Evidence-Based Recommendations for the Assessment of Severe Acute Malnutrition in Children Aged 6-59 Months in the Central African Republic

Thirty-five percent of mortalities in children under the age of five can be attributed to malnutrition (World Health Organization (WHO), n.d.). Nearly 24 percent of children less than five from 2008-2012 in the Central African Republic were moderately or severely underweight and nearly eight percent suffered from severe or moderate wasting (The United Nations International Children’s Emergency Fund, 2013). As a result of recent sectarian violence which began with a coup in March 2013, the Central African Republic is facing a nutrition crisis. As a result, an estimated 28,000 Central African children under the age of five are predicted to be affected by severe acute malnutrition (SAM) and 75,000 from moderately acute malnutrition in the year 2014 (The Assessment Capacities Project, 2014). The WHO (2007) defines SAM in children aged 6-59 months as a low weight-for-height/length below -3z scores/standard deviations (SD)of the median WHO growth standards (WHO, 2006), the presence of nutritional edema, or a mid-upper arm circumference (MUAC) less than 115mm. Uncomplicated cases of SAM may be treated on an outpatient basis through community feeding programs. The limited access to resources such as training materials, protocols, charting systems, accurate scales, height boards, growth charts, or measuring tapes in developing countries hinders the utilization of objective admission, assessment, and discharge criteria. The purpose of this project is to develop practical and evidence-based recommendations for assessing the nutritional status of children aged 6-59 months for a community based nutrition program in the Central African Republic in order to establish evidence-based standards for screening, admission, monitoring, referral, and discharge criteria

Discussions of Diaspora: Cultural Production and Identity in Contemporary Chinese Canadian Literature

This thesis explores modes of cultural production and identity in three Chinese Canadian works of fiction: Disappearing Moon Café, The End of East, and The Better Mother. This research discusses the position of Chinese Canadian literature in relation to the institutional framework of Asian Canadian Studies. Within current academic circles, there exists varied discussions on the many aspects of Asian Canadian’s, this thesis seeks to explore the position of literature written by and about Chinese Canadian’s within the larger framework of Canadian literature and its representations of culture, identity and ethnic enclaves such as Chinatown’s. More specifically, this research explores literary representations of Vancouver’s Chinatown and its links to time, place, cultural identity and sense of family. In doing so, this research aims to add to current discussions of Chinese Canadian literature and theory, while attempting to situate the genre itself among the many other minority genres within Canadian literature

Decoding Code Status: The Case of DNAR

The introduction of cardiopulmonary resuscitation (CPR) in the 1960’s led the American Medical Association to recommend code status – indicating the preference for CPR – for each patient. Currently, all hospitals across the country review code status with patients at admission. A ‘do not attempt resuscitation’ (DNAR) code status means that a patient with decision making capacity has indicated that in the event of a cardiopulmonary arrest, they do not want to receive chest compressions, assisted ventilation or defibrillation. We present the case of a 57-year-old female with a history of bipolar disorder, admitted to our inpatient psychiatric hospital (Henry Ford Kingswood Hospital) for worsening depression, suicidal ideation and a plan to slit her wrists. On admission, she denied suicidal ideation. However, given her extensive psychiatric history including two previous suicide attempts, impulsivity and various non-modifiable risk factors, she was considered at high risk for suicide. In addition, she had multiple co-morbidities including diabetes, previous myocardial infarction (MI), and coronary artery disease with stenting. The patient requested to be DNAR. She articulated the risks/benefits, appreciated the consequences and gave the reasons for her decision. Through this case discussion and review of literature, we present the ethical dilemma of patients requesting DNAR code status while admitted to an inpatient psychiatric unit, after a recent suicide attempt and/or ideations with plan. Providers are required to respect patients’ autonomy, however, also act in patients’ best interests. To what extent should providers respect patient’s autonomy of DNAR code status if there is suspected secondary motive, such as intent to die by suicide or if their decision is impacted by an untreated psychiatric condition, like depression?https://scholarlycommons.henryford.com/merf2019caserpt/1075/thumbnail.jp

A Comparison of Experience-Dependent Plasticity in the Visual and Somatosensory Systems

SummaryIn the visual and somatosensory systems, maturation of neuronal circuits continues for days to weeks after sensory stimulation occurs. Deprivation of sensory input at various stages of development can induce physiological, and often structural, changes that modify the circuitry of these sensory systems. Recent studies also reveal a surprising degree of plasticity in the mature visual and somatosensory pathways. Here, we compare and contrast the effects of sensory experience on the connectivity and function of these pathways and discuss what is known to date concerning the structural, physiological, and molecular mechanisms underlying their plasticity

Effect of Drug Loading Method and Drug Physicochemical Properties on the Material and Drug Release Properties of Poly (Ethylene Oxide) Hydrogels for Transdermal Delivery

Novel poly (ethylene oxide) (PEO) hydrogel films were synthesized via UV cross-linking with pentaerythritol tetra-acrylate (PETRA) as cross-linking agent. The purpose of this work was to develop a novel hydrogel film suitable for passive transdermal drug delivery via skin application. Hydrogels were loaded with model drugs (lidocaine hydrochloride (LID), diclofenac sodium (DIC) and ibuprofen (IBU)) via post-loading and in situ loading methods. The effect of loading method and drug physicochemical properties on the material and drug release properties of medicated film samples were characterized using scanning electron microscopy (SEM), swelling studies, differential scanning calorimetry (DSC), fourier transform infrared spectroscopy (FT-IR), tensile testing, rheometry, and drug release studies. In situ loaded films showed better drug entrapment within the hydrogel network and also better polymer crystallinity. High drug release was observed from all studied formulations. In situ loaded LID had a plasticizing effect on PEO hydrogel, and films showed excellent mechanical properties and prolonged drug release. The drug release mechanism for the majority of medicated PEO hydrogel formulations was determined as both drug diffusion and polymer chain relaxation, which is highly desirable for controlled release formulation

Deep Understandings and Thick Descriptions: Tackling Questions about Race

In this article, three professors of color speak out in response to the continuation of White police killings of Black people in the United States. We contend that there is a strong need for everyone, professors and educators in particular, to be proactive in confronting racism by tackling not avoiding, difficult questions and conversations. We propose that through the enactment of deep understandings and thick descriptions in our classrooms at all levels we may encourage a critical humanitarian response to the challenges of not knowing the diverse “Other.” We present real experiences from our teaching to illustrate the kinds of activities that can be done to engage our students in developing thick descriptions and deep understandings of diverse Others. When we all participate in the development of deep understandings and thick descriptions, maybe the killings and misperceptions will cease and we will think first before making devastating and destructive actions, statements and assumptions about “Others” because we truly recognize our shared humanit

Assembly of the outer retina in the absence of GABA synthesis in horizontal cells

<p>Abstract</p> <p>Background</p> <p>The inhibitory neurotransmitter gamma-amino-butyric acid (GABA) not only modulates excitability in the mature nervous system but also regulates neuronal differentiation and circuit development. Horizontal cells, a subset of interneurons in the outer retina, are transiently GABAergic during the period of cone photoreceptor synaptogenesis. In rodents, both horizontal cells and cone axonal terminals express GABA_Areceptors. To explore the possibility that transient GABA expression in mouse neonatal horizontal cells influences the structural development of synaptic connectivity in the outer retina, we examined a mutant in which expression of GAD67, the major synthesizing enzyme for GABA, is selectively knocked out in the retina.</p> <p>Results</p> <p>Immunocytochemistry and electron microscopy revealed that the assembly of triad synapses involving cone axonal pedicles and the dendrites of horizontal and bipolar cells is unaffected in the mutant retina. Moreover, loss of GABA synthesis in the outer retina did not perturb the spatial distributions and cell densities of cones and horizontal cells. However, there were some structural alterations at the cellular level: the average size of horizontal cell dendritic clusters was larger in the mutant, and there was also a small but significant increase in cone photoreceptor pedicle area. Moreover, metabotropic glutamate receptor 6 (mGluR6) receptors on the dendrites of ON bipolar cells occupied a slightly larger proportion of the cone pedicle in the mutant.</p> <p>Conclusions</p> <p>Together, our analysis shows that transient GABA synthesis in horizontal cells is not critical for synapse assembly and axonal and dendritic lamination in the outer retina. However, pre- and postsynaptic structures are somewhat enlarged in the absence of GABA in the developing outer retina, providing for a modest increase in potential contact area between cone photoreceptors and their targets. These findings differ from previous results in which pharmacological blockade of GABA_Areceptors in the neonatal rabbit retina caused a reduction in cone numbers and led to a grossly disorganized outer retina.</p