Development of the Woman-Centred Care Scale- Midwife Self Report (WCCS-MSR).

BACKGROUND: Woman-centred care is recognised as a fundamental construct of midwifery practice yet to date, there has been no validated tool available to measure it. This study aims to develop and test a self-report tool to measure woman-centred care in midwives. METHODS: A staged approach was used for tool development including deductive methods to generate items, testing content validity with a group of experts, and psychometrically testing the instrument with a sample drawn from the target audience. The draft 58 item tool was distributed in an online survey using professional networks in Australia and New Zealand. Testing included item analysis, principal components analysis with direct oblimin rotation and subscale analysis, and internal consistency reliability. RESULTS: In total, 319 surveys were returned. Analysis revealed five factors explaining 47.6% of variance. Items were reduced to 40. Internal consistency (.92) was high but varied across factors. Factors reflected the extent to which a midwife meets the woman's unique needs; balances the woman's needs within the context of the maternity service; ensures midwifery philosophy underpins practice; uses evidence to inform collaborative practice; and works in partnership with the woman. CONCLUSION: The Woman-Centred Care Scale-Midwife Self Report is the first step in developing a valid and reliable tool to enable midwives to self-assess their woman-centredness. Further research in alternate populations and refinement is warranted.

Assessing the potential to restore historic grazing ecosystems with tortoise ecological replacements.

The extinction of large herbivores, often keystone species, can dramatically modify plant communities and impose key biotic thresholds that may prevent an ecosystem returning to its previous state and threaten native biodiversity. A potentially innovative, yet controversial, landscape-based long-term restoration approach is to replace missing plant-herbivore interactions with non-native herbivores. Aldabran giant (Aldabrachelys gigantea) and Madagascan radiated (Astrochelys radiata) tortoises, taxonomically and functionally similar to the extinct Mauritian giant tortoises (Cylindraspis spp.), were introduced to Round Island, Mauritius, in 2007 to control the non-native plants that were threatening persistence of native species. We monitored the response of the plant community to tortoise grazing for 11 months in enclosures before the tortoises were released and, compared the cost of using tortoises as weeders with the cost of using manual labor. At the end of this period, plant biomass; vegetation height and cover; and adult, seedling, flower, and seed abundance were 3-136 times greater in adjacent control plots than in the tortoise enclosures. After their release, the free-roaming tortoises grazed on most non-native plants and significantly reduced vegetation cover, height, and seed production, reflecting findings from the enclosure study. The tortoises generally did not eat native species, although they consumed those native species that increased in abundance following the eradication of mammalian herbivores. Our results suggest that introduced non-native tortoises are a more cost-effective approach to control non-native vegetation than manual weeding. Numerous long-term outcomes (e.g., change in species composition and soil seed bank) are possible following tortoise releases. Monitoring and adaptive management are needed to ensure that the replacement herbivores promote the recovery of native plants.

Taking up the challenge of trans and non-binary inclusion in midwifery education: Reflections from educators in Aotearoa and Ontario Canada.

Perinatal services are being challenged to acknowledge that not all pregnant and birthing people are women and to ensure the design and delivery of services that are inclusive of, and deliver equitable outcomes for, trans, non-binary, and other gender diverse people. This is posing unique challenges for midwifery with its women-centred philosophy and professional frameworks. This paper presents the critical reflections of midwifery educators located in two midwifery programmes in Aotearoa1 and Ontario Canada, who are engaged in taking up the challenge of trans and non-binary inclusion in their local contexts. The need to progress trans and non-binary inclusion in midwifery education to secure the human rights of gender diverse people to safe midwifery care and equitable perinatal outcomes is affirmed. We respond to an existing lack of research or guidance on how to progress trans and non-binary inclusion in midwifery education. We offer our insights and reflections organised as four themes located within the frameworks of cultural humility and safety. These themes address midwifery leadership for inclusion, inclusive language, a broader holistic approach, and the importance of positioning this work intersectionally. We conclude by affirming the critical role of midwifery education/educators in taking up the challenge of trans and non-binary inclusion to ensure a future midwifery workforce skilled and supported in the provision of care to the growing gender diverse population.

Emergency Department staff experiences of screening and response for intimate partner violence in a multi-site feasibility study: Acceptability, enablers and barriers.

BACKGROUND: Intimate partner violence is a lead cause of ill health and premature death among Australian women. Abused women are likely to present to Emergency Departments. Routine screening provides opportunities to identify and respond to intimate partner violence. METHODS: A six-month screening feasibility study was conducted in two rural and one urban NSW Emergency Departments. Surveys with participating nurses, medical officers and social workers, as well as focus groups with nurses and social workers were conducted at each site to understand their experience. RESULTS: Survey respondents (n = 198) agreed it was appropriate (87%) and acceptable (91%) to screen for intimate partner violence in Emergency Departments. Overall 62% of respondents suggested screening had positive impacts on womens' care. Focus group discussions with 39 nurses and social workers identified enablers of screening as: ease of use of the screening tool; availability of social work response within one hour (as per the study protocol); and executive support. Barriers were: high patient volume; lack of integration with existing processes; lack of privacy and brevity of training. CONCLUSIONS: Screening in Emergency Departments was strongly supported by health practitioners who responded to the survey. Work is needed to address competing demands, integration of screening processes, and staff training.

Cortisol concentrations in human skeletal muscle tissue after phonophoresis with 10% hydrocortisone gel.

CONTEXT: The delivery of hydrocortisone through phonophoresis is a widely prescribed technique for the treatment of various musculoskeletal inflammatory conditions. However, limited scientific evidence exists to support the efficacy of phonophoresis in delivering hydrocortisone to skeletal muscle tissue in humans. OBJECTIVE: To determine hydrocortisone (cortisol) concentrations in human skeletal muscle tissue after a phonophoresis treatment using 10% hydrocortisone gel. DESIGN: Randomized design in which 12 subjects were randomly assigned to either an ultrasound (sham) treatment or a 10% hydrocortisone phonophoresis treatment. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Twelve healthy subjects (8 women, 4 men: age = 22.3 +/- 2.64 years, height = 168.28 +/- 8.19 cm, mass = 69.58 +/- 9.05 kg) with no history of musculoskeletal disease, preexisting inflammatory conditions, or recent orthopaedic injuries. INTERVENTION(S): Ultrasound at 1.0 MHz, 1.0 W/cm (2), at a continuous setting for 7 minutes was applied to a standardized area of the vastus lateralis muscle in both groups. The contralateral limb served as the control (no treatment) for both the sham and the phonophoresis groups. MAIN OUTCOME MEASURE(S): Vastus lateralis muscle biopsies were taken from both legs immediately after treatment, and cortisol concentrations were analyzed using an enzyme-linked immunosorbent assay. RESULTS: We observed no significant difference in muscle cortisol concentration between the contralateral control limb and the treatment limb in either the sham or the phonophoresis group ( P > .05). No significant difference was noted when the treatment limbs in the sham and phonophoresis groups were compared ( P > .05). CONCLUSIONS: Our data suggest that a 10% hydrocortisone-based phonophoresis treatment did not increase cortisol concentrations in human skeletal muscle tissue.

Japanese women's experiences of pharmacological pain relief in New Zealand.

BACKGROUND: In Japan, most women manage labour pain without pharmacological interventions. However, New Zealand statistics show a high percentage of epidural use amongst Asian women. Entonox (a gas mixture of nitrous oxide and oxygen) and pethidine are also available to women in New Zealand. This article investigates how Japanese women in New Zealand respond to the use of pharmacological pain relief in labour. QUESTIONS: The study was guided by two research questions: (1) How do Japanese women experience and manage labour pain in New Zealand? (2) How do they feel about the use of pharmacological pain relief? METHODS: Thirteen Japanese women who had given birth in New Zealand were interviewed individually or in a focus group. The conversations were analysed using thematic analysis. FINDINGS: Although in Japan very few women use pain relief, nine women received epidural and/or Entonox out of 11 women who experienced labour pain. The contrast between their Japanese cultural expectations and their birth experiences caused some of the women subsequent personal conflict. CONCLUSION: Japanese women's cultural perspectives and passive attitudes were demonstrated to influence the decision-making process concerning pain relief. It was concluded that understanding Japanese cultural worldviews and approaches to the role of pain in labour would help maternity providers in their provision of appropriate care for Japanese women.

Reversing defaunation: restoring species in a changing world.

The rate of biodiversity loss is not slowing despite global commitments, and the depletion of animal species can reduce the stability of ecological communities. Despite this continued loss, some substantial progress in reversing defaunation is being achieved through the intentional movement of animals to restore populations. We review the full spectrum of conservation translocations, from reinforcement and reintroduction to controversial conservation introductions that seek to restore populations outside their indigenous range or to introduce ecological replacements for extinct forms. We place the popular, but misunderstood, concept of rewilding within this framework and consider the future role of new technical developments such as de-extinction.

The welfare implications of using exotic tortoises as ecological replacements.

BACKGROUND: Ecological replacement involves the introduction of non-native species to habitats beyond their historical range, a factor identified as increasing the risk of failure for translocations. Yet the effectiveness and success of ecological replacement rely in part on the ability of translocatees to adapt, survive and potentially reproduce in a novel environment. We discuss the welfare aspects of translocating captive-reared non-native tortoises, Aldabrachelys gigantea and Astrochelys radiata, to two offshore Mauritian islands, and the costs and success of the projects to date. METHODOLOGY/PRINCIPAL FINDINGS: Because tortoises are long-lived, late-maturing reptiles, we assessed the progress of the translocation by monitoring the survival, health, growth, and breeding by the founders. Between 2000 and 2011, a total of 26 A. gigantea were introduced to Ile aux Aigrettes, and in 2007 twelve sexually immature A. gigantea and twelve male A. radiata were introduced to Round Island, Mauritius. Annual mortality rates were low, with most animals either maintaining or gaining weight. A minimum of 529 hatchlings were produced on Ile aux Aigrettes in 11 years; there was no potential for breeding on Round Island. Project costs were low. We attribute the success of these introductions to the tortoises' generalist diet, habitat requirements, and innate behaviour. CONCLUSIONS/SIGNIFICANCE: Feasibility analyses for ecological replacement and assisted colonisation projects should consider the candidate species' welfare during translocation and in its recipient environment. Our study provides a useful model for how this should be done. In addition to serving as ecological replacements for extinct Mauritian tortoises, we found that releasing small numbers of captive-reared A. gigantea and A. radiata is cost-effective and successful in the short term. The ability to release small numbers of animals is a particularly important attribute for ecological replacement projects since it reduces the potential risk and controversy associated with introducing non-native species.

Resurrecting extinct interactions with extant substitutes.

There is increasing evidence that restoration ecologists should be most concerned with restoring species interactions rather than species diversity per se [1]. Rewilding with taxon substitutes, the intentional introduction of exotic species to replace the ecosystem functions of recently extinct species, is one way to reverse ecosystem dysfunction following the loss of species interactions [2]. This is highly controversial [3], in part because of a lack of rigorous scientific studies [4]. Here we present the first empirical evidence of an in situ rewilding project undertaken as a hypothesis-driven ecosystem management option. On Ile aux Aigrettes, a 25-hectare island off Mauritius, the critically endangered large-fruited endemic ebony, Diospyros egrettarum (Ebenaceae), was seed-dispersal limited after the extinction of all native large-bodied frugivores, including giant tortoises. We introduced exotic Aldabra giant tortoises, Aldabrachelys gigantea, to disperse the ebony seeds. Not only did the tortoises ingest the large fruits and disperse substantial numbers of ebony seeds, but tortoise gut passage also improved seed germination, leading to the widespread, successful establishment of new ebony seedlings. Our results demonstrate that the introduction of these exotic frugivores is aiding the recovery of ebonies. We argue for more reversible rewilding experiments to investigate whether extinct species interactions can be restored.

Ballistic stretching increases flexibility and acute vertical jump height when combined with basketball activity.

Stretching is often included as part of a warm-up procedure for basketball activity. However, the efficacy of stretching with respect to sport performance has come into question. We determined the effects of 4 different warm-up protocols followed by 20 minutes of basketball activity on flexibility and vertical jump height. Subjects participated in 6 weeks (2 times per week) of warm-up and basketball activity. The warm-up groups participated in ballistic stretching, static stretching, sprinting, or basketball shooting (control group). We asked 3 questions. First, what effect does 6 weeks of warm-up exercise and basketball play have on both flexibility and vertical jump height? We measured sit and reach and vertical jump height before (week -1) and after (week 7) the 6 weeks. Flexibility increased for the ballistic, static, and sprint groups compared to the control group (p < 0.0001), while vertical jump height did not change for any of the groups. Our second question was what is the acute effect of each warm-up on vertical jump height? We measured vertical jump immediately after the warm-up on 4 separate occasions during the 6 weeks (at weeks 0, 2, 4, and 6). Vertical jump height was not different for any group. Finally, our third question was what is the acute effect of each warm-up on vertical jump height following 20 minutes of basketball play? We measured vertical jump height immediately following 20 minutes of basketball play at weeks 0, 2, 4, and 6. Only the ballistic stretching group demonstrated an acute increase in vertical jump 20 minutes after basketball play (p < 0.05). Coaches should consider using ballistic stretching as a warm-up for basketball play, as it is beneficial to vertical jump performance.

Pick on someone your own size.

I've had a weight problem all my life, but it has never stopped me doing anything my thinner and supposedly fitter colleagues have done.