The Midwifery Unit Network: creating a community of practice to enhance maternity services

The Midwifery Unit Network (MUNet) is a community of practice which aims to promote and support the implementation and improvement of midwifery units (MUs) in the UK and internationally. It was launched in April 2016 and has been growing fast since its inception. In this article the co-leads of the MUNet describe how they established the network, and the challenges that they had to overcome. The aim of this article is to inspire more midwives and parent advocates to consider establishing a community of practice, and to offer some guidance on the key aspects involved

Enhancing the measurement of clinical outcomes using Microsoft Kinect

There is a growing body of applications leveraging Microsoft Kinect and the associated Windows Software Development Kit in health and wellness. In particular, this platform has been valuable in developing interactive solutions for rehabilitation including creating more engaging exercise regimens and ensuring that exercises are performed correctly for optimal outcomes. Clinical trials rely upon robust and validated methodologies to measure health status and to detect treatment-related changes over time to enable the efficacy and safety of new drug treatments to be assessed and measured. In many therapeutic areas, traditional outcome measures rely on subjective investigator and patient ratings. Subjective ratings are not always sensitive to detecting small improvements, are subject to inter- and intra-rater variability and limited in their ability to record detailed or subtle aspects of movement and mobility. For these reasons, objective measurements may provide greater sensitivity to detect treatment-related changes where they exist. In this review paper, we explore the use of the Kinect platform to develop low-cost approaches to objectively measure aspects of movement. We consider published applications that measure aspects of gait and balance, upper extremity movement, chest wall motion and facial analysis. In each case, we explore the utility of the approach for clinical trials, and the precision and accuracy of estimates derived from the Kinect output. We conclude that the use of games platforms such as Microsoft Kinect to measure clinical outcomes offer a versatile, easy to use and low-cost approach that may add significant value and utility to clinical drug development, in particular in replacing conventional subjective measures and providing richer information about movement than previously possible in large scale clinical trials, especially in the measurement of gross spatial movements. Regulatory acceptance of clinical outcomes collected in this way will be subject to comprehensive assessment of validity and clinical relevance, and this will require good quality peer-reviewed publications of scientific evidence

Instability and `Sausage-String' Appearance in Blood Vessels during High Blood Pressure

A new Rayleigh-type instability is proposed to explain the `sausage-string' pattern of alternating constrictions and dilatations formed in blood vessels under influence of a vasoconstricting agent. Our theory involves the nonlinear elasticity characteristics of the vessel wall, and provides predictions for the conditions under which the cylindrical form of a blood vessel becomes unstable.Comment: 4 pages, 4 figures submitted to Physical Review Letter

Utilising the Intel RealSense camera for measuring health outcomes in clinical research

Applications utilising 3D Camera technologies for the measurement of health outcomes in the health and wellness sector continues to expand. The Intel® RealSense™ is one of the leading 3D depth sensing cameras currently available on the market and aligns itself for use in many applications, including robotics, automation, and medical systems. One of the most prominent areas is the production of interactive solutions for rehabilitation which includes gait analysis and facial tracking. Advancements in depth camera technology has resulted in a noticeable increase in the integration of these technologies into portable platforms, suggesting significant future potential for pervasive in-clinic and field based health assessment solutions. This paper reviews the Intel RealSense technology’s technical capabilities and discusses its application to clinical research and includes examples where the Intel RealSense camera range has been used for the measurement of health outcomes. This review supports the use of the technology to develop robust, objective movement and mobility-based endpoints to enable accurate tracking of the effects of treatment interventions in clinical trials

Cardiovascular disease in a cohort exposed to the 1940-45 Channel Islands occupation

BACKGROUND To clarify the nature of the relationship between food deprivation/undernutrition during pre- and postnatal development and cardiovascular disease (CVD) in later life, this study examined the relationship between birth weight (as a marker of prenatal nutrition) and the incidence of hospital admissions for CVD from 1997–2005 amongst 873 Guernsey islanders (born in 1923–1937), 225 of whom had been exposed to food deprivation as children, adolescents or young adults (i.e. postnatal undernutrition) during the 1940–45 German occupation of the Channel Islands, and 648 of whom had left or been evacuated from the islands before the occupation began. METHODS Three sets of Cox regression models were used to investigate (A) the relationship between birth weight and CVD, (B) the relationship between postnatal exposure to the occupation and CVD and (C) any interaction between birth weight, postnatal exposure to the occupation and CVD. These models also tested for any interactions between birth weight and sex, and postnatal exposure to the occupation and parish of residence at birth (as a marker of parish residence during the occupation and related variation in the severity of food deprivation). RESULTS The first set of models (A) found no relationship between birth weight and CVD even after adjustment for potential confounders (hazard ratio (HR) per kg increase in birth weight: 1.12; 95% confidence intervals (CI): 0.70 – 1.78), and there was no significant interaction between birth weight and sex (p = 0.60). The second set of models (B) found a significant relationship between postnatal exposure to the occupation and CVD after adjustment for potential confounders (HR for exposed vs. unexposed group: 2.52; 95% CI: 1.54 – 4.13), as well as a significant interaction between postnatal exposure to the occupation and parish of residence at birth (p = 0.01), such that those born in urban parishes (where food deprivation was worst) had a greater HR for CVD than those born in rural parishes. The third model (C) found no interaction between birth weight and exposure to the occupation (p = 0.43). CONCLUSION These findings suggest that the levels of postnatal undernutrition experienced by children, adolescents and young adults exposed to food deprivation during the 1940–45 occupation of the Channel Islands were a more important determinant of CVD in later life than the levels of prenatal undernutrition experienced in utero prior to the occupatio

Perceptions of Acculturative Stress and English Language Learning in Latino Immigrants

AbstractThe process of English language learning (ELL) is a phenomenon, within the acculturation process, that poses challenges for first-generation Latino immigrants and potentially contributes to the susceptibility to acculturative stress. There has been little research on how second language acquisition influences acculturative stress. This study examined the perceptions of the experiences of young adult Latino immigrants who completed an English language learning program in the Washington, DC Metropolitan area. A generic qualitative study using face-to-face virtual interviews inquired about first-generation, young adult Latino immigrants’ perceptions of acculturative stress relative to experiences in adult ELL programs. Berry’s model of acculturation guided the study, due to the impact the four categories of acculturation are noted as having on the vulnerability to acculturative stress. The participants included ten Latino/a immigrants between the ages 18-25 years, who have lived in the United States for more than five years. The data analysis resulted in several themes that emerged under four categories: Motivation to learn English proficiently, obstacles to English language learning program completion, challenges as an English language learning immigrant, and experiences of integrating into the U.S. culture. The findings of the research will provide insights into the challenges young adult Latino immigrants encounter during the process of post-migration English language learning and can be beneficial for the development of systems and structures that improve access to programs and resources, as well as improve mental health support for immigrant students

What does community well-being mean in the university setting? Staff perspectives on connection, compassion, and culture

Settings approaches are vital for positive health promotion at scale, including mental well-being. These can be designed to fit the local context where people live, work and study. Universities are large employers, and there is a drive for settings-based approaches in the workplace. Community well-being is about “being well together” as a collective, and can be applied to communities based on location as well as communities of shared values, interest and purpose, such as an organisation. Designing well-being initiatives and interventions could be informed through the community well-being lens. This study aimed to explore what university staff think are components of community well-being in the workplace. Semi-structured interviews guided by photo-elicitation (n = 15) explored the concept of community well-being. Three themes were created through Reflexive Thematic Analysis of the data: Social and Connected University; Physical Environment; and Compassionate and Supportive Culture. Activities, events and spaces that facilitate getting together, a campus and spaces within it that fosters identity and belonging to the university community, and a culture that nourishes connection, collegiality and participation are all key components of community well-being in universities. Understanding these components has implications for designing well-being initiatives that go beyond the individual. The components identified here also give insights into how community well-being could be operationalised in the workplace setting

Sign-tracking and goal-tracking in humans: utilising eye-tracking in clinical and non-clinical populations.

Background In Pavlovian conditioning, learned behaviour varies according to the perceived value of environmental cues. For goal-trackers (GT), the cue merely predicts a reward, whilst for sign-trackers (ST), the cue holds incentive value. The sign-tracking/goal-tracking model is well-validated in animals, but translational work is lacking. Despite the model’s relevance to several conditions, including attention deficit hyperactivity disorder (ADHD), we are unaware of any studies that have examined the model in clinical populations. Methods The current study used an eye-tracking Pavlovian conditioning paradigm to identify ST and GT in non-clinical (N = 54) and ADHD (N = 57) participants. Eye movements were recorded whilst performing the task. Dwell time was measured for two areas of interest: sign (i.e., cue) and goal (i.e., reward), and an eye-gaze index (EGI) was computed based on the dwell time sign-to-goal ratio. Higher EGI values indicate sign-tracking behaviour. ST and GT were determined using median and tertiary split approaches in both samples. Results Despite greater propensity for sign-tracking in those with ADHD, there was no significant difference between groups. The oculomotor conditioned response was reward-specific (CS+) and present, at least partly, from the start of the task indicating dispositional and learned components. There were no differences in externalising behaviours between ST and GT for either sample. Conclusions Sign-tracking is associated with CS+ trials only. There may be both dispositional and learned components to sign-tracking, potentially more common in those with ADHD. This holds translational potential for understanding individual differences in reward-learning

Their wellbeing affects our wellbeing: student perspectives of lecturer wellbeing and its consequences for student wellbeing

A “whole university approach” has been recommended for addressing concerns about the wellbeing of UK university lecturers and students. Previously, staff wellbeing has been explored from staff perspectives. Student wellbeing has been explored from the perspectives of both students and staff. However, little research has been conducted on student perspectives on staff wellbeing and its possible impact on students. Addressing this gap, this study explored student perceptions of their lecturers’ wellbeing and ways that it can impact on student wellbeing. Three themes were identified from the thematic analysis of 9 focus groups with 41 undergraduate students. First, students notice their lecturer wellbeing, particularly if they have the opportunity to interact with their lecturers. Second, students perceive that their lecturers’ wellbeing can be affected by university policies and practices, student behaviours, and external factors. Third, lecturer wellbeing and student wellbeing are often reciprocal, emphasising the importance of lecturer-student interactions. These findings have implications for a whole university approach, namely development of university practices that support sufficient time for constructive lecturer-student interactions, such as timetabling, allocation of administrative tasks, class size and staffing levels