Women’s use of Preventive Primary Care in the Late Postpartum Period

The literature has limited data on how women access health care after the traditional postpartum period (postpartum). Modeled after a paper by Bryant (2016), this project assesses the prevalence of primary care visits in the late postpartum period (LPP)(60- 730 days postpartum). Study objectives included (1) Identify demographics of general delivering population at UVMMC compared to patients with UVM-affiliated primary care provider (UVMPCP). (2) Understand how the general delivering population uses the UVMHN LPP (3) Among women with a UVM-affiliated PCP, identify the prevalence of preventive care visits in the LPP. (4) Identify characteristics associated with LPP visit attendance. Hypothesis: Women with an established PCP prior to pregnancy are more likely to attend preventive PCP LPP visits. This was a retrospective cohort study for all women who delivered at UVMMC between 7/1/2015-6/30/2017. Data was extracted from Epic EMR. During the study period, 4169 women had one singleton pregnancy, 3413 (82%) had a known PCP, and 1279 (31%) had UVMPCP. 2535 (61%) of all delivering singleton women and 1112 (87%) of UVMPCP women had at least one clinical visit within UVMHN in the LPP. 959 (75%) of UVMPCP women had a LPP PCP visit, and 382 patients (30%) had preventative PCP LPP visits. Our hypothesis was rejected (OR 0.930), but attending any LPP PCP visit was associated with having a PCP established prior to pregnancy (OR 1.684). Attending preventive PCP visit was associated with having the same delivering provider as PCP (OR 1.742), a pre-pregnancy PCP visit (OR 1.460), a PCP visit during prenatal time (OR 1.459), ED visit early postpartum period (OR 0.402), a fetal or neonatal demise (OR 0.445), being single (0.601), and with public insurance (OR 0.489). Further work in understanding these associations will be important in developing improved transition of care models and increasing overall engagement in women’s preventive medicine

Neurodevelopmental outcomes in individuals with fetal alcohol spectrum disorder (FASD) with and without exposure to neglect : clinical cohort data from a national FASD diagnostic clinic

Disentangling the relative developmental impact of prenatal alcohol exposure from postnatal neglect is clinically valuable for informing future service provision. In this study developmental outcomes across groups are compared in a ‘natural experiment’. Methods: Clinical data from 99 persons with fetal alcohol spectrum disorder (FASD) diagnoses were audited. Developmental outcomes (diagnosis of attention deficit hyperactivity disorder, ADHD; social and communication disorder, SCD; or autism spectrum disorder, ASD; Short Sensory Profile, SSP; Vineland II Adaptive Behaviour Scales) were compared across two exposure groups: prenatal alcohol only; and mixed prenatal alcohol and neglect. Results: ADHD (74%) and ASD/SCD (68%) were common, with no significant difference between groups (ADHD, P=0.924; ASD, P=0.742). Vineland age equivalence scores were lower than chronological age (11.1y—prenatal alcohol only—and 12.7y—neglect) across all domains, especially receptive language (3.7y for both groups). Age equivalence did not differ between groups, with the exception of domestic daily living (neglect: 7.7y vs prenatal alcohol only: 5.8y, P=0.027). A probable/definite difference on SSP was more common in the prenatal alcohol only (96% vs 67%, P=0.006). For the individual subscales of SSP, there were no significant differences by neglect category. Discussion: Postnatal neglect in this group did not make the developmental outcome any worse, suggesting that prenatal alcohol influences these outcomes independently. Professionals who support families looking after a child with both FASD and a history of neglect should be aware that the behavioural difficulties are likely to be related to prenatal alcohol exposure and not necessarily reflective of parenting quality

Coupling of marine and continental oxygen isotope records during the Eocene-Oligocene transition

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148587/1/Sheldon_et_al_2016_GSA_Bulletin-EOT_marine-terrestrial_comparison.pd

How doctors diagnose diseases and prescribe treatments: an fMRI study of diagnostic salience

Understanding the brain mechanisms involved in diagnostic reasoning may contribute to the development of methods that reduce errors in medical practice. In this study we identified similar brain systems for diagnosing diseases, prescribing treatments, and naming animals and objects using written information as stimuli. Employing time resolved modeling of blood oxygen level dependent (BOLD) responses enabled time resolved (400 milliseconds epochs) analyses. With this approach it was possible to study neural processes during successive stages of decision making. Our results showed that highly diagnostic information, reducing uncertainty about the diagnosis, decreased monitoring activity in the frontoparietal attentional network and may contribute to premature diagnostic closure, an important cause of diagnostic errors. We observed an unexpected and remarkable switch of BOLD activity within a right lateralized set of brain regions related to awareness and auditory monitoring at the point of responding. We propose that this neurophysiological response is the neural substrate of awareness of one’s own (verbal) response. Our results highlight the intimate relation between attentional mechanisms, uncertainty, and decision making and may assist the advance of approaches to prevent premature diagnostic closure

Association of Osteocalcin and Abdominal Aortic Calcification in Older Women: The Study of Osteoporotic Fractures

Osteocalcin (OC) is produced by osteoblasts and vascular smooth muscle cells. In animal models, serum OC levels are strongly correlated with vascular calcium content, however, the association of OC with vascular calcification in humans is uncertain. The Study of Osteoporotic Fractures (SOF) enrolled community-living women, age ≥65 years. The present study included a subsample of 363 randomly selected SOF participants. Serum total OC was measured by ELISA, and abdominal aortic calcification (AAC) was evaluated on lateral lumbar radiographs. We examined the cross-sectional association between serum OC and AAC. The mean serum OC level was 24 ± 11 ng/ml and AAC was present in 188 subjects (52%). We observed no association of OC and AAC in either unadjusted or adjusted analyses. For example, each standard deviation higher OC level was associated with an odds ratio (OR) for AAC prevalence (AAC score >0) near unity (OR = 1.06; 95% CI, 0.82–1.36) in models adjusted for CVD risk factors. Further adjustment for intact parathyroid hormone, bone-specific alkaline phosphatase, 25-hydroxyvitamin D, and hip and spine bone mineral density did not materially change the results (OR = 1.22; 95% CI, 0.86–1.75). Similarly, higher OC levels were not associated with severity of AAC (P = 0.87). In conclusion, among community-living older women, serum OC is not associated with AAC. These findings suggest that serum OC levels may more closely reflect bone formation than vascular calcification in humans

Part 2 : a qualitative description of participation in an eight-week infant skin integrity study

Background This is the second paper in a two-part series; the first paper was published in volume 29, issue 4 of the British Journal of Midwifery. The qualitative phase of the Baby Skin Integrity Comparison Survey (BaSICS) study was designed to address a dearth of information about research recruitment and retention, and how mothers make decisions about neonatal skincare. Aims The aim of the qualitative phase of the BaSICS study was to explore participants’ experience of participating in the research and how this interrelated with the experience of newborn skincare. Methods Semi-structured, face-to-face or telephone interviews were used to collect data. Interviews were transcribed verbatim. Data analysis used both software and manual methods. Findings Motivation included both altruism and personal benefits. The bespoke smartphone application was a convenient and easy tool for data collection, and being afforded full responsibility for observing and recording infant skin condition increased mothers' awareness of skin changes. Family, friends and the internet were the most commonly used sources of information about baby skincare. Conclusion The qualitative interview component of the BaSICS study provided information that could not have been deduced from the daily survey and final questionnaire alone. This provides valuable guidance for future research in the field of infant skincare

A qualitative study of anticipated barriers and facilitators to the implementation of nurse-delivered alcohol screening, brief intervention, and referral to treatment for hospitalized patients in a Veterans Affairs medical center

Background: Unhealthy alcohol use includes the spectrum of alcohol consumption from risky drinking to alcohol use disorders. Routine alcohol screening, brief intervention (BI) and referral to treatment (RT) are commonly endorsed for improving the identification and management of unhealthy alcohol use in outpatient settings. However, factors which might impact screening, BI, and RT implementation in inpatient settings, particularly if delivered by nurses, are unknown, and must be identified to effectively plan randomized controlled trials (RCTs) of nurse-delivered BI. The purpose of this study was to identify the potential barriers and facilitators associated with nurse-delivered alcohol screening, BI and RT for hospitalized patients. Methods: We conducted audio-recorded focus groups with nurses from three medical-surgical units at a large urban Veterans Affairs Medical Center. Transcripts were analyzed using modified grounded theory techniques to identify key themes regarding anticipated barriers and facilitators to nurse-delivered screening, BI and RT in the inpatient setting. Results: A total of 33 medical-surgical nurses (97% female, 83% white) participated in one of seven focus groups. Nurses consistently anticipated the following barriers to nurse-delivered screening, BI, and RT for hospitalized patients: (1) lack of alcohol-related knowledge and skills; (2) limited interdisciplinary collaboration and communication around alcohol-related care; (3) inadequate alcohol assessment protocols and poor integration with the electronic medical record; (4) concerns about negative patient reaction and limited patient motivation to address alcohol use; (5) questionable compatibility of screening, BI and RT with the acute care paradigm and nursing role; and (6) logistical issues (e.g., lack of time/privacy). Suggested facilitators of nurse-delivered screening, BI, and RT focused on provider- and system-level factors related to: (1) improved provider knowledge, skills, communication, and collaboration; (2) expanded processes of care and nursing roles; and (3) enhanced electronic medical record features. Conclusions: RCTs of nurse-delivered alcohol BI for hospitalized patients should include consideration of the following elements: comprehensive provider education on alcohol screening, BI and RT; record-keeping systems which efficiently document and plan alcohol-related care; a hybrid model of implementation featuring active roles for interdisciplinary generalists and specialists; and ongoing partnerships to facilitate generation of additional evidence for BI efficacy in hospitalized patients

Interactions between downslope flows and a developing cold-air pool

A numerical model has been used to characterize the development of a region of enhanced cooling in an alpine valley with a width of order (Formula presented.) km, under decoupled stable conditions. The region of enhanced cooling develops largely as a region of relatively dry air which partitions the valley atmosphere dynamics into two volumes, with airflow partially trapped within the valley by a developing elevated inversion. Complex interactions between the region of enhanced cooling and the downslope flows are quantified. The cooling within the region of enhanced cooling and the elevated inversion is almost equally partitioned between radiative and dynamic effects. By the end of the simulation, the different valley atmospheric regions approach a state of thermal equilibrium with one another, though this cannot be said of the valley atmosphere and its external environment.Peer reviewe

X-ray spectropolarimetric measurements of the Kerr metric

It is thought that the spacetime geometry around black hole candidates is described by the Kerr solution, but an observational confirmation is still missing. Today, the continuum-fitting method and the analysis of the iron K$\alpha$ line cannot unambiguously test the Kerr paradigm because of the degeneracy among the parameters of the system, in the sense that it is impossible with current X-ray data to distinguish a Kerr black hole from a non-Kerr object with different values of the model parameters. In this paper, we study the possibility of testing the Kerr nature of black hole candidates with X-ray spectropolarimetric measurements. Within our simplified model that does not include the effect of returning radiation, we find that it is impossible to test the Kerr metric and the problem is still the strong correlation between the spin and possible deviations from the Kerr geometry. Moreover, the correlation is very similar to that of other two techniques, which makes the combination of different measurements not very helpful. Nevertheless, our results cannot be taken as conclusive and, in order to arrive at a final answer, the effect of returning radiation should be properly taken into account.Comment: 12 pages, 8 figures. v2: refereed versio