Ethnolinguistic concordance and the receipt of postpartum IUD counseling services in Sri Lanka.

CONTEXT: Ethnic and linguistic concordance are important dimensions of the patient-physician relationship, and are linked to health care disparities. However, evidence on the associations between health behavior and outcomes and patient-provider concordance is limited, especially in low- and middle-income settings. METHODS: To examine how concordance between women and their primary health midwife is associated with women's receipt of postpartum IUD counseling, observational data from a cluster-randomized trial assessing an intervention to increase postpartum IUD counseling were used. Data on 4,497 women who delivered at six hospitals in Sri Lanka between September 2015 and March 2017 were merged with data on 245 primary health midwives, and indicators of linguistic concordance, ethnic concordance and their interaction were generated. Multivariate logistic regression analyses were used to assess the associations between concordance and women's receipt of counseling. RESULTS: Women from non-Sinhalese groups in Sri Lanka face disparities in the receipt of postpartum IUD counseling. Compared with the ethnolinguistic majority (Sinhalese women who speak only Sinhala), non-Sinhalese women have lower odds of having received postpartum IUD counseling, whether they speak both Sinhala and Tamil (odds ratio, 0.6) or only Tamil (0.5). Ethnic discordance- rather than linguistic discordance-is the primary driver of this disparity. CONCLUSIONS: The findings highlight the need for interventions that aim to bridge the sociocultural gaps between providers and patients. Matching women and their providers on ethnolinguistic background may help to reduce disparities in care.Accepted manuscrip

Technology and Web 2.0

Final draft / post-print of book chapte

Designed to Meet Our Institutional Mission: A case study from Grand Valley State University Libraries

Academic libraries exist to fulfill the missions of the institutions they serve. Historically, this included maintaining collections in support of courses and curriculum, providing instructional and reference services, and offering space for student study. Decisions about library space design were based on these priorities. However, technological advancements have changed how libraries store and provide access to collections and, as Anne M. Houston (2015) notes, “…the balance of space is moving away from collection storage and toward space enabled to meet other user needs” (84). Library spaces can now meet institutional missions in ways that go beyond traditional expectations, especially in terms of supporting student learning. Diana Oblinger (2006) affirms “Space—whether physical or virtual—can have an impact on learning. It can bring people together; it can encourage exploration, collaboration, and discussion. Or, space can carry an unspoken message of silence and disconnectedness” (1.1). Designing library spaces that encourage the connection Oblinger describes is prudent for academic libraries because “learning spaces convey an image of the institution\u27s philosophy about teaching and learning” (Somerville and Harlan 2008, 17). Library spaces can enhance the academic experience of students and revitalize the library’s institutional relevancy when design decisions are made through the lens of student learning. Grand Valley State University’s Mary Idema Pew Library Learning and Information Commons is designed to meet the institution’s student-centered focus and liberal education 2 tradition. Opened in 2013, the library has been described as a model of twenty-first century learning (Daly 2012, 16). An open, flexible, user-centered design allows students to manage their own learning, engage with others, find support through a variety of services, and discover serendipitous learning opportunities. Reflecting our institutional mission, student learning was at the core of every design decision and continues to be at the center of ongoing assessment

Stimulation of Piezo1 by mechanical signals promotes bone anabolism

Mechanical loading, such as caused by exercise, stimulates bone formation by osteoblasts and increases bone strength, but the mechanisms are poorly understood. Osteocytes reside in bone matrix, sense changes in mechanical load, and produce signals that alter bone formation by osteoblasts. We report that the ion channel Piezo1 is required for changes in gene expression induced by fluid shear stress in cultured osteocytes and stimulation of Piezo1 by a small molecule agonist is sufficient to replicate the effects of fluid flow on osteocytes. Conditional deletion o

The effect of a postpartum IUD intervention on counseling and choice: Evidence from a cluster-randomized stepped-wedge trial in Sri Lanka

BACKGROUND: The International Federation of Gynaecology and Obstetrics (FIGO), in collaboration with the Sri Lankan College of Obstetrics and Gynaecologists (SLCOG), launched an initiative in 2014 to institutionalize immediate postpartum IUD (PPIUD) services as a routine part of antenatal counseling and delivery room services in Sri Lanka. In this study, we evaluate the effect of the FIGO-SLCOG PPIUD intervention in six hospitals by means of a cluster-randomized stepped-wedge trial. METHODS/DESIGN: Six hospitals were randomized into two groups of three using matched pairs. Following a 3-month baseline period, the intervention was administered to the first group, while the second group received the intervention after 9 months of baseline data collection. We collected data from 39,084 women who delivered in these hospitals between September 2015 and January 2017. We conduct an intent-to-treat (ITT) analysis to determine the impact of the intervention on PPIUD counseling and choice of PPIUD, as measured by consent to receive a PPIUD, as well as PPIUD uptake (insertion following delivery). We also investigate how factors related to counseling, such as counseling timing and quality, are linked to choice of PPIUD. RESULTS: We find that the intervention increased rates of counseling, from an average counseling rate of 12% in all hospitals prior to the intervention to an average rate of 51% in all hospitals after the rollout of the intervention (0.307; 95% CI 0.148-0.465). In contrast, we find the impact of the intervention on choice of PPIUD to be less robust and mixed, with 4.1% of women choosing PPIUD prior to the intervention compared to 9.8% of women choosing PPIUD after the rollout of the intervention (0.027; 95% CI 0.000-0.054). CONCLUSIONS: This study demonstrates that incorporating PPIUD services into postpartum care is feasible and potentially effective. Taking the evidence on both counseling and choice of PPIUD together, we find that the intervention had a generally positive impact on receipt of PPIUD counseling and, to a lesser degree, on choice of the PPIUD. Nevertheless, it is clear that the intervention's effectiveness can be improved to be able to meet the demand for postpartum family planning of women. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02718222 . Registered on 11 March 2016 (retrospectively registered).Published version and Accepted manuscript versions

Rips Complexes of Planar Point Sets

Fix a finite set of points in Euclidean $n$-space \euc^n, thought of as a point-cloud sampling of a certain domain D\subset\euc^n. The Rips complex is a combinatorial simplicial complex based on proximity of neighbors that serves as an easily-computed but high-dimensional approximation to the homotopy type of $D$. There is a natural ``shadow'' projection map from the Rips complex to \euc^n that has as its image a more accurate $n$-dimensional approximation to the homotopy type of $D$. We demonstrate that this projection map is 1-connected for the planar case $n=2$. That is, for planar domains, the Rips complex accurately captures connectivity and fundamental group data. This implies that the fundamental group of a Rips complex for a planar point set is a free group. We show that, in contrast, introducing even a small amount of uncertainty in proximity detection leads to `quasi'-Rips complexes with nearly arbitrary fundamental groups. This topological noise can be mitigated by examining a pair of quasi-Rips complexes and using ideas from persistent topology. Finally, we show that the projection map does not preserve higher-order topological data for planar sets, nor does it preserve fundamental group data for point sets in dimension larger than three.Comment: 16 pages, 8 figure

Cambios esqueletales en pacientes clase III por retrusión maxilar, que han sido tratados con máscara de tracción frontal durante el Post Grado de Ortodoncia de la Facultad de Odontología de la Universidad Andrés Bello.

Tesis (Cirujano Dentista, Especialización en Ortodoncia)INTRODUCCION: La máscara de tracción frontal es un tratamiento ortopédico interceptivo que interviene tempranamente en la maloclusion clase 111, Frecuentemente los ortodoncistas se ven enfrentados a maloclusiones clase 111, por este motivo es necesario investigar cuales son los cambios y cuantificarlos para demostrar la efectividad del tratamiento. El objetivo de esta investigación fue determinar los cambios en el tejido óseo producidos por la máscara de tracción frontal en los pacientes clase 111 por retrusion maxilar, con el fin de cuantificar y comparar la posición maxilar previa y posterior al tratamiento y determinar así la efectividad del tratamiento con máscara. El diseño de estudio utilizado fue longitudinal retrospectivo, en el cual se utilizó telerradiografías de perfil previas y posteriores al tratamiento con máscara de tracción frontal. Se comparó la medición basal para determinar el estado inicial del paciente, y una posterior para determinar los cambios esqueletales ocurridos

Muscle Activation Differs between Three Different Knee Joint-Angle Positions during a Maximal Isometric Back Squat Exercise

The purpose of this study was to compare muscle activation of the lower limb muscles when performing a maximal isometric back squat exercise over three different positions. Fifteen young, healthy, resistance-trained men performed an isometric back squat at three knee joint angles (20∘, 90∘, and 140∘) in a randomized, counterbalanced fashion. Surface electromyography was used to measure muscle activation of the vastus lateralis (VL), vastus medialis (VM), rectus femoris (RF), biceps femoris (BF), semitendinosus (ST), and gluteusmaximus (GM). In general,muscle activity was the highest at 90∘ for the three quadricepsmuscles, yet differences in muscle activation between knee angles were muscle specific. Activity of the GM was significantly greater at 20∘ and 90∘ compared to 140∘.The BF and ST displayed similar activation at all joint angles. In conclusion, knee position altersmuscles activation of the quadriceps and gluteus maximus muscles. An isometric back squat at 90∘ generates the highest overall muscle activation, yet an isometric back squat at 140∘ generates the lowest overall muscle activation of the VL and GM only

Evaluation of the ability of C. albicans to form biofilm in the presence of phage-resistant phenotypes of P. aeruginosa

Pseudomonas aeruginosa and Candida albicans are disparate microbial species, but both are known to be opportunistic pathogens frequently associated with nosocomial infections. The aim of this study was to provide a better understanding of the interactions between these microorganisms in dual-species biofilms. Several bacteriophage-resistant P. aeruginosa phenotypes have been isolated and were used in dual-species mixed-biofilm studies. Twenty-four and 48 h mixed-biofilms were formed using the isolated phenotypes of phage-resistant P. aeruginosa and these were compared with similar experiments using other P. aeruginosa strains with a defined lipopolysaccharide (LPS) deficiency based on chromosomal knockout of specific LPS biosynthetic genes. Overall, the results showed that the variants of phage-resistant P. aeruginosa and LPS mutants were both less effective in inhibiting the growth of C. albicans in mixed-biofilms compared to the wild-type strains of P. aeruginosa. Conversely, the proliferation of P. aeruginosa was not influenced by the presence of C. albicans. In conclusion, the ability of strains of P. aeruginosa to inhibit the formation of a biofilm of C. albicans appears to be correlated with the LPS chain lengths of phenotypes of P. aeruginosa, suggesting that LPS has a suppressive effect on the growth of C. albicans.D. P. P. acknowledges the grant from the project [PTDC/EBB-BIO/114760/2009] from the Portuguese Foundation for Science and Technology (FCT). J.S.L. holds a Canada Research Chair in Cystic Fibrosis and Microbial Glycobiology and research in his laboratory is supported by operating grants from Cystic Fibrosis Canada and the Canadian Institutes of Health Research (CIHR) [Grant MOP-14687]

Numerical 3D modeling of heat transfer in human tissues for microwave radiometry monitoring of Brown fat metabolismo

Background: Brown adipose tissue (BAT) plays an important role in whole body metabolism and could potentially mediate weight gain and insulin sensitivity. Although some imaging techniques allow BAT detection, there are currently no viable methods for continuous acquisition of BAT energy expenditure. We present a non-invasive technique for long term monitoring of BAT metabolism using microwave radiometry. Methods: A multilayer 3D computational model was created in HFSS™ with 1.5 mm skin, 3-10 mm subcutaneous fat, 200 mm muscle and a BAT region (2-6 cm3) located between fat and muscle. Based on this model, a log-spiral antenna was designed and optimized to maximize reception of thermal emissions from the target (BAT). The power absorption patterns calculated in HFSS™ were combined with simulated thermal distributions computed in COMSOL® to predict radiometric signal measured from an ultra-low-noise microwave radiometer. The power received by the antenna was characterized as a function of different levels of BAT metabolism under cold and noradrenergic stimulation. Results: The optimized frequency band was 1.5-2.2 GHz, with averaged antenna efficiency of 19%. The simulated power received by the radiometric antenna increased 2-9 mdBm (noradrenergic stimulus) and 4-15 mdBm (cold stimulus) corresponding to increased 15-fold BAT metabolism. Conclusions: Results demonstrated the ability to detect thermal radiation from small volumes (2-6 cm3) of BAT located up to 12 mm deep and to monitor small changes (0.5°C) in BAT metabolism. As such, the developed miniature radiometric antenna sensor appears suitable for non-invasive long term monitoring of BAT metabolism