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Die Nutzung von Druckluft in der Automatisierungstechnik bietet eine Reihe von Vorteilen. Druckluft ist vielseitig nutzbar, sauber und speicherbar. Außerdem bewegt sie große Lasten und hilft präzise zu positionieren. Dennoch gibt es einen Nachteil: Die Drucklufterzeugung ist energie- und kostenintensiv. Lediglich circa sieben Prozent der eingesetzten elektrischen Energie sind als mechanische Expansionsarbeit nutzbar. Anwender sind daher gut beraten, Druckluftverluste zu vermeiden und sich auf die Suche nach autonomen und prozesssicheren Überwachungslösungen zu machen. Der Beitrag beschreibt die Entwicklung und Anwendung einer kennzahlbasierten Analyse zur Erfassung, Auswertung und Überwachung von Druckluftverlusten am Beispiel automatisierter Produktionsprozesse im Karosseriebau.

Introduction Veterans using the Veterans Administration Health Care System (VAHCS) for obstetrical care experience disparate pregnancy-related risks and health outcomes when compared to their pregnant counterparts. This study examined the prevalence of risk factors associated with pregnancy-related comorbidities among U.S. Veterans receiving obstetrical care using VAHCS benefits in Birmingham, Alabama. Materials and Methods A retrospective chart review was conducted of pregnant Veterans receiving care at a large Veterans Administration facility from 2018 to 2021. Using one-sample t-tests, the data from the study charts were compared to the Alabama overall prevalence of tobacco and alcohol use, pregnancy-related hypertension/preeclampsia, and gestational diabetes and, when the Alabama data were unavailable, the U.S. national average prevalence of overweight, obesity, pre-pregnancy hypertension, posttraumatic stress disorder, depression, and anxiety among patients receiving obstetrical care. The institutional review board at the Birmingham VAHCS approved the study, with an exemption for human subjects research. Results The study sample (N = 210) experienced higher levels of obesity (42.3% vs. 24.3%, P Conclusion The findings highlight the need for further examination of social factors that may be driving disparities among pregnant Veterans, who may benefit from supplemental services to address modifiable comorbidities. Additionally, the implementation of a centralized database to track pregnancy-related outcomes for Veterans would allow these comorbidities to be more closely monitored and addressed. Heightened awareness of a patient’s Veteran status and associated increased risks can alert providers to screen for depression and anxiety more frequently and to familiarize themselves with additional services the VAHCS may offer to patients. These steps could improve referrals to counseling and/or targeted exercise interventions.

Background: Obesity has similar effects in both monkeys and humans, including the development of metabolic syndrome, which is often followed by type 2 diabetes mellitus (DM). The effects of short term and intermittent very low-calorie diets (VLCD) suggest improvement in glycemic control, however, the long term (two year or more) effects of a VLCD have not been examined in obesity with or without diabetes. Methods: The metabolic and glycemic effects of major weight reduction in nonhuman primates using VLCD was compared to major weight reduction in humans using gastric bypass at 2 years post-surgery. In 14 spontaneously obese rhesus monkeys, half with overt T2DM were compared to 18 obese humans, ten with DM and eight without (OB). All humans underwent Roux-en-Y gastric bypass surgery and were followed for two years. The metabolic indices of the NHP and humans were obtained at the beginning and end of the two-year period. Results: All four groups experienced significant weight loss ranging from 22% to 37% reduction. Fasting glucose decreased significantly in both DM groups but were unchanged in both obese groups. In both humans and monkeys, fasting glucose of the DM and OB groups initially differed significantly from each other, but after surgery and after VLCD, did not differ. ß cell function, assessed by the acute insulin response to IV glucose, decreased in both OB groups and increased in both DM groups. In both species, after weight loss, the OB groups retained a higher acute insulin response compared to the DM groups, however, the differences between the OB and DM groups were significant (p-value of 0.032 for monkeys and 0.03 in humans). Insulin sensitivity in humans increased in both DM and OB groups (p NIH grants NO1AG3 1012, NIA, and NIDDK This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Nearly ten years ago, Park Street Intermediate School began the journey of instituting processes, policies, and programs intended to support the development of a learning environment based on trust, respect, optimism, caring, and intentionality as described in the literature of Invitational Education. The purpose of this case study is to trace the development of that journey, from inception to the present, searching for those attitudes and actions that either promoted or presented barriers for the implementation of Invitational Education or its continued development.

Background Tobacco cessation among patients with head/neck cancer continues to be challenging despite evidence that cessation improves treatment outcomes. The purpose of this study was to understand barriers/facilitators to tobacco cessation among patients with head/neck cancer and health care providers and to obtain perspectives toward the development of a patient-centered tobacco cessation intervention. Materials and Methods In-depth qualitative interviews with 10 health care providers and 21 patients with head/neck cancer (12 inpatients and 9 outpatients) who were current or former smokers. Results Health was a common motivator to quit among patients. Although most patients indicated that their health care provider asked and advised them to quit, they were unaware of cessation resources. Suggestions for a tobacco cessation program included involvement of former smokers, health care provider involvement/counseling, supporting written materials, and incorporating follow-up and family support. Health care providers identified patients’ anger/frustration associated with the disease, social/demographic issues, and poor quality of life as the three most frequent challenges in treating patients. Although all providers reported asking about tobacco use, 70% emphasized a lack of formal training in tobacco cessation and lack of time. Their suggestions for a cessation program included having a “quarterback” responsible for this component with support from the entire health care team and continuity between outpatient and inpatient services to promote cessation, prevent relapse, and highlight the importance of follow-up and social support. Conclusion There is great interest and need, both from patients and providers, for tobacco cessation services in the oncology setting tailored for patients with head/neck cancer in the context of cancer care. Implications for Practice Although the combination of pharmacotherapy and cognitive-behavioral intervention is the standard evidence-based treatment for tobacco dependence, it must be adapted to meet the needs and wants of patients and providers to be effective. This study provides an in-depth examination of such needs among patients with head and neck cancer and providers in the context of cancer care. Providers and patients emphasized the need of having a trained health care provider dedicated to providing tobacco cessation through seamless integration between outpatient and inpatient services as well as follow-up with an emphasis on family involvement throughout the process.

We examined factors associated with and reasons for perceived susceptibility to COVID-19 among urban and rural adults in Alabama. We surveyed 575 eligible participants’ engagement in preventive behaviors, concern about COVID-19 in their communities, perceived susceptibility to the virus, and reasons for susceptibility across three response options (Yes, No, and Don’t Know/Not Sure). Bivariate analyses compared characteristics by level of perceived susceptibility to COVID-19. A multinomial logistic regression model evaluated the association of demographics, health insurance coverage, and chronic illness status with perceived susceptibility. Participants’ race, gender, and educational attainment were significantly associated with perceived susceptibility to COVID-19. African Americans and males had higher odds of responding ‘No’, compared to ‘Yes’ and ‘Don’t Know/Not Sure’ than Whites and females. Participants with a high school education and lower had higher odds of responding ‘Don’t Know/Not Sure’ versus ‘Yes’ compared to those with college or higher education. Those unconcerned about COVID-19 in their community had higher odds of responding ‘No’ (OR = 2.51, CI 1.35–4.68) and ‘Don’t Know/Not Sure’ (OR = 2.51, CI 1.26–4.99) versus ‘Yes’, as compared to those who were concerned. Possibility of exposure at work was the most frequent reasons for perceiving themselves susceptible to COVID-19, engagement in recommended preventive measures was the most frequent reason among respondents who indicated ‘No’, and uncertainty/perception that everyone is at risk was the most frequent reason among the ones who indicated ‘Don’t Know/Not Sure’. Results indicate that tailored efforts to heighten perceived susceptibility to COVID-19 among specific demographics are needed.

OBJECTIVE: The purpose of this study was to examine perceptions of COVID-19 related to prevention, coping, and testing of African American residents in under-resourced communities in Alabama. DESIGN: Guided by the PRECEDE-PROCEED model, virtual focus groups were conducted in five urban and rural Alabama communities using secure Zoom meetings. Community residents and stakeholders (N = 36 total) participated; meetings were audio- and video-recorded, transcribed, and analyzed according to Thematic Analysis. Themes were organized by the PRECEDE portion of the model in Predisposing, Reinforcing, and Enabling barriers and facilitators in three focus areas: prevention, coping, and testing. RESULTS: Prevention barriers included apathy, difficulty with social distancing, lack of information, mixed messages from authority figures, and lack of personal protective equipment (PPE). Prevention facilitators included concerns about contracting COVID-19, clear and consistent messages from trusted sources, contact tracing, and the provision of PPE. Coping barriers included food insecurity, mental health issues, isolation, economic hardships, lack of health care access, and issues with virtual schooling and church services, which were exacerbated by the inability to connect to the internet. Facilitators to coping included religious faith, increased physical activity, and a sense of hope. Testing barriers included misunderstanding, fear, mistrust, testing restrictions, and location of testing sites. Facilitators to testing included incentives, clear information from trusted sources, convenient testing locations, and free tests. CONCLUSION: Gaining community members' perspectives can identify barriers and facilitators to prevention, coping, and testing and potentially improve outcomes. While addressing the social determinants of health (e.g. income, education, medical trust) would be an effective path by which to diminish health disparities related to COVID-19, there is an urgent need to mitigate the spread and severity of COVID-19 in vulnerable populations. Interventions should focus on downstream determinants, such as those emerging from our study.

Objectives: Nonadherence to medications has been documented, but the combined effect of social risk factors on medication nonadherence has not been investigated. Methods: We conducted a cross-sectional analysis of data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based prospective cohort. The sample (N = 1506) included subjects who at Year 20 (2005-06) were taking prescription medications and completed a 4-item Medication Adherence Scale. Social risk factors were education of high school or less, annual household income Results: In a fully adjusted logistic regression model, income 3 times higher odds of nonadherence than counterparts with no social risk factors (OR = 3.26 [95% CI 1.72–6.19], p < .001). Conclusion: Low income and chronic stress are associated with medication nonadherence, and the odds of nonadherence increase with the accumulation of social risk factors. Findings may be used to develop risk prediction tools to identify individuals who can benefit from adherence-promoting interventions.

Over the past 25 years, the adult obesity rate in the U.S. has increased 70%, with obesity placing a disproportionate chronic disease burden on African Americans. Using Photovoice methodology, this study aimed to: (1) explore the social determinants contributing to obesity from the perspectives of residents of two low-income municipalities in Birmingham, Alabama with varying levels of segregation, (2) better understand residents’ perceptions of contributors to obesity in their communities, and (3) examine residents’ perceptions of interventions that might be effective in promoting positive change. Focus groups (N=10) segmented by race and community were conducted by trained moderators. Transcriptions were analyzed by theoretical thematic analysis. The study design and data analysis analyses were guided by a conceptual framework based on the Social Determinants of Obesity model. Findings from this study lend support to the efficacy of the conceptual framework as a multilevel approach describing obesity disparities in the south. Regardless of community and race, participants believed that elements of their built environment, such as fast food restaurants and unsafe walking conditions, contributed to obesity, and that schools and churches should play an active role in addressing the issue.

Background: Inclusion of racial/ethnic mi­norities in cancer-related research remains inadequate, continuing to impact disparate health outcomes. Data regarding enrollment of racial/ethnic minorities in nontherapeu­tic, health-related research is sparse, and even less is known about enrollment of those with a double disparity of racial/ethnic minorities in rural settings. Objective: To examine perspectives of Latinx and African American (AA) healthy volun­teers from rural and urban settings in five southern US states and Puerto Rico regarding their trust in research and their willingness to participate in nontherapeutic research trials based on who conducts the research. Methods: This study was conducted in 2013 in rural and urban communities across Alabama, Florida, Georgia, Missis­sippi, Louisiana, and Puerto Rico. A 38-item questionnaire based on the Tuskegee Legacy Project Questionnaire assessed willingness, motivators, and barriers to participation in nontherapeutic cancer-related research. The sample was segmented into four subgroups by urban/rural location and race/ethnicity. Results: Of 553 participants (rural Latinx=151, urban Latinx=158, rural AA=122, urban AA=122), more than 90% had never been asked to participate in research, yet 75% of those asked agreed to participate. Most had positive views regard­ing health-related research. Trust in who conducted research varied by subgroup. Personal doctors and university hospitals were most trusted by all subgroups; for-profit and tobacco companies were least trusted. Both Latinx subgroups trusted pharmaceutical companies more than AAs; local hospitals and for-profit businesses were more trusted by AAs. Both rural subgroups trusted research by insurance companies more than their urban counterparts. Conclusions: If asked, rural and urban AA and Latinx healthy volunteers were willing to participate in health-related research, with personal doctors and university hos­pitals considered the most trusted sources to encourage/conduct research. Ethn Dis. 2021;31(2):263-272; doi:10.18865/ed.31.2.263

OBJECTIVE Racial and ethnic disparities persist in cervical cancer cases, 90% of which are caused by the human papillomavirus (HPV). Suboptimal vaccine uptake is problematic, particularly among Latinx women, who have the highest cervical cancer incidence compared with other racial/ethnic groups. We examined the association of self-efficacy and HPV vaccination intention among Latinx immigrant mothers of unvaccinated 9- to 12-year-old girls. METHODS An interview-administered survey assessed baseline sociodemographic information, knowledge and perceived risk of cervical cancer and HPV, self-efficacy, and intention to vaccinate among 313 Latinx immigrant mothers in Alabama from 2013 to 2017 before the implementation of an intervention to promote HPV vaccination. RESULTS Participants were, on average, 35 years old, with 9 years of education, and had lived in the United States for 12 years. Mothers who perceived their daughters were at risk of HPV infection were more likely to be vaccine intent than their hesitant counterparts (p

Inclusion of racial/ethnic minorities in cancer research can reduce disparities in health outcomes; however, data regarding barriers and motivators to participation are sparse. This study assessed African American (AA) and Latinx healthy volunteers' perspectives regarding willingness to participate in noninvasive and invasive research activities.Using a 38-item questionnaire adapted from the Tuskegee Legacy Project Questionnaire, we assessed willingness to participate in 12 research activities, offering 27 possible barriers and 14 motivators. The sample was segmented into four subgroups by AA/Latinx and rural/urban.Across five states and Puerto Rico, 533 participants completed questionnaires. Overall, participants were more willing to participate in noninvasive versus invasive procedures, although, all subgroups were willing to participate in research if asked. Rural AA were most willing to complete a survey or saliva sample, while rural Latinx were least willing. Urban AA were least willing to provide cheek swab, while rural counterparts were most willing. Self-benefit and benefit to others were among the top three motivators for all subgroups. Curiosity was a primary motivator for urban AA while obtaining health information motivated rural Latinx. Primary barriers included fears of side effects and being experimented on, lack of information, and lack of confidentiality.Latinx and AAs are willing to participate in the continuum of nontherapeutic research activities suggesting their lack of participation may be related to not being asked. Inclusive enrollment may be achieved by assessing needs of participants during the design phase of a study in order to reduce barriers to participation.

We evaluated outcomes from a healthy eating/nutrition label interpretation intervention among Latinx immigrant mothers and their daughters, aged 9–12 years, in Alabama. Between May 2013–October 2017, this cluster randomized controlled trial assigned 299 mother-daughter dyads to either a healthy eating (intervention) or HPV vaccination (control) study arm. Participants attended four group sessions delivered in Spanish by Lay Health Educators covering portion sizes, healthy eating/cooking strategies, and nutrition label reading/interpretation. An individual session in participants’ homes reviewed pantries and developed healthy eating plans. Identical interviewer-administered surveys were completed at baseline and 7-month follow-up by both study arms. Retention rate at follow-up was 93.4% in intervention arm (92.6% in control arm). Positive changes in healthy eating behaviors and proficiency in nutrition label interpretation were assessed. Adjusting for marital status, employment status, and health insurance coverage status, when compared to controls, mothers in the intervention arm had greater odds of increasing daily fruit and vegetable consumption (OR 3.66, 95% CI 2.14–6.27, p

With regard to tobacco cessation, persons living with HIV (PLWH) are an underserved population, given the high prevalence of use and lack of evidence-based cessation programs tailored to this population. This study examined barriers and facilitators to tobacco use and cessation among PLWH in southern Brazil. We interviewed a total of 36 PLWH: 26 current smokers, of whom eight had a previous diagnosis of pulmonary TB, and 10 former smokers. Motivations for smoking included anxiety relief, social influence, and habitual behaviors. Motivations to quit included bad smell/taste and consequences/symptoms. Barriers to cessation included cost of pharmacological aids, distance to treatment, and reluctance to seek tobacco cessation services at the public primary care clinics due to confidentiality concerns. Participants favored individual or group interventions, no-cost pharmacologic aids, and assured confidentiality. There are specific contextual factors associated with tobacco cessation among PLWH in Brazil, which have important clinical, research, and policy implications.

OBJECTIVE: We examined the efficacy of a culturally relevant, community-based HPV vaccination intervention among Latinx immigrant mothers with daughters aged 9–12 in Alabama. METHODS: We conducted a cluster-randomized controlled trial with “place of residence” (e.g., apartment complexes, trailer parks) as the unit of randomization that evaluated two interventions: 1) promotion of HPV vaccination and 2) promotion of healthy eating and appropriate nutrition label interpretation. Identical baseline/post/7-month follow up questionnaires were completed by all participants and both interventions consisted of four group sessions and one individual session. A total of 40 locations were randomized with 317 mother-daughter dyads enrolled in the study between May 2013 and October 2017. RESULTS: A total of 278 mother-daughter dyads met full eligibility and initiated the intervention/control participation. Retention rate overall was 93.2% (92.6% for the intervention arm and 93.7% for the control arm). Daughters in the intervention arm were significantly more likely to receive one, two, and three doses of HPV vaccine than daughters in the control arm p

Intractable epilepsy can be challenging for patients and for their families. Disability rates in patients are high, causing tremendous physical and emotional burden on family caregivers. Additionally, caregivers may experience affiliate stigma, where they perceive and internalize the negative societal views of a condition and exhibit a psychological response. Affiliate stigma has been rarely studied in caregivers of those with intractable epilepsy. This study examined the relationship between affiliate stigma and the levels of burden experienced by caregivers, as well as how these levels may vary between those caring for children and adults. This cross-sectional approach used a self-administered survey offered to caregivers of family members with confirmed diagnoses of intractable epilepsy. We measured burden with the 30-item Carer's Assessment of Difficulties Index (CADI) and affiliate stigma with a six-item scale examining caregivers' perceptions of stigma directed toward themselves and their family members with epilepsy. Four nested ordinary-least-squares regression models were estimated using stigma scale scores to predict levels of perceived burden adjusting for demographic variables. Age of the patient with epilepsy was dichotomized (pediatric/adult) to assess a possible moderating effect of patient's age on the relationship between stigma and caregiver burden. Respondents (N = 136) were predominantly White (83%), female (75%), and married (69%), with an average age of 43 years. Patients with epilepsy were 52% male with ages ranging from 2 to 82 years. Each of the regression models yielded positive associations (p < 0.001) between perceived levels of caregiver burden and affiliate stigma. Additionally, the age of the family member with epilepsy moderated (p < 0.05) the effect, with the relationship stronger for caregivers of adults. In a highly select group of patients with refractory epilepsy recruited mostly from a cannabidiol (CBD) clinic, this study demonstrated that caregivers experience affiliate stigma, which is significantly associated with higher burden levels. Additionally, this study identified specific needs, which when met, may improve caregivers' physical and mental health.

Social characteristics, such as socioeconomic status and race/ethnicity, play a role in the treatment and outcomes of patients with epilepsy (PWE), but little is known about how these factors affect patients receiving cannabidiol (CBD) to treat seizures. This exploratory study examined the sociodemographic profile of patients treated with CBD (n=80) and associations between social factors and patient-centered outcomes - overall health status, Quality of Life in Epilepsy-89 (QOLIE-89), and Profile of Mood States (POMS) - in this population. Associations were examined using Pearson correlations and multiple ordinary-least-squares regression (alpha=0.1). The sample was predominantly white (96%) and non-Hispanic/Latino (96%); 76% of patients had family incomes of $40,000+/year. Some patients/families reported experiencing food scarcity (13%), not being able to make ends meet (6%), or not being able to afford antiepileptic medications (8%). The patients' health ratings declined with age and income (p≤0.014), and there was a statistically significant interaction (p

Patients with treatment-resistant epilepsy (TRE) frequently exhibit memory and attention deficits that contribute to their poor personal and societal outcomes. We studied the effects of adjunct treatment with pharmaceutical grade cannabidiol (CBD) oral solution (Epidiolex®; Greenwich Biosciences, Inc.) on attention control processes related to stimulus conflict resolution in patients with TRE. Twenty-two patients with TRE underwent 3 T magnetic resonance imaging (MRI) before receiving (PRE) and after achieving a stable dose of CBD (ON). Functional MRI (fMRI) data were collected while patients performed 2 runs of a flanker task (FT). Patients were instructed to indicate via button press the congruent (CON) and incongruent (INC) conditions. We performed t-tests to examine with FT attention control processes at PRE and ON visits and to compare the 2 visits using derived general linear model (GLM) data (INC - CON). We performed generalized psychophysiological interaction (gPPI) analyses to assess changes in condition-based functional connectivity on FT. Median time between fMRI visits was 10 weeks, and median CBD dose at follow-up was 25 mg/kg/d. From PRE to ON, participants experienced improvements in seizure frequency (SF) (p = 0.0009), seizure severity (Chalfont Seizure Severity Scale (CSSS); p 0.0001), and mood (Total Mood Disturbance (TMD) score from Profile of Mood States (POMS); p = 0.0026). Repeated measures analysis of variance showed nonsignificant improvements in executive function from 34.6 (23.5)% to 41.9 (22.4)% CON accuracy and from 34.2 (25.7)% to 37.6 (24.4)% INC accuracy (p = 0.199). Change in CON accuracy was associated with change in INC accuracy (r

Willpower, as demonstrated through diet and exercise, is constructed as the only acceptable strategy for losing weight. While weight loss surgery (WLS) is an option for morbidly obese individuals, ...

Treatment-resistant epilepsy (TRE) is associated with low quality of life (QOL). Cannabidiol (CBD) may improve QOL, but it is unclear if such improvements are independent of improvements in seizure control. Our aim was to compare QOL at baseline and after 1 year of treatment with CBD. We hypothesized that QOL would improve independent of changes in seizure frequency (SF) or severity, mood, or adverse events. We assessed QOL using Quality of Life in Epilepsy-89 (QOLIE-89) in an open-label study of purified CBD (Epidiolex®) for the treatment of TRE. All participants received CBD, starting at 5 mg/kg/day and titrated to 50 mg/kg/day in increments of 5 mg/kg/day. We collected QOLIE-89 in adult participants at enrollment and after 1 year of treatment, or at study exit if earlier. We analyzed if the change in QOLIE-89 total score could be explained by the change in SF, seizure severity (Chalfont Seizure Severity Scale, CSSS), mood (Profile of Moods States, POMS), or adverse events (Adverse Event Profile, AEP). Associations among the variables were assessed using bivariate tests and multiple regression. Fifty-three participants completed enrollment and follow-up testing, seven at study termination. Mean QOLIE-89 total score improved from enrollment (49.4 ± 19) to follow-up (57 ± 21.3; p = .004). We also saw improvements in SF, POMS, AEP, and CSSS (all p ≤ .01). Multivariable regression results showed QOLIE-89 at follow-up associated with improvements in POMS at follow-up (p = .020), but not with AEP, CSSS, or SF (p ≥ .135). Improvement in QOL after treatment with CBD is associated with better mood but not with changes in SF, seizure severity, or AEP. Cannabidiol may have beneficial effects on QOL and mood that are independent of treatment response.

Objective To explore the perinatal experiences of African American women in Florida for obtaining information about breastfeeding and also their breastfeeding experiences. Methods This qualitative study utilized convenience sampling of 253 African American women 18 to 35 years old in three Florida counties. Data were derived from the Healthy Futures Perinatal Research and System Design study. One month after giving birth, face-to face interviews were conducted using an interview schedule. Questions about breastfeeding education and experiences were explored. Taped responses were transcribed and analyzed qualitatively. Through subject-level content analysis, key themes were identified. Results Most women received some information about breastfeeding during prenatal care. Mothers who chose to breastfeed were usually aware of some of the benefits for the baby and occasionally benefits for themselves. Mothers who did not breastfeed were concerned about pain associated with breastfeeding, time constraints, returning to work or school, personal health choices, or felt uncomfortable with the idea of breastfeeding. Factors facilitating breastfeeding included healthcare providers that encouraged the practice, knowing the advantages, attending a breastfeeding class or support group, breastfeeding in the birth or recovery room, latch assistance, rooming-in, nesting, and the availability of a breast pump. Reasons for supplementation and cessation were latch problems, pain, concerns the baby wasn't getting enough, mother-infant separation, and medical complications. Implications Intensified prenatal and postpartum efforts to support breastfeeding are needed to increase breastfeeding initiation and duration for African American mothers.

Purpose To review current studies on vaginal douching. Data sources MEDLINE PubMed, CINAHL, and Cochrane databases from 2002 to 2008 using MeSh terms "vaginal AND irrigation or vaginal and douching" from 2002 to 2003 and "vaginal douching" and "vaginal douching and adverse effects" from 2004 to 2008. Study selection MEDLINE PubMed included 156 records, CINAHL 15, and Cochrane 10. Articles in English were reviewed, and those pertaining to vaginal douching and reproductive and gynecologic outcomes were included. References from these articles were reviewed and included when appropriate. 2008 Web sites of the Centers for Disease Control and Prevention were also included. Data extraction Articles were reviewed and summarized. Results Vaginal douching is a common practice for almost one-third of women in the United States. Douching is associated with adverse pregnancy outcomes including ectopic pregnancy, low birth weight, preterm labor, preterm birth, and chorioamnionitis. Douching is more prevalent among non-Hispanic black women than among white women or Hispanic women. Douching alters the vaginal flora and predisposes women to develop bacterial vaginosis (BV), which is also more prevalent among women who douche and among black women. Douching is also associated with serious gynecologic outcomes, including increased risk of cervical cancer, pelvic imflammatory disease, endometritis, and increased risk for sexually transmitted infections, including HIV. Many factors influence women's douching behaviors, including social, cultural, and educational factors. Healthcare providers can influence women to stop douching. Clinical implications Healthcare providers may not be aware of the mounting evidence of negative health outcomes associated with the practice of douching. At every opportunity, healthcare providers should ask women whether they douche and inquire about vaginal douching practices and beliefs associated with the practice. Douching should be discouraged because it places women at risk for multiple health problems.

Currently, about one-third of all women giving birth have a cesarean surgical birth, and the majority are given an epidural or spinal anesthetic containing an opioid for surgery. An unpleasant side effect experienced by many of these women is itching. This article reviews the literature on itching after spinal and epidural administration of opioids and how nurses can best manage this side effect.

BACKGROUND: Teachers in Ontario are expected to implement the physical activity guidelines in the health and physical education (HPE) curriculum document that was introduced in 1998. This study examined Toronto teachers’ perspective on barriers to implementing these guidelines. METHODS: Forty-five teachers from five Toronto elementary schools in which generalist classroom teachers provide physical education classes participated in focus groups. An experienced moderator facilitated each session. Themes were inductively generated from the data. RESULTS: Participants reported that children were not engaged in moderate or vigorous physical activity daily and for the expected duration. Participants identified three categories of barriers to implementing the curriculum guidelines: lower priority for HPE, lack of performance measures for physical activity, and lack of sufficient infrastructure. First, they reported that the new curriculum expectations for other subjects were demanding, which left little time to focus on physical education. They felt that resource support for the HPE curriculum was not sufficient and that physical education specialists were necessary but unavailable to implement the curriculum. Second, participants felt accountable to both government and parents for high student performance on standardized tests in subjects deemed to be of higher priority. Third, participants reported inadequate facilities and equipment, use of portables for classrooms, cancelling physical education to have events in the gymnasium, and unavailability of teachers to supervise off-school physical activity. CONCLUSION: The study suggests that participating teachers perceive physical education to be a low priority in the educational system, making it difficult for them to meet the HPE curriculum expectations.

An evaluability assessment was conducted to plan a community-based, multi-strategy approach to physical activity promotion (MSAPAP) to maximize young children's physical activity in an ethno-racially and socio-economically diverse city. This assessment involved consultation with various stakeholders to develop a program logic model to diagrammatically describe the MSAPAP. First, published literature regarding physical activity was reviewed to describe interventions designed to increase children's physical activity and to identify factors that contributed to program effectiveness. Secondly, key informants from mainstream service organizations and smaller community-based agencies were interviewed to determine their views on how to increase physical activity among children and families. A workgroup developed a draft logic model based on the results of the literature review and community needs assessment results. Thirdly, stakeholders were consulted about the draft model. This consisted of 12 focus groups with members of school boards (two sessions), members of community organizations (three sessions), lay home visitors who provide support to mothers of young children in ethno-racially diverse communities (one session), and parents from six cultural groups (six sessions). The logic model was revised based on the findings from this consultation. The final logic model shows children aged 3-8 years as the main target group, and parents and various community members who influence children as intermediate target groups. The MSAPAP is depicted as six strategies, which are clusters of program activities that are conceptually similar: community engagement, community assessment, accessibility, promotion, education and skill development, and inclusive programming. The logic model shows the 'cause and effect' relationships among program activities, shorter-term outcome objectives (e.g. to reduce user fees for physical activity programs) and longer-term outcome objectives (e.g. to increase the proportion of children who are physically active). The extensive community involvement in planning the MSAPAP facilitated a subsequent plan to develop, implement and evaluate selected program activities in the MSAPAP.

Paper Presentation Objective To determine whether the initiation of skin‐to‐skin contact (SSC) between mothers and newborns in the operating room and thereafter would enhance infant feeding responses, decrease the time of breastfeeding initiation, increase the rates of breastfeeding duration and exclusivity, and promote maternal satisfaction with the cesarean birth process and breastfeeding practices. Design Quasi‐experimental design with convenience sampling and a mixed‐methods approach. Setting This study was implemented at the Women's Pavilion of the participating hospital, which is a private, not‐for‐profit community health care center. Sample The experimental group ( n = 25) was given SSC immediately after cesarean on the operating table and during recovery. The comparison group ( n = 16) was given routine standard care with/without delayed SSC in the recovery room. The experimental group was recruited during the preop admission period by registered nurses, whereas the comparison group was recruited during their 6‐week postpartum checkups from a large physicians’ office in Tallahassee. The same inclusion and exclusion criteria were used for both groups. Methods The outcomes measured included breastfeeding initiation, duration, and exclusivity, infant feeding responses, and maternal satisfaction. During the delivery and recovery periods, a project data sheet was completed on the experimental group and included data on breastfeeding initiation and length of time, latch quality, and infant feeding cues. Maternal satisfaction and overall breastfeeding duration and exclusivity were measured by phone survey at 4 to ‐12 weeks postpartum. Participants in the comparison group were provided with the same postpartum survey as the experimental group and were asked about SSC after cesarean and breastfeeding outcomes (e.g., initiation, duration, and exclusivity). Results The participants who experienced immediate SSC had significantly earlier breastfeeding initiation, significantly longer durations of overall breastfeeding, and significantly greater rates of exclusive breastfeeding than participants in the comparison group. The qualitative analysis of maternal satisfaction was multifactorial and influenced by several perioperative and postpartum factors. Conclusion/Implications for Nursing Practice The findings suggest that SSC after cesarean may decrease breastfeeding initiation time, increase the rates of breastfeeding duration and exclusivity, enhance infant feeding responses, and further promote maternal satisfaction. The incorporation of SSC immediately after birth is considered beneficial for all newborns and mothers and should be implemented in all hospital environments.

Four of the most common problems encountered with newborns in the home include feeding difficulties, jaundice, gastrointestinal problems, and inconsolable crying. This article suggests assessment measures and intervention strategies to deal with these problems and evaluate the home environment for safety. This article also includes suggestions to promote safe infant feeding, bathing, sleeping arrangements, car safety seats, firearm and poison storage, fall prevention, concerns about pets, pest control, heating and cooling, and a nonsmoking environment.

Many previous studies demonstrate that hepatocytes can be reprogrammed into insulin-producing cells (IPCs) utilizing viral vector-mediated delivery of pancreatic transcription factors (PTFs). However, whether these liver-derived IPCs are susceptible to autoimmune attack in animal models of type 1 diabetes remains unclear, in part due to the immunogenicity of the viral vectors used to introduce PTF genes. Adeno-associated virus serotype 2 vector-expressing Pdx1-VP16 (Pdx1) and Ngn3 were prepared and injected into the portal vein of streptozotocin (Stz)/diabetic NOD/SCID mice. The presence of glucose-responsive liver-IPCs and their susceptibility to anti-beta cell autoimmunity were assessed by blood glucose levels, insulin content, IPC cell distribution, and intraperitoneal glucose tolerance test following subtotal pancreatectomy (Px) and passive transfer of diabetogenic splenocytes isolated from diabetic female NOD mice. A combination of two PTF genes (Pdx1/Ngn3) effectively reprogrammed liver cells into glucose-responsive IPCs. These IPCs corrected hyperglycemia in Stz/diabetic NOD/SCID mice and maintained normoglycemia following subtotal Px, indicating that liver-derived IPCs could maintain glucose homeostasis. Importantly, we also demonstrated that the glucose-responsive liver–derived IPCs were susceptible to autoimmune destruction by diabetogenic splenocytes, as indicated by progressive elevation in blood glucose levels as well as mixed T-, and B-lymphocytic infiltrates surrounding liver-IPCs 2~3 weeks following transferring of diabetogenic splenocytes into NOD/SCID mice, and confirmed by immunohistochemical studies. In conclusion, genetically reprogrammed liver-IPCs, like pancreatic islet beta-cells, are susceptible to autoimmune attack, suggesting that for cell-replacement therapy of treating type 1 diabetes, beta-cell surrogates may require concomitant immunotherapy to avoid autoimmune destruction.

Background: Poor oral health is increasingly linked to adverse pregnancy outcomes, including preterm birth and low-birthweight infants. Little is known about childbear- ing women's experiences in obtaining dental care. The objective of this study was to explore Florida women's experience of barriers in obtaining dental care before and during their preg- nancies. Methods: Study data were derived from a larger data set of a study that examined barriers to prenatal care. One month after giving birth face-to-face interviews were conducted with 253 African American women, 18 to 35 years old, who were residents of one of three Flor- ida counties. Interview questions about women's experiences on obtaining oral health care before and during pregnancy, and recall of guidance about oral health care during prenatal visits were transcribed and analyzed qualitatively. Through subject-level content analysis, key themes were assessed about the participants' perspectives on obtaining oral health care before and during pregnancy. Results: Most participants did not obtain dental care and did not recall receiving dental information during prenatal visits. Barriers to dental care included lack of insurance, difficulty in finding a dentist, low priority given to dental care, misconceptions about the safety and appropriateness of dental care during pregnancy, and sporadic anticipa- tory guidance during prenatal care. Conclusions: Misconceptions about the appropriateness of oral health care during pregnancy may affect women's access to and use of this care. Given the implications of poor oral health on possible adverse birth outcomes and its larger connec- tion with the general health of mothers and babies, attention to oral health misconceptions and barriers is warranted. (BIRTH 37:4 December 2010)

We have raised a monoclonal antibody (MAB-1E10) reactive with the intact forms but not the processing products of the chromaffin cell vesicle protein chromogranin B (CgB). The antibody recognizes rat and human, but not bovine and chick adrenal chromaffin cells. In addition, MAB-1E10 immunoreactivity was detected in rat PC 12 pheochromocytoma cells and in pituitaries. Several other tissues, including pancreas, small intestine and superior cervical ganglia, which are known to contain CgB in endocrine cells or neurons, respectively, were found not to be reactive with MAB-1E10. Using short-term cultures of dissociated adrenal chromaffin cells from Hannover-Wistar rats, we found that the expression of intact CgB is developmentally regulated. Between embryonic day 19 and postnatal day 40, about 80% of adrenal chromaffin cells--identified by their reactivity with an antibody against the enzyme dopamine-beta-hydroxylase--were found to be reactive with MAB-1E10. The proportion of positive cells subsequently decreased to about 5% at postnatal day 90. In the presence of glucocorticoids, this decrease was reduced to about 45% CgB-positive cells at postnatal day 90. In another rat strain, Sprague-Dawley rats, the proportion of MAB-1E10-immunoreactive chromaffin cells (about 50%) remained constant from birth to adulthood. Our results indicate that CgB is differentially expressed and/or processed in different rat tissues, strains and during development, and furthermore, that expression or processing in rat chromaffin cells might be regulated by glucocorticoids. Intact CgB appears to be a marker for a subpopulation of chromaffin cells, but its function(s) remains to be clarified.