Ohio First Steps for Healthy Babies: A Program Supporting Breastfeeding Practices in Ohio Birthing Hospitals

Background: Ohio First Steps for Healthy Babies (First Steps) is a free, voluntary statewide designation program coadministered by the Ohio Department of Health and the Ohio Hospital Association that promotes breastfeeding-supportive maternity practices aligned with the Baby-Friendly Hospital Initiative (BFHI).Materials and Methods: We examined Ohio birthing hospitals’ participation in First Steps, and changes in breastfeed-ing rates at hospital discharge, over the first 12 quarters of the program (July 15, 2015, to July 14, 2018) for all 110 licensed Ohio birthing hospitals. The 81 (73.6%) that achieved at least 1 step over the study period (designated as First Steps hospitals) were compared to the 29 non-First Steps hospitals, and the 17 that began participation at First Steps startup (July 15, 2015) were identified for additional analysis. Changes in breastfeeding rates were examined using a mixed effects multivariate regression model.Results: Breastfeeding increased significantly over the program period from 73.8% to 76.7% (mean 0.19% per quarter, p = .0002), but without a significant difference in breastfeeding rates between First Steps and non-First Steps hospitals. However, in a pre- and post-program analysis for the 17 hospitals that began participation at First Steps startup (excluding an additional 6 hospitals with BFHI designation), number of quarters in the program, number of steps completed, and number of births in 2015 were significantly associated with breastfeeding rates. Hospitals that completed at least 2 steps every 5 quarters in the First Steps program increased breastfeeding when compared to those not participating in the program.Conclusion: These encouraging results provide a formal evaluation of a best practices BFHI-modelled statewide program

Using Multiple Imputation to Address Missing Values of Hierarchical Data

Missing data may be a concern for data analysis. If it has a hierarchical or nested structure, the SUDAAN package can be used for multiple imputation. This is illustrated with birth certificate data that was linked to the Centers for Disease Control and Prevention’s National Assisted Reproductive Technology Surveillance System database. The Cox-Iannacchione weighted sequential hot deck method was used to conduct multiple imputation for missing/unknown values of covariates in a logistic model

Limiting distributions for explosive PAR(1) time series with strongly mixing innovation

This work deals with the limiting distribution of the least squares estimators of the coefficients a r of an explosive periodic autoregressive of order 1 (PAR(1)) time series X r = a r X r--1 +u r when the innovation {u k } is strongly mixing. More precisely {a r } is a periodic sequence of real numbers with period P \textgreater{} 0 and such that P r=1 |a r | \textgreater{} 1. The time series {u r } is periodically distributed with the same period P and satisfies the strong mixing property, so the random variables u r can be correlated

HIV-1 DNA/MVA vaccination reduces the per exposure probability of infection during repeated mucosal SHIV challenges

Historically, HIV vaccines specifically designed to raise cellular immunity resulted in protection from disease progression but not infection when tested in monkeys challenged with a single high virus exposure. An alternative approach, more analogous to human sexual exposures, is to repetitively challenge immunized monkeys with a much lower dose of virus until systemic infection is documented. Using these conditions to mimic human sexual transmission, we found that a multi-protein DNA/MVA HIV-1 vaccine is indeed capable of protecting rhesus monkeys against systemic infection when repeatedly challenged with a highly heterologous immunodeficiency virus (SHIV). Furthermore, this repetitive challenge approach allowed us to calculate per-exposure probability of infection, an observed vaccine efficacy of 64%, and undertake a systematic analysis for correlates of protection based on exposures needed to achieve infection. Therefore, improved non-human primate models for vaccine efficacy can provide novel insight and perhaps renew expectations for positive outcomes of human HIV clinical trials

Minority HIV-1 Drug Resistance Mutations Are Present in Antiretroviral Treatment–Naïve Populations and Associate with Reduced Treatment Efficacy

Using real-time PCR to detect HIV resistance mutations present at low levels, Jeffrey Johnson and colleagues investigate prevalence and clinical implications of minority transmitted mutations

Prevention of Rectal SHIV Transmission in Macaques by Daily or Intermittent Prophylaxis with Emtricitabine and Tenofovir

Using a repeat-exposure macaque model, Walid Heneine and colleagues find that pre-exposure prophylaxis with combination antiretroviral drugs provides protection against rectal challenge with a SHIV virus

Long-standing nonkin relationships of older adults in the Netherlands and the United States

The main research questions of this study were (1) How long have adults in the Netherlands and the United States known members of their nonkin networks? (2) What are the predictors of long-standing nonkin relationships? and (3) Which predictors are recognizable in both societies? The data came from the NESTOR-LSN survey (3,229 adults aged 55 to 89 years in the Netherlands) and from the Northern California Community Study (n = 1,050, with 225 respondents aged 55 to 91 years in the United States). In both countries, the duration of nonkin relationships was related to the absence of network-disturbing variables (e.g., the number of years since the last move), network-sustaining variables (e.g., distance to nonkin), and other network properties (e.g., homogeneity). Nationally based differences were also observed (e.g., having a car was related to stable relationships only in the United States, and the special integrative functions of exclusive friendships were elicited only in Europe)

On attainable Cramer - Rao type lower bounds for weighted loss functions

Let Y = (Y1,...,Yn) be any random vector, with density [phi] [gamma] ([gamma], [theta]) where [theta] [epsilon] [Phi] [subset of] R1. Suppose that [phi] is regular. Let g(Y) = - [varpi]2log[phi]/[varpi][theta]2. An attainable lower bound for Eg(Y)([theta]-[theta])2 is developed and an application to the first order autoregressive process is cited.optimality maximum likelihood estimators weighted quadratic loss efficiency

On limiting distributions in explosive autoregressive processes

The limiting distribution is obtained for the maximum likelihood estimator in the AR(p) process with a random and nonrandom normalization and all characteristic roots outside the unit circle, purely explosive process. Though these results have been in the literature, proofs have been omitted. A detailed proof of these results will be presented. With a random normalization the limiting distribution is multivariate standard normal.Purely explosive autoregressive process Characteristic roots Jordan normal, canonical form