Carbon Monoxide Screening in Pregnancy: An Evaluation Study of a Plymouth Pilot Intervention

This report provides an analysis and evaluation of a National Institute for Health and Care Excellence (NICE) recommended pilot intervention which was designed to identify pregnant women exposed to carbon monoxide due to cigarette smoke and refers them to local stop smoking services (LSSS). The pilot intervention was carried out by community midwives working in two areas of Plymouth. The city has areas of social and health inequalities and the study drew on populations from a socially deprived neighbourhood and a socially affluent area. The pilot was instigated following new NICE guidance recommending that all women attending initial ante natal booking appointments with their community midwives be offered a Carbon Monoxide (CO) breath analyser screening to determine their smoking status and or exposure to other forms of CO. This evaluation study identifies the benefits and barriers associated with the implementation of the CO screening pilot. In particular, our aims were to explore any detrimental impact on the relationship between women and their community midwives, identify the impact on midwives in terms of time and resources, reveal the responses and acceptability or otherwise of the screening as perceived and experienced by the women being asked to participate during the booking appointment and finally to evaluate the success of the intervention overall in relation to the numbers of referrals made to Plymouth’s LSSS. A further aim was explore any differences in the two socio demographic areas. We adopted a mixed methods approach involving four focus group interviews with 23 midwives, a survey posted to the 258 women who attended initial antenatal booking appointments in the study areas, an online version of the survey to ascertain the views and experiences of pregnant women and new mothers nationally and an interrogation of an internet forum discussion board for mothers. A two page questionnaire consisting of 12 questions was designed and posted to women who attended the booking appointment with the midwife during the three month pilot period and the same survey was made available online. Questions were designed to elicit women’s views about the information given by the midwife in relation to the screening, whether they had agreed to participate in the CO screening process, their experiences and views about offering CO screening to pregnant women and their smoking status and those of other household members. Of the 258 questionnaires posted to women who had attended the clinic during the pilot intervention 40 completed responses were returned representing a 15.5% response rate. Only 4 responses were received from the online survey posting but an additional 484 comments posted on the Mumsnet website discussion board were analysed. Our findings show that in general there was a high degree of acceptability for the intervention. Midwives and their clients were generally in support of the screening being offered to all pregnant women. However, this support was dependent on a number of contextual factors. Women wanted to be properly informed about the screening and midwives wanted to be kept informed about the effects of the intervention on women’s smoking cessation. Initial and ongoing training of midwives in utilising the protocol and in instructing women to correct use the monitor was also very important. Trust was revealed to be a very important aspect of the relationship between women and their midwives. Some women felt that the CO screening was being used just to check whether or not they were smokers and some midwives also worried about the possible negative effects the CO screening may have on their relationships with women

Uniting mathematics and biology for control of visceral leishmaniasis

The neglected tropical disease (NTD) visceral leishmaniasis (VL) has been targeted by the WHO for elimination as a public health problem on the Indian subcontinent by 2017 or earlier. To date there is a surprising scarcity of mathematical models capable of capturing VL disease dynamics, which are widely considered central to planning and assessing the efficacy of interventions. The few models that have been developed are examined, highlighting the necessity for better data to parameterise and fit these and future models. In particular, the characterisation and infectiousness of the different disease stages will be crucial to elimination. Modelling can then assist in establishing whether, when, and how the WHO VL elimination targets can be met

Inspiring to inspire: Developing teaching in higher education

Following a three-year staff development initiative within one faculty in a UK university, the authors reflected on inspiring teaching and the role that staff development can play in enhancing individual practice. Teaching is a core component of Higher Education and is complex and multi-faceted both theoretically and in practice. Through individual reflections to a set of pre-determined questions, a group of Higher Education teachers (n = 5) with a responsibility for the development of learning, teaching and assessment, share their thoughts, feelings and beliefs on inspiring teaching. The interpretive analysis of the data shows from a staff perspective that the notion of inspiring teaching has three main components which are all interrelated, those being; the actual teaching and learning experience; the design of the curriculum and the teacher/student relationship. Staff development initiatives were found to help people explore and develop their own teaching philosophy, to develop new practices and to share and learn from others. However, individual’s mindset, beliefs and attitudes were found to be a challenge. Teachers can frame their development around the different aspects of inspiring teaching and with support from senior leadership as well as a positive culture, teaching communities can work together towards inspiring teaching

A Bound on the Superpotential

We prove a general bound on the superpotential in theories with broken supersymmetry and broken R-symmetry, 2|W|< f_a F, where f_a and F are the R-axion and Goldstino decay constants, respectively. The bound holds for weakly coupled as well as strongly coupled theories, thereby providing an exact result in theories with broken supersymmetry. We briefly discuss several possible applications.Comment: 20 page

Measuring Quality in Initial Teacher Education (MQuITE) Literature Review: Executive Summary

The MQuITE project seeks to involve all stakeholders in the development of a contextuallyappropriate means of measuring quality in initial teacher education in Scotland. It engages with both literature and practice to inform this process. The project runs for six years (tracking graduates over five years) and involves all ITE universities in Scotland, as well as GTCS. It is designed to be developmental in nature, securing, as it does, a sound base for the study of quality in ITE in its initial phases and then testing this in subsequent years. An ongoing feature of the project is the way in which markers of quality are returned to and modified in light of accrued data. In this way the project does not seek to maintain a static representation of quality but rather a dynamic interpretation that is modified in light of progression both of students as they become teachers and the various routes into teaching that now exist in Scotland. This work will contribute significantly to the development of quality teacher education in Scotland, and will also offer a useful perspective to the international debate on measuring quality in ITE

Measuring Quality in Initial Teacher Education (MQuITE) Literature Review: Executive Summary

The MQuITE project seeks to involve all stakeholders in the development of a contextuallyappropriate means of measuring quality in initial teacher education in Scotland. It engages with both literature and practice to inform this process. The project runs for six years (tracking graduates over five years) and involves all ITE universities in Scotland, as well as GTCS. It is designed to be developmental in nature, securing, as it does, a sound base for the study of quality in ITE in its initial phases and then testing this in subsequent years. An ongoing feature of the project is the way in which markers of quality are returned to and modified in light of accrued data. In this way the project does not seek to maintain a static representation of quality but rather a dynamic interpretation that is modified in light of progression both of students as they become teachers and the various routes into teaching that now exist in Scotland. This work will contribute significantly to the development of quality teacher education in Scotland, and will also offer a useful perspective to the international debate on measuring quality in ITE

Investigating social deprivation and comorbid mental health diagnosis as predictors of treatment access among patients with an opioid use disorder using substance use services: a prospective cohort study

BackgroundOpioid use is a major public health concern across the globe. Opioid use and subsequent access to care is often shaped by co-occurring issues faced by people using opioids, such as deprivation, mental ill-health, and other forms of substance use. We investigated the role of social deprivation and comorbid mental health diagnoses in predicting re-engagement with substance use services or contact with crisis and inpatient services for individuals with opioid use disorder in secondary mental health care in inner-city London.MethodsWe conducted a prospective cohort study which followed individuals diagnosed with a first episode of opioid use disorder who accessed substance use services between September 2015 and May 2020 for up to 12 months, using anonymised electronic health records. We employed negative binominal regression and Cox proportional survival analyses to assess associations between exposures and outcomes.ResultsComorbid mental health diagnoses were associated with higher contact rates with crisis/inpatient services among people with opioid use disorder: incidence rate ratios (IRR) and 95% confidence intervals (CI) were 3.91 (1.74–9.14) for non-opioid substance use comorbidity, 8.92 (1.81–64.4) for a single comorbid mental health diagnosis, and 15.9 (5.89–47.5) for multiple comorbid mental health diagnoses. Social deprivation was not associated with contact rates with crisis/inpatient services within this sample. Similar patterns were found with time to first crisis/inpatient contact. Social deprivation and comorbid mental health diagnoses were not associated with re-engagement with substance use services.ConclusionComorbid substance and mental health difficulties amongst people with an opioid use disorder led to earlier and more frequent contact with crisis/inpatient mental health services during the first 12 months of follow up. Given the common co-occurrence of mental health and substance use disorders among those who use opioids, a better understanding of their wider needs (such as social, financial and other non-medical concerns) will ensure they are supported in their treatment journeys

On the new massive gravity and AdS/CFT

Demanding the existence of a simple holographic $c$-theorem, it is shown that a general (parity preserving) theory of gravity in 2+1 dimensions involving upto four derivative curvature invariants reduces to the new massive gravity theory. We consider extending the theory including upto six derivative curvature invariants. Black hole solutions are presented and consistency with 1+1 CFTs is checked. We present evidence that bulk unitarity is still in conflict with a positive CFT central charge for generic choice of parameters. However, for a special choice of parameters appearing in the four and six derivative terms reduces the linearized equations to be two derivative, thereby ameliorating the unitarity problem.Comment: 16 pages, 2 figures. v4: typo correcte

Analytic Lifshitz black holes in higher dimensions

We generalize the four-dimensional R^2-corrected z=3/2 Lifshitz black hole to a two-parameter family of black hole solutions for any dynamical exponent z and for any dimension D. For a particular relation between the parameters, we find the first example of an extremal Lifshitz black hole. An asymptotically Lifshitz black hole with a logarithmic decay is also exhibited for a specific critical exponent depending on the dimension. We extend this analysis to the more general quadratic curvature corrections for which we present three new families of higher-dimensional D>=5 analytic Lifshitz black holes for generic z. One of these higher-dimensional families contains as critical limits the z=3 three-dimensional Lifshitz black hole and a new z=6 four-dimensional black hole. The variety of analytic solutions presented here encourages to explore these gravity models within the context of non-relativistic holographic correspondence.Comment: 14 page