Deferred anastomosis in severe secondary peritonitis using a temporary intestinal shunt – case report

Introduction: As part of the damage control surgery concept applied to the treatment of sepsis due to severe secondary peritonitis following intestinal perforation and/or in high-risk patients we describe the novel "temporary intestinal shunt" (TIS) technique with delayed intestinal anastomosis, as an alternative to primary anastomosis or enterostomy. Material and Methods: We present three patients in whom urgent laparotomy was performed due to intestinal perforation, with intestinal resection and TIS. Case reports:Case 1: A 39-year-old male presented with acute myeloid leukemia M3 and generalized peritonitis, sigmoid colon perforation and secondary jejunal loop involvement. In view of these findings, we performed 10 cm jejunal resection with TIS placement, sigmoid colon resection, and negative pressure therapy (NPT). Reoperation after 48 hours showed no evidence of peritonitis, so a manual jejuno-jejunal anastomosis and terminal colostomy were performed. Case 2: A 65-year-old woman treated with corticosteroids presented with a pneumoperitoneum secondary to a road traffic accident. Urgent laparotomy revealed a 2 cm jejunal perforation. Resection of the jejunal segment and TIS with NPT was performed. Exploration of the peritoneal cavity 96 hours later showed clinical improvement and a jejuno-ileal anastomosis was performed. Case 3: A 73-year-old male was admitted due to intestinal subocclusion. Clinical deterioration occurred rapidly and we performed an urgent laparotomy diagnosing jejunal perforation secondary to torsion and ischemia of the affected loop, and generalized peritonitis. Intestinal resection and TIS with NPT placement were thus decided. Anastomosis and closure of the abdominal appendage were deferred until 96 hours after the first surgery. Conclusion: Although the evidence we present is limited, we believe TIS to be an additional tool in damage control surgery. This staged management strategy allows definitive reconstruction with the patient in a more favorable physiological condition

A Geologic Play Book for Utica Shale Appalachian Basin Exploration

This “Geologic Play Book for Utica Shale Appalachian Basin Exploration” (hereafter referred to as the “Utica Shale Play Book Study” or simply “Study”) represents the results of a two-year research effort by workers in five different states with the financial support of fifteen oil and gas industry partners. The Study was made possible through a coordinated effort between the Appalachian Basin Oil & Natural Gas Research Consortium (AONGRC) and the West Virginia University Shale Research, Education, Policy and Economic Development Center

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Skewed X-inactivation is common in the general female population

X-inactivation is a well-established dosage compensation mechanism ensuring that X-chromosomal genes are expressed at comparable levels in males and females. Skewed X-inactivation is often explained by negative selection of one of the alleles. We demonstrate that imbalanced expression of the paternal and maternal X-chromosomes is common in the general population and that the random nature of the X-inactivation mechanism can be sufficient to explain the imbalance. To this end, we analyzed blood-derived RNA and whole-genome sequencing data from 79 female children and their parents from the Genome of the Netherlands project. We calculated the median ratio of the paternal over total counts at all X-chromosomal heterozygous single-nucleotide variants with coverage ≥10. We identified two individuals where the same X-chromosome was inactivated in all cells. Imbalanced expression of the two X-chromosomes (ratios ≤0.35 or ≥0.65) was observed in nearly 50% of the population. The empirically observed skewing is explained by a theoretical model where X-inactivation takes place in an embryonic stage in which eight cells give rise to the hematopoietic compartment. Genes escaping X-inactivation are expressed from both alleles and therefore demonstrate less skewing than inactivated genes. Using this characteristic, we identified three novel escapee genes (SSR4, REPS2, and SEPT6), but did not find support for many previously reported escapee genes in blood. Our collective data suggest that skewed X-inactivation is common in the general population. This may contribute to manifestation of symptoms in carriers of recessive X-linked disorders. We recommend that X-inactivation results should not be used lightly in the interpretation of X-linked variants

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance.

Investment in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing in Africa over the past year has led to a major increase in the number of sequences that have been generated and used to track the pandemic on the continent, a number that now exceeds 100,000 genomes. Our results show an increase in the number of African countries that are able to sequence domestically and highlight that local sequencing enables faster turnaround times and more-regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and illuminate the distinct dispersal dynamics of variants of concern-particularly Alpha, Beta, Delta, and Omicron-on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve while the continent faces many emerging and reemerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

An investigation of communities of inquiry within a blended mode of delivery for technology education

PhD (Curriculum Development Innovation and Evaluation), North-West University, Potchefstroom Campus, 2014Enhanced innovative learning through the purposeful development of effective blended teaching and learning environments supported by a variety of interfaces is a strategic focus of the NWU and specifically the Faculty of Educational Science. There are several emerging models to ensure effective online and blended learning but the prominent model that has attracted attention is the Community of Inquiry (CoI) framework developed by Garrison, Anderson and Archer in 2000. The CoI framework is conceptually grounded in theories of teaching and learning in higher education and is consistent with John Dewey’s work on community of inquiry. CoI is deeply rooted into pragmatism as is evident in Dewey’s argument where he explains the idea of extracting meaning from experience. The focused of this study was on blended learning in a graduate teacher training course in Technology Education. The content of Technology as a subject is derived from other disciplines such as science, engineering and design. Due to the unique features of Technology as a subject, it was of great value, within this applied discipline, to investigate the unique patterns and relationships occurring among CoI presences in such a module of a teacher training graduate course. The purpose of the study was to: * develop an understanding of how the three presences (teaching presence, social presence and cognitive presence) in CoI enhance online learning; * investigate the extent of CoI in a blended mode of delivery within a TE graduate course; and * develop, implement and evaluate a module for a graduate course in Technology teacher training for a blended mode of delivery, based on requirements for the development of CoI. A design-based research methodology approach was followed for this study and included qualitative and quantitative methods in a multi-strand design. Design-based research is intrinsically linked to, and developmentally nourished by, multiple design and research methodologies, which utilises many data collection and analysis methods and which makes it suitable for a mixed method research. Findings from the literature review on the value of CoI for the effectiveness of online learning indicated that blended learning is dependent on the ability to facilitate a CoI. It is through the application of the principles for CoI that a successful transition from a face-to-face to a blended mode of delivery for the applied subject TE was possible. Findings with regard to the extent to which CoI manifested itself in this Technology graduate course indicated that teaching presence manifested itself to a good extent in the TE undergraduate course. The main findings that were of concern with regard to teaching presence included: insufficient clear instructions and communication, feelings of isolations and disconnectedness, lack of immediacy and the inability to connect online feedback to lecturer expertise. Although social presence did manifest itself to some extent in the TE undergraduate course, it was the hardest to establish out of the three presences. The main issues arising from the manifestation and existence of social presence included: insufficient sense of belonging in the online environment, students didn’t feel comfortable expressing themselves affectively as well as uneasiness to communicate, interact and participate online with other module participants. Finally, cognitive presence did manifest itself to a satisfying extent in the TE undergraduate course. Findings suggest that there was a not sufficient structured triggering events to create a sense of puzzlement which suggests that more activities must be included that will encourage reflection and therefore will improve the movement through the cognitive inquiry process. Other findings from the study indicated that students experienced time management and the coordination and management of group activities as challenging. These challenges experienced by students reflect a lack of self-regulation skills in learning presence. Other challenges included that students experienced in the online environment of blended learning included: accessibility, lack of technology skills and the newness of blended learning. Design principles for the manifestation and existence of CoI for effective learning within a TE graduate module were establish for teaching presence, social presence and cognitive presence. The research contributed to the field by reporting on the process of how CoI can be enhanced in a blended learning environment for a complex subject such as Technology, and by providing evidence based guidelines for the design and implementation of blended learning with CoI principles as guidelines.Doctora

Effektiewe voordiensopleiding van onderwysers vir die leerarea tegnologie

Thesis (M.Ed.)--North-West University, Potchefstroom Campus, 2010Compared to other subjects, Learning Area Technology teaching is a relatively new knowledge area world-wide, especially in the South African school curriculum, and it consequently presents new challenges. One of these challenges is the fact that no previous tertiary training programmes exist for the Learning Area Technology; thus new ones have to be developed. Since limited research has been done regarding Learning Area Technology teaching, teachers of Technology are forced to base their professional teaching and learning practices on approaches from other fields of knowledge and adapt these. This is not necessarily ideal for Learning Area Technology teaching in the South African context. The following question can thus be posed: To which extent do existing pre-service training programmes develop the essential competences and skills required for the effective teaching of the Learning Area Technology? Against the background of this overarching aim of the study, this research attempted to find answers to the following research questions: •What are the competences a qualified Learning Area Technology teacher should possess? •What is the nature of Learning Area Technology teacher training in South Africa? •What is lacking in training programmes for pre-service Learning Area Technology teachers in South Africa? To provide answers to these questions, a literature study as well as an empirical study was conducted. To achieve the aim of the empirical study a phenomenological approach was applied in executing an exploratory qualitative study. A random sample was drawn from available tertiary institutions training pre-service Technology teachers in the Learning Area Technology. Individual, semi-structured interviews were conducted with lecturers to enable the researcher to comprehend and interpret experiences and realities in terms of the research question. Findings from the literature study on the competences a qualified technology Teacher should possess indicate that a Technology teacher, upon completion of studies, should posses the following competences to present the Learning Area Technology as a subject specialist: indepth subject knowledge of the various knowledge areas for the Learning Area Technology; suitable pedagogical content knowledge to be able to transform technological knowledge to teachable matter; technological skills in technological processes and techniques; and positive values and attitudes which can be integrated successfully during various learning opportunities. It is also imperative that pre-service Learning Area Technology teachers possess knowledge of appropriate teaching strategies to accomplish critical, creative and problem-solving skills among learners. The empirical research was aimed at establishing the nature of pre-service training programmes in South Africa, as well as identifying shortcomings in the training of pre-service Technology teachers. Data analyses regarding the nature of pre-service training of Learning Area Technology teachers-.enabled the researcher to identify particular shortcomings in preservice training programmes in South Africa. The following shortcomings were identified: insufficient subject knowledge and technological subject skills; limited subject specific pedagogical knowledge; lack of real life situations in learning opportunities; and a lack of modelling of teaching strategies during facilitation of the Learning Area Technology. Based on the findings of the research which was also related to the literature, specific recommendations were made in order to improve the quality of pre-service training for the Learning Area Technology. Recommendations on the identified shortcomings include the following: the training of Learning Area Technology teachers as subject specialists by establishing standards appropriate for tertiary training in order to enhance the development of subject knowledge; the development of subject specific pedagogical content knowledge by implementing micro lessons; revision of time planning and facilities for the practising of technological skills; and sufficient opportunities to practise, analyse and reflect on teaching processes to develop proper and appropriate teaching strategies.Master