Lymphatic function is required prenatally for lung inflation at birth

Mammals must inflate their lungs and breathe within minutes of birth to survive. A key regulator of neonatal lung inflation is pulmonary surfactant, a lipoprotein complex which increases lung compliance by reducing alveolar surface tension (Morgan, 1971). Whether other developmental processes also alter lung mechanics in preparation for birth is unknown. We identify prenatal lymphatic function as an unexpected requirement for neonatal lung inflation and respiration. Mice lacking lymphatic vessels, due either to loss of the lymphangiogenic factor CCBE1 or VEGFR3 function, appear cyanotic and die shortly after birth due to failure of lung inflation. Failure of lung inflation is not due to reduced surfactant levels or altered development of the lung but is associated with an elevated wet/dry ratio consistent with edema. Embryonic studies reveal active lymphatic function in the late gestation lung, and significantly reduced total lung compliance in late gestation embryos that lack lymphatics. These findings reveal that lymphatic vascular function plays a previously unrecognized mechanical role in the developing lung that prepares it for inflation at birth. They explain respiratory failure in infants with congenital pulmonary lymphangiectasia, and suggest that inadequate late gestation lymphatic function may also contribute to respiratory failure in premature infants

The Vehicle, Fall 1984

Vol. 26, No. 1 Table of Contents Thoughts on I-57Jim Caldwellpage 3 A Night Between Lonely and BlindJennifer K. Soulepage 4 What is Unnatural is Sometimes MagicAngelique Jenningspage 4 Cutting ClosenessBecky Lawsonpage 5 PhotoBrian Ormistonpage 6 The Sensuality of Corn One Week in AugustMichelle Mitchellpage 7 American MusicJim Caldwellpage 7 Water is WaitingMichael Kuopage 8 WhereJennifer K. Soulepage 8 The Fishing HoleJan Kowalskipage 9 Miller\u27s PondSue Gradypage 9 PhotoCathy Stonerpage 11 Young Man Reading To His LoverMaggie Kennedypage 11 ShellsChristopher R. Albinpage 12 In The ShadeJohn Fehrmannpage 12 FallLynanne Feilenpage 13 IndecisionDave L. Brydenpage 13 Dark Falls SoftlyAngelique Jenningspage 14 Not a Parked \u2757 Chevy in the Summer in the CountryMichelle Mitchellpage 20 BirdAnnie Heisepage 20 Clouds Created Only For Poets And Certain WomenJennifer K. Soulepage 21 SandGraham Lewispage 22 PhotoFred Zwickypage 23 Judgment CallCathy Moepage 23 I was hip that night Dan Hintzpage 24 A Sight Of WindDan Von Holtenpage 25 Tillard Isabel M. Parrottpage 26 The WidowMaggie Kennedypage 27 The SeparationMichelle Mitchellpage 27 The Garden Hose TrialMaggie Kennedypage 28 InterruptionsJennifer K. Soulepage 28 On Happening Across Jesus While Cleaning the BasementMaggie Kennedypage 29 GileonMichelle Mitchellpage 30 If My Father Were A Writer, He Would Still BuildAngelique Jenningspage 36 A Visit to Grandpa Gib\u27s HouseTammy Veachpage 37 For Having SeenAngelique Jenningspage 38 PhotoJudy Klancicpage 39 The Earth in BlueSusan J. Bielskypage 39 Things I Could Have SaidAngelique Jenningspage 40 AcrosticsAnnie Heisepage 40https://thekeep.eiu.edu/vehicle/1044/thumbnail.jp

The Vehicle, Fall 1984

Vol. 26, No. 1 Table of Contents Thoughts on I-57Jim Caldwellpage 3 A Night Between Lonely and BlindJennifer K. Soulepage 4 What is Unnatural is Sometimes MagicAngelique Jenningspage 4 Cutting ClosenessBecky Lawsonpage 5 PhotoBrian Ormistonpage 6 The Sensuality of Corn One Week in AugustMichelle Mitchellpage 7 American MusicJim Caldwellpage 7 Water is WaitingMichael Kuopage 8 WhereJennifer K. Soulepage 8 The Fishing HoleJan Kowalskipage 9 Miller\u27s PondSue Gradypage 9 PhotoCathy Stonerpage 11 Young Man Reading To His LoverMaggie Kennedypage 11 ShellsChristopher R. Albinpage 12 In The ShadeJohn Fehrmannpage 12 FallLynanne Feilenpage 13 IndecisionDave L. Brydenpage 13 Dark Falls SoftlyAngelique Jenningspage 14 Not a Parked \u2757 Chevy in the Summer in the CountryMichelle Mitchellpage 20 BirdAnnie Heisepage 20 Clouds Created Only For Poets And Certain WomenJennifer K. Soulepage 21 SandGraham Lewispage 22 PhotoFred Zwickypage 23 Judgment CallCathy Moepage 23 I was hip that night Dan Hintzpage 24 A Sight Of WindDan Von Holtenpage 25 Tillard Isabel M. Parrottpage 26 The WidowMaggie Kennedypage 27 The SeparationMichelle Mitchellpage 27 The Garden Hose TrialMaggie Kennedypage 28 InterruptionsJennifer K. Soulepage 28 On Happening Across Jesus While Cleaning the BasementMaggie Kennedypage 29 GileonMichelle Mitchellpage 30 If My Father Were A Writer, He Would Still BuildAngelique Jenningspage 36 A Visit to Grandpa Gib\u27s HouseTammy Veachpage 37 For Having SeenAngelique Jenningspage 38 PhotoJudy Klancicpage 39 The Earth in BlueSusan J. Bielskypage 39 Things I Could Have SaidAngelique Jenningspage 40 AcrosticsAnnie Heisepage 40https://thekeep.eiu.edu/vehicle/1044/thumbnail.jp

Design and methods for a randomized clinical trial comparing three outreach efforts to improve screening mammography adherence

<p>Abstract</p> <p>Background</p> <p>Despite the demonstrated need to increase screening mammography utilization and strong evidence that mail and telephone outreach to women can increase screening, most managed care organizations have not adopted comprehensive outreach programs. The uncertainty about optimum strategies and cost effectiveness have retarded widespread acceptance. While 70% of women report getting a mammogram within the prior 2 years, repeat mammography rates are less than 50%. This 5-year study is conducted though a Central Massachusetts healthcare plan and affiliated clinic. All womenhave adequate health insurance to cover the test.</p> <p>Methods/Design</p> <p>This randomized study compares 3 arms: reminder letter alone; reminder letter plus reminder call; reminder letter plus a second reminder and booklet plus a counselor call. All calls provide women with the opportunity to schedule a mammogram in a reasonable time. The invention period will span 4 years and include repeat attempts. The counselor arm is designed to educate, motivate and counsel women in an effort to alleviate PCP burden.</p> <p>All women who have been in the healthcare plan for 24 months and who have a current primary care provider (PCP) and who are aged 51-84 are randomized to 1 of 3 arms. Interventions are limited to women who become ≥18 months from a prior mammogram. Women and their physicians may opt out of the intervention study.</p> <p>Measurement of completed mammograms will use plan billing records and clinic electronic records. The primary outcome is the proportion of women continuously enrolled for ≥24 months who have had ≥1 mammogram in the last 24 months. Secondary outcomes include the number of women who need repeat interventions. The cost effectiveness analysis will measure all costs from the provider perspective.</p> <p>Discussion</p> <p>So far, 18,509 women aged 51-84 have been enrolled into our tracking database and were randomized into one of three arms. At baseline, 5,223 women were eligible for an intervention. We anticipate that the outcome will provide firm data about the maximal effectiveness as well as the cost effectiveness of the interventions both for increasing the mammography rate and the repeat mammography rate.</p> <p>Trial registration</p> <p><url>http://clinicaltrials.gov/</url><a href="http://www.clinicaltrials.gov/ct2/show/NCT01332032">NCT01332032</a></p

Limitations of Conventional Magnetic Resonance Imaging as a Predictor of Death or Disability Following Neonatal Hypoxic-Ischemic Encephalopathy in the Late Hypothermia Trial

Objective: To investigate if magnetic resonance imaging (MRI) is an accurate predictor for death or moderate-severe disability at 18-22 months of age among infants with neonatal encephalopathy in a trial of cooling initiated at 6-24 hours. Study design: Subgroup analysis of infants ≥36 weeks of gestation with moderate-severe neonatal encephalopathy randomized at 6-24 postnatal hours to hypothermia or usual care in a multicenter trial of late hypothermia. MRI scans were performed per each center's practice and interpreted by 2 central readers using the Eunice Kennedy Shriver National Institute of Child Health and Human Development injury score (6 levels, normal to hemispheric devastation). Neurodevelopmental outcomes were assessed at 18-22 months of age. Results: Of 168 enrollees, 128 had an interpretable MRI and were seen in follow-up (n = 119) or died (n = 9). MRI findings were predominantly acute injury and did not differ by cooling treatment. At 18-22 months, death or severe disability occurred in 20.3%. No infant had moderate disability. Agreement between central readers was moderate (weighted kappa 0.56, 95% CI 0.45-0.67). The adjusted odds of death or severe disability increased 3.7-fold (95% CI 1.8-7.9) for each increment of injury score. The area under the curve for severe MRI patterns to predict death or severe disability was 0.77 and the positive and negative predictive values were 36% and 100%, respectively. Conclusions: MRI injury scores were associated with neurodevelopmental outcome at 18-22 months among infants in the Late Hypothermia Trial. However, the results suggest caution when using qualitative interpretations of MRI images to provide prognostic information to families following perinatal hypoxia-ischemia

Impact of Optimized Breastfeeding on the Costs of Necrotizing Enterocolitis in Extremely Low Birthweight Infants

To estimate risk of NEC for ELBW infants as a function of preterm formula and maternal milk (MM) intake and calculate the impact of suboptimal feeding on NEC incidence and costs

Discutindo a educação ambiental no cotidiano escolar: desenvolvimento de projetos na escola formação inicial e continuada de professores

A presente pesquisa buscou discutir como a Educação Ambiental (EA) vem sendo trabalhada, no Ensino Fundamental e como os docentes desta escola compreendem e vem inserindo a EA no cotidiano escolar., em uma escola estadual do município de Tangará da Serra/MT, Brasil. Para tanto, realizou-se entrevistas com os professores que fazem parte de um projeto interdisciplinar de EA na escola pesquisada. Verificou-se que o projeto da escola não vem conseguindo alcançar os objetivos propostos por: desconhecimento do mesmo, pelos professores; formação deficiente dos professores, não entendimento da EA como processo de ensino-aprendizagem, falta de recursos didáticos, planejamento inadequado das atividades. A partir dessa constatação, procurou-se debater a impossibilidade de tratar do tema fora do trabalho interdisciplinar, bem como, e principalmente, a importância de um estudo mais aprofundado de EA, vinculando teoria e prática, tanto na formação docente, como em projetos escolares, a fim de fugir do tradicional vínculo “EA e ecologia, lixo e horta”.Facultad de Humanidades y Ciencias de la Educació