5,392 research outputs found

    Best Practices in Second Stage Labor Care: Maternal Bearing Down and Positioning

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    Despite evidence of adverse fetal and maternal outcomes from the use of sustained Valsalva bearing down efforts, current second-stage care practices are still characterized by uniform directions to “push” forcefully upon complete dilatation of the cervix while the woman is in a supine position. Directed pushing might slightly shorten the duration of second stage labor, but can also contribute to deoxygenation of the fetus; cause damage to urinary, pelvic, and perineal structures; and challenge a woman’s confidence in her body. Research on the second stage of labor care is reviewed, with a focus on recent literature on maternal bearing down efforts, the “laboring down” approach to care, second-stage duration, and maternal position. Clinicians can apply the scientific evidence regarding the detrimental effects of sustained Valsalva bearing down efforts and supine positioning by individualizing second stage labor care and supporting women’s involuntary bearing down sensations that can serve to guide her behaviors

    Seasonal nitrogen uptake and regeneration in the western coastal Arctic

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    Here, we present the first study to investigate the seasonal importance of amino acid-nitrogen (N) to Arctic near shore microbial communities. We measured primary productivity and the uptake of ammonium, nitrate, urea, and amino acids in two size fractions (\u3e 3 m and approximately 0.7-3 m), as well as ammonium regeneration and nitrification using N-15 and C-13 tracer approaches in the near-shore waters of the Chukchi Sea, during January, April, and August for two consecutive years. At discrete depths, nitrate comprised 46-78% of the total dissolved N pool during January and April but only 2-6% during August. Dissolved organic N (DON) concentrations increased between January and August though the carbon (C):N (mol:mol) of the DON pool declined. Of the substrates tested, amino acids supported the bulk of both N and C nutrition in both size fractions during January and April (ice-covered). Urea generally had the lowest uptake rate under ice-covered conditions; uptake of urea-C was only detectable in August. Though previous Arctic studies focused largely on nitrate, we found nitrate uptake was generally lower than other substrates tested. The sharp decline in nitrate concentration between April and August, however, indicates a drawdown of nitrate during that period. Rates of ammonium uptake were highest in August, when it was the dominant N substrate used. During all sample periods, rates of ammonium regeneration were sufficient to supply ammonium demand. Rates of nitrification varied between sample periods, however, with much higher rates seen in January and April

    A preliminary audit of medical and aid provision in English Rugby union clubs:compliance with Regulation 9

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    BackgroundGoverning bodies are largely responsible for the monitoring and management of risks associated with a safe playing environment, yet adherence to regulations is currently unknown. The aim of this study was to investigate and evaluate the current status of medical personnel, facilities, and equipment in Rugby Union clubs at regional level in England.MethodsA nationwide cross-sectional survey of 242 registered clubs was undertaken, where clubs were surveyed online on their current medical personnel, facilities, and equipment provision, according to regulation 9 of the Rugby Football Union (RFU).ResultsOverall, 91 (45. 04%) surveys were returned from the successfully contacted recipients. Of the completed responses, only 23.61% (n = 17) were found to be compliant with regulations. Furthermore, 30.56% (n = 22) of clubs were unsure if their medical personnel had required qualifications; thus, compliance could not be determined. There was a significant correlation (p = −0.029, r = 0.295) between club level and numbers of practitioners. There was no significant correlation indicated between the number of practitioners/number of teams and number of practitioners/number of players. There were significant correlations found between club level and equipment score (p = 0.003, r = −0.410), club level and automated external defibrillator (AED) access (p = 0.002, r = −0.352) and practitioner level and AED access (p = 0.0001, r = 0.404). Follow-up, thematic analysis highlighted widespread club concern around funding/cost, awareness, availability of practitioners and AED training.ConclusionThe proportion of clubs not adhering overall compliance with Regulation 9 of the RFU is concerning for player welfare, and an overhaul, nationally, is required

    Preliminary estimate of contribution of Arctic nitrogen fixation to the global nitrogen budget

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    Dinitrogen (N-2) fixation is the source of all biologically available nitrogen on earth, and its presence or absence impacts net primary production and global biogeochemical cycles. Here, we report rates of 3.5-17.2 nmol N L-1 d(-1) in the ice-free coastal Alaskan Arctic to show that N-2 fixation in the Arctic Ocean may be an important source of nitrogen to a seasonally nitrogen-limited system. If widespread in surface waters over ice-free shelves throughout the Arctic, N-2 fixation could contribute up to 3.5 Tg N yr(-1) to the Arctic nitrogen budget. At these rates, N-2 fixation occurring in ice-free summer waters would offset up to 27.1% of the Arctic denitrification deficit and contribute an additional 2.7% to N-2 fixation globally, making it an important consideration in the current debate of whether nitrogen in the global ocean is in steady state. Additional investigations of high-latitude marine diazotrophic physiology are required to refine these N-2 fixation estimates

    Weekend admission and mortality for gastrointestinal disorders across England and Wales

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    BACKGROUND: Little has been reported on mortality following admissions at weekends for many gastrointestinal (GI) disorders. The aim was to establish whether GI disorders are susceptible to increased mortality following unscheduled admission on weekends compared with weekdays. METHODS: Record linkage was undertaken of national administrative inpatient and mortality data for people in England and Wales who were hospitalized as an emergency for one of 19 major GI disorders. RESULTS: The study included 2 254 701 people in England and 155 464 in Wales. For 11 general surgical and medical GI disorders there were little, or no, significant weekend effects on mortality at 30 days in either country. There were large consistent weekend effects in both countries for severe liver disease (England: 26·2 (95 per cent c.i. 21·1 to 31·6) per cent; Wales: 32·0 (12·4 to 55·1 per cent) and GI cancer (England: 21·8 (19·1 to 24·5) per cent; Wales: 25·0 (15·0 to 35·9) per cent), which were lower in patients managed by surgeons. Admission rates were lower at weekends than on weekdays, most strongly for severe liver disease (by 43·3 per cent in England and 51·4 per cent in Wales) and GI cancer (by 44·6 and 52·8 per cent respectively). Both mortality and the weekend mortality effect for GI cancer were lower for patients managed by surgeons. DISCUSSION: There is little, or no, evidence of a weekend mortality effect for most major general surgical or medical GI disorders, but large weekend effects for GI cancer and severe liver disease. Lower admission rates at weekends indicate more severe cases. The findings for severe liver disease may suggest a lack of specialist hepatological resources. For cancers, reduced availability of end-of-life care in the community at weekends may be the cause

    Defining language impairments in a subgroup of children with autism spectrum disorder

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    Autism spectrum disorder (ASD) is diagnosed on the basis of core impairments in pragmatic language skills, which are found across all ages and subtypes. In contrast, there is significant heterogeneity in language phenotypes, ranging from nonverbal to superior linguistic abilities, as defined on standardized tests of vocabulary and grammatical knowledge. The majority of children are verbal but impaired in language, relative to age-matched peers. One hypothesis is that this subgroup has ASD and co-morbid specific language impairment (SLI). An experiment was conducted comparing children with ASD to children with SLI and typically developing controls on aspects of language processing that have been shown to be impaired in children with SLI: repetition of nonsense words. Patterns of performance among the children with ASD and language impairment were similar to those with SLI, and contrasted with the children with ASD and no language impairment and typical controls, providing further evidence for the hypothesis that a subgroup of children with ASD has co-morbid SLI. The findings are discussed in the context of brain imaging studies that have explored the neural bases of language impairment in ASD and SLI, and overlap in the genes associated with elevated risk for these disorders.M01 RR00533 - NCRR NIH HHS; R01 DC10290 - NIDCD NIH HHS; U19 DC03610 - NIDCD NIH HH

    Maternal nutrition at conception modulates DNA methylation of human metastable epialleles.

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    In experimental animals, maternal diet during the periconceptional period influences the establishment of DNA methylation at metastable epialleles in the offspring, with permanent phenotypic consequences. Pronounced naturally occurring seasonal differences in the diet of rural Gambian women allowed us to test this in humans. We show that significant seasonal variations in methyl-donor nutrient intake of mothers around the time of conception influence 13 relevant plasma biomarkers. The level of several of these maternal biomarkers predicts increased/decreased methylation at metastable epialleles in DNA extracted from lymphocytes and hair follicles in infants postnatally. Our results demonstrate that maternal nutritional status during early pregnancy causes persistent and systemic epigenetic changes at human metastable epialleles
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