Improving Black Maternal Outcomes in Christian County, KY: A Social Marketing Approach to Perinatal Provider Change

Compared to other states in the country, Kentucky has historically poor population health outcomes. While the statewide maternal mortality rate is 16.1 per 100,000 live births, this statistic belies the stark racial disparities that exist. In 2018, the pregnancy-related death rate for Black women was 40.2 per 100,000 live births compared to 13.1 for White women. This pattern is persistent even after controlling for socioeconomic status, prenatal care, and other protective factors. Research shows that institutional and interpersonal racism when receiving obstetric care contributes to poor childbirth and postpartum outcomes for Black women. Additionally, geography and rural status may compound maternal health inequities for Black women, and research shows that negative pregnancy outcomes, including pregnancy-related deaths, are more prevalent in rural communities than in urban areas. While the Black population in Kentucky is largely concentrated in Louisville and Lexington, Black women outside these two urban areas are often overlooked in terms of research projects and other interventions designed to improve health outcomes for the Black population in the state. The Jennie Stuart Health System located in Christian County, KY, which has one of the largest Black populations outside of the two main urban areas in the state, proposes implementing an evidence-informed intervention to change perinatal provider behavior through a social marketing campaign. The goal of this intervention is to reduce Black maternal morbidity and mortality through institutional culture change, community partnership, and investment in the training of our perinatal providers

A Double Segment Periodicity Underlies Segment Generation in Centipede Development

AbstractThe number of leg-bearing segments in centipedes varies extensively, between 15 and 191, and yet it is always odd [1, 2]. This suggests that segment generation in centipedes involves a stage with double segment periodicity and that evolutionary variation in segment number reflects the generation of these double segmental units. However, previous studies have revealed no trace of this [3–5]. Here we report the expression of two genes, an odd-skipped related gene (odr1) and a caudal homolog, that serve as markers for early steps of segment formation in the geophilomorph centipede, Strigamia maritima. Dynamic expression of odr1 around the proctodaeum resolves into a series of concentric rings, revealing a pattern of double segment periodicity in overtly unsegmented tissue. Initially, the expression of the caudal homolog mirrors this double segment periodicity, but shortly before engrailed expression and overt segmentation, the intercalation of additional stripes generates a repeat with single segment periodicity. Our results provide the first clues about the causality of the unique and fascinating “all-odd” pattern of variation in centipede segment numbers and have implications for the evolution of the mechanisms of arthropod segmentation

Strained Silicon on Silicon by Wafer Bonding and Layer Transfer from Relaxed SiGe Buffer

We report the creation of strained silicon on silicon (SSOS) substrate technology. The method uses a relaxed SiGe buffer as a template for inducing tensile strain in a Si layer, which is then bonded to another Si handle wafer. The original Si wafer and the relaxed SiGe buffer are subsequently removed, thereby transferring a strained-Si layer directly to Si substrate without intermediate SiGe or oxide layers. Complete removal of Ge from the structure was confirmed by cross-sectional transmission electron microscopy as well as secondary ion mass spectrometry. A plan-view transmission electron microscopy study of the strained-Si/Si interface reveals that the lattice-mismatch between the layers is accommodated by an orthogonal array of edge dislocations. This misfit dislocation array, which forms upon bonding, is geometrically necessary and has an average spacing of approximately 40nm, in excellent agreement with established dislocation theory. To our knowledge, this is the first study of a chemically homogeneous, yet lattice-mismatched, interface.Singapore-MIT Alliance (SMA

Foreigner talk through word reduction in native/non-native spoken interactions

We explore the properties of foreigner talk through word reduction. Word reduction signals that the speaker is referring to the same entity as previously and should be preserved for foreigner talk. However, it leads to intelligibility loss, which works against foreigner talk. Pairs of speakers engaged in a task where native speakers talked either to a native or non-native listener. Natives talking to non-natives performed foreigner talk for duration and intensity. Duration and intensity were reduced for native and non-native listeners equally. These results suggest that word reduction is insensitive to communicative adjustments in the context of foreign talk.This work was supported by grants from the Spanish Government (PSI2011-23033, Consolider Ingenio 2010 CSD2007-00012) and the Catalan government (Consolidat SGR 2009-1521). Sara RodríguezCuadrado was supported by a predoctoral fellowship from the Spanish Government (FPU 2008–2012). Cristina Baus was supported by the People Program (Marie Curie Actions, FP7- PEOPLE 2014–2016) under REA agreement n° 623845.We would like to thank Sumeer Chadha, Joanna Corey and Carlos Romero-Rivas for their assistance during data recruitment and manuscript elaboration

Ronaldo Pontes block abdominoplasty technique

Introduction: Abdominoplasty involves not only aesthetic characteristics but abdominal wall structural reconstruction. This study aimed to illustrate the authors' experience with abdominoplasty, focusing on the scar's aesthetic results and the evolution of application of the block resection technique of Professor Ronaldo Pontes (RP). Methods: The study included a series of retrospective cases of 124 patients treated between March 2014 and March 2017 who underwent RP block abdominoplasty. Results: In our studies, a minimal incidence of complications and a small number of healing alterations were noted with the RP block technique compared to those found in the literature. Conclusion: A técnica descrita e suas variantes atendem a necessidade de diversos tipos de casos e garantem cirurgias seguras e eficazes, com resultados muito satisfatórios, sendo uma técnica reprodutível

Fibroblast growth factor signalling in multiple sclerosis: inhibition of myelination and induction of pro-inflammatory environment by FGF9

The failure of remyelination in multiple sclerosis is largely unexplained. Lindner et al. report that glial cells in demyelinating lesions show increased expression of fibroblast growth factor 9 (FGF9). This induces astrocyte-dependent responses that inhibit remyelination and stimulate expression of pro-inflammatory chemokines, supporting a feedback loop that amplifies disease activit

Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries

IMPORTANCE: Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS). OBJECTIVES: To evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation management, and use of adjuncts-for example prone positioning-in routine clinical practice for patients fulfilling the ARDS Berlin Definition. DESIGN, SETTING, AND PARTICIPANTS:The Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients undergoing invasive or noninvasive ventilation, conducted during 4 consecutive weeks in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across 5 continents. EXPOSURES:Acute respiratory distress syndrome. MAIN OUTCOMES AND MEASURES: The primary outcome was ICU incidence of ARDS. Secondary outcomes included assessment of clinician recognition of ARDS, the application of ventilatory management, the use of adjunctive interventions in routine clinical practice, and clinical outcomes from ARDS. RESULTS: Of 29,144 patients admitted to participating ICUs, 3022 (10.4%) fulfilled ARDS criteria. Of these, 2377 patients developed ARDS in the first 48 hours and whose respiratory failure was managed with invasive mechanical ventilation. The period prevalence of mild ARDS was 30.0% (95% CI, 28.2%-31.9%); of moderate ARDS, 46.6% (95% CI, 44.5%-48.6%); and of severe ARDS, 23.4% (95% CI, 21.7%-25.2%). ARDS represented 0.42 cases per ICU bed over 4 weeks and represented 10.4% (95% CI, 10.0%-10.7%) of ICU admissions and 23.4% of patients requiring mechanical ventilation. Clinical recognition of ARDS ranged from 51.3% (95% CI, 47.5%-55.0%) in mild to 78.5% (95% CI, 74.8%-81.8%) in severe ARDS. Less than two-thirds of patients with ARDS received a tidal volume 8 of mL/kg or less of predicted body weight. Plateau pressure was measured in 40.1% (95% CI, 38.2-42.1), whereas 82.6% (95% CI, 81.0%-84.1%) received a positive end-expository pressure (PEEP) of less than 12 cm H2O. Prone positioning was used in 16.3% (95% CI, 13.7%-19.2%) of patients with severe ARDS. Clinician recognition of ARDS was associated with higher PEEP, greater use of neuromuscular blockade, and prone positioning. Hospital mortality was 34.9% (95% CI, 31.4%-38.5%) for those with mild, 40.3% (95% CI, 37.4%-43.3%) for those with moderate, and 46.1% (95% CI, 41.9%-50.4%) for those with severe ARDS. CONCLUSIONS AND RELEVANCE: Among ICUs in 50 countries, the period prevalence of ARDS was 10.4% of ICU admissions. This syndrome appeared to be underrecognized and undertreated and associated with a high mortality rate. These findings indicate the potential for improvement in the management of patients with ARDS

VAV1 and BAFF, via NFκB pathway, are genetic risk factors for myasthenia gravis

Objective To identify novel genetic loci that predispose to early‐onset myasthenia gravis (EOMG) applying a two‐stage association study, exploration, and replication strategy. Methods Thirty‐four loci and one confirmation loci, human leukocyte antigen (HLA)‐DRA, were selected as candidate genes by team members of groups involved in different research aspects of MG. In the exploration step, these candidate genes were genotyped in 384 EOMG and 384 matched controls and significant difference in allele frequency were found in eight genes. In the replication step, eight candidate genes and one confirmation loci were genotyped in 1177 EOMG patients and 814 controls, from nine European centres. Results Allele frequency differences were found in four novel loci: CD86, AKAP12, VAV1, B‐cell activating factor (BAFF), and tumor necrosis factor‐alpha (TNF‐α), and these differences were consistent in all nine cohorts. Haplotype trend test supported the differences in allele frequencies between cases and controls. In addition, allele frequency difference in female versus male patients at HLA‐DRA and TNF‐α loci were observed. Interpretation The genetic associations to EOMG outside the HLA complex are novel and of interest as VAV1 is a key signal transducer essential for T‐ and B‐cell activation, and BAFF is a cytokine that plays important roles in the proliferation and differentiation of B‐cells. Moreover, we noted striking epistasis between the predisposing VAV1 and BAFF haplotypes; they conferred a greater risk in combination than alone. These, and CD86, share the same signaling pathway, namely nuclear factor‐kappaB (NFκB), thus implicating dysregulation of proinflammatory signaling in predisposition to EOMG