The role and scope of contemporary midwifery practice in Australia: A scoping review of the literature

Problem: Little is known about the breadth of midwifery scope within Australia, and few midwives work to their full scope of practice. Background: Midwives in Australia are educated and professionally accountable to work in partnership with childbearing women and their families, yet they are currently hindered from practicing within their full scope of practice by contextual influences. Aims: To perform a scoping review of the literature to map out the role and scope of contemporary midwifery practice in Australia To identify any key issues that impact upon working within the full scope of midwifery practice in the Australian context Methods: A scoping review of the literature guided by the Arksey and O’Malley’s five-stage methodological framework, and the ‘best fit’ framework synthesis using the Nursing and Midwifery Board of Australia’s Midwifery Standards for Practice. Findings: Key themes that emerged from the review included Partnership with women; The professional role of the midwife; and Contextual influences upon midwifery practice. Discussion: Tensions were identified between the midwifery scope of practice associated with optimal outcomes for women and babies supported by current evidence and the actual role and scope of most midwives employed in models of care in the current Australian public healthcare system. Conclusions: There is a mismatch between the operational parameters for midwifery practice in Australia and the evidence-based models of continuity of midwifery carer that are associated with optimal outcomes for childbearing women and babies and the midwives themselves

Utility of Parental Mediation Model on Youth’s Problematic Online Gaming

The Parental Mediation Model PMM) was initially designed to regulate children’s attitudes towards the traditional media. In the present era, because of prevalent online media there is a need for similar regulative measures. Spending long hours on social media and playing online games increase the risks of exposure to the negative outcomes of online gaming. This paper initially applied the PMM developed by European Kids Online to (i) test the reliability and validity of this model and (ii) identify the effectiveness of this model in controlling problematic online gaming (POG). The data were collected from 592 participants comprising 296 parents and 296 students of four foreign universities, aged 16 to 22 years in Kuala Lumpur (Malaysia). The study found that the modified model of the five-factor PMM (Technical mediation, Monitoring mediation, Restrictive mediation, Active Mediation of Internet Safety, and Active mediation of Internet Use) functions as a predictor for mitigating POG. The findings suggest the existence of a positive relation between ‘monitoring’ and ‘restrictive’ mediation strategies and exposure to POG while Active Mediation of Internet Safety and Active mediation of Internet use were insignificant predictors. Results showed a higher utility of ‘technical’ strategies by the parents led to less POG. The findings of this study do not support the literature suggesting active mediation is more effective for reducing youth’s risky behaviour. Instead, parents need to apply more technical mediations with their children and adolescents’ Internet use to minimize the negative effects of online gaming

Identification of BDNF sensitive electrophysiological markers of synaptic activity and their structural correlates in healthy subjects using a genetic approach utilizing the functional BDNF Val66Met polymorphism

Increasing evidence suggests that synaptic dysfunction is a core pathophysiological hallmark of neurodegenerative disorders. Brain-derived neurotropic factor (BDNF) is key synaptogenic molecule and targeting synaptic repair through modulation of BDNF signalling has been suggested as a potential drug discovery strategy. The development of such “synaptogenic” therapies depend on the availability of BDNF sensitive markers of synaptic function that could be utilized as biomarkers for examining target engagement or drug efficacy in humans. Here we have utilized the BDNF Val66Met genetic polymorphism to examine the effect of the polymorphism and genetic load (i.e. Met allele load) on electrophysiological (EEG) markers of synaptic activity and their structural (MRI) correlates. Sixty healthy adults were prospectively recruited into the three genetic groups (Val/Val, Val/Met, Met/Met). Subjects also underwent fMRI, tDCS/TMS, and cognitive assessments as part of a larger study. Overall, some of the EEG markers of synaptic activity and brain structure measured with MRI were the most sensitive markers of the polymorphism. Met carriers showed decreased oscillatory activity and synchrony in the neural network subserving error-processing, as measured during a flanker task (ERN); and showed increased slow-wave activity during resting. There was no evidence for a Met load effect on the EEG measures and the polymorphism had no effects on MMN and P300. Met carriers also showed reduced grey matter volume in the anterior cingulate and in the (left) prefrontal cortex. Furthermore, anterior cingulate grey matter volume, and oscillatory EEG power during the flanker task predicted subsequent behavioural adaptation, indicating a BDNF dependent link between brain structure, function and behaviour associated with error processing and monitoring. These findings suggest that EEG markers such as ERN and resting EEG could be used as BDNF sensitive functional markers in early clinical development to examine target engagement or drug related efficacy of synaptic repair therapies in humans

Correlations between grey matter and post-error slowing and between grey matter and ERSP.

<p>Panel A: Correlation between anterior cingulate grey matter volume and post-error slowing for met-carriers and Val/Val group. Met/Met subjects are filled dots, Val/Met subjects are empty dots in the Met-carriers plot. Dashed line indicates 95% confidence interval of the linear regression. Panel B: Correlation between error ERSP and post-error slowing, as above.</p

Time-domain ERN results.

<p>Panel A: Waveforms for correct (grey) and error (black) responses (FCz), for each group. Panel B: ERN wave for the three genetic groups. Panel C: Topographic plots of the ERN peak (40–100 ms). Electrode FCz is marked with disk.</p

Anterior cingulate and prefrontal cortex grey matter volumes.

<p>Panel A: Met/Met vs Val/Val contrast. Significant cluster are rendered onto an average brain in MNI standard space. Panel B: Extracted anterior cingulate grey matter volume for each group. Panel C: Extracted prefrontal cortex (left) grey matter volume for each group. Bars represent standard error.</p

Topographic plots of power in the theta frequency band.

<p>Graph represents averaged values for central, frontal, temporal and parieto-occipital regions, per each genetic group. Bars represent standard error. * p&lt;0.05;° p&lt;0.06 according to post-hoc Tukey-Kramer comparisons (Val/Met vs Val/Val).</p

Correlations.

<p>Columns Var1 and Var2 contain the two variables correlated with each other in the given line. First section: Var1 is Post-error slowing. Second section: Var1 is anterior cingulate grey matter volume. R-values and corresponding p-values are reported for the three genetic groups and for the met-carriers combined. Significant correlations are marked with bold italic typesetting.</p><p>°:p&lt;0.06,</p><p>*:p&lt;0.05;</p><p>**p&lt;0.005.</p

Effect sizes.

<p>P-values (log scale) (X-axis) and corresponding effect sizes (Y-axis) for the met-dominant model for every endpoint. Dotted vertical line marks the alpha level (0.05): endpoints falling on the right side are considered to be statistically significant (i.e. p&lt;0.05). (*) indicates significant endpoints after FDR correction (all adjusted p&lt;0.04). Different platforms are marked with different colours, for further details see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0095558#pone-0095558-t002" target="_blank">Table 2</a>. P-value transform: - log10(<i>p</i>).</p