”I was meant to be able to do this”: women’s experiences of breastfeeding. A phenomenological study

Introduction. There is strong evidence demonstrating that human breastmilk provides complete nutrition for human infants. While the rate of initiation of breastfeeding in the UK has increased steadily over the last 25 years, rates of exclusive breastfeeding in the early weeks and months over the same time period have shown only marginal increases. Method. An interpretive phenomenological approach informed by the philosophy of Martin Heidegger was adopted. The aim was to understand women’s experience of breastfeeding. Women were recruited from one city in the East Midlands in the UK, where the prevalence of breastfeeding is decreasing. Potential participants were recruited via health visitors at the primary birth visit. Ethical approval was received from the university and NHS research ethics committees. Data were collected between three and six months after the birth of their youngest child and analysis was guided by interpretive phenomenological principles. Findings. The women were found to be ill-prepared for the realities of breastfeeding and, for most women, the shock of this experience was overwhelming. In particular there was a lack of understanding and preparation for common problems and a lack of awareness of newborn behaviour. Misunderstandings of newborn behaviour resulted in the women blaming infantfeeding behaviours, such as crying, wakeful states and cluster feeding, on the specific method of infant-feeding. Frequent feeding cues were overwhelming and the women felt overawed by the sense of responsibility. It also led them to question their ability to provide an adequate milk supply. Discussion. The extent to which inadequate preparation for breastfeeding had a negative impact on the breastfeeding experiences of women in this study was a surprise. Antenatal education should focus more on preparing women for the realities. Education and support for breastfeeding women need to encompass infant-feeding cues and infant behaviours

Effect of breed and pasture type on methane emissions from weaned lambs offered fresh forage

To investigate the extent to which enteric methane (CH(4)) emissions from growing lambs are explained by simple body weight and diet characteristics, a 2 × 2 Latin square changeover design experiment was carried out using two sheep breeds and two fresh pasture types. Weaned lambs of two contrasting breed types were used: Welsh Mountain (WM, a small, hardy hill breed) and Welsh Mule × Texel (TexX, prime lamb) (n = 8 per breed). The lambs were zero-grazed on material cut from recently reseeded perennial ryegrass and extensively managed permanent pasture. In each experimental period, individual ad libitum dry matter intake (DMI) was determined indoors following an adaptation period of 2 weeks, and CH(4) emissions were measured individually in open-circuit respiration chambers over a period of 3 days. Although total daily CH(4) emissions were lower for the WM lambs than for the TexX lambs (13·3 v. 15·7 g/day, respectively) when offered fresh forage, the yield of CH(4) per unit DMI was similar for the two breed types (16·4 v. 17·7 g CH(4)/kg DMI). Total output of CH(4) per day was higher when lambs were offered ryegrass compared with permanent pasture (16·1 v. 12·9 g/day, respectively), which was probably driven by differences in DMI (986 v. 732 g/day). Methane emissions per unit DMI (16·4 v. 17·7 g CH(4)/kg DMI) and proportion of gross energy intake excreted as CH(4) (0·052 v. 0·056 MJ/MJ) were both higher on the permanent pasture. No forage × breed type interactions were identified. The results indicate that forage type had a greater impact than breed type on CH(4) emissions from growing weaned lambs. It can be concluded that when calculating CH(4) emissions for inventory purposes, it is more important to know what forages growing lambs are consuming than to know what breeds they are

Reporting methodological search filter performance comparisons : a literature review

© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Journal.Peer reviewedPostprin

Traditional vs modern:Role of breed type in determining enteric methane emissions from cattle grazing as part of contrasting grassland-based systems

Ruminant livestock turn forages and poor-quality feeds into human edible products, but enteric methane (CH4) emissions from ruminants are a significant contributor to greenhouse gases (GHGs) and hence to climate change. Despite the predominance of pasture-based beef production systems in many parts of Europe there are little data available regarding enteric CH4 emissions from free-ranging grazing cattle. It is possible that differences in physiology or behaviour could influence comparative emissions intensities for traditional and modern breed types depending on the nutritional characteristics of the herbage grazed. This study investigated the role of breed type in influencing CH4 emissions from growing beef steers managed on contrasting grasslands typical of intensive (lowland) and extensive (upland) production systems. Using the SF6 dilution technique CH4 emissions were estimated for a modern, fast-growing crossbred (Limousin cross) and a smaller and hardier native breed (Welsh Black) when grazing lowland perennial ryegrass (high nutritional density, low sward heterogeneity) and semi-improved upland pasture (low/medium nutritional density, high sward heterogeneity). Live-weight gain was substantially lower for steers on the upland system compared to the lowland system (0.31 vs. 1.04 kg d-1; s.e.d. = 0.085 kg d-1; P<0.001), leading to significant differences in estimated dry matter intakes (8.0 vs. 11.1 kg DM d-1 for upland and lowland respectively; s.e.d. = 0.68 kg DM d-1; P<0.001). While emissions per unit feed intake were similar for the lowland and upland systems, CH4 emissions per unit of live-weight gain (LWG) were substantially higher when the steers grazed the poorer quality hill pasture (760 vs 214 g kg-1 LWG; s.e.d. = 133.5 g kg-1 LWG; P<0.001). Overall any effects of breed type were relatively small relative to the combined influence of pasture type and location

Choosing and using methodological search filters : searchers' views

© 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Group.Peer reviewedPostprin

An integrated 4249 marker FISH/RH map of the canine genome

BACKGROUND: The 156 breeds of dog recognized by the American Kennel Club offer a unique opportunity to map genes important in genetic variation. Each breed features a defining constellation of morphological and behavioral traits, often generated by deliberate crossing of closely related individuals, leading to a high rate of genetic disease in many breeds. Understanding the genetic basis of both phenotypic variation and disease susceptibility in the dog provides new ways in which to dissect the genetics of human health and biology. RESULTS: To facilitate both genetic mapping and cloning efforts, we have constructed an integrated canine genome map that is both dense and accurate. The resulting resource encompasses 4249 markers, and was constructed using the RHDF5000-2 whole genome radiation hybrid panel. The radiation hybrid (RH) map features a density of one marker every 900 Kb and contains 1760 bacterial artificial chromosome clones (BACs) localized to 1423 unique positions, 851 of which have also been mapped by fluorescence in situ hybridization (FISH). The two data sets show excellent concordance. Excluding the Y chromosome, the map features an RH/FISH mapped BAC every 3.5 Mb and an RH mapped BAC-end, on average, every 2 Mb. For 2233 markers, the orthologous human genes have been established, allowing the identification of 79 conserved segments (CS) between the dog and human genomes, dramatically extending the length of most previously described CS. CONCLUSIONS: These results provide a necessary resource for the canine genome mapping community to undertake positional cloning experiments and provide new insights into the comparative canine-human genome maps

Design research, architectural research, architectural design research: an argument on disciplinarity and identity

This paper studies the relationship between design and architectural research and questions whether these can be viewed as separate disciplines. Presented is an historical review of how this relationship has changed over 40-years. Several interventions, including research assessment, provide a motive to identify architecture as a discipline, however locating a unique ‘architectural’ element continues to be problematic. This argument advances this debate noting that recent changes, understanding design as movement for societal change and the involvement of non-academics (researcher/practitioners) in practice-based research, open up new epistemic vantage points. In particular it is at the intersection of architectural design research (ADR) and detailed design studies of architects at work that new ways of constructing architectural and designerly knowledge emerge

Development and Deployment of the OpenMRS-Ebola Electronic Health Record System for an Ebola Treatment Center in Sierra Leone.

BACKGROUND: Stringent infection control requirements at Ebola treatment centers (ETCs), which are specialized facilities for isolating and treating Ebola patients, create substantial challenges for recording and reviewing patient information. During the 2014-2016 West African Ebola epidemic, paper-based data collection systems at ETCs compromised the quality, quantity, and confidentiality of patient data. Electronic health record (EHR) systems have the potential to address such problems, with benefits for patient care, surveillance, and research. However, no suitable software was available for deployment when large-scale ETCs opened as the epidemic escalated in 2014. OBJECTIVE: We present our work on rapidly developing and deploying OpenMRS-Ebola, an EHR system for the Kerry Town ETC in Sierra Leone. We describe our experience, lessons learned, and recommendations for future health emergencies. METHODS: We used the OpenMRS platform and Agile software development approaches to build OpenMRS-Ebola. Key features of our work included daily communications between the development team and ground-based operations team, iterative processes, and phased development and implementation. We made design decisions based on the restrictions of the ETC environment and regular user feedback. To evaluate the system, we conducted predeployment user questionnaires and compared the EHR records with duplicate paper records. RESULTS: We successfully built OpenMRS-Ebola, a modular stand-alone EHR system with a tablet-based application for infectious patient wards and a desktop-based application for noninfectious areas. OpenMRS-Ebola supports patient tracking (registration, bed allocation, and discharge); recording of vital signs and symptoms; medication and intravenous fluid ordering and monitoring; laboratory results; clinician notes; and data export. It displays relevant patient information to clinicians in infectious and noninfectious zones. We implemented phase 1 (patient tracking; drug ordering and monitoring) after 2.5 months of full-time development. OpenMRS-Ebola was used for 112 patient registrations, 569 prescription orders, and 971 medication administration recordings. We were unable to fully implement phases 2 and 3 as the ETC closed because of a decrease in new Ebola cases. The phase 1 evaluation suggested that OpenMRS-Ebola worked well in the context of the rollout, and the user feedback was positive. CONCLUSIONS: To our knowledge, OpenMRS-Ebola is the most comprehensive adaptable clinical EHR built for a low-resource setting health emergency. It is designed to address the main challenges of data collection in highly infectious environments that require robust infection prevention and control measures and it is interoperable with other electronic health systems. Although we built and deployed OpenMRS-Ebola more rapidly than typical software, our work highlights the challenges of having to develop an appropriate system during an emergency rather than being able to rapidly adapt an existing one. Lessons learned from this and previous emergencies should be used to ensure that a set of well-designed, easy-to-use, pretested health software is ready for quick deployment in future

Associations of gestational weight gain with maternal body mass index, waist circumference, and blood pressure measured 16 y after pregnancy: the Avon Longitudinal Study of Parents and Children (ALSPAC)1234

Background: Little is known about associations of gestational weight gain (GWG) with long-term maternal health