News cultures, security and transnational belonging: cross-generational perspectives among british Pakista

"Muslim women have often been stereotyped as being trapped in an oppressive and patriarchal system that neither provides freedom of expression nor develops their full potential. This study addresses such 'misconceptions', highlighting the ability of British Muslim women to construct their religious, national and gender identities by engaging in lively debates and questioning what appears to be unjust. Dominant public and media discourses currently often equate Muslims with 'terrorists'. Muslim women challenge this conception by participating in news cultures and negotiating their transnational citizenship. This study shows that the religious and political cultures of families shape women's perceptions and experiences of security and transnational belonging, rather than education." [author's abstract

A Multi-Population FA for Automatic Facial Emotion Recognition

Automatic facial emotion recognition system is popular in various domains such as health care, surveillance and human-robot interaction. In this paper we present a novel multi-population FA for automatic facial emotion recognition. The overall system is equipped with horizontal vertical neighborhood local binary patterns (hvnLBP) for feature extraction, a novel multi-population FA for feature selection and diverse classifiers for emotion recognition. First, we extract features using hvnLBP, which are robust to illumination changes, scaling and rotation variations. Then, a novel FA variant is proposed to further select most important and emotion specific features. These selected features are used as input to the classifier to further classify seven basic emotions. The proposed system is evaluated with multiple facial expression datasets and also compared with other state-of-the-art models

Effect of L-type calcium channel blocker (amlodipine) on myocardial iron deposition in patients with thalassaemia with moderate-to-severe myocardial iron deposition: protocol for a randomised, controlled trial

Introduction: Sideroblastic cardiomyopathy secondary to repeated blood transfusions is a feared complication in thalassaemia. Control of myocardial iron is thus becoming the cornerstone of thalassaemia management. Recent evidence suggests a role for L-type Ca2+ channels in mediating iron uptake by the heart. Blocking the cellular iron uptake through these channels may add to the benefit of therapy to standard chelation in reducing myocardial iron. We aim to determine the efficacy of amlodipine (a calcium channel blocker) as an adjunct to standard aggressive chelation in retarding myocardial iron deposition in thalassaemics with or without cardiomyopathy.Outcomes: The primary outcome is to compare the efficacy of amlodipine+chelation (intervention) versus standard chelation (control) in retarding myocardial iron deposition. Secondary outcomes include the effect of amlodipine therapy on systolic and diastolic function, strain and strain rate and liver iron content.Methods and analysis: This is a single-centre, parallel-group, prospective randomised control trial. Twenty patients will be randomised in a 1:1 allocation ratio into the intervention and control arms. In addition to conventional echocardiography, MRI T2* values for assessment of cardiac and liver iron load will be obtained at baseline and at 6 and 12 months. Cardiac T2* will be reported as the geometric mean and per cent coefficient of variation, and an increase in cardiac T2* values from baseline will be used as an end point to compare the efficacy of therapy. A p Value of Study setting: Department of Pediatric and Child Health, Aga Khan University Hospital, Karachi, Pakistan.Ethics and dissemination: This study has been approved by the Ethics Review Committee and Clinical Trials Unit at The Aga Khan University with respect to scientific content and compliance with applicable research and human subjects regulations. Findings will be reported through scientific publications and research conferences and project summary papers for participants

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

The Southampton Skills Development Zone apprenticeship: research report

1. An apprenticeship scheme developed by SSDZ has been an innovative attempt by the four public sector employers represented on the SSDZ Board to work with partners to create new training and employment opportunities for local unemployed 18 to 25 year olds. A team from the LLAKES research centre undertook research into the scheme from August 2010 to December 2011. The research aims included:• To develop an evidence base about the apprenticeship scheme, with information on the numbers starting and completing their apprenticeships, and being offered permanent contracts with their employers;• To provide an account of the experiences of all the major stakeholders in the scheme and their perceptions of its strengths and weaknesses;• To identify the key features of the scheme and perceptions of its benefits that can contribute to its dissemination and expansion. 2. The SSDZ apprenticeship scheme provided an opportunity for eligible young people to participate in a pre-apprenticeship training and recruitment process before being recruited by one of the four employers (City Council, University Hospital Southampton (UHS), Primary Care Trust and Southampton Solent University). The apprenticeship consisted of a 12 month fixed-term employment contract in a ‘real job’ role. Apprentices were registered on the government supported Level 2 Apprenticeship programme in health and social care, business administration and in (one case) engineering. 3. The apprentices were paid at the appropriate entry point for the job role. Their wages were paid by the employers with a contribution from the DWP’s (then) Future Jobs Fund (FJF). Off-the-job training was provided by City College (business administration) and UHS (health and social care). The costs of delivering the formal requirements of the relevant apprenticeship frameworks (including the qualifications) are met by the Skills Funding Agency (SfA) 4. There have been three main cohorts of apprentices: cohort 1 began in January and March 2010, Cohort 2 in September 2011 and Cohort 3 in March 2011.5. The research involved a range of data collection activities including observation of the pre-apprenticeship course, key informant interviews with 12 SSDZ Board members (including the four employers, JobCentre Plus, training providers and the SSDZ programme and operations managers), and 22 workplace managers and supervisors and training providers; focus group and one to one interviews (total 21) with apprentices belonging to cohorts 1 and 2; the collection of administrative data on the progress of apprentices. Some apprentices in cohort 2 were interviewed at the beginning, during and at the end of their apprenticeship. A total of 55 participants were interviewed in total.6. The research report provides detailed evidence about the organisation of the scheme, its performance in terms of participation and achievement and the experiences and perspectives of the key informants and the apprentices. The findings can be summarised as follows:Scheme Performance7. A total of 47 apprentices, 32 in cohort 1 and 15 in cohort 2 started the apprenticeship scheme. Overall, 34 (72%) gained employment, mostly with their apprenticeship employer, and 36 (76%) successfully completed their apprenticeship framework.Key Informants8. The commitment and involvement of the SSDZ Board including the chief executives of the participating employers was central to the successful implementation of the scheme. The major partners in the scheme agreed that the scheme had both social and economic goals which they were committed to helping to achieve.9. Participants strongly supported the pre-employment training and recruitment programme, and recognised its value in helping unemployed young people choose and apply for a place on the scheme and a particular apprenticeship opportunity. 10. The apprenticeship scheme was conceived as comprising both the pre-employment training and recruitment process and the one year apprenticeship as an integrated model that could be promoted to other employers including in the private sector.11. The pre-employment training and recruitment process also provided an opportunity for the partners (including the employers, Jobcentre Plus and City College) to build local capacity and shared understanding about the nature and challenges of the scheme and the target group. 12. The ability and willingness of the employers to recruit and employ ‘non-standard’ applicants into ‘real’ jobs was crucial. Without this commitment, the young people would have been unlikely to have been considered for posts by the line managers and HR staff and, therefore, would not have benefited from the experience of an apprenticeship.13. The FJF wage subsidy helped to mitigate the employers’ risk in taking on young people who would not normally have been shortlisted for posts owing to their lack of relevant experience. The challenge of sustaining the scheme at a time of financial austerity for employers was seen as considerable. 14. Workplace supervisors and line managers were positive about the ability of their apprentices to develop the required skills despite their lack of prior experience. They also recognised that they had benefited personally and professionally from supervising and mentoring the apprentices.15. There was some progress in rolling the scheme out to the private sector. The availability of a tested pre-employment training and recruitment model was seen as a benefit and factor that could facilitate the involvement of other employers. 16. The experience and creativity of the key partners in leveraging funding from diverse sources (regional, national and European) was likely to play an increasingly important role in enabling the scheme to be sustained and, or adapted, for example, for inclusion in the plans for the Solent Local Enterprise Partnership (LEP). Apprentices17. Overall, the apprentices were very positive about the opportunity to participate in the scheme. They had all been unemployed for at least six months and were very keen to get jobs with training and qualifications attached to them. 18. The apprentices recognised the value of the pre-employment training and recruitment process in helping them to select the ‘right’ employer and sector for them, as well as to making a good start on the apprenticeship. 19. Apprentices perceived that they would have been highly unlikely to have been shortlisted for jobs with the participating employers because of their lack of relevant work and employment experience. The opportunity to become apprentices and gain employment experience – learning and earning at the same time - with highly reputable public sector employers was highly valued.20. Most participants felt that they had become valued members of their workplace teams, and were making a positive and productive contribution. Apprentices saw themselves as productive employees from a fairly early stage in their one-year contracts. This raised questions about whether the learning goals associated with the apprenticeship should have been more substantial and challenging.21. Apprentices were supported by colleagues, supervisors and line managers in their on-the-job learning and in working more independently. Overall, they spoke highly of the help and encouragement they had received from members of their workplace teams.22. Most of the apprentices experienced an uncertain and anxious period at the end of their contracts when there was considerable uncertainty about whether they would be retained. There was considerable relief when individuals heard that their contracts had been confirmed.23. The apprentices perceived that their CVs had been significantly improved by their participation in the scheme, their achievements and employment experience, and that this would improve their chances in the labour market. In addition, they felt that they had gained in self-confidence and self-esteem and had improved their inter-personal skills.24. Experiences with the formal part of the apprenticeship have been mixed. Issues for improvement raised by the apprentices included: the amount of off-the-job time available to study and to complete assignments; the relevance of the qualifications to actual jobs; the level of qualifications, the timeliness with which they were able to complete aspects of their qualification framework; and having adequate access to workplace assessors. Access to an assessor as part of the work team was highly valued as it meant that assessments could be integrated into daily working practice and therefore could occur more regularly.25. Just under half the apprentices in the interview sample had attained qualifications at Level 3 or above before starting their apprenticeships, which were all at Level 2. This raised questions about whether some individuals at least could have been registered on Level 3 apprenticeships at the outset, or whether they and others could progress directly to Level 3 on completion of the Level 2 programme. 26. Most apprentices had had their educational and career aspirations raised as a consequence of participating in the scheme. There was scope for ensuring that employers provided formal opportunities to discuss career development with individuals so that the completion of the apprenticeship could be viewed as a rung on a ladder, rather than as a single step

Public-private partnerships: implications for primary schooling in Pakistan

Since the early 1990s, the government of Pakistan has promoted a policy of public–private partnerships to increase access and improve the quality of education in Pakistan. This article describes the evolution of the policy and discusses a variety of partnership arrangements aimed to establish and govern primary schools. It suggests that, while partnerships have positive outcomes and may be a viable option for resourceful communities, they are located in a hierarchical structure and lack equal distribution of power and trust between partners. Partnerships are often temporary and established for the purpose of a transition to privatization. These problems make them an unlikely strategy for a sustained increase in the chances of access to good-quality schooling for the poor and disadvantaged