Relations of Reproduction: Men, Masculinities, and Pregnancy in Dakar, Senegal

Around the world, global health initiatives aim to empower women by encouraging men to be more engaged husbands and fathers. In some forms, this means men attending prenatal exams and taking up a more equitable share of domestic responsibilities. In much of West Africa, spaces associated with women’s work or “issues” are sharply gender-designated, meaning that even if men are open to engaging, they may not be welcome. This dissertation research is an ethnographic exploration of the experiences of expectant fathers in Dakar, Senegal, the ways in which they not only navigate these gendered spaces, and how they renegotiate their own masculinities in the context of locally-produced gender norms, changing forms of marriage, religious notions of parenting, and economic precarity. My research finds that there is tension between men’s practices and gendered assumptions about men in global/national public health campaigns. I use the concept “absent presence” to examine the ways in which expectant fathers’ practices and expectations are simultaneously a crucial part of prenatal care in Dakar while also elided from consideration in global, state, and scholarly interventions

Crossed-beam laser spectroscopy of atomic ruthenium

High resolution crossed-beam laser spectroscopy has been used to measure the isotope shifts and hyperfine parameters of nineteen transitions in atomic ruthenium. These results have been used in conjunction with four other existing transition measurements to determine accurate values for the change in mean-square charge radius between the isotopes of ruthenium. The new charge radii measurements exhibit up to an order of magnitude improvement in accuracy compared to the previously published results. These accurate charge radii systematics in ruthenium provide additional data for the interesting N=60 region of the nuclear chart. The transitions measured have been assessed in terms of their suitability for use in future collinear laser spectroscopy measurements of radioactive ruthenium isotopes. One transition in particular, the 349.8942nm Ocm-1 to 28571.890cm-1 transition, has the potential to be highly efficient.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Frequency Domain Functional Near-Infrared Spectrometer (fNIRS) for Crew State Monitoring

A frequency domain functional near-infrared spectrometer (fNIRS) and accompanying software have been developed by the NASA Glenn Research Center as part of the Airspace Operations and Safety Program (AOSP) Technologies for Airplane State Awareness (TASA)SE211 Crew State Monitoring (CSM) Project. The goal of CSM was to develop a suite of instruments to measure the cognitive state of operators while performing operational activities. The fNIRS was one of the instruments intended for the CSM, developed to measure changes in oxygen levels in the brain noninvasively

The role of the intermediate state in angle-resolved photoelectron studies using (2 + 1) resonance-enhanced multiphoton ionization of the chiral terpenes, α-pinene and 3-carene

Photoelectron angular distributions (PADs), ranging up to the maximum 6th order Legendre polynomial term set by the Yang theorem, have been recorded for the (2 + 1) resonance enhanced multiphoton ionization (REMPI) of two terpene isomers, 3-carene and α-pinene, employing femtosecond lasers and electron velocity map imaging detection. PAD measurements made with coincident photoion detection allow ion fragmentation effects to be assessed. Using circular polarization and enantiomerically pure samples the PAD measurements are extended to include chiral (odd) Legendre polynomial terms, and these are analysed and discussed as multiphoton photoelectron circular dichroism (MP-PECD). Comparisons are also made with single photon (synchrotron radiation) PECD of these compounds. Although for a given compound a common final cation state is reached, pronounced differences are observed between PECD and MP-PECD, and between the alternative identified REMPI intermediate states in the case of MP-PECD

Clinical implementation of a knowledge based planning tool for prostate VMAT

Abstract Background A knowledge based planning tool has been developed and implemented for prostate VMAT radiotherapy plans providing a target average rectum dose value based on previously achievable values for similar rectum/PTV overlap. The purpose of this planning tool is to highlight sub-optimal clinical plans and to improve plan quality and consistency. Methods A historical cohort of 97 VMAT prostate plans was interrogated using a RayStation script and used to develop a local model for predicting optimum average rectum dose based on individual anatomy. A preliminary validation study was performed whereby historical plans identified as “optimal” and “sub-optimal” by the local model were replanned in a blinded study by four experienced planners and compared to the original clinical plan to assess whether any improvement in rectum dose was observed. The predictive model was then incorporated into a RayStation script and used as part of the clinical planning process. Planners were asked to use the script during planning to provide a patient specific prediction for optimum average rectum dose and to optimise the plan accordingly. Results Plans identified as “sub-optimal” in the validation study observed a statistically significant improvement in average rectum dose compared to the clinical plan when replanned whereas plans that were identified as “optimal” observed no improvement when replanned. This provided confidence that the local model can identify plans that were suboptimal in terms of rectal sparing. Clinical implementation of the knowledge based planning tool reduced the population-averaged mean rectum dose by 5.6Gy. There was a small but statistically significant increase in total MU and femoral head dose and a reduction in conformity index. These did not affect the clinical acceptability of the plans and no significant changes to other plan quality metrics were observed. Conclusions The knowledge-based planning tool has enabled substantial reductions in population-averaged mean rectum dose for prostate VMAT patients. This suggests plans are improved when planners receive quantitative feedback on plan quality against historical data

Multi-institutional evaluation of a Pareto navigation guided automated radiotherapy planning solution for prostate cancer

Background: Current automated planning solutions are calibrated using trial and error or machine learning on historical datasets. Neither method allows for the intuitive exploration of differing trade-off options during calibration, which may aid in ensuring automated solutions align with clinical preference. Pareto navigation provides this functionality and offers a potential calibration alternative. The purpose of this study was to validate an automated radiotherapy planning solution with a novel multi-dimensional Pareto navigation calibration interface across two external institutions for prostate cancer. Methods: The implemented ‘Pareto Guided Automated Planning’ (PGAP) methodology was developed in RayStation using scripting and consisted of a Pareto navigation calibration interface built upon a ‘Protocol Based Automatic Iterative Optimisation’ planning framework. 30 previous patients were randomly selected by each institution (IA and IB), 10 for calibration and 20 for validation. Utilising the Pareto navigation interface automated protocols were calibrated to the institutions’ clinical preferences. A single automated plan (VMATAuto) was generated for each validation patient with plan quality compared against the previously treated clinical plan (VMATClinical) both quantitatively, using a range of DVH metrics, and qualitatively through blind review at the external institution. Results: PGAP led to marked improvements across the majority of rectal dose metrics, with Dmean reduced by 3.7 Gy and 1.8 Gy for IA and IB respectively (p < 0.001). For bladder, results were mixed with low and intermediate dose metrics reduced for IB but increased for IA. Differences, whilst statistically significant (p < 0.05) were small and not considered clinically relevant. The reduction in rectum dose was not at the expense of PTV coverage (D98% was generally improved with VMATAuto), but was somewhat detrimental to PTV conformality. The prioritisation of rectum over conformality was however aligned with preferences expressed during calibration and was a key driver in both institutions demonstrating a clear preference towards VMATAuto, with 31/40 considered superior to VMATClinical upon blind review. Conclusions: PGAP enabled intuitive adaptation of automated protocols to an institution’s planning aims and yielded plans more congruent with the institution’s clinical preference than the locally produced manual clinical plans

Long- and short-term outcomes in renal allografts with deceased donors: A large recipient and donor genome-wide association study.

Improvements in immunosuppression have modified short-term survival of deceased-donor allografts, but not their rate of long-term failure. Mismatches between donor and recipient HLA play an important role in the acute and chronic allogeneic immune response against the graft. Perfect matching at clinically relevant HLA loci does not obviate the need for immunosuppression, suggesting that additional genetic variation plays a critical role in both short- and long-term graft outcomes. By combining patient data and samples from supranational cohorts across the United Kingdom and European Union, we performed the first large-scale genome-wide association study analyzing both donor and recipient DNA in 2094 complete renal transplant-pairs with replication in 5866 complete pairs. We studied deceased-donor grafts allocated on the basis of preferential HLA matching, which provided some control for HLA genetic effects. No strong donor or recipient genetic effects contributing to long- or short-term allograft survival were found outside the HLA region. We discuss the implications for future research and clinical application

A systematic review of tests of empathy in medicine

Abstract Background Empathy is frequently cited as an important attribute in physicians and some groups have expressed a desire to measure empathy either at selection for medical school or during medical (or postgraduate) training. In order to do this, a reliable and valid test of empathy is required. The purpose of this systematic review is to determine the reliability and validity of existing tests for the assessment of medical empathy. Methods A systematic review of research papers relating to the reliability and validity of tests of empathy in medical students and doctors. Journal databases (Medline, EMBASE, and PsycINFO) were searched for English-language articles relating to the assessment of empathy and related constructs in applicants to medical school, medical students, and doctors. Results From 1147 citations, we identified 50 relevant papers describing 36 different instruments of empathy measurement. As some papers assessed more than one instrument, there were 59 instrument assessments. 20 of these involved only medical students, 30 involved only practising clinicians, and three involved only medical school applicants. Four assessments involved both medical students and practising clinicians, and two studies involved both medical school applicants and students. Eight instruments demonstrated evidence of reliability, internal consistency, and validity. Of these, six were self-rated measures, one was a patient-rated measure, and one was an observer-rated measure. Conclusion A number of empathy measures available have been psychometrically assessed for research use among medical students and practising medical doctors. No empathy measures were found with sufficient evidence of predictive validity for use as selection measures for medical school. However, measures with a sufficient evidential base to support their use as tools for investigating the role of empathy in medical training and clinical care are available.</p

De novo missense variants in FBXW11 cause diverse developmental phenotypes including brain, eye and digit anomalies

The identification of genetic variants implicated in human developmental disorders has been revolutionized by second-generation sequencing combined with international pooling of cases. Here, we describe seven individuals who have diverse yet overlapping developmental anomalies, and who all have de novo missense FBXW11 variants identified by whole exome or whole genome sequencing and not reported in the gnomAD database. Their phenotypes include striking neurodevelopmental, digital, jaw, and eye anomalies, and in one individual, features resembling Noonan syndrome, a condition caused by dysregulated RAS signaling. FBXW11 encodes an F-box protein, part of the Skp1-cullin-F-box (SCF) ubiquitin ligase complex, involved in ubiquitination and proteasomal degradation and thus fundamental to many protein regulatory processes. FBXW11 targets include b-catenin and GLI transcription factors, key mediators of Wnt and Hh signaling, respectively, critical to digital, neurological, and eye development. Structural analyses indicate affected residues cluster at the surface of the loops of the substrate-binding domain of FBXW11, and the variants are predicted to destabilize the protein and/or its interactions. In situ hybridization studies on human and zebrafish embryonic tissues demonstrate FBXW11 is expressed in the developing eye, brain, mandibular processes, and limb buds or pectoral fins. Knockdown of the zebrafish FBXW11 orthologs fbxw11a and fbxw11b resulted in embryos with smaller, misshapen, and underdeveloped eyes and abnormal jaw and pectoral fin development. Our findings support the role of FBXW11 in multiple developmental processes, including those involving the brain, eye, digits, and jaw