Practice Issues for Evaluation and Management of the Suicidal Left Ventricular Assist Device Patient

There is a high prevalence of depression among left ventricular assist device patients, who present with an increased risk of suicidality given access to means via the device either with nonadherence or disconnection. Suicidality via device nonadherence/disconnection is an underresearched clinical issue, as paradoxically this life-saving procedure can also provide a method of lethal means to patients with significant mental health concerns. A case study is used to highlight the course of an attempted suicide by ventricular assistive device nonadherence. Clinical implications and recommendations for practice include a thorough psychological evaluation presurgery, monitoring quality of life and coping styles before and after placement, psychological testing, outlining specific suicide protocols, psychiatric care considerations for patients with highly specialized medical devices, and related ethical concerns

A qualitative investigation of the long -term effects of a staff development project on two middle school science teachers\u27 literacy practices

The focus of this study was to explore the changes in literacy practice that occurred after two middle school science teachers completed their participation in a long-term staff development project on content area literacy. There were two participants in this study, were a sixth-grade life science teacher in her 22nd year of teaching, and an eighth grade physical science teacher in her 4th year of teaching. Multiple data sources were collected, including field notes from the staff development meetings, interviews of participants and other school personnel, classroom observations, descriptive surveys, lesson plans, exit slips and evaluation forms; Qualitative methodologies were used to guide analysis, classification and interpretation of the data collected. The data were read and reread to construct domains and themes (Spradley, 1980) found in each teacher\u27s literacy practices and beliefs. Additionally, the methods of critical discourse analysis were used to analyze the data for issues pertaining to the influential social and political structures of secondary schools (Fairclough, 1989). This second type of analysis afforded opportunities to regard the teachers\u27 literacy practices as social in nature and assumes asymmetrical power distributions within and among three different social contexts---an immediate local context (e.g., the science classroom), a wider institutional context (e.g., teaching, middle school), and the larger social contexts (e.g., Discourses of literacy, adolescents, and schooling). The results showed that the teachers\u27 epistemological stances toward teaching and learning had profound impacts on the strategies they continued to use after the staff development. Findings also indicated that the larger societal Discourses about adolescents, high stakes assessment, and teachers as individuals were reflected in the teachers\u27 decisions to use particular instructional approaches

The effects of weight loss on the biomechanics of walking gait in healthy overweight and obese adults : a systematic review

Obesity is an increasing problem in the developed world with a negative impact on health and quality of life. Weight loss interventions (both lifestyle and surgical therapies) are used as a treatment for clinical obesity and comorbidities. Obesity has been shown to adversely affect the activities of normal daily living, including walking gait and musculoskeletal function. However due to the excess fat mass of obese individuals it is difficult to measure biomechanical effects on gait. The aim of this systematic review was to determine the effects of different weight loss interventions (dietary energy restriction, physical activity/exercise and surgery interventions) on the biomechanics of gait in healthy overweight and clinically obese adults.Six electronic databases were searched for relevant journal articles. Published studies were screened for eligibility according to the predetermined inclusion and exclusion criteria. Seventeen relevant publications were selected for inclusion in the systematic review. Twelve studies used surgery as a weight loss intervention; with two of these including additional exercise after surgery. Five studies used diet and/or exercise as the weight loss intervention; with one using exercise only, one using dietary restriction only, three using combined dietary and exercise/physical activity interventions. The intervention durations ranged from 3-weeks to 48-months, with the surgery interventions typically having longer follow-up.Nine studies compared the participants’ baseline measurements to their post intervention measurements. Four studies were randomised controlled trials comparing the weight loss intervention to a control group. Two studies were non-randomised controlled trials, where the experimental group were undergoing surgery and were compared to a control group.Eleven studies measured gait through functional walking tests which were used to measure gait (walking) velocity. Four studies incorporated more detailed gait analysis outcome measures; including temporal-spatial parameters, with three of these studies also reporting kinematic and kinetic outcome measures.Participants in all studies lost body mass after the dietary restriction, exercise and surgery interventions. Baseline mean body mass index (BMI) ranged from 30.6 ± 3.8 to 51.1 ± 9.2 kg/m² with significant body mass reductions evident in all studies (post intervention BMI ranged from 28.2 ± 8.1 to 40.4 kg/m²). Gait velocity improved after weight loss from the separate dietary restriction, exercise training and surgery interventions.Nine studies measured gait through functional walking tests. The improvement in gait velocity ranged from 0.02 – 0.43 m/s. Overall, more improvement was evident within two surgical intervention (0.05 – 0.15 m/s) studies compared to two studies evaluating diet and exercise intervention (0.05 – 0.08 m/s) with direct gait velocity measures. There has been limited research on gait kinematics and kinetics after weight loss. As a result, there was limited overlap in measurement outcomes in the two studies undertaking 3D gait analysis following weight loss surgery which made it difficult to compare the results of the outcome measures.Further research is required on how weight loss affects the walking gait of obese individuals, especially after dietary and exercise interventions. From the published research, weight loss interventions have significant benefits for the improvement of gait temporal-spatial parameters and to reduce the risk of developing further musculoskeletal disorders. The limited 3D gait analysis available suggests that there is an improvement in gait function following weight loss

Agriculture Policy Is Health Policy.

The Farm Bill is meant to supplement and secure farm incomes, ensure a stable food supply, and support the American farm economy. Over time, however, it has evolved into a system that creates substantial health impacts, both directly and indirectly. By generating more profit for food producers and less for family farmers; by effectively subsidizing the production of lower-cost fats, sugars, and oils that intensify the health-destroying obesity epidemic; by amplifying environmentally destructive agricultural practices that impact air, water, and other resources, the Farm Bill influences the health of Americans more than is immediately apparent. In this article, we outline three major public health issues influenced by American farm policy. These are (1) rising obesity; (2) food safety; and (3) environmental health impacts, especially exposure to toxic substances and pesticides

What precautions should we use with statins for women of childbearing age?

Statins are contraindicated for women who are pregnant or breastfeeding. Data evaluating statin use for women of childbearing age is limited; however, they may be used cautiously with adequate contraception. Pravastatin may be preferred based on its low tissue-penetration properties. Cholesterol-lowering with simvastatin 40 mg/d did not disrupt menstrual cycles or effect luteal phase duration (strength of recommendation: C)

How Do Different Countries Use Labeling Standards: A Case Study Comparing Wisconsin Real Cheese to Parmigiano-Reggiano

 Product labeling is an important dimension in food retailing. The evolution of Protected Geographic Indicators (PGI) and Protected Designation of Origin (PDO) in the European Union are used to identify products grown in a specific region or food products produced using a specific technology. The United States has followed a different path with the use of certifyca-tion/trademarks to identify either product origin or other differentiable characteristics. The divergence of the two approaches has led to trade disputes and WTO lawsuits. In this paper, the main attributes of the two approaches are identified and highlighted with a brief case study comparing Wisconsin Real Cheese and Parmigiano-Reggiano from Italy

Medication abortion provision in Bihar and Jharkhand, India: health facility level and provider level influences

Approximately 9-20% of all maternal deaths in India are attributed to unsafe abortion. Researchers have suggested that medication abortion has the potential to expand women's access to abortion services. This dissertation aimed to: describe the availability of early abortion services in Bihar and Jharkhand, India and the health care provider and health facility level factors that may influence the provision of these services; gain a better understanding of the intentions of obstetrician-gynecologists and general physicians to provide abortion using mifepristone-misoprostol; and establish an understanding of the potential participation of mid-level providers in medication abortion provision. Data utilized in this study came from a project that applied a multistage cluster sample design to the former state of Bihar to achieve a sample of 1346 health facilities and 2039 family planning providers. Surveys were conducted in 2004. Multivariate logistic regression procedures were used to investigate the dissertation aims. Findings indicate that government health facilities have a negligible role in abortion provision in Bihar and Jharkhand. A significant percentage of ob-gyns and general physicians intend to provide mifepristone-misoprostol abortion. Male ob-gyns were significantly less likely to intend to provide medication abortion. Rural health facilities and facilities with three or more family planning providers were more likely to have general physicians intending to provide medication abortion. The majority of mid-level providers were interested in medication abortion training. Mid-level providers who were male, held more permissive abortion attitudes and those that provided abortions using pharmacological drugs were more likely to intend to participate in medication abortion training. More than half of general physicians and over a third of ob-gyns in the study held supportive attitudes towards non-physician participation in early medication abortion provision. Given that the majority of government health facilities in Bihar and Jharkhand are located in rural areas and that most of these facilities are staffed with at least one mid-level provider, great potential exists for pubic facilities to serve as important access points for poor and rural women to obtain safe abortion services if policies in India are adjusted to allow mid-level provider participation in abortion provision, especially medication abortion provision