Prenatal Care Cards: Imparting Patient Autonomy During Pregnancy.

Introduction/Problem: Indiana University Student Outreach Clinic (IU-SOC) has been providing medical care to vulnerable populations for the past 12 years. In that time, students have witnessed barriers to care impacting the neighbors in the community, including lack of health insurance due to financial limitations or limited residency documentation. These barriers are particularly burdensome to pregnant patients, and the bimonthly Prenatal Clinic was created five years ago to address this need. A major limitation is ensuring effective communication between the IU-SOC Electronic Medical Record (EMR), Practice Fusion, and the multiple health systems in the community. Intervention: After reviewing the Pan American Health Organization (P.A.H.O) recommendations for similar communities, we created a tool that can be utilized at all outreach clinics: the prenatal care card. These care cards contain all relevant prenatal information such as first, second, and third trimester prenatal labs, blood pressure measurements, fetal anatomy ultrasound results, and other tests that will allow providers to establish baseline values that determine future care. The card can be easily translated for improved clarity and is printed on sturdy, laminated cardstock. IU-SOC contact information is included on the bottom of the card in case future providers have concerns, and patients receive a photocopy of the card for safekeeping. Our copy is uploaded to Practice Fusion for future reference at IU-SOC. Conclusion: The IU-SOC prenatal care card has been implemented as a way to communicate between the clinic and other healthcare providers, in accordance with P.A.H.O. standards of perinatal care. Since September 2021, four IU-SOC patients have been offered the prenatal care card and have expressed overall satisfaction so far. The value of the prenatal card is three-fold: to provide patients with ownership of their medical information, to be easily shareable with any medical center, and to enhance their pregnancy experience overall. The utility of the prenatal card will be further established as more pregnant patients are provided this tool

Tenofovir disoproxil fumarate induces peripheral neuropathy and alters inflammation and mitochondrial biogenesis in the brains of mice.

Mounting evidence suggests that antiretroviral therapy (ART) drugs may contribute to the prevalence of HIV-associated neurological dysfunction. The HIV envelope glycoprotein (gp120) is neurotoxic and has been linked to alterations in mitochondrial function and increased inflammatory gene expression, which are common neuropathological findings in HIV+ cases on ART with neurological disorders. Tenofovir disproxil fumarate (TDF) has been shown to affect neurogenesis in brains of mice and mitochondria in neurons. In this study, we hypothesized that TDF contributes to neurotoxicity by modulating mitochondrial biogenesis and inflammatory pathways. TDF administered to wild-type (wt) and GFAP-gp120 transgenic (tg) mice caused peripheral neuropathy, as indicated by nerve conduction slowing and thermal hyperalgesia. Conversely TDF protected gp120-tg mice from cognitive dysfunction. In the brains of wt and gp120-tg mice, TDF decreased expression of mitochondrial transcription factor A (TFAM). However, double immunolabelling revealed that TFAM was reduced in neurons and increased in astroglia in the hippocampi of TDF-treated wt and gp120-tg mice. TDF also increased expression of GFAP and decreased expression of IBA1 in the wt and gp120-tg mice. TDF increased tumor necrosis factor (TNF) α in wt mice. However, TDF reduced interleukin (IL) 1β and TNFα mRNA in gp120-tg mouse brains. Primary human astroglia were exposed to increasing doses of TDF for 24 hours and then analyzed for mitochondrial alterations and inflammatory gene expression. In astroglia, TDF caused a dose-dependent increase in oxygen consumption rate, extracellular acidification rate and spare respiratory capacity, changes consistent with increased metabolism. TDF also reduced IL-1β-mediated increases in IL-1β and TNFα mRNA. These data demonstrate that TDF causes peripheral neuropathy in mice and alterations in inflammatory signaling and mitochondrial activity in the brain

Challenging the current hypothesis that thrombosis is responsible for the post-COVID-19 condition

People with the post-COVID-19 condition suffer symptoms that persist beyond 12 weeks following acute COVID-19 infection. Fatigue, shortness of breath, and cognitive dysfunction (“brain fog”) are common. Scientists, clinicians, and patients debate the pathophysiology. One pathophysiological hypothesis is that prothrombotic changes associated with acute COVID-19 persist, causing clots that lead to symptoms. This theory, arising from a research team in South Africa and supported by a paper in Nature Medicine, has been widely disseminated on social media and entered the public narrative as a cause of the post-COVID-19 condition.We describe the development of this theory, examine the findings of a Cochrane review that critically appraises the “microclot” beliefs, and critically appraise the influential study relating clotting biomarkers to cognitive deficits. We conclude the inferences for the hypothesis are not based on evidence, unlicensed use of antithrombotic medication is not justified, and apheresis should not be considered outside of a well-designed clinical trial

Implementation Evaluation of a Professional Development Program for Comprehensive School Physical Activity Leaders

The purpose of this study was to conduct an implementation monitoring evaluation of a yearlong comprehensive school physical activity program (CSPAP) professional development program across eight multi-state physical education (PE) teacher cohorts. Mixed-method data were collected during a three-year implementation period via workshop attendance sheets and evaluations, post-workshop implementation plans and artifacts, and follow-up phone interviews to enumerate and evaluate the program’s process of recruitment, reach, dose delivered, dose received, fidelity, and context. Recruitment strategies reached a total of 234 PE teacher attendees across eight workshops, with 77 PE teachers (primarily female, elementary, public school teachers) completing all program requirements. Facilitators among full program completers were participation incentives and network opportunities, while common inhibitors were difficulty with online technology and perceptions of added workload. Completers submitted implementation plans with at least three action steps, ranging from 4 to 7 months to accomplish, that predominately commenced with securing administration approval as the first step (81%), focused on implementing student physical activity initiatives beyond PE (76%), and evidenced with mostly picture artifacts (78%). Implementation was facilitated by the presence of multilevel support at school and an elevated image of PE and PE teachers at school, and was inhibited by scheduling constraints, unrealistic planning, and conflicting perceptions of physical activity and PE. Overall, this evaluation reveals unique perspectives of PE teachers regarding schoolwide PA promotion and informs future efforts to target and effectively support CSPAP leaders

A Neuromuscular Training Program Performed on Foam is Accompanied by Improved Balance and Jump Height in Recreational Runners

Purpose: To assess balance, plyometric performance, and strength of recreational runners completing a neuromuscular training (NMT) program on a novel foam surface. Methods: After baseline testing, participants (n=14) completed 22-minute exercise sessions on foam twice weekly for eight weeks, and a post-training testing battery. Testing included lower quarter Y-balance test (LQYBT), dynamic leap and balance test (DLBT), squat jump and countermovement jump tests, and isometric strength testing of the foot and ankle via handheld dynamometry (HHD). Participants were asked to maintain their normal running routines throughout the study period and report any training missed due to injury. Results: Participants demonstrated significant (pConclusion: This study supports the use of progressive NMT on foam as a feasible intervention for recreational runners as all participants maintained typical running routines and reported no injuries. While further research is needed to directly inform possible effects of NMT on foam on injury risk and running performance, the improvements in single leg dynamic balance, lower body plyometric performance, and some indices of lower extremity strength in the present study suggest the efficacy of NMT performed on foam

Magneto-optical trapping in a near-surface borehole

Borehole gravity sensing can be used in a number of applications to measure features around a well including rock-type change mapping and determination of reservoir porosity. Quantum technology gravity sensors based on atom interferometry have the ability to offer increased survey speeds and reduced need for calibration. While surface sensors have been demonstrated in real world environments, significant improvements in robustness and reductions to radial size, weight, and power consumption are required for such devices to be deployed in boreholes. To realise the first step towards the deployment of cold atom-based sensors down boreholes, we demonstrate a borehole-deployable magneto-optical trap, the core package of many cold atom-based systems. The enclosure containing the magneto-optical trap itself had an outer radius of ($60\pm0.1$) mm at its widest point and a length of ($890\pm5$) mm. This system was used to generate atom clouds at 1 m intervals in a 14 cm wide, 50 m deep borehole, to simulate an in-borehole gravity surveys are performed. During the survey the system generated on average clouds of (3.0 $\pm 0.1) \times 10^{5}$ $^{87}$Rb atoms with the standard deviation in atom number across the survey observed to be as low as $9 \times 10^{4}$

Magneto-optical trapping in a near-suface borehole

Borehole gravity sensing can be used in a number of applications to measure features around a well, including rock-type change mapping and determination of reservoir porosity. Quantum technology gravity sensors, based on atom interferometry, have the ability to offer increased survey speeds and reduced need for calibration. While surface sensors have been demonstrated in real world environments, significant improvements in robustness and reductions to radial size, weight, and power consumption are required for such devices to be deployed in boreholes. To realise the first step towards the deployment of cold atom-based sensors down boreholes, we demonstrate a borehole-deployable magneto-optical trap, the core package of many cold atom-based systems. The enclosure containing the magneto-optical trap itself had an outer radius of (60 ± 0.1) mm at its widest point and a length of (890 ± 5) mm. This system was used to generate atom clouds at 1 m intervals in a 14 cm wide, 50 m deep borehole, to simulate how in-borehole gravity surveys are performed. During the survey, the system generated, on average, clouds of (3.0 ± 0.1) × 105 87Rb atoms with the standard deviation in atom number across the survey observed to be as low as 8.9 × 104

Assessment of a novel, capsid-modified adenovirus with an improved vascular gene transfer profile

<p>Background: Cardiovascular disorders, including coronary artery bypass graft failure and in-stent restenosis remain significant opportunities for the advancement of novel therapeutics that target neointimal hyperplasia, a characteristic of both pathologies. Gene therapy may provide a successful approach to improve the clinical outcome of these conditions, but would benefit from the development of more efficient vectors for vascular gene delivery. The aim of this study was to assess whether a novel genetically engineered Adenovirus could be utilised to produce enhanced levels of vascular gene expression.</p> <p>Methods: Vascular transduction capacity was assessed in primary human saphenous vein smooth muscle and endothelial cells using vectors expressing the LacZ reporter gene. The therapeutic capacity of the vectors was compared by measuring smooth muscle cell metabolic activity and migration following infection with vectors that over-express the candidate therapeutic gene tissue inhibitor of matrix metalloproteinase-3 (TIMP-3).</p> <p>Results: Compared to Adenovirus serotype 5 (Ad5), the novel vector Ad5T*F35++ demonstrated improved binding and transduction of human vascular cells. Ad5T*F35++ mediated expression of TIMP-3 reduced smooth muscle cell metabolic activity and migration in vitro. We also demonstrated that in human serum samples pre-existing neutralising antibodies to Ad5T*F35++ were less prevalent than Ad5 neutralising antibodies.</p> <p>Conclusions: We have developed a novel vector with improved vascular transduction and improved resistance to human serum neutralisation. This may provide a novel vector platform for human vascular gene transfer.</p&gt

Global Kidney Exchange: Analysis and Background Papers from the Perspective of the Right to Health

Global Kidney Exchange (GKE) is a program aimed at facilitating trans-national kidney donation. Although its proponents aim at reducing the unmet demand of kidneys in the United States through the trans-nationalization of kidney exchange programs, the World Health Organization (WHO) and The Transplantation Society (TTS) have expressed concerns about its potential effect on black markets of organs and transnational organ trafficking, as well as on low- or middle-income countries health systems. For GKE to be implemented, it would need to be permitted to operate in at least some low- or middle-income countries. What are the right to health implications of GKE’s implementation? With the aim of answering this question, the eighteen University of Denver students in the First Year Seminar course I taught in autumn 2017 with the title “The Right to Health in Theory and Practice”, identified and researched the different aspects that would affect this issue, and produced the analysis we present in this report. Based on our analysis, the potential right to health implications of GKE are: First, the program may improve timely access to organ donation primarily to patients with health insurance in the United States. Second, a large-scale implementation of the program may have a positive impact on health costs savings, which potentially could benefit the United States health system. Third, on a global health level, the program relies on existing health inequalities among countries in terms of funding, human resources, and health system strengthening, and it is likely to exacerbate those inequalities. Fourth, the program has the potential of negatively affecting the efforts that low- and middle-income countries are already doing to address end-stage renal failure, including the improvement of their own organ donation systems. Finally, given what we have learned about the current situation of organ trafficking, it is easy to think that GKE would unintentionally end up being linked to chains of organ trade. The only way how a program like GKE could have a positive impact from a right to health perspective is if it establishes local partnerships that have the effect of decreasing health inequalities. Additionally, we identified some issues of concern that are beyond the level of influence of local authorities: the unmet demand of kidneys in high-income countries is a reality that incentivizes organ trade and transplant tourism, and this is a problem in need of solutions; transnational organ trafficking as well as human trafficking with the purpose of organ donation are problems that need more visibility; for a global exchange of organs to be implemented, it would need to rely on supranational or transnational regulation and oversight; and the global epidemic of chronic kidney disease needs to be addressed through a public health perspective that emphasizes prevention