Dissertation submitted in fulfillment of the requirements for the Degree of Master of
Technology: Emergency Medical Care, Durban University of Technology, 2012.
Background
In the emergency setting, ...the onus is on the individual practitioner’s ability to make
critical decisions at critical moments in order to provide the best level of care to their
patient. In order to ensure that these decisions fall in line with the best interests of the
patient, the South African paramedic requires a better understanding of how to arrive at
such a decision; they need to understand the clinical decision making process. This
study focused on South African paramedic clinical decision making with specific
reference to acute traumatic pain management, with the aim of determining the factors
which influence South African paramedic clinical decision making by revealing the
current method of pain management employed by South African paramedics, how they
view the priority of pain management in the continuum of care and if there were any
context specific factors influencing their clinical decision making.
Methods
A mixed method design was used to determine the factors contributing to the clinical
decision making process of South African paramedics in the acute pain management of
patients with acute traumatic pain. A mixture of qualitative and quantitative approaches
was utilized by means of a research questionnaire as well as in-depth interviews. The
questionnaires were targeted at all South African paramedics while the in-depth
interviews were conducted with five participants who had been purposefully selected
from the questionnaire respondents. The data analysis was conducted in a descriptive
manner in order to inform the explanatory nature of the answers to the research
questions and objective.
Results
The results provided insight into the current methods and clinical decision making
processes employed by South African paramedics in the management of patients’
experiencing acute traumatic pain. The study determined that the South African
paramedic’s clinical decision making process involves three key phases in the acute
traumatic pain management setting, the assessment phase, the initiation/pain
management phase and the conclusion/re-evaluation phase, with each phase utilizing
different decision making models, the intuitive/humanist model, the hypothetico-
deductive model and a model which combined both of the aforementioned models.
In addition to this, numerous factors such as the provision of care in order to facilitate
further management and transportation to an appropriate facility, which influenced
clinical decision making, were identified. Amongst South African paramedics, pain
management was identified as coming second only to the interventions required to
manage immediately life threatening conditions in terms of the prioritization of
treatment.
Recommendations
A variety of recommendations which included the need to further the development of
clinical decision making and pain management through research and education as well
as considerations for investigation into the potential expansion of South African
paramedic scope of practice in the pain management environment were made.
Dengue virus (DENV) is a pathogen with a high impact on human health. It replicates in a wide range of cells involved in the immune response. To efficiently infect humans, DENV must evade or inhibit ...fundamental elements of the innate immune system, namely the type I interferon response. DENV circumvents the host immune response by expressing proteins that antagonize the cellular innate immunity. We have recently documented the inhibition of type I IFN production by the proteolytic activity of DENV NS2B3 protease complex in human monocyte derived dendritic cells (MDDCs). In the present report we identify the human adaptor molecule STING as a target of the NS2B3 protease complex. We characterize the mechanism of inhibition of type I IFN production in primary human MDDCs by this viral factor. Using different human and mouse primary cells lacking STING, we show enhanced DENV replication. Conversely, mutated versions of STING that cannot be cleaved by the DENV NS2B3 protease induced higher levels of type I IFN after infection with DENV. Additionally, we show that DENV NS2B3 is not able to degrade the mouse version of STING, a phenomenon that severely restricts the replication of DENV in mouse cells, suggesting that STING plays a key role in the inhibition of DENV infection and spread in mice.
Summary Female survivors of childhood, adolescent, and young adult (CAYA) cancer who were given radiation to fields that include breast tissue (ie, chest radiation) have an increased risk of breast ...cancer. Clinical practice guidelines are essential to ensure that these individuals receive optimum care and to reduce the detrimental consequences of cancer treatment; however, surveillance recommendations vary among the existing long-term follow-up guidelines. We applied evidence-based methods to develop international, harmonised recommendations for breast cancer surveillance among female survivors of CAYA cancer who were given chest radiation before age 30 years. The recommendations were formulated by an international, multidisciplinary panel and are graded according to the strength of the underlying evidence.
Many publications report on stimuli responsive coatings, but only a few on the controlled release of species in order to change the coating surface properties. A sponge‐like coating that is able to ...release and absorb a liquid upon exposure to light has been developed. The morphology of the porous coating is controlled by the smectic liquid crystal properties of the monomer mixture prior to its polymerization, and homeotropic order is found to give the largest contraction. The fast release of the liquid can be induced by a macroscopic contraction of the coating caused by a trans to cis conversion of a copolymerized azobenzene moiety. The liquid secretion can be localized by local light exposure or by creating a surface relief. The uptake of liquid proceeds by stimulating the back reaction of the azo compound by exposure at higher wavelength or by thermal relaxation. The surface forces of the sponge‐like coating in contact with an opposing surface can be controlled by light‐induced capillary bridging revealing that the controlled release of liquid gives access to tunable adhesion.
A photosponge consisting of a porous liquid crystal network with smectic molecular order, crosslinked with an azobenzene molecule is reported. The pores are filled with liquid cyanobiphenyl. UV light irradiation shrinks the network, resulting in liquid secretion by the coating, while visible‐light irradiation triggers reabsorption of the liquid. The coating regulates by light‐induced adhesion and friction at its surface.
Bateman's principles and human sex roles Brown, Gillian R.; Laland, Kevin N.; Mulder, Monique Borgerhoff
Trends in ecology & evolution (Amsterdam),
06/2009, Letnik:
24, Številka:
6
Journal Article
Recenzirano
Odprti dostop
In 1948, Angus J. Bateman reported a stronger relationship between mating and reproductive success in male fruit flies compared with females, and concluded that selection should universally favour ...‘an undiscriminating eagerness in the males and a discriminating passivity in the females’ to obtain mates. The conventional view of promiscuous, undiscriminating males and coy, choosy females has also been applied to our own species. Here, we challenge the view that evolutionary theory prescribes stereotyped sex roles in human beings, firstly by reviewing Bateman's principles and recent sexual selection theory and, secondly, by examining data on mating behaviour and reproductive success in current and historic human populations. We argue that human mating strategies are unlikely to conform to a single universal pattern.
Female survivors of childhood, adolescent, and young adult (CAYA) cancer who were treated with alkylating agents and/or radiation, with potential exposure of the ovaries, have an increased risk of ...premature ovarian insufficiency (POI). Clinical practice guidelines can facilitate these survivors' access to optimal treatment of late effects that may improve health and quality of survival; however, surveillance recommendations vary among the existing long-term follow-up guidelines, which impedes the implementation of screening.
The present guideline was developed by using an evidence-based approach and summarizes harmonized POI surveillance recommendations for female survivors of CAYA cancer who were diagnosed at age < 25 years. The recommendations were formulated by an international multidisciplinary panel and graded according to the strength of the evidence and the potential benefit gained from early detection and intervention. The harmonized POI surveillance recommendations were developed by using a transparent process and are intended to facilitate care for survivors of CAYA cancer.
The harmonized set of POI surveillance recommendations is intended to be scientifically rigorous, to positively influence health outcomes, and to facilitate the care for female survivors of CAYA cancer.
As new evidence is available, the International Late Effects of Childhood Cancer Guideline Harmonization Group has updated breast cancer surveillance recommendations for female survivors of ...childhood, adolescent, and young adult cancer.
We used evidence-based methods to apply new knowledge in refining the international harmonized recommendations developed in 2013. The guideline panel updated the systematic literature review, developed evidence summaries, appraised the evidence, and updated recommendations on the basis of evidence, clinical judgement, and consideration of benefits versus the harms of the surveillance interventions while attaining flexibility in implementation across different health care systems. The GRADE Evidence-to-Decision framework was used to translate evidence to recommendations. A survivor information form was developed to counsel survivors about the potential harms and benefits of surveillance.
The literature update identified new study findings related to the effects of prescribed moderate-dose chest radiation (10 to 19 Gy), radiation dose-volume, anthracyclines and alkylating agents in non-chest irradiated survivors, and the effects of ovarian function on breast cancer risk. Moreover, new data from prospective investigations were available regarding the performance metrics of mammography and magnetic resonance imaging among survivors of Hodgkin lymphoma. Modified recommendations include the performance of mammography and breast magnetic resonance imaging for survivors treated with 10 Gy or greater chest radiation (strong recommendation) and upper abdominal radiation exposing breast tissue at a young age (moderate recommendation) at least annually up to age 60 years. As a result of inconsistent evidence, no recommendation could be formulated for routine breast cancer surveillance for survivors treated with any type of anthracyclines in the absence of chest radiation.
The newly identified evidence prompted significant change to the recommendations formulated in 2013 related to moderate-dose chest radiation and anthracycline exposure as well as breast cancer surveillance modality.
Exposure to cranial radiotherapy is associated with an increased risk of subsequent CNS neoplasms among childhood, adolescent, and young adult (CAYA) cancer survivors. Surveillance for subsequent ...neoplasms can translate into early diagnoses and interventions that could improve cancer survivors' health and quality of life. The practice guideline presented here by the International Late Effects of Childhood Cancer Guideline Harmonization Group was developed with an evidence-based method that entailed the gathering and appraisal of published evidence associated with subsequent CNS neoplasms among CAYA cancer survivors. The preparation of these guidelines showed a paucity of high-quality evidence and highlighted the need for additional research to inform survivorship care. The recommendations are based on careful consideration of the evidence supporting the benefits, risks, and harms of the surveillance interventions, clinical judgment regarding individual patient circumstances, and the need to maintain flexibility of application across different health-care systems. Currently, there is insufficient evidence to establish whether early detection of subsequent CNS neoplasms reduces morbidity and mortality, and therefore no recommendation can be formulated for or against routine MRI surveillance. The decision to start surveillance should be made by the CAYA cancer survivor and health-care provider after careful consideration of the potential harms and benefits of surveillance for CNS neoplasms, including meningioma.
Micrometer‐scale liquid crystal network (LCN) actuators have potential for application areas like biomedical systems, soft robotics, and microfluidics. To fully harness their power, a diversification ...in production methods is called for, targeting unconventional shapes and complex actuation modes. Crucial for controlling LCN actuation is the combination of macroscopic shape and molecular‐scale alignment in the ground state, the latter becoming particularly challenging when the desired shape is more complex than a flat sheet. Here, one‐step processing of an LCN precursor material in a glass capillary microfluidic set‐up to mold it into thin shells is used, which are stretched by osmosis to reach a diameter of a few hundred micrometers and thickness on the order of a micrometer, before they are UV crosslinked into an LCN. The shells exhibit radial alignment of the director field and the surface is porous, with pore size that is tunable via the osmosis time. The LCN shells actuate reversibly upon heating and cooling. The decrease in order parameter upon heating induces a reduction in thickness and expansion of surface area of the shells that triggers continuous buckling in multiple locations. Such buckling porous shells are interesting as soft cargo carriers with capacity for autonomous cargo release.
Thin spherical shells of radially aligned polymeric liquid crystal networks respond to temperature changes by programmed reversible buckling. The shell actuators are produced at high rate in a microfluidic pathway, employing osmosis for alignment, thinning, and ensuring a high degree of porosity. This gives them potential for controlled cargo delivery and localized mixing.
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