P05.28. Current practice amongst acupuncturists treating threatened miscarriage in Australia and New Zealand

To investigate current use and clinical practice considerations amongst acupuncturists treating threatened miscarriage, a common complication of pregnancy that may result in miscarriage and premature labour. Although only a “wait and see approach” is advised medically, treatment recommendations exist within acupuncture texts. However these are conflicting, potentially creating treatment uncertainty and limiting clinical practice. As women increasingly seek acupuncture for their fertility, opportunities exist to offer interested women treatment for threatened miscarriage. To explore this potential, acupuncturist’ views were sought to add to the limited information currently available

"Never let a good crisis go to waste": Positives from disrupted maternity care in Australia during COVID-19.

OBJECTIVE: Due to the COVID-19 pandemic, a number of changes to maternity care were rapidly introduced in all countries, including Australia, to reduce the risk of infection for pregnant women and their care providers. While many studies have reported on the negative effects of these changes, there is a paucity of evidence on factors which women and their providers perceived as positive and useful for future maternity care. DESIGN: Data was analysed from the Birth in the time of COVID-19 (BITTOC 2020) study survey. Conventional content analysis and descriptive statistics were used to analyse the data and examine which aspects of COVID-amended care women experienced as positive. Data from women were compared to data from midwives. SETTING: This project took place in Australia in 2020-2021. PARTICIPANTS: The survey was distributed to women who gave birth and midwives who worked in Australia during the COVID-19 pandemic (March 2020 onwards). MEASUREMENTS AND FINDINGS: Women reported a variety of positives from their maternity care during COVID-19. These included both care-related factors as well as contextual factors. The most commonly mentioned positives for pregnant and postnatal women were care-related, namely fewer visitors in hospital, having increased access to telehealth services. These were also the most commonly reported positives by midwives. Having midwifery continuity of care models, giving birth at home and having their partner work from home were also highlighted by women as positives. KEY CONCLUSIONS: Despite the negative effect of COVID-19-related restrictions on maternity care, a variety of changes were viewed as positive by both women and midwives, with strong agreement between the two groups. IMPLICATIONS FOR PRACTICE: These findings provide evidence to support the inclusion of these positive elements of care and ensure that the lessons learned from the pandemic are utilised to improve maternity care in Australia going forward

The Deepest Supernova Search is Realized in the Hubble Ultra Deep Field Survey

The Hubble Ultra Deep Field Survey has not only provided the deepest optical and near infrared views of universe, but has enabled a search for the most distant supernovae to z~2.2. We have found four supernovae by searching spans of integrations of the Ultra Deep Field and the Ultra Deep Field Parallels taken with the Hubble Space Telescope paired with the Advanced Camera for Surveys and the Near Infrared Multi Object Spectrometer. Interestingly, none of these supernovae were at z>1.4, despite the substantially increased sensitivity per unit area to such objects over the Great Observatories Origins Deep Survey. We present the optical photometric data for the four supernovae. We also show that the low frequency of Type Ia supernovae observed at z>1.4 is statistically consistent with current estimates of the global star formation history combined with the non-trivial assembly time of SN Ia progenitors.Comment: 24 pages (6 figures), submitted to the Astronomical Journa

Multiparous women's confidence to have a publicly-funded homebirth: A qualitative study

Background: Hospital birth is commonly thought to be a safer option than homebirth, despite many studies showing similar rates of safety for low risk mothers and babies when cared for by qualified midwives with systems of back-up in place. Recently in Australia, demand has led to the introduction of a small number of publicly-funded homebirth programs. Women's confidence in having a homebirth through a publicly-funded homebirth program in Australia has not yet been explored. Aim: The aim of the study was to explore the reasons why multiparous women feel confident to have a homebirth within a publicly-funded model of care in Australia. Methods: Ten multiparous English-speaking women who chose to have a homebirth with the St George Hospital Homebirth Program were interviewed in the postnatal period using semi-structured, open-ended questions. Interviews were transcribed, then a thematic analysis was undertaken. Results: Women, having already experienced a normal birth, demonstrated a strong confidence in their ability to give birth at home and described a confidence in their bodies, their midwives, and the health system. Women weighed up the risks of homebirth through information they gathered and integration with their previous experience of birth, their family support and self-confidence. Discussion: Women choosing publicly-funded homebirth display strong confidence in both themselves to give birth at home, and their belief in the health system's ability to cope with any complications that may arise. Implications for practice: Many women may benefit from access to publicly-funded homebirth models of care. This should be further investigated. © 2010 Australian College of Midwives

Pregnancy-Related Lumbopelvic Pain: Listening to Australian Women

To investigate the prevalence and nature of lumbo-pelvic pain (LPP), that is experienced by women in the lumbar and/or sacro-iliac area and/or symphysis pubis during pregnancy. Cross-sectional, descriptive study. An Australian public hospital antenatal clinic. Women in their third trimester of pregnancy. Method. Women were recruited to the study as they presented for their antenatal appointment. A survey collected demographic data and was used to self report LPP. A pain diagram differentiated low back, pelvic girdle or combined pain. Closed and open ended questions explored the experiences of the women.Main OutcomeMeasures. The Visual Analogue Scale and the Oswestry Disability Index (Version 2.1a). Results. There was a high prevalence of self reported LPP during the pregnancy (71%). An association was found between the reporting of LPP, multiparity, and a previous history of LPP. The mean intensity score for usual pain was 6/10 and four out of five women reported disability associated with the condition.Most women (71%) had reported their symptoms to their maternity carer however only a small proportion of these women received intervention. Conclusion. LPP is a potentially significant health issue during pregnancy

Complementary therapies for labour and birth: A randomized controlled trial of antenatal integrative medicine for pain management in labour

Objective: To evaluate the effect of an antenatal integrative medicine education programme in addition to usual care for nulliparous women on intrapartum epidural use. Design: Open-label, assessor blind, randomized controlled trial. Setting: 2 public hospitals in Sydney, Australia. Population: 176 nulliparous women with low-risk pregnancies, attending hospital-based antenatal clinics. Methods and intervention: The Complementary Therapies for Labour and Birth protocol, based on the She Births and acupressure for labour and birth courses, incorporated 6 evidence-based complementary medicine techniques: acupressure, visualisation and relaxation, breathing, massage, yoga techniques, and facilitated partner support. Randomisation occurred at 24–36 weeks’ gestation, and participants attended a 2-day antenatal education programme plus standard care, or standard care alone. Main outcome measures: Rate of analgesic epidural use. Secondary: onset of labour, augmentation, mode of birth, newborn outcomes. Results:There was a significant difference in epidural use between the 2 groups: study group (23.9%) standard care (68.7%; risk ratio (RR) 0.37 (95% CI 0.25 to 0.55), p≤0.001). The study group participants reported a reduced rate of augmentation (RR=0.54 (95% CI 0.38 to 0.77), p Conclusions: The Complementary Therapies for Labour and Birth study protocol significantly reduced epidural use and caesarean section. This study provides evidence for integrative medicine as an effective adjunct to antenatal education, and contributes to the body of best practice evidence

Relaxation techniques for pain management in labour

Background: Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute to the popularity of complementary methods of pain management. This review examined currently available evidence on the use of relaxation therapies for pain management in labour. This is an update of a review first published in 2011. Objectives: To examine the effects of mind-body relaxation techniques for pain management in labour on maternal and neonatal well-being during and after labour. Search methods: We searched Cochrane Pregnancy and Childbirth’s Trials Register (9 May 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 5 2017), MEDLINE (1966 to 24 May 2017), CINAHL (1980 to 24 May 2017), the Australian New Zealand Clinical Trials Registry (18 May 2017), ClinicalTrials.gov (18 May 2017), the ISRCTN Register (18 May 2017), the WHO International Clinical Trials Registry Platform (ICTRP) (18 May 2017), and reference lists of retrieved studies. Selection criteria: Randomised controlled trials (including quasi randomised and cluster trials) comparing relaxation methods with standard care, no treatment, other non-pharmacological forms of pain management in labour or placebo. Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We attempted to contact study authors for additional information. We assessed evidence quality with GRADE methodology. Main results: This review update includes 19 studies (2519 women), 15 of which (1731 women) contribute data. Interventions examined included relaxation, yoga, music and mindfulness. Approximately half of the studies had a low risk of bias for random sequence generation and attrition bias. The majority of studies had a high risk of bias for performance and detection bias, and unclear risk of bias for, allocation concealment, reporting bias and other bias. We assessed the evidence from these studies as ranging from low to very low quality, and therefore the effects below should be interpreted with caution

Detecting z > 2 Type IIn Supernovae

Type IIn supernovae (SNe IIn) dominate the brightest supernova events in observed FUV flux (~1200-2000A). We show that multi-band, multi-epoch optical surveys complete to m_r = 27 can detect the FUV emission of ~25 z > 2 SNe IIn deg^-2 yr^-1 rest-frame (~10 SNe IIn deg^-2 yr^-1 observed-frame) to 4 sigma using a technique monitoring color-selected galaxies. Moreover, the strength and evolution of the bright emission lines observed in low redshift SNe IIn imply that the Ly-a emission features in ~70% of z > 2 SNe IIn are above 8m-class telescope spectroscopic thresholds for ~2 yr rest-frame. As a result, existing facilities have the capability to both photometrically detect and spectroscopically confirm z > 2 SNe IIn and pave the way for efficient searches by future 8m-class survey and 30m-class telescopes. The method presented here uses the sensitivities and wide-field capabilities of current optical instruments and exploits (1) the efficiency of z > 2 galaxy color-selection techniques, (2) the intrinsic brightness distribution ( = -19.0 +/-0.9) and blue profile of SNe IIn continua, (3) the presence of extremely bright, long-lived emission features, and (4) the potential to detect blueshifted SNe Ly-a emission shortward of host galaxy Ly-a features.Comment: 26 pages (pre-print), 6 figures, accepted Ap

Observation of Periodic Orbits on Curved Two - dimensional Geometries

We measure elastomechanical spectra for a family of thin shells. We show that these spectra can be described by a "semiclassical" trace formula comprising periodic orbits on geodesics, with the periods of these orbits consistent with those extracted from experiment. The influence of periodic orbits on spectra in the case of two-dimensional curved geometries is thereby demonstrated, where the parameter corresponding to Planck's constant in quantum systems involves the wave number and the curvature radius. We use these findings to explain the marked clustering of levels when the shell is hemispherical

The Diffuse Supernova Neutrino Background is detectable in Super-Kamiokande

The Diffuse Supernova Neutrino Background (DSNB) provides an immediate opportunity to study the emission of MeV thermal neutrinos from core-collapse supernovae. The DSNB is a powerful probe of stellar and neutrino physics, provided that the core-collapse rate is large enough and that its uncertainty is small enough. To assess the important physics enabled by the DSNB, we start with the cosmic star formation history of Hopkins & Beacom (2006) and confirm its normalization and evolution by cross-checks with the supernova rate, extragalactic background light, and stellar mass density. We find a sufficient core-collapse rate with small uncertainties that translate into a variation of +/- 40% in the DSNB event spectrum. Considering thermal neutrino spectra with effective temperatures between 4-6 MeV, the predicted DSNB is within a factor 4-2 below the upper limit obtained by Super-Kamiokande in 2003. Furthermore, detection prospects would be dramatically improved with a gadolinium-enhanced Super-Kamiokande: the backgrounds would be significantly reduced, the fluxes and uncertainties converge at the lower threshold energy, and the predicted event rate is 1.2-5.6 events /yr in the energy range 10-26 MeV. These results demonstrate the imminent detection of the DSNB by Super-Kamiokande and its exciting prospects for studying stellar and neutrino physics.Comment: 14 pages, 5 figures, 4 tables, some added discussions, accepted for publication in Physical Review