Control for Uterine Fibroid Embolisation- An Initial Experience in East Africa

Uterine fibroid embolisation (UFE) generates moderate to severe post-procedural pain. We present a case series of 24 patients who underwent UFE during our first experience in managing the sometimes excruciating pain that accompanies embolisation of the uterine arteries. We also show the evolution of our protocol for post-procedural pain management from a first to second round of procedures

More than open space! the case for green infrastructure teaching in planning curricula

Since the mid-1990s, the concept of Green Infrastructure (GI) has been gaining traction in fields such as ecology and forestry, (landscape) architecture, environmental and hydrological engineering, public health as well as urban and regional planning. Definitions and aims ascribed to GI vary. Yet, agreement broadly exists on GI’s ability to contribute to sustainability by means of supporting, for example, biodiversity, human and animal health, and storm water management as well as mitigating urban heat island effects. Given an acknowledged role of planners in delivering sustainable cities and towns, professional bodies have highlighted the need for spatial planners to understand and implement GI. This raises questions of what sort of GI knowledge planners may require and moreover by whom and how GI knowledge and competencies may be conveyed? Examining knowledge and skills needs vis-à-vis GI education opportunities indicates a provision reliant primarily on continued professional education and limited ad hoc opportunities in Higher Education. The resulting knowledge base appears fragmented with limited theoretical foundations leading the authors to argue that a systematic inclusion of green infrastructure knowledges in initial planning education is needed to promote and aid effective GI implementation

Metacognition and Abstract Concepts

The problem of how concepts can refer to or be about the non‐mental world is particularly puzzling for abstract concepts. There is growing evidence that many characteristics beyond the perceptual are involved in grounding different kinds of abstract concept. A resource that has been suggested, but little explored, is introspection. This paper develops that suggestion by focusing specifically on metacognition—on the thoughts and feelings that thinkers have about a concept. One example of metacognition about concepts is the judgement that we should defer to others in how a given concept is used. Another example is our internal assessment of which concepts are dependable and useful, and which less so. Metacognition of this kind may be especially important for grounding abstract concepts

One year symptom severity and health-related quality of life changes among Black African patients undergoing uterine fibroid embolisation.

BACKGROUND: The main aim in the treatment of symptomatic fibroids by various modalities including uterine fibroid embolisation (UFE) is to alleviate symptoms and ultimately improve the quality of life. The efficacy of this modality of treatment in Black African women with significant fibroid burden and large uterine volumes is not clear. The main objective of the study was to examine potential changes in symptom severity among Black African patients 1 year following UFE for symptomatic uterine fibroids in a resource-constrained setting, rated using a validated questionnaire (UFS-QOL). Secondary outcomes examined were changes in quality of life and potential associations with age, parity, uterine volume and fibroid number prior to UFE. Additional interventions after UFE were also recorded. METHODS: A prospective before and after study of Black African patients undergoing UFE was undertaken. Participants underwent pelvic MR imaging prior to UFE and completed the UFS-QOL, a validated condition-specific questionnaire at baseline and at 1 year. Ninety five participants were recruited and data from 80 completing 1 year of follow up were available for analysis of changes in the symptom severity scores. RESULTS: The mean reduction in symptom severity score was 29.6 [95% CI 23.6 to 35.6, P < 0.001] and the mean improvement in HRQOL score was 35.7 [95% CI 28.4 to 42.9, P < 0.001]. A greater number of fibroids identified prior to UFE was associated with a more substantial improvement in symptom severity score (rs = 0.28, n = 80, P = 0.013) and participants of higher parity reported a greater improvement in HRQOL score (r = 0.336, P = 0.002). Major and minor surgical interventions were needed in 5 (6.3%) and 10 (12.5%) participants respectively. CONCLUSIONS: UFE is associated with clinically useful and statistically significant symptom relief in Black African patients. Symptom improvement following UFE is not compromised by a large fibroid burden and the rate of subsequent intervention is within an acceptable range. UFE is a safe alternative and efforts are needed to widen access to this non-surgical treatment modality

Constructing a social subject: autism and human sociality in the 1980s

This article examines three key aetiological theories of autism (meta-representations, executive dysfunction and weak central coherence), which emerged within cognitive psychology in the latter half of the 1980s. Drawing upon Foucault’s notion of ‘forms of possible knowledge’, and in particular his concept of savoir or depth knowledge, two key claims are made. First, it is argued that a particular production of autism became available to questions of truth and falsity following a radical reconstruction of ‘the social’ in which human sociality was taken both to exclusively concern interpersonal interaction and to be continuous with non-social cognition. Second, it is suggested that this recon- struction of the social has affected the contemporary cultural experience of autism, shift- ing attention towards previously unacknowledged cognitive aspects of the condition. The article concludes by situating these claims in relation to other historical accounts of the emergence of autism and ongoing debates surrounding changing articulations of social action in the psy disciplines

Theorising Disability: Beyond Common Sense

This article seeks to introduce the topic of disability to political theory via a discussion of some of the literature produced by disability theorists. The author argues that these more radical approaches conceptualise disability in ways that conflict with ‘common-sense’ notions of disability that tend to underpin political theoretical considerations of the topic. Furthermore, the author suggests that these more radical conceptualisations have profound implications for current debates on social justice, equality and citizenship that highlight the extent to which these notions are also currently underpinned by ‘common-sense’ notions of ‘normality’

Coherent frequentism

By representing the range of fair betting odds according to a pair of confidence set estimators, dual probability measures on parameter space called frequentist posteriors secure the coherence of subjective inference without any prior distribution. The closure of the set of expected losses corresponding to the dual frequentist posteriors constrains decisions without arbitrarily forcing optimization under all circumstances. This decision theory reduces to those that maximize expected utility when the pair of frequentist posteriors is induced by an exact or approximate confidence set estimator or when an automatic reduction rule is applied to the pair. In such cases, the resulting frequentist posterior is coherent in the sense that, as a probability distribution of the parameter of interest, it satisfies the axioms of the decision-theoretic and logic-theoretic systems typically cited in support of the Bayesian posterior. Unlike the p-value, the confidence level of an interval hypothesis derived from such a measure is suitable as an estimator of the indicator of hypothesis truth since it converges in sample-space probability to 1 if the hypothesis is true or to 0 otherwise under general conditions.Comment: The confidence-measure theory of inference and decision is explicitly extended to vector parameters of interest. The derivation of upper and lower confidence levels from valid and nonconservative set estimators is formalize

The precautions of clinical waste: disposable medical sharps in the United Kingdom

This article deals with recent changes in UK guidance on clinical waste, in particular a shift to disposable, single-use instruments and sharps. I use interviews conducted with nurses from a GP practice and two clinical waste managers at alternative treatment and incineration sites as a springboard for reflection on the relationship between the legislation on clinical waste management and its implementation. Scrutinizing the UK guidance, European legislation and World Health Organization principles, I draw out interviewees’ concerns that the changed practices lead to an expansion of the hazardous waste category, with an increased volume going to incineration. This raises questions regarding the regulations’ environmental and health effects, and regarding the precautionary approach embedded in the regulations. Tracing the diverse reverberations of the term ‘waste’ in different points along the journeys made by sharps in particular, and locating these questions in relation to existing literature on waste, I emphasize that public health rationales for the new practices are not made clear in the guidance. I suggest that this relative silence on the subject conceals both the uncertainties regarding the necessity for these means of managing the risks of infectious waste, and the tensions between policies of precautionary public health and environmental sustainability