355 W El Camino Real
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Students' voices on spiritual care at a Higher Education Institution in the Western Cape. - Curationis
Nurses have a moral obligation to ensure holistic care of patients, inclusive of the spiritual dimension. However, there seems to be a void in the teaching and learning of spiritual care in nursing curricula. Despite the South African Nursing Council being in favour of holistic nursing, there are no measures in place to ensure implementation of spiritual care, hence its practice is not standardised in nursing education in South Africa. Currently, the undergraduate nursing curriculum does not provide clear direction on how spiritual care in nursing should be integrated and the reason for this is not clear. It appears that the lack of professional regulation, difficulties in definition and the personalised nature of spiritual practice are partly responsible for the practice being barely enforced and scarcely practised by students in clinical placements. The aim of the study was to develop a practice theory for teaching-learning of spiritual care in the undergraduate nursing programme.The study objective was to describe and explore the students' experiencs of teaching-learning of spiritual care in the undergraduate nursing programme.A qualitative, explorative, descriptive and contextual design with purposive sampling was used. The sample consisted of undergraduate nursing students at a University in the Western Cape Province. Measures for trustworthiness were applied.The findings indicated a need to provide support, a conducive learning environment and structure for teaching, learning and practice of spiritual care.There is a need for formal education regarding spiritual care in nursing.
Nurse educators' experiences of case-based education in a South African nursing programme. - Curationis
A school of nursing at a university in the Western Cape experienced an increase in student enrolments from an intake of 150 students to 300 students in the space of one year. This required a review of the teaching and learning approach to ensure that it was appropriate for effective facilitation of large classes. The case-based education (CBE) approach was adopted for the delivery of the Bachelor of Nursing programme in 2005.The aim of the study was to explore nurse educators' experiences, current practices and possible improvements to inform best practice of CBE at the nursing school in the Western Cape.A participatory action research method was applied in a two day workshop conducted with nurse educators in the undergraduate nursing programme. The nominal group technique was used to collect the data.Three themes emerged from the final synthesis of the findings, namely: teaching and learning related issues, student issues and teacher issues. Amongst other aspects, theory and practice integration, as well as the need for peer support in facilitation of CBE, were identified as requiring strengthening.It was concluded that case-based education should continue to be used in the school, however, more workshops should be arranged to keep educators updated and new staff orientated in respect of this teaching and learning approach.
The Koolen-de Vries syndrome: a phenotypic comparison of patients with a 17q21.31 microdeletion versus a KANSL1 sequence variant. - European journal of human genetics : EJHG
The Koolen-de Vries syndrome (KdVS; OMIM #610443), also known as the 17q21.31 microdeletion syndrome, is a clinically heterogeneous disorder characterised by (neonatal) hypotonia, developmental delay, moderate intellectual disability, and characteristic facial dysmorphism. Expressive language development is particularly impaired compared with receptive language or motor skills. Other frequently reported features include social and friendly behaviour, epilepsy, musculoskeletal anomalies, congenital heart defects, urogenital malformations, and ectodermal anomalies. The syndrome is caused by a truncating variant in the KAT8 regulatory NSL complex unit 1 (KANSL1) gene or by a 17q21.31 microdeletion encompassing KANSL1. Herein we describe a novel cohort of 45 individuals with KdVS of whom 33 have a 17q21.31 microdeletion and 12 a single-nucleotide variant (SNV) in KANSL1 (19 males, 26 females; age range 7 months to 50 years). We provide guidance about the potential pitfalls in the laboratory testing and emphasise the challenges of KANSL1 variant calling and DNA copy number analysis in the complex 17q21.31 region. Moreover, we present detailed phenotypic information, including neuropsychological features, that contribute to the broad phenotypic spectrum of the syndrome. Comparison of the phenotype of both the microdeletion and SNV patients does not show differences of clinical importance, stressing that haploinsufficiency of KANSL1 is sufficient to cause the full KdVS phenotype.European Journal of Human Genetics advance online publication, 26 August 2015; doi:10.1038/ejhg.2015.178.
Primary Sinonasal Clear Cell Carcinoma: Case Report. - The Medical journal of Malaysia
Primary sinonasal clear cell carcinoma is a rare neoplasm classified under malignant epithelial tumours of salivary gland - type carcinomas under World Health Organization (WHO) classification. We report a case which occurred on a 69 year old gentleman presented with epistaxis and nasal endoscopy examination showed tumour arising from the right ethmoid cells. Endoscopic excision of the tumour was done and histopathological examination revealed clear cell carcinoma. In addition, other secondary or primary sites of the lesion were excluded by clinical, immunohistochemical and radiological examinations. 10 months into the postoperative period, patient remains well without recurrence of the tumour.We report a rare case of primary sinonasal clear cell carcinoma in addition to the limited literature available and emphasize the differentials with other probable tumour through meticulous microscopic examination and use of special immunostains.
A case of posterior reversible encephalopathy syndrome associated with gilenya(Â®) (fingolimod) treatment for multiple sclerosis. - Frontiers in neurology
We describe posterior reversible encephalopathy syndrome (PRES) in a woman with multiple sclerosis treated with Gilenya(Â®) (Fingolimod). The first symptoms appeared after 21â€‰months of fingolimod treatment. She experienced headache, altered mental status, cognitive deficits, seizures, and visual disturbances. Not at any time during the course of the disease could any signs of infection or rheumatic disorder be detected. Test for anti-neuronal antibodies was also negative. Her blood pressure was normal. MRI showed widespread cortical and subcortical changes with some mass-effect in the temporo-occipital-parietal lobes in the left hemisphere. Contrast enhancement was seen in the leptomeninges and, in addition, there were no areas with restricted diffusion and no signs of hemorrhage. Her condition deteriorated until fingolimod was discontinued. Slowly her condition improved and after 8â€‰months, the only symptoms that remained were two small, non-corresponding, right inferior scotomas. We believe that all symptoms, the clinical course, and the MRI findings in this case can all be explained by considering PRES, a probably rare, but serious, side effect of fingolimod treatment.
MR mammography using diffusion-weighted imaging in evaluating breast cancer: a correlation with proliferation index. - La Radiologia medica
To evaluate whether the variation of the apparent diffusion coefficient (ADC) values obtained with DWI can predict elevated levels of Ki67 proliferation index and aggressive subtypes in patients with breast cancer.Breast MRI studies of 115 patients (mean age 57.3Â years, range 36-81Â years) with a biopsy-proven breast cancers were evaluated in this retrospective IRB-approved study. Examinations were performed on a 1.5Â T magnet and included a Single-Shot Echoplanar DWI sequence with b values of 0 and 1000Â s/mm(2). For each target lesion, ADC was measured. ADC values were compared considering Ki67 status (â‰¥20Â % or <20Â %), histology, grade (G1, G2 or G3) and clinical-pathological classification (Luminal A, Luminal B HER2-positive, Luminal B HER-2 negative, HER-2 enriched and Triple Negative). Mann-Whitney U test and Kruskal-Wallis test were used for comparisons and receiver operating characteristic (ROC) curves were obtained. Inter- and intra-reader variability was evaluated in a subset of 40 patients, using interclass correlation coefficient (ICC) and Bland-Altman plots.Of 115 lesions, 53 (46.1Â %) were assessed as Ki67 positive and 62 (53.9Â %) as Ki67 negative. ADC values were significantly (pÂ <Â 0.0001) lower in Ki67-positive patients (median 0.86Â Ã—Â 10(-3) mm(2)/s; interquartile range 0.75-0.92) compared to Ki67-negative (median 1.03Â Ã—Â 10(-3) mm(2)/s; interquartile range 0.92-1.13). Median ADC was also lower in G2 and G3 cancer and in the Luminal B Her2-negative subtype (pÂ =Â 0.0015). No differences were found when evaluating histology. ROC curve showed a sensitivity and specificity of 83.0 and 66.1Â %, respectively, when using a cutoff of 0.95Â s/mm(2) to differentiate Ki67-positive from Ki67-negative cancers. Inter- and intra-reader variability was moderate (ICCÂ =Â 0.623; ICCÂ =Â 0.548, respectively). No systematic differences were identified with Bland-Altman plots.Lower ADC values are associated with elevated Ki67 proliferation index and more aggressive pathologic features. Moderate agreement in ADC measurement could be a limitation.
Normal tissue complication probability models for severe acute radiological lung injury after radiotherapy for lung cancer. - Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB)
To derive Normal Tissue Complication Probability (NTCP) models for severe patterns of early radiological radiation-induced lung injury (RRLI) in patients treated with radiotherapy (RT) for lung tumors. Second, derive threshold doses and optimal doses for prediction of RRLI to be used in differential diagnosis of tumor recurrence from RRLI during follow-up.Lyman-EUD (LEUD), Logit-EUD (LogEUD), relative seriality (RS) and critical volume (CV) NTCP models, with DVH corrected for fraction size, were used to model the presence of severe early RRLI in follow-up CTs. The models parameters, including Î±/Î², were determined by fitting data from forty-five patients treated with IMRT for lung cancer. Models were assessed using Akaike information criterion (AIC) and area under receiver operating characteristic curve (AUC). Threshold doses for risk of RRLI and doses corresponding to the optimal point of the receiver operating characteristic (ROC) curve were determined.The Î±/Î²s obtained with different models were 2.7-3.2Â Gy. The thresholds and optimal doses curves were EUDs of 3.2-7.8Â Gy and 15.2-18.1Â Gy with LEUD, LogEUD and RS models, and Î¼d of 0.013 and 0.071 with the CV model. NTCP models had AUCs significantly higher than 0.5. Occurrence and severity of RRLI were correlated with patients' values of EUD and Î¼d.The models and dose levels derived can be used in differential diagnosis of tumor recurrence from RRLI in patients treated with RT. Cross validation is needed to prove prediction performance of the model outside the dataset from which it was derived.Copyright Â© 2014 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.
Improving environmental management on small-scale farms: perspectives of extension educators and horse farm operators. - Environmental management
Although the number of small-scale farms is increasing in North America and Europe, few studies have been conducted to better understand environmental management in this sector. We investigate this issue by examining environmental management on horse farms from both the perspective of the "expert" extension educator and horse farm operator. We conducted a Delphi survey and follow-up interviews with extension educators in Indiana and Kentucky. We also conducted interviews and farm assessments with 15 horse farm operators in the two states. Our results suggest a disconnection between the perceptions of extension educators and horse farm operators. Extension educators believed that operators of small horse farms are unfamiliar with conservation practices and their environmental benefits and they found it difficult to target outreach to this audience. In the interviews with horse farm operators, we found that the majority were somewhat familiar with conservation practices like rotational grazing, soil testing, heavy use area protection, and manure composting. It was not common, however, for practices to be implemented to generally recognized standards. The horse farm respondents perceived these practices as interrelated parts of a system of farm management that has developed over time to best deal with the physical features of the property, needs of the horses, and available resources. Because conservation practices must be incorporated into a complex farm management system, traditional models of extension (i.e., diffusion of innovations) may be inappropriate for promoting better environmental management on horse farms.
FN-DFE: fuzzy-neural data fusion engine for enhanced resilient state-awareness of hybrid energy systems. - IEEE transactions on cybernetics
Resiliency and improved state-awareness of modern critical infrastructures, such as energy production and industrial systems, is becoming increasingly important. As control systems become increasingly complex, the number of inputs and outputs increase. Therefore, in order to maintain sufficient levels of state-awareness, a robust system state monitoring must be implemented that correctly identifies system behavior even when one or more sensors are faulty. Furthermore, as intelligent cyber adversaries become more capable, incorrect values may be fed to the operators. To address these needs, this paper proposes a fuzzy-neural data fusion engine (FN-DFE) for resilient state-awareness of control systems. The designed FN-DFE is composed of a three-layered system consisting of: 1) traditional threshold based alarms; 2) anomalous behavior detector using self-organizing fuzzy logic system; and 3) artificial neural network-based system modeling and prediction. The improved control system state-awareness is achieved via fusing input data from multiple sources and combining them into robust anomaly indicators. In addition, the neural network-based signal predictions are used to augment the resiliency of the system and provide coherent state-awareness despite temporary unavailability of sensory data. The proposed system was integrated and tested with a model of the Idaho National Laboratory's hybrid energy system facility known as HYTEST. Experiment results demonstrate that the proposed FN-DFE provides timely plant performance monitoring and anomaly detection capabilities. It was shown that the system is capable of identifying intrusive behavior significantly earlier than conventional threshold-based alarm systems.
Role of magnetic resonance imaging in probably benign (BI-RADS category 3) microcalcifications of the breast. - La Radiologia medica
This study was undertaken to evaluate whether magnetic resonance (MR) imaging is able to rule out malignancy in the case of BI-RADS 3 microcalcifications, providing a sufficient negative predictive value (NPV) for early work-up, and to reduce unnecessary stereotactically guided vacuum-assisted biopsy (SVAB) procedures.We prospectively enrolled consecutive women with BI-RADS 3 microcalcifications, who subsequently underwent MR imaging and SVAB. The MR studies were reviewed according to the MR-BI-RADS classification system; lesions assessed as MR-BI-RADS 1 and 2 were considered negative for malignancy, categories MR-BI-RADS 3, 4 and 5 indicated malignant lesions. The presence of additional findings was recorded. Histologic analysis and follow-up were the reference standard. MR sensitivity, specificity, positive predictive value (PPV) and NPV were calculated.The final population consisted of 71 lesions. Histologic analysis showed malignancy in six cases (malignancy rate 8%). At MR analysis, 60 (85%) lesions were considered negative for malignancy and 11 (15%) malignant. Additional MR imaging findings were identified in 19 (27%) patients, all corresponding to nonmalignant lesions. MR sensitivity was 33%, specificity 86%, PPV 18% and NPV 93%.Because of its relatively low NPV, MR imaging is not able to safely exclude malignancy in the case of BI-RADS 3 microcalcifications. The relatively high malignancy rate found in this study might support SVAB in the case of BI-RADS 3 microcalcifications.
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355 W El Camino Real Mountain View, CA 94040
701 E El Camino Real 3Rd Floor
1411 W El Camino Real Suite B
2500 Hospital Dr Biuld 4A
701 E El Camino Real