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Ensuring Access to Safe and Nutritious Food for All Through the Transformation of Food Systems
Small newborns in post-conflict Northern Uganda: Burden and interventions for improved outcomes
Introduction: A small newborn can be the result of either a low birthweight (LBW), or a preterm birth (PB), or both. LBW can be due to either a preterm appropriate-for gestational-age (preterm-AGA), or a term small-for-gestational age (term-SGA) or intrauterine growth restriction (IUGR). An IUGR is a limited in-utero foetal growth rates or foetal weight < 10th percentile. Small newborns have an increased risk of dying, particularly in low-resource settings. We set out to assess the burden, the modifiable risk factors and health outcomes of small newborns in the post-conflict Northern Ugandan district of Lira. In addition, we studied the use of video-debriefing when training health staff in Helping Babies Breathe.
Subjects and methods: In 2018-19, we conducted a community-based cohort study on 1556 mother-infant dyads, nested within a cluster randomized trial. In our cohort study, we estimated the incidence and risk factors for LBW and PB and the association of LBW with severe outcomes. We explored the prevalence of and factors associated with neonatal hypoglycaemia, as well as any association between neonatal death and hypoglycaemia. In addition, we conducted a cluster randomized trial to compare Helping Babies Breathe (HBB) training in combination with video debriefing to the traditional HBB training alone on the attainment and retention of health worker neonatal resuscitation competency.
Results: The incidence of LBW and PB in our cohort was lower than the global estimates, 7.3% and 5.0%, respectively. Intermittent preventive treatment for malaria was associated with a reduced risk of LBW. HIV infection was associated with an increased risk of both LBW and PB, while maternal formal education (schooling) of â„7 years was associated with a reduced risk of LBW and PB.
The proportions of neonatal deaths were many-folds higher among LBW infants compared to their non-LBW counterparts. The proportion of neonatal deaths among LBW was 103/1000 live births compared to 5/1000 among the non-LBW.
The prevalence of neonatal hypoglycaemia in our cohort was 2.5%. LBW and PB each independently were associated with an increased risk of neonatal hypoglycaemia. Neonatal hypoglycaemia was associated with an increased risk of hospitalisation and severe outcomes.
We demonstrated that neonatal resuscitation training with video debriefing, improved competence attainment and retention among health workers, compared to traditional HBB training alone.
Conclusion: In northern Uganda, small infants still have a many-fold higher risk of dying compared to normal infants. In addition, small infants are also at more risk of neonatal hypoglycaemia compared to normal infants. Efforts are needed to secure essential newborn care, should we reach the target of Sustainable Development Goal number 3.2 of reducing infant mortality to less than 12/1000 live births by 2030
Exploring the Training Factors that Influence the Role of Teaching Assistants to Teach to Students With SEND in a Mainstream Classroom in England
With the implementation of inclusive education having become increasingly valued over the years, the training of Teaching Assistants (TAs) is now more important than ever, given that they work alongside pupils with special educational needs and disabilities (hereinafter SEND) in mainstream education classrooms. The current study explored the training factors that influence the role of TAs when it comes to teaching SEND students in mainstream classrooms in England during their one-year training period. This work aimed to increase understanding of how the training of TAs is seen to influence the development of their personal knowledge and professional skills. The study has significance for our comprehension of the connection between the TAsâ training and the quality of education in the classroom. In addition, this work investigated whether there existed a correlation between the teaching experience of TAs and their background information, such as their gender, age, grade level taught, years of teaching experience, and qualification level.
A critical realist theoretical approach was adopted for this two-phased study, which involved the mixing of adaptive and grounded theories respectively. The multi-method project featured 13 case studies, each of which involved a trainee TA, his/her college tutor, and the classroom teacher who was supervising the trainee TA. The analysis was based on using semi-structured interviews, various questionnaires, and non-participant observation methods for each of these case studies during the TAâs one-year training period. The primary analysis of the research was completed by comparing the various kinds of data collected from the participants in the first and second data collection stages of each case. Further analysis involved cross-case analysis using a grounded theory approach, which made it possible to draw conclusions and put forth several core propositions. Compared with previous research, the findings of the current study reveal many implications for the training and deployment conditions of TAs, while they also challenge the prevailing approaches in many aspects, in addition to offering more diversified, enriched, and comprehensive explanations of the critical pedagogical issues
Die akute Appendizitis im Kindes- und Jugendalter: neue diagnostische Verfahren fĂŒr die prĂ€therapeutische Differenzierung histopathologischer EntitĂ€ten zur UnterstĂŒtzung konservativer Therapiestrategien
Hintergrund der hier zusammengefassten Studien war die aktuelle Datenlage, die dafĂŒr spricht, dass es sich bei der klinisch unkomplizierten, histopathologisch phlegmonösen und der klinisch komplizierten, histopathologisch gangrĂ€nösen Appendizitis um unabhĂ€ngige EntitĂ€ten handelt. Diese können unterschiedlichen Therapieoptionen (konservativ vs. operativ) zugefĂŒhrt werden. Vor diesem Hintergrund war es ein Ziel der Arbeiten zu untersuchen, wie die Formen der akuten Appendizitis im Kindes- und Jugendalter bereits prĂ€therapeutisch unterschieden werden können.
Sowohl in der Labordiagnostik (P1 und P2) als auch im Ultraschall (P3) lassen sich Unterschiede zwischen Patient*innen mit unkomplizierter, phlegmonöser und komplizierter (gangrĂ€nöser und perforierender) Appendizitis aufzeigen. Hierdurch allein kann allerdings aufgrund unzureichender TrennschĂ€rfe noch keine ausreichende Entscheidungssicherheit erreicht werden. Mit Verfahren der kĂŒnstlichen Intelligenz auf Untersucher-unabhĂ€ngige diagnostische Parameter (P4) konnte die Vorhersagegenauigkeit der akuten Appendizitis weiter gesteigert werden. Interessante Ergebnisse bezĂŒglich der unterschiedlichen Pathomechanismen der beiden inflammatorischen EntitĂ€ten ergaben sich durch eine differenzielle Genexpressionsanalyse (P5). In einer Proof-of-Concept-Studie wurden zuvor beschriebene Methoden der kĂŒnstlichen Intelligenz auf die Genexpressionsdaten angewandt (P6). Hierdurch konnte im Modell eine grundsĂ€tzliche Differenzierbarkeit der EntitĂ€ten durch die Anwendung der neuen Methode aufgezeigt werden.
Ein mittelfristiges Ziel ist es, eine Biomarkersignatur zu definieren, die ihre Aussagekraft durch einen Computeralgorithmus hat. Hierdurch soll eine schnelle Therapieentscheidung ermöglicht werden. Im Idealfall sollte diese Biomarkersignatur sicher, objektiv und einfach zu bestimmen sein sowie eine höhere diagnostische Sicherheit als die bisherige Diagnostik mittels Anamnese, Untersuchung, Laboranalyse und Ultraschall bieten.
Langfristiges Ziel von Folgestudien ist die Identifizierung einer Biomarkersignatur mit der bestmöglichen Vorhersagekraft. Hinsichtlich der routinemĂ€Ăigen klinischen Diagnostik ist die Anwendung von Point-of-Care Devices auf PCR-Basis denkbar. Hier könnte eine limitierte Anzahl von Primern fĂŒr eine Biomarkersignatur mit hoher Vorhersagekraft zum Einsatz kommen. Der dadurch ermittelte Biomarker wĂŒrde seine Aussagekraft durch einen einfach anzuwendenden Computeralgorithmus erhalten. Die Kombination aus Genexpressionsanalyse mit Methoden der kĂŒnstlichen Intelligenz kann somit die Grundlage fĂŒr ein neues diagnostisches Instrument zur sicheren Unterscheidung unterschiedlicher AppendizitisentitĂ€ten darstellen
Preferentialism and the conditionality of trade agreements. An application of the gravity model
Modern economic growth is driven by international trade, and the preferential trade agreement constitutes the primary fit-for-purpose mechanism of choice for establishing, facilitating, and governing its flows. However, too little attention has been afforded to the differences in content and conditionality associated with different trade agreements. This has led to an under-considered mischaracterisation of the design-flow relationship. Similarly, while the relationship between trade facilitation and trade is clear, the way trade facilitation affects other areas of economic activity, with respect to preferential trade agreements, has received considerably less attention. Particularly, in light of an increasingly globalised and interdependent trading system, the interplay between trade facilitation and foreign direct investment is of particular importance.
Accordingly, this thesis explores the bilateral trade and investment effects of specific conditionality sets, as established within Preferential Trade Agreements (PTAs).
Chapter one utilises recent content condition-indexes for depth, flexibility, and constraints on flexibility, established by DĂŒr et al. (2014) and Baccini et al. (2015), within a gravity framework to estimate the average treatment effect of trade agreement characteristics across bilateral trade relationships in the Association of Southeast Asian Nations (ASEAN) from 1948-2015. This chapter finds that the composition of a given ASEAN trade agreementâs characteristic set has significantly determined the concomitant bilateral trade flows. Conditions determining the classification of a trade agreements depth are positively associated with an increase to bilateral trade; hereby representing the furthered removal of trade barriers and frictions as facilitated by deeper trade agreements. Flexibility conditions, and constraint on flexibility conditions, are also identified as significant determiners for a given trade agreementâs treatment effect of subsequent bilateral trade flows. Given the political nature of their inclusion (i.e., the appropriate address to short term domestic discontent) this influence is negative as regards trade flows. These results highlight the longer implementation and time frame requirements for trade impediments to be removed in a market with higher domestic uncertainty.
Chapter two explores the incorporation of non-trade issue (NTI) conditions in PTAs. Such conditions are increasing both at the intensive and extensive margins. There is a concern from developing nations that this growth of NTI inclusions serves as a way for high-income (HI) nations to dictate the trade agenda, such that developing nations are subject to âprincipled protectionismâ. There is evidence that NTI provisions are partly driven by protectionist motives but the effect on trade flows remains largely undiscussed. Utilising the Gravity Model for trade, I test Lechnerâs (2016) comprehensive NTI dataset for 202 bilateral country pairs across a 32-year timeframe and find that, on average, NTIs are associated with an increase to bilateral trade. Primarily this boost can be associated with the market access that a PTA utilising NTIs facilitates. In addition, these results are aligned theoretically with the discussions on market harmonisation, shared values, and the erosion of artificial production advantages. Instead of inhibiting trade through burdensome cost, NTIs are acting to support a more stable production and trading environment, motivated by enhanced market access. Employing a novel classification to capture the power supremacy associated with shaping NTIs, this chapter highlights that the positive impact of NTIs is largely driven by the relationship between HI nations and middle-to-low-income (MTLI) counterparts.
Chapter Three employs the gravity model, theoretically augmented for foreign direct investment (FDI), to estimate the effects of trade facilitation conditions utilising indexes established by Neufeld (2014) and the bilateral FDI data curated by UNCTAD (2014). The resultant dataset covers 104 countries, covering a period of 12 years (2001â2012), containing 23,640 observations. The results highlight the bilateral-FDI enhancing effects of trade facilitation conditions in the ASEAN context, aligning itself with the theoretical branch of FDI-PTA literature that has outlined how the ratification of a trade agreement results in increased and positive economic prospect between partners (Medvedev, 2012) resulting from the interrelation between trade and investment as set within an improving regulatory environment. The results align with the expectation that an enhanced trade facilitation landscape (one in which such formalities, procedures, information, and expectations around trade facilitation are conditioned for) is expected to incentivise and attract FDI
Epilepsy Mortality: Leading Causes of Death, Co-morbidities, Cardiovascular Risk and Prevention
a reuptake inhibitor selectively prevents seizure-induced sudden death in the DBA/1 mouse model of sudden unexpected ... Bilateral lesions of the fastigial nucleus prevent the recovery of blood pressure following hypotension induced by ..
How to Be a God
When it comes to questions concerning the nature of Reality, Philosophers and Theologians have the answers.
Philosophers have the answers that canât be proven right. Theologians have the answers that canât be proven wrong.
Todayâs designers of Massively-Multiplayer Online Role-Playing Games create realities for a living. They canât spend centuries mulling over the issues: they have to face them head-on. Their practical experiences can indicate which theoretical proposals actually work in practice.
Thatâs todayâs designers. Tomorrowâs will have a whole new set of questions to answer.
The designers of virtual worlds are the literal gods of those realities. Suppose Artificial Intelligence comes through and allows us to create non-player characters as smart as us. What are our responsibilities as gods? How should we, as gods, conduct ourselves?
How should we be gods
In search of 'The people of La Manche': A comparative study of funerary practices in the Transmanche region during the late Neolithic and Early Bronze Age (250BC-1500BC)
This research project sets out to discover whether archaeological evidence dating between 2500 BC - 1500 BC from supposed funerary contexts in Kent, flanders and north-eastern Transmanche France is sufficient to make valid comparisons between social and cultural structures on either side of the short-sea Channel region. Evidence from the beginning of the period primarily comes in the form of the widespread Beaker phenomenon. Chapter 5 shows that this class of data is abundant in Kent but quite sparse in the Continental zones - most probably because it has not survived well. This problem also affects the human depositional evidence catalogued in Chapter 6, particularly in Fanders but also in north-eastern Transmanche France. This constricts comparative analysis, however, the abundant data from Kent means that general trends are still discernible. The quality and volume of data relating to the distribution, location, morphology and use of circular monuments in all three zones is far better - as demonstrated in Chapter 7 -mostly due to extensive aerial surveying over several decades. When the datasets are taken as a whole, it becomes possible to successfully apply various forms of comparative analyses. Most remarkably, this has revealed that some monuments apparently have encoded within them a sophisticated and potentially symbolically charged geometric shape. This, along with other less contentious evidence, demonstrates a level of conformity that strongly suggests a stratum of cultural homogeneity existed throughout the Transmanche region during the period 2500 BC - 1500 BC. The fact that such changes as are apparent seem to have developed simultaneously in each of the zones adds additional weight to the theory that contact throughout the Transmanche region was endemic. Even so, it may not have been continuous; there may actually have been times of relative isolation - the data is simply too course to eliminate such a possibility
Disunity in society, fractures at home: family relating in the context of divisive socio-political issues
Section A
A systematic literature review conducted to identify and explore research that has investigated adult intrafamilial relationships and divisive political issues since 2016. Ten papers are included in the review. The studies are critiqued using a mixed-methods risk of bias tool. Findings are collated using narrative synthesis. The synthesis focuses on relational responsesâto divisive political issuesâthe potential reasons for these responses, and their consequences. Review findings are discussed in relation to previous theoretical and empirical literature. Finally, clinical and research implications are presented.
Section B
A grounded theory study to develop an understanding of adult intrafamilial invalidation in the context of social and political change. Brexit and COVID-19 serve as the contextual lens through which the phenomenon was observed. Data from 11 participants and 45 screening questionnaire respondents were analysed as part of the study. A model of family âRejection of Youâ experiences is presented outlining foundational and contextual factors that frame the experience, the experience itself, and relational, behavioural, cognitive, and emotional consequences. Findings are discussed in relation to previous theory and previous empirical research. Clinical implications are considered and possible directions for future research are set out
Epistemologies of possibility: social movements, knowledge production and political transformation
Urgent global problems - whether military conflicts, economic insecurities, immigration controls or mass incarceration-not only call for new modes of political action but also demand new forms of knowledge. For if knowledge frameworks both shape the horizons of social intelligibility and chart t he realms of political possibility, then epistemological interventions constitute a crucial part of social change. Social movements play a key role in this work by engaging in dissident knowledge practices that open up space for political transformation. But what are the processes and conditions through which social movements generate new ways of knowing?'What is politically at stake in the various knowledge strategies that activists use to generate social change? Despite a growing literature on the role of epistemological dimensions of protest, social movement studies tend to neglect specific questions of epistemological change. Often treating knowledge as a resource or object rather than a power relation and a social practice, social movement scholars tend to focus on content rather than production, frames rather than practices, taxonomies rather than processes. Missing is a more dynamic account of the conditions, means and power relations through which transformative knowledge practices come to be constituted and deployed. Seeking to better understand processes of epistemological transformation, this thesis explores the relationship between social movements, knowledge production and political change. Starting from an assumption that knowledge not only represents the world, but also works to constitute it, this thesis examines the role of social movement knowledge practices in shaping the conditions of political possibility. Drawing from the context of grassroots queer, transgender and feminist organizing around issues of prisons and border controls in North America, the project explores how activists generate new forms of knowledge and forge new spaces of political possibility. Working through a series of concepts-transformation, resistance, experience, co-optation, solidarity and analogy - this thesis explores different ways of understanding processes of epistemological change with in social movement contexts. It considers processes that facilitate or enable epistemological change and those that limit or prohibit such change. Bringing together a range of theoretical perspectives, including feminist, queer, critical race and post-structuralist analyses, and drawing on interviews with grassroots activists, the thesis explores what is politically at stake in the different ways we conceptualise, imagine and engage in processes of epistemological change
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