Peer-mentoring for first-time mothers from areas of socio-economic disadvantage: a qualitative study within a randomised controlled trial

Objective: To explore the difficulties experienced by lay-workers, women and health professionals involved in a peer-mentoring programme for first-time mothers living in socially disadvantaged areas. Design: Qualitative study; semi-structured interviews with lay-worker peer-mentoring programme participants at two separate stages of the programme (antenatal and postnatal). Setting: Community based. Participants: 11 women receiving peer-mentoring support (from first hospital antenatal visit to one year postnatal); 11 lay-workers; 2 research midwives. Results: Lay-workers had difficulty initiating contact with women and failure to establish contact affected their morale adversely. They felt that women understood their intended role poorly and attempted to develop relationships with them by sharing personal experiences and offering friendship; women who participated in the programme appreciated this. Developing a peer-mentor relationship was difficult if women lacked interest in the programme or in continuing contact. External influences on peer-mentoring uptake and delivery included family and friends who could prevent or encourage women’s participation and cause difficulties for the lay-worker both in delivering support and arranging follow-up. Lay-workers providing support to women from a different ethnic background experienced difficulties relating to both language and culture: these were perceived to affect peer-mentor relationships adversely. Major personal difficulties for lay-workers related to time constraints in reconciling mentoring requirements with demands of family and other work. Informing midwives of these difficulties helped identify solutions through training and ongoing professional support for the lay-workers. Conclusions: Lay-worker peer support is appreciated by first time mothers but difficulties in initiating contact, developing peer-mentor relationships and external influences such as family, ethnicity and time constraints are relevant to poor uptake and high staff turnover. In developing peer support programmes, awareness of potential difficulties and of how professional support can help resolve these should improve uptake and thus optimise the evaluations of their effectiveness.

The contribution of qualitative research in designing a complex intervention for secondary prevention of coronary heart disease in two different healthcare systems

Background: Developing complex interventions for testing in randomised controlled trials is of increasing importance in healthcare planning. There is a need for careful design of interventions for secondary prevention of coronary heart disease (CHD). It has been suggested that integrating qualitative research in the development of a complex intervention may contribute to optimising its design but there is limited evidence of this in practice. This study aims to examine the contribution of qualitative research in developing a complex intervention to improve the provision and uptake of secondary prevention of CHD within primary care in two different healthcare systems.

Methods: In four general practices, one rural and one urban, in Northern Ireland and the Republic of Ireland, patients with CHD were purposively selected. Four focus groups with patients (N = 23) and four with staff (N = 29) informed the development of the intervention by exploring how it could be tailored and integrated with current secondary prevention activities for CHD in the two healthcare settings. Following an exploratory trial the acceptability and feasibility of the intervention were discussed in four focus groups (17 patients) and 10 interviews (staff). The data were analysed using thematic analysis.

Results: Integrating qualitative research into the development of the intervention provided depth of information about the varying impact, between the two healthcare systems, of different funding and administrative arrangements, on their provision of secondary prevention and identified similar barriers of time constraints, training needs and poor patient motivation. The findings also highlighted the importance to patients of stress management, the need for which had been underestimated by the researchers. The qualitative evaluation provided depth of detail not found in evaluation questionnaires. It highlighted how the intervention needed to be more practical by minimising administration, integrating role plays into behaviour change training, providing more practical information about stress management and removing self-monitoring of lifestyle change.

Conclusion: Qualitative research is integral to developing the design detail of a complex intervention and tailoring its components to address individuals' needs in different healthcare systems. The findings highlight how qualitative research may be a valuable component of the preparation for complex interventions and their evaluation.

The journey to concordance for patients with hypertension: a qualitative study in primary care

Objective: We aimed to explore, using qualitative methods, the perspectives of patients with hypertension on issues relating to concordance in prescribing.

Method: This study took place in NHS general practices in Northern Ireland. A purposeful sample of patients who had been prescribed anti-hypertensive medication for at least one year were invited to participate in focus groups or semi-structured interviews; data were analysed using constant comparison.

Main outcome measures: The perspectives of patients with hypertension on issues relating to concordance in prescribing.

Results: Twenty-five individuals participated in five focus groups; two participated in semi-structured interviews. Participants felt they could make valuable contributions to consultations regarding their management. They were prepared to negotiate with GPs regarding their medication, but most deferred to their doctor’s advice, perceiving doctors’ attitudes and time constraints as barriers to their greater involvement in concordant decision-making. They had concerns about taking anti-hypertensive drugs, were aware of lifestyle influences on hypertension and reported using personal strategies to facilitate adherence and reduce the need to take medication.

Conclusions: Participants indicated a willingness to be?involved in concordance in prescribing anti- hypertensive medication but needed health professionals to address their concerns and confusion about the nature of hypertension. These findings suggest that there is a need for doctors and other healthcare professionals with responsibility for prescribing to develop skills specifically to explore the beliefs and views underlying an individual’s medication use. Such skills may need to be developed through specific training programmes at both undergraduate and postgraduate level.

Nurses' perceptions of and satisfaction with the medication administration system in long-term-care homes

The purpose of this study was to explore nurses' perceptions of and level of satisfaction with the medication administration system in long-term care (LTC). The cross-sectional survey design included both quantitative and open-ended questions. Data were collected from licensed registered nurses (RNs) and registered practical nurses (RPNs) at 9 LTC residences in southwestern Ontario, Canada. Using independent sample f tests, the researchers found that RNs were significantly less satisfied than RPNs with their medication administration system, particularly with respect to safety issues. RNs identified a number of related barriers, including time constraints, poor packaging, insufficient drug information, prescription changes, lack of staff competency, and unwieldy medication carts. Implications for practice and policy are discussed, including recommendations for improving medication administration practices and for addressing the workload demands of LTC nurses. © McGill University School of Nursing.

New challenges faced by carers during their child's hospital admission under segregation

Introduction
This paper presents the results of a qualitative study of CF family carers at the Belfast Paediatric CF Centre. The aim of this study was to describe the carer experience of their child’s admission to hospital under segregated care arrangements, and to highlight the meaning of segregation and cross infection from the carer perspective.

Method
Carers of children with CF who were admitted for two week IV antibiotic treatment during the study period were eligible to participate in this qualitative study. A consecutive series of eligible carers were approached in order of admission and within the time constraints of KR who was present two days each week. Recruitment of carers ended when no new themes emerged. Ten carers, 9 mothers and 1 couple, were interviewed about their experiences (mean age of child: 11.8 years; range: 1-17 years). Interpretative Phenomenological Analysis (IPA) was used to analyse and interpret the interview data.

Results and discussion
Balancing demands and dilemmas was the main contextual theme or experience of being a carer of a child with CF, and particularly so during admission to hospital. Many decisions were required every day that resulted in ‘double binds’ comprising uncertainty and stress. Three secondary themes captured the essence of carers’ experiences specifically related to segregation: managing risk and uncertainty; the burden of admission; and getting through each day. These themes will be described with examples illustrating the challenges faced by carers during their child’s hospitalisation, and the impact of segregation upon carers.

Perceptions of the Nurse Practitioner Role in Facilitating the Implementation of an Onsite Pain Management Team in Long Term Care

Background: One strategy to improve pain management in long term care (LTC) is to optimize the emerging role of the nurse practitioner (NP) in LTC. The purpose of this sub study was to learn about the NP role in implementing an onsite, interdisciplinary Pain Team in the LTC home setting.

Methods: We used a case study design that included two NPs who worked at separate LTC homes. Each of the NPs completed a weekly questionnaire of pain-related activities that they engaged in over a one-year implementation period; and a diary, using critical reflection, about their experiences and strategies used to implement the Pain Team. Descriptive statistics and thematic content analysis were used to analyze the case study data.

Findings: NPs tended to be most engaged in pain assessment and collaborated more with licensed nurses and personal support workers; less with pharmacists. NPs were more involved in organizational level activities, such as participating in committee work or assisting with the development of policies and procedures about pain. NPs created palliative care and pain service protocols; engaged in policy development, in-servicing, quality assurance and advocacy; and encouraged best practices. NPs were challenged with time constraints for pain management and balancing other role priorities and felt that increased scope of practice for them was needed.

Conclusions: The results of this study highlight how NPs implemented a Pain Team in LTC which may be helpful to others interested in implementing a similar strategy to reduce residents’ pain.

Effect of feed space allowance and period of access to food on dairy cow performance

Two experiments were conducted to examine the ‘long-term’ effect of feed space allowance and period of access to feed on dairy cow performance. In Experiment 1, three horizontal feed space allowances (20, 40 and 60 cm cow−1) were examined over a 127-d period (14 cows per treatment). In Experiment 2, 48 dairy cows were used in a continuous design (10-week duration) 2 × 2 factorial design experiment comprising two horizontal feed space allowances (15 and 40 cm cow−1), and two periods of access to feed (unrestricted and restricted). With the former, uneaten feed was removed at 08·00 h, while feeding took place at 09·00 h. With the latter, uneaten feed was removed at 06·00 h, while feeding was delayed until 12·00 h. Mean total dry-matter (DM) intakes were 19·0, 18·7 and 19·3 kg cow−1 d−1 with the 20, 40 and 60 cm cow−1 treatments in Experiment 1, and 18·1 and 18·2 kg cow−1 d−1 with the ‘restricted feeding time’ treatments, and 17·8 and 18·1 kg d−1 with the ‘unrestricted feeding time’ treatments (15 and 40 cm respectively) in Experiment 2. None of milk yield, milk composition, or end-of-study live weight or condition score were significantly affected by treatment in either experiment (P > 0·05), while fat + protein yield was reduced with the 15-cm treatment in Experiment 2 (P < 0·05). When access to feed was restricted by space or time constraints, cows modified their time budgets and increased their rates of intake.

Time-resolved optical spectroscopy of the pulsating DA white dwarf HS0507+0434B - New constraints on mode identification and pulsation properties

We present a detailed analysis of time-resolved optical spectra of the ZZ Ceti white dwarf, HS 0507+0434B. Using the wavelength dependence of observed mode amplitudes, we deduce the spherical degree, l, of the modes, most of which have l = 1. The presence of a large number of combination frequencies (linear sums or differences of the real modes) enabled us not only to test theoretical predictions but also to indirectly infer spherical and azimuthal degrees of real modes that had no observed splittings. In addition to the above, we measure line-of-sight velocities from our spectra. We find only marginal evidence for periodic modulation associated with the pulsation modes: at the frequency of the strongest mode in the lightcurve, we measure an amplitude of 2.6 +/- 1.0 kms(-1), which has a probability of 2% of being due to chance; for the other modes, we find lower values. Our velocity amplitudes and upper limits are smaller by a factor of two compared to the amplitudes found in ZZ Psc. We find that this is consistent with expectations based on the position of HS 0507+0434B in the instability strip. Combining all the available information from data such as ours is a first step towards constraining atmospheric properties in a convectionally unstable environment from an observational perspective.

A new look at the pulsating DB white dwarf GD 358: Line-of-sight velocity measurements and constraints on model atmospheres

We report on our findings of the bright, pulsating, helium atmosphere white dwarf GD 358, based on time-resolved optical spectrophotometry. We identify 5 real pulsation modes and at least 6 combination modes at frequencies consistent with those found in previous observations. The measured Doppler shifts from our spectra show variations with amplitudes of up to 5.5 km s-1 at the frequencies inferred from the flux variations. We conclude that these are variations in the line-of-sight velocities associated with the pulsational motion. We use the observed flux and velocity amplitudes and phases to test theoretical predictions within the convective driving framework, and compare these with similar observations of the hydrogen atmosphere white dwarf pulsators (DAVs). The wavelength dependence of the fractional pulsation amplitudes (chromatic amplitudes) allows us to conclude that all five real modes share the same spherical degree, most likely, l=1. This is consistent with previous identifications based solely on photometry. We find that a high signal-to-noise mean spectrum on its own is not enough to determine the atmospheric parameters and that there are small but significant discrepancies between the observations and model atmospheres. The source of these remains to be identified. While we infer Teff =24 kK and log g ~ 8.0 from the mean spectrum, the chromatic amplitudes, which are a measure of the derivative of the flux with respect to the temperature, unambiguously favour a higher effective temperature, 27 kK, which is more in line with independent determinations from ultra-violet spectra.

Managing time: integration of care and paid work amongst low income families and the role of the United Kingdom’s tax credit system

Under the New Labour Governments in the UK, successive reforms of the tax and benefit system sought to improve the financial benefits of paid work. Drawing on two waves of qualitative interviews with low-income working families this article examines the role of the UK tax credit system in shaping decisions about employment and unpaid care work. The article suggests that the financial support provided for lone parent participants by the tax credit system enhanced their temporal autonomy, permitting participation in paid work to align more closely with temporally situated notions of parental responsibility for caring. For couple families however, parental perceptions of responsibility for pre-school children, along with childcare constraints and the structure of the tax credit system served to constrain the autonomy of the main carer and implicitly encourage a gendered specialisation in caring or employment.

Stellar rotation in the Hyades and Praesepe: gyrochronology and braking time-scale

We present the results of photometric surveys for stellar rotation in the Hyades and in Praesepe, using data obtained as part of the SuperWASP exoplanetary transit-search programme. We determined accurate rotation periods for more than 120 sources whose cluster membership was confirmed by common proper motion and colour-magnitude fits to the clusters' isochrones. This allowed us to determine the effect of magnetic braking on a wide range of spectral types for expected ages of ˜600 Myr for the Hyades and Praesepe. Both clusters show a tight and nearly linear relation between J-Ks colour and rotation period in the F, G and K spectral range. This confirms that loss of angular momentum was significant enough that stars with strongly different initial rotation rates have converged to the same rotation period for a given mass, by the ages of Hyades and Praesepe. In the case of the Hyades, our colour-period sequence extends well into the M dwarf regime and shows a steep increase in the scatter of the colour-period relation, with identification of numerous rapid rotators from ˜0.5 Msun down to the lowest masses probed by our survey (˜0.25 Msun). This provides crucial constraints on the rotational braking time-scales and further clears the way to use gyrochronology as an accurate age measurement tool for main-sequence stars.

Exploiting spatio-temporal constraints for robust 2D pose tracking

We present a Spatio-temporal 2D Models Framework (STMF) for 2D-Pose tracking. Space and time are discretized and a mixture of probabilistic "local models" is learnt associating 2D Shapes and 2D Stick Figures. Those spatio-temporal models generalize well for a particular viewpoint and state of the tracked action but some spatio-temporal discontinuities can appear along a sequence, as a direct consequence of the discretization. To overcome the problem, we propose to apply a Rao-Blackwellized Particle Filter (RBPF) in the 2D-Pose eigenspace, thus interpolating unseen data between view-based clusters. The fitness to the images of the predicted 2D-Poses is evaluated combining our STMF with spatio-temporal constraints. A robust, fast and smooth human motion tracker is obtained by tracking only the few most important dimensions of the state space and by refining deterministically with our STMF.

Reciprocal value propositions in practice: Constraints in digital markets

The value proposition concept, while forming a central foundational premise of service-dominant (S-D) logic, has nevertheless been treated somewhat ambiguously. Recent work in attempting to address this has focused through a S-D logic lens on the reciprocal nature of value propositions. Important to this work has been a focus on communicative interactions and resource integration between network suppliers and customers. Overall, value proposition thinking has not studied in detail their adoption and use in practice. Considering the compelling notion of reciprocity, there have been recent calls for research to consider reciprocal value propositions in practice. The overall aim of this paper, therefore, was to explore how reciprocal value propositions are developed (or not) in practice at the network level. The study was set in the mobile television (TV) sector, which, as an internet-driven sector, is viewed as particularly pertinent. To conduct the study an S-D logic and Industrial Marketing and Purchasing (IMP) Group framework are integrated for the first time. A key finding is that while the reciprocal value proposition concept is theoretically intuitive, it is by no means inevitable in practice. Reciprocal value propositions were found to be simultaneously constrained, and, potentially enabled by these constraints in practice. At an overall level this paper contributes to the ongoing collaborative process, which aims to move S-D logic from a framework to a theory. More specifically, we provide new insights into the development of reciprocal value propositions in practice.

Delineation of a quick clay zone at Smørgrav, Norway, with electromagnetic methods under geotechnical constraints

In many coastal areas of North America and Scandinavia, post-glacial clay sediments have emerged above sea level due to iso-static uplift. These clays are often destabilised by fresh water leaching and transformed to so-called quick clays as at the investigated area at Smørgrav, Norway. Slight mechanical disturbances of these materials may trigger landslides. Since the leaching increases the electrical resistivity of quick clay as compared to normal marine clay, the application of electromagnetic (EM) methods is of particular interest in the study of quick clay structures.

For the first time, single and joint inversions of direct-current resistivity (DCR), radiomagnetotelluric (RMT) and controlled-source audiomagnetotelluric (CSAMT) data were applied to delineate a zone of quick clay. The resulting 2-D models of electrical resistivity correlate excellently with previously published data from a ground conductivity metre and resistivity logs from two resistivity cone penetration tests (RCPT) into marine clay and quick clay. The RCPT log into the central part of the quick clay identifies the electrical resistivity of the quick clay structure to lie between 10 and 80 O m. In combination with the 2-D inversion models, it becomes possible to delineate the vertical and horizontal extent of the quick clay zone. As compared to the inversions of single data sets, the joint inversion model exhibits sharper resistivity contrasts and its resistivity values are more characteristic of the expected geology. In our preferred joint inversion model, there is a clear demarcation between dry soil, marine clay, quick clay and bedrock, which consists of alum shale and limestone.

Orthogonal space-time block coded rate-adaptive modulation with outdated feedbasck

Abstract-Channel state information (CSI) at the transmitter can be used to adapt transmission rate or antenna gains in multi-antenna systems. We propose a rate-adaptive M-QAM scheme equipped with orthogonal space-time block coding with simple outdated, finite-rate feedback over independent flat fading channels. We obtain closed-form expressions for the average BER and throughput for our scheme, and analyze the effects of possibly delayed feedback on the performance gains. We derive optimal switching thresholds maximizing the average throughput under average and outage BER constraints with outdated feedback. Our numerical results illustrate the immunity of our optimal thresholds to delayed feedback.