72 research outputs found
A geomorphological and geotechnical investigation of the Roughlands Landslide Complex, Southwest Isle of Wight, UK
No full textThe Roughlands Landslide Complex, comprised of slumped blocks, minor scarps, debris slides and a wide graben, is one of the few contemporary landslides on the Isle of Wight to be without major geomorphological or geotechnical investigation. Furthermore, Roughlands poses a puzzle as to the origin and form of its basal shear surface. If compound coastal landslides in ancient marine sediments are typically controlled by a basal shear surface which is guided by a bedding parallel slide prone horizon, how is the shear surface accommodated into the ancient fluvial Wessex Formation, which is largely without such bedding features? The complex is hence subject to a thorough investigation. This includes a rigorous desk study, geomorphological survey, peg network monitoring campaign using DGPS, comprehensive geotechnical testing program, and the installation of two slip-indicators. Although largely stable during the summer, parts of the landslide complex are recorded moving at up to 6.5m yr-1 during the wet winter months, indicating a high sensitivity to groundwater variation. Following an appraisal of eight possible formation mechanisms, it is concluded that the basal shear surface which underlies the Roughlands Landslide Complex is most plausibly guided by the basal surface of a Cretaceous sheet flood deposit. Support for this comes from palaeo-environment interpretation, which reveals various mechanisms by which sheet floods could entrain swelling clays; the excessive recession at Roughlands in comparison to other parts of the southwest coastline, which indicates that geological dip (which varies about the Brighstone Anticline) is influential; the fossil record; relationships with newly recognized faults; and from field observations. Stability analyses find field mobilized shear strength is greater than laboratory determined residual shear strength, which may be in part due to entrained Cretaceous floodplain debris within the slide mass. The unpredictability of landslides on the Wessex Formation also identifies some geotechnical uncertainties which are a concern for all engineering works in ancient fluvial sediments
The cost-effectiveness and efficiency of intrapartum maternity care in England
No full textBackground High quality evidence on the cost-effectiveness of planned birth in alternative settings (at home, in a midwifery unit or an obstetric unit) has been lacking, and is a priority area for maternity policy. Aim To provide evidence about the efficiency of the configuration of maternity care in England and to estimate the cost-effectiveness of alternative settings for intrapartum care for ‘low risk’ women, thereby providing guidance for commissioners, clinicians and for pregnant women and their families. Methods A literature review of existing evidence was followed by four stand-alone empirical studies using different methods to determine the efficiency and cost-effectiveness of alternative settings for intrapartum care. Data from the Birthplace in England Programme of Research were analysed to explore whether there are differences in the efficiency of maternity units when they are stratified according to the type and scale of unit. Incremental cost-effectiveness ratios were used to estimate the short-term cost-effectiveness of different planned settings for birth for ‘low risk’ women and to develop a template for the design of decision-analytic models to estimate life-long cost-effectiveness for the mother and baby dyad. Findings The larger obstetric units (OUs) tended to be more efficient than the smaller OUs. Less than half of free-standing midwifery units (FMUs) were operating at full efficiency. The cost of intrapartum and after birth care, and associated related complications, was less for births planned at home, in a free standing midwifery unit (FMU), or in an alongside midwifery unit (AMU) compared with planned births in an obstetric unit (OU). Planned birth in a FMU or in an AMU compared with an OU will generate incremental cost savings but with uncertainty surrounding the outcomes for the baby. Planned birth in all non-OU settings generated incremental cost savings and improved outcomes for mothers. For ‘low risk’ women having a second or subsequent birth, planned birth at home was found to be the most cost-effective option
The uses of knowledge : collaboration, commercialization, and the driving cultures project
No full text200
‘Neighbourhood is if they come out and talk to you’: Neighbourly connections and bonding social capital
No full text© The Author(s) 2017. Neighbourly relations have been theorised as ‘friendly distance’ in contrast to connections which are theorised as strong or intensive ties. The article explores the neighbourly relationships between residents of a peri-urban regional area outside Sydney in Australia. Strong interview themes emerged regarding the ways in which residents who were well connected within their locality talked about their neighbours, and this was in direct contrast to those living with a chronic condition – these people expressed a lack of connection with their neighbours. The major theme, ‘not in each other’s pockets’ reflects the negotiated nature of neighbour interactions, while the theme ‘neighbourhood is if they come out and talk to you’ speaks of isolation. The interactions of neighbours may in many cases constitute bonding capital as important weak or casual ties. These may not be available to the chronically ill or socially isolated or adequate without linking and bridging capital
Telling Our Stories: Book Two
No full textCollection of stories by forty local writers describing family histories and anecdotes in the Grayson County, Texas area. Each story is preceded by a brief biographical sketch of the author
Qualitative study of the clinician–parent interface in discussing prognosis following MRI and US imaging of preterm infants in the UK
No full textDownload PDFPDF
Health services research
Research
Qualitative study of the clinician–parent interface in discussing prognosis following MRI and US imaging of preterm infants in the UK
M E Harvey1,2,3, M E Redshaw2 On behalf of the ePrime Research Group
Author affiliations
Abstract
Objective To explore communication and interaction between parents and clinicians following neonatal ultrasound (US) and MRI of the brain of babies born preterm.
Setting This qualitative study was undertaken as part of a larger UK study of neonatal brain imaging. 511 infants were cared for in 14 London neonatal units with MR and cerebral US imaging in a specialist centre.
Participants Parents with infants born at <33 weeks gestation were randomised to receive prognostic information based on either MRI or US findings on their infants at term-corrected age.
Methods Discussions between parents and clinicians about the MRI or US result were audio recorded. Parents were told about the findings and their baby's predicted outcome. A topic guide ensured essential aspects were covered. Recordings were fully transcribed. Discussion of the scan results, the content and style of the interaction and parental response were analysed qualitatively in 36 recordings using NVivo V.10.
Outcomes Key themes and subthemes were identified in the clinician–parent discussions.
Results The overarching theme of ‘the communication interface’ was identified with three key themes: ‘giving information’, ‘managing the conversation’ and ‘getting it right’ and further subthemes. A range of approaches were used to facilitate parental understanding and engagement. There were differences in the exchanges when information about an abnormal scan was given. The overall structure of the discussions was largely similar, though the language used varied. In all of the discussions, the clinicians talked more than the parents.
Conclusions The discussions represent a difficult situation in which the challenge is to give and receive complex prognostic information in the context of considerable uncertainty. The study highlights the importance of being able to re-visit specific issues and any potential areas of misunderstanding, of making time to talk to parents appreciating their perspective and level of knowledge
Redshaw, Peter Robert Gransden, (born 16 April 1942), HM Diplomatic Service, retired; Group Security Adviser, Gallaher Ltd, 1996–2004
No full textThe Birth Satisfaction Scale-Revised Indicator (BSS-RI)
No full text© 2017 The Author(s). Background: The current study sought to develop a short birth satisfaction indicator utilising items from the Birth Satisfaction Scale-Revised (BSS-R) for use as a brief measure of birth satisfaction and as a possible key performance indicator for perinatal service delivery evaluation. Building on the recently developed BSS-R, the study aimed to develop a simplified version of the instrument to assess birth satisfaction easily that could work as a short evaluative measure of clinical service delivery for labour and birth that is consistent with policy documents, placing women at the centre of the birth experience. Methods: The six item Birth Satisfaction Scale-Revised Indicator (BSS-RI) was embedded within the 2014 National Maternity Survey for England. A random selection of mothers who had given birth in a two week period in England were surveyed three months after the birth. Using a two-stage design and split-half dataset, exploratory factor analysis, confirmatory factor analysis, internal consistency, convergent, divergent and known-groups discriminant validity evaluation were conducted in a secondary analysis of the survey data. Results: Using this large population based survey of recent mothers the short revised measure was found to comprise two distinct domains of birth satisfaction, 'stress and emotional response to labour and birth' and 'quality of care'. The psychometric qualities of the tool were robust as were the indices of validity and reliability evaluated. Conclusion: The BSS-RI represents a short easily administered and scored measure of women's satisfaction with care and the experience of labou r and birth. The instrument is potentially useful for researchers, service evaluation and policy makers
- …
