Ceftriaxone is the most used third-generation cephalosporin anti-microbial agent in treating infections caused by gram-positive and gram-negative organisms. Chorea is a movement disorder characterized by involuntary and hyperkinetic movements of the affected body parts due to rapid and unpredictable contractions. We report an uncommon case of ceftriaxone-induced acute reversible chorea. 84-year-old male with a medical history of diabetes mellitus, hypertension, previous myocardial infarction, and gouty arthritis was admitted to the hospital with complaints of altered mental status (AMS) and right 1st metacarpal-phalangeal joint (MTP) swelling, erythema and ruptured wound draining pus-like fluid. The patient was febrile with a temperature of 101.3 F. The rest of the vitals were normal. The patient had an initial workup and was empirically started on ceftriaxone and vancomycin for skin and soft tissue infection. His wound cultures and blood cultures grew pan-sensitive streptococcus agalactiae. His antibiotics were de-escalated to ceftriaxone. X-ray showed severe soft tissue swelling and erosive changes at the base of the proximal phalanx of the first digit secondary to gout or osteomyelitis. MRI of the right foot was attempted, but the patient could not tolerate it. TTE was negative for Endocarditis. The patient had initial improvement in his AMS, but 72 hours later, he became increasingly confused with choreiform movements. Ceftriaxone was discontinued, and Ertapenem was started. Patient’s confusion and choreiform movements improved after the discontinuation of ceftriaxone. Patient was discharged to a rehabilitation facility with four weeks of IV Ertapenem. Ceftriaxone is a third-generation cephalosporin that inhibits mucopeptide synthesis in the bacterial cell wall. Ceftriaxone is a well-tolerated anti-microbial agent with a low toxicity profile. Common adverse effects include gastrointestinal disturbances, skin rashes, and hematological disorders. Neurological symptoms like encephalopathy is an uncommon adverse effect. Chorea is a movement disorder due to hereditary or acquired causes. Drug-induced chorea is one of the rare causes of acquired chorea. History and physical examination are essential in diagnosing acquired causes of chorea. Further workup with laboratory tests and neuroimaging are required to evaluate secondary causes. Chorea due to ceftriaxone is described in a patient with end-stage renal disease on hemodialysis in a case report previously, but our patient did not have any chronic kidney disease [1]. It is postulated that beta-lactam antibiotics increase neurological hyperexcitability by increased glutamate release in the striatum and cerebral cortex, causing movement disorders [2]. It is noted that pre-existing neurological conditions and excessive dosage are shown to be significant risk factors for cephalosporin neurotoxicity. Our patient, however, did not have any neurological condition but was treated with 2 grams of ceftriaxone daily before he had choreiform movements. Upon removal, the patient improved significantly within 36-48 hours. Ceftriaxone is a widely used anti-microbial with broad coverage. Although uncommon, recognizing that neurotoxicity due to third generation cephalosporins is essential. Prompt diagnosis and withdrawal of the offending agent is critical in improving the patient’s symptoms. Age, prior neurological conditions, kidney disease, and dosage must be carefully evaluated before administration.

Background: The etiology of pulmonary disease is complex and influenced by various factors, resulting in a significant public health issue, with 16 million Americans living with chronic obstructive pulmonary disease (COPD) and 24 million with asthma, and cases are on the rise. The purpose of this study was to explore demographic, health status, and lifestyle behaviors with pulmonary disease so patterns of risk can be understood and inform interventions. Methods: This cross-sectional study utilized the National Inpatient Sample Data from 2019 (NIS 2019). The predictor variables consisted of: demographics (age (18+), sex, race), health status (obesity, depression, diabetes), lifestyle behaviors (smoking, alcohol use, and aspirin use), and the outcome variable was pulmonary disease. To ensure accuracy, the data was weighted by the variable discharge weight (DISCWT), and chi-square analyses and ANOVA tests were conducted to determine the independence of categorical and numerical predictor variables. Descriptive statistics were conducted for all variables, simple and multiple logistic regression analyses were performed to identify factors that contribute to the likelihood of having pulmonary disease. Results: The sample of the NIS 2019 data included 6,043,654 cases of which, 22.65% of inpatients had pulmonary disease. The collective sample demographic characteristics were: mean age of 58.4 years, and more than half of inpatients were females (57.05% compared to 42.95% males). In terms of health, 17.75% of the sample were obese, 28.8% had diabetes, and 14.25% were depressed. Within the collective sample, 16.8% of inpatients reported smoking, 9.09% drank alcohol, and 14.51% consumed aspirin (long-term (current) use of aspirin). Results of the multivariate statistical analyses reveal that individuals who were obese were 68.3% more likely to have pulmonary disease compared to non-obese patients (aOR = 1.683, CI 1.679-1.686, pConclusion: Results of our study provide important insights between pulmonary disease and associated risk patterns. As pulmonary symptoms have risen in the wake of the COVID-19 pandemic, there is an urgent public health need to explore disruption of risk pathways to avoid overwhelming fragile global healthcare systems.

This dissertation focuses on the midlife adjustment of individuals from a longitudinal study in its 5th decade of follow-up. The Abecedarian Project, a prospective randomized control trial (RCT), began in 1972 with the primary goal of preventing cognitive impairments and school failure in children born into impoverished families with multiple risk factors by randomly assigning 111 infants to either an early education (n = 57) or control group (n = 54). This dissertation reports midlife outcomes at ages 39 – 45 for 42 individuals who received the early education treatment and 36 who were controls. This dissertation focuses on two primary hypotheses within a twojournal manuscript format. The first primary hypothesis of this dissertation is that the Abecedarian early education intervention will increase the number of successful outcomes over the lifespan, showing the cumulative effect of positive experiences (Sameroff, 2009) and a sense of personal efficacy (Dweck, 2008; Seeman, 1959). The second primary hypothesis of this dissertation is that response contingent learning and being an active agent in early cognitive and social settings during the first five years of life will provide a strong foundation for future perceptions of control over important areas in one’s life (Furnham & Steele, 1993; Walden & Ramey, 1983; Wallston, Wallston, & DeVellis, 1978). The analysis of midlife indices of strength and risk reveal results favoring the treatment group compared to the controls on both the Midlife Strengths Index (F (1,76) = 15.85, p = .000) and the Midlife Risk Index (F (1,76 = 8.88, p = .004). Additionally, a significant interaction exists between group assignment and IQ at age 48 months for the Midlife Strengths Index (β = -.215, p < .05). Analyses of Locus of Control scales reveal that the control group reports “powerful others” have more influence on both their health behaviors (F (1, 76) = 3.962, p = .05) on the Multidimensional Health Locus of Control Scale and their economic behaviors (F (1, 76) = 5.146, p = .026) within the Economic Locus of Control Scale. Additionally, the control group reported more external economic locus of control than the treatment group with a marginal statistical significance (F (1, 76) = 3.359, p = .071). Results are consistent with the conclusion for children born into multi-risk, economically impoverished families there are lifelong benefits of receiving high-quality early care and education that extend into the midlife years. / Ph. D.

Purpose: The purpose of thestudy is to analyzehowdifferenteducatorsworking attwo different preschools, perceiveand reflect onthe conceptofthe competent child. Questionat issue:Howis the concept of the competent child perceived bythe participating preschool teachers? What is the concept loaded with and what meaning is given to the concept by the teachers? Method:The method used for this study is a phenomenographicone where qualitative interviews were conducted with eight teachers from two different preschools. Main theories:The theoretical framework used in this text is phenomenography where focus is on the study of perceptions, and on analysis of how people perceive phenomenon as well as analysis of how people create content and meaning in the relationship between the self and the surrounding world. Summarized conclusion:The results from the eight interviews show that the concept of the competent child is a complex one. However, the analysis of the empirical data shows that the concept can be described through five different perspectives; the perspectives of the child, thepedagogical approach, knowledge, care and education. The study shows that these different perspectives are based on personal experience which forms the basis for how they perceive the child and how they relate to the child. Therefore, we believe it is important that all educators in preschools together reflect on the concept of the competent child to create an equal preschool for all.

O cuidado às famílias das/os usuárias/os dos serviços de saúde mental é aspecto valorizado pelo modelo de atenção biopsicossocial e importante para efetivação da Reforma Psiquiátrica brasileira. Apesar disso, ainda é um desafio no cotidiano dos serviços. Para atender a esta necessidade, a literatura aponta a Educação Permanente em Saúde (EPS) como um recurso para o desenvolvimento desse cuidado, junto às/aos profissionais de saúde. Esta pesquisa tem como objetivo geral entender como o processo conversacional contribui para o desenvolvimento da proposta da EPS e para a formação profissional para o cuidado às famílias de usuários/as de serviços de saúde mental. Para tanto, foram realizados dois processos formativos, com base na proposta da EPS, com dois grupos de profissionais de dois serviços públicos de saúde mental de um município de médio porte do estado de São Paulo. Ao todo, 18 profissionais participaram da pesquisa. A partir desses encontros, as conversas foram gravadas, transcritas e analisadas, utilizando a perspectiva construcionista social como guia teórico-epistemológico. A análise foi realizada com os seguintes objetivos específicos: identificar momentos críticos na interação, como marcos do processo conversacional, que indicam a ocorrência de reflexões e transformação de sentidos com relação à prática com famílias em saúde mental; analisar o uso de Registros Reflexivos como recursos conversacionais para a promoção de reflexões e transformação de sentidos. Com isso, cada um dos processos de EPS realizados foi nomeado a partir de características do seu processo conversacional e, para cada um deles, momentos críticos foram delimitados. No processo Caixa de marimbondo as conversas do grupo em torno das dificuldades do trabalho com famílias provocaram na facilitadora um sentimento de paralisação que, quando explicitado, gerou um momento crítico que permitiu ao grupo refletir sobre os espaços de reunião e seus efeitos. Já no processo Primavera entre os dentes as conversas sobre diferentes questões relacionadas ao cuidado às famílias promoveram transformações de sentido relacionadas à importância do trabalho desenvolvido pelas profissionais, à possibilidade de participação das famílias, à prática interdisciplinar e à importância do processo de EPS desenvolvido. Com isso, é destacada a centralidade do processo conversacional para que a EPS ocorra, sustentando a tese de que a facilitação pautada na responsividade fornece a base para construção de contextos de formação para o trabalho com famílias em saúde mental. / The Brazilian Psychiatric Reform predicts family care as a central aspect for treatment of people who suffers with psychiatric disorders. Nevertheless, it is still a challenge in everyday services in Brazil. To meet this need, literature and health policy point to Permanent Healthcare Education (PHE) as a way to promote this care. This research aimed to understand how conversational process contributes to develop the PHE proposal and to promote professional formation for taking care of family members in mental health services. To do so, two educational processes were carried out, based on the PHE policy and proposal, with two groups of professionals from two public mental health services in a medium-sized municipality in the state of São Paulo, Brazil. In total, 18 professionals participated in the research. The conversations were, then, recorded, transcribed and analyzed, using the social constructionist perspective as a theoreticalepistemological guide. The analysis was performed with the following specific aims: identify critical moments in the interaction, considered as landmarks of the conversational process, which indicate the occurrence of reflections and transformation of meanings regarding the practice with family members in mental health care; analyze the use of Reflexive Records as conversational resources to promote reflections and transformation of meanings. Thus, each of the PHE-processes was named from the characteristics of its conversational process and, for each of them, critical moments were delimited. In the \"Hornet\'s nest process the group\'s conversations about the difficulties of working with family members provoked a feeling of paralysis in the facilitator which, when expressed, generated a critical moment which led the group to reflect on meeting spaces and their effects. In the \"Holding the spring\" process, conversations about different issues related to care practices with family members promoted changes in meanings related to the importance of care practices developed by professionals, to the possibility of participation of family members, to interdisciplinary practices and to the importance of the PHE process developed. With this, the centrality of the conversational process in order to PHE to occur is highlighted, supporting the thesis that facilitation based on responsiveness provides the ground for building educational contexts for working with family members in mental health services.

The topic of the diploma thesis is description of care system for unaccompanied minors in the Czech Republic and mapping of special pedagogical methods used within this system. In my own research I show examples of concrete case studies how individual forms of educational and special pedagogical care help unaccompanied minors in successful integration into the major society. The aim of the thesis is not only to describe the current state of care for minors and special pedagogical methods used, but also its evaluation. Based on the critical assessment of the case studies, they try to outline the possibilities of further development of care for unaccompanied minors in the Czech Republic from the perspective of special pedagogy.

In the first part of the work discribes the poverty as the main development problem of the region sub-saharan Africa and other problems connected with poverty. The second part of the work summarizes the state and diferences of social systems in individual countries of the region. The last part is focusing on the possibilities of improvement social systems to achieve the reduction of development problems.

Historically, the early childhood workforce has been described as undereducated, poor, and disproportionately comprised of women of color. The EDUCATE workforce development policy was designed to advance the professional development of under-paid and under-valued child care workers. This study focuses on the history, intent, and impact of this policy at the intersection between the grantees, the State, the various organizational contexts, and the broader structural forces. More broadly, complex issues and challenges related to the early childhood workforce are surfaced. Finally, through a critical analysis of the findings, the hidden and dominating forces that maintain the current level of inequity for the early childhood workforce are revealed. From an applied anthropological perspective, the findings from this study can inform the design, adjustment, and implementation of the EDUCATE workforce development policy, as well as other policies and practices at state, county, community college, and child care center levels.

Patient-centred care is the gold standard of health care, yet in practice, problems prevail. The use of the ‘expert patient’ in health professional education is one form of learning patient-centred care. A gap in the literature regarding how the use of ‘expert patient’ in health professional education promotes patient-centred care was acknowledged in current research. With Queen’s University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board approval, a sample of Queen’s University MScOT students participated in a qualitative study with the following research question: “How does the students’ experience of interacting with the ‘expert patient’ (‘XP’) relate to learning regarding client-centred practice (CCP)?” Three objectives were proposed: 1. Describe the OT students’ experience of interacting with the ‘expert patient’, 2. Describe the students’ learning regarding client-centered practice, 3. Identify the conditions particular to the ‘expert patient’ experience that led to learning regarding client-centered practice. In-depth interviews were conducted with the students subsequent to their ‘expert patient’ experience. Analysis revealed three conditions that together provided the foundation for student experiential learning regarding client-centred practice: interaction with particular persons with stable disability known as ‘expert patients’; students’ requirement to evaluate them and thus ‘experience power’; and explicit opportunities for ‘directed reflection and discussion’. Questions were raised for researchers, health care professional educators and health care professionals regarding the potentially transformative nature of engaging in unfamiliar contexts with openness to learning. The thesis allowed insight into the lived experience of OT students learning with ‘expert patients’; the admiration, discomfort, humility and gratefulness they experienced while gaining a sense of the meaning of collaboration, respect for autonomy and recognition of expertise. Implications of the research impact all stakeholders in health professional education. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-04-05 00:18:04.617

Thesis (M.S.)--University of Michigan, 1990.