Beyond the numbers of maternal near-miss in Rwanda - a qualitative study on women's perspectives on access and experiences of care in early and late stage of pregnancy.

BACKGROUND: Rwanda has made remarkable progress in decreasing the number of maternal deaths, yet women still face morbidities and mortalities during pregnancy. We explored care-seeking and experiences of maternity care among women who suffered a near-miss event during either the early or late stage of pregnancy, and identified potential health system limitations or barriers to maternal survival in this setting. METHODS: A framework of Naturalistic Inquiry guided the study design and analysis, and the 'three delays' model facilitated data sorting. Participants included 47 women, who were interviewed at three hospitals in Kigali, and 14 of these were revisited in their homes, from March 2013 to April 2014. RESULTS: The women confronted various care-seeking barriers depending on whether the pregnancy was wanted, the gestational age, insurance coverage, and marital status. Poor communication between the women and healthcare providers seemed to result in inadequate or inappropriate treatment, leading some to seek either traditional medicine or care repeatedly at biomedical facilities. CONCLUSION: Improved service provision routines, information, and amendments to the insurance system are suggested to enhance prompt care-seeking. Additionally, we strongly recommend a health system that considers the needs of all pregnant women, especially those facing unintended pregnancies or complications in the early stages of pregnancy.

GOSPEL SINGING IN THE VALLEY: AN INVESTIGATION INTO THE HYMNODY AND CHORAL SINGING OF THE LISU ON THE CHINA-BURMA/MYANMAR BORDER

This dissertation is an ethnomusicological study of contemporary musical practices of the Christian Lisu in Nujiang Prefecture in northwest Yunnan on the China-Myanmar border. Among all the changes that the Nujiang Lisu have experienced since the twentieth century, the spread of Protestant Christianity throughout Nujiang���s mountainous villages has existed for the longest time and had one of the greatest effects. Combining historical investigation and ethnographic description, this study uses the lens of music to examine the impact of this social change on the Lisu living in this impoverished frontier region. The Lisu characteristics have never been vital in the music written by the Christian Lisu in Nujiang. Compared with the practices described in other ethnomusicological writings on Christian music around the world that I have read, this absence of incorporation of indigenous musical elements is unusual. There are probably many other cases similar to that of the Lisu, but few ethnomusicologists have paid attention to them. I aim to elucidate this particular scenario of Lisu Christian music in relation to three social and cultural forces: the missionary legacy of conventions; the government���s identification of the Lisu as a minority nationality and its national policies toward them since the 1950s; and the transnational religious exchange between the Christian Lisu in China and Myanmar since the late 1980s. My examination focuses on two genres which the Lisu use to express their Christian beliefs today: ddoqmuq mutgguat, derived from American northern urban gospel songs, the basis of the Lisu choral singing; and mutgguat ssat, influenced by the Christian pop of the Burmese Lisu, with instrumental accompaniment and daibbit dance and preferred by the young people. Besides studying these two genres in the religious context, I also juxtapose them with other musical traditions in the overall Nujiang music soundscape and look at their role in local social interactions such as those between sacred and secular, and majority and minority. This dissertation demonstrates that the collective performances of shared repertoires have not only created a sense of affinity for the Nujiang Christian Lisu but also have reinforced the formation of Lisu transnational religious networks.

Closing Pandora's box: a defence of Alvin Plantinga's epistemology of religious belief

I argue (1) that Alvin Plantinga���s theory of warrant is plausible and (2) that, contrary to the Pandora���s Box objection, there are certain serious world religions that cannot successfully use Plantinga���s epistemology to demonstrate that their beliefs could be warranted in the same way that Christian belief can be warranted. In arguing for (1), I deploy Ernest Sosa���s Swampman case to show that Plantinga���s proper function condition is a necessary condition for warrant. I then engage three objections to Plantinga���s theory of warrant, each of which attempts to demonstrate that his conditions for warrant are neither necessary nor sufficient. Having defended the plausibility of Plantinga���s theory of warrant, I present and expand his key arguments to the effect that naturalism cannot make use of it. These arguments provide the conceptual tools that are needed to argue for (2): that there are certain world religions that cannot legitimately use Plantinga���s theory of warrant to demonstrate that their beliefs could be warranted in the same way that Christian belief can be warranted.

Teen Girls��� Perspectives on Their Current Dietary Habits and Food Choices: A Qualitative Study in Jeddah, Saudi Arabia

Rapid socioeconomic development in Saudi Arabia, as a result of oil revenues, has had profound effects on people���s lifestyles, including the transformation of people���s dietary habits. Such dietary transformations, known as the nutrition transition, are common in countries undergoing rapid socioeconomic changes. This transition is significant in Saudi Arabia as the traditional Saudi diet is considered a healthy one. Adoption of the Western diet has had negative health effects on the Saudi population, especially adolescents. As evidenced in many studies, adolescents are the most affected population when it comes to changes in dietary habits and physical activity. Adolescence is a vulnerable stage of life when dietary habits are developed, often lasting into adulthood, and may not be easily changed. In the case of Saudi Arabia, youth or adolescents represent almost 60% of the population; therefore, the eating habits they develop now could have profound consequences for population health in the future. To develop effective health promotion strategies, it is important to understand the sociocultural factors that influence the dietary habits and food choices of Saudi teens. I conducted two semi-structured, open-ended interviews, using photo-elicitation techniques, with 12 Saudi girls, aged 15-16 years. Analysis of the data shows four factors that pulled the participants toward eating home cooked traditional food and five factors that pushed participants away from eating home cooked traditional foods. The research suggests that despite the attractiveness of modern, Western ways of eating for Saudi teen girls, parents still play a key role in encouraging and supporting them to eat healthy food.

Ethical Perspectives on Big Data in Agri-food: Ownership and Governance for Safety

Big data are reshaping the way we interact with technology, thus fostering new applications to increase the safety-assessment of foods. An extraordinary amount of information is analysed using machine learning approaches aimed at detecting the existence or predicting the likelihood of future risks. Food business operators have to share the results of these analyses when applying to place on the market regulated products, whereas agri-food safety agencies (including the European Food Safety Authority) are exploring new avenues to increase the accuracy of their evaluations by processing Big data. Such an informational endowment brings with it opportunities and risks correlated to the extraction of meaningful inferences from data. However, conflicting interests and tensions among the involved entities - the industry, food safety agencies, and consumers - hinder the finding of shared methods to steer the processing of Big data in a sound, transparent and trustworthy way. A recent reform in the EU sectoral legislation, the lack of trust and the presence of a considerable number of stakeholders highlight the need of ethical contributions aimed at steering the development and the deployment of Big data applications. Moreover, Artificial Intelligence guidelines and charters published by European Union institutions and Member States have to be discussed in light of applied contexts, including the one at stake. This thesis aims to contribute to these goals by discussing what principles should be put forward when processing Big data in the context of agri-food safety-risk assessment. The research focuses on two interviewed topics - data ownership and data governance - by evaluating how the regulatory framework addresses the challenges raised by Big data analysis in these domains. The outcome of the project is a tentative Roadmap aimed to identify the principles to be observed when processing Big data in this domain and their possible implementations.

New perspectives on A.I. in sentencing. Human decision-making between risk assessment tools and protection of humans rights.

The aim of this thesis is to investigate a field that until a few years ago was foreign to and distant from the penal system. The purpose of this undertaking is to account for the role that technology could plays in the Italian Criminal Law system. More specifically, this thesis attempts to scrutinize a very intricate phase of adjudication. After deciding on the type of an individual's liability, a judge must decide on the severity of the penalty. This type of decision implies a prognostic assessment that looks to the future. It is precisely in this field and in prognostic assessments that, as has already been anticipated in the United, instruments and processes are inserted in the pre-trial but also in the decision-making phase. In this contribution, we attempt to describe the current state of this field, trying, as a matter of method, to select the most relevant or most used tools. Using comparative and qualitative methods, the uses of some of these instruments in the supranational legal system are analyzed. Focusing attention on the Italian system, an attempt was made to investigate the nature of the element of an individual's ���social dangerousness��� (pericolosit�� sociale) and capacity to commit offences, types of assessments that are fundamental in our system because they are part of various types of decisions, including the choice of the best sanctioning treatment. It was decided to turn our attention to this latter field because it is believed that the judge does not always have the time, the means and the ability to assess all the elements of a subject and identify the best 'individualizing' treatment in order to fully realize the function of Article 27, paragraph 3 of the Constitution.

Overview: Individual and organizational perspectives on emotion management and display

As reported in Volume 1 of Research on Emotions in Organizations (Ashkanasy, Zerbe, & H��rtel, 2005), the chapters in this volume are drawn from the best contributions to the 2004 International Conference on Emotion and Organizational Life held at Birkbeck College, London, complemented by additional, invited chapters. (This biannual conference has come to be known as the ���Emonet��� conference, after the listserv of members.) Previous edited volumes (Ashkanasy, H��rtel, & Zerbe, 2000; Ashkanasy, Zerbe, & H��rtel, 2002; H��rtel, Zerbe, & Ashkanasy, 2004) were published every two years following the Emonet conference. With the birth of this annual Elsevier series came the opportunity for greater focus in the theme of each volume, and for greater scope for invited contributions. This volume contains eight chapters selected from conference contributions for their quality, interest, and appropriateness to the theme of this volume, as well as four invited chapters. We again acknowledge in particular the assistance of the conference paper reviewers (see the appendix). In the year of publication of this volume the 2006 Emonet conference will be held in Atlanta, USA and will be followed by Volumes 3 and 4 of Research on Emotions in Organizations. Readers interested in learning more about the conferences or the Emonet list should check the Emonet website http://www.uq.edu.au/emonet/.

The effects of change in lead stimulus modality on the modulation of acoustic blink startle

In two experiments we investigated the effect of generalized orienting induced by changing the modality of the lead stimulus on the modulation of blink reflexes elicited by acoustic stimuli. In Experiment 1 (n = 32), participants were presented with acoustic or visual change stimuli after habituation training with tactile lead stimuli. In Experiment 2 (n = 64), modality of the lead stimulus (acoustic vs. visual) was crossed with experimental condition (change vs. no change). Lead stimulus change resulted in increased electrodermal orienting in both experiments. Blink latency shortening and blink magnitude facilitation increased from habituation to change trials regardless of whether the change stimulus was presented in the same or in a different modality as the reflex-eliciting stimulus. These results are not consistent with modality-specific accounts of attentional startle modulation.

The frontal assessment battery (FAB) reveals neurocognitive dysfunction in substance-dependent individuals in distinct executive domains: Abstract reasoning, motor programming, and cognitive flexibility

Substance-dependence is highly associated with executive cognitive function (ECF) impairments. However. considering that it is difficult to assess ECF clinically, the aim of the present study was to examine the feasibility of a brief neuropsychological tool (the Frontal Assessment Battery FAB) to detect specific ECF impairments in a sample of substance-dependent individuals (SDI). Sixty-two subjects participated in this study. Thirty DSM-IV-diagnosed SDI, after 2 weeks of abstinence, and 32 healthy individuals (control group) were evaluated with FAD and other ECF-related tasks: digits forward (DF), digits backward (DB), Stroop Color Word Test (SCWT), and Wisconsin Card Sorting Test (WCST). SDI did not differ from the control group on sociodemographic variables or IQ. However, SDI performed below the controls in OF, DB, and FAB. The SDI were cognitively impaired in 3 of the 6 cognitive domains assessed by the FAB: abstract reasoning, motor programming, and cognitive flexibility. The FAB correlated with DF, SCWT, and WCST. In addition, some neuropsychological measures were correlated with the amount of alcohol, cannabis, and cocaine use. In conclusion, SDI performed more poorly than the comparison group on the FAB and the FAB`s results were associated with other ECF-related tasks. The results suggested a negative impact of alcohol, cannabis, and cocaine use on the ECF. The FAB may be useful in assisting professionals as an instrument to screen for ECF-related deficits in SDI. (C) 2010 Elsevier Ltd. All rights reserved.

The Cholinergic System in Mild Cognitive Impairment and Alzheimer`s Disease: An In Vivo MRI and DTI study

Few studies have investigated in vivo changes of the cholinergic basal forebrain in Alzheimer`s disease (AD) and amnestic mild cognitive impairment (MCI), an at risk stage of AD. Even less is known about alterations of cortical projecting fiber tracts associated with basal forebrain atrophy. In this study, we determined regional atrophy within the basal forebrain in 21 patients with AD and 16 subjects with MCI compared to 20 healthy elderly subjects using deformation-based morphometry of MRI scans. We assessed effects of basal forebrain atrophy on fiber tracts derived from high-resolution diffusion tensor imaging (DTI) using tract-based spatial statistics. We localized significant effects relative to a map of cholinergic nuclei in MRI standard space as determined from a postmortem brain. Patients with AD and MCI subjects showed reduced volumes in basal forebrain areas corresponding to anterior medial and lateral, intermediate and posterior nuclei of the Nucleus basalis of Meynert (NbM) as well as in the diagonal band of Broca nuclei (P < 0.01). Effects in MCI subjects were spatially more restricted than in AD, but occurred at similar locations. The volume of the right antero-lateral NbM nucleus was correlated with intracortical projecting fiber tract integrity such as the corpus callosum, cingulate, and the superior longitudinal, inferior longitudinal, inferior fronto-occipital, and uncinate fasciculus (P < 0.05, corrected for multiple comparisons). Our findings suggest that a multimodal MRI-DTI approach is supportive to determine atrophy of cholinergic nuclei and its effect on intracortical projecting fiber tracts in AD. Hum Brain Mapp 32: 1349-1362, 2011. (C) 2010 Wiley-Liss, Inc.

To treat or not to treat? A meta-analysis of the use of cholinesterase inhibitors in mild cognitive impairment for delaying progression to Alzheimer`s disease

Individual randomized clinical trials (RCTs) with cholinesterase inhibitors (ChEIs) aiming to delay the progression from mild cognitive impairment (MCI) to Alzheimer`s disease (AD) have not found significant benefit of their use for this purpose. The objective of this study is to meta-analyze the RCTs conducted with ChEIs in order to assess whether pooled analysis could show the benefit of these drugs in delaying the progression from MCI to AD. We searched for references of published and unpublished studies on electronic databases (Medline, Embase, Web of Science, and Clinical Trial Database Registry, particularly the Clinicaltrials.gov-http://www.clinicaltrials.gov). We retrieved 173 references, which yielded three references for data extraction. A total of 3.574 subjects from four RCTs were included in the meta-analysis. Among 1,784 subjects allocated in the ChEI-treatment group, 275 (15.4%) progressed to AD/dementia, as opposed to 366 (20.4%) out of 1,790 subjects in the placebo group. The relative risk (RR) for progression to AD/dementia in the ChEI-treated group was 0.75 [CI(95%) 0.66-0.87], z = -3.89, P < 0.001. The patients on the ChEI group had a significantly higher all-cause dropout risk than the patients on the placebo group (RR = 1.36 CI(95%) [1.24-1.49]; z = 6.59, P < 0.001). The RR for serious adverse events (SAE) in the ChEI-treated group showed no significantly statistical difference from the placebo group (RR = 0.95 [CI(95%) 0.83-1.09], z = -0.72, P = 0.47). The subjects in the ChEI-treated group had a marginally, non-significant, higher risk of death due to any cause than those in the placebo-treated group (RR = 1.04, CI(95%) 0.63-1.70, z = 0.16, P = 0.86). The long-term use of ChEIs in subjects with MCI may attenuate the risk of progression to AD/dementia. This finding may have a significant impact on public health and pharmaco-economic policies.

Treatment with cannabidiol reverses oxidative stress parameters, cognitive impairment and mortality in rats submitted to sepsis by cecal ligation and puncture

Oxidative stress plays an important role in the development of cognitive impairment in sepsis. Here we assess the effects of acute and extended administration of cannabidiol (CBD) on oxidative stress parameters in peripheral organs and in the brain, cognitive impairment, and mortality in rats submitted to sepsis by cecal ligation and perforation (CLP). To this aim, male Wistar rats underwent either sham operation or CLP. Rats subjected to CLP were treated by intraperitoneal injection with ""basic support"" and CBD (at 2.5, 5, or 10 mg/kg once or daily for 9 days after CLP) or vehicle. Six hours after CLP (early times), the rats were killed and samples from lung, liver, kidney, heart, spleen, and brain (hippocampus, striatum, and cortex) were obtained and assayed for thiobarbituric acid reactive species (TBARS) formation and protein carbonyls. On the 10th day (late times), the rats were submitted to the inhibitory avoidance task. After the test, the animals were killed and samples from lung, liver, kidney, heart, spleen, and brain (hippocampus) were obtained and assayed for TBARS formation and protein carbonyls. The acute and extended administration of CBD at different doses reduced TBARS and carbonyl levels in some organs and had no effects in others, ameliorated cognitive impairment, and significantly reduced mortality in rats submitted to CLP. Our data provide the first experimental demonstration that CBD reduces the consequences of sepsis induced by CLP in rats, by decreasing oxidative stress in peripheral organs and in the brain, improving impaired cognitive function, and decreasing mortality. (C) 2010 Elsevier B.V. All rights reserved.