ABSTRACT Cephalopelvic disproportion (CPD) is a common and serious obstetric condition, especially in sub-Saharan Africa. Recognition relies on clinical observations, such as cervical dilatation, head descent, moulding, and size of fetus, all made in a trial of labour. No prospective studies have investigated intrapartum clinical observations and their predictive value for CPD. The objectives of this research were 1) to determine the association of intrapartum clinical findings, especially level of head and moulding, with the outcome of CPD, 2) to determine inter-observer agreement of these findings between clinicians, and 3) to compare intrapartum clinical palpation with symphysis-fundal height (SFH) measurement in the prediction of birth weight. A prospective cross-sectional comparative study was done in the Chris Hani Baragwanath labour ward, a large referral centre. The subjects were women at term, in the active phase of labour, with vertex presentations. The author, blinded to previous clinical or ultrasound findings, performed clinical assessments at the same time as the women’s attending clinicians. His observations were not divulged to the clinicians and he did not participate in obstetric management of the women. The primary outcome measures were CPD, defined as caesarean section for poor progress, and birth weight. Five hundred and eight women were examined, of whom 113 (22.2%) had CPD. Multivariate analysis identified short maternal stature, increased SFH, lesser cervical dilatation, long duration of labour, high degree of parieto-parietal moulding, and high degree of caput succedaneum as independent predictors for CPD. Fetal position and occipito-parietal moulding were not predictive, and level of head, by fifths and by station, was poorly predictive. Inter-observer agreement between the author and attending clinicians was moderate for cervical dilatation, engagement of the head in fifths, and caput succedaneum, and poor for engagement of the head by station. SFH measurement was a slightly better predictor of birth weight than clinical fetal weight estimation. The clinical observations that were shown to be predictive for CPD may be useful adjuncts in the management of a trial of labour. Inter-observer agreement of these findings is at best moderate. Measurement of SFH deserves more attention as an intrapartum predictor of birth weight.

Counseling psychology doctoral trainees’ satisfaction with their clinical methods training is an important predictor of their self-efficacy as counselors, persistence in graduate programs, and probability of practicing psychotherapy in their careers (Fernando &Hulse-Killacky, 2005; Hadjipavlou &Ogrodniczuk, 2007; Morton &;Worthley, 1995). Much of the extant literature related to assessing psychology graduate students’ satisfaction with their training has focused on supervision processes and has not adequately assessed other elements of training such as coursework, clinical experiences, and the learning contexts of practicum sites and program settings. Additionally, the available research is largely quantitative data based on geographically restricted samples that does not adequately explain reasons for trainees’ satisfaction or dissatisfaction. The purpose of the present study was to broadly identify factors that contribute to counseling psychology doctoral students’ satisfaction with their clinical methods training in coursework, clinical experiences, supervision, and practicum and program contexts. Eight advanced doctoral trainees from APA-accredited programs in counseling psychology were interviewed about their satisfaction with their training experiences. Data was analyzed using Consensual Qualitative Research (Hill, 2012). Results indicated that trainees generally entered programs with broad/unclear expectations, but some identified preferences for practicum settings, developing clinical skills, learning approaches to psychotherapy, and training in multicultural competence. Participants expressed higher satisfaction with courses that included multicultural content, training in theoretical approaches to therapy, and clinically-applicable content using teaching methods that included combining lecture with dialogue and experiential exercises. Diversity in clients’ demographics, presenting concerns, therapeutic modalities, and distress levels contributed to higher satisfaction with clinical experiences. Additionally, participants expressed their value for the opportunity to accrue client contact towards internship requirements. Strong supervisory relationships were most frequently identified as contributing to participants’ satisfaction with supervision. Participants expressed highest satisfaction with supervisors who conveyed care and support; were respectful, invested, competent, and experienced; provided new learning and feedback; and demonstrated multicultural competence. Practicum sites which provided an appropriate balance of training and clinical work, met trainees’ expectations for developmentally-appropriate training and clinical experiences, and fostered positive relationships between trainees and competent, invested staff members were described to produce highest satisfaction. Participants also expressed highest satisfaction when they had open, safe interpersonal relationships with faculty and felt secure in their ability to secure practicum placements in a range of settings. All participants stated they would feel more satisfied with their programs if more courses were available, but opinions varied as to the type of additional training desired. Findings are considered from the perspective of experiential learning theory (Kolb, 1984) and situated learning theory (Lave &Wenger, 1991). Implications for program faculty, practicum staff, and future research are discussed.

Note: / Clinical chemistry is a medical discipline whose aim is to diagnose and assess disease by analysis of biological specimens. Modem laboratories can perform several hundred different tests using many different methods developed over the last century. The classical, more traditional assays are typically labour-intensive, not multiplexed (only measure one analyte or disorder per assay), expensive, require a long turnaround time, and may not provide adequate sensitivity and specificity. Developments in mass spectrometry (MS) and related technologies over the last two decades have provided solutions for many if not all of these shortcomings. While MS based applications have not yet been widely implemented in clinical chemistry laboratories, current developments will encourage the replacement of traditional methods as well as the expansion of clinically diagnostic endpoints. Indeed, modem MS can be used to simultaneously analyze and quantitate multiple biomarkers in a single analysis. Currently, no other technique exists that can provide a comparable multiplexed analysis. In this thesis, current MS and related technologies were developed and applied to several important but distinct clinical chemistry applications. [...] / La chimie clinique est une discipline medicale qui a pour but de diagnostiquer la presence et la progression d'une maladie par l'analyse d'echantillons biologiques. Les laboratoires modemes peuvent executer des centaines d'analyses en utilisant plusieurs methodes developpees au courrant des cent demieres annees. Les essaisc1assiques, et plus traditionnels, sont souvent laborieux, non multiplexe (mesurent seulement un analyte par essai), cher, exige un long temps de rotation et risque de ne pas fournir une specificite adequate. Pendant les deux dernieres decennies, les developpements dans Ie domaine de la spectrometrie de masse (MS) et les technologies rattachees ont foumi des solutions a plusieurs, pour ne pas dire tous, manques retrouves dans les methodes d'analyse traditionnelles.

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The study examines to what degree well-documented present and life-time psychotic symptoms in a group of former psychiatric inpatients are ascertained when using the Diagnostic Interview Schedule (DIS). The Inpatient Multidimensional Psychiatric Scale (IMPS) and the Manual for the Assessment and Documentation of Psychopathology/Diagnostische Sichtlochkartei (AMDP/DiaSika) Interview-Checklist approach were used for the “clinical” evaluations of symptoms. The results indicate fair concordance between the two clinical approaches and the DIS with regard to the presence of any delusional or hallucination symptoms. Low to poor agreement was found in the assessment of many of the rather specific hallucinations and delusions. Generally, the concordance found was higher when compared to the more clinical AMDP/DiaSiKa approach than to the IMPS. More detailed comparisons with diagnostic subgroups of schizophrenic and schizoaffective patients substantiated the findings in the overall sample. Overall it was reconfirmed that the DIS approach is limited to those patients who are cooperative and at least partly remitted.

The study examines to what degree well-documented present and life-time psychotic symptoms in a group of former psychiatric inpatients are ascertained when using the Diagnostic Interview Schedule (DIS). The Inpatient Multidimensional Psychiatric Scale (IMPS) and the Manual for the Assessment and Documentation of Psychopathology/Diagnostische Sichtlochkartei (AMDP/DiaSika) Interview-Checklist approach were used for the “clinical” evaluations of symptoms. The results indicate fair concordance between the two clinical approaches and the DIS with regard to the presence of any delusional or hallucination symptoms. Low to poor agreement was found in the assessment of many of the rather specific hallucinations and delusions. Generally, the concordance found was higher when compared to the more clinical AMDP/DiaSiKa approach than to the IMPS. More detailed comparisons with diagnostic subgroups of schizophrenic and schizoaffective patients substantiated the findings in the overall sample. Overall it was reconfirmed that the DIS approach is limited to those patients who are cooperative and at least partly remitted.