UNAIDS 90‐90‐90 Campaign to End the AIDS Epidemic in Historic Perspective

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137622/1/milq12265.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137622/2/milq12265_am.pd

Hyper-curriculum: Transcending Borders of Standardization in the Cosmopolitan Classroom

The world is not just connected; it is hyper-connected. The global flow of ideas, technology, and people are at unmatched levels in history. More classrooms are becoming cosmopolitan centers composed of students with multicultural backgrounds. However, United States public education in this hyper-connected world puts emphasis on standardization and accountability. By doing so, schools driven by federal initiatives fail in helping students to become worldly citizens. Students and teachers are derived of room for creativity or new multicultural possibilities. Hence, this paper intends to develop a theoretical framework for curriculum in the hyper-connected world, aptly named “hyper-curriculum.

Re-exploration of vertical rectus abdominis myocutaneous flap for vaginal reconstruction: Case report and review of the literature.

The vertical rectus abdominis myocutaneous (VRAM) flap is a versatile and well-established reconstructive technique for many defects created as a result of colorectal and gynecologic extirpation. However, major re-operation in the pelvis following a VRAM flap reconstruction several months later is uncommon, and the safety and integrity of the VRAM flap in this setting has not been described. This case examines VRAM flap preservation during repeat exploratory laparotomy, and a unique view of the VRAM flap during interval exploration. We demonstrate an intact flap after lysis of adhesions with an audible Doppler signal, and maintenance of flap integrity in the postoperative period. This further substantiates its use as a durable rotational flap for perineal tissue defects

A Descriptive Multicultural Phenomenology for Culturally Responsive Leadership

As public schools in the United States continue to diversify in culture, educational leaders committed to multicultural education seek qualitative research methodologies for understanding phenomena in order to build culturally responsive leadership initiatives and interventions. This paper argues that a phenomenological research methodology is appropriate and relevant to understand cultural phenomena in the 21st century school. To serve this, the authors elaborate on a descriptive multicultural phenomenological research methodology for educational leaders. A phenomenological framework positions educational leaders to understand the nature and essence of personal experience. This approach will help educational leaders better understand the experiences of the diverse children within their school. Therefore, leaders may utilize a multicultural phenomenological research methodology to build appropriate culturally responsive initiatives and interventions to meet the needs of culturally and linguistically diverse schools

No. 2: The Brain Drain of Health Professionals from Sub-Saharan Africa to Canada

Significant numbers of African-trained health workers migrate every year to developed countries including Canada. They leave severely crippled health systems in a region where life expectancy is only 50 years of age, 16 per cent of children die before their fifth birthday and the HIV/AIDS crisis continues to burgeon. The population of Sub-Saharan Africa (SSA) totals over 660 million, with a ratio of fewer than 13 physicians per 100,000. SSA has seen a resurgence of various diseases that were thought to be receding, while public health systems remain inadequately staffed. According to one report, the region needs approximately 700,000 physicians to meet the Millennium Development Goals. Understaffing results in stress and increased workloads. Many of the remaining health professionals are ill-motivated, not only because of their workload, but also because they are poorly paid, poorly equipped and have limited career opportunities. These, in turn, lead to a downward spiral where workers migrate, crippling the system, placing greater strain on the remaining workers who themselves seek to migrate out of the poor working conditions. The ultimate result is an incontestable crisis in health human resources throughout SSA, the region suffering most from the brain drain of health care professionals. The situation in SSA has become severe enough that the final report of the Joint Learning Initiative on Human Resources for Health – a two-year global initiative sponsored by a number of donors studying various aspects of human resources for health performance – has concluded that the future of global health and development in the 21st century lies in the management of the crisis in human resources for health. There is a considerable body of literature attesting to the fact that the migration of skilled professionals from developing to developed countries is large and increasing dramatically. While different experts espouse different reasons for the increase, all agree that it is happening. Developing countries are hit hardest by the brain drain as they lose sometimes staggering portions of their college-educated workers to wealthy countries which can better weather their relatively smaller losses of skilled workers. Highly skilled professionals account for 65 per cent of migrants moving to industrialized countries. The International Organization for Migration (IOM) estimates that about 20,000 Africans leave Africa every year to take up employment in industrialized countries. We do not know how many of these are health care professionals (largely because of inadequate systems for gathering such statistics in African countries).11 The World Health Organization (WHO), however, found that a quarter to two-thirds of health workers interviewed in a recent study expressed an intention to migrate. Historically, and specific to the SSA context, the brain drain has meant not only the exodus of human capital but financial resources as well, as African health care professionals left countries with their savings and reinvested very little of their foreign earnings back into the region. There is only recent evidence suggesting that, while the numbers of professionals leaving continue to increase, émigrés are slowly reinvesting some of their earnings back into their countries. Other research raises doubts about the value of such reinvestments, however, particularly when they are in the form of remittances that are generally private welfare transfers back to family members and are often used for consumption rather than for savings. In recognition of the enormous challenge posed by the international migration of health personnel to health systems in developing countries, the World Health Organization has proclaimed 2005-2015 the decade on human resources for health (HRH)

Isolated Large Glenoid Fracture in Acute Glenohumeral Dislocation in the Elderly: A Novel Indication for Reverse Shoulder Arthroplasty

Case: Two elderly males presented with traumatic shoulder dislocation and bony Bankart fracture consisting of greater than 25% of the glenoid width. Due to several concomitant factors such as polytrauma, activity level, rotator cuff pathology, optimization of comorbidities, risk of complications, and potential for revision surgery, the patients were treated with reverse shoulder arthroplasty (RSA). Conclusion: RSA may be a satisfactory treatment option for isolated, large glenoid fractures associated with anterior glenohumeral instability in the elderly. These patients are susceptible to rapid deconditioning with prolonged immobilization and may not be medically suited to undergo the prolonged recovery period associated with open reduction internal fixation or potentially undergo revision operations

Convective mixing and high littoral primary production can establish systematic errors in lake diel oxygen curves in shallow, eutrophic lakes

The diel (24-h) oxygen (O2) curves approach has become a popular method for analyzing gross primary production (GPP) and ecosystem respiration (ER) rates in aquatic systems. Despite the simplicity of this approach, there remain aspects of the calculation and interpretation of diel O2 curves which may skew results, with potentially large implications for estimates of metabolic rates. One common problem in lakes is the occurrence of unexpected changes in O2concentrations (for instance, increasing overnight O2 concentrations). Such changes have typically been ascribed to the random mixing of pockets of O2. It has thus been suggested that negative GPP or positive ER values should be included in calculations, on the assumption that under- and overestimates should occur with equal frequency, and thus cancel each other out. Our data from a shallow, eutrophic lake provided a high share of negative GPP values. We argue that these may have been the result of elevated littoral productivity coupled with convective currents produced by consistent differences in the heating or cooling of littoral and offshore waters. Such phenomena might be common in small, sheltered lakes where the role of mixing by wind is diminished. We conclude that a failure to account for consistent metabolic gradients and periodic convective mixing may lead to a chronic underestimation of metabolic rates in lakes when using the diel O2 curves method