Task shifting Midwifery Support Workers as the second health worker at a home birth in the UK: A qualitative study

Objective: Traditionally two midwives attend home births in the UK. This paper explores the implementation of a new home birth care model where births to low risk women are attended by one midwife and one Midwifery Support Worker (MSW). Design and setting: The study setting was a dedicated home birth service provided by a large UK urban hospital. Participants: Seventy-three individuals over 3 years: 13 home birth midwives, 7 MSWs, 7 commissioners (plan and purchase healthcare), 9 managers, 23 community midwives, 14 hospital midwives. Method: Qualitative data were gathered from 56 semi-structured interviews (36 participants), 5 semi-structured focus groups (37 participants) and 38 service documents over a 3 year study period. A rapid analysis approach was taken: data were reduced using structured summary templates, which were entered into a matrix, allowing comparison between participants. Findings were written up directly from the matrix (Hamilton, 2013). Findings: The midwife-MSW model for home births was reported to have been implemented successfully in practice, with MSWs working well, and emergencies well-managed. There were challenges in implementation, including: defining the role of MSWs; content and timing of training; providing MSWs with pre-deployment exposure to home birth; sustainability (recruiting and retaining MSWs, and a continuing need to provide two midwife cover for high risk births). The Service had responded to challenges and modified the approach to recruitment, training and deployment. Conclusions: The midwife-MSW model for home birth shows potential for task shifting to release midwife capacity and provide reliable home birth care to low risk women. Some of the challenges tally with observations made in the literature regarding role redesign. Others wishing to introduce a similar model would be advised to explicitly define and communicate the role of MSWs, and to ensure staff and women support it, consider carefully recruitment, content and delivery of training and retention of MSWs and confirm the model is cost-effective. They would also need to continue to provide care by two midwives at high risk births

Highly neurotic never-depressed students have negative biases in information processing

BACKGROUND: Cognitive theories associate depression with negative biases in information processing. Although negatively biased cognitions are well documented in depressed patients and to some extent in recovered patients, it remains unclear whether these abnormalities are present before the first depressive episode. METHOD: High neuroticism (N) is a well-recognized risk factor for depression. The current study therefore compared different aspects of emotional processing in 33 high-N never-depressed and 32 low-N matched volunteers. Awakening salivary cortisol, which is often elevated in severely depressed patients, was measured to explore the neurobiological substrate of neuroticism. RESULTS: High-N volunteers showed increased processing of negative and/or decreased processing of positive information in emotional categorization and memory, facial expression recognition and emotion-potentiated startle (EPS), in the absence of global memory or executive deficits. By contrast, there was no evidence for effects of neuroticism on attentional bias (as measured with the dot-probe task), over-general autobiographical memory, or awakening cortisol levels. CONCLUSIONS: These results suggest that certain negative processing biases precede depression rather than arising as a result of depressive experience per se and as such could in part mediate the vulnerability of high-N subjects to depression. Longitudinal studies are required to confirm that such cognitive vulnerabilities predict subsequent depression in individual subjects

Spin correlations in Ca3Co2O6: A polarised-neutron diffraction and Monte Carlo study

We present polarised-neutron diffraction measurements of the Ising-like spin-chain compound Ca3Co2O6 above and below the magnetic ordering temperature TN. Below TN, a clear evolution from a single-phase spin-density wave (SDW) structure to a mixture of SDW and commensurate antiferromagnet (CAFM) structures is observed on cooling. For a rapidly-cooled sample, the majority phase at low temperature is the SDW, while if the cooling is performed sufficiently slowly, then the SDW and the CAFM structure coexist between 1.5 and 10 K. Above TN, we use Monte Carlo methods to analyse the magnetic diffuse scattering data. We show that both intra- and inter-chain correlations persist above TN, but are essentially decoupled. Intra-chain correlations resemble the ferromagnetic Ising model, while inter-chain correlations resemble the frustrated triangular-lattice antiferromagnet. Using previously-published bulk property measurements and our neutron diffraction data, we obtain values of the ferromagnetic and antiferromagnetic exchange interactions and the single-ion anisotropy.Comment: 10 pages, 7 figure

Optimised accelerated solvent extraction of hexahydro‐1, 3, 5‐trinitro‐1, 3, 5 triazine (RDX) from polymer bonded explosives

An Accelerated Solvent Extraction (ASE) method was developed and optimised to extract hexahydro‐1,3,5‐trinitro‐1,3,5‐triazine (RDX) from a polyurethane matrix. The ASE method development was benchmarked against Soxhlet extraction with a view to improving extraction efficiency in terms of time and solvent volume. Key parameters for the ASE method development involved selecting the most appropriate solvent, optimising static time, ensuring a safe oven temperature for explosives, determination of a sufficient number of rinse cycles and effective sample preparation. To achieve optimal extraction, cutting the PBX samples to maximise solvent exposure was essential. The use of acetone with a static time of 10 minutes at 100 °C with three rinse cycles achieved 97 %±10 % extraction of RDX from PBX in 40 minutes using 72 mL solvent. Extraction time was reduced from 48 hours and solvent use by half compared to the standard Soxhlet extraction. To validate the developed ASE method, two other PBX samples containing different quantities of explosive were also fully extracted using the same parameters. Overall, ASE efficiency was comparable to Soxhlet, which places the ASE as a good alternative and shows potential for implementation as a standard method for other polymer based explosives

A systematic literature review of research on social procurement in the construction and infrastructure sector : barriers, enablers, and strategies

In Australia, a new feature of public policy is the requirement by governments that large-scale infrastructure projects integrate social procurement practices that alter the traditional focus on balancing price and quality. Social procurement has been gradually developing in practice, but the academic literature has not kept pace. Although past research has identified some of the barriers affecting social procurement implementation in the construction industry, the nature of the barriers impeding its proliferation has not to date been systematically reviewed. This paper undertakes a review of the social procurement literature published from January 2012 to 30 June 2022, with 49 papers chosen under selective criteria. This critical review employs the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) technique to retrieve secondary data on social procurement from available peer-reviewed academic papers through three databases (Scopus, EBSCOhost, Web of Science). The literature analysis focuses on three themes: (1) barriers; (2) enablers; and (3) strategies to overcome the barriers. The paper finds that social procurement as a field of practice is evolving and expanding, but its role in contributing to social value creation remains an under-theorised concept. Recommendations for practice and future research are identified, including the need to measure the real-world impacts of policy

Using an Experimental Medicine Model to Explore Combination Effects of Pharmacological and Cognitive Interventions for Depression and Anxiety

Selective serotonergic reuptake inhibitors (SSRIs) and cognitive therapies are effective in the treatment of anxiety and depression. Previous research suggests that both forms of treatments may work by altering cognitive biases in the processing of affective information. The current study assessed the effects of combining an SSRI with a cognitive intervention on measures of affective processing bias and resilience to external challenge. A total of 62 healthy participants were randomly assigned to receive either 7 days of citalopram (20 mg) or placebo capsules while also completing either an active or a control version of a computerized cognitive bias training task. After treatment, standard measures of affective processing bias were collected. Participants' resilience to external stress was also tested by measuring the increase in negative symptoms induced by a negative mood induction. Participants who received both citalopram and the active cognitive bias training task showed a smaller alteration in emotional memory and categorization bias than did those who received either active intervention singly. The degree to which memory for negative information was altered by citalopram predicted participants' resistance to the negative mood induction. These results suggest that co-administration of an SSRI and a cognitive training intervention can reduce the effectiveness of either treatment alone in terms of anxiety- and depression-relevant emotional processing. More generally, the findings suggest that pinpointing the cognitive actions of treatments may inform future development of combination strategies in mental health

Task shifting Midwifery Support Workers as the second health worker at a home birth in the UK: a qualitative study

Objective: Traditionally two midwives attend home births in the UK. This paper explores the implementation of a new home birth care model where births to low risk women are attended by one midwife and one midwifery support worker (MSW). Design and setting: The study setting was a dedicated home birth service provided by a large UK urban hospital. Participants: 73 individuals over three years: 13 home birth midwives, 7 MSWs, 7 commissioners (plan and purchase healthcare), 9 managers, 23 community midwives, 14 hospital midwives. Method: Qualitative data was gathered from 56 semi-structured interviews (36 participants), 5 semi-structured focus groups (37 participants) and 38 service documents over a three year study period. A Rapid Analysis approach was taken: data were reduced using structured summary templates, which were entered into a matrix, allowing comparison between participants. Findings were written up directly from the matrix (Hamilton, 2013). Findings: The midwife-MSW model for home births was reported to have been implemented successfully in practice, with MSWs working well, and emergencies well-managed. There were challenges in implementation, including: defining the role of MSWs; content and timing of training; providing MSWs with pre-deployment exposure to home birth; sustainability (recruiting and retaining MSWs, and a continuing need to provide two midwife cover for high risk births). The Service had responded to challenges and modified the approach to recruitment, training and deployment. Conclusions: The midwife-MSW model for home birth shows potential for task shifting to release midwife capacity and provide reliable home birth care to low risk women. Some of the challenges tally with observations made in the literature regarding role redesign. Others wishing to introduce a similar model would be advised to explicitly define and communicate the role of MSWs, and to ensure staff and women support it, consider carefully recruitment, content and delivery of training and retention of MSWs and confirm the model is cost-effective . They would also need to continue to provide care by two midwives at high risk births

Using a collaborative research approach to develop an interdisciplinary research agenda for the study of mobile health interventions for older adults.

Licensed under Creative Commons Attribution cc-by 2.0Background: Seniors with chronic diseases are often called on to self-manage their conditions. Mobile health (mHealth) tools may be a useful strategy to help seniors access health information at the point of decision-making, receive real-time feedback and coaching, and monitor health conditions. However, developing successful mHealth interventions for seniors presents many challenges. One of the key challenges is to ensure the scope of possible research questions includes the diverse views of seniors, experts and the stakeholder groups who support seniors as they manage chronic disease. Objective: Our primary objective was to present a case-study of a collaborative research approach to the development of an interdisciplinary research agenda. Our secondary objectives were to report on the results of a nominal group technique (NGT) approach used generate research questions and to assess the success of including non-academic researchers to enrich the scope, priority, and total number of possible research questions. Methods: We invited researchers and stakeholders to participate in a full day meeting that included rapid-style presentations by researchers, health care professionals, technology experts, patients and community groups followed by group discussions. An NGT was used to establish group consensus on the following question: In your opinion, what research needs to be done to better understand the effectiveness, usability and design of mobile health apps and devices for older adults? Results: Overall, the collaborative approach was a very successful strategy to bring together a diverse group of participants with the same end goal. The 32 participants generated 119 items in total. The top three research questions that emerged from the NGT were related to adoption, the need for high quality tools and the digital divide. Strong sub-themes included privacy and security, engagement and design. The NGT also helped us include the perspectives information from non-academic researchers that would not have been captured if the process had been limited to the research team. Conclusions: Developing ways for patients and other stakeholders to have a voice when it comes to developing patient awareness as related to mHealth may guide future research into engagement, ownership, usability and design. It is our intention that our paper be used and adapted by other researchers to engage small or vulnerable populations often excluded from mHealth research and design.None Declare