Low-income first time mothers: Effects on advanced practice nurse (APN) follow up telephone calls on maternal and infant health and health care charges

The United States has over 4 million births annually. Currently healthy women with non-complicated deliveries receive little to no routine postpartum support when discharged from the hospital. This is especially problematic if mothers are first time mothers, poor, have language barriers and little to no social support after giving birth. The purpose of this randomized clinical trial was to compare maternal and infant health outcomes, and health care charges between 2 groups of mothers and newborns. A control ( n = 69) group received routine posthospital discharge care. An intervention group (n = 70) received routine posthospital discharge care plus follow up telephone calls by advanced practice nurses (APNs) on days 3,7,14,21,28 and week 8. Both groups were followed for the first 8 weeks posthospital discharge following delivery to examine maternal health outcomes (perceived maternal stress, social support and perceived maternal physical health), infant health outcomes (routine medical follow up visits immunizations, weight gain), morbidity (urgent care visits, emergency room visits, rehospitalizations), health care charges (urgent care visits, emergency room visits, rehospitalizations) in both groups and charges for APN follow up in the intervention group only. Data were analyzed using descriptive statistics and two-sample t-tests. Study findings indicated that intervention group had significantly lower perceived maternal stress, significantly higher rating of perceived maternal health and higher levels of social support and by the end of the 2nd month posthospital discharge compared to control group mothers. Infants in the intervention group had: increased number of immunizations; fewer emergency room visits; and 1 infant rehospitalization compared to 3 infant rehospitalizations in the control group. The intervention groups' health care charges were significantly lower compared to the control group $14,333/$497 vs. $70,834/$1,068. These study results indicate that an intervention of APN follow up telephone calls in this sample of first time low-income culturally diverse mothers was an effective, safe, low cost, easy to apply intervention which improved mothers' and infants' health outcomes and reduced healthcare charges.

First time measurements of polarization observables for the charged cascade hyperon in photoproduction

The parity violating weak decay of hyperons offers a valuable means of measuring their polarization, providing insight into the production of strange quarks and the matter they compose. Jefferson Lab's CLAS collaboration has utilized this property of hyperons, publishing the most precise polarization measurements for the Λ and Σ in both photoproduction and electroproduction to date. In contrast, cascades, which contain two strange quarks, can only be produced through indirect processes and as a result, exhibit low cross sections thus remaining experimentally elusive.^ At present, there are two aspects in cascade physics where progress has been minimal: characterizing their production mechanism, which lacks theoretical and experimental developments, and observation of the numerous excited cascade resonances that are required to exist by flavor SU(3) F symmetry. However, CLAS data were collected in 2008 with a luminosity of 68 pb−1 using a circularly polarized photon beam with energies up to 5.45 GeV, incident on a liquid hydrogen target. This dataset is, at present, the world's largest for meson photoproduction in its energy range and provides a unique opportunity to study cascade physics with polarization measurements.^ The current analysis explores hyperon production through the γ p → K+K +Ξ− reaction by providing the first ever determination of spin observables P, Cx and Cz for the cascade. Three of our primary goals are to test the only cascade photoproduction model in existence, examine the underlying processes that give rise to hyperon polarization, and to stimulate future theoretical developments while providing constraints for their parameters. Our research is part of a broader program to understand the production of strange quarks and hadrons with strangeness. The remainder of this document discusses the motivation behind such research, the method of data collection, details of their analysis, and the significance of our results.^

A fourth-grade teacher's classroom perspective

Countless books have been written about what is good and what is bad about our educational system. No matter what the book or what the theory, all agree the classroom teacher is critical to the education process. Many influences affect classroom teaching, some of which are beyond her control, but a caring classroom teacher has a central role in the instruction of children The purpose of this case study was to inquire into the beliefs and behaviors of one elementary school teacher in a low socio-economic school and study her classroom perspective. This teacher of five years was a reading specialist and was teaching a full fourth grade curriculum for the first time. Because she suffered from math phobia, she was apprehensive about teaching mathematics. ^ This qualitative study required intense, time-consuming interviews, long and frequent observations, critical journaling, field notes and artifacts provided by the teacher. The resulting descriptive data was coded into categories and reassembled into themes that captured the essence of the teacher's beliefs. ^ The overarching themes found were: first, the teacher's caring attitude towards her students, cultivated by her affectionate family, her mother who is an elementary school teacher, and rich and rewarding elementary school experiences, second, her implementation of the curriculum, influenced by her passion for reading, her math phobia, and standardized tests and third, her attitudes toward her workplace, school administrators and collegiality among teachers. During the school year this teacher “owned” her classroom and was a full participant in its life! Her dedication to teaching was fostered by the satisfaction of knowing she has a profound impact and makes a significant difference in her students' lives. ^ This study suggested areas for further research on the following topics: consideration of teachers with math phobia, the effect of standardized tests on areas of the curriculum and the value of computers in the elementary school classroom. ^

Characteristics of the Commission on Accreditation of Allied Health Education Programs or National Athletic Trainers' Association -accredited athletic training programs associated with first -attempt passing rates on the NATABOC examination

Athletic training is an allied health profession recognized by the American Medical Association requiring certification by examination. There are two routes towards certification as an athletic trainer: attending a university with an accredited athletic training program or with an internship program By 2004, the only route towards certification will be by attending a Commission on Accreditation of Allied Health Education Programs (CAAHEP) or National Athletic Trainers' Association (NATA) accredited athletic training program. CAAHEP looks at passing rates on the NATA Board of Certification (NATABOC) examination when granting accreditation. This study examined characteristics of programs associated with first time passing rates. ^ Directors from 39 CAAHEP or NATA accredited athletic training programs completed a descriptive 17-question survey regarding academic characteristics, faculty characteristics, and program characteristics. Analysis used Spearman's rho correlation coefficient, with significance of p = <.05. Four program directors were interviewed to gather additional insight. ^ There were three program characteristics that showed a significant positive association with first attempt passing rates: the number of full-time and part-time approved clinical instructors (ACIs), and the number of students in the program. Further investigation found a statistically significant association between a low ratio of ACIs to athletic training students and first time passing rates. ACIs are certified athletic trainers (ATCs) who have received special training in order to supervise athletic training students. CAAHEP mandates a 1:8 ratio of ATCs to athletic training student. This study showed that a smaller ratio of ATC to student in combination with ACI training was significantly associated with higher first time passing rates. The number of courses above the required 13 delineated by the Education Council showed a significant negative association with first attempt passing rates. ^ Universities seeking or maintaining accreditation should incorporate characteristics associated with a higher passing rate on the NATABOC examination. Characteristics include utilizing a large number of full-time and part-time ACIs, admitting a large number of students into the program while maintaining a low ACI to athletic training student ratio, and offering curricula that focuses on the 13 courses that have been deemed relevant to the athletic training curriculum by the Education Council. ^

Perceived Risk of Predation Affects Reproductive Life - History Traits in Gambusia holbrooki, but Not in Heterandria formosa

Key to predicting impacts of predation is understanding the mechanisms through which predators impact prey populations. While consumptive effects are well-known, non-consumptive predator effects (risk effects) are increasingly being recognized as important. Studies of risk effects, however, have focused largely on how trade-offs between food and safety affect fitness. Less documented, and appreciated, is the potential for predator presence to directly suppress prey reproduction and affect life-history characteristics. For the first time, we tested the effects of visual predator cues on reproduction of two prey species with different reproductive modes, lecithotrophy (i.e. embryonic development primarily fueled by yolk) and matrotrophy (i.e. energy for embryonic development directly supplied by the mother to the embryo through a vascular connection). Predation risk suppressed reproduction in the lecithotrophic prey (Gambusia holbrokii) but not the matrotroph (Heterandria formosa). Predator stress caused G. holbrooki to reduce clutch size by 43%, and to produce larger and heavier offspring compared to control females. H. formosa, however, did not show any such difference. In G. holbrooki we also found a significantly high percentage (14%) of stillbirths in predator-exposed treatments compared to controls (2%). To the best of our knowledge, this is the first direct empirical evidence of predation stress affecting stillbirths in prey. Our results suggest that matrotrophy, superfetation (clutch overlap), or both decrease the sensitivity of mothers to environmental fluctuation in resource (food) and stress (predation risk) levels compared to lecithotrophy. These mechanisms should be considered both when modeling consequences of perceived risk of predation on prey-predator population dynamics and when seeking to understand the evolution of reproductive modes.

The Road from Emmaus

THE ROAD FROM EMMAUS is a collection of 20 personal and lyric essays that explores the narrator’s role as mother and daughter through a close look at significant life events, including her parents’ divorce, a high-risk pregnancy, the death of her father, talking to her daughter for the first time about sex, and accompanying her daughter to the DMV for a learner’s permit. Through examining familial roles and relationships, the narrator’s longing for home emerges as a unifying theme. The essays in THE ROAD FROM EMMAUS vary in style and tone, from light and funny to serious and probing. The collection is divided into five sections, each highlighting a different aspect of the narrator’s life as she evolves from a child, to a young adult, a mother, and a daughter who must help take care of her aging parents.