An analysis of media reporting on the closure of freestanding midwifery units in England

PROBLEM: Despite clinical guidelines and policy promoting choice of place of birth, 14 Freestanding Midwifery Units were closed between 2008 and 2015, closures justified by low use and financial constraints. BACKGROUND: The Birthplace in England Programme found that freestanding midwifery units provided the most cost-effective birthplace for women at low risk of complications. Women planning birth in a freestanding unit were less likely to experience interventions than those planning obstetric unit birth, with no difference in outcomes for babies. METHODS: This paper uses an interpretative technique developed for policy analysis to explore the representation of these closures in 191 news articles, to explore the public climate in which they occurred. FINDINGS AND DISCUSSION: The articles focussed on underuse by women and financial constraints on services. Despite the inclusion of service user voices, the power of framing was held by service managers and commissioners. The analysis exposed how neoliberalist and austerity policies has privileged representation of individual consumer choice and market-driven provision as drivers of changes in health services. This normative framing makes the reasons given for closure as hard to refute and cultural norms persist that birth is safest in an obstetric setting, despite evidence to the contrary. CONCLUSION: The rise of neoliberalism and austerity in contemporary Britain has influenced the reform of maternity services, in particular the closure of midwifery units. Justifications given for closure silence other narratives, predominantly from service users, that attempt to present women's choice in terms of rights and a social model of care

Factors influencing utilisation of ‘free-standing’ and ‘alongside’ midwifery units for low-risk births in England: a mixed-methods study

Background Midwifery-led units (MUs) are recommended for ‘low-risk’ births by the National Institute for Health and Care Excellence but according to the National Audit Office were not available in one-quarter of trusts in England in 2013 and, when available, were used by only a minority of the low-risk women for whom they should be suitable. This study explores why. Objectives To map the provision of MUs in England and explore barriers to and facilitators of their development and use; and to ascertain stakeholder views of interventions to address these barriers and facilitators. Design Mixed methods – first, MU access and utilisation across England was mapped; second, local media coverage of the closure of free-standing midwifery units (FMUs) were analysed; third, case studies were undertaken in six sites to explore the barriers and facilitators that have an impact on the development of MUs; and, fourth, by convening a stakeholder workshop, interventions to address the barriers and facilitators were discussed. Setting English NHS maternity services. Participants All trusts with maternity services. Interventions Establishing MUs. Main outcome measures Numbers and types of MUs and utilisation of MUs. Results Births in MUs across England have nearly tripled since 2011, to 15% of all births. However, this increase has occurred almost exclusively in alongside units, numbers of which have doubled. Births in FMUs have stayed the same and these units are more susceptible to closure. One-quarter of trusts in England have no MUs; in those that do, nearly all MUs are underutilised. The study findings indicate that most trust managers, senior midwifery managers and obstetricians do not regard their MU provision as being as important as their obstetric-led unit provision and therefore it does not get embedded as an equal and parallel component in the trust’s overall maternity package of care. The analysis illuminates how provision and utilisation are influenced by a complex range of factors, including the medicalisation of childbirth, financial constraints and institutional norms protecting the status quo. Limitations When undertaking the case studies, we were unable to achieve representativeness across social class in the women’s focus groups and struggled to recruit finance directors for individual interviews. This may affect the transferability of our findings. Conclusions Although there has been an increase in the numbers and utilisation of MUs since 2011, significant obstacles remain to MUs reaching their full potential, especially FMUs. This includes the capacity and willingness of providers to address women’s information needs. If these remain unaddressed at commissioner and provider level, childbearing women’s access to MUs will continue to be restricted. Future work Work is needed on optimum approaches to improve decision-makers’ understanding and use of clinical and economic evidence in service design. Increasing women’s access to information about MUs requires further studies of professionals’ understanding and communication of evidence. The role of FMUs in the context of rural populations needs further evaluation to take into account user and community impact. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 12. See the NIHR Journals Library website for further project information

Interrogating fragments using a protein thermal shift assay

Protein thermal shift is a relatively rapid and inexpensive technique for the identification of low molecular weight compound interactions with protein targets. An increase in the melting temperature of the target protein in the presence of a test ligand is indicative of a promising ligand-protein interaction. Due to its simplicity, protein thermal shift is an attractive method for screening libraries and validating hits in drug discovery programs. The methodology has been used successfully in high throughput screens of small molecule libraries, and its application has been extended to report on protein-drug-like-fragment interactions. Here, we review how protein thermal shift has been employed recently in fragment-based drug discovery (FBDD) efforts, and highlight its application to protein-protein interaction targets. Multiple validation of fragment hits by independent means is paramount to ensure efficient and economical progress in a FBDD campaign. We discuss the applicability of thermal shift assays in this light, and discuss more generally what one does when orthogonal approaches disagree

Factors influencing the utilisation of free-standing and alongside midwifery units in England: a qualitative research study

OBJECTIVE: To identify factors influencing the provision, utilisation and sustainability of midwifery units (MUs) in England. DESIGN: Case studies, using individual interviews and focus groups, in six National Health Service (NHS) Trust maternity services in England. SETTING AND PARTICIPANTS: NHS maternity services in different geographical areas of England Maternity care staff and service users from six NHS Trusts: two Trusts where more than 20% of all women gave birth in MUs, two Trusts where less than 10% of all women gave birth in MUs and two Trusts without MUs. Obstetric, midwifery and neonatal clinical leaders, managers, service user representatives and commissioners were individually interviewed (n=57). Twenty-six focus groups were undertaken with midwives (n=60) and service users (n=52). MAIN OUTCOME MEASURES: Factors influencing MU use. FINDINGS: The study findings identify several barriers to the uptake of MUs. Within a context of a history of obstetric-led provision and lack of decision-maker awareness of the clinical and economic evidence, most Trust managers and clinicians do not regard their MU provision as being as important as their obstetric unit (OU) provision. Therefore, it does not get embedded as an equal and parallel component in the Trust's overall maternity package of care. The analysis illuminates how implementation of complex interventions in health services is influenced by a range of factors including the medicalisation of childbirth, perceived financial constraints, adequate leadership and institutional norms protecting the status quo. CONCLUSIONS: There are significant obstacles to MUs reaching their full potential, especially free-standing midwifery units. These include the lack of commitment by providers to embed MUs as an essential service provision alongside their OUs, an absence of leadership to drive through these changes and the capacity and willingness of providers to address women's information needs. If these remain unaddressed, childbearing women's access to MUs will continue to be restricted

Fingerprinting the tertiary structure of electroadsorbed lysozyme at soft interfaces by electrostatic spray ionization mass spectrometry

Lysozyme can be electrochemically detected after adsorption at an electrified gel–water interface. Ex situ characterization by electrostatic spray ionization mass spectrometry provides insights into the interfacial detection mechanism by allowing changes to the tertiary structure of electroadsorbed lysozyme to be fingerprinted for the first time

Influence of positional correlations on the propagation of waves in a complex medium with polydisperse resonant scatterers

We present experimental results on a model system for studying wave propagation in a complex medium exhibiting low frequency resonances. These experiments enable us to investigate a fundamental question that is relevant for many materials, such as metamaterials, where low-frequency scattering resonances strongly influence the effective medium properties. This question concerns the effect of correlations in the positions of the scatterers on the coupling between their resonances, and hence on wave transport through the medium. To examine this question experimentally, we measure the effective medium wave number of acoustic waves in a sample made of bubbles embedded in an elastic matrix over a frequency range that includes the resonance frequency of the bubbles. The effective medium is highly dispersive, showing peaks in the attenuation and the phase velocity as functions of the frequency, which cannot be accurately described using the Independent Scattering Approximation (ISA). This discrepancy may be explained by the effects of the positional correlations of the scatterers, which we show to be dependent on the size of the scatterers. We propose a self-consistent approach for taking this "polydisperse correlation" into account and show that our model better describes the experimental results than the ISA

Anion Distribution, Structural Distortion, and Symmetry-Driven Optical Band Gap Bowing in Mixed Halide Cs₂SnX₆ Vacancy Ordered Double Perovskites

Mixed anion compounds in the Fm-3m vacancy ordered perovskite structure were synthesised and characterised experimentally and computationally with a focus on compounds where A = Cs+. Pure anion Cs2SnX6 compounds were formed with X = Cl, Br and I using a room temperature solution phase method. Mixed anion compounds were formed as solid solutions of Cs2SnCl6 and Cs2SnBr6 and a second series from Cs2SnBr6 and Cs2SnI6. Single phase structures formed across the entirety of both composition series, with no evidence of long range anion ordering observed by diffraction. A distortion of the cubic A2BX6 structure was identified in which the spacing of the BX6 octahedra changes to accommodate the A site cation without reduction of overall symmetry. Optical band gap values varied with anion composition between 4.89 eV in Cs2SnCl6 to 1.35 eV in Cs2SnI6, but proved highly non-linear with changes in composition. In mixed halide compounds it was found that lower energy optical transitions appeared that were not present in the pure halide compounds, and this could be attributed to lowering of the local symmetry within the tin halide octahedra. The electronic structure was characterised by photoemission spectroscopy, and Raman spectroscopy revealed vibrational modes in the mixed halide compounds that could be assigned to particular mixed halide octahedra. This analysis was used to determine the distribution of octahedra types in mixed anion compounds, which was found to be consistent with a near-random distribution of halide anions throughout the structure, although some deviations from random halide distribution were noted in mixed iodide-bromide compounds, where the larger iodide anions preferentially adopted trans configurations

Device-to-device communications: a performance analysis in the context of social comparison-based relaying

Device-to-device (D2D) communications are recognized as a key enabler of future cellular networks which will help to drive improvements in spectral efficiency and assist with the offload of network traffic. Among the transmission modes of D2D communications are single-hop and relay assisted multi-hop transmission. Relay-assisted D2D communications will be essential when there is an extended distance between the source and destination or when the transmit power of D2D user equipments (UEs) is constrained below a certain level. Although a number of works on relay-assisted D2D communications have been presented in the literature, most of those assume that relay nodes cooperate unequivocally. In reality, this cannot be assumed since there is little incentive to cooperate without a guarantee of future reciprocal behavior. Cooperation is a social behavior that depends on various factors, such as peer comparison, incentives, the cost to the donor and the benefit to the recipient. To incorporate the social behavior of D2D relay nodes, we consider the decision to relay using the donation game based on social comparison and characterize the probability of cooperation in an evolutionary context. We then apply this within a stochastic geometric framework to evaluate the outage probability and transmission capacity of relay assisted D2D communications. Through numerical evaluations, we investigate the performance gap between the ideal case of 100% cooperation and practical scenarios with a lower cooperation probability. It shows that practical scenarios achieve lower transmission capacity and higher outage probability than idealistic network views which assume full cooperation. After a sufficient number of generations, however, the cooperation probability follows the natural rules of evolution and the transmission performance of practical scenarios approach that of the full cooperation case, indicating that all D2D relay nodes adopt the same dominant cooperative strategy based on social comparison, without the need for enforcement by an external authority

Mercury Accumulation in Tree Rings: Observed Trends in Quantity and Isotopic Composition in Shenandoah National Park, Virginia

Recent studies have shown that mercury (Hg) concentrations in tree rings have the potential to archive historical Hg exposure from local, regional, and global sources. The southeastern United States has received elevated Hg deposition, yet no studies have evaluated tree ring Hg in this region. Here, we quantify Hg accumulation and isotopic composition in tree rings collected in Shenandoah National Park, Virginia. Cores were collected from three individuals of three tree species—white oak (Quercus alba), northern red oak (Quercus rubra), and pitch pine (Pinus rigida)—within the northern, central, and southern areas of the Park (n = 27 cores). The cores were analyzed for Hg content in 10‐year increments, with some cores dating back to the early 1800s. Overall, tree ring Hg concentrations (ranging from below detection to 4.4 ng/g) were similar to other studies and varied between species, with pitch pine having higher concentrations than the deciduous species. The most notable feature of the tree ring Hg time series was a peak that occurred during the 1930s through 1950s, coinciding with the use of Hg at a local industrial facility. Atmospheric modeling indicates that potential emissions from the plant likely had a stronger impact on the southern region of the Park, consistent with the latitudinal gradient in tree ring Hg concentrations. Mass‐dependent and mass‐independent fractionation of Hg isotopes suggests contributions from both regional anthropogenic and local industrial sources during this period. This study demonstrates the potential usefulness of tree ring dendrochemistry for identifying historical sources of atmospheric Hg exposure.Key PointsTree ring mercury levels in Shenandoah National Park, Virginia, were similar to those measured in other North American forestsTree ring mercury peaked during the 1930s to 1950s, coinciding with mercury use at an industrial facility near the southern end of the ParkMercury isotopes suggest a local source at this time, demonstrating the potential of dendrochemistry to identify historical sourcesPlain Language SummaryFor many years scientists have used tree rings to reconstruct past climate. Increasingly, tree rings are being used to document the historical exposure of trees to pollutants. In this study, we cored trees in Shenandoah National Park, Virginia, dated the tree rings, and then measured the amount of mercury stored within decadal core increments. We were surprised to find that mercury levels peaked in the 1930s to 1950s, even though global mercury emissions continued to rise throughout the past century, mostly as a by‐product of energy production. Our findings suggest that the trees were exposed to a local pollutant source during this earlier time period, perhaps from a nearby industrial plant that used mercury in the production of rayon. By examining the chemistry of wood within tree rings, we can get a clearer picture of when and where human activities have affected air pollution over recent centuries.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153685/1/jgrg21576_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153685/2/jgrg21576.pd

Investigation of lunar surface chemical contamination by LEM descent engine and associated equipment Final report

Lunar surface contamination from LEM rocket exhaust - methods of minimizing sample contaminatio