Use of labour induction and risk of cesarean delivery: A systematic review and meta-analysis

Background: Induction of labour is common, and cesarean delivery is regarded as its major complication. We conducted a systematic review and meta-analysis to investigate whether the risk of cesarean delivery is higher or lower following labour induction compared with expectant management. Methods: We searched 6 electronic databases for relevant articles published through April 2012 to identify randomized controlled trials (RCTs) in which labour induction was compared with placebo or expectant management among women with a viable singleton pregnancy. We assessed risk of bias and obtained data on rates of cesarean delivery. We used regression analysis techniques to explore the effect of patient characteristics, induction methods and study quality on risk of cesarean delivery. Results: We identified 157 eligible RCTs (n = 31 085). Overall, the risk of cesarean delivery was 12% lower with labour induction than with expectant management (pooled relative risk [RR] 0.88, 95% confidence interval [CI] 0.84-0.93; I2 = 0%). The effect was significant in term and post-term gestations but not in preterm gestations. Meta-regression analysis showed that initial cervical score, indication for induction and method of induction did not alter the main result. There was a reduced risk of fetal death (RR 0.50, 95% CI 0.25-0.99; I2 = 0%) and admission to a neonatal intensive care unit (RR 0.86, 95% CI 0.79-0.94), and no impact on maternal death (RR 1.00, 95% CI 0.10-9.57; I2 = 0%) with labour induction. Interpretation: The risk of cesarean delivery was lower among women whose labour was induced than among those managed expectantly in term and post-term gestations. There were benefits for the fetus and no increased risk of maternal death. © 2014 Canadian Medical Association or its licensors

Improving access to high-quality primary care for socioeconomically disadvantaged older people in rural areas: a mixed method study protocol

Introduction: The UK has an ageing population, especially in rural areas, where deprivation is high among older people. Previous research has identified this group as at high risk of poor access to healthcare. The aim of this study is to generate a theory of how socioeconomically disadvantaged older people from rural areas access primary care, to develop an intervention based on this theory and test it in a feasibility trial. Methods and analysis: On the basis of the MRC Framework for Developing and Evaluating Complex Interventions, three methods will be used to generate the theory. First, a realist review will elucidate the patient pathway based on existing literature. Second, an analysis of the English Longitudinal Study of Ageing will be completed using structural equation modelling. Third, 15 semistructured interviews will be undertaken with patients and four focus groups with health professionals. A triangulation protocol will be used to allow each of these methods to inform and be informed by each other, and to integrate data into one overall realist theory. Based on this theory, an intervention will be developed in discussion with stakeholders to ensure that the intervention is feasible and practical. The intervention will be tested within a feasibility trial, the design of which will depend on the intervention. Lessons from the feasibility trial will be used to refine the intervention and gather the information needed for a definitive trial. Ethics and dissemination: Ethics approval from the regional ethics committee has been granted for the focus groups with health professionals and interviews with patients. Ethics approval will be sought for the feasibility trial after the intervention has been designed. Findings will be disseminated to the key stakeholders involved in intervention development, to researchers, clinicians and health planners through peer-reviewed journal articles and conference publications, and locally through a dissemination event

Accounting aspects of ocean iron fertilization

Diminishing emission budgets and increasing risks of catastrophic damages from climate change require analyses of rapid response options including geoengineering options such as ocean iron fertilization (OIF). To decide whether or not OIF might be such an option an assessment of its potential as an abatement option as well as its possible side effects is required. To explore the potential of OIF knowledge on the change of carbon stocks over time is needed. However, economic aspects including accounting of carbon credits need to be considered as well. In our analysis we use data from OIF modeling experiments for different years and analyze how many carbon credits would be generated and could be used for compliance. The amount of credit varies with the accounting method applied. Applying an accounting method which measures the net effect of OIF for the duration of 100 years leads to an annual carbon uptake of 0.56 to 1.69 GtC. For a shorter fertilization period, e.g. ten years the upper range increases to 2.57 GtC per year. Offsets due to other GHGs, especially N2O, as well as operational carbon emissions can be addressed by a discount factor. Considering all experiments and all accounting methods we find a maximum discount factor of 15 percent and an average value of 9 percent. From an economic as well as from an environmental perspective issuing temporary carbon credits which have to be replaced in the next commitment period seems most appropriate for short-term OIF and would provide the largest amount of credits at an early stage. This is equivalent to the existing tCER regulation under the Kyoto Protocol

Communication Strategies Used by 2nd Semesterstudents of English Study Program in Universitas Brawijaya with Different Anxiety Levels in Telling Comic Strips

Yuda Crisilla, Syailendra. 2013. Communication Strategies Used by 2 Semester Students of English Study Program in Universitas Brawijaya with Different Anxiety Levels in Telling Comic Strips. Study Program of English, Department of Languages and Literature, Faculty of Cultural Studies, Universitas Brawijaya.Supervisor: Fatimah; Co-supervisor: Didik HartonoKeywords: communication strategies, anxiety, anxiety levels, foreign languagelearning.Students usually face some problems in speaking a foreign language. To overcome the problems, they have certain ways that are called as communication strategies. Anxiety as an affective factor can influence the students in using communication strategies. In this study, the writer conducted a study on communication strategies used by 2nd semester students of English Study Program in Universitas Brawijaya with different anxiety levels in telling comic strips. The writer uses theory of communication strategies by Dörney (1995) . There are two problems of the study which were proposed: (1) What are the types of communication strategies used by students with high and low anxiety level when telling the comic strips (2) How is the frequency of types of communication strategies used by students with low and high anxiety level when telling the comic strips.This study used qualitative approach in relation to the use of clear and systematic description about the phenomena being studied. There were 16subjects in this study. They came from Academic Speaking Class students who were selected using FLCAS that is developed by Horwitz et al. (1986) and dividedinto two groups, namely subjects with high and low anxiety level. The data wereutterances containing communication strategies in telling comic strips.This study reveals that there are 13 types of communication strategies usedby subjects with high anxiety level. On the other hand, subjects with low anxietylevel used 15 types of communication strategies. The writer also found that thefrequency of the communication strategies used by subjects with high and lowanxiety were different. Subjects with high anxiety level produced higher numberof communication strategies than subjects with low anxiety level. The writer alsoconcludes that the more anxious students tend to produce less effective ofcommunication strategies than those who feel relaxed in speaking. The writer suggests foreign language teacher find an appropriate teaching method to manage the students' anxiety and introduce communication strategies in speaking class. The writer also suggests to the next researchers to conduct moreresearch about communication strategies with other theories and also differentvariables

Factors associated with alcohol reduction in harmful and hazardous drinkers following alcohol brief intervention in Scotland: a qualitative enquiry

Background: Alcohol Brief Intervention (ABI) uses a motivational counselling approach to support individuals to reduce excessive alcohol consumption. There is growing evidence on ABI’s use within various health care settings, although how they work and which components enhance success is largely unknown. This paper reports on the qualitative part of a mixed methods study. It explores enablers and barriers associated with alcohol reduction following an ABI. It focuses on alcohol’s place within participants’ lives and their personal perspectives on reducing consumption. There are a number of randomised controlled trials in this field though few ABI studies have addressed the experiences of hazardous/harmful drinkers. This study examines factors associated with alcohol reduction in harmful/hazardous drinkers following ABI. Methods: This qualitative study was underpinned by a realist evaluation approach and involved semistructured interviews with ten harmful or hazardous alcohol drinkers. Participants (n = 10) were from the intervention arm of a randomised controlled trial (n = 124). All had received ABI, a 20 min motivational counselling interview, six months previously, and had reduced their alcohol consumption. Interviews were recorded, transcribed verbatim and thematically analysed. Results: Participants described their views on alcohol, its’ place in their lives, their personal perspectives on reducing their consumption and future aspirations. Conclusions: The findings provide an insight into participants’ views on alcohol, ABI, and the barriers and enablers to change. Participants described a cost benefit analysis, with some conscious consideration of the advantages and disadvantages of reducing intake or abstaining from alcohol. Findings suggest that, whilst hospital admission can act as a catalyst, encouraging individuals to reflect on their alcohol consumption through ABI may consolidate this, turning this reflective moment into action. Sustainability may be enhanced by the presence of a ‘significant other’ who encourages and experiences benefit. In addition having a purpose or structure with activities linked to employment and/or social and leisure pursuits offers the potential to enhance and sustain reduced alcohol consumption. Trial registration: Trial registration number TRN NCT00982306 September 22nd 200

The role of institutional and family embeddedness in the failure of Sub-Saharan African migrant family businesses

There is considerable interest among European politicians and policymakers in how to integrate migrants in the local and national economy. Drawing on in-depth qualitative interviews with 20 owners of Sub-Saharan African migrant family businesses (SSAMBs) in the United Kingdom, this article critically examines why SSAMBs fail or underperform. This investigation draws upon three streams of literature – notably migrant business failure, institutional theory and family embeddedness. The findings highlight the challenges of doing business and the reasons for business failure among this group. These are different from other small businesses and include culture, family interference and ethnicity. The main contribution of the article lies in the development of a conceptual model that highlights the relationships between institutional contexts and migrant family business outcomes. The model proposes that institution and family embeddedness results in the enactment of ethnic behaviours that drive migrant businesses into cultural markets leading to business underperformance or failure

Methodological Challenges in Sustainability Science: A Call for Method Plurality, Procedural Rigor and Longitudinal Research

Sustainability science encompasses a unique field that is defined through its purpose, the problem it addresses, and its solution-oriented agenda. However, this orientation creates significant methodological challenges. In this discussion paper, we conceptualize sustainability problems as wicked problems to tease out the key challenges that sustainability science is facing if scientists intend to deliver on its solution-oriented agenda. Building on the available literature, we discuss three aspects that demand increased attention for advancing sustainability science: 1) methods with higher diversity and complementarity are needed to increase the chance of deriving solutions to the unique aspects of wicked problems; for instance, mixed methods approaches are potentially better suited to allow for an approximation of solutions, since they cover wider arrays of knowledge; 2) methodologies capable of dealing with wicked problems demand strict procedural and ethical guidelines, in order to ensure their integration potential; for example, learning from solution implementation in different contexts requires increased comparability between research approaches while carefully addressing issues of legitimacy and credibility; and 3) approaches are needed that allow for longitudinal research, since wicked problems are continuous and solutions can only be diagnosed in retrospect; for example, complex dynamics of wicked problems play out across temporal patterns that are not necessarily aligned with the common timeframe of participatory sustainability research. Taken together, we call for plurality in methodologies, emphasizing procedural rigor and the necessity of continuous research to effectively addressing wicked problems as well as methodological challenges in sustainability science

The Derivation of Hybridizable Discontinuous Galerkin Methods for Stokes Flow

In this paper, we introduce a new class of discontinuous Galerkin methods for the Stokes equations. The main feature of these methods is that they can be implemented in an efficient way through a hybridization procedure which reduces the globally coupled unknowns to certain approximations on the element boundaries. We present four ways of hybridizing the methods, which differ by the choice of the globally coupled unknowns. Classical methods for the Stokes equations can be thought of as limiting cases of these new methods

Overcoming cross-cultural group work tensions: mixed student perspectives on the role of social relationships

As universities worldwide rapidly internationalise, higher education classrooms have become unique spaces for collaboration between students from different countries. One common way to encourage collaboration between diverse peers is through group work. However, previous research has highlighted that cross-cultural group work can be challenging and has hinted at potential social tensions. To understand this notion better, we have used robust quantitative tools in this study to select 20 participants from a larger classroom of 860 students to take part in an in-depth qualitative interview about cross-cultural group work experiences. Participant views on social tensions in cross-cultural group work were elicited using a unique mediating artefact method to encourage reflection and in-depth discussion. In our analysis of emergent interview themes, we compared student perspectives on the role of social relationships in group work by their academic performance level. Our findings indicated that all students interviewed desired the opportunity to form social relationships with their group work members, but their motivations for doing so varied widely by academic performance level