Home visits during pregnancy and after birth for women with an alcohol or drug problem.

BACKGROUND: One potential method of improving outcome for pregnant or postpartum women with a drug or alcohol problem is with home visits. OBJECTIVES: To determine the effects of home visits during pregnancy and/or after birth for pregnant women with a drug or alcohol problem. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Trials Register (30 April 2004), CENTRAL (The Cochrane Library, Issue 2, 2004), MEDLINE (1966 to April 2004), EMBASE (1980 to week 16, 2004), CINAHL (1982 to April 2004), PsycINFO (1974 to April 2004), citations from previous reviews and trials, and contacted expert informants. SELECTION CRITERIA: Studies using random or quasi-random allocation of pregnant or postpartum women with a drug or alcohol problem to home visits. Trials enrolling high-risk women of whom more than 50% were reported to use drugs or alcohol were also eligible. DATA COLLECTION AND ANALYSIS: Assessments of trials were performed independently by all review authors. Statistical analyses were performed using fixed and random-effects models where appropriate. MAIN RESULTS: Six studies (709 women) compared home visits after birth with no home visits. None provided a significant antenatal component of home visits. The visitors included community health nurses, pediatric nurses, trained counsellors, paraprofessional advocates, midwives and lay African-American women. Most studies had methodological limitations, particularly large losses to follow up. There were no significant differences in continued illicit drug use (2 studies, 248 women; relative risk (RR) 0.95, 95% confidence interval (CI) 0.75 to 1.20), continued alcohol use (RR 1.08, 95% CI 0.83 to 1.41) failure to enrol in a drug treatment program (2 studies, 211 women; RR 0.45 95% CI 0.10 to 1.94). There was no significant difference in the Bayley MDI (3 studies, 199 infants; weighted mean difference 2.89, 95% CI -1.17 to 6.95) or Psychomotor Index (WMD 3.14, 95% CI -0.03 to 6.32). Other outcomes reported by one study only included breastfeeding at six months (RR 1.00, 95% CI 0.81 to 1.23), incomplete six-month infant vaccination schedule (RR 1.07, 95% CI 0.58 to 1.96), non-accidental injury and non-voluntary foster care (RR 0.16, 95% CI 0.02 to 1.23), failure to use postpartum contraception (RR 0.41, 95% CI 0.20 to 0.82), child behavioural problems (RR 0.46, 95% CI 0.21 to 1.01), and involvement with child protective services (RR 0.38, 95% CI 0.20 to 0.74). AUTHORS' CONCLUSIONS: There is insufficient evidence to recommend the routine use of home visits for women with a drug or alcohol problem. Further large, high-quality trials are needed, and women's views on home visiting need to be assessed.

The Westmead Pediatric TBI Multidisciplinary Outcome study: use of functional outcomes data to determine resource prioritization.

OBJECTIVE: To measure functional outcome in the 2 years after traumatic brain injury (TBI) in 2 groups of children and to determine the usefulness of a TBI severity classification system for resource allocation. DESIGN: Prospective inception cohort study with 3 assessment points during the 2 years after trauma. SETTING: Tertiary pediatric trauma center in Sydney, Australia. PARTICIPANTS: Eighty-one consecutive admissions aged 0 to 14 years. Fifty-one were allocated to the Mild (n = 26) or Severe (n = 25) TBI groups, according to preset determinants of severity; 30 admissions with non-TBI trauma constituted the control group. MAIN OUTCOME MEASURES: Standardized psychometric and clinical assessments of cognition, communication and feeding ability, motor performance (ambulation, fine and gross motor), neurologic status, self-care independence, and school/academic performance. RESULTS: Those with Mild TBI severity had no significant deficits at the 2-year data point. In contrast, those in the Severe TBI group demonstrated continued problems with fine motor performance, neurologic status, self care, and school/academic performance. CONCLUSIONS: A classification system has been developed that may be useful in the allocation of children with a TBI, age younger than 15 years, to 1 of 2 severity groups early in their rehabilitation. This classification system may be useful in determining areas of high and low resource prioritization.

Nutritive value of corn silage as affected by maturity and mechanical processing: a contemporary review.

Stage of maturity at harvest and mechanical processing affect the nutritive value of corn silage. The change in nutritive value of corn silage as maturity advances can be measured by animal digestion and macro in situ degradation studies among other methods. Predictive equations using climatic data, vitreousness of corn grain in corn silage, starch reactivity, gelatinization enthalpy, dry matter (DM) of corn grain in corn silage, and DM of corn silage can be used to estimate starch digestibility of corn silage. Whole plant corn silage can be mechanically processed either pre- or postensiling with a kernel processor mounted on a forage harvester, a recutter screen on a forage harvester, or a stationary roller mill. Mechanical processing of corn silage can improve ensiling characteristics, reduce DM losses during ensiling, and improve starch and fiber digestion as a result of fracturing the corn kernels and crushing and shearing the stover and cobs. Improvements in milk production have ranged from 0.2 to 2.0 kg/d when cows were fed mechanically processed corn silage. A consistent improvement in milk protein yield has also been observed when mechanically processed corn silage has been fed. With the advent of mechanical processors, alternative strategies are evident for corn silage management, such as a longer harvest window.

Characterization of two structurally novel HIV-1 protease inhibitors identified by rational selection.

The human immunodeficiency virus (HIV-1), associated with the AIDS (acquired immunodeficiency syndrome) epidemic, encodes an aspartyl protease that is essential for polyprotein processing in the virus (Navia et al., 1989). It has been demonstrated that inactivation of the protease either catalytically or by an inhibitor prevents infectious virion formation (Kohl et al., 1988; Darke et al., 1989). The acquired knowledge of key molecular interactions occurring between inhibitors and aspartyl proteases, as well as the structural similarities between HIV-1 protease and human renin was used to rationally select candidates for HIV-1 screening from the pool of analogs designed as renin inhibitors. A minimal number of chosen compounds were tested in an HIV-1 protease assay system. Two structurally novel peptides emerged as potent enzymatic protease inhibitors. This study highlights the selection process and characterizes the antiviral properties of the two novel analogs.

Time management in education.

The topic of time management is an area that is very important to today's nurse educationalist, especially with the ever increasing demands being made upon her time. In this paper the writer examines the concept of time management, and some of the issues which should be given due consideration by anyone who is contemplating developing the skills required for success in managing time effectively. The work utilises ideas which enable one to take a problem solving approach to the subject. Here the reader will also find a selection of possible solutions that have been put forward from various sources, many of which the writer has tried herself and found to be extremely helpful in tackling her own problems in this area. One point that is reiterated throughout, is the very personal nature of time management and the fact that it is up to the individual to choose the most useful method in order to achieve an efficient and effective approach to the management of time, hopefully resulting in greater control and equally as important--'peace of mind'.