Evaluating the ‘Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme’: A mixed method study in England

Background Caesarean section plays an important role in ensuring safety of mother and infant but rising rates are not accompanied by measurable improvements in maternal or neonatal mortality or morbidity. The ‘Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme’ was a facilitative initiative developed to promote opportunities for normal birth and reduce Caesarean section rates in England. Objective To evaluate the ‘Focus on Normal Birth and Reducing Caesarean section Rates’ programme, by assessment of: impact on Caesarean section rates, use of service improvements tools and participants’ perceptions of factors that sustain or hinder work within participating maternity units. Design A mixed methods approach included analysis of mode of birth data, web-based questionnaires and in-depth semi-structured telephone interviews. Participants Twenty Hospital Trusts in England (selected from 68 who applied) took part in the ‘Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme’ initiative. In each hospital Trust, the head of midwifery, an obstetrician, the relevant lead for organisational development, a supervisor of midwives, or a clinical midwife and a service user representative were invited to participate in the independent evaluation. Methods Collection and analysis of mode of birth data from twenty participating hospital Trusts, web-based questionnaires administered to key individuals in all twenty Trusts and in-depth semi-structured telephone interviews conducted with key individuals in a sample of six Trusts. Results There was a marginal decline of 0.5% (25.9% from 26.4%) in mean total Caesarean section rate in the period 1 January 2009 to 31 January 2010 compared to the baseline period (1 July to 31 December 2008). Reduced total Caesarean section rates were achieved in eight trusts, all with higher rates at the beginning of the initiative. Features associated with lower Caesarean section rates included a shared philosophy prioritising normal birth, clear communication across disciplines and strong leadership at a range of levels, including executive support and clinical leaders within each discipline. Conclusions It is important that the philosophy and organisational context of care are examined to identify potential barriers and facilitative factors

Molecular Studies of House Mice in Southern New Zealand

The house mouse, Mus Musculus, was first introduced into New Zealand in significant numbers in the mid nineteenth century. Earlier research suggests that multiple introductions of the three subspecies of house mouse M. m. domesticus, M. m. musculus and M. m. castaneus occurred at this time. While M. m. domesticus is widely distributed in New Zealand with M. m. musculus somewhat less so, the only extant evidence found to date for M. m. castaneus is in hybrid mice found principally in the southern half of the South Island. In this study, the hybrid population of mice in the South Island was examined in detail using a variety of molecular techniques. The extent of the hybrid zone was first established using a simple polymerase chain reaction (PCR) technique that enabled rapid identification of mitochondrial genomes as being M. m. domesticus, castaneus or musculus in nature. In the second part of the study, four representative mice from the hybrid zone and three M. m. domesticus from north of this zone were subjected to high density (600K) single nucleotide polymorphism (SNP) analyses in order to pinpoint regions of the genomes that differed in a significant manner between the two groups. In a refinement of these analyses, regions of each genome were identified as being domesticus-, castaneus- or musculus-like, using diagnostic SNP alleles for each sub-species. Some 170 mice, principally collected in the Southern South Island, were screened using the rapid PCR technique. In the coastal regions, all mice further south than 44oS had M. m. castaneus mtDNA whereas those north of 43oS had M. m. domesticus mtDNA. Between the two, there is a ‘contact zone’ in which both subspecies were found, sometimes in the same building. The contact zone extends approximately 50km north to south and some 30km inland. Classical tests with three nuclear DNA markers confirmed earlier work, namely, that the nuclear genomes of all mice appeared to be predominantly domesticus-like. Although there is no obvious geographical, ecological or land-use features that characterise this contact zone it may be relevant that there is the distinct change to a wetter colder climate in the south and inland of the contact zone, especially in winter. The inability to identify obvious defining features is not surprising, given that much research over many years worldwide has failed to yield an explanation for distinct mouse hybrid zones. The high density SNP analyses demonstrated that the nuclear genomes of all seven representative mice were very similar and largely (approximately 95%+) domesticus-like in nature. Despite this similarity, clusters of SNPs did reveal differences throughout the genome, often just extending over a few haplotype blocks and often encompassing much less than a million basepairs (Mb). Some of these were of biological interest, for example clusters of vomeronasal receptor genes and also genes believed to be involved in maternal-fetal conflict, which are known to vary markedly between species. The diagnostic SNP analyses confirmed that no marked differences exist between the genomes of the hybrid and M. m. domesticus mice. As stated above, the genomes were predominantly domesticus-like but small regions (~1Mb) of castaneus-like and musculus-like genome were found scattered throughout all mice but, contrary to initial expectations, there was no preponderance of castaneus-like regions in the hybrid mice. The one exception to the largely identical genomic SNP patterns, were those from the mouse collected in Hamilton. This was quite bizarre, in that its genome contains large (up to 10Mb) musculus-like regions that correspond exactly to the same regions in a common laboratory strain of mouse, C57BL/6J. I conclude that if pure M. m. castaneus mice did originally reach New Zealand, extensive ‘backcrossing’ with M. m. domesticus has virtually eliminated the castaneus genome, with just a few remnants remaining that may or may not confer some selective advantage, but could just as likely represent segregation of recognition factors that give rise to assortative mating. Thus, the most obvious and consistent genetic difference between the mice remains the original observation concerning their mitochondrial genomes and these should be examined in more detail. In future research aimed at identifying potential selective advantages that have allowed the hybrid mice to exclusively populate the southern South Island factors that relate to climate should be considered. Specifically, the fact that, in humans, some mitochondrial haplotypes are believed to confer a selective advantage in colder climates immediately suggests that examining variants of key genes involved in energy metabolism such as NADH-dehydrogenase-subunit-3 ( ND3 ) in the hybrid mice could be a profitable line of future research

Investigating how online fashion product page design affects the consumer's clothing fit appraisal

Clothing fit is the most important consideration during the consumer's garment appraisal process but is the primary reason for the extensive number of online returns generated in the fashion industry. This suggests that when shopping online, consumers are not provided with sufficient information about the fit of a garment. This issue is even more imperative now as COVID-19 has accentuated the shift to shopping for clothing online. Thus, how fashion retailers communicate clothing online is a critical challenge requiring immediate attention. Underpinned by the Stimulus–Organism–Response (S-O-R) framework, this research undertakes a between-subjects factorial web-experiment to investigate how different types of fit information affect the consumers' online garment evaluations and purchasing decisions. The results from 400 UK female responses show that whilst the presence of diverse body shapes (vs. one body shape) enhances the consumers' garment fit evaluations, it does not increase purchase intentions. Alternatively, verbal fit information in the form of clothing fit reviews (vs. absence) increased product fit diagnosticity but had no significant effect on concerns with fit online or purchase intentions. The results provide novel insights into how fashion retailers can enhance the communication of clothing fit on their product pages

Classified information: what's lacking from online herpetofauna sales

In the last decade there has been a massive rise in the number of animals being sold via online classified websites, with herpetofauna (reptiles and amphibians) being no exception. In response to growing concerns regarding irresponsible advertising, the Pet Advertising Advisory Group (PAAG) was established to ensure animals are sold legally and ethically, thus aiming to safeguard animal welfare and enhance consumer confidence. It works by encouraging classified websites to become members, thereby agreeing to 26 rules regarding advert content and self-regulating information that sellers provide based on these rules. It also relies on volunteers for spot-checking adverts, however, with thousands of adverts uploaded every day, it can be hard for both PAAG and its members to identify any violations of the rules. Adverts selling herpetofauna were downloaded from three PAAG member classified websites every week throughout 2019 (n=26,378) and checked against 13 relevant PAAG rules using an SQL database and a bespoke Expert System software. Violations of 12 PAAG rules were found across the three member websites which involved 7986 individual adverts. Violations included the selling of banned invasive species (e.g. Trachemys scripta scripta), false information on the need for an Article 10 certificate, commercial sellers not displaying their council licence number, the selling of animals with health issues or in a gravid state, animals offered for swapping, and the selling of DWA animals without mentioning the need for a licence. There were also adverts that did not specify the species for sale (n= 371), but rather labelled the animal at taxon or class level, and in one concerning case just labelled the animal for sale as ‘pet’. Member websites were also spot-checked for whether they had prominent links to PAAG buying advice and approved care information, with no websites meeting both these requirements. The only PAAG rule met by each website was that they had clear links on how to report an advert that caused concern. Overall, these findings show that PAAG is having a positive impact on classified sales with 70% of adverts meeting PAAG rules, but due to the sheer number of adverts some violations are still slipping through. Recommendations would be for member sites to invest in a software solution to flag key words and frequent sellers, and / or require sellers to include more information via mandatory fields when uploading adverts. Further promotion of PAAG for public awareness would also be of benefit