“Who wants to go repeatedly to the hospital?” : Perceptions and experiences of simplified medical abortion in Rajasthan, India

The aim of this study is to explore women's experiences and perceptions of home use of misoprostol and of the self-assessment of the outcome of early medical abortion in a low-resource setting in India. In-depth interviews were conducted with 20 women seeking early medical abortion, who administered misoprostol at home and assessed their own outcome of abortion using a low-sensitivity pregnancy test. With home use of misoprostol, women were able to avoid inconvenience of travel, child care, and housework, and maintain confidentiality. The use of a low-sensitivity pregnancy test alleviated women's anxieties about retained products. Majority said they would prefer medical abortion involving a single visit in future. This study provides nuanced understanding of how women manage a simplified medical abortion in the context of low literacy and limited communication facilities. Service delivery guidelines should be revised to allow women to have medical abortion with fewer visits.

Variation of System Performance with Design and Climate for Combisystems in Sweden

In Sweden, 90% of the solar heating systems are solar domestic hot water and heating systems (SDHW&H), so called combisystems. These generally supply most of the domestic hot water needs during the summer and have enough capacity to supply some energy to the heating system during spring and autumn. This paper describes a standard Swedish combisystem and how the output from it varies with heating load, climate within Sweden, and how it can be increased with improved system design. A base case is defined using the standard combi- system, a modern Swedish single family house and the climate of Stockholm. Using the simulation program Trnsys, parametric studies have been performed on the base case and improved system designs. The solar fraction could be increased from 17.1% for the base case to 22.6% for the best system design, given the same system size, collector type and load. A short analysis of the costs of changed system design is given, showing that payback times for additional investment are from 5-8 years. Measurements on system components in the laboratory have been used to verify the simulation models used. More work is being carried out in order to find even better system designs, and further improvements in system performance are expected.

A Linguistic Analysis of the Written Production of Second Language Learners : The Variation of Article Usage by Adult Chinese Learners of English

This study aims to test Robertson’s lexical transfer principle, which posits that Chinese learners use demonstratives (particularly this) and the numeral one as markers of definiteness and indefiniteness. This is tested by analysing Chinese learners’ written production collected from the Spoken and Written English Corpus of Chinese Learners 2.0 (SWECCL 2.0). The purpose is to understand the variation of article usage by adult Chinese learners of English. More specifically, the study examines to what extent articles, possessive and demonstrative pronouns are used in Chinese learners’ English and how definite and indefinite articles are used by the Chinese learners. Findings suggest that Robertson’s lexical transfer principle was corroborated by the present study. In addition, Chinese learners prefer to use demonstrative determiners, the possessive determiner our, and the numeral one to perform the function of marking definiteness and indefiniteness. In particular, the learners try to use the demonstrative determiners that and this in the anaphoric function instead of the definite article, and the demonstrative determiner those is frequently used in the cataphoric function. What is more, the learners use the numeral one as a marker of indefiniteness, and it is also used as a marker of definiteness in the anaphoric function. Further, the possessive determiner our is used as a marker of definiteness in larger situation uses referring to something unique. To this end, the study is able to show that the definite article is used to perform the function of marking indefiniteness, and in some particular contexts the definite article functions as a Chinese specifier in Chinese learners’ English. Also, the indefinite article is frequently used in quantifier phrases but is rarely used in other functions. There are three main reasons that may explain why Chinese learners use determiners variously. Firstly, the choice of determiners by Chinese learners is influenced by linguistic contexts. Secondly, because of learning strategies, Chinese learners try to ignore the anaphoric function and cataphoric function that they are not yet ready to process in article usage. Thirdly, interlanguage grammar influences the optionality in the use of articles. 

Self-assessment of the outcome of early medical abortion versus clinic follow-up in India : a randomised, controlled, non-inferiority trial

Background: The need for multiple clinical visits remains a barrier to women accessing safe legal medical abortion services. Alternatives to routine clinic follow-up visits have not been assessed in rural low-resource settings. We compared the effectiveness of standard clinic follow-up versus home assessment of outcome of medical abortion in a low-resource setting. Methods: This randomised, controlled, non-inferiority trial was done in six health centres (three rural, three urban) in Rajasthan, India. Women seeking early medical abortion up to 9 weeks of gestation were randomly assigned (1:1) to either routine clinic follow-up or self-assessment at home. Randomisation was done with a computer-generated randomisation sequence, with a block size of six. The study was not blinded. Women in the home-assessment group were advised to use a pictorial instruction sheet and take a low-sensitivity urine pregnancy test at home, 10-14 days after intake of mifepristone, and were contacted by a home visit or telephone call to record the outcome of the abortion. The primary (non-inferiority) outcome was complete abortion without continuing pregnancy or need for surgical evacuation or additional mifepristone and misoprostol. The non-inferiority margin for the risk difference was 5%. All participants with a reported primary outcome and who followed the clinical protocol were included in the analysis. This study is registered with ClinicalTrials.gov, number NCT01827995. Findings: Between April 23, 2013, and May 15, 2014, 731 women were recruited and assigned to clinic follow-up (n=366) or home assessment (n=365), of whom 700 were analysed for the main outcomes (n=336 and n=364, respectively). Complete abortion without continuing pregnancy, surgical intervention, or additional mifepristone and misoprostol was reported in 313 (93%) of 336 women in the clinic follow-up group and 347 (95%) of 364 women in the home-assessment group (difference -2.2%, 95% CI -5.9 to 1.6). One case of haemorrhage occurred in each group (rate of adverse events 0.3% in each group); no other adverse events were noted. Interpretation Home assessment of medical abortion outcome with a low-sensitivity urine pregnancy test is non-inferior to clinic follow-up, and could be introduced instead of a clinic follow-up visit in a low-resource setting.

Perceptions of European medical staff on the facilitators and barriers to physical closeness between parents and infants in neonatal units

AIM: Studies have provided insights into factors that may facilitate or inhibit parent-infant closeness in neonatal units, but none have specifically focused on the perspectives of senior neonatal staff. The aim of this study was to explore perceptions and experiences of consultant neonatologists and senior nurses in five European countries with regard to these issues. METHODS: Six small group discussions and three one-to-one interviews were conducted with 16 consultant neonatologists and senior nurses representing nine neonatal units from Estonia, Finland, Norway, Spain and Sweden. The interviews explored facilitators and barriers to parent-infant closeness and implications for policy and practice and thematic analysis was undertaken. RESULTS: Participants highlighted how a humanising care agenda that enabled parent-infant closeness was an aspiration, but pointed out that neonatal units were at different stages in achieving this. The facilitators and barriers to physical closeness included socio-economic factors, cultural norms, the designs of neonatal units, resource issues, leadership, staff attitudes and practices and relationships between staff and parents. CONCLUSION: Various factors affected parent-infant closeness in neonatal units in European countries. There needs to be the political motivation, appropriate policy planning, legislation and resource allocation to increase measures that support closeness agendas in neonatal units. This article is protected by copyright. All rights reserved.

Simplified follow-up after medical abortion using a low-sensitivity urinary pregnancy test and a pictorial instruction sheet in Rajasthan, India : study protocol and intervention adaptation of a randomised control trial

The World Health Organisation suggests that simplification of the medical abortion regime will contribute to an increased acceptability of medical abortion, among women as well as providers. It is expected that a home-based follow-up after a medical abortion will increase the willingness to opt for medical abortion as well as decrease the workload and service costs in the clinic. Trial design The study is a randomised, controlled, non-superiority trial . Methods Women screened to participate in the study are those with unwanted pregnancies and gestational ages equal to or less than nine weeks. Eligible women randomised to the home-based assessment group will use a low-sensitivity pregnancy test and a pictorial instruction sheet at home, while the women in the clinic follow-up group will return to the clinic for routine follow-up carried out by a doctor. The primary objective of the study is to evaluate the effectiveness of home-based assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet 10-14 days after an early medical abortion. Providers or research assistants will not be blinded during outcome assessment. To ensure feasibility of the self-assessment intervention an adaption phase took place at the selected study sites before study initiation. This was to optimise and tailor-make the intervention and the study procedures and resulted in the development of the pictorial instruction sheet for how to use the low-sensitivity pregnancy test and the danger signs after a medical abortion. Discussion In this paper, we will describe the study protocol for a randomised control trial investigating the efficacy of simplified follow-up in terms of home-based assessment, 10-14 days after a medical abortion. Moreover, a description of the adaptation phase is included for a better understanding of the implementation of the intervention in a setting where literacy is low and the road-connections are poor. Trial registration: Clinicaltrials.gov NCT01827995. Registered 04 May 2013