Fatores de risco para mortes fetais anteparto no Município de São Paulo, Brasil

OBJETIVO: Analisar os fatores de risco para óbitos fetais anteparto. METODOS: Estudo de caso-controle de base populacional realizado no Município de São Paulo, SP, de agosto de 2000 a janeiro de 2001. Os indivíduos foram selecionados a partir de uma coorte de nascimentos, obtida por meio de vinculação de declarações de nascimento e óbito. Os casos foram 164 óbitos fetais anteparto e os controles, uma amostra aleatória de 313 de sobreviventes até 28 dias. Foram realizadas entrevistas domiciliares com as mães e aplicado protocolo hospitalar. Foi empregada regressão logística para análise dos dados, baseado em modelo conceitual hierárquico. RESULTADOS: Os fatores estatisticamente significantes associados aos óbitos fetais anteparto foram: mães com união recente ou sem união; escolaridade da mãe inferior a quatro anos; nascimentos anteriores de baixo peso; mães com hipertensão, diabetes, e sangramento durante a gestação; ausência ou pré-natal inadequado presença de malformação congênita e presença de pequeno para idade gestacional. As maiores frações de risco atribuível na população foram inadequação do pré-natal (40%), hipertensão (27%), presença de pequeno para idade gestacional (30%), e ausência de união com mais de um ano (26%). CONCLUSÕES: Os fatores de risco proximais são os mais importantes para a mortalidade fetal anteparto. Entretanto, fatores distais como mães de baixa escolaridade e união recente ou ausente também desempenham importante papel. Melhorar acesso e qualidade do pré-natal pode promover impacto positivo na mortalidade fetal.OBJECTIVE: To assess risk factors for antepartum fetal deaths. METHODS: A population-based case-control study was carried out in the city of São Paulo from August 2000 to January 2001. Subjects were selected from a birth cohort from a linked birth and death certificate database. Cases were 164 antepartum fetal deaths and controls were drawn from a random sample of 313 births surviving at least 28 days. Information was collected from birth and death certificates, hospital records and home interviews. A hierarchical conceptual framework guided the logistic regression analysis. RESULTS: Statistically significant factors associated with antepartum fetal death were: mother without or recent marital union; mother's education under four years; mothers with previous low birth weight infant; mothers with hypertension, diabetes, bleeding during pregnancy; no or inadequate prenatal care; congenital malformation and intrauterine growth restriction. The highest population attributable fractions were for inadequacy of prenatal care (40%), hypertension (27%), intrauterine growth restriction (30%) and absence of a long-standing union (26%). CONCLUSIONS: Proximal biological risk factors are most important in antepartum fetal deaths. However, distal factors - mother's low education and marital status - are also significant. Improving access to and quality of prenatal care could have a large impact on fetal mortality

Development and description of a theory-driven, evidence-based, complex intervention to improve adherence to treatment for tuberculosis in the UK: the IMPACT study

Background: Tuberculosis (TB) has a significant treatment burden for patients, requiring at least six months of anti-TB treatment (ATT) with multiple medicines. Ensuring good adherence to ATT is central to global TB strategies, including those in high-income, low-TB incidence (HILI) settings. For adherence interventions to be successful and deliverable, they need to address the personal and environmental factors influencing patient and provider behaviour. // Purpose: This paper describes the application of theory and research evidence to inform the design process of the IMPACT manualised intervention to support ATT adherence for adults with TB disease in the United Kingdom (UK). It also provides a full description of the resulting intervention. // Methods: We synthesised findings from our formative research (qualitative and quantitative scoping reviews and patient and carer interviews) and supplemented these with clinic observations, a literature review, and healthcare provider interviews. Findings were mapped to the guiding theoretical framework (Perceptions and Practicalities Approach) which was operationalised to design the intervention components and content. An Intervention Development Group (IDG) of relevant stakeholders were consulted to adapt the intervention to local clinical settings. // Results: The pragmatic, deliverable components and content for the IMPACT intervention included: (1) an enhanced, structured, risk assessment to systematically identify risk factors for non-adherence plus locally-adapted guidance to mitigate these; and (2) patient educational materials (an animated video and interactive patient booklet) about TB and its treatment, to communicate the need for treatment and address common concerns. // Conclusions: Using a theory– and evidence– based approach incorporating stakeholder input, we have developed a multi-component, pragmatic, manualised intervention, which addresses patients’ personal barriers to adherence within local service resources to improve adherence to ATT within UK TB services

Parental bonding and identity style as correlates of self-esteem among adult adoptees and nonadoptees

Adult adoptees (n equals 100) and non-adoptees (n equals 100) were compared with regard to selfesteem, identity processing style, and parental bonding. While some differences were found with regard to self-esteem, maternal care, and maternal overprotection, these differences were qualified by reunion status such that only reunited adoptees differed significantly from nonadoptees. Moreover, hierarchical regression analyses indicated that parental bonding and identity processing style were more important than adoptive status per se in predicting self esteem. Implications for practitioners who work with adoptees are discussed

Physiology and evolution of nitrate acquisition in Prochlorococcus

Prochlorococcus is the numerically dominant phototroph in the oligotrophic subtropical ocean and carries out a significant fraction of marine primary productivity. Although field studies have provided evidence for nitrate uptake by Prochlorococcus, little is known about this trait because axenic cultures capable of growth on nitrate have not been available. Additionally, all previously sequenced genomes lacked the genes necessary for nitrate assimilation. Here we introduce three Prochlorococcus strains capable of growth on nitrate and analyze their physiology and genome architecture. We show that the growth of high-light (HL) adapted strains on nitrate is ~17% slower than their growth on ammonium. By analyzing 41 Prochlorococcus genomes, we find that genes for nitrate assimilation have been gained multiple times during the evolution of this group, and can be found in at least three lineages. In low-light adapted strains, nitrate assimilation genes are located in the same genomic context as in marine Synechococcus. These genes are located elsewhere in HL adapted strains and may often exist as a stable genetic acquisition as suggested by the striking degree of similarity in the order, phylogeny and location of these genes in one HL adapted strain and a consensus assembly of environmental Prochlorococcus metagenome sequences. In another HL adapted strain, nitrate utilization genes may have been independently acquired as indicated by adjacent phage mobility elements; these genes are also duplicated with each copy detected in separate genomic islands. These results provide direct evidence for nitrate utilization by Prochlorococcus and illuminate the complex evolutionary history of this trait.Gordon and Betty Moore Foundation (Grant GBMF495)National Science Foundation (U.S.) (Grant OCE-1153588)National Science Foundation (U.S.) (Grant DBI-0424599

Azimuthal anisotropy of neutral pion production in Au+Au collisions at sqrt(s_NN) = 200 GeV: Path-length dependence of jet quenching and the role of initial geometry

We have measured the azimuthal anisotropy of pi0's for 1 < pT < 18 GeV/c for Au+Au collisions at sqrt s_NN = 200 GeV. The observed anisotropy shows a gradual decrease in 3 < pT < 7 - 10 GeV/c, but remains positive beyond 10 GeV/c. The magnitude of this anisotropy is under-predicted, up to at least 10 GeV/c, by current perturbative QCD (pQCD) energy-loss model calculations. An estimate of the increase in anisotropy expected from initial-geometry modification due to gluon saturation effects and initial-geometry fluctuations is insufficient to account for this discrepancy. Calculations which implement a path length dependence steeper than what is implied by current pQCD energy-loss models, show reasonable agreement with the data.Comment: 384 authors, 6 pages text, 3 figures. Submitted to Phys. Rev. Lett. Plain text data tables for the points plotted in figures for this and previous PHENIX publications are (or will be) publicly available at http://www.phenix.bnl.gov/papers.htm

De Novo VPS4A Mutations Cause Multisystem Disease with Abnormal Neurodevelopment.

The endosomal sorting complexes required for transport (ESCRTs) are essential for multiple membrane modeling and membrane-independent cellular processes. Here we describe six unrelated individuals with de novo missense variants affecting the ATPase domain of VPS4A, a critical enzyme regulating ESCRT function. Probands had structural brain abnormalities, severe neurodevelopmental delay, cataracts, growth impairment, and anemia. In cultured cells, overexpression of VPS4A mutants caused enlarged endosomal vacuoles resembling those induced by expression of known dominant-negative ATPase-defective forms of VPS4A. Proband-derived fibroblasts had enlarged endosomal structures with abnormal accumulation of the ESCRT protein IST1 on the limiting membrane. VPS4A function was also required for normal endosomal morphology and IST1 localization in iPSC-derived human neurons. Mutations affected other ESCRT-dependent cellular processes, including regulation of centrosome number, primary cilium morphology, nuclear membrane morphology, chromosome segregation, mitotic spindle formation, and cell cycle progression. We thus characterize a distinct multisystem disorder caused by mutations affecting VPS4A and demonstrate that its normal function is required for multiple human developmental and cellular processes.This work was supported by: UK Medical Research Council Project Grants [MR/M00046X/1], [MR/R026440/1] and Project grant from National Institute of Health Research Biomedical Research Centre at Addenbrooke's Hospital (to E.R.), Fondazione Bambino Gesù (Vite Coraggiose) and Italian Ministry of Health (CCR-2017-23669081) (to M.T.), National Institute for Health Research (NIHR) for the Cambridge Biomedical Research Centre and NIHR BioResource (Grant Number RG65966) (to F.L.R.), and a Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (Grant Number 216370/Z/19/Z) (to J.E.). CIMR was supported by a Wellcome Trust Strategic Award [100140] and Equipment Grant [093026]. This research was made possible through access to the data and findings generated by the 100,000 Genomes Project. The 100,000 Genomes Project is managed by Genomics England Limited (a wholly owned company of the Department of Health and Social Care). The 100,000 Genomes Project is funded by the National Institute for Health Research and NHS England. The Wellcome Trust, Cancer Research UK and the Medical Research Council have also funded research infrastructure. The 100,000 Genomes Project uses data provided by patients and collected by the National Health Service as part of their care and support

Transverse momentum dependence of J/psi polarization at midrapidity in p+p collisions at sqrt(s)=200 GeV

We report the measurement of the transverse momentum dependence of inclusive J/psi polarization in p+p collisions at sqrt(s)=200 GeV performed by the PHENIX Experiment at RHIC. The polarization is studied in the helicity, Gottfried-Jackson, and Collins-Soper frames for p_T < 5 GeV/c and |y| < 0.35. The J/psi polarization in the helicity and Gottfried-Jackson frames is consistent with zero for all transverse momenta, with a slight (1.8 sigma) trend towards longitudinal polarization for transverse momenta above 2 GeV/c. No conclusion is allowed due to the limited acceptance in the Collins-Soper frame and the uncertainties of the current data. The results are compared to observations for other collision systems and center of mass energies and to different quarkonia production models.Comment: 384 authors from 62 institutions, 11 pages, 9 figures, 2 tables. v2 is expanded version submitted to Physical Review D. Plain text data tables for the points plotted in figures are available at http://www.phenix.bnl.gov/papers.htm

Transverse momentum and centrality dependence of dihadron correlations in Au+Au collisions at sqrt(s_NN)=200 GeV: Jet-quenching and the response of partonic matter

Azimuthal angle \Delta\phi correlations are presented for charged hadrons from dijets for 0.4 < p_T < 10 GeV/c in Au+Au collisions at sqrt(s_NN) = 200 GeV. With increasing p_T, the away-side distribution evolves from a broad to a concave shape, then to a convex shape. Comparisons to p+p data suggest that the away-side can be divided into a partially suppressed "head" region centered at Delta\phi ~ \pi, and an enhanced "shoulder" region centered at Delta\phi ~ \pi +/- 1.1. The p_T spectrum for the "head" region softens toward central collisions, consistent with the onset of jet quenching. The spectral slope for the "shoulder" region is independent of centrality and trigger p_T, which offers constraints on energy transport mechanisms and suggests that the "shoulder" region contains the medium response to energetic jets.Comment: 420 authors from 58 institutions, 6 pages, 4 figures. Submitted to Physical Review Letters. Plain text data tables for the points plotted in figures for this and previous PHENIX publications are (or will be) publicly available at http://www.phenix.bnl.gov/papers.htm

High p_T Direct Photon and pi^0 Triggered Azimuthal Jet Correlations in sqrt(s)=200 GeV p+p Collisions

Correlations of charged hadrons of 1 < pT < 10 GeV/c with high pT direct photons and pi^ 0 mesons in the range 5 <pT < 15 GeV/c are used to study jet fragmentation in the photon+jet and di-jet channels, respectively. The magnitude of the partonic transverse momentum, kT, is obtained by comparing to a model incorporating a Gaussian kT smearing. The sensitivity of the associated charged hadron spectra to the underlying fragmentation function is tested and the data are compared to calculations using recent global fit results. The shape of the direct photon-associated hadron spectrum as well as its charge asymmetry are found to be consistent with a sample dominated by quark-gluon Compton scattering. No significant evidence of fragmentation photon correlated production is observed within experimental uncertainties.Comment: 431 authors, 18 pages, 18 figures, 4 tables, RevTeX-4. Submitted to Physical Review D. Plain text data tables for the points plotted in figures for this and previous PHENIX publications are (or will be) publicly available at http://www.phenix.bnl.gov/papers.htm

Particle-species dependent modification of jet-induced correlations in Au+Au collisions at sqrt(s_NN) = 200 GeV

We report PHENIX measurements of the correlation of a trigger hadron at intermediate transverse momentum (2.5<p_{T,trig}<4 GeV/c), with associated mesons or baryons at lower p_{T,assoc}, in Au+Au collisions at sqrt(s_NN) = 200 GeV. The jet correlations for both baryons and mesons show similar shape alterations as a function of centrality, characteristic of strong modification of the away-side jet. The ratio of jet-associated baryons to mesons for this jet increases with centrality and p_{T,assoc} and, in the most central collisions, reaches a value similar to that for inclusive measurements. This trend is incompatible with in-vacuum fragmentation, but could be due to jet-like contributions from correlated soft partons which recombine upon hadronization.Comment: 344 authors, 4 pages text, RevTeX, 4 figures. Submitted to Physical Review Letters. Plain text data tables for the points plotted in figures for this and previous PHENIX publications are (or will be) publicly available at http://www.phenix.bnl.gov/papers.htm