Persistent Scarcity Research Articles

Educational practices for the language development of students with intellectual developmental disorder in the school setting: a systematic review

BackgroundIntellectual development disorder (IDD) is a challenging disorder that professionals, most notably teachers, are confronted with daily. Supporting oral language in the classroom is a complex challenge as teachers are expected to implement effective methods to support students’ language. However, they face a persistent scarcity of scientific evidence to draw upon in their practice.AimsThis research provides a first overview of instructional methods and their effectiveness in this population.MethodOur search was conducted through various databases, generating a total of 931 articles. Data from the 14 selected studies were analyzed.Outcomes and resultsThe results reveal limited, heterogenous, and hardly comparable studies in terms of their characteristics (samples, language area, strategies, and effectiveness measures) suggesting a low level of evidence regarding the effectiveness of these practices.Conclusion and implicationsWe discuss the implications of these findings in light of the different factors contributing to the interventions’ effectiveness, as well as considering the issue of transfer and generalization of acquired skills in IDD. We also reveal the urgent need for developing methods addressing cognitive load limitations such as implicit learning approaches, to enhances effectiveness and compensate the gap of available resources tailored to improve oral language outcomes in the IDD population.

Malnutrition and non-compliance to nutritional recommendations in patients with cirrhosis are associated with a lower survival.

BACKGROUNDMalnutrition is frequently encountered in patients with cirrhosis and appears to significantly impact their prognosis. While evaluating the burden of malnutrition in cirrhosis is gathering momentum, as suggested by multiple recently published reports, there is still a persistent scarcity of solid data in the field, especially with regards to the role of nutritional interventions.AIMTo assess the prevalence of malnutrition in patients with advanced cirrhosis and to evaluate its impact on survival. METHODSOne hundred and one consecutive patients with advanced cirrhosis were screened for malnutrition using the Subjective Global Assessment (SGA) criteria and the mid-arm circumference (MAC). Malnutrition was defined as SGA class B and C and MAC < 10th percentile. All patients were interviewed regarding their food intake using an adapted questionnaire. Subsequently, total energy intake was calculated and further subdivided in main nutrients. The data were then compared to the available recommendations at the time of analysis to assess adherence.RESULTS54/79 patients (68.4%) in the decompensated group had malnutrition, while only 3/22 patients (13.6%) were malnourished in the compensated group. After a median follow-up time of 27 mo (0-53), the overall mortality was 70%. Survival was significantly lower among patients with malnutrition. The mortality rates were 50% at 1 year and 63% at 2 years for the patients with malnutrition, compared to 21% at 1 year and 30% at 2 years for patients without malnutrition (P = 0.01). On multivariate analysis, the factors independently associated with mortality were age, creatinine level and adherence to the protein intake recommendations. The mortality was lower in patients with the appropriate protein intake: 8% at 1 year and 28% at 2 years in the adherent group, compared to 47% at 1 year and 56% at 2 years in the non-adherent group.CONCLUSIONThe prevalence of malnutrition is high among patients with advanced cirrhosis and might be related in part to a low adherence to nutritional recommendations, especially with regards to protein intake.

Heart Transplantation After Ventricular Assist Device Therapy: Benefits, Risks, and Outcomes.

Heart transplantation is an established treatment for end-stage heart failure. Due to the increase in demand and persistent scarcity of organ, mechanical circulatory devices have played a major role in therapy for advanced heart failure. Usage of left ventricular assist device (LVAD) has gone up from 6% in 2006 to 43% in 2013 as per the United Network of Organ Sharing database. Majority of patients presenting for a heart transplantation are often bridged with an assist device prior for management of heart failure while on wait-list. On one hand, it is well established that LVADs improve survival on wait-list; on the other hand, the effect of LVAD on morbidity and survival after a heart transplantation is still unclear. In this article, we review the available literature and attempt to infer the outcomes given the risks and benefits of heart transplantation with prior LVAD patients.

Surveying Strategies for Hard-to-Survey Populations: Lessons From the Native Hawaiian and Pacific Islander National Health Interview Survey.

Calls for remedies for the persistent scarcity of accurate, reliable, national, disaggregated health statistics on hard-to-survey populations are common, but solutions are rare. Survey strategies used in community and clinical studies of hard-to-survey populations often cannot be, and generally are not, implemented at the national level.This essay presents a set of approaches, for use in combination with traditional survey methods in large-scale surveys of these populations, to overcome challenges in 2 domains: sampling and motivating respondents to participate. The first approach consists of using the American Community Survey as a frame, and the second consists of implementing a multifaceted community engagement effort.We offer lessons learned from implementing these strategies in a national survey, some of which are relevant to all survey planners. We then present evidence of the quality of the resulting data set. If these approaches were used more widely, hard-to-survey populations could become more visible and accurately represented to those responsible for setting national priorities for health research and services.

Design and Development of Roasted Breadfruit Kernel Processing Machine

An integrated machine has been designed and developed to aid mass production of unparboiled roasted breadfruit kernel in order to avert persistent scarcity of this unique nutritious snack. The machine was fabricated using local sourced standard materials with electric motor, roaster, dehuller, blower, kernel and shell discharging chutes as its major components. Performance analysis revealed that this system eliminated human contact with the breadfruit nuts during processing while 0.74kg/h, 93.63% and 167.93kJ/kg constitute its throughput, efficiency and specific energy consumption respectively. Thus, adoption of this innovation is recommended as a veritable option for quality roasted breadfruit kernel production since it reduced drudgery and improved hygiene.

Breeding biology of Neotropical Accipitriformes: current knowledge and research priorities

Despite the key role that knowledge on breeding biology of Accipitriformes plays in their management and conservation, survey of the state-of-the-art and of information gaps spanning the entire Neotropics has not been done since 1995. We provide an updated classification of current knowledge about breeding biology of Neotropical Accipitridae and define the taxa that should be prioritized by future studies. We analyzed 440 publications produced since 1995 that reported breeding of 56 species. Tere is a persistent scarcity, or complete absence, of information about the nests of eight species, and about breeding behavior of another ten. Among these species, the largest gap of breeding data refers to the former “Leucopternis” hawks. Although 66% of the 56 evaluated species had some improvement on knowledge about their breeding traits, research still focus disproportionately on a few regions and species, and the scarcity of breeding data on many South American Accipitridae persists. We noted that analysis of records from both a citizen science digital database and museum egg collections signifcantly increased breeding information on some species, relative to recent literature. We created four groups of priority species for breeding biology studies, based on knowledge gaps and threat categories at global level. Group I (great scarcity of information, plus higher categories of threat): Leptodon forbesi, Cryptoleucopteryx plumbea, and Buteogallus lacernulatus; Group II (breeding data have recently increased, but threat categories are high): Spizaetus isidori, Accipiter gundlachi, Buteogallus coronatus, Pseudastur occidentalis, and Buteo ventralis; Group III (“Near Treatened” species with still scarce breeding information): Accipiter poliogaster, Accipiter collaris, Buteogallus aequinoctialis, and Pseudastur polionotus; and Group IV (other priority cases): Buteo ridgwayi, Buteo galapagoensis, four eagles (Morphnus guianensis, Harpia harpyja, Spizaetus ornatus and Buteogallus solitarius), Leptodon cayanensis, Accipiter superciliosus, Buteogallus schistaceus, and the three Leucopternis hawks (L. semiplumbeus, L. melanops and L. kuhli). We also discuss the way that novel breeding data can show in what manners different species and populations are responding to environmental changes.

Liver Transplantation With Old Grafts: A Ten-Year Experience

BackgroundThe persistent scarcity of donors has prompted liver transplantation teams to find solutions for increasing graft availability. We report our experience of liver transplantations performed with grafts from older donors, specifically over 70 and 80 years old. Patients and methodsWe analyzed our prospectively maintained single-center database from January 1, 2005, to December 31, 2014, with 380 liver transplantations performed in 354 patients. Six groups were composed according to donor age: <40 (n = 84), 40 to 49 (n = 67), from 50 to 59 (n = 62), from 60 to 69 (n = 76), from 70 to 79 (n = 64), and ≥80 years (n = 27). ResultsDonors <40 years of age had a lower body mass index, died more often from trauma, and more often had cardiac arrest and high transaminase levels. In contrast, older donors (≥70 years of age) died more often from stroke. Recipients of grafts from donors <50 years of age were more frequently infected by hepatitis C virus; recipients of oldest grafts more often had hepatocellular carcinoma. Cold ischemia time was the shortest in donors >80 years of age. Patient survival was not significantly different between the groups. In multivariate analysis, factors predicting graft loss were transaminase peak, retransplantation and cold ischemia time but not donor age. ConclusionsOlder donors >70 and >80 years of age could provide excellent liver grafts.

Rationing Legal Services

There is a deepening crisis in the funding of legal services in the USA with cut backs in Legal Services Corporation and Interest on Lawyers Trust Account funding, rendering more visible the fact that there is and always will be persistent scarcity in the availability of both criminal and civil legal assistance. This article examines how existing Legal Service Providers (LSPs), both civil and criminal, should ration their services when they cannot help everyone. I draw on the bioethics literature on the allocation of medical goods (organs, ICU beds, vaccine doses, etc.) to illuminate the problems facing LSPs and the potential rationing principles they might adopt.

Hepatocellular carcinoma locoregional therapies for patients in the waiting list. Impact on transplantability and recurrence rate

The practice of treating candidates for liver transplantation (LT) for hepatocellular carcinoma (HCC), with locoregional therapies, is common in most transplant centers. However, for T1 tumors and expected waiting times to LT <6 months, there is no evidence that these treatments are beneficial. For T2 tumors and for longer waiting times, neo-adjuvant treatments are usually performed with transarterial chemoembolization (TACE), ablation techniques and liver resection in selected cases. The treatment choice should be based on the BCLC staging system. At present, there is no evidence of the superiority of ablation/resection vs. TACE, but some studies showed better results of the former in achieving a complete response. The response to neo-adjuvant treatments should be evaluated through mRECIST criteria, but few studies adopted these criteria and properly analyzed factors affecting response. The simultaneous evaluation of the impact of neo-adjuvant therapies on dropout rate, post-LT HCC recurrence and patient survival is rarely reported. Tumor stage and volume, alpha-fetoprotein levels, response to treatments and liver function affect pre-LT outcomes. These same factors, together with vascular invasion and poor tumor differentiation, are major determinants of poor post-LT outcomes. Due to the low number of prospective studies with well-defined entry criteria and the variability of results, the role of downstaging is still to be defined. Novel molecular markers seem promising for the estimation of prognosis and/or response to treatments. With a persistent scarcity of organ donors, neo-adjuvant treatments can help identify patients with different probabilities of cancer progression, and consequently balance the priority of HCC and non-HCC-candidates through revised additional scores for HCC.

Bioengineering of liver assist devices.

Over 30 000 patients die annually in the United States from liver failure. In fulminant hepatic failure, a clinical syndrome associated with high mortality, orthotopic liver transplantation is the primary therapeutic option for patients not responding to supportive therapy. However, the persistent scarcity of donor organs has limited this therapeutic modality, resulting in a continued increase in the number of patients who die waiting for a donor liver. An extracorporeal bioartificial liver device could provide vital support to a liver failure patient until a donor liver was available or until the patient's own liver regenerated. Although it is unclear which liver-specific functions must be provided by such a device to be effective, a constant challenge has been to obtain stable, well-differentiated, and normally functioning hepatocytes that can be cultured at high cell densities. Many of the devices currently undergoing clinical trials are limited by designs which are prone to substrate limitations, resulting in compromised hepatocyte function. In devices that avoid substrate limitations, hepatocyte functions can be optimized, thereby leading to increased device efficiency. In this overview, the authors describe the critical issues involved in bioartificial liver development and discuss their experiences in hepatocyte culture optimization within the context of a microchannel, flat-plate bioartificial liver device with an internal membrane oxygenator.

Four Unsolved Rationing Problems A Challenge

Faced with limited resources, medical providers and planners often ask bio-ethicists how to limit or ration the delivery of beneficial services in a or just way. What advice should we give them? To focus our thinking on the problems they face, I offer a friendly challenge to the field: solve the four rationing problems described here. We have generally ignored these problems because we think rationing an unusual phenomenon, associated with gas lines, butter coupons, or organ registries. But rationing is pervasive, not peripheral, since we simply cannot afford, for example, to educate, treat medically, or protect legally people in all the ways that their needs for these goods require or that accepted distributive principles seem to demand. Whenever we design institutions that distribute these goods, and whenever we operate those institutions, we are involved in rationing. Rationing decisions, both at the micro and macro levels, share three key features. First, the goods we often must provide--legal services, health care, educational benefits--are not sufficiently divisible (unlike money) to avoid unequal or lumpy distributions. Meeting the educational, health care, or legal needs of some people, for example, will mean that the requirements of others will go unsatisfied. Second, when we ration, we deny benefits to some individuals who can plausibly claim they are owed then in principle; losers as well as winners have plausible claims to have their needs met. Third, the general distributive principles appealed to by claimants as well as by rationers do not by themselves provide adequate reasons for choosing among claimants. They are too schematic; like my fair equality of opportunity account of just health care, they fail to yield specific solutions to these rationing problems. Solving these problems thus bridges the gap between principles of distributive justice and problems of institutional design. The Fair Choices/Best Outcomes Problem How much should we favor producing the best outcome until our limited resources? Like the other problems, the chances/best outcomes problem arises in both micro and macro contexts. Consider first its more familiar microrationing form: which of several equally needy individuals should get a scarce resource, such as a heart transplant? Suppose that Alice and Betty are the same age, have waited on queue the same length of time, and will each live only one week without a transplant. With the transplant, however, Alice is expected to live two years and Betty twenty. Who should get the transplant?[1] Giving priority to producing best outcomes, as in some point systems for awarding organs, would mean that Betty gets the organ and Alice dies (assuming persistent scarcity of organs, as Dan Brock notes).[2] But Alice might complain, Why should I give up my only chance at survival--and two years of survival is not insignificant--just because Betty has a chance to live longer? Alice demands a lottery that gives her an equal chance with Betty. To see the problem in its macroallocation version, suppose our health care budget allows us to introduce one of two treatments, T1 and T2, which can be given to comparable but different groups. Because T1 restores patients to a higher level of functioning than T2, it has a higher net benefit. We could produce the best outcomes by putting all our resources into T1; then patients treatable by T2 might, like Alice, complain that they are being asked to forgo any chance at a significant benefit. The problem has no satisfactory solution at either the intuitive or theoretical level. Few would agree with Alice, for example, if she had very little chance at survival; more would agree if her outcomes were only somewhat worse that Betty's. At the level of intuitions, there is much disagreement about when and how much to favor best outcomes, though we reject the extreme positions of giving full priority to chances or best outcomes. …