Orphanhood and the living arrangements of children in sub-saharan Africa

Increasing adult mortality due to HIV/AIDS in Sub-Saharan Africa raises considerable concerns about the welfare of surviving children. Studies have found substantial variability across countries in the negative impacts of orphanhood on child health and education. One hypothesis for this variability is the resilience of the extended family network in some countries to care for orphans-networks under increasing pressure by the sheer number of orphans in many settings. Using household survey data from 21 countries in Africa, this study examines trends in orphanhood and living arrangements, and the links between the two. The findings confirm that orphanhood is increasing, although not all countries are experiencing rapid rises. In many countries, there has been a shift toward grandparents taking on increased childcare responsibility-especially where orphan rates are growing rapidly. This suggests some merit to the claim that the extended network is narrowing, focusing on grandparents who are older and may be less able to financially support orphans than working-age adults. However there are also changes in childcare patterns in countries with stable orphan rates or low HIV prevalence. This suggests future work on living arrangements should not exclude low HIV/AIDS prevalence countries, and explanations for changes should include a broader set of factors.Street Children,HIV AIDS,Youth and Governance,Primary Education,Population Policies

King-Devick Test Score is Linked to Cerebral Vasoreactivity During Acute Recovery Phase Post-Concussion

The King-Devick (KD) test is a quick screening tool used to detect oculomotor and attention related brain function impairments following a concussion. Adequate cerebral blood flow (CBF) is an indicator of structural and functional integrity and impairments in CBF have been linked to cognitive deficits following concussion. Cerebral vasoreactivity (CVR), a key measure of hemodynamic reserve, is an important factor in CBFregulation. PURPOSE: To examine the association between CVR and oculomotor and attention function, using KD test scores, in collegiate athletes following a concussion. METHOD: Eighteen male and female athletes diagnosed with a sports-related concussion were enrolled in the prospective cohort study. Twenty-two non-injured athletes were enrolled as controls. Data was collected longitudinally on day-3, day-21, and day-90 following a concussion. Middle cerebral artery blood velocity (MCAV) was obtained using transcranial Doppler ultrasonography (TCD). CO2 was used as a stimulus to assess CVR. End-tidal CO2 (EtCO2) was monitored with an infrared CO2 analyzer attached to a nasal cannula. Continuous MCAV was obtained for 2-minutes each in response to three CO2 stimuli; normal room-air (normocapnia), inspiring 8% CO2 and 21% O2 gas mixture (hypercapnia), and during hyperventilation (hypocapnia). MCAV and EtCO2 data were plotted and CVR was estimated as the slope of the MCAV and EtCO2 relationship. For the KD test, subjects read aloud single-digit-numbers left to right from three test cards with progressive level of difficulty. Subjects were instructed to read as fast as possible without making errors. KD test score was determined as the sum of the total time required to complete the three test cards. Nonparametric Wilcoxon test was used to assess CVR and KD test scores between control and the concussed group at each of the three time points. Spearman rank order correlation was used to assess the association between CVR and KD scores at each time point. RESULTS: Compared to the control, CVR (1.33±0.31vs.1.14±0.43U; p=0.03) was blunted and KD score (44.4±7.7vs.48.1±6.9sec; p=0.04) was slower on day-3. CVR was comparable to the controls on days 21 and 90. However, a learning effect was observed in KD test score over time (42.1±8.9, p=0.02 [day-21]; 42.03±8.5, p=0.03 [day90]). In addition, a negative correlation between CVR and KD test was observed on day-3 (p= 0.04). CONCLUSION: The preliminary results indicate that deficits in oculomotor function and attention, as identified by KD test, may result from inadequate CBF regulation during the acute recovery phase post-concussion. Further studies should be done to evaluate the potential role of CVR in oculomotor function following concussion in collegiate athletes

Baroreflex Sensitivity is Impaired in Athletes Following a Sports-Related Concussion

Sport-related concussions are a major public health concern, with approximately 3.8 million incidences occurring annually in the United States alone. Autonomic nervous system (ANS) dysfunction is implicated in early and later stages of sports-related concussion recovery. Arterial baroreflex, a crucial mechanism by which the ANS controls short-term fluctuations in blood pressure, remains understudied in this population. PURPOSE: Examine baroreflex sensitivity (BRS) at rest during acute and sub-acute recovery phases following a sport-related concussion in collegiate athletes in comparison to non-injured athletes as controls. METHODS: Athletes (20±1 years) with sports-related concussions were tested on days 3 (N=13), 21 (N=13), and 90 (N=11) following the injury. Control athletes (N=12) were assessed at one time-point. Continuous arterial blood pressure (finger photoplethysmography) and R-R intervals (3-lead electrocardiogram) were obtained at rest for 6 minutes and while subjects were seated in an upright position. BRS was estimated with transfer function analysis to assess the fluctuations in systolic blood pressure and R-R intervals during the time period. Transfer gain in the low-frequency range (0.05– 0.15 Hz) quantified the magnitude of the relationship between changes in systolic blood pressure and R-R interval. Therefore, higher gain indicates higher BRS. A linear mixed model was used to examine symptoms and transfer function variables between the controls and the concussed athletes at the three time points. RESULTS: As anticipated, symptoms were worse on day-3 and resolved during the day-21 sub-acute phase. BRS was lower on day-3 (0.656±0.2U; p=0.003), day-21 (0.711±0.29U; p=0.013), and day-90 (0.77±0.27; p=0.04) following the injury compared to the controls (1.05±0.3U). CONCLUSION: The findings confirm impairments in baroreflex sensitivity during the acute and subacute recovery phases following a concussion despite symptom resolution. Blunted baroreflex sensitivity following injury may position athletes in a vulnerable situation while performing tasks that elicit sudden changes in blood pressure on and off the field

Impairments in Cerebral Autoregulation is Associated with Postural Control in Sports Related Concussion

Global and regional deficits in cerebral blood flow are reported with concussions, a major public health concern, with approximately 3.8 million incidences occurring annually in the United States alone. Recent studies have identified an increased risk of musculoskeletal injuries in athletes upon return-to-play. Complexity index is a sensitive marker of postural control, with low complexity index indicating a poor physiological adaptation to stress. PURPOSE: Twofold; 1. Examine complexity index and dynamic cerebral autoregulation (dCA) at rest and during physical stress (rhythmic squatting) in collegiate athletes following a concussion in comparison to non-injured controls. 2. Examine the association between complexity index and dCA. METHODS: Athletes (20±1 years) with sports-related concussions were tested on days 3 (N=33), 21 (N=29), and 90 (N=21) following the injury. Controls (N=27) were assessed at one time-point. Continuous mean arterial pressure (MAP) (finger photoplethysmography) and middle cerebral artery blood flow velocity (MCAV) (2 MHz transcranial Doppler ultrasonography) were obtained at rest for 6 minutes and during physical stress (squatting at 0.1Hz frequency) for 5 minutes. Transfer function analysis of beat-to-beat MAP and MCAV oscillations in the low frequency (LF, 0.07-0.20 Hz) range was utilized to assess dCA. Effective dCA dampens the fluctuations in MCAV in response to MAP oscillations, resulting in a low LF gain. Multiscale entropy analysis was used to determine complexity index from the center of pressure data obtained during quiet standing with eyes closed on a force platform. Two-sample Mann Whitney U test was used to compare data between control and concussed athletes at the three time points. Spearman correlation was used to examine the association between the variables. RESULTS: LF gain at rest was higher on day-3 (1.27±0.4U; p=0.007), and day-21 (1.27±0.5U; p=0.03) compared to the controls (1.03±0.2U). Similar findings were observed in LF gain with physical stress (day-3 p= 0.003; day-21 p=0.001). Postural complexity index was lower on day-3 (4.3±1.3U; p=0.004) and day-21 (4.5±1.1U; p=0.02) compared to the controls (5.4±1.4U). Moreover, a negative association was observed between complexity index and LF gain at rest (β= -0.66, p= 0.04) and during squatting (β= -1.53, p= 0.02). CONCLUSION: The findings confirm impairments in cerebral autoregulation and postural control during the acute and subacute recovery phases following a concussion despite symptom resolution. In addition, poor functional outcome, such as postural control, may be associated with alterations in cerebral blood flow regulation in this population. Tracking cerebral autoregulation during recovery phase may help in preventing musculoskeletal injuries in athletes after return-to-play following a concussion

GIT SMART: A Feasibility Study of a Mars Scout Vehicle to Study Methane

Presented at the Aerospace Systems Design Laboratory External Advisory Board Meeting, 2 May 2006, Guggenheim School of Aerospace Engineering, Georgia Institute of Technology Atlanta, GA

Conceptualising a model to guide nursing and midwifery in the community guided by an evidence review

Background: Successful models of nursing and midwifery in the community delivering healthcare throughout the lifespan and across a health and illness continuum are limited, yet necessary to guide global health services. Primary and community health services are the typical points of access for most people and the location where most care is delivered. The scope of primary healthcare is complex and multifaceted and therefore requires a practice framework with sound conceptual and theoretical underpinnings. The aim of this paper is to present a conceptual model informed by a scoping evidence review of the literature. Methods: A scoping evidence review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Databases included CINAHL, MEDLINE, PsycINFO and SocINDEX using the EBSCO platform and the Cochrane Library using the keywords: model, nursing, midwifery, community, primary care. Grey literature for selected countries was searched using the Google ‘advanced’ search interface. Data extraction and quality appraisal for both empirical and grey literature were conducted independently by two reviewers. From 127 empirical and 24 non-empirical papers, data extraction parameters, in addition to the usual methodological features, included: the nature of nursing and midwifery; the population group; interventions and main outcomes; components of effective nursing and midwifery outcomes. Results: The evidence was categorised into six broad areas and subsequently synthesised into four themes. These were not mutually exclusive: (1) Integrated and Collaborative Care; (2) Organisation and Delivery of Nursing and Midwifery Care in the Community; (3) Adjuncts to Nursing Care and (4) Overarching Conceptual Model. It is the latter theme that is the focus of this paper. In essence, the model depicts a person/client on a lifespan and preventative-curative trajectory. The health related needs of the client, commensurate with their point position, relative to both trajectories, determines the nurse or midwife intervention. Consequently, it is this need, that determines the discipline or speciality of the nurse or midwife with the most appropriate competencies. Conclusion: Use of a conceptual model of nursing and midwifery to inform decision-making in primary/community based care ensures clinical outcomes are meaningful and more sustainable. Operationalising this model for nursing and midwifery in the community demands strong leadership and effective clinical governance

“Still good life”: On the value of reuse and distributive labor in “depleted” rural Maine

This article explores the production of wealth through distributive labor in Maine\u27s secondhand economy. While reuse is often associated with economic disadvantage, our research complicates that perspective. The labor required to reclaim, repair, redistribute, and reuse secondhand goods provides much more than a means of living in places left behind by international capitalism, but the value generated by this work is persistently discounted by dominant economic logics. On the basis of semistructured interviews, participant observation, and statewide surveys with reuse market participants in Maine, we find that the relational value of reuse, produced through caring, flexible, distributive labor, is especially significant. We argue that paying attention to the practices, politics, and value of distribution is critical for understanding wealth in communities perceived to have been left behind by global capitalist systems, particularly as wage labor opportunities and natural resources grow increasingly scarce

Interpreting response time effects in functional imaging studies

It has been suggested that differential neural activity in imaging studies is most informative if it is independent of response time (RT) differences. However, others view RT as a behavioural index of key cognitive processes, which is likely linked to underlying neural activity. Here, we reconcile these views using the effort and engagement framework developed by Taylor, Rastle, and Davis (2013) and data from the domain of reading aloud. We propose that differences in neural engagement should be independent of RT, whereas, differences in neural effort should co-vary with RT. We illustrate these different mechanisms using data from an fMRI study of neural activity during reading aloud of regular words, irregular words, and pseudowords. In line with our proposals, activation revealed by contrasts designed to tap differences in neural engagement (e.g., words are meaningful and therefore engage semantic representations more than pseudowords) survived correction for RT, whereas activation for contrasts designed to tap differences in neural effort (e.g., it is more difficult to generate the pronunciation of pseudowords than words) correlated with RT. However, even for contrasts designed to tap neural effort, activity remained after factoring out the RT-BOLD response correlation. This may reveal unpredicted differences in neural engagement (e.g., learning phonological forms for pseudowords. >. words) that could further the development of cognitive models of reading aloud. Our framework provides a theoretically well-grounded and easily implemented method for analysing and interpreting RT effects in neuroimaging studies of cognitive processes