The relationship between breastfeeding and postpartum weight change-a systematic review and critical evaluation

Pregnancy and the postpartum period is a time of increased vulnerability for retention of excess body fat in women. Breastfeeding (BF) has been shown to have many health benefits for both mother and baby; however, its role in postpartum weight management is unclear. Our aim was to systematically review and critically appraise the literature published to date in relation to the impact of BF on postpartum weight change, weight retention and maternal body composition. Electronic literature searches were carried out using MEDLINE, EMBASE, PubMed, Web of Science, BIOSIS, CINAHL and British Nursing Index. The search covered publications up to 12 June 2012 and included observational studies (prospective and retrospective) carried out in BF mothers (either exclusively or as a subgroup), who were 2 years postpartum and with a body mass index (BMI) >18.5 kg m(-2), with an outcome measure of change in weight (including weight retention) and/or body composition. Thirty-seven prospective studies and eight retrospective studies were identified that met the selection criteria; studies were stratified according to study design and outcome measure. Overall, studies were heterogeneous, particularly in relation to sample size, measurement time points and in the classification of BF and postpartum weight change. The majority of studies reported little or no association between BF and weight change (n=27, 63%) or change in body composition (n=16, 89%), although this seemed to depend on the measurement time points and BF intensity. However, of the five studies that were considered to be of high methodological quality, four studies demonstrated a positive association between BF and weight change. This systematic review highlights the difficulties of examining the association between BF and weight management in observational research. Although the available evidence challenges the widely held belief that BF promotes weight loss, more robust studies are needed to reliably assess the impact of BF on postpartum weight management.International Journal of Obesity advance online publication, 20 August 2013; doi:10.1038/ijo.2013.132.

The role of facilities manager in sustainable practice in the UK and Ireland

Purpose – The purpose of this paper is to explore the role of facilities managers in sustainable practice. It also analyzes the change in facilities management (FM) in terms of sustainability.

Design/methodology/approach – This research adopted a combination of literature review and expert interviews. Empirical data were collected through in-depth interviews with 40 industrial experts in the UK and Ireland.

Findings – The analysis of interview results shows a sustainable movement in the context of FM. Facilities managers play important roles in sustainable practice, including integrating all sustainability considerations, linking strategic level with operational level, incorporating FM knowledge and experience into design, disseminating sustainable knowledge and educating people and encouraging sustainability through innovation.

Research limitations/implications – This research goes beyond the limitations of existing studies that are characterized by a lack of positioning facilities managers in sustainability.

Practical implications – Sustainable delivery represents a direction of FM development. This research describes what facilities managers can do and how they should do for sustainable delivery of FM, based on which improvements are made and benefits are maximized.

Originality/value – This research provides a deeper insight into the FM role in the sustainable agenda. The findings of this research help industrial practitioners and academic researchers to better understand sustainable FM.

On sea level change in the North Sea influenced by the North Atlantic Oscillation: local and remote steric effects

In this study, contributions of both local steric and remote baroclinic effects (i.e., steric variations external to the region of interest) to the inter-annual variability of winter sea level in the North Sea, with respect to the North Atlantic Oscillation (NAO), for the period of 1953–2010 are investigated. On inter-annual time scales in this period, the NAO is significantly correlated to sea level variations in the North Sea only in the winter months (December–March), while its correlation to sea temperature over much of the North Sea is only significant in January and February. The discrepancy in sea level between observations and barotropic tide and surge models forced by tides and local atmospheric forcing, i.e., local atmospheric pressure effects and winds, in the present study are found to be consistent with previous studies. In the North Sea, local thermosteric effects caused by thermal expansion play a minor role on winter-mean NAO related sea level variability compared with atmospheric forcing. This is particularly true in the southeastern North Sea where water depths are mostly less than 25 m. Our calculations demonstrate that the discrepancy can be mostly explained by remote baroclinic effects, which appear as water mass exchanges on the continental shelf and are therefore only apparent in ocean bottom pressure. In the North Sea, NAO related sea level variations seem to be a hybrid of barotropic and baroclinic processes. Hence, they can only be adequately modelled with three-dimensional baroclinic ocean models that include contributions of baroclinic effects and large-scale atmospheric forcing external to the region of interest.

Public management, Peace-building and Creating Change: Shifting the Lens of Analysis from the Macro to the Micro

Considerable time, research money and expertise has been spent exploring the complex reality of ethno nationalist conflict and the role that public management plays in supporting the transition from violent conflict to stability, order and prosperity (Esman 1999; Guelke and Milton-Edwards 2000; Brinkerhoff 2005; Brinkerhoff, Wetterberg et al. 2012; Rao 2014). However, there seems to be a gap in relation to the practical challenges of managing change within, through and beyond such conflict. This paper aims to begin the process of putting a framework around the real experience of public management in conflict and transition by shifting the lens of analysis from macros concerns about sequencing interventions (Rao 2014) and legitimate requirements of security, stability and service delivery (Brinkerhoff, Wetterberg et al. 2012) to a micro analysis of the attitudes, behaviours, challenges and compromises held and faced by those public servants on the front line of conflict management and conflict transformation processes. Using senior managers as the unit of analysis and Northern Ireland as an embryonic case study, this paper discusses the links between ethno nationalist societal conflict, public sector reform and manager behaviour. In doing so, it highlights some initial data from an early pilot study into the experiences of individuals in significant public service roles at various stages of the NI conflict / peace process and draws some tentative conclusions about the viability of a wider study.

Promoting Dignity for All: Human Rights Approaches in the Post-2015 Climate Change, Disaster Risk Reduction and Sustainable Development Frameworks

This article takes as its starting point the potentially negative human rights implications that the effects of climate change, disasters and development practices can have on individuals and communities. It argues that key international instruments, including the post-2015 successors to the Kyoto Protocol, Hyogo Framework for Action on disaster risk reduction and the Millennium Development Goals, appear to be moving towards an express acknowledgment of the relevance of international human rights law as an important mechanism to minimise potential harms that may arise. This raises the question as to the appropriate role of the UN human rights monitoring and accountability mechanisms in identifying the relevant rights-holders and duty-bearers. The article therefore provides an examination of the linkages between climate change and international human rights law, as well as discussion of the human rights considerations and accountability mechanisms for disasters and sustainable development. The article concludes by arguing that despite differential understandings between disciplines as to the meaning of key terms such as ‘vulnerability’ and ‘resilience’, international human rights law provides a comprehensive basis for promoting international and national accountability. It follows that a greater level of coordination and coherence between the human rights approaches of the various post-2015 legal and policy frameworks is warranted as a means of promoting the dignity of those most affected by climate change, disasters and developmental activities.

Factors affecting the successful implementation and sustainability of the Liverpool Care Pathway for dying patients – a realist evaluation

Objectives: The Liverpool Care Pathway for the dying patient (LCP) was designed to improve end-of-life care in generalist health care settings. Controversy has led to its withdrawal in some jurisdictions. The main objective of this research was to identify the influences that facilitated or hindered successful LCP implementation.

Method: An organisational case study using realist evaluation in one health and social care trust in Northern Ireland. Two rounds of semi-structured interviews were conducted with two policy makers and twenty two participants with experience and/or involvement in management of the LCP during 2011 and 2012.

Results: Key resource inputs included facilitation with a view to maintaining LCP ‘visibility’, reducing anxiety among nurses and increasing their confidence regarding the delivery of end-of-life care; and nurse and medical education designed to increase professional self-efficacy and reduce misuse and misunderstanding of the LCP. Key enabling contexts were consistent senior management support; ongoing education and training tailored to the needs of each professional group; and an organisational cultural change in the hospital setting that encompassed end-of-life care.

Conclusion: There is a need to appreciate the organizationally complex nature of intervening to improve end-of-life care. Successful implementation of evidence-based interventions for end-of-life care requires commitment to planning, training and ongoing review that takes account of different perspectives, institutional hierarchies and relationships and the educational needs of professional disciplines. There is a need also to recognise that medical consultants require particular support in their role as gatekeepers and as a lead communication channel with patients and their relatives.

Positioning Clinical Nurse Specialists and Nurse Practitioners as Change Champions to Implement a Pain Protocol in Long-Term Care

Pain management for older adults in long-term care (LTC) has been recognized as a problem internationally. The purpose of this study was to explore the role of a clinical nurse specialist (CNS) and nurse practitioner (NP) as change champions during the implementation of an evidence-based pain protocol in LTC. In this exploratory, multiple-case design study, we collected data from two LTC homes in Ontario, Canada. Three data sources were used: participant observation of an NP and a CNS for 18 hours each over a 3-week period; CNS and NP diaries recording strategies, barriers, and facilitators to the implementation process; and interviews with members of the interdisciplinary team to explore perceptions about the NP and CNS role in implementing the pain protocol. Data were analyzed using thematic content analysis. The NP and CNS used a variety of effective strategies to promote pain management changes in practice including educational outreach with team members, reminders to nursing staff to highlight the pain protocol and educate about practice changes, chart audits and feedback to the nursing staff, interdisciplinary working group meetings, ad hoc meetings with nursing staff, and resident assessment using advanced skills. The CNS and NP are ideal champions to implement pain management protocols and likely other quality improvement initiatives.

A children's nurse's role in the global development of a child with diabetes mellitus.

The nursing care of a six year old with type 1 diabetes reveals the importance of accurate control of the condition for normal physical, emotional and cognitive development. Clearly the children's nurse can educate and support the child, parents and extended family towards achieving independence and self-care. Theoretical knowledge of normal child maturation can guide nurses to constantly adapt their modes of communication and nursing skills, so as to promote every aspect and stage of the child's growth. Prevalence of type 1 diabetes is increasing, and nurses should use their close professional involvement with patients to assist research at every opportunity.

Assessment matters-mentors need support in their role

BACKGROUND:
In the UK the Nursing and Midwifery Council (NMC) standards to support learning and assessment in practice state that mentors are responsible and accountable for the assessment of pre-registration nursing students in practice. This study was undertaken to explore mentors' experience of assessing nursing students in practice post implementation of the NMC standards.
METHOD:
Five focus groups were conducted with mentors (N=35) who had assessed adult pre-registration nursing students in the previous 12 months. The focus groups were recorded, transcribed and analysed to generate categories.
RESULTS:
Five categories were identified from the data: Changing roles and responsibilities; Exploring the past to understand the present; Just knowing; The odds; Time to mentor. The findings highlighted that mentors were aware of their role and responsibility for the assessment of students in practice. However, many felt this was a new responsibility and role in which they lacked experience. Some existing mentors felt that they may not have had the necessary preparation to effectively assess students in practice and identified their need for support.
CONCLUSION:
Given that mentors are expected to be competent assessors of students in practice and protect the public through gate-keeping professional registration, this study suggests that serious consideration should be given to how mentors are prepared and the ongoing support and education they receive in assessment.

Tracking Change in Northern Ireland Policing: Temporal Phases and Key Themes

Purpose
– The purpose of this paper is to explore and explain the change process in Northern Ireland policing through an analysis of temporally bracketed change phases and key change delivery themes ranging from 1996 to 2012.

Design/methodology/approach
– The research approach adopted is process based, longitudinal and multi-method, utilising “temporal bracketing” to determine phases of change and conjunctural reasoning to unravel the systematic factors interacting over time, within the case.

Findings
– The paper identifies and temporally brackets four phases of change: “Tipping point”; “Implementation, Symbolic Modification and Resistance”; “Power Assisted Steering”; and “A Return to Turbulence”, identifies four themes that emerge from RUC-PSNI experience: the role of adaptive leadership; pace and sequencing of change implementation; sufficient resourcing; and the impact of external agents acting as boundary spanners, and comments on the prominence of these themes through the phases. The paper goes on to reflect upon how these phases and themes inform our understanding of organisational change within policing organisations generally and within politically pressurised transition processes.

Originality/value
– The contribution of the paper lies in the documentation of an almost unique organisational case in an environmentally forced change process. In this it contains lessons for other organisations facing similar, if less extreme challenges and presents an example of intense change analysed longitudinally.

Alcohol, Tobacco and Pharmacy Students: Usage and Views on Professional Issues

Introduction/background: This study aimed to ascertain pharmacy students’ use and views on cigarettes and alcohol (including in relation to provision of health promotion advice) and to establish if alcohol intake affected academic performance. Within the United Kingdom (UK), there has been limited research conducted in this area
Methods: Following ethical approval, pharmacy students (n=581) were invited to participate in a pre-piloted electronic questionnaire, consisting of 21 questions on smoking and alcohol. Descriptive statistics and non-parametric tests were used for data analyses.
Results: A response rate of 64.5% (375/581) was obtained (69.9% female, 30.2% male). Many respondents (77.9%) reported that they drank alcohol; whereas only 3.7% stated they currently smoked cigarettes. Students who drank alcohol were more likely to fail elements of the program than those who did not. Less than half (47.8%) were in agreement that it was hypocritical for a pharmacist to give health promotion advice and then get drunk outside of work.
Discussion/conclusions: Students seem to consider that lifestyle recommendations are less relevant for themselves and also that a pharmacist’s responsibility centers on providing advice, rather than being a role-model. Alcohol consumption appears to negatively influence academic achievement.

Size matters: plasticity in metabolic scaling shows body-size may modulate responses to climate change

Variability in metabolic scaling in animals, the relationship between metabolic rate (R) and body mass (M), has been a source of debate and controversy for decades. R is proportional to M-b, the precise value of b much debated, but historically considered equal in all organisms. Recent metabolic theory, however, predicts b to vary among species with ecology and metabolic level, and may also vary within species under different abiotic conditions. Under climate change, most species will experience increased temperatures, and marine organisms will experience the additional stressor of decreased seawater pH ('ocean acidification'). Responses to these environmental changes are modulated by myriad species-specific factors. Body-size is a fundamental biological parameter, but its modulating role is relatively unexplored. Here, we show that changes to metabolic scaling reveal asymmetric responses to stressors across body-size ranges; b is systematically decreased under increasing temperature in three grazing molluscs, indicating smaller individuals were more responsive to warming. Larger individuals were, however, more responsive to reduced seawater pH in low temperatures. These alterations to the allometry of metabolism highlight abiotic control of metabolic scaling, and indicate that responses to climate warming and ocean acidification may be modulated by body-size.

Ecological dynamics of extinct species in empty habitat networks. 1. The role of habitat pattern and quantity, stochasticity and dispersal

We examined a remnant host plant (Primula veris L.) habitat network that was last inhabited by the rare butterfly Hamearis lucina L. in north Wales in 1943, to assess the relative contribution of several spatial parameters to its regional extinction. We first examined relationships between P. veris characteristics and H. lucina eggs in surviving H. lucina populations, and used these to predict the suitability and potential carrying capacity of the habitat network in north Wales. This resulted in an estimate of roughly 4500 eggs (ca 227 adults). We developed a discrete space, discrete time metapopulation model to evaluate the relative contribution of dispersal distance, habitat and environmental stochasticity as possible causes of extinction. We simulated the potential persistence of the butterfly in the current network as well as in three artificial (historical and present) habitat networks that differed in the quantity (current and X3) and fragmentation of the habitat (current and aggregated). We identified that reduced habitat quantity and increased isolation would have increased the probability of regional extinction, in conjunction with environmental stochasticity and H. lucina's dispersal distance. This general trend did not change in a qualitative manner when we modified the ability of dispersing females to stay in, and find suitable habitats (by changing the size of the grid cells used in the model). Contrary to most metapopulation model predictions, system persistence declined with increasing migration rate, suggesting that the mortality of migrating individuals in fragmented landscapes may pose significant risks to system-wide persistence. Based on model predictions for the present landscape we argue that a major programme of habitat restoration would be required for a re-established metapopulation to persist for > 100 years.

Holocene vegetation change in relation to fire and volcanic events in Jilin, Northeastern China

Volatiles erupted from large-scale explosive volcanic activities have a significant impact on climate and environmental changes. As an important ecological factor, the occurrence of fire is affected by vegetation cover, and fire can feed back into both vegetation and climatic change. The causes of fire events are diverse; and can include volcanic eruptions. The amount of charcoal in sediment sequences is related to the frequency and intensity of fire, and hence under good preservation conditions fire history can be reconstructed from fossil charcoal abundance. Until now, little research on the role of fire has been carried out in northeastern China. In this study, through research on charcoal and tephra shards from Gushantun and Hanlongwan, Holocene vegetation change in relation to fire and volcanic events in Jilin, Northeastern China, was investigated. Where tephra shards are present in Gushantun it is associated with low level of both conifers and broadleaved trees, and is also associated with a pronounced charcoal peak. This suggests forest cover was greatly reduced from a fire caused by an eruption of the Tianchi volcano. We also detected one tephra layer in Hanlongwan, which also has the almost same depth with low level forest pollen values and one charcoal peak. This was caused probably by an eruption of the Jinlongdingzi volcano.

Did the Millennium Development Goals Change Trends in Child Mortality?

There has been little assessment of the role the MDGs have had in progressing international development. There has been a 41 per cent reduction in the under-5 mortality rate worldwide from 1990 to 2011 and an acceleration in the rate of reduction since 2000. This paper explores why this has occurred and results for all developing countries indicate that it is not due to more healthcare or public health interventions but is driven by a coincidental burst of economic growth. Although the MDGs are considered to have played an important part in securing progress against poverty, hunger and disease there is very little evidence to back this viewpoint up. A thorough analysis of the successes and failures of the MDGs is therefore necessary before embarking on a new round of global goals.