The influence of self in women's decision-making about birthplace : an interpretive phenomenological study

In the United Kingdom current maternity policy advocates the importance of flexible individualised services that fit with the needs of women. Choice of services for women as consumers is paramount in a system that aims to promote safe, high quality care. As women make choices, they navigate a complex journey; learning from women’s experiences is fundamental to understanding this journey and influencing future policy and practice. Literature on what influences decision-making demonstrates a paucity of information and a limitation of women’s voices. Following an Interpretive Phenomenological approach grounded in a feminist perspective to promote women’s voices, a group of 25 antenatal and postnatal women were asked about their experiences, perceptions and choices in the context of their maternity care. This study explored how they may be socially influenced and pressured to conform to authority in birthplace choices. It illuminates how emancipation and conformity are linked to consider whether emancipation reduces pressure to conform and what the implications of this might mean in a wider sociological context of birth experience.Based on Interpretative Phenomenological Analysis, a unique, seven stage iterative framework of analysis was developed. Self and aspects of self emerged as the most significant theme for decision-making existing within a frame of constant interplay of external influences such as environment, knowledge and professionals. As different pregnancy identities emerged, it was evident that this interplay has positive and negative effects as women experience decision-making.Conformity and emancipation are profoundly linked to decision-making; self is complex but critical to this process. For women to be self-determined and assured in their birthplace choices there is urgent need to reconsider interactions at every level. This approach must address the complexities of self so women and midwives remain equal partners. The implications of this reach beyond the discipline of maternity care

Metal Standards for Waveguide Characterization of Materials

Rectangular-waveguide inserts that are made of non-ferromagnetic metals and are sized and shaped to function as notch filters have been conceived as reference standards for use in the rectangular- waveguide method of characterizing materials with respect to such constitutive electromagnetic properties as permittivity and permeability. Such standards are needed for determining the accuracy of measurements used in the method, as described below. In this method, a specimen of a material to be characterized is cut to a prescribed size and shape and inserted in a rectangular- waveguide test fixture, wherein the specimen is irradiated with a known source signal and detectors are used to measure the signals reflected by, and transmitted through, the specimen. Scattering parameters [also known as "S" parameters (S11, S12, S21, and S22)] are computed from ratios between the transmitted and reflected signals and the source signal. Then the permeability and permittivity of the specimen material are derived from the scattering parameters. Theoretically, the technique for calculating the permeability and permittivity from the scattering parameters is exact, but the accuracy of the results depends on the accuracy of the measurements from which the scattering parameters are obtained. To determine whether the measurements are accurate, it is necessary to perform comparable measurements on reference standards, which are essentially specimens that have known scattering parameters. To be most useful, reference standards should provide the full range of scattering-parameter values that can be obtained from material specimens. Specifically, measurements of the backscattering parameter (S11) from no reflection to total reflection and of the forward-transmission parameter (S21) from no transmission to total transmission are needed. A reference standard that functions as a notch (band-stop) filter can satisfy this need because as the signal frequency is varied across the frequency range for which the filter is designed, the scattering parameters vary over the ranges of values between the extremes of total reflection and total transmission. A notch-filter reference standard in the form of a rectangular-waveguide insert that has a size and shape similar to that of a material specimen is advantageous because the measurement configuration used for the reference standard can be the same as that for a material specimen. Typically a specimen is a block of material that fills a waveguide cross-section but occupies only a small fraction of the length of the waveguide. A reference standard of the present type (see figure) is a metal block that fills part of a waveguide cross section and contains a slot, the long dimension of which can be chosen to tailor the notch frequency to a desired value. The scattering parameters and notch frequency can be estimated with high accuracy by use of commercially available electromagnetic-field-simulating software. The block can be fabricated to the requisite precision by wire electrical-discharge machining. In use, the accuracy of measurements is determined by comparison of (1) the scattering parameters calculated from the measurements with (2) the scattering parameters calculated by the aforementioned software

Cup waveguide antenna with integrated polarizer and OMT

A cup waveguide antenna with integrated polarizer and OMT for simultaneously communicating left and right hand circularly polarized electromagnetic waves is adjustable to obtain efficient propagation and reception of electromagnetic waves. The antenna includes a circular waveguide having an orthomode transducer utilizing first and second pins longitudinally spaced apart and oriented orthogonally with respect to each other. Six radially-oriented adjustable polarizer screws extend from the exterior to the interior of the waveguide. A septum intermediate the first and second pins is aligned with the first pin. Adjustment of the polarizer screws enables maximized propagation of and/or response to left hand circularly polarized electromagnetic waves by the first pin while simultaneously enabling maximized propagation of and/or response to right hand circularly polarized electromagnetic waves by the second pin

Comparative Study of Antenna Elements for TDRSS Enhanced Multiple Access System

We compare three antennas, which are candidates for the TDRSS-Continuation enhanced MA array antenna elements. Measured and simulated data show very good agreement for all antenna elements. All of the antennas meet the specifications with the exception of the SBA isolation. However, improvements can likely be made with further design efforts

Thinking Minds - a cognitive skills intervention: A preliminary study capturing treatment effects with forensic psychiatric patients.

Presented is a preliminary study into the effectiveness of a cognitive skills programme, Thinking Minds, conducted with an adult male forensic psychiatric population (n = 27; 18 treatment, nine waiting list controls). It also addresses the approach to evaluating treatment effectiveness by capturing both group and individual effects. All participants were given a series of measures, to assess domains where treatment effect was thought likely to occur. This included impulsivity, coping, emotional control and self-esteem. It was predicted the treatment group would evidence positive change following the intervention, with no change in waiting list controls. Results indicated partial acceptance of the group effect prediction, with the waiting list control demonstrating no group change across time and the treatment group demonstrating improvement in rational and detached coping and in the social component of self-esteem. The individual change results demonstrated a mixed picture. It confirmed improvement in adaptive coping and social self-esteem for the treatment group but widened positive effects to cover aggression control. It also indicated evidence of deterioration on outcome measures. Deterioration was noted across all measures for the control group, suggesting that a degree of deterioration may be a naturally occurring process on self-report measures, regardless of intervention. This is an issue that future evaluations need to reflect on and accommodate. Results are discussed with regards to how the findings can begin to influence our approach to treatment evaluation

Women's decision-making about birthplace choices: Booking for birth centre, hospital or home birth in the North of England

Aim This paper presents findings from an Interpretive Phenomenological study that illuminates unique characteristics of the different social representations of antenatal primigravida and multigravida women who book to birth their babies in a birth centre, hospital, or at home. Methods Semi-structured interviews were conducted with 19 women and analysed by interpretive phenomenological analysis. Findings Analysis revealed different social representations independent of each other, that illustrate how these social groups, determined by women's collective voices, are uniquely characterised by group views, beliefs, misinterpretations and preconceptions and establishes what influences women in decision-making about choice of birthplace. Conclusion Women make decisions about what they want for themselves in this birthing experience. These decisions are made long before this impending experience. Recognising the different social representations of women in pregnancy, reveals deeper insight into the complexities of women's decision-making about birth choices, and highlights why some women might opt for certain choices. Knowing that some women may make decisions based on little or misrepresented information, confirms midwives are best placed in their interactions with women to provide positive influences, empowering them to make decisions based upon what they want for themselves. This affirms the woman and her midwife should remain partners in the decision-making process

Macrolide antibiotics for bronchiectasis

Background Bronchiectasis is a chronic respiratory disease characterised by abnormal and irreversible dilatation and distortion of the smaller airways. Bacterial colonisation of the damaged airways leads to chronic cough and sputum production, often with breathlessness and further structural damage to the airways. Long-term macrolide antibiotic therapy may suppress bacterial infection and reduce inflammation, leading to fewer exacerbations, fewer symptoms, improved lung function, and improved quality of life. Further evidence is required on the efficacy of macrolides in terms of specific bacterial eradication and the extent of antibiotic resistance. Objectives To determine the impact of macrolide antibiotics in the treatment of adults and children with bronchiectasis. Search methods We identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted all searches on 18 January 2018. Selection criteria We included randomised controlled trials (RCTs) of at least four weeks' duration that compared macrolide antibiotics with placebo or no intervention for the long-term management of stable bronchiectasis in adults or children with a diagnosis of bronchiectasis by bronchography, plain film chest radiograph, or high-resolution computed tomography. We excluded studies in which participants had received continuous or high-dose antibiotics immediately before enrolment or before a diagnosis of cystic fibrosis, sarcoidosis, or allergic bronchopulmonary aspergillosis. Our primary outcomes were exacerbation, hospitalisation, and serious adverse events. Data collection and analysis Two review authors independently screened the titles and abstracts of 103 records. We independently screened the full text of 40 study reports and included 15 trials from 30 reports. Two review authors independently extracted outcome data and assessed risk of bias for each study. We analysed dichotomous data as odds ratios (ORs) and continuous data as mean differences (MDs) or standardised mean differences (SMDs). We used standard methodological procedures as expected by Cochrane. Main results We included 14 parallel-group RCTs and one cross-over RCT with interventions lasting from 8 weeks to 24 months. Of 11 adult studies with 690 participants, six used azithromycin, four roxithromycin, and one erythromycin. Four studies with 190 children used either azithromycin, clarithromycin, erythromycin, or roxithromycin. We included nine adult studies in our comparison between macrolides and placebo and two in our comparison with no intervention. We included one study with children in our comparison between macrolides and placebo and one in our comparison with no intervention. In adults, macrolides reduced exacerbation frequency to a greater extent than placebo (OR 0.34, 95% confidence interval (CI) 0.22 to 0.54; 341 participants; three studies; I2 = 65%; moderate-quality evidence). This translates to a number needed to treat for an additional beneficial outcome of 4 (95% CI 3 to 8). Data show no differences in exacerbation frequency between use of macrolides (OR 0.31, 95% CI 0.08 to 1.15; 43 participants; one study; moderate-quality evidence) and no intervention. Macrolides were also associated with a significantly better quality of life compared with placebo (MD -8.90, 95% CI -13.13 to -4.67; 68 participants; one study; moderate-quality evidence). We found no evidence of a reduction in hospitalisations (OR 0.56, 95% CI 0.19 to 1.62; 151 participants; two studies; I2 = 0%; low-quality evidence), in the number of participants with serious adverse events, including pneumonia, respiratory and non-respiratory infections, haemoptysis, and gastroenteritis (OR 0.49, 95% CI 0.20 to 1.23; 326 participants; three studies; I2 = 0%; low-quality evidence), or in the number experiencing adverse events (OR 0.83, 95% CI 0.51 to 1.35; 435 participants; five studies; I2 = 28%) in adults with macrolides compared with placebo. In children, there were no differences in exacerbation frequency (OR 0.40, 95% CI 0.11 to 1.41; 89 children; one study; low-quality evidence); hospitalisations (OR 0.28, 95% CI 0.07 to 1.11; 89 children; one study; low-quality evidence), serious adverse events, defined within the study as exacerbations of bronchiectasis or investigations related to bronchiectasis (OR 0.43, 95% CI 0.17 to 1.05; 89 children; one study; low-quality evidence), or adverse events (OR 0.78, 95% CI 0.33 to 1.83; 89 children; one study), in those receiving macrolides compared to placebo. The same study reported an increase in macrolide-resistant bacteria (OR 7.13, 95% CI 2.13 to 23.79; 89 children; one study), an increase in resistance to Streptococcus pneumoniae (OR 13.20, 95% CI 1.61 to 108.19; 89 children; one study), and an increase in resistance to Staphylococcus aureus (OR 4.16, 95% CI 1.06 to 16.32; 89 children; one study) with macrolides compared with placebo. Quality of life was not reported in the studies with children. Authors' conclusions Long-term macrolide therapy may reduce the frequency of exacerbations and improve quality of life, although supporting evidence is derived mainly from studies of azithromycin, rather than other macrolides, and predominantly among adults rather than children. However, macrolides should be used with caution, as limited data indicate an associated increase in microbial resistance. Macrolides are associated with increased risk of cardiovascular death and other serious adverse events in other populations, and available data cannot exclude a similar risk among patients with bronchiectasis

Exploring patient characteristics and barriers to Hepatitis C treatment in patients on opioid substitution treatment (OST) attending a community based fibro-scanning clinic.

Background and Objectives: Hepatitis C virus (HCV) infection is a major public health issue. There is substandard uptake in HCV assessment and treatment among people who inject drugs (PWID). Community fibroscanning is used to assess disease severity and target treatment. Methods: A survey was administered to a cohort of chronically HCV infected patients attending a community fibroscanning clinic. Questions targeted diagnosis of HCV, suitability, willingness and barriers to engagement in treatment. Descriptive and regression analysis, with thematic analysis of open-ended data was conducted. Results: There was high acceptance of community fibroscanning among this cohort with over 90% (68) attending. High levels of unemployment (90%) and homelessness (40%) were identified. Most patients were on methadone treatment and had been HCV infected for greater than 10 years with length of time since HCV diagnosis being significantly longer in patients with fibroscan scores > 8.5 kPa (P = 0.016). With each unit increase in methadone dose, the odds of the >8.5 fibroscan group increased by 5.2%. Patient identified barriers to engagement were alcohol and drug use, fear of HCV treatment and liver biopsy, imprisonment, distance to hospital and early morning appointments. Conclusion: The study highlights the usefulness of community fibroscanning. Identifying barriers to treatment in this cohort affords an opportunity to increase the treatment uptake. The availability of afternoon clinics and enhanced prison linkage are warranted