The 'active ingredients' for successful community engagement with disadvantaged expectant and new mothers: a qualitative comparative analysis

AIMS: To explore which conditions of community engagement are implicated in effective interventions targeting disadvantaged pregnant women and new mothers. BACKGROUND: Adaptive experiences during pregnancy and the early years are key to reducing health inequalities in women and children worldwide. Public health nurses, health visitors and community midwives are well placed to address such disadvantage, often using community engagement strategies. Such interventions are complex; however, and we need to better understand which aspects of community engagement are aligned with effectiveness. DESIGN: Qualitative comparative analysis conducted in 2013, of trials data included in a recently published systematic review. METHODS: Two reviewers agreed on relevant conditions from 24 maternity or early years intervention studies examining four models of community engagement. Effect size estimates were converted into 'fuzzy' effectiveness categories and truth tables were constructed. Using fsQCA software, Boolean minimization identified solution sets. Random effects multiple regression and fsQCA were conducted to rule out risk of methodological bias. RESULTS/FINDINGS: Studies focused on antenatal, immunization, breastfeeding and early professional intervention outcomes. Peer delivery (consistency 0·83; unique coverage 0·63); and mother-professional collaboration (consistency 0·833; unique coverage 0·21) were moderately aligned with effective interventions. Community-identified health need plus consultation/collaboration in intervention design and leading on delivery were weakly aligned with 'not effective' interventions (consistency 0·78; unique coverage 0·29). CONCLUSIONS: For disadvantaged new and expectant mothers, peer or collaborative delivery models could be used in interventions. A need exists to design and test community engagement interventions in other areas of maternity and early years care and to further evaluate models of empowerment

The effectiveness of community engagement in public health interventions for disadvantaged groups: a meta-analysis

BACKGROUND: Inequalities in health are acknowledged in many developed countries, whereby disadvantaged groups systematically suffer from worse health outcomes such as lower life expectancy than non-disadvantaged groups. Engaging members of disadvantaged communities in public health initiatives has been suggested as a way to reduce health inequities. This systematic review was conducted to evaluate the effectiveness of public health interventions that engage the community on a range of health outcomes across diverse health issues. METHODS: We searched the following sources for systematic reviews of public health interventions: Cochrane CDSR and CENTRAL, Campbell Library, DARE, NIHR HTA programme website, HTA database, and DoPHER. Through the identified reviews, we collated a database of primary studies that appeared to be relevant, and screened the full-text documents of those primary studies against our inclusion criteria. In parallel, we searched the NHS EED and TRoPHI databases for additional primary studies. For the purposes of these analyses, study design was limited to randomised and non-randomised controlled trials. Only interventions conducted in OECD countries and published since 1990 were included. We conducted a random effects meta-analysis of health behaviour, health consequences, self-efficacy, and social support outcomes, and a narrative summary of community outcomes. We tested a range of moderator variables, with a particular emphasis on the model of community engagement used as a potential moderator of intervention effectiveness. RESULTS: Of the 9,467 primary studies scanned, we identified 131 for inclusion in the meta-analysis. The overall effect size for health behaviour outcomes is d = .33 (95% CI .26, .40). The interventions were also effective in increasing health consequences (d = .16, 95% CI .06, .27); health behaviour self-efficacy (d = .41, 95% CI .16, .65) and perceived social support (d = .41, 95% CI .23, .65). Although the type of community engagement was not a significant moderator of effect, we identified some trends across studies. CONCLUSIONS: There is solid evidence that community engagement interventions have a positive impact on a range of health outcomes across various conditions. There is insufficient evidence to determine whether one particular model of community engagement is more effective than any other

Conceptual and statistical analysis of complex interventions in the presence of confounding variables: An example from public health

Background: Meta-analyses of complex interventions are challenging because causality operates through multiple paths and confounding variables can be difficult to distinguish. Objectives: To meta-analyse public health interventions that engage members of the community in their conception, design, or delivery. To disentangle intervention complexity by analysing according to their theories of change. Study selection criteria: Published after 1990; outcome or process evaluation; community engagement intervention; written in English; reported health or community outcomes; study populations or differential impacts reported according to social determinants of health. Analysis: Intervention complexity was examined by conceptualising, operationalising, and mapping their theories of change; and through random effects subgroup analyses. Main results: 131 studies were included in the synthesis. Three main theories of change were identified, which were useful in describing trends in intervention effectiveness. Statistically significant between-group differences were not detected, since there were likely to have been too many confounding variables. Conclusions: Intervention complexity in systematic reviews can be addressed through examining theories of change and trends in effect size estimates. Such complexity appears to defy current meta-analytical methods when confounding variables undermine analysis of variance

Prioritising references for systematic reviews with RobotAnalyst: A user study

Screening references is a time-consuming step necessary for systematic reviews and guideline development. Previous studies have shown that human effort can be reduced by using machine learning software to prioritise large reference collections such that most of the relevant references are identified before screening is completed. We describe and evaluate RobotAnalyst, a Web-based software system that combines text-mining and machine learning algorithms for organising references by their content and actively prioritising them based on a relevancy classification model trained and updated throughout the process. We report an evaluation over 22 reference collections (most are related to public health topics) screened using RobotAnalyst with a total of 43 610 abstract-level decisions. The number of references that needed to be screened to identify 95% of the abstract-level inclusions for the evidence review was reduced on 19 of the 22 collections. Significant gains over random sampling were achieved for all reviews conducted with active prioritisation, as compared with only two of five when prioritisation was not used. RobotAnalyst's descriptive clustering and topic modelling functionalities were also evaluated by public health analysts. Descriptive clustering provided more coherent organisation than topic modelling, and the content of the clusters was apparent to the users across a varying number of clusters. This is the first large-scale study using technology-assisted screening to perform new reviews, and the positive results provide empirical evidence that RobotAnalyst can accelerate the identification of relevant studies. The results also highlight the issue of user complacency and the need for a stopping criterion to realise the work savings

Interpretive analysis of 85 systematic reviews suggests that narrative syntheses and meta-analyses are incommensurate in argumentation

Using Toulmin's argumentation theory, we analysed the texts of systematic reviews in the area of workplace health promotion to explore differences in the modes of reasoning embedded in reports of narrative synthesis as compared with reports of meta‐analysis. We used framework synthesis, grounded theory and cross‐case analysis methods to analyse 85 systematic reviews addressing intervention effectiveness in workplace health promotion. Two core categories, or ‘modes of reasoning’, emerged to frame the contrast between narrative synthesis and meta‐analysis: practical–configurational reasoning in narrative synthesis (‘what is going on here? What picture emerges?’) and inferential–predictive reasoning in meta‐analysis (‘does it work, and how well? Will it work again?’). Modes of reasoning examined quality and consistency of the included evidence differently. Meta‐analyses clearly distinguished between warrant and claim, whereas narrative syntheses often presented joint warrant–claims. Narrative syntheses and meta‐analyses represent different modes of reasoning. Systematic reviewers are likely to be addressing research questions in different ways with each method. It is important to consider narrative synthesis in its own right as a method and to develop specific quality criteria and understandings of how it is carried out, not merely as a complement to, or second‐best option for, meta‐analysis

Beef production from feedstuffs conserved using new technologies to reduce negative environmental impacts

End of project reportMost (ca. 86%) Irish farms make some silage. Besides directly providing feed for livestock, the provision of grass silage within integrated grassland systems makes an important positive contribution to effective grazing management and improved forage utilisation by grazing animals, and to effective feed budgeting by farmers. It can also contribute to maintaining the content of desirable species in pastures, and to livestock not succumbing to parasites at sensitive times of the year. Furthermore, the optimal recycling of nutrients collected from housed livestock can often be best achieved by spreading the manures on the land used for producing the conserved feed. On most Irish farms, grass silage will remain the main conserved forage for feeding to livestock during winter for the foreseeable future. However, on some farms high yields of whole-crop (i.e. grain + straw) cereals such as wheat, barley and triticale, and of forage maize, will be an alternative option provided that losses during harvesting, storage and feedout are minimised and that input costs are restrained. These alternative forages have the potential to reliably support high levels of animal performance while avoiding the production of effluent. Their production and use however will need to advantageously integrate into ruminant production systems. A range of technologies can be employed for crop production and conservation, and for beef production, and the optimal options need to be identified. Beef cattle being finished indoors are offered concentrate feedstuffs at rates that range from modest inputs through to ad libitum access. Such concentrates frequently contain high levels of cereals such as barley or wheat. These cereals are generally between 14% to 18% moisture content and tend to be rolled shortly before being included in coarse rations or are more finely processed prior to pelleting. Farmers thinking of using ‘high-moisture grain’ techniques for preserving and processing cereal grains destined for feeding to beef cattle need to know how the yield, conservation efficiency and feeding value of such grains compares with grains conserved using more conventional techniques. European Union policy strongly encourages a sustainable and multifunctional agriculture. Therefore, in addition to providing European consumers with quality food produced within approved systems, agriculture must also contribute positively to the conservation of natural resources and the upkeep of the rural landscape. Plastics are widely used in agriculture and their post-use fate on farms must not harm the environment - they must be managed to support the enduring sustainability of farming systems. There is an absence of information on the efficacy of some new options for covering and sealing silage with plastic sheeting and tyres, and an absence of an inventory of the use, re-use and post-use fate of plastic film on farms. Irish cattle farmers operate a large number of beef production systems, half of which use dairy bred calves. In the current, continuously changing production and market conditions, new beef systems must be considered. A computer package is required that will allow the rapid, repeatable simulation and assessment of alternate beef production systems using appropriate, standardised procedures. There is thus a need to construct, evaluate and utilise computer models of components of beef production systems and to develop mathematical relationships to link system components into a network that would support their integration into an optimal system model. This will provide a framework to integrate physical and financial on-farm conditions with models for estimating feed supply and animal growth patterns. Cash flow and profit/loss results will be developed. This will help identify optimal systems, indicate the cause of failure of imperfect systems and identify areas where applied research data are currently lacking, or more basic research is required

Neutron stars from young nearby associations the origin of RXJ1605.3+3249

Many neutron stars (NSs) and runaway stars apparently come from the same regions on the sky. This suggests that they share the same birth places, namely associations and clusters of young massive stars. To identify NS birth places, we attempt to and NS-runaway pairs that could be former companions that were disrupted in a supernova (SN). The remains of recent (<few Myr) nearby (< 150 pc) SNe should still be identifiable by observing the emission of rare radioisotopes such as 26Al and 60Fe that can also be used as additional indicators to confirm a possible SN event. We investigated the origin of the isolated NS RXJ1605.3+3249 and found that it was probably born ~100 pc far from Earth 0.45 Myr ago in the extended Corona-Australis or Octans associations, or in Sco OB4 ~1 kpc 3.5 Myr ago. A SN in Octans is supported by the identification of one to two possible former companions the runaway stars HIP 68228 and HIP 89394, as well as the appearance of a feature in the gamma ray emission from 26Al decay at the predicted SN place. Both, the progenitor masses estimated by comparison with theoretical 26Al yields as well as derived from the life time of the progenitor star, are found to be ~11MSun.Comment: accepted for publication in PASA, special volume Astronomy with Radioactivities; 10 pages, 4 figures, 5 table

Are medical procedures that induce coughing or involve respiratory suctioning associated with increased generation of aerosols and risk of SARS-CoV-2 infection? A rapid systematic review.

BACKGROUND: The risk of transmission of SARS-CoV-2 from aerosols generated by medical procedures is a cause for concern. AIM: To evaluate the evidence for aerosol production and transmission of respiratory infection associated with procedures that involve airway suctioning or induce coughing/sneezing. METHODS: The review was informed by PRISMA guidelines. Searches were conducted in PubMed for studies published between January 1st, 2003 and October 6th, 2020. Included studies examined whether nasogastric tube insertion, lung function tests, nasendoscopy, dysphagia assessment, or suctioning for airway clearance result in aerosol generation or transmission of SARS-CoV-2, SARS-CoV, MERS, or influenza. Risk of bias assessment focused on robustness of measurement, control for confounding, and applicability to clinical practice. FINDINGS: Eighteen primary studies and two systematic reviews were included. Three epidemiological studies found no association between nasogastric tube insertion and acquisition of respiratory infections. One simulation study found low/very low production of aerosols associated with pulmonary lung function tests. Seven simulation studies of endoscopic sinus surgery suggested significant increases in aerosols but findings were inconsistent; two clinical studies found airborne particles associated with the use of microdebriders/drills. Some simulation studies did not use robust measures to detect particles and are difficult to equate to clinical conditions. CONCLUSION: There was an absence of evidence to suggest that the procedures included in the review were associated with an increased risk of transmission of respiratory infection. In order to better target precautions to mitigate risk, more research is required to determine the characteristics of medical procedures and patients that increase the risk of transmission of SARS-CoV-2

Adoption of improved chickpea varieties: KRIBHCO experience in tribal region of Gujarat, India

The study aims to track adoption of improved chickpea varieties, and assess their on-farm benefits in some remote and backward tribal villages in Gujarat, India, where few newly developed varieties were introduced by a non-government organization. It also determines key factors which were influencing their adoption. The study found that adoption of improved chickpea varieties was gradually increasing by replacing a prominent local variety. Duration of crop maturity, farm size, yield risk, and farmers' experience of growing chickpea crop were significantly influencing their adoption. The on-farm benefits as a result of improved varieties were realized in terms of increased yield levels, higher income and labor productivity, more marketable surplus, price premium and stabilized yields in fluctuating weather. Breeding short duration varieties with stable yield levels under varying weather, and organizing seed multiplication and dissemination in regions, where moisture stress is a problem during maturity of chickpea, are the major suggestion

Measurement of the diffractive structure function in deep inelastic scattering at HERA

This paper presents an analysis of the inclusive properties of diffractive deep inelastic scattering events produced in $ep$ interactions at HERA. The events are characterised by a rapidity gap between the outgoing proton system and the remaining hadronic system. Inclusive distributions are presented and compared with Monte Carlo models for diffractive processes. The data are consistent with models where the pomeron structure function has a hard and a soft contribution. The diffractive structure function is measured as a function of \xpom, the momentum fraction lost by the proton, of $\beta$, the momentum fraction of the struck quark with respect to \xpom, and of $Q^2$. The \xpom dependence is consistent with the form \xpoma where $a~=~1.30~\pm~0.08~(stat)~^{+~0.08}_{-~0.14}~(sys)$ in all bins of $\beta$ and $Q^2$. In the measured $Q^2$ range, the diffractive structure function approximately scales with $Q^2$ at fixed $\beta$. In an Ingelman-Schlein type model, where commonly used pomeron flux factor normalisations are assumed, it is found that the quarks within the pomeron do not saturate the momentum sum rule.Comment: 36 pages, latex, 11 figures appended as uuencoded fil