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How is quality of care conceptualised by the different constituencies involved in maternity care in the UK? An organisational ethnography
Get PDFBackground: A consensus exists between different constituencies involved at all levels of maternity care that high quality care is important. The implicit assumption is that everyone defines and understands the idea of quality in maternity care identically. However, contemporary debate about where the balance between safety and personalisation in maternity care lies, raises important questions about the different definitions that might be operating when people talk about ‘Quality’ in this context.
Methods: This PhD aimed to examine how quality of maternity care is defined by the different constituencies in maternity care over time, and how its dimensions are implemented. A meta-narrative review, analysis of the Babies Born Better survey, and an in-depth organisational ethnography in two diverse maternity units within one English NHS Trust were conducted, including interviews, focus-groups, documentary analysis, and observations. Framework analysis, based on previous study phases, was applied inductively to analyse the data obtained.
Findings: Sixty-three papers were included in the meta-narrative review, thirty-seven surveys were analysed, and forty-eight participants (managers, frontline staff, women, and their birthing partners) were recruited for the organisational ethnography. Twenty-seven interviews and two focus-groups were conducted. One hundred and eighty hours of observation took place, and twenty documents were collected. Results indicate that the understanding of ‘quality’ and implementation of the ‘quality of maternity care dimensions’ was not uniform. Closely interlinked factors such as safety and personalisation were seen as separate entities, where the organisation’s definition of safety was largely prioritised over the woman’s personal or individual preferences.
Conclusions: Even though people think they are communicating a shared concept when they talk about quality of maternity care, this study suggests that their underlying definitions for the term may differ substantially. High quality maternity care goes far beyond preventing morbidity and mortality. The implementation of a clear and shared vision about what goes well, for whom, under what circumstances is necessary for a maternity service to thrive
Implementing an Intervention Based on Dialogic Argumentation to Prevent Incidents of Cyber-Bullying/ Victimisation
Get PDFThe literature shows the negative consequences of bullying/cyberbullying incidents and the need for more effective interventions for prevention. Risk and protective factors may also play a role in these incidents. Recent dialogue-based interventions seem promising for the prevention of bullying/cyberbullying. Thus, the current research project attempted to address the above issues with the implementation of 3 studies. Study 1 aimed to examine potential relationships among bullying and victimisation, argumentation skills, alexithymia, and self-efficacy. It was hypothesised that bullying and victimisation would be correlated to argumentation skills, alexithymia, and self-efficacy. Primary schools in Cyprus were approached and 100 early adolescents were recruited to measure their frequency of bullying and victimisation, their level of alexithymia, their level of self-efficacy for peer interactions, and their argumentative performance. The results showed significant correlations between bullying and victimisation and alexithymia, and between victimisation and self-efficacy for peer interactions, but no correlations between bullying and victimisation and argumentation skills, and between bullying and self-efficacy for peer interactions. Therefore, the results in Study 1 partially supported the hypotheses set initially. Study 2, aimed to examine potential relationships among cyberbullying and cyber-victimisation, argumentation skills, and generalised self-efficacy. It was hypothesised that cyberbullying and cyber-victimisation would be correlated to argumentation skills and generalised self-efficacy. University-level students from Cyprus and the United Kingdom were recruited, 100 in total to measure the frequency of cyberbullying and cyber-victimisation incidents, their level of generalised self-efficacy, and their argumentative performance. The results showed significant correlations between academic self-efficacy and cyber-victimisation, and between academic self-efficacy and arguments strengthening the other position only. No correlations were found between cyberbullying and cyber-victimisation and argumentation skills. Thus, the results in Study 2 did not support the hypotheses set initially.
The main experimental study of this research project was Study 3, which aimed to examine potential changes that engagement in dialogic argumentation would elicit in argumentation skills, cyberbullying and cyber-victimisation, and generalised self-efficacy. It was hypothesised that dialogic argumentation would trigger changes in argumentation skills, cyberbullying and cyber-victimisation, and generalised self-efficacy. University-level students, 40 in total were randomly allocated to the intervention group (n=20) and the control group (n=20). Then, the intervention group engage in an intervention based on dialogic argumentation. The main task of this intervention was the exchange of arguments between students on a social topic in the form of dialogues through an instant messaging platform. The argumentation skills of students, their frequency of cyberbullying and cyber-victimisation, and their level of generalised self-efficacy were assessed before the intervention and 1 month after. The most salient findings came from Study 3, where the participants from the intervention group exhibited larger gains in their argumentation skills and reported fewer incidents of cyber-victimisation compared to the control group. However, significant changes were not found in the frequency of cyberbullying incidents and the level of generalised self-efficacy after comparing the intervention group to the control group. Overall, the results in Study 3 partially supported the hypotheses set initially. Thus, it was concluded that dialogic argumentation can advance argumentation skills, which can help students avoid cyber-victimisation incidents. These findings highlighted the importance of investigating further this programme based on dialogic argumentation to determine whether it can contribute to the effective prevention of cyberbullying and cyber-victimisation
Correlation Between Propulsive Velocity, Maximum Velocity, and Power and the 2D:4D Ratio in Paralympic Powerlifting Athletes
Get PDFBackground: Among the strength sports we have Paralympic powerlifting, and the factors that influence strength have been investigated; among them is the relationship between strength and the ratio of the size of the second and fourth fingers of the hand (2D:4D).
Objectives: The study is aimed at evaluating the relationship between the 2D:4D finger length ratio and the dynamic strength indicators, mean propulsive velocity (MPV), maximum velocity (Vmax), and power, with loads of 45% and 80% of one repetition maximum (1RM), in Paralympic powerlifting.
Methodology: Sixteen elite Paralympic powerlifting athletes were evaluated for dynamic strength indicators, MPV, Vmax, and power, with loads of 45% and 80% 1RM. The 2D:4D proportions and correlations between the indicators were evaluated of 2D:2D ratios and dynamic strength indicators.
Results: Moderate correlations were found between MPV 45% and 4D (r = 0.551, p = 0.027), between MPV 45% and R-L 2D:4D diff. (r = −0.595, p = 0.015), between power 80% and L2 (r = 0.542, p = 0.030), and between MPV 45% and R-L 2D:4D (r = −0.585, p = 0.017). There was also a moderate correlation between power 80% left 2D (r = −0.542, p = 0.030). However, no correlation was found between the 2D:4D ratios and dynamic strength indicators in Paralympic powerlifting.
Conclusion: The 2D:4D ratio presents a moderate correlation with dynamic strength indicators in Paralympic powerlifting athletes, where the ratios with the velocity of 45 of 1RM can be used as a predictor but with caution
Suicide-related stigma and its relationship with help-seeking, mental health, suicidality and grief: scoping review
Get PDFBackground
Suicide-related stigma (i.e. negative attitudes towards people with suicidal thoughts and/or behaviours as well as those bereaved by suicide) is a potential risk factor for suicide and mental health problems. To date, there has been no scoping review investigating the association between suicide-related stigma and mental health, help-seeking, suicide and grief across several groups affected by suicide.
Aims
To determine the nature of the relationship between suicide-related stigma and mental health, help-seeking, grief (as a result of suicide bereavement) and suicide risk.
Method
This review was registered with PROSPERO (CRD42022327093). Five databases (Web of Science, APA PsycInfo, Embase, ASSIA and PubMed) were searched, with the final update in May 2024. Studies were included if they were published in English between 2000 and 2024 and assessed both suicide-related stigma AND one of the following: suicide, suicidal thoughts or suicidal behaviours, help-seeking, grief or other mental health variables. Following screening of 14 994 studies, 100 eligible studies were identified. Following data charting, cross-checking was conducted to ensure no relevant findings were missed.
Results
Findings across the studies were mixed. However, most commonly, suicide-related stigma was associated with higher levels of suicide risk, poor mental health, lowered help-seeking and grief-related difficulties. A model of suicide-related stigma has been developed to display the directionality of these associations.
Conclusions
This review emphasises the importance of reducing the stigma associated with suicide and suicidal behaviour to improve outcomes for individuals affected by suicide. It also identifies gaps in our knowledge as well as providing suggestions for future research
P331: Evaluating the Impact of the SAVI Scout Device on Positive Margin Rates in Breast-Conserving Surgery: A Systematic Review
Get PDFP364: Comparison of Magseed and Savi Scout Localisation Systems for Wide Local Excision: A Retrospective Cohort Study Across Two Hospitals
Get PDFIdentifying Alzheimer’s disease genes in apolipoprotein E−/− mice brains with confirmed Porphyromonas gingivalis entry
Get PDFBackground
The apolipoprotein E allele ε4 is the most well-known predisposing genetic risk factor for Alzheimer’s disease (AD).
Objective
To identify AD genes in apolipoprotein E−/− (ApoE−/−) mice brains with confirmed entry of Porphyromonas gingivalis.
Methods
TaqMan™ Mouse AD arrays were performed on orally infected ApoE−/− mice with confirmed P. gingivalis entry and compared with sham infected mice brains (N = 4) at 12 and 24 weeks post infection.
Results
Gene expression by qPCR demonstrated that in the P. gingivalis 12 weeks post oral infection, two genes were statistically significantly changed in their expression. These were cyclin dependent kinase 5 regulatory subunit 1 (Cdk5r1, 0.15 logfold change, p = 0.05) and Interleukin 1 alpha, (IL1a, -0.10 log fold change, p = 0.012). In the P. gingivalis 24 weeks post oral infection, three genes were statistically significantly changed in their expression. These were cholinergic receptor nicotinic alpha 7 subunit or Chrna7 (0.10 log fold change, p = 0.02), mitogen-activated protein kinase 1 or Mapk1 (0.10 log fold change, p = 0.05) and visinin like 1 or Vnsl1 (0.01 log fold change, p = 0.04). 87 out of 92 AD target genes demonstrated no difference between infected and sham mice brains.
Conclusions
Five genes, from a recognised AD panel had statistically significantly altered expression in the ApoE-/- mouse AD model following P. gingivalis entry into the brain. This suggests the ApoE-/- genetic variation may control the biological activity of specific genes relevant to inflammation and neuronal plasticity following P. gingivalis infection
Fecal Impaction in Children aged 0 to 18 years: A Systematic Review and Meta-Narrative Analysis of Definitions Used
Get PDFBackground Faecal impaction is the result of functional constipation in the majority of cases. Surprisingly, a uniform definition for the term faecal impaction is lacking, leading to heterogeneity across study results.
Aim To conduct a metanarrative systematic review to ascertain how trial studies define faecal impaction among children aged 0–18 years with functional constipation.
Methods We conducted a systematic metanarrative review to uncover what criteria are used to define faecal impaction and to recommend directions for creating a globally accepted definition. A comprehensive literature search was conducted using prominent databases, including CENTRAL, MEDLINE, Embase, WHO ICTR (international clinical trials registry) and ClinicalTrials.gov. All relevant publications of RCTs on both faecal impaction and functional constipation from inception to June 2024, including children aged 0–18 years without underlying organic aetiology, were included.
Results 6211 studies were screened, of which 155 were reviewed for eligibility, 76 were included in the review and five are awaiting classification. Seven studies gave an explicit definition, with three referencing a previous consensus definition. 45 studies gave an implicit definition derived from their prescreening or exclusion criteria in a larger piece of research. Clinical assessment was the most common element of definitions, with a mixture of abdominal or rectal assessments reported in 44 studies. A further six studies suggested such clinical assessments are combined with radiographs, and one study reported a definition using radiographs alone. One study reported the duration of symptoms in a definition.
Conclusion There is a clear lack of consensus for defining faecal impaction in children with functional constipation. Despite the clinical, diagnostic and prognostic importance of having a unified definition of faecal impaction, currently there seems to be no universally accepted definition
Modelling Capabilities of Two Physically Based Hydrologic Models for Streamflow Simulations
Get PDFHydrologic processes in a watershed are typically simulated through hydrologic models due to their availability in the public domain and improved computational capacities. However, choosing a suitable model among the many available for a region of interest is challenging. In our work, we compared streamflow generated by the Soil and Water Assessment Tool (SWAT) and the Hydrological Engineering Centre-Hydrologic Modeling System (HEC-HMS) in the Kalu River Basin (KRB), Sri Lanka, frequently impacted by floods. Meteorological data including rainfall and temperature from 1990 to 2000 were used to force the hydrologic models. In addition, we used soil, land use data and a digital elevation model (DEM) for model development. During the calibration phase (1993-1996) of the SWAT model we achieved a coefficient of determination (R²) of 0.93 and a Nash-Sutcliffe Efficiency (NSE) of 0.87. In the validation phase (1997–2000), these indices yielded values of 0.87 and 0.66, respectively. In the HEC-HMS model, during the calibration phase, R2 and NSE yielded values of 0.89 and 0.91 while in the validation phase, these indices yielded values of 0.77 and 0.56, respectively. The exceedance probabilities at 10%, 50%, and 90% derived from flow duration curves (FDCs) from HEC-HMS and SWAT models were 395, 159, 54.5 and 400.5, 148, 29.11 (all in m3/s), respectively. Similarly, for observed flow, these values were 344.40, 138.98, and 65.35 m3/s, respectively. Thus, the FDCs suggest that the HEC-HMS model captures low flows reasonably. Neither model accurately resembled high flows. During the first inter-monsoon season (March-April) the HEC-HMS and SWAT underpredicted 3%, and 4% while during the northeast monsoon season (December-February) the models underpredicted 9%, and 2%, respectively. Similarly, during the second inter-monsoon season (October-November) and the southwest monsoon season (May-September), HECHMS and SWAT models overestimated observed flow by 11%, 5%, and 8%, 17%, respectively. Both models performed reasonably well on a seasonal basis with slight over-predictions and under-predictions. Overall, it is clear that both models can generally capture the hydrology of the KRB
Concurrent Agreement and Test–Retest Reliability of a Global-Positioning-System Device for Measuring Maximal Horizontal Deceleration Ability in Elite Youth Academy Soccer Players
Get PDFPurpose: Investigate the concurrent agreement and test–retest reliability of 10-Hz global-positioning-system (GPS) device against a criterion measure (47-Hz radar device) to assess maximal horizontal deceleration ability (maximum deceleration [DECMax], average deceleration [DECAve], time to stop, and distance to stop). Methods: Thirty-two male elite youth academy soccer players (age 18.1 [1.6] y, body mass 76.6 [7.9] kg) completed the acceleration–deceleration ability test with 16 completing a second test to assess test–retest reliability. Maximal horizontal deceleration ability was measured concurrently using GPSRaw (10-Hz data), GPSExport (STATSports software), and a radar device. Bland–Altman method and equivalence testing assessed concurrent agreement and intraclass correlations with coefficient of variation (%) was used to assess test–retest reliability. Results: Equivalence testing showed mean difference between the radar device and GPS-derived values of DECAve and DECMax were within equivalence bounds. GPSRaw and GPSExport derived values of DECMax showed good overall (intraclass correlations = .84–.86, coefficient of variation % = 4.50–5.48) test–retest reliability. Conclusion: Practitioners can consider using deceleration variables (DECAve and DECMax) obtained from GPS as a cost-effective, valid, and reliable alternative to radar technology to assess maximal horizontal deceleration ability in team-sport players