A retrospective analysis of variations in antenatal care initiation in an ethnically diverse maternal population in the UK with high levels of area deprivation

Background: Research has indicated differential utilisation of antenatal care among ethnic minority mothers in the UK.  However, links between ethnicity, area deprivation and the timing of antenatal care initiation remain poorly understood.   This study investigates variations in antenatal care initiation among mothers residing in an ethnically diverse area in the UK with high levels of area deprivation.  Methods:  Data were derived from an on-going  retrospective cohort study using routinely collected anonymous data of live singleton  births over a 9 year period from 2007-2016 in a maternity unit catering to an ethnically diverse population. Logistic regression and Geographical Information Systems (GIS) were used to examine the associations between antenatal care initiation and ethnicity with and without adjustment for area deprivation. Preliminary results:  Among 45695 births recorded on the Ciconia Maternity information System, great  majority (80%) of mothers lived in neighbourhoods that are in the three most deprived area quintiles and 34.4% belonged to one of the ethnic minority groups. One fifth (20.8%)  of mothers initiated antenatal care late after 12 weeks of gestation. Late initiation was the highest among Black African (34.2%) and Black Caribbean (29.0%) groups who were more than twice as likely than the White British group to initiate antenatal care late (Odds ratio [OR]= 2.65 and 2.08 respectively). The risk appeared to remain after adjustment for area deprivation. Conclusions:  Ethnic minority mothers from some groups are at substantially higher risk of initiating antenatal care late compared to White British mothers regardless of the level of area deprivation. Main messages: Mothers from some ethnic minority groups are at  substantially higher risk of initiating antenatal care after 12 weeks of gestation compared to White British mothers.  Area level deprivation has very little effect on ethnic variations in antenatal care initiation

Novel CMOS RFIC Layout Generation with Concurrent Device Placement and Fixed-Length Microstrip Routing

With advancing process technologies and booming IoT markets, millimeter-wave CMOS RFICs have been widely developed in re- cent years. Since the performance of CMOS RFICs is very sensi- tive to the precision of the layout, precise placement of devices and precisely matched microstrip lengths to given values have been a labor-intensive and time-consuming task, and thus become a major bottleneck for time to market. This paper introduces a progressive integer-linear-programming-based method to gener- ate high-quality RFIC layouts satisfying very stringent routing requirements of microstrip lines, including spacing/non-crossing rules, precise length, and bend number minimization, within a given layout area. The resulting RFIC layouts excel in both per- formance and area with much fewer bends compared with the simulation-tuning based manual layout, while the layout gener- ation time is significantly reduced from weeks to half an hour.Comment: ACM/IEEE Design Automation Conference (DAC), 201

Ontology-based Fuzzy Markup Language Agent for Student and Robot Co-Learning

An intelligent robot agent based on domain ontology, machine learning mechanism, and Fuzzy Markup Language (FML) for students and robot co-learning is presented in this paper. The machine-human co-learning model is established to help various students learn the mathematical concepts based on their learning ability and performance. Meanwhile, the robot acts as a teacher's assistant to co-learn with children in the class. The FML-based knowledge base and rule base are embedded in the robot so that the teachers can get feedback from the robot on whether students make progress or not. Next, we inferred students' learning performance based on learning content's difficulty and students' ability, concentration level, as well as teamwork sprit in the class. Experimental results show that learning with the robot is helpful for disadvantaged and below-basic children. Moreover, the accuracy of the intelligent FML-based agent for student learning is increased after machine learning mechanism.Comment: This paper is submitted to IEEE WCCI 2018 Conference for revie

Whole-body vibration training effect on physical performance and obesity in mice

The purpose of this study was to verify the beneficial effects of whole-body vibration (WBV) training on exercise performance, physical fatigue and obesity in mice with obesity induced by a high-fat diet (HFD). Male C57BL/6 mice were randomly divided into two groups: normal group (n=6), fed standard diet (control), and experimental group (n=18), fed a HFD. After 4-week induction, followed by 6-week WBV of 5 days per week, the 18 obese mice were divided into 3 groups (n=6 per group): HFD with sedentary control (HFD), HFD with WBV at relatively low-intensity (5.6 Hz, 0.13 g) (HFD+VL) or high-intensity (13 Hz, 0.68 g) (HFD+VH). A trend analysis revealed that WBV increased the grip strength in mice. WBV also dose-dependently decreased serum lactate, ammonia and CK levels and increased glucose level after the swimming test. WBV slightly decreased final body weight and dose-dependently decreased weights of epididymal, retroperitoneal and perirenal fat pads and fasting serum levels of alanine aminotransferase, CK, glucose, total cholesterol and triacylglycerol. Therefore, WBV could improve exercise performance and fatigue and prevent fat accumulation and obesity-associated biochemical alterations in obese mice. It may be an effective intervention for health promotion and prevention of HFD-induced obesity

Nonlinear and conventional biosignal analyses applied to tilt table test for evaluating autonomic nervous system and autoregulation

Copyright © Tseng et al.; Licensee Bentham Open. This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.Tilt table test (TTT) is a standard examination for patients with suspected autonomic nervous system (ANS) dysfunction or uncertain causes of syncope. Currently, the analytical method based on blood pressure (BP) or heart rate (HR) changes during the TTT is linear but normal physiological modulations of BP and HR are thought to be predominately nonlinear. Therefore, this study consists of two parts: the first part is analyzing the HR during TTT which is compared to three methods to distinguish normal controls and subjects with ANS dysfunction. The first method is power spectrum density (PSD), while the second method is detrended fluctuation analysis (DFA), and the third method is multiscale entropy (MSE) to calculate the complexity of system. The second part of the study is to analyze BP and cerebral blood flow velocity (CBFV) changes during TTT. Two measures were used to compare the results, namely correlation coefficient analysis (nMxa) and MSE. The first part of this study has concluded that the ratio of the low frequency power to total power of PSD, and MSE methods are better than DFA to distinguish the difference between normal controls and patients groups. While in the second part, the nMxa of the three stages moving average window is better than the nMxa with all three stages together. Furthermore the analysis of BP data using MSE is better than CBFV data.The Stroke Center and Department of Neurology, National Taiwan University, National Science Council in Taiwan, and the Center for Dynamical Biomarkers and Translational Medicine, National Central University, which is sponsored by National Science Council and Min-Sheng General Hospital Taoyuan

Effects of and satisfaction with short message service reminders for patient medication adherence: a randomized controlled study

BACKGROUND: Medication adherence is critical for patient treatment. This study involved evaluating how implementing Short Message Service (SMS) reminders affected patient medication adherence and related factors. METHODS: We used a structured questionnaire to survey outpatients at three medical centers. Patients aged 20 years and older who were prescribed more than 7 days of a prescription medication were randomized into SMS intervention or control groups. The intervention group received daily messages reminding them of aspects regarding taking their medication; the control group received no messages. A phone follow-up was performed to assess outcomes after 8 days. Data were collected from 763 participants in the intervention group and 435 participants in the control group. RESULTS: After participants in the intervention group received SMS reminders to take medication or those in the control group received no messages, incidences of delayed doses were decreased by 46.4 and 78.8% for those in the control and intervention groups, respectively. The rate of missed doses was decreased by 90.1% for participants in the intervention group and 61.1% for those in the control group. We applied logistic regression analysis and determined that participants in the intervention group had a 3.2-fold higher probability of having a decrease in delayed doses compared with participants in the control group. Participants in the intervention group also showed a 2.2-fold higher probability of having a decrease in missed doses compared with participants in the control group. CONCLUSIONS: Use of SMS significantly affected the rates of taking medicine on schedule. Therefore, daily SMS could be useful for reminding patients to take their medicine on schedule

Development, acceptability and feasibility of a community-based intervention to increase timely initiation of antenatal care in an area of high ethnic diversity and low socio-economic status in the UK

BACKGROUND: Antenatal care plays an important role in preventing adverse maternal and new-born outcomes. Women from ethnic minority backgrounds and of low socio-economic status are at greater risk of initiating antenatal care later than the recommended 10 weeks. There is a paucity of research exploring the development and evaluation of community-based interventions to increase the timely initiation of antenatal care. OBJECTIVE: To develop and evaluate the acceptability and feasibility of a co-produced community-based intervention to increase uptake of antenatal care in an area with high ethnic diversity and low socio-economic status. DESIGN: The intervention was developed using co-production workshops and conversations with 20 local service users and 14 stakeholders, underpinned by the theory of Diffusion of Innovation. The intervention was evaluated, on the domains of acceptability, adoption, appropriateness, and feasibility. Questionnaires (n=36), interviews (n=10), and focus groups (n=13) were conducted among those who received the intervention. Observations (n=13) of intervention sessions were conducted to assess intervention fidelity. Quantitative and qualitative data were analysed using SPSS and NVivo software respectively. RESULTS: Over 91% of respondents positively ranked the intervention. Qualitative findings with respect to ‘acceptability’ included four subthemes: how the intervention was communicated, the characteristics of the person delivering the intervention and their knowledge, and the reassurance offered by the intervention. The ‘adoption’ theme included three sub-themes: being informed helps women to engage with antenatal care, the intervention provides information for future use, and onwards conveyance of the intervention information. The ‘appropriateness’ theme included three sub-themes: existing gap in information, nature of information given as part of the intervention, and talking about pregnancy in public. The ‘feasibility’ theme included two sub-themes: value of delivering the intervention in areas of high footfall and relational aspect of receiving the intervention. Observations showed intervention fidelity of 100%. CONCLUSION: The community-based intervention, coproduced with women and maternity care stakeholders, was positively evaluated, and offered an innovative and promising approach to engage and educate women about the timely initiation of antenatal care in an ethnically diverse and socio-economically deprived community

Ethnic minority women’s experiences of accessing antenatal care in high income European countries: a systematic review

Background: Women from ethnic minority backgrounds are at greater risk of adverse maternal outcomes. Antenatal care plays a crucial role in reducing risks of poor outcomes. The aim of this study was to identify, appraise, and synthesise the recent qualitative evidence on ethnic minority women’s experiences of accessing antenatal care in high-income European countries, and to develop a novel conceptual framework for access based on women’s perspectives. Methods: We conducted a comprehensive search of seven electronic databases in addition to manual searches to identify all qualitative studies published between January 2010 and May 2021. Identified articles were screened in two stages against the inclusion criteria with titles and abstracts screened first followed by full-text screening. Included studies were quality appraised using the Critical Appraisal Skills Programme checklist and extracted data were synthesised using a ‘best fit’ framework, based on an existing theoretical model of health care access. Results: A total of 30 studies were included in this review. Women’s experiences covered two overarching themes: ‘provision of antenatal care’ and ‘women's uptake of antenatal care’. The ‘provision of antenatal care’ theme included five sub-themes: promotion of antenatal care importance, making contact and getting to antenatal care, costs of antenatal care, interactions with antenatal care providers and models of antenatal care provision. The ‘women's uptake of antenatal care’ theme included seven sub-themes: delaying initiation of antenatal care, seeking antenatal care, help from others in accessing antenatal care, engaging with antenatal care, previous experiences of interacting with maternity services, ability to communicate, and immigration status. A novel conceptual model was developed from these themes. Conclusion: The findings demonstrated the multifaceted and cyclical nature of initial and ongoing access to antenatal care for ethnic minority women. Structural and organisational factors played a significant role in women’s ability to access antenatal care. Participants in majority of the included studies were women newly arrived in the host country, highlighting the need for research to be conducted across different generations of ethnic minority women taking into account the duration of stay in the host country where they accessed antenatal care

Risk of low birthweight and late antenatal care initiation in an ethnically diverse maternal cohort

Background Babies born with low birthweight (LBW,10 weeks gestation) and LBW in an ethnically diverse maternal cohort in the UK. Methods A retrospective cross sectional study using routinely collected anonymous data of singleton births during April 2015 - October 2022 from a large UK National Health Service maternity unit in an ethnically diverse area. Logistic regression models were used to examine associations between late ANC initiation and prevalence of low (<2500 g); very low (VLBW, <1500 g) and extremely low (ELBW, <1000g) birth weight. Results Of 39,785 singleton births recorded, more than one third (34.6%) were to mothers from Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi backgrounds. Birthweight was reported for 39,698 (99.78%) neonates; among them 8.9% had LBW, including 1.0% VLBW and 1.1% ELBW. More than one third (34.8%) of mothers had first appointment at > 10 weeks, including 26% during 11-19 weeks and 8.8% at > 20 weeks. Late ANC initiation was associated with increased risk of LBW for neonates: OR = 1.15 [95% CI: 1.07, 1.23] and 1.60 [1.44, 1.78] for ANC initiation at > 10 weeks and ≥20 weeks respectively (vs ≤ 10 weeks). Mothers who started care at ≥ 20 weeks were 5.37 times (95% CI: 4.31, 6.70) more likely to have a baby born with ELBW (vs ≤ 10 weeks). Conclusions Neonates born to mothers who started antenatal care late in ethnically diverse neighborhoods are more likely to have low birthweight, highlighting the need for targeted primary and secondary interventions.Wellbeing of Women in partnership with the Burdett Trust for Nursing (RG2245)gold o

Applications of Differential CDMA Schemes and Control Technology for Distribution Substations

This paper presents an approach to achieve monitoring and control of distribution systems in a distribution substation using power-line communication (PLC) combined with Hadamard code. Four different techniques, i.e., binary phase shift keying (BPSK), quadrature phase shift keying (QPSK), 16-quadrature amplitude modulator (QAM) and 64-QAM in code division multiple access (CDMA), are employed. With spreading-spectrum modulation and demodulation in the studied PLC system, the proposed approach can achieve reliable high-speed information transmission through power lines. With Hadamard code, the signals corresponding to different relays are orthogonal to each other and the interference among them can be reduced. The proposed approach has the advantages of high-speed detection, bi-direction communication, reading and backup data, control and turn-off functions, displaying the real-time system information, etc. When 100 kHz is used as the carrier frequency for 256 relays under power-line noise below 14 dB, the simulation results show that the bit error rate (BER) is less than 10-5 . The proposed scheme can be applied to the smart-grid distribution substation of the studied distribution systems