Providing Maternity Care to the Underserved: A Comparative Case Study of Three Maternity Care Models Serving Women in Washington, D.C.

Compares the content and structure of maternity care provided at a city birth center, a safety net clinic, and a not-for-profit teaching and research hospital; populations served; providers; costs; and the women's and providers' perceptions of each model

Constructing and Deconstructing \u27Victory, 1918\u27 at the Canadian War Museum

This article explores the history behind the creation of the Canadian War Museum’s exhibition, Victory, 1918: The Last Hundred Days. The exhibition presented the story of the Canadian Corps during the Hundred Days campaign of the First World War and the Canadian contributions to Allied victory. What follows is a glimpse into the challenges of exhibition development. Together, artifacts, personal stories, films, works of art, immersive spaces, reconstructions and colourized historical photographs created an engaging visitor experience while communicating key concepts about the Hundred Days. Cet article explore l’histoire de la création de l’exposition Victoire 1918: Les cent derniers jours du Musée canadien de la guerre. L’exposition présentait l’histoire du Corps canadien lors de la campagne des Cent Jours de la Première Guerre mondiale et les contributions canadiennes à la victoire des Alliés. Voici donc un aperçu des défis liés au développement de l’exposition. Grâce aux objets, histoires personnelles, films, oeuvres d’art, espaces immersifs, reconstructions et des photographies historiques colorisées, l’exposition permet aux visiteurs de vivre une expérience captivante tout en leur expliquant les concepts clés des Cent Jours

Limit to the ultra-high energy gamma-ray flux using data from the surface detectors of the Pierre Augar observatory

Cosmic-rays are highly energetic particles originating from outer space. Ultrahigh energy cosmic-rays (UHECRs) are defined as those above 10^18 eV. The Pierre Auger Observatory is a hybrid detector comprising a surface array of over 1660 water-Cherenkov detectors and 27 nitrogen-fluorescence detectors, the data from which can be studied separately or combined in hybrid mode. Data-taking began in 2004, with construction of the array completed in 2008. The mass-composition of UHECR, in particular the flux of photons, is currently unknown. UHECR photons are expected from the interaction of protons with energies greater than ∼ 3×10^19 eV with the cosmic microwave background. Previous limits on the fraction of UHECR photons from surface array data are of the order of a few % above 10^19 eV. Surface array data have been used to update and improve a mass-sensitive shower-timing parameter, (Δ), derived from the signal risetimes of individual detectors. A complete overhaul of this method has been performed, providing a more robust parameter sensitive to the mass-composition of UHECR. The change of (Δ) with energy has been investigated and a correlation between (Δ) and another mass-sensitive parameter - the depth of maximum, Xmax, has been found. A study of the mass-sensitivity of (Δ) has been made by comparison to photon and hadronic simulations. From this comparison it is found that the composition of UHECRs, on average, tends towards heavier primaries with increasing energy. Ten events have been identified as potential photon-initiated air showers. Conservative integral upper limits to the flux of UHE photons have been computed at 8.7 × 10^−3, 4.7 × 10^−3, 2.8 × 10^−3 and 2.3 × 10^−3 km^−2 sr^−1 yr^−1 above 10, 20, 30 and 40EeV respectively. Integral upper limits to the fraction of photons have also been found at 1.5%, 3.2%, 4.9% and 9.1% above these energies. These new limits improve upon previous works and exclude all ‘top-down’ models for photonproduction except the Z-burst model, which is strongly disfavoured. These limits do not yet probe the GZK region. The arrival directions of these photon-candidates have been compared to the positions of nearby AGN from the VCV and Swift-BAT catalogues. No obvious sources have been found for these events and none of the photon-candidate arrival directions lie close to Cen A. The differences between those events above 5 × 10^19 eV that correlate with AGN from the VCV catalogue, or originate from within 18◦ angular separation of Centaurus A, to those that do not, have been studied using the (Δ) parameter. No significant differences in their average (Δ) have been found, nor is a systematic change in (Δ) observed as a function of angular distance from Cen A. Finally, the azimuthal asymmetry on the risetimes has been reviewed as a potential mass-sensitive parameter in relation to previous works. A possible alternative method for determining the dependence of the asymmetry on the energy has been explored with limited success. This new method is in the early stages of development and further study is required

Top-down modulation of the perception of other people in schizophrenia and autism

Accurately and efficiently perceiving social cues such as body movements and facial expressions is important in social interaction. Accurate social perception of this kind does not solely rely on “bottom-up” visual processing but is also subject to modulation by “top-down” signals. For example, if instructed to look for signs of happiness rather than fear, participants are more likely to categorize facial expressions as happy—this prior expectation biases subsequent perception. Top-down modulation is also important in our reactions to others. For example, top-down control over imitation plays an important role in the development of smooth and harmonious social interactions. This paper highlights the importance of top-down modulation in our perception of, and reactions to, others. We discuss evidence that top-down modulation of social perception and imitation is atypical in Autism Spectrum Conditions and in schizophrenia, and we consider the effect this may have on the development of social interactions for individuals with these developmental disorders

Clinical trial metadata:Defining and extracting metadata on the design, conduct, results and costs of 125 randomised clinical trials funded by the National Institute for Health Research Health Technology Assessment programme

Background:  By 2011, the Health Technology Assessment (HTA) programme had published the results of over 100 trials with another 220 in progress. The aim of the project was to develop and pilot ‘metadata’ on clinical trials funded by the HTA programme.   Objectives: The aim of the project was to develop and pilot questions describing clinical trials funded by the HTA programme in terms of it meeting the needs of the NHS with scientifically robust studies. The objectives were to develop relevant classification systems and definitions for use in answering relevant questions and to assess their utility.   Data sources: Published monographs and internal HTA documents.   Review methods: A database was developed, ‘populated’ using retrospective data and used to answer questions under six prespecified themes. Questions were screened for feasibility in terms of data availability and/or ease of extraction. Answers were assessed by the authors in terms of completeness, success of the classification system used and resources required. Each question was scored to be retained, amended or dropped.    Results: One hundred and twenty-five randomised trials were included in the database from 109 monographs. Neither the International Standard Randomised Controlled Trial Number nor the term ‘randomised trial’ in the title proved a reliable way of identifying randomised trials. Only limited data were available on how the trials aimed to meet the needs of the NHS. Most trials were shown to follow their protocols but updates were often necessary as hardly any trials recruited as planned. Details were often lacking on planned statistical analyses, but we did not have access to the relevant statistical plans. Almost all the trials reported on cost-effectiveness, often in terms of both the primary outcome and quality-adjusted life-years. The cost of trials was shown to depend on the number of centres and the duration of the trial. Of the 78 questions explored, 61 were well answered, 33 fully with 28 requiring amendment were the analysis updated. The other 17 could not be answered with readily available data.   Limitations: The study was limited by being confined to 125 randomised trials by one funder.   Conclusions: Metadata on randomised controlled trials can be expanded to include aspects of design, performance, results and costs. The HTA programme should continue and extend the work reported here

Securing medical devices Part A : what's available for endotracheal tubes?

Oral endotracheal tubes (ETTs) and nasogastric tubes (NGT) are common devices used in adult intensive care and numerous options exist for safe and comfortable securement of these devices. The aim of this project was to identify the available range of ETT and NGT securement devices in Australia as a resource for clinicians seeking to explore options for tube stabilisation. This article reports part A of this project: ETT securement options. Part B will report NGT device fixation options. Securing ETTs to ensure a patent airway with minimal ETT movement, promotion of patient comfort and absence of adverse events such as ETT dislodgement, unplanned extubation and device-related injury1, are essential critical care nursing actions. The ETT requires a fixation method that is robust yet does not traumatise or injure the mucosal tissues of the mouth and soft tissue of the lips.2,3 Choice of a securement apparatus is often determined by product availability in our units or hospitals but is also driven by evidence-based practice and clinician preference. Trying to put this information together can be difficult and time-consuming for the bedside clinician..

‘Repeat abortion’, a phrase to be avoided? Qualitative insights into labelling and stigma

Background In recent years there has been growing international interest in identifying risk factors associated with ‘repeat abortion’, and developing public health initiatives that might reduce the rate. This article draws on a research study looking at young women's abortion experience in England and Wales. The study was commissioned with a specific focus on women who had undergone more than one abortion. We examine what may influence women's post-abortion reproductive behaviour, in addition to exploring abortion-related stigma, in the light of participants' own narratives. Study design Mixed-methods research study: a quantitative survey of 430 women aged 16–24 years, and in-depth qualitative interviews with 36 women who had undergone one or more abortions. This article focuses on the qualitative data from two subsets of young women: those we interviewed twice (n=17) and those who had experienced more than one unintended/unwanted pregnancy (n=15). Results The qualitative research findings demonstrate the complexity of women's contraceptive histories and reproductive lives, and thus the inherent difficulty of establishing causal patterns for more than one abortion, beyond the obvious observation that contraception was not used, or not used effectively. Women who had experienced more than one abortion did, however, express intensified abortion shame. Conclusions This article argues that categorising women who have an abortion in different ways depending on previous episodes is not helpful. It may also be damaging, and generate increased stigma, for women who have more than one abortion

The team as a secure base revisited: Remote working and resilience among child and family social workers during COVID-19

Purpose: Social work teams can provide a secure base for social workers, supporting them to manage the emotional demands of child and family social work (Biggart et al., 2017). As the COVID-19 pandemic has necessitated increased remote working, social workers have needed to maximise their use of virtual networks and navigate new ways of connecting with colleagues. This study aims to examine the extent to which social work teams can function as a secure base in the context of remote working. Design/methodology/approach: Between 19th March and 13th June, the authors undertook 31 in-depth, qualitative interviews with child and family social workers across 9 local authorities in England. this research captured social workers’ perspectives on remote working and team support throughout lockdown in England. Findings: In this study, the authors report findings in three key areas: how social workers experienced the sudden shift to increased remote working; how social work teams provided a secure base for remote working; and the challenges for sustaining the team as a secure base when working remotely. Originality/value: These findings will be of interest to social workers, managers and local authorities as they adapt to the challenges of increased remote working in child and family social work