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Search Results: 1 - 10 of 403145 matches for " Barry M. Lester "
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Mother-infant consultation during drug treatment: Research and innovative clinical practice
CF Zachariah Boukydis, Barry M Lester
Harm Reduction Journal , 2008, DOI: 10.1186/1477-7517-5-6
Abstract: A sequential cohort model was used to assign participants to 1. NNNS consultation versus 2. standard care. The effects of NNNS consultation were evaluated using the Parenting Stress Index and NNNS summary scores.Participants in the NNNS consultation condition had significantly less stress overall, and less stress related to infant behavior than participants in standard care. There were no differences in infant behavior on the NNNS Summary scores.The implications for NNNS consultation in drug treatment programs is outlined. The importance of prevention/intervention to establish satisfactory mother-infant interaction in recovery programs which include a central parenting component is indicated.In the past fifteen year, there have been marked changes in drug treatment services for women (Finkelstein, 1996 [1]; Homan et al, 1993[2]; Clayson, Berkowitz & Brindis, 1995[3]; Lester, Twomey, Boukydis, 2000[4]). One central feature to these services is the recognition of challenges that many women of childbearing age face to progress in recovery, and as mothers, to grow and mature as parents with their children. There is an identified need to integrate parenting support and education into traditional drug treatment programs (Weissman et al, 1995[5]; Jones, 2006 [6]). Programs which combine drug treatment and parenting services are more likely to retain women in treatment and decrease the likelihood of relapse (Roberts & Nishimoto, 1996[7]; Szuster et al, 1996[8]; Kaltenbach & Finnegan, 1998[9]; Jones, 2006[6]). There has also been a need to integrate and evaluate new models derived from fields such as child development, applied developmental psychology and infant mental health (Lester, Affleck. Boukydis, Freier & Boris, 1996[10]; Sameroff, 2004[11]). The central focus of this paper is on the use of neonatal assessment to consult with mothers and infants in order to improve maternal ability to read the unique signals of their infant, provide a satisfactory beginning to early p
Substance use during pregnancy: time for policy to catch up with research
Barry M Lester, Lynne Andreozzi, Lindsey Appiah
Harm Reduction Journal , 2004, DOI: 10.1186/1477-7517-1-5
Abstract: The purpose of this review is to summarize policy research findings in the area of maternal prenatal substance abuse to (1) inform and advance this field, (2) identify future research needs, (3) inform policy making and (4) identify implications for policy. As a review, this is a systematic analysis of existing data (findings) on maternal drug use during pregnancy for determining the best policy among the alternatives for dealing with drug using mothers and their children. We will address issues of efficacy (which policies work?), economics (how much does it cost?) and politics (who is it for or against?). For new policies we will also consider how they fit with existing policies or laws, the social impact, ethical issues and the feasibility of implementation and administration.The issue of substance abuse is one that has perpetually plagued society. The complexities surrounding addiction are not easily overcome. These complexities are even more defined in cases of substance abuse by pregnant women, an issue that has been pushed to the forefront of the public consciousness over the course of the past 20 years. Maternal prenatal substance abuse is defined as chronic use of alcohol and/or other drugs [1]. The acronym AOD is often used to describe the generic problem of alcohol and other drugs. However, AOD is not specific to mothers and includes both prenatal and postnatal use as well as use by men. This review will encompass the three main types of addictive substances used during pregnancy: alcohol, tobacco and illegal drugs (ATID). Maternal Alcohol, Tobacco and Illegal Drugs (MATID) will be used to describe maternal use of these substances during pregnancy that threatens the well being of the child.Rising cocaine use and the emergence of crack cocaine use in the 1980s created a public outcry and redress and served to shine the spotlight on this issue. One of the goals of this review is to see how what we learned from the cocaine controversy can be applied to issues
Placental 11-Beta Hydroxysteroid Dehydrogenase Methylation Is Associated with Newborn Growth and a Measure of Neurobehavioral Outcome
Carmen J. Marsit, Matthew A. Maccani, James F. Padbury, Barry M. Lester
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0033794
Abstract: Background There is growing evidence that the intrauterine environment can impact the neurodevelopment of the fetus through alterations in the functional epigenome of the placenta. In the placenta, the HSD11B2 gene encoding the 11-beta hydroxysteroid dehydrogenase enzyme, which is responsible for the inactivation of maternal cortisol, is regulated by DNA methylation, and has been shown to be susceptible to stressors from the maternal environment. Methodology/Principal Findings We examined the association between DNA methylation of the HSD11B2 promoter region in the placenta of 185 healthy newborn infants and infant and maternal characteristics, as well as the association between this epigenetic variability and newborn neurobehavioral outcome assessed with the NICU Network Neurobehavioral Scales. Controlling for confounders, HSD11B2 methylation extent is greatest in infants with the lowest birthweights (P = 0.04), and this increasing methylation was associated with reduced scores of quality of movement (P = 0.04). Conclusions/Significance These results suggest that factors in the intrauterine environment which contribute to birth outcome may be associated with placental methylation of the HSD11B2 gene and that this epigenetic alteration is in turn associated with a prospectively predictive early neurobehavioral outcome, suggesting in some part a mechanism for the developmental origins of infant neurological health.
Services used by perinatal substance-users with child welfare involvement: a descriptive study
Kenneth J McCann, Jean E Twomey, Donna Caldwell, Rosemary Soave, Lynne Fontaine, Barry M Lester
Harm Reduction Journal , 2010, DOI: 10.1186/1477-7517-7-19
Abstract: Data collected during the first four years of VIP-RI were used to identify characteristics of program participants, services received, and child welfare outcomes: closed child welfare cases, reunification with biological mothers and identified infant permanent placements.Medical and financial services were associated with positive child welfare outcomes. Medical services included family planning, pre- and post-natal care and HIV test counseling. Financial services included assistance with obtaining entitlement benefits and receiving tangible support such as food and clothing.Findings from this study suggest services that address basic family needs were related to positive child welfare outcomes. The provision of basic services, such as health care and financial assistance through entitlement benefits and tangible donations, may help to establish a foundation so mothers can concentrate on recovery and parenting skills. Identification of services for perinatal substance users that are associated with more successful child welfare outcomes has implications for the child welfare system, treatment providers, courts and families.According to the Substance Abuse and Mental Health Service Administration (SAMHSA), 5% of pregnant women used illicit drugs in the past month [1]. The 2006 National Survey on Drug Use and Health found that rates of past month drug use were similar between non-pregnant women and recent mothers [2]. A study examining the prevalence of substance use among more than 7,800 pregnant women enrolled in prenatal care clinics identified 9% as using illicit substances when they were screened using the 4P's Plus tool, a measure comprised of four questions [3]. An endorsement of any of the questions is indicative of a positive screen.Maternal substance use raises concerns about a woman's capability to adequately care for her child. Risk factors associated with substance abuse such as co-occuring psychiatric problems, violence, difficulties in interpersonal rel
Patterning in Placental 11-B Hydroxysteroid Dehydrogenase Methylation According to Prenatal Socioeconomic Adversity
Allison A. Appleton, David A. Armstrong, Corina Lesseur, Joyce Lee, James F. Padbury, Barry M. Lester, Carmen J. Marsit
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0074691
Abstract: Background Prenatal socioeconomic adversity as an intrauterine exposure is associated with a range of perinatal outcomes although the explanatory mechanisms are not well understood. The development of the fetus can be shaped by the intrauterine environment through alterations in the function of the placenta. In the placenta, the HSD11B2 gene encodes the 11-beta hydroxysteroid dehydrogenase enzyme, which is responsible for the inactivation of maternal cortisol thereby protecting the developing fetus from this exposure. This gene is regulated by DNA methylation, and this methylation and the expression it controls has been shown to be susceptible to a variety of stressors from the maternal environment. The association of prenatal socioeconomic adversity and placental HSD11B2 methylation has not been examined. Following a developmental origins of disease framework, prenatal socioeconomic adversity may alter fetal response to the postnatal environment through functional epigenetic alterations in the placenta. Therefore, we hypothesized that prenatal socioeconomic adversity would be associated with less HSD11B2 methylation. Methods and Findings We examined the association between DNA methylation of the HSD11B2 promoter region in the placenta of 444 healthy term newborn infants and several markers of prenatal socioeconomic adversity: maternal education, poverty, dwelling crowding, tobacco use and cumulative risk. We also examined whether such associations were sex-specific. We found that infants whose mothers experienced the greatest levels of socioeconomic adversity during pregnancy had the lowest extent of placental HSD11B2 methylation, particularly for males. Associations were maintained for maternal education when adjusting for confounders (p<0.05). Conclusions Patterns of HSD11B2 methylation suggest that environmental cues transmitted from the mother during gestation may program the developing fetus’s response to an adverse postnatal environment, potentially via less exposure to cortisol during development. Less methylation of placental HSD11B2 may therefore be adaptive and promote the effective management of stress associated with social adversity in a postnatal environment.
Observations of nightside auroral plasma upflows in the F-region and topside ionosphere
C. Foster,M. Lester
Annales Geophysicae (ANGEO) , 2003,
Abstract: Observations from the special UK EISCAT program UFIS are presented. UFIS is a joint UHF-VHF experiment, designed to make simultaneous measurements of enhanced vertical plasma flows in the F-region and topside ionospheres. Three distinct intervals of upward ion flow were observed. During the first event, upward ion fluxes in excess of 1013 m–2 s–1 were detected, with vertical ion velocities reaching 300 m s–1 at 800 km. The upflow was associated with the passage of an auroral arc through the radar field of view. In the F-region, an enhanced and sheared convection electric field on the leading edge of the arc resulted in heating of the ions, whilst at higher altitudes, above the precipitation region, strongly enhanced electron temperatures were observed; such features are commonly associated with the generation of plasma upflows. These observations demonstrate some of the acceleration mechanisms which can exist within the small-scale structure of an auroral arc. A later upflow event was associated with enhanced electron temperatures and only a moderate convection electric field, with no indication of significantly elevated ion tem- peratures. There was again some evidence of F-region particle precipitation at the time of the upflow, which exhibited vertical ion velocities of similar magnitude to the earlier upflow, suggesting that the behaviour of the electrons might be the dominant factor in this type of event. A third upflow was detected at altitudes above the observing range of the UHF radar, but which was evident in the VHF data from 600 km upwards. Smaller vertical velocities were observed in this event, which was apparently uncorrelated with any features observed at lower altitudes. Limitations imposed by the experimental conditions inhibit the interpretation of this event, although the upflow was again likely related to topside plasma heating.
Potential Range Expansion of the Invasive Red Shiner, Cyprinella lutrensis (Teleostei: Cyprinidae), under Future Climatic Change  [PDF]
Helen M. Poulos, Barry Chernoff
Open Journal of Ecology (OJE) , 2014, DOI: 10.4236/oje.2014.49045

We built climate envelope models under contemporary and future climates to explore potential range shifts of the invasive Red Shiner-Cyprinella lutrensis. Our objective was to estimate aquatic habitat vulnerability to Red Shiner invasion in North America under future climatic change. We used presence records from within the species’ native and invaded distributions, a suite of bioclimatic predictor variables from three climate models (CCCma, CSIRO, and HadCM3), and maximum entropy modeling to generate potential distribution maps for the year 2080. Our model predicted major range expansion by Red Shiner under both low and high carbon emissions scenarios. The models exceeded average area under the receiver operator characteristic curve values of 0.92, indicating good overall model performance. The model predictions fell largely outside of areas of climatic extrapolation (i.e. regions predicted into environments different from training the region) indicating good model performance. The results from this study highlight the large potential range expansion across North America of Red Shiner under future warmer climates.

Incomplete Reporting of HIV/AIDS by Uganda’s Surveillance System and the Associated Factors  [PDF]
Denis Akankunda Bwesigye, Barry M. Loneck, Barry R. Sherman
Open Journal of Preventive Medicine (OJPM) , 2016, DOI: 10.4236/ojpm.2016.64011
Abstract: Introduction: The United States government supported Ugandan government by introducing the District Health Information Software 2 (DHIS2) in 2012 to improve HIV/AIDS surveillance. Districts have yet to fully adopt this relatively new system given a 70.2% reporting completeness achieved nationally between April-June 2013. Methods: The study examined one dependent variable of districts’ reporting completeness against four independent variables: 1) Number of client visits; 2) Number of district health units; 3) Number of NGOs delivering HIV/AIDS services; and 4) Regional location. The study employed cross-sectional study design which allowed researchers to compare many different variables at the same time. HIV/AIDS program data that were reported by districts into DHIS2 during the period of April to June 2013 were used to assess for reporting completeness. Findings: Districts with the lowest number of client visits (under 2500) achieved the highest mean reporting completeness (81.6%), whereas a range of 2501 - 5000, or over 5001client visits recorded 72.4% and 51.7% respectively. The higher the number of client visits is, the lower the reporting completeness is (p < 0.05). Those districts that were receiving support from only one and two NGO recorded 56.7% and 67.2% respectively. Districts supported by over three NGOs had the highest (80.6%) mean reporting completeness. NGOs-district support was statistically associated with reporting completeness (p < 0.05). The number of health units operated by a district was also significantly associated with reporting completeness (p < 0.05). The regional location of a district was not associated with reporting completeness (p = 0.674). Conclusion: The study results led us to recommend targeted future NGO support to districts with higher patient volume for HIV/AIDS services. Particularly, newly funded NGOs are to be established in districts operating over 40 health units. Incomplete reporting undermines identification of HIV-affected individuals and limits the ability to make evidence-based decisions regarding HIV/AIDS program planning and service delivery.
Transfusion, erythropoiesis-stimulating agent therapy, and kidney transplant wait time  [PDF]
Robert M. Perkins, H. Lester Kirchner, Rajesh Govindasamy
Open Journal of Internal Medicine (OJIM) , 2012, DOI: 10.4236/ojim.2012.21001
Abstract: Aim: Anemia is highly prevalent among patients wait-listed for renal transplant, and management with blood transfusion or erythropoietin stimulating agents may impact transplant wait time. The purpose of this study was to examine the impact of blood transfusion and erythropoiesis stimulating agent therapy on renal transplant wait time. Methods: We retrospectively analyzed all adult patients listed for first deceased donor kidney transplantation at two transplant centers in Central Pennsylvania between 2004 and 2008. The exposures of interest were blood transfusion and erythropoietin stimulating agent therapy. Cox proportional hazards were used to model time to deceased donor kidney transplant. Results: Among 407 patients listed for transplant, 84 received a deceased donor kidney during a median follow-up of 26.3 months. In an adjusted Cox proportional hazards model, with erythropoiesis stimulating agent and transfusion both treated as time-dependent exposures, UNOS inactive status at listing date (hazard ratio [HR] 0.81; 95% CI 0.73 - 0.89; P < 0.001) and transfusion during the wait list period (HR 0.27; 95% CI 0.11 - 0.69; P = 0.01) independently predicted longer transplant wait time. Erythropoiesis stimulating agent use prior to or after transplant wait listing date did not independently predict wait time. Conclusion: Blood transfusion while waitlisted for kidney transplant is strongly associated with prolonged wait time.
A classification of spectral populations observed in HF radar backscatter from the E region auroral electrojets
S. E. Milan ,M. Lester
Annales Geophysicae (ANGEO) , 2001,
Abstract: Observations of HF radar backscatter from the auroral electrojet E region indicate the presence of five major spectral populations, as opposed to the two predominant spectral populations, types I and II, observed in the VHF regime. The Doppler shift, spectral width, backscatter power, and flow angle dependencies of these five populations are investigated and described. Two of these populations are identified with type I and type II spectral classes, and hence, are thought to be generated by the two-stream and gradient drift instabilities, respectively. The remaining three populations occur over a range of velocities which can greatly exceed the ion acoustic speed, the usual limiting velocity in VHF radar observations of the E region. The generation of these spectral populations is discussed in terms of electron density gradients in the electrojet region and recent non-linear theories of E region irregularity generation. Key words. Ionosphere (ionospheric irregularities)
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