2,363 research outputs found
Identity and dislocation in Caribbean women's literature: a study of the writings of Velma Pollard
No full textJamaican-born Velma Pollard has been publishing poetry and short stories for nearly
thirty years. Her first poems appeared in the 1970s, her first volume of short stories in
1989, and her first novel in 1994. Despite this considerable literary output, in the evergrowing
critical literature on Caribbean women's writing Pollard's work has not attracted
any of the scholarly treatment accorded to other writers. Given this lack of critical
attention to Pollard's considerable body of work, this thesis aims to provide the first
detailed and contextualised study of her writings (excluding the majority of her poetry
and of her writings on linguistics), and to accord Pollard the recognition her work
deserves.
Chapter 1 of this thesis situates Pollard's writings in the context of Caribbean
(women's) literature, and writings on identity, dislocations and (Caribbean) migration. I
argue that Pollard's principal contribution to Caribbean literature is found in her
engagement with two main subjects, return migration and relationships (male-female and
female-female), within a wider context of debates on identity and dislocation.
Chapter 2 introduces Pollard's work by way of a general discussion of her novella
Karl, which won the Casa de las Americas literary award in 1992. I consider Karl to be
central to Pollard's work, not least because it features many of the themes explored by
her later writings, including her novel, Homestretch, which is the subject of Chapter 3.
Pollard's first novel, Homestretch, which was published in 1994, explores the themes
of identity and dislocation through the experiences of 'return migrants' and 'repeat
migrants' and their comparison of life in England, the United States and Jamaica. The
novel chronicles how these migrants come to reconnect with and accept their cultural
heritage.
In chapters 4 and 5 I discuss selected stories taken from Pollard's two collections
of short stories, Considering Woman ('Cages', 'My Sisters', 'My Mother', and 'Gran') and
from Karl and Other Stories ('A Night's Tale', 'Miss Chandra', 'Betsy Hyde', and 'Altamont
Jones'). In these stories Pollard explores male-female relationships and the lives of
several generations and a wide range of Caribbean women and men. Pollard utilises the
West Indian setting, speech, situations and conflicts in these stories to graphically
describe familiar Caribbean role models and to provide a narrative and literary
examination of the frustrations and conflicting desires of women in the region.
In my conclusion, I address the ethnographic quality and significance of her work,
and its contribution to an understanding of the Caribbean
Should we delay covid-19 vaccination in children?
No full textThe net benefit of vaccinating children is unclear, and vulnerable people worldwide should be prioritised instead, say Dominic Wilkinson, Ilora Finlay, and Andrew J Pollard
Application of a challenge model to assess the protective efficacy of oral typhoid vaccines in humans
No full textHuman infection by Salmonella Typhi has been occurring for the last 50,000 years and still accounts for ∼ 22million new cases each year worldwide. Through faeco-oral transmission, this human-restricted infection disproportionately affects the most impoverished sections of endemic communities where adequate sanitation infrastructure and effective vaccination approaches are lacking. Development of new control measures to accurately measure the burden of disease and to prevent infection with new vaccine candidates are hindered by an incomplete understanding of host-pathogen interactions and of what constitutes a protective human response after exposure. In this thesis I describe the practical application of a recently developed human challenge model of typhoid infection in assessing new control measures, including the evaluation of the oral single-dose vaccine candidate, M01ZH09. In performing a large, double-blind, placebo-controlled study, I was able to measure the direct protective efficacy (PE) of vaccination with either M01ZH09 or 3-dose Ty21a by performing human challenge with 104CFU Salmonella Typhi, Quailes strain, 28-days later. Using clinical and microbiological definitions to confirm typhoid diagnosis during a 14-day period after ingestion, I found insignificant levels of protection afforded by a single dose of M01ZH09 (12.9%), and a low PE after Ty21a vaccination (35%), demonstrating the stringency of the model and the endpoints used. Many additional insights into pathogen dynamics and host responses were found highlighting several important characteristics of oral vaccination. M01ZH09 was highly immunogenic, and both active vaccines significantly reduced bacterial burden (bacteraemia and stool shedding) while having no effect on symptomatic severity of infection in those diagnosed. M01ZH09 receipt resulted in a significantly longer incubation period, suggesting underlying protective responses were being generated. Further findings included the first objective demonstration of primary bacteraemia occurring after typhoid exposure, and frequent asymptomatic infection or stool shedding in those exposed but remaining well. Overall, these data also demonstrated significant protective effects against challenge by anti-Vi antibody status and age at baseline. Taking these factors into account, M01ZH09 and Ty21a vaccination did convey an overall protective advantage against developing typhoid infection, each reducing the risk of diagnosis by ~two-fold during the challenge period
Vi polysaccharide-protein conjugate vaccine for the prevention of typhoid fever in children: hope or hype?
No full textThe full-text of this article is not currently available in ORA, but you may be able to access the article via the publisher link on this record page. Citation: Pulickal, A. S. & Pollard, A. J. (2007). 'Vi polysaccharide-protein conjugate vaccine for the prevention of typhoid fever in children: hope or hype?', Expert Review of Vaccines 6(3), 293-295. [Available at http://www.expert-reviews.com/loi/erv]
A population based observational study of childhood encephalitis in children admitted to pediatric intensive care units in England and Wales
No full textBACKGROUND: Encephalitis is a serious neurologic condition which can result in admission to intensive care. Yet, there are no studies on pediatric intensive care unit (PICU) admission rates and usage of intensive care resources by children with encephalitis in England and Wales. The objectives of this study were to (i) define the PICU incidence and mortality rates for childhood encephalitis, (ii) describe usage of intensive care resources by children with encephalitis admitted to PICU, and (iii) explore the associated cost from PICU encephalitis admissions.METHODS: Retrospective analysis of anonymized data for 1031 children (0-17 years) with encephalitis admitted (January 2003 to December 2013) to PICU in England and Wales.RESULTS: The PICU encephalitis incidence was 0.79/100,000 population/year (95%CI 0.74-0.84), which gives an annual total of 214 bed days of intensive care occupancy for children admitted with encephalitis and an estimated annual PICU bed cost of £414,230 (IQR 198,111-882,495) for this cohort. PICU encephalitis admissions increased during the study period (annual percentage change = 4.5%, 95%CI 2.43%-6.50%, p=<0.0001). In total, 808/1024 (78.9%) received invasive ventilation while 216/983 (22.0%) and 50/890 (5.6%) cases received vasoactive treatment and renal support, respectively. There were 87 deaths (8.4%), giving a PICU encephalitis mortality rate of 0.07 /100,000 population (0-17 years)/year (95%CI 0.05-0.08).CONCLUSIONS: These data suggest that encephalitis places a significant burden to the healthcare service. More work is needed to improve outcomes for children with encephalitis.</p
Intravenous immunoglobulin for the treatment of childhood encephalitis
No full textBackground: Encephalitis is a syndrome of neurological dysfunction due to inflammation of the brain parenchyma, caused by an infection or an exaggerated host immune response, or both. Attenuation of brain inflammation through modulation of the immune response could improve patient outcomes. Biological agents such as immunoglobulin that have both anti-inflammatory and immunomodulatory properties may therefore be useful as adjunctive therapies for people with encephalitis.Objectives: To assess the efficacy and safety of intravenous immunoglobulin (IVIG) as add-on treatment for children with encephalitis.Search methods: The Cochrane Multiple Sclerosis and Rare Diseases of the CNS group's Information Specialist searched the following databases up to 30 September 2016: CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, and the WHO ICTRP Search Portal. In addition, two review authors searched Science Citation Index Expanded (SCI-EXPANDED) & Conference Proceedings Citation Index - Science (CPCI-S) (Web of Science Core Collection, Thomson Reuters) (1945 to January 2016), Global Health Library (Virtual Health Library), and Database of Abstracts of Reviews of Effects (DARE).Selection criteria: Randomised controlled trials (RCTs) comparing IVIG in addition to standard care versus standard care alone or placebo.Data collection and analysis: Two review authors independently selected articles for inclusion, extracted relevant data, and assessed quality of trials. We resolved disagreements by discussion among the review authors. Where possible, we contacted authors of included studies for additional information. We presented results as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI).Main results: The search identified three RCTs with 138 participants. All three trials included only children with viral encephalitis, one of these included only children with Japanese encephalitis, a specific form of viral encephalitis. Only the trial of Japanese encephalitis (22 children) contributed to the primary outcome of this review and follow-up in that study was for three to six months after hospital discharge. There was no follow-up of participants in the other two studies. We identified one ongoing trial.For the primary outcomes, the results showed no significant difference between IVIG and placebo when used in the treatment of children with Japanese encephalitis: significant disability (RR 0.75, 95% CI 0.22 to 2.60; P = 0.65) and serious adverse events (RR 1.00, 95% CI 0.07 to 14.05; P = 1.00).For the secondary outcomes, the study of Japanese encephalitis showed no significant difference between IVIG and placebo when assessing significant disability at hospital discharge (RR 1.00, 95% CI 0.60 to 1.67). There was no significant difference (P = 0.53) in Glasgow Coma Score at discharge between IVIG (median score 14; range 3 to 15) and placebo (median 14 score; range 7 to 15) in the Japanese encephalitis study. The median length of hospital stay in the Japanese encephalitis study was similar for IVIG-treated (median 13 days; range 9 to 21) and placebo-treated (median 12 days; range 6 to 18) children (P = 0.59).Pooled analysis of the results of the other two studies resulted in a significantly lower mean length of hospital stay (MD -4.54 days, 95% CI -7.47 to -1.61; P = 0.002), time to resolution of fever (MD -0.97 days, 95% CI -1.25 to -0.69; P < 0.00001), time to stop spasms (MD -1.49 days, 95% CI -1.97 to -1.01; P < 0.00001), time to regain consciousness (MD -1.10 days, 95% CI -1.48 to -0.72; P < 0.00001), and time to resolution of neuropathic symptoms (MD -3.20 days, 95% CI -3.34 to -3.06; P < 0.00001) in favour of IVIG when compared with standard care.None of the included studies reported other outcomes of interest in this review including need for invasive ventilation, duration of invasive ventilation, cognitive impairment, poor adaptive functioning, quality of life, number of seizures, and new diagnosis of epilepsy. The quality of evidence was very low for all outcomes of this review.Authors' conclusions: The findings suggest a clinical benefit of adjunctive IVIG treatment for children with viral encephalitis for some clinical measures (i.e. mean length of hospital stay, time (days) to stop spasms, time to regain consciousness, and time to resolution of neuropathic symptoms and fever. For children with Japanese encephalitis, IVIG had a similar effect to placebo when assessing significant disability and serious adverse events.Despite these findings, the risk of bias in the included studies and quality of the evidence make it impossible to reach any firm conclusions on the efficacy and safety of IVIG as add-on treatment for children with encephalitis. Furthermore, the included studies involved only children with viral encephalitis, therefore findings of this review cannot be generalised to all forms of encephalitis. Future well-designed RCTs are needed to assess the efficacy and safety of IVIG in the management of children with all forms of encephalitis. There is a need for internationally agreed core outcome measures for clinical trials in childhood encephalitis.</p
Vascular endothelial growth factor restores delayed tumor progression in tumors depleted of macrophages
No full textGenetic depletion of macrophages in Polyoma Middle T oncoprotein (PyMT)-induced mammary tumors in mice delayed the angiogenic switch and the progression to malignancy. To determine whether vascular endothelial growth factor A (VEGF-A) produced by tumor-associated macrophages regulated the onset of the angiogenic switch, a genetic approach was used to restore expression of VEGF-A into tumors at the benign stages. This stimulated formation of a high-density vessel network and in macrophage-depleted mice, was followed by accelerated tumor progression. The expression of VEGF-A led to a massive infiltration into the tumor of leukocytes that were mostly macrophages. This study suggests that macrophage-produced VEGF regulates malignant progression through stimulating tumor angiogenesis, leukocytic infiltration and tumor cell invasion
Who was buried at Stonehenge?
No full textStonehenge continues to surprise us. In this new study of the twentieth-century excavations,
together with the precise radiocarbon dating that is now possible, the authors propose that the
site started life in the early third millennium cal BC as a cremation cemetery within a circle
of upright bluestones. Britain’s most famous monument may therefore have been founded as the
burial place of a leading family, possibly from Wales
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