This qualitative study explores midwifery practice during the second stage of labour focusing specifically on whether midwives adopt a directed or physiological approach to maternal pushing. It was undertaken against the backdrop of research findings suggesting that there is no proven benefit to directing a woman's pushing efforts but anecdotal evidence suggests that this remains a routine and accepted part of midwifery practice in the United Kingdom (UK). Semi- structured interviews were undertaken with ten midwives who had recent experience of caring for women during the second stage of labour, ten women who had recently given birth and four obstetricians. A form of thematic analysis was undertaken. Findings were viewed through a lens of critical social theory (CST) and drew on feminist principles to provide a deeper understanding of the emergent themes. Findings indicated that a directed approach to second stage pushing was the norm in this UK Maternity Unit and was deeply embedded within the cultural context of what it meant to be a midwife that involved ' doing' rather than 'being'. Reasons explaining why midwives continue to use directed pushing were grouped into themes; ' time passing and watching the clock' 'different worlds' , 'different women', 'midwives take charge', 'growth of confidence and changing practice' and 'conflict'. When viewed from a CST perspective midwives undertaking directed pushing is seen as an example of institutionalised oppressive behaviour symbolising the way in which knowledge and rationality are disregarded in favour of a risk averse practice that is paradoxically the opposite of what evidence recommends. Midwives are identified as being oppressed by the dominant biomedical model to the extent that they do not view directed pushing as an intervention. In order to promote a more physiological approach with its' associated benefits, a return to a social model of midwifery with a focus on salutogenesis rather than pathogenesis is called for. Recommendations for midwifery education, practice and research are provided in order to support the transformational shift in midwifery culture that is needed if such a change is to become a reality.

The anomalous origin of coronary arteries has been extensively documented in the literature. Most of the anomalies are incidentally found either during coronary angiography or imaging studies and are usually benign; however, malignant outcomes have been reported in the literature. Here, we present the case of a 76-year-old male with non-ST segment elevation myocardial infarction who was found to have an asymptomatic anomalous origin left anterior descending artery from the right sinus of Valsalva.

L'objectif de cette thèse est l'élaboration et l'application de traitements d'images pour permettre une étude objective et fiable des sinus de Valsalva, importantes cavités de la base de l'aorte. Les méthodes proposées s'appliquent aux séquences ciné-IRM et aux examens de scanner sans qu'il n'y ait à modifier le paramétrage entre deux examens. Pour cela, nous avons d'abord étudié la morphologie de cette zone anatomique puis détaillé les différentes propriétés communes à toutes les images de sinus. Ceux-ci font en l'occurrence partie des principaux organes clairs et peu mobiles. Nous avons donc développé un algorithme qui détecte ces éléments et caractérise chacun d'entre eux par une trajectoire unique. Divers outils de morphologie mathématique ont été utilisés à cette occasion, tout comme pour l'extraction du contour des sinus dans chaque image. L'étape de segmentation repose elle sur la reconstruction géodésique, qui s'avère plus efficace et surtout plus robuste que l'usage de contours actifs usuels. L'intérieur des sinus forme un domaine simplement connexe et étoilé. Grâce à ce postulat, nous avons conçu une nouvelle reconstruction, nommée transformée en aurore, qui limite la propagation des intensités aux supports radiaux et présente les résultats dans un repère polaire pour une meilleure lecture des contours.Les points caractéristiques des sinus ont également été détectés, par étude de rayons et détermination de points dominants. Ces points fournissent les éléments nécessaires à une mesure automatique des sinus, mesure cohérente avec les mesures actuellement réalisées manuellement et les variations intra et inter-observateurs de celles-ci. D'autres outils sont enfin esquissés pour modéliser le contour par coniques, classer les images d'examens cinétiques en fonction du moment du cycle et suivre le mouvement des valves dans ces mêmes examens.L'ensemble de ces travaux ont amené à la réalisation d'un logiciel d'aide au diagnostic qui intègre nos méthodes et dont l'interface est également présentée dans le présent mémoire. / This Phd thesis deals with the design and the use of image processing tools in order to allow a reliable and objective study of the sinuses of Valsalva which are important cavities of the aortic root. The proposed methods can be applied on cine-MR sequences and CT examinations without any change in the settings between two examinations.Firstly, we studied the morphology of this anatomical area and its constant properties in all images of the dataset. Sinuses are one of the main bright organs with limited movements. Hence a new algorithm has been designed. It detects and characterizes each bright organ by a single trajectory. Various tools of mathematical morphology are used for this step, as for the extraction of the contour of the sinuses in each image.The segmentation step is based on the geodesic reconstruction, which is more effective and more robust than the usual active contours. The shape depicting the sinuses is simply connected and a star domain. With this assumption, a new reconstruction is proposed, called the Aurora transform. This transform limits the spread of intensities only on the radial lines and shows its results in a polar space for a better reading of edges.The relevant points of the sinuses are also detected by a study of radii and the determination of dominant points along edges. An automatic measurement of the sinuses is deduced from these points. The values are very close to the manual measures currently done according to the intra-and inter-observer variations.Some other tools are finally outlined. They includes the modeling of edges by conics, the image classification depending on the time of the cycle in sequences and the tracking of the aortic valves in these examinations.This work led to the devlopement of a diagnostic aid software based on our methods. Its interface is also presented herein.

L'objectif de cette thèse est l'élaboration et l'application de traitements d'images pour permettre une étude objective et fiable des sinus de Valsalva, importantes cavités de la base de l'aorte. Les méthodes proposées s'appliquent aux séquences ciné-IRM et aux examens de scanner sans qu'il n'y ait à modifier le paramétrage entre deux examens. Pour cela, nous avons d'abord étudié la morphologie de cette zone anatomique puis détaillé les différentes propriétés communes à toutes les images de sinus. Ceux-ci font en l'occurrence partie des principaux organes clairs et peu mobiles. Nous avons donc développé un algorithme qui détecte ces éléments et caractérise chacun d'entre eux par une trajectoire unique. Divers outils de morphologie mathématique ont été utilisés à cette occasion, tout comme pour l'extraction du contour des sinus dans chaque image. L'étape de segmentation repose elle sur la reconstruction géodésique, qui s'avère plus efficace et surtout plus robuste que l'usage de contours actifs usuels. L'intérieur des sinus forme un domaine simplement connexe et étoilé. Grâce à ce postulat, nous avons conçu une nouvelle reconstruction, nommée transformée en aurore, qui limite la propagation des intensités aux supports radiaux et présente les résultats dans un repère polaire pour une meilleure lecture des contours.Les points caractéristiques des sinus ont également été détectés, par étude de rayons et détermination de points dominants. Ces points fournissent les éléments nécessaires à une mesure automatique des sinus, mesure cohérente avec les mesures actuellement réalisées manuellement et les variations intra et inter-observateurs de celles-ci. D'autres outils sont enfin esquissés pour modéliser le contour par coniques, classer les images d'examens cinétiques en fonction du moment du cycle et suivre le mouvement des valves dans ces mêmes examens.L'ensemble de ces travaux ont amené à la réalisation d'un logiciel d'aide au diagnostic qui intègre nos méthodes et dont l'interface est également présentée dans le présent mémoire.

Background: A squat is a common exercise that is used in many areas of strength training and for different purposes and the literature is inconclusive when it comes to whether the weight lifting belt (WB) affects performance and/or is injury-preventing. The use of breathing techniques is common during heavy lifting and therefore the practice of the breathing teqnice; valsalva maneuver (VM) may be of interest to study and if this along with the WB can provide some advantages in power output and velocity. Aim: The specific aim of the study was to evaluate whether the velocity in the eccentric and the concentric phase of the squat, and the peak velocity in the concentric phases are affected in power output through the use of the VM when the subjects use or did not use a WB. Method: Fifteen subjects (10 men and 5 women) volunteered freely to participate and did a total of 12 squats divided in four different sets with three repetitions each on 75% of their self-reported one repetition maximum (1RM). The first two sets were either with or without WB and the third and fourth sets were either with or without the practice of the VM. The three conditions (with WB, with WB + VM and VA only) were compared to each other and to the control group (without any instructions and no WB) in terms of power output and velocity in the eccentric, concentric and peak velocity in the concentric phase of the squat. Result: There was no significant difference in power output when comparing the four different test conditions. The velocity in the eccentric, concentric and peak velocity in the concentric phase did not have a significant difference between the different test conditions. Conclusions: This study shows a different output compared to previous literature. The WB and the practice of VM did not affect the power output and velocity in a squat, alone or together. / Bakgrund: Det finns många olikheter i litteraturen när det gäller huruvida tyngdlyftarbältet påverkar prestationen och/eller om det minskar skaderisken. En knäböj är en vanlig övning som används inom många områden av styrketräning och för olika ändamål. Användning av andningstekniker är vanligt vid tunga lyft och därför kan utförandet av andningstekniken; valsalvamanövern vara av intresse att studera och om det tillsammans med lyftbältet kan ge effekt på effektutveckling och hastighet i lyft. Syfte: Syftet med studien var att utvärdera hastigheten i en knäböjs olika faser (excentriska, koncentriska och topphastigheten i den koncentriska fasen) och hur effektutvecklingen påverkas av lyftarbälte och valsalvamanövern. Metod: Femton personer (10 män och 5 kvinnor) deltog frivilligt och utförde totalt 12 knäböj i fyra olika sets med tre repetitioner på 75 % av testpersonernas självrapporterade 1RM. De första två seten var utförda antingen med eller utan tyngdlyftarbälte och de tredje och fjärde seten var utförda antingen med eller utan utövande av valsalvamanövern. Dessa tre förhållanden ( med lyftarbälte, med lyftarbälte + VA och VA endast) jämfördes med varandra och med kontrollgruppen ( ingen VM och inget lyftarbälte) med avseende på effektutveckling och hastigheten i den excentriska, koncentriska och topphastighet i knäböjens koncentriska fas. Resultat: Effektutvecklingen gav ingen signifikant skillnad i någon av de fyra olika förutsättningarna (med lyftarbälte, utan lyftarbälte, med bälte och valsalvamanövern och utan bälte och valsalvamanövern). Hastigheten i den excentriska, koncentriska och topphastigheten i den koncentriska fasen visade ingen signifikant skillnad mellan de fyra olika seten. Konklusion: Studien visade ingen skillnad vilket kan jämföras med tidigare litteratur där en skillnad fanns. Lyftarbältet och utförandet av valsalva manövern påverkade inte effektutvecklingen och/eller hastigheten när en knäböj utfördes.

Brass musicians are known to experience a performance problem that is sometimes called valsalva maneuver or musical stuttering. This problem is known to cause difficulty starting a first note, tension in the throat, and tightness in the chest. Unfortunately, the research literature lacks sufficient details for evidence-based interventions. Therefore, the purpose of this study is to characterize and define this performance problem as experienced by brass musicians. An online epidemiologic survey was developed and deployed to collect data from brass musicians who have experienced this problem in their own playing. The survey was designed to acquire data in order to characterize and define the phenomenon through a biopsychosocial framework. The survey was also designed to assess whether this problem aligns with Altenmuller's heuristic model of motor control disruptions. A diverse group of brass musicians (n = 252) participated and offered relevant details for characterizing and defining this problem. Analysis of characteristic data suggests this problem is not a form of musical stuttering. Considering these data through Altenmuller's model suggests that this problem is experienced as a spectrum of motor disruptions that can develop into a unique type of musician's dystonia. While additional research is warranted, the results of this study are applicable to brass musicians, brass pedagogues, music educators, and performing arts health clinicians.