Perspectives of Chinese couples on their experience of assisted reproductive technology (ART) treatment

The aim of this study is to explore the way in which Chinese couples experience and make sense of Assisted Reproductive Technology (ART) treatment. An understanding of how infertile couples experience their infertility and ART treatment is essential if the development of supportive infertility care is to be effective. Experiential accounts of infertile Hong Kong Chinese couples have received little attention in the literature. This study is a phenomenological one, using the Husserlian philosophical approach. A purposive sample of 15 Hong Kong Chinese couples was selected for interview. Each of the participant couples were followed through one treatment cycle and interviewed separately on one, and jointly on two occasions; a total of 60 interviews were obtained. Data was generated from taped interviews and the researcher's field notes. Data was analyzed by using a modified Colaizzi (1978) method. By using a couple-centred approach, rich experiential data was obtained.Five mega themes emerged from the data: uncertainty posed by infertility, ART as a means to achieve biological parenthood, normalising the ART treatment process, dealing with the treatment outcome and making sense of ART treatment. The data demonstrated that infertility posed uncertainty for the couples and that their intentions for parenthood were shaped by personal, social and cultural factors. The ART process revealed the stressful nature of the treatment and how the couples attempted to normalise this by engaging in cognitive, affective and behavioural strategies to deal with the process. When the treatment failed, the couples used selective disclosure and spiritual faith to help them to process and accept their sense of loss. They developed a greater emotional awareness during the course of the treatment and afterwards, found they had gained a better sense of understanding of its complexities and its impact on them. Consequently, the couples began to reffame their lives and reproductive goals. The findings of this thesis will add to existing knowledge of Hong Kong Chinese couples' experiences of infertility and the ART treatment process. The implications for clinical practice, nursing education and research are discussed

Migrant Polish women overcoming communication challenges in Scottish maternity services: a qualitative descriptive study.

Background: Migrant women are more likely to experience sub-optimal maternity outcomes and are often described in a problematised way. Communication is crucial in maternity and can be compromised if the language of that service is delivered in a language incomprehensible to migrant women. Methods: Qualitative descriptive study using 9 in-depth individual interviews with Polish women who recently had experience of local maternity services. Recorded interviews were transcribed and thematically analysed. A salutogenic conceptual framework was adopted for data analysis. Findings: Three descriptive themes: ‘Communication and understanding’, ‘Relationships matter’ and Values and expectations’. Seven related subthemes where identified. Discussion: Vulnerability in this study is understood as uncertainty, risk and emotional exposure to situations that are not understandable. Applying a salutogenic lens to analysis reveals the significance of quality communication, relationship and culturally sensitive practices as ways of mitigating feelings of vulnerability in the host country. Antonovski’s Sense of Coherence’ (SoC) highlights migrant women’s ability to comprehend and capacity to understand their unique experiences of communication challenges. Participant’s psychosocial, cultural, and individual beliefs reveal an ability to trust maternity systems that are different from their own cultural values and help them move towards a Sense of Coherence (SOC) and face their vulnerability. Conclusion: Working with migrant women requires a salutary focus. Maternity care professionals involved in the care of this population need to consider individual internal and external resources and avoid treating migrant women as a problematic group. Maternity care provision needs to acknowledge migrant women’s strengths, values and expectations and adapt local services. This is done by addressing individual woman’s needs through a salutary focus, person-centredness and a system of care that values relationships and social connectedness

Heuristics and biases in cardiovascular disease prevention:How can we improve communication about risk, benefits and harms?

Objective Cardiovascular disease (CVD) prevention guidelines recommend medication based on the probability of a heart attack/stroke in the next 5–10 years. However, heuristics and biases make risk communication challenging for doctors. This study explored how patients interpret personalised CVD risk results presented in varying formats and timeframes. Methods GPs recruited 25 patients with CVD risk factors and varying medication history. Participants were asked to ‘think aloud’ while using two CVD risk calculators that present probabilistic risk in different ways, within a semi-structured interview. Transcribed audio-recordings were coded using Framework Analysis. Results Key themes were: 1) numbers lack meaning without a reference point; 2) risk results need to be both credible and novel; 3) selective attention to intervention effects. Risk categories (low/moderate/high) provided meaningful context, but short-term risk results were not credible if they didn’t match expectations. Colour-coded icon arrays showing the effect of age and interventions were seen as novel and motivating. Those on medication focused on benefits, while others focused on harms. Conclusion CVD risk formats need to be tailored to patient expectations and experiences in order to counteract heuristics and biases. Practice implications Doctors need access to multiple CVD risk formats to communicate effectively about CVD prevention

Is There a Weekly Pattern for Health Searches on Wikipedia and Is the Pattern Unique to Health Topics?

Published version. Source at http://doi.org/10.2196/jmir.5038.Background: Online health information–seeking behaviors have been reported to be more common at the beginning of the workweek. This behavior pattern has been interpreted as a kind of “healthy new start” or “fresh start” due to regrets or attempts to compensate for unhealthy behavior or poor choices made during the weekend. However, the observations regarding the most common health information–seeking day were based only on the analyses of users’ behaviors with websites on health or on online health-related searches. We wanted to confirm if this pattern could be found in searches of Wikipedia on health-related topics and also if this search pattern was unique to health-related topics or if it could represent a more general pattern of online information searching—which could be of relevance even beyond the health sector. Objective: The aim was to examine the degree to which the search pattern described previously was specific to health-related information seeking or whether similar patterns could be found in other types of information-seeking behavior. Methods: We extracted the number of searches performed on Wikipedia in the Norwegian language for 911 days for the most common sexually transmitted diseases (chlamydia, gonorrhea, herpes, human immunodeficiency virus [HIV], and acquired immune deficiency syndrome [AIDS]), other health-related topics (influenza, diabetes, and menopause), and 2 nonhealth-related topics (footballer Lionel Messi and pop singer Justin Bieber). The search dates were classified according to the day of the week and ANOVA tests were used to compare the average number of hits per day of the week. Results: The ANOVA tests showed that the sexually transmitted disease queries had their highest peaks on Tuesdays (P<.001) and the fewest searches on Saturdays. The other health topics also showed a weekly pattern, with the highest peaks early in the week and lower numbers on Saturdays (P<.001). Footballer Lionel Messi had the highest mean number of hits on Tuesdays and Wednesdays, whereas pop singer Justin Bieber had the most hits on Tuesdays. Both these tracked search queries also showed significantly lower numbers on Saturdays (P<.001). Conclusions: Our study supports prior studies finding an increase in health information searching at the beginning of the workweek. However, we also found a similar pattern for 2 randomly chosen nonhealth-related terms, which may suggest that the search pattern is not unique to health-related searches. The results are potentially relevant beyond the field of health and our preliminary findings need to be further explored in future studies involving a broader range of nonhealth-related searches

Thermal fatigue of laser modified tool steels mould surface at high temperature

In die casting environment, tool steel service life decrease due to the oxidation, erosion, corrosion and thermal fatigue cracks which occur on the die surface that cause production downtime and losses. Thermal fatigue cracks is a significant failure which is around 70% in die casting dies. In order to reduce the thermal fatigue cracks, the surface roughness (SR) and hardness of laser modified samples have to be tailored. In this study, the effect of laser surface modification parameters on SR and hardness was investigated to reduce the thermal fatigue crack. The hardness and microstructure of laser modified and asreceived AISI H13 tool steels that subjected to the thermal fatigue test were also investigated. First, a full factorial design of experiment (DOE) was developed. The three factors were peak power (W), pulse repetition frequency (PRF) and overlap rate (%) with the range of 1500-1900W, 40-60Hz and 10-30% respectively. Then, fiber laser system with pulse mode was applied on the surface of AISI H13 tool steel. The SR and hardness of all the laser modified samples were then measured. After that, the as-received AISI H13 and selected laser modified samples were used to conduct a thermal fatigue test which involve cyclic immersion test. The thermal fatigue test was conducted by continuously heating the samples in molten aluminium and cooling in a water bath at a respective temperature range of 850-900 °C and 27 °C. The characterisation of asreceived and laser modified samples for hardness, microstructure and thermal fatigue crack conducted before and after 5000 cycles. From the findings, the hardness of the laser modified samples increased 3 times from 203.3 HV to 744.6 HV. However, the SR has also increased from 1.3 µm to the range of 8.97-42.31 µm due to the various parameters of laser surface modification. The overlap rate has a significant effect on hardness. While, a low SR can be obtained at 1900 W of peak power and 10% of overlap rate. However, the PRF was an insignificant parameter to affect the hardness and SR. Prediction model was developed to identify suitable laser parameters setting for the intended value of SR and hardness. The hardness and microstructure of laser modified samples before and after thermal fatigue (TF) test were investigated. The hardness of laser modified samples decreased dramatically due to the microstructure changed. However, the laser modified samples significantly performance well than the as-received AISI H13. Laser modified samples reduce the number and length of cracks from 27 to 17 and 6.87 mm to 1.84 mm respectively. In conclusion, a suitable laser parameters setting can produce a low SR and high hardness sample. The thermal fatigue test proved that high hardness has a high resistance of thermal fatigue which can reduce the thermal fatigue cracks. Low SR can also reduce the accumulation of oxide which can generate the thermal fatigue cracks. Overall, this study is significant to enhance the surface properties such as resistance of thermal fatigue and hardness for AISI H13 tool steel in high temperature applications

Expectant parents’ perspectives on the influence of a single antenatal relaxation class: a qualitative study.

Aim: This study explores the perspectives of expectant parents on the influence of a single antenatal class incorporating education on childbirth physiology and relaxation techniques. Method: The data for this qualitative descriptive study were collected via in-depth interviews with six women and three birth partners. Findings: An enhanced understanding of childbirth physiology formed a ‘different way of thinking’ about childbirth, ‘inspired and motivated’ the exertion of the learnt relaxation techniques which led to a ‘deep sense of calmness’ associated with increased confidence and reduced fear. However, reaching such sense of calmness during childbirth required a ‘space for relaxation’ which was influenced by birth attendants. An overarching theme of ‘a positive outlook’ towards childbirth was identified. Conclusion: Including education on childbirth physiology and a range of relaxation techniques may reduce fear, empower prospective parents and positively influence their experiences of pregnancy and childbirth

Policy, evidence and practice for post-birth care plans: a scoping review.

Background: Postnatal care continually attracts less attention than other parts of the childbirth year. Many regions consistently report poor maternal satisfaction with care in the post-birth period. Despite policy recommending post-birth planning be part of maternity services there remains a paucity of empirical evidence and reported experience using post-birth care plans. There is a need to report on post-birth care plans, identify policy and guideline recommendations and gaps in the current empirical research, as well as experiences creating and using post-birth care plans. Methods: This scoping review accessed empirical literature and government and professional documents from 2005 to present day to build a picture of current understanding of policy imperatives and existent published empirical evidence. The review was informed by the Arksey and O’Malley approach employing five stages. Results: The review revealed that post-birth care planning is promoted extensively in health policy and there is emergent evidence for its implementation. Yet there is a paucity of practice examples and only one evaluation in the UK. The review identified four over arching themes: ‘Positioning of post-birth care planning in policy; ‘Content and approach’ ; ‘Personalised care and relational continuity’; 'Feasibility and acceptability in practice’. Conclusions: Empirical evidence supports post-birth care planning, but evidence is limited leaving many unanswered questions. Health care policy reflects evidence and recommends implementation of post-birth care plans, however, there remains a paucity of information in relation to post-birth care planning experience and implementation in practice. Women need consistent information and advice and value personalised care. Models of care that facilitate these needs are focused on relational continuity and lead to greater satisfaction. It remains unclear if a combination of post-birth care planning and continuity of carer interventions would improve post-birth outcomes and satisfaction. Gaps in research knowledge and practice experience are identified and implications for practice and further research suggested

Giant palaeotsunami in Kiribati: Converging evidence from geology and oral history

For tsunami science within Oceania, the vast Central and Western Pacific (CEWEP) is an anomalous region because of the scarcity of historical tsunami observations and the complete absence of dated palaeotsunami evidence. This paper therefore records the first dated high‐magnitude palaeotsunami event within the CEWEP region. A combination of both geological data and oral history is provided for a palaeotsunami that struck remote Makin island, northernmost of the Gilbert Islands in Kiribati, toward the end of the 16th century. A previously undocumented oral tradition of giant waves is well known to the people of Makin. Narration of this legend by the Wiin te Maneaba, traditional storyteller on Makin, provided important details supporting a tsunami hypothesis. The legend preserves credible information surrounding the giant‐wave origin of Rebua and Tokia, two prominent subaerial megaclasts of blade and block geometry that were transported 80–130 m shorewards from the reef‐edge source and deposited in sideways and inverted orientations. From available hydrodynamic flow transport equations, minimum flow velocities of 7.3–16.3 m s−1 were generated, depending on whether the reefblocks were rotated or lifted onto the reef platform. The youngest U‐Th age‐dates for fossil corals retrieved from the reefblocks give a maximum age for the palaeotsunami of circa AD 1576. Several far‐field Pacific Rim and regional possibilities exist for tsunamigenesis. These include subduction‐zone seismicity and catastrophic volcanic eruption, both of which have been linked to earlier (late 15th century) palaeotsunami events recorded elsewhere in the Pacific Islands. However, the available evidence here suggests that the ~AD 1576 Makin palaeotsunami was more likely to have been locally generated by tsunamigenic offshore submarine slope failure close to Makin\u27s western reef, associated with the giant arcuate bight structure that characterizes the northern rim of Butaritari atoll