An integrative review on women living with obstetric fistula and after treatment experiences

Aims and objectives. To review literature on the experiences of women with obstetric fistula, their lived experiences after treatment; and to provide evidence for future research. Background. Obstetric fistula is an injury most commonly resulting from a pro-longed labour. Long eradicated in developed countries, obstetric fistula remains a public health issue in sub-Saharan Africa and Asia. This is a highly stigmatised health condition, and an understanding of the women’s experience is required to inform holistic approaches for care and prevention. Design. An integrative review. Data sources. EBSCO host (Academic Search Premier, MEDLINE, PsychINFO, CINAHL), Web of Science; Grey literature and websites of international organisa-tions such as Women’s Dignity Project and EngenderHealth. Keywords, inclusion and exclusion criteria were defined and 25 articles published from 2004–January 2015 were identified. Review method. The review was guided by Whittemore and Knafl’s revised ana-lytical framework. All articles were assessed for methodological quality and criti-cally analysed to elicit emergent themes and subthemes. Results. Three broad themes were identified: challenges of living with fistula; treatment and care experiences; and reintegration experiences of women after fis-tula repair. Conclusions. Living with a fistula presents multidimensional consequences affect-ing women, families and communities. Accessing treatment is difficult, and there are no standardised treatment packages. Surgical repairs were variable in their success rate. Some authors claim women resume normal lives irrespective of their continence status, whilst others claim they face discrimination despite being conti-nent, thereby hindering reintegration. Quality of life is diminished for those remaining incontinent. Postrepair psychosocial support services are beneficial for reintegration, but research on programme benefits is limited. Therefore, further research is required to support its benefits and for policy development to meet care provision for women with fistula

Spin waves in periodic media and magnetic textures

This thesis contains 3 Chapters of original research in the field of micro-magnetism, preceded by an introductory chapter outlining the background theory and literature. The research chapters, in order of appearance: A simulation and theoretical investigation of Bloch oscillations of spin waves in periodic magnetic media. An experimental investigation into a magnetic texture known as a BiSkyrmion using X-ray holography. A micro magnetic simulation based investigation of the collective magnetic dynamics of a lattice of magnetic bubble domains that are stabilised in a ferromagnetic film that is patterned with a hexagonal lattice of holes, known as antidots.Engineering and Physical Sciences Research Council (EPSRC

The Expansion and elaboration of the category personality disorders in South Africa 1948-1982

This archival study tracks the expansion and elaboration of the category personality disorders in South Africa from 1948 to 1982. Valkenberg Hospital patient files, official documents and professional publications are triangulated with interviews with clinicians. Previous findings that the diagnosis was applied primarily to white, and to a lesser extent coloured, patients in both the early and late 20th century are confirmed. The thesis argues that the expansion and elaboration of the category personality disorders occurred in interactional fashion both from the top down (via the state and the psy-professions) and from the bottom up (in interactions between clinicians and patients). It was linked to the professionalization of the psy-professions articulating with the state's need to manage the dangerous individual in the context of fears about white degeneration

Modelling the impacts of pasture contamination and stocking rate for the development of targeted selective treatment strategies for Ostertagia ostertagi infection in calves

A simulation study was carried out to assess whether variation in pasture contamination or stocking rate impact upon the optimal design of targeted selective treatment (TST) strategies. Two methods of TST implementation were considered: 1) treatment of a fixed percentage of a herd according to a given phenotypic trait, or 2) treatment of individuals that exceeded a threshold value for a given phenotypic trait. Four phenotypic traits, on which to base treatment were considered: 1) average daily bodyweight gain, 2) faecal egg count, 3) plasma pepsinogen, or 4) random selection. Each implementation method (fixed percentage or threshold treatment) and determinant criteria (phenotypic trait) was assessed in terms of benefit per R (BPR), the ratio of average benefit in weight gain to change in frequency of resistance alleles R (relative to an untreated population). The impact of pasture contamination on optimal TST strategy design was investigated by setting the initial pasture contamination to 100, 200 or 500 O. ostertagi L3/kg DM herbage; stocking rate was investigated at a low (3calves/ha), conventional (5 calves/ha) or high (7 calves/ha) stocking rates. When treating a fixed percentage of the herd, treatments according to plasma pepsinogen or random selection were identified as the most beneficial (i.e. resulted in the greatest BPR) for all levels of initial pasture contamination and all stocking rates. Conversely when treatments were administered according to threshold values ADG was most beneficial, and was identified as the best TST strategy (i.e. resulted in the greatest overall BPR) for all levels of initial pasture contamination and all stocking rates

Modelling the consequences of targeted selective treatment strategies on performance and emergence of anthelmintic resistance amongst grazing calves

The development of anthelmintic resistance by helminths can be slowed by maintaining refugia on pasture or in untreated hosts. Targeted selective treatments (TST) may achieve this through the treatment only of individuals that would benefit most from anthelmintic, according to certain criteria. However TST consequences on cattle are uncertain, mainly due to difficulties of comparison between alternative strategies. We developed a mathematical model to compare: 1) the most ‘beneficial’ indicator for treatment selection and 2) the method of selection of calves exposed to Ostertagia ostertagi, i.e. treating a fixed percentage of the population with the lowest (or highest) indicator values versus treating individuals who exceed (or are below) a given indicator threshold. The indicators evaluated were average daily gain (ADG), faecal egg counts (FEC), plasma pepsinogen, combined FEC and plasma pepsinogen, versus random selection of individuals. Treatment success was assessed in terms of benefit per R (BPR), the ratio of average benefit in weight gain to change in frequency of resistance alleles R (relative to an untreated population). The optimal indicator in terms of BPR for fixed percentages of calves treated was plasma pepsinogen and the worst ADG; in the latter case treatment was applied to some individuals who were not in need of treatment. The reverse was found when calves were treated according to threshold criteria, with ADG being the best target indicator for treatment. This was also the most beneficial strategy overall, with a significantly higher BPR value than any other strategy, but its degree of success depended on the chosen threshold of the indicator. The study shows strong support for TST, with all strategies showing improvements on calves treated selectively, compared with whole-herd treatment at 3, 8, 13 weeks post-turnout. The developed model appeared capable of assessing the consequences of other TST strategies on calf populations

A stochastic model to investigate the effects of control strategies on calves exposed to Ostertagia ostertagi

Predicting the effectiveness of parasite control strategies requires accounting for the responses of individual hosts and the epidemiology of parasite supra- and infra-populations. The first objective was to develop a stochastic model that predicted the parasitological interactions within a group of first season grazing calves challenged by Ostertagia ostertagi, by considering phenotypic variation amongst the calves and variation in parasite infra-population. Model behaviour was assessed using variations in parasite supra-population and calf stocking rate. The model showed the initial pasture infection level to have little impact on parasitological output traits, such as worm burdens and FEC, or overall performance of calves, whereas increasing stocking rate had a disproportionately large effect on both parasitological and performance traits. Model predictions were compared with published data taken from experiments on common control strategies, such as reducing stocking rates, the ‘dose and move’ strategy and strategic treatment with anthelmintic at specific times. Model predictions showed in most cases reasonable agreement with observations, supporting model robustness. The stochastic model developed is flexible, with the potential to predict the consequences of other nematode control strategies, such as targeted selective treatments on groups of grazing calves

The Effect of Myostatin-antagonist4 on a Severe Muscle Burn Injury

Myostatin is a growth and differentiation factor which belongs to the transforming growth factor-beta superfamily of genes. Mutations or deletions in the myostatin gene leads to the heavy muscling phenotype seen in various cattle breeds, including Belgian Blue and Peidmontese, and also in myostatin knockout mice. More recently, a human child with the heavy muscling phenotype was also found to carry a mutation in the myostatin gene. Conversely, increased expression of myostatin has been linked to various muscle wasting conditions induced by ageing or disease. Myostatin is therefore regarded as a strong inhibitor of muscle growth. In addition, myostatin has also been shown to control satellite cell activation post-natally, and is therefore considered a potent negative regulator of muscle regeneration and repair. The ability to block myostatin function has enormous potential in the treatment of muscle injuries and various muscle wasting conditions. The Functional Muscle Genomics group at AgResearch Ltd. have recently developed several myostatin antagonists, produced by truncating the biologically active mature myostatin sequence. The following thesis describes the first in vivo study using the myostatin antagonist, Mstn-ant4, where its effect on wound healing was evaluated using a murine muscle burn injury model. Some promising results that Mstn-ant4 could improve muscle wound healing after a severe burn injury were obtained. Specifically, Mstn-ant4-treated mice recovered from the burn-induced loss of body weight earlier than the saline-treated mice. Mighty gene expression,which is a downstream target of myostatin and is involved in muscle hypertrophy, was also significantly higher in the burnt muscles of mice treated with Mstn-ant4 compared to saline-treated mice. In addition, histochemical analysis indicated that administration of Mstn-ant4 may have been terminated too early during the in vivo trial, as reflected by the sudden decrease in centrally formed nuclei in the burnt muscles of Mstn-ant4-treated mice at day 14, with the last subcutaneous injection of Mstn-ant4 occurring at day 15. Although no other statistically significant results were obtained by histology, immunocytochemistry or gene expression analysis to support these results, it would be difficult to conclude that significant results could not be generated when the antagonist was used under optimised conditions. That is, further studies into the administration schedule of the antagonist need to be undertaken, particularly with regard to the frequency of administration and duration of treatment. Overall, Mstn-ant4 has significant potential to improve wound healing following a severe muscle burn injury