Carbon Monoxide Screening in Pregnancy: An Evaluation Study of a Plymouth Pilot Intervention

This report provides an analysis and evaluation of a National Institute for Health and Care Excellence (NICE) recommended pilot intervention which was designed to identify pregnant women exposed to carbon monoxide due to cigarette smoke and refers them to local stop smoking services (LSSS). The pilot intervention was carried out by community midwives working in two areas of Plymouth. The city has areas of social and health inequalities and the study drew on populations from a socially deprived neighbourhood and a socially affluent area. The pilot was instigated following new NICE guidance recommending that all women attending initial ante natal booking appointments with their community midwives be offered a Carbon Monoxide (CO) breath analyser screening to determine their smoking status and or exposure to other forms of CO. This evaluation study identifies the benefits and barriers associated with the implementation of the CO screening pilot. In particular, our aims were to explore any detrimental impact on the relationship between women and their community midwives, identify the impact on midwives in terms of time and resources, reveal the responses and acceptability or otherwise of the screening as perceived and experienced by the women being asked to participate during the booking appointment and finally to evaluate the success of the intervention overall in relation to the numbers of referrals made to Plymouth’s LSSS. A further aim was explore any differences in the two socio demographic areas. We adopted a mixed methods approach involving four focus group interviews with 23 midwives, a survey posted to the 258 women who attended initial antenatal booking appointments in the study areas, an online version of the survey to ascertain the views and experiences of pregnant women and new mothers nationally and an interrogation of an internet forum discussion board for mothers. A two page questionnaire consisting of 12 questions was designed and posted to women who attended the booking appointment with the midwife during the three month pilot period and the same survey was made available online. Questions were designed to elicit women’s views about the information given by the midwife in relation to the screening, whether they had agreed to participate in the CO screening process, their experiences and views about offering CO screening to pregnant women and their smoking status and those of other household members. Of the 258 questionnaires posted to women who had attended the clinic during the pilot intervention 40 completed responses were returned representing a 15.5% response rate. Only 4 responses were received from the online survey posting but an additional 484 comments posted on the Mumsnet website discussion board were analysed. Our findings show that in general there was a high degree of acceptability for the intervention. Midwives and their clients were generally in support of the screening being offered to all pregnant women. However, this support was dependent on a number of contextual factors. Women wanted to be properly informed about the screening and midwives wanted to be kept informed about the effects of the intervention on women’s smoking cessation. Initial and ongoing training of midwives in utilising the protocol and in instructing women to correct use the monitor was also very important. Trust was revealed to be a very important aspect of the relationship between women and their midwives. Some women felt that the CO screening was being used just to check whether or not they were smokers and some midwives also worried about the possible negative effects the CO screening may have on their relationships with women

Dealing with Complexity: Infant Feeding Choices and Experiences for Mothers with Infants in Neonatal Intensive Care Units and Transitional Care Wards

EXECUTIVE SUMMARY The central aim of the research on which this document reports was: To explore the knowledge, perceptions and experiences of infant feeding of mothers with infants in neonatal intensive care units (NICU) and transitional care wards (TCW) and the support these mothers receive from healthcare professionals and significant others with the aim of contributing to further support of mothers, significant others and healthcare professionals in the future. The objectives were: 1. To explore mothers’ with infants in NICU knowledge and understanding of infant, feeding and how this influences feeding choices. 2. To gain an understanding of mothers experiences of infant feeding, 3. To investigate the challenges of infant feeding in NICU. 4. To explore the significance of their self-identity and perception as ‘good’ or ‘not so good’ mothers in relation to this choice. 5. To ascertain the support women receive from healthcare professionals and significant others. 6. To identify further research needs, develop service provision and inform practice and policy. Background to the study is supported by a review of the clinical and sociologically relevant literature and brief detail on a previous related study (Stenhouse and Letherby 2013) which focused on the experience of mothers’ whose pregnancies were complicated by diabetes. A mixed method ethnographic approach was adopted: • Observations in the NICU and TCW were undertaken (alongside interviewing) amounting to approximately six hours. • One-to-one and dyad/group interviewing were undertaken with mothers and some of their partners. • Questionnaires (consisting of 10 questions, some of which were open to allow more respondent input) were distributed to all healthcare professionals working in NICU and TCW. An audit involving a systematic and independent examination of maternal and infant notes was undertaken at the same time as the primary data was collected. DATA AND DISCUSSION The Audit: This section provides a snapshot of infant feeding and expression of breastmilk from a cohort of mothers and babies who had previously been cared for in NICU, TCW or both. Appendix IV is a copy of a poster presented as part of the Medical Training Special Studies Unit. Interview and Questionnaire Data: This section reports on data collected from women, significant others and healthcare professionals and includes detailed reference to the significance of ‘The Journey’, the mixed experience of ‘Skills and Support’ and the experiences of ‘Pleasure, Pressure and Propaganda’. CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS Six summary points 1. Training for staff is mixed and this is linked to confidence in supporting women. 2. Women ‘sensed’ the lack of confidence of some staff and this caused anxiety i.e. if the combination of staff on a shift had little experience/knowledge. 3. Women recognised that certain occupation groups had more time and experience to support them i.e. nursery nurses on TCW, midwives on NICU. 4. The physical environment was an issue for respondents. For example: a. TCW privacy, or not, when expressing and feeding. b. In NICU screens used for expressing or feeding sometimes caused anxiety given that screens are also used when baby is poorly/undergoing a procedure. 5. In TCW, formula feed was linked to early discharge resulting in some experiencing subtle pressure to formula feed. 6. Community outreach team very supportive to some and women respondents felt they would have benefited from longer support. Six recommendations 1. Training needs to be consistent for all grades of staff and a whole day annually is preferred by healthcare professional respondents. 2. Release from service essential to ensure training is undertaken and given the high priority it deserves. 3. Different coloured screens for expressing/feeding AND for procedures would be beneficial and reduce stress for mothers and significant others. 4. Active recruitment of peer supporters with experience of having a baby in NICU. 5. Ensure continued support from peer supporters when moving from breastfeeding to formula feeding. 6. More information related to equipment available in the community on discharge i.e. hospital grade breast pumps

Productivity, Survival, and Movements of Female Moose in a Low-density Population, Northwest Territories, Canada

Moose (Alces alces andersoni) occur at low density (140-160 moose/1000 sq km) and are the most important game animal in much of the Mackenzie Valley, western Northwest Territories. Productivity and survival of 30 female moose (>=1.5 yr.) were studied from November 1985 through November 1988. Twenty-nine of these moose were radio-tracked for a total of 1039 relocations. Pregnancy rates were 96% for adult and 40% for yearling females. Most females returned to the same restricted area to calve each year. Mean newborn calf:female ratio and twinning rates were 1.2:1 and 31%, respectively. Mean annual female survival rate was 85%. Annual calf survival was high and stable (44±0.02%). Individual total home range size varied from 40 sq km to 942 sq km. Mean home range size for 29 moose was 174±31 sq km and 202±59 sq km for the 14 moose radio-tracked the entire three years of study. Fall home ranges were twice the size of winter and summer home ranges; seasonal ranges overlapped widely, indicating that these moose were non-migratory.Key words: moose, low density, productivity, movements, Mackenzie Valley, Northwest TerritoriesL'orignal (Alces alces andersoni) est présent à faible densité (140-160 orignaux/1000 km²) et constitue le gibier le plus important dans la plupart de la vallée du Mackenzie, à l'ouest des Territoires du Nord-Ouest. On a étudié la productivité et le taux de survie de 30 orignaux femelles (<= 1,5 ans) de novembre 1985 à novembre 1988. Vingt-neuf de ces orignaux ont été suivis par radio sur un total de 1039 déplacements. Les taux de gestation étaient de 96 p. cent pour les adultes et de 40 p. cent pour les femelles d'un an. La plupart des femelles retournaient chaque année mettre bas dans la même zone restreinte. Le rapport moyen mâle/femelle parmi les nouveau-nés était de 1,2 pour 1, et le pourcentage de jumeaux était de 30 p. cent. Le taux de survie annuel moyen des femelles était de 85 p. cent. Le taux de survie annuel des veaux était élevé et stable (44 ± 0,02 p. cent). Le territoire individuel total variait de 40 à 942 km². Le territoire moyen mesurait 174 ± 31 km² pour l'ensemble des 29 orignaux, et 202 ± 59 km² pour les 14 orignaux suivis par radio du début à la fin de la période triennale d'étude. Les territoires étaient deux fois plus étendus en automne qu'en hiver ou en été; les territoires saisonniers se recoupaient largement, ce qui indique que ces orignaux n'étaient pas migratoires.Mots clés: orignal, faible densité, productivité, mouvements, vallée du Mackenzie, Territoires du Nord-Ouest&nbsp

<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

Communities in university mathematics

This paper concerns communities of learners and teachers that are formed, develop and interact in university mathematics environments through the theoretical lens of Communities of Practice. From this perspective, learning is described as a process of participation and reification in a community in which individuals belong and form their identity through engagement, imagination and alignment. In addition, when inquiry is considered as a fundamental mode of participation, through critical alignment, the community becomes a Community of Inquiry. We discuss these theoretical underpinnings with examples of their application in research in university mathematics education and, in more detail, in two Research Cases which focus on mathematics students' and teachers' perspectives on proof and on engineering students' conceptual understanding of mathematics. The paper concludes with a critical reflection on the theorising of the role of communities in university level teaching and learning and a consideration of ways forward for future research

The density of anthropogenic features explains seasonal and behaviour-based functional responses in selection of linear features by a social predator

Anthropogenic linear features facilitate access and travel efficiency for predators, and can influence predator distribution and encounter rates with prey. We used GPS collar data from eight wolf packs and characteristics of seismic lines to investigate whether ease-of-travel or access to areas presumed to be preferred by prey best explained seasonal selection patterns of wolves near seismic lines, and whether the density of anthropogenic features led to functional responses in habitat selection. At a broad scale, wolves showed evidence of habitat-driven functional responses by exhibiting greater selection for areas near low-vegetation height seismic lines in areas with low densities of anthropogenic features. We highlight the importance of considering landscape heterogeneity and habitat characteristics, and the functional response in habitat selection when investigating seasonal behaviour-based selection patterns. Our results support behaviour in line with search for primary prey during summer and fall, and ease-of-travel during spring, while patterns of selection during winter aligned best with ease-of-travel for the less-industrialized foothills landscape, and with search for primary prey in the more-industrialized boreal landscape. These results highlight that time-sensitive restoration actions on anthropogenic features can affect the probability of overlap between predators and threatened prey within different landscapes

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