An examination of inpatient medical record keeping in the Orthopaedic Department of Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania

Introduction: There is a lack of published evidence examining the quality of patient notes in African healthcare settings. We aim to examine the completeness of the orthopaedic inpatient notes and begin development of a formal audit framework in a large Tanzanian Hospital. Methods: A retrospective review of 155 orthopaedic inpatient notes at Kilimanjaro Christian Medical Centre (KCMC) was conducted spanning 3 months. Notes were reviewed using an agreed data collection pro forma considering 3 main outcomes; i) quantity of complete entries, ii) percentage completeness of individual sections, iii) documentation of follow-up. Results: Primary outcome: 8% (n=13) of the inpatient documents were complete (10/10 sections). 11% (n=17) of the inpatient documents had 9 of 10 sections completed. 30% (n=46) of the inpatient documents had 8 of 10 sections completed. Therefore, 51% (n=79) of inpatient entries had 7 or fewer sections filled in. Secondary outcome: Admission information and Demographics were both completed 88% (n=137) of the time. History and the Examination sections were complete in 96% (n=149) of cases. Investigations were complete in 77% (n=119) and Diagnosis in 88% (n=137). The Treatment section was complete 85% (n=132) of the time and the Attending doctor 50% (n=78). Procedures were 27% (n=42) filled in while Summary of a day and Follow-up were 32% (n=49) and 0% (n=0) respectively. Tertiary outcome: Follow-up was not completed in any entries. Conclusion: There are a number of sections of the inpatient pro forma that remain inadequately completed. Regular auditing is essential for the continued progress in patient care.Keywords: Tanzania, quality improvement, service evaluation, orthopaedics.Pan African Medical Journal 2016; 2

An Analysis of the Financial Literacy of Senior Students Across Fields of Study at the University of Mississippi

This thesis examines the financial literacy of senior students at the University of Mississippi, as well as which variables influence a student’s financial literacy level. Financial literacy is crucial for both an individual’s current and long-term well-being and financial health. Students in various major fields of study participated in a multiple-choice survey, including demographic, socioeconomic, and financial literacy questions. The student’s answers were analyzed using univariate analyses, an ordinary least squares stepwise regression, and a logistic stepwise regression. The study found that the average student score of 2.75 out of five financial literacy questions was comparable to the national average of 2.9 out of five financial literacy questions. Six key variables were found to influence financial literacy: gender, ethnicity, being enrolled in a business-related field of study, father’s education level, parental income level, and actively planning for retirement

Comparison of Adaptive and Maladaptive Institutionalized Educable Retarded Children's Responses to Direct and Indirect Social Reinforcement

Psycholog

Investigating the impact of molecular stratification on ovarian cancer treatment and outcome

Ovarian cancer is the most lethal gynaecological malignancy in the developed world. High grade serous (HGS) ovarian carcinoma (OC) represents the majority of cases and most frequently presents at advanced stage, where the five year survival rate is around 30%. Over the last two decades, our understanding of the molecular events underpinning HGS OC has advanced substantially, identifying cases rendered deficient in homologous recombination DNA repair (HR) by virtue of BRCA1 or BRCA2 (BRCA) mutation (BRCAm). BRCAm patients experience a distinct clinical phenotype which has been translated into stratification of routine OC care, with poly-(ADP-ribose) polymerase (PARP) inhibitors showing marked efficacy in this patient group. However, phenotypic characterisation of HGS OCs in non-BRCA molecular subtypes is less well defined and ultimately molecular characterisation of OC beyond BRCAm is not used to guide disease management or prognostication. This body of work performs characterisation of clinical specimens from patients diagnosed with OC, identified retrospectively using the Edinburgh Ovarian Cancer Database, through which detailed patient outcome data is available. These analyses aim to determine the clinical consequences of molecular events that underpin OC, correlating specific events with survival and chemotherapy response. Firstly, a cohort of OC treated with pegylated liposomal doxorubicin (PLD) is identified and characterised using next generation sequencing (NGS) analysis for the BRCA genes to determine whether BRCAm patients are more sensitive to this non-platinum DNA damaging agent. HGS OCs with BRCA sequence aberrations demonstrated significantly higher response rates to PLD, including a higher response rate in patients harbouring the BRCA1 SNP rs1799950. vii Pre-existing gene expression data for a cohort of 265 HGS OC patients is then used to identifying a subgroup of patients who have high expression of C11orf30/EMSY, whose gene product encodes a BRCA2-binding protein reported to disrupt BRCA2 function. These patients are demonstrated to behave similarly to BRCAm patients, showing prolonged survival and hypersensitivity to platinum-based chemotherapy. The survival benefit of high- EMSY HGS OC patients is recapitulated in multiple independent datasets, including the MRC ICON7 clinical trial cohort. Finally, integrated molecular characterisation of a large HGS OC cohort is performed to investigate the overlap and interplay between genomically and transcriptomically-defined subgroups described in HGS OC. Tumour-infiltrating lymphocytes are quantified and overlaid with molecular data to deconvolute the clinical impact of molecular subtypes with high granularity. These analyses reveal differential distribution of genomic subgroups between transcriptionally-defined subtypes, and identify the Angio subtype as a subtype demonstrating poor tumour engagement by the immune system. Patients with HGS OC harbouring CCNE1 copy number gain are demonstrated to display poorer outcome. Integrated molecular subtyping separates HGS OCs into three classes each with distinct OS profiles, and reveals potential novel context-specific associations of molecular events with clinical outcome. Together, these data extend our knowledge of the clinical impact of molecular subtypes of HGS OC, paving the way for improved stratification of OC patient management

The epidemiology and treatment of femur fractures at a northern Tanzanian referral centre

Introduction: Femoral fractures are the most common presenting injury at the orthopaedic department in a large Tanzanian hospital. To date, there has been no current examination of the epidemiology of femoral fractures and the disease burden has not been quantified.Methods: A retrospective descriptive study of patient records in the orthopaedic department at  Kilimanjaro Christian Medical Centre (KCMC) was performed. Patient demographics, aetiology of fractures, diagnosis and treatment were all recorded. Results: A total of 540 consecutive patient admission records were reviewed over a 9 month period. Of these 540 cases, 213 (39%) were diagnosed with a femoral fracture. The 21-30 age group were the most commonly affected by femur fractures (20% n=42). Within this group, motor traffic accidents (MTA)  were the cause of 71% of injuries (n=30). For males, MTA's caused 59% of all femur fractures (n=80), while falls were the most common cause of femur fractures in females (70%; n=49). 80% of the fractures in the 51-100 age group were caused by falls (n=52). In both the male and female groups the most common fracture seen was mid shaft femoral fracture (males 33% (n=48), females 25% (n=18)). The most common treatment was skeletal traction used in 40% (n=85) of patients.Conclusion: Femur fracture most commonly presented in males under age 30. Femur fracture was most frequently caused by MTAs in males and by falls in females. The most common diagnosis was mid shaft of femur fracture. Skeletal traction was the most frequent treatment.Key words: Femoral fractures, orthopaedics, Tanzania, epidemiolog

High-resolution 3D shallow crustal structure in Long Beach, California: Application of ambient noise tomography on a dense seismic array

Ambient noise tomography has proven to be effective in resolving shallow earth structure. We applied ambient noise tomography on a dense seismic array in Long Beach, California. The array was composed of more than 5200 stations with an average spacing close to 100 m. Three weeks of passive ambient noise were crosscorrelated between each station pair, which resulted in more than 13.5 million crosscorrelations within the area. Clear fundamental-mode Rayleigh waves were observed between 0.5 and 4 Hz, which were most sensitive to structure above 1-km depth. For each station pair, we applied frequency-time analysis to determine the phase traveltime dispersion, and, for each frequency, we applied eikonal tomography to determine the Rayleigh wave phase velocity map. The eikonal tomography accounted for ray bending by tracking the wavefront and allowed uncertainties to be estimated through statistical analysis. The compilation of phase velocity maps was then used to invert for 3D shear velocity structure. The inverted model showed clear correlation with the known geologic features such as the shallow south–north velocity dichotomy and a deeper fast anomaly associated with the Newport-Inglewood fault zone. Our results can potentially be used to complement traditional active source studies

Is State Law Looking for Trouble: The Federal Arbitration Act Flexes Its Preemptive Muscle

This article begins with an overview of the preemption concept as it affects the American legal system. The source of preemption power is revealed and the most common forms of preemption are introduced. Next, the article discusses preemption and its interaction with the Federal Arbitration Act (FAA). The discussion begins with a chronological view of the cases that have defined the effects the FAA has on arbitration agreements via its preemption power and ends with a summary of the current state of the law