Non-native Bullhead in Scotland: Molecular and Morphological Identification and Parasite Links with Native Fauna

The arrival of a non-native species to has the potential to shape native communities by influencing ecological interactions such as predation, foraging, competition and disease transfer. A designation of invasive is applied to an introduced non-native species that has the potential to threaten the continued wellbeing of a native species, pose a risk to human health or negatively impact the economy. The European bullhead (Cottus perifretum) is a freshwater benthic-dwelling fish that is native to England but considered invasive in Scotland. The species was first reported in Scotland in the 1950's and thriving populations are now established in the waters of the Clyde, Forth and Tweed catchments. Bullhead presence is thought to negatively impact native stone loach (Barbatula barbatula) and brown trout (Salmo trutta) parr, due to shared preferences for habitat and prey resources. They are also thought to prey upon the eggs of native Atlantic salmon (Salmo salar) and brown trout, two species that are of high commercial value in Scotland. In other areas of introduction, bullheads have been found to increase parasite infection rates in native fishes. The species therefore has the capacity to incite competition and alter parasite/host interactions in areas of introduction, to the potential detriment of native fauna and the Scottish economy. The European bullhead has been the subject of considerable taxonomic scrutiny in recent years, resulting in its reclassification as a species complex. What was once considered a single species with a distribution encompassing Europe, Russia, Asia and Scandinavia, has been shown to consist of at least 15 distinct species. Genetic examination of bullheads from England confirmed the presence of Cottus perifretum, not Cottus gobio as traditionally listed in all UK literature and legislation. Native English bullhead is currently protected under Annex II of the European Commission Habitats Directive 92/43/EEC, based on the historic assumption that the species present is C. gobio. Analysis of the taxonomic identity of Scottish bullheads has remained outstanding. In this study the invasive status of bullhead was explored by examining feeding and parasitological interactions between bullheads and native freshwater communities in south-east Scotland. An assessment of the feeding preferences of native brown trout and stone loach in the presence and absence of bullheads tested competition for prey resources. Parasitological interactions were investigated by examining the shared parasite fauna of bullheads and native fish and invertebrate species. Bullheads from the Clyde and Forth catchments were analysed to provide a molecular and morphological description of this introduced species. Phylogenetic analysis of COX1 sequences obtained from Scottish bullheads, and a pair-wise distance calculation based on a Kimura 2-parameter model, showed that samples clustered in a distinct clade with English C. perifretum. Significant intraspecific variation was reported in all morphological features examined, but pooled data also revealed a resemblance to the published description provided for C. perifretum. Scottish bullhead is therefore confirmed to be an introduced pocket of the native English species, which is considered under threat in some areas due to habitat modifications and population decline. Comparisons between the dietary compositions of bullheads, brown trout and stone loach showed that the prey selection of brown trout and stone loach varied in the sample locations that contained co-occuring bullheads, when compared to locations where bullheads were absent. However, no direct evidence of trophic competition between bullheads and either brown trout or stone loach was reported. An examination of parasitological interactions recovered eight parasite species from four distinct taxonomic groups in total, of which four species (Echinorhynchus truttae, Apatemon gracilis, Diplostomum volvens and Raphidascaris acus) were shared between bullheads and one or more native fishes. Echinorhynchus truttae was also shared with gammarid crustaceans. Bullhead presence was found to coincide with D. volvens infections in European minnow (Phoxinus phoxinus) and a reduced prevalence of E. truttae in brown trout. Diplostomum volvens was only reported from minnow found in sites with bullheads, strongly suggesting bullheads were responsible for introducing this parasite to native minnows. Bullheads functioned as an alternative host for E. truttae, diluting brown trout parasite loads and reducing overall infection rates in sites where bullhead and brown trout co-exist. The findings reported for both feeding preference and parasite burdens in the presence and absence of bullheads suggest that bullheads do have some effect on the ecology of native species, but these are considered minimal and unlikely to impact the long-term survival of native species. Eradication of Scottish bullhead may contradict the conservation effort that is currently in place. Given the current lack of evidence to validate bullhead's invasive qualities and the recent confirmation of its genetic lineage, revisiting the designation of the bullhead as invasive is warranted. Active eradication should be treated with caution until a significant negative impact can be proven

‘The greatest feeling you get, knowing you have made a big difference’: survey findings on the motivation and experiences of trained volunteer doulas in England

Background Support from a doula is known to have physical and emotional benefits for mothers, but there is little evidence about the experiences of volunteer doulas. This research aimed to understand the motivation and experiences of volunteer doulas who have been trained to support women during pregnancy, birth and the postnatal period. Methods A postal questionnaire survey was sent to volunteer doulas at five volunteer doula projects working in low-income areas in England. Quantitative and qualitative data were analysed in parallel using summary statistics and content analysis respectively. Results Eighty-nine volunteer doulas (response rate 34.5 %) from diverse backgrounds responded to the survey. Major motivators for volunteering included a desire to help others and, to a lesser extent, factors related to future employment. Most reported that the training was effective preparation for their role. They continued volunteering because they derived satisfaction from the doula role, and valued its social aspects. Their confidence, skills, employability and social connectedness had all increased, but many found the ending of the doula-mother relationship challenging. For a minority, negative aspects of their experience included time waiting to be allocated women to support and dissatisfaction with the way the doula service was run. Discussion and conclusions Most respondents found the experience rewarding. To maintain doulas’ motivation as volunteers, services should: ensure doulas can start supporting women as soon as possible after completing the training; consider the merits of more flexible endings to the support relationship; offer opportunities for ongoing mutual support with other doulas, and ensure active support from service staff for volunteers

Access to Maternity Care for ‘Failed’ Asylum Seekers

This article analyses provision of health and social care for pregnant women and new families who have been unsuccessful in their asylum claims in the United Kingdom. It identifies the contribution of maternity care to child health, and examines the implications of the legislation that excludes ‘failed’ asylum seekers from free NHS secondary health care and denies them housing and financial support. Finally, the article examines the impact on pregnant women and their babies of being held in removal (detention) centres

The processes of implementing and sustaining an intensive volunteer one-to-one support (doula) service for disadvantaged pregnant women

'Doulas' (lay women who are trained to support other women during pregnancy, birth and postnatally) can improve outcomes for disadvantaged mothers and babies. This Realist Evaluation study uses qualitative interviews to explore the views of staff, commissioners and local champions about the processes of establishing and sustaining five volunteer doula support projects in England. The six key factors in their successful implementation are: fitting with local commissioning priorities; staff commitment and skills; networking with other agencies; defining and marketing the role; providing strong support for volunteers; and having some costs absorbed by others. The four key factors in sustaining the projects are: finding ways to balance the numbers of referrals and volunteers; shaping the service to local service drivers; constant networking; and creative responses to funding shortages. It is a constant challenge to balance the rate of referrals and the number of trained volunteers within tight budgets and timescales ..

"Reassurance that you're doing okay, or guidance if you're not": A qualitative descriptive study of pregnant first time mothers' expectations and information needs about postnatal care in England

To explore what first time mothers in England expect from postnatal care while they are pregnant, what they would ideally like, where they get their information on postnatal care, and their views on the sufficiency of this information. A qualitative descriptive interview-based study. England PARTICIPANTS: A maximum variation sample of 40 women who were currently in the third trimester of pregnancy; aged 16 or over; planning to give birth in England and had not given birth previously. Semi structured interviews were carried out between October 2017 and March 2018, by telephone (n = 32) and face to face (n = 8). Interviews were analysed using thematic analysis. There were six themes and twelve subthemes. The themes were: (1) 'Piecing together snippets of information' containing subthemes 'Incomplete official sources' and 'Other mothers' stories'; (2) 'Planning ahead or going with the flow' containing subthemes 'Wanting more information' and 'Postnatal care not a priority'; (3) 'Judgement or reassurance' containing subthemes 'Real: Being judged', 'Ideal: Reassurance and non-judgmental advice'; (4) 'Focus of care' containing subthemes 'Real: A focus on checks and feeding', 'Ideal: More focus on mother's wellbeing'; (5) 'A system under pressure' containing subthemes 'Real: Busy midwives, reactive care', 'Ideal: Reliable, proactive information'; (6) 'Deciding about discharge', containing subthemes 'Real: Confusion about decision-making', 'Ideal: More control over length of hospital stay'. First time mothers' experience of the transition to parenthood could be improved by antenatal access to comprehensive information about the timing, location, content and purpose of postnatal care. Information should take a woman-centred perspective and cover all settings (hospitals, birth centres, home, community), including the roles and responsibilities of all the professionals who may be involved. Clear and comprehensive information about postnatal care should be provided to all women in ways that are accessible at any stage of pregnancy or the postnatal period. As women pregnant for the first time worry about being judged if they seek professional advice and reassurance postnatally, information about postnatal care should aim to address this. [Abstract copyright: Copyright © 2020. Published by Elsevier Ltd.

The WHEAT pilot trial-WithHolding Enteral feeds Around packed red cell Transfusion to prevent necrotising enterocolitis in preterm neonates: a multicentre, electronic patient record (EPR), randomised controlled point-of-care pilot trial

INTRODUCTION: Necrotising enterocolitis (NEC) is a potentially devastating neonatal disease. A temporal association between red cell transfusion and NEC is well described. Observational data suggest that withholding enteral feeds around red cell transfusions may reduce the risk of NEC but this has not been tested in randomised trials; current UK practice varies. Prevention of NEC is a research priority but no appropriately powered trials have addressed this question. The use of a simplified opt-out consent model and embedding trial processes within existing electronic patient record (EPR) systems provide opportunities to increase trial efficiency and recruitment. METHODS AND ANALYSIS: We will undertake a randomised, controlled, multicentre, unblinded, pilot trial comparing two care pathways: continuing milk feeds (before, during and after red cell transfusions) and withholding milk feeds (for 4 hours before, during and for 4 hours after red cell transfusions), with infants randomly assigned with equal probability. We will use opt-out consent. A nested qualitative study will explore parent and health professional views. Infants will be eligible if born at <30+0 gestational weeks+days. Primary feasibility outcomes will be rate of recruitment, opt-out, retention, compliance, data completeness and data accuracy; clinical outcomes will include mortality and NEC. The trial will recruit in two neonatal networks in England for 9 months. Data collection will continue until all infants have reached 40+0 corrected gestational weeks or neonatal discharge. Participant identification and recruitment, randomisation and all trial data collection will be embedded within existing neonatal EPR systems (BadgerNet and BadgerEPR); outcome data will be extracted from routinely recorded data held in the National Neonatal Research Database. ETHICS AND DISSEMINATION: This study holds Research Ethics Committee approval to use an opt-out approach to consent. Results will inform future EPR-embedded and data-enabled trials and will be disseminated through conferences, publications and parent-centred information. TRIAL REGISTRATION NUMBER: ISRCTN registry ISRCTN62501859; Pre-results