bluuebunny/crossref_metadata_2025 huggingface dataset:
Importance of Including Early Nonadherence in Estimations of Medication Adherence
Authors: Raebel Marsha A , Carroll Nikki M , Ellis Jennifer L , Schroeder Emily B , Bayliss Elizabeth A
Published: August 2011

Background

Many medication adherence metrics are based on refill rates determined from pharmacy claims databases. However, these methods do not incorporate assessment of nonadherence to new prescriptions when those prescriptions are never dispensed (primary nonadherence), or dispensed only once (early nonpersistence). As a result, published studies may overestimate adherence, but the extent of overestimation posed by not considering patients with primary nonadherence and early nonpersistence has not been assessed.

Objective:

To estimate the magnitude of misestimation in adherence estimates that results from not including patients with primary nonadherence and early nonpersistence,

Methods:

We conducted a retrospective cohort study of 15,417 patients enrolled in an integrated health care delivery system who were newly prescribed an antihypertensive, antidiabetic, or antihyperlipidemic medication. We linked prescription orders to medication dispensings. Based on dispensing and refill rates, we stratified patients into primary nonadherent, early nonpersistent, and ongoing dispensings groups. Adherence was estimated using the proportion of days covered (PDC). Standardized observation periods were applied across all groups.

Results:

A total of 1142 (7.4%) patients were primarily nonadherent, 3356 (21.8%) demonstrated early nonpersistence, and 10,919 (70.8%) patients received ongoing dispensings, with a mean PDC of 84%. Not including primarily nonadherent and early nonpersistent patients in calculations resulted in adherence estimates overestimated by 9-18%.

Conclusions:

When medication adherence is estimated from pharmacy claims databases, adherence estimates are substantially inflated because primarily nonadherent and early nonpersistent patients are not included in the estimations. An implication of this incorrect estimation is potential distortion of the true relationship between medication adherence and clinical outcomes.
Baseline and Follow-up Laboratory Monitoring of Cardiovascular Medications
Authors: Tjia Jennifer , Fischer Shira H , Raebel Marsha A , Peterson Daniel , Zhao Yanfang , Gagne Shawn J , Gurwitz Jerry H , Field Terry S
Published: August 2011

Background

Laboratory monitoring of medications is typically used to establish safety prior to drug initiation and to detect drug-related injury following initiation. It is unclear whether black box warnings (BBWs) as well as evidence- and consensus-based clinical guidelines increase the likelihood of appropriate monitoring.

Objective:

To determine the proportion of patients newly initiated on selected cardiovascular medications with baseline assessment and follow-up laboratory monitoring and compare the prevalence of laboratory testing for drugs with and without BBWs and guidelines.

Methods:

This cross-sectional study Included patients aged 18 years or older from a large multispecialty group practice who were prescribed a cardiovascular medication (angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, amlodarone, digoxin, lipid-lowering agents, diuretics, and potassium supplements) between January 1 and July 31, 2008. The primary outcome measure was laboratory test ordering for baseline assessment and follow-up monitoring of newly initiated cardiovascular medications.

Results:

The number of new users of each study drug ranged from 49 to 1757 during the study period. Baseline laboratory test ordering across study drugs ranged from 37.4% to 94.8%, and follow-up laboratory test ordering ranged from 20.0% to 77.2%. Laboratory tests for drugs with baseline laboratory assessment recommendations in BBWs were more commonly ordered than for drugs without BBWs (66.4% vs 78.0%, p < 0.001), Drugs with follow-up monitoring recommendations in clinical guidelines had a lower prevalence of monitoring (33.1% va 50.7%. p< 0.001).

Conclusions:

Baseline assessment of cardiovascular medication monitoring is variable. Quality measurement of adherence to BBW recommendations may improve monitoring.
Domperidone-Induced Tardive Dyskinesia and Withdrawal Psychosis in an Elderly Woman with Dementia
Authors: Roy-Desruisseaux Jessika , Landry Julie , Bocti Christian , Tessier Daniel , Hottin Paule , Trudel Jean-François
Published: August 2011

Objective:

To report a case of probable domperidone-induced tardive dyskinesia and withdrawal psychosis in an elderly woman.

Case Summary:

A 75-year-old woman was first assessed for cognitive decline and personality changes. On clinical examination, diffuse choreoathetoid movements were noted. Chronic domperidone use seemed the most likely cause for the movement disorder and was abruptly discontinued. Within a few days, she developed a severe psychotic syndrome with Capgras delusions; the movement disorder continued unabated. Both the movement disorder and psychotic symptoms promptly remitted with risperidone treatment.

Discussion:

Domperidone has, on rare occasions, been associated with acute extrapyramidal syndromes, especially in young children, but, to our knowledge, this is the first case of domperidone-Induced tardive dyskinesia and withdrawal psychosis, adverse effects associated with chronic central nervous system dopaminergic blockade. Domperidone is a dopamine D2 receptor antagonist that does not usually cross the blood-brain barrier. However, blood-brain barrier alterations occur with aging and dementia, which may explain central nervous system penetration of domperidone in our patient, diagnosed with probable frontotemporal dementia. The association was rated as probable on the Naranjo probability scale.

Conclusions:

Chronic use of domperidone may, on rare occasions, induce neuropsychiatric syndromes similar to those seen with the use of antipsychotics. This may be more likely in situations in which the blood-brain barrier is damaged, as in vascular and degenerative dementias.
Insulin modulates glucose-dependent insulinotropic polypeptide (GIP) secretion from enteroendocrine K cells in rats
Authors: Irwin Nigel , Francis Jacqueline M.E. , Flatt Peter R.
Published: August 2011

Effects of insulin excess and deficiency on glucose-dependent insulinotropic polypeptide (GIP) was examined in rats following insulinoma transplantation or streptozotocin (STZ) administration. Over 14 days, food intake was increased (p<0.001) in both groups of rats, with decreased body weight (p<0.01) in STZ rats. Non-fasting plasma glucose levels were decreased (p<0.01) and plasma insulin levels increased (p<0.001) in insulinoma-bearing rats, whereas STZ treatment elevated glucose (p<0.001) and decreased insulin (p<0.01). Circulating GIP concentrations were elevated (p<0.01) in both animal models. At 14 days, oral glucose resulted in a decreased glycaemic excursion (p<0.05) with concomitant elevations in insulin release (p<0.001) in insulinoma-bearing rats, whereas STZ-treated rats displayed similar glucose-lowering effects but reduced insulin levels (p<0.01). GIP concentrations were augmented in STZ rats (p<0.05) following oral glucose. Plasma glucose and insulin concentrations were not affected by oral fat, but fat-induced GIP secretion was particularly (p<0.05) increased in insulinoma-bearing rats. Exogenous GIP enhanced (p<0.05) glucose-lowering in all groups of rats accompanied by insulin releasing (p<0.001) effects in insulinoma-bearing and control rats. Both rat models exhibited increased (p<0.001) intestinal weight but decreased intestinal GIP concentrations. These data suggest that circulating insulin has direct and indirect effects on the synthesis and secretion of GIP.
Zum genus substantivi der Fremdwörter im Althochdeutschen bis zum 8. Jahrhundert
Authors: Petkov Marin
Published: August 2011

The German language has borrowed many words from other languages due to their strong cultural influence which lasted for centuries. As most of these have been substantives, they have obligatorily received grammatical gender. The present article is an attempt at showing the principles which determined the grammatical gender of the loan-words witnessed in OHG sources from the 8th century.
Application of ASTM Standard Practice D6602 in the Investigation of Outdoor Environmental Surface Particulate Including Darkening Agents
Authors: Millette James R. , Rook Harry L. , Compton Steven
Published: August 2011

ASTM D6602 “Standard Practice for Sampling and Testing of Possible Carbon Black Fugitive Emissions or Other Environmental Particulate, or Both” was developed for the investigation of outdoor sooty surface problems and distinguishing manufactured carbon black, in the N100 to N900 series, from other environmental particulates. It is a microscopy technique that is well suited for the study of darkening agent complaints. Samples are collected from surfaces with cotton balls, wipes, and tape-lifts. The particulate is then analyzed by light microscopy and electron microscopy. The practice is used as a means to differentiate between darkening caused by fungal growth (biofilms), soots, or other dark particles. Polarized light microscopy provides information about the relative amounts of the different types of particles present and some information about the type of biofilm, if present. Transmission electron microscopy provides confirmation of aciniform soot, if present, and some information about the possible source of the soot. An investigation of dark surface particulate in a city where both a carbon black manufacturing facility and an oil refinery were possible industrial sources provides an illustration of the use of the method.
Evaluation of Measured and Estimated Dynamic Moduli for Selected Asphalt Mixes
Authors: Singh Dharamveer , Zaman Musharraf , Commuri Sesh
Published: August 2011

An accurate measurement or estimation of dynamic modulus (|E*|) of a hot mix asphalt (HMA) mix is important to understand stress–strain behavior of flexible pavements under loading and unloading conditions. The Mechanistic Empirical Pavement Design Guide (MEPDG) (Transportation Research Board, Washington, D.C., 2004) recommends that |E*| be used in all three levels of design (i.e., Level 1, Level 2, and Level 3). For Level 1, |E*| is measured in the laboratory, while it is estimated using the Witczak models for Level 2 and Level 3 designs. The measurement of |E*| in the laboratory is not always feasible because it requires costly equipment and skilled personnel. Consequently, use of empirical models seems to be a reasonable approach to estimate |E*|. Several researchers have reported that the accuracy of the Witczak models varies with local materials and volumetric properties. The present study was undertaken to compare the measured and the estimated |E*| for some commonly used mixes in Oklahoma. Specifically, |E*| of five different HMA mixes, comprised of aggregates from several sources and sizes, binder grades, and air voids, were measured in the laboratory. The Witczak 1999 model (Andrei et al., 1999) was used to estimate |E*| for each of these mixes. A comparison was made between the measured and the estimated |E*| at four different levels of air voids, namely, 6%, 8%, 10%, and 12%. It was observed that the Witczak 1999 model overestimates |E*| at all four levels of air voids. To address these overestimates, the Witczak 1999 model was calibrated. The calibrated model was similar in form to the Witczak 1999 model but having different numerical coefficients. Verification of this model was done using a mix that was not used in the calibration process. Furthermore, two full depth field cores were obtained to further verify the accuracy of the calibrated model. Three different criteria, namely, goodness-of-fit statistics, matching the measured and the estimated |E*|, and average relative error (%), revealed that the calibrated model exhibits much better performance compared to the Witczak 1999 model. It is expected that the calibrated model would be useful in estimating |E*| for the Level 2 and Level 3 designs for the implementation of the MEPDG in Oklahoma.
The Use of the Normalization Data Reduction Technique for Measuring Upper Shelf Toughness Under Impact Loading Rates
Authors: Lucon Enrico
Published: August 2011

The multiple-specimen method (low-blow or stop-block tests) is the conventional approach for measuring the upper shelf fracture toughness of steels under impact loading rates, using fatigue precracked Charpy (PCC) specimens tested with an instrumented pendulum machine. The method is fairly simple but requires a relatively large number of specimens. As an alternative, the single-specimen method denominated normalization data reduction (NDR) is based on the analysis of the instrumented force/displacement trace and does not need dedicated instrumentation for the measurement of crack extension during the test. In this study, the NDR technique was applied to low-blow tests performed at different temperatures on two reactor pressure vessel (RPV) steels, 20MnMoNi55 and A553B Cl. 1. Analyses were performed after applying a double fitting approach to the raw test data, which allows selecting a limited set of force/displacement data which are representative of the whole instrumented trace. Results show that the NDR technique provides acceptable accuracy in terms of both ductile crack initiation and resistance to crack propagation (tearing modulus).
Hypogonadism as a risk factor for cardiovascular mortality in men: a meta-analytic study
Authors: Corona Giovanni , Rastrelli Giulia , Monami Matteo , Guay André , Buvat Jaques , Sforza Alessandra , Forti Gianni , Mannucci Edoardo , Maggi Mario
Published: August 2011

Objective

To verify whether hypogonadism represents a risk factor for cardiovascular (CV) morbidity and mortality and to verify whether testosterone replacement therapy (TRT) improves CV parameters in subjects with known CV diseases (CVDs).

Design

Meta-analysis.

Methods

An extensive Medline search was performed using the following words ‘testosterone, CVD, and males’. The search was restricted to data from January 1, 1969, up to January 1, 2011.

Results

Of the 1178 retrieved articles, 70 were included in the study. Among cross-sectional studies, patients with CVD have significantly lower testosterone and higher 17-β estradiol (E2) levels. Conversely, no difference was observed for DHEAS. The association between low testosterone and high E2levels with CVD was confirmed in a logistic regression model, after adjusting for age and body mass index (hazard ratio (HR)=0.763 (0.744–0.783) and HR=1.015 (1.014–1.017), respectively, for each increment of total testosterone and E2levels; bothP<0.0001). Longitudinal studies showed that baseline testosterone level was significantly lower among patients with incident overall- and CV-related mortality, in comparison with controls. Conversely, we did not observe any difference in the baseline testosterone and E2levels between case and controls for incident CVD. Finally, TRT was positively associated with a significant increase in treadmill test duration and time to 1 mm ST segment depression.

Conclusions

Lower testosterone and higher E2levels correlate with increased risk of CVD and CV mortality. TRT in hypogonadism moderates metabolic components associated with CV risk. Whether low testosterone is just an association with CV risk, or an actual cause–effect relationship, awaits further studies.
Denosumab for bone diseases: translating bone biology into targeted therapy
Authors: Tsourdi Elena , Rachner Tilman D , Rauner Martina , Hamann Christine , Hofbauer Lorenz C
Published: August 2011

Signalling of receptor activator of nuclear factor-κB (RANK) ligand (RANKL) through RANK is a critical pathway to regulate the differentiation and activity of osteoclasts and, hence, a master regulator of bone resorption. Increased RANKL activity has been demonstrated in diseases characterised by excessive bone loss such as osteoporosis, rheumatoid arthritis and osteolytic bone metastases. The development and approval of denosumab, a fully MAB against RANKL, has heralded a new era in the treatment of bone diseases by providing a potent, targeted and reversible inhibitor of bone resorption. This article summarises the molecular and cellular biology of the RANKL/RANK system and critically reviews preclinical and clinical studies that have established denosumab as a promising novel therapy for metabolic and malignant bone diseases. We will discuss the potential indications for denosumab along with a critical review of safety and analyse its potential within the concert of established therapies.
Charcoal remains from a tonstein layer in the Faxinal Coalfield, Lower Permian, southern Paraná Basin, Brazil
Authors: Jasper André , Uhl Dieter , Guerra-Sommer Margot , Abu Hamad Abdalla M. B , Machado Neli T. G
Published: August 2011

Fossil charcoal has been discovered in the Faxinal Coalfield, Early Permian, Rio Bonito Formation, in the southernmost portion of the Paraná Basin, Brazil. Three types of pycnoxylic gymnosperm woods recovered from a single tonstein layer are described and confirm the occurrence of paleowildfire in this area. A decrease of the charcoal concentration from the base to the top within the tonstein layer indicates that the amount of fuel declined during the deposition probably due to the consumption of vegetation by the fire. The presence of inertinite in coals overlying and underlying the tonstein layer indicates that fire-events were not restricted to the ash fall interval. The integration of the new data presented in the current study with previously published data for the Faxinal Coalfield demonstrates that volcanic events that occurred in the surrounding areas can be identified as one potential source of ignition for the wildfires. The presence of charcoal in Permian sediments associated with coal levels at different localities demonstrates that wildfires have been relatively common events in the peat-forming environments in which the coal formation took place in the Paraná Basin.
Perfil clínico-epidemiológico dos casos de tétano acidental ocorridos em Ribeirão Preto, Estado de São Paulo, no período de 1990 a 2009
Authors: Neves Fábio Fernandes , Faiolla Rivian Christina Lopes , Napoli Emília Maria Guimarães de , Lima Geovana Momo Nogueira de , Muniz Renata Zomer de Albernaz , Pazin-Filho Antônio
Published: August 2011

INTRODUÇÃO: O tétano continua sendo um grave problema de saúde pública nos países em desenvolvimento. No Brasil, apesar dos avanços tecnológicos, não houve um decréscimo significativo da taxa de letalidade nos últimos anos. Nesta casuística, foram analisados dados clínicos e epidemiológicos dos pacientes diagnosticados em Ribeirão Preto, nas últimas duas décadas. MÉTODOS: Este é um estudo retrospectivo que analisou dados dos pacientes internados por tétano acidental no Hospital das Clínicas de Ribeirão Preto, entre 1990 e 2009. O diagnóstico do tétano foi realizado segundo critérios do Ministério da Saúde do Brasil. RESULTADOS: Onze (47,8%), casos positivos, dos 23 suspeitos de tétano, foram incluídos neste estudo. Não houve mortes, mas dois (18,2%) pacientes apresentaram déficit neurológico permanente. O indicador prognóstico Tetanus Severity Score variou entre 0 a 8 pontos. A mediana da permanência hospitalar foi de 17 dias, variando de 6 a 98 dias. A ausência de óbitos pode ser explicada pelo diagnóstico clinico precoce da doença com instituição imediata de terapia. CONCLUSÕES: Ribeirão Preto é uma área onde o tétano não é um relevante problema de saúde pública.
Abordagem existencial do cuidar em enfermagem psiquiátrica hospitalar
Authors: Furlan Marcela Martins , Ribeiro Cléa Regina de Oliveira
Published: August 2011

A Saúde Mental no Brasil tem se voltado aos serviços comunitários de atenção psiquiátrica substitutivos ao modelo asilar. Entretanto, o portador de transtorno mental continua transitando entre o serviço comunitário e o hospital psiquiátrico, sendo alvo, ainda, da disciplinarização e violência que colocam em questão a qualidade do trabalho em enfermagem. O objetivo deste estudo foi compreender ontologicamente o cuidar em enfermagem na internação psiquiátrica. Participaram da pesquisa quatro portadores de transtornos mentais freqüentadores de um centro de atenção psicossocial que aceitaram discorrer sobre a vivência da internação psiquiátrica, por meio de entrevista semi-dirigida. Os sujeitos rememoraram a experiência da internação psiquiátrica e teceram significações a respeito. Aplicou-se a Analítica Existencial de Heidegger, que gerou o Núcleo do Sentido: Ser-no-mundo-cuidado na impessoalidade, que propiciou o desvelamento do fenômeno mediante a estrutura de Dasein, sendo possível delinear o cuidar ontológico em enfermagem em hospital psiquiátrico.
Assessment of Volumetric Changes with a Best-Fit Method in Three-Dimensional Stereophotograms
Authors: Ongkosuwito E.M. , Goos J.A.C. , Wattel E. , Van Der Wal K.G.H. , Van Adrichem L.N.A. , Van Neck J.W.
Published: August 2011

Objective

Different three-dimensional stereophotogrammetry systems and analyzing methods exist that often use landmarks for comparison. Measurement errors in landmark or surface comparison are mostly within 1 mm, which seems clinically acceptable. The aim of this study was to validate a three-dimensional stereophotogrammetric best-fit method of assessing volumetric changes and to compare three devices.

Methods

The validation of the best-fit method was at first done on a life-size dummy head. Scans were made in the ideal position, as well as in four additional positions, and a scan was made in which a soft putty specimen was added to the dummy head. The comparison was executed with a best-fit method using triangulation. Student's t tests were used to detect statistically significant differences. Second, comparisons were made among scans of a white man in the ideal position and with volume changes added.

Results

The different positions tested for the dummy head showed no significant volume differences within each system or among systems. The differences found when adding a soft putty specimen fell into the same range as the differences between various positions. The differences within a live situation were 10 times greater compared with the dummy-head situation.

Conclusions

In a dummy-head situation, the different systems gave similar results when tested with a best-fit method. However, in live situations the differences may become 10 times greater, possibly due to different facial expressions. These differences may become clinically relevant and, therefore, further research in volumetric changes is needed.
Multi-stakeholder engagement for sustainable bridge delivery
Authors: Zhang Chao , Canning Lee , Dubois Leonie , Vipham Marc
Published: August 2011

There is constant pressure for the civil engineering industry to keep improving its cost efficiency. In the meantime, the industry has to operate within an increasingly stringent policy and regulatory environment, more recently driven by the growing commitment to sustainable development. To overcome these challenges often requires more effective collaboration between professionals from different disciplines and wider stakeholder engagement in general. This paper focuses on the bridge engineering sector in the UK and identifies the main areas for improvement in the project delivery process, especially where effective collaboration can play a significant role. The increasing need for effective engagement of the affected community is highlighted and its implications for practising engineers are discussed. Key factors to enable effective collaboration in practice are then considered, with particular attention given to effective community engagement, after which the benefits of effective collaboration and community engagement are demonstrated by way of examples. Attempts are made to highlight some unique challenges brought about for engineers in practice by the implementation of sustainability principles. Key skills are identified to enable engineers to contribute to more sustainable bridge delivery. In order for their actions to be most effective, the development of applications-oriented, bridge-project-specific, best practice guides is proposed.
The EU WFD and the river basin management plans in Spain
Authors: Estrela Teodoro
Published: August 2011

The European water framework directive (WFD) 2000/60/EC, establishes a framework for community action in the field of water policy, introducing a new perspective from a modern view of water policy to all Member States of the European Union, with important consequences for future water management. This paper reviews the status of the implementation of the EU water framework directive in Spain focusing on river basin management plans, which are an essential tool established by the EU water framework directive to reach the environmental objectives in the European Union water bodies. Spain has a long tradition in water resources planning and current plans, the main aim of which is to allocate water resources to water uses. These plans are being revised and extended to include water protection requirements derived from the EU water framework directive. Recently, specific and related plans, such as drought management plans, have been approved.
Integrated modelling for river basin management planning
Authors: Safiolea Eleftheria , Baki Sotiria , Makropoulos Christos , Deliège Jean Francois , Magermans Paul , Everbecq Etienne , Gkesouli Anthoula , Stamou Anastasios , Mimikou Maria
Published: August 2011

Complex spatio-temporal environmental problems call for an integrated assessment of environmental systems due to their interdisciplinary nature. Within this context, the approach of integrated water resource management (IWRM) at the catchment scale, which is at the heart of advanced European environmental policy such as the water framework directive (WFD), argues for integrated modelling tools and approaches. This paper examines recent technological developments that facilitate integrated modelling and focuses on a novel approach, the open modelling interface (OpenMI), which allows models built by different developers to communicate at runtime. The individual models, when made compliant with the OpenMI standard, can be considered as ‘components' of an integrated model and seamlessly exchange data. Two OpenMI-enabled integrated modelling case studies are presented and their results critically discussed. The paper concludes with opportunities and challenges towards the design of flexible, component-based models supporting integrated environmental policy in general and the WFD implementation in particular.
Rivers in trust: stakeholders and delivery of the EU water framework directive
Authors: Newson Malcolm
Published: August 2011

This paper describes the potential role of third-sector rivers trusts charities in co-delivery of the EU water framework directive. It uses as a case study the Tyne Rivers Trust in northeast England. The aim of the paper is to critically evaluate the capacity of the third sector to help deliver the vital public engagement, evidence-based strategies and practical measures required by the directive within a ‘big society' political context. The trust has several avenues of work, which heavily depend on stakeholder participation, from education, through debates on problem issues concerning the river to active voluntary work on measures to relieve ‘pressures' identified for local waterbodies under the directive. The trust also undertakes, in partnership with the Environment Agency, riparian works on aggravated sources of siltation – an identified threat to the biodiversity of the River Tyne. The paper ends with an assessment of the successes and failures of the organisation in its stakeholder relationships: ‘engagement' is identified as a vital element of the niche occupied by rivers trusts. It is seen as vital for the trust to maintain and adapt its successful ‘localism' model during a period of rapidly growing influence on river management issues.
Japanese Translation and Cultural Adaptation of the Listening to Mothers II Questionnaire
Authors: Kishi Rieko , McElmurry Beverly , Vonderheid Susan , Altfeld Susan , McFarlin Barbara , Tashiro Junko
Published: August 2011

The questionnaire used for the U.S. Listening to Mothers II survey was translated and culturally adapted to measure Japanese women’s experience during the period of pregnancy planning through early postpartum. Methods included expert panels and two phases of cognitive interviews with 20 postpartum Japanese adult women. The number of problems with the translated questionnaire effectively decreased in the iterative process. Most problems were found in the question–interpretation stage of cognitive processing, such as wording/tone. Culture-specific concepts and unclear items were adapted to prevent erroneous interpretations in future studies. The future use of this questionnaire to generate data sets will be useful for professionals interested in developing evidence-based practices. The knowledge from this study can be helpful in improving health-care services and education for women with diverse languages and cultural backgrounds.
Factors Associated With Exclusive Breastfeeding 2 to 4 Weeks Following Discharge From a Large, Urban, Academic Medical Center Striving for Baby-Friendly Designation
Authors: DiFrisco Eileen , Goodman Karen E. , Budin Wendy C. , Lilienthal Marge W. , Kleinman Aviva , Holmes Barbara
Published: August 2011

Substantial evidence documents the superiority of breastfeeding for mothers and breastmilk for babies. Although the American Academy of Pediatrics and the U.S. Healthy People 2010 initiative promote breastfeeding, current breastfeeding rates often fall short of recommendations. This study determined factors associated with exclusive breastfeeding 2 to 4 weeks following discharge from a large, urban, academic medical center striving for Baby-Friendly designation. Results indicated that mothers who breastfed within the first hour of birth (61%) were significantly more likely to be exclusively breastfeeding 2 to 4 weeks after discharge. Incorporating care practices that include a number of the “Ten Steps to Successful Breastfeeding,” as recommended by the Baby-Friendly Hospital Initiative, may increase the duration of exclusive breastfeeding after discharge.
The Journal of Perinatal Education, No Longer a Baby
Authors: Budin Wendy C.
Published: August 2011

In this column, the editor of The Journal of Perinatal Education (JPE) acknowledges how, over the past 20 years, the JPE has matured into a highly respected journal for normal-birth advocates and other health professionals and announces a new partnership with Springer Publishing Company. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote natural, safe, and healthy birth.
Factors Related to Breastfeeding Discontinuation Between Hospital Discharge and 2 Weeks Postpartum
Authors: Brand Elizabeth , Kothari Catherine , Stark Mary Ann
Published: August 2011

Although breastfeeding is known to be beneficial to both mother and infant, many women encounter barriers to breastfeeding, even after successful breastfeeding initiation, which may put them at greater risk for early cessation of breastfeeding. The objectives of this study were to conduct a secondary analysis of data from a longitudinal study of postpartum depression to (a) examine factors related to very early discontinuation of breastfeeding (at 2 weeks postpartum) following hospital discharge and (b) identify women’s reasons for very early cessation of breastfeeding. The results of this study support findings from previous research. Having a perceived support system, whether it is personal or professional, may have an effect on both the initiation and duration of breastfeeding. Educating expectant and new mothers, especially women who encounter multiple barriers and are at risk for very early cessation of breastfeeding, of the benefits of breastfeeding and supporting them in developing efficient techniques and problem-solving skills can help increase the duration of breastfeeding.
African American Women’s Preparation for Childbirth From the Perspective of African American Health-Care Providers
Authors: Abbyad Christine , Robertson Trina Reed
Published: August 2011

Preparation for birthing has focused primarily on Caucasian women. No studies have explored African American women’s birth preparation. From the perceptions of 12 African American maternity health-care providers, this study elicited perceptions of the ways in which pregnant African American women prepare for childbirth. Focus group participants answered seven semistructured questions. Four themes emerged: connecting with nurturers, traversing an unresponsive system, the need to be strong, and childbirth classes not a priority. Recommendations for nurses and childbirth educators include: (a) self-awareness of attitudes toward African Americans, (b) empowering of clients for birthing, (c) recognition of the role that pregnant women’s mothers play, (d) tailoring of childbirth classes for African American women, and (e) research on how racism influences pregnant African American women’s preparation for birthing.
Waiting to Inhale: How to Unhurry the Moment of Birth
Authors: Malloy Mary Esther
Published: August 2011

A doula and expectant mother’s view of birth is forever changed when she sees a midwife simply place a newly born child below her mother at the moment of birth. The pause that the mother experiences in this moment as she studies, touches, and claims her child prompts the author to reflect in this guest editorial on ways we might be disturbing the natural sequence of birth as we deliver babies directly to their mothers’ chests.
Comparisons in Perceived Importance of and Needs for Maternal Gestational Weight Information Between African American and Caucasian Pregnant Women
Authors: Shieh Carol , Weaver Michael T.
Published: August 2011

This study compared the perceived importance of and needs for maternal gestational weight information between African American and Caucasian pregnant women. A secondary analysis of data from 113 pregnant women (82 African Americans and 31 Caucasians) attending an inner-city prenatal clinic was conducted for this study. Perceived importance of and needs for information were measured in five areas: (1) nutrition, (2) prenatal vitamins, (3) rest/activity balance, (4) exercise, and (5) appropriate weight gain. African American women demonstrated significantly higher perceived importance of and needs for information on rest/activity balance and appropriate weight gain than Caucasian women. Exercise information was rated lower in importance but was most needed by both African American and Caucasian women. Education programs about maternal gestational weight need to be cognizant of ethnic women’s needs.
Lamaze Breathing
Authors: Lothian Judith A.
Published: August 2011

Lamaze breathing historically is considered the hallmark of Lamaze preparation for childbirth. This column discusses breathing in the larger context of contemporary Lamaze. Controlled breathing enhances relaxation and decreases perception of pain. It is one of many comfort strategies taught in Lamaze classes. In restricted birthing environments, breathing may be the only nonpharmacological comfort strategy available to women. Conscious breathing and relaxation, especially in combination with a wide variety of comfort strategies, can help women avoid unnecessary medical intervention and have a safe, healthy birth.
Dayton William Dix’s Birth Story
Authors: Hirschenfang Jill
Published: August 2011

In this birth story, a young mother relates her experience of moving beyond fear of labor and birth and developing confidence in her ability to give birth without an epidural. Knowledge and support, including the support of a doula, during the last months of pregnancy helped this mother change her plans for the labor and birth. This story highlights the importance of continuous emotional and physical support and how knowledge and confidence set the stage for a satisfying, safe, and healthy birth.
Teaching and Learning Birth
Authors: Powell Kennedy Holly
Published: August 2011

This guest editorial explores the idea that our worldview, regardless of education, influences our childbirth practices, sometimes interfering with achieving the goals of our discipline. Over time, we have lost our ability to support women through the process of childbirth so that they emerge as strong, healthy women. The high road ahead is to teach everyone, including ourselves, that we need to provide optimal, evidence-based care. Pursuing this path will take courage and commitment.
Construct Validity of the Childbirth Trauma Index for Adolescents
Authors: Anderson Cheryl
Published: August 2011

The potentially traumatic nature of childbirth for adult mothers has been confirmed in research; however, adolescent childbirth trauma is unexplored. This article presents research on the construct validity of the Childbirth Trauma Index by providing a conceptual analysis of psychological childbirth trauma, factor validity of the Childbirth Trauma Index, and discussion of testing the Childbirth Trauma Index via contrasted-groups approach. Childbirth trauma can result in an acute stress reaction or actual posttraumatic stress disorder. Using subjective reports, the Impact of Event Scale, and the Childbirth Trauma Index, an appraisal of birth trauma, trauma impact, and indicators associated with childbirth trauma were revealed among 112 adolescents. Clinical implications and research recommendations are offered.
Being a Resource for Both Mother and Child
Authors: Erlandsson Kerstin , Lindgren Helena
Published: August 2011

The aim of this study was to describe fathers’ experiences of being present on a postnatal ward and during the first days at home following a complicated birth. Fifteen fathers were interviewed, and content analysis was used for the analysis. The theme illustrated that fathers were a resource for both mother and child through practical and emotional engagement. The categories describe how the father empowers the mother and illustrates adapting to new family roles. Following complicated birth, fathers should be invited to stay around-the-clock on postnatal wards because it gives them the opportunity to place their resources at the disposal of mother and child. In antenatal courses, fathers should be prepared for their empowering role after a complicated birth.
Another Breastfeeding Controversy
Authors: Budin Wendy C.
Published: August 2011

In this column, the editor of The Journal of Perinatal Education discusses the latest breastfeeding controversy—a new doll that is intended to help little girls learn to breastfeed. The goal of the doll’s manufacturers is to spread the word that breastfeeding is a normal, natural way to feed a baby. Its purpose is to raise awareness about the positive health benefits associated with breastfeeding. But not everyone seems to agree. Pros and cons are presented. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote natural, safe, and healthy birth.
Welcoming Nora: A Family Event
Authors: Walsh Allison J. , Walsh Paul R. , Walsh Jane M. , Walsh Gavin T.
Published: August 2011

In this column, Allison and Paul Walsh share the story of the birth of Nora, their third baby and their second child to be born at home. Allison and Paul share their individual memories of labor and birth. But their story is only part of the story of Nora’s birth. Nora’s birth was a family event, with Allison and Paul’s other children very much part of the experience. Jane and Gavin share their own memories of their baby sister’s birth.
A Road Map for Change: Ensuring That Women Have Breastfeeding Support
Authors: Stanton Robin W.
Published: August 2011

Despite new policy changes and national dialogue about breastfeeding, significant barriers in all sectors of society continue to exist for most women who decide to breastfeed. Breastfeeding rates fall short of current medical recommendations and our nation’s own public health goals, resulting in significant health and economic impacts. The launch of The Surgeon General’s Call to Action to Support Breastfeeding provides an opportunity for a society-wide approach in removing barriers that make it difficult for many women to succeed. Childbirth educators are urged to use these action steps as a springboard to influence lasting change so that all women have the opportunity to breastfeed their children.
The Evidence Base for the Cues Program for Mothers of Very Low Birth Weight Infants: An Innovative Approach to Reduce Anxiety and Support Sensitive Interaction
Authors: Feeley Nancy , Zelkowitz Phyllis , Westreich Ruta , Dunkley David
Published: August 2011

Very low birth weight (VLBW) infants, born weighing less than 1,500 g, are at risk for several developmental problems. Consequently, there has been interest in developing intervention programs to prevent such problems. This article describes the empirical evidence that guided the development of an innovative, multicomponent intervention program for mothers of VLBW infants, as well as the program content and features. Based on the evidence, the program was designed to include six sessions and commence shortly after birth to reduce maternal psychological distress during the infant’s hospitalization in the neonatal intensive care unit and to promote sensitive mother–infant interaction. The program incorporates various learning activities, including written materials, observational exercises, discussion, and video feedback.
Fathers Online: Learning About Fatherhood Through the Internet
Authors: StGeorge Jennifer M. , Fletcher Richard J.
Published: August 2011

In the transition to fatherhood, men face numerous challenges. Opportunities to learn new practices and gain support are limited, although the provisions of father-specific spaces such as fathers’ antenatal classes or “responsible fathering” programs are important advances. This article explores how men use the social space of a father-specific Internet chat room to learn about fathering. Messages to an Australian-hosted, father-specific chat room (for fathers of infants or young children) were examined, and three overlapping themes illustrated men’s perceptions of their transition to fatherhood. The themes concerned recognition of and response to a lack of social space, services, and support for new fathers. The implications for fathers’ perinatal education are discussed.
Pain, Suffering, and Trauma in Labor and Prevention of Subsequent Posttraumatic Stress Disorder
Authors: Simkin Penny
Published: August 2011

In this column, Kimmelin Hull, community manager ofScience & Sensibility, Lamaze International’s research blog, reprints and discusses a recent blog post series by acclaimed writer, lecturer, doula, and normal birth advocate Penny Simkin. Examined here is the fruitful dialog that ensued—including testimonies from blog readers about their own experiences with traumatic birth and subsequent posttraumatic stress disorder. Hull further highlights the impact traumatic birth has not only on the birthing woman but also on the labor team—including doulas and childbirth educators—and the implied need for debriefing processes for birth workers. Succinct tools for assessing a laboring woman’s experience of pain versus suffering are offered by Simkin, along with Hull’s added suggestions for application during the labor and birth process.
3D Modelling Photogrammetry Wellhead Inspection and Repair
Authors: Sloan Andrew , Ramsay Derek , MacCormick Marie , Hall Anthony , Trower Alastair
Published: August 2011

In December 2009, an unplanned operation during subsea operations caused substantial damage to a subsea wellhead, leaving the tree-hub, H-4 profile and Internal Tree Cap severely deformed. The wellhead was not in production at the time and well integrity was maintained.

As part of an initiative to ascertain the extent of the damage and bring the well back online, Chevron contracted Welaptega to perform two 3D modelling photogrammetry surveys. Welaptega collected high quality digital still images of the tree-hub surface, and processed them to construct geometrically accurate 3D models representing the inside and outside geometry of the tree-hub.

The 3D model was imported into OEM design software for comparison to as-built drawings, and then used to design a bespoke Internal Tree Cap hold-down tool to ensure well integrity during VX gasket removal. Using the 3D model, a phased work plan was constructed, involving customised cutting tools, to return the tree-hub to a condition which would allow the BOP to be run back onto the tree.

In two separate DSV interventions, divers removed the damaged VX gasket with hydraulic arms, and cut the damaged area using a diamond rope cutter and Grayserv cutter. It was then possible to trial fit an H-4 connector over the tree hub, complete with a custom gasket which was designed to form a seal.
Use of Ketamine in Ameliorating Opioid Withdrawal Symptoms During an Induction Phase of Buprenorphine
Authors: Omoigui Sota , Hashmat Fahad , Bernardo Zeudi
Published: August 2011

Ketamine can be used in the treatment of opioid withdrawal symptoms. Here are two case discussions of treatment of withdrawal symptoms in opioid dependent patients undergoing detoxification. Our case reports endorse the hypothesis that N-methyl D-aspartate (NMDA) antagonists may selectively inhibit the expression of opiate withdrawal. The use of intravenous ketamine can be considered as a bridge to successful initiation of buprenorphine to wean the
patient off from high opioid doses while providing adequate analgesia during the transition period.
Solubility of Palm Oil Components in Supercritical Carbon Dioxide
Authors: Puah Chiew Wei , Choo Yuen May , Ma Ah Ngan , Chuah Cheng Hock
Published: August 2011

The effects of operating pressures and temperatures on the solubilities of acylglycerols and free fatty acids (FFA) of palm oil (Elaeis guineensis) in supercritical carbon dioxide (SC-CO2) were determined using a dynamic (flow-through) supercritical fluid extraction system. The solubility of palm oil was also investigated. The experiments were carried out in a 3 X 3 factorial design with three equally spaced pressures (14, 22 and 30 MPa) and three equally spaced temperatures (40, 60 and 80°C). The solubilities (mg/g CO2) of acylglycerols and FFA followed this order: TAG > FFA > DAG > MAG for high pressure. However, highest solubility of FFA was observed at low pressure. The results showed that the solubility of palm oil in SC-CO2 was in the range of 0.1751 ± 0.0007 to 6.60 ± 0.03 mg/g for the conditions studied. The solubility of palm oil in SC-CO2 is significantly influenced by the solubilities of acylglycerols and FFA. The optimum condition for maximum solubility of palm oil was found to be at 60°C and 30 MPa. The experimental data obtained for the palm oil solubility was compared with other vegetable oils and correlated by the improved density-based equation proposed by del Valle-Aguilera.
Separation of the maxima in samples of geometric random variables
Authors: Brennan Charlotte , Knopfmacher Arnold , Mansour Toufik , Wagner Stephan
Published: August 2011

We consider samples of n geometric random variables W1 W2 ... Wn where P{W)
= i} = pqi-l, for 1 ? j ? n, with p + q = 1. For each fixed integer d > 0, we
study the probability that the distance between the consecutive maxima in
these samples is at least d. We derive a probability generating function for
such samples and from it we obtain an exact formula for the probability as a
double sum. Using Rice's method we obtain asymptotic estimates for these
probabilities. As a consequence of these results, we determine the average
minimum separation of the maxima, in a sample of n geometric random variables
with at least two maxima.