The bigger picture: Piecing together the experiences of family members living with high-functioning children with Autism Spectrum Disorder

The purpose of this research was to explore the experiences of family members living with a child with ASD. The specific research questions that were addressed included: 1. How is a family member affected by having a child with ASD in the family unit; and 2. How does living with a child with ASD affect family functioning? The theoretical orientation of phenomenology was used to guide this research and to allow the “voice” of family members of children with ASD to be heard. The purpose of phenomenology is to distill individuals’ experiences with a phenomenon down to an “essence” of the experience by looking for common themes in the meanings participants give to their lived experiences with the phenomenon being studied (Creswell, 2013). Face sheets, semi-structured interviews, field notes, and member checks were used to collect data from 9 family members living with children with ASD. Analysis of the data revealed six major themes regarding the lived experiences of family members of children with ASD. The themes that related to the family unit as a whole were: (1) “It is a big change”; (2) “It isn’t in the moment, it is prepare for the moment”; (3) “The whole education end of things…”; and (4) “I am just not feeling the best these days…”: ASD takes its toll. The themes associated with the unique experiences of family members were: (5) The sibling experience, and (6) The parent experience. It is undeniable that there are both positives and negatives associated with living with and caring for children with ASD. By having participants reflect on their experiences of living with children with ASD as well as their perceptions of their family members’ experiences, this study was able to provide an in-depth and holistic picture of the effects living with children with ASD have on the family as an interconnected unit

Tensions and conflicts in ‘choice’: Women’s experiences of freebirthing in the UK

Background the concept of choice is a central tenet of modern maternity care. However, in reality women’s choice of birth is constrained by a paucity of resources and dominant medical and risk adverse discourses. In this paper we add to this debate through highlighting the tensions and conflicts that women faced when enacting a freebirthing choice. Methods secondary analysis of data collected to explore why women choose to freebirth in the UK was undertaken. Ten women were recruited from diverse areas of the UK via invitations on freebirthing websites. Women provided a narrative and/or participated in an in-depth interview. A thematic analysis approach was used. Findings we present three key themes. First ‘violation of rights’ highlights the conflicts women faced from maternity care systems who were unaware of women’s legal rights to freebirth, conflating this choice with issues of child protection. ‘Tactical planning’ describes some of the strategies women used in their attempts to achieve the birth they desired and to circumnavigate any interference or reprisals. The third theme, ‘unfit to be a mother’ describes distressing accounts of women who were reported to social services. Conclusion and implications for practice women who choose to freebirth face opposition and conflict from maternity providers, and often negative and distressing repercussions through statutory referrals. These insights raise important implications for raising awareness among health professionals about women’s legal rights. They also emphasise a need to develop guidelines and care pathways that accurately and sensitively support the midwives professional scope of practice and women’s choices for birth

Understanding how midwives employed by the National Health Service facilitate women’s alternative birthing choices: Findings from a feminist pragmatist study

UK legislation and government policy favour women’s rights to bodily autonomy and active involvement in childbirth decision-making including the right to decline recommendations of care/treatment. However, evidence suggests that both women and maternity professionals can face challenges enacting decisions outside of sociocultural norms. This study explored how NHS midwives facilitated women’s alternative physiological birthing choices–defined in this study as ‘birth choices that go outside of local/national maternity guidelines or when women decline recommended treatment of care, in the pursuit of a physiological birth’. The study was underpinned by a feminist pragmatist theoretical framework and narrative methodology was used to collect professional stories of practice via self-written narratives and interviews. Through purposive and snowball sampling, a diverse sample in terms of age, years of experience, workplace settings and model of care they operated within, 45 NHS midwives from across the UK were recruited. Data were analysed using narrative thematic that generated four themes that described midwives’ processes of facilitating women’s alternative physiological births: 1. Relationship building, 2. Processes of support and facilitation, 3. Behind the scenes, 4. Birth facilitation. Collectively, the midwives were involved in a wide range of alternative birth choices across all birth settings. Fundamental to their practice was the development of mutually trusting relationships with the women which were strongly asserted a key component of safe care. The participants highlighted a wide range of personal and advanced clinical skills which was framed within an inherent desire to meet the women’s needs. Capturing what has been successfully achieved within institutionalised settings, specifically how, maternity providers may benefit from the findings of this study

Caring for women making unconventional birth choices: A meta-ethnography exploring the views, attitudes, and experiences of midwives

Introduction: Women can face opposition when exerting autonomous decision-making regarding their birth choices, particularly when the decisions involve going against medical advice and/or outside of national guidelines. Termed ‘unconventional birth choices’, some research has explored women’s reasons and experiences of making such choices, but less is known about the midwives caring for them. Objectives: To synthesize existing qualitative literature on the views, attitudes, and experiences of midwives caring for women who make unconventional birth choices. Methods: A systematic search and meta-ethnography informed by Noblit and Hare and Schutz was undertaken. Eight databases were searched using predetermined search terms, alongside author, reference, citation chasing, and hand searching. Searches were conducted in July 2016 and updated in October 2017. Qualitative studies published since 1993 in English were included. Included studies were subjected to quality appraisal, conducted independently by two reviewers. Analysis was informed by the interpretative meta-ethnography methods. Main results: Five studies met the inclusion criteria. Eight subthemes emerged. These resulted in three higher level interpretative themes emerged: perceptions of women’s decision making, conflicting tensions as caregivers, ways of working with-woman. Conclusions: Midwives can play a pivotal role in ensuring that respectful maternity care includes supporting women in their birthing decisions. Whilst limited research has been undertaken in this area, available insights suggest that midwives’ views in this area are situated along a spectrum from ‘willingly facilitative’ to ‘reluctantly accepting’. Views were influenced by context, as well as prior philosophies and values. While further research is needed, this study offers insights into the challenges women can face in seeking unconventional birth choices if they require support from midwives to do so

Analyses of injuries to equestrians in a Swedish district over a 16-year period

Horse riding is a popular, yet dangerous, sport, and as such, horse-related injuries contribute considerably to the total number of people hospitalized every year. While some investigations have explored this public health issue, many have focused only on hospital registrations or insurance information, while neglecting the cases where the rider may have not required hospitalization. This study investigated the pattern of equestrian injuries in Sweden and examined factors for predicting hospitalized injuries, using visits to hospital, local medical centers, and public dental services. Data were gathered over a 16-year period at all medical facilities within Skaraborg, Sweden, and retrospectively reviewed. There were 7815 horse-related injury events during the study period. The sample of horse-related injuries were largely represented by females (88%) and those aged between 10 and 20\ua0years old. Injuries commonly took place during private/leisure time (90.8%) and in the afternoon. Logistic regression analysis found that older riders were significantly more likely to be admitted to hospital (OR\ua0=\ua01.013), while female riders were less likely to be admitted than males (OR\ua0=\ua00.739). The numbers of people registering at medical facilities due to horse-related injuries are increasing. Therefore, improved intervention measures must be further investigated

Introducing elements of inquiry in to undergraduate laboratories

Inquiry-based laboratories are an emerging and popular way of teaching practical chemistry. They lead students towards independent research by inspiring critical thinking, curiosity, and a conceptual understanding of experimental processes. Inquiry laboratories need a base of knowledge, usually built upon a foundation of expository experiments that teach fundamental skills. As such, the first year of a teaching laboratory may well keep an expository structure, even when later years embrace inquiry learning. In this work, we have shown that elements of inquiry can be introduced lightly and early in the curriculum, using the approach of Szalay and Tóth. In this work, a robust suite of existing experiments has had elements of inquiry introduced with a series of small, standalone modifications. Adaptation of existing experiments allows a tight control on the extent to which a student pushes into unfamiliar territory — particularly important for introductory laboratories, where unexpected results are likely to overwhelm or discourage. The modified experiments confer many of the same benefits as an inquiry laboratory, such as students’ sense of independence and control. The approach works best when supported by prelaboratory exercises, for calculations or procedure-writing steps. The approach builds on prior work introducing inquiry into a school curriculum, and we have shown that it can be used on a large scale in two different undergraduate teaching laboratory environments. In our implementation, we placed a heavy focus on structured support for students, and conducted numerical and written surveys of students and postgraduate demonstrators to measure perceptions of the work

Simple Sprinkler Performance Testing for Rich County

This fact sheet describes how to perform a site inspection and a sprinkler test so you can irrigate your landscape more efficiently. It also provides an irrigation schedule for Rich County, Utah

Horse-related incidents and factors for predicting injuries to the head

Objectives Head injuries are the leading cause of death in horse-related injury events and, even since the introduction of helmets, represent a sizeable proportion of all horse-related injuries. Falls from horseback and kicks to the head are the most frequent type of incident causing head injuries, but it is unknown whether these incidents are predictors of head injury. This study aimed to investigate head injuries and the association between incident type and head injury. Method Retrospective review of 7815 horse-related injury events was conducted. Data were gathered from hospitals, local healthcare centres and public dental services in Skaraborg, Sweden. Binary logistic regression was used to analyse the association between the incident type and occurrence of head injury while controlling for risk factors. Results Approximately 20% of riders sustained a head injury, mostly soft tissue injuries (56.3%) and concussions (33.4%). A fall from or with the horse was the primary cause of head injury (63.9%). Those who fell from a carriage or other height or who were injured through contact with the horse had no difference in the likelihood of head injury when compared with those that fell from or with the horse. However, those who sustained an injury without any horse contact had lower odd of head injury (OR: 0.640, p<0.00005, 95% CI 0.497 to 0.734). Additionally, the older the rider, the lower the odds of head injury (OR=0.989, p<0.00005, 95% CI 0.985 to 0.993). Conclusion Improved protection for those suffering falls from horseback as well as those who are kicked in the head should be investigated

Is it time to stop being crude? Elderly mortality rates in a refugee camp in Maban County, South Sudan

Background: Mortality is a key indicator in defining and monitoring the scale and severity of a complex humanitarian emergency. While collection of age-disaggregated data is advised in guidelines such as the Sphere handbook, in practice data are rarely disaggregated beyond the under-5s. Despite widespread use of prospective mortality surveillance systems in complex emergencies, there are few guidelines on their implementation and limited evidence of their value. In 2012, 68,000 refugees from Sudan settled in Maban County, South Sudan. MSF introduced a community based surveillance system in Jamam camp to monitor mortality and reported causes of death. Observation of a high proportion of deaths in older refugees led to the adaptation of the surveillance system to collect age-specific mortality data. Here we describe the implementation, outcomes and lessons learnt

Abetalipoproteinemia Due to a Novel Splicing Variant in MTTP in 3 Siblings

Abetalipoproteinemia (ABL) is a rare recessive condition caused by biallelic loss-of-function mutations in the MTTP gene encoding the microsomal triglyceride transfer protein large subunit. ABL is characterized by absence of apolipoprotein B–containing lipoproteins and deficiencies in fat-soluble vitamins leading to multisystem involvement of which neurological complications are the most serious. We present 3 siblings with ABL who were born to non-consanguineous parents of Filipino and Chinese background. Identical twin boys with long-standing failure to thrive and malabsorption were diagnosed at age 2 years. ABL therapy with vitamins and a specialized diet was initiated, replacing total parenteral nutrition at age 3 years. Their younger sister was diagnosed from a blood sample taken at birth; treatment was instituted shortly thereafter. We observed in the twins reversal and in their sister prevention of ABL systemic features following early implementation of fat restriction and high doses of oral fat-soluble vitamins. A targeted sequencing panel found that each affected sibling is homozygous for a novel MTTP intron 13 -2A\u3eG splice acceptor site mutation, predicted to abolish splicing of intron 13. This variant brings to more than 60 the number of reported pathogenic mutations, which are summarized in this article. The twin boys and their sister are now doing well at 11 and 4 years of age, respectively. This experience underscores the importance of early initiation of targeted specialized dietary and fat-soluble vitamin replacements in ABL