bluuebunny/crossref_metadata_2025 huggingface dataset:
An ATP signalling pathway in plant cells: extracellular ATP triggers programmed cell death in Populus euphratica
Authors: SUN JIAN , ZHANG CHUN‐LAN , DENG SHU‐RONG , LU CUN‐FU , SHEN XIN , ZHOU XIAO‐YANG , ZHENG XIAO‐JIANG , HU ZAN‐MIN , CHEN SHAO‐LIANG
Published: November 2011

We elucidated the extracellular ATP (eATP) signalling cascade active in programmed cell death (PCD) using cell cultures of Populus euphratica. Millimolar amounts of eATP induced a dose‐ and time‐dependent reduction in viability, and the agonist‐treated cells displayed hallmark features of PCD. eATP caused an elevation of cytosolic Ca2+ levels, resulting in Ca2+ uptake by the mitochondria and subsequent H2O2 accumulation. P. euphratica exhibited an increased mitochondrial transmembrane potential, and cytochrome c was released without opening of the permeability transition pore over the period of ATP stimulation. Moreover, the eATP‐induced increase of intracellular ATP, essential for the activation of caspase‐like proteases and subsequent PCD, was found to be related to increased mitochondrial transmembrane potential. NO is implicated as a downstream component of the cytosolic Ca2+ concentration but plays a negligible role in eATP‐stimulated cell death. We speculate that ATP binds purinoceptors in the plasma membrane, leading to the induction of downstream intermediate signals, as the proposed sequence of events in PCD signalling was terminated by the animal P2 receptor antagonist suramin.
Removal of prion infectivity by affinity ligand chromatography during OctaplasLG® manufacturing – results from animal bioassay studies
Authors: Heger A. , Bailey A. , Neisser‐Svae A. , Ertl M. , Römisch J. , Svae T.‐E.
Published: November 2011

Background  OctaplasLG® is a 2nd‐generation virus inactivated pooled plasma for infusion. Prions are removed by the principle of chromatography, utilizing an affinity ligand gel (LG) developed for binding of prion proteins and their infectivity. The goal of this study was to verify, using the gold standard animal bioassay system, whether or not prion infectivity can be removed by the LG affinity step under conditions used in the routine manufacturing process.

Materials and methods  Aliquots of pooled plasma were spiked with a microsomal/cytosolic (MIC) fraction of brain‐derived hamster‐adapted scrapie 263K and subjected to the OctaplasLG® manufacturing process. Validated Western blot tests and animal bioassays studies were performed to determine the logarithmic reduction factors (RF) and the prion infectivity binding capacity.

Results  Bioassay studies demonstrated different logarithmic RFs (i.e. 1·73 and 0·76 log10) at two different plasma‐to‐resin ratios, the latter one representing the actual manufacturing ratio of 100:1, which can be explained by the differences in the study design. However, both bioassay studies showed a reproducible and high prion infectivity binding capacity of ≥5·64 log10 ID50/ml gel.

Conclusion  Bioassay studies confirmed the capacity of the LG to bind brain‐derived MIC prion proteins spiked into plasma. Even through infectivity was still detected following passage over the LG, this can be attributed to the high loads used in the study design, and the binding capacity of the LG still ensures a significant safety margin – binding the prion agents at the levels of prion infectivity that might be present in plasma and beyond.
Mating Behavior and Dual‐Purpose Armaments in a Camel Cricket
Authors: Haley Estenia L. , Gray David A.
Published: November 2011

Sexual selection has often been dichotomized into intersexual and intrasexual components of selection, favoring ornaments and weapons, respectively. Here, we show that a weapon used in male–male combat is sometimes also used in a functionally similar manner for grasping females during mating. The hind legs of adult males of some species of Pristoceuthophilus camel crickets have strongly bent tibia and stout femora with two large conspicuous spines. Here, we show that (1) leg armature is positively allometric, (2) males use these leg modifications when fighting other males, (3) males sometimes use the same leg modifications in the same functional manner for grabbing and holding females for mating, (4) virgin females show more interest in males than do non‐virgin females, and (5) males are more likely to use their leg modifications to grab and hold females when paired with non‐virgin females than when paired with virgin females. We interpret these results as suggesting that males employ an alternative coercive mating strategy when paired with unreceptive females; alternative explanations are also discussed.
Causes of primary amenorrhea: A report of 295 cases in Thailand
Authors: Tanmahasamut Prasong , Rattanachaiyanont Manee , Dangrat Chongdee , Indhavivadhana Suchada , Angsuwattana Surasak , Techatraisak Kitirat
Published: November 2011

Aims:  The aim of this study was to determine the prevalence of etiologic causes of primary amenorrhea in Thailand.

Methods:  A retrospective study was performed using 295 complete medical records of women with primary amenorrhea who attended the Gynecologic Endocrinology Clinic, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand from September 1992 to February 2009.

Results:  The three most common causes of primary amenorrhea were Müllerian agenesis (39.7%), gonadal dysgenesis (35.3%), and hypogonadotropic hypogonadism (9.2%). Amongst 88 cases of gonadal dysgenesis, 59 cases (67.0%) incurred abnormal karyotype including 45X (n = 21), mosaic (n = 31), and others (n = 7).

Conclusions:  The present study has currently been the largest case series of primary amenorrhea. Müllerian agenesis is the most prevalent cause in our study, while gonadal dysgenesis is the most common cause in the largest‐scale study in the USA. Hence, racial, genetic and environmental factors could play roles in the cause of primary amenorrhea.
Clinical evaluation of severe anemia in pregnancy with special reference to macrocytic anemia
Authors: Tripathi Reva , Tyagi Shakun , Singh Tejinder , Dixit Amrapali , Manju  , Mala Y. M.
Published: November 2011

Aims:  Anemia in pregnancy has been almost synonymous with iron‐deficiency anemia but there appears to be a changing trend with emerging evidence of macrocytic anemia. The aim of this study was to evaluate the clinical profile of patients having severe anemia in pregnancy.

Methods:  This study included all antenatal patients presenting with severe anemia (hemoglobin < 7 gm%) over a period of 2 years from January 2008 to December 2009 in the Department of Obstetrics and Gynaecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi.

Results:  Although iron‐deficiency anemia remains the most important cause of anemia (48.1%) there is also a high prevalence of macrocytic anemia (40%) amongst these cases of severe anemia in pregnancy. The maternal and fetal morbidity and mortality is higher in macrocytic anemia as compared to iron‐deficiency anemia.

Conclusion:  There is an emerging trend of macrocytic anemia among antenatal patients with severe anemia. Both maternal and fetal morbidity appears to be higher in these cases. This has important implications in terms of diagnosis and therapy to optimize both maternal and perinatal outcomes. Once clinicians and health administrators recognize the magnitude of this problem it may be considered relevant to start public health interventions by way of requirement of appropriate food fortification.
Gestational diabetes and pre‐pregnancy overweight: Possible factors involved in newborn macrosomia
Authors: Olmos Pablo Roberto , Borzone Gisella Rosa , Olmos Roberto Ignacio , Valencia Claudio Nicolás , Bravo Felipe Andrés , Hodgson María Isabel , Belmar Cristián Gastón , Poblete José Andrés , Escalona Manuel Orlando , Gómez Bernardita
Published: November 2011

Aim:  Good glycemic control in gestational diabetes mellitus (GDM) seems not to be enough to prevent macrosomia (large‐for‐gestational‐age newborns). In GDM pregnancies we studied the effects of glycemic control (as glycosylated hemoglobin [HbA1c]), pre‐pregnancy body mass index (PP‐BMI) and gestational weight gain per week (GWG‐W) on the frequency of macrosomia.

Methods:  We studied 251 GDM pregnancies, divided into two groups: PP‐BMI < 25.0 kg/m2 (the non‐overweight group; n = 125), and PP‐BMI ≥ 25.0 kg/m2 (the overweight group; n = 126). A newborn weight Z‐score > 1.28 was considered large‐for‐gestational‐age. Statistical analysis was carried out using the Student's t‐test and χ2‐test, receiver–operator characteristic curves and linear and binary logistic regressions.

Results:  Prevalence of macrosomia was 14.9% among GDM (n = 202/251, 88.4%) with good glycemic control (mean HbA1c < 6.0%), and 28.1% in those with mean HbA1c ≥ 6.0% (n = 49/251, P < 0.025). Macrosomia rates were 10.4% in the non‐overweight group and 24.6% in the overweight group (P = 0.00308), notwithstanding both having similar mean HbA1c (5.48 ± 0.065 and 5.65 ± 0.079%, P = 0.269), and similar GWG‐W (0.292 ± 0.017 and 0.240 ± 0.021 kg/week, P = 0.077). Binary logistic regressions showed that PP‐BMI (P = 0.012) and mean HbA1c (P = 0.048), but not GWG‐W (P = 0.477), explained macrosomia.

Conclusions:  Good glycemic control in GDM patients was not enough to reduce macrosomia to acceptable limits (<10% of newborns). PP‐BMI and mean HbA1c (but not GWG‐W) were significant predictors of macrosomia. Thus, without ceasing in our efforts to improve glycemic control during GDM pregnancies, patients with overweight/obesity need to be treated prior to becoming pregnant.
Tubal ligation and survival of ovarian cancer patients
Authors: Zhang Min , Holman C. D'Arcy J.
Published: November 2011

Aim:  The aim of the present study was to investigate associations between ovarian cancer survival and reproductive, gynecological and hormone factors.

Material and Methods:  A prospective follow‐up study was conducted in the Southeast of China. The cohort comprised 202 patients with histopathologically confirmed epithelial ovarian cancer who were enrolled during 1999–2000 and followed‐up for 5 years subsequently. One hundred and ninety five (96.5%) of the cohort or their close relatives were traced. Information was obtained on reproductive, gynecological and hormone factors prior to diagnosis, actual survival time and number of deaths. Cox proportional models were used to estimate mortality hazard ratios (HR) and associated 95% confidence intervals (CI) for tubal ligation, adjusting for age at diagnosis, body mass index (BMI), menopausal status, International Federation of Gynaecology and Obstetrics (FIGO) stage, histological grade of differentiation, cytology of ascites, and chemotherapy status.

Results:  The HR was significantly increased and survival was worse in ovarian cancer patients with a previous tubal ligation, but not with any other reproductive, gynecological and hormone factor. Only 21 (38.9%) of 54 patients who had tubal ligation survived to the time of interview, in contrast to 95 women (67.4%) still alive among the 141 women without tubal ligation (P < 0.001). Compared to the patients who had no tubal ligation, the adjusted HR was 1.62 (95% CI 1.01–2.59; P = 0.04) for those who had tubal ligation. There was no association with age at menarche, menopausal status, parity, breastfeeding, hormone replacement therapy, oral contraceptive use, and hysterectomy.

Conclusion:  Previous tubal ligation was an independently adverse prognostic factor for epithelial ovarian cancer survival. Further studies that examine the relationship are warranted to confirm these results.
Uterus‐like mass of ovarian ligament: Image diagnosis and management by laparoendoscopic single‐site surgery
Authors: Takeda Akihiro , Imoto Sanae , Mori Masahiko , Yamada Junko , Nakamura Hiromi
Published: November 2011

Uterus‐like mass composed of a cavity lined by mucosa resembling endometrium and surrounding smooth muscle layer simulating myometrium is an extremely rare disease entity of which the histogenesis is presently unknown. A 39‐year‐old, gravida 2, para 2, woman presented with sudden onset of lower abdominal pain and was found to have left adnexal mass with unusual image diagnostic appearance. The adnexal mass arising from the left ovarian ligament was excised by laparoendoscopic single‐site surgery. Histopathological diagnosis was uterus‐like mass of ovarian ligament.
Effects of aliskiren on QT duration and dispersion in hypertensive patients with type 2 diabetes mellitus
Authors: Fogari R. , Zoppi A. , Maffioli P. , Monti C. , Lazzari P. , Mugellini A. , Derosa G.
Published: November 2011

Aim: To evaluate the effect of aliskiren compared to amlodipine on QT duration and dispersion in hypertensive patients with type 2 diabetes.

Methods: A total of 170 outpatients aged 50–75 years with mild to moderate hypertension (SBP >130 and <180 mmHg and DBP >80 and <100 mmHg) and type 2 diabetes were randomly treated with aliskiren 300 mg or amlodipine 10 mg, both given once daily for 24 weeks, according to a prospective, open label, blinded‐end point, parallel group design. At the end of the placebo run‐in, and after 12, and 24 weeks of treatment blood pressure (BP) measurements (by mercury sphygmomanometer, Korotkoff I and V), plasma biochemistry and a standard 12‐lead surface ECG were evaluated.

Results: Both aliskiren and amlodipine significantly reduced systolic blood pressure (SBP)/diastolic blood pressure (DBP) values (−27.2/−14.3 mmHg, p < 0.001 vs. placebo and −27.8/−14.2 mmHg, p < 0.001 vs. placebo, respectively), with no statistical difference between the two drugs. Aliskiren, but not amlodipine, significantly reduced maximum QT interval (QTmax) (−14 ms at 12 weeks and −17 ms at 24 weeks, both p < 0.05 vs. placebo) and corrected QT max (QTc max) (−26 ms and −31 ms, p < 0.01) as well as the dispersion of both QT (−11 ms and −13 ms, p < 0.01) and QTc (−18 ms and −19 ms, p < 0.01).

Conclusions: Despite similar BP lowering effect, aliskiren, but not amlodipine, reduced QT duration and dispersion, which might be related to the ability of aliskiren to interfere with mechanisms underlying myocardial electrical instability in the heart of diabetic hypertensive patients.
A synthesis of existing systematic reviews and meta‐analyses of school‐based behavioural interventions for controlling and preventing obesity
Authors: Khambalia A. Z. , Dickinson S. , Hardy L. L. , Gill T. , Baur L. A.
Published: November 2011

Schools are an attractive and popular setting for implementing interventions for children. There is a growing body of empirical research exploring the efficacy of school‐based obesity prevention programs. While there have been several reviews on the topic, findings remain mixed. To examine the quality of evidence and compare the findings from existing systematic reviews and meta‐analyses of school‐based programs in the prevention and control of childhood obesity. This paper systematically appraises the methodology and conclusions of literature reviews examining the effectiveness of school‐based obesity interventions published in English in peer‐reviewed journals between January 1990 and October 2010. Eight reviews were examined, three meta‐analyses and five systematic reviews. All of the reviews recognized that studies were heterogeneous in design, participants, intervention and outcomes. Intervention components in the school setting associated with a significant reduction of weight in children included long‐term interventions with combined diet and physical activity and a family component. Several reviews also found gender differences in response to interventions. Of the eight reviews, five were deemed of high quality and yet limited evidence was found on which to base recommendations. As no single intervention will fit all schools and populations, further high‐quality research needs to focus on identifying specific program characteristics predictive of success.
SCORAD 75: a new metric for assessing treatment outcomes in atopic dermatitis
Authors: Harari M. , Dreiher J. , Czarnowicki T. , Ruzicka T. , Ingber A.
Published: November 2011

Objective  The scoring atopic dermatitis (SCORAD) is a well‐established severity‐scoring tool for atopic dermatitis (AD). Dead Sea climatotherapy (DSC) is a natural selective balneo‐phototherapy utilized for many years to treat severe AD. The study’s goal was to evaluate the impact of DSC on AD patients through assessment of SCORAD scores and to identify parameters associated with greater improvement.

Methods  The files of 78 European patients (37 male patients and 41 female patients, mean age 37.8 years) with AD undergoing DSC were included in this retrospective study. Three sub‐groups were delineated based on disease severity (as determined using the SCORAD). Demographic and clinical parameters as well as treatment characteristics – maximal and cumulative sun exposure doses – were recorded. SCORAD values were again recorded for assessment of treatment response. SCORAD 75 was defined as ≥75% decrease in SCORAD values following therapy. Statistical analysis including logistic regression models was used in multivariable analysis.

Results  After an average of 30 days of treatment, mean SCORAD values dropped from 50.5 to 11 (76.7%, P < 0.001). 64.1% of all patients, regardless of sub‐group, reached SCORAD 75, whereas 78.9% of patients with severe disease achieved this result. In a multivariate logistic regression, factors associated with achieving SCORAD 75 were maximal sun exposure, family history of AD and age at disease onset (P = 0.002, P = 0.009 and P = 0.040 respectively).

Conclusion  Dead Sea climatotherapy is a particularly effective treatment method for the sub‐population of adults with severe AD. The SCORAD 75 can be useful for defining sub‐populations in which treatment is more likely to be successful.
Human placenta and chorion: potential additional sources of hematopoietic stem cells for transplantation
Authors: Bárcena Alicia , Muench Marcus O. , Kapidzic Mirhan , Gormley Matthew , Goldfien Gabriel A. , Fisher Susan J.
Published: November 2011

BACKGROUND: Hematopoietic stem cell (HSC) transplantation is an essential element of medical therapy, leading to cures of previously incurable hematological and nonhematological diseases. Many patients do not find matched donors in a timely manner, which has driven efforts to find alternative pools of transplantable HSCs. The use of umbilical cord blood (UCB) as a source of transplantable HSCs began more than two decades ago. However, the use of UCB as a reliable source of HSCs for transplantation still faces crucial challenges: the number of HSCs present in a unit of UCB is usually sufficient for younger children but not for adults, and the persistent delayed engraftment often seen can result in high rates of infection and mortality.

STUDY DESIGN AND METHODS: We propose a new approach to a solution of these problems: a potential increase of the limited number of UCB‐HSCs available by harvesting HSCs contained in the placenta and the fetal chorionic membrane available at birth.

RESULTS: We investigated the presence of hematopoietic progenitors and HSCs in human placenta and chorion at different gestational ages. The characterization of these cells was performed by flow cytometry and immunolocalization, and their functional status was investigated by transplanting them into immunodeficient mice.

CONCLUSION: HSCs are present in extraembryonic tissues and could be banked in conjunction to the UCB‐HSCs. This novel approach could have a large impact on the field of HSC banking and, more crucially, on the outcome of patients undergoing this treatment by greatly improving the use of life‐saving hematopoietic transplants.
A journey to produce platelets in vitro
Authors: Reems Jo‐Anna
Published: November 2011

Allogeneic platelet transfusions protect patients from bleeding episodes and also make aggressive medical procedures such as those involving marrow transplants requiring chemotherapy and/or radiotherapy possible. These patients are dependent upon an unfailing supply of platelets that can sometimes be in short supply due to high demands coupled with an extremely short expiration date for platelet products of only 5 days. One approach that is under investigation to overcome platelet shortages is to harness the extraordinary capabilities of stem cells to proliferate and differentiate into various cell types and to use this ability to specifically produce clinical scale quantities of functional platelets in bioreactors. To accomplish such an enormous and complex task requires an appreciation of the regulatory mechanisms that occur during the development of megakaryocytes (MKs) and the subsequent biogenesis of functional platelets from mature MKs. This means understanding the complex network of intracellular and extracellular regulatory mechanisms that act at each phase of a developmental process that ushers stem cells along the MK lineage to produce billions of platelets per day in a healthy individual.
New Treatment Approach for Osteopenia
Authors: Tufts Gillian
Published: November 2011

Nearly 44 million persons in the United States have osteoporosis or osteopenia, most of whom are osteopenic. Because of sheer numbers, an increased number of fractures occur in the osteopenic group. Bone mineral density alone, based on dual energy X‐ray absorptiometry scan results, is not enough to identify persons at increased risk for fracture. The World Health Organization (WHO) Working Group On Osteoporosis has developed an online tool, known as FRAX, to calculate future hip fracture probability based on individual clinical risk factors. Determining the risk of hip fracture is critical because it is the most devastating osteoporosis complication. The FRAX model was developed from population‐based cohort studies in Europe, North America, Asia, and Australia. In 2008, the National Osteoporosis Foundation (NOF) adopted the WHO approach in the treatment of osteopenia. This article presents a clinical scenario to demonstrate the application of the WHO FRAX tool and the new NOF guidelines.
Applying the Global Positioning System and Google Earth to Evaluate the Accessibility of Birth Services for Pregnant Women in Northern Malawi
Authors: Chen Solomon Chih‐Cheng , Wang Jung‐Der , Yu Joseph Kwong‐Leung , RN Tzu‐Yi Chiang , Chan Chang‐Chuan , RN Hsiu‐Hung Wang , Nyasulu Yohane M. Z. , Kolola‐Dzimadzi Rose
Published: November 2011

Introduction: The objective of this study was to validate the combined use of the Global Positioning System (GPS) and Google Earth for measuring the accessibility of health care facilities for pregnant women in northern Malawi.

Methods: We used GPS and Google Earth to identify 5 major health care facilities in Mzuzu (Malawi) and the homes of 79 traditional birth attendants (TBAs). The distance and time required for each TBA to reach the nearest health care facility were measured by both GPS and by self‐report of the TBAs. A convenience sample of 1138 pregnant women was interviewed about their choices of birth sites for current and previous pregnancies and the time and cost required to access health care facilities.

Results: The correlation coefficient between the objective measurements by GPS and subjective reports by TBAs for time required from their homes to health care facilities was 0.654 (P < .001). Among pregnant women, 45.6% reported that they could reach a health care facility within 2 hours; 23.8% reported paying more than $1 for transportation to health care facilities. For the current study, 82.6% of women intended to give birth at a health care facility. However, only 48.7% of women actually gave birth in a health care facility in a previous pregnancy, and 32.6% were assisted by TBAs.

Discussion: Combined GPS and Google Earth can be useful in the evaluation of accessibility of health care facilities, especially for emergency obstetric care.
Acceptability and Feasibility of a Multiple‐Behavior, Computer‐Tailored Intervention for Underserved Pregnant Women
Authors: Mauriello Leanne , Dyment Sharon , Prochaska Janice , Gagliardi Amy , Weingrad‐Smith Jan
Published: November 2011

Introduction: A pilot test of a computer‐tailored intervention designed to promote positive health behaviors during pregnancy among a low‐income population across multiple ethnic groups was conducted.

Methods: Intervention content, based on the transtheoretical model, offered pregnant women assistance with smoking cessation, stress management, and increasing fruit and vegetable consumption. Pregnant women (N = 87) were recruited from federally qualified health centers. After completing the intervention, women answered a 16‐item evaluation.

Results: Participants rated the program very positively, with 89.7% to 95.5% of participants agreeing or strongly agreeing with all evaluation items. For example, 95.4% of respondents reported that the program could help them be healthier, that they learned new information, and that the program was designed for pregnant women like themselves. Additionally, the majority of participants (92%) reported that they would recommend the program to a friend. There were no significant differences in the ratings based on demographic characteristics of the participants. Qualitative responses support acceptability for the program. Further, assessments before and after completion of the program indicated an increase in intention to make behavioral changes.

Discussion: With acceptability and feasibility confirmed, the next steps are to test efficacy and consequently to distribute the program to populations of underserved pregnant women.
Recurrence Risk of Hyperemesis Gravidarum
Authors: Fejzo Marlena S. , MacGibbon Kimber W. , Romero Roberto , Goodwin T. Murphy , Mullin Patrick M.
Published: November 2011

Introduction: The purpose of this study is to describe the recurrence risk for hyperemesis gravidarum (HG).

Methods: Women who registered on a Web site sponsored by the Hyperemesis Education and Research Foundation as having had one HG‐complicated pregnancy were contacted to follow‐up on a subsequent pregnancy. Participants completed an online survey.

Results: One hundred women responded. Fifty‐seven had become pregnant again, 2 were trying to conceive, 37 were not willing to get pregnant again because of HG, and 4 did not have a second pregnancy for other reasons. Among the 57 women who responded that they had become pregnant again, 81% reported having severe nausea and vomiting in their second pregnancy. Among the women reporting recurrent HG, 98% reported losing weight and taking prescribed medication for HG, 83% reported treatment with intravenous fluids, 20% reported treatment with total parenteral nutrition or nasogastric tube feeding, and 48% reported hospitalization for HG.

Discussion: This study demonstrates both a high recurrence rate of HG and a large percentage of women who change reproductive plans because of their experiences with HG.
Midwives’ Knowledge, Attitudes, and Practices Related to Newborn Hearing Screening
Authors: Goedert Martha Hoffman , Moeller Mary Pat , White Karl R.
Published: November 2011

Introduction: Hearing loss is the most common congenital condition screened for at birth in the United States, and more than 95% of newborns are currently screened for hearing. Newborn hearing screening is most effective when infants receive timely and effective interventions. Unfortunately, follow‐up rates for newborns not passing their initial hearing screenings are as low as 50% in some states. Midwives are well‐positioned to encourage families to follow‐up with their neonatal providers when newborns are referred for further testing. Newborn hearing screening is a relatively new practice in the United States and, to date, there has been no research regarding the informational needs and practices of certified nurse‐midwives or certified midwives related to hearing screening. This study examined the knowledge, attitudes, and follow‐up practices of midwives related to newborn hearing screening and intervention.

Methods: A survey instrument was developed and sent to 5255 American College of Nurse‐Midwives members in 50 states and 2 territories.

Results: Five hundred and eighteen surveys were returned, yielding a response rate of 9.9%. Only 68% of respondents said it was very important to screen all newborns for hearing loss. Respondents reported significant gaps in their knowledge about screening procedures, steps for referral, and the availability of resources when newborns did not pass the test. Midwives also reported the need for information about hearing loss conditions and genetics, screening guidelines, protocols for follow‐up, referral networks, and therapies available.

Discussion: Current practices in newborn hearing screening and intervention programs can be enhanced by strengthening the basic midwifery knowledge of and rationale for follow‐up when newborns fail their hearing screenings. Midwives can play an integral role in optimizing hearing, speech, and family interaction by assuring that each newborn has access to the best hearing screening and referrals.
Lost in Translation: Reproductive Health Care Experiences of Somali Bantu Women in Hartford, Connecticut
Authors: Gurnah Khadija , Khoshnood Kaveh , Bradley Elizabeth , Yuan Christina
Published: November 2011

Introduction: Reproductive health problems are the leading cause of women's morbidity and mortality worldwide. In the United States, officially sponsored refugee women continue to face challenges in accessing reproductive health programs despite having access to health insurance.

Methods: The objective of this study was to explore the reproductive health experiences of 1 such population—Somali Bantu women in Connecticut—to identify potential barriers to care experienced by marginalized populations. The study was qualitative, consisting of key informant interviews, a focus group session, and a semistructured survey.

Results: Although all the women in the study reported having access to reproductive health care services, they also reported having unmet health needs resulting from barriers to care that included ethnic distinction/language barriers, passive acceptance of incorrect care, cultural discordance in family planning services, patient‐provider sex discordance, and desire but limited scope for ownership in health care outcomes. The root cause of the various types of patient‐provider discordance was the lack of recognition that the Somali Bantu are distinct in culture, language, and solidarity from ethnic Somalis, resulting in Language Line translation services being conducted in a Somali language that the Somali Bantu women did not understand.

Discussion: The results of the study primarily highlight the larger issue of information asymmetry within the health care system that, if left unaddressed, will persist as new vulnerable populations of refugees arrive in the United States.
Integration of Routine Rapid HIV Screening in an Urban Family Planning Clinic
Authors: Criniti Shannon M. , Aaron Erika , Hilley Amy , Wolf Sandra
Published: November 2011

Introduction: Family planning centers can play an important role in HIV screening, education, and risk‐reduction counseling for women who are sexually active. This article describes how 1 urban Title X–funded family planning clinic transitioned from using a designated HIV counselor for targeted testing to a model that uses clinic staff to provide integrated, routine, nontargeted, rapid HIV testing as standard of care.

Methods: Representative clinic staff members developed an integrated testing model that would work within the existing clinic flow. Education sessions were provided to all staff, signs promoting routine HIV testing were posted, and patient and clinician information materials were developed. A review of HIV testing documentation in medical charts was performed after the new model of routine, nontargeted, rapid HIV testing was integrated, to determine any changes in patient testing rates. A survey was given to all staff members 6 months after the transition to full integration of HIV testing to evaluate the systems change process.

Results: Two years after the transition, the rate of patients with an HIV test in the medical chart within the last 12 months increased 25.5%. The testing acceptance rate increased 17%. Sixteen HIV seropositive individuals were identified and linked into medical care. All surveyed clinic staff agreed that offering routine HIV screening to all patients is very important, and 78% rated the integration efforts as successful.

Discussion: Integrating routine HIV screening into a family planning clinic can be critical to identifying new HIV infections in women. This initiative demonstrated that routine, nontargeted, rapid HIV screening can be offered successfully as a standard of care in a high‐volume, urban, reproductive health care setting. This description and evaluation of the process of changing the model of HIV testing in a clinic setting is useful for clinicians who are interested in expanding routine HIV testing in their clinics.
Postpartum Depression and Correlated Factors in Women Who Received In Vitro Fertilization Treatment
Authors: Lee Shu‐Hsin , Liu Lin‐Chuan , Kuo Pi‐Chao , Lee Maw‐Sheng
Published: November 2011

Introduction: Postpartum depression is a significant mental health problem that occurs more frequently in the first 4 weeks postpartum and also may occur later during the first postpartum year. Women who receive in vitro fertilization (IVF) treatment have a particular perinatal experience that may create postpartum mental health concerns. The purpose of this cross‐sectional study was to evaluate factors associated with postpartum depression in women who received IVF treatment.

Methods: Sixty of 71 eligible postpartum women who were treated at an infertility treatment center and who conceived by IVF were included in this study, which used a self‐administered, structured questionnaire.

Results: The prevalence of postpartum depression was 25%, including mild (16.7%), moderate (6.7%), and severe (1.7%). Pearson correlation analysis showed that the frequency of receiving IVF treatment and perceived stress were positively correlated with postpartum depression, whereas family function and social support were negatively correlated with postpartum depression. Multiple regression analysis showed that the frequency of receiving IVF treatment, birth method, and social support were significant predictive factors for postpartum depression when covariates were controlled (R2 56.6%).

Discussion: A higher frequency of IVF treatment, cesarean birth, and inadequate social support increase the possibility of postpartum depression, and clinicians should provide appropriate anticipatory education or counseling.
Postpartum Care: Evaluation and Experience Among Care Providers and Care Receivers
Authors: Valbø Annelill , Iversen Hilde Hestad , Kristoffersen Marit
Published: November 2011

Introduction: There have been substantial alterations in the structure of postpartum care over the last several decades. Our aim was to investigate the perceived quality of, and satisfaction with, postpartum care among caregivers and care receivers in the maternity ward of a community hospital in Norway with about 2600 births per year.

Methods: We conducted a cohort study of women giving birth and the caregiving staff in the maternity ward during a 7‐month period. A questionnaire, with a Cronbach α coefficient above 0.8, was filled in anonymously, both by the staff in the ward and by the women. The questionnaire explored the respondents’ evaluations of the information offered by the staff; the teaching of skills in child care and establishment of breastfeeding; assistance with practical tasks like making beds, serving meals, and keeping order in the room; visiting rules; level of noise in the ward; whether the pediatric service was adequate; length of the stay; and to what extent caregivers were able to respond to the individual needs of the mothers. Finally, the questionnaire explored the degree of kindliness communicated by the staff. Five extra questions in the women's questionnaire explored their personal experiences in the ward.

Results: The care receivers’ evaluations of the maternity ward did not differ significantly from that of the caregivers in questions related to overall care and service. However, the mothers rated the importance of assistance with child care during the night significantly higher than did the staff. Responses to questions addressing noise in the ward demonstrated a higher tolerance among the mothers compared with the staff. In addition, mothers tended (but not a statistically significant result) to rate the quality of the teaching of child‐care skills lower, compared with the staff's ratings.

Discussion: By exploring both the caregivers’ and care receivers’ evaluations and expectations of the actual services in the maternity ward, areas for enhancement of the quality of the ward and its services can be detected and carried out. The present study revealed 2 areas needing further focus: assistance with child care during the night and teaching of child‐care skills during the stay. We believe that investigations that collect data from both caregivers and care receivers, by using adapted and validated questionnaires to gather information on quality and satisfaction with the maternity ward, are mandatory for improvement and continuous adaptation of health services.
Australian Midwives’ Knowledge of Antenatal and Postpartum Depression: A National Survey
Authors: Jones Cindy J. , Creedy Debra K. , Gamble Jenny A.
Published: November 2011

Introduction: Emotional care provided by midwives may improve health and well‐being; reduce stress, trauma, and depressive symptoms; and enhance maternal outcomes in childbearing women. The provision of intrapartum and postpartum emotional care can be challenging and requires a good knowledge base for the provider to screen and assist distressed women. This study assessed Australian midwives’ levels of knowledge and learning needs regarding antenatal depression and postpartum depression.

Methods: Eight hundred and fifteen members of the Australian College of Midwives completed a postal survey, which consisted of 20 items drawn from the literature and the National Baseline Survey—Health Professional Knowledge Questionnaire.

Results: On average, respondents correctly answered 62.9% of items related to antenatal depression and 70.7% of questions about postpartum depression. Many midwives were unable to identify the risk factors (70.6%) or prevalence of antenatal depression (49.6%). Nearly all (98.3%) respondents underestimated the percentage of antenatally depressed women that attempts suicide. Significant percentages of midwives did not correctly identify the incidence (44.4%), onset period (71%), and treatment options (32%) associated with postpartum depression. About half did not understand the use of antidepressant medications (48.6%) and incorrectly reported that the Edinburgh Postnatal Depression Scale was a suitable instrument to assess symptoms of psychotic depression (43.8%).

Discussion: There are key knowledge deficits relating to onset of, assessment of, and treatment for depressive symptoms during the antenatal and postpartum periods. There is a need for continuing professional education to improve midwives’ knowledge and competency in the assessment and care of women suffering depression.
Knowledge of Human Papillomavirus Among Publicly and Privately Insured Women
Authors: Kennedy Sara , Osgood Rebekah , Rosenbloom Laura , Feinglass Joseph , Simon Melissa
Published: November 2011

Introduction: The purpose of this study was to identify characteristics associated with high and low levels of human papillomavirus (HPV) knowledge among women presenting for HPV vaccination.

Methods: Surveys were administered to women presenting for HPV vaccination at 2 distinct clinics: a private obstetrics and gynecology office with predominantly privately insured patients and a resident clinic with primarily Medicaid‐insured patients. Nine outcome measures were collected in addition to open‐ended response questions regarding motivation for vaccination.

Results: Forty‐six women were recruited from the resident clinic, and 39 women were recruited from the private clinic. Knowledge scores differed significantly between the 2 recruitment sites: mean score of 19.7 at the resident clinic compared to a mean score of 24.9 at the private clinic (P < .0001, power = 80%). After controlling for age, zip code poverty prevalence, educational attainment, and parental educational attainment, clinical site was no longer independently associated with knowledge score. Rather, having attended at least 1 year of college was the only measured item independently associated with a higher HPV knowledge score. Reported condom use, having a regular sexual partner, history of an abnormal Papanicolaou (Pap) test, and having received a Pap test within the previous year were not independently associated with knowledge scores. Themes for motivation to vaccinate include protection from cervical cancer and prevention of HPV infection.

Discussion: Knowledge of HPV among women presenting for vaccination was significantly associated with educational attainment of some college. Common themes of low knowledge include the viral etiology of cervical cancer, the clinical presentation of HPV infection, and the lack of complete protection against cervical cancer with the HPV vaccine.
Trends in Midwife‐Attended Births, 1989 to 2007
Authors: Declercq Eugene
Published: November 2011

Introduction: Rates of births attended by certified nurse‐midwives (CNMs) rose throughout the 1990s and into the early part of this century, when rates leveled at about 7%.

Methods: The data in this report are based on records gathered as part of the US National Standard Certificate of Live Birth from the public use Web site, VitalStats, that allows users to create and download specialized tables.

Results: For the first time since such data were available in 1989, births attended by CNMs declined from the previous year in absolute terms, as a proportion of all births, and as a proportion of vaginal births. After an all‐time high of 317,168 in 2006, CNM‐attended births declined marginally to 316,811 in 2007. With total births reaching a US record of 4,316,233 births, the CNM proportion of total births declined for the fifth straight year to 7.3%, the same proportion as in 1999. Births attended by “other midwives” rose substantially to 23,943 although some of that increase may be the result of misclassification of CNM births in some states into the other midwife category.

Discussion: The proportion of CNM births has remained steady at between 7.3% and 7.6% since 1999. However, when the number of births attended by CNMs is combined with the number attended by other midwives, their number reached an all‐time high in 2007.
Examining the Content Validity of the Birthing Unit Design Spatial Evaluation Tool Within a Woman‐Centered Framework
Authors: Sheehy Annabel , Foureur Maralyn , Catling‐Paull Christine , Homer Caroline
Published: November 2011

Introduction: The environment for birth influences women in labor. Optimal birthing environments have the potential to facilitate normal labor and birth. The measurement of optimal birth units is currently not possible because there are no tools. An audit tool, the Birth Unit Design Spatial Evaluation Tool (BUDSET), was developed to assess the optimality of birthing environments. The BUDSET is based on 4 domains (fear cascade, facility, aesthetics, support), each comprising design principles that are further differentiated into specific assessable design items. In the process of developing measurement tools, content validity must be established. The aim of this study was to establish the content validity of the BUDSET from the perspective of women and midwives.

Methods: This was a mixed‐methods study with a survey assessing agreement with BUDSET items and in‐depth interviews. Survey results were analyzed using an item‐level content validity index and a survey‐level validity index. Interview data were analyzed using a directed content analysis approach. The study was conducted in 2 locations—a major maternity hospital and a midwifery research center, both in Australia. Study participants were 10 women and 2 midwifery academics.

Results: The survey revealed that content‐related validity varied according to the BUDSET domain, with the domains of facility and support established as content valid by most participants. The domains of the fear cascade and aesthetic were less strong, particularly among pregnant women. Interview data analysis provided content validity evidence of both the fear cascade and aesthetic domains. A further 4 subthemes of fear cascade also were identified: foreign space, medical‐hospital‐emergency, being sterile/clinical, and protecting the woman from the environment. Content validity evidence for facility and support domains also was established.

Discussion: This study has established that the BUDSET is content valid for assessing the optimality of birthing environments. Some further refinement of the tool is now possible.
Nanoscale Analysis of the Interaction Between Cyanoacrylate and Vacuum Metal Deposition in the Development of Latent Fingermarks on Low‐Density Polyethylene*
Authors: Jones Benjamin J. , Downham Rory , Sears Vaughn G.
Published: November 2011

Abstract:  Vacuum metal deposition (VMD) has been previously demonstrated as an effective development technique for latent fingermarks and in some cases has been shown to enhance prints developed with cyanoacrylate (CA) (superglue) fuming. This work utilizes scanning electron microscopy (SEM) to investigate the interactions of the two development techniques when applied to latent fingermarks on low‐density polyethylene. CA is shown to act principally on the eccrine deposits around sweat pores, where polymerization results in long polymer fibrils a few 100 nm in width. Subsequent VMD processing results in additional areas of development, for example, between pores. However, the primary mode of deposition of zinc is by interaction with the polymerized CA, the fibrils of which become decorated with zinc nanoparticles. Areas with limited CA deposition and no significant polymerization are also enhanced with the VMD process, resulting in increased print development.
Tracking Plant, Fungal, and Bacterial DNA in Honey Specimens*
Authors: Olivieri Cristina , Marota Isolina , Rollo Franco , Luciani Stefania
Published: November 2011

Abstract:  Consuming honey can result in adverse effects owing to poisoning by bacterial (botulism) or plant toxins. We have devised a method to extract polymerase chain reaction (PCR) amplifiable DNA of up to c. 400 bp in length based on dialysis of a 15‐mL honey sample for 18 h against deionized water followed by sequential extraction using phenol, phenol/chloroform/isoamyl alcohol, chloroform/isoamyl alcohol, and ether. Sequence analysis of PCR products obtained using “universal” plant, fungal, and bacterial primers targeted to the ribosomal RNA genes has allowed us to identify six different orders of plants (Apiales, Fabales, Asterales, Solanales, Brassicales, and Sapindales), two orders of fungi (Entylomatales and Saccharomycetales), and six orders of bacteria (Sphingomonadales, Burkholderiales, Pseudomonadales, Enterobacteriales, Actinomycetales, and Bifidobacteriales) in a single honey specimen.