Who, and what, is odd here? De-naturalizing students\u27 experiences of \u27the other\u27

This paper reviews a teaching process that aimed to prepare final year social work students for critical practice with diverse and marginalized populations. Alongside lecture input, in small group discussions and in the two sequenced written assignments students were encouraged to personalize questions of bias and stigma by recalling both their experiences of being &lsquo;other-ed&rsquo; as well as their participation in practices that &lsquo;other-ed&rsquo;, such as racist and homophobic imaging and acting. Feedback to the unit\u27s first iteration in 2004 was generally positive yet a significant minority of students were clearly dissatisfied. Whilst retaining the same formal content in 2005, greater attention was devoted to generating a supportive group process and a positive environment for &lsquo;negative&rsquo; self-disclosure. This milieu acted to contain and normalize the students\u27 struggle with internalized stereotypes, a stage associated with their greater preparedness to identify and challenge their own personal, cultural and ideological locations. Within the context of the unit remaining explicit about its value stance, by adopting an approach to the teaching/learning process that neither collided nor colluded we believe the 2005 revision better achieved the units aims. First, the unit received broader positive appraisal from students and, second, it appeared that the unit more firmly promoted the prospects for students carrying forward a capacity for critical self review post graduation. <br /

Clinical review: Goal-directed therapy in high risk surgical patients

A small group of patients account for the majority of peri-operative morbidity and mortality. These 'high-risk' patients have a poor outcome due to their inability to meet the oxygen transport demands imposed on them by the nature of the surgical response during the peri-operative period. It has been shown that by targeting specific haemodynamic and oxygen transport goals at any point during the peri-operative period, the outcomes of these patients can be improved. This goal directed therapy includes the use of fluid loading and inotropes, in order to optimize the preload, contractility and afterload of the heart whilst maintaining an adequate coronary perfusion pressure. Despite the benefits seen, it remains a challenge to implement this management due to difficulties in identifying these patients, scepticism and lack of critical care resources

The impact of coronary angiography on renal transplant function

Introduction: There may be reluctance to perform coronary angiography in kidney transplant patients due to perceived risk of iodinated contrast, despite an increased risk of cardiovascular disease compared with the general population. Aim: We sought to determine if renal transplant function was adversely affected within 7, 30 and 180 days of coronary angiography. Design and methods: Renal transplant recipients undergoing coronary angiography in a single centre (01/2006–02/2018) were identified retrospectively. Baseline and highest SCr within 7, 30 and 180 days of coronary angiography were extracted from the electronic patient record. Rise in creatinine &gt;26 micromol/l was considered significant [equivalent to Acute Kidney Injury (AKI) Network criteria stage 1 AKI] and case note review performed to determine circumstance of renal decline. Results: There were 127 coronary angiographies conducted in 90 patients: 67.7% were male and mean age was 58.0 (±10.1) years. There was AKI within 7 days in 18.9% cases, but SCr returned to baseline within 7 days or there was an alternative explanation for AKI in 83.3% of these. In the remaining four cases, there was progressive decline in renal transplant function. In the absence of critical illness, no patient required dialysis or extended hospital stay for contrast-associated AKI. Conclusions: In this cohort of renal transplant recipients undergoing coronary angiography, AKI occurred in a minority of cases, and in more than 95% of such cases this effect was transient, with progressive renal decline a rare and predictable event. Renal transplant should not be regarded as a contraindication to coronary angiography

Vitamin K status, supplementation and vascular disease: a systematic review and meta-analysis

Objectives: Vascular stiffness (VS) and vascular calcification (VC) are surrogate markers of vascular health associated with cardiovascular events. Vitamin K-dependent proteins (VKDP) are associated with VS and VC and require vitamin K for activity. We conducted a systematic review and meta-analysis of: (1) the effect of vitamin K supplementation on VS and VC and (2) association of inactive VKDP levels with incident cardiovascular disease and mortality. Methods: Two authors searched MEDLINE and Embase databases and Cochrane and ISRCTN registries for studies of vitamin K clinical trials that measured effects on VC, VS or VKDP and longitudinal studies assessing effect of VKDP on incident CVD or mortality. Random effects meta-analyses were performed. Results: Thirteen controlled clinical trials (n=2162) and 14 longitudinal studies (n=10 726) met prespecified inclusion criteria. Vitamin K supplementation was associated with significant reduction in VC (−9.1% (95% CI −17.7 to −0.5); p=0.04) and VKDP (desphospho-uncarboxylated matrix Gla protein; −44.7% (95% CI −65.1 to −24.3), p&lt;0.0001) and uncarboxylated osteocalcin; −12.0% (95% CI −16.7 to −7.2), p&lt;0.0001) compared with control, with a non-significant improvement in VS. In longitudinal studies with median follow-up of 7.8 (IQR 4.9–11.3) years, VKDP levels were associated with a combined endpoint of CVD or mortality (HR 0.45 (95% CI 0.07 to 0.83), p=0.02). Conclusions: Supplementation with vitamin K significantly reduced VC, but not VS, compared with control. The conclusions drawn are limited by small numbers of studies with substantial heterogeneity. VKDP was associated with combined endpoint of CVD or mortality. Larger clinical trials of effect of vitamin K supplementation to improve VC, VS and long-term cardiovascular health are warranted. Trial registration number: CRD42017060344

'It is just the way it was in the past before I went to test': a qualitative study to explore responses to HIV prevention counselling in rural Tanzania.

BACKGROUND: Voluntary counselling and testing (VCT) for HIV first evolved in Western settings, with one aim being to promote behaviours which lower the risk of onward transmission or acquisition of HIV. However, although quantitative studies have shown that the impact of VCT on sexual behaviour change has been limited in African settings, there is a lack of qualitative research exploring perceptions of HIV prevention counselling messages, particularly among clients testing HIV-negative. We conducted a qualitative study to explore healthcare worker, community and both HIV-negative and HIV-positive clients' perceptions of HIV prevention counselling messages in rural Tanzania. METHODS: This study was carried out within the context of an ongoing community HIV cohort study in Kisesa, northwest Tanzania. Nine group sessions incorporating participatory learning and action (PLA) activities were conducted in order to gain general community perspectives of HIV testing and counselling (HTC) services. Thirty in-depth interviews (IDIs) with HIV-negative and HIV-positive service users explored individual perceptions of HIV prevention counselling messages, while five IDIs were carried out with nurses or counsellors offering HTC in order to explore provider perspectives. RESULTS: Two key themes revolving around socio-cultural and contextual factors emerged in understanding responses to HIV prevention counselling messages. The first included constraints to client-counsellor interactions, which were impeded as a result of difficulties discussing private sexual behaviours during counselling sessions, a hierarchical relationship between healthcare providers and clients, insufficient levels of training and support for counsellors, and client concerns about confidentiality. The second theme related to imbalanced gender-power dynamics, which constrained the extent to which women felt able to control their HIV-related risk. CONCLUSION: Within the broader social context of a rural African setting, HIV prevention counselling based on a Western model of individual-level agency seems unlikely to make a significant contribution to sexual behaviour change until there is greater recognition by counsellors of the ways in which power dynamics within many relationships influence behaviour change. More culturally relevant counselling strategies and messages and infrastructural improvements such as additional training for counsellors and counselling rooms which ensure privacy and confidentiality, may lead to better outcomes in terms of sexual risk reduction

NUMERICAL INVESTIGATION OF HEEL-SHOE INTERACTION IN RUNNING

Human heel sensitivity to mechanical loading, which is associated with the strain/stress state around the sensory receptors, is an important body function for sport, exercise and other daily activities (Lake & lafortune, 1998; Patritti, 2002). The sensory receptors within the heel transmit the mechanical signals (e.g. strains) into neural signals and enable human body to sense and adapt to changes of external loadings. To improve the understanding of the mechanics of this process, a realistic numerical model was developed in this work to establish quantitative relationships between the external loads and the state of stresses/strains at sensory receptor locations in running

Key Considerations: Cross-Border Dynamics Between Uganda and Tanzania in the Context of the Outbreak of Ebola, 2022

This brief summarises key considerations concerning cross-border dynamics between Tanzania and Uganda in the context of the outbreak of Ebola (Sudan Virus Disease, SVD) in Uganda. It is part of a series focusing on at-risk border areas between Uganda and four high priority neighbouring countries: Rwanda; Tanzania; Kenya and South Sudan. The current outbreak is of the Sudan strain of Ebola (SVD). SVD is used in this paper to refer to the current outbreak in East Africa, whereas outbreaks of Zaire Ebolavirus disease or general references to Ebola are referred to as EVD. The current outbreak began in Mubende, Uganda, on 19 September 2022, approximately 240km from the Uganda-Tanzania border. It has since spread to nine Ugandan districts, including two in the Kampala metropolitan area. Kampala is a transport hub, with a population over 3.6 million. While the global risk from SVD remains low according to the World Health Organization, its presence in the Ugandan capital has significantly heightened the risk to regional neighbours. At the time of writing, there had been no cases of Ebola imported from Uganda into Tanzania. This brief provides details about cross-border relations, the political and economic dynamics likely to influence these, and specific areas and actors most at risk. It is based on a rapid review of existing published and grey literature, previous ethnographic research in Tanzania, and informal discussions with colleagues from the Tanzania’s Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), Tanzania National Institute for Medical Research (NIMR), Uganda Red Cross Society, Tanzania Red Cross Society (TRCS), International Organization for Migration (IOM), IFRC, US CDC and CDC Tanzania. The brief was developed by Shelley Lees and Mark Marchant (London School of Hygiene & Tropical Medicine) with support from Olivia Tulloch (Anthrologica) and Hugh Lamarque (University of Edinburgh). Additional review and inputs were provided by The Tanzania Red Cross and UNICEF. The brief is the responsibility of the Social Science in Humanitarian Action Platform (SSHAP).Wellcome TrustForeign, Commonwealth & Development Office (FCDO

The morphology and sculpture of ossicles in the Cyclopteridae and Liparidae (Teleostei) of the Baltic Sea

Small to very small bones (ossicles) in one species each of the families Cyclopteridae and Liparidae (Cottiformes) of the Baltic Sea are described and for the first time illustrated with SEM images. These ossicles, mostly of dermal origin, include dermal platelets, scutes, tubercles, prickles and sensory line segments. This work was undertaken to reveal characteristics of the morphology, sculpture and ultrasculpture of these small ossicles that could be useful as additional features in taxonomy and systematics, in a manner similar to their use in fossil material. The scutes and tubercles of the cyclopterid Cyclopterus lumpus Linnaeus are built of small denticles, each having its own cavity viscerally. The thumbtack prickles of the liparid Liparis liparis (Linnaeus) have a tiny spinule on a porous basal plate; the small size of the prickles seems to be related to their occurrence in the exceptionally thin skin, to an adaptation for minimizing weight and/or metabolic cost and possibly to their evolution from isolated ctenii no longer attached to the scale plates of ctenoid scales. Nodular ultrasculpture was found on the tubercle denticles of C.lumpus, resembling some kinds of ultrasculpture seen in Palaeozoic vertebrates. Samples from the posterior part of the head of C. lumpus and the anterior part of the trunk of L. liparis each contained an ossified sensory line segment with distinct characteristics, as also reported in other cottoids

The morphology and sculpture of ossicles in the Cottidae (Teleostei) of the Baltic Sea

Small to very small ossified structures (ossicles) such as cephalic horns, dermal tubercles, fin-ray rods, lateral-line canal segments, branchial tooth plates and gill-raker tubercles of three species of the teleostean fish family Cottidae inhabiting the Baltic Sea are described and for the first time illustrated with SEM images, with emphasis on their microscopic external features. The morphology and sculpture of these small ossicles notably differ in the three genera, but differences can also occur between males and females, as documented here in Myoxocephalus scorpius (Linnaeus). The detailed features of such ossicles are potentially useful for taxonomic identification in sea-floor sediments or gut contents, in a manner similar to their use in many modern and fossil fishes, and may also prove useful as phylogenetically important characters at generic and familial levels