Group based prenatal care in a low-and high risk population in the Netherlands: a study protocol for a stepped wedge cluster randomized controlled trial

Background. CenteringPregnancy (CP) is a multifaceted group based care-model integrated in routine prenatal care, combining health assessment, education, and support. CP has shown some positive results on perinatal outcomes. However, the effects are less obvious when limited to the results of randomized controlled trials: as there are few trials and there is a variation in reported outcomes. Furthermore, former research was mostly conducted in the United States of America and in specific (often high risk) populations. Our study aims to evaluate the effects of CP in the Netherlands in a general population of pregnant women (low and high risk). Furthermore we aim to explore the mechanisms leading to the eventual effects by measuring potential mediating factors. Design. We will perform a stepped wedge cluster randomized controlled trial, in a Western region in the Netherlands. Inclusion criteria are <24 weeks of gestation and able to communicate in Dutch (with assistance). Women in the control period will receive individual care, women in the intervention period (starting at the randomized time-point) will be offered the choice between individual care or CP. Primary outcomes are maternal and neonatal morbidity, retrieved from a national routine database. Secondary outcomes are health behavior, psychosocial outcomes, satisfaction, health care utilization and process outcomes, collected through self-administered questionnaires, group-evaluations and individual interviews. We will conduct intention-to-treat analyses. Also a per protocol analysis will be performed comparing the three subgroups: control group, CP-participants and non-CP-participants, using multilevel techniques to account for clustering effects. Discussion. This study contributes to the evidence regarding the effect of CP and gives a first indication of the effect and implementation of CP in both low and high-risk pregnancies in a high-income Western society other than the USA. Also, measuring factors that are hypothesized to mediate the effect of CP will enable to explain the mechanisms that lead to effects on maternal and neonatal outcomes. Trial registration. Dutch Trial Register, NTR4178, registered September 17th 2013

Quasi 1-dimensional photonic crystals as building block for compact integrated optical sensors

A quasi one-dimensional photonic crystal has been fabricated and the applicability of this kind of structure for optical sensing has been investigated by measuring the transmission spectra as a function of the cladding refractive index. The cladding index was varied using a liquid flow, of which the index was slowly varied over a small range. The shift with cladding index of the steep stop band edge provides a relatively sensitive detection mechanism in an extremely compact device

Exendin-4 analogs in insulinoma theranostics

Contains fulltext : 209104.pdf (publisher's version ) (Open Access)Insulinomas, neuroendocrine tumors arising from pancreatic beta cells, often show overexpression of the glucagon-like peptide-1 receptor. Therefore, imaging with glucagon-like peptide analog exendin-4 can be used for diagnosis and preoperative localization. This review presents an overview of the development and clinical implementation of exendin-based tracers for nuclear imaging, and the potential use of exendin-4 based tracers for optical imaging and therapeutic applications such as peptide receptor radionuclide therapy or targeted photodynamic therapy

A developmentally regulated chaperone complex for the endoplasmic reticulum of male haploid germ cells

Glycoprotein folding is mediated by lectin-like chaperones and protein disulfide isomerases (PDIs) in the endoplasmic reticulum (ER). Calnexin and the PDI homologue ERp57 work together to help fold nascent polypeptides with glycans located toward the N-terminus of a protein, whereas PDI and BiP may engage proteins that lack glycans or have sugars toward the C-terminus. In this study, we show that the PDI homologue PDILT is expressed exclusively in post-meiotic male germ cells, in contrast to the ubiquitous expression of many other PDI family members in the testis. PDILT is induced during puberty and represents the first example of a PDI family member under developmental control. We find that PDILT is not active as an oxido-reductase, but interacts with the model peptide -somatostatin and nonnative BPTI in vitro, indicative of chaperone activity. In vivo, PDILT forms a tissue-specific chaperone complex with the calnexin homologue calmegin. The identification of a redox-inactive chaperone partnership defines a new system of testis-specific protein folding with implications for male fertility

Biometfical genetic analysis of serum Cholesterol response and basal serum HDL cholesterol level in the rabbit

The inheritance of the susceptibility for dietary cholesterol (serum cholesterol response) and of basal serum HDL cholesterol level in the rabbit have been studied by measuring serum total cholesterol levels and HDL cholesterol levels in animalsfrom crosses between hyperresponding and hyporesponding inbred strains. The serum cholesterol response and basal serum HDL cholesterol levels of the resulting six populations (the two parental strains, Fl-hybrid, two baekerosses and F7)were subjected to a biomedical genetic analysis to determine the number of loci involved and the (narrow sense) heritability 0f the two traits. The study revealed that 30% of the individual variation of the serum cholesterol response is under geneticcontrol and that 10 to 16 loci may be involved. The heritability for basal serum HDL cholesterol levels was 50 to 80%, whereas two to five loci may be involved in regulating the basal serum HDL cholesterol level in rabbits

Rabbit serum esterase genotyping and relationship to serum cholesterol response and basal serum HDL cholesterol level

Previous studies have indicated that esterases might be involved in the serum cholesterol response in rabbits. The question addressed in this study is whether in rabbits esterase loci of Linkage Group VI (LG VI) are genetically linked withthe serum cholesterol response to dietary cholesterol or the basal serum HDL cholesterol level. For this purpose the Est-2 and Es-1 genotypes of rabbits in segregating populations derived from a cross between IIIVO/JU (hyporespender andhigh basal serum HDL cholesterol level) and AX/1U (hypettesponder and low basal serum HDL cholesterol level) rabbits were determined. The segregating populations were fed a cholesterol-rich diet for 35 days. Both the Est-2 and Es—1 alleles failed to cosegregate with the serum cholesterol response, whereas a highly significant cosegregation was found with the basal serum HDL cholesterol level. It is concluded that one or more genes of LG VI are regulating the basal serumHDL cholesterol level in rabbits

A Role for Health Communication in the Continuum of HIV Care, Treatment, and Prevention

Health communication has played a pivotal role in HIV prevention efforts since the beginning of the epidemic. The recent paradigm of combination prevention, which integrates behavioral, biomedical, and structural interventions, offers new opportunities for employing health communication approaches across the entire continuum of care. We describe key areas where health communication can significantly enhance HIV treatment, care, and prevention, presenting evidence from interventions that include health communication components. These interventions rely primarily on interpersonal communication, especially individual and group counseling, both within and beyond clinical settings to enhance the uptake of and continued engagement in care. Many successful interventions mobilize a network of trained community supporters or accompagnateurs, who provide education, counseling, psychosocial support, treatment supervision, and other pragmatic assistance across the care continuum. Community treatment supporters reduce the burden on overworked medical providers, engage a wider segment of the community, and offer a more sustainable model for supporting people living with HIV. Additionally, mobile technologies are increasingly seen as promising avenues for ongoing cost-effective communication throughout the treatment cascade. A broader range of communication approaches, traditionally employed in HIV prevention efforts, that address community and sociopolitical levels through mass media, school- or workplace-based education, and entertainment modalities may be useful to interventions seeking to address the full care continuum. Future interventions would benefit from development of a framework that maps appropriate communication theories and approaches onto each step of the care continuum to evaluate the efficacy of communication components on treatment outcomes

Microarrays as a diagnostic tool in prenatal screening strategies: ethical reflection

Obstetric