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Search Results: 1 - 10 of 17958 matches for " Siobhan Mark "
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HIV Mother-to-Child Transmission, Mode of Delivery, and Duration of Rupture of Membranes: Experience in the Current Era
Siobhan Mark,Kellie E. Murphy,Stanley Read,Ari Bitnun,Mark H. Yudin
Infectious Diseases in Obstetrics and Gynecology , 2012, DOI: 10.1155/2012/267969
Abstract: Objective. To evaluate whether the length of time of rupture of membranes (ROM) in optimally managed HIV-positive women on highly active antiretroviral therapy (HAART) with low viral loads (VL) is predictive of the risk of mother to child transmission (MTCT) of the human immunodeficiency virus (HIV). Study Methods. A retrospective case series of all HIV-positive women who delivered at two academic tertiary centers in Toronto, Canada from January 2000 to November 2010 was completed. Results. Two hundred and ten HIV-positive women with viral loads <1,000 copies/ml delivered during the study period. VL was undetectable (<50 copies/mL) for the majority of the women (167, 80%), and <1,000 copies/mL for all women. Mode of delivery was vaginal in 107 (51%) and cesarean in 103 (49%). The median length of time of ROM was 0.63 hours (range 0 to 77.87 hours) for the entire group and 2.56 hours (range 0 to 53.90 hours) for those who had a vaginal birth. Among women with undetectable VL, 90 (54%) had a vaginal birth and 77 (46%) had a cesarean birth. Among the women in this cohort there were no cases of MTCT of HIV. Conclusions. There was no association between duration of ROM or mode of delivery and MTCT in this cohort of 210 virally suppressed HIV-positive pregnant women. 1. Introduction In economically developed countries, the human immunodeficiency virus (HIV) infection is now considered a chronic disease, with life expectancy approaching that of the general population [1]. Many HIV-positive women choose to pursue pregnancies [2]. Management of the HIV-positive pregnant patient should focus on both decreasing the risk of mother to child transmission (MTCT) and minimizing maternal and neonatal complications. The Society of Obstetricians and Gynaecologists of Canada (SOGC) and American College of Obstetricians and Gynecologists (ACOG) recommend that elective cesarean section (cesarean section before labor or rupture of membranes (ROMs) be performed for delivery when viral load is detectable [3] or greater than 1000 copies/mL [4] as there is a 12-fold increased risk of MTCT [3, 5]. This is based on several studies that showed that the combination of intrapartum zidovudine (ZDV) and elective cesarean section significantly decreased vertical transmission compared to other delivery modes [6–8]. With the addition of highly active antiretroviral therapy (HAART), the risk of vertical transmission has continued to decrease [5]. ROM increases fetal exposure to maternal blood and vaginal fluids, and prolonged duration of ROM has been shown to be a significant risk factor
The Role of Primary Care in Service Provision for People with Severe Mental Illness in the United Kingdom
Siobhan Reilly, Claire Planner, Mark Hann, David Reeves, Irwin Nazareth, Helen Lester
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0036468
Abstract: Background Severe mental illness is a serious and potentially life changing set of conditions. This paper describes and analyses patient characteristics and service usage over one year of a representative cohort of people with a diagnosis of severe mental illness across England, including contacts with primary and secondary care and continuity of care. Methods and Findings Data were collected from primary care patient notes (n = 1150) by trained nurses from 64 practices in England, covering all service contacts from 1st April 2008 to 31st March 2009. The estimated national rate of patients seen only in primary care in the period was 31.1% (95% C.I. 27.2% to 35.3%) and the rates of schizophrenia and bipolar disorder were 56.8% (95% C.I. 52.3% to 61.2%) and 37.9% (95% C.I. 33.7% to 42.2%). In total, patients had 7,961 consultations within primary care and 1,993 contacts with mental health services (20% of the total). Unemployed individuals diagnosed more recently were more likely to have contact with secondary care. Of those seen in secondary care, 61% had at most two secondary care contacts in the period. Median annual consultation rates with GPs were lower than have been reported for previous years and were only slightly above the general population. Relational continuity in primary care was poor for 21% of patients (Modified Modified Continuity Index = <0.5), and for almost a third of new referrals to mental health services the primary care record contained no information on the referral outcome. Conclusions Primary care is centrally involved in the care of people with serious mental illness, but primary care and cross-boundary continuity is poor for a substantial proportion. Research is needed to determine the impact of poor continuity on patient outcomes, and above all, the impact of new collaborative ways of working at the primary/secondary care interface.
Complex interplay between intrinsic and extrinsic drivers of long-term survival trends in southern elephant seals
Siobhan C de Little, Corey JA Bradshaw, Clive R McMahon, Mark A Hindell
BMC Ecology , 2007, DOI: 10.1186/1472-6785-7-3
Abstract: First-year survival decreased with density during the period of highest population size, and survival increased during years when the Southern Oscillation Index (SOI) anomaly (deviation from a 50-year mean) during the mother's previous foraging trip to sea was positive (i.e., El Ni?o). However, when environmental stochasticity and density were considered together, the effect of density on first-year survival effectively disappeared. Ignoring density effects also leads to models placing too much emphasis on the environmental conditions prevailing during the na?ve pup's first year at sea.Our analyses revealed that both the state of the environment and population density combine to modify juvenile survival, but that the degree to which these processes contributed to the variation observed was interactive and complex. This underlines the importance of evaluating the relative contribution of both the intrinsic and extrinsic factors that regulate animal populations because false conclusions regarding the importance of population regulation may be reached if they are examined in isolation.A central aim in population biology is to discern the relative contribution of intrinsic (density-regulated) and extrinsic (environmental) factors to fluctuations in population size and demographic composition, with increasing emphasis placed on quantifying the complex interplay between the two [1-4]. The mounting number of long-term ecological studies available for the measurement of population dynamical parameters, although still relatively rare, is providing a more refined understanding of the combined effects of these mechanisms [4-8]. For instance, investigating the relationships between population density, environmental conditions and survival probability using mark-recapture techniques has provided important advances in this regard [e.g., [9-11]].Given that populations of large, long-lived mammals tend to have a relatively low capacity for growth due to their long generation times
Umbilical artery tone in maternal obesity
Mark P Hehir, Audrey T Moynihan, Siobhan V Glavey, John J Morrison
Reproductive Biology and Endocrinology , 2009, DOI: 10.1186/1477-7827-7-6
Abstract: Sections of umbilical artery were obtained from umbilical cord samples immediately after delivery and mounted for isometric recording in organ tissue baths under physiological conditions. Cumulative additions of 5-Hydroxytryptamine (5-HT) and Prostaglandin F-2alpha (PgF2alpha) were added in the concentration range of 1 nmol/L to 10 micromol/L. Control vessels were exposed to Krebs physiological salt solution (PSS) only. The resultant effects of each drug addition were measured using the Powerlab hardware unit.5-HT exerted a significant effect on human umbilical artery tone at concentrations of 100 nmol/L, 1 micromol/L, and 10 micromol/L in normal (n = 5; P < 0.05) and obese (n = 5; P < 0.05) women. The contractile effect was significantly greater in vessels from obese women {Mean Maximum Tension (MMT) = 4.2532 g} than in those from women of normal BMI (MMT = 2.97 g; P < 0.05). PgF2alpha exerted a significant contractile effect on vessels at 1 micromol/L and 10 micromol/L concentrations when compared with controls (n = 5; P < 0.05). There was a non-significant trend towards an enhanced tone response in vessels from obese women (MMT = 3.02 g; n = 5), in comparison to vessels from women of a normal BMI (MMT = 2.358 g; n = 5; P > 0.05).These findings support the hypothesis that endogenous regulation of umbilical artery tone is altered in association with maternal obesity. This may be linked to the cardiovascular effects of secretory products of adipose tissue, with implications for the feto-maternal circulation.It has become evident in recent years that there is a marked increase in the prevalence of obesity among the adult and child population [1,2]. While some of the adverse effects of this on health and wellbeing are obvious, the more subtle systemic effects of the so called metabolic syndrome, are hitherto not fully understood. In obstetric practice, it is well established that obesity is associated with a wide range of disorders in pregnancy including hypertensive
Prednisolone Trial: Study protocol for a randomised controlled trial of prednisolone for women with idiopathic recurrent miscarriage and raised levels of uterine natural killer (uNK) cells in the endometrium
Ai-Wei Tang, Zarko Alfirevic, Mark A Turner, Jo Drury, Siobhan Quenby
Trials , 2009, DOI: 10.1186/1745-6215-10-102
Abstract: We propose a randomised, double-blind, placebo controlled trial of prednisolone with a pilot phase to assess feasibility of recruitment, integrity of trial procedures, and to generate data to base future power calculations. The primary aim is to investigate whether prednisolone therapy during the first trimester of pregnancy is able to improve live birth rates in patients with idiopathic recurrent miscarriage and raised uNK cells in the endometrium. Secondary outcomes include conception rate, karyotype of miscarriage, miscarriages (first and second trimester), stillbirths, pregnancy complications, gestational age at delivery, congenital abnormality and side effects of steroids. The trial has 2 stages: i) screening of non-pregnant women and ii) randomisation of the pregnant cohort. All patients who fit the inclusion criteria (<40 years old, ≥3 consecutive miscarriages with no cause found and no contraindications to prednisolone therapy) will be asked to consent to an endometrial biopsy in the mid-luteal phase to assess their levels of uNK cells. Women with high levels of uNK cells (≥5%), will be randomised to either prednisolone or placebo when a pregnancy is confirmed. Follow-up includes 2 weekly ultrasound scans in the first trimester, an anomaly scan at 20 weeks gestation, growth scans at 28 and 34 weeks gestation and a postnatal follow-up at 6 weeks.Current Controlled Trials ISRCTN28090716Recurrent miscarriage (RM) is defined as the loss of 3 or more consecutive pregnancies and is a stressful condition for both patients and clinicians alike. It affects about 1% of all fertile couples trying to conceive [1,2]. Despite a wide range of investigations, no apparent cause is found in more that 50% of cases and they are categorized as idiopathic recurrent miscarriage [2,3]. Apart from supportive care in a dedicated early pregnancy unit with regular reassurance scans and psychological support, empirical treatment in this group of women is not recommended [1,4]. Immunomod
“The Mad”, “The Bad”, “The Victim”: Gendered Constructions of Women Who Kill within the Criminal Justice System
Siobhan Weare
Laws , 2013, DOI: 10.3390/laws2030337
Abstract: Women commit significantly fewer murders than men and are perceived to be less violent. This belief about women’s non-violence reflects the discourses surrounding gender, all of which assume that women possess certain inherent essential characteristics such as passivity and gentleness. When women commit murder the fundamental social structures based on appropriate feminine gendered behaviour are contradicted and subsequently challenged. This article will explore the gendered constructions of women who kill within the criminal justice system. These women are labelled as either mad, bad or a victim, by both the criminal justice system and society, depending on the construction of their crime, their gender and their sexuality. Symbiotic to labelling women who kill in this way is the denial of their agency. That is to say that labelling these women denies the recognition of their ability to make a semi-autonomous decision to act in a particular way. It is submitted that denying the agency of these women raises a number of issues, including, but not limited to, maintaining the current gendered status quo within the criminal law and criminal justice system, and justice both being done, and being seen to be done, for these women and their victims.
Considering Animals: Contemporary Studies in Human-Animal Relations. By Carol Freeman, Elizabeth Leane and Yvette Watt. Ashgate: Surrey, UK, 2011; Hardcover, 236 pp; ISBN 978-1-4094-0013-4
Siobhan O’Sullivan
Animals , 2012, DOI: 10.3390/ani2030377
Abstract: In 2005 a small group of academics gathered at the University of Western Australia for a modest yet highly significant interdisciplinary conference focused on scholarship in the emerging field of human-animal studies. A critical mass of academics from the University of Tasmania attended that first conference and pledged to host a second human-animal studies conference two years later. True to their word a second human-animal studies conference was held in Hobart, Australia, in 2007. The organisers called the second conference “Considering Animals” and the book under review here is a compilation of papers presented at that conference. [...]
Free Will, Evil, and Saint Anselm
Siobhan Nash-Marshall
The Saint Anselm Journal , 2008,
Abstract: In this lecture I concentrate on one of the questions that an adequate definition of freedom must address. The question is one with which many contemporary thinkers are currently concerned: need one have alternate possible courses of action in order to be free? This question admits of many formulations. The specific formulation which I address in this lecture is: must I genuinely be ready to take either one of two possible courses of action—to perform or not to perform a given act—in order for my taking either one of these courses of action to be free? This question is admittedly just a small part of the problem of defining freedom. Nevertheless it is a crucial part of the problem of defining freedom. It is also a part of the problem of freedom about which Saint Anselm had a great deal to say.
Properties, Conflation, and Attribution: the Monologion and Divine Simplicity
Nash-Marshall, Siobhan
The Saint Anselm Journal , 2007,
Abstract: One of the crucial metaphysical issues that has proven to be a great stumbling block for so many contemporary thinkers in their understanding and appraisal of the doctrine of divine simplicity is central to what one might call the "property-based metaphysics" of a great many contemporary thinkers. It is the belief that properties are basic and invariant features of reality. This belief clearly makes the doctrine of divine simplicity seem irrational for if properties are indeed basic and invariant features of reality, then the claim that all of God's properties are identical to each other cannot but sound absurd. But this, of course, begs the question: need properties be thought of as basic and invariant features of reality? This is the question that will be discussed here.
Investigating the effect of language and culture on student interaction with and in WebC
Siobhan L. Devlin
ITALICS , 2007,
Abstract: Students studying in Higher Education establishments around the world are increasingly required to interact with Virtual Learning Environments (VLEs) for their education, yet it is not widely understood whether or not factors such as language and culture affect the interaction and even perhaps place some students at a disadvantage to others. This study sought to elicit from students from various educational, cultural and linguistic backgrounds, their experiences and attitudes towards working within this medium. The results showed that language and culture do impact upon a person’s interaction with online materials and the primary research largely supported the work uncovered in the literature survey.
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