The closure of rural and remote maternity services: Where are the midwives?

Decisions to close small maternity units in rural and remote communities have often precipitated a community response as women and families rally to save local services. But where are the midwives? We argue here that professional bodies such as colleges of midwives have a responsibility to advocate more strongly at a political level for evidence-based decisionmaking regarding the allocation of rural services. We suggest that adopting a comprehensive definition of maternity services risk that considers both social and health services risks and their impact on clinical risk, could provide a solid basis for effective advocacy by professional bodies

DC and high-frequency conductivity of the organic metals beta"-(BEDT-TTF)2SF5RSO3 (R = CH2CF2 and CHF)

The temperature dependences of the electric-transport properties of the two-dimensional organic conductors beta"-(BEDT-TTF)2SF5CH2CF2SO3, beta"-(d8-BEDT-TTF)2SF5CH2CF2SO3, and beta"-(BEDT-TTF)2SF5CHFSO3 are measured by dc methods in and perpendicular to the highly-conducting plane. Microwave measurements are performed at 24 and 33.5 GHz to probe the high-frequency behavior from room temperature down to 2 K. Superconductivity is observed in beta"-(BEDT-TTF)2SF5CH2CF2SO3 and its deuterated analogue. Although all the compounds remain metallic down to low-temperatures, they are close to a charge-order transition. This leads to deviations from a simple Drude behavior of the optical conductivity which become obvious already in the microwave range. In beta"-(BEDT-TTF)2SF5CH2CF2SO3, for instance, charge fluctuations cause an increase in microwave resistivity for T < 20 K which is not detected in dc measurements. beta"-(BEDT-TTF)2SF5CHFSO3 exhibits a simple metallic behavior at all frequencies. In the dc transport, however, we observe indications of localization in the perpendicular direction.Comment: 8 pages, 9 figure

Measuring dopaminergic function in the 6-OHDA-lesioned rat: a comparison of PET and microdialysis

BACKGROUND: [(18) F]fluorodopa (FDOPA) positron emission tomography (PET) allows assessment of levodopa (LDOPA) metabolism and is widely used to study Parkinson's disease. We examined how [(18) F]FDOPA PET-derived kinetic parameters relate the dopamine (DA) and DA metabolite content of extracellular fluid measured by microdialysis to aid in the interpretation of data from both techniques. METHODS: [(18) F]FDOPA PET imaging and microdialysis measurements were performed in unilaterally 6-hydroxydopamine-lesioned rats (n = 8) and normal control rats (n = 3). Microdialysis testing included baseline measurements and measurements following acute administration of LDOPA. PET imaging was also performed using [(11)C]dihydrotetrabenazine (DTBZ), which is a ligand for the vesicular monoamine transporter marker and allowed assessment of denervation severity. RESULTS: The different methods provided highly correlated data. Lesioned rats had reduced DA metabolite concentrations ipsilateral to the lesion (p < 0.05 compared to controls), with the concentration being correlated with FDOPA's effective distribution volume ratio (EDVR; r = 0.86, p < 0.01) and DTBZ's binding potential (BP(ND); r = 0.89, p < 0.01). The DA metabolite concentration in the contralateral striatum of severely (>80%) lesioned rats was lower (p < 0.05) than that of less severely lesioned rats (<80%) and was correlated with the ipsilateral PET measures (r = 0.89, p < 0.01 for BP(ND)) but not with the contralateral PET measures. EDVR and BP(ND) in the contralateral striatum were not different from controls and were not correlated with the denervation severity. CONCLUSIONS: The demonstrated strong correlations between the PET and microdialysis measures can aid in the interpretation of [(18) F]FDOPA-derived kinetic parameters and help compare results from different studies. The contralateral striatum was affected by the lesioning and so cannot always serve as an unaffected control

Rural health service planning: the need for a comprehensive approach to costing

The precipitous closure of rural maternity services in industrialized countries over the past two decades is underscored in part by assumptions of efficiencies of scale leading to cost-effectiveness. However, there is scant evidence to support this and the costing evidence that exists lacks comprehensiveness. To clearly understand the cost-effectiveness of rural services we must take the broadest societal perspective to include not only health system costs, but also those costs incurred at the family and community levels. We must consider manifest costs (hard, easily quantifiable costs, both direct and indirect) and latent costs (understood as what is sacrificed or lost), and take into account cost shifting (reallocating costs to different parts of the system) and cost downloading (passing costs on to women and families). Further, we must compare the costs of having a rural maternity service to those incurred by not having a service, a comparison that is seldom made. This approach will require determining a methodological framework for weighing all costs, one which will likely involve attention to the rich descriptions of those experiencing loss

Reconceptualising risk: Perceptions of risk in rural and remote maternity service planning.

OBJECTIVE: to explore perceptions and examples of risk related to pregnancy and childbirth in rural and remote Australia and how these influence the planning of maternity services. DESIGN: data collection in this qualitative component of a mixed methods study included 88 semi-structured individual and group interviews (n=102), three focus groups (n=22) and one group information session (n=17). Researchers identified two categories of risk for exploration: health services risk (including clinical and corporate risks) and social risk (including cultural, emotional and financial risks). Data were aggregated and thematically analysed to identify perceptions and examples of risk related to each category. SETTING: fieldwork was conducted in four jurisdictions at nine sites in rural (n=3) and remote (n=6) Australia. PARTICIPANTS: 117 health service employees and 24 consumers. MEASUREMENTS AND FINDINGS: examples and perceptions relating to each category of risk were identified from the data. Most medical practitioners and health service managers perceived clinical risks related to rural birthing services without access to caesarean section. Consumer participants were more likely to emphasise social risks arising from a lack of local birthing services. KEY CONCLUSIONS: our analysis demonstrated that the closure of services adds social risk, which exacerbates clinical risk. Analysis also highlighted that perceptions of clinical risk are privileged over social risk in decisions about rural and remote maternity service planning. IMPLICATIONS FOR PRACTICE: a comprehensive analysis of risk that identifies how social and other forms of risk contribute to adverse clinical outcomes would benefit rural and remote people and their health services. Formal risk analyses should consider the risks associated with failure to provide birthing services in rural and remote communities as well as the risks of maintaining services

Impedance model for the polarization-dependent optical absorption of superconducting single-photon detectors

We measured the single-photon detection efficiency of NbN superconducting single photon detectors as a function of the polarization state of the incident light for different wavelengths in the range from 488 nm to 1550 nm. The polarization contrast varies from ~5% at 488 nm to ~30% at 1550 nm, in good agreement with numerical calculations. We use an optical-impedance model to describe the absorption for polarization parallel to the wires of the detector. For lossy NbN films, the absorption can be kept constant by keeping the product of layer thickness and filling factor constant. As a consequence, we find that the maximum possible absorption is independent of filling factor. By illuminating the detector through the substrate, an absorption efficiency of ~70% can be reached for a detector on Si or GaAs, without the need for an optical cavity.Comment: 15 pages, 5 figures, submitted to Journal of Applied Physic

Electronic correlation in the infrared optical properties of the quasi two dimensional κ\kappa-type BEDT-TTF dimer system

The polarized optical reflectance spectra of the quasi two dimensional organic correlated electron system $\kappa$-(BEDT-TTF)$_{2}$Cu[N(CN)$_{2}$]$Y$, $Y =$ Br and Cl are measured in the infrared region. The former shows the superconductivity at $T_{\rm c} \simeq$ 11.6 K and the latter does the antiferromagnetic insulator transition at $T_{\rm N} \simeq$ 28 K. Both the specific molecular vibration mode $\nu_{3}(a_{g})$ of the BEDT-TTF molecule and the optical conductivity hump in the mid-infrared region change correlatively at $T^{*} \simeq$ 38 K of $\kappa$-(BEDT-TTF)$_{2}$Cu[N(CN)$_{2}$]Br, although no indication of $T^{*}$ but the insulating behaviour below $T_{\rm ins} \simeq$ 50-60 K are found in $\kappa$-(BEDT-TTF)$_{2}$Cu[N(CN)$_{2}$]Cl. The results suggest that the electron-molecular vibration coupling on the $\nu_{3}(a_{g})$ mode becomes weak due to the enhancement of the itinerant nature of the carriers on the dimer of the BEDT-TTF molecules below $T^{*}$, while it does strong below $T_{\rm ins}$ because of the localized carriers on the dimer. These changes are in agreement with the reduction and the enhancement of the mid-infrared conductivity hump below $T^{*}$ and $T_{\rm ins}$, respectively, which originates from the transitions between the upper and lower Mott-Hubbard bands. The present observations demonstrate that two different metallic states of $\kappa$-(BEDT-TTF)$_{2}$Cu[N(CN)$_{2}$]Br are regarded as {\it a correlated good metal} below $T^{*}$ including the superconducting state and {\it a half filling bad metal} above $T^{*}$. In contrast the insulating state of $\kappa$-(BEDT-TTF)$_{2}$Cu[N(CN)$_{2}$]Cl below $T_{\rm ins}$ is the Mott insulator.Comment: 8 pages, 7 figure

Competition between Charge Ordering and Superconductivity in Layered Organic Conductors α\alpha-(BEDT-TTF)2M_2MHg(SCN)4_4 (M = K, NH4_4)

While the optical properties of the superconducting salt $\alpha$-(BEDT-TTF)$_2$NH$_4$Hg(SCN)$_4$ remain metallic down to 2 K, in the non-superconducting K-analog a pseudogap develops at frequencies of about 200 cm$^{-1}$ for temperatures T < 200 K. Based on exact diagonalisation calculations on an extended Hubbard model at quarter-filling we argue that fluctuations associated with short range charge ordering are responsible for the observed low-frequency feature. The different ground states, including superconductivity, are a consequence of the proximity of these compounds to a quantum phase charge-ordering transition driven by the intermolecular Coulomb repulsion.Comment: 4 pages, 3 figure

On-chain electrodynamics of metallic (TMTSF)_2 X salts: Observation of Tomonaga-Luttinger liquid response

We have measured the electrodynamic response in the metallic state of three highly anisotropic conductors, (TMTSF)_2 X, where X=PF_6, AsF_6, or ClO_4, and TMTSF is the organic molecule tetramethyltetraselenofulvalene. In all three cases we find dramatic deviations from a simple Drude response. The optical conductivity has two features: a narrow mode at zero frequency, with a small spectral weight, and a mode centered around 200 cm^{-1}, with nearly all of the spectral weight expected for the relevant number of carriers and single particle bandmass. We argue that these features are characteristic of a nearly one-dimensional half- or quarter-filled band with Coulomb correlations, and evaluate the finite energy mode in terms of a one-dimensional Mott insulator. At high frequencies (\hbar\omega > t_\perp, the transfer integral perpendicular to the chains), the frequency dependence of the optical conductivity \sigma_1(\omega) is in agreement with calculations based on an interacting Tomonaga-Luttinger liquid, and is different from what is expected for an uncorrelated one-dimensional semiconductor. The zero frequency mode shows deviations from a simple Drude response, and can be adequately described with a frequency dependent mass and relaxation rate.Comment: 12 pages, 7 figures, RevTeX; minor corrections to text and references; To be published in Phys. Rev. B, 15 July 199

Responding to health inequities: Indigenous health system innovations

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.Over the past decades, Indigenous communities around the world have become more vocal and mobilized to address the health inequities they experience. Many Indigenous communities we work with in Canada, Australia, Latin America, the USA, New Zealand and to a lesser extent Scandinavia have developed their own culturally-informed services, focusing on the needs of their own community members. This paper discusses Indigenous healthcare innovations from an international perspective, and showcases Indigenous health system innovations that emerged in Canada (the First Nation Health Authority) and Colombia (Anas Wayúu). These case studies serve as examples of Indigenous-led innovations that might serve as models to other communities. The analysis we present suggests that when opportunities arise, Indigenous communities can and will mobilize to develop Indigenous-led primary healthcare services that are well managed and effective at addressing health inequities. Sustainable funding and supportive policy frameworks that are harmonized across international, national and local levels are required for these organizations to achieve their full potential. In conclusion, this paper demonstrates the value of supporting Indigenous health system innovations