Mobility and Maternal Position during Childbirth in Tanzania: An Exploratory Study at Four Government Hospitals.

Emerging research evidence suggests a potential benefit in being upright in the first stage of labour and a systematic review of trials suggests both benefits and harmful effects associated with being upright in the second stage of labour. Implementing evidence-based obstetric care in African countries with scarce resources is particularly challenging, and requires an understanding of the cumulative nature of science and commitment to applying the most up to date evidence to clinical decisions. In this study, we documented current practice rates, explored the barriers and opportunities to implementing these procedures from the provider perspective, and documented women's preferences and satisfaction with care. This was an exploratory study using quantitative and qualitative methods. Practice rates were determined by exit interviews with a consecutive sample of postnatal women. Provider views were explored using semi-structured interviews (with doctors and traditional birth attendants) and focus group discussions (with midwives). The study was conducted at four government hospitals, two in Dar es Salaam and two in the neighbouring Coast region, Tanzania. MAIN OUTCOME MEASURES: Practice rates for mobility during labour and delivery position; women's experiences, preferences and views about the care provided; and provider views of current practice and barriers and opportunities to evidence-based obstetric practice. Across all study sites more women were mobile at home (15.0%) than in the labour ward (2.9%), but movement was quite restricted at home before women were admitted to labour ward (51.6% chose to rest with little movement). Supine position for delivery was used routinely at all four hospitals; this was consistent with women's preferred choice of position, although very few women are aware of other positions. Qualitative findings suggest obstetricians and midwives favoured confining to bed during the first stage of labour, and supine position for delivery. The barriers to change appear to be complicated and require providers to want to change, and women to be informed of alternative positions during the first stage of labour and delivery. We believe that highlighting the gap between actual practice and current evidence provides a platform for dialogue with providers to evaluate the threats and opportunities for changing practice

Segmenting Publics

This research synthesis was commissioned by the National Co-ordinating Centre for Public Engagement (NCCPE) and the Economic and Social Research Council (ESRC) to examine audience segmentation methods and tools in the area of public engagement. It provides resources for assessing the ways in which segmentation tools might be used to enhance the various activities through which models of public engagement in higher education are implemented. Understanding the opinions, values, and motivations of members of the public is a crucial feature of successful engagement. Segmentation methods can offer potential resources to help understand the complex set of interests and attitudes that the public have towards higher education. Key findings: There exist a number of existing segmentations which address many of the areas of activity found in Universities and HEIs. These include segmentations which inform strategic planning of communications; segmentations which inform the design of collaborative engagement activities by museums, galleries, and libraries; and segmentations that are used to identify under-represented users and consumers. Segmentation is, on its own, only a tool, used in different ways in different contexts. The broader strategic rationale shaping the application and design of segmentation methods is a crucial factor in determining the utility of segmentation tools. Four issues emerged of particular importance: 1. Segmentation exercises are costly and technically complex. Undertaking segmentations therefore requires significant commitment of financial and professional resources by HEIs; the appropriate interpretation, analysis, and application of segmentation exercises also require high levels of professional capacity and expertise 2. Undertaking a segmentation exercise has implications for the internal organisational operations of HEIs, not only for how they engage with external publics and stakeholders 3. Segmentation tools are adopted to inform interventions of various sorts, and superficially to differentiate and sometime discriminate between how groups of people are addressed and engaged. 4. For HEIs, the ethical issues and reputational risks which have been identified in this Research Synthesis as endemic to the application of segmentation methods for public purposes are particularly relevant

Sense Tagging: Semantic Tagging with a Lexicon

Sense tagging, the automatic assignment of the appropriate sense from some lexicon to each of the words in a text, is a specialised instance of the general problem of semantic tagging by category or type. We discuss which recent word sense disambiguation algorithms are appropriate for sense tagging. It is our belief that sense tagging can be carried out effectively by combining several simple, independent, methods and we include the design of such a tagger. A prototype of this system has been implemented, correctly tagging 86% of polysemous word tokens in a small test set, providing evidence that our hypothesis is correct.Comment: 6 pages, uses aclap LaTeX style file. Also in Proceedings of the SIGLEX Workshop "Tagging Text with Lexical Semantics

The role of healthcare professionals in encouraging parents to see and hold their stillborn baby: a meta-synthesis of qualitative studies.

Background: Globally, during 2013 there were three million recorded stillbirths. Where clinical guidelines exist some recommend that professionals do not encourage parental contact. The guidance is based on quantitative evidence that seeing and holding the baby is not beneficial for everyone, but has been challenged by bereaved parents' organisations. We aim to inform future guideline development through a synthesis of qualitative studies reporting data relevant to the research question; how does the approach of healthcare professionals to seeing and holding the baby following stillbirth impact parents views and experiences? Methods/Findings: Using a predetermined search strategy of PubMed and PsychINFO we identified robust qualitative studies reporting bereaved parental views and/or experiences relating to seeing and holding their stillborn baby (final search 24 February, 2014). Eligible studies were English language, reporting parental views, with gestational loss >20weeks. Quality was independently assessed by three authors using a validated tool. We used meta-ethnographic techniques to identify key themes and a line of argument synthesis. We included 12 papers, representing the views of 333 parents (156 mothers, 150 fathers, and 27 couples) from six countries. The final themes were: "[Still]birth: Nature of care is paramount", "Real babies: Perfect beauties, monsters and spectres", and "Opportunity of a lifetime lost." Our line-of-argument synthesis highlights the contrast between all parents need to know their baby, with the time around birth being the only time memories can be made, and the variable ability that parents have to articulate their preferences at that time. Thus, we hypothesised that how health professionals approach contact between parents and their stillborn baby demands a degree of active management. An important limitation of this paper is all included studies originated from high income, westernised countries raising questions about the findings transferability to other cultural contexts. We do not offer new evidence to answer the question "Should parents see and hold their stillborn baby?", instead our findings advance understanding of how professionals can support parents to make appropriate decisions in a novel, highly charged and dynamic situation. Conclusions: Guidelines could be more specific in their recommendations regarding parental contact. The role of healthcare professionals in encouraging parents to see and hold their stillborn baby is paramount. Parental choice not to see their baby, apprehension, or uncertainty should be continuously revisited in the hours after birth as the opportunity for contact is fleeting and final

How to encourage intrinsic motivation in the clinical teaching environment?: a systematic review from the self-determination theory

Purpose: Internalization of students’ motivation towards an intrinsic form is associated with increased interest, commitment, learning, and satisfaction with education. Self-Determination theory postulates that intrinsic motivation and autonomous forms of self-regulation are the desired type of motivation; as they have been associated with deep learning, better performance and well-being. It claims three basic psychological needs have to be satisfied in order to achieve intrinsic motivation. These are the needs for autonomy, competence and relatedness. This study aims to provide a review on how these basic psychological needs are encouraged in undergraduate students so they can be transferred to the clinical teaching environment. Methods: Electronic searches were performed across four databases (Medline, Embase, PsycINFO, and ERIC), relevant journals, and retrieved bibliography of selected articles. In total, searches produced 4,869 references, from which 16 studies met the inclusion criteria. Results: Main themes were coded in three categories: The support of autonomy, competence and relatedness. The research-based evidence appears to be of reasonable quality, and indicates that teachers should work to satisfy students’ basic psychological needs to foster internalization of self-regulation. Our findings suggest that teachers should interact with students in a more ‘human centred’ teaching style, as these actions predict motivational internalization. Several themes emerged from different contexts and further investigation should expand them. Conclusion: This review identified actions that clinical teachers could implement in their daily work to support students’ self-determination. Autonomy supportive teaching in health professions educations would benefit students and may actually result in more effective health care delivery

The Space of Geometric Limits of One-generator Closed Subgroups of PSL2(R)

We give a complete description of the closure of the space of one-generator closed subgroups of PSL2(R) for the Chabauty topology, by computing explicitly the matrices associated with elements of Aut(D) = PSL2(R), and finding quantities parametrizing the limit cases. Along the way, we investigate under what conditions sequences of maps transform convergent sequences of closed subsets of the domain into convergent sequences of closed subsets of the range. In particular, this allows us to compute certain geometric limits of PSL2(R) only by looking at the Hausdorff limit of some closed subsets of C.Comment: 28 pages, 6 figure

Sustainability motivations and practices in small tourism enterprises in European protected areas

A survey of around 900 tourism enterprises in 57 European protected areas shows that small firms are more involved in taking responsibility for being sustainable than previously expected, including eco-savings related operational practices but also reporting a wide range of social and economic responsibility actions. Two-step cluster analysis was used to group the firms in three groups based on their motivations to be sustainable. Business driven firms implement primarily eco-savings activities and are commercially oriented. Legitimization driven firms respond to perceived stakeholder pressure and report a broad spectrum of activities. Lifestyle and value driven firms report the greatest number of environmental, social and economic activities. No profile has a higher business performance than average. The study has implications for policy programmes promoting sustainability behaviour change based primarily on a business case argument