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Leveraging qualitative insights for dashboard development to address perinatal health inequalities in maternity, neonatal and perinatal services
No full text© 2025 The Authors. Published by Wiley. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1111/jep.70130Introduction
Perinatal health inequalities, referring to disparities in maternal and neonatal outcomes among different ethnic groups, persist despite numerous calls to action. A quality improvement initiative, such as the perinatal health inequality dashboard, could serve as a tool to provide real-time data, highlight trends and patterns, and capture and analyse disparities in maternal and neonatal outcomes across various population groups.
Aim
To explore the development process of the perinatal health inequality dashboard and conduct a preliminary evaluation of the barriers and facilitators in effectively presenting data and highlighting disparities in maternal and neonatal outcomes on the dashboard in the Leicester, Leicestershire, and Rutland (LLR) region in the United Kingdom.
Method
A qualitative study was conducted at the University Hospital of Leicester (UHL) involving the dashboard development team and end users, who are clinicians specializing in obstetrics, neonatal care, and perinatal mental health from the Leicester, Leicestershire, and Rutland (LLR) region. Ten clinicians were interviewed using a semi-structured approach over a 3-month period. The data were analysed using thematic analysis following Braun and Clarke's method.
Results
The study findings are presented in two sections: the dashboard development process and dashboard evaluation. Key themes in the development process include data sourcing, integration, and accuracy in neonatal care. Evaluation themes focus on the potential impact of the dashboard, a user-friendly interface, balancing qualitative and quantitative data, sustainability through continuous oversight, and system integration and interoperability. These findings offer critical insights for the ongoing refinement and effective deployment of the dashboard.
Conclusion
The dashboard has the potential to improve health outcomes based on clinicians' insights. However, continuous refinement and modification of its functionality are necessary to address the challenges associated with its use.This work was funded by the local maternity and neonatal services (LMNS) for Leicestershire, Leicester and Rutland
The identification and recording of potential biological hazards in ancient monuments for inclusion in HBIM within refurbishment and demolition in ancient castles
No full textA thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the degree of Doctor of Philosophy.Background - Owing to the role that micro-organisms play, it can be seen that the need to comprehend the composition and functionality of complex microbial groups, within ancient structures is important as to ascertain if it is dangerous to health. This research aims to demonstrate the possibility of showing this within a process of demolition and refurbishment on a heritage
historical building information modelling platform.
Purpose - Little or no application exists regarding the implication or recording of health and safety information, (especially legislation), primarily aimed at ancient structures, specifically at designated areas of demolition and refurbishment, particularly considering the inclusion of the identification of micro-organisms, which have adapted to varying environmental conditions
throughout time.
Aims - The production of a prototype working HBIM (Historical Building Information Modelling) model to identify micro-organisms found within an ancient monument or otherwise; to produce a full analysis within a platform that informs the stakeholder of the micro-organism communities present; its analysis; to highlight results and portray a document management system within a HBIM platform to indicate and create health & safety legislation required, or sought, within the refurbishment sector, by means of Act of Parliament.
Method - Initial collection of specimens from site were analysed using a PCR, (Polymerase Chain Reaction), to extract DNA as to determine the Genus within the community. All results have been portrayed within a HBIM model and data management system to ascertain the required Health and Safety legislation is required for refurbishment within this or a similar site.
Results – Experiments from the case study concluded to what data collection procedure would be more adaptable or suitable for the research, to give evidence and realisation seen from a HBIM precedent. Metagenomic analysis would satisfy a collection and creation of multiple datasets, however PCR would be required initially to amplify DNA. The research would have a significant impetus within construction, heritage, and the refurbishment of old and ancient monuments.
Conclusion & Recommendations - This process of the data collection method used, particularly within the metagenomic application and collection of data from questionnaires has created a standardisation and availability for such data from ancient monuments, hence, to make available all data stored as such analysis becomes substantially important to enable the production of
datasets for comparison. Such results have shown within the research that there is a need for such a method to be made available for all future analysis of data collection within ancient castles
Case study of hydrogen distribution via ammonia-to-hydrogen system in the UK Humber industrial cluster
Full text link© 2025 The authors. Published by Elsevier. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1016/j.ijhydene.2025.152739The creation of a low-carbon hydrogen energy distribution system is essential to the decarbonisation of the UK Humber industrial cluster and other industrial clusters worldwide. In the UK, it is expected that a good proportion of hydrogen will be imported by 2050 in the form of ammonia derivative due to the material and physical limitation of transporting and storing hydrogen. The Immingham Green Energy Terminal (IGET) in the UK Humbers industrial cluster is envisioned to become a strategic landing point for imported low carbon ammonia which will be decomposed thereafter to obtain and supply hydrogen to the end-user heavy industries in the cluster. This study evaluates various ammonia-to-hydrogen network configurations through a comprehensive techno-economic analysis. A technical design was developed to calculate pipeline diameters, accurately accounting for the fluid properties of both hydrogen gas and liquid ammonia across proposed network designs. The results informed the optimisation of the pipeline configurations for each variation. The network simulation was implemented in Aspen Plus V14, validating the technical design outcomes. An economic assessment calculated the levelised costs of transmission (LCOT), ammonia cracking (LCOC), and hydrogen delivery (LCOH). LCOT values ranged from £0.024/kg NH3 to £0.029/kg H2, while LCOC values ranged from £4.25–£4.46/kg H2. LCOH values of £3.53 and £3.49/kg H2 were determined for centralized and decentralized ammonia-to-hydrogen networks, respectively. Comparison with existing literature revealed discrepancies due to differences in annual hydrogen throughput assumptions, limiting direct validation.This research was supported by funding from the Industrial Decarbonisation Research and Innovation Centre (IDRIC), UK.Published versio
An in vivo study of novel genetic modifiers in autosomal recessive polycystic kidney disease (ARPKD)
No full textA thesis submitted in partial fulfilment of the requirement of the University of Wolverhampton for the degree of Doctor of Philosophy.Autosomal Recessive Polycystic Kidney Disease (ARPKD) is a rare genetic disorder that manifests with bilaterally enlarged, cystic kidneys, hepatic fibrosis and pulmonary hypoplasia, with death reported in around 30 – 50% of affected neonates. Mutations in PKHD1 and DZIP1L have been identified as causative genes for ARPKD, with the protein products of both genes localising to the primary cilium. Ciliary signalling pathways, such as Wnt signalling, have been investigated to dissect potential molecular mechanisms of ARPKD, however, these remain unclear. To overcome this, researchers have tried to develop rodent models that replicate human ARPKD and thus far, this has proven challenging.
Using our current understanding regarding pathogenic variants in ARPKD patients, we have developed the novel Pkhd1T37M/T37M mouse model that carries the most common and severe truncating mutation in human ARPKD. For this study, we aimed to characterise this model by performing experiments in the kidney, liver and lung, across different developmental stages, as presented in human ARPKD. From our data, we found that the kidney phenotype in Pkhd1T37M/T37M mice was overall mild, presenting as tubular dilation from around P2, and cytoskeletal defects in aged mice. Furthermore, novel Pkhd1 targets, including Muc1, Tacstd2 and Epor, were identified via RNA-sequencing analysis with metabolic pathways such as oxidative phosphorylation appearing dysregulated. In the liver, Pkhd1T37M/T37M mice presented progressive liver fibrosis and increased canonical Wnt signalling. Excitingly, for the first time, we provide evidence that the lung may be a primary characteristic of ARPKD, rather than a secondary consequence, with mutations in Pkhd1 resulting in changes in the gross morphological structure of Pkhd1T37M/T37M mouse lungs and aberrant expression of key PKD and Wnt signalling genes, including Pkd1, Atmin and Vangl2. Interestingly, RNA-sequencing analysis also identified Aqp2, Foxf1 and Igfbp2 as novel Pkhd1 targets in the lung, as well as dysregulation of STAT3 signalling in Pkhd1T37M/T37M mice. Together, this data further highlights potential mechanisms of action for the lung phenotype and sets the ground for future investigations to dissect these relationships.
Overall, our study shows that the Pkhd1T37M/T37M mouse exhibits an ARPKD-like phenotype and could be a useful tool to advance our understanding of ARPKD and the potential molecular mechanisms involved
Exploring the relaxation potential of nature soundscapes and photography through field recordings and meditation nature walks
No full textA thesis submitted in fulfilment of the requirements of the University of Wolverhampton for the degree of Doctor of Philosophy.This thesis investigates the potential of nature soundscapes, paired with nature photography, to promote relaxation. The research opens with the context of the soundscape and R. Murray Schafer’s notion of acoustic ecology. Schafer’s work from the 1970s onward examines how individuals interact with sounds through cultural contexts and personal perceptions. His ideas have since permeated various disciplines, including well-being and audiovisual art. This thesis focuses on the intersection of soundscapes within meditation and well-being, as well as psychology and sound art, providing examples of contemporary artists as well as contemporary therapeutic practices for relaxation. This thesis also explores theories within audiovisuals, including Michel Chion’s added value approach in relation to sound and image. Likewise, key theories within soundscapes are explored, such as Schafer’s notions hi-fi, lo-fi, and concepts of positive and negative soundscape design. Practitioners and theorists who critique Schafer are included in this research: for example, Drever’s concept of aural diversity is addressed.
Through the combined audio and visual experience, six nature soundscapes generated by the researcher during the COVID-19 crisis are explored within sound ecology, well-being, and audiovisual art. Three focus groups comprised of 4-6 participants each were analysed using Braun and Clarke’s (2006) thematic analysis method to examine the impact of culture, nature visuals, and the factors that contribute to individuals using nature soundscapes for relaxation. Additionally, the nature soundscapes were analysed using qualitative autoethnographic data in blogs and memories to explore the impact of the creative process. There is reflection on the creative process following the soundwalk methods of Schafer, Watson, and Westerkamp. The research concludes that nature sounds can promote relaxation, but it is dependent on the individual’s perception, culture, and memories. Thematic analysis determined that nature soundscapes prompted participants to have feelings evoked from their memories and associations. Online spaces using nature sound and nature images provided similar memories and associations that participants would have to real-world nature spaces. Autoethnographic analysis determined that the researcher coped with anxiety by carrying out the creative process (from the sound walk, composition of soundscapes, editing nature images, and playing back the final versions of the nature soundscapes). This thesis has an adjoining project titled Core Opulence, which the researcher used to share the research and findings.
The research limitations address the lack of diversity within the small number of participants of the focus groups. Future recommendations suggest larger groups of participants with varying backgrounds outside of being university students. Practical implications include broadening the soundwalk process to account for disabilities. Originality of this research rests within broadening sound studies to include image. By providing equal weight to sound and image, nature soundscapes paired with photography are established as a form of audio and visual sound art
Optimising neonatal services for very preterm births between 27+0 and 31+6 weeks gestation in England: the OPTIPREM mixed-methods study
No full text©2025 The Authors. Published by NIHR. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link:
https://doi.org/10.3310/JYWC6538Aim
To investigate, for preterm babies born between 27+0 and 31+6 weeks gestation in England, optimal place of birth and early care.
Design
Mixed methods.
Setting
National Health Service neonatal care, England.
Methods
To investigate whether birth and early care in neonatal intensive care units (tertiary units) compared to local neonatal units (non-tertiary units) influenced gestation-specific survival and other major outcomes, we analysed data from the National Neonatal Research Database, for 29,842 babies born between 27+0 and 31+6 weeks gestation and discharged from neonatal care between 1 January 2014 and 31 December 2018. We utilised an instrumental variable (maternal excess travel time between local neonatal units and neonatal intensive care units) to control for unmeasured differences. Sensitivity analyses excluded postnatal transfers within 72 hours of birth and multiple births. Outcome measures were death in neonatal care, infant mortality, necrotising enterocolitis, retinopathy of prematurity, severe brain injury, bronchopulmonary dysplasia, and receipt of breast milk at discharge. We also analysed outcomes by volume of neonatal intensive care activity. We undertook a health economic analysis using a cost-effectiveness evaluation from a National Health Service perspective and using additional lives saved as a measure of benefit, explored differences in quality of care in high compared with low-performing units and performed ethnographic qualitative research.
Results
The safe gestational age cut-off for babies to be born between 27+0 and 31+6 weeks and early care at either location was 28 weeks. We found no effect on mortality in neonatal care (mean difference −0.001; 99% confidence interval −0.011 to 0.010; p = 0.842) or in infancy (mean difference −0.002; 99% confidence interval −0.014 to 0.009; p = 0.579) (n = 18,847), including after sensitivity analyses.
A significantly greater proportion of babies in local neonatal units had severe brain injury (mean difference −0.011; 99% confidence interval −0.022 to −0.001; p = 0.007) with the highest mean difference in babies born at 27 weeks (−0.040). Those transferred in the first 72 hours were more likely to have severe brain injury. For 27 weeks gestation, birth in centres with neonatal intensive care units reduced the risk of severe brain injury by 4.2% from 11.9% to 7.7%. The number needed to treat was 25 (99% confidence interval 10 to 59) indicating that 25 babies at 27 weeks would have to be delivered in a neonatal intensive care unit to prevent one severe brain injury.
For babies born at 27 weeks gestation, birth in a high-volume unit (> 1600 intensive care days/year) reduced the risk of severe brain injury from 0.242 to 0.028 [99% confidence interval 0.035 to 0.542; p = 0.003; number needed to treat = 4 (99% confidence interval 2 to 29)].
Estimated annual total costs of neonatal care were £262 million. The mean (standard deviation) cost per baby varied from £75,594 (£34,874) at 27 weeks to £27,401 (£14,947) at 31 weeks. Costs were similar between neonatal intensive care units and local neonatal units for births at 27+0 to 29+6 weeks gestation, but higher for local neonatal units for those born at 30+0 to 31+6 weeks. No difference in additional lives saved were observed between the settings. These results suggested that neonatal intensive care units are likely to represent value for money for the National Health Service. However, careful interpretation of this results should be exercised due to the ethical and practical concerns around the reorganisation of neonatal care for very preterm babies from local neonatal units to neonatal intensive care units purely on the grounds of cost savings.
We identified a mean reduction in length of stay (1 day; 95% confidence interval 1.029 to 1.081; p < 0.001) in higher-performing units, based on adherence to evidence- and consensus-based measures. Staff reported that decision-making to optimise capacity for babies was an important part of their work. Parents reported valuing their baby’s development, homecoming, continuity of care, inclusion in decision-making, and support for their emotional and physical well-being.
Conclusions
Birth and early care for babies ≥ 28 weeks is safe in both neonatal intensive care units and local neonatal units in England. For anticipated births at 27 weeks, antenatal transfer of mothers to centres colocated with neonatal intensive care units should be supported. When these inadvertently occur in centres with local neonatal units, clinicians should risk assess decisions for postnatal transfer, taking patient care requirements, staff skills and healthcare resources into consideration and counselling parents regarding the increased risk of severe brain injury associated with transfer.
Study registration
This study is registered as Current Controlled Trials NCT02994849 and ISRCTN74230187.
Funding
This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/70/104) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 12. See the NIHR Funding and Awards website for further award information.This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/70/104)
Factors influencing whether doctors intend to stay working in primary health care after completing residency in family and community medicine in Paraíba, Brazil
No full text© 2025 The Authors. Published by Springer Nature. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1007/s44250-025-00200-2Background
In the last decade, there has been a 250% increase in the number of doctors trained in Family and Community Medicine (FCM) residency programs in Brazil; however, it is estimated that there is a need to train around 50,000 specialists to work in Primary Health Care (PHC) teams, especially in more remote regions with vulnerable populations. This study investigates the factors associated with the intention of doctors linked to the ten FCM residency programs in the state of Paraíba to continue working in PHC.
Methods
This is a cross-sectional, analytical study with a quantitative approach and a census-type sample of 211 doctors, residents and preceptors. Data was obtained using an electronic questionnaire which we administered in the second half of 2023. Descriptive, bivariate (Chi-square and Fisher's exact) and logistic regression analyses were carried out. We found that the grouping variable “intention to continue working in PHC” was associated with sociodemographic and academic variables and that intrinsic and extrinsic factors that could influence doctors' decisions.
Results
Most participants were female (61.6%), without a partner (57.3%), and without children (82%). 42 (19.9%) worked as preceptors and 169 (80.1%) as residents. 90.5% of the preceptors intended to continue in primary care, compared to 54.4% of the residents. There was an association between the grouping variable and being married or in a stable union (p = 0.031), having children (p = 0.002), having graduated from a public institution (p = 0.017) and having experience in PHC (p = 0.049). Most doctors make the decision to continue working in PHC during their undergraduate studies (p < 0.001), while the period of experience in PHC contributes to the decision (p = 0.002), as do more stable employment relationships, such as a permanent job (p = 0.015), statutory requirements (p < 0.001), or the offer of a master's degree (p < 0.001).
Conclusion
The intention of doctors linked to the ten FCM residency programs in the state of Paraíba to continue working in PHC was associated with their identification with the area, the decision having been made during graduation and strengthened with experience. More stable employment relationships, the offer of a master's degree in the area and the opportunity to act as a preceptor in the FCM residency program all contributed to the desire to remain in PHC throughout their professional career.No funding.Published onlin
Strategies for improving maternal care for ethnic minority women with obstetric anal sphincter injuries in the UK
No full textBackground
Women from minority ethnic groups in the UK have the highest prevalence of obstetric anal sphincter injuries (OASI), including third- and fourth-degree perineal tears sustained during childbirth. Incorporating the voices of mothers at higher risk of OASI is crucial in developing strategies to improve care and well-being.
Aim
To identify strategies perceived as important by women with lived experience of OASI in Leicester, UK, to improve their care and well-being.
Methodology
Women at high risk of and with lived experience of OASI in Leicester, UK, were invited, through our local maternity and neonatal voices partnership, to participate in a virtual focus group discussion (FGDs). Two FGDs were conducted to accommodate participants' availability. The first session included seven women, while the second session included three women. All participants were from underrepresented groups with lived experiences of OASI within the past one to ten years. A discussion guide was used to explore participants’ perceptions and experiences of OASI care, as well as their views on culturally and linguistically sensitive maternal care strategies. The discussion was recorded and transcribed. The data were analysed using the six-step thematic analysis approach by Braun and Clarke.
Results
The participants identified strategies to provide culturally appropriate care for obstetric anal sphincter injuries, including linguistically accessible prenatal resources, comprehensive midwifery training, updated prenatal education, standardized postpartum care, the inclusion of fathers in prenatal education, empathetic care, building trust, and community engagement and education.
Conclusion
This study highlights disparities in maternal healthcare outcomes for women from diverse ethnic backgrounds who experience OASI. Addressing these inequalities requires incorporating the voices of those directly affected to inform culturally sensitive policies and practices in maternal care.This work was funded by the Local Maternity and Neonatal System (LMNS) for Leicester, Leicestershire and Rutland’s
3D printed titanium TPMS for personalised tibial bone implant
No full text©2025 The Authors. Published by Elsevier. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link: https://doi.org/10.1016/j.bea.2025.100166Porous titanium scaffolds offer hope for reducing stress shielding and encouraging new bone growth, moving the field closer to personalised load bearing implants. This study explores four triply periodic minimal surface (TPMS) tibial scaffolds informed by Gyroid (GSC), Lidinoid (LSC), Diamond (DSC), and Schwartz Primitive (SSC) unit cells. These scaffolds were made using Laser Powder Bed Fusion (L-PBF) 3D printing, with a targeted porosity of 60 % to closely match the mechanical behaviour of natural tibial bone. Mechanical testing of these scaffolds revealed an elastic modulus of 10.42 to 13.62 GPa and compressive strengths ranging from 209 to 393 MPa, meeting the requirements for load-bearing tibial implants. Multi-criteria decision-making (MCDM) methods, AHP and TOPSIS, were applied to evaluate the designs, considering four favourable factors of relative importance in the order porosity>yield strength>elastic modulus>ultimate strength. This analysis identified SSC scaffold featuring Schwartz Primitive architecture as the most promising candidate for load-bearing applications. The biological compatibility of these scaffolds was also found to be equally compelling. In vitro testing with U-2OS osteosarcoma cells confirmed high cell viability, underscoring the cytocompatibility of these TPMS designs and reinforcing their potential for biomedical applications. Together, these findings offer a path toward the use of titanium scaffolds in orthopaedics, setting the stage for further in vivo studies and a potential breakthrough in functional bone implant design.Published versio
Causes of and risk factors for postpartum haemorrhage: a systematic review and meta-analysis
No full text© 2025 The Authors. Published by Elsevier. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1016/S0140-6736(25)00448-9Background
An understanding of the causes of postpartum haemorrhage is needed to provide appropriate treatment and services. Knowledge of the risk factors for postpartum haemorrhage can help address modifiable risk factors. We did a systematic review and meta-analysis to identify and quantify the various causes and risk factors for postpartum haemorrhage.
Methods
In this systematic review and meta-analysis, we did a systematic literature search in MEDLINE, Embase, Web of Science, Cochrane Library, and Google Scholar for cohort studies of postpartum haemorrhage from Jan 1, 1960, to Nov 30, 2024 without language restrictions. At least two authors independently undertook study selection, data extraction, and quality assessment. Population-based cohort studies available in English were eligible. Rates of postpartum haemorrhage causes as well as crude and adjusted odds ratios (ORs) for risk factors were pooled using a random-effects model. Risk factors were classified as having weak, moderate, or strong association based on the pooled ORs: weak (OR >1 to 1·5), moderate (OR >1·5 to 2), and strong (OR >2). This study is registered with PROSPERO, CRD42023479686.
Findings
We synthesised data from 327 studies, including 847 413 451 women with no restriction on age, race, or ethnicity. Most studies were of high methodological quality. The pooled rates of the five commonly reported causes of postpartum haemorrhage were uterine atony (70·6% [95% CI 63·9–77·3]; n=834 707 women, 14 studies), genital tract trauma (16·9% [9·3–24·6]; n=18 449 women, six studies), retained placenta (16·4% [12·3–20·5]; n=235 021 women, nine studies), abnormal placentation (3·9% [0·1–7·6]; n=29 638 women, two studies), and coagulopathy (2·7% [0·8–4·5]; n=236 261, nine studies). The pooled rate of women with multiple postpartum haemorrhage causes was 7·8% (95% CI 4·7–10·8; n=666, two studies). Risk factors with a strong association with postpartum haemorrhage included anaemia, previous postpartum haemorrhage, caesarean birth, female genital mutilation, sepsis, no antenatal care, multiple pregnancy, placenta praevia, assisted reproductive technology use, macrosomia with a birthweight of more than 4500 g, and shoulder dystocia. Risk factors with moderate association with postpartum haemorrhage included BMI ≥30 kg/m2, COVID-19 infection, gestational diabetes, polyhydramnios, pre-eclampsia, and antepartum haemorrhage. Risk factors with weak association with postpartum haemorrhage included Black and Asian ethnicity, BMI 25–29·9 kg/m2, asthma, thrombocytopenia, uterine fibroids, antidepressant use, induction of labour, instrumental birth, and premature rupture of membranes.
Interpretation
The finding that uterine atony is the commonest cause of postpartum haemorrhage supports the WHO recommendation for all women giving birth to be given prophylactic uterotonics. Knowledge of risk factors with a strong association with postpartum haemorrhage can help to identify women at high risk of postpartum haemorrhage who could benefit from enhanced prophylaxis and treatment. The importance of multiple concurrent causes of postpartum haemorrhage supports the use of treatment bundles.Gates Foundation.Published versio