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Building faculty capacity for competency-based midwifery education in Rwanda - a cross-sectional study
No full textBACKGROUND: Competency-based education is globally recognized as the standard for preparing midwives to provide high-quality, evidence-based care. In 2024, Rwanda introduced a standardized, competency-based curriculum for midwifery education aligned with the International Confederation of Midwives (ICM) Essential Competencies. However, the successful implementation of this curriculum depends on the capacity of midwifery educators to deliver it effectively. Understanding faculty development needs is essential for supporting this transition. AIM: To identify the specific faculty development needs of midwifery educators in Rwanda to inform strategies for strengthening their capacity to deliver competency-based education. METHOD: A cross-sectional mixed-methods study was conducted in December 2024 using an anonymous online survey. The survey was conducted immediately following the curriculum introduction. Midwifery faculty from all eight institutions offering midwifery education in Rwanda were invited to participate. The survey included Likert-scale and open-ended questions to assess training needs across various educational domains. Quantitative data were analysed using descriptive statistics, and qualitative responses were textually analysed. RESULTS : A total of 48 out of 60 midwifery educators responded. The highest reported needs were in curriculum design and module development (79%), scientific writing (79%), management and leadership (79%), and research skills (77%). Capacity needs were also noted in clinical teaching, particularly using simulation (66%), and in the clinical environment (77%). Faculty expressed preferences for faculty development programs using blended learning with predominantly face-to-face components, and they favored intensive, short-term training formats. CONCLUSION: Midwifery faculty in Rwanda expressed strong needs for capacity development across education, leadership, and research domains. These findings highlight the importance of targeted, context-specific faculty development initiatives. Given the shared challenges across low-resource settings, the findings may be transferable to similar contexts aiming to develop faculty development programs aligned with global standards
Teacher expectations and equity groups : Preservice teacher views from Australia, Sweden and England
No full textTeachers today must be able to cater for diversity in their class-rooms, so they can prepare all students to live and work in a globaleconomy. This requires teachers to have equitable expectations forstudents from diverse backgrounds. As part of a larger study onpreservice teacher cultural competence, this paper investigates thedeveloping teacher expectations of preservice teachers regardingstudents from equity groups. Survey respondents came from threeuniversities in Australia, Sweden and England (n = 351). Whileresults across the samples for the overall survey were mostly similar,there were some clear differences. The Teacher Expectations Scalewas the area of least development for all cohorts and received themost comments in the open responses. Preservice teachers weremore aware of teacher expectations’ importance for some groupsof students than others. The authors outline considerations forinitial teacher education (ITE) programmes regarding the develop-ment of preservice teacher knowledge about teacher expectation
L’ENSEIGNEMENT DU VOCABULAIRE EN FLE : ENTRE PRATIQUES DE CLASSE ET MANUELS SCOLAIRES : Une étude fondée sur des observations en classes et sur l’analyse de manuels scolaires
No full textThis thesis focuses on the teaching of vocabulary within the context of French as a Foreign Language (FFL) at the high school level in Sweden. Through classroom observations and an analysis of three FFL textbooks, the study examines how vocabulary is taught in high school classes and how textbooks address its learning. The findings indicate that vocabulary teaching primarily relies on a deductive and explicit approach, centered around lists of French words accompanied by their Swedish equivalents. Although some classroom activities include opportunities for contextualized oral production, such instances remain infrequent. The analysis of the textbooks reveals a more varied approach, combining both deductive and inductive methods: vocabulary is introduced through translation, but also via exercises on synonyms, antonyms, expressions, and contextual meaning. However, despite this presence, improvements are necessary, particularly through the creation of dedicated sessions, regular vocabulary review, and more frequent integration into authentic communicative activities. These adjustments could enhance vocabulary learning in French as a Foreign Language (FFL) in a more sustainable and functional manner.Ce mémoire s'intéresse à l'enseignement du vocabulaire dans le cadre du français langue étrangère (FLE) au niveau du lycée en Suède. À travers des observations en classe et l’analyse de trois manuels scolaires de FLE, l’étude examine comment le vocabulaire est enseigné dans les cours au lycée et comment les manuels scolaires abordent son apprentissage. Les résultats montrent que l’enseignement du vocabulaire repose principalement sur une approche déductive et explicite, centrée sur des listes de mots français accompagnés de leur équivalent en suédois. Bien que certaines activités en classe intègrent une dimension de production orale contextualisée, ces occasions demeurent peu fréquentes. L’analyse des manuels révèle une approche plus variée, mêlant méthodes déductives et inductives : le vocabulaire y est introduit par la traduction, mais aussi au moyen d’exercices sur les synonymes, les antonymes, les expressions et le sens en contexte. Toutefois, malgré cette présence, des améliorations sont nécessaires, notamment par la création de séances spécifiques, une révision régulière du vocabulaire, et une intégration plus fréquente dans des activités communicatives authentiques. Ces ajustements pourraient renforcer l’apprentissage du vocabulaire en FLE de manière plus durable et fonctionnelle
Women’s experiences of their sexuality during their menopausal transition and the support offered to them by healthcare providers : A systematic review and metasynthesis
No full textIntroduction:Menopause can significantly impact women's sexuality and sexual health, yet knowledge gaps among healthcare practitioners is a barrier to adequate support. Research on women's issues is less prioritized and limited funds are invested in studying female sexuality. In addition, women may feel hesitant to seek medical assistance for sexual health concerns during menopause due to lack of knowledge or societal taboos. Methods:This is a meta-synthesis of qualitative research on women's experiences of their sexuality during the menopausal transition and the support offered by healthcare providers. Data collection was conducted using PubMed, CINAHL, and PsycINFO. A total of 21 qualitative studies from diverse cultural contexts, including Lebanon, Iran, Sweden/ Chile, Spain, UK, Ireland, Thailand, Singapore, Australia, USA, China, Malaysia, and Taiwan, were synthesized, encompassing 610 participants. Results:Women's experiences of sexuality during menopause are highly individualized and influenced by relationship dynamics, sexual autonomy, and personal perceptions of menopause. The synthesis also highlighted a common concern: women reported a lack of adequate healthcare support, knowledge, and targeted treatments to address their sexual well-being during this period. Conclusions:Menopause can profoundly affect women's health, sexuality, and quality of life. For women to make informed choices regarding menopausal healthcare, extended knowledge, education, destigmatisation, and access to healthcare are essential. This synthesis underscores the critical need for enhanced education and interdisciplinary collaboration within healthcare systems
The effect of neighbouring cows within the milking parlour on a cow's daily milk yield
No full textSocial interactions in a dairy herd are essential to maintain the herd's structure. Disturbances in social relationships can be stressful and may impact both animal welfare and production. Pathological and physiological changes, biological variations, but also the social environment induced by surrounding cows can affect variation in the daily milk production. This study aims to investigate the social interplay between cows during milking by examining the milking order in a milking parlour and determining if the individuals a cow stands next to will affect its daily milk yield. Milking order data from 234 individuals was collected from a two-sided herringbone parlour twice a day for 35 days. The indirect effect of the neighbour cows in the milking parlour was studied by fitting a linear mixed model to the daily milk yield residuals. The estimated indirect effects on milk yield ranged from-1.07 kg to 0.85 kg. We described a weak negative correlation of-0.26 (SE: 0.09) between direct and indirect effect estimates. The average of the indirect effects of neighbouring cows differed between different lactation stages and regrouped cows changed to a more negative estimated indirect effect in their new group. Our results show individual variation in the average indirect effect on the milk yield of the neighbour, with some individuals having a positive effect on their group mates, while others have a more negative effect. Further investigation of these effects would be helpful in selecting the best individuals in a herd and optimising group composition and milking routines
Understanding, Assessing and Conceptualising Visitor Compliance under Open Access : The case of Trail Pass Systems for Cross-Country Skiing in Sweden
No full textThis licentiate thesis investigates visitor compliance with funding models for recreational infrastructure in legally and geographically open access settings, where payment is requested but not enforceable. Focusing on Swedish cross-country ski trails, the thesis examines how compliance with trail pass systems can be understood and assessed in the context of public access rights and commercial service provision. By combining qualitative interviews with cross-country skiers (Paper I) about the reasons for compliance with a quantitative data-driven triangulation to assess the compliance rate (Paper II), the thesis provides a mixed-methods perspective on compliance behaviour. The findings challenge traditional compliance theories that separate compliance in the context of private and legally enforceable goods from compliance in the context of common goods, arguing that open access products must be understood and conceptualised as a mixture of both, given that they are operating within a legal grey zone. A visualisation presents compliance in the context of private and common goods and where these domains intertwine. Social norms, including perceived peer behaviour, perceived transparency, trust, and fairness in the provider and personal conviction and reward, partly based on legal frameworks, emerge as critical interlinking factors that guide compliance behaviour in the study context. The assessment of a compliance rate can be complemented by focussing on enhancing the social norm of paying for groomed trails and perceived compliance of peers. The thesis advances research on nature-based tourism and outdoor recreation management, working toward a better understanding of how tourism infrastructure that depends on visitor compliance can be sustainably financed using behavioural insights. It draws on compliance and behavioural theory to better understand request-following in contexts where legal enforcement is limited or absent. The findings have practical relevance for trail providers, policy makers and tourism destination managers to consider for the framing of payment requests.Vid tidpunkten för framläggningen av avhandlingen var följande delarbete opublicerat: delarbete 2, manuskript.At the time of the defence the following paper was unpublished: paper 2, manuscript.</p
Global age-sex-specific all-cause mortality and life expectancy estimates for 204 countries and territories and 660 subnational locations, 1950-2023 : a demographic analysis for the Global Burden of Disease Study 2023
No full textBACKGROUND: Comprehensive, comparable, and timely estimates of demographic metrics-including life expectancy and age-specific mortality-are essential for evaluating, understanding, and addressing trends in population health. The COVID-19 pandemic highlighted the importance of timely and all-cause mortality estimates for being able to respond to changing trends in health outcomes, showing a strong need for demographic analysis tools that can produce all-cause mortality estimates more rapidly with more readily available all-age vital registration (VR) data. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is an ongoing research effort that quantifies human health by estimating a range of epidemiological quantities of interest across time, age, sex, location, cause, and risk. This study-part of the latest GBD release, GBD 2023-aims to provide new and updated estimates of all-cause mortality and life expectancy for 1950 to 2023 using a novel statistical model that accounts for complex correlation structures in demographic data across age and time. METHODS: We used 24 025 data sources from VR, sample registration, surveys, censuses, and other sources to estimate all-cause mortality for males, females, and all sexes combined across 25 age groups in 204 countries and territories as well as 660 subnational units in 20 countries and territories, for the years 1950-2023. For the first time, we used complete birth history data for ages 5-14 years, age-specific sibling history data for ages 15-49 years, and age-specific mortality data from Health and Demographic Surveillance Systems. We developed a single statistical model that incorporates both parametric and non-parametric methods, referred to as OneMod, to produce estimates of all-cause mortality for each age-sex-location group. OneMod includes two main steps: a detailed regression analysis with a generalised linear modelling tool that accounts for age-specific covariate effects such as the Socio-demographic Index (SDI) and a population attributable fraction (PAF) for all risk factors combined; and a non-parametric analysis of residuals using a multivariate kernel regression model that smooths across age and time to adaptably follow trends in the data without overfitting. We calibrated asymptotic uncertainty estimates using Pearson residuals to produce 95% uncertainty intervals (UIs) and corresponding 1000 draws. Life expectancy was calculated from age-specific mortality rates with standard demographic methods. For each measure, 95% UIs were calculated with the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS: In 2023, 60·1 million (95% UI 59·0-61·1) deaths occurred globally, of which 4·67 million (4·59-4·75) were in children younger than 5 years. Due to considerable population growth and ageing since 1950, the number of annual deaths globally increased by 35·2% (32·2-38·4) over the 1950-2023 study period, during which the global age-standardised all-cause mortality rate declined by 66·6% (65·8-67·3). Trends in age-specific mortality rates between 2011 and 2023 varied by age group and location, with the largest decline in under-5 mortality occurring in east Asia (67·7% decrease); the largest increases in mortality for those aged 5-14 years, 25-29 years, and 30-39 years occurring in high-income North America (11·5%, 31·7%, and 49·9%, respectively); and the largest increases in mortality for those aged 15-19 years and 20-24 years occurring in Eastern Europe (53·9% and 40·1%, respectively). We also identified higher than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 5-14 years (87·3% higher in GBD 2023 than GBD 2021 on average across countries and territories over the 1950-2021 period) and for females aged 15-29 years (61·2% higher), as well as lower than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 50 years and older (13·2% lower), reflecting advances in our modelling approach. Global life expectancy followed three distinct trends over the study period. First, between 1950 and 2019, there were considerable improvements, from 51·2 (50·6-51·7) years for females and 47·9 (47·4-48·4) years for males in 1950 to 76·3 (76·2-76·4) years for females and 71·4 (71·3-71·5) years for males in 2019. Second, this period was followed by a decrease in life expectancy during the COVID-19 pandemic, to 74·7 (74·6-74·8) years for females and 69·3 (69·2-69·4) years for males in 2021. Finally, the world experienced a period of post-pandemic recovery in 2022 and 2023, wherein life expectancy generally returned to pre-pandemic (2019) levels in 2023 (76·3 [76·0-76·6] years for females and 71·5 [71·2-71·8] years for males). 194 (95·1%) of 204 countries and territories experienced at least partial post-pandemic recovery in age-standardised mortality rates by 2023, with 61·8% (126 of 204) recovering to or falling below pre-pandemic levels. There were several mortality trajectories during and following the pandemic across countries and territories. Long-term mortality trends also varied considerably between age groups and locations, demonstrating the diverse landscape of health outcomes globally. INTERPRETATION: This analysis identified several key differences in mortality trends from previous estimates, including higher rates of adolescent mortality, higher rates of young adult mortality in females, and lower rates of mortality in older age groups in much of sub-Saharan Africa. The findings also highlight stark differences across countries and territories in the timing and scale of changes in all-cause mortality trends during and following the COVID-19 pandemic (2020-23). Our estimates of evolving trends in mortality and life expectancy across locations, ages, sexes, and SDI levels in recent years as well as over the entire 1950-2023 study period provide crucial information for governments, policy makers, and the public to ensure that health-care systems, economies, and societies are prepared to address the world's health needs, particularly in populations with higher rates of mortality than previously known. The estimates from this study provide a robust framework for GBD and a valuable foundation for policy development, implementation, and evaluation around the world. FUNDING: Gates Foundation.GBD 2023 Demographics Collaborators</p
Do smart charging and vehicle-to-grid strengthen or strain power grids with rising EV adoption? : Insights from a Swedish residential network
No full textThe rapid growth of electric vehicles (EVs) is placing new demands on residential distribution networks. Smart charging and Vehicle-to-Grid (V2G) technologies offer potential solutions for mitigating the large peak load and enhancing the grid hosting capacity (HC), yet their effectiveness across varying EV penetration levels remains underexplored. Therefore, this study evaluates how EV penetration levels affect the effectiveness of these two technologies. Furthermore, to help improve the grid performances, this study also pioneeringly proposes two hypothetical pricing settings—diverse electricity buying prices and reduced electricity selling prices—and evaluates their performances by comparing with existing price settings. Using real-world network and EV charging data from Sweden, we assess peak load and HC under different scenarios of power flow direction, charging controls, and electricity prices strategies across eight EV penetration levels. Results reveal that coordinated charging, especially with V2G, more effectively reduces peak loads compared to individual controls. However, V2G, if not regulated well, can increase peak loads at high EV penetration levels. Diversified electricity buying prices help lower aggregated peak loads but are less effective in enhancing local HC due to peak load shifting rather than peak load reduction. Additionally, high electricity selling prices benefit at low EV penetration but become less effective as penetration grows. The findings suggest that electricity pricing strategies and charging controls should adapt dynamically to the level of EV penetration. These insights provide critical guidance to policymakers, distribution system operators, and aggregators in designing adaptive pricing and control strategies to integrate EVs without overburdening the grid
The Experience of Abuse and Depressive Symptoms Among Adolescents in a Post-Conflict Setting : A Cross-Sectional Study
No full textThis study aimed to explore the relationship between the experience of abuse and depressive symptoms among children and adolescents in a post-conflict setting while controlling for perceived support and individual background factors. This cross-sectional study was conducted in the post-conflict setting of Borama, Somaliland. A total of 645 adolescents that attended upper primary and lower secondary schools were included. The exposure variables were (a) experience of physical abuse, (b) experience of psychological abuse, and (c) experience of either or both forms of abuse. The outcome was depressive symptoms as measured by the Patient Health Questionnaire-9. Physical and psychological abuse were associated with higher levels of depressive symptoms (B = 2.74, p < 0.001 and B = 1.62, p < 0.001, respectively). The girls had higher levels of depressive symptoms than the boys (B = 0.71, p = 0.004). Moreover, a greater age was associated with higher levels of symptoms (B = 0.17, p = 0.033). Higher social support levels were associated with lower levels of depressive symptoms (B = −0.08, p = 0.001). Our findings suggest that interventions providing social support to adolescents who experience abuse may be beneficial in reducing depressive symptoms
From Valleys to Peaks : The Role of Evolvability in Fitness Landscape Navigation
No full textUnderstanding the balance between evolvability and mutational robustness is crucial for exploring adaptation in complexfitness landscapes. This study examines how heterogeneous populations adapt under varying mutation rates (μ) andfitness landscape ruggedness (K), emphasizing their distinct starting conditions in valleys, slopes (low prominence), orpeaks (high prominence). Using an extended NK model, we simulate populations capable of initiating anywhere in thelandscape. Our findings reveal that starting positions strongly influence whether robustness or evolvability is advantageous.Populations beginning in low-prominence regions (valleys and slopes) exhibited high levels of epistasis (ϵ) and pleiotropy(π), enhancing evolvability and enabling exploration of the fitness landscape. In contrast, populations starting in highprominenceregions (peaks) reduced ϵ and π, prioritizing robustness to maintain stability against mutations. This studyhighlights the role of starting conditions in shaping evolutionary trajectories, offering insights into the interplay betweenevolvability and robustness