Residential mobility and associated factors as predictors of psychological well-being among Somali refugees in London

PhDBackground: Previous research has consistently documented that residential mobility creates stress, of various degrees, on the individuals involved. However, when the process of mobility compounds other stressful postmigration events such as poor housing, lack of relocation choice, deprivation and disruption to the social support networks, it may have more devastating health impact on vulnerable groups. Objective: To explore the relationship between residential mobility and mental health of Somali refugees and whether mobility across primary care trust (PCT) boundaries, choice over move and distances moved are associated with higher risk of mental disorder. Methods: Of the 150 individuals planned, 143 (95.3%) were successfully interviewed. 100 subjects were recruited from qualitatively mapped non-health community venues and 43 from General Practitioners’ (GP) registers in two boroughs of London. The present study assessed the mental status of the study participants using culturally adopted Mini Neuro-psychiatric Interview (MINI). Modified Accommodation Record Questionnaire collected information on their residential movements and choice of relocation in the preceding five and half years. Results: Overall, 108 (75.5%) of the participants made one or more moves in the last 5.5 years. Of these, 60 (55.6%) were females and 48 (44.4%) males; (χ2 = 4.8, df =1, p<0.03). The majority of the movers 71 (65.7%) were recruited from non-health community venues while the remaining 37 (34.3%) were recruited from the General Practice (GP) registers; χ2 = 3.7, df =1, p<0.05. In logistic regression analysis, when fully adjusted for age, gender, marital status, social network beyond household, insult because of race or religion, immigration status, tenure current and period of stay in the UK; risk of mental disorder was associated with residential mobility (Odds Ratio [OR], 3.8; 95% 5 CI: 1.2 – 9.9, P < 0.02), Crossing Primary Care Trust Boundaries (OR, 4.0; 95%CI = 1.4 – 11.5; p = 0.005), lack of choice over move (OR, 4.3; 95% CI = 1.5 – 12.4; p = 0.008), most recent move (5.1; 95%CI = 1.6 – 16.1; p = 0.005) and moving longer distances than 10.2km (OR, 4.6; 95% CI = 1.4 – 15; p = 0.01). Men who were cases were more likely to change address (OR, 4.9; 95%CI: 1.3 – 19; p < 0.02) than women (OR, 2.0; 95%CI: 0.5 - 11.1; p < 0.2) even after adjusting for all possible confounding variables. Conclusion: In addition to documented post-migration difficulties, residential mobility, lack of choice in the process of moving and longer distances moved were all associated with mental disorders in Somali refugees and asylum seekers living in London. Involving clients in the decision making during the relocation process and also taking into account the practical social support network may lessen the burden of mental disorders of the study population

Seroprevalence of bovine brucellosis in agro pastoral areas of Jijjiga zone of Somali National Regional State, Eastern Ethiopia

A cross-sectional study was carried out from October 2008- March 2009 to determine the sero-prevalence of bovine brucellosis in four districts of Jijjiga Zone, eastern Ethiopia. Purposive sampling technique was employed to select the four districts and nine peasant associations (PAs). A total of 435 blood samples were collected from cattle of 6 or more months of age with no history of previous vaccination against brucellosis. All serum samples were initially screened by Rose-Bengal- Plate Test (RBPT) and those positive reactors to RBPT (n=8) were further tested by complement fixation test (CFT) for confirmation. Out of the 8 RBPT positive sera 6 were found to be positive to CFT. Accordingly, the overall seroprevalence of bovine brucellosis in Jijjiga Zone was 1.38% (6/435). The seroprevalence of bovine brucellosis in the four districts namely Awbare, Harshi, Kebribayah and Fafan districtes were 0.78%, 2.91%, 2.06% and 0%, respectively. Statistically there is no significant deference among the four districts (÷2 = 3.37, df = 3, P = 0.268). The study also revealed absence of significant statistical variation in the seroprevalence of brucellosis in different age and sex groups of the study animals (P > 0.05). Result of this study showed that the seroprevalence of bovine brucellosis in the study area is low. However, it is highly likely that the disease spreads in unaffected animals and herds given the extensive production system prevailing in the area which may allow contact of animals during grazing and at watering points. The public in general and high risk group in particular should be made aware of the zoonotic importance of bovine brucellosis

Urine Output Based Fluid Management in the Critically Ill: assessing hypovolemia and preventing hypervolemia

Intravenous fluids have become commonplace in medical care, and are used to hydrate patients who are either not allowed or temporarily unable to eat, restore or maintain intravascular volume, or as a dilutive agent for intravenous medication. In the critically ill, there appears to be a mismatch between intravenous fluid administration and fluid loss via urine output, which leads to fluid overload and related adverse events. The main aim of this thesis is to investigate whether additional fluid administration aimed at improving urine output has the desired effect, whether this effect can be predicted, and whether this effect impacts patients’ outcome

Neutrophil Gelatinase-Associated Lipocalin as a Diagnostic Marker for Acute Kidney Injury in Oliguric Critically Ill Patients: A Post-Hoc Analysis

__Background:__ Oliguria occurs frequently in critically ill patients, challenging clinicians to distinguish functional adaptation from serum-creatinine-defined acute kidney injury (AKIsCr). We investigated neutrophil gelatinase-associated lipocalin (NGAL)'s ability to differentiate between these 2 conditions. __Methods:__ This is a post-hoc analysis of a prospective cohort of adult critically ill patients. Patients without oliguria within the first 6 h of admission were excluded. Plasma and urinary NGAL were measured at 4 h after admission. AKIsCr was defined using the AKI network criteria with pre-admission serum creatinine or lowest serum creatinine value during the admission as the baseline value. Hazard ratios for AKIsCr occurrence within 72 h were calculated using Cox regression and adjusted for risk factors such as sepsis, pre-admission serum creatinine, and urinary output. Positive predictive values (PPV) and negative predictive values (NPV) were calculated for the optimal cutoffs for NGAL. __Results:__ Oliguria occurred in 176 patients, and 61 (35%) patients developed AKIsCr. NGAL was a predictor for AKIsCr in univariate and multivariate analysis. When NGAL was added to a multivariate model including sepsis, pre-admission serum creatinine and lowest hourly urine output, it outperformed the latter model (plasma p = 0.001; urinary p = 0.048). Cutoff values for AKIsCr were 280 ng/ml for plasma (PPV 80%; NPV 79%), and 250 ng/ml for urinary NGAL (PPV 58%; NPV 78%). __Conclusions:__ NGAL can be used to distinguish oliguria due to the functional adaptation from AKIsCr, directing resources to patients more likely to develop AKIsCr

Traffic aware wireless sensor networks MAC protocol for smart grid applications using spiral backoff mechanism

Smart grid is an innovative electrical power delivery networks which integrate distributed renewable energy sources and electric vehicles with the main power grid. Smart grid employs communication network to automate the generation, transmission and distribution and collect metering information from different parts of the grid and the customers to optimize energy distribution and consumption. Moreover, Distribution automation, Demand-Response (DR) and Direct Load Control (DLC) are applied to reduce the consumption of electricity during peak hours. However, it requires a robust, reliable communication network to facilitate real time data exchange between the utility gateway and smart meters of the customer premises. IEEE 802.15.4 standard provides a low cost, low power WSNs solution for smart grid communication networks. The IEEE 802.15.4 standard uses slotted Carrier Sense Multiple Access-Collision Avoidance (CSMA-CA) with binary exponential backoff algorithm (BEB) to avoid collision between the sensor nodes. However, BEB does not consider the s requirement which degrade the smart grid network performance. In this paper, a traffic aware spiral backoff mechanism is proposed to improve the network performance. Simulation results show that proposed spiral backoff algorithm reduces the end-to-end delay and increase packet delivery ratio (PDR) for real time data

Targeting urine output and 30-day mortality in goal-directed therapy: A systematic review with meta-analysis and meta-regression.

Background: Oliguria is associated with a decreased kidney- and organ perfusion, leading to orga

Wellbeing, leadership and motivation in care institutions

Bacheloroppgave i ledelse og organisasjonsutvikling 2017 & Bacheloroppave i serviceledelse og markedsføring 2017I oppgaven vår tok vi for oss og forsket på temaene ledelse, trivsel og motivasjon. Formålet var å se i hvilken grad ledelse og trivsel påvirket motivasjonen til ansatte med følgende problemstilling: Hvordan påvirker trivsel og ledelse motivasjonen hos ansatte ved to ulike sykehjem? For å besvare problemstillingen vår har vi brukt kvalitativ metode med fenomenologisk forskningsdesign, videre har vi valgt utvalg med maksimal variasjon innenfor strategisk utvalg for å finne våre informanter. Vi valgte å bruke semistrukturert intervju og utviklet en intervjuguide ut ifra teori rundt temaene våre for å sikre at informantene våre ga oss svar som belyste problemstillingen vår. Deretter analyserte vi funnene våre opp mot relevant teori innenfor ledelse, trivsel og motivasjon. Teoriene som ble mest brukt var Herzbergs tofaktorteori, Maslows Behovsteori samt teori om transformasjonsledelse og transaksjonsledelse. Resultatet av analysen vår viser at trivsel og ledelse har innvirkning på motivasjon, mer spesifisert at god trivsel og relasjonsorienterte ledere har en positiv innvirkning mens dårlig trivsel og fraværende ledere har en negativ innvirkning på motivasjon.Engelsk sammendrag (abstract) The main themes of this study were leadership, wellbeing and motivation. The aim was to research the extent leadership and wellbeing affected employees’ motivation with the following question: How wellbeing and leadership affected motivation amongst employees in two separate care institutions? To investigate this question qualitative methods were used with phenomenological research design, further we used a selection with maximal variation, within strategic selection to select informants. Semi-structured interviews were used and an interview guide was developed based on theory within our chosen themes, to ensure our informants’ answers enlightened our question. The data was then analysed against relevant theory within leadership, wellbeing and motivation. Herzberg’s two-factor Theory, Maslow’s hierarchy of needs theory together with transformational- and transactional leadership theory was used. Our analysis shows that wellbeing and leadership influence motivation, more specifically that good wellbeing and relationship- orientated leaders have a positive impact. Meanwhile poor wellbeing and absentee leaders have a negative impact on motivation