6 research outputs found

    Critically ill patients: Family experiences of interfacility transfers from rural to urban centers and impact on family relationships

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    A critical illness event is intensely stressful for family members and can lead to negative psychological, emotional, social and financial consequences. In geographically rural areas, critically ill patients may require an interfacility transfer to an urban centre for advanced critical care services. In this context, research suggests that these family members from rural areas experience additional burdens, yet little is known about these experiences. An interpretive phenomenological approach was used to explore lived experiences of family members from rural areas whose critically ill relative undergoes an interfacility transfer to an urban centre for advanced critical care services. Participants described feelings of vulnerability in the urban centre, the need to protect the critically ill patient and other relatives, maintaining responsibilities at home, navigating family relationships, and a loss of connection during the transfer window. These findings may better position nurses to address family members’ stress and anxiety during this experience

    The role of the accused in English and Islamic criminal justice

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    This thesis is a comparative study of the role of the accused in the systems of English and Islamic criminal justice. It seeks to explore the underlying relationship between the individual and the state through an historical, structural and contextual analysis of their rules relating to questioning and of confessions. The analysis of the English system covers the period 1800 to 1984, with particular reference to developments during the nineteenth century when the foundations for the modern English state were established. The analysis of the Islamic system combines traditionally Islamic and modern methods, assessing the "Islamisation" movement in Malaysia through a religico-structural understanding of juristic opinion from the four main schools of Sunnite jurisprudence. The thesis contributes to existing knowledge on a number of levels: first, it questions and revises the "myth" of "progress" that has dominated observations of the history of the English criminal justice system; second, it elucidates the relationship between Islamic law in theory and the law that is applied and proposed in its name in Muslim states; third, it provides an analytical framework for drawing comparisons between the underlying values of the systems of English and Islamic criminal justice. While acknowledging fundamental differences in terms of outlook and articulation, the author concludes there are important similarities expressed through such notions as "suspect" in the English system and "kafir"I"fasiq" in the Islamic. These act as intermediate constitutional categories to whom the state owe less protection. But the author notes also that these similarities are not observed necessarily in the "law" which is implemented or proposed in Muslim states; exact correspondence depends upon the over-arching political structure and the institution of Caliphate. The thesis is divided into six chapters: chapter one sets out the conventional view of the historical development of English criminal procedure and evidence; chapter two subjects that to a critique and chapter three offers a revised thesis. Chapter four, explores methods for interpreting and explaining Islam; chapter five sets out rules relating to confessions and questioning according to the four Sunni schools; chapter six puts them into "context" through an examination of the "Islamisation" process in Malaysia

    Increased systemic inflammation is associated with cardiac and vascular dysfunction over the first 12 weeks of antiretroviral therapy among undernourished, HIV-infected adults in Southern Africa.

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    This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.INTRODUCTION: Persistent systemic inflammation is associated with mortality among undernourished, HIV-infected adults starting antiretroviral therapy (ART) in sub-Saharan Africa, but the etiology of these deaths is not well understood. We hypothesized that greater systemic inflammation is accompanied by cardiovascular dysfunction over the first 12 weeks of ART. METHODS: In a prospective cohort of 33 undernourished (body mass index <18.5 kg/m2) Zambian adults starting ART, we measured C-reactive protein (CRP), tumor necrosis factor-α receptor 1 (TNF-α R1), and soluble CD163 and CD14 at baseline and 12 weeks. An EndoPAT device measured the reactive hyperemia index (LnRHI; a measure of endothelial responsiveness), peripheral augmentation index (AI; a measure of arterial stiffness), and heart rate variability (HRV; a general marker of autonomic tone and cardiovascular health) at the same time points. We assessed paired changes in inflammation and cardiovascular parameters, and relationships independent of time point (adjusted for age, sex, and CD4+ T-cell count) using linear mixed models. RESULTS: Serum CRP decreased (median change -3.5 mg/l, p=0.02), as did TNF-α R1 (-0.31 ng/ml, p<0.01), over the first 12 weeks of ART. A reduction in TNF-α R1 over 12 weeks was associated with an increase in LnRHI (p=0.03), and a similar inverse relationship was observed for CRP and LnRHI (p=0.07). AI increased in the cohort as a whole over 12 weeks, and a reduction in sCD163 was associated with a rise in the AI score (p=0.04). In the pooled analysis of baseline and 12 week data, high CRP was associated with lower HRV parameters (RMSSD, p=0.01; triangular index, p<0.01), and higher TNF- α R1 accompanied lower HRV (RMSSD, p=0.07; triangular index, p=0.06). CONCLUSIONS: Persistent inflammation was associated with impaired cardiovascular health over the first 12 weeks of HIV treatment among undernourished adults in Africa, suggesting cardiac events may contribute to high mortality in this population.This work was supported by the Vanderbilt Meharry Center for AIDS Research (NIH grant number P30 AI54999); the NIH Fogarty International Center, Office of the Director, National Institutes of Health, National Heart, Blood, and Lung Institute, and National Institute of Mental Health, through the Vanderbilt-Emory-Cornell-Duke Consortium for Global Health Fellows (grant number R25 TW009337); the National Center for Advancing Translational Sciences (CTSA award number UL1TR000445) and the European and Developing Countries Clinical Trials Partnership (grant IP.2009.33011.004)

    Blanco DECam Bulge Survey (BDBS) IV: Metallicity Distributions and Bulge Structure from 2.6 Million Red Clump Stars

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    We present photometric metallicity measurements for a sample of 2.6 million bulge red clump stars extracted from the Blanco DECam Bulge Survey (BDBS). Similar to previous studies, we find that the bulge exhibits a strong vertical metallicity gradient, and that at least two peaks in the metallicity distribution functions appear at b < -5. We can discern a metal-poor ([Fe/H] ~ -0.3) and metal-rich ([Fe/H] ~ +0.2) abundance distribution that each show clear systematic trends with latitude, and may be best understood by changes in the bulge's star formation/enrichment processes. Both groups exhibit asymmetric tails, and as a result we argue that the proximity of a star to either peak in [Fe/H] space is not necessarily an affirmation of group membership. The metal-poor peak shifts to lower [Fe/H] values at larger distances from the plane while the metal-rich tail truncates. Close to the plane, the metal-rich tail appears broader along the minor axis than in off-axis fields. We also posit that the bulge has two metal-poor populations -- one that belongs to the metal-poor tail of the low latitude and predominantly metal-rich group, and another belonging to the metal-poor group that dominates in the outer bulge. We detect the X-shape structure in fields with |Z| > 0.7 kpc and for stars with [Fe/H] > -0.5. Stars with [Fe/H] < -0.5 may form a spheroidal or "thick bar" distribution while those with [Fe/H] > -0.1 are strongly concentrated near the plane.Comment: 26 pages, 22 figures, accepted for publication in MNRAS; the full data table is very long so only a stub table has been provided here; the full electronic table will be provided through MNRAS upon publication, but early access to the full table will be granted upon request to the author

    Routledge handbook of cultural gerontology.

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    Later years are changing under the impact of demographic, social and cultural shifts. No longer confined to the sphere of social welfare, they are now studied within a wider cultural framework that encompasses new experiences and new modes of being. Drawing on influences from the arts and humanities, and deploying diverse methodologies – visual, literary, spatial – and theoretical perspectives Cultural Gerontology has brought new aspects of later life into view. This major new publication draws together these currents including: Theory and Methods; Embodiment; Identities and Social Relationships; Consumption and Leisure; and Time and Space. Based on specially commissioned chapters by leading international authors, the Routledge Handbook of Cultural Gerontology will provide concise authoritative reviews of the key debates and themes shaping this exciting new field.Acknowledgements x-- List of illustrations xi-- Author biographies xii-- 1 The field of cultural gerontology: an introduction Julia Twigg and Wendy Martin 1 -- SECTION I Theory and methods 17-- 2 Theory and methods: introduction 19-- Julia Twigg and Wendy Martin 3 Aged by culture Margaret Morganroth Gullette 21-- 4 The cultural turn in gerontology Chris Gilleard and Paul Higgs 29-- 5 Beyond the view of the West: ageing and anthropology Sarah Lamb 37-- 6 Historians of ageing and the 'cultural turn' 45-- Antje Kampf 7 Literature and ageing 53-- Sarah Falcus 8 Theatre and ageing Miriam Bernard and Lucy Munro 61-- 9 Ageing in film Aagje Swinnen69-- 10 Popular music and ageing Ros Jennings 77-- 11 Art, ageing and the body Michelle Meagher 85-- 12 Visual methods in ageing research Wendy Martin 93-- 13 Ethnographies of ageing Cathrine Degnen 105-- 14 Ageing, narrative and biographical methods Joanna Bornat 113-- SECTION II Embodiment 121-- 15 Embodiment: introduction Julia Twigg and Wendy Martin 123 -- 16 Theorising embodiment and ageing Emmanuelle Tulle 125-- 17 Gender, ageing and appearance Laura Hurd Clarke and Erica V. Bennett 133-- 18 Hair and age Richard Ward 141-- 19 Dress and age157-- Julia Twigg 20 Science, technology and ageing 149 -- Kelly Joyce, Meika Loe and Lauren Diamond-Brown157-- 21 Ageing, risk and the falling body Stephen Katz 165-- 22 Dementia and embodiment Pia Kontos 173-- 23 Suffering and pain in old age Kate de Medeiros and Helen Black 181-- SECTION III Identities and social relationships 189 -- 24 Identities and social relationships: introduction Julia Twigg and Wendy Martin 191-- 25 Intersectionality and age Toni Calasanti and Neal King 193-- 26 Gender: implications of a contested area Jeff Hearn and Sharon Wray 201-- 27 Anti-ageing and identities Barbara L. Marshall 210-- 28 Sex, sexuality and later life Linn Sandberg 218-- 29 Lesbian, gay, bisexual and transgender ageing 226-- Yiu-tung Suen 30 Grandparenting Sara Arber and Virpi Timonen 234-- 31 Widowhood and its cultural representations Anne Martin-Matthews 243-- 32 Loneliness and isolation 252-- Christina Victor and Mary Pat Sullivan 33 The fourth age Liz Lloyd 261-- 34 Cultures of care Michael Fine 269 -- 35 Ethnicity, culture and migration Sandra Torres277-- 36 Ageing well across cultures Matthew Carroll and Helen Bartlett285-- SECTION IV 293-- Consumption and leisure 295-- 37 Consumption and leisure: introduction Julia Tuigg and Wendy Martin 295-- 38 Retirement. Evolution, revolution or retrenchment Sarah Vickerstaff 297-- 39 Money and later life 305-- Debora Price and Lynne Livsey 40 Possessions as a material convoy David J. Ekerdt 313-- 41 Gardens and gardening in later life Christine Milligan and Amanda Bingley 321-- 42 Sport, physical activity and ageing Cassandra Phoenix and Meridith Griffin 329-- 43 Travel and tourism in later life Martin Hyde 337-- 44 Volunteering in later life Jeni Warburton 345-- 45 Youth culture, ageing and identity Andy Bennett 353-- 46 Celebrity culture and ageing Kirsty Fairclough-Isaacs 361-- 47 Representations of ageing in the media Virpi Ylänne 369 -- 48 'Late style' and late-life creativity David Amigoni and Gordon McMullan 377-- SECTION V Time and space 385-- 49 Time and space: introduction Julia Tuige and Wendy Martin 387-- 50 Global and local ties and the reconstruction of later life 389-- Chris Phillipson 51 Time in late modern ageing Jan Baars 397-- 52 Transitions, time and later life Amanda Grenier 404-- 53 Rural and urban ageing Ricca Edmondson and Thomas Scharf 412-- 54 Lifestyle migration Karen O'Reilly and Michaela Benson 420-- 55 Ageing trends in the Asia-Pacific region Alfred C. M. Chan and Carol H.Κ. Μα 428-- 56 Connectivity, digital technologies and later life Ian Rees Jones 438-- 57 Meanings of home and age Sheila Peace 447-- 58 Public places and age Caroline Holland 455-- 59 Cemeteries and age Allison Kirkman 463-- Index ix 471-
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