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

Insulin clearance and the incidence of type 2 diabetes in Hispanics and African Americans: the IRAS Family Study.

ObjectiveWe aimed to identify factors that are independently associated with the metabolic clearance rate of insulin (MCRI) and to examine the association of MCRI with incident type 2 diabetes in nondiabetic Hispanics and African Americans.Research design and methodsWe investigated 1,116 participants in the Insulin Resistance Atherosclerosis Study (IRAS) Family Study with baseline examinations from 2000 to 2002 and follow-up examinations from 2005 to 2006. Insulin sensitivity (S(I)), acute insulin response (AIR), and MCRI were determined at baseline from frequently sampled intravenous glucose tolerance tests. MCRI was calculated as the ratio of the insulin dose over the incremental area under the curve of insulin. Incident diabetes was defined as fasting glucose ≥126 mg/dL or antidiabetic medication use by self-report.ResultsWe observed that S(I) and HDL cholesterol were independent positive correlates of MCRI, whereas fasting insulin, fasting glucose, subcutaneous adipose tissue, visceral adipose tissue, and AIR were independent negative correlates (all P < 0.05) at baseline. After 5 years of follow-up, 71 (6.4%) participants developed type 2 diabetes. Lower MCRI was associated with a higher risk of incident diabetes after adjusting for demographics, lifestyle factors, HDL cholesterol, indexes of obesity and adiposity, and insulin secretion (odds ratio 2.01 [95% CI 1.30-3.10], P = 0.0064, per one-SD decrease in loge-transformed MCRI).ConclusionsOur data showed that lower MCRI predicts the incidence of type 2 diabetes

Novel spin-liquid states in the frustrated Heisenberg antiferromagnet on the honeycomb lattice

Recent experiment on a honeycomb-lattice Heisenberg antiferromagnet (AF) Bi$_3$Mn$_4$O$_{12}$(NO$_3$) revealed a novel spin-liquid-like behavior down to low temperature, which was ascribed to the frustration effect due to the competition between the AF nearest- and next-nearest-neighbor interactions $J_1$ and $J_2$. Motivated by the experiment, we study the ordering of the $J_1$ -$J_2$ frustrated classical Heisenberg AF on a honeycomb lattice both by a low-temperature expansion and a Monte Carlo simulation. The model has been known to possess a massive degeneracy of the ground state, which, however, might be lifted due to thermal fluctuations leading to a unique ordered state, the effect known as 'order-by-disorder'. We find that the model exhibits an intriguing ordering behavior, particularly near the AF phase boundary. The energy scale of the order-by-disorder is suppressed there down to extremely low temperatures, giving rise to exotic spin-liquid states like a "ring-liquid" or a "pancake-liquid" state accompanied by the characteristic spin structure factor and the field-induced antiferromagnetism. We argue that the recent experimental data are explicable if the system is in such exotic spin-liquid states

Statistical and Dynamical Study of Disease Propagation in a Small World Network

We study numerically statistical properties and dynamical disease propagation using a percolation model on a one dimensional small world network. The parameters chosen correspond to a realistic network of school age children. We found that percolation threshold decreases as a power law as the short cut fluctuations increase. We found also the number of infected sites grows exponentially with time and its rate depends logarithmically on the density of susceptibles. This behavior provides an interesting way to estimate the serology for a given population from the measurement of the disease growing rate during an epidemic phase. We have also examined the case in which the infection probability of nearest neighbors is different from that of short cuts. We found a double diffusion behavior with a slower diffusion between the characteristic times.Comment: 12 pages LaTex, 10 eps figures, Phys.Rev.E Vol. 64, 056115 (2001

Overcoming status quo bias in the human brain

Humans often accept the status quo when faced with conflicting choice alternatives. However, it is unknown how neural pathways connecting cognition with action modulate this status quo acceptance. Here we developed a visual detection task in which subjects tended to favor the default when making difficult, but not easy, decisions. This bias was suboptimal in that more errors were made when the default was accepted. A selective increase in subthalamic nucleus (STN) activity was found when the status quo was rejected in the face of heightened decision difficulty. Analysis of effective connectivity showed that inferior frontal cortex, a region more active for difficult decisions, exerted an enhanced modulatory influence on the STN during switches away from the status quo. These data suggest that the neural circuits required to initiate controlled, nondefault actions are similar to those previously shown to mediate outright response suppression. We conclude that specific prefrontal-basal ganglia dynamics are involved in rejecting the default, a mechanism that may be important in a range of difficult choice scenarios

Scaling up kangaroo mother care in South Africa: 'on-site' versus 'off-site' educational facilitation

Background Scaling up the implementation of new health care interventions can be challenging and demand intensive training or retraining of health workers. This paper reports on the results of testing the effectiveness of two different kinds of face-to-face facilitation used in conjunction with a well-designed educational package in the scaling up of kangaroo mother care. Methods : Thirty-six hospitals in the Provinces of Gauteng and Mpumalanga in South Africa were targeted to implement kangaroo mother care and participated in the trial. The hospitals were paired with respect to their geographical location and annual number of births. One hospital in each pair was randomly allocated to receive either 'on-site' facilitation (Group A) or 'off-site' facilitation (Group B). Hospitals in Group A received two on-site visits, whereas delegates from hospitals in Group B attended one off-site, 'hands-on' workshop at a training hospital. All hospitals were evaluated during a site visit six to eight months after attending an introductory workshop and were scored by means of an existing progress-monitoring tool with a scoring scale of 0-30. Successful implementation was regarded as demonstrating evidence of practice (score >10) during the site visit. Results : There was no significant difference between the scores of Groups A and B (p = 0.633). Fifteen hospitals in Group A and 16 in Group B demonstrated evidence of practice. The median score for Group A was 16.52 (range 00.00-23.79) and that for Group B 14.76 (range 07.50-23.29). Conclusion : A previous trial illustrated that the implementation of a new health care intervention could be scaled up by using a carefully designed educational package, combined with face-to-face facilitation by respected resource persons. This study demonstrated that the site of facilitation, either on site or at a centre of excellence, did not influence the ability of a hospital to implement KMC. The choice of outreach strategy should be guided by local circumstances, cost and the availability of skilled facilitators

Singly generated quasivarieties and residuated structures

A quasivariety K of algebras has the joint embedding property (JEP) iff it is generated by a single algebra A. It is structurally complete iff the free countably generated algebra in K can serve as A. A consequence of this demand, called "passive structural completeness" (PSC), is that the nontrivial members of K all satisfy the same existential positive sentences. We prove that if K is PSC then it still has the JEP, and if it has the JEP and its nontrivial members lack trivial subalgebras, then its relatively simple members all belong to the universal class generated by one of them. Under these conditions, if K is relatively semisimple then it is generated by one K-simple algebra. It is a minimal quasivariety if, moreover, it is PSC but fails to unify some finite set of equations. We also prove that a quasivariety of finite type, with a finite nontrivial member, is PSC iff its nontrivial members have a common retract. The theory is then applied to the variety of De Morgan monoids, where we isolate the sub(quasi)varieties that are PSC and those that have the JEP, while throwing fresh light on those that are structurally complete. The results illuminate the extension lattices of intuitionistic and relevance logics

Nonclassical correlations in damped quantum solitons

Using cumulant expansion in Gaussian approximation, the internal quantum statistics of damped soliton-like pulses in Kerr media are studied numerically, considering both narrow and finite bandwidth spectral pulse components. It is shown that the sub-Poissonian statistics can be enhanced, under certain circumstances, by absorption, which damps out some destructive interferences. Further, it is shown that both the photon-number correlation and the correlation of the photon-number variance between different pulse components can be highly nonclassical even for an absorbing fiber. Optimum frequency windows are determined in order to realize strong nonclassical behavior, which offers novel possibilities of using solitons in optical fibers as a source of nonclassically correlated light beams.Comment: 15 pages, 11 PS figures (color

Phases of planar 5-dimensional supersymmetric Chern-Simons theory

In this paper we investigate the large-$N$ behavior of 5-dimensional $\mathcal{N}=1$ super Yang-Mills with a level $k$ Chern-Simons term and an adjoint hypermultiplet. As in three-dimensional Chern-Simons theories, one must choose an integration contour to completely define the theory. Using localization, we reduce the path integral to a matrix model with a cubic action and compute its free energy in various scenarios. In the limit of infinite Yang-Mills coupling and for particular choices of the contours, we find that the free-energy scales as $N^{5/2}$ for $U(N)$ gauge groups with large values of the Chern-Simons 't\,Hooft coupling, $\tilde\lambda\equiv N/k$. If we also set the hypermultiplet mass to zero, then this limit is a superconformal fixed point and the $N^{5/2}$ behavior parallels other fixed points which have known supergravity duals. We also demonstrate that $SU(N)$ gauge groups cannot have this $N^{5/2}$ scaling for their free-energy. At finite Yang-Mills coupling we establish the existence of a third order phase transition where the theory crosses over from the Yang-Mills phase to the Chern-Simons phase. The phase transition exists for any value of $\tilde\lambda$, although the details differ between small and large values of $\tilde\lambda$. For pure Chern-Simons theories we present evidence for a chain of phase transitions as $\tilde\lambda$ is increased. We also find the expectation values for supersymmetric circular Wilson loops in these various scenarios and show that the Chern-Simons term leads to different physical properties for fundamental and anti-fundamental Wilson loops. Different choices of the integration contours also lead to different properties for the loops.Comment: 40 pages, 17 figures, Minor corrections, Published versio

Critical Behavior of the Supersolid transition in Bose-Hubbard Models

We study the phase transitions of interacting bosons at zero temperature between superfluid (SF) and supersolid (SS) states. The latter are characterized by simultaneous off-diagonal long-range order and broken translational symmetry. The critical phenomena is described by a long-wavelength effective action, derived on symmetry grounds and verified by explicit calculation. We consider two types of supersolid ordering: checkerboard (X) and collinear (C), which are the simplest cases arising in two dimensions on a square lattice. We find that the SF--CSS transition is in the three-dimensional XY universality class. The SF--XSS transition exhibits non-trivial new critical behavior, and appears, within a $d=3-\epsilon$ expansion to be driven generically first order by fluctuations. However, within a one--loop calculation directly in $d=2$ a strong coupling fixed point with striking ``non-Bose liquid'' behavior is found. At special isolated multi-critical points of particle-hole symmetry, the system falls into the 3d Ising universality class.Comment: RevTeX, 24 pages, 16 figures. Also available at http://www.cip.physik.tu-muenchen.de/tumphy/d/T34/Mitarbeiter/frey.htm