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1.

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   
2.
Summary. This study investigates whether there was evidence of increasing risk of still-birth with increasing paternal exposure to ionizing radiation received during employment at the Sellafield nuclear installation before the child was conceived. A significant positive association is found between the total paternal preconceptional exposure to external ionizing radiation and the risk of still-birth (after adjustment for year of birth, social class, birth order and paternal age, odds ratio at 100 mSv 1.24 (95% confidence interval 1.04–1.45)). A summary of the principal scientific findings of this study has been published in the Lancet . This paper describes in detail the statistical methods that were used in the investigation and presents the results in full.  相似文献   
3.
Twelve problem poker machine players and thirteen horse race gamblers (20 males and 5 females; age range 28–69) completed a series of questionnaires which assessed levels of anxiety, their preferred state of arousal and their motivations to gamble. As predicted, problem poker machine gamblers were found to be more anxious and reported avoiding arousal more frequently than the horse race gamblers. Alternately, problem horse race gamblers were found to prefer heightened levels of arousal and appeared to gamble to achieve these optimal levels of arousal. However, there was no difference between the groups on proneness to boredom. The present results provide evidence which is consistent with the Reversal theory and its application to the field of problem gambling.  相似文献   
4.
This paper examines the role of nonprofit organizations (NPOs) in the process of family policy formulation in eight member states and three applicant states of the European Union. Drawing upon interviews with representatives from the nonprofit sector, the author argues that the experiences of NPOs in family policy-making vary considerably between countries because of the way state–nonprofit relations operate. Social origins theory illustrates why these variations exist by pointing to broad societal influences on the nonprofit sector, but new empirical evidence presented here suggests that, in a particular policy field, other factors, such as the significance of the field on policy agendas, the strength of one particular organization in a specific cultural context, party ideology, and financial viability of the NPO, shape the role of organizations in the formulation of policies  相似文献   
5.
This article presents the findings of a qualitative research project about the difficulties in accessing advocacy faced by adults labelled as having autism and Asperger's Syndrome in the Northwest of England. It is also an example of partnership working between three organisations. The article examines both the process of team-led (emancipatory) research and the project findings. Seven main themes emerged throughout the research: late diagnosis and lack of service support; bad experiences with systems of care; feelings of 'not belonging' (identity issues); barriers around communication and sensitivity towards individuals; lack of awareness and access to advocacy and rights; difficulties of 'fitting into' what is already available; and interest in developing knowledge around advocacy. Examination of the main themes pointed to a disturbing link between poor service response, episodes of crisis and mental ill health. The Carlisle People First Research Team is made up of 6 researchers who are labelled as having 'learning difficulties' who work in partnership with one other researcher.  相似文献   
6.
The effects of sectoral shifts, measured by dispersion in the growth rates of employment or earning across industries or regions, on unemployment are tested in a specification controlling for the effects of other labor-market variables and shifts in the demographic composition of the labor force. Interindustry and geographical shifts in labor demand have significant unemployment effects, with adult males the group most strongly affected. The estimated equations imply that most of the fluctuation in unemployment over the period 1956-87 was been due to microeconomic causes rather than aggregate demand.  相似文献   
7.
8.
In recent years sport-based interventions have been implemented as a mechanism via which to target marginalised youth in relation to the development of social inclusion. Much of the political rhetoric surrounding social inclusion programmes highlights engagement with education, employment, or training, as key metrics. This has led some scholars to observe that conceptualising social inclusion in this way can act to further marginalise young people who fail to engage with these metrics. In contrast, this paper seeks to employ an alternative understanding of social inclusion, which uses the concepts of recognition and acceptance, to infer how participation in sports-based programmes may enable marginalised youth to meet mainstream societal expectations and aid with social assimilation. Drawing upon findings from two small-scale studies of sport-based interventions located in three UK cities, this paper places participant accounts at the centre of the analysis to explore broader notions of pro-social development in relation to recognition and interpersonal acceptance. The paper concludes by suggesting that within contexts in which young people are able to generate strong interpersonal relationships with key personnel (such as coaches), and which are built upon trust, recognition and developing self-worth, there is clear potential for sport-based programmes to incubate social assimilation.  相似文献   
9.
In this note, it is shown that the finite-sample distributions of the Wald, likelihood ratio, and Lagrange multiplier statistics in the classical linear regression model are members of the generalized beta model introduced by McDonald and Xu (1995a McDonald, J.B., Xu, Y.J. (1995a). A generalization of the beta distribution with applications. J. Econom. 66:133152.[Crossref], [Web of Science ®] [Google Scholar]). This is useful for examining the properties of these test statistics. For example, this characterization makes it easy to find distribution, quantile, and density functions for each test statistic, makes it clear why Wald tests may overreject the null hypothesis using asymptotic critical values, and formalizes the fact that the Lagrange multiplier statistic follows a distribution with bounded support.  相似文献   
10.
Wheelchair users experience many situations that affect the stability and associated performance of their wheelchair. Stability is affected by user characteristics and abilities, environmental features and conditions, and wheelchair modification and accessories. Wheelchair prescribers need effective tools and methods to provide quantitative evaluation and prediction of the behavior of the user-wheelchair system in a variety of static and dynamic situations. Such information is very important to guide efficient management of associated risks and adjust chairs accordingly. This project involves a user-centered approach for design and evaluation of a load cell based wheelchair stability assessment system (Wheel-SAS). Here, the current methods for assessing stability are described, and their shortcomings explained. The user-centered design approach being applied to the development of the associated Wheel-SAS hardware and software is described. Future work including semi-structured interviews and an online survey with wheelchair prescribers and associated healthcare professionals for deriving user requirements and a design specification for a load cell system for measuring dynamic wheelchair stability are detailed.  相似文献   
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