Disabled Autonomy

Disability law is still undertheorized. In 2007, Ruth Colker wrote that disability law was undertheorized because it conflated “separate” with “unequal,” and because disability was largely ignored or poorly understood within theories of justice. The solution for Colker was to attach the anti-subordination perspective, which was developed to apply to race and sex, directly to disability. This Article argues that this transportation from the race and sex contexts was a partial solution, but is not sufficient to give full substance to disability law theory. Concepts from critical race theory and feminist jurisprudence have long been simply transported into the disability context, acting as an imperfect facsimile. The primary purpose of those concepts was to describe, analyze, and remedy problems primarily related to race and gender, not disability. While disability law has benefitted to some extent from inclusion in these legal theories, many of the unique features and complexities of disability law have been left on the table. This Article explores those complexities. Autonomy, usually thought of as an uncomplicated social good for other groups, is challenged in disability theory by two competing values. The value of anti-subordination is critical because it seeks to address, and redress, discrimination, sigma, and stereotyping. An anti-subordination perspective gives a voice and supplies resources to people with disabilities, and will counsel against choices that support stigma and stereotyping. An anti-subordination perspective might seek to limit a right to physician-assisted suicide, for example, because of concerns about exploitation and the messaging that disabled lives are not worth living. This runs counter to an autonomy-focused perspective, which would support the choice to end one’s life in the end stages of a terminal disease. An anti-eliminationism perspective advocates for the preservation of, and resources for, disabled lives. This comes to mean that not only are people with disabilities valued, but their disability is valued too. Instead of seeking to end Autism, for example, an anti-elimination perspective seeks to support Autistics. However, an anti-eliminationism perspective might also support the restriction of choice, and therefore come into conflict with autonomy, where there is a choice that results in the end of a disability. An anti-elimination perspective could seek to restrict the ability to selectively terminate pregnancies when a disability is found, for example. Anti-eliminationism inherently challenges the notion that getting rid of disability is a good thing. Parts I, II, and III of this Article describe the values of autonomy, anti-subordination, and anti-eliminationism in the disability context, and argue that these values are each critical components of disability law and theory. Part IV of this article provides an overview of some real-world examples where these values come into immediate conflict

The Rates of Mothers Who Continually Breastfeed After Implemented Breastfeeding Teaching

Many mothers are unaware of the benefits of breastfeeding. This lack of knowledge leads to an inability to weigh the advantages and disadvantages of the potential source of nutrition their infant will receive during his or her first months of life. Many mothers never even attempt to breastfeed their infant. Even among the mothers who do initially choose to breastfeed, the majority deviate to other forms of feeding early in the postpartum period. Despite the fact that most major medical organizations encourage exclusive breastfeeding through the first six months of an infant’s life, the CDC report for 2013 claims the number of mothers exclusively breastfeeding in Arkansas at 6 months to be strikingly low at 9.2%. Considerable efforts are being made to dramatically improve this. This study used a pre-­‐ post-­‐ retrospective medical records review to compare prior and post implementation of WRMC’s exclusive breastfeeding intervention. The findings provided by this study highlight the importance of consistent and continuous breastfeeding education and support beginning in the prenatal period and going throughout the postpartum period. They recognize the effectiveness of the teaching provided by the lactation consultant and healthcare personnel at Washington Regional Medical Center but also identify areas of growt

Effects of a Repeated Writing Intervention on Writing Fluency and Writing Quality

Writing is a fundamental skill that is essential for students’ academic success. In fact, students with writing difficulties are shown to have lower academic achievement and reduced likelihood of college acceptance (Graham & Perin, 2007). Writing fluency is a crucial component in the development of writing abilities, as it allows for the development of higher-order writing skills (Bloom, 1986, Binder, Haughton & Bateman, 2002). Limited research exists of interventions targeted specially for writing fluency; however, performance feedback procedures have been shown as effective (Hier & Eckert, 2016). Literature suggests the skills of reading and writing share similar processes of learning (Nueman & Dickinson, 2001). The current study examines the impact of a writing intervention structured after the repeated reading intervention, incorporating a modeling component, on the writing fluency of elementary school students

Factors affecting continuation of clean intermittent catheterisation in people with multiple sclerosis: results of the COSMOS mixed-methods study

Background:  Clean intermittent catheterisation (CIC) is often recommended for people with multiple sclerosis (MS).  Objective:  To determine the variables that affect continuation or discontinuation of the use of CIC.  Methods:  A three-part mixed-method study (prospective longitudinal cohort (n = 56), longitudinal qualitative interviews (n = 20) and retrospective survey (n = 456)) was undertaken, which identified the variables that influenced CIC continuation/discontinuation. The potential explanatory variables investigated in each study were the individual’s age, gender, social circumstances, number of urinary tract infections, bladder symptoms, presence of co-morbidity, stage of multiple sclerosis and years since diagnosis, as well as CIC teaching method and intensity.  Results:  For some people with MS the prospect of undertaking CIC is difficult and may take a period of time to accept before beginning the process of using CIC. Ongoing support from clinicians, support at home and a perceived improvement in symptoms such as nocturia were positive predictors of continuation. In many cases, the development of a urinary tract infection during the early stages of CIC use had a significant detrimental impact on continuation.  Conclusion:  Procedures for reducing the incidence of urinary tract infection during the learning period (i.e. when being taught and becoming competent) should be considered, as well as the development of a tool to aid identification of a person’s readiness to try CIC

The Incidence of Malignancy and the Preoperative Assessment of Women Undergoing Hysterectomy with Morcellation for Benign Indications

Background: The use of power morcellation in gynecologic surgery has come under scrutiny secondary to concerns for occult malignancy dissemination. The incidence of undiagnosed gynecologic malignancy when hysterectomy performed for benign indications is not definitive but has been quoted as high as 2.7% (1:37). There is not a standard recommended preoperative evaluation, and variation is anticipated by preoperative complaint or diagnosis. Objectives: To quantify the malignancy incidence in women undergoing hysterectomy for benign indications and to compare the preoperative evaluation of patients undergoing hysterectomy with and without morcellation. Methods: Retrospective cohort of women undergoing hysterectomies between October 2007 and June 2014 was identified by procedural codes through the hospital billing system. Exclusions included hysterectomies performed by gynecologic oncologists or non-gynecologic surgeons and surgeries performed outside the UMass healthcare system. Chart abstraction included demographics; pre-hysterectomy evaluation, including current cervical cytology, pathologic endometrial assessment (biopsy, dilation and curettage), and imaging (ultrasound, MRI, CT scan, sonohysterogram, or hysteroscopy); intraoperative factors; and final diagnosis. Results: Analytic cohort included 2,332 women undergoing hysterectomy with 396 (17.0%) including use of morcellation. The malignancy incidence on final pathology was 2.1% and was different between non-morcellated versus morcellated specimens (2.5% vs. 0.3%, p Conclusion: The incidence of malignancy at time ofhysterectomy performed by non­-oncology trained gynecologists was 2.1% overall, and 0.3% in morcellated cases. The pre-operative evaluation of patients undergoing hysterectomy with morcellation is similar to those without morcellation, except for lower rates of pathologic endometrial assessment. An argument could be made that a pathology assessment is indicated in this group due to risk of dissemination in the case of occult malignancy. The risk of occult malignancy is rare, but this should be discussed with patients and taken into account during the pre-operative evaluation

\u3ci\u3eMyzus fataunae\u3c/i\u3e Shinji (Hemiptera: Aphididae), \u3ci\u3ePilea\u3c/i\u3e aphid, new to North America

Minute aphids belonging to the species Myzus fataunae Shinji (Hemiptera: Aphididae) were found at a nursery in Seminole County, Florida. Morphological and molecular data support this determination. The Florida population only colonized species of Pilea Lindl. in our host range experiments. It did not colonize Fatoua villosa. Nakai. Likewise, it did not colonize tested common Florida species of Urticaceae other than Pilea spp. Myzus fataunae is adventive, and it appears to be established in the United States

Rapid Depletion of Target Proteins Allows Identification of Coincident Physiological Responses

Targeted protein degradation is a powerful tool that can be used to create unique physiologies depleted of important factors. Current strategies involve modifying a gene of interest such that a degradation peptide is added to an expressed target protein and then conditionally activating proteolysis, either by expressing adapters, unmasking cryptic recognition determinants, or regulating protease affinities using small molecules. For each target, substantial optimization may be required to achieve a practical depletion, in that the target remains present at a normal level prior to induction and is then rapidly depleted to levels low enough to manifest a physiological response. Here, we describe a simplified targeted degradation system that rapidly depletes targets and that can be applied to a wide variety of proteins without optimizing target protease affinities. The depletion of the target is rapid enough that a primary physiological response manifests that is related to the function of the target. Using ribosomal protein Si as an example, we show that the rapid depletion of this essential translation factor invokes concomitant changes to the levels of several mRNAs, even before appreciable cell division has occurred

Relationship of Blood Lactate and Sweat Lactate on Exercise Intensity

Typical procedures for measuring blood lactate involve either finger stick blood samples or venous blood draws. The literature is equivocal regarding whether sweat lactate values change with exercise intensity. Recently, wearable technology devices have been developed to measure sweat lactate. Purpose: To examine the relationship between sweat lactate and blood lactate values during incremental exercise. Methods: This study consisted of 12 (8 male, 4 female) healthy recreationally active individuals (VO2peak 35.5 ± 7.6 ml/kg/min) between the ages of 18 and 25 (22 ± 2 yrs) who volunteered for the study. Participants performed an exercise test on a cycle ergometer to volitional fatigue to determine blood lactate, lactate threshold, VO2peak, and peak heart rate (HR). Blood lactate was collected via finger stick at each 3-min stage of exercise. Participants performed a subsequent exercise session at 40, 60, and 80% heart rate reserve (HRR). During the 20-min stages of this test, blood and sweat lactate were collected during each intensity level. Sweat lactate was collected in a sweat “pouch” at each state of exercise. Sweat lactate samples were analyzed via the lactate oxidase method on a Chemwell 2910 chemistry analyzer. Blood lactate samples were analyzed using a Lactate Plus analyzer. Whole body sweat rate was calculated from pre- and post-exercise body weight at each intensity, factoring in water consumed and urine voided. Results: Sweat rate increased with increasing intensity (40%: 9.66 ± 7.58; 60%: 18.10 ± 12.51; 80% 24.32 ± 15.44 ml/min). Sweat lactate significantly differed between 60 and 80% intensities (15.66 ± 5.73, 12.52 ± 4.44 mmol/L, respectively), P = 0.03. Blood lactate levels at 40, 60, and 80% intensities were 2.67 ± 1.15, 3.60 ± 1.90, and 4.83 ± 1.52, respectively (P \u3c 0.001). CONCLUSION: These findings agree with Buono, Lee, & Miller, 2010 who found sweat lactate decreases as sweat rate increases. It is likely that sweat lactate decreases with increasing exercise intensity due to dilution as sweat rate increases. From this data, it appears that sweat lactate does not demonstrate a relationship with blood lactate that warrants replacing blood lactate in exercise testing with sweat lactate. This may be due to the lactate in sweat originating from eccrine glands and thus is not reflective of muscle metabolism

Randomised controlled feasibility trial of a web-based weight management intervention with nurse support for obese patients in primary care

<b>Background</b><p></p> There is a need for cost-effective weight management interventions that primary care can deliver to reduce the morbidity caused by obesity. Automated web-based interventions might provide a solution, but evidence suggests that they may be ineffective without additional human support. The main aim of this study was to carry out a feasibility trial of a web-based weight management intervention in primary care, comparing different levels of nurse support, to determine the optimal combination of web-based and personal support to be tested in a full trial.<p></p> <b>Methods</b><p></p> This was an individually randomised four arm parallel non-blinded trial, recruiting obese patients in primary care. Following online registration, patients were randomly allocated by the automated intervention to either usual care, the web-based intervention only, or the web-based intervention with either basic nurse support (3 sessions in 3 months) or regular nurse support (7 sessions in 6 months). The main outcome measure (intended as the primary outcome for the main trial) was weight loss in kg at 12 months. As this was a feasibility trial no statistical analyses were carried out, but we present means, confidence intervals and effect sizes for weight loss in each group, uptake and retention, and completion of intervention components and outcome measures.<p></p> <b>Results</b><p></p> All randomised patients were included in the weight loss analyses (using Last Observation Carried Forward). At 12 months mean weight loss was: usual care group (n = 43) 2.44 kg; web-based only group (n = 45) 2.30 kg; basic nurse support group (n = 44) 4.31 kg; regular nurse support group (n = 47) 2.50 kg. Intervention effect sizes compared with usual care were: d = 0.01 web-based; d = 0.34 basic nurse support; d = 0.02 regular nurse support. Two practices deviated from protocol by providing considerable weight management support to their usual care patients.<p></p> <b>Conclusions</b><p></p> This study demonstrated the feasibility of delivering a web-based weight management intervention supported by practice nurses in primary care, and suggests that the combination of the web-based intervention with basic nurse support could provide an effective solution to weight management support in a primary care context