<p> When Title IX was first signed into law in the United States in 1972, its intended purpose was to guarantee equal opportunity for women in educational settings. In collegiate athletics Title IX quickly became a battle ground. It became a battle ground over how to increase the number of female collegiate athletes without impacting men&rsquo;s programs, and also a battle ground over who would have primary responsibility for the administration of women&rsquo;s sports. When the male-dominated NCAA took over the administration of women&rsquo;s varsity teams after a 10-year battle with the female-led AIAW, female athletic administrators were forced to relinquish their authority over long-held ideals which governed women&rsquo;s sports. The AIAW and other leaders in women&rsquo;s collegiate athletics didn&rsquo;t go down without a fight, and many expressed grave concern for the direction of women&rsquo;s athletics under the leadership of men. Now, more than 40 years after the implementation of Title IX, after dramatic increases have been realized in the number of women competing on collegiate sports teams across the US, what if those fears have been realized? Are women&rsquo;s sports and female athletes better now that they have been forced to adopt the male model of collegiate competition, or would the increases in participation and the opportunities for female athletes, female coaches, and female administrators have been even more dramatic if the AIAW had survived? The principles of education, participation, and character that governed women&rsquo;s athletics for nearly 100 years have been lost in a system that only sees one way of administering athletics. Women have been forced to adopt a male approach to athletics for the sake of equality, but is equal really better? Is there a path that leads to a future where women once again lead women&rsquo;s athletics? I think there is, and this dissertation points the way.</p>

<p> The purpose of this study is to examine the role of physicians in the process of healing within the context of our current medical system. As an autoethnographic study, it explores the healing process from wounds the researcher experienced as a physician, teacher, student, and at times a sick patient. This study reflects on the experiences, insights, and observations that have molded the researcher&rsquo;s spirit toward that of a healer not only of patients but also of the fragmented medical system. This study explores the early childhood experiences and wounds that were instrumental in the researcher&rsquo;s initial pursuit of a medical career. In addition, this study explores how the researcher&rsquo;s journey of over 40 years, dedicated to practicing high tech, high risk, intensive care medicine of critically ill patients has deeply shaped the researcher&rsquo;s persona as a healer. Since the time of the researcher&rsquo;s initial specialization in medicine, other areas of medicine as well as other disciplines relating to the humanities have been explored. This study incorporates the lessons, knowledge, experiences, and perspectives from those disciplines and thereby expands the scope of this research study. The autoethnographic approach is appropriate for gaining a greater understanding of self, others, and the culture. The essence of healing necessitates the integration of mind, body, spirit, and consciousness, which encompass multiple therapeutic approaches. In summary, the healing process incorporates aspects of both art and science that optimally benefit not only the patient, doctor, and healer, but also the medical system.</p>

<p>Iron is an essential nutrient involved in numerous cellular functions and tightly regulated within cells. It is extremely important to maintain both systemic and intracellular iron homeostasis by orchestrating iron uptake, storage, utilization and export. Many human diseases are associated with disruption of iron homeostasis. Both iron overload and iron deficiency have been associated with cardiomyopathy and heart failure, but the molecular details of cardiac iron utilization are incompletely understood. Although it was known that transferrin receptor 1 (Tfr1) is responsible for iron uptake in erythroid precursors, its role in other tissues, and other possible roles, have not been studied in detail. We hypothesized that Tfr1 might play a role in cardiac iron uptake and used gene targeting to examine the role of Tfr1 in the heart in vivo. Tfr1 was deleted specifically in cardiomyocytes, and loss of Tfr1 caused iron deficiency in the heart. Surprisingly, we found that decreased iron was associated with severe cardiac metabolic consequences. Mice lacking Tfr1 in the heart died in the second week of life, with cardiomegaly, poor cardiac function, failure of mitochondrial respiration and ineffective mitophagy. The phenotype could only be rescued by aggressive and ongoing iron therapy, but it was ameliorated by either a mutant Tfr1 allele that does not bind transferrin or administration of nicotinamide riboside, an NAD precursor. </p><p> In summary, our study found that Tfr1 plays a primary role in uptake of Tf-bound iron in the heart, and yet may have other iron-independent functions in autophagy. Our results showed that iron is critical for the normal cellular metabolism, mitochondrial respiration and mitophagy in the heart. Our findings underscore the importance of both Tfr1 and iron in the heart and provide mechanistic evidence for iron therapy in heart failure patients. By elucidating the processes iron participates in the heart and the consequences of cardiac iron deficiency, our study may inform the identification of new therapeutic targets for heart failure. Finally, we found that NR prolonged the lifespan of mice with cardiac iron deficiency, suggesting possible benefit in treating heart failure accompanied by iron deficiency.</p> / Dissertation

Many antibiotics have been developed and are available on the market. An increase in the use of antibiotics in hospitals was observed and antibiotics are among the medicines most commonly prescribed to paediatric patients. Resistance to antibiotics is increasing and is a major problem not only in the Paediatric Intensive Care Unit at Universitas Hospital in Bloemfontein, but in South Africa in general. The continued value and effectiveness of antibiotics depend on careful use to avoid bacterial resistance from developing. Thus, guidelines for rational antibiotic use and prevention of resistance should be developed and implemented. This requires an understanding of the factors influencing antibiotic use in a particular setting, in this case the Paediatric Intensive Care Unit at Universitas Hospital. Therefore, the aim of this study is to describe the factors that influence the use of antibiotics in the Paediatric Intensive Care Unit from 1998 to 2007. This research consisted of a retrospective study of the records of patients admitted to the Paediatric Intensive Care Unit from 1998 to 2007. Using a datasheet, the following information was captured and evaluated: patientsâ demography, indication for admission, co-morbid conditions, antibiotic and other drug therapy, culture and sensitivity and other relevant parameters. Of the 1 221 patients admitted during the study period, information could only be retrieved for 967 patients, and of these 685 patients (385 males and 299 females) met the study criteria. The Paediatric Intensive Care Unit performance, measured as Intensive Care Unit utilisation, was optimal at 63%, implying that no patient needing intensive care was denied. The most common conditions on admission were respiratory (23.4%), gastro-intestinal (22%) and cardiovascular (19%) related problems. Pneumonia (8.9%) was the most common infective condition. The most common infective complications while in the Paediatric Intensive Care Unit were pneumonia (35.6%), septicaemia (11.1%) and urinary tract infection (8.8%). Broad-spectrum antibiotics were prescribed the most widely. The top ten antibiotics included cefotaxime (18.2%), amikacin (14.7%), vancomycin (9.8%), cefuroxime (8.1%) imipenem (7.5%), metronidazole (7.2%), penicillin G (6.5%), cloxacillin (4.1%), co-trimoxazole (2.7%) and gentamicin (2.4%). The top ten bacteria genera cultured were Staphylococcus (29.3%), Klebsiella (11.9%), Acinetobacter (11.7%), Pseudomonas (11.2%), Escherichia (8.5%), Enterococcus (5.9%), Streptococcus (4.1%), Enterobacter (4.1%), Stenotrophomonas (3.4%) and Haemophilus (2%). There was high resistance of the Staphylococcus genus to penicillins and penicillin-allergy substitutes (>80%, with methicillin-resistance of 85%), but no resistance to vancomycin was observed. The Klebsiella and Pseudomonas genera exhibited considerable resistance to most aminoglycosides (40â78%) and cephalosporins (70â100%), but Klebsiella remained sensitive to imipenem (1.9%), while Pseudomonas was moderately sensitive to amikacin (22.9%). The nosocomial bacteria genera Acinetobacter and Stenotrophomonas were resistant (>70%) to almost all antibiotics excluding tobramycin (25.8%) for Acinetobacter and co-trimoxazole (10.5%) for Stenotrophomonas. Lastly, the persistently challenging factors that influenced antibiotic use in the Paediatric Intensive Care Unit from 1998 to 2007 were common bacteria cultured from specific specimens, bacterial innate resistance, interaction of bacterial and host factors (multiple and severe infections), disease pattern, new antibiotics, overuse of antibiotics, length of stay, personal preferences and treatment guidelines. In conclusion, it was illustrated that bacterial resistance to antibiotics is increasing, and that antibiotic use in the Paediatric Intensive Care Unit at Universitas Hospital was greatly influenced by the efforts to contain antibiotic resistance.

INTRODUCTION Switching from screen-film mammography to digital mammography entails a lot more for the reporting radiologists, than switching from a light box to a computer monitor. Soft-copy viewing of the digitally processed image demands different skills and thus knowledge from the radiologist. The image processing option on digital mammography units is vendor dependant and the optimal processing options have not yet been established. The main aim of this study was to develop and evaluate a soft-copy viewing protocol for mammography through participative learning to improve radiological reporting. METHODS A phantom-based method was used to identify a smaller set of processing options to be evaluated for image quality assessment on clinical images. Three (3) radiologists were trained in the new modality with specific emphasis on how to address the challenges of soft-copy viewing. The viewing protocol was developed through participative learning. The radiologists scored the image quality on thirty six (36) medio-lateral oblique images processed with four (4) different image processing options (MUSICA2, MUSICA2 Invert, Unprocessed, and Unprocessed Invert). An image quality score was calculated to find the best processing option for the anatomical structures overall, anatomical structures individually, masses, calcifications, noise, and the early detection of breast cancer. A viewing protocol was recommended based on the findings. The effect of the viewing protocol was assessed by comparing diagnostic accuracy of the radiologists before and after the viewing protocol. They reported on eighty (80) mammograms using the breast imaging and reporting data system (BI-RADS) of the American College of Radiology. Sensitivity, specificity, positive predictive value (PPV) and BI-RADS category 3 were calculated and compared. RESULTS The phantom-based method found Unprocessed Invert, MUSICA2, MUSICA2 Invert, and Unprocessed to provide the best image quality. These processing options were therefore identified for image quality assessment on clinical images. For the anatomical structures overall, MUSICA2 provided significantly superior image quality compared to Unprocessed (p<0.0001) and Unprocessed Invert (p<0.0001). MUSICA2 Invert also provided significantly superior image quality compared to Unprocessed (p<0.0001) and Unprocessed Invert (p=0.0003) for that. The only significant difference between MUSICA2 and MUSICA2 Invert was found for skin outline for which MUSICA2 Invert showed superiority (p=0.0563). The image quality of vessels in dense parenchyma was found be significantly inferior to that of all other anatomical structures with all processing options, even with the processed images (p<0.0001). For calcifications MUSICA2 provided significantly superior image quality compared to Unprocessed and its Invert (p=0.0066 and p=0.0001 respectively). However, no significant difference was found between any of the processing options for masses (p>0.05). Noise was significantly less visible for Unprocessed compared to MUSICA2 (p = 0.016) although it was still acceptable to all three radiologists in 97.2% of cases with MUSICA2. For the early detection of breast cancer, MUSICA2 was found to be significantly superior to Unprocessed (p=0.0003) and Unprocessed Invert (p=0.0005). The recommended default processing option for the viewing protocol was MUSICA2 Invert. After the development of the viewing protocol, sensitivity increased for two of the radiologists [from 90% to 95% (p=0.6752)], and from 90% to 97.5% (p =0.3589) respectively]; specificity increased for two of the radiologists [from 61.5% to 72.5% (p=0.2999), and from 70% to 85% (p=0.1082) respectively]; PPV increased for all three radiologists [from 71.7% to 77.6% (p=0.6198), from 75% to 86.4% (p=0.1699), and from 83.7% to 84.8% (p=0.8907) respectively]. The percentage BI-RADS category 3 cases decreased for two of the radiologists [from 15% to 12.5% (p=0.6461) and from 28.8% to 22.5% (p=0.2810) respectively]. CONCLUSIONS Although not significant, the study found improvement in diagnostic accuracy after the development of the viewing protocol. Training of radiologists in the new modality and knowledge of the effect of image processing on image quality is regarded as important. The development of the viewing protocol through participative learning of the radiologist provided evidence to the radiologists that they could confidently use the proposed viewing protocol in clinical practice.

Introduction: The need for physiotherapy intervention in the treatment of mandibular condyle fractures has been highlighted. No unifying criteria are currently available regarding a postsurgical functional exercise program for patients who sustained mandibular condyle fractures. Aim: The research study conducted aimed to perform a needs analysis amongst maxillo-facial surgeons and physiotherapists in South Africa, regarding the perceived need for a postoperative physiotherapy intervention program for patients who sustained mandibular condyle fractures. The study also aimed to develop a post-operative functional exercise program for patients who sustained mandibular condyle fractures. Methodology: The first part of the research comprised of a needs analysis questionnaire, sent out to qualified experts: one physiotherapist and one maxillo-facial surgeon from each of the training institutions in South Africa. The data obtained from the needs analysis questionnaire was used to compile an online questionnaire with statements regarding the type and dosage of a suitable physiotherapeutic treatment protocol. The Delphi method was used, and this questionnaire was sent out to a further 20 experts (national and international) in the fields of physiotherapy, maxillo-facial surgery and dental surgery. A convenience sampling method was used to select appropriately trained participants for the needs analysis and Delphi questionnaire. Results: A definite need for physiotherapy intervention for mandibular condyle fracture patients was proposed by the needs analysis participants (100%). A total of 85.7 % (needs analysis) and 100 % (Delphi questionnaire) of respondents indicated that all mandibular condyle fracture patients should receive in-hospital physiotherapy intervention. By utilising the Delphi method, a suitable physiotherapy intervention program for mandibular condyle fracture patients was developed. Inter-reviewer consensus was reached regarding what each exercise entails, as well as what in-hospital physiotherapy visits should be comprised of. Stability was reached regarding the commencement and dosage of the various jaw exercises. Conclusion: Experts in the field proposed that physiotherapists should provide post-operative rehabilitative therapy to patients who have sustained mandibular condyle fractures. The proposed post-surgical intervention program provided in this study can serve as a baseline for implementation in further research studies. The advantages of referring mandibular condyle fracture patients to physiotherapy were also presented.

<p> The Centers for Disease Control (CDC) and the World Health Organization (WHO) estimate that there are approximately 1.4 million cases of hospital acquired infections (HAIs) at any given time worldwide. Recent reports indicate that 722,000 patients acquire HAIs, with 75,000 or more succumbing to the infections and dying. This quality improvement project focused on the value of re-educating practicing nurses on hand hygiene practices as an approach to reduce the incidence of HAIs. Pre-intervention rates of HAIs were compared with post-intervention rates of HAIs across 2 units (Unit A and Unit B) in an acute care setting to determine if re-educating nurses about hand hygiene was a plausible strategy in reducing HAIs in the acute care setting. The pre-intervention mean rate of Unit A was 0.146% and the post-mean rate was 0.00%. A Wilcoxon signed-rank test showed that the educational intervention did not elicit a statistically significant change in infection rates (z = -1.63, p > 0.05). Similarly, the pre-intervention mean rate of Unit B was 0.12% and the post-mean rate was 0.00%. A Wilcoxon signed-rank test showed that the educational intervention did not elicit a statistically significant change in infection rates (z = 1.732, p > 0.05). Despite the lack of statistical significance, there was a reduction in the mean rate to 0.00% following the educational intervention. The results of this quality improvement project suggest a value in re-educating nurses on the importance of hand hygiene as a strategy to reduce and prevent HAIs in health care organizations in order to promote positive patient outcomes. </p>

Pro gradu tutkimuksessa tutkittiin gerontologiseen hoitotyöhön osallistuvien sairaanhoitajien, lähihoitajien ja lähiesimiesten asennetta, osaamista ja edistäviä ja estäviä tekijöitä näyttöön perustuvaa toimintaa kohtaan. Tutkimuksen tarkoituksena oli kuvata ja selvittää yhden suuren kaupungin gerontologiseen hoitotyöhön osallistuvan hoitohenkilökunnan ja lähiesimiesten näyttöön perustuvaa asennetta, osaamista sekä näyttöön perustuvan hoitotyön edistäviä ja estäviä tekijöitä. Tutkimuksen tavoitteena oli tuottaa tietoa näyttöön perustuvan hoitotyön haasteista, jotta voidaan jatkossa kehittää näyttöön perustuvaa toimintaa gerontologisessa hoitotyössä. Tutkimuksen aineisto kerättiin sähköisellä kyselylomakkeella, joka lähetettiin sähköpostitse henkilöstölle lähiesimiesten kautta (n=85). Vastausprosentti oli 9.9 %. Aineisto analysoitiin tilastollisesti SPSS ja Excel-ohjelmilla. Avoin kysymys analysoitiin kvantitatiivisella sisällön erittelyllä. Tutkimuksen tuloksissa hoitohenkilökunnan ja lähiesimiesten asenteet näyttöön perustuvaa hoitotyötä kohtaan ovat positiiviset. Lähiesimiesten ja hoitohenkilökunnan tutkitun tiedon osaamista tulee edelleen vahvistaa ja työyksiköissä tulee tarkastella monipuolisten tietoyhteyksien ja – lähteiden mahdollisuuksia tutkitun tiedonhaun mahdollistamiseksi. Gerontologisessa hoitotyössä näyttöön perustuvan hoitotyön estäviä tekijöitä olivat tieteellisten tutkimusten heikko saatavuus ja elektronisten tietokantojen puuttuminen. Näyttöön perustuvan hoitotyön edistävänä tekijänä oli koulutusmahdollisuus. Tutkimustuloksia voidaan hyödyntää gerontologisessa hoitotyössä hoitajien ja lähiesimiesten osaamisen kehittämisessä. Tutkimus tuotti tietoa paikallisista hoitotyön olosuhteista, joita voidaan käyttää hyväksi gerontologisen hoitotyön kehittämisessä. Lisäksi tutkimustuloksia voidaan hyödyntää hoitotyön koulutuksessa ja sen kehittämisessä. Yhteiskunnan näkökulmasta on tärkeää huolehtia hoitotyöntekijöiden ja lähiesimiesten riittävästä osaamisesta hoidon vaikuttavuuden, kustannustehokkuuden ja tuloksellisuuden parantamiseksi.

BACKGROUND: Management of chronic diseases has become one of the major challenges for the health care community. Most of disease management relies on patient’s self-management, influenced in part by their illness perspectives or explanatory models of illness (EMI). Unfortunately, assessing patient’s EMI and using this information to engage patients in chronic illness self-management continues to be a challenge. This is due to time constraints, ambiguity in the design of EMI assessments, lack of motivation, and low health literacy. This study used ‘mind mapping’, a graphic representation of ideas, to develop a process that captures EMI. We will refer to this process as “Health Mind Mapping” (HMM). We explored patient’s experiences using HMM and potential uses of this tool during their care. METHODS: 20 adult (>18 years old) English and Spanish patients with uncontrolled (HbA1c >7%) type 2 diabetes were recruited from a primary care clinic. Participants developed their health mind maps with the guide of a facilitator. Each participant also completed a semi-structured interview in which patients were asked about their experience with HMM. The HMM process and qualitative interviews were video and audio recorded. Transcriptions were analyzed using grounded thematic analysis to identify how patients perceived and were impacted by the process. RESULTS: Two domains regarding the HMM process were identified: patient’s perceptions of the process itself and patient’s reports of potential uses of HMM. Three main themes related to the process itself emerged: 1) Helps to develop insight about self and illness; 2) Catalyst for taking actions to improve their illness; 3) Opportunity to actively share illness. Four main themes related to potential uses of HMM were identified: 1) Communicating their illness to others in their social network; 2) Communicating with their providers; 3) Share to help others with diabetes; 4) Use to encourage ongoing engagement in diabetes self-care. CONCLUSIONS: HMM helped patients to develop new insight about their illness and represented a catalyst for taking control of their illness. Additional research is needed to determine how to use HMM to facilitate patient communication and better engage patients in collaborative goal setting to improve self-care in chronic illness. / 2017-05-05T00:00:00Z

The United States spends about 17% of its gross domestic product (GDP) on healthcare, the most of any industrialized nation. Oncology care alone accounts for 5-10% of this expenditure. Although the cancer survival data in the US are better than of most industrialized nations, the fact that healthcare expenditure is rising faster than the GDP makes the current situation unsustainable. In 2010 lung cancer accounted for 13% of the 124 billion dollars the USA spent on cancer care. Though survival for some patients with metastatic non -small cell lung cancer is improving with increasing use of targeted therapy, for the majority of patients it is still short but the amount of money spent treating them is quit high. With many different chemotherapy regimens to choose from , different threshold for individual clinicians to initiate and discontinue therapy as well as the lack of firm guidelines to image patients during treatment, we decided to study the cost and cost distribution of treating this patient population at our institution with the goal of identifying areas of waste reduction and improve efficiency.