The role of [clinical] legal education in legal reform in the People’s Republic of China: chicken, egg – or fox?

China has a long and sophisticated “legal” history. This makes commenting upon it a daunting and humbling task, particularly for someone like me, who comes from a nation with only a fairly short and (relatively) straight-line story by comparison. Nonetheless, I shall begin by attempting both to describe the current situation in the People’s Republic of China and to place it in some historical context

A Discipleship Model for Oral Preference Learners: Specifically Related to the Turkana People of Kenya

The Turkana people of Kenya are primarily oral learners, processing information in oral ways. Oral learners are completely reliant on what they hear, see, and experience because they cannot or choose not to read.1 Missionaries from highly literate western cultures unwittingly burdened these oral learners with literacy dependent teaching methods and discipleship practices. This has particularly left Turkana Christian leaders with few options for deepening their own Christian spirituality or leading others in discipleship. Additionally, a cultural disconnect between western spiritual categories taught by the missionaries and Turkana spiritual categories have left several Turkana spiritual needs unmet. The Turkana Christians clearly need a culturally appropriate oral education by missionaries instead of the current systems. These systems created a crippling deficit in Turkana Christian spiritual formation and discipleship practices. This deficit creates an opportunity to design a discipleship model that will meet the culturally specific needs among the Turkana people, equipping and empowering them to make disciples and grow spiritually. This model includes: small community discipleship and accountability groups, oral telling of Bible stories connected to the overarching story of the Bible, robust discussion around the story told, applications discovered with the guiding of the Holy Spirit, and the use of culturally appropriate oral arts to help participants remember and share what they have learned. 1. W. J. Moon, Fad or Renaissance? Misconceptions of the Orality Movement, International Bulletin of Mission Research 40, no. 1 (2016): 12, https://doi.org/10.1177/239693931562597

The Syndrome of Toxemia: An Expression of General Nervous Discharge Through the Sympathetic System

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Ka-band MMIC subarray technology program (Ka-Mist)

The broad objective of this program was to demonstrate a proof of concept insertion of Monolithic Microwave Integrated Circuit (MMIC) device technology into an innovative (tile architecture) active phased array antenna application supporting advanced EHF communication systems. Ka-band MMIC arrays have long been considered as having high potential for increasing the capability of space, aircraft, and land mobile communication systems in terms of scan performance, data rate, link margin, and flexibility while offering a significant reduction in size, weight, and power consumption. Insertion of MMIC technology into antenna systems, particularly at millimeter wave frequencies using low power and low noise amplifiers in close proximity to the radiating elements, offers a significant improvement in the array transmit efficiency, receive system noise figure, and overall array reliability. Application of active array technology also leads to the use of advanced beamforming techniques that can improve beam agility, diversity, and adaptivity to complex signal environments

Ethylene glycol: an estimate of tolerable levels of exposure based on a review of animal and human data

Upon ingestion ethylene glycol (EG, monoethylene glycol) is rapidly absorbed from the gastrointestinal tract, and depending on the severity of exposure signs of toxicity may progress through three stages. Neurological effects characterize the first step consisting of central nervous depression (intoxication, lethargy, seizures, and coma). The second stage, usually 12-24h after ingestion, is characterized by metabolic acidosis due to the accumulation of acidic metabolites of EG, primarily glycolic acid (GA), contributing to the ensuing osmolal and anion gaps. Stage 3, generally 24-72h after ingestion, is determined mainly by oxalic acid excretion, nephropathy, and eventual renal failure. Because the toxicity of EG is mediated principally through its metabolites, adequate analytical methods are essential to provide the information necessary for diagnosis and therapeutic management. The severe metabolic acidosis and multiple organ failure caused by ingestion of high doses of EG is a medical emergency that usually requires immediate measures to support respiration, correct the electrolyte imbalance, and initiate hemodialysis. Since metabolic acidosis is not specific to EG, whenever EG intoxication is suspected, every effort should be made to determine EG as well as its major metabolite GA in plasma to confirm the diagnosis and to institute special treatment without delay. A number of specific and sensitive analytical methods (GC, GC-MS, or HPLC) are available for this purpose. Due to the rapid metabolism of EG, the plasma concentration of GA may be higher than that of EG already upon admission. As toxicity is largely a consequence of metabolism of EG to GA and oxalic acid, the simultaneous quantification of EG and GA is important. Formation of calcium oxalate monohydrate in the urine may be a useful indicator of developing oxalate nephrosis although urine crystals can result without renal injury. The pathways involved in the metabolism of EG are qualitatively similar in humans and laboratory animals, although quantitative differences have been reported. Comparison between species is difficult, however, because the information on humans is derived mainly from acute poisoning cases whereas the effects of repeated exposures have been investigated in animal experiments. Based on published data the minimum human lethal dose of EG has been estimated at approx. 100ml for a 70-kg adult or 1.6g/kg body weight (calculation of dose in ml/kg to mg/kg based in EG density=1.11g/l). However, human data from case reports are generally insufficient for the determination of a clear dose-response relationship and quantification of threshold doses for systemic toxicity, in particular renal effects, is limited. As toxicity is largely a consequence of metabolism of EG to GA, it is important to note that no signs of renal injury have developed at initial plasma glycolate concentrations of up to 10.1mM (76.7mg/dl). Plasma EG levels of 3.2mM (20mg/dl) are considered the threshold of toxicity for systemic exposure, if therapeutic strategy is based on the EG concentration alon

Ethylene Oxide: Acute Four-Hour and One-Hour Inhalation Toxicity Testing in Rats

Ethylene oxide was tested on groups of rats for either 4-hour or 1-hour inhalation exposure, followed by 14 days of observation. Groups of five Sprague-Dawley rats/sex were exposed, and clinical signs and mortality were recorded. Clinical signs noted included irregular breathing, absence of certain reflexes, and tremors. Rats that died had moderate to severe pulmonary congestion. The calculated LC50 values, reported as ppm by volume (with 95% confidence limits), were as follows. 4-hour LC50 values were 1972 (1887 to 2061) ppm for males; 1537 (1391 to 1698) ppm for females; 1741 (1655 to 1831) ppm for the combined sexes. The 1-hour LC50 values were 5748 (5276 to 6262) ppm for males; 4439 (4034 to 4884) ppm for females; 5029 (4634 to 5459) ppm for the combined sexes

Screening Patients for Physical Frailty in the Preoperative Phase

Background: Frailty is a syndrome characterized by an increased burden of symptoms and higher susceptibility to adverse health, including higher functional decline rates, pressure ulcers, falls, delirium, extended hospital stay, and discharge to assisted living facilities. Screening patients for frailty before undergoing a surgical procedure is recommended to minimize postoperative complications. In the preoperative phase at a midwestern academic hospital, surgical patients are not screened for frailty using a validated screening tool. Purpose: This project sought to calculate the Clinical Frailty Scale (CFS) score using a novel algorithm. After validating the novel algorithm, this research project predicted that clinicians would appropriately refer to the novel algorithm to identify frail patients. Other long-term goals included enhancing patient outcomes and influencing organization policies utilizing a frailty screening tool. Theoretical/Conceptual Framework: The Johns Hopkins Nursing Evidence-Based Practice model was utilized to implement the frailty screening tool and evaluate its impact on frailty identification. The model uses a three-step process involving practice questions, evidence, and translation. Method: This project utilized existing patient data from the patient’s Electronic Medical Record (EMR) and identified physical frailty using a novel algorithm developed by the research team. The CFS, a validated screening tool, was used to validate the novel algorithm’s ability to predict frailty. Results: The correlation coefficient (r) between the novel algorithm and the CFS score from researcher #1 was 0.66835. The r value between the novel algorithm and the CFS score from researcher #2 was 0.637808. The r value of the CFS scores between researcher #1 and researcher # 2 was 0.8122. These findings suggest that the novel algorithm is a reliable tool for assessing frailty, and that there is agreement between the two researchers in their assessment of CFS. Conclusion: In this project, the moderate positive relationship between the novel algorithm score and the CFS score suggest that the novel algorithm may be a useful tool for assessing the same construct as the CFS tool. However, further research is needed to determine the extent to which the novel algorithm and the CFS tool scores measure the same construct and whether one is more valid, reliable, or efficient than the other. Overall, the findings from this project suggests that the novel algorithm may have clinical significance as a potential alternative or complementary tool to the CFS tool for assessing the same construct

Follow-up of Mothers with Suspected Postpartum Depression from Pediatrics Clinics

Purpose Pediatric providers are increasingly screening for postpartum depression (PD), yet, it is unknown how often mothers comply with recommendations to seek treatment. The objectives were to describe the rate at which mothers with suspected PD seek treatment and explore factors that predict help-seeking behavior. Design and methods Mothers were recruited from four pediatric clinics after identification using the Child Health Improvement through Computer Automation (CHICA) system. Mothers with a positive screen were invited to participate in a telephone interview between January 2012 and December 2014. Mothers reported if they sought treatment or called a community resource. Results 73 of 133 eligible mothers participated (55% response rate). Fifty women recalled a recommendation to seek help. Only 43.8% (32/73) made a follow-up appointment with an adult provider and even fewer kept the appointment. Conclusion A majority of mothers suspected of having PD recalled a referral for further intervention; yet, less than half took action. Further investigation of barriers of help-seeking behavior is warranted

Group Visits to Improve Pediatric ADHD Chronic Care Management

Objective: Children with attention-deficit hyperactivity disorder (ADHD) may experience continued impairment at home and school even after medication initiation. Group visits offer a way for pediatricians to provide more time to address ongoing needs. A pilot study was undertaken to examine whether a group visit model improved ADHD management in the pediatric medical home. Methods: Parents and children aged 6 to 18 years with ADHD were recruited and randomized to group visits or a usual care control. Data included attendance at ADHD follow-up visits, parent-rated ADHD symptoms, adaptive functioning, and quality of life. Longitudinal linear mixed models (continuous variables) and generalized linear mixed models (binary outcomes) were used to compare groups. In our statistical models, child and family were random effects; study assignment was a fixed effect. Results: Twenty families representing 29 children participated (intervention: 9 parents/13 children and control: 11 parents/16 children). Aside from race, baseline characteristics of participants were similar. None of the intervention families missed the expected 5 ADHD follow-up visits over 1 year; control families missed 1 or more visits over the same period. Intervention families reported an improved level of adaptive functioning at 12 months compared with control (mean severity score: 3.7 vs 4.4, p = .003). All families reported greater limitations and poorer quality of life compared with national norms. Conclusion: Group visits in the pediatric medical home can improve adherence, and preliminary results show a variety of improvements for the family