The Status of Iowa Sleep-Related Infant Mortality: An Evaluation of Safe Sleep Education Delivery, Policy, and Practice in Birthing Hospitals

142 pagesProblem: Sleep-related infant mortality, including sudden infant death syndrome, asphyxia, and undetermined or unknown causes, is the third leading cause of death nationally and in Iowa (Harris, 2014; Malloy & Ramirez, 2013). Evidence exists for increasing rates of bed sharing, a major risk factor for sleep-related mortality (Kemp et al., 2000). Preventive messaging is most widely and effectively delivered by health professionals at time of birth (Shaefer, Herman, Frank, Adkins, & Tehaar, 2010). The intent of this study was to provide a characterization of infant, maternal, and environmental factors contributing to sleep-related infant mortality and a comprehensive review of safe sleep education policy and practices in Iowa birthing hospitals. Procedures: An experimental, cross-sectional study design was used to analyze infant mortality data reported by the Iowa Office of the State Medical Examiner to the Child Death Reporting system from 2004-2012. Analyses included mortality trends for sleep-related mortality parsed by Sudden Infant Death (SIDS), asphyxia, and undetermined or unknown cause, descriptive statistics for maternal and infant demographic factors, and correlations for environmental factors potentially contributing to sleep-related death. An adjacent effort with Iowa birthing hospitals involved use of a web-based survey to assess policies, parent education programs, clinical practice, and training related to safe infant sleep or SIDS. The survey was directed toward obstetric unit coordinators with content drawn from previous efforts to ascertain clinical practice. Findings: Sleep-related mortality in Iowa has been steadily increasing since 2004. Subcategorical examination of this trend revealed rises in SIDS and undetermined or unknown cases, but a stable rate of deaths due to asphyxia. These infants (n=384) were more often males (58.6%), lived an average age of 102 days, were living with multiple children at time of death, and had a young mother. An alarming 42% of infants were bed sharing at time of death, with only 43% placed on their back to sleep prior to the event. Significant racial disparities were present. Non-white infants were more likely to have died while bed sharing compared to white infants, Pearson χ2(1, n=151)=6.7, p=0.01, and non-white infants were also more likely to usually sleep someplace other than a crib, Pearson χ2(2, n=151)=5.05, p=0.025. The hospital survey (N=42) revealed that three-quarters have policies addressing SIDS or safe sleep education. Of those with policies, topics covered included sleep positioning, surface, bed sharing, and the infant’s sleep environment. Respondents indicated nearly uniform demonstration of supine sleep, though some cited fear of aspiration, as a reason supine sleep might not be used. Less than half of hospitals require clinical staff to complete safe sleep education training. Unit coordinators rated their SIDS or safe infant sleep programs an average strength of 7.66 out of 10. Conclusions: Sleep-related mortality incidence in Iowa is increasing and state-specific risk factors exist. Racial disparities in sleep environment practice are of particular concern. Hospital policy addressing safe infant sleep is not universal. Consistent demonstration of supine sleep may be inhibited by concerns over aspiration. Training opportunities could be improved as access to programs external to the hospital setting and online are not fully utilized. Recommendations: Greater awareness of the risk factors associated with sleep-related infant mortality is needed among parents and caregivers of infants. Expansion or strengthening of existing hospital-based education programs may improve protective parental actions. The Health Belief Model may be an important tool in examining why parents are not be universally adhering to guidance against bed sharing

A novel mode of capping protein-regulation by Twinfilin

Cellular actin assembly is controlled at the barbed ends of actin filaments, where capping protein (CP) limits polymerization. Twinfilin is a conserved in vivo binding partner of CP, yet the significance of this interaction has remained a mystery. Here, we discover that the C-terminal tail of Twinfilin harbors a CP-interacting (CPI) motif, identifying it as a novel CPI-motif protein. Twinfilin and the CPI-motif protein CARMIL have overlapping binding sites on CP. Further, Twinfilin binds competitively with CARMIL to CP, protecting CP from barbed-end displacement by CARMIL. Twinfilin also accelerates dissociation of the CP inhibitor V-1, restoring CP to an active capping state. Knockdowns of Twinfilin and CP each cause similar defects in cell morphology, and elevated Twinfilin expression rescues defects caused by CARMIL hyperactivity. Together, these observations define Twinfilin as the first \u27pro-capping\u27 ligand of CP and lead us to propose important revisions to our understanding of the CP regulatory cycle

Dicarbonyl­dichloridobis(trimethyl­phosphane)iron(II)–carbonyl­dichlorido­tris(trimethyl­phosphane)iron(II)–tetra­hydro­furan (1/1/2)

The asymmetric unit of the title crystal, [FeCl2(C3H9P)3(CO)]·[FeCl2(C3H9P)2(CO)2]·2C4H8O, contains half mol­ecules of the two closely related FeII complexes lying on mirror planes and a tetra­hydro­furan solvent mol­ecule, one C atom of which is disordered over two sets of sites with site occupancy factors 0.633 (9) and 0.367 (9). In both FeII complex mol­ecules, a distorted octa­hedral coordination geometry has been observed around the Fe atoms. Weak intermolecular C—H⋯O inter­actions are observed in the crystal structure

Strategies to Recruit and Retain College Smokers in Cessation Trials

Techniques to recruit and retain college fraternity and sorority members who reported past 30-day smoking into a cessation trial are described. Recruitment efforts included relationship-building, raffles, and screening survey administration during existing meetings. Surveys were administered to 76% (n = 3,276) of members in 30 chapters, 79% of eligible members agreed to participate, and 76% of those completed assessments and were enrolled in the trial (n = 452). The retention rate was 73%. Retention efforts included cash incentives, flexible scheduling, multiple reminders, chapter incentives, and use of chapter members as study personnel. Retention was not related to demographic, behavioral, or group characteristics. The strategies of partnership, convenience, and flexibility appear effective and may prove useful to investigators recruiting similar samples

Subducted lithospheric boundary tomographically imaged beneath the arc-continent collision in eastern Indonesia

We use travel‐times from a temporary seismic deployment of 30 broadband seismometers and a national catalog of arrival times to construct a finite frequency teleseismic P‐wave tomographic model of the upper mantle beneath eastern Indonesia, where subduction of the Indo‐Australian plate beneath the Banda Arc transitions to arc‐continent collision. The change in tectonics is due to a change from oceanic to continental lithosphere in the lower plate as inferred from geologic mapping and geophysical, geochemical, and geodetic measurements. At this inferred transition, we seismically image the subducted continent‐ocean boundary at upper mantle depths that links volcanism on Flores to amagmatic orogenesis on Timor. Our tomographic images reveal a relatively high velocity feature within the upper mantle, which we interpret as the subducted Indo‐Australian slab. The slab appears continuous yet deformed as a result of the change in buoyancy due to the composition of the incoming continental lithosphere. Accordingly, there is a difference in dip angle between the oceanic and continental sections of the slab albeit not a gap or discontinuity. We suggest the slab has deformed without tearing to accommodate structural and kinematic changes across the continent‐ocean boundary as the two sections of the slab diverge. These results suggest that deformation in tectonic collisions can be localized along a continent‐ocean boundary, even at depth. We propose that future slab tearing may develop where we observe slab deformation in our study region and that a similar process may take place in collisions generally.This work was funded by the National Science Foundation (NSF) Grant EAR‐1250214 as well as DIKTI Grant 127/SP2H/ PTNBH/DRPM/2018

Testing Longitudinal Relationships Between Binge Drinking, Marijuana Use, and Depressive Symptoms and Moderation by Sex

Both substance use and depression are common in adolescence and often comorbid. Past research has produced conflicting results on whether there is a temporal relationship and if so, in which direction it operates and how it may vary by sex. We examined the longitudinal associations between substance use frequency and depressive symptoms from adolescence into young adulthood, and whether the associations were moderated by sex

Inverse Kinematic Assessment of Rehabilitative Therapy in Children Using Orthotics

Pathologic movement patterns are characterized by abnormal kinematics that alter how muscles support the body during walking. Individual muscles are often the target of interventions with physical therapy and surgery alike, yet the tools to assess individual muscles clinically remain limited. The aim of this study is to assess OpenSim as a clinical tool for individualized rehabilitative evaluation of children using orthotics. This anatomic and kinematic modeling study was focused on pre- and post-treatment assessment of gait characteristics in fourteen children using orthotic devices. A range of four to twelve acceptable gait capture trials was collected for each child before therapy began and again after four weeks of treatment. The effects of therapy were significant in four of the lower extremity muscle analyses, three of the temporal parameters, and eighteen of the spatial parameters. All muscle lengths showed less deviation from normal values after physical therapy across all subjects. Results of this study support the further evaluation of OpenSim as a tool to improve quantitative assessment of musculoskeletal dynamics during the course of rehabilitative therapy in children using orthotics

Donated Records Partnership Project-The Collection Match

Presentation titled, "Donated Records Partnership Project -- The Collection Match" given by Dawn Sherman-Fells, Meghan Ryan Guthorn, William Casari, Beth Harris, and Laura Poll at the MARAC Spring 2014 conference, S4 - April 25, 2014, Rochester, N

The effects of high dose interferon-β1a on plasma microparticles: Correlation with MRI parameters

<p>Abstract</p> <p>Objectives</p> <p>We previously reported a correlation between levels of microparticles carrying CD31 (PMP ^CD31+) and disease activity in MS. However, the effects of long term (12 month) treatment with high dose, high frequency interferon-β1a (Rebif™) on plasma levels of PMP^CD31+, PMP^CD146+, and PMP^CD54+and MRI measures of disease activity have not yet been assessed.</p> <p>Methods</p> <p>During this prospective 1-year study, we used flow cytometry to measure changes in plasma microparticles (PMP) bearing CD31 (PMP^CD31+), CD146 (PMP^CD146+), and CD54/ICAM-1 (PMP^CD54+) in 16 consecutive patients with relapsing-remitting MS (RRMS) before and after 3, 6, and 12 months of subcutaneous therapy with interferon-beta1a (44 micrograms, 3X weekly). At each visit, clinical exams and expanded disability status scale (EDSS) scores were recorded.</p> <p>Results</p> <p>Plasma levels of PMP^CD31+, and PMP^CD54+were significantly reduced by treatment with IFN-β1a. PMP^CD146+appeared to decrease only at 3 months and did not persist at 6 and 12 months (p = 0.0511). In addition, the decrease in plasma levels of PMP^CD31+and PMP^CD54+levels at 12 months were associated with a significant decrease in the number and volume of contrast enhancing T1-weigthed lesions.</p> <p>Conclusion</p> <p>Our data suggest that serial measurement of plasma microparticles (PMP), particularly in the initial stages of MS (when neuro-inflammatory cascades are more intense), may serve as reliable and reproducible surrogate markers of response to IFN-β1a therapy for MS. In addition, the progressive decline in plasma levels of PMP^CD31+and PMP^CD54+further supports the concept that IFN-β1a exerts stabilizing effect on the cerebral endothelial cells during pathogenesis of MS.</p