Examining Provider Perceptions and Roles Associated to Breastfeeding Support and Medical Management in Primary Care

Background: Human milk is recommended as the exclusive source of nutrition for all infants in the first six months of life. Current rates of exclusive breastfeeding at six months are well below the public health recommendations (24.9% as of 2015). New mothers may experience many challenges which impact both breastfeeding initiation and duration rates in the postpartum period. Studies indicate that breastfeeding rates improve when women receive a combination of prenatal education coupled with postnatal support. Primary care practitioners in outpatient settings have a unique opportunity to provide lactation education, support, and medical management for their patients to improve outcomes. Research aim/question(s): To develop and validate a survey questionnaire used to assess healthcare provider perceptions and roles related to lactation practices in a primary care setting. Subsequently, to describe the perceptions and roles of practitioners involved in primary care for pregnant, postpartum, and infant populations. Materials and Methods: This research created a cross-sectional survey questionnaire targeting primary care and ancillary providers in outpatient settings. The pilot instrument was both content and face validated through an electronic method using a panel of 18 experts known to work with pregnant and iii lactating populations. The final 58-item instrument was distributed to primary care providers in the Southeastern United States. A total of 38 questions have been reported on in this analysis. The final results for the sample (n = 40) are described utilizing descriptive statistics and frequencies. Results: The pilot instrument consisted of 49 questions while the final instrument expanded to include 58 questions. Results of the survey highlight the majority of primary care providers (76%) believe it is the role of the physician to deliver lactation education, support, and medical management. However, 40% of the respondents reported referring patients to lactation professionals most of the time. Additional analysis of survey variables focused on reasons for referral and clinical barriers to lactation care suggest that integrated care models may be necessary to properly support pregnant, postpartum, and infant populations. Conclusion: Healthcare providers in outpatient settings believe lactation education, support, and medical management is important to provide to their patients. Time is a consistent barrier for point-of-care practices yet the reason for referral are clinically significant for breastfeeding success. Future research is necessary to adequately assess the coordination of care across primary and ancillary providers. Finally, standardized evidence-based practices should be developed for implementation in outpatient care settings

Multiomics modeling of the immunome, transcriptome, microbiome, proteome and metabolome adaptations during human pregnancy.

MotivationMultiple biological clocks govern a healthy pregnancy. These biological mechanisms produce immunologic, metabolomic, proteomic, genomic and microbiomic adaptations during the course of pregnancy. Modeling the chronology of these adaptations during full-term pregnancy provides the frameworks for future studies examining deviations implicated in pregnancy-related pathologies including preterm birth and preeclampsia.ResultsWe performed a multiomics analysis of 51 samples from 17 pregnant women, delivering at term. The datasets included measurements from the immunome, transcriptome, microbiome, proteome and metabolome of samples obtained simultaneously from the same patients. Multivariate predictive modeling using the Elastic Net (EN) algorithm was used to measure the ability of each dataset to predict gestational age. Using stacked generalization, these datasets were combined into a single model. This model not only significantly increased predictive power by combining all datasets, but also revealed novel interactions between different biological modalities. Future work includes expansion of the cohort to preterm-enriched populations and in vivo analysis of immune-modulating interventions based on the mechanisms identified.Availability and implementationDatasets and scripts for reproduction of results are available through: https://nalab.stanford.edu/multiomics-pregnancy/.Supplementary informationSupplementary data are available at Bioinformatics online

Teaching Critical Thinking in Statistics for Natural Resource Education

Graduate education in natural resource fields requires high level critical thinking in specialized areas of interest to the student. This challenge is typically embraced by graduate students who are excited to be learning in the areas of their choice. Most graduate programs in natural resources require students to take a course in statistics or data analysis and natural resources research relies heavily on these tools. But many students have limited experience with quantitative science and that experience may not have been recent. This poses a challenge when teaching courses in statistics. In this presentation I will outline the challenges to teaching and the barriers to learning that can be present for some students in natural resources. I will suggest some approaches to teaching statistics that have been successful in the classroom and outline how different kinds of learning activities can be used together to improve student learning of statistics

A Great Big Melting Pot: Exploring Patterns of Glass Supply, Consumption and Recycling in Roman Coppergate, York

One hundred and ninety three glass fragments from the canabae in York were analysed (first to fourth centuries). They fall into six compositional groups: antimony colourless (Sb), high-manganese (high-Mn), low-manganese (low-Mn), mixed antimony and manganese (Sb–Mn), high iron, manganese and titanium (HIMT) and plant ash. Some groups represent production groups, some of which appear to be in limited supply in this western outpost, but are more prevalent elsewhere, and others reflect changing supply mechanisms. The majority of glasses fall into groups that demonstrate extensive recycling of glass. This has important implications for determining provenance using trace elements and isotopes

The effects of fluid loss on physical performance: A critical review

AbstractPurposeThe purpose of this review was to critically analyse the current evidence investigating the effect of an athlete's hydration status on physical performance.MethodsA literature search of multiple databases was used to identify studies that met the inclusion criteria for this review. The included studies were then critically appraised using the Downs and Black protocol.ResultsNine articles were found to meet the inclusion criteria, with an average score of 79% for methodological quality representative of a “high” standard of research.ConclusionThe evidence suggests that dehydration has a negative impact on physical performance for activities lasting more than 30 s in duration. However dehydration was found to have no significant impact on physical performance for activities lasting less than 15 s in duration

THE RELATIONSHIP BETWEEN FAMILY SUPPORT AND MATERNAL ANXIETY LEVELS WITH FAILURE TO PROVIDE BASIC IMMUNIZATION AS SCHEDULED DURING THE COVID-19 PANDEMIC AT SIPATANA HEALTH CENTER

Imunisasi yaitu suatu upaya untuk meningkatkan kekebalan seseorang secara aktif terhadap suatu penyakit, sehingga bila suatu saat terpajan dengan penyakit tersebut tidak akan sakit atau hanya mengalami sakit ringan. Berdasarkan data dari Dinas Kota Gorontalo menunjukkan bahwa imunisasi pada tahun 2019 ke tahun 2020, memiliki penurunan yang cukup dari pencapaian target 95% setiap tahun. Kebaruan penelitian ini karena meneliti tentang hubungan dukungan keluarga dan tingkat kecemasan ibu dengan kegagalan pemberian imunisasi dasar sesuai jadwal di masa pandemic Covid-19 di Puslesmas Sipatana. Tujuan penelitian untuk mengetahui hubungan keluarga dan tingkat kecemasan ibu dengan kegagalan pemberian imunisasi dasar sesuai jadwal di masa pandemic covid-19 di Puskesmas Sipatana. Metode penelitian ini adalah observasional analitik yaitu dengan pendekatan Cross Sectional.Populasi dan sampel pada penelitian ini adalah ibu yang memiliki bayi 0-12 bulan sebanyak 187 responden. Analisis data menggunakan ujistatistik Chi-Square. Hasil penelitian dalam variabel dukungan keluarga dengan kegagalan pemberian imunisasi yaitu nilai p-value 0,000 atau p ≤ 0,05. Dan  Tingkat Kecemasan Ibu dengan kegagalan pemberian imunisasi yaitu nilai P value 0,0002 atau P ≤ 0,05. Simpulan penelitian berdasarkan perhitungan menggunakan uji statistik Chi-Square bahwa ada hubungan antara dukungan keluarga dan tingkat kecemasan ibu dengan kegagalan pemberian imunisasi sesuai jadwal di masa pandemic Covid-19.Kata Kunci : Imunisasi; Dukungan Keluarga; Tingkat Kecemasan Ibu  AbstractImmunization is an effort to actively increase a person's immunity to a disease so that if one day exposed to the disease will not get sick or only experience mild pain. Data from the Gorontalo City Office shows that immunization from 2019 to 2020 has a sufficient decrease from achieving the target of 95% every year. The novelty of this study is that it examines the relationship between family support and maternal anxiety levels with the failure to provide basic immunizations as scheduled during the Covid-19 pandemic at Puslesmas Sipatana. The purpose of the study was to determine the family relationship and the level of maternal anxiety with the failure to provide primary immunization as scheduled during the COVID-19 pandemic at the Sipatana Health Center. Data analysis using Chi-Square statistical tests. This research method is analytical observational, namely with a Cross-Sectional approach. The population and sample in this study were mothers who had babies 0-12 months, with as many as 187 respondents. The study results in the family support variable with the failure to provide immunization were a p-value of 0.000 or p ≤ 0.05. And the level of maternal anxiety with the inability to provide immunization is a P value of 0.0002 or P ≤ 0.05. Based on calculations using the Chi-Square statistical test, the study concluded that there is a relationship between family support and maternal anxiety levels with the failure to provide immunizations as scheduled during the Covid-19 pandemic.Keywords: Immunization; Family Support,  Mother's Anxiety Level

Spatial Patterns in Forest Understories: Relationships to Overstory Thinning Intensity and Understory Plant Diversity

Amount, spatial distribution, and species composition of understory plant communities have been shown to respond to changes in overstory structure. While response of the amount and composition of understory vegetation to thinning has been investigated in several ecosystems, spatial distributions have received less attention. We investigated spatial statistical techniques to examine associations of patch size of clonal shrubs and annual ruderals as they relate to overstory conditions after thinnings. We assessed the interpretation of empirical semivariograms in describing spatial pattern and whether semivariogram parameters can be useful when comparing impacts of different thinning regimes. We simulated vegetation patterns to test the ability of empirical semivariograms to describe patch sizes and suggest a nonparametric semivariogram range parameter as a metric of patch size. We applied results from the simulations to data from a long-term thinning study, in which intensity and spatial patterns of thinnings varied. We used range parameters from semivariograms of percent cover to compare response of patch sizes among thinning treatments and life forms. Initial results indicated that empirical semivariograms quantified both patch sizes and distance between patches. Nonparametric semivariogram estimates of patch size showed differences among thinning treatments, suggesting that spatial patterns of overstory conditions are influencing spatial distributions of understory vegetation. Patches of selected clonal shrubs were smallest in the treatment with spatially variable thinnings. Overall patch size of clonal shrubs was less strongly associated with thinning treatments than patch size of annual ruderals, likely reflecting differences in mobility between species that mainly regenerate by sprouting versus seeds. We conclude that spatial pattern of understory vegetation is responsive to thinning treatments and empirical semivariograms can provide useful information for developing silvicultural prescriptions

Utilizing small nutrient compounds as enhancers of exercise-induced mitochondrial biogenesis.

Endurance exercise, when performed regularly as part of a training program, leads to increases in whole-body and skeletal muscle-specific oxidative capacity. At the cellular level, this adaptive response is manifested by an increased number of oxidative fibers (Type I and IIA myosin heavy chain), an increase in capillarity and an increase in mitochondrial biogenesis. The increase in mitochondrial biogenesis (increased volume and functional capacity) is fundamentally important as it leads to greater rates of oxidative phosphorylation and an improved capacity to utilize fatty acids during sub-maximal exercise. Given the importance of mitochondrial biogenesis for skeletal muscle performance, considerable attention has been given to understanding the molecular cues stimulated by endurance exercise that culminate in this adaptive response. In turn, this research has led to the identification of pharmaceutical compounds and small nutritional bioactive ingredients that appear able to amplify exercise-responsive signaling pathways in skeletal muscle. The aim of this review is to discuss these purported exercise mimetics and bioactive ingredients in the context of mitochondrial biogenesis in skeletal muscle. We will examine proposed modes of action, discuss evidence of application in skeletal muscle in vivo and finally comment on the feasibility of such approaches to support endurance-training applications in humans

Glass groups, glass supply and recycling in late Roman Carthage

Carthage played an important role in maritime exchange networks during the Roman and late antique periods. One hundred ten glass fragments dating to the third to sixth centuries CE from a secondary deposit at the Yasmina Necropolis in Carthage have been analysed by electron microprobe analysis (EPMA) to characterise the supply of glass to the city. Detailed bivariate and multivariate data analysis identified different primary glass groups and revealed evidence of extensive recycling. Roman mixed antimony and manganese glasses with MnO contents in excess of 250 ppm were clearly the product of recycling, while iron, potassium and phosphorus oxides were frequent contaminants. Primary glass sources were discriminated using TiO2 as a proxy for heavy minerals (ilmenite/spinel), Al2O3 for feldspar and SiO2 for quartz in the glassmaking sands. It was thus possible to draw conclusions about the chronological and geographical attributions of the primary glass types. Throughout much of the period covered in this study, glassworkers in Carthage utilised glass from both Egyptian and Levantine sources. Based on their geochemical characteristics, we conclude that Roman antimony and Roman manganese glasses originated from Egypt and the Levant, respectively, and were more or less simultaneously worked at Carthage in the fourth century as attested by their mixed recycling (Roman Sb-Mn). In the later fourth and early fifth centuries, glasses from Egypt (HIMT) and the Levant (two Levantine I groups) continued to be imported to Carthage, although the Egyptian HIMT is less well represented at Yasmina than in many other late antique glass assemblages. In contrast, in the later fifth and sixth centuries, glass seems to have been almost exclusively sourced from Egypt in the form of a manganese-decolourised glass originally described and characterised by Foy and colleagues (2003). Hence, the Yasmina assemblage testifies to significant fluctuations in the supply of glass to Carthage that require further attention

An immune clock of human pregnancy

The maintenance of pregnancy relies on finely tuned immune adaptations. We demonstrate that these adaptations are precisely timed, reflecting an immune clock of pregnancy in women delivering at term. Using mass cytometry, the abundance and functional responses of all major immune cell subsets were quantified in serial blood samples collected throughout pregnancy. Cell signaling-based Elastic Net, a regularized regression method adapted from the elastic net algorithm, was developed to infer and prospectively validate a predictive model of interrelated immune events that accurately captures the chronology of pregnancy. Model components highlighted existing knowledge and revealed previously unreported biology, including a critical role for the interleukin-2-dependent STAT5ab signaling pathway in modulating T cell function during pregnancy. These findings unravel the precise timing of immunological events occurring during a term pregnancy and provide the analytical framework to identify immunological deviations implicated in pregnancy-related pathologies