What factors influence midwives to provide obstetric high dependency care on the delivery suite or request care be escalated away from the obstetric unit? Findings of a focus group study

Abstract Background In the United Kingdom, midwives will engage in discussions with the multidisciplinary team as to whether they can provide Obstetric High Dependency Care (OHDC) on the Delivery Suite or whether a woman’s care should be escalated to the critical care team. This study aimed to explore the question: What factors influence midwives to provide OHDC or request care be escalated away from the obstetric unit in hospitals remote from tertiary referral centres? Methods Focus groups were undertaken with midwives (n = 34) across three obstetric units in England, with annual birth rates ranging from 1500 to 5000 per annum, in District General Hospitals. Three scenarios in the form of video vignettes of handover were used as triggers for the focus groups. Scenario 1; severe pre-eclampsia, physiologically unstable 2; major postpartum haemorrhage requiring invasive monitoring 3; recent admission of woman with chest pain receiving facial oxygen and requiring continuous electrocardiogram (ECG) monitoring. Two focus groups were conducted in each of the obstetric units with experienced midwives. Data were analysed using a qualitative framework approach. Results Factors influencing midwives’ care escalation decisions included the care environment, a woman’s diagnosis and fetal or neonatal factors. The overall plan of care including the need for ECG and invasive monitoring were also influential factors. Midwives in the smallest obstetric unit did not have access to the facilities for OHDC provision. Midwives in the larger obstetric units provided OHDC but identified varying degrees of skill and sometimes used ‘workarounds’ to facilitate care provision. Midwifery staffing levels, skill mix and workload were also influential. Some differences of opinion were evident between midwives working in the same obstetric units as to whether OHDC could be provided and the support they would enlist to help them provide it. Reliance on clinical guidelines appeared variable. Conclusions Findings indicate that there may be inequitable OHDC provision at a local level. Organisationally robust systems are required to promote safe, equitable OHDC care including skills development for midwives and precise escalation guidelines to minimise workarounds. Training for midwives must include strategies that prevent skills fade. </jats:sec

<i>‘What retention’ means to me</i>: the position of the adult learner in student retention

Studies of student retention and progression overwhelmingly appear adopt definitions that place the institution, rather than the student, at the centre. Retention is most often conceived in terms of linear and continuous progress between institutionally identified start and end points. This paper reports on research that considered data from 38 in-depth interviews conducted with individuals who had characteristics often associated with non-traditional engagement in higher education who between 2006 and 2010 had studied an ‘Introduction to HE’ module at one distance higher education institution, some of whom had progressed to further study at that institution, some of whom had not. The research deployed a life histories approach to seek a finer grained understanding of how individuals conceptualise their own learning journey and experience, in order to reflect on institutional conceptions of student retention. The findings highlight potential anomalies hidden within institutional retention rates – large proportions of the interview participants who were not ‘retained’ by the institution reported successful progression to and in other learning institutions and environments, both formal and informal. Nearly all described positive perspectives on lifelong learning which were either engendered or improved by the learning undertaken. This attests to the complexity of individuals’ lives and provides clear evidence that institution-centric definitions of retention and progression are insufficient to create truly meaningful understanding of successful individual learning journeys and experiences. It is argued that only through careful consideration of the lived experience of students and a re-conception of measures of retention, will we be able to offer real insight into improving student retention

Secondary literacy across the curriculum: Challenges and possibilities

This paper discusses the challenges and possibilities attendant upon successfully implementing literacy across the curriculum initiatives – or ‘school language policies’ as they have come to be known - particularly at the secondary or high school level. It provides a theoretical background to these issues, exploring previous academic discussions of school language policies, and highlights key areas of concern as well as opportunity with respect to school implementation of such policies. As such, it provides a necessary conceptual background to the subsequent papers in this special issue, which focus upon the Secondary Schools’ Literacy Initiative (SSLI) – a New Zealand funded programme that aims to establish cross-curricular language and literacy policies in secondary schools

Collaborative action research through technologically mediated agoras.

ABSTRACT: The study presented in this article forms part of a wider project promoting collaboration between junior researchers from different universities with the objective of rethinking and improving teaching practice in relation to the use of technology. The article describes research carried out during the 2012/13 academic year aimed at developing collaborative action research through technologically mediated agoras involving students from three Spanish universities. The main results of this study show that junior researchers improved their teaching practice through technologically mediated inside and outside agoras. In addition, the transformation of university classrooms into agoras enabled the negotiated reconstruction of knowledge for the analysis of good practice in the use of technology. Likewise, these agoras helped reduce limitations by breaking down the barriers of time, distance and resources for sharing findings and limitations between junior researchers. Furthermore, they pave the way for improvements and their implementation in learning processes during initial teacher training

Machine learning outperforms clinical experts in classification of hip fractures

Hip fractures are a major cause of morbidity and mortality in the elderly, and incur high health and social care costs. Given projected population ageing, the number of incident hip fractures is predicted to increase globally. As fracture classification strongly determines the chosen surgical treatment, differences in fracture classification influence patient outcomes and treatment costs. We aimed to create a machine learning method for identifying and classifying hip fractures, and to compare its performance to experienced human observers. We used 3659 hip radiographs, classified by at least two expert clinicians. The machine learning method was able to classify hip fractures with 19% greater accuracy than humans, achieving overall accuracy of 92%

The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

Background Poor service user experiences are often reported on mental health inpatient wards. Crisis houses are an alternative, but evidence is limited. This paper investigates therapeutic alliances in acute wards and crisis houses, exploring how far stronger therapeutic alliance may underlie greater client satisfaction in crisis houses. Methods and Findings Mixed methods were used. In the quantitative component, 108 crisis house and 247 acute ward service users responded to measures of satisfaction, therapeutic relationships, informal peer support, recovery and negative events experienced during the admission. Linear regressions were conducted to estimate the association between service setting and measures, and to model the factors associated with satisfaction. Qualitative interviews exploring therapeutic alliances were conducted with service users and staff in each setting and analysed thematically. Results We found that therapeutic alliances, service user satisfaction and informal peer support were greater in crisis houses than on acute wards, whilst self-rated recovery and numbers of negative events were lower. Adjusted multivariable analyses suggest that therapeutic relationships, informal peer support and negative experiences related to staff may be important factors in accounting for greater satisfaction in crisis houses. Qualitative results suggest factors that influence therapeutic alliances include service user perceptions of basic human qualities such as kindness and empathy in staff and, at service level, the extent of loss of liberty and autonomy. Conclusions and Implications We found that service users experience better therapeutic relationships and higher satisfaction in crisis houses compared to acute wards, although we cannot exclude the possibility that differences in service user characteristics contribute to this. This finding provides some support for the expansion of crisis house provision. Further research is needed to investigate why acute ward service users experience a lack of compassion and humanity from ward staff and how this could be changed

The purpose of mess in action research: building rigour though a messy turn

Mess and rigour might appear to be strange bedfellows. This paper argues that the purpose of mess is to facilitate a turn towards new constructions of knowing that lead to transformation in practice (an action turn). Engaging in action research - research that can disturb both individual and communally held notions of knowledge for practice - will be messy. Investigations into the 'messy area', the interface between the known and the nearly known, between knowledge in use and tacit knowledge as yet to be useful, reveal the 'messy area' as a vital element for seeing, disrupting, analysing, learning, knowing and changing. It is the place where long-held views shaped by professional knowledge, practical judgement, experience and intuition are seen through other lenses. It is here that reframing takes place and new knowing, which has both theoretical and practical significance, arises: a 'messy turn' takes place

Action research in physical education: focusing beyond myself through cooperative learning

This paper reports on the pedagogical changes that I experienced as a teacher engaged in an action research project in which I designed and implemented an indirect, developmentally appropriate and child‐centred approach to my teaching. There have been repeated calls to expunge – or at least rationalise – the use of traditional, teacher‐led practice in physical education. Yet despite the advocacy of many leading academics there is little evidence that such a change of approach is occurring. In my role as teacher‐as‐researcher I sought to implement a new pedagogical approach, in the form of cooperative learning, and bring about a positive change in the form of enhanced pupil learning. Data collection included a reflective journal, post‐teaching reflective analysis, pupil questionnaires, student interviews, document analysis, and non‐participant observations. The research team analysed the data using inductive analysis and constant comparison. Six themes emerged from the data: teaching and learning, reflections on cooperation, performance, time, teacher change, and social interaction. The paper argues that cooperative learning allowed me to place social and academic learning goals on an even footing, which in turn placed a focus on pupils’ understanding and improvement of skills in athletics alongside their interpersonal development

Scattering of long wavelengths into thin silicon photovoltaic films by plasmonic silver nanoparticles

Nanoparticles and nanostructures with plasmonic resonances are currently being employed to enhance the efficiency of solar cells. Ag stripe arrays have been shown theoretically to enhance the short-circuit current of thin silicon layers. Monolayers of Ag nanoparticles with diameter d < 300 nm have shown strong plasmonic resonances when coated in thin polymer layers with thicknesses < d. We study experimentally the diffuse vs. specular scattering from monolayer arrays of Ag nanoparticles (spheres and prisms with diameters in the range 50 – 300 nm) coated onto the front side of thin (100 nm < t < 500 nm) silicon films deposited on glass and flexible polymer substrates, the latter originating in a roll-to-roll manufacturing process. Ag nanoparticles are held in place and aggregation is prevented with a polymer overcoat. We observe interesting wavelength shifts between maxima in specular and diffuse scattering that depend on particle size and shape, indicating that the nanoparticles substantially modify the scattering into the thin silicon film.United States. Air Force (United States. Army. Natick Soldier Research Development and Engineering Center Contract FA8721-05-C-0002)Massachusetts Institute of Technology. Institute for Soldier Nanotechnologies (Contract W911NF-07-D0004