In-hospital formula supplementation of breastfed infants negatively impacts breastfeeding duration. Infants from low-income families have some of the lowest exclusive breastfeeding rates in the United States. The objectives of this study were to identify (1) reasons low-income breastfeeding mothers begin in-hospital formula supplementation and (2) risk factors for in-hospital formula supplementation. We surveyed 150 low-income mothers in a Washington, DC, clinic. Sixty percent had initiated breastfeeding, and 78% of these breastfed infants received formula supplementation in the hospital. There was no clear medical need for supplementation for 87% of the breastfed infants receiving supplementation. Infants of mothers who did not attend a prenatal breastfeeding class were almost 5 times more likely to receive in-hospital formula supplementation than those infants whose mothers had attended a class (OR, 4.7; 95% CI, 1.05-21.14). Improved knowledge about breastfeeding among nursing and medical providers is important to minimize unnecessary formula supplementation for breastfed infants.
A population of items which break down at random times and require repair is studied (the classic "machine repair problem with spares"). It is desired to determine the number of repair channels anil spares required over a multiyear planning horizon in which population size and component reliability varies, and a service level constraint is imposed. When an item fails, a spare (if available) is immediately dispatched to replace the failed item. The failed item is removed, transported to the repair depot, repaired, and then placed in the spares pool (which is constrained to be empty not more than 10% of the time) unless there is a backlog of requests for spares, in which case it is dispatched immediately. The first model considered treats removal, transportation, and repair as one service operation. The second model is a series queue which allows for the separate treatment of removal, transportation, and repair. Breakdowns are assumed Poisson and repair times exponential.
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