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To examine the effects of preoperative gabapentin administration on postoperative pain in pediatric patients undergoing tonsillectomy/adenoidectomy (T/A) in a single ambulatory surgery location within a pediatric healthcare organization.This randomized, controlled pilot study enrolled patients age 3-18 years with American Society of Anesthesiologists (ASA) scores of I-II undergoing T/A.Both gabapentin and placebo groups were given study medication preoperatively and received standard opiate regimens intraoperatively and postoperative pain instructions. Outcome measurements included: time to first analgesic medication in the postanesthesia care unit (PACU), mean acetaminophen, ibuprofen, and opiate doses in mg/kg. Additionally, we examined pain scores, medication use, and side effects reported by daily pain diaries completed by patients/families for 3 days postoperatively.Forty-nine patients were included in final analysis (gabapentin n = 26, placebo n = 23). Demographic and clinical characteristics of both groups were similar; the majority (46 of 49) were under the age of 13. Both groups received opiates in PACU. Some patients in both groups received hydrocodone/acetaminophen postoperatively. There were no reported differences in side effects between groups. Gabapentin group reported less use of opiates, acetaminophen, and ibuprofen post-discharge. We identified small effect sizes for opiates and acetaminophen, and medium effect size for ibuprofen (80.1% gabapentin versus 100% placebo, RR 0.81 [95% CI 0.67-0.97]). Median pain scores were 4 on a scale of 10 for both groups for all 3 days of follow-up. Overall median satisfaction score was 9, with a mean difference of 0.35 (95% CI -0.78 - 1.37). Analysis of variance revealed no difference in pain scores or satisfaction per pain diaries between the groups in general and no difference in score trajectory.We were able to establish a rigorous process and feasibility to launch a larger, multi-center trial to examine this important issue. There remain few evidence-based options for acute pain relief in pediatric surgical populations besides opiatessup./supIdentifying opiate alternatives that are effective, cost efficient and safe are needed for pediatric tonsillectomy patients.

Aim The purpose of the study was to evaluate clinical safety and effectiveness of Oasis® Wound Matrix as a treatment for full-thickness pressure ulcers and compare it to Standard Care. Methods A total of 130 adults with Stage III or Stage IV pressure ulcers were randomly assigned, received either multiple topical treatments of SIS plus standard care (n = 67), or standard care alone (n = 63), and were subsequently evaluated. Ulcer size was determined at enrollment and weekly throughout treatment. Healing was assessed at each visit for a period of up to 12 weeks, with incidence of complete healing and 90% reduction in ulcer area being the primary outcome measures. Results The proportion of complete healing in the SIS group was 40% as compared to 29% in the standard of care group (p = 0.111); the percentage of patients having a 90% reduction in ulcer surface area was 55% in the SIS group versus 38% in the standard of care group (p = 0.037). Conclusions The results of this study suggest that within the setting of a comprehensive wound care program, weekly treatment of chronic pressure ulcers with SIS wound matrix increases the incidence of 90% reduction in wound size versus standard of care alone.

This brief paper provides a snapshot of Kenya's economic development and perspectives on its developmental policies, including visualization comparisons with member states of the East African Community.

Summary This discussion paper will explore contemporary clinical nursing in Australia and simulation technologies used in universities to educate Bachelor of Nursing (BN) students. Informed by auto-ethnographic principles the authors reflect on their teaching experiences in both clinical and tertiary sectors with specific reference to challenges encountered through the use of simulation technologies. Further, increased reliance on simulation as a teaching tool in nursing education is discussed and techniques for embracing this explored. The authors' pedagogical goal is to ensure students develop the capacity to competently process patient information, enabling them to safely plan, implement and evaluate interventions and outcomes.

OBJECTIVES: To assess the nutrition content and overall quality of mobile apps for children that focus on food preparation. These apps are games that require the user to cook, prepare and decorate virtual foods. METHODS: A systematic search of the Canadian Apple App and Google Play Stores was conducted using 16 unique search terms related to nutrition, education, and children. Apps were included for analysis if they were rated appropriate for children, if the app had been updated since January 2016 and was in English. App titles, developers and descriptions were screened to identify apps eligible for analysis. App content was assessed by classifying foods according to the Canadian Food Guide categorizations. App quality was evaluated using the Mobile Application Rating Scale (MARS), which ranges from 1 (lowest quality) to 5 (highest quality). All screening and analysis were conducted by two independent reviewers with a third reviewer to resolve disagreements. RESULTS: A total of 2575 unique apps were identified. After screening, 142 were included in the analysis. Apps were most likely to contain the following foods: Dairy products (73%), candy/frozen desserts (71%), refined grains (68%) fruits (61%), lean meats (52%), desserts/baked goods (49%), vegetables (44%), sugar-sweetened beverages (38%) and processed meats (33%). Apps were least likely to include fish (14%), plant-based proteins (10%), and whole grains (4%). Although the appearance of fruits in apps was high, in 55% of apps fruit was shown in combination with desserts, chocolate and candy, and rarely on their own (7%). Apps were more likely to include sweet, high-sugar foods and/or sugar-sweetened beverages (86%) over savoury, high-sodium foods (40%). No app directly provided nutrition information and only 3% of apps included healthy eating messages. The mean MARS score was 3.6 (range 2.5–4.8), indicating moderate quality overall. CONCLUSIONS: Children's food preparation games were moderate quality and include many foods that are not recommended by dietary guidelines. Given the popularity of these games, collaborations between app developers and nutritionists could enhance the quality and content of food preparation apps by incorporating a variety of foods recommended by current guidelines and healthy eating messages. FUNDING SOURCES: Ontario Research Excellence Fund. SUPPORTING TABLES, IMAGES AND/OR GRAPHS

Why are the black brownstone owners in Harlem and Brooklyn disproportionately West Indian? The landlords, West Indian-American? The tenants African-American? These are tough questions. For students of housing discrimination, West Indian Americans have long presented a quandary. If it is reasonable to assume that racial exclusions are being consistently applied to persons who are dark-skinned, one would expect to find that housing discrimination has had similar effects on West Indian-Americans and African-Americans. Yet this is not the case: West Indian-Americans generally own and rent higher quality housing than African-Americans. Moreover, these advantages began long ago. For example, when racial covenants, that is, restrictions barring racial and ethnic groups from owning real property in particular neighborhoods were rife in New York, they were not consistently applied against West Indians, who were sometimes able to buy into tony neighborhoods. While it is true that such covenants were also inconsistently applied against other ethnic and religious groups such as Jewish New Yorkers, West-Indians still stand out. Since West Indians are overwhelmingly dark-skinned persons of African descent they typically did not have the option of "passing" that may have been available to other groups. Eschewing more traditional explanations in the civil rights literature, I apply the literature in which racial segregation in real property ownership is conceived as a racial monopoly in which racial cartels appropriate anti-competitive techniques to monopolize access to real property. Maintaining a racial cartel is dependent on white owners maintaining a united front, that is, they must uniformly refuse to sell. Importantly, realtors play a gate keeping role in real estate and West Indians dominated the realtor sector. As realtors, they were expert at finding defectors, namely, whites willing to break norms of racial exclusivity, in exchange for their ability to extract a premium for selling to blacks early. Brokers then proceeded to buy significant numbers of titles, which were then off-loaded to fellow West Indians. West Indian brokers could act in confidence because they had cash-rich clients and were often buying in trust (de facto if not de jure) for fellow West Indians. In so doing, West Indian brokers in New York were simply replicating techniques that had been utilized by their land-brokering ancestors. I discuss the history that "previews" this period in New York, albeit in a different context: in the British West Indian islands from the migrants originated. There are repeated instances of blacks "busting" white monopolies in land-ownership, throughout the West Indian colonies in contravention of racial norms in the British colonies of who was allowed to own land where. Upon arrival in New York, West Indians encountered another racial monopoly in real property ownership, namely Northern racial segregation. They essentially appropriated the same techniques that they had utilized in the West Indies to break into white neighborhoods in New York.

Students look forward to their clinical practicum to learn within the context of reality nursing. As educators we need to actively develop models of clinical practicum whereby students are supported to engage and learn in the clinical learning environment. The aim of this paper is to describe an innovative model of supportive clinical teaching and learning for undergraduate nursing students as implemented in a large teaching hospital in New South Wales, Australia. The model of supportive clinical teaching and learning situates eight students at a time, across a shift, on one ward, with an experienced registered nurse from the ward specialty, who is employed as the clinical teacher to support nursing students during their one to two week block practicum. Results from written evaluation statements inform the discussion component of the paper for a model that has proved to be successful in this large healthcare facility.

The triaging of individuals who present to general hospital emergency departments with suicidal thoughts and behaviours is especially challenging and fraught with uncertainty. Although the suicide literature is vast, and risk factor research has a long history, there is a dearth of articles that address the "point of care" factors that need to be considered in triaging a suicidal patient. In order to address this dilemma for nurses performing the triage function, this paper is a targeted review of the suicide risk factor literature designed to discern factors that may have implications for making a triage determination with the intent of improving the accuracy and quality of triage for suicidal patients. Contextual and compositional factors suggesting long-term risk; situational, precipitating, factors that may impact one's immediate risk; and cues and clues to imminent risk are presented along with evidence-based suggestions for assessment and safety.

Cellular apoB in primary rat hepatocyte cultures was pulse-labeled with ( 35 S)methionine for 1 h. Cells were then chased with excess unlabeled methionine for periods of up to 16 h in the presence or absence of BMS-200150, an inhibitor of microsomal triglyceride transfer protein (MTP). The secretion of apoB-48-VLDL was more sensitive to MTP inhibition than was apoB-100-VLDL. Inhibition of MTP had no inhibitory effect on the secretion of denser particles (apoB-48 HDL and apoB-100 HDL). BMS-200150 delayed the net removal of newly synthesized apoB-48 and apoB-100 from the microsomal and Golgi membranes, but not from the corresponding lumenal compartments. Only minor pro- portions of the microsomal lumen apoB-48 and apoB-100 (12-16% and 17-19%, respectively) were present as VLDL irrespective of whether MTP was inactivated or not. The HDL fraction contained most of the lumenal apoB-48 (67- 73%) and a somewhat smaller proportion of apoB-100 (44- 47%). The remainder of the lumenal apoB was associated with the IDL/LDL fraction. These proportions were unaf- fected by MTP inactivation. Excess labeled apoB which accumulated in the membranes in the presence of BMS- 200150 was degraded. Inhibition of MTP prevented the re- moval of pre-synthesized triacylglycerol (TAG) from the hepatocytes as apoB-VLDL. Under these conditions intra- cellular TAG accumulated mainly in the cell cytosol, but also, to a lesser extent, in the microsomal membranes. The results suggest that inactivation of MTP inhibits a path- way of VLDL assembly which does not involve the bulk lu- menal compartments of the microsomes. Suppression of this pathway ultimately prevents the net transfer of cytosolic TAG into mature apoB-VLDL. —Hebbachi, A-M., A-M. Brown, and G. F. Gibbons. Suppression of cytosolic triacyl- glycerol recruitment for very low density lipoprotein assem- bly by inactivation of microsomal triglyceride transfer pro- tein results in a delayed removal of apoB-48 and apoB-100 from microsomal and Golgi membranes of primary rat hepatocytes. J. Lipid Res. 1999. 40: 1758-1768.

The imaging of children presenting with suspected non-accidental injury (NAI) can stir deep emotions in radiographers. Despite this, radiographers must retain their professionalism, not pass judgement and provide optimum quality images. The images produced will be used by the radiologist to give a diagnostic opinion, and could be used in a court of law for either the prosecution or the defence. Consequently, the role of the radiographer is crucial within the child protection team and the Family Proceedings Court. This paper outlines areas of good practice for individual radiographers, but can also be used by departments to write or review NAI protocols. The paper is based on a research project which was undertaken to determine the extent of knowledge radiographers have around the area of NAI, in an attempt to establish training needs for qualified staff.

Cultured hepatocytes from rats fed a low fat, chow diet (LF) or diets rich in fish oil (FO, 20% v/w) or olive oil (OO, 20%, v/w) were used to determine how the intracellular metabolism and secretion of apolipoproteins (apo)B-100 and B-48 respond to in vivo and in vitro manipulations of fatty acid esterification, storage, secretion, and oxidation. Hepatocytes from the FO- and OO-fed rats had higher initial triacylglycerol (TAG) contents and higher rates of fatty acid oxidation and ketogenesis than hepatocytes from the LF-fed group. However, only in the cells from the FO-fed animals was there any decrease in the rate of TAG synthesis and in the secretion of VLDL TAG. Decreased secretion of TAG by the FO hepatocytes was accompanied by a decreased synthesis and degradation of apoB, particularly apoB-48, and a decreased secretion of apoB-48 VLDL. In all dietary groups a substantial proportion of the apoB-48 and apoB-100 secreted into the medium was associated with small, lipid-poor particles of density > 1.006. FO feeding had no effect on the amounts of apoB-48 and apoB-100 that appeared in this fraction. Dietary composition affected the channelling of exogenous oleate in the culture medium into the oxidative and esterification pathways. While exogenous fatty acid increased the secretion of VLDL TAG in the FO-fed group, VLDL TAG secretion remained lower than that observed in the hepatocytes from the LF- and OO-fed groups cultured under identical conditions. Exogenous oleate did not significantly increase the secretion of either newly-synthesized apoB-48 or apoB-100 by hepatocytes in either of the dietary groups. We conclude that, in rat liver, a decreased capacity to transport TAG out of the hepatocyte after consumption of a diet rich in fish oil is associated with a decreased synthesis and presecretory degradation of apoB-48, and with a decreased secretion of VLDL apoB-48.

Nonsteroidal antiinflammatory drugs have unique properties that aid the cataract surgeon. In phacoemulsification surgery, patients routinely receive nonsteroidal antiinflammatory drugs along with their dilating drops to inhibit intraoperative miosis. After surgery, these drugs can control inflammation and inhibit the development of cystoid macular edema. We present two prospective randomized studies. In the first, diclofenac sodium was compared with prednisolone acetate for control of postoperative inflammation. In the second, diclofenac sodium was compared with flurbiprofen for inhibition of intraoperative miosis. Diclofenac sodium was found to be as effective as prednisolone acetate for control of postoperative inflammation and as effective as flurbiprofen for inhibition of intraoperative miosis. Thus, whereas in the past we used a nonsteroidal antiinflammatory drug before surgery for inhibition of intraoperative miosis and a steroid drop in the postoperative period to control postsurgical inflammation, we now have equal efficacy using the same drug in the entire perioperative period.

Enzymic activity and protein levels of xanthine oxidase were measured in serial samples of breast milk donated by each of 14 mothers, starting, in all but two cases, within 7 days following parturition. Enzyme activity varied widely, usually reaching peak values during the first 15 days and falling thereafter, by as much as 98%, to basal levels that were subsequently largely maintained. Corresponding changes in xanthine oxidase protein levels were not observed and, consequently, the specific activity of xanthine oxidase followed the above pattern. The capacity of human xanthine oxidase to undergo activation-deactivation cycles at the molecular level has important implications, not only for its role in breast milk, but also for its potential as a source of reactive oxygen species in other human tissues.

In 1971, the South East Asian country of Bangladesh, then known as East Pakistan, was caught up in a brutal war for independence from Pakistan. Bangladeshi collaborators along with Pakistani soldiers and militia dealt ruthlessly to suppress the uprisings for autonomy in East Pakistan. It is estimated that during this bloody nine-month period, close to three million individuals were killed, hundreds of thousands of women were raped, and millions were displaced. In Bangladesh and elsewhere, the crimes committed by Pakistan in order to eradicate a growing political threat have been described as nothing short of genocide; yet despite their gravity, little has been done to end impunity for perpetrators.Almost forty years later, in March 2010, Bangladesh ratified the Rome Statue and the same week, “announced the establishment of a special war crimes tribunal that will hear cases against individuals accused of war crimes during the 1971 Bangladesh Liberation War.” The International Crimes Tribunal has since indicted several individuals for atrocities committed during the 1971 civil war. Since 2010, Bangladesh’s efforts to procure justice for the victims of crimes committed in 1971 have received mixed reviews at both the international and domestic level. This paper seeks to serve as an introductory piece on the Bangladesh International Crimes Tribunal, the law it applies, and some brief perspectives on its work to date.

Paper prepared by ILI-ACLE Legal Intern, Kimberly M. Brown for distribution to East African law faculty participants in two-day training seminar in Nairobi, Kenya on International Criminal Law (ICL) by International Law Institute – African Centre for Legal Excellence (ILI-ACLE) & Open Society Initiative for East Africa (OSIEA).International Criminal Court (ICC) - Since its establishment in 2002 via the Rome Statute, the ICC has played an important role in shaping and influencing the parameters of international criminal law. The Rome Statute created an independent international criminal court of limited jurisdiction that aimed to investigate and prosecute individuals who commit war crimes, crimes against humanity, and genocide. The ICC currently has twenty-two active cases pending against individuals in five African states. In total, the ICC is investigating seven situations, all within the African continent and all having been referred to the ICC in one of the three ways pursuant to the Statute. Uganda, the Democratic Republic of Congo and the Central African Republic all signatories to the Rome Statute, individually referred situations from their countries to the Prosecutor. The United Nations (U.N.) Security Council referred the situations in Darfur, Sudan and Libya to the ICC Prosecutor. Following questionable actions of leaders in Cote d’Ivoire, on May 20, 2011 the presidency of the ICC assigned the situation to Pre-Trial Chamber II to determine whether the court has jurisdiction over alleged crimes. Most recently, on May 30, 2011, the Pre-Trial Chamber II confirmed the admissibility of two cases in the Kenyan situation after the prosecutor requested authorization from the ICC.

Due to the globalized and transient nature of world societies, throughout the last several decades and the relative low risk involved, organized crime and related syndicates have begun to more widely exploit the lucrative market found in the trafficking of persons. After drug and arms trafficking, trafficking in persons is the third largest criminal activity in the world. Trafficking victims can be used to fuel a variety of economic demands, whether in labor industries or the billion-dollar commercial sex industry. Sub-Saharan Africa (SSA) has seen no exceptions to this terrible trend. The sub-Sahara African region has long seen cross-border and local migration including, contract workers, labor migrants, skilled professionals moving to urban areas, as well as migration by refugees and displaced persons from famine and conflict. This paper examines regional mechanisms, discusses best practices and involves case studies from Nigeria and South Africa.

This memorandum explores Kenya’s assumed responsibility for prosecuting apprehended Somali piracy suspects from capturing nation states through bilateral agreements and the conflicts that might arise when incorporating international legal norms. This memorandum also includes a discussion on the evolution of piracy in international law, Kenya’s domestication of international maritime law, and the procedural issues that may arise from trying piracy and applying international legal norms in Kenyan domestic courts. The issues include human rights, the sovereign rights of states, international maritime law, international criminal legal standards, global security and economic concerns, as well as a “new” pirate. Also, in an attempt to explore other possible issues that may arise for the Kenyan courts during the piracy trials, this memorandum provides brief case studies of other domestic courts, which have in the past or are currently adhering to international criminal law standards. Lastly, this memorandum examines ways in which the Kenyan courts can address the obstacles presented.

Immigration is a hot button issue about which Americans have sent a clear message. They prefer not to admit more aliens until the government is able to credibly screen for entrants who will abide by the terms of admission and sanction those who do not. While immigration debates now focus almost entirely on undocumented workers, they have overshadowed another critical, yet poorly understood challenge: designing institutions to properly screen for aliens who are visa-compliant and sanction non-compliant aliens. Because failed guest worker programs unquestionably increase the size of the undocumented population, this article addresses the difficulty of institutional design by analyzing the highly controversial guest worker provisions of the Immigration and Nationality Act. This article presents original data from a study of visa-compliance decisions of Jamaicans who work in Canada under a program in which screening is precise, sanctioning is effective and compliance is high. On the basis of this study, this comparative immigration law project contends that the United States should partially outsource screening and sanctioning to source-labor countries. This article critiques the historical uni-national approach to immigration law. This approach fails to recognize that there are critical asymmetries between the United States and the countries from which aliens originate in their capacity to gather information about potential entrants and to sanction visa-violators. This recognition leads to the following insight: source-labor countries are often better placed to screen because can they access accurate information about potential entrants from their communities. Source-labor countries are also often well-placed to deter non-compliance because through collective sanctioning, they can influence communities of origin to persuade their members to abide by visa terms. The criminal law scholarship regularly recognizes the impact of norms on deterring crimes; this ethnographic study suggests that the same may be true with respect to immigration violations. This article contends that aliens are more likely to be compliant so long as the authorities design legal rules that augment compliance norms already present in source-labor communities and incentivize community members to reinforce them.

Introduction Metabolomics is a powerful scientific strategy which identifies low molecular weight (bio)chemicals (metabolites) present in the metabolome of a cell, tissue or organism. The aim of this study was to undertake a two-stage metabolomic study of circulatory serum from patients with ulcerative colitis (UC) and Crohn9s disease (CD) and matched healthy controls, to determine if we could establish a characteristic metabolic signature for each of these diseases. Methods Patients were selected from a cohort of 332 IBD patients, comprising 134 males and 198 females during November 2007–March 2009. The base study comprised 30 CD, 30 UC and 29 control patients, all white male Results After quality assurance, 4289 peaks were consistently detected by the UPLC-MS analysis of the base study samples. After univariate screening (p Conclusion This study illustrates, for the first time, that serum metabolomics is effective at distinguishing IBD patients from normal subjects, and to a lesser extent CD from UC. It demonstrates the potential of metabolomics to differentiate disease phenotypes and may give new insights into the aetiology of IBD.

4,17α-Dimethyl-4-aza-5-androsten-17β-ol-3-one, 4,17α-dimethyl-4-aza-5α-androstan-17β-ol-3-one, 4,17α-dimethyl-4-aza-5α-androstan-17β-ol, and their corresponding acetate esters were synthesized and compared for antimicrobial activity. 4,17α-Dimethyl-4-aza-5α-androstan-17β-ol acetate exhibited significant activity.