Causes and consequences of acidification in the Baltic Sea: implications for monitoring and management

Increasing atmospheric CO2 drives ocean acidification globally. In coastal seas, acidification trends can however be either counteracted or enhanced by other processes. Ecosystem effects of acidification are so far small in the Baltic Sea, but changes should be anticipated unless CO2 emissions are curbed. Possible future acidification trends in the Baltic Sea, conditional on CO2 emissions, climate change, and changes in productivity, can be assessed by means of model simulations. There are uncertainties regarding potential consequences for marine organisms, partly because of difficulties to assign critical thresholds, but also because of knowledge gaps regarding species' capacity to adapt. Increased temporal and spatial monitoring of inorganic carbon system parameters would allow a better understanding of current acidification trends and also improve the capacity to predict possible future changes. An additional benefit is that such measurements also provide quantitative estimates of productivity. The technology required for precise measurements of the inorganic carbon system is readily available today. Regularly updated status evaluations of acidification, and the inorganic carbon system in general, would support management when assessing climate change effects, eutrophication or characteristics of the pelagic habitats. This would, however, have to be based on a spatially and temporally sufficient monitoring program.

On the uncertainty and confidence in decision support tools (DSTs) with insights from the Baltic Sea ecosystem

Ecosystems around the world are increasingly exposed to multiple, often interacting human activities, leading to pressures and possibly environmental state changes. Decision support tools (DSTs) can assist environmental managers and policy makers to evaluate the current status of ecosystems (i.e. assessment tools) and the consequences of alternative policies or management scenarios (i.e. planning tools) to make the best possible decision based on prevailing knowledge and uncertainties. However, to be confident in DST outcomes it is imperative that known sources of uncertainty such as sampling and measurement error, model structure, and parameter use are quantified, documented, and addressed throughout the DST set-up, calibration, and validation processes. Here we provide a brief overview of the main sources of uncertainty and methods currently available to quantify uncertainty in DST input and output. We then review 42 existing DSTs that were designed to manage anthropogenic pressures in the Baltic Sea to summarise how and what sources of uncertainties were addressed within planning and assessment tools. Based on our findings, we recommend future DST development to adhere to good modelling practise principles, and to better document and communicate uncertainty among stakeholders.

Decision-Support Tools Used in the Baltic Sea Area: Performance and End-User Preferences

Decision-support tools (DSTs) synthesize complex information to assist environmental managers in the decision-making process. Here, we review DSTs applied in the Baltic Sea area, to investigate how well the ecosystem approach is reflected in them, how different environmental problems are covered, and how well the tools meet the needs of the end users. The DSTs were evaluated based on (i) a set of performance criteria, (ii) information on end user preferences, (iii) how end users had been involved in tool development, and (iv) what experiences developers/hosts had on the use of the tools. We found that DSTs frequently addressed management needs related to eutrophication, biodiversity loss, or contaminant pollution. The majority of the DSTs addressed human activities, their pressures, or environmental status changes, but they seldom provided solutions for a complete ecosystem approach. In general, the DSTs were scientifically documented and transparent, but confidence in the outputs was poorly communicated. End user preferences were, apart from the shortcomings in communicating uncertainty, well accounted for in the DSTs. Although end users were commonly consulted during the DST development phase, they were not usually part of the development team. Answers from developers/hosts indicate that DSTs are not applied to their full potential. Deeper involvement of end users in the development phase could potentially increase the value and impact of DSTs. As a way forward, we propose streamlining the outputs of specific DSTs, so that they can be combined to a holistic insight of the consequences of management actions and serve the ecosystem approach in a better manner.

[Dying at Life's Beginning]

AIM

When parents-to-be are faced with a terminal prenatal diagnosis, they are confronted with the decision either to continue the pregnancy or to terminate it at an advanced stage. This difficult decision is intimately affected by the experience of the inevitability of loss, and ethical dilemmas posed in this usually completely unexpected situation. Studies indicate that perinatal child loss due to lethal foetal anomalies is a major life event and a source of serious psychological issues, which can last for many years after the experience. Moreover, it has been shown that care for bereaved parents, if guided by their needs, can ease their burden, regardless of whether they choose to end or continue the pregnancy. The aim of this study is to inspect current practices of counselling and support of affected families and develop practical guidelines for health and social professionals involved.

METHODS

A sample of 32 parents in the German-speaking part of Switzerland was investigated between December 2012 and March 2014. Semi-structured problem-centred interviews were conducted, transcribed verbatim and thematically analysed.

RESULTS

4 main time periods and 6 themes were identified by participants ranging from diagnosis until birth: "shock", "choices and dilemmas", "taking responsibility", "still being pregnant", "saying goodbye/letting go" and "planning the future". However, findings reflect critical points of care and showed gaps not only between emphasising time periods but also between affected parents' and involved professionals' views. This article reports the findings from the parents.

CONCLUSION

This study provided new insights into parental responses when they are confronted with a fatal prenatal diagnosis. The results contribute towards rethinking current practices in midwifery and other healthcare during pregnancy, birth and puerperium as well as the palliative care of the child.

Establishing a Master׳s for Europe--A transnational model for higher education

BACKGROUND AND CONTEXT

Over the last 50 years leading international organisations have been emphasising the key role that midwives play in the provision of quality care for women and babies throughout the pregnancy continuum. Midwifery education, however, generally remained at pre-university level until recently when Bachelors' programmes were developed. In Europe this development was taken further with the awarding of a European Union Lifelong Learning Programme grant to a consortium of five universities in four countries to develop a joint Master's degree in midwifery. The first students, drawn not only from the countries of the partner institutions but also from other European countries and from countries outside of Europe, commenced their studies in 2009. DOES THE PROGRAMME MEET ITS OBJECTIVES AND THOSE SET OUT IN THE LANCET SERIES?: The objectives of the programme were in line with the requirements for effective midwifery care and evidence based practice as discussed in the Lancet series.

THREATS AND CHALLENGES TO SUSTAINABILITY

As an EU funded project all the goals were met. However, in terms of its long-term sustainability problems arose due to the need for universities to rationalise programmes. The number of students has remained steady but low with the projected growth not taking place thus it has been impossible to perceive an impact on midwifery practice and the health of women and children where graduates are working.

CONCLUSION

Despite limitations, the programme serves as an exemplary model of how a Master's programme in midwifery can be successfully built through a collaboration of interested parties from different countries, and can be applied at a global level in other regions of the world, with sufficient political and economic support.

Competencies of midwives with single or dual qualifications at the point of registration in Scotland

OBJECTIVE

to compare and contrast competencies of midwives with single or dual qualifications at the point of registration in Scotland.

DESIGN

self-completing survey using the Glasgow Royal Maternity Hospital's Skills' Inventory by midwives at the point of registration and by Supervisors of Midwives analysed using non-parametric statistical tests. Content analysis of semi-structured interviews with experienced midwives and Supervisors of Midwives.

SETTING

midwifery education and practice settings throughout Scotland.

PARTICIPANTS

157 midwives at the point of registration, 166 Supervisors of Midwives.

MEASUREMENTS

Mann-Whitney and Kruskal Wallis analysis of skills of midwives at the point of registration in prenatal, labour, post-natal, neonatal areas and extended skills areas. FINDINGS/IMPLICATIONS FOR PRACTICE: all newly qualified midwives in Scotland, regardless of their educational preparation, are capable of providing care for women and babies in normal midwifery situations. While support for the direct entry programmes has been clearly demonstrated, this is not unanimous, although as more direct entry midwives take up positions, attitudes are becoming more positive.

Exploring Spanish emergency nurses' lived experience of the care provided for suddenly bereaved families

AIM OF THE STUDY

To investigate the experience of emergency nurses caring for suddenly bereaved family members in the clinical setting, particularly after they are informed about the loss of a loved one.

DESIGN/METHODS

Data was obtained from semi-structured interviews with seven emergency nurses drawn from emergency nursing staff working in a Spanish Hospital. Interviews were tape recorded, and hermeneutic-phenomenological analysis was applied to gain understanding from the emergency nurses' experiences.

SETTING

The Accident and Emergency department in the Hospital Universitario Insular de Gran Canaria (Spain). Study undertaken in partial fulfillment of the main author's MSc (Department of Nursing and Community Health) at Glasgow Caledonian University.

RESULTS

Several themes emerged from those interviews, which appeared to form the basis of the emergency nurses' reality: knowing, relationships, culture and reality. They showed the need to reflect on personal and professional experiences to facilitate personal growth, discover meaning for emergency nurses and examine the possible implications for clinical care.

CONCLUSIONS

This study enabled both participants and the researcher to evaluate critically what was troublesome from their perspective and to identify sources of innovation and liberation within everyday practices.

An action research inquiry into a health visitor parenting programme for parents of pre-school children with behaviour problems

An action research inquiry into a health visitor parenting programme for parents of pre-school children with behaviour problems Parent education programmes have recently been given a high profile in this country, such provision deemed necessary because of the commonality of children's behaviour problems and because of their potentially far-reaching effects on the child, the family and society. This action research study, undertaken in Scotland, aims to explore a health visitor parenting programme for parents of pre-school children with behaviour problems. Within this study, children with behaviour problems were identified as those whose parents perceived them to have such problems, the children eliciting a wide range of behaviours and to varying degrees. Critical social science is the chosen methodology, since it allows exploration of how people comprehend their social reality. Group interactions were recorded on audio-tape and themes associated with the methodology of enlightenment, empowerment and emancipation were identified. The results of the study demonstrate how a liberating, collaborative approach to parental education can empower mothers, by increasing understanding and raising self-esteem.

Minimizing postpartum pain: a review of research pertaining to perineal care in childbearing women

This paper provides a review of literature that relates to perineal pain and care. Articles evaluated include systematic reviews and research papers from the disciplines of midwifery, physiotherapy and obstetrics. The major themes to emerge from the literature and be reviewed are the need for episiotomy, suturing methods and materials, assessment of perineal trauma, treatment of perineum in the postpartum period, and postpartum recovery. Research has highlighted that many practices relating to perineal care remain un-researched and therefore the need for evaluation is urgent. Further postpartum morbidity has been seen to affect many women, but is often unrecognized by practitioners. It is also a topic that requires further evaluation through well-designed and implemented research.

Campylobacter peritonitis in continuous ambulatory peritoneal dialysis: report of eight cases and a review of the literature

Continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis remains the most common complication of this form of renal replacement therapy and the potential causative organisms are many and varied. Campylobacter bacteria are unusual causes of peritonitis in CAPD patients and we report our experience with eight cases and review those cases reported in the literature. In many episodes, there is a strong association with acute enterocolitis, which may precede the onset of cloudy dialysate by many days. The method of spread of these organisms from the gastrointestinal tract to the peritoneal cavity remains speculative. Bacteremic transfer would appear the most likely route, although it is probable that no single mode of spread explains all episodes. The treatment of choice of Campylobacter peritonitis is with intraperitoneal aminoglycoside in combination with oral erythromycin. An awareness of the potential for Campylobacter to cause CAPD-associated peritonitis, particularly when diarrhea is a prominent feature, has resulted in this organism becoming increasingly isolated in our unit.