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In low-income countries, prospective data on combined effects of in utero teratogen exposure are lacking and necessitates new research. The aim of the present study was to explore the effect of in utero teratogen exposure on the size of the kidneys and pancreas 5 years after birth in a low-income paediatric population. Data was collected from 500 mother–child pairs from a low-income setting. Anthropometric measurements included body weight, (BW) body height, mid-upper arm and waist circumference (WC). Clinical measurements included blood pressure (BP), mean arterial pressure and heart rate. Ultrasound measurements included pancreas, and kidney measurements at age 5 years. The main outcome of interest was the effect of maternal smoking and alcohol consumption on ultrasound measurements of organ size at age 5 years. Left and right kidney length measurements were significantly lower in smoking exposed children compared to controls (p = 0.04 and p = 0.03). Pancreas body measurements were significantly lower in smoking exposed children (p = 0.04). Multiple regression analyses were used to examine the associations between the independent variables (IDVs), maternal age, body mass index (BMI), mid-upper arm circumference (MUAC) and BW of the child, on the dependent variables (DVs) kidney lengths and kidney volumes. Also, the association between in utero exposure to alcohol and nicotine and pancreas size. WC was strongest (r = 0.28; p < 0.01) associated with pancreas head [F (4, 454) = 13.44; R2 = 0.11; p < 0.01] and tail (r = 0.30; p < 0.01) measurements at age 5 years, with in utero exposure, sex of the child and BMI as covariates. Kidney length and pancreas body measurements are affected by in utero exposure to nicotine at age 5 years and might contribute to cardiometabolic risk in later life. Also, findings from this study report on ultrasound reference values for kidney and pancreas measurements of children at age 5 years from a low-income setting.
Care-leavers – those transitioning from alternative care towards young adulthood – are widely recognized as a vulnerable population, yet child protection legislation seldom applies to them because they have reached adulthood. Despite this, little internationally comparative research on care-leaving policy and legislation has been conducted. This paper maps multinational policy and legislation and its impact on the services to care-leavers and the challenges they experience. An online survey was conducted with key informants in 36 countries and analysed by a multinational team of care-leaving scholars. Findings reveal that few countries have well-developed care-leaving legislation. Most countries provide little aftercare beyond the age of 18, even when legislation provides for it. Within the context of suboptimal social policy and limited aftercare services, findings also reveal high vulnerability among care-leavers. Recommendations for policy development, global dialogue, further research and advocacy are proposed.
In writing about Africa and the International Criminal Court (ICC) over the past two decades, the temptation to allude to Epic narratives has been ever-present, and one in particular has haunted our collective reflections on the subject. We have written about ‘stormy years’, ‘being caught between Scylla and Charybdis’ and on more than one occasion, an early draft has had the phrase ‘the Odyssey continues’ lurking somewhere in the text, if not the title. Recently, employing Homer's Epic became more difficult, as the Odyssey appeared to be headed towards a precipitous and premature end when African states started making plans for their collective withdrawal from the Rome Statute. While threats of a mass withdrawal have simmered – in the end only Burundi followed through (South Africa demurred) – there seems to be little hope of a rapprochement. In fact, recent developments in the Afghanistan situation suggest another storm might be on the horizon.
On reflection, in our writings at least, it has been unclear who was steering the ship: was the hero of the story the ICC navigating the waters (and avoiding the Siren calls) of international politics, or were African states navigating the waters of international law? In this chapter we want to focus specifically on the role that the ICC has played, not as hero but as protagonist, in Africa over the past two decades. We do so, jumping mythologies, with the intention of neither burying nor praising the ICC, but in order to reflect critically on the role it has played in the demise of this once promising relationship, and we consider whether the story might have turned out differently (or might yet still). For, while much of the blame is currently placed solely at the feet of African states and their hostility towards specific investigations (particularly against heads of state), this chapter aims to show that: (1) the fractures within this relationship have come about as a result of the actions (and inactions) of the ICC and its supporters; and (2) as far as African states’ complaints are concerned, these were general concerns they had about the ICC that were present at its founding in 1998, and these concerns have come to be realised, for the worse, with each passing year.
This study aimed to determine the knowledge, perceptions and practices of dietitians in South Africa regarding the Regulations Relating to Foodstuffs for Infants and Young Children (R991).
A mixed methods, cross-sectional design was used.
Quantitative data were collected using an online survey (n 282) and qualitative data by means of two focus group discussions (n 12).
Participants were dietitians registered with the Health Professions Council of South Africa.
Dietitians’ average knowledge score was 64·8 % ± 12·5. Those working in infant and young child feeding had a 5 % higher knowledge score (95 % CI 1·4, 8·6, P = 0·01). Perceptions towards the Regulations were generally positive, and the majority of practices were compliant. Positive perceptions seemed to correlate with compliant practices. The most frequently selected enabler to the implementation of the Regulations was ‘Increase in other initiatives which support, protect and promote breastfeeding’, and the most frequently selected barrier was ‘Lack of awareness of the Regulation among health care providers’. The major themes from the focus group discussions comprised: less knowledge among dietitians and mothers about products controlled under the Regulations, non-compliance of other health care providers, the dietitians’ role in support and enforcement, the discrepancy between practice in private and public sectors and a lack of enforcement.
South Africa has taken a bold step in legislating the International Code of Marketing of Breast-milk Substitutes and should upscale programmes to ensure consistent monitoring and enforcing of the Regulations.
On 30 September 2017, an Air France Airbus A380-800 suffered a failure of its fourth engine while over Greenland. This failure resulted in the loss of the engine fan hub, fan blades and surrounding structure. An initial search recovered 30 pieces of light debris, but the primary part of interest, a ~220 kg titanium fan hub, was not recovered because it had a different fall trajectory than the light debris, impacted into the ice-sheet's snow surface, and was quickly covered by drifting snow. Here we describe the methods used for the detection of the fan hub and details of the field campaigns. The search area included two crevasse fields of at least 50 snow-covered crevasses 1 to ~30 m wide with similar snow bridge thicknesses. After 21 months and six campaigns, using airborne synthetic aperture radar, ground-penetrating radar, transient electromagnetics and an autonomous vehicle to survey the crevasse fields, the fan hub was found within ~1 m of a crevasse at a depth of ~3.3 to 4 m and was excavated with shovels, chain saws, an electric winch, sleds and a gasoline heater, by workers using fall-arrest systems.
The Department of Health in the UK wants the National Health Service to make £20 Billion worth of efficiency savings by 2015 to reinvest.
In the UK the General Hospitals use paper records which are then scanned to create electronic records while Psychiatric Hospitals require that information to be typed on to their electronic records and these electronic records are not available to each other.
Therefore liaison psychiatry assessments require a written entry to be made in the Medical notes and a second entry typed on to the psychiatric electronic patient record which requires a full psychiatric history.
This duplication in typing information was consuming a considerable amount of this Teams time and resources which could have instead been spent with patients.
To identify how much time is spent by Staff typing information on to the psychiatric electronic patient records.
We electronically checked for the preceding three months the amount of time spent typing information on to the electronic records after every liaison psychiatry assessment.
We were then able to obtain the average for every week.
On average about 36 to 40 hours were spent every week typing information on to the electronic records.
Liaison Psychiatry should dispense with the requirement for information to be duplicated on to the electronic patient records and should instead scan the written entry made in the Medical notes.
This should lead to a saving of about £50,000, enough to employ an additional member of Staff every week.
When the compilers of Justinian's Digest in the sixth century CE reflected on the origins of Roman law as a legal order, they decided that the topic was of such importance that it had to be placed at the very front of the Digest, in book 1 title 2, directly after the introductory title in which central concepts such as ‘justice’ and ‘law’ were explained. In compiling this title, they relied on the works of two Roman jurists. The first, the enigmatic Gaius, a jurist of the mid-second century CE who, in a book (now lost) on the Twelve Tables (lex Duodecim Tabularum), wrote: ‘Since I am aiming to give an interpretation of the ancient laws, I have concluded that I must trace the law of the Roman people from the very beginning of their city. This is not because I like making excessively wordy commentaries, but because I can see that in every subject a perfect job is one whose parts hang together properly.’ While there is no doubt some Greek philosophy latent in this statement, it is not the main focus of our discussion here. For us, as for Gaius, it is important to stress that origins matter. No subject can be understood properly without a fundamental appreciation of its history. This fundamental principle is one the Romans understood only too well and, in this time of ‘presentism’, has become more important than ever.
But the compilers did not rely solely on Gaius’ book on the Twelve Tables. We do not know why. Instead, they chose to populate the rest of the title with a long passage from Pomponius’ Enchiridion (Manual). Much has been written about this account of the history of Roman law, written by a Roman jurist who lived during the reign of Marcus Aurelius. As the only comprehensive narrative concerning the development of Roman law, it has become a cornerstone for subsequent understanding of the nature and contours of the Roman legal order. And although not unproblematic, given the absence of corroborating evidence, it has left an enduring imprint – it is, for example, central to Edward Gibbon's account of Roman law in his seminal Decline and Fall.
Bringing together a team of international experts from different subject areas – including law, BG, archaeology and anthropology – this book re-evaluates the traditional narratives surrounding the origins of Roman law before the enactment of the Twelve Tables.
The English language has been present in South Africa since the end of the eighteenth century. Although regional varieties were established as part of the nineteenth-century development of South African English (SAfE) as its own variety, the general consensus has been that since the mid-twentieth century the ancestral ‘settler’ variety of SAfE has shown a high degree of regional homogeneity and only a limited set of regionalisms. This chapter investigates more recent developments in this regard, drawing on an acoustic analysis of data from upper-middle class male and female speakers of General SAfE from the three largest urban conurbations of South Africa: Johannesburg, Cape Town and Durban. The focus is on vowel quality and the results include (1) greater centralization of KIN in Durban (2) a Cape Town-centered process of TRAP and DRESS lowering accompanied by STRUT backing (the so-called Reverse Short Front Vowel Shift in SAfE) (3) clearly diphthongal variants of PRICE in Johannesburg and Cape Town in comparison to Durban and (4) backed and lowered variants of GOAT in Johannesburg and Durban as compared to Cape Town. Overall the results suggest a growing degree of regional differentiation in South African English.
This paper investigates artificial neural network (ANN)-based simulators as an alternative to physics-based approaches for evolving controllers in simulation for a complex snake-like robot. Prior research has been limited to robots or controllers that are relatively simple. Benchmarks are performed in order to identify effective simulator topologies. Additionally, various controller evolution strategies are proposed, investigated and compared. Using ANN-based simulators for controller fitness estimation during controller evolution is demonstrated to be a viable approach for the high-dimensional problem specified in this work.
Exercise training has been shown to increase exercise capacity in survivors of Fontan surgery. The geographic distribution of the Fontan population has been a barrier to hospital-based exercise training programmes. The objective of this study was to establish whether a home exercise training programme could achieve similar improvements to a hospital programme.
Adolescents with a Fontan circulation aged 12–19 years were prospectively recruited in a hospital or home exercise training programme. Patients underwent cardiopulmonary exercise testing and completed the Paediatric Quality of Life Inventory at initial assessment and after completion of an 8-week programme. Both groups performed two 1-hour training sessions per week. Patients in the home training programme had their first session in the hospital, and then progressed independently with one phone consult per week and one home visit by a physiotherapist.
In total, 17 patients, with a mean age of 15±3 years, completed the training programme (six hospital). Characteristics and baseline performance of patients were similar in both groups. Oxygen consumption at anaerobic threshold increased from 19.3±3.8 to 21.6±6.0 ml/kg/minute (p=0.02) and peak oxygen pulse increased from 8.8±2.5 to 9.5±2.7 ml/beat (p=0.049). Total quality of life scale improved from 68 to 74% (p=0.01) and psychosocial health improved from 67 to 74% (p=0.02). No patient experienced training-related complications.
Exercise training is beneficial and most likely safe after Fontan, resulting in improved exercise capacity and self-reported quality of life. Home exercise training programmes are probably as effective as hospital programmes. Home exercise training programmes should be integrated in the follow-up care of patients undergoing Fontan surgery.