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Purpose: To examine patterns of exclusive breastfeeding, combination feeding, and exclusive bottle-feeding among a sample of women identified at 2-4 weeks postpartum with positive PPD symptoms.Study Design and Methods: The sample included 122 women who were part of a larger study testing an intervention for promoting maternal-infant interaction among women with elevated PPD symptoms. Data were collected during three postpartum home visits. Demographic and feeding pattern data were described. Variables related to and predictors of feeding pattern were analyzed. The sample was compared to a random sample of postpartum women in New England.Results: Severity of depression was not significantly related to breastfeeding. Older maternal age, living with a partner, and higher income were positively related to breastfeeding. Compared to a random sample, the level of exclusive breastfeeding was significantly lower in this sample than the level of combination feeding.Clinical Implications: Nurses should be involved in screening all prenatal and postpartum women for PPD symptoms, particularly when they present with breastfeeding difficulties, and refer for treatment when appropriate. For breastfeeding mothers, PPD treatment must include consideration of therapeutic options as well as implications for the breastfeeding relationship. When appropriate treatment for PPD is being considered, thought should be given to the importance and value of breastfeeding to the mother. [ABSTRACT FROM AUTHOR]

The relationships of maternal attributes, resources, and perceptions of the postpartum experience to postpartum depression (PPD) were examined. One hundred and forty-three mothers completed measures of maternal attributes, resources, and perceptions of the postpartum experience, as well as depressed mood and clinical depression symptoms. Results from canonical correlation analysis revealed two patterns. Pattern 1: Women without history of depression, more emotional support from partners, higher parenting evaluation, lower centrality of the infant in the mother's thoughts and actions, and fewer life changes had lower depressed mood and fewer clinical depression symptoms than their counterparts. Pattern 2: Mothers without history of depression who were married, with higher financial stress, and lower parenting evaluation had higher depressed mood, but not more clinical depression symptoms. Maternal age, parity, time since delivery, income, and help from partner were unrelated to either depression indicator. These patterns suggest multiple paths to PPD, and the need for routine mental health assessment and exploration of women's perceptions of their postpartum experience. [ABSTRACT FROM AUTHOR]

BACKGROUND: In the United States, 9% to 15% of children experience chronic teasing and bullying that may be harmful. OBJECTIVE: The purpose was to explore teasing and bullying experiences of middle school students as part of the Child-Adolescent Teasing Scale (CATS) project. STUDY DESIGN: Seven focus groups were conducted with 11-to 14-year-old middle school students from Massachusetts, New Mexico, and Mississippi. Moderators used a semistructured interview guide to elicit views. Recorded sessions were transcribed; content analysis of verbatim accounts was used to identify sources of teasing and bullying. RESULTS: Sources of teasing and bullying were physical appearance, personal behavior, family and environment, and school relations. 'Being different in any way' was the underlying theme. CONCLUSIONS: Teasing and bullying were universal and distressing, and were affected by context, frequency, and individually attributed meanings. Clinicians and school staff may use findings to identify children who might be at risk for psychological and physical harm. [ABSTRACT FROM AUTHOR]

This column describes findings and best-practice recommendations from CARE (Communicating and Relating Effectively), a prospective randomized study in which 5,169 mothers were screened for postpartum depression. The prevalence rate was 13%. Results support use of the Edinburgh Postnatal Depression Screening Scale and a diagnostic assessment for those who screen positive. Of the 674 mothers with positive screens, 26% were not asked about their emotional state by clinicians. Screening must be linked to treatment options via referral and follow-up. Best-practice strategies for implementing screening include educating clinicians and postpartum women. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic wrought significant negative impacts on youth well-being, particularly among Black, Hispanic, American Indian, Alaska Native, and LGBTQ+ (Lesbian, gay, bisexual, transgender, queer or questioning) youth. The pandemic disrupted connections to family, school, and community, which are essential supports for youth mental health. Lessons learned from the pandemic suggest the role of stress and windows of opportunity to build resiliency. Drawing from a policy dialog on the youth mental health crisis conducted by 4 American Academy of Nursing Expert Panels, we present approaches to the current increase in youth mental health problems. Included is emerging literature on building youth resilience, particularly via re-establishing school and community connections. The role of families, schools, and community support is emphasized, particularly by creating a healing school environment and the pivotal role of school nurses. Recommendations include increased support for families, engaging the school nurse role, and developing school-based innovative programs to build connections and youth wellness., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The PRECEDE-PROCEED model is a comprehensive planning and theoretical framework that incorporates epidemiological, environmental, behavioral, and social factors systematically to design, implement, and evaluate health promotion programs. As such, PRECEDE-PROCEED is a highly effective tool for addressing complex and significant public health concerns like postpartum depression (PPD). PPD negatively impacts mothers and their infants, with studies showing that approximately one in eight mothers experience PPD, leading to adverse effects on maternal functioning and infant development. However, access to specialized evidence-based treatment remains significantly limited due to barriers including social determinants of health. This paper explores the application of the PRECEDE-PROCEED model as a planning and theoretical framework for the design and development of MommaConnect, an innovative digital healthcare platform aimed at reducing PPD symptoms and improving maternal-infant interaction while overcoming barriers to treatment. Key components of the MommaConnect design and development process are mapped onto the steps of the PRECEDE-PROCEED model. MommaConnect features are aligned with specific stages of the model, from assessing, predisposing, enabling, and reinforcing factors to designing, implementing, and evaluating the intervention. By leveraging this model, MommaConnect represents a promising innovative approach to address PPD to improve maternal functioning and infant health in a digitally-enabled era. This paper underscores the importance of utilizing a framework like the PRECEDE-PROCEED model in the design and development of innovative healthcare solutions., Competing Interests: Conflicts of interest The authors declare that they have no conflicts of interest.

Abstract: Stress experienced by family caregivers of individuals with opioid use disorder (OUD) contributes to caregiver burden. To understand the stressors experienced by family caregivers of individuals with OUD and the factors that influence their personal resiliency, data were collected from a convenience sample of family caregivers who answered two open-ended questions about sources of stress and factors that affect their personal resilience as part of an online survey. Yin's thematic analysis revealed five objective and two subjective burden themes and four resilience themes. Results indicate OUD places significant burden on families and may contribute to decreased physical and mental well-being in caregivers. Caregivers who perceived adequate support were able to use their experience and innate knowledge to cope and emerge with more resilience. Results of this study support the need for translational research to increase resilience and coping in this population of caregivers., Competing Interests: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article., (Copyright © 2023 International Nurses Society on Addictions.)

Background: Women with perinatal depression (PD) are at high risk for unhealthy dietary behaviors and suboptimal child feeding practices. Despite evidence supporting the importance of healthful nutrition-related behaviors during and after pregnancy, few behavioral nutrition interventions for women with PD have been developed. The objectives of this study were to identify nutrition-related challenges and needs among women with PD and to elucidate the role that feeding plays in mother-infant interaction, to inform the development of nutrition interventions., Methods: Using a qualitative study design, in-depth interviews were conducted with 18 mothers with a history of PD and 10 interdisciplinary healthcare providers with expertise in PD. Data were thematically analyzed using a hybrid inductive and deductive coding approach., Results: Mean age of mothers was 31 ± 6 years, 56% identified as non-Hispanic White, and 33% identified as Black/African American. Eighty percent of healthcare providers practiced for more than five years. Six themes were identified: (a) Time scarcity mindset; (b) Importance of social support; (c) Unrealistic expectations of motherhood; (d ) Mom as the last priority; (e) Postpartum body changes and shape ideals; and (f) Contentment associated with infant and young child feeding., Conclusion: Women with PD have several needs pertaining to their nutrition and that of their children. The findings from this study illustrate key considerations and recommendations for addressing these needs.

Background: Family caregivers are an essential resource for individuals with opioid use disorder (OUD). Overburdened caregivers often experience detrimental effects to their emotional and physical well-being., Method: A cross-sectional, nonexperimental, correlational study was used to identify correlates and predictors of burden and resilience in caregivers of care recipients with OUD. Pearson product-moment correlation and multiple regression analysis were used to explore the relationships between caregiver characteristics, care recipient characteristics, the caregiver-care-recipient dyad characteristics, and burden and resilience among caregivers of individuals with OUD and to determine the best predictive model. Participants ( N = 152) completed the study using an online electronic survey., Results: The standardized regression coefficients indicated that supervision of care recipient behavioral problems (β = .29), dyadic interaction (β = .29), caregiver stress (β = .28), and care recipient opioid use (β = .12) were the strongest predictors of caregiver burden, whereas caregiver mental health (β = -.31) and physical health (β = .30) were the strongest predictors of caregiver resilience., Conclusions: Caregiver and care recipient characteristics, and their dyadic interaction, directly influence the degree of burden and resilience reported by family caregivers. Caregivers experiencing increased stress who are tasked with supervising problematic care recipient behaviors are more likely to experience higher levels of burden. In contrast, caregivers with good physical and mental health and adequate resources showed higher levels of resilience., Competing Interests: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article., (Copyright © 2021 International Nurses Society on Addictions.)

Despite the growth of intensive perinatal mental health programs in the United States, too few programs serve women with perinatal mood and anxiety disorders (PMADs). Furthermore, little is known about program operations, services, the women served, and the methods of collecting outcome data. With this Open Forum, the authors aimed to share their investigation of intensive perinatal mental health programs in the United States and offer recommendations to improve services for women with PMADs. The authors recommend forming a national consortium that can foster collaboration to expand existing services and establish a national database to inform program development, evaluation, policies, and funding.

Over the past 3 decades, there has been a vast expansion of research in both tissue engineering and organic electronics. Although the two fields have interacted little, the materials and fabrication technologies which have accompanied the rise of organic electronics offer the potential for innovation and translation if appropriately adapted to pattern biological materials for tissue engineering. In this work, we use two organic electronic materials as adhesion points on a biocompatible poly( p -xylylene) surface. The organic electronic materials are precisely deposited via vacuum thermal evaporation and organic vapor jet printing, the proven, scalable processes used in the manufacture of organic electronic devices. The small molecular-weight organics prevent the subsequent growth of antifouling polyethylene glycol methacrylate polymer brushes that grow within the interstices between the molecular patches, rendering these background areas both protein and cell resistant. Last, fibronectin attaches to the molecular patches, allowing for the selective adhesion of fibroblasts. The process is simple, reproducible, and promotes a high yield of cell attachment to the targeted sites, demonstrating that biocompatible organic small-molecule materials can pattern cells at the microscale, utilizing techniques widely used in electronic device fabrication.

During the perinatal period, women are at increased risk for developing perinatal mood and anxiety disorders (PMADs). As perinatal mental health screening efforts increase, significantly more women will be identified who require mental health services. Evidence-based treatments exist, yet many women do not receive adequate care. Patient navigation (PN) offers a promising patient-centered approach to improve treatment attendance and engagement. The purpose of this study is to describe the development of a stepped care PN service at an intensive outpatient program for women with PMADs. Our experience incorporating this model of PN revealed significant features that may guide other treatment care facilities to adopt this service to increase identification and connection to care., Competing Interests: C.B.D., P.A.G., A.B., B.P., J.A.H., and L.A.C. declare that no competing financial interests exist., (© Christina Bricca DiSanza et al. 2020; Published by Mary Ann Liebert, Inc.)

Hospital-acquired conditions (HACs) have been the focus of recent initiatives by the Centers for Medicare and Medicaid Services in an effort to improve patient safety and outcomes. Spine surgery can be complex and may carry significant comorbidity burden, including so called "never events." The objective was to determine the rates of common HACs that occur within 30-days post-operatively for elective spine surgeries and compare them to other common surgical procedures. Patients: >18 y/o undergoing elective spine surgery were identified in the American College of Surgeons' NSQIP database from 2005 to 2013. Patients were stratified by whether they experienced >1 HAC, then compared to those undergoing other procedures including bariatric surgery, THA and TKA. Of the 90,551 spine surgery patients, 3021 (3.3%) developed at least one HAC. SSI was the most common (1.4%), followed by UTI (1.3%), and VTE (0.8%). Rates of HACs in spine surgery were significantly higher than other elective procedures including bariatric surgery (2.8%) and THA (2.8%) (both p < 0.001). Spine surgery and TKA patients had similar rates of HACs(3.3% vs 3.4%, p = 0.287), though spine patients experienced higher rates of SSI (1.4%vs0.8%, p < 0.001) and UTI (1.3%vs1.1%, p < 0.001) but lower rates of VTE (0.8%vs1.6%, p < 0.001). Spine surgery patients had lower rates of HACs overall (3.3%vs5.9%) when compared to cardiothoracic surgery patients (p < 0.001). When compared to other surgery types, spine procedures were associated with higher HACs than bariatric surgery patients and knee and hip arthroplasties overall but lower HAC rates than patients undergoing cardiothoracic surgery., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Previous studies have shown that nurses have negative attitudes toward caring for patients with substance use disorder (SUD); these negative attitudes also have been noted with nursing students. This study examined nursing students' attitudes toward and empathy for patients with SUD to determine whether there were differences across practice settings., Method: Fifty-three students were surveyed before and after a 120-hour mentor-ship practicum; 25 students participated in focus groups., Results: Students' empathy scores improved significantly across all practice settings, and students' attitudes improved significantly in all settings except maternal child health. Qualitative analysis revealed themes related to perceived lack of educational preparation, observing generational differences in nursing care, transitioning from fear to empathy, familial exposure, and feelings of helplessness and blame., Conclusion: Findings support the need for educational interventions in both academic and professional practice settings. [J Nurs Educ. 2020;59(3):149-153.]., (Copyright 2020, SLACK Incorporated.)

Postpartum depression (PPD) and other perinatal mental health disorders have profound adverse effects on maternal-infant interaction and child health. However, standard psychiatric treatment does not necessarily improve the quality of mother-infant interaction. The purpose of this article is to describe the evidence-based CARE intervention and its translation to practice as Mother-Baby Interaction (MBI) Therapy to promote infant outcomes by supporting mothers' sensitive, responsive, and contingent interactions with their infants. Two vignettes illustrate MBI. We advocate that MBI needs to be a requisite adjunct treatment for PPD, and other perinatal mental health disorders, to promote maternal functioning, and positive long-term infant health outcomes., (Copyright © 2019. Published by Elsevier Inc.)

Study Design: Retrospective review., Objective: To identify and compare the incidences of fragility fractures amongst three elderly populations: the general population, patients with surgically treated cervical spondylotic myelopathy (CSM), and patients with CSM not surgically treated., Summary of Background Data: CSM is a common disease in the elderly. Progression of myelopathic symptoms, including gait imbalance, can be a source of morbidity as it can lead to increased falls., Methods: Records of elderly patients with Medicare insurance from 2005 to 2014 were retrospectively reviewed. Three mutually exclusive populations of patients were identified for analysis, including a cohort of patients with a diagnosis of CSM who were not treated with surgery; a cohort of patients with CSM who were treated with surgery; and a group of control patients who had never been treated with cervical spine surgery nor were diagnosed with CSM. Incidence of fractures of the distal radius, proximal humerus, proximal femur, and lumbar spine were assessed and compared between cohorts, adjusted by age, sex, osteoporosis, dementia, cerebrovascular disease, and Charlson Comorbidity Index., Results: A total of 891,864 patients were identified, of which 60,332 had a diagnosis of CSM and 24,439 underwent cervical spine surgery. Compared to general population controls, the 12-month adjusted odds of experiencing at least one fragility fracture were 1.59 times higher in patients with CSM who were not treated with surgery (P < 0.001). The analogous odds ratio was 1.34 (P < 0.001) at 3 years. Compared to nonsurgically treated patients with CSM, the odds of experiencing at least one fragility fracture were reduced to 0.89 in surgically treated patients (P = 0.008)., Conclusion: Fragility fractures are a significant source of morbidity and mortality in elderly patients. CSM is associated with increased rates of fragility fractures, although surgical management of CSM may be protective against risk of fragility fracture., Level of Evidence: 3.

Background: Cervical deformity (CD) surgery has become increasingly more common and complex, which has also led to reoperations for complications such as distal junctional kyphosis (DJK). Cost-utility analysis has yet to be used to analyze CD revision surgery in relation to the cost-utility of primary CD surgeries. The aim of this study was to determine the cost-utility of revision surgery for CD correction., Methods: Retrospective review of a multicenter prospective CD database. CD was defined as at least one of the following: C2-C7 Cobb >10°, cervical lordosis (CL) >10°, cervical sagittal vertical axis (cSVA) >4 cm, chin-brow vertical angle (CBVA) >25°. Quality-adjusted life year (QALY) were calculated by EuroQol Five-Dimensions questionnaire (EQ-5D) and Neck Disability Index (NDI) mapped to SF-6D index and utilized a 3% discount rate to account for residual decline to life expectancy (men: 76.9 years, women: 81.6 years). Medicare reimbursement at 30 days assigned costs for index procedures (9+ level posterior fusion, 4-8 level posterior fusion with anterior fusion, 2-3 level posterior fusion with anterior fusion, 4-8 level anterior fusion) and revision fusions (2-3 level, 4-8 level, or 9+ level posterior refusion). Cost per QALY gained was calculated., Results: Eighty-nine CD patients were included (61.6 years, 65.2% female). CD correction for these patients involved a mean 7.7±3.7 levels fused, with 34% combined approach surgeries, 49% posterior-only and 17% anterior-only, 19.1% three-column osteotomy. Costs for index surgeries ranged from $20,001-55,205, with the average cost for this cohort of $44,318 and cost per QALY of $27,267. Eleven revision surgeries (mean levels fused 10.3) occurred up to 1-year, with an average cost of $41,510. Indications for revisions were DJK (5/11), neurologic impairment [4], infection [1], prominent/painful instrumentation [1]. Average QALYs gained was 1.62 per revision patient. Cost was $28,138 per QALY for reoperations., Conclusions: CD revisions had a cost of $28,138 per QALY, in addition to the $27,267 per QALY for primary CD surgeries. For primary CD patients, CD surgery has the potential to be cost effective, with the caveats that a patient livelihood extends long enough to have the benefits and durability of the surgery is maintained. Efforts in research and surgical technique development should emphasize minimization of reoperation causes just as DJK that significantly affect cost utility of these surgeries to bring cost-utility to an acceptable range., Competing Interests: Conflicts of Interest: The International Spine Study Group (ISSG) is funded through research grants from DePuy Synthes, and supported the current work. The other authors have no conflicts of interest to declare.

Background: Bariatric surgery (BS) is an increasingly common treatment for morbid obesity that has the potential to effect bone and mineral metabolism. The effect of prior BS on spine surgery outcomes has not been well established. The aim of this study was to assess differences in complication rates following spinal surgery for patients with and without a history of BS., Methods: Retrospective analysis of the prospectively collected New York State Inpatient Database (NYSID) years 2004-2013. BS patients and morbidly obese patients (non-BS) were divided into cervical and thoracolumbar surgical groups and propensity score matched for age, gender, and invasiveness and complications compared., Results: One thousand nine hundred thirty-nine spine surgery patients with a history of BS were compared to 1625 non-BS spine surgery patients. The average time from bariatric surgery to spine surgery is 2.95 years. After propensity score matching, 740 BS patients were compared to 740 non-BS patients undergoing thoracolumbar surgery, with similar comorbidity rates. The overall complication rate for BS thoracolumbar patients was lower than non-BS (45.8% vs 58.1%, P < 0.001), with lower rates of device-related (6.1% vs 23.2%, P < 0.001), DVT (1.2% vs 2.7%, P = 0.039), and hematomas (1.5% vs 4.5%, P < 0.001). Neurologic complications were similar between BS patients and non-BS patients (2.3% vs 2.7%, P = 0.62). For patients undergoing cervical spine surgery, BS patients experienced lower rates of bowel issues, device-related, and overall complication than non-BS patients (P < 0.05)., Conclusions: Bariatric surgery patients undergoing spine surgery experience lower overall complication rates than morbidly obese patients. This study warrants further investigation into these populations to mitigate risks associated with spine surgery for bariatric patients.

Study Design: Retrospective review of prospectively collected data., Objective: To assess the clinical impact and economic burden of the three most common hospital-acquired conditions (HACs) that occur within 30-day postoperatively for all spine surgeries and to compare these rates with other common surgical procedures., Summary of Background Data: HACs are part of a non-payment policy by the Centers for Medicare and Medicaid Services and thus prompt hospitals to improve patient outcomes and safety., Methods: Patients more than 18 years who underwent elective spine surgery were identified in American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2013. Primary outcomes were cost associated with the occurrence of three most common HACs. Cost associated with HAC occurrence derived from the PearlDiver database., Results: Ninety thousand five hundred fifty one elective spine surgery patients were identified, where 3021 (3.3%) developed at least one HAC. Surgical site infection (SSI) was the most common HAC (1.4%), then urinary tract infection (UTI) (1.3%) and venous thromboembolism (VTE) (0.8%). Length of stay (LOS) was longer for patients who experienced a HAC (5.1 vs. 3.2 d, P < 0.001). When adjusted for age, sex, and Charlson Comorbidity Index, LOS was 1.48 ± 0.04 days longer (P < 0.001) and payments were $8893 ± $148 greater (P < 0.001) for patients with at least one HAC. With the exception of craniotomy, patients undergoing common procedures with HAC had increased LOS and higher payments (P < 0.001). Adjusted additional LOS was 0.44 ± 0.02 and 0.38 ± 0.03 days for total knee arthroplasty and total hip arthroplasty, and payments were $1974 and $1882 greater. HACs following hip fracture repair were associated with 1.30 ± 0.11 days LOS and $4842 in payments (P < 0.001). Compared with elective spine surgery, only bariatric and cardiothoracic surgery demonstrated greater adjusted additional payments for patients with at least one HAC ($9975 and $10,868, respectively)., Conclusion: HACs in elective spine surgery are associated with a substantial cost burden to the health care system. When adjusted for demographic factors and comorbidities, average LOS is 1.48 days longer and episode payments are $8893 greater for patients who experience at least one HAC compared with those who do not., Level of Evidence: 3.

Perinatal mental health problems, experienced by 15-20% of women, are a significant public health issue associated with adverse effects among childbearing women; yet only 20-25% receive adequate treatment. There has been a recent proliferation of intensive perinatal day treatment programs in the United States. To meet this need in the greater Philadelphia area, we introduce Mother Baby Connections (MBC), an innovative interdisciplinary, attachment-focused, intensive, outpatient perinatal mental health program recently launched at Drexel University. The purpose of this paper is to (1) present an overview of MBC, its theoretical framework for services, and its evidence-based components, highlighting the unique factors that differentiate this program from traditional outpatient treatment, and (2) present clinical outcome data utilizing scores from reliable and valid scales, including enrollment to discharge outcomes from 20 months of MBC operation. In sum, outcomes for 20 predominantly minority women with complete measures showed significant improvements in maternal depression symptom severity, maternal functioning, birth trauma symptoms, perceived stress, parenting stress, and emotional regulation. Effect sizes were medium to large (i.e., 0.42-2.00). We conclude that MBC is a viable model for tailored intensive outpatient treatment to foster maternal mental health and functioning during the perinatal period.

Study Design: Retrospective review., Objective: To identify the incidence and analyze the risk of postoperative complications amongst elderly patients with rheumatoid arthritis undergoing anterior cervical fusion., Summary of Background Data: Previous studies have reported elevated risks of postoperative complications for patients with rheumatoid arthritis undergoing orthopedic procedures. However, little is known about the risk of postoperative complications in rheumatoid arthritis patients after spine surgery., Methods: A commercially available database was queried for all Medicare patients 65 years of age and older undergoing one- or two-level primary anterior cervical fusion surgeries from 2005 to 2013. Complications, hospitalization costs, and length of stay were queried. Multivariate logistic regression analyses were performed to estimate the odds ratio for each complication adjusted for age, sex, and Charlson Comorbidity Index., Results: A total of 6067 patients with a history of rheumatoid arthritis and 113,187 controls were identified. Significantly higher incidences of major medical complications (7.5% vs. 5.9%, P < 0.001), postoperative infections (2.6% vs. 1.5%, P < 0.001), and revision surgery (1.1% vs. 0.6%, P < 0.001) were observed amongst the rheumatoid arthritis cohort. Significantly greater average cost of hospitalization ($17,622 vs. $12,489, P < 0.001) and average length of stay (3.13 vs. 2.08 days, P < 0.001) were also observed., Conclusion: Patients with rheumatoid arthritis undergoing anterior cervical fusion face increased risks of postoperative infection and revision surgery compared to normal controls. This information is valuable for preoperative counseling and risk stratification., Level of Evidence: 3.

Objective: To identify independent risk factors, additional length of stay, and additional cost associated with postoperative ileus following anterior lumbar interbody fusion in elderly patients., Methods: The PearlDiver Patient Records Database was queried for all Medicare patients ≥65 years of age undergoing 1- or 2-level primary elective anterior lumbar interbody fusion from 2005 to 2014. Independent risk factors, additional length of stay, and additional cost associated with postoperative ileus were evaluated with multivariate analysis., Results: There were 13,139 patients identified, and 642 patients experienced postoperative ileus within 3 days after surgery. Multivariate analysis identified perioperative fluid or electrolyte imbalance (odds ratio = 4.03; 95% confidence interval, 3.37-4.80; P < 0.001) and male sex (odds ratio = 1.72; 95% confidence interval, 1.48-2.00; P < 0.001) as independent risk factors for ileus. Multivariate analysis associated postoperative ileus with additional length of stay of 2.83 ± 0.11 days (P < 0.001) and additional cost of $2,349 ± $419 (P < 0.001)., Conclusions: Patients with perioperative fluid and electrolyte imbalances were 4 times as likely to experience postoperative ileus. Fluid balance and electrolyte levels should be carefully monitored during the perioperative period in patients undergoing anterior lumbar interbody fusion as a potential means to reduce the incidence of postoperative ileus and the additional length of stay and cost burden associated with this complication., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Preeclampsia (PE), a serious and variable pregnancy complication affecting 5%-10% of the obstetric population, has an undetermined etiology, yet inflammation is concomitant with its development, particularly in relation to endothelial dysfunction., Objective: The purpose of this systematic review was to examine the published evidence concerning an association between PE and inflammatory markers for their usefulness in the prediction or early identification of women with PE in antepartum clinical settings., Methods: In this systematic review, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Cumulative Index for Nursing and Allied Health and MEDLINE/OVID were the electronic databases used for identifying published articles. We placed no time limit on the publication year., Results: The search generated 798 articles. After removing duplicates, screening abstracts, and conducting full-text reviews, we retained 73 articles and examined 57 unique markers. This review shows that C-reactive protein and the cytokines, specifically the proinflammatory markers IL-6, IL-8, and tumor necrosis factor alpha, garner the most support as potential inflammatory markers for clinical surveillance of PE, particularly during the second and third trimesters., Discussion: Based on this review, we cannot recommend any single inflammatory marker for routine clinical use to predict/identify PE onset or progression. Research is recommended to examine a combination panel of these four inflammatory markers both with and without clinical risk factors toward the goal of translation to practice.

Background: Long-term narcotic use has risks and potentially life-threatening opioid-related side effects. Extended narcotic use in patients undergoing discectomy raises concerns of other underlying causes of pain or overprescription and/or abuse. The goal of this study was to determine which factors have an effect on active narcotic prescription >3 months after discectomy., Methods: The PearlDiver Database was used in this study. Patients 30-55 years old undergoing discectomy without fusions were queried for active narcotic drug prescription occurring >30 days and >3 months after original surgery. Medical co-diagnoses were independently analyzed for effects on long-term active narcotic prescriptions. Prior narcotic use was defined by use within 4 months before surgery., Results: Of 1321 patients undergoing discectomy, 621 had actively prescribed narcotics >3 months after surgery. Preoperative narcotic use had the largest effect on odds of postoperative prescription (odds ratio [OR] = 3.4). Medical comorbidities increasing odds of long-term narcotic prescriptions included migraines (OR = 1.4), diabetes mellitus (OR = 1.4), depression (OR = 1.6), and smoking (OR = 1.9)., Conclusions: Narcotic abuse is a serious problem rooted in overprescription of these drugs, which has ultimately led to much more caution in prescribing among physicians. Because pain management and drug prescription must be balanced, identifying patients who may be susceptible to narcotic overprescription is important. Patients with co-diagnoses increasing odds of long-term narcotic prescriptions would benefit from early and continual postsurgical follow-up to ensure accurate pain management and to determine if narcotic prescriptions are justly warranted in the later postoperative period., (Copyright © 2018 Elsevier Inc. All rights reserved.)

We have developed a single-shot terahertz time-domain spectrometer to perform optical-pump/terahertz-probe experiments in pulsed, high magnetic fields up to 30 T. The single-shot detection scheme for measuring a terahertz waveform incorporates a reflective echelon to create time-delayed beamlets across the intensity profile of the optical gate beam before it spatially and temporally overlaps with the terahertz radiation in a ZnTe detection crystal. After imaging the gate beam onto a camera, we can retrieve the terahertz time-domain waveform by analyzing the resulting image. To demonstrate the utility of our technique, we measured cyclotron resonance absorption of optically excited carriers in the terahertz frequency range in intrinsic silicon at high magnetic fields, with results that agree well with published values.

Interprofessional education (IPE) is becoming an integral part of the education of health professions students. However, teaching students to become successful members of interprofessional teams is complex, and it is important for students to learn the combinations of skills necessary for teams to function effectively. There are many instruments available to measure many features related to IPE. However, these instruments are often too cumbersome to use in an observational situation since they tend to be lengthy and contain many abstract characteristics that are difficult to identify. The Jefferson Teamwork Observation Guide (JTOG) is a short tool that was created for students early in their educational program to observe teams in action with a set of guidelines to help them focus their observation on behaviors indicative of good teamwork. The JTOG was developed over a 2-year period based on student and clinician feedback and the input of experts in IPE. While initially developed as a purely educational tool for prelicensure students, it is becoming clear that it is an easy-to-use instrument that assesses the behavior of clinicians in practice.

Poor adherence to continuous positive airway pressure (CPAP) treatment is associated with substantial health care costs, morbidity and mortality, and has been a leading obstacle in the effective management of obstructive sleep apnea (OSA). Successful interventions to improve CPAP adherence may ultimately include a variety of components. For patients living with spouses (refers to all domestic partners), the spouse will likely be an integral component to any successful intervention. Developing understanding of the role of spouses in adherence to CPAP has been identified to be a critical research need. This review expands the investigation of CPAP adherence to a broader context, from an exclusive focus on individual patients to a dyadic perspective encompassing both patients and their spouses. A conceptual framework based on social support and social control theories is proposed to understand spousal involvement in CPAP adherence. Methodologies for future investigations are discussed, along with implications for developing interventions that engage both patients and their spouses to improve CPAP use., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Every day, normative functions of parenting and their significance are under-investigated. An integrative review of tasks and communication involved in parenting young children informed by Horowitz (1995) and Blumer (1969) was conducted.Research articles consistent with inclusion criteria were published from 1995 to 2013 and focused on parenting tasks and communication. Themes consistent with Horowitz and Blumer were identified. Nurses are reminded about the significance of attending to the everyday, normative work of parenting young children, the potential meaning derived from this work, and the importance of assessing parental development as well as the importance of continuing research in this area., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To test the efficacy of the relationship-focused behavioral coaching intervention Communicating and Relating Effectively (CARE) in increasing maternal/infant relational effectiveness between depressed mothers and their infants during the first 9 months postpartum., Design: Randomized clinical trial (RCT) with three phases., Methods: In this three-phase study, women were screened for postpartum depression (PPD) in Phase I at 6 weeks postpartum. In Phase II, women were randomly assigned to treatment or control conditions and maternal/infant interaction was video recorded at four intervals postpartum: 6 weeks, 3 months, 6 months, and 9 months. Phase III involved focus group and individual interviews with study participants., Setting: Phase I mothers were recruited from obstetric units of two major medical centers. Phase II involved the RCT, a series of nurse-led home visits beginning at 6 weeks and ending at 9 months postpartum. Phase III focus groups were conducted at the university and personal interviews were conducted by telephone or in participants' homes., Participants: Postpartum mother/infant dyads (134) representative of southeastern New England, United States participated in the RCT. One hundred and twenty-five mother/infant dyads were fully retained in the 9-month protocol., Results: Treatment and control groups had significant increases in quality of mother/infant interaction and decreases in depression severity. Qualitative findings indicated presence of the nurse, empathic listening, focused attention and self-reflection during data collection, directions for video-recorded interaction, and assistance with referrals likely contributed to improvements for both groups., Conclusions: Efficacy of the CARE intervention was only partially supported. Nurse attention given to the control group and the data collection process likely confounded results and constituted an unintentional treatment. Results suggest that nurse-led home visits had a positive effect on outcomes for all participants., (© 2013 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Purpose: Incorporation of cytarabine into DNA activates checkpoint kinase 1 (Chk1), which stabilizes stalled replication forks, induces S-phase slowing, and diminishes cytarabine cytotoxicity. The selective Chk1 inhibitor SCH 900776 abrogates cytarabine-induced S-phase arrest and enhances cytarabine cytotoxicity in acute leukemia cell lines and leukemic blasts in vitro. To extend these findings to the clinical setting, we have conducted a phase I study of cytarabine and SCH 900776., Experimental Design: Twenty-four adults with relapsed and refractory acute leukemias received timed sequential, continuous infusion cytarabine 2 g/m(2) over 72 hours (667 mg/m(2)/24 hours) beginning on day 1 and again on day 10. SCH 900776 was administered as a 15- to 30-minute infusion on days 2, 3, 11, and 12. The starting dose of SCH 900776 was 10 mg/m(2)/dose., Results: Dose-limiting toxicities consisting of corrected QT interval prolongation and grade 3 palmar-plantar erythrodysesthesia occurred at 140 mg flat dosing (dose level 5, equivalent to 80 mg/m(2)). Complete remissions occurred in 8 of 24 (33%) patients, with 7 of 8 at 40 mg/m(2) or higher. SCH 900776 did not accumulate at any dose level. Marrow blasts obtained pretreatment and during therapy showed increased phosphorylation of H2Ax after SCH 900776 beginning at 40 mg/m(2), consistent with unrepaired DNA damage., Conclusions: These data support a randomized phase II trial of cytarabine +/- SCH 900776 at a recommended flat dose of 100 mg (equivalent to 56 mg/m(2)) for adults with poor-risk leukemias. The trial (SP P05247) was registered at www.clinicaltrials.gov as NCT00907517., (©2012 AACR.)

Treatment of aqueous zinc solutions with incremental additions of a ditopic fluorescent sensor of the Zinpyr family, based on pyridine/pyrazine-containing metal recognition units, affords a fluorescence titration curve with a sharp maximum at a sensor:Zn(2+) ratio of 0.5 (Zhang, X-a.; Hayes, D.; Smith, S. J.; Friedle, S.; Lippard, S. J. J. Am. Chem. Soc.2008, 130, 15788-15789). This fluorescence response enables the quantification of readily chelatable zinc in biological samples by a simple titration protocol. In the present work a new set of ditopic fluorescence zinc sensors functionalized with pyridine/pyrazine-containing metal chelating units is described, and through detailed studies the principles governing the characteristic OFF-ON-OFF fluorescence behavior and quantification capabilities of the family are delineated. Incorporation of carboxylate/ester groups in the 6 position of the fluorescein allows for control of the spatial distribution of the sensor for selective extra- or intracellular imaging of mobile zinc, without introducing significant changes in zinc-binding properties. A combination of spectrophotometric and potentiometric measurements provided a complete description of the H(+)- and Zn(2+)-binding properties of the compounds and their correlation with the observed fluorescence profile. The first zinc-binding event has an apparent affinity, K(1)', of 1.9 × 10(9)-3.1 × 10(9) M(-1), whereas for coordination of the second Zn(2+) ion, responsible for fluorescence turn-on, the apparent formation constant, K(2)', is 5.5 × 10(7)-6.9 × 10(7) M(-1). A detailed chemical and mathematical analysis of the system demonstrated that the difference in emission efficiencies of the dimetalated (LZn(2)) vs monometalated (LZn) and metal-free (L) forms, a consequence of the combined quenching effects of the two metal-chelating units, significantly influences the shape of the titration curve. The scope of the titration method was investigated mathematically, and a lower boundary for the range of concentrations that can be determined was established as a function of the magnitude of K(2)'. Our results suggest that the principles governing the response of the ZPP1 series are applicable to other analogues of the Zinpyr family. Moreover, they may guide the design of other ditopic sensors suitable for determining the concentrations of a wide range of mobile metal ions and other chemical signaling agents of relevance in biological systems.

Objectives: To conduct a community-based, postpartum depression (PPD) screening initiative, and recommend PPD screening practices., Design: Descriptive correlational., Settings: Two academic medical centers, a university research office, and participants' homes., Participants: Five thousand one hundred and sixty-nine postpartum women age 14 to 49 years., Methods: The Agency for Healthcare Research and Quality (AHRQ) framework was implemented by identifying a cohort of mothers and conducting PPD screening followed by diagnostic evaluation of those with positive screens. Mothers in the postpartum period were recruited from two academic medical centers and screened for PPD at 4 to 6 weeks postpartum by telephone or mail using the Edinburgh Postnatal Depression Scale (EPDS). Mothers with EPDS scores ≥10 were invited to participate in the Structured Clinical Interview for DSM IV (SCID) to confirm PPD., Results: Six hundred and seventy-four (13%) women had EPDS scores ≥10; 185 women with elevated EPDS scores agreed to have a SCID diagnostic interview, and 144 were diagnosed with minor or major depression. A significantly higher percentage of women who self-administered and mailed in the EPDS than women who were screened via telephone had scores ≥10. Elevated PPD scores were not associated with age or parity. Race/ethnicity identification other than White and having less than high school education were associated with higher PPD scores., Conclusions: The AHRQ framework was effective in guiding a large-scale PPD screening initiative by identifying mothers at risk for PPD. Results support previous findings regarding prevalence, selected risk factors, and continued use of the EPDS with SCID confirmation., (© 2010 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

There is growing evidence that physical health problems are caused and exacerbated by psychological factors. Research indicates that psychological distress leads to physical disease through impairment of the neuroendocrine system and its interface with the body's immune response. However, the current health care delivery system splinters care into "psychiatric" and "physical" health silos. New approaches are needed to assure adequate professional knowledge of behavioral health at basic licensure, to increase the use of advanced practice psychiatric-mental health nurses in primary care settings, to identify and teach behavioral competencies for primary care providers, and to fund the design and evaluation of integrative models of care.

Background: This article presents the psychometric evaluation of the Child-Adolescent Teasing Scale (CATS), an instrument to be used as a screening measure with middle school students., Methods: A 70-item scale was initially derived from qualitative data obtained from focus groups comprised of middle school students. A diverse sample of participants (N=764) then completed the CATS and the Piers-Harris Children's Self-Concept Scale (PHCSCS); their mothers completed the Pediatric Symptom Checklist (PSC) and a demographic information form. A psychometric sample (N=666) without missing data was used for subsequent analyses., Results: Principal components analysis resulted in a 32-item, 4-factor solution: Personality & Behavior Teasing (14 items), Family & Environment Teasing (7 items), School-Related Teasing (9 items), and Teasing About My Body (2 items). The standardized Cronbach's alpha for the final version was .94 and ranged from .83 to .90 for the subscales. The CATS's content validity, initially ascertained a priori by experts, was re-reviewed upon the instrument's refinement and supported. One-tailed t tests of mean differences between low- and high-scoring CATS groups on the PSC (t=-3.41, p<.03) and the PHCSCS (t=-11.39, p<.001) and supported the CATS's criterion-related validity., Conclusions: The 4-factor, 32-item CATS is psychometrically defensible and has demonstrated potential as a screening measure to identify students who are at risk from distressing teasing.

Objective: To examine differences in depression symptom rates and severity and factors associated with depression ratings., Participants: Cross-sectional sample of 1,359 American women who had delivered a single, live infant within the previous 2 years., Design: Data were collected using the Edinburgh Postnatal Depression Scale online to screen for depression symptoms as part of Listening to Mothers, a national survey sponsored by Childbirth Connection of New York City and administered by Harris Interactive between May and June 2002., Results: Evidence of continued mild and moderate-to-severe depression symptom rates throughout the first 2 years postpartum was found. Age, income, education, and employment had significant negative associations with depression symptom severity, and parity had a significant positive association with depression symptom severity. Race was not associated with depression symptom severity., Conclusions: Long-term screening for childbearing women is justified based on the study findings. The ease in survey administration suggests potential for online depression screening by health care providers and researchers. Furthermore, risk factors identified from this large-scale national survey, specifically young maternal age, low income, low education, not being employed full time, and multiparity, merit evaluation in clinical practice and future research.

Using reliable and valid measurements of mothering can enhance clinicians' and researchers' ability to identify problematic patterns that pose risks to the health of mothers and infants during the first postpartum year. A critical review of observational and self-report instruments for measuring components of mothering is presented. Positive indicators of mothering are discussed, and implications for intervention and referral for problematic aspects of mothering are suggested., ((c) 2006, AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses)

The major focus of intrahepatic arterial (IHA) administration of adenoviruses (Ad) has been on safety. Currently, there is little published data on the biological responses to Ad when administered via this route. As part of a Phase I study, we evaluated biological responses to a replication-defective adenovirus encoding the p53 transgene (SCH 58500) when administered by hepatic arterial infusion to patients with primarily colorectal cancer metastatic to the liver. In analyzing biological responses to the Ad vector, we found that both total and neutralizing Ad antibodies increased weeks after SCH 58500 infusion. The fold increase in antibody titers was not dependent on SCH 58500 dosage. The proinflammatory cytokine interleukin-6 (IL-6) transiently peaked within 6 h of dosing. The cytokine sTNF-R2 showed elevation by 24 h post-treatment, and fold increases were directly related to SCH 58500 doses. Cytokines TNF-alpha, IL-1beta, and sTNF-R1 showed no increased levels over 24 h. Predose antibody levels did not appear to predict transduction, nor did serum Ad neutralizing factor (SNF). Delivery of SCH 58500 to tumor tissue occurred, though we found distribution more predominantly in liver tissues, as opposed to tumors. RT-PCR showed significantly higher expression levels (P<0.0001, ANOVA) for adenovirus type 2 and 5 receptor (CAR) in liver tissues, suggesting a correlation with transduction. Evidence of tumor-specific apoptotic activity was provided by laser scanning cytometry, which determined a coincidence of elevated nuclear p53 protein expression with apoptosis in patient tissue. IHA administration of a replication defective adenovirus is a feasible mode of delivery, allowing for exogenous transfer of the p53 gene into target tissues, with evidence of functional p53. Limited and transient inflammatory responses to the drug occurred, but pre-existing immunity to Ad did not preclude SCH 58500 delivery.

In this article, the authors offer a solution to a phenomenon identified as "silencing" among nurse colleagues during national, regional, and international scholarly conferences. Through an electronic anonymous survey, data were collected regarding perceptions of the structure and process at scholarly nursing conferences. The need for critique and dialogue while sharing research ideas or findings is identified as a means to encourage direct exchange at professional conferences. Based on an examination of the process of critique and dialogue, and theories that explain why honest and direct dialogue are sometimes subdued, the authors propose a model of constructive scholarly dialogue for conference participation. The goals of implementing this model are to make scholarly exchanges normative at nursing conferences, and to revise standard conference formats so that constructive critique and dialogue are encouraged actively. The likely outcomes include improved nursing science and professional development of nurses.

Postpartum depression affects 10% to 20% of women in the United States and negatively influences maternal, infant, and family health. Assessment of risk factors and depression symptoms is needed to identify women at risk for postpartum depression for early referral and treatment. Individual and group psychotherapy have demonstrated efficacy as treatments, and some complementary/alternative therapies show promise. Treatment considerations include severity of depression, whether a mother is breastfeeding, and mother's preference. Nurses who work with childbearing women can advise depressed mothers regarding treatment options, make appropriate recommendations, provide timely and accessible referrals, and encourage engagement in treatment.

Reports of non-Western prevalence of postpartum depression (PPD) are highly variable. This variation may indicate that the label of PPD may be unacceptable in some groups or not used, that manifestations may vary by culture, or that cross-cultural diagnostic standards do not match Western clinical criteria. These factors complicate efforts to explore the relationship of postpartum traditional practices to PPD between Western and non-Western cultures. Although Stern and Kruckman viewed PPD as a culture-bound phenomenon of Western culture, an expanding international literature has demonstrated that PPD occurs in a variety of countries. To address these issues, the authors examined the literature to describe cultural postpartum traditions, to explore possible relationships among practices and PPD prevalence, to critique the culture-bound theory, and to discuss clinical practice implications.

Participation of children in focus groups has received scant attention despite the effectiveness of group interviews in eliciting children's views. Focus groups are a valuable approach for generating qualitative data from children; however, conducting school-based focus groups involves challenges specific to the school milieu and the ages and development of the participants. Lessons learned from conducting school-based focus groups during the Child-Adolescent Teasing Scale (CATS) project are applied to examination of key issues including entry to schools, informed consent and confidentiality, students' cognitive development, safety within the group, and appropriate procedures.