Cardiovascular computed tomography : technical developments and clinical applications

Chapter 1 reviews technical developments of cardiac CT and current status, recommendations and future perspective of various clinical cardiac CT applications. In chapter 2, the eff ect of dose reduction on diagnostic performance in CT coronary angiography is assessed. Chapter 3 evaluates the eff ect of thin-slice image reconstructions on coronary artery calcium measurements. In chapter 4, the assessment of Agatston scores using coronary CT angiography is studied. Chapter 5 evaluates the predictive value of CT-derived RV/LV ratios and cardiac biomarkers for short term clinical outcome in patients with suspected acute PE. In chapter 6, the incremental value of ventricular function with ECG-synchronized cardiac CT over standard pulmonary CTA-derived RV/LV ratios for predicting clinical outcome in patients with suspected acute PE is discussed. Chapter 7 studies the influence of timing of NT-pro-BNP sampling for predicting adverse clinical outcome.Hartstichting Stichting IMAGOUBL - phd migration 201

Improving communication and practical skills in working with inpatients who self-harm: a pre-test/post-test study of the effects of a training programme

BACKGROUND: Differing perspectives of self-harm may result in a struggle between patients and treatment staff. As a consequence, both sides have difficulty communicating effectively about the underlying problems and feelings surrounding self-harm. Between 2009 and 2011, a programme was developed and implemented to train mental health care staff (nurses, social workers, psychologists, psychiatrists, and occupational therapists) in how to communicate effectively with and care for patients who self-harm. An art exhibition focusing on self-harm supported the programme. Lay experts in self-harm, i.e. people who currently harm themselves, or who have harmed themselves in the past and have the skills to disseminate their knowledge and experience, played an important role throughout the programme. METHODS: Paired sample t-tests were conducted to measure the effects of the training programme using the Attitude Towards Deliberate Self-Harm Questionnaire, the Self-Perceived Efficacy in Dealing with Self-Harm Questionnaire, and the Patient Contact Questionnaire. Effect sizes were calculated using r. Participants evaluated the training programme with the help of a survey. The questionnaires used in the survey were analysed descriptively. RESULTS: Of the 281 persons who followed the training programme, 178 completed the questionnaires. The results show a significant increase in the total scores of the three questionnaires, with large to moderate effect sizes. Respondents were positive about the training, especially about the role of the lay expert. CONCLUSION: A specialised training programme in how to care for patients who self-harm can result in a more positive attitude towards self-harm patients, an improved self-efficacy in caring for patients who self-harm, and a greater closeness with the patients. The deployment of lay experts is essential here

Female brain size affects the assessment of male attractiveness during mate choice

Mate choice decisions are central in sexual selection theory aimed to understand how sexual traits evolve and their role in evolutionary diversification. We test the hypothesis that brain size and cognitive ability are important for accurate assessment of partner quality and that variation in brain size and cognitive ability underlies variation in mate choice. We compared sexual preference in guppy female lines selected for divergence in relative brain size, which we have previously shown to have substantial differences in cognitive ability. In a dichotomous choice test, large-brained and wild-type females showed strong preference for males with color traits that predict attractiveness in this species. In contrast, small-brained females showed no preference for males with these traits. In-depth analysis of optomotor response to color cues and gene expression of key opsins in the eye revealed that the observed differences were not due to differences in visual perception of color, indicating that differences in the ability to process indicators of attractiveness are responsible. We thus provide the first experimental support that individual variation in brain size affects mate choice decisions and conclude that differences in cognitive ability may be an important underlying mechanism behind variation in female mate choice

Acute symptoms during the course of head and neck radiotherapy or chemoradiation are strong predictors of late dysphagia

AbstractPurposeTo determine if acute symptoms during definitive radiotherapy (RT) or chemoradiation (CHRT) are prognostic factors for late dysphagia in head and neck cancer (HNC).Material and methodsThis prospective cohort study consisted of 260 HNC patients who received definitive RT or CHRT. The primary endpoint was grade 2–4 swallowing dysfunction at 6months after completing RT (SWALM6). During treatment, acute symptoms, including oral mucositis, xerostomia and dysphagia, were scored, and the scores were accumulated weekly and entered into an existing reference model for SWALM6 that consisted of dose–volume variables only.ResultsBoth acute xerostomia and dysphagia were strong prognostic factors for SWALM6. When acute scores were added as variables to the reference model, model performance increased as the course of treatment progressed: the AUC rose from 0.78 at the baseline to 0.85 in week 6. New models built for weeks 3–6 were significantly better able to identify patients with and without late dysphagia.ConclusionAcute xerostomia and dysphagia during the course of RT are strong prognostic factors for late dysphagia. Including accumulated acute symptom scores on a weekly basis in prediction models for late dysphagia significantly improves the identification of high-risk and low-risk patients at an early stage during treatment and might facilitate individualized treatment adaptation

Discipline in Education

This book addresses a perennial challenge to the success of the South African education system, namely, discipline. This volume steers the interrogation of discipline in a new direction, reflecting on ways in which recent research can benefit South African schools. This includes the need for alternative discipline that will enhance education. The scholarly contribution lies in its in-depth exploration of the relevance of research findings to South African schools and to the twenty-first-century socio-political environment. For the first time, scholarly interrogation of the issue of learner discipline in South African schools draws on indigenous knowledge systems. Its post-colonial and decolonial perspectives offer an ethical and moral compass for behaviour that could contribute to the well-being of South African society (and other societies similarly afflicted by anti-social behaviour). The book offers a range of perspectives on the debates on discipline and associated issues, and should stimulate future discussions on discipline and indiscipline at a time when South Africa and many other societies engage with the effects of social and political transformation. This scholarly book is aimed at academics and researchers. The contributors include philosophers, moralists, corporativists, education law specialists, curriculum specialists, specialists in education and culture, advocates of ubuntu, and people using meta-syntheses of approaches and practices and religious practices such as a Christian ethical/moral approach to parental and school discipline. They draw on their insights into postcolonialism, the impact of indigenous knowledge, theories of agency, dysfunctionality and school underperformance. The book offers an intriguing depiction of opposing views on discipline

Relationship between videofluoroscopic and subjective (physician- and patient- rated) assessment of late swallowing dysfunction after (chemo) radiation:Results of a prospective observational study

BACKGROUND AND PURPOSE: Primary (chemo)radiation (CHRT) for HNC may lead to late dysphagia. The purpose of this study was to assess the pattern of swallowing disorders based on prospectively collected objective videofluoroscopic (VF) assessment and to assess the correlations between VF findings and subjective (physician- and patient-rated) swallowing measures. MATERIAL AND METHODS: 189 consecutive HNC patients receiving (CH)RT were included. Swallowing evaluation at baseline and 6 months after treatment (T6) encompassed: CTCAE v.4.0 scores (aspiration/dysphagia), PROMs: SWAL QOL/ EORTC QLQ-H&N35 (swallowing domain) questionnaires and VF evaluation: Penetration Aspiration Scale, semi-quantitative swallowing pathophysiology evaluation, temporal measures and oral/pharyngeal residue quantification. Aspiration specific PROMs (aPROMs) were selected. Correlations between late penetration/aspiration (PA_T6) and: clinical factors, CTCAE and aPROMs were assessed using uni- and multivariable analysis. RESULTS: Prevalence of PA increased from 20% at baseline to 43% after treatment (p<0.001).The most relevant baseline predictors for PA_T6 were: PA_T0, age, disease stage III-IV, bilateral RT and baseline aPROM 'Choking when drinking' (AUC: 0.84). In general aPROMs correlated better with VF-based PA than CTCAE scores. The most of physiological swallowing components significantly correlated and predictive for PA (i.e. Laryngeal Vestibular Closure, Laryngeal Elevation and Pharyngeal Contraction) were prone to radiation damage. CONCLUSION: The risk of RT-induced PA is substantial. Presented prediction models for late penetration/aspiration may support patient selection for baseline and follow-up VF examination. Furthermore, all aspiration related OARs involved in aforementioned swallowing components should be addressed in swallowing sparing strategies. The dose to these structures as well as baseline PROMs should be included in future NTCP models for aspiration

Discipline in Education

This book addresses a perennial challenge to the success of the South African education system, namely, discipline. This volume steers the interrogation of discipline in a new direction, reflecting on ways in which recent research can benefit South African schools. This includes the need for alternative discipline that will enhance education. The scholarly contribution lies in its in-depth exploration of the relevance of research findings to South African schools and to the twenty-first-century socio-political environment. For the first time, scholarly interrogation of the issue of learner discipline in South African schools draws on indigenous knowledge systems. Its post-colonial and decolonial perspectives offer an ethical and moral compass for behaviour that could contribute to the well-being of South African society (and other societies similarly afflicted by anti-social behaviour). The book offers a range of perspectives on the debates on discipline and associated issues, and should stimulate future discussions on discipline and indiscipline at a time when South Africa and many other societies engage with the effects of social and political transformation. This scholarly book is aimed at academics and researchers. The contributors include philosophers, moralists, corporativists, education law specialists, curriculum specialists, specialists in education and culture, advocates of ubuntu, and people using meta-syntheses of approaches and practices and religious practices such as a Christian ethical/moral approach to parental and school discipline. They draw on their insights into postcolonialism, the impact of indigenous knowledge, theories of agency, dysfunctionality and school underperformance. The book offers an intriguing depiction of opposing views on discipline