The Logitech Alert digital video security system comes with a host of goodies: motion-triggered built-in DVR, 130-degree wide-angle lens, 720p video. But what's got me most excited is the ability to watch the feed from pretty much anywhere. More »
Google Earth is great to use—until it bites you on the bum and alerts the authorities to the existence of your swimming pool. After Greece found out backyard swimmers last year, a US town is cracking down now. More »
More and more American women (1 in 200) are opting for home birth, and midwife-assisted home birth is common in other developed countries. How safe is it compared to birth in a hospital? A new study sheds some light on the subject. It was recently published in the American Journal of Obstetrics and Gynecology: Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis, by Wax et al.
All the existing studies have flaws. It would be ideal to do a study where women were randomly assigned to home or hospital birth; that isn’t possible, so we have to fall back on studies that are possible. Just comparing home births to hospital births isn’t good enough, because high-risk births occur primarily in hospitals, and between 9% and 37% of planned home births end up with transfer to the hospital during labor and are converted into hospital births. Cohort studies comparing planned home with planned hospital births provide the best sources of data by intended delivery location. There have been several such studies, but the numbers were small and the results were inconclusive. This new study is a meta-analysis that combines the data into one large set for better understanding.
Wax et al. combed the published literature and found studies covering 342,056 planned home and 207,551 planned hospital deliveries. Studies were included in their analysis if they were performed in developed Western countries, published in English-language peer-reviewed literature, if maternal and newborn outcomes were analyzed by planned delivery location, and if data were presentable in a 2X2 table. They looked at several measures of maternal intervention (epidurals, C-sections, etc.), maternal outcomes (mortality, hemorrhage, infection, etc.), and neonatal outcomes (Apgar scores, perinatal deaths, etc.). Here’s what they found:
RESULTS: Planned home births were associated with fewer maternal interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative delivery. These women were less likely to experience lacerations, hemorrhage, and infections. Neonatal outcomes of planned home births revealed less frequent prematurity, low birthweight, and assisted newborn ventilation. Although planned home and hospital births exhibited similar perinatal mortality rates, planned home births were associated with significantly elevated neonatal mortality rates.
CONCLUSION: Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate.
It’s important to understand the difference between perinatal and neonatal mortality. The write-up of the study is confusing because a typo erroneously defines perinatal mortality as deaths up to 28 days after birth. Perinatal mortality includes stillbirths and deaths in the first 7 days of life; neonatal mortality includes all deaths in the first 28 days of life.
Neonatal death was twice as likely overall with home birth (Odds Ratio 1.98, 95% confidence interval 1.19–3.28) and three times as likely for non-anomalous births (OR 2.87, CI 1.32–6.25). Non-anomalous means without congenital defects. These findings are robust, consistent across all studies, and even more impressive in that women planning home deliveries had equal or lower obstetric risk. The relative risk is striking, but the absolute risk is small due to the small number of home births. They estimate the population-based attributable risk of overall neonatal death to be 0.3%.
One of the stated goals of women planning home births is to avoid unnecessary interventions. They did indeed have fewer interventions. But planned home births were characterized by a greater proportion of deaths attributed to respiratory distress and failed resuscitation. Intrapartum asphyxia is a major cause of death in hospital births, and it is decreased by interventions. This raises the question of whether the decreased obstetric intervention in the home birth group may have caused more neonatal deaths due to asphyxia.
Women intending home deliveries had better outcomes: fewer infections, 3rd-degree lacerations, perineal and vaginal lacerations, hemorrhages, and retained placentas; and there was no significant difference in the rate of umbilical cord prolapse. There were too few maternal deaths to analyze.
Babies of mothers planning home births were less likely to be born preterm or be of low birthweight, but were more likely to have an extended gestation of 42 weeks. Perinatal mortality was similar, but neonatal mortality was significantly greater. This is puzzling and it would have been helpful to know more about the cause of death and the course of illness. How could intrapartum events cause equal mortality up to one week and greater mortality only between 7 and 28 days? The incidence of infection in the babies was not reported. Fear of hospital-acquired infections is one stated reason for choosing home delivery: is it a valid reason? One could argue that the best solution is to reduce the rate of hospital-acquired infection, not to avoid the hospital. Mothers had fewer infections, but is it possible that more babies got infections during home births, infections that contributed to death between 7 and 28 days? What other factors might account for delayed deaths? And why should the death rate of normal babies exceed that of babies with congenital defects?
The authors commented that
the lower obstetric risk characterizing women self-selecting planned home birth likely underestimates the risk and overestimates the benefit of this delivery choice.
They reported that a study published after their analysis found similar perinatal mortality rates in planned home and hospital deliveries, but after adjustment for the later gestational ages at delivery and greater birthweights among home births, the perinatal mortality was actually greater for planned home deliveries, especially for women who required transfer to the hospital. Up to 37% of women planning a home birth with their first pregnancy end up being transferred to the hospital because of emergencies that arise during the labor process.
They commented that the studies analyzed were of low-risk women considering home birth with highly trained, regulated midwives who are fully integrated into existing health care systems. As such, they might not be generalizable to all women opting for home birth in the United States.
Midwives’ groups are already attacking this new study as flawed and politically motivated, but of course they themselves are politically motivated to show the safety of home birth, and their own studies are flawed. Passions run high on both sides of the debate. This study is far from perfect, and it’s certainly not the final answer, but it’s the best we’ve got to go on at the moment.
I think the real message from this study is that we need to develop a better understanding of which interventions are really necessary to save babies’ lives and how to improve the outcome of all deliveries, whether at home or in a hospital.
A non-trivial percentage of planned home births end up with transport to a hospital. Home birth advocates recognize that these emergencies occur. It seems intuitively obvious that increasing the time delay for emergency interventions ought to increase adverse outcomes, that distance from a hospital is a crucial factor, and that the optimum scenario is immediate availability of emergency response, i.e. labor in a hospital rather than at home.
I submit that delayed treatment of unexpected emergencies constitutes a small but undeniable risk for planned home births. It has not been established that the benefits of home birth (lower maternal infection rate, etc.) can outweigh that risk. And it has not been established that those benefits couldn’t be obtained just as well by improving hospital practices. What do women really want? If they just want to be at home, they may be willing to accept a small increase in risk. If they want fewer interventions, that doesn’t require that they give birth at home.
I admit to prejudice. I support the right of informed patients to choose home birth with a qualified midwife and reasonable precautions, but I personally want no part of it. Having delivered a lot of babies myself and having seen normal low-risk deliveries turn to disaster in a heartbeat, I would never have considered having my own babies at home, and I would personally be very frightened to attend a home birth, especially if there was a 37% chance of it ending with a nerve-wracking rush to the hospital. I would rather see babies born within easy reach of a C-section and other lifesaving interventions. I think this could be accomplished by integrating the “kinder, gentler,” less interventionist midwife approach into a home-like hospital birthing facility in close coordination and communication with obstetricians and pediatricians. This approach would increase patient satisfaction without sacrificing safety, and it is already being tried in many hospitals.
This study leaves a lot of questions unanswered, but it does give us better information to help patients make an informed decision.
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Normally, I'd call this an insane idea that'll never happen, but apparently it's going to: China is building gigantic buses that ride over traffic rather than with it, allowing it to skip gridlock entirely. Ho-kay. More »
NASA ISS On-Orbit Status 2 August 2010
"Time again for Skvortsov & Yurchikhin for recharging the Motorola Iridium-9505A satellite phones located in Soyuz TMA-18/22S (at MRM2) & Soyuz TMA-19/23S (docked at MRM1), a monthly routine job and Fyodor's 2nd, Sasha's 4th. [After retrieving the phones from their location in the spacecraft Descent Modules (BO), the crewmembers initiated the recharge of the lithium-ion batteries, monitoring the process every 10-15 minutes as it took place. Upon completion, the phones were returned inside their SSSP Iridium kits and stowed back in the BO's ODF (operational data files) container. The satphone accompanies returning ISS crews on Soyuz reentry & landing for contingency communications with SAR (Search-and-Rescue) personnel after touchdown (e.g., after an "undershoot" ballistic reentry, as happened during the 15S return)."
Keith's note: I hope these phones work better on the steppes of Kazakhstan than they did at Everest Base Camp (lots of big mountains in your face). Scott Parazynski and I used to have phone conversations with our families back home via our Iridium phone (that I smuggled into Nepal since no one knew how to give me a formal permit) albeit in 2 minute increments interspersed with 5 minute intervals of silence while another satellite popped into (and then out of) view. That said, Scott and the Singing Sherpas did manage to sing Happy Birthday to Mike Barratt on the ISS via an Iridium phone at 21,500 feet on Mt. Everest.
Coronal mass ejections (or CMEs) are large clouds of charged particles that are ejected from the Sun over the course of several hours and can carry up to ten billion tons (1016 grams) of plasma. They expand away from the Sun at speeds as high as a million miles an hour. A CME can make the 93-million-mile journey to Earth in just three to four days.
When a coronal mass ejection reaches Earth, it interacts with our planet’s magnetic field, potentially creating a geomagnetic storm. Solar particles stream down the field lines toward Earth’s poles and collide with atoms of nitrogen and oxygen in the atmosphere, resulting in spectacular auroral displays. On the evening of August 3rd/4th, skywatchers in the northern U.S. and other countries should look toward the north for the rippling dancing “curtains” of green and red light.
The Sun goes through a regular activity cycle about 11 years long. The last solar maximum occurred in 2001 and its recent extreme solar minimum was particularly weak and long lasting. These kinds of eruptions are one of the first signs that the Sun is waking up and heading toward another solar maximum expected in the 2013 time frame.
For more information visit http://www.nasa.gov/topics/solarsystem/sunearthsystem/main/News080210-cme.html
Down to the Wire for Station Repair Spacewalks, CBS
"NASA astronauts and engineers are refining plans for two spacewalks by astronauts Douglas Wheelock and Tracy Caldwell Dyson to replace a large ammonia pump module that shut down Saturday, knocking out one of the International Space Station's two cooling loops. The astronauts hope to carry out the first spacewalk Friday morning, starting at 6:55 a.m. EDT, and a second excursion Monday to finish the job, one of the so-called "big 14" on a list of critical components that require spacewalk repair if problems crop up. NASA managers initially targeted Thursday for the first spacewalk and Sunday for the second, but decided late Monday they needed more time to review procedures. "This is an anomaly we knew someday would happen," said space station Program Manager Mike Suffredini. "It's an anomaly we have trained for; it's an anomaly we have planned for." With four spare pump modules on board the station, "we're in a good position to go solve this problem," he said. "It is a significant failure, though, in terms of systems on board ISS, so it's one we need to go after."
If I had access to a secret stash of iPhone knockoffs - a phone that worked identically to the real iPhone, but was a bootleg made of inauthentic parts - how much could I charge? Why could I charge that? More »
The 1971 AMC Penske Javelin that Mark Donohue drove to victory in the 1971 Trans-Am series will be auctioned off next month. The car has been restored to concours-level condition by MAECO Motorsport of Northridge, California, and won awards in its class at the Amelia Island Concours in 2008. Th
Answer: No.
Okay, let me embellish. There is no way that you can add, switch, or remove one molecule that would make margarine turn into a plastic bottle. That being said, there are a lot of common misconceptions regarding margarine and how it measures up to butter.
The Origin
At 5 acres, 5 Cove Island is a quaint island tucked away within the pristine wilderness of British Columbia. This rare island is connected to the mainland by white sandy beaches and enjoys the most unobstructed views of the sourrounding mountains and islands.
The island’s location is ideal for a smaller luxury development because it is only 30 minutues by boat to Vancouver, boasts some of the most spectacular untouched views and already has subdivision approval.
5 Coves’ micro-climate sustains an abundant variety of wildlife in and out of the water. Bears, seals and otters take in the sun, feed and play around Zoor Bay. Families of Orcas follow schools of herring into Howe Sound. Swans and geese pause to feed on their journey South. Eagles watch for prey from tall evergreens. Crabs, prawns and shellfish, slamon and mackerel are plentiful in the waters around the island.
Inquire at Private Islands Online for more images and a PDF of the proposed development.
Harvard Medical School rolls out new rules to stop its faculty from accepting ... Natural News.com But Harvard Medical School has now made a new rule that prohibits its 11000 faculty members from engaging in this activity. The school is also requiring ... U-M Hires Almost 200 New Medical School Faculty Members Since MayPR Newswire (press release) University of Michigan Medical School hits 'highest point ever' in faculty hiringAnnArbor.com Growth in research funding spurs UM Medical School to hire record number of ...Crain's Detroit Business Healthcare Digital (press release) all 14 news articles » |
The Bluetooth earpiece is an essential component of any 21st Century d-bag's uniform, a fact which has generally steered the more cynical gadget-using population away from them. But this custom Bluetooth ear piece shows that you totally get all that. More »
 Smart Business Network | International Doctors in US Perform Better Than Home-Grown Physicians Bloomberg Photographer: Joe Raedle/Getty Images US patients of doctors who went to medical school outside the country and weren't American citizens had a 9 percent ... Foreign-Born Doctors Give Equal Care in USNew York Times No real difference seen in quality of care from foreign-trained docsModernHealthcare.com Peeking over your physician's shoulder: Should we have open access to our ...The Star-Ledger - NJ.com (blog) Reuters India -Monitor -Chronicle of Higher Education (subscription) all 30 news articles » |
If there's a video game console or dedicated game machine not covered in this epic 23-minute walkthrough, I don't want to know about it. In fact, there are plenty here that I don't recognize. More »
Astrium signs development contract with Vietnam for an Earth observation satellite - VNREDSat-1
"Astrium has signed a contract worth 055.2 million with the Vietnam Academy of Science and Technology (VAST) for the development, manufacture and launch of an Earth observation optical satellite system. This follows on from last November's intergovernmental agreement on space co-operation between France and Vietnam, in which the French government affirmed its commitment to building a closer partnership with Vietnam in the domain of science and technology."
Ever wanted to be an astronaut? You're in good company: For many people, space represents the unexplored, a place free from boundaries. And space flight represents the extreme of human experience. More »
Cross your fingers — the final static kill procedure begins tomorrow. Meanwhile, those who don’t live near the Gulf are wondering where the oil in the ocean went. (To some Americans, if you can’t see it, it must not exist). I’ve even read columnists sarcastically wonder why everyone was so worried in the first place, and whether the media stories were overblown.  Sadly, the oil is still mostly where BP put it, in the ocean. Some of it is in the sand on beaches. If the oil is in the water column, or the sea bed soil, it’s still there, mixed with dispersants. Like CO2 in the air — you can’t necessarily see it, but you can see its effects on wildlife and in some cases, the marshes are still full of oil, as is the sand.
Oil is elbow-deep under the sand in some areas. (See photo of this at right)
BP is still defending the unprecedented amount of dispersants used to break up the oil and they are going to great pains to defend dumping poisons in the ocean. They are getting a lot of facetime on TV too, unfortunately. The EPA then released a new study saying that dispersants mixed with oil are no more toxic than the oil itself. The problem with that, if you believe it, is that the oil is very toxic and is still killing wildlife every day. I just read yesterday that frustrated people are cleaning hermit crabs with Q-tips. The EPA states:
“All eight dispersants were found to be less toxic than the dispersant-oil mixture to both test species. Louisiana Sweet Crude Oil was more toxic to mysid shrimp than the eight dispersants when tested alone. Oil alone had similar toxicity to mysid shrimp as the dispersant-oil mixtures, with exception of the mixture of Nokomis 3-AA and oil, which was found to be more toxic than oil.”
The flow rate estimate was released today and the media is telling us the oil released started out at 62,000 barrels a day, and then later went down to 53,000 barrels a day. Wait a minute — why can they tell us this now, when the oil flow has stopped, but somehow they couldn’t do it when it was actually measurable?
All in all, we are told 4.9 million barrels of oil flowed into the Gulf. Many people think it was twice that, or three times or even more.
However much is still there, it is “hovering”.
A Greenwire report published in the The Times put it this way:
That dispersed oil now hovers, diluted in the water column, posing a challenge for scientists to track and measure the subsea plumes. Mapping the long-term effects of the nearly 2 million gallons of dispersant used by BP PLC may well be equally difficult, given the array of unanswered questions that surround the products’ rapid breakdown of oil droplets and their chronic toxicity.
In other words, while dispersants may have helped spare [...]
Not many accessories beat Apple at its own game, but this one would. The Wireless Streaming Music Centre concept makes your iPod seemingly levitate while it streams music through beautifully designed speakers. More »
Look, I get that there are going to be product tie-ins with Toy Story 3. It makes sense. But for that scene? Just make sure the kid you buy it for doesn't cry easily. [Amazon via Jeff Rubin] More »
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