Services for Pregnant Women with Opiate Use Disorder

The presentation will highlight the best practices of both Stable Cradle and The Ohio State University Wexner Medical Center's (OSUWMC) Substance Abuse, Treatment, Education and Prevention Program (STEPP) clinics as a model to address the issues of pregnant women with opiate use disorders. Wanda Dillard, MS, will provide a history of the Stable Cradle Program, and Dr. Mona Prasad will provide overview of the OSUWMC STEPP clinic operations and how the two programs work together. The presentation will further discuss current initiatives to address the opiate epidemic. In Franklin County, at least 353 people overdosed in 2016. The number of babies diagnosed with neonatal abstinence syndrome (NAS) increased by 750 percent in Ohio from 2004-2015. NAS is a set of symptoms associated with abrupt withdrawal of opioids and other drugs when infants are born to mothers with opiate use disorder. In 2013, there were 1,691 drug-dependent babies admitted to Ohio hospitals with a cost for their care at nearly $100 million. Since the beginning of 2017, 40 NAS infants have been admitted to Franklin County nurseries and treated for withdrawal symptoms with a length stay of 28 days (86 percent of the women were white and 13 percent were African American.) Since 1997, OSUWMC has provided outreach services to more than 2,000 pregnant women struggling with addiction in partnership with Maryhaven's Women Program. Since 2010, more than 500 expectant mothers with opiate use disorder have received high-risk obstetrics care at OSUWMC's STEPP clinic. Both programs work from a model of harm reduction rather than harm elimination. OSUWMC's STEPP clinic currently provides high-risk obstetric services for opiate disorders and resources one full day each week. The Maryhaven Women Program's addiction specialist and the two mentors each provide 40 hours a week to conduct outreach with pregnant women on substances.AUTHOR AFFILIATION: Wanda Dillard, Director of Community Development, The Ohio State UniversityWMC, [email protected] (Corresponding Author); Mona Prasad, Physician, Maternal Fetal Medicine, The Ohio State UniversityWMC.Learn about current initiatives to address services for pregnant women with opiate use disorder and babies diagnosed with neonatal abstinence syndrome. To address these myriad concerns, we created a unique community partnership between The Ohio State University Wexner Medical Center (OSUWMC) and Maryhaven's Women's Program. Since 1997, OSUWMC has provided outreach services to more than 2,000 pregnant women struggling with addiction in partnership with Maryhaven's Women Program. Since 2010, more than 500 expectant mothers with opiate use disorder have received high-risk obstetrics care at OSUWMC's Substance Abuse, Treatment, Education and Prevention Program (STEPP) clinic. Both programs work from a model of harm reduction rather than harm elimination

Large scale copy number variation (CNV) at 14q12 is associated with the presence of genomic abnormalities in neoplasia

BACKGROUND: Advances made in the area of microarray comparative genomic hybridization (aCGH) have enabled the interrogation of the entire genome at a previously unattainable resolution. This has lead to the discovery of a novel class of alternative entities called large-scale copy number variations (CNVs). These CNVs are often found in regions of closely linked sequence homology called duplicons that are thought to facilitate genomic rearrangements in some classes of neoplasia. Recently, it was proposed that duplicons located near the recurrent translocation break points on chromosomes 9 and 22 in chronic myeloid leukemia (CML) may facilitate this tumor-specific translocation. Furthermore, ~15–20% of CML patients also carry a microdeletion on the derivative 9 chromosome (der(9)) and these patients have a poor prognosis. It has been hypothesised that der(9) deletion patients have increased levels of chromosomal instability. RESULTS: In this study aCGH was performed and identified a CNV (RP11-125A5, hereafter called CNV14q12) that was present as a genomic gain or loss in 10% of control DNA samples derived from cytogenetically normal individuals. CNV14q12 was the same clone identified by Iafrate et al. as a CNV. Real-time polymerase chain reaction (Q-PCR) was used to determine the relative frequency of this CNV in DNA from a series of 16 CML patients (both with and without a der(9) deletion) together with DNA derived from 36 paediatric solid tumors in comparison to the incidence of CNV in control DNA. CNV14q12 was present in ~50% of both tumor and CML DNA, but was found in 72% of CML bearing a der(9) microdeletion. Chi square analysis found a statistically significant difference (p ≤ 0.001) between the incidence of this CNV in cancer and normal DNA and a slightly increased incidence in CML with deletions in comparison to those CML without a detectable deletion. CONCLUSION: The increased incidence of CNV14q12 in tumor samples suggests that either acquired or inherited genomic variation of this new class of variation may be associated with onset or progression of neoplasia

PROTECCIÓN QUE EL ESTADO MEXICANO DEBE BRINDAR AL ADULTO MAYOR RESPECTO DE SU PATRIMONIO: LOS JUZGADORES DEL ESTADO DE MÉXICO

La reforma constitucional de 2011, colocó en el centro del sistema jurídico mexicano a los Derechos Humanos así, el artículo 1° constitucional señala: “Todas las autoridades, en el ámbito de sus competencias, tienen la obligación de promover, respetar, proteger y garantizar los derechos humanos de conformidad con los principios de universalidad, interdependencia, indivisibilidad y progresividad. En consecuencia, el Estado deberá prevenir, investigar, sancionar y reparar las violaciones a los derechos humanos, en los términos que establezca la ley.” Para efectos de que los adultos mayores estén en aptitud de dinamizar sus derechos y estos no queden sólo en el terreno de ideal normativo, el Estado mexicano, como garante de los derechos de los gobernados debe ir adaptando las normas protectoras conforme se presenten cambios sociales. El derecho debe ser tan dinámico como la propia sociedad, la normatividad debe revisarse en forma permanente y el legislador debe de realizar las adecuaciones pertinentes para que los derechos se dinamicen en términos de efectividad. Respecto de la protección del patrimonio de los adultos mayores es una prioridad revisar no sólo la armónica normatividad que ha de aplicar el juzgador, ya que en el diario quehacer jurisdiccional se perciben las más variadas acciones que ejercen fundamentalmente familiares para despojar de sus bienes a los adultos mayores, sin que ellos reciban beneficio directo alguno.La presente tesis muestra a través de su desarrollo el marco jurídico existente en cuanto a la protección del patrimonio del hombre de la tercera edad en el estado de México. En conjunto con la información del párrafo anterior se muestran datos estadísticos acerca de esta rama de la población (las personas de la tercera edad), así como del sistema judicial en materia civil que existe en el estado de México para la protección de sus patrimonio

Using Colistin as a Trojan Horse: Inactivation of Gram-Negative Bacteria with Chlorophyllin

Colistin (polymyxin E) is a membrane-destabilizing antibiotic used against Gram-negative bacteria. We have recently reported that the outer membrane prevents the uptake of antibacterial chlorophyllin into Gram-negative cells. In this study, we used sub-toxic concentrations of colistin to weaken this barrier for a combination treatment of Escherichia coli and Salmonella enterica serovar Typhimurium with chlorophyllin. In the presence of 0.25 µg/mL colistin, chlorophyllin was able to inactivate both bacteria strains at concentrations of 5–10 mg/L for E. coli and 0.5–1 mg/L for S. Typhimurium, which showed a higher overall susceptibility to chlorophyllin treatment. In accordance with a previous study, chlorophyllin has proven antibacterial activity both as a photosensitizer, illuminated with 12 mW/cm2, and in darkness. Our data clearly confirmed the relevance of the outer membrane in protection against xenobiotics. Combination treatment with colistin broadens chlorophyllin’s application spectrum against Gram-negatives and gives rise to the assumption that chlorophyllin together with cell membrane-destabilizing substances may become a promising approach in bacteria control. Furthermore, we demonstrated that colistin acts as a door opener even for the photodynamic inactivation of colistin-resistant (mcr-1-positive) E. coli cells by chlorophyllin, which could help us to overcome this antimicrobial resistance

New labor curves of dilation and station to improve the accuracy of predicting labor progress.

BACKGROUND: The diagnosis of failure to progress, the most common indication for intrapartum cesarean delivery, is based on the assessment of cervical dilation and station over time. Labor curves serve as references for expected changes in dilation and fetal descent. The labor curves of Friedman, Zhang et al, and others are based on time alone and derived from mothers with spontaneous labor onset. However, labor induction is now common, and clinicians also consider other factors when assessing labor progress. Labor curves that consider the use of labor induction and other factors that influence labor progress have the potential to be more accurate and closer to clinical decision-making. OBJECTIVE: This study aimed to compare the prediction errors of labor curves based on a single factor (time) or multiple clinically relevant factors using two modeling methods: mixed-effects regression, a standard statistical method, and Gaussian processes, a machine learning method. STUDY DESIGN: This was a longitudinal cohort study of changes in dilation and station based on data from 8022 births in nulliparous women with a live, singleton, vertex-presenting fetus ≥35 weeks of gestation with a vaginal delivery. New labor curves of dilation and station were generated with 10-fold cross-validation. External validation was performed using a geographically independent group. Model variables included time from the first examination in the 20 hours before delivery; dilation, effacement, and station recorded at the previous examination; cumulative contraction counts; and use of epidural anesthesia and labor induction. To assess model accuracy, differences between each models predicted value and its corresponding observed value were calculated. These prediction errors were summarized using mean absolute error and root mean squared error statistics. RESULTS: Dilation curves based on multiple parameters were more accurate than those derived from time alone. The mean absolute error of the multifactor methods was better (lower) than those of the single-factor methods (0.826 cm [95% confidence interval, 0.820-0.832] for the multifactor machine learning and 0.893 cm [95% confidence interval, 0.885-0.901] for the multifactor mixed-effects method and 2.122 cm [95% confidence interval, 2.108-2.136] for the single-factor methods; P<.0001 for both comparisons). The root mean squared errors of the multifactor methods were also better (lower) than those of the single-factor methods (1.126 cm [95% confidence interval, 1.118-1.133] for the machine learning [P<.0001] and 1.172 cm [95% confidence interval, 1.164-1.181] for the mixed-effects methods and 2.504 cm [95% confidence interval, 2.487-2.521] for the single-factor [P<.0001 for both comparisons]). The multifactor machine learning dilation models showed small but statistically significant improvements in accuracy compared to the mixed-effects regression models (P<.0001). The multifactor machine learning method produced a curve of descent with a mean absolute error of 0.512 cm (95% confidence interval, 0.509-0.515) and a root mean squared error of 0.660 cm (95% confidence interval, 0.655-0.666). External validation using independent data produced similar findings. CONCLUSION: Cervical dilation models based on multiple clinically relevant parameters showed improved (lower) prediction errors compared to models based on time alone. The mean prediction errors were reduced by more than 50%. A more accurate assessment of departure from expected dilation and station may help clinicians optimize intrapartum management

Modulation by decitabine of gene expression and growth of osteosarcoma U2OS cells in vitro and in xenografts: Identification of apoptotic genes as targets for demethylation

<p>Abstract</p> <p>Background</p> <p>Methylation-mediated silencing of genes is one epigenetic mechanism implicated in cancer. Studies regarding the role of modulation of gene expression utilizing inhibitors of DNA methylation, such as decitabine, in osteosarcoma (OS) have been limited. A biological understanding of the overall effects of decitabine in OS is important because this particular agent is currently undergoing clinical trials. The objective of this study was to measure the response of the OS cell line, U2OS, to decitabine treatment both <it>in vitro </it>and <it>in vivo</it>.</p> <p>Results</p> <p>Microarray expression profiling was used to distinguish decitabine-dependent changes in gene expression in U2OS cells, and to identify responsive loci with demethylated CpG promoter regions. U2OS xenografts were established under the sub-renal capsule of immune-deficient mice to study the effect of decitabine <it>in vivo </it>on tumor growth and differentiation. Reduced nuclear methylation levels could be detected in xenografts derived from treated mice by immunohistochemistry utilizing a 5-methylcytidine antibody. Decitabine treatment reduced tumor xenograft size significantly (p < 0.05). Histological analysis of treated U2OS xenograft sections revealed a lower mitotic activity (p < 0.0001), increased bone matrix production (p < 0.0001), and a higher number of apoptotic cells (p = 0.0329). Microarray expression profiling of U2OS cultured cells showed that decitabine treatment caused a significant induction (p < 0.0025) in the expression of 88 genes. Thirteen had a ≥2-fold change, 11 of which had CpG-island-associated promoters. Interestingly, 6 of these 11 were pro-apoptotic genes and decitabine resulted in a significant induction of cell death in U2OS cells <it>in vitro </it>(p < 0.05). The 6 pro-apoptotic genes (<it>GADD45A</it>, <it>HSPA9B</it>, <it>PAWR</it>, <it>PDCD5</it>, <it>NFKBIA</it>, and <it>TNFAIP3</it>) were also induced to ≥2-fold <it>in vivo</it>. Quantitative methylation pyrosequencing confirmed that the tested pro-apoptotic genes had CpG-island DNA demethylationas a result of U2OS decitabine treatment both <it>in vitro </it>and in xenografts</p> <p>Conclusion</p> <p>These data provide new insights regarding the use of epigenetic modifiers in OS, and have important implications for therapeutic trials involving demethylation drugs. Collectively, these data have provided biological evidence that one mode of action of decitabine may be the induction of apoptosis utilizing promoter-CpG demethylation of specific effectors in cell death pathways in OS.</p

Distributed Sensing, Computing, Communication, and Control Fabric: A Unified Service-Level Architecture for 6G

With the advent of the multimodal immersive communication system, people can interact with each other using multiple devices for sensing, communication and/or control either onsite or remotely. As a breakthrough concept, a distributed sensing, computing, communications, and control (DS3C) fabric is introduced in this paper for provisioning 6G services in multi-tenant environments in a unified manner. The DS3C fabric can be further enhanced by natively incorporating intelligent algorithms for network automation and managing networking, computing, and sensing resources efficiently to serve vertical use cases with extreme and/or conflicting requirements. As such, the paper proposes a novel end-to-end 6G system architecture with enhanced intelligence spanning across different network, computing, and business domains, identifies vertical use cases and presents an overview of the relevant standardization and pre-standardization landscape

Association of Recorded Estimated Fetal Weight and Cesarean Delivery in Attempted Vaginal Delivery at Term:

To evaluate the association between documentation of estimated fetal weight, and its value, with cesarean delivery

Outcomes of Induction vs Prelabor Cesarean Delivery at \u3c33 Weeks for Hypertensive Disorders of Pregnancy

BACKGROUND: Hypertensive disorders of pregnancy are the leading cause of indicated preterm birth; however, the optimal delivery approach for pregnancies complicated by preterm hypertensive disorders of pregnancy remains uncertain. OBJECTIVE: This study aimed to compare maternal and neonatal morbidity in patients with hypertensive disorders of pregnancy who either went induction of labor or prelabor cesarean delivery at \u3c33 \u3eweeks\u27 gestation. In addition, we aimed to quantify the length of induction of labor and rate of vaginal delivery in those who underwent induction of labor. STUDY DESIGN: This is a secondary analysis of an observational study which included 115,502 patients in 25 hospitals in the United States from 2008 to 2011. Patients were included in the secondary analysis if they were delivered for pregnancy associated hypertension (gestational hypertension or preeclampsia) between 23 RESULTS: A total of 471 patients met inclusion criteria, of whom 271 (58%) underwent induction of labor and 200 (42%) underwent prelabor cesarean delivery. Composite maternal morbidity was 10.2% in the induction group and 21.1% in the cesarean delivery group (unadjusted odds ratio, 0.42 [0.25-0.72]; adjusted odds ratio, 0.44 [0.26-0.76]). Neonatal morbidity in the induction group vs the cesarean delivery was 51.9% and 63.8 %, respectively (unadjusted odds ratio, 0.61 [0.42-0.89]; adjusted odds ratio, 0.71 [0.48-1.06]). The frequency of vaginal delivery in the induction group was 53% (95% confidence interval, 46.8-58.7) and the median duration of labor was 13.9 hours (interquartile range, 8.7-22.2). The frequency of vaginal birth was higher in patients at or beyond 29 weeks (39.9% at 24 CONCLUSION: Among patients delivered for hypertensive disorders of pregnancy \u3c3