Health Reform in Massachusetts as of Fall 2010: Getting Ready for the Affordable Care Act & Addressing Affordability

Provides updated survey findings about trends since fall 2006 in the insurance coverage, healthcare access and use, costs and affordability, financial difficulties, and attitudes toward state healthcare reform among non-elderly adults in Massachusetts

Lensing magnification of supernovae in the GOODS-fields

Gravitational lensing of high-redshift supernovae is potentially an important source of uncertainty when deriving cosmological parameters from the measured brightness of Type Ia supernovae, especially in deep surveys with scarce statistics. Photometric and spectroscopic measurements of foreground galaxies along the lines-of-sight of 33 supernovae discovered with the Hubble Space Telescope, both core-collapse and Type Ia, are used to model the magnification probability distributions of the sources. Modelling galaxy halos with SIS or NFW-profiles and using M/L scaling laws provided by the Faber-Jackson and Tully-Fisher relations, we find clear evidence for supernovae with lensing (de)magnification. However, the magnification distribution of the Type Ia supernovae used to determine cosmological distances matches very well the expectations for an unbiased sample, i.e.their mean magnification factor is consistent with unity. Our results show that the lensing distortions of the supernova brightness can be well understood for the GOODS sample and that correcting for this effect has a negligible impact on the derived cosmological parameters.Comment: 22 pages, 9 figures, accepted for publication by Ap

"You are either with me on this or not": A meta-ethnography of the influence birth partners and care-providers have on coping strategies learned in childbirth education and used by women during labour.

BACKGROUND: Childbirth education, which includes providing information and practical techniques to help manage childbirth, aims to support women and their birth partners. It is unknown how birth partners and care providers influence the utilisation of childbirth education information and techniques during women's labour and birth. AIM: To explore the literature that investigates the influence that birth partners and care-providers have on the application of childbirth education information and techniques used by women during childbirth. METHODS: A meta-ethnography was performed using a systematic synthesis of reciprocal translation and refutational investigation. There were 22 papers included in the final synthesis. Quality appraisal was undertaken using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBIQARI) quality appraisal tool for qualitative studies. FINDINGS: An over-arching theme of 'you are either with me on this or not' emerged from the data, which expressed the positive and negative influences on the use of childbirth education information and techniques during labour and birth. The influence of birth partners was captured in the themes 'stepping up to their full potential' and 'a spare part'. The themes 'in alignment with the woman' and 'managed by another' were conceptualised from the data in relation to care-providers' influence. A theme, 'the right fit', described organisational and contextual influences. CONCLUSION: Birth partners and care-providers who are present during a woman's labour have significant potential to influence her use of childbirth education strategies in labour, which provides important insights for translation of evidence into practice

Complementary therapies for labour and birth: A randomized controlled trial of antenatal integrative medicine for pain management in labour

Objective: To evaluate the effect of an antenatal integrative medicine education programme in addition to usual care for nulliparous women on intrapartum epidural use. Design: Open-label, assessor blind, randomized controlled trial. Setting: 2 public hospitals in Sydney, Australia. Population: 176 nulliparous women with low-risk pregnancies, attending hospital-based antenatal clinics. Methods and intervention: The Complementary Therapies for Labour and Birth protocol, based on the She Births and acupressure for labour and birth courses, incorporated 6 evidence-based complementary medicine techniques: acupressure, visualisation and relaxation, breathing, massage, yoga techniques, and facilitated partner support. Randomisation occurred at 24–36 weeks’ gestation, and participants attended a 2-day antenatal education programme plus standard care, or standard care alone. Main outcome measures: Rate of analgesic epidural use. Secondary: onset of labour, augmentation, mode of birth, newborn outcomes. Results:There was a significant difference in epidural use between the 2 groups: study group (23.9%) standard care (68.7%; risk ratio (RR) 0.37 (95% CI 0.25 to 0.55), p≤0.001). The study group participants reported a reduced rate of augmentation (RR=0.54 (95% CI 0.38 to 0.77), p Conclusions: The Complementary Therapies for Labour and Birth study protocol significantly reduced epidural use and caesarean section. This study provides evidence for integrative medicine as an effective adjunct to antenatal education, and contributes to the body of best practice evidence

Blunt cones in rarefied hypersonic flow: Experiments and Monte-Carlo simulations

The drag coefficients for cones with hot and cold walls and different bluntness ratios have been found experimentally. There is a small wall temperature effect which can be accounted for by the change in the pressure drag that occurs in the free molecular limiting flow. The results from the Monte-Carlo calculations agree well with the experiments and they show that the flow field is characterised by the free molecular behaviour at least as far as Knudsen = 0.02 (based on bade diameter) and that the shear drag is the predominant force. From the experimental results it seems reasonable to conclude that the flow fields are characterised by the free molecular behaviour down to the lowest value of Knudsen number tested, which was 0.006. The nose bluntness effect on the measured drag can be correlated by normalising the coefficient by the value in the free molecular limit and by defining a Knudsen number based on the cone lengt

Near-IR Search for Lensed Supernovae Behind Galaxy Clusters - II. First Detection and Future Prospects

Powerful gravitational telescopes in the form of massive galaxy clusters can be used to enhance the light collecting power over a limited field of view by about an order of magnitude in flux. This effect is exploited here to increase the depth of a survey for lensed supernovae at near-IR wavelengths. A pilot SN search program conducted with the ISAAC camera at VLT is presented. Lensed galaxies behind the massive clusters A1689, A1835 and AC114 were observed for a total of 20 hours split into 2, 3 and 4 epochs respectively, separated by approximately one month to a limiting magnitude J<24 (Vega). Image subtractions including another 20 hours worth of archival ISAAC/VLT data were used to search for transients with lightcurve properties consistent with redshifted supernovae, both in the new and reference data. The feasibility of finding lensed supernovae in our survey was investigated using synthetic lightcurves of supernovae and several models of the volumetric Type Ia and core-collapse supernova rates as a function of redshift. We also estimate the number of supernova discoveries expected from the inferred star formation rate in the observed galaxies. The methods consistently predict a Poisson mean value for the expected number of SNe in the survey between N_SN=0.8 and 1.6 for all supernova types, evenly distributed between core collapse and Type Ia SN. One transient object was found behind A1689, 0.5" from a galaxy with photometric redshift z_gal=0.6 +- 0.15. The lightcurve and colors of the transient are consistent with being a reddened Type IIP SN at z_SN=0.59. The lensing model predicts 1.4 magnitudes of magnification at the location of the transient, without which this object would not have been detected in the near-IR ground based search described in this paper (unlensed magnitude J~25). (abridged)Comment: Accepted by AA, matches journal versio

Finite elements and the discrete variable representation in nonequilibrium Green's function calculations. Atomic and molecular models

In this contribution, we discuss the finite-element discrete variable representation (FE-DVR) of the nonequilibrium Green's function and its implications on the description of strongly inhomogeneous quantum systems. In detail, we show that the complementary features of FEs and the DVR allows for a notably more efficient solution of the two-time Schwinger/Keldysh/Kadanoff-Baym equations compared to a general basis approach. Particularly, the use of the FE-DVR leads to an essential speedup in computing the self-energies. As atomic and molecular examples we consider the He atom and the linear version of H$_3^+$ in one spatial dimension. For these closed-shell models we, in Hartree-Fock and second Born approximation, compute the ground-state properties and compare with the exact findings obtained from the solution of the few-particle time-dependent Schr\"odinger equation.Comment: 12 pages, 3 figures, submitted as proceedings of conference "PNGF IV

Nonequilibrium Green's functions approach to strongly correlated few-electron quantum dots

The effect of electron-electron scattering on the equilibrium properties of few-electron quantum dots is investigated by means of nonequilibrium Green's functions theory. The ground and equilibrium state is self-consistently computed from the Matsubara (imaginary time) Green's function for the spatially inhomogeneous quantum dot system whose constituent charge carriers are treated as spin-polarized. To include correlations, the Dyson equation is solved, starting from a Hartree-Fock reference state, within a conserving (second order) self-energy approximation where direct and exchange contributions to the electron-electron interaction are included on the same footing. We present results for the zero and finite temperature charge carrier density, the orbital-resolved distribution functions and the self-consistent total energies and spectral functions for isotropic, two-dimensional parabolic confinement as well as for the limit of large anisotropy--quasi-one-dimensional entrapment. For the considered quantum dots with N=2, 3 and 6 electrons, the analysis comprises the crossover from Fermi gas/liquid (at large carrier density) to Wigner molecule or crystal behavior (in the low-density limit)

Massage, reflexology and other manual methods for pain management in labour

Background Many women would like to avoid pharmacological or invasive methods of pain management in labour, and thismay contribute towards the popularity of complementary methods of pain management. This review examined the evidence currently available on manual methods, including massage and reflexology, for pain management in labour. This review is an update of the review first published in 2012. Objectives To assess the effect, safety and acceptability of massage, reflexology and other manual methods to manage pain in labour. Search methods For this update, we searched Cochrane Pregnancy and Childbirth’s Trials Register (30 June 2017), the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 6), MEDLINE (1966 to 30 June 2017, CINAHL (1980 to 30 June 2017), the Australian New Zealand Clinical Trials Registry (4 August 2017), Chinese Clinical Trial Registry (4 August 2017), ClinicalTrials.gov, (4 August 2017), the National Center for Complementary and Integrative Health (4 August 2017), theWHO International Clinical Trials Registry Platform (ICTRP) (4 August 2017) and reference lists of retrieved trials. Selection criteria We included randomised controlled trials comparing manual methods with standard care, other non pharmacological forms of pain management in labour, no treatment or placebo. We searched for trials of the following modalities: massage, warm packs, thermal manual methods, reflexology, chiropractic, osteopathy, musculo-skeletal manipulation, deep tissue massage, neuro-muscular therapy, shiatsu, tuina, trigger point therapy, myotherapy and zero balancing. We excluded trials for pain management relating to hypnosis, aromatherapy, acupuncture and acupressure; these are included in other Cochrane reviews. Data collection and analysis Two review authors independently assessed trial quality, extracted data and checked data for accuracy. We contacted trial authors for additional information. We assessed the quality of the evidence using the GRADE approach. Main results We included a total of 14 trials; 10 of these (1055 women) contributed data to meta-analysis. Four trials, involving 274 women, metour inclusion criteria but did not contribute data to the review. Over half the trials had a low risk of bias for random sequence generationand attrition bias. The majority of trials had a high risk of performance bias and detection bias, and an unclear risk of reporting bias.We found no trials examining the effectiveness of reflexology. Massage We found low-quality evidence that massage provided a greater reduction in pain intensity (measured using self-reported pain scales) than usual care during the first stage of labour (standardised mean difference (SMD) −0.81, 95% confidence interval (CI) −1.06 to −0.56, six trials, 362 women). Two trials reported on pain intensity during the second and third stages of labour, and there was evidence of a reduction in pain scores in favour of massage (SMD −0.98, 95% CI −2.23 to 0.26, 124 women; and SMD −1.03, 95% CI −2.17 to 0.11, 122 women). There was very low-quality evidence showing no clear benefit of massage over usual care for the length of labour (in minutes) (mean difference (MD) 20.64, 95% CI −58.24 to 99.52, six trials, 514 women), and pharmacological pain relief (average risk ratio (RR) 0.81, 95% CI 0.37 to 1.74, four trials, 105 women). There was very low-quality evidence showing no clear benefit of massage for assisted vaginal birth (average RR 0.71, 95% CI 0.44 to 1.13, four trials, 368 women) and caesarean section (RR 0.75, 95% CI 0.51 to 1.09, six trials, 514 women). One trial reported less anxiety during the first stage of labour for women receiving massage (MD -16.27, 95% CI −27.03 to −5.51, 60 women). One trial found an increased sense of control from massage (MD 14.05, 95% CI 3.77 to 24.33, 124 women, low-quality evidence). Two trials examining satisfaction with the childbirth experience reported data on different scales; both found more satisfaction with massage, although the evidence was low quality in one study and very low in the other. Warm packs We found very low-quality evidence for reduced pain (Visual Analogue Scale/VAS) in the first stage of labour (SMD −0.59, 95%CI −1.18 to −0.00, three trials, 191 women), and the second stage of labour (SMD −1.49, 95% CI −2.85 to −0.13, two trials,128 women). Very low-quality evidence showed reduced length of labour (minutes) in the warm-pack group (MD −66.15, 95% CI −91.83 to −40.47; two trials; 128 women). Thermal manual methods One trial evaluated thermal manual methods versus usual care and found very low-quality evidence of reduced pain intensity during The first phase of labour for women receiving thermal methods (MD −1.44, 95% CI −2.24 to −0.65, one trial, 96 women). There was a reduction in the length of labour (minutes) (MD −78.24, 95% CI −118.75 to −37.73, one trial, 96 women, very low-quality evidence). There was no clear difference for assisted vaginal birth (very low-quality evidence). Results were similar for cold packs versus usual care, and intermittent hot and cold packs versus usual care, for pain intensity, length of labour and assisted vaginal birth. Music One trial that compared manual methods with music found very low-quality evidence of reduced pain intensity during labour in the massage group (RR 0.40, 95% CI 0.18 to 0.89, 101 women). There was no evidence of benefit for reduced use of pharmacological pain relief (RR 0.41, 95% CI 0.16 to 1.08, very low-quality evidence). Of the seven outcomes we assessed using GRADE, only pain intensity was reported in all comparisons. Satisfaction with the childbirthexperience, sense of control, and caesarean section were rarely reported in any of the comparisons. Authors’ conclusions Massage, warm pack and thermal manual methods may have a role in reducing pain, reducing length of labour and improving women’s sense of control and emotional experience of labour, although the quality of evidence varies from low to very low and few trials reported on the keyGRADE outcomes. Few trials reported on safety as an outcome. There is a need for further research to address these outcomes and to examine the effectiveness and efficacy of these manual methods for pain management

Gastro-oesophageal reflux: A mixed methods study of infants admitted to hospital in the first 12months following birth in NSW (2000-2011)

© 2018 The Author(s). Background: Gastro-oesophageal reflux (GOR) is common in infants. When the condition causes pathological symptoms and/or complications it is considered gastro-oesophageal reflux disease (GORD). It appears to be increasingly diagnosed and causes great distress in the first year of infancy. In New South Wales (NSW), residential parenting services support families with early parenting difficulties. These services report a large number of babies admitted with a label of GOR/GORD. The aim of this study was to explore the maternal and infant characteristics, obstetric interventions, and reasons for clinical reporting of GOR/GORD in NSW in the first 12months following birth (2000-2011). Methods: A three phase, mixed method sequential design was used. Phase 1 included a linked data population based study (n=869,188 admitted babies). Phase 2 included a random audit of 326 medical records from admissions to residential parenting centres in NSW (2013). Phase 3 included eight focus groups undertaken with 45 nurses and doctors working in residential parenting centres in NSW. Results: There were a total of 1,156,020 admissions recorded of babies in the first year following birth, with 11,513 containing a diagnostic code for GOR/GORD (1% of infants admitted to hospitals in the first 12months following birth). Babies with GOR/GORD were also more likely to be admitted with other disorders such as feeding difficulties, sleep problems, and excessive crying. The mothers of babies admitted with a diagnostic code of GOR/GORD were more likely to be primiparous, Australian born, give birth in a private hospital and have: a psychiatric condition; a preterm or early term infant (37-or-38weeks); a caesarean section; an admission of the baby to SCN/NICU; and a male infant. Thirty six percent of infants admitted to residential parenting centres in NSW had been given a diagnosis of GOR/GORD. Focus group data revealed two themes: "It is over diagnosed" and "A medical label is a quick fix, but what else could be going on?" Conclusions: Mothers with a mental health disorder are nearly five times as likely to have a baby admitted with GOR/GORD in the first year after birth. We propose a new way of approaching the GOR/GORD issue that considers the impact of early birth (immaturity), disturbance of the microbiome (caesarean section) and mental health (maternal anxiety in particular)