Delivery outcomes after induction of labor among women with hypertensive disorders of pregnancy.

OBJECTIVE: Induction of labor is known to be safe and highly effective in low-risk women. However, only limited research considers the relative success rates of induction of labor among women with one or more obstetric comorbidities. Our objective was to determine if the risk of cesarean delivery after induction of labor (IOL) is increased in women with a spectrum of hypertensive disorders of pregnancy compared to women with normotensive pregnancies. STUDY DESIGN: We analyzed data from 1842 women undergoing IOL occurring at Grady Memorial Hospital in Atlanta, Georgia 2016-2018. We used multivariable log binomial models to estimate unadjusted and adjusted risk ratios (aRR) describing the association between hypertensive disorder diagnosis (preeclampsia with or without severe features, gestational hypertension, and chronic hypertension) and cesarean delivery, adjusting for demographics, pre-pregnancy conditions, and gestational age at delivery. RESULTS: Overall, 44% (n = 808) of women in our study were diagnosed with any hypertensive disorder. Among women with hypertensive disorders, 74% had a successful vaginal delivery after IOL as compared to 82% of women without a hypertensive disorder. In the fully adjusted model, women with preeclampsia with severe features (aRR: 1.6, 95% CI: (1.3, 2.0)) and chronic hypertension had the largest risk for cesarean delivery (aRR 1.3, 95% CI: 0.9, 1.7)) compared with women with a normotensive pregnancy. CONCLUSION: Our study suggests that while patients with certain hypertensive diagnoses may be at increased risk for cesarean delivery following IOL, most patients with hypertensive disorders were still able to undergo a successful vaginal delivery following IOL.

Assessing Influenza Vaccination Behaviors Among Medically Underserved Obstetric Patients.

Background: Despite recommendations, maternal influenza vaccine acceptance has stagnated around 50%. Materials and Methods: A prospective cohort study was conducted of pregnant women seen in the clinic from September 2018 to April 2019. Primary outcomes included influenza vaccine uptake and reasons for vaccine refusal, categorized based on the Health Belief Model. We compared characteristics between three vaccination groups (never refused, refused and vaccinated, and refused and not vaccinated) by using chi-square and one-way analysis of variance. We used multivariate logistic regression to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between patient characteristics and vaccine acceptance. Mixed-effects logistic regression models were used to explore the impact of provider-patient race concordance on influenza vaccine uptake. Results: Among 1666 women, 902 (54.1%) were vaccinated. Of these, 183 (20.3%) initially refused. Those who refused and were never vaccinated were more likely to be non-Hispanic black (aOR: 1.64, 95% CI: 1.05-2.56) and less likely to be Hispanic (aOR: 0.44, 95% CI: 0.24-0.81). Overall, perceived barriers were the most common reason for refusal (52.4%). Women who refused consistently were more likely to cite reasons related to perceived benefits (38.5% vs. 7.6%). Those who eventually accepted were more likely to cite cue to action (22.4% vs. 12.6%). Women who were race discordant with their provider were more likely to be vaccinated compared with those who were race concordant (57.9% vs. 52.9%, aOR: 1.16, 95% CI: 1.07-1.27). Conclusions: Women who refuse influenza vaccination in pregnancy may later choose to be vaccinated. Continued promotion of vaccination throughout pregnancy is crucial for vaccine uptake.

Suppressing the Neurospora crassa circadian clock while maintaining light responsiveness in continuous stirred tank reactors.

Neurospora crassa has been utilized as a model organism for studying biological, regulatory, and circadian rhythms for over 50 years. These circadian cycles are driven at the molecular level by gene transcription events to prepare for environmental changes. N. crassa is typically found on woody biomass and is commonly studied on agar-containing medium which mimics its natural environment. We report a novel method for disrupting circadian gene transcription while maintaining light responsiveness in N. crassa when held in a steady metabolic state using bioreactors. The arrhythmic transcription of core circadian genes and downstream clock-controlled genes was observed in constant darkness (DD) as determined by reverse transcription-quantitative PCR (RT-qPCR). Nearly all core circadian clock genes were up-regulated upon exposure to light during 11hr light/dark cycle experiments under identical conditions. Our results demonstrate that the natural timing of the robust circadian clock in N. crassa can be disrupted in the dark when maintained in a consistent metabolic state. Thus, these data lead to a path for the production of industrial scale enzymes in the model system, N. crassa, by removing the endogenous negative feedback regulation by the circadian oscillator.

Parental reports of emotional and behavioural difficulties on the SDQ for school-age children with vertically acquired HIV infection living in London.

This study uses a screening questionnaire (the Strengths and Difficulties Questionnaire, SDQ) to indicate levels of parental or carer concern about behavioural or emotional difficulties in a representative group of school-age children with vertically acquired HIV attending London clinics. Fourteen per cent of the total 107 children screened were reported to have behavioural and emotional difficulties scoring in the "abnormal" range. Older children tended to have higher scores. Overall, levels of reported difficulties were found to be similar to those reported for other chronic childhood illnesses and slightly higher than in the general child population.