Impact of mother-baby friendly initiative plus approach on improving human milk feeding for neonates in hospital: a quality improvement before-and-after uncontrolled study.

Breastfeeding, use of pasteurised donor human milk when mother's own milk is unavailable and kangaroo mother care have independently proven benefits in improving survival of vulnerable sick babies. A triangulated approach called the Mother Baby Friendly Initiative Plus (MBFI+) model, bringing together the combined benefits of these proven interventions, was used to improve exclusive human milk feeding at health facilities through quality improvement and system strengthening approach. This quality improvement before-and-after uncontrolled study enrolled 5343 term and 278 very low birth weight (VLBW) mother-infant dyads. Pre- and post-intervention data were compared to evaluate effect on feeding-related healthcare processes and outcomes. Primary outcome which was incidence of exclusive human milk feeding during hospital stay, improved from 44 to 64.8% (RR 1.47, 95% CI: 1.40-1.55) among term and from 60.5 to 80.7% (RR: 1.33; 95% CI: 1.12-1.59) among VLBW neonates. Neonates receiving extended KMC improved from 43 to 71.1% (RR: 1.65; 95% CI: 1.30-2.10).Conclusion: MBFI+ approach improved exclusive human milk feeding among term and preterm VLBW neonates. What is Known: • Breastfeeding has immense health benefits to sick preterm neonates admitted in NICU. What is New: • Quality improvement approach can lead to system strengthening and can help overcome hindrances to achieve increased breastfeeding rates.

Evaluating the effectiveness of on-street bicycle lane and assessing risk to bicyclists in Charlotte, North Carolina.

The objectives of this manuscript are (1) to evaluate the effectiveness of on-street bicycle lane in reducing crashes involving bicyclists on urban roads, (2) to quantify and compare risk to bicyclists on road segments with and without on-street bicycle lane, (3) to evaluate the effect of on-street bicycle lane on other road network users (all crashes), and, (4) to assess the role of on-network characteristics (speed limit, the number of lanes, the width of on-street bicycle lane, the width of the right-most travel lane, and, the numbers of driveways, unsignalized approaches and signalized intersections per unit distance) on risk to bicyclists. Data for thirty-six segments with on-street bicycle lane and twenty-six segments without on-street bicycle lane in the city of Charlotte, North Carolina were extracted to compute and compare measures such as the number of bicycle crashes per center-lane mile, the number of bicycle crashes per annual million vehicle miles traveled (MVMT), the number of all crashes per center-lane mile, and the number of all crashes per MVMT. The results obtained from analysis indicate that bicyclists are three to four times at higher risk (based on traffic conditions) on segments without on-street bicycle lane than when compared to segments with on-street bicycle lane. An analysis conducted considering all crashes showed that on-street bicycle lanes do not have a statistically significant negative effect on overall safety. An increase in annual MVMT (exposure) and the number of signalized intersections per mile increases the number of bicycle crashes, while an increase in on-street bicycle lane width or right-most travel lane width (if on-street bicycle lane cannot be provided) decreases the number of bicycle crashes. Installing wider on-street bicycle lanes, limiting driveways to less than 50 per mile and unsignalized approaches to less than 10 per mile, increasing spacing between signalized intersections, and, facilitating wider right-most travel lane if on-street bicycle lane cannot be provided reduces occurrence of bicycle crashes and lowers risk to bicyclists on roads.

Delayed normalization of uterine artery Doppler waveforms is not a benign phenomenon.

OBJECTIVE: To evaluate the pregnancy outcome in patients with abnormal uterine artery Doppler flow velocity waveforms (FVW's) at 19-21 weeks, which were subsequently normal by 24-26 weeks, and to study the effect of low-dose aspirin on these waveforms. DESIGN: The study group consisted of 49 patients who had abnormal uterine artery flow velocity waveforms (FVW's) at 19-21 weeks. These women were initially commenced on 100 mg slow-release aspirin at 20 weeks, which was discontinued at the follow-up visit, after confirming normal uterine artery Doppler FVW. The control group consisted of 730 patients with normal uterine artery Doppler waveforms at 19-21 weeks. The main outcome measures were: small for gestational age (SGA) <10th centile, pre-eclampsia, placental abruption, and perinatal mortality rate (PMR). RESULTS: When compared with the control group, the study group had an increased risk of placental abruption (2% versus 0.27%, P = 0.05) 95% Confidence Intervals CI = 0.01-0.13), low birth weight (3087 versus 3383 gm, P = 0.0003), SGA <10th centile (32.7% versus 11.9%, P