19 research outputs found
Late reproductive effects of cancer treatment
No full textGynaecologists are seeing an ever-growing population of cancer survivors who are at risk from developing a broad range of adverse outcomes relating to cancer treatment. This review discusses the most commonly observed reproductive concerns in young people who are awaiting, or have undergone treatment for cancer. We also discuss the options for maintaining fertility in both men and women, and possible subsequent pregnancy outcomes. The fertility preservation options available to any particular cancer survivor will depend on age at the time of diagnosis and treatment, the cancer type and primary site, the stage and the type of treatment.<br/
Biological rhythms in female reproduction: a link with clinical data, uterine receptivity and implantation
No full textMany aspects of physiological function are strongly circadian. Disturbance of these intrinsic modulators is implicated in disease states, but the role of biological rhythmic control in the context of reproduction is still largely unknown. The circadian network is apparent in all aspects of reproductive functioning; from menstruation to implantation and pregnancy. Endometrial dysfunction may occur if regulatory processes do not happen, with a disruptive effect on the synchronisation of implantation. Whether this dysregulation happens at the level of the endometrium, at the embryo-endometrial interface or at the level of clock genes is not known.This work has investigated the role these biological rhythms, in particular those pertaining to that of uterine receptivity and implantation. By a systematic review and a meta-analysis of shift workers, a population being at risk of adverse early reproductive outcomes was identified. The link between experiencing poor early reproductive outcomes and sleep and activity was further investigated and it was shown that sleeping and activity patterns are different in reproductive pathology as compared with fertile healthy women.The molecular basis of observed relationships between sleep and reproductive difficulty was investigated by examination of the uterine environment. Human samples were compared in-vivo, and with in-vitro culture models in unstimulated, normal menstrual cycles. This was to examine whether the difference in the circadian rhythm, which leads to deleterious effects in other pro-inflammatory disease, could be linked to the uterine environment of women with reproductive pathology. The immunomodulatory uterine secretome profile in women suffering from recurrent implantation failure (RIF) was shown to be different from fertile women.The expression of core clock genes within the uterus was shown to be cyclical in a circadian manner. The effect of decidualisation appeared to effect the phase, but not the period of this expression. The distinct pattern of endometrial secretions in each group of women (RIF and fertile controls) was compared with the reciprocal core clock gene expression, and was shown to be correlated with a four-hour time lag. The geneimmunomodulator association was effected by decidualisation, more so in the women suffering from RIF than the controls. The addition of melatonin to the cell culture model made the RIF endometrium respond more like the control endometrium. After treatment with melatonin, cells from women with RIF had a more similar geneimmunomodulator profile to the control women. This effect was more noticeable after decidualisation. Whether or not this can be considered a beneficial alteration has not been ascertained
Are skin scar characteristics associated with the degree of pelvic adhesions at laparoscopy?
No full textObjectiveTo investigate whether individual or a combination of abdominal surgical scar characteristics can predict the severity and extent of intra-abdominal adhesions.DesignA prospective cohort study.SettingA tertiary referral center in the United Kingdom.Patient(s)One hundred women who had previously undergone abdominopelvic surgery and were undergoing an elective laparoscopic gynecologic operations.Intervention(s)Abdominal scars were evaluated preoperatively using the modified Manchester Scar Questionnaire Adhesions were assessed intraoperatively and compared with the cutaneous findings.Main Outcome Measure(s)Presence and severity of intra-abdominal adhesions.Result(s)Of 100 women recruited into this study, 71 (71%) women were found to have intra-abdominal Aadhesions, and 29 (29%) had no adhesions. Women who had more than one abdominal scar, a palpable scar, and/or a longer scar were most likely to have pelvic adhesions during the current surgery. Women with the highest mean scar scores also had a greater total adhesion score.Conclusion(s)Adhesions are a common postoperative consequence of open or laparoscopic surgery. Skin scar characteristics are associated with the presence and degree of pelvic adhesions. Future studies should examine whether these characteristics can be used as a preoperative predictive tool to facilitate surgical decision-making and elective operating room organization
Provision of obstetrics and gynaecology services during the COVID19 pandemic : a survey of junior doctors in the UK National Health Service
No full textObjective: The COVID-19 pandemic is disrupting health services worldwide. We aimed to evaluate the provision of obstetrics and gynaecology services in the UK during the acute-phase of the COVID-19 pandemic.
Design: Interview-based national survey.
Setting: Women’s healthcare units in the National Health Service.
Population: Junior doctors in obstetrics and gynaecology.
Methods: Participants were interviewed by members of the UKARCOG trainees’ collaborative between 28th March and 7th of April 2020. We used a quantitative analysis for closed-ended questions and a thematic framework analysis for open comments.
Results: We received responses from 148/155 units (95%), majority of the participants were in years 3-7 of training (121/148, 82%). Most completed specific training drills for managing obstetric and gynaecological emergencies in women with COVID-19 (89/148, 60.1%) and two-persons donning and doffing of Personal Protective Equipment (PPE) (96/148, 64.9%). The majority of surveyed units implemented COVID-19 specific protocols (130/148, 87.8%), offered adequate PPE (135/148, 91.2%) and operated dedicated COVID-19 emergency theatres (105/148, 70.8%).
Most units reduced face-to-face antenatal clinics (117/148, 79.1%), and suspended elective gynaecology services (131/148, 88.5%). The two-week referral pathway for oncology gynaecology was not affected in half of the units (76/148, 51.4%), while half reported a planned reduction in oncology operating (82/148, 55.4%).
Conclusion: The provision of obstetrics and gynaecology services in the UK during the acute phase of the COVID-19 pandemic seems to be in line with current guidelines, but strategic planning is needed to restore routine gynaecology services and ensure safe access to maternity care on the longterm
Mansions of Memories: Linden Hill and the Long Shadow of the Lumber Industry in Little Falls, 1891-2010
No full textAuthor Alexander Ames offers a portrait of a Minnesota river town redolent with heritage, resonant with a sense of place, and intent on forging an identity in a changing world. The privileged status of Linden Hill in Little Falls’ collective memory owes itself to the town’s faltering economic and cultural-historical development—as well as to the life and work of a woman named Laura Jane Musser, who endeared the mansions and grounds to the town’s psyche, and who transformed the lumber barons’ homes into mansions of memories
Is sleep deficit associated with infertility and recurrent pregnancy losses? Results from a prospective cohort study
No full textThe risk of assessment: Understanding service providers' use of risk assessment for intimate partner violence and homicide prevention with Indigenous populations
No full textRisk assessments for intimate partner violence focus on the risk a victim may face of being revictimized and/or the likelihood that a perpetrator will reoffend. In many cases, these risk assessments involve an actuarial assessment of these risks, paying little attention to contextual and historical risk factors. With the over-representation of Indigenous populations in intimate partner violence victimization and perpetration, it is imperative that risk assessments consider the impact of colonization on Indigenous people’s increased vulnerability to intimate partner violence.
Few researchers have critiqued the implications of clinical and actuarial risk assessments on Indigenous people. In an effort to address this issue, this thesis: (1) takes stock of current risk assessment strategies used by Canada’s service providers in the anti-violence sector; (2) identifies useful “promising practices” and barriers to effective risk assessment as identified by service providers; (3) discusses the ways in which these findings can be used to conceptualize an alternative approach to risk assessment; and (4) provides recommendations for the future of risk assessment based on the shortcomings identified in both the literature and interviews with service providers. This research uses a convenience sample of 30 telephone interviews with service providers, all of which were conducted by the author, which include 17 in Manitoba, seven in British Columbia, five in Alberta, and one in Nunavut. The sectors represented include, police, shelters, healthcare, victim services, probation. Findings indicate that many service providers use a patchwork approach to risk assessment, combining elements of structured and unstructured tools and practices to suit the individual and address the complex interplay of individual and systemic factors.October 201
Utility of newer technologies for the diagnosis of active and latent tuberculosis
No full textIncludes bibliographical references (leaves 91-109).Since the 1800s the tuberculin skin test (TST) has been the only available test for latent tuberculosis (LTBI). Recently, interferon-gamma release assays (IGRAs) have been developed which are based upon the responses of peripheral blood effector cells to M.tb-specific antigens [early secretory antigenic target -6 (ESAT-6) and culture filtrate protein (CFP10)]. Discordance between the TST and IGRAs has been well documented but remains largely unexplained
Three Women/Three Margins: Political Engagement and the Art of Claude Cahun, Jeanne Mammen, and Paraskeva Clark
No full textEThOS - Electronic Theses Online ServiceGBUnited Kingdo
Resilient places? The healthcare gardens and the Maggie's Centres
No full textThis thesis takes as its focus the Maggie’s Cancer Centres exploring for the first time the impact of their designed gardens. This research is situated within the immediate context of Maggie’s ambitions as an organisation and looks closely at their design process. It is also set within the wider debates about the effects of green space on health and the historical context of the restorative garden. By exploring both historical and contemporary examples, it argues that a healthcare garden may be a space for transformation.
Using four different Maggie’s gardens as case studies, the research seeks to investigate the role of these outdoor spaces and their impact on users. Through ethnographic and sensory methods, each garden is considered and mapped. It looks at the design brief and the intentions of the designers’, but the core work is an exploration of the experiences of staff and visitors. The focus is on the everyday use of these gardens as well as the design historiography. The experiences of gardens within healthcare are examined in order to expose the ways in which gardens, people, health and care are entwined.
Through the qualitative research process this thesis develops a new hypothesis as to how healthcare gardens may operate – offering a new definition for them as “resilient places”. Careful analysis of the data reveals the specific networks and affordances presented by these gardens. The thesis argues, based on the evidence of users, that healthcare gardens can uniquely embrace certain “essences” where essence is defined as conveying a quality or attribute. These garden essences are identified as thresholds, sensory richness, the density of time and homeliness. The thesis also argues that a healthcare garden can provide specific and unique opportunities for care and this, in turn, can enhance the healing ethos of an organisation such as Maggie’s
