Empowering change: Realist evaluation of a Scottish Government programme to support normal birth

Objective: Midwife-led care has consistently been found to be safe and effective in reducing routine childbirth interventions and improving women’s experience of care. Despite consistent UK policy support for maximising the role of the midwife as the lead care provider for women with healthy pregnancies, implementation has been inconsistent and the persistent use of routine interventions in labour has given rise to concern. In response the Scottish Government initiated Keeping Childbirth Natural and Dynamic, a maternity care programme that aimed to support normal birth by implementing multi-professional care pathways and making midwife-led care for healthy pregnant women the national norm. Design: The evaluation was informed by realist evaluation. It aimed to explore and explain the ways in which the KCND programme worked or did not work in different maternity care contexts. Methods: The evaluation was conducted in three phases. In phase one semi- structured interviews and focus groups were conducted with key informants to elicit the programme theory. At phase two, this theory was tested using a multiple case study approach. Semi-structured interviews and focus groups were conducted and a case record audit was undertaken. In the final phase the programme theory was refined through analyses and interpretation of the data. Setting and participants: The setting for the evaluation was NHS Scotland. In phase one, 12 national programme stakeholders and 13 consultant midwives participated. In phase two case, studies were undertaken in three health boards; overall 73 participants took part in interviews or focus groups. A case record audit was undertaken of all births in Scotland during one week in two consecutive years before and after pathway implementation. Findings: Government and health board level commitment to, and support of, the programme signalled its importance and facilitated change. Consultant midwives tailored change strategies, using different approaches in response to the culture of care and inter-professional relationships within contexts. In contexts where practice was already changing KCND was seen as validating and facilitating. In areas where a more medical culture existed there was strong resistance to change from midwives and medical staff and robust implementation strategies were required. Overall the pathways appeared to enable midwives to achieve change. Key conclusions: Our study highlighted the importance of those involved in a change programme working across levels of hierarchy within an organisation and from the macro-context of national policy and institutions to the meso-context of regional health service delivery and the micro-context of practitioner’s experiences of providing care. The assumptions and propositions that inform programmes of change, which are often left at a tacit level and unexamined by those charged with implementing them, were made explicit. This examination illuminated the roles of the three key change mechanisms adopted in the KCND programme - appointment of consultant midwives as programme champions, multidisciplinary care pathways, and midwife-led care. It revealed the role of the commitment mechanism, which built on the appointment of the local change champions. The analysis indicated that the process of change, despite these clear mechanisms, needed to be adapted to local contexts and responses to the implementation of KCND. Implications for practice: Initial formative evaluation should be conducted prior to development of complex healthcare programmes to ensure that 1. The interventions will address the changes required 2. Key stakeholders who may support or resist change are identified 3. Appropriate facilitation strategies are developed tailored to context

Modelling and validation of synthesis of poly lactic acid using an alternative energy source through a continuous reactive extrusion process

PLA is one of the most promising bio-compostable and bio-degradable thermoplastic polymers made from renewable sources. PLA is generally produced by ring opening polymerization (ROP) of lactide using the metallic/bimetallic catalyst (Sn, Zn, and Al) or other organic catalysts in a suitable solvent. In this work, reactive extrusion experiments using stannous octoate Sn(Oct)2 and tri-phenyl phosphine (PPh)3 were considered to perform ROP of lactide. Ultrasound energy source was used for activating and/or boosting the polymerization as an alternative energy (AE) source. Ludovic® software, designed for simulation of the extrusion process, had to be modified in order to simulate the reactive extrusion of lactide and for the application of an AE source in an extruder. A mathematical model for the ROP of lactide reaction was developed to estimate the kinetics of the polymerization process. The isothermal curves generated through this model were then used by Ludovic software to simulate the “reactive” extrusion process of ROP of lactide. Results from the experiments and simulations were compared to validate the simulation methodology. It was observed that the application of an AE source boosts the polymerization of lactide monomers. However, it was also observed that the predicted residence time was shorter than the experimental one. There is potentially a case for reducing the residence time distribution (RTD) in Ludovic® due to the ‘liquid’ monomer flow in the extruder. Although this change in parameters resulted in validation of the simulation, it was concluded that further research is needed to validate this assumption

Strongly residual coordinates over A[x]

For a domain A of characteristic zero, a polynomial f over A[x] is called a strongly residual coordinate if f becomes a coordinate (over A) upon going modulo x, and f becomes a coordinate upon inverting x. We study the question of when a strongly residual coordinate is a coordinate, a question closely related to the Dolgachev-Weisfeiler conjecture. It is known that all strongly residual coordinates are coordinates for n=2 . We show that a large class of strongly residual coordinates that are generated by elementaries upon inverting x are in fact coordinates for arbitrary n, with a stronger result in the n=3 case. As an application, we show that all Venereau-type polynomials are 1-stable coordinates.Comment: 15 pages. Some minor clarifications and notational improvements from the first versio

Capsulization of Weather Broadcasting System using Raspberry pi

Weather broadcasting plays an important role in human life, so the collection of information about the temporal dynamics of weather changes is very important. The fundamental aim of this project is to develop an embedded system and design a weather broadcast system which enables the broadcasting of weather parameters for different sector. Such a system contain pair of sensors like temperature, pressure and humidity, which is used to sense the atmospheric parameter. Block diagram consist of the Raspberry pi, DHT-22 and BMP-180 sensor which is used for analyze the atmospheric parameters. The data from the sensors are collected by the microcontroller and it stored in SD cardand LCD screen is used to display the result

The Łojasiewicz exponent over a field of arbitrary characteristic

Let K be an algebraically closed field and let K((XQ)) denote the field of generalized series with coefficients in K. We propose definitions of the local Łojasiewicz exponent of F = ( f1, . . . , fm) ∈ K[[X, Y ]]m as well as of the Łojasiewicz exponent at infinity of F = ( f1, . . . , fm) ∈ K[X, Y ]m, which generalize the familiar case of K = C and F ∈ C{X, Y }m (resp. F ∈ C[X, Y ]m), see Cha˛dzy´nski and Krasi´nski (In: Singularities, 1988; In: Singularities, 1988; Ann Polon Math 67(3):297–301, 1997; Ann Polon Math 67(2):191–197, 1997), and prove some basic properties of such numbers. Namely, we show that in both cases the exponent is attained on a parametrization of a component of F (Theorems 6 and 7), thus being a rational number. To this end, we define the notion of the Łojasiewicz pseudoexponent of F ∈ (K((XQ))[Y ])m for which we give a description of all the generalized series that extract the pseudoexponent, in terms of their jets. In particular, we show that there exist only finitely many jets of generalized series giving the pseudoexponent of F (Theorem 5). The main tool in the proofs is the algebraic version of Newton’s Polygon Method. The results are illustrated with some explicit examples

A Carleman type theorem for proper holomorphic embeddings

In 1927, Carleman showed that a continuous, complex-valued function on the real line can be approximated in the Whitney topology by an entire function restricted to the real line. In this paper, we prove a similar result for proper holomorphic embeddings. Namely, we show that a proper \cC^r embedding of the real line into \C^n can be approximated in the strong \cC^r topology by a proper holomorphic embedding of \C into \C^n

Progress in environmental-friendly polymer nanocomposite material from PLA: synthesis, processing and applications

The disposal of large amounts of waste from daily use polymers is among one of the foremost concerns in the current era. Effective utilization of bio-renewable materials procured from natural sources has been proposed as a potential solution to this problem. Among such different polymers, Poly lactic acid (PLA) which is a bio-degradable polymer, resembles quite promotable features, which can be polymerized from sustainable sources as chips sugarcane, starch and corn. Ring-opening polymerization (ROP) of Lactide (LA) monomer considering catalysts such as Al, Sn or Zn is one of the efficient methods for the PLA synthesis. However, the PLA polymerized through this type of catalysts may contain trace elements of the catalyst. Due to their carcinogenic nature, the traces of such catalysts should be (ideally) removed from the synthesis process. The use of alternative energy (AE- UV, Microwave) sources could be a potential route. Alternative development of non-metal catalysts is best alternatives for the processing of PLA through ROP. PLA layer based composite materials are gaining huge interest due to their multiple application (food, medical etc.) as eco-friendly material. In this article, we review on the implementation of AE sources for PLA processing and to populate the current state-of-the-art associated with the PLA research, especially application in nanocomposite materials field

Rapid detection of trace bacteria in biofluids using porous monoliths in microchannels

We present advancements in microfluidic technology for rapid detection of as few as 10 rickettsial organisms in complex biological samples. An immuno-reactive filter, macroporous polyacrylamide monolith (PAM), fabricated within a microfluidic channel enhances solid-phase immuno-capture, staining and detection of targeted bacteria. Bacterial cells in samples flowing through the channel are forced to interact with the PAM filter surface due to size exclusion, overcoming common transport and kinetic limitations for rapid (min), high-efficiency (~100%) capture. In the process, targeted cells in sample volumes of 10 ?l to >100 ?l are concentrated within a sub-50 nl region at the PAM filter edge in the microchannel, thus concentrating them over 1000-fold. This significantly increases sensitivity, as the hydrophilic PAM also yields low non-specific immuno-fluorescence backgrounds with samples including serum, blood and non-targeted bacteria. The concentrated target cells are detected using fluorescently-labeled antibodies. With a single 2.0�0�3 mm PAM filter, as few as 10 rickettsial organisms per 100 祃 of lysed blood sample can be analyzed within 60 min, as compared to hours or even days needed for conventional detection methods. This method is highly relevant to rapid, multiplexed, low-cost point of care diagnostics at early stages of infection where diagnostics providing more immediate and actionable test results are needed to improve patient outcomes and mitigate potential natural and non-natural outbreaks or epidemics of rickettsial diseases

Patient information leaflets (PILs) for UK randomised controlled trials : a feasibility study exploring whether they contain information to support decision making about trial participation

Peer reviewedPublisher PD

A Classification of Integrable Quasiclassical Deformations of Algebraic Curves

A previously introduced scheme for describing integrable deformations of of algebraic curves is completed. Lenard relations are used to characterize and classify these deformations in terms of hydrodynamic type systems. A general solution of the compatibility conditions for consistent deformations is given and expressions for the solutions of the corresponding Lenard relations are provided.Comment: 21 page