Aims and objectives To determine factors that facilitate or impede adjustment to residential aged care (RAC) from the perspectives of residents with dementia, families of residents with dementia and facility staff. Background The transition to a RAC facility can be highly stressful for people with dementia and their families, but we lack an understanding of how people with dementia experience this transition. Knowledge on adjustment to the new environment is essential in order to develop procedures and interventions that better support residents. Design and methods This study consisted of interviews with 12 residents with dementia who had resided at a RAC facility for six months or less; 14 family members of RAC residents with dementia; and 12 RAC facility staff members. Parallel interview schedules were constructed, with questions on the experience of relocating to RAC for a person with dementia and views on enablers and barriers to successful adjustment. Thematic analysis guided the analysis of data. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) guidelines (see Supplementary File S1). Results Adjustment to RAC appeared variable, with several residents reporting poor acceptance of their circumstances several months after the relocation. The three groups were largely congruent regarding the importance of support from families and staff, and the development of new relationships with other residents, but not all residents had succeeded in forming friendships. The provision of meaningful activities and opportunities to exert autonomy day‐to‐day were seen as critical, but staff experienced challenges in providing individualised care due to lack of dedicated time to engage with residents. Conclusion and relevance to clinical practice There is a need for evaluated interventions to help people with dementia to successfully transition to RAC. Attention should be paid to the way in which care is coordinated within the RAC sector, to enable staff to provide individualised approaches to facilitate adjustment.

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An infant with Down syndrome (DS) and RH isoimmunization developed transient myeloproliferative disorder (TMD) during the neonatal period. At 16 months she presented with acute nonlymphocytic leukemia (ANLL). Cytogenetic studies during TMD showed trisomy 21 only but new abnormalities emerged during ANLL. She is now in complete remission 5 years after diagnosis. Patients with TMD have either trisomy 21 or mosaic 21 in blood and bone marrow but in phenotypically normal children this cell line disappears with resolution of the TMD. A review of the literature indicates that there are no clinical, hematological, or cytogenetic differences between DS children with TMD who subsequently develop acute leukemia and those who do not. However, the leukemia in the former group may differ in presentation, type, and possibly survival time from other DS children who develop leukemia de novo.

In the normal infant birth is usually followed by a substantial rise in the concentration of haemoglobin (Hb) and in the packed cell volume (PCV) of the blood, while the concentration of plasma protein tends to rise only slightly (Gairdner, Marks, Roscoe and Brettell, 1958). From these facts we have inferred that immediately following birth there is a loss from the vascular compartment of a large fraction, up to a quarter or more, of the circulating plasma.We do not know the fate of the plasma lost from the vascular compartment, but we have suggested that the major changes which take place in the pulmonary circulation at birth might be expected to favour a shift of fluid from the circulation at this site. If so, then shift of plasma into the interstitial spaces of the lung might play a part in the pulmonary failure which so often overtakes the premature infant in the first few hours or days after birth. For this reason, we have extended our observations to premature infants to determine whether there is any relationship between the postnatal haemoconcentration effect and the development of pulmonary symptoms.Material and Methods Cord blood was obtained from 24 infants with birth weight of less than 2,500 g., of whom 22 were born vaginally and two by caesarean section. Maternal toxaemia was present in six cases. Neither the method of delivery, nor the presence of maternal toxaemia appeared to affect the results, and they have not been separately analysed here.The cord was always clamped as soon as conveniently possible, both in vaginal and in caesarean deliveries. A blood sample was taken by puncture of the umbilical vein between placenta and clamp. Subsequent specimens were taken by insertion of a polyvinyl cannula (internal diameter I 0 mm.) into the umbilical vein, or in a few cases by femoral vein puncture. Samples were taken into siliconized bottles containing ethylenediamine tetra-acetate as anticoagulant.Hb concentration and PCV were estimated as described previously (Marks, Gairdner and Roscoe, 1955), in duplicate in most cases. Plasma protein concentration was estimated by the biuret method using 0 2 ml. plasma. The estimations required less than 2 ml. blood.The infants were closely observed for signs of respiratory distress; those commonly observed were rapid moaning respirations, often with rib recession. Nine infants showed such signs and six of these recovered.Three infants died at 20, 22 and 32 hours; all showed respiratory distress by five hours or earlier. At necropsy the lungs showed the picture of secondary atelectasis with hyaline membrane in all three cases, together with massive intra-alveolar haemorrhage in one case, and broncho-pneumonia in another.