Early newborn care practices and the development and functionality of the human microbiome

Background: The protease family, a group of enzymes produced by the host and bacterial species, play important roles in maintaining the homeostasis of the intestinal barrier. The concentrations of major gastrointestinal proteases including; pepsin, trypsin, and chymotrypsin, have been measured in preterm neonates. However, their longitudinal development is not well described. This thesis aims to investigate the dynamics of proteases, relate activity to disease and bacterial colonisation and measure their impact in vitro in a neonatal cohort. Methods: Daily faecal and ileostomy samples were collected from birth until discharge or death in 66 preterm neonates born before 32 weeks’ gestation. Substrate and inhibitor-based assays were applied to profile total protease activity (ng/µL trypsin equivalent (TE)) in 20 control neonates, three surgically confirmed necrotising enterocolitis (NEC) cases, one spontaneous intestinal perforation (SIP) case, one intestinal atresia case, and three culture confirmed septicaemia cases. Postnatal colonisation of the intestinal tract was followed in 15 neonates by metataxonomic analysis. The proteolytic impact on the intestinal barrier was assessed in a Caco-2 cell model. Results: Control, NEC/SIP and septicaemia neonates were characterised by patterns of high and low proteolytic activities. Activity increased with postmenstrual age only in control neonates (p<0.05). Inhibitor analysis revealed faecal and ileostomy samples were characterised by serine and cysteine proteases. Colonisation was irregular and dominated by genera that were not influenced by postnatal age, mode of delivery or feeding regimen. Correlation analysis revealed positive associations between Clostridium sensu stricto and Corynebacterium genera and faecal and ileostomy proteolytic activity (p <0.05). Caco-2 cell exposure to samples with low protease activity (< 250 ng/µL TE) led to a greater decrease in transepithelial electrical resistance. Conclusions: Having established that proteases are present and active during the early neonatal period; this thesis provides the scope to continue investigating their associations with bacteria and their roles in neonatal diseases.Open Acces

Exploring women's experiences, views and understanding of vaginal examinations during intrapartum care:A meta-ethnographic synthesis

Objective: To conduct a systematic review exploring women’s experiences, views and understanding of any vaginal examinations during intrapartum care, in any care setting and by any healthcare professional. Intrapartum vaginal examination is deemed both an essential assessment tool and routine intervention during labour. It is an intervention that can cause significant distress, embarrassment, and pain for women, as well as reinforce outdated gender roles. In view of its widespread and frequently reported excessive use, it is important to understand women’s views on vaginal examination to inform further research and current practice.Design: A systematic search and meta-ethnography synthesis informed by Noblit and Hare (1988) and the eMERGe guidance (France et al. 2019) was undertaken. Nine electronic databases were searched systematically using predefined search terms in August 2021, and again in March 2023. Studies meeting the following criteria: English language, qualitative and mixed-method studies, published from 2000 onwards, and relevant to the topic, were eligible for quality appraisal and inclusion.Findings: Six studies met the inclusion criteria. Three from Turkey, one from Palestine, one from HongKong and one from New Zealand. One disconfirming study was identified. Following both a reciprocal and refutational synthesis, four 3rd order constructs were formed, titled: Suffering the examination, Challenging the power dynamic, Cervical-centric labour culture embedded in societal expectations, and Context of care. Finally, a line of argument was arrived at, which brought together and summarised the 3rd orde rconstructs.Key conclusions and implications of practice: The dominant biomedical discourse of vaginal examination and cervical dilatation as central to the birthing process does not align with midwifery philosophy or women’s embodied experience. Women experience examinations as painful and distressing but tolerate them as they view them as necessary and unavoidable. Factors such as context of care setting, environment, privacy, midwifery care, particularly in a continuity of carer model, have considerable positive affect on women’s experience of examinations. Further research into women’s experiences of vaginal examination in different care models as well as research into less invasive intrapartum assessment tools that promote physiological processes is urgently require

Exploring women's experiences, views and understanding of vaginal examinations during intrapartum care:A meta-ethnographic synthesis

Objective: To conduct a systematic review exploring women’s experiences, views and understanding of any vaginal examinations during intrapartum care, in any care setting and by any healthcare professional. Intrapartum vaginal examination is deemed both an essential assessment tool and routine intervention during labour. It is an intervention that can cause significant distress, embarrassment, and pain for women, as well as reinforce outdated gender roles. In view of its widespread and frequently reported excessive use, it is important to understand women’s views on vaginal examination to inform further research and current practice.Design: A systematic search and meta-ethnography synthesis informed by Noblit and Hare (1988) and the eMERGe guidance (France et al. 2019) was undertaken. Nine electronic databases were searched systematically using predefined search terms in August 2021, and again in March 2023. Studies meeting the following criteria: English language, qualitative and mixed-method studies, published from 2000 onwards, and relevant to the topic, were eligible for quality appraisal and inclusion.Findings: Six studies met the inclusion criteria. Three from Turkey, one from Palestine, one from HongKong and one from New Zealand. One disconfirming study was identified. Following both a reciprocal and refutational synthesis, four 3rd order constructs were formed, titled: Suffering the examination, Challenging the power dynamic, Cervical-centric labour culture embedded in societal expectations, and Context of care. Finally, a line of argument was arrived at, which brought together and summarised the 3rd orde rconstructs.Key conclusions and implications of practice: The dominant biomedical discourse of vaginal examination and cervical dilatation as central to the birthing process does not align with midwifery philosophy or women’s embodied experience. Women experience examinations as painful and distressing but tolerate them as they view them as necessary and unavoidable. Factors such as context of care setting, environment, privacy, midwifery care, particularly in a continuity of carer model, have considerable positive affect on women’s experience of examinations. Further research into women’s experiences of vaginal examination in different care models as well as research into less invasive intrapartum assessment tools that promote physiological processes is urgently require

Senior Recital: Alec Jenkins, Clarinet; Momoko Gresham, Piano; Christian Rucinski, Clarinet; Erin Brown, Clarinet; Holly Peters, Clarinet; April 20, 2024

Kemp Recital HallApril 20, 2024SaturdayNoo

Prevalence of perinatal post-traumatic stress disorder (PTSD) in low-income and middle-income countries: a systematic review and meta-analysis

Objectives: To systematically synthesise the evidence on prevalence of perinatal post-traumatic stress disorder (PTSD) in low-income and middle-income countries (LMICs). Design: Systematic review and meta-analysis. Data sources: MEDLINE, Embase, PsycINFO, Scopus, Web of Science, Global Health, Global Index Medicus and the grey literature were searched with no language or date restrictions. The final search was carried out on 3 May 2022. Eligibility criteria: Cross-sectional, cohort or case–control studies that assessed the prevalence of PTSD in pregnant or postpartum women in LMICs were included. Data extraction and synthesis: Screening, data extraction and quality assessment were conducted independently by two reviewers. Pooled prevalence estimates were calculated with 95% CIs and prediction intervals (PI) using random-effects meta-analyses. Subgroup analyses and meta-regression were conducted to explore possible sources of statistical heterogeneity. Results: 39 studies were included in the systematic review of which 38 were included in meta-analysis. The pooled prevalence of clinically diagnosed perinatal PTSD was 4.2% (95% CI 2.2% to 6.8%; 95% PI 0–18%; 15 studies). The pooled prevalence of self-reported perinatal PTSD symptoms was 11.0% (95% CI 7.6% to 15.0%; 95% PI 0–36%; 23 studies). There was no evidence of differences in prevalence according to perinatal stage (antenatal versus postnatal), geographical region, type of setting or study quality. Conclusions: Findings of this review suggest 1 in 10 perinatal women experiences symptoms of PTSD and 1 in 20 experiences clinically diagnosed PTSD. Statistical heterogeneity between studies persisted in subgroup analyses and results should be interpreted with caution. More research from low-income countries is needed to improve understanding of the burden of perinatal PTSD in these settings. PROSPERO registration number: CRD42022325072

Assessing processing-based measures of implicit statistical learning: Three serial reaction time experiments do not reveal artificial grammar learning

Implicit statistical learning, whereby predictable relationships between stimuli are detected without conscious awareness, is important for language acquisition. However, while this process is putatively implicit, it is often assessed using measures that require explicit reflection and conscious decision making. Here, we conducted three experiments combining an artificial grammar learning paradigm with a serial reaction time (SRT-AGL) task, to measure statistical learning of adjacent and nonadjacent dependencies implicitly, without conscious decision making. Participants viewed an array of six visual stimuli and were presented with a sequence of three auditory (nonsense words, Expt. 1; names of familiar objects, Expt. 2) or visual (abstract shapes, Expt. 3) cues and were asked to click on the corresponding visual stimulus as quickly as possible. In each experiment, the final stimulus in the sequence was predictable based on items earlier in the sequence. Faster responses to this predictable final stimulus compared to unpredictable stimuli would provide evidence of implicit statistical learning, without requiring explicit decision making or conscious reflection. Despite previous positive results (Christiansen et al. 2009 and Misyak et al. 2010) we saw little evidence of implicit statistical learning in any of the experiments, suggesting that in this case, these SRT-AGL tasks were not an effective measure implicit statistical learning

Local-scale environmental gradients in ‘snail-shell’ stable isotopes from Holocene Jordanian archaeological sites

Reconstructing environments around archaeological sites is complicated by past land management practices and regional-scale climate proxies that can be contradictory and are often located at a distance from the sites themselves. Here we explore environmental information from fossil snail shells which, even when few in number on an archaeological site, may prove invaluable in constructing site-specific data. The palaeoecology of fossil snails and the stable isotopic composition of their shell carbonate can provide context-specific information on vegetation, water availability, and relative humidity during the occupation of a site. We studied terrestrial and aquatic snails from two later Neolithic archaeological sites in the Jordanian badia, Wadi al-Qattafi and Wisad Pools. At specific archaeological site-scale our study highlights the importance of aquatic snails in the reconstruction of semi-arid environments. At Wisad pools rare aquatic snails in contexts dating between ~8.0 and ~7.6 ka demonstrate episodes of wetness; moreover, their shell isotopic compositions indicate that local watercourses were well established, corroborating previous findings that during this period the immediate environs of Wisad Pools were host to C3 plant species more typical of the Mediterranean zone. Moreover, the δ18O signal in these snail shells allow tentative reconstruction of rainwater isotopic compositions and identify the effects of evaporation. Such fine-grained environmental information is much less evident from the terrestrial snail shell data alone, showing that an ensemble of snail shell data can be highly sensitive to environmental differentials across an archaeological site. Finally, at a regional palaeoclimate-scale our Wisad Pools snail shell stable isotope data are consistent with a sustained, Rapid Climate Change (RCC)-driven wetness between 8.6 and 7.6 ka concurrent with cold and wet conditions in the wider Levant

Altering the availability of healthier vs. less healthy items in UK hospital vending machines: a multiple treatment reversal design

Abstract: Background: Altering the availability of healthier or less-healthy products may increase healthier purchases, but evidence is currently limited. The current study aimed to investigate the impact of altering the absolute-and-relative availability of healthier and less-healthy products – i.e. simultaneously altering the number of options available and the proportion of healthier options – in hospital vending machines. Methods: An adapted multiple treatment reversal design was used, altering products available in ten vending machines serving snack foods and/or cold drinks in one English hospital. Machines were randomised to one of two sequences for the seven 4-week study periods: ABCADEA or ADEABCA. In Condition A (study periods 1, 4 and 7) the proportions of healthier products were standardised across all machines, so that 25% of all snack slots and 75% of drink slots were healthier. In Condition B, 20% of vending machine slots were emptied by removing less-healthy products. In Condition C, the empty slots created in Condition B were filled with healthier products. Conditions D and E were operationalised in the same way as B and C, except healthier products were removed in D, and then less-healthy products added in E. Sales data were obtained from machine restocking records. Separate linear mixed models were conducted to examine the impact of altering availability on energy purchased (kcal) from (i) snacks or (ii) drinks each week, with random effects for vending machine. Results: The energy purchased from drinks was reduced when the number of slots containing less-healthy drinks was decreased, compared to standardised levels (− 52.6%; 95%CI: − 69.3,-26.9). Findings were inconclusive for energy purchased from snacks when less-healthy snack slots were reduced (− 17.2%; 95%CI: − 47.4,30.5). Results for altering the number of slots for healthier drinks or snacks were similarly inconclusive, with no statistically significant impact on energy purchased. Conclusions: Reducing the availability of less-healthy drinks could reduce the energy purchased from drinks in vending machines. Further studies are needed to establish whether any effects might be smaller for snacks, or found with higher baseline proportions of healthier options

Shining a light on clinical spectroscopy : translation of diagnostic IR, 2D-IR and Raman spectroscopy towards the clinic

In recent years, the application of vibrational spectroscopy in biomedical research has rapidly expanded; covering aspects of pharmaceutical development, to point-of-care technologies. Vibrational spectroscopy techniques such as Fourier-transform IR (FTIR), and Raman spectroscopy have been at the forefront of this movement, with their complementary information able to shine light onto a range of medical applications. As a relative newcomer to biomedical applications, two-dimensional (2D)-IR is also gaining traction in the field. Here we describe the recent development of these techniques as analytical tools in medical science, and their relative advancements towards the clinic