An observation on the bias in clinic-based estimates of malnutrition rates

Clinic-based data on malnutrition are the most readily available for following malnutrition levels and trends in most countries, but there is a bias inherent in clinic-based estimates of malnutrition rates. The authors compare annual clinic-based malnutrition data and those from four household surveys in Jamaica. The clinic data give lower estimates of malnutrition than the survey data in all four cases - significantly so in three. The size of the bias was variable over time, so the clinic data were not a good indicator of either levels of trends in nutrition status.Health Monitoring&Evaluation,Early Child and Children's Health,Early Childhood Development,Health Systems Development&Reform,Regional Rural Development

The Directing of Melanie Marnich\u27s These Shining Lives

This thesis is submitted in partial fulfillment of Master of the Fine Arts degree in theatre. It is a detailed account of author Kristin N. Fox\u27s directorial process in directing the play These Shining Lives in the fall of 2017. This thesis chronicles the director\u27s process from pre-production through performance in five chapters: a pre-production analysis, a historical and critical perspective, a rehearsal and performance journal, a post-production analysis and a process development analysis. Appendices and works cited are included

Structure‐function relations for old yellow enzyme

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154277/1/fsb2009015004.pd

A programme for risk assessment and minimisation of progressive multifocal leukoencephalopathy developed for vedolizumab clinical trials

Introduction Over the past decade, the potential for drug-associated progressive multifocal leukoencephalopathy (PML) has become an increasingly important consideration in certain drug development programmes, particularly those of immunomodulatory biologics. Whether the risk of PML with an investigational agent is proven (e.g. extrapolated from relevant experience, such as a class effect) or merely theoretical, the serious consequences of acquiring PML require careful risk minimisation and assessment. No single standard for such risk minimisation exists. Vedolizumab is a recently developed monoclonal antibody to α4β7 integrin. Its clinical development necessitated a dedicated PML risk minimisation assessment as part of a global preapproval regulatory requirement. Objective The aim of this study was to describe the multiple risk minimisation elements that were incorporated in vedolizumab clinical trials in inflammatory bowel disease patients as part of the risk assessment and minimisation of PML programme for vedolizumab. Methods A case evaluation algorithm was developed for sequential screening and diagnostic evaluation of subjects who met criteria that indicated a clinical suspicion of PML. An Independent Adjudication Committee provided an independent, unbiased opinion regarding the likelihood of PML. Results Although no cases were detected, all suspected PML events were thoroughly reviewed and successfully adjudicated, making it unlikely that cases were missed. Conclusion We suggest that this programme could serve as a model for pragmatic screening for PML during the clinical development of new drugs

World of Viruses: the Frozen Horror

https://digitalcommons.unmc.edu/coph_books/1000/thumbnail.jp

Identifying Acute Coronary Syndrome Patients Approaching End-of-Life

Background: Acute coronary syndrome (ACS) is common in patients approaching the end-of-life (EoL), but these patients rarely receive palliative care. We compared the utility of a palliative care prognostic tool (Gold Standards Framework (GSF)) and the Global Registry of Acute Coronary Events (GRACE) score, to help identify patients approaching EoL. Methods and Findings: 172 unselected consecutive patients with confirmed ACS admitted over an eight-week period were assessed using prognostic tools and followed up for 12 months. GSF criteria identified 40 (23%) patients suitable for EoL care while GRACE identified 32 (19%) patients with $10 % risk of death within 6 months. Patients meeting GSF criteria were older (p = 0.006), had more comorbidities (1.660.7 vs. 1.260.9, p = 0.007), more frequent hospitalisations before (p = 0.001) and after (0.0001) their index admission, and were more likely to die during follow-up (GSF+ 20 % vs GSF- 7%, p = 0.03). GRACE score was predictive of 12-month mortality (C-statistic 0.75) and this was improved by the addition of previous hospital admissions and previous history of stroke (C-statistic 0.88). Conclusions: This study has highlighted a potentially large number of ACS patients eligible for EoL care. GSF or GRACE could be used in the hospital setting to help identify these patients. GSF identifies ACS patients with more comorbidity and at increased risk of hospital readmission

Parentage of Hydatidiform Moles

We were presented with the STR (short tandem repeat) profiles from two separate paternity trios. Each trio consisted of a mother, an alleged father, and products of conception (POC) that contained a hydatidiform mole but no visible fetus. In both cases, antecedent pregnancies had followed alleged sexual assaults. Mole classification and pathogenesis are described in order to explain the analyses and statistical reasoning used in each case. One mole exhibited several loci with two different paternal alleles, indicating it was a dispermic (heterozygous) mole. Maternal decidua contaminated the POC, preventing the identification of paternal obligate alleles (POAs) at some loci. The other mole exhibited only one paternal allele/locus at all loci and no maternal alleles, indicating it was a diandric and diploid (homozygous) mole. In each case, traditional calculations were used to determine paternity indices (PIs) at loci that exhibited one paternal allele/locus. PIs at mole loci with two different paternal alleles/locus were calculated from formulas first used for child chimeras that are always dispermic. Combined paternity indices in both mole cases strongly supported the paternity of each suspect.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155886/1/jfo14291.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155886/2/jfo14291_am.pd

An emerging field of research: challenges in pediatric decision making

There is growing interest in pediatric decision science, spurred by policies advocating for children's involvement in medical decision making. Challenges specific to pediatric decision research include the dynamic nature of child participation in decisions due to the growth and development of children, the family context of all pediatric decisions, and the measurement of preferences and outcomes that may inform decision making in the pediatric setting. The objectives of this article are to describe each of these challenges, to provide decision researchers with insight into pediatric decision making, and to establish a blueprint for future research that will contribute to high-quality pediatric medical decision making. Much work has been done to address gaps in pediatric decision science, but substantial work remains. Understanding and addressing the challenges that exist in pediatric decision making may foster medical decision-making science across the age spectrum