Minerva Access

Do rugby league players under-report concussion symptoms? A cross-sectional study of elite teams based in Australia

Fri, 01 Jan 2021 00:00:00 GMT

Longworth, T; McDonald, A; Cunningham, C; Khan, H; Fitzpatrick, J 2021-01 Do rugby league players under-report concussion symptoms? A cross-sectional study of elite teams based in Australia ObjectiveTo determine the rate of under-reporting of concussion and its symptoms in elite rugby league players in Australia.MethodsThe study was conducted in the preseason of the 2020 National Rugby League (NRL) competition.A total of 151 male, NRL club contracted rugby league players across three professional clubs participated.The participants completed a voluntary, anonymous survey exploring player demographics, concussion data, under-reporting instances and reasons for under-reporting over the 2018 and 2019 rugby league seasons.Results17.2% of surveyed players reported sustaining a likely concussion over the past 2 years and not reporting to medical staff. 22% of NRL first grade players admitted to not reporting at least one concussion during the 2018 and 2019 seasons. The most common reason not to report was the player ‘not wanting to be ruled out of the game or training session’ (57.7%), followed by ‘not wanting to let down the coaches or teammates’ (23.1%). 85.4% of surveyed players reported having concussion education by their club in the previous two seasons.Conclusions17.2 % of elite rugby league players in Australia chose not to report likely concussive episodes and concussion-related symptoms during the 2018 and 2019 seasons. Clinicians need to be aware of under-reporting in athletes when assessing players following head injuries. The findings highlight the need for development of validated, objective testing for concussion following sports-associated head injury. Journal Article

Life after COVID-19: The importance of a safe return to physical activity

Jewson, J; McNamara, A; Fitzpatrick, J Life after COVID-19: The importance of a safe return to physical activity The Australasian College of Sport and Exercise Physicians has developed a guideline for primary care practitioners to assist with safe return of patients to physical activity after COVID-19. Journal Article

UniMorph 3.0: Universal morphology

Wed, 01 Jan 2020 00:00:00 GMT

McCarthy, AD; Kirov, C; Grella, M; Nidhi, A; Xia, P; Gorman, K; Vylomova, E; Mielke, SJ; Nicolai, G; Silfverberg, M; Arkhangelskij, T; Krizhanovsky, N; Krizhanovsky, A; Klyachko, E; Sorokin, A; Mansfield, J; Ernštreits, V; Pinter, Y; Jacobs, CL; Cotterell, R; Hulden, M; Yarowsky, D 2020-01-01 UniMorph 3.0: Universal morphology The Universal Morphology (UniMorph) project is a collaborative effort providing broad-coverage instantiated normalized morphological paradigms for hundreds of diverse world languages. The project comprises two major thrusts: a language-independent feature schema for rich morphological annotation and a type-level resource of annotated data in diverse languages realizing that schema. We have implemented several improvements to the extraction pipeline which creates most of our data, so that it is both more complete and more correct. We have added 66 new languages, as well as new parts of speech for 12 languages. We have also amended the schema in several ways. Finally, we present three new community tools: two to validate data for resource creators, and one to make morphological data available from the command line. UniMorph is based at the Center for Language and Speech Processing (CLSP) at Johns Hopkins University in Baltimore, Maryland. This paper details advances made to the schema, tooling, and dissemination of project resources since the UniMorph 2.0 release described at LREC 2018. Conference Paper

Coriolis effect on centrifugal buoyancy-driven convection in a thin cylindrical shell

Wed, 10 Mar 2021 00:00:00 GMT

Rouhi, A; Lohse, D; Marusic, I; Sun, C; Chung, D 2021-03-10 Coriolis effect on centrifugal buoyancy-driven convection in a thin cylindrical shell Abstract Journal Article

Spatial effects of controlling security measures in places of mass gathering

Wed, 01 Jan 2020 00:00:00 GMT

Miller, Claire Eleanor 2020 Spatial effects of controlling security measures in places of mass gathering This project examines the spatial effects of controlling security measures in places of mass gathering, specifically public squares, and develops a generalised framework for evaluating these effects in other spaces. Over the first decades of the twenty-first century there has been a rapid and transformative shift in perceptions of threat and national security, particularly in the west, towards preemption. This reactionary shift has introduced new motivations behind controlling security measures, amplifying tensions between security imperatives and rights to the city. Security in public space is not new, but in recent years there has been an increase in protective security interventions and a tightening of rules about acceptable behaviours. This project is motivated by a lack of understanding of the small-scale, spatial impacts of national security imperatives and the global doctrine of preemption on the fabric and lived experiences of urban places. This research employs a multiple case study analysis method to reveal generalised spatial conditions and security effects. The case study sites are Federation Square in Melbourne, Trafalgar Square in London, and Hashemite Plaza in Amman. Twelve security measures were investigated at each site, within three broad categories – panoptic devices, regulatory procedures and fortress measures. Primary source data was collected as spatial observations in the form of mapping, photographing and analysing. Each site was visited over several days during different conditions, times and events. At each visit the spatial layout of security measures was observed and noted, including how they interact with and effect each other, people and events in the space. Historical research into each site explains their development; the process of securitisation; and their varied historical, social and cultural contexts. This research reveals generalised patterns of control and power relations across diverse global sites, expressed through controlling security measures. Unexpectedly, the most insidious spatial control technique is site branding. This is the fixing of a preferred identity to a place, defining sanctioned behaviours and excluding deviating behaviours or competing spatial identities. This research explores how the political impacts the socio-spatial and is located at the intersection of urban theory, with social and political science. It contributes to the existing body of knowledge by introducing an analysis method that can be applied to other sites, and expands the existing literature geographically, and to include small scale analysis of public spaces. Opportunities for further research includes analysis of the continued development of the case study sites as new threats emerge, and the focus of global and national security shifts. While global threats today are different than when this research began, security responses continue to be characterised by control of human behaviour in public space. © 2020 Claire Eleanor Miller PhD thesis

An integrated circuit towards improved management of epilepsy and other neurological conditions

Wed, 01 Jan 2020 00:00:00 GMT

Slater, Kyle 2020 An integrated circuit towards improved management of epilepsy and other neurological conditions Epilepsy is the second-most common neurological disorder, with an estimated prevalence of 1% worldwide. Antiepileptic drugs (AEDs) are the frontline treatment but, despite more than 25 agents available, there can be significant difficulties in finding a treatment plan that controls seizures without unacceptable side effects. Furthermore, approximately 30% of patients do not obtain full control of seizures with the available AEDs. Therefore, there exists a need for novel therapies. Therapeutic electrical stimulation of the brain and peripheral nervous system has shown great promise in treating those with refractory epilepsy, but still little is known about the mechanisms underlying this. Recent work looking at prolonged recordings of the brain has revealed a deep rhythmicity to seizures that may provide a method of developing patient-specific prediction algorithms that could be used to titrate electrical stimulation therapies. What is missing in research and in clinical practise is an implantable device which provides enough flexibility to explore new paradigms and adapt to suit the needs of the patient. Safety considerations of implantable devices necessarily precedes large-scale clinical evaluation, and this has prevented exploration of speculative higher density arrays, which come at a cost to power, complexity and mechanical reliability with no guarantee of improvement to efficacy. Rather than redesign the system from scratch, this PhD thesis asks, “how can existing implantable technology be leveraged to create flexible high-density brain recording and stimulation systems?” In response to this question, an integrated circuit called XPAND was designed to enable seamless expansions of electrode count for a wide variety of commercial stimulators. Comprising a 6 x 64 element high voltage crosspoint switch powered and configured entirely using biphasic stimulation pulses, XPAND was designed with clinical safety in mind. Fabricated in Austria Microsystems H35 high voltage CMOS process, key modules within the chip were characterised, and the crosspoint switch shown to simultaneously route high voltage stimulation and ECG signals. © 2020 Kyle Slater PhD thesis

Intelligence analysis in multidisciplinary teams - affordances of the collaborative online SWARM platform for public service and education application

Wed, 01 Jan 2020 00:00:00 GMT

Wright, Andrew James 2020 Intelligence analysis in multidisciplinary teams - affordances of the collaborative online SWARM platform for public service and education application Intelligence analysts from Australian Commonwealth, State and Territory Government agencies and departments regularly work in teams with other roles, referred to in this research as multidisciplinary teams (MDTs). MDTs operate within a ‘framework’, which provides the central mechanism for team coordination and structure. However, there is little available research on intelligence MDT frameworks including challenges. To address this gap and explore potential MDT frameworks, this thesis examines intelligence MDTs and the Hunt Lab’s collaborative software prototype SWARM Platform as a framework to support the functions of intelligence MDTs. The Hunt Lab developed the Platform in 2017 to improve collaboration and quality of reasoning of intelligence analysts. We investigated whether the Platform can move beyond its origins to provide a framework to support the business and training functions of intelligence MDTs, including affordances for managers and educators. As a first step, we developed a maturity model, informed by the intelligence teamwork literature for the purposes of defining and evaluating the key indicators of intelligence MDTs. We detail the development of our maturity model that contains seven pillars against which MDT performance could be evaluated: Mission, Accountability, Agility, Efficiency, Communication, Collaboration and Output. This maturity model formed the central coding mechanism for this research to evaluate MDT performance. We conducted three studies to address our research questions focusing on current MDT workplace application and whether the Platform supports business and training MDT framework functions. Study 1 applied the maturity model to a case study of intelligence MDT performance in the Australian Government, where we identified Mission and Collaboration as a strength but Efficiency as a weakness of their MDT framework. In Studies 2 and 3, we evaluated the Platform as a potential framework to support the business and training functions of intelligence MDTs, first in a small-scale pilot within an Australian Government workplace and then on a larger scale in an analytical competition involving public and intelligence organisation teams. In these two studies, we found the Platform mostly supported key MDT pillars but also identified varying weaknesses across pillars of Accountability, Efficiency and Communication. Despite the Platform’s broad support for the MDT maturity pillars, this research identified technical and cultural issues that prevent adoption of the Platform as a business framework without further prioritised research. Instead, our research indicates the Platform has more immediate benefits in supporting training functions as a computer-supported collaborative learning (CSCL) tool, where research participants reported both cognitive and social learning outcomes in the same studies. This research developed insights relevant to MDT frameworks more broadly including scaffolding strategies to improve multiple maturity model pillars. These strategies include teamwork schema development; launch meetings; accountability practices; and data management. We also developed insights into engaging and researching government with intelligence functions that are an emergent but not unforeseen result from this research. These findings have implications for future collaboration between the tertiary research sector and government with intelligence functions. © 2020 Andrew James Wright Masters Research thesis

Planning and Investment in a Peasant Landscape: the Site of Podere Marzuolo (Tuscany, Italy)

Wed, 01 Jan 2020 00:00:00 GMT

Van Oyen, A; Tol, G; Vennarucci, R 2020 Planning and Investment in a Peasant Landscape: the Site of Podere Marzuolo (Tuscany, Italy) Conference Paper

A Naïve faith in images: indexicality, silence and fabrication in the construction of narrative

Wed, 01 Jan 2020 00:00:00 GMT

Rodriguez Chaves, Emanuel 2020 A Naïve faith in images: indexicality, silence and fabrication in the construction of narrative A Naive Faith in Images explores the veracity of photographic and pictorial documents presented as information in the public realm, that is in the media, public institutional archives and broadly in historical documents. The research examines the role that memory and narrative play within discourses of conflict and the construction of histories. Specifically, the project addresses how contemporary art establishes and negotiates relationships between philosophical aspects around the manipulation of images and socio-political imaginaries (the values, systems and symbols common to a particular social group) to construct new narratives. Thus, the exegesis is based on three structural streams of inquiry, that of image interpretation (W. J. T. Mitchell, Hans Belting, Jacques Ranciere, Susie Linfield, Vilem Flusser), image collection and archival practices (Georges Didi-Huberman, Hal Foster, Aby Warburg, Peter Osborne) and an expanded notion of painting (Isabelle Graw, Gerhard Richter). Two historical cases are provided to create a blueprint, used to scrutinise the structural streams of inquiry, as they posed specific problems in regard to the use of images and image interpretation. I was motivated by their geographical, political and ideological relevance. One instance is factual and delves into the investigation of the murder of Viviana Gallardo, a Costa Rican leftist militant and activist who was shot in prison and whose persona was exploited by the conservative right-wing ideology of the time. This case is of significance to the overall project, as it examines how images are used to manipulate discursive narratives. The study follows the ways in which the narrative of this recent event was constructed from a multiplicity of interpretations, such as that from Gallardo’s family, friends, ex-militants and the generally uninformed public. The second case manufactures the story of Svetoslav S., a fictional painter whose life and work explore the role of art history in the play between politics, identity and the indiscriminate use of images. In this research, the first case study is embedded in the notion of the image as an index, covering the complexities this assumption entails historically and the consequences it presents in a particular context (Costa Rica). The second case serves to question and bend the latter assumption by placing the character within a global narrative that has affected the western historical construct. It also explores the role of the artist as a manipulator of images, through the potentialities and contradictions underpinned by an extended notion of painting, as well as the different identities that can be created from the mix between fiction and factuality. Both cases show us phenomenological aspects of images—the platforms and contexts in which particular images have portrayed events and individuals; as well as highlighting the level of engagement audiences have when interacting with different versions of a single event and how these have an effect upon the understanding and creation of history. On an individual level, I was interested in how differently I interpret and manipulate particular images—those that have an impersonal relationship to me—my connection to them and my subsequent artistic response. In opposition to this, I will show the effect that other pictures with more personal and sensitive subject matter can produce and how this affects my relationship to them and the subjects that these represent. In one instance, I became an interpreter, in the other, a medium or mediator. © 2020 Emanuel Rodriguez Chaves PhD thesis

The biofilm formation and iron acquisition systems of Klebsiella pneumoniae

Wed, 01 Jan 2020 00:00:00 GMT

Jebeli, Leilaalsadat 2020 The biofilm formation and iron acquisition systems of Klebsiella pneumoniae Klebsiella pneumoniae is an opportunistic bacterial pathogen and a common cause of healthcare-associated infections. Due to the emergence of antimicrobial-resistant and hypervirulent strains, K. pneumoniae is recognised as a major public health threat. The ability of some K. pneumoniae strains to form biofilms increases this concern, particularly in healthcare settings where bacteria can colonise surfaces of indwelling devices. Biofilms can mediate more effective host colonisation and bacterial cells within biofilms are often more resistant to antimicrobial treatments. Given the importance of biofilms in enhancing virulence and complicating treatment regimens, greater understanding of biofilm formation among Klebsiella isolates is required. This dissertation revealed that the K. pneumoniae clinical isolates AJ094, AJ097 and AJ218 exhibited different biofilm formation capabilities, and their biofilms had variable responses to DNase and proteinase treatment, suggesting qualitative differences. The early-stage biofilms formed by AJ094 and AJ218 could be destabilised by DNase, suggesting that the presence of extracellular DNA in the biofilm matrix was important for biofilm development. Dispersal of AJ218 biofilms by proteinase treatment indicated the importance of protein components such as fimbriae in maintaining the biofilm. Proteomic analysis revealed that cells were more metabolically active in the planktonic compared to the biofilm state, and differential expression of certain proteins suggested physiological variation between planktonic and biofilm cells. Proteomic experiments also showed that type 3 fimbrial proteins were expressed at higher levels in the biofilm state, particularly in the AJ218 strain, which is known to form biofilms via type 3 fimbriae. Some proteins expressed in the biofilm state were involved in metal ion uptake and AJ094, AJ097 and AJ218 were all shown to require iron supplementation for optimal growth and biofilm formation in minimal media. Mutation of an enterobactin-mediated iron acquisition gene in AJ094 significantly reduced biofilms under iron limiting conditions compared to iron-replete conditions. On the other hand, the siderophore yersiniabactin was shown to be less important than enterobactin for supporting in vitro biofilm formation and growth. Highly invasive Klebsiella strains often carry genes for yersiniabactin synthesis and, compared to enterobactin, this siderophore is less well-understood. A transposon mutagenesis approach was employed in this study to identify novel regulators and efflux systems for yersiniabactin. The study was successful in identifying known yersiniabactin-related factors, including genes located outside of the yersiniabactin operon that were directly or indirectly related to yersiniabactin metabolism and transport. During construction of the transposon mutant library, a spontaneous 70-kb chromosomal deletion occurred in the parent strain. The deletion mutant exhibited reduced siderophore activity when associated with a transposon insertion within a hypothetical gene (orf684). However, when the 70-kb region was present, inactivation of the orf684 gene no longer caused reduced siderophore activity. This study has improved our understanding of biofilm composition and the requirement of iron and siderophores in the formation of K. pneumoniae biofilms. Further research into fundamental characteristics of iron, siderophores and matrix components in regard to bacterial growth and biofilm formation may lead to the development of novel drugs or preventive strategies to reduce the burden of bacterial infection. © 2020 Leilaalsadat Jebeli PhD thesis

Selecting life course frameworks to guide and communicate large new cohort studies: Generation Victoria (GenV) case study

Wang, J; Hu, YJ; Clifford, S; Goldfeld, S; Wake, M Selecting life course frameworks to guide and communicate large new cohort studies: Generation Victoria (GenV) case study Abstract While birth cohorts are shaped by underpinning life course frameworks, few if any report how they select them. This review aimed to (1) summarise publicly available frameworks relevant to planning and communicating large new early-life cohorts and (2) help select frameworks to guide and communicate Generation Victoria (GenV), a whole-of-state birth and parent cohort in planning in the state of Victoria, Australia. We identified potential frameworks from prior knowledge, networks and a pragmatic literature search in 2019. We considered for inclusion only frameworks with an existing visual graphic. We summarised each framework’s concept, then judged it on a seven-item matrix (Scope, Dimensions, Outcomes, Life course, Mechanisms, Multi-age, and Visual Clarity) to be of high, intermediate or low relevance to GenV. We presented and evaluated 14 life course frameworks across research and policy. Two, nine and three frameworks, respectively, were ranked as high, intermediate and low relevance to GenV, although none totally communicated its scope and intent. Shonkoff’s biodevelopmental framework was selected as GenV’s primary framework, adapted to include ongoing feedback loops through the life course and influence of an individual’s outcomes on the next generation. Because conceptual simplicity precluded the primary framework from capturing the wide range of relevant exposures, we selected the Australian Institute of Health and Welfare’s person-centred model as a secondary framework. This summary of existing life course frameworks may prove helpful to other cohorts in planning. Our transparent process and focus on visual communication are already assisting in explaining and selecting measures for GenV. The feasibility, comprehension and validity of these frameworks could be further tested at implementation. Journal Article

"Place" and sexual and reproductive health in Australia

Wed, 01 Jan 2020 00:00:00 GMT

Bingham, Amie Lee 2020 "Place" and sexual and reproductive health in Australia Sexual and reproductive health are significant public health concerns, and come with considerable costs to be individuals and the public, whether physical, emotional, mental or financial. There have been calls, particularly internationally, for responses to sexual and reproductive health issues to take an ecological perspective, addressing the multiple levels of influence on people’s health outcomes, such that interventions may potentially be more effective and enduring. ‘Place based’ approaches to health engage with ecological understandings of health, and a small body of literature has applied this framework to sexual and reproductive health. Few have done so within the Australian context, however. The aim of this thesis was to improve understanding of whether and how geographic location may be impacting on the sexual and sexual and reproductive health of Australians. In order to do so, three objectives were addressed: 1 - to explore associations between geographic location and sexual and reproductive health outcomes in Australia; 2 - to explore associations between geographic location and sexual and reproductive health risk behaviours in Australia; and 3 - explore the mechanisms by which geographic location may be affecting sexual and reproductive health behaviours and outcomes. Chapters 1 to 3 are introductory chapters, including a review of relevant literature pertaining to both sexual and reproductive health, and to conceptual frameworks which may inform place-based approaches to understanding health. Chapters 4, 5 and 6 present analyses of associations between ‘place’ and sexual and reproductive health outcomes and behaviours. Chapter 4 comprises a publication in analysing associations between country-level income inequality and notifications of Neisseria gonorrhoea in females. It finds that higher levels of income inequality were significantly associated with higher rates of notification for gonorrhoea. Chapters 5 and 6 report on analyses of a national dataset of prescribing data for the subdermal contraceptive implant and the levonorgestrel intra-uterine device, respectively, finding associations between living outside major cities and higher rates of prescription of long-acting contraceptives. The analyses also tested associations between proximity to specialist health services, such as Aboriginal Medical Services and Family Planning Clinics, but found little evidence of significant association. Chapter 7 presents the finding of a qualitative analysis of interviews with key informants in rural and regional areas of Australia, exploring mechanisms though which characteristics of their local communities may be affecting the sexual and reproductive health of young people. Participants were able to articulate a broad range of factors related to their location that were affecting these – and other – outcomes, including: the social context, broader social and political structures, local structural elements, and geographic location. Informed by findings from the qualitative analysis, Chapter 8 explores associations between alcohol availability and prevalent chlamydia at the level of postcode, multilevel analyses, finding no evidence of significant associations. Together, these analyses have contributed to a small body of Australian literature which takes a place-based approach to sexual and reproductive health outcomes. Showing associations at various levels, it emphasises the potential utility of taking an ecological approach to interventions designed to improve sexual and reproductive health – from the national level to the level of individuals. © 2020 Amie Lee Bingham PhD thesis

Dynamic loads on prefabricated modular building unit during road transportation

Wed, 01 Jan 2020 00:00:00 GMT

Godbole, Siddhesh 2020 Dynamic loads on prefabricated modular building unit during road transportation Prefabricated modular construction is set to revolutionize the modern construction industry once again. Over the past couple of centuries, prefabrication has proven to be a more cost-efficient and time-saving alternative to conventional design practices. Computer-aided design has facilitated more complex projects in terms of architecture, planning and cost. Prefabricated construction has benefitted from the advent of building information modelling (BIM), 3-D printing, robotics, and assembly line automation. What is poised to become a multi-trillion-dollar industry in the coming decade, the modular construction is still navigating through its bottlenecks around different parts of the world. Benefits of doing lesser at the construction site and more at the offsite are pushing the frontiers of prefabricated modular construction every day. The demand for pre-furnished, all equipped plug-in ready modules has increased. With many issues pertaining to skilled labour availability, shipping, transportation, and erection issues, structural robustness, and project economics, yet to be resolved, the industry demand for prefabrication is ever increasing. The research undertaken in this project focused on quantifying the hazards due to road induced vibrations to the modular building unit and its internal components. A stepwise approach of the project quantified the vertical acceleration spectra for non-structural components inside the modules. The first part addressed the continuous vibrations sustained by the modular unit and the internal components due to road roughness. The second part calculated the impact-induced hazard by predicting the risk of the vertical separation between the module and the trailer-bed. Stochastic modelling was employed using stationary processes to create a large sample of road profiles consistent with the required roughness power spectral density functions. Multi-degree of freedom lumped mass model was developed to predict the truck trailer's response to the road profile roughness in the vertical plane. The truck-road numerical modelling was validated with field experiments on known road surfaces. Response acceleration spectra for the components attached to the modules carried by trailer were reported as the sustained dynamic actions on the cargo. A probabilistic estimate for vertical gap formation (and vertical impact velocity) between the strapped cargo (module) and the trailer-bed was made by extending the truck-road interaction model. The impact between the air-borne edge of the box module structure with that of the trailer-bed was studied analytically, numerically and experimentally. Component response acceleration spectra were derived for such a pounding scenario considering different masses of the modules impacting with different velocities. Design acceleration spectra for components were broadly classified into three frequency regimes (< 20 Hz, < 50 Hz, > 50 Hz) stipulating vertical acceleration demand of the non-structural component fixtures inside modules during transportation. Structural guidelines available for the component fixture design could only be found in seismic standards. What is typically sufficient for component design in conventional buildings may not be so for furnished modular structures as the transportation induced dynamic loads could be much higher than the seismic provisions for the non-structural components. This study offers guidelines for the capacity design of the internal fixtures of a fully furnished modular structural unit through numerical analysis backed by experimental tests. The findings of this study are expected to assist the engineers in designing the building utilities, suspended ceilings, non-structural walls, wall-mounted equipment of a modular building unit for transportation induced loads. Recommendations: 1. Incorporate higher design forces for internal component fixtures governed by the acceleration response spectra derived in the study. 2. Provide rigid latching between the MBU and the trailer-bed similar to that of the container shipping module. 3. In the case of larger MBUs that cannot be rigidly fastened to the trailer-bed, increase vertical tie strength to 40% of the total weight of the cargo to avoid vertical separation. 4. Incorporate softer palleting materials: a. To filter out high-frequency vibrations b. To alleviate the damage hazard during pounding should it occur. 5. Increase the support locations for the MBU by increasing the number of mounts/pallets used during transportation. 6. Orient the MBU on the trailer-bed such that vibration-sensitive components would lie in the front portion of the trailer. © 2020 Siddhesh Godbole PhD thesis

Acoustic cues to prominence and phrasing in bilingual speech

Wed, 01 Jan 2020 00:00:00 GMT

Torres Orjuela, Catalina 2020 Acoustic cues to prominence and phrasing in bilingual speech This dissertation investigates the prosodic structure of French and the Oceanic language Drehu, spoken by a small bilingual community on the island of Lifou, in the South Pacific. Lifou is a remote island belonging to the archipelago of New Caledonia, localised more than 16000 km away from mainland France. Although officially a French overseas territory, live in Lifou is to a large degree organised according to customary tradition of the indigenous population, the Kanak people. There is no obvious societal majority language on the island and French and Drehu are commonly spoken by the indigenous population, who make up the majority of the inhabitants. The aim of this examination is to develop a phonetic prosodic model for the two languages and determine whether there are effects of prosodic transfer between the two languages of bilingual speakers. Of particular interest is the the phonetic description of prominence and phrasing of the two languages for a categorisation of their prosodic typology. This thesis presents five studies dealing with (i) the acoustics of Drehu word prosody, (ii) the acoustic correlates of intonational structure in Lifou French, (iii) the acoustic durational properties of Lifou French, (iv) the acoustics of prominence marking and phrasing in Drehu, and (v) acoustic cues used in word recognition in Drehu and French. The speech and perception data for these studies were collected during four field work trips to the island of Lifou, where more than 100 adult and teenage speakers participated. To investigate processing in the French language and incorporate a monolingual control group, additional experimental work was conducted in the facilities of the Laboratoire Parole et Langage, Aix Marseille University, CNRS, in Aix-en-Provence, in metropolitan France. A variety of methods, typically used in laboratory phonology, such as controlled reading tasks or a forced choice word identification experiment were employed. For exploration and interpretation of the data, all five studies include a statistical analysis. This work puts forward a revised model of Drehu word prosody and postulates an intonation phonological account of the language. In addition, the intonational phonology of Lifou French is documented, providing the first description of this previously undocumented variety. Building on this descriptive work and taking into consideration previous phonetic research on the speech production and prosody of bilingual speakers, the role of sociolinguistic motivations and functional constraints is discussed. This dissertation highlights the relevance of applying detailed acoustic descriptions to under-documented languages which are poorly understood regarding their prosodic systems. It contributes to the documentation of the languages in the Oceanic region and advances our understanding of bilingual speech processes. © 2020 Catalina Torres Orjuela PhD thesis

New protocols and computational tools for scRNAseq analysis

Wed, 01 Jan 2020 00:00:00 GMT

Tian, Luyi 2020 New protocols and computational tools for scRNAseq analysis The fast development of single cell RNA sequencing (scRNAseq) presents new challenges in data analysis and opportunities for protocol development. To address challenges in data preprocessing, I developed scPipe, an R/Bioconductor package that integrates barcode demultiplexing, read alignment, UMI-aware gene-level quantification and quality control of raw sequencing data generated by multiple protocols. Results from scPipe can be used as input for downstream analyses and can be easily incorporated into R-based pipelines with other tools. In order to compare different computational methods for scRNAseq data, I generated a realistic benchmark experiment that included single cells and admixtures of cells or RNA to create `pseudo cells' from up to five distinct cancer cell lines. Multiple datasets were generated using both droplet and plate-based scRNAseq protocols and processed by scPipe. We found pipelines suited to different types of data for different tasks. Our data and analysis provide a comprehensive framework for benchmarking most common scRNA-seq analysis steps. Finally, I developed single cell full-length transcript sequencing by sampling (FLT-seq), together with the computational pipeline FLAMES to perform isoform discovery and quantification, splicing analysis and mutation detection in single cells. With FLT-seq and FLAMES, I performed a comprehensive characterization of the full-length isoform landscape in single cells of different types and species and found conserved functional modules that were enriched for alternative transcript usage in different cell populations, including ribosome biogenesis and mRNA splicing. The datasets, protocols and tools that I developed and generated are useful resources for the single cell research community. © 2020 Luyi Tian PhD thesis

Epoché and objectivity in Phenomenological meaning-making in Educational Research

Mon, 04 Jan 2021 00:00:00 GMT

de Bruin, L 2021-01-04 Epoché and objectivity in Phenomenological meaning-making in Educational Research Epoché within phenomenology sets aside or suspends assumptions and resistance to prejudices that rest on the principal that humans bring schemas and frameworks into being. This stance of analysis and multi-layered process reveals phenomenologically lived experiences and ‘being in the world’ that as essences shape forms of reflective thought and understanding on phenomena. In this chapter, the notion of epoché, or bracketing as an essential attitude to phenomenological reasoning, is surveyed through leading thinkers spanning the field of phenomenology. Epoché as an essential attitude to transcendental, hermeneutic and existential phenomenological reasoning, and argumentation between essence and existence, as well as more recent ‘bridling’ and ‘sidling’ approaches are considered. This chapter informs researchers, especially those recent to phenomenological investigation, of the implications of such theories and techniques, their evolution in the minds of developing researcher minds, and the complexity and delicacy with which all researchers are compelled to approach this fascinating aspect of qualitative understanding and meaning making. Chapter

Instrumental Music Educators in a COVID Landscape: A Reassertion of Relationality and Connection in Teaching Practice

Fri, 08 Jan 2021 00:00:00 GMT

de Bruin, LR 2021-01-08 Instrumental Music Educators in a COVID Landscape: A Reassertion of Relationality and Connection in Teaching Practice For many countries instrumental music tuition in secondary schools is a ubiquitous event that provides situated and personalized instruction in the learning of an instrument. Opportunities and methods through which teachers operate during the COVID-19 outbreak challenged music educators as to how they taught, engaged, and interacted with students across online platforms, with alarm over aerosol dispersement a major factor in maintaining online instrumental music tuition even as students returned to “normal” face to face classes. This qualitative study investigated the practices employed by instrumental music educators in secondary schools in Melbourne, Australia, analyzing teacher perspectives to music tuition amidst the restriction of interaction with students remotely via online means. Thematic analysis of the interview transcripts revealed music educational approaches that fostered connection, empathy and receptiveness to relationship-building, guiding students in slower and deeper learner-centered approaches, asserting pedagogical practices that reinforced and promoted interpersonal connectedness in and through musical experience and discovery. These findings provide a framework for how music educators can facilitate connection, motivation and student autonomy generating personal meaning and commitment to music making and the learning relationship, which can translate to significant student learning and value in the learning music. Exploring teachers’ pedagogical practices and behaviors within this dyadic teacher-student relationship is a significant addition to the literature, enabling the consideration of the type of connective behaviors required to stimulate and develop long-term interest in music. Journal Article

COVID-19 Community Response Strategy in Local Governments: Lessons and Considerations for Planning

Sun, 20 Dec 2020 00:00:00 GMT

Recio, R; Ordonez, M; Berse, K; Torneo, A; Rayo, A; Borja, AL; Andres, AA; Nazareno, R; Soriano, CR; Salvosa II, F 2020-12-20 COVID-19 Community Response Strategy in Local Governments: Lessons and Considerations for Planning In the Philippines, local governments are at the frontline of addressing the COVID-19 pandemic. While the national government has focused on building the capacities of the health system, mobilising national resources, and issuing policies, interpreting and implementing actual measures have been largely left at the hands of local government units. This chapter outlines key policy considerations for local government units (LGUs) - provinces, cities and municipalities – as they revisit their Covid-19 Community Response Strategy and draw up post-pandemic recovery plans. Chapter

Prevalence and factors associated with antenatal care service access among Indigenous women in the Chittagong Hill Tracts, Bangladesh: A cross-sectional study.

Wed, 01 Jan 2020 00:00:00 GMT

Akter, S; Rich, JL; Davies, K; Inder, KJ 2020 Prevalence and factors associated with antenatal care service access among Indigenous women in the Chittagong Hill Tracts, Bangladesh: A cross-sectional study. BACKGROUND: Prevalence of accessing antenatal care (ANC) services among Indigenous women in the Chittagong Hill Tracts (CHT) is unknown. This study aims to estimate the prevalence of accessing ANC services by Indigenous women in the CHT and identify factors associated with knowledge of, and attendance at, ANC services. METHODS: Using a cross-sectional design three Indigenous groups in Khagrachari district, CHT, Bangladesh were surveyed between September 2017 and February 2018. Indigenous women within 36 months of delivery were asked about attending ANC services and the number who attended was used to estimate prevalence. Socio-demographic and obstetric characteristics were used to determine factors associated with knowledge and attendance using multivariable logistic regression techniques adjusted for clustering by village; results are presented as odds ratios (OR), adjusted OR, and 95% confidence intervals (CI). RESULTS: Of 494 indigenous women who met the inclusion criteria in two upazilas, 438 participated (89% response rate) in the study, 75% were aged 16-29 years. Sixty-nine percent were aware of ANC services and the prevalence of attending ANC services was 53% (n = 232, 95%CI 0.48-0.58). Half (52%; n = 121) attended private facilities. Independent factors associated with knowledge about ANC were age ≥30 years (OR 2.2, 95%CI 1.1-4.6), monthly household income greater than 20,000 Bangladeshi Taka (OR 3.4, 95%CI 1.4-8.6); knowledge of pregnancy-related complications (OR 3.6, 95%CI 1.6-8.1), knowledge about nearest health facilities (OR 4.3, 95%CI 2.1-8.8); and attending secondary school or above (OR 4.8, 95%CI 2.1-11). Independent factors associated with attending ANC services were having prior knowledge of ANC benefits (OR 7.7, 95%CI 3.6-16), Indigenous women residing in Khagrachhari Sadar subdistrict (OR 6.5, 95%CI 1.7-25); and monthly household income of 20,000 Bangladeshi Taka or above (OR 2.8, 95%CI 1.1-7.4). CONCLUSION: Approximately half of Indigenous women from Chittagong Hill Tracts Bangladesh attended ANC services at least once. Better awareness and education may improve ANC attendance for Indigenous women. Cultural factors influencing attendance need to be explored. Journal Article

Toward identifying the critical mass in spatial two-sided markets

Sun, 01 Nov 2020 00:00:00 GMT

Navidi, Z; Nagel, K; Winter, S 2020-11-01 Toward identifying the critical mass in spatial two-sided markets Unlike their nonspatial counterparts, spatial multi-sided platforms are matchmaking platforms with an additional layer of complexity: their customers expect to meet in space, not only virtually. This additional challenge will be studied in this paper in the context of a two-sided ride-sharing platform, which serves drivers and passengers. As with any two-sided platform, there is an interdependence between both groups of customers: More drivers are more attractive for passengers, and vice versa. This interdependence creates the old chicken-and-egg problem, only that here drivers and passengers need to be matched not for a virtual transaction, but by their ability to meet physically and travel jointly. We argue, and illustrate by simulations, that in spatial multi-sided markets there is not a single critical mass frontier that needs to be reached in order to make the system self-sustained (as in nonspatial markets), and that this frontier is varying from one location to the next, depending on the density and distribution of the demand and supply over space and time. Identification of the critical mass frontier will allow for better evaluation of implementation policies and regulations. Journal Article

Community perspectives of barriers indigenous women face in accessing maternal health care services in the Chittagong Hill Tracts, Bangladesh

Tue, 22 Dec 2020 00:00:00 GMT

Akter, S; Davies, K; Rich, JL; Inder, KJ 2020-12-22 Community perspectives of barriers indigenous women face in accessing maternal health care services in the Chittagong Hill Tracts, Bangladesh OBJECTIVES: Bangladesh has achieved notable success in improving maternal health by increasing women's access to good quality and low-cost maternal health care (MHC) services. However, the health system of Bangladesh has earned criticism for not ensuring equitable MHC access for all women, particularly for Indigenous women in the Chittagong Hill Tracts (CHT). Little is known about Indigenous communities' perspectives on these inequalities in MHC service access in the CHT. Therefore, this study aimed to explore Indigenous communities' perspectives on challenges and opportunities for improving MHC service access in the CHT. DESIGN: This qualitative descriptive study was conducted in two sub-districts of Khagrachhari between September 2017 and February 2018. Eight Indigenous key informants from three Indigenous communities (Chakma, Marma and Tripura) were recruited via snowballing and purposive techniques and participated in face-to-face, semi-structured interviews. Key informants comprised community leaders and health care providers. Data were analysed thematically using Nvivo12 software. RESULTS: Findings suggest that distance, poor availability of resources and infrastructure, lack of community engagement in the design of health interventions, Indigenous cultural beliefs, misconceptions about MHC services, and maltreatment from health care providers were the key barriers to accessing MHC services; all are interconnected. Indigenous women faced humiliation and maltreatment from MHC staff. Failure to provide a culturally-safe environment suggests a lack of cultural competency among health staff, including Indigenous staff. CONCLUSION: Findings suggest that cultural competency training for all health care providers is needed to improve cultural appropriateness and accessibility of services. Refresher training and undisrupted supply of basic MHC services for front-line care providers will benefit the entire community and will likely be cost-effective for the government. Designing health programmes through extensive community consultation is essential. Journal Article

Perceptions and experiences of the prevention, identification and management of postpartum haemorrhage: a qualitative evidence synthesis

Akter, S; Lorencatto, F; Forbes, G; Miller, S; Althabe, F; Coomarasamy, A; Gallos, ID; Oladapo, OT; Vogel, JP; Thomas, E; Bohren, MA Perceptions and experiences of the prevention, identification and management of postpartum haemorrhage: a qualitative evidence synthesis Journal Article

Transforming intrapartum care: Respectful maternity care

Sat, 01 Aug 2020 00:00:00 GMT

Bohren, MA; Tuncalp, O; Miller, S 2020-08-01 Transforming intrapartum care: Respectful maternity care Respectful maternity care is recommended by the World Health Organization and refers to care that maintains dignity, privacy, confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labour and childbirth. In this paper, we review the evidence of respectful maternity care and discuss considerations for professional practice for health care providers. While there is limited evidence on what type of interventions can improve respectful maternity care, promising skills development for providers has included training on values, transforming attitudes, and interpersonal communication. Within a health facility, enabling environments may be created by setting up quality improvement teams, monitoring experiences of poor treatment, mentorship, and improved working conditions for staff. In order to provide respectful care, health facilities and health systems must be structured in a way that supports and respects providers, and ensures adequate infrastructure and organisation of the maternity ward. Journal Article

How Women Are Treated During Facility-Based Childbirth in Four Countries: A Cross-sectional Study With Labour Observations and Community-Based Surveys

Wed, 01 Apr 2020 00:00:00 GMT

Bohren, MA; Mehrtash, H; Fawole, B; Maung, TM; Balde, MD; Maya, E; Thwin, SS; Aderoba, AK; Vogel, JP; Irinyenikan, TA; Adeyanju, AO; Mon, NO; Adu-Bonsaffoh, K; Landoulsi, S; Guure, C; Adanu, R; Diallo, BA; Gulmezoglu, AM; Soumah, A-M; Sall, AO; Tuncalp, O 2020-04-01 How Women Are Treated During Facility-Based Childbirth in Four Countries: A Cross-sectional Study With Labour Observations and Community-Based Surveys Journal Article

Mistreatment during childbirth reply

Sat, 19 Sep 2020 00:00:00 GMT

Bohren, MA; Adu-Bonsaffoh, K; Irinyenikan, TA; Maung, TM; Balde, MD; Tuncalp, O 2020-09-19 Mistreatment during childbirth reply Journal Article

Labour companionship and women's experiences of mistreatment during childbirth: results from a multi-country community-based survey

Wed, 01 Jan 2020 00:00:00 GMT

Balde, MD; Nasiri, K; Mehrtash, H; Soumah, A-M; Bohren, MA; Diallo, BA; Irinyenikan, TA; Maung, TM; Thwin, SS; Aderoba, AK; Vogel, JP; Mon, NO; Adu-Bonsaffoh, K; Tuncalp, O 2020-01-01 Labour companionship and women's experiences of mistreatment during childbirth: results from a multi-country community-based survey BACKGROUND: Evidence has shown the benefits of labour companions during childbirth. Few studies have documented the relationship between the absence of labour companions and mistreatment of women during childbirth in low-income and middle-income countries using a standardised tool. METHODS: We conducted a secondary analysis of the WHO multi-country study on how women are treated during childbirth, where a cross-sectional community survey was conducted with women up to 8 weeks after childbirth in Ghana, Guinea, Nigeria and Myanmar. Descriptive analysis and multivariable logistic regression were used to examine whether labour companionship was associated with various types of mistreatment. RESULTS: Of 2672 women, about half (50.4%) reported the presence of a labour companion. Approximately half (49.6%) of these women reported that the timing of support was during labour and after childbirth and most of the labour companions (47.0%) were their family members. Across Ghana, Guinea and Nigeria, women without a labour companion were more likely to report physical abuse, non-consented medical procedures and poor communication compared with women with a labour companion. However, there were country-level variations. In Guinea, the absence of labour companionship was associated with any physical abuse, verbal abuse, or stigma or discrimination (adjusted OR (AOR) 3.6, 1.9-6.9) and non-consented vaginal examinations (AOR 3.2, 1.6-6.4). In Ghana, it was associated with non-consented vaginal examinations (AOR 2.3, 1.7-3.1) and poor communication (AOR 2.0, 1.3-3.2). In Nigeria, it was associated with longer wait times (AOR 0.6, 0.3-0.9). CONCLUSION: Labour companionship is associated with lower levels of some forms of mistreatment that women experience during childbirth, depending on the setting. Further work is needed to ascertain how best to implement context-specific labour companionship to ensure benefits while maintaining women's choices and autonomy. Journal Article

Work and breast milk feeding: a qualitative exploration of the experience of lactating mothers working in ready made garments factories in urban Bangladesh

Tue, 01 Dec 2020 00:00:00 GMT

Hasan, AMR; Smith, G; Selim, MA; Akter, S; Khan, NUZ; Sharmin, T; Rasheed, S 2020-12 Work and breast milk feeding: a qualitative exploration of the experience of lactating mothers working in ready made garments factories in urban Bangladesh Abstract Background In Bangladesh 65% of children under 6 months of age were exclusively breastfed with maternal employment being a risk factor that has jeopardized exclusive breastfeeding. As Ready Made Garment (RMG) factories have been the largest employer of low income women in Bangladesh, the objective of our study was to explore the barriers and facilitators of breastfeeding and perceptions about use of expressed breast milk among mothers who worked in the RMG sector. Methods This formative research was conducted during July–September 2015 in two slums of Dhaka among RMG workers who were mothers and the caregivers of 0–12 month old infants. Qualitative data was obtained from purposively selected participants of 8 in-depth interviews and 4 focus group discussions (mothers and caregivers), and 2 key informant (RMG factory official) interviews. Mothers were from multiple RMG factories while factory officials were from a single factory. Thematic analysis was conducted. Results The main themes of qualitative exploration were knowledge and experience of breastfeeding; structural barriers (home and workplace); consequences of inadequate breastfeeding; and perception and experience of using expressed breast milk. Despite knowledge both of the benefits of breast milk and of the importance of breastfeeding for 6 months, most mothers introduced formula as early as 2 months to prepare for their return to work. Barriers such as excessive workload, inadequate crèche facilities at work, and lack of adequate caregivers at home impeded exclusive breastfeeding. Mothers and caregivers had very little knowledge about the use of expressed breast milk and were concerned about contamination. Conclusion As RMG factories are the largest employer of low-income women in Bangladesh, facilitating RMG factory working mothers’ ability to use breast milk could help to promote infant health and help women remain in the workforce. Journal Article

The first 2 h after birth: prevalence and factors associated with neonatal care practices from a multicountry, facility-based, observational study.

Fri, 01 Jan 2021 00:00:00 GMT

Sacks, E; Mehrtash, H; Bohren, M; Balde, MD; Vogel, JP; Adu-Bonsaffoh, K; Portela, A; Aderoba, AK; Irinyenikan, TA; Maung, TM; Thwin, SS; Mon, NO; Soumah, A-M; Guure, C; Diallo, BA; Adeyanju, AO; Maya, E; Adanu, R; Gülmezoglu, AM; Tunçalp, Ö 2021-01 The first 2 h after birth: prevalence and factors associated with neonatal care practices from a multicountry, facility-based, observational study. BACKGROUND: Amid efforts to improve the quality of care for women and neonates during childbirth, there is growing interest in the experience of care, including respectful care practices. However, there is little research on the prevalence of practices that might constitute mistreatment of neonates. This study aims to describe the care received by neonates up to 2 h after birth in a sample of three countries in west Africa. METHODS: Data from this multicountry, facility-based, observational study were collected on 15 neonatal care practices across nine facilities in Ghana, Guinea, and Nigeria, as part of WHO's wider multicountry study on how women are treated during childbirth. Women were eligible if they were admitted to the participating health facilities for childbirth, in early established labour or active labour, aged 15 years or older, and provided written informed consent on behalf of themselves and their neonate. All labour observations were continuous, one-to-one observations of women and neonates by independent data collectors. Descriptive statistics and multivariate logistic regressions were used to examine associations between these neonatal care practices, maternal and neonate characteristics, and maternal mistreatment. Early neonate deaths, stillbirths, and higher order multiple births were excluded from analysis. FINDINGS: Data collection took place from Sept 19, 2016, to Feb 26, 2017, in Nigeria; from Aug 1, 2017, to Jan 18, 2018, in Ghana; and from July 1 to Oct 30, 2017, in Guinea. We included data for 362 women-neonate dyads (356 [98%] with available data for neonatal care practices) in Nigeria, 760 (749 [99%]) in Ghana, and 558 (522 [94%]) in Guinea. Delayed cord clamping was done for most neonates (1493 [91·8%] of 1627); other practices, such as skin-to-skin contact, were less commonly done (1048 [64·4%]). During the first 2 h after birth, separation of the mother and neonate occurred in 844 (51·9%) of 1627 cases; and was more common for mothers who were single (adjusted odds ratio [AOR; adjusting for country, maternal age, education, marital status, neonate weight at birth, and neonate sex] 1·8, 95% CI 1·3-2·6) than those who were married or cohabiting. Lack of maternal education was associated with increased likelihood of neonates not receiving recommended breastfeeding practices. Neonates with a low birthweight (<2·5 kg) were more likely (1·7, 1·1-2·8) to not begin breastfeeding on demand than full weight neonates. When women experienced physical abuse from providers within 1 h before childbirth, their neonates were more likely to be slapped (AOR 1·9, 1·1-3·9). INTERPRETATION: A high proportion of neonates did not receive recommended care practices, and some received practices that might constitute mistreatment. Further research is needed on understanding and measuring mistreatment to improve care, including respectful care, for mothers and neonates. FUNDING: US Agency for International Development, and the UNDP/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO. Journal Article

Women's experiences and expectations after disclosure of intimate partner abuse to a healthcare provider: A qualitative meta-synthesis

Wed, 01 Jan 2020 00:00:00 GMT

Tarzia, L; Bohren, MA; Cameron, J; Garcia-Moreno, C; O'Doherty, L; Fiolet, R; Hooker, L; Wellington, M; Parker, R; Koziol-McLain, J; Feder, G; Hegarty, K 2020-01-01 Women's experiences and expectations after disclosure of intimate partner abuse to a healthcare provider: A qualitative meta-synthesis OBJECTIVE: To identify and synthesise the experiences and expectations of women victim/survivors of intimate partner abuse (IPA) following disclosure to a healthcare provider (HCP). METHODS: The databases MEDLINE, Embase, CINAHL, PsychINFO, SocINDEX, ASSIA and the Cochrane Library were searched in February 2020. Included studies needed to focus on women's experiences with and expectations of HCPs after disclosure of IPA. We considered primary studies using qualitative methods for both data collection and analysis published since 2004. Studies conducted in any country, in any type of healthcare setting, were included. The quality of individual studies was assessed using an adaptation of the Critical Appraisal Skills Programme checklist for qualitative studies. The confidence in the overall evidence base was determined using Grading of Recommendations, Assessment, Development and Evaluations (GRADE)-Confidence in the Evidence from Reviews of Qualitative Research methods. Thematic synthesis was used for analysis. RESULTS: Thirty-one papers describing 30 studies were included in the final review. These were conducted in a range of health settings, predominantly in the USA and other high-income countries. All studies were in English. Four main themes were developed through the analysis, describing women's experiences and expectations of HCPs: (1) connection through kindness and care; (2) see the evil, hear the evil, speak the evil; (3) do more than just listen; and (4) plant the right seed. If these key expectations were absent from care, it resulted in a range of negative emotional impacts for women. CONCLUSIONS: Our findings strongly align with the principles of woman-centred care, indicating that women value emotional connection, practical support through action and advocacy and an approach that recognises their autonomy and is tailored to their individual needs. Drawing on the evidence, we have developed a best practice model to guide practitioners in how to deliver woman-centred care. This review has critical implications for practice, highlighting the simplicity of what HCPs can do to support women experiencing IPA, although its applicability to low-income and-middle income settings remains to be explored. Journal Article

Imagining maternity care as a complex adaptive system: understanding health system constraints to the promotion of respectful maternity care.

Tue, 01 Dec 2020 00:00:00 GMT

Asefa, A; McPake, B; Langer, A; Bohren, MA; Morgan, A 2020-12 Imagining maternity care as a complex adaptive system: understanding health system constraints to the promotion of respectful maternity care. Evidence of the health system challenges to promoting respectful maternity care (RMC) is limited in Ethiopia and globally. This study investigated the health system constraints to RMC in three Southern Ethiopian hospitals. We conducted a qualitative study (7 focus group discussions (FGDs) with providers of RMC and 12 in-depth interviews with focal persons and managers) before and after the implementation of an RMC intervention. We positioned childbirth services within the health system and applied complex adaptive system theory to analyse the opportunities and constraints to the promotion of RMC. Both system "hardware" and "software" factors influencing the promotion of RMC were identified, and their interaction was complex. The "hardware" factors included bed availability, infrastructure and supplies, financing, and health workforce. "Software" factors encompassed service providers' mindset, staff motivation, and awareness of RMC. Interactions between these factors included privacy breaches for women when birth companions were admitted in labour rooms. Delayed reimbursement following the introduction of fee-exemption for maternity services resulted in depleted revenues, supply shortages, and ultimately disrespectful behaviour among providers. Other financial constraints, including the insufficient and delayed release of funds, also led to complex interactions with the motivation of staff and the availability of workforce and supplies, resulting in poor adherence to RMC guidance. Interventions aimed at improving only behavioural components fall short of mitigating the mistreatment of women. System-wide interventions are required to address the complex interactions that constraint RMC. Journal Article