Assessment of the Use of Non-Pharmacological Methods for Managing Depression in Patients with Myotonic Dystrophy (DM) and Facioscapulohumeral Muscular Dystrophy (FSHD)

Background: Myotonic dystrophy (DM) and facioscapulohumeral muscular dystrophy (FSHD) are two types of muscular dystrophies with multi-system manifestations. Purpose: The purpose of this study was to determine 1: the prevalence of depression in patients with myotonic dystrophy (DM) and facioscapulohumeral muscular dystrophy (FSHD) and 2: which non-pharmacological methods DM and FSHD patients are using to manage their depression. Methods: A survey was conducted using the online system, Qualtrics. The voluntary and anonymous survey was emailed to 1,205 eligible patients from the National Registry for DM and FSHD Patients and Family Members at the University of Rochester. Participants were at least 18 years old, a member of the registry, and diagnosed with DM or FSHD. The 65 question survey included questions on basic demographic information, depression diagnosis, medication use and effectiveness, and non-pharmacological management. Surveys were collected between May 2017 and August 2017 and the responses were analyzed and compared to the general population. The study was approved by the St. John Fisher College Institutional Review Board and the Registry Scientific Advisory Committee. Results: Of the 1,205 surveys that were sent, 466 patients responded. A total of 46 percent of patients had DM (DM1 30 percent, n=138/460 and DM2 16 percent, n=75/460) and 48 percent (n=223/460) of respondents had FSHD. Of the study respondents, 34 percent (n=150/436) reported being diagnosed with depression, while 8 percent (n=24/294) feel depressed, but haven’t been diagnosed. Non-pharmacological techniques used by patients who were diagnosed with depression or feel that they are depressed included: exercise (33 percent, n=57/150), relaxation techniques once per week (51 percent, n=50/98), and visiting a counselor or therapist once per week (11 percent, n=4/37). The most common type of relaxation technique used was meditation (52 percent, n=77/147) followed by yoga (18 percent, n=24/147). In conclusion, 32 percent (n=34/107) stated that relaxation techniques helped them, and 49 percent (n=52/107) stated that relaxation techniques may have helped them. Conclusion: Patients with both DM and FSHD have been diagnosed with depression. To manage their depression, and similar to what occurs in the general population, DM and FSHD patients are using a combination of both pharmacologic and non-pharmacologic strategies. DM and FSHD patients also believe that these non-pharmacologic methods, which include exercise, counseling, and relaxation techniques are helpful in their managing depression

Identifying Patterns in Health Care Disparities and Barriers to Health Care in Rural Tanzania

Tanzania is a country in East Africa with a population of 55 million people. HIV/AIDs, malaria and nutritional deficiencies claim the lives of many each year across Tanzania. The World Health Organization (WHO) reported in 2013 that approximately 70 percent of the population of Tanzania live in more rural areas where access to healthcare, health education, and medications for these diseases may be limited. The objective of this study was to illuminate significant health disparities in rural Tanzania based on literature and direct observations to identify barriers to quality health care. A comprehensive literature evaluation was completed on reports published on healthcare and health statistics in Tanzania from 1995 to present using Google Scholar and PubMed searches. This information was compared to direct observations, clinic evaluations and pharmacy inventories completed during a two week service program to villages in rural Tanzania. During this two-week trip, local health systems were directly observed and publicly available information about healthcare disparities in the region was recorded. Inventories of major diseases treated, services offered, and medications at two hospitals, one medical clinic and two pharmacies were recorded in the towns of Iringa and Ipalamwa, Tanzania. Despite the need, many rural villages, like Ipalamwa, have no functional health clinic and limited pharmacies available to its people, preventing necessary care. In 2013 in Tanzania, there were 159 deaths per 100,000 people due to HIV/AIDs. Observations made in Iringa and Ipalamwa revealed that despite local pharmacies, antiretroviral therapies are not readily available. The WHO reported that 44 people per 100,000 people die every year from malaria and that in all regions of Tanzania, malaria is a major cause of health services for all ages. Observations made in rural Tanzania reveal that government run pharmacies only offer limited medications for malaria treatment, primarily Artequick (artemisinin/piperaquine), Lumiter (artemether/lumefantrine), and Coartem D (artemether/ lumefantrine). From 2010-2011 it was reported that for children in Tanzania under the age of 5 years old, 13.6 percent were underweight, 6.6 percent experienced wasting, and finally 38.4 percent experienced stunting. Initial observations indicate that rates in rural areas well over 50 percent. Rural Tanzanian locations like Iringa are the highest producing maize regions and diet in the areas observed consists mainly of carbohydrate rich foods, such as corn and rice. Nutrient-rich food groups are avoided or sold for income or because of cultural beliefs. Due to geographic location in rural regions of Tanzania, lack of resources present a barrier to health care. Lack of access to HIV/AIDs and malaria treatment raise concern. Due to the abundance of maize-heavy diets in rural settings, many have an imbalanced diet which leads to nutritional deficiencies and stunting. Despite access to other sources of food, many people do not take advantage due to lack of knowledge and cultural beliefs. Identification of unique issues in rural Tanzania along with specific barriers is critical as this will allow for programs and interventions to be more targeted in rural settings

Stability of Extemporaneously Prepared Sodium Benzoate Oral Suspension

The stability of extemporaneously prepared sodium benzoate oral suspension in cherry syrup and Ora-Sweet was studied. Oral solutions of 250-mg/mL sodium benzoate were prepared in either cherry syrup or Ora-Sweet. To a beaker, 50 grams of Sodium Benzoate Powder USP was dissolved and filtered, the solution was divided equally into two parts, and each aliquot was added into two separate calibrated 100-mL amber vials. In the first vial, cherry syrup was added to make a final volume of 100 mL. In the second vial, Ora-Sweet was added to give a final volume of 100 mL. This process was repeated to prepare three solutions of each kind and all were stored at room temperature. A 250-µL sample was withdrawn immediately after preparation and again at 7, 14, 28, 60, and 90 days for each sample. At each time point, further dilution was made to an expected concentration of 0.25 mg/mL with sample diluent, and the samples were assayed in triplicate by stability-indicating high-performance liquid chromatography. Stability was defined as the retention of at least 90% of the initial concentration. At least 92% of the initial concentration of sodium benzoate in cherry syrup and at least 96% of the sodium benzoate in Ora-Sweet remained throughout the 90-day study period. There were no detectable changes in color and no visible microbial growth in any sample. Extemporaneously compounded suspensions of sodium benzoate in cherry syrup or Ora-Sweet were stable for at least 90 days when stored in a 4-oz amber plastic bottle at room temperature in reduced lighting

Keep your distance: People sit farther away from a man with schizophrenia versus diabetes

Although concrete behavior—such as avoidance, discrimination, rejection—is foundational to most definitions of stigma, knowledge of psychiatric stigma has been constructed mostly on the basis of measurement of self-reported attitudes, beliefs, and feelings. To help fill this gap, the current study examined avoidance behavior in psychiatric stigma. That is, we predicted that people would seek more physical distance from a man with a psychiatric problem than a man with a medical problem. One hundred fourteen undergraduates expected to meet a man with either Type II diabetes or schizophrenia. After completing several measures of self-reported stigma, participants eventually moved to an adjacent room and sat in one of several seats that systematically varied in their proximity to a seat ostensibly occupied by the target man. Results indicated that the expectation of meeting a man with schizophrenia, compared with diabetes, led to greater desired social distance, greater self-reported fear, and higher appraisals of the man’s dangerousness and unpredictability. More importantly, participants elected to sit farther away from the ostensible man with schizophrenia. This pattern of findings offers behavioral evidence of the psychiatric stigma phenomenon that has mostly been documented via measurement of self-reported attitudes and impressions. We hope that these results stimulate renewed interest in measuring stigma-relevant behavior in the laboratory setting. (PsycINFO Database Record (c) 2018 APA, all rights reserved

Executive Disorder

In lieu of an abstract, here is the essay\u27s first two paragraphs: In How We Got Here (2000), David Frum plumbed the 1970s for essential truths about contemporary American life, seeing in that decade the engines of economic and social transformation that, as the book\u27s subtitle puts it, brought [us] modern life—for better or worse. Frum called the 1970s a time of unease and despair, punctuated by disaster. \u27 He was writing in the waning days of the twentieth century, with Bill Clinton in the White House and a fog of unease and nostalgia misting the land. But if he was worried about the state of American life in 2000, he is even more concerned now in 2017. In the years since his book was published, the country has endured the terrorist attacks of September 11, 2001, two seemingly interminable wars, a financial meltdown that brought into stark relief the privileging of the financial sector by the federal government, the emergence of both left-wing (Occupy) and right-wing (Tea Party) populist movements in response to political, social, and economic unease, and a rise in racial tensions. Perhaps most importantly, the country has installed Donald Trump in the White House. Frum\u27s cover story of the March 2017 issue of The Atlantic, How to Build an Autocracy, spells out how the Trump administration could lead the United States away from liberal democracy. Widely read and widely admired, Frum grimly assesses the current political situation, seeing in Trump threats to American life that are perhaps unlike any encountered in the past

On continuum beliefs and psychiatric stigma: Similarity to a person with schizophrenia can feel too close for comfort

Continuum belief interventions that blur boundaries between “normal” individuals and individuals with psychiatric problems have shown promise in reducing psychiatric stigma. Interventions to date have afforded participants considerable psychological distance from individuals with mental illness. An intervention that compels psychological closeness to individuals with mental illness may lead to increased anxiety/threat and an attenuated intervention effect on stigma. In a randomized experiment, one hundred thirty-five participants listened to a bogus interview involving an ostensible person with schizophrenia who shared numerous characteristics in common with participants. In the interview, the target person (1) did not verbally broach issues of similarity to “normal” people, (2) endorsed a continuum view, or (3) endorsed a categorical view. Participants then read a bogus research article on schizophrenia that (1) was agnostic with respect to the continuum/categorical distinction, (2) attested to a continuum view, or (3) attested to a categorical view. Correlational analyses demonstrated that greater endorsement of continuum beliefs predicted less stigma. Experimental analyses demonstrated that the continuum intervention had no effect on stigma. The continuum intervention increased participants’ feelings of anxiety/threat, measured via self-report and a lexical decision task. These findings might usefully inform the design of stigma reduction programming centered on continuum beliefs

Hydrochloric Acid Infusion for the Treatment of Metabolic Alkalosis in Surgical Intensive Care Unit Patients

Background: Older reports of use of hydrochloric acid (HCl) infusions for treatment of metabolic alkalosis document variable dosing strategies and risk. Objectives: This study sought to characterize use of HCl infusions in surgical intensive care unit patients for the treatment of metabolic alkalosis. Methods: This retrospective review included patients who received a HCl infusion for \u3e8 hours. The primary end point was to evaluate the utility of common acid-base equations for predicting HCl dose requirements. Secondary end points evaluated adverse effects, efficacy, duration of therapy, and total HCl dose needed to correct metabolic alkalosis. Data on demographics, potential causes of metabolic alkalosis, fluid volume, and duration of diuretics as well as laboratory data were collected. Results: A total of 30 patients were included, and the average HCl infusion rate was 10.5 ± 3.7 mEq/h for an average of 29 ± 14.6 hours. Metabolic alkalosis was primarily diuretic-induced (n = 26). Efficacy was characterized by reduction in the median total serum CO2 from 34 to 27 mM/L (P \u3c 0.001). The change in chloride ion deficit and change in apparent strong ion difference (SIDa) were not correlated with total HCl administered. There were no documented serious adverse effects related to HCl infusions. Conclusion: HCl was effective for treating metabolic alkalosis, and no serious adverse events were seen. In this clinical setting, the baseline chloride ion deficit and SIDa were not useful for prediction of total HCl dose requirement, and serial monitoring of response is recommended

Reversibility of the catalytic ketonization of carboxylic acids and of beta-keto acids decarboxylation

Decarboxylation of beta-keto acids in enzymatic and heterogeneous catalysis has been considered in the literature as an irreversible reaction due to a large positive entropy change. We report here experimental evidence for its reversibility in heterogeneous catalysis by solid metal oxide(s) surfaces. Ketones and carboxylic acids having 13C-labeled carbonyl group undergo 13C/12C exchange when heated in an autoclave in the presence of 12CO2 and ZrO2 catalyst. In the case of ketones, the carbonyl group exchange with CO2 serves as evidence for the reversibility of all steps of the catalytic mechanism of carboxylic acids ketonic decarboxylation, i.e. enolization, condensation, dehydration and decarboxylation

Legitimation and Delegitimation in Global Governance

This book explores processes of legitimation and delegitimation of global governance institutions (GGIs). How, why, and with what impact on audiences, are GGIs legitimated and delegitimated? The book develops a comprehensive theoretical framework for studying processes of (de)legitimation in global governance and provides broad comparative analyses to uncover patterns of (de)legitimation processes. It covers a diverse set of global and regional governmental and nongovernmental institutions in different policy fields. Variation across these GGIs is explained with reference to institutional setup, policy field characteristics, and broader social structures, as well as to the qualities of agents of (de)legitimation. The approach builds on a mixed-methods research design that uses both quantitative and qualitative new empirical data. Three main interlinked elements of processes of legitimation and delegitimation are at the center of the analysis: the varied practices employed by different state and non-state agents that may boost or challenge the legitimacy of global governance institutions; the normative justifications that these agents draw on when engaging in legitimation and delegitimation practices; and the different audiences that may be impacted by legitimation and delegitimation. This results in a dynamic interplay between legitimation and delegitimation in contestation over the legitimacy of GGIs