Comparison of labour and birth outcomes between nulliparous women who used epidural analgesia in labour and those who did not: A prospective cohort study

ObjectiveTo compare labour and birth outcomes between nulliparous women who used versus did not use intrapartum epidural analgesia.DesignProspective cohort study.SettingTwo maternity hospitals in Ireland.PopulationA total of 1221 nulliparous women who gave birth vaginally or by emergency caesarean section.MethodsMultinomial logistic regression was used to analyse categorical outcomes, with results presented as ratios of relative risks (RRR). For dichotomous outcomes we used logistic regression, with results presented as odds ratios (OR).Main outcome measuresMode of birth, IV syntocinon use, pyrexia (≥38 °C), antibiotic treatment, first stage labour ≥10 h, second stage labour ≥2 h, blood loss (≥500 mls, ≥1000 mls), perineal trauma. Neonatal outcomes included Apgar score ≥7 at 1 min and 5 min, admission to neonatal intensive care unit, and infant feeding method.ResultsWomen using EA were more likely to require a vacuum-assisted birth (RRR 3.35, p < 0.01) or forceps-assisted birth (RRR 11.69, p < 0.01). Exposure to EA was associated with significantly greater risk of ≥10 h first (OR 6.72, p = 0.01) and ≥2 h second (OR 2.25, p < 0.01) stage labour, increased likelihood of receiving IV syntocinon (OR 9.38, p < 0.01), antibiotics (OR 2.97, p < 0.01) and a greater probability of pyrexia (OR 10.26, p < 0.01). Women who used EA were half as likely to be breastfeeding at three months postpartum (OR 0.53, p < 0.01). No differences were observed between groups in neonatal outcomes.ConclusionsOur data shows significant associations between EA use and several intrapartum outcomes.     

Evaluation of an intervention supporting breastfeeding among late-preterm infants during in-hospital stay

BackgroundLate-preterm infants show lower breastfeeding rates when compared with term infants. Current practice is to keep them in low-risk wards where clinical guidelines to support breastfeeding are well established for term infants but can be insufficient for late-preterm.ObjectiveThe aim of this study was to evaluate an intervention supporting breastfeeding among late-preterm infants in a maternity service in the Basque Country, Spain.MethodsThe intervention was designed to promote parents’ education and involvement, provide a multidisciplinary approach and decision-making, and avoid separation of the mother-infant dyad. A quasi-experimental study was conducted with a control (n = 212) and an intervention group (n = 161). Data was collected from clinical records from November 2012 to January 2015. Feeding rate at discharge, breast-pump use, incidence of morbidities, infant weight loss and hospital stay length were compared between the two groups.ResultsInfants in the control group were 50.7% exclusive breastfeeding, 37.8% breastfeeding, and, 11.5% formula feeding at discharge, whereas in the intervention group, frequencies were 68.4%, 25.9%, and 5.7%, respectively (p = 0.002). Mothers in the intervention group were 2.66 times more likely to use the breast-pump after almost all or all feeds and 2.09 times more likely to exclusively breastfeed at discharge. There were no significant differences in morbidities and infant weight loss between groups. Hospital stay was longer for infants who required phototherapy in the intervention group (p = 0.009).ConclusionThe intervention resulted in a higher breastfeeding rate at discharge. Interventions aimed to provide specific support among late-pretem infants in maternity services are effective.     

赏析邱吉尔的"对德宣言"

邱吉尔的Speech in H itler’s Invasion of the U.S.S.R.是一篇语言与结构俱佳的演讲稿。从分析其文体的角度出发,引导读者赏析原文中大量使用的平行,重复,押韵,比喻等修辞手法是如何使演讲稿达到音,形,义的完美结合,从而在听众心里产生强烈的共鸣。     

Residual analysis for spatial point processes (with discussion)

Summary.  We define residuals for point process models fitted to spatial point pattern data, and we propose diagnostic plots based on them. The residuals apply to any point process model that has a conditional intensity; the model may exhibit spatial heterogeneity, interpoint interaction and dependence on spatial covariates. Some existing ad hoc methods for model checking (quadrat counts, scan statistic, kernel smoothed intensity and Berman's diagnostic) are recovered as special cases. Diagnostic tools are developed systematically, by using an analogy between our spatial residuals and the usual residuals for (non-spatial) generalized linear models. The conditional intensity λ plays the role of the mean response. This makes it possible to adapt existing knowledge about model validation for generalized linear models to the spatial point process context, giving recommendations for diagnostic plots. A plot of smoothed residuals against spatial location, or against a spatial covariate, is effective in diagnosing spatial trend or co-variate effects. Q – Q -plots of the residuals are effective in diagnosing interpoint interaction.     

海水淡化装置水流特性的三维数值模拟

运用计算流体力学方法，对多级闪发式海水淡化装置第一级的流动进行了三维数值模拟，分析了闪发室内的水流特性，并将有阻流板的与无阻流板的计算结果进行了比较，数值模拟结果表明，闪发室内存在着大尺度的环流和旋涡，且主导着闪发室内的流态，对闪发效率产生重要影响；阻流板确能很大地改变整个闪发室的水流特性，但目前的阻流板设置方式对提高闪发效率是不利的．     

獭兔养殖综合技术研究

对獭兔的适应性、饲养管理、疾病防治、产品加工等养殖综合技术进行了研究,提出了獭兔的“三改、两杯、两早一分和两选两适”规范化饲养管理制度和疾病综合防治技术措施,探索出了优质獭兔毛皮和“富钙兔肉脯”的加工工艺以及獭兔良种推广的有效途径。     

Bias correction for parameter estimates of spatial point process models

When a spatial point process model is fitted to spatial point pattern data using standard software, the parameter estimates are typically biased. Contrary to folklore, the bias does not reflect weaknesses of the underlying mathematical methods, but is mainly due to the effects of discretization of the spatial domain. We investigate two approaches to correcting the bias: a Newton–Raphson-type correction and Richardson extrapolation. In simulation experiments, Richardson extrapolation performs best.     

一种疏水缔合聚合物快速溶解方法研究

研究了疏水缔合聚合物（AP–P4）经过拉伸装置后的溶解时间。结果表明，拉伸装置可以缩短疏水缔合聚合物的溶解时间；拉伸装置的最佳间距为200 μm，此时疏水缔合聚合物的溶解时间为25 min。经拉伸装置处理后的疏水缔合聚合物可以在30 min 内达到溶解；提高温度可以显著改善疏水缔合聚合物的溶解效果，缩短疏水缔合聚合物的溶解时间。     

Navigating infant feeding supports after migration: Perspectives of Arabic and Chinese mothers and health professionals in Australia

Optimal feeding practices can establish lifelong, transgenerational and global health benefits. Migration and cultural factors impact infant feeding practices and the support mothers receive for optimal infant feeding. This qualitative study explored support for infant feeding among Arabic and Chinese speaking migrant mothers in Australia.Semi-structured focus groups were conducted in language with 24 Arabic and 22 Chinese-Mandarin speaking migrant mothers with children under five years of age. Individual interviews were conducted in English with 20 health professionals working with Arabic or Chinese speaking migrant families. Data were thematically analysed using the framework method.Traditional family networks and trusted bi-cultural doctors were influential infant feeding supports for mothers. Health professionals perceived maternal and child health services to be poorly understood, and some mothers who accessed services felt they were not always culturally sensitive. Mothers sought additional information and support through online sources and peers. Both mothers and health professionals recognised the challenges of managing conflicting infant feeding advice and seeking best-practice support.The findings of this study highlight opportunities for health professionals to better support migrant mothers’ infant feeding practices, for example through engaging families and working with doctors. There is a need for greater cultural sensitivity within maternal and child health services and culturally relevant programs to support healthy infant feeding practices among migrant communities.     

Narratives from the neighbourhood: The discursive construction of integration problems in talkback radio1

This paper examines how speakers deploy narrative devices in talking about Sudanese refugees. Particularly, we show how narrative constructions form an important basis for the advancement of accounts about integration problems into the local polity. We analyse talkback ‘phone‐in’ calls to a local Adelaide radio station that provide callers an opportunity to give accounts of events and social phenomena that concern them in their local settings. Analysis shows that speakers regularly deployed narrative constructions, first‐hand ‘witnessing’ devices that functioned to legitimate accounts as veridical versions of events, and contrast devices to explicate the moral and behavioural aberrance of Sudanese refugees. The analysis illustrates how these discursive devices function rhetorically in interaction, in ways that differentiate Sudanese refugees as problematic. Through this analysis, we contend that narrative devices precipitate and bolster socio‐political policies that have serious, negative consequences for Sudanese refugees.