A narrative synthesis of factors that affect women speaking up about early warning signs and symptoms of pre-eclampsia and responses of healthcare staff.

BACKGROUND: One of the challenges for treating pre-eclampsia and preventing further deterioration is determining how best to enable early detection. If women or their partners and families are able to raise early warnings about potential signs and symptoms of pre-eclampsia in pregnancy, birth and in the postnatal period, women may be able to receive earlier intervention to prevent severe pre-eclampsia from developing. The aim of this study was to improve understanding of factors affecting the ability of women to recognise symptoms and signs of pre-eclampsia/eclampsia and seek appropriate medical help and factors affecting health care professionals' responses to women and their families who 'speak up' about early warning signs and symptoms. METHODS: A narrative synthesis was conducted of evidence relevant to address the research question. The following electronic data bases were searched for qualitative studies which met inclusion criteria from January 1980 to April 2016; Medline, CINAHL, HMIC, PsycINFO, Embase, BNI, ASSIA, Scopus, Maternity and Infant Care, Web of Science, Google Scholar, Cochrane, JBI and IBSS with the support of an Information Service Consultant. RESULTS: Following thematic analysis, three themes were identified; 1: Women's understanding and knowledge of pre-eclampsia/eclampsia; 2: Factors affecting help seeking behaviour from perspectives of women and their families'; 3: Factors affecting staff response. There was widespread lack of knowledge and understanding of signs and symptoms of pre-eclampsia/eclampsia among women and their families, with some women not exhibiting signs and symptoms of pre-eclampsia or unable to distinguish them from 'normal' pregnancy changes. CONCLUSIONS: Women and their families not only need to be made aware of signs and symptoms of pre-eclampsia/eclampsia but also require information on the most effective ways to seek urgent medical assessment and care. Some women did not experience prodromal signs and symptoms, which raises concerns about how women and families can detect early onset, and is an issue which needs further exploration. There is very limited research exploring clinical staff response to women who raise concerns about their health when experiencing symptoms and signs of pre-eclampsia/eclampsia with further research needed if safety and quality of care are to be improved

Temperature dependence of antiferromagnetic order in the Hubbard model

We suggest a method for an approximative solution of the two dimensional Hubbard model close to half filling. It is based on partial bosonisation, supplemented by an investigation of the functional renormalisation group flow. The inclusion of both the fermionic and bosonic fluctuations leads in lowest order to agreement with the Hartree-Fock result or Schwinger-Dyson equation and cures the ambiguity of mean field theory . We compute the temperature dependence of the antiferromagnetic order parameter and the gap below the critical temperature. We argue that the Mermin-Wagner theorem is not practically applicable for the spontaneous breaking of the continuous spin symmetry in the antiferromagnetic state of the Hubbard model. The long distance behavior close to and below the critical temperature is governed by the renormalisation flow for the effective interactions of composite Goldstone bosons and deviates strongly from the Hartree-Fock result.Comment: New section on critical behavior 31 pages,17 figure

Assessing the intergranular crack initiation probability of a grain boundary distribution by an experimental misalignment study of adjacent slip systems

Crack initiation at grain boundaries due to blocked slip transfer of dislocations is a main failure mechanism during the fatigue of metals. A quantification of the resistance effect of a grain boundary is needed to assess a textured or texture-free microstructure for fatigue strength. Geometric approaches based on the misalignment of slip systems in adjacent grains are widely used. Hence, we validated the geometric transmission factor of Shen et al. in coarse-grained high-purity aluminum under the assumption that the combination of a large slip activity and a blocked slip at a grain boundary leads to intergranular crack initiation and revealed that a detailed knowledge of the 3D-orientation of the grain boundary is essential. Thereby we gathered information about the 3D-microstructure using FIB-cross-sectioning. Hence it is possible to evaluate potential crack initiation sites for a specific microstructure or to estimate the fatigue strength of a textured microstructure in terms of a crack initiation probability

Влияние неоднородностей температуры поверхности на теплообмен воздуха с Землей

В работе проведено моделирование процесса натекания воздуха с холодной поверхности воды на теплую поверхность суши и сравнение расчетов с результатами измерений. Из расчетов следует, что потоки тепла в прибрежной зоне могут более чем на 20% превышать значения потоков тепла, вычисленных из предположения о горизонтальной однородности приземного слоя. Таким образом, горизонтальную неоднородность атмосферы следует учитывать при расчетах охлаждения водоемов, горизонтальный размер которых имеет масштаб ~100 м.В роботі проведено моделювання процесу натікання повітря з холодної поверхні води на теплу поверхню суші та порівняння розрахунків із вимірюваннями. З розрахунків видно, що потоки тепла в прибережній зоні можуть більш ніж на 20% перевищувати значення потоків тепла, обчислених з припущення про горизонтальну однорідність приземного шару. Таким чином, горизонтальну неоднорідність атмосфери слід враховувати при розрахунках охолодження водойм, горизонтальний розмір яких має масштаб ~100 м.In the paper, the air flow process from the cold water surface onto the warm land surface was simulated. The comparisons of calculations with measurements were performed as well. The calculations show that the heat flux in the narrow coastal zone may be more than 20% higher than the values of heat fluxes calculated from the assumption of horizontal homogeneity of the surface layer. Thus, the horizontal inhomogeneity of the atmosphere must be taken into account in the calculation of the cooling water, the horizontal size of which has a scale of ~100 m

Improving inpatient postnatal services: midwives views and perspectives of engagement in a quality improvement initiative

Background: despite major policy initiatives in the United Kingdom to enhance women's experiences of maternity care, improving in-patient postnatal care remains a low priority, although it is an aspect of care consistently rated as poor by women. As part of a systems and process approach to improving care at one maternity unit in the South of England, the views and perspectives of midwives responsible for implementing change were sought. Methods: a Continuous Quality Improvement (CQI) approach was adopted to support a systems and process change to in-patient care and care on transfer home in a large district general hospital with around 6000 births a year. The CQI approach included an initial assessment to identify where revisions to routine systems and processes were required, developing, implementing and evaluating revisions to the content and documentation of care in hospital and on transfer home, and training workshops for midwives and other maternity staff responsible for implementing changes. To assess midwifery views of the quality improvement process and their engagement with this, questionnaires were sent to those who had participated at the outset. Results: questionnaires were received from 68 (46%) of the estimated 149 midwives eligible to complete the questionnaire. All midwives were aware of the revisions introduced, and two-thirds felt these were more appropriate to meet the women's physical and emotional health, information and support needs. Some midwives considered that the introduction of new maternal postnatal records increased their workload, mainly as a consequence of colleagues not completing documentation as required. Conclusions: this was the first UK study to undertake a review of in-patient postnatal services. Involvement of midwives at the outset was essential to the success of the initiative. Midwives play a lead role in the planning and organisation of in-patient postnatal care and it was important to obtain their feedback on whether revisions were pragmatic and achieved anticipated improvements in care quality. Their initial involvement ensured priority areas for change were identified and implemented. Their subsequent feedback highlighted further important areas to address as part of CQI to ensure best quality care continues to be implemented. Our findings could support other maternity service organisations to optimise in-patient postnatal services

The Lorentzian distance formula in noncommutative geometry

For almost twenty years, a search for a Lorentzian version of the well-known Connes' distance formula has been undertaken. Several authors have contributed to this search, providing important milestones, and the time has now come to put those elements together in order to get a valid and functional formula. This paper presents a historical review of the construction and the proof of a Lorentzian distance formula suitable for noncommutative geometry.Comment: 16 pages, final form, few references adde

Spontaneous symmetry breaking in the colored Hubbard model

The Hubbard model is reformulated in terms of different ``colored'' fermion species for the electrons or holes at different lattice sites. Antiferromagnetic ordering or d-wave superconductivity can then be described in terms of translationally invariant expectation values for colored composite scalar fields. A suitable mean field approximation for the two dimensional colored Hubbard model shows indeed phases with antiferromagnetic ordering or d-wave superconductivity at low temperature. At low enough temperature the transition to the antiferromagnetic phase is of first order. The present formulation also allows an easy extension to more complicated microscopic interactions.Comment: 19 pages, 5 figure

Perineal Assessment and Repair Longitudinal Study (PEARLS): a matched-pair cluster randomized trial.

Perineal trauma during childbirth affects millions of women worldwide every year. The aim of the Perineal Assessment and Repair Longitudinal Study (PEARLS) was to improve maternal clinical outcomes following childbirth through an enhanced cascaded multiprofessional training program to support implementation of evidence-based perineal management