Factors influencing the utilisation of free-standing and alongside midwifery units in England: a qualitative research study

OBJECTIVE: To identify factors influencing the provision, utilisation and sustainability of midwifery units (MUs) in England. DESIGN: Case studies, using individual interviews and focus groups, in six National Health Service (NHS) Trust maternity services in England. SETTING AND PARTICIPANTS: NHS maternity services in different geographical areas of England Maternity care staff and service users from six NHS Trusts: two Trusts where more than 20% of all women gave birth in MUs, two Trusts where less than 10% of all women gave birth in MUs and two Trusts without MUs. Obstetric, midwifery and neonatal clinical leaders, managers, service user representatives and commissioners were individually interviewed (n=57). Twenty-six focus groups were undertaken with midwives (n=60) and service users (n=52). MAIN OUTCOME MEASURES: Factors influencing MU use. FINDINGS: The study findings identify several barriers to the uptake of MUs. Within a context of a history of obstetric-led provision and lack of decision-maker awareness of the clinical and economic evidence, most Trust managers and clinicians do not regard their MU provision as being as important as their obstetric unit (OU) provision. Therefore, it does not get embedded as an equal and parallel component in the Trust's overall maternity package of care. The analysis illuminates how implementation of complex interventions in health services is influenced by a range of factors including the medicalisation of childbirth, perceived financial constraints, adequate leadership and institutional norms protecting the status quo. CONCLUSIONS: There are significant obstacles to MUs reaching their full potential, especially free-standing midwifery units. These include the lack of commitment by providers to embed MUs as an essential service provision alongside their OUs, an absence of leadership to drive through these changes and the capacity and willingness of providers to address women's information needs. If these remain unaddressed, childbearing women's access to MUs will continue to be restricted

Mapping midwifery and obstetric units in England

OBJECTIVE: to describe the configuration of midwifery units, both alongside&free-standing, and obstetric units in England. DESIGN: national survey amongst Heads of Midwifery in English Maternity Services SETTING: National Health Service (NHS) in England PARTICIPANTS: English Maternity Services Measurements descriptive statistics of Alongside Midwifery Units and Free-standing Midwifery Units and Obstetric Units and their annual births/year in English Maternity Services FINDINGS: alongside midwifery units have nearly doubled since 2010 (n = 53-97); free-standing midwifery units have increased slightly (n = 58-61). There has been a significant reduction in maternity services without either an alongside or free-standing midwifery unit (75-32). The percentage of all births in midwifery units has trebled, now representing 14% of all births in England. This masks significant differences in percentage of all births in midwifery units between different maternity services with a spread of 4% to 31%. KEY CONCLUSIONS: In some areas of England, women have no access to a local midwifery unit, despite the National Institute for Health&Clinical Excellence (NICE) recommending them as an important place of birth option for low risk women. The numbers of midwifery units have increased significantly in England since 2010 but this growth is almost exclusively in alongside midwifery units. The percentage of women giving birth in midwifery units varies significantly between maternity services suggesting that many midwifery units are underutilised. IMPLICATIONS FOR PRACTICE: Both the availability and utilisation of midwifery units in England could be improved

Public opinion on energy crops in the landscape: considerations for the expansion of renewable energy from biomass

Public attitudes were assessed towards two dedicated biomass crops – Miscanthus and Short Rotation Coppice (SRC), particularly regarding their visual impacts in the landscape. Results are based on responses to photographic and computer-generated images as the crops are still relatively scarce in the landscape. A questionnaire survey indicated little public concern about potential landscape aesthetics but more concern about attendant built infrastructure. Focus group meetings and interviews indicated support for biomass end uses that bring direct benefits to local communities. Questions arise as to how well the imagery used was able to portray the true nature of these tall, dense, perennial plants but based on the responses obtained and given the caveat that there was limited personal experience of the crops, it appears unlikely that wide-scale planting of biomass crops will give rise to substantial public concern in relation to their visual impact in the landscape

The Glucose Transporter 2 regulates CD8+ T cell function via environment sensing

T cell activation is associated with a profound and rapid metabolic response to meet increased energy demands for cell division, differentiation and development of effector function. Glucose uptake and engagement of the glycolytic pathway are major checkpoints for this event. Here we show that the low-affinity, concentration-dependent glucose transporter 2 (Glut2) regulates the development of CD8+ T cell effector responses in mice by promoting glucose uptake, glycolysis and glucose storage. Expression of Glut2 is modulated by environmental factors including glucose and oxygen availability and extracellular acidification. Glut2 is highly expressed by circulating, recently primed T cells, allowing efficient glucose uptake and storage. In glucose-deprived inflammatory environments, Glut2 becomes downregulated, thus preventing passive loss of intracellular glucose. Mechanistically, Glut2 expression is regulated by a combination of molecular interactions involving hypoxia-inducible factor-1 alpha, galectin-9 and stomatin. Finally, we show that human T cells also rely on this glucose transporter, thus providing a potential target for therapeutic immunomodulation

Energyscapes: linking the energy system and ecosystem services in real landscapes

The drive for sustainable energy production is leading to increased deployment of land based renewables. Although there is public support, in principle, for renewable energy at a national level, major resistance to renewable energy technologies often occurs at a local level. Within this context, it can be useful to consider the "energyscape" which we initially define as the complex spatial and temporal combination of the supply, demand and infrastructure for energy within a landscape. By starting with a consideration of the energyscape, we can then consider the positive and negative interactions with other ecosystem services within a particular landscape. This requires a multidisciplinary systems-approach that uses existing knowledge of landscapes, energy options, and the different perspectives of stakeholders. The approach is examined in relation to pilot case-study comprising a 155 km2 catchment in Bedfordshire, England

Anxiety disorders in children with Williams syndrome, their mothers, and their siblings: Implications for the etiology of anxiety disorders

This study examines the prevalence of anxiety disorders in children with Williams syndrome (WS), their sibling closest in age, and their mothers as well as the predictors of anxiety in these groups. The prevalence of anxiety disorders was assessed and compared to that in the general population. Children with WS had a significantly higher prevalence of specific phobia, generalized anxiety disorder (GAD), and separation anxiety in comparison to children in the general population. While mothers had a higher prevalence of GAD than population controls, the excess was accounted for by mothers who had onset after the birth of their WS child. The siblings had rates similar to the general population. This pattern of findings suggests the presence of a gene in the WS region whose deletion predisposes to anxiety disorders. It is also worthwhile to investigate relations between genes deleted in WS and genes previously implicated in anxiety disorders

Fishing Production and Fishing Changes in Hong Kong after the Ground Trawl Ban of 31st December 2012: A Geospatial Evaluation

From data published by the Hong Kong SAR (HKSAR) government in their two sole fisheries surveys of 2006 and 2016/2017, the current authors produced regional maps using spatial interpolation to more accurately describe and estimate the geographic coverage of changes in fishing production in Hong Kong waters since the ground trawl ban of 2012 December 31st. These suggest the fishing industry has adapted to smaller craft, and that fishing production increased in several areas in the period after the ground trawl ban came into effect. In addition, the maps enable a smoother assessment to be made of the geospatial changes in fishing production which have occurred since the ground trawl ban and suggest a ‘workaround’ by fishermen. In particular, small fishing craft known as sampans are able to take advantage by being more suitable vessels for areas such as narrower or shallower bays. Marine plastics pollution is also a proxy indicator of these activities, as evidenced by discarded fishing gear that includes plastic nets, floats, and other fishing boat equipment

Prevention of post splenectomy sepsis: a population based approach.

Background The aim of the study was to prevent the occurrence of serious, overwhelming infection following splenectomy, by a district based initiative. Subjects were residents of Plymouth and Torbay District Health Authority (DHA) who had undergone splenectomy in the past and general practitioners (GPs) within the District. Methods District guidelines on the prevention of post splenectomy sepsis were developed and disseminated among local GPs and hospital doctors. Patients who had undergone operative splenectomy were actively traced through GP and hospital information systems so that they could be offered sepsis preventive measures in accordance with the guidelines. Data capture-recapture was used as an ascertainment adjustment method to estimate the district prevalence of alive patients who have had an operative splenectomy. A postal questionnaire of district GPs was undertaken after one year to determine their awareness and use of the guidelines. Results Eight-eight alive patients who had undergone splenectomy were not previously identified by their GP as being asplenic.They were traced so that they could be offered sepsis preventive measures in line with the local guidelines. The estimated district prevalence of individuals who had had an operative splenectomy after ascertainment adjustment using data capture-recapture is ρ′ =9.75 per 10000 population [95 per cent confidence interval (Cl) (7.87, 11.64) per 10000]. Out of 367 district GPs, 201 used the local guidelines after one year Conclusions Effective prevention of overwhelming infection following splenectomy requires an active population based approach.</p

Prevention of post splenectomy sepsis: a population based approach.

Background The aim of the study was to prevent the occurrence of serious, overwhelming infection following splenectomy, by a district based initiative. Subjects were residents of Plymouth and Torbay District Health Authority (DHA) who had undergone splenectomy in the past and general practitioners (GPs) within the District. Methods District guidelines on the prevention of post splenectomy sepsis were developed and disseminated among local GPs and hospital doctors. Patients who had undergone operative splenectomy were actively traced through GP and hospital information systems so that they could be offered sepsis preventive measures in accordance with the guidelines. Data capture-recapture was used as an ascertainment adjustment method to estimate the district prevalence of alive patients who have had an operative splenectomy. A postal questionnaire of district GPs was undertaken after one year to determine their awareness and use of the guidelines. Results Eight-eight alive patients who had undergone splenectomy were not previously identified by their GP as being asplenic.They were traced so that they could be offered sepsis preventive measures in line with the local guidelines. The estimated district prevalence of individuals who had had an operative splenectomy after ascertainment adjustment using data capture-recapture is ρ′ =9.75 per 10000 population [95 per cent confidence interval (Cl) (7.87, 11.64) per 10000]. Out of 367 district GPs, 201 used the local guidelines after one year Conclusions Effective prevention of overwhelming infection following splenectomy requires an active population based approach.</p