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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.
Urban Ecosystems - Urban insect communities are structured by hierarchical filters including regional processes, human facilitation, and species interactions. We sought to inform future urban...  相似文献   
3.
Large oil spills are disasters associated with psychological effects for exposed communities. The amount of worry that individuals experience after a disaster may be influenced by many factors, such as the type and extent of exposure to disaster impacts, prior trauma, and sociodemographic characteristics. This study examined the nature and predictors of worry about ongoing impacts of the 2010 Deepwater Horizon (DH) oil spill reported by Gulf of Mexico coastal residents. A random sample of 2,520 adult residents of Gulf of Mexico coastal counties were administered a telephone survey in 2016, including items about persistent worry and exposure to DH impacts, prior trauma, residence at the time of the spill, and sociodemographic characteristics. Respondents varied in the amount of worry they reported about ongoing health, social, and economic impacts. Controlling for sociodemographic characteristics, higher exposure to the DH oil spill was related to higher levels of worry about ongoing impacts, with past traumatic events related specifically to worry about health impacts. Unexpectedly, those who moved into the region after the spill showed similar levels of worry to residents exposed to the spill, and higher levels than residents who did not recall being exposed to the DH oil spill. This study highlights the impact of the DH oil spill on coastal residents many years after the DH disaster. The findings underscore the need to examine multiple pathways by which individuals experience disasters and for risk researchers to close knowledge gaps about long-term impacts of oil spills within a multi-dimensional framework.  相似文献   
4.
Effective risk communication is an integral part of responding to terrorism, but until recently, there has been very little pre‐event communication in a European context to provide advice to the public on how to protect themselves during an attack. Following terrorist attacks involving mass shootings in Paris, France, in November 2015, the U.K. National Police Chiefs’ Council released a Stay Safe film and leaflet that advises the public to “run,” “hide,” and “tell” in the event of a firearms or weapons attack. However, other countries, including Denmark, do not provide preparedness information of this kind, in large part because of concern about scaring the public. In this survey experiment, 3,003 U.K. and Danish participants were randomly assigned to one of three conditions: no information, a leaflet intervention, and a film intervention to examine the impact of “Run, Hide, Tell” advice on perceptions about terrorism, the security services, and intended responses to a hypothetical terrorist firearms attack. Results demonstrate important benefits of pre‐event communication in relation to enhancing trust, encouraging protective health behaviors, and discouraging potentially dangerous actions. However, these findings also suggest that future communications should address perceived response costs and target specific problem behaviors. Cross‐national similarities in response suggest this advice is suitable for adaptation in other countries.  相似文献   
5.
Gambling studies have described a “near-miss effect” wherein the experience of almost winning increases gambling persistence. The near-miss has been proposed to inflate the value of preceding actions through its perceptual similarity to wins. We demonstrate here, however, that it acts as a conditioned stimulus to positively or negatively influence valuation, dependent on reward expectation and cognitive engagement. When subjects are asked to choose between two simulated slot machines, near-misses increase valuation of machines with a low payout rate, whereas they decrease valuation of high payout machines. This contextual effect impairs decisions and persists regardless of manipulations to outcome feedback or financial incentive provided for good performance. It is consistent with proposals that near-misses cause frustration when wins are expected, and we propose that it increases choice stochasticity and overrides avoidance of low-valued options. Intriguingly, the near-miss effect disappears when subjects are required to explicitly value machines by placing bets, rather than choosing between them. We propose that this task increases cognitive engagement and recruits participation of brain regions involved in cognitive processing, causing inhibition of otherwise dominant systems of decision-making. Our results reveal that only implicit, rather than explicit strategies of decision-making are affected by near-misses, and that the brain can fluidly shift between these strategies according to task demands.  相似文献   
6.
For quite a few years the two authors have been engaging in dialogues about management issues. Using as a model Plato's dialogues between Socrates and his various students, we have tried to clarify the nature of a concept by asking questions and thinking carefully about the answers. We disagree about many things, but agree that we respect each other's opinions, and can clarify our own viewpoints by debating them respectfully with another. For this dialogue, we decided to focus on the question of the scale of business operations. One of us has a particular preference for small scale enterprise, and for the localisation of the economy, because he believes that the giganticism of corporations is behind many of the problems we face today. As you will see, the other protagonist disagrees, arguing instead that other issues than scale are at the root of why some businesses do bad things.  相似文献   
7.
Planners in England routinely include shared ownership (SO) housing in the affordable housing element of new developments. Government policies in a number of European countries have also backed intermediate housing market mechanisms as a solution to housing affordability. The rhetoric of such mechanisms makes claims about its social progressiveness, its role in facilitating socio-economic mobility and helping people move from rented accommodation into full owner-occupation. SO schemes in England have been justified on the grounds of being transitional tenures and planners have accepted SO on this basis. However, given the paucity of rigorous empirical work, there is a concern that this is a policy based on assumption rather than evidence. This paper delineates existing knowledge, clarifies dimensions of the intermediate housing market and highlights underlying policy issues based on a large data-set of shared owners in England. Our analysis indicates that SO may not be appropriately classified as affordable housing, and justifiable policy requires further evidence.  相似文献   
8.
Van Valen's Red Queen hypothesis states that within a homogeneous taxonomic group the age is statistically independent of the rate of extinction. The case of the Red Queen hypothesis being addressed here is when the homogeneous taxonomic group is a group of similar species. Since Van Valen's work, various statistical approaches have been used to address the relationship between taxon age and the rate of extinction. We propose a general class of test statistics that can be used to test for the effect of age on the rate of extinction. These test statistics allow for a varying background rate of extinction and attempt to remove the effects of other covariates when assessing the effect of age on extinction. No model is assumed for the covariate effects. Instead we control for covariate effects by pairing or grouping together similar species. Simulations are used to compare the power of the statistics. We apply the test statistics to data on Foram extinctions and find that age has a positive effect on the rate of extinction. A derivation of the null distribution of one of the test statistics is provided in the supplementary material.  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.
Using ethnographic and interview data, this article explores hopes for the future of young Indonesian musicians. The young people are seen to consider their future trajectories in multiple, hierarchical music fields. The article also takes into account the ontological insecurity of jobs as a professional musician, arguing that there is continuous reproduction of a doxa, namely ‘survival of the fittest’ in Indonesia. Yet despite abundant risks to livelihoods, young Indonesian musicians expressed optimistic views about the future. The analysis of data below bridges the gap between the traditionally separate youth studies fields of youth transitions and youth cultures. Our interpretation critically contextualises the dialogue between these two fields based on the experiences of young Indonesian musicians as a part of the Global South.  相似文献   
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