Judy Shakespeare

Low insertion loss and low dispersion penalty InGaAsP quantum-well high-speed electroabsorption modulator for 40-Gb/s very-short-reach, long-reach, and long-haul applications

We present a metal-organic-chemical-vapor-deposition-grown low-optical-insertion-loss InGaAsP/InP multiple-quantum-well electroabsorption modulator (EAM), suitable for both nonreturn-to-zero (NRZ) and return-to-zero (RZ) applications. The EAM exhibits a dynamic (RF) extinction ratio of 11.5 dB at 1550 nm for 3 Vp-p drive under 40-Gb/s modulation. The optical insertion loss of the modulator in the on-state is -5.2 dB at 1550 nm. In addition, the EAM also exhibits a 3-dB small-signal response (S21) of greater than 38 GHz, allowing it to be used in both 40-Gb/s NRZ and 10-Gb/s RZ applications. The dispersion penalty at 40 Gb/s is measured to be 1.2 dB over /spl plusmn/40 ps/nm of chromatic dispersion. Finally, we demonstrate 40-Gb/s transmission performance over 85 km and 700 km.

Experiences with maternal and perinatal death reviews in the UK—the MBRRACE‐UK programme

Established in 1952, the programme of surveillance and Confidential Enquiries into Maternal Deaths in the UK is the longest running such programme worldwide. Although more recently instituted, surveillance and confidential enquiries into perinatal deaths are also now well established nationally. Recent changes to funding and commissioning of the Enquiries have enabled both a reinvigoration of the processes and improvements to the methodology with an increased frequency of future reporting. Close engagement with stakeholders and a regulator requirement for doctors to participate have both supported the impetus for involvement of all professionals leading to greater potential for improved quality of care for women and babies.

How do women with postnatal depression experience listening visits in primary care? A qualitative interview study

Background: Listening visits are a routine intervention offered to women with postnatal depression. Objectives: To explore the experiences of women who have received listening visits for postnatal depression. Methods: An in‐depth qualitative interview study involving a purposive sample of 39 postnatal women from patients of 22 general practices within Oxford City PCG area. This paper addresses the question: What factors affected womens experience of listening visits for postnatal depression? A qualitative thematic analysis was used. Results: Sixteen women reported receiving listening visits. The factors that made listening visits a positive experience were: (1) agreeing with a medical model for postnatal depression; (2) a good relationship with the health visitor; (3) being offered choices and options; (4) a clear and flexible process for the visits. Conclusions: This study showed that there certain conditions that needed to be met if women with postnatal depression were to view listening visits as a positive experience. These results need to be evaluated in a larger study since this intervention is already so widespread.

Maternal health in pregnancy: messages from the 2014 UK Confidential Enquiry into Maternal Death

The Confidential Enquiry into Maternal Deaths began in 1952 and has led to major improvements in care for pregnant and postnatal women. In 2012, the responsibility for awarding and monitoring the contract passed to the Healthcare Quality Improvement Partnership (HQIP). The maternal, newborn, and infant enquires were awarded to a collaboration called MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries). The maternal death enquiry runs from the National Perinatal Epidemiology Unit (NPEU) in Oxford. There have been changes; there are now annual reports, with surveillance of deaths based on 3-year rolling averages and an annual topic-specific serious morbidity and mortality review. A maternal death is defined as a death during pregnancy or up to 42 days postnatal. Deaths are classified as ‘direct’ — deaths resulting from obstetric complications of the pregnant state; ‘indirect’ — deaths from a previous existing disease or a disease that develops during pregnancy, or that is aggravated by pregnancy; ‘late’ — deaths occurring between 42 days and 1 year postnatal that are due to a direct or indirect cause; and coincidental — deaths from unrelated causes that happen in pregnancy or the puerperium. The process of producing the report involves obtaining and anonymising the medical records for each case, including the GP records, and completion of a short report. There has been difficulty obtaining information from GPs, although the General Medical Council states that: ‘All doctors in clinical practice have a duty to participate in clinical audit and to contribute to National Confidential Inquiries’ .1 GPs have been involved in the review process for the past 10 years. There is now a team of eight GP assessors, working in pairs; each case is assessed twice and conclusions agreed jointly. The case is also reviewed by an appropriate range of specialists. Finally, a …

Physical activity for pregnant women: an infographic for healthcare professionals.

Three simple evidence-based infographics have been developed to support healthcare professionals (HCPs) in the implementation of the 2011 UK Chief Medical Officers’ (CMOs) physical activity (PA) recommendations.1 They are designed to empower HCPs to promote PA behaviour change across the life course. They address birth to 5 years, children and young people (5–18 years), and adults and older people. However, no recommendations were made specifically for perinatal PA in the CMOs’ 2011 report.1 This is perhaps reflected in the NICE guidelines for antenatal care in the uncomplicated pregnancy whereby the guidance regarding PA is vague.2 Nevertheless, pregnancy provides a unique opportunity to promote PA behaviour change, as women are highly motivated to optimise their lifestyle and there …

The Confidential Enquiry into Maternal Deaths 2015: lessons for GPs

The Confidential Enquiry into Maternal Deaths began in 1952 and has led to major improvements in care for pregnant and postnatal women. Between 2011 and 2013 there were 240 maternal deaths during or up to 6 weeks after pregnancy, giving a maternal death rate of 9 in every 100 000 women, a statistically significant decrease compared with 2009– 2012.1 Two-thirds of the deaths were due to medical and mental health comorbidities and one-third were due to obstetric causes. There has been no significant change in deaths from medical and mental health condition causes over the last 10 years. The surveillance data in this article covers 2011–2013, but cases from 2009–2013 were reviewed because the Enquiry was suspended during 2009–2010. Different conditions leading to death are covered in each report. In this article the focus will be on thromboembolic disease, mental illness, homicide, domestic violence, and late deaths (more than 6 weeks after birth). Forty eight women died from pregnancy-related venous thrombosis or thromboembolism (VTE) during or up to 6 weeks after pregnancy between 2009 and 2013. One-quarter died in the first trimester of pregnancy, before usual maternity booking, although many had risk factors. GPs need to be aware of the Royal College of Obstetricians and Gynaecologists green-top guidelines;2 if they see a woman prior to booking and consider that she is at high or medium risk, they should refer urgently for advice on thromboprophylaxis. On several occasions, despite being assessed as at …