Lotions and Lubricants

First paragraph: Few studies have been published by midwives regarding the lotions and lubricants used in vaginal examination and procedures in labour and in the immediate postnatal period. In this article I review published research and present the findings of my own research conducted in 1993. Although seven years ago it describes a range of practices which are as relevant today as they were then

Prioritising research and dissemination: a Delphi study of NHS Highland midwives

 This paper reports on a Delphi study undertaken by a health librarian and two midwifery professionals, to determine the research priorities of midwives working in NHS Highland. Six important topics were identified: workforce issues, second stage of labour, obesity in pregnancy, women's expectations of pregnancy and of childbirth, place of birth, and breastfeeding. Related evidence was examined to identify topics where dissemination of existing evidence was needed. The study dealt both with the practice of midwifery in general and with the information needs of local midwives in particular. The Delphi technique was found to be a useful method to determine research priorities but it was not without its limitations

Evaluating the impact of nursing and midwifery sensitive clinical quality indicators on practice

This narrative literature review aimed to examine the literature that identified clinical quality indicators (CQIs) in nursing and midwifery and that also measured the impact of nursing and midwifery practice on CQI implementation and outcome. Specifically, the review objectives were to: (a) examine the evidence that reviewed how quality indicators are being used to influence care delivered by nursing and midwifery practitioners, and (b) from the evidence reviewed, identify the quality indicators that are most readily applied to nursing and midwifery practice in NHS Highland. Nurse and midwifery sensitive CQIs are quantitative measures which reflect professional care standards that monitor and evaluate particular aspects of care for which nurses and midwives have key responsibility. This narrative literature review considered the nurse and midwifery CQIs that have been implemented in NHS Scotland and identified themes from these indicators which reflect the nurse or midwives' distinct professional contribution to CQI outcomes. Additionally, factors have been identified that have been shown to support successful implementation of nurse and midwife sensitive CQIs into clinical practice

Exploring women's experiences, views and understanding of vaginal examinations during intrapartum care:A meta-ethnographic synthesis

Objective: To conduct a systematic review exploring women’s experiences, views and understanding of any vaginal examinations during intrapartum care, in any care setting and by any healthcare professional. Intrapartum vaginal examination is deemed both an essential assessment tool and routine intervention during labour. It is an intervention that can cause significant distress, embarrassment, and pain for women, as well as reinforce outdated gender roles. In view of its widespread and frequently reported excessive use, it is important to understand women’s views on vaginal examination to inform further research and current practice.Design: A systematic search and meta-ethnography synthesis informed by Noblit and Hare (1988) and the eMERGe guidance (France et al. 2019) was undertaken. Nine electronic databases were searched systematically using predefined search terms in August 2021, and again in March 2023. Studies meeting the following criteria: English language, qualitative and mixed-method studies, published from 2000 onwards, and relevant to the topic, were eligible for quality appraisal and inclusion.Findings: Six studies met the inclusion criteria. Three from Turkey, one from Palestine, one from HongKong and one from New Zealand. One disconfirming study was identified. Following both a reciprocal and refutational synthesis, four 3rd order constructs were formed, titled: Suffering the examination, Challenging the power dynamic, Cervical-centric labour culture embedded in societal expectations, and Context of care. Finally, a line of argument was arrived at, which brought together and summarised the 3rd orde rconstructs.Key conclusions and implications of practice: The dominant biomedical discourse of vaginal examination and cervical dilatation as central to the birthing process does not align with midwifery philosophy or women’s embodied experience. Women experience examinations as painful and distressing but tolerate them as they view them as necessary and unavoidable. Factors such as context of care setting, environment, privacy, midwifery care, particularly in a continuity of carer model, have considerable positive affect on women’s experience of examinations. Further research into women’s experiences of vaginal examination in different care models as well as research into less invasive intrapartum assessment tools that promote physiological processes is urgently require

Exploring women's experiences, views and understanding of vaginal examinations during intrapartum care:A meta-ethnographic synthesis

Objective: To conduct a systematic review exploring women’s experiences, views and understanding of any vaginal examinations during intrapartum care, in any care setting and by any healthcare professional. Intrapartum vaginal examination is deemed both an essential assessment tool and routine intervention during labour. It is an intervention that can cause significant distress, embarrassment, and pain for women, as well as reinforce outdated gender roles. In view of its widespread and frequently reported excessive use, it is important to understand women’s views on vaginal examination to inform further research and current practice.Design: A systematic search and meta-ethnography synthesis informed by Noblit and Hare (1988) and the eMERGe guidance (France et al. 2019) was undertaken. Nine electronic databases were searched systematically using predefined search terms in August 2021, and again in March 2023. Studies meeting the following criteria: English language, qualitative and mixed-method studies, published from 2000 onwards, and relevant to the topic, were eligible for quality appraisal and inclusion.Findings: Six studies met the inclusion criteria. Three from Turkey, one from Palestine, one from HongKong and one from New Zealand. One disconfirming study was identified. Following both a reciprocal and refutational synthesis, four 3rd order constructs were formed, titled: Suffering the examination, Challenging the power dynamic, Cervical-centric labour culture embedded in societal expectations, and Context of care. Finally, a line of argument was arrived at, which brought together and summarised the 3rd orde rconstructs.Key conclusions and implications of practice: The dominant biomedical discourse of vaginal examination and cervical dilatation as central to the birthing process does not align with midwifery philosophy or women’s embodied experience. Women experience examinations as painful and distressing but tolerate them as they view them as necessary and unavoidable. Factors such as context of care setting, environment, privacy, midwifery care, particularly in a continuity of carer model, have considerable positive affect on women’s experience of examinations. Further research into women’s experiences of vaginal examination in different care models as well as research into less invasive intrapartum assessment tools that promote physiological processes is urgently require

Design, Synthesis, and Evaluation of Tetrasubstituted Pyridines as Potent 5-HT2C Receptor Agonists.

A series of pyrido[3,4-d]azepines that are potent and selective 5-HT2C receptor agonists is disclosed. Compound 7 (PF-04781340) is identified as a suitable lead owing to good 5-HT2C potency, selectivity over 5-HT2B agonism, and in vitro ADME properties commensurate with an orally available and CNS penetrant profile. The synthesis of a novel bicyclic tetrasubstituted pyridine core template is outlined, including rationale to account for the unexpected formation of aminopyridine 13 resulting from an ammonia cascade cyclization.We would like to thank the EPSRC (SVL, grant nº EP/K0099494/1 and nº EP/K039520/1) for financial support.This is the accepted manuscript. The final version is available from ACS at http://pubs.acs.org/doi/abs/10.1021/ml500507v

Flexible aggregation in multiple attribute decision making: Application to the Kuranda Range Road Upgrade

The conventional method of aggregating the satisfaction of transport projects with respect to multiple attributes is commonly some variant of Simple Additive Weighting (SAW), which involves the sum of products of standardized outcomes of projects with respect to attributes and attribute importance weights. It is suggested that alternative forms of aggregation might be more useful, in particular, the Ordered Weighted Averaging (OWA) operator introduced by Yager (1988). Attribute importance weights and satisfaction of attributes by projects may be aggregated prior to aggregation via an OWA operator. In this case OWA operator weights may be based on the "attitudinal character of the decision maker expressed in terms of the degree of "orness and "andness of the aggregation. A well-known approach is maximum entropy aggregation, in which weights are derived to be as "even (or as minimally dispersed) as a possible subject to satisfying a given "orness or "andness constraint. Recently, aggregation processes have been proposed by Larsen (199920022003) which have several desirable properties and also may be considered as alternative forms of aggregation. An example is given relating to the Kuranda Range Road upgrade (Queensland, Australia) which is limited by grade, poor overtaking opportunities, poor horizontal alignment, and other constraints, and the road is expected to become increasingly congested over the next few years. A more flexible Multiple Attribute Decision Making is used to identify a "best project from a set of four alternative projects

Why do women invest in pre-pregnancy health and care? A qualitative investigation with women attending maternity services

Background Despite the importance attributed to good pre-pregnancy care and its potential to improve pregnancy and child health outcomes, relatively little is known about why women invest in pre-pregnancy health and care. We sought to gain insight into why women invested in pre-pregnancy health and care. Methods We carried out 20 qualitative in-depth interviews with pregnant or recently pregnant women who were drawn from a survey of antenatal clinic attendees in London, UK. Interviewees were purposively sampled to include high and low investors in pre-pregnancy health and care, with variation in age, partnership status, ethnicity and pre-existing medical conditions. Data analysis was conducted using the Framework method. Results We identified three groups in relation to pre-pregnancy health and care: 1) The “prepared” group, who had high levels of pregnancy planning and mostly positive attitudes to micronutrient supplementation outside of pregnancy, carried out pre-pregnancy activities such as taking folic acid and making changes to diet and lifestyle. 2) The “poor knowledge” group, who also had high levels of pregnancy planning, did not carry out pre-pregnancy activities and described themselves as having poor knowledge. Elsewhere in their interviews they expressed a strong dislike of micronutrient supplementation. 3) The “absent pre-pregnancy period” group, had the lowest levels of pregnancy planning and also expressed anti-supplement views. Even discussing the pre-pregnancy period with this group was difficult as responses to questions quickly shifted to focus on pregnancy itself. Knowledge of folic acid was poor in all groups. Conclusion Different pre-pregnancy care approaches are likely to be needed for each of the groups. Among the “prepared” group, who were proactive and receptive to health messages, greater availability of information and better response from health professionals could improve the range of pre-pregnancy activities carried out. Among the “poor knowledge” group, better response from health professionals might yield greater uptake of pre-pregnancy information. A different, general health strategy might be more appropriate for the “absent pre-pregnancy period” group. The fact that general attitudes to micronutrient supplementation were closely related to whether or not women invested in pre-pregnancy health and care was an unanticipated finding and warrants further investigation.This report is independent research commissioned and funded by the Department of Health Policy Research Programme Pre-Pregnancy Health and Care in England: Exploring Implementation and Public Health Impact, 006/0068

Measurement of the Spectral Shape of the beta-decay of 137Xe to the Ground State of 137Cs in EXO-200 and Comparison with Theory

We report on a comparison between the theoretically predicted and experimentally measured spectra of the first-forbidden non-unique $\beta$-decay transition ^{137}\textrm{Xe}(7/2^-)\to\,^{137}\textrm{Cs}(7/2^+). The experimental data were acquired by the EXO-200 experiment during a deployment of an AmBe neutron source. The ultra-low background environment of EXO-200, together with dedicated source deployment and analysis procedures, allowed for collection of a pure sample of the decays, with an estimated signal-to-background ratio of more than 99-to-1 in the energy range from 1075 to 4175 keV. In addition to providing a rare and accurate measurement of the first-forbidden non-unique $\beta$-decay shape, this work constitutes a novel test of the calculated electron spectral shapes in the context of the reactor antineutrino anomaly and spectral bump.Comment: Version as accepted by PR