Plos One
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Observational Study
Hemopexin and α1-microglobulin heme scavengers with differential involvement in preeclampsia and fetal growth restriction.
Hemopexin and α1-microglobulin act as scavengers to eliminate free heme-groups responsible for hemoglobin-induced oxidative stress. The present study evaluated maternal and fetal plasma concentrations of these scavengers in the different phenotypes of placenta-mediated disorders. Singleton pregnancies with normotensive fetal growth restriction [FGR] (n = 47), preeclampsia without FGR (n = 45) and preeclampsia with FGR (n = 51) were included prospectively as well as uncomplicated pregnancies (n = 49). ⋯ In maternal blood in preeclampsia with and without FGR, hemopexin was significantly lower (p = 0.003 and p<0.001, respectively) and α1-microglobulin was significantly higher (p<0.001 in both) whereas no difference existed in normotensive FGR mothers compared to controls. In contrast, in fetal blood in growth restricted fetuses with and without preeclampsia, both hemopexin and α1-microglobulin were significantly lower (p<0.001 and p = 0.001 for hemopexin, p = 0.016 and p = 0.013 for α1-microglobulin, respectively) with no difference in fetuses from preeclampsia without FGR in comparison to controls. Thus, hemopexin and α1-microglobulin present significantly altered concentrations in maternal blood in the maternal disease -preeclampsia- and in cord blood in the fetal disease -FGR-, which supports their differential role in placenta-mediated disorders in accordance with the clinical presentation of these disorders.
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Observational Study
Long term impact of ladder-related injuries as measured by the AQoL instrument.
Ladder-related falls are a common cause of patients presenting to emergency departments (ED) with serious injury. The impacts of ladder-related injuries were assessed at six-months post-injury using the quality of life, AQoL 4D Basic (AQoL) instrument. ⋯ Older males using ladders at home are at high risk for serious long-term injury. Injury prevention strategies and the safety instructions packaged with the ladder need to be targeted to this at-risk community group. There may also be a role for regulatory bodies to mandate a stabilising device to be included with the ladder at the time of purchase.
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Opioid overdose mortality continues to increase in the United States despite significant investments to reverse the epidemic. The national response to-date has focused primarily on reducing opioid prescribing, yet reductions in prescribing have been associated with patients reporting uncontrolled pain, psychological distress, and transition to illicit substances. The aim of this study is to qualitatively explore chronic pain management experiences among PLWH with a history of illicit substance use after long-term opioid therapy reductions or discontinuations. ⋯ After being reduced/discontinued from OPRs, HIV-positive patients with a history of substance use reported experimenting with a range of pain management modalities including nonpharmacological therapies and illicit substance use to manage symptoms of opioid withdrawal and pain. Providers should consider that any change to a patients' long-term opioid therapy may result in experimentation with pain management outside of the medical setting and may want to employ patient-centered, holistic approaches when managing patients' opioid prescriptions and chronic pain.
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Mentorship plays an essential role in enhancing the success of junior faculty. Previous evaluation tools focused on specific types of mentors or mentees. The main objective was to develop and provide validity evidence for a Mentor Evaluation Tool (MET) to assess the effectiveness of one-on-one mentoring for faculty in the academic health sciences. ⋯ The Mentor Evaluation Tool demonstrates evidence of validity for research, clinical, educational or career mentors in academic health science careers. However, MET did not distinguish individuals nominated as outstanding mentors from other mentors. MET validity evidence can be studied further with mentor-mentee pairs and to follow prospectively the rating of mentors before and after a mentorship training program.
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Timely delivery of fetal growth restriction (FGR) is important in reducing stillbirth. However, targeted earlier delivery of FGR preferentially removes smaller babies from later gestations, thereby right-shifting the distribution of birthweights at term. This artificially increases the birthweight cutoffs defining the lower centiles and redefines normally grown babies as small by population-based birthweight centiles. Our objective was to compare updated Australian national population-based birthweight centile charts over time with the prescriptive INTERGROWTH-21st standard. ⋯ Locally-derived population-based birthweight centiles are better for clinical audit of care but should not be updated. Prescriptive birthweight standards are less useful in defining 'small' due to their significant left-shift.