Fetal Alcohol Spectrum Disorders in a Rocky Mountain Region City: Child Characteristics, Maternal Risk Traits, and Prevalence.

OBJECTIVE: To document prevalence and traits of children with fetal alcohol spectrum disorders (FASD) and maternal risk factors in a Rocky Mountain city. METHODS: Variations on active case ascertainment methods were used in 2 first-grade cohorts in all city schools. The consent rate was 59.2%. Children were assessed for physical growth, dysmorphology, and neurobehavior and their mothers interviewed. RESULTS: Thirty-eight children were diagnosed with FASD and compared with 278 typically developing controls. Total dysmorphology scores summarized well the key physical indicators of FASD and defined specific diagnostic groups. On average, children with FASD performed significantly poorer than controls on intellectual, adaptive, learning, attention, and behavioral tasks. More mothers of children with FASD reported drinking prior to pregnancy and in the first and second trimesters, and had partners with drinking problems than mothers of controls; however, reports of comorbid alcohol use and 6 other drugs were similar for mothers of children with FASD and mothers of controls. Mothers of children with FASD were significantly younger at pregnancy, had lower average weight before pregnancy and less education, initiated prenatal clinic visits later, and reported more health problems (e.g., stomach ulcers and accidents). Children with FASD had significantly lower birth weight and more problems at birth, and were less likely to be living with biological mother and father. Controlling for other drug and tobacco use, a FASD diagnosis is 6.7 times (OR = 6.720, 95% CI = 1.6 to 28.0) more likely among children of women reporting prepregnancy drinking of 3 drinks per drinking day (DDD) and 7.6 times (OR = 7.590, 95% CI = 2.0 to 31.5) more likely at 5 DDD. Prevalence of FAS was 2.9-5.8 per 1,000 children, and total FASD was 34.9 to 82.5 per 1,000 children or 3.5 to 8.3% at this site. CONCLUSION: This site had the second highest prevalence of FASD of the 4 Collaboration on FASD Prevalence sites and clearly identifiable child and maternal risk traits.

"I don't want to take any risks even if it's gonna mean this service-user is gonna be happier": A thematic analysis of community support staff perspectives on delivering Transforming Care.

BACKGROUND: Transforming Care is making mixed progress in supporting people with intellectual and developmental disabilities, and complex needs, move to more appropriate specialist accommodations closer to home. Community support staff often spend greatest amounts of time with service-users, yet are some of the least heard voices about why placements succeed and fail to varying extents. METHOD: Managers and support staff (n = 13), working in ostensibly "specialist" community placements, were interviewed about perceived barriers and facilitators to implementing Transforming Care. Transcripts were subjected to thematic analysis. RESULTS: Participants identified difficulties balancing people's rights, safety and quality of life needs, and felt the system's expectations of them are hard to deliver within the resources, legislation, values and support models provided them. Multidisciplinary expertise was highly valued for both emotional and practical support, but was least valued when perceived as overly blaming or inspectorial. Specialist health input was seen to withdraw prematurely for this particular client group. CONCLUSION: Recommendations are provided for how staff perspectives should inform Transforming Care in interests of service-users.

A preliminary investigation to explore the cognitive resources of physicians experiencing difficulty in training.

BACKGROUND: Treating patients is complex, and research shows that there are differences in cognitive resources between physicians who experience difficulties, and those who do not. It is possible that differences in some cognitive resources could explain the difficulties faced by some physicians. In this study, we explore differences in cognitive resources between different groups of physicians (that is, between native (UK) physicians and International Medical Graduates (IMG); those who continue with training versus those who were subsequently removed from the training programme); and also between physicians experiencing difficulties compared with the general population. METHODS: A secondary evaluation was conducted on an anonymised dataset provided by the East Midlands Professional Support Unit (PSU). One hundred and twenty one postgraduate trainee physicians took part in an Educational Psychology assessment through PSU. Referrals to the PSU were mainly on the basis of problems with exam progression and difficulties in communication skills, organisation and confidence. Cognitive resources were assessed using the Wechsler Adult Intelligence Scale (WAIS-IV). Physicians were categorised into three PSU outcomes: 'Continued in training', 'Removed from training' and 'Active' (currently accessing the PSU). RESULTS: Using a one-sample Z test, we compared the referred physician sample to a UK general population sample on the WAIS-IV and found the referred sample significantly higher in Verbal Comprehension (VCI; z = 8.78) and significantly lower in Working Memory (WMI; z = -4.59). In addition, the native sample were significantly higher in Verbal Comprehension than the UK general population sample (VCI; native physicians: z = 9.95, p < .001, d = 1.25), whilst there was a lesser effect for the difference between the IMG sample and the UK general population (z = 2.13, p = .03, d = 0.29). Findings also showed a significant difference in VCI scores between those physicians who were 'Removed from training' and those who 'Continued in training'. CONCLUSIONS: Our results suggest it is important to understand the cognitive resources of physicians to provide a more focussed explanation of those who experience difficulties in training. This will help to implement more targeted interventions to help physicians develop compensatory strategies.

A role for virtue in unifying the 'knowledge' and 'caring' discourses in nursing theory.

A critical examination of contemporary nursing theory suggests that two distinct discourses coexist within this field. On the one hand, proponents of the 'knowledge discourse' argue that nurses should drop the 'virtue script' and focus on the scientific and technical aspects of their work. On the other hand, proponents of the 'caring discourse' promote a view of nursing that embodies humanistic qualities such as compassion, empathy and mutuality. In view of this, we suggest a way to reconcile both discourses despite the fact that they appear to be at odds theoretically and practically. To that end, we argue that nursing theory must give a prominent role to the Aristotelian conception of virtue, and we offer an account that includes both character and intellectual virtues. This account allows for a focus on moral competence but also accommodates the demands for discipline-specific knowledge. Our account incorporates the caring discourse by suggesting a way for individuals to cultivate the conditions within themselves that make 'caring in nursing' possible, while the knowledge discourse is accommodated via the acquisition of the intellectual virtues. The process for achieving both these ends is the same: an intention to consistently develop, hone and exercise certain character traits over time.

Type IIA topoisomerase inhibition by a new class of antibacterial agents.

Despite the success of genomics in identifying new essential bacterial genes, there is a lack of sustainable leads in antibacterial drug discovery to address increasing multidrug resistance. Type IIA topoisomerases cleave and religate DNA to regulate DNA topology and are a major class of antibacterial and anticancer drug targets, yet there is no well developed structural basis for understanding drug action. Here we report the 2.1 A crystal structure of a potent, new class, broad-spectrum antibacterial agent in complex with Staphylococcus aureus DNA gyrase and DNA, showing a new mode of inhibition that circumvents fluoroquinolone resistance in this clinically important drug target. The inhibitor 'bridges' the DNA and a transient non-catalytic pocket on the two-fold axis at the GyrA dimer interface, and is close to the active sites and fluoroquinolone binding sites. In the inhibitor complex the active site seems poised to cleave the DNA, with a single metal ion observed between the TOPRIM (topoisomerase/primase) domain and the scissile phosphate. This work provides new insights into the mechanism of topoisomerase action and a platform for structure-based drug design of a new class of antibacterial agents against a clinically proven, but conformationally flexible, enzyme class.

Strategies to enhance waste minimization and energy conservation within organizations: a case study from the UK construction sector.

Strategies for enhancing environmental management are a key focus for the government in the UK. Using a manufacturing company from the construction sector as a case study, this paper evaluates selected interventionist techniques, including environmental teams, awareness raising and staff training to improve environmental performance. The study employed a range of methods including questionnaire surveys and audits of energy consumption and generation of waste to examine the outcomes of the selected techniques. The results suggest that initially environmental management was not a focus for either the employees or the company. However, as a result of employing the techniques, the company was able to reduce energy consumption, increase recycling rates and achieve costs savings in excess of £132,000.

Implementation and evaluation of a rural general practice assessment pathway for possible cardiac chest pain using point-of-care troponin testing: a pilot study.

OBJECTIVES: To assess the feasibility and acceptability, and additionally to preliminarily evaluate, the effectiveness and safety of an accelerated diagnostic chest pain pathway in rural general practice using point-of-care troponin to identify patients at low risk of acute myocardial infarction, avoiding unnecessary patient transfer to hospital and enabling early discharge home. DESIGN: A prospective observational pilot evaluation. SETTING: Twelve rural general (family) practices in the Midlands region of New Zealand. PARTICIPANTS: Patients aged ≥18 years who presented acutely to rural general practice with suspected ischaemic chest pain for whom the doctor intended transfer to hospital for serial troponin measurement. OUTCOME MEASURES: The proportion of patients managed using the low-risk pathway without transfer to hospital and without 30-day major adverse cardiac event (MACE); pathway adherence; rate of 30-day MACE; patient satisfaction with care; and agreement between point-of-care and laboratory measured troponin concentrations. RESULTS: A total of 180 patients were assessed by the pathway. The pathway classified 111 patients (61.7%) as low-risk and all were managed in rural general practice with no 30-day MACE (0%, 95% CI 0.0% to 3.3%). Adherence to the low-risk pathway was 95.5% (106 out of 111). Of the 56 patients classified as non-low-risk and referred to hospital, 9 (16.1%) had a 30-day MACE. A further 13 non-low-risk patients were not transferred to hospital, with no events. The sensitivity of the pathway for 30-day MACE was 100.0% (95% CI 70.1% to 100%). Of low-risk patients, 94% reported good to excellent satisfaction with care. Good concordance was observed between point-of-care and duplicate laboratory measured troponin concentrations. CONCLUSIONS: The use of an accelerated diagnostic chest pain pathway incorporating point-of-care troponin in a rural general practice setting was feasible and acceptable, with preliminary results suggesting that it may safely and effectively reduce the urgent transfer of low-risk patients to hospital.

Use of contraception in the United States: 1982-2008.

OBJECTIVE: This report presents national estimates of contraceptive use and method choice based on the 1982, 1995, 2002, and 2006-2008 National Surveys of Family Growth (NSFG). METHODS: Data for 2006-2008 were collected through in-person interviews with 13,495 men and women 15-44 years of age in the household population of the United States. This report is based on the sample of 7,356 women interviewed in 2006-2008. The response rate for women in the 2006-2008 survey was about 76%. RESULTS: More than 99% of women 15-44 years of age who have ever had sexual intercourse with a male (referred to as "sexually experienced women") have used at least one contraceptive method. The percentage of women who have ever used emergency contraception, the contraceptive patch, and the contraceptive ring increased between 2002 and 2006-2008. Looking at contraceptive use in the month of interview, or current use, the leading method of contraception in the United States during 2006-2008 was the oral contraceptive pill, used by 10.7 million women; the second leading method was female sterilization, used by 10.3 million women. While contraceptive use is virtually universal in the United States, women with different characteristics make different choices of methods--for example, college educated women are much more likely to use the pill and less likely to use female sterilization than less educated women. Age, parity, marital status, and income are also closely related to the choice of method. These method choices are related to the risk of unintended pregnancy in these groups.

Demographic, Health Care, and Fertility-related Characteristics of Adults Aged 18-44 Who Have Ever Been in Foster Care: United States, 2011-2017.

Objective-This report presents demographic characteristics, health service access and use, and timing of key fertility-related milestones among adults aged 18-44 who had ever been in foster care as compared with those who had never been in foster care in the United States. Methods-The National Survey of Family Growth (NSFG) is a nationally representative survey, with data collected through in-person interviews of the household population of the United States. Analyses used 6 years of NSFG interviews spanning September 2011 through September 2017, and included 11,527 male and 14,439 female respondents aged 18-44. Bivariate analyses examined demographic characteristics and health service access and use by having ever been in foster care, as measured by household roster information and childhood background items. Cumulative probabilities of first sexual intercourse, first marriage, and first birth by age were estimated using Kaplan-Meier procedures. All estimates were stratified by sex. Results-Overall, 2.6% of adults aged 18-44 had ever been in foster care, and the percentage was higher for women (3.0%) than for men (2.3%). Lower percentages of men and women who were ever in foster care had a bachelor's degree or higher (4.8% for men and 9.1% for women) compared with those who had never been in foster care (31.1% and 36.2%, respectively). Receipt of public assistance in the past 12 months was more likely among adults who were ever in foster care compared with those who were never in foster care. Adults ever in foster care were less likely than adults never in foster care to be currently covered by private health insurance and were more likely to be covered by Medicaid. Adults ever in foster care also had higher probabilities of first sexual intercourse and first births at younger ages than those never in foster care.

The Rural Family Medicine Café Project: A Social Media Strategy to Reduce Occupational Isolation and Improve Support for Rural Healthcare Professionals.

Background: Globally rural medicine is currently suffering from staff shortages. Social and professional isolation are identified as significant pressures on health professionals working in rural areas. Social media (SOME) has created new methods of social engagement where conventional forms have failed. The Rural Family Medicine Café (RFMC) is a SOME project created to engage and support those interested in rural family medicine thus decreasing occupational isolation. Methods: A quantitative analysis of SOME activity associated with the RFMC was done by measuring the frequency of #ruralcafe, #ruralwomenGP, #ruralGP, #ruralstories, and #ruralmedicine from October 2015 to October 2016 along with the number of Facebook page likes and YouTube views. A time series and regression analysis were done to assess the correlation between the frequencies of hashtag use and the number of new likes or views. A qualitative analysis of the content of tweets using the associated hashtags and comments on the RFMC YouTube videos was then done to assess participants' response to the RFMC. To add context to the data collected, regularly attending participants were invited for a semi-structured interview. Results: There was a positive trend in the number of Facebook page likes (+273%) and Twitter hashtag use (+2,458%) but a negative trend (-92%) in the number of RFMC YouTube views. There was no statistically significant relationship between the number of views on the RFMC YouTube and RFMC associated SOME activity (p = 0.141). A significant relationship was shown between the number of Facebook page likes and the number of views on the RFMC YouTube (p = 0.037). Participants felt positively about the RFMC with recurring themes of; promotion, advocacy, public health, engagement, inspire, sharing, spreading information, feeling connected and general positive comments such as "enjoying tweets," "great discussion." Participants shared anecdotes, useful links, and book recommendations. Conclusion: The RFMC has seen an increase in the amount of associated SOME activity despite having less viewers. This is most likely due to the few participants of the RFMC continuing the café discussions on SOME, particularly Twitter, and engaging outside of the RFMC. The RFMC has developed into a virtual community which is reducing occupational isolation for its participants.

Adoption experiences of women and men and demand for children to adopt by women 18-44 years of age in the United States, 2002.

UNLABELLED: This report presents national estimates of the prevalence of adoption for men and women 18-44 years of age, the demand for children to adopt by women, and women's preferences for characteristics of the adopted child. METHODS: Analysis is based on data from the 2002 National Survey of Family Growth. This survey interviewed a nationally representative sample of women and men 15-44 years of age in their households. Results are weighted to produce national estimates of the characteristics of men and women who have adopted children, lifetime and current demand for adoption by women, and the characteristics of children preferred by women when they are considering adoption. RESULTS: Adoption remains rare in the United States. Among all women aged 18-44 in 2002, only 1.1% had adopted a child and 1.6% were currently seeking to adopt. Women were more likely to be currently seeking to adopt, to have ever sought to adopt, and to have actually adopted a child if they had used infertility services or had impaired fecundity. Older women and women who were in their second or later marriage were also more likely to have adopted a child. Hispanic and non-Hispanic black women were more likely to be currently seeking to adopt compared with non-Hispanic white women. More men than women have adopted children in their lifetimes. Among adopters, 17% of women and 6% of men were never married. CONCLUSIONS: Adopting a child has been and remains a relatively rare event in the United States. Adoption is a mechanism by which adults legalize their parental relationship to nonbiological children as well as a means to bring children into families. Studies examining adoption should include men as well as women and persons of all marital statuses.

BIRTH OF A MIDWIFE.

Like many experienced midwives and nurses I have a plethora of experience spanning over 13 years. I completed my nursing degree in my home town of Derry City, Northern Ireland before completing my Post Graduate Degree in Midwifery at Queens University, Belfast.

Fertility, contraception, and fatherhood: data on men and women from cycle 6 (2002) of the 2002 National Survey of Family Growth.

OBJECTIVE: This report presents national estimates of fertility, family formation, contraceptive use, and father involvement indicators among males 15-44 years of age in the United States in 2002 from Cycle 6 of the National Survey of Family Growth (NSFG). Data are also shown for women for purposes of comparison. METHODS: Descriptive tables of numbers and percentages are presented. Data were collected through in-person interviews of the household population 15-44 years of age in the United States between March 2002 and March 2003. The sample included 7,643 females and 4,928 males. This report focuses primarily on data from the male sample, but compares findings with the female data whenever appropriate. The overall response rate for Cycle 6 of the NSFG was 79 percent, and the response rate for men was 78 percent. RESULTS: This report covers a wide range of topics including first sexual intercourse and its timing in relation to marriage; contraceptive use; wantedness of births in the past 5 years; marital and cohabiting status at first birth; living arrangement of fathers with their children; father's activities with children they live with and those they do not live with; HIV-risk related behaviors; and infertility services. CONCLUSION: The reproductive experiences of men and women 15-44 years of age in the United States vary significantly, and often sharply, by demographic characteristics such as education, income, and Hispanic origin and race.

Demystifying professional support for trainees: what does it mean?

'Professional support' is a commonly used term in medical training but it is not always clear what is meant by it and what the implications are for an individual trainee and his/her trainer. This article explores the concept of professional support in medical training.