Determinants of Severe Maternal Morbidity and Its Racial/Ethnic Disparities in New York City, 2008–2012

Objectives Severe maternal morbidity (SMM) is an important indicator for identifying and monitoring efforts to improve maternal health. Studies have identified independent risk factors, including race/ethnicity; however, there has been limited investigation of the modifying effect of socioeconomic factors. The study aims were to quantify SMM risk factors and to determine if socioeconomic status modifies the effect of race/ethnicity on SMM risk. Methods We used 2008–2012 NYC birth certificates matched with hospital discharge records for maternal deliveries. SMM was defined using an algorithm developed by the Centers for Disease Control and Prevention. Mixed-effects logistic regression models estimated SMM risk by demographic, socioeconomic, and health characteristics. The final model was stratified by Medicaid status (as a proxy for income), education, and neighborhood poverty. Results Of 588,232 matched hospital deliveries, 13,505 (229.6 per 10,000) had SMM. SMM rates varied by maternal age, birthplace, education, income, pre-existing chronic conditions, pre-pregnancy weight status, trimester of prenatal care entry, plurality, and parity. Race/ethnicity was consistently and significantly associated with SMM. While racial differences in SMM risk persisted across all socioeconomic groupings, the risk was exacerbated among Latinas and Asian-Pacific Islanders with lower income when compared to white non-Latinas. Similarly, living in the poorest neighborhoods exacerbated SMM risk among both black non-Latinas and Latinas. Conclusions for Practice SMM determinants in NYC mirror national trends, including racial/ethnic disparities. However, these disparities persisted even in the highest income and educational groups suggesting other pathways are needed to explain racial/ethnic differences

The IC2118 association: new T Tauri stars in high-latitude molecular clouds

We identified new pre-main sequence stars in the region of high-latitude molecular clouds associated with the reflection nebula IC2118, around l = 208 degr and b = -27 degr. The stars were selected as T Tauri candidates in objective prism plates obtained with the Schmidt telescope of Konkoly Observatory. Results of spectroscopic follow-up observations, carried out with the FLAIR spectrograph installed on the UK Schmidt and with ALFOSC on Nordic Optical Telescope, are presented in this paper. Based on spectral types, presence of emission lines and lithium absorption line, we identified five classical T Tauri stars and a candidate weak-line T Tauri star projected on the molecular clouds, as well as two candidate pre-main sequence stars outside the nebulous region. Using the near infrared magnitudes obtained from the 2MASS All Sky Catalog. we determined the masses and ages of these stars. We found that the five classical T Tauri stars projected on the clouds are physically related to them, whereas the other stars are probably background objects. Adopting a distance of 210 pc for IC2118 (Kun et al. 2001) and using Palla & Stahler's (1999) evolutionary tracks we derived an average age of 2.5 million yrs and a mass interval of 0.4--1.0 M_sun for the members of the IC2118 association.Comment: 11 pages, 6 figures, accepted for publication by Astronomy and Astrophysic

A 42.3-43.6 GHz spectral survey of Orion BN/KL: First detection of the v=0 J=1-0 line from the isotopologues 29SiO and 30SiO

We have surveyed molecular line emission from Orion BN/KL from 42.3 to 43.6 GHz with the Green Bank Telescope. Sixty-seven lines were identified and ascribed to 13 different molecular species. The spectrum at 7 mm is dominated by SiO, SO2, CH3OCH3, and C2H5CN. Five transitions have been detected from the SiO isotopologues 28SiO, 29SiO, and 30SiO. We report here for the first time the spectra of the 29SiO and 30SiO v=0 J=1-0 emission in Orion BN/KL, and we show that they have double-peaked profiles with velocity extents similar to the main isotopologue. The main motivation for the survey was the search of high-velocity (100-1000 km/s) outflows in the BN/KL region as traced by SiO Doppler components. Some of the unidentified lines in principle could be high-velocity SiO features, but without imaging data their location cannot be established. Wings of emission are present in the v=0 28SiO, 29SiO and 30SiO profiles, and we suggest that the v=0 emission from the three isotopologues might trace a moderately high-velocity (~30-50 km/s) component of the flows around the high-mass protostar Source I in the Orion BN/KL region. We also confirm the 7 mm detection of a complex oxygen-bearing species, acetone (CH3COCH3), which has been recently observed towards the hot core at 3 mm, and we have found further indications of the presence of long cyanopolyynes (HC5N and HC7N) in the quiescent cold gas of the extended ridge.Comment: 27 pages, 3 figures, accepted by Ap

Determining Peptide Partitioning Properties via Computer Simulation

The transfer of polypeptide segments into lipid bilayers to form transmembrane helices represents the crucial first step in cellular membrane protein folding and assembly. This process is driven by complex and poorly understood atomic interactions of peptides with the lipid bilayer environment. The lack of suitable experimental techniques that can resolve these processes both at atomic resolution and nanosecond timescales has spurred the development of computational techniques. In this review, we summarize the significant progress achieved in the last few years in elucidating the partitioning of peptides into lipid bilayer membranes using atomic detail molecular dynamics simulations. Indeed, partitioning simulations can now provide a wealth of structural and dynamic information. Furthermore, we show that peptide-induced bilayer distortions, insertion pathways, transfer free energies, and kinetic insertion barriers are now accurate enough to complement experiments. Further advances in simulation methods and force field parameter accuracy promise to turn molecular dynamics simulations into a powerful tool for investigating a wide range of membrane active peptide phenomena

High-Redshift Star-Forming Galaxies: Angular Momentum and Baryon Fraction, Turbulent Pressure Effects and the Origin of Turbulence

The structure of a sample of high-redshift (z=2), rotating galaxies with high star formation rates and turbulent gas velocities of sigma=40-80 km/s is investigated. Fitting the observed disk rotational velocities and radii with a Mo, Mao, White (1998) (MMW) model requires unusually large disk spin parameters lambda_d>0.1 and disk-to-dark halo mass fraction m_d=0.2, close to the cosmic baryon fraction. The galaxies segregate into dispersion-dominated systems with 1<vmax/sigma<3, maximum rotational velocities vmax<200 km/s and disk half-light radii rd=1-3 kpc and rotation-dominated systems with vmax>200 km/s, vmax/sigma>3 and rd=4-8 kpc. For the dispersion-dominated sample, radial pressure gradients partly compensate the gravitational force, reducing the rotational velocities. Including this pressure effect in the MMW model, dispersion-dominated galaxies can be fitted well with spin parameters lf lambda_d=0.03-0.05 for high disk mass fractions of m_d=0.2 and with lambda_d=0.01-0.03 for m_d=0.05. These values are in good agreement with cosmological expectations. For the rotation-dominated sample however pressure effects are small and better agreement with theoretically expected disk spin parameters can only be achieved if the dark halo mass contribution in the visible disk regime (2-3*rd) is smaller than predicted by the MMW model. We argue that these galaxies can still be embedded in standard cold dark matter halos if the halos did not contract adiabatically in response to disk formation. It is shown that the observed high turbulent gas motions of the galaxies are consistent with a Toomre instability parameter Q=1 which is equal to the critical value, expected for gravitational disk instability to be the major driver of turbulence. The dominant energy source of turbulence is then the potential energy of the gas in the disk.Comment: 23 pages, 4 figures, ApJ, in pres

Managing lifestyle change to reduce coronary risk: a synthesis of qualitative research on peoples’ experiences

Background Coronary heart disease is an incurable condition. The only approach known to slow its progression is healthy lifestyle change and concordance with cardio-protective medicines. Few people fully succeed in these daily activities so potential health improvements are not fully realised. Little is known about peoples’ experiences of managing lifestyle change. The aim of this study was to synthesise qualitative research to explain how participants make lifestyle change after a cardiac event and explore this within the wider illness experience. Methods A qualitative synthesis was conducted drawing upon the principles of meta-ethnography. Qualitative studies were identified through a systematic search of 7 databases using explicit criteria. Key concepts were identified and translated across studies. Findings were discussed and diagrammed during a series of audiotaped meetings. Results The final synthesis is grounded in findings from 27 studies, with over 500 participants (56% male) across 8 countries. All participants experienced a change in their self-identity from what was ‘familiar’ to ‘unfamiliar’. The transition process involved ‘finding new limits and a life worth living’ , ‘finding support for self’ and ‘finding a new normal’. Analyses of these concepts led to the generation of a third order construct, namely an ongoing process of ‘reassessing past, present and future lives’ as participants considered their changed identity. Participants experienced a strong urge to get back to ‘normal’. Support from family and friends could enable or constrain life change and lifestyle changes. Lifestyle change was but one small part of a wider ‘life’ change that occurred. Conclusions The final synthesis presents an interpretation, not evident in the primary studies, of a person-centred model to explain how lifestyle change is situated within ‘wider’ life changes. The magnitude of individual responses to a changed health status varied. Participants experienced distress as their notion of self identity shifted and emotions that reflected the various stages of the grief process were evident in participants’ accounts. The process of self-managing lifestyle took place through experiential learning; the level of engagement with lifestyle change reflected an individual’s unique view of the balance needed to manage ‘realistic change’ whilst leading to a life that was perceived as ‘worth living’. Findings highlight the importance of providing person centred care that aligns with both psychological and physical dimensions of recovery which are inextricably linked

Inelastic Black Hole Scattering from Charged Scalar Amplitudes

We explain how the lowest-order classical gravitational radiation produced during the inelastic scattering of two Schwarzschild black holes in General Relativity can be obtained from a tree scattering amplitude in gauge theory coupled to scalar fields. The gauge calculation is related to gravity through the double copy. We remove unwanted scalar forces which can occur in the double copy by introducing a massless scalar in the gauge theory, which is treated as a ghost in the link to gravity. We hope these methods are a step towards a direct application of the double copy at higher orders in classical perturbation theory, with the potential to greatly streamline gravity calculations for phenomenological applications.Comment: 28 pages, 6 figure

Understanding caretakers' dilemma in deciding whether or not to adhere with referral advice after pre-referral treatment with rectal artesunate

BACKGROUND: Malaria kills. A single rectal dose of artesunate before referral can reduce mortality and prevent permanent disability. However, the success of this intervention depends on caretakers' adherence to referral advice for follow-up care. This paper explores the dilemma facing caretakers when they are in the process of deciding whether or not to transit their child to a health facility after pre-referral treatment with rectal artesunate. METHODS: Four focus group discussions were held in each of three purposively selected villages in Mtwara rural district of Tanzania. Data were analysed manually using latent qualitative content analysis. RESULTS: The theme "Caretakers dilemma in deciding whether or not to adhere with referral advice after pre-referral treatment with rectal artesunate" depicts the challenge they face. Caretakers' understanding of the rationale for going to hospital after treatment--when and why they should adhere--influenced adherence. Caretakers, whose children did not improve, usually adhered to referral advice. If a child had noticeably improved with pre-referral treatment however, caretakers weighed whether they should proceed to the facility, balancing the child's improved condition against other competing priorities, difficulties in reaching the health facilities, and the perceived quality of care at the health facility. Some misinterpretation were found regarding the urgency and rationale for adherence among some caretakers of children who improved which were attributed to be possibly due to their prior understanding. CONCLUSION: Some caretakers did not adhere when their children improved and some who adhered did so without understanding why they should proceed to the facility. Successful implementation of the rectal artesunate strategy depends upon effective communication regarding referral to clinic

Structure-based statistical analysis of transmembrane helices

Recent advances in determination of the high-resolution structure of membrane proteins now enable analysis of the main features of amino acids in transmembrane (TM) segments in comparison with amino acids in water-soluble helices. In this work, we conducted a large-scale analysis of the prevalent locations of amino acids by using a data set of 170 structures of integral membrane proteins obtained from the MPtopo database and 930 structures of water-soluble helical proteins obtained from the protein data bank. Large hydrophobic amino acids (Leu, Val, Ile, and Phe) plus Gly were clearly prevalent in TM helices whereas polar amino acids (Glu, Lys, Asp, Arg, and Gln) were less frequent in this type of helix. The distribution of amino acids along TM helices was also examined. As expected, hydrophobic and slightly polar amino acids are commonly found in the hydrophobic core of the membrane whereas aromatic (Trp and Tyr), Pro, and the hydrophilic amino acids (Asn, His, and Gln) occur more frequently in the interface regions. Charged amino acids are also statistically prevalent outside the hydrophobic core of the membrane, and whereas acidic amino acids are frequently found at both cytoplasmic and extra-cytoplasmic interfaces, basic amino acids cluster at the cytoplasmic interface. These results strongly support the experimentally demonstrated biased distribution of positively charged amino acids (that is, the so-called the positive-inside rule) with structural data

Dietary fat intake and lung cancer risk: a pooled analysis

Purpose Dietary fat may play a role in lung carcinogenesis. Findings from epidemiologic studies, however, remain inconsistent. In this pooled analysis of 10 prospective cohort studies from the United States, Europe, and Asia, we evaluated the associations of total and specific types of dietary fat with lung cancer risk. Methods Cox regression was used to estimate hazard ratios (HRs) and 95% CIs in each cohort. Study-specific risk estimates were pooled by random- or fixed-effects meta-analysis. The first 2 years of follow-up were excluded to address potential influence of preclinical dietary changes. Results Among 1,445,850 participants, 18,822 incident cases were identified (mean follow-up, 9.4 years). High intakes of total and saturated fat were associated with an increased risk of lung cancer (for highest v lowest quintile: HR, 1.07 and 1.14, respectively; 95% CI, 1.00 to 1.15 and 1.07 to 1.22, respectively; P for trend for both < .001). The positive association of saturated fat was more evident among current smokers (HR, 1.23; 95% CI, 1.13 to 1.35; P for trend < .001) than former/never smokers (P for interaction = .004), and for squamous cell and small cell carcinoma (HR, 1.61 and 1.40, respectively; 95% CI, 1.38 to 1.88 and 1.17 to 1.67, respectively; P for trend for both < .001) than other histologic types (P for heterogeneity < .001). In contrast, a high intake of polyunsaturated fat was associated with a decreased risk of lung cancer (HR, 0.92; 95% CI, 0.87 to 0.98 for highest v lowest quintile; P for trend = .02). A 5% energy substitution of saturated fat with polyunsaturated fat was associated with a 16% to 17% lower risk of small cell and squamous cell carcinoma. No associations were found for monounsaturated fat. Conclusion Findings from this large, international cohort consortium suggest that modifying dietary fat intake (ie, replacing saturated fat with polyunsaturated fat) may reduce lung cancer risk, particularly among smokers and for squamous cell and small cell carcinoma