The Emotional and Practical Experiences of Formula-Feeding Mothers

The majority of infant‐feeding research is focused on identifying mother's reasons for the cessation of breastfeeding. The experience of mothers who choose to use formula is largely overlooked in quantitative designs. This study aimed to describe the emotional and practical experiences of mothers who formula feed in any quantity, and examine whether these experiences would vary among different cohorts of formula‐feeding mothers according to prenatal feeding intention and postnatal feeding method. A total of 890 mothers of infants up to 26 weeks of age, who were currently formula feeding in any quantity, were recruited through relevant international social media sites via advertisements providing a link to an online survey. Predictors of emotional experiences included guilt, stigma, satisfaction, and defense as a result of their infant feeding choices. Practical predictor variables included support received from health professionals, respect displayed by their everyday environment, and main sources of infant feeding information. Descriptive findings from the overall sample highlighted a worryingly high percentage of mother's experienced negative emotions as a result of their decision to use formula. Multinomial logit models revealed that negative emotions such as guilt, dissatisfaction, and stigma were directly associated with feeding intention and method. The evidence suggests that the current approach to infant‐feeding promotion and support may be paradoxically related to significant issues with emotional well‐being. These findings support criticisms of how infant‐feeding recommendations are framed by health care professionals and policy makers, and highlight a need to address formula feeding in a more balanced, woman‐centered manner

Examining maternal anxiety and infant feeding from pregnancy to parenthood.

This thesis uses an exploratory sequential design to examine the relationship between maternal anxiety and infant feeding from pregnancy to parenthood. Chapter 1 provides an overview of the thesis and a contextual framework of breastfeeding behaviour. Chapter 2 systematically reviews the literature examining prenatal anxiety and infant feeding, while Chapter 3 systematically reviews the literature examining postpartum anxiety and infant feeding. Chapter 4 uses qualitative, longitudinal methods to explore the impact of pregnancy-specific anxiety on prenatal infant feeding intentions and subsequent postpartum breastfeeding behaviour. Chapters 5 and 6 examine the emotional and practical experiences of breastfeeding and formula feeding women to identify potentially influencing mechanisms within the relationship. Chapter 7 reports the development and validation of a new measure of postpartum-specific anxiety. Chapter 8 then examines whether this measure is a more effective predictor of infant feeding outcomes than a general measure of anxiety. First, the findings reveal that there is insufficient evidence to make firm conclusions regarding the relationship between prenatal anxiety and infant feeding outcomes. However, the thesis finds convincing evidence for the relationship between postpartum anxiety and diverse infant feeding outcomes and behaviours. Second, a qualitative, longitudinal design suggests that pregnancy-specific anxiety may strengthen breastfeeding intentions in pregnancy, but this does not translate into improved breastfeeding outcomes postpartum. Third, the findings provide consistent evidence that failure to adhere to current infant feeding recommendations elicits negative emotional and practical experiences, which may potentially influence the relationship. Finally, the findings reveal new evidence for the efficacy of a validated measure of postpartum specific anxiety, relative to general measures of anxiety and depression, in predicting infant feeding outcomes and behaviours. Collectively, this thesis demonstrates that maternal anxiety, particularly in the months following childbirth is; like depression; an individual-level determinant of breastfeeding. Policy makers should raise awareness of this under-recognised psychological determinant, and distinguish it from depression, and anxiety occurring at other times of life

General practice palliative care: Patient and carer expectations, advance care plans and place of death-a systematic review

Background: With an increasing ageing population in most countries, the role of general practitioners (GPs) and general practice nurses (GPNs) in providing optimal end of life (EoL) care is increasingly important. Objective: To explore: (1) patient and carer expectations of the role of GPs and GPNs at EoL; (2) GPs’ and GPNs’ contribution to advance care planning (ACP) and (3) if primary care involvement allows people to die in the place of preference. Method: Systematic literature review. Data sources: Papers from 2000 to 2017 were sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases. Results: From 6209 journal articles, 51 papers were relevant. Patients and carers expect their GPs to be competent in all aspects of palliative care. They valued easy access to their GP, a multidisciplinary approach to care and well-coordinated and informed care. They also wanted their care team to communicate openly, honestly and empathically, particularly as the patient deteriorated. ACP and the involvement of GPs were important factors which contributed to patients being cared for and dying in their preferred place. There was no reference to GPNs in any paper identified. Conclusions: Patients and carers prefer a holistic approach to care. This review shows that GPs have an important role in ACP and that their involvement facilitates dying in the place of preference. Proactive identification of people approaching EoL is likely to improve all aspects of care, including planning and communicating about EoL. More work outlining the role of GPNs in end of life care is required

A stacking-fault based microscopic model for platelets in diamond

We propose a new microscopic model for the $\{001\}$ planar defects in diamond commonly called platelets. This model is based on the formation of a metastable stacking fault, which can occur because of the ability of carbon to stabilize in different bonding configurations. In our model the core of the planar defect is basically a double layer of three-fold coordinated $sp^2$ carbon atoms embedded in the common $sp^3$ diamond structure. The properties of the model were determined using {\it ab initio} total energy calculations. All significant experimental signatures attributed to the platelets, namely, the lattice displacement along the $[001]$ direction, the asymmetry between the $[110]$ and the $[1\bar{1}0]$ directions, the infrared absorption peak $B^\prime$, and broad luminescence lines that indicate the introduction of levels in the band gap, are naturally accounted for in our model. The model is also very appealing from the point of view of kinetics, since naturally occurring shearing processes will lead to the formation of the metastable fault.Comment: 5 pages, 4 figures. Submitted for publication on August 2nd, 200

Supporting perinatal anxiety in the digital age; a qualitative exploration of stressors and support strategies

Background The period surrounding childbirth is one of profound change, which can often be experienced as stressful and overwhelming. Indeed, around 20% of women may experience significant levels of anxiety in the perinatal period. However, most women experiencing perinatal anxiety (PNA) go unrecognised and untreated. The Internet offers a potentially scalable solution to improve access to support, however a dearth of research in this area means that work is needed to better understand women’s experience of PNA, so that potential targets for intervention can be identified and possible barriers to support overcome. This study aimed to qualitatively explore women’s experience of anxiety triggers and support in the perinatal period; and gain insight into what online support is acceptable for women with PNA. Methods Women who were either pregnant or within one-year postpartum were invited to participate in focus groups across the UK. Focus groups were used to allow a diversity of perspectives to be heard, while simultaneously promoting the identification and prioritisation of important support needs and solutions. Interviews were transcribed and thematically analysed. Results Five key themes emerged in relation to women’s experience with PNA: holding unrealistic expectations of birth and motherhood; stigma; the importance of peer support; uncertainty and poor maternal confidence; and a lack of mental health support and knowledge. Perinatal women felt under-supported and poorly prepared for motherhood. A mismatch between their expectations and the reality of their experience, alongside a pressure to be the ‘perfect mum’ was the primary source of their anxiety. Furthermore, stigma associated with PNA may have exacerbated these issues and led to help-seeking avoidance. Overall, women felt these issues could be addressed via online support, through the delivery of more realistic information, providing psychoeducation about PNA symptoms and management, and the inclusion of authentic peer experiences. Thus, delivering evidence-based information and interventions online may provide a solution that is acceptable to this cohort. Conclusions This work provides unique insight into potential sources of anxiety for women in the perinatal period, while also offering potential internet-based support solutions that are likely to be acceptable and helpful for women with PNA

Enterovirus D68 subclade B3 Strain Circulating and Causing an Outbreak in the United States in 2016

In 2014 the United States experienced a nationwide outbreak of Enterovirus D68 (EV-D68) infection. There were no confirmed cases of EV-D68 in 2015 and CDC was only aware of limited sporadic EV-D68 detection in the US in 2016. In this report, we analyzed 749 nasopharyngeal (NP) specimens collected in 2015 and 2016 from patients in the Lower Hudson Valley, New York using a previously validated EV-D68-specific rRT-PCR assay. EV-D68 was detected in none of 199 NP specimens collected in 2015, and in one of 108 (0.9%) samples from January to May and 159 of 442 (36.0%) samples from July to October 2016. Complete EV-D68 genome sequences from 22 patients in 2016 were obtained using a metagenomic next-generation sequencing assay. Comparative genome analysis confirmed that a new EV-D68 strain belonging to subclade B3, with 3.2-4.8% divergence in nucleotide from subclade B1 strains identified during the 2014 US outbreak, was circulating in the US in 2016 and caused an outbreak in the Lower Hudson Valley, New York with 160 laboratory-confirmed cases. Our data highlight the genetic variability and capacity in causing outbreak by diverse EV-D68 strains, and the necessity of awareness and more surveillance on their active circulation worldwide

The agricultural potential of Owingup Swamp. 1. Soil survey of Owingup Swamp. 2. Comparison of Owingup and Grasmere Swamps

The two swamps, Owingup and Grasmere are practically identical with regard to soil conditions. Grasmere swamp however has been cleared and used for agriculture for some 60 years while Owingup swamp is as yet unalientated. Soils on both swamps consist of mainly organic diatomaceous clay. Findings of the survey indicate that some 2000 acres at Owingup swamp would be suitable for vegetable growing following clearing and draining

Quantitative imaging of hybrid chiral spin textures in magnetic multilayer systems by Lorentz microscopy

Chiral magnetic textures in ultrathin perpendicularly magnetised multilayer film stacks with an interfacial Dzyaloshinskii-Moriya interaction have been the focus of much research recently. The chirality associated with the broken inversion symmetry at the interface between an ultrathin ferromagnetic layer and a heavy metal with large spin-orbit coupling supports homochiral N\'eel domain walls and hedgehog (N\'eel) skyrmions. Under spin-orbit torques these N\'eel type magnetic structures are predicted, and have been measured, to move at high velocities. However recent studies have indicated that some multilayered systems may possess a more complex hybrid domain wall configuration, due to the competition between interfacial DMI and interlayer dipolar fields. These twisted textures are expected to have thickness dependent N\'eel and Bloch contributions to the domain or skyrmion walls. In this work, we use the methods of Lorentz microscopy to measure quantitatively for the first time experimentally both; i) the contributions of the N\'eel and Bloch contributions and ii) their spatial spin variation at high resolution. These are compared with modelled and simulated structures which are in excellent agreement with our experimental results. Our quantitative analysis provides powerful direct evidence of the Bloch wall component which exists in these hybrid walls and will be significant when exploiting such phenomena in spintronic applications.Comment: 12 page