Midwifery-led antenatal care models: mapping a systematic review to an evidence-based quality framework to identify key components and characteristics of care

Background: Implementing effective antenatal care models is a key global policy goal. However, the mechanisms of action of these multi-faceted models that would allow widespread implementation are seldom examined and poorly understood. In existing care model analyses there is little distinction between what is done, how it is done, and who does it. A new evidence-informed quality maternal and newborn care (QMNC) framework identifies key characteristics of quality care. This offers the opportunity to identify systematically the characteristics of care delivery that may be generalizable across contexts, thereby enhancing implementation. Our objective was to map the characteristics of antenatal care models tested in Randomised Controlled Trials (RCTs) to a new evidence-based framework for quality maternal and newborn care; thus facilitating the identification of characteristics of effective care.

Methods: A systematic review of RCTs of midwifery-led antenatal care models. Mapping and evaluation of these models’ characteristics to the QMNC framework using data extraction and scoring forms derived from the five framework components. Paired team members independently extracted data and conducted quality assessment using the QMNC framework and standard RCT criteria.

Results: From 13,050 citations initially retrieved we identified 17 RCTs of midwifery-led antenatal care models from Australia (7), the UK (4), China (2), and Sweden, Ireland, Mexico and Canada (1 each). QMNC framework scores ranged from 9 to 25 (possible range 0–32), with most models reporting fewer than half the characteristics associated with quality maternity care. Description of care model characteristics was lacking in many studies, but was better reported for the intervention arms. Organisation of care was the best-described component. Underlying values and philosophy of care were poorly reported.

Conclusions: The QMNC framework facilitates assessment of the characteristics of antenatal care models. It is vital to understand all the characteristics of multi-faceted interventions such as care models; not only what is done but why it is done, by whom, and how this differed from the standard care package. By applying the QMNC framework we have established a foundation for future reports of intervention studies so that the characteristics of individual models can be evaluated, and the impact of any differences appraised.

Joint Analysis of Multiple Algorithms and Performance Measures

There has been an increasing interest in the development of new methods using Pareto optimality to deal with multi-objective criteria (for example, accuracy and time complexity). Once one has developed an approach to a problem of interest, the problem is then how to compare it with the state of art. In machine learning, algorithms are typically evaluated by comparing their performance on different data sets by means of statistical tests. Standard tests used for this purpose are able to consider jointly neither performance measures nor multiple competitors at once. The aim of this paper is to resolve these issues by developing statistical procedures that are able to account for multiple competing measures at the same time and to compare multiple algorithms altogether. In particular, we develop two tests: a frequentist procedure based on the generalized likelihood-ratio test and a Bayesian procedure based on a multinomial-Dirichlet conjugate model. We further extend them by discovering conditional independences among measures to reduce the number of parameters of such models, as usually the number of studied cases is very reduced in such comparisons. Data from a comparison among general purpose classifiers is used to show a practical application of our tests.

Effective end wall profiling rules for a highly loaded compressor cascade

This paper presents a numerical study of a linear compressor cascade to investigate the effective end wall profiling rules for highly-loaded axial compressors. The first step in the research applies a correlation analysis for the different flow field parameters by a data mining over 600 profiling samples to quantify how variations of loss, secondary flow and passage vortex interact with each other under the influence of a profiled end wall. The result identifies the dominant role of corner separation for control of total pressure loss, providing a principle that only in the flow field with serious corner separation does the does the profiled end wall change total pressure loss, secondary flow and passage vortex in the same direction. Then in the second step, a multi-objective optimization of a profiled end wall is performed to reduce loss at design point and near stall point. The development of effective end wall profiling rules is based on the manner of secondary flow control rather than the geometry features of the end wall. Using the optimum end wall cases from the Pareto front, a quantitative tool for analyzing secondary flow control is employed. The driving force induced by a profiled end wall on different regions of end wall flow are subjected to a detailed analysis and identified for their positive/negative influences in relieving corner separation, from which the effective profiling rules are further confirmed. It is found that the profiling rules on a cascade show distinct differences at design point and near stall point, thus loss control of different operating points is generally independent.

The Status of Multi-Dimensional Core-Collapse Supernova Models

Models of neutrino-driven core-collapse supernova explosions have matured considerably in recent years. Explosions of low-mass progenitors can routinely be simulated in 1D, 2D, and 3D. Nucleosynthesis calculations indicate that these supernovae could be contributors of some lighter neutron-rich elements beyond iron. The explosion mechanism of more massive stars remains under investigation, although first 3D models of neutrino-driven explosions employing multi-group neutrino transport have become available. Together with earlier 2D models and more simplified 3D simulations, these have elucidated the interplay between neutrino heating and hydrodynamic instabilities in the post-shock region that is essential for shock revival. However, some physical ingredients may still need to be added/improved before simulations can robustly explain supernova explosions over a wide range of progenitors. Solutions recently suggested in the literature include uncertainties in the neutrino rates, rotation, and seed perturbations from convective shell burning. We review the implications of 3D simulations of shell burning in supernova progenitors for the ‘perturbations-aided neutrino-driven mechanism,’ whose efficacy is illustrated by the first successful multi-group neutrino hydrodynamics simulation of an 18 solar mass progenitor with 3D initial conditions. We conclude with speculations about the impact of 3D effects on the structure of massive stars through convective boundary mixing.