24 research outputs found
Optical Spectral Variability of the Very-High-Energy Gamma-Ray Blazar 1ES 1011+496
We present results of five years of optical (UBVRI) observations of the
very-high-energy gamma-ray blazar 1ES 1011+496 at the MDM Observatory. We
calibrated UBVRI magnitudes of five comparison stars in the field of the
object. Most of our observations were done during moderately faint states of
1ES 1011+496 with R > 15.0. The light curves exhibit moderate, closely
correlated variability in all optical wavebands on time scales of a few days. A
cross-correlation analysis between optical bands does not show significant
evidence for time lags. We find a positive correlation (Pearson's r = 0.57;
probability of non-correlation P(>r) ~ 4e-8) between the R-band magnitude and
the B - R color index, indicating a bluer-when-brighter trend. Snap-shot
optical spectral energy distributions (SEDs) exhibit a peak within the optical
regime, typically between the V and B bands. We find a strong (r = 0.78;
probability of non-correlation P (>r) ~ 1e-15) positive correlation between the
peak flux and the peak frequency, best fit by a relation with k = 2.05 +/- 0.17. Such a correlation is
consistent with the optical (synchrotron) variability of 1ES 1011+496 being
primarily driven by changes in the magnetic field.Comment: Accepted for publication in ApJ. 16 pages, including 7 figure
Existing maternal obesity guidelines may increase inequalities between ethnic groups: a national epidemiological study of 502,474 births in England
Abstract Background: Asians are at increased risk of morbidity at a lower body mass index (BMI) than European Whites, particularly relating to metabolic risk. UK maternal obesity guidelines use general population BMI criteria to define obesity, which do not represent the risk of morbidity among Asian populations. This study compares incidence of first trimester obesity using Asian-specific and general population BMI criteria. Method: A retrospective epidemiological study of 502,474 births between 1995 and 2007, from 34 maternity units across England. Data analyses included a comparison of trends over time between ethnic groups using Asian-specific and general population BMI criteria. Logistic regression estimated odds ratios for first trimester obesity among ethnic groups following adjustment for population demographics
Inside the âimperfect mosaicâ: Minority ethnic womenâs qualitative experiences of race and ethnicity during pregnancy, childbirth, and maternity care in the United Kingdom
Background: Persistent, high rates of maternal mortality amongst ethnic minorities is one of the UKâs starkest examples of racial disparity. With greater risks of adverse outcomes during maternity care, ethnic minority women are subjected to embedded, structural and systemic discrimination throughout the healthcare service. Methods: Fourteen semi-structured interviews were undertaken with minority ethnic women who had recent experience of UK maternity care. Data pertaining to ethnicity and race were subject to iterative, inductive coding, and constant comparison through Grounded Theory Analysis to test a previously established theory: The âImperfect Mosaicâ. Analysis & findings: A related theory emerged, comprising four themes: âStopping Short of Agentic Birthâ; âSilenced and Stigmatised through Tick-Box Careâ; âAnticipating Discrimination and the Need for Advocacyâ; and âNavigating Cultural Differencesâ. The new theory: Inside the âImperfect Mosaicâ, demonstrates experiences of those who received maternity care which directly mirrors experiences of those who provide care, as seen in the previous theory we set-out to test. However, the current theory is based on more traditional and familiar notions of racial discrimination, rather than the nuanced, subtleties of socio-demographic-based micro-aggressions experienced by healthcare professionals. Conclusions: Our findings suggest the need for the following actions: Prioritisation of bodily autonomy and agency in perinatal physical and mental healthcare; expand awareness of social and cultural issues (i.e., moral injury; cultural safety) within the NHS; and undertake diversity training and support, and follow-up of translation of the training into practice, across (maternal) health services
Precarity and preparedness during the SARS-CoV-2 pandemic: A qualitative service evaluation of maternity healthcare professionals
Introduction: The SARS-CoV-2 pandemic has devastated populations, posing unprecedented challenges for healthcare services, staff and service-users. In the UK, rapid reconfiguration of maternity healthcare service provision changed the landscape of antenatal, intrapartum and postnatal care. This study aimed to explore the experiences of maternity services staff who provided maternity care during the SARS-CoV-2 pandemic to inform future improvements in care. Material and methods: A qualitative interview service evaluation was undertaken at a single maternity service in an NHS Trust, South London. Respondents (n = 29) were recruited using a critical case purposeful sample of maternity services staff. Interviews were conducted using video-conferencing software, and were transcribed and analyzed using Grounded Theory Analysis appropriate for cross-disciplinary health research. The focus of analysis was on staff experiences of delivering maternity services and care during the SARS-CoV-2 pandemic. Results: A theory of âPrecarity and Preparednessâ was developed, comprising three main emergent themes: âEndemic precarity: A health system under pressureâ; âA top-down approach to managing the health system shockâ; and âFrom un(der)-prepared to future flourishingâ. Conclusions: Maternity services in the UK were under significant strain and were inherently precarious. This was exacerbated by the SARS-CoV-2 pandemic, which saw further disruption to service provision, fragmentation of care and pre-existing staff shortages. Positive changes are required to improve staff retention and team cohesion, and ensure patient-centered care remains at the heart of maternity care
Reflective, pragmatic, and reactive decision-making by maternity service providers during the SARS-CoV-2 pandemic health system shock: a qualitative, grounded theory analysis
Background: Pregnant and postpartum women were identified as having particular vulnerability to severe symptomatology of SARS-CoV-2 infection, so maternity services significantly reconfigured their care provision. We examined the experiences and perceptions of maternity care staff who provided care during the pandemic in South London, United Kingdom â a region of high ethnic diversity with varied levels of social complexity. Methods: We conducted a qualitative interview study, as part of a service evaluation between August and November 2020, using in-depth, semi-structured interviews with a range of staff (N = 29) working in maternity services. Data were analysed using Grounded Theory analysis appropriate to cross-disciplinary health research. Analysis & findings: Maternity healthcare professionals provided their views, experiences, and perceptions of delivering care during the pandemic. Analysis rendered three emergent themes regarding decision-making during reconfigured maternity service provision, organised into pathways: 1) âReflective decision-makingâ; 2) âPragmatic decision-makingâ; and 3) âReactive decision-makingâ. Whilst pragmatic decision-making was found to disrupt care, reactive-decision-making was perceived to devalue the care offered and provided. Alternatively, reflective decision-making, despite the difficult working conditions of the pandemic, was seen to benefit services, with regards to care of high-quality, sustainability of staff, and innovation within the service. Conclusions: Decision-making within maternity care was found to take three forms â where at best changes to services could be innovative, at worst they could cause devaluation in care being delivered, and more often than not, these changes were disruptive. With regard to positive changes, healthcare providers identified staff empowerment, flexible working patterns (both for themselves and collectively as teams), personalised care delivery, and change-making in general, as key areas to capitalise on current and ongoing innovations borne out of the pandemic. Key learnings included a focus on care-related, meaningful listening and engagement of staff at all levels, in order to drive forward high-quality care and avoid care disruption and devaluation
On race and ethnicity during a global pandemic: An âimperfect mosaicâ of maternal and child health services in ethnically-diverse South London, United Kingdom
Background: The SARS-CoV-2 pandemic has brought racial and ethnic inequity into sharp focus, as Black, Asian, and Minority Ethnic people were reported to have greater clinical vulnerability. During the pandemic, priority was given to ongoing, reconfigured maternity and children's healthcare. This study aimed to understand the intersection between race and ethnicity, and healthcare provision amongst maternity and children's healthcare professionals, during the SARS-CoV-2 pandemic. Methods: A qualitative study consisting of semi-structured interviews (N = 53) was undertaken with maternity (n = 29; August-November 2020) and children's (n = 24; June-July 2021) healthcare professionals from an NHS Trust in ethnically-diverse South London, UK. Data pertinent to ethnicity and race were subject to Grounded Theory Analysis, whereby data was subjected to iterative coding and interpretive analysis. Using this methodology, data are compared between transcripts to generate lower and higher order codes, before super-categories are formed, which are finally worked into themes. The inter-relationship between these themes is interpreted as a final theory. Findings: Grounded Theory Analysis led to the theory: An âImperfect Mosaicâ, comprising four themes: (1) âA System Set in Plasterâ; (2) âThe Marginalised Majorityâ; (3) âSelf-Discharging Responsibility for Change-Makingâ; and (4) âSlow Progress, Not No Progressâ. The NHS was observed to be brittle, lacking plasticity to deliver change at pace. Overt racism based on skin colour has been replaced by micro-aggressions between in-groups and out-groups, defined not just by ethnicity, but by other social determinants. Contemporaneously, responsibility for health, wellbeing, and psychological safety in the workplace is discharged to, and accepted by, the individual. Interpretation: Our findings suggest three practicable solutions: (1) Representation of marginalised groups at all NHS levels; (2) Engagement in cultural humility which extends to other social factors; and (3) Collective action at system and individual levels, including prioritising equity over simplistic notions of equality. Funding: This service evaluation was supported by the King's College London King's Together Rapid COVID-19 Call, successfully awarded to Laura A. Magee, Sergio A. Silverio, Abigail Easter, & colleagues (reference:- 204823/Z/16/Z), as part of a rapid response call for research proposals. The King's Together Fund is a Wellcome Trust funded initiative
A consensus statement on perinatal mental health during the COVID-19 pandemic and recommendations for post-pandemic recovery and re-build
Introduction: The COVID-19 pandemic posed a significant lifecourse rupture, not least to those who had specific physical vulnerabilities to the virus, but also to those who were suffering with mental ill health. Women and birthing people who were pregnant, experienced a perinatal bereavement, or were in the first post-partum year (i.e., perinatal) were exposed to a number of risk factors for mental ill health, including alterations to the way in which their perinatal care was delivered. Methods: A consensus statement was derived from a cross-disciplinary collaboration of experts, whereby evidence from collaborative work on perinatal mental health during the COVID-19 pandemic was synthesised, and priorities were established as recommendations for research, healthcare practice, and policy. Results: The synthesis of research focused on the effect of the COVID-19 pandemic on perinatal health outcomes and care practices led to three immediate recommendations: what to retain, what to reinstate, and what to remove from perinatal mental healthcare provision. Longer-term recommendations for action were also made, categorised as follows: Equity and Relational Healthcare; Parity of Esteem in Mental and Physical Healthcare with an Emphasis on Specialist Perinatal Services; and Horizon Scanning for Perinatal Mental Health Research, Policy, & Practice. Discussion: The evidence base on the effect of the pandemic on perinatal mental health is growing. This consensus statement synthesises said evidence and makes recommendations for a post-pandemic recovery and re-build of perinatal mental health services and care provision