Future Selves: Career choices of young disabled people

There is growing recognition that gaining the views of young people is crucial for understanding issues that affect their lives. However, to date, very little is known about the way in which disabled children, make sense of their identities, and create a sense of their past and their imagined futures over time. This three year study, funded by the European Social Fund, and conducted by Dr Sonali Shah and colleagues at the University of Nottingham, used various methods to explore how physically disabled students, in full-time special or mainstream education, make choices concerning their occupational futures. It identified the factors that shape their educational and career related choices and chances, and explored how social relations, social processes, and social policies influenced the extent to which their aspirations were achieved. This study presents disabled children and young people as critical social actors who are telling their own stories of how social structures and processes shape their choices and aspirations for their future selves. It illustrates the importance of consulting children and young people about issues concerning their lives, and not rely solely on adults’ conceptions of childhood. The young disabled people’s experiences and views can be used to develop a new flexible system which offers the benefits of mainstream and special education, and facilitates young disabled people’s self-determination to make choices to participate in and contribute to their independent futures.

LOOKING FOR DIONYSUS: HEDWIG RAABE AND THE HAUNTING OF THE BIRTH OF TRAGEDY

This thesis explores the relationship of the actress Hedwig Raabe’s 1866 performance in Charlotte Birch-Pfeiffer’s play Die Grille to the philosopher Friedrich Nietzsche’s 1872 book The Birth of Tragedy. This exploration is structured by theatre scholar Marvin Carlson’s concept of haunting. I conclude that the haunting of Nietzsche’s text by Raabe’s performance destabilizes the former and points towards new ways of understanding The Birth of Tragedy in the fields of theatre and performance studies.

UNDERSTANDING CUSTOMER CHOICES IN SERVICE OUTSOURCING AND REVENUE MANAGEMENT

This dissertation investigates customer behavior modeling in service outsourcing and revenue management in the service sector (i.e., airline and hotel industries). In particular, it focuses on a common theme of improving firms’ strategic decisions through the understanding of customer preferences. Decisions concerning degrees of outsourcing, such as firms’ capacity choices, are important to performance outcomes. These choices are especially important in high-customer-contact services (e.g., airline industry) because of the characteristics of services: simultaneity of consumption and production, and intangibility and perishability of the offering. Essay 1 estimates how outsourcing affects customer choices and market share in the airline industry, and consequently the revenue implications from outsourcing. However, outsourcing decisions are typically endogenous. A firm may choose whether to outsource or not based on what a firm expects to be the best outcome. Essay 2 contributes to the literature by proposing a structural model which could capture a firm’s profit-maximizing decision-making behavior in a market. This makes possible the prediction of consequences (i.e., performance outcomes) of future strategic moves. Another emerging area in service operations management is revenue management. Choice-based revenue systems incorporate discrete choice models into traditional revenue management algorithms. To successfully implement a choice-based revenue system, it is necessary to estimate customer preferences as a valid input to optimization algorithms. The third essay investigates how to estimate customer preferences when part of the market is consistently unobserved. This issue is especially prominent in choice-based revenue management systems. Normally a firm only has its own observed purchases, while those customers who purchase from competitors or do not make purchases are unobserved. Most current estimation procedures depend on unrealistic assumptions about customer arriving. This study proposes a new estimation methodology, which does not require any prior knowledge about the customer arrival process and allows for arbitrary demand distributions. Compared with previous methods, this model performs superior when the true demand is highly variable.

Drinking water disinfection by-products, genetic polymorphisms, and birth outcomes in a european mother-child cohort study

International audience

Coherent childbearing

Background: Over the last 10 years, Australia's spontaneous vaginal birth rate has decreased approximately 1% each year and the caesarean section rate has increased approximately 1% each year. This trend has serious implications for the health of women and babies. As midwives we are the caretakers of normal birth and therefore partly responsible for its decline and the solution to its decline. Although antenatal education is in a potentially powerful position to promote normal birth, a structured review conducted as part of this thesis found that it does not realise that potential. Currently framed in pathogenesis, antenatal education in particular and maternity services in general, are in need of reframing. The theory of salutogenesis may offer a new lens as it focuses on health rather than illness. Sense of coherence is the cornerstone of salutogenesis and is a predictive indicator of health. What is unclear is the role pregnant women's sense of coherence plays in their birthing outcomes. This study explored associations between pregnant women's sense of coherence, their pregnancy choices, their anticipated labour choices, their labour and birthing outcomes as well as factors associated with modification to sense of coherence from the antenatal to postnatal periods. Methods: After a comprehensive review of the literature, questionnaire development and psychometric tool testing and modification, a longitudinal survey was conducted where eligible women completed a questionnaire before the 30th week of pregnancy (Phase One) and approximately 8 weeks after birth (Phase Two). Eligible women were less than 30 weeks pregnant with a single fetus, could read and write in English and lived in the Australian Capital Territory in Australia. Phase One provided information on women's sense of coherence scores, Edinburgh Postnatal Depression Scale (EPDS) scores, Support Behaviour Inventory (SBI) scores, pregnancy choices including care proVider, planned place of birth, planned birth type and anticipated epidural use and demographics. Phase Two provided information on women's sense of coherence scores, EPDS scores and their labour and birthing outcomes. Findings: 1074 women completed Phase One representing a 61.3% response rate. 753 women completed Phase Two representing a 70.1% retention rate between phases. Compared to women with low sense of coherence, women with high sense of coherence were older, reported fewer pregnancy conditions such as diabetes or hypertension, were less likely to have depressive symptoms, were more likely to feel well supported, were less likely to experience a caesarean section and more likely to experience an assisted vaginal birth. Sense of coherence was not associated with women's pregnancy choices. Higher EPDS scores, lower sense of coherence and greater satisfaction with birth were associated with an increase in women's sense of coherence from the antenatal to the postnatal period. Decreased birth satisfaction and experiencing epidural anaesthesia in labour and assisted vaginal birth were associated with a decrease in sense of coherence from the antenatal to the postnatal period. Conclusion: Strong sense of coherence in pregnant women halved the likelihood of experiencing caesarean section compared to women with low sense of coherence. Sense of coherence is a modifiable predictor of women's childbearing health and was found to be raised by birth satisfaction and lowered by birth dissatisfaction and labour interventions. These important findings add to the limited body of knowledge about sense of coherence and childbearing.

Transition into adulthood : the impact of the great recession in schooling and financial choices of young adults

Mestrado em Finanças

Investigation of H19/RsaI Polymorphism in Children With Low Birth Weight in Pernambuco, Brazil

Background: H19 is a strong candidate gene for influencing birth weight variation and is exclusively imprinted maternally. In an attempt to understand the relationship of this gene polymorphism with low birth weight children, we investigated association of H19/RsaI polymorphism with low birth weight and normal birth weight in children and their mothers. Objectives: The aim of our study was to establish the association between H19 gene polymorphism and LW in children born in Pernambuco, state of Brazil. Patients and Methods: It were selected 89 children, 40 low birth weight (LW) and 49 normal birth weight (NW) and 71 mothers (40 mothers of newborns NW and 31 mothers of newborns LW) attended at Dom Malan Hospital, Petrolina, Pernambuco - Brazil. Peripheral blood samples were collected from patients and genomic DNA was extracted and detected by electrophoresis agarose gel, stained by Blue Green Loading Dye. DNA PCR amplification was done using the primers H1 (sense) and H3 (antisense). PCR products were digested with RsaI and electrophoresed on agarose gel stained by ethidium bromide. Statistical analyses were performed using the program BioEstat version 5.0. Results: The RsaI polymorphism in the H19 gene showed that genotype frequencies did not differ statistically between low birth weight (AA = 12.5%, AB = 45%, BB = 42.5%) and control (AA = 8.6% AB = 36.73%, BB= 55.10% groups) and the allele frequencies were not significantly different (P = 0.2897). We also did not observe any association between maternal H19 allele polymorphism and low birth weight newborns (P =0.7799) or normal birth weight children (P = 0.8976). Conclusions: The small size of sample may be the explanation for these results; future studies with more patients are needed to confirm the effect of H19/RsaI polymorphism on birth weight of LW newborns.

An Evaluation of Oxidative Status in Serum and Breast Milk of Mothers Giving Birth Prematurely and at Full-Term

Background: Burning fat and carbohydrates to provide energy in biological systems causes the formation of free oxygen species. Objectives: This study aimed to evaluate the oxidative status of serum and breast milk of mothers giving birth prematurely and at full-term. Materials and Methods: The study comprised 50 mothers who gave birth at full-term at more than 38 weeks and 43 mothers who gave birth pre-term at below 32 weeks. On the postnatal 5th day, samples of the mother’s milk and serum were taken and stored at -80°C until the study day. On the study day, the total oxidant and total antioxidant levels were measured using the Erel method and the oxidative stress index (OSI) was calculated. Results: While the total oxidant level and total antioxidant level values of the milk of the premature birth mothers were found to be significantly high compared to those of the full-term birth mothers (P = 0.001), no statistically significant difference was found in the oxidative stress index values (P > 0.05). No statistically significant difference was found in the total oxidant level and oxidative stress index values of the serum of the premature birth mothers compared to those of the full-term birth mothers, while the total antioxidant level was found to be significantly low (P = 0.04). Conclusions: The oxidants and antioxidants in the milk of mothers giving birth prematurely were found to be significantly higher than those of full-term birth mothers. This can be evaluated as the milk of the premature birth mothers providing increased antioxidant defense to protect the infant.

Atypical features and treatment choices in bipolar disorders: a result of the National Bipolar Mania Pathway Survey in China.

In this study, we examined the point prevalence rate of atypical features in bipolar disorder, and estimated the potential impact of these features on treatment practices in China. Using the atypical features criteria of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV), we documented the atypical symptoms in 3 906 consecutive participants with bipolar disorder enrolled at 26 psychiatric services across China. We further assessed the association between atypical features and the treatment approaches, including the prescription of antidepressants. The overall point prevalence rate of atypical features was 9.1% among patients with various bipolar disorder subtypes. When the definition was broadened to include atypical features B, the overall rate increased to 11.8%. Interestingly, among patients with the mixed state and remission subtypes, there was a significant difference in the rates of antidepressant medication usage between patients who met and those who did not meet the criteria for atypical features B. These findings indicate a trend of using antidepressants for these two types of patients with atypical features. Further, for both mixed state and remission patients, treatment approaches were related to atypical features B. Our findings provide evidence to assist clinicians to readily recognize atypical features in bipolar subtypes and can propose treatments based on these diagnoses.

The emergence of the private entrepreneur in reform era China: re-birth of an earlier tradition, or a more recent product of development and change?

A private sector that now dominates economic activity has emerged in China since 1978, even though many of the essential institutions for market competition have been lacking or are under-developed. We find that there is no evidence that this upsurge of entrepreneurship is a re-birth of an earlier tradition. Instead, the dynamics of entrepreneurial emergence can be attributed to reforms and institutional changes that have occurred since 1949, both before and after the introduction of economic reforms in late 1978. We find that these institutional changes have been evolutionary, adapting to, as well as shaping, emerging forms of economic activity, including entrepreneurship. Our conclusion is that these dynamics of adaptation and evolution produce ‘rule ambiguities’ within the institutional framework that create opportunities for entrepreneurs as well as making these opportunities vulnerable to further institutional change.

Maternal creatine supplementation during pregnancy prevents long-term changes in diaphragm muscle structure and function after birth asphyxia

Using a model of birth asphyxia, we previously reported significant structural and functional deficits in the diaphragm muscle in spiny mice, deficits that are prevented by supplementing the maternal diet with 5% creatine from mid-pregnancy. The long-term effects of this exposure are unknown. Pregnant spiny mice were fed control or 5% creatine-supplemented diet for the second half of pregnancy, and fetuses were delivered by caesarean section with or without 7.5 min of in-utero asphyxia. Surviving pups were raised by a cross-foster dam until 33±2 days of age when they were euthanized to obtain the diaphragm muscle for ex-vivo study of twitch tension and muscle fatigue, and for structural and enzymatic analyses. Functional analysis of the diaphragm revealed no differences in single twitch contractile parameters between any groups. However, muscle fatigue, induced by stimulation of diaphragm strips with a train of pulses (330 ms train/sec, 40 Hz) for 300 sec, was significantly greater for asphyxia pups compared with controls (p<0.05), and this did not occur in diaphragms of creatine + asphyxia pups. Birth asphyxia resulted in a significant increase in the proportion of glycolytic, fast-twitch fibres and a reduction in oxidative capacity of Type I and IIb fibres in male offspring, as well as reduced cross-sectional area of all muscle fibre types (Type I, IIa, IIb/d) in both males and females at 33 days of age. None of these changes were observed in creatine + asphyxia animals. Thus, the changes in diaphragm fatigue and structure induced by birth asphyxia persist long-term but are prevented by maternal creatine supplementation.

Young maternal age at first birth and mental health later in life: does the association vary by birth cohort?

BACKGROUND: It is well established that maternal age at childbirth has implications for women's mental health in the short term, however there has been little research regarding longer term implications and whether this association has changed over time. We investigated longer term mental health consequences for young mothers in Australia and contrasted the effects between three birth cohorts. METHODS: Using thirteen waves of data from 4262 women aged 40 years or above participating in the Household, Income and Labour Dynamics in Australia Survey, we compared the mental health of women who had their first child aged 15-19 years, 20-24 years, and 25 years and older. Mental health was measured using the mental health component summary score of the SF-36. We used random-effects linear regression models to generate estimates of the association between age at first birth and mental health, adjusted for early life socioeconomic characteristics (country of birth, parents' employment status and occupation) and later life socioeconomic characteristics (education, employment, income, housing tenure, relationship status and social support). We examined whether the association changed over time, testing for effect modification across three successive birth cohorts. RESULTS: In models adjusted for early life and later life socioeconomic characteristics, there was strong evidence of an association between teenage births and poor mental health, with mental health scores on average 2.76 to 3.96 points lower for mothers aged younger than 20 years than for mothers aged 25 years and older (Late Baby Boom (born 1936-1945): -3.96, 95% CI -5.38, -2.54; Early Baby Boom (born 1946-1955): -3.01, 95% CI -4.32, -1.69; Lucky Few (born 1956-1965): -2.76, 95% CI -4.34, -1.18), and evidence of an association for mothers aged 20-24 years compared to mothers aged 25 years and older in the most recent birth cohort only (-1.09, 95% CI -2.01, -0.17). There was some indication (though weak) that the association increased in more recent cohorts. CONCLUSION: This study highlights that young mothers, and particularly teenage mothers, are a vulnerable group at high risk of poor mental health outcomes compared to mothers aged 25 years and above, and there was some suggestion (though weak) that the health disparities increased over time.

Women's autonomy, education and birth intervals in India: visiting the less familiar

Using data from the third National Family Health Survey (NFHS-3) on currently married fecund women who have had at least one birth during 2001–2002 and Cox-proportional hazard models, this study examines the less researched association between women's autonomy and birth-to-conception intervals in India. It also examines whether women's autonomy mediates or moderates the relationship between education and birth-to-conception interval. Our results indicate that after adjusting for demographic and socioeconomic factors, women's autonomy was a significant predictor of birth-to-conception intervals, with higher autonomy positively associated with larger birth-to-conception intervals. Education of women was also independently associated with longer birth-to-conception intervals. However, this study did not provide any support to the general perception that women's autonomy mediates the association between women's education and birth-to-conception interval. Women's autonomy rather than being a mediator acted as a moderator in this association. Policy measures to increase the spacing between births should emphasise not only improving the education of women but also their autonomy.

Screening for post 32-week preterm birth risk: how helpful is routine perinatal data collection?

BACKGROUND: Preterm birth is a clinical event significant but difficult to predict. Biomarkers such as fetal fibronectin and cervical length are effective, but the often are used only for women with clinically suspected preterm risk. It is unknown whether routinely collected data can be used in early pregnancy to stratify preterm birth risk by identifying asymptomatic women. This paper tries to determine the value of the Victorian Perinatal Data Collection (VPDC) dataset in predicting preterm birth and screening for invasive tests.

METHODS: De-identified VPDC report data from 2009 to 2013 were extracted for patients from Barwon Health in Victoria. Logistic regression models with elastic-net regularization were fitted to predict 37-week preterm, with the VPDC antenatal variables as predictors. The models were also extended with two additional variables not routinely noted in the VPDC: previous preterm birth and partner smoking status, testing the hypothesis that these two factors add prediction accuracy. Prediction performance was evaluated using a number of metrics, including Brier scores, Nagelkerke's R(2), c statistic.

RESULTS: Although the predictive model utilising VPDC data had a low overall prediction performance, it had a reasonable discrimination (c statistic 0.646 [95% CI: 0.596-0.697] for 37-week preterm) and good calibration (goodness-of-fit p = 0.61). On a decision threshold of 0.2, a Positive Predictive Value (PPV) of 0.333 and a negative predictive value (NPV) of 0.941 were achieved. Data on previous preterm and partner smoking did not significantly improve prediction.

CONCLUSIONS: For multiparous women, the routine data contains information comparable to some purposely-collected data for predicting preterm risk. But for nulliparous women, the routine data contains insufficient data related to antenatal complications.