Supporting Employee Lactation: Do U.S. Workplace Lactation Benefit Mandates Align with Evidence-Based Practice?

Within the United States, there are governmental benefits and policies in place to support breastfeeding mothers as they return to work. However, the effectiveness and inclusiveness of these policies is not always clear. Because of this, breastfeeding at work, in general, and governmental workplace mandates, specifically, often receive negative press and social media attention as women struggle to reconcile their workplace and lactation demands. To provide evidence-based recommendations for how to best support breastfeeding employees, we use an organizational science perspective to review the existing research for evidence on the (1) effectiveness of the existing legal benefits and supports within the US, and (2) barriers or facilitators that impact benefit success. Through this, we identify areas for improvement and provide suggestions for policy

Brucella melitensis VjbR and C12-HSL regulons: contributions of the N-dodecanoyl homoserine lactone signaling molecule and LuxR homologue VjbR to gene expression

<p>Abstract</p> <p>Background</p> <p>Quorum sensing is a communication system that regulates gene expression in response to population density and often regulates virulence determinants. Deletion of the <it>luxR </it>homologue <it>vjbR </it>highly attenuates intracellular survival of <it>Brucella melitensis </it>and has been interpreted to be an indication of a role for QS in <it>Brucella </it>infection. Confirmation for such a role was suggested, but not confirmed, by the demonstrated <it>in vitro </it>synthesis of an auto-inducer (AI) by <it>Brucella </it>cultures. In an effort to further delineate the role of VjbR to virulence and survival, gene expression under the control of VjbR and AI was characterized using microarray analysis.</p> <p>Results</p> <p>Analyses of wildtype <it>B. melitensis </it>and isogenic Δ<it>vjbR </it>transciptomes, grown in the presence and absence of exogenous <it>N</it>-dodecanoyl homoserine lactone (C₁₂-HSL), revealed a temporal pattern of gene regulation with variances detected at exponential and stationary growth phases. Comparison of VjbR and C₁₂-HSL transcriptomes indicated the shared regulation of 127 genes with all but 3 genes inversely regulated, suggesting that C₁₂-HSL functions via VjbR in this case to reverse gene expression at these loci. Additional analysis using a Δ<it>vjbR </it>mutant revealed that AHL also altered gene expression in the absence of VjbR, up-regulating expression of 48 genes and a <it>luxR </it>homologue <it>blxR </it>93-fold at stationary growth phase. Gene expression alterations include previously un-described adhesins, proteases, antibiotic and toxin resistance genes, stress survival aids, transporters, membrane biogenesis genes, amino acid metabolism and transport, transcriptional regulators, energy production genes, and the previously reported <it>fliF </it>and <it>virB </it>operons.</p> <p>Conclusions</p> <p>VjbR and C₁₂-HSL regulate expression of a large and diverse number of genes. Many genes identified as virulence factors in other bacterial pathogens were found to be differently expressed, suggesting an important contribution to intracellular survival of <it>Brucella</it>. From these data, we conclude that VjbR and C₁₂-HSL contribute to virulence and survival by regulating expression of virulence mechanisms and thus controlling the ability of the bacteria to survive within the host cell. A likely scenario occurs via QS, however, operation of such a mechanism remains to be demonstrated.</p

Length polymorphism in the Period 3 gene is associated with sleepiness and maladaptive circadian phase in night‐shift workers

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111752/1/jsr12264.pd

Environmental and biological controls on water and energy exchange in Florida scrub oak and pine flatwoods ecosystems

Scrub oak and pine flatwoods are two contrasting ecosystems common to the humid subtropical climate of Florida. Scrub oak forests are short in stature (<2 m) and occur on well-drained sandy soils, and pine flatwoods are much taller and occur in areas with poorly drained soils. Eddy covariance measurements were made from January 2001 to February 2003 over a scrub oak forest and from January 2002 to February 2003 over an adjacent pine flatwoods located on in central Florida, USA, and exposed to similar atmospheric conditions to evaluate how the dynamics of latent heat (lambda E) and sensible heat (H) exchanges are affected by environmental and biological variables. Annual evapotranspiration (Et) for the scrub oak was 737 and 713 mm in 2001 and 2002, respectively. Et was comparatively higher, 812 mm, in 2002 at the pine flatwoods due to higher soil moisture and leaf area. In both ecosystems, springtime increases in lambda E coincided with increasing leaf area and evaporative demand. However, H was the main energy-dissipating component in the spring due to the seasonal decrease in soil water content in the upper soil profile. In the spring, mean weekly Bowen ratio (beta, i.e. H/lambda E) values reached 1.6 and 1.2 in the scrub oak and pine flatwoods, respectively. With the onset of the summertime rainy season, lambda E became the dominant energy flux and beta fells to < 0.4. In both ecosystems, beta was strongly controlled by the interaction between leaf area and soil moisture. The lowest values of the decoupling coefficient (Omega, 0.2 and 0.25 scrub oak and pine flatwoods, respectively) also occurred during the dry springtime period indicating that surface conductance (g(s)) was the mechanism controlling energy partitioning causing high beta in both ecosystems. Et increases in the spring, when water in the upper soil profile was scarce and strongly retained by soil particles, indicated that plants in both ecosystems obtained water from deeper sources. The results from this research elucidate how energy partitioning differs and is regulated in contrasting ecosystems within the Florida landscape, which is important for refining regional hydrological and climate models

Cost-effectiveness of malaria diagnosis using rapid diagnostic tests compared to microscopy or clinical symptoms alone in Afghanistan

Background Improving access to parasitological diagnosis of malaria is a central strategy for control and elimination of the disease. Malaria rapid diagnostic tests (RDTs) are relatively easy to perform and could be used in primary level clinics to increase coverage of diagnostics and improve treatment of malaria.&lt;p&gt;&lt;/p&gt; Methods A cost-effectiveness analysis was undertaken of RDT-based diagnosis in public health sector facilities in Afghanistan comparing the societal and health sector costs of RDTs versus microscopy and RDTs versus clinical diagnosis in low and moderate transmission areas. The effect measure was ‘appropriate treatment for malaria’ defined using a reference diagnosis. Effects were obtained from a recent trial of RDTs in 22 public health centres with cost data collected directly from health centres and from patients enrolled in the trial. Decision models were used to compare the cost of RDT diagnosis versus the current diagnostic method in use at the clinic per appropriately treated case (incremental cost-effectiveness ratio, ICER).&lt;p&gt;&lt;/p&gt; Results RDT diagnosis of Plasmodium vivax and Plasmodium falciparum malaria in patients with uncomplicated febrile illness had higher effectiveness and lower cost compared to microscopy and was cost-effective across the moderate and low transmission settings. RDTs remained cost-effective when microscopy was used for other clinical purposes. In the low transmission setting, RDTs were much more effective than clinical diagnosis (65.2% (212/325) vs 12.5% (40/321)) but at an additional cost (ICER) of US$4.5 per appropriately treated patient including a health sector cost (ICER) of US$2.5 and household cost of US$2.0. Sensitivity analysis, which varied drug costs, indicated that RDTs would remain cost-effective if artemisinin combination therapy was used for treating both P. vivax and P. falciparum. Cost-effectiveness of microscopy relative to RDT is further reduced if the former is used exclusively for malaria diagnosis. In the health service setting of Afghanistan, RDTs are a cost-effective intervention compared to microscopy.&lt;p&gt;&lt;/p&gt; Conclusions RDTs remain cost-effective across a range of drug costs and if microscopy is used for a range of diagnostic services. RDTs have significant advantages over clinical diagnosis with minor increases in the cost of service provision.&lt;p&gt;&lt;/p&gt

Environmental and biological controls on water and energy exchange in Florida scrub oak and pine flatwoods ecosystems

Scrub oak and pine flatwoods are two contrasting ecosystems common to the humid subtropical climate of Florida. Scrub oak forests are short in stature (\u3c2 \u3em) and occur on well-drained sandy soils, and pine flatwoods are much taller and occur in areas with poorly drained soils. Eddy covariance measurements were made from January 2001 to February 2003 over a scrub oak forest and from January 2002 to February 2003 over an adjacent pine flatwoods located on in central Florida, USA, and exposed to similar atmospheric conditions to evaluate how the dynamics of latent heat (lambda E) and sensible heat (H) exchanges are affected by environmental and biological variables. Annual evapotranspiration (Et) for the scrub oak was 737 and 713 mm in 2001 and 2002, respectively. Et was comparatively higher, 812 mm, in 2002 at the pine flatwoods due to higher soil moisture and leaf area. In both ecosystems, springtime increases in lambda E coincided with increasing leaf area and evaporative demand. However, H was the main energy-dissipating component in the spring due to the seasonal decrease in soil water content in the upper soil profile. In the spring, mean weekly Bowen ratio (beta, i.e. H/lambda E) values reached 1.6 and 1.2 in the scrub oak and pine flatwoods, respectively. With the onset of the summertime rainy season, lambda E became the dominant energy flux and beta fells to \u3c 0.4. In both ecosystems, beta was strongly controlled by the interaction between leaf area and soil moisture. The lowest values of the decoupling coefficient (Omega, 0.2 and 0.25 scrub oak and pine flatwoods, respectively) also occurred during the dry springtime period indicating that surface conductance (g(s)) was the mechanism controlling energy partitioning causing high beta in both ecosystems. Et increases in the spring, when water in the upper soil profile was scarce and strongly retained by soil particles, indicated that plants in both ecosystems obtained water from deeper sources. The results from this research elucidate how energy partitioning differs and is regulated in contrasting ecosystems within the Florida landscape, which is important for refining regional hydrological and climate models

The anxiolytic effects of cognitive behavior therapy for insomnia: preliminary results from a web-delivered protocol

Though the efficacy of cognitive behavior therapy for insomnia (CBTI) is well-established, the paucity of credentialed providers hinders widespread access. Further, the impact of alternatives such as web-delivered CBTI has not been adequately tested on common insomnia comorbidities such as anxiety. Therefore, we assessed the impact of an empirically validated web-delivered CBTI intervention on insomnia and comorbid anxiety symptoms. A sample of 22 adults (49.8±13.5 yo; 62.5% female) with DSM-5 based insomnia were randomized to either an active CBTI treatment group (n = 13) or an information-control (IC) group (n = 9). Participants in the CBTI group underwent a standard CBTI program delivered online by a 'virtual' therapist, whereas the IC group received weekly 'sleep tips' and general sleep hygiene education via electronic mail. All participants self-reported sleep parameters, including sleep onset latency (SOL), insomnia symptoms per the Insomnia Severity Index (ISI), and anxiety symptoms per the Beck Anxiety Inventory (BAI) at both baseline as well as follow- up assessment one week post-treatment. There were no significant differences between the CBTI and IC groups on baseline measures. The CBTI group showed significantly larger reductions in BAI scores (t = 2.6; p &lt; .05; Cohen's d = .8) and ISI scores (t = 2.1; p &lt; .05; Cohen's d = .9) at follow-up than did the IC group. Further, changes in SOL from baseline (62.3±44.0 minutes) to follow-up (22.3±14.4 minutes) in the CBTI group were also significantly greater (t = 2.3; p &lt; .05; Cohen's d = .9) than in the IC group (baseline: 55.0±44.2 minutes; follow-up: 50.±60.2 minutes).This study offers preliminary evidence that a web-delivered CBTI protocol with minimal patient contact can improve comorbid anxiety symptoms among individuals with insomnia

Economic evaluation of a cluster randomized trial of interventions to improve health workers' practice in diagnosing and treating uncomplicated malaria in Cameroon.

BACKGROUND: Malaria rapid diagnostic tests (RDTs) are a valid alternative to malaria testing with microscopy and are recommended for the testing of febrile patients before prescribing an antimalarial. There is a need for interventions to support the uptake of RDTs by health workers. OBJECTIVE: To evaluate the cost-effectiveness of introducing RDTs with basic or enhanced training in health facilities in which microscopy was available, compared with current practice. METHODS: A three-arm cluster randomized trial was conducted in 46 facilities in central and northwest Cameroon. Basic training had a practical session on RDTs and lectures on malaria treatment guidelines. Enhanced training included small-group activities designed to change health workers' practice and reduce the consumption of antimalarials among test-negative patients. The primary outcome was the proportion of febrile patients correctly treated: febrile patients should be tested for malaria, artemisinin combination therapy should be prescribed for confirmed cases, and no antimalarial should be prescribed for patients who are test-negative. Individual patient data were obtained from facility records and an exit survey. Costs were estimated from a societal perspective using project reports and patient exit data. The analysis used bivariate multilevel modeling and adjusted for imbalance in baseline covariates. RESULTS: Incremental cost per febrile patient correctly treated was $8.40 for the basic arm and$3.71 for the enhanced arm. On scale-up, it was estimated that RDTs with enhanced training would save $0.75 per additional febrile patient correctly treated. CONCLUSIONS: Introducing RDTs with enhanced training was more cost-effective than RDTs with basic training when each was compared with current practice

Sleep to Reduce Incident Depression Effectively (STRIDE): study protocol for a randomized controlled trial comparing stepped-care cognitive-behavioral therapy for insomnia versus sleep education control to prevent major depression

BACKGROUND: Prevention of major depressive disorder (MDD) is a public health priority. Strategies targeting individuals at elevated risk for MDD may guide effective preventive care. Insomnia is a reliable precursor to depression, preceding half of all incident and relapse cases. Thus, insomnia may serve as a useful entry point for preventing MDD. Cognitive-behavioral therapy for insomnia (CBT-I) is recommended as the first-line treatment for insomnia, but widespread implementation is limited by a shortage of trained specialists. Innovative stepped-care approaches rooted in primary care can increase access to CBT-I and reduce rates of MDD. METHODS/DESIGN: We propose a large-scale stepped-care clinical trial in the primary care setting that utilizes a sequential, multiple assignment, randomized trial (SMART) design to determine the effectiveness of dCBT-I alone and in combination with clinician-led CBT-I for insomnia and the prevention of MDD incidence and relapse. Specifically, our care model uses digital CBT-I (dCBT-I) as a first-line intervention to increase care access and reduce the need for specialist resources. Our proposal also adds clinician-led CBT-I for patients who do not remit with first-line intervention and need a more personalized approach from specialty care. We will evaluate negative repetitive thinking as a potential treatment mechanism by which dCBT-I and CBT-I benefit insomnia and depression outcomes. DISCUSSION: This project will test a highly scalable model of sleep care in a large primary care system to determine the potential for wide dissemination and implementation to address the high volume of population need for safe and effective insomnia treatment and associated prevention of depression. TRIAL REGISTRATION: ClinicalTrials.gov NCT03322774. Registered on October 26, 2017

Accounting for Calibration Uncertainties in X-ray Analysis: Effective Areas in Spectral Fitting

While considerable advance has been made to account for statistical uncertainties in astronomical analyses, systematic instrumental uncertainties have been generally ignored. This can be crucial to a proper interpretation of analysis results because instrumental calibration uncertainty is a form of systematic uncertainty. Ignoring it can underestimate error bars and introduce bias into the fitted values of model parameters. Accounting for such uncertainties currently requires extensive case-specific simulations if using existing analysis packages. Here we present general statistical methods that incorporate calibration uncertainties into spectral analysis of high-energy data. We first present a method based on multiple imputation that can be applied with any fitting method, but is necessarily approximate. We then describe a more exact Bayesian approach that works in conjunction with a Markov chain Monte Carlo based fitting. We explore methods for improving computational efficiency, and in particular detail a method of summarizing calibration uncertainties with a principal component analysis of samples of plausible calibration files. This method is implemented using recently codified Chandra effective area uncertainties for low-resolution spectral analysis and is verified using both simulated and actual Chandra data. Our procedure for incorporating effective area uncertainty is easily generalized to other types of calibration uncertainties.Comment: 61 pages double spaced, 8 figures, accepted for publication in Ap