Perspectives on financial incentives to health service providers for increasing breast feeding and smoking quit rates during pregnancy: a mixed methods study

Objective: To explore the acceptability, mechanisms and consequences of provider incentives for smoking cessation and breast feeding as part of the Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS) study. Design: Cross-sectional survey and qualitative interviews. Setting: Scotland and North West England. Participants: Early years professionals: 497 survey respondents included 156 doctors; 197 health visitors/maternity staff; 144 other health staff. Qualitative interviews or focus groups were conducted with 68 pregnant/postnatal women/family members; 32 service providers; 22 experts/decision-makers; 63 conference attendees. Methods: Early years professionals were surveyed via email about the acceptability of payments to local health services for reaching smoking cessation in pregnancy and breastfeeding targets. Agreement was measured on a 5-point scale using multivariable ordered logit models. A framework approach was used to analyse free-text survey responses and qualitative data. Results: Health professional net agreement for provider incentives for smoking cessation targets was 52.9% (263/497); net disagreement was 28.6% (142/497). Health visitors/maternity staff were more likely than doctors to agree: OR 2.35 (95% CI 1.51 to 3.64; p<0.001). Net agreement for provider incentives for breastfeeding targets was 44.1% (219/497) and net disagreement was 38.6% (192/497). Agreement was more likely for women (compared with men): OR 1.81 (1.09 to 3.00; p=0.023) and health visitors/maternity staff (compared with doctors): OR 2.54 (95% CI 1.65 to 3.91; p<0.001). Key emergent themes were 'moral tensions around acceptability', 'need for incentives', 'goals', 'collective or divisive action' and 'monitoring and proof'. While provider incentives can focus action and resources, tensions around the impact on relationships raised concerns. Pressure, burden of proof, gaming, box-ticking bureaucracies and health inequalities were counterbalances to potential benefits. Conclusions: Provider incentives are favoured by non-medical staff. Solutions which increase trust and collaboration towards shared goals, without negatively impacting on relationships or increasing bureaucracy are required

Rectangular Hierarchical Cartograms for Socio-Economic Data

We present rectangular hierarchical cartograms for mapping socio-economic data. These density-normalising cartograms size spatial units by population, increasing the ease with which data for densely populated areas can be visually resolved compared to more conventional cartographic projections. Their hierarchical nature enables the study of spatial granularity in spatial hierarchies, hierarchical categorical data and multivariate data through false hierarchies. They are space-filling representations that make efficient use of space and their rectangular nature (which aims to be as square as possible) improves the ability to compare the sizes (therefore population) of geographical units. We demonstrate these cartograms by mapping the Office for National Statistics Output Area Classification (OAC) by unit postcode (1.52 million in Great Britain) through the postcode hierarchy, using these to explore spatial variation. We provide rich and detailed spatial summaries of socio-economic characteristics of population as types of treemap, exploring the effects of reconfiguring them to study spatial and non-spatial aspects of the OAC classification

Multi-Granular Trend Detection for Time-Series Analysis

Time series (such as stock prices) and ensembles (such as model runs for weather forecasts) are two important types of one-dimensional time-varying data. Such data is readily available in large quantities but visual analysis of the raw data quickly becomes infeasible, even for moderately sized data sets. Trend detection is an effective way to simplify time-varying data and to summarize salient information for visual display and interactive analysis. We propose a geometric model for trend-detection in one-dimensional time-varying data, inspired by topological grouping structures for moving objects in two- or higher-dimensional space. Our model gives provable guarantees on the trends detected and uses three natural parameters: granularity, support-size, and duration. These parameters can be changed on-demand. Our system also supports a variety of selection brushes and a time-sweep to facilitate refined searches and interactive visualization of (sub-)trends. We explore different visual styles and interactions through which trends, their persistence, and evolution can be explored

Roadmap to the multidisciplinary design analysis and optimisation of wind energy systems

A research agenda is described to further encourage the application of Multidisciplinary Design Analysis and Optimisation (MDAO) methodologies to wind energy systems. As a group of researchers closely collaborating within the International Energy Agency (IEA) Wind Task 37 for Wind Energy Systems Engineering: Integrated Research, Design and Development, we have identified challenges that will be encountered by users building an MDAO framework. This roadmap comprises 17 research questions and activities recognised to belong to three research directions: model fidelity, system scope and workflow architecture. It is foreseen that sensible answers to all these questions will enable to more easily apply MDAO in the wind energy domain. Beyond the agenda, this work also promotes the use of systems engineering to design, analyse and optimise wind turbines and wind farms, to complement existing compartmentalised research and design paradigms

Perceptions and experiences of using a nipple shield among parents and staff - an ethnographic study in neonatal units

Background: Preterm infants have an immature sucking behavior and the capacity to be exclusively breastfed may be reduced for a period of weeks or months, depending on gestational age. Nipple shields have been used, not only as a device to help mothers with sore nipples, but also to facilitate the infant’s latch on to the breast. However, the benefits of using nipple shields have been debated. The aim of this study was to explore perceptions and experiences of using a nipple shield among parents and staff in neonatal units in Sweden and England. Methods: An ethnographic study was undertaken where observations and interviews were conducted in four neonatal units in Sweden and England. The data were analyzed using a thematic networks analysis. Result: The global theme was developed and named, ‘Nipple shield in a liminal time’. This comprised of two organizing themes: ‘Relational breastfeeding’ and ‘Progression’. ‘Relational breastfeeding’ was underpinned by the basic themes, ‘good enough breast’, ‘something in between’ and ‘tranquil moment’. ‘Progression’ was underpinned by the basic themes, ‘learning quicker’, ‘short-term solution’ and ‘rescue remedy’. Although breastfeeding was seen primarily as a nutritive transaction, the relational aspects of breastfeeding were of crucial importance. These two organizing themes show the tension between acknowledging the relational aspects of breastfeeding and yet facilitating or supporting the progression of breastfeeding in the period from tube feeding or cup feeding to breastfeeding. It is a liminal time as mothers and their infants are “in between” phases and the outcome, in terms of breastfeeding, is yet to be realized. Conclusion: This study demonstrates parents’ and staffs’ perceptions of the nipple shield as a short term solution to help initiation of breastfeeding but also as a barrier between the mother and infant. It is important that the mother and baby’s own particular needs are taken into account, in a person-centred way and on an ongoing basis. Furthermore, we need to emphasise the importance of the ‘relational’ whilst understanding the need for ‘progression’. Holding these in balance may be the key to appropriate use of the nipple shield

The Black Caribs (Garifuna) of Livingston, Guatemala: Genetic Markers and Admixture Estimates

This is the published version. Copyright 1981 Wayne State University Press.The Black Caribs (Garifuna) are descendants of West African and Amerindian groups from St. Vincent Island who were transplanted to the coast of Central America in 1797. The founding population, estimated at 2,500 to 5,000 persons, gave rise to 65,000 Black Caribs who presently reside in 54 fishing villages spread geographically from Stann Creek (Dangriga), Belize, to LaFe, Nicaragua. This paper documents the genetic variation observed for 24 blood group, red blood cell and serum protein systems in one of the Black Carib communities of Livingston, Guatemala. Admixture estimates, based upon Gm, suggest the following parental population contribution for Livingston: 70% African, 29% Indian and 1% European