Diversity, seasonal abundance, and environmental drivers of chaetognath populations in North Inlet Estuary, South Carolina, USA

Chaetognaths (Phylum: Chaetognatha) are one of the most abundant phyla of zooplankton worldwide and play an important role in marine trophic interactions. Although the role of chaetognaths in global ecosystems is well understood, the spatial variation and environmental drivers of estuarine chaetognath populations is poorly understood. To provide the first known record of chaetognath species composition in a coastal estuary in the south-eastern USA, chaetognaths were identified and quantified from zooplankton samples collected on a monthly basis in 2019 and 2020 from North Inlet Estuary in South Carolina. Parasagitta tenuis was the most abundant species of the five found, making up 33% of total abundance. The egg presence of these chaetognaths was further analyzed to gauge reproductive cycles. Abundance and egg presence were compared with surface and bottom measurements of temperature, salinity, and dissolved oxygen levels to determine the driving abiotic factors behind chaetognath's seasonal variability and reproductive cycles. Temperature, salinity, and dissolved oxygen all had low (r < ±.29), non-significant correlations with abundance. Chaetognath egg production was most significantly associated with dissolved oxygen (p < .001) and seasonal changes in temperature (p < .001). Our initial findings indicate the continued abundance of chaetognath in a local estuary are dependent on abiotic factors that are strongly influenced by a changing climate.

A Prediction Model for Positive Infant Meconium and Urine Drug Tests

OBJECTIVE

This study aimed to determine the factors associated with positive infant drug screen and create a shortened screen and a prediction model.

STUDY DESIGN

This is a retrospective cohort study of all infants who were tested for drugs of abuse from May 2012 through May 2014. The primary outcome was positive infant urine or meconium drug test. Multivariable logistic regression was used to identify independent risk factors. A combined screen was created, and test characteristics were analyzed.

RESULTS

Among the 3,861 live births, a total of 804 infants underwent drug tests. Variables associated with having a positive infant test were (1) positive maternal urine test, (2) substance use during pregnancy, (3) ≤ one prenatal visit, and (4) remote substance abuse; each p-value was less than 0.0001. A model with an indicator for having at least one of these four predictors had a sensitivity of 94% and a specificity of 69%. Application of this screen to our population would have decreased drug testing by 57%. No infants had a positive urine drug test when their mother's urine drug test was negative.

CONCLUSION

This simplified screen can guide clinical decision making for determining which infants should undergo drug testing. Infant urine drug tests may not be needed when a maternal drug test result is negative.

KEY POINTS

· Many common drug screening criteria are not predictive.. · Four criteria predicted positive infant drug tests.. · No infant urine drug test is needed if the mother tests negative..

Breastfeeding Advocacy: A Look into the Gap Between Breastfeeding Support Guidelines and Personal Breastfeeding Experiences of Faculty Physicians

Objectives: Despite increased lactation support for mothers over the past few decades, physician mothers still face considerable challenges to achieving their breastfeeding goals. Disparities in breastfeeding exist between physician and nonphysician mothers in the United States. To formulate an effective advocacy agenda for this population, we surveyed faculty physician mothers about their breastfeeding experiences. We hypothesized that identifying frequent, modifiable barriers to breastfeeding could generate ideas for improved lactation support for female physicians. Study Design: A deidentified breastfeeding survey was sent to female faculty physicians at an academic children's hospital in 2020. Inclusion criteria included female faculty physicians who had given birth within the past 5 years. The responses of those who selected "yes" when asked if they had breastfed were analyzed. Results: Fifteen percent of respondents stated that they did not meet their breastfeeding goals. The most prevalent theme for both positive and negative factors in the qualitative analysis was pumping breast milk. Physician mothers provided key insight into (1) the impact of their role as physicians on their breastfeeding experience, (2) impact of their return to work on breastfeeding, and (3) ideas for improved lactation support. Conclusion: This study highlights the need to improve maternal and infant health by advocating for faculty physicians who are providing breast milk for their children. Advocacy efforts should focus on improving conditions for breast milk pumping and for effective policies around return to work after delivery. Further development and study of individualized breastfeeding support plans for physician mothers is needed.

Pulmonary embolism during and after pregnancy

BACKGROUND

Venous thromboembolic disease is among the most common causes of morbidity and mortality during pregnancy. The clinical evaluation alone is insufficient for the diagnosis of venous thromboembolic disease, and the normal pregnant state makes this evaluation even more challenging.

DIAGNOSIS

Objective testing is the mainstay of diagnosis, including compression ultrasound, impedance plethysmography, ventilation-perfusion scanning, computed tomography scanning, and pulmonary angiography. All of these tests can be safety performed during pregnancy.

TREATMENT

If deep vein thrombosis or pulmonary embolism is diagnosed, anticoagulation should be initiated. Either (unfractionated) heparin or low molecular weight heparin is an acceptable treatment for acute venous thromboembolic disease. Both have risks and benefits, but both can be used safely during pregnancy. Intravenous heparin is the treatment of choice surrounding delivery due to its short half life. Because of the risk of adverse effects on the fetus, warfarin is not generally used during pregnancy. Unstable pulmonary embolism is difficult to treat during pregnancy, as there are minimal data regarding the safety and efficacy of thrombolytic therapy, inferior vena cava filters, and embolectomy during pregnancy. Case reports and case series suggest that thrombolytic therapy may be associated with lower risks of fetal loss than embolectomy.

CONCLUSIONS

Venous thromboembolic disease is a significant cause of morbidity and mortality during pregnancy and the puerperal period. Objective testing is critical to establish the diagnosis and can be safely performed during pregnancy. Anticoagulation with heparin is the mainstay of therapy during the pregnancy, but patients may be transitioned to warfarin after delivery.

Pulmonary embolism and pregnancy

Pulmonary embolism is a significant cause of morbidity and mortality during pregnancy and the puerperium. The spectrum of venous thromboembolism is difficult to diagnose. Objective diagnostic testing is crucial and should not be delayed. Anticoagulation is the mainstay of therapy for deep vein thrombosis and pulmonary embolism. Most of the literature and practice protocols for the treatment of pregnant women are based on data extrapolated from the nonpregnant population, and more research is needed to improve the understanding of the efficacy and safety of testing and therapy in the pregnant population.

The evolving scope of nurse-midwifery practice in the United States

The purpose of this article is to review the evolving scope of practice of nurse-midwifery since its introduction in the United States in 1925. Factors that contributed to the profession's evolution in practice are identified.

Nurse-midwifery service in a rural setting

This article describes the structure and development of a successful, rural nurse-midwifery service consisting of nine certified nurse-midwives and four obstetricians. The model has shown that the addition of a nurse-midwifery service and the adoption of a collaborative care model can improve obstetric outcomes. The outcomes of this model include an increase in the number of women served each year, a decrease in the cesarean section rate, an increase in the number of twin gestations delivered vaginally, an increase in the number of breech presentations delivered vaginally, an increase in the success rate of vaginal birth after cesarean section, and decreased numbers of episiotomies, with a resulting decrease in the number of third- and fourth-degree lacerations.