Women’s use of Preventive Primary Care in the Late Postpartum Period

The literature has limited data on how women access health care after the traditional postpartum period (postpartum). Modeled after a paper by Bryant (2016), this project assesses the prevalence of primary care visits in the late postpartum period (LPP)(60- 730 days postpartum). Study objectives included (1) Identify demographics of general delivering population at UVMMC compared to patients with UVM-affiliated primary care provider (UVMPCP). (2) Understand how the general delivering population uses the UVMHN LPP (3) Among women with a UVM-affiliated PCP, identify the prevalence of preventive care visits in the LPP. (4) Identify characteristics associated with LPP visit attendance. Hypothesis: Women with an established PCP prior to pregnancy are more likely to attend preventive PCP LPP visits. This was a retrospective cohort study for all women who delivered at UVMMC between 7/1/2015-6/30/2017. Data was extracted from Epic EMR. During the study period, 4169 women had one singleton pregnancy, 3413 (82%) had a known PCP, and 1279 (31%) had UVMPCP. 2535 (61%) of all delivering singleton women and 1112 (87%) of UVMPCP women had at least one clinical visit within UVMHN in the LPP. 959 (75%) of UVMPCP women had a LPP PCP visit, and 382 patients (30%) had preventative PCP LPP visits. Our hypothesis was rejected (OR 0.930), but attending any LPP PCP visit was associated with having a PCP established prior to pregnancy (OR 1.684). Attending preventive PCP visit was associated with having the same delivering provider as PCP (OR 1.742), a pre-pregnancy PCP visit (OR 1.460), a PCP visit during prenatal time (OR 1.459), ED visit early postpartum period (OR 0.402), a fetal or neonatal demise (OR 0.445), being single (0.601), and with public insurance (OR 0.489). Further work in understanding these associations will be important in developing improved transition of care models and increasing overall engagement in women’s preventive medicine

Neurodevelopmental outcomes in individuals with fetal alcohol spectrum disorder (FASD) with and without exposure to neglect : clinical cohort data from a national FASD diagnostic clinic

Disentangling the relative developmental impact of prenatal alcohol exposure from postnatal neglect is clinically valuable for informing future service provision. In this study developmental outcomes across groups are compared in a ‘natural experiment’. Methods: Clinical data from 99 persons with fetal alcohol spectrum disorder (FASD) diagnoses were audited. Developmental outcomes (diagnosis of attention deficit hyperactivity disorder, ADHD; social and communication disorder, SCD; or autism spectrum disorder, ASD; Short Sensory Profile, SSP; Vineland II Adaptive Behaviour Scales) were compared across two exposure groups: prenatal alcohol only; and mixed prenatal alcohol and neglect. Results: ADHD (74%) and ASD/SCD (68%) were common, with no significant difference between groups (ADHD, P=0.924; ASD, P=0.742). Vineland age equivalence scores were lower than chronological age (11.1y—prenatal alcohol only—and 12.7y—neglect) across all domains, especially receptive language (3.7y for both groups). Age equivalence did not differ between groups, with the exception of domestic daily living (neglect: 7.7y vs prenatal alcohol only: 5.8y, P=0.027). A probable/definite difference on SSP was more common in the prenatal alcohol only (96% vs 67%, P=0.006). For the individual subscales of SSP, there were no significant differences by neglect category. Discussion: Postnatal neglect in this group did not make the developmental outcome any worse, suggesting that prenatal alcohol influences these outcomes independently. Professionals who support families looking after a child with both FASD and a history of neglect should be aware that the behavioural difficulties are likely to be related to prenatal alcohol exposure and not necessarily reflective of parenting quality

Purification of matrix Gla protein from a marine teleost fish, Argyrosomus regius: Calcified cartilage and not bone as the primary site of MGP accumulation in fish

Matrix Gla protein (MGP) belongs to the family of vitamin K-dependent, Gla-containing proteins, and in mammals, birds, and Xenopus, its mRNA was previously detected in extracts of bone, cartilage, and soft tissues (mainly heart and kidney), whereas the protein was found to accumulate mainly in bone. However, at that time, it was not evaluated if this accumulation originated from protein synthesized in cartilage or in bone cells because both coexist in skeletal structures of higher vertebrates and Xenopus. Later reports showed that MGP also accumulated in costal calcified cartilage as well as at sites of heart valves and arterial calcification. Interestingly, MGP was also found to accumulate in vertebra of shark, a cartilaginous fish. However, to date, no information is available on sites of MGP expression or accumulation in teleost fishes, the ancestors of terrestrial vertebrates, who have in their skeleton mineralized structures with both bone and calcified cartilage. To analyze MGP structure and function in bony fish, MGP was acid-extracted from the mineralized matrix of either bone tissue (vertebra) or calcified cartilage (branchial arches) from the bony fish, Argyrosomus regius,(1) separated from the mineral phase by dialysis, and purified by Sephacryl S-100 chromatography. No MGP was recovered from bone tissue, whereas a protein peak corresponding to the MGP position in this type of gel filtration was obtained from an extract of branchial arches, rich in calcified cartilage. MGP was identified by N-terminal amino acid sequence analysis, and the resulting protein sequence was used to design specific oligonucleotides suitable to amplify the corresponding DNA by a mixture of reverse transcription-polymerase chain reaction (RT-PCR) and 5'rapid amplification of cDNA (RACE)-PCR. In parallel, ArBGP (bone Gla protein, osteocalcin) was also identified in the same fish, and its complementary DNA cloned by an identical procedure. Tissue distribution/accumulation was analyzed by Northern blot, in situ hybridization, and immunohistochemistry. In mineralized tissues, the MGP gene was predominantly expressed in cartilage from branchial arches, with no expression detected in the different types of bone analyzed, whereas BGP mRNA was located in bone tissue as expected. Accordingly, the MGP protein was found to accumulate, by immunohistochemical analysis, mainly in the extracellular matrix of calcified cartilage. In soft tissues, MGP mRNA was mainly expressed in heart but in situ hybridization, indicated that cells expressing the MGP gene were located in the bulbus arteriosus and aortic wall, rich in smooth muscle and endothelial cells, whereas no expression was detected in the striated muscle myocardial fibers of the ventricle. These results show that in marine teleost fish, as in mammals, the MGP gene is expressed in cartilage, heart, and kidney tissues, but in contrast with results obtained in Xenopus and higher vertebrates, the protein does not accumulate in vertebra of non-osteocytic teleost fish, but only in calcified cartilage. In addition, our results also indicate that the presence of MGP mRNA in heart tissue is due, at least in fish, to the expression of the MGP gene in only two specific cell types, smooth muscle and endothelial cells, whereas no expression was found in the striated muscle fibers of the ventricle. In light of these results and recent information on expression of MGP gene in these same cell types in mammalian aorta, it is likely that the levels of MGP mRNA previously detected in Xenopus, birds, and mammalian heart tissue may be restricted toregions rich in smoot Our results also emphasize the need to re-evaluate which cell types are involved in MGP gene expression in other soft tissues and bring further evidence that fish are a valuable model system to study MGP gene expression and regulation.NIAMS NIH HHS [AR25921]info:eu-repo/semantics/publishedVersio

Coupling of marine and continental oxygen isotope records during the Eocene-Oligocene transition

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148587/1/Sheldon_et_al_2016_GSA_Bulletin-EOT_marine-terrestrial_comparison.pd

The BaSICS (Baby Skin Integrity Comparison Survey) study : a prospective experimental study using maternal observations to report the effect of baby wipes on the incidence of irritant diaper dermatitis in infants, from birth to eight weeks of age

Background Baby wipes have been shown to be safe and effective in maintaining skin integrity when compared to the use of water alone. However, no previous study has compared different formulations of wipe. The aim of the BaSICS study was to identify any differences in incidence of irritant diaper dermatitis (IDD) in infants assigned to three different brands of wipe, all marketed as suitable for neonates, but which contained varying numbers of ingredients. Methods Women were recruited during the prenatal period. Participants were randomly assigned to receive one of three brands of wipe for use during the first eight weeks following childbirth. All participants received the same nappies. Participants reported their infant’s skin integrity on a scale of 1 to 5 daily using a bespoke smartphone application. Analysis of effect of brand on clinically significant IDD (score 3 or more) incidence was conducted using a negative binomial generalised linear model, controlling for possible confounders at baseline. Analysts were blind to brand of wipe. Results Of 737 women enrolled, 15 were excluded (admitted to neonatal intensive care, premature or other infant health issues). Of the 722 eligible babies, 698 (97%) remained in the study for the full 8-week duration, 24.6% of whom had IDD at some point during the study. Mothers using the brand with the fewest ingredients reported fewer days of clinically significant nappy rash (score≥3) than participants using the two other brands (p=0.002 and p<0.001). Severe IDD (grades 4 and 5) was rare (2.4%). Conclusions Rarity of severe IDD suggested that sensitive formula baby wipes are safe when used in cleansing babies from birth to eight weeks during nappy changes. The brand with fewest ingredients had significantly fewer days of clinically significant IDD. Daily observations recorded on a smartphone application proved to be a highly acceptable method of obtaining real-time data on IDD

How doctors diagnose diseases and prescribe treatments: an fMRI study of diagnostic salience

Understanding the brain mechanisms involved in diagnostic reasoning may contribute to the development of methods that reduce errors in medical practice. In this study we identified similar brain systems for diagnosing diseases, prescribing treatments, and naming animals and objects using written information as stimuli. Employing time resolved modeling of blood oxygen level dependent (BOLD) responses enabled time resolved (400 milliseconds epochs) analyses. With this approach it was possible to study neural processes during successive stages of decision making. Our results showed that highly diagnostic information, reducing uncertainty about the diagnosis, decreased monitoring activity in the frontoparietal attentional network and may contribute to premature diagnostic closure, an important cause of diagnostic errors. We observed an unexpected and remarkable switch of BOLD activity within a right lateralized set of brain regions related to awareness and auditory monitoring at the point of responding. We propose that this neurophysiological response is the neural substrate of awareness of one’s own (verbal) response. Our results highlight the intimate relation between attentional mechanisms, uncertainty, and decision making and may assist the advance of approaches to prevent premature diagnostic closure

The LSST DESC data challenge 1: Generation and analysis of synthetic images for next-generation surveys

Data Challenge 1 (DC1) is the first synthetic data set produced by the Rubin Observatory Legacy Survey of Space and Time (LSST) Dark Energy Science Collaboration (DESC). DC1 is designed to develop and validate data reduction and analysis and to study the impact of systematic effects that will affect the LSST data set. DC1 is comprised of r-band observations of 40 deg2 to 10 yr LSST depth. We present each stage of the simulation and analysis process: (a) generation, by synthesizing sources from cosmological N-body simulations in individual sensor-visit images with different observing conditions; (b) reduction using a development version of the LSST Science Pipelines; and (c) matching to the input cosmological catalogue for validation and testing. We verify that testable LSST requirements pass within the fidelity of DC1. We establish a selection procedure that produces a sufficiently clean extragalactic sample for clustering analyses and we discuss residual sample contamination, including contributions from inefficiency in star-galaxy separation and imperfect deblending. We compute the galaxy power spectrum on the simulated field and conclude that: (i) survey properties have an impact of 50 per cent of the statistical uncertainty for the scales and models used in DC1; (ii) a selection to eliminate artefacts in the catalogues is necessary to avoid biases in the measured clustering; and (iii) the presence of bright objects has a significant impact (2-6) in the estimated power spectra at small scales (&gt; 1200), highlighting the impact of blending in studies at small angular scales in LSST

Association of Osteocalcin and Abdominal Aortic Calcification in Older Women: The Study of Osteoporotic Fractures

Osteocalcin (OC) is produced by osteoblasts and vascular smooth muscle cells. In animal models, serum OC levels are strongly correlated with vascular calcium content, however, the association of OC with vascular calcification in humans is uncertain. The Study of Osteoporotic Fractures (SOF) enrolled community-living women, age ≥65 years. The present study included a subsample of 363 randomly selected SOF participants. Serum total OC was measured by ELISA, and abdominal aortic calcification (AAC) was evaluated on lateral lumbar radiographs. We examined the cross-sectional association between serum OC and AAC. The mean serum OC level was 24 ± 11 ng/ml and AAC was present in 188 subjects (52%). We observed no association of OC and AAC in either unadjusted or adjusted analyses. For example, each standard deviation higher OC level was associated with an odds ratio (OR) for AAC prevalence (AAC score >0) near unity (OR = 1.06; 95% CI, 0.82–1.36) in models adjusted for CVD risk factors. Further adjustment for intact parathyroid hormone, bone-specific alkaline phosphatase, 25-hydroxyvitamin D, and hip and spine bone mineral density did not materially change the results (OR = 1.22; 95% CI, 0.86–1.75). Similarly, higher OC levels were not associated with severity of AAC (P = 0.87). In conclusion, among community-living older women, serum OC is not associated with AAC. These findings suggest that serum OC levels may more closely reflect bone formation than vascular calcification in humans

Part 2 : a qualitative description of participation in an eight-week infant skin integrity study

Background This is the second paper in a two-part series; the first paper was published in volume 29, issue 4 of the British Journal of Midwifery. The qualitative phase of the Baby Skin Integrity Comparison Survey (BaSICS) study was designed to address a dearth of information about research recruitment and retention, and how mothers make decisions about neonatal skincare. Aims The aim of the qualitative phase of the BaSICS study was to explore participants’ experience of participating in the research and how this interrelated with the experience of newborn skincare. Methods Semi-structured, face-to-face or telephone interviews were used to collect data. Interviews were transcribed verbatim. Data analysis used both software and manual methods. Findings Motivation included both altruism and personal benefits. The bespoke smartphone application was a convenient and easy tool for data collection, and being afforded full responsibility for observing and recording infant skin condition increased mothers' awareness of skin changes. Family, friends and the internet were the most commonly used sources of information about baby skincare. Conclusion The qualitative interview component of the BaSICS study provided information that could not have been deduced from the daily survey and final questionnaire alone. This provides valuable guidance for future research in the field of infant skincare