Multiple gestation: time interval between delivery of the first and second twins.

Journal ArticleA clinical investigation was undertaken to challenge the commonly accepted view that the interval between the birth of the first and second twins should be preferably within 15 minutes and certainly no more than 30 minutes. During 1981 and 1982, 115 patients with live-born twins at 34 or more weeks' gestation underwent an attempted vaginal delivery at four regional perinatal centers. The interval between vaginal delivery of the first and second twins (mean, 21 minutes, range, one to 134 minutes) was 15 minutes or less in 70 (61%) cases and more than 15 minutes in 45 (39%) cases. Excluding conditions associated primarily with prematurity, all second twins delivered beyond 15 minutes did well despite the delay and had no signs of excess trauma or low five-minute Apgar scores. Maternal complications were also uncommon, although combined vaginal-abdominal delivery was more frequent if there was a delay of more than 15 minutes (eight of 45 versus two of 70, P less than .02). The authors conclude that if there is continuous fetal and uterine monitoring, a time restriction for the delivery interval between the first and second infants is not necessary

Formulation of an Optimum Winter Food-Patch Mix for Bobwhite Quail

Many state game agencies are seeking to improve winter quail food and habitat by means of artificial food-patch plantings. The objective of such plantings is to increase the limited supplies of nutrients available to quail in late winter. Desirable qualities of food species included in the seeding mixture are: low seeding cost, high nutrient and energy content, persistent seeds, and cultivation ease. Presently used mixtures have been formulated in the absence of detailed nutritional analysis and cost-minimization techniques. This paper seeks to demonstrate the utility of modern operations-research technology in such decisions by outlining the procedures for determining the composition of an optimum food-patch mix. This mix will meet nutrient and cultivation requirements at a least-possible cost per acre of food planting. Although a solution is presented, the emphasis of the paper is on the method for obtaining such a solution

Service provision when consumers have nowhere else to go: A grounded theory of consumers' captive service experience

In this research, I propose that while typical service consumers might anticipate fulfillment of their needs and desires coupled with positive service outcomes, consumers of captive services may instead experience service captivity and several other negative outcomes in their service experiences. Captive services are those services that operate with structures and processes that, to varying degrees, limit consumer choice, control, or power. Service captivity refers to a consumer's perception that s/he has no options for obtaining a needed service other than the current provider. While it is often suggested that firms actively manage the service delivery process to improve consumers' service experience perceptions, in captive services power imbalance in favor of the organization can short-circuit the need to do so. The result of this power imbalance is consumer feelings of service captivity. As a result consumers are thought to experience service deficiencies untenable in typical service contexts.To explore these possibilities, a qualitative study is performed. Specifically a grounded theory is developed of consumers' captive service experience. Findings suggest captive service exists and consumers feel service captivity. In this it is found that service concepts seen vital in prior service research do not manifest or manifest differently in a context of captive service. Consumers' service experience is colored by power imbalance in favor of providers. Felt dependency further leads to feelings of powerless and dehumanization. The burden of managing interactions emotionally, relationally, and procedurally shifts to consumers. These outcomes notwithstanding consumers attempt to exert their influence in service interactions, thereby taking back some control of the service experience.Findings in this study expose that providers are sometimes in control rather than the implicitly held notion that consumers always have power in service exchanges. Understanding of "service" in such captive services is provided. Ultimately, the negative outcomes for consumers of this shift in power is delineated and interpreted in relation to existing literature

A simple flip of an obstetrics clerkship lecture focusing on interactive learning

Abstract Objective: To determine the value of interactive learning after a low-tech flip of a traditional lecture during an obstetrics and gynecology clerkship. Design: All third-year medical students completed a flipped learning experience between May 2014 and April 2016. Central to the change was replacement of a mid-clerkship lecture ("late term and prolonged gestation") with interactive learning at seven stations by student pairs (one each on separate obstetrics and gynecology services). Before class, students electronically received a handout that described learning objectives, subject background, and interactive stations. The stations featured manipulative models, instruments, data, and images involving prenatal care, fetal growth and testing, and labor and delivery decision-making. Results: The flipped model was easily executed with proper preparation. The 178 consecutive students completed the two mandated surveys. The median score given by students about the same instructor's effectiveness increased from 4.0 (previous two years) to 4.4 (on a 5-point scale). Compared with traditional lectures by other clerkship faculty, the flipped classroom was judged by students to be easier for understanding and more interactive. Students perceived being more responsible for learning with better recall and application to practice. Conclusions: A low-tech approach to the flipped classroom was easily executed with favorable responses from students about interactive learning

Supplement 20, Part 3, Parasite-Subject Catalogue: Parasites: Trematoda and Cestoda

United States Department of Agriculture, Bureau of Animal Industr

An analysis of a long-lived MCV observed over the Southern Plains using Potential Vorticity diagnostics.

On the morning of 28 May 1998, a mesoscale convectively-generated vortex (MCV) was observed over the Southern Plains. This MCV was evident in the GOES-8 visual satellite imagery resulting in a spectacular picture. An analysis of this event is offered using many data sources, including products available now via the world-wide-web (WWW), the National Center for Environmental Prediction (NCEP) re-analyses, and Eta model initializations. This MCV developed out of a mesoscale convective system (MCS) that existed during 26 and 27 May over Texas. This MCV was associated with reports of severe weather and heavy precipitation over southern Arkansas. While the MCV is shown to have characteristics similar to other MCV events documented, this event is unique in that it maintained it's character, while propagating further east than other events. A dynamical analysis using potential vorticity diagnostics (PV) shows that the mid-latitude vorticity field strengthened at least partially as a result of diabatic heating. Also, the most severe weather was associated with high values of integrated 500 - 300 hPa PV values over the Southern Plains

Severe hypoglycemia during pregnancy: Its frequency and predisposing factors in diabetic women

Severe hypoglycemic episodes, as defined as altered consciousness to the extent that self treatment is impossible, were sought prospectively in pregnant diabetic women. One or more episodes were found in none of 21 gestational onset, insulin-requiring women during their 28 pregnancies but were present in 19 (33%) of the 57 already insulin dependent (Type 1) women during 26 (36%) of their 72 pregnancies. The most common predisposing factors included strict glucose control, anorexia, early morning hours (1200-0900), lack of an adrenergic response and time shortly before the next anticipated meal.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26085/1/0000161.pd

Perspectives and limitations of gene expression profiling in rheumatology: new molecular strategies

The deciphering of the sequence of the human genome has raised the expectation of unravelling the specific role of each gene in physiology and pathology. High-throughput technologies for gene expression profiling provide the first practical basis for applying this information. In rheumatology, with its many diseases of unknown pathogenesis and puzzling inflammatory aspects, these advances appear to promise a significant advance towards the identification of leading mechanisms of pathology. Expression patterns reflect the complexity of the molecular processes and are expected to provide the molecular basis for specific diagnosis, therapeutic stratification, long-term monitoring and prognostic evaluation. Identification of the molecular networks will help in the discovery of appropriate drug targets, and permit focusing on the most effective and least toxic compounds. Current limitations in screening technologies, experimental strategies and bioinformatic interpretation will shortly be overcome by the rapid development in this field. However, gene expression profiling, by its nature, will not provide biochemical information on functional activities of proteins and might only in part reflect underlying genetic dysfunction. Genomic and proteomic technologies will therefore be complementary in their scientific and clinical application