Palliative care of children with brain tumors: A parental perspective

Objective: To explore the end-of-life experience of children with brain tumors and their families. Design: Qualitative analysis of focus group interviews. Setting: Children\u27s Hospital, London Health Sciences Center. Participants: Twenty-five parents of 17 children who had died of brain tumors. Intervention: Parents participated in 3 semistructured focus group interviews. Main Outcome Measures: Themes identified through thematic analysis of interview transcripts. Results: Qualitative analysis identified 3 primary themes. (1) Parents described the dying trajectory of their child as characterized by progressive neurologic deterioration, with the loss of the ability to communicate as a turning point. Parental coping mechanisms included striving to maintain normality and finding spiritual strength through maintaining hope and in the resilience of their child. (2) Parental struggles during this phase included balancing competing responsibilities and speaking with their child about death. (3) Barriers to achieving a home death included suboptimal symptom management, financial and practical hardships, and inadequate community support. A fourth, secondary theme concerned the therapeutic benefits of the interview. Conclusion: The neurologic deterioration that characterizes the dying trajectory of children with brain tumors may create significant challenges for health care professionals and the children\u27s parents, supporting the need for increased awareness of the distinct issues in the palliative care of children with brain tumors and for early anticipatory guidance provided for families. ©2010 American Medical Association. All rights reserved

Global HIV/AIDS initiatives, recipient autonomy and country ownership: an analysis of the rise and decline of Global Fund and PEPFAR funding in Namibia

The Global Fund to Fight HIV/AIDS, Malaria and TB and U.S President’s Emergency Fund for AIDS Relief (PEPFAR) are global health initiatives (GHIs) that were established in the early 2000s with the mandates to increase global capacity to address HIV and AIDS rapidly. When the two GHIs were created, Namibia was one of the highest recipients of funding from both GHIs. A significant portion of their support to the country went to the Ministry of Health, which was the principal provider of treatment services in the country. Critics have argued, however, that the rise of financial support from the Global Fund and PEPFAR was associated with the creation of new administrative structures and procedures at the country level. This approach raises important questions about the degree to which Namibian health policymakers were able to exercise autonomy in the presence of GHI support. The aim of this thesis is to analyse the implications for institutional capacity and autonomy at the rise and fall of funding from the Global Fund and PEPFAR to the Ministry of Health concerning financial flows; human resources recruitment; and civil society engagement. With a focus on the changing relationship between the Ministry of Health and the two initiatives, the thesis examines the implications for country ownership and health systems capacity in the context of decreasing financial support from the Global Fund and PEPFAR. The field studies for this research was undertaken in 2011- 2012, when the two GHIs had indicated their intentions to scale-down the financial support made available to Namibia. This thesis uses multiple sources of data to qualitatively analyse the influences of Global Fund and PEPFAR support to Namibia from when the two initiatives were first established in 2002 and 2004, respectively, to 2012. A principal source of data was 43 semi-structured interviews conducted in Namibia during a placement with the Directorate of Special Programs in the Ministry of Health in early 2012. For financial flows, both the Global Fund and PEPFAR channelled and managed their funding through funder-specific structures and procedures that were developed and operated in parallel to existing Ministry of Health operations. Both for financial flows and human resources, initial structures and processes created difficulties for the Ministry of Health’s long-term objectives for HIV and AIDS. For civil society engagement, the thesis examined the Ministry of Health’s relationship with the Global Fund. At the rise of funding, the Global Fund required the establishment of a new multi-sector coordination structure for HIV and AIDS. This new structure operated at the same time as the existing national coordination structure and was perceived as having undermined the Ministry of Health’s role as the primary steward of Namibia's response. The Global Fund was also criticised for initially funding civil society organisations without making provisions for sustaining their capacity in the event of funding decline. The findings presented in this thesis indicate that at the rise of financing, the Ministry of Health’s engagement with the two HIV and AIDS GHIs initiatives was governed by the objectives of the two initiatives, rather than the long-term health systems goals of the Namibian Government. Their relationships with Namibia had an adverse impact on the Ministry of Health’s autonomy in making decisions on the national response to HIV and AIDS. The initial operations of the GHIs also had negative implications for Namibia's ability to sustain the health systems capacity they had helped to increase

Understanding carbide evolution and surface chemistry during deep cryogenic treatment in high-alloyed ferrous alloy

The study investigates the effect of deep cryogenic treatment (DCT) on a high-alloyed ferrous alloy (HAFA) and its effectiveness on carbide evolution and chemical shifts of alloying elements. With ex-situ and in-situ observations ranging from the microscopic to the nanoscopic level, we uncover the atomistic mechanism by which DCT affects carbide precipitation, resulting in a 50% increase in carbide volume fraction. Synchrotron-based scanning photoelectron microscopy provides insight into the agglomeration of carbon during exposure to DCT. We find that Mo plays a crucial role in DCT through its modification of chemical bonding states, which is postulated to originate from the loosely-formed primordial Mo2C carbides formed during exposure to cryogenic temperatures. These in turn provide energetically favorable nucleation zones that accelerate the formation of M7C3 carbides, which serve as intermediate states for the formation of M23C6 carbides, which most strongly impact the mechanical properties. These results are supported by atom probe tomography, showing the preferential formation of Mo-rich M7C3 carbides in DCT samples, resulting from greater solute mobility. This work clarifies the fundamental mechanisms on how DCT affects HAFA, solving a long-elusive problem

Implementation and the Governance Problem: A Pressure Participant Perspective

This article has two aims: to qualify the UK government's ‘problem' of governance in a comparison with Scotland and Wales, and to use implementation studies (the ancestors of the new governance literature) to explore policy developments since devolution in Britain. It presents a puzzling finding from extensive interview research: that while we may expect UK government policy to suffer a bigger ‘implementation gap' based on distinctive governance problems (such as greater service delivery fragmentation and the unintended consequences of top-down policy styles), pressure participants in Scotland and Wales are more likely to report implementation failures. Using a ‘top-down' framework, it explores three main explanations for this finding: that the size of the implementation gap in England is exaggerated by a focus on particular governance problems; that pressure participant dissatisfaction follows unrealistic expectations in the devolved territories; and that the UK government undermines devolved policy implementation, by retaining control of key policy instruments and setting the agenda on measures of implementation success

Is Scotland a Westminster-style Majoritarian Democracy or a Scandinavian-style Consensus Democracy? A Comparison of Scotland, the UK and Sweden

Peer reviewedPostprin

Growing up with interfering neighbours : the influence of time of learning and vocabulary knowledge on written word learning in children

Evidence suggests that new vocabulary undergoes a period of strengthening and integration offline, particularly during sleep. Practical questions remain, however, including whether learning closer to bedtime can optimize consolidation, and whether such an effect varies with vocabulary ability. To examine this, children aged 8-12-years-old (n 59) were trained on written novel forms (e.g. BANARA) in either the morning (long delay) or the evening (short delay). Immediately after training and the next day, lexical competition (a marker of integration) was assessed via speeded semantic decisions to neighbouring existing words (e.g. BANANA); explicit memory was measured via recognition and recall tasks. There were no main effects indicating performance changes across sleep for any task, counter to studies of spoken word learning. However, a significant interaction was found, such that children with poorer vocabulary showed stronger lexical competition on the day after learning if there was a short delay between learning and sleep. Furthermore, while poorer vocabulary was associated with slower novel word recognition speed before and after sleep for the long delay group, this association was only present before sleep for the short delay group. Thus, weak vocabulary knowledge compromises novel word acquisition, and when there is a longer period of post-learning wake, this disadvantage remains after a consolidation opportunity. However, when sleep occurs soon after learning, consolidation processes can compensate for weaker encoding and permit lexical integration. These data provide preliminary suggestion that children with poorer vocabulary may benefit from learning new words closer to bedtime

Developing reading-writing connections; the impact of explicit instruction of literary devices on the quality of children's narrative writing

The purpose of this collaborative schools-university study was to investigate how the explicit instruction of literary devices during designated literacy sessions could improve the quality of children's narrative writing. A guiding question for the study was: Can children's writing can be enhanced by teachers drawing attention to the literary devices used by professional writers or “mentor authors”? The study was conducted with 18 teachers, working as research partners in nine elementary schools over one school year. The research group explored ways of developing children as reflective authors, able to draft and redraft writing in response to peer and teacher feedback. Daily literacy sessions were complemented by weekly writing workshops where students engaged in authorial activity and experienced writers' perspectives and readers' demands (Harwayne, 1992; May, 2004). Methods for data collection included video recording of peer-peer and teacher-led group discussions and audio recording of teacher-child conferences. Samples of children's narrative writing were collected and a comparison was made between the quality of their independent writing at the beginning and end of the research period. The research group documented the importance of peer-peer and teacher-student discourse in the development of children's metalanguage and awareness of audience. The study suggests that reading, discussing, and evaluating mentor texts can have a positive impact on the quality of children's independent writing