The United States has the highest maternal mortality rate among industrialized countries, and this rate is increasing.1 Historically, marginalized racial and ethnic groups have the highest rates of ...maternal mortality and morbidity 2 Poor interprofessional teamwork and communication during medical deteriorations in pregnancy are a leading cause of maternal deaths 3 This is a highly modifiable and improvable aspect of maternal health care. Perimortem cesarean delivery (advanced cardiac life support): The scenario was a term, pregnant patient brought into the emergency department after being found unresponsive at home. Care teams interpreted the fetal tracings based on the American Congress of Obstetricians and Gynecologists guidelines and nomenclature.5 EVALUATION METHOD AND FINDINGS We collected evaluation data via a posttraining survey, which had a response rate of 91 %.
Nasopharyngeal carriage is a precursor for pneumococcal disease and can be useful for evaluating pneumococcal conjugate vaccine (PCV) impact. We studied pre-PCV pneumococcal carriage among ...HIV-infected and -uninfected children in Mozambique. Between October 2012 and March 2013, we enrolled HIV-infected children age <5 years presenting for routine care at seven HIV clinics in 3 sites, including Maputo (urban-south), Nampula (urban-north), and Manhiça (rural-south). We also enrolled a random sample of HIV-uninfected children <5 years old from a demographic surveillance site in Manhiça. A single nasopharyngeal swab was obtained and cultured following enrichment in Todd Hewitt broth with yeast extract and rabbit serum. Pneumococcal isolates were serotyped by Quellung reaction and multiplex polymerase chain reaction. Factors associated with pneumococcal carriage were examined using logistic regression. Overall pneumococcal carriage prevalence was 80.5% (585/727), with similar prevalences among HIV-infected (81.5%, 339/416) and HIV-uninfected (79.1%, 246/311) children, and across age strata. Among HIV-infected, after adjusting for recent antibiotic use and hospitalization, there was no significant association between study site and colonization: Maputo (74.8%, 92/123), Nampula (83.7%, 82/98), Manhiça (84.6%, 165/195). Among HIV-uninfected, report of having been born to an HIV-infected mother was not associated with colonization. Among 601 pneumococcal isolates from 585 children, serotypes 19F (13.5%), 23F (13.1%), 6A (9.2%), 6B (6.2%) and 19A (5.2%) were most common. The proportion of serotypes included in the 10- and 13-valent vaccines was 44.9% and 61.7%, respectively, with no significant differences by HIV status or age group. Overall 36.9% (n = 268) of children were colonized with a PCV10 serotype and 49.7% (n = 361) with a PCV13 serotype. Pneumococcal carriage was common, with little variation by geographic region, age, or HIV status. PCV10 was introduced in April 2013; ongoing carriage studies will examine the benefits of PCV10 among HIV-infected and-uninfected children.
We present a catalog of 5324 massive stars in the Small Magellanic Cloud (SMC), with accurate spectral types compiled from the literature, and a photometric catalog for a subset of 3654 of these ...stars, with the goal of exploring their infrared properties. The photometric catalog consists of stars with infrared counterparts in the Spitzer SAGE-SMC survey database, for which we present uniform photometry from 0.3to24 Delta *mm in the UBVIJHKs +IRAC+MIPS24 bands. We compare the color-magnitude diagrams and color-color diagrams to those of stars in the Large Magellanic Cloud (LMC), finding that the brightest infrared sources in the SMC are also the red supergiants, supergiant Be (sgBe) stars, luminous blue variables, and Wolf-Rayet stars, with the latter exhibiting less infrared excess, the red supergiants being less dusty and the sgBe stars being on average less luminous. Among the objects detected at 24 Delta *mm in the SMC are a few very luminous hypergiants, four B-type stars with peculiar, flat spectral energy distributions, and all three known luminous blue variables. We detect a distinct Be star sequence, displaced to the red, and suggest a novel method of confirming Be star candidates photometrically. We find a higher fraction of Oe and Be stars among O and early-B stars in our SMC catalog, respectively, when compared to the LMC catalog, and that the SMC Be stars occur at higher luminosities. We estimate mass-loss rates for the red supergiants, confirming the correlation with luminosity even at the metallicity of the SMC. Finally, we confirm the new class of stars displaying composite A & F type spectra, the sgBe nature of 2dFS1804 and find the F0 supergiant 2dFS3528 to be a candidate luminous blue variable with cold dust.
On April 10, 2020, the FDA approved selumetinib (KOSELUGO, AstraZeneca) for the treatment of pediatric patients 2 years of age and older with neurofibromatosis type 1 who have symptomatic, inoperable ...plexiform neurofibromas. Approval was based on demonstration of a durable overall response rate per Response Evaluation in Neurofibromatosis and Schwannomatosis criteria and supported by observed clinical improvements in plexiform neurofibroma-related symptoms and functional impairments in 50 pediatric patients with inoperable plexiform neurofibromas in a single-arm, multicenter trial. The overall reponse rate per NCI investigator assessment was 66% (95% confidence interval, 51-79) with at least 12 months of follow-up. The median duration of response was not reached, and 82% of responding patients experienced duration of response ≥12 months. Clinical outcome assessment endpoints provided supportive efficacy data. Risks of selumetinib are consistent with MAPK (MEK) inhibitor class effects, including ocular, cardiac, musculoskeletal, gastrointestinal, and dermatologic toxicities. Safety was assessed across a pooled database of 74 pediatric patients with plexiform neurofibromas and supported by adult and pediatric selumetinib clinical trial data in cancer indications. The benefit-risk assessment for selumetinib in patients with inoperable plexiform neurofibromas was considered favorable.
•Temporally regulated gene modules are expressed at distinct phases of postmitotic RGC differentiation in mice.•Transcription factors and recognition molecules are selectively expressed by subsets of ...45 developing or adult RGC types.•Three models of visual deprivation showed that vision is dispensable for RGC type specification.•Visual deprivation does, however, affect molecular aspects of RGC maturation and maintenance.
The development and connectivity of retinal ganglion cells (RGCs), the retina’s sole output neurons, are patterned by activity-independent transcriptional programs and activity-dependent remodeling. To inventory the molecular correlates of these influences, we applied high-throughput single-cell RNA sequencing (scRNA-seq) to mouse RGCs at six embryonic and postnatal ages. We identified temporally regulated modules of genes that correlate with, and likely regulate, multiple phases of RGC development, ranging from differentiation and axon guidance to synaptic recognition and refinement. Some of these genes are expressed broadly while others, including key transcription factors and recognition molecules, are selectively expressed by one or a few of the 45 transcriptomically distinct types defined previously in adult mice. Next, we used these results as a foundation to analyze the transcriptomes of RGCs in mice lacking visual experience due to dark rearing from birth or to mutations that ablate either bipolar or photoreceptor cells. 98.5% of visually deprived (VD) RGCs could be unequivocally assigned to a single RGC type based on their transcriptional profiles, demonstrating that visual activity is dispensable for acquisition and maintenance of RGC type identity. However, visual deprivation significantly reduced the transcriptomic distinctions among RGC types, implying that activity is required for complete RGC maturation or maintenance. Consistent with this notion, transcriptomic alternations in VD RGCs significantly overlapped with gene modules found in developing RGCs. Our results provide a resource for mechanistic analyses of RGC differentiation and maturation, and for investigating the role of activity in these processes.
We present deep polarimetric observations at 154 MHz with the Murchison Widefield Array (MWA), covering 625 deg^2 centered on RA=0 h, Dec=-27 deg. The sensitivity available in our deep observations ...allows an in-band, frequency-dependent analysis of polarized structure for the first time at long wavelengths. Our analysis suggests that the polarized structures are dominated by intrinsic emission but may also have a foreground Faraday screen component. At these wavelengths, the compactness of the MWA baseline distribution provides excellent snapshot sensitivity to large-scale structure. The observations are sensitive to diffuse polarized emission at ~54' resolution with a sensitivity of 5.9 mJy beam^-1 and compact polarized sources at ~2.4' resolution with a sensitivity of 2.3 mJy beam^-1 for a subset (400 deg^2) of this field. The sensitivity allows the effect of ionospheric Faraday rotation to be spatially and temporally measured directly from the diffuse polarized background. Our observations reveal large-scale structures (~1 deg - 8 deg in extent) in linear polarization clearly detectable in ~2 minute snapshots, which would remain undetectable by interferometers with minimum baseline lengths >110 m at 154 MHz. The brightness temperature of these structures is on average 4 K in polarized intensity, peaking at 11 K. Rotation measure synthesis reveals that the structures have Faraday depths ranging from -2 rad m^-2 to 10 rad m^-2 with a large fraction peaking at ~+1 rad m^-2. We estimate a distance of 51+/-20 pc to the polarized emission based on measurements of the in-field pulsar J2330-2005. We detect four extragalactic linearly polarized point sources within the field in our compact source survey. Based on the known polarized source population at 1.4 GHz and non-detections at 154 MHz, we estimate an upper limit on the depolarization ratio of 0.08 from 1.4 GHz to 154 MHz.
Traditional micro air vehicles (MAVs) are miniature versions of full-scale aircraft from which their design principles closely follow. The first step in aircraft design is the development of a ...conceptual design, where basic specifications and vehicle size are established. Conceptual design methods do not rely on specific knowledge of the propulsion system, vehicle layout and subsystems; these details are addressed later in the design process. Non-traditional MAV designs based on birds or insects are less common and without well-established conceptual design methods. This paper presents a conceptual design process for hovering flapping-wing vehicles. An energy-based accounting of propulsion and aerodynamics is combined with a one degree-of-freedom dynamic flapping model. Important results include simple analytical expressions for flight endurance and range, predictions for maximum feasible wing size and body mass, and critical design space restrictions resulting from finite wing inertia. A new figure-of-merit for wing structural-inertial efficiency is proposed and used to quantify the performance of real and artificial insect wings. The impact of these results on future flapping-wing MAV designs is discussed in detail.
The water and dissolved inorganic carbon exported by rivers are important net fluxes that connect terrestrial and oceanic water and carbon reservoirs. For most rivers, the majority of dissolved ...inorganic carbon is in the form of bicarbonate. The riverine bicarbonate flux originates mainly from the dissolution of rock minerals by soil water carbon dioxide, a process called chemical weathering, which controls the buffering capacity and mineral content of receiving streams and rivers. Here we introduce an unprecedented high-temporal-resolution, 100-year data set from the Mississippi River and couple it with sub-watershed and precipitation data to reveal that the large increase in bicarbonate flux that has occurred over the past 50 years (ref. 3) is clearly anthropogenically driven. We show that the increase in bicarbonate and water fluxes is caused mainly by an increase in discharge from agricultural watersheds that has not been balanced by a rise in precipitation, which is also relevant to nutrient and pesticide fluxes to the Gulf of Mexico. These findings demonstrate that alterations in chemical weathering are relevant to improving contemporary biogeochemical budgets. Furthermore, land use change and management were arguably more important than changes in climate and plant CO2 fertilization to increases in riverine water and carbon export from this large region over the past 50 years.
An orbiting spacecraft and ground observatories have been used to obtain interferometric observations of cosmic radio sources. The Tracking and Data Relay Satellite System (TDRSS) was used as the ...orbiting observatory in conjunction with two 64-meter radio telescopes at ground observatories, one in Australia and one in Japan. The quasars 1730-130 (NRAO 530), 1510-089, and 1741-038 were observed at a frequency of 2.3 gigahertz, and a maximum projected baseline of 1.4 earth diameters was achieved. All quasar observations for which valid data were acquired resulted in detected fringes. Many of the techniques proposed for a dedicated very long baseline interferometry observatory in space were used successfully in this experiment.
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