Symptomology Associated with in Utero Exposures to Polysubstance in an Appalachian Population.

Neonatal abstinence syndrome (NAS) is seen as a very high rate at our institution in Huntington, West Virginia, and the majority of exposures are polysubstance in nature. Polysubstance can have different meaning for each region. At our institution, polysubstance is any combination of opioids, gabapentin, methamphetamine, cocaine, marijuana, benzodiazepines, nicotine or other neuroactive substances with 3-4 substances being the norm. Rapidly changing combinations of drug use and the lack of literature create a difficult situation for clinicians who are often reliant on treatment recommendations that lack references or conclusive data supporting the clinical approaches. Elucidating withdrawal symptoms consistent with in utero exposures to particular drug combinations is difficult. Many substances induce similar withdrawal symptoms in neonates and the vast majority of cases present as polysubstance exposure. Standard methodology often leads to a research approach which isolates populations and substance of exposure to determine the individual effects on the neonate. In some drug combinations, like opioid and gabapentin exposure, the substances in concert create symptoms and complications that are not observed with either drug alone. The history of responses to substance use epidemics has been to handle each drug as a separate disease process, this is no longer a viable option. The following is a review of the literature available discussing individual substance withdrawal characteristics in neonates combined with the clinical insight gained at our hospital from treating such high rates of complex polysubstance exposure

Increasing Number of Unusual Brain Abnormalities Seen in Rural West Virginia

The incidence rate of schizencephaly is 1.5 in 100,000 live births and the rate of holoprosencephaly is 1 in 16,000 live births. Both malformations are rare, but our institution has seen a dramatic increase in both malformations in recent years with no known cause. Schizencephaly is the most severe cortical malformation and holoprosencephaly is the most common defect in the prosencephalon during development however, it is still not very common to see a fetus with this defect live to delivery. Our institution seen four cases of schizencephaly and three cases of holoprosencephaly within two years. No two neonates seem to share a common factor. All had different co-morbidities and presentations, all mothers were different ages and showed few risk factors if any for these deformities. This paper is a report of the cases found of these rare birth defects seen at our institution in recent years

Does Health & Her app use improve menopausal symptoms? A longitudinal cohort study

Objectives: The Health & Her app provides menopausal women with a means of monitoring their symptoms, symptom triggers and menstrual periods, and enables them to engage in a variety of digital activities designed to promote well-being. This study aimed to examine whether sustained weekly engagement with the app is associated with improvements in menopausal symptoms. Design: A pre–post longitudinal cohort study. Setting: Analysed data collected from Health & Her app users. Participants: 1900 women who provided symptom data via the app across a 2-month period. Primary and secondary outcome measures: Symptom changes from baseline to 2 months was the outcome measure. A linear mixed effects model explored whether levels of weekly app engagement influenced symptom changes. Secondary analyses explored whether app-usage factors such as total number of days spent logging symptoms, reporting triggers, reporting menstrual periods and using in-app activities were independently predictive of symptom changes from baseline. Covariates included hormone replacement therapy use, hormonal contraceptive use, present comorbidities, age and dietary supplement use. Results: Findings demonstrated that greater engagement with the Health & Her app for 2 months was associated with greater reductions in symptoms over time. Daily use of in-app activities and logging symptoms and menstrual periods were each independently associated with symptom reductions. Conclusions: This study demonstrated that greater weekly engagement with the app was associated with greater reductions in symptoms. It is recommended that women be made aware of menopause-specific apps, such as that provided by Health & Her, to support them to manage their symptoms

Use of Pregnancy Associated Glycoproteins to Determine Fetal Age Throughout Gestation in Cattle

Objective The objective of the current study was to determine if a commercially available blood pregnancy test could be modified to detect differences in pregnancy-associated glycoprotein (PAG) concentrations to indicate stage of pregnancy or fetal age in cattle. Study Description Previously identified pregnant females were grouped by age (pre-primiparous or multiparous). Blood samples were collected between day 27 and 190 of pregnancy (n = 176 from pre-primiparous and n = 240 from multiparous) and serum was tested in duplicate using a commercially available blood pregnancy test, IDEXX Alertys Pregnancy Test. Procedures were adapted to allow concentrations to fall within the detectible range of the assay. Animals were grouped by parity (pre-primiparous vs multiparous) into 4 gestational groups (group 1 - \u3c 30 days, group 2 - 30 to 90 days, group 3 - 91 to 178 days, and group 4 - \u3e178 days). Data were analyzed using the MIXED procedure of SAS with parity and gestational age in the model. There was an effect of parity, gestational age, and a parity by gestational age interaction (P \u3c 0.01). Pre-primiparous animals had greater concentrations of PAGs compared to multiparous animals. Among pre-primiparous animals, serum PAG concentrations did not differ between gestational age groups 1, 2, or 3 (P \u3e 0.37), but group 4 had greater PAG concentrations than all other groups (P \u3c 0.01). Among multiparous animals, serum PAG concentrations decreased from group 1 to 2 (P \u3c 0.01), and then increased throughout gestation (P \u3c 0.01). Data were then analyzed using the REG procedure in SAS within gestational age group. There was a positive correlation between gestational age and PAG concentrations among both pre-primiparous (P \u3c 0.01; R2 = 0.25) and multiparous (gestational age 30 and greater P \u3c 0.01; R2 = 0.64)

Use of Pregnancy Associated Glycoproteins to Determine Fetal Age Throughout Gestation and Clearance Rate in Postpartum Beef Cattle

Study Description: Previously identified pregnant females from four different herds and postpartum females from one herd were utilized. Blood samples were collected (n = 1,753; study 1) between d 28 and 285 of gestation and (heifers n = 418 and cows n = 657; study 2) once a week for up to 12 weeks after calving. Serum was tested in duplicate using a commercially available blood pregnancy test, IDEXX Alertys Pregnancy Test. In study 1, procedures were modified to allow PAG concentrations to fall within the detectible range of the assay. Data were analyzed using the MIXED procedure of SAS with cow age and gestational age (also divided into four gestational age groups: 1) \u3c 30 d; 2) 30-90 d; 3) 91-180 d; 4) \u3e 180 d) in the model and then analyzed further using the REG procedure in SAS within gestational age group. In study 2, data were analyzed as repeated measure using the MIXED procedure of SAS with cow age, days postpartum (dpp), and cow age by dpp in the model, then data were analyzed further using the REG procedure in SAS. In study 1, there was a significant effect of gestational age and cow age by gestational age interaction (P \u3c 0.01) as well as a tendency of cow age (P = 0.08). Among heifers and cows, serum PAG concentrations did not differ between gestational age groups 1 and 2 (P \u3e 0.84), however, PAG concentrations differed between groups 2 and 3 (P \u3c 0.0001) and 3 and 4 (P \u3c 0.0001). There was a positive correlation between gestational age and PAG concentrations (P \u3c 0.01; r2 = 0.2604). In study 2, there was a significant effect of days postpartum (dpp; P \u3c 0.01) on PAG concentrations; however, PAG concentrations were not influenced by cow age (P = 0.73) or cow age by dpp (P = 0.55). Concentrations of PAGs rapidly decreased from d 0 to 50 postpartum and then continued to gradually decrease (P \u3c 0.01; r2 = 0.8083). Prior to 42 dpp, PAG concentrations were sufficiently elevated which resulted in false positive readings

Comparison of Lateral Flow to Other Pregnancy Determination Methods in Order to Determine Accuracy of Pregnancy Status in Beef Cattle Pre and Postpartum

Study Description: Blood samples were collected from six different Bos taurus herds between day 27 and 285 of gestation (heifers n = 1,205 and cows n = 1,539). Blood samples to determine PAG clearance interval were collected weekly postpartum for up to 12 weeks (heifers n = 418 and cows n = 657). Serum was tested using the lateral flow test and were read by two technicians who were blind to pregnancy status. Level of agreement between the tests were determined by Pearson’s correlation coefficients and Kappa scores. The MIXED procedure of SAS was used to evaluate the effect of dpp and age (heifers or cows) on postpartum test results. There was a positive correlation between transrectal ultrasonography and the lateral flow test (r2 = 0.71; P \u3c 0.01), and agreement between the two tests was very good (Kappa = 0.84). Of the animals that were diagnosed nonpregnant by transrectal ultrasonography, 5.61% were called pregnant by the lateral flow test. Of the animals diagnosed pregnant by transrectal ultrasonography, 2.00% were called not pregnant by the lateral flow test. Thus, a 92.38% agreement occurred between the two methods. For postpartum samples, there was no effect (P = 0.21) of age, but there was an effect of dpp (P \u3c 0.01) and a tendency for a dpp by age interaction (P = 0.06). All animals were still considered pregnant from the previous pregnancy through 35 dpp (100 ± 2.58%). The percentage of females receiving a false positive test result further decreased with time postpartum, by 77 dpp there were 13.72 ± 3.16% of the females positive for pregnancy and at 84 dpp there were 4.11 ± 4.39% positive for pregnancy detection

Interactions of Change in Nutrition After AI on Plasma Metabolites, Steroid Hormone Production, and Uterine Environment

Objective The objective was to evaluate the impact of nutritional changes post artificial insemination (AI) on plasma metabolites, steroid hormones, and uterine environment. Study Description Beef heifers (n = 43) were randomly assigned to two dietary treatment groups (High = 161.5% or Low = 77.5% of maintenance energy) for 14 d after AI (post-AI). Post-AI dietary treatments continued until uteri were flushed for embryo recovery (d 14 post-AI). Blood samples were collected on d -3, 0 (day of AI), 3, 6, 9, 12, and 14 for analysis of plasma glucose, proteins, non-esterified fatty acids (NEFAs), and cholesterol using colorimetric assays. Plasma collected on d 0, 3, 6, 9, 12, and 14 was analyzed for progesterone concentrations by radioimmunoassay. Uterine flushes were analyzed for mineral concentrations of Mg, P, S, K, Ca, Cu, Zn, Se, Mn, Co, B, Cr, and Fe by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Plasma progesterone, NEFAs, protein, glucose and cholesterol (repeated measures) and uterine mineral concentrations were analyzed using the MIXED procedures in SAS. Plasma NEFA concentrations differed between treatments (P = 0.03) with heifers on the low diet treatment having elevated NEFA concentrations. Plasma NEFA concentrations weren’t affected by embryo recovery (P \u3e 0.10), treatment by embryo recovery (P \u3e 0.10), and treatment by embryo recovery by day (P \u3e 0.10). Plasma progesterone, glucose, protein, and cholesterol concentrations were not influenced by treatment (P \u3e 0.10), embryo recovery (P \u3e 0.10), treatment by embryo recovery (P \u3e 0.10), and treatment by embryo recovery by day (P \u3e 0.10). Uterine mineral concentrations were affected by embryo presence for Mg (P = 0.02) and S (P = 0.01) a tendency for Ca (P = 0.08) with decreased concentrations in uterine flushes when an embryo was recovered. A tendency for increased concentration of Mn (P = 0.06) was observed in uterine flushes when an embryo was recovered. Additionally, treatment tended to impact Fe concentrations (P = 0.09), with heifers on the restricted diet having reduced uterine Fe concentrations. In conclusion, changing plane of nutrition post-AI had an effect on NEFA plasma concentrations, but no effect on plasma progesterone, protein, glucose, and cholesterol concentrations. The presence of an embryo however affected uterine mineral concentrations

Design of a Green Monopropellant Propulsion System for the Lunar Flashlight CubeSat Mission

Lunar Flashlight is a 6U CubeSat mission from NASA\u27s Jet Propulsion Laboratory that will search for water-ice deposits near the lunar south pole. Lunar Flashlight aims to add to the flight experience of deep-space CubeSats by demonstrating an orbit insertion using a green monopropellant propulsion system designed uniquely for this mission. Developed by NASA Marshall Spaceflight Center (MSFC) and Georgia Tech\u27s Space Systems Design Laboratory (SSDL), the Lunar Flashlight Propulsion System (LFPS) delivers over 2500N-s of total impulse for the orbit insertion and necessary attitude maneuvers. The custom propulsion system fits within a 2.5U volume and has a total wet mass of less than six kilograms. It will be fueled byAF-M315E, which is a green monopropellant developed by the Air Force Research Laboratory (AFRL) as a safer alternative to hydrazine. Additive manufacturing is utilized to fabricate several components of its primary structure. Upon completion, Lunar Flashlight may become the first CubeSat to achieve orbit around a celestial body besides Earth. The LFPS aims to be a pathfinder device for CubeSat missions by demonstrating how monopropellant systems, green monopropellant fuel, and additive manufacturing can be utilized to expand the reach of small satellite space exploration

Phyllosphere microbiology with special reference to diversity and plant genotype

The phyllosphere represents the habitat provided by the aboveground parts of plants, and on a global scale supports a large and complex microbial community. Microbial interactions in the phyllosphere can affect the fitness of plants in natural communities, the productivity of agricultural crops, and the safety of horticultural produce for human consumption. The structure of phyllosphere communities reflects immigration, survival and growth of microbial colonists, which is influenced by numerous environmental factors in addition to leaf physico-chemical properties. The recent use of culture-independent techniques has demonstrated considerable previously unrecognized diversity in phyllosphere bacterial communities. Furthermore, there is significant recent evidence that plant genotype can play a major role in determining the structure of phyllosphere microbial communities. The main aims of this review are: (i) to discuss the diversity of phyllosphere microbial populations; (ii) to consider the processes by which microbes colonize the phyllosphere; (iii) to address the leaf characteristics and environmental factors that determine the survival and growth of colonists; (iv) to discuss microbial adaptations that allow establishment in the phyllosphere habitat and (v) to evaluate evidence for plant genotypic control of phyllosphere communities. Finally, we suggest approaches and priority areas for future research on phyllosphere microbiology

Gestational diabesity and foetoplacental vascular dysfunction

Gestational diabetes mellitus (GDM) shows a deficiency in the metabolism of D-glucose and other nutrients, thereby negatively affecting the foetoplacental vascular endothelium. Maternal hyperglycaemia and hyperinsulinemia play an important role in the aetiology of GDM. A combination of these and other factors predisposes women to developing GDM with pre-pregnancy normal weight, viz. classic GDM. However, women with GDM and prepregnancy obesity (gestational diabesity, GDty) or overweight (GDMow) show a different metabolic status than women with classic GDM. GDty and GDMow are associated with altered l-arginine/nitric oxide and insulin/adenosine axis signalling in the human foetoplacental microvascular and macrovascular endothelium. These alterations differ from those observed in classic GDM. Here, we have reviewed the consequences of GDty and GDMow in the modulation of foetoplacental endothelial cell function, highlighting studies describing the modulation of intracellular pH homeostasis and the potential implications of NO generation and adenosine signalling in GDty-associated foetal vascular insulin resistance. Moreover, with an increase in the rate of obesity in women of childbearing age worldwide, the prevalence of GDty is expected to increase in the next decades. Therefore, we emphasize that women with GDty and GDMow should be characterized with a different metabolic state from that of women with classic GDM to develop a more specific therapeutic approach for protecting the mother and foetus