77 research outputs found
"There’s a problem with BMI”: An exploration of midwives’ perspectives on the provision of maternity care to women with an increased BMI during pregnancy and childbirth in NZ
No full textThe global burden of ‘maternal obesity’1 continues to receive worldwide attention, with the dominating focus being the identification and management of the perceived risks obesity poses to pregnancy. This focus, however, has neglected to seek solutions and perspectives from the individuals themselves and those others that may be best placed to understand the nuanced dynamics and realities. In Aotearoa New Zealand (NZ) over 95% of women2 choose a midwife as their Lead Maternity Carer (LMC) (Ministry of Health [MOH], 2020) yet research exploring midwives’ perspectives on the provision care to women with increased Body Mass Index (BMI) is limited.
The aim for this thesis was to explore ‘the perspectives of midwives in NZ regarding the provision of maternity care to women with an increased body mass index (BMI).’ The research question driving this study was “What are midwives’ perspectives on the provision of maternity care to women with an increased BMI in New Zealand?” To answer this question, this qualitative study utilised a feminist standpoint theoretical lens to explore the experiences of seventeen midwives who provide care to such women, in three separate geographical locations in NZ. Data was collected using focus groups and semi-structured interviews and Braun and Clark’s (2013) thematic analysis process was used to identify four themes.
Midwives within this study perceived that the use of BMI as a single measure of risk in maternity was flawed. They identified that hype exists around increased BMI which leads to over medicalisation and unnecessary and potentially harmful interventions taking place when women present with an increased BMI. Midwives are aware of and witness both discriminatory behaviour towards, and poor treatment of women with increased BMI within their midwifery work. Midwives desire change, yet often feel obstructed and powerless within the current maternity system which is dominated by these practices. The study themes presented are titled, a flawed approach, concern for women's experience, being stuck, and sticking together.
This study suggests that systemic and structural barriers to equitable care exist within the maternity system in NZ regarding the provision of care to women with increased BMI. Viewing this situation from a feminist standpoint perspective has enabled the articulation of a position that despite midwives feeling the system hampers their ability to advocate for women and protect normal birth, their expertise about how to most effectively work with obese women has the potential to transform women’s experience and improve maternity outcomes. Explicit pathways for women who are obese require strengthening within our current system to enable judgment-free informed choice regarding interventionist or non- interventionist care.
1 Maternal obesity is a term used often in literature to refer to women who are obese (≥ 30 kg/m2) in pregnancy. The author acknowledges that this term has the potential to cause offense and is not one that the author condones.
2 The words ‘women/woman/her/she/māmā are used throughout this thesis, yet the author would like to acknowledge trans/nonbinary individuals within our communities and within the maternity spac
Postoperative concurrent chemoradiotherapy versus postoperative radiotherapy in high-risk cutaneous Squamous cell carcinoma of the head and neck: the randomized phase III TROG 05.01 trial
No full textPublished at jco.org on March 14, 2018.Abstract not availableSandro Virgilio Porceddu, Mathias Bressel, Michael Geoffrey Poulsen, Adam Stoneley, Michael John Veness, Lizbeth Moira Kenny, Chris Wratten, June Corry, Stephen Cooper, Gerald Blaise Fogarty, Marnie Collins, Michael Kevin Collins, Andrew Martin John Macann, Christopher Gerard Milross, Michael Gordon Penniment, Howard Yu-hao Liu, Madeleine Trudy King, Benedict James Panizza, and Danny Rischi
Near-Infrared Sensitized Photocathodes and Film Sensitivities for Typical Xenon-Lamp Radiation and Related Subjects
No full textAuthor Institution: Solid State Physics Research Laboratory, Wright-Patterson Air Force Base, Ohio 45433Weighting or assessment factors of near-infrared photocathodes and Kodak 5424 film are determined for xenon-lamp illumination. These values are important for selecting detectors and determining the basic sensitivity for a given situation and instrumentation; for example, in medicine, when obtaining retinal pictures. Some other typical applications are also discussed. Charts showing the radiation from a xenon-arc lamp, with a 0.5 mm arc length and 800 watt input, and the typical efficiency values of photocathodes and film to xenon-lamp radiation are presented at spectral intervals of 20 nm for the range of 400 to 1100 nm, with and without Kodak Wratten filter 89b
Farmland, food, and bioenergy crops need not compete for land
No full textThe need to mitigate the effects of climate change has resulted in some governments setting mandates to attain targets for bioenergy production. Recently, there has been concern that the large-scale use of first-generation biofuel feedstocks may result in ‘food displacement.’ New second-generation bioenergy crops can be produced on poor soil and provide a potential solution to this problem if grown on marginal land that was previously uneconomic for agricultural production. However, consequences of this production method are biodiversity loss and carbon release if previously fallow land is cultivated. Marginal land is also less agriculturally productive, and if profits from biomass plantations exceed those from food production, farmers will grow bioenergy crops on prime agricultural land in order to maximize profit.
Alternative approaches include utilizing mixtures of native grassland perennials grown on agriculturally degraded lands for bioenergy production and producing biodiesel from microalgae. In New Zealand, research is being conducted on the benefits of integrating bioenergy crops within the present farming system. In this research, the ecosystem services (ES) value of re-instated shelter on irrigated dairy farms is assessed using the novel approach of adopting a bioenergy crop for shelterbelt creation. Together with on-farm ES as well as those external to the farm, ES delivery from shelterbelts—rows of trees or shrubs planted to provide wind protection—potentially improves the profitability of the farming enterprise. By planting a shelterbelt of Miscanthus x giganteus (Mxg), a sterile hybrid bioenergy grass that grows four meters tall, in the northerly corners of fields, we were able to measure the multiple ES advantages generated including shelter for livestock, the growing of a harvestable crop for fodder or renewable fuels, and benefits from creating a new on-farm habitat such as a refuge for beneficial predatory insects and pollinators. Findings show that pastures benefiting from the shelter of the grass have reduced evapotranspiration rates, the process by which water is transferred from the land to the atmosphere by evaporation from the soil and other surfaces and by transpiration from plants, resulting in increased yields. In the sheltered field areas, there was a positive influence on soil mineralization rates and beneficial insects. By having bioenergy crops as a valuable co-product of the existing farming system, in this case dairy production, the problem of replacing land used for food production with bioenergy cropping is overcome. The loss of food-productive land is potentially more than compensated for by the value of ES benefits gained if long term sustainability of the farming system and global threats associated with fossil-carbon use are considered.The prime source of funding for this New Zealand-based Mxg shelterbelt research was provided by Westland Milk Products Ltd, Hokitika, NZ, largely due to the efforts of Chris Pullen, their Environmental Manager. Further funding was provided by DairyNZ and the Bio-Protection Research Centre, Lincoln University
Eating As Treatment (EAT): a stepped-wedge, randomised controlled trial of a health behaviour intervention provided by dietitians to improve nutrition in patients with head and neck cancer undergoing radiotherapy
No full textInfections after fiducial marker implantation for prostate radiotherapy: are we underestimating the risks?
No full textThe impact of preradiation residual disease volume on time to locoregional failure in cutaneous merkel cell carcinoma - A TROG substudy
No full textPurpose: This study evaluated the impact of margin status and gross residual disease in patients treated with chemoradiation therapy for high-risk stage I and II Merkel cell cancer (MCC). Methods and Materials: Data were pooled from 3 prospective trials in which patients were treated with 50 Gy in 25 fractions to the primary lesion and draining lymph nodes and 2 schedules of carboplatin based chemotherapy. Time to locoregional failure was analyzed according to the burden of disease at the time of radiation therapy, comparing patients with negative margins, involved margins, or macroscopic disease. Results: Analysis was performed on 88 patients, of whom 9 had microscopically positive resection margins and 26 had macroscopic residual disease. The majority of gross disease was confined to nodal regions. The 5-year time to locoregional failure, time to distant failure, time to progression, and disease-specific survival rates for the whole group were 73%, 69%, 62%, and 66% respectively. The hazard ratio for macroscopic disease at the primary site or the nodes was 1.25 (95% confidence interval 0.57-2.77), P=.58. Conclusions: No statistically significant differences in time to locoregional failure were identified between patients with negative margins and those with microscopic or gross residual disease. These results must, however, be interpreted with caution because of the limited sample size
Gastrostomy dependency trends over 15 years of patients at a large tertiary referral center following the insertion of a prophylactic gastrostomy for chemoradiation for mucosal head and neck cancer
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