Provider Navigation of Cannabis Use Among Patients Who Seek Reproductive Healthcare

Background: Research and data show increasing trends of individuals who use cannabis in Washington state and across the US, with limited information regarding specific populations such as those who are pregnant, postpartum, or breastfeeding. Many research studies highlight the historic lack of information in healthcare professionals’ curriculums and competencies regarding cannabis use for treatment of health symptoms. Measures: This practice-based inquiry utilizes a survey method to determine how reproductive healthcare providers navigate cannabis use among pregnant, postpartum, and breastfeeding patients. Outcomes: 12 individuals participated in the online survey with the majority that practice in Washington state. Almost all healthcare providers in this study reported managing or caring for patients that disclose cannabis use in general, during pregnancy, postpartum, and while breastfeeding. They report feeling confident and comfortable discussing and managing the care of patients that use cannabis across all populations. However, they were not at all confident or comfortable educating, recommending/authorizing cannabis to patients in treatment of their health symptoms in any category. Conclusion: The findings from this study provide a glimpse into how some providers may navigate cannabis use among their patients who seek reproductive care. It is recommended that better education regarding cannabis use, and incorporation of cannabis-related evidence-based practices and guidelines can help build trusting relationships and increase shared decision-making between providers and patients while simultaneously reducing racial and gender inequities seen in medical and institutional systems and reduce harm

An experimental study of the applicability of flooding phenomena to the dynamic lubrication method of well control

This research investigates the feasibility of the dynamic lubrication method of well control as an alternative to conventional stepwise lubrication. The applicability of flooding phenomena to dynamic lubrication and its use in an optimization method to maximize pumping rates was also investigated. An experimental approach was taken in which experiments were conducted in a 13’ long laboratory apparatus designed to emulate the geometry in a wellhead and also in a full-scale research well. The laboratory experiments were conducted to visually investigate the mechanism of flooding and derive a flooding correlation applicable to this type of system. The full-scale experiments were done to evaluate the dynamic lubrication method, compare it to conventional lubrication, attempt dynamic lubrication at high pumping rates, assess the applicability of flooding as the rate determining phenomenon, and identify any complications encountered during this process. The laboratory tests produced a correlation that was applicable over a range of 3 annular sizes. The equation resembled correlations from previous studies by Richter (1981) and Dempster(1984) and used dimensionless volumetric fluxes as the non-dimensional parameter. The full-scale tests showed that dynamic lubrication was more efficient in removing gas trapped at the wellhead, and reduced the severity of pressure fluctuations inherent in conventional stepwise lubrication. Pumping at constant high rates had an adverse effect on the process. This high pumping rate reduced the rate of accumulation of liquid in the well by 50% when compared to the more conservative pumping rates. The boundary between efficient and inefficient pump rates corresponded well to the correlation from laboratory tests if the relevant dimensions were assumed to be dependent on wellhead geometry. For this wellhead, the casing-casing annulus has a smaller cross sectional area and therefore higher velocities, which logically should control flooding. However, using the casing annulus geometry in the flooding correlation results in incorrect prediction of the onset of flooding unless revised coefficients are used. These revised coefficients were adopted for a proposed preliminary optimization method

Recurrent subacute visual loss presenting in a 52-year-old Caucasian woman with chronic relapsing inflammatory optic neuropathy: a case report

<p>Abstract</p> <p>Introduction</p> <p>Chronic relapsing inflammatory optic neuropathy is a recently described form of recurrent isolated subacute optic neuropathy. The condition is highly responsive to systemic steroid treatment and prone to relapse on steroid withdrawal. A complete work up for demyelination, autoimmune disease and sarcoidosis must be made before considering chronic relapsing inflammatory optic neuropathy.</p> <p>Case presentation</p> <p>We describe the case of a 52-year-old Caucasian woman who presented with isolated subacute optic neuropathy. There was no evidence of demyelination, autoimmunity or sarcoidosis. There was an abrupt and prompt response to systemic corticosteroids and a relapse of the condition on steroid withdrawal.</p> <p>Conclusions</p> <p>Chronic relapsing inflammatory optic neuropathy requires careful consideration and differentiation from demyelinating optic neuritis and ischemic optic neuropathy since the treatment is different and the outcome without treatment is likely to be poor. The importance of identifying these patients has considerable clinical implications as the condition is highly responsive to steroids.</p

The use of visual reasoning by successful mathematics teachers : a case study.

Doctor of Philosophy in Education Studies. University of KwaZulu-Natal, Edgewood 2015.Visualization has become increasingly important in view of the advent of technology which allows us to understand an idea at a single glance. Globally, educationists have been searching for ways to improve learners‘ understanding of mathematics. This has led them to believe that perhaps the focus on the teaching of mathematics needs to change. Contrary to the view that mathematics can only be presented sequentially, another view exists that mathematics is a multimodal discourse where different modes of representation are necessary. Whilst many of our learners experience serious difficulties in mathematics, as testified by the education authorities, there are groups of teachers that attain outstanding results in this subject. In this study I chose to explore how this group of people attain success, whilst engaging with the phenomenon of visual reasoning. The intention of this research was to interpret the kind of meanings that these successful teachers offered in their use of visual reasoning in their practice. Therefore in order to explore the personal, social and learning experiences of these successful mathematics teachers, a case study form of enquiry was employed, with the use of a social constructivist research paradigm, following a qualitative research tradition. A purposeful maximal sampling technique was used to identify five participants. Knowledge is not merely received but constructed by individuals or groups of people who try to make sense of their experiential worlds. This study sought to explore the ways in which these successful teachers constructed and interpreted the knowledge that they passed onto their learners, using the phenomenon of visual reasoning. Furthermore, constructivism as a research paradigm is characterised by plurality and multiple perspectives. Taking this into account, Attribution Theory, Gardner‘s Multiple Intelligences Theory and Situated Cognition Theory were used as a lens to explain the complex phenomena of visual reasoning and successful teaching. The results of the study showed that all the participants were actively engaged in using visual reasoning as a pedagogic practice in their mathematics classrooms. Explanations for their actions in terms of using visual reasoning resonated with the literature and the theoretical frameworks that were used

Spread of multi drug resistant tuberculosis (MDR) including extensively drug resistant turberculosis (XDR TB), in rural KwaZulu-Natal.

Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2011.Mycobacterium tuberculosis (MTB) is an airborne pathogen that is easily transmitted from person to person. An intact immune system prevents the organism from causing disease in most individuals. In South Africa, the prevalence of human immunodeficiency virus (HIV) has reached astronomical levels and is now fuelling the tuberculosis (TB) epidemic. Drug resistant MTB strains combined with a weakened host immune system is a lethal combination. Multi-drug resistant (MDR) including extensively drug resistant (XDR) tuberculosis is on the increase, with Tugela Ferry in KwaZulu-Natal South Africa, reporting the largest cluster of XDR cases in the world. It is unknown whether a single clone of the drug resistant strain is circulating in this area or whether there are multiple strains at play. Using 2 complementary genotyping methods, we showed that the MDR strains present are the result of clonal spread associated with the F28 family, as well as de novo resistance which manifests as unique patterns. The XDR epidemic in Tugela Ferry is the result of clonal spread of a strain belonging to the F15/LAM4/KZN family

MYOCARDIAL INFARCTION IN A YOUNG PATIENT WITH METHYLENE TETRAHYDROFOLATE REDUCTASE (MTHFR) GENE MUTATION

We report a case of a 40 year old female patient who presents with chest pain and is diagnosed with a inferior myocardial infarction (MI) and when tested she was found to be heterozygous (C677T) for Methylene Tetrahydrofolate Reductase (MTHFR) gene mutation. The patient was stopped from using the OCP and was started on life-long oral daily folic acid supplementation. Screening of her siblings led to the discovery that her two sisters were both homozygous for MTHFR deficiency. This case clearly illustrates that we as clinicians must look beyond the box and not just treat common conditions like CHD. When the risk factors do not add up, we must go in search of an identifiable cause that can have future benefit for the patient and other family members

GT2011-45214 EFFECTS OF ROTATING STALL ON AN AXIAL FAN DESIGN

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Increasing Drug Resistance in Extensively Drug-Resistant Tuberculosis, South Africa

We expanded second-line tuberculosis (TB) drug susceptibility testing for extensively drug-resistant Mycobacterium tuberculosis isolates from South Africa. Of 19 patients with extensively drug-resistant TB identified during February 2008–April 2009, 13 (68%) had isolates resistant to all 8 drugs tested. This resistance leaves no effective treatment with available drugs in South Africa

PROMOTING PRO-ENVIRONMENTAL BEHAVIORS: THE INFLUENCE OF ENVIRONMENTAL EDUCATION AND ENVIRONMENTAL AWARENESS ON LITTERING WITHIN TWO ECOTOURISM DESTINATIONS IN TRINIDAD

The purpose of this study was to investigate the influence of environmental education and awareness on littering behavior within two ecotourism destinations (Asa Wright Nature Center and Rio Seco Waterfall). Furthermore, an attempt was made to produce a model that identified and explained the possible relationships between various constructs that affected the pro-environmental behavior of “not littering by ecotourists at the two ecotourism destinations. The conceptual background of this research venture was derived from the Theory of Planned Behavior and was further informed by the Grounded Theory. A mixed methods approach including both a qualitative phase and quantitative phase was utilized for the relevant data collection and analyses in this study. The qualitative data were collected from informal interviews with a total of two managers and six tour guides. Data analysis through a thematic coding procedure utilized the results to inform a final questionnaire design for quantitative data collection. Subsequently, quantitative data were collected via the administration of survey questionnaires to a total of 404 ecotourist participants at the Asa Wright Nature Center and the Rio Seco Waterfall. Descriptive statistics and path analyses were executed for analysis of the quantitative data. Findings indicated the hypothesized significance of ecotourists practicing more pro-environmental behavior based on their level of environmental awareness

Eating identity: challenging narratives of Canadianness through culinary identity building

This MRP will examine how food can be used as a tool for challenging traditional nation stories and growing notions of what it means to be Canadian. There is an opportunity to write and shape a Canadian narrative that is inclusive of its evolving demography while simultaneously reconciling its violent history by developing a Canadian culinary identity. Food is political, social and cultural. Food can bring people together and can provide a platform to have compelling discussions about what it means to be Canadian; who is included in the definition of Canadian; and, how we can develop a sense of Canadianness that speaks to an evolving population. Historically and at present, Canada’s story has often excluded or minimized the cultural, political and social contributions of Indigenous peoples and racialized immigrants. There remains a prevailing sense of Canadian identity being tethered to whiteness despite over a century of global immigration. However, the very idea of what defines Canadianness is relatively tenuous one. There are few traits, markers, or qualities that are seen as characteristically Canadian. This is even more true for Canada’s culinary identity. What exactly is Canadian food? Canada, as a nation, is a relatively new country without a clear culinary identity. Further, Canada is an expansive land mass covering different time zones, geographic regions, and climates. To further complicate matters, it is place for people from all over the world to immigrate. Nowhere is the impact of immigration and the diversity of people more evident than in Toronto. How the city has changed demographically is reflected in the diversification of it’s culinary landscape. The wide range of available foods reveals and affirms how the appetites and desires of those that live here have also changed. International foods, restaurants and markets are not only ubiquitous, but a defining characteristic of the city. Where, what and how people eat can provide insight into how historical systems of inequality and colonial narratives persist. Growing and developing Canadian culinary identity is a way of challenging the idea of whiteness as a prerequisite for being Canadian. It is a potential way to acknowledge and include immigrant contributions. Food is wrapped up in politics of inequality and injustice, just as much as it is in pleasure and desire. Mapping how food is used as a tool that furthers colonization and racist dogma is key for shifting food to a tool for education and understanding. Food has the power to open up conversation and reshape understandings of Canadian identity through developing and defining a distinct Canadian culinary position. If an understanding about Canadian culinary identity is inclusive of its complex and divergent cultural and political history, then perhaps there is an opportunity to rethink Canadian identity as a whole. The goal of this MRP is to establish that food can be used as an ideological intervention that examines, challenges and reimagines Canadian identity.</jats:p