A Critical Examination of the Social Organizations within Canadian NGOs in the Provision of HIV/AIDS Health Work in Tanzania

The purpose of this study was to critically examine the social organizations within Canadian non-government organizations (NGOs) in the provision of HIV/AIDS health work in Tanzania. Using a post-Marxist theoretical framework, I employed the tools of institutional ethnography to understand how distinct forms of coordinated work are reproduced and embedded within the institution of Canadian NGOs at the local site of lived experiences. Multiple, concurrent methods, including text analysis, participant observation and in-depth interviews, were utilized. Data collection occurred over approximately a 19-month period of time in Tanzania and Canada. Interviews were conducted with health work volunteers, NGO administrators and staff and bilateral agency employees. Participant observation was used to record insights from the interviews as well as observations of the participants’ everyday work experiences. Further, since text-based forms of knowledge are essential in understanding ideologies, working activities, and power relations of an institution, text-analysis was used as a data collection technique. The findings, implications and recommendations of this study were theoretically derived. Neoliberalism and neo-colonialism ruled the coordination of international volunteer health work. In this study, three social relational levels were exposed: interpersonal social relations, organizational social relations, institutional social relation. Gender, race and class were the interpersonal social relations that advantaged the international volunteer health workers as ‘experts’ over the local community. \u27Volunteer as client\u27, ‘experience as commodity\u27 and ‘free market evaluation\u27 were the organizational social relations pervasive in talk and text. Neoliberal ideology and the third sector were interwoven and worked together to inform values and activities of international health work volunteers. Finally, the three institutional social relations, ‘favoring private sector interests’, ‘hegemonic accountability’ and ‘reality disconnected from rhetoric’ exposed the conflation between aid and trade bilaterally. This study has extended our understanding of the ways in which health work volunteers, NGO administrators, and bilateral agency employees come together to produce health work in Tanzania. The findings illuminate the need to generate additional awareness and response related to social inequities embedded in international volunteer \u27health work\u27 beyond who constitutes ‘the expert’. Health promotion strategies include challenging the role of neoliberalism, including foreign trade, in the delivery of international aid

SIBLING/SIBLING-IN-LAW RELATIONSHIPS IN THE PROVISION OF PARENTAL CARE TO PERSONS LIVING WITH DEMENTIA: A CRITICAL ANALYSIS

The current homecare structure cannot sustain adequate care for seniors living at home even with the support of family caregivers (Forbes & Neufeld , 2008). Indeed, two thirds of community-dwelling seniors receive some form of care from their adult children/children-in-law. However, seniors living with dementia can have additional care needs. Siblings/siblings-in-law are often involved in the negotiation of homecare with their parents/parents-in-law living with dementia. Based on a larger critical ethnographie study of client-caregiver-provider relationships in home-based dementia care (WardGriffin, McWilliam, Forbes, Klosek, Mowatt, & Bol, 2008), the purpose of this qualitative secondary analysis was to examine the relationships of siblings/siblings-in- law in the negotiation of home-based dementia care. The findings revealed two overarching themes, the social determinants of care and the negotiation of care. There were three social determinants of care: gender, birth order and proximity. The negotiation of care was the continuous enactment of performance measurement and positional power, premised on a set of expectations and quantifiable benchmarks. The social determinants of care coupled with the negotiation of care shaped the health experiences of the siblings/siblings-in-law of this study. The health enhancing experiences were epitomized by family cohesion, while the health threatening experiences embodied conflict and inequities in the distribution of care. These findings have direct implications for homecare nursing practice, policy and future research, which could further recognize the complexity of sibling/sibling-in-law relationships in terms of care planning

Condenser capacity and hyperbolic diameter

Given a compact connected set $E$ in the unit disk $\mathbb{B}^{2}$, we give a new upper bound for the conformal capacity of the condenser $(\mathbb{B}^{2}, E)$ in terms of the hyperbolic diameter $t$ of $E$. Moreover, for $t>0$, we construct a set of hyperbolic diameter $t$ and apply novel numerical methods to show that it has larger capacity than a hyperbolic disk with the same diameter. The set we construct is called a Reuleaux triangle in hyperbolic geometry and it has constant hyperbolic width equal to $t$.Comment: 15 pages, 5 figure

Referrals between Public Sector Health Institutions for Women with Obstetric High Risk, Complications, or Emergencies in India - A Systematic Review.

Emergency obstetric care (EmOC) within primary health care systems requires a linked referral system to be effective in reducing maternal death. This systematic review aimed to summarize evidence on the proportion of referrals between institutions during pregnancy and delivery, and the factors affecting referrals, in India. We searched 6 electronic databases, reviewed four regional databases and repositories, and relevant program reports from India published between 1994 and 2013. All types of study or reports (except editorials, comments and letters) which reported on institution-referrals (out-referral or in-referral) for obstetric care were included. Results were synthesized on the proportion and the reasons for referral, and factors affecting referrals. Of the 11,346 articles identified by the search, we included 232 articles in the full text review and extracted data from 16 studies that met our inclusion criteria Of the 16, one was RCT, seven intervention cohort (without controls), six cross-sectional, and three qualitative studies. Bias and quality of studies were reported. Between 25% and 52% of all pregnancies were referred from Sub-centres for antenatal high-risk, 14% to 36% from nurse run delivery or basic EmOC centres for complications or emergencies, and 2 to 7% were referred from doctor run basic EmOC centres for specialist care at comprehensive EmOC centres. Problems identified with referrals from peripheral health centres included low skills and confidence of staff, reluctance to induce labour, confusion over the clinical criteria for referral, non-uniform standards of care at referral institutions, a tendency to by-pass middle level institutions, a lack of referral communication and supervision, and poor compliance. The high proportion of referrals from peripheral health centers reflects the lack of appropriate clinical guidelines, processes, and skills for obstetric care and referral in India. This, combined with inadequate referral communication and low compliance, is likely to contribute to gaps and delays in the provision of emergency obstetric care

Image augmentation with conformal mappings for a convolutional neural network

For augmentation of the square-shaped image data of a convolutional neural network (CNN), we introduce a new method, in which the original images are mapped onto a disk with a conformal mapping, rotated around the center of this disk and mapped under such a M\"obius transformation that preserves the disk, and then mapped back onto their original square shape. This process does not result the loss of information caused by removing areas from near the edges of the original images unlike the typical transformations used in the data augmentation for a CNN. We offer here the formulas of all the mappings needed together with detailed instructions how to write a code for transforming the images. The new method is also tested with simulated data and, according the results, using this method to augment the training data of 10 images into 40 images decreases the amount of the error in the predictions by a CNN for a test set of 160 images in a statistically significant way (p-value=0.0360).Comment: 13 pages, 3 figure

The Global Burden of Perinatal Common Mental Disorders and Substance Use Amongst Migrant Women:A Systematic Review and Meta-Analysis

BACKGROUND: There are one billion migrants globally, of whom 82 million are forced migrants. Pregnant migrants face pre-migration stressors such as conflict, transit stressors including poverty, and post-migration stressors including navigating the immigration system; these stressors can make them vulnerable to mental illness. We aimed to assess the global prevalence of and risk factors for perinatal mental health disorders or substance use among women who are migrants. METHODS: In this systematic review and meta-analysis, we searched OVID MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from database inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in pregnancy or the postnatal period (ie, up to a year after delivery) or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal common mental health disorders among women who are migrants, globally. Data for study quality and risk factors were also extracted. A random-effects meta-analysis was used to calculate pooled prevalence estimates, when appropriate. Sensitivity analyses were conducted according to study quality, sample representativeness, and method of outcome assessment. Risk factor data were synthesised narratively. This study is registered with PROSPERO, CRD42021226291. FINDINGS: 18 650 studies were retrieved, of which 135 studies comprising data from 621 995 participants met the inclusion criteria. 123 (91%) of 135 studies were conducted in high-income host countries. Five (4%) of 135 studies were interventional, 40 (30%) were cohort, and 90 (66%) were cross-sectional. The most common regions of origin of participants were South America, the Middle East, and north Africa. Only 26 studies presented disaggregated data for forced migrants or economic migrants. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I2 98·8%; τ2 0·01) among all women who are migrants, 32·5% (1·5-81·6; 98·7%; 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; 0·01) among economic migrants (p<0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I2 96·8%; τ2 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I2 97·4%; τ2 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I2 96·6%; τ2 0·32). Key risk factors for perinatal depression were being a recently arrived immigrant (ie, approximately within the past year), having poor social support, and having a poor relationship with one's partner. INTERPRETATION: One in four women who are migrants and who are pregnant or post partum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher among women who are forced migrants compared with women who are economic migrants. To our knowledge, we have provided the first pooled estimate of perinatal depression and PTSD among women who are forced migrants. Interpreting the prevalence estimate should be observed with caution due to the very wide range found within the included studies. Additionally, 66% of studies were cross-sectional representing low quality evidence. These findings highlight the need for community-based routine perinatal mental health screening for migrant communities, and access to interventions that are culturally sensitive, particularly for forced migrants who might experience a higher burden of disease than economic migrants. FUNDING: UK National Institute for Health Research (NIHR); March of Dimes European Preterm Birth Research Centre, Imperial College; Imperial College NIHR Biomedical Research Centre; and Nuffield Department of Population Health, University of Oxford