A retrospective analysis of variations in antenatal care initiation in an ethnically diverse maternal population in the UK with high levels of area deprivation

Background: Research has indicated differential utilisation of antenatal care among ethnic minority mothers in the UK.  However, links between ethnicity, area deprivation and the timing of antenatal care initiation remain poorly understood.   This study investigates variations in antenatal care initiation among mothers residing in an ethnically diverse area in the UK with high levels of area deprivation.  Methods:  Data were derived from an on-going  retrospective cohort study using routinely collected anonymous data of live singleton  births over a 9 year period from 2007-2016 in a maternity unit catering to an ethnically diverse population. Logistic regression and Geographical Information Systems (GIS) were used to examine the associations between antenatal care initiation and ethnicity with and without adjustment for area deprivation. Preliminary results:  Among 45695 births recorded on the Ciconia Maternity information System, great  majority (80%) of mothers lived in neighbourhoods that are in the three most deprived area quintiles and 34.4% belonged to one of the ethnic minority groups. One fifth (20.8%)  of mothers initiated antenatal care late after 12 weeks of gestation. Late initiation was the highest among Black African (34.2%) and Black Caribbean (29.0%) groups who were more than twice as likely than the White British group to initiate antenatal care late (Odds ratio [OR]= 2.65 and 2.08 respectively). The risk appeared to remain after adjustment for area deprivation. Conclusions:  Ethnic minority mothers from some groups are at substantially higher risk of initiating antenatal care late compared to White British mothers regardless of the level of area deprivation. Main messages: Mothers from some ethnic minority groups are at  substantially higher risk of initiating antenatal care after 12 weeks of gestation compared to White British mothers.  Area level deprivation has very little effect on ethnic variations in antenatal care initiation

Ethnic minority women’s experiences of accessing antenatal care in high income European countries: a systematic review

Background: Women from ethnic minority backgrounds are at greater risk of adverse maternal outcomes. Antenatal care plays a crucial role in reducing risks of poor outcomes. The aim of this study was to identify, appraise, and synthesise the recent qualitative evidence on ethnic minority women’s experiences of accessing antenatal care in high-income European countries, and to develop a novel conceptual framework for access based on women’s perspectives. Methods: We conducted a comprehensive search of seven electronic databases in addition to manual searches to identify all qualitative studies published between January 2010 and May 2021. Identified articles were screened in two stages against the inclusion criteria with titles and abstracts screened first followed by full-text screening. Included studies were quality appraised using the Critical Appraisal Skills Programme checklist and extracted data were synthesised using a ‘best fit’ framework, based on an existing theoretical model of health care access. Results: A total of 30 studies were included in this review. Women’s experiences covered two overarching themes: ‘provision of antenatal care’ and ‘women's uptake of antenatal care’. The ‘provision of antenatal care’ theme included five sub-themes: promotion of antenatal care importance, making contact and getting to antenatal care, costs of antenatal care, interactions with antenatal care providers and models of antenatal care provision. The ‘women's uptake of antenatal care’ theme included seven sub-themes: delaying initiation of antenatal care, seeking antenatal care, help from others in accessing antenatal care, engaging with antenatal care, previous experiences of interacting with maternity services, ability to communicate, and immigration status. A novel conceptual model was developed from these themes. Conclusion: The findings demonstrated the multifaceted and cyclical nature of initial and ongoing access to antenatal care for ethnic minority women. Structural and organisational factors played a significant role in women’s ability to access antenatal care. Participants in majority of the included studies were women newly arrived in the host country, highlighting the need for research to be conducted across different generations of ethnic minority women taking into account the duration of stay in the host country where they accessed antenatal care

Development, acceptability and feasibility of a community-based intervention to increase timely initiation of antenatal care in an area of high ethnic diversity and low socio-economic status in the UK

BACKGROUND: Antenatal care plays an important role in preventing adverse maternal and new-born outcomes. Women from ethnic minority backgrounds and of low socio-economic status are at greater risk of initiating antenatal care later than the recommended 10 weeks. There is a paucity of research exploring the development and evaluation of community-based interventions to increase the timely initiation of antenatal care. OBJECTIVE: To develop and evaluate the acceptability and feasibility of a co-produced community-based intervention to increase uptake of antenatal care in an area with high ethnic diversity and low socio-economic status. DESIGN: The intervention was developed using co-production workshops and conversations with 20 local service users and 14 stakeholders, underpinned by the theory of Diffusion of Innovation. The intervention was evaluated, on the domains of acceptability, adoption, appropriateness, and feasibility. Questionnaires (n=36), interviews (n=10), and focus groups (n=13) were conducted among those who received the intervention. Observations (n=13) of intervention sessions were conducted to assess intervention fidelity. Quantitative and qualitative data were analysed using SPSS and NVivo software respectively. RESULTS: Over 91% of respondents positively ranked the intervention. Qualitative findings with respect to ‘acceptability’ included four subthemes: how the intervention was communicated, the characteristics of the person delivering the intervention and their knowledge, and the reassurance offered by the intervention. The ‘adoption’ theme included three sub-themes: being informed helps women to engage with antenatal care, the intervention provides information for future use, and onwards conveyance of the intervention information. The ‘appropriateness’ theme included three sub-themes: existing gap in information, nature of information given as part of the intervention, and talking about pregnancy in public. The ‘feasibility’ theme included two sub-themes: value of delivering the intervention in areas of high footfall and relational aspect of receiving the intervention. Observations showed intervention fidelity of 100%. CONCLUSION: The community-based intervention, coproduced with women and maternity care stakeholders, was positively evaluated, and offered an innovative and promising approach to engage and educate women about the timely initiation of antenatal care in an ethnically diverse and socio-economically deprived community

Novel CMOS RFIC Layout Generation with Concurrent Device Placement and Fixed-Length Microstrip Routing

With advancing process technologies and booming IoT markets, millimeter-wave CMOS RFICs have been widely developed in re- cent years. Since the performance of CMOS RFICs is very sensi- tive to the precision of the layout, precise placement of devices and precisely matched microstrip lengths to given values have been a labor-intensive and time-consuming task, and thus become a major bottleneck for time to market. This paper introduces a progressive integer-linear-programming-based method to gener- ate high-quality RFIC layouts satisfying very stringent routing requirements of microstrip lines, including spacing/non-crossing rules, precise length, and bend number minimization, within a given layout area. The resulting RFIC layouts excel in both per- formance and area with much fewer bends compared with the simulation-tuning based manual layout, while the layout gener- ation time is significantly reduced from weeks to half an hour.Comment: ACM/IEEE Design Automation Conference (DAC), 201

Lightly Weighted Automatic Audio Parameter Extraction for the Quality Assessment of Consensus Auditory-Perceptual Evaluation of Voice

The Consensus Auditory-Perceptual Evaluation of Voice is a widely employed tool in clinical voice quality assessment that is significant for streaming communication among clinical professionals and benchmarking for the determination of further treatment. Currently, because the assessment relies on experienced clinicians, it tends to be inconsistent, and thus, difficult to standardize. To address this problem, we propose to leverage lightly weighted automatic audio parameter extraction, to increase the clinical relevance, reduce the complexity, and enhance the interpretability of voice quality assessment. The proposed method utilizes age, sex, and five audio parameters: jitter, absolute jitter, shimmer, harmonic-to-noise ratio (HNR), and zero crossing. A classical machine learning approach is employed. The result reveals that our approach performs similar to state-of-the-art (SOTA) methods, and outperforms the latent representation obtained by using popular audio pre-trained models. This approach provide insights into the feasibility of different feature extraction approaches for voice evaluation. Audio parameters such as jitter and the HNR are proven to be suitable for characterizing voice quality attributes, such as roughness and strain. Conversely, pre-trained models exhibit limitations in effectively addressing noise-related scorings. This study contributes toward more comprehensive and precise voice quality evaluations, achieved by a comprehensively exploring diverse assessment methodologies.Comment: Published in IEEE 42th International Conference on Consumer Electronics (ICCE 2024

Applications of Differential CDMA Schemes and Control Technology for Distribution Substations

This paper presents an approach to achieve monitoring and control of distribution systems in a distribution substation using power-line communication (PLC) combined with Hadamard code. Four different techniques, i.e., binary phase shift keying (BPSK), quadrature phase shift keying (QPSK), 16-quadrature amplitude modulator (QAM) and 64-QAM in code division multiple access (CDMA), are employed. With spreading-spectrum modulation and demodulation in the studied PLC system, the proposed approach can achieve reliable high-speed information transmission through power lines. With Hadamard code, the signals corresponding to different relays are orthogonal to each other and the interference among them can be reduced. The proposed approach has the advantages of high-speed detection, bi-direction communication, reading and backup data, control and turn-off functions, displaying the real-time system information, etc. When 100 kHz is used as the carrier frequency for 256 relays under power-line noise below 14 dB, the simulation results show that the bit error rate (BER) is less than 10-5 . The proposed scheme can be applied to the smart-grid distribution substation of the studied distribution systems

Ontology-based Fuzzy Markup Language Agent for Student and Robot Co-Learning

An intelligent robot agent based on domain ontology, machine learning mechanism, and Fuzzy Markup Language (FML) for students and robot co-learning is presented in this paper. The machine-human co-learning model is established to help various students learn the mathematical concepts based on their learning ability and performance. Meanwhile, the robot acts as a teacher's assistant to co-learn with children in the class. The FML-based knowledge base and rule base are embedded in the robot so that the teachers can get feedback from the robot on whether students make progress or not. Next, we inferred students' learning performance based on learning content's difficulty and students' ability, concentration level, as well as teamwork sprit in the class. Experimental results show that learning with the robot is helpful for disadvantaged and below-basic children. Moreover, the accuracy of the intelligent FML-based agent for student learning is increased after machine learning mechanism.Comment: This paper is submitted to IEEE WCCI 2018 Conference for revie

Ethnic variations in risk of preterm birth in an ethnically dense socially disadvantaged area in the UK: a retrospective cross-sectional study

Objective To investigate ethnic variations in risk of preterm birth (PTB), including extreme preterm birth (EPTB) and moderately preterm birth (MPTB), among mothers in an ethnically dense, socially disadvantaged area, and to examine whether any variations were dependent of area deprivation and maternal biological and behavioural factors. Design Retrospective cross-sectional study using routinely collected data. Setting A large UK National Health Service maternity unit. Participants 46 307 women who gave singleton births between April 2007 and March 2016. Outcome measures PTB defined as <37 weeks of gestation and further classified into EPTB (<28 weeks of gestation) and MPTB (28 to <37 weeks of gestation). Results Overall prevalence of PTB was higher (8.3%) compared with the national average (7.8%). Black Caribbean (2.2%) and black African (2.0%) mothers had higher absolute risk of EPTB than white British mothers (1.3%), particularly black Caribbean mothers whose relative risk ratio (RRR) was nearly twice after adjustment for all covariates (RRR=1.93[1.20 to 3.10]). Excess relative risk of EPTB among black African mothers became non-significant after adjustment for prenatal behavioural factors (RRR=1.41[0.99 to 2.01]). Bangladeshi mothers had the lowest absolute risk of EPTB (0.6%), substantially lower than white British mothers (1.3%); the difference in relative risk remained significant after adjustment for area deprivation (RRR=0.59[0.36 to 0.96]), but became non-significant after adjustment for maternal biological factors. Changes were evident in the relative risk of EPTB and MPTB among some ethnic groups compared with the white British on adjustment for different covariates. Conclusions Higher than national rates of PTB point to the need for evidence-based antenatal and neonatal care programmes to support preterm babies and their families in ethnically dense socially disadvantaged areas. Differential impact of area deprivation and the role of modifiable behavioural factors highlight the need for targeted preventive interventions for groups at risk

Assessing water resources vulnerability and resilience of southern Taiwan to climate change

Water resources management has become more challenging in Taiwan due to rapid socio-economic development and the complications of climate change. This study developed a systematic procedure for assessing water resources vulnerability and resilience with an integrated tool, TaiWAP, including climate change scenarios, a weather generator, a hydrological model, and system dynamic models. Five assessment indicators, including two for vulnerability, two for resilience, and one for availability were used to quantify changes in water resources and improvements after implementing adaption measures. Each indicator was presented with 3 grades, namely low, medium, and high. Water resources vulnerability and resilience for Tainan City in southern Taiwan were evaluated. Insufficient water supply facilities capacity is the major weakness causing low resilience. Water resources allocation flexibility is limited by substantial agricultural water demands. A total of 9 adaption measures and combinations of measures were assessed. Desalination plant implementation can steadily supply public water to lessen system failure duration. Although agricultural water conservation and fallow land can greatly reduce water demand, fallow compensation is a potential cost. When food security is considered, reducing irrigation leakage will be a better adaption measure to both water and agriculture stakeholders. Both agriculture water conservation and cropping systems adjustment have cross-spatial flexibilities. The combination of desalination, reservoirs and public water conservation provide the most beneficial effects in reducing climate change impact

Simulation and Measurement Analysis of an Integrated Flow Battery Energy-Storage System with Hybrid Wind/Wave Power Generation

This study aims to evaluate the power-system stability and the mitigation of fluctuations in a hybrid wind/wave power-generation system (HWWPGS) under different operating and disturbance conditions. This evaluation is performed by employing a vanadium redox flow battery-based energy storage system (VRFB-ESS) as proposed. The measurement results obtained from a laboratory-scale HWWPGS platform integrated with the VRFB-ESS, operating under specific conditions, are used to develop the laboratory-scale simulation model. The capacity rating of this laboratory-scale simulation model is then enlarged to develop an MW-scale power-system model of the HWWPGS. Both operating characteristics and power-system stability of the MW-scale HWWPGS power system model are evaluated through frequency-domain analysis (based on eigenvalue) and time-domain analysis (based on nonlinear-model simulations) under various operating conditions and disturbance conditions. The simulation results demonstrate that the fluctuations and stability of the studied HWWPGS under different operating and disturbance conditions can be effectively smoothed and stabilized by the proposed VRFB-ESS