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.

Modified atmosphere packaging effects on the postharvest quality of papaya fruit

Export of Fijian papaya (Carica papaya) fruit to destinations such as New Zealand has increased significantly over the last several years. Shipment by sea rather than air is the preferred method, given the capacity for larger volumes and reductions in cost. Long shipping times, however, can compromise fruit quality, although the use of modified atmosphere packaging (MAP) may provide a viable solution for extending fruit storage life. In a collaborative ACIAR project, Australian and Fijian researchers investigated the potential of using MAP to extend storage life of a Fijian papaya ('Fiji Red') fruit based on simulated sea transport conditions. Fruit were packed in one of three MAP environments within cartons, consisting of either a (1) Low Density Polyethylene (LDPE) bag with 10 g of KMnO4, (2) Polyamide Film (PF) bag with macro-perforations or (3) without a bag (control fruit). Fruit were held for 1, 2 or 3 weeks at 10°C before being unpacked, ripened and assessed for quality. On day 6 after outturn, fruit with the highest overall quality were those held in LDPE bags. LDPE fruit generally coloured up faster at outturn than PF or control fruit, had less overall moisture loss and scored high in flavour. Headspace carbon dioxide and oxygen concentrations within the LDPE bags were also near recommended levels for maintaining optimum storage-life quality. The LDPE bag provided the most suitable conditions for long term storage of fresh papaya fruit and is therefore the recommended MAP type for use with sea freight export out of Fiji.

Postharvest quality changes in fresh-cut watercress stored under conventional and inert gas-enriched modified atmosphere packaging

The effect of modified atmosphere packaging (MAP) on the postharvest quality of fresh-cut watercress (Nasturtium officinale R. Br.) stored at 4 ºC for 7 d was studied. A portion of watercress was immediately analyzed (non-stored control) and the remaining fresh material was stored packaged under atmospheres enriched with N2, Ar, air, or vacuum. The analyzed parameters included colour, total soluble solids, pH, macronutrients, the individual profiles of sugars, organic acids, tocopherols and fatty acids, and total phenolics and flavonoids. Furthermore, four in vitro assays were performed to evaluate the antioxidant activity. After assessing the effect on individual quality parameters, it was possible to conclude that air was the less efficient atmosphere in preserving quality attributes of the non-stored control samples during cold storage. In turn, Ar-enriched MAP was the most suitable choice to preserve the overall postharvest quality. The present study also highlighted the nutritional and antioxidant properties of watercress, as well as the interest of its inclusion in human diets.

Environmental quality of life index incorporationg MCA & GIS : case study Lisbon Metropolitan Area, Portugal

The study of Quality of Life (Qol) has been conducted on various scales throughout the years with focus on assessing overall quality of living amongst citizens. The main focus in these studies have been on economic factors, with the purpose of creating a Quality of Life Index (QLI).When it comes down to narrowing the focus to the environment and factors like Urban Green Spaces (UGS) and air quality the topic gets more focused on pointing out how each alternative meets this certain criteria. With the benefits of UGS and a healthy environment in focus a new Environmental Quality of Life Index (EQLI) will be proposed by incorporating Multi Criteria Analysis (MCA) and Geographical Information Systems (GIS). Working with MCA on complex environmental problems and incorporating it with GIS is a challenging but rewarding task, and has proven to be an efficient approach among environmental scientists. Background information on three MCA methods will be shown: Analytical Hierarchy Process (AHP), Regime Analysis and PROMETHEE. A survey based on a previous study conducted on the status of UGS within European cities was sent to 18 municipalities in the study area. The survey consists of evaluating the current status of UGS as well as planning and management of UGS with in municipalities for the purpose of getting criteria material for the selected MCA method. The current situation of UGS is assessed with use of GIS software and change detection is done on a 10 year period using NDVI index for comparison purposes to one of the criteria in the MCA. To add to the criteria, interpolation of nitrogen dioxide levels was performed with ordinary kriging and the results transformed into indicator values. The final outcome is an EQLI map with indicators of environmentally attractive municipalities with ranking based on predefinedMCA criteria using PROMETHEE I pairwise comparison and PROMETHEE II complete ranking of alternatives. The proposed methodology is applied to Lisbon’s Metropolitan Area, Portugal.

The sensitivity of mapping methods to reference data quality:training supervised image classifications with imperfect reference data

The accuracy of a map is dependent on the reference dataset used in its construction. Classification analyses used in thematic mapping can, for example, be sensitive to a range of sampling and data quality concerns. With particular focus on the latter, the effects of reference data quality on land cover classifications from airborne thematic mapper data are explored. Variations in sampling intensity and effort are highlighted in a dataset that is widely used in mapping and modelling studies; these may need accounting for in analyses. The quality of the labelling in the reference dataset was also a key variable influencing mapping accuracy. Accuracy varied with the amount and nature of mislabelled training cases with the nature of the effects varying between classifiers. The largest impacts on accuracy occurred when mislabelling involved confusion between similar classes. Accuracy was also typically negatively related to the magnitude of mislabelled cases and the support vector machine (SVM), which has been claimed to be relatively insensitive to training data error, was the most sensitive of the set of classifiers investigated, with overall classification accuracy declining by 8% (significant at 95% level of confidence) with the use of a training set containing 20% mislabelled cases.

The Scored Patient-Generated Subjective Global Assessment (PG-SGA) and its Association with Quality of Life in Ambulatory Patients Receiving Radiotherapy

OBJECTIVE: To evaluate the scored Patient-generated Subjective Global Assessment (PG-SGA) tool as an outcome measure in clinical nutrition practice and determine its association with quality of life (QoL). DESIGN: A prospective 4 week study assessing the nutritional status and QoL of ambulatory patients receiving radiation therapy to the head, neck, rectal or abdominal area. SETTING: Australian radiation oncology facilities. SUBJECTS: Sixty cancer patients aged 24-85 y. INTERVENTION: Scored PG-SGA questionnaire, subjective global assessment (SGA), QoL (EORTC QLQ-C30 version 3). RESULTS: According to SGA, 65.0% (39) of subjects were well-nourished, 28.3% (17) moderately or suspected of being malnourished and 6.7% (4) severely malnourished. PG-SGA score and global QoL were correlated (r=-0.66, P<0.001) at baseline. There was a decrease in nutritional status according to PG-SGA score (P<0.001) and SGA (P<0.001); and a decrease in global QoL (P<0.001) after 4 weeks of radiotherapy. There was a linear trend for change in PG-SGA score (P<0.001) and change in global QoL (P=0.003) between those patients who improved (5%) maintained (56.7%) or deteriorated (33.3%) in nutritional status according to SGA. There was a correlation between change in PG-SGA score and change in QoL after 4 weeks of radiotherapy (r=-0.55, P<0.001). Regression analysis determined that 26% of the variation of change in QoL was explained by change in PG-SGA (P=0.001). CONCLUSION: The scored PG-SGA is a nutrition assessment tool that identifies malnutrition in ambulatory oncology patients receiving radiotherapy and can be used to predict the magnitude of change in QoL.

Guidelines on building design and operation to minimize air quality impacts from major roads in transit oriented development

Poor air quality has a huge detrimental effect, both economic and on the quality of life, in Australia. Transit oriented design (TOD), which aims to minimise urban sprawl and lower dependency on vehicles, leads to an increasing number of buildings close to transport corridors. This project aims at providing guidelines that are appropriate to include within City Plan to inform future planning along road corridors, and provide recommendations on when mitigation measures should be utilised.