Collegial midwifery assistance during the active second stage of labour

AbstractSevere perineal trauma (SPT) is a serious complication following vaginal birth. To reduce its incidence rate, various preventive strategies have been implemented in Swedish obstetric units. Collegial midwifery assistance (CMA), involving an additional midwife being present during the active second stage of labour, is a clinical practice that was evaluated in the Oneplus trial, which proved a 30% reduction in SPT. The primary aim of this thesis was to investigate midwives’ and women’s experiences of collegial assistance during the active second stage of labour. The secondary aim was to obtain an improved understanding of the learning embedded within this clinical practice. The four papers included in this thesis are part of the Oneplus trial. Paper I has a qualitative design, using reflexive thematic analysis based on five focus group interviews with midwives (n=37). Papers II, III, and IV have quantitative designs using data from the Oneplus trial. In Papers II and IV, data was collected from clinical registration forms (CRFs) completed by the primary and second midwife after each birth (n=1430) and local databases. Paper III is a cohort study based on data from a questionnaire completed by women one-month postpartum, local databases, and CRFs (n=1050). For Papers II, III, and IV, we performed descriptive statistics as well as univariable and multivariable logistic regression analyses. In Paper I, four key themes were constructed: (i) challenging the professional role, (ii) a balancing act between different roles, (iii) not just why and how - but who, (iv) a potential arena for learning. In Paper II, the majority of the midwives fully agreed on items related to perceived confidence and considered having a colleague present to be a positive experience (61% and 56% respectively). Midwives with less than two years of work experience were more likely to fully agree on feeling confident (aOR 9.18, 95% CI 6.28-13.41) and experiencing the presence of a colleague as positive (aOR 4.04 % CI 2.83-5.78). Paper III showed that the clinical practice was well received by women, with 36% strongly agreeing that they felt safe and 43% expressing willingness to have CMA in the event of a subsequent birth. Women who experienced fear of birth, who had a lower level of education, and who did not have Swedish as their mother tongue showed higher levels of satisfaction with CMA. Midwives with less than two years of work experience reported new learning in three out of four births (76%) and those with over 20 years of work experience reported learning in one out of five births (22%). The importance of various factors influencing learning differed for primary and second midwives and were also influenced by the level of work experience. Our findings indicated that the CMA intervention was a well-accepted clinical practice among both midwives and women giving birth. CMA was found to provide valuable support and professional learning, which was especially pronounced among early career midwives. Experiences were complex and influenced by various factors, and the findings can be used to facilitate implementation and guide future practice

Promoting Sustainable Transportation with Campus Car Policies and Public Outreach

In fall of 2016 at California State University Monterey Bay (CSUMB), the Environmental Studies undergraduate program began offering its first group-based capstone course that was based on its first Projects for Sustainable City Year course (ENSTU 471). Capstone projects are a senior-level, project based graduation requirement for an undergraduate degree. The Sustainable City Year projects focused on increasing sustainable transportation at two locations; one in the nearby city of Salinas, California, and one on the CSUMB campus. A majority of the community in Salinas drive which has limited the quality and effectiveness of the shuttle system provided by Monterey-Salinas Transit (MST). Our group seeks to help increase ridership and promote sustainable transportation in this region. At CSUMB, traffic congestion on campus is increasingly problematic as the student body continues to row. The majority of students drive to campus in single passenger vehicles which increases the traffic on campus. Sustainable transportation via buses, bicycling, and carpooling helps decrease traffic congestion. In the following paper, the CSUMB project covers a proposed freshman vehicle restriction policy to encourage sustainable modes of transportation and a bus-bicycle culture. For the Salinas project, we worked directly with MST to encourage common knowledge of bus usage by creating an informational and interactive booklet

A REVIEW OF THE EFFICACY AND ROLE OF THE CARD SORT EXERCISE IN THE TREATMENT OF BIPOLAR DISORDER

The current card sort exercise described by Agius et al. in 2006 provides a tool for patients and their families to characterise the temporal pattern of occurrence of both stereotyped and idiosyncratic prodromal symptoms that serve as early warning signs predicting a relapse. This \u27individual relapse signature\u27 is highly specific for bipolar relapse, and aids identification of a relapse such that patients can be channeled into appropriate early intervention pathways. This review examines the role of the card sort exercise in the treatment of bipolar disorder, and evaluates the evidence for its efficacy. Few studies involve the card sort exercise, and those that do paired it with other early therapeutic interventions, such that it was difficult to assess the true contribution of the card sort exercise alone to outcome measures such as time-to-relapse or hospitalisation avoidance. We went back to first principles and evaluated the literature concerning various factors necessary for the card sort exercise to be useful. We concluded that there is good evidence that replicable relapse signatures exist as early warning signs for bipolar relapse, and that a certain subgroup of patients and their families can reliably use these signs to seek help and activate therapeutic interventions to abort the relapse episode. Early intervention is both possible and efficacious, which makes early identification of relapse yet more important. The card sort is of less use for depressive relapses, where prodromal symptoms are harder to pinpoint. The card sort exercise is useful in elucidating the relapse signature for each patient, which can then be used in psychoeducation or identification of future relapse episodes. However, more research is needed directly assessing the usefulness of the card sort exercise in helping patients and their families gain insight into the possibility of an imminent relapse

Ethical considerations in AI for child health and recommendations for child-centered medical AI

There does not exist any previous comprehensive review on AI ethics in child health or any guidelines for management, unlike in adult medicine. This review describes ethical principles in AI for child health and provides recommendations for child-centered medical AI. We also introduce the Pediatrics EthicAl Recommendations List for AI (PEARL-AI) framework for clinicians and AI developers to ensure ethical AI enabled systems in healthcare for children

Negative affect, stress, and smoking in college students: unique associations independent of alcohol and marijuana use

a b s t r a c t a r t i c l e i n f o Introduction: Stress and negative affect (NA) figure prominently in theoretical models of smoking initiation, maintenance and relapse, yet few studies have examined these associations among college students. Further complicating examination of these associations, smoking often occurs in the context of other substance use (e.g., alcohol, marijuana) in college populations. Thus, it remains unclear whether stress and NA are associated with cigarette use among college students, and if so, whether these associations are evident after controlling for effects of other substance use. The goals of this study were: a) to examine whether several aspects of stress (objective events, subjective experiences) and NA (sad mood, general emotional distress) were associated with cigarette smoking among college students and b) whether associations remained after accounting for alcohol and marijuana use. Sample: A large sample of college freshmen (N = 633) followed longitudinally over 35 weeks via internet assessments. Results: Results of hierarchical linear modeling demonstrated that measures of subjective stress and NA were positively related to cigarette use, whereas measures of objective stressful events were negatively related to cigarette use. When alcohol and marijuana use were added to the models, associations between smoking and stress/NA were diminished. Associations between NA and smoking remained significant; however, associations between subjective stress/stressful events and smoking were no longer significant. Conclusions: This is the first study to comprehensively examine links between subjective and objective measures of stress and smoking behavior among college students while also considering the influence of other substance use. Negative affect was the most robust correlate of smoking among college students. Subjective and objective stress do not appear to be strongly associated with college smoking above and beyond alcohol and marijuana use. Stress may not be an important etiological factor for relatively low levels of cigarette use among college students. Given that relations between NA/stress and cigarette smoking were diminished when concurrent alcohol and marijuana use was considered, it is imperative for future studies of college students to consider other substance use

การสร้างและหาประสิทธิภาพเครื่องหั่นฟ้าทะลายโจร ผลิตระดับวิสาหกิจชุมชน

งานวิจัยมีวัตถุประสงค์เพื่อ 1) สร้างเครื่องหั่นฟ้าทะลายโจร ระดับวิสาหกิจชุมชนในพื้นที่จังหวัดสระแก้ว และ 2) หาประสิทธิภาพการทำงานที่เหมาะสมของเครื่องหั่นฟ้าทะลายโจร  ผู้วิจัยจึงได้ออกแบบเครื่องหั่นฟ้าทะลายโจร เลือกใช้วัสดุโครงสร้างเป็นวัสดุสแตนเลส SUS 304 และใช้มอเตอร์ไฟฟ้าเป็นต้นกำลังขนาด 1 แรงม้า ขับกำลังด้วยพูลเลย์ สายพาน รอบความเร็วที่ใช้คือ 846 รอบต่อนาที และเลือกใช้ใบมีดหั่นแบบ 2 ใบมีด โดยใช้หลักการวิศวกรรมตามทฤษฎีแรงเฉือนจากการหมุนเหวี่ยงใบมีด ปริมาณการผลิตของเครื่องหั่นฟ้าทะลายโจรคือ 50 กิโลกรัม/ชั่วโมง และได้ศึกษาหาประสิทธิภาพของเครื่องหั่นฟ้าทะลายโจร โดยการทดลองหั่น 10 ครั้ง ครั้งละ 1,000 กรัม ผลการวิจัยพบว่า 1) ผลที่ได้จากการหั่นคือ ฟ้าทะลายโจรมีขนาดความยาวต่ำกว่า 2 นิ้ว ตามความต้องการของวิสาหกิจชุมชน ระยะเวลาเฉลี่ยที่ใช้สำหรับหั่นฟ้าทะลายโจรคือ 69.60 วินาที และ 2) ประสิทธิภาพโดยรวมของเครื่องหั่นฟ้าทะลายโจรเท่ากับ 99.57 % การวิเคราะห์จุดคุ้มทุนทางด้านเศรษฐศาสตร์วิศวกรรม ต้นทุนการสร้างเครื่องหั่นฟ้าทะลายโจรเท่ากับ 75,000 บาท และต้นทุนแปรผันได้แก่ต้นทุนการหั่นเท่ากับ 1.13 บาท/กิโลกรัม ปริมาณการผลิตเท่ากับ 12,000 กิโลกรัม/เดือน จำหน่ายกิโลกรัมละ 150 บาท พบว่าจุดคุ้มทุนเท่ากับ 503 กิโลกรัม ระยะเวลาการคืนทุนของเครื่องหั่นฟ้าทะลายโจร สามารถคืนทุนได้ภายในระยะเวลาประมาณ 1 เดือน จะทำให้วิสาหกิจชุมชนจะมีรายได้ 1,800,000 บาท/เดือน    งานวิจัยมีวัตถุประสงค์เพื่อ  1) สร้างเครื่องหั่นฟ้าทะลายโจร ระดับวิสาหกิจชุมชนในพื้นที่จังหวัดสระแก้ว             2) หาประสิทธิภาพการทำงานที่เหมาะสมของเครื่องหั่นฟ้าทะลายโจร  ผู้วิจัยจึงได้ออกแบบเครื่องหั่นฟ้าทะลายโจร เลือกใช้วัสดุโครงสร้างเป็นวัสดุสแตนเลส SUS 304 และใช้มอเตอร์ไฟฟ้าเป็นต้นกำลังขนาด 1 แรงม้า ขับกำลังด้วยพูลเลย์ สายพาน รอบความเร็วที่ใช้คือ 846 รอบต่อนาที และเลือกใช้ใบมีดหั่นแบบ 2 ใบมีด โดยใช้หลักการวิศวกรรมตามทฤษฎีแรงเฉือนจากการหมุนเหวี่ยงใบมีด ปริมาณการผลิตของเครื่องหั่นฟ้าทะลายโจรคือ 50 กิโลกรัม/ชั่วโมง และได้ศึกษาหาประสิทธิภาพของเครื่องหั่นฟ้าทะลายโจร โดยการทดลองหั่น 10 ครั้ง ครั้งละ 1,000 กรัม ผลที่ได้จากการหั่นคือ ฟ้าทะลายโจรมีขนาดความยาวต่ำกว่า 2 นิ้ว ตามความต้องการของวิสาหกิจชุมชน ระยะเวลาเฉลี่ยที่ใช้สำหรับหั่นฟ้าทะลายโจรคือ 69.60 วินาที และประสิทธิภาพโดยรวมของเครื่องหั่นฟ้าทะลายโจรเท่ากับ 99.57 % การวิเคราะห์จุดคุ้มทุนทางด้านเศรษฐศาสตร์วิศวกรรม ต้นทุนการสร้างเครื่องหั่นฟ้าทะลายโจรเท่ากับ 75,000 บาท และต้นทุนแปรผันได้แก่ต้นทุนการหั่นเท่ากับ 1.125 บาท/กิโลกรัม ปริมาณการผลิตเท่ากับ 12,000 กิโลกรัม/เดือน จำหน่ายกิโลกรัมละ 150 บาท พบว่าจุดคุ้มทุนเท่ากับ 503 กิโลกรัม ระยะเวลาการคืนทุนของเครื่องหั่นฟ้าทะลายโจร สามารถคืนทุนได้ภายในระยะเวลาประมาณ 1 เดือน จะทำให้วิสาหกิจชุมชนจะมีรายได้ 1,800,000 บาท/เดือ

Evaluating the impact of Brexit on the pharmaceutical industry.

INTRODUCTION: The UK Pharmaceutical Industry is arguably one of the most important industries to consider in the negotiations following the Brexit vote. Providing tens of thousands of jobs and billions in tax revenue and research investment, the importance of this industry cannot be understated. At stake is the global leadership in the sector, which produces some of the field's most influential basic science and translation work. However, interruptions and losses may occur at multiple levels, affecting patients, researchers, universities, companies and government. GOALS: By understanding the current state of pharmaceutical sector, the potential effect of leaving the European Union (EU) on this successful industry can be better understood. This paper aims to address the priorities for negotiations by collating the analyses of professionals in the field, leading companies and non-EU member states. RESEARCH METHODS: A government healthcare policy advisor and Chief Science Officer (CSO) for a major pharmaceutical firm were consulted to scope the paper. In these discussions, five key areas were identified: contribution, legislative processes, regulatory processes, research and outcomes, commercial risk. Multiple search engines were utilised for selecting relevant material, predominantly PubMed and Google Scholar. To supplement this information, Government documents were located using the "GOV.UK" publications tool, and interviews and commentaries were found through the Google News search function. CONCLUSION: With thorough investigation of the literature, we propose four foundations in the advancement of negotiations. These prioritise: negotiation of 'associated country' status, bilaterally favourable trade agreements, minimal interruption to regulatory bodies and special protection for the movement of workforce in the life sciences industry

Perpendicular dowel-bearing strength properties without glue line for Mengkulang species / Nor Jihan Abd Malek … [et al.]

The aim of this project is generate connection data that can employed in the design of connections for Malaysian timber species particularly for glulam products. This investigation focuses on evaluating dowel-bearing strength for timber based products. Thus far, limited studies on dowel-bearing strength were published and reported. Mengkulang, (Heritiera spp), was used to evaluate the dowel-bearing strength properties, Two bolt diameters 16 and 20mm consecutively were selected in this study. The project comprised experimental work that was based ASTMD5 764, using half-hole testing setup. The dowel-bearing strength, Fₑ for 16mm and 20mm diameter were determined from 5% diameter offset yield load method. Through the experimental work and analysis, the percentage difference between 16mm and 20mm was found 15% increased from 16.24N/mm² to 19.2 IN/mm², respectively. The dowel-bearing strength increased when the dowel diameter increased. The comparison between dowel-bearing strength of 5% diameter offset load, Fₑ and maximum load, Fh of glulam without glue line has successfully analysed. The Fe and Fh was found 16.24 N/mm² and 18.50N/ mm² for the 16 mm diameter while was 19.2 IN/ mm² and 22.69 N/ mm² for the 20mm diameter respectively

Need for recovery amongst emergency physicians in the UK and Ireland: a cross-sectional survey.

OBJECTIVES: To determine the need for recovery (NFR) among emergency physicians and to identify demographic and occupational characteristics associated with higher NFR scores. DESIGN: Cross-sectional electronic survey. SETTING: Emergency departments (EDs) (n=112) in the UK and Ireland. PARTICIPANTS: Emergency physicians, defined as any registered physician working principally within the ED, responding between June and July 2019. MAIN OUTCOME MEASURE: NFR Scale, an 11-item self-administered questionnaire that assesses how work demands affect intershift recovery. RESULTS: The median NFR Score for all 4247 eligible, consented participants with a valid NFR Score was 70.0 (95% CI: 65.5 to 74.5), with an IQR of 45.5-90.0. A linear regression model indicated statistically significant associations between gender, health conditions, type of ED, clinical grade, access to annual and study leave, and time spent working out-of-hours. Groups including male physicians, consultants, general practitioners (GPs) within the ED, those working in paediatric EDs and those with no long-term health condition or disability had a lower NFR Score. After adjusting for these characteristics, the NFR Score increased by 3.7 (95% CI: 0.3 to 7.1) and 6.43 (95% CI: 2.0 to 10.8) for those with difficulty accessing annual and study leave, respectively. Increased percentage of out-of-hours work increased NFR Score almost linearly: 26%-50% out-of-hours work=5.7 (95% CI: 3.1 to 8.4); 51%-75% out-of-hours work=10.3 (95% CI: 7.6 to 13.0); 76%-100% out-of-hours work=14.5 (95% CI: 11.0 to 17.9). CONCLUSION: Higher NFR scores were observed among emergency physicians than reported in any other profession or population to date. While out-of-hours working is unavoidable, the linear relationship observed suggests that any reduction may result in NFR improvement. Evidence-based strategies to improve well-being such as proportional out-of-hours working and improved access to annual and study leave should be carefully considered and implemented where feasible

A protein risk score for all-cause and respiratory-specific mortality in non-Hispanic white and African American individuals who smoke

Protein biomarkers are associated with mortality in cardiovascular disease, but their effect on predicting respiratory and all-cause mortality is not clear. We tested whether a protein risk score (protRS) can improve prediction of all-cause mortality over clinical risk factors in smokers. We utilized smoking-enriched (COPDGene, LSC, SPIROMICS) and general population-based (MESA) cohorts with SomaScan proteomic and mortality data. We split COPDGene into training and testing sets (50:50) and developed a protRS based on respiratory mortality effect size and parsimony. We tested multivariable associations of the protRS with all-cause, respiratory, and cardiovascular mortality, and performed meta-analysis, area-under-the-curve (AUC), and network analyses. We included 2232 participants. In COPDGene, a penalized regression-based protRS was most highly associated with respiratory mortality (OR 9.2) and parsimonious (15 proteins). This protRS was associated with all-cause mortality (random effects HR 1.79 [95% CI 1.31-2.43]). Adding the protRS to clinical covariates improved all-cause mortality prediction in COPDGene (AUC 0.87 vs 0.82) and SPIROMICS (0.74 vs 0.6), but not in LSC and MESA. Protein-protein interaction network analyses implicate cytokine signaling, innate immune responses, and extracellular matrix turnover. A blood-based protein risk score predicts all-cause and respiratory mortality, identifies potential drivers of mortality, and demonstrates heterogeneity in effects amongst cohorts