An analysis of factors linked to the decline in maternal mortality in Nepal

Peer reviewedPublisher PD

Exploring the Experiences of Communication Partners of People with Parkinson\u27s Disease: A Qualitative Study

The purpose of this phenomenological qualitative study was to explore interactions between persons with Parkinson\u27s disease (PD) and their communication partners. People with PD experience difficulties that can have a profound effect on their ability to communicate. This qualitative study explored the thoughts and feelings of primary communication partners of people with PD. The primary communication partners were interviewed using open-ended questions. The seven participants identified and detailed how declines in communication due to PD have resulted in changes in daily life, including; social participation, daily tasks, and psychosocial well-being. Commonalities that communication partners experienced will aid speech-language pathologists to better understand the effects that PD has on communication

Modeling and Managing Urban Growth at the Rural-Urban Fringe: A Parcel-Level Model of Residential Land Use Change

As many local and state governments in the United States grapple with increasing growth pressures, the need to understand the economic and institutional factors underlying these pressures has taken on added urgency. From an economic perspective, individual land use decisions play a central role in the manifestation of growth pressures, as changes in land use pattern are the cumulative result of numerous individual decisions regarding the use of lands. In this study, the issue of growth management is addressed by developing a spatially disaggregated, microeconomic model of land conversion decisions suitable for describing residential land use change at the rural-urban fringe. The model employs parcel-level data on land use in Calvert County, Maryland, a rapidly growing rural-urban fringe county. A probabilistic model of residential land use change is estimated using a duration model, and the parameter estimates are employed to simulate possible future growth scenarios under alternative growth management scenarios. Results suggest that "smart growth" objectives are best met when policies aimed at concentrating growth in target areas are implemented in tandem with policies designed to preserve rural or open space lands.Land Economics/Use,

Positive Indirect Interactions in Marine Herbivores and Algae

There is an increasing interest in how nested positive indirect interactions involving at least three species maintain community structure. Recent research shows that positive indirect effects can strongly influence community structure, organisation and functioning. It is thus important to understand and identify positive indirect effects for the purpose of predicting system responses to certain perturbations. In order to investigate indirect effects, experimental manipulations must be carried out within the entire framework of the community of interest. Hence, often due to logistical difficulties, indirect effects, especially those that yield positive results, have been less studied. Here we present a synthesis of current information on patterns of positive indirect effects and review and compare recently conducted experimental studies in marine herbivores and algae

Pregnancy outcomes for women employed as hairdressers, cosmetologists and laboratory workers: systematic review of the literature and data-analysis of Finnish medical birth registry

This thesis included a systematic literature review, yielding studies on three employment categories: hairdressers, cosmetologists and laboratory workers. The original research examined pregnancy outcomes for Finnish singleton births between 1990 and 2010. The parameters were increased male gender, low birth-weight, high birth-weight, pre-term delivery, post-term delivery, small for gestational age, large for gestational age, stillbirth and early neonatal death. Finnish Birth Registry data included 507,659 prima gravida women who delivered singletons with at least 22 weeks’ gestation 1990- 2010. There were 12,854 hairdressers, 1841 cosmetologists and 3587 laboratory workers. Control populations: 40,405 teachers, 1968 musicians and 447,004 women-general population. When hairdressers were compared to the general public, there were three marginally statistically significant results for new-borns: SGA, (OR 1.01, 95% CI 1.00 - 1.02), LGA, (OR 1.02, 95% CI 1.00 - 1.03) and post-term delivery (OR 1.06, 95% CI 1.02 -1.11). Marginal increased statistically significant results for pooled effect size (ES) from the meta-analysis were found for LBW among hairdressers ES 1.083 (95% CI, 1.017-1.153) and SGA infants among hairdressers ES 1.077 (95% CI, 1.006-1.153). Hairdressers may be at a marginally increased risk of low birth weight and small size for gestational age. This may be due to occupational exposure

Revision of failed traditional fundoplication using EsophyX® transoral fundoplication

BACKGROUND: Laparoscopic revision of failed traditional fundoplication is difficult and involves risk of gastric, esophageal, and vagal nerve injury that is higher than that of the primary fundoplication. This study assessed feasibility and clinical outcomes of the transoral approach to revision of loose Nissen. METHODS: Between November 2009 and August 2011, a total of 11 patients underwent transoral repair as opposed to 70 patients who underwent laparoscopic or open revision of a failed fundoplication. Subjective and objective outcomes were evaluated with the GERD health-related quality of life (GERD-HRQL) questionnaire and the reflux symptom index (RSI) questionnaire and ambulatory pH testing. The competency of the new antireflux barrier was evaluated by endoscopy. Wilcoxon signed-rank test was used to compare pre- and postoperative variables. RESULTS: All 11 patients evidenced loosening of the Nissen fundoplication without evidence of hiatal failure. Mean age was 57 years, BMI was 25.1 kg/m(2), and 4 of 11 (36 %) were female. Indications for operation were abnormal pH-metry off PPIs (6), impedance/pH on PPIs (3), esophagitis (1), and evidence of free reflux on barium swallow (1). One patient developed a postoperative bleed requiring transfusion. Two patients had laparoscopic revision at 6 and 8 months after the transoral procedure. At a median follow-up of 14 (range = 6–28) months, 8/10 patients reported resolution of their primary symptoms. Eight patients had pH testing off PPIs both pre- and postoperatively; median % time with pH <4 improved by dropping from 8.1 % (21–4.8 %) to 0.6 % (13.4–0.01 %) (p = 0.008). Esophageal acid exposure normalized in 5/6 patients. Mean GERD-HRQL score improved significantly by dropping from 28.6 (10.6) preoperatively to 6.7 (6.1) post-TIF (p = 0.016). Mean RSI score improved more than 50 % in 5/7 patients. CONCLUSION: Transoral revision of failed traditional fundoplication without herniation is technically feasible. It results in symptomatic and objective improvement of GERD without the risks of laparoscopic dissection for a majority of patients

COORDINATION AND VARIABILITY IN AUSTRALIAN RULES FOOTBALL KICKING: IMPLICATIONS FOR PERFORMANCE

The purpose of this study was to quantify coordination and coordination variability (CV) of drop-punt kicking in professional Australian Football players and investigate the association between CV and in-game kicking performance and professional playing experience. Intra-limb couplings described to be associated with kicking accuracy were investigated during 30m successful drop-punt kicking efforts in 14 players. Coordination and CV were quantified using a modified vector coding technique. Higher CV of frontal plane trunk/pelvis, frontal and transverse plane thigh/leg and frontal plane leg/foot coupled motion were associated with higher in-game kicking performance. In-game kicking performance and CV did not change following two years of professional experience. These results highlight the significance of junior level skill development and kicking performance in talent identification

From Global Rights to Local Relationships: Exploring Disconnects in Respectful Maternity Care in Malawi

Widespread reports of “disrespect and abuse” in maternity wards in low- and middle-income countries have triggered the development of rights-based respectful maternity care (RMC) standards and initiatives. To explore how international standards translate into local realities, we conducted a team ethnography, involving observations in labor wards in government facilities in central Malawi, and interviews and focus groups with midwives, women, and guardians. We identified a dual disconnect between, first, universal RMC principles and local notions of good care and, second, between midwives and women and guardians. The latter disconnect pertains to fraught relationships, reproduced by and manifested in mechanistic care, mutual responsibilization for trouble, and misunderstandings and distrust. RMC initiatives should be tailored to local contexts and midwife-client relationships. In a hierarchical, resource-strapped context like Malawi, promoting mutual love, understanding, and collaboration may be a more productive way to stimulate “respectful” care than the current emphasis on formal rights and respect