Effectiveness of Doula Massage on Reduction of Pain During an Active Phase of First Stage of Labour among Primigravida Mothers admitted in Selected Hospitals at Tirunelveli District

This study was undertaken to assess the effectiveness of doula massage on reduction of pain during an active phase of first stage of labour among primigravida mothers admitted in selected hospitals at Tirunelveli district. A study was conducted by Ms.K.Kanaga, in partial fulfillment of the requirement for the degree of Master of Science in nursing at Sri K.Ramachandran Naidu College of Nursing, under The Tamilnadu Dr.M.G.R. Medical University, Chennai during the year of October 2019. OBJECTIVES: 1. To assess the pre and post test level of pain during an active phase of first stage of labour among primigravida mothers in experimental and control group. 2. To find out the effectiveness of doula massage on reduction of pain during an active phase of first stage of labour among primigravida mothers in the experimental group. 3. To compare the pre and post test level of pain during an active phase of first stage of labour among primigravida mothers in experimental and control group. 4. To associate the post test level of pain during an active phase of first stage of labour among primigravida mothers with their selected demographic variables such as age of the women, religion, education, type of family, marital status, family monthly income, previous occupation, type of activity, number of antenatal visit, type of pregnancy, and area of living. THE FOLLOWING HYPOTHESES WERE FRAMED FOR THE STUDY AND ALL THE HYPOTHESES ARE TESTED AT 0.05 LEVELS: RH1: Mean post test level of pain among primigravida mothers in experimental group, will be significantly lower than the post test level of pain among primigravida mothers in control group. RH2: Mean post test level of pain among primigravida mothers in experimental group, will be significantly lower than their mean pre test level of labour pain. RH3: Mean post test level of pain among primigravida mothers in control group, will be significantly higher than their mean pre test level of labour pain among primigravida mothers. RH4: There will be a significant association between the post test level of pain among primigravida mothers in experimental and control group with their selected demographic variables such as age of the women, relation, education, type of family, marital status, family monthly income, previous occupation, type of activity, number of antenatal visit, type of pregnancy, and area of living. The conceptual framework of this study was based on Melzack and wall gate control theory and it provided a complete framework in order to achieve the objectives of the study. The research methodology adopted for this study was quasi experimental pre and post test control group design. The main study was conducted in selected hospitals at Tirunelveli district. The total sample size was sixty samples who fulfilled the inclusive criteria were allotted to experimental group (n=30) and control group (n=30) by non probability purposive sampling technique. The investigator given doula massage for experimental group and no intervention for control group. The collected data was analyzed and interpreted based on the objectives by using descriptive and inferential statics. MAJOR FINDINGS OF THE STUDY: With regard to the age of women with pain during an active phase of first stage of labour among primigravida mothers out of 60 samples, 8 (26.6%) of the were between the age group of 15-20 years, 15 (50%) were between the age group of 21-25 years, and 7 (23.3%) were between the age group of 26-30 years, in the experimental group. Where as in control group, 10 (33%) of them were between the age group of 15-20 years, 6 (20.6%) were between the age group of 21-25 years, 14 (46.6%) were between the age group of 26-30 years. With analysis to the religion out of 60 samples, 16 (53.3%) were belongs to hindu, 13 (43.3%) of them were belongs to christian, 1 (3.33%) were belongs to muslim none of them were belongs to other religion in the experimental group. Where as in control group, 18 (60%) were belongs to hindu, 25 (40%) were belongs to christian, none of them were belongs to muslim and other religion. With respect to educational status out of 60 samples, 10 (33.3%) were illiterate, 15 (50%) were studied primary education, 5 (16.6%) were completed secondary education, none of them were completed graduate and above in the experimental group. Whereas control group 12 (40%) were illiterate, 10 (33.3%) studied primary education, 8 (26.6%) were completed secondary education, none of them were completed graduate and above. With regard to type of family out of 60 samples, 24 (80%) samples were belongs to nuclear family, 6 (20%) were belongs to joint family, none of them were belongs to extended family in the experimental group. Where as in control group 27 (90%) were belongs to nuclear family, 3 (10%) were belongs to joint family, none of them were belongs to extended family. In relation to marital status out of 60 samples, 30 (100%) were got married, none of them were single, widow and divorced in the experimental group. Where as in control group 30 (100%) were got married, none of them were single, widow and divorced With respect to income in rupees per month none of them were earning Rs>2000, 10 (33.3%) were earning between Rs.2001-5000, 20 (66.6%) were earning between Rs.5001-10,000 and none of them were earning > 10,001. Where as in control group none of them were earning Rs>2000, 8 (26.6%) were earning between 2001-5000, 22 (73.3%) were earning between Rs.5001-10,000 and none of them were earning > 10,001. On analysis of previous occupation out of 60 samples, 10 (33.3%) were coolie worker, 20 (66.6%) were private employee/self employee, none of them were unemployed, none of them were government employee in the experimental group. Where as in control group none of them were unemployed, 12 (40%) were coolie worker, 18 (60%) were private employee/self employee, none of them were government employee. With regard the type of activity out of 60 samples, 10 (33.3%) were doing sedentary activity, 20 (66.6%) were doing moderate activity, none of them were doing heavy activity in the experimental group. Where as in control group 15 (50%) were doing sedentary activity, 15 (50%) doing were moderate activity, none of them were doing heavy activity. With regard the number of antenatal visits out of 60 samples, none of them were attended >3 visits, 25 (83.3%) were attended 4-6 visits, 5 (16.6%) were attended 7-10 visits, none of them attended more than 10 visits in the experimental group. Where as in control group none of them were attended >3 visits, 20 (66.6%) were attended 4-6 visits, 10 (33.3%) were attended 7-10 visits, none of them attended more than 10 visits. With regard the type of pregnancy out of 60 samples, 10 (33.3%) were planned, 20 (66.6%) were unplanned in the experimental group. Where as in control group 8 (26.6%) were planned, 22 (73.3%) were unplanned. With regard the area of living out of 60 samples, 15 (50%) were living in urban, 15 (50%) were living in rural in the experimental group. Where as in control group 20 (66.6%) were living in urban, 10 (33.3%) living in rural. With regard the pre test level of pain among Primigravida mothers experimental group, 3 (10%) had mild level of pain, 10 (33.3%) had moderate level of pain, and 17 (56.6%) had severe pain. Whereas control group, 2 (6.6%) had mild level of pain, 12 (40%) had moderate level of pain, 16 (53.3%) had severe pain. With regard the post test among the experimental group, 3 (10%) of them had mild level of pain, 10 (33.3%) of them had moderate level of pain, and 17 (56.6%) had severe pain. It is evident from the above table that, in the post test among control group, 2 (6.6%) had mild level of pain, 12 (40%) had moderate level of pain, and 16 (53.3%) had severe pain. Comparison of mean post test value for experimental group was 3.53 and standard deviation was 2.08, where as in control group post test mean value was 6.63 and standard deviation was 2.41. Their mean difference was 3.1. The calculated “t’ value was 1.72. Which shows that there was a significance difference in the effectiveness of doula massage between experimental and control group at p<0.05 level. So the research hypothesis was accepted. Comparison of the experimental group the mean pre-test value was 7.1 and standard deviation was 6.49 and mean post-test value was 3.53 and standard deviation was 2.08. Their mean difference is 3.57, and the calculated ‘t’ value was 2.32. Which shows that there was significance difference in the pre test and post test level of pain during an active phase of first stage of labour among Primigravida mothers in experimental group at p<0.05 level. So the research hypothesis was accepted. Comparison of control group the mean pre-test value was 5.8 and standard deviation was 7.61 and mean post-test value was 6.63 and standard deviation was 2.41. Their mean difference is 0.83, and the calculated ‘t’ value was 5.2 which shows that there was a significant difference in the pre test and post test level of pain during an active phase of first stage of labour among primigravida mothers in control group at p<0.05 level. So the research hypothesis was accepted. Chi-square test to associate the post test level of pain with their selected demographic variables in the experimental group. While analyzing the statistical significant at (P<0.05) level shows that there was a significant association between the post test level of pain with the selected demographic variables like Religion, Educational Status, Family monthly income, Previous occupation, Type of activity, Number of ante natal visit, Type of pregnancy, and Area of living. There is no significant association of age of the women, type of family, marital status. Chi-square test to associate the post test level of pain with their selected demographic variables in the control group. While analyzing the statistical significant at (P<0.05) level shows that there was a significant association between the post test the level of pain with the selected demographic variables like Age of the women, Religion, Educational Status, Marital status, Family monthly income, Previous occupation, Type of activity, Number of ante natal visit, Type of pregnancy, and Area of living. There was no significant association in type of family. BASED ON THE FINDINGS OF THE STUDY IT IS RECOMMENDED THAT: • The study can be conducted with large samples for better generalization. • A study can be conducted to assess the knowledge and practice of doula massage for labour pain management among nurse midwives. • A study can be conducted to assess the knowledge and attitude of complementary therapies for first stage of labour pain management among nurse midwives. • A study can be conducted to assess the effectiveness of other alternative measures such as music, aromatherapy and acupuncture for reduction of labour pain among Primigravida mothers. • A study can be conducted to assess the effectiveness of doula massage on induction of labour in Primigravida mothers during labour. • A study can be conducted to assess the effectiveness of doula massage on reduction of anxiety in Primigravida mothers during first stage of labour. CONCLUSION: The present study assessed the effectiveness of doula massage on reduction of pain during an active phase of first stage of labour among Primigravida mothers. The result of the study was concluded that doula massage was effective in reduction of pain among Primigravida mothers

Nanoscale Friction Switches: Friction Modulation of Monomolecular Assemblies Using External Electric Fields

This paper presents experimental investigations to actively modulate the nanoscale friction properties of a self-assembled monolayer (SAM) assembly using an external electric field that drives conformational changes in the SAM. Such “friction switches” have widespread implications in interfacial energy control in micro/nanoscale devices. Friction response of a low-density mercaptocarboxylic acid SAM is evaluated using an atomic force microscope (AFM) in the presence of a DC bias applied between the sample and the AFM probe under a nitrogen (dry) environment. The low density allows reorientation of individual SAM molecules to accommodate the attractive force between the −COOH terminal group and a positively biased surface. This enables the surface to present a hydrophilic group or a hydrophobic backbone to the contacting AFM probe depending upon the direction of the field (bias). Synthesis and deposition of the low-density SAM (LD-SAM) is reported. Results from AFM experiments show an increased friction response (up to 300%) of the LD-SAM system in the presence of a positive bias compared to the friction response in the presence of a negative bias. The difference in the friction response is attributed to the change in the structural and crystalline order of the film in addition to the interfacial surface chemistry and composition presented upon application of the bias

MOAP-1 Mediates Fas-Induced Apoptosis in Liver by Facilitating tBid Recruitment to Mitochondria

SummaryFas apoptotic signaling regulates diverse physiological processes. Acute activation of Fas signaling triggers massive apoptosis in liver. Upon Fas receptor stimulation, the BH3-only protein Bid is cleaved into the active form, tBid. Subsequent tBid recruitment to mitochondria, which is facilitated by its receptor MTCH2 at the outer mitochondrial membrane (OMM), is a critical step for commitment to apoptosis via the effector proteins Bax or Bak. MOAP-1 is a Bax-binding protein enriched at the OMM. Here, we show that MOAP-1-deficient mice are resistant to Fas-induced hepatocellular apoptosis and lethality. In the absence of MOAP-1, mitochondrial accumulation of tBid is markedly impaired. MOAP-1 binds to MTCH2, and this interaction appears necessary for MTCH2 to engage tBid. These findings reveal a role for MOAP-1 in Fas signaling in the liver by promoting MTCH2-mediated tBid recruitment to mitochondria

Timing of radiotherapy after radical prostatectomy (RADICALS-RT): a randomised, controlled phase 3 trial

Background: The optimal timing of radiotherapy after radical prostatectomy for prostate cancer is uncertain. We aimed to compare the efficacy and safety of adjuvant radiotherapy versus an observation policy with salvage radiotherapy for prostate-specific antigen (PSA) biochemical progression. / Methods: We did a randomised controlled trial enrolling patients with at least one risk factor (pathological T-stage 3 or 4, Gleason score of 7–10, positive margins, or preoperative PSA ≥10 ng/mL) for biochemical progression after radical prostatectomy (RADICALS-RT). The study took place in trial-accredited centres in Canada, Denmark, Ireland, and the UK. Patients were randomly assigned in a 1:1 ratio to adjuvant radiotherapy or an observation policy with salvage radiotherapy for PSA biochemical progression (PSA ≥0·1 ng/mL or three consecutive rises). Masking was not deemed feasible. Stratification factors were Gleason score, margin status, planned radiotherapy schedule (52·5 Gy in 20 fractions or 66 Gy in 33 fractions), and centre. The primary outcome measure was freedom from distant metastases, designed with 80% power to detect an improvement from 90% with salvage radiotherapy (control) to 95% at 10 years with adjuvant radiotherapy. We report on biochemical progression-free survival, freedom from non-protocol hormone therapy, safety, and patient-reported outcomes. Standard survival analysis methods were used. A hazard ratio (HR) of less than 1 favoured adjuvant radiotherapy. This study is registered with ClinicalTrials.gov, NCT00541047. / Findings: Between Nov 22, 2007, and Dec 30, 2016, 1396 patients were randomly assigned, 699 (50%) to salvage radiotherapy and 697 (50%) to adjuvant radiotherapy. Allocated groups were balanced with a median age of 65 years (IQR 60–68). Median follow-up was 4·9 years (IQR 3·0–6·1). 649 (93%) of 697 participants in the adjuvant radiotherapy group reported radiotherapy within 6 months; 228 (33%) of 699 in the salvage radiotherapy group reported radiotherapy within 8 years after randomisation. With 169 events, 5-year biochemical progression-free survival was 85% for those in the adjuvant radiotherapy group and 88% for those in the salvage radiotherapy group (HR 1·10, 95% CI 0·81–1·49; p=0·56). Freedom from non-protocol hormone therapy at 5 years was 93% for those in the adjuvant radiotherapy group versus 92% for those in the salvage radiotherapy group (HR 0·88, 95% CI 0·58–1·33; p=0·53). Self-reported urinary incontinence was worse at 1 year for those in the adjuvant radiotherapy group (mean score 4·8 vs 4·0; p=0·0023). Grade 3–4 urethral stricture within 2 years was reported in 6% of individuals in the adjuvant radiotherapy group versus 4% in the salvage radiotherapy group (p=0·020). / Interpretation: These initial results do not support routine administration of adjuvant radiotherapy after radical prostatectomy. Adjuvant radiotherapy increases the risk of urinary morbidity. An observation policy with salvage radiotherapy for PSA biochemical progression should be the current standard after radical prostatectomy. / Funding: Cancer Research UK, MRC Clinical Trials Unit, and Canadian Cancer Society

Functional Crosstalk between Type I and II Interferon through the Regulated Expression of STAT1

Small "priming" quantities of type I interferon enhance cellular responses to type II interferon by maintaining basal levels of STAT1, explaining the observed crosstalk between these two cytokines

Ecological Effects of Genotypic Diversity on Community and Ecosystem Function

Genotypic diversity within populations can have important evolutionary consequences, but the ecological effects of intraspecific genetic variation on community and ecosystem function have only been studied in a few systems. I present the results of a three-year study designed to address the ecological impacts of genotypic diversity in quaking aspen (Populus tremuloides Michx.), using aspen genotypes planted across genotypic diversity levels (monoculture and mixture) and watering treatment levels (well-watered and water-limited). First, I demonstrated that significant variation exists among genotypes for a wide range of growth, morphological and physiological traits, and quantified high heritability and coefficient of genetic variation values for those traits. This demonstrates that heritable phenotypic variation exists within an aspen population, which could potentially have community and ecosystem implications. Secondly, I collected ground-dwelling arthropods across experimental treatment levels to determine if there are any community-level implications of genotypic diversity and watering treatment. Ground-dwelling arthropods were significantly affected by the genotypic diversity × watering treatment interaction, such that arthropod taxonomic diversity was lowest in water-limited genotypic mixtures. This result runs counter to the bulk of the plant diversity-arthropod diversity literature, which predicts that plant and arthropod diversity should be positively correlated, and highlights the importance of environmental conditions in mediating the plant-arthropod diversity relationship. Lastly, I show that there are no overall effects of genotypic diversity or watering treatment on tree growth patterns. Instead, there are high levels of variation among genotypes in their responses to treatments (significant genotype × diversity × watering treatment interactions), which are often opposing in direction. I also show that there are significant collection site × diversity × watering treatment interactions, demonstrating that genotypes vary in their response to experimental treatments based in part on their original collection site conditions in the field. This study demonstrates that aspen populations contain high levels of genotypic diversity, but that the ecological effects of genotypic diversity are mediated by the environment (in this case, watering treatment) and can be considerably more complicated than found in most previous studies

A REVIEW ON BREAST ELECTRICAL IMPEDANCE TOMOGRAPHY CLINICAL ACCURACY

ABSTRACT Electrical Impedance Tomography (EIT) is a non-invasive procedure using electrical impedance to image the human breast. Due to its mobility and using non-compression technique it is appealing to patients. This scanning device does not emit any ionizing radiation thus it can be done on pregnant women by means of no age limit. Since the EIT has play some supplementary function in the breast imaging, a lot of research on its clinical accuracy has been done. Therefore, the aim is to carry out a review of EIT clinical accuracy and assess the quality of journal by using Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria. The journals that assess the sensitivity were search through various databases and the clinical accuracy of EIT in each journal is recorded. The review shows that the range sensitivity (Sn) of EIT system to human breast in ten journals was between 17% and 94.6%. The range of specificity (Sp) is between 49% and 97.1%. The negative (NPV) and positive predictive value (PPV) is between 74% and 98%; 4% and 73.3% respectively. The accuracy (ACC) of EIT is between 69% and 80.5%. This value is found to be supported that EIT can be used as an adjunct screening technique for human breast