Older mothers’ experiences of postnatal depression. An interpretative phenomenological analysis

This study uses Interpretative Phenomenology Analysis to explore the lived experience of postnatal depression. The four participants, all aged 30 years or above at the birth of their first child, had never suffered from depression prior to the birth. Each was interviewed on two separate occasions, with a period of 4 to 6 months between interviews. The inductive approach of IPA sought to capture the richness and complexity of participants’ lived emotional world. Six superordinate themes emerged from the interviews: striving to be a perfect mother; feeling a failure; being sucked dry; shame of the others gaze; feeling stuck and overwhelmed and becoming lost. Participants sacrificed themselves in the hopeless pursuit of their own expectations of being the perfect mother and fulfilling all their child’s needs. Not wanting to appear inadequate to others, and desperate to make sense of what was happening to them, they continued to suffer in silence in a context of depleting resources and the loss of their former life, wellbeing and sense of self. The findings suggest that particular themes of postnatal depression exist within older mothers’ experiences. While such themes may be less relevant to younger mothers, their presence suggests a tailored treatment approach for older first-time mothers with PND. Aspects of these findings can be found in previous postnatal depression research with primigravida and multigravida women of varying ages. In a situation where postnatal depression is the most common complication of childbearing in the UK, affecting between ten and fifteen percent of new mothers (Royal College of Psychiatrists, 2014) and where the birth rate for women aged 30+ is growing faster than for any other age group in the UK, research that furthers understanding of the experience of postnatal depression for mothers in this age group can help guide interventions and support. (The words ‘postnatal depression’ and ‘postpartum depression’ are used interchangeably in this text)

Will the Adoption of Basel II Encourage Increased Bank Merger Activity? Evidence from the United States

This study presents two tests of the hypothesis that adoption of an internal ratings-based approach to determining minimum capital requirements, proposed as part of the Basel II capital accord, would cause adopting banking organizations to increase their acquisition activity. The study employs U.S. data and focuses on the advanced internal ratings-based approach, as proposed for banking organizations in the United States. The first test estimates the relationship between excess regulatory capital and subsequent merger activity, including organization and time fixed effects, while the second test employs a " difference in difference" analysis of the change in merger activity that occurred the last time U.S. regulatory capital standards were changed. Estimated coefficients and observed differences have signs consistent with the hypothesis, but results are either statistically insignificant or imply differences that are small in magnitude.

Monovision LASIK in emmetropic presbyopic patients.

BackgroundTo evaluate the efficacy and patient satisfaction of laser in situ keratomileusis (LASIK) monovision correction in presbyopic emmetropic patients.MethodsA retrospective review of 294 patients who underwent LASIK for monovision was conducted. All patients had preoperative uncorrected distance visual acuity in each eye of 20/25 or better in both eyes and underwent primary LASIK treatment in one eye with a near target; 82 patients underwent surgery in the distant eye for hypermetropia. Patients completed a patient-reported-outcome questionnaire at their one-month postoperative visit. Analysis was performed on a per patient basis with a logistic regression model.ResultsPatients achieved a postoperative mean spherical equivalent of -0.05 diopters (D) in the distant eye and -1.92 D in the near eye. Prior to surgery, 64.7% (n=178) of patients reported they were satisfied or very satisfied with their vision; postoperatively, this increased to 85.4% (n=251). The greatest predictor of dissatisfaction after surgery was severe patient-reported visual phenomena (glare, halos, starbursts, ghosting) (odds ratio 1.18, P=0.001).ConclusionsLASIK monovision for presbyopic patients with low refractive error and good preoperative uncorrected distance visual acuity is both safe and effective with high patient satisfaction. Patients who were dissatisfied in the postoperative period tended to be those with postoperative visual symptoms

Informed consent in refractive surgery: in-person vs telemedicine approach.

Purpose:The aim of this study was to compare the quality of consent process in refractive surgery between patients who had a preoperative consent discussion with the surgeon using a telemedicine approach and those who had a face-to-face discussion. Methods:Patients treated between January and December 2017 (8,184 laser vision correction [LVC] and 3,754 refractive lens exchange [RLE] patients) that attended day 1 and 1-month postoperative visit were retrospectively reviewed. Preoperative consent preparation included a consultation with an optometrist, observation of an educational video, and written information. Patients then selected either a face-to-face appointment with their surgeon (in-clinic group) or a telemedicine appointment (remote group) for their consent discussion, according to their preference. Patient experience questionnaire and clinical data were included in a multivariate model to explore factors associated with consent quality. Results:Prior to surgery, 80.1% of LVC and 47.9% of RLE patients selected remote consent. Of all LVC patients, 97.5% of in-clinic and 98.3% of remote patients responded that they were adequately consented for surgery (P=0.04). Similar percentages in the RLE group were 97.6% for in-clinic and 97.9% for remote patients (P=0.47). In a multivariate model, the major predictor of patient's satisfaction with the consent process was postoperative satisfaction with visual acuity, responsible for 80.4% of variance explained by the model. Other significant contributors were postoperative visual phenomena and dry eyes, difficulty with night driving, close-up and distance vision, postoperative uncorrected distance visual acuity, change in corrected distance visual acuity, and satisfaction with the surgeon's approach. The type of consent (remote or in-clinic) had no impact on patient's perception of consent quality in the regression model. Conclusion:The majority of patients opted for telemedicine-assisted consent. Those who chose it were equally satisfied as those who had a face-to-face meeting with their surgeon. Dissatisfaction with surgical outcome was the major factor affecting patient's perception of consent quality, regardless of the method of their consent

Effects of Compression Processing Parameters and Antioxidants on Molecular Degradation of Biodegradable Poly-L-Lactide (PLLA)

The purpose of this research was to find a combination of poly (L-lactic acid), also known as poly-L-lactide or (PLLA) and antioxidants that would, together, produce a product whose degradation rate would be advantageous for use in biodegradable medical implants. Intrinsic viscosity tests were conducted on compression molded samples of PLLA that were molded at various processing parameters in order to find optimal parameters. The optimal processing parameters were found to be time 10 minutes, temperature 220°C, and pressure 1000 psi. The molecular weight of PLLA sample was taken while pressure, time, and temperature were varied. As pressure increased, no significant change in molecular weight was noticed. When the time was increased, the molecular weight decreased. Then when temperature increased, the molecular weight of PLLA also decreased. Compression molded samples were also made with a mixture of PLLA and antioxidants. At 0.6% of concentration, antioxidants in this study did not prove any benefits for PLLA to reduce the molecular degradation. All samples with 0.6% antioxidants showed lower molecular weight than pure PLLA. Outcomes of this research provide a better understanding of biodegradable polymers and the factors that contribute to a successful mold. This research develops the best possible poly-L-lactic acid compression sample for further studies in the industry, including medical applications

Revisiting the Core Ontology and Problem in Requirements Engineering

In their seminal paper in the ACM Transactions on Software Engineering and Methodology, Zave and Jackson established a core ontology for Requirements Engineering (RE) and used it to formulate the "requirements problem", thereby defining what it means to successfully complete RE. Given that stakeholders of the system-to-be communicate the information needed to perform RE, we show that Zave and Jackson's ontology is incomplete. It does not cover all types of basic concerns that the stakeholders communicate. These include beliefs, desires, intentions, and attitudes. In response, we propose a core ontology that covers these concerns and is grounded in sound conceptual foundations resting on a foundational ontology. The new core ontology for RE leads to a new formulation of the requirements problem that extends Zave and Jackson's formulation. We thereby establish new standards for what minimum information should be represented in RE languages and new criteria for determining whether RE has been successfully completed.Comment: Appears in the proceedings of the 16th IEEE International Requirements Engineering Conference, 2008 (RE'08). Best paper awar