Communicating choice: an exploration of mothers' experiences of birth

YesObjective: This article gives an in-depth insight into the ways in which communication between midwives and the birthing woman shape the birth experience. Background: Birth is a significant life event for many women that can have profound, long-lasting effects on how they see themselves as women and mothers. Within the literature the importance of control over the birth experience and the support that the birthing woman receives from midwives is stressed. Methods: Six women who had recently given birth participated in one-to-one semi-structured interviews designed to explore the kinds of support they received before, during and after their birth. An inductive thematic analysis was employed in order to identify and explore key issues which ran throughout the interviews. Results: Within the interviews the importance of being an active mother, someone who made decisions in relation to her labour, was stressed. The analysis explores the ways in which communication style and compassionate care either enabled or prevented women from adopting the position of ‘active’ mother. Conclusion: It is argued that a personal connection with midwives and clear and open communication which places the birthing woman in a position of control are key to positive birth experiences

Geologic and Structural Evolution of the NE Lau Basin, Tonga: Morphotectonic Analysis and Classification of Structures Using Shallow Seismicity

The transition from subduction to transform motion along horizontal terminations of trenches is associated with tearing of the subducting slab and strike-slip tectonics in the overriding plate. One prominent example is the northern Tonga subduction zone, where abundant strike-slip faulting in the NE Lau back-arc basin is associated with transform motion along the northern plate boundary and asymmetric slab rollback. Here, we address the fundamental question: how does this subduction-transform motion influence the structural and magmatic evolution of the back-arc region? To answer this, we undertake the first comprehensive study of the geology and geodynamics of this region through analyses of morphotectonics (remote-predictive geologic mapping) and fault kinematics interpreted from ship-based multibeam bathymetry and Centroid-Moment Tensor data. Our results highlight two unique features of the NE Lau Basin: (1) the occurrence of widely distributed off-axis volcanism, in contrast to typical ridge-centered back-arc volcanism, and (2) fault kinematics dominated by shallow-crustal strike slip-faulting (rather than normal faulting) extending over ~120 km from the transform boundary. The orientations of these strike-slip faults are consistent with reactivation of earlier-formed normal faults in a sinistral megashear zone. Notably, two distinct sets of Riedel megashears are identified, indicating a recent counter-clockwise rotation of part of the stress field in the back-arc region closest to the arc. Importantly, these structures directly control the development of complex volcanic-compositional provinces, which are characterized by variably-oriented spreading centers, off-axis volcanic ridges, extensive lava flows, and point-source rear-arc volcanoes that sample a heterogenous mantle wedge, with sharp gradients and contrasts in composition and magmatic affinity. This study adds to our understanding of the geologic and structural evolution of modern backarc systems, including the association between subduction-transform motions and the siting and style of seafloor volcanism

Rapid microtubule self-assembly kinetics

SUMMARY Microtubule assembly is vital for many fundamental cellular processes. Current models for microtubule assembly kinetics assume that the subunit dissociation rate from a microtubule tip is independent of free subunit concentration. Total-Internal-Reflection-Fluorescence (TIRF) microscopy experiments and data from a laser tweezers assay that measures in vitro microtubule assembly with nanometer resolution, provides evidence that the subunit dissociation rate from a microtubule tip increases as the free subunit concentration increases. These data are consistent with a two-dimensional model for microtubule assembly, and are explained by a shift in microtubule tip structure from a relatively blunt shape at low free concentrations to relatively tapered at high free concentrations. We find that because both the association and the dissociation rates increase at higher free subunit concentrations, the kinetics of microtubule assembly are an order-ofmagnitude higher than currently estimated in the literature

Medicare Expenditures and Healthcare Utilization in a Multi-ethnic Community-based Population with Dementia from Incidence to Death

Introduction: While individuals live with dementia for many years, utilization and expenditures from disease onset through the end-of-life period have not been examined in ethnically diverse samples. Methods: We used a multiethnic, population-based, prospective study of cognitive aging (Washington Heights-Inwood Columbia Aging Project) linked to Medicare claims to examine total Medicare expenditures and health care utilization among individuals with clinically diagnosed incident dementia from disease onset to death. Results: High-intensity treatment (hospitalizations, life-sustaining procedures) was common and mean Medicare expenditures per year after diagnosis was $69,000. Non-Hispanic blacks exhibited higher spending relative to Hispanics and non-Hispanic whites 1 year after diagnosis. Non-Hispanic blacks had higher total (mean=$205,000) Medicare expenditures from diagnosis to death compared with non-Hispanic whites (mean=$118,000). Hispanics’ total expenditures and utilization after diagnosis was similar to non-Hispanic whites despite living longer with dementia. Discussion: Health care spending for patients with dementia after diagnosis through the end-of-life is high and varies by ethnicity

Nanoparticles Containing Anti-inflammatory Agents as Chemotherapy Adjuvants II: Role of Plasma Esterases in Drug Release

The pre-administration of the anti-inflammatory drugs dexamethasone (DEX) and cortisone acetate reduces toxicity and enhances efficacy of anticancer agents in murine models and in human clinical trials (1–5). We previously reported on the formulation of the lipophilic dexamethasone palmitate ester (DEX-P) in nanoparticles (NPs) employing a microemulsion template engineering technique to achieve tumor-specific delivery of dexamethasone (6). The nanoparticles exhibited significantly enhanced stealth properties as indicated by reduced macrophage uptake and decreased adsorption of opsonin proteins in in vitro assays (6). Unexpectedly, preliminary biodistribution studies of NPs containing [3H]-DEX-P in tumor-bearing mice showed that the radiolabel was cleared from the circulation rapidly and exhibited high liver uptake. Our previous in vitro release studies demonstrated that rapid release of the radiolabel from the NPs was observed when 10% mouse plasma was used as the medium, while nominal release was observed in phosphate-buffered saline (PBS) buffer (6). Esterolysis of NP-associated DEX-P was presumed to be the main cause for the rapid drug release in plasma, as most of the released radioactivity was in the form of DEX and not DEX-P. High degradation rates of ester prodrugs in rodent plasma has been attributed to increased esterase activity, while only minimal degradation in human plasma has been observed (7–9). Based on our observation of the release of [3H]-DEX from NPs in mouse plasma, we studied the release of DEX from nanoparticles in various plasma sources as a guide for the design of future in vivo experiments

Massive star mergers and the recent transient in NGC 4490: A more massive cousin of V838 Mon and V1309 Sco

The Galactic transient V1309 Sco was the result of a merger in a low-mass star system, while V838 Mon was thought to be a similar merger event from a more massive B-type progenitor. In this paper, we study a recent optical and infrared (IR) transient discovered in the nearby galaxy NGC4490 named NGC4490-OT2011 (NGC 4490-OT hereafter), which appeared similar to these merger events (unobscured progenitor, irregular multi-peaked light curve, increasingly red colour, similar optical spectrum, IR excess at late times), but which had a higher peak luminosity and longer duration in outburst. NGC4490-OT has less in common with the class of SN 2008S-like transients. A progenitor detected in pre-eruption Hubble Space Telescope (HST) images, combined with upper limits in the IR, requires a luminous and blue progenitor that has faded in late-time HST images. The same source was detected by Spitzer and groundbased data as a luminous IR (2-5 μm) transient, indicating a transition to a self-obscured state qualitatively similar to the evolution seen in other stellar mergers and in luminous blue variables. The post-outburst dust-obscured source is too luminous and too warm at late times to be explained with an IR echo, suggesting that the object survived the event. The luminosity of the enshrouded IR source is similar to that of the progenitor. Compared to proposed merger events, the more massive progenitor of NGC4490-OT seems to extend a correlation between stellar mass and peak luminosity, and may suggest that both of these correlate with duration. We show that spectra of NGC4490-OT and V838 Mon also resemble light-echo spectra of η Car, prompting us to speculate that η Car may be an extreme extension of this phenomenon

Many quality measurements, but few quality measures assessing the quality of breast cancer care in women: A systematic review

BACKGROUND: Breast cancer in women is increasingly frequent, and care is complex, onerous and expensive, all of which lend urgency to improvements in care. Quality measurement is essential to monitor effectiveness and to guide improvements in healthcare. METHODS: Ten databases, including Medline, were searched electronically to identify measures assessing the quality of breast cancer care in women (diagnosis, treatment, followup, documentation of care). Eligible studies measured adherence to standards of breast cancer care in women diagnosed with, or in treatment for, any histological type of adenocarcinoma of the breast. Reference lists of studies, review articles, web sites, and files of experts were searched manually. Evidence appraisal entailed dual independent assessments of data (e.g., indicators used in quality measurement). The extent of each quality indicator's scientific validation as a measure was assessed. The American Society of Clinical Oncology (ASCO) was asked to contribute quality measures under development. RESULTS: Sixty relevant reports identified 58 studies with 143 indicators assessing adherence to quality breast cancer care. A paucity of validated indicators (n = 12), most of which assessed quality of life, only permitted a qualitative data synthesis. Most quality indicators evaluated processes of care. CONCLUSION: While some studies revealed patterns of under-use of care, all adherence data require confirmation using validated quality measures. ASCO's current development of a set of quality measures relating to breast cancer care may hold the key to conducting definitive studies