An appreciative inquiry to midwifery education in Aotearoa

Background: Education is a transformative process, that promotes both self and professional development, and has rewards and challenges (Griffiths, 2012). For women, choosing a career pathway that gives meaning and purpose is an integral element of their decision making (Elley-Brown, 2015). The themes from our literature review identify midwifery educators as helping to sustain the profession by inspiring others, and promoting self and professional development through higher education. The role of the educator is identified as highly relational and often assumes an advisory and mentoring role (Elly-Brown, 2015). Midwifery educators promote growth and development of the profession (Albarran & Rosser, 2014). When considering recruitment of students into midwifery as a profession and midwives into education, it was clear that this is strongly linked to internal drivers; these include the feeling of making a difference, inspiring educational role models, having particular attributes, and encouragement from others (Albarran, & Rosser, 2014; Crowther, Hunter, McAra-Couper, Warren, Gilkison, Hunter, Fielder, & Kirkam, 2016; Doherty, M, 2010; Elley-Brown, 2015; Gilkison, Pairman, McAra-Couper, Kensington, & James, 2016; Gui, Barriball, & While, 2009). The credibility and impact of midwifery teachers was explored by Fraser, Avis & Mallik (2013) who found that teachers were valued for their unique and crucial role in the support of student’s application of knowledge into practice. Briscoe & Clarke, (2018) also commented that midwifery education needs to be dynamic and responsive to societal changes, showing authenticity within a curriculum that is evidence-based and supports students to reach their full potential as a health professional. Reciprocity of relationship between women and midwives, midwifery colleagues, students and teachers are also valued (Crowther, Hunter, McAra-Couper, Warren, Gilkison, Hunter, Feilder, Kirkham, 2016). He aha te mea nui? He tāngata, He tāngata, He tāngata! What is the greatest thing? It is people, it is people, it is people

A cross-sectional study of breech birth in New Zealand, 2000-2014. Masters Project

Abstract Background: Breech birth has been a controversial topic since the mid-twentieth century. The publication of a randomised controlled trial dubbed the Term Breech Trial in 2000 dramatically altered practice internationally when it published findings that vaginal breech birth is unsafe and that elective caesarean section should be the recommended mode of birth. Since 2000 there has been a rapid decline in vaginal breech birth despite further robust research finding no statistical significance in significant neonatal outcomes. This has had negative implications to both maternal health and mid and long-term neonatal outcomes, as well on health economics and health literacy levels on a complex multifactorial issue. Methods: A cross-sectional study was undertaken analysing anonymous data from the National Minimum Dataset from 2000- 2014. Epi Info 7 was used to perform statistical analysis. Results: The incidence of breech birth in New Zealand from 2000-2014 was 3.1%, vaginal breech birth being achieved in less than 0.5% of all births in 2015. The incidence of breech birth increases with parity. Being of Maori, Pacific or of Asian descent is protective against breech birth RR=0.53 (95% CI 0.50-0.54), RR=0.75(95% CI 0.72-0.79), and RR=0.94 (95% CI 0.90-0.98) respectively. There was a trend of increasing length of hospital stay with breech birth compared to all births. Conclusion: Breech birth services need to be reviewed to reflect current and robust research that is focused on women centred care and informed choices. In updating health policies and clinical guidelines affecting breech presentation and birth it is imperative to promote collaborative practice, continuing education and development of both clinical skills and theory on breech presentation (including ECV services) and birth

Facilitating Upper Limb Function using Assistive Technology in a Neurological Patient with Bilateral Upper Limb Impairment: A Case Report

Purpose: A combination of a stroke and spinal cord injury adversely affecting both upper limbs is an unusual combination for a patient presenting for outpatient rehabilitation services. Although the management of these conditions in isolation is well documented, there is limited literature regarding rehabilitation for these conditions in combination, particularly the use of assistive technology in this setting. Methods: A case report is presented of a 53-year-old male referred for outpatient rehabilitation following a left-sided stroke, with resultant dense right sided hemiplegia. A pre-existing spinal cord injury had affected his left upper limb such that he had marked proximal weakness. This combination of impairments meant he was unable to perform even basic activities of daily living involving the upper limbs. A therapy program, led by an occupational therapist with support and input from the multi-disciplinary team, included the use of an assistive device (a mobile arm support) to facilitate functional upper limb activities. This greatly improved his ability to do upper limb functional activities. Conclusion: The use of an assistive device enabled the patient to engage in meaningful activities of daily living involving the upper limbs

Vestibular‐guided visual search

The amnesic symptoms that accompany vestibular dysfunction point to a functional relationship between the vestibular and visual memory systems. However, little is known about the underpinning cognitive processes. As a starting point, we sought evidence for a type of cross-modal interaction commonly observed between other sensory modalities in which the identification of a target (in this case, visual) is facilitated if earlier coupled to a unique, temporally coincident stimulus from another sensory domain (in this case, vestibular). Participants first performed a visual detection task in which stimuli appeared at random locations within a computerised grid. Unknown to participants, the onset of one particular stimulus was accompanied by a brief, sub-sensory pulse of galvanic vestibular stimulation (GVS). Across two visual search experiments, both old and new targets were identified faster when presented in the grid location at which the GVS-paired visual stimulus had appeared in the earlier detection task. This location advantage appeared to be based on relative rather than absolute spatial co-ordinates since the effect held when the search grid was rotated 90°. Together these findings indicate that when individuals return to a familiar visual scene (here, a 2D grid), visual judgements are facilitated when targets appear at a location previously associated with a unique, task-irrelevant vestibular cue. This novel case of multisensory interplay has broader implications for understanding how vestibular signals inform cognitive processes and helps constrain the growing therapeutic application of GVS

A systematic review of the characteristics and needs of older prisoners

The older prisoner population is growing faster than the older general population and placing a strain on prisons. Much of the existing literature focusses on the healthcare needs of, or in-prison initiatives for, older prisoners. Typically, these are responsive and lacking an evidence-based understanding of the characteristics and needs of this group. There is a need to review and understand what the existing evidence base concludes about the needs of this population. This paper presents a systematic review of the existing literature on the needs and characteristics of older people in contact with the criminal justice system. After a thorough search and selection process, 21 papers, from 2002 onwards, were included in the final analysis. The review process was structured through PICOs and reported using PRISMA. The contradictions within the existing evidence base make it difficult to reach firm conclusions about the needs and characteristics of older prisoners. What is clear from the existing research are the relatively high levels of need. There is also some consensus that where older people commit homicide the victim is likely to be an intimate partner. Overall, there a need for consistent recording and reporting of characteristics and demographics and more systematic study design. This paper has highlighted the key findings and limitations in the existing literature. Future research should make use of secondary official data sources to provide a clearer understanding of the characteristics of this group, their routes to prison, their needs, and challenges they present

Modern lineages of Mycobacterium tuberculosis exhibit lineage-specific patterns of growth and cytokine induction in human monocyte-derived macrophages

BACKGROUND: Strains of Mycobacterium tuberculosis vary in virulence. Strains that have caused outbreaks in the United States and United Kingdom have been shown to subvert the innate immune response as a potential immune evasion mechanism. There is, however, little information available as to whether these patterns of immune subversion are features of individual strains or characteristic of broad clonal lineages of M. tuberculosis . METHODS: Strains from two major modern lineages (lineage 2 [East-Asian] and lineage 4 [Euro-American]) circulating in the Western Cape in South Africa as well as a comparator modern lineage (lineage 3 [CAS/Delhi]) were identified. We assessed two virulence associated characteristics: mycobacterial growth (in liquid broth and monocyte derived macrophages) and early pro-inflammatory cytokine induction. RESULTS: In liquid culture, Lineage 4 strains grew more rapidly and reached higher plateau levels than other strains (lineage 4 vs. lineage 2 p = 0.0024; lineage 4 vs. lineage 3 p = 0.0005). Lineage 3 strains were characterized by low and early plateau levels, while lineage 2 strains showed an intermediate growth phenotype. In monocyte-derived macrophages, lineage 2 strains grew faster than lineage 3 strains (p<0.01) with lineage 4 strains having an intermediate phenotype. Lineage 2 strains induced the lowest levels of pro-inflammatory TNF and IL-12p40 as compared to other lineages (lineage 2: median TNF 362 pg/ml, IL-12p40 91 pg/ml; lineage 3: median TNF 1818 pg/ml, IL-12p40 123 pg/ml; lineage 4: median TNF 1207 pg/ml, IL-12p40 205 pg/ml;). In contrast, lineage 4 strains induced high levels of IL-12p40 and intermediate level of TNF. Lineage 3 strains induced high levels of TNF and intermediate levels of IL-12p40. CONCLUSIONS: Strains of M. tuberculosis from the three major modern strain lineages possess distinct patterns of growth and cytokine induction. Rapid growth and immune subversion may be key characteristics to the success of these strains in different human populations

Ethical and Policy Issues Raised by Uterus Transplants

Introduction: In 2014, Brännström and colleagues reported the first human live birth following uterine transplantation (UTx). Research into this treatment for absolute uterine factor infertility has since grown with clinical trials currently taking place across centers in at least thirteen countries worldwide. Sources of data: This review summarizes and critiques the academic literature on ethical and policy issues raised by UTx. Areas of agreement: There is general agreement on the importance of risk reduction and, in principle, to the sharing and maintenance of patient data on an international registry. Areas of controversy: There are numerous areas of controversy ranging from whether it is ethically justified to carry out uterus transplants at all (considering the associated health risks) to how deceased donor organs for transplant should be allocated. This review focuses on three key issues: the choice between deceased and living donors, ensuring valid consent to the procedure and access to treatment. Growing points; UTx is presently a novel and rare procedure but is likely to become more commonplace in the foreseeable future, given the large number of surgical teams working on it worldwide. Areas timely for developing research: Uterus transplantation requires us to re-examine fundamental questions about the ethical and social value of gestation. If eventually extended to transgender women or even to men, it may also require us to reconceptualize what it is to be a ‘father’ or to be a ‘mother’, and the definition of these terms in law

Self-identified strategies to manage intake of tempting foods: cross-sectional and prospective associations with BMI and snack intake

Objectives:Individuals often use self-directed strategies to manage intake of tempting foods, but what these strategies are and whether they are effective is not well understood. This study assessed the frequency of use and subjective effectiveness of self-directed strategies in relation to BMI and snack intake.Design:A cross-sectional and prospective study with three timepoints (T1: baseline, T2: 3 months, T3: 3 years). At T1, demographics, frequency of use and subjective effectiveness of 41 identified strategies were assessed. At T2 and T3, current weight was reported, and at T2 frequency of snack intake was also recorded.Setting:Online study in the UK.Participants:Data from N=368 participants (Mage=34.41 years; MBMI=25.06 kg/m2) was used for analysis at T1, N=170 (46.20% of the total sample) at T2 and N=51 (13.59%) at T3.Results:Two strategy factors were identified via principal axis factoring: 1) Diet, exercise, reduction of temptations, and cognitive strategies, and 2) Planning, preparation and eating style. For strategy 1, frequency of use, but not subjective effectiveness, was positively related to BMI at T1. Subjective effectiveness predicted an increase in BMI from T1 and T2 to T3. No relationship to snack intake was found. For strategy 2, frequency of use was negatively related to BMI at T1. Neither frequency of use nor subjective effectiveness were related to changes in BMI over time, but subjective effectiveness was negatively correlated with unhealthy snack intake.Conclusion:Self-directed strategies to reduce the intake of tempting foods are not consistently related to BMI or snack intake