Role of midwives

Dr. Alfano (New England Journal of Medicine 296: 1126, 1977) is certainly entitled to his personal opinions, but when they appear in a major publication in a setting that calls for factual information, they cannot go unchallenged. Midwives have played and continue to play a major part in maternal-infant services in many advanced European countries. Combined midwife-physician services in Sweden, Finland, Japan, Netherlands, Denmark, Norway, and Switzerland produced infant mortality rates in 1972 superior to those reported by Dr. Alfano for the Commonwealth of Massachusetts in 1974. Even in 1967 Sweden and the Netherlands (where most infants are delivered by midwives) had infant mortality rates, respectively, of 12.9 and 13.4/100 live births. These numbers, of course, do not mean that midwives are superior to doctors, but they do not seem to prove them inferior when they are employed in an appropriate setting. In Oregon (where certified nurse-midwives have been employed for some years) the professional midwife is found mainly in the "expensive" practices, so that if there is a "3rd-level of care," it is delivered to the well-to-do rather than the indigent. It is a little early to tell, but the impression around here is that although the quality of the birth experience may be changed by addition of midwives to an upper-middle-class practice, the outcome in terms of numbers of live babies is no different. This finding may not apply when 1 is dealing with the economically disadvantaged. A striking study from California demonstrated a definite improvement in fetal outcome when certified midwives were added to an established program and a tendency for the infant mortality rate to rise again when their services were discontinued for lack of funds. A similar program is under way in Oregon, but it is much too early for results to be apparent. This letter is not written in defense of midwives - it is a plea for balance and rationality. Medicine is no place for a territorial imperative. Only by calling on the expertise of all qualified members of a society can one hope to progress and to improve the human condition.     

Distribution of non-diffusible calcium and sodium in normal and cataractous human lenses

In this work, the authors studied the morphology of the axillary and mediastinal lymph nodes and their efferent branches in the white rat (Rattus norvegicus). The main characteristics observed were: The presence of two groups of axillary lymph nodes, one in the lateral and the other in the medial portion, and the presence of two groups of mediastinal lymph nodes, one being ventrolateral and the other dorsoventral relating to cranial precava veins. Usually, in both sides, there is a lymphatic plexus dorsally to the jugulsubclavian angle, formed by reunion of internal jugular and subclavian trunks and the thoracic duct (to the left) or the right lymphatic trunk (to the right). From this plexus, one or two branches run off and flow into the venous jugulosubclavian angle. The subclavian trunk begins in the medial axillar lymph nodes and joins to the lymphatic plexus at the internal jugular trunk or at the thoracic duct or yet at the right lymphatic trunk according to the site, and finally it may link itself directly to the venous system. The mediastinal lymph nodes at the side send branches forming the right lymphatic trunk and branches adhering to the lymphatic plexus; the left lymph nodes join to the plexus or the thoracic duct.     

Co-encapsulation of fish oil with phytosterol esters and limonene by milk proteins

Co-encapsulated microcapsules containing three lipophilic bioactive components (LBCs) including fish oil, phytosterols and limonene were studied and compared with those containing only fish oil. Milk proteins (whey protein isolate and sodium caseinate in a ratio of 4:1) were used as wall materials. Results show that good quality microcapsules can be obtained at inlet temperature of 170 °C and outlet temperature of 70 °C, with the wall to core ratio of 4:1. There was no significant different (p > 0.05) in the microencapsulation efficiency and the oxidation indicators (PV and AV) after the accelerated storage for both types of microcapsules. However, the retention of EPA and DHA in the LBCs-microcapsules was significantly higher (p < 0.05) than the fish oil microcapsules. The phytosterols content was unchanged but loss of limonene occurred after storage. The LBCs-microcapsules had better flavor/odour profile than the fish oil microcapsules after drying and storage.     

Controlling selectivity in catalysis: Selective greener oxidation of cyclohexene under microwave conditions

A smart and greener microwave approach to the selective oxidation of cyclohexene is reported whereby, depending on the reaction conditions, the epoxide (65% conversion, 75% selectivity), the enol (70% conversion, 80% selectivity) or the enone (>99% conversion, 89% selectivity) can be obtained in a short period of time ranging from 1 to 20 min. A cobalt-salen-SBA-15 material was employed as catalyst. The reported solventless microwave protocol was simple, greener and more efficient compared to any other reported cyclohexene oxidations.     

G. Stanley Hall's Contribution to Science, Practice and Policy: The Child Study, Parent Education, and Child Welfare Movements.

G. Stanley Hall influenced several social movements that had great implications for child wellbeing: the Child Study, Parent Education, and Child Welfare Movements. However, while Hall laid much of the foundation for the field of scientific child study and policy-relevant research, his legacy is virtually nonexistent. The current article reviews the life and contributions of G. Stanley Hall, and the dual role Hall played in history as a revered leader of the Child Study Movement and a controversial figure in the landscape of early child psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)