Postgraduate

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A comparison between autocorrelation and CPPS derived voice onset thresholds for Phonation Stabilisation Time
(Queen Margaret University, 2017)
A comparison of free maternal health polices in Sierra Leone and Ghana: lessons for Nigeria
(Queen Margaret University, 2016)
INTRODUCTION 1.1. PROBLEM STATEMENT The number of women dying annually from pregnancy, childbirth and attendant complications are still a global concern (WHO 2015). Lack of access to quality healthcare services for pregnancy and delivery are among the reasons for high maternal mortality rates worldwide (Alvarez et al. 2009) with the situation particularly marked in many low-resource settings. For example, despite the reported increase in the proportion of skilled delivery care recorded across the world, only just over half of all deliveries in sub-Saharan Africa are attended by skilled health workers (WHS 2015). Available evidence has shown that the highest number of maternal deaths occur during the delivery and post delivery period (Khan et al. 2006), and increasing access to skilled birth attendance at delivery and provision of emergency obstetric services for women with complications are effective interventions in reducing maternal deaths (Paxton et al. 2005; Rosenfield et al. 2007). In addition, half of the maternal deaths and complications that occur during pregnancy are preventable by antenatal care programs that provide essential services to pregnant women (Abou-Zahr & Wardlaw 2003; Lincetto et al. 2006). Therefore, timely access to maternal care services, therefore, remain an important indicator for monitoring the progress of maternal outcomes including maternal mortality. Access to maternal health services Nigeria is still marked with inequities across geographical and economic gradients (Fagbamigbe & Idemudia 2015a). Financial inaccessibility owing to inability to afford the cost of care have been established as a barrier to use of health facilities, particularly for the poor and vulnerable women (Ekabua et al. 2011). Studies correlating utilisation of maternal health services with models of healthcare financing in low income countries found that higher proportion of government financing is associated with greater utilization of skilled birth attendants and caesarean section (Kruk et al.2007). However, out of pocket financing of the costs of facility delivery has been shown to have substantial repercussion on households including having to borrow money or sell valuable household items making families more vulnerable to impoverishment (Russell 1996; McIntyre et al. 2006). According to Alvarez et al. (2009), Maternal mortality ratios in sub-Saharan African Countries is inversely correlated with per-capita government expenditure on health and directly related to the out-of-pocket expenditure on health, the more out-of-pocket expenditure in health in a country the higher the maternal mortality rate (MMR). Over the last decade, there has been shift towards the eradication of user fees for maternal health services in low and middle income countries with studies showing marked improvement in service coverage with their removal (Ponsar et al. 2011).
A Comparison of Outcome Measures Following Electropalatography (EPG) Therapy in Children with Down's Syndrome
(Queen Margaret University, 2016)
Background Electropalatography (EPG) therapy has shown to remediate speech sound errors that have been intractable through traditional speech therapy. In more recent years, EPG therapy has been explored as an intervention technique for children with Down's syndrome. There are a variety of ways to measure progress following EPG therapy. However, at present, too much reliance is placed on subjective measures to analyse EPG patterns and this does not promote consistency within research addressing the clinical effectiveness of EPG therapy. Aims The principle aim of this project is to compare outcome measures post EPG therapy and identify if a change seen in one outcome measure is also reflected in other outcome measures, and if not then why not? A secondary aim of this project is to explore the possibility of quantifying EPG patterns by developing a classification scheme that provides a set of criteria associated with a target phoneme's idealized articulatory pattern. Methodology Three children with DS were selected from a larger study. Each child received EPG therapy from the school learning assistant with the aim for therapy to be carried out daily in schools over the course of twelve weeks. Each child had an individualized word list which contained phonemes considered most problematic at pre-therapy recordings. The word lists presented target phonemes in word initial and word final position. Four analyses were carried out; a percent consonant correct analysis, an EPG pattern analysis, a property analysis and analysis of intelligibility measures. A classification scheme designed by the author was implemented to enable quantitative results from the EPG pattern analysis. Results from these outcome measures were compared. Results Participants showed variability between different outcome measures and within the results from the same outcome measure, suggesting that the clinical effectiveness of EPG therapy was reflected differently depending on the outcome measure that was used. Intelligibility measures did not provide enough evidence to capture progress about therapy goals and inform intervention. Conclusions This project highlighted questions surrounding the ability of EPG patterns to be quantified and demonstrated how sensitive these patterns can be when analysed in a quantitative manner. The devised classification scheme was binary (tongue palate contact patterns were measured as acceptable or unacceptable) and was therefore unable to measure and recognize incremental change within EPG patterns from pre to post-therapy. Speech and language therapists should give closer consideration to well written therapy goals with carefully designed outcome measures that reflect those therapy goals.
A Comparison of thermoplastic and 3D printed beam directional shells on viability for external beam radiotherapy and user experience
(Queen Margaret University, 2017)
Background: The precision of a patient's set-up for the accurate delivery of radiotherapy is paramount. For patients receiving radiotherapy for head and neck cancer it is particularly critical due to the need to prescribe the maximum therapeutic dose to the tumour while sparing normal tissue in very close proximity. Through advances in new technology three-dimensional printing gives the potential for creating an anatomically precise beam directional shell (BDS) directly from a three-dimensional computer model of the patient. Purpose: The aim of this study is to determine the viability of using three-dimensionally printed BDSs by comparing them to the currently used thermoplastic BDSs. Materials and methods: A direct comparison of three-dimensional and thermoplastic BDSs will be assessed. Seventeen healthy volunteers had both BDSs created and a retrospective isocentre positioned on the masks to be used as a baseline for set up. The retrospective isocentre mark allowed left-right, superior-inferior, anterior-posterior alignment and rotation to be assessed over four sessions. After each session of wearing the BDS, the volunteers immediately completed a State Trait Anxiety Inventory (STAI) Part 1 to assess their emotional experience of that particular BDS. Results and conclusion: The data was assessed for normality and homogeneity. If the data was considered normally distributed and homogeneous then a two-way repeated measures Analysis of Variance was performed. If it was not normally distributed then a non-parametric Friedman and Man Whitney U test was used. It was found that there was no significant difference in the external reproducibility of the 3D printed compared to the thermoplastic BDS for the Vertical, Longitudinal and Lateral couch parameters. There was however a statistically significant difference for the Rotational variable. The results obtained from the STAI Part 1 suggested that the thermoplastic BDS produced significantly higher scores in anxiety and distress compared to the 3D printed BDS. The results obtained give encouraging evidence to indicate that 3D printed BDSs could be a viable immobilisation device used for patients requiring EBRT to the head and neck region.
A Comparison of Two Imaging Protocols for Patient's Receiving a Radical Course of Radiotherapy to the Brain.
(Queen Margaret University, 2016)
Background Accurate patient positioning is vital in radiotherapy to deliver precise targets to defined areas. Image guided radiotherapy (IGRT) can help to increase this accuracy. In a large regional radiotherapy department patients receiving a course of radical radiotherapy to the brain undergo daily image guidance prior to delivery of treatment. A 3-mm tolerance of movement is in place for these patients. This service evaluation examined whether it is essential to perform this type of imaging on a daily basis or whether a less frequent imaging protocol would be more clinically relevant. Method This retrospective small scale service evaluation was based on quantitative research. A quasi-experimental design was used. IGRT data was collected from 25 patients who had previously undergone daily image radiotherapy to the brain. Retrospectively couch movements in anterior/posterior, left /right and superior/inferior directions for all the patients for a total of 704 fractions. Data was divided into two groups. Group 1 (daily image group), this group consisted of data from all 25 patients for each daily image recorded throughout their treatment. Group 2 (weekly image group) consisted of data from all patients on the first three days then once weekly. Results A one-sided one-sample t-test was performed to confirm that the mean movement was less than 3-mm. The p-value was p=0.000, the null hypothesis was rejected. Hence μ (the true mean of the movement data) is less than 3-mm. A two sample unpaired t-test (two sided) was carried out to show that the mean movement for the daily group data was not significantly different to the mean movement for the weekly data group. The p-value was above 0.05, the null hypothesis was not rejected. Hence μ_D (the true mean of the daily data) is equal to μ_W (the true mean of the weekly data). Conclusion There was no statistical difference when both imaging schedules were compared. Therefore weekly image guidance would be a more suitable type of imaging schedule. Weekly imaging would also reduce radiographer workload and any potential contaminant dose to the patient.
A Comparison of Two Set-up Techniques for Tangential Breast Radiotherapy Treatments Using Portal Imaging and In-vivo Transit Dosimetry Data
(Queen Margaret University, 2016)
Background Accurate patient positioning for tangential breast treatments is crucial as this can influence the dose the patient receives. Two different set-up techniques have been examined for tangential breast radiotherapy treatments to determine which results in more accurate patient positioning and ultimately gives a better dose distribution across the target volume. Method This single centre service evaluation used a quasi-experimental design consisting of two technique groups; '5mm deviation' and the 'set to medial point' group. Each group contained 30 patients. Patients were found using relevant filters in Aria Report Manager and a method of stratified random sampling was used to find tangential treatments between 6-10MV. Image match analysis was carried out and any discrepancy in magnitude and direction between the Digitally Reconstructed Radiograph (DRR) and the integrated image noted and the corresponding transit dosimetry results were recorded from the DosimetryCheck program (Math Resolutions, LLC, Columbia, MD). Results The image match results for the 'set to medial point' technique showed 40% had a match discrepancy of 1mm compared to 3.3% in the '5mm deviation' group, only 3.3% of the matches in the 'set to medial point' group were above the 5mm accepted tolerance for analysing images offline compared to 23.3% in the '5mm deviation' group. The transit results for the '5mm deviation' group showed that two patients were outside the accepted +/- 10% tolerance and an additional five readings were over +/- 9%. In the 'set to medial point' group no in-vivo readings were outside +/- 10% and only 9.9% had readings above +/- 5%. A Spearman's Rho test showed a statistically significant, weak, positive monotonic correlation for the image match and transit results for the '5mm deviation' technique (rs,=0.358, n=30, p=0.052), in contrast to a non-significant, very weak correlation in the 'set to medial point' group (rs,=-0.041 n=30, p=0.830). Conclusions These findings illustrate that the 'set to medial point' technique provides a more stable patient set-up and also an improved dose distribution in comparison to the '5mm deviation' technique. Additionally, the DosimetryCheck program has proven its usefulness as a tool capable of identifying an unacceptable dose distribution when the patient's alignment differs significantly from the planned position.
A Critical re-conceptualization of Traditional Ecological Knowledge: First Nations psychosocial narratives of Healing, Advocacy, Expression and Reciprocity
(Queen Margaret University, 2015)
Spiritual, ceremonial, socio-ecological and socio-emotional conceptualizations of First Nations relationship with the land was explored through the space of 'Traditional Ecological Knowledge'. Utilizing a qualitative methodology combining observation, community participation and semi-structured interviews this study engaged in a case study of Taykwa Tagamou and area First Nations in Northern Ontario, Canada. Through participation and observation in medicine picking, traditional food preparation, women's drumming, co-management policy and environmental meetings, Indigenous knowledge and restoration conference and interviews conducted both on Taykwa Tagamou First Nations reserve and in the town of Cochrane this research was holistic in its approach. The findings from this study suggest that socio-emotional connections and conceptualizations of First Nations in the TTN community and area in relation to the 'land', 'being on the land' and 'traditional medicines' impact their emotional, social, physical and spiritual wellbeing and 'healing' capacities and are central components of Traditional Ecological Knowledge in the First Nations context.
A pilot study showing the feasibility for investigating the effects of tart cherry juice on cognitive and cardiovascular health in older adults aged 50 to 70 years
(Queen Margaret University, 2017)
Aim - There have been studies in which the health effects of flavonoid rich food are investigated. Flavonoids and phytonutrient, found in various foods, are known to have multiple health benefits through their antioxidant activity. For example, tart cherries contain two sub-types of flavonoids; anthocyanins and flavonols. These fruits, especially rich in anthocyanins, have been found to enhance cognitive and cardiovascular functions during several studies. The aim of this pilot study is to analyse the common methodology for investigating the effects of tart cherry juice on cardiovascular and cognitive health in older adults from the results and suggest ideal research methods. Methodology - This pilot study is a randomised open-labelled study. Five healthy adults aged 50 to 70 years with a BMI of less than 30kg/m2 were recruited in Edinburgh. The study involved two drinks: commercially available tart cherry juice and cherry flavoured water. Ferric ion reducing antioxidant power (FRAP) and Folin-Ciocalteu assays revealed that tart cherry juice had significantly higher levels of both polyphenols and antioxidant activity than cherry flavoured water. Subjects were asked to consume 250ml of one of these treatments twice daily for fourteen days. Cardiovascular measurements included systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse wave velocity (PWV). Cognitive function was measured by two distinct tests; trail making test (TMT) and serial sevens test. Four measurements were taken: baseline characteristics before the consumption, acute effects two hours after drinking the first treatment, short-term effects taken after two weeks, the last measurement taken one day after halting the consumption. Results - Analysis of results from this study was not sufficient to confirm significant differences in both cardiovascular and cognitive functions. Nevertheless, it suggests the feasibility of undertaking a similar study in the future.
A Qualitatative Exploration into the Lived Experience of Adults with Anxiety Using Mindfulness in Everyday Occupational Engagement
(Queen Margaret University, 2016)
Mental health is a major public health challenge both globally and nationally. Not only is there significant economic, health and social costs, mental health problems relating to anxiety have an occupational cost too. Consequently there is increasing emphasis on early detection and management. A method for managing these costs is to explore innovative and evidence-based interventions that might address these challenges. An intervention used in clinical and general populations with promising results in healthcare, education, and law enforcement is the use of mindfulness. The review of literature from psychology, nursing, business and occupational therapy, suggests that the regular use of mindfulness practice can enhance quality of life. Enhanced quality of life has been attributed to improved health and well-being resulting from symptom reduction, the development of better coping strategies and enhanced occupational engagement. Yet there is a paucity of research that in occupational therapy that specifically explores how adults with anxiety respond and experience the use of mindfulness in everyday occupational engagement. In order to address this research gap, the following research is proposed. The purpose of this qualitative research pilot study is twofold: 1) to explore the meaning and lived experience of adults with anxiety using mindfulness in everyday occupational engagement and 2) to investigate its feasibility with this novel population. In order to achieve this, participant's perspectives, insights and attitudes will be gained by recruiting four participants who would have attended a mindfulness training group run by occupational therapists. Rich phenomenological data will be obtained through semi-structured interviews at the end of the mindfulness training group (participants will be asked about their overall experience of participating in the training group and how these mindful experiences are being translated into daily life). Interpretative phenomenological analysis (IPA) will be used to discern findings by using literature to aid the interpretation of the significance that participants have ascribed to the structure and essence of their lived experience. The research aims to contribute to the existing occupational therapy research. This dissertation comprises of two sections. The first section will explore the experiences of using mindfulness with adults in relation to anxiety in everyday occupational engagement in a general sense (literature review). The second section will specifically explore the meaning and lived experience of adults with anxiety using mindfulness in everybody occupational engagement (research proposal).
A qualitative exploratory study to examine the views and experiences of Nurse Educators delivering Simulation Based Learning to Undergraduate Nursing Students.
(Queen Margaret University, 2016)
There has been an increased use of Simulation Based Learning in undergraduate nursing education within the UK and overseas during recent years (Cant and Cooper 2010). This has been driven predominantly, by a growing emphasis on patient safety and concern relating to the clinical competency of nursing students at the point of registration (NMC 2007, The Willis Commission 2012). Research carried out exploring this topic has largely focussed upon the student experience in this learning environment, with little consideration given to the role and perceptions of educators who deliver this teaching strategy. This extensive research proposal sets out the planning process of a study designed to explore how nurse educators, delivering simulation based learning perceive their preparedness to undertake this teaching strategy. The qualitative exploratory research study will be conducted at a Scottish University. Participants will be selected, using purposive sampling, from the academic staff delivering simulation based learning to undergraduate nurses, and data collection will take the form of semi structured interviews. The data will be analysed using thematic analysis and a report of findings will be produced. It is anticipated from this research that the findings will contribute towards an increased understanding from the educators' viewpoint, of how this teaching strategy can be more successfully delivered. It is expected that this increased understanding will improve the learning experience for the student and ultimately contribute towards improvement in the quality of patient care delivered. Findings from this proposed study will generate data, which should be useful in conducting further research into this topic
A qualitative study exploring the self-perceived training, education and support needs of health visitors in relation to the field of child development using a focus group design
(Queen Margaret University, 2015)
This research proposal will examine the political landscape pertaining to health visiting practice both in the UK and Scotland and explore the implications for practice in relation to core health visiting practice such as assessment skills in child development. The paper discusses the changing policy drivers that have impacted on the profession and explores the argument regarding a concerning trend of skill depletion within the workforce. A literature search was undertaken to discover themes in relation to current health visiting practice and educational priorities within the research community. Key themes are identified and discussed such as the health visiting role lacking in professional identify and an eradication of core skills such as child developmental assessment and health promotion. A full proposal for a research study to investigate the self-perceived continuing professional development needs of health visitors (Specialist Public Health Nurses) in relation to their knowledge and understanding of child development is given. Justification for a qualitative paradigm using hermeneutic phenomenology with a focus group design is discussed. The implications for practice are explored which could support academics and educators in their planning of continued learning delivery or form the basis of a larger scale study.
A service evaluation on the influence of daily micro-enemas on interfraction prostate motion and acute bowel side effects in patients receiving external beam radiotherapy to the prostate
(Queen Margaret University, 2016)
Purpose: To evaluate the effect that daily micro-enemas had on interfraction prostate motion and acute bowel side effects during external beam radiotherapy (EBRT) to the prostate. Methods: 30 patients were recruited into two groups. 15 patients had used daily micro-enemas and 15 had not. Interfraction prostate motion was determined as the prostate shift relative to bony anatomy on each patient's daily cone beam computed tomography (CBCT) scans. These shifts were analysed for each of the patient's 37 treatments, therefore a total of 1100 fractions were included in total, with three sets of shifts being analysed for each fraction. These shifts were representative of the left/right (X), superior/inferior (Y) and anterior/posterior (Z) movements. Patients' side effects were observed by analysing changes to weekly bowel Radiation Therapy Oncology Group (RTOG) assessment scores to determine if a difference was observed between the two groups. Each patient had a baseline bowel RTOG assessment, followed by seven weekly RTOG scores. Therefore, each patient had eight scores making a total of 240 scores included in the service evaluation. Results: Interfraction prostate motion was significantly reduced in the enema group in the left/right (X) and anterior/posterior (Z) directions (p<0.05). In the superior/inferior (Y) direction the non-enema group had significantly smaller moves than the enema group (p<0.05). Bowel side effects were found to be significantly lower in the enema group when compared to the non-enema group (p<0.05). Conclusion: This service evaluation concluded that the use of daily micro-enemas was an effective way to reduce interfraction prostate motion and side effects in these groups of patients. A further prospective randomised study is advocated to validate these results before implementing a change in clinical protocols.
A Study To Determine The Impact Of Permaculture On Dietary Diversity And Nutritional Status In Children Below 5 Years In Malawi.
(Queen Margaret University, 2015)
Introduction: Every year, 3.1 million child deaths are associated with poor nutritional status, the majority occurring in the most socio-economically deprived areas (Black et al. 2013). Malawi is a Sub-Saharan African country where over 60% of people live below the international poverty line and 1 in 2 children are chronically malnourished (UNICEF 2013). Interventions in the agricultural sector have the potential to reduce the burden of malnutrition by increasing food production, diversity and consequently, dietary intake and nutritional status (Heywood 2013). Permaculture is an alternative agricultural design which mimics natural ecosystems to create a diverse productive system and has been reported to produce thrice as many crop varieties as the commonly practiced maize monocropping in Malawi (Conrad 2014). This study investigates the impact of permaculture farming on dietary diversity and nutritional status in children below the age of 5 years living in Malawi. Methods: A sample of 10 children was taken from permaculture-practicing families in Central Malawi and matched with 10 controls of similar ages. They were compared based on diversity of dietary intake and nutritional status. Dietary diversity was scored based on number of food groups consumed during the previous 24-hours, while nutritional status was defined by comparing anthropometric measurements against international growth standards (Kennedy et al. 2010; WHO 2006). Results: Mean dietary diversity scores were significantly higher in the intervention group than in controls (p=.003) and prevalence of consumption of 7 or more food groups was 40% higher in the intervention group. Anthropometric measurements revealed a 20% higher prevalence of underweight and wasting and a 30% higher prevalence of severe stunting among controls than intervention group (p>.05). Conclusion: Permaculture has a positive impact on dietary diversity in Malawian children; however the evidence for impact on nutritional status was not strong hence conclusions could not be drawn. Keywords: Permaculture, Malnutrition, Dietary Diversity, Malawi
A study to investigate the impact of Low Level Laser Therapy (LLLT) on the improved healing and pain reduction in patients with Venous Leg Ulcers (VLUs).
(Queen Margaret University, 2017)
Venous leg ulcers (VLUs) are the most common ulcers of the lower limb accounting for 70% of all ulcerations of that kind. Reports suggest that with the current prevalence of chronic venous leg ulcers (CVLUs) of between 0.1% and 0.3% almost 1% of the population in the UK will suffer from VLUs at some stage in their lives (Agale, 2013). Currently the cost of VLU treatment by the NHS is estimated to range between £168 million and £198 million each year with 100,000 new cases of VLUs being reported annually (WELSH WOUND NETWORK.2017). VLUs are open wounds which can be reoccurring and can remain active for many weeks or even years. They have the potential to cause severe secondary complications such as squamous cell carcinoma, osteomyelitis or cellulites (Reich-Schupke et al. 2015). Many affected patients present with copious exudate, swelling and inflammation which lead to profound pain as well as psychological problems such as anxiety, depression, reduced sleep and a general sense of discomfort (Edwards et al. 2014). Recently, low level laser therapy (LLLT) has gained increased attention in treatment of VLUs, a phenomenon particularly evident from more than 400 double blinded randomised placebo control human trials supported by over 4,000 scientific research studies investigating the underlying mechanisms that present a local and systemic response to LLLT (Perlin, 2015). Low level laser therapy is thought to be beneficial in the healing of VLUs as it is believed to modulate Matrix Metalloproteinase levels (MMP) and reduce Reactive Oxygen Species (ROS), factors typically increased in CVLU patients. In addition, LLLT can lead to reduction of infection and pain associated with CVLUs. There are significant variations in the operational parameters of the lasers resulting in different outputs and these include the wavelength, power density, power output and fluence. If the incorrect parameters are chosen, which has been documented by a number of authors in the past, little or no effectiveness of the treatment or even tissue damage can be reported. Therefore it is imperative for positive results to choose the correct values of the critical factors. A thorough literature review on the effects of LLLT on wound healing and venous leg ulcers has been completed as part of this research proposal. Based on the literature review a number of parameters have been selected and are believed to be the most suitable for the application in the therapy of VLUs. The proposed 11 month long study is designed as a double blind randomised control trial with 44 participants recruited from wound clinics in cork. The participants will be appropriately randomised to receive LLLT or light emitting diode (LED) placebo; a conventional treatment of a hydrocolloid dressing and four layer compression bandaging will be applied after each treatment session regardless of the treatment group. The company supplying the laser machine for the study has assured that no difference in both the treatment and the placebo will be evident, making the distinction between the two treatment types effectively impossible even to a trained personnel. The obtained empirical data will be analysed by a qualified statistician and presented graphically to facilitate result interpretation.
A systematic Review: Comparing the Effectiveness of Internal and External Markers as Surrogates for Tracking Tumour Motion in Patients Undergoing Stereotactic Ablative Body Radiotherapy for Non Small Cell Lung Cancer
(Queen Margaret University, 2016)
Aim: The aim of this study is to evaluate if internal or external markers are effective at tracking the tumour when treating NSCLC patients with SABR. Background: Stereotactic ablative radiotherapy (SABR) has improved the survival for medically inoperable patients with non-small cell lung cancer (NSCLC). Respiratory tumour motion is challenging when implementing SABR treatment. This tumour motion can be localised and tracked by either internal or external markers. Method: A systematic review was conducted following PRISMA guidelines, to assess the treatment of NSCLC with SABR utilising either internal or external surrogates to determine which is more efficient at tracking tumour motion. The secondary endpoint was analysing if either surrogate demonstrated less toxicities and an improved rate of local control and overall survival outcomes. Eligible studies of SABR using surrogates to localise the tumour were retrieved through extensive searches of the Medline, CINAHL Plus, PubMed, Cochrane Library and Science Direct databases from 2008 to May 2016. Result: The search returned 120 articles; 17 met the inclusion criteria. No one paper had the ability to answer both primary and secondary outcomes. Four articles were included for analysis of the primary outcomes and 13 articles for secondary outcomes. From these articles data was extracted and analysed. Conclusion: The primary conclusion from the systematic review suggests internal markers are more effective at tumour tracking. The correlation between tumour and external marker did not demonstrate accurate results. Furthermore, due to technological advances, radiotherapy systems are incorporating both surrogates to track the tumour, hence the reason only a select few papers are included in the primary outcomes. Toxicity outcomes show that external markers are more beneficial as they incur less side effects. In contrast, local control and overall survival have better outcomes when using internal markers.
Abortion Practices in Humanitarian Settings - An Analysis of 3 Regions: The Middle East, East Africa, and Europe.
(2017)
Acceptability of Male circumcision for HIV prevention in Kenya
(Queen Margaret University, 2016)
Three randomized control trials in South Africa, Kenya and Uganda, demonstrated that there was a significant risk reduction of acquiring (sexually transmitted) HIV from women to men who are circumcised. Following these trials in 2007, the World Health Organization (WHO) and the Joint United Nations Programme on AIDS (UNAIDS) recommended the use of medical male circumcision (MC) for HIV prevention in eastern and southern Africa. However, the uptake of MC in countries with high HIV prevalence varies and the progress has been patchy. For example, only 3% of the targeted males in Lesotho have been reached, while 63% of the targeted males have been reached in Kenya (Gulland 2014). In this paper, the author explores the challenges and successes of MC for HIV prevention in Kenya.
Access to Reproductive Health Services for Asylum Seeker and Refugee Women in Scotland.
(Queen Margaret University, 2016)
Refugees and asylum seekers flee their home countries worldwide as a result of conflict and other reasons, and Scotland is home to thousands of refugees and asylum seekers. The aim of this study was to find out possible issues which may arise for refugee and asylum seekers in Scotland when accessing reproductive health (RH) services. The literature search on the rest of the United Kingdom (UK) in relation to access to RH services for asylum seeking and refugee women showed seven key access issues which comprised: communication and the language barrier, missed appointments or late antenatal care (ANC) booking, immigration status, dispersal, insufficient information, provider attitudes and health systems and cultural differences. The UK findings formed the basis for the study questions of the second part of the study which was done through primary data collection. Initial interview questions were more general, followed by questions related to the seven UK findings. Responses from three providers who were interviewed, one from Glasgow (2-6 Sandyford Place) and two in Edinburgh (Pennywell Resource Centre) revealed similarities with the UK findings except in the area of the provider attitude that did not come up during interviews with providers. A web-based search for information materials together with a visit to two facilities in Edinburgh and Glasgow was done in order to analyse how and the type of material on RH services are shared with women and the type of information provided. The findings revealed that although most asylum seeking and refugee women (ASARW) cannot speak or read English, most of the materials were predominantly written in English, which is another challenge to accessing information for these women and the type of information provided. Even though National Health Service (NHS) and Sandyford provide translation and interpretation services, challenges were still experienced in terms of the limited number of key languages that materials can be translated into and the lack of: interpreters for some languages or interprteters of the desired gender, and their limited availability in some cases. Finally, the Liverpool gender analysis framework for health was adapted for discussing the findings in relation to: the environment, bargaining position, resources, activities and gender norms, and Paul Farmer's theory on structural violence was also used. The further broader research was recommended to include ASARW from different countries and groups in order to get a broader perspective on the findings.
Accompanied and Unaccompanied Adolescent Asylum Seekers in Scotland: Access to Sexual and Reproductive Health Services
(Queen Margaret University, 2016)
Adolescent asylum seekers are a vulnerable population who may have faced human rights violations prior to seeking asylum. In addition, there are many challenges when arriving in a new country. These include language barriers, not knowing how to navigate through a health system, lack of health education, and lack of knowledge about current resources. This desk study will use a conceptual framework developed to guide the literature review. This desk study will also look at the literature around what sexual and reproductive health services are available for adolescent asylum seekers in Scotland and what challenges they face when accessing sexual and reproductive health care. This desk study used a systematic approach to the literature review. Databases such as EBSCOHOST, ProQuest, SCOPUS, and Medline were used along with the Journal of Refugee Studies. The results from the literature review shows many challenges that adolescents, asylum seekers, and unaccompanied asylum seekers face. Some challenges include vulnerability to mental health problems, sexual exploitation, lack of health education, and knowledge about local resources. Adolescent asylum seekers also face resource, asylum related, and socio-cultural challenges. This literature review has highlighted many issues that affect adolescent asylum seekers and the need for sexual and reproductive health services. Keywords: Sexual and reproductive health, adolescents, asylum seekers, refugees, Scotland
Acquisition of the word-initial stop voicing contrast: a longitudinal single case study
(Queen Margaret University, 2017)
In order to fully understand disordered speech and be able to treat it we must be able to compare this to typical speech development characteristics. Voicing contrast is a speech characteristic that has received a lot of attention in the literature. This is the difference between a voiced and voiceless phoneme at the same place of articulation (e.g. the difference between a /p/ and a /b/). Acoustically, we can analyse this by recording the voice onset time (VOT) in each phoneme. The length of time between the release of the stop consonant and the onset of the vibration of the glottis, describes VOT. In this study, we looked at the acquisition of voice onset time through a single case study of an English-speaking child. This child's VOT was recorded bimonthly from 70 weeks to 144 weeks old. The labial and alveolar targets were extracted from the data and the VOT was recorded. This data was then analysed using both means and token-by-token data analysis methods. We found similarly to Hitchcock and Koeing (2013, 2015), that VOT acquisition is not a discreet acquisition event and instead it is variable and may take months if not years to reach adult like VOT values consistently.