Time to listen: strategies to improve hospital-based postnatal care

BACKGROUND: In Australia and internationally, women report high levels of dissatisfaction with hospital-based postnatal care. AIM: To design and implement strategies to improve hospital-based postnatal care at a Sydney metropolitan hospital. METHOD: This was an Action Research study. In Phase One, midwives considered the literature and participated in group discussions and interviews to determine their perceptions of postnatal care and the factors that facilitate or hinder the provision of quality care. In Phase Two, midwives participated in 12 working group meetings to design strategies to improve care. RESULTS: Several important principles of postnatal care were described, including building a relationship with women, meeting their individual needs, being flexible in approach and providing continuity of care. 'Listening to women', 'being there,' and 'normalising experiences and expectations' were believed to be critical to achieving these principles. A key strategy 'One to One Time' was designed to provide women with an uninterrupted period of time each day with a midwife who was available to listen to their needs and concerns and discuss issues related to their health and that of their baby. CONCLUSION: Midwives designed and implemented strategies that they believed would improve in-hospital postnatal care.     

Employment and earnings of foreign-born scientists and engineers

Population Research and Policy Review -     

Punks,Goths, and Other Eye‐Catching Peer Crowds: Do They Fulfill a Function for Shy Youths?

Adolescent peer crowds such as Punks and Goths are mainly identified by their strikingly unusual or even shocking appearances. Although many studies find these crowds, few have tried to explain why some youths take on these startling or shocking appearances. We hypothesized that an off‐putting appearance is a way to cope with behavioral inhibition by limiting social contacts. Using data from 1,200 7th–11th graders, we compared peer crowds characterized by their startling appearance (“Radical” crowds) with three theoretically relevant comparison groups. Results showed that youths affiliating with Radical crowds were more inhibited than other youths, including those in crowds previously shown to be shy or socially anxious. Inhibited Radicals, however, had poorer emotional adjustment than inhibited youths in other crowds. If Radical styles are a way for inhibited youths to cope by limiting social contacts, the strategy does not seem to be beneficial for emotional adjustment.     

Ecological research can augment restoration practice in urban areas degraded by invasive species—examples from Chicago Wilderness

Urban biodiversity conservation needs a firm scientific foundation, one that draws upon active and regionally calibrated research programs. Until recently this foundation has not existed. In this paper we examine the way in which the emerging discipline of restoration ecology in an urban context can learn from the experiences of ongoing restoration projects and in turn how novel insights from research of urban soils can help these projects define and reach their goals. Limitations on collaboration between academic researchers and practitioners continues be problematic. We discuss a model whereby this impediment may be removed. A case study of Rhamnus cathartica, an invader of Midwestern woodlands which modifies some important soil ecosystem properties will be used to illustrate the potential for engagement between research and practice.     

What shapes plant and animal diversity on urban golf courses?

Recent concern over increasing loss of biodiversity has prompted considerable interest in the role of urban green spaces as reservoirs of local biodiversity. This study assessed the diversity of three indicator taxa - plants, ants and birds - on golf courses spanning a wide range of environmental variation in terms of climate, elevation, course age, size and connectivity to native woodland. Species richness and community composition was further compared between contrasting on-course habitat types that reflect different management intensities. We identified a set of taxon-specific environmental correlates indicating an intricate interplay of landscape- and local-scale variables that affect local species diversity. Our results show that floristic diversity is positively associated with the amount of rainfall, whereas ant and bird diversity are related to local-scale factors, particularly the number of trees and the size of water features on a site. The amount of on-course native habitat was a strong predictor of plant and ant diversity and was also associated with the number of unique species at the site level; this reinforces the value of remnant habitat patches as local biodiversity reservoirs that represent mini hot-spots in an otherwise species-poor urban landscape. Community composition for all three taxa differed markedly between non-playing and playing areas, with boundary and remnant habitats generally having more diverse, species-rich communities. Our results suggest that local floral and faunal biodiversity on urban golf courses can be enhanced by creating woody non-playing areas and, especially, by preserving, restoring or expanding remnant habitats.     

Identity Formation in Children and Young People in Open Adoptions from Out-of-home Care in New South Wales,Australia

Semi-structured interviews were used to explore identity development for nine adoptees (aged 9–23 years) who were adopted by their foster carers in New South Wales, Australia. Adoptions were open, with court-ordered face-to-face contact with birth families. Findings suggest that participants had healthy adoptive identities, with coherent and meaningful narratives about their life histories. Adoption provided a sense of security and belonging. Openness provided information to build a self-narrative and encouraged discussion of adoption issues within adoptive families. Adoptive parents were critical in helping children understand their adoption and facilitating direct contact with birth families, thus laying foundations for positive identity development.     

Allegations of child sexual abuse in parenting disputes: An examination of judicial determinations in the Family Court of Australia

This study examined Family Court of Australia (FCA) judicial determinations in parenting disputes when allegations of child sexual abuse (CSA) are made by an interested party, usually the mother. For the study, 156 published judgments from 2013–2015 were examined to measure how often allegations of CSA are substantiated, suspected to be true, and disbelieved. The characteristics most common in substantiated versus unsubstantiated cases, evidence of abuse presented, and resulting parenting orders were assessed. Findings indicate that, against international comparisons, FCA judges substantiate cases very conservatively, with rates of substantiation much lower than in other studies. Allegations made by mothers against fathers were disproportionately unsubstantiated, as were those which did not fall under the Magellan case management system. Cases where the only evidence of CSA was a child’s disclosure and parent’s allegation were common in both substantiated and unsubstantiated cases, meaning that a lack of other evidence does not preclude a positive finding of risk of CSA by the FCA. Those cases also involving a protection order against the accused were more likely to be substantiated. Confirmation biases and a judicial tendency to err on the side of false negatives are discussed.     

Statistical modeling for Bayesian extrapolation of adult clinical trial information in pediatric drug evaluation

Children represent a large underserved population of “therapeutic orphans,” as an estimated 80% of children are treated off‐label. However, pediatric drug development often faces substantial challenges, including economic, logistical, technical, and ethical barriers, among others. Among many efforts trying to remove these barriers, increased recent attention has been paid to extrapolation; that is, the leveraging of available data from adults or older age groups to draw conclusions for the pediatric population. The Bayesian statistical paradigm is natural in this setting, as it permits the combining (or “borrowing”) of information across disparate sources, such as the adult and pediatric data. In this paper, authored by the pediatric subteam of the Drug Information Association Bayesian Scientific Working Group and Adaptive Design Working Group, we develop, illustrate, and provide suggestions on Bayesian statistical methods that could be used to design improved pediatric development programs that use all available information in the most efficient manner. A variety of relevant Bayesian approaches are described, several of which are illustrated through 2 case studies: extrapolating adult efficacy data to expand the labeling for Remicade to include pediatric ulcerative colitis and extrapolating adult exposure‐response information for antiepileptic drugs to pediatrics.