The Experiences and Perceptions of Neonatal Clinicians When Using a Responsive Bassinet.

BACKGROUND: Innovative technologies, such as the SNOO Smart Sleeper responsive bassinet (SNOO), may offer support to neonatal clinicians in their work environment. PURPOSE: The objectives of this study were to describe the experiences of clinicians when using the SNOO in their clinical settings, including their perceptions of the SNOO on the quality of infant care and their work environment. METHODS: A retrospective, secondary analysis was conducted using 2021 survey data across 44 hospitals participating in the SNOO donation program. Respondents included 204 clinicians, predominantly neonatal nurses. RESULTS: The SNOO was used in a variety of clinical scenarios, including with fussy, preterm, and healthy full-term infants, as well as substance-exposed infants experiencing withdrawal. The SNOO was perceived as a driver of positive infant and parent experiences, including enhanced quality of care. Respondents perceived the SNOO as providing them with support in their daily caring for newborns, reducing their stress, and helping them in lieu of hospital volunteers. Clinicians reported an average time savings of 2.2 hours per shift. IMPLICATIONS FOR PRACTICE AND RESEARCH: Results from this study provide evidence for future evaluation of the SNOO as a technology for hospitals to adopt to improve neonatal clinician satisfaction and retention, as well as improve the quality of patient care and parental satisfaction.

Tapinarof cream 1% once daily for the treatment of plaque psoriasis: Patient-reported outcomes from the PSOARING 3 trial.

BACKGROUND: Tapinarof cream 1% once daily demonstrated significant efficacy versus vehicle and was well tolerated in two 12-week, phase 3 pivotal trials in adults with mild-to-severe plaque psoriasis. OBJECTIVE: To assess long-term, health-related quality of life and patient satisfaction with tapinarof. METHODS: Patients completing the 12-week trials were eligible for 40 weeks of open-label tapinarof based on Physician Global Assessment score in PSOARING 3, with a 4-week follow-up. Dermatology Life Quality Index was assessed at every visit; Patient Satisfaction Questionnaire responses were assessed at week 40 or early termination. RESULTS: Seven hundred sixty-three (91.6%) eligible patients enrolled; 78.5% completed the Patient Satisfaction Questionnaire. DLQI scores improved and were maintained. By week 40, 68.0% of patients had a DLQI of 0 or 1, indicating no impact of psoriasis on health-related quality of life. Most patients strongly agreed or agreed with all Patient Satisfaction Questionnaire questions assessing confidence in tapinarof and satisfaction with efficacy (62.9%-85.8%), application ease and cosmetic elegance (79.9%-96.3%), and preference for tapinarof versus prior psoriasis therapies (55.3%-81.7%). LIMITATIONS: Open-label; no control; may not be generalizable to all forms of psoriasis. CONCLUSIONS: Continued and durable improvements in health-related quality of life, high rates of patient satisfaction, and positive perceptions of tapinarof cream were demonstrated.

Level and determinants of birth preparedness and complication readiness among pregnant women: A cross sectional study in a rural area in Bangladesh.

BACKGROUND: Increasing the level of birth preparedness and complication readiness (BP/CR) is one of the key interventions to promote optimal utilization of skilled maternal health services. It is therefore essential to determine the women's ability to recognize the danger signs and the level of BP/CR. This information can be used to design more effective health interventions. OBJECTIVES: This study was conducted to determine the knowledge in recognition of maternal complications, and the level and factors associated with BP/CR in rural Matlab, Bangladesh. METHODS: A community-based cross-sectional survey was conducted from June- October 2015 on a randomly selected 2262 women who delivered live or stillbirth during the year 2014. A pretested and structured questionnaire was used for data collection. Descriptive and analytical statistical methods were used. RESULTS: The proportion of study participants with "good knowledge", measured by the ability to recognise three or more danger signs, in pregnancy and delivery were 26% and 23%, respectively. Out of four BP/CR components, about 15% women saved money, 12% women identified facility for delivery, 9.6% women planned to deliver by skilled birth attendant and 5.3% of women arranged transport. About 12% of women were "well prepared", measured by planning of at least two components, for skilled childbirth and emergency obstetric complications. In the multivariable logistic regression analysis, asset index, antenatal care (ANC) visits and knowledge of danger signs during pregnancy and delivery were associated with BP/CR. The adjusted odds ratio (OR) of "well prepared" was 4.09 (95% confidence interval [CI]: 2.45-6.82) among women with an asset index of five (richest), compared with women in the asset index of one (poorest). The odds of "well prepared" was six times (OR 5.98, 95% CI: 3.85-9.28) higher for women with four or more ANC visits, compared to women with none or one ANC visit. In comparison to women with "poor knowledge" on maternal danger signs during pregnancy and delivery, the odds ratio of "well prepared" among women with good knowledge during pregnancy and in delivery were 1.95 (95% CI: 1.44-2.63) and 1.74 (95% CI: 1.28-2.36), respectively. CONCLUSION: The study revealed a low level of maternal knowledge of danger signs and BP/CR among pregnant women. Further, low socioeconomic status, fewer ANC visits and poor knowledge in recognition of dangers signs on maternal health were associated with low BP/CR. More emphasis should be placed on the quality of information offered to the pregnant women during the prenatal contact and women from low socio-economic gradient should be prioritized to optimize the impact of future BP/CR interventions.

The Cost of War on Public Health: An Exploratory Method for Understanding the Impact of Conflict on Public Health in Sri Lanka.

PURPOSE: The direct impact of protracted conflict on population health and development is well understood. However, the extent of a war's impact on long-term health, and the opportunity costs, are less well understood. This research sought to overcome this gap by asking whether or not health outcomes in Sri Lanka would have been better in the absence of a 26-year war than they were in the presence of war. METHODS: A counterfactual model of national and district-level health outcomes was created for Sri Lanka for the period 1982 to 2002. At the national level, the model examined life expectancy, infant mortality rate (IMR), and maternal mortality ratios (MMR). At the district level, it looked at IMR and MMR. The model compared outcomes generated by the counterfactual model to actual obtained health outcomes. It looked at the rate of change and absolute values. RESULTS: The analysis demonstrated that war altered both rate of change and absolute health outcomes for the worse. The impact was most clearly evident at the district level. IMR was poorer than predicted in 10 districts; of these 8 were outside of the conflict zone. The MMR was worse than expected in 11 districts of which 9 were not in the conflict zone. Additionally, the rate of improvement in IMR slowed as a result of war in 16 districts whereas the rate of improvement in MMR slowed in 9. CONCLUSION: This project showed that protracted conflict degraded the trajectory of public health in Sri Lanka and hurt population health outside of the conflict zone. It further provided a novel methodology with which to better understand the indirect impact of conflict on population health by comparing what is to what could have been achieved in the absence of war. In so doing, this research responded to two public health challenges by providing a tool through which to better understand the human and opportunity costs of war and by answering a call for new methodologies.

Health care resource use, productivity, and costs among patients with moderate to severe plaque psoriasis in the United States.

BACKGROUND: Comprehensive studies on costs of moderate to severe plaque psoriasis (MSPP) have not been conducted in the United States. OBJECTIVE: We sought to evaluate current health care resource use, productivity, and costs among patients with MSPP in routine practice. METHODS: A total of 200 adults seeking MSPP treatment enrolled in 9 US sites. Consented patients reported symptoms, treatment, lost productivity, and costs; 6-month retrospective chart review captured health care resource use and clinical characteristics. Costs were assigned to health care resource use and lost productivity using standard algorithms. Differences by Psoriasis Area and Severity Index (PASI) group, based on PASI score (≤10, >10-≤20, >20) at enrollment, were evaluated. Analyses included descriptive statistics and analysis of variance or Kruskal-Wallis tests. RESULTS: Most patients (79.5%) were prescribed 1 or more MSPP medications (mean: 1.5); 36.0% and 9.0% received self-administered biologics and systemic therapies, respectively. Mean number of nonprescription treatments was 12.3. Differences by PASI group were observed for overall work and activity impairment (P < .02). Six-month total MSPP direct costs per patient were $11,291; indirect costs were $2101 and differed across PASI groups (P = .0008). LIMITATIONS: This study enrolled patients with MSPP actively seeking care. CONCLUSION: Despite treatment, a number of patients with MSPP continue to experience moderate to severe PASI scores, impaired functioning, and high costs suggesting a need for new treatment options.

Postbreeding heifer management.

Rebreeding performance of the first-calf heifer has major economic consequences for cow-calf producers. Management systems that allow heifers to cost-effectively achieve a body condition score of 5 to 6 at calving and maintain this through rebreeding have a higher probability of pregnancy success.

An ecological analysis of alcohol-outlet density and campus-reported violence at 32 U.S. colleges.

OBJECTIVE: The purpose of this study was to assess the relationships among campus violence, student drinking levels, and the physical availability of alcohol at off-campus outlets in a multisite design. METHOD: An ecological analysis of on-campus violence was conducted at 32 U.S. colleges. Dependent variables included campus-reported rates of rape, robbery, assault, and burglary obtained from a U.S. Department of Education online database for the years 2000-2004. Measures of student alcohol use and demographics were obtained from student surveys conducted for the Social Norms Marketing Research Project from 2000 to 2004. Measures of alcohol-outlet density within 3 miles of each campus were obtained from state alcohol-licensing authorities for 2004. RESULTS: Both on- and off-premise alcohol-outlet densities were associated with the campus rape-offense rate but not with the assault or robbery rates. Student drinking level was associated with both campus rape and assault rates but not with the campus robbery rate. The apparent effect of on-premise outlet density on campus rape-offense rates was reduced when student drinking level was included in the model, suggesting that the effect of on-premise outlet density may be mediated by student drinking level. Separate analyses revealed a similar mediational role for off-premise outlet density. CONCLUSIONS: These findings demonstrate that there is a campus-level association between sexual violence and the campus-community alcohol environment.

Geospatial methods for identification of core groups for HIV/AIDS.

OBJECTIVES: Disease transmission dynamics among members of a sexual network's core group make the group an ideal target for prevention for positives. Identifying the geographic territory of an HIV/AIDS core group is complicated by the numerous factors that may spatially structure cases including alcohol availability. We employ spatial analytic methods in an attempt to identify the geographic distribution of the core HIV/AIDS group. METHODS: Five year HIV/AIDS detection rates were analyzed for each HIV/AIDS risk category (i.e., MSM, IDU, HRH) at the census tract level (n = 164) in New Orleans using spatial analytic techniques in multivariate models. RESULTS: MSM was the most common risk category for newly detected HIV cases. Both MSM and IDU cases appeared to decline or enter an endemic phase. Each risk category exhibited unique spatial structure. Among IDUs and HRHs nearly all the spatial structure was explained in terms of the independent variables. However, among MSMs residual spatial structure remained after controlling for independent variables. CONCLUSIONS: Residual spatial structure in the MSM HIV/AIDS detection rates after controlling for social structure could be explained by the presence of core group members. The study's limitations are noted.

Resource loss, coping, alcohol use, and posttraumatic stress symptoms among survivors of Hurricane Katrina: a cross-sectional study.

OBJECTIVE: To assess the impact of Hurricane Katrina on the faculty, staff and students at a university located in New Orleans, LA. DESIGN: A cross-sectional, Web-based survey. SETTING: A local college university in New Orleans, LA. PARTICIPANTS: A total of 364 faculty, staff and students surveyed during mid July 2006 to September 2006. MAIN OUTCOME MEASURES: Posttraumatic stress disorder (PTSD) symptoms, coping, resource loss, and substance use. RESULTS: The study revealed substantial degree of resource loss and consequences due to Katrina. Approximately 22 percent of respondents had PTSD symptoms one year post-Katrina. Positive coping was strongly protective of PTSD symptoms in our sample. Alcohol and drug consumption, on the other hand, was associated with greater PTSD symptoms. Coping, alcohol use, and personal and family injury were also associated with resource loss. CONCLUSIONS: Survivors of a disaster need mental health and substance use services and resources well beyond the first year post disaster, and the student population should be factored in any evacuation planning.

Molecular and imaging techniques for bacterial biofilms in joint arthroplasty infections.

Biofilm formation on surfaces is an ancient and integral strategy for bacterial survival. Billions of years of adaptation provide microbes with the ability to colonize any surface, including those used in orthopaedic surgery. Although remarkable progress has been made in the treatment of orthopaedic diseases with implanted prostheses, infection rates remain between 1% and 2%, and are higher for revision surgeries. The chronic nature of implant infections, their nonresponsiveness to antibiotics, and their frequent culture negativity can be explained by the biofilm paradigm of infectious disease. However, the role of biofilms in orthopaedic implant infections and aseptic loosening is controversial. To address these issues, we developed molecular diagnostic and confocal imaging techniques to identify and characterize biofilms associated with infected implants. We designed PCR and reverse transcription (RT)-PCR-based assays that can be used to detect bacterial infections associated with culture-negative joint effusions that distinguish between physiologically active Staphylococcus aureus and Staphylococcus epidermidis. Using clinical isolates of Pseudomonas aeruginosa, we constructed a series of reporter strains expressing colored fluorescent proteins to observe biofilms growing on 316L stainless steel and titanium orthopaedic screws. Three-dimensional structures of Pseudomonas aeruginosa and staphylococci biofilms growing on the screws were documented using confocal microscopy. The application of these tools for clinical diagnosis and biofilm research in animal and in vitro models is discussed.