Cervical ripening at home or in-hospital-prospective cohort study and process evaluation (CHOICE) study: a protocol.

IntroductionThe aim of the cervical ripening at home or in-hospital-prospective cohort study and process evaluation (CHOICE) study is to compare home versus in-hospital cervical ripening to determine whether home cervical ripening is safe (for the primary outcome of neonatal unit (NNU) admission), acceptable to women and cost-effective from the perspective of both women and the National Health Service (NHS).Methods and analysisWe will perform a prospective multicentre observational cohort study with an internal pilot phase. We will obtain data from electronic health records from at least 14 maternity units offering only in-hospital cervical ripening and 12 offering dinoprostone home cervical ripening. We will also conduct a cost-effectiveness analysis and a mixed methods study to evaluate processes and women/partner experiences. Our primary sample size is 8533 women with singleton pregnancies undergoing induction of labour (IOL) at 39+0 weeks' gestation or more. To achieve this and contextualise our findings, we will collect data relating to a cohort of approximately 41 000 women undergoing IOL after 37 weeks. We will use mixed effects logistic regression for the non-inferiority comparison of NNU admission and propensity score matched adjustment to control for treatment indication bias. The economic analysis will be undertaken from the perspective of the NHS and Personal Social Services (PSS) and the pregnant woman. It will include a within-study cost-effectiveness analysis and a lifetime cost-utility analysis to account for any long-term impacts of the cervical ripening strategies. Outcomes will be reported as incremental cost per NNU admission avoided and incremental cost per quality adjusted life year gained.Research ethics approval and disseminationCHOICE has been funded and approved by the National Institute of Healthcare Research Health Technology and Assessment, and the results will be disseminated via publication in peer-reviewed journals.Trial registration numberISRCTN32652461

Experience of induction of labour:a cross-sectional postnatal survey of women at UK maternity units

OBJECTIVES: This study explored women's views and experiences of key elements of the induction of labour (IOL) process, including at home or in hospital cervical ripening (CR). DESIGN: A questionnaire-based postnatal survey undertaken as part of the CHOICE Study process evaluation. The questionnaire was administered online and included fixed response and free-text options. SETTING: National Health Service maternity units in the UK. PARTICIPANTS: 309 women who had an IOL. OUTCOME MEASURES: The primary outcome measure was experience of IOL. Few women returned home during CR, meaning that statistical comparison between those who experienced home-based and hospital-based CR was not possible. Findings are reported as descriptive statistics with content analysis of women's comments providing context. RESULTS: Information to support choice and understand what to expect about IOL is often inadequate or unavailable. Having IOL can create anxiety and remove options for birth that women had hoped would enhance their experience. Although it can provide a more comfortable environment, home CR is not always an acceptable solution. Women described maternity care negatively impacted by staffing shortages; delays to care sometimes led to unsafe situations. Women who had a positive experience of IOL described supportive interaction with staff as a significant contribution to that. CONCLUSIONS: Women do not experience IOL as a benign and consequence free intervention. There is urgent need for research to better target IOL and optimise safety and experience for women and their babies. Relatively few women were offered CR at home and further research is needed on this experience

Upconverted Nanophosphors for Increasing Efficiency in a Dye-Sensitized Solar Cell

Upconverting nanoparticles has a significant potential to enhance solar cell efficiency as a “spectral converter”. Here, we report a phase pure, cubic, upconverting BaGdF5:Er/Yb-doped nanocrystal accessible via ionic liquids that are combined with TiO2 to apply as the absorption layer in a dye-sensitized solar cell (DSSC) as a potential technology to harvest solar energy. Bright-green (520 and 540 nm) and red (665 nm) emissions were observed due to transitions of 2H11/2 + 4S3/2 → 4I15/2 and 4F9/2 → 4I15/2, respectively. The experimental data for 540 and 665 nm emission bands of BaGdF5:Er3+/Yb3+ nanoparticles have been fitted with a straight line with a slope of ∼2, which confirms the two-photon absorption process. It is also found that not only the overall upconversion intensity but also the IG/IR ratio has a significant effect on device efficiency. Under 1 sun illumination, cells fabricated with the BaGdF5:Er3+(1%)/Yb3+(10%)/TiO2 absorption layer showed the highest photon conversion efficiency (PCE) of 7.75% with current density Jsc = 15.9 mA/cm2. However, when only TiO2 is used as the absorption layer, a much lesser PCE of 4.60% along with Jsc = 9.6 mA/cm2 is obtained. Almost a 68.47% enhancement in photon conversion efficiency and a significant increase in current density (Jsc) (65.62%) for the BaGdF5:Er3+(1%)/Yb3+(10%)/TiO2-based device compared to the bare TiO2 cells promise the potential use of upconverting materials as a spectral converter in the DSSC and other solar cell devices