Trying to conceive: An interpretive phenomenological analysis of couples’ experiences of pregnancy after stillbirth

Objective: Stillbirth affects 1:200 pregnancies in high income countries. Most women are pregnant again within 12 months. Little is known about how couples negotiate a subsequent pregnancy. This paper presents findings from a study exploring the experiences of couples’ in pregnancy after stillbirth. Methods: Qualitative, interpretive phenomenological analysis was used to conduct in-depth interviews with eight heterosexual couples in the immediate pregnancy after stillbirth. Couples were interviewed together to explore their dyadic, lived experiences of stillbirth and the pregnancy that follows. Results: Hoping for a born alive baby was one superordinate theme and Trying to conceive one of its subordinate themes, is presented here. Couples jointly negotiated their decision to get pregnant again, varying upon their individual circumstances, including their experiences of stillbirth. Gender differences were apparent in a couple’s agreement to pursue a pregnancy after stillbirth and may be explained by the desire of men to fully parent the baby who died before reaching a decision about a subsequent pregnancy. Sexual intercourse often became less about emotional connection and more about a means to achieve a pregnancy. Conclusion: Couples spoke of the need for each partner to be in agreement with the decision for a pregnancy. The experiences of trying to conceive after stillbirth impacted the couple relationships. Couples who were able to discuss their feelings with one another appeared more cohesive than those who experienced communication challenges in the aftermath of loss. New insights into men’s thinking about the decision to get pregnant after stillbirth were revealed

Timing behavior of the Magnetically Active Rotation-Powered Pulsar in the Supernova Remnant Kestevan 75

We report a large spin-up glitch in PSR J1846-0258 which coincided with the onset of magnetar-like behavior on 2006 May 31. We show that the pulsar experienced an unusually large glitch recovery, with a recovery fraction of Q=8.7+/- 2.5, resulting in a net decrease of the pulse frequency. Such a glitch recovery has never before been observed in a rotation-powered pulsar, however, similar but smaller glitch over-recovery has been recently reported in the magnetar AXP 4U~0142+61 and may have occurred in the SGR 1900+14. We also report a large increase in the timing noise of the source. We discuss the implications of the unusual timing behavior in PSR J1846-0258 on its status as the first identified magnetically active rotation-powered pulsar.Comment: 14 pages, 5 figures, Accepted for publication in the Astrophysical Journal. Incorporates changes from an anonymous referee; additional analysis and discussion include

Strategies to optimize the impact of nutritional surveys and epidemiological studies

The development of nutrition and health guidelines and policies requires reliable scientific information. Unfortunately, theoretical considerations and empirical evidence indicate that a large percentage of science-based claims rely on studies that fail to replicate. The session "Strategies to Optimize the Impact of Nutrition Surveys and Epidemiological Studies" focused on the elements of design, interpretation, and communication of nutritional surveys and epidemiological studies to enhance and encourage the production of reliable, objective evidence for use in developing dietary guidance for the public. The speakers called for more transparency of research, raw data, consistent data-staging techniques, and improved data analysis. New approaches to collecting data are urgently needed to increase the credibility and utility of findings from nutrition epidemiological studies. Such studies are critical for furthering our knowledge and understanding of the effects of diet on health

Witnessing Stories: Definitional Ceremonies in Narrative Therapy with Adults who Stutter

Background: Narrative therapy (White & Epston, 1990) was developed as an approach to counselling, as a response to the power relations that influence people\u27s lives. Its use with people who stutter has been documented. A basic tenet of narrative therapy is that the dominant problem-saturated narrative is challenged by externalizing the problem, in due course facilitating development of an alternative narrative. Within this process, the definitional ceremony involving outsider witnesses is a key procedure used to influence change. Aims: This paper describes definitional ceremonies, and their application within a narrative approach to therapy for stuttering. The analysis of a specific definitional ceremony is presented, leading to an exploration of identity as a public and social achievement. Methods: A definitional ceremony involving a woman who stutters and family members was recorded and analysed using two methods: interpretative phenomenological analysis and Heideggerian hermeneutic phenomenological analysis. Details of the clinical application of definitional ceremonies with this client are described. Results and Conclusions: Results from both methods of analysis were found to be similar. Notable results include the fact that the stuttering per se was not presented as the problem; rather, the impact of stuttering, especially the experience of bullying, was a dominant theme. This paper shows how definitional ceremonies can open opportunities for clients to present themselves in a preferred way, forming the basis for a new story and re-vised identity. Emerging themes can be identified for reflection and discussion with the client for therapeutic benefit

EDUCATION OF EUROPEAN FLUENCY SPECIALISTS The European Clinical Specialization on Fluency Disorders (ECSF)

The European Clinical Specialization on Fluency Disorders (ECSF) project consists of one-year post-qualification fluency specialization training and a harmonized graduate fluency program. It was developed by eight European universities/colleges to provide the means whereby graduates would meet comparable standards of competence to practice in the field of fluency disorders. In this paper we describe criteria that guided the consortium in their decision making process to create an optimal learning environment for participants. A review of the first completed course cycle, with 23 international participants, is discussed

Disorders of communication: the science of intervention, 2nd.ed/ Leahy

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Clinical cases in fluency disorders

Clinical Cases in Dysfluency is an imperative work that introduces dysfluency in clinical and cultural contexts while encouraging reflection on clinical decision-making involving the assessment and management of clients. With inputs from eminent clinical researchers across the world, this text brings together diverse voices and expertise to provide readers with innovative ideas for their own practice. The book assists in refining clinical problem solving and valuing exchanges between clients and clinicians. Featuring real-life case studies covering stuttering and cluttering in children and adults, it showcases the importance of evidence-based practice and practitioner reflection, demonstrating a range of approaches to address problems experienced with dysfluency, and their management. The authors go on to discuss issues of stereotyping, resilience, and therapeutic commonalities in general, and in multicultural contexts, whilst also introducing the discipline of Dysfluency Studies, where stuttering is considered positively in its complexity and not as a disorder. These concepts are effectively further illustrated through accompanying online resources including videos, and weblinks. This is an indispensable resource for students and clinicians in the domains of Fluency, Speech and Language Pathology and Communication Disorders, and will be valuable reading to anyone interested in communication disorders, dysfluencies, and application of theory to practice in these disciplines

Midwives' experiences of caring for women's emotional and mental well-being during pregnancy

Aims and Objectives: To explore midwives’ experiences of caring for women’s emotional and mental well‐being during pregnancy. Background: Pregnancy and childbirth is one of the most life changing transitions a woman can encounter and therefore approximately 15‐25% of women will experience a perinatal mental health problem. Providing psychological support to mothers by midwives is acknowledged internationally. The 2016 Irish National Maternity Strategy identifies midwives as being ideally placed to assess women’s emotional needs. The research revealed a paucity of qualitative research from an Irish context in this area, therefore this study addressed this gap in the literature. Design: Qualitative descriptive design. Methods: Semi‐structured interviews were conducted with a purposive sample of 10 midwives’ recruited from the Irish midwifery e‐group. Data were analysed using Burnard (1991) thematic content analysis. Transcripts were coded, and meanings were formulated to reflect significant statements, which were categorised. Categories then evolved into subthemes and eventually three themes emerged using the COREQ checklist. Results: Three salient themes emerged from the data: ‘awareness of Perinatal Mental Health’, ‘discussing emotional well‐being’, and ‘the woman has something to divulge’. The themes convey the midwife’s awareness, recognition and perceptions of mental well‐being during pregnancy. How midwives discuss and assess emotional well‐being, the observational skills they utilise, and what they perceive as the barriers and facilitators to discussing mental well‐being were all identified. Conclusions: Midwives reported an awareness and acceptance that women’s emotional health was as important as their physical health. Midwives utilised every antenatal opportunity to raise awareness about perinatal mental health, whilst also identifying key challenges in getting women to talk. Relevance to Clinical Practice: Care pathways for assessing and identifying Perinatal Mental Health issues should be available in all maternity services. More support for midwives is required to debrief, which would assist them in supporting women’s emotional well‐being

Midwives\u27 experiences of caring for women\u27s emotional and mental well-being during pregnancy

Aims and Objectives: To explore midwives’ experiences of caring for women’s emotional and mental well‐being during pregnancy. Background: Pregnancy and childbirth is one of the most life changing transitions a woman can encounter and therefore approximately 15‐25% of women will experience a perinatal mental health problem. Providing psychological support to mothers by midwives is acknowledged internationally. The 2016 Irish National Maternity Strategy identifies midwives as being ideally placed to assess women’s emotional needs. The research revealed a paucity of qualitative research from an Irish context in this area, therefore this study addressed this gap in the literature. Design: Qualitative descriptive design. Methods: Semi‐structured interviews were conducted with a purposive sample of 10 midwives’ recruited from the Irish midwifery e‐group. Data were analysed using Burnard (1991) thematic content analysis. Transcripts were coded, and meanings were formulated to reflect significant statements, which were categorised. Categories then evolved into subthemes and eventually three themes emerged using the COREQ checklist. Results: Three salient themes emerged from the data: ‘awareness of Perinatal Mental Health’, ‘discussing emotional well‐being’, and ‘the woman has something to divulge’. The themes convey the midwife’s awareness, recognition and perceptions of mental well‐being during pregnancy. How midwives discuss and assess emotional well‐being, the observational skills they utilise, and what they perceive as the barriers and facilitators to discussing mental well‐being were all identified. Conclusions: Midwives reported an awareness and acceptance that women’s emotional health was as important as their physical health. Midwives utilised every antenatal opportunity to raise awareness about perinatal mental health, whilst also identifying key challenges in getting women to talk. Relevance to Clinical Practice: Care pathways for assessing and identifying Perinatal Mental Health issues should be available in all maternity services. More support for midwives is required to debrief, which would assist them in supporting women’s emotional well‐being

Reliability and validity evidence of the Assessment of Language Use in Social Contexts for Adults (ALUSCA)

Background: The appropriate use of language in context depends on the speaker's pragmatic language competencies. A coding system was used to develop a specific and adult-focused self-administered questionnaire to adults who stutter and adults who do not stutter, The Assessment of Language Use in Social Contexts for Adults, with three categories: precursors, basic exchanges, and extended literal/non-literal discourse. This paper presents the content validity, item analysis, reliability coefficients and evidences of construct validity of the instrument. Methods: Content validity analysis was based on a two-stage process: first, 11 pragmatic questionnaires were assessed to identify items that probe each pragmatic competency and to create the first version of the instrument; second, items were assessed qualitatively by an expert panel composed by adults who stutter and controls, and quantitatively and qualitatively by an expert panel composed by clinicians. A pilot study was conducted with five adults who stutter and five controls to analyse items and calculate reliability. Construct validity evidences were obtained using the hypothesized relationships method and factor analysis with 28 adults who stutter and 28 controls. Results: Concerning content validity, the questionnaires assessed up to 13 pragmatic competencies. Qualitative and quantitative analysis revealed ambiguities in items construction. Disagreement between experts was solved through item modification. The pilot study showed that the instrument presented internal consistency and temporal stability. Significant differences between adults who stutter and controls and different response profiles revealed the instrument's underlying construct. Conclusion: The instrument is reliable and presented evidences of construct validity.publishe