Twelve-year follow-up of conservative management of postnatal urinary and faecal incontinence and prolapse outcomes : randomised controlled trial

© 2013 Royal College of Obstetricians and Gynaecologists. Funded by Royal College of Obstetricians and Gynaecologists, London, UK; Health Research Council of New Zealand. Grant Number: RG 819/06 New Zealand Lottery Grant Board Health Services Research Unit, University of Aberdeen Chief Scientist Office of the Scottish Government Health DirectoratesPeer reviewedPostprin

Qualitative Evaluation of Web-Based Digital Intervention to Prevent and Reduce Excessive Alcohol Use and Harm Among Young People Aged 14-15 Years: A "Think-Aloud" Study

BACKGROUND: In the United Kingdom, despite some downward trends in alcohol use among young people, over one-fifth of young people reported excessive alcohol use in the past month, which is associated with short- and long-term harm to health. Digital interventions to reduce alcohol use, such as websites, among young people present an appealing and cost-effective mode of intervention that can be integrated into the education system. However, relatively few school-based digital alcohol-focused interventions have been developed and evaluated for young people in the United Kingdom. OBJECTIVE: This study aims to develop a novel web-based intervention, Rethink Alcohol, to prevent and reduce excessive alcohol use and related harm among young people aged between 14 and 15 years, and explore the views of young people, teachers, and youth workers in relation to the content, design, and usability of the intervention. METHODS: Intervention development followed the person-based approach, using theories of social norms and social influence. Qualitative "Think-Aloud" interviews, either one-to-one or paired, were conducted while participants perused and worked through the web-based intervention, talking aloud. Participants included 20 young people (12 female, 8 male), 5 youth workers (4 female, 1 male), 3 teachers (2 male, 1 female), and 1 (male) clinical professional, recruited via youth groups and professional networks. Interviews were audio recorded, transcribed verbatim, and analyzed thematically. RESULTS: The prototype web-based intervention included normative feedback, information, a quiz, interactive activities, and scenarios. On a rating scale of impressions from poor (1) to excellent (5), participants gave an average score of 3.6/5. A total of 5 themes were identified: content, credibility of the website, making the website easy to understand, design and navigation, and suitability for the audience. These themes reflected views that the content was interesting, credible, informative, and embodied a neutral and nonjudgmental tone, but stronger messaging was needed regarding social pressures and short-term risks regarding safety and risk behavior alongside clarity around pathways of risk; credibility and trustworthiness of information were critical features, determined in part, by the professionalism of design and referencing of sources of information provided; and messages should be succinct and come to life through design and interactive features. CONCLUSIONS: Together, the data illustrated the importance and challenge of communicating nuanced alcohol-focused public health messages to young people in concise, clear, nonjudgmental, and appealing ways. Young people report interest in clear, credible, neutral, and interactive messages regarding social pressures and short-term risks of alcohol use via a web-based intervention. There is scope for optimization and feasibility testing of the Rethink Alcohol intervention

Low-Surface-Brightness Galaxies in the Sloan Digital Sky Survey. I. Search Method and Test Sample

In this paper we present results of a pilot study to use imaging data from the Sloan Digital Sky Survey (SDSS) to search for low-surface-brightness (LSB) galaxies. For our pilot study we use a test sample of 92 galaxies from the catalog of Impey et al. (1996) distributed over 93 SDSS fields of the Early Data Release (EDR). Many galaxies from the test sample are either LSB or dwarf galaxies. To deal with the SDSS data most effectively a new photometry software was created, which is described in this paper. We present the results of the selection algorithms applied to these 93 EDR fields. Two galaxies from the Impey et al. test sample are very likely artifacts, as confirmed by follow-up imaging. With our algorithms, we were able to recover 87 of the 90 remaining test sample galaxies, implying a detection rate of $\sim$96.5%. The three missed galaxies fall too close to very bright stars or galaxies. In addition, 42 new galaxies with parameters similar to the test sample objects were found in these EDR fields (i.e., $\sim$47% additional galaxies). We present the main photometric parameters of all identified galaxies and carry out first statistical comparisons. We tested the quality of our photometry by comparing the magnitudes for our test sample galaxies and other bright galaxies with values from the literature. All these tests yielded consistent results. We briefly discuss a few unusual galaxies found in our pilot study, including an LSB galaxy with a two-component disk and ten new giant LSB galaxies.Comment: 36 pages, 16 figures, accepted for publication by AJ, some figures were bitmapped to reduce the siz

The mass-dependent star formation histories of disk galaxies: infall model versus observations

We introduce a simple model to explore the star formation histories of disk galaxies. We assume that the disk origins and grows by continuous gas infall. The gas infall rate is parametrized by the Gaussian formula with one free parameter: infall-peak time $t_p$. The Kennicutt star formation law is adopted to describe how much cold gas turns into stars. The gas outflow process is also considered in our model. We find that, at given galactic stellar mass $M_*$, model adopting late infall-peak time $t_p$ results in blue colors, low metallicity, high specific star formation rate and high gas fraction, while gas outflow rate mainly influences the gas-phase metallicity and star formation efficiency mainly influences the gas fraction. Motivated by the local observed scaling relations, we construct a mass-dependent model by assuming low mass galaxy has later infall-peak time $t_p$ and larger gas outflow rate than massive systems. It is shown that this model can be in agreement with not only the local observations, but also the observed correlations between specific star formation rate and galactic stellar mass $SFR/M_* \sim M_*$ at intermediate redshift $z<1$. Comparison between the Gaussian-infall model and exponential-infall model is also presented. It shows that the exponential-infall model predicts higher star formation rate at early stage and lower star formation rate later than that of Gaussian-infall. Our results suggest that the Gaussian infall rate may be more reasonable to describe the gas cooling process than the exponential infall rate, especially for low-mass systems.Comment: 12 pages, 6 figures, ApJ, 2010, 722, 38

Structure of Disk Dominated Galaxies I. Bulge/Disk Parameters, Simulations, and Secular Evolution

(Abridged) A robust analysis of galaxy structural parameters, based on the modeling of bulge and disk brightnesses in the BVRH bandpasses, is presented for 121 face-on and moderately inclined late-type spirals. Each surface brightness (SB) profile is decomposed into a sum of a generalized Sersic bulge and an exponential disk. The reliability and limitations of our bulge-to-disk (B/D) decompositions are tested with extensive simulations of galaxy brightness profiles (1D) and images (2D). Galaxy types are divided into 3 classes according to their SB profile shapes; Freeman Type-I and Type-II, and a third ``Transition'' class for galaxies whose profiles change from Type-II in the optical to Type-I in the infrared. We discuss possible interpretations of Freeman Type-II profiles. The Sersic bulge shape parameter for nearby Type-I late-type spirals shows a range between n=0.1-2 but, on average, the underlying surface density profile for the bulge and disk of these galaxies is adequately described by a double-exponential distribution. We confirm a coupling between the bulge and disk with a scale length ratio r_e/h=0.22+/-0.09, or h_bulge/h_disk=0.13+/-0.06 for late-type spirals, in agreement with recent N-body simulations of disk formation and models of secular evolution. This ratio increases from ~0.20 for late-type spirals to ~0.24 for earlier types. The similar scaling relations for early and late-type spirals suggest comparable formation and/or evolution scenarios for disk galaxies of all Hubble types.Comment: 78 pages with 23 embedded color figures + tables of galaxy structural parameters. Accepted for publication in the Astrophysical Journal. The interested reader is strongly encouraged to ignore some of the low res figures within; instead, download the high resolution version from http://www.astro.ubc.ca/people/courteau/public/macarthur02_disks.ps.g

Revising acute care systems and processes to improve breastfeeding and maternal postnatal health: a pre and post intervention study in one English maternity unit

Background Most women in the UK give birth in a hospital labour ward, following which they are transferred to a postnatal ward and discharged home within 24 to 48 hours of the birth. Despite policy and guideline recommendations to support planned, effective postnatal care, national surveys of women’s views of maternity care have consistently found in-patient postnatal care, including support for breastfeeding, is poorly rated. Methods Using a Continuous Quality Improvement approach, routine antenatal, intrapartum and postnatal care systems and processes were revised to support implementation of evidence based postnatal practice. To identify if implementation of a multi-faceted QI intervention impacted on outcomes, data on breastfeeding initiation and duration, maternal health and women’s views of care, were collected in a pre and post intervention longitudinal survey. Primary outcomes included initiation, overall duration and duration of exclusive breastfeeding. Secondary outcomes included maternal morbidity, experiences and satisfaction with care. As most outcomes of interest were measured on a nominal scale, these were compared pre and post intervention using logistic regression. Results Data were obtained on 741/1160 (64%) women at 10 days post-birth and 616 (54%) at 3 months post-birth pre-intervention, and 725/1153 (63%) and 575 (50%) respectively postintervention. Post intervention there were statistically significant differences in the initiation (p = 0.050), duration of any breastfeeding (p = 0.020) and duration of exclusive breastfeeding to 10 days (p = 0.038) and duration of any breastfeeding to three months (p = 0.016). Post intervention, women were less likely to report physical morbidity within the first 10 days of birth, and were more positive about their in-patient care. Conclusions It is possible to improve outcomes of routine in-patient care within current resources through continuous quality improvement

Achieving sustainable quality in maternity services – using audit of incontinence and dyspareunia to identify shortfalls in meeting standards

BACKGROUND: Some complications of childbirth (for example, faecal incontinence) are a source of social embarrassment for women, and are often under reported. Therefore, it was felt important to determine levels of complications (against established standards) and to consider obstetric measures aimed at reducing them. METHODS: Clinical information was collected on 1036 primiparous women delivering at North and South Staffordshire Acute and Community Trusts over a 5-month period in 1997. A questionnaire was sent to 970 women which included self-assessment of levels of incontinence and dyspareunia prior to pregnancy, at 6 weeks post delivery and 9 to 14 months post delivery. RESULTS: The response rate was 48%(470/970). Relatively high levels of obstetric interventions were found. In addition, the rates of instrumental deliveries differed between the two hospitals. The highest rates of postnatal symptoms had occurred at 6 weeks, but for many women problems were still present at the time of the survey. At 9–14 months high rates of dyspareunia (29%(102/347)) and urinary incontinence (35%(133/382)) were reported. Seventeen women (4%) complained of faecal incontinence at this time. Similar rates of urinary incontinence and dyspareunia were seen regardless of mode of delivery. CONCLUSION: Further work should be undertaken to reduce the obstetric interventions, especially instrumental deliveries. Improvements in a number of areas of care should be undertaken, including improved patient information, improved professional communication and improved professional recognition and management of third degree tears. It is likely that these measures would lead to a reduction in incontinence and dyspareunia after childbirth

Design of a speed meter interferometer proof-of-principle experiment

The second generation of large scale interferometric gravitational wave detectors will be limited by quantum noise over a wide frequency range in their detection band. Further sensitivity improvements for future upgrades or new detectors beyond the second generation motivate the development of measurement schemes to mitigate the impact of quantum noise in these instruments. Two strands of development are being pursued to reach this goal, focusing both on modifications of the well-established Michelson detector configuration and development of different detector topologies. In this paper, we present the design of the world's first Sagnac speed meter interferometer which is currently being constructed at the University of Glasgow. With this proof-of-principle experiment we aim to demonstrate the theoretically predicted lower quantum noise in a Sagnac interferometer compared to an equivalent Michelson interferometer, to qualify Sagnac speed meters for further research towards an implementation in a future generation large scale gravitational wave detector, such as the planned Einstein Telescope observatory.Comment: Revised version: 16 pages, 6 figure

Qualitative Evaluation of Web-Based Digital Intervention to Prevent and Reduce Excessive Alcohol Use and Harm Among Young People Aged 14-15 Years: A "Think-Aloud" Study

This is the final version. Available on open access from JMIR Publications via the DOI in this recordBACKGROUND: In the United Kingdom, despite some downward trends in alcohol use among young people, over one-fifth of young people reported excessive alcohol use in the past month, which is associated with short- and long-term harm to health. Digital interventions to reduce alcohol use, such as websites, among young people present an appealing and cost-effective mode of intervention that can be integrated into the education system. However, relatively few school-based digital alcohol-focused interventions have been developed and evaluated for young people in the United Kingdom. OBJECTIVE: This study aims to develop a novel web-based intervention, Rethink Alcohol, to prevent and reduce excessive alcohol use and related harm among young people aged between 14 and 15 years, and explore the views of young people, teachers, and youth workers in relation to the content, design, and usability of the intervention. METHODS: Intervention development followed the person-based approach, using theories of social norms and social influence. Qualitative "Think-Aloud" interviews, either one-to-one or paired, were conducted while participants perused and worked through the web-based intervention, talking aloud. Participants included 20 young people (12 female, 8 male), 5 youth workers (4 female, 1 male), 3 teachers (2 male, 1 female), and 1 (male) clinical professional, recruited via youth groups and professional networks. Interviews were audio recorded, transcribed verbatim, and analyzed thematically. RESULTS: The prototype web-based intervention included normative feedback, information, a quiz, interactive activities, and scenarios. On a rating scale of impressions from poor (1) to excellent (5), participants gave an average score of 3.6/5. A total of 5 themes were identified: content, credibility of the website, making the website easy to understand, design and navigation, and suitability for the audience. These themes reflected views that the content was interesting, credible, informative, and embodied a neutral and nonjudgmental tone, but stronger messaging was needed regarding social pressures and short-term risks regarding safety and risk behavior alongside clarity around pathways of risk; credibility and trustworthiness of information were critical features, determined in part, by the professionalism of design and referencing of sources of information provided; and messages should be succinct and come to life through design and interactive features. CONCLUSIONS: Together, the data illustrated the importance and challenge of communicating nuanced alcohol-focused public health messages to young people in concise, clear, nonjudgmental, and appealing ways. Young people report interest in clear, credible, neutral, and interactive messages regarding social pressures and short-term risks of alcohol use via a web-based intervention. There is scope for optimization and feasibility testing of the Rethink Alcohol intervention