Clinical applications of MRI in the diagnosis of pulmonary embolism

Pulmonary embolism (PE) is a potentially serious medical condition and is the third most common cause of death among cardiovascular diseases. The diagnosis of PE is made with imaging due to its nonspecific clinical signs and symptoms. Historically, pulmonary angiography has been the gold standard until the emergence of computed tomography pulmonary angiography (CTPA), which has now become the go-to modality due to its fast imaging, availability, and high diagnostic accuracy. However, as with pulmonary angiography, CTPA has its drawbacks, such as ionizing radiation and iodinated contrast agents. It is estimated that approximately 20% of patients with suspected PE have a contraindication to this method. The overall aim of this doctoral thesis can be divided into three parts: 1. To evaluate the diagnostic accuracy of our in-house developed MRI protocol for diagnosing acute PE. 2. To explore other areas where this method could be of benefit since it allows for multiple examinations without any risk to the patients. 3. To understand the emergency doctor's decisions regarding imaging requests for suspected PE. Studies 1–3 are based on a native standard SSFP sequence under free breathing and without respiratory or cardiac gating, repeated five times at each anatomical position. This is done to catch/image the vessels at different breathing and cardiac cycles. Study 4 is a retrospective analysis of the protocol used by physicians to order CTPA in the clinical setting. In Study 1, we looked at the one-year outcome of patients who underwent our MRI protocol as the only diagnostic method for suspected PE due to contraindication to CTPA. This study used clinical outcome instead of an imaging modality as the reference. Our results showed that out of 45 patients with a negative MRI result for PE, only one was diagnosed with DVT within three months. In Study 2, we looked at the feasibility of the MRI method for looking at the natural history of acute PE. We examined 18 patients within 36 hours of PE diagnosis with CTPA and then at one week, one, three, and six months. Our results showed that most of the resolution happens within the first few weeks of the treatment. In Study 3, we evaluated the diagnostic accuracy of our in-house developed MRI protocol in reference to CTPA. A total of 243 cases were included, and two radiologists read the MRI exams. Our results showed a sensitivity of 87% and 89% for Readers 1 and 2, specificity of 100% for both, and a kappa value of 0.88. In Study 4, we looked at PE from a clinician's perspective. Therefore, we retrospectively calculated the clinical decision support system (CDSS) points by extracting data from the Electronic Medical Records (EMR) to examine whether the radiology requests were based on a clinical hunch or the available and recommended clinical decision support systems. Our results showed that clinician bypass these CDSS, which unfortunately leads to lower yield. To conclude, this doctoral thesis has shown that our MRI method is a viable option for diagnosing PE in patients with contraindication to CTPA and can also be used in treatment follow-up of these patients. However, insights from study number 4 inthis thesis showed that the diagnosis of PE is complicated, and more research is needed to improve the diagnostic accuracy for these patients

First year student teachers' perceptions of their constructivist classroom learning environments in accounting 1 and implications for teacher educators

Published ThesisThis mixed methods study was carried out at Central University of Technology, Free State, Welkom Campus. Its aim was to investigate the perceptions of first year student teachers about their constructivist classroom learning environments in Accounting 1 and implications of such perceptions for teacher educators. The ultimate goal was to develop strategies to improve and enhance a positive constructivist classroom learning environment. The study is grounded in constructivism and viewed the learning environment from the socio-ecological approach paradigm. The population was all the first year Bachelor of Education (B.Ed.) Accounting students. Convenience sampling was used to select a study sample of 112 students. Data was collected using a questionnaire called the Constructivist Learning Environment Survey (CLES). The CLES was adopted and adapted for use in this study as it had already been tested for reliability and validity by its developers. Students’ responses of their perceptions were measured on a 5 point Likert-type scale in seven categories. Semi-structured interviews were used to supplement questionnaire data. The quantitative data revealed positive perceptions of students in aspects regarding learning to speak out, learning to communicate, an interest in accounting and teacher support in Accounting. The study further revealed that students were not satisfied with some aspects in the learning to learn category. Although they were partially satisfied with the learning about the world and learning about accounting aspects, the qualitative findings showed that more needed to be done to improve their satisfaction and create positive perceptions. It was revealed that the students remained alienated and marginalized from the designing and planning of their academic activities and the overall classroom instruction. The findings pointed to the need for teaching staff to move away from standardized lectures to customized instruction which acknowledges that every student in the classroom has different needs and abilities. The study recommends that lecturers should strive towards promoting constructivist learning environments in their classrooms where constructivist ideas and principles are encouraged. To this effect, they need to be equipped with the necessary skills and competencies to create social constructivist classrooms and learning environments

The Learning Experiences Of First Year Accounting Student Teachers And Implications On Curriculum Implementation

ThesisThis study explored the learning experiences of first year accounting student teachers and the implications such learning experiences have on curriculum implementation. The researcher sought to explore these learning experiences and the realities in the learning environment from a student perspective. To this effect, grounded in the theoretical assumptions of multiple intelligences and social constructivism, a sequential explanatory mixed methods design was used to answer the research questions and satisfy the research objectives. The population was all the first year B.Ed. accounting student teachers. Purposive sampling was used for the quantitative strand of the study while random sampling was used for the qualitative part. Data was collected using a Multiple Intelligence and Constructivist Learning Questionnaire which was specifically developed by the researcher for the study. Guided by relevant literature, the sections of the questionnaire comprised of analytical intelligence, practical intelligence, creative intelligence, guided instruction and social constructivism. It had a total of eighty-six items which students had to rate between a scale of one and seven. For the correlational part of the quantitative strand, twenty-seven hypotheses were formulated for the Pearson correlation coefficient and t-tests. Descriptive statistics were used to analyse data on the students’ scores on the extent to which they encountered learning activities which appealed to the constructs of multiple intelligences. Inferential statistics were used to analyse data on the relationship between age, gender and multiple intelligences, guided instruction and social constructivism and between multiple intelligences, guided instruction and social constructivism. Descriptive statistics revealed that students moderately experienced learning activities which promoted analytical intelligence while they always experienced those which promoted practical intelligence. Creative intelligence was the most neglected one in the learning activities. Inferential statistics revealed no relationship between gender, age and multiple intelligences, guided instruction and social constructivism. However, a strong positive relationship was established between multiple intelligences, guided instruction and social constructivism. The quantitative findings were used to formulate 19 questions for the focus group interviews in the qualitative part of the study. These questions were also justified by relevant literature. The qualitative verdicts and the phenomenological voices of the students concurred with the quantitative diagnosis. The findings establish and reaffirm the need to adopt social constructivist teaching approaches which are not only pedagogically compatible with the assumptions of multiple intelligences, but also stimulate and promote the development of all the cognitive levels of students as epitomised by the revised Bloom taxonomy. The study has produced compelling empirical evidence to argue that in comparative terms student centred approaches are more appealing to both multiple intelligences and the revised Bloom taxonomy. The study convincingly established that student centred approaches do not only provide students with meaningful learning experiences, but also develop, enhance and promote their multiple intelligences and sustainable academic and cognitive development. Social constructivist teaching approaches have been established as pedagogically effective enough to galvanise students to participate in the teaching and learning process, take collective ownership of their learning progress and that of their classmates and to demonstrate enough intrinsic motivation in pursuit of academic objectives. Informed by the study findings and the pedagogical ramifications of social constructivism, the theory of multiple intelligences and the instructional imperatives of the revised Bloom taxonomy, the study developed a model called the Curriculum Implementation and Attainment of Learning Objectives Model. The model is an embodiment and illustration of curriculum implementation which is anchored on a mirage of social constructivist learning perspectives towards the realisation of multiple intelligences and the cognitive learning objectives enshrined in the revised Bloom taxonomy

An assessment of HIV and AIDS knowledge, attitudes and safer sex practices among student men who have sex with men (MSM) at a higher education institution in the Western Cape

Thesis (MPhil)--Stellenbosch University, 2015.ENGLISH ABSTRACT: The objective of this study was to measure the level of HIV and Aids knowledge, attitudes and safer sex practices among student men who have sex with men (MSM) at a higher education institution in the Western Cape. The study served to recommend guidelines for effective and enhanced targeted intervention response for MSM student community. A total of 36 MSM students aged between 19 and 36 (of which most were South African, black and Xhosa speaking) were recruited to take part in the study. Selection was done via snowball sampling. Respondents completed questionnaires upon consenting to participate in the study. The study found moderately high levels of basic HIV knowledge among the sampled MSM population. There were, however, lower levels of knowledge reported regarding the associated risk and effective prevention strategies of anal sex when compared to similar information about vaginal sex and oral sex. Findings also show that participants had very positive attitudes towards HIV testing, condom use and a non-discriminating environment. Respondents lacked confidence in both management and student leadership with regards to their responsibility in mitigating homophobia/discrimination against MSM student population. Furthermore, a high number of respondents reported having sex with men and women as well as multiple sexual partnerships. Self-reported alcohol and drug use were found to be very low, with the majority of participants indicating non-use. Participants stated little challenges accessing health care services. However, respondents felt MSM specific information about health care related rights and needs were lacking. Recommendations from this study include current HIV and Aids policy reform, mainstreaming MSM-friendly health care services, introducing combination HIV prevention programmes such as Mpowerment and addressing the human rights needs of MSM.AFRIKAANSE OPSOMMING: Die doel van hierdie studie was om die vlakke van MIV en Vigs kennis, houdings en veilige seksuele praktyke onder manlike studente wat seks het met mans (MSM) by 'n hoër onderwys instansie in die Wes-Kaap te meet. Die studie het gepoog om riglyne daar te stel vir die bewerkstelling van effektiewe en verbeterde geteikende intervensies vir die MSM studente gemeenskap. Daar was 36 MSM studente tussen die ouderdomme van 19 en 36 (meestal Suid-Afrikaans, swart en Xhosa-sprekend) gewerf vir die studie. Seleksie is gedoen deur middel van die sneeubal steekproef-metode. Deelnemers het 'n vraelys voltooi nadat hulle ingewillig het om deel te neem aan die studie. Deelnemers het matig tot hoë vlakke van basiese MIV en Vigs kennis getoon. Daar was egter laer vlakke van kennis oor gepaardgaande risiko’s en effektiewe voorkoming strategieë ten opsigte van anale seks in vergelyking met dieselfde informasie oor vaginale en orale seks. Die studie het verder bevind dat deelnemers baie positiewe houdings gehad het teenoor MIV-toetsing, die gebruik van kondome en 'n nie-diskriminerende omgewing. Verder het hulle min vertroue getoon in beide die bestuur en studente leierskap se vermoë om sake wat verband hou met homofobie en/of diskriminasie teen die MSM studente bevolking, effektief te hanteer. Daar is gevind dat baie respondente seks het met mans en vroue en ook verskeie seksuele maats het. Self-gerapporteerde alkohol- en dwelmgebruik was relatief laag onder respondente met die meerderheid wat aangedui het hulle glad nie alkohol of dwelms gebruik nie. Deelnemers het ook rapporteer dat gesondheidsdienste vir hulle maklik toeganklik is. Respondente het ook gevoel dat MSM spesifieke informasie oor gesondheidsverwante regte en behoeftes tans ontbreek. Aanbevelings wat voortspruit uit hierdie studie sluit in die hersien van die huidige MIV en Vigs beleid, die skepping van MSM-vriendelike dienste, die implementering van MIV-voorkomingsprogramme soos Mpowerment en die bevordering van menseregte wat verband hou met MSM

Tracking resource and policy impact in Malawi : Incorporating Malawi poverty reduction strategy paper indicators, millennium development goals & poverty monitoring across sectors

This report is prepared jointly by National Statistical Office in Malawi and Statistics Norway. The objective has been to establish a system for statistical information to follow the potential effects of resources related to poverty and/or allocated to social sectors and through all steps from available public service towards the final outcome and end goals. This has included overall national policies affecting resource allocation for social sectors; allocation and distribution of resources between and within sectors; access to and use of social service; outcome and achievements; poverty reduction and other end goals; and feed back to economic, human and social development. The information presented aims at allowing the reader to follow resource allocation from policy decisions towards human welfare and quality of life, and the feed back towards economic and social development. Data presented are selected to provide information for indicators of the Malawi Poverty Reduction Strategy Paper and the Millennium Development Goal indicators and resources which potentially might affect these indicators

Anti-Retroviral Treatment Outcomes among Older Adults in Zomba District, Malawi

BACKGROUND: There are approximately 3 million people aged 50 and older in sub-Saharan Africa who are HIV-positive. Despite this, little is known about the characteristics of older adults who are on treatment and their treatment outcomes. METHODS: A retrospective cohort analysis was performed using routinely collected data with Malawi Ministry of Health monitoring tools from facilities providing antiretroviral therapy services in Zomba district. Patients aged 25 years and older initiated on treatment from July 2005 to June 2010 were included. Differences in survival, by age group, were determined using Kaplan-Meier survival plots and Cox proportional hazards regression models. RESULTS: There were 10,888 patients aged 25 and older. Patients aged 50 and older (N = 1419) were more likely to be male (P<0.0001) and located in rural areas (P = 0.003) than those aged 25-49. Crude survival estimates among those aged 50-59 were not statistically different from those aged 25-49 (P = 0.925). However, survival among those aged 60 and older (N = 345) was worse (P = 0.019) than among those 25-59. In the proportional hazards model, after controlling for sex and stage at initiation, survival in those aged 50-59 did not differ significantly from those aged 25-49 (hazard ratio 1.00 (95% CI: 0.79 to 1.27; P = 0.998) but the hazard ratio was 1.46 (95% CI: 1.03 to 2.06; P = 0.032) for those aged 60 and older compared to those aged 25-49. CONCLUSIONS: Treatment outcomes of those aged 50-59 are similar to those aged 25-49. A better understanding of how older adults present for and respond to treatment is critical to improving HIV services

Ação de estimulantes vegetais no desenvolvimento do girassol (Helianthus annuus L.)

This research deals with the effects of application of three plant stimulants (Ergostim, Agrostemmin and Triacontanol) on growth of two sunflower cultivars (Uruguay and Anhandy), under greenhouse conditions. Sunflower was sowing in pots and Triacontanol (0.05 mg/l), Agrostemmin (l g/10 1/3 l) and Ergostim (1.5 ml/l) where applied 24 and 43 days after sowing. Ergostim and Agrostemmin promoted growth and increased dry matter production by sunflower plants. Triacontanol promoted flowering and reduced dry matter production.Verificou-se em condições de casa de vegetação o efeito de três estimulan tes no desenvolvimento de girassol cultivares Uruguay e Anhandy. A semeadura do girassol foi realizada em 17.08.82, em vasos de cerâmica, sendo que 24 e 43 dias aps a semeadura as plantas foram pulverizadas com Triacontanol (l-hidroxitriacontano ) na dosagem de 0,05 mg/l, Agrostemin (alantoina, triptofano, adenina e outros aminoácidos) 1 g/10 ml/3 1 e Ergostim (ácido N-acetil tiazolidin-4-carboxílico com ácido fólico) 1,5ml/ 1, além do controle. Foi verificado que Ergostim promoveu aumentos no crescimento e no peso da matéria seca das plantas de girassol mais pronunciados do que Agrostemin. Triacontanol aumentou a florescência e reduziu o peso da matéria seca das plantas

Polyphenol oxidase activity in white tan-plant-type sorghums : an important determinant of the relatively dark colour of their porridges

The relatively dark colour of food products from white tan-plant (food-grade) sorghums can compromise their acceptability. The relationship between white tan-plant sorghum polyphenol oxidase activity (PPO) and porridge colour was investigated, primarily using lines grown in the same locality over two seasons. Sorghum was intermediate in PPO between wheat and maize. White tan-plant sorghum and white maize whole grain flours were similar in colour. However, with white tan-plant sorghum, the transition from flour to porridge caused a much larger reduction in L* value. Further, the correlation between white tan-plant sorghum PPO activity and porridge L* values was highly significantly negative (P < 0.001), the relationship accounting for 40–50% of variation. PPO in white tan-plant-type sorghums is therefore an important determinant of the relatively dark colour of porridges. Breeding to reduce PPO activity could improve consumer appeal. Cultivar Sima (IS 23520) that had low PPO activity and produced light-coloured porridge could be useful for breeding.INTSORMILhttp://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-2621hb201

A educação como instrumento de protagonismo social da juventude em vulnerabilidade social / Education as an instrument of social protagonism for socially vulnerable youth

Este trabalho consiste em analisar a Educação como instrumento de protagonismo social da juventude em vulnerabilidade social. A juventude está relacionada intrinsecamente como uma construção social. Este processo de construção perpassa a sua constituição de subjetividade que inclui a cultura, os modos de vida, os sistemas simbólicos, sociais e educativos. Observa-se que os jovens em situações de vulnerabilidade social são os mais atingidos pelas dificuldades de acesso à educação, ao trabalho e ao lazer, em função de diversas desigualdades que perpassam a distribuição de renda, classe social, racismo, gênero, dentre outras. Trata-se de uma pesquisa bibliográfica de caráter qualitativo, com a base de pesquisa em artigos científicos publicados em periódicos e livros que discutem a temática proposta. Diante da investigação realizada, constata-se que a Educação como função libertadora, é um instrumento de protagonismo para a juventude em vulnerabilidade social que é permeada por diversas desigualdades no Brasil

Decentralized Heart Failure Management in Neno, Malawi

Background: Cardiovascular disease (CVD) is a major cause of death in Malawi. In rural districts, heart failure (HF) care is limited and provided by non-physicians. The causes and patient outcomes of HF in rural Africa are largely unknown. In our study, non-physician providers performed focused cardiac ultrasound (FOCUS) for HF diagnosis and longitudinal clinical follow-up in Neno, Malawi. Objectives: We described the clinical characteristics, HF categories, and outcomes of patients presenting with HF in chronic care clinics in Neno, Malawi. Methods: Between November 2018 and March 2021, non-physician providers performed FOCUS for diagnosis and longitudinal follow-up in an outpatient chronic disease clinic in rural Malawi. A retrospective chart review was performed for HF diagnostic categories, change in clinical status between enrollment and follow-up, and clinical outcomes. For study purposes, cardiologists reviewed all available ultrasound images. Results: There were 178 patients with HF, a median age of 67 years (IQR 44 – 75), and 103 (58%) women. During the study period, patients were enrolled for a mean of 11.5 months (IQR 5.1–16.5), after which 139 (78%) were alive and in care. The most common diagnostic categories by cardiac ultrasound were hypertensive heart disease (36%), cardiomyopathy (26%), and rheumatic, valvular or congenital heart disease (12.3%). At follow-up, the proportion of New York Heart Association (NYHA) class I patients increased from 24% to 50% (p < 0.001; 95% CI: 31.5 – 16.4), and symptoms of orthopnea, edema, fatigue, hypervolemia, and bibasilar crackles all decreased (p < 0.05). Conclusion: Hypertensive heart disease and cardiomyopathy are the predominant causes of HF in this elderly cohort in rural Malawi. Trained non-physician providers can successfully manage HF to improve symptoms and clinical outcomes in limited resource areas. Similar care models could improve healthcare access in other rural African settings