Indigenous lands and health access:The influence of a sense of place on disparities in post-stroke recovery in Taiwan

Despite many countries having policies and systems for universal healthcare coverage, health disparity persists, with significant variations in disease prevalence and life expectancy between different groups of people. This focused ethnography explored the post-stroke recovery of Indigenous and non-Indigenous populations in three geographical areas in Taiwan. Forty-eight observations and 24 interviews were carried out with 12 dyads of stroke survivors and family caregivers, revealing their varied experiences of healthcare. Findings indicate that repeatedly engaging in social activities in the same place increases stroke survivors' attachment to the environment, facilitating their reintegration into the community and improving wellbeing following stroke. The significance of ‘place’ in post-stroke life and healthcare access is particularly salient for Indigenous people's recovery. Indigenous people tend to employ cultural symbols, such as Indigenous languages and kinship ties, to define and interpret their surrounding environment and identity. Indigenous people residing within or close to their own native communities make better recoveries than those based in urban settings, who are attached to and yet located away from their native lands. A sense of place contributes to identity, while loss of it leads to invisibility and healthcare inaccessibility. To promote equitable healthcare access, future policymaking and care practices should address the environmental and cultural geography and structural barriers that impede the connection between minority groups and the mainstream community healthcare system. The study findings suggest extending welfare resources beyond Indigenous administrative regions and establishing partnerships between Indigenous organisations and the mainstream healthcare system. Leveraging Indigenous people's attachment to cultural symbols and increasing healthcare facilities staffed with Indigenous healthcare workers could help ease structural barriers, maintain identifiable Indigenous beneficiaries and increase entry points into the mainstream healthcare system.</p

Biographical continuation:Recovery of stroke survivors and their family caregivers in Taiwan

AIM: To explore the experiences pertaining to long-term care services from the perspectives of dyads of stroke survivors and their family caregivers in indigenous and non-indigenous communities. BACKGROUND: Stroke occurrence is a life-changing event associated with quality of life for stroke survivors and their families, especially those who provide primary support. Indigenous people are more likely to experience a stroke at a younger age and have a higher likelihood of hospitalisation and death due to health disparities. Few studies have investigated family dyads or indigenous populations to understand their experiences of coping with changed body-self and to contextualise their reintegration into communities post-stroke. METHODS: Ethnographic fieldwork over nine months in 2018-2019 with indigenous, urban-based, and non-indigenous populations, resulting in 48 observations and 24 interviews with 12 dyads in three geo-administrative communities. FINDINGS: The post-stroke recovery trajectory is illuminated, delineating the dyads' life transitions from biographical disruption to biographical continuation. The trajectory is shaped by seven states involving four mindsets and three status passages. The four mindsets are sense of loss and worry, sense of interdependence, sense of independence, and wellbeing state. The status passages identified in this study are acceptance, alteration, and identification. A community-based and family-centred long-term care system, aligning with medical healthcare and community resources, underpinned each dyad's biographical continuation by: (1) providing rehabilitation that afforded time and space for recovery adaptation; (2) acknowledging the individuality of family caregivers and helping to alleviate their multitasking; and (3) reintegrating stroke survivors into their communities. Key to determining the quality of recovery for the indigenous participants was their reintegration into their native community and regaining of identity. Therefore, integrating post-stroke care into various care contexts and incorporating indigenous-specific needs into policymaking can support dyads in adapting to their communities.</p

Two-dimensional Endoanal Ultrasound Scan Correlates with External Anal Sphincter Structure and Function, but not with Puborectalis

AbstractBackgroundTo investigate the relevance of two-dimensional (2D) endoanal ultrasonic (EAUS) assessment of anal sphincter and puborectalis morphology by comparison to functional measures derived from patient symptoms and anorectal physiology.MethodsThirty women (mean age 44 years, mean parity 2) with anal incontinence underwent 2D EAUS, anorectal pull-through manometry, anorectal electosensitivity and sensation to rectal distension, pelvic floor dynamometry, and completed Wexner incontinence scores. EAUS images were reported blind to physiological assessments by a single experienced observer. The external and internal sphincters, and puborectalis were measured and scored for integrity and atrophy, and correlated with symptom load (Wexner score) and physiological data.ResultsThe mean Wexner score was 10 (range 1–20). The puborectalis could not be accurately measured in 12 patients (44%) on EAUS. Anal squeeze pressure correlated with integrity of the external sphincter (r = −0.4, p = 0.02) but not integrity or atrophy of the puborectalis. There were no other significant correlations between EAUS features and patient symptom load or anorectal physiology (r range, −0.42–0.26, p > 0.05).ConclusionTwo-dimensional EAUS can define sphincter integrity, has a limited role for assessment of muscular quality but is not useful for assessment of the puborectalis

Community participation for transformative action on women's, children's and adolescents' health.

The Global strategy for women's, children's and adolescents' health (2016-2030) recognizes that people have a central role in improving their own health. We propose that community participation, particularly communities working together with health services (co-production in health care), will be central for achieving the objectives of the global strategy. Community participation specifically addresses the third of the key objectives: to transform societies so that women, children and adolescents can realize their rights to the highest attainable standards of health and well-being. In this paper, we examine what this implies in practice. We discuss three interdependent areas for action towards greater participation of the public in health: improving capabilities for individual and group participation; developing and sustaining people-centred health services; and social accountability. We outline challenges for implementation, and provide policy-makers, programme managers and practitioners with illustrative examples of the types of participatory approaches needed in each area to help achieve the health and development goals

Nanoporous aluminosilicate catalyzed Friedel–Crafts alkylation reactions of indoles with aldehydes and acetals

Nanoporous aluminosilicate materials efficiently catalyze Friedel-Crafts reactions of indoles to produce bisindolylalkane products. These reactions proceed rapidly and in high yields when acetals are used in place of the more commonly used carbonyl reagents. It is possible to capitalise on the large difference in the rates of reaction observed with aldehydes and acetals to develop a tandem acetalization-Friedel-Crafts protocol in which the acetal is generated in situ and undergoes subsequent reaction. © 2011 The Royal Society of Chemistry

Final Technical Report

The two main objectives of this project were: 1) to develop and test technologies to harvest, transport, store, and separate corn stover to supply a clean raw material to the bioproducts industry, and 2) engineer fermentation systems to meet performance targets for lactic acid and ethanol manufacturers. Significant progress was made in testing methods to harvest corn stover in a “single pass” harvest mode (collect corn grain and stover at the same time). This is technically feasible on small scale, but additional equipment refinements will be needed to facilitate cost effective harvest on a larger scale. Transportation models were developed, which indicate that at a corn stover yield of 2.8 tons/acre and purchase price of $35/ton stover, it would be unprofitable to transport stover more than about 25 miles; thus suggesting the development of many regional collection centers. Therefore, collection centers should be located within about 30 miles of the farm, to keep transportation costs to an acceptable level. These collection centers could then potentially do some preprocessing (to fractionate or increase bulk density) and/or ship the biomass by rail or barge to the final customers. Wet storage of stover via ensilage was tested, but no clear economic advantages were evident. Wet storage eliminates fire risk, but increases the complexity of component separation and may result in a small loss of carbohydrate content (fermentation potential). A study of possible supplier-producer relationships, concluded that a “quasi-vertical” integration model would be best suited for new bioproducts industries based on stover. In this model, the relationship would involve a multiyear supply contract (processor with purchase guarantees, producer group with supply guarantees). Price will likely be fixed or calculated based on some formula (possibly a cost plus). Initial quality requirements will be specified (but subject to refinement).Producers would invest in harvest/storage/transportation equipment and the processor would build and operate the plant. Pilot fermentation studies demonstrated dramatic improvements in yields and rates with optimization of batch fermentor parameters. Demonstrated yields and rates are approaching those necessary for profitable commercial operation for production of ethanol or lactic acid. The ability of the biocatalyst to adapt to biomass hydrolysate (both biomass sugars and toxins in the hydrolysate) was demonstrated and points towards ultimate successful commercialization of the technology. However, some of this work will need to be repeated and possibly extended to adapt the final selected biocatalyst for the specific commercial hydrolysate composition. The path from corn stover in the farm field to final products, involves a number of steps. Each of these steps has options, problems, and uncertainties; thus creating a very complex multidimensional obstacle to successful commercial development. Through the tasks of this project, the technical and commercial uncertainties of many of these steps have been addressed; thus providing for a clearer understanding of paths forward and commercial viability of a corn stover-based biorefinery