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- Genre: Academic theses
Community-based development: scaling up the correct use of misoprostol at home births in Afghanistan
Description
Globally, more than 350 000 women die annually from complications during pregnancy and childbirth (UNFPA, 2011). Nearly 99% of these, according to World Health Organization (WHO) trends (2010) occur in the developing world outside of a hospital setting with limited resources including emergency care (WHO, 2012; UNFPA, 2011). The most prevalent cause of death is postpartum hemorrhage (PPH), accounting for 25% of deaths according to WHO statistics (2012). Conditions in Afghanistan are reflective of the scope and magnitude of the problem. In Afghanistan, maternal mortality is thought to be among the highest in the world. The Afghan Mortality Survey (AMS) data implies that one Afghan woman dies about every 2 hours from pregnancy-related causes (AMS, 2010). Lack of empowerment, education and access to health care resources increase a woman's risk of dying during pregnancy (AMS, 2010). This project aims to investigate the prospects of scaling-up the correct use of misoprostol, a prostaglandin E1 analogue, to treat PPH in developing countries where skilled assistance and resources are scant. As there has been little published on the lessons learned from programs already in place, this study is experience-driven, based on the knowledge of industry experts. This study employs a concurrent triangulation approach to synthesize quantitative data obtained from previous studies with qualitative information gathered through the testimonies of key personnel who participated in pilot programs involving misoprostol. There are many obstacles to scaling-up training initiatives in Afghanistan and other low-resource areas. The analysis concludes that the most crucial factors for scaling-up community-based programs include: more studies analyzing lessons learns from community driven approaches; stronger partnerships with community health care workers; overcoming barriers like association with abortion, misuse and product issues; and a heightened global and community awareness of the severity of PPH without treatment. These results have implications for those who actively work in Afghanistan to promote maternal health and other countries that may use Afghanistan's work as a blueprint for reducing maternal mortality through community-based approaches. Keywords: Afghanistan, community-based interventions, community-driven, maternal mortality, MDG5, misoprostol, postpartum hemorrhage, reproduction, scale-up
ContributorsCristy, Candice (Author) / Grossman, Gary (Thesis advisor) / Parmentier, Mary-Jane (Committee member) / Byrd, Denise (Committee member) / Arizona State University (Publisher)
Created2013
Description
Reproduction is energetically costly and seasonal breeding has evolved to capitalize on predictable increases in food availability. The synchronization of breeding with periods of peak food availability is especially important for small birds, most of which do not store an extensive amount of energy. The annual change in photoperiod is the primary environmental cue regulating reproductive development, but must be integrated with supplementary cues relating to local energetic conditions. Photoperiodic regulation of the reproductive neuroendocrine system is well described in seasonally breeding birds, but the mechanisms that these animals use to integrate supplementary cues remain unclear. I hypothesized that (a) environmental cues that negatively affect energy balance inhibit reproductive development by acting at multiple levels along the reproductive endocrine axis including the hypothalamus (b) that the availability of metabolic fuels conveys alterations in energy balance to the reproductive system. I investigated these hypotheses in male house finches, Haemorhous mexicanus, caught in the wild and brought into captivity. I first experimentally reduced body condition through food restriction and found that gonadal development and function are inhibited and these changes are associated with changes in hypothalamic gonadotropin-releasing hormone (GnRH). I then investigated this neuroendocrine integration and found that finches maintain reproductive flexibility through modifying the release of accumulated GnRH stores in response to energetic conditions. Lastly, I investigated the role of metabolic fuels in coordinating reproductive responses under two different models of negative energy balance, decreased energy intake (food restriction) and increased energy expenditure (high temperatures). Exposure to high temperatures lowered body condition and reduced food intake. Reproductive development was inhibited under both energy challenges, and occurred with decreased gonadal gene expression of enzymes involved in steroid synthesis. Minor changes in fuel utilization occurred under food restriction but not high temperatures. My results support the hypothesis that negative energy balance inhibits reproductive development through multilevel effects on the hypothalamus and gonads. These studies are among the first to demonstrate a negative effect of high temperatures on reproductive development in a wild bird. Overall, the above findings provide important foundations for investigations into adaptive responses of breeding in energetically variable environments.
ContributorsValle, Shelley (Author) / Deviche, Pierre (Thesis advisor) / McGraw, Kevin (Committee member) / Orchinik, Miles (Committee member) / Propper, Catherine (Committee member) / Sweazea, Karen (Committee member) / Arizona State University (Publisher)
Created2018
Description
Environmental changes are occurring at an unprecedented rate, and these changes will undoubtedly lead to alterations in resource availability for many organisms. To effectively predict the implications of such changes, it is critical to better understand how organisms have adapted to coping with seasonally limited resources. The vast majority of previous work has focused on energy balance as the driver of changes in organismal physiology. While energy is clearly a vital currency, other resources can also be limited and impact physiological functions. Water is essential for life as it is the main constituent of cells, tissues, and organs. Yet, water has received little consideration for its role as a currency that impacts physiological functions. Given the importance of water to most major physiological systems, I investigated how water limitations interact with immune function, metabolism, and reproductive investment, an almost entirely unexplored area. Using multiple species and life stages, I demonstrated that dehydrated animals typically have enhanced innate immunity, regardless of whether the dehydration is a result of seasonal water constraints, water deprivation in the lab, or high physiological demand for water. My work contributed greatly to the understanding of immune function dynamics and lays a foundation for the study of hydration immunology as a component of the burgeoning field of ecoimmunology. While a large portion of my dissertation focused on the interaction between water balance and immune function, there are many other physiological processes that may be impacted by water restrictions. Accordingly, I recently expanded the understanding of how reproductive females can alter metabolic substrates to reallocate internal water during times of water scarcity, an important development in our knowledge of reproductive investments. Overall, by thoroughly evaluating implications and responses to water limitations, my dissertation, when combined previous acquired knowledge on food limitation, will enable scientists to better predict the impacts of future climate change, where, in many regions, rainfall events are forecasted to be less reliable, resulting in more frequent drought.
ContributorsBrusch, George, IV (Author) / DeNardo, Dale F (Thesis advisor) / Blattman, Joseph (Committee member) / French, Susannah (Committee member) / Sabo, John (Committee member) / Taylor, Emily (Committee member) / Arizona State University (Publisher)
Created2019
Description
Pregnancy and childbirth are both natural occurring events, but still little is known about the signaling mechanisms that induce contractions. Throughout the world, premature labor occurs in 12% of all pregnancies with 36% of infant deaths resulting from preterm related causes. Even though the cause of preterm labor can vary, understanding alternative signaling pathways, which affect muscle contraction, could provide additional treatment options in stopping premature labor. The uterus is composed of smooth muscle, which is innervated, with a plexus of nerves that cover the muscle fibers. Smooth muscle can be stimulated or modulated by many sources such as neurotransmitters [i.e. dopamine], hormones [i.e. estrogen], peptides [i.e. oxytocin] and amines. This study focuses on the biogenic monoamine tyramine, which is produced in the tyrosine catecholamine biosynthesis pathway. Tyramine is known to be associated with peripheral vasoconstriction, increased cardiac output, increased respiration, elevated blood glucose and the release of norepinephrine. This research has found tyramine, and its specific receptor TAAR1, to be localized within mouse uterus and that this monoamine can induce uterine contractions at levels similar to oxytocin.
ContributorsObayomi, SM Bukola (Author) / Baluch, Debra P (Thesis advisor) / Deviche, Pierre (Thesis advisor) / Smith, Brian H. (Committee member) / Arizona State University (Publisher)
Created2017
Description
In times of fast paced technology, the ability to differentiate quality differences between a reproduction and an original work of art has new urgency. The use of digital reproductions in the classroom is a useful and convenient teaching tool, but can convey visual distortions specifically in regards to texture, size, and color. Art educators often struggle to achieve a balance between incorporating the use of digital technology and fostering an appreciation for experiences with original artworks. The purpose of this study was to examine the ways in which Dewey's theory of experiential learning explains how thoroughly high school students differentiate between a reproduction and original artwork. This study also explored the influences of painting style (realistic or semi-abstract) and sequence on a student's ability to identify the differences and select a preference between the reproduction and original artwork. To obtain insight into how a student is able to differentiate between a reproduction and an original artwork, this study engaged 27 high school student participants in viewing a digital reproduction and the respective original artwork of one realistic and one semi-abstract painting at the ASU Art Museum. Analysis of qualitative and quantitative data suggests that sequence influences a student's ability to differentiate between a reproduction and original artwork. Students who saw reproductions before viewing the originals, demonstrated a more comprehensive understanding of the differences between the two presentation formats. Implications of this study include the recommendation that art educators address definitional issues surrounding the terms original and reproduction in their teaching, and consider collaborative ways to prepare students for meaningful experiences with original artworks.
ContributorsUscher, Dawn (Author) / Erickson, Mary (Thesis advisor) / Stokrocki, Mary (Committee member) / Young, Bernard (Committee member) / Arizona State University (Publisher)
Created2011
Description
Human preterm labor is the single most significant issue in modern obstetrics andgynecology, affecting ten percent of pregnancies, constituting the leading cause of infant death, and contributing significantly to chronic childhood disease. Obstetricians and reproductive scientists are faced with the major challenge of trying to increase the understanding of the complex molecular and cellular signals that regulate uterine activity during human pregnancy and labor. Even though preterm labor accounts for a large portion of perinatal mortality and morbidity, there still is not an effective therapeutic strategy for the treatment or prevention of preterm labor. This dissertation presents tyramine as an alternative modulator of uterine activity. In this dissertation the aims were as follows: 1) to investigate the localization of tyramine and trace amine associated receptor 1 (TAAR1) in the mouse uterine horn using immunohistochemistry as well as confirm the presence of tyramine in the uterine tissue using high performance liquid chromatography, 2) identify which TAAR 1-9 subtypes were present in the mouse uterine horn using RT-qPCR, 3) investigate ultrastructural differences in the mouse uterine horn following tyramine and dopamine treatment using transmission electron microscopy and 4) investigate pinopod ultrastructure as well as pinopod ultrastructural differences following tyramine and dopamine treatment. The research presented in this dissertation showed: 1) tyramine has very specific localization in the mouse endometrium, mainly in the uterine glands, TAAR1 is localized all throughout the perimetrium, myometrium and endometrium, and that tyramine was confirmed and quantified using HPLC, 2) TAAR 1- 9 genes are expressed in trace levels in the mouse uterine horn, 3) tyramine influences changes in endometrial ultrastructure, and 4) tyramine influences changes in pinopod ultrastructure. Ultimately these findings can help with identifying novel treatment options not only for spontaneous preterm labor contractions but also for other uterine related disorders.
ContributorsObayomi, SM Bukola (Author) / Baluch, Debra P (Thesis advisor) / Roberson, Robert (Thesis advisor) / Sweazea, Karen (Committee member) / Brent, Colin (Committee member) / Arizona State University (Publisher)
Created2023
Description
Ectotherms rely on external heat to attain target body temperatures which can vary based on the animal’s current physiological activity. Many ectotherms become thermophilic (“heat-loving”) during crucial physiological processes like digestion and reproduction, behaviorally thermoregulating to increase body temperature higher than what they otherwise prefer. However, there is a positive relationship between body temperature and water loss that dictates increasing body temperature typically elicits an increase in water loss. Animals that inhabit areas where water is at least seasonally limited (e.g., deserts, wet-dry forests) may face a tradeoff between prioritizing behavioral thermophily to optimize physiological processes versus prioritizing water balance and potentially sacrificing some aspect of total performance capability.It is thus far unknown how reduced water availability and subsequent dehydration may influence thermophily in ectotherms. I hypothesized that behaviorally thermoregulating ectotherms exhibit thermophily during critical physiological events, and the extent to which thermophily is expressed is influenced by the animal’s hydric state. Using Children’s pythons (Antaresia childreni), I investigated the effects of dehydration on behavioral thermophily during digestion and reproduction. I found that dehydration caused a suppression in digestion-associated thermophily, where dehydrated snakes returned to pre-feeding body temperature sooner than they did when they were hydrated. In contrast, water deprivation at different reproductive stages had no effect on thermophily despite leading to a significant increase in the female’s plasma osmolality.
ii
Additionally, the timing of water deprivation during reproduction had differing effects on plasma osmolality and circulating triglyceride, total protein, and corticosterone concentrations. My research provides evidence of the sensitive and complex dynamic between body temperature, water balance, and physiological processes. At a time when many dry ecosystems are becoming hotter and drier, my investigation of dehydration and its influence on thermal dynamics and physiological metrics provides insight into cryptic effects on the vital processes of digestion and reproduction.
ContributorsAzzolini, Jill L. (Author) / Denardo, Dale F. (Thesis advisor) / John-Alder, Henry (Committee member) / Angilletta, Michael (Committee member) / Pratt, Stephen (Committee member) / Arizona State University (Publisher)
Created2023
Description
The desire to start a family is something millions of people around the globe strive to achieve. However, many factors such as the societal changes in family planning due to increasing maternal age, use of birth control, and ever-changing lifestyles have increased the number of infertility cases seen in the United States each year. Infertility can manifest as a prolonged inability to conceive, or inability to carry a pregnancy full-term. Modern advancements in the field of reproductive medicine have begun to promote the use of Assisted Reproductive Technologies (ART) to circumvent reduced fertility in both men and women. Implementation of techniques such as In Vitro Fertilization, Intracytoplasmic Sperm Injection, and Pre-Implantation Genetic Testing have allowed many couples to conceive. There is continual effort being made towards developing more effective and personalized fertility treatments. This often begins in the form of animal research—a fundamental step in biomedical research. This dissertation examines infertility as a medical condition through the characterization of normal reproductive anatomy and physiology in the introductory overview of reproduction. Specific pathologies of male and female-factor infertility are described, which necessitates the use of ARTs. The various forms of ARTs currently utilized in a clinical setting are addressed including history, preparations, and protocols for each technology. To promote continual advancement of the field, both animal studies and human trials provide fundamental stepping-stones towards the execution of new techniques and protocols. Examples of research conducted for the betterment of human reproductive medicine are explored, including an animal study conducted in mice exploring the role of tyramine in ovulation. With the development and implementation of new technologies and protocols in the field, this also unearths ethical dilemmas that further complicate the addition of new technologies in the field. Combining an extensive review in assisted reproduction, research and clinical fieldwork, this study investigates the history and development of novel research conducted in reproductive medicine and explores the broader implications of new technologies in the field.
ContributorsPeck, Shelbi Marie (Author) / Baluch, Debra P (Thesis advisor) / Maienschein, Jane (Thesis advisor) / Sweazea, Karen (Committee member) / Ellison, Karin (Committee member) / Arizona State University (Publisher)
Created2021