Erfaringer med kartleggingsverktøyet DAt-Kon

Masteroppgave i tilpassa opplæring - Universitetet i Nordland, 2011Bakgrunn er kjennskap til kartleggingsverktøyet DAt-Kon i jobben som spesialpedagog i PPtjenesten. Det er få undersøkelser gjennomført med utgangspunkt i DAt- Kon og av den grunn er det av interesse å se nærmere på nytten av kartleggingsverktøyet, og hvordan samarbeidet er mellom de involverte partene. Erfaringer er innhentet fra tre perspektiv: foreldre, pedagoger og PP- rådgivere. Formålet med oppgaven er å innhente erfaringer fra bruken som kan bidra til at andre brukere av DAt-Kon reflekterer over de prosesser som iverksettes ved bruken av kartleggingsverktøyet og deres betydning i gjennomføringen. Personlig har undersøkelsen gitt meg muligheten til å ta et verdifullt steg ut av min rolle som spesialpedagog i PP- tjenesten til rollen som forsker. Undersøkelsen har gitt meg mulighet til å reflektere over egen praksis og gitt meg økte kunnskaper om DAt-Kon. Med dette som utgangspunkt er problemstillingen i oppgaven: Hvilke erfaringer har foreldre, pedagoger og pedagogisk- psykologisk rådgivere med bruken av kartleggingsverktøyet DAt-Kon i samarbeidet rundt 3 elever i grunnskolen? For å belyse problemstillingen på best mulig måte har jeg valgt å gjennomføre et kvalitativt forskningsarbeid med intervju som metode. Det er gjennomført et sammensatt singelcase studie med flere analyseenheter. Intervjuguiden er utarbeidet med tanke på gjennomføre et semistrukturert intervju som gav mulighet for utdypende spørsmål ut fra informantens svar. Utvalget består av 2 foreldre, 2 pedagoger og 3 PP- rådgivere. Disse er tilknyttet hver av de 3 elevene i grunnskolen. I bearbeiding av data er det brukt hermeneutisk- fenomenologisk tilnærming. Resultater av undersøkelsen: Resultatene viser at alle informantene synes DAt-Kon er et nyttig verktøy, men at det er tidkrevende. Undersøkelsen viser at samarbeidet mellom hjem- skole er vanskelig, men at det ble bedre når kontakten med PP- tjenesten ble etablert. PP- rådgiverens ferdigheter og foreldrenes kontakt med PP- rådgiver har betydning for å etablere et bedre samarbeid mellom hjem og skole. Resultater fra undersøkelsen viser at pedagogene synes det er utfordrende å være lærer til elever med atferds- og konsentrasjonsvansker, men at de føler en trygghet ved å gjennomføre DAt- Kon og få veiledning fra rådgiverne i PP- tjenesten. Erfaringer fra brukerne viser at kartleggingen er med på å gi økt samarbeid og en felles forståelse som igjen gir et nytt utgangspunkt for samarbeid. Pedagogene utrykker med dette et ønske om mer veiledning. Ut fra tilbakemeldinger fra informantene kan en se at DAt-Kon gjennomføres ulikt av PPrådgiverne og en kan se tendenser til at dette er med på å påvirke kvaliteten på den prosessen kartleggingen igangsetter. PP- rådgiverne utrykker at de ikke alltid får gjennomført et tilfredsstillende karteleggingsarbeid på grunn av kapasitetsproblemer

Rigid, Complete Annuloplasty Rings Increase Anterior Mitral Leaflet Strains in the Normal Beating Ovine Heart

Background-Annuloplasty ring or band implantation during surgical mitral valve repair perturbs mitral annular dimensions, dynamics, and shape, which have been associated with changes in anterior mitral leaflet (AML) strain patterns and suboptimal long-term repair durability. We hypothesized that rigid rings with nonphysiological three-dimensional shapes, but not saddle-shaped rigid rings or flexible bands, increase AML strains

This is the future: A reconstruction of the UK business web space (1996–2001)

This is the author accepted manuscript. The final version is available from SAGE via http://dx.doi.org/10.1177/1461444816643791Institute of Historical Researc

Incidence and progression of mild aortic regurgitation after Tirone David reimplantation valve-sparing aortic root replacement

ObjectiveThe study objective was to determine whether recurrent or residual mild aortic regurgitation, which occurs after valve-sparing aortic root replacement, progresses over time.MethodsBetween 2003 and 2008, 154 patients underwent Tirone David-V valve-sparing aortic root replacement; 96 patients (62%) had both 1-year (median, 12 ± 4 months) and mid-term (62 ± 22 months) transthoracic echocardiograms available for analysis. Age of patients averaged 38 ± 13 years, 71% were male, 31% had a bicuspid aortic valve, 41% had Marfan syndrome, and 51% underwent aortic valve repair, predominantly cusp free margin shortening.ResultsForty-one patients (43%) had mild aortic regurgitation on 1-year echocardiogram. In 85% of patients (n = 35), mild aortic regurgitation remained stable on the most recent echocardiogram (median, 57 ± 20 months); progression to moderate aortic regurgitation occurred in 5 patients (12%) at a median of 28 ± 18 months and remained stable thereafter; severe aortic regurgitation developed in 1 patient, eventually requiring reoperation. Five patients (5%) had moderate aortic regurgitation at 1 year, which did not progress subsequently. Two patients (2%) had more than moderate aortic regurgitation at 1 year, and both ultimately required reoperation.ConclusionsAlthough mild aortic regurgitation occurs frequently after valve-sparing aortic root replacement, it is unlikely to progress over the next 5 years and should not be interpreted as failure of the valve-preservation concept. Further, we suggest that mild aortic regurgitation should not be considered nonstructural valve dysfunction, as the 2008 valve reporting guidelines would indicate. We need 10- to 15-year follow-up to learn the long-term clinical consequences of mild aortic regurgitation early after valve-sparing aortic root replacement

Mitral annular dynamics are influenced by left ventricular load and contractility in an acute animal model

The purpose of this study was to investigate the effects of loading conditions and left ventricular (LV) contractility on mitral annular dynamics. In 10 anesthetized pigs, eight piezoelectric transducers were implanted equidistantly around the mitral annulus. High-fidelity catheters measured left ventricular pressures and the slope of the end-systolic pressure-volume relationship (Ees) determined LV contractility. Adjustments of pre- and afterload were done by constriction of the inferior caval vein and occlusion of the descending aorta. Mitral annulus area indexed to body surface area (MAAi ), annular circularity index (ACI), and nonplanarity angle (NPA) were calculated by computational analysis. MAAi was more dynamic in response to loading interventions than ACI and NPA. However, MAAi maximal cyclical reduction (−Δr) and average deformational velocity (−v) did not change accordingly (p=0.31 and p=0.22). Reduced Ees was associated to attenuation in MAAi -Δr and MAAi -v (r 2=0.744; p=0.001 and r 2=0.467; p=0.029). In conclusion, increased cardiac load and reduced LV contractility may cause deterioration of mitral annular dynamics, likely impairing coaptation and increasing susceptibility to valvular incompetence.publishedVersio

Markers of extracellular matrix remodeling and systemic inflammation in patients with heritable thoracic aortic diseases

Background: In approximately 20% of patients with thoracic aortic aneurysms or dissections a heritable thoracic aortic disease (HTAD) is suspected. Several monogenic connective tissue diseases imply high risk of aortic disease, including both non-syndromic and syndromic forms. There are some studies assessing inflammation and extracellular matrix remodeling in patients with non-hereditary aortic disease, but such studies in patients with hereditary diseases are scarce. Aims: To quantify markers of extracellular matrix (ECM) and inflammation in patients with vascular connective tissue diseases versus healthy controls. Methods: Patients with Loeys-Dietz syndrome (LDS, n = 12), Marfan syndrome (MFS, n = 11), and familial thoracic aortic aneurysm 6 (FTAA6, n = 9), i.e., actin alpha 2 (ACTA2) pathogenic variants, were recruited. Exome or genome sequencing was performed for genetic diagnosis. Several markers of inflammation and ECM remodeling were measured in plasma by enzyme immunoassays. Flow cytometry of T-cell subpopulations was performed on a subgroup of patients. For comparison, blood samples were drawn from 14 healthy controls. Results: (i) All groups of HTAD patients had increased levels matrix metalloproteinase-9 (MMP-9) as compared with healthy controls, also in adjusted analyses, reflecting altered ECM remodeling. (ii) LDS patients had increased levels of pentraxin 3 (PTX3), reflecting systemic inflammation. (iii) LDS patients have increased levels of soluble CD25, a marker of T-cell activation. Conclusion: Our data suggest that upregulated MMP-9, a matrix degrading enzyme, is a common feature of several subgroups of HTAD. In addition, LDS patients have increased levels of PTX3 reflecting systemic and in particular vascular inflammation

Baseline and follow-up assessment of regional left ventricular volume using 3-dimensional echocardiography: comparison with cardiac magnetic resonance

The assessment of regional volumes is an option for analysis of the response of LV segments to interventions such as revascularization or cell therapy. We sought to compare regional volumes from 3D-echocardiography (3DE) with cardiac magnetic resonance (CMR) over follow-up

Анкетирование в выделении групп риска развития рака молочной железы, как возможный компонент программы скрининга

МОЛОЧНОЙ ЖЕЛЕЗЫ НОВООБРАЗОВАНИЯНОВООБРАЗОВАНИЯ ПО ЛОКАЛИЗАЦИИ (ВНЕШ)МОЛОЧНОЙ ЖЕЛЕЗЫ БОЛЕЗНИАНКЕТИРОВАНИЕДАННЫХ СБОРФАКТОРЫ РИСКАДИАГНОСТИЧЕСКИ СВЯЗАННЫЕ ГРУППЫ БОЛЬНЫ

Comprehensive 4D velocity mapping of the heart and great vessels by cardiovascular magnetic resonance

<p>Abstract</p> <p>Background</p> <p>Phase contrast cardiovascular magnetic resonance (CMR) is able to measure all three directional components of the velocities of blood flow relative to the three spatial dimensions and the time course of the heart cycle. In this article, methods used for the acquisition, visualization, and quantification of such datasets are reviewed and illustrated.</p> <p>Methods</p> <p>Currently, the acquisition of 3D cine (4D) phase contrast velocity data, synchronized relative to both cardiac and respiratory movements takes about ten minutes or more, even when using parallel imaging and optimized pulse sequence design. The large resulting datasets need appropriate post processing for the visualization of multidirectional flow, for example as vector fields, pathlines or streamlines, or for retrospective volumetric quantification.</p> <p>Applications</p> <p>Multidirectional velocity acquisitions have provided 3D visualization of large scale flow features of the healthy heart and great vessels, and have shown altered patterns of flow in abnormal chambers and vessels. Clinically relevant examples include retrograde streams in atheromatous descending aortas as potential thrombo-embolic pathways in patients with cryptogenic stroke and marked variations of flow visualized in common aortic pathologies. Compared to standard clinical tools, 4D velocity mapping offers the potential for retrospective quantification of flow and other hemodynamic parameters.</p> <p>Conclusions</p> <p>Multidirectional, 3D cine velocity acquisitions are contributing to the understanding of normal and pathologically altered blood flow features. Although more rapid and user-friendly strategies for acquisition and analysis may be needed before 4D velocity acquisitions come to be adopted in routine clinical CMR, their capacity to measure multidirectional flows throughout a study volume has contributed novel insights into cardiovascular fluid dynamics in health and disease.</p