Positively Essential ; Traditional Birth Attendants in Malawi

The role of Traditional Birth Attendants in Malawi was vital within a country where maternity services were stretched to their limits

Belfast's Traditional Music Scene: A Narrative of Change and Development

Today Belfast is home to a vibrant traditional music scene. There have never been more sessions, concerts, classes or lectures devoted to traditional music in the north's biggest city. A complex system of promoters, performers and listeners has emerged in a city that is growing in confidence as it moves away from the dark days of the Troubles. But how does this system function? While Dowling (2014) has examined the development of traditional music-making in Belfast as it shifted from a pre-conflict to conflict ridden environment, little research has been carried out into the reasons behind the boom in traditional music-making in a post-conflict setting.

This paper examines the impact upon the traditional music scene of the first wave of students to arrive in Belfast after the signing of the Good Friday Agreement in 1998. These musicians, such as Donal O'Connor, Ruadhrai O'Kane and Aidan Walsh have had a lasting impact upon the lives of musicians native to Belfast, helping to bring traditional music to new venues and audiences.

The work of Belfast-based music schools with varying remits, such as Belfast Trad., and the Andersonstown School of Traditional and Contemporary Music, is also examined for the purpose of illustrating how both adults and young people are being educated about their musical heritage.

Environmental forensic investigations: The potential use of a novel heavy metal sensor and novel taggants

This chapter presents a novel hand-held instrument capable of real-time in situ detection and identification of heavy metals, along with the potential use of novel taggants in environmental forensic investigations. The proposed system provides the facilities found in a traditional laboratory-based instrument but in a hand held design, without the need for an associated computer. The electrochemical instrument uses anodic stripping voltammetry, which is a precise and sensitive analytical method with excellent limits of detection. The sensors comprise a small disposable plastic strip of screen-printed electrodes rather than the more common glassy carbon disc and gold electrodes. The system is designed for use by a surveyor on site, allowing them to locate hotspots, thus avoiding the expense and time delay of prior laboratory analysis. This is particularly important in environmental forensic analysis when a site may have been released back to the owner and samples could be compromised on return visits. The system can be used in a variety of situations in environmental assessments, the data acquired from which provide a metals fingerprint suitable for input to a database. The proposed novel taggant tracers, based on narrow-band atomic fluorescence, are under development for potential deployment as forensic environmental tracers. The use of discrete fluorescent species in an environmentally stable host has been investigated to replace existing toxic, broadband molecular dye tracers. The narrow band emission signals offer the potential for tracing a large number of signals in the same environment. This will give increased data accuracy and allow multiple source environmental monitoring of environmental parameters.

The Modern Ordinary: Changing culture of living in Egypt’s traditional quarters at the turn of the twentieth Century

Having experienced social and political structures of the 19th century Europe, Western- educated Egyptian elite used public institutions to force legislative structures and procedures that ruled out traditional housing forms and spatial systems. This essay detects direct and indirect impact of these changes that informed the spatial change of modern living in Egypt in the first quarter of the twentieth century. It offers analysis of socio-spatial practices and change in ordinary Cairenes’ modes of everyday living, using social routine and interaction to explain spatial systems and changing house forms during the first quarter of the 20th century. In doing so, the essay utilized archival documents, accounts, formal decrees, and novels of the time as well as conducting survey of house forms and spatial organizations in Old Cairo.

Analysis of electric vehicle charging using the traditional generation expansion planning analysis tool WASP-IV

Electric vehicles (EV) are proposed as a measure to reduce greenhouse gas emissions in transport and support increased wind power penetration across modern power systems. Optimal benefits can only be achieved, if EVs are deployed effectively, so that the exhaust emissions are not substituted by additional emissions in the electricity sector, which can be implemented using Smart Grid controls. This research presents the results of an EV roll-out in the all island grid (AIG) in Ireland using the long term generation expansion planning model called the Wien Automatic System Planning IV (WASP-IV) tool to measure carbon dioxide emissions and changes in total energy. The model incorporates all generators and operational requirements while meeting environmental emissions, fuel availability and generator operational and maintenance constraints to optimize economic dispatch and unit commitment power dispatch. In the study three distinct scenarios are investigated base case, peak and off-peak charging to simulate the impacts of EV’s in the AIG up to 2025.

Musculoskeletal (MSK) and Sport and Exercise Medicine (SEM) in General Practice (GP): A Novel GP-based MSK and SEM Clinic for Managing Musculoskeletal symptoms in a GP

Musculoskeletal (MSK) complaints are common within primary care (1) (2) (3) but some General Practitioners (GPs)/family physicians do not feel comfortable managing these symptoms (3), preferring to refer onto hospital specialists or Integrated Clinical Assessment and Treatment Services (ICATs). Long waiting times for hospital outpatient reviews are a major cause of patient inconvenience and complaints (4). We therefore aimed to establish a GP-ran MSK and sport and exercise medicine (SEM) clinic based within a Belfast GP surgery that would contribute to a sustainable improvement in managing these common conditions within primary care as well as reducing waiting times for patients with these conditions to see a specialist. This shift from hospital-based to community-based management is in-keeping with recent policy changes within the UK health-system, including Transforming Your Care within Northern Ireland (NI) (5). The GP-ran MSK and SEM clinic was held monthly within a Belfast GP practice, staffed by one GP with a specialist interest in MSK and SEM conditions and its performance was reviewed over a three month period. Parameters audited included cases seen, orthopaedic and x-ray referral rates and secondary care referrals comparing the GP practice’s performance to the same time period in the previous year as well as patient satisfaction questionnaires.

Hydrophilic Interaction Ultra-High Performance Liquid Chromatography Coupled with Triple-Quadrupole Mass Spectrometry for Determination of Nucleosides and Nucleobases in Animal Horns

Traditional Chinese Medicines (TCMs) derived from animal horns are one of the most important types of Chinese medicine. In the present study, a fast and sensitive analytical method was established for qualitative and quantitative determination of 14 nucleosides and nucleobases in animal horns using hydrophilic interaction ultra-high performance liquid chromatography coupled with triple-quadruple tandem mass spectrometry (HILIC-UPLC-QQQ-MS/MS) in selective reaction monitoring (SRM) mode. The method was optimized and validated, and showed good linearity, precision, repeatability, and accuracy. The method was successfully used to determine contents of the 14 nucleosides and nucleobases in 25 animal horn samples. Hierarchical clustering analysis (HCA) and principal component analysis (PCA) were performed and the 25 samples were thereby divided into two groups, which agreed with taxonomy. The method may enable quick and effective search of substitutes for precious horns.

How should teaching on whole person medicine, including spiritual issues, be delivered in the undergraduate medical curriculum in the United Kingdom?

Background

Although the General Medical Council recommends that United Kingdom medical students are taught ‘whole person medicine’, spiritual care is variably recognised within the curriculum. Data on teaching delivery and attainment of learning outcomes is lacking. This study ascertained views of Faculty and students about spiritual care and how to teach and assess competence in delivering such care.

A questionnaire comprising 28 questions exploring attitudes to whole person medicine, spirituality and illness, and training of healthcare staff in providing spiritual care was designed using a five-point Likert scale. Free text comments were studied by thematic analysis. The questionnaire was distributed to 1300 students and 106 Faculty at Queen’s University Belfast Medical School.

351 responses (54 staff, 287 students; 25 %) were obtained. >90 % agreed that whole person medicine included physical, psychological and social components; 60 % supported inclusion of a spiritual component within the definition. Most supported availability of spiritual interventions for patients, including access to chaplains (71 %), counsellors (62 %), or members of the patient’s faith community (59 %). 90 % felt that personal faith/spirituality was important to some patients and 60 % agreed that this influenced health. However 80 % felt that doctors should never/rarely share their own spiritual beliefs with patients and 67 % felt they should only do so when specifically invited. Most supported including training on provision of spiritual care within the curriculum; 40-50 % felt this should be optional and 40 % mandatory. Small group teaching was the favoured delivery method. 64 % felt that teaching should not be assessed, but among assessment methods, reflective portfolios were most favoured (30 %). Students tended to hold more polarised viewpoints but generally were more favourably disposed towards spiritual care than Faculty. Respecting patients’ values and beliefs and the need for guidance in provision of spiritual care were identified in the free-text comments.

Students and Faculty generally recognise a spiritual dimension to health and support provision of spiritual care to appropriate patients. There is lack of consensus whether this should be delivered by doctors or left to others. Spiritual issues impacting patient management should be included in the curriculum; agreement is lacking about how to deliver and assess.

A systematic review investigating the effectiveness of Complementary and Alternative Medicine (CAM) for the management of low back and/or pelvic pain (LBPP) in pregnancy

Aim: To evaluate and summarize the current evidence on the effectiveness of complementary and alternative medicine for the management of low back pain and/or pelvic pain in pregnancy.

Background: International research demonstrates that 25-30% of women use complementary and alternative medicine to manage low back and pelvic pain in pregnancy without robust evidence demonstrating its effectiveness.

Design: A systematic review of randomized controlled trials to determine the effectiveness of complementary and alternative medicine for low back and/or pelvic pain in pregnancy.

Data Sources: Cochrane library (1898-2013), PubMed (1996-2013), MEDLINE (1946-2013), AMED (1985-2013), Embase (1974-2013), Cinahl (1937-2013), Index to Thesis (1716-2013) and Ethos (1914-2013).

Review Methods: Selected studies were written in English, randomized controlled trials, a group 1 or 2 therapy and reported pain reduction as an outcome measure. Study quality was reviewed using Risk of Bias and evidence strength the Cochrane Grading of Recommendations and Development Evaluation Tool.

Results: Eight studies were selected for full review. Two acupuncture studies with low risk of bias showed both clinically important changes and statistically significant results. There was evidence of effectiveness for osteopathy and chiropractic. However, osteopathy and chiropractic studies scored high for risk of bias. Strength of the evidence across studies was very low.

Conclusion: There is limited evidence supporting the use of general CAM for managing pregnancy-related low back and/or pelvic pain. However, the restricted availability of high-quality studies, combined with the very low evidence strength, makes it impossible to make evidence-based recommendations for practice.