Curved versus straight scissors to avoid 3rd and 4th degree perineal tears: A randomised feasibility study

BackgroundSevere perineal tears sustained during childbirth cause significant distress and morbidity amongst women. The objective of this study was to compare the use of straight scissors for cutting an episiotomy with the use of curved scissors, which are designed to curve away from the anal sphincter.MethodsWe used a single-centre, randomised feasibility trial. The intervention was the use of curved scissors. Women were recruited during a prenatal visit and randomised in the delivery suite, when it became clear that an episiotomy was required. The feasibility outcomes were the proportion of women able to be recruited, randomised and followed up. We also calculated the incidence of obstetric anal sphincter injury when either straight or curved scissors were used to cut an episiotomy. Other outcomes assessed were pain, length of hospital stay, perineal infection and perineal dehiscence.ResultsOf the 155 patients recruited in the prenatal period, only 20 (12.9%) were eventually randomised at birth. The main reasons for the high loss were that women either did not have a vaginal delivery (38, 24.5%), or they did not need an episiotomy (72, 46.5%). Rates of obstetric anal sphincter injury and other outcomes were similar between groups.DiscussionAnal sphincter injury during childbirth remains an important problem. Although the use of curved scissors provides a theoretical solution, we found that the high attrition rate made feasibility of conducting a suitably powered, randomised trial using the current design untenable. Alternative strategies have been suggested to make any future study more viable.     

Introduction: “There Is a Person Here”: An Interview with Judith Butler

In this interview, the coeditors, along with other contributors, ask Judith Butler a variety of questions regarding queer theory, gender identities, scientific and legal discourse, bodily abjection, race and class positioning, and political organizing. This range of subject matter suggests not only the breadth of Butler's work, but also its applicability to any number of people, whose relation to theory ranges from highly politicized to politically indifferent. The interview demonstrates the responsiveness of Butler's work to cultural translation and political action.     

CMHS/CSAT Collaborative Demonstration Program for Homeless Individuals

The Collaborative Demonstration Program for Homeless Individuals is providing an opportunity for several community agencies in the United States to explore innovative intervention and treatment strategies to address the needs of homeless people with co-occurring (mental illness and substance abuse) disorders. This cooperative agreement, funded jointly by the Center for Mental Health Services (CMHS) and the Center for Substance Abuse Treatment (CSAT), is a $3 million project supporting programs in various community agencies to develop, document, and evaluate programs for persons who are homeless with co-occurring disorders to be used as models in other communities. The program models include: Assertive Community Treatment, Psychosocial Rehabilitation, Therapeutic Community, and an integrated treatment model. The first phase of the two-phase project funded 16 programs in the U.S. to develop manuals within their primary treatment modalities for homeless people with co-occurring disorders. For Phase II of the project, six of the 16 model programs were competitively selected to demonstrate program impact through formal program evaluation efforts. The data derived from the various projects will be compiled into a compendium of information for state agencies and community service providers throughout the U.S.     

Sibling Relationships and Social-emotional Adjustment in Different Family Contexts

The aims of this study were to examine family type (nonstep, stepfather, stepmother, and single mother) and sibling type (full‐ and half‐siblings) differences in sibling relationship quality (positivity and negativity), and to investigate links between sibling relationship quality and child externalizing and internalizing problems. The sample included 192 families with a 5‐year‐old target child and an older sibling. In addition, 80 of these families included a third older child. Mothers and the older siblings (8 years and older) completed questionnaires and interviews regarding conflict and support in their sibling relationships, and parents and teachers reported on each child's social‐emotional adjustment. Sibling negativity (conflict, aggression) was highest in single‐mother families and full‐siblings were more negative than half‐ and stepsiblings. There was some evidence that sibling antagonism was associated with more child behavioral and emotional problems, but these effects were moderated by family type.     

建设中国最先进的晶圆芯片厂

有朋自远方来，不亦乐乎。这句流传千年的名言告诉我们：中华民族是礼仪之邦，中国人民热情友好，珍视情谊!     

‘Speak roughly to your little boy’? Sex Differences in the Relations Between Parenting and Preschoolers’ Understanding of Mind

The present study explores relations between young children's understanding of mind and parental emotional expression and disciplinary style, along with gender differences in these relations. Participants were recruited from a study of 125 same-sex twin-pairs (58% female; group mean age 5 43 months, SD 5 1 month). Each child received a comprehensive set of theory-of-mind tasks, and was filmed at home for 20 minutes in dyadic interactions with the primary caregiver, who was also interviewed about disciplinary strategies. Ratings of discipline and positive and negative parental affect and control were made from direct observation, from the interview, and from the videoed interactions. Strong correlations were found between family SES, parenting measures, and child verbal IQ and theory-of-mind score. However, regression analyses showed that parental behaviours were significant predictors of children's theory-of-mind performance, even when sex, verbal IQ and family SES were taken into account. Sex differences in these relations were also identified; parental affect was especially salient for understanding of mind in girls, while discipline was more salient for boys. Taken together, these findings highlight the importance of individual differences in the proximal processes associated with early understanding of mind, and suggest that development in mental-state awareness is associated with distinct aspects of parenting for girls and boys.     

有限的伙伴关系:1928年至1944年中国与德国、苏联和美国的关系

自1928年国民党统治开始,中国第一次进入了其现代意义上的国际合作关系时期,寻求国际伙伴关系首次成为中国内政与外交政策的主要目标.20世纪30年代和40年代早期的中德、中俄和中美关系各自具有鲜明的特性.中德关系建立在两国领导人互相信任和经验积累的基础之上,某些意识形态上的类似是其得以发展的主要因素,但更重要的是互补的经济利益使国民党可以实现平等的合作.中苏关系和中美关系一开始就是为了增强双方对付共同敌人的力量而形成结盟的,之前都不具有恰当的合作机制,而意识形态是一个复杂的、不利于结盟的因素.在中苏关系中,结盟意味着从直接敌对状态转向谨慎的合作.而中美之间非国家层面上的合作既没有达到一个较高的水平,这些合作也不会自动强化双方的官方关系.当结盟机制仓促建立起来时,却缺乏坚实的结构基础.     

An investigation of unmet intimacy needs in marital relationships

In this investigation we examined partners' responses to unmet intimacy needs in hopes of better understanding how these responses may affect intimacy satisfaction and overall relationship satisfaction. Eighty-four married couples, plus four additional husbands and 12 additional wives, were recruited from the community and completed measures of relationship satisfaction, intimacy need satisfaction, and attributional and communication responses to unmet intimacy needs. Consistent with the proposed mediational model, less negative attributional and communication responses to unmet intimacy needs were found to be beneficial for overall intimacy satisfaction and relationship satisfaction. In addition, more positive communication responses contributed to greater intimacy satisfaction. Limitations and clinical implications of the current study and directions for future work are discussed.     

Access to health care: does neighborhood residential instability matter?

Many Americans do not have access to adequate medical care. Previous research on this problem focuses primarily on individual-level determinants of access such as income and insurance coverage. The role of community-level factors in helping or hindering individuals in obtaining needed medical care, however, has not received much attention. We address this gap in the literature by investigating the association between neighborhood residential instability and access to health care. Using individual-level data from the 2000 Medical Expenditure Panel Survey and block-group level data from the 2000 decennial census, we find that individuals who live in neighborhoods with high residential turnover have worse health care access than residents of other neighborhoods. This association persists even when the prevalence of poverty, the supply of health care, and a variety of individual characteristics are held constant. We offer explanations for these findings and suggest directions for future research.