5,809 research outputs found
Resistance to hydroxyurea in Aspergillus nidulans by gene mutation and by putative gene amplification.
Resistance to hydroxyurea in Aspergillus nidulans by gene mutation and by putative gene amplification
Recommended from our members
Factors influencing utilisation of âfree-standingâ and âalongsideâ midwifery units for low-risk births in England: a mixed-methods study
Background
Midwifery-led units (MUs) are recommended for âlow-riskâ 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 â 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 trustâs 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 womenâs 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 womenâs information needs. If these remain unaddressed at commissioner and provider level, childbearing womenâs access to MUs will continue to be restricted.
Future work
Work is needed on optimum approaches to improve decision-makersâ understanding and use of clinical and economic evidence in service design. Increasing womenâs access to information about MUs requires further studies of professionalsâ 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
Recommended from our members
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
Recent La Plata basin drought conditions observed by satellite gravimetry
The Gravity Recovery and Climate Experiment (GRACE) provides quantitative
measures of terrestrial water storage (TWS) change. GRACE data show a
significant decrease in TWS in the lower (southern) La Plata river basin of
South America over the period 2002-2009, consistent with recognized drought
conditions in the region. GRACE data reveal a detailed picture of temporal and
spatial evolution of this severe drought event, which suggests that the drought
began in lower La Plata in around austral spring 2008 and then spread to the
entire La Plata basin and peaked in austral fall 2009. During the peak, GRACE
data show an average TWS deficit of ~12 cm (equivalent water layer thickness)
below the 7 year mean, in a broad region in lower La Plata. GRACE measurements
are consistent with accumulated precipitation data from satellite remote
sensing and with vegetation index changes derived from Terra satellite
observations. The Global Land Data Assimilation System model captures the
drought event but underestimates its intensity. Limited available
groundwater-level data in southern La Plata show significant groundwater
depletion, which is likely associated with the drought in this region.
GRAC-observed TWS change and precipitation anomalies in the studied region
appear to closely correlate with the ENSO climate index, with dry and wet
seasons corresponding to La Ni\~na and El Ni\~no events, respectively
Rationality as the Rule of Reason
The demands of rationality are linked both to our subjective normative perspective (given that rationality is a person-level concept) and to objective reasons or favoring relations (given that rationality is non-contingently authoritative for us). In this paper, I propose a new way of reconciling the tension between these two aspects: roughly, what rationality requires of us is having the attitudes that correspond to our take on reasons in the light of our evidence, but only if it is competent. I show how this view can account for structural rationality on the assumption that intentions and beliefs as such involve competent perceptions of downstream reasons, and explore various implications of the account
Immorality and Irrationality
Does immorality necessarily involve irrationality? The question is often taken to be among the deepest in moral philosophy. But apparently deep questions sometimes admit of deflationary answers. In this case we can make way for a deflationary answer by appealing to dualism about rationality, according to which there are two fundamentally distinct notions of rationality: structural rationality and substantive rationality. I have defended dualism elsewhere. Here, Iâll argue that it allows us to embrace a sensible â I will not say boring â moderate view about the relationship between immorality and irrationality: roughly, that immorality involves substantive irrationality, but not structural irrationality. I defend this moderate view, and argue that many of the arguments for less moderate views turn either on missing the distinction between substantive and structural rationality, or on misconstruing it
Beam alignment techniques based on the current multiplication effect in photoconductors Third summary technical progress report, 15 Nov. 1966 - 15 Oct. 1967
Beam alignment techniques developed for infrared sensitive single crystal germanium to study multiplication effect in photoconductor
Recommended from our members
Tablet PCs in schools: Case study report: A report for Becta by the Open University
The publication provides an analysis of twelve case studies involving schools in England that were using Tablet PCs. The analysis is complemented by brief individual reports describing aspects of how each of these schools was using Tablet PCs
N incorporation and associated localized vibrational modes in GaSb
We present results of electronic structure calculations on the N-related localized vibrational modes in the dilute nitride alloy GaSb1âxNx. By calculating the formation energies of various possible N incorporation modes in the alloy, we determine the most favorable N configurations, and we calculate their vibrational mode frequencies using density functional theory under the generalized gradient approximation to electron exchange and correlation, including the effects of the relativistic spin-orbit interactions. For a single N impurity, we find substitution on an Sb site, NSb, to be most favorable, and for a two-N-atom complex, we find the N-N split interstitial on an Sb site to be most favorable. For these defects, as well as, for comparison, defects comprising two N atoms on neighboring Sb sites and a N-Sb split interstitial on an Sb site, we find well-localized vibration modes (LVMs), which should be experimentally observable. The frequency of the triply degenerate LVM associated with NSb is determined to be 427.6 cmâ1. Our results serve as a guide to future experimental studies to elucidate the incorporation of small concentrations of N in GaSb, which is known to lead to a reduction of the band gap and opens the possibility of using the material for long-wavelength applications
A second primitive marine snake: Pachyophis woodwardi from the Cretaceous of Bosnia-Herzegovina
- âŠ