The development of a neonatal vital signs database

Modern intelligent monitoring systems use digital computer technology to analyze and evaluate physiological vital signs. This analytical and evaluative process is performed by algorithms developed for this purpose. The degree of 'intelligence' of the monitoring system is dependent on the 'sensitivity' and 'specificity' of these algorithms. In order to develop robust and clinically valid algorithms, a database of representative waveforms is required. The aim of this thesis was to create a neonatal vital signs database to be used for this purpose, by means of a computer-based central station. The computer was interfaced to a number of neonatal monitors (Neonatal ICU, Groote Schuur Hospital). The monitors were interrogated to obtain patient condition, ECG waveforms and respiration waveforms using the impedance technique. When possible, percentage oxygen saturation was also captured. The database contains 509 documented clinical records obtained from 35 patients and 20 records containing examples of technical alarm conditions and high frequency noise. Additional patient record data is included. Clinical events recorded include apnoea, bradycardia, periodic breathing tachycardia, tachypnoea and normal traces. These events were recorded against a variety of signal quality conditions that have been characterized in Appendix C. A prototype rate detection algorithm was checked using samples from the database

Smoking and looked-after children: a mixed-methods study of policy, practice, and perceptions relating to tobacco use in residential units

Despite the implementation of smoke-free policies by local authorities and a statutory requirement to promote the health and well-being of looked-after children and young people in England, rates of tobacco use by this population are substantially higher than in the general youth population. A mixed-methods study, comprising a survey of residential care officers in 15 local authority-operated residential units and semi-structured, face-to-face interviews with residential carers in three local authority-operated residential units, was conducted in the East Midlands. Survey data were descriptively analysed; and interview data were transcribed and analysed using thematic framework analysis. Forty-two care officers (18% response rate) completed the survey, and 14 participated in the interviews. Despite reporting substantial awareness of smoke-free policies, a lack of adherence and enforcement became apparent, and levels of reported training in relation to smoking and smoking cessation were low (21%). Potential problems relating to wider tobacco-related harms, such as exploitative relationships; a reliance on tacit knowledge; and pessimistic attitudes towards LAC quitting smoking, were indicated. The findings highlight the need for the development of comprehensive strategies to promote adherence to and enforcement of local smoke-free policy within residential units for looked-after children and young people, and to ensure appropriate support pathways are in place for this population

Black girls navigate the physical and emotional landscape of the neighbourhood: Normalized violence and strategic agency

This article considers how young Black women living in gang-affected neighbourhoods in an urban area in England, UK navigate their safety in public and private spaces, and how these spaces overlap and intersect. Drawing on a project with 18 participants aged 14–19, the research seeks to understand how the participants inhabit, navigate and strategize for their safety through their narratives of life and survival in an unsafe neighbourhood. Findings indicate that they experience sexual harassment in public spaces and gang-associated sexual and physical violence as common, accepted aspects of their everyday realities, from as young as 12. The narratives suggest that participants navigate complex friendship groups to protect each other and their families through tight codes of trust, secrecy, privacy and conflict-management strategies. This article seeks to bring attention to how young women utilize their agency to illuminate the coping strategies they draw on to navigate their physical environments. The article concludes with a discussion of the implications for interventions

Trust and Distrust: Listening to Children about Their Relationships with Professionals

This article explores trust in children’s relationships with professionals in the context of safeguarding concerns. With exception, existing research with children about trust in professionals often fails to unpick trust. Using sociological conceptualisations of trust, most often considered in relation to adults, this article unravels this complex concept. It arrives at a conception of trust as socially situated, an attribute of relationships, and a combination of interpretation (knowledge and experience) and faith. This conceptualization of trust is examined in the context of interview accounts from children that were aged 8–10 in an English primary school. Interviews invited their perspectives on three fictional vignettes about peer conflict, domestic abuse, and child sexual abuse. My analysis, although small-scale, argues that focusing on the process of trust in children’s professional relationships and the social, cultural, political, and relational contexts that shape this process, is a lucrative way to gain enhanced understandings of how trust is generated and what facilitates and undermines trust. It sheds light on children’s interpretations of existing relationships and imagined interactions with professionals, revealing the knowledge that they hold and what they do not yet, or cannot know, and how this knowledge (or lack of) influences their trust. This analysis is socially situated attending to children’s biographies, which offers insights that provide good grounds for improving children’s relationships with professionals

Enablers of help-seeking for deaf and disabled children following abuse and barriers to protection: a qualitative study

Research internationally has highlighted the increased vulnerability of deaf or disabled children to abuse and the frequently inadequate response of services. However, first-hand accounts of deaf or disabled children have rarely been sought. This paper reports selected findings from one of the first studies exploring deaf and disabled children’s experiences of help-seeking following maltreatment. Innovative and sensitive research methods were employed to support ten deaf or disabled people (children and adults) to take part in guided conversations. The study identifies three enablers of help-seeking of deaf or disabled children: the capacity of adults to detect abuse and respond to disclosures, supportive relationships or circumstances which facilitate disclosure; and, for Deaf children, access to registered interpreters. Barriers to protection related to these are also discussed. Recommendations directed at policy makers, practitioners and families include: education and awareness raising amongst practitioners, children, parents and carers; addressing deaf and disabled children’s social isolation; providing comprehensive support services that address the needs of the child holistically; ensuring the voice of the child is heard; routine access to registered interpreters for Deaf children within mainstream and specialist services and measures to address disablism at a local and institutional level