Reliability of ultrasonic diaphragm thickness measurement in mechanically ventilated infants and children: A pilot study

Background. Diaphragmatic atrophy in mechanically ventilated infants and children may be due to ventilator-induced diaphragmatic dysfunction, which could lead to extubation failure. Ultrasound may be used as a means by which diaphragmatic atrophy can be reliably identified. There are currently no data reporting on the use of ultrasound to monitor diaphragm atrophy in the paediatric population. Objectives. To assess the inter- and intra-rater reliability of using ultrasound to measure diaphragm thickness in mechanically ventilated infants and children. Method. Diaphragm thickness measurements were compared between two individual researchers for inter-rater reliability and between multiple measurements from a single researcher for intra-rater reliability. Measurements were compared using Intraclass correlation coefficients and Bland- Altman plots. Results. Results indicated excellent reliability between measurements for both inter-and intra-rater reliability, with slightly better reliability for intra-rater compared with inter-rater reliability. Intraclass correlation coefficients for inter-rater reliability were between 0.77 and 0.98, and 0.94 for intra-rater reliability. Conclusion. Ultrasound measurements of diaphragm thickness can be used to reliably measure diaphragm thickness in mechanically ventilated infants and children. This modality could therefore be used as a reliable outcome measure for future clinical research studies to establish the relationship between ventilator-induced diaphragmatic atrophy and children who are at risk for extubation failure

Confirmation of metastases by fine needle aspiration biopsy in patients with gynecologic malignancies

Fine needle aspirations (FNA) were performed on 48 patients treated for gynecologic malignancies and suspected of having recurrence of their disease. The suspected sites of metastases were peripheral lymph nodes (38 patients) and the retroperitoneal region (10 patients). Metastatic tumors were detected in 22 out of the 48 patients (45%) by FNA, with 9 patients having additional confirmation by excisional biopsies. Of the remaining patients, 9 had unsatisfactory specimens, and 2 had false-negative results. The report emphasizes the efficacy of this procedure, especially when positive results are obtained. Open biopsy can be restricted to those patients with negative or unsatisfactory results and a high clinical suspicion of metastasis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23788/1/0000026.pd

Non-affirmative Theory of Education as a Foundation for Curriculum Studies, Didaktik and Educational Leadership

This chapter presents non-affirmative theory of education as the foundation for a new research program in education, allowing us to bridge educational leadership, curriculum studies and Didaktik. We demonstrate the strengths of this framework by analyzing literature from educational leadership and curriculum theory/didaktik. In contrast to both socialization-oriented explanations locating curriculum and leadership within existing society, and transformation-oriented models viewing education as revolutionary or super-ordinate to society, non-affirmative theory explains the relation between education and politics, economy and culture, respectively, as non-hierarchical. Here critical deliberation and discursive practices mediate between politics, culture, economy and education, driven by individual agency in historically developed cultural and societal institutions. While transformative and socialization models typically result in instrumental notions of leadership and teaching, non-affirmative education theory, previously developed within German and Nordic education, instead views leadership and teaching as relational and hermeneutic, drawing on ontological core concepts of modern education: recognition; summoning to self-activity and Bildsamkeit. Understanding educational leadership, school development and teaching then requires a comparative multi-level approach informed by discursive institutionalism and organization theory, in addition to theorizing leadership and teaching as cultural-historical and critical-hermeneutic activity. Globalisation and contemporary challenges to deliberative democracy also call for rethinking modern nation-state based theorizing of education in a cosmopolitan light. Non-affirmative education theory allows us to understand and promote recognition based democratic citizenship (political, economical and cultural) that respects cultural, ethical and epistemological variations in a globopolitan era. We hope an American-European-Asian comparative dialogue is enhanced by theorizing education with a non-affirmative approach

Reliability of ultrasonic diaphragm thickness measurement in mechanically ventilated infants and children : a pilot study

CITATION: Terhart, M. N., et al. 2018. Reliability of ultrasonic diaphragm thickness measurement in mechanically ventilated infants and children : a pilot study. Southern African Journal of Critical Care, 34(1):52-66, doi:10.7196/SAJCC.201.v34i1.344.The original publication is available at http://www.sajcc.org.zaBackground: Diaphragmatic atrophy in mechanically ventilated infants and children may be due to ventilator-induced diaphragmatic dysfunction, which could lead to extubation failure. Ultrasound may be used as a means by which diaphragmatic atrophy can be reliably identified. There are currently no data reporting on the use of ultrasound to monitor diaphragm atrophy in the paediatric population. Objectives: To assess the inter- and intra-rater reliability of using ultrasound to measure diaphragm thickness in mechanically ventilated infants and children. Method: Diaphragm thickness measurements were compared between two individual researchers for inter-rater reliability and between multiple measurements from a single researcher for intra-rater reliability. Measurements were compared using Intraclass correlation coefficients and Bland- Altman plots. Results: Results indicated excellent reliability between measurements for both inter-and intra-rater reliability, with slightly better reliability for intra-rater compared with inter-rater reliability. Intraclass correlation coefficients for inter-rater reliability were between 0.77 and 0.98, and 0.94 for intra-rater reliability. Conclusion: Ultrasound measurements of diaphragm thickness can be used to reliably measure diaphragm thickness in mechanically ventilated infants and children. This modality could therefore be used as a reliable outcome measure for future clinical research studies to establish the relationship between ventilator-induced diaphragmatic atrophy and children who are at risk for extubation failure.http://www.sajcc.org.za/index.php/SAJCC/article/view/344Publisher's versio