The implementation and effectiveness of the one stop centre model for intimate partner and sexual violence in low- and middle-income countries: a systematic review of barriers and enablers.

Introduction: Many low- and middle-income countries have implemented health-system based one stop centres to respond to intimate partner violence (IPV) and sexual violence. Despite its growing popularity in low- and middle-income countries and among donors, no studies have systematically reviewed the one stop centre. Using a thematic synthesis approach, this systematic review aims to identify enablers and barriers to implementation of the one stop centre (OSC) model and to achieving its intended results for women survivors of violence in low- and middle-income countries. Methods: We searched PubMed, CINAHL and Embase databases and grey literature using a predetermined search strategy to identify all relevant qualitative, quantitative and mixed methods studies. Overall, 42 studies were included from 24 low- and middle-income countries. We used a three-stage thematic synthesis methodology to synthesise the qualitative evidence, and we used the CERQual (Confidence in the Evidence from Reviews of Qualitative Research) approach to assess confidence in the qualitative research. Meta-analysis could not be performed due heterogeneity in results and outcome measures. Quantitative data are presented by individual study characteristics and outcomes, and key findings are incorporated into the qualitative thematic framework. Results: The review found 15 barriers with high-confidence evidence and identified seven enablers with moderate-confidence evidence. These include barriers to implementation such as lack of multisectoral staff and private consultation space as well as barriers to achieving the intended result of multisectoral coordination due to fragmented services and unclear responsibilities of implementing partners. There were also differences between enablers and barriers of various OSC models such as the hospital-based OSC, the stand-alone OSC and the NGO-run OSC. Conclusion: This review demonstrates that there are several barriers that have often prevented the OSC model from being implemented as designed and achieving the intended result of providing high quality, accessible, acceptable, multisectoral care. Existing OSCs will likely require strategic investment to address these specific barriers before they can achieve their ultimate goal of reducing survivor retraumatisation when seeking care. More rigorous and systematic evaluation of the OSC model is needed to better understand whether the OSC model of care is improving support for survivors of IPV and sexual violence.The systematic review protocol was registered and is available online (PROSPERO: CRD42018083988)

Equine Endometrial Explants Undergo Significant Degenerative Changes in Culture

The current study evaluated equine endometrial explants following 12, 24, and 48 hours in culture. Measurement of an indicator of cell death in explant supernatant, light microscopy, and gene expression of biomarkers of endometrial function and cellular stress, were used to compare the effect of six different media on explant viability and morphology. Viability of explants was assessed indirectly through measuring LDH activity in the culture supernatant. Regardless of culture medium composition, a significant increase in LDH activity was observed within 12 hours of culture, indicating occurrence of cell damage. Morphological analysis through light microscopy revealed degenerative changes occurring within 12 hours and after 48 hours there is nearly complete loss of luminal and superficial glandular epithelium and diffuse detachment of deep glandular epithelium. Transcript abundance of prostaglandin-endoperoxide synthase 2 (PTGS2), estrogen receptor 1 (ESR1), and vascular endothelial growth factor (VEGF) was assessed as biomarkers of endometrial function. A marked increase in PTGS2 and VEGF expression occurred, ESR1 displayed more or less steady expression levels. Above described changes were seen irrespective of cell culture medium used. The marked increase in expression in PTGS2 expression presents a limitation to using endometrial explants in the current culture system to study aspects of endometrial function such as the inflammatory response to insemination

Effects of hypothermia on brain glucose metabolism in acute liver failure: a H/C-nuclear magnetic resonance study

Mild hypothermia has a protective effect on brain edema and encephalopathy in both experimental and human acute liver failure. The goals of the present study were to examine the effects of mild hypothermia (35°C) on brain metabolic pathways using combined 1H and 13C-Nuclear Magnetic Resonance (NMR) spectroscopy, a technique which allows the study not only of metabolite concentrations but also their de novo synthesis via cell-specific pathways in the brain. :1H and 13C NMR spectroscopy using [1-13C] glucose was performed on extracts of frontal cortex obtained from groups of rats with acute liver failure induced by hepatic devascularization whose body temperature was maintained either at 37°C (normothermic) or 35°C (hypothermic), and appropriate sham-operated controls. At coma stages of encephalopathy in the normothermic acute liver failure animals, glutamine concentrations in frontal cortex increased 3.5-fold compared to sham-operated controls (P < 0.001). Comparable increases of brain glutamine were observed in hypothermic animals despite the absence of severe encephalopathy (coma). Brain glutamate and aspartate concentrations were respectively decreased to 60.9% ± 7.7% and 42.2% ± 5.9% (P < 0.01) in normothermic animals with acute liver failure compared to control and were restored to normal values by mild hypothermia. Concentrations of lactate and alanine in frontal cortex were increased to 169.2% ± 15.6% and 267.3% ± 34.0% (P < 0.01) respectively in normothermic rats compared to controls. Furthermore, de novo synthesis of lactate and alanine increased to 446.5% ± 48.7% and 707.9% ± 65.7% (P < 0.001), of control respectively, resulting in increased fractional 13C-enrichments in these cytosolic metabolites. Again, these changes of lactate and alanine concentrations were prevented by mild hypothermia. Mild hypothermia (35°C) prevents the encephalopathy and brain edema resulting from hepatic devascularization, selectively normalizes lactate and alanine synthesis from glucose, and prevents the impairment of oxidative metabolism associated with this model of ALF, but has no significant effect on brain glutamine. These findings suggest that a deficit in brain glucose metabolism rather than glutamine accumulation is the major cause of the cerebral complications of acute liver failure

Selective alterations of brain osmolytes in acute liver failure: protective effect of mild hypothermia

The principal cause of mortality in patients with acute liver failure (ALF) is brain herniation resulting from intracranial hypertension caused by a progressive increase of brain water. In the present study, ex vivo high-resolution 1H-NMR spectroscopy was used to investigate the effects of ALF, with or without superimposed hypothermia, on brain organic osmolyte concentrations in relation to the severity of encephalopathy and brain edema in rats with ALF due to hepatic devascularization. In normothermic ALF rats, glutamine concentrations in frontal cortex increased more than fourfold at precoma stages, i.e. prior to the onset of severe encephalopathy, but showed no further increase at coma stages. In parallel with glutamine accumulation, the brain organic osmolytes myo-inositol and taurine were significantly decreased in frontal cortex to 63\% and 67\% of control values, respectively, at precoma stages (p<0.01), and to 58\% and 67\%, respectively, at coma stages of encephalopathy (p<0.01). Hypothermia, which prevented brain edema and encephalopathy in ALF rats, significantly attenuated the depletion of myo-inositol and taurine. Brain glutamine concentrations, on the other hand, did not respond to hypothermia. These findings demonstrate that experimental ALF results in selective changes in brain organic osmolytes as a function of the degree of encephalopathy which are associated with brain edema, and provides a further rationale for the continued use of hypothermia in the management of this condition

A Framework for Effective Collaboration with Crisis-Affected Communities

In 2016, a localisation agenda was set across the international aid industry with the understanding that humanitarian interventions need to be led by local actors and local communities. Despite international agreements, the localisation efforts are largely failing. This paper demonstrates the challenges that prevent effective collaboration between international humanitarian agencies and crisis-affected communities. It draws on evaluation reports to highlight an inability to learn lessons or follow recommendations from previous crises. Based on the authors’ experiences, we present a novel framework for effectively collaborating with crisis-affected communities. The Communities Framework provides a pathway to establishing effective community collaboration and locally owned and led humanitarian interventions. The importance of local leadership, trust building, and local context are at the heart of the framework. In light of the need for a more localised and decolonial humanitarian response, this framework supports humanitarian actors and the affected communities in moving from a charity-led approach to one of mutual aid. The paper draws on alternative notions of compassion from the Global South of contemporary humanitarian interventions as a philosophical foundation for the framework. Caring for others and the world is central to implementing an appropriate and effective humanitarian response. There remains a largely unexplored scope regarding the outcome of resolving crises when both humanitarian actors and affected communities work as equal partners and how that will shape modern humanitarianism as we understand it today

The Maré Museum: an integrated project of community development

Cadernos de SociomuseologiaThe Maré Museum, founded on 8 May 2006, arose from the desire of the inhabitants of the community to have a place of memory, a place that is immersed in the past and looks to the future, a place that reflects on this community, on their conditions and identities and on their territorial and cultural diversity. The intention of the Maré Museum is to break with the tradition that the experiences to be recollected and the places of memory to be remembered are those elected by the official version, the "winner" version of the story that restricts the representations of history and memory of large portions of the population. The Maré Museum, as a pioneer initiative in the city scene, proposed to expand the museological concept, so that it is not restricted to intellectual social groups and cultural spaces that are not accessible to the general population. The museum has established recognition that the slum is a place of memory and so has initiated a museographic reading of the Mare community. .

Funding Era Free Speech Theory: Applying Traditional Speech Protection to the Regulation of Anonymous Cyberspace

Abstract Background Blunt trauma is the most frequent mechanism of injury in multiple trauma, commonly resulting from road traffic collisions or falls. Two of the most frequent injuries in patients with multiple trauma are chest trauma and extremity fracture. Several trauma mouse models combine chest trauma and head injury, but no trauma mouse model to date includes the combination of long bone fractures and chest trauma. Outcome is essentially determined by the combination of these injuries. In this study, we attempted to establish a reproducible novel multiple trauma model in mice that combines blunt trauma, major injuries and simple practicability. Methods Ninety-six male C57BL/6 N mice (n = 8/group) were subjected to trauma for isolated femur fracture and a combination of femur fracture and chest injury. Serum samples of mice were obtained by heart puncture at defined time points of 0 h (hour), 6 h, 12 h, 24 h, 3 d (days), and 7 d. Results A tendency toward reduced weight and temperature was observed at 24 h after chest trauma and femur fracture. Blood analyses revealed a decrease in hemoglobin during the first 24 h after trauma. Some animals were killed by heart puncture immediately after chest contusion; these animals showed the most severe lung contusion and hemorrhage. The extent of structural lung injury varied in different mice but was evident in all animals. Representative H&E-stained (Haematoxylin and Eosin-stained) paraffin lung sections of mice with multiple trauma revealed hemorrhage and an inflammatory immune response. Plasma samples of mice with chest trauma and femur fracture showed an up-regulation of IL-1β (Interleukin-1β), IL-6, IL-10, IL-12p70 and TNF-α (Tumor necrosis factor- α) compared with the control group. Mice with femur fracture and chest trauma showed a significant up-regulation of IL-6 compared to group with isolated femur fracture. Conclusions The multiple trauma mouse model comprising chest trauma and femur fracture enables many analogies to clinical cases of multiple trauma in humans and demonstrates associated characteristic clinical and pathophysiological changes. This model is easy to perform, is economical and can be used for further research examining specific immunological questions

The Maré Museum: an integrated project of community development

 The Maré Museum, founded on 8 May 2006, arose from the desire of the inhabitants of the community to have a place of memory, a place that is immersed in the past and looks to the future, a place that reflects on this community, on their conditions and identities and on their territorial and cultural diversity. The intention of the Maré Museum is to break with the tradition that the experiences to be recollected and the places of memory to be remembered are those elected by the official version, the "winner" version of the story that restricts the representations of history and memory of large portions of the population. The Maré Museum, as a pioneer initiative in the city scene, proposed to expand the museological concept, so that it is not restricted to intellectual social groups and cultural spaces that are not accessible to the general population. The museum has established recognition that the slum is a place of memory and so has initiated a museographic reading of the Mare community. ..