What are the essential components of antenatal care? A systematic review of the literature and development of signal functions to guide monitoring and evaluation.

BACKGROUND: Antenatal care (ANC) is one of the key care packages required to reduce global maternal and perinatal mortality and morbidity. OBJECTIVES: To identify the essential components of ANC and develop signal functions. SEARCH STRATEGY: MESH headings for databases including Cinahl, Cochrane, Global Health, Medline, PubMed and Web of Science. SELECTION CRITERIA: Papers and reports on content of ANC published from 2000 to 2020. DATA COLLECTION AND ANALYSIS: Narrative synthesis of data and development of signal function through 7 consensus-building workshops with 184 stakeholders. MAIN RESULTS: A total of 221 papers and reports are included from which 28 essential components of ANC were extracted and used to develop 15 signal functions with the equipment, medication and consumables required for implementation of each. Signal functions for the prevention and management of infectious diseases (malaria, HIV, tuberculosis, syphilis and tetanus) can be applied depending on population disease burden. Screening and management of pre-eclampsia, gestational diabetes, anaemia, mental and social health (including intimate partner violence) are recommended universally. Three signal functions address monitoring of fetal growth and wellbeing, and identification and management of obstetric complications. Promotion of health and wellbeing via education and support for nutrition, cessation of substance abuse, uptake of family planning, recognition of danger signs and birth preparedness are included as essential components of ANC. CONCLUSIONS: New signal functions have been developed which can be used for monitoring and evaluation of content and quality of ANC. Country adaptation and validation is recommended.

Intimate partner violence and partner notification of sexually transmitted infections among adolescent and young adult family planning clinic patients.

Patient-initiated partner notification of sexually transmitted infection (STI), i.e. patients informing their sexual partners of a diagnosis, is a cornerstone of STI prevention. Growing evidence suggests that women exposed to intimate partner violence (IPV) may fear such notification, or face negative consequences in response to STI disclosure. The current study assessed associations of IPV with fear of partner notification, and experiences of partner notification, among adolescent and young adult female family planning clinic patients. Women aged 16-29 years attending five family planning clinics in Northern California, USA (n = 1282) participated in a cross-sectional survey. A history of physical or sexual IPV was associated with fear of partner notification. Moreover, participants exposed to IPV were more likely to have partners say that it was not from them or otherwise accuse them of cheating in response to partner notification. Such partners were less likely to seek indicated STI treatment or testing. Current findings suggest that partner notification for STI may be compromised by IPV. Clinical practices and policies to support effective partner notification should include IPV assessment, and provide mechanisms to address related fears concerning partner notification.

The first dental college: emergence of dentistry as an autonomous profession.

Old as the ills of mankind, dentistry has been practiced as a specialty of surgery by physicians, surgeons, and artisans, at various times with titles such as barber surgeon, toothdrawer, operator for the teeth, and surgeon dentist. There being universal need for dental services, and lacking enforceable standards of practice and qualification, the profession was invaded by dubiously prepared pretenders at practice. The unconscionable consequence remained largely unremedied until realization of a philosophically sound basis of professional literature, organization, and education incident to the institution of the first dental college and the American system of dental education that elevated dentistry to the status of a recognized autonomous profession.

The chemical interconversion of GHB and GBL: forensic issues and implications.

In this work, the interconversion of GHB and GBL in a variety of aqueous media was studied. The effects of solution pH and time were determined by spiking GHB or GBL into pure water and buffered aqueous solutions, and determining the GHB and GBL contents at various time intervals. The degree of GBL hydrolysis to GHB was determined for several commercial aqueous-based GBL products, and further studied as a function of time. The effects of temperature and time were also determined for five commercial beverages spiked with GHB or GBL. GHB and GBL contents were determined using high performance liquid chromatography (HPLC). GHB and/or GBL confirmations were made using gas chromatography-mass spectrometry (GC-MS) and/or infrared spectroscopy (IR). Solution pH, time, and storage temperature were determined to be important factors affecting the rate and extent of GBL hydrolysis to GHB. Under strongly alkaline conditions (pH 12.0), GBL was completely converted to GHB within minutes. In pure water, GBL reacted to form an equilibrium mixture comprising ca. 2:1 GBL:GHB over a period of months. This same equilibrium mixture was established from either GHB or GBL in strongly acidic solution (pH 2.0) within days. A substantial portion of GBL (ca. 1/3) was hydrolyzed to GHB in aqueous-based GBL products, and in spiked commercial beverages, after ambient storage for a period ranging from several weeks to several months. Heat increased and refrigeration decreased the rate of GBL hydrolysis relative to ambient conditions. These studies show that hydrolysis of GBL to GHB does occur in aqueous-based solutions, with samples and time frames that are relevant to forensic testing. Implications for forensic testing and recommendations are discussed.

The relative buffering capacities of saliva and moist snuff: implications for nicotine absorption.

Commercial moist snuff products are used by placing a portion of tobacco inside the mouth between the inner cheek or lip and gum. Nicotine is absorbed into the blood stream via transfer across various oral membranes including the buccal mucosa (cheek lining). The resulting salivary pH when a given moist snuff product is placed in the mouth is an important factor for nicotine absorption because it will affect the proportion of free base nicotine that is readily available for absorption. The resulting salivary pH for a given moist snuff product will be determined in part by the relative acid-base buffering capacities of the saliva and moist snuff, as well as the pHs of the saliva and moist snuff prior to coming in contact with one another. In the current study, the acid-base buffering capacities (mu eq/g) of a series of commercial moist snuff products were determined and compared to the acid-base buffering capacity for unstimulated, whole human saliva. The buffering capacities of the moist snuff products were determined to be 10-20 times higher than the buffering capacity of human saliva. The resulting salivary pH ranges after contact between an artifical saliva and the various moist snuff products were also determined; the results were used to predict the proportion of free base nicotine that can be expected to occur in the mouth during the first few minutes of product use. These studies provide a basis for examining and understanding the effects that moist snuff product pHs and buffering capacities may be expected to have on nicotine absorption.

Reversed phase ion-pair liquid chromatographic determination of nicotine in commercial tobacco products. 1. Moist snuff.

The official methods for the determination of nicotine in commercial tobacco products (AOAC, CORESTA) are based on approaches that are not selective for nicotine (colorimetric measurement, steam distillation, perchloric acid titration), and the availability of published methods based on state-of-the-art chromatographic methods is limited. Reversed phase ion-pair liquid chromatography has been established as a viable alternative for the analysis of basic analytes. A reversed phase ion-pair liquid chromatographic method for the determination of nicotine in commercial tobacco products was developed and optimized in separate experiments (Ciolino, L. A.; Turner, J. A.; McCauley, H. A.; Smallwood, A. W.; Yi, T. Y. J. Chromatogr. 1999a, 852 (2), 451-463). An extensive within-laboratory performance study of the optimized method was subsequently conducted, and results are presented here for the determination of nicotine in commercial moist snuff. Results for the determination of nicotine in commercial cigarettes are presented in a subsequent paper.

Reversed phase ion-pair liquid chromatographic determination of nicotine in commercial tobacco products. 2. Cigarettes.

A reversed phase ion-pair liquid chromatographic method for the determination of nicotine in commercial tobacco products was previously developed and optimized (Ciolino, L. A.; Turner, J. A.; McCauley, H. A.; Smallwood, A. W.; Yi, T. Y. J. Chromatogr. 1999a, 852 (2), 451-463) and provided reliable results for the determination of nicotine in commercial moist snuff (Ciolino, L. A.; McCauley, H. A.; Fraser, D. B.; Barnett, D. Y.; Yi, T. Y.; Turner, J. A. J. Agric. Food Chem. 1999b, 47, 3706-3712). The method uses an aqueous-based sample extraction and provides rapid separation of nicotine from the minor tobacco alkaloids and other commercial tobacco components. In the present work, the method is evaluated for the determination of nicotine in commercial cigarettes and compared to both an official AOAC method for total alkaloids in tobacco (AOAC, AOAC Official Methods of Analysis of AOAC International, 16th ed.; AOAC International: Gaithersburg, MD, 1995; pp 30-31), and a published GC method (Lyerly, L. A.; Greene, G. H. Beitr. Tabakforsch. 1976, 8 (6), 359-361). Good agreement was obtained between the ion-pair LC method and the GC method with relative differences in determined nicotine contents of 0.6 to 5% for a series of commercial and reference cigarettes.

Optimization study for the reversed-phase ion-pair liquid chromatographic determination of nicotine in commercial tobacco products.

The availability of published methods for the determination of nicotine in commercial tobacco products based on state-of-the-art chromatographic methods is limited. Nicotine is a diprotic base with pKa's of 3.12 (pyridine ring) and 8.02 (pyrrolidine ring). Other monoprotic and diprotic bases are also present in commercial tobacco including anatabine, nornicotine, anabasine, and cotinine. In this paper, the chromatography of nicotine and the minor tobacco alkaloids under reversed-phase ion-pairing conditions is thoroughly studied. The results of this study are used to understand the retention mechanisms of the tobacco alkaloids, to examine their observed elution order with respect to fundamental analyte properties (size, functionality, and acid-base strength), and to select optimum chromatographic conditions for the determination of nicotine in commercial tobacco products.

Professional dentistry's road to autonomy.

Throughout recorded history the dental ills of mankind have been treated by medical specialists particularly associated with surgery. However, deep-rooted cultural tradition relegated surgeons and those engaged in the dental art to a class deemed socially, intellectually and economically inferior to that of the physician, causing widespread neglect of dentistry until the 16th century. Organizational developments and advances in the technology of medicine and surgery during the next two centuries in Europe engendered the emergence of dentistry from a virtual trade to a recognized specialty of medicine, setting the stage for its phenomenal growth in 19th century America. Perceiving the common need, far-seeing and dedicated representatives of dentistry organized, collected available literature, instituted an unprecedented system of dental education, eliminated the untutored and untrained practitioner, and left the heritage of an independent and honored self-governing health care profession.

Factors that influence the determination of residual solvents in pharmaceuticals by automated static headspace sampling coupled to capillary GC-MS.

The impact of several experimental parameters on static headspace sampling for volatile impurities is discussed. Figures of merit are provided for some common organic solvents dissolved in dimethylacetamide. The performance is compound specific, but in the best case, detectability is about 0.2 mg/L with the mass spectrometer operating in the scanning mode. Sensitivity improves by about a factor of 50 when single ion monitoring is used. Linearity extends for about 4 orders of magnitude. This system is used to determine acetone as a residual solvent in the sulfonamide antibiotic, sulfamethazine, at levels of 1 to 15 mg/kg with precision of 3 to 5%.

Baltimore fluoridates.

In all the history of human progress, there is no measure for the advancement or protection of the public health more effective at lesser cost than fluoridation of domestic water supplies for the control of tooth decay, the adjustment of the concentration of a substance naturally present in water to a level found to be optimal for dental health. This is the story of its adoption in a city of nearly one million people.