The Design and Impact of a Rural Community Supported Doula Program

The purpose of this study is to describe the design and impact of a rural community supported doula program. The Washington County Mental Health Doula Project is a unique collaboration between the Central Vermont Medical Center and Washington County Mental Health Services, whereby doula support services are offered for at risk patients during their pregnancy, through the birth process and the post partum period, and up to one year post delivery. Many more typical doula programs are of significant cost to the patient, making this support inaccessible to those that may need it the most. This program is unique in that not only are the doula services free for patients in need, but also the program is funded by a collaboration between a hospital and a community organization. What further sets this program apart is the case management background of the doulas and the significant logistical support offered to these clients who have a host of needs that go beyond just birth support. The WCMHS Doula Project has been a crucial element of women’s healthcare services in this rural community over the years, but no formal research has been conducted to evaluate the impact of the program. Through a qualitative analysis, this project seeks to give voice to the clients receiving the services in order to demonstrate the unique design and impact that such services have in the lives of patients facing numerous hardships during their pregnancy and early parenting period in rural Vermont.https://scholarworks.uvm.edu/fmclerk/1736/thumbnail.jp

The Design and Impact of a Rural Community Supported Doula Program

Objective: to evaluate the design and impact of a doula program in rural Vermont by exploring client demographics and perspectives on the doula care received. This research aims to better understand the population the program serves, the specific challenges they face, and how to mitigate these challenges in the perinatal and post-partum period with a social work model of doula care. Design: a qualitative, descriptive study giving voice to the client experience of a doula program steeped in a social work model of care. Methods: semi-structured interviews carried out in July and August of 2021. Interviews were coded and analyzed thematically. Setting: A doula program offered by a mental health agency, offering doula services for clientele with a mental health diagnosis and qualifications for VT Medicaid. Results: Significant portions of participants reported life challenges due to lack of resources, abuse, and mental health concerns, of which having a social-work focused doula was helpful in terms of logistical and emotional support. Without a doula, access and experience of healthcare during the prenatal, birthing, and post-partum period would have been more challenging for the population interviewed. Themes that arose included doula as logistical support, the doula’s role in emotional/mental health support, and the doula as educator and advocate for a socioeconomically high-risk population. Key conclusions and implications for practice: The WCMHS Doula Program is serving a high-risk population which would be beyond the reaches of more typical doula models. Doula work that is within the field of social work increases access and mitigates challenges that other doula models do not. Placing doula services within a community mental health agency and offering case management style doula care allows the services to make great impact on the lives and wellbeing of people who would otherwise face significant challenges in accessing healthcare. This has large implications for increasing equity of doula offerings and makes great strides in improving birth outcomes and experiences for an at-risk population. This study indicates the value of a social work model of doula care and the importance of bringing doula services to populations that have historically been left without access. Key words: doula, case management, at-risk population, rural health, pregnancy, childbirth support, advocacy, health equit

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The Design and Impact of a Rural Community Supported Doula Program

The study evaluates the design and impact of a doula program in rural Vermont. This qualitative research aims to understand the population the program serves, the specific challenges clients face, and how to mitigate such challenges in the perinatal and post-partum period with a social work model of doula care. The WCMHS Doula Program serves a high-risk population which would otherwise be beyond the reaches of more typical doula models. Placing doula services within a mental health agency and offering case management style doula services makes great impact on the wellbeing of people who face significant challenges in accessing healthcare

Coronal Heating as Determined by the Solar Flare Frequency Distribution Obtained by Aggregating Case Studies

Flare frequency distributions represent a key approach to addressing one of the largest problems in solar and stellar physics: determining the mechanism that counter-intuitively heats coronae to temperatures that are orders of magnitude hotter than the corresponding photospheres. It is widely accepted that the magnetic field is responsible for the heating, but there are two competing mechanisms that could explain it: nanoflares or Alfv\'en waves. To date, neither can be directly observed. Nanoflares are, by definition, extremely small, but their aggregate energy release could represent a substantial heating mechanism, presuming they are sufficiently abundant. One way to test this presumption is via the flare frequency distribution, which describes how often flares of various energies occur. If the slope of the power law fitting the flare frequency distribution is above a critical threshold, $\alpha=2$ as established in prior literature, then there should be a sufficient abundance of nanoflares to explain coronal heating. We performed $>$600 case studies of solar flares, made possible by an unprecedented number of data analysts via three semesters of an undergraduate physics laboratory course. This allowed us to include two crucial, but nontrivial, analysis methods: pre-flare baseline subtraction and computation of the flare energy, which requires determining flare start and stop times. We aggregated the results of these analyses into a statistical study to determine that $\alpha = 1.63 \pm 0.03$. This is below the critical threshold, suggesting that Alfv\'en waves are an important driver of coronal heating.Comment: 1,002 authors, 14 pages, 4 figures, 3 tables, published by The Astrophysical Journal on 2023-05-09, volume 948, page 7

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field