Carbon Monoxide Screening in Pregnancy: An Evaluation Study of a Plymouth Pilot Intervention

This report provides an analysis and evaluation of a National Institute for Health and Care Excellence (NICE) recommended pilot intervention which was designed to identify pregnant women exposed to carbon monoxide due to cigarette smoke and refers them to local stop smoking services (LSSS). The pilot intervention was carried out by community midwives working in two areas of Plymouth. The city has areas of social and health inequalities and the study drew on populations from a socially deprived neighbourhood and a socially affluent area. The pilot was instigated following new NICE guidance recommending that all women attending initial ante natal booking appointments with their community midwives be offered a Carbon Monoxide (CO) breath analyser screening to determine their smoking status and or exposure to other forms of CO. This evaluation study identifies the benefits and barriers associated with the implementation of the CO screening pilot. In particular, our aims were to explore any detrimental impact on the relationship between women and their community midwives, identify the impact on midwives in terms of time and resources, reveal the responses and acceptability or otherwise of the screening as perceived and experienced by the women being asked to participate during the booking appointment and finally to evaluate the success of the intervention overall in relation to the numbers of referrals made to Plymouth’s LSSS. A further aim was explore any differences in the two socio demographic areas. We adopted a mixed methods approach involving four focus group interviews with 23 midwives, a survey posted to the 258 women who attended initial antenatal booking appointments in the study areas, an online version of the survey to ascertain the views and experiences of pregnant women and new mothers nationally and an interrogation of an internet forum discussion board for mothers. A two page questionnaire consisting of 12 questions was designed and posted to women who attended the booking appointment with the midwife during the three month pilot period and the same survey was made available online. Questions were designed to elicit women’s views about the information given by the midwife in relation to the screening, whether they had agreed to participate in the CO screening process, their experiences and views about offering CO screening to pregnant women and their smoking status and those of other household members. Of the 258 questionnaires posted to women who had attended the clinic during the pilot intervention 40 completed responses were returned representing a 15.5% response rate. Only 4 responses were received from the online survey posting but an additional 484 comments posted on the Mumsnet website discussion board were analysed. Our findings show that in general there was a high degree of acceptability for the intervention. Midwives and their clients were generally in support of the screening being offered to all pregnant women. However, this support was dependent on a number of contextual factors. Women wanted to be properly informed about the screening and midwives wanted to be kept informed about the effects of the intervention on women’s smoking cessation. Initial and ongoing training of midwives in utilising the protocol and in instructing women to correct use the monitor was also very important. Trust was revealed to be a very important aspect of the relationship between women and their midwives. Some women felt that the CO screening was being used just to check whether or not they were smokers and some midwives also worried about the possible negative effects the CO screening may have on their relationships with women

Emotional real-world scenes impact visual search

Research shows that emotional stimuli can capture attention, and this can benefit or impair performance, depending on the characteristics of a task. Additionally, whilst some findings show that attention expands under positive conditions, others show that emotion has no influence on the broadening of attention. The current study investigated whether emotional real-world scenes influence attention in a visual search task. Participants were asked to identify a target letter embedded in the centre or periphery of emotional images. Identification accuracy was lower in positive images compared to neutral images, and response times were slower in negative images. This suggests that real-world emotional stimuli have a distracting effect on visual attention and search. There was no evidence that emotional images influenced the spatial spread of attention. Instead, it is suggested that findings may provide support for the argument that positive emotion encourages a global processing style and negative emotion promotes local processing

Mapping lung cancer epithelial-mesenchymal transition states and trajectories with single-cell resolution.

Elucidating the spectrum of epithelial-mesenchymal transition (EMT) and mesenchymal-epithelial transition (MET) states in clinical samples promises insights on cancer progression and drug resistance. Using mass cytometry time-course analysis, we resolve lung cancer EMT states through TGFβ-treatment and identify, through TGFβ-withdrawal, a distinct MET state. We demonstrate significant differences between EMT and MET trajectories using a computational tool (TRACER) for reconstructing trajectories between cell states. In addition, we construct a lung cancer reference map of EMT and MET states referred to as the EMT-MET PHENOtypic STAte MaP (PHENOSTAMP). Using a neural net algorithm, we project clinical samples onto the EMT-MET PHENOSTAMP to characterize their phenotypic profile with single-cell resolution in terms of our in vitro EMT-MET analysis. In summary, we provide a framework to phenotypically characterize clinical samples in the context of in vitro EMT-MET findings which could help assess clinical relevance of EMT in cancer in future studies

Dealing with Complexity: Infant Feeding Choices and Experiences for Mothers with Infants in Neonatal Intensive Care Units and Transitional Care Wards

EXECUTIVE SUMMARY The central aim of the research on which this document reports was: To explore the knowledge, perceptions and experiences of infant feeding of mothers with infants in neonatal intensive care units (NICU) and transitional care wards (TCW) and the support these mothers receive from healthcare professionals and significant others with the aim of contributing to further support of mothers, significant others and healthcare professionals in the future. The objectives were: 1. To explore mothers’ with infants in NICU knowledge and understanding of infant, feeding and how this influences feeding choices. 2. To gain an understanding of mothers experiences of infant feeding, 3. To investigate the challenges of infant feeding in NICU. 4. To explore the significance of their self-identity and perception as ‘good’ or ‘not so good’ mothers in relation to this choice. 5. To ascertain the support women receive from healthcare professionals and significant others. 6. To identify further research needs, develop service provision and inform practice and policy. Background to the study is supported by a review of the clinical and sociologically relevant literature and brief detail on a previous related study (Stenhouse and Letherby 2013) which focused on the experience of mothers’ whose pregnancies were complicated by diabetes. A mixed method ethnographic approach was adopted: • Observations in the NICU and TCW were undertaken (alongside interviewing) amounting to approximately six hours. • One-to-one and dyad/group interviewing were undertaken with mothers and some of their partners. • Questionnaires (consisting of 10 questions, some of which were open to allow more respondent input) were distributed to all healthcare professionals working in NICU and TCW. An audit involving a systematic and independent examination of maternal and infant notes was undertaken at the same time as the primary data was collected. DATA AND DISCUSSION The Audit: This section provides a snapshot of infant feeding and expression of breastmilk from a cohort of mothers and babies who had previously been cared for in NICU, TCW or both. Appendix IV is a copy of a poster presented as part of the Medical Training Special Studies Unit. Interview and Questionnaire Data: This section reports on data collected from women, significant others and healthcare professionals and includes detailed reference to the significance of ‘The Journey’, the mixed experience of ‘Skills and Support’ and the experiences of ‘Pleasure, Pressure and Propaganda’. CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS Six summary points 1. Training for staff is mixed and this is linked to confidence in supporting women. 2. Women ‘sensed’ the lack of confidence of some staff and this caused anxiety i.e. if the combination of staff on a shift had little experience/knowledge. 3. Women recognised that certain occupation groups had more time and experience to support them i.e. nursery nurses on TCW, midwives on NICU. 4. The physical environment was an issue for respondents. For example: a. TCW privacy, or not, when expressing and feeding. b. In NICU screens used for expressing or feeding sometimes caused anxiety given that screens are also used when baby is poorly/undergoing a procedure. 5. In TCW, formula feed was linked to early discharge resulting in some experiencing subtle pressure to formula feed. 6. Community outreach team very supportive to some and women respondents felt they would have benefited from longer support. Six recommendations 1. Training needs to be consistent for all grades of staff and a whole day annually is preferred by healthcare professional respondents. 2. Release from service essential to ensure training is undertaken and given the high priority it deserves. 3. Different coloured screens for expressing/feeding AND for procedures would be beneficial and reduce stress for mothers and significant others. 4. Active recruitment of peer supporters with experience of having a baby in NICU. 5. Ensure continued support from peer supporters when moving from breastfeeding to formula feeding. 6. More information related to equipment available in the community on discharge i.e. hospital grade breast pumps

Force and energy dissipation variations in non-contact atomic force spectroscopy on composite carbon nanotube systems

UHV dynamic force and energy dissipation spectroscopy in non-contact atomic force microscopy were used to probe specific interactions with composite systems formed by encapsulating inorganic compounds inside single-walled carbon nanotubes. It is found that forces due to nano-scale van der Waals interaction can be made to decrease by combining an Ag core and a carbon nanotube shell in the Ag@SWNT system. This specific behaviour was attributed to a significantly different effective dielectric function compared to the individual constituents, evaluated using a simple core-shell optical model. Energy dissipation measurements showed that by filling dissipation increases, explained here by softening of C-C bonds resulting in a more deformable nanotube cage. Thus, filled and unfilled nanotubes can be discriminated based on force and dissipation measurements. These findings have two different implications for potential applications: tuning the effective optical properties and tuning the interaction force for molecular absorption by appropriately choosing the filling with respect to the nanotube.Comment: 22 pages, 6 figure

Patients’ preferred mode of travel to the orthopaedic theatre

AIM: To determine the preferred mode of travel to the operating theatre for elective orthopaedic patients. METHODS: Data was collected prospectively over a 2-wk period at an elective Orthopaedic Treatment Centre. Patients were asked to complete a patient satisfaction questionnaire following their surgery on their experience and subsequent preferred mode of transport to theatre. The data was then recorded in a tabulated format and analysed with percentages. Fisher’s exact test was used to determine if there was any statistical association between patients’ preference to walk and various groups; in-patient or day case procedures, and whether patients were < 60 years or > 60 years of age. RESULTS: Seventy patients (40 females and 30 males) fully completed the questionnaire. In total there were 33 d-cases and 37 in-patients. The spectrum of orthopaedic sub-specialties included was knee (41%), hip (17%), foot and ankle (24%), spine (13%) and upper limb (4%). Patient satisfaction for overall experience of travelling to theatre was either excellent (77%) or good (23%). Following their experience of travelling to theatre, 87% (95%CI: 79%-95%) of the total cohort would have preferred to walk to the operating theatre. There was a statistically significant association (P = 0.003) between patients’ preference to walk and whether they were day-case or in-patients. Similarly, there was a statistically significance association (P = 0.028) between patients’ preference to walk and whether they were < 60 years or > 60 years of age. CONCLUSION: This study confirms the majority of Orthopaedic elective patients would prefer to walk to theatre, when given the choice and if practically possible

Advances in pultiple-pulse radio-frequency-gradient imaging of solids

Magnetic resonance imaging (MRI) has become the premier tool for the non-destructive evaluation of soft tissue in living systems [1]. Established liquid-state MRI strategies are generally found to be inappropriate for the imaging of rigid solids, because the linewidth for nuclear magnetic resonance in solids is orders-of-magnitude larger than in liquids. Methods currently under development for the NMR imaging of solids either involve the use of very large (fringe-field) magnetic field gradients to encode spatial information over very short periods of time [2], or employ multiple-pulse line-narrowing techniques that prolong a solid’s apparent transverse relaxation time [3–7]. In the latter methods, the magnetic field gradients may be much weaker, but must generally be pulsed synchronously with the line-narrowing sequence. The benefits of implementing this are improved sensitivity and spectroscopic resolution