Time, risk and midwife practice: The vaginal examination

In this article, we examine the impact on midwifery practice of clinical governance in the UK with its shift from individual autonomous practice based on personal experience and intuition (embodied knowledge) to the collective control of work based on guidelines and protocols (encoded knowledge) associated with the scientific-bureaucratic approach to care. We focus on the ways in which midwives use partograms and associated vaginal examinations to monitor and manage the progress of labour. The partogram represents (among other things) a timetable for dilation of the cervix during labour. Women who fail to keep up with this timetable are shifted from a low-to-high risk category and subjected to additional surveillance and intervention. In this article, we draw on empirical evidence taken from two independent ethnographic studies of midwifery talk and practice in England undertaken in 2005-2007 and 2008-2010, to describe the ways in which midwives practice of vaginal examinations during labour both complies with, while at the same time creatively subverts, the scientific-bureaucratic approach to maternity care. We argue that although divergent in nature, each way of practicing is mutually dependent upon the other: the space afforded by midwifery creativity not only co-exists with the scientific-bureaucratic approach to care, but also sustains it. © 2014 © 2014 Taylor & Francis

The MEGAPIE-TEST Project

The goals of the MEGAPIE initiative are to design, build and operate a 1MW heavy liquid metal target. The first step towards the realization of the MEGAPIE target was the feasibility studies, which outlined the entire project. Contextually to the feasibility studies the conceptual design phase started with the establishment of R&D working groups assisting the design and validation of both the target and its ancillary systems. In this framework the EU project MEGAPIE-TEST has been structured in three work packages with tasks concerning the finalization of the engineering design, the components and subsystem testing, the integral test and the first irradiation period. The MEGAPIE-TEST consortium is composed by the 14 partners: FZK, PSI, CEA, ENEA, SCK-CEN, CNRS /IDFE, IN2P3, LMPGM, EMN, ISMRA, UNIV-NANTES, U-PSUDXI, USTL. Currently the engineering design of the target has been finalized, its manufacturing has been launched and the design activities on the ancillary systems were almost completed. R&D activities in the fields of materials, thermal – hydraulics, structural mechanics, neutronic and nuclear assessment and liquid metal technologies were performed in order to assist specific design issues. Some Subsystem and component tests were also performed and the preparation of the integral test is an ongoing activity

Comparison of IgG diffusion and extracellular matrix composition in rhabdomyosarcomas grown in mice versus in vitro as spheroids reveals the role of host stromal cells

The tumour extracellular matrix acts as a barrier to the delivery of therapeutic agents. To test the hypothesis that extracellular matrix composition governs the penetration rate of macromolecules in tumour tissue, we measured the diffusion coefficient of nonspecific IgG in three rhabdomyosarcoma subclones growing as multicellular spheroids in vitro or as subcutaneous tumours in dorsal windows in vivo. In subcutaneous tumours, the diffusion coefficient decreased with increasing content of collagen and sulphated glycosaminoglycans. When grown as multicellular spheroids, no differences in either extracellular matrix composition or diffusion coefficient were found. Comparison of in vitro vs in vivo results suggests an over-riding role of host stromal cells in extracellular matrix production subjected to modulation by tumour cells. Penetration of therapeutic macromolecules through tumour extracellular matrix might thus be largely determined by the host organ. Hence, caution must be exercised in extrapolating drug penetrability from spheroids and multilayer cellular sandwiches consisting of only tumour cells to tumours in vivo

Engineering validation for lithium target facility of the IFMIF under IFMIF/EVEDA project

The International Fusion Materials Irradiation Facility (IFMIF), presently in the Engineering Validation and Engineering Design Activities (EVEDA) phase was started from 2007 under the frame of the Broader Approach (BA) agreement. In the activities, a prototype Li loop with the world's highest flow rate of 3000L/min was constructed in 2010, and it succeeded in generating a 100mm wide and 25mm thick with a free-surface lithium flow along a concave back plate steadily at a high-speed of 15m/s at 250°C for 1300h. In the demonstration operation it was needed to develop the Li flowing measurement system with precious resolution less than 0.1mm, and a new wave height measuring method which is laser-probe method was developed for measurements of the 3D geometry of the liquid Li target surface. Using the device, the stability of the variation in the Li flowing thickness which is required in the IFMIF specification was ±1mm or less as the liquid Li target, and the result was satisfied with it and the feasibility of the long-term stable liquid Li flow was also verified. The results of the other engineering validation tests such as lithium purification tests of lithium target facility have also been evaluated and summarized

Paradigms in multiple sclerosis: time for a change, time for a unifying concept

It has recently been suggested that, rather than being an autoimmune disease, multiple sclerosis (MS) is an example of a neurocristopathy, a pathological process resulting from a faulty development of the neural crest. Whilst several characteristics of the disease suggest a neurocristopathy, other aetiological factors require consideration, including hygiene-related factors that alter the immune responses to common pathogens resulting in an eclipse of immune reactivity that could protect against MS, the possible role of human endogenous retroviruses (HERVs) in pathogenesis and autoimmune phenomena, HLA polymorphism, vitamin D levels before and after birth and immune repair mechanisms. A postulated aetiological factor in MS, associated with altered vitamin D metabolism and abnormal HERV expression, is a long-lasting disturbed redox regulation in the biosynthesis of a melanoma-like melanin pigment. Although intensive further studies on melanin pigments in nerve tissue in MS are required, the known properties of a pathological form of such pigments in melanoma could explain a number of observations in MS, including the impact of light, UV-light, and vitamin D, and could explain the clinical manifestations of MS on the basis of an oscillating process of oxidative charge and discharge of the pigments and a threshold phenomenon with a change of the quasi-catalytic function of the pigment from destroying reactive oxygen radicals or species to transforming them to more harmful long-persisting highly reactive species. Taken together with the consequences of an adaptive process in partly demyelinated neurons, resulting in an increase in number of mitochondria, and the impact of stressful life events, these conditions are necessary and sufficient to explain the disease process of MS with its spatial (plaques) and temporal (attacks and remissions) characteristics. This suggested unifying concept of the pathogenesis of MS may open perspectives for prevention, diagnosis and therapy. In particular, prevention may be achieved by vaccinating against Epstein-Barr virus in early childhood

Assessment of motor functioning in the preschool period

The assessment of motor functioning in young children has become increasingly important in recent years with the acknowledgement that motor impairment is linked with cognitive, language, social and emotional difficulties. However, there is no one gold standard assessment tool to investigate motor ability in children. The aim of the current paper was to discuss the issues related to the assessment of motor ability in young pre-school children and to provide guidelines on the best approach for motor assessment. The paper discusses the maturational changes in brain development at the preschool level in relation to motor ability. Other issues include sex differences in motor ability at this young age, and evidence for this in relation to sociological versus biological influences. From the previous literature it is unclear what needs to be assessed in relation to motor functioning. Should the focus be underlying motor processes or movement skill assessment? Several key assessment tools are discussed that produce a general measure of motor performance followed by a description of tools that assess specific skills, such as fine and gross motor, ball and graphomotor skills. The paper concludes with recommendations on the best approach in assessing motor function in pre-school children