The Effect of Active Warming Before Total Knee Arthroplasty on Intraoperative Body Temperature and Comfort: A Randomized Control Trial.

PURPOSE: This study was conducted to determine the effect of active warming on intraoperative body temperature and comfort before total knee arthroplasty. DESIGN: This study was a randomized controlled trial designed according to the Consolidated Standards of Reporting Trials. METHODS: The study was conducted on 54 patients in a public hospital in Türkiye. In the study, patients in the intervention group were prewarmed for 30 minutes before surgery. The patients in the intervention and control groups were warmed with a warming bed during the surgery. FINDINGS: In this study, the first entry temperature to the operating room after anesthesia induction and the mean body temperature of the patients in the intervention group were higher than the control group. The mean comfort score of the patients in the intervention group was higher than the control group. CONCLUSIONS: As a result of this study, we found that the combination of preoperative prewarming and intraoperative warming reduced the decrease in the patient's body temperature and increased the comfort.

Postural supporting cervical traction workstation to improve resting state brain activity in digital device users: EEG study.

Objective: This study aimed to determine the effect of postural support workstation on inducing effective brain activity during rest. Methods: Thirty-five healthy digital overusers were recruited as participants. We conducted two interventions of head weight support traction (ST) and conventional traction (CT) strength on all participants in random order. Participants' arousal levels and psychological comfort were assessed. In addition, changes in brain activity caused by traction were confirmed by measuring changes in resting state brain activity using an electroencephalogram (EEG). Results: Under the ST condition, psychological comfort improved while alert levels were maintained. In addition the resting brain activity of EEG was characterized by strong focused attention and relaxed activity, as evidenced by increased alpha waves throughout the brain. By contrast, in the CT condition, no significant improvement in comfort was observed. Furthermore, high-frequency brain activity, such as beta 3 and gamma waves, was observed across the entire brain regions. Conclusion: In this study, the ST workstation was shown to effectively improve resting attention and psychological comfort in individuals who excessively use digital devices by inducing resting state alpha activity without stimulating high-frequency brain waves, while maintaining an upright posture with appropriate traction.

A novel method of cardia visualization and comfort level enhancement during magnetic capsule gastroscopy via sugar-glued tether-assisted technique: a randomized pilot study inspired by a Chinese snack-making process (with video).

BACKGROUND: Magnetic capsule gastroscopy (MCG) is a non-invasive diagnostic method for the digestive tract. However, its efficiency in visualizing the gastric cardia is often compromised due to the capsule's rapid passage. This study introduces a novel sugar-glued tether-assisted technique inspired by a traditional Chinese snack-making process to enhance cardia visualization and patient comfort during MCG. METHODS: This pilot, open-label, single-center, randomized controlled, non-inferiority study was conducted at Binzhou Medical University Hospital. Seventy-eight patients were enrolled and divided into three groups: conventional MCG, suction cup tether-assisted MCG, and sugar-glued tether-assisted MCG. The primary outcomes included safety, comfort level, and gastric cardia visualization quality. Secondary outcomes assessed technique-associated performance and clinical factors. RESULTS: The sugar-glued tether-assisted MCG demonstrated comparable cardia visualization quality to the suction cup method, with significantly better results than conventional MCG. Comfort levels were significantly higher in the sugar-glued group compared to the suction cup group. The number of swallow attempts was significantly lower in the sugar-glued group, with no adverse events reported. Secondary outcomes showed no significant differences in MCG assembly time and ingestion-to-detachment period between the suction cup and sugar-glued groups. CONCLUSION: The sugar-glued tether-assisted MCG is a feasible and safe modification that enhances gastric cardia visualization while improving patient comfort. This technique provides a cost-effective alternative to the suction cup method, warranting further investigation in larger, multi-center studies.

The Impact of Preangiography Anxiety on Postangiography Comfort in Older Adults: Implications for Perianesthesia Nursing Care.

PURPOSE: To determine the relationship between anxiety before coronary angiography and comfort after coronary angiography in people over 65 years of age. DESIGN: A descriptive cross-sectional study. METHODS: The study population consisted of patients aged 65 years and older who agreed to participate in the study and underwent coronary angiography. The study was carried out on a total of 201 patients. Data for the study were collected using the Sociodemographic and Medical Information Form, Surgical Fear Questionnaire (SFQ), Early Postoperative Comfort Scale, Visual Anxiety Scale (VAS), and Angiography Information Form. Pearson's test was used to determine the direction of the relationship between comfort after angiography and fear and anxiety before angiography. Multivariate linear regression program was used for different orders of magnitude between predictors of comfort rates. FINDINGS: A negative and low-level correlation was found between Early Postoperative Comfort Scale and short-term SFQ, long-term SFQ, total SFQ, and VAS. Variables and scale scores that showed statistically significant differences in predicting patient comfort after angiography in univariate analyses were evaluated using stepwise multiple linear regression analysis. The best model for the postangiography comfort score was created in step 4. Increasing age, the presence of a chronic disease, and high levels of anxiety and fear before angiography were found to be negative predictors of comfort after angiography. CONCLUSIONS: Comfort after angiography was reduced by high fear and anxiety before angiography, increasing age, and the presence of chronic disease. This study highlights the importance of anxiety management and individualized care before angiography in older people.

The effect of guided group reflection on the ability and convenience of breaking bad news in pre-hospital emergency staff.

BACKGROUND: Bad news refers to any information that create negative changes in a person's understanding or expectations of in present and future. Breaking Bad News (BBN) is a stressful task that may have disturbing effects on the professional performance and general health of the medical staff. Pre-hospital emergency staff often needs to deliver bad news to the patient or his family. This study was conducted to determine the effect of guided group reflection training on the ability and comfort of BBN in pre-hospital emergency staff. METHODS: This quasi-experimental study was conducted on 95 staff of the pre-hospital emergency, in the test and the control groups. For the test group, a 4-hour training workshop on BBN was held, and then a group was formed in virtual space to discuss and exchange opinions about the scenarios of BBN and reflecting on it. Data collection tools were SPIKES Questionnaire and the Visual Analogue Mood Scale. The data were analyzed with SPSS V.18. RESULTS: The mean score of the ability to BBN after the intervention was 44.01 ± 6.21 in the test group and 31.40 ± 4.51 in the control group, and a significant difference was found using the independent t-test (P = 0.0001). Besides, the mean scores of the convenience of BBN in post-test was 5.52 ± 1.64 in the test group and 3.50 ± 1.28 in the control group using the independent t-test with a significant difference (P = 0.0001). CONCLUSION: According to the findings, training in guided group reflection improved the ability to BBN and its convenience in pre-hospital emergency staff. Therefore, it is suggested the use of this method in training for health care providers. Relating to BBN.

The relationship of decision regret with quality of life and comfort level in patients undergoing laparoscopic sleeve gastrectomy: a cross-sectional study.

BACKGROUND: Laparoscopic sleeve gastrectomy (SG) is one of the effective methods of weight loss. It is essential to determine patients' regret and predictive factors to improve their quality of life and comfort. No study has investigated decision regret and affecting factors in patients undergoing SG in Turkey. OBJECTIVES: The study aimed to determine the relationship of decision regret with quality of life and comfort level in patients undergoing SG. SETTING: The research was carried out with patients who had undergone SG in a private hospital in the west of Turkey. METHODS: The research was conducted as a descriptive, correlational, and cross-sectional study. Data were collected between March and May 2023, and the study was completed with 286 patients. Data were collected using the Personal Information Form, Decision Regret Scale (DRS), Quality of Life Following Obesity Surgery Scale (QoL-OS), and Comfort Scale. RESULTS: Patients' mean score on the DRS was 5.27 ± 13.41 (0-100), the total mean score on the QoL-OS-Biopsychosocial dimension was 79.57 ± 9.35 (18-90), the mean score on the QoL-OS-Complications dimension was 17.17 ± 4.60 (7-35), and the environmental comfort score average was 8.87 ± 2.23 (0-10). Patients' decision regret was significantly affected by the QoL-OS-Biopsychosocial Area dimension in the first place (Beta = -.516; P < .001), social comfort in the second place (Beta = -.278; P < .001), postoperative weight gain in the third place (Beta = .221; P < .001), and complication development in the fourth place (Beta = .163; P < .001). CONCLUSIONS: The study revealed that patients' decision regret levels were very low up to 3 years after surgery and found that low postoperative quality of life and social comfort level, postoperative weight gain, and complications affected decision regret.

The effect of mode of delivery on postpartum comfort level and breastfeeding self-efficacy: a systematic review and meta-analysis.

OBJECTIVE: This study was conducted to determine the effect of the mode of delivery on maternal postpartum comfort level and breastfeeding self-efficacy. METHODS: The study was conducted as a systematic review and a meta-analysis. Searching was performed from March to July 2022, on PubMed, National Thesis Center, Dergi Park, Google Scholar, Web of Science, and EBSCO search engines and we included studies from the last 10 years. The Joanna Briggs Institute Critical Appraisal tools used in cross-sectional studies were employed to appraise the methodological quality and performed meta-analyses using a random-effects model for all outcomes. Study data consisted of continuous variables calculated by Mean Difference. RESULTS: From 3732 records received, 21 cross-sectional studies involving 5266 participants were determined to be eligible. Meta-analysis results showed that cesarean section reduced postpartum comfort, albeit not statistically significant (MD: -0.87 95%: -1.98-0.24, Z = 1.53, p = 0.44), whereas the combined results of breastfeeding self-efficacy showed that delivery type did not affect breastfeeding self-efficacy. CONCLUSION: The results of this review have clinical implications for postpartum caregivers, as the effects of mode of delivery on postpartum comfort and breastfeeding self-efficacy have been well documented in previous studies. The authors recommend caregivers plan maternal care to increase their comfort, taking into account the factors that may affect postpartum comfort in the light of evidence-based practices.

Impact of fetal spine alignment according to maternal lateralization during early labor on maternal comfort and birth outcomes: A prospective cohort study in Kelantan, Malaysia.

INTRODUCTION: Maternal positioning during labor significantly influences maternal comfort. This study aims to identify the preferred maternal lateral position during the latent phase and examine the impact of alignment between maternal lateralization and fetal spine positioning during the active phase of the first stage of labor on maternal comfort. METHODS: Pregnant women in the first stage of labor beyond 37 weeks of gestation were recruited over six months from March to August 2020 for this prospective cohort study at Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan, Malaysia. Eligible individuals were randomly allocated to align with the fetal spine (n=180) or oppose it (n=180). Fetal spine positions were confirmed via transabdominal ultrasound. Maternal mean comfort scores were assessed using the established Maternal Comfort Assessment Tool. Statistical analysis was performed using IBM SPSS version 27, with a p<0.05 considered significant. RESULTS: There was a significant association between the preferred maternal position during the latent phase and concordance with the same maternal lateralization-fetal spine alignment (p<0.001). Higher mean comfort scores were observed when the maternal lateral position matched the fetal spine alignment during the active phase of labor. There was a significant association of normal CTG tracings when the maternal position was aligned with the fetal spine (p<0.001). CONCLUSIONS: Parturients preferred lying in alignment with the fetal spine lateralization during the latent phase. This position also offers increased comfort during the active phase of labor. It highlights the importance of considering maternal-fetal alignment as a critical factor in intrapartum care.

Oral Patch/Film for Drug Delivery-Current Status and Future Prospects.

In recent years, there has been extensive research into drug delivery systems aimed at enhancing drug utilization while minimizing drug toxicities. Among these systems, oral patches/films have garnered significant attention due to their convenience, noninvasive administration, ability to bypass hepatic first-pass metabolism, thereby enhancing drug bioavailability, and their potential to ensure good compliance, particularly among special patient populations. In this review, from the perspective of the anatomical characteristics of the oral cavity and the advantages and difficulties of oral drug delivery, we illustrate the design ideas, manufacturing techniques, research methodologies, and the essential attributes of an ideal oral patch/film. Furthermore, the applications of oral patches/films in both localized and systemic drug delivery were discussed. Finally, we offer insights into the future prospects of the oral patch/film, aiming to provide valuable reference for the advancement of oral localized drug delivery systems.

Patient- vs Technologist-Controlled Mammography Compression: A Prospective Comparative Study of Patient Discomfort and Breast Compression Thickness.

OBJECTIVE: We assess whether mammographic patient-assisted compression (PAC) has an impact on breast compression thickness and patient discomfort compared with technologist-assisted compression (TAC). METHODS: A total of 382 female patients between ages 40 and 90 years undergoing screening mammography from February 2020 to June 2021 were recruited via informational pamphlet to participate in this IRB-approved study. Patients without prior baseline mammograms were excluded. The participating patients were randomly assigned to the PAC or TAC study group. Pre- and postmammogram surveys assessed expected pain and experienced pain, respectively, using a 100-mm visual analogue scale and the State-Trait Anxiety Inventory. Breast compression thickness values from the most recent mammogram were compared with the patient's recent prior mammogram. RESULTS: Between the 2 groups, there was no significant difference between the expected level of pain prior to the mammogram (P = .97). While both study groups reported a lower level of experienced pain than was expected, the difference was greater for the PAC group (P <.0001). Additionally, the PAC group reported significantly lower experienced pain during mammography compared with the TAC group (P = .014). The correlation of trait/state anxiety scores with pre- and postmammogram pain scores was weak among the groups. Lastly, the mean breast compression thickness values for standard screening mammographic views showed no significant difference in the PAC group when compared with the patient's prior mammogram. CONCLUSION: Involving patients in compression reduces their pain independent of the patient's state anxiety during mammography while having no effect on breast compression thickness. Implementing PAC could improve the mammography experience.

Smart insole-based analysis of gait biomechanics for insoles in patients with flatfoot.

BACKGROUND: Assessing the effect of insoles on gait biomechanics and foot comfort remains challenging. Our novel in-insole-type wearable sensor device (smart insole) enables accurate quantitative evaluation of gait parameters without affecting the subject's foot comfort. RESEARCH QUESTION: What are the effects of insoles on gait biomechanics and foot comfort in patients with flatfoot, as evaluated using a novel smart insole? METHODS: Thirty-three subjects with 61 flatfeet were recruited. Three different types of prefabricated insoles were tested: a control insole as an experimental control, a flat insole with only cushion pads for the shock absorbing function, and an arch support insole with both cushioning pads and arch support functions. Gait parameters and visual analog scale (VAS) scores for foot comfort were measured during 30 m of straight walking with each insole incorporating the wearable sensor device. The differences in gait parameters and foot comfort between the flat and arch support insoles relative to the control insole were analyzed. Additionally, the correlations between gait parameters and foot comfort were evaluated. RESULTS: Maximum plantarflexion angle significantly decreased (p = 0.03) and the toe-out angle significantly increased (p < 0.01) with arch support insoles compared to flat insoles. Significantly better foot comfort was demonstrated when walking with arch support insoles than with flat insoles (p < 0.01). The only gait parameter correlated with foot comfort was foot lift height while walking with an arch support insole (r = -0.45, p < 0.01). SIGNIFICANCE: A novel smart insole revealed that foot lift height was a key gait parameter for determining foot comfort while walking with an arch support insole. Our findings provide important evidence for selecting a comfortable flatfoot insole based on gait data measured using a smart insole.

Clothing and Outdoor Thermal Comfort (OTC) in tourist environments: a case study from Porto (Portugal).

This study focuses on assessing tourists' perception of bioclimatic comfort in the urban context of Porto, Portugal, specifically in the areas of Avenida dos Aliados and Praça da Liberdade. The study examines the relationship between meteorological conditions, tourists' clothing choices, and their physical activity levels. The study integrates microclimatic measurements and questionnaire surveys carried out during the summers of 2019 and 2020, and the winter of 2019-2020. A comprehensive questionnaire following international standards was administered to a representative sample of 563 tourists. The results show significant variations in mean air temperature (AT), wind speed (Wχ), relative humidity (RH), global radiation (GRAD), and total mean radiant temperature (TMRT) over the study periods. The assessment of Outdoor Thermal Comfort (OTC) is based on ASHRAE 55 standards, using the Thermal Sensation Vote (TSV) scale and the tourists' opinions on their thermal preferences. Clothing choices are found to be influenced by AT, with tourists choosing lighter clothing in warmer conditions. Gender and age differences in clothing insulation (Icl) are identified, suggesting potential differences in OTC perception. AT varied significantly, with an inflection point in clothing choices at 21.7°C and a correlation between AT and reduction in clothing layers (r2 = 0.846; p < 0.05). The study also observes seasonal variations in physical activity levels of tourists, with higher activity levels in summer due to milder weather (110.0 W·m⁻2). More thermally comfortable environments tend to promote a sense of well-being among visitors, which directly affects their satisfaction during their stay in the city. When tourists feel comfortable with the thermal conditions of the urban environment, they are more likely to explore and enjoy local attractions for longer periods of time, thereby enhancing their cultural and leisure experiences. Women tend to wear fewer layers of clothing than men in summer, reflecting potential differences in OTC perception. Results align with previous studies, indicating the impact of clothing insulation of individual subject (Icl) on OTC varies across locations and cultures. Cultural factors influence clothing preferences and thermal tolerance, emphasizing the need for nuanced considerations in understanding OTC perceptions. The study provides to the understanding of the OTC of tourists in the city of Porto, but also offers relevant contributions for improving the visitor experience and sustainable development, namely in other geographical contexts. The major contribution of this research lies in the comparative analysis of Icl and OTC between tourists, based on physical measurements and questionnaire surveys conducted in summer and winter, providing valuable insights for tourist spot design.

Where is the heat threat in a city? Different perspectives on people-oriented and remote sensing methods: The case of Prague.

Extreme heat in urban areas has a severe impact on urban populations worldwide. In light of the threats posed by climate change, it is clear that more holistic and people-oriented approaches to reducing heat stress in urban areas are needed. From this perspective we aim to identify and compare thermal hotspots and places with favourable thermal conditions, based on three different methods - thermal walk, participatory-based cognitive mapping, and remote sensing in a Central European city. Although major hotspots in large low-rise development zones were identified by all three methods, the overall agreement between on-site thermal sensation votes, cognitive maps and surface temperatures is low. In the urban canyon of compact mid-rise and open mid-rise development, the thermal walk method proved to be useful in the identification of the specific (parts of) streets and public spaces where citizens can expect thermal discomfort and experience heat stress, e.g. crossroads, arterial streets with a lack of greenery, north facing unshaded parts of streets, and streets with inappropriate tree spacing. Cognitive maps on an urban neighbourhood scale are not specific enough on a street level; however, as a supplementary method they can help identify discrepancies between on-site sensations and thermal conditions. For further research on effective and cost-efficient urban heat mitigation, we suggest combining thermal walks with numerical model simulations.

Determining the Spiritual Care and Comfort Needs of Patients Having Undergone Open-Heart Surgery: Cross-Sectional Descriptive Study in Turkey.

This study was aimed at determining the spiritual care and comfort needs of patients having undergone open-heart surgery. This cross-sectional descriptive study was conducted with 147 patients in the Cardiovascular Surgery Intensive Care Unit of a training and research hospital in Izmir, a province in western Turkey, between May 1, 2022 and November 1, 2022. The comfort level of the patients who had undergone open-heart surgery was moderate, and the levels of their spiritual care needs were high. A statistically significant relationship was found between the patients' Perianesthesia Comfort Scale total score and the Spiritual Care Needs Inventory (p < 0.05). We concluded that the patients' comfort levels decreased as their spiritual care needs increased. We recommend authors to conduct studies in the future which should include different sample groups and compare the data obtained before and after the surgery.

Comfort feeding in hospitalised people with dementia: a retrospective study of survival following comfort feeding recommendations.

OBJECTIVES: Persistent and significant swallowing impairment can occur in individuals with dementia. Determining prognosis and establishing realistic goals of care in this population is complex and comfort feeding may be recommended. This study aimed to establish evidence relating to patient outcomes following recommendation of comfort feeding to aid informed decision making. DESIGN: A multi-centre, retrospective audit was conducted for a two-year period to establish the survival and readmission rates for hospitalised people with dementia, following recommendation of a comfort feeding plan. SETTING: The study was conducted at three acute care hospitals in Adelaide, South Australia. PARTICIPANTS: A total of 163 participants were included, 90 male and 73 female, with a median age of 88 years. MEASUREMENTS: Mortality within 30 and 90 days of admission and readmission rates within 30 days of discharge were calculated. RESULTS: Forty-two percent of participants died during the admission during which a comfort feeding plan was recommended. Overall median survival time and one month survival was 13 days and 25%, respectively. Readmission rates were low (7.4% of those discharged). Comfort feeding recommendations aligned with dysphagia severity and those for whom Nil By Mouth (NBM) or ice chips only were recommended were at highest risk of dying in hospital, those recommended thickened fluids +/- ice chips were most likely to be alive 30 days after their original admission date. CONCLUSION: Dementia and comfort feeding were associated with high mortality rates, high rates of discharge to a supportive care facility and low readmission rates. Dysphagia severity associated with the consistency of fluids recommended.

Evaluating thermal comfort indices for outdoor spaces on a university campus.

This study evaluates the applicability of three thermal comfort indices-Physiologically Equivalent Temperature (PET), Standard Effective Temperature (SET), and Universal Thermal Climate Index (UTCI)-in various outdoor environments on the campus of Xi'an University, China. Meteorological data were collected on sunny days using a portable weather station at a height of 1.5 m, and subjective questionnaires were administered to 25 healthy university students over three months to gather Thermal Sensation Votes (TSV) and Thermal Comfort Votes (TCV). The study was conducted at four distinct outdoor locations: a lakeside area (Location 1), a shaded path (Location 2), a sports field (Location 3), and a plaza (Location 4). PET, SET, and UTCI values were calculated from the collected data using Rayman software. The analysis revealed significant differences in thermal comfort across the four locations, with the highest proportion of subjects feeling hot at the sports field (54.4%) and the highest proportion feeling cold at the lakeside (39%). The shaded path had the highest proportion of subjects feeling comfortable (79.4%), while the lakeside had the lowest (60.1%). The results indicated that SET underestimated thermal sensation at Locations 1, 3, and 4, necessitating calibration. PET was suitable for Locations 2, 3, and 4 but failed to reflect the thermal sensation at Location 1 due to prolonged sun exposure. In contrast, UTCI demonstrated applicability across all locations. To enhance accuracy, revised indices SET' and PET' were formulated using the mean-median method, providing more precise thermal comfort assessments. These findings underscore the limitations of SET and PET under specific conditions and highlight the robustness of UTCI, offering valuable insights for urban planning and design aimed at improving outdoor thermal comfort and well-being.

Investigating the validity of the hue-heat effect on thermal sensitivity.

In this study, we aimed to investigate the validity of the hue-heat effect on the body thermal sensitivity. Previous research on thermal comfort has proposed associations between red and warmth, and blue with cold. However, inconsistencies in confirming this effect have arisen, with studies often relying on subjective scales for thermal comfort assessment, introducing potential confounding variables. To overcome these limitations, we conducted a study focusing on the hue-heat effect within the domain of thermal sensitivity, providing a more objective measurement of thermal perception. Participants (n = 26) were required to compare the perceived temperatures inside different climate chambers lighted by either red or blue lights following two different paradigms. In the congruent paradigm, the warmest chamber was lighted by red lights, while the coldest chamber had blue lights. On the contrary, the incongruent condition featured the warmest chamber with blue lights and the coldest chamber with red lights, thereby violating the hue-heat effect. We found comparable performance in both conditions, challenging the hypothesis that congruence between colour and temperature enhances thermal perception. Notably, some participants aligned with our hypothesis, while others exhibited opposing behaviour, highlighting the potentially subjective nature of the hue-heat effect. Furthermore, we compared the present results with our previous data without the added stimuli of the lights. Surprisingly, the sensitivity observed in this experiment was even lower than the one measured in our previous study (p-value < 0.0001), suggesting that the colour of the lights might have increased participants' cognitive load, leading to a decline in their performance.

Exploring birth experience of mothers, based on comfort theory.

Objectives: To analyse the phenomenon of "giving birth" on the basis of the lived experiences of women and midwives. METHODS: The qualitative study was conducted in the delivery room of a mother-friendly hospital in western Turkey from March 1 to December 30, 2019, and comprised primiparous women aged 18-35 years having a spontaneous vaginal birth, and midwives who delivered the babies. Data was collected through indepth interviews that were audiorecorded. Additionally, women's written birth stories and researcher's observation regarding the participants were used. Data was subjected to content analysis using NVIVO 12 Pro software. RESULTS: Of the 28 subjects 15(53.6%) were lay women with mean age 24.2±3.87 years (range: 18-30 years), and 13(46.4%) were midwives with mean age 42.61±4.50 years (range: 37-50 years). The most referred conceptual themes in Kolcaba's Theory of Comfort were "enhanced comfort", "mother-friendly hospital policy", and "midwives' comforting interventions." Under the theme of "Increasing Comfort", women cared about psychological and environmental comfort. Women had the most psychospiritual comfort and environmental comfort as well as physical and sociocultural comfort. Women cared about psychological and environmental comfort that facilitated birth. CONCLUSIONS: The mother-friendly hospital policy increased and contributed to the support and comfort provided to women. Kolcaba's Comfort Theory was an appropriate and working theory for birth and midwifery care, indicating that women's comfort should be ensured in the psychospiritual, environmental, physical and sociocultural contexts.

Geometry of milk liners affects milking performance in dairy cows.

The geometry of milk liners may affect milking performance and cow comfort as the milk liner is the only part of the milking machine that comes into contact with the teat. To determine the effect of alternative shape of milk liners we compared square (SQR) vs. the conventional round (RND) teat cup liner on milking performance and comfort of dairy cows. Treatment milk liners were randomly allocated to clusters within each side of the 12 a side double up-herringbone dairy shed in a complete randomised block design over two periods. Milking performance data from a total of 10 065 (late stage of lactation and once-a-day milking frequency, LATE) and 18 048 (early stage of lactation and twice-a-day milking frequency, EARLY) milking events were automatically recorded by a DeLaval milk meter, and separately analysed for LATE and EARLY, respectively. In EARLY, cow comfort behaviour was also recorded during afternoon milking sessions. Across the two study periods, average milk flow rate, milk flow rate during 0-15, 15-30 and 30-60 s after cluster attachment, and milk flow rate at cluster take-off were higher in SQR compared to RND treatment. Proportion of time in a milking session with low milk flow rate and duration of milking session were less in SQR compared to RND treatment. However, effect of geometry of milk liner on peak milk flow rate was inconsistent across the two-study periods. Peak milk flow rate was higher (P < 0.001) in SQR than RND in LATE, but higher (P < 0.001) in RND than SQR in EARLY. Stomping and kicking behaviours of cows were similar between treatments. Results of this study suggest that square milk liners potentially improve milking performance, without adverse effect on cow comfort compared to conventional round liners. Long-term, multi-site studies are required to confirm potential teat-end health benefits associated with square milk liners and further verify these results.