The Recognition of Excessive blood loss At ChildbirTh (REACT) Study: a two-phase exploratory, sequential mixed methods inquiry using focus groups, interviews and a pilot, randomised crossover study

Objectives: To explore how childbirth-related blood loss is evaluated and excessive bleeding recognised; and develop and test a theory of postpartum haemorrhage (PPH) diagnosis. Design: Two-phase, exploratory, sequential mixed methods design using focus groups, interviews and a pilot, randomised crossover study. Setting: Two hospitals in North West England. Sample: Women (following vaginal birth with and without PPH), birth partners, midwives and obstetricians. Methods: Phase one (qualitative): 8 focus groups and 20 one-to-one, semi-structured interviews were conducted with 15 women, 5 birth partners, 11 obstetricians, 1 obstetric anaesthetist and 19 midwives (n=51). Phase two (quantitative): 11 obstetricians and 10 midwives (n=21) completed two simulations of fast and slow blood loss using a high-fidelity childbirth simulator. Results: Responses to blood loss were described as automatic, intuitive reactions to the speed, nature and visibility of blood flow. Health professionals reported that quantifying volume was most useful after a PPH diagnosis, to validate intuitive decisions and guide on-going management. During simulations, PPH treatment was initiated at volumes at or below 200ml (fast mean blood loss 79.6ml, SD 41.1; slow mean blood loss 62.6ml, SD 27.7). All participants treated fast, visible blood loss, but only half treated slow blood loss, despite there being no difference in volumes (difference 18.2ml, 95% CI -5.6 to 42.2ml, p=0.124). Conclusions: Experience and intuition, rather than blood loss volume, inform recognition of excessive blood loss after birth. Women and birth partners want more information and open communication about blood loss. Further research exploring clinical decision-making and how to support it is required

Recent progress on the design of aperture arrays for radio astronomy

\u3cp\u3eDesign considerations and contemporary methods for analyzing and designing aperture arrays for radio astronomy are reviewed, with reference to the SKA. The use of computational electromagnetic tools to evaluate array performance, including embedded element patterns is addressed, as well as an approximation which includes some effects of mutual coupling. The subsequent inclusion of network models of the RF front-ends and including the beamformer are also considered. The analysis of receiving systems is specifically discussed.\u3c/p\u3

Rapid range expansion of the invasive quagga mussel in relation to zebra mussel presence in The Netherlands and Western Europe

Contains fulltext : 117190.pdf (publisher's version ) (Closed access

Origin of Spanish invasion by the zebra mussel, Dreissena polymorpha (Pallas, 1771) revealed by amplified fragment length polymorphism (AFLP) fingerprinting.

Contains fulltext : 75622.pdf (publisher's version ) (Open Access)Special Issue13 p

Environmental and morphological factors influencing predatory behaviour by invasive non-indigenous gammaridean species

Contains fulltext : 75986.pdf (publisher's version ) (Closed access)Special Issue12 p