The evidence for the benefits from breast milk in the neurodevelopment of premature babies – a review of the recent literature

Introduction. The brain in preterm babies is usually not fully developed and therefore early post-term events can have long-lasting neurodevelopment and cognitive outcomes. It is known that cerebral white matter connectivity is important for later intact cognitive functioning amongst children born very preterm and that breast milk imparts neurotrophic factors. The relationship between breastfeeding and child development is a long and well-studied area, and the evidence in support of breast milk is already substantial. Here we review the recent literature on the topic to establish whether additional evidence is available to strengthen the view that breast milk is superior in maximizing neurological development in premature infants. Materials and Methods. A search was undertaken of PubMed, limited to the last 10 years and humans. No language restrictions were imposed. Results. The search yielded 45 articles, of which 12 included all three elements of breast milk, neurological/cognitive development and preterm babies; 10 were reviewed. The gestation period and birth weight (either or both were reported) ranged from 23 to 36 weeks and from 580g t

Merchandising - modern technique used in the process of goods sales

Introducing the new forms of sales determined functional changes in organizing the shops and gave an impulse to modernizing the commercial technique by means of merchandising, that means the totality of techniques and previsions necessary to sell the right product in the right place, in the right quantities, at the right time and at the right price. Merchandising is based on the techniques of presenting the products at the sale place, using everything that could be more attractive: conditioning and presentation, fractionation, packing, exposure and display of goods in a special place designed for a certain type of sale. Therefore, in order to determine the consumer to purchase new products, the use of old sales methods is no longer efficient: the new techniques must adjust to the new products.merchandising, goods sales, modern technique

Emergency surgery on mentally impaired patients: standard in consenting

Emergency surgery is often performed on the elderly and susceptible patients with significant comorbidities; as a consequence, the risk of death or severe complications are high. Consent for surgery is a fundamental part of medical practice, in line with legal obligations and ethical principles. Obtaining consent for emergency services (for surgical patients with chronic or acute mental incapacity, due to surgical pathology) is particularly challenging, and meeting the standards requires an up-to-date understanding of legislation, professional body guidelines, and ethical or cultural aspects. The guidance related to consent requires physicians and other medical staff to work with patients according to the process of ‘supported decision-making’. Despite principles and guidelines that have been exhaustively established, the system is sometimes vulnerable in actual clinical practice. The combination of an ‘emergency’ setting and a patient without mental ‘capacity’ is a challenge between patient-centered and ‘paternalistic’ approaches, involving legislation and guidelines on ‘best interests’ of the patient

Factors Affecting Length of Stay in Children and Adolescents Admitted with an Eating Disorder to a Large Urban Pediatric Hospital

Background: Hospitalizations including the diagnosis of an eating disorder (ED) have increased significantly in the pediatric population over the past few decades. Patients who are male, who areage, who receive an nasogastric (NG) tube, or who require admission to a residential treatment program often remain in the hospital for longer periods of time. Few studies examining LOS exist for children and adolescents with an ED. Longer lengths of stay have previously been associated with factors such as having Medicaid, a reduced body mass index (BMI) upon admission, and a diagnosis of anorexia nervosa (AN). Objective: The purpose of this study is to examine risk factors related to a longer LOS in children and adolescents admitted to a large urban pediatric hospital with AN or bulimia nervosa (BN). Participants/setting: A retrospective cohort study was conducted in 65 patients 9-20 years of age who were admitted to Children’s Healthcare of Atlanta (CHOA) between January 1, 2014 and December 31, 2015. Statistical Analysis: Frequency statistics were used to describe the demographic, anthropometric, and clinical characteristics of the population. A Mann Whitney U test or Kruskal-Walllis test was used to examine differences in LOS by demographic characteristics, mode of nutrition therapy, discharge treatment program location, and admission BMI category. The association between LOS category by demographic and clinical characteristics was determined using a Chi-square statistic. Results: A total of 65 patients (94% female, 89% Caucasian) with a mean age of 14.6 ± 2.4 years were admitted during the study period. The median LOS was 9 days (IQR; 6, 13) and was significantly longer in those who had an NG tube placed vs. oral diet (11 days (IQR; 7, 21) vs. 8 days (IQR; 5, 9.3), respectively; p Conclusion: The characteristics of hospitalized pediatric patients with an ED were consistent with those of other studies. Longer lengths of stay in those who had an NG tube placed may have been due to the patient’s lack of compliance, failure to gain weight, and severity of malnutrition since more time is needed for medical recovery. More treatment centers for children and adolescents with an ED are needed in the state of Georgia to potentially reduce LOS. Future studies should include a greater percentage of males and larger population of children and adolescents

Women in The Canterbury Tales: the Prioress, the Wife of Bath, the Second Nun, a hen and a lady falcon

Treball Final de Grau en Estudis Anglesos. Codi: EA0938. Curs acadèmic: 2017/2018In a society controlled by men, the Church and its authorities, fourteen century women had little space for their personal aspirations in life. Their submission and passivity to men controlled all the facets of their existence. Geoffrey Chaucer’s The Canterbury Tales present a unique and copious vision of medieval society through his variety of characters belonging to different social classes, thus providing the perfect source from which to analyze women’s roles in the Middle Ages. From his twenty-nine pilgrims, Chaucer only chose to introduce three women: the Prioress, the Wife of Bath and the Second Nun. Though many other women appeared in the Tales, none of them were given voice. This choice yields many interpretations, from those who critique Chaucer to those who applaud him. This work analyzes the roles of the three medieval women who appear in The Canterbury Tales, their possibilities in such society and tests if their depiction is accurate. Aspects such as their characterization, attitudes and actions from both their Prologues and Tales will be studied according to already existing analyses. Moreover, two other uncommon but surprising female characters, a hen and a lady falcon, will be investigated and subjected to the supposition of “what if” they could be considered as representatives of real medieval women. In doing so, a better understanding of Chaucer’s women characters, and most importantly, of the women’s role in such era, will be presented

Investigation of the molecular mechanisms downstream of T cell receptor signalling during thymic T cell development

The key feature of T cells is their T cell receptor (TCR), which renders them specific to antigen. Immature double positive (DP) T cells develop in the thymus into mature single positive (SP) cells. During this maturation process, developing T cells are positively selected if their receptors are able to receive a signal from self-antigen and negatively selected by the proapoptotic Bim-mediated mechanism if they bind self-antigen too strongly. Meanwhile, DP cells are lineage selected into either CD4 or CD8 SP cells. Some self-reactive cells are agonist-selected and upregulate Foxp3 to become regulatory T cells (Treg), which suppress immune responses. The temporal order of these selection processes is not well understood due to a lack of tools to investigate temporal changes of T cell development in vivo. To determine the sequence of and relationship between these events, this project used the novel technology Timer of Cell Kinetics and Activity (Tocky), which analyses the maturation of a fluorescent timer (Timer) protein to show temporal changes in transcription. Here, Tocky was developed and used to study in vivo transcriptional dynamics of Foxp3 and a gene immediately downstream TCR signalling, Nr4a3, to analyse Treg differentiation and TCR signalling downstream activities. In Nr4a3-Tocky mice, Timer+ cells were enriched with cells that undergo negative and agonist selection. Nr4a3-Tocky:BimKO/KO mice showed that Bim-mediated negative selection occurred rapidly at both DP and SP stages in the most immature Timer+ cells. Foxp3 was detected after Bim transcription was downregulated in Timer+ cells, following persistent TCR signals. Intriguingly, in Nr4a3-Tocky:BimKO/KO mice Timer+ cells were enriched with cells that escaped negative selection and highly self-reactive Foxp3+ cells were accumulated in both DP and SP fractions. Based on this work, a new model for the temporal order of thymic selection processes and T cell maturation is proposed.Open Acces