Delivery Experience Research Articles

Consumer impatience in the e-commerce home delivery context: a consumer-centric supply chain perspective for time-based competition

PurposeThis paper aims to introduce the concept of consumer impatience, empirically explore how it relates to time-based logistics performance (delivery speed and delivery timeliness) and discuss its impact on consumer satisfaction. This research argues that gaining insights related to delivery performance from a consumer’s perspective can help the development of more effective time-based logistics strategies for e-commerce home deliveries.Design/methodology/approachHypotheses in this study are developed using attribution theory and tested with empirical data collected through an online behavioral consumer experiment. Middle-range theorizing is used to develop an understanding of the mechanisms that impact the relationship between time-based logistics performance and consumer satisfaction.FindingsFindings indicate that consumer impatience with delivery speed and delivery timeliness play an essential role in the relationship between time-based delivery performance and consumer satisfaction. Issues with delivery timeliness are shown to have a more negative impact on consumer satisfaction than issues with delivery speed, while delivery communication is demonstrated to have a positive relationship with consumer satisfaction.Originality/valueThis empirical study adds to existing time-based competition literature by taking a consumer-centric perspective and bringing a largely overlooked but critical concept – consumer impatience – into the logistics and supply chain management setting. Middle-range theorizing allows for a conceptualized understanding of consumers’ delivery experiences that can help companies develop proactive actions in their time-based competition initiatives.

Last-Mile Delivery Optimization: Balancing Cost Efficiency and Environmental Sustainability

The significance of last-mile delivery in supply chains has increased due to the growth of e-commerce. Last- mile delivery (LMD) is responsible for a large amount of the environmental impact and overall logistical costs. In order to balance economic effectiveness and environmental sustainability in last-mile delivery operations, this article examines optimization options. The study used a descriptive design; collected and analyzed quantitative data. Key players in last-mile delivery, including logistics firms, online merchants, and delivery service providers, who were given surveys via Google Forms to collect primary data. The topics covered included cost structures, environmental issues, current optimization techniques, and practices. Data on current last-mile delivery strategies, optimization techniques, and environmental sustainability projects were gathered through a literature review. With a case study in Lagos, Nigeria, the study focused on metropolitan areas. Participants with substantial last-mile delivery and logistics experience were chosen using a purposive sample technique. Twenty logistics and supply chain managers, ten couriers and delivery drivers, ten owners of e-commerce businesses, thirty customers, five transportation and logistics service providers, five sustainability specialists, eight city officials and urban planners, and seven technology providers were included in the sample. The analysis with statistical methods, such as table and charts, was used to analyzed the participants opinions. The paper contributes to the growing body of literature that links supply chain efficiency with sustainability goals

Improving psychological and social support needs after traumatic birth: A qualitative study

IntroductionEmergency deliveries increase maternal risk for postpartum depression (PPD) and post-traumatic stress disorder (PTSD). One in three women describe their birth experience as traumatic, but patient-centered support needs are unclear. We conducted a qualitative study of women with traumatic birth to identify patient-centered priorities to optimize mental health support. MethodsSemi-structured interviews were conducted with women who experienced an emergency during birth, and who self-identified as experiencing traumatic birth. The Stanford Acute Stress Reaction Questionnaire and PTSD Checklist were completed. Interviews included open-ended questions about birth events that improved or worsened their delivery experience, perceptions of mental, physical, and emotional support provided by staff, and patient perspectives about psychological and social support referrals after emergent deliveries. ResultsA majority of participants met positive screening criteria for PTSD at the time of interviews. Birth experiences were affected by prenatal expectations, as well as the style and quality of clinical staff communication during and after delivery. There were four key themes central to their experiences and perceptions: (1) Emotional Impact and Intensity, (2) Factors Influencing Birth Experience, (3) Perceived Lack of Emotional Support, and (4) Desire for Post-Birth Follow-Up and Support. Participants almost unanimously desired to be offered psychosocial services after birth trauma. ConclusionThere are significant gaps in emotional support and communication for patients experiencing traumatic births. Offering structured, in-hospital mental health referrals may address immediate psychological needs, aid in trauma recovery, and potentially mitigate long-term mental health consequences. These findings advocate for a more holistic approach to postpartum care that prioritizes both physical and emotional well-being.

Barriers and enablers towards integrated care for sexual violence victims in humanitarian settings

Abstract Background Sexual violence (SV) is a complex public health issue that necessitates a coordinated multisectoral response. Ideally, this response should be provided through an integrated care package to strengthen timely access and comprehensive care for victims. However, in humanitarian settings with high levels of SV, care is often offered through fragmented silos, exacerbating the burden on the health workforce and victims. Methods Using the Valentijn framework, a qualitative, real-time Delphi study was conducted with 17 SV care experts representing 7 geographical subregions to gain informed opinions on key contextual and health system barriers and enablers for integrated care for SV victims in humanitarian settings. Results Challenges and enablers reported across the diversity of the participants’ contexts showed consistency. Contextual challenges included volatile contexts, collapsed health systems, and poor infrastructure. Professional challenges included a lack of expertise among healthcare providers (HCPs), high staff attrition, and compassion fatigue among HCPs. Health systems challenges included poor referral and coordination mechanisms, insufficient resources, misaligned donor-programme priorities and low prioritisation of SV comprehensive care. Key enablers reported were effective networking, community engagement, capacity building, co-locating services, participatory management, promoting staff’s sense of ownership, digitalised information systems, and joint patient files. Conclusions The sustainability of integrated care for SV victims can be strengthened by ensuring HCPs access regular psychological support and training and are incentivised to provide quality care. Regular coordination among actors, including donors, can support integrating care that responds to patients’ holistic needs. Further research is needed to assess HCPs’ and SV victims’ experiences of current service delivery and how to optimise integrated care in humanitarian settings. Key messages • Addressing care providers challenges in humanitarian settings, such as high attrition, lack of training, psychosocial support, and burnout, can ensure proper integration of sexual violence care. • Integration of sexual violence care demands systemic changes, including aligning donor-programme goals, building accountability mechanisms and the buy-in of political and community leaders.

Student Co-Created Learning Experiences in Block Delivery

Student Co-Created Learning Experiences in Block Delivery

High-risk pregnancy and risk of breastfeeding failure

BackgroundThere is growing evidence that supports the role of breastfeeding in reducing the burden of non-communicable diseases (NCDs). There are considerable gaps in breastfeeding outcomes in mothers with chronic diseases due to a lack of knowledge and support in the postpartum period. Mothers who have NCDs and pregnancy complications are at risk of breastfeeding failure.AimTo compare breastfeeding outcomes in mothers with NCDs with healthy mothers and determine the underlying challenges that lead to poor outcomes.MethodsA prospective cohort study was conducted among 150 women (50 with high-risk pregnancies (HRP) and 100 with normal pregnancies (NP)). They were recruited from those attending the immunization and outpatient clinics at Sohag General Hospital. Mothers were recruited at 34 weeks gestation and were followed up at 2 weeks, 6 weeks, and 6 months after delivery. A pretested and validated questionnaire was used to collect detailed epidemiological, personal, health-related status, medications, hospitalizations, reproductive history, current delivery, and previous breastfeeding experiences. On follow-up they were assessed for breastfeeding practices, their health and health and growth of their children, and social support.ResultsDelivery by cesarean section and postpartum bleeding were commoner among HRP patients. Initiation of breastfeeding in the 1st hour of delivery was significantly lower among women with HRP than those with normal pregnancies (48.0% versus 71.0%, p = 0.006). The most common reason for not initiating breastfeeding among the NP group was insufficient milk (34.5%), while in the HRP group, it was the mother’s illness (80.8%). Skin-to-skin contact with the baby after birth was significantly less practiced in the HRP than in the NP group (38.0% vs 64.0% at p = 0.003). Herbs (such as cumin, caraway, cinnamon, aniseed, and chamomile) were the most common pre-lacteal feeds offered (63.0% in NP vs 42.0% in HRP). Artificial milk was more used in HRP than NP (24.0% vs 4.0%). Breast engorgement was 3 times more common in the HRP compared to the NP group (61.5% vs19.6%). Stopping breastfeeding due to breast problems was 2.5 times higher in the HRP than in the NP group (38.5% vs. 15.2%, p = 0.003). Nipple fissures were twice as common among the NP than among the HRP group ((73.0%) vs. (38.5%), p = 0.026). Exclusive breastfeeding during the period of follow-up was lower in the HRP than in the NP group (40.0% vs 61.0%, p < 0.05) and formula feeding was twice as common in the HRP as in the NP group (34.0% vs. 18.0%, p = 0.015). Child illness was significantly higher among women with HRP than those with NP (66.0% vs 48.0%, p = 0.037).ConclusionsWomen with HRP are at a high risk of poor breastfeeding outcomes with increased lactation problems and formula feeding rates. Encouraging women especially those with HRP to achieve optimal breastfeeding practices is a simple intervention that can be included in daily practice and may have a positive impact on mothers’ health.

Interrogating the effectiveness of service engagement for underserved populations in complex health and social care systems: towards an equitable engagement strategy

There are increased sector-wide efforts within health and social care systems to engage those with lived experience in service design, delivery, and monitoring – aiming to secure more equitable health outcomes. However, critical knowledge gaps persist around how national whole-system engagement strategies can account for the challenges experienced by populations that encounter exclusion within complex multi-layered systems. This includes a failure to delineate shared challenges across groups, and to develop transferable cross-group frameworks to assist sector-wide change. There is, therefore, a danger that those groups already least heard will be collectively left behind. With a view to informing a more inclusive engagement strategy in Ireland, this national study aims to investigate multi-level (policy and strategic, operational, on-the-ground services, individual) shared challenges impacting engagement for five populations who have been identified as underserved groups in a complex health and social care system, including: (1) those who misuse drugs and alcohol, (2) those who are experiencing homelessness, (3) those experiencing mental health, (4) migrants and those of minority ethnicies, and (5) Irish Travellers. Adopting a mixed-methods approach which draws on an evidence-informed multistakeholder perspective, this study employs data from: focus groups and life-course interviews with lived-experience populations (n=136), five focus groups (n=39) and a national on-line survey (n=320) with population-specific services providers; and national-level stakeholder interviews (n=9). Two cross-group participatory consultative forums with lived-experience and provider participants (n=28) were used to co-produce priority action areas based on study findings. This article presents findings on shared challenges in engaging these groups around leadership and commitment, implementation and action, population capacities, trust, and representation, stigma, and discrimination. Derived from these challenges, six development areas are presented to advance an inclusive equitable engagement approach in Ireland. These comprise: 1) balancing top-down prioritisation, and bottom-up direction; 2) sustaining multi-level, multi-form implementation; 3) measuring effectiveness and action; 4) embedding inclusive equitable engagement; 5) trust as a prerequisite, and outcome; and 6) an equalising, agency empowering agenda.

Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) Online: a mixed methods evaluation exploring the feasibility of implementing a virtual culturally tailored diabetes self-management programme for African and Caribbean communities

ObjectivesTo assess the feasibility and acceptability of delivering Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) Online.InterventionHEAL-D Online—a 7-week culturally tailored type 2 diabetes educational programme delivered using online platform.SettingProgramme...

The current status of primipara’s childbirth experience and its correlation with their reproductive intention: a cross-sectional survey study

BackgroundThe childbirth experience of primipara profoundly impacts her future physical and mental health, reproductive intention, and choice of childbirth mode. This study aimed to explore the current situation of primipara’s childbirth experience, to analyze the factors influencing negative childbirth experience, and to explore the relationship between childbirth experience and reproductive intention.MethodsA cross-sectional survey of a convenience sample of 522 primipara 1–5 days postpartum was conducted at five hospitals in Guangdong Province (May to July 2024). Data were collected using the General Information Questionnaire, the Social Support Rating Scale, the Childbirth Readiness Scale, the Caring Behaviors Inventory Scale, the Wijma Delivery Experience Questionnaire, and the Questionnaire on Reproduction Intention of Primipara.ResultsThe mean score of fear of childbirth was 68.86 ± 17.68. A total of 137 respondents met the clinical criteria for fear of childbirth (≥ 85 points), indicating that 26.2% of primipara had a negative experience of childbirth. Binary logistic regression model showed that elderly primipara [odds ratio (OR) (95% confidence interval (CI)): 11.167 (2.737–45.559)], pregnancy comorbidities or maternal childbirth complications [OR (95%CI): 6.596 (3.046–14.287)], childbirth intervention [OR (95%CI): 6.168 (2.869–13.258)], and severe pain [OR (95%CI): 4.660 (2.197–9.882)] were risk factors for negative childbirth experience. Childbirth accompaniment [OR (95%CI): 0.081 (0.018–0.368)], high level of social support [OR (95%CI): 0.768 (0.704–0.839)], and high level of childbirth readiness [OR (95%CI): 0.878 (0.812–0.950)] protected against a negative birth experience. There was a negative correlation between the fear of childbirth score and reproduction intention scores.ConclusionsChildbirth accompaniment and high levels of social support and childbirth readiness can reduce primipara’s perception of negative childbirth experience. Negative childbirth experience can reduce reproduction intention.

Experiences of maternal healthcare delivery in South Africa: Perinatal women's viewpoints.

Becoming a mother should be an exciting experience in woman's life. No mother should have to endure adverse encounters. while seeking healthcare in any maternal services facility. this is a phenomenon occurring globally. Delivery of these maternal healthcare services has a bearing on the obstetrical outcomes of mothers from preconception until six weeks after delivery. The study aims to understand the experiences of perinatal women regarding maternal healthcare services in the public hospitals of Gauteng province in South Africa. This study followed an exploratory and descriptive qualitative approach using a purposive sampling method. The study was conducted in three selected public hospitals representing different levels of care namely, district, tertiary provincial, and academic in the Gauteng province. A total of forty-six perinatal women were selected to take part in six focus groups. Data were thematically analysed following the six steps given by Braun and Clarke (2013). Three themes emerged as follows: 1) individual 2) interpersonal reasons and 3) impact of poor complaints procedure on maternal healthcare. The study showed that maternity services rendered to perinatal women in the three selected public hospitals are affected by several factors, such as midwives' attitudes, knowledge and skills, professional ethics, communication, and delayed maternal healthcare. These findings demonstrate an urgent need for practice and policy interventions that go beyond just a routine service but quality and organised maternal healthcare services provided in public hospitals, for improved healthcare outcomes at the point of service.

Informal contracts' influence on shipping efficiency: a customer- perspective of package delivery agent

Understanding the role of informal agreements can help delivery services prioritize customer preferences, leading to improved service quality and customer satisfaction. Unfortunately, where there are gaps either on general understanding of communication stand in-between the different of failure and success. This qualitative research study delves into the dynamics of informal contracts between customers and package delivery agents, and their impact on the efficiency of the shipping process. The research aims to gain a deeper understanding of how these unwritten agreements affect various aspects of the delivery process from both the customer and delivery agent viewpoints. Through in-depth interviews and thematic analysis, this study sheds light on the nuances of these informal arrangements and their role in shaping the overall shipping experience. The study revealed that informal agreements play a significant role in package delivery experiences. Participants described unspoken arrangements formed through trust and effective communication. Adherence to these agreements positively influenced service efficiency, with prioritized deliveries and improved accuracy. However, deviations from agreements led to emotional reactions such as frustration and disappointment, impacting the perceived trustworthiness of the delivery service. Additionally, the study highlighted cultural variations in the adoption of informal agreements and the importance of clear communication in establishing and maintaining these arrangements.

Proteomic and metabolomic analysis of plasma for pain at different labor stages

Labor pain has an important impact on maternal labor experience, mood, and postpartum depression. It is of great emotional significance to pay attention to the pain stress response of pregnant women and take necessary intervention measures in the labor process to weaken the sense of delivery experience and reduce the risk of complications. To better understand the molecular alteration of pain and stress changes during the delivery, we analyzed the metabolomic and proteomic of the plasma collected during the labor process at different stages, revealing the significant changes in metabolites and proteins and the key regulatory pathways. The KEGG enrichment analysis showed the differentially expressed metabolites and differentially expressed proteins were mainly enriched in glutamate metabolism, glutathione metabolism, oxidative phosphorylation, glycolysis/gluconeogenesis, and citrate cycle (TCA cycle). In particular, the glutathione metabolism played a major role in the metabolic pathway of the whole labor process. The result demonstrated the potential significance of the glutathione metabolic pathway in pain regulation.

The Impact of Cloud Technology on Entrepreneurship in the Hospitality Industry

Purpose: Cloud technology has significantly transformed modern business operations, particularly within the hospitality industry, by offering scalable, cost-effective, and flexible computing solutions. This paradigm shift has democratized access to advanced tools and services, thereby enhancing operational efficiency and competitive capability for entrepreneurs. This integrative paper examines the impact of cloud computing on entrepreneurship within the hospitality sector, focusing on operational efficiency, cost structures, scalability, and innovation. Materials and Methods: By employing the Resource-Based View (RBV) and Innovation Diffusion Theory (IDT), this integrative study provides a framework for understanding how cloud technology enhances competitive advantage and adoption patterns. Findings: Through a comprehensive review of literature and case studies, this study identifies and addresses critical research gaps, including the limited empirical evidence on the long-term effects of cloud technology on business growth, sustainability, and competitive advantage. It also highlights the need for further exploration of regional differences in cloud technology adoption, particularly in emerging markets, and underscores the insufficient exploration of security and privacy concerns, advocating for more detailed research on cloud security models. Moreover, the study seeks to bridge gaps in understanding how cloud technology drives innovation in service delivery and customer experience. Implications to Theory, Practice and Policy: Policy contributions from this study include recommending targeted guidelines for secure cloud adoption, strategies for addressing regional disparities in cloud technology implementation, and policy frameworks that support innovation while safeguarding data privacy. Recommendations for entrepreneurs include strategically adopting cloud solutions, investing in staff training, and continuously monitoring cloud-related expenses. This study ultimately contributes to a nuanced understanding of cloud technology’s role in shaping entrepreneurial practices and policies within the hospitality sector.

RESSECÇÃO DE AMELOBLASTOMAS CONVENCIONAIS APÓS TRATAMENTO CONSERVADOR E RELATO DE TRANSFORMAÇÃO PERIFÉRICA: SÉRIE DE CASOS E REVISÃO INTEGRATIVA

Introduction: Ameloblastoma is a slow-growing tumor, presenting bone expansion and high recurrence rates. It originates from the tooth enamel, dental follicle, periodontal ligament or lining of odontogenic cysts and odontogenic epithelium. Recently, in 2022, the WHO reclassified ameloblastomas into conventional, unicystic, peripheral and metastatic due to prospective views based on updates to genetic studies, which has generated a dilemma in the literature regarding the ideal therapeutic approach for conventional ameloblastoma, to provide a lower surgical risk and morbidity to patients. Purpose: Carry out an integrative review of the literature, describing 02 resections of conventional ameloblastomas after conservative treatment and 01 report of peripheral transformation, providing valuable information on management. Methodology: The current study was divided into two stages. The first step consists in a descriptive series of three cases of conventional ameloblastomas treated by conservative methods, where two of them were subsequently submitted to partial resection and the third one turned into a peripheral ameloblastoma. In the second step, an integrative and systematic review was carried out in accordance with the PRISMA recommendations on resection and excision for treating conventional ameloblastomas. Results: Classification and treatment methods in cases of ameloblastoma are based on histopathological characteristics and can range from enucleation to resection with reconstruction. This study focuses on three case reports of patients with conventional ameloblastoma. The treatment consisted in two partial resections with primary reconstructions and one enucleation combined with a peripheral osteotomy after conservative treatments without prolonged follow-up. The treatment of choice and recurrence were evaluated, and the patients had satisfactory results. Conclusion: There is no consensus on the treatment of ameloblastomas. Both conservative surgeries and radical interventions are used. The chosen treatment must take into account the location of the tumor, size, age, general health condition and cooperation of the patient, possibility of long-term delivery, histopathological pattern and professional experience.

Performance Testing Techniques for Live TV Streaming on STBs

In the realm of live TV streaming, performance testing is critical to ensure seamless delivery and optimal user experience on Set-Top Boxes (STBs). This paper presents a comprehensive exploration of performance testing techniques tailored for live TV streaming on STBs, focusing on methodologies, challenges, and best practices. With the growing demand for high-quality, uninterrupted live TV content, effective performance testing becomes imperative to address issues related to latency, buffering, and overall system reliability. The study begins with an overview of the unique performance challenges associated with live TV streaming on STBs. Unlike on-demand streaming, live TV requires real-time data processing and minimal latency to deliver a continuous viewing experience. The paper categorizes performance testing into several key areas: network performance, system resource utilization, and user experience. Network performance testing evaluates the efficiency of data transmission across various network conditions. Techniques such as bandwidth measurement, latency analysis, and jitter assessment are employed to simulate different network scenarios and determine their impact on streaming quality. These tests help in identifying bottlenecks and optimizing network configurations to support smooth streaming.

Patient and provider perspectives on pain and other dimensions of anesthesia experience for cesarean delivery: A qualitative study.

There is a lack of evidence on the importance of pain or other aspects of clinical care in the overall patient experience and patient-centered outcomes in cesarean delivery. The purpose of this study was to discover patient priorities in cesarean delivery anesthesia experience, to compare patient and provider perspectives, and to explore attitudes on shared decision-making around anesthesia choices for cesarean delivery. Patients with recent cesarean deliveries and clinical care providers were approached using a purposeful sampling strategy for this prospective observational qualitative study. Patients were included if they were in the hospital within 72 hours of a cesarean delivery (scheduled or unscheduled), spoke English fluently, and had term gestation. Providers were included if they currently provide regular clinical care to patients having cesarean deliveries and have at least 3 years of practice experience. Semi-structured interviews were conducted using an interview guide. Interview transcripts were independently coded by three coders and qualitatively analyzed for major themes until thematic saturation was achieved. A total of 42 participants (20 patients and 22 providers) completed interviews. Five major themes emerged reflecting patient attitudes and beliefs toward cesarean delivery experience: 1) effective communication, education, and respect; 2) emotional support by care team; 3) intraoperative pain or discomfort; 4) varying acceptability around pain therapies; 5) stigma surrounding cesarean delivery. Five major themes emerged reflecting provider attitudes and beliefs toward cesarean delivery priorities: 1) complexity of pain responses; 2) multiple pain control strategies; 3) effective communication during emergency cesarean delivery; 4) patient psychological well-being during cesarean delivery; 5) barriers to observing the patients' birth plans. Patients and providers alike prioritize pain management, psychological well-being, and effective communication during cesarean delivery experiences. Patients emphasize relationships and trust in their cesarean experience, while clinicians emphasize clinical complexities and physical treatments. Our results guide future research in patient perspectives in cesarean deliveries.

Linking Post-Treatment Rehabilitation with Healthcare Roles: How Nurses and Technicians Influence Patient Satisfaction

Post-treatment rehabilitation is a critical component of healthcare that significantly influences patient recovery and long-term outcomes. This review explores the interconnected roles of nurses and technicians in delivering effective post-treatment rehabilitation and its impact on patient satisfaction. Nurses play a vital role in patient education, monitoring, and emotional support, while technicians ensure the proper functioning of medical equipment and therapies. Through a collaborative care model, both healthcare roles contribute to improving service delivery and patient experiences. However, challenges such as resource constraints, communication barriers, and the need for specialized training must be addressed to fully harness their potential. By enhancing the roles of nurses and technicians in rehabilitation services, healthcare systems can improve patient satisfaction and develop more efficient, patient-centered services.

PowerPoint-based lectures and students’ experiences in Eritrean Higher Education Institutions

PowerPoint (PPT) is extensively used in Higher Education Institutions (HEIs), including those in Eritrea, for lecture delivery and student presentations. This raises questions about whether these lectures or student presentations are effectively designed and implemented and encourage students’ participation. This study explores instructors’ use of PPT-based lectures and students’ experience in Eritrean HEIs. Additionally, it seeks to identify and understand the challenges HEIs face in using PPT-based teaching. Data were collected through semi-structured interviews, focus groups, and observations, involving nine instructors and fifteen students from three Eritrean HEIs. The study indicated a relationship between PPT design and delivery and revealed varied outcomes regarding the design and delivery of PPT-based lectures. The study also found discipline-specific differences regarding students’ experiences of PPT-based delivery. Moreover, it identified challenges related to institutional leadership, curriculum flexibility, internet access, and pedagogical expertise and commitment of instructors as key obstacles to the successful integration of PPT-based lectures within these institutions.

Effective Epidural Analgesia during Labor: A Feasible Method to Decrease Unnecessary Cesarean Deliveries in Thailand

Thailand has reported a high rate of cesarean delivery (45%–55%), prompting global concern about an increase in cesarean delivery rates. Fear of labor pains is one of the most common reasons pregnant women opt for cesarean delivery. Labor pain is associated with cervix dilation and fetal descent into the birth canal, which is exacerbated by ischemic pain caused by uterine contraction. Modern medical and non-medical techniques have demonstrated efficacy in reducing pain and ensuring safety during labor and delivery. Neuraxial labor analgesia is a highly effective medical pain relief method but has no effect on the rate of cesarean or assisted vaginal delivery. Medication administration for pain relief during labor, using a combination of a local anesthetic and an opioid, was observed to be transmitted across the placenta to the fetus, but had no significant effects on fetal outcomes in mothers who chose epidural analgesia. There are several techniques for administering neuraxial labor analgesia that can be customized for each pregnant woman. To achieve the most wonderful feasible labor and delivery experience, effective epidural labor analgesia is a crucial technique for reducing anxiety and suffering about labor pain. It is safe, widely used world-wide, and effective. Implementing a policy to increase public and medical providers awareness and acceptance of labor pain relief, as well as establishing a safe obstetric anesthesia service provided by obstetric anesthesiologists, could improve maternal and neonatal safety while significantly lowering the rate of unnecessary cesarean deliveries.

A national evaluation of Project Cautioning And Relationship Abuse ('CARA') awareness raising workshops for first time offenders of domestic violence and abuse: protocol for a concurrent mixed-methods evaluation design.

Interventions related to the perpetration of Domestic Violence and Abuse (DVA) have gained traction over the past several years, in response to dissatisfaction by victims, an inadequate response from the criminal justice system, increased demand on police time and a lack of rehabilitative responses to the perpetration of domestic abuse. The CARA model is a conditional diversionary caution, offered by police for first time offenders of 'standard' or 'medium risk' domestic abuse, that engages perpetrators in awareness raising workshops and signposts them onto further services. Although quasi-experimental studies have indicated that CARA showed promise at reducing reoffending, the CARA model has yet to be evaluated nationally and there is no qualitative evidence related to understanding or learning about the lived experience of perpetrators and victims as they engage with the intervention. Using a concurrent pragmatic mixed methods design model we will undertake a national evaluation of CARA by triangulating quantitative data from up to nine police forces, and routine data from service providers, with qualitative data from workshop participants, victims and professional stakeholders to: (1) understand the long-term impact of CARA implementation on DVA reoffending and engagement with services and (2) explore perceptions and experiences of both delivery and receipt of CARA. We will use qualitative methodologies that draw on interpretivist and phenomenological perspectives, as well as quantitative methodologies using interrupted time series models, Poisson regression models, Geo mapping and a cost benefits analysis. Where currently the CARA model is being introduced as a national option for standard risk first-time offending, we will engage with policymakers and academics nationally in the live debate on its effectiveness and suitability during its roll-out. Ethical approval was approved by the University of Southampton on the 1 st June 2022 (Ref: ERGO ID: 71818.A1).