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61.

Problem

Research suggests that the skill and experience of the attendant significantly affect the outcomes of vaginal breech births, yet practitioner experience levels are minimal within many contemporary maternity care systems.

Background

Due to minimal experience and cultural resistance, few practitioners offer vaginal breech birth, and many practice guidelines and training programmes recommend delivery techniques requiring supine maternal position. Fewer practitioners have skills to support physiological breech birth, involving active maternal movement and choice of birthing position, including upright postures such as kneeling, standing, squatting, or on a birth stool. How professionals learn complex skills contrary to those taught in their local practice settings is unclear.

Question

How do professionals develop competence and expertise in physiological breech birth?

Methods

Nine midwives and five obstetricians with experience facilitating upright physiological breech births participated in semi-structured interviews. Data were analysed iteratively using constructivist grounded theory methods to develop an empirical theory of physiological breech skill acquisition.

Results

Among the participants in this research, the deliberate acquisition of competence in physiological breech birth included stages of affinity with physiological birth, critical awareness, intention, identity and responsibility. Expert practitioners operating across local and national boundaries guided less experienced practitioners.

Discussion

The results depict a specialist learning model which could be formalised in sympathetic training programmes, and evaluated. It may also be relevant to developing competence in other specialist/expert roles and innovative practices.

Conclusion

Deliberate development of local communities of practice may support professionals to acquire elusive breech skills in a sustainable way.  相似文献   
62.
《共产党宣言》蕴含着深刻的生态思想,其体系以人、社会、自然整体为背景,其核心观点认为生态问题是由资本主义生产方式引起的.马克思在唯物史观视野下,科学论证了资产阶级的所有制必然灭亡、共产主义必然实现的历史发展逻辑,廓清了人与人、人与自然之间双重和解的演化路径.其中关于科技提升、市场拓展、交通和通信发展等引起世界市场“生态扩张”的思想,对全球化程度日益加深境况下“生态文明”和“人类命运共同体”的构建具有重大的理论和实践指导价值.  相似文献   
63.
郑立新  罗鹏 《云梦学刊》2020,(1):115-124
农民是农业和农村的主体,也是乡村振兴的内生因素,发挥农民主体作用对实施乡村振兴战略意义重大。当前农民对乡村振兴关注度和支持度较高,农民的主体作用发挥成为乡村振兴的根本动力。但现实中,农民主体作用也受到诸如农业综合效益较低、农民自身思想文化和能力素质不高、管理机制滞后及基础条件薄弱等多方面的因素制约,需要党委、政府综合施策,采取完善乡村治理、健全政策扶持、建立引导机制、补齐短板缺陷、加强培育培训等一系列政策措施,尊重、引导、激励和支持农民自我管理、自我发展,激发农民的主动性、积极性、创造性。  相似文献   
64.
系统总结了在伸展构造背景下,导致反映构造特征的地层倾角模式复杂化的多种因素。沉积相的不同、岩性变化、井眼状况和测井作业时间等多种因素都可能使地层倾角资料复杂化。进一步指出在拉张盆地中,进行倾角资料的构造解释,必须了解其构造样式的多样性和复杂性,解释存在的多解性。重点解剖了铲式断层在横剖面情况下,对于不同构造位置下的倾角模式。详细分析了一个倾角模式对应多种构造样式的倾角构造解释实例。倾角资料的构造解释应是综合解释,既要综合井筒的相关地质资料,又要综合测井与地质知识,还必须考虑综合地震资料。  相似文献   
65.
《一个人老了》写于1991年4月,彼时作者的生理年龄与诗中感悟分别处于跨度相距较远的不同生命时段,由此在形成诗歌内在张力的同时,也使阅读必须面对在“四月”与“衰老”之间存在的强烈反差,问题由此被提出。对这种反差的成因分析是从文本的抒情节奏、抒情肌理以及价值立场与生命观等方面的异质特征切入,解读其在诗歌渊源上与博尔赫斯、聂鲁达等世界诗人之间的互文关系,进而追溯至作者西川所代表的“知识分子写作”对阅读经验的习惯性倚重。  相似文献   
66.
Random effects regression mixture models are a way to classify longitudinal data (or trajectories) having possibly varying lengths. The mixture structure of the traditional random effects regression mixture model arises through the distribution of the random regression coefficients, which is assumed to be a mixture of multivariate normals. An extension of this standard model is presented that accounts for various levels of heterogeneity among the trajectories, depending on their assumed error structure. A standard likelihood ratio test is presented for testing this error structure assumption. Full details of an expectation-conditional maximization algorithm for maximum likelihood estimation are also presented. This model is used to analyze data from an infant habituation experiment, where it is desirable to assess whether infants comprise different populations in terms of their habituation time.  相似文献   
67.
19世纪末20世纪初,马克思的思想就传入了中国,梁启超在传统大同思想与社会主义贯通中对它进行解读;早期国民党人在批判资本主义,建构民生主义中对它进行评价;无政府主义在反传统中认同马克思的共产主义。虽然各有局限性,但又各有自身的意义。以十月革命的经验解读马克思主义,遮蔽了对马克思思想早期传播的研究,研究马克思主义在中国的早期传播,对认识马克思主义中国化有重要意义。  相似文献   
68.
The landscape of political humor and satire is changing rapidly, and it is becoming an increasingly relevant aspect of our culture. Although scholars have been actively trying to capture this change, majority of the existing frameworks for understanding humor and satire in politics still reduce these phenomena to mere genres or rhetoric tools. In addition, they provide insufficient accounts concerning the reception of humor and satire, and neglect to interpret and explain what they communicate. In the article, a general understanding of humor and satire outside of a political context, followed by an overview of studies discussing humor and satire in politics through their applications in social movements, as leadership tools, and through their manifestations in mass media has been presented. Lastly, a cultural sociological perspective to the field has been introduced. It has been argued that approaching humor and satire in politics through a structural hermeneutic method of the Strong Program will enable us to recognize and treat political humor and satire as autonomous and complex cultural systems which carry an internal power to move people.  相似文献   
69.
A central issue for family therapy is the critical question of how to define its role in influencing social change. Family therapy has tended to focus on how to liberate and empower individual clients, not communities, from the travails of tradition. This article highlights social change mechanisms implemented by the oppressed majority in South Africa during the apartheid period. It draws inspiration from the pedagogy of the oppressed articulated by Steve Biko and other members of his generation. This enabled the Black majority in South Africa ‘to name their world by reflecting on their conditions, imagining a better world, and then taking action to create it’ (Freire, 1968, p. 253) through the use of revolutionary songs that resulted in the collapse of the cruel apartheid system. The implications for family therapy are discussed.  相似文献   
70.
本文采用深度门控循环单元(GRU)神经网络探讨三种汇率货币模型(弹性价格、前瞻性和实际利率差模型)的非线性协整关系。GRU技术在深度学习中具有智能记忆、自主学习和强逼近能力等优点。为此,本文运用该技术对6组典型浮动汇率制国别数据进行了非线性Johansen协整检验。结果表明,汇率与宏观经济基本面之间存在非线性协整关系,从而说明了货币模型在非线性条件下的有效性,以及先进的深度学习工具在检验经济理论中的优势。  相似文献   
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