180 research outputs found
Lithofacies variations within the Wessex Formation and their influence on coastal stability
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Explanations and information-giving: clinician strategies used in talking to parents of preterm infants
No full textBackground: The study is part of a larger research programme on neonatal brain imaging in the trial element of which parents were randomised to receive prognostic information based upon either magnetic resonance imaging (MRI) or ultrasound findings (ePrime study). The aim of this study was to investigate the strategies used by clinicians in communicating with parents following imaging at term age of the brain of preterm infants born before 33 weeks gestation, focusing on explanations and information-giving about prognosis Method: Audio recordings of discussions between parents and clinicians were made following MRI and ultrasound assessment. Parents were given the scan result and the baby's predicted prognosis. A framework was developed based on preliminary analysis of the recordings and findings of other studies of information-giving in healthcare. Communication of scan results by the clinicians was further explored in qualitative analysis with 36 recordings using NVivo 10 and the specifically developed framework. Emerging themes and associated sub-themes were identified. Results: The ways in which clinicians gave information and helped parents to understand were identified. Within the over-arching theme of clinician strategies a wide range of approaches were used to facilitate parental understanding. These included orienting, checking on previously acquired information, using analogies, explaining terminology, pacing the information, confirming understanding, inviting clarification, answering parents' questions and recapping at intervals. Ultimately four key themes were identified: 'Framing the information-giving', 'What we are looking at', 'Presenting the numbers and explaining the risk' and 'Appreciating the position of parents'. Conclusions: The interviews represent a multifaceted situation in which there is a tension between the need to explain and inform and the inherent complexity of neurological development, potential problems following preterm birth and the technology used to investigate and monitor these. © 2016 Redshaw and Harvey
Qualitative study of the clinician–parent interface in discussing prognosis following MRI and US imaging of preterm infants in the UK
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Health services research
Research
Qualitative study of the clinician–parent interface in discussing prognosis following MRI and US imaging of preterm infants in the UK
M E Harvey1,2,3, M E Redshaw2 On behalf of the ePrime Research Group
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Abstract
Objective To explore communication and interaction between parents and clinicians following neonatal ultrasound (US) and MRI of the brain of babies born preterm.
Setting This qualitative study was undertaken as part of a larger UK study of neonatal brain imaging. 511 infants were cared for in 14 London neonatal units with MR and cerebral US imaging in a specialist centre.
Participants Parents with infants born at <33 weeks gestation were randomised to receive prognostic information based on either MRI or US findings on their infants at term-corrected age.
Methods Discussions between parents and clinicians about the MRI or US result were audio recorded. Parents were told about the findings and their baby's predicted outcome. A topic guide ensured essential aspects were covered. Recordings were fully transcribed. Discussion of the scan results, the content and style of the interaction and parental response were analysed qualitatively in 36 recordings using NVivo V.10.
Outcomes Key themes and subthemes were identified in the clinician–parent discussions.
Results The overarching theme of ‘the communication interface’ was identified with three key themes: ‘giving information’, ‘managing the conversation’ and ‘getting it right’ and further subthemes. A range of approaches were used to facilitate parental understanding and engagement. There were differences in the exchanges when information about an abnormal scan was given. The overall structure of the discussions was largely similar, though the language used varied. In all of the discussions, the clinicians talked more than the parents.
Conclusions The discussions represent a difficult situation in which the challenge is to give and receive complex prognostic information in the context of considerable uncertainty. The study highlights the importance of being able to re-visit specific issues and any potential areas of misunderstanding, of making time to talk to parents appreciating their perspective and level of knowledge
Insights into the structures adopted by titanocalix[6 and 8]arenes and their use in the ring opening polymerization of cyclic esters
No full textInteraction of p-tert-butylcalix[6]areneH6, L1H6, with [TiCl4] afforded the complex
[Ti2Cl3(MeCN)2(OH2)(L1H)][Ti2Cl3(MeCN)3(L1H)]·4.5MeCN (1·4.5MeCN), in which two pseudo octahedral titanium centres are
bound to one calix[6]arene. A similar reaction but employing THF resulted in the THF ring-opened product [Ti4Cl2(μ3-O)2(NCMe)2(L)2(O(CH2)4Cl)2]·4MeCN (2·4MeCN), where LH4 = p-tert-butylcalix[4]areneH4. Interaction of L1H6 with TiF4 (3
equiv.) led, after work-up, to the complex [(TiF)2(μ -F)L1H]2·6.5MeCN (3·6.5MeCN). Treatment of p-tert-butylcalix[8]areneH8,
L
2H8, with [TiCl4] led to the isolation of the complex [(TiCl)2(TiClNCMe)2(μ3-O)2(L2
)]·1.5MeCN (4·1.5MeCN). From a similar
reaction, a co-crystallized complex [Ti4O2Cl4(MeCN)2(L2
)][Ti3Cl6(MeCN)5(OH2)(L2H2)]·H2O·11MeCN (5·H2O 11MeCN) was
isolated. Extension of the L2H8 chemistry to [TiBr4] afforded, depending on the stoichiometry, the complexes
[(TiBr)2(TiBrNCMe)2(μ3-O)2(L2
)]·6MeCN (6·6MeCN) or [Ti(NCMe)2Br]2[Ti(O)Br2(NCMe)](L2
)]·7.5MeCN (7·7.5MeCN), whilst use
of [TiF4] afforded complexes containing Ca2+ and Na+
, thought to originate from drying agents, namely
[Ti8CaF20(OH2)Na2(MeCN)4(L2
)2]·14MeCN (8·14MeCN), [Na(MeCN)2][Ti8CaF20NaO16(L2
)2]·7MeCN (9·7MeCN) or
[Na]6[Ti8F20Na(MeCN)2(L2
)][Ti8F20Na(MeCN)0.5(L2
)]·15.5(C2H3N) (10·15.5MeCN). In the case of TiI4, the ladder
[(TiI)2(TiINCMe)2(μ3-O)2(L2
)]·7.25CH2Cl2 (11·7.25CH2Cl2) was isolated. These complexes have been screened for their potential
to act as catalysts in the ring opening polymerization (ROP) of ε-caprolactone (ε-CL), δ-valerolactone (δ-VL) and rac-lactide
(r-LA), both in air and N2. For ε-CL and δ-VL, moderate activity at 130 oC over 24 h was observed for 1, 9 and 11; for r-LA,
only 1 exhibited reasonable activity. In the case of the co-polymerization of ε-CL with δ-VL, the complexes 1 and 11 afforded
reasonable conversions and low molecular weight polymers, whilst 4, 6, and 9 were less effective. None of the complexes
proved to be active in the co-polymerization of ε-CL and r-LA under the conditions employed herein.</p
Cognitive, Emotional and Environmental Mediators of Early Parenting in High Risk Families
No full textA thesis submitted in partial fulfilment of the
requirements of the University of Wolverhampton for
the degree of Doctor of PhilosophyThe UK currently has the highest number of premature births (babies born before 37 weeks gestation age and below 2.5kg) in Europe affecting around 70,000 babies and their caregivers each year. Consequently many interventions have been created to support the development of the preterm newborn and minimise the complications of prematurity. Many of the interventions developed have been predominantly tactile and have almost exclusively focused upon their effect upon the baby and not, for example considered the effect that this type of intervention might have upon the parents; specifically the mother, when they are the ones who perform the therapy. In fact there is a severe lack of systematic studies investigating the latter. Hence, the aim of this thesis was to search for research-based evidence on the benefits of environmental support to both babies (e.g. increased weight gain or awake periods) and their mothers (e.g. higher perceptions of themselves as a mother) during hospital confinement and within the context of Neonatal Health Psychology (NNHP). For this reason, the main hypothesis investigated whether mothers’ cognitions and emotions; specifically Maternal Self-Efficacy, Self-Esteem and Attachment, would be affected by environmental mediators in the form of structured or non-structured tactile sensory nurturing interventions. The empirical work reported in this thesis is divided into 3 distinct phases. Firstly, as their was no appropriate measure of maternal Self-Efficacy for mothers of hospitalised preterm neonates the main aim of Phase-1 was to develop and validate an appropriate measure. Using a prospective survey method and a mixed design (between/within and correlational) a total of 160 mother-preterm dyads (pooled from 2 cohorts; cohort 1, N=100; cohort 2, N=60) were recruited. The results demonstrated that the Perceived Maternal Parenting Self-Efficacy (PMPS-E) tool had good initial psychometric properties (including internal/external reliability and construct validity) for its use with mothers of relatively healthy hospitalised preterm neonates. Secondly, in order to investigate mothers’ perceived maternal parenting self-efficacy beliefs further Phase-2 examined whether the type of feeding a mother chose to give to her baby mediated her self-efficacy beliefs. The results suggested that breastfeeding a preterm neonate during hospital confinement may adversely affect mothers’ perceptions of their efficacy in all aspects of parenting. Finally, using an experimental method Phase-3 tested the main hypothesis of this thesis and used a randomised cluster control trial (RCCT) design to allocate 60 mothers and their preterms equally to one of three cluster groups; consisting of either structured (e.g. TAC-TIC therapy or Using a Toy) or non-structured (Placebo/Control) tactile sensory nurturing interventions. The main findings illustrate that tactile sensory nurturing interventions do mediate maternal cognitions and emotions, preterm weight gain and behavioural state. In particular, mothers who performed TAC-TIC demonstrated significantly higher self-reported perceptions in their self-efficacy, self-esteem and attachment, which was attributed to the fact that these babies spent increased amounts of time in an alert and responsive behavioural state, and gained more weight throughout the study period. Thus, the work presented throughout this thesis has implications for Neonatal Health Psychologists and other Health Care professionals’ practice within neonatal units, the use of Neonatal Health Psychology as a framework to study the preterm neonate and their family, and also the way in which both mothers and their hospitalised preterm neonates are supported during hospital confinement
Use of titanocalix[4]arenes in the ring opening polymerization of cyclic esters
No full textThe known dichloride complexes [TiCl2L(O)2(OR)2] (type I: R = Me (1), n-Pr (2) and n-pentyl (3); L(OH)2(OR)2 = 1,3-dialkyloxy-p-tert-butylcalix[4]arene), together with the new complexes {[TiL(O)3(OR)]2(μ-Cl)2}·6MeCN (R = n-decyl (4·6MeCN)), and [Ti(NCMe)Cl(L(O)3(OR))]·MeCN (type II: R = Me, 5·MeCN) are reported. Attempts to prepare type II for R = n-Pr and n-pentyl using [TiCl4] resulted in the complexes {[TiL(O)3(On-propyl)]2(μ-Cl)(μ-OH)} 6·7MeCN and {[TiL(O)3(On-pentyl)]2(μ-Cl)(μ-OH)}·7.5MeCN (7·7.5MeCN), respectively; use of [TiCl4(THF)2] resulted in a co-crystallized THF ring-opened product [Ti(NCMe)(μ3-O)L(O)4TiCl(O(CH2)4Cl)]2-2[TiCl(NCMe)(L(O)3(On-Pr))]·11MeCN (8·11MeCN). The molecular structures of 2·2MeCN, 4·6MeCN, and 5·MeCN together with the hydrolysis products {[TiL(O)3(OR)]2(μ-Cl)(μ-OH)} (R = n-Pr 6·7MeCN; n-pentyl, 7·7.5MeCN, 9·9MeCN); R = n-decyl 10·8.5MeCN) and that of the ring opened product 8·11MeCN and the co-crystallized species [Ti2(OH)Cl(L(O)3(OR))][L(OH)2(OR)2]·2.85(C2H3N)·0.43(H2O) (R = n-pentyl, 11·2.85(C2H3N)·0.43(H2O)) are reported. Type I and II complexes have been screened for their ability to act as catalysts in the ring opening polymerization (ROP) of ϵ-caprolactone (ϵ-CL), δ-valerolactone (δ-VL), ω-pentadecalactone (ω-PDL) and rac-lactide (r-LA), both with and without benzyl alcohol present and either under N2 or in air. The copolymerization of ϵ-CL with δ-VL and with r-LA has also been investigated. For the ROP of ϵ-CL, all performed efficiently (>99% conversion) at 130 °C over 24 h both under N2 and in air, whilst over 1 h, for the type I complexes the trend was 3 > 2 > 1 but all were poor (≤12% conversion). By contrast, 5 over 1 h at 130 °C was highly active (85% conversion). At 80 °C, the activity trend followed the order 5 ≈ 4 > 3 > 2 > 1. For δ-VL, at 80 °C the activity trend 5 ≈ 4 > 1 > 2 > 3 was observed. ROP of the larger ω-PDL was only possible using 5 at 130 °C over 24 h with moderate activity (48% conversion). For r-LA, only low molecular weight products were obtained, whilst for the co-polymerization of ϵ-CL with δ-VL using 5, high activity was observed at 80 °C affording a polymer of molecular weight >23,000 Da and with equal incorporation of each monomer. In the case of ϵ-CL/r-LA co-polymerization using 5 either under N2 or air, the polymerization was more sluggish and only 65% conversion of CL was observed and the resultant co-polymer had 65:35 incorporation. Complex 5 could also be supported on silica, however this system was not as active as its homogeneous counterpart. Finally, the activity of these complexes is compared with that of three benchmark species: a di-phenolate Ti compound {TiCl2(2,2′-CH3CH[4,6-(t-Bu)2C6H2O]2)} (12) and a previously reported NO2-containing titanocalix[4]arene catalyst, namely cone-5,17-bis-tert-butyl-11,23-dinitro-25,27-dipropyloxy-26,28-dioxo-calix[4]arene titanium dichloride (13), as well as [Ti(Oi-Pr)4]; the parent calixarenes were also screened
Telling Our Stories: Book Two
No full textCollection of stories by forty local writers describing family histories and anecdotes in the Grayson County, Texas area. Each story is preceded by a brief biographical sketch of the author
Association between congenital toxoplasmosis and preterm birth, low birthweight and small for gestational age birth.
No full textOBJECTIVE: To determine the association between congenital toxoplasmosis and preterm birth, low birthweight and small for gestational age birth. DESIGN: Multicentre prospective cohort study. SETTING: Ten European centres offering prenatal screening for toxoplasmosis. POPULATION: Deliveries after 23 weeks of gestation in 386 women with singleton pregnancies who seroconverted to toxoplasma infection before 20 weeks of gestation. Deliveries after 36 weeks in 234 women who seroconverted at 20 weeks or later, and tested positive before 37 weeks. METHODS: Comparison of infected and uninfected births, adjusted for parity and country of birth. MAIN OUTCOME MEASURES: Differences in gestational age at birth, birthweight and birthweight centile. RESULTS: Infected babies were born or delivered earlier than uninfected babies: the mean difference for seroconverters before 20 weeks was -5.4 days (95% CI: -1.4, -9.4), and at 20 weeks or more, -2.6 days (95% CI: -0.5, -4.7). Congenital infection was associated with an increased risk of preterm delivery when seroconversion occurred before 20 weeks (OR 4.71; 95% CI: 2.03, 10.9). No significant differences were detected for birthweight or birthweight centile. CONCLUSION: Babies with congenital toxoplasmosis were born earlier than uninfected babies but the mechanism leading to shorter length of gestation is unknown. Congenital infection could precipitate early delivery or prompt caesarean section or induction of delivery. We found no evidence for a significant association between congenital toxoplasmosis and reduced birthweight or small for gestational age birth
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