Barriers and facilitators to uptake and retention of inner-city ethnically diverse women in a postnatal weight management intervention: a mixed-methods process evaluation within a feasibility trial in England.

OBJECTIVES: To understand the barriers and facilitators to uptake and retention of postnatal women randomised to a commercial group weight management intervention using the COM-B (capability, opportunity, motivation and behaviour) behaviour change model. DESIGN: Concurrent mixed-methods (qualitative dominant) process evaluation nested within a feasibility randomised controlled trial, comprising questionnaires and interviews at 6 and 12 months postbirth. SETTING: One National Health Service maternity unit in an inner city area in the south of England. PARTICIPANTS: 98 postnatal women with body mass indices>25 kg/m2 (overweight/obese) at pregnancy commencement. INTERVENTION: Twelve-week Slimming World (SW) commercial group weight management programme, commencing anytime from 8 to 16 weeks postnatally. PRIMARY AND SECONDARY OUTCOME MEASURES: Data regarding uptake and retention from questionnaires and interviews conducted 6 and 12 months postbirth analysed thematically and mapped to the COM-B model. RESULTS: Barriers to SW uptake mostly concerned opportunity issues (eg, lack of time or childcare support) though some women also lacked motivation, not feeling that weight reduction was a priority, and a few cited capability issues such as lacking confidence. Weight loss aspirations were also a key factor explaining retention, as were social opportunity issues, particularly in relation to factors such as the extent of group identity and relationship with the group consultant; and physical opportunity such as perceived support from and fit with family lifestyle. In addition, barriers relating to beliefs and expectations about the SW programme were identified, including concerns regarding compatibility with breastfeeding and importance of exercise. Women's understanding of the SW approach, and capability to implement into their lifestyles, appeared related to level of attendance (dose-response effect). CONCLUSIONS: Uptake and retention in commercial weight management programmes may be enhanced by applying behaviour change techniques to address the barriers impacting on women's perceived capability, motivation and opportunity to participate. TRIAL REGISTRATION NUMBER: ISRCTN39186148

Crystal growth furnace safety system validation

The findings are reported regarding the safe operation of the NASA crystal growth furnace (CGF) and potential methods for detecting containment failures of the furnace. The main conclusions are summarized by ampoule leak detection, cartridge leak detection, and detection of hazardous species in the experiment apparatus container (EAC)

Digital tools for direct assessment of autism risk during early childhood: A systematic review

Current challenges in early identification of autism spectrum disorder lead to significant delays in starting interventions, thereby compromising outcomes. Digital tools can potentially address this barrier as they are accessible, can measure autism-relevant phenotypes and can be administered in children’s natural environments by non-specialists. The purpose of this systematic review is to identify and characterise potentially scalable digital tools for direct assessment of autism spectrum disorder risk in early childhood. In total, 51,953 titles, 6884 abstracts and 567 full-text articles from four databases were screened using predefined criteria. Of these, 38 met inclusion criteria. Tasks are presented on both portable and non-portable technologies, typically by researchers in laboratory or clinic settings. Gamified tasks, virtual-reality platforms and automated analysis of video or audio recordings of children’s behaviours and speech are used to assess autism spectrum disorder risk. Tasks tapping social communication/interaction and motor domains most reliably discriminate between autism spectrum disorder and typically developing groups. Digital tools employing objective data collection and analysis methods hold immense potential for early identification of autism spectrum disorder risk. Next steps should be to further validate these tools, evaluate their generalisability outside laboratory or clinic settings, and standardise derived measures across tasks. Furthermore, stakeholders from underserved communities should be involved in the research and development process

Labour market experiences of young UK Bangladeshi men: Identity, inclusion and exclusion in inner-city London

Detailed qualitative data are used to explore the processes perpetuatinglabour market disadvantage among young UK-Bangladeshi men living in central London. Strong forces of inclusion within the Bangladeshi community are found to interact with forces of exclusion from ‘mainstream’ society to constrain aspirations and limit opportunities. Though diverse forms of young Bangladeshi masculinity are found, a common pattern is heavy dependency on intra-ethnic networks. Negative experiences of and isolation from ‘mainstream’ society further reinforce reliance on ‘our own people’. However, acute ambivalence towards belonging to a dense Bangladeshi community exists, exemplified in the widespread denigration of the restaurant trade. Many respondents express the desire to ‘break out’ and access new experiences. The findings support current policy emphasis on ‘connecting people to work’ but highlight the more fundamental need to connect people across ethnic boundaries. The paper urges researchers to ‘unpack’ ethnicity to consider carefully what ethnic identity implies in terms of access to resources and opportunities for different individuals in different contexts in order better to understand the diversity of labour market outcomes and the persistence of disadvantage

Exploring the psychological rewards of a familiar semirural landscape: connecting to local nature through a mindful approach

This study analyses a 53,000 word diary of a year engaging with nature through over 200 trips to a semi-rural landscape. Thematic analysis revealed two themes; the transition from observer to nature connectedness and the ways in which the natural environment was experienced once a connection was made. These themes are discussed in relation to theories that seek to explain the positive effect of nature and nature connectedness. The findings are important as they suggest that repeated engagement with local semi-rural countryside can lead to a mindful approach and psychological rewards that do not require travel into the wilderness. The work informs further research into outcomes and processes of nature based interventions such as: trip frequency, duration and diary keeping

Uninterested youth? Young people's attitudes towards party politics in Britain

Following the outcome of the 2001 and 2005 General Elections, when the numbers of abstainers outweighed the numbers of Labour voters on both occasions, much attention has focused upon the state of British democracy and how to enthuse the electorate, especially young people. While the government is exploring ways to make the whole process of voting easier, it may be failing to tackle the real problem - that youth appear to find the business of politics uninviting and irrelevant. This paper examines data derived from a nationwide survey of over 700 young people in order to shed light on what lies at the heart of young people's apparent disengagement from formal politics in Britain - political apathy or a sense of political alienation. The findings reveal that they support the democratic process, but are sceptical of the way the British political system is organised and led, and are turned off by politicians and the political parties. However, there is no uniform youth orientation to politics, and the data indicate that views differ according to social class, educational history, and also gender. However both ethnicity and region of the country in which young people live seem to have little influence in structuring political attitudes and behaviour

Pharmacokinetics-pharmacodynamics of tazobactam in combination with cefepime in an in vitro infection model

We previously demonstrated that for tazobactam administered in combination with ceftolozane, the pharmacokinetic-pharmacodynamic (PK-PD) index that best described tazobactam efficacy was the percentage of the dosing interval that tazobactam concentrations were above a threshold (%T>threshold). Using data from studies of Enterobacteriaceae-producing ESBL, a relationship between tazobactam %T>threshold and reduction in log10 CFU from baseline, for which tazobactam threshold concentration was the product of the isolate's ceftolozane-tazobactam MIC value and 0.5, was identified. However, since the kinetics of cephalosporin hydrolysis vary among ESBLs and compounds, it is likely that the translational relationship to derive the tazobactam threshold concentration varies among enzymes and compounds. Using a one-compartment in vitro infection model, the PK-PD of tazobactam administered in combination with cefepime was characterized and a translational relationship across ESBL-producing Enterobacteriaceae was developed. Four clinical isolates, two Escherichia coli and two Klebsiella pneumoniae, known to produce CTX-M-15 β-lactamase enzymes and displaying cefepime MIC values of 2 to 4 mg/L in the presence of 4 mg/L tazobactam, were evaluated. Tazobactam threshold concentrations from 0.0625-1 times the tazobactam-potentiated cefepime MIC value were considered. The threshold that best described the relationship between tazobactam %T>threshold and change in log10 CFU from baseline was the product of 0.125 and the cefepime-tazobactam MIC (R2=0.813). The magnitude of %T>threshold associated with net bacterial stasis and a 1-log10 CFU/mL reduction from baseline at 24 hours was 21.9 and 52.8%, respectively. These data will be useful to support the identification of tazobactam dosing regimens in combination with cefepime for evaluation in future clinical studies

Exploratory investigation of drivers of attainment in ethnic minority adult learners

There is evidence that ethnic minority learners in further education in England either under-achieve or are under-represented because they face various inhibitors connected to their ethnicity. Motivators may be in place, however, which increase attainment specifically for some ethnic groups. This exploratory study intends to examine what works and what does not among South Asian (Pakistani and Bangladeshi heritage) females and black male adult learners in FE. A mixed-method study was carried out using questionnaires and focus groups with 68 ethnic minority students in three further education colleges in England. The combination of the results showed that being a member of a minority culture and/or religion may increase feelings of isolation in academic settings; teaching staff who are knowledgeable about the student’s culture increase feelings of inclusion; and role models are crucially important. Results are discussed in light of British data of school experiences of ethnic minority learners

Polarization of coalitions in an agent-based model of political discourse

Political discourse is the verbal interaction between political actors in a policy domain. This article explains the formation of polarized advocacy or discourse coalitions in this complex phenomenon by presenting a dynamic, stochastic, and discrete agent-based model based on graph theory and local optimization. In a series of thought experiments, actors compute their utility of contributing a specific statement to the discourse by following ideological criteria, preferential attachment, agenda-setting strategies, governmental coherence, or other mechanisms. The evolving macro-level discourse is represented as a dynamic network and evaluated against arguments from the literature on the policy process. A simple combination of four theoretical mechanisms is already able to produce artificial policy debates with theoretically plausible properties. Any sufficiently realistic configuration must entail innovative and path-dependent elements as well as a blend of exogenous preferences and endogenous opinion formation mechanisms

A qualitative study of the experiences and expectations of women receiving in-patient postnatal care in one English maternity unit

Background Studies consistently highlight in-patient postnatal care as the area of maternity care women are least satisfied with. As part of a quality improvement study to promote a continuum of care from the birthing room to discharge home from hospital, we explored women’s expectations and experiences of current inpatient care. Methods For this part of the study, qualitative data from semi-structured interviews were transcribed and analysed using content analyses to identify issues and concepts. Women were recruited from two postnatal wards in one large maternity unit in the South of England, with around 6,000 births a year. Results Twenty women, who had a vaginal or caesarean birth, were interviewed on the postnatal ward. Identified themes included; the impact of the ward environment; the impact of the attitude of staff; quality and level of support for breastfeeding; unmet information needs; and women’s low expectations of hospital based postnatal care. Findings informed revision to the content and planning of in-patient postnatal care, results of which will be reported elsewhere. Conclusions Women’s responses highlighted several areas where changes could be implemented. Staff should be aware that how they inter-act with women could make a difference to care as a positive or negative experience. The lack of support and inconsistent advice on breastfeeding highlights that units need to consider how individual staff communicate information to women. Units need to address how and when information on practical aspects of infant care is provided if women and their partners are to feel confident on the woman’s transfer home from hospital