Interventions for the management of mandibular fractures

BACKGROUND Fractures of the mandible (lower jaw) are a common occurrence and usually related to interpersonal violence or road traffic accidents. Mandibular fractures may be treated using open (surgical) and closed (non-surgical) techniques. Fracture sites are immobilized with intermaxillary fixation (IMF) or other external or internal devices (i.e. plates and screws) to allow bone healing. Various techniques have been used, however uncertainty exists with respect to the specific indications for each approach. OBJECTIVES The objective of this review is to provide reliable evidence of the effects of any interventions either open (surgical) or closed (non-surgical) that can be used in the management of mandibular fractures, excluding the condyles, in adult patients. SEARCH METHODS We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 28 February 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 1), MEDLINE via OVID (1950 to 28 February 2013), EMBASE via OVID (1980 to 28 February 2013), metaRegister of Controlled Trials (to 7 April 2013), ClinicalTrials.gov (to 7 April 2013) and the WHO International Clinical Trials Registry Platform (to 7 April 2013). The reference lists of all trials identified were checked for further studies. There were no restrictions regarding language or date of publication. SELECTION CRITERIA Randomised controlled trials evaluating the management of mandibular fractures without condylar involvement. Any studies that compared different treatment approaches were included. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed trial quality and extracted data. Results were to be expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated to include both clinical and methodological factors. MAIN RESULTS Twelve studies, assessed as high (six) and unclear (six) risk of bias, comprising 689 participants (830 fractures), were included. Interventions examined different plate materials and morphology; use of one or two lag screws; microplate versus miniplate; early and delayed mobilization; eyelet wires versus Rapid IMF™ and the management of angle fractures with intraoral access alone or combined with a transbuccal approach. Patient-oriented outcomes were largely ignored and post-operative pain scores were inadequately reported. Unfortunately, only one or two trials with small sample sizes were conducted for each comparison and outcome. Our results and conclusions should therefore be interpreted with caution. We were able to pool the results for two comparisons assessing one outcome. Pooled data from two studies comparing two miniplates versus one miniplate revealed no significant difference in the risk of post-operative infection of surgical site (risk ratio (RR) 1.32, 95% CI 0.41 to 4.22, P = 0.64, I(2) = 0%). Similarly, no difference in post-operative infection between the use of two 3-dimensional (3D) and standard (2D) miniplates was determined (RR 1.26, 95% CI 0.19 to 8.13, P = 0.81, I(2) = 27%). The included studies involved a small number of participants with a low number of events. AUTHORS' CONCLUSIONS This review illustrates that there is currently inadequate evidence to support the effectiveness of a single approach in the management of mandibular fractures without condylar involvement. The lack of high quality evidence may be explained by clinical diversity, variability in assessment tools used and difficulty in grading outcomes with existing measurement tools. Until high level evidence is available, treatment decisions should continue to be based on the clinician's prior experience and the individual circumstances.

Magnetic resonance imaging and genetic investigation of a case of Rottweiler leukoencephalomyelopathy.

BACKGROUND Leukoencephalomyelopathy is an inherited neurodegenerative disorder that affects the white matter of the spinal cord and brain and is known to occur in the Rottweiler breed. Due to the lack of a genetic test for this disorder, post mortem neuropathological examinations are required to confirm the diagnosis. Leukoencephalopathy with brain stem and spinal cord involvement and elevated lactate levels is a rare, autosomal recessive disorder in humans that was recently described to have clinical features and magnetic resonance imaging (MRI) findings that are similar to the histopathologic lesions that define leukoencephalomyelopathy in Rottweilers. Leukoencephalopathy with brain stem and spinal cord involvement is caused by mutations in the DARS2 gene, which encodes a mitochondrial aspartyl-tRNA synthetase. The objective of this case report is to present the results of MRI and candidate gene analysis of a case of Rottweiler leukoencephalomyelopathy to investigate the hypothesis that leukoencephalomyelopathy in Rottweilers could serve as an animal model of human leukoencephalopathy with brain stem and spinal cord involvement. CASE PRESENTATION A two-and-a-half-year-old male purebred Rottweiler was evaluated for generalised progressive ataxia with hypermetria that was most evident in the thoracic limbs. MRI (T2-weighted) demonstrated well-circumscribed hyperintense signals within both lateral funiculi that extended from the level of the first to the sixth cervical vertebral body. A neurodegenerative disorder was suspected based on the progressive clinical course and MRI findings, and Rottweiler leukoencephalomyelopathy was subsequently confirmed via histopathology. The DARS2 gene was investigated as a causative candidate, but a sequence analysis failed to identify any disease-associated variants in the DNA sequence. CONCLUSION It was concluded that MRI may aid in the pre-mortem diagnosis of suspected cases of leukoencephalomyelopathy. Genes other than DARS2 may be involved in Rottweiler leukoencephalomyelopathy and may also be relevant in human leukoencephalopathy with brain stem and spinal cord involvement.

An evaluation of a community-based program for homeless adults with mental disorders and comorbid alcohol drug and mental disorders

Limited research has been conducted evaluating programs that are designed to improve the outcomes of homeless adults with mental disorders and comorbid alcohol, drug and mental disorders. This study conducted such an evaluation in a community-based day treatment setting with clients of the Harris County Mental Health and Mental Retardation Authority's Bristow Clinic. The study population included all clients who received treatment at the clinic for a minimum of six months between January 1, 1995 and August 31, 1996. An electronic database was used to identify clients and to track their program involvement. A profile was developed of the study participants and their level of program involvement included an examination of the amount of time spent in clinical, social and other interventions, the type of interventions encountered and the number of interventions encountered. Results were analyzed to determine whether social, demographic and mental history affected levels of program involvement and the effects of the levels of program involvement on housing status and psychiatric functioning status.^ A total of 101 clients met the inclusion criteria. Of the 101 clients, 96 had a mental disorder, and five had comorbidity. Due to the limited numbers of participants with comorbidity, only those with mental disorders were included in the analysis. The study found the Bristow Clinic population to be primarily single, Black, male, between the ages of 31 and 40 years, and with a gross family income of less than $4,000. There were more persons residing on the streets at entry and at six months following treatment than in any other residential setting. The most prevalent psychiatric diagnoses were depressive disorders and schizophrenia. The Global Assessment of Functioning (GAF) scale which was used to determine the degree of psychiatric functioning revealed a modal GAF score of 31--40 at entry and following six months in treatment. The study found that the majority of clients spent less than 17 hours in treatment, had less than 51 encounters and had clinical, social, and other encounters. In regard to social and demographic factors and levels of program involvement, there were statistically significant associations between gender and ethnicity and the types of interventions encountered as well as the number of interventions encountered. There was also a statistically significant difference between the amount of time spent in clinical interventions and gender. Relative to outcomes measured, the study found female gender to be the only background variable that was significantly associated with improved housing status and the female gender and previous MHMRA involvement to be statistically associated with improvement in GAF score. The total time in other (not clinical or social) interventions and the total number of encounters with other interventions were also significantly associated with improvement in housing outcome. The analysis of previous services and levels of program involvement revealed significant associations between time spent in social and clinical interventions and previous hospitalizations and previous MHMRA involvement.^ Major limitations of this study include the small sample size which may have resulted in very little power to detect differences and the lack of generalizability of findings due to site locations used in the study. Despite these limitations, the study makes an important contribution to the literature by documenting the levels of program involvement and the social and demographic factors necessary to produce outcomes of improved housing status and psychiatric functioning status. ^

Risk factors associated with the longevity of multi-rooted teeth. Long-term outcomes after active and supportive periodontal therapy

AIM To investigate risk factors for the loss of multi-rooted teeth (MRT) in subjects treated for periodontitis and enrolled in supportive periodontal therapy (SPT). MATERIAL AND METHODS A total of 172 subjects were examined before (T0) and after active periodontal therapy (APT)(T1) and following a mean of 11.5 ± 5.2 (SD) years of SPT (T2). The association of risk factors with loss of MRT was analysed with multilevel logistic regression. The tooth was the unit of analysis. RESULTS Furcation involvement (FI) = 1 before APT was not a risk factor for tooth loss compared with FI = 0 (p = 0.37). Between T0 and T2, MRT with FI = 2 (OR: 2.92, 95% CI: 1.68, 5.06, p = 0.0001) and FI = 3 (OR: 6.85, 95% CI: 3.40, 13.83, p < 0.0001) were at a significantly higher risk to be lost compared with those with FI = 0. During SPT, smokers lost significantly more MRT compared with non-smokers (OR: 2.37, 95% CI: 1.05, 5.35, p = 0.04). Non-smoking and compliant subjects with FI = 0/1 at T1 lost significantly less MRT during SPT compared with non-compliant smokers with FI = 2 (OR: 10.11, 95% CI: 2.91, 35.11, p < 0.0001) and FI = 3 (OR: 17.18, 95% CI: 4.98, 59.28, p < 0.0001) respectively. CONCLUSIONS FI = 1 was not a risk factor for tooth loss compared with FI = 0. FI = 2/3, smoking and lack of compliance with regular SPT represented risk factors for the loss of MRT in subjects treated for periodontitis.

Attitudes and Beliefs of Pig Farmers and Wild Boar Hunters Towards Reporting of African Swine Fever in Bulgaria, Germany and the Western Part of the Russian Federation

This study investigated the attitudes and beliefs of pig farmers and hunters in Germany, Bulgaria and the western part of the Russian Federation towards reporting suspected cases of African swine fever (ASF). Data were collected using a web-based questionnaire survey targeting pig farmers and hunters in these three study areas. Separate multivariable logistic regression models identified key variables associated with each of the three binary outcome variables whether or not farmers would immediately report suspected cases of ASF, whether or not hunters would submit samples from hunted wild boar for diagnostic testing and whether or not hunters would report wild boar carcasses. The results showed that farmers who would not immediately report suspected cases of ASF are more likely to believe that their reputation in the local community would be adversely affected if they were to report it, that they can control the outbreak themselves without the involvement of veterinary services and that laboratory confirmation would take too long. The modelling also indicated that hunters who did not usually submit samples of their harvested wild boar for ASF diagnosis, and hunters who did not report wild boar carcasses are more likely to justify their behaviour through a lack of awareness of the possibility of reporting. These findings emphasize the need to develop more effective communication strategies targeted at pig farmers and hunters about the disease, its epidemiology, consequences and control methods, to increase the likelihood of early reporting, especially in the Russian Federation where the virus circulates

Dystrophic cardiomyopathy: role of TRPV2 channels in stretch-induced cell damage

Aims Duchenne muscular dystrophy (DMD), a degenerative pathology of skeletal muscle, also induces cardiac failure and arrhythmias due to a mutation leading to the lack of the protein dystrophin. In cardiac cells, the subsarcolemmal localization of dystrophin is thought to protect the membrane from mechanical stress. The absence of dystrophin results in an elevated stress-induced Ca2+ influx due to the inadequate functioning of several proteins, such as stretch-activated channels (SACs). Our aim was to investigate whether transient receptor potential vanilloid channels type 2 (TRPV2) form subunits of the dysregulated SACs in cardiac dystrophy. Methods and results We defined the role of TRPV2 channels in the abnormal Ca2+ influx of cardiomyocytes isolated from dystrophic mdx mice, an established animal model for DMD. In dystrophic cells, western blotting showed that TRPV2 was two-fold overexpressed. While normally localized intracellularly, in myocytes from mdx mice TRPV2 channels were translocated to the sarcolemma and were prominent along the T-tubules, as indicated by immunocytochemistry. Membrane localization was confirmed by biotinylation assays. Furthermore, in mdx myocytes pharmacological modulators suggested an abnormal activity of TRPV2, which has a unique pharmacological profile among TRP channels. Confocal imaging showed that these compounds protected the cells from stress-induced abnormal Ca2+ signals. The involvement of TRPV2 in these signals was confirmed by specific pore-blocking antibodies and by small-interfering RNA ablation of TRPV2. Conclusion Together, these results establish the involvement of TRPV2 in a stretch-activated calcium influx pathway in dystrophic cardiomyopathy, contributing to the defective cellular Ca2+ handling in this disease.

Function of cardiolipin in mitochondria of Saccharomyces cerevisiae

Cardiolipin and its precursor phosphatidylglycerol, phospholipids found uniquely in membranes engaged in oxidative phosphorylation, play important roles in multimeric complexes of the energy transducing system (ETS) associated with the inner mitochondrial membrane. A combined molecular genetic and biochemical approach was used to more precisely define the role of cardiolipin in cell processes. ^ Strains of yeast Saccharomyces cerevisiae unable to synthesize cardiolipin because of the crd1Δ allele (encodes cardiolipin synthase) with different phenotypes were analyzed to determine which phenotypes are due to lack of cardiolipin. We concluded that many of the severe phenotypes ascribed to cells lacking cardiolipin, particularly when grown at 37°C, are because of the synergistic interaction of the crd1Δ mutation with the reduced expression of the PET56 gene which encodes a component essential for the formation of functional mitochondrial ribosomes. We also demonstrate that much of the reduced mitochondrial function in crd1Δ is because of reduced expression of ETS components at elevated temperature. ^ A crd1Δ mutant of S. cerevisiae has less severe physiological changes than strains lacking both phosphatidylglycerol and cardiolipin due to an increased level of phosphatidylglycerol, which might partially substitute for the cardiolipin-requiring functions. By varying the level of cardiolipin, we were able to correlate phenotypes in a dose-dependent manner with the level of cardiolipin to support more strongly an involvement of cardiolipin in a particular cellular process. There is almost complete lack of a supercomplex composed of cytochrome bc1 complex (complex III) and cytochrome c oxidase (complex IV) in extracts of cardiolipin-lacking mitochondria when compared to wild type cells and the level of supercomplex varies in proportion to the cardiolipin levels. Reduced cardiolipin levels also compromise the growth properties of yeast in a dose-dependent manner suggesting that the loss in growth efficiency is related to a role of cardiolipin that cannot be replaced by phosphatidylglycerol. An independent kinetic approach was performed to compare organization of the respiratory chain in wild-type and cardiolipin-lacking mitochondria. Cardiolipin-lacking mitochondria display kinetic properties for electron transfer between complexes III and IV via cytochrome c consistent with cytochrome c being a freely diffusible carrier, confirming complexes III and IV exist as individual complexes and not associated into a supercomplex in cardiolipin-lacking mitochondria. ^

Geochemistry of the oldest Atlantic oceanic crust

Controversy has surrounded the issue of whether mantle plume activity was responsible for Pangaean continental rifting and massive flood volcanism (resulting in the Central Atlantic Magmatic Province or CAMP, emplaced around 200 Ma) preceding the opening of the central Atlantic Ocean in the Early Mesozoic. Our new Sr-Nd-Pb isotopic and trace element data for the oldest basalts sampled from central Atlantic oceanic crust by deep-sea drilling show that oceanic crust generated from about 160 to 120 Ma displays clear isotopic and chemical signals of plume contamination (e.g., 87Sr/86Sr(i) = 0.7032-0.7036, epsilonNd(t) =+6.2 to +8.2, incompatible element patterns with positive Nb anomalies), but these signals are muted or absent in crust generated between 120 and 80 Ma, which resembles young Atlantic normal mid-ocean ridge basalt. The plume-affected pre-120 Ma Atlantic crustal basalts are isotopically similar to lavas from the Ontong Java Plateau, and may represent one isotopic end-member for CAMP basalts. The strongest plume signature is displayed near the center of CAMP magmatism but the hotspots presently located nearest this location in the mantle reference frame do not appear to be older than latest Cretaceous and are isotopically distinct from the oldest Atlantic crust. The evidence for widespread plume contamination of the nascent Atlantic upper mantle, combined with a lack of evidence for a long-lived volcanic chain associated with this plume, leads us to propose that the enriched signature of early Atlantic crust and possibly the eruption of the CAMP were caused by a relatively short-lived, but large volume plume feature that was not rooted at a mantle boundary layer. Such a phenomenon has been predicted by recent numerical models of mantle circulation.

Isotopic composition of Manihiki and Ontong Java basalts

Pb, Nd, and Sr isotopic results for lavas of the Cretaceous Ontong Java and Manihiki oceanic plateaus fall well within the modern-day oceanic island or hot pot field. The data provide no evidence of old continental basements but indicate a major involvement of 'Kerguelen-type' or 'EM-I'-like mantle in the sources of both plateaus, which appear to have probably been formed, at least in part, by hotspots. However, the presently active hotspots that Pacific plate reconstructions suggest might have been possible plateau sources lack Kerguelen-type isotopic compositions. Either these hotspots did not participate in the formation of the two plateaus, or if they did, Kerguelen-type material must have been volumetrically much more important early in their existence. Two hypotheses for the origins of these plateaus which involve hotspot sources are consistent with the sparse available geochemical, geochronological and geophysical data. The first holds that the plateaus formed cataclysmically in association with surfacing plume heads; the second posits a relatively steady but robust hotspot at or near a ridge crest and requires a much longer period of formation. A near-ridge origin appears to be indicated by evidence that most of the Pacific plateaus were built largely on relatively young ocean crust. However, we suggest that a near-ridge origin is also compatible with the plume head concept in that plume heads appear very likely to become associated with spreading axes through their influence on rift propagation, which should be substantially greater than for ordinary hotspots. In either case, the lack of hotspot tracks (seamount chains) attached to the two plateaus would be a consequence of ridge migration or rift propagation in a near-ridge setting.

Comprehensive Validation Of A Measure Of Student School Engagement: A Pilot Study Of Middle School Students

Although it may sound reasonable that American education continues to be more effective at sending high school students to college, in a study conducted in 2009, The Council of the Great City Schools states that "slightly more than half of entering ninth grade students arrive performing below grade level in reading and math, while one in five entering ninth grade students is more than two years behind grade level...[and] 25% received support in the form of remedial literacy instruction or interventions" (Council of the Great City Schools, 2009). Students are distracted with technology (Lei & Zhao, 2005), family (Xu & Corno, 2003), medical illnesses (Nielson, 2009), learning disabilities and perhaps the most detrimental to academic success, the very lack of interest in school (Ruch, 1963). In a Johns Hopkins research study, Building a Graduation Nation - Colorado (Balfanz, 2008), warning signs were apparent years before the student dropped out of high school. The ninth grade was often referenced as a critical point that indicated success or failure to graduate high school. The research conducted by Johns Hopkins illustrates the problem: students who become disengaged from school have a much greater chance of dropping out of high school and not graduating. The first purpose of this study was to compare different measurement models of the Student School Engagement (SSE) using Factor Analysis to verify model fit with student engagement. The second purpose was to determine the extent to which the SSE instrument measures student school engagement by investigating convergent validity (via the SSE and Appleton, Christenson, Kim and Reschly's instrument and Fredricks, Blumenfeld, Friedel and Paris's instrument), discriminant validity (via Huebner's Student Life Satisfaction Survey) and criterion-related validity (via the sub-latent variables of Aspirations, Belonging and Productivity and student outcome measures such as achievement, attendance and discipline). Discriminant validity was established between the SSE and the Appleton, Christenson, Kim and Reschly's model and Fredricks, Blumenfeld, Friedel and Paris's (2005) Student Engagement Instruments (SEI). When confirming discriminant validity, the SSE's correlations were weak and statistically not significant, thus establishing discriminant validity with the SLSS. Criterion-related validity was established through structural equation modeling when the SSE was found to be a significant predictor of student outcome measures when both risk score and CSAP scores were used. The third purpose of this study was to assess the factorial invariance of the SSE instrument across gender to ensure the instrument is measuring the intended construct across different groups. Conclusively, configural, weak and metric invariances were established for the SSE as a non-significant change in chi-square indicating that all parameters including the error variances were invariant across groups of gender. Engagement is not a clearly defined psychological construct; it requires more research in order to fully comprehend its complexity. Hopefully, with parental and teacher involvement and a sense of community, student engagement can be nurtured to result in a meaningful attachment to school and academic success.

A Differentiated, Balanced and Patient Approach? The EU’s Involvement with Georgia’s Secessionist Conflicts beyond the August 2008 War. EU Diplomacy Paper 06/2015.

The August war in 2008 between Russia and Georgia caught the world by surprise but nevertheless brought the European Union (EU) to the forefront of the international efforts to end the hostilities, and the EU became the leading international actor involved with the conflict resolution process. However, in the years following the armed conflict, the conflict resolution process lost pace, and the impact of the EU beyond the immediate aftermath of the August 2008 war has been put into question. By undertaking a qualitative case study, this paper aims to explore to what extent the EU has impacted on the conflict resolution process of Georgia’s secessionist conflicts in 2008-2015. It will argue that the EU’s policies have only to a limited extent impacted on this conflict resolution process, which can be related to the objectives, priorities and time perspectives of the EU’s conflict resolution policies. The EU’s efforts have significantly contributed to the objective of conflict prevention, but the profile of the EU in the field of international conflict management weakened its position in the area of conflict transformation, where the lack of progress in turn limited the EU’s impact in the areas of international conflict management and conflict settlement. The main conclusion put forward is that in order to have a true impact, the EU needs to undertake a differentiated, balanced and patient approach to conflict resolution.

Involvement and detachment in David Cameron and Ed Miliband’s political discourse. An analysis of deictic shields on the pronoun ‘I’ in UK 2015 General Election news interviews

The goal of my study is to investigate the relationship between selected deictic shields on the pronoun ‘I’ and the involvement/detachment dichotomy in a sample of television news interviews. I focus on the use of personal pronouns in political discourse. Drawing upon Caffi’s (2007) classification of mitigating devices into bushes, hedges and shields, I focus on deictic shields on the pronoun ‘I’: I examine the way a selection of ‘I’-related deictic shields is employed in a collection of news interviews broadcast during the electoral campaign prior to the UK 2015 General Election. My purpose is to uncover the frequencies of each of the linguistic items selected and the pragmatic functions of those linguistic items in the involvement/detachment dichotomy. The research is structured as follows. Chapter 1 provides an account of previous studies on the three main areas of research: speech event analysis, institutional interaction and the news interview, and the UK 2015 General Election television programmes. Chapter 2 is centred on the involvement/detachment dichotomy: I provide an overview of nonlinguistic and linguistic features of involvement and detachment at all levels of sentence structure. Chapter 3 contains a detailed account of the data collection and data analysis process. Chapter 4 provides an accurate description of results in three steps: quantitative analysis, qualitative analysis and discussion of the pragmatic functions of the selected linguistic features of involvement and detachment. Chapter 5 includes a brief summary of the investigation, reviews the main findings, and indicates limitations of the study and possible inputs for further research. The results of the analysis confirm that, while some of the linguistic items examined point toward involvement, others have a detaching effect. I therefore conclude that deictic shields on the pronoun ‘I’ permit the realisation of the involvement/detachment dichotomy in the speech genre of the news interview.

A framework of lessons learned from community-based marine reserves and its effectiveness in guiding a new coastal management initiative in the Philippines

Community-based coastal resource management has been widely applied within the Philippines. However, small-scale community-based reserves are often inefficient owing to management inadequacies arising because of a lack of local support or enforcement or poor design. Because there are many potential pitfalls during the establishment of even small community-based reserves, it is important for coastal managers, communities, and facilitating institutions to have access to a summary of the key factors for success. Reviewing relevant literature, we present a framework of lessons learned during the establishment of protected areas, mainly in the Philippines. The framework contains summary guidance on the importance of (1) an island location, (2) small community population size, (3) minimal effect of land-based development, (4) application of a bottom-up approach, (5) an external facilitating institution, (6) acquisition of title, (7) use of a scientific information database, (8) stakeholder involvement, (9) the establishment of legislation, (10) community empowerment, (11) alternative livelihood schemes, (12) surveillance, (13) tangible management results, (14) continued involvement of external groups after reserve establishment, and (15) small-scale project expansion. These framework components guided the establishment of a community-based protected area at Danjugan Island, Negros Occidental, Philippines. This case study showed that the framework was a useful guide that led to establishing and implementing a community-based marine reserve. Evaluation of the reserve using standard criteria developed for the Philippines shows that the Danjugan Island protected area can be considered successful and sustainable. At Danjugan Island, all of the lessons synthesized in the framework were important and should be considered elsewhere, even for relatively small projects. As shown in previous projects in the Philippines, local involvement and stewardship of the protected area appeared particularly important for its successful implementation. The involvement of external organizations also seemed to have a key role in the success of the Danjugan Island project by guiding local decision-makers in the sociobiological principles of establishing protected areas. However, the relative importance of each component of the framework will vary between coastal management initiatives both within the Philippines and across the wider Asian region.

Generative acts: Family and community involvement of older Australians

The article adopts a developmental approach to successful human aging by exploring the concept of generativity in relation to a study of older Australians' lived experiences of involvement in the family and community. Qualitative data, collected through focus group interviews, were analyzed interpretively using recent developments in Erikson's theory of generativity as a framework. As a result, the present study contributes an in-depth understanding of the role of generative acts to the lives of older people. The data provide illustrative support for Erikson's contention of a generativity/stagnation crisis in later life. Involvement in the family and community is seen as a productive and generative activity, which promotes a positive experience of aging. Two further emergent themes are also explored. First, the experiences of study participants illustrate the reciprocal and cyclical nature of grand-generativity, and the importance of intergenerational relationships. Finally, the data contribute to our knowledge of cultural generativity, and in particular the passing on of cultural knowledge through narratives and modeling.

The experiences and perceptions of fathers attending the birth and immediate care of their baby

Fathers in the United Kingdom (UK) usually attend the birth and immediate care of their baby. They also have an increasing presence during complicated and preterm childbirth, newborn resuscitation and early neonatal unit(NNU) care. However, there is limited evidence about the effect of these experiences on them. The aim of this study was to gain an understanding of the experiences of fathers encountering these situations. The study consisted of three phases and was undertaken in one National Health Service trust in the UK. Qualitative semi-structured interviews using a phenomenological approach were undertaken with 20 first-time fathers present at the delivery, resuscitation and/or admission of their baby to the NNU. Direct observations were made of 22 normal and complicated deliveries and initial newborn care and qualitative semi-structured interviews using the critical incident approach were undertaken with 37 health care professionals (HCPs). The study generated qualitative and quantitative data that were analysed accordingly. The findings show that most fathers were involved for at least some of the time and often spontaneously initiated their involvement. Their most important need was for information. They were usually more concerned about their partner, irrespective of the baby?s need for resuscitation and NNU care. To facilitate their involvement, fathers needed guidance and support from HCPs, particularly delivery suite midwives. Most HCPs recognised the needs of fathers and ways in which they could be helped to connect with their experience. However, these needs were not always met, usually because of inadequate staffing levels, a lack of resources or a mother-centred philosophy of care. The findings suggest the service often determines the extent to which fathers are involved. It is anticipated that these findings will inform HCP education and training and the development of both policy and health education thereby enhancing the quality of care provision for fathers.