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Abstract Background In 2022 the Academy of Breastfeeding Medicine (ABM) published Clinical Protocol #36: The Mastitis Spectrum, which aims to update clinical approaches to management of benign lactation-related breast inflammation. The protocol has been timely because of the exponential increase in knowledge about the human milk microbiome over the past decade. This Commentary aims to continue respectful debate amongst clinicians and researchers within the Academy of Breastfeeding Medicine and more broadly, confident that we share a fundamental commitment to promote breastfeeding and support the well-being of lactating women, their infants and their families. Analysis Although Clinical Protocol #36 offers advances, it does not fulfil the principles of best practice implementation science for translation of evidence into clinical guidelines. Clinical Protocol #36 inaccurately represents studies; misrepresents theoretical models as proven aetiologies; does not consistently attribute sources; does not reliably apply the SORT taxonomy; and relies upon single case reports. As a result, various recommendations in Clinical Protocol #36 lack an evidence-base or credible underlying theoretical model. This includes recommendations to use ‘lymphatic drainage’ massage, therapeutic ultrasound, and oral lecithin. Similarly, based on a contestable theoretical model which is presented as fact, Clinical Protocol #36 makes the recommendation to either reduce frequency of milk removal or to maintain current frequency of milk removal during an episode of breast inflammation. Although Clinical Protocol #36 limits this advice to cases of ‘hyperlactation’, the diagnosis ‘hyperlactation’ itself is undefinable. As a result, this recommendation may put breastfeeding women who present with breast inflammation at risk of worsened inflammation and decreased breast milk production. Conclusion Clinical Protocol #36 offers some advances in the management of breast inflammation. However, Clinical Protocol #36 also exposes clinicians to two international trends in healthcare which undermine health system sustainability: overdiagnosis, including by over-definition, which increases risk of overtreatment; and antibiotic over-use, which worsens the crisis of global antimicrobial resistance. Clinical Protocol #36 also recommends unnecessary or ineffective interventions which may be accessed by affluent patients within advanced economies but are difficult to access for the global majority. The Academy of Breastfeeding Medicine may benefit from a review of processes for development of Clinical Protocols.

Navigating the challenges of new motherhood, a staggering 50 to 70 percent of women find themselves grappling with clogged milk ducts.. Aloe vera gel compresses can be used on breasts to reduce edema. Aloe vera is known for its effective anti-inflammatory properties. This study aimed to investigate the effect of aloe vera gel compresses on breast engorgement in postpartum mothers. The study included postpartum mothers as the target population. The research design employed a pretest-posttest methodology comprising a control group and non-probability sampling using consecutive sampling. Statistical analyses involved the Paired T-Test and Independent T-Test, with a significance level of p < 0.05. The sample consisted of thirty respondents, with 15 in the control group and 15 in the experimental group. Over a period of three days, aloe vera gel compresses were applied to the breasts twice a day. The Bourbonnais pain scale evaluation checklist was used to assess the degree of breast pain. The findings of this study demonstrate that the intervention involving aloe vera gel compresses significantly reduced breast engorgement (p=0.000; mean SD 2±1.25) and associated pain (p=0.000; mean SD 2.2±1.37). The results of this study suggest that the use of aloe vera gel compresses can effectively alleviate breast pain and swelling in postpartum mothers. Given the substantial benefits observed, healthcare professionals may consider incorporating aloe vera gel compresses as a non-invasive and natural intervention for postpartum mothers experiencing breast engorgement and discomfort. [ABSTRACT FROM AUTHOR]

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Background: In 2022 the Academy of Breastfeeding Medicine (ABM) published Clinical Protocol #36: The Mastitis Spectrum, which aims to update clinical approaches to management of benign lactation-related breast inflammation. The protocol has been timely because of the exponential increase in knowledge about the human milk microbiome over the past decade. This Commentary aims to continue respectful debate amongst clinicians and researchers within the Academy of Breastfeeding Medicine and more broadly, confident that we share a fundamental commitment to promote breastfeeding and support the well-being of lactating women, their infants and their families. Analysis: Although Clinical Protocol #36 offers advances, it does not fulfil the principles of best practice implementation science for translation of evidence into clinical guidelines. Clinical Protocol #36 inaccurately represents studies; misrepresents theoretical models as proven aetiologies; does not consistently attribute sources; does not reliably apply the SORT taxonomy; and relies upon single case reports. As a result, various recommendations in Clinical Protocol #36 lack an evidence-base or credible underlying theoretical model. This includes recommendations to use 'lymphatic drainage' massage, therapeutic ultrasound, and oral lecithin. Similarly, based on a contestable theoretical model which is presented as fact, Clinical Protocol #36 makes the recommendation to either reduce frequency of milk removal or to maintain current frequency of milk removal during an episode of breast inflammation. Although Clinical Protocol #36 limits this advice to cases of 'hyperlactation', the diagnosis 'hyperlactation' itself is undefinable. As a result, this recommendation may put breastfeeding women who present with breast inflammation at risk of worsened inflammation and decreased breast milk production. Conclusion: Clinical Protocol #36 offers some advances in the management of breast inflammation. However, Clinical Protocol #36 also exposes clinicians to two international trends in healthcare which undermine health system sustainability: overdiagnosis, including by over-definition, which increases risk of overtreatment; and antibiotic over-use, which worsens the crisis of global antimicrobial resistance. Clinical Protocol #36 also recommends unnecessary or ineffective interventions which may be accessed by affluent patients within advanced economies but are difficult to access for the global majority. The Academy of Breastfeeding Medicine may benefit from a review of processes for development of Clinical Protocols. [ABSTRACT FROM AUTHOR]

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Copyright of Irrigation & Drainage is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Lactation and breastfeeding are core components of reproductive health care and obstetrical providers should be familiar with common complications that may arise in lactating individuals. While many breastfeeding challenges are best addressed by a lactation consultant, there are conditions that fall out of their scope and require care from a clinician. The objective of this chapter is to review common complications of breastfeeding and lactation including inflammatory conditions, disorders of lactogenesis, dermatologic conditions, and persistent pain with lactation. [ABSTRACT FROM AUTHOR]

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Despite the known benefits of breastfeeding for both infant and mother, clinical support for problems such as benign inflammation of the lactating breast remain a research frontier. Breast pain associated with inflammation is a common reason for premature weaning. Multiple diagnoses are used for benign inflammatory conditions of the lactating breast which lack agreed or evidence-based aetiology, definitions, and treatment. This article is the second in a three-part series. This second review analyses the heterogeneous research literature concerning benign lactation-related breast inflammation from the perspectives of the mechanobiological model and complexity science, to re-think classification, prevention, and management of lactation-related breast inflammation. Benign lactation-related breast inflammation is a spectrum condition, either localized or generalized. Acute benign lactation-related breast inflammation includes engorgement and the commonly used but poorly defined diagnoses of blocked ducts, phlegmon, mammary candidiasis, subacute mastitis, and mastitis. End-stage (non-malignant) lactation-related breast inflammation presents as the active inflammations of abscess, fistula, and septicaemia, and the inactive condition of a galactocoele. The first preventive or management principle of breast inflammation is avoidance of excessively high intra-alveolar and intra-ductal pressures, which prevents strain and rupture of a critical mass of lactocyte tight junctions. This is achieved by frequent and flexible milk removal. The second preventive or management principle is elimination of the mechanical forces which result in high intra-alveolar pressures. This requires elimination of conflicting vectors of force upon the nipple and breast tissue during milk removal; avoidance of focussed external pressure applied to the breast, including avoidance of lump massage or vibration; and avoidance of other prolonged external pressures upon the breast. Three other key preventive or management principles are discussed. Conservative management is expected to be effective for most, once recommendations to massage or vibrate out lumps, which worsen micro-vascular trauma and inflammation, are ceased. [ABSTRACT FROM AUTHOR]

Central venous stenosis is a rare cause of neurologic pathology. Here we present a case of brachiocephalic vein stenosis causing cervical myelopathy through venous engorgement. Our patient was a 51-y/o male who presented with ambulatory dysfunction so he was evaluated for cervical myelopathy. Imaging revealed cord compression from venous engorgement and brachiocephalic vein stenosis. He was treated with angioplasty and vessel stenting which significantly improved flow on postintervention imaging. In conclusion, preoperative vascular imaging should be considered in myelopathic patients as it can detect this rare but dangerous etiology.

Background: Breast engorgement is a serious condition that should be evaluated objectively affecting mother and baby. Objective: The aim of this study is to validate the Turkish validity and reliability of the 6-point breast fullness assessment scale to describe changes in the breast during breastfeeding in the first 14 days postpartum. Methodology: It is a cross-sectional, descriptive study. The research was carried out with 49 women who gave birth at specified date intervals, met inclusion criteria, agreed to participate in the research and completed follow-up process. First assessment of the scale was made by each puerperant and the researcher, and the puerperant women were asked to evaluate breast engorgement twice a day after breastfeeding every morning and evening. Postpartum monitoring was continued for 14 days. Results: Ages of women participating in the research are minimum 20 and maximum 45 years and their mean age is 27.91±4.97. They have at least 1 and at most 5 children and mean number of children is 1.95±0.81. Scale scores were compared in terms of education, age, first breastfeeding time, family type, number of children and type of childbirth. A statistically significant relationship was found between type of childbirth and scale scores. Higher scale score was found in caesarean delivery. Conclusion: The days when breast engorgement increases as the literature indicates and the ones when this increase has been seen on the scale showed similar results. It was decided that the scale could be used by women in the evaluation and follow-up of breast filling. [ABSTRACT FROM AUTHOR]

Objective: To describe a novel method of inducing emesis in the dog using gingival administration of apomorphine, compare the efficacy of inducing emesis with gingival apomorphine to conjunctival apomorphine, and describe adverse effects associated with the gingival route. Design: Retrospective study from January 2017 to September 2018. Setting: Independent all‐hours primary and secondary emergency and critical care referral center. Animals: Five hundred fifty‐eight client‐owned dogs. Measurements and Main Results: The medical records of dogs presenting for induction of emesis were searched. Dogs receiving either gingival or conjunctival apomorphine were included in the study. A short online survey was sent to clients whose dogs received gingival apomorphine. Apomorphine was administered conjunctivally in 430 (77.1%) dogs and gingivally in 128 (22.9%) dogs. There was no difference between route of administration and success of emesis (p = 0.29). A total of 14 clients responded to the survey, and diarrhea, lethargy, hyperactivity, and sedation were reported as adverse effects of gingival apomorphine administration. No clients sought veterinary attention for any of the adverse effects reported. Conclusions: Gingival administration of apomorphine is easy, appears to be safe, and is an effective method of inducing emesis in the dog. Gingival administration of apomorphine may be considered in cases where parenteral administration is not feasible and could replace conjunctival administration in compliant dogs. [ABSTRACT FROM AUTHOR]

Background: The most important factor affecting weight gain after birth is the type and mode of neonatal feeding. The most suitable nutrition is exclusive breastfeeding. However, breastfeeding can be accompanied with some difficulties, such as breast engorgement, which results in neonatal feeding complications. Breast Oketani-massage therapy is proposed as a treatment for breast engorgement. Aim: This study aimed to determine the effect of breast Oketani-massage therapy on neonatal weight gain among lactating women with breast engorgement. Method: This randomized controlled clinical trial was conducted on 100 postpartum (i.e., on the first five days of childbirth) women admitted to the Midwifery Clinic and Gynecology and Obstetric Department of Imam Reza Hospital, Mashhad, Iran, due to breast engorgement from August to November 2016. The subjects were divided into two groups, namely Oketani massage and routine care training, through random block allocation. The data were collected regarding neonatal weight gain before and after the intervention and analyzed in SPSS (version 20) using repeated measures ANOVA. Results: The results revealed no significant difference between the two groups in terms of neonatal weight gain on within days 1-5 day before the intervention (P=0.17). However, a statically significant difference was observed between the two groups in this regard 14 and 28 days post-intervention (P

Unfortunately, not every mammary gland functions in full when fulfils its main function, which is milk production for infant feeding. Most often, the technical errors during breastfeeding the baby cause nipple cracks, maceration and women stop breastfeeding. Engorgement is one of the most common problems faced during natural breastfeeding. The article highlights the issues of the physiology of lactation, discusses the problems arising during lactation, the risk factors for the development of hypogalactia, and describes the rules for using breast pumps to maintain lactation.

Overcrowding in Emergency Departments is often considered as an outcome of insufficient access to hospital beds or primary care, therefore a potential lack of health resources. We sought to describe the quantitative evolution of health resources in the French health care system, in comparison with demographic and epidemiologic parameters that reflect health needs. Overall, in the last decade, parameters of capacity and human resources stagnated while activity and spending increased jointly, stimulated by ageing of the population and chronic diseases mostly. Nevertheless, recent official previsions have again recommended to proceed with hospital bed reduction until 2030. This has led to a dangerous saturation of emergency care and to the ongoing systemic health crisis. This situation will require ambitious health resources reinforcement plans in both hospital and primary care. Furthermore, ageing of the population and chronic diseases must lead society to deliberate on the fundamental goals and funding of our health care system. [ABSTRACT FROM AUTHOR]

Introduction: During the postpartum period, breast engorgement in preparation for lactation may trigger the onset of vulvar labial nodules that present with pain and discomfort. These labial nodules may originate from ectopic breast tissue and can rarely present in women during the postpartum period in the labia majora. Main Issue: A 37-year-old African American female, gravida 1 para 1, presented to the Loma Linda University Medical Center with complaints of new onset labial swelling worsening 6 days following her full term spontaneous vaginal delivery. Additionally, our respondent complained of difficulty breastfeeding due to intermittent lack of milk production. She reported bilateral breast engorgement with tenderness, despite frequent attempts at breastfeeding. The respondent's presentation did not meet the criteria for other common differentials due to the physical characteristics of the nodules. The location of the nodules along the milk line led physicians to believe that the respondent was presenting with engorged extra-mammary breast tissue in the labia majora. Management: The participant was told to observe her course over the next few days as she began to have milk production and ejection. The respondent was seen in clinic for her 6-week postpartum visit, and was no longer complaining of difficulty with breastfeeding. The labial nodules had resolved spontaneously. Conclusion: A literature search yielded no case reports that described a case of an extra-mammary vulvar mass that self-resolved with resolution of breast engorgement. The infrequent presentation of extra-mammary vulvar tissue makes it difficult to conclude a guideline for diagnosis and management. [ABSTRACT FROM AUTHOR]

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Abstract Background Since 1997, human-biting ticks submitted to the Department of Defense Human Tick Test Kit Program (HTTKP) of the US Army Public Health Command have been tested for pathogens by PCR. We noted differences in the phenology and infection prevalence among Ixodes scapularis ticks submitted from military installations in different geographic regions. The aim of this study was to characterize these observed differences, comparing the phenology and pathogen infection rates of I. scapularis submitted from soldiers at two sites in the upper Midwest (Camp Ripley, MN, and Ft. McCoy, WI) and one site in the northeastern US (Ft. Indiantown Gap, PA). Methods From 1997 through 2012, the HTTKP received 1,981 I. scapularis from the three installations and tested them for Anaplasma phagocytophilum, Babesia microti, Borrelia burgdorferi and the Ehrlichia muris-like (EML) agent using PCR; pathogen presence was confirmed via sequencing or amplification of a second gene target. Pathogen and co-infection prevalence, tick engorgement status, and phenology were compared among installations. Results Greater rates of A. phagocytophilum and Ba. microti infections were detected in ticks submitted from installations in Minnesota than in Wisconsin or Pennsylvania, and the EML agent was only detected in ticks from Minnesota and Wisconsin. Midwestern ticks were also more likely to be co-infected than those from Pennsylvania. Both adult and nymphal ticks showed evidence of feeding on people, although nymphs were more often submitted engorged. Adult I. scapularis were received more frequently in June from Minnesota than from either of the other sites. Minnesota adult and nymphal peaks overlapped in June, and submissions of adults exceeded nymphs in that month. Conclusions There were clear differences in I. scapularis phenology, pathogen prevalence and rates of co-infection among the three military installations. Seasonal and temperature differences between the three sites and length of time a population had been established in each region may contribute to the observed differences. The synchrony of adults and nymphs observed in the upper Midwest has implications for pathogen infection prevalence. The EML agent was only detected in Minnesota and Wisconsin, supporting the previous assertion that this pathogen is currently limited to the upper Midwest.

Breast feeding is the most enriching and unique experience for every mother. It plants the seeds of mother child bonding but the common problem experienced by most of the mothers is breast engorgement. It involves three elements: congestion, increased vascularity & accumulation of milk. Managing breast engorgement has always been a challenge for nurses working with postnatal mothers. Objective: To assess the effectiveness of cold vs. warm compresses on reduction of breast engorgement among primi postnatal mothers. Methodology: A quasiexperimental study was conducted to assess the effectiveness of cold vs. warm compresses on reduction of breast engorgement among primi postnatal mothers at SGRD hospital, Amritsar. Data was collected from 90 primi postnatal mothers(30 in each group i.e. cold compress, hot compress, control )by using convenience sampling technique. A standardized scale i.e. six point breast engorgement scale was used to assess engorgement. Results: The pre-test mean score of breast engorgement group I i.e. cold compresses (n=30) was 2.87 ± 0.63 and it decreased to 2.80 ± 0.71 after cold compresses('t '= 12.98, <0.01). The pre-test mean score of breast engorgement in group II i.e. warm compresses (n=30) was 2.80 ± 0.66 and it decreased to 2.10 ± 1.21 after warm compress (t = 14.69, p =< 0.01). Conclusion: It is concluded from the present study that hot compress is more effective than cold compress to relieve breast engorgement. [ABSTRACT FROM AUTHOR]

Copyright of Irrigation & Drainage is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Irrigation & Drainage is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Following an infant death, if breast milk production is not weaned, this could lead to issues for the mother. Lactation suppression can be done safely with proper education and support. Caregivers should be educated on how to provide support to the lactating woman during this difficult situation. An abrupt wean can lead to engorgement and milk trapping. This can be uncomfortable and possibly lead to mastitis with infection. The mother who has been providing breast milk needs special attention. Providing her with the knowledge of what to expect and the use of comfort measures will make the discontinuation of her milk production a smoother and more comfortable process. The emotional support of the grieving process begins in the NICU. Encourage follow-up for the bereaved family by offering them resources. Give the parents the option to donate breast milk. In some situations, donation promotes healing and closure. [ABSTRACT FROM AUTHOR]

Background Australian breastfeeding rates fall significantly in the months following birth, often as a result of breastfeeding complications. Aim To explore the potential risk factors for nipple trauma and breast engorgement in a group of women who were referred to the in home breastfeeding service in Melbourne, Australia. Method A retrospective, cross-sectional analyses of the maternal–infant records ( n = 653) from 2003 to 2007 including demographic characteristics; pregnancy, labour and birth data; the presenting complications and observational and diagnostic results. Bivariate and logistic regression analyses were conducted to explore the predictors of nipple trauma and engorgement. Results Nipple trauma was the most common presenting complication (62.9%). Logistic regression analyses identified four statistically significant predictors: facio-mandibular asymmetry (AOR 4.21, 95% CI [1.25–14.20]), inflammatory mastitis (AOR 2.99, 95% CI [1.57–5.68], nipple malignment (AOR 2.51, 95% CI [1.13–5.55]) and the cross-cradle technique (AOR 1.90, 95% CI [1.03–3.50]). Engorgement was associated with the first postpartum breastfeed being less than one-hour duration (AOR 2.01, 95% CI [1.07–3.79]). Conclusion Nipple trauma was associated with commonly taught techniques that involved the cross-cradle hold and manoeuvres of the breast, nipple and baby that resulted in nipple malalignment and facio-mandibular asymmetry. This practice, appeared to interfere with the baby's intra-oral function by restricting movement of the cranio-cervical spine and nuchal ligament. The combination appeared to limit the baby's instinctive ability to activate neuro-sensory mammalian behaviours to freely locate and effectively draw the nipple and breast tissue without causing trauma. Changes to the first and early breastfeeding techniques are recommended. [ABSTRACT FROM AUTHOR]

Female Amblyomma hebraeum ticks (Acari: Ixodidae) increase their weight ∼10-fold during a ‘slow phase of engorgement’ (7–9 days), and a further 10-fold during the ‘rapid phase’ (12–24 h). During the rapid phase, the cuticle thins by half, with a plastic (permanent) deformation of greater than 40% in two orthogonal directions. A stress of 2.5 MPa or higher is required to achieve this degree of deformation (Flynn and Kaufman, 2015). Using a dimensional analysis of the tick body and applying the Laplace equation, we calculated that the tick must achieve high internal hydrostatic pressures in order to engorge fully: greater than 55 kPa at a fed:unfed mass ratio of ∼20:1, when cuticle thinning commences (Flynn and Kaufman, 2011). In this study we used a telemetric pressure transducer system to measure the internal hydrostatic pressure of ticks during feeding. Sustained periods of irregular high frequency (>20 Hz) pulsatile bursts of high pressure (>55 kPa) were observed in two ticks: they had been cannulated just prior to the rapid phase of engorgement, and given access to a host rabbit for completion of the feeding cycle. The pattern of periods of high pressure generation varied over the feeding cycle and between the two specimens. We believe that these pressures exceed those reported so far for any other animal. [ABSTRACT FROM AUTHOR]

Background: The current breastfeeding initiation rate in Canada is approximately 87%. By one month, about 21% of women have stopped breastfeeding. Engorgement and edema in breast tissue can lead to breastfeeding challenges which may contribute to early weaning. The aims of this pilot research study were to explore the relationship between intrapartum intravenous fluids given to mothers and postpartum breast swelling in the first 10 days postpartum and to determine if a larger study was warranted and feasible. Methods: A prospective, longitudinal, observational cohort pilot study with repeated measures and a within-subjects design was completed. Participants were first time mothers who have a single, healthy newborn and had a spontaneous vaginal birth. Daily data collection from admission into the study until postpartum day 10 took place. Descriptive statistics are reported and linear regression analysis was used to model the relationship between IV therapy and postpartum breast edema. Results: Women who received intravenous fluids during labour had higher levels of breast edema postpartum and rated their breasts as firmer and more tender than women who did not receive intravenous fluids. Participants who had intravenous fluids described patterns of fullness that appeared to be related to edema as opposed to fullness associated with engorgement and lactogenesis II. Conclusions: The findings demonstrate that mothers in this pilot study who received intravenous fluids in labour and postpartum had higher levels of breast edema. These results suggest a larger study is warranted to more fully examine the effects of intravenous fluids on postpartum breast swelling. [ABSTRACT FROM AUTHOR]

The most common tick species parasitizing animals in Poland are Ixodes ricinus and Dermacentor reticulatus. These tick species differ in their distribution, habitats, seasonal activity and host specificity. Ixodes ricinus is the most prevalent and widely distributed, whereas the range of D. reticulatus is limited to eastern and central parts of the country with several new foci in the middle-west and the west. However, as in many central European countries, the range of D. reticulatus is expanding, and some authors have correlated this expansion with an increasing number of available hosts. The aim of the present study was to determine the tick fauna on domestic and livestock animals in two areas endemic for I. ricinus and D. reticulatus and to compare the risk of infestation with different tick species in open and forest areas. Over a 14 month period, 732 ticks were collected from five host species including domestic animals (dogs and cats), livestock (cows and horses) and wildlife (European bison) in two areas, central and NE Poland, endemic for D. reticulatus. Three tick species were recorded: D. reticulatus (623 individuals; 85.1 % of all collected ticks), I. ricinus (106 individuals; 14.5 %) and three females of Ixodes hexagonus (0.4 %) from a dog. Dermacentor reticulatus was the dominant tick species found on four host species and constituted 86, 81, 97 and 100 % of all ticks from dogs, horses, cows and bison, respectively, and was collected from animals throughout the year, including during the winter. The common tick, I. ricinus, was the dominant tick collected from cats (94 %). Fully-engorged, ready-for-reproduction females of D. reticulatus were collected from all host species. In May 2012, questing ticks were collected by dragging in forest or open habitats. The density of adult marsh ticks in open areas was around 2 ticks/100 m in the majority of locations, with a maximum of 9.5 ticks/100 m. The density of adult I. ricinus was much lower in its typical habitat (forests: range 0.8-2.2 ticks/100 m) between three and seven times lower than the density of D. reticulatus in its typical habitat. In regions endemic for marsh ticks, this tick species constitutes the main risk of tick infestation for livestock and dogs throughout the year. Livestock and companion animals are competent hosts for D. reticulatus, enabling the completion of the tick's life cycle. Anti-tick treatment should be adjusted to marsh tick seasonal activity and drug sensitivity. [ABSTRACT FROM AUTHOR]

Background: Since 1997, human-biting ticks submitted to the Department of Defense Human Tick Test Kit Program (HTTKP) of the US Army Public Health Command have been tested for pathogens by PCR. We noted differences in the phenology and infection prevalence among Ixodes scapularis ticks submitted from military installations in different geographic regions. The aim of this study was to characterize these observed differences, comparing the phenology and pathogen infection rates of I. scapularis submitted from soldiers at two sites in the upper Midwest (Camp Ripley, MN, and Ft. McCoy, WI) and one site in the northeastern US (Ft. Indiantown Gap, PA). Methods: From 1997 through 2012, the HTTKP received 1,981 I. scapularis from the three installations and tested them for Anaplasma phagocytophilum, Babesia microti, Borrelia burgdorferi and the Ehrlichia muris-like (EML) agent using PCR; pathogen presence was confirmed via sequencing or amplification of a second gene target. Pathogen and co-infection prevalence, tick engorgement status, and phenology were compared among installations. Results: Greater rates of A. phagocytophilum and Ba. microti infections were detected in ticks submitted from installations in Minnesota than in Wisconsin or Pennsylvania, and the EML agent was only detected in ticks from Minnesota and Wisconsin. Midwestern ticks were also more likely to be co-infected than those from Pennsylvania. Both adult and nymphal ticks showed evidence of feeding on people, although nymphs were more often submitted engorged. Adult I. scapularis were received more frequently in June from Minnesota than from either of the other sites. Minnesota adult and nymphal peaks overlapped in June, and submissions of adults exceeded nymphs in that month. Conclusions: There were clear differences in I. scapularis phenology, pathogen prevalence and rates of co-infection among the three military installations. Seasonal and temperature differences between the three sites and length of time a population had been established in each region may contribute to the observed differences. The synchrony of adults and nymphs observed in the upper Midwest has implications for pathogen infection prevalence. The EML agent was only detected in Minnesota and Wisconsin, supporting the previous assertion that this pathogen is currently limited to the upper Midwest. [ABSTRACT FROM AUTHOR]

Ixodid ticks were collected from 13 sika deer, Cervus n. nippon, shot in the Boso Peninsula in central Japan from late February to early March 1999. Haemaphysalis megaspinosa was the most abundant species of the adults collected, although Haemaphysalis longicornis, H. flava, H. kitaokai, H. cornigera, Ixodes ovatus, and Amblyomma testudinarium were also collected. Males were more abundant than females for H. longicornis, H. megaspinosa, H. flava, and H. kitaokai. Ticks that had inserted their hypostome into its host skin (designated attached) were distinguished from those that were detached and on the host's surface. A greater fraction of males than females of all four species were detached. Females were classified in three feeding stages (engorged, partially engorged, and unfed). More H. longicornis and H. megaspinosa unfed female ticks than engorged and partially-engorged female ticks were collected detached. Our results indicated that H. megaspinosa, H. longicornis, H. flava, and H. kitaokai male ticks detached sooner than female ticks after their host died. [ABSTRACT FROM AUTHOR]

Objective. To explore the experiences of bereaved mothers as they suppress lactation following late miscarriage (>20 weeks), stillbirth or neonatal death. Method. A qualitative, focused ethnographic approach was used involving in-depth interviews with 15 bereaved mothers, who attended a maternity hospital in Dublin. Data were collected from January to August 2012. Findings. Three key themes were identified: (1) suppression of lactation following the loss of a baby: silent tears; (2) mothering; (3) supportive care needs and the bereaved mother's experience. This paper focuses on the first global theme. The majority of bereaved mothers found engorgement and leaking milk particularly challenging both physically and emotionally following the loss of their baby; especially as their baby's funeral or wake took place during this period. The study highlights a number of areas where women could be better prepared for this experience. Conclusion. The findings highlight that the majority of bereaved mothers will require improved guidance and support with their breast care needs following the loss of their baby with awareness and sensitivity to their shortened motherhood. [ABSTRACT FROM AUTHOR]

Purpose: This study was to develop a breastfeeding promotion program and to test effects of the program on levels of breast discomfort, breast size, sodium in breast milk, and type of feeding in mothers with breast engorgement following cesarean birth. Methods: A non-synchronized non-equivalent control group pretest-posttest design was used in this study. The participants were 70 postpartum mothers who were admitted to a postpartum care center and experienced breast engorgement following cesarean birth. The planned nursing intervention was the breastfeeding promotion program consisting of breast massage and 1:1 breastfeeding education, counseling, and support focusing on individualized problem solving provided for 10 days. Fifty-three women completed the program (experimental group 26, control group, 27). Measurements were level of breast discomfort, breast size, sodium in breast milk and type of feeding at pre and posttest. Results: Women who participated in the program experienced lower scores for breast discomfort, greater decrease in breast size, lower levels of sodium in breast milk, and practiced breastfeeding more than those in the control group. Conclusion: Results indicate that this breastfeeding promotion program is effective in reducing breast engorgement and improving breastfeeding practices, and is therefore recommended to enhance breastfeeding promotion practice in postpartum care centers. [ABSTRACT FROM AUTHOR]

Copyright of Irrigation & Drainage is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Natural processes do not always function perfectly. In breastfeeding, problems are encountered in up to 80% of mother-infant dyads. Altogether, in Western societies, the difficulties reduce the breastfeeding rate within the first months drastically. To deal with the problems of breastfeeding efficiently requires a profound understanding of its physiology, as well as of its psychological and social determinants. This review focuses on the current knowledge of breastfeeding physiology, only touching the psychosocial factors, which are included in the promotion strategies. Subsequently, it scrutinizes definitions, incidences, prevention, and treatment of breastfeeding problems faced most frequently by nursing mothers and their consultants. Not all measures used in counseling mothers and not all treatments for the most common medical problems withstand a careful evaluation on the basis of current scientific data. However, applying proven prevention strategies will significantly improve the well being of mothers and their infants, and may contribute to an affective attitude that increases the success, frequency, and duration of breastfeeding. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Plant Science is the property of Canadian Science Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Irrigation & Drainage is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The conventional technique of insertion and fixation of the Esophageal Tracheal Combitube™ (ETC) is occasionally associated with engorgement of the tongue. This study sought to evaluate the efficacy of an alternative placement technique in reducing the incidence of this complication. Methods: Thirty ASA I and II adult patients posted for elective surgery under general anaesthesia lasting from 30 to 120 min were randomly divided into two groups ( n=15, each). In Group A, the ETC was inserted and fixed in the midline. In Group B, the ETC was inserted along the angle of the mouth and was fixed at this lateral position. Intra-operative occurrence of engorgement of the tongue, the time of such an occurrence and any complaints of post-operative discomfort were recorded. Results: The overall incidence of engorgement of the tongue in Group A patients (67%) was significantly more ( P<0.01) as compared with Group B (17%). The incidence significantly increased ( P<0.01) with an increase in the duration of surgery in both the groups. The engorgement persisted into the post-operative period in three patients in Group A and resolved spontaneously in <15 min in each case. Conclusion: Lateral insertion and fixation of the ETC is an easy, safe and effective method of preventing engorgement of the tongue associated with the use of this device without compromising a leak-proof oropharyngeal cavity. [ABSTRACT FROM AUTHOR]

Abstract: This study determined the effects of contact with DEET on guinea pig skin on mortality, probing time, blood feeding rate, engorgement time, and fecundity responses in female Anopheles quadrimaculatus Say. Exposure, in this manner, to 10% DEET (in ethanol) for 5min, resulted in 98% mortality in mosquitoes after 24h. The median probing time (PT50) required by females, when exposed to 0.1%, 1.0%, and 10% DEET, was significantly (P <0.0001) longer (12.5, 12.1, and 19.1s, respectively) than the 6.8s required by females to probe ethanol-treated skin (control). Similarly, mean blood feeding rates in populations of females exposed to 1.0% DEET for ⩽5min (14.4%) was 6× lower (P <0.001) (85.5%) than in females exposed to ethanol-treated skin, whereas the mean engorgement time on skin treated with 1.0% DEET (66.3s) was significantly shorter (P <0.0001) than for females feeding on the control guinea pigs (105.9s). The mean number of mature oöcytes per female (fecundity) in treatment (1.0% DEET) and control mosquitoes was not significantly different. The responses to DEET observed in this study suggest that repeated exposure of female A. quadrimaculatus populations to this repellent, in laboratory bioassays, could result in confounding of toxicant and repellent effects and inaccurate estimates of DEET repellency. [Copyright &y& Elsevier]

The horse fly Tabanus nigrovittatus Macquart (Diptera: Tabanidae), a hematophagous insect, is a nuisance pest along the Atlantic Coast. A description of the engorgement pattern throughout the season is lacking in the literature for this species. The percentage of flies engorging a bloodmeal in the laboratory throughout the season was recorded, and here we demonstrate that the percentage of flies that are blood feeding fluctuates, leading to a decrease in flies engorging as the season ends. Additionally, three recent nonhematophagous insect studies demonstrated that sulfakinins, a vertebrate homologue of cholecystokinin, function in feeding inhibition as a satiety factor. We found that groups of flies injected with one nanomole of perisulfakinin were inhibited from blood feeding by 45-60%. The satiation of feeding reported here is in agreement with the previous research by using nonhematophagous species. When groups of flies were injected with 10 nmol of perisulfakinin, the percentage of flies engorging was increased relative to the sham-injected flies, although not significantly. The stimulation of engorgement by sulfakinin has not previously been demonstrated, and its mode of action remains unclear. [ABSTRACT FROM AUTHOR]

Phi thickenings, lignified thickenings found on the radial and tangential walls of root cortical cells, are present in a restricted number of angiosperms and gymnosperms. To test whether their occurrence is constitutive or environmentally induced, seedlings of Cryptomeria japonica (L.f.) D. Don (Cupressaceae, phi thickenings present), and Pinus aristata Engel. and Pinus rigida Mill. (Pinaceae, phi thickenings absent) were grown under conditions of waterlogging and soil compaction. After 4 months, five morphological characters and the presence and cross-sectional area of phi thickenings were measured. All measured aspects of seedling morphology were affected by the treatments, and the two treatment factors (waterlogging and compaction) interacted significantly with one another. Taproots were significantly shorter, lateral roots were shorter and fewer in number, and root:shoot ratios were smaller in waterlogged and compacted soil in all three species. Despite these morphological effects, phi thickening presence or absence did not vary: phi thickenings were always found in C. japonica and never in the two Pinus species. However, the phi ratio (the area occupied by phi thickenings relative to the total root area) decreased significantly with both waterlogging and compaction even though it remained unchanged with root maturity. Thus, although root morphology and phi thickening anatomy were significantly affected by the environment, the presence of phi thickenings was not, and is evidently a constitutive anatomical feature in the species examined.Key words: phi thickenings, root anatomy, Cryptomeria, Pinus, waterlogging, soil compaction. [ABSTRACT FROM AUTHOR]

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The Academy of Breastfeeding Medicine recognizes that not all lactating individuals identify as women. Using gender-inclusive language, however, is not possible in all languages and all countries and for all readers. The position of the Academy of Breastfeeding Medicine (https://doi.org/10.1089/bfm.2021.29188.abm) is to interpret clinical protocols within the framework of inclusivity of all breastfeeding, chestfeeding, and human milk-feeding individuals.