Discontinuation of Routine Postpartum Complete Blood Count in Uncomplicated Vaginal Deliveries

Introduction The aim of this prospective study is to assess the clinical utility and safety of discontinuing routine Complete Blood Count (CBC) testing in uncomplicated vaginal deliveries with a focus on identifying potential benefits, risks, and overall cost-effectiveness of this practice. This routine CBC is used to assess for postpartum anemia and the need for a blood transfusion but is currently performed regardless of initial blood count on admission or estimated blood loss during delivery. However, recent evidence suggests that routine CBC testing may not significantly impact clinical outcomes in low-risk pregnancies. In this study, we hypothesize that routine postpartum CBC testing is not indicated following uncomplicated vaginal delivery if hemoglobin upon admission is \u3e10 g/dL and if estimated blood loss during delivery is \u3c500mL. Methods A postpartum complete blood count (CBC) is currently obtained from all obstetric patients at Cabell Huntington Hospital who have had a successful vaginal delivery. A prospective study was performed on 88 consecutive patients presenting to Cabell Huntington Hospital Labor and Delivery. A protocol was instituted whereby a postpartum-day-1 CBC was not indicated on patients undergoing vaginal delivery with an admission hemoglobin of \u3e10 g/dL and an estimated blood loss at the time of delivery of Results Analysis of the case series revealed no difference in blood transfusions, symptomatic anemia, postpartum complications, or maternal length of hospital stay before and after the institution of the protocol. There was a significant difference (p= Conclusion The findings from this prospective study have the potential to inform evidence-based postpartum care guidelines for low-risk pregnancies. If discontinuing routine CBC testing in uncomplicated vaginal deliveries is proven to be safe and cost-effective, it could lead to more efficient healthcare resource allocation, reduced healthcare costs, and improved patient experience. This study contributes valuable insights to the ongoing efforts in optimizing postpartum care protocols and may influence future clinical practice guidelines for low-risk pregnancies

Resilience reconciled

Resilience scholarship continues to inspire opaque discourse and competing frameworks often inconsistent with the complexity inherent in social–ecological systems. We contend that competing conceptualizations of resilience are reconcilable, and that the core theory is useful for navigating sustainability challenges. Resilience as a scientific concept exploded in the early 2000s and is now being adopted by a range of disciplines and by a wide diversity of actors, from city planners to networks of global protectedarea managers. Resilience concepts are now integrated within national and international calls for proposals, research initiatives and centres in both the biophysical and social sciences. However, resilience scholarship has encouraged abstract discourse including many new and derivative frameworks aimed at re-conceptualizing resilience. Competing frameworks contribute to a loss of clarity about the original concept and theory of resilience; these frameworks often differ only minimally from each other and, most importantly, are often inconsistent with the complexity inherent in social–ecological systems (SESs). We believe that this is because the concept of resilience has both an attractive simplicity, and a rich underlying complexity, which leaves key aspects open for debate. Despite apparent discrepancies among numerous competing frameworks and the recognition that a diversity of approaches is healthy for scientific progress, we contend that the prevailing definitions of resilience, such as those rooted in ecological stability (for example, recovery, robustness and persistence), are reconcilable under the umbrella of the original theory of ecological resilience (the amount of disturbance needed to cause a regime shift; for example, a clear-water lake changing to a turbid lake)2. Reconciling definitions of resilience is not trivial; our collective understanding and application of resilience has widespread implications for how we, as a society, understand and navigate global change. A view of the Earth as nested SESs — systems of dynamic, linked feedbacks between humans and the biophysical environment (for example, the influence of political economy on landscape shifts and vice versa) — is essential for definitions of resilience to resonate. Currently, resilience is applied as a descriptor, a measure, and a tool for relative analysis of system dynamics. Here we revisit three core uses of the term: resilience as a process, a rate, and an emergent property of SESs3. We reconcile these core uses with ecological resilience2 and provide examples of successful application and growth of the concept

Differences in Innate Immunologic Response to Group B Streptococcus Between Colonized and Noncolonized Women

Objective: To evaluate the functional capacity of granulocytes and monocytes from pregnant and nonpregnant women in relation to group B streptococcus (GBS) colonization status. Methods: Engulfment of fluorescent GBS by peripheral blood phagocytes from GBS-colonized and noncolonized women was measured by flow cytometry. Intracellular superoxiode generated in response to GBS challenge to monocytes and granulocytes enriched from peripheral blood of these women was also measured by flow cytometry, and extracellular superoxide was determined by colorimetric assay. Results: Monocytes and granulocytes from pregnant, GBS-colonized women engulfed significantly greater numbers of GBS than phagocytes from pregnant, noncolonized women. No difference in intracellular superoxide production was detected between any of the groups of women; however, monocytes from pregnant, colonized women released significantly more superoxide into the extracellular milieu than did granulocytes from the same women. No differences in extracellular release of superoxide were observed among noncolonized women whether they were pregnant or not. Conclusions: Monocytes from pregnant, colonized women engulf more GBS and release more of the superoxide into the extracellular environment, where it is unlikely to be an effective defense mechanism against intracellular bacteria. This suggests that components of the innate immune system that should serve in a protective role may function suboptimally, thereby contributing to the colonization process by GBS

Resilience reconciled

Resilience scholarship continues to inspire opaque discourse and competing frameworks often inconsistent with the complexity inherent in social–ecological systems. We contend that competing conceptualizations of resilience are reconcilable, and that the core theory is useful for navigating sustainability challenges

Quantifying Uncertainty and Trade-offs in Resilience Assessments

Several frameworks have been developed to assess the resilience of social-ecological systems, but most require substantial data inputs, time, and technical expertise. Stakeholders and practitioners often lack the resources for such intensive efforts. Furthermore, most end with problem framing and fail to explicitly address trade-offs and uncertainty. To remedy this gap, we developed a rapid survey assessment that compares the relative resilience of social-ecological systems with respect to a number of resilience properties. This approach generates large amounts of information relative to stakeholder inputs. We targeted four stakeholder categories: government (policy, regulation, management), end users (farmers, ranchers, landowners, industry), agency/public science (research, university, extension), and NGOs (environmental, citizen, social justice) in four North American watersheds, to assess social-ecological resilience through surveys. Conceptually, social-ecological systems are comprised of components ranging from strictly human to strictly ecological, but that relate directly or indirectly to one another. They have soft boundaries and several important dimensions or axes that together describe the nature of social-ecological interactions, e.g., variability, diversity, modularity, slow variables, feedbacks, capital, innovation, redundancy, and ecosystem services. There is no absolute measure of resilience, so our design takes advantage of cross-watershed comparisons and therefore focuses on relative resilience. Our approach quantifies and compares the relative resilience across watershed systems and potential trade-offs among different aspects of the social-ecological system, e.g., between social, economic, and ecological contributions. This approach permits explicit assessment of several types of uncertainty (e.g., self-assigned uncertainty for stakeholders; uncertainty across respondents, watersheds, and subsystems), and subjectivity in perceptions of resilience among key actors and decision makers and provides an efficient way to develop the mental models that inform our stakeholders and stakeholder categories

The Effect of Hepatitis C on Maternal Bile Acid Level and the Fetal Left Ventricular Tei Index

Hepatitis C (HCV) is a common form of liver disease encountered in pregnancy. The purpose of this study is to evaluate if hepatitis C is associated with elevated maternal serum bile acids and abnormal fetal cardiac function measured by the left ventricular Tei index in the absence of intrahepatic cholestasis of pregnancy. This is a prospective cohort study on pregnant women with hepatitis C seen through Marshall University’s high-risk obstetrics clinic from 2013 to 2014. Women with hepatitis C had a laboratory evaluation and an ultrasound on the fetus to calculate the left ventricular Tei index. Demographic information and delivery outcomes were recorded. There were 77 participants with hepatitis C recruited and consented for this study. Sixty-one participants had complete laboratory and delivery information available for analysis. Twenty-one participants had a viral load that was not detectable and 40 participants had a detectable viral load. The mean viral load overall was 1943771 IU/mL (SD 4257143). There was no difference in Tei index between detectable and non-detectable viral load, 0.41 and 0.38 respectively (p = 0.41). There was no statistical difference in bile acid level between detectable and undetectable viral load, 12 and 8 µmol/L respectively (p = 0.05). Hepatic liver disease manifested by elevated hepatitis C viral load or elevated bile acids did not affect the left ventricular Tei index

Biological invasions, ecological resilience and adaptive governance

In a world of increasing interconnections in global trade as well as rapid change in climate and land cover, the accelerating introduction and spread of invasive species is a critical concern due to associated negative social and ecological impacts, both real and perceived. Much of the societal response to invasive species to date has been associated with negative economic consequences of invasions. This response has shaped a war-like approach to addressing invasions, one with an agenda of eradications and intense ecological restoration efforts towards prior or more desirable ecological regimes. This trajectory often ignores the concept of ecological resilience and associated approaches of resilience-based governance. We argue that the relationship between ecological resilience and invasive species has been understudied to the detriment of attempts to govern invasions, and that most management actions fail, primarily because they do not incorporate adaptive, learning-based approaches. Invasive species can decrease resilience by reducing the biodiversity that underpins ecological functions and processes, making ecosystems more prone to regime shifts. However, invasions do not always result in a shift to an alternative regime; invasions can also increase resilience by introducing novelty, replacing lost ecological functions or adding redundancy that strengthens already existing structures and processes in an ecosystem. This paper examines the potential impacts of species invasions on the resilience of ecosystems and suggests that resilience-based approaches can inform policy by linking the governance of biological invasions to the negotiation of tradeoffs between ecosystem services

Integrative analysis of the plasma proteome and polygenic risk of cardiometabolic diseases.

Cardiometabolic diseases are frequently polygenic in architecture, comprising a large number of risk alleles with small effects spread across the genome1-3. Polygenic scores (PGS) aggregate these into a metric representing an individual's genetic predisposition to disease. PGS have shown promise for early risk prediction4-7 and there is an open question as to whether PGS can also be used to understand disease biology8. Here, we demonstrate that cardiometabolic disease PGS can be used to elucidate the proteins underlying disease pathogenesis. In 3,087 healthy individuals, we found that PGS for coronary artery disease, type 2 diabetes, chronic kidney disease and ischaemic stroke are associated with the levels of 49 plasma proteins. Associations were polygenic in architecture, largely independent of cis and trans protein quantitative trait loci and present for proteins without quantitative trait loci. Over a follow-up of 7.7 years, 28 of these proteins associated with future myocardial infarction or type 2 diabetes events, 16 of which were mediators between polygenic risk and incident disease. Twelve of these were druggable targets with therapeutic potential. Our results demonstrate the potential for PGS to uncover causal disease biology and targets with therapeutic potential, including those that may be missed by approaches utilizing information at a single locus

PPARγ Controls Dectin-1 Expression Required for Host Antifungal Defense against Candida albicans

We recently showed that IL-13 or peroxisome proliferator activated receptor γ (PPARγ) ligands attenuate Candida albicans colonization of the gastrointestinal tract. Here, using a macrophage-specific Dectin-1 deficient mice model, we demonstrate that Dectin-1 is essential to control fungal gastrointestinal infection by PPARγ ligands. We also show that the phagocytosis of yeast and the release of reactive oxygen intermediates in response to Candida albicans challenge are impaired in macrophages from Dectin-1 deficient mice treated with PPARγ ligands or IL-13. Although the Mannose Receptor is not sufficient to trigger antifungal functions during the alternative activation of macrophages, our data establish the involvement of the Mannose Receptor in the initial recognition of non-opsonized Candida albicans by macrophages. We also demonstrate for the first time that the modulation of Dectin-1 expression by IL-13 involves the PPARγ signaling pathway. These findings are consistent with a crucial role for PPARγ in the alternative activation of macrophages by Th2 cytokines. Altogether these data suggest that PPARγ ligands may be of therapeutic value in esophageal and gastrointestinal candidiasis in patients severely immunocompromised or with metabolic diseases in whom the prevalence of candidiasis is considerable

Investigations of the Mars Upper Atmosphere with ExoMars Trace Gas Orbiter

The Martian mesosphere and thermosphere, the region above about 60 km, is not the primary target of the ExoMars 2016 mission but its Trace Gas Orbiter (TGO) can explore it and address many interesting issues, either in-situ during the aerobraking period or remotely during the regular mission. In the aerobraking phase TGO peeks into thermospheric densities and temperatures, in a broad range of latitudes and during a long continuous period. TGO carries two instruments designed for the detection of trace species, NOMAD and ACS, which will use the solar occultation technique. Their regular sounding at the terminator up to very high altitudes in many different molecular bands will represent the first time that an extensive and precise dataset of densities and hopefully temperatures are obtained at those altitudes and local times on Mars. But there are additional capabilities in TGO for studying the upper atmosphere of Mars, and we review them briefly. Our simulations suggest that airglow emissions from the UV to the IR might be observed outside the terminator. If eventually confirmed from orbit, they would supply new information about atmospheric dynamics and variability. However, their optimal exploitation requires a special spacecraft pointing, currently not considered in the regular operations but feasible in our opinion. We discuss the synergy between the TGO instruments, specially the wide spectral range achieved by combining them. We also encourage coordinated operations with other Mars-observing missions capable of supplying simultaneous measurements of its upper atmosphere