Perinatal and newborn care in a two years retrospective study in a first level peripheral hospital in Sicily (Italy)

BACKGROUND: Two hundred seventy-five thousand maternal deaths, 2.7 million neonatal deaths, and 2.6 million stillbirths have been estimated in 2015 worldwide, almost all in low-income countries (LICs). Moreover, more than 20 million severe disabilities result from the complications of pregnancy, childbirth or its management each year. A significant decrease of mortality/morbidity rates could be achieved by providing effective perinatal and newborn care also in high-income countries (HICs), especially in peripheral hospitals and/or rural areas, where the number of childbirths per year is often under the minimal threshold recognized by the reference legislation. We report on a 2 years retrospective cohort study, conducted in a first level peripheral hospital in Cefalù, a small city in Sicily (Italy), to evaluate care provided and mortality/morbidity rates. The proposed goal is to improve the quality of care, and the services that peripheral centers can offer. METHODS: We collected data from maternity and neonatal records, over a 2-year period from January 2017 to December 2018. The informations analyzed were related to demographic features (age, ethnicity/origin area, residence, educational level, marital status), diagnosis at admission (attendance of birth training courses, parity, type of pregnancy, gestational age, fetal presentation), mode of delivery, obstetric complications, the weight of the newborns, their feeding and eventual transfer to II level hospitals, also through the Neonatal Emergency Transport Service, if the established criteria were present. RESULTS: Eight hundred sixteen women were included (age 18-48 years). 179 (22%) attended birth training courses. 763 (93%) were Italian, 53 foreign (7%). 175 (21%) came from outside the province of Palermo. Eight hundred ten were single pregnancies, 6 bigeminal; 783 were at term (96%), 33 preterm (4%, GA 30-41 WG); 434 vaginal deliveries (53%), 382 caesarean sections (47%). One maternal death and 28 (3%) obstetric complications occurred during the study period. The total number of children born to these women was 822, 3 of which stillbirths (3.6‰). 787 (96%) were born at term (>37WG), 35 preterm (4%), 31 of which late preterm. Twenty-one newborns (2.5%) were transferred to II level hospitals. Among them, 3 for moderate/severe prematurity, 18 for mild prematurity/other pathology. The outcome was favorable for all women (except 1 hysterectomy) and the newborns transferred, and no neonatal deaths occurred in the biennium under investigation. Of the remaining 798 newborns, 440 were breastfed at discharge (55%), 337 had a mixed feeding (breastfed/formula fed, 42%) and 21 were formula fed (3%). CONCLUSIONS: Although the minimal standard of adequate perinatal care in Italy is >500 childbirths/year, the aims of the Italian legislation concern the rationalization of birth centers as well as the structural, technological and organizational improvement of health facilities. Therefore, specific contexts and critical areas need to be identified and managed. Adequate resources and intervention strategies should be addressed not only to perinatal emergencies, but also to the management of mild prematurity/pathology, especially in vulnerable populations for social or orographic reasons. The increasing availability and spread of health care offers, even in HICs, cannot be separated from the goal of quality of care, which is an ethic and public health imperative

Irreversible phase transitions induced by an oscillatory input

A novel kind of irreversible phase transitions (IPT's) driven by an oscillatory input parameter is studied by means of computer simulations. Second order IPT's showing scale invariance in relevant dynamic critical properties are found to belong to the universality class of directed percolation. In contrast, the absence of universality is observed for first order IPT's.Comment: 18 pages (Revtex); 8 figures (.ps); submitted to Europhysics Letters, December 9th, 199

Critical Behavior of an Ising System on the Sierpinski Carpet: A Short-Time Dynamics Study

The short-time dynamic evolution of an Ising model embedded in an infinitely ramified fractal structure with noninteger Hausdorff dimension was studied using Monte Carlo simulations. Completely ordered and disordered spin configurations were used as initial states for the dynamic simulations. In both cases, the evolution of the physical observables follows a power-law behavior. Based on this fact, the complete set of critical exponents characteristic of a second-order phase transition was evaluated. Also, the dynamic exponent $\theta$ of the critical initial increase in magnetization, as well as the critical temperature, were computed. The exponent $\theta$ exhibits a weak dependence on the initial (small) magnetization. On the other hand, the dynamic exponent $z$ shows a systematic decrease when the segmentation step is increased, i.e., when the system size becomes larger. Our results suggest that the effective noninteger dimension for the second-order phase transition is noticeably smaller than the Hausdorff dimension. Even when the behavior of the magnetization (in the case of the ordered initial state) and the autocorrelation (in the case of the disordered initial state) with time are very well fitted by power laws, the precision of our simulations allows us to detect the presence of a soft oscillation of the same type in both magnitudes that we attribute to the topological details of the generating cell at any scale.Comment: 10 figures, 4 tables and 14 page

Topological Effects caused by the Fractal Substrate on the Nonequilibrium Critical Behavior of the Ising Magnet

The nonequilibrium critical dynamics of the Ising magnet on a fractal substrate, namely the Sierpinski carpet with Hausdorff dimension $d_H$ =1.7925, has been studied within the short-time regime by means of Monte Carlo simulations. The evolution of the physical observables was followed at criticality, after both annealing ordered spin configurations (ground state) and quenching disordered initial configurations (high temperature state), for three segmentation steps of the fractal. The topological effects become evident from the emergence of a logarithmic periodic oscillation superimposed to a power law in the decay of the magnetization and its logarithmic derivative and also from the dependence of the critical exponents on the segmentation step. These oscillations are discussed in the framework of the discrete scale invariance of the substrate and carefully characterized in order to determine the critical temperature of the second-order phase transition and the critical exponents corresponding to the short-time regime. The exponent $\theta$ of the initial increase in the magnetization was also obtained and the results suggest that it would be almost independent of the fractal dimension of the susbstrate, provided that $d_H$ is close enough to d=2.Comment: 9 figures, 3 tables, 10 page

Stereochemistry of the insertion of disubstituted alkynes into the metal aminocarbyne bond in diiron complexes

Terminal alkynes (HCdropCR') (R'=COOMe, CH2OH) insert into the metal-carbyne bond of the diiron complexes [Fe-2{mu-CN(Me)(R)} (mu-CO)(CO)(NCMe)(Cp)(2)][SO3CF3] (R=Xyl, 1a; CH2Ph, 1b; Me, 1c; Xyl=2,6-Me2C6H3), affording the corresponding mu-vinyliminium complexes [Fe-2{mu-sigma:eta(3)-C(R')=CHC=N(Me)(R)}(mu-CO)(CO)(Cp)(2)][SO3CF3] (R=Xyl, R'=COOMe, 2; R=CH2Ph, R'=COOMe, 3; R=Me, R'=COOMe, 4; R=Xyl, R'=CH2OH, 5; R=Me, R'=CH2OH, 6). The insertion is regiospecific and C-C bond formation selectively occurs between the carbyne carbon and the CH moiety of the alkyne. Disubstituted alkynes (R'CdropCR') also insert into the metal-carbyne bond leading to the formation of [Fe-2{mu-sigma:eta(3)- C(R')=C(R')C=N(Me)(R)}(mu-CO)(CO)(Cp)(2)][SO3CF3] (R'=Me, R=Xyl, 8; R'=Et, R=Xyl, 9; R'=COOMe, R=Xyl, 10; R'=COOMe, R=CH2Ph, 11; R'= COOMe, R=Me, 12). Complexes 2, 3, 5, 8, 9 and 11, in which the iminium nitrogen is unsymmetrically substituted, give rise to E and/or Z isomers. When iminium substituents are Me and Xyl, the NMR and structural investigations (X-ray structure analysis of 2 and 8) indicate that complexes obtained from terminal alkynes preferentially adopt the E configuration, whereas those derived from internal alkynes are exclusively Z. In complexes 8 and 9, trans and cis isomers have been observed, by NMR spectroscopy, and the structures of trans-8 and cis-8 have been determined by X-ray diffraction studies. Trans to cis isomerization occurs upon heating in THF at reflux temperature. In contrast to the case of HCdropCR', the insertion of 2-hexyne is not regiospecific: both [Fe-2{mu-sigma:eta(3)-C(CH2CH2CH3)=C(Me)C=N(Me)(R)} (mu-CO)(CO)(Cp)(2)][SO3CF3] (R=Xyl, 13; R=Me, 15) and [Fe-2{mu-sigma:eta(3)-C(Me)=C(CH2CH2CH3)C=N(Me)(R)}(mu-CO)(CO)(Cp)(2)][SO3CF3] (R=Xyl, 14, R=Me, 16) are obtained and these compounds are present in solution as a mixture of cis and trans isomers, with predominance of the former

Hydride addition at m-vinyliminium ligand obtained from disubstituted alkynes

New μ-vinylalkylidene complexes cis-[Fe2{μ-η1:η3-Cγ(R′)Cβ(R″)CαHN(Me)(R)}(μ-CO)(CO)(Cp)2] (R = Me, R′ = R″ = Me, 3a; R = Me, R′ = R″ = Et, 3b; R = Me, R′ = R″ = Ph, 3c; R = CH2Ph, R′ = R″ = Me, 3d; R = CH2Ph, R′ = R″ = COOMe, 3e; R = CH2 Ph, R′ = SiMe3, R″ = Me, 3f) have been obtained b yreacting the corresponding vinyliminium complexes [Fe2{μ-η1:η3-Cγ(R′)Cβ(R″)CαN(Me)(R)}(μ-CO)(CO)(Cp)2][SO3CF3] (2a–f) with NaBH4. The formation of 3a–f occurs via selective hydride addition at the iminium carbon (Cα) of the precursors 2a–f. By contrast, the vinyliminiumcis-[Fe2{μ-η1:η3-Cγ (R′) = Cβ(R″)Cα = N(Me)(Xyl)}(μ-CO)(CO)(Cp)2][SO3CF3] (R′ = R″ = COOMe, 4a; R′ = R″ = Me, 4b; R′ = Prn, R″ = Me, 4c; Prn = CH2CH2CH3, Xyl = 2,6-Me2C6H3) undergo H− addition at the adjacent Cβ, affording the bis-alkylidene complexes cis-[Fe2{μ-η1:η2-C(R′)C(H)(R″)CN(Me)(Xyl)}(μ-CO)(CO)(Cp)2], (5a–c). The cis and trans isomers of [Fe2{μ-η1:η3-Cγ(Et)Cβ(Et)CαN(Me)(Xyl)}(μ-CO)(CO)(Cp)2][SO3CF3] (4d) react differently with NaBH4: the former reacts at Cα yielding cis-[Fe2{μ-η1:η3-Cγ(Et)Cβ(Et)CαHN(Me)(Xyl)}(μ-CO)(CO)(Cp)2], 6a, whereas the hydride attack occurs at Cβ of the latter, leading to the formation of the bis alkylidene trans-[Fe2{μ-η1:η2-C(Et)C(H)(Et)CN(Me)(Xyl)}(μ-CO)(CO)(Cp)2] (5d). The structure of 5d has been determined by an X-ray diffraction study. Other μ-vinylalkylidene complexes cis-[Fe2{μ-η1:η3-Cγ(R′)Cβ(R″)CαHN(Me)(Xyl)}(μ-CO)(CO)(Cp)2], (R′ = R″ = Ph, 6b; R′ = R″ = Me, 6c) have been prepared, and the structure of 6c has been determined by X-ray diffraction. Compound 6b results from treatment of cis-[Fe2{μ-η1:η3-Cγ(Ph)Cβ(Ph)CαN(Me)(Xyl)}(μ-CO)(CO)(Cp)2][SO3CF3] (4e) with NaBH4, whereas 6c has been obtained by reacting 4b with LiHBEt3. Both cis-4d and trans-4d react with LiHBEt3 affording cis-6a

Numerical study of a first-order irreversible phase transition in a CO+NO catalyzed reaction model

The first-order irreversible phase transitions (IPT) of the Yaldran-Khan model (Yaldran-Khan, J. Catal. 131, 369, 1991) for the CO+NO reaction is studied using the constant coverage (CC) ensemble and performing epidemic simulations. The CC method allows the study of hysteretic effects close to coexistence as well as the location of both the upper spinodal point and the coexistence point. Epidemic studies show that at coexistence the number of active sites decreases according to a (short-time) power law followed by a (long-time) exponential decay. It is concluded that first-order IPT's share many characteristic of their reversible counterparts, such as the development of short ranged correlations, hysteretic effects, metastabilities, etc.Comment: 17 pages, 10 figure

The relationship between working alliance with peer mentors and eating psychopathology in a digital 6-week guided self-help intervention for anorexia nervosa

Objective: The quality of working alliance (WA) is associated with treatment outcomes across several types of psychiatric disorders and psychological interventions. This study examined the role of WA with peer mentors (people with lived experience of illness) and student mentors (graduated psychology students) in a 6-week, digital, guided self-help (GSH) intervention for anorexia nervosa. Method: Ninety-nine patients rated weekly, for 6 weeks: (a) eating psychopathology using the short version of the Eating Disorder Examination Questionnaire (EDE-QS) and (b) WA with a student mentor (n = 14) or a peer mentor (n = 10). WA was assessed by asking patients the extent to which they felt comfortable working with their mentor and the extent to which they agreed with them on the goals for support. WA with mentors and the association with eating psychopathology change were measured on a session-by-session basis. The analysis involved a random intercepts cross-lagged panel model. Results: WA with peer mentors was slightly higher than WA with students (ES = 0.3). Peer mentors' WA in the previous session was significantly associated with eating psychopathology ratings in the next session. No significant relationship was found between the previous session's EDE-QS scores and peer mentor alliance in the following session. In the student mentor group, there were no session-by-session associations between WA and eating psychopathology. However, greater WA with the student mentor across sessions was associated with less eating psychopathology. Discussion: These findings suggest that clinical outcomes are in part associated with the characteristics of the mentor delivering guidance in an online GSH for eating disorders

Decay of metastable phases in a model for the catalytic oxidation of CO

We study by kinetic Monte Carlo simulations the dynamic behavior of a Ziff-Gulari-Barshad model with CO desorption for the reaction CO + O $\to$ CO$_2$ on a catalytic surface. Finite-size scaling analysis of the fluctuations and the fourth-order order-parameter cumulant show that below a critical CO desorption rate, the model exhibits a nonequilibrium first-order phase transition between low and high CO coverage phases. We calculate several points on the coexistence curve. We also measure the metastable lifetimes associated with the transition from the low CO coverage phase to the high CO coverage phase, and {\it vice versa}. Our results indicate that the transition process follows a mechanism very similar to the decay of metastable phases associated with {\it equilibrium} first-order phase transitions and can be described by the classic Kolmogorov-Johnson-Mehl-Avrami theory of phase transformation by nucleation and growth. In the present case, the desorption parameter plays the role of temperature, and the distance to the coexistence curve plays the role of an external field or supersaturation. We identify two distinct regimes, depending on whether the system is far from or close to the coexistence curve, in which the statistical properties and the system-size dependence of the lifetimes are different, corresponding to multidroplet or single-droplet decay, respectively. The crossover between the two regimes approaches the coexistence curve logarithmically with system size, analogous to the behavior of the crossover between multidroplet and single-droplet metastable decay near an equilibrium first-order phase transition.Comment: 27 pages, 22 figures, accepted by Physical Review

Immunomodulatory drugs in acute myeloid leukemia treatment

Immunomodulatory drugs (IMiDs) are analogs of thalidomide. They have immunomodulatory, antiangiogenic and proapoptotic properties and exert a role in regulating the tumor microenvironment. Recently IMiDs have been investigated for their pleiotropic properties and their therapeutic applications in both solid tumors (melanoma, prostate carcinoma and differentiated thyroid cancer) and hematological malignancies. Nowadays, they are applied in de novo and relapsed/ refractory multiple myeloma, in myelodysplastic syndrome, in del5q syndrome with specific use of lenalidomide and B-cell lymphoma. Several studies have been conducted in the last few years to explore IMiDs possible use in acute myeloid leukemia treatment. Here we report the mechanisms of action of IMiDs in acute myeloid leukemia and their potential future therapeutic application in this disease