Challenges in combatting female genital mutilation: narratives of black Sub-Saharan African (BSSA) women in the English west Midlands region

Purpose: It is believed that more than 120 million women have undergone female genital mutilation (FGM) and more than 2 million young girls are at risk of undergoing FGM. FGM is practiced in different parts of the world. With globalisation and the increased movement of people across the globe, FGM is now a global problem. While ending FGM remains a priority, the approaches and strategies being used have generated contested views across the social divide. The purpose of this study is to explore the challenges in combatting FGM as experienced by Black Sub-Saharan African (BSSA) women in Diaspora. Design/methodology/approach: This qualitative study used a phenomenological approach. Narratives were collected from 40 BSSA women from 20 Sub-Saharan African countries living in the English West Midlands region. A thematic approach underpinned by the four phases of data analysis in the Silences Framework were used to analyse the data. Findings: The research study found that stigmatisation of survivors, utilisation of graphic images in FGM awareness, exclusion of practising communities' gatekeepers in FGM interventions, conflation of religion and FGM practice and obsession with securing a conviction were obstacles in combating FGM. Diaspora community-driven studies exploring FGM and contested notions in addressing it from women perspectives are scarce. Originality/value: This study pulls together the experiences of BSSA women and their perspectives on contested notions in combating FGM in the UK. The debate asserts the growing need to consider gender sensitive radical interventions, which involves educating perpetrators and gatekeepers among FGM practising communities

Bimodal distribution of fasting gastric acidity in a rural African population

Setting. The people of Transkei eat a diet high in linoleic acid, the principal fatty acid in maize. The theory has been put forward that a diet high in linoleic acid and low in fat and riboflavin, such as the traditional diet in Transkei, results in overproduction of prostaglandin E2 in the gastric mucosa, and that this overproduction in turn causes a suppression of gastric add production.Objective. To investigate the effect of diet on fasting gastric pH in a rural black African population.Design. Fasting gastric acid samples were obtained by fine nasogastric tube aspiration from 150 volunteers at a rural health clinic. The pH of these samples was measured and a full dietary questionnaire was used. Helicobacter pylori serology was done on a subgroup of 30 volunteers.Results and conclusions. A bimodal pH distribution was found. Approximately half the population had a gastric pH within the range 1 - 4; Half had a pH of over 4. A high pH was significantly associated with consumption of maize (p = 0.006), and with consumption of both pumpkin and beans (p = 0.006). A high proportion of this rural African population has a diet-associated abnormally high gastric pH. The pattern of upper gastrointestinal disease may be significantly affected by diet in this community and in others with a similar diet

Settling the Variance of Multi-Agent Policy Gradients

Policy gradient (PG) methods are popular reinforcement learning (RL) methods where a baseline is often applied to reduce the variance of gradient estimates. In multi-agent RL (MARL), although the PG theorem can be naturally extended, the effectiveness of multi-agent PG (MAPG) methods degrades as the variance of gradient estimates increases rapidly with the number of agents. In this paper, we offer a rigorous analysis of MAPG methods by, firstly, quantifying the contributions of the number of agents and agents’ explorations to the variance of MAPG estimators. Based on this analysis, we derive the optimal baseline (OB) that achieves the minimal variance. In comparison to the OB, we measure the excess variance of existing MARL algorithms such as vanilla MAPG and COMA. Considering using deep neural networks, we also propose a surrogate version of OB, which can be seamlessly plugged into any existing PG methods in MARL. On benchmarks of Multi-Agent MuJoCo and StarCraft challenges, our OB technique effectively stabilises training and improves the performance of multi-agent PPO and COMA algorithms by a significant margin. Code is released at https://github.com/morning9393/Optimal-Baseline-for-Multi-agent-Policy-Gradients

COVID-19 lockdown and mental health: exploring triggers of mental health distress among women in the Copperbelt province, Zambia

More than 60,000 deaths from COVID-19 had been confirmed as of the 1st of August 2020. Concerns about physical and psychological wellbeing had increased across the world with women disproportionately being affected. This research was set to explore the triggers of mental health distress among women during COVID-19 lockdown. The research study utilized a qualitative descriptive approach. Forty (N = 40) women were recruited to take part in the research study. A one to one semi structured interview schedule was used to collect data. NVivo Version 11, QSR International Pty was utilized to organize data for analysis. Content analysis was used to identify, describe, and make inferences about the qualitative data generated. Findings from new interviews were compared for consensus and disagreement. Categories were then collapsed and analyzed into clusters from which concepts and themes were developed. The research study found that the triggers for mental health distress among the research participants included domestic violence, loss of employment, stress of managing children indoors, fear of COVID-19 infection, loneliness and poor access to health services. There is need to consider radical sensitive approaches in preventing triggers of mental health distress among women

Promotion of rapid testing for HIV in primary care (RHIVA2): a cluster-randomised controlled trial

Department of Health, NHS City and Hackney; (ClinicalTrials.gov: ISRCTN63473710)

Community resilience : a policy tool for local government?

In many countries, local government has been a prime target of austerity measures. In response, local authorities are exploring a new repertoire of policy approaches in a bid to provide more with less. In England, local authorities have been drawn to community resilience as a pragmatic response to the challenge of deploying shrinking resources to support communities exposed to social and economic disruption. This application of resilience thinking is not without its challenges. It demands a working definition of community resilience that recognises the potential for communities to prove resilient to shocks and disruptions, but avoids blaming them for their predicament. There is also the practical challenge of developing and targeting interventions to promote and protect resilience. This paper sets out to explore these issues and establish the potential utility of community resilience as a policy tool through case study analysis in the city of Sheffield

Heatwave planning: the role of the community in co-producing resilience

Drawing on a thematic analysis of relevant policy documents, the aim of this paper is to comment on an apparent disconnect between two associated contemporary UK policy areas: planning for heatwaves and community resilience. Regional and national policy documents that plan for heatwaves in the UK tend to focus on institutional emergency responses and infrastructure development. In these documents, although communities are mentioned, they are understood as passive recipients of resilience that is provided by active institutions. Meanwhile, contemporary discussion about community resilience highlights the potential for involving communities in planning for and responding to emergencies (although the concept is also the subject of critique). Within this context, the paper proposes that – through engagement with the ‘community resilience’ policy agenda and its critique – effort should be made to articulate and realise greater participation by individuals, and voluntary and community sector groups in heatwave preparation, planning and response

Validation of a Novel Multivariate Method of Defining HIV-Associated Cognitive Impairment

Background. The optimum method of defining cognitive impairment in virally suppressed people living with HIV is unknown. We evaluated the relationships between cognitive impairment, including using a novel multivariate method (NMM), patientreported outcome measures (PROMs), and neuroimaging markers of brain structure across 3 cohorts.Methods. Differences in the prevalence of cognitive impairment, PROMs, and neuroimaging data from the COBRA, CHARTER, and POPPY cohorts (total n = 908) were determined between HIV-positive participants with and without cognitive impairment defined using the HIV-associated neurocognitive disorders (HAND), global deficit score (GDS), and NMM criteria.Results. The prevalence of cognitive impairment varied by up to 27% between methods used to define impairment (eg, 48% for HAND vs 21% for NMM in the CHARTER study). Associations between objective cognitive impairment and subjective cognitive complaints generally were weak. Physical and mental health summary scores (SF-36) were lowest for NMM-defined impairment (P<.05). There were no differences in brain volumes or cortical thickness between participants with and without cognitive impairment defined using the HAND and GDS measures. In contrast, those identified with cognitive impairment by the NMM had reduced mean cortical thickness in both hemispheres (P<.05), as well as smaller brain volumes (P<.01). The associations with measures of white matter microstructure and brain-predicted age generally were weaker.Conclusion. Different methods of defining cognitive impairment identify different people with varying symptomatology and measures of brain injury. Overall, NMM-defined impairment was associated with most neuroimaging abnormalities and poorer selfreported health status. This may be due to the statistical advantage of using a multivariate approach