103 research outputs found
The Impact of Lead and Mecury on the Common Loon (Gavia immer)
No full text(Statement of Responsibility) by Ushma Mehta(Thesis) Thesis (B.A.) -- New College of Florida, 2000(Electronic Access) RESTRICTED TO NCF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE(Bibliography) Includes bibliographical references.(Source of Description) This bibliographic record is available under the Creative Commons CC0 public domain dedication. The New College of Florida, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.(Local) Faculty Sponsor: Beulig, Alfre
Self-Reported Antenatal Medicines Use Among Women Living with and Without HIV in Western Cape, South Africa: A Sub-Analysis of the B Positive Cohort Study
No full textGlobally, innumerable women take medication while they are pregnant, and this trend is growing. The pipeline of medicines targeting maternal comorbidities is expanding. However, for most medicines, there is insufficient data on their safety in pregnancy. In addition, women may be taking medication for chronic or acute conditions before they recognize that they are pregnant. This study compared the self-reported pattern of medicine use during the course of pregnancy in a cohort of pregnant women either living with or without HIV; seeking care at Gugulethu primary health care obstetric clinic in Western Cape, South Africa. Data on medicine use was collected over 3 antenatal visits. Medications reported were manually classified and coded by a clinical pharmacist and medical doctor. Structured interviews using a detailed questionnaire on medication use were administered to n=989 pregnant women. Women who had an ectopic pregnancy or an elective termination of pregnancy (TOP) were excluded from the analysis. 982 of these women were included in our analysis (n=507 HIV-negative and n=475 HIV positive). Of these, 39 (4.0%) did not report taking any medicine during pregnancy. Most 907 (92.3%) pregnant women reported using at least one over-the-counter medicine (OTC) and the majority, 601 (61.2%), at least one prescription medicine. A total of 36 (3.7%) reported using at least one herbal or traditional medicine over the course of the pregnancy. Pregnant women living with HIV were significantly less likely to report use of OTC medicine (56.2% vs 77.7%, p=<0.001). Pregnant women living with HIV also reported less herbal medicine use (2.9% vs 4.7%, p=0.07) compared to pregnant women living without HIV, though the effect was non-significant within this sample. Excluding antiretroviral medicines, prescription medicine use was essentially the same among pregnant women living with and without HIV (30.5% vs 30.2%, p=0.96). Exposure to medicines known to be potentially teratogenic or unsafe in pregnancy was reported in 300 (30.65%) pregnant women, with aspirin 238 (24.2%) and nonsteroidal anti-inflammatory medicines 46 (4.7%) medicines being the most reported. This study provides valuable information on self-reported medication use among pregnant women living with and without HIV in a South African primary healthcare setting. Medicine use was widespread in the study cohort, particularly OTC, with high prevalence of potentially unsafe medicines used during pregnancy. Our finding highlights the urgent need to build awareness around rational and safe medicine use among antenatal staff; pharmacists; and women of child-bearing age in South Africa, encouraging the taking of a thorough history of medicine exposure throughout the antenatal period
The use of m-Health active participant centred (MAPC) systems to improve surveillance of adverse events following Immunization (AEFIs) in Zimbabwe
No full textIntroduction A robust national AEFI surveillance system ensures timely AEFI detection, good quality AEFI reports, prompt case investigation and robust causality assessment for corrective AEFI case management, signal detection and appropriate feedback ultimately to improve public safety and trust in vaccines and the immunization programme. Each AEFI surveillance method has advantages and disadvantages. This thesis aimed to develop an evidence-based and empirical foundation to guide recommendations for the use of mHealth for active vaccine safety surveillance (AVSS) in Zimbabwe to strengthen its passive (spontaneous) AEFI surveillance system. The primary hypothesis of the thesis is that an mHealth application system that supports AEFI detection and reporting is a feasible approach to supporting active AEFI surveillance in Zimbabwe. Method I used mixed methods comprising a scoping and narrative literature review, a descriptive evaluation of Zimbabwe's AEFI system, a randomised control trial (RCT) to assess the impact of the Zimbabwe stimulated telephone assisted rapid safety surveillance (Zm-STARSS) approach, and a consumer and healthcare professional (HCP) survey to assess their experience and the acceptability of Zm-STARSS. Results The scoping and narrative review revealed that most MAPC AEFI surveillance studies (92%, 24/26) were conducted in High Income Countries(HICs) and only two in Low Middle-Income Countries (LMICs). The mean response rate to (Short Message Services)SMS prompts was 71% among 23 studies. Out of 1440 assessed Zimbabwean AEFI reports 54.2% were non-serious, 29.7% non-serious but deemed medically important, 6.6% causing prolonged hospitalizations and 8.1% fatal. In the Zm-STARSS RCT, despite a relatively low (31%, n = 704) response rate, we demonstrated that the SMS group had a 2% AEFI detection rate compared to 0% in the passive control arm. Of the 31 HCPs and 96 consumers who responded, 96% and 71%, respectively, supported the use of Zm-STARSS for improving AEFI reporting. Respondents identified lack of feedback after reporting, fear of negative consequences, and mobile phone costs as major barriers to SMS reporting. Conclusion and recommendations The paucity of MAPC surveillance in LMICs highlights the need for more active surveillance of AEFIs in these regions. Zm-STARSS AEFI surveillance improved AEFI detection and reporting in an LMIC setting. Although the response rate was lower than what was seen in HICs, potential barriers to responding can be mitigated with simple reprogramming. Therefore, we recommend its use in LMIC settings. To support this improved reporting and ensure appropriate responses to these reports, it is imperative to strengthen the remaining elements of AEFI surveillance, including case investigation, causality assessment, case management and feedback. In addition, prioritising training and awareness initiatives aimed at mitigating factors contributing to underreporting, including addressing HCPs and consumers' fear of victimisation, is essential. The cost of MAPC for both consumers and HCPs should be minimised to improve AEFI reporting in Zimbabwe and similar LMICs. This may require engagement with mobile phone operators to lower rates (toll-free) for mHealth surveillance systems. Further studies should investigate the feasibility and effectiveness of the mHealth approach in other LMIC settings, particularly consumer response rates, impact on AEFI reporting rates and the regulatory and Immunization programmes' responses to these reports
Noma in northwest Nigeria: a neglected disease in neglected populations
No full textBackground Noma, also known as cancrum oris, is a gangrenous infection of the oral cavity, which causes widespread orofacial destruction. If untreated, noma has a reported 90% mortality rate within weeks after the onset of first symptoms. Noma progresses through distinct stages defined by the World Health Organisation (WHO); Stage 0: simple gingivitis; Stage 1: acute necrotizing gingivitis; Stage 2: oedema; Stage 3: gangrene; Stage 4: scarring. Stage 5: sequelae. It is unclear how many patients with the early stages of noma will progress to the later stages of disease. Treatment in the early reversible stages with antibiotics, wound debridement and nutritional support greatly reduces morbidity and mortality. Acute noma is most often reported in children aged between two and five years. Many patients who survive the acute stages of the disease suffer into adulthood with disfigurement and disability of varying degrees. Noma is thought to be most prevalent in developing countries in Africa and Asia. Estimates for noma prevalence and incidence vary. In 1998, the WHO estimated an annual incidence of 140,000 cases of acute noma and 770,000 noma survivors living with sequelae. Two Nigerian studies estimated the burden of disease ranged from seven cases per 1,000 children aged between one and 16 years (2003) to 6.4 per 1,000 children (2003). A study from 2019 estimated the period prevalence of noma from 2010 to 2018 was 1.6 per 100,000 population at risk in Nigeria. These estimates are based on expert opinion, number of hospital admissions and retrospectively collected hospital-based data and it is unclear which stages of noma were included. Risk factors for the disease include poor oral hygiene, malnutrition, comorbidities and low socioeconomic status. Despite its ancient history (reported by Hippocrates (460 - 370 BC)), noma-related literature remains mainly confined to case reports and case series. By employing both qualitative and quantitative methods, we sought to examine the biopsychosocial features of noma, its epidemiology and treatment in northwest Nigeria in order to inform advocacy and prevention efforts. The three overarching objectives to fulfil this aim were to assess the distribution of noma among children in northwest Nigeria; identify factors associated with noma (including factors influencing health-seeking behaviour and risk factors for the development of noma) and gain an understanding of the biomedical and non-biomedical care provided to noma patients in this setting. The knowledge gained through this thesis will support the assessment of the need for advocacy around noma, effective resource allocation and the planning of intervention strategies. Methods We conducted a scoping literature review, three quantitative studies (risk factors, outcomes, prevalence) and two qualitative studies (language and beliefs and traditional healing practices) in northwest Nigeria. Data were collected from patient caretakers at the Noma Children's Hospital, hospital staff, children and traditional healers in villages within Sokoto and Kebbi States. Data collection methods included quantitative surveys, oral screenings, anthropometric measurements, quality of life questionnaires, qualitative in-depth interviews and focus group discussions. Consenting adult respondents answered questionnaires and participated in interviews, and where applicable, data was collected from assenting children. Quantitative analyses included descriptive statistics as well as univariable and multivariable risk factor analyses. Qualitative data was manually coded and analysed thematically. Findings We included 74 cases (noma patients presenting at the hospital in the year preceding data collection) and 222 controls (both median age of five years (inter-quartile range 3, 15 years)) in the risk factor study. Vaccination coverage for polio and measles was below 7% in both cases and controls. The multivariable analysis identified the child being fed pap every day (adjusted odds ratio (aOR) 9.8; 95% confidence interval (CI 1.5, 62.7) as a risk factor. The mother being the primary caretaker (aOR 0.08; CI 0.01, 0.5) and the caretaker being married (aOR 0.006; CI 0.0006, 0.5) were protective factors. Of the 37 patients with noma sequelae included in the outcomes study, 21 (56.8%) were male and 22 (62.9%) were aged six years or older. Fifteen patients (40.5%) had two to three surgeries. The most frequently used surgical procedure was a deltopectoral flap (n=16 patients; 43.2%). Trismus was released in 12 patients (32.4%), of these; none had a normal mouth opening at the follow-up visit. Despite this finding, all respondents reported that the surgery had improved their quality of life. In the cross-sectional study assessing the prevalence of all stages of noma, we included 3,499 households and 7,122 children aged <15 years; 4,239 (59.8%) were aged 0 to 5 years. Simple gingivitis was identified in 3.1% (n=181; CI 2.6-3.8), acute necrotizing gingivitis in 0.1% (n=10; CI 0.1-0.3), and oedema in 0.05% (n=3; CI 0.02-0.2). No cases of late-stage noma were detected. Naming of the disease differed between caretakers and healthcare workers in the language and beliefs study. Beliefs about the causes of noma were varied (spirits, animals, insects, previous infections). Noma patient caretakers spoke of the mental health strain due to stigmatization as a key issue. Difficulty in accessing care was evident. A lack of trust in the health system was mentioned as a barrier to care. Traditional healers offered specialised forms of care for specific conditions and referral guidance. They viewed the stages of noma as different conditions with individualised remedies and were willing to refer noma patients. Caretakers trusted traditional healers. Conclusion Social conditions and childhood feeding practices are associated with the occurrence of noma in northwest Nigeria. This thesis has shown that following their last surgical intervention, noma patients do experience some improvements in their quality of life, but continue to face functional challenges that inhibit their daily life. We found many, widely distributed, early-stage noma cases in northwest Nigeria indicating a large population at risk of progressing to the later stages of disease. Caretaker and practitioner perspectives may enlighten efforts to improve case finding, and to understand barriers to accessing health care. Differences in disease naming illustrated the difference in beliefs about the disease. Traditional healers could play a crucial role in the early detection of noma and the health-seeking decision-making process of patients. Intervention programmes should include traditional healers through training and referral partnerships. In conclusion, this thesis provides a unique view of the biopsychosocial features, epidemiology and treatment options for noma in northwest Nigeria. Noma is a disease, which is indicative of a weak health system and socio-economic environments of extreme deprivation. Intervention programmes should include widespread health system improvements that could address a host of risk factors for noma, and simultaneously other childhood diseases. These include increasing access to quality health care (including vaccinations), ensuring effective referral mechanisms, predominantly in rural areas, and the creation of a robust surveillance network. Health financing initiatives would need to be paired with these improvements. Nutritional programs aimed at caretakers of young children and community-based oral health initiatives could be effective mechanisms to curb the number of noma cases. Awareness-building initiatives targeting healthcare workers and community members are necessary to improve the detection and timely management of noma in endemic settings. The combined findings of this thesis highlight the neglected nature of noma and make a strong case for placing noma on the WHO neglected tropical diseases list. This initiative could foster awareness among policy-makers and governments and direct much needed funding to facilitate further research, surveillance and targeted health interventions that would contribute to the eradication of noma
A comparative analysis of the medicine use and exposures in infants who are HIV exposed uninfected and HIV unexposed uninfected in the first year in Cape Town, South Africa
No full textBackground: Despite several studies investigating medicine exposures in infants, the administration and monitoring of medications in infants who are HIV-exposed uninfected (HEU), a growing population, remains poorly studied. This study aimed to describe and compare medication consumption patterns, including immunization coverage, between infants who are HEU and HIV-unexposed uninfected (HUU) during their first year of life. Methods: This was a secondary analysis of a birth cohort study of pregnant women living with and without HIV and their infants between 2017 and 2019 in Cape Town, South Africa. Interviewer- administered questionnaires captured sociodemographic factors, self-reported medication use, infant feeding practices, and vaccine use over four postnatal visits (<7 days, 10 weeks, 6 and 12 months). Data was manually classified and coded by a clinical pharmacist and student. Logistic regression models were employed to compare patterns of use among infants who are HEU and HUU, as well as identify other maternal and infant factors associated with medication use and vaccine coverage. Findings: A total of 772 mother-infant pairs were analyzed. Compared to infants who are HUU, HEU infants were preterm (64/393 vs. 39/379; p = 0.02), less often breastfed (314/393 vs. 322/379; p <0.001), and weighed less (median, 3288g vs. 3405 g; p = 0.03). HEU infants were found to take at least one medication at a significantly higher rate 388/393 (98.7%) vs 345/379 (91.0%) than infants who are HUU (p <0.001). HEU infants reported lower use of over-the-counter (OTC) medicine (69.2% vs. 80.2%; p <0.01) and traditional, complementary, and alternative medicine (TCAM) (16.8% vs. 26.1%; p <0.001) compared to HUU infants. Mothers of HEU infants were less likely to forget a medicine's name (29.3% vs. 36.9%, p<0.001) than HUU mothers. Prescription medicine use, excluding antiretroviral (ARV) prophylaxis medicines routinely administered to infants who are HEU at birth, was significantly higher among infants who are HEU compared to HUU (65.4%. vs. 23.0%; p <0.01). Vaccine coverage showed no significant difference between infants who are HEU and HUU but steadily declined over the year (95.0% coverage with birth immunizations, vs 70.0% at 9 months) across the entire cohort. Only 293 infants (38.0%) had complete immunization coverage at 1 year. In the adjusted models, being a HEU infant was a protective factor against self-medication. (aOR 0.45; 95% CI 0.31 –0.65; p <0.001). Conversely, being breastfed (aOR 2.46; 95% CI 1.56 –3.83; p <0.001) was a significant risk factor for self-medication infants. Prescription medicine use (excluding ARV prophylaxis medicines) was significantly associated with increased maternal age (aOR 1.06; 95% CI 1.03 – 1.08; p <0.001) and infants who are HEU (aOR 6.52; 95% CI 4.66 – 9.21; p <0.001). No significant associations were found between maternal and infant characteristics and full vaccine coverage. Interpretation: The study revealed that infants who are HEU were more exposed to prescribed medicine (excluding ARV prophylaxis medicines) compared to their HUU counterparts, however, mothers of HUU infants, generally reported higher usage of both TCAM and OTC compared to HEU infants. The study also revealed drops in vaccine coverage rates among infants over the first year of life, indicating a gap in protection against vaccine-preventable diseases. Further research is needed to study medication patterns in different settings. Medication literacy efforts need to be prioritized in pregnant women and mothers of newborns to support rational and safe medicine (including vaccine) usage and subsequently improve the health outcomes for all infants, irrespective of HIV status
Niranjaner Ushma : Between the Lines and Beyond/ নিরঞ্জনের উষ্মা : পাঠে-পাঠান্তরে
No full textNiranjaner Rushma (or Ushma) by Ramai Pandit is an integral part of Shunyapurana. The mythological, historical and social significance of this particular section stands as a cornerstone in the pre-modern Bengali Mangalkavya literature. There is no concrete etymology for the word ‘Rushma’. It can happen that while reading or listening, there were some errors in comprehending; Or else there is a possibility that, this new term was strategically coined to imply the fiery wrath of Dharmaraj! In essence, Niranjaner Ushma is a fragment of the ‘Jalali Kalima’, vividly depicting the Turkic conquest of Jajpur in Odisha. Here, the story unfolds the torture of rapacious Brahmins for honorarium and the exploitation of the common folks which are beyond words. Into this turmoil, Dharmathakur emerged in the disguise of a Yavana who strategically put them in their places and hence justice prevailed.
Many celebrated historians of literature had framed the context of this piece as an era of conflict between Hindu-Buddhist ideologies. And so, in the fading twilight of Buddhism, we witnessed that Brahmanical culture rose to ultimate dominance and tyranny and as an expected outcome, persecuted Buddhists (Saddharmi) dived into the open arms of Islam. This chapter, stained with both power and pain, lingers in the annals of literature as a silent witness. Literature remembers this not as history, but as confession.
Perhaps scholars like Haraprasad Shastri, Nagendranath Basu or Dineshchandra Sen would delve into the political history of 10th–12th century of Bengal and dig up evidence—tracing the rise of royal dynasties (the Sens, Varmans, Chandras, Devas or Khargas). These kingswere devoted patrons of Brahminical culture. So, regionally the rise of the Brahmin community as the economic and religious superiors in Bengal’s society was the real driving force behind this phenomenon.
Not only West Bengal, esteemed historian of the East Bengal, Ahmed Sharif has also declared ‘Bada Jalali & Chhota Jalali’ Kalima as a burning evidence of the seething rage and bitter defiance of an near-extinct Buddhist community against the expanding, oppressive Brahminical order. According to the author of “Bangla Sahitya Kosh”, Mr. Wakil Ahmed also interpreted that ‘Niranjaner Rushma’ is nothing but a literary historic instance of the desperate surrender of the oppressed Buddhists who are trying their best to escape from the pathetic tyranny of Brahmins. In his words, this persecuted community maintained a safe distance and enjoyed the conquest of Turks and the shameful downfall of the Brahmins. As a token of gratitude towards Muslims, they worshipped Niranjan dharma infused with Islamic monotheism. In ‘Niranjaner Rushma’ there is a subtle hint of socio-religious shift where the oppressed Buddhists started to get converted in Islam in a large number.
On the other contrary, historian of Bengali Language, Dr. Sukumar Sen will emphasis that ‘Jalali Kalima’ is nothing but a reminiscence of the rapid raid of Delhi Emperor Badshah Firoz-Shah-Tughlak in Bengal and Odisha during the 14th centuries.
Moreover, entirely refuting the imagined periodization of Hindu-Buddhist conflicts, Shashibhushan Dasgupta would shift the focus and add: The residues of Buddhism, the framework of Hindu popular thought, certain indigenous non-Aryan ritual practices, and the ethos of Islamic ideology formed into an entirely new tapestry of folk ‘Dharma’.
But we’d argue that interpreting this from such scattered, fragmentary angles misses the bigger picture. Take the Ramai Pandit’s scripture on Dharma worship rituals (Vishwabharati MS No. 129)—when we piece together the stories before and after ‘Niranjaner Ushma,’ a fascinating narrative unfolds. Here, the Dharma worshippers’ belief system describes the cosmic creation process of Dharma-Raja himself, where diverse human races emerge—and right there eventually, the almighty Niranjan (in his form as Khoda) was creating the Muslim community.
Dharmapandit Ramai had replaced Hindu deities like Karticka, Ganesha, Brahma, Vishnu, Maheshwara, Chandi Mata, Manasa etc with Kaji, Gaji, Khoda, Pekambar, Baba Adam, Fakir, Nurbibi etc. This is nothing but Hindu mythological pattern. A hallmark of Hindu mythic tradition is its syncretic impulse—assimilating disparate beliefs by refracting them through the prism of its own deities. In the ecumenical vision of devout seekers, Gods and Goddesses of all faiths converge under one roof; where Khoda, Ishwar, and Dharmathakur had unified into one entity and created this cosmos. In the alchemy of converging divinities, ‘Niranjaner Ushma’ kindles into scripture where all faiths dissolved into a single syllable
Implementation of Raman Spectroscopy for in-line monitoring of critical process parameters of CHO cell perfusion cultures
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Centering Chicago Public Schools’ Portfolio Strategy on Racial Equity, Students & Community through Organizational Learning & Innovation
No full textIn 2013, the massive closure of 50 Chicago Public Schools bred community mistrust, harmed students academically, and left abandoned school buildings as relics of community divestments. With current declining enrollment and the need for accelerated learning, there is an urgent call to examine the district’s portfolio of schools and ensure every Chicago neighborhood has high-quality, well-resourced school programming for 330,000 students. Moreover, there is a vital need to take a different approach to manage the district’s portfolio of schools that strengthens the community, improves learning for students, and establishes greater trust among students and families.
In the capstone, I elevate two different small-scale innovations – one focused on improving the current portfolio approach and another focused on introducing a radical schema to disrupt the traditional portfolio approach. The capstone describes a liberatory design approach to co-create and implement both innovations. While each small-scale innovation had varying success amid leadership transitions, organizational learning is key to centering the portfolio approach around racial equity, community responsiveness, and student experience.
The capstone outlines potential implications for me as a leader, Chicago Public Schools as the site, and the PreK-12 education sector. Chicago Public Schools acknowledges that a portfolio approach for all schools must include racial equity, community responsiveness, and student experience. The district is on a path to make significant strides to redefine the traditional portfolio model to restore community trust and reimagine effective school options for all Chicago Public Schools students
The effects of maternal prepregnancy body mass index and psychological factors on infant feeding behaviors
No full textThe American Academy of Pediatrics recommends exclusive breastfeeding for 6 months with continued breastfeeding until at least 1 year of age. Three-quarters of women in the U.S. initiate breastfeeding but rates decline considerably by 6 and 12 months postpartum; furthermore, many women introduce complementary foods before the recommended age. Low breastfeeding rates and early introduction of foods may be explained, in part, by the rise in obesity among women of childbearing age. There is some evidence that women who enter pregnancy overweight and obese are more likely to not breastfeed, to breastfeed for a shorter duration and to introduce complementary foods earlier than women of normal body mass index (BMI). It is unclear why this association exists but possible reasons include obesity-related biological changes, psychological changes and mechanical difficulties. The purpose of this research was to determine the association between pregravid BMI and infant feeding behaviors and explore whether the relationship was mediated by psychological factors present during pregnancy (depressive symptoms, stress, anxiety, and self-esteem). Data came from the postpartum component of the Pregnancy, Infection, and Nutrition study. Pregnant women, recruited from the University of North Carolina hospitals between January 2001 and June 2005, were followed from pregnancy to postpartum. Using multivariable regression analysis, we found that women who entered pregnancy overweight or obese were less likely to adhere to current infant feeding recommendations. Specifically, overweight or obese women were less likely to initiate breastfeeding; more likely to breastfeed for shorter duration (any or exclusive); and more likely to introduce complementary foods before 4 months of age compared to women of normal BMI. We did not find evidence to support the hypothesis that the association between pregravid BMI and infant feeding was mediated by psychological factors. Our results showed a strong association between maternal pregravid BMI and infant feeding behaviors but, contrary to our expectations, we did not find evidence for a mediatory psychological pathway. This suggests that other factors may be more important in explaining the pregravid BMI-infant feeding relationship. Future studies need to explore why overweight and obese women are less likely to adhere to infant feeding guidelines
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