The impact of endometrial injury to the risk of preeclampsia

Thesis (Ph.D.)--Boston UniversityPreeclampsia is associated with disproportionately high rates of neonatal mortality and morbidity. Both therapeutic and prophylactic interventions have been lacking and delivery of the placenta remains the only effective cure for this obstetrical complication. In study 1 we examined the association between prior induced abortion and preeclampsia among nulliparous women in the Medical Birth Register (MBR) of Finland from 1996-2010. Preeclampsia cases (n=12,650) and frequency matched controls (n=50,600) were linked with the Finnish Registry of Induced Abortions to collect data on any prior induced abortions (IA), method of IA, and gestational age at the time of IA. History ofiA was associated with a decreased risk ofpreeclampsia (OR 0.89, 95% CI 0.84, 0.95). The risk of preeclampsia decreased further with an increasing number of prior IA with decreased risks of 8%, 23%, and 26% for 1, 2, and 2:3 lAs, respectively. These associations become more protective after restricting the analysis to women with no history of spontaneous abmtion (SAB). Surgical abortions at 2:12 weeks were associated with the greatest reduction in risk of preeclampsia (OR 0.81 95% CI 0.61, 1.06). Our study confirms previous findings of a protective effect of IA on risk of preeclampsia and provides new information regarding method and gestational age of abortion in relation to preeclampsia risk. In study 2 we investigated the potential for a differential effect of placental abruption on preeclampsia, based on the gestational age at the time of abruption among parous women in the MBR of Finland from 1996-2010. Cases of preeclampsia (n=6,487) and frequency matched controls (n=25,948) were linked to the Hospital Discharge Registry (HDR) and MBR to ascertain data on prior placental abruption. Placental abruption was categorized as preterm (<37 weeks) or term (2:37 weeks). Preterm abruptions were associated with a two-fold increase in risk of preeclampsia (OR 2.18 95% CI 1.45, 3.30). In contrast term placental abruption was not associated with preeclampsia. The association between preterm placental abruption and preeclampsia was further elevated among women with a history of preeclampsia. Associations with preterm abruption were also strengthened when the outcome was defined as early-onset preeclampsia (<34 weeks). Placental abruption in a prior pregnancy conferred a different risk of preeclampsia based on the gestational age of the abruption affected pregnancy. Lastly, in study 3 we examined the association between intrauterine device (IUD) use and preeclampsia among women in the United Kingdom's Clinical Practice Research Database from 1993-2010. Data on IUD use was obtained from patient records for 2,837 cases and 11 ,221 matched controls. Any prior IUD use was associated with a reduced risk of preeclampsia (OR 0.77 95% CI 0.61 , 0.98). Timing of removal in relation to the start of pregnancy showed an inverse association, with shorter intervals associated with the largest decreases in risk of preeclampsia. IUD removal within a year prior to pregnancy had an OR of 0.66 (95% CI 0.46, 0.96). Associations were most notable for women with a BMI <25kg/m and for women with no prior births. IUD use prior to pregnancy was associated with a reduced risk of preeclampsia, which was most apparent for those using an IUD within a year prior to pregnancy

The presentation of the self and professional identity: countering the accountant’s stereotype

Purpose: As its central objective, this study explores the intersection of professional values and career roles in accountants’ presentations of their professional identity, in the face of enduring stereotyping of the accounting role. Design/methodology/approach: This study presents a qualitative investigation of accountants’ construction of their professional identities and imagery using a Goffmanian dramaturgical perspective. Viewing professional identity construction as a presentational matter of impression management, the investigation employs a reflexive photo-interviewing methodology. Findings: Accountants use a variety of workplace dramatization, idealization and mystification strategies inside and outside the workplace to counter the traditional accounting stereotype. They also attempt to develop a professional identity that is a subset of their overall life values. Research limitations/implications: Their professional orientation is found to embrace role reconstruction and revised image mystification while not necessarily aiming for upward professional mobility. This has implications for understanding the career trajectories of contemporary accountants with associated implications for continuing professional development and education. Originality/value: The paper focuses on professional role, identity, values and image at the individual accountant level, while most prior research has focussed upon these issues at the macro association-wide level. In offering the first use of reflexive photo-interviewing method in the accounting research literature, it brings the prospect of having elicited different and possibly more reflective observations, reflections and understandings from actors not otherwise possible from more conventional methods

Would those who need ISA, use it? Investigating the relationship between drivers' speed choice and their use of a voluntary ISA system

Intelligent Speed Adaptation (ISA) is one of the most promising new technologies for reducing the prevalence and severity of speed-related accidents. Such a system could be implemented in a number of ways, representing various "levels of control" over the driver. An ISA system could be purely advisory or could actually control the maximum speed of a vehicle. A compromise would be to introduce a system that allows a driver to choose when to engage ISA, thus creating a “voluntary” system. Whilst these voluntary systems are considered more acceptable by drivers, they will not offer safety benefits if they are not used by the driver. Two studies were carried out that examined the relationship between drivers’ reported and actual speeding behaviour, their propensity to engage a voluntary ISA system and their attitudes towards such a system. These studies were carried out in a driving simulator and in an instrumented vehicle. In both the studies, drivers’ propensity to exceed the speed limit was lowered when ISA was available but this effect was confined to the lower speed limits. In general, drivers engaged ISA for approximately half of their driving time, depending on the speed limit of the road and indeed, on the nature of the road and the surrounding traffic. This was particularly true in the field study where drivers were more inclined to “keep up with” the surrounding traffic. The results from the on-road study indicated that those drivers who considered ISA to be both a useful and pleasant system, were overall more likely to engage it. However, those drivers who confessed to enjoying exceeding the speed limit were less likely to use ISA. This is an important finding when considering the mechanisms for implementing ISA: those drivers who would benefit most would be less likely to use a voluntary system

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The effectiveness of personal budgets for people with mental health problems : a systematic review

BACKGROUND: Personal budgets are a key policy priority in adult social care in England and are expected to become increasingly important in the care of adults with mental health problems. AIMS: This article systematically reviews evidence for the effectiveness of personal budgets for people with mental health problems across diverse outcomes. METHODS: The review, conducted in 2013, used the EPPI-Centre methodology for conducting a systematic review informed by Social Care Institute for Excellence guidelines. Data were extracted from studies and combined using meta-synthesis. RESULTS: Fifteen studies were included in the review which found mostly positive outcomes in terms of choice and control, quality of life, service use and cost-effectiveness. However, methodological limitations make these findings rather unreliable and insufficient to inform personal budgets policy and practice for mental health service users. CONCLUSIONS: Further high quality studies are required to inform policy and practice for mental health service users, which lags behind other adult social care groups in the use of personal budgets

Effectiveness of Prescribed Burn Treatment on Forested Land as a Method to Reduce Lyme Disease Human-Contractions in the State of Virginia

Virginia, and the greater United States, are currently experiencing an expansion in the range and increase in cases reported of Lyme disease, caused by the bacteria Borrelia burgdorferi. A parasitic tick, Ixodes sp., is the primary vector of the disease causing bacteria in the Eastern United States. The vector tick has been increasing its range to the north, west, and south, leading many land management professionals to inquire into the effectiveness of stopping the spread of Lyme disease by reducing Ixodes sp. range expansion. Understanding how the effects of natural resource management on the expanding range and subsequent expanding number of Lyme disease cases is paramount in determining best practices for mitigating the Lyme disease human risk. Prescribed burn treatment of viable forested habitat has more recently been touted as viable and potentially effective natural resource management method to reduce tick populations. The effectiveness of prescribed burn treatment to actually reduce rates of human Lyme disease case reporting in Virginia, however, is not fully understood. This study examined the spatial patterns of Center for Disease Control Lyme disease case reports in Virginia and whether the current usage of prescribed burn treatment reduces the reported contraction of Lyme disease in human populations. A spatial autocorrelation analysis concluded Lyme disease estimated incidence rates per 100,000 persons by county exhibited clustered spatial patterns. These clusters reflected areas of high population density and suitable forested habitat for Ixodes sp. and host species. A regression analysis examining the effects of the number of acres applied with prescribed burn treatment on the reduction of estimated incidence rates is yet unclear. Further analysis is of paramount importance in the decisions made by public and private landowners in how to implement land management practices that reduce the risk of Lyme disease

“No powers, man!”: A student perspective on designing university smart building interactions

Smart buildings offer an opportunity for better performance and enhanced experience by contextualising services and interactions to the needs and practices of occupants. Yet, this vision is limited by established approaches to building management, delivered top-down through professional facilities management teams, opening up an interaction-gap between occupants and the spaces they inhabit. To address the challenge of how smart buildings might be more inclusively managed, we present the results of a qualitative study with student occupants of a smart building, with design workshops including building walks and speculative futuring. We develop new understandings of how student occupants conceptualise and evaluate spaces as they experience them, and of how building management practices might evolve with new sociotechnical systems that better leverage occupant agency. Our findings point to important directions for HCI research in this nascent area, including the need for HBI (Human-Building Interaction) design to challenge entrenched roles in building management

Empirical Challenges in Organizational Aesthetics Research: Towards a Sensual Methodology

Despite growing scholarly interest in aesthetic dimensions of organizational life, there is a lack of literature expressly engaging with the methodological mechanics of 'doing aesthetics research'. This article addresses that gap. It begins with an overview of the conceptual idiosyncrasies of 'aesthetics' as a facet of human existence and maps out the challenges these pose for empirical research methodology. A review of methodological approaches adopted to date in empirical studies of organizational aesthetics is then presented. The remainder of the article draws on the author's experiences and suggests methods and techniques to address both conceptual and practical challenges encountered during the execution of an organizational aesthetics research project. The article calls for a firmer focus on the aesthetic experiences of organizational members in addition to those of researchers and concludes with some suggestions as to the future of such 'sensual methodologies' </jats:p

The WASS Collective: Gender Transformations in Higher Education

This paper offers a critical perspective on issues around gender and sexual transformation within the context of UK Higher Education. Drawing on qualitative data carried out by undergraduate and postgraduate students, the analysis explores some of the diverse and often challenging ways in which young/er women and men are thinking and talking about gender, sexuality and feminism, as well as their strategies for turning ideas into political action. The research focuses on the activities and opinions of students belonging to an anti-sexist organisation within one UK university, who are engaged in campaigns to raise awareness about the damaging effects of gender and sexual inequalities, as well as promoting the popular appeal of contemporary feminisms. Locating the voices and research findings of the students themselves at the centre of the discussion, the paper is produced collaboratively between students and teachers who are involved in both the activist and research elements of this project. The paper also argues for (and provides evidence of) the transformative potential of alternative and critical forms of student engagement and student/ staff collaboration in relation to gender informed academic activism.Feminism, Post-Feminism, Anti-Sexism, Higher Education, Activism, Academic Activism, Praxis, Critical Pedagogy, Collaborative Methods

Prevention of Decubitus Ulcers in the Clinical Setting

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