The impact of first pregnancy and delivery on pelvic floor dysfunction

Background: The first childbirth has the greatest impact on a woman’s pelvic floor when major changes occur. The aim of this study was to comprehensively describe pelvic floor dysfunction (PFD) in young nulliparous women, and its correlation with postnatal pathology. Methods: A prospective study was performed at Cork University Maternity Hospital, Ireland. Initially 1484 nulliparous women completed the validated Australian Pelvic Floor Questionnaire at 15 weeks’ gestation and repeatedly at one year postnatally (N=872). In the second phase, at least one year postnatally, 202 participants without subsequent pregnancies attended the clinical follow up which included: pelvic organ prolapse quantification, a 3D-Transperineal ultrasound scan and collagen level assessment. Results: A high pre-pregnancy prevalence of various types of PFD was detected, which in the majority of cases persisted postnatally and included multiple types of PFD. The first birth had a negative impact on severity of pre-pregnancy symptoms in <15% of cases. Apart from prolapse, vaginal delivery, including instrumental delivery did not increase the risk of PFD symptoms, where as Caesarean section was protective for all types of PFD. The first birth had a bigger impact on pre-existing symptoms of overactive bladder compared to stress urinary incontinence. Pelvic organ prolapse is extremely prevalent in young primiparous women, however usually it is low grade and asymptomatic. Congenital factors and high collagen type III levels play an important role in the aetiology of pelvic organs prolapse. Levator ani trauma is present in one in three women after the first pregnancy and delivery. Conclusion: The main damage to the pelvic floor most likely occurs due to an undiagnosed congenital intrinsic weakness of the pelvic floor structures. PFD is highly associated with first childbirth, however it seems that pregnancy and delivery are contributing factors only which unmask the congenital intrinsic weakness of the pelvic floor support.

Human pavlovian-instrumental transfer.

The vigor with which a participant performs actions that produce valuable outcomes is subject to a complex set of motivational influences. Many of these are believed to involve the amygdala and the nucleus accumbens, which act as an interface between limbic and motor systems. One prominent class of influences is called pavlovian-instrumental transfer (PIT), in which the motivational characteristics of a predictor influence the vigor of an action with respect to which it is formally completely independent. We provide a demonstration of behavioral PIT in humans, with an audiovisual predictor of the noncontingent delivery of money inducing participants to perform more avidly an action involving squeezing a handgrip to earn money. Furthermore, using functional magnetic resonance imaging, we show that this enhanced motivation was associated with a trial-by-trial correlation with the blood oxygenation level-dependent (BOLD) signal in the nucleus accumbens and a subject-by-subject correlation with the BOLD signal in the amygdala. Our data dovetails well with the animal literature and sheds light on the neural control of vigor.

The biogeochemical structuring role of horizontal stirring: Lagrangian perspectives on iron delivery downstream of the Kerguelen Plateau

Field campaigns are instrumental in providing ground truth for understanding and modeling global ocean biogeochemical budgets. A survey however can only inspect a fraction of the global oceans, typically a region hundreds of kilometers wide for a temporal window of the order of (at most) several weeks. This spatiotemporal domain is also the one in which the mesoscale activity induces through horizontal stirring a strong variability in the biogeochemical tracers, with ephemeral, local contrasts which can easily mask the regional and seasonal gradients. Therefore, whenever local in situ measures are used to infer larger-scale budgets, one faces the challenge of identifying the mesoscale structuring effect, if not simply to filter it out. In the case of the KEOPS2 investigation of biogeochemical responses to natural iron fertilization, this problem was tackled by designing an adaptive sampling strategy based on regionally optimized multisatellite products analyzed in real time by specifically designed Lagrangian diagnostics. This strategy identified the different mesoscale and stirring structures present in the region and tracked the dynamical frontiers among them. It also enabled back trajectories for the ship-sampled stations to be estimated, providing important insights into the timing and pathways of iron supply, which were explored further using a model based on first-order iron removal. This context was essential for the interpretation of the field results. The mesoscale circulation-based strategy was also validated post-cruise by comparing the Lagrangian maps derived from satellites with the patterns of more than one hundred drifters, including some adaptively released during KEOPS2 and a subsequent research voyage. The KEOPS2 strategy was adapted to the specific biogeochemical characteristics of the region, but its principles are general and will be useful for future in situ biogeochemical surveys.

Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: a randomised controlled trial

Background

Epidural analgesia is the most effective labour pain relief but is associated with increased rates of instrumental vaginal delivery and other effects, which might be related to the poor motor function associated with traditional epidural. New techniques that preserve motor function could reduce obstetric intervention. We did a randomised controlled trial to compare low-dose combined spinal epidural and low-dose infusion (mobile) techniques with traditional epidural technique.
Methods

Between Feb 1, 1999, and April 30, 2000, we randomly assigned 1054 nulliparous women requesting epidural pain relief to traditional (n=353), low-dose combined spinal epidural (n=351), or low-dose infusion epidural (n=350). Primary outcome was mode of delivery, and secondary outcomes were progress of labour, efficacy of procedure, and effect on neonates. We obtained data during labour and interviewed women postnatally.
Findings

The normal vaginal delivery rate was 35·1% in the traditional epidural group, 42·7% in the low-dose combined spinal group (odds ratio 1·38 [95% CI 1·01–1·89]; p=0·04); and 42·9% in the low-dose infusion group (1·39 [1·01–1·90]; p=0·04). These differences were accounted for by a reduction in instrumental vaginal delivery. Overall, 5 min APGAR scores of 7 or less were more frequent with low-dose technique. High-level resuscitation was more frequent in the low-dose infusion group.

Brokering knowledge : managing knowledge in a network of government and non-government human service delivery agencies

This paper examines aspects of knowledge management that are particularly important in the network of human service delivery agencies in Victoria. This network is characterised by four features: it is a cluster of networked organisations; professionals and others may act as knowledge brokers within and between organisations in the network; rapid change in both knowledge and organisation accentuates the importance of innovative knowledge and emergent organisation over and above routine instrumental knowledge within stable organisation; and consequently there is an underlying concern with dialogical rather than instrumental knowledge and its management, and particularly how it constitutes and is constituted by organisation. The paper describes the analytical tools that we consider particularly important in examining this situation – in particular, the distinction between instrumental and dialogical knowledge, and the role of knowledge brokers (and professionals as knowledge brokers). It concludes by relating this analysis to broader issues in organisation studies, and suggests paths for further examination of these issues.

Exercise during pregnancy reduces the rate of cesarean and instrumental deliveries: results of a randomized controlled trial

Objective: In this study, the authors assessed the effects of a structured, moderate-intensity exercise program during the entire length of pregnancy on a woman’s method of delivery. Methods: A randomized controlled trial was conducted with 290 healthy pregnant Caucasian (Spanish) women with a singleton gestation who were randomly assigned to either an exercise (n=138) or a control (n=152) group. Pregnancy outcomes, including the type of delivery, were measured at the end of the pregnancy. Results: The percentage of cesarean and instrumental deliveries in the exercise group were lower than in the control group (15.9%, n=22; 11.6%, n=16 vs. 23%, n=35; 19.1%, n=29, respectively; p=0.03). The overall health status of the newborn as well as other pregnancy outcomes were unaffected. Conclusions: Based on these results, a supervised program of moderate-intensity exercise performed throughout pregnancy was associated with a reduction in the rate of cesarean sections and can be recommended for healthy women in pregnancy.

Attributes of service delivery modes and their impact on consumer satisfaction

Consumersatisfaction is fundamental to organisational success. It is well recognised that personal service is important in achieving consumer satisfaction. However, the application of self-service technology (SST) is widcning and is attennuating traditional exchanges between consumers and service employees. The effect of this reduction of personal service on consumer satisfaction judgements is not well understood. This study addresses this gap by investigating the relative effects of SST and personal service attributes on overall consumer satisfaction. Thc study highlights important service attributes applicable to SST and personal service. The conceptual framework is tested using data collected from 241 leisure and business travellers drawn from premium hotels in a regional area. Structural equation modelling techniques support the conceptual framework. As expected, the attributes of personal service and SST contribute to consumer satisfaction. However, thc impact of personal service attributes 011 consumer satisfaction is much stronger than the effects of SST attributes. Though SST is an important determinant of consumer satisfaction, interactions with staff are critical. These results have applications for the theory and practice of services marketing, and high light avenues for further investigation.

Orals ain't orals : how instruction and assessment practices affect delivery choices with prepared student oral presentations.

Despite an ostensibly technology-driven society, the ability to communicate orally is still seen as an essential ability for students at school and university, as it is for graduates in the workplace. The need to develop effective oral communication skills is often tied to future work-related tasks. One tangible way that educators have assessed proficiency in this area is through prepared oral presentations. While some use the terms oral communication and oral presentation interchangeably, other writers question the role more formal presentations play in the overall development of oral communication skills. Adding to the discussion, this paper is part of a larger study examining the knowledge and skills students bring into the academy from previous educational experiences. The study examines some of the teaching and assessment methods used in secondary schools to develop oral communication skills through the use of formal oral presentations. Specifically, it will look at assessment models and how these are used as a form of instruction as well as how they contribute to an accurate evaluation of student abilities. The purpose of this paper is to explore key terms and identify tensions between expectations and practice. Placing the emphasis on the ‘oral’ aspect of this form of communication this paper will particularly look at the ‘delivery’ element of the process.

Literature Review Value Alignment Process for Project Delivery

The objective of the project “Value Alignment Process for Project Delivery” is to provide a catalyst and tools for reform in the building and construction industry to transform business-as-usual performance into exceptional performance. The outcomes of this project will be beneficial to not only the construction industry, but to the community as a whole because a more sophisticated industry can deliver more effective use of assets, financing, operating and maintenance of facilities to suit the community’s needs. The research project consists of a study into best practice project delivery and the development of a suite of products, resources and services to guide project teams towards the best approach for a specific project. These resources will be focused on promoting the principles that underlie best practice project delivery, rather than on identifying a particular delivery system. The need for such tools and resources becomes more and more acute as the environment within which the construction industry operates becomes more and more complex, and as business and political imperatives shift to encompass or represent diverse stakeholder interests. To this end, this literature review looks at why it is essential to achieve transformation in the Australian construction industry in the context of its importance to the Australian economy. It seeks to investigate the concepts of ‘alignment’ and value’ as they pertain to construction industry processes and relationships. It comprehensively reviews drivers of project excellence and best practice project delivery principles and looks at how clients approach selection of project delivery systems. It critiques existing project delivery strategies and gives an overview of recent best practice initiatives. The literature review represents a milestone against the Project Agreement and forms a foundation document for this research project