Length of Stay after Vaginal Birth: Sociodemographic and Readiness-for-Discharge Factors

Background: The impact of reductions in postpartum length of stay have been widely reported, but factors influencing length of hospital stay after vaginal birth have received less attention. The study purpose was to compare the sociodemographic characteristics and readiness for discharge of new mothers and their newborns at 3 discharge time intervals, and to determine which variables were associated with postpartum length of stay. Methods: The study sample comprised 1,192 mothers who were discharged within 2 postpartum days after uncomplicated vaginal birth at a tertiary perinatal center in the midwestern United States. The sample was divided into 3 postpartum length-of-stay groups: group 1 (18–30 hr), group 2 (31–42 hr), and group 3 (43–54 hr). Sociodemographic and readiness-for-discharge data were collected by self-report and from a computerized hospital information system. Measures of readiness for discharge included perceived readiness (single item and Readiness for Discharge After Birth Scale), documented maternal and neonatal clinical problems, and feeding method. Results: Compared with other groups, the longest length-of-stay group was older; of higher socioeconomic status and education; and with more primiparous, breastfeeding, white, married mothers who were living with the baby’s father, had adequate home help, and had a private payor source. This group also reported greater readiness for discharge, but their newborns had more documented clinical problems during the postbirth hospitalization. In logistic regression modeling, earlier discharge was associated with young age, multiparity, public payor source, low socioeconomic status, lack of readiness for discharge, bottle-feeding, and absence of a neonatal clinical problem. Conclusions: Sociodemographic chracteristics and readiness for discharge (clinical and perceived) were associated with length of postpartum hospital stay. Length of stay is an outcome of a complex interface between patient, provider, and payor influences on discharge timing that requires additional study. Including perceived readiness for discharge in clinical discharge criteria will add an important dimension to assessment of readiness for discharge after birth

Μελέτη επί της τρισδιάστατης απεικόνισης και αυτόματης ανακατασκευής τρισδιάστατων προϊστορικών αγγείων

88 σ.Στην παρούσα διπλωματική εργασία γίνεται, αρχικά, μία αναφορά σε αρχές της θεωρίας των καμπυλών και επιφανειών της διαφορικής γεωμετρίας οι οποίες αποτελούν ένα απαραίτητο μαθηματικό υπόβαθρό της σχετικής προσέγγισης. Δίνεται έμφαση σε βασικές έννοιες, όπως της καμπύλης, της επιφάνειας αλλά και άλλων μεγεθών-εργαλείων που τις συνοδεύουν, ούτως ώστε να γίνει εφικτή η προσέγγιση στο θέμα της αυτόματης ανασυγκρότησης θραυσμάτων. Στην συνέχεια, ακολουθεί περιγραφή της επεξεργασίας, την οποία υπέστησαν τρισδιάστατες απεικονίσεις θραυσμάτων αγγείων, οι οποίες προέρχονται από την τρισδιάστατη σάρωση των πραγματικών θραυσμάτων με τρισδιάστατο σαρωτή. Η παραπάνω επεξεργασία αποτελεί προκαταρκτικό στάδιο για την εφαρμογή μίας νέας μεθόδου η οποία προσφέρει αποτελεσματική λύση στο πρόβλημα της αυτόματης εικονικής ανασυγκρότησης των θραυσμένων αγγείων για την οποία γίνεται αναφορά στη συνέχεια.In this thesis, initially, a report on principles of the theory of curves and surfaces, in differential geometry, takes place. These principles are the mathematical background of this thesis. The understanding of basic concepts such as curve , surface and other sizes–tools which surround them, is emphasized thanks to which the approach to automatic reconstruction of fragments is feasible. Then, follows a description of the processing that was applied in three-dimensional representations of broken vessels. These represantations derived from the three-dimensional scan of the real fragments with three-dimensional scanner. The above process is a preliminary step for the implementation of a new method which is an effective solution to the problem of automatic virtual reconstruction of broken vessels to which reference is made below.Ιωάννης Γ. Κοτζά

Incidence of injury in elite junior Rugby Union: a prospective descriptive study

The high incidence of injury in Rugby Union is well documented, particularly at elite levels of competition. This article describes the incidence and nature of all injuries sustained by elite Western Australian junior Rugby Union players during the 26 weeks up to and including the 1997 National Championship campaign. Informed consent was gained for each participant (n=44) prior to completion of an extensive baseline questionnaire. Exposure and injury data were collected at each training session and game. The injury incidence rate over the 26 week period was 13.26/1000 player hours. Injury data were analysed by phase of play, position, severity and if occurred at games or training. The incidence of injury was significantly associated with the position played (X2 = 67.49, p value = 0.008) and the phase of play in which the injury occurred (X2 = 8.07, p value = 0.042). Tackling was the most dangerous phase of play (52% of injuries) and the most common site of injury was the lower limb (37%). Most injuries occurred during games (56%) and the flanker was the position most at risk of injury (12%).Further research is needed to identify the aetiology of injury at all levels of competition and to use these findings to develop effective injury prevention strategies in this sport. Positionspecific risk factors should also be investigated, as should the mechanism of injury associated with tackling which is the phase of play in which significantly more injuries occur in rugby

Complex sample design effects and inference for mental health survey data

Mental health researchers world-wide are using large-scale sample survey methods to study mental health epidemiology and services utilization in general, non-clinical populations (Alegria et al. in press). This article reviews important statistical methods and software that apply to descriptive and multivariate analysis of data collected in sample surveys. A comparative analysis of mental health surveys in international locations is used to illustrate analysis procedures and ‘design effects’ for survey estimates of population statistics, model parameters and test statistics. This article addresses the following questions. How should a research analyst approach the analysis of sample survey data? Are there software tools available to perform this analysis? Is the use of ‘correct’ survey analysis methods important to interpretation of survey data? It addresses the question of approaches to the analysis of complex sample survey data. The latest developments in software tools for the analysis of complex sample survey data are covered, and empirical examples are presented that illustrate the impact of survey sample design features on the interpretation of confidence intervals and test statistics for univariate and multivariate analyses. Copyright © 1998 Whurr Publishers Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/35145/1/34_ftp.pd

Genomic and environmental selection patterns in two distinct lettuce crop-wild hybrid crosses

Genomic selection patterns and hybrid performance influence the chance that crop (trans)genes can spread to wild relatives. We measured fitness(-related) traits in two different field environments employing two different crop–wild crosses of lettuce. We performed quantitative trait loci (QTL) analyses and estimated the fitness distribution of early- and late-generation hybrids. We detected consistent results across field sites and crosses for a fitness QTL at linkage group 7, where a selective advantage was conferred by the wild allele. Two fitness QTL were detected on linkage group 5 and 6, which were unique to one of the crop–wild crosses. Average hybrid fitness was lower than the fitness of the wild parent, but several hybrid lineages outperformed the wild parent, especially in a novel habitat for the wild type. In early-generation hybrids, this may partly be due to heterosis effects, whereas in late-generation hybrids transgressive segregation played a major role. The study of genomic selection patterns can identify crop genomic regions under negative selection across multiple environments and cultivar–wild crosses that might be applicable in transgene mitigation strategies. At the same time, results were cultivar-specific, so that a case-by-case environmental risk assessment is still necessary, decreasing its general applicability

Identifying symptoms of ovarian cancer: a qualitative and quantitative study

INTRODUCTION: Symptoms of ovarian cancer are often vague and consequently a high proportion of women with ovarian cancer are not referred to the appropriate clinic. OBJECTIVE: To identify diagnostic factors for ovarian cancer. DESIGN: A qualitative and quantitative study. SETTING: Four UK hospitals. SAMPLE: One hundred and twenty-four women referred to hospital with suspected ovarian malignancy. METHODS: Women were interviewed prior to diagnosis (n = 63), or soon after. A thematic analysis was conducted. Emergent symptoms were quantitatively analysed to identify distinguishing features of ovarian cancer. MAIN OUTCOMES: Symptoms in women with and without ovarian cancer. RESULTS: Diagnoses comprised 44 malignancies, 59 benign gynaecological pathologies and 21 normal findings. Of the malignancies, 25 women had stage III or more disease, with an average age of 59 years. The benign/normal cohort was significantly younger (48 years). Multivariate analysis revealed persistent abdominal distension (OR 5.2, 95% CI 1.3-20.5), postmenopausal bleeding (OR 9.2, 95% CI 1.1-76.1), appetite loss (OR 3.2, 95% CI 1.1-9.2), early satiety (OR 5.0, 95% CI 1.6-15.7) and progressive symptoms (OR 3.6, 95% CI 1.3-9.8) as independent, statistically significant variables associated with ovarian cancer. Fluctuating distension was not associated with ovarian cancer (OR 0.4, 95% CI 0-4.1). Women frequently used the term bloating, but this represented two distinct events: persistent abdominal distension and fluctuating distension/discomfort. CONCLUSIONS: Ovarian cancer is not a silent killer. Clinicians should distinguish between persistent and fluctuating distension. Recognition of the significance of symptoms described by women could lead to earlier and more appropriate referral

Incidence and correlates of delirium in a West African mental health clinic

Objective: <br/> <br/> To determine the incidence of delirium in those patients presenting to a psychiatric clinic in Nigeria and to examine if any demographic or clinical variables were correlated with this diagnosis. <br/> <br/> Method <br/> <br/> A prospective survey design; 264 consecutive new referrals to a psychiatric clinic in Nigeria were assessed for the presence of delirium using a standardised diagnostic scale. Data was analysed for normality and appropriate statistical test employed to examine the relationships between the presence of delirium and demographic and clinical variables. <br/> <br/> Results <br/> <br/> Of individuals presenting to the mental health clinics, 18.2% had delirium. No demographic variable was significant regarding the presence or absence of delirium. With regard to clinical variables duration of current symptoms, referral source and the presence of comorbid physical illness were significantly associated with the presence of delirium. Most delirium was due to infections. Nearly all patients with delirium were prescribed psychotropic medication (95.2%), and most attributed their symptoms to a spiritual cause.Conclusion(s) Delirium presents more commonly to psychiatry services in the less developed world compared to the West. Development efforts should focus on recognition and management of delirium to improve outcomes and maximise resource