Does interprofessional education improve safety and outcomes for the assessment of fetal welfare?

University of Technology Sydney. Faculty of Health.The New South Wales (NSW) Fetal welfare, Obstetric emergency, Neonatal resuscitation, Training (FONT) program commenced in 2008 when 233 midwives and doctors were trained to teach FONT to all maternity clinicians in 80 maternity services across NSW. FONT aimed to improve knowledge, teamwork, communication and clinical outcomes in fetal welfare assessment and maternity emergency management. This thesis presents an evaluation of the fetal welfare component of the FONT program. Study Aim: To evaluate a range of educational and clinical outcomes before and after the introduction of FONT/IPE. Methods: A pragmatic, mixed methods study design using four quantitative and qualitative studies was used. The studies included: a pre and post knowledge test administered to 233 clinicians who attended the initial FONT/IPE train the trainer program in 2008; a subsequent purposely developed, 34 item, Likert-scaled questionnaire administered to these same trainers, one year later, to evaluate satisfaction and engagement with the ongoing delivery of FONT/IPE; individual, semi-structured and in-depth interviews with a purposive sample of the trainers and maternity service managers, to further explore FONT/IPE engagement and impact; and an evaluation of NSW state-wide, maternal and neonatal clinical outcomes associated with fetal welfare, before and after the implementation of FONT/IPE. The outcomes of the four studies were linked using the six levels of the “Barr/Kirkpatrick Educational Evaluation framework” (Barr et al. 2005). Results: FONT/IPE increased clinicians’ knowledge, skills and confidence in fetal welfare assessment, communication, escalation and advocacy and resulted in improved collegiality and clinical debate amongst most staff. There was evidence of resistance to changing the organisational culture by some senior medical staff with analysis of interviews revealing two major themes of either fear of power loss (on the part of medical staff) or power gained (on the part of midwives) through participation in the program. These themes were interpreted using a framework of professional closure strategies (Witz 1992) and insights provided by the science of neuroleadership. There was an associated significant reduction in neonatal death rates (p=0.038) and a reduction in rates of Hypoxic Ischaemic Encephalopathy (p=0.032) when comparing data from four years before and four years after the implementation of FONT, however the clinical outcomes cannot be viewed as directly arising from the FONT/IPE intervention. Conclusion: FONT/IPE and IPE programs generally, may be further enhanced using a framework of “RESPECT” (Reciprocity, Equality, Status, Patient/Woman, Experience, Connection and Trust) arising from this study, to overcome barriers to success

Diminishing Connections: Nature, the Domestic, and Thingness

In my work I am examining Nature/Culture dualism manifested in contemporary material culture through domestic objects. I\u27m surprised by how many things around me (furniture, textiles, wall coverings, etc.) reference something natural but how there isn\u27t anything one would consider Nature . It is evident that traces of the natural are all around us but it is mediated through man-made things. It is as if Nature has been co-opted, commoditized, and grafted into what defines the domestic realm. I question if artificial and abstracted representations of Nature within the domestic space, manufactured or hand made, have relegated Nature to the level of thingness . I use theory from Jane Bennett and Daniel Miller to illustrate the agency that objects and things hold as well as their ability to influence people. My work combines, conflates, and deconstructs objects and materials from the domestic realm to interrogate their underlying order. I tease apart what is instilled by an object\u27s form, aesthetics, function, as well as spatial and socioeconomic location. As I uncover the internal order of a thing I very quickly disrupt that order as a form of critiquing the system it participates in. That system may be consumer culture, Nature/Culture dualism, subject/object relationships, or issues of the individual versus the social. By teasing apart this combination that exists within an object, my work offers viewers the opportunity to reconsider their position in relation to things as well as to reconsider the terms defining what is natural, cultural, and domestic

Genetically engineered parasites: the solution to designing an effective malaria vaccine?

Genetic engineering provides an ingenious method of attenuating Plasmodium falciparum parasites for next generation vaccines. A novel approach stimulates new optimism in the struggle to eliminate the burden of malaria

Newly Identified Vitamin K-producing Bacteria Isolated from the Neonatal Faecal Flora

Fat-soluble vitamin K is an essential component of the blood clotting process. Menaquinones are the naturally occurring form of vitamin K identified in bacteria. Lipid extracts were made from three bacteria originally isolated from the human neonatal gut and identified as Enterobacter agglomerans, Serratia marcescens and Enterococcus faecium. Following preparative thin layer chromatography (TLC), the lipid extracts were subjected to liquid chromatography-mass spectrometry (LC-MS) analysis. Peak analysis of the LC-MS data showed that the three bacteria produce various forms of menaquinone

Intracortical Microstimulation Maps of Motor, Somatosensory, and Posterior Parietal Cortex in Tree Shrews (Tupaia Belangeri) Reveal Complex Movement Representations

Long-train intracortical microstimulation (LT-ICMS) is a popular method for studying the organization of motor and posterior parietal cortex (PPC) in mammals. In primates, LT-ICMS evokes both multi-joint and multiple body-part movements in primary motor, premotor, and posterior parietal cortex. In rodents LT-ICMS evokes complex movements of a single limb in motor cortex. Unfortunately, very little is known about motor/PPC organization in other mammals. Tree shrews are closely related to both primates and rodents and could provide insights into the evolution of complex movement domains in primates. The present study investigated the extent of cortex in which movements could be evoked with ICMS and the characteristics of movements elicited using both short-train (ST) and LT ICMS in tree shrews. We demonstrate that LT-ICMS and ST-ICMS maps are similar, with the movements elicited with ST-ICMS being truncated versions of those elicited with LT-ICMS. In addition, LT-ICMS evoked complex movements within motor cortex similar to those in rodents. More complex movements involving multiple body parts such as the hand and mouth were also elicited in motor cortex and PPC, as in primates. Our results suggest that complex movement networks present in PPC and motor cortex were present in mammals prior to the emergence of primates

Characterization of the Fatty Acids in the Lipids of Snake Venoms

Biochemistr

Comparing the Gut Flora of Irish Breastfed and Formula-fed Neonates Aged Between Birth and 6 Weeks Old

The exact composition of the complex microsystem that constitutes the gut flora continues to be explored as molecular methodology supplements traditional microbiological studies. The current study reports a random analysis of the faecal flora composition for 31 neonates in the 0–1 day age group, 41 neonates aged 2–5 days and 33 6-week-old neonates. All infants, born at the National Maternity Hospital, Ireland, were considered healthy, full-term normal deliveries and were either exclusively breastfed or formula-fed from birth. Microbiological and biochemical analyses of the faecal samples were used to specifically enumerate Lactobacillus spp., Bifidobacterium spp., Enterococcus spp., Staphylococcus spp., Bacteroides spp., Clostridium spp. and coliforms present in the gut. The results were analysed for the presence, prevalence and dominance of each of the species. In general, there were no major statistical variations in the findings for the two feeding regimes. However, Escherichia coli was found to be more dominant (p=0.042) in the gut flora of 6-week-old formula-fed neonates, while there was a tendency for Bifidobacterium spp. to be more prevalent in the gut flora of breastfed neonates at 2–5 days (p=0.108)