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Frederick Douglass was perhaps the most successful African American abolitionist to traverse the Atlantic and tour the British Isles. In town halls, churches, taverns, and private parlor rooms across the country he spoke to hundreds of thousands of people, sparking a wave of transatlantic abolition that had a deep impact on the British landscape. While he only traveled to Britain and Ireland three times, the friendships and networks he created, together with his transformative experiences there, shaped, supported and sustained his public antislavery work in the United States for the rest of his life.
Miscarriage and stillbirth are not rare events and losing a baby can have an overwhelming and long-term impact on parents, on existing and subsequent children and on wider family. Potential parents’ feelings of devastation, intense grief, anxiety, guilt and self-blame and loss following such a death have been identified in literature written over past centuries. Fifty years ago, miscarriage and stillbirth were a private matter and unspoken of, leaving parents to manage their grief alone. This chapter aims to shine a light on the changes in attitudes and the support available to those who have experienced miscarriage and perinatal death since the 1960s. A review of relevant research, policy and practice identified significant advances in medical science and major changes to the law – changes that have influenced attitudes to abortion, same-sex parenthood and single mothers. Medical advances have made childbirth safer and the use of IVF has extended the opportunity of motherhood to a wider group of women. The campaigning of numerous charities has led to far greater understanding of the impact of baby loss on parental mental health and parenting capacity.
To assess the sexual and reproductive health (SRH) needs of women admitted to a psychiatric intensive care unit (PICU), and acceptability of delivering specialist SRH assessments/interventions in this setting. Secondary aims were to explore the barriers to access and the feasibility of providing SRH assessments and interventions in the PICU.
A retrospective analysis of fifteen months’ activity data found that only 25 SRH referrals had been made across 205 PICU admissions. This low referral rate of 12% likely reflected pathway barriers and was unlikely to represent the actual clinical need in female PICU patients. A bi-monthly SRH in-reach clinic and a nurse led SRH referral pathway were implemented on the PICU over a seven-month period. Within a quality improvement framework, a staff training needs assessment was performed, training delivered, a protocol developed, staff attitudes explored, and patient and carer engagement sought.
A quality improvement approach streamlined SRH assessments on the PICU and resulted in 42% of women being assessed and a 3.5-fold increase in uptake. At least 30% of the women in the PICU had unmet SRH needs identified and proceeded to a specialist appointment. This amounts to a minimum 2.5-fold increase in SRH unmet need detection.
The most common SRH needs were complex gynaecological issues (such as period problems, pelvic pain, vaginal discharge), STI advice/testing and contraception advice/options. 21% of women initiated SRH interventions, and 14% completed all the interventions required for their needs. The most common interventions were in the areas of contraception advice/family planning and STI advice/testing.
Staff confidence on assessing SRH topics was identified as a barrier to access with a positive shift noted after bespoke SRH training was implemented and a protocol introduced: on a scale of 0-10 (with 10 being high), 81.3% of staff rated their confidence 8 or above in relation to discussing contraception/sexually transmitted infections (pre-training: 25.0%), and 93.8% in relation to discussing risky behaviours (pre-training: 18.8%). All 11 patient and carer participants felt it was important to have a forum to talk about SRH and 8 (72.7%) agreed it was important in the PICU.
Results identify that SRH needs for PICU admissions are greater than previously realised. Staff highlighted the acceptability and importance of SRH care, if interventions are appropriately timed and the patient's individual risk profile considered. Providing a nurse led referral pathway for an SRH in-reach clinic is acceptable, feasible and beneficial for PICU patients.
To compare two sexual and reproductive health (SRH) clinical pathways (a priority appointment at a mainstream SRH clinic versus assertive community outreach), and to explore how each improves access to care for people with psychotic mental illness, severe addictions and/or learning disability.
Observational, descriptive study of two clinical access pathways within SHRINE (Sexual and Reproductive Health Rights, Inclusion and Empowerment), a specialist SRH programme to improve SRH care for severely marginalised people.
The SHRINE programme delivers effective, ethical, accessible and user-centred SRH care for people with severe addiction, serious mental illness and/or learning disability in the deprived inner London boroughs of Lambeth and Southwark. These individuals often find accessing conventional SRH clinics very difficult. SHRINE clients can self-refer but most of them are referred by their health or social worker.
Clients or referrers indicate their preferred pathway: priority appointment at the mainstream clinic or assertive community outreach. The priority appointment pathway at Camberwell Sexual Health Centre (CSHC) is as flexible as possible, with minimal waiting times, reminders, invitation to bring a friend or care worker and active follow-up of non-attenders via key workers. Assertive community outreach can be in an addiction clinic, postnatal ward, mental health centre, psychiatric ward, outpatient clinic, homeless hostel or the client's home.
Time allocation for outreach and priority appointment-based care was 8 and 4 hours per week respectively. Care in both pathways was provided by senior doctors. Content of care was similar but facility for provision of gynaecological care including cervical smears and investigations for abnormal uterine bleeding e.g. pelvic ultrasound scans and endometrial biopsies were only available in the mainstream clinic setting at CSHC.
From May 2016 to December 2020 SHRINE received 1367 referrals from 125+ teams. We offered 1591 first or follow-up appointments of which 1369 (86%) were attended. A total of 1153 (84%) of our patient contacts occurred in the outreach setting where 93% the appointments were attended. Of the 358 appointments at CSHC 316 (60%) were attended.
Making clinic access as simple and convenient as possible is not a sufficient strategy to meet the SRH needs of marginalised people. To enable them to realise their human right to sexual and reproductive health we need to leave our clinics and meet our clients where they are. A combined model of outreach and priority access clinic pathways is essential for provision of SRH care for people with mental illness.
To assess the feasibility and utility of introducing the following changes on to in-patient units:
Structural and cultural adaptation to create a sleep friendly ward environment
A “Protected Sleep Time” between midnight and 6am
Routine screening for sleep disorders, including obstructive sleep apnoea and restless leg syndrome
Insomnia and other sleep disturbances are cause, correlate and consequence of psychiatric disorders. Routine hourly night time observations, ward noise, bright lights at night time, sleep disorders, insufficient exercise, insufficient day light exposure, too much caffeine and inappropriate psychotropic use are all causes of disturbed sleep (Horne 2018).
Seven wards participated in a pilot (SleepWell). These consisted of one male and two female Acute Wards (General Adult), a High Dependency Unit, a Neurorehabilitation ward, an in-patient dementia service and one rehabilitation ward. These wards were supported via an existing trust management structure and the pilot was specifically supported by two trust managers (RW and RB) and by a clinical director (PK). The expectation was that each ward would identify a sleep champion from existing staff to facilitate the changes. A “product” was developed which identified core sleep management features but, in addition, wards were not confined to these. The existing policy that all inpatients should be checked each hour over night was suspended for the pilot wards and the patients had protected sleep time (PST) if the MDT agreed that it was clinically appropriate.
Quantitative and qualitative techniques were used to identify facilitators of change, impact on sleep and, outcome.
Protected sleep was viewed positively by all staff and approximately 50% of patients on the pilot wards were able to have PST at some point in their admission. Routine sleep disorder assessments were harder to implement and 33% of patients were screened. There were no deaths or significant events on patients due to PST. Hypnotic use on the pilot wards reduced. It is anticipated that PST where it is safe will be rolled out across all adult and old age wards in the trust.
With support, it has been feasible to change many aspects of sleep management across a breadth of inpatient units in a large NHS trust.
This chapter focuses on the lexicogrammatical systems of IMPERATIVE MOOD and INDICATIVE MOOD in the Australian language, Pitjantjatjara, in relation to the discourse-semantic systems of NEGOTIATION, SPEECH FUNCTION, ENGAGEMENT and GRADUATION and the phonological system of TONE. It treats co-selections of features in MOOD and TONE as instantial couplings (Martin 2008) that realise variations in speech function. This discourse-semantic orientation departs from the treatment in Halliday (1967), Halliday & Greaves (2008) and Rose (2001, 2008) of tone/mood relations in terms of grammatical delicacy. Options in NEGOTIATION and SPEECH FUNCTION are illustrated with a series of exchanges that exemplify the coupling of MOOD and TONE selections. Imperative and indicative mood systems are then described in detail and exemplified with mood/tone couplings, including options for metaphors of mood. The chapter concludes by outlining grammatical and phonological realisations of ENGAGEMENT and GRADUATION, including the lexicogrammatical system of MODAL ASSESSMENT.
When people living in poverty are asked to describe their living conditions, mental health issues quickly come to mind (grief, sadness, anger, fear, bitterness, frustration, discontent, anxiety, and emotional damage consisting of low mood and depression, fatigue, hypersensitivity, sleep difficulties and physical pain). Although the association between poverty and mental health have been widely demonstrated in the literature, care must be taken to avoid the psychiatrization of poverty. However, how can healthcare be provided to people living in poverty when basic needs are not met? This article explores the global challenge of providing mental health services in impoverished populations, using the example of the poorest country in America: Haiti. It examines the availability of services offered through the Mental Health Centre at Morne Pelé, and the necessity for innovative and comprehensive approaches to provide culturally appropriate care that meets the real needs of populations. It highlights effective measures that policy makers should implement to develop an efficient mental healthcare system based on the lessons of the Mental Health Centre at Morne Pelé.
Within the context of the work and achievements of James Croll, this paper reviews the records of direct observations of glacial landforms and sediments made by Charles Lyell, Archibald and James Geikie and James Croll himself, in order to evaluate their contributions to the sciences of glacial geology and Quaternary environmental change. The paper outlines the social and physical environment of Croll's youth and contrasts this with the status and experiences of Lyell and the Geikies. It also outlines the character and role of the ‘Glasgow School’ of geologists, who stimulated Croll's interest into the causes of climate change and directed his focus to the glacial and ‘interglacial’ deposits of central Scotland. Contributions are outlined in chronological order, drawing attention to: (i) Lyell's high-quality observations and interpretations of glacial features in Glen Clova and Strathmore and his subsequent rejection of the glacial theory in favour of processes attributed to floating icebergs; (ii) the significant impact of Archibald Geikie's 1863 paper on the ‘glacial drift of Scotland’, which firmly established the land-ice theory; (iii) the fact that, despite James Croll's inherent dislike of geology and fieldwork, he provided high-quality descriptions and interpretations of the landforms and sediments of central Scotland in order to test his theory of climate change; and (iv) the great communication skills of James Geikie, enhanced by contacts and evidence from around the world. It is concluded that whilst direct observations of glacial landforms and sediments were critical to the long-term development of the study of glaciation, the acceptance of this theory was dependent also upon the skills, personality and status of the Geikies and Croll, who developed and promoted the concepts. Sadly, the subsequent rejection of the land-ice concept by Lyell resulted in the same factors challenging the acceptance of the glacial theory.
As championed by the work of Ed Zigler, investing in nurturing environments for all children is a chief tenet of primary prevention that will have far-reaching benefits to the health and welfare of all members of society. Children who endure child maltreatment (CM) are among society's most vulnerable. Prospective longitudinal research aimed at a comprehensive understanding of the mechanisms linking CM to subsequent adverse health consequences is needed to improve outcomes and to strengthen causal inference. This paper outlines the methods of the Child Health Study (CHS), a large, state-wide longitudinal cohort of recently maltreated and nonmaltreated youth aged 8–13 who will be assessed every 2 years. The CHS is designed to include in-depth assessments of multiple environmental, behavioral, neural, physiological, and molecular mechanisms through which CM may impact a broad spectrum of youth development, including behavioral and physical health outcomes. In addition to describing the conceptual framework and methods underlying the CHS, we provide information on valuable “lessons learned” in the hopes of supporting future research efforts facing similar challenges. The ultimate goal of this research is demonstrating how policies regarding CM impact the well-being, resilience and recovery of survivors and that they are worthy of large public investment.
In this study it is hypothesized that there are differences between immunoglobulin G (IgG) content in colostrum from beef (Chianina, Podolica) and dairy (Holstein Friesian) cows and that variables such as breed, and parity can influence IgG content. The further objective was to determine if these factors may vary in terms of sensitivity, specificity and the cut point when data obtained with the digital Brix refractometer is compared with the gold standard radial immunodiffusion assay (RID). A total of 90 samples of first-milking colostrum were collected within 2 h after parturition. IgG concentration was determined indirectly by digital Brix refractometer and directly by RID. Results obtained by RID were compared among breed and parity. For the digital Brix refractometer, sensitivity and specificity to detect colostrum with an IgG concentration lower than 50 g/l were calculated and the optimal cut-point was selected for each breed. Samples containing less than <50 g/l IgG accounted for 15.9% of the total. Parity influenced colostral IgG concentration and beef cows had a higher mean concentration of IgG (101.1 g/l in Chianina and 90.6 g/l in Podolica) than dairy cows (71.1 g/l in Holstein Friesian) First parity Chianina cows had the highest IgG mean content (116.1 g/l). At the optimal cut-point for Brix refractometer (20%) sensitivity and specificity were 0.93 (0.84–0.97) and 0.81 (0.70–0.88), however, a breed-related cut-point could be used to reduce evaluation error. Linear regression modeling showed that refractometer data were related to RID (r = 0.78). Results obtained suggest that breed and parity can influence IgG content of colostrum and, despite the Brix refractometer being an excellent on-farm tool, a breed-based definition of optimal cut point is needed.
The fact that there is a large and growing number of older Canadians has generated a sense of urgency in improving seniors’ access to health and long-term care services. Many provincial health care systems have engaged in a range of reforms to help older adults remain healthy and independent. Although many transformational changes have taken place across Canada to improve primary care, variations exist across provinces and territories in terms of older adults’ access to primary health care. Opportunities exist for provinces to learn from successful reforms implemented in other Canadian jurisdictions. Residents of assisted living (AL) facilities are an ideal group to whom to target primary health care reforms, given the important role these facilities play in the care continuum and the complex needs of their residents. Allowing practitioners to practice to their full scope and assume greater responsibility within the health care system is a strategy adopted in some jurisdictions with success. This article reports on reforms that have been made to expand the scopes of practice of nurse practitioners and paramedics in some provinces, but also have the potential to improve access to primary health care for those living in AL across the entire country, including those living in smaller provinces such as New Brunswick.
Our objective was to describe, for the first time in an English-speaking Caribbean country, the contribution of ultra-processed foods (UPFs) to nutrients linked to non-communicable disease. Using a cross-sectional study design, dietary data were collected from two non-consecutive 24-h dietary recalls. Recorded food items were then classified according to their degree of processing by the NOVA system. The present study took place in Barbados (2012–13). A representative population-based sample of 364 adult Barbadians (161 males and 203 females) aged 25–64 years participated in the study. UPFs represented 40⋅5 % (838 kcal/d; 95 % CI 791, 885) of mean energy intake. Sugar-sweetened beverages made the largest contribution to energy within the UPF category. Younger persons (25–44 years) consumed a significantly higher proportion of calories from UPF (NOVA group 4) compared with older persons (45–64 years). The mean energy shares of UPF ranged from 22⋅0 to 58⋅9 % for those in the lowest tertile to highest tertile. Within each tertile, the energy contribution was significantly higher in the younger age group (25–44 years) compared with the older (45–64 years). One-quarter of persons consume ≥50 % of their daily calories from UPF, this being significantly higher in younger persons. The ultra-processed diet fraction contained about six times the mean of free sugars and about 0⋅8 times the dietary fibre of the non-ultra-processed fraction (NOVA groups 1–3). Targeted interventions to decrease the consumption of UPF especially in younger persons is thus of high priority to improve the diet quality of Barbadians.
Although bovine embryo in vitro production (IVP) is a common assisted reproductive technology, critical points warrant further study, including sperm traits and oxidative status of sperm for in vitro fertilization (IVF). Our aim was to evaluate whether the lipid peroxidation index of commercial bull semen is influenced by sperm traits and oxidative status of sperm populations selected using Percoll® gradient. Semen straws from 48 batches from 14 Nelore bulls were thawed individually, analyzed for motility and subjected to Percoll selection. After Percoll, the lipid peroxidation index of the extender was evaluated, whereas selected sperm were analyzed for motility, acrosome and membrane integrity, mitochondrial membrane potential, chromatin resistance and oxidative potential under IVF conditions. Batches were divided retrospectively in four groups according to lipid peroxidation index. Sperm from Group 4 with the lowest index of lipid peroxidation had, after Percoll selection, greater plasma membrane integrity (81.3%; P = 0.004), higher mitochondrial potential (81.1%; P = 0.009) and lower oxidative potential (135.3 ng thiobarbituric acid reactive substances (TBARS)/ml; P = 0.026) compared with Group 1 with highest lipid peroxidation index (74.3%, 73% and 213.1 ng TBARS/ml, respectively). Furthermore, we observed negative correlations for the lipid peroxidation index with motility, membrane integrity and mitochondrial potential, and positive correlations with oxidative potential. In conclusion, oxidative stress in semen straws, as determined using lipid peroxidation in the extender, is associated with sperm traits and their oxidative potential under IVF conditions. These results provided further insights regarding the importance of preventing oxidative stress during semen handling and cryopreservation, as this could affect sperm selected for IVF. Finally, Percoll selection did not completely remove sperm with oxidative markers.
In two nearly identical judgments dated July 14, 2020, the International Court of Justice (ICJ or Court) reviewed a decision taken by the Council of the International Civil Aviation Organization (ICAO) in a dispute about aviation restrictions imposed on Qatar by Bahrain, Egypt, Saudi Arabia, and the United Arab Emirates (UAE). These cases represent the second time that the Court has heard an appeal concerning a decision of the ICAO Council, a treaty body which has executive, administrative, and dispute settlement functions. As in 1972, when the Court heard an appeal brought by India against Pakistan, the Court's 2020 judgments concern a Council decision on preliminary objections to jurisdiction and admissibility. These judgments not only reinforce the ICJ's findings in its 1972 judgment, which raised similar procedural issues, but they also highlight the scope and the limits of the Court's rare appellate function.