Women's experiences and satisfaction with having a cesarean birth: An integrative review.

BACKGROUND:With around one third of woman having a cesarean birth, better understanding of women's experiences of having a cesarean is vital to improve women's experiences of care. The aim of this review was to gain insight into women's experiences of and satisfaction with cesarean and to identify factors that contribute to women's poor experiences of care. METHODS:Using an integrative methodology, evidence was systematically considered in relation to women's experiences of cesarean birth and whether they were satisfied with their experience of care. To identify studies, PubMed, Maternity and Infant Care, MEDLINE, and Web of Science were searched for the period from 2008 to 2018, and reference lists of included studies were examined. RESULTS:Twenty-six studies were included. Although the majority of women were satisfied with their cesarean, a large minority of women were dissatisfied and reported a negative experience. In particular, women who had an emergency cesarean were less satisfied than women who had a vaginal birth. Nonmedical factors or experiences that appear associated with dissatisfaction include (a) feeling ignored and disempowered; (b) experiencing a loss of control; (c) not being informed; and (d) birth values that favor vaginal birth. CONCLUSIONS:Women's experiences of cesarean birth appear influenced by the circumstances (emergency vs planned), the extent to which they felt involved in decision-making and in control of their experience, and their birth values and beliefs. Increasing antenatal, intrapartum, and postpartum communication and shared decision-making may help engage women as an active participant in their own birth

On the Crepant Resolution Conjecture in the Local Case

In this paper we analyze four examples of birational transformations between local Calabi-Yau 3-folds: two crepant resolutions, a crepant partial resolution, and a flop. We study the effect of these transformations on genus-zero Gromov-Witten invariants, proving the Coates-Corti-Iritani-Tseng/Ruan form of the Crepant Resolution Conjecture in each case. Our results suggest that this form of the Crepant Resolution Conjecture may also hold for more general crepant birational transformations. They also suggest that Ruan's original Crepant Resolution Conjecture should be modified, by including appropriate "quantum corrections", and that there is no straightforward generalization of either Ruan's original Conjecture or the Cohomological Crepant Resolution Conjecture to the case of crepant partial resolutions. Our methods are based on mirror symmetry for toric orbifolds.Comment: 27 pages. This is a substantially revised and shortened version of my preprint "Wall-Crossings in Toric Gromov-Witten Theory II: Local Examples"; all results contained here are also proved there. To appear in Communications in Mathematical Physic

Achieving minimal disease activity in psoriatic arthritis predicts meaningful improvements in patients’ health-related quality of life and productivity

Background Although psoriatic arthritis is complex and involves multiple domains, recent advances in treatments have made remission or near-remission of most symptoms a potentially achievable goal for many patients. We sought to evaluate whether achieving minimal disease activity (MDA) criteria represented meaningful improvement from the patient perspective. Methods Data were combined from two randomized, multinational, 24 week clinical studies of ixekizumab, a high-affinity monoclonal antibody selectively targeting interleukin-17A, in biological drug-naïve or experienced adults. MDA required 5 of 7 of: tender joint count ≤1; swollen joint count ≤1; Psoriasis Area and Severity Index total score ≤ 1 or body surface area ≤ 3%; patient’s assessment of pain visual analogue scale (VAS) ≤15; patient’s global assessment of disease activity VAS ≤20; Health Assessment Questionnaire Disability Index ≤0.5; and tender entheseal points ≤ 1. MDA responders and non-responders were compared for mean change from baseline on the 36-Item Short Form Health Survey (SF-36), European Quality of Life 5 Dimension 5 Level Health Questionnaire (EQ-5D-5 L); EQ-5D-5 L VAS; and Work Productivity and Activity Impairment–Specific Health Problem (WPAI-SHP) questionnaire. Results MDA responders had significantly greater improvements versus non-responders in each SF-36 domain and in the SF-36 physical summary score; improvements were also greater in the EQ-5D-5 L and EQ-5D-5 L VAS, and in 3 of the 4 WPAI-SHP domains. MDA responders were more likely to achieve minimal clinically important differences than non-responders. Conclusion These findings support MDA response as being strongly associated with achieving improved disease status based on measures of patient reported health-related quality of life and productivity. Trial registration SPIRIT-P1, NCT01695239, First Posted: September 27, 2012; and SPIRIT-P2, NCT02349295, First Posted: January 28, 2015

Proliferating cell nuclear antigen expression in non-cycling cells may be induced by growth factors in vivo.

The proliferating cell nuclear antigen (PCNA) is required for DNA replication and DNA nucleotide excision repair. Considerable evidence points to PCNA expression being a marker of proliferation in many situations. However, while levels of PCNA are normally very low in non-cycling tissues, high levels of the protein have been observed in the normal tissues surrounding human breast and pancreatic tumours. Using two model systems we have shown that PCNA is induced in non-cycling cells by adjacent transplanted tumour cells and that this phenomenon may be mimicked by the in vivo administration of growth factors (transforming growth factor alpha and epidermal growth factor). These data suggest that tumours may elaborate factors that induce PCNA expression in nearby normal cells. PCNA induction the normal cells surrounding tumours is a direct example of the effect of tumour cells on normal surrounding tissues. This effect may prove to be a useful parameter in the analysis of tumour-host interactions

Uninvited guest in mixed derivative Hořava gravity

We revisit the mixed-derivative extension of Hořava gravity which was designed to address the naturalness problems of the standard theory in the presence of matter couplings. We consider the minimal theory with mixed-derivative terms that contain two spatial and two temporal derivatives. Including all terms compatible with the (modified) scaling rules and the foliation-preserving diffeomorphisms, we calculate the dispersion relations of propagating modes. We find that the theory contains four propagating degrees of freedom, as opposed to three in the standard Hořava gravity. The new degree of freedom is another scalar graviton, and it is unstable at low energies. Our result brings tension to the Lorentz-violation suppression mechanism that relies on separation of scales

The interaction of class and gender in illness narratives

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2008 BSA Publications Ltd.Perspectives on gender and identity that emphasize variability of performance, local context and individual agency have displaced earlier paradigms.These are now perceived to have supported gender stereotypes and language ideologies by emphasizing gender difference and homogeneity within genders. In a secondary analysis of health and illness narratives we explore the interaction of class and gender in individuals' constructions of gendered identity. High social class men perform gender in particularly varied ways and we speculate that this variable repertoire, including the use of what was once termed `women's language', is linked to a capacity to maintain social distinction and authority. Men's performance of conventional masculinity is often threatened by both the experience of illness and being interviewed about personal experience. Lower social class women in particular demonstrate an intensification of a pre-existing informal family and support group culture, marking successful members by awarding them the accolade of being `lovely'.ESR

What are women's mode of birth preferences and why? A systematic scoping review

Background: The optimal caesarean section rate is estimated to be between 10–15%; however, it is much higher in high and many middle-income countries and continues to be lower in some middle and low-income countries. While a range of factors influence caesarean section rates, women's mode of birth preferences also play a role. The aim of this study was to map the literature in relation to women's mode of birth preferences, and identify underlying reasons for, and factors associated with, these preferences. Method: Using a scoping review methodology, quantitative and qualitative evidence was systematically considered. To identify studies, PubMed, Maternity and Infant Care, MEDLINE, and Web of Science were searched for the period from 2008 to 2018, and reference lists of included studies were examined. Findings: A total of 65 studies were included. While the majority of women prefer a vaginal birth, between 5–20% in high-income countries and 1.4 to 50% in low-middle-income countries prefer a caesarean section. The six main reasons or factors associated with a mode of birth preference were: (1) perceptions of safety; (2) fear of pain; (3) previous birth experience; (4) encouragement and dissuasion from health professionals; (5) social and cultural influences; and (6) access to information and educational levels. Conclusion: To help ensure women receive the required care that is aligned with their preferences, processes of shared decision-making should be implemented. Shared decision-making has the potential to reduce the rate of unnecessary interventions, and also improve the willingness of women to accept a medically-indicated caesarean section in low-income countries

What are women's mode of birth preferences and why? A systematic scoping review.

BACKGROUND:The optimal caesarean section rate is estimated to be between 10-15%; however, it is much higher in high and many middle-income countries and continues to be lower in some middle and low-income countries. While a range of factors influence caesarean section rates, women's mode of birth preferences also play a role. The aim of this study was to map the literature in relation to women's mode of birth preferences, and identify underlying reasons for, and factors associated with, these preferences. METHOD:Using a scoping review methodology, quantitative and qualitative evidence was systematically considered. To identify studies, PubMed, Maternity and Infant Care, MEDLINE, and Web of Science were searched for the period from 2008 to 2018, and reference lists of included studies were examined. FINDINGS:A total of 65 studies were included. While the majority of women prefer a vaginal birth, between 5-20% in high-income countries and 1.4 to 50% in low-middle-income countries prefer a caesarean section. The six main reasons or factors associated with a mode of birth preference were: (1) perceptions of safety; (2) fear of pain; (3) previous birth experience; (4) encouragement and dissuasion from health professionals; (5) social and cultural influences; and (6) access to information and educational levels. CONCLUSION:To help ensure women receive the required care that is aligned with their preferences, processes of shared decision-making should be implemented. Shared decision-making has the potential to reduce the rate of unnecessary interventions, and also improve the willingness of women to accept a medically-indicated caesarean section in low-income countries