Community-level characteristics of high infant mortality: A tool to identify at-risk communities

Infant mortality (IM) rate is a key indicator of population health and has been gradually improving in the United States. However, it is still a public health problem among minority and low-income communities. Maternal factors explain some of the variation, but community-level factors may also be a contributor. This study examines measures to identify a set of indicators that explain variations in IM at the community-level. Data for 77 communities in a city were obtained from local health databases. We used multivariable linear regression models to examine the strength of the association between IM and maternal, population, community wealth, and social capital characteristics. Community-level IM rates ranged from 2.1 – 25.6 deaths per 1,000 live births in 2000-2002. The final model explained 75% of the variation in IM rates at the community-level (R2=0.75). The model included a high percentage of low birth weight babies, a decline in mothers who began prenatal care in the second trimester, an increase in the percentage of Hispanics, increased unemployment rates, an increase in the percentage of veterans, an increased rate of foreign-born residents, and smaller average family sizes. Social capital variables, homicide rate and vacant housing, were also significant in the final model. Identifying communities at risk for high IM rates is imperative to improve maternal and child health outcomes because of shortages in public health resources. The development of a parsimonious set of community-level indicators can assist public health practitioners in targeting their resources to prevent infant mortality in high-risk communities

An Assessment of Knowledge and Attitude Towards Stock Epinephrine Among Kentucky School Nurses

This cross-sectional, pre-post intervention study was designed to gather information on Kentucky School Nurses attitude and knowledge toward non-prescribed epinephrine auto injectors in Kentucky Schools. All 500 members of the Kentucky Schools Nurses Association received a link to the pretest, educational intervention and posttest via email. Of those, 75 nurses responded and 72 were eligible to participate in the study. The data was analyzed through a paired t-test using SPSS. The results showed an increase in level of comfort with epinephrine, although it was not statistically significant. There was a statistical significance between the pretest and posttest when school nurses were asked about legal obligations when administering epinephrine. There was also an increase in knowledge with one question related to hospitalizations showing statistical significance between the pretest and posttest

The Relation Between Language and Social Skills In Children with Down Syndrome: Examination of Pressure Equalization Tube Placement During the Critical Developmental Period

The current study examined the relation among status regarding placement of pressure equalization tubes (PET), expressive language, receptive language, and social skills in children with Down syndrome. Previous research has documented the importance of PET placement for children with Down syndrome who suffer from chronic otitis media during the critical developmental period for language —not only to treat ear infections but also to prevent permanent damage leading to hearing loss. For the current study, the critical developmental period was defined as birth to 36 months. Parents and teachers of three children with Down syndrome (ages 12 to 15 years) completed social skills questionnaires concerning each child’s general and compensatory social skills. A parent demographic and diagnostic form was used to collect data on history of intervention and assessment, hearing impairment, cognitive level, and key demographics of each child. Direct assessment of each child’s expressive language, receptive language, and IQ was conducted by the researcher. No results were significant (likely due to limited power), but effect sizes were large. As predicted (based on effect size), expressive language and receptive language were positively related to social skills. Likewise, if a child did not require PET placement or required PET placement and received it within the critical developmental period, expressive language, receptive language, and general social skills were higher when compared to a child who was determined to need PET placement but did not receive it during the critical developmental period. Potential moderator and mediator models, including the possible role of compensatory social skills, were explored. The results from this pilot study are promising and underscore the importance of continued research that may inform early intervention efforts for children with Down syndrome, particularly regarding the placement of PET for these children

PATHWAYS TO MALADJUSTMENT AND RESILIENCE IN INNER-CITY MINORITY YOUTH: EXAMINING ACADEMIC FAILURE AND HOPELESSNESS AS MEDIATORS BETWEEN CONTEXTUAL RISK FACTORS AND CHILD MALADJUSTMENT FROM A DEVELOPMENTAL PSYCHOPATHOLOGY PERSPECTIVE

Literature has consistently documented links between contextual factors and developmental outcomes in inner city youth. Most of these associations, however, have been cross-sectional in nature. Furthermore, there is only a limited understanding of the pathways contributing to maladjustment and resilience in this population. While ethnographic studies have taken into account factors of academic failure and hopelessness, quantitative studies have lagged. The present study examines these issues by addressing the main question of how the experiences of low-income, African-American children contribute to later maladjustment or resilience, focusing on academic failure and hopelessness as significant mediators in the pathway to later outcomes.Specific aims of the proposed study are to determine whether 1) a hypothesized mediational model of the development of inner-city minority youth is supported as a better fit for the data from a multicohort, longitudinal study, than competing non-mediational models, 2) gender, religiosity, extracurricular involvement, and affiliation with prosocial peers moderate the associations specified within the model, and 3) there is a subgroup within this larger sample with higher levels of hopelessness who are significantly more likely to suffer from the risks and outcomes in the model as compared to their lower hopelessness counterparts. The following document begins with an introduction to outcomes in this population and links between contextual factors and outcomes. This is followed by a section devoted to academic failure and hopelessness as mediators, beginning with a description of why one would expect these to function as contributors to later maladjustment. As a conceptual framework, a model of the development of inner-city youth is presented, and each of its components included in the current study is described. Following this is a section that describes methodological improvements of the current study over existing research, including developmental considerations, multiple domains of risks, and mechanisms driving the associations. Primary questions are stated next. The methods section of the document then identifies the sample and describes the study procedures. Lastly, the results section outlines the findings from the completed analyses, followed by the conclusion which revisits the questions and the results from the current study and suggests directions for future researchers

Implications of a Multicomponent Sleep Program After Brain Injury: A Mixed Methods Study

Decreased sleep can negatively affect mental and physical health and can significantly disrupt participation in daily occupations and leisure interests. Even though sleep is an area of occupation, there is limited evidence on the effectiveness of occupational therapy interventions for sleep. The purpose of this embedded mixed methods research study was to identify how disruptions in sleep affected daily occupational performance and to understand the effectiveness of occupational therapy- directed non-pharmacological sleep interventions for three participants in a community re-entry program for brain injury. This study utilized a single-subject research design during a 4- to 5-week multicomponent sleep program using multiple sleep-related outcome measures and daily sleep diary and Fitbit data. Semi-structured interviews were also utilized. Identified qualitative themes were changes in sleep patterns and living with sleep disturbance. Participants reported decreased energy and fatigue after disrupted sleep but also reported still being able to complete daily occupations. Quantitative results yielded variable changes in sleep, with overall positive responses to interventions noted in a cumulative effect over time. The most significant improvements were in sleep efficiency and total sleep time for all three participants using sleep diary data. Additionally, two participants reported decreased sleepiness and increased functional outcomes after participating in the sleep interventions. In conclusion, simple behavioral, occupational, and environmental adaptations can improve sleep after brain injury. This study also further supports the role of occupational therapy in addressing sleep in education, practice, and research

In memoriam: Silvano Adami

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Stereodivergent, Diels-Alder-initiated organocascades employing α,β-unsaturated acylammonium salts: scope, mechanism, and application.

Chiral α,β-unsaturated acylammonium salts are novel dienophiles enabling enantioselective Diels-Alder-lactonization (DAL) organocascades leading to cis- and trans-fused, bicyclic γ- and δ-lactones from readily prepared dienes, commodity acid chlorides, and a chiral isothiourea organocatalyst under mild conditions. We describe extensions of stereodivergent DAL organocascades to other racemic dienes bearing pendant secondary and tertiary alcohols, and application to a formal synthesis of (+)-dihydrocompactin is described. A combined experimental and computational investigation of unsaturated acylammonium salt formation and the entire DAL organocascade pathway provide a rationalization of the effect of Brønsted base additives and enabled a controllable, diastereodivergent DAL process leading to a full complement of possible stereoisomeric products. Evaluation of free energy and enthalpy barriers in conjunction with experimentally observed temperature effects revealed that the DAL is a rare case of an entropy-controlled diastereoselective process. NMR analysis of diene alcohol-Brønsted base interactions and computational studies provide a plausible explanation of observed stabilization of exo transition-state structures through hydrogen-bonding effects

Chaos in one-dimensional lattices under intense laser fields

A model is investigated where a monochromatic, spatially homogeneous laser field interacts with an electron in a one-dimensional periodic lattice. The classical Hamiltonian is presented and the technique of stroboscopic maps is used to study the dynamical behavior of the model. The electron motion is found to be completely regular only for small field amplitudes, developing a larger chaotic region as the amplitude increases. The quantum counterpart of the classical Hamiltonian is derived. Exact numerical diagonalizations show the existence of universal, random-matrix fluctuations in the electronic energy bands dressed by the laser field. A detailed analysis of the classical phase space is compatible with the statistical spectral analysis of the quantum model. The application of this model to describe transport and optical absorption in semiconductor superlattices submitted to intense infrared laser radiation is proposed.Comment: 9 pages, RevTex 3.0, EPSF (6 figures), to appear in Europhys. J.

The multifrequency behaviour of the recurrent nova RS Ophiuchi

This review concentrates on the multifrequency behaviour of RS Ophiuchi and in particular during its latest outburst. Confirmation of the 1945 outburst, bipolar outflows and its possible fate as a Type Ia Supernova are discussed.Comment: 5 pages, 5 figures, in The Golden Age of Cataclysmic Variables and Related Objects, F. Giovannelli & L. Sabau-Graziati (eds.), Mem. SAIt. 83 N.2 (in press