Dr. Fisher believes that dispassionate, rigorous study of birth across all settings is more important than ever given disparities in women's access to trained and licensed care providers, current and future physician workforce issues, rising costs of health care, and unacceptably high
rates of adverse outcomes for mothers and infants in the U.S. compared to other industrialized countries.
Regulating it, using better trained practitioners and proper guidelines for risking - out and transfer definitely would reduce
the rate of adverse outcomes.
In many previous U.S. studies, it was not possible to disaggregate planned in - hospital births from planned out - of - hospital births that took place in the hospital after a woman's intrapartum transfer to the hospital.3, 9,10 The latter births represent 16.5 % of planned out - of - hospital births in our population, and misclassification of these births as in - hospital births caused
rates of adverse outcomes among planned out - of - hospital births to be underestimated (in some cases, substantially).
Did they provide you with the relative
rates of adverse outcomes in home vs. hospital?
The rates of some adverse outcomes were too low for us to draw statistical comparisons, and ongoing evaluation of home birth is warranted.
Professor Heal said there was no difference in
the rates of adverse outcomes (skin irritation, etc) in either group.
Both one and two year
rates of adverse outcomes compared favorably with historical performance criteria established among medically managed patients with aortic stenosis.
Not exact matches
Important factors that could cause actual results to differ materially from those reflected in such forward - looking statements and that should be considered in evaluating our outlook include, but are not limited to, the following: 1) our ability to continue to grow our business and execute our growth strategy, including the timing, execution, and profitability
of new and maturing programs; 2) our ability to perform our obligations under our new and maturing commercial, business aircraft, and military development programs, and the related recurring production; 3) our ability to accurately estimate and manage performance, cost, and revenue under our contracts, including our ability to achieve certain cost reductions with respect to the B787 program; 4) margin pressures and the potential for additional forward losses on new and maturing programs; 5) our ability to accommodate, and the cost
of accommodating, announced increases in the build
rates of certain aircraft; 6) the effect on aircraft demand and build
rates of changing customer preferences for business aircraft, including the effect
of global economic conditions on the business aircraft market and expanding conflicts or political unrest in the Middle East or Asia; 7) customer cancellations or deferrals as a result
of global economic uncertainty or otherwise; 8) the effect
of economic conditions in the industries and markets in which we operate in the U.S. and globally and any changes therein, including fluctuations in foreign currency exchange
rates; 9) the success and timely execution
of key milestones such as the receipt
of necessary regulatory approvals, including our ability to obtain in a timely fashion any required regulatory or other third party approvals for the consummation
of our announced acquisition
of Asco, and customer adherence to their announced schedules; 10) our ability to successfully negotiate, or re-negotiate, future pricing under our supply agreements with Boeing and our other customers; 11) our ability to enter into profitable supply arrangements with additional customers; 12) the ability
of all parties to satisfy their performance requirements under existing supply contracts with our two major customers, Boeing and Airbus, and other customers, and the risk
of nonpayment by such customers; 13) any
adverse impact on Boeing's and Airbus» production
of aircraft resulting from cancellations, deferrals, or reduced orders by their customers or from labor disputes, domestic or international hostilities, or acts
of terrorism; 14) any
adverse impact on the demand for air travel or our operations from the outbreak
of diseases or epidemic or pandemic outbreaks; 15) our ability to avoid or recover from cyber-based or other security attacks, information technology failures, or other disruptions; 16) returns on pension plan assets and the impact
of future discount
rate changes on pension obligations; 17) our ability to borrow additional funds or refinance debt, including our ability to obtain the debt to finance the purchase price for our announced acquisition
of Asco on favorable terms or at all; 18) competition from commercial aerospace original equipment manufacturers and other aerostructures suppliers; 19) the effect
of governmental laws, such as U.S. export control laws and U.S. and foreign anti-bribery laws such as the Foreign Corrupt Practices Act and the United Kingdom Bribery Act, and environmental laws and agency regulations, both in the U.S. and abroad; 20) the effect
of changes in tax law, such as the effect
of The Tax Cuts and Jobs Act (the «TCJA») that was enacted on December 22, 2017, and changes to the interpretations
of or guidance related thereto, and the Company's ability to accurately calculate and estimate the effect
of such changes; 21) any reduction in our credit
ratings; 22) our dependence on our suppliers, as well as the cost and availability
of raw materials and purchased components; 23) our ability to recruit and retain a critical mass
of highly - skilled employees and our relationships with the unions representing many
of our employees; 24) spending by the U.S. and other governments on defense; 25) the possibility that our cash flows and our credit facility may not be adequate for our additional capital needs or for payment
of interest on, and principal
of, our indebtedness; 26) our exposure under our revolving credit facility to higher interest payments should interest
rates increase substantially; 27) the effectiveness
of any interest
rate hedging programs; 28) the effectiveness
of our internal control over financial reporting; 29) the
outcome or impact
of ongoing or future litigation, claims, and regulatory actions; 30) exposure to potential product liability and warranty claims; 31) our ability to effectively assess, manage and integrate acquisitions that we pursue, including our ability to successfully integrate the Asco business and generate synergies and other cost savings; 32) our ability to consummate our announced acquisition
of Asco in a timely matter while avoiding any unexpected costs, charges, expenses,
adverse changes to business relationships and other business disruptions for ourselves and Asco as a result
of the acquisition; 33) our ability to continue selling certain receivables through our supplier financing program; 34) the risks
of doing business internationally, including fluctuations in foreign current exchange
rates, impositions
of tariffs or embargoes, compliance with foreign laws, and domestic and foreign government policies; and 35) our ability to complete the proposed accelerated stock repurchase plan, among other things.
These risks and uncertainties include, among others: the unfavorable
outcome of litigation, including so - called «Paragraph IV» litigation and other patent litigation, related to any
of our products or products using our proprietary technologies, which may lead to competition from generic drug manufacturers; data from clinical trials may be interpreted by the FDA in different ways than we interpret it; the FDA may not agree with our regulatory approval strategies or components
of our filings for our products, including our clinical trial designs, conduct and methodologies and, for ALKS 5461, evidence
of efficacy and adequacy
of bridging to buprenorphine; clinical development activities may not be completed on time or at all; the results
of our clinical development activities may not be positive, or predictive
of real - world results or
of results in subsequent clinical trials; regulatory submissions may not occur or be submitted in a timely manner; the company and its licensees may not be able to continue to successfully commercialize their products; there may be a reduction in payment
rate or reimbursement for the company's products or an increase in the company's financial obligations to governmental payers; the FDA or regulatory authorities outside the U.S. may make
adverse decisions regarding the company's products; the company's products may prove difficult to manufacture, be precluded from commercialization by the proprietary rights
of third parties, or have unintended side effects,
adverse reactions or incidents
of misuse; and those risks and uncertainties described under the heading «Risk Factors» in the company's most recent Annual Report on Form 10 - K and in subsequent filings made by the company with the U.S. Securities and Exchange Commission («SEC»), which are available on the SEC's website at www.sec.gov.
For healthy nulliparous women with a low risk pregnancy, the risk
of an
adverse perinatal
outcome seems to be higher for planned births at home, and the intrapartum transfer
rate is high in all settings other than an obstetric unit
* If * morbidity is lower in the homebirth group because more
of those ill women died, and were thus removed from the sample, the apparent
rate of «severe
adverse maternal»
outcomes has been artificially deflated in the homebirth group — by an unknown amount — and therefore is evidence
of pretty much nothing.
«Women with planned home birth had lower
rates of all
adverse maternal
outcomes, albeit not significantly so for nulliparous women.»
The strengths
of the study include the ability to compare
outcomes by the woman's planned place
of birth at the start
of care in labour, the high participation
of midwifery units and trusts in England, the large sample size and statistical power to detect clinically important differences in
adverse perinatal
outcomes, the minimisation
of selection bias through achievement
of a high response
rate and absence
of self selection bias due to non-consent, the ability to compare groups that were similar in terms
of identified clinical risk (according to current clinical guidelines) and to further increase the comparability
of the groups by conducting an additional analysis restricted to women with no complicating conditions identified at the start
of care in labour, and the ability to control for several important potential confounders.
This was a systematic review
of cohort and case - control studies that compared
rates of any
adverse pregnancy
outcome (such as miscarriages, preterm delivery, intrauterine growth restriction, major congenital malformations and long - term developmental
outcomes) between women who experienced NVP and women who did not.
Regional variations in practice significantly affect
rates of interventions, near misses, and
adverse outcomes.
A 2014 study that examines nearly 17,000 courses
of midwife - led care confirms that among low - risk women, home births result in low
rates of interventions without an increase in
adverse outcomes for babies and mothers alike.
The study reviewed the births
of nearly 17,000 women and found that, among low - risk women, planned home births result in low
rates of birth interventions without an increase in
adverse outcomes for mothers and newborns.
Rates of obstetrical intervention are high in U.S. hospitals, and we found large absolute differences in the risks
of these interventions between planned out -
of - hospital births and in - hospital births.38 In contrast, serious
adverse fetal and neonatal
outcomes are infrequent in all the birth settings we assessed, and the absolute differences in risk that we observed between planned birth locations were correspondingly small; for example, planned out -
of - hospital births were associated with an excess
of less than 1 fetal death per 1000 deliveries in multivariate and propensity - score - adjusted analyses.
Labor induction has been increasing since the early 1990s, 1 and the
rate is running at about 20 % for pregnancies at term.2, 3 Induction
of labor compared with spontaneous labor is associated with
adverse maternal
outcomes, including at least a doubling in the caesarean delivery
rate, 4,5 25 — 50 % increase in instrumental vaginal delivery
rate, 3,5 higher postpartum hemorrhage
rate, 5 and prolonged labor.5 Neonates born after induced labor are more likely to have low Apgar score and low umbilical cord blood pH. 5
«Planned home births result in low
rates of interventions without an increase in
adverse outcomes for mothers and babies,» Simkins boasts.
Countries that have the highest
rates of midwifery care have the lowest
rates of complications and
adverse outcomes.
These findings follow earlier research by Janssen that demonstrated that planned home births resulted in fewer interventions and similar
rates of adverse newborn
outcomes compared to planned hospital births among women who met the criteria for home births.
Low - risk women in this cohort experienced high
rates of physiologic birth and low
rates of intervention without an increase in
adverse outcomes.»
In today's peer - reviewed Journal
of Midwifery & Women's Health (JMWH), a landmark study confirms that among low - risk women, planned home births result in low
rates of interventions without an increase in
adverse outcomes for mothers and babies.
They go on to say «Low - risk women in this cohort experienced high
rates of physiologic birth and low
rates of intervention without an increase in
adverse outcomes» which is a lie.
«among low - risk women, planned home births result in low
rates of interventions without an increase in
adverse outcomes for mothers and babies.»
When we restricted the home - birth group to women who actually gave birth at home, the
rates of adverse maternal and newborn
outcomes did not differ significantly from those among all planned home births.
Our study showed that planned home birth attended by a registered midwife was associated with very low and comparable
rates of perinatal death and reduced
rates of obstetric interventions and
adverse maternal
outcomes compared with planned hospital birth attended by a midwife or physician.
«Our research indicates that insertion
of cervical pessary at around 22 weeks in both randomly selected women pregnant with twins and in patients with a short cervix
of less than 25 millimeters does not reduce the
rate of spontaneous early preterm birth, perinatal death,
adverse neonatal
outcome, or need for neonatal therapy.»
He points out that babies still die or are damaged because
of intrapartum hypoxia and that focusing entirely on the fetal heart
rate without taking account
of other relevant risk factors «may create a lack
of situational awareness and lead to
adverse outcomes.»
The study found that the higher the number
of group visits attended, the lower the
rates of adverse birth
outcomes.
«The results suggest that the environment is a stronger contributor to
adverse birth
outcomes than genes, since there are differences in
rates of birth
outcomes across states» Thayer said.
«Although signs suggest that obstetric interventions are being used too readily in developed countries, the lower
rates we saw among First Nations mothers are
of concern when coupled with the known increased risk
of adverse perinatal and infant
outcomes,» writes Corinne Riddell, PhD candidate, Department
of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, with coauthors.
Overall, «the absolute
rates of adverse maternal and neonatal
outcomes are low» — regardless
of whether a woman who has had a prior C - section undergoes vaginal delivery or has a repeat C - section, noted study author Dr. Carmen Young,
of the University
of Alberta.
«Abnormalities in thyroid function can have an
adverse effect on reproductive health and result in reduced
rates of conception, increased miscarriage risk and
adverse pregnancy and neonatal
outcomes,» said study co-author Amanda Jefferys in a journal news release.
If one accepts the conclusions
of the enormous body
of literature that finds no difference in perinatal mortality
rates or other
adverse outcomes between planned, midwife - attended home births and hospital births, then the pursuit
of this line
of reasoning is a non-starter.
An important study shows that home birth for low risk women reduces the
rate of interventions without increasing
adverse outcomes.
several high - quality Canadian studies confirming no difference in the
rates of perinatal death between planned home and hospital birth with much lower
rates of both interventions and
adverse outcomes (19 - 21);
The authors
of the report tie high suspension
rates to other
adverse outcomes, including low graduation
rates and involvement with the juvenile justice system.
Such statements reflect the current views
of Barnes & Noble with respect to future events, the
outcome of which is subject to certain risks, including, among others, the general economic environment and consumer spending patterns, decreased consumer demand for Barnes & Noble's products, low growth or declining sales and net income due to various factors, possible disruptions in Barnes & Noble's computer systems, telephone systems or supply chain, possible risks associated with data privacy, information security and intellectual property, possible work stoppages or increases in labor costs, possible increases in shipping
rates or interruptions in shipping service, effects
of competition, possible risks that inventory in channels
of distribution may be larger than able to be sold, possible risks associated with changes in the strategic direction
of the device business, including possible reduction in sales
of content, accessories and other merchandise and other
adverse financial impacts, possible risk that component parts will be rendered obsolete or otherwise not be able to be effectively utilized in devices to be sold, possible risk that financial and operational forecasts and projections are not achieved, possible risk that returns from consumers or channels
of distribution may be greater than estimated, the risk that digital sales growth is less than expectations and the risk that it does not exceed the
rate of investment spend, higher - than - anticipated store closing or relocation costs, higher interest
rates, the performance
of Barnes & Noble's online, digital and other initiatives, the success
of Barnes & Noble's strategic investments, unanticipated increases in merchandise, component or occupancy costs, unanticipated
adverse litigation results or effects, product and component shortages, the potential
adverse impact on the Company's businesses resulting from the Company's prior reviews
of strategic alternatives and the potential separation
of the Company's businesses, the risk that the transactions with Microsoft and Pearson do not achieve the expected benefits for the parties or impose costs on the Company in excess
of what the Company anticipates, including the risk that NOOK Media's applications are not commercially successful or that the expected distribution
of those applications is not achieved, risks associated with the international expansion contemplated by the relationship with Microsoft, including that it is not successful or is delayed, the risk that NOOK Media is not able to perform its obligations under the Microsoft and Pearson commercial agreements and the consequences thereof, risks associated with the restatement contained in, the delayed filing
of, and the material weakness in internal controls described in Barnes & Noble's Annual Report on Form 10 - K for the fiscal year ended April 27, 2013, risks associated with the SEC investigation disclosed in the quarterly report on Form 10 - Q for the fiscal quarter ended October 26, 2013, risks associated with the ongoing efforts to rationalize the NOOK business and the expected costs and benefits
of such efforts and associated risks and other factors which may be outside
of Barnes & Noble's control, including those factors discussed in detail in Item 1A, «Risk Factors,» in Barnes & Noble's Annual Report on Form 10 - K for the fiscal year ended April 27, 2013, and in Barnes & Noble's other filings made hereafter from time to time with the SEC.
Such statements reflect the current views
of Barnes & Noble with respect to future events, the
outcome of which is subject to certain risks, including, among others, the effect
of the proposed separation
of NOOK Media, the general economic environment and consumer spending patterns, decreased consumer demand for Barnes & Noble's products, low growth or declining sales and net income due to various factors, possible disruptions in Barnes & Noble's computer systems, telephone systems or supply chain, possible risks associated with data privacy, information security and intellectual property, possible work stoppages or increases in labor costs, possible increases in shipping
rates or interruptions in shipping service, effects
of competition, possible risks that inventory in channels
of distribution may be larger than able to be sold, possible risks associated with changes in the strategic direction
of the device business, including possible reduction in sales
of content, accessories and other merchandise and other
adverse financial impacts, possible risk that component parts will be rendered obsolete or otherwise not be able to be effectively utilized in devices to be sold, possible risk that financial and operational forecasts and projections are not achieved, possible risk that returns from consumers or channels
of distribution may be greater than estimated, the risk that digital sales growth is less than expectations and the risk that it does not exceed the
rate of investment spend, higher - than - anticipated store closing or relocation costs, higher interest
rates, the performance
of Barnes & Noble's online, digital and other initiatives, the success
of Barnes & Noble's strategic investments, unanticipated increases in merchandise, component or occupancy costs, unanticipated
adverse litigation results or effects, product and component shortages, risks associated with the commercial agreement with Samsung, the potential
adverse impact on the Company's businesses resulting from the Company's prior reviews
of strategic alternatives and the potential separation
of the Company's businesses (including with respect to the timing
of the completion thereof), the risk that the transactions with Pearson and Samsung do not achieve the expected benefits for the parties or impose costs on the Company in excess
of what the Company anticipates, including the risk that NOOK Media's applications are not commercially successful or that the expected distribution
of those applications is not achieved, risks associated with the international expansion previously undertaken, including any risks associated with a reduction
of international operations following termination
of the Microsoft commercial agreement, the risk that NOOK Media is not able to perform its obligations under the Pearson and Samsung commercial agreements and the consequences thereof, the risks associated with the termination
of Microsoft commercial agreement, including potential customer losses, risks associated with the restatement contained in, the delayed filing
of, and the material weakness in internal controls described in Barnes & Noble's Annual Report on Form 10 - K for the fiscal year ended April 27, 2013, risks associated with the SEC investigation disclosed in the quarterly report on Form 10 - Q for the fiscal quarter ended October 26, 2013, risks associated with the ongoing efforts to rationalize the NOOK business and the expected costs and benefits
of such efforts and associated risks and other factors which may be outside
of Barnes & Noble's control, including those factors discussed in detail in Item 1A, «Risk Factors,» in Barnes & Noble's Annual Report on Form 10 - K for the fiscal year ended May 3, 2014, and in Barnes & Noble's other filings made hereafter from time to time with the SEC.
Such statements reflect the current views
of Barnes & Noble with respect to future events, the
outcome of which is subject to certain risks, including, among others, the general economic environment and consumer spending patterns, decreased consumer demand for Barnes & Noble's products, low growth or declining sales and net income due to various factors, including store closings, higher - than - anticipated or increasing costs, including with respect to store closings, relocation, occupancy (including in connection with lease renewals) and labor costs, the effects
of competition, the risk
of insufficient access to financing to implement future business initiatives, risks associated with data privacy and information security, risks associated with Barnes & Noble's supply chain, including possible delays and disruptions and increases in shipping
rates, various risks associated with the digital business, including the possible loss
of customers, declines in digital content sales, risks and costs associated with ongoing efforts to rationalize the digital business and the digital business not being able to perform its obligations under the Samsung commercial agreement and the consequences thereof, the risk that financial and operational forecasts and projections are not achieved, the performance
of Barnes & Noble's initiatives including but not limited to its new store concept and e-commerce initiatives, unanticipated
adverse litigation results or effects, potential infringement
of Barnes & Noble's intellectual property by third parties or by Barnes & Noble
of the intellectual property
of third parties, and other factors, including those factors discussed in detail in Item 1A, «Risk Factors,» in Barnes & Noble's Annual Report on Form 10 - K for the fiscal year ended April 30, 2016, and in Barnes & Noble's other filings made hereafter from time to time with the SEC.
Kennedys partner Mark Burton said: «The enormous increase in claims costs caused by the new
rate risks a number
of adverse outcomes.
The best chance
of getting a good underwriting
outcome will occur when lung cancer was diagnosed at an early stage, like In Situ or Stage I. (Note, it is probable you will receive an
adverse rating if you apply too soon after completing cancer treatment.
If your car is old for a considerable amount
of period it will not automatically command a lower
rate but it may have an
adverse effect on the
outcome of the price.
Attention - deficit / hyperactivity disorder (ADHD) is the most common childhood neurodevelopmental disorder.1, 2 Important questions about adult
outcomes for childhood ADHD remain, including the
rate of persistence
of ADHD into adulthood, the psychiatric comorbidities
of adult ADHD, and the risk
of serious
adverse outcomes, such as criminality and mortality.
Perinatal depression is common; in high - income countries the point prevalence is approximately 13 %, with higher
rates estimated in low - income and middle - income countries.1 Furthermore, perinatal depression is associated with an increased risk
of adverse child
outcomes, including behavioural, emotional and cognitive difficulties, 2 which persist into late childhood and adolescence.
On social - emotional measures, foster children in the NSCAW study tended to have more compromised functioning than would be expected from a high - risk sample.43 Moreover, as indicated in the previous section, research suggests that foster children are more likely than nonfoster care children to have insecure or disordered attachments, and the
adverse long - term
outcomes associated with such attachments.44 Many studies
of foster children postulate that a majority have mental health difficulties.45 They have higher
rates of depression, poorer social skills, lower adaptive functioning, and more externalizing behavioral problems, such as aggression and impulsivity.46 Additionally, research has documented high levels
of mental health service utilization among foster children47 due to both greater mental health needs and greater access to services.
Rates of preterm birth, low birth weight, and other
adverse birth
outcomes in the US are higher than in most other developed countries.