From pregnancy to palliative care: advancing professional midwifery practice?

Historically midwives may have not considered palliative care as a part of their professional role. Enhanced technologies and antenatal screening have broadened the boundaries of care. However do midwives truly embrace the philosophy of palliative care into their practice? This paper presents the discussion round a case study that demonstrates the evolving area of advanced practice: perinatal palliative care. What we highlight is that midwives in fact have an important collaborative role to play in ensuring that palliative care for the baby and family starts as soon as a life-limiting condition is recognised, thus ensuring best care and support are provided for those parents and families for whom pregnancy sadly leads to palliative care. Five key lessons for practice are outlined.

Threshold Magic: Impressionism and the Domestic Interior

This article focuses on the liminal space of the threshold in paintings by female Impressionists. It engages with Cultural theory and History of Design in order to offer a new interpretation of domestic spaces

Serum Fatty Acid Binding Protein 4 (FABP4) Predicts Pre-eclampsia in Women with Type 1 Diabetes

Objective: To examine the association between fatty acid binding protein 4 (FABP4) and pre-eclampsia risk in women with type 1 diabetes.
Reesearch Design and Methods: Serum FABP4 was measured in 710 women from the Diabetes and Pre-eclampsia Intervention Trial (DAPIT) in early pregnancy and in the second trimester (median 14 and 26 weeks gestation, respectively).
Results: FABP4 was significantly elevated in early pregnancy (geometric mean 15.8 ng/mL [interquartile range 11.6–21.4] vs. 12.7 ng/mL [interquartile range 9.6–17]; P < 0.001) and the second trimester (18.8 ng/mL [interquartile range 13.6–25.8] vs. 14.6 ng/mL [interquartile range 10.8–19.7]; P < 0.001) in women in whom pre-eclampsia later developed. Elevated second-trimester FABP4 level was independently associated with pre-eclampsia (odds ratio 2.87 [95% CI 1.24, 6.68], P = 0.03). The addition of FABP4 to established risk factors significantly improved net reclassification improvement at both time points and integrated discrimination improvement in the second trimester.
Conclusions: Increased second-trimester FABP4 independently predicted pre-eclampsia and significantly improved reclassification and discrimination. FABP4 shows potential as a novel biomarker for pre-eclampsia prediction in women with type 1 diabetes.

Effect of intravenous haloperidol on the duration of delirium and coma in critically ill patients (Hope-ICU):A randomised, double-blind, placebo-controlled trial

Background: Delirium is frequently diagnosed in critically ill patients and is associated with poor clinical outcomes. Haloperidol is the most commonly used drug for delirium despite little evidence of its effectiveness. The aim of this study was to establish whether early treatment with haloperidol would decrease the time that survivors of critical illness spent in delirium or coma. Methods: We did this double-blind, placebo-controlled randomised trial in a general adult intensive care unit (ICU). Critically ill patients (≥18 years) needing mechanical ventilation within 72 h of admission were enrolled. Patients were randomised (by an independent nurse, in 1:1 ratio, with permuted block size of four and six, using a centralised, secure web-based randomisation service) to receive haloperidol 2·5 mg or 0·9% saline placebo intravenously every 8 h, irrespective of coma or delirium status. Study drug was discontinued on ICU discharge, once delirium-free and coma-free for 2 consecutive days, or after a maximum of 14 days of treatment, whichever came first. Delirium was assessed using the confusion assessment method for the ICU (CAM-ICU). The primary outcome was delirium-free and coma-free days, defined as the number of days in the first 14 days after randomisation during which the patient was alive without delirium and not in coma from any cause. Patients who died within the 14 day study period were recorded as having 0 days free of delirium and coma. ICU clinical and research staff and patients were masked to treatment throughout the study. Analyses were by intention to treat. This trial is registered with the International Standard Randomised Controlled Trial Registry, number ISRCTN83567338. Findings: 142 patients were randomised, 141 were included in the final analysis (71 haloperidol, 70 placebo). Patients in the haloperidol group spent about the same number of days alive, without delirium, and without coma as did patients in the placebo group (median 5 days [IQR 0-10] vs 6 days [0-11] days; p=0·53). The most common adverse events were oversedation (11 patients in the haloperidol group vs six in the placebo group) and QTc prolongation (seven patients in the haloperidol group vs six in the placebo group). No patient had a serious adverse event related to the study drug. Interpretation: These results do not support the hypothesis that haloperidol modifies duration of delirium in critically ill patients. Although haloperidol can be used safely in this population of patients, pending the results of trials in progress, the use of intravenous haloperidol should be reserved for short-term management of acute agitation. Funding: National Institute for Health Research. © 2013 Elsevier Ltd.

Palladium-Catalyzed Cross-Couplings of 2-Alkylaziridines and Alkenylboronic Acids

Thesis (Master's)--University of Washington, 2016-08

”Tiesittekö tytöt, että tissit...?” Tapaustutkimus tyttöyden neuvottelusta internetmeemissä

Pro gradu -tutkielma tarkastelee tyttöyttä ja ruumiillisuutta tyttöjen internet-vuorovaikutuksessa keskittyen erityisesti siihen, kuinka tytöt yhtäältä normittavat sukupuolitetun ruumiin esittämisen tapoja, ja kuinka he toisaalta aktiivisesti neuvottelevat näitä normeja nettimeemin välityksellä. Nettimeemit ovat verkon käyttäjien välityksellä leviävien, usein imitaatiolle, parodialle ja kommentoinnille perustuvien kulttuuristen yksiköiden kuten muuntuvilla teksteillä varustettujen kuvien tai videoiden ryhmiä. Aiempi tutkimus on nostanut esiin nettimeemien potentiaalin toimia yhteisöllisyyden ja identiteettien rakentamisen välineinä, mutta etenkin ruumiillisuuden näkökulma on jäänyt tarkasteluissa taka-alalle. Tässä tutkimuksessa pureudutaan nettimeemin mahdollistamaan vuorovaikutukseen sekä kytköksiin, joita meemi voi saada suhteessa ruumiisiin. Tutkimus keskittyy Hey girls, did you know –internetilmiön (HGDYK) tapaukseen. HGDYK on Tumblr-verkkosivustolta vuonna 2012 alkunsa saanut digitaalinen esitysmuoto, jossa usein tytöiksi tunnistettavat internetin käyttäjät alunperin kommentoivat joidenkin tyttöjen paljastavaa pukeutumista tai voimakasta meikkaustyyliä valokuvaa ja tekstiä yhdistelevän kuvasarjan välityksellä. HGDYK-meemiä tarkastellaan performatiivisena ilmiönä kahdella tasolla: netinkäyttäjien yksilöllisinä performansseina sekä kategorisia identiteettejä ja sosiaalista todellisuutta tuottavina tekoina eli performatiiveina. Aineisto koostuu 71:stä HGDYK-meemiin lukeutuvasta kuvasarjasta, joissa tytöiksi ymmärrettävät esiintyjät ottavat jollain tavoin kantaa siihen, miten ruumis tulisi hyväksyttävällä tavalla esittää internetissä tai sen ulkopuolella. Kuvasarjat on kerätty vuosina 2013 ja 2014 verkkosivustoilta, joilla niitä on julkaistu tai arkistoitu ja jotka ovat yhteydessä Tumblriin. Analyysissa on sovellettu diskurssianalyyttista otetta, jossa on aineiston kielellisten piirteiden ohella huomioitu multimodaalisuus ja vuorovaikutus. Analyysi perustuu ennen kaikkea teoreettisen kehyksen ja tutkimuskirjallisuudessa esitettyjen käsitteellistysten ohjaamaan aineiston lähilukuun. Tutkimus osoittaa nettimeemin voivan toimia tyttöjen välisen verkkovuorovaikutuksen mediumina ja sukupuolitetun ruumiin normeista käytävän neuvottelun muotona. Lisäksi se voidaan itsessään nähdä ruumiillisena käytäntönä, sillä meemikuvat rakentuvat tekijöidensä toisiaan imitoivista ja parodioivista ruumiinesityksistä. HGDYK-meemi toimii tyttöjen välisen vuorovaikutuksen muotona, jossa yhdistyvät nettimeemeille tyypilliset piirteet – toisto, imitaatio, variaatio, kommentointi, huumori ja parodia – ja sukupuolittunut verkkotiloihin sijoittuva draama, jonka keskeisiä piirteitä ovat vastavuoroisuus ja konfliktit.

Rainbow World: Poems from many cultures.

This work is an authoritative collection of poems from other cultures for the 21st century. Poets included range from Valerie Bloom, Jackie Kay, Benjamin Zephaniah, Lemn Sissay, Meiling Jin, Tao Lang Pee and Bekleen Leong to Rabrindranath Tagore, Monica Alvi and Chuang Tzu. Comprising over 100 contributions, there is a balance of poets in ethnicity and gender, and of poems in content, form and style. Themes covered include: Food, festivals and festivities; Race, culture and identity; Families, friends and enemies; Travel and landscape; Language and nonsense; The animal world; and, School and playground and Mystery, myth and magic.

Indoor environment and the impact on the health of pre-exisiting asthmatics at work: the development of a risk management framework

This thesis examines the spatial and temporal variation in nitrogen dioxide (NO2) levels in Guernsey and the impacts on pre-existing asthmatics. Whilst air quality in Guernsey is generally good, the levels of NO2 exceed UK standards in several locations. The evidence indicates that people suffering from asthma have exacerbation of their symptoms if exposed to elevated levels of air pollutants including NO2, although this research has never been carried out in Guernsey before. In addition, exposure assessment of individuals is rarely carried out and research in this area is limited due to the complexity of undertaking such a study, which will include a combination of exposures in the home, the workplace and ambient exposures, which vary depending on the individual daily experience. For the first time in Guernsey, this research has examined NO2 levels in correlation with asthma patient admissions to hospital, assessment of NO2 exposures in typical homes and typical workplaces in Guernsey. The data showed a temporal correlation between NO2 levels and the number of hospital admissions and the trend from 2008-2012 was upwards. Statistical analysis of the data did not show a significant linear correlation due to the small size of the data sets. Exposure assessment of individuals showed a spatial variation in exposures in Guernsey and assessment in indoor environments showed that real-time analysis of NO2 levels needs to be undertaken if indoor micro environments for NO2 are the be assessed adequately. There was temporal and spatial variation in NO2 concentrations measured using diffusion tubes, which provide a monthly mean value, and analysers measuring NO2 concentrations in real time. The research shows that building layout and design are important factors for good air flow and ventilation and the dispersion of NO2 indoors. Environmental Health Officers have statutory responsibilities for ambient air quality, hygiene of buildings and workplace environments and this role needs to be co-ordinated with healthcare professionals to improve health outcomes for asthmatics. The outcome of the thesis was the development of a risk management framework for pre-existing asthmatics at work for use by regulators of workplaces and an information leaflet to assist in improving health outcomes for asthmatics in Guernsey.

Creating Common Ground: Architecture For Tactical Learning and Creative Convergence

Certain environments can inhibit learning and stifle enthusiasm, while others enhance learning or stimulate curiosity. Furthermore, in a world where technological change is accelerating we could ask how might architecture connect resource abundant and resource scarce innovation environments? Innovation environments developed out of necessity within urban villages and those developed with high intention and expectation within more institutionalized settings share a framework of opportunity for addressing change through learning and education. This thesis investigates formal and informal learning environments and how architecture can stimulate curiosity, enrich learning, create common ground, and expand access to education. The reason for this thesis exploration is to better understand how architects might design inclusive environments that bring people together to build sustainable infrastructure encouraging innovation and adaptation to change for years to come. The context of this thesis is largely based on Colin McFarlane’s theory that the “city is an assemblage for learning” The socio-spatial perspective in urbanism, considers how built infrastructure and society interact. Through the urban realm, inhabitants learn to negotiate people, space, politics, and resources affecting their daily lives. The city is therefore a dynamic field of emergent possibility. This thesis uses the city as a lens through which the boundaries between informal and formal logics as well as the public and private might be blurred. Through analytical processes I have examined the environmental devices and assemblage of factors that consistently provide conditions through which learning may thrive. These parameters that make a creative space significant can help suggest the design of common ground environments through which innovation is catalyzed.

Musikalisches Involviertsein als Modell kultureller Teilhabe und Teilnahme

In recent years, the concept of cultural participation has become very popular both in the scientific context as well as in the political discourse. Despite that, a sound definition of the construct allowing for solid empirical data collection and analysis is still missing. While this is a major obstacle for researchers, society and political decision makers ask for evidence-based knowledge concerning the effects and benefits of cultural education and assistant measures. Based on Amartya Sen’s “Capability Approach” and on a broad conception of culture, the authors try to fill this gap and propose a theoretical model of “musical involvement” to describe cultural participation in music. (DIPF/Orig.)

Mass mortality in bivalves and the intricate case of the Pacific oyster, Crassostrea gigas

Massive mortality outbreaks in cultured bivalves have been reported worldwide and they have been associated with infection by a range of viral and bacterial pathogens. Due to their economic and social impact, these episodes constitute a particularly sensitive issue in Pacific oyster (Crassostrea gigas) production. Since 2008, mortality outbreaks affecting C. gigas have increased in terms of intensity and geographic distribution. Epidemiologic surveys have lead to the incrimination of pathogens, specifically OsHV-1 and bacteria of the Vibrio genus, in particular Vibrio aestuarianus. Pathogen diversity may partially account for the variability in the outcome of infections. Host factors (age, reproductive status…) including their genetic background that has an impact on host susceptibility towards infection, also play a role herein. Finally, environmental factors have significant effects on the pathogens themselves, on the host and on the host-pathogen interaction. Further knowledge on pathogen diversity, classification, and spread, may contribute towards a better understanding of this issue and potential ways to mitigate the impact of these outbreaks.

Promoting Investment and Increasing Employment among the Economically Inactive - A Review of Best Practice.

Final report to the Department of Enterprise, Trade and Investment, Northern Ireland. This report sets out the findings from a study into strategies that link the promotion of investment and the employment of economically inactive groups. The aim is to ascertain current practice in 10 relevant countries (Australia; Belgium; Denmark; Finland; Germany; the Netherlands; New Zealand; Slovenia; Spain; USA plus Great Britain) and their transferability to the Northern Ireland (NI) policy and labour market context. The study was carried out by the Employment Research Institute at Edinburgh Napier University on behalf of the Department of Trade, Enterprise and Investment in NI (DETI). The study describes cases of good practice in securing investment in areas, sectors and occupations that provide accessible entry-level positions for economically inactive groups. It seeks to identify the ‘critical success factors’ common to effective strategies, drawing out lessons for future Northern Ireland policy. In this study ‘Investment’ includes foreign direct investment (FDI) and private investment that expands the ‘export’ capacity of the NI economy (i.e. excluding investment aimed at the NI market). ‘Economically inactive’ people are those excluded or seriously at risk of exclusion from the labour market.

Recommandations pour l'adaptation de l'évaluation du risque écotoxicologique pour le Nord québécois

Pour assurer une gestion adéquate des écosystèmes nordiques à l’approche du développement de nouvelles activités économiques, le Centre d’expertise en analyse environnementale du Québec a pris l’initiative d’adapter certains de ses outils, plus particulièrement sa Procédure d’évaluation du risque écotoxicologique. En effet, bien que l’outil soit applicable au Québec méridional, des recommandations pour adapter la méthodologie au Nord en permettraient une utilisation plus judicieuse pour les divers intervenants utilisant cet outil de gestion de l’environnement. L’objectif de cet essai est d’identifier les aspects de l’outil devant être adaptés pour son application dans le Nord québécois et de proposer des recommandations pour y arriver. Ainsi, une première analyse des activités économiques en essor sur le territoire a permis d’identifier les substances qui pourraient être problématiques et pour lesquelles aucun critère de gestion ou de valeur toxicologique de référence n’est disponible au Québec, comme les métaux des terres rares, l’uranium et les fractions des hydrocarbures pétroliers. Une recherche approfondie sur les particularités du territoire à l’étude a permis, pour sa part, d’identifier des espèces écologiques représentatives et qui pourraient être utilisées comme récepteurs potentiels. À la suite de l’analyse de l’outil de gestion d’évaluation du risque écotoxicologique, trois recommandations principales ont pu être émises dans le but de l’adapter à ce territoire unique : 1) établir des critères de sols pour les contaminants susceptibles d’être émis dans le Nord québécois, 2) développer des valeurs toxicologiques de références pour le plus haut niveau de sensibilités pour ces mêmes substances et 3) recueillir les informations nécessaires sur des récepteurs nordiques clés pour pouvoir évaluer le risque écotoxicologique qu’ils courent. Finalement, un exemple d’application des recommandations, notamment l’utilisation de nouveaux récepteurs, tels que le caribou migrateur et le lièvre arctique, ainsi que l’utilisation de critères génériques et de valeurs toxicologiques de référence d’autres juridictions, a permis d’évaluer le risque pour un cas fictif en milieu nordique. Bien que le besoin d’investir des efforts de recherches pour pallier certaines lacunes ait été identifié, les recommandations proposées permettront de cibler ces efforts sur les éléments les plus problématiques pour permettre, finalement, d’adapter l’outil aux réalités des écosystèmes fragiles et uniques de ce territoire particulier.

Appendices - Promoting investment and increasing employment among the economically inactive.

Appendices - Promoting investment and increasing employment among the economically inactive.

Mixed Layer formation and restratification in presence of mesoscale and submesoscale turbulence

Recent realistic high resolution modeling studies show a net increase of submesoscale activity in fall and winter when the mixed layer depth is at its maximum. This submesoscale activity increase is associated with a reduced deepening of the mixed layer. Both phenomena can be related to the development of mixed layer instabilities, which convert available potential energy into submesoscale eddy kinetic energy and contribute to a fast restratification by slumping the horizontal density gradient in the mixed layer. In the present work, the mixed layer formation and restratification was studied by uniformly cooling a fully turbulent zonal jet in a periodic channel at different resolutions, from eddy resolving (10 km) to submesoscale permitting (2 km). The effect of the submesoscale activity, highlighted by these different horizontal resolutions, was quantified in terms of mixed layer depth, restratification rate and buoyancy fluxes. Contrary to many idealized studies focusing on the restratification phase only, this study addresses a continuous event of mixed layer formation followed by its complete restratification. The robustness of the present results was established by ensemble simulations. The results show that, at higher resolution, when submesoscale starts to be resolved, the mixed layer formed during the surface cooling is significantly shallower and the total restratification almost three times faster. Such differences between coarse and fine resolution models are consistent with the submesoscale upward buoyancy flux, which balances the convection during the formation phase and accelerates the restratification once the surface cooling is stopped. This submesoscale buoyancy flux is active even below the mixed layer. Our simulations show that mesoscale dynamics also cause restratification, but on longer time scales. Finally, the spatial distribution of the mixed layer depth is highly heterogeneous in the presence of submesoscale activity, prompting the question of whether it is possible to parameterize submesoscale effects and their effects on the marine biology as a function of a spatially-averaged mixed layer depth.