Wound care and pressure ulceration in midwifery: a neglected area?

Wound care and pressure ulceration in midwifery are important and neglected areas within the profession where much work needs to be done, both clinically and educationally. Indeed, the National Patient Safety Agency (NPSA) has announced plans to work with the NHS to reduce levels of harm in ten high risk areas and one of these is ‘reducing avoidable harm in childbirth’ (NPSA, 2010). Although I am now an academic midwife, I still practise as a bank midwife in local NHS birth centres and community midwifery and have a long career history in the NHS. During my career I have seen advice and treatments for wound care in our profession change regularly, and often according to the preferences of the obstetrician and midwife. Pressure ulceration is not a new phenomenon in midwifery, but the need to avoid unnecessary harm to women in childbirth is becoming increasingly important because of advances in pain management and choices now available for women

A Double Agent Down Under: Australian Security and the Infiltration of the Left

Because of its clandestine character, the world of the undercover agent has remained murky. This article attempts to illuminate this shadowy feature of intelligence operations. It examines the activities of one double agent, the Czech-born Maximilian Wechsler, who successfully infiltrated two socialist organizations, in the early 1970s. Wechsler was engaged by the Australian Security Intelligence Organisation. However, he was ‘unreliable’: he came in from the cold and went public. The article uses his exposés to recreate his undercover role. It seeks to throw some light on the recruitment methods of ASIO, on the techniques of infiltration, on the relationship between ASIO and the Liberal Party during a period of political volatility in Australia, and on the contradictory position of the Labor Government towards the security services

Political Activism, Academic Freedom and the Cold War: an American Experience

Professor Lyman Bradley was chairman of the German Department at New York University and an executive member of the Joint Anti-Fascist Refugee Committee, listed by the Attorney General as a subversive organization. In 1951 he was fired and his long academic career ended. His dismissal, the first by the New York University on political grounds, raises broader concerns about the character of university governance and the fragility of academic freedom in the modern age. In most accounts of academic McCarthyism there have been two historiographical tendencies. One emphasises the overwhelming power of institutions that were allied with McCarthyism; such political power rendered impotent any academic resistance. The other argues that academic McCarthyism was only effective because professors were too timid or frightened to act publicly or collectively in defence of academic freedom. This study will demonstrate that neither can solely explain Bradley’s political persecution. The denial of civil liberties and the violation of academic freedom required three interlocking factors: a powerful Congressional Committee, a determined University administration and a complicit academic staff

The Irish soldier in the British army during the Napoleonic Wars, 1808-1815

Consideration by historians of Irish soldiers’ service in the regular British army during the Napoleonic Wars has been primarily through the perspective of the Irish regiments and the Irish enlisted man. This note presents new perspectives by demonstrating that Irish service was more widespread due to the presence of Irish officers and enlisted men across all regiments of the regular army. Important aspects of Irish service such as promotion, discipline, and the presence of Irish families are highlighted with the intention of facilitating a new perspective on the relationship between the regular British army and Irish society

Engaging with clinical supervision in a community midwifery setting : an action research study

The main aim of this research study was to explore midwives' views and experiences of their support needs in clinical practice and then to identify how they would wish to receive such support. There was much literature to support the existence of stress and burnout in midwifery but no research that addressed ways of alleviating this. Further aims were to redress that imbalance by planning and facilitating a model of clinical supervision devised by the participating midwives. The study took an action research approach that involved working with a group of eight National Health Service (NHS) community midwives in a collaborative, non-hierarchical and democratic way in order to achieve change. This accorded with a woman-centred approach to working with clients that was being encouraged within midwifery. The midwives were typical of many community-based midwives in the United Kingdom (UK) who were working in increasingly stressful, complex and changing environments. Wider organisational and cultural issues are considered that affect working relationships. The nature of the way the midwives worked when they were offered and received support, and how they reacted and coped when their work team and work situation was threatened, was also explored. Each midwife was interviewed twice; before and after the experience of clinical supervision. They also participated in two focus groups before clinical supervision. In- depth individual interviews lasted up to two hours, as did the focus groups. The interviews and the focus groups were taped, transcribed and then analysed using a relational voice-centred methodology. The main findings were that recent and ongoing change plus the organisational demands placed on the midwives by the NHS and their managers were detrimental to working relationships with their colleagues and clients. This also inhibited the process of change. A discourse of denigration became apparent within the interviews and the midwives behaviour and coping strategies revealed some well developed defence mechanisms, as well as an apparent lack of understanding on their part and that of their midwifery managers in relation to emotion work. Resistance to change was a key defence mechanism used by the midwives. Strong messages emerge about certain 'performances' being available to midwives and the use of defence mechanisms as a way of 'getting the work done'. There are also messages about the cultural legacy of midwifery and how this can inhibit autonomous behaviour by midwives. Developing and increasing self awareness is still not viewed as being intrinsic to the work of the midwife and midwives are being asked to undertake a level of work that they have not been adequately prepared for. Neither do there appear to be effective role models for midwives. The bureaucratic pressures of working in a large maternity unit are also addressed where the system is seen as more important than the midwives

Investigation of Northeast Extreme Tee (NEXT) D Beam Bridges as an Alternative to Precast Hollow Core Bridges: An Exploration of Appropriate Slab Design Forces

Adjacent precast, prestressed concrete beam bridges have become a popular solution throughout the country because deck forming can be eliminated and construction is rapid. In South Carolina, adjacent beam bridges primarily consist of flat slab or hollow core sections, and they are currently only used on secondary, low-volume, short-span bridges. Durability and load sharing issues stemming from cracking, however, have caused concern with the longevity of these bridge types. Thus, the South Carolina Department of Transportation (SCDOT) has sought an alternative to the flat slab for short span bridges that can be used on high volume roads without an overlay. This research focuses on the selection of the Northeast Extreme Tee (NEXT) D beam as an alternative and later focuses on the deck design for the bridge and appropriate slab design forces for the section. The NEXT D sections designed for larger spans in the Northeast were scaled down since shorter spans were targeted in this project than in the original concept. Preliminary prestressed design was performed to verify the new section geometry. The deck was designed using the American Association of State Highway and Transportation Officials (AASHTO) Load Resistance and Factor Design (LRFD) Specifications assuming the deck functioned as a continuous beam with infinitely rigid supports. A sensitivity study was completed which involved varying the stiffness of the beam webs and the shear keys and studying the resulting shear and moment responses in the deck in order to determine appropriate slab forces for design. The NEXT D section proposed in the Northeast was scaled down to six-feet (NEXT D6) and eight-feet (NEXT D8) wide alternatives, both 20 inches deep, and confirmed to meet AASHTO requirements for flexure and limit stresses for a 40-ft. span bridge. Through the sensitivity study, the AASHTO equivalent strip method was found to be conservative for shear but non-conservative for moment. The design positive moment values calculated using the AASHTO equivalent strip method for a 40-ft. span bridge were found to be on-average 2.51 times less than those determined through the sensitivity study which calculated the web stiffness using classical beam theory. Therefore, in order to be conservative, the stiffness of the beam webs should be determined using classical beam theory, instead of assuming infinite rigidity, when designing the NEXT D slab. The average ratio of positive to negative moment generated in the shear key was found to be approximately 2:1 for the NEXT D6 and 6:1 for the NEXT D8. Therefore, the headed reinforcing bars should be placed one inch below the mid-depth of the shear key in order to optimize the moment capacity of the key by providing more eccentricity for positive moment. In addition, the translational and rotational stiffness of the shear key should be assumed to be fully rigid in order to produce conservative design forces in the key; however further numerical and experimental studies should be performed to determine more appropriate design forces for the shear key

The Influence of Vegetation and Green Spaces on Air Quality and Outdoor Air Temperature Mitigation on Multiple Scales

City cores and urban areas exhibit warmer temperatures than surrounding areas due to the urban heat island (UHI) phenomenon. UHIs are caused by land-use changes, specifically replacing natural land cover with hard urban surfaces including pavement and built infrastructure, as well as from anthropogenic heat release from fuel combustion within cities. Built materials absorb and retain heat, therefore increasing average outdoor air temperatures, while certain pollutants decrease air quality and contributes to temperature increases. Climate change will most likely cause these conditions to prevail and worsen as heatwaves become more intense and frequent. While heat events persist, the need for cooling systems indoors increases and in turn creates a rise in energy consumption and further anthropogenic heat combustion. An increase in urban vegetation can help to reduce the UHI effect by shading building surfaces, increasing land albedo, and releasing moisture into the atmosphere. While several studies have examined the role of urban greenspaces in offsetting UHIs, there are few data regarding whether UHIs exist at small scales such as in small towns and villages in rural areas. Moreover, there is potential for green spaces within developed rural areas including small towns and villages to improve air quality and decrease outdoor air temperatures at a local scale. In this study, I examine the air filtration and cooling effects of ten small-scale village greens throughout Vermont. These village greens tend to have park-like characteristics including open lawn and tree and shrub vegetation. Many historic Vermont village greens are located adjacent to the areas with the most development within a given town, which includes areas of impervious surfaces such as roads and buildings. In this study, air quality and temperature are measured at two edge locations and one center location within each of ten village greens throughout the Fall of 2020. I hypothesized that the air quality would be higher in the center of greens and generally found this to be true. For temperatures, while I hypothesized the centers of the green spaces to be cooler, a difference of no larger than 0.4°C was observed between the edge and centers of village greens. The ten village greens were also separated into five more urban towns and five more rural towns to compare temperature and air quality among locations to see whether there might be a greater contrast between edge and center data points in the comparatively urban Vermont towns versus the rural towns. Overall results showed better air quality and wider temperature variation in rural locations compared to urban locations