Maternal Role & High-Risk Pregnancy Experience with Antepartum Hospitalization

Purpose. The focus of maternal role development, historically, has been on the tasks and processes during pregnancy as they relate to postpartum role transition. The purpose of this study was to investigate how women hospitalized with high-risk pregnancy cognitively construct pregnancy and impending motherhood. ^ Design. The study employed a triangulation design using a convergence model with a dominant focused ethnographic approach. ^ Setting. The antepartum units of two tertiary care centers in a large metropolitan city in southeast Texas. ^ Sample. Data saturation was determined with thirteen (13) primigravid women who had been hospitalized more than 72 hours with preterm labor (PTL) or preterm premature rupture of membranes (PPROM) who subsequently delivered seventeen (17) infants which included 4 sets of twins. ^ Methods. Open-ended, semi-structured interviews and field work were used to explore the development of maternal role in this population. After collecting descriptive data, long individual interviews were conducted and the Prenatal Self Evaluation Questionnaire (PSEQ), an instrument to measure prenatal adaptation to pregnancy, was administered. The interview focused on exploring the woman's experiences of pregnancy and impending motherhood while hospitalized. Interview data and field notes were coded and analyzed using qualitative thematic analytic techniques. The PSEQ was scored and the findings of the qualitative data and PSEQ data were compared. ^ Findings. Thematic analysis of the qualitative data provided an understanding of the cognitive process that occurs as the pregnant woman builds a relationship with the fetus. Thematic analysis resulted in a conceptual model with two complementary components that occur throughout the pregnancy: Establishing a Relationship and Dynamic Equilibrium. Establishing a Relationship includes subthemes of: Courting, Building a Connection, and Engagement. Dynamic equilibrium is the balance between expectations and reality and exists regardless of pregnancy complications. The negotiation of this potential imbalance is triggered by uncertainty, loss of autonomy and control, and isolation and is exacerbated by the high-risk pregnancy and subsequent hospitalization. These triggers can serve as obstacles to maternal role development, but may be mediated by external support from friends and family or health care providers. Support from others may come in the form of anticipatory guidance, presence, or activities that promote self-agency. PSEQ scores were similar to previous reports, but due to the small sample, scores were used primarily for comparison to qualitative data. The qualitative findings were congruent with the PSEQ findings in all of the subscales except in the concern for the well-being of the baby. Interview reports included comments demonstrating significant concern for the well-being of the infant, yet the related subscale did not demonstrate such concern. ^ Conclusions. An understanding of the cognitive process involved in establishing a relationship with the developing fetus related to impending motherhood and the importance of dynamic equilibrium can allow healthcare providers and those who interact with pregnant women to support development of the maternal role and anticipate those barriers that may impede that process. Findings from this study identify those triggers and mediators that influence development of the maternal role and suggest potential intervening strategies for those involved in the care of childbearing families. ^

Factors associated with home health care costs

Characteristics of Medicare-certified home health agencies in Texas and the contributions of selected agency characteristics on home health care costs were examined. Cost models were developed and estimated for both nursing and total visit costs using multiple regression procedures. The models included home health agency size, profit status, control, hospital-based affiliation, contract-cost ratio, service provision, competition, urban-rural input-price differences, and selected measures of patient case-mix. The study population comprised 314 home health agencies in Texas that had been certified at least one year on July, 1, 1986. Data for the analysis were obtained from Medicare Cost Reports for fiscal year ending between July 1, 1985 to June 30, 1986.^ Home health agency size, as measured by the logs of nursing and total visits, has a statistically significant negative linear relationship with nursing visit and total visit costs. Nursing and total visit costs decrease at a declining rate as size increases. The size-cost relationship is not altered when controlling for any other agency characteristic. The number of visits per patient per year, a measure of patient case-mix, is also negatively related to costs, suggesting that costs decline with care of chronic patients. Hospital-based affiliation and urban location are positively associated with costs. Together, the four characteristics explain 19 percent of the variance in nursing visit costs and 24 percent of the variance in total visit costs.^ Profit status and control, although correlated with other agency characteristics, exhibit no observable effect on costs. Although no relationship was found between costs and competition, contract cost ratio, or the provision on non-reimburseable services, no conclusions can be made due to problems with measurement of these variables. ^

A study of the relationship of support systems and adolescent pregnancy outcomes in an adolescent family life project

This study analyzed the relationship of family support systems and adolescent pregnancy outcomes. The population for the study was 390 adolescents who had attended the Marion County Health Department Adolescent Family Life Project in Indianapolis, Indiana during a two-year period.^ The study is unique in that it afforded the opportunity to compare adolescent pregnancy-related characteristics, of white and non-white adolescents in the same study.^ The pregnancy outcomes studied were: Infant birthweight, school attendance, and pregnancy recidivism.^ Significant results were found in the analysis that supported other research in regard to factors that are associated with school attendance when family support, adolescent's age, and ethnicity were controlled. Infant birthweight and repeat pregnancy outcome relationships were not found to have any consistently significant relationship with independent variables anticipated to be associated. However, the comparisons of infant birthweight among the adolescents with, and without, family support, by ethnicity resulted in some interesting findings. Repeat pregnancy proved an enigma, in that there seemed to be almost no variables in this study that were associated with the adolescent having a repeat pregnancy.^ Familial support in this study seemed to be of less importance as a factor in adolescent pregnancy outcomes than was ethnicity. The non-white adolescents in this study had a better record for remaining in school, both those non-white adolescents who lived with parents, and those who did not live with parents. More low birthweight occurred in the non-white adolescent, both those adolescents who lived with parents, and those who did not live with parents. Repeat pregnancy occurred more in the non-white adolescent whether she lived with parents, or did not live with parents. ^

Comparison of medical care costs, utilization, and satisfaction of AIDS patients with and without home care

A sample of 157 AIDS patients 17 years of age or over were followed for six months from the date of hospital discharge to derive average total cost of medical care, utilization and satisfaction with care. Those referred for home care follow-up after discharge from the hospital were compared with those who did not receive home care.^ The average total cost of medical care for all patients was $34,984. Home care patient costs averaged \$29,614 while patients with no home care averaged $37,091. Private hospital patients had average costs of \$50,650 compared with $25,494 for public hospital patients. Hospital days for the six months period averaged 23.9 per patient for the no home care group and 18.5 days for home care group. Patient satisfaction with care was higher in the home care group than no home care group, with a mean score of 68.2 compared with 61.1.^ Other health services information indicated that 98% of the private hospital patients had insurance while only 2% of public hospital patients had coverage. The time between the initial date of diagnosis with AIDS and admission to the study was longer for private hospital patients, survival time over the study period was shorter, and the number of hospitalizations prior to entering the study was higher for private hospital patients. These results suggest that patients treated in the private hospital were sicker than public hospital patients, which may explain their higher average total cost. Statistical analyses showed that cost and utilization have no significant relationship with home care or no home care when controlling for indicators of the severity of illness and treatment in public or private hospital.^ In future studies, selecting a matched group of patients from the same hospital and following them for nine months to one year would be helpful in making a more realistic comparison of the cost effectiveness of home care. ^

Logistic regression with Markov chains as covariates

The tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) is an obvious carcinogen for lung cancer. Since CBMN (Cytokinesis-blocked micronucleus) has been found to be extremely sensitive to NNK-induced genetic damage, it is a potential important factor to predict the lung cancer risk. However, the association between lung cancer and NNK-induced genetic damage measured by CBMN assay has not been rigorously examined. ^ This research develops a methodology to model the chromosomal changes under NNK-induced genetic damage in a logistic regression framework in order to predict the occurrence of lung cancer. Since these chromosomal changes were usually not observed very long due to laboratory cost and time, a resampling technique was applied to generate the Markov chain of the normal and the damaged cell for each individual. A joint likelihood between the resampled Markov chains and the logistic regression model including transition probabilities of this chain as covariates was established. The Maximum likelihood estimation was applied to carry on the statistical test for comparison. The ability of this approach to increase discriminating power to predict lung cancer was compared to a baseline "non-genetic" model. ^ Our method offered an option to understand the association between the dynamic cell information and lung cancer. Our study indicated the extent of DNA damage/non-damage using the CBMN assay provides critical information that impacts public health studies of lung cancer risk. This novel statistical method could simultaneously estimate the process of DNA damage/non-damage and its relationship with lung cancer for each individual.^

Ocean acidification rapidly reduces dinitrogen fixation associated with the hermatypic coral Seriatopora hystrix

Since productivity and growth of coral-associated dinoflagellate algae is nitrogen (N)-limited, dinitrogen (N2) fixation by coral-associated microbes is likely crucial for maintaining the coral-dinoflagellate symbiosis. It is thus essential to understand the effects future climate change will have on N2 fixation by the coral holobiont. This laboratory study is the first to investigate short-term effects of ocean acidification on N2 fixation activity associated with the tropical, hermatypic coral Seriatopora hystrix using the acetylene reduction assay in combination with calcification measurements. Findings reveal that simulated ocean acidification ( pCO2 1080 µatm) caused a rapid and significant decrease (53%) in N2 fixation rates associated with S. hystrix compared to the present day scenario ( pCO2 486 µatm). In addition, N2 fixation associated with the coral holobiont showed a positive exponential relationship with its calcification rates. This suggests that even small declines in calcification rates of hermatypic corals under high CO2 conditions may result in decreased N2 fixation activity, since these 2 processes may compete for energy in the coral holobiont. Ultimately, an intensified N limitation in combination with a decline in skeletal growth may trigger a negative feedback loop on coral productivity exacerbating the negative long-term effects of ocean acidification.

Finite volume modelling of an icefield with subglacial lake

Momentum, mass and energy balance laws provide the tools for the study of the evolution of an icefield covering a subglacial lake. The ice is described as a non-Newtonian fluid with a power-law constitutive relationship with temperature- and stress-dependent viscosity (Glen?s law) [1]. The phase transition mechanisms at the air/ice and ice/water interfaces yield moving boundary formulations, and lake hydrodynamics requires equation reduction for treating the turbulence.

Resilence, rural development and suistainable management: a working with people model approach

Nowadays, it has become evident the need to seek sustainable development models that address challenges arising in a variety of contexts. The resilience concept appears connected to the ability of people to cope with adversities that inevitably arise due to context dynamics, at different spatial and temporal scales. This concept is related to the model known as Working With People (WWP), focused on rural development projects planning, management and evaluation, from the integration of three dimensions: technical-entrepreneurial, ethical-social and political-contextual. The research reported is part of the RETHINK European Project, whose overall aim is farm modernization and rural resilience. The resilience concept has been analyzed, in the scope of rural development projects management, and a relationship with the WWP model has been established. To this end, a thorough review of the scientific literature concerning this topic has been addressed, in order to develop the state of the art of the different concepts and models involved. A conceptual proposal for the integration of resilience in rural development projects sustainable management, through the three-dimensional WWP model is presented.

MARCAS ORGANIZACIONAIS E A AGREGAÇÃO DE VALOR INSTITUCIONAL POR MEIO DO INVESTIMENTO EM AÇÕES SOCIAIS ALTERNATIVAS

Em um cenário de mercado com alta competitividade e saturação, marcas e seus valores podem ter um papel decisivo na diferenciação e decisão de compra por parte dos consumidores. As marcas devem entender a necessidade da responsabilidade social e se preocuparem com questões sociais e ambientais, caso contrário, podem ser vistas com negatividade, isto é, como corporações que só desejam lucrar. Para compreender o espaço das marcas organizacionais na sociedade contemporânea, esta pesquisa apresenta um resgate de evoluções históricas, sobretudo nas últimas décadas, para mostrar os consideráveis progressos no modo de pensar em relação aos valores das marcas, ao relacionamento com públicos interessados e à sociedade em geral. É a partir destas análises que se apresenta a importância do investimento em causas sociais não como obrigação ou autopromoção, mas como abordagem que deve se tornar premissa básica e parte da cultura das organizações. O recorte desta pesquisa volta-se ao estudo de causas sociais menos difundidas ou de menor reper- cussão midiática, procurando verificar se o investimento nessas causas podem se refletir em valores para marcas, assim como se espera do apoio a causas mais conhe- cidas, como por exemplo, o câncer, a pobreza ou a fome. O estudo se complementa a partir de entrevistas em profundidade com executivos do Grupo Abril e da Volkswagen do Brasil para avaliar como estas organizações se posicionam frente à possibilidade de investir em causas menos conhecidas, como o daltonismo.

MÍDIAS SOCIAIS DIGITAIS: ESPAÇO DE RELACIONAMENTO E COMUNICAÇÃO ESTRATÉGICA

O trabalho tem como proposta avaliar a postura das organizações nas mídias sociais digitais, considerando o fato de que esses novos ambientes virtuais têm modificado drasticamente a maneira pela qual elas promovem o relacionamento com seus públicos estratégicos. O objetivo principal da pesquisa é identificar e compreender como as organizações se posicionam diante de comentários desfavoráveis nas mídias sociais digitais que possam impactar sua imagem e reputação, bem como mostrar a importância de monitorar constantemente o consumidor e dialogar com ele nos canais digitais para evitar riscos à marca. A metodologia aplicada denomina-se Estudo de Casos Múltiplos, por meio da qual analisaram-se os comentários desfavoráveis às marcas: Vivo, Tim e Oi, na página do Facebook, durante o mês de setembro de 2015. Construiu-se um protocolo de pesquisa, e realizou-se o acompanhamento dessas marcas analisando-lhes os posts e os comentários desfavoráveis coletados no período. Constatou-se, após tais procedimentos que as operadoras apresentam frequentemente dificuldades para se relacionar com os públicos nas mídias sociais digitais, o que as coloca em risco quanto à sua imagem e reputação.

The insect neuropeptide prothoracicotropic hormone is released with a daily rhythm: re-evaluation of its role in development.

Prothoracicotropic hormone (PTTH) is the central cerebral neurohormone in insect development. Its release has been believed for decades to be confined to one (or two) critical moments early in each developmental stage at which time it triggers prolonged activation of the prothoracic glands to synthesize and release the steroid molting hormones (ecdysteroids), which elicit developmental responses in target tissues. We used an in vitro assay for PTTH released from excised brains of the bug Rhodnius prolixus and report that release of PTTH does occur at the expected time on day 6, but that this release is merely the first in a daily rhythm of release that continues throughout most of the 21 days of larval-adult development. This finding, together with reports of circadian control of ecdysteroid synthesis and titer throughout this time, raises significant challenges to several features of the current understanding of the hormonal control of insect development. New questions are raised concerning the function(s) of PTTH, its relationship with the prothoracic glands, and the significance of circadian rhythmicity throughout this endocrine axis. The significance of the reported observations derives from the set of entirely new questions they raise concerning the regulation of insect development.

Parameters affecting conscious versus unconscious visual discrimination with damage to the visual cortex (V1).

When the visual (striate) cortex (V1) is damaged in human subjects, cortical blindness results in the contralateral visual half field. Nevertheless, under some experimental conditions, subjects demonstrate a capacity to make visual discriminations in the blind hemifield (blindsight), even though they have no phenomenal experience of seeing. This capacity must, therefore, be mediated by parallel projections to other brain areas. It is also the case that some subjects have conscious residual vision in response to fast moving stimuli or sudden changes in light flux level presented to the blind hemifield, characterized by a contentless kind of awareness, a feeling of something happening, albeit not normal seeing. The relationship between these two modes of discrimination has never been studied systematically. We examine, in the same experiment, both the unconscious discrimination and the conscious visual awareness of moving stimuli in a subject with unilateral damage to V1. The results demonstrate an excellent capacity to discriminate motion direction and orientation in the absence of acknowledged perceptual awareness. Discrimination of the stimulus parameters for acknowledged awareness apparently follows a different functional relationship with respect to stimulus speed, displacement, and stimulus contrast. As performance in the two modes can be quantitatively matched, the findings suggest that it should be possible to image brain activity and to identify the active areas involved in the same subject performing the same discrimination task, both with and without conscious awareness, and hence to determine whether any structures contribute uniquely to conscious perception.

The Caregiver–Child Relationship, Youth Mental Health, and Placement Stability in a Child Welfare Sample

Objective: Healthy relationships between adolescents and their caregivers have been robustly associated with better youth outcomes in a variety of domains. Youth in contact with the child welfare system are at higher risk for worse outcomes including mental health problems and home placement instability. A growing body of literature points to youth mental health problems as both a predictor and a consequence of home placement instability in this population; the present study aimed to expand our understanding of these phenomena by examining the interplay among the caregiver-child relationship, youth mental health symptoms, and placement change over time. Method: The sample consisted of 1,179 youths aged 11-16, from the National Survey of Child and Adolescent Well-Being, a nationally representative sample of children in contact with the child welfare system. We used bivariate correlations and autoregressive cross-lagged path analysis to examine how youths’ reports of their externalizing and internalizing symptoms, their relationship with their caregivers, and placement changes reciprocally influenced one another over three time points. Results: In the overall models, early internalizing symptoms significantly negatively predicted the quality of the caregiver-child relationship at the next time point, and early externalizing symptoms predicted subsequent placement change. In addition, later externalizing symptoms negatively predicted subsequent reports of relationship quality, and later placement changes predicted subsequent externalizing problems; these relationships were significant only at the trend level (p < .10). The quality of the relationship was significantly negatively correlated with externalizing and internalizing problems at all time points, and all variables demonstrated autoregressive stability over time. Conclusions: Our findings support the importance of comprehensive interventions for youth in contact with the child welfare system, which target not only youth symptoms in isolation, but also the caregiver-child relationship, as a way to improve social-emotional outcomes in this high-risk population.

E-CRM e a influência da digital analytics.

O mercado consumidor passou por diversas transformações ao longo do tempo devido principalmente à evolução tecnológica. A evolução tecnológica proporcionou ao consumidor a possibilidade de escolher por produtos e marcas, e permite a oportunidade de colaborar e influenciar a opinião de outros consumidores através do compartilhamento de experiências, principalmente através da utilização de plataformas digitais. O CRM (gerenciamento do relacionamento com o consumidor) é a forma utilizada pelas empresas para conhecerem o consumidor e criar um relacionamento satisfatório entre empresa e consumidor. Esse relacionamento tem o intuito de satisfazer e fidelizar o consumidor, evitando que ele deixe de consumir a marca e evitando que ele influencie negativamente outros consumidores. O e-CRM é o gerenciamento eletrônico do relacionamento com o consumidor, que possui todas as tradicionais características do CRM, porém com o incremento do ambiente digital. O ambiente digital diminuiu a distância entre pessoas e empresas e se tornou um meio colaborativo de baixo custo de interação com o consumidor. Por outro lado, este é um meio onde o consumidor deixa de ser passivo e se torna ativo, o que o torna capaz de influenciar não só um pequeno grupo de amigos, mas toda uma rede de consumidores. A digital analytics é a medição, coleta, análise e elaboração de relatórios de dados digitais para os propósitos de entendimento e otimização da performance em negócios. A utilização de dados digitais auxilia no desenvolvimento do e-CRM através da compreensão do comportamento do consumidor em um ambiente onde o consumidor é ativo. O ambiente digital permite um conhecimento mais detalhado dos consumidores, baseado não somente nos hábitos de compra, mas também nos interesses e interações. Este estudo tem como objetivo principal compreender como as empresas aplicam os conceitos do e-CRM em suas estratégias de negócios, compreendendo de que forma a digital analytics contribui para o desenvolvimento do e-CRM, e compreendendo como os fatores críticos de sucesso (humano, tecnológico e estratégico) impactam na implantação e desenvolvimento do e-CRM. Quatro empresas de diferentes segmentos foram estudadas através da aplicação de estudo de caso. As empresas buscam cada vez mais explorar as estratégias de e-CRM no ambiente digital, porém existem limitações identificadas devido à captação, armazenamento e análise de informações multicanais, principalmente considerando os canais digitais. Outros fatores como o apoio da alta direção e a compreensão de funcionários para lidar com estratégias focadas no consumidor único também foram identificados neste estudo. O estudo foi capaz de identificar as informações mais relevantes para a geração de estratégias de gerenciamento eletrônico do relacionamento com o consumidor e identificou os aspectos mais relevantes dos fatores críticos de sucesso.

Effects of Annual Spring Flow Events on Abundance of Rio Grande Sillvery Minnow, Red Shiner, and Fathead Minnow with Notes on Recovery Needs for the Rio Grande Silvery Minnow

I investigated effects of annual spring flows on the abundance of Rio Grande silvery minnow, red shiner, and fathead minnow within two segments of the Middle Rio Grande (i.e., above and below the Rio Puerco) using 12 years of data. Rio Grande silvery minnow abundance was positively related to high spring flows and negatively related to low spring flows. Conversely, the abundance of the red shiner and fathead minnow were negatively related to high spring flows and positively related to low spring flows. The strength of these relationships varied with species and location but results from analyses below the Rio Puerco showed a stronger positive and negative relationship (with high and low spring flows, respectively) for Rio Grande silvery minnow.