Poor Maternal Nutrition during Gestation Alters Placental IGF-I, IGF-II, and IGFBP-3 mRNA Expression in Sheep

Insulin-like growth factors (IGF) modulate placental and fetal growth and development through nutrient sensing and endocrine signaling. We hypothesized that poor maternal nutrition during gestation would alter IGF-I, IGF binding protein (IGFBP)-2, and IGFBP-3 mRNA expression in the ovine placenta, but would not affect IGF-II mRNA expression. Pregnant ewes (n=57) were individually fed: 60% (restricted fed; RES), 100% (control fed; CON), or 140% (over fed; OVER) of National Research Council requirements for TDN starting at day 30±0.2 of gestation. Ewes were euthanized and cotyledon and caruncle samples were collected at days 45, 90, and 135 of gestation. Relative mRNA expression of IGF-I, IGF-II, IGFBP-2, and IGFBP-3 was quantified using real-time PCR. Data were analyzed using the MIXED procedure in SAS. Relative IGF-I mRNA expression was less at day 45 than at days 90 and 135 in the caruncle (P \u3c 0.001; d45: 0.96 ± 0.06, d90: 1.28 ± 0.06, d135: 1.38 ± 0.05). In the caruncle, IGFBP-2 expression was less at day 45 than at days 90 and 135 (P \u3c 0.001; d45: 0.67 ± 0.20, d90: 1.90 ± 0.20, d135: 1.65 ± 0.18). There was no detectable impact of diet or time on IGF-II or IGFBP-3 expression in the caruncle (P \u3e 0.12). In the cotyledon, IGF-I expression tended to be greater in RES than OVER, which was similar to CON (P = 0.08; RES: 1.10 ± 0.06, OVER: 0.89 ± 0.07, CON: 0.96 ± 0.07). Relative IGF-II mRNA expression was greater in RES than OVER cotyledons (P = 0.01; RES: 1.96 ± 0.31, OVER: 0.54 ± 0.32, CON: 1.30 ± 0.35). Relative IGFBP-2 mRNA expression decreased over time in the cotyledon (P \u3c 0.001; d45: 1.26 ± 0.12, d90: 0.93 ± 0.12, d135: 0.59 ± 0.11). Relative IGFBP-3 mRNA expression was less in RES than in OVER or CON cotyledons (P = 0.009; RES: 0.03 ± 0.57, OVER: 3.62 ± 0.66, CON: 1.84 ± 0.64). In response to poor maternal diet, changes in IGF expression in the cotyledon were greater than in the caruncle, suggesting a potential mechanism by which maternal-fetal exchange may be modified to restrict placental and fetal growth

A compilation, tabulation, and analysis of spelling errors in grade six for a six-week period.

Thesis (Ed.M.)--Boston Universit

Consensus Statement of the International Summit on Intellectual Disabilityand Dementia Related to Nomenclature

A working group of the 2016 International Summit on Intellectual Disability and Dementia was charged to examine the terminology used to define and report on dementia in publications related to intellectual disability (ID). A review of related publications showed mixed uses of terms associated with dementia or causative diseases. As with dementia research in the non-ID population, language related to dementia in the ID field often lacks precision and could lead to a misunderstanding of the condition(s) under discussion; an increasingly crucial issue given the increased global attention dementia is receiving in that field. Most articles related to ID and dementia reporting clinical or medical research generally provide a structured definition of dementia or related terms; social care articles tend toward term use without definition. Toward terminology standardization within studies/reports on dementia and ID, the Summit recommended that a consistent approach is taken that ensures (a) growing familiarity with dementia-related diagnostic, condition-specific, and social care terms (as identified in the working group's report), (b) creating a guidance document on accurately defining and presenting information about individuals or groups referenced, and (c) that in reports on neuropathologies or cognitive decline or impairment, definitions are used and data include subjects' ages, sex, level of ID, residential situation, basis for dementia diagnosis, presence of Down syndrome (or other risk conditions), years from diagnosis, and if available, scores on objective measures of changing function

International Summit Consensus Statement: Intellectual Disability Inclusion in National Dementia Plans

The WHO has called for the development and adoption of national plans or strategies to guide public policy and set goals for services, supports, and research related to dementia. It called for distinct populations to be included within national plans, including adults with intellectual disability (ID). Inclusion of this group is important as having Down syndrome is a significant risk factor for early-onset dementia. Adults with other ID may have specific needs for dementia-related care that, if unmet, can lead to diminished quality of old age. An International Summit on Intellectual Disability and Dementia in Scotland reviewed the inclusion of ID in national plans recommending that inclusion goes beyond just description and relevance of ID. Reviews of national plans and reports on dementia show minimal consideration of ID and the challenges that their carers face. The Summit recommended that persons with ID, as well as family carers, should be included in consultation processes and greater advocacy is required from national organisations on behalf of families, with need for an infrastructure in health and social care that supports quality care for dementia

The Gas Cylinder, the Motorcycle and the Village Health Team Member: A Proof-of-Concept Study for the Use of the Microsystems Quality Improvement Approach to Strengthen the Routine Immunization System in Uganda

Although global efforts to support routine immunization (RI) system strengthening have resulted in higher immunization rates, the World Health Organization (WHO) estimates that the proportion of children receiving recommended DPT3 vaccines has stagnated at 80% for the past 3 years (WHO Fact sheet-Immunization coverage 2014, WHO, 2014). Meeting the WHO goal of 90% national DPT3 coverage may require locally based strategies to support conventional approaches. The Africa Routine Immunization Systems Essentials-System Innovation (ARISE-SI) initiative is a proof-of-concept study to assess the application of the Microsystems Quality Improvement Approach for generating local solutions to strengthen RI systems and reach those unreached by current efforts in Masaka District, Uganda. The ARISE-SI intervention had three components: health unit (HU) advance preparations, an action learning collaborative, and coaching of improvement teams. The intervention was informed and assessed using qualitative and quantitative methods. Data collection focused on changes and outcomes of improvement efforts among five HUs and one district-level team during the intervention (June 2011-February 2012) and five follow-up months

Reduction and prevention of agitation in persons with neurocognitive disorders: an international psychogeriatric association consensus algorithm

Objectives: To develop an agitation reduction and prevention algorithm is intended to guide implementation of the definition of agitation developed by the International Psychogeriatric Association (IPA). Design: Review of literature on treatment guidelines and recommended algorithms; algorithm development through reiterative integration of research information and expert opinion. Setting: IPA Agitation Workgroup. Participants: IPA panel of international experts on agitation. Intervention: Integration of available information into a comprehensive algorithm. Measurements: None. Results: The IPA Agitation Work Group recommends the Investigate, Plan, and Act (IPA) approach to agitation reduction and prevention. A thorough investigation of the behavior is followed by planning and acting with an emphasis on shared decision-making; the success of the plan is evaluated and adjusted as needed. The process is repeated until agitation is reduced to an acceptable level and prevention of recurrence is optimized. Psychosocial interventions are part of every plan and are continued throughout the process. Pharmacologic interventions are organized into panels of choices for nocturnal/circadian agitation; mild-moderate agitation or agitation with prominent mood features; moderate-severe agitation; and severe agitation with threatened harm to the patient or others. Therapeutic alternatives are presented for each panel. The occurrence of agitation in a variety of venues-home, nursing home, emergency department, hospice-and adjustments to the therapeutic approach are presented. Conclusions: The IPA definition of agitation is operationalized into an agitation management algorithm that emphasizes the integration of psychosocial and pharmacologic interventions, reiterative assessment of response to treatment, adjustment of therapeutic approaches to reflect the clinical situation, and shared decision-making.publishedVersio

Agitation in cognitive disorders: Progress in the International Psychogeriatric Association consensus clinical and research definition

Background: The International Psychogeriatric Association (IPA) published a provisional consensus definition of agitation in cognitive disorders in 2015. As proposed by the original work group, we summarize the use and validation of criteria in order to remove "provisional" from the definition. Methods: This report summarizes information from the academic literature, research resources, clinical guidelines, expert surveys, and patient and family advocates on the experience of use of the IPA definition. The information was reviewed by a working group of topic experts to create a finalized definition. Results: We present a final definition which closely resembles the provisional definition with modifications to address special circumstances. We also summarize the development of tools for diagnosis and assessment of agitation and propose strategies for dissemination and integration into precision diagnosis and agitation interventions. Conclusion: The IPA definition of agitation captures a common and important entity that is recognized by many stakeholders. Dissemination of the definition will permit broader detection and can advance research and best practices for care of patients with agitation.publishedVersio

The SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines for quality improvement reporting: explanation and elaboration

As the science of quality improvement in health care advances, the importance of sharing its accomplishments through the published literature increases. Current reporting of improvement work in health care varies widely in both content and quality. It is against this backdrop that a group of stakeholders from a variety of disciplines has created the Standards for QUality Improvement Reporting Excellence, which we refer to as the SQUIRE publication guidelines or SQUIRE statement. The SQUIRE statement consists of a checklist of 19 items that authors need to consider when writing articles that describe formal studies of quality improvement. Most of the items in the checklist are common to all scientific reporting, but virtually all of them have been modified to reflect the unique nature of medical improvement work

Impact of the ABCDE triage on the number of patient visits to the emergency department

Peer reviewe

The web testing handbook

Floridaxxii, 410 p.: fig., tab.; 23 cm