A meta-ethnographic study of health care staff perceptions of the WHO/UNICEF Baby Friendly Health Initiative

Background Implementation of the Baby Friendly Health Initiative (BFHI) is associated with increases in breastfeeding initiation and duration of exclusive breastfeeding and ‘any’ breastfeeding. However, implementation of the BFHI is challenging. Aim To identify and synthesise health care staff perceptions of the WHO/UNICEF BFHI and identify facilitators and barriers for implementation. Method Seven qualitative studies, published between 2003 and 2013 were analysed using meta-ethnographic synthesis. Findings Three overarching themes were identified. First the BFHI was viewed variously as a ‘desirable innovation or an unfriendly imposition’. Participants were passionate about supporting breastfeeding and improving consistency in the information provided. This view was juxtaposed against the belief that BFHI represents an imposition on women's choices, and is a costly exercise for little gain in breastfeeding rates. The second theme highlighted cultural and organisational constraints and obstacles to BFHI implementation including resource issues, entrenched staff practices and staff rationalisation of non-compliance. Theme three captured a level of optimism and enthusiasm amongst participants who could identify a dedicated and credible leader to lead the BFHI change process. Collaborative engagement with all key stakeholders was crucial. Conclusions Health care staff hold variant beliefs and attitudes towards BFHI, which can help or hinder the implementation process. The introduction of the BFHI at a local level requires detailed planning, extensive collaboration, and an enthusiastic and committed leader to drive the change process. This synthesis has highlighted the importance of thinking more creatively about the translation of this global policy into effective change at the local level

Modified spin-wave theory with ordering vector optimization I: frustrated bosons on the spatially anisotropic triangular lattice

We investigate a system of frustrated hardcore bosons, modeled by an XY antiferromagnet on the spatially anisotropic triangular lattice, using Takahashi's modified spin-wave (MSW) theory. In particular we implement ordering vector optimization on the ordered reference state of MSW theory, which leads to significant improvement of the theory and accounts for quantum corrections to the classically ordered state. The MSW results at zero temperature compare favorably to exact diagonalization (ED) and projected entangled-pair state (PEPS) calculations. The resulting zero-temperature phase diagram includes a 1D quasi-ordered phase, a 2D Neel ordered phase, and a 2D spiraling ordered phase. We have strong indications that the various ordered or quasi-ordered phases are separated by spin-liquid phases with short-range correlations, in analogy to what has been predicted for the Heisenberg model on the same lattice. Within MSW theory we also explore the finite-temperature phase diagram. We find that the zero-temperature long-range-ordered phases turn into quasi-ordered phases (up to a Berezinskii-Kosterlitz-Thouless temperature), while zero-temperature quasi-ordered phases become short-range correlated at finite temperature. These results show that modified spin-wave theory is very well suited for describing ordered and quasi-ordered phases of frustrated XY spins (or, equivalently, of frustrated lattice bosons) both at zero and finite temperatures. While MSW theory, just as other theoretical methods, cannot describe spin-liquid phases, its breakdown provides a fast method for singling out Hamiltonians which may feature these intriguing quantum phases. We thus suggest a tool for guiding our search for interesting systems whose properties are necessarily studied with a physical quantum simulator.Comment: 40 pages, 16 figure

Ten steps or climbing a mountain: A study of Australian health professionals' perceptions of implementing the baby friendly health initiative to protect, promote and support breastfeeding

Background: The Baby Friendly Hospital (Health) Initiative (BFHI) is a global initiative aimed at protecting, promoting and supporting breastfeeding and is based on the ten steps to successful breastfeeding. Worldwide, over 20,000 health facilities have attained BFHI accreditation but only 77 Australian hospitals (approximately 23%) have received accreditation. Few studies have investigated the factors that facilitate or hinder implementation of BFHI but it is acknowledged this is a major undertaking requiring strategic planning and change management throughout an institution. This paper examines the perceptions of BFHI held by midwives and nurses working in one Area Health Service in NSW, Australia. Methods: The study used an interpretive, qualitative approach. A total of 132 health professionals, working across four maternity units, two neonatal intensive care units and related community services, participated in 10 focus groups. Data were analysed using thematic analysis. Results: Three main themes were identified: ‘Belief and Commitment’; ‘Interpreting BFHI’ and ‘Climbing a Mountain’. Participants considered the BFHI implementation a high priority; an essential set of practices that would have positive benefits for babies and mothers both locally and globally as well as for health professionals. It was considered achievable but would take commitment and hard work to overcome the numerous challenges including a number of organisational constraints. There were, however, differing interpretations of what was required to attain BFHI accreditation with the potential that misinterpretation could hinder implementation. A model described by Greenhalgh and colleagues on adoption of innovation is drawn on to interpret the findings. Conclusion: Despite strong support for BFHI, the principles of this global strategy are interpreted differently by health professionals and further education and accurate information is required. It may be that the current processes used to disseminate and implement BFHI need to be reviewed. The findings suggest that there is a contradiction between the broad philosophical stance and best practice approach of this global strategy and the tendency for health professionals to focus on the ten steps as a set of tasks or a checklist to be accomplished. The perceived procedural approach to implementation may be contributing to lower rates of breastfeeding continuation

Women's perceptions and experiences of breastfeeding support: A metasynthesis

Background: Both peer and professional support have been identified as important to the success of breastfeeding. The aim of this metasynthesis was to examine women’s perceptions and experiences of breastfeeding support, either professional or peer, in order to illuminate the components of support that they deem ‘supportive’. Methods: The metasynthesis included studies of both formal or ‘created’ peer and professional support for breastfeeding women but excluded studies of family or informal support. Qualitative studies were included as well as large scale surveys if they reported the analysis of qualitative data gathered through open ended responses. Primiparous and multiparous women who initiated breastfeeding were included. Only studies published in English, in peer reviewed journals and undertaken between 1990 and December 2007 were included. After assessment for relevance and quality, 31 studies were included in the metasynthesis. Meta-ethnographic methods were used to identify categories and themes. Results: The metasynthesis resulted in four categories comprising a total of 20 themes. The synthesis indicates that support for breastfeeding occurs along a continuum from authentic presence at one end, perceived as effective support, to disconnected encounters at the other, perceived as ineffective or even discouraging and counterproductive. Second, the synthesis identified a facilitative approach, versus a reductionist approach as contrasting styles of support women experienced as helpful or unhelpful. Conclusions: The findings of this metasynthesis emphasise the importance of person-centred communication skills and of relationships in supporting a woman to breastfeed. Organisational systems and services that facilitate continuity of care/r, for example continuity of midwifery care or peer support models, are more likely to facilitate an authentic presence

In vitro pancreatic carcinogenesis

Studies in our laboratories have indicated that pancreatic cancer originates not only from pancreatic ductal/ductular cells but also from within the Langerhans' islets, probably from reserve (precursor, stem) cells. To identify, enrich and characterize these cells, we established a long-term hamster islet culture and studied their growth, differentiation and response to the pancreatic carcinogen, N-nitrosobis(2-oxopropyl)amine (BOP). One group of cultured islets was treated in vitro with BOP (KL5B group) and the other group of islets served as an untreated control (KL5N group). During the early culture days, in both groups all cultured islets showed a progressive loss of endocrine cells and replacement by ductular, acinar and intermediary cells. However, all these cells disappeared after 35 days in culture and gave room to undifferentiated cells, which we believe represent stem cells. No differences were found between KL5N and KL5B cells with regard to cell growth and differentiation until day 35, when the growth of the KL5B cells accelerated and the cells underwent increasing pleomorphism and atypia. At day 133, KL5B cells but not KL5N cells showed colony formation in soft agar and formed invasive, poorly differentiated adenocarcinomas of the ductal type when transplanted into hamsters. All of these tumors showed mutation of the K-ras gene and extensive chromosomal damage. We concluded that like ductal/ductular cells, certain cell populations within islets are responsive to the carcinogenic effect of BOP. We could not ascertain whether these cells present a preexisting (stem, reserve) cell population within the islets or transdifferentiated islet cell

Optical Trapping of an Ion

For several decades, ions have been trapped by radio frequency (RF) and neutral particles by optical fields. We implement the experimental proof-of-principle for trapping an ion in an optical dipole trap. While loading, initialization and final detection are performed in a RF trap, in between, this RF trap is completely disabled and substituted by the optical trap. The measured lifetime of milliseconds allows for hundreds of oscillations within the optical potential. It is mainly limited by heating due to photon scattering. In future experiments the lifetime may be increased by further detuning the laser and cooling the ion. We demonstrate the prerequisite to merge both trapping techniques in hybrid setups to the point of trapping ions and atoms in the same optical potential.Comment: 5 pages, 3 figure