Maternal methadone use in pregnancy : factors associated with the development of neonatal abstinence syndrome and implications for healthcare resources

The objectives of this study were to investigate factors associated with the development of neonatal abstinence syndrome (NAS) and to assess the implications for healthcare resources of infants born to drug-misusing women. Design. Retrospective cohort study from 1 January 2004 to 31 December 2006. Setting. Inner-city maternity hospital providing dedicated multidisciplinary care to drug-misusing women. Four hundred and fifty singleton pregnancies of drugmisusing women prescribed substitute methadone in pregnancy. Development of NAS and duration of infant hospital stay. 45.5% of infants developed NAS requiring pharmacological treatment. The odds ratio of the infant developing NAS was independently related to prescribed maternal methadone dose rather than associated polydrug misuse. Breastfeeding was associated with reduced odds of requiring treatment for NAS (OR 0.55, 95% CI 0.34-0.88). Preterm birth did not influence the odds of the infant receiving treatment for NAS. 48.4% infants were admitted to the neonatal unit (NNU) 40% of these primarily for treatment of NAS. The median total hospital stay for all infants was 10 days (interquartile range 7-17 days). Infants born to methadone-prescribed drug-misusing mothers represented 2.9% of hospital births, but used 18.2% of NNU cot days. Higher maternal methadone dose is associated with a higher incidence of NAS. Pregnant drug-misusing women should be encouraged and supported to breastfeed. Their infants are extremely vulnerable and draw heavily on healthcare resources

Sampling Errors and Confidence Intervals for Order Statistics: Implementing the Family Support Act

The Family Support Act allows states to reimburse child care costs up to the 75th percentile of local market price for child care. States must carry out surveys to estimate these 75th percentiles. This estimation problem raises two major statistical issues: (1) picking a sample design that will allow one to estimate the percentiles cheaply, efficiently and equitably; and (2) assessing the sampling variability of the estimates obtained. For Massa- chusetts, we developed a sampling design that equalized the standard errors of the estimated percentiles across 65 distinct local markets. This design was chosen because state administrators felt public day care providers and child advocates would find it equitable, thus limiting costly appeals. Estimation of standard errors for the sample 75th percentiles requires estimation of the density of the population at the 75th percentile. We implement and compare a number of parametric and nonparametric methods of density estimation. A kernel estimator provides the most reasonable estimates. On the basis of the mean integrated squared error criterion we selected the Epanechnikov kernel and the Sheather-Jones automatic bandwidth selection procedure. Because some of our sample sizes were too small to rely on asymptotics, we also constructed nonparametric confidence intervals using the hypergeometric distrition. For most of our samples, these confidence intervals were similar to those based on the asymptotic standard errors. Substantively we find wide variation in the price of child care, depending on the child's age, type of care and geographic location. For full-time care, the 75th percentiles ranged from $242 per week for infants in child care centers in Boston to$85 per week for family day care in western Massachusetts.

Efficacy of imidacloprid + moxidectin and selamectin topical solutions against the KS1 Ctenocephalides felis flea strain infesting cats

<p>Abstract</p> <p>Background</p> <p>Two studies were conducted to evaluate and compare the efficacy of imidacloprid + moxidectin and selamectin topical solutions against the KS1 flea strain infesting cats. In both studies the treatment groups were comprised of non-treated controls, 6% w/v selamectin (Revolution^®; Pfizer Animal Health) topical solution and 10% w/v imidacloprid + 1% w/v moxidectin (Advantage <it>Multi</it>^®for Cats, Bayer Animal Health) topical solution. All cats were infested with 100 fleas on Days -2, 7, 14, 21, and 28. The difference in the studies was that in study #1 efficacy evaluations were conducted at 24 and 48 hours post-treatment or post-infestation, and in study #2 evaluations were conducted at 12 and 24 hours.</p> <p>Results</p> <p>In study #1 imidacloprid + moxidectin and the selamectin formulation provided 99.8% and 99.0% efficacy at 24 hours post-treatment. On day 28, the 24 hour efficacy of the selamectin formulation dropped to 87.1%, whereas the imidacloprid + moxidectin formulation provided 98.9% efficacy. At the 48 hour assessments following the 28 day infestations, efficacy of the imidacloprid + moxidectin and selamectin formulations was 96.8% and 98.3% respectively. In study # 2 the efficacy of the imidacloprid + moxidectin and selamectin formulations 12 hours after treatment was 100% and 69.4%, respectively. On day 28, efficacy of the imidacloprid + moxidectin and selamectin formulations 12 hours after infestation was 90.2% and 57.3%, respectively. In study #2 both formulations provided high levels of efficacy at the 24 hour post-infestation assessments, with selamectin and imidacloprid + moxidectin providing 95.3% and 97.5% efficacy, following infestations on day 28.</p> <p>Conclusions</p> <p>At the 24 and 48 hour residual efficacy assessments, the imidacloprid + moxidectin and selamectin formulations were similarly highly efficacious. However, the imidacloprid + moxidectin formulation provided a significantly higher rate of flea kill against the KS1 flea strain infesting cats at every 12 hour post-infestation residual efficacy assessment. Both formulations should provide excellent flea control for an entire month on cats.</p

Improved Apparatus for the Measurement of Fluctuations of Air Speed in Turbulent Flow

This report describes recent improvements in the design of the equipment associated with the hot-wire anemometer for the measurement of fluctuating air speeds in turbulent air flow, and presents the results of some experimental investigations dealing with the response of the hot wire to speed fluctuations of various frequencies. Attempts at measuring the frequency of the fluctuations encountered in the Bureau of Standards' 54-inch wind tunnel are also reported. In addition, the difficulties encountered in the use of such apparatus and the precautions found helpful in avoiding them are discussed

Antimicrobial Treatmdent of "Complicated" Intra-Abdominal Infections and The New IDSA Guidelines - A Commentary and an Alternative European Approach According to Clinical Definitions

Recently, an update of the IDSA guidelines for the treatment of complicated intraabdominal infections has been published. No guideline can cater for all variations in ecology, antimicrobial resistance patterns, patient characteristics and presentation, health care and reimbursement systems in many different countries. In the short time the IDSA guidelines have been available, a number of practical clinical issues have been raised by physicians regarding interpretation of the guidelines. The main debatable issues of the new IDSA guidelines are described as follows

Size and shape analysis of error-prone shape data

We consider the problem of comparing sizes and shapes of objects when landmark data are prone to measurement error. We show that naive implementation of ordinary Procrustes analysis that ignores measurement error can compromise inference. To account for measurement error, we propose the conditional score method for matching configurations, which guarantees consistent inference under mild model assumptions. The effects of measurement error on inference from naive Procrustes analysis and the performance of the proposed method are illustrated via simulation and application in three real data examples. Supplementary materials for this article are available online

Spectral geometry of the Steklov problem on orbifolds

We consider how the geometry and topology of a compact $n$-dimensional Riemannian orbifold with boundary relates to its Steklov spectrum. In two dimensions, motivated by work of A. Girouard, L. Parnovski, I. Polterovich and D. Sher in the manifold setting, we compute the precise asymptotics of the Steklov spectrum in terms of only boundary data. As a consequence, we prove that the Steklov spectrum detects the presence and number of orbifold singularities on the boundary of an orbisurface and it detects the number each of smooth and singular boundary components. Moreover, we find that the Steklov spectrum also determines the lengths of the boundary components modulo an equivalence relation, and we show by examples that this result is the best possible. We construct various examples of Steklov isospectral Riemannian orbifolds which demonstrate that these two-dimensional results do not extend to higher dimensions. In addition, we give two- imensional examples which show that the Steklov spectrum does \emph{not} detect the presence of interior singularities nor does it determine the orbifold Euler characteristic. In fact, a flat disk is Steklov isospectral to a cone. In another direction, we obtain upper bounds on the Steklov eigenvalues of a Riemannian orbifold in terms of the isoperimetric ratio and a conformal invariant. We generalize results of B. Colbois, A. El Soufi and A. Girouard, and the fourth author to the orbifold setting; in the process, we gain a sharpness result on these bounds that was not evident in the manifold setting. In dimension two, our eigenvalue bounds are solely in terms of the orbifold Euler characteristic and the number each of smooth and singular boundary components

Differential stabilization of reaction intermediates: specificity checkpoints for M.EcoRI revealed by transient fluorescence and fluorescence lifetime studies

M.EcoRI, a bacterial sequence-specific S-adenosyl-l-methionine-dependent DNA methyltransferase, relies on a complex conformational mechanism to achieve its remarkable specificity, including DNA bending, base flipping and intercalation into the DNA. Using transient fluorescence and fluorescence lifetime studies with cognate and noncognate DNA, we have characterized several reaction intermediates involving the WT enzyme. Similar studies with a bending-impaired, enhanced-specificity M.EcoRI mutant show minimal differences with the cognate DNA, but significant differences with noncognate DNA. These results provide a plausible explanation of the way in which destabilization of reaction intermediates can lead to changes in substrate specificity

Preparation, Maintenance and Utilisation of Maize Silage: A Review

Forage conservation has become an important tool for animal enterprises to ensure an adequate supply of quality feed throughout the year. This in turn contributes to stability in animal production and thus economic performance. Silage is often the preferred preserved fodder when animals are fed adjacent to the storage site. Plant species that are suitable for silage are those that have high dry matter yield per hectare and high digestibility, low buffer capacity and a high amount of water soluble carbohydrates. Whole plant corn has a range of 28 to 42 % of dry matter for about 2 weeks during grain filling, low buffer capacity and a high amount of water-soluble carbohydrates. These characteristics make maize an ideal silage crop. The preparation, storage and utilisation of silage can be divided in four phases - aerobic, respiration, stable and feed out phases. During these four phases losses of dry matter occur. These losses can be divided in unavoidable (i.e. those inherent in the process of production of silage) and avoidable (those that are the result of design and operational inefficiencies in harvest, storage and feed out). Factors that contribute to high quality of silage include harvesting the crop when the soluble carbohydrate (principally sugars) concentration in the crop is high, minimising respiration, achieving and maintaining an effective silage storage environment, maintaining anaerobic conditions during the stable phase, and minimising spoilage losses during the feed out phase. Additives can also be used to optimise the silage storage environment. Acceptance by animals of silage measured as dry matter intake is mainly related to quality of the material, particle length and feeding methods. This paper examines the principles and practices of maize silage preparation, the preservation of its quality in storage and utilisation in animal production