Effects of Monthly Simulation Experiences on Neonatal Resuscitation Confidence and Competency Levels in Nurses

Neonatal resuscitation program (NRP) is a set of interventions that may be performed to assist a newborn after delivery with airway, breathing, and circulation. It is crucial for all members of the healthcare team caring for a newborn to hold this certification and demonstrate competency. Typically, NRP course renewals occur every two years. If delivery situations do not regularly require further implementation of NRP interventions, it may become more difficult for nurses and other members of the healthcare team to feel confident with their skills. The purpose of this study is to explore how monthly simulation experiences in the obstetrics department affect nurses and their confidence and competency levels in neonatal resuscitation

Breastfeeding and the Individual: The Impact of Everyday Stressful Experience and Hormonal Change on Breastfeeding Duration Among Women in São Paulo, Brazil

Breastfeeding offers significant benefits to the breastfed infant as well as the breastfeeding woman. The World Health Organization now recommends exclusive breastfeeding until six months, followed by supplementation and continued breastfeeding to two years or more. Around the world, public health programs endeavour to promote breastfeeding through educational programs. In Brazil, such programming is widespread, and yet less than 30% of women in São Paulo breastfeeding exclusively even to four months post-partum. This study uses a qualitative-quantitative bio-experiential approach to explore the way that stressful experiences and circumstances in the lives of low-income women from the Eastern Zone of São Paulo, Brazil, influence their decision to wean or supplement their infant before 12 weeks post-partum. Sixty-five first-time mothers participated in a 12-week longitudinal study of life stressors and breastfeeding practice. Participants were asked to complete one pre-partum and six post-partum interviews. Narrative and biological data were collected from each participant at each interview. Statistical analysis revealed that among these participants the breastfeeding hormone oxytocin did not mediate breastfeeding duration. Oxytocin appeared to act as a biomarker of stressful experience, while Epstein-Barr Virus antibody titre, a commonly used biological measure of psychosocial stress, did not. Unplanned pregnancy, older age and higher mean oxytocin level were statistically associated with weaned outcome at 12 weeks. Unplanned pregnancy, older age, higher mean oxytocin level, higher mean satisfaction score regarding financial situation and lower mean satisfaction score regarding interpersonal factors were associated with decreased duration of any breastfeeding. Unplanned pregnancy, older age and lower mean satisfaction score regarding interpersonal factors were associated with decreased duration of exclusive breastfeeding. Ethnographic analysis revealed that the effect of unplanned pregnancy may be connected to the discourse of the self-sacrificial, child-centric “good mother.” Exclusive breastfeeding was seen as a hallmark of this idealised maternal type. Single women with unplanned pregnancies expressed a great deal of ambivalence towards their own maternity and toward the somewhat unobtainable good mother ideal, especially with relation to the physical and psychological challenges breastfeeding. Women’s ambivalence appeared to influence their decisions to supplement or wean their infants by or before 12 weeks post-partum

Biologically normal sleep in the mother‐infant dyad

Objectives We examine infant sleep from evolutionary, historico‐cultural, and statistical/epidemiological perspectives and explore the distinct conceptions of “normal” produced by each. We use data from the “Sleeping Like a Baby” study to illustrate how these perspectives influence the ideals and practices of new parents. Methods The “Sleeping Like a Baby” study investigated maternal–infant sleep in north‐east England. Sleep data for exclusively breastfeeding (EBF) and formula‐feeding (EFF) dyads were captured every 2 weeks from 4 to 18 weeks postpartum through actigraphy and maternal report. Mothers also reported their infant sleep ideals and practices. Results explore objective and maternally‐reported infant sleep parameters, and concordance of maternal ideals and practices with public health guidance. Results Comparison of sleep measures showed that mothers overestimate infant sleep duration compared with actigraphy; EFF mothers' reports were significantly more inaccurate than those of EBF mothers. For infants moved to a separate bedroom, maternally‐reported sleep increases were not borne out by actigraphy. Across the study period, concordance of maternal ideal sleep location with public health recommendations occurred on average for 54% of mothers, while concordance in practice fell from 75% at 4–8 weeks to 67% at 14–18 weeks. Discordance for EBF dyads occurred due to bedsharing, and for EFF dyads due to infants sleeping in a room alone. Conclusions Beliefs about “normal” infant sleep influence parents' perceptions and practices. Clinical and scientific infant sleep discourses reinforce dominant societal norms and perpetuate these beliefs, but biological and evolutionary views on infant sleep norms are beginning to gain traction with parents and health practitioners

Capecitabine-Induced Coronary Vasospasm

Capecitabine, an oral prodrug of 5-fluorouracil (5-FU), is approved for early-stage and advanced colorectal cancer and metastatic breast cancer. Cardiotoxicity of 5-FU is well described in the literature. However, cardiac adverse effects of capecitabine are poorly described. We report a case of coronary vasospasm induced by capecitabine. A 41-year-old female with metastatic breast cancer presented with chest pain 3 days after starting capecitabine. The chest pain was relieved by rest and exacerbated by exertion. Her physical examination was unremarkable except for a rapid heart rate of 100 bpm. Electrocardiogram test showed no acute ischemic changes. Troponin tests were negative. CT angiography of the chest was negative for acute pulmonary embolism. An echocardiogram showed a left ventricular ejection fraction of 60% without any wall motion abnormalities. The chest pain resolved with aspirin and analgesic use. She was discharged following an inconclusive cardiac workup. Further use of capecitabine was discontinued

Provocation of the Non-Place [A Place for Alienation]

The “non-place” is a term used by author Marc Augé to describe a place that is itself not a destination but rather a place of everyday passing, a place of being in-between in which he critically claims we experience alienation. The thesis uses his definition of the non-place to describe Union Station as a threshold into the city, a place of passing in which there is an undeniable sense of alienation. Yet the thesis is critical of Augé’s inadequacy to describe and capture the essential meaning of the non-place, and the significance of its alienation, as he ultimately only describes the conditions particular to our capitalist structures leading to globalization and which though in effect dominate its experience, are nonetheless not of its essence. The thesis turns to social theorist Siegried Kracauer’s text on the “hotel lobby” to truly grasp an understanding of the non-place phenomenon as a place of ambiguity, of infinite possibility out of which we in part choose how to structure relations in society. The ambiguity which Kracauer describes liberates understanding of the non-place from its economic grasp and allows it to be considered as a place where many different relationships can take place with many different structures. Different ways for the conscious city to structure relations in the non-place are investigated. First interpretive narratives identify the structures by which we experience alienation in Union Station’s monumental head house, underground concourses and platforms. Then, similar structures are found in different sites of Toronto where they are reconsidered from a perspective based on connectivity. Various interventions expressed through drawings, photographs and text explore how to re-negotiate these structures through an architectural language that enables instead of denies the experience of contact. The thesis concludes that the ability to create connections is contingent on the ability to accept the unknown and face the fear of things we cannot control. The final design considers the non-place as a place where this paradox can be embodied and its significance drawn out. It proposes to renovate, develop and expand Union Station as an architectural agent of otherness. Responding to the current political crisis which Augé alludes to, the thesis turns the diagram of his argument inside out by providing a resolution to alienation in an architectural expression of its acceptance. Extending upon the ability to engage with new things and be open to deeper connections, at Union Station Toronto can integrate into its fabric a sense of the unknown and include an existential awareness of the outside. A non-place that architecturally manifests its meaning as a place of ambiguity instills a sense of infinite possibility; it becomes a place where we can confront our fears — begin to transcend them — place ourselves at the edge and prepare to experience what is outside our boundaries

Discrepancies in maternal reports of infant sleep vs. actigraphy by mode of feeding

Objectives: Many studies of infant sleep rely solely on parentally-reported data, assuming that parents accurately report their infant’s sleep parameters. The objective of this paper is to examine whether night-time sleep parameters of exclusively breastfed or exclusively formula-fed infants differ, and whether correspondence between parental reports and objective measures varies by feeding type. Methods: Mother-infant dyads intending to breastfeed or formula-feed exclusively for 18 weeks were recruited. Mothers were multiparas and primiparas, aged between 18 and 45 years. Infants were full-term, normal birthweight singletons. Maternal report and actigraphic data on infant sleep were collected fortnightly, from four to 18 weeks postpartum. Data were analysed cross-sectionally using t-tests and GLM analysis to control for interaction between feed-type and sleep location. Results: Actigraphy-assessed infant sleep parameters did not vary by feed-type but parentally reported sleep parameters did. Maternal report and actigraphy data diverged at 10 weeks postpartum and discrepancies were associated with infant feeding type. Compared to actigraphy, maternal reports by formula-feeding mothers (controlling for infant sleep location) over-estimated infant’s Total Sleep Time (TST) at 10 weeks and Longest Sleep Period (LSP) at 10, 12 and 18 weeks. Conclusions: These results raise questions about the outcomes of previous infant sleep studies where accuracy of parentally-reported infant sleep data is assumed. That parental reports of infant sleep vary by feeding type is particularly important for reconsidering previous studies of infant sleep development and intervention studies designed to influence sleep outcomes, especially where feed-type was heterogeneous, but was not considered as an independent variable

Diagnóstico limnológico pesquero de 6 lagunas del partido de Puán : Propuesta de pautas de gestión del recurso

The territory of Puán County encompasses 133 shallow lakes, which resources are barely used. Technical knowledge of the shallow lakes is limited, hence the management policy currently being applied is generic. The aim of this paper is to make a primary proposal for the strategic use of the fisheries, supported by an expeditious diagnostic of various environments. Each shallow lake exhibits particular characteristics. The CPUE ranges from 0 to very abundant. In general, the rate of exploitation is low, producing an excellent yield and high quality fish resources. The trophic chain is short, with relevant zooplankton size and density, sustaining an abundant pejerrey Odontesthes bonariensis population. The services offered to the anglers in the shores are few or nonexistent. Tourism development is scarce in spite of the strong potential. Weaknesses and strengths are analyzed considering different parameters and situations. The use of resources through sport fishing is proposed, targeting on high-income fishermen looking for high quality pejerrey catch in a near pristine shallow lake and enjoying privacy. Such a fisherman demands quality and professionalism in the services received, as well as personal or exclusive attention by providers. On the other hand, those shallow lakes not selected for a sport fishing circuit, can be managed by the local government allowing the catch of pejerrey, controlling the correct use of gill nets, creating more jobs, and also providing fish to the town’s popular kitchens feeding the needy. The potential emergent problems contemplated in the execution of the project are listed and compared to the current situation.Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) - Instituto de Limnología "Dr. Raul A. Ringuelet" (ILPLA

Diagnóstico limnológico pesquero de 6 lagunas del partido de Puán : Propuesta de pautas de gestión del recurso

The territory of Puán County encompasses 133 shallow lakes, which resources are barely used. Technical knowledge of the shallow lakes is limited, hence the management policy currently being applied is generic. The aim of this paper is to make a primary proposal for the strategic use of the fisheries, supported by an expeditious diagnostic of various environments. Each shallow lake exhibits particular characteristics. The CPUE ranges from 0 to very abundant. In general, the rate of exploitation is low, producing an excellent yield and high quality fish resources. The trophic chain is short, with relevant zooplankton size and density, sustaining an abundant pejerrey Odontesthes bonariensis population. The services offered to the anglers in the shores are few or nonexistent. Tourism development is scarce in spite of the strong potential. Weaknesses and strengths are analyzed considering different parameters and situations. The use of resources through sport fishing is proposed, targeting on high-income fishermen looking for high quality pejerrey catch in a near pristine shallow lake and enjoying privacy. Such a fisherman demands quality and professionalism in the services received, as well as personal or exclusive attention by providers. On the other hand, those shallow lakes not selected for a sport fishing circuit, can be managed by the local government allowing the catch of pejerrey, controlling the correct use of gill nets, creating more jobs, and also providing fish to the town’s popular kitchens feeding the needy. The potential emergent problems contemplated in the execution of the project are listed and compared to the current situation.Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) - Instituto de Limnología "Dr. Raul A. Ringuelet" (ILPLA

Diagnóstico limnológico pesquero de 6 lagunas del partido de Puán : Propuesta de pautas de gestión del recurso

The territory of Puán County encompasses 133 shallow lakes, which resources are barely used. Technical knowledge of the shallow lakes is limited, hence the management policy currently being applied is generic. The aim of this paper is to make a primary proposal for the strategic use of the fisheries, supported by an expeditious diagnostic of various environments. Each shallow lake exhibits particular characteristics. The CPUE ranges from 0 to very abundant. In general, the rate of exploitation is low, producing an excellent yield and high quality fish resources. The trophic chain is short, with relevant zooplankton size and density, sustaining an abundant pejerrey Odontesthes bonariensis population. The services offered to the anglers in the shores are few or nonexistent. Tourism development is scarce in spite of the strong potential. Weaknesses and strengths are analyzed considering different parameters and situations. The use of resources through sport fishing is proposed, targeting on high-income fishermen looking for high quality pejerrey catch in a near pristine shallow lake and enjoying privacy. Such a fisherman demands quality and professionalism in the services received, as well as personal or exclusive attention by providers. On the other hand, those shallow lakes not selected for a sport fishing circuit, can be managed by the local government allowing the catch of pejerrey, controlling the correct use of gill nets, creating more jobs, and also providing fish to the town’s popular kitchens feeding the needy. The potential emergent problems contemplated in the execution of the project are listed and compared to the current situation.Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) - Instituto de Limnología "Dr. Raul A. Ringuelet" (ILPLA