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And Delivery (and + delivery)
Kinds of And Delivery Selected AbstractsThe one-commodity pickup-and-delivery traveling salesman problem: Inequalities and algorithmsNETWORKS: AN INTERNATIONAL JOURNAL, Issue 4 2007Hipólito Hernández-Pérez Abstract This article concerns the "One-commodity Pickup-and-Delivery Traveling Salesman Problem" (1-PDTSP), in which a single vehicle of fixed capacity must either pick up or deliver known amounts of a single commodity to a given list of customers. It is assumed that the product collected from the pickup customers can be supplied to the delivery customers, and that the initial load of the vehicle leaving the depot can be any quantity. The problem is to find a minimum-cost sequence of the customers in such a way that the vehicle's capacity is never exceeded. This article points out a close connection between the 1-PDTSP and the classical "Capacitated Vehicle Routing Problem" (CVRP), and it presents new inequalities for the 1-PDTSP adapted from recent inequalities for the CVRP. These inequalities have been implemented in a branch-and-cut framework to solve to optimality the 1-PDTSP that outperforms a previous algorithm (Hernández-Pérez and Salazar-González, Discrete Appl Math 145 (2004), 126,139). Larger instances (with up to 100 customers) are now solved to optimality. The classical "Traveling Salesman Problem with Pickups and Deliveries" (TSPPD) is a particular case of the 1-PDTSP, and this observation gives an additional motivation for this article. The here-proposed algorithm for the 1-PDTSP was able to solve to optimality TSPPD instances with up to 260 customers. © 2007 Wiley Periodicals, Inc. NETWORKS, Vol. 50(4), 258,272 2007 [source] Care and Outcome of Out-of-hospital DeliveriesACADEMIC EMERGENCY MEDICINE, Issue 7 2000Harry C Moscovitz MD Abstract. Objectives: To identify interventions by paramedics in out-of-hospital deliveries and predictors of neonatal outcome. Methods: A prospective case series of consecutive out-of-hospital deliveries at Yale-New Haven Hospital from January 1991 to January 1994. Data describing out-of-hospital interventions, demographics, maternal risk factors, and neonatal outcomes were collected from out-of-hospital, emergency department (ED), and hospital records. Subgroups defined by source of prenatal care were compared using a multiple logistic regression model to determine predictors of poor neonatal outcome. Results: Ninety-one patients presented to the hospital after delivery. Paramedics attended 78 (86%) of the cases. Paramedics performed endotracheal intubation in one neonate and supported ventilation in four others. Suctioning and warming of the neonate were documented in 58% and 76%, respectively, and hypothermia was common (47%) in the paramedicattended deliveries. There were 9 neonatal deaths. Eight (89%) of the neonatal deaths were in the group with no prenatal care (p < 0.0001). Lack of prenatal care (RR 304, 95% CI = 5.0 to 18,472) and history of poor prenatal care (RR 22.5, 95% CI = 1.19 to 427) were significant predictors of poor neonatal outcome. Sixteen percent of all study patients and 43% of those with no prenatal care were treated in the ED during their pregnancies. Eighteen percent of the patients had had no prenatal care during previous pregnancies. Conclusions: Paramedics manage labor and delivery of a high-risk population. Fundamental aspects of care were not universally documented. Lack of prenatal care was associated with high neonatal morbidity and mortality. Nearly half of the mothers who went on to deliver without prenatal obstetric care saw emergency physicians during their pregnancies. [source] Obstetric Complications in Women with Diagnosed Mental Illness: The Relative Success of California's County Mental Health SystemHEALTH SERVICES RESEARCH, Issue 1 2010Dorothy Thornton Objective. To examine disparities in serious obstetric complications and quality of obstetric care during labor and delivery for women with and without mental illness. Data Source. Linked California hospital discharge (2000,2001), birth, fetal death, and county mental health system (CMHS) records. Study Design. This population-based, cross-sectional study of 915,568 deliveries in California, calculated adjusted odds ratios (AORs) for obstetric complication rates for women with a mental illness diagnosis (treated and not treated in the CMHS) compared with women with no mental illness diagnosis, controlling for sociodemographic, delivery hospital type, and clinical factors. Results. Compared with deliveries in the general non,mentally ill population, deliveries to women with mental illness stand a higher adjusted risk of obstetric complication: AOR=1.32 (95 percent confidence interval [CI]=1.25, 1.39) for women treated in the CMHS and AOR=1.72 (95 percent CI=1.66, 1.79) for women not treated in the CMHS. Mentally ill women treated in the CMHS are at lower risk than non-CMHS mentally ill women of experiencing conditions associated with suboptimal intrapartum care (postpartum hemorrhage, major puerperal infections) and inadequate prenatal care (acute pyelonephritis). Conclusion. Since mental disorders during pregnancy adversely affect mothers and their infants, care of the mentally ill pregnant woman by mental health and primary care providers warrants special attention. [source] Idealized design of perinatal careJOURNAL OF HEALTHCARE RISK MANAGEMENT, Issue S1 2006Faith McLellan PhD Idealized Design of Perinatal Care is an innovation project based on the principles of reliability science and the Institute for Healthcare Improvement's (IHI's) model for applying these principles to improve care.1 The project builds upon similar processes developed for other clinical arenas in three previous IHI Idealized Design projects. The Idealized Design model focuses on comprehensive redesign to enable a care system to perform substantially better in the future than the best it can do at present. The goal of Idealized Design of Perinatal Care is to achieve a new level of safer, more effective care and to minimize some of the risks identified in medical malpractice cases. The model described in this white paper, Idealized Design of Perinatal Care, represents the Institute for Healthcare Improvement's best current assessment of the components of the safest and most reliable system of perinatal care. The four key components of the model are: 1) the development of reliable clinical processes to manage labor and delivery; 2) the use of principles that improve safety (i.e., preventing, detecting, and mitigating errors); 3) the establishment of prepared and activated care teams that communicate effectively with each other and with mothers and families; and 4) a focus on mother and family as the locus of control during labor and delivery. Reviews of perinatal care have consistently pointed to failures of communication among the care team and documentation of care as common factors in adverse events that occur in labor and delivery. They are also prime factors leading to malpractice claims.2 Two perinatal care "bundles", a group of evidence-based interventions related to a disease or care process that, when executed together, result in better outcomes than when implemented individually , are being tested in this Idealized Design project: the Elective Induction Bundle and the Augmentation Bundle. Experience from the use of bundles in other clinical areas, such as care of the ventilated patient, has shown that reliably applying these evidence-based interventions can dramatically improve outcomes.3 The assumption of this innovation work is that the use of bundles in the delivery of perinatal care will have a similar effect. The authors acknowledge that other organizations have also been working on improving perinatal care through the use of simulation training and teamwork and communication training. IHI's model includes elements of these methods. The Idealized Design of Perinatal Care project has two phases. Sixteen perinatal units from hospitals around the US participated in Phase I, from February to August 2005. The goals of Phase I were identifying changes that would make the most impact on improving perinatal care, selecting elements for each of the bundles, learning how to apply IHI's reliability model to improve processes, and improving the culture within a perinatal unit. This white paper provides detail about the Idealized Design process and examines some of the initial work completed by teams. Phase II, which began in September 2005, expands on this work. This phase focuses particularly on managing second stage labor, including common interpretation of fetal heart monitoring, developing a reliable tool to identify harm, and ensuring that patient preferences are known and honored. [source] Effects of HIV/AIDS on Maternity Care Providers in KenyaJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 5 2008Janet M. Turan ABSTRACT Objective: To explore the impact of HIV/AIDS on maternity care providers in labor and delivery in a high HIV-prevalence setting in sub-Saharan Africa. Design: Qualitative one-on-one in-depth interviews with maternity care providers. Setting: Four health facilities providing labor and delivery services (2 public hospitals, a public health center, and a small private maternity hospital) in Kisumu, Nyanza Province, Kenya. Participants: Eighteen maternity care providers, including 14 nurse/midwives, 2 physician assistants, and 2 physicians (ob/gyn specialists). Results: The HIV/AIDS epidemic has had numerous adverse effects and a few positive effects on maternity care providers in this setting. Adverse effects include reductions in the number of health care providers, increased workload, burnout, reduced availability of services in small health facilities when workers are absent due to attending HIV/AIDS training programs, difficulties with confidentiality and unwanted disclosure, and maternity care providers' fears of becoming HIV infected and the resulting stigma and discrimination. Positive effects include improved infection control procedures on maternity wards and enhanced maternity care provider knowledge and skills. Conclusion: A multifaceted package including policy, infrastructure, and training interventions is needed to support maternity care providers in these settings and ensure that they are able to perform their critical roles in maternal healthcare and prevention of HIV/AIDS transmission. [source] New tides: Updates in the management of preterm labor and delivery and pre-eclampsiaJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 2007Prof Mario R. Festin [source] Continuous spinal analgesia for labor and delivery in a parturient with hypertrophic obstructive cardiomyopathyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2002T. Okutomi Induction of labor under analgesia was planned for a 30-year-old-primiparous patient with hypertrophic obstructive cardiomyopathy (HOCM), as her fetal evaluation revealed intrauterine growth restriction at 38 weeks' gestation. However, regional analgesia during labor may present a potential risk for hemodynamic instability in patients with HOCM due to the possibility of a sympathetic block, as a result of vasodilation associated with the administration of local anesthesia. This case report demonstrates the successful management of the patient with analgesia provided by a continuous spinal catheter dosed with a continuous infusion of fentanyl and supplemental meperidine. Fetal surveillance monitoring included fetal pulse oximetry in addition to conventional cardiotocography, on the basis of which cesarean section was avoided. [source] Ex vivo assessment of mouse cervical remodeling through pregnancy via 23Na MRSNMR IN BIOMEDICINE, Issue 8 2010Xiang Xu Abstract Preterm birth occurs in 12.5% of births in the United States and can lead to risk of infant death or to lifelong serious health complications. A greater understanding by which the two main processes, uterine contraction and cervical remodeling are regulated is required to reduce rates of preterm birth. The cervix must undergo extensive remodeling through pregnancy in preparation for parturition, the process of labor and delivery of young. One key aspect of this dynamic process is a change in the composition and abundance of glycosaminoglycans (GAGs) and proteoglycans within the extracellular matrix, which influences the loss of tensile strength or stiffness of the cervix during labor. 23Na NMR spectroscopy has previously been validated as a method to quantify GAGs in tissues. In the current study, the Na+ concentration was measured at several time points through pregnancy in mouse cervices using 23Na NMR spectroscopy. The Na+ concentration increased progressively during pregnancy and peaked one day before birth followed by a rapid decline after birth. The same trend was seen in GAGs as measured by a biochemical assay using independent cervix samples over the course of pregnancy. We suggest that monitoring the Na+ concentration via 23Na NMR spectroscopy can serve as an informative physiological marker in evaluating the stages of cervical remodeling ex vivo and warrants further investigation to determine its utility as a diagnostic tool for the identification of women at risk for impending preterm birth. Copyright © 2010 John Wiley & Sons, Ltd. [source] Reproductive Functions of Corticotropin-Releasing Hormone.AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 4 2004Potential Clinical Utility of Antalarmins (CRH Receptor Type 1 Antagonists), Research Background:, The hypothalamic-pituitary-adrenal (HPA) axis exerts a complex, mostly inhibitory, effect on the female reproductive system. In addition, the principal regulator of this axis, the hypothalamic neuropeptide corticotropin-releasing hormone (CRH) and its receptors have been identified in most female reproductive tissues, including the ovary, uterus, and placenta. Furthermore, CRH is secreted in peripheral inflammatory sites where it exerts strong inflammatory actions. Antalarmins (CRH receptor type 1 antagonists) have been used to elucidate the roles of CRH in stress, inflammation and reproduction. Method of study:, We review existing data on the effects of CRH in the female reproductive system. Results:, Ovarian CRH participates in female sex steroid production, follicular maturation, ovulation and luteolysis. Uterine CRH participates in decidualization, implantation, and early maternal tolerance. Placental CRH participates in the physiology of pregnancy and the onset of parturition. Circulating placental CRH is secreted mostly during the latter half of pregnancy and is responsible for the concurrently increasing physiologic hypercortisolism of this period. After labor and delivery, this hypercortisolism is ensued by a transient suppression of hypothalamic CRH secretion, which may explain the postpartum blues and depression and the increased autoimmune manifestations depression of period, the postpartum period. Conclusions:, These data show that CRH is present in female reproductive tissues, and is regulating key reproductive functions with an inflammatory component, such as ovulation, luteolysis, implantation, and parturition. [source] A Randomized Controlled Trial of Continuous Labor Support for Middle-Class Couples: Effect on Cesarean Delivery RatesBIRTH, Issue 2 2008Susan K. McGrath PhD ABSTRACT: Background: Previous randomized controlled studies in several different settings demonstrated the positive effects of continuous labor support by an experienced woman (doula) for low-income women laboring without the support of family members. The objective of this randomized controlled trial was to examine the perinatal effects of doula support for nulliparous middle-income women accompanied by a male partner during labor and delivery. Methods: Nulliparous women in the third trimester of an uncomplicated pregnancy were enrolled at childbirth education classes in Cleveland, Ohio, from 1988 through 1992. Of the 686 prenatal women recruited, 420 met enrollment criteria and completed the intervention. For the 224 women randomly assigned to the experimental group, a doula arrived shortly after hospital admission and remained throughout labor and delivery. Doula support included close physical proximity, touch, and eye contact with the laboring woman, and teaching, reassurance, and encouragement of the woman and her male partner. Results: The doula group had a significantly lower cesarean delivery rate than the control group (13.4% vs 25.0%, p = 0.002), and fewer women in the doula group received epidural analgesia (64.7% vs 76.0%, p = 0.008). Among women with induced labor, those supported by a doula had a lower rate of cesarean delivery than those in the control group (12.5% vs 58.8%, p = 0.007). On questionnaires the day after delivery, 100 percent of couples with doula support rated their experience with the doula positively. Conclusions: For middle-class women laboring with the support of their male partner, the continuous presence of a doula during labor significantly decreased the likelihood of cesarean delivery and reduced the need for epidural analgesia. Women and their male partners were unequivocal in their positive opinions about laboring with the support of a doula. (BIRTH 35:2 June 2008) [source] | ||||||||||