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Objective: Rates of mother's own milk (MOM) provision in the neonatal intensive care unit (NICU) vary widely, despite acceptance as the gold standard for nutrition in preterm infants. Direct breastfeeding (DBF) supports long-term provision of MOM, but factors that support DBF in preterm infants are unknown. The purpose of this study was to identify factors that predict DBF at oral feeding initiation and at NICU discharge. Methods: This was a retrospective cohort study of preterm infants born at ≤ 32 weeks who were receiving MOM at 32 weeks corrected gestational age (cohort 1) and at discharge to home (cohort 2). The primary outcomes were rates of DBF at oral feeding initiation (cohort 1) and at hospital discharge (cohort 2). We examined bivariate associations between infant characteristics, maternal sociodemographic factors, and hospital practices (e.g., lactation visit timing and frequency) with DBF outcomes and then built logistic regression models to determine the adjusted odds ratio and 95% confidence interval ([adjusted odds ratio [aOR] [95%CI]) for independent predictors of the DBF outcomes. Results: Sixty-four percent of eligible infants initiated DBF, and 51% were DBF at discharge. Sociodemographic, NICU, and lactation support factors were associated with both outcomes. Post hoc analysis showed that similar factors also influenced lactation support provision. Conclusions: Lactation support, NICU and sociodemographic variables influence DBF initiation and DBF at discharge. Interventions that optimize efficient use of available lactation support, address bias, and provide ample opportunity for DBF practice could improve rates.

Solutions-driven research is a transdisciplinary approach that incorporates diverse forms of expertise to identify solutions to stakeholder-identified environmental problems. This qualitative evaluation of early solutions-driven research projects provides transferable recommendations to improve researcher and stakeholder experiences and outcomes in transdisciplinary environmental research projects. Researchers with the U.S. Environmental Protection Agency (EPA) Office of Research and Development recently piloted a solutions-driven research approach in two parallel projects; one addressing nutrient management related to coastal waters and another studying wildland fire smoke impacts on indoor air quality. Studying the experiences of those involved with these pilots can enhance the integration of researcher and experiential expertise, improving solutions-driven research outcomes. Data collection included semi-structured interviews with 17 EPA researchers and 12 other stakeholders and reflective case narratives from the authors. We used conventional content analysis to qualitatively analyze perspectives on implementing innovative engagement and research approaches in a solutions-driven process. Findings that reflect common perspectives include the importance of continuous engagement, the challenges of differing timelines and priorities for researchers and stakeholders, and the need to define consistent markers of success across researchers and stakeholders. Key lessons to improve transdisciplinary research identified from the analysis are (1) improving clarity of roles and responsibilities; (2) planning to provide sufficient, continuous project funding over multiple years; (3) expecting research needs and plans to adapt to evolving circumstances; and (4) clearly defining the end of the project., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Ltd.)

Background and Objectives: Few U.S. women meet the public health recommendations to exclusively breastfeed for 6 months and continue breastfeeding for at least 1-2 years. We compared prenatally collected demographic, health, and breastfeeding support/intention variables to examine how these factors intersect to predict meeting breastfeeding recommendations. Methods: PREVAIL, a CDC-funded birth cohort in Cincinnati, OH, was approved by the IRB at CDC, Cincinnati Children's Hospital, and the hospitals where enrollment (third trimester, 2017-2018) occurred. The prenatal questionnaire captured sociodemographics, pre-pregnancy weight and height, breastfeeding environment, and breastfeeding intention, while health factors were obtained from obstetrical records. Body mass index (BMI) (kg/m 2 ) was categorized as healthy (18.5-24.9), overweight (25-29.9), obesity 1 (30-34.9), and obesity 2+ (≥35). Mothers self-reported date of exclusive and any breastfeeding cessation through quarterly postnatal questionnaires. Random forest was used for variable selection, cross-validated in multivariable logistic models. Results: Analysis included n  = 237 mothers with BMI ≥18.5. Random forest identified BMI category, prenatal intention, and insurance type as the most important predictors of meeting breastfeeding recommendations. The resulting logistic models explained >40% of the variance with an area under the curve of ≥0.89 for both recommendations. More than 73% of the risk of not meeting breastfeeding recommendations was attributable to having an elevated BMI or lacking strong breastfeeding intention. Conclusions: In PREVAIL, maternal BMI and prenatal intention explained most risks of not meeting breastfeeding exclusivity and duration recommendations. Our findings suggest efforts to improve breastfeeding exclusivity and duration should focus on strengthening prenatal breastfeeding intention and identifying effective interventions for supporting breastfeeding among mothers with higher BMI.

Colfax, Louisiana hosts a commercial hazardous waste thermal treatment (TT) facility, which treats fireworks, explosives, and military ordnances by open-burn/open-detonation one mile from the edge of the nearest community. Seventy-one percent of Colfax's residents are Black, and forty-six percent live below poverty, indicating the community's structural vulnerability. This community-based study originated at the behest of Colfax community members. We hypothesized that the close relationships among members of this enclave may have enhanced the community's ability to mobilize in opposition to the TT facility. We conducted semi-structured oral history interviews with nineteen community members and examined the social and interorganizational networks used by the Colfax community to claim its role in decision-making regarding the TT facility after years of exclusion from this process. Interview transcripts were analyzed through the lens of community capacity theory to gain insight into how interactions among community members about the environmental hazards led to social mobilization and improved participation in the decision-making process using codes for communication, organization, and outcome. Additionally, we reviewed Louisiana Department of Environmental Quality records for complaints about the facility to gauge public participation. One notable theme across several interviews was exclusion from the initial decision-making process related to the facility. However, interviewees noted a sustained effort was made among community members to educate themselves about the facility, organize a response through neighbor-to-neighbor contact, and take action by submitting formal complaints and participating in public hearings. Through the lens of environmental justice, this study illustrates an evolving condition of procedural justice.

Purpose: Investigating transgender people's experiences sharing health information in clinical encounters may yield insights for family medicine clinicians., Methods: This was a qualitative study using a community-based participatory research approach and interpretive description methodology. Seven qualitative focus groups were conducted with 30 transgender adults living in North America. We used purposive sampling to ensure diversity. The focus groups were transcribed verbatim, and 2 investigators independently reviewed and coded each transcript, then they mutually reviewed the transcripts, reconciled their coding, and summarized the codes into themes. Themes were reviewed with community members, participants, and uninvolved clinically oriented investigators for member checking and peer debriefing., Results: Four themes were noted: (1) transgender people often perceive clinicians' questions as voyeuristic, stigmatizing, or self-protective; (2) patients describe being pathologized, denied or given substandard care, or harmed when clinicians learned they are transgender; (3) transgender people frequently choose between risking stigma when sharing information and risking ineffective clinical problem solving if clinicians do not have all the information about their medical histories; (4) improving the safety of transgender people is difficult in the context of contemporary medical systems., Conclusions: Transgender people often must choose between stigma and potentially suboptimal care. Improvements in medical culture, policies, procedures, and data collection tools are necessary to improve the quality and safety of clinical care for transgender people. Institutional and systems changes may be required to safely and effectively implement sexual orientation and gender identity (SOGI) data collection in clinical settings., (© 2023 Annals of Family Medicine, Inc.)

Human milk is the ideal source of nutrition for most infants, but significant gaps remain in our understanding of human milk biology. As part of addressing these gaps, the Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN) Project Working Groups 1-4 interrogated the state of knowledge regarding the infant-human milk-lactating parent triad. However, to optimize the impact of newly generated knowledge across all stages of human milk research, the need remained for a translational research framework specific to the field. Thus, with inspiration from the simplified environmental sciences framework of Kaufman and Curl, Working Group 5 of the BEGIN Project developed a translational framework for science in human lactation and infant feeding, which includes 5 nonlinear, interconnected translational stages, T1: Discovery; T2: Human health implications; T3: Clinical and public health implications; T4: Implementation; and T5: Impact. The framework is accompanied by 6 overarching principles: 1) Research spans the translational continuum in a nonlinear, nonhierarchical manner; 2) Projects engage interdisciplinary teams in continuous collaboration and cross talk; 3) Priorities and study designs incorporate a diverse range of contextual factors; 4) Research teams include community stakeholders from the outset through purposeful, ethical, and equitable engagement; 5) Research designs and conceptual models incorporate respectful care for the birthing parent and address implications for the lactating parent; 6) Research implications for real-world settings account for contextual factors surrounding the feeding of human milk, including exclusivity and mode of feeding. To demonstrate application of the presented translational research framework and its overarching principles, 6 case studies are included, each illustrating research gaps across all stages of the framework. Applying a translational framework approach to addressing gaps in the science of human milk feeding is an important step toward the aligned goals of optimizing infant feeding across diverse contexts as well as optimizing health for all., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The 21st Century Cures Act and the OpenNotes movement have brought patients immediate access to their electronic health records (EHRs). The experiences of marginalized people, including transgender people, accessing and reviewing their EHRs could inform documentation guidelines to improve patient-clinician rapport and reduce harm., Objective: To investigate the experiences of transgender people reviewing EHRs., Design: Qualitative study using community-engaged research and an interpretive description methodology. Participants were recruited via social media, snowball sampling was employed, and purposive sampling was used to ensure diversity in terms of age, race/ethnicity, and other factors. In focus groups, participants were asked to discuss their experiences reviewing their EHRs and, for those participants who were clinicians, their experiences reviewing other clinicians' documentation., Participants: Thirty transgender adults aged 20 to 67 years, including 10 clinicians., Approach: Digital audio-recordings of focus groups were transcribed verbatim. Content was analyzed to identify emerging essential elements and analysis was continued until no new themes emerged (i.e., saturation)., Key Results: Four themes were noted. (1) Using the wrong name, pronoun, or gender marker for patients is common in the EHR, erodes trust, and causes trauma. (2) Various aspects of clinicians' notes contradict, blame, or stigmatize patients, across multiple axes of oppression. (3) Limitations of EHR capabilities create barriers to quality care. (4) Certain medical customs set the stage for marginalizing, objectifying, and pathologizing transgender people., Conclusions: Transgender people experience harm via various aspects of EHR documentation, suggesting that changes must be made to improve patient-clinician relationships and reduce ill-effects for patients., (© 2022. The Author(s).)

Background: Breast milk reduces morbidity and mortality in infants admitted to neonatal intensive care unit (NICU). Objectives: We determined predictors of procuring mother's own milk (MOM) among NICU-admitted newborn-mother dyads: (1) initiation of any milk expression; (2) initiation of milk expression within 6 hours of birth; (3) MOM as the first enteral feeding; (4) colostrum for oral care within 36 hours of birth if not yet orally fed; and (5) provision of MOM at 21 days of life or discharge, whichever occurred first. Methods: We performed a retrospective chart review of NICU-admitted newborn-mother dyads at an urban medical center from June 1, 2018-May 31, 2019. We excluded infants not directly admitted to the NICU, those never enterally fed, multiple gestations if not the first to be discharged, and infants discharged to a nonbiological caregiver. We used chi-square analysis to examine unadjusted associations between independent variables and MOM outcomes and then used logistic regression to determine the adjusted odds ratio and 95% confidence interval (AOR [95% CI]) for predictors of MOM outcomes. Results: There were 341 mother-infant dyads who met inclusion criteria and 71% of these mothers initiated milk expression. Smoking, multiparity, gestational diabetes, and Hepatitis C lowered the odds for at least one MOM outcome; whereas mothers who delivered at 28-32 weeks versus ≥33 weeks, and infants with birthweight <1,500 g versus 1,500-2,500 g had higher odds for at least one MOM outcome. Conclusion: Maternal/infant dyad characteristics may predict some, but not all NICU breastfeeding outcomes. This suggests that hospital practices may influence these outcomes and can inform future interventions.

Midstream oil and gas infrastructure comprises vast networks of gathering and transmission pipelines that connect upstream extraction to downstream consumption. In the United States (US), public policies and corporate decisions have prompted a wave of proposals for new gathering and transmission pipelines in recent years, raising the question: Who bears the burdens associated with the existing pipeline infrastructure in the US? With this in mind, we examined the density of natural gas gathering and transmission pipelines in the US, together with county-level data on social vulnerability. For the 2,261 US counties containing natural gas pipelines, we found a positive correlation between county-level pipeline density and an index of social vulnerability. In general, counties with more socially vulnerable populations have significantly higher pipeline densities than counties with less socially vulnerable populations. In particular, counties in the top quartile of social vulnerability tend to have pipeline densities that are much higher than pipeline densities for counties in the bottom quartile of social vulnerability. The difference grows larger for counties at the upper extremes of pipeline density within each group. We discuss some of the implications for the indigenous communities and others affected by recent expansions of oil and gas infrastructure. We offer recommendations aimed at improving ways in which decision-makers identify and address the societal impacts and environmental justice implications of midstream pipeline infrastructure., Competing Interests: The authors declare no conflicts of interest relevant to this study., (© 2021. The Authors. GeoHealth published by Wiley Periodicals LLC on behalf of American Geophysical Union.)

Background: Data from the Ohio Department of Health for Hamilton County reveal that the rate of breastfeeding steadily increased for non-Hispanic white babies from 72% initiation in 2006 to 79.8% initiation in 2018. Over the same time period, the rate of breastfeeding initiation increased from 52% to 65.7% for African American babies. Despite positive gains in breastfeeding for the African American community, significant disparities remain. Research Aim/Question(s): Our aim was to gain insight into the breastfeeding experiences of African American women and professionals working primarily with African American women to promote and support breastfeeding. Methods: In this study, a critical race theory approach was used to explore the lived experiences of African American women and health care providers who serve African American communities through the analysis of breakout conference sessions. Breakout sessions were semistructured, with questions developed in a strengths, weaknesses, opportunities, and threats analysis format aimed at obtaining information related to sociocultural factors impacting breastfeeding initiation and duration, with the goal of developing actionable community objectives to address breastfeeding disparities for African American women. Results: Three themes emerged stereotypes and microaggressions, representation, and provider support. Conclusion: Qualitative analysis of the conference proceedings reveals insights that can be developed into an action plan to address breastfeeding disparities in Hamilton County.

Nationally representative data from mother-child dyads that capture human milk composition (HMC) and associated health outcomes are important for advancing the evidence to inform federal nutrition and related health programs, policies, and consumer information across the governments in the United States and Canada as well as in nongovernment sectors. In response to identified gaps in knowledge, the National Institute of Diabetes and Digestive and Kidney Diseases of the NIH sponsored the "Workshop on Human Milk Composition-Biological, Environmental, Nutritional, and Methodological Considerations" held 16-17 November 2017 in Bethesda, Maryland. Through presentations and discussions, the workshop aimed to 1) share knowledge on the scientific need for data on HMC; 2) explore the current understanding of factors affecting HMC; 3) identify methodological challenges in human milk (HM) collection, storage, and analysis; and 4) develop a vision for a research program to develop an HMC data repository and database. The 4 workshop sessions included 1) perspectives from both federal agencies and nonfederal academic experts, articulating scientific needs for data on HMC that could lead to new research findings and programmatic advances to support public health; 2) information about the factors that influence lactation and/or HMC; 3) considerations for data quality, including addressing sampling strategies and the complexities in standardizing collection, storage, and analyses of HM; and 4) insights on how existing research programs and databases can inform potential visions for HMC initiatives. The general consensus from the workshop is that the limited scope of HM research initiatives has led to a lack of robust estimates of the composition and volume of HM consumed and, consequently, missed opportunities to improve maternal and infant health., (Published by Oxford University Press on behalf of the American Society for Nutrition 2019.)

Background: Metformin improves insulin action, but feasibility in treating low milk supply is unknown., Research Aim: To determine the feasibility of a metformin- versus-placebo definitive randomized clinical trial in women with low milk production and signs of insulin resistance., Methods: Pilot trial criteria included: Mother 1-8 weeks postpartum (ideally 1-2 weeks), low milk production, and ≥1 insulin resistance sign; and singleton, healthy, term infant. Eligible mothers were randomly assigned 2:1 (metformin:placebo) and instructed in frequent milk removal for 28 days with option to stop at 14 days., Results: From 02/2015 through 06/2016, we screened 114 women, completed baseline assessments on 46, and trialed 15 (median, 36 days postpartum). Comparing metformin-assigned ( n = 10) to placebo ( n = 5), 70% versus 80% continued to day 28; peak median change in milk output was +8 versus -58 mL/24 hr ( p = .31) and 80% peaked at Day 14 for both groups; 0% versus 20% desired to continue assigned drug after study completion; 44% versus 0% reported nausea/vomiting. Post-hoc, median peak change in milk output was +22 (metformin completers, n = 8) versus -58 mL/24 hr (placebo + non-completers, n = 7, p = .07). At baseline assessment, median milk production was significantly lower in those with ( n = 31), versus those without ( n = 15) signs of insulin resistance ( p = .002)., Conclusions: Although results trend toward hypothesized direction, trial feasibility concerns include late enrollment and only 20% of metformin-assigned participants sustaining improved milk output to Day 28, with none perceiving metformin worthwhile. Better tools are needed to identify and treat metabolically-driven low milk production. Registered at ClinicalTrials.gov (NCT02179788) on 02/JUL/2014.

In fisheries management-as in environmental governance more generally-regulatory arrangements that are thought to be helpful in some contexts frequently become panaceas or, in other words, simple formulaic policy prescriptions believed to solve a given problem in a wide range of contexts, regardless of their actual consequences. When this happens, management is likely to fail, and negative side effects are common. We focus on the case of individual transferable quotas to explore the panacea mindset, a set of factors that promote the spread and persistence of panaceas. These include conceptual narratives that make easy answers like panaceas seem plausible, power disconnects that create vested interests in panaceas, and heuristics and biases that prevent people from accurately assessing panaceas. Analysts have suggested many approaches to avoiding panaceas, but most fail to conquer the underlying panacea mindset. Here, we suggest the codevelopment of an institutional diagnostics toolkit to distill the vast amount of information on fisheries governance into an easily accessible, open, on-line database of checklists, case studies, and related resources. Toolkits like this could be used in many governance settings to challenge users' understandings of a policy's impacts and help them develop solutions better tailored to their particular context. They would not replace the more comprehensive approaches found in the literature but would rather be an intermediate step away from the problem of panaceas., Competing Interests: The authors declare no conflict of interest.

Background/aim: The association of dietary patterns representing multiple dietary components and breast cancer risk is not clearly understood. Our objective was to conduct a systematic review of the association between dietary patterns and breast cancer risk., Materials and Methods: The original articles included, were published between January 2013 and May 2017 and characterized diets using a priori and posteriori approaches to examine associations between dietary patterns and breast cancer risk. A novel scoring matrix was used to grade posteriori dietary pattern alignment with the American Cancer Society dietary guidelines., Results: Seventeen case-control and nested case-control studies identified 15 healthy, and 10 unhealthy, dietary patterns determined posteriori, and 7 dietary indices determined a priori. Vegetables were consistently found in breast cancer protective patterns whereas saturated fat and red and processed meats were consistently found in patterns associated with increased breast cancer risk., Conclusion: Findings suggest that dietary patterns that include vegetables and limit saturated fat and red and processed meats may lower breast cancer risk., (Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: Lower-cost air quality sensors (hundreds to thousands of dollars) are now available to individuals and communities. This technology is undergoing a rapid and fragmented evolution, resulting in sensors that have uncertain data quality, measure different air pollutants and possess a variety of design attributes. Why and how individuals and communities choose to use sensors is arguably influenced by social context. For example, community experiences with environmental exposures and health effects and related interactions with industry and government can affect trust in traditional air quality monitoring. To date, little social science research has been conducted to evaluate why or how sensors, and sensor data, are used by individuals and communities, or how the introduction of sensors changes the relationship between communities and air quality managers., Objectives: This commentary uses a risk governance/responsible innovation framework to identify opportunities for interdisciplinary research that brings together social scientists with air quality researchers involved in developing, testing, and deploying sensors in communities., Discussion: Potential areas for social science research include communities of sensor users; drivers for use of sensors and sensor data; behavioral, socio-political, and ethical implications of introducing sensors into communities; assessing methods for communicating sensor data; and harnessing crowdsourcing capabilities to analyze sensor data., Conclusions: Social sciences can enhance understanding of perceptions, attitudes, behaviors, and other human factors that drive levels of engagement with and trust in different types of air quality data. New transdisciplinary research bridging social sciences, natural sciences, engineering, and design fields of study, and involving citizen scientists working with professionals from a variety of backgrounds, can increase our understanding of air sensor technology use and its impacts on air quality and public health., (Published by Elsevier B.V.)

Severe combined immunodeficiency (SCID) is a rare but important condition. Affected infants are born with profound abnormalities of immune cell function that lead to severe and recurrent infection that are almost always fatal in the first year of life without treatment. Infants with SCID are often initially seen by general paediatricians in the hospital care setting, and the recognition of the cardinal features of the disease and alertness to specific laboratory parameters are important in making an early diagnosis. There is also increasing interest in newborn screening for SCID, which has the potential to significantly improve outcome through early diagnosis and implementation of prophylactic medications. Definitive treatments such as haematopoietic stem cell transplantation and gene therapy have also made major advances over the last decade and again promise to improve the overall outcome for SCID with reduced long-term toxicities. In this review, we highlight some of the major advances in diagnosis and management of the disease, but we also want to emphasise the important role of the general paediatrician in making an early diagnosis and in ongoing management., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Background: Factors associated with successful provision of mother's own milk (MOM) for premature infants in a Japanese neonatal intensive care unit (NICU) context are not well known., Objective: We determined the independent risk factors for low milk volume at day 4 postpartum and formula feeding at the time of NICU discharge., Methods: We reviewed the medical records of mothers who delivered at < 32 weeks' gestation. We determined maternal, premature infant, and milk expression variables predictive of (1) day 4 postpartum milk volume being less than the cohort median and (2) formula feeding at the time of NICU discharge, reported as adjusted odds ratios (95% confidence interval)., Results: Among 85 dyads, median (quartile range) milk volume on day 4 postpartum was 153 (34-255) mL. The rate of formula feeding at discharge was 42%. Mothers delivering by cesarean (vs vaginal) delivery had 4.3-fold (1.5-12.4) greater odds of day 4 milk volume < median (P < .01). Pregnancy-induced hypertension, delayed milk expression initiation, and low pumping frequency were strongly associated with cesarean delivery. Subsequently, mothers with day 4 milk volume < median (vs ≥ median) had 7.1-fold (2.6-19.5) greater odds of formula feeding at discharge (P < .01)., Conclusion: Cesarean delivery is associated with lower milk volume on day 4 but may represent a composite of underlying risk factors for low milk volume in the early postpartum period. Further, low milk volume on day 4 is a strong correlate of lack of exclusive breast milk feeding at NICU discharge., (© The Author(s) 2014.)

Introduction: Greater attention has been directed to endovascular recanalization of acute ischemic stroke in septuagenarians and above., Technique: A retrospective chart review was conducted to include patients treated for acute ischemic stroke from 2006 to 2012. All patients underwent initial neurological assessment and non-contrast head CT. Patients treated from 2009 to 2012 additionally received emergent CT angiogram and CT perfusion. 51 patients met the clinical and radiographic criteria and underwent multimodal endovascular revascularization for acute ischemic events., Results: All patients underwent cerebral angiography and met angiographic criteria for endovascular thrombolysis. 34 patients (67%) were older than 80 years of age. 23 patients (45%) received intravenous tissue plasminogen activator prior to admission. Eight (16%) patients underwent stent placement after intra-arterial thrombolysis, 10 (20%) underwent balloon angioplasty and seven (14%) underwent both angioplasty and stent placement. 21 (41%) required only intra-arterial thrombolytics. An improvement in Thrombolysis in Myocardial Infarction score was noted in 34 patients (67%). The average modified Rankin Scale score on discharge was 3.9. Symptomatic intracranial hemorrhage occurred in three patients (6%); none required surgery. One patient (1.9%) had a postoperative retroperitoneal hematoma, which was managed conservatively. Two fatalities resulted from intraoperative vessel rupture (3.9%), with a combined morbidity and mortality of 27.5%., Conclusions: Multimodal endovascular recanalization of acute ischemic stroke is a relatively safe treatment option in patients older than 75 years of age. Careful patient selection by clinical and radiographic inclusion criteria is necessary for the successful management of stroke in this age group.

The interplay of factors that affect post-partum loss or retention of weight gained during pregnancy is not fully understood. The objective of this paper is to describe patterns of weight change in the six sites of the World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) and explore variables that explain variation in weight change within and between sites. Mothers of 1743 breastfed children enrolled in the MGRS had weights measured at days 7, 14, 28 and 42 post-partum, monthly from 2 to 12 months and bimonthly thereafter until 24 months post-partum. Height, maternal age, parity and employment status were recorded and breastfeeding was monitored throughout the follow-up. Weight change patterns varied significantly among sites. Ghanaian and Omani mothers lost little or gained weight post-partum. In Brazil, India, Norway and USA, mothers on average lost weight during the first year followed by stabilization in the second year. Lactation intensity and duration explained little of the variation in weight change patterns. In most sites, obese mothers tended to lose less weight than normal-weight mothers. In Brazil and Oman, primiparous mothers lost about 1 kg more than multiparous mothers in the first 6 months. In India and Ghana, multiparous mothers lost about 0.6 kg more than primiparas in the second 6 months. Culturally defined mother-care practices probably play a role in weight change patterns among lactating women. This hypothesis should stimulate investigation into gestational weight gain and post-partum losses in different ethnocultural contexts., (© 2011 Blackwell Publishing Ltd.)

Prior research focusing on risk perceptions has led to the observation that well-educated and politically conservative white males tend to systematically perceive lower levels of risk from a wide range of hazards when compared to other members of society (e.g., white women, nonwhite women and men). While this "white male effect (WME)" is quite striking given that many policymakers fall into this group, a byproduct of this finding is that it deflects attention from the heterogeneity, in terms of people's concerns about risks, that exists in African-American and other minority communities. The research reported here set out to explore this heterogeneity by asking a simple question: Can a phenomenon similar to the WME be found in the African-American community? It can, and its implications for research and practice in risk management are discussed.

We report an experimental study of nonlinear effects, characteristic of mutual optical coupling, in an ultra-short coupling regime observed in a distributed Bragg reflector laser pair fabricated on the same chip. Optical feedback is amplified via a double pass through a common on-chip optical amplifier, which introduces further nonlinear phenomena. Optical coupling has been introduced via back reflection from a cleave-ended fibre. The coupling may be varied in strength by varying the distance of the fibre from the output of the chip, without significantly affecting the coupling time.

Multiple sclerosis (MS) is a disease of the CNS in which inflammation, demyelination and neurodegeneration contribute to its initiation and progression. A frequently employed model of MS is experimental autoimmune encephalomyelitis (EAE). Here, to gain new insights into the disease process, an analysis of proteins in extracts of lumbar spinal cord from naïve and EAE rats was undertaken. The data mainly confirm that inflammation and blood-brain barrier (BBB) breakdown are the major hallmarks of disease in this model. Given their importance in the BBB, junctional proteins were further investigated. Occludin, a protein localizing to tight junctions in brain endothelial cells, showed strikingly increased migration in EAE when analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). This increased migration was mimicked by in vitro phosphatase treatment, implying its dephosphorylation in EAE. Occludin dephosphorylation coincided with the onset of inflammation, slightly preceding visible signs of disease, and was just prior to apparent changes in BBB permeability. These findings suggest occludin is a target for signaling processes in EAE, perhaps regulating the response of the BBB to the inflammatory environment as seen in MS.

Dimethoate [O, O-dimethyl-S-(N-methylcarbamoyl-methyl) phosphorodithioate] is a broad-spectrum systemic insecticide currently used worldwide and on many vegetables in Kentucky. Dimethoate is a hydrophilic compound (log KOW = 0.7) and has the potential of offsite movement from the application site into runoff and infiltration water. The dissipation patterns of dimethoate residues were studied on spring broccoli leaves and heads under field conditions. Following foliar application of Dimethoate 4E on broccoli foliage at the rate of 0.47 L acre(-1), dimethoate residues were monitored in soil, runoff water collected down the land slope, and in infiltration water collected from the vadose zone. The study was conducted on a Lowell silty loam soil (pH 6.9) planted with broccoli under three soil management practices: (i) soil mixed with municipal sewage sludge, (ii) soil mixed with yard waste compost, and (iii) no-mulch rototilled bare soil. The main objective of this investigation was to study the effect of mixing native soil with municipal sewage sludge or yard waste compost, having considerable amounts of organic matter, on off-site movement of dimethoate residues into runoff and infiltration water following spring rainfall. The initial deposits of dimethoate were 6.2 and 21.4 micro g g(-1) on broccoli heads and leaves, respectively. These residues dissipated rapidly and fell below the maximum residue limit of 2 micro g g(-1) on the heads and leaves after 10 and 14 d, respectively, with half-lives of 5.7 d on broccoli heads and 3.9 d on the leaves. Dimethoate residues detected in top 15 cm of soil (due to droplet drift and wash off residues from broccoli foliage) one day (d) following spraying, were 30.5 ng g(-1) dry soil in the sewage sludge treatment, and 46.1 and 134.5 ng g(-1) dry soil in the yard waste and no mulch treatments, respectively. Water infiltration was greater from yard waste compost treatment than from no mulch treatment, however concentrations of dimethoate in the vadose zone of the three soil treatments did not differ.

Background and Purpose: Exercise is advocated in the management of Parkinson disease (PD), however, little is known regarding the potential benefits of complementary mind/body exercise for this clinical population. The purpose of this pilot program evaluation was to gain insight into participant and instructor perceptions of the perceived benefits and potential utility of a taiji exercise program., Program Evaluation: Program participants (N=15) included 8 individuals with PD and 7 support partners with no history of PD. Group taiji instruction was offered in 45-minute weekly sessions, for 12 weeks at a community facility. Post-program evaluation included administration of a survey questionnaire, thematic analysis of a focus group discussion, instructor reflections, and review of attendance records., Results: Benefits were perceived by participants in physical, psychological, and social domains. Thirteen of the survey respondents, including 6 of the 8 respondents with PD reported perceiving a physical benefit attributed to taiji practice. Improved balance was reported most frequently. Instructor observations and participant testimony suggest movement capability for individuals with Parkinsons may also be improved by performing taiji., Conclusion: This preliminary research provides support for further Taiji Buddy program examination and application.

Background: The accurate measurement of body composition is useful in assessments of infant growth and nutritional status., Objective: This study evaluated the reliability and accuracy of a new air-displacement plethysmography (ADP) system for body-composition assessment in infants., Design: Between- and within-day reliability was assessed by comparing the percentage body fat (%BF) obtained on consecutive days and on the same day, respectively, in 36 full-term infants. Accuracy was assessed by comparing %BF measured with the use of ADP and %BF measured with the use of deuterium (2H2O) dilution in 53 infants., Results: There were no significant differences in %BF between days (-0.50 +/- 1.21%BF) or within days (0.16 +/- 1.44%BF). Mean between- and within-day test-retest SDs of 0.69 and 0.72%BF, respectively, indicated excellent reliability. The %BF measurements obtained by using ADP were not significantly influenced by infant behavioral state. Mean %BF obtained by using ADP (20.32%BF) did not differ significantly from that obtained by using 2H2O dilution (20.39%BF), and the regression line [%BF(2H2O) = 0.851%BF (ADP) + 3.094] gave a high R2 (0.76) and a low SEE (3.26). The 95% limits of agreement between ADP and 2H2O (-6.84%BF, 6.71%BF) were narrower than those reported for other body-composition techniques used in infants. Individual differences between the 2 methods were not a function of body mass or fatness., Conclusion: ADP is a reliable and accurate instrument for determining %BF in infants, and it has the potential for use in both research and clinical settings.

A preliminary evaluation of a new air displacement plethysmography (ADP) system for body composition assessment in infants was performed on 17 subjects on 2 consecutive days. Mean (+/-SD) percent body fat (%BF) obtained from test 1 on day 1, and tests 1 and 2 on day 2 was 23.21+/-7.63, 22.94+/-7.50, and 22.55+/-7.61, respectively. Mean differences in %BF of within- (-0.39+/-0.81) and between-day tests (-0.27+/-0.97) did not significantly differ from zero. %BF 95% limits of agreements were very close (-2.0-1.2, and -2.2-1.7 for within- and between-day tests, respectively). %BF SDs (0.52 and 0.60 %BF for within- and between-day reliability, respectively) were not a function of the subject's behavioral state, body weight, or %BF. Mean %BF obtained from the 3 tests (22.90+/-7.56) was comparable with expected %BF values calculated using data from multi-compartment studies (25.84+/-8.39 and 21.93+/-4.46).

The purpose of this study was to compare certain demographic, clinical, and criminal variables within subgroups of obsessional followers, and compare them to a group of offenders with mental disorders to attempt to replicate earlier findings. A static group archival design utilized a non-random group of convenience and a randomly selected comparison group. Sixty-five obsessional followers and 65 offenders with mental disorders were evaluated by psychiatrists and psychologists for court ordered reasons during their criminal proceedings. Both groups were evaluated during the same period, in the same court diagnostic clinic, and generally for sentencing determinations. The obsessional followers were measured on demographic, diagnostic, pursuit, victim, threat, violence, emotional, motivational, and defense variables. Inferential comparisons that used parametric and nonparametric statistics were done within and between groups on select variables. The obsessional followers had significantly greater estimated IQ than the offenders with mental disorders, but were neither older nor better educated. There were no significant differences in the high prevalence of both DSM-IV Axis I and II diagnoses. Obsessional followers who stalked prior sexual intimates were significantly more likely to have a substance abuse or dependence diagnosis. Obsessional followers who stalked strangers or acquaintances were more likely to be delusional. The majority of the obsessional followers, primarily motivated by anger, both threatened and were violent toward person or property. The modal obsessional follower is an average or above IQ, unemployed, unmarried male in his fourth decade of life. chronically pursuing a prior sexually intimate female. He is diagnosed with substance abuse or dependence and a personality disorder NOS, and has a prior psychiatric, criminal and substance abuse history. He is angry, likely to threaten her, and assault her person or property without causing serious injury.

The purpose of this longitudinal study was to evaluate whether a loss of body fat during lactation between 4 and 20 wk postpartum increases the concentration of environmental contaminants in breast milk. We examined this relationship in two different cohorts of exclusively breastfeeding women: (1) California women with low exposure to contaminants (n = 10 whose weight was stable [mean change, 0.0 +/- 0.2 kg] and n = 11 who lost weight [mean loss, -4.1 +/- 0.4 kg]) and (2) Hispanic women (n = 30) who had recently immigrated to North Carolina, primarily from Mexico, and were presumed to have a higher prior exposure to contaminants. Breast milk samples were analyzed for hexachlorobenzene (HCB) and DDT and its related products. There was no significant relationship between change in body composition and change in milk contaminant concentrations in either California or North Carolina women. Concentrations of HCB were similar between the California and North Carolina women, but those of DDT and related products were higher in the North Carolina subjects. Results suggest that moderate weight loss in lactating women with low exposure to environmental contaminants does not increase contaminant concentration in breast milk.

Background: Limiting postpartum weight retention is important for preventing adult obesity, but the effect of weight loss on lactation has not been studied adequately., Objective: We evaluated whether weight loss by dieting, with or without aerobic exercise, adversely affects lactation performance., Design: At 12+/-4 wk postpartum, exclusively breast-feeding women were randomly assigned for 11 d to a diet group (35% energy deficit; n = 22), a diet plus exercise group (35% net energy deficit; n = 22), or a control group (n = 23). Milk volume, composition, and energy output; maternal weight, body composition, and plasma prolactin concentration; and infant weight were measured before and after the intervention., Results: Weight loss averaged 1.9, 1.6, and 0.2 kg in the diet, diet + exercise, and control groups, respectively (P < 0.0001) and was composed of 67% fat in the diet group and nearly 100% fat in the diet + exercise group. Change in milk volume, composition, and energy output and infant weight did not differ significantly among groups. However, there was a significant interaction between group and baseline percentage body fat: in the diet group only, milk energy output increased in fatter women and decreased in leaner women. The plasma prolactin concentration was higher in the diet and diet + exercise groups than in the control group., Conclusions: Short-term weight loss (approximately 1 kg/wk) through a combination of dieting and aerobic exercise appears safe for breast-feeding mothers and is preferable to weight loss achieved primarily by dieting because the latter reduces maternal lean body mass. Longer-term studies are needed to confirm these findings.

The amount of stress experienced by both the mother and fetus during labor and delivery varies considerably and is likely to be different in primiparous and multiparous women. In this study we explored relations between the birth experience and lactation performance of 40 women. Stress hormones were measured in serum or plasma during pregnancy, parturition (cord and maternal blood), and lactation. Milk samples were obtained and breast-feeding frequency was recorded each day during the first 2 wk postpartum. Four outcomes were used as markers of lactogenesis: the time when the subject first felt fullness in the breasts, 24-h milk volume on day 5 postpartum, milk lactose concentration on day 5, and the day of appearance of casein in the milk as determined by gel electrophoresis. There were significant intercorrelations among the outcome variables, except for milk lactose. Compared with multiparous women, primiparous mothers experienced a delay in breast fullness and lower milk volume on day 5. In multiple regression analyses excluding subjects who had cesarean deliveries (n = 5), markers of both fetal and maternal stress during labor and delivery (cord glucose concentration and maternal exhaustion score) were associated with delayed breast fullness and casein appearance; delayed casein appearance was also associated independently with a longer duration of labor. Milk volume on day 5 was lower in women with higher exhaustion scores, and, in multiparous women, those who breast-fed less frequently on day 2. The milk lactose concentration was inversely related to pregnancy weight gain. These results indicate that primiparity, long labor, stress to the mother and fetus during labor and delivery, and elevated cord glucose concentrations are risk factors for delayed lactogenesis.

Estimation of energy expenditure (EE) by heart-rate (HR) monitoring (HRM) assumes that the relation between HR and oxygen consumption (VO2) is stable between days and within a day. To evaluate this assumption, 12 healthy subjects underwent an HR-VO2 calibration session on two mornings and two afternoons, with one morning and one afternoon session on the same day. Measurements were made while subjects were supine, sitting, standing while shifting body weight side-to-side, and walking at four intensities. Subjects wore an HR monitor during waking hours on another day (15.1 +/- 1.5 h). Regression analysis was used to determine the relation between HR and VO2 in the sedentary and active HR ranges, and four EE values (HRM-EE) based on the four calibration sessions were calculated for each subject. The four group mean HRM-EE values were nearly identical (CV: 1.1%). The regression equations generated from the four calibration sessions did not differ significantly for the group as a whole, but for some subjects there were significant differences among sessions in the slope of the active regression equation (P = 0.005). Intraindividual CVs for HRM-EE were generally < 10%, but ranged from 0.1% to 24.7%. In general, within an individual, HR was more variable than was VO2, and intraindividual variability in EE was associated with intraindividual variability in the flex HR and sedentary HR range. HRM is appropriate for assessment of EE for a group; however, caution is recommended when HRM is used for individual determinations of EE.

To determine whether breast-feeding is protective against infection in relatively affluent populations, morbidity data were collected by weekly monitoring during the first 2 years of life from matched cohorts of infants who were either breast fed (BF) (N = 46) or formula fed (FF) (N = 41) until at least 12 months of age. Cohorts were matched for characteristics such as birth weight and parental socioeconomic status, and we controlled for use of day care in data analysis. Mean maternal educational level was high (16 years) in both groups. In the first year of life the incidence of diarrheal illness among BF infants was half that of FF infants; the percentage with any otitis media was 19% lower and with prolonged episodes (> 10 days) was 80% lower in BF compared with FF infants. There were no significant differences in rates of respiratory illness; nearly all cases were mild upper respiratory infections. Morbidity rates did not differ significantly between groups in the second year of life, but the mean duration of episodes of otitis media was longer in FF than BF infants (8.8 +/- 5.3 vs 5.9 +/- 3.5 days, respectively; p = 0.01). These results indicate that the reduction in morbidity associated with breast-feeding is of sufficient magnitude to be of public health significance.

Using the Living Sky Health District in rural Saskatchewan as a sample case, this paper illustrates and discusses the use of location theory modelling tools as an aid to achieving high levels of efficiency coupled with administrator-determined levels of access. The paper begins by examining access issues as they affect location decisions. One of the empirical pillars of the paper is the well-documented idea that people will travel great distances in situations of acute circumstances, but are unwilling to travel far for important preventive care and monitoring of some chronic conditions. The study continues by presenting a non-technical overview of location theory which demonstrates the applicability of location modelling to the present problem; several possible location scenarios for Living Sky Health District are calculated, the most appropriate of which will depend on the goals and priorities of the district board. Finally, the study's results and more general conclusions are presented and discussed.

To examine the effects of exercise on plasma lipids and metabolism during lactation, sedentary, exclusively breast-feeding women were randomly assigned to an exercise (E) or control (C) group at 6-8 wk postpartum. E subjects performed aerobic exercise 45 min.d-1, 5 d.wk-1, for 12 wk. Resting metabolic rate (RMR), energy expenditure, body composition, and dietary intake were measured at 6-8, 12-14, and 18-20 wk postpartum. Maximum oxygen uptake (VO2max), postprandial insulin, glucose, and thermic response, and plasma lipid levels were measured at 6-8 and 18-20 wk. VO2max increased by 25% vs 5% in the E vs the C group, respectively (P < 0.0001). RMR was similar between groups and did not change over time. Weight and percent body fat declined (P < 0.01) during the study, but there was no difference between E and C groups. Exercise marginally increased high-density lipoprotein cholesterol levels (P < 0.08), but did not affect other lipid concentrations. Insulin response decreased as VO2max increased (P = 0.05). There was no effect of time or group on glucose or thermic response. Exercise improves cardiovascular fitness during lactation, but does not increase the rate of postpartum weight loss.

Duration of postpartum amenorrhoea (PPA) was compared among women who breast-fed for > or = 6 months (breast-feeding group) or < or = 3 months (formula-feeding group) and was found to be significantly shorter among the latter. Associations between maternal factors and duration of PPA were examined. Within the formula-feeding group, the only variable associated with duration of PPA was duration of breast-feeding. Among breast-feeding mothers who resumed menstruation after 3 months postpartum, duration of PPA was positively associated with parity and negatively associated with maternal body mass index (BMI) at 3 months postpartum. Among breast-feeding mothers who resumed menstruation after 6 months, duration of PPA was positively associated with parity, pregnancy weight gain, number of night feeds and milk volume at 6 months, and negatively associated with maternal age and BMI at 6 months postpartum. These results indicate that maternal anthropometric status is related to duration of PPA, even in a relatively well-nourished population of lactating women.

Background: The potential risks and benefits of regular exercise during lactation have not been adequately evaluated. We investigated whether regular aerobic exercise had any effects on the volume or composition of breast milk., Methods: Six to eight weeks post partum, 33 sedentary women whose infants were being exclusively breast-fed were randomly assigned to an exercise group (18 women) or a control group (15 women). The exercise program consisted of supervised aerobic exercise (at a level of 60 to 70 percent of the heart-rate reserve) for 45 minutes per day, 5 days per week, for 12 weeks. Energy expenditure, dietary intake, body composition, and the volume and composition of breast milk were assessed at 6 to 8, 12 to 14, and 18 to 20 weeks post partum. Maximal oxygen uptake and the plasma prolactin response to nursing were assessed at 6 to 8 and 18 to 20 weeks., Results: The women in the exercise group expended about 400 kcal per day during the exercise sessions but compensated for this energy expenditure with a higher energy intake than that recorded by the control women (mean [+/- SD], intake, 2497 +/- 436 vs. 2168 +/- 328 kcal per day at 18 to 20 weeks; P < 0.05). Maximal oxygen uptake increased by 25 percent in the exercising women but by only 5 percent in the control women (P < 0.001). There were no significant differences between the two groups in maternal body weight or fat loss, the volume or composition of the breast milk, the infant weight gain, or maternal prolactin levels during the 12-week study., Conclusions: In this study, aerobic exercise performed four or five times per week beginning six to eight weeks post partum had no adverse effect on lactation and significantly improved the cardiovascular fitness of the mothers.

The association between pelvic actinomycosis and the use of intrauterine devices is well established. However, abdominal wall actinomycosis without clinical involvement of the pelvic organs has been reported only once in the literature. The authors present a second case, which occurred in a 24-year-old woman who was using a copper 7 intrauterine device.

The advantages of practice in a community encompassing a population of about 35 000 include readily available beds and operating rooms, a relative diversity of surgical problems, increased job satisfaction and solid community support through service clubs and other volunteer organizations. Disadvantages in some situations can include lack of investigational facilities and of internists for consultation. A lack of surgical assistants, anesthetists and intensive-care-unit support are other potential negative factors. The quest for continuing medical education requires definite resolve, and practice finesse must be well honed.