Delivered With Care. A National Survey of Women's Experience of Maternity Care 2010

As maternity services change and the population of women and families served also changes, there is a need to document the views of women with recent experience of care. Maternity services are evolving and the information from this study provides a picture of current practice and point of comparison for the future. This survey was carried out in 2010 and used similar methods to those employed in 1995 and 2006. A random sample of 10,000 women giving birth in England over a two week period were selected by the Office for National Statistics from birth registration records. Women whose babies had died and new mothers less than 16 years of age were excluded. The usable response rate was 54%, with 5,333 women participating. A total of 14% of respondents came from Black and Minority Ethnic (BME) groups and 21% had been born outside the UK. An online version of the questionnaire was made available to all survey participants; only 8% of those responding used this method of return. Data were analysed and are presented by parity, with some specific univariate analyses in relation to clinical factors such as mode of delivery and demographic factors, such as maternal age or geographical region. Some comparisons are made with previous surveys. Multivariate analyses, with adjustment for potential confounders, were carried out in relation to 20 selected outcomes contributing to quality of care

Identifying the Optimal Age to Perform Newborn Screening for Hearing Loss in Uganda

Background: Permanent congenital hearing loss affects up to 6/1000 births in developing countries. Currently, in Uganda there is no newborn screening for hearing loss (NSHL) program and no published work on this topic. Within the existing healthcare system there are two opportunities to deliver screening, at birth or 6 weeks of age when infants receive their immunizations. Aim: This study explored the outcomes of otoacoustic emission (OAE) testing in infants at birth and 6 weeks of age, to identify the optimal age for screening. Subjects and Methods: This cross‑sectional pilot study recruited 60 consecutive infants from two health centres in Kampala, Uganda. Thirty infants were newborns recruited from the postnatal ward and 30 were aged 4–8 weeks from the immunization clinic, we performed OAE testing on all infants. Results: The results showed 56.7% (17/30) of newborn infants passed OAE testing compared with 90.0% (27/30) of the immunization infants, P < 0.01. Furthermore, of the 11 newborn infants aged ≥24 h of age 90.9% (10/11) passed, compared with the 19 infants <24 h of age where 37% (7/19) passed, P < 0.01. Conclusions: This study demonstrates a higher pass rate for OAE testing for infants ≥24 h of age compared to those <24 h of age. The overall lower pass rate of the newborn infants could be due to external ear debris and middle ear fluid compromising the OAE testing. These findings would support a NSHL programme in Uganda that offers screening to infants ≥24 h of age, to maximize the cost‑effectiveness of the program.Keywords: Hearing loss, Newborn, Screenin

Synthesis, structures and cytotoxicity studies of p-sulfonatocalix[4]arene lanthanide complexes

A number of p-sulfonatocalix[4]arene complexes of the lanthanides (Tb, Gd, and Eu) have been prepared, some in the presence of tetraazamacrocycle 1,4,7,10-tetraazacyclododecane-1,4,7-triacetic acid (DO3A), and fully characterised. Crystal structure determinations reveal lanthanide coordination at the sulfonate group, bridging several calixarene units, giving coordination polymers. All complexes in this study have been determined to be relatively non-toxic using in vitro cell assays with CC₅₀ values in the range 30–170 μM

QED calculation of the n=1 and n=2 energy levels in He-like ions

We perform ab initio QED calculations of energy levels for the $n=1$ and $n=2$ states of He-like ions with the nuclear charge in the range $Z = 12$-100. The complete set of two-electron QED corrections is evaluated to all orders in the parameter \aZ. Uncalculated contributions to energy levels come through orders \alpha^3 (\aZ)^2, \alpha^2 (\aZ)^7, and higher. The calculation presented is the first treatment for excited states of He-like ions complete through order \alpha^2 (\aZ)^4. A significant improvement in accuracy of theoretical predictions is achieved, especially in the high-$Z$ region.Comment: 23 pages, 5 figure

Mapping maternity care facilities in England

Objective. To describe the organisation of maternity care at trust and unit level in England. Methods. All NHS trusts providing maternity care participated in a survey as part of the Healthcare Commission review of maternity care in England in 2007. Data on trusts and numbers of units were also collected in 2009 as part of the Birthplace in England programme. Results. Models of care provision are limited: in 2007 two-thirds of trusts provided choice between home birth and birth in an obstetric unit only. Geographical variation is substantial, with approximately 70% of trusts in the North-West, Yorkshire and Humberside and London Strategic Health Authority regions having only obstetric units, compared with 50% or less in the South-West and East Midlands. Availability and proximity of specialist facilities for women and babies within trusts varies and is linked with obstetric units. Changes in trust configuration, identified in 2009, have largely resulted from opening alongside midwifery units, then available in a quarter of trusts. Freestanding midwifery units continue to provide care for small numbers of women, commonly in more rural areas. Conclusions. In 2007, 66% of trusts had no midwifery-led units and this is likely to have limited the choices that women were able to make about their planned place of birth and the possibility of having midwife-led care in nonobstetric unit settings. Recent data suggest that women’s options for care may have increased, although capacity and staffing issues, reflected in closures to admissions, may affect these

Effect of pregnancy planning and fertility treatment on cognitive outcomes in children at ages 3 and 5: longitudinal cohort study

Objective To investigate how pregnancy planning, time to conception, and infertility treatment influence cognitive development at ages 3 and 5

Cognitive development following ART: effect of choice of comparison group, confounding and mediating factors

BACKGROUND: Epidemiological studies have examined the health of children born after assisted reproductive technology (ART), with contradictory results. In this article, we address the question 'Do singletons born after ART have a poorer cognitive developmental outcome at 3 years of age?' We assess the implications of using different comparison groups, and discuss appropriate analytical approaches for the control of confounding and mediating variables. METHODS: Data were drawn from the Millennium Cohort Study. Interviews captured sociodemographic, behavioural and pregnancy information. Developmental assessments conducted at age three included the British Ability Scales II Naming Vocabulary (BAS-NV) instrument. We compared ART infants (born after IVF or ICSI) to four comparison groups: a 'matched' group; a 'subfertile' group (time to conception >12 months); a 'fertile' group (time to conception <12 months); and an 'any spontaneous conceptions' group. Linear regression provided estimates of the difference in mean BAS-NV scores in the ART and comparison groups; both unadjusted estimates and those adjusted for confounding and mediating factors are presented. RESULTS: In the unadjusted analyses, ART children gained significantly better BAS-NV test results than did the comparison group children. When converted to an estimate of developmental age gap, ART children were 2.5, 2.7, 3.6 and 4.5 months ahead of the 'matched', 'subfertile', 'fertile' and 'spontaneous conception' children, respectively. After adjusting for confounding and mediating factors, the differences were reduced, and were not statistically significant. CONCLUSIONS: ART is not associated with poorer cognitive development at 3 years. We have highlighted methodological considerations for researchers planning to study the effect of infertility and ART on childhood outcomes

Monte Carlo evaluation of the external gamma, neutron and muon induced background sources in the CUORE experiment

CUORE is a 1 ton scale cryogenic experiment aiming at the measurement of the Majorana mass of the electron neutrino. The detector is an array of 988 TeO2 bolometers used for a calorimetric detection of the two electrons emitted in the BB0n of 130Te. The sensitivity of the experiment to the lowest Majorana mass is determined by the rate of background events that can mimic a BB0n. In this paper we investigate the contribution of external sources i.e. environmental gammas, neutrons and cosmic ray muons to the CUORE background and show that the shielding setup designed for CUORE guarantees a reduction of this external background down to a level <1.0E-02 c/keV/kg/y at the Q-value, as required by the physical goal of the experiment.Comment: 14 pages, 7 figure