Midwifery Basics: Assessing students

Midwifery Basics: Mentorship 4 Mentorship: is the fourteenth series of ‘Midwifery basics’ targeted at practising midwives. It aims to provide information to raise awareness of the impact of the work of midwives on student learning and ultimately on women’s experiences and encourages midwives to seek further information through a series of activities. In this the fourth article Julie Parkin and Joyce Marshall consider some of the key issues related to the responsibility of the sign off mentor in the process of assessing student midwives’ competence in clinical practice. Scenario Suzanne is practising on labour ward and is mentoring Emily, a second year student midwife. She is concerned that at the end of her first week Emily does not appear to be making the transition to being a second year student as she still requires close supervision and direction, and is struggling to communicate with women and their birth partner

Essays on Urban Sprawl

Essay 1 Sprawl is an ill-defined and complex concept and this contributes to the difficulties in addressing it. Many studies and local policies are implemented without defining the very situation that is trying to be prevented. In this dissertation, I address this issue by computing and empirically testing a number of different measures that capture some of the elements of sprawl. While controlling for a number of other explanatory factors, I examine different fiscal factors that may contribute to the level of sprawl an area experiences. Because the property tax is the predominant source of local tax revenue, my main focus is on the impact that property tax rates have on sprawl in metropolitan areas. I next examine how the reliance on different types of revenue sources influence sprawl. I then offer insight into how local governments may use this information to look at their own sprawl issues. I find that higher property taxes are found in areas with lower degrees of sprawl, but that greater property tax differentials result in more sprawl. Essay 2 The second essay of this dissertation addresses one of the inefficiencies often attributed to sprawl: the increase in the cost of delivering public services. Although this is one of the most common complaints concerning sprawl, there have been few studies examining how sprawl impacts public service costs. Using the same sprawl measures as in the first essay, I examine how differing levels of sprawl impact the costs of not only total public service expenditures, but also a number of local services important to residents. With this essay, I contribute to the debate on the relationship between sprawl and public service costs. The results of this study show that sprawl has a very limited relationship with most types of local public service expenditures

Switching modalities in a sentence verification task: ERP evidence for embodied language processing

In an event related potential (ERP) experiment using written language materials only, we investigated a potential modulation of the N400 by the modality switch effect. The modality switch effect occurs when a first sentence, describing a fact grounded in one modality, is followed by a second sentence describing a second fact grounded in a different modality. For example, "A cellar is dark" (visual), was preceded by either another visual property "Ham is pink" or by a tactile property "A mitten is soft." We also investigated whether the modality switch effect occurs for false sentences ("A cellar is light"). We found that, for true sentences, the ERP at the critical word "dark" elicited a significantly greater frontal, early N400-like effect (270370 ms) when there was a modality mismatch than when there was a modality-match. This pattern was not found for the critical word "light" in false sentences. Results similar to the frontal negativity were obtained in a late time window (500700 ms). The obtained ERP effect is similar to one previously obtained for pictures. We conclude that in this paradigm we obtained fast access to conceptual properties for modality-matched pairs, which leads to embodiment effects similar to those previously obtained with pictorial stimuli

Exploring changes in health visitors' knowledge, confidence and decision-making for women with perinatal mental health difficulties following a brief training package

Rationale and objective: Perinatal Mental Health (PMH) is an issue that spans the spectrum of pregnancy and childbirth and is now acknowledged to be significant on a global level. Health visitors (HVs) are increasingly expected to extend their knowledge and to understand and identify PMH in the antenatal period and across the spectrum from mild/moderate to severe. While training has been shown to enable HVs to identify post-natal depression (PND) effectively and reduce the proportion of women at risk, the mechanisms underpinning this success are unclear. This paper reports on the findings of a mixed methods study aimed at examining the impact of a single half day training session on perinatal mental health problems (PMHP) on HVs knowledge, confidence and empowerment in relation to managing PMH. Methods: Findings from data gathered by Likert Scales and focus group discussions are presented. Results: Training can empower HVs to identify PMHP beyond PND and plays a vital role in promoting confidence. Conclusions: This research highlights the potential that training of this type has on service provision and delivery. In a resource-limited service, the feasibility of a brief training package has demonstrated positive results for health visitors, childbearing women and their families

Hot-Fire Testing of 100 LB(sub F) LOX/LCH4 Reaction Control Engine at Altitude Conditions

Liquid oxygen/liquid methane (LO2/LCH4 ) has recently been viewed as a potential green propulsion system for both the Altair ascent main engine (AME) and reaction control system (RCS). The Propulsion and Cryogenic Advanced Development Project (PCAD) has been tasked by NASA to develop these green propellant systems to enable safe and cost effective exploration missions. However, experience with LO2/LCH4 as a propellant combination is limited, so testing of these systems is critical to demonstrating reliable ignition and performance. A test program of a 100 lb f reaction control engine (RCE) is underway at the Altitude Combustion Stand (ACS) of the NASA Glenn Research Center, with a focus on conducting tests at altitude conditions. These tests include a unique propellant conditioning feed system (PCFS) which allows for the inlet conditions of the propellant to be varied to test warm to subcooled liquid propellant temperatures. Engine performance, including thrust, c* and vacuum specific impulse (I(sub sp,vac)) will be presented as a function of propellant temperature conditions. In general, the engine performed as expected, with higher performance at warmer propellant temperatures but better efficiency at lower propellant temperatures. Mixture ratio effects were inconclusive within the uncertainty bands of data, but qualitatively showed higher performance at lower ratios

Summary of Altitude Pulse Testing of a 100-lbf L02/LCH4 Reaction Control Engine

Recently, liquid oxygen-liquid methane (LO2/LCH4) has been considered as a potential "green" propellant alternative for future exploration missions. The Propulsion and Cryogenic Advanced Development (PCAD) project has been tasked by NASA to develop this propulsion combination to enable safe and cost effective exploration missions. To date, limited experience with such combinations exist, and as a result a comprehensive test program is critical to demonstrating the viability of implementing such a system. The NASA Glenn Research Center has conducted a test program of a 100-lbf (445-N) reaction control engine (RCE) at the center s Altitude Combustion Stand (ACS), focusing on altitude testing over a wide variety of operational conditions. The ACS facility includes a unique propellant conditioning feed system (PCFS) which allows precise control of propellant inlet conditions to the engine. Engine performance as a result of these inlet conditions was examined extensively during the test program. This paper is a companion to the previous specific impulse testing paper, and discusses the pulsed mode operation portion of testing, with a focus on minimum impulse bit (I-bit) and repeatable pulse performance. The engine successfully demonstrated target minimum impulse bit performance at all conditions, as well as successful demonstration of repeatable pulse widths. Some anomalous conditions experienced during testing are also discussed, including a double pulse phenomenon which was not noted in previous test programs for this engine

Spark Ignition Characteristics of a L02/LCH4 Engine at Altitude Conditions

The use of non-toxic propellants in future exploration vehicles would enable safer, more cost effective mission scenarios. One promising "green" alternative to existing hypergols is liquid methane/liquid oxygen. To demonstrate performance and prove feasibility of this propellant combination, a 100lbf LO2/LCH4 engine was developed and tested under the NASA Propulsion and Cryogenic Advanced Development (PCAD) project. Since high ignition energy is a perceived drawback of this propellant combination, a test program was performed to explore ignition performance and reliability versus delivered spark energy. The sensitivity of ignition to spark timing and repetition rate was also examined. Three different exciter units were used with the engine s augmented (torch) igniter. Propellant temperature was also varied within the liquid range. Captured waveforms indicated spark behavior in hot fire conditions was inconsistent compared to the well-behaved dry sparks (in quiescent, room air). The escalating pressure and flow environment increases spark impedance and may at some point compromise an exciter s ability to deliver a spark. Reduced spark energies of these sparks result in more erratic ignitions and adversely affect ignition probability. The timing of the sparks relative to the pressure/flow conditions also impacted the probability of ignition. Sparks occurring early in the flow could trigger ignition with energies as low as 1-6mJ, though multiple, similarly timed sparks of 55-75mJ were required for reliable ignition. An optimum time interval for spark application and ignition coincided with propellant introduction to the igniter and engine. Shifts of ignition timing were manifested by changes in the characteristics of the resulting ignition

Early identification of the difficult airway from orbital deformity

"We report an adult patient presenting for surgery with hidden marked orbital exenteration (Figures 1, 2). The patient had history of resected left orbital neoplasm that remained concealed under an eye patch during preoperative physical examination and presentation to the operating room. Face mask ventilation proved impossible after anesthetic induction. Removal of the eye patch revealed a large facial orbital floor defect from exenteration of the orbit floor and the patient immediately underwent endotracheal intubation. Following the procedure, postoperative respiratory insufficiency required additional airway support. Emergent placement of a laryngeal mask airway provided adequate ventilation."--CaseJulie M. Marshall, Noah J. Timko (Department of Anesthesiology and Perioperative Medicine, University of Missouri)Includes bibliographical reference