An analysis of media reporting on the closure of freestanding midwifery units in England

PROBLEM: Despite clinical guidelines and policy promoting choice of place of birth, 14 Freestanding Midwifery Units were closed between 2008 and 2015, closures justified by low use and financial constraints. BACKGROUND: The Birthplace in England Programme found that freestanding midwifery units provided the most cost-effective birthplace for women at low risk of complications. Women planning birth in a freestanding unit were less likely to experience interventions than those planning obstetric unit birth, with no difference in outcomes for babies. METHODS: This paper uses an interpretative technique developed for policy analysis to explore the representation of these closures in 191 news articles, to explore the public climate in which they occurred. FINDINGS AND DISCUSSION: The articles focussed on underuse by women and financial constraints on services. Despite the inclusion of service user voices, the power of framing was held by service managers and commissioners. The analysis exposed how neoliberalist and austerity policies has privileged representation of individual consumer choice and market-driven provision as drivers of changes in health services. This normative framing makes the reasons given for closure as hard to refute and cultural norms persist that birth is safest in an obstetric setting, despite evidence to the contrary. CONCLUSION: The rise of neoliberalism and austerity in contemporary Britain has influenced the reform of maternity services, in particular the closure of midwifery units. Justifications given for closure silence other narratives, predominantly from service users, that attempt to present women's choice in terms of rights and a social model of care

Critical realism, agency and sickle cell: case studies of young people with sickle cell disorder at school

Critical realism suggests that historical structures may operate as underlying generative mechanisms but not always be activated. This explains the near-absence of references to racism by black students with sickle cell disorder (SCD). Through case studies we show how latent mechanisms are not activated, and how social actors come to develop corporate agency. Themes discussed include: wider/historical racisms (carers' own experiences of overt racism at school); conscious actions (moving away from a school where racism was experienced); naming racism as an emergent strategy (when communal discussions enable multiple negative experiences to be framed and named as racism); and `passing` (not ostensibly experiencing racism if one is sufficiently light-skinned). Critical realism suggests how racism may be structuring the experiences of students with SCD at school even in the absence of specific accounts by young people

Factors influencing utilisation of ‘free-standing’ and ‘alongside’ midwifery units for low-risk births in England: a mixed-methods study

Background Midwifery-led units (MUs) are recommended for ‘low-risk’ births by the National Institute for Health and Care Excellence but according to the National Audit Office were not available in one-quarter of trusts in England in 2013 and, when available, were used by only a minority of the low-risk women for whom they should be suitable. This study explores why. Objectives To map the provision of MUs in England and explore barriers to and facilitators of their development and use; and to ascertain stakeholder views of interventions to address these barriers and facilitators. Design Mixed methods – first, MU access and utilisation across England was mapped; second, local media coverage of the closure of free-standing midwifery units (FMUs) were analysed; third, case studies were undertaken in six sites to explore the barriers and facilitators that have an impact on the development of MUs; and, fourth, by convening a stakeholder workshop, interventions to address the barriers and facilitators were discussed. Setting English NHS maternity services. Participants All trusts with maternity services. Interventions Establishing MUs. Main outcome measures Numbers and types of MUs and utilisation of MUs. Results Births in MUs across England have nearly tripled since 2011, to 15% of all births. However, this increase has occurred almost exclusively in alongside units, numbers of which have doubled. Births in FMUs have stayed the same and these units are more susceptible to closure. One-quarter of trusts in England have no MUs; in those that do, nearly all MUs are underutilised. The study findings indicate that most trust managers, senior midwifery managers and obstetricians do not regard their MU provision as being as important as their obstetric-led unit provision and therefore it does not get embedded as an equal and parallel component in the trust’s overall maternity package of care. The analysis illuminates how provision and utilisation are influenced by a complex range of factors, including the medicalisation of childbirth, financial constraints and institutional norms protecting the status quo. Limitations When undertaking the case studies, we were unable to achieve representativeness across social class in the women’s focus groups and struggled to recruit finance directors for individual interviews. This may affect the transferability of our findings. Conclusions Although there has been an increase in the numbers and utilisation of MUs since 2011, significant obstacles remain to MUs reaching their full potential, especially FMUs. This includes the capacity and willingness of providers to address women’s information needs. If these remain unaddressed at commissioner and provider level, childbearing women’s access to MUs will continue to be restricted. Future work Work is needed on optimum approaches to improve decision-makers’ understanding and use of clinical and economic evidence in service design. Increasing women’s access to information about MUs requires further studies of professionals’ understanding and communication of evidence. The role of FMUs in the context of rural populations needs further evaluation to take into account user and community impact. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 12. See the NIHR Journals Library website for further project information

Turbine Electrified Energy Management (TEEM) For Enabling More Efficient Engine Designs

NASA is investing in Electrified Aircraft Propulsion (EAP) research as part of an effort to assist industry in meeting the future needs of a global aviation market. The integration of electric machines into traditional turbine-based propulsion provides opportunities to change system architectures effecting radical improvements in propulsive efficiency. However, less consideration has been afforded to the utilization of these electrical machines to improve the thermal efficiency and performance of the gas turbine engine. Noting this deficit, a novel operability concept is proposed and is referred to as Turbine Electrified Energy Management (TEEM). The concept is a transient control technology that supplements the main fuel control for the suppression of the natural off-design dynamics associated with changes in engine operating state. Here the electric machines, used as engine actuators during the transient, add or extract torque from the engine shafts to maintain the speed-flow characteristics of steady-state design operation. This greatly reduces the need to maintain transient stall margin stack in the compressors, among other potential benefits. This paper demonstrates the feasibility of the concept in dynamic simulation using a Numerical Propulsion System Simulation (NPSS) engine model of a NASA hybrid electric propulsion concept known as the Parallel Hybrid Electric Turbofan (hFan)

Development of a Temperature Sensor for Jet Engine and Space Mission Applications

Electronics for Distributed Turbine Engine Control and Space Exploration Missions are expected to encounter extreme temperatures and wide thermal swings. In particular, circuits deployed in a jet engine compartment are likely to be exposed to temperatures well exceeding 150 C. To meet this requirement, efforts exist at the NASA Glenn Research Center (GRC), in support of the Fundamental Aeronautics Program/Subsonic Fixed Wing Project, to develop temperature sensors geared for use in high temperature environments. The sensor and associated circuitry need to be located in the engine compartment under distributed control architecture to simplify system design, improve reliability, and ease signal multiplexing. Several circuits were designed using commercial-off-the-shelf as well as newly-developed components to perform temperature sensing at high temperatures. The temperature-sensing circuits will be described along with the results pertaining to their performance under extreme temperature

Factors influencing the utilisation of free-standing and alongside midwifery units in England: a qualitative research study

OBJECTIVE: To identify factors influencing the provision, utilisation and sustainability of midwifery units (MUs) in England. DESIGN: Case studies, using individual interviews and focus groups, in six National Health Service (NHS) Trust maternity services in England. SETTING AND PARTICIPANTS: NHS maternity services in different geographical areas of England Maternity care staff and service users from six NHS Trusts: two Trusts where more than 20% of all women gave birth in MUs, two Trusts where less than 10% of all women gave birth in MUs and two Trusts without MUs. Obstetric, midwifery and neonatal clinical leaders, managers, service user representatives and commissioners were individually interviewed (n=57). Twenty-six focus groups were undertaken with midwives (n=60) and service users (n=52). MAIN OUTCOME MEASURES: Factors influencing MU use. FINDINGS: The study findings identify several barriers to the uptake of MUs. Within a context of a history of obstetric-led provision and lack of decision-maker awareness of the clinical and economic evidence, most Trust managers and clinicians do not regard their MU provision as being as important as their obstetric unit (OU) provision. Therefore, it does not get embedded as an equal and parallel component in the Trust's overall maternity package of care. The analysis illuminates how implementation of complex interventions in health services is influenced by a range of factors including the medicalisation of childbirth, perceived financial constraints, adequate leadership and institutional norms protecting the status quo. CONCLUSIONS: There are significant obstacles to MUs reaching their full potential, especially free-standing midwifery units. These include the lack of commitment by providers to embed MUs as an essential service provision alongside their OUs, an absence of leadership to drive through these changes and the capacity and willingness of providers to address women's information needs. If these remain unaddressed, childbearing women's access to MUs will continue to be restricted

Development of a Temperature Sensor for Jet Engine and Space Missions Environments

Electronic systems in aerospace and in space exploration missions are expected to encounter extreme temperatures and wide thermal swings. To address the needs for extreme temperature electronics, research efforts exist at the NASA Glenn Research Center (GRC) to develop and evaluate electronics for extreme temperature operations, and to establish their reliability under extreme temperature operation and thermal cycling; conditions that are typical of both the aerospace and space environments. These efforts are supported by the NASA Fundamental Aeronautics/Subsonic Fixed Wing Program and by the NASA Electronic Parts and Packaging (NEPP) Program. This work reports on the results obtained on the development of a temperature sensor geared for use in harsh environments