Prenatal Care Cards: Imparting Patient Autonomy During Pregnancy.

Introduction/Problem: Indiana University Student Outreach Clinic (IU-SOC) has been providing medical care to vulnerable populations for the past 12 years. In that time, students have witnessed barriers to care impacting the neighbors in the community, including lack of health insurance due to financial limitations or limited residency documentation. These barriers are particularly burdensome to pregnant patients, and the bimonthly Prenatal Clinic was created five years ago to address this need. A major limitation is ensuring effective communication between the IU-SOC Electronic Medical Record (EMR), Practice Fusion, and the multiple health systems in the community. Intervention: After reviewing the Pan American Health Organization (P.A.H.O) recommendations for similar communities, we created a tool that can be utilized at all outreach clinics: the prenatal care card. These care cards contain all relevant prenatal information such as first, second, and third trimester prenatal labs, blood pressure measurements, fetal anatomy ultrasound results, and other tests that will allow providers to establish baseline values that determine future care. The card can be easily translated for improved clarity and is printed on sturdy, laminated cardstock. IU-SOC contact information is included on the bottom of the card in case future providers have concerns, and patients receive a photocopy of the card for safekeeping. Our copy is uploaded to Practice Fusion for future reference at IU-SOC. Conclusion: The IU-SOC prenatal care card has been implemented as a way to communicate between the clinic and other healthcare providers, in accordance with P.A.H.O. standards of perinatal care. Since September 2021, four IU-SOC patients have been offered the prenatal care card and have expressed overall satisfaction so far. The value of the prenatal card is three-fold: to provide patients with ownership of their medical information, to be easily shareable with any medical center, and to enhance their pregnancy experience overall. The utility of the prenatal card will be further established as more pregnant patients are provided this tool

Cosmological Aspects of Rolling Tachyon

We examine the possibility of rolling tachyon to play the dual roll of inflaton at early epochs and dark matter at late times. We argue that enough inflation can be generated with the rolling tachyon either by invoking the large number of branes or brane world assisted inflation. However, reheating is problematic in this model.Comment: RevTeX 4 pages, Talk delivered in PASCOS held at TIFR (Mumbai) from 3rd Jan to 9th Jan. To appear in the proceedings of PASCOS to be published in a special issue of Praman

Laparoscopic Splenectomy in Children

BACKGROUND: Laparoscopic splenectomy is being performed more commonly in children, although its advantages are not clear. We sought to determine whether laparoscopic splenectomy was superior to open splenectomy. METHODS: The records of all pediatric patients undergoing splenectomy without significant comorbidities over a 12-year period were examined. The patients were divided into those undergoing laparoscopic splenectomy and those undergoing open splenectomy. Demographics, operative time, estimated blood loss, spleen size, length of stay, and total charges were compared between the groups. RESULTS: Eighty-one (58%) children underwent laparoscopic splenectomy, and 59 (42%) children underwent open splenectomy. The groups were similar in age and sex; hereditary spherocytosis was more common in the LS group. Operating time was longer in the laparoscopic splenectomy group (231 +/- 10 min vs 138 +/- 9 min; P\u3c0.001), but blood loss and complication rates were similar. Twelve (15%) conversions were necessary primarily due to spleen size. Although children undergoing LS had a shorter length of stay (2.4 +/- 0.1 vs 4.1 +/- 0.3 days; P\u3c0.001), they incurred higher charges (dollars 21199 +/- 664 vs dollars 15723 +/- 1737; P\u3c0.002). CONCLUSION: Laparoscopic splenectomy is a safe procedure in children, resulting in shorter hospital stay, which may translate into earlier return to activity and a smaller burden on the child\u27s caretakers

Aspects of Tachyonic Inflation with Exponential Potential

We consider issues related to tachyonic inflation with exponential potential. We find exact solution of evolution equations in the slow roll limit in FRW cosmology. We also carry out similar analysis in case of Brane assisted tachyonic inflation. We investigate the phase space behavior of the system and show that the dust like solution is a late time attractor. The difficulties associated with reheating in the tachyonic model are also indicated.Comment: New References added. To appear in Phys. Rev.

Leading indicators of operational risk on the railway: A novel use for underutilised data recordings

Flight Data Monitoring (FDM) is the process by which data from on-board recorders, or so-called ‘black boxes’, is analysed after every journey to detect subtle trends which, if allowed to continue, would lead to an accident. An opportunity has been identified to advance the state of the art in FDM processes by coupling recorder data to established Human Factors methodologies so that issues arising from the strategically important human/machine-system interface can be better understood and diagnosed. The research has also identified a significantly underused source of recorder-data within the railway industry. Taking this data, the paper demonstrates how key areas of driver performance can be quantified using a simple behavioural cluster detection method coupled to sensitivity and response bias metrics. Faced with a class of operational accident that is increasingly human-centred, an underused source of data, and methods that can join it to established human performance concepts, the potential for detecting risks in advance of an accident are significant. This paper sets out to describe and demonstrate this potential

Predictors of Long‐term Adherence to Evidence‐based Cardiovascular Disease Medications in Outpatients With Stable Atherothrombotic Disease: Findings From the REACH Registry

Background Despite overall improvements in cardiovascular‐disease therapies and outcomes, medication nonadherence remains an important barrier to effective secondary prevention of atherothrombotic disease. Hypothesis Long‐term medication adherence in outpatients with stable atherothrombotic disease is impacted by demographic and clinical factors. Methods We examined data from the prospective international Reduction of Atherothrombosis for Continued Health ( REACH ) Registry. Analyses were derived from 25 737 patients with established atherothrombotic disease with complete adherence data at enrollment and at year 4. Adherence was defined as patients' self‐report of taking medications based on class I American College of Cardiology/American Heart Association guidelines for secondary prevention as defined, including antiplatelet agents, statins, and antihypertensive medications. Results Among patients with atherothrombotic disease, 12 500 (48.6%) were deemed adherent to guideline‐recommended medications. Adherent patients were younger, white, and had less polyvascular disease. Hispanic and East Asian patients were less likely to be adherent as compared with white patients (odds ratio [ OR ]: 0.72, 95% confidence interval [ CI ]: 0.59‐0.88; and OR : 0.67, 95% CI : 0.53‐0.83, respectively). Patients who had a nonfatal MI or underwent coronary angioplasty/stenting during follow‐up were more likely to be adherent compared with patients without these events ( OR : 1.73, 95% CI : 1.25‐2.38; and OR : 2.15, 95% CI : 1.72‐2.67, respectively). On the other hand, nonfatal stroke during follow‐up was inversely associated with adherence ( OR : 0.77, 95% CI : 0.61‐0.97). Conclusions Using a large international registry of outpatients with atherothrombotic disease, we found that age, region, race/ethnicity, and incident cardiovascular events were predictive of long‐term guideline adherence for secondary prevention, suggesting that certain patient groups may benefit from targeted interventions to improve adherence.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102180/1/clc22217.pd

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Natural Products from the Lithistida: A Review of the Literature since 2000

Lithistid sponges are known to produce a diverse array of compounds ranging from polyketides, cyclic and linear peptides, alkaloids, pigments, lipids, and sterols. A majority of these structurally complex compounds have very potent and interesting biological activities. It has been a decade since a thorough review has been published that summarizes the literature on the natural products reported from this amazing sponge order. This review provides an update on the current taxonomic classification of the Lithistida, describes structures and biological activities of 131 new natural products, and discusses highlights from the total syntheses of 16 compounds from marine sponges of the Order Lithistida providing a compilation of the literature since the last review published in 2002

The counseling african americans to control hypertension (caatch) trial: baseline demographic, clinical, psychosocial, and behavioral characteristics

<p>Abstract</p> <p>Background</p> <p>Effectiveness of combined physician and patient-level interventions for blood pressure (BP) control in low-income, hypertensive African Americans with multiple co-morbid conditions remains largely untested in community-based primary care practices. Demographic, clinical, psychosocial, and behavioral characteristics of participants in the Counseling African American to Control Hypertension (CAATCH) Trial are described. CAATCH evaluates the effectiveness of a multi-level, multi-component, evidence-based intervention compared with usual care (UC) in improving BP control among poorly controlled hypertensive African Americans who receive primary care in Community Health Centers (CHCs).</p> <p>Methods</p> <p>Participants included 1,039 hypertensive African Americans receiving care in 30 CHCs in the New York Metropolitan area. Baseline data on participant demographic, clinical (<it>e.g</it>., BP, anti-hypertensive medications), psychosocial (<it>e.g</it>., depression, medication adherence, self-efficacy), and behavioral (<it>e.g</it>., exercise, diet) characteristics were gathered through direct observation, chart review, and interview.</p> <p>Results</p> <p>The sample was primarily female (71.6%), middle-aged (mean age = 56.9 ± 12.1 years), high school educated (62.4%), low-income (72.4% reporting less than $20,000/year income), and received Medicaid (35.9%) or Medicare (12.6%). Mean systolic and diastolic BP were 150.7 ± 16.7 mm Hg and 91.0 ± 10.6 mm Hg, respectively. Participants were prescribed an average of 2.5 ± 1.9 antihypertensive medications; 54.8% were on a diuretic; 33.8% were on a beta blocker; 41.9% were on calcium channel blockers; 64.8% were on angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs). One-quarter (25.6%) of the sample had resistant hypertension; one-half (55.7%) reported medication non-adherence. Most (79.7%) reported one or more co-morbid medical conditions. The majority of the patients had a Charlson Co-morbidity score ≥ 2. Diabetes mellitus was common (35.8%), and moderate/severe depression was present in 16% of participants. Participants were sedentary (835.3 ± 1,644.2 Kcal burned per week), obese (59.7%), and had poor global physical health, poor eating habits, high health literacy, and good overall mental health.</p> <p>Conclusions</p> <p>A majority of patients in the CAATCH trial exhibited adverse lifestyle behaviors, and had significant medical and psychosocial barriers to adequate BP control. Trial outcomes will shed light on the effectiveness of evidence-based interventions for BP control when implemented in real-world medical settings that serve high numbers of low-income hypertensive African-Americans with multiple co-morbidity and significant barriers to behavior change.</p