The need of lactation consultant for night shift

Abstract Breastfeeding can provide many health benefits for both mother and baby. To increase the health benefits for patients, a change project will be implemented to increase the rates of exclusive breastfeeding for postpartum patients. The project will be focusing on teaching and be providing information on health benefits of exclusive breastfeeding. Our project is aiming to increase the rates of exclusive breastfeeding by providing lactation consultants during night shift. Surveys and interviews were conducted pre-program and found most patients are unaware of the health benefits of breastfeeding and the lactation consultant services provided by the hospital. The method used to assist in implementation of this project was Lewin’s Change Theory. This theory focuses on three stages to best help change projects. The first stage is unfreezing; the phase focuses on the recognition of a problem within the facility. The second stage is moving; this process involves in-depth discussion to cultivate this new project. The last phase is refreezing, in this stage, the new process has begun implementation. This stage is vital in the sustainability of this project. A Root Cause Analysis was explored to substantiate the need for this project. This analysis showed that our patients’ lack of knowledge and information provided along with the negative social norms were causative factors in our patients’ hesitancy for exclusive breastfeeding. A cost analysis was conducted and found that hospitalization for an infant who is breastfed exclusively will cost $0 for breast milk, while infants on formula will cost approximately$0.19 per ounce. There was not an opportunity to evaluate this project due to many contributory factors in implementation. There have been many discrepancies in different departments and between day and night shifts, which caused a delay in the execution of this project. Further clarification on discrepancies between shifts and departments is needed to gain success with this project. Once this project is fully functional it is anticipated that there will be a 20% increase in exclusive breastfeeding rates, and a positive patient outcome is expected. Patient satisfaction scores will be gathered at the six-month mark to measure the success of this project. The summation of this project will be to increase exclusive breastfeeding rates for patients in postpartum, which is beneficial for the health of both mother and baby

Modulation of walking speed by changing optic flow in persons with stroke

<p>Abstract</p> <p>Background</p> <p>Walking speed, which is often reduced after stroke, can be influenced by the perception of optic flow (OF) speed. The present study aims to: 1) compare the modulation of walking speed in response to OF speed changes between persons with stroke and healthy controls and 2) investigate whether virtual environments (VE) manipulating OF speed can be used to promote volitional changes in walking speed post stroke.</p> <p>Methods</p> <p>Twelve persons with stroke and 12 healthy individuals walked on a self-paced treadmill while viewing a virtual corridor in a helmet-mounted display. Two experiments were carried out on the same day. In experiment 1, the speed of an expanding OF was varied sinusoidally at 0.017 Hz (sine duration = 60 s), from 0 to 2 times the subject's comfortable walking speed, for a total duration of 5 minutes. In experiment 2, subjects were exposed to expanding OFs at discrete speeds that ranged from 0.25 to 2 times their comfortable speed. Each test trial was paired with a control trial performed at comfortable speed with matching OF. For each of the test trials, subjects were instructed to walk the distance within the same time as during the immediately preceding control trial. VEs were controlled by the CAREN-2 system (Motek). Instantaneous changes in gait speed (experiment 1) and the ratio of speed changes in the test trial over the control trial (experiment 2) were contrasted between the two groups of subjects.</p> <p>Results</p> <p>When OF speed was changing continuously (experiment 1), an out-of-phase modulation was observed in the gait speed of healthy subjects, such that slower OFs induced faster walking speeds, and vice versa. Persons with stroke displayed weaker (p < 0.05, T-test) correlation coefficients between gait speed and OF speed, due to less pronounced changes and an altered phasing of gait speed modulation. When OF speed was manipulated discretely (experiment 2), a negative linear relationship was generally observed between the test-control ratio of gait speed and OF speed in healthy and stroke individuals. The slope of this relationship was similar between the stroke and healthy groups (p > 0.05, T-test).</p> <p>Conclusion</p> <p>Stroke affects the modulation of gait speed in response to changes in the perception of movement through different OF speeds. Nevertheless, the preservation of even a modest modulation enabled the persons with stroke to increase walking speed when presented with slower OFs. Manipulation of OF speed using virtual reality technology could be implemented in a gait rehabilitation intervention to promote faster walking speeds after stroke.</p

Relationship between Nutritional Status and Flat Foot in Children

Background: Pediatric flatfoot has been reported as the highest clinical complains for foot problems in pediatric department. Nutritional status has showed great influence on the occurrence of flat foot. There are many debates regarding whether underweight or overweight children are more prone to flatfoot. The aim of this study was to analyze the relationship between nutritional status and flatfoot in children.Methods: A cross sectional study was conducted from July to October 2015 in 3 primary schools in Kecamatan Jatinangor. There were 259 children of grade 4 to 5 included in this study. Flatfoot screening was based on measurement of footprint and calculation using Chippaux-smirak index (CSI). The height and weight of children were measured to obtain their Body Mass Index (BMI). Nutritional status was classified based on CDC BMI-for-age growth charts. Analysis was done using chi-square test.Results: There was significant association between nutritional status and flatfoot with p value<0.001.The prevalence of flatfoot in children grade 4to5is40%. When compared to the normal weight children, the overweight children showed prevalence ratio of 1.97(95% CI:1.47 to 2.64) while the underweight children showed prevalence ratio of 1.34 (95% CI:1.78 to 2.25).This stated that the risk of developing flat foot was higher in overweight children.Conclusions: There is significant association between nutritional status with children grade4 to 5. Overweight children are more prone to flat foot. [AMJ.2017;4(1):152–6] DOI: 10.15850/amj.v4n1.103

Best practices to prevent transmission and control outbreaks of hand, foot, and mouth disease in childcare facilities: a systematic review.

INTRODUCTION: Hand, foot, and mouth disease continues to cause seasonal epidemics in the Asia-Pacific Region. Since the current Enterovirus 71 vaccines do not provide cross-protection for all Enterovirus species that cause hand, foot, and mouth disease, there is an urgent need to identify appropriate detection tools and best practice to prevent its transmission and to effectively control its outbreaks. This systematic review aimed to identify characteristics of outbreak and assess the impact and effectiveness of detection tools and public health preventive measures to interrupt transmission. The findings will be used to recommend policy on the most effective responses and interventions in Hong Kong to effectively minimise and contain the spread of the disease within childcare facilities. METHODS: We searched the following databases for primary studies written in Chinese or English: MEDLINE, EMBASE, Global Health, WHO Western Pacific Region Index Medicus database, China National Knowledge Infrastructure Databases, and Chinese Scientific Journals Database. Studies conducted during or retrospective to outbreaks of hand, foot, and mouth disease caused by Enterovirus 71 from 1980 to 2012 within childcare facilities and with a study population of 0 to 6 years old were included. RESULTS: Sixteen studies conducted on outbreaks in China showed that hand, foot, and mouth disease spread rapidly within the facility, with an outbreak length of 4 to 46 days, especially in those with delayed notification (after 24 hours) of clustered outbreak (with five or more cases discovered within the facility) to the local Center for Disease Control and Prevention and delayed implementation of a control response. The number of classes affected ranged from 1 to 13, and the attack rate for children ranged from 0.97% to 28.18%. CONCLUSIONS: Communication between key stakeholders about outbreak confirmation, risk assessment, and surveillance should be improved. Effective communication facilitates timely notification (within 24 hours) of clustered outbreaks to a local Center for Disease Control and Prevention. Timely implementation of a control response is effective in minimising incidence and length of an outbreak in childcare facilities. The government should provide incentives for childcare facilities to train infection control specialists who can serve as the first contact, knowledge, and communication points, as well as facilitate exchange of information and provision of support across stakeholders during a communicable disease epidemic

Relationship between Nutritional Status and Flat Foot in Children

Background: Pediatric flatfoot has been reported as the highest clinical complains for foot problems in pediatric department. Nutritional status has showed great influence on the occurrence of flat foot. There are many debates regarding whether underweight or overweight children are more prone to flatfoot. The aim of this study was to analyze the relationship between nutritional status and flatfoot in children.Methods: A cross sectional study was conducted from July to October 2015 in 3 primary schools in Kecamatan Jatinangor. There were 259 children of grade 4 to 5 included in this study. Flatfoot screening was based on measurement of footprint and calculation using Chippaux-smirak index (CSI). The height and weight of children were measured to obtain their Body Mass Index (BMI). Nutritional status was classified based on CDC BMI-for-age growth charts. Analysis was done using chi-square test.Results: There was significant association between nutritional status and flatfoot with p value<0.001.The prevalence of flatfoot in children grade 4to5is40%. When compared to the normal weight children, the overweight children showed prevalence ratio of 1.97(95% CI:1.47 to 2.64) while the underweight children showed prevalence ratio of 1.34 (95% CI:1.78 to 2.25).This stated that the risk of developing flat foot was higher in overweight children.Conclusions: There is significant association between nutritional status with children grade4 to 5. Overweight children are more prone to flat foot. [AMJ.2017;4(1):152–6] DOI: 10.15850/amj.v4n1.103

Type 2 innate immunity drives distinct neonatal immune profile conducive for heart regeneration.

Neonatal immunity is functionally immature and skewed towards a T 2-driven, anti-inflammatory profile. This neonatal immunotolerance is partly driven by the type 2 cytokines: interleukin-4 (IL-4) and interleukin-13 (IL-13). Studies on neonatal cardiac regeneration reveal the beneficial role of an anti-inflammatory response in restoring cardiac function after injury. However, the role of an imbalanced immune repertoire observed in neonates on tissue regeneration is poorly understood; specifically, whether IL-4 and IL-13 actively modulate neonatal immunity during cardiac injury. Neonatal mice lacking IL-4 and IL-13 (DKOs) examined at 2 days after birth exhibited reduced anti-inflammatory immune populations with basal cardiac immune populations like adult mice. Examination of neonates lacking IL-4 and IL-13 at 2 days post cardiac ischemic injury, induced on the second day after birth, showed impaired cardiac function compared to their control counterparts. Treatment with either IL-4 or IL-13 cytokine during injury restored both cardiac function and immune population profiles in knockout mice. Examination of IL-4/IL-13 downstream pathways revealed the role of STAT6 in mediating the regenerative response in neonatal hearts. As IL-4/IL-13 drives polarization of alternatively activated macrophages, we also examined the role of IL-4/IL-13 signaling within the myeloid compartment during neonatal cardiac regeneration. Injury of IL-4Rα myeloid specific knockout neonates 2 days after birth revealed that loss of IL-4/IL-13 signaling in macrophages alone was sufficient to impair cardiac regeneration. Our results confirm that the T 2 cytokines: IL-4 and IL-13, which skews neonatal immunity to a T 2 profile, are necessary for maintaining and mediating an anti-inflammatory response in the neonatal heart, in part through the activation of alternatively activated macrophages, thereby permitting a niche conducive for regeneration. [Abstract copyright: © The author(s).

Creating a rehabilitation living lab to optimize participation and inclusion for persons with physical disabilities

AbstractWe present an on-going multidisciplinary and multisectorial strategic development project put forth by the Centre for Interdisciplinary Research in Rehabilitation of greater Montréal (CRIR) in Quebec, Canada and its members, in collaboration with a Montréal “renovation-ready” shopping mall, local community organizations, and local, national and international research and industrial partners. Beginning in 2011, within the context of the Mall as Living Lab (MALL), more than 45 projects were initiated to: (1) identify the environmental, physical and social obstacles and facilitators to participation; (2) develop technology and interventions to optimize physical and cognitive function participation and inclusion; (3) implement and evaluate the impact of technology and interventions in vivo. Two years later and working within a participatory action research (PAR) approach, and the overarching WHO framework of the International Classification of Functioning, Disability and Health (ICF), we discuss challenges and future endeavors. Challenges include creating and maintaining partnerships, ensuring a PAR approach to engage multiple stakeholders (e.g. people with disabilities, rehabilitation and design researchers, health professionals, community members and shopping mall stakeholders) and assessing the overall impact of the living lab. Future endeavors, including the linking between research results and recommendations for renovations to the mall, are also presented

Drosophila Exo70 is Essential for Neurite Extension and Survival under Thermal Stress

The octomeric exocyst complex governs the final step of exocytosis in both plants and animals. Its roles, however, extend beyond exocytosis and include organelle biogenesis, ciliogenesis, cell migration, and cell growth. Exo70 is a conserved component of the exocyst whose function in Drosophila is unclear. In this study, we characterized two mutant alleles of Drosophila exo70. exo70 mutants exhibit reduced synaptic growth, locomotor activity, glutamate receptor density, and mEPSP amplitude. We found that presynaptic Exo70 is necessary for normal synaptic growth at the neuromuscular junction (NMJ). At the neuromuscular junction, exo70 genetically interacts with the small GTPase ralA to regulate synaptic growth. Loss of Exo70 leads to the blockage of JNK signaling-, activity-, and temperature-induced synaptic outgrowths. We showed that this phenotype is associated with an impairment of integral membrane protein transport to the cell surface at synaptic terminals. In octopaminergic motor neurons, Exo70 is detected in synaptic varicosities, as well as the regions of membrane extensions in response to activity stimulation. Strikingly, mild thermal stress causes severe neurite outgrowth defects and pharate adult lethality in exo70 mutants. exo70 mutants also display defective locomotor activity in response to starvation stress. These results demonstrated that Exo70 is an important regulator of induced synaptic growth and is crucial for an organism’s adaptation to environmental changes