‘Being romantic’, agency and the (re)production and (re)negotiation of traditional gender roles.

Doctoral Degree. University of KwaZulu-Natal, Pietermaritzburg.Romance is a ubiquitous, Western cultural context which is constructed as an important tool for relationship success. However, research by gender scholars on romance as a site for gender enactment has been limited. Therefore, this study investigated the way that romance and romantic gendered identities may be produced or resisted, and investigated how ‘being romantic’ may produce affordances for particular gendered identities and limit others. This study took an ethnographic discursive approach and five middleclass, heterosexual South African couples were recruited to take part. Each participant was asked to plan a ‘romantic event’ for their partner and was interviewed multiple times in different contexts. A total of 25 interviews were conducted over eight months in 2013. The transcribed interviews were analysed using a discursive approach to investigate how romance, masculinity and femininity were constructed and performed. The study’s theoretical model viewed the romantic context as providing a range of situated affordances and discursive scripts for identity production, and explored how romantic masculinity and femininity were co-constructed as different but complementary gender identities. The findings suggested that romance was differentiated according to time, effort, and flexibility in deviating from the discursive scripts that govern it. Three forms of romance emerged, and the more rigid the discursive boundaries, the more romantic it was produced as being and thus as offering the best access to emotional intimacy. This emotional intimacy was positioned as being central to relationship maintenance, especially within the context of marriage. It was found that romantic masculinity was characterised by chivalry and the active orchestration of romance. In contrast, participants struggled to operationalise romantic femininity, especially in ways that allowed for active romancing of the man. Some romantic feminine agency was presented in resistance to this gendered norm, but appeared to need more justificatory work and more effort in its execution in comparison to that of the men participants. 6 By studying the co-production of masculinity and femininity as a product of the romantic context, a key finding has emerged. It has been argued elsewhere that women are responsible for the emotional housekeeping of their relationships, and this was evident in the data as well. However, this analysis argues that the narrow, rigid scope of the situational discursive scripts of grand dates limit the ways that women can take the initiative to enact them in meaningful ways. Thus, our modern understanding of romance places women in a dilemmatical position: they are expected to do relationship-maintenance, but the greater comparative effort and the stigmatising effect on both the active romantic woman and her partner means that women must rely on men to produce it. While it is possible to re-imagine romance, until we can collectively reduce this normative pressure, we will be strong-armed into re-enacting romance in ways that support patriarchal, old-fashioned gender identities

A systematic review of the safety information contained within the Summaries of Product Characteristics of medications licensed in the United Kingdom for Attention Deficit Hyperactivity Disorder. how does the safety prescribing advice compare with national guidance?

<p>Abstract</p> <p>Background</p> <p>The safety of paediatric medications is paramount and contraindications provide clear pragmatic advice. Further advice may be accessed through Summaries of Product Characteristics (SPCs) and relevant national guidelines. The SPC can be considered the ultimate independent guideline and is regularly updated. In 2008, the authors undertook a systematic review of the SPC contraindications of medications licensed in the United Kingdom (UK) for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). At that time, there were fewer contraindications reported in the SPC for atomoxetine than methylphenidate and the specific contraindications varied considerably amongst methylphenidate formulations. In 2009, the European Medicines Agency (EMA) mandated harmonisation of methylphenidate SPCs. Between September and November 2011, there were three changes to the atomoxetine SPC that resulted in revised prescribing information. In addition, Clinical Guidance has also been produced by the National Institute for Health and Clinical Excellence (NICE) (2008), the Scottish Intercollegiate Guidelines Network (SIGN) (2009) and the British National Formulary for Children (BNFC).</p> <p>Methods</p> <p>An updated systematic review of the Contraindications sections of the SPCs of all medications currently licensed for treatment of ADHD in the UK was undertaken and independent statements regarding contraindications and relevant warnings and precautions were then compared with UK national guidance with the aim of assessing any disparity and potential areas of confusion for prescribers.</p> <p>Results</p> <p>As of November 2011, there were seven medications available in the UK for the treatment of ADHD. There are 15 contraindications for most formulations of methylphenidate, 14 for dexamfetamine and 5 for atomoxetine. Significant differences exist between the SPCs and national guidance part due to the ongoing reactive process of amending the former as new information becomes known. In addition, recommendations are made outside UK SPC licensed indications and a significant contraindication for methylphenidate (suicidal behaviours) is missing from both the NICE and SIGN guidelines. Particular disparity exists relating to monitoring for suicidal and psychiatric side effects. The BNFC has not yet been updated in line with the European Union (EU) Directive on methylphenidate; it does not include any contraindications for atomoxetine but describes contraindications for methylphenidate that are no longer in the SPC.</p> <p>Conclusion</p> <p>Clinicians seeking prescribing advice from critical independent sources of data, such as SPCs and national guidelines, may be confused by the disparity that exists. There are major differences between guidelines and SPCs and neither should be referred to in isolation. The SPC represents the most relevant source of safety data to aid prescribing of medications for ADHD as they present the most current safety data in line with increased exposure. National guidelines may need more regular updates.</p

Associations between nutritional properties of food and consumer perceptions related to weight management

Consumer perceptions of food (for example, how filling or healthy) influence eating behaviour and appetite control. Therefore approaches to understand the global nutritional attributes of foods that predict the strength of consumer perceptions are of academic and commercial interest. The current research describes the development of a flexible platform for systematically mapping the global nutritional attributes of foods (both objective and perceived) to consumer perceptions of those foods. The platform consists of a database of standardised UK food images (currently n= 300), linked to a catalogue of detailed perceptual, nutritional, sensory, cost, and psychological information ('nutritional attributes'). The platform also incorporates demographic and psychometric questionnaires to examine the importance of nutritional attributes on consumer perceptions within or between relevant target groups. In the current study, the platform was applied to a sample of dieting and non-dieting British men and women (n= 887) to examine the global attributes of a subset of foods (n= 75) and their association with successful weight management (i.e. supportive of weight loss, weight loss maintenance or prevention of weight gain). Generalised linear models identified energy density, cost (£/kcal), perceived energy content and satiating capacity as the main nutritional attributes underlying dieters' and non-dieters' perception of successful weight management food. Additionally, pleasantness, and desire not to (over) eat were uniquely associated with dieters' perception of food as good for weight management; pleasantness was positively associated with weight management and desire to eat was negatively associated with weight management. Therefore, global nutritional attributes of foods can predict and distinguish the extent consumers' perceive a food to be related to successful weight management. This platform will be extended to increase the variety of foods and specificity of nutritional attributes in the database suitable for a range of commercial, academic or clinical research applications

Using performance-based regulation to reduce childhood obesity

BackgroundWorldwide, the public health community has recognized the growing problem of childhood obesity. But, unlike tobacco control policy, there is little evidence about what public policies would work to substantially reduce childhood obesity. Public health leaders currently tend to support traditional "command and control" schemes that order private enterprises and governments to stop or start doing specific things that, is it hoped, will yield lower childhood obesity rates. These include measures such as 1) taking sweetened beverages out of schools, 2) posting calorie counts on fast-food menu boards, 3) labeling foods with a "red light" if they contain high levels of fat or sugar, 4) limiting the density of fast food restaurants in any neighborhood, 5) requiring chain restaurants to offer "healthy" alternatives, and 6) eliminating junk food ads on television shows aimed at children. Some advocates propose other regulatory interventions such as 1) influencing the relative prices of healthy and unhealthy foods through taxes and/or subsidies and 2) suing private industry for money damages as a way of blaming childhood obesity on certain practices of the food industry (such as its marketing, product composition, or portion size decisions). The food industry generally seeks to deflect blame for childhood obesity onto others, such as parents and schools

The global pharmacy workforce: a systematic review of the literature

The importance of health workforce provision has gained significance and is now considered one of the most pressing issues worldwide, across all health professions. Against this background, the objectives of the work presented here were to systematically explore and identify contemporary issues surrounding expansion of the global pharmacy workforce in order to assist the International Pharmaceutical Federation working group on the workforce

Experimental validation of motor primitive-based control for leg exoskeletons during continuous multi-locomotion tasks

An emerging approach to design locomotion assistive devices deals with reproducing desirable biological principles of human locomotion. In this paper, we present a bio-inspired controller for locomotion assistive devices based on the concept of motor primitives. The weighted combination of artificial primitives results in a set of virtual muscle stimulations. These stimulations then activate a virtual musculoskeletal model producing reference assistive torque profiles for different locomotion tasks (i.e., walking, ascending stairs, and descending stairs). The paper reports the validation of the controller through a set of experiments conducted with healthy participants. The proposed controller was tested for the first time with a unilateral leg exoskeleton assisting hip, knee, and ankle joints by delivering a fraction of the computed reference torques. Importantly, subjects performed a track involving ground-level walking, ascending stairs, and descending stairs and several transitions between these tasks. These experiments highlighted the capability of the controller to provide relevant assistive torques and to effectively handle transitions between the tasks. Subjects displayed a natural interaction with the device. Moreover, they significantly decreased the time needed to complete the track when the assistance was provided, as compared to wearing the device with no assistance

Content validity and clinical meaningfulness of the HFMSE in spinal muscular atrophy

© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise statedBACKGROUND: Reports on the clinical meaningfulness of outcome measures in spinal muscular atrophy (SMA) are rare. In this two-part study, our aim was to explore patients' and caregivers' views on the clinical relevance of the Hammersmith Functional Motor Scale Expanded- (HFMSE). METHODS: First, we used focus groups including SMA patients and caregivers to explore their views on the clinical relevance of the individual activities included in the HFMSE. Then we asked caregivers to comment on the clinical relevance of possible changes of HFMSE scores over time. As functional data of individual patients were available, some of the questions were tailored according to their functional level on the HFMSE. RESULTS: Part 1: Sixty-three individuals participated in the focus groups. This included 30 caregivers, 25 patients and 8 professionals who facilitated the discussion. The caregivers provided a comparison to activities of daily living for each of the HFMSE items. Part 2: One hundred and forty-nine caregivers agreed to complete the questionnaire: in response to a general question, 72% of the caregivers would consider taking part in a clinical trial if the treatment was expected to slow down deterioration, 88% if it would stop deterioration and 97% if the treatment was expected to produce an improvement. Caregivers were informed of the first three items that their child could not achieve on the HFMSE. In response 75% indicated a willingness to take part in a clinical trial if they could achieve at least one of these abilities, 89% if they could achieve two, and 100% if they could achieve more than 2. CONCLUSIONS: Our findings support the use of the HFMSE as a key outcome measure in SMA clinical trials because the individual items and the detected changes have clear content validity and clinical meaningfulness for patients and their caregivers.Peer reviewedFinal Published versio

An exploration of workarounds and their perceived impact on antibiotic stewardship in the adult medical wards of a referral hospital in Malawi: a qualitative study

Abstract Background Antibiotic stewardship, the proper management of antibiotics to ensure optimal patient outcomes, is based on quality improvement. Evidence-based guidelines and protocols have been developed to improve this process of care. Safe and timely patient care also requires optimal coordination of staff, resources, equipment, schedules and tasks. However, healthcare workers encounter barriers when implementing these standards and engage in workarounds to overcome these barriers. Workarounds bypass or temporarily ‘fix’ perceived workflow hindrances to achieve a goal more readily. This study examines workaround behaviours that nurses and doctors employ to address the challenges encountered during their antibiotic stewardship efforts and their impact, at a tertiary hospital in Malawi. Methods This was a qualitative descriptive case study design and is part of a large mixed methods study aimed at understanding nurses’ role in antibiotic stewardship and identifying barriers that informed the development of nurse-focused interventions. For this study, we conducted interviews with staff and observations of nurses antibiotic stewardship practices on two adult medical wards. We convened three focus group discussions with doctors, pharmacists and laboratory technologists (n = 20), focusing on their attitudes and experiences with nurses’ roles in antibiotic stewardship. We also observed nurses’ antibiotic stewardship practices and interactions duringfour events: shift change handovers (n = 10); antibiotic preparation (n = 13); antibiotic administration (n = 49 cases); and ward rounds (n = 7). After that, the researcher conducted follow up interviews with purposively selected observed nurses (n = 13). Results Using inductive and deductive approaches to thematic analysis, we found that nurses established their ways of overcoming challenges to achieve the intended task goals with workarounds. We also found that nurses’ practices influenced doctors’ workarounds. We identified six themes related to workarounds and grouped them into two categories: “Taking shortcuts by altering a procedure” and “Using unauthorized processes”. These behaviors may have both positive and negative impacts on patient care and the health care system. Conclusion The study provided insight into how nurses and doctors work around workflow blocks encountered during patient antibiotic management at a tertiary hospital in Malawi. We identified two categories of workaround namely taking shortcuts by altering a procedure and using unauthorized processes. Addressing the blocks in the system by providing adequate resources, training, improving multidisciplinary teamwork and supportive supervision can minimize workarounds