Vitamin A supplementation for postpartum women

In areas where vitamin A deficiency (VAD) is a public health concern, the maternal dietary intake of vitamin A may be not sufficient to meet either the maternal nutritional requirements, or those of the breastfed infant, due the low retinol concentrations in breast milk. To evaluate the effects of vitamin A supplementation for postpartum women on maternal and infant health. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (8 February 2016), LILACS (1982 to December 2015), Web of Science (1945 to December 2015), and the reference lists of retrieved studies. Randomised controlled trials (RCTs) or cluster‐randomised trials that assessed the effects of vitamin A supplementation for postpartum women on maternal and infant health (morbidity, mortality and vitamin A nutritional status). Two review authors independently assessed trials for inclusion, conducted data extraction, assessed risk of bias and checked for accuracy. We assessed the quality of the evidence using the GRADE approach. Fourteen trials of mainly low or unclear risk of bias, enrolling 25,758 women and infant pairs were included. The supplementation schemes included high, single or double doses of vitamin A (200,000 to 400,000 internation units (IU)), or 7.8 mg daily beta‐carotene compared with placebo, no treatment, other (iron); or higher (400,000 IU) versus lower dose (200,000 IU). In all trials, a considerable proportion of infants were at least partially breastfed until six months.

Journeys Towards Intercultural Capability in Language Classrooms

This open access book presents an account of five teacher educators who, over a two-year period, undertook a research project with five teachers of languages other than English in pre-secondary schools in New Zealand. Their collaborative aim was to develop students’ intercultural capability in the context of learning a new language. The school participants were typical of many in New Zealand’s pre-secondary sector; the teachers had limited language-teaching experience and limited prior knowledge of how to develop the intercultural dimension in their language classrooms, and the students were largely at the beginning stages of learning a new language. The book discusses the findings obtained using a range of data collection methods, including classroom observations, reflective interviews with teachers, and focus groups with students. It documents instances of breakthrough and growth for teachers and students and reveals the problems and tensions. Lastly, it reflects on the lessons learned in the course of this project and speculates on the roles that teacher education needs to play if the goal of intercultural capability is to be better achieved in language classrooms, both in New Zealand and internationally. Of interest to a wide range of stakeholders in the area of education, the book allows readers to gain an understanding of the opportunities of working with teachers through an action–research model, alongside the challenges that this brings and ways in which intercultural capability may be strengthened

Clinical research and leadership training program as a knowledge translation initiative across an Australian health care service

&nbsp;Health professionals need to be integrated more effectively in clinical research initiatives to ensure that research addresses key clinical needs and provides practical, implementable solutions at the coal face of care. Here we describe the informative phase of a broader program to enable and support health professionals at Monash Health who do not have a research background, to engage in and lead research to improve healthcare outcomes. The findings will be used to develop a dedicated clinical research and leadership training program. The training program will support Monash Health staff to up-skill or enhance skills to conduct rigorous research; engage and lead multidisciplinary, collaborative teams; and to use research to guide practice, as well as identify and address gaps in clinical research. &nbsp;</div

Routinely collected infant feeding data:Time for global action

The importance of breastfeeding is clear. However, global action to support breastfeeding is hindered by the lack of reliable standard data, which continues to impede progress. Routinely collected data can monitor the effectiveness of health policy, evaluate interventions, and enhance international research collaboration and comparisons. Use of routine data to support effective public health initiatives such as smoking cessation has been demonstrated. However, the data collected about infant feeding practices worldwide is inconsistent in timing, methods, definitions, detail, storage, and consistency. Improvements to the reach and quality of routinely collected data about infant feeding are needed to strengthen the global evidence and policy base. An international collaborative effort is called for to progress this

Development, implementation and evaluation of a clinical research engagement and leadership capacity building program in a large Australian health care service

BACKGROUND: Health professionals need to be integrated more effectively in clinical research to ensure that research addresses clinical needs and provides practical solutions at the coal face of care. In light of limited evidence on how best to achieve this, evaluation of strategies to introduce, adapt and sustain evidence-based practices across different populations and settings is required. This project aims to address this gap through the co-design, development, implementation, evaluation, refinement and ultimately scale-up of a clinical research engagement and leadership capacity building program in a clinical setting with little to no co-ordinated approach to clinical research engagement and education. METHODS/DESIGN: The protocol is based on principles of research capacity building and on a six-step framework, which have previously led to successful implementation and long-term sustainability. A mixed methods study design will be used. Methods will include: (1) a review of the literature about strategies that engage health professionals in research through capacity building and/or education in research methods; (2) a review of existing local research education and support elements; (3) a needs assessment in the local clinical setting, including an online cross-sectional survey and semi-structured interviews; (4) co-design and development of an educational and support program; (5) implementation of the program in the clinical environment; and (6) pre- and post-implementation evaluation and ultimately program scale-up. The evaluation focuses on research activity and knowledge, attitudes and preferences about clinical research, evidence-based practice and leadership and post implementation, about their satisfaction with the program. The investigators will evaluate the feasibility and effect of the program according to capacity building measures and will revise where appropriate prior to scale-up. DISCUSSION: It is anticipated that this clinical research engagement and leadership capacity building program will enable and enhance clinically relevant research to be led and conducted by health professionals in the health setting. This approach will also encourage identification of areas of clinical uncertainty and need that can be addressed through clinical research within the health setting

Antenatal breast milk expression by women with diabetes for improving infant outcomes (Review)

BackgroundSome women with diabetes in pregnancy are encouraged to express and store colostrum prior to birthing. Following birth, the breastfed infant may be given the stored colostrum to minimise the use of artificial formula or intravenous dextrose administration if correction of hypoglycaemia is required. However, findings from observational studies suggest that antenatal breast milk expression may stimulate labour earlier than expected and increase admissions to special care nurseries for correction of neonatal hypoglycaemia.ObjectivesTo evaluate the benefits and harms of the expression and storage of breast milk during late pregnancy by women with diabetes.Search methodsWe searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2014).Selection criteriaAll published and unpublished randomised controlled trials comparing antenatal breast milk expressing with not expressing, by pregnant women with diabetes (pre-existing or gestational) and a singleton pregnancy.Data collection and analysisTwo review authors independently evaluated reports identified by the search strategy.Main resultsThere were no published or unpublished randomised controlled trials comparing antenatal expressing with not expressing. One randomised trial is currently underway.Authors' conclusionsThere is no high level systematic evidence to inform the safety and efficacy of the practice of expressing and storing breast milk during pregnancy

Fetal pulse oximetry for fetal assessment in labour (Review)

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Vibroacoustic stimulation for fetal assessment in labour in the presence of a nonreassuring fetal heart rate trace (Review)

Background: Fetal vibroacoustic stimulation (VAS) is a simple, non-invasive technique where a device is placed on the maternal abdomen over the region of the fetal head and sound is emitted at a predetermined level for several seconds. It is hypothesised that the resultant startle reflex in the fetus and subsequent fetal heart rate (FHR) acceleration or transient tachycardia following VAS provide reassurance of fetal well-being. This technique has been proposed as a tool to assess fetal well-being in the presence of a nonreassuring cardiotocographic (CTG) trace during the first and second stages of labour. Objectives: To evaluate the clinical effectiveness and safety of VAS in the assessment of fetal well-being during labour, compared with mock or no stimulation for women with a singleton pregnancy exhibiting a nonreassuring FHR pattern. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 September 2012) and reference lists of all retrieved articles. We sought unpublished trials and abstracts submitted to major international congresses and contacted expert informants. Selection criteria: All published and unpublished randomised trials that compared maternal and fetal/neonatal/infant outcomes when VAS was used to evaluate fetal status in the presence of a nonreassuring CTG trace during labour, compared with mock or no stimulation. Data collection and analysis: Two review authors independently sought to assess for inclusion all the potential studies we identified as a result of the search strategy. We planned to resolve any disagreement through discussion or, if required, to consult a third person. Where there was uncertainty about a particular study, we attempted to contact study authors for additional information. However, these attempts were unsuccessful. Main results: The search strategies yielded six studies for consideration of inclusion. However, none of these studies fulfilled the requirements for inclusion in this review. Authors' conclusions: There are currently no randomised controlled trials that address the safety and efficacy of VAS used to assess fetal well-being in labour in the presence of a nonreassuring CTG trace. Although VAS has been proposed as a simple, non-invasive tool for assessment of fetal well-being, there is insufficient evidence from randomised trials on which to base recommendations for use of VAS in the evaluation of fetal well-being in labour in the presence of a nonreassuring CTG trace

Evidence of Resilience in Reef Islands in Response to Rising Sea Level on Huvadhoo Atoll, Maldives

Reef islands are at the forefront of concern for future accelerating sea-level rise since their low-lying and isolated nature puts them at higher risk of marine inundation compared to continental coastlines. However, the perceived threat of complete submersion as implied by projected future sea-level rise and current island elevations do not consider the morphologically resilient nature of reef island systems. In particular, the role of sediment supply in the resilience of these islands is still relatively poorly studied. This study presents detailed descriptions of the sedimentary characteristics and stratigraphy of two lagoonal platform islands in Huvadhoo Atoll, Maldives, that formed during periods of Holocene sea-level rise. Island subsurface stratigraphy was reconstructed by analysing the skeletal composition and textural properties of 306 sediment samples from 37 cores extracted across the islands. Island sediments were dominated by coral sands with varied proportions of secondary constituents (molluscs, Halimeda, foraminifera, and crustose coralline algae). Downcore variations in composition show that the proportion of coral sands decrease with depth and the proportion of molluscs and Halimeda increase with depth (with the exception of cores that terminated on lagoon infill). The increased proportion of Halimeda and molluscs in these early island deposits may have resulted from the catch-up growth strategy of the reef during the mid-Holocene highstand as both organisms have high turnover rates and directly contribute to sediment production after death. The sedimentological response of increased Halimeda and molluscs highlights the resilient and dynamic nature of reef islands and the ability of reefs to adjust ecologically to changing sea levels