Maternal Hypertension Influences Mortality and Severe Morbidity in Infants Born Extremely Preterm

Worldwide, more than 1 million infants die as a result of premature birth. In the United States, where 1 in 10 births occurs preterm, premature birth is the leading cause of infant mortality. Premature infants have high rates of mortality and morbidity, with the highest rates seen in those infants born extremely preterm -- prior to 30 weeks gestation. Severe morbidity in these infants often contributes to life-long health problems. Maternal hypertension (HTN) is one contributor to preterm birth and also contributes to fetal growth restriction, resulting in birth weights which are small for gestational age (SGA, and generally within the lowest 10th percentile). Within this high risk population, SGA infants have increased risk of mortality compared to appropriate for gestational age infants. Therefore the impact of maternal HTN on neonatal outcome might be presumed to be negative. Previous studies however, have been contradictory, with both higher and lower rates of infant mortality reported in infants born to mothers with HTN, as well as differing reports analyzing the relationship between serious morbidity and maternal HTN. Utilizing the Vermont Oxford Network Very Low Birth Weight database, a collaborative database of Level III Neonatal Intensive Care Units across the world, 88,275 North American infants born between 22+0 and 29+6 weeks gestational age between 2008 and 2011 were identified. This dissertation explores the relationship between maternal HTN and gestational age at time of birth within this population, and the reported rates of morbidity and mortality in infants born prior to 30 weeks gestation. The independent contributions of maternal HTN with neonatal morbidity and mortality in our population were estimated using logistic regression and adjusting for factors previously known to be associated with risk, including birth weight, antenatal steroid exposure, infant sex, maternal race/ethnicity, prenatal care, inborn/outborn status, and birth year. We hypothesized that mortality rates would be lower for infants born to mothers with HTN compared to those born due to other factors, when corrected for the noted confounding variables and surviving infants would have better prognoses, as evidenced by lower rates of severe morbidity, including bronchopulmonary dysplasia, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, and infection. Within the higher-risk SGA population, we hypothesized that mortality rates would be higher than observed in appropriately grown infants, but decreased in those born to mothers with HTN, despite the association between maternal HTN and SGA. This dissertation begins with an explanation of current knowledge about preterm birth, maternal HTN, and their associations. Chapter 2 focuses on the relationship between maternal HTN and infant mortality in extremely preterm infants. Chapter 3 examines the risk associated with severe morbidities in surviving infants. In addition, we also use a combined morbidity risk assessment score which has previously been used to determine future risk of long term disability. In Chapter 4, SGA infants are separately evaluated for their risk of mortality and the association with maternal HTN. These analyses support the high mortality and morbidity rates seen in extremely preterm infants. Maternal HTN, after adjustment, results in reduced risk of both mortality and severe morbidities in infants compared to infants born to mothers with other underlying contributors to preterm birth. This suggests that clinical practices and parental counseling should reflect differing risk profiles in sub-populations of extremely preterm infants

Messenger RNA transport in the opportunistic fungal pathogen Candida albicans

Candida albicans, a common commensal fungus, can cause disease in immunocompromised hosts ranging from mild mucosal infections to severe bloodstream infections with high mortality rates. The ability of C. albicans cells to switch between a budding yeast form and an elongated hyphal form is linked to pathogenicity in animal models. Hyphal-specific proteins such as cell-surface adhesins and secreted hydrolases facilitate tissue invasion and host cell damage, but the specific mechanisms leading to asymmetric protein localization in hyphae remain poorly understood. In many eukaryotes, directional cytoplasmic transport of messenger RNAs that encode asymmetrically localized proteins allows efficient local translation at the site of protein function. Over the past two decades, detailed mechanisms for polarized mRNA transport have been elucidated in the budding yeast Saccharomyces cerevisiae and the filamentous fungus Ustilago maydis. This review highlights recent studies of RNA-binding proteins in C. albicans that have revealed intriguing similarities to and differences from known fungal mRNA transport systems. I also discuss outstanding questions that will need to be answered to reach an in-depth understanding of C. albicans mRNA transport mechanisms and the roles of asymmetric mRNA localization in polarized growth, hyphal function, and virulence of this opportunistic pathogen

Re-shaping trade union democracy : developing effective representation for women in UNISON

The under-representation of women and over-representation of men in trade unions raises questions as to why it occurs, its consequences for women and how it can be overcome. This thesis engages with these questions. It indicates the dominant ideologies and institutions which underpin the dominant male model of trade unions and discusses strategies designed to change the 'rules of the game'. The creation of UNISON on 1st July 1993 provides a research site in which to study the extent to which trade union democracy can be deliberately re-shaped so as to reflect the interests of women. UNISON represents 1.3 million workers within the public service sector, two-thirds of whom are women. It has been the express intention of UNISON to achieve gender democracy through empowering its women members to participate in its representative structures. In particular, the adoption of three key principles in the rule book: proportionality for women, fair representation at all levels and self-organisation for four disadvantaged groups, is intended to have a significant impact on the nature of women's involvement in the union. This thesis contains extensive case study material collected within UNISON over a two year period, ending November 1995. It reveals the opportunities which the three rule book commitments provide for effective representation by women in UNISON. By excluding men so that women can take the majority of representative positions, proportionality and fair representation change the predominant values and beliefs of trade union democracy. By providing opportunities for women to determine their own agenda, in the absence of men, self-organisation challenges the ideology that union strength is based on unity and common interests. However, the dominant model of trade unionism is not being re-shaped without tension or resistance. This thesis argues that ideologies and institutions remain which prevent women's access to representative structures being translated into the discussion of women's concerns in UNISON's decision making arena. VI

Dysregulation of cadherins in the intercalated disc of the spontaneously hypertensive stroke-prone rat

The structural integrity of cardiac cells is maintained by the Ca2+-dependent homophilic cell-cell adhesion of cadherins. N-cadherin is responsible for this adhesion under normal physiological conditions. The role of cadherins in adverse cardiac pathology is less clear. We studied the hearts of the stroke-prone spontaneously hypertensive (SHRSP) rat as a genetic model of cardiac hypertrophy and compared them to Wistar-Kyoto control animals. Western blotting of protein homogenates from 12-week old SHRSP animals indicated that similar levels of [beta], [gamma]-, and [alpha]-catenin and T, N and R-cadherin were expressed in the control and SHRSP animals. However, dramatically higher levels of E-cadherin were detected in SHRSP animals compared to controls at 6, 12 and 18áweeks of age. This was confirmed by quantitative Taqman PCR and immunohistochemistry. E-cadherin was located at the intercalated disc of the myocytes in co-localisation with connexin 43. Adenoviral overexpression of E-cadherin in rat H9c2 cells and primary rabbit myocytes resulted in a significant reduction in myocyte cell diameter and breadth. E-cadherin overexpression resulted in re-localisation of [beta]-catenin to the cell surface particularly to cell-cell junctions. Subsequent immunohistochemistry of the hearts of WKY and SHRSP animals also revealed increased levels of [beta]-catenin in the intercalated disc in the SHRSP compared to WKY. Therefore, remodelling of the intercalated disc in the hearts of SHRSP animals may contribute to the altered function observed in these animal

Animal Welfare: A Contemporary Understanding Demands a Contemporary Approach to Behavior and Training

Contemporary understanding of One Welfare highlights the intrinsic link between animal and human welfare and ethics, regarding physical and psychological well-being as equally important. These principles apply to all animals we keep, regardless of why we keep them. One factor influencing psychological welfare is how animals are prepared for their life, including how they are taught (trained) to behave. Where such preparation is lacking or inappropriate methods are used, animals will be fearful and/or frustrated, resulting in impaired welfare, problematic behavior, and potential injury to humans and other animals. How animals are trained and by whom are the focus of this paper. Currently, animal trainers and behaviorists are unregulated. Thus anyone can claim to be a “professional” or “expert” with no required testing of knowledge or skill. This enables the continued use of outdated, less humane methods and increases confusion for those seeking competent help and for those looking for a career path. With increasing numbers of companion animals, there is commercial incentive to work in this sector and an urgent need for clarity and regulation if One Welfare is to be enhanced. This paper catalogues the UK experience of developing a regulatory framework for this sector. It argues the need for and benefits of regulation and maps the progress of the Animal Behaviour and Training Council since its inception in 2010 with the bringing together of various stakeholders including veterinary organizations, animal welfare charities, and associations representing practitioners. It describes the rationales leading to the development of agreed standards, academic provision to support those standards, and assessment procedures common to all. It considers future challenges within a turbulent political and economic environment, including securing government recognition for a single UK regulatory authority. Though this goal is yet to be realized, significant progress has been made and momentum is gathering

The role of boundary spanners in delivering collaborative care: a process evaluation

BACKGROUND: On average, people with schizophrenia and psychosis die 13–30 years sooner than the general population (World Psychiatry 10 (1):52–77, 2011). Mental and physical health care is often provided by different organisations, different practitioners and in different settings which makes collaborative care difficult. Research is needed to understand and map the impact of new collaborative ways of working at the primary/secondary care interface (PloS One 7 (5); e36468). The evaluation presented in this paper was designed to explore the potential of a Community and Physical Health Co-ordinator role (CPHC) (CPHCs were previously Care Co-ordinators within the Community Mental Health Team, Community in the title CPHC refers to Community Mental Health) and Multi-Disciplinary Team (MDT) meetings across primary and community care, with the aim of improving collaboration of mental and physical health care for service users with Severe Mental Illness (SMI). METHODS: Data collection took place across five general practices (GPs) and a Community Mental Health Team (CMHT) in the Northwest of England, as part of a process evaluation. Semi-structured interviews were conducted with a purposive sample of GP staff (n= 18) and CMHT staff (n=4), a focus group with CMHT staff (n=8) and a survey completed by 13 CMHT staff, alongside cardiovascular risk data and MDT actions. Framework analysis was used to manage and interpret data. RESULTS: The results from the evaluation demonstrate that a CPHC role and MDT meetings are effective mechanisms for improving the collaboration and co-ordination of physical health care for SMI service users. The findings highlight the importance of embedding and supporting the CPHC role, with an emphasis on protected time and continuing professional roles and integrating multiple perspectives through MDT meetings. Considering the importance of physical health care for SMI service users and the complex environment, these are important findings for practitioners, researchers and policy makers in the field of primary care and mental health. CONCLUSION: There is an increasing focus on integration and collaborative working to ensure the delivery of quality care across the whole patient pathway, with a growing need for professionals to work together across service and professional boundaries. The introduction of a two pronged approach to collaboration has shown some important improvements in the management of physical health care for service users with SMI

Research Report: Assessing the Impacts of Service Learning on Middle School Students: Wyman\u27s Teen Outreach Program®

Research Report: Assessing the Impacts of Service Learning on Middle School Students: Wyman\u27s Teen Outreach Program

A survey of common rabbit handling methods and reasons for their use

Rabbits are both popular pets commonly seen within veterinary practices, and frequently used in laboratories in the United Kingdom and elsewhere. However, to date there is minimal research that has investigated why and how people handle rabbits and why they choose to use such methods. In addition, few studies have considered the sources individuals use to learn about rabbit handling and their reasons to not use specific handling methods

A review of handling methods of rabbits within pet, laboratory and veterinary contexts

Rabbits are considered to be the third most frequently kept pet in the UK as well as being utilised for medical and veterinary research. Despite this, little research has been conducted on rabbit handling methods. A literature review was conducted that focused directly on proposed handling methods of rabbits within different contexts. This included books where specific handling sections could be identified which were produced for pet owners, veterinary staff and laboratory staff. A range of textbooks were selected between the years [2000–2015] that were available on both Google books and Amazon. To identify the recommended handling methods and evaluate information available the following was recorded; number of handling and restraint methods described, justification for suggested methods, identification of inappropriate handling methods and relevant details, word count, use of images and any recommended equipment and its use (e.g. towel to avoid kicking or reduce stress). In total 20 books were reviewed, ten pet rabbit, seven veterinary animal/rabbit and three laboratory animal/rabbit books. Results indicate that recommended handling methods differ between contexts and that there is some confusion about the use of some methods, such as scruffing and ‘Tonic Immobility’, which have been noted to potentially be stressful. Some methods, such as picking a rabbit up by the ears, were consistently considered inappropriate. The authors describe research currently being undertaken and highlight the need for further research such as investigating handling methods and associated educational material provided by rescue centres and pet shops before, during and after the point of purchase/rehoming