Early detection and treatment of malnutrition in patients on hemodialysis (HD) is hampered by lack of a sensitive biochemical marker. We compared the value of serum insulin-like growth factor-I (IGF-I) with other biochemical indices in detecting malnutrition in 61 HD patients. Protein and energy intakes were low in the majority of patients. Of all patients, 59.6% had severe reduction in triceps skinfold thickness (TSF thickness, less than or equal to 60% of normal), whereas midarm muscle circumference (MAMC) was mildly reduced (less than or equal to 90%) in 23%. Serum IGF-I proved superior to the other indices in predicting TSF thickness. A serum IGF-I concentration of 300 micrograms/L discriminated between wasted (TSF thickness less than or equal to 60%) and robust patients. In 16 patients with a history of recent infection, IGF-I was significantly reduced well before changes in anthropometric measurements could be detected. IGF-I is a useful and early marker of undernutrition in HD patients.
In the rat isolation has both short- and long-term influences upon behavior. Rats isolated at any age will show increases in timidity and aggression, but both effects can be reversed by periods of social housing. However, isolation before 50 days of age has permanent effects upon behavior. We have previously found that rats between 25 and 45 days of age may be protected from the deleterious effects of isolation by short daily periods of social contact if, during these daily contact periods, the rats engage in intense bouts of rough-and-tumble play. In this study we examined the permanence of the effects of isolation on the rat, mouse, guinea pig and gerbil. As predicted by the play hypothesis, species which do not engage in extensive social play do not show permanent deficits if isolated prior to 50 days. Only rats which engage in long bouts of rough-and-tumble play between 20 and 50 days show any permanent behavioral effects of isolation during this period.
Te Pua/Keith Park playground employed an innovative early program of co-design with an All Abilities Project Group (AAPG), representing disability organisations and key stakeholders from the community. Through ongoing engagement with disabled people as experts, the outcome was an inclusive and welcoming play space for a diverse range of children, young people and their caregivers.Play equipment included a range of vestibular, visual, and auditory pieces as well as a customised 2m high wheelchair accessible play tower for inclusive play experiences. Caregivers were enabled to play with their children through smooth and step-free surfaces as well as specific play equipment such as an adult and child swing. Children and young people of different ages and abilities were encouraged to sit/lie/stand in the basket swing and see-saw together. Unique to this playground, communication boards were innovatively and collaboratively designed with visual images representing various features of the playground and QR codes linking to online videos with New Zealand Sign Language.In addition to play equipment, the AAPG identified that the toilet facilities were crucial to ensuring accessibility to many families, including those with bigger children or teens with access needs who were often faced with the reality of needing to be changed in unsanitary and unsafe ways without the appropriate facilities being available. Keith Park worked with a leading toilet manufacturer to co-design a bespoke double toilet block with enhanced accessibility features including an adult-sized change table.Every aspect of the park was carefully selected and designed including fencing, furniture, plants and colours. Colour enhanced accessibility by guiding children with low vision and created a play circuit to assist the neurodiverse community. The resultant playground is one that welcomes all to play, which is a core tenet of child development, socialisation and participation. Read the full article in accessible html-format here.
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