Methods:We calculated descriptive statistics for maternal demographics, antenatal risk profiles, procedures, and outcomes of planned home births in the Midwives Alliance of North American Statistics Project (MANA Stats) 2.0 data registry. Data were analyzed according to intended and actual place of birth.Results: Among 16,924 women who planned home births at the onset of labor, 89.1% gave birth at home. The majority of intrapartum transfers were for failure to progress, and only 4.5% of the total sample required oxytocin augmentation and/or epidural analgesia. The rates of spontaneous vaginal birth, assisted vaginal birth, and cesarean were 93.6%, 1.2%, and 5.2%, respectively. Of the 1054 women who attempted a vaginal birth after cesarean, 87% were successful. Low Apgar scores (Ͻ 7) occurred in 1.5% of newborns. Postpartum maternal (1.5%) and neonatal (0.9%) transfers were infrequent. The majority (86%) of newborns were exclusively breastfeeding at 6 weeks of age. Excluding lethal anomalies, the intrapartum, early neonatal, and late neonatal mortality rates were 1.30, 0.41, and 0.35 per 1000, respectively. Discussion:For this large cohort of women who planned midwife-led home births in the United States, outcomes are congruent with the best available data from population-based, observational studies that evaluated outcomes by intended place of birth and perinatal risk factors. Low-risk women in this cohort experienced high rates of physiologic birth and low rates of intervention without an increase in adverse outcomes.
Seasonal variation in lipid content and composition was studied in deposit-feeding amphipods from a Baltic archipelago. In Monoporeia afinis, which is more active and has a higher respiration rate, lipid levels were low in winter and early spring, rose to 27% of the dry mass in late summer, then declined in autumn. In Pontoporeia femorata, which regulates its oxygen consumption, lipid levels were 20-23% of the dry mass. In October, maturing male P. fimorata had a significantly lower lipid content than females. Triacylglyccrol and phospholipid accounted for -90% of lipids. Phospholipid dominated in M. afinis in March, but triacylglycerol accumulated and became the main lipid after the spring bloom. Triacylglycerol was always the main lipid in P. femorata, but also accumulated after the spring diatom bloom. Both species seem to assimilate and store food resources from the diatom bloom. The higher feeding rate of M. afinis may explain its greater accumulation of lipid. Lower metabolic costs in P. femorata may allow it to maintain steady lipid levels for most of the year.
Division of Research developed a Web-based data collection system to gather information on the practices and outcomes associated with midwife-led births in the United States. This system, called the MANA Statistics Project (MANA Stats), grew out of a widely acknowledged need for more reliable data on outcomes by intended place of birth. This article describes the history and development of the MANA Stats birth registry and provides an analysis of the 2.0 dataset's content, strengths, and limitations.Methods: Data collection and review procedures for the MANA Stats 2.0 dataset are described, along with methods for the assessment of data accuracy. We calculated descriptive statistics for client demographics and contributing midwife credentials, and assessed the quality of data by calculating point estimates, 95% confidence intervals, and kappa statistics for key outcomes on pre-and postreview samples of records. Results:The MANA Stats 2.0 dataset (2004)(2005)(2006)(2007)(2008)(2009) contains 24,848 courses of care, 20,893 of which are for women who planned a home or birth center birth at the onset of labor. The majority of these records were planned home births (81%). Births were attended primarily by certified professional midwives (73%), and clients were largely white (92%), married (87%), and college-educated (49%). Data quality analyses of 9932 records revealed no differences between pre-and postreviewed samples for 7 key benchmarking variables (kappa, 0.98-1.00).Discussion: The MANA Stats 2.0 data were accurately entered by participants; any errors in this dataset are likely random and not systematic. The primary limitation of the 2.0 dataset is that the sample was captured through voluntary participation; thus, it may not accurately reflect population-based outcomes. The dataset's primary strength is that it will allow for the examination of research questions on normal physiologic birth and midwife-led birth outcomes by intended place of birth. Keywords: birth center, cohort study, data collection, home childbirth, midwifery, parturition, registry, research design INTRODUCTIONIn 1982, the Midwives Alliance of North America (MANA) was established as an inclusive professional organization with the express goal of uniting and representing all North American midwives, regardless of educational background, credentials, or primary place of practice.1 Over the last 30 years, however, MANA has become largely US-based due, in part, to the increasing number of professional midwifery organizations that have formed in Canada and Mexico. 2, 3 Today, the mission of MANA is to work with other midwifery organizations, including the American College of Nurse-Midwives (ACNM), the National Association of Certified Professional Midwives, and the International Confederation of Midwives, to strengthen the midwifery profession and improve access to high-quality maternity care for all women and newborns both in the United States and globally.Over the last decade, one of MANA's key initiatives has been the development of the MAN...
ABSTRACT. Zebra mussels, Dreissena polymorpha, were collected monthly from April/May to November in 1990 and
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