Case study: obesity, genital oedema and lower limb compression bandaging

The purpose of this article is to present an evidenced based rationale for lymphoedema compression bandaging one aspect of treatment for a patient with complex lower limb lymphoedema. The current health care climate requires treatment decisions to be transparent based on the best available evidence. The challenge faced by community nurses is to formulate treatment plans which incorporate the patients’ preferences and best utilise limited resources provided by clinical environments. The article appraises research in order to formulate a suitable treatment plan and provides discussion and reflection regarding the challenges faced by the nursing profession in achieving evidence based practice. Evidence based practice is beneficial in formulating patient centred and cost effective treatment plans, developing competence is not straightforward, however clinical guidelines can provide much needed guidance

Synthesis of Piperidine-Based Inhibitors of KasA, a Vital Enzyme of M. tuberculosis

Tuberculosis is the leading cause of death from infectious disease in the world. Although tuberculosis drugs exist, the rise of drug-resistant tuberculosis has created a need for new research. Identifying novel, effective drugs for treatment of tuberculosis could reduce the cost of care and treatment time, saving millions of lives. The enzyme KasA, which synthesizes part of the tuberculosis bacterial cell wall, has been identified as an attractive drug target. A virtual screen using KasA discovered a compound, 4-(4-bromophenyl)-1-pyrenemethyl-4-piperidinol (1), which inhibited bacterial growth in vitro. In this research, nine derivatives of compound 1 were synthesized for future testing with live bacteria. A lithium-halogen exchange reaction was used to attempt to create a piperidinone-based derivative with varied substituents, but the method yields were low and difficult to purify. A Grignard process was also attempted with similar results. Alkylation of 4-substituted-4-piperidinols was successful in creating derivatives with arylmethyl substituents in yields from 51-85%. A silane reduction to remove the 4-hydroxy group was also explored but exhibited low yields. In future research, these derivatives will be tested in vitro to determine suitability for development as potential tuberculosis drugs

WE\u27RE ALL MONSTERS HERE AND OTHER STORIES

The purpose of this thesis is to examine characters caught up in a transformation of identity: either a transfiguration or a transmogrification. Through the lens of fantasy, I sought to explore the trials of these characters in an exaggerated fashion that allowed me to take familiar questions and themes and attempt to make them new. All of my characters face a realization of identity: either they are startled into understanding that they are not who they thought they were, or they struggle to assert their version of self against pressure to be what others want. In “Marked”, Dwire has his self-conceived identity shaken because he was willing to do things that made him no better than the monsters he hunted. The narrator of “I Am” faces a situation almost completely opposite to Dwire’s; when he defies his purpose for being and says, ‘I am not a killer’, he undergoes a transfiguration. For Katya and Shai-Neferat, they struggle against the will of both loved ones and society to assert themselves as individuals rather than have an identity forced upon them. Shai-Neferat goes so far as to defy her god’s plan for her. Through these crises, and their responses to them, my characters change, none of them able to simply return to things as they were. These questions of identity stem from my observations of those around me who have grappled with many of the same issues my characters face and from my own stubborn fight to preserve my identity—to know when I ought to change and when I ought to stand my ground. In kindling life in these characters, I have struggled most with their voices, fighting to give them words that are their own rather than sallow imitations of mine. It is well into the revision process that my tone deaf ear begins to hear, and I am be able to attempt to craft individual voices, often word by word. I must also fight my natural inclination to write in the highest rhetorical style, even when it is not suited for an individual story. Ultimately, I write because I am a teller of tales, and I have been fascinated by the ‘what if’s’ of the world since I was young, put to bed with ‘Magic Tree Stories’ where my father sent me and my favorite stuffed toy leaping through a magic leaf pile into other worlds. Since then, there have been many who have guided me along my writer’s path: among them Megan Whalen Turner, Madeleine L’Engle, and every mythmaker that ever tried to weave meaning into their world through story. I also owe a debt to J.R.R. Tolkien for instilling in me a respect for world building and fostering my sense of storytelling, leading me to the exploration of what would become some of my strengths as a writer. As a Christian writer of fantasy, he also validated my own writing with his concept of sub-creation: “We make in our measure…because we are made: and not only made, but made in the image and likeness of a Maker.

Essays on resilience measurement

Robust measurement is key to the design and targeting of resilience-building interventions. Yet, conventional approaches to resilience measurement are often ill-suited to the needs of development and humanitarian stakeholders, proving costly, timeconsuming and difficult to coordinate. In this thesis I explore the use, validity and viability of an alternative suite of approaches: subjective measures of resilience. I start by clarifying the conceptual distinctions between subjectivity and objectivity as they relate to resilience measurement, before introducing a continuum that highlights the strengths and weaknesses of different types of approaches. I then develop a new perception-based measure, coined the Subjectively self-Evaluated Resilience Score (SERS). Using a large household survey in Northern Uganda, I provide like-for-like comparisons between SERS and a conventional objective approach to resilience measurement. While I show that the two measures are moderately correlated, they differ notably in associations with key socio-economic traits. In order to further probe the validity of subjective measures, I examine whether SERS is sensitive to external shocks. Using mobile phones to conduct remote interviews I assemble a novel high-frequency panel survey on resilience. Here I reveal how perceived levels of resilience fluctuate in the aftermath of seasonal flooding in Eastern Myanmar: dropping sharply in the first few months, before slowly converging over the course of a year. I also compare the impact of flood exposure across different socio-economic groups, revealing how female-headed households are hardest hit. Lastly, using the same site in Myanmar, I look more closely at the temporal dynamics of resilience. Insights from an extended panel provide quantitative evidence of intra-annual variation in levels of resilience. Here I find consistent non-linear associations between subjectively-evaluated scores and changes in seasonality and weather. Findings also point to potential resilience thresholds and tipping points. Weighed together, these results: challenge core assumptions in the resilience literature; highlight the potential of subjective measures; and point to the need for greater diversity of resilience evidence

Maintaining Oral Health with Parkinson’s disease and Arthritis.

PosterObjective: The objective of this case presentation is to discuss the modifications of dental care for a patient with Parkinson’s disease. Background: A 72 year old Caucasian male presented to the dental hygiene clinic for a periodontal maintenance appointment. Significant findings in the medical history include current treatment of Parkinson’s disease, arthritis in the hands and feet, and medications Omeprazole, Fluoxetine, Gemfibrozil, Gabapentin, Levodopa, and Clonazepam. Assessment: Patient presents with generalized moderate plaque induced gingivitis evidenced by reddish-pink gingiva, 60% BOP, bulbous, spongy papillae. Clinically the patient presented with generalized 4-8mm clinical attachment levels. Radiographically, the patient presented with generalized mild to moderate bone loss evidenced by 3-5mm from the CEJ. The primary contributing factor to the gingival inflammation was the plaque score of 97%. The patient struggles with oral hygiene due to his Parkinson’s disease and arthritis in hands. DH Care Plan: patient received full mouth debridement, instruction on a modified floss holder with clay, product recommendations of xylitol gum and toothpaste to reduce xerostomia. Results: Oral health indicators from previous appointments showed minimal or no improvements due to the patient’s medical condition. Conclusions: Since last recall a few sites had improved including probing depths by 1-2mm. Patient was referred to a comprehensive care clinic for extraction of tooth number four, and an implant is treatment planned for replacement. It is recommended that the patient continue on 3 month intervals to monitor his oral health status and identify dental disease earl

Establishing adult lifelong connections for emancipating foster youth

The purpose of this study was to examine the ways in which Riverside County Children\u27s Social Services Workers (CSSW\u27s) are establishing adult lifelong connections for emancipating foster youth. Interviews were conducted with CSSW\u27s from the Independent Living Program (ILP) and the Planned Permanency Living Arrangement (PPLA) units. The purpose of the interviews was to identify resources that CSSW\u27s are using to secure adult lifelong connections for youth transitioning out of the foster care system

Investigating Neighborhood Walkability and its Association with Physical Activity Levels and Body Composition of a Sample of Maryland Adolescent Girls

Recent ecologic studies have begun to focus on characteristics of the built environment that influence physical activity (PA). Specifically, neighborhood walkability is emerging as an important determinant of PA in adults. At this point in time, there is conflicting evidence on how neighborhood walkability influences the PA levels of adolescents. The aim of this study was to investigate the relationship between individual's neighborhood walk score and individual's body mass index, body fat percentage, weight status, PA levels and meeting PA guidelines in a sample of adolescent girls. Additional analysis investigated the correlation between two objective measures of neighborhood walkability. This analysis was unable to show an association between PA levels or body composition of adolescent girls from the TAAG Maryland field site. Neighborhood walkability as assessed by the website walkscore.com was positively correlated with a GIS derived walkability index (r=.63 p<.0001)