Remediating Family Photography: Savita’s Image and the Campaign to Repeal the 8th Amendment

Following her tragic death in October 2012, a snapshot of Savita Halappanavar became the face of the movement to repeal the 8th Amendment to the Irish Constitution prohibiting abortion. This smiling photographic portrait, which had originated in a domestic, familial realm, was re-appropriated and gained iconic status in the years that followed. In the aftermath of certain tragedies, images of the deceased and sometimes even their bodies can be co-opted by certain causes, becoming public rather than private property, to be used for a political purpose. This article will trace the image’s trajectory from the family album to the streets of Ireland and the world. Savita’s face was reproduced on a myriad of posters, flyers and on murals, in both its original photographic form and in other media, such as screen prints, paintings and illustrations. Drawing upon the work of Gillian Rose and Martha Langford on family photography and the vernacular, I will show how a quotidian head and shoulders portrait became symbolic of a kind of martyrdom, akin to the instantly recognisable images of political leaders and rebels. It will also explore the resonance of Savita’s presence upon the street, giving a face to the cause for repeal, and embodying the human consequences of failing to provide abortion. Finally, the use of photography in performative protest, as well as its placement in temporary shrines and memorials (like those erected at the George Bernard Shaw public house, Dublin) will be addressed

The analysis of the relationship between domestic and silvatic populations of Rhodnius prolixus/robustus (Hemiptera: Reduviidae) in Venezuela by geometric morphometric and molecular methods

Despite four decades of control of Chagas disease in Venezuela, domestic infestations still persist and transmission of Trypanosoma cruzi may be increasing. This is in contrast to the Southern cone region where control has successfully eliminated domestic populations of the main vector Triatoma infestans over large areas. However unlike T. infestans, the main vector in Venezuela, Rhodnius prolixus, has a widespread silvatic distribution occurring primarily in palm trees, which are a ubiquitous feature of the Venezuelan landscape. The palm tree is an important part of campensino life and is maintained for fruit, shade and for use in house construction. Control failures may be due to reinvasion of houses by these prevalent silvatic populations. However, debate exists as to whether the silvatic populations are in fact Rhodnius robustus, a related species of minor epidemiological importance, and therefore no threat to control. With an estimated 800,000 people infected with T. cruzi in Venezuela and a further 3 million at risk of infection, an effective control programme is required, which necessitates that this relationship between silvatic and domestic populations is resolved. This study was undertaken in order to (1) confirm the identity of silvatic populations of Rhodnius in Venezuela and (2) determine if domestic and silvatic populations are isolated, thus to clarify the role of silvatic populations in maintaining house infestations. To achieve these aims field collected silvatic and domestic populations of Rhodnius from 5 States were analysed by genetic methods, direct sequencing (cytochrome b, D2) and microsatellites, and by geometric morphometric analysis. A total of 551 specimens from 31 localities in six Venezuelan states were analysed by direct sequencing of cytochrome b (cytb). Results confirmed the presence of R. prolixus in both silvatic and domestic ecotopes, dispelling the belief that all silvatic populations are R.robustus. Rhodnius robustus does however occur and was found in this study in the Andean State Trujillo. Here it was limited to the silvatic environment. This project found that silvatic and domestic populations of R. prolixus are not isolated, sharing 6 haplotypes, including four silvatic haplotypes also detected in domestic nymphs, indicating that silvatic specimens are capable of domestic colonisation. This was also confirmed from the analysis of adjacent domestic and silvatic populations in Portuguesa and Barinas State where population homogeneity was detected. Additionally cytb analysis identified an introgression event between Amazonian R. robustus and R prolixus, confirmed by incongruence of cytb and D2 nuclear characterisation. Phylogenetic analysis of specimens was also undertaken. To investigate further fine scale population heterogeneity a panel of microsatellite markers, hitherto unavailable, was developed for R prolixus, using an enrichment technique. A panel of 10 loci was available for analysis following PCR screening and linkage analysis. A total of 555 specimens were analysed from 33 populations . Microsatellite analysis also detected population homogeneity between ecotopes, including adjacent populations, indicating that silvatic populations are not isolated. Population heterogeneity was greater among localities in Portuguesa than Barinas, may be due to landscape variation. Differences between control programmes may also play a role. Geometric morphometries identified shape similarity between populations across all States. However, shape convergence by ecotope was detected and results indicated that morphometries might be of limited use for the analysis of populations of R prolixus, with the exception of post-control reinvasion\recrudescent studies. The three methods did not always concur precisely. However comparison was difficult due to detected introgression and shape convergence distorting, respectively, mitochondrial and morphometric analysis. Results indicated that a combined use of microsatellites and morphometries would be beneficial in the analysis of adjacent domestic and silvatic populations. A similar pattern of a lack of isolation between silvatic and domestic ecotopes was detected by both genetic methods, with limited morphometries overlap detected; broadly all three methods showed that populations from differing ecotopes are not isolated. This is also supported by a parallel project on risk-factor analysis. From this study it is clear that silvatic populations of R prolixus present an unquestionable threat to the successful control of Chagas disease in some endemic regions of Venezuela and, unlike the Southern cone, elimination of domestic infestations may not be possible in areas where silvatic R prolixus occur. A restructuring of the control programme in Venezuela is required to deal with this silvatic threat. This may include increased vigilance and methodical respraying and the incorporation of novel approaches to deal with silvatic invasion such as use of insecticide treated curtains; ultimately more investment in the improvement of the rural rancho is required.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Can Early Intervention Policies Improve Well-being? Evidence from a randomized controlled trial *

Many authors have proposed incorporating measures of well-being into evaluations of public policy. Yet few evaluations use experimental design or examine multiple aspects of well-being, thus the causal impact of public policies on well-being is largely unknown. In this paper we examine the effect of an intensive early intervention program on maternal well-being in a targeted disadvantaged community. Using a randomized controlled trial design we estimate and compare treatment effects on global well-being using measures of life satisfaction, experienced well-being using both the Day Reconstruction Method (DRM) and a measure of mood yesterday, and also a standardized measure of parenting stress. The intervention has no significant impact on negative measures of well-being, such as experienced negative affect as measured by the DRM and global measures of well-being such as life satisfaction or a global measure of parenting stress. Significant treatment effects are observed on experienced measures of positive affect using the DRM, and a measure of mood yesterday. The DRM treatment effects are primarily concentrated during times spent without the target child which may reflect the increased effort and burden associated with additional parental investment. Our findings suggest that a maternal-focused intervention may produce meaningful improvements in experienced well-being. Incorporating measures of experienced affect may thus alter cost-benefit calculations for public policies

Can Early Intervention Improve Maternal Well-Being? Evidence from a Randomized Controlled Trial

Objective   This study estimates the effect of a targeted early childhood intervention program on global and experienced measures of maternal well-being utilizing a randomized controlled trial design. The primary aim of the intervention is to improve children’s school readiness skills by working directly with parents to improve their knowledge of child development and parenting behavior. One potential externality of the program is well-being benefits for parents given its direct focus on improving parental coping, self-efficacy, and problem solving skills, as well as generating an indirect effect on parental well-being by targeting child developmental problems.  Methods   Participants from a socio-economically disadvantaged community are randomly assigned during pregnancy to an intensive 5-year home visiting parenting program or a control group. We estimate and compare treatment effects on multiple measures of global and experienced well-being using permutation testing to account for small sample size and a stepdown procedure to account for multiple testing.  Results  The intervention has no impact on global well-being as measured by life satisfaction and parenting stress or experienced negative affect using episodic reports derived from the Day Reconstruction Method (DRM). Treatment effects are observed on measures of experienced positive affect derived from the DRM and a measure of mood yesterday.  Conclusion   The limited treatment effects suggest that early intervention programs may produce some improvements in experienced positive well-being, but no effects on negative aspects of well-being. Different findings across measures may result as experienced measures of well-being avoid the cognitive biases that impinge upon global assessments

Analysis of gene expression in the bovine corpus luteum through generation and characterisation of 960 ESTs

To gain new insights into gene identity and gene expression in the bovine corpus luteum (CL) a directionally cloned CL cDNA library was constructed, screened with a total CL cDNA probe and clones representing abundant and rare mRNA transcripts isolated. The 5Vterminal DNA sequence of 960 cDNA clones, composed of 192 abundant and 768 rare mRNA transcripts was determined and clustered into 351 non-redundant expressed sequence tag (EST) groups. Bioinformatic analysis revealed that 309 (88%) of the ESTs showed significant homology to existing sequences in the protein and nucleotide public databases. Several previously unidentified bovine genes encoding proteins associated with key aspects of CL function including extracellular matrix remodelling, lipid metabolism/steroid biosynthesis and apoptosis, were identified. Forty-two (12%) of the ESTs showed homology with human or with other uncharacterised ESTs, some of these were abundantly expressed and may therefore play an important role in primary CL function. Tissue-specificity and temporal CL gene expression of selected clones previously unidentified in bovine CL tissue was also examined. The most interesting finds indicated that mRNA encoding squalene epoxidase was constitutively expressed in CL tissue throughout the oestrous cycle and 7-fold down-regulated ( P < 0.05)in late luteal tissue, concomitant with the disappearance of systemic progesterone, suggesting that de novo cholesterol biosynthesis plays an important role in steroidogenesis. The mRNA encoding the growth factor, insulin-like growth factor-binding protein-related protein 1 (IGFBP-rP1), remained constant during the oestrous cycle and was 1.8-fold up-regulated ( P < 0.05) in late luteal tissue implying a role in CL regression

Moderate Champagne consumption promotes an acute improvement in acute endothelial-independent vascular function in healthy human volunteers

Epidemiological studies have suggested an inverse correlation between red wine consumption and the incidence of CVD. However, Champagne wine has not been fully investigated for its cardioprotective potential. In order to assess whether acute and moderate Champagne wine consumption is capable of modulating vascular function, we performed a randomised, placebo-controlled, cross-over intervention trial. We show that consumption of Champagne wine, but not a control matched for alcohol, carbohydrate and fruit-derived acid content, induced an acute change in endothelium-independent vasodilatation at 4 and 8 h post-consumption. Although both Champagne wine and the control also induced an increase in endothelium-dependent vascular reactivity at 4 h, there was no significant difference between the vascular effects induced by Champagne or the control at any time point. These effects were accompanied by an acute decrease in the concentration of matrix metalloproteinase (MMP-9), a significant decrease in plasma levels of oxidising species and an increase in urinary excretion of a number of phenolic metabolites. In particular, the mean total excretion of hippuric acid, protocatechuic acid and isoferulic acid were all significantly greater following the Champagne wine intervention compared with the control intervention. Our data suggest that a daily moderate consumption of Champagne wine may improve vascular performance via the delivery of phenolic constituents capable of improving NO bioavailability and reducing matrix metalloproteinase activity

Apalutamide-Induced Toxic Epidermal Necrolysis in a Caucasian Patient with Metastatic Castration-Sensitive Prostate Cancer: A Case Report and Review of the Literature

Apalutamide is a novel nonsteroidal androgen receptor inhibitor that has been shown to improve outcomes for patients with nonmetastatic castration-resistant prostate cancer and metastatic castration-sensitive prostate cancer when combined with androgen deprivation therapy. Apalutamide-induced skin rash occurred commonly in clinical trials, with 23.8–27.1% of patients experiencing a rash of any grade, and 5.2–6.3% experiencing a rash of grade three or higher. There were no cases of severe cutaneous adverse reactions (SCARs) such as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) reported in clinical trials; however, there are rare cases reported in the literature with the majority occurring in Asian patients. An 83-year-old Caucasian male was commenced on apalutamide, combined with degarelix, for the management of metastatic castration-sensitive prostate cancer. During week five of apalutamide treatment, the patient developed a widespread erythematous maculopapular rash. On presentation, the rash affected 80% of his body surface area (BSA) and a diagnosis of a severe cutaneous drug eruption was made. He was commenced on methylprednisolone (MP) therapy. Despite 5 days of MP, the rash continued to deteriorate involving 95% of his BSA. Nikolsky’s sign was positive. A diagnosis of overlap SJS/TEN was made, supported by skin biopsy. His SCORTEN score was three. He was then commenced on intravenous immunoglobulin and transferred to the intensive care unit. Over the coming days, the rash began to stabilise, and his steroid dose was weaned. He was discharged from hospital 38 days after rash onset. We report the first suggested case of apalutamide-induced SJS/TEN in a Caucasian patient. We discuss other cases of apalutamide-induced SCARs reported in the literature. Risk factors seem to include low body weight and Japanese race, as well as short time to onset of rash

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake