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"Theobald, S."
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Investigation of Head Kinematics and Brain Strain Response During Soccer Heading Using a Custom-Fit Instrumented Mouthguard
Association football, also known as soccer in some regions, is unique in encouraging its participants to intentionally use their head to gain a competitive advantage, including scoring a goal. Repetitive head impacts are now being increasingly linked to an inflated risk of developing long-term neurodegenerative disease. This study investigated the effect of heading passes from different distances, using head acceleration data and finite element modelling to estimate brain injury risk. Seven university-level participants wore a custom-fitted instrumented mouthguard to capture linear and angular acceleration-time data. They performed 10 headers within a laboratory environment, from a combination of short, medium, and long passes. Kinematic data was then used to calculate peak linear acceleration, peak angular velocity, and peak angular acceleration as well as two brain injury metrics: head injury criterion and rotational injury criterion. Six degrees of freedom acceleration-time data were also inputted into a widely accepted finite element brain model to estimate strain-response using mean peak strain and cumulative strain damage measure values. Five headers were considered to have a 25% concussion risk. Mean peak linear acceleration equalled 26 ± 7.9 g, mean peak angular velocity 7.20 ± 2.18 rad/s, mean peak angular acceleration 1730 ± 611 rad/s2, and 95th percentile mean peak strain 0.0962 ± 0.252. Some of these data were similar to brain injury metrics reported from American football, which supports the need for further investigation into soccer heading.
Journal Article
Do chest compressions during simulated infant CPR comply with international recommendations?
Background Morbidity and mortality remain high following infant cardiac arrest. Optimal cardiopulmonary resuscitation (CPR) is therefore imperative. Objective Comparison of two-thumb (TT) and two-finger (TF) infant chest compression technique compliance with international recommendations. Design Randomised cross-over experimental study. Methods Twenty-two certified Advanced Paediatric Life Support (APLS) instructors performed 2 min continuous TT and TF chest compressions on an instrumented infant CPR manikin. Compression depth (CD), release force (RF), compression rate (CR) and duty cycles (DCs) were recorded. Quality indices were developed to calculate the proportion of compressions that complied with internationally recommended targets, and an overall quality index was used to calculate the proportion that complied with all four targets. Results Mean CD was 33 mm and 26 mm (p<0.001; target ≥36.7 mm), mean RF was 0.8 kg and 0.2 kg (p<0.001; target <2.5 kg), mean CR was 128/min and 131/min (p=0.052; target 100–120/min) and mean DCs was 61% and 53% (p<0.001; target 30–50%) for the TT and TF techniques, respectively. With the exception of RF, the majority of compressions failed to comply with targets. The TT technique improved median CD compliance (6% vs 0% (p<0.001)), while the TF technique improved median DC compliance (23% vs 0% (p<0.001)). Overall compliance with all four targets was <1% for both techniques (p=0.14). Conclusions Compliance of APLS instructors with current international recommendations during simulated infant CPR is poor. The TT technique provided improved CD compliance, while the TF technique provided superior DC compliance. If this reflects current clinical practice, optimisation of performance to achieve international recommendations during infant CPR is called for.
Journal Article
Can mHealth improve timeliness and quality of health data collected and used by health extension workers in rural Southern Ethiopia?
Health extension workers (HEWs) are the key cadre within the Ethiopian Health Extension Programme extending health care to rural communities. National policy guidance supports the use of mHealth to improve data quality and use. We report on a mobile Health Management Information system (HMIS) with HEWs and assess its impact on data use, community health service provision and HEWs' experiences.
We used a mixed methods approach, including an iterative process of intervention development for 2 out of 16 essential packages of health services, quantitative analysis of new registrations, and qualitative research with HEWs and their supervisors.
The iterative approach supported ownership of the intervention by health staff, and 8833 clients were registered onto the mobile HMIS by 62 trained HEWs. HEWs were positive about using mHealth and its impact on data quality, health service delivery, patient follow-up and skill acquisition. Challenges included tensions over who received a phone; worries about phone loss; poor connectivity and power failures in rural areas; and workload.
Mobile HMIS developed through collaborative and locally embedded processes can support quality data collection, flow and better patient follow-up. Scale-up across other community health service packages and zones is encouraged together with appropriate training, support and distribution of phones to address health needs and avoid exacerbating existing inequalities.
CHWs, equity, ethics, Ethiopia, Health Management Information system, HEP, maternal health, mHealth, TB.
Journal Article
Can real-time feedback improve the simulated infant cardiopulmonary resuscitation performance of basic life support and lay rescuers?
BackgroundPerforming high-quality chest compressions during cardiopulmonary resuscitation (CPR) requires achieving of a target depth, release force, rate and duty cycle.ObjectiveThis study evaluates whether ‘real time’ feedback could improve infant CPR performance in basic life support-trained (BLS) and lay rescuers. It also investigates whether delivering rescue breaths hinders performing high-quality chest compressions. Also, this study reports raw data from the two methods used to calculate duty cycle performance.MethodologyBLS (n=28) and lay (n=38) rescuers were randomly allocated to respective ‘feedback’ or ‘no-feedback’ groups, to perform two-thumb chest compressions on an instrumented infant manikin. Chest compression performance was then investigated across three compression algorithms (compression only; five rescue breaths then compression only; five rescue breaths then 15:2 compressions). Two different routes to calculate duty cycle were also investigated, due to conflicting instruction in the literature.ResultsNo-feedback BLS and lay groups demonstrated <3% compliance against each performance target. The feedback rescuers produced 20-fold and 10-fold increases in BLS and lay cohorts, respectively, achieving all targets concurrently in >60% and >25% of all chest compressions, across all three algorithms. Performing rescue breaths did not impede chest compression quality.ConclusionsA feedback system has great potential to improve infant CPR performance, especially in cohorts that have an underlying understanding of the technique. The addition of rescue breaths—a potential distraction—did not negatively influence chest compression quality. Duty cycle performance depended on the calculation method, meaning there is an urgent requirement to agree a single measure.
Journal Article
The role of women's leadership and gender equity in leadership and health system strengthening
Gender equity is imperative to the attainment of healthy lives and wellbeing of all, and promoting gender equity in leadership in the health sector is an important part of this endeavour. This empirical research examines gender and leadership in the health sector, pooling learning from three complementary data sources: literature review, quantitative analysis of gender and leadership positions in global health organisations and qualitative life histories with health workers in Cambodia, Kenya and Zimbabwe. The findings highlight gender biases in leadership in global health, with women underrepresented. Gender roles, relations, norms and expectations shape progression and leadership at multiple levels. Increasing women's leadership within global health is an opportunity to further health system resilience and system responsiveness. We conclude with an agenda and tangible next steps of action for promoting women's leadership in health as a means to promote the global goals of achieving gender equity.
Journal Article
Delivering post-rape care services: Kenya's experience in developing integrated services
Comprehensive service delivery models for providing post-rape care are largely from resource-rich countries and do not translate easily to resource-limited settings such as Kenya, despite an identified need and high rates of sexual violence and HIV.
Starting in 2002, we undertook to work through existing governmental structures to establish and sustain health sector services for survivors of sexual violence.
In 2003 there was a lack of policy, coordination and service delivery mechanisms for post-rape care services in Kenya. Post-exposure prophylaxis against HIV infection was not offered.
A standard of care and a simple post-rape care systems algorithm were designed. A counselling protocol was developed. Targeted training that was knowledge-, skills- and values-based was provided to clinicians, laboratory personnel and trauma counsellors. The standard of care included clinical evaluation and documentation, clinical management, counselling and referral mechanisms. Between early 2004 and the end of 2007, a total of 784 survivors were seen in the three centres at an average cost of US$ 27, with numbers increasing each year. Almost half (43%) of these were children less than 15 years of age.
This paper describes how multisectoral teams at district level in Kenya agreed that they would provide post-exposure prophylaxis, physical examination, sexually transmitted infection and pregnancy prevention services. These services were provided at casualty departments as well as through voluntary HIV counselling and testing sites. The paper outlines which considerations they took into account, who accessed the services and how the lessons learned were translated into national policy and the scale-up of post-rape care services through the key involvement of the Division of Reproductive Health.
Journal Article
Cyclin L1 (CCNL1) gene alterations in human head and neck squamous cell carcinoma
We evaluated the expression and amplification of
cyclin L1
(
CCNL1)
gene, a potential oncogene localised in the commonly amplified 3q25–28 region, in human head and neck squamous cell carcinomas (HNSCCs). Overexpression was observed in 55 out of 96 cases (57%) and amplification in nine out of 35 tumours (26%) with no relationships to the clinico-pathological parameters. The Cyclin L1 antibody we developed labels nuclear speckles in tumour cells compatible with a role for CCNL1 in RNA splicing.
Journal Article