Safeguarding and promoting children in maternity services- implications for policy and practice

The article debates the issues involved in safeguarding and protecting children in maternity services and offers implications for professional practice. Midwives and other staff who work as members of the maternity team have a safeguarding role to play in the identification of babies and children who have been abused, or at risk of abuse, and in subsequent intervention and protection services. The study highlights how domestic violence increases during pregnancy and the postpartum period, and is significantly related to all types of child maltreatment up to the child's fifth year, and children under one being at the highest risk of injury, or death. Close inter-agency liaison is required with midwives who are accountable and not afraid to challeneg hiostorical working practices.

The abundance of HNCO and its use as a diagnostic of environment

Aims. We aim to investigate the chemistry and gas phase abundance of HNCO and the variation of the HNCO/CS abundance ratio as a diagnostic of the physics and chemistry in regions of massive star formation. Methods. A numerical-chemical model has been developed which self-consistently follows the chemical evolution of a hot core. The model comprises of two distinct stages. The first stage follows the isothermal, modified free-fall collapse of a molecular dark cloud. This is immediately followed by an increase in temperature which represents the switch on of a central massive star and the subsequent evolution of the chemistry in a hot, dense gas cloud (the hot core). During the collapse phase, gas species are allowed to accrete on to grain surfaces where they can participate in further reactions. During the hot core phase surface species thermally desorb back in to the ambient gas and further chemical evolution takes place. For comparison, the chemical network was also used to model a simple dark cloud and photodissociation regions. Results. Our investigation reveals that HNCO is inefficiently formed when only gas-phase formation pathways are considered in the chemical network with reaction rates consistent with existing laboratory data. This is particularly true at low temperatures but also in regions with temperatures up to ~200 K. Using currently measured gas phase reaction rates, obtaining the observed HNCO abundances requires its formation on grain surfaces – similar to other “hot core” species such as CH3OH. However our model shows that the gas phase HNCO in hot cores is not a simple direct product of the evaporation of grain mantles. We also show that the HNCO/CS abundance ratio varies as a function of time in hot cores and can match the range of values observed. This ratio is not unambiguously related to the ambient UV field as been suggested – our results are inconsistent with the hypothesis of Martín et al. (2008, ApJ, 678, 245). In addition, our results show that this ratio is extremely sensitive to the initial sulphur abundance. We find that the ratio grows monotonically with time with an absolute value which scales approximately linearly with the S abundance at early times.

Diagnostic based modelling of radio-frequency driven atmospheric pressure plasmas

Diagnostic based modelling (DBM) actively combines complementary advantages of numerical plasma simulations and relatively simple optical emission spectroscopy (OES). DBM is employed to determine absolute atomic oxygen ground state densities in a helium–oxygen radio-frequency driven atmospheric pressure plasma jet. A comparatively simple one-dimensional simulation yields detailed information on electron properties governing the population dynamics of excited states. Important characteristics of the electron dynamics are found to be largely insensitive to details of the chemical composition and to be in very good agreement with space and phase-resolved OES. Benchmarking the time and space resolved simulation allows us to subsequently derive effective excitation rates as the basis for DBM with simple space and time integrated OES. The population dynamics of the upper O 3p 3P (? = 844 nm) atomic oxygen state is governed by direct electron impact excitation, dissociative excitation, radiation losses and collisional induced quenching. Absolute values for atomic oxygen densities are obtained through tracer comparison with the upper Ar 2p1 (? = 750.4 nm) state. The presented results for the atomic oxygen density show excellent quantitative agreement with independent two-photon laser-induced fluorescence measurements.

Pulmonary rehabilitation and follow-on services: a Northern Ireland survey

There should be a clear pathway through pulmonary rehabilitation and follow-on services. The aim of this survey was to determine the characteristics of the different components of the patient pathway, that is, pulmonary rehabilitation programs, ongoing exercise facilities, and support networks in Northern Ireland. Questionnaires were sent to current providers of pulmonary rehabilitation, providers of ongoing exercise, and support groups in Northern Ireland. Findings relating to the current status of pulmonary rehabilitation in Northern Ireland up to January 2007 are reported. There are currently 23 pulmonary rehabilitation programs in Northern Ireland. There appears to be a pathway through the short-term pulmonary rehabilitation program (6-8 weeks). Programs met standards for structure and format, except for the frequency of supervised exercise. Not all programs have links for the provision of ongoing exercise, but a range of exercise programs are available in leisure centers in Northern Ireland that include people with respiratory disease. There are 13 support groups for patients with respiratory disease in Northern Ireland and their function is diverse. Pulmonary rehabilitation is established in Northern Ireland, although not all patients are able to access these. Facilities for ongoing exercise and support groups are less developed. Improvements could be facilitated by better communication within the patient pathway and a strategic coordinated approach.

Evaluation and outcome of patients with chronic non-productive cough using a comprehensive diagnostic protocol

Background-Asthma, post-nasal drip syndrome (PNDS), and gastrooesophageal reflux (GOR) account for many cases of chronic non-productive cough (CNPC). Each may simultaneously contribute to cough even when clinically silent, and failure to recognise their contribution may lead to unsuccessful treatment.

Methods—Patients (all lifetime non-smokers with normal chest radiographs and spirometric measurements) referred with CNPC persisting for more than three weeks as their sole respiratory symptom underwent histamine challenge, home peak flow measurements, ear, nose and throat (ENT) examination, sinus CT scanning, and 24 hour oesophageal pH monitoring. Treatment was prescribed on the basis of diagnoses informed by investigation results.

RESULTS—Forty three patients (29 women) of mean age 47.5 years (range 18-77) and mean cough duration 67 months (range 2-240) were evaluated. On the basis of a successful response to treatment, a cause for the cough was identified in 35 patients (82%) as follows: cough variant asthma (CVA) (10 cases), PNDS (9 cases), GOR (8cases), and dual aetiologies (8 cases). Histamine challenge correctly predicted CVA in 15 of 17 (88%) positive tests. ENT examination and sinus CT scans each had low positive predictive values for PNDS (10 of 16 (63%) and 12 of 18 (67%) positive cases, respectively), suggesting that upper airways disease frequently co-exists but does not always contribute to cough. When negative, histamine challenge and 24 hour oesophageal pH monitoring effectively ruled out CVA and GOR, respectively, as a cause for cough.

CONCLUSION—This comprehensive approach aids the accurate direction of treatment and, while CVA, PNDS and GOR remain the most important causes of CNPC to consider, a group with no identifiable aetiology remains.

Do environmental and task characteristics matter in the control of externalized local public services? Unveiling the relevance of party characteristics and citizens’ offstage voice

Purpose: The purpose of this paper is to investigate the mechanisms adopted by cities to control the provision of externalized public services and to explore the determinants of such control choices.

Design/methodology/approach: The paper presents the results of a multiple case study based on the experiences of three cities and three public services (transport, solid waste collection and home care services for the elderly), where control mechanisms and their possible antecedents were analyzed.

Findings: The results show that the control models found in the cases analyzed do not correspond to the "pure" patterns described in the private sector literature and that the factors identified by management control contributions do not seem to be exhaustive in explaining the configuration of control systems in the public sector. While environmental and task characteristics only partially explain the adoption of certain configurations of control, the features of the control systems seem to be rather influenced by variables that are related to party characteristics.

Originality/value: The paper shows that the combinations of control mechanisms are more multifaceted than those presented in the literature, and that the factors identified in the private sector literature do not seem to explain comprehensively the configuration of control systems in the public sector. © Emerald Group Publishing Limited.

Diagnostic-based modeling on a micro-scale atmospheric-pressure plasma jet

Diagnostic-based modeling (DBM) actively combines complementary advantages of numerical plasma simulations and relatively simple optical emission spectroscopy (OES). DBM is applied to determine spatial absolute atomic oxygen ground-state density profiles in a micro atmospheric-pressure plasma jet operated in He–O2. A 1D fluid model with semi-kinetic treatment of the electrons yields detailed information on the electron dynamics and the corresponding spatio-temporal electron energy distribution function. Benchmarking this time- and space-resolved simulation with phase-resolved OES (PROES) allows subsequent derivation of effective excitation rates as the basis for DBM. The population dynamics of the upper O(3p3P) oxygen state (? = 844 nm) is governed by direct electron impact excitation, dissociative excitation, radiation losses, and collisional induced quenching. Absolute values for atomic oxygen densities are obtained through tracer comparison with the upper Ar(2p1) state (? = 750.4 nm). The resulting spatial profile for the absolute atomic oxygen density shows an excellent quantitative agreement to a density profile obtained by two-photon absorption laser-induced fluorescence spectroscopy.