Risk factors for postpartum maternal mortality and hospital readmission in low- and middle-income countries: a systematic review.

BACKGROUND: In low- and middle-income countries, approximately two thirds of maternal deaths occur in the postpartum period. Yet, care for women beyond 24 h after discharge is limited. The objective of this systematic review is to summarize current evidence on socio-demographic and clinical risk factors for (1) postpartum mortality and (2) postpartum hospital readmission. METHODS: A combination of keywords and subject headings (i.e. MeSH terms) for postpartum maternal mortality or readmission were searched. Articles published up to January 9, 2021 were identified in MEDLINE, EMBASE, and CINAHL databases, without language restrictions. Studies reporting socio-demographic or clinical risk factors for postpartum mortality or readmission within six weeks of delivery among women who delivered a livebirth in a low- or middle-income country were included. Data were extracted independently by two reviewers based on study characteristics, population, and outcomes. Included studies were assessed for quality and risk of bias using the Downs and Black checklist for ratings of randomized and non-randomized studies. RESULTS: Of 8783 abstracts screened, seven studies were included (total N = 387,786). Risk factors for postpartum mortality included Caesarean mode of delivery, nulliparity, low or very low birthweight, and shock upon admission. Risk factors for postpartum readmission included Caesarean mode of delivery, HIV positive serostatus, and abnormal body temperature. CONCLUSIONS: Few studies reported individual socio-demographic or clinical risk factors for mortality or readmission after delivery in low- and middle-income countries; only Caesarean delivery was consistently reported. Further research is needed to identify factors that put women at greatest risk of post-discharge complications and mortality. Understanding post-discharge risk would facilitate targeted postpartum care and reduce adverse outcomes in women after delivery. TRIAL REGISTRATION: PROSPERO registration number: CRD42018103955.

Experimental and numerical observation of dark and bright breathers in the band gap of a diatomic electrical lattice.

We observe dark and bright intrinsic localized modes (ILMs), also known as discrete breathers, experimentally and numerically in a diatomic-like electrical lattice. The experimental generation of dark ILMs by driving a dissipative lattice with spatially homogenous amplitude is, to our knowledge, unprecedented. In addition, the experimental manifestation of bright breathers within the band gap is also novel in this system. In experimental measurements the dark modes appear just below the bottom of the top branch in frequency. As the frequency is then lowered further into the band gap, the dark ILMs persist, until the nonlinear localization pattern reverses and bright ILMs appear on top of the finite background. Deep into the band gap, only a single bright structure survives in a lattice of 32 nodes. The vicinity of the bottom band also features bright and dark self-localized excitations. These results pave the way for a more systematic study of dark breathers and their bifurcations in diatomic-like chains.

Linear impurity modes in an electrical lattice: Theory and experiment.

We examine theoretically and experimentally the localized electrical modes existing in a bi-inductive electrical lattice containing a bulk or a surface capacitive impurity. By means of the formalism of lattice Green's functions, we are able to obtain closed-form expressions for the frequencies of the impurity (bound-state) eigenmodes and for their associated spatial profiles. This affords us a systematic understanding of how these mode properties change as a function of the system parameters. We test these analytical results against experimental measurements, in both the bulk and surface cases, and find very good agreement. Last, we turn to a series of quench experiments, where either a parameter of the lattice or the lattice geometry itself is rapidly switched between two values or configurations. In all cases, we are able to naturally explain the results of such quench experiments from the larger analytical picture that emerges as a result of the detailed characterization of the impurity-mode solution branches.

Increased brain and behavioural susceptibility to portion size in children with loss of control eating.

BACKGROUND: Portion size influences intake (i.e. the portion size effect [PSE]), yet determinants of susceptibility to the PSE are unclear. OBJECTIVE: We tested whether children who reported an episode of loss of control (LOC) eating over the last 3 months would be more susceptible to the PSE and would show differential brain responses to food cues compared with children with no-LOC. METHODS: Across five sessions, children (n = 47; 7-10 years) consumed four test meals at 100%, 133%, 167% and 200% conditions for portion size and completed a functional magnetic resonance imaging scan while viewing pictures of foods varied by portion size and energy density (ED). Incidence of LOC over the past 3 months was self-reported. Random coefficient models were tested for differences in the shape of the PSE curve by LOC status. A whole-brain analysis was conducted to determine response to food cues during the functional magnetic resonance imaging. RESULTS: Reported LOC (n = 13) compared with no-LOC (n = 34) was associated with increased susceptibility to the PSE, as evidenced by a positive association with the linear slope (P < 0.005), and negative association with the quadratic slope (P < 0.05) of the intake curve. Children who reported LOC compared with no-LOC showed increased activation in the left cerebellum to small relative to large portions (P < 0.01) and right cerebellum to High-ED relative to Low-ED food cues (P < 0.01). CONCLUSION: Children who reported LOC were more susceptible to the PSE and showed alterations in food-cue processing in the cerebellum, a hindbrain region implicated in satiety signalling.

Analysis and observation of moving domain fronts in a ring of coupled electronic self-oscillators.

In this work, we consider a ring of coupled electronic (Wien-bridge) oscillators from a perspective combining modeling, simulation, and experimental observation. Following up on earlier work characterizing the pairwise interaction of Wien-bridge oscillators by Kuramoto-Sakaguchi phase dynamics, we develop a lattice model for a chain thereof, featuring an exponentially decaying spatial kernel. We find that for certain values of the Sakaguchi parameter α, states of traveling phase-domain fronts involving the coexistence of two clearly separated regions of distinct dynamical behavior, can establish themselves in the ring lattice. Experiments and simulations show that stationary coexistence domains of synchronization only manifest themselves with the introduction of a local impurity; here an incoherent cluster of oscillators can arise reminiscent of the chimera states in a range of systems with homogeneous oscillators and suitable nonlocal interactions between them.

Brain regions implicated in inhibitory control and appetite regulation are activated in response to food portion size and energy density in children.

OBJECTIVE: Large portions of energy-dense foods drive energy intake but the brain mechanisms underlying this effect are not clear. Our main objective was to investigate brain function in response to food images varied by portion size (PS) and energy density (ED) in children using functional magnetic resonance imaging (fMRI). METHODS AND DESIGN: Blood-oxygen-level-dependent (BOLD) fMRI was completed in 36 children (ages 7-10 years) after a 2-h fast while viewing food images at two levels of PS (Large PS, Small PS) and two levels of ED (High ED, Low ED). Children rated perceived fullness pre- and post-fMRI, as well as liking of images on visual analog scales post-fMRI. Anthropometrics were completed 4 weeks before the fMRI. Large PS vs Small PS and High ED vs Low ED were compared with region-of-interest analyses using Brain Voyager v 2.8. RESULTS: Region-of-interest analyses revealed that activation in the right inferior frontal gyrus (P=0.03) was greater for Large PS vs Small PS. Activation was reduced for High ED vs Low ED in the left hypothalamus (P=0.03). Main effects were no longer significant after adjustment for pre-fMRI fullness and liking ratings (PS, P=0.92; ED, P=0.58). CONCLUSION: This is the first fMRI study to report increased activation to large portions in a brain region that is involved in inhibitory control. These findings may contribute to understanding why some children overeat when presented with large portions of palatable food.

Prevalence of Ethanol Use Among Pregnant Women in Southwestern Uganda.

Introduction The prevalence of ethanol use in many Sub-Saharan African countries is high, but little research exists on use during pregnancy. The objective of this study was to assess the prevalence and predictors of ethanol use among pregnant women in Southwestern Uganda. Methods This descriptive, cross-sectional study was conducted in the maternity ward at Mbarara Regional Referral Hospital (MRRH). All pregnant women giving birth at MRRH between September 23, 2013 and November 23, 2013 were eligible for enrollment. The primary outcome was the proportion of women with ethanol use during pregnancy as determined by self-report. Secondary outcomes included the proportion with positive fatty acid ethyl ester (FAEE) results (indicating ethanol use) and positive TWEAK questionnaire results (indicating possible problem drinking). Predictors of ethanol use were assessed and stratified by patterns of ethanol intake. Results Overall, 505 mother-child dyads enrolled in the study. The proportion of women who reported any ethanol use during pregnancy was 16 % (n = 81, 95 % CI 13-19 %) and the prevalence of heavy drinking 6.3 % (n = 32, 95 % CI 3.8-7.9 %). The strongest predictor of use during pregnancy was pre-pregnancy use, with maternal education as a protective factor. Few neonates (n = 11, 2 %) tested positive for FAEE > 2.00 nmol/g in meconium. The TWEAK questionnaire captured 75 % of women who reported moderate/heavy drinking and aligned more with self-reported ethanol use than meconium results. Conclusions The substantial prevalence and clear predictors of ethanol use suggest that legislative action and educational interventions to increase awareness of potential harms could assist in efforts to decrease use during pregnancy in Southwestern Uganda.

Molecular characterization and antimicrobial susceptibility of Acinetobacter baumannii isolates obtained from two hospital outbreaks in Los Angeles County, California, USA.

BACKGROUND: Antibiotic resistant strains of Acinetobacter baumannii have been responsible for an increasing number of nosocomial infections including bacteremia and ventilator-associated pneumonia. In this study, we analyzed 38 isolates of A. baumannii obtained from two hospital outbreaks in Los Angeles County for the molecular epidemiology, antimicrobial susceptibility and resistance determinants. METHODS: Pulsed field gel electrophoresis, tri-locus multiplex PCR and multi-locus sequence typing (Pasteur scheme) were used to examine clonal relationships of the outbreak isolates. Broth microdilution method was used to determine antimicrobial susceptibility of these isolates. PCR and subsequent DNA sequencing were employed to characterize antibiotic resistance genetic determinants. RESULTS: Trilocus multiplex PCR showed these isolates belong to Global Clones I and II, which were confirmed to ST1 and ST2, respectively, by multi-locus sequence typing. Pulsed field gel electrophoresis analysis identified two clonal clusters, one with 20 isolates (Global Clone I) and the other with nine (Global Clone II), which dominated the two outbreaks. Antimicrobial susceptibility testing using 14 antibiotics indicated that all isolates were resistant to antibiotics belonging to four or more categories of antimicrobial agents. In particular, over three fourth of 38 isolates were found to be resistant to both imipenem and meropenem. Additionally, all isolates were found to be resistant to piperacillin, four cephalosporin antibiotics, ciprofloxacin and levofloxacin. Resistance phenotypes of these strains to fluoroquinolones were correlated with point mutations in gyrA and parC genes that render reduced affinity to target proteins. ISAba1 was detected immediately upstream of the bla OXA-23 gene present in those isolates that were found to be resistant to both carbapenems. Class 1 integron-associated resistance gene cassettes appear to contribute to resistance to aminoglycoside antibiotics. CONCLUSION: The two outbreaks were found to be dominated by two clonal clusters of A. baumannii belonging to MLST ST1 and ST2. All isolates were resistant to antibiotics of at least four categories of antimicrobial agents, and their antimicrobial susceptibility profiles correlate well with genetic determinants. The results of this study will facilitate our understanding of the molecular epidemiology, antimicrobial susceptibility and mechanisms of resistance of A. baumannii obtained from Los Angeles hospitals.

Expression of Apoptosis-regulating Proteins Bcl-2 and Bax in Lymph Node Aspirates from Dogs with Lymphoma.

BACKGROUND: Dysregulated apoptosis is a hallmark of tumorigenesis, and is also involved in resistance to cytotoxic treatment, and might be relevant in lymphoma in dogs. HYPOTHESIS/OBJECTIVES: That Bcl-2/Bax expression patterns differ between lymphoma immunophenotypes, and that Bcl-2/Bax ratio is correlated with prognosis. ANIMALS: Fifty-five client-owned dogs with multicentric lymphoma and 5 healthy dogs. METHODS: Prospective, case-control study. We compared 3 methods (flow cytometry, qRT-PCR, Western blot) for Bcl-2 and Bax quantification in a subset of dogs. The effect of time on Bcl-2/Bax ratios measured by flow cytometry was assessed in lymphoma cell lines. Immunophenotype and Bcl-2/Bax expression by flow cytometry were determined in LN aspirates from all dogs with multicentric lymphoma compared to healthy dogs. Progression-free survival (PFS) was retrospectively evaluated in a group of dogs all receiving similar treatment. RESULTS: Bcl-2/Bax ratios remain consistent for at least 5 days after sample collection. Bcl-2/Bax ratio was higher in dogs with T-cell lymphoma (TCL; median 0.97, range 0.37-1.36) compared to B-cell lymphoma (BCL; median 0.36, range 0.07-1.45) (P < .0001) and normal dogs (median 0.36, range 0.21-0.48) (P = .0006), respectively. Dogs with Bcl-2/Bax ratios higher than the median of the group experienced a median PFS of 101 days and dogs with ratios equal and lower than the median had PFS of 130 days (P = .19). CONCLUSIONS AND CLINICAL IMPORTANCE: Higher intrinsic resistance to apoptosis following cytotoxic treatment might contribute to the less favorable prognosis associated with multicentric TCL in dogs. Whether Bcl-2/Bax will be helpful to identify canine BCL and TCL with more aggressive and more indolent behavior, respectively, should be evaluated in larger prospective clinical studies.

Emergence and analysis of Kuramoto-Sakaguchi-like models as an effective description for the dynamics of coupled Wien-bridge oscillators.

We derive the Kuramoto-Sakaguchi model from the basic circuit equations governing two coupled Wien-bridge oscillators. A Wien-bridge oscillator is a particular realization of a tunable autonomous oscillator that makes use of frequency filtering (via an RC bandpass filter) and positive feedback (via an operational amplifier). In the past few years, such oscillators have started to be utilized in synchronization studies. We first show that the Wien-bridge circuit equations can be cast in the form of a coupled pair of van der Pol equations. Subsequently, by applying the method of multiple time scales, we derive the differential equations that govern the slow evolution of the oscillator phases and amplitudes. These equations are directly reminiscent of the Kuramoto-Sakaguchi-type models for the study of synchronization. We analyze the resulting system in terms of the existence and stability of various coupled oscillator solutions and explain on that basis how their synchronization emerges. The phase-amplitude equations are also compared numerically to the original circuit equations and good agreement is found. Finally, we report on experimental measurements of two coupled Wien-bridge oscillators and relate the results to the theoretical predictions.

Experimental study of synchronization of coupled electrical self-oscillators and comparison to the Sakaguchi-Kuramoto model.

We explore the collective phase dynamics of Wien-bridge oscillators coupled resistively. We carefully analyze the behavior of two coupled oscillators, obtaining a transformation from voltage to effective phase. From the phase dynamics we show that the coupling can be quantitatively described by Sakaguchi's modification to the Kuramoto model. We also examine an ensemble of oscillators whose frequencies are taken from a flat distribution within a fixed frequency interval. We characterize in detail the synchronized cluster, its initial formation, as well as its effect on unsynchronized oscillators, all as a function of a global coupling strength.

CD45+ and CD45- lymphocyte populations identified by flow cytometry from dogs with lymphoma exhibit similar morphology and the same clonal (B cell or T cell) lineage.

Flow cytometric analysis of canine lymphoma sometimes demonstrates a mixed population of CD45+ and CD45- lymphocytes. Recently, indolent forms of canine lymphoma have been described which are associated with the loss of CD45 expression, warranting further investigation of the role of CD45 in canine lymphoma. The purpose of this study was to compare morphology and assess clonal origin between CD45+ and CD45- lymphocyte populations identified by flow cytometry in confirmed cases of canine B- and T-cell lymphoma. Our hypothesis was that the CD45- population of lymphocytes represented a phenotypic variant of the CD45+ population. Fifteen client-owned dogs with lymphoma and distinct CD45+ and CD45- lymphocyte populations identified by flow cytometry were identified for a blinded, prospective assessment of morphology and clonal origin (B cell or T cell) between populations of sorted CD45+ and CD45- cells. Lymphocytes were isolated from 11 dogs for paired cytologic evaluation. In 10/11 dogs, the CD45+ and CD45- samples were similar (95% C.I., 0.301-1.00). DNA was harvested from sorted populations of CD45+ and CD45- cells from 12/15 dogs and PARR analysis produced amplicons of identical size from both populations, indicating that 100% (12/12) were of the same lineage, B cell or T cell (95% C.I., 0.757-1.00). Collectively, our data suggests that the CD45- population identified in dogs with lymphoma represents a phenotypic variant of the CD45+ population.

Synchronization in phase-coupled Kuramoto oscillator networks with axonal delay and synaptic plasticity.

We explore both analytically and numerically an ensemble of coupled phase oscillators governed by a Kuramoto-type system of differential equations. However, we have included the effects of time delay (due to finite signal-propagation speeds) and network plasticity (via dynamic coupling constants) inspired by the Hebbian learning rule in neuroscience. When time delay and learning effects combine, interesting synchronization phenomena are observed. We investigate the formation of spatiotemporal patterns in both one- and two-dimensional oscillator lattices with periodic boundary conditions and comment on the role of dimensionality.

Outbreak of bloodstream infections associated with multiuse dialyzers containing O-rings.

This report details an outbreak investigation conducted by the Los Angeles County Department of Public Health of 3 cases of bacterial infection among patients receiving hemodialysis who were treated at the same dialysis center in 2011. Improper disinfection of reusable dialyzers was hypothesized as the source of transmission.

Nonlinear localized modes in two-dimensional electrical lattices.

We report the observation of spontaneous localization of energy in two spatial dimensions in the context of nonlinear electrical lattices. Both stationary and moving self-localized modes were generated experimentally and theoretically in a family of two-dimensional square as well as honeycomb lattices composed of 6 × 6 elements. Specifically, we find regions in driver voltage and frequency where stationary discrete breathers, also known as intrinsic localized modes (ILMs), exist and are stable due to the interplay of damping and spatially homogeneous driving. By introducing additional capacitors into the unit cell, these lattices can controllably induce mobile discrete breathers. When more than one such ILMs are experimentally generated in the lattice, the interplay of nonlinearity, discreteness, and wave interactions generates a complex dynamics wherein the ILMs attempt to maintain a minimum distance between one another. Numerical simulations show good agreement with experimental results and confirm that these phenomena qualitatively carry over to larger lattice sizes.

Generation of localized modes in an electrical lattice using subharmonic driving.

We show experimentally and numerically that an intrinsic localized mode (ILM) can be stably produced (and experimentally observed) via subharmonic, spatially homogeneous driving in the context of a nonlinear electrical lattice. The precise nonlinear spatial response of the system has been seen to depend on the relative location in frequency between the driver frequency, ω(d), and the bottom of the linear dispersion curve, ω(0). If ω(d)/2 lies just below ω(0), then a single ILM can be generated in a 32-node lattice, whereas, when ω(d)/2 lies within the dispersion band, a spatially extended waveform resembling a train of ILMs results. To our knowledge, and despite its apparently broad relevance, such an experimental observation of subharmonically driven ILMs has not been previously reported.

Discrete breathers in a nonlinear electric line: modeling, computation, and experiment.

We study experimentally and numerically the existence and stability properties of discrete breathers in a periodic nonlinear electric line. The electric line is composed of single cell nodes, containing a varactor diode and an inductor, coupled together in a periodic ring configuration through inductors and driven uniformly by a harmonic external voltage source. A simple model for each cell is proposed by using a nonlinear form for the varactor characteristics through the current and capacitance dependence on the voltage. For an electrical line composed of 32 elements, we find the regions, in driver voltage and frequency, where n-peaked breather solutions exist and characterize their stability. The results are compared to experimental measurements with good quantitative agreement. We also examine the spontaneous formation of n-peaked breathers through modulational instability of the homogeneous steady state. The competition between different discrete breathers seeded by the modulational instability eventually leads to stationary n-peaked solutions whose precise locations is seen to sensitively depend on the initial conditions.

Traveling and stationary intrinsic localized modes and their spatial control in electrical lattices.

This work focuses on the production of both stationary and traveling intrinsic localized modes (ILMs), also known as discrete breathers, in two closely related electrical lattices; we demonstrate experimentally that the interplay between these two ILM types can be utilized for the purpose of spatial control. We describe a novel mechanism that is responsible for the motion of driven ILMs in this system, and quantify this effect by modeling in some detail the electrical components comprising the lattice.