Capillaroscopy is a non-invasive and safe tool which allows the evaluation of the morphology of the microcirculation. Since its recent incorporation in the 2013 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for systemic sclerosis together with its assessed role to monitor disease progression, capillaroscopy became a ‘mainstream’ investigation for rheumatologists. Given its increasing use by a variety of physicians internationally both in daily practice to differentiate primary from secondary Raynaud's phenomenon, as well as in research context to predict disease progression and monitor treatment effects, standardisation in capillaroscopic image acquisition and analysis seems paramount. To step forward to this need, experts in the field of capillaroscopy/microcirculation provide in this very consensus paper their view on image acquisition and analysis, different capillaroscopic techniques, normal and abnormal capillaroscopic characteristics and their meaning, scoring systems and reliability of image acquisition and interpretation. / Revisión por pares

Text in Afrikaans / he goal of this research study is to determine whether clay has any diagnostic value to the Educational Psychologist. The phenomenon of claywork with children has been examined by literature to determine whether this subject has been researched before. The developmental phases in claywork and the development of clayfigures are discussed, as well as the clay techniques which are applied by children. A comparison between clay as a three-dimensional medium and drawings as two-dimensional medium is made. The ways of application of clay are discussed by means of case studies. The general value of clay for the Educational Psychologist is also mentioned. On the grounds of certain short-comings in the literature study, "The Clay-feelingstory technique" is initiated and applied. For the empirical study eighty learners in the foundation phase, aged between five and nine years, were involved. Random sampling was used. This research study uses the combined method design in order to better understand the phenomenon of clay projections. Although the study is mainly qualitative in nature, some data is quantified. The research results prove that clay projections have diagnostic value, concerning the child's verbal and non-verbal messages, the way he applies clay techniques, by decoding his symbolic messages, emotions come to the fore, actions are portrayed and described, relations are revealed, themes come to the fore and needs are expressed. It also seems that clay projections can be taken in group context as an identification medium to help the child in need. It also seems that clay projections can be applied as a supplementary projection medium and that hypothesis can be verified with other exploratory media. Guidelines are given for the application and interpretation of clay as projection medium. / Educational Studies / D.Ed. (Sielkundige Opvoedkunde)

Text in Afrikaans / he goal of this research study is to determine whether clay has any diagnostic value to the Educational Psychologist. The phenomenon of claywork with children has been examined by literature to determine whether this subject has been researched before. The developmental phases in claywork and the development of clayfigures are discussed, as well as the clay techniques which are applied by children. A comparison between clay as a three-dimensional medium and drawings as two-dimensional medium is made. The ways of application of clay are discussed by means of case studies. The general value of clay for the Educational Psychologist is also mentioned. On the grounds of certain short-comings in the literature study, "The Clay-feelingstory technique" is initiated and applied. For the empirical study eighty learners in the foundation phase, aged between five and nine years, were involved. Random sampling was used. This research study uses the combined method design in order to better understand the phenomenon of clay projections. Although the study is mainly qualitative in nature, some data is quantified. The research results prove that clay projections have diagnostic value, concerning the child's verbal and non-verbal messages, the way he applies clay techniques, by decoding his symbolic messages, emotions come to the fore, actions are portrayed and described, relations are revealed, themes come to the fore and needs are expressed. It also seems that clay projections can be taken in group context as an identification medium to help the child in need. It also seems that clay projections can be applied as a supplementary projection medium and that hypothesis can be verified with other exploratory media. Guidelines are given for the application and interpretation of clay as projection medium. / Educational Studies / D.Ed. (Sielkundige Opvoedkunde)

Carta al editor / Revisión por pares

Submitted by Noeme Timbo (noeme.timbo@metodista.br) on 2018-03-20T20:10:47Z No. of bitstreams: 1 FabianaGaviolli.pdf: 3390419 bytes, checksum: 7fc1a667a8deb55a265974d0f7a879c0 (MD5) / Made available in DSpace on 2018-03-20T20:10:47Z (GMT). No. of bitstreams: 1 FabianaGaviolli.pdf: 3390419 bytes, checksum: 7fc1a667a8deb55a265974d0f7a879c0 (MD5) Previous issue date: 2017-08-30 / This dissertation addresses the use of diagnosis as an instrument that if it is used strategically can provide conditions for organizational communication to create value. The diagnosis is the foundation of planning by establishing priorities, support the formulation of strategies and point out discrepancies between perceptions of the real world scenario and the projected scenario. This research is bibliographical and contains semi-structured interviews with organizational communication agencies that offer the diagnosis on their own services menu as a way to align concepts and practices of the diagnosis in organizational communication. The main goal is to investigate how the diagnosis may contribute to the valuation of organizational communication for organizations. At the end of this study, we present a suggestion of Public Relations Diagnostic Model for Organizational Communication and through this model, we show how to reflect the contrast found between theory and practice of diagnosis in Organizational Communication. The considerations presents a prognosis, as a result of this study as a diagnosis and it is a warning for that the relationship between the academy and the market that could be greater and better. From this behaviour, we would be able to foresee the future of strategic organizational communication leaving a speech and become practical reality in the organizations. / Esta dissertação aborda o uso do diagnóstico como um instrumento que, se usado estrategicamente, oferece condições para a comunicação organizacional gerar valoração. O diagnóstico é o alicerce do planejamento por estabelecer prioridades, embasar a formulação das estratégias e apontar discrepâncias entre percepções do cenário real e do cenário projetado. Essa pesquisa é bibliográfica e contém entrevistas semiestruturadas com agências de comunicação organizacional que ofertam o diagnóstico em seu menu de serviços, como forma de alinhar conceitos e práticas do diagnóstico em comunicação organizacional. O objetivo é investigar como o diagnóstico pode contribuir com a valoração da comunicação organizacional para as organizações. Ao final do estudo, apresentamos uma sugestão de modelo de Diagnóstico de Relações Públicas para a Comunicação Organizacional e por meio dele refletimos sobre as diferenças encontradas entre teoria e prática do Diagnóstico em Comunicação Organizacional. As considerações apresentam um prognóstico, fruto desse estudo como diagnóstico, é um alerta para que o relacionamento entre a academia e o mercado seja maior e melhor. A partir desse comportamento, poderemos futuramente vislumbrar de fato a comunicação organizacional estratégica deixando de ser apenas um discurso e passando a ser realidade prática nas organizações.

Hintergrund und Ziele: Gadolinium (Gd) wird seit 1988 als Kontrastmittel (KM) für Hirn-Magnetresonanztomographie (MRT)-Untersuchungen verwendet und gilt auch heute noch in vielen Kliniken zum Standard einer „lege artis“ durchgeführten pädiatrischen Hirnuntersuchung. Es galt lange Zeit als sehr nebenwirkungsarm, doch in den letzten Jahren wurden vermehrt Studien veröffentlicht, die von zum Teil schweren Folgen aufgrund der Gd-Applikation berichteten (Nephrotic systemic fibrosis, Gadolinium deposition disease). Ziel dieser Studie war es, den diagnostischen Zugewinn durch die generelle Gabe von Gd bei Kindern zu beurteilen, wenn initial im nativen Hirn-MRT kein pathologischer Befund zu finden war. Methodik: Für diese retrospektive Studie wurden 6.683 kraniale KM-MRT-Untersuchungen von Kindern im Alter von 0 bis 16 Jahren nochmals ausgewertet und daraufhin untersucht, ob die KM-Gabe zusätzliche relevante Informationen liefern konnte. Ergebnisse: In 8 von 3.003 (0,03 %) nativ unauffälligen Untersuchungen konnte durch KM-Gabe ein relevanter Zusatzbefund ermittelt werden. In allen 8 Fällen handelte es sich dabei um ein meningeales Enhancement. Dies entspricht einem negativen prädiktiven Wert (NPV) von 0,97. Von diesen relevanten Zusatzbefunden war das Enhancement nur bei einem Kind (0,03 %) richtungsweisend für die Diagnostik. Bei den nativ auffälligen Untersuchungen konnte in 297 von 3.680 (8,1 %) MRT´s ein relevanter Zusatzbefund gefunden werden. Schlussfolgerungen: Unsere Studie zeigte, dass eine KM-Gabe bei nativ unauffälligem Befund nur in einem Fall (0,03 %) eine richtungsweisende Diagnose mit Änderung der therapeutischen Strategie brachte. Stellt man diesem Ergebnis die Nachteile einer routinemäßigen Gd-Applikation gegenüber, ergibt sich eine zahlenmäßig begründete Evidenz, zukünftig routinemäßig auf die KM-Gabe bei nativ unauffälligen Befunden zu verzichten. In Einzelfällen kann von dieser Empfehlung abgewichen werden, wenn klinisch der Verdacht auf eine ZNS-Infektion besteht, oder wenn bei unklarer Symptomatik ein spreitender meningealer Tumor mit KM-Gabe ausgeschlossen werden soll. Bei pädiatrischen MRT-Untersuchungen des Gehirns, die schon vor KM-Gabe Auffälligkeiten zeigen, besteht weiterhin eine klare Indikation für die KM-Applikation. / Abstract Background: Brain imaging is the most common examination in pediatric magnetic resonance imaging (MRI), often combined with the use of a gadolinium-based contrast medium. The application of gadolinium-based contrast medium poses some risk. There is limited evidence of the benefits of contrast medium in pediatric brain imaging. Objective: To assess the diagnostic gain of contrast-enhanced sequences in brain MRI when the unenhanced sequences are normal. Materials and methods: We retrospectively assessed 6,683 brain MR examinations using contrast medium in children younger than 16 years in the pediatric radiology department of the University Hospital Leipzig to determine whether contrast-enhanced sequences delivered additional, clinically relevant information to pre-contrast sequences. All examinations were executed using a 1.5-T or a 3-T system. Results: In 8 of 3,003 (95% confidence interval 0.12-0.52%) unenhanced normal brain examinations, a relevant additional finding was detected when contrast medium was administered. Contrast enhancement led to a change in diagnosis in only one of these cases. Conclusion: Children with a normal pre-contrast brain MRI rarely benefit from contrast medium application. Comparing these results to the risks and disadvantages of a routine gadolinium application, there is substantiated numerical evidence for avoiding routine administration of gadolinium in a pre-contrast normal MRI examination.

Summaries in Afrikaans and English / Die primere skoolkind bevind horn in 'n fase van groot verandering wat aanpassings verg en hoe eise stel. Die ervaringe wat die kind gedurende hierdie tydperk opdoen, is beduidend omdat dit sy vormingsjare is. Omdat die kind nie altyd kan verbaliseer watter probleme hy ervaar nie, is met hierdie studie gepoog om vas te stel of skooltekeninge van enige diagnostiese waarde kan wees om die kind in nood te verstaan. Die empiriese studie het bewys dat skooltekeninge nie net waarde as 'n identifiseringsmedium inhou nie, maar ook as 'n aanvullende ortopedagogiese medium aangewend kan word. Die kind neig om sy probleme, persepsies, houdings en so meer visueel te projekteer. Hoewel hierdie studie bevindinge van vroeere navorsing bevestig, is bepaalde verskille ook geidentifiseer. Die studie is afgesluit met riglyne vir die gebruik van skooltekeninge, asook aanbevelings met die oog op die verfyning van hierdie projeksiemedium. / The primary school child finds himself in a phase of great change which makes high demands and requires adjustments. What happens to the child during these years is critical because these are foundation laying years. Because a child is not always able to verbalise problems which he may experience, this study is an . endeavour to determine whether school drawings have any diagnostic value to identify a child in need. The empirical study has confirmed that school drawings have diagnostic value not only as a medium of identification, but also as a supplementary orthopedagogical medium. The child· tends to project his problems, perceptions and attitude visually. Although this study confirms findings of previous studies, certain differences were also identified. The study was concluded with guidelines for the use of school drawings, as well as recommendations regarding the refinement of this projection medium. / Psychology of Education / M. Ed. (met spesialisering in Voorligting)

Background Major incidents are characterized by a lack of resources compared to an overwhelming number of casualties, requiring a prioritization of medical treatment. Triage algorithms are an essential tool for prioritizing the urgency of treatment for patients, but the evidence to support one over another is very limited. We determined the influence of blood pressure limits on the diagnostic value of triage algorithms, considering if pulse should be palpated centrally or peripherally. Methods We used a database representing 500 consecutive HEMS patients. Each patient was allocated a triage category (T1/red, T2/yellow, T3/green) by a group of experienced doctors in disaster medicine, independent of any algorithm. mSTaRT, ASAV, Field Triage Score (FTS), Care Flight (CF), “Model Bavaria” and two Norwegian algorithms (Nor and TAS), all containing the question “Pulse palpable?”, were translated into Excel commands, calculating the triage category for each patient automatically. We used 5 blood pressure limits ranging from 130 to 60 mmHg to determine palpable pulse. The resulting triage categories were analyzed with respect to sensitivity, specificity and Youden Index (J) separately for trauma and non-trauma patients, and for all patients combined. Results For the entire population of patients within all triage algorithms the Youden Index (J) was highest for T1 (J between 0,14 and 0,62). Combining trauma and non-trauma patients, the highest J was obtained by ASAV (J = 0,62 at 60 mmHg). ASAV scored the highest within trauma patients (J = 0,87 at 60 mmHg), whereas Model Bavaria (J = 0,54 at 80 mmHg) reached highest amongst non-trauma patients. FTS performed worst for all patients (J = 0,14 at 60 mmHg), showing a lower score for trauma patients (J = 0,0 at 60 mmHg). Change of blood pressure limits resulted in different diagnostic values of all algorithms. Discussion We demonstrate that differing blood pressure limits have a remarkable impact on diagnostic values of triage algorithms. Further research is needed to determine the lowest blood pressure value that is possible to palpate at a peripheral artery compared to a central artery. Conclusion As a consequence, it might be important in which location pulses are palpated according to the algorithm at hand during triage of patients.

Summaries in Afrikaans and English / Die primere skoolkind bevind horn in 'n fase van groot verandering wat aanpassings verg en hoe eise stel. Die ervaringe wat die kind gedurende hierdie tydperk opdoen, is beduidend omdat dit sy vormingsjare is. Omdat die kind nie altyd kan verbaliseer watter probleme hy ervaar nie, is met hierdie studie gepoog om vas te stel of skooltekeninge van enige diagnostiese waarde kan wees om die kind in nood te verstaan. Die empiriese studie het bewys dat skooltekeninge nie net waarde as 'n identifiseringsmedium inhou nie, maar ook as 'n aanvullende ortopedagogiese medium aangewend kan word. Die kind neig om sy probleme, persepsies, houdings en so meer visueel te projekteer. Hoewel hierdie studie bevindinge van vroeere navorsing bevestig, is bepaalde verskille ook geidentifiseer. Die studie is afgesluit met riglyne vir die gebruik van skooltekeninge, asook aanbevelings met die oog op die verfyning van hierdie projeksiemedium. / The primary school child finds himself in a phase of great change which makes high demands and requires adjustments. What happens to the child during these years is critical because these are foundation laying years. Because a child is not always able to verbalise problems which he may experience, this study is an . endeavour to determine whether school drawings have any diagnostic value to identify a child in need. The empirical study has confirmed that school drawings have diagnostic value not only as a medium of identification, but also as a supplementary orthopedagogical medium. The child· tends to project his problems, perceptions and attitude visually. Although this study confirms findings of previous studies, certain differences were also identified. The study was concluded with guidelines for the use of school drawings, as well as recommendations regarding the refinement of this projection medium. / Psychology of Education / M. Ed. (met spesialisering in Voorligting)

Background Major incidents are characterized by a lack of resources compared to an overwhelming number of casualties, requiring a prioritization of medical treatment. Triage algorithms are an essential tool for prioritizing the urgency of treatment for patients, but the evidence to support one over another is very limited. We determined the influence of blood pressure limits on the diagnostic value of triage algorithms, considering if pulse should be palpated centrally or peripherally. Methods We used a database representing 500 consecutive HEMS patients. Each patient was allocated a triage category (T1/red, T2/yellow, T3/green) by a group of experienced doctors in disaster medicine, independent of any algorithm. mSTaRT, ASAV, Field Triage Score (FTS), Care Flight (CF), “Model Bavaria” and two Norwegian algorithms (Nor and TAS), all containing the question “Pulse palpable?”, were translated into Excel commands, calculating the triage category for each patient automatically. We used 5 blood pressure limits ranging from 130 to 60 mmHg to determine palpable pulse. The resulting triage categories were analyzed with respect to sensitivity, specificity and Youden Index (J) separately for trauma and non-trauma patients, and for all patients combined. Results For the entire population of patients within all triage algorithms the Youden Index (J) was highest for T1 (J between 0,14 and 0,62). Combining trauma and non-trauma patients, the highest J was obtained by ASAV (J = 0,62 at 60 mmHg). ASAV scored the highest within trauma patients (J = 0,87 at 60 mmHg), whereas Model Bavaria (J = 0,54 at 80 mmHg) reached highest amongst non-trauma patients. FTS performed worst for all patients (J = 0,14 at 60 mmHg), showing a lower score for trauma patients (J = 0,0 at 60 mmHg). Change of blood pressure limits resulted in different diagnostic values of all algorithms. Discussion We demonstrate that differing blood pressure limits have a remarkable impact on diagnostic values of triage algorithms. Further research is needed to determine the lowest blood pressure value that is possible to palpate at a peripheral artery compared to a central artery. Conclusion As a consequence, it might be important in which location pulses are palpated according to the algorithm at hand during triage of patients.