Ariel - Volume 2 Number 1

Editors Delvun C. Case, Jr. Paul M. Fernhoff Associate Editors Donald Bergman Daniel B. Gould Richard Bonanno Ronald Hoffman Lay-Out Editor Carol Dolinskas Sports Editor James Nocon Business Manager Nick Grego Contributing Editors Michael J. Blecker Stephen P. Flynn Lin Sey Edwards Jack Guralnik W. Cherry Ligh

Early skin-to-skin contact for mothers and their healthy newborn infants.

BackgroundMother-infant separation post birth is common. In standard hospital care, newborn infants are held wrapped or dressed in their mother's arms, placed in open cribs or under radiant warmers. Skin-to-skin contact (SSC) begins ideally at birth and should last continually until the end of the first breastfeeding. SSC involves placing the dried, naked baby prone on the mother's bare chest, often covered with a warm blanket. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neuro-behaviors ensuring fulfillment of basic biological needs. This time frame immediately post birth may represent a 'sensitive period' for programming future physiology and behavior.ObjectivesTo assess the effects of immediate or early SSC for healthy newborn infants compared to standard contact on establishment and maintenance of breastfeeding and infant physiology.Search methodsWe searched the Cochrane Pregnancy and Childbirth Group's Trials Register (17 December 2015), made personal contact with trialists, consulted the bibliography on kangaroo mother care (KMC) maintained by Dr Susan Ludington, and reviewed reference lists of retrieved studies.Selection criteriaRandomized controlled trials that compared immediate or early SSC with usual hospital care.Data collection and analysisTwo review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Quality of the evidence was assessed using the GRADE approach.Main resultsWe included 46 trials with 3850 women and their infants; 38 trials with 3472 women and infants contributed data to our analyses. Trials took place in 21 countries, and most recruited small samples (just 12 trials randomized more than 100 women). Eight trials included women who had SSC after cesarean birth. All infants recruited to trials were healthy, and the majority were full term. Six trials studied late preterm infants (greater than 35 weeks' gestation). No included trial met all criteria for good quality with respect to methodology and reporting; no trial was successfully blinded, and all analyses were imprecise due to small sample size. Many analyses had statistical heterogeneity due to considerable differences between SSC and standard care control groups. Results for womenSSC women were more likely than women with standard contact to be breastfeeding at one to four months post birth, though there was some uncertainty in this estimate due to risks of bias in included trials (average risk ratio (RR) 1.24, 95% confidence interval (CI) 1.07 to 1.43; participants = 887; studies = 14; I² = 41%; GRADE: moderate quality). SSC women also breast fed their infants longer, though data were limited (mean difference (MD) 64 days, 95% CI 37.96 to 89.50; participants = 264; studies = six; GRADE:low quality); this result was from a sensitivity analysis excluding one trial contributing all of the heterogeneity in the primary analysis. SSC women were probably more likely to exclusively breast feed from hospital discharge to one month post birth and from six weeks to six months post birth, though both analyses had substantial heterogeneity (from discharge average RR 1.30, 95% CI 1.12 to 1.49; participants = 711; studies = six; I² = 44%; GRADE: moderate quality; from six weeks average RR 1.50, 95% CI 1.18 to 1.90; participants = 640; studies = seven; I² = 62%; GRADE: moderate quality).Women in the SCC group had higher mean scores for breastfeeding effectiveness, with moderate heterogeneity (IBFAT (Infant Breastfeeding Assessment Tool) score MD 2.28, 95% CI 1.41 to 3.15; participants = 384; studies = four; I² = 41%). SSC infants were more likely to breast feed successfully during their first feed, with high heterogeneity (average RR 1.32, 95% CI 1.04 to 1.67; participants = 575; studies = five; I² = 85%). Results for infantsSSC infants had higher SCRIP (stability of the cardio-respiratory system) scores overall, suggesting better stabilization on three physiological parameters. However, there were few infants, and the clinical significance of the test was unclear because trialists reported averages of multiple time points (standardized mean difference (SMD) 1.24, 95% CI 0.76 to 1.72; participants = 81; studies = two; GRADE low quality). SSC infants had higher blood glucose levels (MD 10.49, 95% CI 8.39 to 12.59; participants = 144; studies = three; GRADE: low quality), but similar temperature to infants in standard care (MD 0.30 degree Celcius (°C) 95% CI 0.13 °C to 0.47 °C; participants = 558; studies = six; I² = 88%; GRADE: low quality). Women and infants after cesarean birthWomen practicing SSC after cesarean birth were probably more likely to breast feed one to four months post birth and to breast feed successfully (IBFAT score), but analyses were based on just two trials and few women. Evidence was insufficient to determine whether SSC could improve breastfeeding at other times after cesarean. Single trials contributed to infant respiratory rate, maternal pain and maternal state anxiety with no power to detect group differences. SubgroupsWe found no differences for any outcome when we compared times of initiation (immediate less than 10 minutes post birth versus early 10 minutes or more post birth) or lengths of contact time (60 minutes or less contact versus more than 60 minutes contact).Authors' conclusionsEvidence supports the use of SSC to promote breastfeeding. Studies with larger sample sizes are necessary to confirm physiological benefit for infants during transition to extra-uterine life and to establish possible dose-response effects and optimal initiation time. Methodological quality of trials remains problematic, and small trials reporting different outcomes with different scales and limited data limit our confidence in the benefits of SSC for infants. Our review included only healthy infants, which limits the range of physiological parameters observed and makes their interpretation difficult

Challenges with Delivering Gender-Specific and Comprehensive Primary Care to Women Veterans

Background The growing presence of women veterans in Veterans Administration (VA) settings has prompted the need for greater attention to clinical proficiency related to women's health (WH) primary care needs. Instead of making appointments for multiple visits or referring patients to a WH clinic or alternate site for gender-specific care, a comprehensive primary care model now allows for women veteran patients be seen by primary care providers (PCPs) who have WH training/experience and can see patients for both primary and WH care in the context of a single visit. However, little is currently known about the barriers and facilitators WH-PCPs face in using this approach to incorporate gender-specific services into women veterans' primary care services. Methods We conducted qualitative in-depth interviews with 22 WH-PCPs at one Midwestern VA Medical Center. All participants were members of one of four outpatient primary care clinics within the main medical center, one off-site satellite clinic, or two off-site community-based outpatient clinics. Results Inductive thematic analysis identified six themes: 1) Time constraints, 2) importance of staff support, 3) necessity of sufficient space and equipment/supplies, 4) perceptions of discomfort among patients with trauma histories, 5) lack of education/training, and 6) challenges with scheduling/logistics. Conclusion Although adequate staff was a key facilitator, the findings suggest that there may be barriers that undermine the ability of VA WH-PCPs to provide high-quality, comprehensive primary and gender-specific care. The nature of these barriers is multifactorial and multilevel in nature, and may therefore require special policy and practice action

Multiple Measures Placement Using Data Analytics: An Implementation and Early Impacts Report

Many incoming college students are referred to remedial programs in math or English based on scores they earn on standardized placement tests. Yet research shows that these tests do not always assess student skills accurately, and colleges that rely on them often assign students to remedial courses who could succeed in college-level courses. Seven community colleges in the State University of New York (SUNY) system are participating in a random assignment study of a multiple measures placement system based on data analytics to determine whether it yields placement determinations that lead to better student outcomes than a system based on test scores alone. This interim report from the Center for the Analysis of Postsecondary Readiness (CAPR) examines the implementation of the alternative placement system at the colleges and presents results on first-term impacts for a subset of the students in the study. The early findings show that: - Many program group students were placed differently than they would have been under the status quo placement system. In math, 14 percent of program group students placed higher than they would have under a test-only system (i.e., in college-level), while 7 percent placed lower (i.e., in remedial). In English, 41.5 percent placed higher, while 6.5 percent placed lower. - Program group students were 3.1 and 12.5 percentage points more likely than control group students to both enroll in and complete (with a grade of C or higher) a college-level math or English course in the first term. - Implementation of the alternative system added roughly $110 per student to status quo fall-term costs for testing and placing students at the colleges; ongoing costs in the subsequent fall term were roughly$40 per student above status quo costs. The final report, to be released in 2019, will examine a range of student outcomes for three cohorts, including completion of introductory college-level courses, persistence, and the accumulation of college credits over the long term

Three-dimensional modeling of a primary health care clinic in Ho, Ghana: its contribution to student engagement, fundraising, and program planning

Improvements in computer-based technologies can be leveraged to enhance engagement of remote stakeholders with the health needs of a geographically distant community. Three-dimensional (3D) modeling offers a platform to create detailed spatial representations through which stakeholders can experience improvements in shared understanding as well as increased involvement in community health projects occurring anywhere in the world. This case study describes the development of a 3D model of a community health clinic in rural Ghana used to encourage fundraising and sustain global engagement among students at Northwestern University. The resulting ‘virtual clinic’ was achieved quickly and at little cost, suggesting a broader utility of 3D modeling for global health practitioners for increasing donor engagement and resource mapping

002-Biodiesel Production from Chlorella Vulgaris and Synechococcus

Fossil fuels are the largest contributors to global climate change, accounting for nearly 75% of total greenhouse gas emissions. A green energy solution can be found in autotrophs, which both sequester carbon in their growth and can be made into biodiesel.Chlorella vulgarishas been studied for lipid extraction and production, both of which were made more efficient through means of culturing the algae in different media and by evaluating the biodiesel produced via IR spectroscopies.Synechococcus,a genus of cyanobacteria that grows prolifically in Conesus Lake, may be an even better source of fuel thanC. vulgarisbecause it grows at a rate nearly twice as fast and is known to be a strong carbon sequester. (This species has not yet been specified, but is believed to be of thevulcanococcusspecies.) Growth ofSynechococcuswas observed in a variety of media and it was determined that BG-11 fosters the most prolific growth.Synechococcusphospholipids will be extracted from dead cells and converted into biodiesel using a transesterification process. Finally, we will compare our results fromSynechococcuswith previous studies onC. vulgaristo determine which organism is the better source of biodiesel

Perceived outcomes of periacetabular osteotomy

Aims: Social media is a popular resource for patients seeking medical information and sharing experiences. periacetabular osteotomy (PAO) is the gold-standard treatment for symptomatic acetabular dysplasia with good long-term outcomes. However, little is known regarding the perceived outcomes of PAO on social media. The aims of this study were to describe the perceived outcomes following PAO using three social media platforms: Facebook, Instagram, and X (formerly known as Twitter). Methods: Facebook, Instagram, and X posts were retrospectively collected from 1 February 2023. Facebook posts were collected from the two most populated interest groups: “periacetabular osteotomy” and “PAO Australia.” Instagram and X posts were queried using the most popular hashtags: #PAOwarrior, #periacetabularosteotomy, #periacetabularosteotomyrecovery, #PAOsurgery, and #PAOrecovery. Posts were assessed for demographic data (sex, race, location), perspective (patient, physician, professional organization, industry), timing (preoperative vs postoperative), and perceived outcome (positive, negative, neutral). Results: A total of 1,054 Facebook posts, 1,003 Instagram posts, and 502 X posts were consecutively assessed from 887 unique authors. The majority (63.3%) of these posts were from patients in the postoperative period, with a median of 84 days postoperatively (interquartile range 20 to 275). The longest follow-up timeframe postoperatively was 20 years. Regarding perceived outcomes, 52.8% expressed satisfaction, 39.7% held neutral opinions, and 7.5% were dissatisfied. Most dissatisfied patients (50.9%) reported pain (chronic or uncontrolled acute) as an attributing factor. Conclusion: Most PAO-perceived surgical outcomes on social media had a positive tone. Findings also indicate that a small percentage of patients reported negative perceived outcomes. However, dissatisfaction with PAO primarily stemmed from postoperative pain. Social media posts from other sources (physicians, hospitals, professional organizations, etc.) trend towards neutrality. Healthcare providers must consider the social media narratives of patients following PAO, as they may reveal additional outcome expectations and help improve patient-centred care, create informed decision-making, and optimize treatment outcomes