Content of prenatal care and spontaneous preterm birth: Findings from the 1988 National Maternal and Infant Health Survey

The purposes of this study were to examine (1) the relationship between selected components of the content of prenatal care and spontaneous preterm birth; and (2) the degree of comparability between maternal and caregivers' responses regarding the number of prenatal care visits, selected components of the content of prenatal care, and gestational age, based on analyses of the 1988 National Maternal and Infant Health Survey conducted by the National Centers for Health Statistics. Spontaneous preterm birth was subcategorized into very preterm and moderately preterm births, with term birth as the controls. The study population was limited to non-Hispanic Anglo- and African-American mothers. The racial differences in terms of birth outcomes were also compared.^ This study concluded that: (1) there was not a high degree of comparability (less than 80%) between maternal and prenatal care provider's responses regarding the number of prenatal care visits and the content of prenatal care; (2) there was a low degree of comparability (less than 50%) between maternal and infant's hospital of delivery responses regarding gestational age at birth; (3) there were differences in selected components of the content of prenatal care between the cases and controls, overall and stratified by ethnicity (i.e., hemoglobin/hematocrit test, weight measurement, and breast-feeding counseling), but they were confounded with missing values and associated preterm delivery bias; (4) there were differences in selected components of the content of prenatal care between Anglo- and African-American cases (i.e., vitamin/mineral supplement advice, weight measurement, smoking cessation and drug abuse counseling), but they, too, were difficult to interpret definitively due to item nonresponse and preterm delivery biases; (5) no significant predictive association between selected components of the content of prenatal care and spontaneous preterm birth was found; and (6) inadequate/intermediate prenatal care and birth out of wedlock were found to be associated with moderately preterm birth.^ Future research is needed to examine the validity of maternal and prenatal care providers' responses and identify the sources of disagreement between their responses. In addition, further studies are needed to examine the relationship between the quality of prenatal care and preterm birth. Finally, the completeness and quality of patient and provider data on the utilization and content of prenatal care needs to be strengthened in subsequent studies. ^

IN.PACT Amphirion paclitaxel eluting balloon versus standard percutaneous transluminal angioplasty for infrapopliteal revascularization of critical limb ischemia: rationale and protocol for an ongoing randomized controlled trial

BACKGROUND The effectiveness and durability of endovascular revascularization therapies for chronic critical limb ischemia (CLI) are challenged by the extensive burden of infrapopliteal arterial disease and lesion-related characteristics (e.g., severe calcification, chronic total occlusions), which frequently result in poor clinical outcomes. While infrapopliteal vessel patency directly affects pain relief and wound healing, sustained patency and extravascular care both contribute to the ultimate "patient-centric" outcomes of functional limb preservation, mobility and quality of life (QoL). METHODS/DESIGN IN.PACT DEEP is a 2:1 randomized controlled trial designed to assess the efficacy and safety of infrapopliteal arterial revascularization between the IN.PACT Amphirion™ paclitaxel drug-eluting balloon (IA-DEB) and standard balloon angioplasty (PTA) in patients with Rutherford Class 4-5-6 CLI. DISCUSSION This multicenter trial has enrolled 358 patients at 13 European centers with independent angiographic core lab adjudication of the primary efficacy endpoint of target lesion late luminal loss (LLL) and clinically driven target lesion revascularization (TLR) in major amputation-free surviving patients through 12-months. An independent wound core lab will evaluate all ischemic wounds to assess the extent of healing and time to healing at 1, 6, and 12 months. A QoL questionnaire including a pain scale will assess changes from baseline scores through 12 months. A Clinical Events Committee and Data Safety Monitoring Board will adjudicate the composite primary safety endpoints of all-cause death, major amputation, and clinically driven TLR at 6 months and other trial endpoints and supervise patient safety throughout the study. All patients will be followed for 5 years. A literature review is presented of the current status of endovascular treatment of CLI with drug-eluting balloon and standard PTA. The rationale and design of the IN.PACT DEEP Trial are discussed. IN.PACT DEEP is a milestone, prospective, randomized, robust, independent core lab-adjudicated CLI trial that will evaluate the role of a new infrapopliteal revascularization technology, the IA-DEB, compared to PTA. It will assess the overall impact on infrapopliteal artery patency, limb salvage, wound healing, pain control, QoL, and patient mobility. The 1-year results of the adjudicated co-primary and secondary endpoints will be available in 2014. TRIAL REGISTRATION NCT00941733

Tidally Driven Exchange in an Archipelago Strait: Biological and Optical Responses

Measurements in San Bernardino Strait, one of two major connections between the Pacific Ocean and the interior waters of the Philippine Archipelago, captured 2-3 m s(-1) tidal currents that drove vertical mixing and net landward transport. A TRIAXUS towed profiling vehicle equipped with physical and optical sensors was used to repeatedly map subregions within the strait, employing survey patterns designed to resolve tidal variability of physical and optical properties. Strong flow over the sill between Luzon and Capul islands resulted in upward transport and mixing of deeper high-salinity, low-oxygen, high-particle-and-nutrient-concentration water into the upper water column, landward of the sill. During the high-velocity ebb flow, topography influences the vertical distribution of water, but without the diapycnal mixing observed during flood tide. The surveys captured a net landward flux of water through the narrowest part of the strait. The tidally varying velocities contribute to strong vertical transport and diapycnal mixing of the deeper water into the upper layer, contributing to the observed higher phytoplankton biomass within the interior of the strait.

Metacognitive monitoring and control in elementary school children: Their interrelations and their role for test performance

Contemporary models of self-regulated learning emphasize the role of distal motivational factors for student's achievement, on the one side, and the proximal role of metacognitive monitoring and control for learning and test outcomes, on the other side. In the present study, two larger samples of elementary school children (9- and 11-year-olds) were included and their mastery-oriented motivation, metacognitive monitoring and control skills were integrated into structural equation models testing and comparing the relative impact of these different constituents for self-regulated learning. For one, results indicate that the factorial structure of monitoring, control and mastery motivation was invariant across the two age groups. Of specific interest was the finding that there were age-dependent structural links between monitoring, control, and test performance (closer links in the older compared to the younger children), with high confidence yielding a direct and positive effect on test performance and a direct and negative effect on adequate control behavior in the achievement test. Mastery-oriented motivation was not found to be substantially associated with monitoring (confidence), control (detection and correction of errors), or test performance underlining the importance of proximal, metacognitive factors for test performance in elementary school children.

SwissScoring--a nationwide survey of NEMS assessing practices and its accuracy.

BACKGROUND The nine equivalents of nursing manpower use score (NEMS) is used to evaluate critical care nursing workload and occasionally to define hospital reimbursements. Little is known about the caregivers' accuracy in scoring, about factors affecting this accuracy and how validity of scoring is assured. METHODS Accuracy in NEMS scoring of Swiss critical care nurses was assessed using case vignettes. An online survey was performed to assess training and quality control of NEMS scoring and to collect structural and organizational data of participating intensive care units (ICUs). Aggregated structural and procedural data of the Swiss ICU Minimal Data Set were used for matching. RESULTS Nursing staff from 64 (82%) of the 78 certified adult ICUs participated in this survey. Training and quality control of scoring shows large variability between ICUs. A total of 1378 nurses scored one out of 20 case vignettes: accuracy ranged from 63.7% (intravenous medications) to 99.1% (basic monitoring). Erroneous scoring (8.7% of all items) was more frequent than omitted scoring (3.2%). Mean NEMS per case was 28.0 ± 11.8 points (reference score: 25.7 ± 14.2 points). Mean bias was 2.8 points (95% confidence interval: 1.0-4.7); scores below 37.1 points were generally overestimated. Data from units with a greater nursing management staff showed a higher bias. CONCLUSION Overall, nurses assess the NEMS score within a clinically acceptable range. Lower scores are generally overestimated. Inaccurate assessment was associated with a greater size of the nursing management staff. Swiss head nurses consider themselves motivated to assure appropriate scoring and its validation.

Factors influencing fixed retention practices in German-speaking Switzerland : A survey.

AIM Several surveys evaluate different retention approaches among orthodontists, but none exist for general dentists. The primary aim of this survey was to record the preferred fixed retainer designs and retention protocols amongst general dentists and orthodontists in Switzerland. A secondary aim was to investigate whether retention patterns were associated with parameters such as gender, university of graduation, time in practice, and specialist status. METHODS An anonymized questionnaire was distributed to general dentists (n = 401) and orthodontists (n = 398) practicing in the German-speaking part of Switzerland. A total of 768 questionnaires could be delivered, 562 (73.2 %) were returned and evaluated. Descriptive statistics were performed and responses to questions of interest were converted to binary outcomes and analyzed using multiple logistic regression. Any associations between the answers and gender, university of graduation (Swiss or foreign), years in practice, and specialist status (orthodontist/general dentist) were assessed. RESULTS Almost all responding orthodontists (98.0 %) and nearly a third of general dentists (29.6 %) reported bonding fixed retainers regularly. The answers were not associated with the practitioner's gender. The university of graduation and number of years in practice had a moderate impact on the responses. The answers were mostly influenced by specialist status. CONCLUSION Graduation school, years in practice, and specialist status influence retention protocol, and evidence-based guidelines for fixed retention should be issued to minimize these effects. Based on the observation that bonding and maintenance of retainers are also performed by general dentists, these guidelines should be taught in dental school and not during post-graduate training.

Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia-Pacific, sub-Saharan Africa and the Americas: results of a site assessment conducted by the International epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration

INTRODUCTION HIV care and treatment programmes worldwide are transforming as they push to deliver universal access to essential prevention, care and treatment services to persons living with HIV and their communities. The characteristics and capacity of these HIV programmes affect patient outcomes and quality of care. Despite the importance of ensuring optimal outcomes, few studies have addressed the capacity of HIV programmes to deliver comprehensive care. We sought to describe such capacity in HIV programmes in seven regions worldwide. METHODS Staff from 128 sites in 41 countries participating in the International epidemiologic Databases to Evaluate AIDS completed a site survey from 2009 to 2010, including sites in the Asia-Pacific region (n=20), Latin America and the Caribbean (n=7), North America (n=7), Central Africa (n=12), East Africa (n=51), Southern Africa (n=16) and West Africa (n=15). We computed a measure of the comprehensiveness of care based on seven World Health Organization-recommended essential HIV services. RESULTS Most sites reported serving urban (61%; region range (rr): 33-100%) and both adult and paediatric populations (77%; rr: 29-96%). Only 45% of HIV clinics that reported treating children had paediatricians on staff. As for the seven essential services, survey respondents reported that CD4+ cell count testing was available to all but one site, while tuberculosis (TB) screening and community outreach services were available in 80 and 72%, respectively. The remaining four essential services - nutritional support (82%), combination antiretroviral therapy adherence support (88%), prevention of mother-to-child transmission (PMTCT) (94%) and other prevention and clinical management services (97%) - were uniformly available. Approximately half (46%) of sites reported offering all seven services. Newer sites and sites in settings with low rankings on the UN Human Development Index (HDI), especially those in the President's Emergency Plan for AIDS Relief focus countries, tended to offer a more comprehensive array of essential services. HIV care programme characteristics and comprehensiveness varied according to the number of years the site had been in operation and the HDI of the site setting, with more recently established clinics in low-HDI settings reporting a more comprehensive array of available services. Survey respondents frequently identified contact tracing of patients, patient outreach, nutritional counselling, onsite viral load testing, universal TB screening and the provision of isoniazid preventive therapy as unavailable services. CONCLUSIONS This study serves as a baseline for on-going monitoring of the evolution of care delivery over time and lays the groundwork for evaluating HIV treatment outcomes in relation to site capacity for comprehensive care.

International variation in GP treatment strategies for subclinical hypothyroidism in older adults: a case-based survey

Background: There is limited evidence about the impact of treatment for subclinical hypothyroidism, especially among older people. Aim: To investigate the variation in GP treatment strategies for older patients with subclinical hypothyroidism depending on country and patient characteristics. Design and setting: Case-based survey of GPs in the Netherlands, Germany, England, Ireland, Switzerland, and New Zealand. Method: The treatment strategy of GPs (treatment yes/no, starting-dose thyroxine) was assessed for eight cases presenting a woman with subclinical hypothyroidism. The cases differed in the patient characteristics of age (70 versus 85 years), vitality status (vital versus vulnerable), and thyroid-stimulating hormone (TSH) concentration (6 versus 15 mU/L). Results: A total of 526 GPs participated (the Netherlands n = 129, Germany n = 61, England n = 22, Ireland n = 21, Switzerland n = 262, New Zealand n = 31; overall response 19%). Across countries, differences in treatment strategy were observed. GPs from the Netherlands (mean treatment percentage 34%), England (40%), and New Zealand (39%) were less inclined to start treatment than GPs in Germany (73%), Ireland (62%), and Switzerland (52%) (P = 0.05). Overall, GPs were less inclined to start treatment in 85-year-old than in 70-year-old females (pooled odds ratio [OR] 0.74 [95% confidence interval [CI] = 0.63 to 0.87]). Females with a TSH of 15 mU/L were more likely to get treated than those with a TSH of 6 mU/L (pooled OR 9.49 [95% CI = 5.81 to 15.5]). Conclusion: GP treatment strategies of older people with subclinical hypothyroidism vary largely by country and patient characteristics. This variation underlines the need for a new generation of international guidelines based on the outcomes of randomised clinical trials set within primary care

Predicting the "usefulness" of 5-ALA-derived tumor fluorescence for fluorescence-guided resections in pediatric brain tumors: a European survey.

BACKGROUND Five-aminolevulinic acid (Gliolan, medac, Wedel, Germany, 5-ALA) is approved for fluorescence-guided resections of adult malignant gliomas. Case reports indicate that 5-ALA can be used for children, yet no prospective study has been conducted as of yet. As a basis for a study, we conducted a survey among certified European Gliolan users to collect data on their experiences with children. METHODS Information on patient characteristics, MRI characteristics of tumors, histology, fluorescence qualities, and outcomes were requested. Surgeons were further asked to indicate whether fluorescence was "useful", i.e., leading to changes in surgical strategy or identification of residual tumor. Recursive partitioning analysis (RPA) was used for defining cohorts with high or low likelihoods for useful fluorescence. RESULTS Data on 78 patients <18 years of age were submitted by 20 centers. Fluorescence was found useful in 12 of 14 glioblastomas (85 %), four of five anaplastic astrocytomas (60 %), and eight of ten ependymomas grades II and III (80 %). Fluorescence was found inconsistently useful in PNETs (three of seven; 43 %), gangliogliomas (two of five; 40 %), medulloblastomas (two of eight, 25 %) and pilocytic astrocytomas (two of 13; 15 %). RPA of pre-operative factors showed tumors with supratentorial location, strong contrast enhancement and first operation to have a likelihood of useful fluorescence of 64.3 %, as opposed to infratentorial tumors with first surgery (23.1 %). CONCLUSIONS Our survey demonstrates 5-ALA as being used in pediatric brain tumors. 5-ALA may be especially useful for contrast-enhancing supratentorial tumors. These data indicate controlled studies to be necessary and also provide a basis for planning such a study.

Clinical usefulness of therapeutic concentration monitoring for imatinib dosage individualization: results from a randomized controlled trial.

PURPOSE This study assessed whether a cycle of "routine" therapeutic drug monitoring (TDM) for imatinib dosage individualization, targeting an imatinib trough plasma concentration (C min) of 1,000 ng/ml (tolerance: 750-1,500 ng/ml), could improve clinical outcomes in chronic myelogenous leukemia (CML) patients, compared with TDM use only in case of problems ("rescue" TDM). METHODS Imatinib concentration monitoring evaluation was a multicenter randomized controlled trial including adult patients in chronic or accelerated phase CML receiving imatinib since less than 5 years. Patients were allocated 1:1 to "routine TDM" or "rescue TDM." The primary endpoint was a combined outcome (failure- and toxicity-free survival with continuation on imatinib) over 1-year follow-up, analyzed in intention-to-treat (ISRCTN31181395). RESULTS Among 56 patients (55 evaluable), 14/27 (52 %) receiving "routine TDM" remained event-free versus 16/28 (57 %) "rescue TDM" controls (P = 0.69). In the "routine TDM" arm, dosage recommendations were correctly adopted in 14 patients (median C min: 895 ng/ml), who had fewer unfavorable events (28 %) than the 13 not receiving the advised dosage (77 %; P = 0.03; median C min: 648 ng/ml). CONCLUSIONS This first target concentration intervention trial could not formally demonstrate a benefit of "routine TDM" because of small patient number and surprisingly limited prescriber's adherence to dosage recommendations. Favorable outcomes were, however, found in patients actually elected for target dosing. This study thus shows first prospective indication for TDM being a useful tool to guide drug dosage and shift decisions. The study design and analysis provide an interesting paradigm for future randomized TDM trials on targeted anticancer agents.

Networks of Information Exchange Under Uncertainty: The Case of Unconventional Gas Development in the United Kingdom

Modern policy-making is increasingly influenced by different types of uncertainty. Political actors are supposed to behave differently under the context of uncertainty then in “usual” decision-making processes. Actors exchange information in order to convince other actors and decision-makers, to coordinate their lobbying activities and form coalitions, and to get information and learn on the substantive issue. The literature suggests that preference similarity, social trust, perceived power and functional interdependence are particularly important drivers of information exchange. We assume that social trust as well as being connected to scientific actors is more important under uncertainty than in a setting with less uncertainty. To investigate information exchange under uncertainty analyze the case of unconventional shale gas development in the UK from 2008 till 2014. Our study will rely on statistical analyses of survey data on a diverse set of actors dealing with shale gas development and regulation in the UK.

Policy Instrument Selection under Uncertainty: The Case of Micropollution Regulation

The paper addresses the question of which factors drive the formation of policy preferences when there are remaining uncertainties about the causes and effects of the problem at stake. To answer this question we examine policy preferences reducing aquatic micropollutants, a specific case of water protection policy and different actor groups (e.g. state, science, target groups). Here, we contrast two types of policy preferences: a) preventive or source-directed policies, which mitigate pollution in order to avoid contact with water; and b) reactive or end-of-pipe policies, which filter water already contaminated by pollutants. In a second step, we analyze the drivers for actors’ policy preferences by focusing on three sets of explanations, i.e. participation, affectedness and international collaborations. The analysis of our survey data, qualitative interviews and regression analysis of the Swiss political elite show that participation in the policy-making process leads to knowledge exchange and reduces uncertainties about the policy problem, which promotes preferences for preventive policies. Likewise, actors who are affected by the consequences of micropollutants, such as consumer or environmental associations, opt for anticipatory policies. Interestingly, we find that uncertainties about the effectiveness of preventive policies can promote preferences for end-of-pipe policies. While preventive measures often rely on (uncertain) behavioral changes of target groups, reactive policies are more reliable when it comes to fulfilling defined policy goals. Finally, we find that in a transboundary water management context, actors with international collaborations prefer policies that produce immediate and reliable outcomes.

International online survey to assess current practice in equine anaesthesia.

REASONS FOR PERFORMING STUDY Multicentre Confidential Enquiries into Perioperative Equine Fatalities (CEPEF) have not been conducted since the initial CEPEF Phases 1-3, 20 years ago. OBJECTIVES To collect data on current practice in equine anaesthesia and to recruit participants for CEPEF-4. STUDY DESIGN Online questionnaire survey. METHODS An online questionnaire was prepared and the link distributed internationally to veterinarians possibly performing equine anaesthesia, using emails, posters, flyers and an editorial. The questionnaire included 52 closed, semiclosed and open questions divided into 8 subgroups: demographic data, anaesthetist, anaesthesia management (preoperative, technical equipment, monitoring, drugs, recovery), areas of improvements and risks and motivation for participation in CEPEF-4. Descriptive statistics and Chi-squared tests for comparison of categorical variables were performed. RESULTS A total of 199 questionnaires were completed by veterinarians from 14 different countries. Of the respondents, 43% worked in private hospitals, 36% in private practices and 21% in university teaching hospitals. In 40 institutions (23%) there was at least one diplomate of the European or American colleges of veterinary anaesthesia and analgesia on staff. Individual respondents reported routinely employ the following anaesthesia monitoring modalities: electrocardiography (80%), invasive arterial blood pressures (70%), pulse oximetry (60%), capnography (55%), arterial blood gases (47%), composition of inspired and expired gases (45%) and body temperature (35%). Drugs administered frequently or routinely as part of a standard protocol were: acepromazine (44%), xylazine (68%), butorphanol (59%), ketamine (96%), diazepam (83%), isoflurane (76%), dobutamine (46%), and, as a nonsteroidal anti-inflammatory drug, phenylbutazone (73%) or flunixin meglumine (66%). Recovery was routinely assisted by 40%. The main factors perceived by the respondents to affect outcome of equine anaesthesia were the preoperative health status of the animal and training of the anaesthetist. CONCLUSIONS Current practice in equine anaesthesia varies widely, and the study has highlighted important topics relevant for designing a future prospective multicentre cohort study (CEPEF-4). The Summary is available in Chinese - see Supporting information.

Leader–member exchange (LMX), job autonomy, and creative work involvement

Researchers have claimed that high quality of supervisor–employee relationships (i.e., leader– member exchange; LMX) fosters creativity at work. Moreover, researchers have acknowledged that this relationship is not clear-cut but rather complex. The present study focused on the moderating role of job autonomy in the LMX-creative work involvement relationship. Longitu-dinal field survey data (N = 144) collected in a high-technology firm revealed a positive asso-ciation between LMX and creative work involvement and confirmed our assumptions on the moderating role of job autonomy. The positive relationship between LMX and creative work involvement was stronger when employees experienced greater job autonomy. Our findings point to the importance of considering the interplay of both, the leader–member relationship and job design issues for increasing employees' creative work involvement.