Co-Occurrence and Non-Overlap Among Behavioral and Health-Related Problems in Preschool Children

Integrating mental health and healthcare services increases the reach of healthcare while reducing costs and stigma associated with seeking mental health services. To provide such services for preschool aged children we must first understand how behaviors related to healthy lifestyle and mental/behavioral health overlap. This study examined the relationship between behavior problems, sleep duration, screen time, and eating patterns and assessed the frequency of co-occurring problems in these areas. Because of the importance of parenting across these domains, the association between parent disciplinary strategies and the co-occurrence of behaviors in the different problem areas was assessed. MANOVAs revealed that there was a relationship between several problem areas. Elevated screen time was associated with a higher intensity of behavior problems, lower sleep duration, and less healthy eating patterns. A high intensity of behavior problems was associated with higher screen time use. Lower sleep was associated with higher screen time use and less healthy diet. High intensity behavior problems and elevated screen time use were also related to less effective parenting styles. And lax parenting styles predicted more co-occurring problems. Findings suggest support for addressing these problem areas using an integrative health care approach

Optimizing treatment for soil-transmitted helminthiasis

Soil-transmitted helminths (STHs), namely Ascaris lumbricoides ̧ Trichuris trichiura and hookworms, are intestinal parasites infecting a quarter of the people living in the world today. Highest at risk for infection are children in subtropical and tropical climates with limited access to improved drinking water sources, inadequate sanitation and living in poverty. Infections with helminths tend to be asymptomatic, though more intense infections can cause abdominal discomfort, anemia and wasting. Preventive chemotherapy, or treatment without diagnosis, to at-risk populations is the current recommendation by the World Health Organization (WHO) for the control of STHs. The strategy of preventive chemotherapy is carried out through mass drug administration of either single dose albendazole or mebendazole to reduce the morbidity of infections in the target population. Though there has been a reduction in the prevalence of STHs in the last 15 years, the low efficacy of both treatment options against T. trichiura, and to a lesser extent hookworm infections, is a drawback to control strategies. Optimized therapies for STH control are needed if elimination is to be reached and maintained. The objectives of this thesis are to assess regimens and dosages of current available treatment options that are potentially available for mass drug administration. The first and second objectives of this thesis are to identify an optimal dose of the currently used albendazole in preschool-aged children (PSAC), school-aged children (SAC) and adults infected with either T. trichiura or hookworms in Côte d'Ivoire. In the first objective of this PhD thesis, results show albendazole, regardless of dose, has low efficacy against T. trichiura, though findings need to be interpreted carefully as recruitment goals were not met for PSAC and adults. In the second objective, moderate efficacy of albendazole was shown against hookworm; specifically, an 800 mg dose (twice the current standard dose) provides superior efficacy in adults. The third objective of this PhD research was to design and conduct a multi-country trial assessing the efficacy of combination therapy of albendazole and ivermectin against T. trichiura. The trial was conducted in three settings: Pemba Island, Tanzania, Lao PDR and Côte d'Ivoire using the same standardized protocol. Though the combination therapy was proved to be efficacious in Pemba Island, Tanzania and Lao PDR, albendazole combined with ivermectin was not found to be superior than monotherapy of albendazole in Côte d'Ivoire. Potential reasons for this discrepancy range from emerging resistance to population-based differences, which are being further investigated. The last objective of this thesis aimed to identify potential gut morbidity markers in participants included in the efficacy trial of the third objective. Identifying two potential morbidity markers: fecal calprotectin and fecal occult blood, the study assessed the correlation between the markers and STH infection. No association was found between either marker and STH infection, making them poor markers for STH gut morbidity. Based on the findings of the research conducted, it is recommended that alternative combination therapies be used for the control of STHs. Drugs such as oxantel pamoate or moxidectin combined with a higher dose of albendazole could be highly efficacious against all three STHs, especially in settings such as Côte d'Ivoire. Furthermore, a thorough evaluation of control programs are needed to assess the benefits and costs of mass drug administration in reducing the burden of disease. Finally, research in the fields of STH and neglected tropical diseases need to expand and diversify the study designs used in assessing drug efficacy and effectiveness

Reliability Generalization of the Alcohol Use Disorders Identification Test.

The Alcohol Use Disorder Identification Test (AUDIT) is a brief screening instrument for assessing alcohol use problems among adults. This instrument is widely used and continued evaluation of its psychometric performance is needed. Reliability and validity are the primary psychometric characteristics of interest when evaluating psychological instruments. The focus of the present study is on reliability, which reflects the consistency or repeatability of the scores produced by a given instrument. Using meta-analytic methods, results showed that approximately 65% of previously published studies using the AUDIT did not appropriately report reliability estimates. Among the remaining studies, weighted reliability estimate centered on .81 (SD = .07) suggesting that the AUDIT generally produces scores of adequate reliability for most research purposes. Multiple regression equations showed that, among a variety of sample and methodological characteristics, the standard deviation of scores was the only statistically significant predictor of the variability in AUDIT score reliability estimates

Overseas investment of Chinese enterprises : a casebook on corporate social responsibility

This book offers unique case studies on Corporate Social Responsibility (CSR) in overseas investments of Chinese Enterprises, covering different industry sectors and regions. The decision making process of key stakeholders in ethical dilemmas, successes, failures and lessons learnt in CSR are analyzed. This book also offers an analysis of the core principles of effective stakeholder engagement, strategic planning and due diligence in the investment process, in topics such as infrastructure, mergers and acquisition, integration of local employees, trade unions and responsible advertising. It reiterates the importance of responsible business for the success of effective Outbound Direct Investment (ODI) strategies

Changes in lower incisor inclination following the treatment of Class II malocclusions with the Twin-Block and Button-and-Bead appliances: a single centre randomised controlled trial

AIM: To compare post-treatment changes in lower incisor inclination in patients with Class II division 1 malocclusions treated with the Twin-Block and Button-and-Bead appliances. METHOD: A UK based, single centre, prospective, two-armed randomised controlled trial with a 1:1 allocation ratio was conducted at the Birmingham Dental Hospital between July 2017 and January 2018. A total of 64 participants (28 males and 36 females) were recruited to the study and participants were randomly allocated to one of the two arms of the study. The primary outcome measure was differences in changes in lower incisor inclination in patients treated with the Twin-Block and Button-and-Bead appliances. Secondary outcomes included differences in the changes in upper incisor inclination, the ANB angle, changes in the maxillary-mandibular planes angle (MMPA) and lower anterior face height (LAFH). RESULTS: Treatment was successfully completed by 47 participants (21 males and 26 females). A total of 17 (27%) participants did not complete the intervention as planned. There was no statistically significant difference in the change in lower incisor inclination between the two appliances (p=0.372). The Button-and-Bead appliance resulted in a statistically significant greater degree of upper incisor retroclination whilst the Twin-Block appliance resulted in statistically significant greater reductions in the ANB angle. No statistically significant differences were found for MMPA and LAFH between the two appliances. CONCLUSION: Both appliances were effective in the treatment of Class II division 1 malocclusions. The Twin-Block appliance appeared to result in a greater degree of skeletal change compared to the Button-and-Bead appliance, although these differences are unlikely to be of clinical significance. There was no difference in the degree of lower incisor proclination between the two appliances

Abordagem multicritério de apoio à decisão no planeamento da manutenção: estudo de caso

Dissertação de natureza científica para obtenção do grau de Mestre em Engenharia e Gestão IndustrialO papel da manutenção tem vindo a evoluir devido ao reconhecimento da sua importância em diversas vertentes, nomeadamente na qualidade das prestações do serviço de uma empresa, garantido a fiabilidade e a segurança dos equipamentos, mas também nas vertentes financeiras e económicas pela otimização do ciclo de vida dos equipamentos. O objetivo do presente trabalho consistiu numa análise crítica da situação atual de uma PME, cuja finalidade é a prestação de serviços de alojamento a pessoas com incapacidade física e mental, e criar uma estratégia de gestão de manutenção a ser implementada, baseada na construção de um plano de manutenções de elevadores, de forma a melhorar o resultado empresarial e a qualidade do serviço prestado. Para atingir o objetivo mencionado acima foram necessários vários procedimentos, começando com a análise do equipamento mais critico e o respetivo modo de falha mais critico, com a ajuda das ferramentas de decisão multicritério AHP, Método dos 5 Porquês e FMEA, de forma a decidir para que equipamento e para que finalidade o plano de manutenções deverá ser desenvolvido. Uma vez elaborado o plano de manutenções, fez-se um estudo da viabilidade económica do projeto através das ferramentas de análise de investimento, VAL e TIR, assim como a análise de risco através do processo do Bowtie. Através da identificação dos principais perigos e fontes de risco, desenvolveram-se duas barreiras de prevenção fundamentais a serem incluídas no plano de manutenções de forma a evitar a interrupção ou a não implementação mesmo. Após a introdução das barreiras de prevenção, avaliou-se novamente a viabilidade económica do projeto, onde foram necessários alguns reajustes em relação ao investimento inicial e o tempo de vida útil do projeto. Um dos trabalhos futuros a ser desenvolvido com base no plano de manutenções elaborado, será a criação do programa de Gestão Lean a longo prazo para a organização ser capaz de combater o aumento da taxa de inflação e os respetivos custos, promovendo uma melhor qualidade de serviço ao cliente. Outro aspeto a considerar seria o desenvolvimento de um programa de controlo de circulação diária nos elevadores, de forma a tornar o processo mais rápido e eficaz, regularizando a circulação por todos os elevadores.The role of maintenance has been evolving due to the recognition of its importance in several aspects, such as the quality of a company's services, guaranteeing the reliability and safety of equipment, as well as in financial and economic aspects by optimizing the life cycle of the equipment. The objective of this work was to critically analyze the current situation of an SME, whose purpose is to provide accommodation services to people with physical and mental disabilities, and to create a maintenance management strategy to be implemented, based on the construction of a elevator maintenance plan, in order to improve business results and the quality of the service provided. To achieve the objective mentioned above, several procedures were necessary, starting with the analysis of the most critical equipment and its most critical failure mode, with the help of the multi-criteria decision tools AHP, 5 Whys Method and FMEA, in order to decide for what equipment and for what purpose the maintenance plan should be developed. Once the maintenance plan was drawn up, a study of the project's economic viability was carried out using investment analysis tools, VAL and IRR, as well as risk analysis through the Bowtie process. By identifying the main hazards and sources of risk, two fundamental prevention barriers were developed to be included in the maintenance plan in order to avoid interruption or non-implementation. After the introduction of prevention barriers, the economic viability of the project was again assessed, where some readjustments were necessary in relation to the initial investment and the useful life of the project. One of the future works to be developed based on the maintenance plan prepared, will be the creation of a long-term Lean Management program for the organization to be able to combat the increase in the inflation rate and the respective costs, promoting a better quality of service. to the client. Another aspect to consider would be the development of a daily circulation control program in elevators, in order to make the process faster and more efficient, regularizing circulation in all elevators.N/

Pattern of histopathological lesions in lung autopsy

Background: A large number of pathologic conditions involve the lung parenchyma like inflammatory, neoplastic and others. The lungs are also involved in almost all terminal events of cardiovascular disease. Autopsy is an important and most useful way to find out the condition of internal organs and to evaluate any localized lesions or systemic disease and hence determine cause of death. Aims and objectives of study are to identify the histopathological spectrum of lung disease. To find out frequency of various lung pathologies in respect to age and sex.Methods: This study was retrospective and done on 649 cases of medico legal autopsies. The tissue specimens were fixed and processed. Routine paraffin sectioning was done followed by Hematoxylene and eosin (H and E) staining. Special stains were done whenever required. Relevant clinical and postmortem findings, gross and microscopic examination findings were recorded.Results: After thorough histopathological examinations, of total 649 cases, various pulmonary lesions were identified in 348(53.6%) cases while in 301(46.4%) cases no significant pathology was seen. Most commonly affected age group was 30-49 years 43.1% followed by age group of >60years 17.8%. Majority of diseased were male 285 (81.9%). Most common lung pathology found was Edema and congestion in 93 cases (26.72%), chronic venous congestion in 92 cases (26.44%) pneumonia in 65 cases (18.68%) followed by Tuberculosis/Tuberculous pneumonia in 29 cases (8.3%).Conclusions: In our population, the present study reveals that infectious disease are still the most common cause of mortality, despite recent advances in diagnostic technology, the autopsy has remained an important complementary tool for identifying and understanding pathology of disease.

Atypical Presentation of Ankylosing Spondylitis

Radiographic axial spondyloarthritis axSpA ) or typical ankylosing spondyloarthritis (AS) is a classification of axial spondyloarthritis with the classic radiographic features of sacroiliitis. Axial spondyloarthritis is a disabling spondyloarthropathy of the spine that presents with chronic back pain usually before the age of 45. It may be associated with extraspinal features including dactylitis , synovitis, and enthesitis in addition to other nonarticular signs. Chronic back pain is one of the most common presenting symptoms for AS , but frequently there is a 5-7 year delay between the onset of symptoms and diagnosis of the disease . A standard AP plain radiograph demonstrating changes to the sacroiliac joint including erosions, ankylosis or sclerosis along with the patient’s complaints of chronic back pain are strong indicators for AS. We present a case of an atypical presentation of AS in a patient with recently diagnosed asthma and no other past medical history who had a 40 pound rapid (4 month) weight loss and polyarticular joint pain. Our case is unusual due to the short time course between presenting symptoms and time to diagnosis

Characterization and assembly of the Pseudomonas aeruginosa aspartate transcarbamoylase-pseudo dihydroorotase complex

Pseudomonas aeruginosa is a virulent pathogen that has become more threatening with the emergence of multidrug resistance. The aspartate transcarbamoylase (ATCase) of this organism is a dodecamer comprised of six 37 kDa catalytic chains and six 45 kDa chains homologous to dihydroorotase (pDHO). The pDHO chain is inactive but is necessary for ATCase activity. A stoichiometric mixture of the subunits associates into a dodecamer with full ATCase activity. Unlike other known ATCases, the P. aeruginosa catalytic chain does not spontaneously assemble into a trimer. Chemical-crosslinking and size-exclusion chro- matography showed that P. aeruginosa ATCase is monomeric which accounts for its lack of catalytic activity since the active site is a composite comprised of residues from adjacent monomers in the trimer. Circular dichroism spectroscopy indicated that the ATCase chain adopts a structure that contains secondary structure elements although neither the ATCase nor the pDHO subunits are very stable as determined by a thermal shift assay. Formation of the complex increases the melting temperature by about 30 ̊C. The ATCase is strongly inhibited by all nucleotide di- and triphosphates and exhibits extreme cooperativity. Previous studies suggested that the regulatory site is located in an 11-residue extension of the amino end of the catalytic chain. However, deletion of the extensions did not affect catalytic activity, nucleotide inhibition or the assembly of the dodecamer. Nucleotides destabilized the dode- camer which probably accounts for the inhibition and apparent cooperativity of the substrate saturation curves. Contrary to previous interpretations, these results suggest that P. aerugi- nosa ATCase is not allosterically regulated by nucleotides

A Case Report of Suspected Choledocholithiasis 20 Years After Cholecystectomy

Gallstones are a common prevalence in western societies where approximately 15% of Americans have gallstones. The mainstay treatment for symptomatic cholelithiasis is laparoscopic cholecystectomy. It is estimated approximately 650,000 to 700,000 cholecystectomies are performed every year. Most patients feel relief after a laparoscopic cholecystectomy, but a small number of patients experience post cholecystectomy syndrome, which presents as biliary colic pain. Although the pathophysiology of the post cholecystectomy syndrome is unclear, one theory proposes that it is due to the alteration in bile flow after the removal of the gallbladder, which serves as a reservoir for bile. This bile is thought to be the main trigger in patients with mild gastroduodenal symptoms or diarrhea. The lack of bile reservoir can furthermore create a nidus for de novo biliary stone formation, and can cause choledocholithiasis. There have been only a few case reports of post cholecystectomy bile duct stones occurring more than 10 years following surgery in literature. Most of these reports describe the presence of stones within the gallbladder/cystic duct remnant or secondary to migrating surgical clips. We report a suspected case of choledocholithiasis 20 years following open cholecystectomy secondary to a primary biliary stone