Women's perceptions of Nurse-Midwives' caring behaviours during perinatal loss in Lilongwe, Malawi: An Exploratory study

Objective The Objective for this study was to explore women’s perceptions of and satisfaction with nursing care they received following stillbirth and neonatal death in villages around a community hospital in Lilongwe. Methods This qualitative, exploratory study through a mixture of purposive and snowball sampling, recruited 20 women who had lost a child through stillbirth or neonatal death in the past 2 years. Data were collected through semi-structured interviews in the privacy of the homes of the women. All interviews were tape-recorded and transcribed verbatim and were analyzed using thematic analysis. Results Almost half of the respondents expressed satisfaction with the way nurses cared for them after experiencing perinatal loss, although some felt unable to comment on the quality of care received. However, several bereaved women were dissatisfied with how nurses handled their loss. They noted nurses not providing attention or explanations and some even attributed the death of their child to nurses’ neglect. Conclusions Interventions are needed which foster awareness where nurses become more sensitive to the mothers’ emotional needs in an equally sensitive health care system. There is also need for more research into care provided following perinatal deaths in resource-poor settings to increase the evidence-base for informed and improved care for women who have experienced child loss.

Some features of the law and order model in Spain

This research is based on the hypothesis that law and order model is displacing the procedura justice system in Spain. After a thorough review of the international literature, one can observe that the traditional structure of the penal system does not seem to be capable of containing the new forms of crime. The new penal model assumes that public opinion is alarmed and unwilling to understand rational approaches to crime, so it will be likely to accept measures aimed at calming the fear of crime, through extensive control policies and penal tools to manage uncivil behavior. Objectives and methodology A measuring instrument has been developed to confirm this hypothesis, consisting of ten features that characterize the law and order model. This instrument has been used to identify examples of its ten features in the rules and practices developed at each phase of the Spanish criminal justice system. The analysis has focused specifically on public discourse about delinquency, criminal policy decisions, legislative processes, police routines, judicial dynamics, and prison system practices. Main results The investigation has shown that there are many processes and practices indicating that the law and order model is consolidating itself in the Spanish penal system. Nevertheless this process has a different intensity at each phase, being stronger at the legislative stage and softer in the penitentiary enforcement phase. One of the main conclusions is, therefore, that the designed instrument is ideal for measuring the degree of penetration of the model throughout the system. Some of the most striking results of the reasearch will be presented at the conference. Finally, proposals arise that could prevent the new model is fully seated in our criminal justice system, finding that the trend toward more severe penalties shown already unsustainable.

Flexible endoscopic treatment of Zenker's diverticulum: thirteen years' experience in Spain

Introduction: Flexible endoscopic treatment is one of the alternative approaches for the management of Zenker's diverticum. The present paper shows our short-term and long-term results with flexible endoscopic cricopharyngeal myotomy/septotomy. Patients and methods: A retrospective analysis of our experience in patients with Zenker's diverticulum treated using a flexible endoscope, assisted by a flexible diverticuloscope, between 2002 and 2015. Myotomy/septotomy was performed with a needle-knife papillotome under deep sedation or general anesthesia. Results: Among the 64 patients treated, two died within 10 days of surgery from causes not directly related to the procedure, and one presented with pharyngo-esophageal perforation, which recovered with conservative management at 47 days after admission. Four additional patients were lost to short-term follow-up. Among the 57 remaining patients, 52 had complete relief of dysphagia after 6 weeks. Eleven of these had recurrent symptoms on the mid and the long term. Eight were retreated with the same flexible endoscopic technique, one with a hybrid endoscopic approach, one with classical open surgery and one refused retreatment. After a mean follow-up of 2 years and a half, 33 of 37 patients reported absent or minimal dysphagia, controllable with punctual dietary restrictions. Conclusions: Flexible endoscopic treatment for Zenker's diverticulum is effective and safe. It represents an option on an equal footing to rigid endoscopy and classical open surgery and may also be used when the latter two are technically impracticable or contraindicated.

Changing family models in Spain: the impact of the sociodemographic factors

Abstract During the last few decades, there has been an increasing international recognition of the studies related to the analysis of the family models change, the focus being the determinants of the female employment and the problems related to the work family balance (Lewis, 2001; Petit & Hook, 2005Saraceno, Crompton & Lyonette, 20062008; Pfau-Effinger, 2012). The majority of these studies have been focused on the analysis of the work-family balance problems as well as the effectiveness of the family and gender policies in order to encourage female employment (Korpi et al., 2013). In Spain, special attention has been given to the family policies implemented, the employability of women and on the role of the father in the family (Flaquer et al., 2015; Meil, 2015); however, there has been far less emphasis on the analysis of the family cultural models (González and Jurado, 2012; Crespi and Moreno, 2016). The purpose of this paper is to present some of the first results on the influence of the socio-demographic factors on the expectations and attitudes about the family models. This study offers an analytical reflection upon the foundation of the determinants of the family ambivalence in Spain from the cultural and the institutional dimension. This study shows the Spanish family models of preferences following the Pfau-Effinger (2004) classification of the famiy living arrangements. The reason for this study is twofold; on the one hand, there is confirmed the scarcity of studies that have focused their attention on this objective in Spain; on the other hand, the studies carried out in the international context have confirmed the analytical effectiveness of researching on the attitude and value changes to explain the meaning and trends of the family changes. There is also presented some preliminary results that have been obtained from the multinomial analysis related to the influence of the socio-demographic factors on the family model chosen by the individuals in Spain (father and mother working full time; mother part-time father full-time; mother not at work father full-time; mother and father part-time). 3 The database used has been the International Social Survey Programme: Family and Changing Gender Roles IV- ISSP 2012-. Spain is the only country of South Europe that has participated in the survey. For this reason it has been considered as a representative case study.

Seven Ulmus minor clones tolerant to Ophiostoma novo-ulmi registered as forest reproductive material in Spain

The Spanish elm programme began in 1986 in response to the devastating impact of Dutch elm disease on natural elm stands and urban trees. Its main objectives were to conserve remaining genetic resources and select and breed tolerant native elm genotypes. After 27 years of work conducting susceptibility trials on thousands of elm genotypes, the first seven tolerant Ulmus minor trees are now being registered by the Spanish Environmental Administration. This paper presents the results of the susceptibility tests on these clones and their distinctive genetic, morphological and phenological features. In all susceptibility trials the commercial ?Sapporo Autumn Gold? clone, which is highly tolerant to O. novo-ulmi, was used as a control. The registered clones were named ?Ademuz?, ?Dehesa de la Villa?, ?Majadahonda?, ?Toledo?, ?Dehesa de Amaniel?, ?Retiro? and ?Fuente Umbría?. The most tolerant clone was ?Dehesa de Amaniel?, as its wilting values were below 5% during the two consecutive inoculation trials performed in Madrid. ?Fuente Umbría?, tested over four consecutive years in Guadalajara and Palencia, was the Spanish clone with the most reliable tolerance level to O. novo-ulmi. The ?Ademuz? and ?Majadahonda? clones had the highest ornamental scores and are promising trees for use in urban environments and tree breeding for ornamental quality. These two genotypes showed a later bud burst phenology than the other U. minor clones, demonstrating suitability to areas with late frost events. The Spanish programme aims to substantially increase the range of tolerant native elms through new selections and crossings to gain a better understanding of the genetic basis of resistance.

Cost-free feed-in tariffs for renewable energy deployment in Spain

Feed-in-tariff (FIT) schemes have been widely employed to promote renewable energy deployment. While FITs may be perceived by consumers as an extra cost, renewable energies cause a noticeable price reduction in wholesale electricity markets. We analyse both effects for the case of the Spanish electricity market during 2010. In particular, we examine the level of FITs that makes savings and extra costs to be similar on an hourly basis. Results are obtained for a wide range of renewable generation scenarios. It is found that FITs with null extra costs for consumers are in the range of 50–80 €/MWh. Some of the side-effects of a high penetration of renewable energy in the market are analysed in detail and discussed.

The conversation on political issues on Twitter: an analysis of the participation and frames in the debate on the 'Wert law' and evictions in Spain

The aim of this study is to determine which social agents are involved in the political debate on Twitter and whether the interpretive hegemony of actors that have traditionally been the most prominent is tempered by the challenge of framing shared with audiences. The relationship between the interpretations expressed and the profiles of participants is analyzed in comparison with the frames used by mainstream media. The chosen methodology combines content analysis and discourse analysis techniques on a sample of 1,504 relevant tweets posted on two political issues –the approval of the education law LOMCE and the evictions caused by the crisis, which have also been studied in the front pages of four leading newspapers in Spain. The results show a correlation between political issue singularities, frames and the type of discussion depending on the participants.

Epidemiological investigation of bovine tuberculosis herd breakdowns in Spain 2009/2011

We analyzed the most likely cause of 687 bovine tuberculosis (bTB) breakdowns detected in Spain between 2009 and 2011 (i.e., 22% of the total number of breakdowns detected during this period). Seven possible causes were considered: i) residual infection; ii) introduction of infected cattle from other herds; iii) sharing of pastures with infected herds; iv) contiguous spread from infected neighbor herds; v) presence of infected goats in the farm; vi) interaction with wildlife reservoirs and vii) contact with an infected human. For each possible cause a decision tree was developed and key questions were included in each of them. Answers to these key questions lead to different events within each decision tree. In order to assess the likelihood of occurrence of the different events a qualitative risk assessment approach was used. For this purpose, an expert opinion workshop was organized and ordinal values, ranging from 0 to 9 (i.e., null to very high likelihood of occurrence) were assigned. The analysis identified residual infection as the most frequent cause of bTB breakdowns (22.3%; 95%CI: 19.4-25.6), followed by interaction with wildlife reservoirs (13.1%; 95%CI: 10.8-15.8). The introduction of infected cattle, sharing of pastures and contiguous spread from infected neighbour herds were also identified as relevant causes. In 41.6% (95%CI: 38.0-45.4) of the breakdowns the origin of infection remained unknown. Veterinary officers conducting bTB breakdown investigations have to state their opinion about the possible cause of each breakdown. Comparison between the results of our analysis and the opinion from veterinary officers revealed a slight concordance. This slight agreement might reflect a lack of harmonized criteria to assess the most likely cause of bTB breakdowns as well as different perceptions about the importance of the possible causes. This is especially relevant in the case of the role of wildlife reservoirs.

Survey of quantitative antimicrobial consumption per production stage in farrow-to-finish pig farms in Spain

Objectives: To characterise antimicrobial use (AMU) per production stage in terms of drugs, routes of application, indications, duration and exposed animals in farrow-to-finish pig farms in Spain. Design: Survey using a questionnaire on AMU during the six months prior to the interview, administered in face-to-face interviews completed from April to October 2010. Participants: 108 potentially eligible farms covering all the country were selected using a multistage sampling methodology; of these, 33 were excluded because they did not fulfil the participation criteria and 49 were surveyed. Results: The rank of the most used antimicrobials per farm and production stage and administration route started with polymyxins (colistin) by feed during the growing and the preweaning phases, followed by β-lactams by feed during the growing and the preweaning phases and by injection during the preweaning phase. Conclusions: The study demonstrates that the growing stage (from weaning to the start of finishing) has the highest AMU according to different quantitative indicators (number of records, number of antimicrobials used, percentage of farms reporting use, relative number of exposed animals per farm and duration of exposure); feed is the administration route that produces the highest antimicrobial exposure based on the higher number of exposed animals and the longer duration of treatment; and there are large differences in AMU among individual pig farms.

Expression of Potato virus Y cytoplasmic inclusion protein in tobacco results in disorganization of parenchyma cells, distortion of epidermal cells, and induces mitochondrial and chloroplast abnormalities, formation of membrane whorls and atypical lipid accumulation

Infection of plant cells by potyviruses induces the formation of cytoplasmic inclusions ranging in size from 200 to 1000 nm. To determine if the ability to form these ordered, insoluble structures is intrinsic to the potyviral cytoplasmic inclusion protein, we have expressed the cytoplasmic inclusion protein from Potato virus Y in tobacco under the control of the chrysanthemum ribulose-1,5-bisphosphate carboxylase small subunit promoter, a highly active, green tissue promoter. No cytoplasmic inclusions were observed in the leaves of transgenic tobacco using transmission electron microscopy, despite being able to clearly visualize these inclusions in Potato virus Y infected tobacco leaves under the same conditions. However, we did observe a wide range of tissue and sub-cellular abnormalities associated with the expression of the Potato virus Y cytoplasmic inclusion protein. These changes included the disruption of normal cell morphology and organization in leaves, mitochondrial and chloroplast internal reorganization, and the formation of atypical lipid accumulations. Despite these significant structural changes, however, transgenic tobacco plants were viable and the results are discussed in the context of potyviral cytoplasmic inclusion protein function.

A lava park in Spain

The lava park is surrounded by the volcanic mountains of Les Preses, revealed as the edges of a vast caldera and repeated at a human scale with low walls made up of small volcanic boulders. These walls are evidence of how successive communities have gradually worked amongst this lava flow to create arable land, supported by rich soils. The people saw the land prosper and learned how to maximise its productivity. Boulders that had come to the surface during agricultural cultivation were moved with human labour to create "artigas“, the characteristic pilings of volcanic stone. They have been used to raise and lower areas, to create shelter and exposure for their crops and to make caves for storage. Amongst all this, paths weave and cross. The whole place is made up of grey and black rocks with a constant cover of green crops or grass.

Clinical results in primary THR

Written by the surgeons of the Exeter Hip Team and their colleagues from around the world, this book describes 40 years of innovation and development with cemented hip replacement. Topics covered include the basic science behind successful cemented hip replacement, modern surgical techniques and recent advances. There is also extensive coverage of the revision techniques developed at Exeter and elsewhere, focussing on femoral and acetabular impaction grafting. Each chapter is a self-contained article with an emphasis, where appropriate, on practical techniques and surgical tips, supported by line drawings and intra-operative photographs.

In vivo knockdown of the androgen receptor results in growth inhibition and regression of well-established, castration-resistant prostate tumours

Purpose: Progression to the castration-resistant state is the incurable and lethal end stage of prostate cancer, and there is strong evidence that androgen receptor (AR) still plays a central role in this process. We hypothesize that knocking down AR will have a major effect on inhibiting growth of castration-resistant tumors. Experimental Design: Castration-resistant C4-2 human prostate cancer cells stably expressing a tetracycline-inducible AR-targeted short hairpin RNA (shRNA) were generated to directly test the effects of AR knockdown in C4-2 human prostate cancer cells and tumors. Results:In vitro expression of AR shRNA resulted in decreased levels of AR mRNA and protein, decreased expression of prostate-specific antigen (PSA), reduced activation of the PSA-luciferase reporter, and growth inhibition of C4-2 cells. Gene microarray analyses revealed that AR knockdown under hormone-deprived conditions resulted in activation of genes involved in apoptosis, cell cycle regulation, protein synthesis, and tumorigenesis. To ensure that tumors were truly castration-resistant in vivo, inducible AR shRNA expressing C4-2 tumors were grown in castrated mice to an average volume of 450 mm3. In all of the animals, serum PSA decreased, and in 50% of them, there was complete tumor regression and disappearance of serum PSA. Conclusions: Whereas castration is ineffective in castration-resistant prostate tumors, knockdown of AR can decrease serum PSA, inhibit tumor growth, and frequently cause tumor regression. This study is the first direct evidence that knockdown of AR is a viable therapeutic strategy for treatment of prostate tumors that have already progressed to the castration-resistant state.

CDKN2A mutation in a non-FAMMM kindred with cancers at multiple sites results in a functionally abnormal protein

The CDKN2A gene encodes p16 (CDKN2A), a cell-cycle inhibitor protein which prevents inappropriate cell cycling and, hence, proliferation. Germ-line mutations in CDKN2A predispose to the familial atypical multiple-mole melanoma (FAMMM) syndrome but also have been seen in rare families in which only 1 or 2 individuals are affected by cutaneous malignant melanoma (CMM). We therefore sequenced exons 1alpha and 2 of CDKN2A using lymphocyte DNA isolated from index cases from 67 families with cancers at multiple sites, where the patterns of cancer did not resemble those attributable to known genes such as hMLH1, hMLH2, BRCA1, BRCA2, TP53 or other cancer susceptibility genes. We found one mutation, a mis-sense mutation resulting in a methionine to isoleucine change at codon 53 (M531) of exon 2. The individual tested had developed 2 CMMs but had no dysplastic nevi and lacked a family history of dysplastic nevi or CMM. Other family members had been diagnosed with oral cancer (2 persons), bladder cancer (1 person) and possibly gall-bladder cancer. While this mutation has been reported in Australian and North American melanoma kindreds, we did not observe it in 618 chromosomes from Scottish and Canadian controls. Functional studies revealed that the CDKN2A variant carrying the M531 change was unable to bind effectively to CDK4, showing that this mutation is of pathological significance. Our results have confirmed that CDKN2A mutations are not limited to FAMMM kindreds but also demonstrate that multi-site cancer families without melanoma are very unlikely to contain CDKN2A mutations.