Generosity of spirit sustains caseloading Lead Maternity Carer midwives in New Zealand.

Background: This article is the third in a series reporting on original research exploring the sustainability of Lead Maternity Carer (LMC) midwifery. Previous publications have described sustainable practice arrangements and the way that partnership and reciprocity with women sustain LMC midwives. Research about sustainable caseload practice is important because lessons can be learnt that ensure this model of care, with its excellent outcomes and high levels of maternal satisfaction, continues. Aim: The aim of this paper is to provide stand-alone data in relation to what sustains LMC midwives in midwifery practice over time. The final theme to emerge from our original research arose from data which support the strong relationship between the midwives' generosity of spirit alongside professional boundaries that is critical to sustaining caseloading practice. Method: A qualitative descriptive study was conducted in New Zealand. Eleven LMC midwives with between 8-20 years of practice experience were interviewed. Interviews were transcribed and the data thematically analysed. The researchers within the group undertook the analysis together in a reciprocal fashion between the individual interviews and all the data as a whole. Themes were clustered into groups and excerpts from the data used to illustrate the agreed themes. Ethics approval was obtained from Auckland University of Technology Ethics Committee. Conclusion: This paper draws attention to the significance of generosity of spirit in LMC practice and how this acts synergistically with personal and professional boundaries. Reciprocity and partnership work well when generosity of spirt is enabled to flourish, and this, in turn, supports joy of practice. This paper provides further insight into how LMC practice is sustained over time and provides direction for midwives in LMC practice, and those planning to enter LMC practice, in New Zealand and elsewhere

Leveraging the Dissemination of Scholarly Works

The objective of this research was to analyze the marketing and economic outcomes and benefits from the dissemination of the data from the Airline Quality Rating (AQR) (http://airlinequalityrating.com) over the past 27 years, including the newer distributive avenues such as social media and open access venues online. Industry standards are set by the AQR, providing consumers and industry watchers objective performance-based data to compare performance quality among different U.S. airlines. The AQR weighted average formula highlights criteria including baggage handling, customer complaints, denied boarding and on-time arrivals. The scholarly publication of the AQR was first released in 1991; the authors were interviewed on Good Morning America, gaining national media attention for the authors as well as their university. The annual media release of this report grew in reputation over the first three years to a national media event as a valid rating/ranking of the major airlines’ quality; this was validated by an advertising value of over two million dollars. In 2016, the release of the AQR report reached over 1.2 billion people globally, with an advertising and publicity value of twelve million dollars. Today, faculty members can and should utilize the newer distributive platforms for dissemination of their research and scholarly works; some examples of these avenues include: (1) research and scholarly publications being uploaded to Google Scholar for scholarly as well as general public use, (2) taking advantage of social media’s global market, (3) utilizing media venues, including media releases, (4) using online open-access repositories for scholarship submissions. The dissemination of data from the AQR is just one example of the limitless topics that could be applied to other scholarship efforts, benefitting faculty members and their associated universities by effectively leveraging the distribution of their research and associated publications beyond only being published as an obscure journal article

The Future of Social Media Usage for Scholarly Research

The research method for this project – examining the dissemination of research artifacts through social media as well as the impact social media can have on scholarly research – originated with Dr. Brent Bowen of Embry-Riddle Aeronautical University at the Prescott, Arizona campus and Dr. Dean E. Headley of Wichita State University. Drs. Bowen and Headley introduced the Airline Quality Rating (AQR) in early 1991 as an objective method for comparing and scoring airline performance in areas deemed to be important for consumers. Scores are calculated by defining 15-elements in four major areas, focusing on airline performance and the significance the factors to consumers of air travel in a given calendar year. The report is a summary and evaluation of month-by-month ratings for U.S. airlines, based on domestic performance data which these companies are required to publish. The general case study focus of this research is the AQR as it relates to the news of the AQR’s release as disseminated through social media platforms, the subsequent utilization of and references to the research by social media users, and the global reach of social media. We will examine social media metrics, based on traditional news releases. These news releases, when amplified by social media platforms, assist in broadening the viewership and the utilization of research. The AQR’s Visibility Reports evaluate four aspects of online traffic - Total Pickup, Traffic flow, Audience, and Engagement. We will discuss how the Airline Quality Rating has helped to facilitate a worldwide discussion on U.S. airlines and domestic air travel within the U.S

Midwifing the notion of a 'good' birth: a philosophical analysis.

Objective: to ponder afresh what makes a good birth experience in a listening manner. Design: a hermeneutic approach that first explores the nature of how to listen to a story that is already familiar to us and then draws on Heidegger's notion of the fourfold to seek to capture how the components of a'good birth' come together within experience. Setting: primary birthing centre, New Zealand Participants: the focus of this paper is the story of one participant. It was her second birth; her first birth involved a lot of medical intervention. She had planned to travel one hour to the tertiary birthing unit but in labour chose to stay at the Birth Centre. Her story seems to portray a 'very good birth'. Findings: in talking of birth, the nature of a research approach is commonly to focus on one aspect: the place, the care givers, or the mode of care. In contrast, we took on the challenge of first listening to all that was involved in one woman's story. We came to see that what made her experience 'good' was'everything' gathered together in a coherent and supportive oneness. Heidegger's notion of the fourfold helped reveal that one cannot talk about one thing without at the same time talking about all the other things as well. Confidence was the thread that held the story together. Key conclusions: there is value in putting aside the fragmented approach of explicating birth to recognise the coming together of place, care, situation, and the mystery beyond explanation. Women grow a confidence in place when peers and community encourage the choice based on their own experience. Confidence of caregiver comes in relationship. Feeling confident within 'self' is part of the mystery. When confidence in the different dimensions holds together, birth is 'good'. Implications or practice: one cannot simply build a new birthing unit and assume it will offer a good experience of birth. Experience is about so much more. Being mindful of the dimensions of confidence that need to be built up and sheltered is a quest for wise leaders. Protecting the pockets where we know 'good birth' already flourishes is essential

Towards increased concentration sensitivity for continuous wave EPR investigations of spin-labeled biological macromolecules at high fields

This work was performed at the National High Magnetic Field Laboratory (NHMFL), which is supported by the National Science Foundation (DMR-1157490) and the State of Florida. L.S. acknowledges support from the National Institutes of Health (AI091693) and the NHMFL User Collaboration Grants Program (Award No. 5080). G.E.F. acknowledges support from the National Science Foundation (MCB-1329467) and the National Institutes of Health (GM105409 and S10RR031603). S.H. acknowledges support from the National Science Foundation (DMR-1309463). J.M.E acknowledges support from the National Science Foundation (DGE-0802270).High-field, high-frequency electron paramagnetic resonance (EPR) spectroscopy at W- (∼95 GHz) and D-band (∼140 GHz) is important for investigating the conformational dynamics of flexible biological macromolecules because this frequency range has increased spectral sensitivity to nitroxide motion over the 100 ps to 2 ns regime. However, low concentration sensitivity remains a roadblock for studying aqueous samples at high magnetic fields. Here, we examine the sensitivity of a non-resonant thin-layer cylindrical sample holder, coupled to a quasi-optical induction-mode W-band EPR spectrometer (HiPER), for continuous wave (CW) EPR analyses of: (i) the aqueous nitroxide standard, TEMPO; (ii) the unstructured to α-helical transition of a model IDP protein; and (iii) the base-stacking transition in a kink-turn motif of a large 232 nt RNA. For sample volumes of ∼50 μL, concentration sensitivities of 2-20 μM were achieved, representing a ∼10-fold enhancement compared to a cylindrical TE011 resonator on a commercial Bruker W-band spectrometer. These results therefore highlight the sensitivity of the thin-layer sample holders employed in HiPER for spin-labeling studies of biological macromolecules at high fields, where applications can extend to other systems that are facilitated by the modest sample volumes and ease of sample loading and geometry.PostprintPeer reviewe

A reinforcement learning agent for head and neck intensity-modulated radiation therapy

Head and neck (HN) cancers pose a difficult problem in the planning of intensity-modulated radiation therapy (IMRT) treatment. The primary tumor can be large and asymmetrical, and multiple organs at risk (OARs) with varying dose-sparing goals lie close to the target volume. Currently, there is no systematic way of automating the generation of IMRT plans, and the manual options face planning quality and long planning time challenges. In this article, we present a reinforcement learning (RL) model for the purposes of providing automated treatment planning to reduce clinical workflow time as well as providing a better starting point for human planners to modify and build upon. Several models with progressing complexity are presented, including the relevant plan dosimetry analysis and model interpretations of the resulting strategies learned by the auto-planning agent. Models were trained on a set of 40 patients and validated on a set of 20 patients. The presented models are shown to be consistent with the requirements of an RL model to be underpinned by a Markov decision process (MDP). In-depth interpretability of the models is presented by examination of the decision space using action hyperplanes. The auto-planning agent was able to generate plans with superior reduction in the mean dose of the left and right parotid glands by approximately 7 Gy ± 2.5 Gy (p < 0.01) over a starting, static template plan with only pre-defined general prescription information. RL plans were comparable to a human expert’s clinical plans for the primary (44 Gy), boost (26 Gy) , and the summed plans (70 Gy) with p-values of 0.43, 0.72, and 0.67, respectively, for the dosimetric endpoints and uniform target coverage normalization. The RL planning agent was able to produce the plans used in validation in an average of 13.58 min, with a minimum and a maximum planning time of 2.27 and 44.82 min, respectively

The Effects of Obesity on Outcomes in Trauma Injury: Overview of the Current Literature

Obesity has reached epidemic proportions and is now considered a chronic disease by the National Institute of Health (NIH) in the West. Its impact on trauma outcomes is of particular interest with several studies presenting conflicting information. The present overview suggests a strong association between obesity and injury severity, hospital length of stay (LOS), intensive care unit (ICU) admission, pattern of injury, rate of complications and mortality. The nature of the observations may relate to an underlying physiological state of the obese patient and its associated comorbidities with a constant heightened inflammatory state aggravated by the second hit on an injury

Pacific university graduates in New Zealand: what helps and hinders completion

Increasing the numbers of Pacific Island students who graduate from New Zealand universities is important for the students’ futures, their families, communities and society in general. In this study, Pacific graduates (N = 365) who are participants in the Graduate Longitudinal Study New Zealand were asked to describe what factors helped or hindered their qualification completion. Graduates from all eight New Zealand universities were surveyed between July and December 2011. Pacific graduates identified external (e.g. family), institutional (e.g. university staff) and student or personal (e.g. motivation) factors that both helped and hindered the successful completion of their studies. Understanding the hindrance factors faced by Pacific students and the factors that have contributed to their educational success can help to inform policy and practice to achieve national priorities of equity and successful outcomes for Pacific learners.Peer Reviewe