Coral-seeding devices with fish-exclusion features reduce mortality on the Great Barrier Reef.

Restoration methods that seed juvenile corals show promise as scalable interventions to promote population persistence through anthropogenic warming. However, challenges including predation by fishes can threaten coral survival. Coral-seeding devices with refugia from fishes offer potential solutions to limit predation-driven mortality. In an 8-month field study, we assessed the efficacy of such devices for increasing the survival of captive-reared Acropora digitifera (spat and microfragments) over control devices (featureless and caged). Devices with fish-exclusion features demonstrated a twofold increase in coral survival, while most corals seeded without protection suffered mortality within 48 h. Overall, spat faced more grazing and higher mortality compared to microfragments, and upward-facing corals were more vulnerable than side-facing corals. Grazing-induced mortality varied by site, with lower activity in locations abundant in mat-forming cyanobacteria or Scleractinian corals. Many scraping parrotfish were found feeding on or near the seeded corals; however, bites by Scarus globiceps explained the most site-related variation in grazing. Cyanobacteria may be preferred over corals as a nutritional resource for scraping parrotfish-advancing our understanding of their foraging ecology. Incorporating side-facing refugia in seeding devices and deploying to sites with nutrient-rich food sources for fish are potential strategies to enhance coral survival in restoration programs.

A large-scale, rapid public health response to rabies in an organ recipient and the previously undiagnosed organ donor.

This article describes and contrasts the public health response to two human rabies cases: one organ recipient diagnosed within days of symptom onset and the transplant donor who was diagnosed 18 months post-symptom onset. In response to an organ-transplant-related rabies case diagnosed in 2013, organ donor and recipient investigations were conducted by multiple public health agencies. Persons with potential exposure to infectious patient materials were assessed for rabies virus exposure. An exposure investigation was conducted to determine the source of the organ donor's infection. Over 100 persons from more than 20 agencies spent over 2700 h conducting contact investigations in healthcare, military and community settings. The 564 persons assessed include 417 healthcare workers [5.8% recommended for post-exposure prophylaxis (PEP)], 96 community contacts (15.6% recommended for PEP), 30 autopsy personnel (50% recommended for PEP), and 21 other persons (4.8% recommended for PEP). Donor contacts represented 188 assessed with 20.2% recommended for PEP, compared with 5.6% of 306 recipient contacts recommended for PEP. Human rabies cases result in substantial use of public health and medical resources, especially when diagnosis is delayed. Although rare, clinicians should consider rabies in cases of encephalitis of unexplained aetiology, particularly for cases that may result in organ donation.

Determinants of incident chronic kidney disease and progression in a cohort of HIV-infected persons with unrestricted access to health care.

OBJECTIVES: As socioeconomic factors may impact the risk of chronic kidney disease (CKD), we evaluated the incidence and risk factors of incident CKD among an HIV-infected cohort with universal access to health care and minimal injecting drug use (IDU). METHODS: Incident CKD was defined as an estimated glomerular filteration rate (eGFR) <60 ml/min/1.73 m(2) for ≥ 90 days. eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Rates were calculated per 1000 person-years (PY). Associations with outcomes were assessed using two separate Cox proportional hazard models, adjusting for baseline and time-updated covariates. RESULTS: Among 3360 participants [median age 29 years; 92% male; 44% African American (AA)] contributing 23,091 PY of follow-up, 116 developed incident CKD [5.0/1000 PY; 95% confidence interval (CI) 4.2-6.0/1000 PY]. The median first eGFR value was 97.0 mL/min/1.73 m(2) [interquartile range (IQR) 85.3-110.1 mL/min/1.73 m(2)]. Baseline factors associated with CKD included older age, lower CD4 count at HIV diagnosis [compared with CD4 count ≥ 500 cells/µL, hazard ratio (HR) 2.1 (95% CI 1.2-3.8) for CD4 count 350-499 cells/µL; HR 3.6 (95% CI 2.0-6.3) for CD4 count 201-349 cells/µL; HR 4.3 (95% CI 2.0-9.4) for CD4 count ≤ 200 cells/µL], and HIV diagnosis in the pre-highly active antiretroviral therapy (HAART) era. In the time-updated model, low nadir CD4 counts, diabetes, hepatitis B, hypertension and less HAART use were also associated with CKD. AA ethnicity was not associated with incident CKD in either model. CONCLUSIONS: The low incidence of CKD and the lack of association with ethnicity observed in this study may in part be attributable to unique features of our cohort such as younger age, early HIV diagnosis, minimal IDU, and unrestricted access to care. Lower baseline CD4 counts were significantly associated with incident CKD, suggesting early HIV diagnosis and timely introduction of HAART may reduce the burden of CKD.

Immunoglobulin G subclass levels and antibody responses to the 2009 influenza A (H1N1) monovalent vaccine among human immunodeficiency virus (HIV)-infected and HIV-uninfected adults.

Immunoglobulin (Ig)G levels are important for antibody vaccine responses and IgG subclass deficiencies have been associated with severe 2009 influenza A (H1N1) infections. Studies have demonstrated variations in immune responses to the H1N1 vaccine, but the aetiology of this is unknown. We determined the associations between pre-vaccination overall and influenza-specific IgG subclass levels and 2009 H1N1-specific antibody responses post-vaccination (robust versus poor at day 28) stratified by human immunodeficiency virus (HIV) status. Logistic regression models were utilized to evaluate whether pre-vaccination IgG subclass levels were associated with the antibody response generated post-vaccination. We evaluated 48 participants as part of a clinical study who were stratified by robust versus poor post-vaccination immune responses. Participants had a median age of 35 years; 92% were male and 44% were Caucasian. HIV-infected adults had a median CD4 count of 669 cells/mm(3) , and 79% were receiving highly active anti-retroviral therapy. HIV-infected participants were more likely to have IgG2 deficiency (<240 mg/dl) than HIV-uninfected individuals (62% versus 4%, P < 0·001). No association of pre-vaccination IgG subclass levels (total or influenza-specific) and the antibody response generated by HIN1 vaccination in either group was found. In summary, pre-vaccination IgG subclass levels did not correlate with the ability to develop robust antibody responses to the 2009 influenza A (H1N1) monovalent vaccine. IgG2 deficiencies were common among HIV-infected individuals but did not correlate with poor influenza vaccine responses. Further investigations into the aetiology of disparate vaccine responses are needed.

Comparison of coronary venous defibrillation with conventional transvenous internal defibrillation in man.

OBJECTIVE: Animal studies have shown that defibrillation in coronary veins is more effective than in the right ventricle. We aimed to assess the feasibility of placing defibrillation electrodes in the middle cardiac vein (MCV) in man and its impact on defibrillation requirements. METHODS: A prospective randomised study conducted in a tertiary referral centre. 10 patients (9 male) undergoing ICD implantation (65 (12) yrs) for NASPE/BPEG indications were studied. Defibrillation thresholds (DFT) were measured, using a binary search and an external defibrillator after 10 seconds of ventricular fibrillation, for the following configurations in each patient (order of testing randomised): RV + MCV --> Can and RV --> SVC + Can. INTERVENTIONS: A dual coil defibrillation electrode was placed transvenously in the right ventricle (RV) in the conventional manner. Using a guiding catheter a 3.2 Fr (67.5 mm length) electrode was placed transvenously in MCV. A test-can was placed subcutaneously in the left pectoral region. RESULTS: Lead placement was possible in 8/10 pts. Time to perform a middle cardiac venogram and place the electrode was 21 (23) mins. No adverse events were observed. Defibrillation current was less (6.7 (2.7) A) with RV + MCV --> Can compared to the conventional RV --> SVC + Can configuration (8.9 (3.4) A, p = 0.03). There was no significant difference in defibrillation voltage or energy. However, shock impedance was higher in the former configuration (57 (10) v. 43 (6) Omega, p = 0.001). CONCLUSIONS: In the majority of cases placement of a defibrillation lead in MCV is feasible. Defibrillation current requirements are 25% less when the shock is delivered using a MCV electrode.

Reduction in defibrillation threshold using an auxiliary shock delivered in the middle cardiac vein.

Defibrillation in the middle cardiac vein (MCV) has been shown to reduce ventricular defibrillation thresholds (DFTs). Low amplitude auxiliary shock (AS) from an electrode sutured to the left ventricle at thoracotomy have also been shown to reduce DFT if delivered immediately prior to a biphasic shock (between the ventricular RV and superior vena caval (SVC) electrodes). This study investigates the impact on DFT of an AS shock from a transvenously placed MCV lead system. A standard defibrillation electrode was positioned in the RV in eight anesthetized pigs (35-43 kg). A 50 x 1.8-mm electrode was inserted in the MCV through an 8 Fr angioplasty guide catheter. A 150-V (leading edge) monophasic AS was delivered (95 microF capacitor) from the MCV-->Can with three different pulse widths (3, 5, 7 ms). A primary biphasic shock (PS) (95 microF capacitor, phase 1: 44% tilt, 1.6-ms extension and phase 2: 2.5-ms fixed duration) was delivered from the RV-->Can +/- AS. The four configurations were randomized and DFTs (PS + AS) assessed using a modified binary search. Ventricular fibrillation (VF) was induced with 60 Hz AC followed 10 seconds later by the test shock. The DFTs were compared using repeated measures analysis of variance (ANOVA). All configurations incorporating AS produced significant (P < 0.05) reduction in the DFT compared to no AS (13.8 +/- 7.4 J). There was no difference in the efficacy of differing pulse widths (P > 0.05); 3 ms (11.0 +/- 5.4 J), 5 ms (11.5 +/- 6.0), and 7 ms (10.6 +/- 5.3 J). In conclusion, delivering an AS from a transvenous lead system deployed in the MCV reduces the DFT by 23% compared to a conventional RV-->Can shock alone.

Brief report: birth status, medical complications, and social environment: individual differences in development of preterm, very low birth weight infants.

OBJECTIVE: To assess whether medical complications mediate the relationship between birth status (i.e., birth weight and gestational age) and developmental outcome of preterm, very low birth weight (VLBW) infants, as well as the role of the early social environment (maternal distress and social support) in infant development. METHOD: Birth status and medical complication information was collected during the child's NICU stay. Maternal distress was assessed with the Beck Depression Inventory and the Parenting Stress Index at 4 months corrected infant age. Social support was measured with the Dunst Scales at 4 months corrected age. Child development measures were collected at 4 and 13 months corrected age (Bayley MDI and PDI), and at 36 months chronological age (PPVT-R and Achenbach CBCL). RESULTS: Medical complications mediated the birth status-outcome relationship at 4 and 13 months, but not at 36 months. The 36-month outcomes were predicted by 4-month maternal distress and social support. CONCLUSIONS: Prematurity and VLBW are indirectly related to early developmental outcome through their association with medical complications. However, by 36 months, developmental outcomes are more closely related to aspects of the early social environment than to early physiological factors.

Prenatal maternal predictors of cognitive and emotional delays in children of adolescent mothers.

The present study examined relationships among prenatal characteristics of 121 adolescent mothers-including cognitive readiness for parenting, intelligence, social support, and personal adjustment-and intellectual-linguistic development, social-emotional functioning, and adaptive behavior in their children at three years of age. Only 28% of the children scored within normal ranges on all three types of outcomes. Intellectual and linguistic delays were predicted best by prenatal measures of maternal Performance IQ and social support from extended family. Socioemotional problems were predicted best by maternal internalizing problems and social support from partner and friends. Adaptive behavior was associated with parenting style. Implications for the early identification of high-risk children--and associated intervention programs--are discussed.

Increased defibrillation threshold with right-sided active pectoral can.

UNLABELLED: The aim of this study was to identify the optimal position on the chest wall to place an implant able cardioverter defibrillator in a two-electrode system, consisting of a right ventricular electrode and active can. METHODS AND RESULTS: Defibrillation thresholds (DFT) were measured in 10 anaesthetised pigs (weight 33-45 kg). An Angeflextrade mark lead was introduced transvenously to the right ventricular apex. The test-can (43 cc) was implanted submuscularly in each of four locations: left pectoral (LP), right pectoral (RP), left lateral (LL) and apex (A). The sequence in which the four locations were tested was randomized. Ventricular fibrillation (VF) was induced using 60 Hz alternating current. Rectangular biphasic shocks were delivered 10 seconds after VF induction. The DFT was measured using a modified four-reversal binary search. The results of the four configurations were: LP, 14.6+/- 4.0 J; RP, 18.8+/- 4.2 J; LL, 14.7+/- 4.1 J; A, 14.9+/- 3.1 J. Repeated measures analysis of variance showed that the DFT of RP was significantly higher than LP, LL and A (p < 0.05). CONCLUSIONS: Implanting an active can in the RP position increases the DFT by 29% compared to LP, LL and A sites. The can position on the left thorax does not appear to have a significant influence on DFT.

Inspiration induced by phrenic nerve stimulation increases internal defibrillation energy requirements.

INTRODUCTION: The purpose of this study was to systematically evaluate the effects of active inspiration induced by phrenic nerve stimulation on the energy required for 50% successful defibrillation (E50). METHODS AND RESULTS: Shocks (95-microF biphasic waveform) were delivered after 10 seconds of ventricular fibrillation between a right ventricular coil and left pectoral test can in ten anesthetized pigs (25 to 37 kg). Using a 1-J step size, the E50 was determined with an up/down, three-reversal method. Positive-pressure ventilation was halted just before fibrillation, and shocks were delivered during expiration or at the end of 2 seconds of bilateral phrenic stimulation (50 Hz, 0.3 msec, 5 to 6 V). Phrenic stimulation produced inspiratory volumes that were 15.3 +/- 1.7 mL/kg (mean +/- SD). The E50 was 9.8 +/- 1.9 J during expiration and increased to 13.0 +/- 1.7 during inspiration (P = 0.001). The leading-edge voltage at the E50 was 451 +/- 46 V during expiration and 519 +/- 33 V during inspiration (P = 0.001). The leading-edge current at the E50 was 9.7 +/- 1.0 A during expiration and increased to 11.3 +/- 1.4 A during inspiration (P = 0.002). The average impedance was 47.8 +/- 2.7 omega during expiration and 47.3 +/- 3.3 omega during inspiration (P = 0.12). CONCLUSION: Inspiration induced by phrenic stimulation results in a 31% increase in the E50 compared with expiration. The decrease in shock efficacy occurs in the absence of a change in impedance. Active inspiration may alter the distribution of the electrical field leading to a decrease in shock efficacy.

Low voltage direct current delivered through unipolar transvenous leads: an alternate method for the induction of ventricular fibrillation.

The induction of VF during testing of an ICD may not always be possible using either burst pacing or high energy T wave shocks. The purpose of this study was to evaluate the effectiveness of low energy DC stimulation for inducing VF in a porcine model. The VFT was measured using constant voltage stimuli and a step-up method in ten anesthetized pigs (25-30 kg). Stimuli of different durations (0.5, 1.0, 2.0 s) were delivered (unsynchronized) between a right ventricular apical coil and a subcutaneous test can. Current was measured from the voltage drop across a series resistor (10 omega). With anodal stimulation, VF required 6.4 +/- 0.2 V compared to 13.8 +/- 0.6 V with cathodal stimulation (P < 0.001). The current required to induce VF (measured 10 ms after the stimulus onset) was 58.3 +/- 2.2 mA with anodal stimulation and 119.3 +/- 4.7 mA with cathodal stimulation (P < 0.001). Stimulus duration did not significantly influence the voltage or current required for VF induction. In 6 of the 10 pigs, synchronizing a 0.5-second stimulus to the R wave did not significantly alter the VFT compared to same stimulus synchronized to mid-upslope of the T wave. The results indicate that VF can be consistently induced through transvenous electrodes by passing unsynchronized DC for 0.5-2 seconds. The induction of VF required about 50% less current and voltage with anodal stimulation. It should be possible to induce VF with the DC voltage available from the internal battery source of an ICD.

A longitudinal analysis of maternal abuse potential and developmental delays in children of adolescent mothers.

OBJECTIVE: This project was designed to examine the impact of adolescent mothers' abuse potential on the development of preschool children. The specific aims were to demonstrate relationships between maternal abuse potential and developmental problems in preschool children, to examine these relationships across time, and to determine whether maternal abuse potential predicted developmental delays after controlling for problematic parenting orientations. METHOD: Using a longitudinal design, we examined 146 first time mothers and their children. Maternal abuse potential was assessed when children were 1, 3, and 5 years old; problematic parenting orientation was assessed when the children were 6 months old; and child development (i.e., IQ, adaptive behavior, and behavior problems) was assessed at ages 3 and 5. RESULTS: Regression analyses revealed significant relationships between maternal abuse potential and a variety of developmental problems. Path analyses revealed unidirectional relationships between abuse potential predicting IQ and adaptive behaviors. Further analyses indicated that maternal abuse potential at 1 and 3 years predicted intelligence and adaptive behavior at ages 3 and 5, even when problematic parenting orientation was controlled. In contrast, children's behavioral problems at ages 3 and 5 was better accounted for by problematic parenting orientation than by abuse potential. CONCLUSIONS: The results of this study revealed that developmental delays in children of adolescent are related to abuse potential. Two pathways were found for predicting developmental delays: One pathway linked child abuse potential with IQ and adaptive functioning: the other pathway showed that problematic parenting orientation accounted for the development of emotional and behavioral problems.

Performance characteristics of rapid (30-second) prescreening. Implications for calculating the false-negative rate and comparison with other quality assurance techniques.

Rapid (30-second) prescreening of cervicovaginal smears can be used to detect false-negative cases and determine the false-negative rate of primary screening, but the performance characteristics have not been evaluated fully. A test set of 242 cases including 80 originally false-negative cases were rapidly screened by 4 different cytotechnologists on 2 occasions. Intraobserver and interobserver reproducibility were good. Median specificity for each round of observations was 89% (range, 30%-96%). Median sensitivity for all true-positive cases was 78% (range, 63%-97%); for all false-negative cases it was 59% (range, 38%-89%). The relative sensitivity of rapid screening for true-positive and false-negative cases varied with the diagnosis. Rapid screening detected almost the same percentage of false-negative cases of atypical squamous cells of uncertain significance (ASCUS) as true-positive ASCUS cases (median ratio, 1.12; range, 0.72-1.52). The median ratio of false-negative to true-positive ASCUS cases was significantly different than the ratio for low-grade plus high-grade squamous intraepithelial lesions (0.68; range, 0.50-0.96). Although performance varies between individuals, in this test population the reproducibility, specificity, and sensitivity were good. Because it detects more false-negative cases at a lower cost per case than routine rescreening, rapid prescreening should be considered as an alternative to current quality control measures.

Transient posterior knee pain with the meniscal arrow.

A 31% incidence of focal posterior knee pain was noted in our initial experience with all-inside meniscal repair using the absorbable Meniscal Arrow system (Bioscience, Tampere, Finland). The pain was transient, resolved by 6 months in all cases, and was unrelated to the length of implant. A typical case is presented to assist surgeons in counseling patients who experience transient posterior knee pain after meniscal repair with this system.

Significance of cell groups in voided urine.

OBJECTIVE: To determine the significance of different types of cell groups in voided urine for diagnosing transitional cell carcinoma (TCC). STUDY DESIGN: We reviewed voided urine specimens, with corresponding biopsies taken within 120 days after urine collection, for cell groups. Type and number of cell groups were correlated with the histologic diagnoses. RESULTS: Of 5,001 voided urine specimens, 134 (3%) had corresponding biopsies. Flat sheets were significantly more common in urine specimens with corresponding negative biopsies (24%) than in those with biopsies showing TCC (6%) (chi 2 P = .0032). The incidence of collared, three-dimensional cell groups was low (0-7%) and not associated with biopsy findings. Irregular, three-dimensional cell groups were more common than collared cell groups and were most common in cases with invasive TCC on biopsy (38%). While this was statistically significantly more common than in urines associated with negative biopsies (17%) (chi 2 P = .0499), it was not specific. Requiring three or more irregular cell groups did not improve discrimination between TCC and benign cases. Cell groups of any type or number were not more common in cases associated with grade 1 papillary TCC than negative biopsies. Diagnoses associated with multiple irregular, three-dimensional cell groups and a negative biopsy included medullary sponge kidney, hemorrhagic cystitis, cystitis not otherwise specified, and urolithiasis. CONCLUSION: Irregular, three-dimensional cell groups were most common in voided urine from patients with invasive TCC, but the identification of cell groups of any type in voided urine had little diagnostic utility.

Predicting adolescent mothers' transition to adulthood.

This study investigates the relation among prenatal maternal resources (including intellectual ability, cognitive readiness for parenting, personal adjustment and social support), maternal perceptions about parenting and children's temperament when children were 6 months of age, and individual differences in the adaptation of 90 adolescent mothers 3 years after the birth of their first child. It was hypothesized that adolescent mothers¿ pre-existing resources and emerging perceptions about parenting determine not only their children's but also their own later adaptation to critical life events. Maternal resources uniquely predicted later maternal cognitive functioning, personal adjustment, and child abuse potential, whereas maternal perceptions uniquely predicted maternal demographic status 3 years after childbirth. Moreover, maternal perceptions were found to mediate the influence of maternal resources on parent-child interactional styles. The unique roles that maternal resources and perceptions played in determining later maternal functioning are discussed.

Adolescent mothers and child abuse potential: an evaluation of risk factors.

This research examines maternal and child factors that place adolescent mothers at risk for abusing their children. Using a longitudinal design, relationships among four risk factors (social supports, maternal psychological adjustment, maternal preparation for parenting, and child temperament), maternal psychological predisposition for aggressive coping (perceptions of stress and endorsements of punitive parenting), and maternal abuse potential were examined in a sample of 75 primiparous adolescent mothers and their children. Preparation for parenting, a construct which included knowledge and attitudes about children's development, was the strongest direct predictor of abuse potential; however, its effects were also partially mediated by the mother's psychological predisposition for aggressive coping. Similarly, the effects of child temperament on abuse were mediated by the mother's psychological predisposition for aggressive coping. Implications for designing intervention programs, and identifying at-risk adolescents, were also discussed.

PIP: The capability of four contextual risk factors (social support, maternal psychological adjustment, maternal preparation for parenting, and child temperament) as well as maternal predisposition for aggression (stress perception and endorsement of punitive parenting) to predict child abuse potential in adolescent mothers was investigated in 75 mother-child dyads. These pairs were drawn from a larger, longitudinal study on adolescent parenting conducted in Indiana and South Carolina (US). Mothers averaged 17.3 years of age at delivery and were predominantly (64%) African-American. Data were collected prenatally, at 6 months, and at 12 months. Compared to the general teen population, mothers showed above-average levels of financial stress and internalizing psychological problems (e.g., depression); they were uncertain about their roles as parents and rated their infants as difficult. A higher score on the risk composite was significantly (p 0.01) associated with a higher score on the abuse potential index. Also significant (p 0.001) was an association between the risk composite and a predisposition for aggressive coping. However, separate analyses revealed that the four risk factors were not equally effective in predicting child abuse potential. Abuse potential was significantly related only to parenting preparation (p 0.001). Endorsement of punitive parenting was an influential mediator of the relationships between risk factors. These findings suggest a need for interventions aimed at educating teens about child development and realistic expectations, expanding their repertoire of parenting skills, and teaching them to control aggression.

Electrical measurement for detecting early postmortem changes in porcine muscle.

Use of electrical measurements to detect quality defects in porcine muscle in the early postmortem period was evaluated. Justification for use of a tetrapolar, constant current electrode configuration instead of bipolar electrodes was provided for measurements at low frequencies. Interrelationships among electrical properties, pH values, ATP decline, temperature, time postmortem, and final water-holding capacity (WHC) of porcine muscle were quantified using 25 hogs. Immediately after exsanguination, a section of the left longissimus muscle (LM) was excised to obtain rigor shortening patterns and complex impedance measurements over a 10-h period at 37 degrees C. Complex impedance measurements were taken using a tetrapolar electrode configuration at 1 kHz and .156 mA. At 15, 45, and 90 min postmortem, pH, ATP/IMP absorbance (R), and conductivity measured by the Tecpro Pork Quality Meter (PQM) were measured on the right side LM. At 24 h postmortem, WHC, pH, R, PQM, Hunter Color Lab values, and subjective quality scores were evaluated on the left LM. The WHC measurements were used to group carcasses into normal (n = 17) and abnormal (n = 8) categories. Mean pH and R at 45 and 90 min were different (P < .05) but pH at 24 h was not different between the normal and abnormal groups. Onset and completion of rigor were more rapid in carcasses with low WHC (P < .05). The PQM values were greater (P < .05) in the abnormal group at 90 min and 24 h postmortem. Excised muscle measurements of relative impedance (Z*) and phase (theta*) showed Z* and theta* increased more rapidly within the first 15 min postmortem (P < .1) for samples with abnormal WHC. However, one PSE carcass showed an immediate rapid decrease in Z* and theta*. Results suggest measurement of rate of change of impedance and phase angle before 90 min postmortem would be a better prediction of ultimate quality than absolute magnitude of impedance.

Personal adjustment during pregnancy and adolescent parenting.

This study examined "naturally occurring differences" in personal adjustment (social competence, behavior problems, and problem-solving skills) among representative groups of pregnant and nonpregnant adolescents and pregnant adults. Differences in parenting stress and parenting style were also assessed among a subsample of adolescent and adult mothers. Finally, the relationship between prenatally assessed personal adjustment and parenting was evaluated in the adolescent mother group. The contributions of important demographic characteristics (socioeconomic status and race) to both between- and within-group relationships were examined. Results suggested that pregnant adolescents were less socially competent and less proficient in their problem solving than their nonpregnant peers and that they exhibited more behavioral problems than a pregnant adult comparison group. Adolescent mothers displayed higher levels of parenting stress and were less responsive and sensitive in interactions with their infants than adult mothers. Support for the hypothesized link between prenatally assessed personal adjustment and adolescent parenting stress was found, whereas no relationship between socioeconomic status and race and parenting stress was established. These results suggest that intervention with young mothers identified during pregnancy as having personal problems might forestall parenting problems that arise during early child rearing.