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This study offers evidence of the impact of language background on the performance of students enrolled in an accounting study unit. It aims to quantify the effects of language background on perfor...

The study explores women's experiences and expectations of maternity care in Timor-Leste.Qualitative, descriptive research using focused ethnography. Thirty women and seventeen health professionals from three districts in Timor-Leste were interviewed and/or participated in focus groups.Women's expectations of care include the provision of information, advice and clinical assessment from midwives who have the capacity to provide emergency obstetric care if required. Midwives' access to technology (for example: the fetal doppler), increased the women's confidence in services. The women also identified poor experiences, including angry, busy midwives, poor communication, and lack of privacy in antenatal and birthing services. The lack of privacy inhibits women's communication with health professionals. An absence of covers and multiple staff present during labour and birth embarrass the women and their families. Many Timorese women live in poverty and have poor literacy skills. These women want knowledgeable, approachable, and clinically competent midwives who can support them through their pregnancies and childbirth. Poor communication, angry, busy midwives and lack of privacy cause discomfort and embarrassment and may discourage the women and their family's uptake of skilled birth attendant (SBA) services.Midwives have a critical primary role in the provision of advice, information and care of Timorese women during the childbirth continuum. Continuing education of midwives with an emphasis on communication and culturally congruent care will improve women's satisfaction and childbirth outcomes. Impoverished women are particularly vulnerable when birthing in health care services. Attention to the women's privacy and her additional needs can include a focus on the birthing space and the number of staff who have access to it.

In the United States, African Americans continue to bear a disproportionate amount of risk from HIV and illicit drug use, highlighting the importance of culturally responsive prevention programming. Manualized HIV and substance use prevention curricula that are conceptually African centered are few, and evaluative data of such programs are sparse. This research brief aims to describe a field evaluation of the “Color it Real” (CIR) program, a 6-session, 12-hr HIV and substance use prevention curriculum for African American males and females aged 18 to 24 years. Participants ( n = 225) were recruited using convenience sampling from two cities within a high-risk county in Indiana. Attitudes, knowledge, and confidence related to HIV and substance use were assessed before and after the intervention. Wilcoxon and McNemar tests were used to compare pretest and posttest scores, and binary logistic regression models were used to examine sociodemographic associations with outcomes. Among the analytic sample ( n = 195), the CIR program was associated with several improved attitudes and increased knowledge related to HIV and substance use, but not with increased confidence in sexual negotiation skills. These findings represent the first published data from CIR since the developers’ original study, and support continued use of the curriculum by our program. Given the positive findings (i.e., attitudes and knowledge) and community receptiveness to CIR, we believe that a randomized, controlled trial of the intervention that includes longitudinal behavioral measurement would be a meaningful addition to prevention research.

AimsOur first aim was to first find out how confident general practitioners were about referring in to the Gloucester Recovery Team and managing psychotropic medications. Our second aim was to then improve general practitioner's self-rated scores of confidence in managing psychotropic medication whilst also improving general practitioner's satisfaction with waiting times for patient's referred to the Gloucester Recovery Team.MethodWe planned to introduce an email address for GPs to use to seek medication and diagnostic advice for patients known to and not known to the Recovery Team. We initially introduced this for the ‘Team 2’ catchment area consisting of five practices within Gloucester. These were then read and replied to by the Team 2 consultant, Dr Ikram, as appropriate. A further survey was then sent out.. These results provided both quantitative ordinal data through a likert scale, which was then transformed into binomial data, such as those scoring ‘extremely confident’ ‘very confident’ ‘somewhat confident’ vs ‘not so confident’ and ‘not confident at all’ which is then compared using relative risk.ResultOur response rate for our initial survey was 8 general practitioners, and for our follow-up survey 1 general practitioner and 2 nurse prescribers. Confidence in continuing psychotropic medications increased from 7 out of the 8 (78%) stating somewhat confident to extremely confident to 3 out of the 3 (100%) after the introduction of the email; a relative change of 1.14 (95% confidence interval 0.87-1.48 p = 0.318). Confidence in initiating psychotropic medications increased from 4 out of the 8 (50%) stating somewhat confident to extremely confident to 2 out of the 3 (66%) after the introduction of the email; a relative change of 1.33 (95% confidence interval 0.46-3.84 p = 0.594).ConclusionAnalysing the qualitative data showed the email address was used for a variety of requests and advice including: 1) A capacity assessment, 2) Initiating medications for depression and anxiety, 3) Medications during pregnancy, 4) Medication for those with Intellectual Disability, 5) Switching medication, 6) Medications for poor sleep and 7) Mood stabilising medication.This change appeared to be well received, however the response rate was very low which makes full analysis difficult. We also included nurse practitioners working in primary mental health in our second survey, whereas the initial survey was only sent to GPs. This initiative was also only started for 5 of the GP practices within Gloucester, and there may be a different knowledge base/confidence amongst the other practices.

Objective To describe the barriers to women's access to maternity services in three districts of Timor-Leste. Research design/setting: Focused ethnography with data collection methods commensurate with a qualitative research design. Setting and participants: Data was collected in three districts in Timor-Leste. Participants included seventeen stakeholders, health professionals and managers providing skilled birth attendance (SBA) in Timor-Leste and thirty women who have given birth and are competent to give consent. Findings: Access to SBA services is seriously impeded by poor roads and lack of transportation, the poor condition and amenity of services, restricted hours of opening, the lack of availability of skilled SBA professionals and medical resources. Participants also commented upon the lack of privacy and multiple caregivers. Timorese patriarchal family structures, intergenerational decision-making and cultural attitudes towards reproductive health information and services potentially reduce women's access to reproductive health services. Conclusion This data provides a comprehensive record of the multiple structural barriers to women's access to SBA services. The modified AAAQA framework provides categories and an organisational structure to these barriers to SBA services. Implications for practice Maternity care in Timor-Leste is extremely poorly resourced. Midwives and other SBA will need to provide innovative low cost solutions if they are to consistently provide respectful culturally safe midwifery care. This includes the provision of privacy and a one to one midwifery relationship `with woman'. In addition, many women are unable to access SBA, where possible the MoH can consider strategies to improve the provision of SBA services to women birthing in community.

This article explores the application of key informant research to examine barriers and facilitators to maternal health services in rural and pastoralist Ethiopia. The key informants were health extension workers (HEWs) who assist women with birth preparedness and facilitate timely referral to health centres for birth. While women encounter many barriers to giving birth in health facilities, where HEWs are supported by their communities and health centre staff, they can effectively encourage women to travel to health centres to give birth with skilled birth attendants rather than at home with unskilled relatives or traditional birth attendants.

Topologies of multiterminal HVDC-VSC transmission systems for large offshore wind farms are investigated. System requirements for multiterminal HVDC are described, particularly the maximum power loss allowed in the event of a fault. Alternative control schemes and HVDC circuit topologies are reviewed, including the need for HVDC circuit breakers. Various topologies are analyzed and compared according to a number of criteria: number and capacity of HVDC circuits, number of HVDC circuit breakers, maximum power loss, flexibility, redundancy, lines utilization, need for offshore switching platforms and fast communications.

Working memory (WM) processes are often thought to play an important role in the cognitive regulation of negative emotions. However, little is known about how they influence emotional processing. We report two experiments that tested whether a concurrent working memory task could modulate the emotional startle eyeblink effect, a well-known index of emotional processing. In both experiments, emotionally negative and neutral pictures were viewed in two conditions: a "cognitive load" (CL) condition, in which participants had to actively maintain information in working memory (WM) while viewing the pictures, and a control "no load" (NL) condition. Picture-viewing instructions were identical across CL and NL. In both experiments, results showed a significant reduction of the emotional modulation of the startle eyeblink reflex in the CL condition compared to the NL condition. These findings suggest that a concurrent WM task disrupts emotional processing even when participants are directing visual focus on emotionally relevant information.

Ghana, like many African countries, continues to grapple with domestic violence issues. Ghana's 1992 Constitution mandates provisions that should eradicate the scourge of violence against women and children. In this paper, two main questions are asked. First, will the 1992 Constitution ultimately lead to victories over discrimination and violence against Ghanaian women? Second, has progress been made in eradicating violence against women in Ghana to date? In that regard, have governmental and non-governmental organizations supported Ghanaian women to arrive at relative stability, empowerment and freedom from violence? Progress thus far is encouraging. Presently, there are several holistic or organic approaches being used to combat domestic violence in Ghana. however, an epidemiological examination of custom and a psychosocial approach towards domestic violence may facilitate permanent meaningful solutions.

Using story-telling as the medium for conveying a message was a method favoured by the Jewish prophetic and Rabbinical traditions, and, supremely, by Jesus himself. This article draws on the writer’s own experiments with this medium to explore some of the implications, advantages and risks of preaching through narrative.

Illness attributions and myocardial infarction: the influence of gender and socio-economic circumstances on illness beliefs Aim. To present findings from a study conducted between 1996 and 1998 to investigate participants' perceptions of illness causation following a myocardial infarction. Rationale. The underlying assumption of many practitioners is that perceptions of illness causation will influence emotions and adjustment to illness. Design. Phenomenology was the research methodology used to examine perceptions of illness causation. A convenience sample was taken of 24 men and women who were admitted to a regional hospital in Victoria, Australia, with a provisional diagnosis of myocardial infarction. Participants were interviewed shortly after hospitalization, and interviews were taped, transcribed and thematically analysed. Findings. Stress was the most commonly cited cause of illness. Men and women demonstrated distinct differences in illness attribution. Participants who verbalized concerns about their loss of autonomy and their subsequent ability for self-management were predominantly female and uniformly members of the lowest socio-economic group Conclusion. The article concludes with a discussion of implications of the findings for practice.

Objective to explore barriers and facilitators that enable women to access skilled birth attendance in Afar Region, Ethiopia. Design researchers used a Key Informant Research approach (KIR), whereby Health Extension Workers participated in an intensive training workshop and conducted interviews with Afar women in their communities. Data was also collected from health-care workers through questionnaires, interviews and focus groups. Participants fourteen health extension workers were key informants and interviewers; 33 women and eight other health-care workers with a range of experience in caring for Afar childbearing women provided data as individuals and in focus groups. Findings participants identified friendly service, female skilled birth attendants (SBA) and the introduction of the ambulance service as facilitators to SBA. There are many barriers to accessing SBA, including women׳s low status and restricted opportunities for decision making, lack of confidence in health-care facilities, long distances, cost, domestic workload, and traditional practices which include a preference for birthing at home with a traditional birth attendant. Key conclusions many Afar men and women expressed a lack of confidence in the services provided at health-care facilities which impacts on skilled birth attendance utilisation. Implications for practice ambulance services that are free of charge to women are effective as a means to transfer women to a hospital for emergency care if required and expansion of ambulance services would be a powerful facilitator to increasing institutional birth. Skilled birth attendants working in institutions need to ensure their practice is culturally, physically and emotionally safe if more Afar women are to accept their midwifery care. Adequate equipping and staffing of institutions providing emergency obstetric and newborn care will assist in improving community perceptions of these services. Most importantly, mutual respect and collaboration between traditional birth attendants (Afar women׳s preferred caregiver), health extension workers and skilled birth attendants will help ensure timely consultation and referral and reduce delay for women if they require emergency maternity care.

OBJECTIVE To determine whether reliable birth cohort prevalence rates of disabling conditions in early childhood can be obtained from child health information systems. DESIGN Comparison of two sources of information on motor and sensory disabilities: from child health information systems held by health authorities, and a population register that uses multiple sources of ascertainment. SETTING The counties of Oxfordshire, Buckinghamshire, and Northamptonshire. PARTICIPANTS Children born to residents of the three counties between 1984 and 1989. RESULTS Eight hundred and twenty children (6.0/1000 live births) were identified from the child health system as having one or more of the conditions, and 580 (4.2/1000 live births) were identified from the population register; however, only 284 children were identified by both sources. CONCLUSIONS It is currently impossible to monitor trends in the prevalence rate of disabling disorders in childhood using the child health information systems. Agreement about ways of collecting, recording, and collating information on disability would be a useful step towards realising the full potential of these systems.

AIMS—To describe the birthweight specific rate of severe vision loss among babies born between 1 January 1984 and 31 December 1987 to mothers resident in a geographically defined area, to classify the causes of vision loss by time of origin, and to describe the associated sensory and motor impairments and disabilities. METHODS—Cases were identified from a population register of children with early childhood impairment, which uses multiple sources of ascertainment. Further clinical information was retrieved from hospital records and by asking ophthalmologists caring for the children. RESULTS—166 (1.25/1000 live births) children with severe vision loss diagnosed by the age of 5 years were identified. The rate among babies born weighing less than 1500 g at birth was 26 times higher than the rate for babies between 2500 g and 3499 g. These very low birthweight babies contribute 17.5% of all severely visually impaired children. Almost two thirds of children with severe vision loss have a lesion of prenatal origin. Other sensory or motor deficits are present in 69% of the children. Retinopathy of prematurity accounted for 5.4% of all visually impaired children and seven of the 166 children met the criteria for perinatal asphyxia. CONCLUSIONS—Although the contribution made by babies with a low birth weight to overall severe vision loss in the community is small, many of these children have additional impairments and probably place considerable demands on health and educational services and families. Reduction in the frequency of vision problems in the preschool population as a whole is unlikely to occur until there are major advances in the understanding of the aetiology and prevention of eye conditions of genetic, prenatal, and developmental origin. Keywords: low birth weight; vision loss

Working memory (WM) processes are often thought to play an important role in the cognitive regulation of negative emotions. However, little is known about how they influence emotional processing. We report two experiments that tested whether a concurrent working memory task could modulate the emotional startle eyeblink effect, a well-known index of emotional processing. In both experiments, emotionally negative and neutral pictures were viewed in two conditions: a "cognitive load" (CL) condition, in which participants had to actively maintain information in working memory (WM) while viewing the pictures, and a control "no load" (NL) condition. Picture-viewing instructions were identical across CL and NL. In both experiments, results showed a significant reduction of the emotional modulation of the startle eyeblink reflex in the CL condition compared to the NL condition. These findings suggest that a concurrent WM task disrupts emotional processing even when participants are directing visual focus on emotionally relevant information.

(1999). O'Brien's How to Tell a True War Story. The Explicator: Vol. 57, No. 3, pp. 182-184.

Severe hyperhidrosis affects 2.8% of the population and can be emotionally devastating. First-line therapy employs topical agents such as aluminum chloride (AC), but efficacy and tolerability vary widely. Botulinum toxin type A (BTX-A) is FDA-approved for the treatment of primary focal axillary hyperhidrosis unresponsive to topical therapy. A single-center, randomized, parallel, open-label, 12-week study was performed to compare the efficacy and safety of BTX-A with 20% AC for the treatment of primary focal axillary hyperhidrosis. Twenty-five subjects were randomized to either BTX-A or AC treatment, and were evaluated for treatment response by an improvement ofor =2 grades on the Hyperhidrosis Disease Severity Scale (HDSS). At week 4, 92% of the subjects in the BTX-A group achieved treatment response compared with 33% of the subjects in the AC group. Overall, treatment with BTX-A was more effective and provided greater patient satisfaction than with AC. Treatment with AC was effective and tolerated in 29% of the subjects.

Objective to explore the experiences of women with type 1 diabetes, living in rural Australia, while preparing for pregnancy and childbirth. Additionally, we aimed to describe the women's engagement with, and expectations of, health-care providers during this period, and subsequently highlight potential service and informational gaps. Design qualitative research using a collective case-study design; seven women with type 1 diabetes who had given birth within the previous 12 months participated in in-depth interviews about their experiences of pregnancy and birth. Data were analysed thematically. Setting The experience of type 1 diabetes, preconception preparation and pregnancy among rural Australian women was explored, including interactions with health professionals. Participants seven women aged between 26 and 35 years agreed to be interviewed. The woman had one or two children and had given birth within the past 12 months. Findings rigid narrow control of blood glucose levels before conception and during pregnancy created unfamiliar body responses for women, with hypoglycaemic symptoms disappearing or changing. For example, some women mentioned developing tunnel vision or numbness and tingling around their lips and tongue as different symptoms of hypoglycaemia. Women needed information and support to differentiate between what might be normal or abnormal bodily processes associated with pregnancy, diabetes, or both. The women's preparation for conception and pregnancy was reliant on the level of available expertise and advice. Participants' experiences were coloured by their limited access and interactions with expert health professionals. Conclusion women with type 1 diabetes experienced significant hardship during their pregnancy, including a higher incidence of hypoglycaemic episodes, a loss of hypoglycaemic symptom recognition and weight gain. These difficulties were compounded by a scarcity of available information to support the management of their pregnancy and a lack of availability of experienced health professionals. Implications for practice national and international consensus guidelines emphasise the importance of preconception and pregnancy care for women with type 1 diabetes. Close clinical supervision and the development of closer co-operation and partnership between the women and health-care providers before conception and during pregnancy may improve outcomes for these women and their babies. Building confidence in professional care requires increased access to specialist services, increased levels of demonstrated knowledge and expertise and better general community access to information about preparation for pregnancy and birth among women who have type 1 diabetes.

The purpose of this study was to evaluate the impact of nursing telephone triage on the appropriateness of emergency department (ED) use among 563 patients at a military hospital by comparing 286 ED patients referred by the Tel-a-Nurse Line (TAN) with 277 non-TAN-referred patients from October 2000 to November 2000. When controlling for confounding factors, TAN-referred patients had less appropriate ED use than non-TAN-referred patients, although this was not statistically significant (odds ratio = 0.87, p = 0.452). After excluding TAN patients with a primary clinic disposition but who were directed to the ED because no clinic appointments were available, TAN-referred patients had more appropriate referrals than non-TAN patients, although this was also not significant (odds ratio = 1.19, p = 0.401). TAN patients directed to the ED because of clinic appointment unavailability contributed significantly to inappropriate ED use with 62% having low acuity. This finding underscores the need to evaluate clinic availability for the TAN line and possibly for all patients as well.

Atomic force microscope (AFM) is now a standard imaging tool in laboratories but has displayed limited capability of nanolithography. We discover that an internal tensile strain exists in poly(3-hexylthiophene-2,5-diyl) (P3HT) films, and the physical effect is utilized to achieve highly tunable and high-throughput nanolithography. Trenches with widths spanning nearly two orders of magnitude from 40nmto2.3μm are fabricated. We show that P3HT is also excellent for pattern transfer to inorganic materials. Furthermore, a lithography speed of 0.5mm∕s is achieved, which is a few orders of magnitude higher than other known methods of AFM-based nanolithography.