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"Hardy, Janice"
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Blue fire
While trying to lead the Takers out of Geveg, fifteen-year-old Nya is captured by bounty hunters and taken to Baseer, where she escapes and soon finds herself helping the Baseeri.
Book
Implementing a contextual discipleship curriculum to impact biblical knowledge and application for women in a large church in Ghana
The purpose of writing Implementing A Contextual Discipleship Curriculum to Impact Biblical Knowledge and Application for Women in a Large Church in Ghana was to add to the body of knowledge concerning discipleship curricula for women in developing countries. Christianity is growing most rapidly in developing countries, and women play a pivotal role largely due to their influence on the children, the future generations. Yet there is a dearth of information on how to disciple the women in these areas. This project tested a 16-week contextual discipleship curriculum at Rhema Outreach Church in Ashaiman, Ghana, West Africa. The students were members of the Women's Ministry, and most of them were market women. The average class size was 50 women. The program was geared towards oral learners because some of the women were illiterate. The project centered around lessons in biblical knowledge, biblical leadership, and biblical financial awareness/stewardship. This project used mixed research methods, relying heavily on qualitative analyses with an embedded quantitative analysis. The data strongly suggested that a contextual curriculum can be effective in enhancing the discipleship knowledge and practices of women in developing countries. The results also demonstrated that discipleship among women in developing countries is a critical area that the global church needs to address. Chapter 1 states the thesis and hypothesis as well as the rationale for the project, and the community and church context. The biblical, systematic, and ecclesiological/historical foundations of the project are also discussed. Chapter 2 discusses literature related to the topic in the broad categories of discipleship, lessons learned from practitioners in the field, contextual theologians, and the voices of selected African female theologians. Chapter 3 presents the research methodology used, the rationale for the methodology, and how it was applied at the Rhema Outreach Church in Ghana. Chapter 4 presents the findings from the research instruments, including the voice of the women at Rhema Outreach Church. Some of their opinions differed from that of the researcher and peer reviewers. Chapter 5 offers reasons for the disparities between the Rhema women's opinions and the findings of the qualitative and quantitative analyses. It also offers suggestions for future research in this area and implications of the project's findings for the larger Christian community.
Dissertation
The shifter
Nya, a fifteen-year-old war orphan, becomes a pawn in a bigger political game when her uncanny--and dangerous--ability to draw out people's pain and then give it to someone else turns out to be the only weapon she has to save her sister.
Book
China's claim null and void
I REFER to Tony K. S. Ngai's letter regarding the status of Tibet and the selection of the Panchen Lama (South China Morning Post,...
Newspaper Article
C9orf72 expansions in frontotemporal dementia and amyotrophic lateral sclerosis
C9orf72 hexanucleotide repeat expansions are the most common cause of familial frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS) worldwide. The clinical presentation is often indistinguishable from classic FTD or ALS, although neuropsychiatric symptoms are more prevalent and, for ALS, behavioural and cognitive symptoms occur more frequently. Pathogenic repeat length is in the hundreds or thousands, but the minimum length that increases risk of disease, and how or whether the repeat size affects phenotype, are unclear. Like in many patients with FTD and ALS, neuronal inclusions that contain TARDBP are seen, but are not universal, and the characteristic pathological finding is of dipeptide repeat (DPR) proteins, formed by unconventional repeat-associated non-ATG translation. Possible mechanisms of neurodegeneration include loss of C9orf72 protein and function, RNA toxicity, and toxicity from the DPR proteins, but which of these is the major pathogenic mechanism is not yet certain.
Journal Article
Ibrutinib dose modifications in the management of CLL
Background
Ibrutinib is a Bruton tyrosine kinase inhibitor approved for the treatment of chronic lymphocytic leukemia (CLL) in 2014. Ibrutinib is often used to treat patients who are younger than the patients originally included in theclinical trials have additional unfavorable prognostic factors and suffer from additional comorbidities excluded from the original phase III trials. Our objective was to examine current clinical practices and their impact in this expanded population of CLL patients who often require adjustments in the standard prescribed dose and schedule of therapy.
Materials and methods
An extensive review of the medical literature was conducted to establish the consensus on ibrutinib dose modifications in patients with CLL. Twenty-nine studies were reviewed including fourteen clinical trials and fifteen “real-world practice” studies.
Results
The average discontinuation rate was similar between clinical trials and “real-world practice” studies though the reasons for discontinuation differed. CLL progression was a more common reason for discontinuation in clinical trial studies while toxicity was a more common reason for discontinuation in “real-world practice” studies. Some studies have suggested worse outcomes in patients requiring dose reductions in ibrutinib while others have shown no change in treatment efficacy in patients requiring dose reductions due to concomitant CYP medications or increased immunosuppression post-transplant.
Conclusion
The impact of ibrutinib dose modifications on clinical outcome remains unclear. Patients on concomitant CYP3A inhibitors should be prescribed a lower dose than the standard 420 mg daily, in order to maintain comparable pharmacologic properties. Further research is required to establish definitive clinical practice guidelines.
Journal Article
A cluster-randomised controlled trial of the LifeLab education intervention to improve health literacy in adolescents
Adolescence offers a window of opportunity during which improvements in health behaviours could benefit long-term health, and enable preparation for parenthood—albeit a long way off, passing on good health prospects to future children. This study was carried out to evaluate whether an educational intervention, which engages adolescents in science, can improve their health literacy and behaviours. A cluster-randomised controlled trial of 38 secondary schools in England, UK was conducted. The intervention (LifeLab) drew on principles of education, psychology and public health to engage students with science for health literacy, focused on the message “Me, my health and my children’s health”. The programme comprised: • Professional development for teachers. • A 2–3 week module of work for 13-14-year-olds. • A “hands-on” practical health science day visit to a dedicated facility in a university teaching hospital. Data were collected from 2929 adolescents (aged 13–14 years) at baseline and 2487 (84.9%) at 12-month follow-up. The primary outcome was change in theoretical health literacy from pre- to 12 months post- intervention. This study is registered (ISRCTN71951436) and the trial status is complete. Participation in the LifeLab educational intervention was associated with an increase in the students’ standardised total theoretical health literacy score (adjusted difference between groups = 0.27 SDs (95%CI = 0.12, 0.42)) at 12-month follow-up. There was an indication that intervention participants subsequently judged their own lifestyles more critically than controls, with fewer reporting their behaviours as healthy (53.4% vs. 59.5%; adjusted PRR = 0.94 [0.87, 1.01]). We conclude that experiencing LifeLab led to improved health literacy in adolescents and that they demonstrated a move towards a more critical judgement of health behaviour 12 months after the intervention. Further work is needed to examine whether this leads to sustained behaviour change, and whether other activities are needed to support this change.
Journal Article
Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players
In retired professional association football (soccer) players with a past history of repetitive head impacts, chronic traumatic encephalopathy (CTE) is a potential neurodegenerative cause of dementia and motor impairments. From 1980 to 2010, 14 retired footballers with dementia were followed up regularly until death. Their clinical data, playing career, and concussion history were prospectively collected. Next-of-kin provided consent for six to have post-mortem brain examination. Of the 14 male participants, 13 were professional and 1 was a committed amateur. All were skilled headers of the ball and had played football for an average of 26 years. Concussion rate was limited in six cases to one episode each during their careers. All cases developed progressive cognitive impairment with an average age at onset of 63.6 years and disease duration of 10 years. Neuropathological examination revealed septal abnormalities in all six post-mortem cases, supportive of a history of chronic repetitive head impacts. Four cases had pathologically confirmed CTE; concomitant pathologies included Alzheimer’s disease (
N
= 6), TDP-43 (
N
= 6), cerebral amyloid angiopathy (
N
= 5), hippocampal sclerosis (
N
= 2), corticobasal degeneration (
N
= 1), dementia with Lewy bodies (
N
= 1), and vascular pathology (
N
= 1); and all would have contributed synergistically to the clinical manifestations. The pathological diagnosis of CTE was established in four individuals according to the latest consensus diagnostic criteria. This finding is probably related to their past prolonged exposure to repetitive head impacts from head-to-player collisions and heading the ball thousands of time throughout their careers. Alzheimer’s disease and TDP-43 pathologies are common concomitant findings in CTE, both of which are increasingly considered as part of the CTE pathological entity in older individuals. Association football is the most popular sport in the world and the potential link between repetitive head impacts from playing football and CTE as indicated from our findings is of considerable public health interest. Clearly, a definitive link cannot be established in this clinico-pathological series, but our findings support the need for further systematic investigation, including large-scale case–control studies to identify at risk groups of footballers which will justify for the implementation of protective strategies.
Journal Article
Changes in factors influencing fellowship choices among radiology residents from 2008 to 2018 and methods that may increase interest in the pediatric radiology subspecialty
BackgroundFewer residents are choosing a career in pediatric radiology, which is contributing to an ongoing shortage of pediatric radiologists.ObjectiveTo identify potential causes of reduced interest in pediatric radiology as a career given a projected worsening of a nationwide shortage of pediatric radiologists.Materials and methodsAn online questionnaire using previously published questions was approved and distributed by the Program Directors in Diagnostic Radiology to diagnostic radiology residents on behalf of the Society for Pediatric Radiology (SPR). Descriptive statistics including means with standard error and independent t-tests were used to compare mean scores between survey years.ResultsNearly all of the 353 respondents (90.9%) planned on pursuing a fellowship. The majority (57.7%) identified their fellowship subspecialty before the 3rd year of residency with only 5.7% selecting pediatric radiology. Overall, 18.2% of survey respondents favored academic practice compared to 40% in the pediatric radiology subgroup. Fellowship choices were most strongly based on area of strong personal interest, marketability and area of strong personal knowledge, while the pediatric radiology subgroup emphasized area of strong personal interest, increased interaction with other physicians and enjoyable residency rotations. The pediatric radiology subgroup believed their impact on patient care was more significant than other subspecialties. Pediatric radiology job opportunities were thought to be more limited, geographically confining, and to have lower salaries than other subspecialties. More flexible job opportunities and higher demand were identified as factors needing to change before a resident would consider a pediatric radiology career.ConclusionThe influence on fellowship selection is multifactorial. By emphasizing the favorable job market and marketability of pediatric radiology in all practice types/geographic locations, correcting perceived salary gaps and stressing the impact on patient care as early as medical school, the number of residents choosing a career in pediatric radiology may grow.
Journal Article
alpha-Synucleinopathy associated with G51D SNCA mutation: a link between Parkinson's disease and multiple system atrophy?
We report a British family with young-onset Parkinson's disease (PD) and a G51D SNCA mutation that segregates with the disease. Family history was consistent with autosomal dominant inheritance as both the father and sister of the proband developed levodopa-responsive parkinsonism with onset in their late thirties. Clinical features show similarity to those seen in families with SNCA triplication and to cases of A53T SNCA mutation. Post-mortem brain examination of the proband revealed atrophy affecting frontal and temporal lobes in addition to the caudate, putamen, globus pallidus and amygdala. There was severe loss of pigmentation in the substantia nigra and pallor of the locus coeruleus. Neuronal loss was most marked in frontal and temporal cortices, hippocampal CA2/3 subregions, substantia nigra, locus coeruleus and dorsal motor nucleus of the vagus. The cellular pathology included widespread and frequent neuronal [alpha]-synuclein immunoreactive inclusions of variable morphology and oligodendroglial inclusions similar to the glial cytoplasmic inclusions of multiple system atrophy (MSA). Both inclusion types were ubiquitin and p62 positive and were labelled with phosphorylation-dependent anti-[alpha]-synuclein antibodies In addition, TDP-43 immunoreactive inclusions were observed in limbic regions and in the striatum. Together the data show clinical and neuropathological similarities to both the A53T SNCA mutation and multiplication cases. The cellular neuropathological features of this case share some characteristics of both PD and MSA with additional unique striatal and neocortical pathology. Greater understanding of the disease mechanism underlying the G51D mutation could aid in understanding of [alpha]-synuclein biology and its impact on disease phenotype.[PUBLICATION ABSTRACT]
Journal Article