The experiences of midwives and women during intrapartum transfer from one-to-one midwife-led birth environments to obstetric-led units

Objective: To explore the transition from midwifery one-to-one support in labour within a midwife-led birth environment to an obstetricled unit from the perspectives of midwives and women. Design: Ethnographic study. Data was collected from eleven transfers to an obstetric-led unit. The transfer process was observed for four women. Semi-structured interviews were completed following the births with eleven women and eleven midwives. Nine maternity records were also analysed. Setting: An alongside midwife-led unit, freestanding midwife-led unit, women's homes in England. Findings: Territorial behaviour was the main theme experienced by midwives when transferring women to obstetric-led units. Territorial behaviour manifested itself as a feeling of 'us versus them' behaviours, 'feeling under scrutiny' and being aware of 'conflicting ideologies'. For women there were four themes that had an impact on their experiences of transfer obstetric-led units including: (1) their midwife continuing the care on the labour ward, (2) having time to adjust to their new situation, (3) all staff introducing themselves and (4) not being separated from their baby for long periods of time. Conclusion and implications for practice: Transfer from a midwife-led birth environment to an obstetric-led unit is a stressful situation for midwives and women. This paper highlights how territorial behaviours impacted negatively for midwives during transfer to an obstetric-led unit. More research is required to understand territorial behaviours within the maternity services and how more respectful compassionate working relationships can be created. Additionally, from the perspective of women this paper highlights four aspects of care that positively impacted on the experiences of women and even helped them to build resilience to cope with the change of location, situation, medical interventions and new carers when transferring to an obstetric-led unit

Examining arts-based practice in midwifery education: An integrative review

Aims: The aim of this integrative review is to synthesise the literature on creative teaching methods in midwifery education. The review question seeks to investigate the experiences of student midwives and midwifery educators of using creative methods as a learning approach. Background: The benefits of creative teaching methods are widely acknowledged but the ways in which this may impact midwifery students’ learning processes, or how this relates to their developing professional development, is not well understood. Research focused specifically on student midwives is yet to be synthesised. Design: An integrative review was undertaken using data comparison with reflexive thematic analysis to identify common themes. Methods: Eight electronic databases were searched with key terms in June 2022. English language studies from qualitative, quantitative, mixed-methods and wider literature were included. Results: Twenty-two texts were included in the synthesis. Four themes were generated from the data; 1) What is the offering - More than a lecture; exploring the educator and student exchange and environment for learning; 2) Working in parallel - examining the change in teaching dynamic and collaborative partnerships; 3) Journeying towards holism - focused on student’s integration of learning processes; and 4) Stepping into the professional - engaging with how using creativity can aid students’ growing sense of themselves as professionals. This highlights improvements in levels of confidence, professional development and emotional intelligence in midwifery students. Conclusion: Creative teaching and learning methods enable student midwives to make meaningful connections between theoretical and practice learning environments, assisting knowledge and skills acquisition

Treatment of benign prostatic hyperplasia by natural drugs

Benign prostatic hyperplasia (BPH) is one of the most common urinary diseases affecting men, generally after the age of 50. The prevalence of this multifactorial disease increases with age. With aging, the plasma level of testosterone decreases, as well as the testosterone/estrogen ratio, resulting in increased estrogen activity, which may facilitate the hyperplasia of the prostate cells. Another theory focuses on dihydrotestosterone (DHT) and the activity of the enzyme 5α-reductase, which converts testosterone to DHT. In older men, the activity of this enzyme increases, leading to a decreased testosterone/DHT ratio. DHT may promote prostate cell growth, resulting in hyperplasia. Some medicinal plants and their compounds act by modulating this enzyme, and have the above-mentioned targets. This review focuses on herbal drugs that are most widely used in the treatment of BPH, including pumpkin seed, willow herb, tomato, maritime pine bark, Pygeum africanum bark, rye pollen, saw palmetto fruit, and nettle root, highlighting the latest results of preclinical and clinical studies, as well as safety issues. In addition, the pharmaceutical care and other therapeutic options of BPH, including pharmacotherapy and surgical options, are discussed, summarizing and comparing the advantages and disadvantages of each therapy

MeerKLASS: MeerKAT Large Area Synoptic Survey

We discuss the ground-breaking science that will be possible with a wide area survey, using the MeerKAT telescope, known as MeerKLASS (MeerKAT Large Area Synoptic Survey). The current specifications of MeerKAT make it a great fit for science applications that require large survey speeds but not necessarily high angular resolutions. In particular, for cosmology, a large survey over $\sim 4,000 \, {\rm deg}^2$ for $\sim 4,000$ hours will potentially provide the first ever measurements of the baryon acoustic oscillations using the 21cm intensity mapping technique, with enough accuracy to impose constraints on the nature of dark energy. The combination with multi-wavelength data will give unique additional information, such as exquisite constraints on primordial non-Gaussianity using the multi-tracer technique, as well as a better handle on foregrounds and systematics. Such a wide survey with MeerKAT is also a great match for HI galaxy studies, providing unrivalled statistics in the pre-SKA era for galaxies resolved in the HI emission line beyond local structures at z > 0.01. It will also produce a large continuum galaxy sample down to a depth of about 5\,$\mu$Jy in L-band, which is quite unique over such large areas and will allow studies of the large-scale structure of the Universe out to high redshifts, complementing the galaxy HI survey to form a transformational multi-wavelength approach to study galaxy dynamics and evolution. Finally, the same survey will supply unique information for a range of other science applications, including a large statistical investigation of galaxy clusters as well as produce a rotation measure map across a huge swathe of the sky. The MeerKLASS survey will be a crucial step on the road to using SKA1-MID for cosmological applications and other commensal surveys, as described in the top priority SKA key science projects (abridged).Comment: Larger version of the paper submitted to the Proceedings of Science, "MeerKAT Science: On the Pathway to the SKA", Stellenbosch, 25-27 May 201

Overview of first atmospheric results from InSight

The InSight spacecraft landed in the flat regions of Elysium Planitia on November 26th 2018. The instruments on board InSight make it capable of acting as a meteorological station at the surface of Mars. A pressure sensor (PS), two temperature and wind sensor booms (TWINS), along with the InSight FluxGate (IFG) magnetometer, form the Auxiliary Sensor Payload Suite (APSS). This is complemented by capabilities to measure surface brightness temperature by the radiometer in the Heat-Flow and Physical Properties Package (HP3) suite, to explore the impact of atmospheric processes on seismic measurements by SEIS, and to use InSight cameras to estimate atmospheric opacity (notably caused by suspended dust particles) and other atmospheric phenomena such as clouds and dust devils. We will discuss results drawn from atmospheric measurements on board InSight over the first two months of operation, highlighting new perspectives permitted by the high-frequency, continuous nature of the InSight acquisitions. Surface pressure measurements record global-to-local atmospheric phenomena: CO2 condensation (annual), dust cycle and storms (seasonal), baroclinic waves (weekly), thermal tides (daily), gravity waves (thousands of seconds), convective cells (hundreds of seconds), convective vortices (tens of seconds, leading to dust devils if dust particles are transported in the vortex). Two main large-scale wind regimes were expected from Global Climate Modeling at the InSight landing site during a typical year: towards the northwest in northern spring and summer, then in the opposite direction in southern summer. Existing in-situ measurements on Mars and Large-Eddy Simulations indicate that daytime convective vortices and cells not only impact pressure, but also temperature and winds; the nighttime atmosphere on Mars is comparatively much less turbulent and dominated by shear-driven turbulence, in contrast to the buoyancy-driven turbulence active in daytime. All such existing measurements and model predictions will be compared and challenged with InSight measurements. Seismic signatures associated with atmospheric phenomena will also be discussed, with a particular emphasis on the knowledge gained by the unprecedented measurements performed by InSight’s seismometers

How does study quality affect the results of a diagnostic meta-analysis?

Background: The use of systematic literature review to inform evidence based practice in diagnostics is rapidly expanding. Although the primary diagnostic literature is extensive, studies are often of low methodological quality or poorly reported. There has been no rigorously evaluated, evidence based tool to assess the methodological quality of diagnostic studies. The primary objective of this study was to determine the extent to which variations in the quality of primary studies impact the results of a diagnostic meta-analysis and whether this differs with diagnostic test type. A secondary objective was to contribute to the evaluation of QUADAS, an evidence-based tool for the assessment of quality in diagnostic accuracy studies. Methods: This study was conducted as part of large systematic review of tests used in the diagnosis and further investigation of urinary tract infection (UTI) in children. All studies included in this review were assessed using QUADAS, an evidence-based tool for the assessment of quality in systematic reviews of diagnostic accuracy studies. The impact of individual components of QUADAS on a summary measure of diagnostic accuracy was investigated using regression analysis. The review divided the diagnosis and further investigation of UTI into the following three clinical stages: diagnosis of UTI, localisation of infection, and further investigation of the UTI. Each stage used different types of diagnostic test, which were considered to involve different quality concerns. Results: Many of the studies included in our review were poorly reported. The proportion of QUADAS items fulfilled was similar for studies in different sections of the review. However, as might be expected, the individual items fulfilled differed between the three clinical stages. Regression analysis found that different items showed a strong association with test performance for the different tests evaluated. These differences were observed both within and between the three clinical stages assessed by the review. The results of regression analyses were also affected by whether or not a weighting (by sample size) was applied. Our analysis was severely limited by the completeness of reporting and the differences between the index tests evaluated and the reference standards used to confirm diagnoses in the primary studies. Few tests were evaluated by sufficient studies to allow meaningful use of meta-analytic pooling and investigation of heterogeneity. This meant that further analysis to investigate heterogeneity could only be undertaken using a subset of studies, and that the findings are open to various interpretations. Conclusion: Further work is needed to investigate the influence of methodological quality on the results of diagnostic meta-analyses. Large data sets of well-reported primary studies are needed to address this question. Without significant improvements in the completeness of reporting of primary studies, progress in this area will be limited

Women’s Empowerment Mitigates the Negative Effects of Low Production Diversity on Maternal and Child Nutrition in Nepal

We use household survey data from Nepal to investigate relationships between women’s empowerment in agriculture and production diversity on maternal and child dietary diversity and anthropometric outcomes. Production diversity is positively associated with maternal and child dietary diversity, and weight-for-height z-scores. Women’s group membership, control over income, reduced workload, and overall empowerment are positively associated with better maternal nutrition. Control over income is positively associated with height-for-age z-scores (HAZ), and a lower gender parity gap improves children’s diets and HAZ. Women’s empowerment mitigates the negative effect of low production diversity on maternal and child dietary diversity and HAZ

First Atmospheric Results from InSight APSS

NASA’s Mars InSight Spacecraft landed on Nov 26, 2018 (Ls=295°) in Elysium Planitia (~4.5°N, 136°E). InSight’s main scientific purpose is to investigate the interior structure and heat flux from Mars, but it is also equipped with instrumentation that can serve as a very capable meteorological station. To remove unwanted environmental noise from the seis- mic signals, InSight carries a very precise pressure sensor (PS) and the first magnetometer (IFG) to the surface of Mars. Additionally, to aid in removing the atmospheric pressure-induced seismic noise, and to identify periods when wind-induced seismic noise may reduce sensitivity, InSight also carries a pair of Wind and Air temperature sensors (TWINS). These three sensors comprise the Auxiliary Payload Sensor Suite (APSS) [1]. Complementing this are a radiometer in the HP3 suite to measure surface radiance, the seismic measurements of SEIS which can record interesting atmospheric phenomena, and the InSight cameras to image clouds and dust devils and estimate atmospheric opacity from dust or clouds. The Lander also carried accelerometers that can be used to reconstruct the at- mospheric structure during descent. We will discuss results drawn from atmospheric measurements on board InSight from the first months of operation, high- lighting the new perspectives permitted by the novel high-frequency, and continuous nature of the InSight data acquisition. Details on pre-landing scientific perspectives for atmospheric science with InSight are found in [2]

How do informal information sources influence women’s decision-making for birth? A meta-synthesis of qualitative studies

Background: Women approach birth using various methods of preparation drawing from conventional healthcare providers alongside informal information sources (IIS) outside the professional healthcare context. An investigation of the forms in which these informal information sources are accessed and negotiated by women, and how these disconnected and often conflicting elements influence women’s decision-making process for birth have yet to be evaluated. The level of antenatal preparedness women feel can have significant and long lasting implications on their birth experience and transition into motherhood and beyond. The aim of this study was to provide a deeper understanding of how informal information sources influence women’s preparation for birth. Methods: Seven electronic databases were searched with predetermined search terms. No limitations were imposed for year of publication. English language studies using qualitative methods exploring women’s experiences of informal information sources and their impact upon women’s birth preparation were included, subject to a quality appraisal framework. Searches were initiated in February 2016 and completed by March 2016. Studies were synthesised using an interpretive meta-ethnographic approach. Results: Fourteen studies were included for the final synthesis from Great Britain, Australia, Canada and the United States. Four main themes were identified: Menu Birth; Information Heaven/Hell; Spheres of Support; and Trust. It is evident that women do not enter pregnancy as empty vessels devoid of a conceptual framework, but rather have a pre-constructed embodied knowledge base upon which other information is superimposed. Allied to this, it is clear that informal information was sought to mitigate against the widespread experience of discordant information provided by maternity professionals. Conclusion: Women’s access to the deluge of informal information sources in mainstream media during pregnancy have significant impact on decision making for birth. These informal sources redefine the power dynamic between women and maternal healthcare providers, simultaneously increasing levels of anxiety and challenging women’s pre- existing ideations and aspirations of personal birth processes. A lack of awareness by some professionals of women’s information seeking behaviours generates barriers to women-centred support, leaving an experience expectation mismatch unchecked