Cholecystitis in Pregnancy

Biliary tract disease is a relatively uncommon, heterogenous disease in pregnancy. Specifically, acute cholecystitis can be especially difficult to recognize in pregnancy. However, once diagnosed, the initial management plan should be conservative and include antibiotic therapy. Subsequent management depends on the gestational age at diagnosis. Surgical therapy, when indicated, should not be delayed and a planned intervention during the second trimester appears to offer a better outcome than surgery performed under emergent conditions

Measuring migration motives with open-ended survey data:Methodological and conceptual issues

Motives for migration are difficult to measure. Open‐ended data collection can be an attractive option, but also comes with pitfalls. We use the “Motives for Migration” survey on internal migration in Sweden to identify some of these pitfalls. We identify five categories of methodological issues: how the respondents—and we—dealt with multiple motives for migration; who the motive pertained to (i.e., the respondents themselves or someone else in the household); whether the motive was related to a status or an event; which third‐party person(s) the respondent meant to refer to; and which geographical unit the motive pertained to. We also identify two conceptual issues: (1) the distinction between reasons for moving and location choice and (2) the distinction between moving “from” and moving “to” somewhere. We present some suggestions that will be useful for future attempts to study the topic and possibly such other topics as motives for immigration, getting married, or leaving the parental home

Exploring Cold War Religious Persecution Using the Rank-Order Approach

This lesson explores religious persecution in East Germany. Students must decide plausible actions to take against the Protestant Church to diminish power. Acting as a member of The East German Secret Police, students, evaluate, rank, and justify decisions to minimalize Christianity in an atheist society

The Northern Ireland Baby Hearts Study: A Case-Control study using a hybrid data linkage method

Background The Northern Ireland (NI) Baby Hearts study aimed to investigate risk factors for congenital heart defects (CHD), and to investigate the health behaviours of a representative sample of NI pregnant women. Methods We performed a case-control study with hybrid data collection methods, including self-administered iPad questionnaire or postal questionnaire, information held in maternity records and linkage to prescription records. Cases (n=286) were recruited following diagnosis prenatally or postnatally, controls (n=966) were recruited during recruitment months in each maternity unit at 18-20 weeks gestation. Findings Refusal rates for questionnaire completion were low (7-8%). Among those recruited, consent for access and linkage to medical records was high (98%). Recruitment of both cases and controls was closely representative of the NI population in terms of age, area of residence and deprivation. There was considerable discordance between self-report questionnaires, maternity records and prescription records regarding medications taken in the first trimester, and between self-report questionnaires and maternity records regarding behaviours such as preconceptional folic acid, pregnancy planning, and smoking. However, there were no differences between cases and controls that would indicate recall bias. Conclusions Our results suggest that hybrid data collection approaches are a useful way forward for aetiological studies

The Baby Hearts Study – A case-control protocol with data linkage to evaluate risk and protective factors for congenital heart disease

Introduction The Baby Hearts study aimed to investigate risk and protective factors for congenital heart disease (CHD), and to investigate the health behaviours of a representative sample of pregnant women in Northern Ireland. Objectives We describe and evaluate the population-based case-control design enhanced with data linkage to administrative health data. Methods Cases (mothers of babies with CHD, n=286) were recruited following diagnosis prenatally or postnatally. Controls (mothers of babies without CHD, n=966) were recruited at 18-22 weeks gestation, from all women attending each maternity unit during a designated month. Hybrid data collection methods were used, including a self-administered iPad/postal questionnaire, and linkage to maternity and prescription records. Results Refusal rates were low (8%). iPad questionnaire completion at clinic or home visit had high acceptability whereas postal questionnaires were poorly returned leading to a further 9-10% loss of eligible cases/controls. In total, 61% of eligible cases and 68% of eligible controls were recruited, closely representative of the Northern Ireland population, with no evidence of selection bias. Of those recruited, 97% gave consent for linkage to medical records. Thirty-three percent of women had an unplanned pregnancy and 76% suspected they were pregnant by 5 weeks gestation, with no significant differences between cases and controls. There was considerable discordance between self-report, maternity and prescription records regarding medications obtained/taken in the first trimester, but no evidence of differences between cases and controls that would indicate substantial recall bias. Although there was high concordance between self-report and maternity records regarding folic acid supplementation, cases had significantly lower concordance than controls. Conclusions Our results suggest hybrid data collection approaches are a useful way forward for aetiological studies to reduce responder burden and address and estimate recall bias, and that the Baby Hearts study protocol is suitable for replication in other populations, modified to the local context

Laminar flow of two miscible fluids in a simple network

When a fluid comprised of multiple phases or constituents flows through a network, non-linear phenomena such as multiple stable equilibrium states and spontaneous oscillations can occur. Such behavior has been observed or predicted in a number of networks including the flow of blood through the microcirculation, the flow of picoliter droplets through microfluidic devices, the flow of magma through lava tubes, and two-phase flow in refrigeration systems. While the existence of non-linear phenomena in a network with many inter-connections containing fluids with complex rheology may seem unsurprising, this paper demonstrates that even simple networks containing Newtonian fluids in laminar flow can demonstrate multiple equilibria. The paper describes a theoretical and experimental investigation of the laminar flow of two miscible Newtonian fluids of different density and viscosity through a simple network. The fluids stratify due to gravity and remain as nearly distinct phases with some mixing occurring only by diffusion. This fluid system has the advantage that it is easily controlled and modeled, yet contains the key ingredients for network non-linearities. Experiments and 3D simulations are first used to explore how phases distribute at a single T-junction. Once the phase separation at a single junction is known, a network model is developed which predicts multiple equilibria in the simplest of networks. The existence of multiple stable equilibria is confirmed experimentally and a criteria for their existence is developed. The network results are generic and could be applied to or found in different physical systems

Chronic viral infection promotes sustained Th1-derived immunoregulatory IL-10 via BLIMP-1

During the course of many chronic viral infections, the antiviral T cell response becomes attenuated through a process that is regulated in part by the host. While elevated expression of the immunosuppressive cytokine IL-10 is involved in the suppression of viral-specific T cell responses, the relevant cellular sources of IL-10, as well as the pathways responsible for IL-10 induction, remain unclear. In this study, we traced IL-10 production over the course of chronic lymphocytic choriomeningitis virus (LCMV) infection in an IL-10 reporter mouse line. Using this model, we demonstrated that virus-specific T cells with reduced inflammatory function, particularly Th1 cells, display elevated and sustained IL-10 expression during chronic LCMV infection. Furthermore, ablation of IL-10 from the T cell compartment partially restored T cell function and reduced viral loads in LCMV-infected animals. We found that viral persistence is needed for sustained IL-10 production by Th1 cells and that the transcription factor BLIMP-1 is required for IL-10 expression by Th1 cells. Restimulation of Th1 cells from LCMV-infected mice promoted BLIMP-1 and subsequent IL-10 expression, suggesting that constant antigen exposure likely induces the BLIMP-1/IL-10 pathway during chronic viral infection. Together, these data indicate that effector T cells self-limit their responsiveness during persistent viral infection via an IL-10-dependent negative feedback loop.This work was supported by an Australian NHMRC Overseas Biomedical Postdoctoral Fellowship (to I.A. Parish); a Yale School of Medicine Brown-Coxe Postdoctoral Fellowship (to I.A. Parish); the Alexander von Humboldt Foundation (SKA2010, to P.A. Lang); a CIHR grant (to P.S. Ohashi); and by the Howard Hughes Medical Institute and NIH grant RO1AI074699 (to S.M. Kaech). P.S. Ohashi holds a Canada Research Chair in Autoimmunity and Tumor immunity

Using an Escape Room toolbox approach to enhance pharmacology education

Background: Faculty are encouraged to use a variety of teaching/learning strategies to engage nursing students. While simulation and games are now common, there were no reports in the nursing literature using an “escape room” concept. Escape rooms use an entertainment approach as teams engage in critical thinking to solve puzzles and find clues to escape a room. In the classroom setting, this concept is modified to solve a mystery by finding various objects through a series of puzzles to locate clues. Some of these games involve finding numerical clues to open locks on a box, such as a toolbox. The purpose of this study was to describe the use of a toolbox gaming strategy based on an escape room concept to help students learn about cardiovascular medications in a pharmacology course. Methods: This pilot study employed a descriptive qualitative method to investigate an approach to pharmacology education. The sample consisted of first semester nursing students. Results: Student responses to criteria-based questions resulted in three themes: engaging, teamwork, and frustration, related to using a toolbox scenario strategy as a pathway to learning. Conclusions: This descriptive study yielded mixed results from the students who were frustrated by time constraints but engaged in the learning experience. Lessons are offered for future improvements

High-Resolution Spectroscopic Study of Extremely Metal-Poor Star Candidates from the SkyMapper Survey

The SkyMapper Southern Sky Survey is carrying out a search for the most metal-poor stars in the Galaxy. It identifies candidates by way of its unique filter set that allows for estimation of stellar atmospheric parameters. The set includes a narrow filter centered on the Ca II K 3933A line, enabling a robust estimate of stellar metallicity. Promising candidates are then confirmed with spectroscopy. We present the analysis of Magellan-MIKE high-resolution spectroscopy of 122 metal-poor stars found by SkyMapper in the first two years of commissioning observations. 41 stars have [Fe/H] <= -3.0. Nine have [Fe/H] <= -3.5, with three at [Fe/H] ~ -4. A 1D LTE abundance analysis of the elements Li, C, Na, Mg, Al, Si, Ca, Sc, Ti, Cr, Mn, Co, Ni, Zn, Sr, Ba and Eu shows these stars have [X/Fe] ratios typical of other halo stars. One star with low [X/Fe] [X/Fe values appears to be "Fe-enhanced," while another star has an extremely large [Sr/Ba] ratio: >2. Only one other star is known to have a comparable value. Seven stars are "CEMP-no" stars ([C/Fe] > 0.7, [Ba/Fe] < 0). 21 stars exhibit mild r-process element enhancements (0.3 <=[Eu/Fe] < 1.0), while four stars have [Eu/Fe] >= 1.0. These results demonstrate the ability to identify extremely metal-poor stars from SkyMapper photometry, pointing to increased sample sizes and a better characterization of the metal-poor tail of the halo metallicity distribution function in the future.Comment: Minor corrections to text, missing data added to Tables 3 and 4; updated to match published version. Complete tables included in sourc

HerMES: the rest-frame UV emission and a lensing model for the z= 6.34 luminous dusty starburst galaxy HFLS3

We discuss the rest-frame ultraviolet emission from the starbursting galaxy HFLS3 at a redshift of 6.34. The galaxy was discovered in Herschel/SPIRE data due to its red color in the submillimeter wavelengths from 250 to 500 μm. Keck/NIRC2 K s -band adaptive optics imaging data showed two potential near-IR counterparts near HFLS3. Previously, the northern galaxy was taken to be in the foreground at z = 2.1, while the southern galaxy was assumed to be HFLS3's near-IR counterpart. The recently acquired Hubble/WFC3 and Advanced Camera for Surveys (ACS) imaging data show conclusively that both optically bright galaxies are in the foreground at z < 6. A new lensing model based on the Hubble imaging data and the millimeter-wave continuum emission yields a magnification factor of 2.2 ± 0.3, with a 95% confidence upper limit on the magnification of 3.5. When corrected for lensing, the instantaneous star formation rate is 1320 M ☉ yr–1, with the 95% confidence lower limit around 830 M ☉ yr–1. The dust and stellar masses of HFLS3 from the same spectral energy distribution (SED) models are at the level of 3 × 108 M ☉ and ~5 × 1010 M ☉, respectively, with large systematic uncertainties on assumptions related to the SED model. With Hubble/WFC3 images, we also find diffuse near-IR emission about 0.5 arcsec (~3 kpc) to the southwest of HFLS3 that remains undetected in the ACS imaging data. The emission has a photometric redshift consistent with either z ~ 6 or a dusty galaxy template at z ~ 2