Through babies' eyes: Practical and theoretical considerations of using wearable technology to measure parent-infant behaviour from the mothers' and infants' view points.

AIMS: To explore the utility of first-person viewpoint cameras at home, for recording mother and infant behaviour, and for reducing problems associated with participant reactivity, which represent a fundamental bias in observational research. METHODS: We compared footage recording the same play interactions from a traditional third-person point of view (3rd PC) and using cameras worn on headbands (first-person cameras [1st PCs]) to record first-person points of view of mother and infant simultaneously. In addition, we left the dyads alone with the 1st PCs for a number of days to record natural mother-child behaviour at home. Fifteen mothers with infants (3-12 months of age) provided a total of 14h of footage at home alone with the 1st PCs. RESULTS: Codings of maternal behaviour from footage of the same scenario captured from 1st PCs and 3rd PCs showed high concordance (kappa >0.8). Footage captured by the 1st PCs also showed strong inter-rater reliability (kappa=0.9). Data from 1st PCs during sessions recorded alone at home captured more 'negative' maternal behaviours per min than observations using 1st PCs whilst a researcher was present (mean difference=0.90 (95% CI 0.5-1.2, p<0.001 representing 1.5 SDs). CONCLUSION: 1st PCs offer a number of practical advantages and can reliably record maternal and infant behaviour. This approach can also record a higher frequency of less socially desirable maternal behaviours. It is unclear whether this difference is due to lack of need of the presence of researcher or the increased duration of recordings. This finding is potentially important for research questions aiming to capture more ecologically valid behaviours and reduce demand characteristics.

Scoping Review on Maternal Health among Immigrant and Refugee Women in Canada: Prenatal, Intrapartum, and Postnatal Care.

The last fifteen years have seen a dramatic increase in both the childbearing age and diversity of women migrating to Canada. The resulting health impact underscores the need to explore access to health services and the related maternal health outcome. This article reports on the results of a scoping review focused on migrant maternal health within the context of accessible and effective health services during pregnancy and following delivery. One hundred and twenty-six articles published between 2000 and 2016 that met our inclusion criteria and related to this group of migrant women, with pregnancy/motherhood status, who were living in Canada, were identified. This review points at complex health outcomes among immigrant and refugee women that occur within the compelling gaps in our knowledge of maternal health during all phases of maternity. Throughout the prenatal, intrapartum, and postnatal periods of maternity, barriers to accessing healthcare services were found to disadvantage immigrant and refugee women putting them at risk for challenging maternal health outcomes. Interactions between the uptake of health information and factors related to the process of immigrant settlement were identified as major barriers. Availability of appropriate services in a country that provides universal healthcare is discussed.

Effect of Zinc Intake on Growth in Infants: A Meta-analysis.

A systematic review and meta-analysis of available randomized controlled trials (RCTs) was conducted to evaluate the effect of zinc (Zn) intake on growth in infants. Out of 5500 studies identified through electronic searches and reference lists, 19 RCTs were selected after applying the exclusion/inclusion criteria. The influence of Zn intake on growth was considered in the overall meta-analysis. Other variables were also taken into account as possible effect modifiers: doses of Zn intake, intervention duration, nutritional status, and risk of bias. From each select growth study, final measures of weight, length, mid upper arm circumference (MUAC), head circumference, weight for age z-score (WAZ), length for age z-score (LAZ), and weight for length z-score (WLZ) were assessed. Pooled ß and 95% confidence interval (CI) were calculated. Additionally, we carried out a sensitivity analysis. Zn intake was not associated with weight, length, MUAC, head circumference, and LAZ in the pooled analyses. However, Zn intake had a positive and statistically effect on WAZ (ß = 0.06; 95%CI 0.02 to 0.10) and WLZ (ß = 0.05; 95%CI 0.01 to 0.08). The dose-response relationship between Zn intake and these parameters indicated that a doubling of Zn intake increased WAZ and WLZ by approximately 4%. Substantial heterogeneity was present only in length analyses (I(2) = 45%; p = 0.03). Zn intake was positively associated with length values at short time (four to 20 weeks) (ß = 0.01; CI 95% 0 to 0.02) and at medium doses of Zn (4.1 to 8 mg/day) (ß = 0.003; CI 95% 0 to 0.01). Nevertheless, the effect magnitude was small. Our results indicate that Zn intake increases growth parameters of infants. Nonetheless, interpretation of these results should be carefully considered.

Ciguatera fish poisoning in an international ship crew in Saint John Canada: 2015.

An international ship crew presented for medical care in Saint John, New Brunswick, following rapid onset of gastrointestinal and in some cases neurological and cardiac symptoms after a common fish meal. Ciguatera poisoning was identified as the cause of illness. This report describes the public health investigation and management of this incident, including collaboration between the implicated provincial and federal authorities.

Texture analysis of periventricular echogenicity on neonatal cranial ultrasound predicts periventricular leukomalacia.

BACKGROUND: White matter periventricular echogenicity detected in neonatal cranial ultrasound (US) scans may be followed by cystic periventricular leukomalacia (PVL) or might resolve. Serial US are therefore needed to clarify the outcome. Texture analysis is a computerized method to analyze images and distinguish findings that are undetectable by the human eye. OBJECTIVE: To test whether texture analysis can differentiate echogenicities that resolve from those that develop cystic PVL. MATERIAL AND METHODS: Neonates with echogenicities on their initial US scan were studied; texture analysis was performed on the coronal and sagittal sections. Texture parameters were entered into a linear discriminant analysis (LDA) to classify the scans along two axes called most discriminant features (MDF) 1 and 2. RESULTS: We studied twenty infants with periventricular echogenicities on initial scans; ten of them later resolved (group A), while the other ten infants developed cystic PVL (group B). The classification accuracy was 66% and 82% for group A and B on sagittal sections, and 75%, and 80% on coronal. In the coronal and sagittal plane respectively, a MDF1 value of 0.98 and 0.24 and an MDF2 value of 0.86 and 0.001 provided the best sensitivity, specificity, positive and negative likelihood ratio. CONCLUSION: Texture analysis is a promising objective tool to early identify which cranial echogenicity that will develop into cystic PVL.

Electronic Health Record Adoption - Maybe It's not about the Money: Physician Super-Users, Electronic Health Records and Patient Care.

OBJECTIVE: The slow adoption of electronic health record (EHR) systems has been linked to physician resistance to change and the expense of EHR adoption. This qualitative study was conducted to evaluate benefits, and clarify limitations of two mature, robust, comprehensive EHR Systems by tech-savvy physicians where resistance and expense are not at issue. METHODS: Two EHR systems were examined - the paperless VistA / Computerized Patient Record System used at the Veterans' Administration, and the General Electric Centricity Enterprise system used at an academic medical center. A series of interviews was conducted with 20 EHR-savvy multiinstitutional internal medicine (IM) faculty and house staff. Grounded theory was used to analyze the transcribed data and build themes. The relevance and importance of themes were constructed by examining their frequency, convergence, and intensity. RESULTS: Despite eliminating resistance to both adoption and technology as drivers of acceptance, these two robust EHR's are still viewed as having an adverse impact on two aspects of patient care, physician workflow and team communication. Both EHR's had perceived strengths but also significant limitations and neither were able to satisfactorily address all of the physicians' needs. CONCLUSION: Difficulties related to physician acceptance reflect real concerns about EHR impact on patient care. Physicians are optimistic about the future benefits of EHR systems, but are frustrated with the non-intuitive interfaces and cumbersome data searches of existing EHRs.

Overweight and obesity in pregnancy do not adversely affect neonatal outcomes: new evidence.

We studied neonatal outcomes of infants of obese mothers in a cohort of 6,125 deliveries, using logistic multivariate analysis to remove the role of potential confounding variables. Although, as in previous reports, the crude unadjusted prevalence of several adverse neonatal outcomes was higher in these infants, the multivariable analysis revealed that only two outcomes remained significantly associated with maternal overweight and obesity: neonatal macrosomia (adjusted odds ratios aOR 1.4, p < 0.001) and meconium aspiration syndrome (aOR 1.6, p = 0.05), indicating that the unadjusted association with the other outcomes was caused by confounding factors. Nonetheless, as macrosomia is associated with increased health risks both to the mothers and their infants, and maternal obesity with considerable maternal morbidity during pregnancy, these results should not lead to complacency, but instead encourage better prevention of obesity in general and during pregnancy in particular.

A multi-centre multi-national survey of anaesthetists regarding the range of anaesthetic and surgical practices for paediatric scoliosis surgery.

Institutional responses to a detailed multi-national survey were used to characterise the range of current anaesthetic and surgical practices for paediatric scoliosis surgery. Questions addressed surgical practice, anaesthetic agents, blood-sparing techniques, neurophysiological monitoring used and recalled major complications. Twenty-seven (87%) institutions responded. The median number of cases of these institutions was 40 per year (range 5 to 700). Common practices included inhaled volatile anaesthetic maintenance (80%), omission of nitrous oxide (81%), intravenous remifentanil (88% [range 0.05 to 2.00 microg x kg(-1) x min(-1)]), and double intravenous antiemetic agent prophylaxis (59%); multimodal analgesia with paracetamol and parenteral opioids, non-steroidal anti-inflammartory drugs and epidural local anaesthetic or opioid infusion (UK) and intrathecal opioids and sub-anaesthetic doses of intravenous ketamine by infusion (Australia); use of cell-saver (81%), controlled hypotension (77%) and antifibrinolytic agents (74%) (intravenous aprotinin [59%] or tranexamic acid [44%]); and epidural somatosensory (92%), neurogenic motor-evoked (32%), compound motor action (31%) and transcranial motor-evoked potential monitoring (54%), with routine wake-up test used infrequently (19%). Fifty-four neurological or cardiac adverse events or deaths were recalled. While institutional practices varied, common themes were identified. The information obtained may suggest new strategies to various centres and could be useful for planning multi-centre audits and trials.

Infants of diabetic mothers with abnormal fetal growth missed by standard growth charts.

Diabetic pregnancies may result in fetal macrosomia when glycaemia is poorly controlled, and when associated with diabetic vasculopathy, with small for gestational age (SGA) neonates. Both groups of infants have high neonatal morbidity. As fetal growth depends on maternal genetic influences, ethnic group or parity, relying exclusively on population-based growth charts may wrongly categorise the growth pattern of these infants. We compared neonatal morbidity and mortality of a cohort of 214 infants of diabetic mothers (IDM), identified either by population standards or by customised birth weight percentiles (adjusted for maternal height, booking weight, parity, ethnic origin, gestational age at delivery and sex). A total of 68 (31.8%) were diagnosed with macrosomia, 11 (16%) of whom were identified by the customised growth method alone, and 16 were diagnosed as SGA (7.5%), of whom the majority (13 or 81.2%) were identified by the customised growth method alone. None had increased mortality and morbidity.

New geochronological, paleoclimatological, and archaeological data from the Narmada Valley hominin locality, central India.

The oldest known fossil hominin in southern Asia was recovered from Hathnora in the Narmada Basin, central India in the early 1980's. Its age and taxonomic affinities, however, have remained uncertain. Current estimates place its maximum age at >236ka, but not likely older than the early middle Pleistocene. The calvaria, however, could be considerably younger. We report recent fieldwork at Hathnora and associated Quaternary type-sections that has provided new geological and archaeological insights. The portion of the exposed 'Boulder Conglomerate' within the Surajkund Formation, which forms a relict terrace and has yielded the hominin fossils, contains reworked and stylistically mixed lithic artifacts and temporally mixed fauna. Three mammalian teeth stratigraphically associated with the hominin calvaria were dated by standard electron spin resonance (ESR). Assuming an early uranium uptake (EU) model for the teeth, two samples collected from the reworked surface deposit averaged 49+/-1ka (83+/-2ka, assuming linear uptake [LU]; 196+/-7ka assuming recent uptake [RU]). Another sample recovered from freshly exposed, crossbedded gravels averaged 93+/-5ka (EU), 162+/-8ka (LU) or 407+/-21ka (RU). While linear uptake models usually provide the most accurate ages for this environment and time range, the EU ages represent the minimum possible age for fossils in the deposit. Regardless, the fossils are clearly reworked and temporally mixed. Therefore, the current data constrains the minimum possible age for the calvaria to 49+/-1ka, although it could have been reworked and deposited into the Hathnora deposit any time after 160ka (given the LU uptake ages) or earlier (given the RU ages). At Hathnora, carbonaceous clay, bivalve shells, and a bovid tooth recovered from layers belonging to the overlying Baneta Formation have yielded (14)C ages of 35.66+/-2.54cal ky BP, 24.28+/-0.39cal ky BP, and 13.15+/-0.34ky BP, respectively. Additional surveys yielded numerous lithics and fossils on the surface and within the stratigraphic sequence. At the foot of the Vindhyan Hills 2km from the river, we recovered a typologically Early Acheulean assemblage comprised of asymmetrical bifaces, large cleavers with minimal working, trihedral picks, and flake tools in fresh condition. These tools may be the oldest Acheulean in the Narmada Valley. Several lithics recovered from the Dhansi Formation may represent the first unequivocal evidence for an early Pleistocene hominin presence in India. In situ invertebrate and vertebrate fossils, pollen, and spores indicate a warm, humid climate during the late middle Pleistocene. High uranium concentrations in the mammalian teeth indicate exposure to saline water, suggesting highly evaporative conditions in the past. Late Pleistocene sediment dated between 24.28+/-0.39cal ky BP and 13.15+/-340ky BP has yielded pollen and spores indicating cool, dry climatic conditions corresponding to Oxygen Isotope Stage 2 (OIS 2). An early Holocene palynological assemblage from the type locality at Baneta shows evidence for relatively dry conditions and a deciduous forest within the region. The Dhansi Formation provisionally replaces the Pilikarar Formation as the oldest Quaternary formation within the central Narmada Basin. The Baneta Formation, previously dated at 70ka to 128ka, correlates with the late Pleistocene and early Holocene. Our results highlight the need for further Quaternary geological and paleoanthropological research within the Narmada Basin, especially because dam construction threatens these deposits.

Growing urban health: community gardening in South-East Toronto

This article describes results from an investigation of the health impacts of community gardening, using Toronto, Ontario as a case study. According to community members and local service organizations, these gardens have a number of positive health benefits. However, few studies have explicitly focused on the health impacts of community gardens, and many of those did not ask community gardeners directly about their experiences in community gardening. This article sets out to fill this gap by describing the results of a community-based research project that collected data on the perceived health impacts of community gardening through participant observation, focus groups and in-depth interviews. Results suggest that community gardens were perceived by gardeners to provide numerous health benefits, including improved access to food, improved nutrition, increased physical activity and improved mental health. Community gardens were also seen to promote social health and community cohesion. These benefits were set against a backdrop of insecure land tenure and access, bureaucratic resistance, concerns about soil contamination and a lack of awareness and understanding by community members and decision-makers. Results also highlight the need for ongoing resources to support gardens in these many roles. (AU)

Growing urban health: community gardening in South-East Toronto

This article describes results from an investigation of the health impacts of community gardening, using Toronto, Ontario as a case study. According to community members and local service organizations, these gardens have a number of positive health benefits. However, few studies have explicitly focused on the health impacts of community gardens, and many of those did not ask community gardeners directly about their experiences in community gardening. This article sets out to fill this gap by describing the results of a community-based research project that collected data on the perceived health impacts of community gardening through participant observation, focus groups and in-depth interviews. Results suggest that community gardens were perceived by gardeners to provide numerous health benefits, including improved access to food, improved nutrition, increased physical activity and improved mental health. Community gardens were also seen to promote social health and community cohesion. These benefits were set against a backdrop of insecure land tenure and access, bureaucratic resistance, concerns about soil contamination and a lack of awareness and understanding by community members and decision-makers. Results also highlight the need for ongoing resources to support gardens in these many roles. (AU)

Enhanced response of granulosa and theca cells from sheep carriers of the FecB mutation in vitro to gonadotropins and bone morphogenic protein-2, -4, and -6.

The FecB (Booroola) mutation, which leads to increased ovulation rates and multiple births in sheep, is now known to occur in the signaling domain of the bone morphogenic protein (BMP)-1B receptor. We examined the effect of the mutation on the responsiveness of granulosa (GC) and theca cells (TC) to BMPs and other local regulators using tissue from animals with (Fec(B/B)) and without (Fec(+/+)) the FecB mutation. Experiments examined the effect of BMP-2, -4, and -6 (0.005-50 ng/ml), and their interaction with IGF-I (0.1-10 ng/ml LR3 analog) and gonadotropins, on the proliferation and differentiation of GCs and TCs isolated from small (<2 mm) antral follicles and maintained in serum-free culture for up to 8 d. Dose-finding studies using ovaries from wild-type sheep obtained from the abbattoir showed no difference among the different BMPs in stimulating (P < 0.001) estradiol (E2) production by GCs cultured with FSH (10 ng/ml), but there was a clear interaction (P < 0.001) with IGF-I. BMPs had no effect on GC proliferation or the sensitivity of GCs to FSH. In contrast, higher doses of BMPs (5-50 ng/ml) inhibited LH-stimulated androstenedione production by TCs, whereas lower doses (0.005-0.05 ng/ml) stimulated TC proliferation (P < 0.01). Regardless of dose of IGF-I, at the end of culture (96-192 h) hormone production by GCs (E2, inhibin A) and TCs (androstenedione) was 4- to 5-fold greater (P < 0.001) by cells from Fec(B/B), compared with Fec(+/+) ewes exposed to the same dose of gonadotropin. In the presence of low concentrations of IGF-I (0.1 ng/ml), the maximum increase in the production of E2 and inhibin A by GCs from FF ewes in response to BMPs was observed at doses that were 3- to 10-fold lower (3-10 ng/ml) than ++ (30 ng/ml; P < 0.001). Low doses of BMPs stimulated proliferation of TCs from ++ (P < 0.01) but not FF ewes. Immunohistochemistry confirmed BMP-6 protein expression in the oocyte, granulosa, and thecal layers of antral follicles from both genotypes. These results confirm a major role for BMPs in controlling ovarian somatic cell function in sheep and provide evidence to support the hypothesis that the FecB mutation increases the BMP response of somatic cells when stimulated to differentiate by gonadotropins.

Development and validation of an instrument to measure the postgraduate clinical learning and teaching educational environment for hospital-based junior doctors in the UK.

This paper describes the development and validation of a 40-item inventory, the Postgraduate Hospital Educational Environment Measure (PHEEM), by researchers in Scotland and the West Midlands using a combination of grounded theory and Delphi process. The instrument has since returned an alpha reliability >0.91 in two administrations in England and may be a useful instrument in the quality assurance process for postgraduate medical education and training.

Influence of larval stage and virus inoculum on virus yield in insect host Neodiprion abietis (Hymenoptera: Diprionidae).

Virus yield produced by dead larvae of balsam fir sawfly, Neodiprion abietis (Harris) (Hymenoptera: Diprionidae), that had been infected at four different larval stages (second, third, fourth, or fifth instar) with two virus concentrations (10(5) polyhedral inclusion bodies (PIB) /ml or 10(7) PIB/ml), were analyzed and compared to determine the effects of instar and amount of virus inoculum on virus production. The results indicate that both larval stage and inoculation dosage significantly affect virus yield. On average, each dead larva produced 1.36-12.21 x 10(7) PIB, depending upon larval age and virus concentration of inoculation. Although each dead larva produced more PIB when it was inoculated in the fourth or fifth stage, inoculation of these larvae did not result in the highest virus yield because of low larval mortality. In terms of net virus return, third instars would maximize virus yield when they are inoculated with a virus concentration that can cause 95-100% larval mortality.