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HOME MECHANICAL VENTILATION OF CHILDREN

The medical records of 89 ventilator-assisted children followed at the University of Michigan Medical Center from 1978 to 1993 were reviewed. The status of these children was remarkably stable. Parameters of communication, nutrition, education, and mobility changed very little over time, and fewer than half had to be rc-admitted. Children aged 9 to 12 years had the most nursing hours; in terms of diagnosis, those with spinal cord injury and bronchopulmonary dysplasia had the most. The younger children had the longest initial hospital stay and the most re-admissions. The authors conclude that appropriate rehabilitation during the initial hospitalization can minimize later changes, instability and rehospitalizations, and that careful follow-up and periodic evaluation can improve the patients' health and function. R SUM Ventilation assist e a domicile chez enfant: param tres ďune volution durant quinze ans ďexp rience Les dossiers m dicaux de 89 enfants ayant b n fici ďune ventilation assist e et suivis par le Centre M dical de Universit du Michigan entrc 1978 et 1993 ont t examines. tat de ces enfants est apparu remarquablement stable. Les param tres de communication, alimentation. ducation et d placements volu rent tr s peu et moms de la moiti des enfants devaient tre r hospitalis e. Les enfants de 9 12 ans cxigeaient le plus ďheures ďinfirmi re; de m me, en terme de diagnostic, les enfants avec lesions de la moelle epiniere ou une dysplasie broncho-pulmonaire. Les enfants les plus jeunes exigeaient le temps hospitalier initial le plus long et les r hospitalisations les plus fr quentes. Les auteurs concluent qu'une prise en charge appropri e durant hospitalisation initiate peut att nuer les modifications ult rieures, instabilit ou la r hospitalisation, et qu'un suivi soigneux et des valuations p riodiques peuvent am liorer la sant et les capacit s des patients. ZUSAMMENFASSUNG Heimbeatmimg von Kindern: Ver ndemngen nach 15 Jaliren Erfalirung Die Krankengeschichten von 89 Kindern mit assistierter Beatmung, die von 1978 zu 1993 in der Universitatsklinik von Michigan betreut wurden, sind durchgesehen worden. Der Zustand dieser Kinder war bemerkenswert stabil. Die Parameter f r Kommunikation, Ern hrung, Erziehung und Mobilit t nderten sich in diesem Zeitraum kaum und weniger als die H lfte mu ten wieder aufgenommen werden. Kinder im Alter zwischen 9 und 12 Jahren brauchten die meisten Pflegestunden, unter Ber cksichtigung der Diagnose hatten Kinder mit Riickenmarksverletzungen und bronchopulmonaler Dysplasie die meisten. Die j ngeren Kinder warcn am l ngsten in der Klinik und mu tcn am h ufigsten wieder aufgenommen werden. Die Autoren schlie en daraus, da eine ausreichende Rehabilitation beim ersten Krankenhausaufenthalt sp tere Ver nderungen, Instabilit ten und Rehospitalisierungen reduzieren und sorgf ltige Kontrollen und periodische Beurteilungen die Gesundheit und Funktion der Patienten verbessern k nnen. R SUM Ventilaci n mec nica de ni os a domicilio: par metros de cambio en una experiencia de quince a as Se revisaron las historias cl nicas de 89 ni os con ventilaci n asistida, seguidos en el Medical Center de la Universidad de Michigan dcsde 1978 a 1993. El estado de estos ni os era notablemente estable. Los par metros de comunicaci n, nutrici n, educaci n y movilidad cambiaron muy poco a lo largo del tiempo y s 1o tuvieron que reingresar menos de la mitad de ellos. Los ni os de 9 a 12 a os ten an el mayor numero de horas decuidados y en t rminos de diagn stico los ni os con lesion medular y displasia broncopulmonar necesitaban el m ximo de cuidados. Los ni os m s peque os presentaban el estadio inicial hospitalario m s largo y el mayor n mero de reingresos. Los autorcs concluyen que una apropiada rehabilitaci n durante el inicio de la hospitalizaci n puede minimizar los cambios posteriores, la inestabilidad y las rehospitalizaciones. Igualmente un seguimiento cuidadoso y evaluaciones peri dicas pueden mejorar la salud y la funcion de los pacientes.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66446/1/j.1469-8749.1996.tb12140.x.pd

Consistent phenological shifts in the making of a biodiversity hotspot: the Cape flora

Background The best documented survival responses of organisms to past climate change on short (glacial-interglacial) timescales are distributional shifts. Despite ample evidence on such timescales for local adaptations of populations at specific sites, the long-term impacts of such changes on evolutionary significant units in response to past climatic change have been little documented. Here we use phylogenies to reconstruct changes in distribution and flowering ecology of the Cape flora - South Africa's biodiversity hotspot - through a period of past (Neogene and Quaternary) changes in the seasonality of rainfall over a timescale of several million years. Results Forty-three distributional and phenological shifts consistent with past climatic change occur across the flora, and a comparable number of clades underwent adaptive changes in their flowering phenology (9 clades; half of the clades investigated) as underwent distributional shifts (12 clades; two thirds of the clades investigated). Of extant Cape angiosperm species, 14-41% have been contributed by lineages that show distributional shifts consistent with past climate change, yet a similar proportion (14-55%) arose from lineages that shifted flowering phenology. Conclusions Adaptive changes in ecology at the scale we uncover in the Cape and consistent with past climatic change have not been documented for other floras. Shifts in climate tolerance appear to have been more important in this flora than is currently appreciated, and lineages that underwent such shifts went on to contribute a high proportion of the flora's extant species diversity. That shifts in phenology, on an evolutionary timescale and on such a scale, have not yet been detected for other floras is likely a result of the method used; shifts in flowering phenology cannot be detected in the fossil record

Exploring key-stakeholder perceptions on non-communicable disease care during the COVID-19 pandemic in Kenya

Introduction: over one third of total Disability-Adjusted-Life-Years lost in Kenya are due to non-communicable diseases (NCD). In response, the Government declared significant commitment towards improving NCD care. The COVID-19 pandemic increased the burden on the already overstretched health systems in Kenya. The aims of this study are to assess whether health care providers perceived NCD care to be optimal during the pandemic and explore how to improve responses to future emergencies. Methods: this cross-sectional online survey included healthcare personnel with non-clinical roles (public health workers and policy-makers) and those delivering health care (doctors and nurses). Respondents were recruited between May and September 2021 by random sampling, completed by snowball sampling. Results: among 236 participants (42% in clinical, 58% in non-clinical roles) there was an overall consensus between respondents on NCD care being disrupted and compromised during the pandemic in Kenya. Detracted supplies, funding, and technical resources affected the continuity of NCDs’ response, despite government efforts. Respondents agreed that the enhanced personnel capacity and competencies to manage COVID-19 patients were positive, but noted a lack of guidance for redirecting care for chronic diseases, and advocated for digital innovation as a solution. Conclusion: this paper explores the perceptions of key stakeholders involved in the management of NCDs in Kenya to improve planning for future emergency responses. Gaps were identified in health system response and preparedness capacity during the pandemic including the perceived need to strengthen NCD services, with solutions offered to guide resilience efforts to protect the health system from disruption

An Online Survey of the Perceptions of Clinical and Non-Clinical Professionals on Healthcare for Non-Communicable Diseases and COVID-19 Measures During the Pandemic in Malaysia

Objectives: This study assesses the opinions of health professionals in Malaysia on the disruption of non-communicable disease (NCD) services during the COVID-19 pandemic from March 2020 to January 2022. Methods: We conducted a cross-sectional online survey with 191 non-clinical public health workers and clinical health service workers in Malaysia from November 2021 to January 2022. Participants were recruited by the Malaysian Ministry of Health using major networks including key experts and practitioners. Secondary respondents were subsequently enrolled through snowballing. Results: The most notable issues raised by the survey participants relate to NCD service disruption, the redirection of NCD care resources, and NCD care being overburdened post-pandemic. Respondents also reported accounts of resilience and prompt reaction from the healthcare system, as well as calls for innovation. Conclusion: Most respondents perceived that the challenges arising from COVID-19 were mostly managed well by the healthcare system, which was able to provide the necessary services to NCD patients during this health emergency. However, the study identifies gaps in the health system response and preparedness capacity, and highlights solutions for strengthening NCD services

An Online Survey of the Perceptions of Clinical Professionals on Healthcare for Non-Communicable Diseases and Covid-19 Measures During the Pandemic in Malaysia

El material suplementario del artículo puede ser encontrado de manera online en: https://www.ssph-journal.org/articles/10.3389/ijph.2023.1605861/full#supplementary-material Este artículo está sujeto a una licencia CC BY 4.0.Objectives: This study assesses the opinions of health professionals in Malaysia on the disruption of non-communicable disease (NCD) services during the COVID-19 pandemic from March 2020 to January 2022. Methods: We conducted a cross-sectional online survey with 191 non-clinical public health workers and clinical health service workers in Malaysia from November 2021 to January 2022. Participants were recruited by the Malaysian Ministry of Health using major networks including key experts and practitioners. Secondary respondents were subsequently enrolled through snowballing. Results: The most notable issues raised by the survey participants relate to NCD service disruption, the redirection of NCD care resources, and NCD care being overburdened post-pandemic. Respondents also reported accounts of resilience and prompt reaction from the healthcare system, as well as calls for innovation. Conclusion: Most respondents perceived that the challenges arising from COVID-19 were mostly managed well by the healthcare system, which was able to provide the necessary services to NCD patients during this health emergency. However, the study identifies gaps in the health system response and preparedness capacity, and highlights solutions for strengthening NCD services.Peer reviewe

Exploring key-stakeholder perceptions on non-communicable disease care during the COVID-19 pandemic in Kenya

Este artículo está sujeto a una licencia CC BY 4.0Introduction: over one third of total Disability-Adjusted-Life-Years lost in Kenya are due to non-communicable diseases (NCD). In response, the Government declared significant commitment towards improving NCD care. The COVID-19 pandemic increased the burden on the already overstretched health systems in Kenya. The aims of this study are to assess whether health care providers perceived NCD care to be optimal during the pandemic and explore how to improve responses to future emergencies. Methods: this cross-sectional online survey included healthcare personnel with non-clinical roles (public health workers and policy-makers) and those delivering health care (doctors and nurses). Respondents were recruited between May and September 2021 by random sampling, completed by snowball sampling. Results: among 236 participants (42% in clinical, 58% in non-clinical roles) there was an overall consensus between respondents on NCD care being disrupted and compromised during the pandemic in Kenya. Detracted supplies, funding, and technical resources affected the continuity of NCDs response, despite government efforts. Respondents agreed that the enhanced personnel capacity and competencies to manage COVID-19 patients were positive, but noted a lack of guidance for redirecting care for chronic diseases, and advocated for digital innovation as a solution. Conclusion: this paper explores the perceptions of key stakeholders involved in the management of NCDs in Kenya to improve planning for future emergency responses. Gaps were identified in health system response and preparedness capacity during the pandemic including the perceived need to strengthen NCD services, with solutions offered to guide resilience efforts to protect the health system from disruption.Peer reviewe

Manganese Superoxide Dismutase: Guardian of the Powerhouse

The mitochondrion is vital for many metabolic pathways in the cell, contributing all or important constituent enzymes for diverse functions such as β-oxidation of fatty acids, the urea cycle, the citric acid cycle, and ATP synthesis. The mitochondrion is also a major site of reactive oxygen species (ROS) production in the cell. Aberrant production of mitochondrial ROS can have dramatic effects on cellular function, in part, due to oxidative modification of key metabolic proteins localized in the mitochondrion. The cell is equipped with myriad antioxidant enzyme systems to combat deleterious ROS production in mitochondria, with the mitochondrial antioxidant enzyme manganese superoxide dismutase (MnSOD) acting as the chief ROS scavenging enzyme in the cell. Factors that affect the expression and/or the activity of MnSOD, resulting in diminished antioxidant capacity of the cell, can have extraordinary consequences on the overall health of the cell by altering mitochondrial metabolic function, leading to the development and progression of numerous diseases. A better understanding of the mechanisms by which MnSOD protects cells from the harmful effects of overproduction of ROS, in particular, the effects of ROS on mitochondrial metabolic enzymes, may contribute to the development of novel treatments for various diseases in which ROS are an important component

Volume 177: Defense, Deficits, and Deployments: The Future of U.S. Military Policy

Created as part of the 2012 Jackson School for International Studies SIS 495: Task force. Adam Smith Task Force Advisor; Erin C. Conaton Evaluator.America’s economic strength and military might go hand in hand. Each is indispensable to the other. Thus, in times such as the present when America’s deteriorating fiscal position requires swift and reasoned attention, it becomes incumbent on the Department of Defense to evaluate how its own operations help or hinder the situation. Deliberate decisions by Congress have further entrenched this relationship vis-à-vis the Budget Control Act of 2011 which directly imposes cuts to DoD spending as part of a larger effort to bring the federal budget toward balance. Even if not for the fiscal circumstances, the present moment is a good one for reevaluating the trajectory of US military strategy. Now that Operation Iraqi Freedom has ended and activities in Afghanistan are waning, DoD will face very different demands on its resources than it has over the past ten years. Asymmetric threats to national security such as terror cells and cyber warfare also continue to pose novel challenges, requiring adaptation by the department