Women’s experiences of transfer from primary maternity unit to tertiary hospital in New Zealand: part of the prospective cohort Evaluating Maternity Units study

BACKGROUND: There is worldwide debate regarding the appropriateness and safety of different birthplaces for well women. The Evaluating Maternity Units (EMU) study’s primary objective was to compare clinical outcomes for well women intending to give birth in either a tertiary level maternity hospital or a freestanding primary level maternity unit. Little is known about how women experience having to change their birthplace plans during the antenatal period or before admission to a primary unit, or transfer following admission. This paper describes and explores women’s experience of these changes-a secondary aim of the EMU study. METHODS: This paper utilised the six week postpartum survey data, from the 174 women from the primary unit cohort affected by birthplace plan change or transfer (response rate 73 %). Data were analysed using descriptive statistics and thematic analysis. The study was undertaken in Christchurch, New Zealand, which has an obstetric-led tertiary maternity hospital and four freestanding midwife-led primary maternity units (2010–2012). The 702 study participants were well, pregnant women booked to give birth in one of these facilities, all of whom received continuity of midwifery care, regardless of their intended or actual birthplace. RESULTS: Of the women who had to change their planned place of birth or transfer the greatest proportion of women rated themselves on a Likert scale as unbothered by the move (38.6 %); 8.8 % were ‘very unhappy’ and 7.6 % ‘very happy’ (quantitative analysis). Four themes were identified, using thematic analysis, from the open ended survey responses of those who experienced transfer: ‘not to plan’, control, communication and ‘my midwife’. An interplay between the themes created a cumulatively positive or negative effect on their experience. Women’s experience of transfer in labour was generally positive, and none expressed stress or trauma with transfer. CONCLUSIONS: The women knew of the potential for change or transfer, although it was not wanted or planned. When they maintained a sense control, experienced effective communication with caregivers, and support and information from their midwife, the transfer did not appear to be experienced negatively. The model of continuity of midwifery care in New Zealand appeared to mitigate the negative aspects of women’s experience of transfer and facilitate positive birth experiences

Weighted network modules

The inclusion of link weights into the analysis of network properties allows a deeper insight into the (often overlapping) modular structure of real-world webs. We introduce a clustering algorithm (CPMw, Clique Percolation Method with weights) for weighted networks based on the concept of percolating k-cliques with high enough intensity. The algorithm allows overlaps between the modules. First, we give detailed analytical and numerical results about the critical point of weighted k-clique percolation on (weighted) Erdos-Renyi graphs. Then, for a scientist collaboration web and a stock correlation graph we compute three-link weight correlations and with the CPMw the weighted modules. After reshuffling link weights in both networks and computing the same quantities for the randomised control graphs as well, we show that groups of 3 or more strong links prefer to cluster together in both original graphs.Comment: 19 pages, 7 figure

Large Magellanic Cloud Planetary Nebula Morphology: Probing Stellar Populations and Evolution

Planetary Nebulae (PNe) in the Large Magellanic Cloud (LMC) offer the unique opportunity to study both the Population and evolution of low- and intermediate-mass stars, by means of the morphological type of the nebula. Using observations from our LMC PN morphological survey, and including images available in the HST Data Archive, and published chemical abundances, we find that asymmetry in PNe is strongly correlated with a younger stellar Population, as indicated by the abundance of elements that are unaltered by stellar evolution (Ne, Ar, S). While similar results have been obtained for Galactic PNe, this is the first demonstration of the relationship for extra-galactic PNe. We also examine the relation between morphology and abundance of the products of stellar evolution. We found that asymmetric PNe have higher nitrogen and lower carbon abundances than symmetric PNe. Our two main results are broadly consistent with the predictions of stellar evolution if the progenitors of asymmetric PNe have on average larger masses than the progenitors of symmetric PNe. The results bear on the question of formation mechanisms for asymmetric PNe, specifically, that the genesis of PNe structure should relate strongly to the Population type, and by inference the mass, of the progenitor star, and less strongly on whether the central star is a member of a close binary system.Comment: The Astrophysical Journal Letters, in press 4 figure

Neural Correlates of Treatment in Adolescents with Generalized Anxiety Disorder: A Preliminary Investigation

Objective: Generalized anxiety disorder (GAD) is a prevalent and debilitating psychiatric condition in adolescence. Two effective forms of treatment are cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors. This pilot study examined changes in brain function following each type of treatment in GAD. Method: Subjects were 14 youth with GAD (7 had CBT, 7 received fluoxetine) and 10 age- and gender-matched healthy peers. FMRI scans were acquired before and after treatment for patients, and over two comparable time points for controls. During fMRI acquisition, a probe detection task with emotional (angry, happy) and neutral faces allowed for assessment of neural response to threat. Following previous research, region of interest analyses were performed in the right ventrolateral prefrontal cortex (VLPFC). Results: FMRI results showed increased VLPFC activation, relative to controls, in the medication (t(15) = 3.01, p \u3c 0.01) and CBT (t(15) = 3.22, p \u3c 0.01) groups following treatment. Conclusions: This study shows significant increase in VLPFC activation in response to angry faces following treatment with CBT or fluoxetine for GAD. This is consistent with previous research indicating that the VLPFC may facilitate effective responding to underlying neural correlates of anxiety in other brain regions, such as the amygdala

On stability of discretizations of the Helmholtz equation (extended version)

We review the stability properties of several discretizations of the Helmholtz equation at large wavenumbers. For a model problem in a polygon, a complete $k$-explicit stability (including $k$-explicit stability of the continuous problem) and convergence theory for high order finite element methods is developed. In particular, quasi-optimality is shown for a fixed number of degrees of freedom per wavelength if the mesh size $h$ and the approximation order $p$ are selected such that $kh/p$ is sufficiently small and $p = O(\log k)$, and, additionally, appropriate mesh refinement is used near the vertices. We also review the stability properties of two classes of numerical schemes that use piecewise solutions of the homogeneous Helmholtz equation, namely, Least Squares methods and Discontinuous Galerkin (DG) methods. The latter includes the Ultra Weak Variational Formulation

Model Order Reduction for Rotating Electrical Machines

The simulation of electric rotating machines is both computationally expensive and memory intensive. To overcome these costs, model order reduction techniques can be applied. The focus of this contribution is especially on machines that contain non-symmetric components. These are usually introduced during the mass production process and are modeled by small perturbations in the geometry (e.g., eccentricity) or the material parameters. While model order reduction for symmetric machines is clear and does not need special treatment, the non-symmetric setting adds additional challenges. An adaptive strategy based on proper orthogonal decomposition is developed to overcome these difficulties. Equipped with an a posteriori error estimator the obtained solution is certified. Numerical examples are presented to demonstrate the effectiveness of the proposed method

Gene expression time delays & Turing pattern formation systems

The incorporation of time delays can greatly affect the behaviour of partial differential equations and dynamical systems. In addition, there is evidence that time delays in gene expression due to transcription and translation play an important role in the dynamics of cellular systems. In this paper, we investigate the effects of incorporating gene expression time delays into a one-dimensional putative reaction diffusion pattern formation mechanism on both stationary domains and domains with spatially uniform exponential growth. While oscillatory behaviour is rare, we find that the time taken to initiate and stabilise patterns increases dramatically as the time delay is increased. In addition, we observe that on rapidly growing domains the time delay can induce a failure of the Turing instability which cannot be predicted by a naive linear analysis of the underlying equations about the homogeneous steady state. The dramatic lag in the induction of patterning, or even its complete absence on occasions, highlights the importance of considering explicit gene expression time delays in models for cellular reaction diffusion patterning