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AbstractFew evidence-based interventions exist to improve person-centred maternity care in low-resource settings. This study aimed to understand whether a quality improvement (QI) intervention could improve person-centred maternity care (PCMC) experiences for women delivering in public health facilities in Kenya. A pre–post design was used to examine changes in PCMC scores across three intervention and matched control facilities at baseline (n = 491) and endline (n = 677). A QI intervention, using the Model for Improvement, was implemented in three public health facilities in Nairobi and Kiambu Counties in Kenya. Difference-in-difference analyses using models that included main effects of both treatment group and survey round was conducted to understand the impact of the intervention on PCMC scores. Findings suggest that intervention facilities’ average total PCMC score decreased by 5.3 points post-intervention compared to baseline (95% CI: −8.8, −1.9) and relative to control facilities, holding socio-demographic and facility variables constant. Additionally, the intervention was significantly associated with a 1.8-point decrease in clinical quality index pre–post-intervention (95% CI: −2.9, −0.7), decreased odds of provider visits, and less likelihood to plan to use postpartum family planning. While improving the quality of women’s experiences during childbirth is a critical component to ensure comprehensive, high-quality maternity care experiences and outcomes, further research is required to understand which intervention methods may be most appropriate to improve PCMC in resource-constrained settings.

BACKGROUND: Limited evidence exists on how women's experiences of care, specifically person-centered maternity care during childbirth, influence maternal and newborn health outcomes. OBJECTIVE: This study aimed to examine the associations between person-centered maternity care and maternal and newborn health outcomes. STUDY DESIGN: Longitudinal data were collected with 1014 women who completed baseline at a health facility and followed up at 2 weeks and 10 weeks after birth. A validated 30-item person-centered maternity care scale was administered to postpartum women within 48 hours after childbirth. The person-centered maternity care scale has 3 subscales: dignity and respect, communication and autonomy, and supportive care. Bivariate and multivariable log Poisson regressions were used to examine the relationship between person-centered maternity care and reported maternal complications, newborn complications, postpartum depression, postpartum family planning uptake, exclusive breastfeeding, and newborn immunizations. RESULTS: Controlling for demographic characteristics, women with high total person-centered maternity care score at baseline had significantly lower risk of reporting maternal complications (adjusted relative risk, 0.63; 95% confidence interval, 0.42–0.95), screening positive for depression (adjusted relative risk, 0.55; 95% confidence interval, 0.38–0.81), and reporting newborn complications (adjusted relative risk, 0.74; 95% confidence interval, 0.56–0.97), respectively, than women with low total person-centered maternity care scores. Women with high scores on the supportive care subscale had significantly lower risk of reporting maternal and newborn complications than women with low scores on these subscales (adjusted relative risk, 0.52 [95% confidence interval, 0.42–0.65] and 0.74 [95% confidence interval, 0.60–0.91], respectively). Significant associations were found between all 3 subscale scores and screening positive for depression. Women with high total person-centered maternity care scores were also more likely to adopt a family planning method than those with low scores (adjusted relative risk, 1.25; 95% confidence interval, 1.02–1.52). In particular, women with high scores on the communication and autonomy subscale had significantly higher odds of adopting a family planning method than women with low scores (risk ratio, 1.15; 95% confidence interval, 1.08–1.23). CONCLUSION: Improving person-centered maternity care may improve maternal and newborn health outcomes. Specifically, improving supportive care may decrease the risk of maternal and newborn complications, whereas improving communication and autonomy may increase postpartum family planning uptake.

Single-cell imaging has emerged as a powerful means to study viral replication dynamics and identify sites of virus–host interactions. Multivariate aspects of viral replication cycles yield challenges inherent to handling large, complex imaging datasets. Herein, we describe the design and implementation of an automated, imaging-based strategy, “Human Immunodeficiency Virus Red-Green-Blue” (HIV RGB), for deriving comprehensive single-cell measurements of HIV-1 unspliced (US) RNA nuclear export, translation, and bulk changes to viral RNA and protein (HIV-1 Rev and Gag) subcellular distribution over time. Differentially tagged fluorescent viral RNA and protein species are recorded using multicolor long-term (>24 h) time-lapse video microscopy, followed by image processing using a new open-source computational imaging workflow dubbed “Nuclear Ring Segmentation Analysis and Tracking” (NR-SAT) based on ImageJ plugins that have been integrated into the Konstanz Information Miner (KNIME) analytics platform. We describe a typical HIV RGB experimental setup, detail the image acquisition and NR-SAT workflow accompanied by a step-by-step tutorial, and demonstrate a use case wherein we test the effects of perturbing subcellular localization of the Rev protein, which is essential for viral US RNA nuclear export, on the kinetics of HIV-1 late-stage gene regulation. Collectively, HIV RGB represents a powerful platform for single-cell studies of HIV-1 post-transcriptional RNA regulation. Moreover, we discuss how similar NR-SAT-based design principles and open-source tools might be readily adapted to study a broad range of dynamic viral or cellular processes.

Background More than 600 000 coronary stents are implanted during percutaneous coronary interventions (PCIs) annually in the United States. Because no real‐world surveillance system exists to monitor their long‐term safety, claims data are often used for this purpose. The extent to which adverse events identified with claims data can be reasonably attributed to a specific medical device is uncertain. Methods and Results We used deterministic matching to link the NCDR (National Cardiovascular Data Registry) CathPCI Registry to Medicare fee‐for‐service claims for patients aged ≥65 years who underwent PCI with drug‐eluting stents (DESs) between July 1, 2009 and December 31, 2013. We identified subsequent PCIs within 1 year of the index procedure in Medicare claims as potential safety events. We linked these subsequent PCIs back to the NCDR CathPCI Registry to ascertain how often the revascularization could be reasonably attributed to the same coronary artery as the index PCI (ie, target vessel revascularization). Of 415 306 DES placements in 368 194 patients, 33 174 repeat PCIs were identified in Medicare claims within 1 year. Of these, 28 632 (86.3%) could be linked back to the NCDR CathPCI Registry; 16 942 (51.1% of repeat PCIs) were target vessel revascularizations. Of these, 8544 (50.4%) were within a previously placed DES: 7652 for in‐stent restenosis and 1341 for stent thrombosis. Of 16 176 patients with a claim for acute myocardial infarction in the follow‐up period, 4446 (27.5%) were attributed to the same coronary artery in which the DES was implanted during the index PCI (ie, target vessel myocardial infarction). Of 24 288 patients whose death was identified in claims data, 278 (1.1%) were attributed to the same coronary artery in which the DES was implanted during the index PCI. Conclusions Most repeat PCIs following DES stent implantation identified in longitudinal claims data could be linked to real‐world registry data, but only half could be reasonably attributed to the same coronary artery as the index procedure. Attribution among those with acute myocardial infarction or who died was even less frequent. Safety signals identified using claims data alone will require more in‐depth examination to accurately assess stent safety.

Few evidence-based interventions exist to improve person-centred maternity care in low-resource settings. This study aimed to understand whether a quality improvement (QI) intervention could improve person-centred maternity care (PCMC) experiences for women delivering in public health facilities in Kenya. A pre-post design was used to examine changes in PCMC scores across three intervention and matched control facilities at baseline (n = 491) and endline (n = 677). A QI intervention, using the Model for Improvement, was implemented in three public health facilities in Nairobi and Kiambu Counties in Kenya. Difference-in-difference analyses using models that included main effects of both treatment group and survey round was conducted to understand the impact of the intervention on PCMC scores. Findings suggest that intervention facilities' average total PCMC score decreased by 5.3 points post-intervention compared to baseline (95% CI: -8.8, -1.9) and relative to control facilities, holding socio-demographic and facility variables constant. Additionally, the intervention was significantly associated with a 1.8-point decrease in clinical quality index pre-post-intervention (95% CI: -2.9, -0.7), decreased odds of provider visits, and less likelihood to plan to use postpartum family planning. While improving the quality of women's experiences during childbirth is a critical component to ensure comprehensive, high-quality maternity care experiences and outcomes, further research is required to understand which intervention methods may be most appropriate to improve PCMC in resource-constrained settings.

Invariant natural killer T (iNKT) cells are innate T lymphocytes that promote host defense against a variety of microbial pathogens. Whether microbial ligands are required for their protective effects remains unclear. Here, we show that iNKT cells stimulate human-monocyte-derived dendritic cells (DCs) to produce inflammatory mediators in a manner that does not require the presence of microbial compounds. Interleukin 2 (IL-2)-exposed iNKT cells selectively induced repeated cytoplasmic Ca2+ fluxes in DCs that were dependent on signaling by the P2X7 purinergic receptor and mediated by ATP released during iNKT-DC interactions. Exposure to iNKT cells led to DC cyclooxygenase 2 (PTGS2) gene transcription, and release of PGE2 that was associated with vascular permeabilization in vivo. Additionally, soluble factors were released that induced neutrophil recruitment and activation and enhanced control of Candida albicans. These results suggest that sterile interactions between iNKT cells and monocyte-derived DCs lead to the production of non-redundant inflammatory mediators that promote neutrophil responses.

Retroviruses encode cis-acting RNA nuclear export elements that override nuclear retention of intron-containing viral mRNAs including the full-length, unspliced genomic RNAs (gRNAs) packaged into assembling virions. The HIV-1 Rev-response element (RRE) recruits the cellular nuclear export receptor CRM1 (also known as exportin-1/XPO1) using the viral protein Rev, while simple retroviruses encode constitutive transport elements (CTEs) that directly recruit components of the NXF1(Tap)/NXT1(p15) mRNA nuclear export machinery. How gRNA nuclear export is linked to trafficking machineries in the cytoplasm upstream of virus particle assembly is unknown. Here we used long-term (>24 h), multicolor live cell imaging to directly visualize HIV-1 gRNA nuclear export, translation, cytoplasmic trafficking, and virus particle production in single cells. We show that the HIV-1 RRE regulates unique, en masse, Rev- and CRM1-dependent "burst-like" transitions of mRNAs from the nucleus to flood the cytoplasm in a non-localized fashion. By contrast, the CTE derived from Mason-Pfizer monkey virus (M-PMV) links gRNAs to microtubules in the cytoplasm, driving them to cluster markedly to the centrosome that forms the pericentriolar core of the microtubule-organizing center (MTOC). Adding each export element to selected heterologous mRNAs was sufficient to confer each distinct export behavior, as was directing Rev/CRM1 or NXF1/NXT1 transport modules to mRNAs using a site-specific RNA tethering strategy. Moreover, multiple CTEs per transcript enhanced MTOC targeting, suggesting that a cooperative mechanism links NXF1/NXT1 to microtubules. Combined, these results reveal striking, unexpected features of retroviral gRNA nucleocytoplasmic transport and demonstrate roles for mRNA export elements that extend beyond nuclear pores to impact gRNA distribution in the cytoplasm.

Nocturnal habits, affinity for eerie places, and silent, darting flight have made bats the subjects of a great deal of folklore and superstition through the years. Given their ability to function in the dark when and where humans cannot, it is no wonder that bats have long been associated with the supernatural. Bats remain poorly understood even today. This revised 5-page fact sheet describes the species of bats that occur in Florida and provides simple tips for their identification. It was written by Holly K. Ober, Martin B. Main, and Ginger M. Allen and published by the UF Department of Wildlife Ecology and Conservation, November 2010. WEC 186/UW203: Bats of Florida (ufl.edu)

The Florida Environment series, by Martin B. Main and Ginger M. Allen is published by the UF Department of Wildlife Ecology and Conservation, July 2007.

The Florida Environment series, by Martin B. Main and Ginger M. Allen is published by the UF Department of Wildlife Ecology and Conservation, July 2007.

The Florida Environment series, by Martin B. Main and Ginger M. Allen is published by the UF Department of Wildlife Ecology and Conservation, July 2007. Revised October 2007.

The Florida Environment series, by Martin B. Main and Ginger M. Allen is published by the UF Department of Wildlife Ecology and Conservation, July 2007.

This 7-page fact sheet is part of the Florida's Environment series. Written by Martin B. Main and Ginger M. Allen, and published by the UF Department of Wildlife Ecology and Conservation, July 2007.

The Florida Environment series, by Martin B. Main and Ginger M. Allen is published by the UF Department of Wildlife Ecology and Conservation, July 2007.

The Florida Environment series, by Martin B. Main and Ginger M. Allen is published by the UF Department of Wildlife Ecology and Conservation, July 2007.

Revised! Circular 912, an 11-page publication by Martin B. Main, Ginger M. Allen, and Ken A. Langeland, provides guidance on choosing the right types of native freshwater plants, plants you should avoid, planting techniques, and maintenance tips. Includes list of references for additional information, extensive listing of native Florida freshwater wetland plants, and a table listing invasive, non-native wetland plants that are illegal in Florida. Originally published in 1997 as "Aquascaping: Planting and Maintenance" by the UF Fisheries and Aquatic Sciences Department, this version is published jointly by the UF Department of Wildlife Ecology and Conservation and The UF Department of Agronomy, July 2006.

WEC204, a 3-page fact sheet by Martin B. Main and Ginger M. Allen, provides tips and guidelines for developing a trifold brochure and includes a Microsoft Word template that can be copied and easily modified to present the reader a message. Published by the UF Department of Wildlife Ecology and Conservation, July 2006.

Florida's temperate to subtropical climate and abundant moisture create excellent growing conditions for ferns. Tropical storms and winds have transported fern spores to Florida from Caribbean islands and resulted in a high diversity of species. Consequently, Florida has more species of ferns than any state except Hawaii. There are an estimated 123 native fern and fern-like species, and at least 21 exotic and hybrid (crossbreeding of two species) species of ferns found in Florida. This document is Circular 1471, one of a series of the Wildlife Ecology and Conservation Department, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Published: May 2005.

Bromeliads are members of the pineapple family Bromeliaceae. They are perennial herbs that lack woody stems and typically grow on other plants or substrates. Bromeliads are not mosses as some of their common names suggest. They are flowering plants, although their blossoms can be very small. This document is CIR 1466, one of a series of the Wildlife Ecology and Conservation Department, UF/IFAS Extension. Original publication date September 2004. CIR 1466/UW205: Florida's Native Bromeliads (ufl.edu)

Florida has a diversity of habitats that support a rich flora and fauna. Ponce DeLeon, who explored Florida in 1513 in search of the mythical “Fountain of Youth,” recognized Florida for its beauty. DeLeon claimed Florida for Spain and named this new land “Pascua de Florida,” which translates as “feast of flowers.” Florida was sold to the United States in 1819 and became the 27th state of the United States on March 3, 1845. Today, Florida is known as the Sunshine State. The state capitol resides in Tallahassee. In honor of Florida's natural resources, state legislators have identified several state symbols. This document is Circular 1467, one of a series of the Department of Wildlife Ecology & Conservation, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication Date: May 2005. CIR1467/UW209: Florida State Symbols (ufl.edu)

Florida's geological history has been principally affected by changing sea levels, which influenced the formation of bedrock, the resulting soils, and surface topography. These geological factors influence Florida's plant communities, which support animal communities. Geological history, therefore, has influenced Florida's environment and ecology in the past, during the present, and will continue to have effects in the future. This document is Fact Sheet WEC 189, one of a series of the Department of Wildlife Ecology and Conservation, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication Date: May 2005. WEC189/UW208: Florida's Geological History (ufl.edu)

This document discusses representative species of the bats that occur in Florida and provides a simple key for their identification. This document is Fact Sheet WEC 186, one of a series of the Department of Wildlife Ecology & Conservation, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Publication date: October 2004. WEC 186/UW203: Bats of Florida (ufl.edu)

Ranching is important to Florida's economy and environment. Of Florida's 34.5-plus million acres of land, 10.2 million acres were utilized for farmland in 2003, with the majority partially or totally used for cattle production. Cattle production contributed more than $348 million to the state's economy in 2003. Ranching helps protect water resources, provides natural greenways for wildlife and recreation, and preserves many components of the natural landscape. Both the environmental and economical health of ranching are therefore critical to the state's citizens. This document is WEC 187, one of a series of the Wildlife Ecology and Conservation Department, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. First published as Extension document SS-SA-8, February 2000; revised September 2004. https://edis.ifas.ufl.edu/uw202

In this document we provide an introduction to ethnobotany in Florida and brief insight into the historical importance of some of Florida's plants to humans. We hope this document inspires readers to further investigate their region's ethnobotanical history. This information is not intended as a guide to using plants for medicinal or other purposes. This document is Circular 1439, one of a series of the Wildlife Ecology and Conservation Department, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Published: December 2002.

IntroductionPersonal digital devices that provide health information, such as the Apple Watch, have developed an increasing array of cardiopulmonary tracking features which have received regulatory clearance and are directly marketed to consumers. Despite their widespread and increasing use, data about the impact of personal digital device use on patient-reported outcomes and healthcare utilisation are sparse. Among a population of patients with atrial fibrillation and/or atrial flutter undergoing cardioversion, our primary aim is to determine the impact of the heart rate measurement, irregular rhythm notification, and ECG features of the Apple Watch on quality of life and healthcare utilisation.Methods and analysisWe are conducting a prospective, open-label multicentre pragmatic randomised clinical trial, leveraging a unique patient-centred health data sharing platform for enrolment and follow-up. A total of 150 patients undergoing cardioversion for atrial fibrillation or atrial flutter will be randomised 1:1 to receive the Apple Watch Series 6 or Withings Move at the time of cardioversion. The primary outcome is the difference in the Atrial Fibrillation Effect on QualiTy-of-life global score at 6 months postcardioversion. Secondary outcomes include inpatient and outpatient healthcare utilisation. Additional secondary outcomes include a comparison of the Apple Watch ECG and pulse oximeter features with gold-standard data obtained in routine clinical care settings.Ethics and disseminationThe Institutional Review Boards at Yale University, Mayo Clinic, and Duke University Health System have approved the trial protocol. This trial will provide important data to policymakers, clinicians and patients about the impact of the heart rate, irregular rhythm notification, and ECG features of widely used personal digital devices on patient quality of life and healthcare utilisation. Findings will be disseminated to study participants, at professional society meetings and in peer-reviewed journals.Trial registration numberNCT04468321.

BackgroundLimited evidence exists on how women's experiences of care, specifically person-centered maternity care during childbirth, influence maternal and newborn health outcomes.ObjectiveThis study aimed to examine the associations between person-centered maternity care and maternal and newborn health outcomes.Study designLongitudinal data were collected with 1014 women who completed baseline at a health facility and followed up at 2 weeks and 10 weeks after birth. A validated 30-item person-centered maternity care scale was administered to postpartum women within 48 hours after childbirth. The person-centered maternity care scale has 3 subscales: dignity and respect, communication and autonomy, and supportive care. Bivariate and multivariable log Poisson regressions were used to examine the relationship between person-centered maternity care and reported maternal complications, newborn complications, postpartum depression, postpartum family planning uptake, exclusive breastfeeding, and newborn immunizations.ResultsControlling for demographic characteristics, women with high total person-centered maternity care score at baseline had significantly lower risk of reporting maternal complications (adjusted relative risk, 0.63; 95% confidence interval, 0.42-0.95), screening positive for depression (adjusted relative risk, 0.55; 95% confidence interval, 0.38-0.81), and reporting newborn complications (adjusted relative risk, 0.74; 95% confidence interval, 0.56-0.97), respectively, than women with low total person-centered maternity care scores. Women with high scores on the supportive care subscale had significantly lower risk of reporting maternal and newborn complications than women with low scores on these subscales (adjusted relative risk, 0.52 [95% confidence interval, 0.42-0.65] and 0.74 [95% confidence interval, 0.60-0.91], respectively). Significant associations were found between all 3 subscale scores and screening positive for depression. Women with high total person-centered maternity care scores were also more likely to adopt a family planning method than those with low scores (adjusted relative risk, 1.25; 95% confidence interval, 1.02-1.52). In particular, women with high scores on the communication and autonomy subscale had significantly higher odds of adopting a family planning method than women with low scores (risk ratio, 1.15; 95% confidence interval, 1.08-1.23).ConclusionImproving person-centered maternity care may improve maternal and newborn health outcomes. Specifically, improving supportive care may decrease the risk of maternal and newborn complications, whereas improving communication and autonomy may increase postpartum family planning uptake.

Thoracic endovascular aneurysm repair has been well described in the literature as a treatment for a wide range of thoracic aortic pathologies. As with any intervention, there remains a risk of an unfavorable outcome, including endoleak, a term used to describe unexpected blood flow between the stent-graft and the wall of the excluded aneurysm. Endoleaks cause pressurized enlargement of the aneurysmal sac and may lead to catastrophic outcomes such as rupture and death. Type 1b endoleak represents a distal landing zone that is compromised by retrograde blood flow. Moreover, there is a lack of data on type 1b endoleaks and its management options. With the increase in emerging endovascular techniques and technologies, endoleaks are more frequent. However, the management of endoleaks is not standardized among different centers. The purpose of this article is to provide an overview of type 1b endoleaks after thoracic endovascular aneurysm repair, current management options, and our experience. [ABSTRACT FROM AUTHOR]

Deciding which instructional strategies to employ is a complex issue faced daily by middle school teachers. Although a wealth of literature on developmentally appropriate and responsive middle school instructional practices is available, the extent to which these strategies are employed is often unknown. Thus, the purpose of this study was to explore the instructional practices being utilized in core academic subjects in middle schools in a southeastern state. Using a mixed methods case study design, teachers' espoused beliefs about instruction and instructional practices were explored through a questionnaire and interviews and their actual practices were observed during classroom instruction. Findings revealed a disconnect between teachers' espoused beliefs and actual practices. One third of participating teachers indicated that the strategy employed most often in their classrooms is that of authentic inquiry, but there was little evidence of this in classroom observations. Instead, 78.3% of observations involved teacher-directed instruction or student seatwork supported by the teacher. Implications for school administrators are also discussed. (Contains 6 tables.)

Students in Ginger M. Eikmeier's high school classes link themes and terms from their readings to episodes of "The Simpsons." Because students are already familiar with "The Simpsons," Eikmeier believes that using the show supports students' comprehension and retention by activating prior knowledge. Additionally, it shows students that she cares about their interests when designing the curriculum. (Contains 1 figure.)