exceed those generally achievable by currently available IAHA products. Conclusion: The characteristics described by these statements from the ISIAT set new standards for what should be expected from an innovative IAHA. These statements should serve as a framework for driving the development of innovative IAHA products that will surpass the actual outcomes achieved by current viscosupplements in patients with mild-to-moderate KOA. [ABSTRACT FROM AUTHOR]

Implementing supported and customized employment in all their components is essential for supporting job seekers with disabilities to achieve their career goals. We asked 42 employment consultants in nine employment programs to respond daily to three quick questions about their employment support activities, for 6 months. Through monthly coaching, we helped the managers of these organizations engage their teams of employment consultants to interpret the data, reflect, set goals, and take action for quality improvement. Based on the positive results of this pilot, we recommend that employment consultants be provided with data-enabled feedback that supports decision making and helps them fully implement supported and customized employment as a necessary step toward improving job seekers' employment outcomes. [ABSTRACT FROM AUTHOR]

We investigated the extent to which employment consultants implemented job development practices recommended in the literature when assisting job seekers with intellectual or developmental disabilities. We contacted 83 employment consultants from 25 employment programs in Minnesota and Connecticut. Fifty-nine participants were eligible and completed surveys. We found inconsistencies between the employment consultants' practices and the job development literature in areas such as involvement of family members and acquaintances, observation of job seekers in work and nonwork environments, analyses of employers' needs, development of customized jobs, and assistance with work incentives planning. We recommend a system-wide effort for supporting employment consultants in implementing promising job development practices. This effort needs to involve funding agencies, employment programs, accreditation agencies, training programs, and researchers.

Using logistic and multiple regressions, the authors investigated predictors of employment and postsecondary education outcomes of youth with autism in the Vocational Rehabilitation Program. Data were obtained from the RSA911 data set, fiscal year 2008. Findings showed that the odds of gaining employment were greater for youth who received job placement services, yet only 48% of youth received this service. In addition, postsecondary education was among the strongest predictors of better earnings, yet only 10% of youth received college services. The authors recommended providing job placement services and college services to more youth with autism. At the same time, due to the relatively moderate effect sizes of these regression models, they recommend investigating additional variables currently not included in the RSA911 data set. (Contains 5 tables.)

This article describes a secondary analysis of variables from the National Longitudinal Transition Survey 2 (NLTS-2) database. Specifically, students with intellectual disability (ID) were compared to students with other disabilities regarding post-school transition goals listed on their IEPs/Transition Plans, contacts/referrals made to outside agencies during transition planning, participation of other agencies/organizations in transition planning (e.g., vocational rehabilitation and higher education representatives), and students' postsecondary education and employment outcomes. Students with ID were less likely to have postsecondary education or competitive employment goals and outcomes and more likely to have sheltered and supported employment goals and outcomes compared to students with other disabilities. Contacts with and participation of external professionals in IEP/Transition Plan meetings also differed between the two groups of students. (Contains 3 tables and 1 note.)

This study examined the extent to which employment specialists implemented the job development practices recommended in the research literature when assisting job seekers with intellectual or developmental disabilities. Self-reported data were collected through a Web-based survey from 163 employment specialists from 74 employment programs in 28 states. Questions focused on the following four clusters of activities: getting to know job seekers, finding job openings, engaging employers to hire, and facilitating transition to a job. Findings showed that some employment specialists self-reported practices conflicted with the practices advocated in the literature. On the basis of our findings, we recommended a greater emphasis on implementing job development activities recommended in the literature as well as furthering research on effective, evidence-based practices. (Contains 1 footnote and 3 tables.)