Search

Abstract Background Abortion-related complications remain a main cause of maternal mortality. There is little evidence on the availability and quality of post-abortion care (PAC) in humanitarian settings. We assessed the quality of PAC in two hospitals supported by an international organization in Jigawa State (Nigeria) and Bangui (Central African Republic, CAR). Methods We mapped indicators corresponding to the eleven domains of the WHO Maternal and Newborn Health quality-of-care framework to assess inputs, processes (provision and experience of care), and outcomes of PAC. We measured these indicators in four components of a cross-sectional multi-methods study: 1) an assessment of the hospitals’ PAC signal functions, 2) a survey of the knowledge, attitudes, practices, and behavior of 140 Nigerian and 84 CAR clinicians providing PAC, 3) a prospective review of the medical records of 520 and 548 women presenting for abortion complications and, 4) a survey of 360 and 362 of these women who were hospitalized in the Nigerian and CAR hospitals, respectively. Results Among the total 27 PAC signal functions assessed, 25 were available in the Nigerian hospital and 26 in the CAR hospital. In both hospitals, less than 2.5% were treated with dilatation and sharp curettage. Over 80% of women received blood transfusion or curative antibiotics when indicated. However, antibiotics were given to about 30% of patients with no documented indication. Among discharged women in CAR, 99% received contraceptive counseling but only 39% did in Nigeria. Over 80% of women in Nigeria reported positive experiences of respect and preservation of dignity. Conversely, in CAR, 37% reported that their privacy was always respected during examination and 62% reported short or very short waiting time before seeing a health provider. In terms of communication, only 15% felt able to ask questions during treatment in both hospitals. The risk of abortion-near-miss happening ≥ 24h after presentation was 0.2% in Nigeria and 1.1% in CAR. Only 65% of women in the Nigerian hospital and 34% in the CAR hospital reported that the staff provided them best care all the time. Conclusion Our comprehensive assessment identified that these two hospitals in humanitarian settings provided lifesaving PAC. However, hospitals need to strengthen the patient-centered approach engaging patients in their own care and ensuring privacy, short waiting times and quality provider-patient communication. Health professionals would benefit from instituting antibiotic stewardships to prevent antibiotic-resistance.

BackgroundA specific phobia is an anxiety disorder that is characterised by persistent and excessive fear in the presence of the object of the phobia. Animal phobias are the most prevalent forms of specific phobia among humans. Fear of snakes (snake phobia) is present in non-human primates which suggests its evolutionary origins as the ability to detect the threat of snakes was critical for survival. Snake phobia is a critical factor in protecting snakes and mitigating snakebite burden. To date, only one standardised psychometric test [the Snake Questionnaire (SNAQ) developed in 1974] has been used to quantify snake phobia although this was not performed in snakebite-endemic countries. In this study, we aimed to determine snake phobia in India, where snakebites and resulting deaths, disabilities and socioeconomic impacts are high.Methodology/principal findingsA modified version of the SNAQ (i.e. SNAQ12), which has previously demonstrated internal consistency, excellent reliability, and good discrimination between phobics and non-phobics in Europe was used in this study. SNAQ12 was developed both in English and Tamil and validated by testing on several individuals. Then, the final questionnaire was disseminated to members of the public through various methods including social media and in person through academic and clinical organisations. We received a total of 2032 responses, comprising 1086 [53.4%] males and 946 [46.6%] females, and these data were analysed to determine various aspects of snake phobia in the study population.Conclusions/significanceThe results demonstrated good internal consistency in using SNAQ12 to determine the phobia amongst the tested population. The data suggests that males are more snake-phobic in all age groups than females in India, in contrast to previous research that suggested that females are usually more snake-phobic. No other critical factors contribute to snake phobia in this study population. The use of the SNAQ12 allowed us to easily discriminate between individuals with phobia and non-clinical controls. This tool can be used as part of the One Health approach to better understand the relationships between snake phobia and snakebites and their impact on the mental health and well-being of vulnerable populations.

Abstract The urinary bladder harbors a community of microbes termed the urobiome, which remains understudied. In this study, we present the urobiome of healthy infant males from samples collected by transurethral catheterization. Using a combination of enhanced culture and amplicon sequencing, we identify several common bacterial genera that can be further investigated for their effects on urinary health across the lifespan. Many genera were shared between all samples suggesting a consistent urobiome composition among this cohort. We note that, for this cohort, early life exposures including mode of birth (vaginal vs. Cesarean section), or prior antibiotic exposure did not influence urobiome composition. In addition, we report the isolation of culturable bacteria from the bladders of these infant males, including Actinotignum spp., a bacterial genus that has been associated with urinary tract infections in older male adults. Herein, we isolate and sequence 9 distinct strains of Actinotignum spp. enhancing the genomic knowledge surrounding this genus and opening avenues for delineating the microbiology of this urobiome constituent. Furthermore, we present a framework for using the combination of culture-dependent and sequencing methodologies for uncovering mechanisms in the urobiome.

Abstract Background Hypoadrenocorticism is an important differential for hypercalcemia. The etiology of hypercalcemia in hypoadrenocorticism in dogs is unclear. Objective To review the prevalence of hypercalcemia and use statistical models to identify clinical, demographic, and biochemical variables associated with hypercalcemia in dogs with primary hypoadrenocorticism. Animals One hundred ten dogs with primary hypoadrenocorticism; 107 with recorded total calcium (TCa), 43 recorded ionized calcium (iCa). Methods Multicenter retrospective observational study at 4 UK referral hospitals. Univariable logistic regression analyses were performed to assess the association between independent variables of signalment, hypoadrenocorticism type (glucocorticoid only deficient hypoadrenocorticism [GHoC] vs glucocorticoid and mineralocorticoid deficient hypoadrenocorticism [GMHoC]), clinicopathological variables and hypercalcemia. Hypercalcemia was defined as elevated TCa, an elevated iCa, or both elevated TCa and iCa (Model 1) or as elevated iCa (Model 2). Results Overall prevalence of hypercalcemia was 34.5% (38/110). The odds of hypercalcemia (Model 1) were increased (P

IntroductionUnderstanding what drives differences in values toward wild meat is important for developing legislation and behavioral change campaigns that promote sustainable use. Value orientations (VOs) underly behavior. VOs are influenced by personal (e.g., gender, generation), social (e.g., media, family), location (e.g., rural versus urban), and experience determinants. In Guyana, an ethnic diverse nation in South America, the national hunting laws have recently been instated. The wildlife management agency is rolling out a behavioral change campaign in collaboration with a sustainable use initiative. To support this campaign, we evaluated VOs toward wild meat across Guyana.MethodsApplying Multiple Correspondence Analysis and generalized linear models to data from interviews, we examined location, personal, and societal determinants for their influence on these VOs and explored how VOs translated into behavior, specifically wild meat consumption frequency.ResultsLocation (Indigenous and coastal: rural, town, urban), intertwined with ethnicity, and gender showed the strongest associations with variation in VOs. Respondents from Indigenous territories expressed mostly positive VOs compared to coastal Guyanese. Women expressed more neutral or negative, and more negative biocentric VOs compared to men, and this difference was largest among Indigenous but non-existent in urban sites. Negative anthropocentric VOs toward wild meat consistently grouped together and dominated among those not consuming wild meat. Highest consumption was seen among those expressing positive materialistic VOs. Positive anthropocentric VOs were associate with intermediate consumption frequencies and most typical for men. Those expressing negative values toward wild meat based on biocentric orientations toward wildlife consumed wild meat, but rarely.DiscussionOur results direct behavioral change efforts to men on the coast who consume wild meat for enjoyment at bars, restaurants, or family events. Based on our study, positive messaging promoting the coexistence between consumption of mostly resilient species and caring about wildlife would be well-received to support sustainable use policies.

Maternal near-miss events are a key measure of maternal health; abortion-related complications are one source of near-miss events. To understand the pathway to care of women with severe abortion-related events in a fragile context, we conducted in-depth semi-structured interviews with women who obtained treatment at a referral hospital in Jigawa State, Nigeria, in 2020–2021 (n = 61). We used the Three Delays Model (Thaddeus & Maine, 1994) to examine impediments in reaching care.The first delay (from the onset of symptoms of the pregnancy loss to the decision to seek care) was characterized by the duration of time it took to recognize the pregnancy and pregnancy loss in addition to religious beliefs that it is the will of a higher power that she lost the pregnancy. The second delay (from the decision to seek care to arriving at a place that could provide adequate care for her complication, i.e. the study site); was due to lack of money, lack of passable roads and transport, use of traditional healers, challenges being seen by providers at lower-level facilities, referrals not being facilitated and misdirection by healthcare providers. The third delay was not present in our results. No respondent said she knowingly interfered with the pregnancy; understanding why these pregnancy losses resulted in near-miss complications is critical to reducing maternal morbidity and mortality in Northern Nigeria. Addressing health literacy as well as social and financial barriers holds the potential to get women to care sooner and avert these near-miss or potentially life-threatening events.

Abstract Background Abortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR). Methods We used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records’ reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity. Results We analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%). Conclusion Our data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings.

n/a

Aleksandr Blok's 1912 poem “The Commander's Footsteps” is a response to personal trauma and loss that points towards a collective catharsis in history, namely, the end of the feudal social order, signaled by the approach of an automobile in the night. A unique modernist re-imagining of the Don Juan legend's occult finale (the confrontation between Don Juan and the statue of the Commander he killed), written at the nadir of Blok’s personal happiness, the poem removes the elements of passion and desire to focus exclusively on the subject’s anxiety and guilt. Yet though the title of the poem famously heralds the retribution to be visited on Don Juan, the work notably omits any resolution-- beyond a cryptic prophecy that Donna Anna, Don Juan’s nemesis, victim and (within the poem’s anagrammatic structure, analyzed by V. V. Ivanov in a seminal 1982 paper) twin, will rise from the dead. The silent, ambivalent, un-dead ‘Dead Mother’ later theorized by André Green thus replaces the Phallic Mother and pre-Oedipal mother of Blok’s previous periods (preceding and immediately succeeding the failed 1905 Revolution) as the embodiment of hopes for a revolutionary cataclysm, likewise superseding the phallogocentric Law represented by the punishing patriarchal Commander.

In some schools of thought of radicalisation research there is a tacit assumption that individuals become gradually radicalised in their ideas, attitudes, political preferences and worldview, and then motivated by this subsequently radicalise their actions to commit an act of terrorism. This article supports those who question this linear model and I argue that these two processes, which are here labelled as ideological and behavioural radicalisation, must be differentiated. Drawing on ideas from radicalisation in genocide studies, this article contributes to the social movement theory approaches to terrorism. As such, the article differentiates between ideological and behavioural radicalisation processes and argues that these two types of radicalisation can be sequenced with either first. This article posits that it is possible for individuals to engage in radical actions without having extreme preferences, just as it is equally possible for other individuals to have radical ideologies without acting on them, supporting more social movement theory approaches to radicalisation. The article provides a plausibility probe for this sequencing, demonstrating its empirical utility for participation in genocidal violence.

In response to declining sea ice cover, human activity in the Arctic is increasing, with access to the Arctic Ocean becoming more important for socio-economic reasons. Accurate knowledge of sea ice conditions is therefore becoming increasingly important for reducing the risk and operational cost of human activities in the Arctic. Satellite-based sea ice charting is routinely used for tactical ice management, but the marine sector does not yet make optimal use of sea ice thickness (SIT) or sea ice concentration (SIC) forecasts on weekly timescales. This is because forecasts have not achieved sufficient accuracy, verification and resolution to be used in situations where maritime safety is paramount, and assessing the suitability of forecasts can be difficult because they are often not available in the appropriate format. In this paper, existing SIT forecasts currently available on the Copernicus Marine Service (CMS) or elsewhere in the public domain are evaluated for the first time. These include the seven-day forecasts from the UK Met Office, MET Norway, the Nansen Environmental and Remote Sensing Center (NERSC) and the European Centre for Medium-Range Weather Forecasts (ECMWF). Their forecast skills were assessed against unique in situ data from five moorings deployed between 2016 and 2019 by the Barents Sea Metocean and Ice Network (BASMIN) and Barents Sea Exploration Collaboration (BaSEC) Joint Industry Projects. Assessing these models highlights the importance of data assimilation in short-term forecasting of SIT and suggests that improved assimilation of sea ice data could increase the utility of forecasts for navigational purposes. This study also demonstrates that forecasts can achieve similar or improved correlation with observations when compared to a persistence model at a lead time of seven days, providing evidence that, when used in conjunction with sea ice charts, SIT forecasts could provide valuable information on future sea ice conditions.

How much agency perpetrators have during genocide is highly contested and significant for dealing with the past after the end of conflict. In this context, ascriptions of roles such as perpetrators, bystanders and victims are drawn upon to delineate responsibility and innocence. Yet, this simple, black-and-white categorisation belies the complexity of roles which individuals can take on and the actions they engage in during genocide and mass violence. Naturally, there are many actors who fit neatly into categories as perpetrators who kill, victims who are killed or heroes who rescue. However, people can often be more aptly located in the ‘grey zones’ between these categories. This article explores the various types of actions that former low-level cadres of the Khmer Rouge engaged in, and looks at how they represent these actions. Former Khmer Rouge portray themselves only rarely and indirectly as perpetrators, but more often as victims and sometimes as heroes; this article uncovers various strategies they employ to justify these self-representations. These various actions and self-representations are drawn upon to reflect on the notion of agency of low-level perpetrators within the context of an oppressive genocidal regime.

Introduction: The nutrition situation in Bangladesh has improved substantially over the last decade. Nevertheless, dietary diversity of women of reproductive age continues to be low. In addition, global evidence on the effect of nutrition-sensitive agriculture interventions on dietary diversity is still developing. The Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project implemented a Farmer Nutrition School (FNS) intervention in two divisions (regions) in Bangladesh from 2012 to 2016. FNS targeted pregnant women and mothers with children less than two years of age (PLW) in the lowest two wealth quintiles. FNS was based on three well-established, evidence-based strategies--the essential nutrition and hygiene actions, the homestead food production approach, and farmer field schools. Methods: This study aims to assess the effect of SPRING’s FNS program on women’s dietary diversity, measured by a women’s dietary diversity score (WDDS) based on the nine-item FANTA/FAO scale. We followed up one cohort of women who participated in FNS beginning in November 2014. We undertook a two-stage sampling design to identify these women. First, forty-four FNS groups were randomly selected from the 2,560 FNS that were planned to be implemented during 2014-15. Second, 10 women were randomly drawn from each of the 44 FNS groups, which were scattered across 38 upazilas (sub-districts), 19 each in Barisal and Khulna Divisions. Sample size was calculated to detect a 0.25 effect size in the WDDS with a power of 80% and confidence interval of 95%. Three phases of surveys were conducted: before the FNS began (Phase 1-P1, November 2014), immediately after the completion of the FNS (Phase 2-P2, July - August, 2015), and one year after (Phase 3-P3, July 2016). A total of 386 women completed all three surveys. Data analyses included descriptive statistics and t-tests. Statistical significance is tested by the adjusted Wald test with a 95% confidence interval. Results: The percentage of FNS participants’ households that produced vegetables, poultry and fish significantly increased between P1 and P2, from 43% to 95% (p

For quite some time, theories on the role of intent in genocide were conceptually frozen in polarised liberal and post-liberal, or purpose- and knowledge-based approaches, respectively. In accordance with recent criminological thought that moves beyond the narrow debate, this article develops a new sociological perspective on the role of intent in genocide. Drawing on frame analysis it is argued that intent is mainly relevant for framing genocidal action at the macro level. However, individual low-level perpetrators act from a large number of different motivations, of which ideologies of intent are only one. Others range from obedience to authority, coercion and group pressures to sadism, opportunism or the allure of status and power. Further, rethinking genocide with social movement theory helps to combine purpose- and knowledge-based approaches without abandoning a distinct concept of genocide.

We present the successful utilization of resuscitative endovascular balloon occlusion of the aorta (REBOA) in a case of penetrating abdominal aortic injury. This allowed for hemorrhagic control and exposure of a large aortic defect at the level of the celiac access, which otherwise would have been diffi cult to control in an open fashion. Although use in this specifi c injury pattern in the literature is limited, REBOA can be a life-saving maneuver.

The study of the motivations of the people participating in genocide is necessary to fully understand the dynamics of genocide and its genesis, as these are the people who actually implement genocidal policies and provide its material manifestation. This paper looks into the motivations of mid-level perpetrators of the Armenian Genocide through the verdicts of the Ottoman Special Military Tribunal which was established in 1919. It is found that opportunistic motivations dominated for perpetrators’ participation, particularly the opportunity for material gain, rape, forced marriage, free labour and career progression. However, the ambiguous nature of authority, coercive structures and ideological tenets also provided a framework within which perpetrators could become motivated to participate.

For nearly forty years a violent conflict has been raging in Mindanao where the Moros are fighting for independence from the Philippine state. On August 5th 2008 the peace negotiation panels of the Government of the Philippines and the Moro Islamic Liberation Front were set to sign a Memorandum of Agreement on Ancestral Domain (MoA-AD), a final stepping stone on the way to a comprehensive peace agreement. However, a well-organised wave of protest swept from Christian settlers in Mindanao to the Supreme Court in Manila which declared the agreement unconstitutional. This paper presents a chronology of events surrounding the debate, analyses the arguments used in support and opposition of the MoA-AD and searches for causes of its demise, before looking at lessons to be learned for the future, especially regarding what President Arroyo can achieve before leaving office this year and what will be left to her successor.

Cellular abnormalities are not limited to motor neurons in amyotrophic lateral sclerosis (ALS). There are numerous observations of astrocyte dysfunction in both humans with ALS and in SOD1(G93A) rodents, a widely studied ALS model. The present study therapeutically targeted astrocyte replacement in this model via transplantation of human Glial-Restricted Progenitors (hGRPs), lineage-restricted progenitors derived from human fetal neural tissue. Our previous findings demonstrated that transplantation of rodent-derived GRPs into cervical spinal cord ventral gray matter (in order to target therapy to diaphragmatic function) resulted in therapeutic efficacy in the SOD1(G93A) rat. Those findings demonstrated the feasibility and efficacy of transplantation-based astrocyte replacement for ALS, and also show that targeted multi-segmental cell delivery to cervical spinal cord is a promising therapeutic strategy, particularly because of its relevance to addressing respiratory compromise associated with ALS. The present study investigated the safety and in vivo survival, distribution, differentiation, and potential efficacy of hGRPs in the SOD1(G93A) mouse. hGRP transplants robustly survived and migrated in both gray and white matter and differentiated into astrocytes in SOD1(G93A) mice spinal cord, despite ongoing disease progression. However, cervical spinal cord transplants did not result in motor neuron protection or any therapeutic benefits on functional outcome measures. This study provides an in vivo characterization of this glial progenitor cell and provides a foundation for understanding their capacity for survival, integration within host tissues, differentiation into glial subtypes, migration, and lack of toxicity or tumor formation.

Epidermoid cysts are uncommon accounting for less than 1% of all intracranial tumors. Among them, giant intradiploic epidermoid cysts of the posterior fossa i.e. those exceeding 5 cm are an even rarer entity. Here we report on the complete resection of a 7 cm posterior fossa epidermoid cyst involving the occipital bone in a 32-year-old female presenting with an acute on chronic exacerbation of headaches and vertigo. Complete resection including the cyst wall is crucial in preventing recurrence and malignant transformation. We add to limited existing data by reporting on the first systematic review to date assessing 25 cases of giant epidermoid cysts of the posterior fossa to discuss presentation, clinical and radiographic features and definitive management strategies.