Women’s-Perceived Quality In Postpartum Care

Increased competition among healthcare organizations for the obstetric consumer market has led to increased interest in women’s perceptions of their obstetric experience. This study explored women’s perceptions of quality and women’s perceptions of benefits for women who received family-centered postpartum care (FCPPC) and women who received traditional postpartum care (TPPC). The study also assessed the relationship between women’s-perceived quality (WPQ) and women’s-perceived benefit (WPB) for those receiving FCPPC and those receiving TPPC. Quality and beneficence are the two concepts of Larrabee’s (1992) model of quality operationalized in this study. The sample consisted of 60 postpartum women, 30 receiving care on an all FCPPC unit and 30 receiving care on a TPPC unit delivering both FCPPC and TPPC. Women’s quality was measured by obtaining satisfaction scores using the modified patient participation questionnaire, with responses rated on a five-point Likert scale. Women’s-perceived benefit was measured by obtaining responses to benefit items rated on a five-point Likert scale score. Chi-Square and ANOVA revealed no demographic differences between groups. The study findings indicate that women receiving FCPPC have higher perceptions of quality on some dimensions of care than women receiving TPPC because FCPPC group scores were significantly higher on 8 out of 22 WPQ items. WPQ Mean scores for both FCPPC and TPPC groups were high. However, FCPPC group scores were significantly higher on 8 out of 22 WPQ items. In addition, the study findings indicate that women receiving FCPPC have higher perceptions of some benefits than women receiving TPPC because the FCPPC group scores were significantly higher on 3 out of 7 WPB items. Results also indicated that a relationship exists between quality and beneficence. These findings suggest implications that nurses working in TPPC units should incorporate FCPPC approaches to giving care, pertaining to those eight WPQ aspects of care and for the three WPB aspects of care. Results further imply that if women perceive care as beneficial they will also perceive it as quality. Health care providers should focus care activities and quality improvement activities on aspects of care women perceive as beneficial and for which quality improvement is indicated from the women’s perspective

Can Implicit Measures Augment Suicide Detection in Youth? The Feasibility and Acceptability of the Death Implicit Association Test Among Pediatric Medical Impatients

Background: Medically ill youth are at increased suicide risk, necessitating early detection. This study aimed to assess the feasibility of administering the Death Implicit Association Test (Death IAT) to pediatric medical inpatients. Methods: Participants completed measures including the Ask Suicide-Screening Questions (ASQ) and the Death IAT. Results: Over 90% of participants found the Death IAT to be acceptable and more than 75% of participants were comfortable completing the task. There was a small, but statistically significant, improvement from pre-survey to post-survey reports of mood (t(174) = 3.02, p = 0.003, d = 0.15). Participants who endorsed a past suicide attempt on the ASQ had significantly higher “suicide” trial D-scores than those without a past suicide attempt (Wilcoxon W = 1312; p = 0.048; d = 0.61). Conclusions: Implementing an IAT measure among pediatric medical inpatients was feasible and acceptable. In exploratory analyses, “suicide” trial IAT D-scores were associated with past suicide attempts, suggesting future studies should examine whether implicit measures may be useful in hospital settings to augment detection of youth suicide risk

From Bitstreams to Heritage: Putting Digital Forensics into Practice in Collecting Institutions

This paper examines the application of digital forensics methods to materials in collecting institutions – particularly libraries, archives and museums. It discusses motivations, challenges, and emerging strategies for the use of these technologies and workflows. It is a product of the BitCurator project. The BitCurator project began on October 1, 2011, through funding from the Andrew W. Mellon Foundation. BitCurator is an effort to build, test, and analyze systems and software for incorporating digital forensics methods into the workflows of a variety of collecting institutions. It is led by the School of Information and Library Science (SILS) at the University of North Carolina, Chapel Hill and the Maryland Institute for Technology in the Humanities (MITH) at the University of Maryland, and involves contributors from several other institutions. Two groups of external partners are contributing to this process: a Professional Expert Panel (PEP) of individuals who are at various levels of implementing digital forensics tools and methods in their collecting institution contexts, and a Development Advisory Group (DAG) of individuals who have significant experience with software development.2 This paper is a product of phase one of BitCurator (October 1, 2011 – September 30, 2013). The second phase of the project (October 1, 2013 – September 29, 2014) continues the development of the BitCurator environment, along with expanded professional engagement and community outreach activities

A clinical genetic method to identify mechanisms by which pain causes depression and anxiety

BACKGROUND: Pain patients are often depressed and anxious, and benefit less from psychotropic drugs than pain-free patients. We hypothesize that this partial resistance is due to the unique neurochemical contribution to mood by afferent pain projections through the spino-parabrachial-hypothalamic-amygdalar systems and their projections to other mood-mediating systems. New psychotropic drugs for pain patients might target molecules in such brain systems. We propose a method to prioritize molecular targets by studying polymorphic genes in cohorts of patients undergoing surgical procedures associated with a variable pain relief response. We seek molecules that show a significant statistical interaction between (1) the amount of surgical pain relief, and (2) the alleles of the gene, on depression and anxiety during the first postoperative year. RESULTS: We collected DNA from 280 patients with sciatica due to a lumbar disc herniation, 162 treated surgically and 118 non-surgically, who had been followed for 10 years in the Maine Lumbar Spine Study, a large, prospective, observational study. In patients whose pain was reduced >25% by surgery, symptoms of depression and anxiety, assessed with the SF-36 Mental Health Scale, improved briskly at the first postoperative measurement. In patients with little or no surgical pain reduction, mood scores stayed about the same on average. There was large inter-individual variability at each level of residual pain. Polymorphisms in three pre-specified pain-mood candidate genes, catechol-O-methyl transferase (COMT), serotonin transporter, and brain-derived neurotrophic factor (BDNF) were not associated with late postoperative mood or with a pain-gene interaction on mood. Although the sample size did not provide enough power to persuasively search through a larger number of genes, an exploratory survey of 25 other genes provides illustrations of pain-gene interactions on postoperative mood – the mu opioid receptor for short-term effects of acute sciatica on mood, and the galanin-2 receptor for effects of unrelieved post-discectomy pain on mood one year after surgery. CONCLUSION: Genomic analysis of longitudinal studies of pain, depression, and anxiety in patients undergoing pain-relieving surgery may help to identify molecules through which pain alters mood. Detection of alleles with modest-sized effects will require larger cohorts

On the influence of the cosmological constant on gravitational lensing in small systems

The cosmological constant Lambda affects gravitational lensing phenomena. The contribution of Lambda to the observable angular positions of multiple images and to their amplification and time delay is here computed through a study in the weak deflection limit of the equations of motion in the Schwarzschild-de Sitter metric. Due to Lambda the unresolved images are slightly demagnified, the radius of the Einstein ring decreases and the time delay increases. The effect is however negligible for near lenses. In the case of null cosmological constant, we provide some updated results on lensing by a Schwarzschild black hole.Comment: 8 pages, 1 figure; v2: extended discussion on the lens equation, references added, results unchanged, in press on PR

Engagement with Care, Substance Use, and Adherence to Therapy in HIV/AIDS

Engagement with care for those living with HIV is aimed at establishing a strong relationship between patients and their health care provider and is often associated with greater adherence to therapy and treatment (Flickinger, Saha, Moore, and Beach, 2013). Substance use behaviors are linked with lower rates of engagement with care and medication adherence (Horvath, Carrico, Simoni, Boyer, Amico, and Petroli, 2013). This study is a secondary data analysis using a cross-sectional design from a larger randomized controlled trial (n = 775) that investigated the efficacy of a self-care symptom management manual for participants living with HIV. Participants were recruited from countries of Africa and the US. This study provides evidence that substance use is linked with lower self-reported engagement with care and adherence to therapy. Data on substance use and engagement are presented. Clinical implications of the study address the importance of utilizing health care system and policy factors to improve engagement with care