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Objective To examine the smoking patterns of women who experienced stressful life events and the impact of racial disparities on the relationship between stressful life events, and prenatal/ postpartum smoking. Methods The study analyzed data from the Pregnancy Risk Assessment Monitoring System Phase 8 (2016-2018) survey across five states (CT, LA, MA, MO, WI). Four stressful life event categories were created using thirteen affiliated questions: financial, trauma, partner, and emotional. We assessed: 1) the association between smoking and stressful life events, 2) the impact of race on the relation between smoking and stressful life events, and 3) the long-term effects of smoking on health by assessing the association between smoking and maternal morbidity. Bivariate statistics and multivariate Poisson regression models were conducted. Results A total of 24,209 women from five states were included. 8.9% of respondents reported smoking during pregnancy, and 12.7% reported smoking postpartum. There was a significant association between all stressful life events and smoking. Trauma stressful life event had the strongest association with smoking during pregnancy (adjusted PR=2.01; CI: 1.79-2.27) and postpartum (adjusted PR= 1.80; CI: 1.64-1.98). Race and stressful life event interaction effects on smoking had varied significant findings, but at least one racial/ ethnic minority group (Black, Hispanic, Asian) had a higher smoking prevalence than non-Hispanic White per stressful life event category. Lastly, the prevalence of maternal morbidity was higher for smoking during pregnancy (adjusted PR= 1.28; CI: 1.19-1.38) and postpartum (adjusted PR= 1.30; CI: 1.22-1.38) compared to no smoking. Conclusions for Practice Culturally congruent, multi-disciplinary care teams are needed to address both clinical and social needs to reduce stressful life events and smoking. Screenings for stress should be standardized with a referral system in place to provide ongoing support., Author(s): Rauta Aver Yakubu [sup.1] [sup.2] , Kobi V. Ajayi [sup.1] [sup.3] , Shubhecchha Dhaurali [sup.1] [sup.4] , Keri Carvalho [sup.1] , Anna Kheyfets [sup.1] [sup.5] , Blessing Chidiuto Lawrence [...]

Children with single ventricle heart disease typically require a series of three operations, (1) Norwood, (2) Glenn, and (3) Fontan, which ultimately results in complete separation of the pulmonary and systemic circuits to improve pulmonary/systemic circulation. In the last stage, the Fontan operation, the inferior vena cava (IVC) is connected to the pulmonary arteries (PAs), allowing the remainder of deoxygenated blood to passively flow to the pulmonary circuit. It is hypothesized that optimizing the Fontan anatomy would lead to decreased power loss and more balanced hepatic flow distribution. One approach to optimizing the geometry is to create a patient-specific digital twin to simulate various configurations of the Fontan conduit, which requires a computational model of the proximal PA anatomy and resistance, as well as the distal Pulmonary Vascular Resistance (PVR), at the Glenn stage. To that end, an optimization pipeline was developed using 3D computational fluid dynamics (CFD) and 0D lumped parameter (LP) simulations to iteratively refine the PVR of each lung by minimizing the simulated flow and pressure error relative to patients' cardiac magnetic resonance (CMR) and catheterization (CATH) data. While the PVR can also be estimated directly by computing the ratio of pressure gradients and flow from CATH and CMR data, the computational approach can separately identify the different components of PVR along the Glenn pathway, allowing for a more detailed depiction of the Glenn vasculature. Results indicate good correlation between the optimized PVR of the CFD and LP models (n = 16), with an intraclass correlation coefficient (ICC) of 0.998 (p = 0.976) and 0.991 (p = 0.943) for the left and right lung, respectively. Furthermore, compared to CMR flow and CATH pressure data, the optimized PVR estimates result in mean outlet flow and pressure errors of less than 5%. The optimized PVR estimates also agree well with the computed PVR estimates from CATH pressure and CMR flow for both lungs, yielding a mean difference of less than 4%.

The growing restrictive abortion policies nationwide and the Supreme Court decision on Dobbs v. Jackson Women’s Health Organization place increasing barriers to abortion access in the United States. These restrictions disproportionately affect low-income people of color, immigrants, and non-English speakers, and have the potential to exacerbate already existing racial inequities in maternal and neonatal outcomes. The United States is facing a Black maternal health crisis where Black birthing people are more than twice as likely to experience maternal mortality and severe maternal morbidity compared to White birthing people. Restrictions creating geographic, transportation, and financial barriers to obtaining an abortion can result in increased rates of maternal death and adverse outcomes across all groups but especially among Black birthing people. Restrictive abortion laws in certain states will decrease already limited training opportunities in abortion care for medical professionals, despite the existing abortion provider shortage. There is an immediate need for federal legislation codifying broad abortion care access into law and expanding access to abortion training across medical education. This commentary explores the impact of restrictive abortion laws on the Black maternal health crisis through multiple pathways in a logic model. By identifying current barriers to abortion education in medical school and residency, we created a list of action items to expand abortion education and access.

Introduction Due to the disproportionate impact of COVID-19 on communities of color, racial disparities in maternal mortality and morbidity are likely to increase. However, neighborhood and social support factors have yet to be discussed as potential mechanisms by which COVID-19 can exacerbate racial disparities. Methods We examined literature on the role of neighborhood factors and social support on maternal health outcomes and provided analytical perspective on the potential impacts of COVID-19 on Black birthing people. Results Even prior to the pandemic, Black individuals were disproportionately impacted by psychosocial stress. However, the compounding effect of pre-existing and current pandemic psychosocial stressors may be a mechanism by which racial disparities are exacerbated and result in higher rates of maternal mortality and morbidity in Black women. Conclusion We recommend continued monitoring of data related to racial disparities in maternal mortality and morbidity throughout the pandemic. Given that Black women may be disproportionately impacted by psychosocial stress, it is necessary for leadership structures and communities to recognize the potential for worsening disparities and intervene., Author(s): Keri Carvalho [sup.1] , Anna Kheyfets [sup.1] , Blessing Lawrence [sup.1] , Alison Moky [sup.1] , Lauren Harris [sup.1] , Siwaar Abouhala [sup.1] , Ndidiamaka Amutah-Onukagha [sup.1] Author Affiliations: [...]

Purpose The purpose of this report from the field is to describe the process by which an multidisciplinary workgroup, selected by the CDC Foundation in partnership with maternal health experts, developed a definition of racism that would be specifically appropriate for inclusion on the Maternal Mortality Review Information Application (MMRIA) form. Description In the United States Black women are nearly 4 times more likely to experience a pregnancy-related death. Recent evidence points to racism as a fundamental cause of this inequity. Furthermore, the CDC reports that 3 of 5 pregnancy related deaths are preventable. With these startling facts in mind, the CDC created the Maternal Mortality Review Information Application (MMRIA) for use by Maternal Mortality Review Committees (MMRC) to support standardized data abstraction, case narrative development, documentation of committee decisions, and analysis on maternal mortality to inform practices and policies for preventing maternal mortality. Assessment Charged with the task of defining racism and discrimination as contributors to pregnancy related mortality, the work group established four goals to define their efforts: (1) the desire to create a product that was inclusive of all forms of racism and discrimination experienced by birthing people; (2) an acknowledgement of the legacy of racism in the U.S. and the norms in health care delivery that perpetuate racist ideology; (3) an acknowledgement of the racist narratives surrounding the issue of maternal mortality and morbidity that often leads to victim blaming; and (4) that the product would be user friendly for MMRCs. Conclusion The working group developed three definitions and a list of recommendations for action to help MMRC members provide suggested interventions to adopt when discrimination or racism were contributing factors to a maternal death. The specification of these definitions will allow the systematic tracking of the contribution of racism to maternal mortality through the MMRIA and allow a greater standardization of its identification across participating jurisdictions with MMRCs that use the form., Author(s): Rachel R. Hardeman [sup.1] , Anna Kheyfets [sup.2] , Allison Bryant Mantha [sup.3] , Andria Cornell [sup.4] , Joia Crear-Perry [sup.5] , Cornelia Graves [sup.6] , William Grobman [sup.7] [...]

Author(s): Rachel R. Hardeman [sup.1] , Anna Kheyfets [sup.2] , Allison Bryant Mantha [sup.3] , Andria Cornell [sup.4] , Joia Crear-Perry [sup.5] , Cornelia Graves [sup.6] , William Grobman [sup.7] [...]

Abstract Aims A method for estimating right ventricular ejection fraction (RVEF) from RV pressure waveforms was recently validated in an experimental model. Currently, cardiac magnetic resonance imaging (MRI) is the clinical reference standard for measurement of RVEF in pulmonary arterial hypertension (PAH). The present study was designed to test the hypothesis that the pressure‐based method can detect clinically significant reductions in RVEF as determined by cardiac MRI in patients with PAH. Methods and results RVEF estimates derived from analysis of RV pressure waveforms recorded during right heart catheterization (RHC) in 25 patients were compared with cardiac MRI measurements of RVEF obtained within 24 h. Three investigators blinded to cardiac MRI results independently performed pressure‐based RVEF estimation with the mean of their results used for comparison. Linear regression was used to assess correlation, and a receiver operator characteristic (ROC) curve was derived to define ability of the pressure‐based method to detect a maladaptive RV response, defined as RVEF

Abstract Ventricular interdependence plays an important role in pulmonary arterial hypertension (PAH). It can decrease left ventricular (LV) longitudinal strain (LVLS) and lead to a leftward displacement (“transverse shortening”) of the interventricular septum (sTS). For this study, we hypothesized the ratio of LVLS/sTS would be a sensitive marker of systolic ventricular interactions in PAH. In a cross‐sectional cohort of patients with PAH (n = 57) and matched controls (n = 57), we quantified LVLS and septal TS in the amplitude and time domain. We then characterized LV phenotypes using upset plots, ventricular interactions using network analysis, and longitudinal analysis in a representative cohort of 45 patients. We also measured LV metrics in mice subjected to pulmonary arterial banding (PAB) using a 7 T magnetic resonance imaging at baseline, Week 1, and Week 7 post‐PAB (N = 9). Patients with PAH had significantly reduced absolute LVLS (15.4 ± 3.4 vs. 20.1 ± 2.3%, p

Background Pulmonary arterial hypertension (PAH) is a heterogeneous and complex pulmonary vascular disease associated with substantial morbidity. Machine-learning algorithms (used in many PAH risk calculators) can combine established parameters with thousands of circulating biomarkers to optimise PAH prognostication, but these approaches do not offer the clinician insight into what parameters drove the prognosis. The approach proposed in this study diverges from other contemporary phenotyping methods by identifying patient-specific parameters driving clinical risk. Methods We trained a random forest algorithm to predict 4-year survival risk in a cohort of 167 adult PAH patients evaluated at Stanford University, with 20% withheld for (internal) validation. Another cohort of 38 patients from Sheffield University were used as a secondary (external) validation. Shapley values, borrowed from game theory, were computed to rank the input parameters based on their importance to the predicted risk score for the entire trained random forest model (global importance) and for an individual patient (local importance). Results Between the internal and external validation cohorts, the random forest model predicted 4-year risk of death/transplant with sensitivity and specificity of 71.0–100% and 81.0–89.0%, respectively. The model reinforced the importance of established prognostic markers, but also identified novel inflammatory biomarkers that predict risk in some PAH patients. Conclusion These results stress the need for advancing individualised phenotyping strategies that integrate clinical and biochemical data with outcome. The computational platform presented in this study offers a critical step towards personalised medicine in which a clinician can interpret an algorithm's assessment of an individual patient.

Abstract Background The role of interventricular mechanics in pediatric pulmonary arterial hypertension (PAH) and its relation to right ventricular (RV) dysfunction has been largely overlooked. Here, we characterize the impact of maintained pressure overload in the RV–pulmonary artery (PA) axis on myocardial strain and left ventricular (LV) mechanics in pediatric PAH patients in comparison to a preclinical PA-banding (PAB) mouse model. We hypothesize that the PAB mouse model mimics important aspects of interventricular mechanics of pediatric PAH and may be beneficial as a surrogate model for some longitudinal and interventional studies not possible in children. Methods Balanced steady-state free precession (bSSFP) cardiovascular magnetic resonance (CMR) images of 18 PAH and 17 healthy (control) pediatric subjects were retrospectively analyzed using CMR feature-tracking (FT) software to compute measurements of myocardial strain. Furthermore, myocardial tagged-CMR images were also analyzed for each subject using harmonic phase flow analysis to derive LV torsion rate. Within 48 h of CMR, PAH patients underwent right heart catheterization (RHC) for measurement of PA/RV pressures, and to compute RV end-systolic elastance (RV_Ees, a measure of load-independent contractility). Surgical PAB was performed on mice to induce RV pressure overload and myocardial remodeling. bSSFP-CMR, tagged CMR, and intra-cardiac catheterization were performed on 12 PAB and 9 control mice (Sham) 7 weeks after surgery with identical post-processing as in the aforementioned patient studies. RV_Ees was assessed via the single beat method. Results LV torsion rate was significantly reduced under hypertensive conditions in both PAB mice (p = 0.004) and pediatric PAH patients (p

Slow wave activity (SWA) during sleep is associated with synaptic regulation and memory processing functions. Each cycle of non-rapid-eye-movement (NREM) sleep demonstrates a waxing and waning amount of SWA during the transitions between stages N2 and N3 sleep, and the deeper N3 sleep is associated with an increased density of SWA. Further, SWA is an amalgam of different types of slow waves, each identifiable by their temporal coupling to spindle subtypes with distinct physiological features. The objectives of this study were to better understand the neurobiological properties that distinguish different slow wave and spindle subtypes, and to examine the composition of SWA across cycles of NREM sleep. We further sought to explore changes in the composition of NREM cycles that occur among aging adults. To address these goals, we analyzed subsets of data from two well-characterized cohorts of healthy adults: (1) The DREAMS Subjects Database (n = 20), and (2) The Cleveland Family Study (n = 60). Our analyses indicate that slow wave/spindle coupled events can be characterized as frontal vs. central in their relative distribution between electroencephalography (EEG) channels. The frontal predominant slow waves are identifiable by their coupling to late-fast spindles and occur more frequently during stage N3 sleep. Conversely, the central-associated slow waves are identified by coupling to early-fast spindles and favor occurrence during stage N2 sleep. Together, both types of slow wave/spindle coupled events form the composite of SWA, and their relative contribution to the SWA rises and falls across cycles of NREM sleep in accordance with depth of sleep. Exploratory analyses indicated that older adults produce a different composition of SWA, with a shift toward the N3, frontal subtype, which becomes increasingly predominant during cycles of NREM sleep. Overall, these data demonstrate that subtypes of slow wave/spindle events have distinct cortical propagation patterns and differ in their distribution across lighter vs. deeper NREM sleep. Future efforts to understand how slow wave sleep and slow wave/spindle coupling impact memory performance and neurological disease may benefit from examining the composition of SWA to avoid potential confounds that may occur when comparing dissimilar neurophysiological events.

Глобализация потребления — принципиально новый этап современного экономического развития. Интернет и цифровые технологии стали ключевыми факторами такой глобализации. Для исследования происходящих процессов был разработан метод количественной оценки, который рассматривает как фактическую, так и потенциальную глобализацию потребления. Процесс потребительской глобализации был проанализирован на примере стран Европейского союза. Полученные результаты позволяют сделать вывод, что уровень глобализации потребителей выше в странах с высоким доходом на душу населения и большей доступностью интернет-технологий. Самые высокие темпы роста глобализации отмечены в странах с низкими показателями глобализации — среди потребителей на Кипре, в Болгарии, Греции, Словении и Румынии. Разный уровень экономического развития, а также обеспеченности инфраструктурой и информационно-коммуникационными технологиями в государствах ЕС обуславливает различия в интенсивности процессов глобализации. Оценка глобализации потребления показала, что потребители всех стран Европейского союза в 2018 г. стали более глобализированными по сравнению с 2014 г. Полученные данные позволяют с уверенностью говорить о начале нового этапа экономической глобализации, в котором важную роль играют современные технологии и потребительские сети. Результаты исследования способствуют лучшему пониманию происходящих процессов глобализации. Индекс глобализации потребления может использоваться для анализа вовлеченности потребителей в международные отношения, изучения потенциала развития этих отношений, а также исследования различий в глобализации потребления между разными странами, отдельными регионами внутри одной страны и различными социальными группами населения.

Due to post-crisis slowdown in globalization, there is a necessity to structurally transform the Russian economy, strengthen the existing strategic partnerships and explore new economic growth points. Thus, the paper substantiates the importance of Russia’s participation in macro-regional economic associations. We examine the problems and risks of partnership development between the countries. Based on a mutual trade significance index, we analyse the importance of trade between the Russian Federation and the countries of the Eurasian Economic Union (EAEU), BRICS (Brazil, India, China and South Africa), and Shanghai Cooperation Organisation (SCO). The analysis shows that the share of Russian trade with the BRICS and SCO countries is growing fastest, largely due to the trade with China. At the same time, for the economic growth of the EAEU member countries, intra-union trade is less beneficial than the development of foreign trade relations. Moreover, recently the EAEU partners of Russia have been more interested in establishing and developing relations with third countries. The EAEU countries face a variety of problems during the integration process, including the fundamental incompatibility of the interests of the participants. Based on the obtained results, we demonstrate the development prospects of cooperation between Russia and various integration associations. The main obstacle for establishing new economic unions is the low competitiveness of the Russian economy. Even though the current situation does not enhance inter-regional cooperation, it provides Russia an opportunity to strengthen cooperation in the Asia-Pacific region and increase its participation in multilateral mechanisms. We conclude that in the medium term EAEU has to focus on strengthening the existing institutions and creating a modern flexible economic partnership.

Aims Ventricular–vascular coupling, the ratio between the right ventricle’s contractile state (Ees) and its afterload (Ea), may be a useful metric in the management of paediatric pulmonary arterial hypertension (PAH). In this study we assess the prognostic capacity of the ventricular–vascular coupling ratio (Ees/Ea) derived using right ventricular (RV) pressure alone in children with PAH.Methods One hundred and thirty paediatric patients who were diagnosed with PAH via right heart catheterisation were retrospectively reviewed over a 10-year period. Maximum RV isovolumic pressure and end-systolic pressure were estimated using two single-beat methods from Takeuchi et al (Ees/Ea_(Takeuchi)) and from Kind et al (Ees/Ea_(Kind)) and used with an estimate of end-systolic pressure to compute ventricular–vascular coupling from pressure alone. Patients were identified as either idiopathic/hereditary PAH or associated PAH (IPAH/HPAH and APAH, respectively). Haemodynamic data, clinical functional class and clinical worsening outcomes—separated into soft (mild) and hard (severe) event categories—were assessed. Adverse soft events included functional class worsening, syncopal event, hospitalisation due to a proportional hazard-related event and haemoptysis. Hard events included death, transplantation, initiation of prostanoid therapy and hospitalisation for atrial septostomy and Pott’s shunt. Cox proportional hazard modelling was used to assess whether Ees/Ea was predictive of time-to-event.Results In patients with IPAH/HPAH, Ees/Ea_(Kind) and Ees/Ea_(Takeuchi) were both independently associated with time to hard event (p=0.003 and p=0.001, respectively) and when adjusted for indexed pulmonary vascular resistance (p=0.032 and p=0.013, respectively). Neither Ees/Ea_(Kind) nor Ees/Ea_(Takeuchi) were associated with time to soft event. In patients with APAH, neither Ees/Ea_(Kind) nor Ees/Ea_(Takeuchi) were associated with time to hard event or soft event.Conclusions Ees/Ea derived from pressure alone is a strong independent predictor of adverse outcome and could be a potential powerful prognostic tool for paediatric PAH.

Background: Black women in the United States experience maternal mortality three to four times more often than white women (1, 2). States vary in degree of disparity, partially due to programs and policies available to pregnant people. In Massachusetts, Black women were approximately twice as likely as white women to experience pregnancy-associated mortality, with a large percentage of these deaths reported to be preventable (3).Methods: Using Massachusetts as a state-level comparison to national policies, we searched the US Congress and Massachusetts legislative databases for maternal health policies from 2010 to 2020. We screened 1,421 national and 360 Massachusetts bills, following set inclusion/exclusion criteria. Data analysis included (1) assessment of bill characteristics, (2) thematic analysis, and a (3) quality appraisal following an adapted model of the analytical framework for evaluating public health policy proposed by the National Collaborating Centre for Healthy Public Policy. Additionally, our data analysis identified the level of racism (internalized, interpersonal or institutional) that each policy addressed.Results: From 2010 to 2020, 31 national and 16 state-level policies were proposed that address maternal health and racial disparities. The majority of policies addressed racism at the institutional level alone (National: N = 19, 61.3%, Massachusetts: N = 14, 87.5%). Two national and two Massachusetts-level policies became law, while two national policies passed only the House of Representatives. Our critical appraisal revealed that the majority of unintended effects would be neutral or positive, however, some potential negative unintended effects were identified. The appraisal also identified 54.8% (n = 17) of national policies and 68.8% (n = 11) of Massachusetts with positive impact on health equity.Conclusions: There has been an increase in policies proposed addressing racial disparities and health equity in maternal health over the last 10 years. Although half of national policies proposed showed positive impact on health equity, shedding light on the work the U.S. is doing on a federal level to confront the Black maternal health crisis, only two policies made it to law, only one of which addressed racial disparities directly and had a positive impact on health equity.

Children with single ventricle heart disease typically require a series of three operations, (1) Norwood, (2) Glenn, and (3) Fontan, which ultimately results in complete separation of the pulmonary and systemic circuits to improve pulmonary/systemic circulation. In the last stage, the Fontan operation, the inferior vena cava (IVC) is connected to the pulmonary arteries (PAs), allowing the remainder of deoxygenated blood to passively flow to the pulmonary circuit. It is hypothesized that optimizing the Fontan anatomy would lead to decreased power loss and more balanced hepatic flow distribution. One approach to optimizing the geometry is to create a patient-specific digital twin to simulate various configurations of the Fontan conduit, which requires a computational model of the proximal PA anatomy and resistance, as well as the distal Pulmonary Vascular Resistance (PVR), at the Glenn stage. To that end, an optimization pipeline was developed using 3D computational fluid dynamics (CFD) and 0D lumped parameter (LP) simulations to iteratively refine the PVR of each lung by minimizing the simulated flow and pressure error relative to patients' cardiac magnetic resonance (CMR) and catheterization (CATH) data. While the PVR can also be estimated directly by computing the ratio of pressure gradients and flow from CATH and CMR data, the computational approach can separately identify the different components of PVR along the Glenn pathway, allowing for a more detailed depiction of the Glenn vasculature. Results indicate good correlation between the optimized PVR of the CFD and LP models (n = 16), with an intraclass correlation coefficient (ICC) of 0.998 (p = 0.976) and 0.991 (p = 0.943) for the left and right lung, respectively. Furthermore, compared to CMR flow and CATH pressure data, the optimized PVR estimates result in mean outlet flow and pressure errors of less than 5%. The optimized PVR estimates also agree well with the computed PVR estimates from CATH pressure and CMR flow for both lungs, yielding a mean difference of less than 4%. [ABSTRACT FROM AUTHOR]

Import substitution is a top priority of Russia’s economic policy in recent years. Complex geopolitical conditions, Western sanctions and consequent Russian countermeasures necessitated urgent compensation for the reduced volume of imported goods through increasing domestic production. Despite a significant rise in the number of publications on the problems of import substitution policy, the issues of assessing the efficiency of the ongoing policy are yet to be studied. The analysis of the existing methods for quantitative assessment of import substitution revealed their focus on assessing the potential or expediency of substituting imported products with domestically produced goods. Further, such analysis showed poor applicability of these methods when monitoring the results of the current policy. Thus, we developed a system for assessing the efficiency and monitoring the results of import substitution policy as a component of structural policy aimed at the modernisation of the Russian industries and manufacture of competitive products. The obtained results have demonstrated that, during the study period, the potential of the Russian agriculture was increasing due to a reduced import and accelerated growth of investments in fixed capital, in reconstruction and modernization. The detected rise in innovation potential of agriculture is largely attributable to low base effect. At the same time, the efficiency of using the potential of structural and technological modernisation in agriculture demonstrates a clear trend. However, intensive growth in the potential of import substitution modernisation in agriculture in subsequent periods may provide higher growth rates of modernisation targets. The proposed approach allows identifying the cause and effect relationship between ongoing processes and forecasting the dynamics of the industry development. The obtained method can be used to substantiate decisions related to the development of import substitution projects.