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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.
Abstract

Objective: Cocaine use is increasing. Comorbidities and diagnostic sequencing are needed among college students to inform treatment of cocaine use disorder (CUD). Method: Using electronic medical records from the psychiatric clinic at the student health care center of a large, public university from 2005 to 2015, patients diagnosed with CUD were identified. Their top mental health conditions were identified and assessed to see whether the first diagnosis of these conditions was made (1) before, (2) at the same time as, or (3) after the first diagnosis of CUD. Results: Among the 50 CUD patients, their most common mental health comorbidities were alcohol use disorder, anxiety, depression, and cannabis use disorder. Anxiety and depression were likely to be diagnosed before CUD; alcohol and cannabis use disorders were likely to be diagnosed concurrently with CUD. Conclusion: Diagnostic sequencing can be used to inform screening, workup, and treatment for patients with CUD.  相似文献   
3.
安大简《国风》并非全本,各风次序与今本《诗经》不尽相同,但其相对次序值得重视。在安大简中,《秦》在《魏》前,与《左传》相合;在安大简中,《侯》在《魏》前,从其实际内容看,相当于《魏》在《唐》前,与传世古书的次序相合。有一种可能性的解释是《侯》即《唐》,安大简中关于《魏》《唐》的实际相对次序与传世古书并无二致,但安大简的抄写者误将“侯(唐)”“魏”的风名分别安到《魏》和《侯(唐)》之上。  相似文献   
4.
In this paper, we introduce two new modified scrambled Faure sequences based on linear digit scrambling method with good two-dimensional projections in consecutive dimensions using two new linear digit scrambling matrices for linear and nonlinear scrambled Faure sequences. Also, we present performance of our two new scrambling methods by two-dimensional projections and test-integrals.  相似文献   
5.
6.
艺术现象学的基本问题是一种非对象性的艺术创作是否可能及如何可能的问题。直观相继而来的被给予性,并非所有的被给予性都绝对的通向非对象创作,唯有基于虚静主体的直观被给予性,才能真正实现非对象性的绘画创作。首先论述虚静就是世间一切存在的根源和本性。其次论述直观对于画家真正接近事物和实现非对象性创作的重要意义。再次论述马里翁所勾画的新主体如何取代了建构性的“我”,从而实现了去主体形而上学的历史使命。最后论述了具象表现绘画理论对于非对象性绘画创作的启示。  相似文献   
7.
Housing recovery is an unequal and complex process presumed to occur in four stages: emergency shelter, temporary shelter, temporary housing, and permanent housing. This work questions the four-stage typology and examines how different types of shelter align with multiple housing recovery stages given different levels of social vulnerability. This article also presents a Markov chain model of the postdisaster housing recovery process that focuses on the experience of the household. The model predicts the sequence and timing of a household going through housing recovery, capturing households that end in either permanent housing or a fifth possible stage of failure. The probability of a household transitioning through the stages is computed using a transition probability matrix (TPM). The TPM is assembled using proposed transition probability models that vary with the social vulnerability of the household. Monte Carlo techniques are applied to demonstrate the range of sequences and timing that households experience going through the housing recovery process. A set of computational rules are established for sending a household to the fifth stage, representing a household languishing in unstable housing. This predictive model is exemplified on a virtual community, Centerville, where following a severe earthquake scenario, differences in housing recovery times exceed four years. The Centerville analysis results in nearly 5% of households languishing in unstable housing, thereby failing to reach housing recovery. These findings highlight the disparate trajectories experienced by households with different levels of social vulnerability. Recommendations are provided at the end for more equitable postdisaster recovery policies.  相似文献   
8.
In this paper, we consider the estimation of the three determining parameters of the efficient frontier, the expected return, and the variance of the global minimum variance portfolio and the slope parameter, from a Bayesian perspective. Their posterior distribution is derived by assigning the diffuse and the conjugate priors to the mean vector and the covariance matrix of the asset returns and is presented in terms of a stochastic representation. Furthermore, Bayesian estimates together with the standard uncertainties for all three parameters are provided, and their asymptotic distributions are established. All obtained findings are applied to real data, consisting of the returns on assets included into the S&P 500. The empirical properties of the efficient frontier are then examined in detail.  相似文献   
9.
The aim of this paper is to propose methods of detecting change in the coefficients of a multinomial logistic regression model for categorical time series offline. The alternatives to the null hypothesis of stationarity can be either the hypothesis that it is not true, or that there is a temporary change in the sequence. We use the efficient score vector of the partial likelihood function. This has several advantages. First, the alternative value of the parameter does not have to be estimated; hence, we have a procedure that has a simple structure with only one parameter estimation using all available observations. This is in contrast with the generalized likelihood ratio-based change point tests. The efficient score vector is used in various ways. As a vector, its components correspond to the different components of the multinomial logistic regression model’s parameter vector. Using its quadratic form a test can be defined, where the presence of a change in any or all parameters is tested for. If there are too many parameters one can test for any subset while treating the rest as nuisance parameters. Our motivating example is a DNA sequence of four categories, and our test result shows that in the published data the distribution of the four categories is not stationary.  相似文献   
10.
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