Ecological Systems Affecting Urban Childbearing Puerto Rican Women in the City of Philadelphia

Maternal and Child Health Journal - The purpose of this study was to explore socio-ecological influences affecting the daily lives of urban, pregnant Puerto Rican women and factors negatively...     

Predictors of a difficult intubation in the bariatric patient: does preoperative body mass index matter?

BackgroundThe incidence of difficult intubations in morbidly obese patients has been reported to be 12–20%; however, no well-established predictors of a difficult intubation exist for this patient population. Our objective was to evaluate the factors associated with a difficult intubation in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass at an integrated multispecialty health system with a 325-bed community teaching hospital serving 19 counties.MethodsThe anesthetic records of patients undergoing LRYGB from 2001 to 2010 were reviewed. Difficult intubations were defined as direct laryngoscopy graded ≥1 on a 0–2 difficulty scale and unplanned fiberoptic intubations. Statistical analysis included chi-square, univariate, and multivariate logistic regression.ResultsA total of 915 consecutive patients underwent LRYGB during the study period. Of these, 3 patients were excluded because of incomplete data. Of the 912 included patients, 25 (2.7%) underwent planned fiberoptic intubation, 830 (91%) had an uneventful intubation, and 57 (6.3%) had a difficult intubation. Difficult intubations were more common in men than in women (11% versus 6%, P = .027). Difficult intubations were not associated with an increasing preoperative body mass index (P = .073), the presence of obstructive sleep apnea (P = .784), or the presence of gastroesophageal reflux disease (P = .335). Multivariate predictors of a difficult intubation were Mallampati class 4 (odds ratio [OR] 2.76, P = .035), abnormal thyromental distance (OR 4.39, P = .001), restricted jaw mobility (OR 3.26, P = .018), and a history of a difficult intubation (OR 4.17, P = .002).ConclusionsAn increased Mallampati class, abnormal thyromental distance, restricted jaw mobility, and a history of difficult intubations were independent predictors of a difficult intubation. An increasing body mass index did not predict for a difficult intubation.     

Stereoisomers of quaternary and tertiary 4-methyl piperidine analogs of hemicholinium-3

Previous studies have shown that quaternary and tertiary 4-methyl piperidine derivatives of hemicholinium-3 (A-5 and A-4, respectively) are potent inhibitors of choline uptake. The d-, l-, and mesostereoisomers of A-5 and A-4 were separated and the potency and reversibility were compared. Isomeric forms of each compound were found to be approximately equipotent inhibitors in the following preparations: inhibition of rabbit neuromuscular transmission using the sciatic nerve-gastrocnemius muscle preparation, reductions in acetylcholine content in rat caudate tissue slices and inhibition of choline uptake in neuroblastoma cells, line NB41A3. Because these results show no difference in potency or reversibility for the stereoisomers of A-5 or A-4, these studies indicate that hydroxyl substitutions in these agents do not play a role in their biologic activity. Perhaps only 2-point attachment is required for inhibition of choline transport by hemicholinium-like compounds.     

Coping and Sexual Harassment: How Victims Cope across Multiple Settings

The ways sexual harassment occurs both online and in face-to-face settings has become more complicated. Sexual harassment that occurs in cyberspace or online sexual harassment adds complexity to the experiences of victims, current research understandings, and the legal dimensions of this phenomenon. Social networking sites (SNS) are a type of social media that offer unique opportunities to users and sometimes the communication that occurs on SNS can cross the line from flirtation into online sexual harassment. Victims of sexual harassment employ communicative strategies such as coping to make sense of their experiences of sexual harassment. The current study qualitatively examined problem-focused, active emotion-focused, and passive emotion-focused coping strategies employed by sexual harassment victims across multiple settings. We conducted 26 in-depth interviews with victims that had experienced sexual harassment across multiple settings (e.g., face-to-face and SNS). The findings present 16 types of coping strategies—five problem-focused, five active emotion-focused, and six passive emotion-focused. The victims used an average of three types of coping strategies during their experiences. Theoretical implications extend research on passive emotion-focused coping strategies by discussing powerlessness and how victims blame other victims. Furthermore, theoretically the findings reveal that coping is a complex, cyclical process and that victims shift among types of coping strategies over the course of their experience. Practical implications are offered for victims and for SNS sites.