Resolving couples' work-family conflicts: The complexity of decision making and the introduction of a new framework

The goal of this study is to develop a theoretical framework in order to illuminate the cues involved in real life work-family conflict resolution within dual-earner couples. We draw on episodic and longitudinal data from qualitative diaries kept for a one-month period by both members of 24 dual-earner couples (48 participants) with child dependants, as well as from introductory and subsequent in-depth qualitative interviews with the couples, both together and apart. Two distinct types of work-family decision making: a) anchoring decisions and b) daily decisions were revealed, each of which were differentially impacted by enabling and constraining cues, considerations of fairness and equity, and beliefs, values and preferences. The findings suggest that the decision-making process engaged in by couples in incidents of work-family conflict does not progress in a logical sequence, but instead involves numerous complex negotiations and interactions. A decision-making framework encapsulating these findings is reported, highlighting the cues considered when making both types of work-family conflict decisions, and the relationships between them.Full Tex

Providing, Performing and Protecting: The Importance of Work Identities in Negotiating Conflicting Work-Family Ideals as a Single Mother

Open access articleThe aims of this paper are twofold. First, we aim to expand understanding of work–family experiences beyond the prevalent emphasis on traditional couple-headed families within organization and management literatures by focusing on the experiences of employed single mothers. Second, we aim to gain insight into how work and family meanings may be negotiated in the context of heightened conflicting ideals and demands. Drawing on rich qualitative data from in-depth interviews and diaries, our findings make three important contributions to the existing work–family literature. First, we show that conflicting work and family ideals are not only exacerbated for single mothers, but viable narrative strategies with which to negotiate this conflict are also restricted. Second, we highlight how narratives constructed around the meaning of work are key to single mothers’ negotiation of conflicting work and family ideals and identify three work narratives drawn upon by single mothers focused on providing, performing and protecting. Finally, we demonstrate how shifts between single mothers’ work narratives are particularly influenced by progression opportunities and a supportive work environment. We conclude by making suggestions for future work–family researc

Human serum IgM glycosylation: identification of glycoforms that can bind to mannan-binding lectin

The glycoprotein IgM is the major antibody produced in the primary immune response to antigens, circulating in the serum both as a pentamer and a hexamer. Pentameric IgM has a single J chain, which is absent in the hexamer. The mu (heavy) chain of IgM has five N-linked glycosylation sites. Asn-171, Asn-332, and Asn-395 are occupied by complex glycans, whereas Asn-402 and Asn-563 are occupied by oligomannose glycans. The glycosylation of human polyclonal IgM from serum has been analyzed. IgM was found to contain 23.4% oligomannose glycans GlcNAc2Man5-9, consistent with 100% occupancy of Asn-402 and 17% occupancy of the variably occupied site at Asn-563. Mannan-binding lectin (MBL) is a member of the collectin family of proteins, which bind to oligomannose and GlcNAc-terminating structures. A commercial affinity chromatography resin containing immobilized MBL has been reported to be useful for partial purification of mouse and also human IgM. Human IgM glycoforms that bind to immobilized MBL were isolated; these accounted for only 20% of total serum IgM. Compared with total serum IgM, the MBL-binding glycoforms contained 97% more GlcNAc-terminating structures and 8% more oligomannose structures. A glycosylated model of pentameric IgM was constructed, and from this model, it became evident that IgM has two distinct faces, only one of which can bind to antigen, as the J chain projects from the non-antigen-binding face. Antigen-bound IgM does not bind to MBL, as the target glycans appear to become inaccessible once IgM has bound antigen. Antigen-bound IgM pentamers therefore do not activate complement via the lectin pathway, but MBL might have a role in the clearance of aggregated IgM

Randomised controlled trial of food elimination diet based on IgG antibodies for the prevention of migraine like headaches

<p>Abstract</p> <p>Background</p> <p>Research suggests that food intolerance may be a precipitating factor for migraine like headaches.</p> <p>Aim</p> <p>To evaluate the effectiveness of the ELISA (Enzyme Linked Immuno-Sorbent Assay) Test and subsequent dietary elimination advice for the prevention of migraine like headaches.</p> <p>Design</p> <p>Randomised controlled trial.</p> <p>Setting</p> <p>Community based volunteers in the UK.</p> <p>Participants</p> <p>Volunteers who met the inclusion criteria for migraine like headaches and had one or more food intolerance were included in the study. Participants received either a true diet (n = 84) or a sham diet (n = 83) sheet. Participants were advised to remove the intolerant foods from their diet for 12 weeks.</p> <p>Main outcome measures</p> <p>Number of headache days over a 12 week period (item A MIDAS questionnaire). Other measures includes the total MIDAS score and total HIT-6 score.</p> <p>Results</p> <p>The results indicated a small decrease in the number of migraine like headaches over 12 weeks, although this difference was not statistically significant (IRR 1.15 95% CI 0.94 to 1.41, p = 0.18). At the 4 week assessment, use of the ELISA test with subsequent diet elimination advice significantly reduced the number of migraine like headaches (IRR 1.23 95%CI 1.01 to 1.50, p = 0.04). The disability and impact on daily life of migraines were not significantly different between the true and sham diet groups.</p> <p>Conclusions</p> <p>Use of the ELISA test with subsequent diet elimination advice did not reduce the disability or impact on daily life of migraine like headaches or the number of migraine like headaches at 12 weeks but it did significantly reduce the number of migraine like headaches at 4 weeks.</p> <p>Trial registration number</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRTCN89559672">ISRTCN89559672</a></p

A prospective stroke register in Sierra Leone: Demographics, stroke type, stroke care and hospital outcomes

Introduction Stroke is the second most common cause of adult death in Africa. This study reports the demographics, stroke types, stroke care and hospital outcomes for stroke in Freetown, Sierra Leone. Methods A prospective observational register recorded all patients 18 years and over with stroke between May 2019 and April 2020. Stroke was defined according to the WHO criteria. Pearson’s chi squared test was used to examine associations between categorical variables and unpaired t-tests for continuous variables. Multivariable logistic regression,to explain in-hospital death, was reported as odds ratios (OR) and 95% confidence intervals. Results 385 strokes were registered, 315 (81.8%) were first in a lifetime events. Mean age was 59.2 (SD 13.8) and 187 (48.6%) were male. 327 (84.9%) of strokes were confirmed by CT scan. 231 (60.0%) were ischaemic, 85 (22.1%) intracerebral haemorrhage, 11 (2.9%) subarachnoid haemorrhage and 58 (15.1%) undetermined stroke type. The median National Institute of Health Stroke Scale on presentation was 17 (IQR 9-25). Haemorrhagic strokes compared to ischaemic strokes were more severe, 20 (IQR 12-26) vs 13 (IQR 7-22) (p<0.001), and occurred in a younger population, mean age 52.3 (SD 12.0) vs 61.6 (SD 13.8) (p<0.001), with a lower level of educational attainment 28.2% vs 40.7% (p=0.04). The median time from stroke onset to arrival at the principal referral hospital was 25 hours (IQR 6-73). Half the patients (50.4%) sought care at another health provider prior to arrival. 151 patients died in hospital (39.5%). 43 deaths occurred within 48 hours of arriving at hospital with median time to death of 4 days (IQR 0-7 days). 49.6% of patients had ≥1 complication, 98 (25.5%) pneumonia, 33 (8.6%) urinary tract infection. Male gender (OR 3.33,1.65 - 6.75), pneumonia (OR 3.75, 1.82 – 7.76), subarachnoid haemorrhage (OR 43.1, 6.70-277.4) and undetermined stroke types (OR 6.35, 2.17– 18.60), were associated with higher risk of in-hospital death. Discussion We observed severe strokes occurring in a young population with high in hospital mortality. Further work to deliver evidence-based stroke care is essential to reduce stroke mortality in Sierra Leone

Stern Review: The Economics of Climate Change

The Review's executive summary states that "the Review first examines the evidence on the economic impacts of climate change itself, and explores the economics of stabilizing greenhouse gases in the atmosphere. The second half of the Review considers the complex policy challenges involved in managing the transition to a low-carbon economy and in ensuring that societies can adapt to the consequences of climate change that can no longer be avoided". The report's main conclusion is that the benefits of strong, early action on climate change considerably outweigh the costs

Stroke in Sierra Leone: Case fatality rate and functional outcome after stroke in Freetown

Background: There is limited information on long term outcomes after stroke in Sub-Saharan Africa (SSA). Current estimates of case fatality rate (CFR) in SSA are based on small sample sizes with varying study design and report high heterogeneity. Aims: We report CFR and functional outcomes from a large, prospective, longitudinal cohort of stroke patients in Sierra Leone and describe factors associated with mortality and functional outcome. Methods: A prospective longitudinal stroke register was established at both adult tertiary government hospitals in Freetown, Sierra Leone. It recruited all patients ≥18 years with stroke, using the World Health Organization definition, from May 2019 until October 2021. To reduce selection bias onto the register all investigations were paid by the funder and outreach conducted to raise awareness of the study. Sociodemographic data, National Institute of Health Stroke Scale (NIHSS) and Barthel Index (BI) was collected on all patients on admission, at seven days, 90 days, one year and two years post stroke. Cox proportional-hazards models were constructed to identify factors associated with all-cause mortality. A binomial logistic regression model reports odds ratio (OR) for functional independence at one year. Results: 986 patients with stroke were included, of which 847 (85.9%) received neuroimaging. Follow up rate was 81.5% at one year, missing item data was &lt;1% for most variables. Stroke cases were equally split by sex and mean age was 58.9 (SD: 14.0) years. 625 (63%) were ischaemic, 206 (21%) primary intracerebral haemorrhage, 25 (3%) subarachnoid haemorrhage and 130 (13%) were of undetermined stroke type. Median NIHSS was 16 (9-24). CFR at 30 days, 90 days, 1 year and 2 years was 37.1%, 44.4%, 49.7% and 53.2% respectively. Factors associated with increased fatality were male sex HR:1.28 (1.05-1.56), previous stroke HR:1.34 (1.04-1.71), atrial fibrillation HR:1.58(1.06-2.34), subarachnoid haemorrhage HR:2.31 (1.40-3.81), undetermined stroke type HR: 3.18(2.44-4.14) and in-hospital complications HR: 1.65 (1.36-1.98). 93% of patients were completely independent prior to their stroke, declining to 19% at one year after stroke. Functional improvement was most likely to occur between 7 and 90-days post stroke with 35% patients improving, and 13% improving between 90 days to one year. Increasing age OR: 0.97(0.95-0.99), previous stroke OR: 0.50 (0.26-0.98), NIHSS OR 0.89 (0.86-0.91), undetermined stroke type OR:0.18 (0.05-0.62) and ≥1 in hospital complication OR:0.52 (0.34-0.80) were associated with lower OR of functional independence at one year. Whilst hypertension OR:1.98 (1.14-3.44) and being the primary breadwinner of the household OR:1.59 (1.01-2.49) were associated with functional independence. Discussion: Stroke in Sierra Leone affected younger people, and resulted in high rates of fatality and functional impairment relative to global averages. Key clinical priorities for reducing fatality include preventing stroke-related complications through evidence-based stroke care; improved detection and management of atrial fibrillation, and increasing coverage of secondary prevention. Further research into care pathways and interventions to encourage care seeking for less severe strokes should be prioritized. Data availability: Requests for access to anonymized data for academic use should be made to the SISLE team https://www.kcl.ac.uk/research/stroke

Addressing the climate challenge

In 2021, colleagues from across the University of Birmingham community were invited to write articles about topics relevant to the COP26 climate change summit. In this series of articles, experts from across many different disciplines provide new insight and evidence on how we might all understand and tackle climate change

Prospective, multicentre study of screening, investigation and management of hyponatraemia after subarachnoid haemorrhage in the UK and Ireland

Background: Hyponatraemia often occurs after subarachnoid haemorrhage (SAH). However, its clinical significance and optimal management are uncertain. We audited the screening, investigation and management of hyponatraemia after SAH. Methods: We prospectively identified consecutive patients with spontaneous SAH admitted to neurosurgical units in the United Kingdom or Ireland. We reviewed medical records daily from admission to discharge, 21 days or death and extracted all measurements of serum sodium to identify hyponatraemia (&lt;135 mmol/L). Main outcomes were death/dependency at discharge or 21 days and admission duration &gt;10 days. Associations of hyponatraemia with outcome were assessed using logistic regression with adjustment for predictors of outcome after SAH and admission duration. We assessed hyponatraemia-free survival using multivariable Cox regression. Results: 175/407 (43%) patients admitted to 24 neurosurgical units developed hyponatraemia. 5976 serum sodium measurements were made. Serum osmolality, urine osmolality and urine sodium were measured in 30/166 (18%) hyponatraemic patients with complete data. The most frequently target daily fluid intake was &gt;3 L and this did not differ during hyponatraemic or non-hyponatraemic episodes. 26% (n/N=42/164) patients with hyponatraemia received sodium supplementation. 133 (35%) patients were dead or dependent within the study period and 240 (68%) patients had hospital admission for over 10 days. In the multivariable analyses, hyponatraemia was associated with less dependency (adjusted OR (aOR)=0.35 (95% CI 0.17 to 0.69)) but longer admissions (aOR=3.2 (1.8 to 5.7)). World Federation of Neurosurgical Societies grade I–III, modified Fisher 2–4 and posterior circulation aneurysms were associated with greater hazards of hyponatraemia. Conclusions: In this comprehensive multicentre prospective-adjusted analysis of patients with SAH, hyponatraemia was investigated inconsistently and, for most patients, was not associated with changes in management or clinical outcome. This work establishes a basis for the development of evidence-based SAH-specific guidance for targeted screening, investigation and management of high-risk patients to minimise the impact of hyponatraemia on admission duration and to improve consistency of patient care

Molecular Characterization Of Putative Mesenchymal Progenitor Cells From Equine Bone Marrow Aspirates

Bone marrow contains many cell types including hematopoietic cells and their precursors, adipocytes, endothelial cells, and osteocytes. There are also cells with reported capacity to differentiate into bone, cartilage, and other tissues. Their descriptive terminology varies and includes mesenchymal stem cell (MSC), stromal stem cell (SSC), and mesenchymal progenitor cell (MPC), used herein. The cellsurface phenotypes of cultured MPCs have been described for humans and other species. However, there is no consensus on their phenotype from uncultured bone marrow mononuclear cells (BMMNC) and poor understanding of their phenotypic changes during culture. These issues complicate clinical use of MPCs in cell-based therapies as extended periods of culture (typically 4-6 weeks) are required to purify and expand cell numbers, making the original phenotype unclear and delaying treatment. To address this problem, my experiments were designed to study the phenotypic changes that occur in equine BMMNCs from isolation through one month culture. Flow cytometry and reverse transcriptase quantitative polymerase chain Results reaction (RT-qPCR) were used to analyze cell-surface molecules. demonstrated numerous dynamic changes in BMMNC phenotype. Next, cell sorting experiments were performed to determine if phenotypic changes during early culture could be exploited for MPC colony enrichment. Magnetic activated cell sorting (MACS) was used to separate adherent BMMNCs based on their expression of cluster of differentiation (CD) marker CD14. BMMNCs were separated into three groups; CD14 positive, CD14 negative, or unsorted. Flow cytometry and RT-qPCR were used to evaluate sorting efficiency and compare groups over time. At day seven, cells positively selected for CD14 were significantly more likely to form colonies than both unsorted and negatively selected cells (P less than or equal to 0.005). Further, MPCs maintained low levels of CD14 expression in long-term culture and upregulated expression in response to lipopolysaccharide. These findings were surprising because by definition, MPCs are thought to be non-hematopoietic because they lack expression of specific hematopoietic molecules such as CD14. Only certain lineages of hematopoietic cells are known to express CD14. Results of my studies support that equine MPCs express and are enriched by CD14, suggesting they have either been misclassified, or may represent a differentiated descendant of a hematopoietic cell