Pregnancy-Related Hypertension in North Dakota: Incidence, Outcomes, and Nursing Care Practices

Preeclampsia and pregnancy-induced hypertension complicate 6 to 7% of all pregnancies in the United States with the incidence varying among different regions, counties, and states. For improved perinatal outcomes in high-risk pregnancies there must be adequate care given in a timely and appropriate manner. Very little has been written on the incidence and trends in rural America and even less is known about incidence and trends in the rural Native American population. It is unknown how effective small rural hospitals are in the nursing care of the hypertensive pregnant women they encounter. This project was an epidemiological retrospective cohort study of pregnancy- related hypertension (PRH) which also included a descriptive analysis of nursing care practices for hypertensive pregnant women in North Dakota hospitals. It encompassed all births to North Dakota residents from 1989 through 1997 who were Caucasian and Native American. The epidemiological data was extracted from the North Dakota Health Department birth records. A survey was sent to all North Dakota hospitals offering delivery services to obtain data on nursing care practices. Of the 87,737 births analyzed, the overall incidence of PRH was 3.8%, lower than the national average. The Caucasian population with an overall incidence of 3.8% is slightly more at risk than the Native American population, with overall incidence of 3.6%. Plurality of births posed the greatest relative risk with 1995 showing a high of 3.34, with a 95% confidence interval of (2.40, 4.64). The relative risk for infants of hypertensive pregnancies to be of low birth weight ranged from 2.51 to 4.13, and prematurity of gestation was also a great risk at 3.09. Consistently throughout the nine years smoking was a protective factor against preeclampsia. The risk of having PRH and a low birth weight infant were higher in the nonsmoking groups than the smoking groups. Maternal outcomes include an increased risk of being transferred to a referral hospital and delivery by cesarean section. The survey of nursing care practices revealed that the hypertensive pregnant woman is being effectively cared for, overall, and appropriately transferred when necessary. The greatest concerns expressed by nursing staff in caring for mothers with PRH are lack of experience and fears of inability to handle seizures and other emergency situations. There is a great need for providing education to nurses in these small rural communities. Astute nursing surveillance is essential during the antepartum and intrapartum periods to mitigate the effects of PRH and decrease perinatal morbidity and mortality. Future studies need to focus on the paradoxical effects of smoking and pregnancy, and what makes it protective for preeclampsia. Nursing research is needed on the effectiveness of activity restriction with preeclampsia, and whether controlling the environment actually makes a difference in illness experiences and the outcomes for mothers and infants

Evaluation of a Group Administered 24-Hour Recall Method for Dietary Assessment

A group administered 24-hour food recall was developed by the Expanded Food and Nutrition Education Program of Texas to expedite dietary assessment of clients. The study reported here evaluated the group recall and an individual recall method. Data for one meal collected with the use of dietary recalls, either group of individual, were compared to observational data. Results suggest that the group recall may be at least as effective as the individual recall to estimate dietary intakes of subjects. The group recall method could be used by programs such as EFNEP to simplify and expedite dietary assessment of clients

The effect of a miscarriage patient's age and parity status on nurses' emotional care

Three hundred nine obstetrical nurses participated in an experimental study to investigate the effects of situational variables on nurses' emotional care. Two independent variables, woman's age and parity status, were tested. Three levels of woman's age and three levels of parity status were combined in 9 vignettes representing a typical, yet fictional clinical situation of miscarriage. The vignettes were randomly presented to the subjects for their consideration. A 14-item questionnaire was developed to measure components of emotional care for miscarriage patients. Each item was measured on a 7-point rating scale. A factor analysis of the questionnaire revealed three interpretable factors which became the three dependent variables. The dependent variables were (a) the emotional seriousness of the miscarriage, (b) the priority of care, and (c) the need for emotional support

Spatiotemporal regulation of liver development by the Wnt/β- catenin pathway

While the Wnt/β-catenin pathway plays a critical role in the maintenance of the zonation of ammonia metabolizing enzymes in the adult liver, the mechanisms responsible for inducing zonation in the embryo are not well understood. Herein we address the spatiotemporal role of the Wnt/β-catenin pathway in the development of zonation in embryonic mouse liver by conditional deletion of Apc and β-catenin at different stages of mouse liver development. In normal development, the ammonia metabolising enzymes carbamoylphosphate synthetase I (CPSI) and Glutamine synthetase (GS) begin to be expressed in separate hepatoblasts from E13.5 and E15.5 respectively and gradually increase in number thereafter. Restriction of GS expression occurs at E18 and becomes increasingly limited to the terminal perivenous hepatocytes postnatally. Expression of nuclear β-catenin coincides with the restriction of GS expression to the terminal perivenous hepatocytes. Conditional loss of Apc resulted in the expression of nuclear β-catenin throughout the developing liver and increased number of cells expressing GS. Conversely, conditional loss of β-catenin resulted in loss of GS expression. These data suggest that the Wnt pathway is critical to the development of zonation as well as maintaining the zonation in the adult liver

A Phase 1 study of intravenous infusions of tigecycline in patients with acute myeloid leukemia.

Acute myeloid leukemia (AML) cells meet the higher energy, metabolic, and signaling demands of the cell by increasing mitochondrial biogenesis and mitochondrial protein translation. Blocking mitochondrial protein synthesis through genetic and chemical approaches kills human AML cells at all stages of development in vitro and in vivo. Tigecycline is an antimicrobial that we found inhibits mitochondrial protein synthesis in AML cells. Therefore, we conducted a phase 1 dose-escalation study of tigecycline administered intravenously daily 5 of 7 days for 2 weeks to patients with AML. A total of 27 adult patients with relapsed and refractory AML were enrolled in this study with 42 cycles being administered over seven dose levels (50-350 mg/day). Two patients experienced DLTs related to tigecycline at the 350 mg/day level resulting in a maximal tolerated dose of tigecycline of 300 mg as a once daily infusion. Pharmacokinetic experiments showed that tigecycline had a markedly shorter half-life in these patients than reported for noncancer patients. No significant pharmacodynamic changes or clinical responses were observed. Thus, we have defined the safety of once daily tigecycline in patients with refractory AML. Future studies should focus on schedules of the drug that permit more sustained target inhibition

Next Gen NEAR: Near Earth Asteroid Human Robotic Precursor Mission Concept

Asteroids have long held the attention of the planetary science community. In particular, asteroids that evolve into orbits near that of Earth, called near-Earth objects (NEO), are of high interest as potential targets for exploration due to the relative ease (in terms of delta V) to reach them. NASA's Flexible Path calls for missions and experiments to be conducted as intermediate steps towards the eventual goal of human exploration of Mars; piloted missions to NEOs are such example. A human NEO mission is a valuable exploratory step beyond the Earth-Moon system enhancing capabilities that surpass our current experience, while also developing infrastructure for future mars exploration capabilities. To prepare for a human rendezvous with an NEO, NASA is interested in pursuing a responsible program of robotic NEO precursor missions. Next Gen NEAR is such a mission, building on the NEAR Shoemaker mission experience at the JHU/APL Space Department, to provide an affordable, low risk solution with quick data return. Next Gen NEAR proposes to make measurements needed for human exploration to asteroids: to demonstrate proximity operations, to quantify hazards for human exploration and to characterize an environment at a near-Earth asteroid representative of those that may be future human destinations. The Johns Hopkins University Applied Physics Laboratory has demonstrated exploration-driven mission feasibility by developing a versatile spacecraft design concept using conventional technologies that satisfies a set of science, exploration and mission objectives defined by a concept development team in the summer of 2010. We will describe the mission concept and spacecraft architecture in detail. Configuration options were compared with the mission goals and objectives in order to select the spacecraft design concept that provides the lowest cost, lowest implementation risk, simplest operation and the most benefit for the mission implementation. The Next Gen NEAR spacecraft was designed to support rendezvous with a range of candidate asteroid targets and could easily be launched with one of several NASA launch vehicles. The Falcon 9 launch vehicle supports a Next Gen NEAR launch to target many near-Earth asteroids under consideration that could be reached with a C3 of 18 km2/sec2 or less, and the Atlas V-401 provides added capability supporting launch to NEAs that require more lift capacity while at the same time providing such excess lift capability that another payload of opportunity could be launch in conjunction with Next Gen NEAR. Next Gen NEAR will measure and interact with the target surface in ways never undertaken at an asteroid, and will prepare for first human precursor mission by demonstrating exploration science operations at an accessible NEO. This flexible mission and spacecraft design concept supports target selection based on upcoming Earth-based observations and also provides opportunities for co-manifest & international partnerships. JHU/APL has demonstrated low cost, low risk, high impact missions and this mission will help to prepare NASA for human NEO exploration by combining the best of NASA s human and robotic exploration capabilities

Sufficient conditions for two-dimensional localization by arbitrarily weak defects in periodic potentials with band gaps

We prove, via an elementary variational method, 1d and 2d localization within the band gaps of a periodic Schrodinger operator for any mostly negative or mostly positive defect potential, V, whose depth is not too great compared to the size of the gap. In a similar way, we also prove sufficient conditions for 1d and 2d localization below the ground state of such an operator. Furthermore, we extend our results to 1d and 2d localization in d dimensions; for example, a linear or planar defect in a 3d crystal. For the case of D-fold degenerate band edges, we also give sufficient conditions for localization of up to D states.Comment: 9 pages, 3 figure

E-cadherin can limit the transforming properties of activating β-catenin mutations

Wnt pathway deregulation is a common characteristic of many cancers. But only Colorectal Cancer predominantly harbours mutations in APC, whereas other cancer types (hepatocellular carcinoma, solid pseudopapillary tumours of pancreas) have activating mutations in β-catenin (CTNNB1). We have compared the dynamics and the potency of β-catenin mutations in vivo. Within the murine small intestine (SI), an activating mutation of β-catenin took much longer to achieve a Wnt deregulation and acquire a crypt-progenitor-cell (CPC) phenotype than Apc or Gsk3 loss. Within the colon, a single activating mutation of β-catenin was unable to drive Wnt deregulation or induce the CPC phenotype. This ability of β-catenin mutation to differentially transform the SI versus the colon correlated with significantly higher expression of the β-catenin binding partner E-cadherin. This increased expression is associated with a higher number of E-cadherin:β-catenin complexes at the membrane. Reduction of E-cadherin synergised with an activating mutation of β-catenin so there was now a rapid CPC phenotype within the colon and SI. Thus there is a threshold of β-catenin that is required to drive transformation and E-cadherin can act as a buffer to prevent β-catenin accumulation

Comparison of the in vitro invasive capabilities of Plasmodium falciparum schizonts isolated by Percoll gradient or using magnetic based separation

<p>Abstract</p> <p>Background</p> <p>Percoll gradient centrifugation is often used for synchronization, enrichment, or isolation of a particular stage of <it>Plasmodium falciparum</it>. However, Percoll, a hyperosmotic agent, may have harmful effects on the parasites. Magnetic bead column (MBC) separation has been used as an alternative. This is a report of a head-to-head comparison of the <it>in vitro </it>invasive capabilities of parasites isolated by either of the two methods.</p> <p>Methods</p> <p>The <it>P. falciparum </it>laboratory strain isolate 7G8 was grown <it>in vitro </it>using standard procedures and synchronized using 5% sorbitol. On separate days when the schizont parasitaemia was >1%, the culture was split and half was processed by Percoll gradient centrifugation and the other half by magnetic bead column separation. Both processed parasites were placed back in culture and allowed to invade new uninfected erythrocytes.</p> <p>Results</p> <p>In 10 paired assays, the mean efficiency of invasion of 7G8 parasites treated by Percoll gradient centrifugation was 35.8% that of those treated by magnetic bead column separation (95% CI, p = 0.00067) A paired <it>t </it>test with two tails was used for these comparisons.</p> <p>Conclusions</p> <p>In this comparison, magnetic bead column separation of 7G8 schizonts resulted in higher viability and efficiency of invasion than utilizing Percoll gradient centrifugation.</p

Potential Cost-effectiveness of Early Identification of Hospital-acquired Infection in Critically Ill Patients

Limitations in methods for the rapid diagnosis of hospital-acquired infections often delay initiation of effective antimicrobial therapy. New diagnostic approaches offer potential clinical and cost-related improvements in the management of these infections. We developed a decision modeling framework to assess the potential cost-effectiveness of a rapid biomarker assay to identify hospital-acquired infection in high-risk patients earlier than standard diagnostic testing. The framework includes parameters representing rates of infection, rates of delayed appropriate therapy, and impact of delayed therapy on mortality, along with assumptions about diagnostic test characteristics and their impact on delayed therapy and length of stay. Parameter estimates were based on contemporary, published studies and supplemented with data from a four-site, observational, clinical study. Extensive sensitivity analyses were performed. The base-case analysis assumed 17.6% of ventilated patients and 11.2% of nonventilated patients develop hospital-acquired infection and that 28.7% of patients with hospital-acquired infection experience delays in appropriate antibiotic therapy with standard care. We assumed this percentage decreased by 50% (to 14.4%) among patients with true-positive results and increased by 50% (to 43.1%) among patients with false-negative results using a hypothetical biomarker assay. Cost of testing was set at $110/d. In the base-case analysis, among ventilated patients, daily diagnostic testing starting on admission reduced inpatient mortality from 12.3 to 11.9$1,640 per patient, resulting in an incremental cost-effectiveness ratio of $21,389 per life-year saved. Among nonventilated patients, inpatient mortality decreased from 7.3 to 7.1$1,381 with diagnostic testing. The resulting incremental cost-effectiveness ratio was $42,325 per life-year saved. Threshold analyses revealed the probabilities of developing hospital-acquired infection in ventilated and nonventilated patients could be as low as 8.4 and 9.8$50,000 per life-year saved. Development and use of serial diagnostic testing that reduces the proportion of patients with delays in appropriate antibiotic therapy for hospital-acquired infections could reduce inpatient mortality. The model presented here offers a cost-effectiveness framework for future test development