On trade-offs and communal breeding: the behavioural ecology of Agta foragers

Time is finite and no organism can avoid the allocation dilemma that this necessarily entails. A quintessential trade-off is that between parental investment and reproduction, otherwise known as the quality-quantity trade-off. However, humans may be exceptional among apes given our high quantity production of high quality offspring. This success has been argued only to be possible by breeding communally. In this thesis I explore questions surrounding trade-offs, communal breeding and their fitness consequences in a small-scale foraging society, the Agta. The first analysis examines the composition of Agta childcare using an innovative form of data collection to maximise sample sizes, previously a major limitation in hunter-gatherer research. The Agta, like many small-scale societies are prolific communal breeders. However, contra previous conclusions, juveniles and non-kin appeared to provide more allocare than grandmothers. Interactions with non-kin were associated with significant decreases in maternal workload, while interactions with siblings and grandmothers were not. The next analysis explores why both kin and non-kin behave cooperatively, finding support for kin selection among close kin and reciprocity for distant kin and non-kin allocare. Communal breeding appears to be an important mechanism to ensure enough childcare was received in the absence of other strategies to counter shortfalls in household energy budgets. The next analysis asks, what are the fitness consequences of maternal social networks and allocare? Mothers’ network centrality positively correlated with non-kin allocare as well as reproductive success, revealing the adaptive value of communal breeding. These results highlight the optimising nature of hunter-gatherer cooperation and life history strategies

Evaluating the Programme for Integrated Child Health

1.1 Background, aims and research questions Improving child health depends on a rounded understanding of what constitutes good child health. Improving child health is not simply a matter of responding to clinical needs, but must involve the psychosocial dimension of care, and the ability to ensure not only that ill-health is treated, but that good health is maintained which includes attention to prevention. Delivering this holistic care depends on effective collaborative practices between hospital-based and community-based settings which have person-centred care as the driving force behind service design. Integration of child health services should offer an efficient approach which is better designed to improve child health, and a crucial aspect of this is effective communication between general practitioners and paediatricians. The Programme for Integrated Child Health (PICH) has been developed in anticipation of a continuing move towards integrating high quality holistic paediatric care and with the aim of preparing paediatric and general practice trainees for new ways of working in the delivery of child health in the community. The aim of this evaluation was firstly to provide a synthesis of current research and perspectives about integrated care through a rapid review of the literature review. Then, subsequently to evaluate participants’ and mentors’ experiences of being involved in the PICH programme, to explore the following research questions: 1. How do course participants evaluate the PICH programme, in particular? a) What are the participants’ views about the structure of the programme? b) What did the participants learn from the programme? 2. What are participants’ views about integrated care and its impact on healthcare, in particular? a) How do participants understand the concept of integrated care, its aims, and its importance? b) What do participants say are the structural issues relevant to delivering integrated care? 3. How does the intraprofessional nature of the programme influence the participants? 1.2 Methodology A rapid review of the literature was followed by a mixed methods empirical study in which 1:1 interviews and ethnographic observations were used to explore the experiences and perceptions of mentors, GPs and paediatric trainees involved in the programme. 1.2.1 Participant sampling framework and recruitment The study population comprised trainees and mentors from Cohorts 1 and 2 of the PICH programme, which corresponded to the first and second years that the programme had run. All participants volunteered to take part in the study. The induction session from Cohort 3 was observed further research with that cohort was outside of the scope of this evaluation. 1.2.2 Data gathering Three PICH programme sessions were observed and 23 one-to-one participant interviews took place. A semi-structured interview schedule guided all interviews and they were audio-recorded and subsequently transcribed verbatim by a professional stenographer. 1.2.3 Data analysis Observation data and interview transcripts were subjected to thematic analysis. QSR NVivo 11© software was used to assist in the analysis and ensure inter-coder reliability. Data was analysed inductively from themes arising from the data but also deductively in response to the research questions. 1.2.4 Ethics Ethical approval was granted by UCL Research ethics committee (Ref: 8949/001). Participants gave their consent verbally at the start of the interviews. 1.3 Results 1.3.1 Participants Four teaching sessions were observed, three from cohort 2 and the induction session from cohort 3. One-to-one interviews were conducted with 23 participants. 1.3.2 Main findings 1.3.2.1 Programme evaluation The PICH programme was perceived to be well run, worthwhile, and provided the desired benefits in terms of education and learning about how integrated care can be delivered. The observations and interviews both revealed the enthusiasm of participants, mentors and programme leads and this undoubtedly contributed to the supportive yet ‘buzzing’ atmosphere described by many of the course participants. The induction session, the project website, the mentoring scheme, and the monthly seminars were all largely evaluated positively. There were some complications, for example, it was difficult for all trainees to attend all seminars due to busy work schedules. The induction was felt to be rather long and presentations, whilst of immense high quality, were perceived to be ‘too good’ and somewhat intimidating. Mentorship and support was appreciated by many of the trainees, both peers and mentors provided sources of influential advice. Some trainees felt that the mentoring was too open-ended and those who were unable to finalise their projects at the end of the year missed out on guidance. One critical component of the programme was the project. It caused both frustration and pleasure. Where barriers and delays were encountered, which derailed participants from submitting in a timely fashion, they often felt disappointment. However, many reflected later on the generic learning and the importance of the process. The projects gave participants a deep understanding of how using real data could influence traditional systems: an authentic problem-based approach. It also provided a sense of autonomy, enabling them to craft something of personal and professional relevance, to innovate and shape their own clinical environment. There was a widespread and positive perception of the style of learning delivered by the PICH programme. The aims of the project were clearly and spontaneously articulated in the interviews, demonstrating the success in delivering the PICH programme. Whilst participants did talk about learning clinical knowledge and skills in a speciality to which they would not necessarily have exposure, the vast majority of their talk was directed towards their own personal development: gaining confidence, independence, forming networks, tools for individual reflection and application. An important finding from the interviews, with both trainees and mentors, was that the course appeared to be successful in delivering tools for leadership too. Participants acquired skills to take forward integrated care initiatives; ready to enact change as ‘leaders’ of integrated care for the future. 1.3.2.2 Integrated care Trainees and mentors on the PICH programme were all integrated care enthusiasts, having been involved in other educational initiatives, in particular the ‘Learning Together’ clinics or having prior interest in the area. The rationale for integrating care was well understood and articulated by participants. All participants perceived a drive towards integration as rational, since they specified the patient must always be at the centre of care and it is in the patient’s interest that care is seamless, which integrated care enables. Moreover, there was a widespread feeling that integrated care is an idea whose time has come, not only because of the growing prominence of ‘patient-centred care’ as an ideal, but also given the need to increase efficiency in view of increasing economic pressures on healthcare. Participants were hopeful that integrated care was a driver for positive health systems change and believed that more integration was inevitable. However, they were mindful of significant barriers to implementation, including financial and territorial issues. Integrated care was reported to impact on patient care positively. Specific examples of overcoming current voids in the system were smoother referral processes and getting timely specialist advice. Integrated care was also felt to improve efficiency by preventing work from being duplicated. Integration was seen as an important concept centralizing the patient in systems-based re-organisation of health care which was likely to have tangible positive impacts for children and their families. 1.3.2.3 Integrated professions One of the most influential aspects of the programme was the creation of a shared spare for participants to talk about providing care by sharing stories. These narratives became fuller and more nuanced as the diversity of the participants increased. There were frequent stories about how responsibilities are shared within child health care and this provided the impetus for them to start thinking critically about how professional boundaries interlock and / or cross over between paediatrics and general practice. They talked about the vital role of effective communication in both the intra as well as interprofessional context, although the vast majority of the dialogue related to the latter. Communication was seen as a means of establishing effective relationships and reciprocally, building relationships resulted in improved communication and improved sharing of information. During the PICH programme participants’ learnt about seeing the other side of things, others working environment, the burden of paediatric clinical work, service pressures and affiliated health care networks which supported or undermined clinical practice. It was clear that their close perceived professional alignment – paediatricians and GP – was a natural one. However, alignment was not reported as universal. Certain specialities were not seen to align as similarly, which may be problematic for implementing future integrated care pathways. Participants gained a deeper understanding of the differences and similarities in each other’s clinical roles and how, crucially, they would now alter their own professional practice to take these into account. They became a more ‘blended professional’; one who adapts their own practice mindful of the others. This emergence of a blended professional raises the concept of professional identity, how they thought about themselves in their clinical capacity and how stepping out of traditional identities and thus roles aided the development of them as integrated professionals. 1.4 Conclusions The PICH programme was highly evaluated by participants and mentors. The overall feeling was that of a generally well-run course, which was populated by enthusiastic mentors and trainees, and which led to significant learning for everyone involved. Fundamental to its success were two key ingredients. Firstly, the learning environment established at the seminars provided both support and challenge from peers and senior colleagues and secondly, the project which allowed participants to engage with data, work with authentic problems and innovate. Whilst there were logistic issues with attendance and some frustration about project completion participant’s reported developing clinical, professional and transferable skills including leadership. Participants were all enthusiastic adopters of the concept of integrated care. However, they were aware of the practical realities of implementation, often significant structural barriers, but considered integrated care to be an effective patient-centred model for health service development. Alongside organisational systems participants learnt, through the PICH programme, the importance of the interpersonal. They articulated the value of understanding and adapting roles and identities to change professional behaviours and how to work as ‘integrated professionals’

Emotional and informational social support from health visitors and breastfeeding outcomes in the UK

Background: Shorter breastfeeding duration is associated with detrimental consequences for infant health/development and maternal health. Previous studies suggest social support is essential in maintaining breast/chest-feeding and helping to improve general infant feeding experiences. Public health bodies therefore work to support breastfeeding in the UK, yet UK breastfeeding rates continue to be one of the lowest globally. With this, a better understanding of the effectiveness and quality of infant feeding support is required. In the UK, health visitors (community public health nurses specialising in working with families with a child aged 0–5 years) have been positioned as one of the key providers of breast/chest-feeding support. Research evidence suggests that both inadequate informational support and poor/negative emotional support can lead to poor breastfeeding experiences and early breastfeeding cessation. Thus, this study tests the hypothesis that emotional support from health visitors moderates the relationship between informational support and breastfeeding duration/infant feeding experience among UK mothers. / Methods: We ran cox and binary logistic regression models on data from 565 UK mothers, collected as part of a 2017–2018 retrospective online survey on social support and infant feeding. / Results: Informational support, compared to emotional support, was a less important predictor of both breastfeeding duration and experience. Supportive emotional support with unhelpful or absent informational support was associated with the lowest hazard of breastfeeding cessation before 3 months. Results for breastfeeding experience followed similar trends, where positive experience was associated with supportive emotional and unhelpful informational support. Negative experiences were less consistent; however, a higher probability of negative experience was found when both types of support were reported as unsupportive. / Conclusions: Our findings point to the importance of health visitors providing emotional support to bolster the continuation of breastfeeding and encourage a positive subjective experience of infant feeding. The emphasis of emotional support in our results encourages increased allocation of resources and training opportunities to ensure health visitors are able to provide enhanced emotional support. Lowering health visitors caseloads to allow for personalised care is just one actionable example that may improve breastfeeding outcomes in the UK

Developing individual and team resilience in elite sport: research to practice

Drawing on the growing body of resilience research in elite sport, and the evaluation of the applied impact of this research with various national and international athletes and teams, the purpose of this article is to discuss the development of individual and team resilience with practical recommendations provided for athletes, coaches, and sport psychology practitioners operating in elite sport. Four overarching practical recommendations are provided to aid the development of individual resilience: ensure clarity of what resilience is and is not, enhance and refine personal qualities, evoke and maintain a challenge mindset, and create a facilitative environment. Furthermore, five psychosocial processes are outlined and practical recommendations are provided to develop team resilience: Transformational leadership, shared leadership, social identity, team learning, and team enjoyment and positive emotions. We hope that this article will help bridge the gap between research and practice in this area

The Management and Use of Social Network Sites in a Government Department

In this paper we report findings from a study of social network site use in a UK Government department. We have investigated this from a managerial, organisational perspective. We found at the study site that there are already several social network technologies in use, and that these: misalign with and problematize organisational boundaries; blur boundaries between working and social lives; present differing opportunities for control; have different visibilities; have overlapping functionality with each other and with other information technologies; that they evolve and change over time; and that their uptake is conditioned by existing infrastructure and availability. We find the organisational complexity that social technologies are often hoped to cut across is, in reality, something that shapes their uptake and use. We argue the idea of a single, central social network site for supporting cooperative work within an organisation will hit the same problems as any effort of centralisation in organisations. We argue that while there is still plenty of scope for design and innovation in this area, an important challenge now is in supporting organisations in managing what can best be referred to as a social network site 'ecosystem'.Comment: Accepted for publication in JCSCW (The Journal of Computer Supported Cooperative Work

The differential role of practical and emotional support in infant feeding experience in the UK.

Social support is a known determinant of breastfeeding behaviour and is generally considered beneficial. However, social support encompasses a myriad of different supportive acts, providing scope for diverse infant feeding outcomes. Given the vulnerability of postpartum mental health, this paper aims to explore both how support prolongs breastfeeding and which forms of support promote the positive experience of all infant feeding. Using survey data collected online from 515 UK mothers with infants aged 0-108 weeks, Cox regression models assessed the relationship between receiving different types of support, support need and breastfeeding duration. Quasi-binomial logistic regression models assessed the relationship between receiving support, infant feeding mode and maternal experience of infant feeding. Rates of negative infant feeding experience indicate the widespread need for support: e.g. 38% of currently, 47% of no longer and 31% of never breastfeeding women found infant feeding stressful. Overall, practical support via infant feeding broadly predicted shorter breastfeeding durations and poorer feeding experience; results in relation to other forms of support were more complex. Our findings indicate different forms of support have different associations with infant feeding experience. They also highlight the wide range of individuals beyond the nuclear family on which postpartum mothers in the UK rely. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'

Hunter-gatherer health and development policy: How the promotion of sedentism worsens the Agta's health outcomes

Many hunter-gatherer groups live on the outskirts of wider society, experiencing poor health outcomes with little access to medical care. From a development perspective, key interventions include the sedentarisation of these mobile peoples into camps nearby larger towns with sanitation infrastructure and medical care, as increased access to services is assumed to improve outcomes. However, recent research in the Agta (Philippine foragers from North-east Luzon) has demonstrated that individuals residing in more ‘developed’ communities suffer from increased morbidity and mortality. Here, using quantitative and ethnographic data on health collected between 2002 and 2014, we explore why this trend occurs by examining the relationship between key development initiatives with self-reported illness and the uptake of medical interventions with 415 Agta men, women and children. We demonstrate that health outcomes worsen as sedentarisation progresses, despite some increases in medical access. We argue this is because the development paradigm is not evidence-based, but rather stems from an ideological dislike of mobile hunter-gatherer lifestyles. Compounded by cultural insensitivity and daily discrimination, current interventions are ill-suited to the unique needs of hunter-gatherers, and thus ineffective. Based on our findings we offer future short and long-term policy suggestions which seek to reduce the Agta's vulnerability, rather than increase it

Emotional and informational social support from health visitors and breastfeeding outcomes in the UK

Availability of data and materials: The dataset supporting the conclusions of this article is available in the OSF repository, https://osf.io/2d4v5/.Supplementary Information is available online at https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-023-00551-7#Sec20 .Copyright © The Author(s) 2023. Shorter breastfeeding duration is associated with detrimental consequences for infant health/development and maternal health. Previous studies suggest social support is essential in maintaining breast/chest-feeding and helping to improve general infant feeding experiences. Public health bodies therefore work to support breastfeeding in the UK, yet UK breastfeeding rates continue to be one of the lowest globally. With this, a better understanding of the effectiveness and quality of infant feeding support is required. In the UK, health visitors (community public health nurses specialising in working with families with a child aged 0–5 years) have been positioned as one of the key providers of breast/chest-feeding support. Research evidence suggests that both inadequate informational support and poor/negative emotional support can lead to poor breastfeeding experiences and early breastfeeding cessation. Thus, this study tests the hypothesis that emotional support from health visitors moderates the relationship between informational support and breastfeeding duration/infant feeding experience among UK mothers.The Medical Research Council part-funded this research, by funding Abigail E. Page fellowship (grant number MR/P014216/1)

Why so many Agta boys? Explaining ‘extreme’ sex ratios in Philippine foragers

Male-biased sex ratios have been observed in multiple small-scale societies. Although intentional and systematic female-biased mortality has been posited as an explanation, there is often a lack of ethnographic evidence of systematic female neglect and/or infanticide. The Agta, a foraging population from the Philippines, have a skewed sex ratio of 1.29 (129 males per 100 females) aged 15 years or under. We hypothesised that this skew was not caused by greater female deaths, but due to an adaptive response, where more males were produced at birth in reaction to high male-biased extrinsic mortality. To test this hypothesis we utilise census, childcare and mortality data from 915 Agta. The Agta's sex ratio is significantly male-biased in the <1 (n = 48, 2:1) and 1–5 year (n = 170, 1.39:1) age cohorts; however, we find no evidence of systematic female neglect in patterns of childcare. Furthermore, the sex ratio decreases over cohorts, becoming balanced by the end of the juvenile period, owing to significantly higher male mortality. Taken together, these results are not supportive of female infanticide or neglect, and instead suggest an adaptive mechanism, acting in utero as a response to male-biased juvenile mortality, following Fisherian principles of equalising parental investment

Biodegradable zinc-containing mesoporous silica nanoparticles for cancer therapy

Triple-negative breast cancers are extremely aggressive with limited treatment options because of the reduced response of the cancerous cells to hormonal therapy. Here, monodispersed zinc-containing mesoporous silica nanoparticles (MSNPs-Zn) were produced as a tuneable biodegradable platform for delivery of therapeutic zinc ions into cells. We demonstrate that the nanoparticles were internalized by cells, and a therapeutic dose window was identified in which the MSNPs-Zn were toxic to breast cancer cells but not to healthy epithelial (MCF-10a) cells or to murine macrophages. A significant reduction in the viability of triple negative MDA-MB-231 and MCF-7 (ER+) breast cancer cells was seen following 24 h exposure to MSNPs-Zn. The more aggressive MDA-MB-231 cells, with higher metastatic potential, were more sensitive to MSNPs-Zn than the MCF-7 cells. MSNPs-Zn underwent biodegradation inside the cells, becoming hollow structures, as imaged by high-resolution transmission electron microscopy. The mesoporous silica nanoparticles provide a biodegradable vehicle for therapeutic ion release inside cells