Barriers to Healthy Births at Nigerian Hospitals

Maternal mortality is a problem everywhere, but it is especially dangerous in Nigeria where the average woman experiences pregnancy six times during her lifetime (Population Reference Bureau, 2001). Many researchers focus on the medical complications associated with labor, such as hemorrhage, eclampsia, or infection. Although these birth complications are the direct sources of maternal death, it is also important to recognize how maternal mortality is a multifaceted issue influenced by local cultural groups, religions, politics, poverty level and the absence of basic infrastructures. Although maternal mortality is interconnected with social and geographical elements, my paper concentrates on Nigerian hospitals and their contribution to the maternal death rate. The eight most pressing issues in Nigerian hospitals include strict hours of operation, lack of affordability in medical costs, poor Johnston 5 distribution, insufficient oversight and lax hiring standards, staff shortages, scarcity of supplies, unprofessional staff behavior, and lack of sensitivity towards religions and cultures

Some New Properties of Chiral Molecules

The work in this thesis divides naturally into two distinct parts which are linked by the general underlying theme of chiral discrimination. The first part concerns the discriminatory response of chiral molecules to circularly polarized light which constitutes optical activity, the second, chiral discrimination in intermolecular forces. Specifically, in Part I, a detailed study of rotational optical activity is undertaken. Expressions are derived to describe Raman optical activity, optical rotation and circular dichroism by first treating the simple case of a symmetric top molecule and then allowing this to be the basis for the more sophisticated development required for an asymmetric top molecule. In Part II, discrimination in the dispersion interaction between odd-electron chiral molecules is studied. It is shown that novel contributions to the discriminatory interaction are introduced by allowing for the time-odd part of the molecular optical activity tensor which is supported by chiral molecular systems in which there is some source of time asymmetry, as provided, for example, by the residual electronic angular momenta of odd-electron molecules. Both a semi-classical and a quantum electrodynamical treatment are given, the latter making possible a study of the wave-zone region in which the finite speed of light must be taken into account. Calculations, within the semi-classical model, on a hypothetical odd-electron chiral transition metal complex of 0* symmetry indicate that the new discriminatory contributions could be within an order of magnitude of the conventional discriminatory contributions

Des stratégies d’étude pratiques et personnalisables pour réussir son année d’externat

The transition from a pre-clerkship curriculum to the clerkship year presents a need to re-examine and modify study strategies for clinical subject examinations and ultimately the United States Medical License Examination STEP 2 Clinical Knowledge. Efficient and effective learning are keys in balancing the significantly increased responsibility of patient care and decreased time for examination preparation. We describe several customizable study approaches, advice on selecting resources, and methods for applying the educational framework of deliberate practice and corrective feedback to learning during a medical student’s clerkship years. These strategies focus on intentional and outcome-driven self-assessments to identify and patch knowledge gaps tailored to the clerkship year that will empower learners.Le passage du programme de préexternat à l’année d’externat exige que les étudiants revoient leurs stratégies d’étude pour les examens de matières cliniques et, à terme, pour l’examen STEP 2 Clinical Knowledge du United States Medical License Examination. Un apprentissage efficace et efficient est essentiel pour trouver un équilibre entre l’importante augmentation des responsabilités de soins aux patients et la diminution du temps consacré à la préparation des examens. Nous proposons aux étudiants en médecine plusieurs approches d’étude personnalisables, ainsi que des conseils sur la sélection de ressources et méthodes pour appliquer le modèle éducatif de la pratique délibérée et de la rétroaction corrective à leur apprentissage pendant les années d’externat. Ces stratégies, adaptées à l’année d’externat, sont focalisées sur l’autoévaluation intentionnelle et axée sur les résultats pour repérer et combler les lacunes en matière de connaissances. Elles aideront les apprenants à se sentir en confiance de leurs moyens

Uptake and participation in physical activity referral schemes in the UK: an investigation of patients referred with mental health problems

The study compared outcomes of uptake, attendance, and completion between two patient groups (mental health, n = 134 and physical health, n = 2767) in a physical activity referral scheme in the UK during 2000 to 2003. Despite similar rates for the physical health and mental health groups for initial progression (94% vs. 90%), referral uptake (60% vs. 69%; p < 0.001) and programme completion (22% vs. 34%; p < 0.001) were significantly lower in the mental health referrals. In conclusion, physical activity referral schemes appear to be less well suited to the needs of the mental health patient. Further research is recommended

Practical and customizable study strategies for clerkship year success

The transition from a pre-clerkship curriculum to the clerkship year presents a need to re-examine and modify study strategies for clinical subject examinations and ultimately the United States Medical License Examination STEP 2 Clinical Knowledge. Efficient and effective learning are keys in balancing the significantly increased responsibility of patient care and decreased time for examination preparation. We describe several customizable study approaches, advice on selecting resources, and methods for applying the educational framework of deliberate practice and corrective feedback to learning during a medical student’s clerkship years. These strategies focus on intentional and outcome-driven self-assessments to identify and patch knowledge gaps tailored to the clerkship year that will empower learners

Applying the behaviour change technique (BCT) taxonomy v1: a study of coder training.

Behaviour Change Technique Taxonomy v1 (BCTTv1) has been used to detect active ingredients of interventions. The purpose of this study was to evaluate effectiveness of user training in improving reliable, valid and confident application of BCTTv1 to code BCTs in intervention descriptions. One hundred sixty-one trainees (109 in workshops and 52 in group tutorials) were trained to code frequent BCTs. The following measures were taken before and after training: (i) inter-coder agreement, (ii) trainee agreement with expert consensus, (iii) confidence ratings and (iv) coding competence. Coding was assessed for 12 BCTs (workshops) and for 17 BCTs (tutorials). Trainees completed a course evaluation. Methods improved agreement with expert consensus (p < .05) but not inter-coder agreement (p = .08, p = .57, respectively) and increased confidence for BCTs assessed (both p < .05). Methods were as effective as one another at improving coding competence (p = .55). Training was evaluated positively. The training improved agreement with expert consensus, confidence for BCTs assessed, coding competence but not inter-coder agreement. This varied according to BCT.This work was carried out as part of the Behavior Change Technique Taxonomy project funded by the Medical Research Council via its Methodology panel [G0901474/1].This is the accepted manuscript version. The final publication is available from Springer at http://link.springer.com/article/10.1007%2Fs13142-014-0290-

The CATH Domain Structure Database and related resources Gene3D and DHS provide comprehensive domain family information for genome analysis

The CATH database of protein domain structures (http://www.biochem.ucl.ac.uk/bsm/cath/) currently contains 43 229 domains classified into 1467 superfamilies and 5107 sequence families. Each structural family is expanded with sequence relatives from GenBank and completed genomes, using a variety of efficient sequence search protocols and reliable thresholds. This extended CATH protein family database contains 616 470 domain sequences classified into 23 876 sequence families. This results in the significant expansion of the CATHHMMmodel library to include models built from the CATH sequence relatives, giving a10%increase in coveragefor detecting remote homologues. An improved Dictionary of Homologous superfamilies (DHS) (http://www.biochem.ucl.ac.uk/bsm/dhs/) containing specific sequence, structural and functional information for each superfamily in CATH considerably assists manual validation of homologues. Information on sequence relatives in CATH superfamilies, GenBank and completed genomes is presented in the CATH associated DHS and Gene3D resources. Domain partnership information can be obtained from Gene3D (http://www.biochem.ucl.ac.uk/bsm/cath/Gene3D/). A new CATH server has been implemented (http://www.biochem.ucl.ac.uk/cgi-bin/cath/CathServer.pl) providing automatic classification of newly determined sequences and structures using a suite of rapid sequence and structure comparison methods. The statistical significance of matches is assessed and links are provided to the putative superfamily or fold group to which the query sequence or structure is assigned

Declaring a tuberculosis outbreak over with genomic epidemiology

We report an updated method for inferring the time at which an infectious disease was transmitted between persons from a time-labelled pathogen genome phylogeny. We applied the method to 48 Mycobacterium tuberculosis genomes as part of a real-time public health outbreak investigation, demonstrating that although active tuberculosis (TB) cases were diagnosed through 2013, no transmission events took place beyond mid-2012. Subsequent cases were the result of progression from latent TB infection to active disease, and not recent transmission. This evolutionary genomic approach was used to declare the outbreak over in January 2015

Canine pseudopregnancy: an evaluation of prevalence and current treatment protocols in the UK

Background: There is a dearth of literature on pseudopregnancy in the bitch, with only a few treatment-based studies published since the 1990s. Pseudopregnancy may be under-recognised in bitches and may account for a proportion of behavioural cases seen in veterinary practices including aggression. Little is known about commonly used treatments for overtly pseudopregnant bitches and it is possible that current regimes may not be prescribed for a sufficient duration to control any clinical signs including, physical and behavioural changes. To investigate current trends in diagnosis and treatment of canine pseudopregnancy, a postal survey was sent to 2000 randomly selected veterinary surgeons in UK veterinary practices. The questionnaire queried how often vets recognise cases of pseudopregnancy in spayed and entire bitches, which physical or behavioural signs are commonly recognised for diagnosis, and which management or treatment protocols are used. Results: The response rate was 19.8% (397/2000). Ninety-six percent of veterinary surgeons reported seeing pseudopregnant bitches showing behavioural changes without any physical changes within the last 12 months. Of those behavioural changes, collecting and mothering objects was the most frequently reported behavioural sign (96%). Ninety-seven percent of vets had seen aggression in pseudopregnant bitches. Nevertheless, only 52% of vets routinely asked owners about behavioural changes during consultations. Forty-nine percent of respondents reported seeing pseudopregnancy in spayed bitches. The most commonly reported physical sign was enlarged mammary glands and/or milk production (89%). Treatment options varied (surgical, medical or none) and depended on duration and severity of physical and behavioural signs, owners’ preference, cost, concurrent disease, drug availability and previous history. Conclusions: This is the largest epidemiological study of canine pseudopregnancy in the UK. The prevalence and severity of clinical signs in dogs with pseudopregnancy are variable and possibly under-estimated. Dogs with overt pseudopregnancy experience diverse physical and behavioural changes and information on standard treatment protocols are lacking. Although, progress on our understanding of diagnosis and treatment of pseudopregnancy in spayed and entire bitches has been made, further studies are warranted