Utilization of Care by Infants with Neonatal Abstinence Syndrome in Delaware

From 1999-2013, the nationwide incidence of neonatal abstinence syndrome (NAS) due to maternal drug use rose from 1.5/1000 to 6/1000 hospital births. There is a dearth of information regarding what happens to these children when they are discharged. The purpose of this Practice Inquiry Project is to utilize existing Delaware Medicaid data to retrospectively explore the utilization of services and gaps in care for the infant with NAS in the first year of life. Key findings include less than expected well child visits and immunizations along with higher hospital re-admission rates. This represents missed opportunities for care, also demonstrating the need for more robust social supports. Potential for prospective outpatient management and avenues for future research are outlined. Presented at Jefferson Accelerator Zone as completion of doctoral work. Note: Poster available at bottom of pag

Opioid Exposed Mothers and Infants in Delaware: Clinical and Legal Considerations

Drug use is on the rise in Delaware, as demonstrated by the continued increase in infants born with neonatal abstinence syndrome. Thoughful, evidence based, and coordinated approaches are necessary to impact this problem. There is solid evidence that mothers and infants who remain together have improved outcomes. Professional medical and nursing societies are unanimous in support of non-punitive approaches to care. Medical Professionals, legislators, and society in general would benefit from ongoing education on the addiction disease process in order to best care for the increasing number of mother/baby dyads with neonatal abstinence syndrome

Thermal budget of superconducting digital circuits at sub-kelvin temperatures

Superconducting single-flux-quantum (SFQ) circuits have so far been developed and optimized for operation at or above helium temperatures. The SFQ approach, however, should also provide potentially viable and scalable control and read-out circuits for Josephson-junction qubits and other applications with much lower, milli-kelvin, operating temperatures. This paper analyzes the overheating problem which becomes important in this new temperature range. We suggest a thermal model of the SFQ circuits at sub-kelvin temperatures and present experimental results on overheating of electrons and silicon substrate which support this model. The model establishes quantitative limitations on the dissipated power both for "local" electron overheating in resistors and "global" overheating due to ballistic phonon propagation along the substrate. Possible changes in the thermal design of SFQ circuits in view of the overheating problem are also discussed.Comment: 10 pages, 8 figures, submitted to J. Appl. Phy

Elliptic operators in odd subspaces

An elliptic theory is constructed for operators acting in subspaces defined via odd pseudodifferential projections. Subspaces of this type arise as Calderon subspaces for first order elliptic differential operators on manifolds with boundary, or as spectral subspaces for self-adjoint elliptic differential operators of odd order. Index formulas are obtained for operators in odd subspaces on closed manifolds and for general boundary value problems. We prove that the eta-invariant of operators of odd order on even-dimesional manifolds is a dyadic rational number.Comment: 27 page

Adolescent girls’ osteoporosis knowledge and understanding with analysis of their current lifestyle choices

Adolescent girls especially, need to be aware of the possible onset of osteoporosis in future years so that it’s effects can at least be reduced if not totally prevented. Recently, it has been reported that one out of three adolescent girls had neither heard nor read anything about osteoporosis (Gurney, 2007). The aim of this research was to assess osteoporosis awareness and related behaviors amongst adolescent teenage girls with a view to help prevent osteoporosis occurring in later life. One hundred and forty two female students from a secondary comprehensive school aged 12-16 took part in a questionnaire. The questionnaire consisted of 40 questions and was split into four sections: Section A: An assessment of current osteoporosis knowledge. Section B: An assessment of dietary and physical activity knowledge. Section C: An assessment of current dietary intake for participant. Section D: An assessment of current physical activity for participant. General osteoporosis knowledge, risk factors, prevention, lifestyle behaviors, calcium intake, physical activity, smoking and alcohol intake were central aspects within the questionnaire. The following hypothesis was tested: that adolescent girls have adequate osteoporosis, dietary and physical activity knowledge and understanding (Hi). The null hypothesis (Ho) for this research was therefore given that adolescent girls have inadequate osteoporosis, dietary and physical activity knowledge and understanding. Descriptive statistics, using excel were used to tabulate and analyse the data. Section A focused on osteoporosis knowledge. An average of 31% of questions were answered correctly (mean score of 7 out of 23 correct answers and a standard deviation of 4.4). Section B focused on dietary and physical activity knowledge. An average of 57% of questions were answered correctly (mean score of 10 out of 18 correct answers and a standard deviation of 2.3). Section C focused on an assessment of current dietary intake, most calcium consumption amongst the adolescent girls occurred around one to three times a week which consisted on average of seven to twenty one calcium containing products. The results from section C also showed other products such as cakes, buns, biscuits, pizza, cola and fizzy drinks were consumed amongst adolescent girls most frequently two to three times a month. Overall the results from section C showed that most adolescent girls consume calcium rich products more frequently than the other less healthier portions of food. Section D focused on current physical activity levels, most of the adolescent girls spent two to four times a week participating in physical activity. Adolescent girls mostly tended to spend one to two hours per week and one two hours over the weekend watching the television (a relatively small proportion of their time). One to two hours was spent on homework during the week. Over the weekend one to two hours was also spent on homework. The null hypothesis (Ho) that adolescent girls have inadequate knowledge and understanding of osteoporosis was confirmed as the adolescent girls’ current knowledge of osteoporosis was found to be ‘poor’. Their dietary and physical activity knowledge however, was found to be ‘good’. Overall this research supports the null hypothesis. The average percentage of correct answers in sections A and B was 44% equating to ‘poor’ osteoporosis and related dietary and physical activity knowledge. Adolescent girls were generally unaware of osteoporosis issues and are currently doing moderate exercise and have a moderate consumption of calcium rich food, both of which must be increased to prevent the occurrence of osteoporosis in later life. Targeted education programmes are needed and should be aimed at improving osteoporosis knowledge to affect health beliefs and lifestyle choices in a manner appropriate and appealing to these girls. The National Osteoporosis Society is focusing on secondary education awareness in 2010

Alienation, Agency and Authenticity: a Synthesis of Practice and Effects in Student Engagement.

In recent years a number of authors have undertaken extensive reviews of the international research literature to investigate student engagement in higher education. This paper presents the findings of a study that undertook a project to synthesise the qualitative research literature systematically, through the use of qualitative research synthesis. The concepts and themes that have recurred across the student engagement literature which are discussed in terms of four themed approaches to student engagement. c The challenges and opportunities of using the methodology are presented along with providing a number of recommendations for further research regarding integrated approaches to student engagement

Long-range/short-range separation of the electron-electron interaction in density functional theory

By splitting the Coulomb interaction into long-range and short-range components, we decompose the energy of a quantum electronic system into long-range and short-range contributions. We show that the long-range part of the energy can be efficiently calculated by traditional wave function methods, while the short-range part can be handled by a density functional. The analysis of this functional with respect to the range of the associated interaction reveals that, in the limit of a very short-range interaction, the short-range exchange-correlation energy can be expressed as a simple local functional of the on-top pair density and its first derivatives. This provides an explanation for the accuracy of the local density approximation (LDA) for the short-range functional. Moreover, this analysis leads also to new simple approximations for the short-range exchange and correlation energies improving the LDA.Comment: 18 pages, 14 figures, to be published in Phys. Rev.

We can do better: An argument for improved care of the opioid addicted mother-infant dyad

As the number of addicted maternal-infant dyads increases, so does the need for nursing to expand its understanding of the addiction process and the evidencebased interventions that best serve mothers and infants. Nursing attitudes toward the opioid-addicted mother and infant dyad are influenced by knowledge deficits and communication difficulties. Care required encompasses medical, legal, social, and economic perspectives. Professionals and society at large have disagreements regarding whether to approach the phenomenon from a punitive or supportive strategy. Facilities to care for the mother-infant dyad with addiction are limited. Increasing knowledge has great potential for active understanding and ability to impact these vulnerable patients. Policies must be carefully considered and nuanced. Opportunities for research are myriad. Nurses are well positioned to intervene and create positive outcomes for mother-infant dyads experiencing opioid addiction

Perceptions of Neonatal Nurse Practitioner Role Among NICU Nurses

Purpose: The purpose of this project was to examine Neonatal Intensive Care Unit (NICU) nurses’ perceptions of the NNP role and barriers to entering the role. Background: A shortage of neonatal nurse practitioners (NNPs) exists. Hiring NNPs from outside the current NICU staff has resulted in turnover and additional cost. If current nursing staff prepared as NNPs, the organization would benefit; yet few nurses have done so. Reasons that dissuade nurses from pursuing the NNP role have not been adequately examined. Knowing how nurses perceive the NNP role may help to decrease barriers and inform plans to address the problem