The Smoking MUMS (Maternal Use of Medication and Safety) Study: protocol for a population-based cohort study using linked administrative data

Introduction: Approximately 14% of Australian women smoke during pregnancy. Although the risk of adverse outcomes is reduced by smoking cessation, less than 35% of Australian women quit smoking spontaneously during pregnancy. Evidence for the efficacy of bupropion, varenicline or nicotine replacement therapy as smoking cessation aids in the non-pregnant population suggest that pharmacotherapy for smoking cessation is worth exploring in women of childbearing age. Currently, little is known about the utilisation, effectiveness and safety of pharmacotherapies for smoking cessation during pregnancy; neither the extent to which they are used prior to pregnancy nor whether their use has changed in response to related policy reforms. The Smoking MUMS (Maternal Use of Medications and Safety) Study will explore these issues using linked person-level data for a population-based cohort of Australian mothers. Methods and analysis: The cohort will be assembled by linking administrative health records for all women who gave birth in New South Wales or Western Australia since 2003 and their children, including records relating to childbirth, use of pharmaceuticals, hospital admissions, emergency department presentations and deaths. These longitudinal linked data will be used to identify utilisation of smoking cessation pharmacotherapies during and between pregnancies and to explore the associated smoking cessation rates and maternal and child health outcomes. Subgroup and temporal analyses will identify potential differences between population groups including indigenous mothers and social security recipients and track changes associated with policy reforms that have made alternative smoking cessation pharmacotherapies available.Ethics and dissemination: Ethical approval has been obtained for this study. To enhance the translation of the project's findings into policy and practice, policy and clinical stakeholders will be engaged through a reference group and a policy forum will be held. Outputs from the project will include scientific papers and summary reports designed for policy audiences

Placental Passage of Protopine in an Ex Vivo Human Perfusion System

The placental passage of protopine was investigated with a human ex vivo placental perfusion model. The model was first validated with diazepam and citalopram, 2 compounds known to cross the placental barrier, and antipyrine as a positive control. All compounds were quantified by partially validated U(H)PLC-MS/MS bioanalytical methods. Protopine was transferred from the maternal to the fetal circuit, with a steady-state reached after 90 min. The study compound did not affect placental viability or functionality, as glucose consumption, lactate production, and beta-human chorionic gonadotropin, and leptin release remained constant. Histopathological evaluation of all placental specimens showed unremarkable, age-appropriate parenchymal maturation with no pathologic findings

Recent Patterns in Population-Based HIV Prevalence in Swaziland

Background: The 2011 Swaziland HIV Incidence Measurement Survey (SHIMS) was conducted as part of a national study to evaluate the scale up of key HIV prevention programs. Methods: From a randomly selected sample of all Swazi households, all women and men aged 18-49 were considered eligible, and all consenting adults were enrolled and received HIV testing and counseling. In this analysis, population-based measures of HIV prevalence were produced and compared against similarly measured HIV prevalence estimates from the 2006-7 Swaziland Demographic and Health. Also, measures of HIV service utilization in both HIV infected and uninfected populations were documented and discussed. Results: HIV prevalence among adults aged 18-49 has remained unchanged between 2006-2011 at 31-32%, with substantial differences in current prevalence between women (39%) and men (24%). In both men and women, between since 2006-7 and 2011, prevalence has fallen in the young age groups and risen in the older age groups. Over a third (38%) of the HIV-infected population was unaware of their infection status, and this differed markedly between men (50%) and women (31%). Of those aware of their HIV-positive status, a higher percentage of men (63%) than women (49%) reported ART use. Conclusions: While overall HIV prevalence remains roughly constant, age-specific changes strongly suggest both improved survival of the HIV-infected and a reduction in new HIV infections. Awareness of HIV status and entry into ART services has improved in recent years but remains too low. This study identifies opportunities to improve both HIV preventive and care services in Swaziland

OpenCog Hyperon: A Framework for AGI at the Human Level and Beyond

An introduction to the OpenCog Hyperon framework for Artificiai General Intelligence is presented. Hyperon is a new, mostly from-the-ground-up rewrite/redesign of the OpenCog AGI framework, based on similar conceptual and cognitive principles to the previous OpenCog version, but incorporating a variety of new ideas at the mathematical, software architecture and AI-algorithm level. This review lightly summarizes: 1) some of the history behind OpenCog and Hyperon, 2) the core structures and processes underlying Hyperon as a software system, 3) the integration of this software system with the SingularityNET ecosystem's decentralized infrastructure, 4) the cognitive model(s) being experimentally pursued within Hyperon on the hopeful path to advanced AGI, 5) the prospects seen for advanced aspects like reflective self-modification and self-improvement of the codebase, 6) the tentative development roadmap and various challenges expected to be faced, 7) the thinking of the Hyperon team regarding how to guide this sort of work in a beneficial direction ... and gives links and references for readers who wish to delve further into any of these aspects

The Peculiar Debris Disk of HD 111520 as Resolved by the Gemini Planet Imager

Using the Gemini Planet Imager (GPI), we have resolved the circumstellar debris disk around HD 111520 at a projected range of ~30-100 AU in both total and polarized $H$-band intensity. The disk is seen edge-on at a position angle of ~165$^{\circ}$ along the spine of emission. A slight inclination or asymmetric warping are covariant and alters the interpretation of the observed disk emission. We employ 3 point spread function (PSF) subtraction methods to reduce the stellar glare and instrumental artifacts to confirm that there is a roughly 2:1 brightness asymmetry between the NW and SE extension. This specific feature makes HD 111520 the most extreme examples of asymmetric debris disks observed in scattered light among similar highly inclined systems, such as HD 15115 and HD 106906. We further identify a tentative localized brightness enhancement and scale height enhancement associated with the disk at ~40 AU away from the star on the SE extension. We also find that the fractional polarization rises from 10 to 40% from 0.5" to 0.8" from the star. The combination of large brightness asymmetry and symmetric polarization fraction leads us to believe that an azimuthal dust density variation is causing the observed asymmetry.Comment: 9 pages, 8 Figures, 1 table, Accepted to Ap

Varenicline is More Effective than Nicotine Replacement Therapy During Pregnancy: Findings from the Smoking MUMS (Maternal Use of Medications and Safety) Study

Introduction Studies in the general population suggest that varenicline is more effective than nicotine replacement therapy (NRT) for smoking cessation. However, clinical guidelines recommend against the use of varenicline during pregnancy and suggest NRT be used when the expected benefits outweigh the potential risks. Objectives and Approach We evaluated whether varenicline was more effective than NRT for smoking cessation when used during pregnancy. Routinely-collected records of all births (01/01/2011-12/31/2012) in New South Wales and Western Australia were used to identify a cohort of women who smoked during the first 20 weeks of pregnancy. Pharmaceutical dispensing data were then linked to identify varenicline or NRT dispensing in the first 20 weeks of pregnancy. Smoking cessation was defined as women reported not smoking after the first 20 weeks of pregnancy. Inverse probability of treatment weighting with propensity scores were used to account for differences between the two treatment groups. Results Overall, 117 women used varenicline and 135 NRT in the first 20 weeks of pregnancy. In the unweighted sample, more women who used varenicline quit smoking after the first 20 weeks than women using NRT (28.2% vs. 11.1%, crude rate difference:17.1%, 95% confidence intervals[CI]:7.4-26.8%). In the weighted sample, quitting rate was 12.7% (95%CI:0.8-24.6%) higher in pregnant smokers who used varenicline (27.4% vs. 14.7%) when compared to those who used NRT. Conclusion/Implications Pregnant smokers using varenicline were more likely to quit smoking than those using NRT. This information will assist healthcare providers to make informed recommendations, but data regarding safety of varenicline in pregnancy are also urgently needed. Future studies with greater statistical power are required to confirm our results