Induction of labour (IOL) is one of the most commonly performed interventions in maternity care, with outpatient cervical ripening increasingly offered as an option for women undergoing IOL. The ...COVID-19 pandemic has changed the context of practice and the option of returning home for cervical ripening may now assume greater significance. This work aimed to examine whether and how the COVID-19 pandemic has changed practice around IOL in the UK.
We used an online questionnaire to survey senior obstetricians and midwives at all 156 UK NHS Trusts and Boards that currently offer maternity services. Responses were analysed to produce descriptive statistics, with free text responses analysed using a conventional content analysis approach.
Responses were received from 92 of 156 UK Trusts and Boards, a 59% response rate. Many Trusts and Boards reported no change to their IOL practice, however 23% reported change in methods used for cervical ripening; 28% a change in criteria for home cervical ripening; 28% stated that more women were returning home during cervical ripening; and 24% noted changes to women's response to recommendations for IOL. Much of the change was reported as happening in response to attempts to minimise hospital attendance and restrictions on birth partners accompanying women.
The pandemic has changed practice around induction of labour, although this varied significantly between NHS Trusts and Boards. There is a lack of formal evidence to support decision-making around outpatient cervical ripening: the basis on which changes were implemented and what evidence was used to inform decisions is not clear.
To identify the challenges and opportunities for rolling out a bespoke model of group antenatal care called Pregnancy Circles (PC) within the National Health Service: what kind of support and ...training is needed and what adaptations are appropriate, including during a pandemic when face-to-face interaction is limited.
Exploratory qualitative study (online focus group). Study co-designed with midwives. Data analysed thematically using an ecological model to synthesise.
Five maternity services within the National Health Service.
Seven midwives who facilitated PCs. Three senior midwives with implementation experience participated in the co-design process.
Three themes operating across the ecological model were identified: ‘Implementing innovation’, ‘Philosophy of care’ and ‘Resource management’. Tensions were identified between group care’s focus on relationships and professional autonomy, and concepts of efficiency within the NHS's market model of care. Midwives found protected time, training and ongoing support essential for developing the skills and confidence needed to deliver this innovative model of care. Integrating Pregnancy Circles with continuity of carer models was seen as the most promising opportunity for long-term implementation. Midwives perceived continuity and peer support as the most effective elements of the model and there was some evidence that the model may be robust enough to withstand adaptation to online delivery.
Midwives facilitating group care enjoyed the relationships, autonomy and professional development the model offered. Harnessing this personal (micro-level) satisfaction is key to wider implementation. Group care is well aligned with current maternity policy but the challenges midwives face (temporal, practical and cultural) must be anticipated and addressed at macro and meso level for wider implementation to be sustainable. The PC model may be flexible enough to adapt to online delivery and extend continuity of care but further research is needed in these areas.
Implementation of group care in the NHS requires senior leadership and expertise in change management, protected time for training and delivery of the model, and funding for equipment. Training and ongoing support, are vital for sustainability and quality control. There is potential for online delivery and integrating group care with continuity models.
Trichinella spiralis and Trichuris muris are nematode parasites of the mouse, dwelling in the small and large intestines, respectively: worm expulsion requires development of a Th2 immune response. ...The chemokine CCL11 is agonist for the chemokine receptor CCR3 and acts in synergy with IL‐5 to recruit eosinophils to inflammatory sites. The role of CCL11 in gastrointestinal helminth infection has not been previously studied. We challenged wild‐type (WT) BALB/c, CCL11 single knockout (SKO) and CCL11 IL‐5 double knockout (DKO) mice with either T. spiralis muscle larvae or T. muris eggs in order to examine eosinophil recruitment to the small and large intestine during helminth infection. A peripheral eosinophilia was seen in WT and SKO mice during T. spiralis infection but not with T. muris. Gastrointestinal eosinophilia was markedly reduced but not ablated in SKO mice ‐ and negligible in DKO mice ‐ infected with either nematode. The residual eosinophilia and up‐regulation of CCL24 mRNA in the gastrointestinal tract of SKO mice infected with either nematode, together with the presence of an eosinophil‐active factor in T. spiralis and T. muris products, suggest that CCL11 is the salient but not the sole eosinophil chemoattractant of biological significance during gastrointestinal helminth infection.
National Agriculture Imagery Program (NAIP) orthophotography is a potentially useful data source for land cover classification in the United States due to its nationwide and generally cloud-free ...coverage, low cost to the public, frequent update interval, and high spatial resolution. Nevertheless, there are challenges when working with NAIP imagery, especially regarding varying viewing geometry, radiometric normalization, and calibration. In this article, we compare NAIP orthophotography and RapidEye satellite imagery for high-resolution mapping of mining and mine reclamation within a mountaintop coal surface mine in the southern coalfields of West Virginia, USA. Two classification algorithms, support vector machines and random forests, were used to classify both data sets. Compared to the RapidEye classification, the NAIP classification resulted in lower overall accuracy and kappa and higher allocation disagreement and quantity disagreement. However, the accuracy of the NAIP classification was improved by reducing the number of classes mapped, using the near-infrared band, using textural measures and feature selection, and reducing the spatial resolution slightly by pixel aggregation or by applying a Gaussian low-pass filter. With such strategies, NAIP data can be a potential alternative to RapidEye satellite data for classification of surface mine land cover.
While it is known that glutamate is critical to CNS development and function, less is known about the role of kainate receptors, a subclass of ionotropic glutamate receptors, during ontogeny. This is ...especially true with respect to the emergence and expression of behaviour. It is also known that the neonatal CNS differs from that of adults with respect to excitatory amino acid (EAA) toxicity. Our aim was to determine the effects of early low-dose stimulation of kainate receptors on physical and behavioural development in the rat. Saline, one of two subtoxic doses of domoic acid (DOM) (5 and 20 μg/kg), or in a parallel study, saline, or one of two pharmacologically equivalent doses of kainic acid (KA) (25 and 100 μg/kg), were systemically administered once daily from postnatal days (PNDs) 8–14. While DOM or KA had no effect on typical measures of toxicity such as weight gain, acoustic startle, ultrasonic vocalizations (UVs), or maternal retrieval, these doses were shown to be physiologically relevant, producing particular group differences in eye opening, conditioned place preference, and activity levels. We conclude that administration of very low doses of selective kainate receptor agonists during the second postnatal week produces changes in neurobehavioural development in the rat.
Sometimes an unexpected event or crisis can occur that is of sociological interest where for a period of time a particular society is faced with a number of challenges. This sociological impression ...will explore one such event, the New York blackout of 2003, by developing a ‘street level snapshot’ of the experiences of New Yorkers during the power outage. The majority of material for this impression was gathered by acting as sociological flâneur, guided by the ideas of Benjamin, Simmel, Parks, and Jacobs into understanding the experience of modernity and city life by taking to the streets and directly observing what transpires. Further material from the internet and the media is used to augment the personal observation. Finally, drawing on the sociology of emotions a speculative discussion attempts to make sense of what was observed particularly the strong upsurge in emotion and the passionate way in which New Yorkers kept their neighbourhoods and city functioning. Throughout the essay reflexive and reflective comments will be made concerning the sociologist carrying out ‘spontaneous’ research into temporary but significant events.
Doppler echocardiography is a relatively new procedure used to assess certain cardiovascular disorders in the dog. The objectives of this study were to determine the range of values for the maximal ...peak velocity of blood flow across each of the four cardiac valves in a sample population of normal adult dogs, using duplex continuous wave Doppler echocardiography, and to determine the optimal tomographic planes to use for an adequate continuous wave Doppler evaluation of the canine heart. Twenty normal dogs were examined to obtain values for peak transvalvular velocity for each of the four cardiac valves. The mean values +/- 1 SD, in cm/s were: 98.1 +/- 9.4 for the pulmonary valve imaged from the left side of the chest, 95.5 +/- 10.3 for the pulmonary valve imaged from the right side of the chest (n = 19), 118.1 +/- 10.8 for the aortic valve, 86.2 +/- 9.5 for the mitral valve and 68.9 +/- 8.4 for the tricuspid valve. Regurgitation was detected across the pulmonic valve in 14 of the 20 dogs, and across the tricuspid valve in ten dogs. The analysis of the tomographic images confirmed that for a complete assessment of a given intracardiac valve, the valve must be examined from all possible directions to obtain maximum values for peak velocity.
A series of six hemodialysis vascular access patients was evaluated with duplex Doppler sonography and angiography to identify Doppler sonographic parameters that are predictors of venous outflow ...stenosis. This preliminary series indicates that no venous outflow stenosis was present angiographically when the resistive index gradient across the venous anastomosis is less than or equal to zero and a significant venous outflow stenosis (50 to 100%) was present when the resistive index gradient is 0.15 or greater (P = 0.002, r = 0.963). Doppler acquisition of resistive index gradients across regions of venous outflow is a promising, noninvasive means of rapid radiologic evaluation of hemodialysis graft patients, especially when the need for angiography is equivocal.
Conservative care of sports hernias within soccer players: A case series Yuill, Erik A., DC, MSc, BSc, BPHE; Pajaczkowski, Jason A., DC, BSc, FCCSS(C), FCCRS(C); Howitt, Scott D., DC, MSc, FCCSS(C), FCCRS(C)
Journal of bodywork and movement therapies,
10/2012, Letnik:
16, Številka:
4
Journal Article
Recenzirano
Summary Objective To detail the progress of 2 high-level soccer players and 1 recreational soccer player with chronic groin pain that was exacerbated by participation in sports and relieved by rest. ...The patients under went a conservative treatment plan featuring manual therapy, therapeutic modalities, and plyometric training. Clinical features The most important examination findings were palpable tenderness over the internal oblique fascia and anterior pubic tubercle, pain with resisted hip adduction, and pain with a resisted abdominal curl-up. Conventional treatment aimed at decreasing healing time of the injury through manual therapy, including soft tissue and modality techniques; rehabilitative exercises, focusing on the pelvic muscles; and plyometric training, aiming at sport specific functional improvement. Intervention The conservative treatment approach utilized in this case series involved manual therapy, 1–2 times a week for 6–8 weeks, consisting of soft tissue, laser, microcurrent, and acupuncture; rehabilitative exercise and plyometric training, 3 times a week for 8 weeks, to help improve strength, coordination, and correct pelvic muscle imbalances. Outcome measures included visual analog scale scores and resisted muscle testing. Summary Three soccer players, of varying levels of ability, presenting with a suspected sports hernia (chronic groin pain exacerbated by sports and relieved by rest) were relieved of their pain after 8 weeks of conservative care featuring manual therapy, rehabilitative exercises, and plyometric training.
We wanted to compare an ultrasound examination with the bone scintiscan to diagnose stress fractures.
Using the bone scintiscan as the reference standard, we conducted a prospective, double-blind ...study of 78 patients (87 percent were men, mean age 24 years) referred for bone scintiscan to rule out tibial stress fractures. After the participants were injected with radionuclide, we examined each tibia once using ultrasound adjusted for an active intensity of 2.0 W/cm2 and again with the wand turned off. The patient was blinded to the mode used. The patient's response to the ultrasound was considered positive if the patient reported pain as the wand passed over the tibia. A bone scintiscan was considered positive according to the criteria of Zwas. One sonography technician performed all examinations; both he and the nuclear medicine department were blinded to the other's findings. The final results were tabulated by a third, uninvolved party. A positive correlation between the scintiscan and ultrasound examination consisted of pain with active ultrasound and any degree of stress fracture in any part of the same tibia as found on the bone scintiscan.
Thirty-five stress fractures were found on bone scintiscan, whereas only 15 were detected by ultrasound examination (sensitivity 43 percent). With ultrasound testing there were 22 false positives (specificity 49 percent) and 20 false negatives. These findings resulted in a positive predictive value of 41 percent and a negative predictive value of 51 percent.
Ultrasound is not reliable in the diagnosis of tibial stress fractures. Bone scintiscan remains the test of choice.
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