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- Blomgren, J., et al.
(author)
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Putting co-creation into practice : lessons learned from developing a midwife-led quality improvement intervention
- 2023
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In: Global Health Action. - : Taylor and Francis Ltd.. - 1654-9716 .- 1654-9880. ; 16:1
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Journal article (peer-reviewed)abstract
- Background: Integrating evidence-based midwifery practices improves healthcare quality for women and newborns, but an evidence-to-practice gap exists. Co-created quality improvement initiatives led by midwives could bridge this gap, prevent resource waste and ensure intervention relevance. However, how to co-create a midwife-led quality improvement intervention has not been scientifically explored. Objective: The objective of this study is to describe the co-creation process and explore the needs and determinants of a midwife-led quality improvement targeting evidence-based midwifery practices. Methods: A qualitative deductive approach using the Consolidated Framework for Advancing Implementation Science was employed. An analysis matrix based on the framework was developed, and the data were coded according to categories. Data were gathered from interviews, focus group discussions, observations and workshops. New mothers and birth companions (n = 19) were included through convenience sampling. Midwives (n = 26), professional association representatives, educators, policymakers, managers, and doctors (n = 7) were purposely sampled. Results: The co-creation process of the midwife-led Quality Improvement intervention took place in four stages. Firstly, core elements of the intervention were established, featuring a group of midwife champions leading a quality improvement initiative using a train-the-trainers approach. Secondly, the intervention needs, context and determinants were explored, which showed knowledge and skills gaps, a lack of shared goals among staff, and limited resources. However, there was clear relevance, compatibility, and mission alignment for a midwife-led quality improvement at all levels. Thirdly, during co-creation workshops with new mothers and companions, the consensus was to prioritise improved intrapartum support, while workshops with midwives identified enhancing the use of birth positions and perineal protection as key focus areas for the forthcoming Quality Improvement intervention. Lastly, the findings guided intervention strategies, including peer-assisted learning, using existing structures, developing educational material, and building stakeholder relationships. Conclusions: This study provides a practical example of a co-creation process for a midwife-led quality improvement intervention, which can be relevant in different maternity care settings. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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- Burkhardt, C., et al.
(author)
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An overview of Hydrogen assisted (Direct) recycling of Rare earth permanent magnets
- 2023
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In: Journal of Magnetism and Magnetic Materials. - : ELSEVIER. - 0304-8853 .- 1873-4766. ; 588:B
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Journal article (peer-reviewed)abstract
- Rare Earths (RE) permanent magnets are essential components for Europe’s successful green and digital transition However, the entire value chain of RE magnetic materials depends on imports, which are highly vulnerable in current global supply chain models. To mitigate this situation, EU Regulation plans that at least 15 % of the EU’s annual consumption of permanent magnets should be covered by recycling capacities by 2030. Researchers in the EU H2020 project SUSMAGPRO consortium have shown that hydrogen can be used as a very efficient recycling method to extract NdFeB magnet powder from various EOL Components in the IP protected Hydrogen-based Processing of Magnet Scrap (HPMS). On exposure to hydrogen the sintered NdFeB magnets break down into a friable, demagnetised, hydrogenated powder containing an interstitial hydride of Nd2Fe14BHX (10 mu m) and smaller particles (<1 m) from the grain-boundary phase NdH2.7. This process delivers a sustainable source of magnetic material for the production of sintered, polymer bonded and metal-injection moulded magnets. The paper will present numerous results along the whole value chain of magnet recycling, including automatic dismantling of magnet containing products, magnets extraction, HPMS recycling, production of recycled magnets and demonstrator testing. It will also discuss best practices and bottlenecks of the processes as an outlook for successful design-for-recycling of future applications.
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- Erlandsson, Kerstin, 1961-, et al.
(author)
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Implementing an internet-based capacity building program for interdisciplinary midwifery-lead teams in Ethiopia, Kenya Malawi and Somalia
- 2021
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In: Sexual & Reproductive HealthCare. - : Elsevier B.V.. - 1877-5756 .- 1877-5764. ; 30
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Journal article (peer-reviewed)abstract
- The Swedish care model MIDWIZE defined as midwife-led interdisciplinary care and zero separation between mother and newborn, was implemented in 2020–21 in Ethiopia, Kenya, Malawi, and Somalia in a capacity building programme funded by the Swedish Institute. Objective: To determine the feasibility of using an internet-based capacity building programme contributing to effective midwifery practices in the labour rooms through implementation of dynamic birthing positions, delayed umbilical cord clamping and skin-to-skin care of newborns in the immediate postnatal period. Methods: The design is inspired by process evaluation. Focus group discussions with policy leaders, academicians, and clinicians who participated in the capacity building programme were carried out. Before and after the intervention, the numbers for dynamic birthing positions, delayed umbilical cord clamping and skin-to-skin care of the newborn in the immediate postnatal period were detected. Results: Participants believed the internet-based programme was appropriate for their countries’ contexts based on their need for improved leadership and collaboration, the need for strengthened human resources, and the vast need for improved outcomes of maternal and newborn health. Conclusion: The findings provide insight into the feasibility to expand similar online capacity building programmes in collaboration with onsite policy leaders, academicians, and clinicians in sub-Saharan African countries with an agenda for improvements in maternal and child health. © 2021
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- Kiragu, J. M., et al.
(author)
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Costs and intermediate outcomes for the implementation of evidence-based practices of midwifery under a MIDWIZE framework in an urban health facility in Nairobi, Kenya
- 2023
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In: Sexual & Reproductive HealthCare. - : Elsevier. - 1877-5756 .- 1877-5764. ; 37
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Journal article (peer-reviewed)abstract
- Background: Three evidence-based midwife-led care practices: dynamic birth positions (DBP), immediate skin-to-skin contact (SSC) with zero separation between mother and newborn, and delayed cord clamping (DCC), were implemented in four sub-Saharan African countries after an internet-based capacity building program for midwifery leadership in quality improvement (QI). Knowledge on costs of this QI initiative can inform resource mobilization for scale up and sustainability. Methods: We estimated the costs and intermediate outcomes from the implementation of the three evidence-based practices under the midwife-led care (MIDWIZE) framework in a single facility in Kenya through a pre- and post-test implementation design. Daily observations for the level of practice on DBP, SSC and DCC was done at baseline for 1 week and continued during the 11 weeks of the training intervention. Three cost scenarios from the health facility perspective included: scenario 1; staff participation time costs ($515 USD), scenario 2; staff participation time costs plus hired trainer time costs, training material and logistical costs ($1318 USD) and scenario 3; staff participation time costs plus total program costs for the head trainer as the QI leader from the capacity building midwifery program ($8548 USD). Results: At baseline, the level of DBP and SSC practices per the guidelines was at 0 % while that of DCC was at 80 %. After 11 weeks, we observed an adoption of DBP practice of 36 % (N = 111 births), SSC practice of 79 % (N = 241 births), and no change in DCC practice. Major cost driver(s) were midwives’ participation time costs (56 %) for scenario 1 (collaborative), trainers’ material and logistic costs (55 %) in scenario 2(collaborative) and capacity building program costs for the trainer (QI lead) (94 %) in scenario 3 (programmatic). Costs per intermediate outcome were $2.3 USD per birth and $0.5 USD per birth adopting DBP and SSC respectively in Scenario 1; $6.0 USD per birth adopting DBP and $1.4 USD per birth adopting SSC in Scenario 2; $38.5 USD per birth adopting DBP and $8.8 USD per birth adopting SSC in scenario 3. The average hourly wage of the facility midwife was $4.7 USD. Conclusion: Improving adoption of DBP and SSC practices can be done at reasonable facility costs under a collaborative MIDWIZE QI approach. In a programmatic approach, higher facility costs would be needed. This can inform resource mobilization for future QI in similar resource-constrained settings. © 2023
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- Kristiansen, Ingela, 1961-
(author)
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Medical, cognitive and motor outcome after treatment of pilocytic astrocytoma in the posterior fossa in childhood
- 2020
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Doctoral thesis (other academic/artistic)abstract
- Introduction: Pilocytic astrocytoma is the most common brain tumour in childhood. The aim of the studies was to investigate late medical, cognitive and motor complications in patients treated in childhood for pilocytic astrocytoma in the posterior fossa. Methods: We present a retrospective study including 193 children treated for CNS tumours 1995-2006 and, from the same cohort, 3 descriptive studies including 20 patients (out of 27 eligible patients) treated for pilocytic astrocytoma in the posterior fossa 1995-2011. The patients participated in an interview, a neurological investigation, screening tools for psychiatric symptoms, health-related quality of life (HRQoL), and tests of cognitive, language, academic and motor functions. Results: Ten patients reported problems with motor skills, mainly from the upper limbs, and 8 reported learning difficulties. None had low results in screening for psychiatric symptoms or HRQoL. Intelligence tests showed average results, but 5 scored <-1 SD (70-84) and 3 low average (85-92) on full scale IQ. Patients scored average compared with norms in tests of executive function, except for significantly lower results in inhibition/switching (p= 0.004). In language and academic tests patients scored significantly lower results in naming ability (p=0.049), inference (p=0.046) and reading speed (p=0.024). Results in tests of motor function were normal, but in the Bruininks-Oseretsky Test of Motor Proficiency, patients had significantly lower results in manual dexterity (p=0.008). In the Mini-Balance Evaluation Systems Test, patients had significantly lower results compared with matched controls (p=0.036). Patients who reported learning difficulties had worse results in the performed tests. Conclusions: Although long-term functional outcome for patients treated for pilocytic astrocytoma was generally favourable, 40% of the patients display cognitive, learning and motor difficulties. Therefore, it is imperative to identify those in need of more thorough cognitive and motor follow-up programmes, including pedagogic interventions in school and training of motor functions.
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- Venero, J. L., et al.
(author)
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ARG1 expression in basal forebrain microglia modulates hippocampal innervation and cognition during postnatal development
- 2023
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In: Glia. - : John Wiley & Sons. - 0894-1491 .- 1098-1136. ; 71:Suppl. 1, s. E512-E512
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Journal article (other academic/artistic)abstract
- Diversity within microglia, the resident brain immune cells, is reported. Whether microglial subsets constitute different subtypes with intrinsic properties and unique functions has not been fully elucidated. Here, we describe a microglial subtype characterized by the expression of the enzyme Arginase-1, i.e.Arg1+microglia, which is found predominantly in the cholinergic neuron-rich forebrain region during early postnatal development. Arg1+microgliacontain cellular inclusions and exhibit a distinct molecular signature including upregulation of genes such as Apoe, Clec7a, Igf1, Lgals3and Mgl2. Arg1-knockout in microglia results in a deficient cholinergic innervation along with impaired dendritic spine maturation in the hippocampus where cholinergic neurons project, impaired long-term potentiation and cognitive behavioural deficiencies in female mice. Our results expand on microglia diversity and provide insights into distinctive spatiotemporal functions exerted by microglial subtypes.
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| 15. |
- Zhou, K., et al.
(author)
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An overlooked subset of Cx3cr1(wt/wt) microglia in the Cx3cr1(CreER-Eyfp/wt) mouse has a repopulation advantage over Cx3cr1(CreER-Eyfp/wt) microglia following microglial depletion
- 2022
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In: Journal of Neuroinflammation. - : Springer Science and Business Media LLC. - 1742-2094. ; 19:1
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Journal article (peer-reviewed)abstract
- Background Fluorescent reporter labeling and promoter-driven Cre-recombinant technologies have facilitated cellular investigations of physiological and pathological processes, including the widespread use of the Cx3cr1(CreER-Eyfp/wt) mouse strain for studies of microglia. Methods Immunohistochemistry, Flow Cytometry, RNA sequencing and whole-genome sequencing were used to identify the subpopulation of microglia in Cx3cr1(CreER-Eyfp/wt) mouse brains. Genetically mediated microglia depletion using Cx3cr1(CreER-Eyfp/wt)Rosa26(DTA/wt) mice and CSF1 receptor inhibitor PLX3397 were used to deplete microglia. Primary microglia proliferation and migration assay were used for in vitro studies. Results We unexpectedly identified a subpopulation of microglia devoid of genetic modification, exhibiting higher Cx3cr1 and CX3CR1 expression than Cx3cr1(CreER-Eyfp/wt)Cre(+)Eyfp(+) microglia in Cx3cr1(CreER-Eyfp/wt) mouse brains, thus termed Cx3cr1(high)Cre(-)Eyfp(-) microglia. This subpopulation constituted less than 1% of all microglia under homeostatic conditions, but after Cre-driven DTA-mediated microglial depletion, Cx3cr1(high)Cre(-)Eyfp(-) microglia escaped depletion and proliferated extensively, eventually occupying one-third of the total microglial pool. We further demonstrated that the Cx3cr1(high)Cre(-)Eyfp(-) microglia had lost their genetic heterozygosity and become homozygous for wild-type Cx3cr1. Therefore, Cx3cr1(high)Cre(-)Eyfp(-) microglia are Cx3cr1(wt/wt)Cre(-)Eyfp(-). Finally, we demonstrated that CX3CL1-CX3CR1 signaling regulates microglial repopulation both in vivo and in vitro. Conclusions Our results raise a cautionary note regarding the use of Cx3cr1(CreER-Eyfp/wt) mouse strains, particularly when interpreting the results of fate mapping, and microglial depletion and repopulation studies.
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