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Refuge: Examining perceptions of family and domestic violence accommodation design in Australia
Get PDFWithin Australia, family and domestic violence (FDV) has been described as a national pandemic.
However, despite the critical role that refuges play in providing safe and supported accommodation
for women and children seeking shelter from FDV, there is a lack of robust research that evaluates the
architectural design of refuge facilities. Through a mixed methods approach this research examines how
the design of purpose-built refuges within Australia influences perceptions of safety, health and wellbeing
within refuge environments. The study brings together empirical data from a systematic literature
review, semi-structured interviews (n=55), structured interviews and a demographic survey of staff and
residents (n=52), photo diary log and photo elicitation interviews (n=20), refuge case studies (n=15), an
applied examination of visual stress within refuges (n=60), and research validation workshops (n=6).
The findings reveal key differences between resident and staff perceptions of the refuge spaces and
design. Staff placed significantly greater emphasis on the importance of physical security measures,
hidden refuge locations, and confidence in rules and procedures than residents. For residents, physical
security, emotional safety, personal support, adequate provision for children, autonomy and control were
seen as important in supporting safety and wellbeing. Within the refuges, a high proportion of residents
identified as having a disability, mental health needs, or sensitivity to environmental triggers. However,
despite the need for trauma-informed environments, the research identified potential environmental
visual stressors within refuges that may negatively impact trauma-affected individuals.
The lack of evidence-based information on refuge models and design approaches presents significant
challenges for architects, service providers, and government agencies in the design and development of
refuges - resulting in a typology that has typically developed around a very narrowly defined set of needs,
perceived risks, the idea of ‘physical security as safety’, and socio-cultural entrenched approaches to
gendered safekeeping. Whilst many of the case studies demonstrate innovative approaches to FDV refuge
design and targeted design interventions aimed at creating a safe refuge environment that supported
wellbeing, it was found that children (and teenage boys in particular), those presenting with a range of
disabilities, cultural safety, ‘within refuge safety’, and the needs of trauma-impacted occupants were
often poorly catered for within refuges. This study contributes to theoretical understanding by challenging
existing refuge models and advocating for trauma-informed design that better supports diverse needs.
Through an intersectional analysis, the research reveals that current design practices may inadvertently
reinforce structural inequalities and identifies opportunities for more inclusive trauma-informed design
approaches that better support Aboriginal and Torres Strait Islander residents, neurodiverse building
occupants, children, and diverse client needs. This research is the first comprehensive mixed methods
examination of Australian FDV refuge design that incorporates residents’ perspectives and provides
evidence-based insights to support FDV refuge design and policy. The findings demonstrate an urgent
need to develop more effective trauma-informed design practices that extend beyond physical safety and
respond to the plurality of residents’ needs.
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Effect of a needs-based model of care on the characteristics of healthcare services in England: the i-THRIVE National Implementation Programme.
Get PDFAIMS: Developing integrated mental health services focused on the needs of children and young people is a key policy goal in England. The THRIVE Framework and its implementation programme, i-THRIVE, are widely used in England. This study examines experiences of staff using i-THRIVE, estimates its effectiveness, and assesses how local system working relationships influence programme success. METHODS: This evaluation uses a quasi-experimental design (10 implementation and 10 comparison sites.) Measurements included staff surveys and assessment of 'THRIVE-like' features of each site. Additional site-level characteristics were collected from health system reports. The effect of i-THRIVE was evaluated using a four-group propensity-score-weighted difference-in-differences model; the moderating effect of system working relationships was evaluated with a difference-in-difference-in-differences model. RESULTS: Implementation site staff were more likely to report using THRIVE and more knowledgeable of THRIVE principles than comparison site staff. The mean improvement of fidelity scores among i-THRIVE sites was 16.7, and 8.8 among comparison sites; the weighted model did not find a statistically significant difference. However, results show that strong working relationships in the local system significantly enhance the effectiveness of i-THRIVE. Sites with highly effective working relationships showed a notable improvement in 'THRIVE-like' features, with an average increase of 16.41 points (95% confidence interval: 1.69-31.13, P-value: 0.031) over comparison sites. Sites with ineffective working relationships did not benefit from i-THRIVE (-2.76, 95% confidence interval: - 18.25-12.73, P-value: 0.708). CONCLUSIONS: The findings underscore the importance of working relationship effectiveness in the successful adoption and implementation of multi-agency health policies like i-THRIVE
Research data supporting "High-pressure synthesis of quantum magnet M-YbTaO4 with a stretched diamond lattice"
No full textAnti-inflammatory therapy with low-dose IL-2 in acute coronary syndromes: a randomized phase 2 trial.
Get PDFRegulatory T (Treg) cells are powerful endogenous modulators of the immune response and their levels are reduced in patients with acute coronary syndromes (ACSs). Low-dose interleukin-2 (IL-2) has been shown to increase Treg cell levels, potentially providing an immunomodulatory strategy in ACSs. The IVORY trial was a double-blind, placebo-controlled, phase 2 trial in which patients presenting with ACSs and high-sensitivity C-reactive protein levels >2 mg l-1 were randomized in a 1:1 ratio to receive subcutaneous low-dose IL-2 (1.5 × 106 IU) or placebo for 8 weeks. [18F]Fluorodeoxyglucose positron emission tomography-computed tomography of the ascending aorta and carotid arteries was performed before and after treatment. Here the primary outcome was the difference in arterial inflammation in the index vessel (the vessel with the highest average maximum target-to-background ratio pre-treatment) on follow-up imaging between the two groups (placebo = 29 (female-to-male ratio (F-to-M) = 6:23); low-dose IL-2 = 31 (F-to-M = 3:28)). At the end of treatment, arterial inflammation was -0.171 (-7.7%) lower in the low-dose IL-2 group compared to the placebo group (95% confidence interval -0.308 to -0.034, P = 0.015). In secondary efficacy analyses, the difference in arterial inflammation between the low-dose IL-2 and placebo groups was greater (-8.3%, P = 0.009) in more inflamed segments and low-dose IL-2 treatment increased Treg cell levels compared to placebo (P < 0.0001). Low-dose IL-2 treatment appeared to be safe, with no major adverse cardiovascular events at the 2-year follow-up, compared to three patients with such events in the placebo group. In conclusion, in patients with ACSs, low-dose IL-2 safely increases Treg cell levels and reduces arterial inflammation. The clinical benefit of low-dose IL-2 requires validation in larger studies. ClinicalTrials.gov registration: NCT04241601
Anti-Müllerian hormone (AMH) in the Diagnosis of Menstrual Disturbance Due to Polycystic Ovarian Syndrome.
Get PDFIntroduction: Polycystic ovarian syndrome (PCOS) is a leading cause of female subfertility worldwide, however due to the heterogeneity of the disorder, the criteria for diagnosis remains subject to conjecture. In the present study, we evaluate the utility of serum Anti-Müllerian hormone (AMH) in the diagnosis of menstrual disturbance due to PCOS. Method: Menstrual cycle length, serum AMH, gonadotropin and sex-hormone levels, total antral follicle count (AFC), body mass index (BMI) and ovarian morphology on ultrasound were analyzed in a cohort of 187 non-obese women, aged 18-35 years, screened for participation in a clinical trial of fertility treatment between 2013 and 2016 at a tertiary reproductive endocrine center. Results: Serum AMH was higher in women with menstrual disturbance when compared to those with regular cycles (65.6 vs. 34.8 pmol/L; P 60 pmol/L, in comparison to those with an AMH < 15 pmol/L. AMH better discriminated women with menstrual disturbance (area under ROC 0.77) from those with regular menstrual cycles than AFC (area under ROC 0.67), however the combination of the two markers increased discrimination than either measure alone (0.83; 95% CI 0.77-0.89). Serum AMH was higher in women with all three cardinal features of PCOS (menstrual disturbance, hyperandrogenism, polycystic ovarian morphology) when compared to women with none of these features (65.6 vs. 14.6 pmol/L; P < 0.0001). The odds of menstrual disturbance were increased by 10.7-fold (95% CI 2.4-47.1) in women with bilateral polycystic morphology ovaries than those with normal ovarian morphology. BMI was a stronger predictor of free androgen index (FAI) than either AMH or AFC. Conclusion: Serum AMH could serve as a useful biomarker to indicate the risk of menstrual disturbance due to PCOS. Women with higher AMH levels had increased rates of menstrual disturbance and an increased number of features of PCOS
Early life exposures and school readiness: an observational cohort study using the Born in Bradford longitudinal birth cohort data.
Get PDFOBJECTIVE: To assess the associations of early life exposures with school readiness. DESIGN, SETTING, MAIN OUTCOME MEASURE AND PARTICIPANTS: Using data from the Born in Bradford (BiB) birth cohort, we investigated the association of early life exposures and the likelihood of children achieving a 'Good Level of Development' (GLD) as measured by the Early Years Foundation Stage Profile at the end of their first school year. Multivariable logistic regression modelling was used to estimate associations of early life exposures with school readiness. RESULTS: Outcome data were available for 10 589 of 13 858 BiB participants. 6272 (59%) children achieved a GLD. 17 variables were investigated, including child characteristics, maternal factors, family environment and socioeconomic exposures. In our multivariable model (n=7981), children with the following characteristics were significantly less likely to achieve a GLD: males (OR 0.43, 95% CI 0.39 to 0.47), Pakistani ethnicity (OR 0.76, 95% CI 0.66 to 0.89), younger children (OR 1.18 per month, 95% CI 1.16 to 1.19), preterm birth (gestational age<32 weeks OR 0.34, 95% CI 0.19 to 0.62; 32-36 weeks OR 0.64, 95% CI 0.51 to 0.80), younger maternal age (OR 1.01 per year of maternal age, 95% CI 1.00 to 1.02), lower maternal education (OR 0.27, 95% CI 0.20 to 0.37 with no qualifications, compared with higher degrees), never breastfed (OR 0.87, 95% CI 0.78 to 0.97), lower paternal employment status (OR 0.66, 95% CI 0.54 to 0.81, for unemployed, compared with non-manual employment), receiving benefits during pregnancy (OR 0.89, 95% CI 0.80 to 0.99) and eligible for free school meals (OR 0.71, 95% CI 0.62 to 0.81). A sensitivity analysis using multiple imputation (n=10 589) found consistent results. CONCLUSIONS: The exposures most strongly associated with low school readiness were male sex, low maternal education and preterm birth (<32 weeks gestation). Greater understanding of the exposures associated with school readiness can inform a proportionate universal approach to policymaking to improve school readiness and subsequent life outcomes
Management of Impacted Fetal Head at Caesarean Birth (2025 Second Edition)
Get PDFPlain Language Summary Over one‐quarter of women in the UK have a caesarean birth (CB). More than one in 20 of these caesarean births occurs near the end of labour, when the cervix is fully dilated (second stage). In these circumstances, and when labour has been prolonged, the baby's head can become lodged deep in the maternal pelvis making it challenging to deliver the baby. During the CB, difficulty in delivery of the baby's head may result—this emergency is known as impacted fetal head (IFH). These are technically challenging births that pose significant risks to both the woman and baby. Complications for the woman include tears in the womb, serious bleeding and longer hospital stays. Babies are at increased risk of injury including damage to the head and face, lack of oxygen to the brain, nerve damage, and in rare cases, the baby may die from these complications. Maternity staff are increasingly encountering IFH at CB, and reports of associated injuries have risen dramatically in recent years. The latest UK studies suggest that IFH may complicate as many as one in 10 unplanned caesarean births (1.5% of all births) and that two in 100 babies affected by IFH die or are seriously injured. Moreover, there has been a sharp increase in reports of babies having brain injuries when their birth was complicated by IFH. When an IFH occurs, the maternity team can use different approaches to help deliver the baby's head at CB. These include: an assistant (another obstetrician or midwife) pushing the head up from the vagina; delivering the baby's feet first; using a specially designed inflatable balloon device to elevate the baby's head and/or giving the mother a medicine to relax the womb. There has been a lack of consensus for how best to manage these births. [Correction added on 11 November 2025, after first online publication: The preceding sentence has been added in this version.] This has resulted in a lack of confidence among maternity staff, variable practice and potentially avoidable harm in some circumstances. This paper reviews the current evidence regarding the prediction, prevention and management of IFH at CB, integrating findings from a systematic review commissioned from the Avoiding Brain Injury in Childbirth (ABC) programme
Bitter Taste Perception in BaYaka Hunter‐Gatherers
Get PDFObjectives: This study examined variation in bitter taste perception among BaYaka hunter‐gatherers from the Republic of Congo, comparing individuals from the same population that were born and grew up in a forest ecology to those from a logging town. Methods: Bitter‐tasting phenotype was assessed in 112 BaYaka individuals using a paper‐strip taste‐detection task with single‐concentration strips of phenylthiocarbamide (PTC) and thiourea (thiocarbamide). Participants were grouped by the place where they were born and grew up: forest camps or the town. Logistic regression was used to test associations between location, sex, age, and bitter taste perception. Results: Town‐born individuals were more likely to perceive both compounds as bitter than forest‐born individuals (PTC: OR = 3.93, 95% CI: 1.75–9.17, p < 0.01; thiourea: OR = 4.44, 95% CI: 1.97–10.42, p < 0.01). No significant associations were found between bitter taste perception and sex or age. Conclusion: Bitter‐tasting phenotype differed among BaYaka individuals, with higher proportions of bitter tasters among those born and raised in town compared to those from forest camps. These results suggest that early‐life ecological context may contribute towards variation in bitter taste perception, which we hypothesize might be due to differences in exposure to bitter wild plant compounds
Evaluating the impact of financial navigation on financial catastrophe and distress for cancer care: a randomized control trial-COST-FIN.
Get PDFBACKGROUND: As with most Sub-Saharan African countries, Nigeria has a rising incidence of cancer, with disproportionate mortality rates. The financial burden of cancer care often results in catastrophic healthcare spending, leading to treatment refusal, disruption, and discontinuation. This is particularly significant in Nigeria, where nearly all patients are uninsured, and out-of-pocket costs often exceed households' ability to pay. Financial navigation programs (FNPs) have been shown to mitigate treatment-related financial toxicity in cancer care and reduce treatment abandonment, but there is a paucity of high-quality data on this intervention in resource-constrained settings. Here, we present a randomized controlled trial to evaluate the impact of a novel FNP in Nigeria. METHODS: We designed the COST-FIN trial, a multi-site pragmatic single-blinded randomized controlled trial of newly diagnosed (<6 weeks from diagnosis) adults (≥18 years) with breast, colorectal, or prostate cancer at two tertiary cancer centers in Nigeria. Participants (n = 200) will be randomized (1:1) to either the intervention (FNP) or the control arm and followed for 12 months. Data on key individual, treatment, and financial parameters will be collected via structured interviews and chart abstraction at baseline, 3-, 6-, and 12-month follow-up. In addition, participants randomized to the FNP will receive a tailored financial literacy assessment, financial planning support, and enhanced access to resources by trained financial navigators. Primary and secondary outcomes are financial catastrophe (FC) and financial distress (FD), respectively. Exploratory outcomes will include cost-related non-adherence and cost-effectiveness of the program. An interim analysis will be conducted when 50% of the estimated accruals reach 6 months of follow-up, with crossover if compelling evidence of benefit is demonstrated at that time point. All participants will be followed for 12 months from recruitment. DISCUSSION: This first-of-its-kind study will provide evidence on the role of FNP in potentially eliminating financial barriers to cancer care in Nigeria. Given the country's renewed interest in cancer control through the passage of the National Cancer Control Plan, findings from this study have the potential to influence policy reform and set the stage for further studies to evaluate the scalability and implementation of similar interventions in resource-limited settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT06630962 . Registered on Oct 8, 2024
