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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.
Drawing from ethnographic work carried out between 2005 and 2007, this article considers the ways in which a women’s network has developed strategies to find meaning around the absences of loved ones, killed or ‘disappeared’ during the decades of conflict in Sri Lanka. For most of these women, the fate of their husbands, brothers, sons and fathers is not known and the lack of answers means that they are unable to fully grieve and find closure. In order to survive, they must find ways to deal with the absent bodies and present memories of those who may never be located and accounted for. These strategies include tree-planting ceremonies carried out as a way of not only remembering and mourning loved ones but also asking questions about how one makes sense of loss and what it means to carry the burden of unanswered absences through everyday life and into the future.  相似文献   
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The focus of criminology on crimes and harms committed by and against humans has broadened over time. Only since the 1990s, however, has the discipline recognized the significance of crimes and harms concerning the environment and nonhuman animals. A variety of approaches and bodies of work now contribute to what can be described as “green criminology.” This article summarizes research on types of environmental crime and harm, as well as different eco‐philosophical orientations and related justice‐based approaches. It concludes with an example illustrating the ways in which these approaches may overlap.  相似文献   
5.

Background

The increasing prevalence of obesity in sub-Saharan African women is not well understood, and black South African women in the region are particularly vulnerable. This study aimed to examine whether the relationship of socioeconomic status (SES) with changes in body mass index (BMI) and waist circumference (WC) is mediated by physical activity in ageing African women.

Methods

In a longitudinal analysis of the 518 caregivers associated with the Birth to Twenty Plus study, the role of SES associated with 10-year changes in BMI and WC was tested using structural equation modelling (SEM). The degree of mediation of moderate-vigorous physical activity (MVPA) and sitting time in this association was also assessed.

Results

The prevalence of obesity increased significantly from baseline to follow-up (p?<?0.0001). In the SEM models, baseline SES had a direct positive effect on changes in BMI (β, 95% CI, 0.02 (0.005 to 0.04), and a direct negative effect on changes in MVPA (β, 95% CI, ??3.81 (??6.92 to ??0.70). Baseline MVPA had a direct negative effect (β, 95% CI, ??0.002 (??0.003 to ??0.0003) and indirect positive effect via change in MVPA (β, 95% CI, 0.01 (0.0001 to 0.001) on change in WC.

Conclusions

Our study demonstrates the role and interaction of sociodemographic and behavioural predictors of obesity, and suggests a multifaceted approach to management of the crisis in communities of ageing urban African women.
  相似文献   
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Unclaimed prize information (i.e., the number of prizes still available to be won) is information commonly provided to scratch card gamblers. However, unless the number of tickets remaining to be purchased is also provided, this information is uninformative. Despite its lack of utility in assisting gamblers in choosing the most favourable type of scratch card to play, we hypothesized that unclaimed prize information would bias participants’ judgments within a scratch card gambling context. In Experiment 1 (N?=?201), we showed that participants are influenced by this information such that they felt more likely to win, were more excited to play, and preferred to hypothetically purchase more of the scratch card with the greatest number of unclaimed prizes. In Experiment 2 (N?=?201), we attempted to ameliorate this bias by providing participants with the number of tickets remaining to be purchased and equating the payback percentages of all three games. The bias, although attenuated, still persisted in these conditions. Finally, in Experiment 3 (N?=?200), we manipulated the hypothetical scratch cards such that games with the highest number of unclaimed prizes were the least favourable, and vice versa. As in Experiment 2, participants still favoured cards with greater numbers of unclaimed prizes. Possible mechanisms underlying this bias are discussed. In conclusion, across three experiments, we demonstrate that salient unclaimed prize information is capable of exerting a strong effect over judgments related to scratch card games.  相似文献   
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