Building a new generation of midwifery faculty members in Bangladesh

This paper presents an initiative to build a new generation of midwifery faculty in Bangladesh, with the ultimate objective of providing insight into how to build capacity in the midwifery faculty to best utilize the existing academic, health care and policy environment. The initiative focuses on a promising approach that starts with a new generation of midwifery faculty who can lead a chain of change when separating midwifery teaching from nursing. The initiative identified four different interdependent components of equal importance, namely the initiation of master’s and bachelor’s degrees, development of accreditation guidelines and tools, and a mentorship programme. Building a new generation of midwifery faculty has the potential, despite challenges, to enhance retention, foster greater commitment for the institutions, increase research and contribute to the attainment of national goals

The Historical Development of the Midwifery Profession in Bangladesh

Sexual and reproductive health and rights have been identified as the core areas of practice, theory and research for the midwifery profession. The midwifery profession, as defined by the International Confederation of Midwives Global Standards, is new in Bangladesh. This paper aims to give an overview of the historical process that has taken place in the past decades to develop the midwifery profession in Bangladesh. The professional development of midwives is the result of many years of collaboration and relationship building among stakeholders such as the government, non-government organizations, academia, professional associations, United Nations agencies, and donors. All are working toward achieving the common goal of preventing/ reducing maternal and child mortality through education, the development of supportive laws, policies and guidelines, and the deployment of midwives. Lessons learnt from the Bangladesh experience can provide useful guidance for other countries in Asia that are currently establishing midwifery as a profession that aims to provide safe and high quality sexual, reproductive, maternal and newborn care

Understanding of water resilience in the Anthropocene

Water is indispensable for Earth resilience and sustainable development. The capacity of social-ecological systems to deal with shocks, adapting to changing conditions and transforming in situations of crisis are fundamentally dependent on the functions of water to e.g., regulate the Earth's climate, support biomass production, and supply water resources for human societies. However, massive, inter-connected, human interference involving climate forcing, water withdrawal, dam constructions, and land-use change have significantly disturbed these water functions and induced regime shifts in social-ecological systems. In many cases, changes in core water functions have pushed systems beyond tipping points and led to fundamental shifts in system feedback. Examples of such transgressions, where water has played a critical role, are collapse of aquatic systems beyond water quality and quantity thresholds, desertification due to soil and ecosystem degradation, and tropical forest dieback associated with self-amplifying moisture and carbon feedbacks. Here, we aggregate the volumes and flows of water involved in water functions globally, and review the evidence of freshwater related linear collapse and non-linear tipping points in ecological and social systems through the lens of resilience theory. Based on the literature review, we synthesize the role of water in mediating different types of ecosystem regime shifts, and generalize the process by which life support systems are at risk of collapsing due to loss of water functions. We conclude that water plays a fundamental role in providing social-ecological resilience, and suggest that further research is needed to understand how the erosion of water resilience at local and regional scale may potentially interact, cascade, or amplify through the complex, globally hyper-connected networks of the Anthropocene. © 2018 The Author

The need for flexibility in forest harvesting services - a case study on contractors' workflow variations

In many parts of the world, contractors account for the main share of harvesting work. Harvesting is characterized by innate complexity and volatility, and this can affect contractors' workflow and ultimately their profitability. Thus, there is certainly a need for flexibility in harvesting service provision and procedures, but our current knowledge about contractors' workflow variations are limited. This study investigates workflow variations in harvesting services by comparing monthly variations between contractors' workload in terms of harvested volumes and the time spent on operations. The data originates from 77 machines belonging to contractors and their harvesting of 6.6 million m(3) of roundwood in Sweden during a two-year period. The results indicate differences between contractors' workflow variations which can be attributed to the number of machines, machine sizes, and the workload in harvested volume and hours. These findings are relevant for guiding both the customer and contractor in this business relationship, and they could also serve as a basis for further research on the need for flexibility to effectively increase and decrease volume production in harvesting services

Resources and predation: drivers of sociality in a cyclic mesopredator

In socially fexible species, the tendency to live in groups is expected to vary through a trade-of between costs and benefts, determined by ecological conditions. The Resource Dispersion Hypothesis predicts that group size changes in response to patterns in resource availability. An additional dimension is described in Hersteinsson’s model positing that sociality is further afected by a cost–beneft trade-of related to predation pressure. In the arctic fox (Vulpes lagopus), group-living follows a regional trade-of in resources’ availability and intra-guild predation pressure. However, the efect of local fuctuations is poorly known, but ofers an unusual opportunity to test predictions that difer between the two hypotheses in systems where prey availability is linked to intra-guild predation. Based on 17-year monitoring of arctic fox and cyclic rodent prey populations, we addressed the Resource Dispersion Hypothesis and discuss the results in relation to the impact of predation in Hersteinsson’s model. Group-living increased with prey density, from 7.7% (low density) to 28% (high density). However, it remained high (44%) despite a rodent crash and this could be explained by increased benefts from cooperative defence against prey switching by top predators. We conclude that both resource abundance and predation pressure are factors underpinning the formation of social groups in fuctuating ecosystems.publishedVersio

Osteoporosis in experimental postmenopausal polyarthritis: the relative contributions of estrogen deficiency and inflammation

Generalized osteoporosis in postmenopausal rheumatoid arthritis (RA) is caused both by estrogen deficiency and by the inflammatory disease. The relative importance of each of these factors is unknown. The aim of this study was to establish a murine model of osteoporosis in postmenopausal RA, and to evaluate the relative importance and mechanisms of menopause and arthritis-related osteoporosis. To mimic postmenopausal RA, DBA/1 mice were ovariectomized, followed by the induction of type II collagen-induced arthritis. After the mice had been killed, paws were collected for histology, one femur for bone mineral density (BMD) and sera for analyses of markers of bone resorption (RatLaps; type I collagen cross-links, bone formation (osteocalcin) and cartilage destruction (cartilage oligomeric matrix protein), and for the evaluation of antigen-specific and innate immune responsiveness. Ovariectomized mice displayed more severe arthritis than sham-operated controls. At termination of the experiment, arthritic control mice and non-arthritic ovariectomized mice displayed trabecular bone losses of 26% and 22%, respectively. Ovariectomized mice with arthritis had as much as 58% decrease in trabecular BMD. Interestingly, cortical BMD was decreased by arthritis but was not affected by hormonal status. In addition, markers of bone resorption and cartilage destruction were increased in arthritic mice, whereas markers of bone formation were increased in ovariectomized mice. This study demonstrates that the loss of endogenous estrogen and inflammation contribute additively and equally to osteoporosis in experimental postmenopausal polyarthritis. Markers of bone remodeling and bone marrow lymphocyte phenotypes indicate different mechanisms for the development of osteoporosis caused by ovariectomy and arthritis in this model

Survivin Measurement improves Clinical Prediction of Transition From Arthralgia to RA—Biomarkers to Improve Clinical Sensitivity of Transition From Arthralgia to RA

Background: Arthralgia often predates development of rheumatoid arthritis (RA). A set of joint symptoms commonly found in patients during their transition from arthralgia to RA, has been recently proposed.Aim: To combine clinical and serological markers and to improve recognition of imminent rheumatoid arthritis (RA) among patients with arthralgia.Methods: The total of 1,743 first-visit patients attending the rheumatology ward in Gothenburg for joint symptoms were identified during 12 consecutive months. Among those, 63 patients were classified as RA, 73 had undifferentiated arthritis and 180 had unexplained arthralgia. New RA cases, which prospectively developed during 48 months, comprised the preclinical (pre) RA group. The joint symptoms of the first-visit were analyzed aiming to distinguish patients with arthralgia and arthritis, and patients with pre-RA, who later developed the disease. The receiver operating characteristics curves were constructed. In the model, symptoms with the odds ratio >2.0 between the arthralgia and pre-RA were combined with information about RA-specific antibodies, C-reactive protein (CRP), and survivin in serum.Results: The proposed set of clinical symptoms distinguished the arthralgia patients from RA and pre-RA. Presence of survivin in serum showed strong association with clinical joint symptoms in arthralgia. A combination of symptoms in several small joint areas, increasing number of joints with symptoms, and patient's experience of swelling in small hand joints at the first visit identified pre-RA cases with 93% specificity. Grouping those symptoms with information about survivin, RA-specific antibodies, and CRP (or gender) in the final algorithm achieved 91% specificity and 55.2% of positive prediction for transition from arthralgia to RA.Conclusion: Clinical and serological parameters in combination aid recognition of imminent RA among arthralgia patients with appropriate sensitivity