Why 'down under' is a cut above: a comparison of rates of and reasons for caesarean section in England and Australia

Background Most studies examining determinants of rising rates of caesarean section have examined patterns in documented reasons for caesarean over time in a single location. Further insights could be gleaned from cross-cultural research that examines practice patterns in locations with disparate rates of caesarean section at a single time point. Methods We compared both rates of and main reason for pre-labour and intrapartum caesarean between England and Queensland, Australia, using data from retrospective cross-sectional surveys of women who had recently given birth in England (n = 5,250) and Queensland (n = 3,467). Results Women in Queensland were more likely to have had a caesarean birth (36.2%) than women in England (25.1% of births; OR = 1.44, 95% CI = 1.28-1.61), after adjustment for obstetric characteristics. Between-country differences were found for rates of pre-labour caesarean (21.2% vs. 12.2%) but not for intrapartum caesarean or assisted vaginal birth. Compared to women in England, women in Queensland with a history of caesarean were more likely to have had a pre-labour caesarean and more likely to have had an intrapartum caesarean, due only to a previous caesarean. Among women with no previous caesarean, Queensland women were more likely than women in England to have had a caesarean due to suspected disproportion and failure to progress in labour. Conclusions The higher rates of caesarean birth in Queensland are largely attributable to higher rates of caesarean for women with a previous caesarean, and for the main reason of having had a previous caesarean. Variation between countries may be accounted for by the absence of a single, comprehensive clinical guideline for caesarean section in Queensland. Keywords: Caesarean section; Childbirth; Pregnancy; Cross-cultural comparison; Vaginal birth after caesarean; Previous caesarean section; Patient-reported data; Quality improvement

An intervention to discourage Australian mothers from unnecessarily exposing their babies to the sun for therapeutic reasons

Parents play a key role in children’s sun-protective behaviour, with good sun-protective habits established early tending to be sustained. We designed a maternity hospital-based educational intervention to reduce myths that could result in mothers intentionally sunning their babies. Interviews were conducted with two cross-sections of healthy post-partum inpatients in the maternity ward of a large regional public hospital. The first group (n¼106) was recruited before the commencement of educational in-services for maternity nursing staff; the second group (n¼203) was interviewed after the last staff in-service session. More pre-intervention than post-intervention women reported they would expose their baby to sunlight to: treat suspected jaundice (28.8% vs. 13.3%; p<0.001) or help their baby’s skin adapt to sunlight (10.5% vs. 2.5%; p¼0.003). Fewer post-intervention women indicated they would sun themselves to treat breastfeeding-associated sore/cracked nipples (7.6% vs. 2%; p¼0.026). This educational intervention should be used to educate parents, health professionals and students

Use your freedom of choice : reasons for choosing homeschool in Australia

In Australia, the decision to home educate is becoming increasingly popular (cf. Harding & Farrell, 2003; Townsend, 2012). In spite of its increasing popularity, the reasons home education is chosen by Australian families is under-researched (cf. Jackson & Allan, 2010). This paper reports on a case study that set out to explore the links between families that unschool and the parenting philosophies they follow. In- depth, qualitative interviews were conducted with a group of home education families in one of Australia’s most populated cities. Data were analysed using Critical Discourse Analysis. The analysis revealed that there were links between the parents’ beliefs about home education and their adherence to Attachment Parenting.

Modes of nanotube growth in plasmas and reasons for single-walled structure

The conditions for carbon nanotube synthesis in the bulk of arc discharges and on plasma-exposed solid surfaces are compared to reveal the main distinguishing features of the growth kinetics and explain the striking difference between the growth of the nanotubes in both cases. It is shown that this difference is due to very different exposure of the discharge-synthesized and surface-bound nanotubes to ion fluxes, with the ratio of the ion fluxes collected per nanotube in the two cases reaching up to six orders of magnitude. Depending on the plasma parameters and the sizes of the nanotubes and metal catalyst particles, four distinct growth modes of the nanotubes in the plasma bulk have been identified. These results shed light on why single-walled carbon nanotube growth is more favourable in the bulk of arc plasmas rather than on plasma-exposed surfaces.

School based youth health nurses and attrition : the reasons for moving on

Like the UK, Australia has a number of school nursing models and programmes. The School Based Youth Health Nurse Program (SBYHNP) is a new and unique model of school nursing in Queensland, Australia. The SBYHNP represents a philosophical and structural shift from traditional school nursing programmes. The purpose of this qualitative case study is to explore the reasons School Based Youth Health Nurses (SBYHN) leave school nursing. Sixteen in-depth interviews were conducted with participants who practiced as SBYHN and left the SBYHNP. This case study reveals six themes: The politics’: Navigating the organisational divide, 'Unconditional positive regard’: Surviving without team cohesion, 'Absolutely exhausted’: Maintaining physical and emotional strength, ‘Definitely geographical’: Managing the tyranny of time and distance, ‘If things fell into place’: Thinking about what could have been, and ‘A stepping stone’: Moving on to the next nursing position. This case study suggests nurses considering school nursing as a specialty should seek opportunity to understand this complex role, ensure realistic expectations and ndertake relevant qualifications. This approach may secure the investment made by nurses and schools and create demand for a highly sort after position.

Subjective reasons why immigrant patients attend the emergency department

Background Some patients visit a hospital’s emergency department (ED) for reasons other than an urgent medical condition. There is evidence that this practice may differ among patients from different backgrounds. The objective of this study was to examine the reasons why patients from a non-English speaking background (NESB) and patients with an English speaking background but not born in Australia (ESB-NBA) visit the ED, as compared to patients from English-speaking backgrounds but born in Australia (ESB-BA). Methods A cross-sectional survey was conducted at the ED of a tertiary hospital in metropolitan Brisbane, Queensland, Australia. Over a four-month period patients who were assigned an Australasian Triage Scale score of 3, 4 or 5 were surveyed. Pearson chi-square test and multivariate logistic regression analyses were performed to examine the differences between the ESB and NESB patients’ reported reasons for attending the ED. Results A total of 828 patients participated in this study. Compared to ESB-BA patients NESB patients were less likely to consider contacting a general practitioner (GP) before attending the ED (Odds Ratios (OR) 0.6 (95% Confidence Interval (CI) 0.4–0.8, p < .05) While ESB-NBA were more likely to consider contacting a GP 1.7 (1.1–2.5, p < .05). Both the NESB patients and the ESB-NBA patients were far more likely than ESB-BA patients to report that they had visited the ED either because they do not have a GP (OR 7.9, 95% CI 4.7–13.4, p < .001) and 2.2 (95% CI 1.1–4.4, p < .05) respectively and less likely to think that the ED could deal with their problem better than a GP(OR 0.5 (95% CI 0.3–0.8, p < .05) and 0.7 (0.3–0.9, p < .05) respectively. The NESB patients also thought it would take too long to make an appointment to consult a GP (OR 6.2, 95% CI 3.7–10.4, p < 0.001). Conclusions NESB patients were the least likely to consider contacting a GP before attending hospital EDs. Educational interventions may help direct NESB people to the appropriate health services and therefore reduce the burden on tertiary hospitals ED.

Tipping points: Teachers' reported reasons for referring primary school children for excessive anxiety

The current study explored the reasons that primary school teachers reported were tipping points for them in deciding whether or not and when to refer a child to the school student support team for excessive anxiety. Twenty teachers in two Queensland primary schools were interviewed. Content analysis of interview transcripts revealed six themes reflecting teachers' perceived reasons for deciding to refer anxious children: 1)impact on learning; 2)atypical child behavior; 3)repeated difficulties that do not improve over time; 4)poor response to strategies; 5)teachers' need for support; and 6)information from parents/carers. Teachers considered different combinations of reasons, and had many different tipping points for making a referral. Both teacher-and system-level influences impacted referral decisions. Implications and future research are discussed.

Comparison of marketing policies applied by the same company in different countries and analysis of the reasons for the differences

The focus of this project is going to be, as the title indicates, on the comparison of marketing policies applied by the same company in different countries and analysis of the reasons for the differences. In order to do that, I have selected the company Nestlé to analyze the marketing decisions it makes across national boundaries to market the brand of Kit Kat and keep it as a leader snack worldwide. After having analyzed the brand in all continents, I can say the execution of the strategy used by Nestlé with Kit Kat really matches the planning of the strategy which is to think globally and act locally. Nestlé uses global brand identity but, from the internal point of view, it uses local ingredients and gives autonomy to its local branches based in different countries to make pricing and distributions decisions and therefore satisfy different consumers’ needs and preferences in local environments where changes happen very rapidly. The “glocal” approach to marketing is an effective way for Nestlé Kit Kat to stay focused on the consumer in worldwide markets.

Reasons for roadmapping: A study of the Singaporean SME manufacturing sector

To encourage Singaporean small and medium sized enterprises to move up the value chain, Operation and Technology Roadmapping (OTR) has been developed and introduced to the sector. This technique is based upon the T-Plan process developed at Cambridge University. To-date close to thirty companies have used the process to create a 'first-cut' roadmap. This paper initially reviews the application of roadmapping in small companies, and then highlights the various areas where the companies have applied the roadmapping technique. © 2004 IEEE.

The Reasons for Ligand-Dependent Quantum Yields and Absorption Spectrum of Four Polypyridylruthenium(II) Complexes with a Tetrazolate-Based Ligand: TDDFT Study

The quantum yield, lifetime, and absorption spectrum of four [Ru(bpy)(2)L](+) [where bpy is 2,2'-bipyridyl; L is represented by the deprotonated form of 2-(1H-tetrazol-5-yl)pyridine (L1) or 2-(1H-tetrazol-5-yl)pyrazine (L2)], as well as their methylated complexes [Ru(bpy)(2)LMe](2+) (RuL1Me and RuL2Me) are closely ligand dependent. In this paper, density functional theory (DFT) and time-dependent DFT (TDDFT) were performed to compare the above properties among these complexes. The calculated results reveal that the replacement of pyridine by pyrazine or the attachment of a CH3 group to the tetrazolate ring greatly increases the pi-accepting ability of the ancillary ligands.

A multi-technology approach to identifying the reasons for lateral drift in professional and recreational darts

This work performs an extensive charterisation of precision targeted throwing in professional and recreational darts. The goal is to identify the contributing factors for lateral drift or throwing inaccuracy in the horizontal plane. A multitechnology approach is adopted whereby a custom built body area network of wireless inertial measurement devices monitor tilt, force and timing, an optical 3D motion capture system provides a complete kinematic model of the subject, electromyography sensors monitor muscle activation patterns and a force plate and pressure mat capture tactile pressure and force measurements. The study introduces the concept of constant throwing rhythm and highlights how landing errors in the horizontal plane can be attributable to a number of variations in arm force and speed, centre of gravity and the movements of some of the bodies non throw related extremities.

Reasons to hide

A visceral and lyrical exploration of power and intimacy. When things get tough who can you trust?

On the reasons for stepwise changes in the tunnelling current across nanogaps

The role of the crystalline orientation of the STM tip in the generation of metal clusters is studied by atom dynamics simulations. When a (111) facet is facing the surface, the process is accompanied by a perturbation of the surface stronger than that observed for more open tip structures. This implies a technological application: the possibility of orienting a nanocrystallite deposited on a tip according to the changes observed in the force on the tip.