Disabled women’s experiences of accessing and utilising maternity services when they are affected by domestic abuse: a critical incident technique study

Background: Women and their babies are entitled to equal access to high quality maternity care. However, when women fit into two or more categories of vulnerability they can face multiple, compound barriers to accessing and utilising services. Disabled women are up to three times more likely to experience domestic abuse than non-disabled women. Domestic abuse may compromise health service access and utilisation and disabled people in general have suboptimal access to healthcare services. Despite this, little is known about the compounding effects of disability and domestic abuse on women’s access to maternity care.

Methods: The aim of the study was to identify how women approach maternity care services, their expectations of services and whether they are able to get the type of care that they need and want. We conducted a qualitative, Critical Incident Technique study in Scotland. Theoretically we drew on Andersen’s model of healthcare use. The model was congruent with our interest in women’s intended/actual use of maternity services and the facilitators and barriers
impacting their access to care. Data were generated during 2013 using one-to-one interviews.

Results: Five women took part and collectively reported 45 critical incidents relating to accessing and utilising maternity services. Mapped to the underpinning theoretical framework, our findings show how the four domains of attitudes; knowledge; social norms; and perceived control are important factors shaping maternity care experiences.

Conclusions: Positive staff attitude and empowering women to have control over their own care is crucial in influencing women’s access to and utilisation of maternity healthcare services. Moreover these are cyclical, with the consequences and outcomes of healthcare use becoming part of the enabling or disabling factors affecting future healthcare decisions.Further consideration needs to be given to the development of strategies to access and recruit women in these circumstances. This will provide an opportunity for under-represented and silenced voices to be heard.

Moral distress experienced by health care professionals who provide home-based palliative care

Health care providers regularly encounter situations of moral conflict and distress in their practice. Moral distress may result in unfavorable outcomes for both health care providers and those in their care. The purpose of this study was to examine the experience of moral distress from a broad range of health care occupations that provide home-based palliative care as the initial step of addressing the issue. A critical incident approach was used in qualitative interviews to elicit the experiences on moral distress from 18 health care providers drawn from five home visiting organizations in south central Ontario, Canada. Most participants described at least two critical incidents in their interview generating a total of 47 critical incidents. Analyses of the critical incidents revealed 11 issues that triggered moral distress which clustered into three themes, (a) the role of informal caregivers, b) challenging clinical situations and (c) service delivery issues. The findings suggest that the training and practice environments for health care providers need to be designed to recognize the moral challenges related to day-to-day practice.

Critical evaluation of pulse-echo ultrasonic test method for the determination of setting and mechanical properties of acrylic bone cement: Influence of mixing technique

Currently there is no reliable objective method to quantify the setting properties of acrylic bone cements within an operating theatre environment. Ultrasonic technology can be used to determine the acoustic properties of the polymerising bone cement, which are linked to material properties and provide indications of the physical and chemical changes occurring within the cement. The focus of this study was the critical evaluation of pulse-echo ultrasonic test method in determining the setting and mechanical properties of three different acrylic bone cement when prepared under atmospheric and vacuum mixing conditions. Results indicated that the ultrasonic pulse-echo technique provided a highly reproducible and accurate method of monitoring the polymerisation reaction and indicating the principal setting parameters when compared to ISO 5833 standard, irrespective of the acrylic bone cement or mixing method used. However, applying the same test method to predict the final mechanical properties of acrylic bone cement did not prove a wholly accurate approach. Inhomogeneities within the cement microstructure and specimen geometry were found to have a significant influence on mechanical property predictions. Consideration of all the results suggests that the non-invasive and non-destructive pulse-echo ultrasonic test method is an effective and reliable method for following the full polymerisation reaction of acrylic bone cement in real-time and then determining the setting properties within a surgical theatre environment. However the application of similar technology for predicting the final mechanical properties of acrylic bone cement on a consistent basis may prove difficult.

An experiment in group learning technology: evaluating critical thinking in face-to-face and computer-supported seminars

Can learning quality be maintained in the face of increasing class size by the use of Computer Supported Co-operative Learning (CSCL) technologies? In particular, can Computer-Mediated Communication promote critical thinking in addition to surface information transfer? We compared face-to-face seminars with asynchronous computer conferencing in the same Information Management class. From Garrison's theory of critical thinking and Henri's critical reasoning skills, we developed two ways of evaluating critical thinking: a student questionnaire and a content analysis technique. We found evidence for critical thinking in both situations, with some subtle differences in learning style. This paper provides an overview of this work.

CHARACTERIZATION OF A LASER-PRODUCED PLASMA USING THE TECHNIQUE OF POINT-PROJECTION ABSORPTION-SPECTROSCOPY

The technique of point-projection spectroscopy has been shown to be applicable to the study of expanding aluminum plasmas generated by approximately 80 ps laser pulses incident on massive, aluminum stripe targets of approximately 125-mu-m width. Targets were irradiated at an intensity of 2.5 +/- 0.5 x 10(13) W/cm2 in a line focus geometry and under conditions similar to those of interest in x-ray laser schemes. Hydrogenic and heliumlike aluminum resonance lines were observed in absorption using a quasicontinuous uranium back-lighter plasma. Using a pentaerythrital Bragg crystal as the dispersive element, a resolving power of approximately 3500 was achieved with spatial resolution at the 5-mu-m level in frame times of the order of 100 ps. Reduction of the data for times up to 150 ps after the peak of the incident laser pulse produced estimates of the temperature and ion densities present, as a function of space and time. The one-dimensional Lagrangian hydrodynamic code MEDUSA coupled to the atomic physics non-local-thermodynamic-equilibrium ionized material package was used to simulate the experiment in planar geometry and has been shown to be consistent with the measurements.

Organic Matter-Solid Phase Interactions Are Critical for Predicting Arsenic Release and Plant Uptake in Bangladesh Paddy Soils

Agroecological zones within Bangladesh with low levels of arsenic in groundwater and soils produce rice that is high in arsenic with respect to other producing regions of the globe. Little is known about arsenic cycling in these soils and the labile fractions relevant for plant uptake when flooded. Soil porewater dynamics of field soils (n = 39) were recreated under standardized laboratory conditions to investigate the mobility and interplay of arsenic, Fe, Si, C, and other elements, in relation to rice grain element composition, using the dynamic sampling technique diffusive gradients in thin films (DGT). Based on a simple model using only labile DGT measured arsenic and dissolved organic carbon (DOC), concentrations of arsenic in Aman (Monsoon season) rice grain were predicted reliably. DOC was the strongest determinant of arsenic solid-solution phase partitioning, while arsenic release to the soil porewater was shown to be decoupled from that of Fe. This study demonstrates the dual importance of organic matter (OM), in terms of enhancing arsenic release from soils, while reducing bioavailability by sequestering arsenic in solution.

Application of a mechanobiological simulation technique to stents used clinically

Many cardiovascular diseases are characterised by the restriction of blood flow through arteries. Stents can be expanded within arteries to remove such restrictions; however, tissue in-growth into the stent can lead to restenosis. In order to predict the long-term efficacy of stenting, a mechanobiological model of the arterial tissue reaction to stress is required. In this study, a computational model of arterial tissue response to stenting is applied to three clinically relevant stent designs. We ask the question whether such a mechanobiological model can differentiate between stents used clinically, and we compare these predictions to a purely mechanical analysis. In doing so, we are testing the hypothesis that a mechanobiological model of arterial tissue response to injury could predict the long-term outcomes of stent design. Finite element analysis of the expansion of three different stent types was performed in an idealised, 3D artery. Injury was calculated in the arterial tissue using a remaining-life damage mechanics approach. The inflammatory response to this initial injury was modelled using equations governing variables which represented tissue-degrading species and growth factors. Three levels of inflammation response were modelled to account for inter-patient variability. A lattice-based model of smooth muscle cell behaviour was implemented, treating cells as discrete agents governed by local rules. The simulations predicted differences between stent designs similar to those found in vivo. It showed that the volume of neointima produced could be quantified, providing a quantitative comparison of stents. In contrast, the differences between stents based on stress alone were highly dependent on the choice of comparison criteria. These results show that the choice of stress criteria for stent comparisons is critical. This study shows that mechanobiological modelling may provide a valuable tool in stent design, allowing predictions of their long-term efficacy. The level of inflammation was shown to affect the sensitivity of the model to stent design. If this finding was verified in patients, this could suggest that high-inflammation patients may require alternative treatments to stenting.

SURFACE-PLASMON ENHANCED LASER-ABLATION OF THIN METAL-FILMS

Surface plasmon enhancement of laser ablation of thin Al films is examined with a view to its application in metal film patterning and nano-structuring. Al films, deposited on silica prisms, are first characterized by attenuated total reflection using a broadband UV source and appropriate interference filter. The films are subsequently subjected to excimer laser radiation of wavelength 248 nm under conditions both of direct incidence from the air side of the film, and of surface plasmon excitation in which light is incident through the prism at greater than critical angle. For a given level of ablation damage in a particular film the fluence required using the surface plasmon technique is 3-5 times less than that needed when direct incidence is used. This is roughly in line with the energy absorbed in the film. From a practical standpoint it is clear that ablation of metal films can be achieved with much lower fluences than has hitherto been possible, thus reducing the requirements on laser output and relaxing the power handling constraints on any input optical elements.

A critical review of labelling techniques used to quantify rhizosphere carbon-flow

The rhizosphere is a major sink for photo-assimilated carbon and quantifying inputs into this sink is one of the main goals of rhizosphere biology as organic carbon lost from plant roots supports a higher microbial population in the rhizosphere compared to bulk soil. Two fundamentally different¹⁴CO₂ labelling strategies have been developed to estimate carbon fluxes through the rhizosphere - continuous feeding of shoots with labelled carbon dioxide and pulse-chase experiments. The biological interpretation that can be placed on the results of labelling experiments is greatly biased by the technique used. It is the purpose of this paper to assess the advantages, disadvantages and the biological interpretation of both continuous and pulse labelling and to consider how to partition carbon fluxes within the rhizosphere. © 1994 Kluwer Academic Publishers.