What is known and objective: Amiodarone, a commonly used class III antiarrhythmic agent notable for a relatively long half-life of up to 6 months and its pronounced adverse effect profile, is used for both acute and chronic management of cardiac arrhythmias. Chronic use of amiodarone has been associated with asymptomatic hepatotoxicity; however, acute toxicity is thought to be uncommon. There are only six reported cases of acute liver failure (ALF) secondary to amiodarone. In all these cases the outcome of death during the same hospitalization resulted. We aimed to report the only case of acute liver failure secondary to amiodarone infusion in the existing literature where the patient survived. Case summary: A 79-year-old woman admitted with atrial flutter was being treated with intravenous (IV) amiodarone when she abruptly developed coagulopathy, altered mental status and liver enzyme derangement. She was diagnosed with acute liver failure (ALF) secondary to an amiodarone adverse drug reaction, with a calculated score of seven on the Naranjo adverse drug reaction probability scale. Amiodarone was immediately withheld, and N-acetylcysteine (NAC) was initiated. Clinical improvement was seen within 48 hours of holding the drug and within 24 hours of initiating NAC. On post-hospital follow-up visit she was reported to have complete recovery. What is new and conclusion: This report emphasizes the importance of monitoring liver enzymes and mental status while a patient is being administered IV amiodarone. N-acetylcysteine administration may have possibly contributed to the early and successful recovery from ALF in our patient. To date, she is the only patient in the existing literature who has been reported to survive ALF secondary to amiodarone administration.

Philosophiae Doctor - PhD / The growing interest in the well-being of children who have been orphaned due to HIV/AIDS is widely reflected in the emerging body of research. Children orphaned by AIDS-related causes are identified as a vulnerable population of youth who display lower levels of psychosocial well-being and experience increased psychosocial distress. While HIV-related stigma remains a salient risk factor hindering the psychosocial well-being of children orphaned by AIDS, the concept remains elusive and poorly understood. Hence, the call for a comprehensive understanding to support an effective response to stigma reduction, and for the systematic identification and response to the psychosocial needs and challenges of children in the context of HIV/AIDS. The overall aim of this study was therefore to develop a model to understand the manner in which HIV-related stigma affects the psychosocial well-being of children orphaned by AIDS. A mixed method, exploratory, sequential design situated within a theory generative research approach was implemented in four sequential phases geared towards model development. The specific objectives of this study were to: (1) review existing literature focusing on the relationship between HIV-related stigma and the psychosocial well-being of children orphaned by AIDS (systematic review); (2) explore children orphaned by AIDS perceptions and experiences of HIV-related stigma (qualitative exploratory design); (3) develop a model that offers an understanding of the manner in which HIV-related stigma affects the psychosocial well-being of children orphaned by AIDS (a theory generative design); and (4) determine the functionality of the developed model through the use of the Delphi technique (a modified Delphi technique). The systematic review conducted in Phase I indicated the presence of HIV-related stigma, which inhibited the psychosocial well-being of children orphaned by AIDS. The findings further highlighted the mediating role of maladaptive coping strategies and social support likely to reduce healthy psychosocial well-being and cause psychosocial distress among children orphaned by AIDS. Similarly, the findings arising from the qualitative exploration in Phase II indicated that children orphaned by AIDS were highly perceptive and experienced HIV-related stigma as a result of parental illness and death. These experiences negatively affected the psychological, emotional, and social well-being, self-concept and self-esteem, and future orientation of children orphaned by AIDS. The theory generative design in Phase III identified, classified, and defined six focal concepts upon which the model is based, namely, (1) enacted stigma, (2) perceived stigma, (3) internalized stigma, (4) coping strategies, (5) psychosocial well-being, and (6) interpersonal relations. The developed relationship statements of the model indicated: (1) the bidirectional relationship between enacted, perceived, and internalized stigma; (2) the mediating role of coping strategies; (3) the direct and indirect influences of HIV-related stigma on the psychosocial well-being of children orphaned by AIDS; and (4) the contextual role of interpersonal relationships in which the process of stigmatization may unfold. The modified Delphi technique conducted in Phase IV indicated that the developed model was simplistic, clear, generalizable, accessible, and important for use in research and practice. The developed model will aid future studies by providing a theoretical lens through which HIV-related stigma and its influence on the psychosocial well-being of children orphaned by AIDS may be viewed. HIV-related stigma should be considered strongly when addressing the well-being of orphaned children, so that tailored programs, interventions, and services may be set in place to effectively bring about the reduction of stigma and ensure the psychosocial well-being of children. The recommendations set out serves to further inform practice and programs and form a baseline for future empirical research focusing on HIV-related stigma and the psychosocial well-being of children orphaned by AIDS.

BACKGROUND In 2010, glycated haemoglobin A1c (HbA1c) was officially recommended as a screening tool to diagnose type 2 diabetes mellitus (T2DM) and pre-diabetes, with cut-off points 6.5% and 5.7% to 6.4% respectively. The implications of using the HbA1c criterion, compared to the general diagnostic criteria: fasting glucose test (FPG) and oral glucose tolerance test (OGTT), is however still being debated. OBJECTIVES The objectives of this study were to evaluate and compare the pooled prevalence of type 2 diabetes mellitus (T2DM) and pre-diabetes, as measured by the Haemoglobin A1c (HbA1c) test, or the fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT). Secondly, to determine and compare the diagnostic test characteristics (sensitivity, specificity) of these tests. METHODS Published papers, with a cross sectional study design, were selected for a systematic review and meta-analysis. The search strategy was an electronic review of journal articles listed on MEDLINE, PubMed and Google scholar between 1996 and 2012. Reference lists were checked, journals were hand searched and experts were contacted when necessary. Initially all studies related to the validation of HbA1c as a tool to detect pre-diabetes or T2DM in humans, published in English, were examined. Studies were excluded if they did not meet the above mentioned criteria, and/or were conducted with pregnant women. Further analysis was done if FPG or OGTT was compared to HbA1c. The diagnosis of diabetes had to have been based on ADA or WHO criteria. These criteria are: HbA1c 5.7%-6.4% for pre-diabetes and >=6.5% for T2DM; FPG 5.6mmol-7mmol/l for pre-diabetes and >=7mmol/l for T2DM; OGTT 7.8mmol-11.1mmol/l for pre-diabetes and >=11.1mmol/l for T2DM). The OGTT and FPG tests were used as the reference tests and the prevalence reflected as a positive or negative proportion. The sensitivity and specificity of HbA1c >=6.5% among cases defined by OGTT or FPG should have been reported, or it was possible to calculate these from the data provided. Study results relating to diagnostic accuracy were extracted and synthesized using multivariate random effects meta-analysis methods. This study focused on patients who were suspected of having T2DM, from two sub-groups (a community-based group and a high-risk group) to compare the detection rate of HbA1c with FPG and OGTT. / Dissertation (MSc)--University of Pretoria, 2014. / lk2014 / School of Health Systems and Public Health (SHSPH) / MSc / Unrestricted

This manuscript provides a critical review of the literature on parent–child physiological synchrony—the matching of biological states between parents and children. All eligible studies found some evidence of physiological synchrony, though the magnitude and direction of synchrony varied according to methodological factors, including the physiological system examined (i.e., parasympathetic or sympathetic nervous system activity, adrenocortical functioning) and the statistical approach used (e.g., multilevel modeling, correlation). The review underscores the need to consider the context in which physiological synchrony occurs (e.g., family risk) to best understand its significance. Furthermore, the review delineates vital avenues for future research, including the need to assess synchrony across multiple physiological systems and the importance of documenting continuity/change in physiological synchrony across developmental periods. Such research is crucial for understanding how the parent–child relationship unfolds at a physiological level and, in turn, how this relationship can facilitate or hinder parent, child, and family adjustment.

Background: Nurses are responsible for creating a trustworthy relationship and good communication with patients as well as relatives. Swedish universities provide limited education regarding palliative care for students in the nursing program and relatives experience several deficits in nurses treatment. Relatives wish to be seen and recieve emotional support by the nurses. Aim: To describe nurses experiences of meeting relatives of dying patients Method: Systematic literature review with qualitative approach and descriptive synthesis according to Evans’ (2002) description of the analysis method. Results: The nurses experienced deficiency in their communication with relatives. The majority of challenges and difficulties described were rooted in lack of time and lack of experience and education according to the nurses. Meeting with relatives also became a challenge as the nurses had to play the role as intermediary between the patients and their families. Furthermore, the nurses became emotionally involved with the patients which led to difficulties in maintaining professionality. Conclusion: The education provided for nursing students in the current situation is insufficient in comparison with the requirements the nurses experience in the workplace. This affects not only the nurses but the relatives as well as they may be overlooked. Relatives need more of the nurses’ time to feel seen and a change in the nursing program is needed for future nurses to be prepared for the profession. / Bakgrund: Sjuksköterskor ansvarar i sitt arbete för att skapa förtroendefulla relationer och god kommunikation med patient såväl som anhöriga. Svenska lärosäten tillhandahåller begränsad utbildning inom palliativ vård för studenter på sjuksköterskeprogrammet och anhöriga upplever flertalet brister i sjuksköterskors bemötande. Anhöriga vill bli sedda och stöttade i sina känslor av sjuksköterskor. Syfte: Att beskriva sjuksköterskors upplevelser av att bemöta anhöriga till döende patienter. Metod: Systematisk litteraturstudie med kvalitativ ansats och beskrivande syntes enligt Evans (2002) beskrivning av analysmetoden. Resultat: Sjuksköterskorna upplevde brister i sin kommunikation med anhöriga. Flertalet av de utmaningar och svårigheter som beskrevs grundade sig i tidsbrist och brist på erfarenhet och utbildning enligt sjuksköterskorna. Bemötande av anhöriga blev även en utmaning då sjuksköterskorna fick agera mellanhand mellan anhöriga och patienten. Dessutom blev sjuksköterskorna emotionellt involverade med de anhöriga vilket ledde till svårigheter att upprätthålla sin professionella yrkesroll. Slutsats: Utbildningen som tillhandahålls för sjuksköterskestudenter är i dagsläget otillräcklig i jämförelse med de krav som sjuksköterskor upplever på arbetsplatsen. Detta påverkar inte enbart sjuksköterskorna utan även anhöriga som kan bli förbisedda. Anhöriga behöver få mer av sjuksköterskornas tid för att upplevas sedda och det behövs en förändring i sjuksköterskeutbildningen för att framtida sjuksköterskor ska komma förberedda ut i yrket.

Water scarcity is an issue faced across the globe that is only expected to worsen in the coming years. We are therefore in need of methods for treating non-traditional sources of water. One promising method is desalination of brackish and seawater via reverse osmosis (RO). RO, however, is limited by biofouling, which is the buildup of organisms at the water-membrane interface. Biofouling causes the RO membrane to clog over time, which increases the energy requirement of the system. Eventually, the RO membrane must be treated, which tends to damage the membrane, reducing its lifespan. Additionally, antifoulant chemicals have the potential to create antimicrobial resistance, especially if they remain undegraded in the concentrate water. Finally, the hazard of chemicals used to treat biofouling must be acknowledged because although unlikely, smaller molecules run the risk of passing through the membrane and negatively impacting humans and the environment. It is, therefore, integral to investigate techniques for prevention of biofouling and removal of mature biofilms that are effective, less damaging to the membrane, and safe for humans and the environment. A common experimental setup is biofilm antimicrobial microdilution susceptibility tests. To acquire meaningful data from these tests, however, appropriate organisms must be tested. Manuscripts 1 investigates, via semi-systematic reviews, the question of what organisms are appropriate to represent the complexity of a biofilm in antimicrobial tests. Ultimately, we recommend utilizing the model biofilm-forming, pioneer organism, Pseudomonas aeruginosa for these studies. Biofouling studies also must present data in a useful manner to the many disciplines that are interested in preventing or removing biofouling. Our goal is to investigate both via antimicrobial microdilution susceptibility tests. In Manuscript 2 we investigate the metrics of each discipline with an interest in anti-biofouling studies. Ultimately we recommend utilizing both crystal violet stain to assess total biomass removal and the LIVE/DEAD BacLight stain to assess cell vitality (including log reduction and MIC, BPC, MBIC, MBC, BBC, and MBEC), to satisfy the metrics of all interested disciplines. Finally, in Manuscript 3 we implement the recommendations from Manuscripts 1-2 for biofilm prevention and biofilm removal antimicrobial microdilution susceptibility tests. In this manuscript, we work with a subset of safer preservatives including, methylisothiazolinone, phenoxyethanol, and sodium benzoate. We found that methylisothiazolinone was the most effective antimicrobial, however, it was not the safest. Additionally, we investigated the relationship between MBIC and BPC, which was found to vary between the preservatives. Ultimately, we have provided recommendations for biofilm antimicrobial susceptibility tests that produce widely applicable and useful metrics, as well as utilized these recommendations to investigate the efficacy of safer antimicrobials. All of this work provides a framework for which even safer and effective novel antimicrobials can be investigated. / Graduate / 2021-07-22

The secondary analysis undertaken for this MPH dissertation examines the global prevalence of trichiasis in relation to gender in trachoma endemic countries. Part A is the research protocol which outlines the background and the process of this research. This study is a population-based analytical study using data from the Global Trachoma Mapping Project (GTMP). GTMP was a standardized population-based trachoma prevalence survey undertaken to provide trachoma prevalence estimates. GTMP data was collected using the World Health Organisation–recommended population based prevalence survey methodology. Trachoma suspect district were identified for inclusion and multistage random sampling was used to sample households for examination of residents for clinical trachoma. Part B presents the background and highlights the importance of this research by exploring the existing theoretical and empirical literature relevant to the topic. It describes how trachoma is transmitted, its clinical manifestations, and the way it can lead to blindness. Results from previous studies on gender and trichiasis are presented. Part C presents the research project in a format suitable for journal submission. The background of this research project is summarized and the meta-analysis is conducted at the global level, at the country level, the regional level, the state level and at the EU level but all in accordance to prevalence of trichiasis in the EUs. The implications of the findings are discussed and limitations in interpretation presented.

BACKGROUND: Delayed symptomatic hyponatremia (DSH) is among the most common reasons for readmission following transsphenoidal surgery. Patients can present with a large range of symptoms, requiring immediate attention and prolonging hospital stay. In rare and severe cases, DSH can result in death. While various risk factors for DSH have been investigated, there is still a need for better understanding in order to identify patients who are at risk. Clinicians can then take preventative measures to improve patient outcomes. A systematic review was performed to determine both predictors and rates of DSH after both endoscopic (eTSS) and microscopic transsphenoidal surgery (mTSS). METHODS: We conducted a systematic search through databases MEDLINE/PUBMED, MEBASE, and The Cochrane Library. Included studies were selected with the following criteria: (i) case series with at least 10 cases reported, (ii) adult patients who underwent eTSS or mTSS for pituitary adenomas, and (iii) reported occurrence of DSH (hyponatremia defined as blood sodium level <135 mEq/L) three days post-operatively. Data were analyzed using CMA V.3 Statistical Software (2014). RESULTS: We identified 10 case series that satisfied the inclusion criteria consisting of 2,947 patients with pituitary adenomas. The following were investigated as potential predictors of DSH: age, CSF leak, gender, and tumor size. Rates of DSH were found to be between 4 and 12 percent for both mTSS and eTSS. CONCLUSIONS: Age, gender, tumor size, rate of blood sodium level decline between post-operative day (POD) 4 and 7, and Cushing’s disease are potential predictors of DSH. A better understanding of these predictors can help clinicians identify patients at risk for DSH so preventative measures can be taken to reduce the deleterious effects of hyponatremia after transsphenoidal surgery.

No description available.

No description available.