Premature Infants Conceived with Assisted Reproductive Technology: An Analysis of Infant Morbidity, Compared with Infants Conceived Naturally.

OBJECTIVE: This article evaluates the morbidity of infants born via assisted reproductive technology (ART) compared with matched naturally conceived infants. STUDY DESIGN: This is a retrospective review of maternal and infant data among inborn infants conceived via ART and matched control infants born at 30 to 34 weeks' gestational age (GA) between 2006 and 2012. Data were analyzed using paired t-test or Wilcoxo-Mann-Whitney test for continuous and Fisher's exact test for categorical variables. p-Value of < 0.05 was considered significant. RESULT: Of 120 study infants, 60 were conceived via ART and 60 naturally. Control infants were matched for GA, gender, race, and multiple gestations. ART infants required more respiratory support and took longer to reach full feeds compared with control infants. CONCLUSION: Infants born via ART are physiologically more immature with more intensive care needs than naturally conceived infants of similar gestation, potentially increasing health care costs. This immaturity should be considered when planning early delivery in these pregnancies.

Tolerability and clinical outcome of coseasonal treatment with Escherichia coli strain Nissle 1917 in grass pollen-allergic subjects.

BACKGROUND: Nonpathogenic Escherichia coli strain Nissle 1917 (EcN) has immunomodulatory properties and can act on different cells which are important for the allergic immune response. Herein, we investigated the efficacy and tolerability of EcN in subjects with grass pollen-dependent allergic rhinoconjunctivitis. METHODS: Grass pollen-allergic subjects were randomly allocated to receive EcN in a double-blind, placebo-controlled manner. The treatment was performed from 2 months before onset until the end of one grass pollen season (in total: 6 months). The clinical symptom score and the intake of symptomatic medications were assessed. A skin prick test and grass pollen-specific immunoglobulin (Ig) E and IgA were evaluated before and after treatment. RESULTS: Our results show that coseasonal treatment with EcN in grass pollen-allergic subjects was not superior to placebo as assessed using the symptom-medication score (p = 0.257). Interestingly, an increase [median (range)] in grass pollen-specific IgA was detectable in the EcN group [20,556 LU/ml (1,812-60,800)] versus placebo [5,246 LU/ml (944-50,467)] (p = 0.048). CONCLUSIONS: The results indicate that 6 months of coseasonal nonspecific immunomodulation by EcN is not sufficient to achieve clinical efficacy in grass pollen-allergic subjects. Future approaches in which such immunomodulators are combined with an allergen-specific protocol might enhance the clinical efficacy of the allergen-specific treatment.

Intercultural competence development: A qualitative case study.

AIM: The aim of this study was to explore Bachelor of Science in Nursing (BSN) students' perceptions of the effectiveness of a unique teaching-learning strategy using their results from the Intercultural Development Inventory (IDI), an instrument for the assessment of intercultural competence, with their customized Intercultural Development Plan (IDP) in enhancing their cultural competence development in a nursing senior practicum. The study also examined student insights about how having a plan to develop their intercultural competence will have an impact on their future nursing practice. BACKGROUND: Intercultural competence is vital for providing quality healthcare, yet there is a gap in understanding how educational interventions are designed and implemented to enhance cultural competence among nursing students. This paper describes a strategy for developing intercultural competence. The IDI was administered to Bachelor of Science in Nursing (BSN) students in the fourth semester of a five-semester BSN program. Based on their IDI results, each student received a customized IDP that suggested specific activities and encouraged guided self-reflection to enhance intercultural competence development. In the fifth-semester senior practicum course, the students developed personal intercultural competence development goals based on their IDP. They also kept weekly journals on their intercultural competence development during their practicum. DESIGN: This study used a Qualitative Case Study design. METHODS: This study was conducted from January to July 2021 with 47 senior practicum students in a large BSN program in the Southeastern United States. Data consisted of student written responses to prompts on how the IDI/IDP influenced their intercultural development and its potential effect on their future practice. The data were analyzed through inductive content analysis. RESULTS: Three key themes emerged: self-awareness, recognition of cultural influences and growth goals. Student reflections suggested that they desired to develop intercultural competence so they could provide the best possible nursing care for their patients. Still, most students did not have a plan for how to grow in this area. Many students reported that their IDI/IDP heightened cultural awareness throughout their practicum, guiding their development of intercultural competence and leading to a deeper and broader understanding of culture. Students suggested that this enhanced cultural understanding, along with their IDP, will facilitate their continued development of intercultural competence in their future professional practice. CONCLUSION: This study contributes to existing knowledge about intercultural competence development and effective teaching methods by providing empirical evidence of the positive impact of the IDI/IDP on nursing students' perceived intercultural development. These findings can inform the development and implementation of pedagogical strategies to enhance intercultural competence, which will ultimately improve patient care outcomes in all healthcare settings.

Psychiatric symptoms and cognitive appraisal following the near sinking of a research submarine.

OBJECTIVE: This study assessed the stress reactions of a submarine crew forced to abandon their vessel in high seas after flooding and fire damaged their ship. METHODS: The remaining crew members (n = 22) were surveyed 7 months after the incident regarding exposures, initial emotional responses, peritraumatic dissociation, subsequent life events, current safety appraisal, and current symptoms of posttraumatic stress disorder (PTSD) and depression. RESULTS: At 7 months, 9.1% met criteria for PTSD and none met criteria for depression. Higher levels of depressive symptoms were associated with previous traumatic exposures, subsequent life events, and higher levels of PTSD symptoms; higher levels of PTSD symptoms were associated with greater peritraumatic dissociation and initial emotional response. CONCLUSION: Acute exposures of highly trained professionals to potentially fatal events may not result in high levels of posttraumatic symptoms. Previous and subsequent life events may play a more significant role in the level of postdisaster symptoms.

Diffuse electrical injury: a study of 89 subjects reporting long-term symptomatology that is remote to the theoretical current pathway.

Historically, tissue damage from electrical contact was thought to arise from resistive heating of tissues along the current pathway. The modern view has accepted that tissue damage can result from cellular rupture (electroporation) induced by the presence of an electric field. There remain electrical injuries that defy explanation by either theory. In rare electrical contacts, diffuse symptomatology arises that is neither proportionate to the electrical contact nor does it occur along the theoretical linear pathway of the current from entry point to exit point. Disproportionate, remote electrical injury is most notable when the contact voltage is low (120 and 240 V). Symptoms occur, absent diagnostic evidence, that defy explanation as organic injury. A Web-based interactive survey was used to locate and query individuals suffering from rarely occurring responses to electrical contact. The results of the study suggest that there is a common symptomatology that is neither linked to voltage nor loss of consciousness at the time of contact.

Assessment of personality and crew interaction skills in successful naval aviators.

PURPOSE: We were interested in studying a full range of successful aviators to discern which personality factors were present and whether these factors correlate with age, rank, and accumulated flight time. METHOD: The Armstrong Laboratory Aviator Personality Survey (ALAPS) was administered to 312 designated naval aviators and flight officers from a variety of aircraft communities. The sample included O-3/O-4 elite aviators who were selected for their squadron billets based on superior performance, O-5/O-6 aviators selected for command positions, and 59 flag officers. RESULTS: The junior aviators scored higher on the factor associated with Dogmatism and lower on the factor associated with Team Orientation and Socialness. This pattern was reversed for the flag officers, while O-5/O-6 aviators received intermediate scores on each of these factors. CONCLUSIONS: The present study demonstrates a correlation between specific ALAPS factors and experience, rank, age, and flight time. The combination of high Dogmatism, low Team Orientation, and low Socialness in junior aviators could suggest lower openness to crew input and increased risk for mishaps.

Informed consent for psychotherapy: a look at therapists' understanding, opinions, and practices.

Forensic experts agree that the doctrine of informed consent now applies to psychotherapy. The optimum level of detail and content in this interaction remains nebulous. This study examines opinions and practices of therapists. The authors administered a survey regarding this subject to 231 psychotherapists. Six scales were constructed from this survey. High scores on these scales suggest more positive opinions regarding the application of the doctrine of informed consent to psychotherapy. Psychiatrists scored significantly lower on the Informed Consent (p = 0.005), Written Consent (p < 0.001), and Self-Disclosure (p = 0.026) scales than other types of therapists (suggesting a more negative opinion of the application of this doctrine to psychotherapy). Interpersonal therapists scored significantly higher than psychodynamic psychotherapists on the Informed Consent (p = 0.003) and Patient (p = 0.003) scales. Psychodynamic psychotherapists scored significantly lower than therapists with different modalities on the Written Consent scale. This paper suggests that opinions and practices of informed consent for psychotherapy vary with the characteristics of the therapist. More research in this area could serve as a guide for therapists embarking on the process of informed consent or for professional organizations who wish to establish guidelines.

Older adults' perspectives on naturopathic medicine's impact on healthy aging.

CONTEXT: High rates of complementary and alternative medicine (CAM) utilization among older adults are of interest because studies suggest relationships among CAM, self-care, and healthy lifestyle. These potential relationships are of particular interest because of the contribution of self-care in maintaining physical, emotional, and spiritual health as key strategies to successful aging. Naturopathic medicine (NM) is a type of primary care CAM used by older adults, yet little is known about older adults' use of NM or its role in healthy aging. OBJECTIVES: We sought to examine perceptions about, and utilization of, NM and the experience of addressing health and wellness as part of the aging process. DESIGN: Phenomenology-based qualitative inquiry. SETTING: A total of 13 community-based clinics affiliated with a naturopathic medical school. PARTICIPANTS: A total of 47 adults aged 58-100 years. METHODS: Qualitative analysis of semi-structured focus groups with quantitative analysis of clinical administrative data. RESULTS: Over 2543 older adults used NM services affiliated with a natural academic clinic in Seattle in 2011 for diagnoses consistent with primary care: fatigue, anxiety, diabetes, diarrhea, and depression, in rank order. Participants reported they sought NM because it offered a different system of care aligned with their values. Themes included (1) feeling heard, (2) a focus on health education including prevention and self-care, and (3) feeling supported. Themes further distilled into optimal descriptive characteristics of patient-centered providers that may best support older adults' healthy aging. A final theme described barriers to further utilization.

The Effect of Arterial pH on Oxygenation Persists Even in Infants Treated with Inhaled Nitric Oxide.

Objective. To validate the empiric observation that pH has an important effect on oxygenation in infants receiving iNO. Study Design. Demographics, ventilator settings, arterial blood gases (ABG), and interventions for up to 96 hours of life were extracted from the charts of 51 infants receiving iNO. Need for ECMO and survival to discharge were noted. Mean blood pressure (MBP) and mean airway pressure (MAP) were recorded. The arterial/alveolar (a/A) ratio was used as the primary outcome. Analysis was by simple linear regression and multiple linear regression analyses and Fisher's exact test. pH responsiveness was arbitrarily defined as a correlation coefficient (CC) of >0.40 with P < 0.05. Results. Mean gestational age was 38.8 weeks and mean birth weight was 3300 g. All patients had clinical diagnosis of PPHN. Clear responsiveness to pH was found in 31/51 infants. MAP and MBP did not correlate with a/A ratio. Three responders had a critical pH > 7.55. Of 11 patients requiring ECMO, only 3 exhibited responsiveness at any time in their course. Three responders required ECMO. Conclusion. This small study suggests that failure or inability to optimize pH may account for observed unresponsiveness to iNO. Maintaining a pH > 7.5 using hyperventilation is not recommended.