THE DECLINE OF INFANT MORTALITY IN ENGLAND AND WALES 1871-1948: A MEDICAL CONUNDRUM. MICRO LEVEL STUDY OF BEXLEY URBAN SUB-REGISTRATION DISTRICT 1893-1898.

It is the aim of this thesis to examine the infant mortality rate within the Bexley Sub-Registration District in the years 1893-1898, in order to test the theories put forward by other writers, as to the factors bearing upon it. Whereas the statistics produced by the Registrar General are only available down to the sub-registration district or town level, this research uses vaccination, parish and cemetery registers to identify the actual individuals concerned and the streets and houses in which they lived. The births and infant deaths are considered by sex, legitimacy, social status, locality and such external factors as sewerage and water supply, in order to examine whether or not there is a direct link between any or all of these factors and the infant mortality rate. The key conclusion from this research is that there is no single factor accounting for levels and changes in the infant mortality rate, rather it is affected by a combination of different factors. Certainly children born outside marriage consistently experience a higher infant mortality rate than those born within it, possibly because single parents (almost invariably women) have reduced incomes with implications for diet, housing, sanitary conditions etc. Social status and locality do not appear, from this study, to influence the infant mortality rate greatly. The infant mortality rate amongst male children is, however, consistently higher than that for females. My main contention is that sanitary conditions and water supply were the most important factors, a contention supported by both the statistical and documentary evidence available at this micro-level

Clinical academic career pathway for nursing and allied health professionals: clinical academic role descriptors

The clinical academic pathway outlined highlights the range of typical practice and research-focused activities that a practitioner on a clinical academic career pathway might normally engage in at different levels and points along this career path. The activities are intended as a guide for practitioners interested in learning more about the practice and research components of a clinical academic career, as well as those already employed in clinical academic roles. They may also be useful for health care organisations and Higher Education Institutions as a tool for developing clinical academic roles

Carer experience of appetite changes in people living with dementia at home.

Statement of the Problem: The number of people providing unpaid care across the world is significant. 15.4 million Americans and 670,000 UK adults provide US$216 billion and £8 billion of unpaid care each year for people living with dementia. The term carer in this context relates to individuals who provide unpaid or informal care and usually comprise of family members. Being a carer often brings a sense of satisfaction but is also associated with greater risk of developing physical and psychological health problems. This ‘cost’ of caring is commonly described as carer burden. Appetite changes in people with dementia are a recognised cause of carer burden. This is significant as appetite change is one of the known behavioural and psychological symptoms of dementia and can cause malnutrition, hyperphagia and pica. These can significantly impact the health and function of the person with dementia and effect relationships and family dynamics. However appetite changes are also described as difficult to manage by both healthcare professionals and carers. The purposes of this study are to explore how carers of people with dementia living at home manage and respond to appetite changes and to understand their views on what resources or interventions they would consider useful to enable them and other carers to manage these changes. Methodology: This study was developed with patient and public involvement and takes a narrative inquiry approach; a recognised method used to explore experience. Interviews using open-ended questions allow participants to tell the stories of their experience. The transcribed, anonymised data is analysed using logic and intuition with judgments made about meaning and relevance. This approach enables participant experiences to be described and interpreted providing insight into carer experience and how to best support carers in managing appetite changes in people living with dementia

'I just want a job' : what do we really know about young people in jobs without training?

Over recent years, a central concern of policy has been to drive up post-16 participation rates in full-time education and address the needs of young people not in education, employment or training (NEET). As a result, young people who enter work which is classified as 'without training' at 16/17 have largely been ignored. However, the decision to Raise the Participation Age (RPA) for continuing in learning for all 17-year olds from 2013 and for all 18-year olds from 2015 in England, together with a growing unease about the impact of the current recession on youth unemployment rates, have revived interest in the 'jobs without training' (JWT) group. This paper draws on the findings from two studies: first, a qualitative study in two contrasting local labour markets, of young people in JWT, together with their employers and parents; and second, an evaluation of the Learning Agreement Pilots (LAP), which was the first policy initiative in England targeted at the JWT group. Both studies reveal a dearth of understanding about early labour market entrants and a lack of policy intervention and infrastructure to support the needs of the JWT group throughout the UK. From this, it is concluded that questionable assumptions have been made about the composition and the aspirations of young people in JWT, and their employers, on the basis of little or no evidence. As a consequence, a policy 'quick fix' to satisfy the RPA agenda will not easily be achieved. If the decision to raise the participation age is adopted also by the Welsh and Scottish parliaments, similar challenges may have to be faced

Perioperative nursing: maintaining momentum and staying safe.

Perioperative practice underpins one of the key activities of many healthcare services but the work of perioperative nurses is little known. A better understanding of their work is important to enable articulation of their contribution to clinical practice. This study observed the practice of perioperative nurses and explored how they described their role. Using ethnographic observation and interview, eighty-five hours observation of eleven nurses were undertaken and eight nurses were interviewed. Thematic analysis was undertaken enabling themes to emerge with two being identified. The first, 'maintaining momentum', described the need to keep people and equipment moving. The second, ‘accounting for safety’, referred to the need to keep the patient safe during this dangerous period. Tension between these two phenomena was apparent. Perioperative nurses describe one of their key roles as maintaining the momentum of the patient’s journey through the operating theatre but having to balance this with the need to ensure the patient’s safety. A core component of the perioperative nurse’s work is thus management of the tension between these. This study illuminated how these nurses understand their practice

Finite element modelling of cochlear electrical coupling

The operation of each hair cell within the cochlea generates a change in electrical potential at the frequency of the vibrating basilar membrane beneath the hair cell. This electrical potential influences the operation of the cochlea at nearby locations and can also be detected as the cochlear microphonic signal. The effect of such potentials has been proposed as a mechanism for the non-local operation of the cochlear amplifier, and the interaction of such potentials has been thought to be the cause of the broadness of cochlea microphonic tuning curves. The spatial extent of influence of these potentials is an important parameter for determining the significance of their effects. Calculations of this extent have typically been based on calculating the longitudinal resistance of each of the scalae from the scala cross sectional area, and the conductivity of the lymph. In this paper, the range of influence of the electrical potential is examined using an electrical finite element model. It is found that the range of influence of the hair cell potential is much shorter than the conventional calculation, but is consistent with recent measurements

The role impairment associated with mental disorder risk profiles in the WHO World Mental Health International College Student Initiative

OBJECTIVE: The objective of this study is to assess the contribution of mental comorbidity to role impairment among college students. METHODS: Web-based self-report surveys from 14,348 first-year college students (Response Rate [RR] = 45.5%): 19 universities, eight countries of the World Mental Health International College Student Initiative. We assessed impairment (Sheehan Disability Scales and number of days out of role [DOR] in the past 30 days) and seven 12-month DSM-IV disorders. We defined six multivariate mental disorder classes using latent class analysis (LCA). We simulated population attributable risk proportions (PARPs) of impairment. RESULTS: Highest prevalence of role impairment was highest among the 1.9% of students in the LCA class with very high comorbidity and bipolar disorder (C1): 78.3% of them had severe role impairment (vs. 20.8%, total sample). Impairment was lower in two other comorbid classes (C2 and C3) and successively lower in the rest. A similar monotonic pattern was found for DOR. Both LCA classes and some mental disorders (major depression and panic, in particular) were significant predictors of role impairment. PARP analyses suggest that eliminating all mental disorders might reduce severe role impairment by 64.6% and DOR by 44.3%. CONCLUSIONS: Comorbid mental disorders account for a substantial part of role impairment in college students. © 2018 John Wiley & Sons, Ltd

Generalization Mediates Sensitivity to Complex Odor Features in the Honeybee

Animals use odors as signals for mate, kin, and food recognition, a strategy which appears ubiquitous and successful despite the high intrinsic variability of naturally-occurring odor quantities. Stimulus generalization, or the ability to decide that two objects, though readily distinguishable, are similar enough to afford the same consequence [1], could help animals adjust to variation in odor signals without losing sensitivity to key inter-stimulus differences. The present study was designed to investigate whether an animal's ability to generalize learned associations to novel odors can be influenced by the nature of the associated outcome. We use a classical conditioning paradigm for studying olfactory learning in honeybees [2] to show that honeybees conditioned on either a fixed- or variable-proportion binary odor mixture generalize learned responses to novel proportions of the same mixture even when inter-odor differences are substantial. We also show that the resulting olfactory generalization gradients depend critically on both the nature of the stimulus-reward paradigm and the intrinsic variability of the conditioned stimulus. The reward dependency we observe must be cognitive rather than perceptual in nature, and we argue that outcome-dependent generalization is necessary for maintaining sensitivity to inter-odor differences in complex olfactory scenes