Infant Mortality: A Community Engagement Model

The Worcester Healthy Baby Collaborative (WHBC) consists of a group of volunteers from organizations with an interest in reducing infant mortality in Worcester, including representatives from UMass Memorial, Family Health Center of Worcester, the Massachusetts Department of Public Health, and the March of Dimes. The organization originally began as the Worcester Infant Mortality Reduction Task Force in the mid-1990s in order to examine trends in Worcester\u27s infant mortality rate (IMR). This work has continued, evolving in response to changes in both the needs and desires of the local community, and has come to encompass several intervention and reduction strategies over the past two decades. Ultimately, in pursuit of the goal of IM reduction, the WHBC\u27s mission is to improve health outcomes for infants and their families by engaging and working collaboratively with the community to reduce health inequities, so that Worcester’s infant mortality rate is decreased. Our work thus seeks to make a wide variety of improvements in the “social determinants of health.” The WHBC collects and examines data around IM by conducting reviews of the medical charts surrounding an infant death, and tackles specific projects addressing these social determinants of health. Although overall IMR has decreased from 8-10 to about 5, ongoing disparities remain with Hispanic IMR higher than our overall IMR at a time when state and national trends do not show this higher Hispanic IMR. Presenters will describe their progress in the last decade in addressing the racial and ethnic disparities in Worcester using a community-engagement model. Presenters will review their work with the local Ghanaian community that led to the Nhyira Ba project, with lessons learned from that project informing 2016 work with the Latino community and from their work to develop Worcester\u27s Baby Box initiative. Throughout this work, real time chart audits by volunteer physicians have enabled the group to remain ahead of the state\u27s data about local IMR. This panel discussion will include the current preventive medicine faculty member who does the chart reviews discussing her work with local college students using in-depth Geographic Information Systems (GIS) to analyze data; the current family medicine faculty member who chairs the WHBC and the current nurse member who is recent past vice-chair to review the history and future goals; the current Commonwealth Medicine member who leads the Baby Box community project funded by the UMass Remillard Foundation, with multidisciplinary groups of medical and nursing students working in the community. Presenters will survey the audience before their presentation on their knowledge of WHBC work and survey the audience during Q&A for ways to further engage with the community. Objectives of this breakout session include: 1) Explain concepts of community-oriented approach to addressing infant mortality disparities, using Worcester as an example, 2) Summarize three projects that use these concepts currently in Worcester (chart audit and academic collaboration, Baby Box program, ongoing WHBC work)

Separating British marsh tits Poecile palustris and willow tits P. montana using a new feature trialled in an online survey

Confident separation of Marsh Tits and Willow Tits remains a challenge in Britain due to the similar appearance of the local races of both species. Several criteria are available to assist the identification of birds in the hand, but none is completely diagnostic and most are invalid for young juvenile birds. Due to the continued decline in abundance of both species, however, it is becoming increasingly difficult to trial new identification criteria in the field, as very few ringers are catching sufficient numbers of either species. This paper describes the results of an online survey that was used to test a proposed new identification feature for separating the two species, based on differences in the pattern of colour contrast on the greater covert feathers. The online survey was effective in recruiting a sufficient sample of ringers of varying experience, who were asked to identify images of Marsh Tits or Willow Tits based only on features of the greater coverts that were demonstrated using training images. On average, each ringer correctly identified 82% of the 18 images, and each image was correctly identified by an average 84% of the 140 ringers. The pattern of the greater coverts is therefore recommended as an additional, complementary criterion for separating Marsh Tits from Willow Tits. Online surveys are also recommended as an efficient platform for the trialling of identification features among the ringing community

Comparative biometrics of British marsh tits Poecile palustris and willow tits P. montana

Biometrics are commonly used to compare bird species. For Marsh Tits and Willow Tits in Britain there are few biometric data from birds of known age and sex, despite their value for population analyses in estimating the proportion of males and females in samples. Comparing measurements between the two species could also aid identification and the monitoring of these declining species in Britain. We present biometrics for a large sample of Marsh Tits of known age and sex, and new data for Willow Tits, which act as reliable reference material. Overall, adults of both species were larger than first-years and males were larger than females, but not among first-year Willow Tits. Marsh Tits were slightly larger and heavier than Willow Tits, but Willow Tits had proportionately longer tails. Discriminant analyses produced new equations for separating the species based on wing length and the measurement between the shortest and longest tail feathers. Probabilities were generated for estimating Marsh Tit population structure from samples of ringing data, but there was a greater overlap between sexes in Willow Tit measurements. We conclude by discussing issues of measurement accuracy and consistency in the collection and analysis of biometric data

Maternal–Fetal Microtransfusions and HIV-1 Mother-to-Child Transmission in Malawi

Background: Between 25% and 35% of infants born to HIV-infected mothers become HIV-1 infected. One potential route of mother-to-child transmission (MTCT) could be through a breakdown in the placental barrier (i.e., maternal–fetal microtransfusions). Methods and Findings: Placental alkaline phosphatase (PLAP) is a 130-kD maternal enzyme that cannot cross the intact placental barrier. We measured PLAP activity in umbilical vein serum as an indicator of maternal–fetal microtransfusion, and related this to the risk of HIV-1 MTCT. A case-cohort study was conducted of 149 women randomly selected from a cohort of HIV-1-infected pregnant Malawians; these women served as a reference group for 36 cases of in utero MTCT and 43 cases of intrapartum (IP) MTCT. Cord PLAP activity was measured with an immunocatalytic assay. Infant HIV status was determined by real-time PCR. The association between cord PLAP activity and HIV-1 MTCT was measured with logistic regression using generalized estimating equations. Among vaginal deliveries, PLAP was associated with IP MTCT (risk ratio, 2.25 per $log_{10}$ ng/ml PLAP; 95% confidence interval, 0.95–5.32) but not in utero MTCT. In a multivariable model adjusted for HIV-1 RNA load, chorioamnionitis, and self-reported fever, the risk of IP MTCT almost tripled for every $log_{10}$ increase in cord PLAP activity (risk ratio, 2.87; 95% confidence interval, 1.05–7.83). Conclusion: These results suggest that during vaginal deliveries, placental microtransfusions are a risk factor for IP HIV-1 MTCT. Future studies are needed to identify factors that increase the risk for microtransfusions in order to prevent IP HIV-1 MTCT

Insights into the mechanism for gold catalysis: behaviour of gold(i) amide complexes in solution

We report the synthesis and activity of new mononuclear and dinuclear gold amide complexes . The dinuclear complexes and were characterised by single crystal X-ray analysis. We also report solution NMR and freezing point depression experiments to rationalise their behaviour in solution and question the de-ligation process invoked in gold catalysis

Real-time PCR/MCA assay using fluorescence resonance energy transfer for the genotyping of resistance related DHPS-540 mutations in Plasmodium falciparum

BACKGROUND: Sulphadoxine-pyrimethamine has been abandoned as first- or second-line treatment by most African malaria endemic countries in favour of artemisinin-based combination treatments, but the drug is still used as intermittent preventive treatment during pregnancy. However, resistance to sulphadoxine-pyrimethamine has been increasing in the past few years and, although the link between molecular markers and treatment failure has not been firmly established, at least for pregnant women, it is important to monitor such markers. METHODS: This paper reports a novel sensitive, semi-quantitative and specific real-time PCR and melting curve analysis (MCA) assay using fluorescence resonance energy transfer (FRET) for the detection of DHPS-540, an important predictor for SP resistance. FRET/MCA was evaluated using 78 clinical samples from malaria patients and compared to PCR-RFLP. RESULTS: Sixty-two samples were in perfect agreement between both assays. One sample showed a small wild type signal with FRET/MCA that indicates a polyclonal infection. Four samples were not able to generate enough material in both assays to distinguish mutant from wild-type infection, six samples gave no signal in PCR-RFLP and five samples gave no amplification in FRET/MCA. CONCLUSION: FRET/MCA is an effective tool for the identification of SNPs in drug studies and epidemiological surveys on resistance markers in general and DHPS-540 mutation in particular

Reclaiming the political : emancipation and critique in security studies

The critical security studies literature has been marked by a shared commitment towards the politicization of security – that is, the analysis of its assumptions, implications and the practices through which it is (re)produced. In recent years, however, politicization has been accompanied by a tendency to conceive security as connected with a logic of exclusion, totalization and even violence. This has resulted in an imbalanced politicization that weakens critique. Seeking to tackle this situation, the present article engages with contributions that have advanced emancipatory versions of security. Starting with, but going beyond, the so-called Aberystwyth School of security studies, the argument reconsiders the meaning of security as emancipation by making the case for a systematic engagement with the notions of reality and power. This revised version of security as emancipation strengthens critique by addressing political dimensions that have been underplayed in the critical security literature

Applicant Reactions to the AAMC Standardized Video Interview During the 2018 Application Cycle

PURPOSE: This study examined applicant reactions to the Association of American Medical Colleges (AAMC) Standardized Video Interview (SVI) during its first year of operational use in emergency medicine (EM) residency program selection in order to identify strategies to improve applicants\u27 SVI experience and attitudes. METHOD: Individuals who self-classified as EM applicants applying in the Electronic Residency Application Service 2018 cycle and completed the SVI in summer 2017 were invited to participate in two surveys. Survey 1, which focused on procedural issues, was administered immediately after SVI completion. Survey 2, which focused on applicants\u27 SVI experience, was administered in fall 2017, after SVI scores were released. RESULTS: The response rates for surveys 1 and 2 were 82.3% (2,906/3,532) and 58.7% (2,074/3,532), respectively. Applicant reactions varied by aspect of the SVI studied and their SVI total scores. Most applicants were satisfied with most procedural aspects of the SVI, but most applicants were not satisfied with the SVI overall or with their total SVI scores. About 20-30% of applicants had neutral opinions about most aspects of the SVI. Negative reactions to the SVI were stronger for applicants who scored lower on the SVI. CONCLUSIONS: Applicants had generally negative reactions to the SVI. Most were skeptical of its ability to assess the target competencies and its potential to add value to the selection process. Applicant acceptance and appreciation of the SVI will be critical to the SVI\u27s acceptance by the graduate medical education community

A Randomized Controlled Pilot Trial of Azithromycin or Artesunate Added to Sulfadoxine-Pyrimethamine as Treatment for Malaria in Pregnant Women

New anti-malarial regimens are urgently needed in sub-Saharan Africa because of the increase in drug resistance. We investigated the safety and efficacy of azithromycin or artesunate combined with sulfadoxine-pyrimethamine used for treatment of malaria in pregnant women in Blantyre, Malawi

Post occupancy evaluation in architecture: experiences and perspectives from UK practice

The importance of post-occupancy evaluation (POE) is widely acknowledged in the academic literature, industry press and, increasingly, by the professional institutes. Learning from previous projects in a systematic way is central to improving building performance, resulting in a built environment that better-fits the needs of clients, end users, wider society and the environment. The key role of architects in pushing forward this agenda has been recognised, however evidence suggests that take-up of POE is low across the profession. Whilst a great deal of research has investigated barriers to POE across the construction industry, very little has considered the unique perspective of architects. Drawing on in-depth interviews with UK-based architects, this paper explores their experiences in relation to POE and their perspectives on its potential as a standard part of architectural practice. The findings indicate that a considerable amount of practical work is being undertaken, but uncertainty over what constitutes POE means it is often excluded from the POE label with significant implications for a rigorous and joined-up evidence base. The paper also identifies an appetite for more holistic evaluation measures that move beyond current preoccupation with energy efficiency and consider building performance, and thereby sustainability, in a wider value framework