Challenging empowerment: AIDS-affected southern African children and the need for a multi-level relational approach

Critics of empowerment have highlighted the concept's mutability, focus on individual transformation, one-dimensionality and challenges of operationalisation. Relating these critiques to children's empowerment raises new challenges. Drawing on scholarship on children's subjecthood and exercise of power, alongside empirical research with children affected by AIDS, I argue that empowerment envisaged as individual self-transformation and increased capacity to act independently offers little basis for progressive change. Rather it is essential to adopt a relational approach that recognises the need to transform power relationships at multiple levels. This analysis has implications for our wider understanding of empowerment in the 21st century. © The Author(s) 2013.This research was funded by DFID

A tectonic-rules-based mantle reference frame since 1 billion years ago – implications for supercontinent cycles and plate–mantle system evolution

Understanding the long-term evolution of Earth's plate–mantle system is reliant on absolute plate motion models in a mantle reference frame, but such models are both difficult to construct and controversial. We present a tectonic-rules-based optimization approach to construct a plate motion model in a mantle reference frame covering the last billion years and use it as a constraint for mantle flow models. Our plate motion model results in net lithospheric rotation consistently below 0.25∘ Myr−1, in agreement with mantle flow models, while trench motions are confined to a relatively narrow range of −2 to +2 cm yr−1 since 320 Ma, during Pangea stability and dispersal. In contrast, the period from 600 to 320 Ma, nicknamed the “zippy tricentenary” here, displays twice the trench motion scatter compared to more recent times, reflecting a predominance of short and highly mobile subduction zones. Our model supports an orthoversion evolution from Rodinia to Pangea with Pangea offset approximately 90∘ eastwards relative to Rodinia – this is the opposite sense of motion compared to a previous orthoversion hypothesis based on paleomagnetic data. In our coupled plate–mantle model a broad network of basal mantle ridges forms between 1000 and 600 Ma, reflecting widely distributed subduction zones. Between 600 and 500 Ma a short-lived degree-2 basal mantle structure forms in response to a band of subduction zones confined to low latitudes, generating extensive antipodal lower mantle upwellings centred at the poles. Subsequently, the northern basal structure migrates southward and evolves into a Pacific-centred upwelling, while the southern structure is dissected by subducting slabs, disintegrating into a network of ridges between 500 and 400 Ma. From 400 to 200 Ma, a stable Pacific-centred degree-1 convective planform emerges. It lacks an antipodal counterpart due to the closure of the Iapetus and Rheic oceans between Laurussia and Gondwana as well as due to coeval subduction between Baltica and Laurentia and around Siberia, populating the mantle with slabs until 320 Ma when Pangea is assembled. A basal degree-2 structure forms subsequent to Pangea breakup, after the influence of previously subducted slabs in the African hemisphere on the lowermost mantle structure has faded away. This succession of mantle states is distinct from previously proposed mantle convection models. We show that the history of plume-related volcanism is consistent with deep plumes associated with evolving basal mantle structures. This Solid Earth Evolution Model for the last 1000 million years (SEEM1000) forms the foundation for a multitude of spatio-temporal data analysis approaches

Search for astronomical neutrinos from blazar TXS 0506+056 in super-kamiokande

We report a search for astronomical neutrinos in the energy region from several GeV to TeV in the direction of the blazar TXS 0506+056 using the Super-Kamiokande detector following the detection of a 100 TeV neutrinos from the same location by the IceCube collaboration. Using Super-Kamiokande neutrino data across several data samples observed from 1996 April to 2018 February we have searched for both a total excess above known backgrounds across the entire period as well as localized excesses on smaller timescales in that interval. No significant excess nor significant variation in the observed event rate are found in the blazar direction. Upper limits are placed on the electron- and muon-neutrino fluxes at the 90% confidence level as 6.0 × 10−7 and 4.5 × 10−7–9.3 × 10−10 [erg cm−2 s−1], respectively

The influence of sea ice cover and Atlantic water advection on annual particle export north of Svalbard

The Arctic Ocean north of Svalbard has recently experienced large sea ice losses and the increasing prominence of Atlantic water (AW) advection. To investigate the impact of these ongoing changes on annual particle export, two moorings with sequential sediment traps were deployed in ice‐free and seasonally ice‐covered waters on the shelf north (NSv) and east (ESv) of Svalbard, collecting sinking particles nearly continuously from October 2017 to October 2018. Vertical export of particulate organic carbon (POC), total particulate matter (TPM), planktonic protists, chlorophyll a, and zooplankton fecal pellets were measured, and swimmers were quantified and identified. Combined with sensor data from the moorings, these time‐series measurements provided a first assessment of the factors influencing particle export in this region of the Arctic Ocean. Higher annual TPM and POC fluxes at the ice‐free NSv site were primarily driven by the advection of AW, higher grazing by large copepods, and a wind‐induced mixing event during winter. Higher diatom fluxes were observed during spring in the presence of sea ice at the ESv site. Along with sea ice cover, regional differences in AW advection and the seasonal presence of grazers played a prominent role in the biological carbon pump along the continental shelf off Svalbard

Optimal functional outcome measures for assessing treatment for Dupuytren's disease: A systematic review and recommendations for future practice

This article is available through the Brunel Open Access Publishing Fund. Copyright © 2013 Ball et al.; licensee BioMed Central Ltd.Background: Dupuytren's disease of the hand is a common condition affecting the palmar fascia, resulting in progressive flexion deformities of the digits and hence limitation of hand function. The optimal treatment remains unclear as outcomes studies have used a variety of measures for assessment. Methods: A literature search was performed for all publications describing surgical treatment, percutaneous needle aponeurotomy or collagenase injection for primary or recurrent Dupuytren’s disease where outcomes had been monitored using functional measures. Results: Ninety-one studies met the inclusion criteria. Twenty-two studies reported outcomes using patient reported outcome measures (PROMs) ranging from validated questionnaires to self-reported measures for return to work and self-rated disability. The Disability of Arm, Shoulder and Hand (DASH) score was the most utilised patient-reported function measure (n=11). Patient satisfaction was reported by eighteen studies but no single method was used consistently. Range of movement was the most frequent physical measure and was reported in all 91 studies. However, the methods of measurement and reporting varied, with seventeen different techniques being used. Other physical measures included grip and pinch strength and sensibility, again with variations in measurement protocols. The mean follow-up time ranged from 2 weeks to 17 years. Conclusions: There is little consistency in the reporting of outcomes for interventions in patients with Dupuytren’s disease, making it impossible to compare the efficacy of different treatment modalities. Although there are limitations to the existing generic patient reported outcomes measures, a combination of these together with a disease-specific questionnaire, and physical measures of active and passive individual joint Range of movement (ROM), grip and sensibility using standardised protocols should be used for future outcomes studies. As Dupuytren’s disease tends to recur following treatment as well as extend to involve other areas of the hand, follow-up times should be standardised and designed to capture both short and long term outcomes

Predictors and outcomes of patient safety culture in hospitals

<p>Abstract</p> <p>Background</p> <p>Developing a patient safety culture was one of the recommendations made by the Institute of Medicine to assist hospitals in improving patient safety. In recent years, a multitude of evidence, mostly originating from developed countries, has been published on patient safety culture. One of the first efforts to assess the culture of safety in the Eastern Mediterranean Region was by El-Jardali et al. (2010) in Lebanon. The study entitled "The Current State of Patient Safety Culture: a study at baseline" assessed the culture of safety in Lebanese hospitals. Based on study findings, the objective of this paper is to explore the association between patient safety culture predictors and outcomes, taking into consideration respondent and hospital characteristics. In addition, it will examine the correlation between patient safety culture composites.</p> <p>Methods</p> <p>Sixty-eight hospitals and 6,807 respondents participated in the study. The study which adopted a cross sectional research design utilized an Arabic-translated version of the Hospital Survey on Patient Safety Culture (HSOPSC). The HSOPSC measures 12 patient safety composites. Two of the composites, in addition to a patient safety grade and the number of events reported, represented the four outcome variables. Bivariate and mixed model regression analyses were used to examine the association between the patient safety culture predictors and outcomes.</p> <p>Results</p> <p>Significant correlations were observed among all patient safety culture composites but with differences in the strength of the correlation. Generalized Estimating Equations for the patient safety composite scores and respondent and hospital characteristics against the patient safety grade and the number of events reported revealed significant correlations. Significant correlations were also observed by linear mixed models of the same variables against the frequency of events reported and the overall perception of safety.</p> <p>Conclusion</p> <p>Event reporting, communication, patient safety leadership and management, staffing, and accreditation were identified as major patient safety culture predictors. Investing in practices that tackle these issues and prioritizing patient safety is essential in Lebanese hospitals in order to improve patient safety. In addition, further research is needed to understand the association between patient safety culture and clinical outcomes.</p

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London