14,654 research outputs found
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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 ≥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
Mathematical models to evaluate the impact of increasing serotype coverage in pneumococcal conjugate vaccines
Of over 100 serotypes of Streptococcus pneumoniae, only 7 were included in the first pneumo- coccal conjugate vaccine (PCV). While PCV reduced the disease incidence, in part because of a herd immunity effect, a replacement effect was observed whereby disease was increasingly caused by serotypes not included in the vaccine. Dynamic transmission models can account for these effects to describe post-vaccination scenarios, whereas economic evaluations can enable decision-makers to compare vaccines of increasing valency for implementation. This thesis has four aims. First, to explore the limitations and assumptions of published pneu- mococcal models and the implications for future vaccine formulation and policy. Second, to conduct a trend analysis assembling all the available evidence for serotype replacement in Europe, North America and Australia to characterise invasive pneumococcal disease (IPD) caused by vaccine-type (VT) and non-vaccine-types (NVT) serotypes. The motivation behind this is to assess the patterns of relative abundance in IPD cases pre- and post-vaccination, to examine country-level differences in relation to the vaccines employed over time since introduction, and to assess the growth of the replacement serotypes in comparison with the serotypes targeted by the vaccine. The third aim is to use a Bayesian framework to estimate serotype-specific invasiveness, i.e. the rate of invasive disease given carriage. This is useful for dynamic transmission modelling, as transmission is through carriage but a majority of serotype-specific pneumococcal data lies in active disease surveillance. This is also helpful to address whether serotype replacement reflects serotypes that are more invasive or whether serotypes in a specific location are equally more invasive than in other locations. Finally, the last aim of this thesis is to estimate the epidemiological and economic impact of increas- ing serotype coverage in PCVs using a dynamic transmission model. Together, the results highlight that though there are key parameter uncertainties that merit further exploration, divergence in serotype replacement and inconsistencies in invasiveness on a country-level may make a universal PCV suboptimal.Open Acces
Re-examining Writer’s Workshop for Emergent Writers in Kindergarten for the Inclusion of Developmentally Appropriate Practice
Writing’s importance in the classroom has been pushed aside by the recent push for reading and math instruction (Cutler & Graham, 2008). In early childhood classrooms, the amount of time spent on writing is limited and early childhood teachers are feeling unprepared to address the needs of their students (Cutler & Graham, 2008; Haland, Home, and McTigue, 2018; Korth et al., 2017; Pelatti, Piasta, Justice, and O’Connell, 2014). From a theoretical perspective of social constructivism, social cognitive theory, and emergent literacy, teachers will build on what students already know and can do and support within the social constructs of the classroom and community (Mackenzie, 2011). By appreciating student’s early marks as emergent writers rather than discounting them as nothing more than scribbles, teachers give students confidence as writers within the classroom (Mackenzie, 2014; Sulzby & Teale, 1985). This project is a resource for teachers to incorporate developmentally appropriate practices within their Writer’s Workshop to support and encourage them to keep writing as part of the daily routine. By centering the focus for emergent writing on illustration at the beginning of students first formal year of school, students begin to build their writing identity and self-efficacy using what they already know how to do when they first arrive at school
Building body identities - exploring the world of female bodybuilders
This thesis explores how female bodybuilders seek to develop and maintain a viable sense of self despite being stigmatized by the gendered foundations of what Erving Goffman (1983) refers to as the 'interaction order'; the unavoidable presentational context in which identities are forged during the course of social life. Placed in the context of an overview of the historical treatment of women's bodies, and a concern with the development of bodybuilding as a specific form of body modification, the research draws upon a unique two year ethnographic study based in the South of England, complemented by interviews with twenty-six female bodybuilders, all of whom live in the U.K. By mapping these extraordinary women's lives, the research illuminates the pivotal spaces and essential lived experiences that make up the female bodybuilder. Whilst the women appear to be embarking on an 'empowering' radical body project for themselves, the consequences of their activity remains culturally ambivalent. This research exposes the 'Janus-faced' nature of female bodybuilding, exploring the ways in which the women negotiate, accommodate and resist pressures to engage in more orthodox and feminine activities and appearances
The Professional Identity of Doctors who Provide Abortions: A Sociological Investigation
Abortion is a medicalised problem in England and Wales, where the law places doctors at the centre of legal provision and puts doctors in control of who has an abortion. However, the sex-selection abortion scandal of 2012 presented a very real threat to 'abortion doctors', when the medical profession's values and practices were questioned in the media, society and by Members of Parliament. Doctors found themselves at the centre of a series of claims that stated doctors were acting both illegally and unethically, driven by profit rather than patient needs. Yet, the perspectives of those doctors who provide abortions has been under-researched; this thesis aims to fill that gap by examining the beliefs and values of this group of doctors. Early chapters highlight the ambiguous position of the abortion provider in Britain, where doctors are seen as a collective group of professionals motivated by medical dominance and medical autonomy. They outline how this position is then questioned and contested, with doctors being presented as unethical. By studying abortion at the macro-, meso- and micro-levels, this thesis seeks to better understand the values of the 'abortion doctor', and how these levels shape the work and experiences of abortion providers in England and Wales. This thesis thus addresses the question: 'What do abortion doctors' accounts of their professional work suggest about the contemporary dynamics of the medicalisation of abortion in Britain?'. It investigates the research question using a qualitative methodological approach: face-to-face and telephone interviews were conducted with 47 doctors who provide abortions in England and Wales. The findings from this empirical study show how doctors' values are linked to how they view the 'normalisation of abortion'. At the macro-level doctors, openly resisted the medicalisation of abortion through the position ascribed to them by the legal framework, yet at the meso-level doctors construct an identity where normalising abortion is based on further medicalising services. Finally, at the micro-level, the ambiguous position of the abortion provider is further identified in terms of being both a proud provider and a stigmatised individual. This thesis shows that while the existing medicalisation literature has some utility, it has limited explanatory power when investigating the problem of abortion. The thesis thus provides some innovative insights into the relevance and value of medicalisation through a comprehensive study on doctors' values, beliefs and practices
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Co-design As Healing: Exploring The Experiences Of Participants Facing Mental Health Problems
This thesis is an exploration of the healing role of co-design in mental health. Although co-design projects conducted within mental health settings are rising, existing literature tends to focus on the object of design and its outcomes while the experiences of participants per se remain largely unexplored. The guiding research question of this study is not how we design things that improve mental health, but how co-designing, as an act, might do so.
The thesis presents two projects that were organized in collaboration with the mental health charity Islington Mind and the Psychosis Therapy Project (PTP) in London.
The project at Islington Mind used a structured design process inviting participants to design for wellbeing. A case study analysis provides insights on how participants were impacted, summarizing key challenges and opportunities.
The design at PTP worked towards creating a collective brief in an emergent fashion, finally culminating in a board game. The experiences of participants were explored through Interpretative Phenomenological Analysis (IPA), using semi-structured interview data. The analysis served to identify key themes characterising the experience of co-design such as contributing, connecting, thinking and intentioning. In addition, a mixed-methods analysis of questionnaires and interview data exploring participants' wellbeing, showed that all participants who engaged fairly consistently in the project improved after the project ended, although some participants' scores returned to baseline six months later.
Reflecting on both projects, an approach to facilitation within mental health is outlined, detailing how the dimensions of weaving and layered participation, nurturing mattering and facilitating attitudes interlace. This contribution raises awareness of tacit dimensions in the practice of facilitation, articulating the nuances of how to encourage and sustain meaningful and ethical engagement and offering insights into a range of tools. It highlights the importance of remaining reflexive in relation to attitudes and emotions and discusses practical methodological and ethical challenges and ways to resolve them which can be of benefit to researchers embarking on a similar journey.
The thesis also offers detailed insights on how methodologies from different fields were integrated into a whole, arguing for transparency and reflexivity about epistemological assumptions, and how underlying paradigms shift in an interdisciplinary context.
Based on the overall findings, the thesis makes a case for considering design as healing (or a designerly way of healing), highlighting implications at a systems, social and individual level. It makes an original contribution to our understanding of design, highlighting its healing character, and proposes a new way to support mental health. The participants in this study not only had increased their own wellbeing through co-designing, but were also empowered and contributed towards healing the world. Hence, the thesis argues for a unique, holistic perspective of design and mental health, recognizing the interconnectedness of the individual, social and systemic dimensions of the healing processes that are ignited
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 ..
Cost-effective non-destructive testing of biomedical components fabricated using additive manufacturing
Biocompatible titanium-alloys can be used to fabricate patient-specific medical components using additive manufacturing (AM). These novel components have the potential to improve clinical outcomes in various medical scenarios. However, AM introduces stability and repeatability concerns, which are potential roadblocks for its widespread use in the medical sector. Micro-CT imaging for non-destructive testing (NDT) is an effective solution for post-manufacturing quality control of these components. Unfortunately, current micro-CT NDT scanners require expensive infrastructure and hardware, which translates into prohibitively expensive routine NDT. Furthermore, the limited dynamic-range of these scanners can cause severe image artifacts that may compromise the diagnostic value of the non-destructive test. Finally, the cone-beam geometry of these scanners makes them susceptible to the adverse effects of scattered radiation, which is another source of artifacts in micro-CT imaging.
In this work, we describe the design, fabrication, and implementation of a dedicated, cost-effective micro-CT scanner for NDT of AM-fabricated biomedical components. Our scanner reduces the limitations of costly image-based NDT by optimizing the scanner\u27s geometry and the image acquisition hardware (i.e., X-ray source and detector). Additionally, we describe two novel techniques to reduce image artifacts caused by photon-starvation and scatter radiation in cone-beam micro-CT imaging.
Our cost-effective scanner was designed to match the image requirements of medium-size titanium-alloy medical components. We optimized the image acquisition hardware by using an 80 kVp low-cost portable X-ray unit and developing a low-cost lens-coupled X-ray detector. Image artifacts caused by photon-starvation were reduced by implementing dual-exposure high-dynamic-range radiography. For scatter mitigation, we describe the design, manufacturing, and testing of a large-area, highly-focused, two-dimensional, anti-scatter grid.
Our results demonstrate that cost-effective NDT using low-cost equipment is feasible for medium-sized, titanium-alloy, AM-fabricated medical components. Our proposed high-dynamic-range strategy improved by 37% the penetration capabilities of an 80 kVp micro-CT imaging system for a total x-ray path length of 19.8 mm. Finally, our novel anti-scatter grid provided a 65% improvement in CT number accuracy and a 48% improvement in low-contrast visualization. Our proposed cost-effective scanner and artifact reduction strategies have the potential to improve patient care by accelerating the widespread use of patient-specific, bio-compatible, AM-manufactured, medical components
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