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Socioeconomic, Behavioral, and Health Profiles of Women with Eclampsia: Findings from the 2020–2022 National Pregnancy Risk Assessment Monitoring System Data
No full textBackground: Eclampsia is a severe obstetric complication with significant maternal health implications, disproportionately affects women with certain sociodemographic and health risk factors. This study investigates the characteristics and outcomes of women who experienced eclampsia using data from the national Pregnancy Risk Assessment Monitoring System (PRAMS).
Methods: This analysis included a sample of 729 women with eclampsia from the 2020–2022 PRAMS (N = 238,575). Descriptive statistics, chi-square tests, and multivariate logistic regression were conducted to examine patterns and factors associated with preterm-birth, low birth weight (LBW), and cesarean delivery.
Results: Over half of the women were aged ≥35 years (50.6%), unmarried (59.4%), never attended college (63.6%), reported unintended pregnancies (60.8%). High rates of cesarean delivery (50.9%), preterm-birth (52.0%), and LBW (58.8%) were observed, with significant racial and age differences. Cesarean delivery was most common among Black women (65.1%), followed by Hispanic (53.1%), White (51.7%), and other race/ethnicity (45.3%). Women aged ≥35 had the highest rates of LBW (66.2%) and cesarean delivery (58.5%). Adjusted analysis showed Black women had higher odds of cesarean delivery (OR: 2.14; 95% CI: 1.19–3.85), and inadequate prenatal care was linked to increased odds of LBW (OR: 1.68; 95% CI: 1.21–2.35) and preterm birth (OR: 2.14; 95% CI: 1.29–3.48).
Conclusion: Women with eclampsia experience socioeconomic and healthcare barriers, with racial and age-related disparities in birth outcomes, underscoring the need for early, equitable maternal care
Using Atrial Pacing Trials After TAVR to Assess Conduction Abnormalities and Predict Need for Pacemaker Implantation
No full textAbstract:
Background: Transcatheter Aortic Valve Replacement (TAVR) is the standard of care for many patients with severe aortic stenosis who cannot undergo surgical intervention. However, conduction disturbances remain a frequent complication, particularly with self-expanding valves. This often leads to permanent pacemaker implantation (PPI). At Sentara Heart Hospital, atrial pacing at 140 bpm is standard practice during TAVR to assess AV conduction.
Objective: This study aims to evaluate whether preserved 1:1 atrioventricular (AV) conduction during routine atrial pacing at 140 bpm after self-expanding TAVR predicts a low likelihood of requiring PPI, thus yielding a high negative predictive value (NPV).
Methods: We will prospectively analyze patients undergoing TAVR with self-expanding valves from January to December 2026. Patients will be stratified into three cohorts based on conduction response to pacing: (1) preserved 1:1 conduction, (2) Wenckebach or first-degree AV block, and (3) persistent high-grade block. Outcomes will include in-hospital and 1-year PPI rates, mortality, and conduction-related complications. Machine learning models will also be developed to explore predictive capability using EMR and procedural data.
Results (Anticipated): We hypothesize that in patients undergoing TAVR with a self-expanding valve, maintenance of 1:1 AV conduction during standard atrial pacing at 140 bpm is associated with a low likelihood of permanent pacemaker implantation. This would establish post-TAVR atrial pacing as a suitable test to yield a high negative predictive value.
Conclusion: This study may help refine post-TAVR management, reduce unnecessary PPI, hospital days, and cost burden in patients receiving self-expanding valves
Challenging Case: Acute Type A Aortic Dissection with Multi-Organ Malperfusion
No full textDescription of case: A 57-year-old male with hypertension and obesity presented with acute, severe chest pain. He developed a cold, numb right leg with motor deficits. He was hypotensive with a lactate of 7.4. CT imaging revealed an acute Type A aortic dissection (TAAD) with malperfusion involving the right internal carotid, right subclavian, and right coronary arteries, as well as the superior mesenteric artery, and right iliac artery (Fig 1A/B). He was transferred to our tertiary center for emergent surgery.
Five hours after presentation, he underwent emergent ascending aortic replacement, deep hypothermic circulatory arrest, and retrograde cerebral perfusion. The dissection flap originated at an anomalous right coronary artery (RCA) arising just above the commissure of the right and left coronary cusps. The proximal aortic wall (adventitia) was extremely thin (Fig 2), and the intimal flap was visibly mobile. Severe aortic insufficiency was addressed with aortic valve repair. Right lower extremity pulse returned with restoration of true lumen flow. Fasciotomy was also performed.
On postoperative day (POD) 1, exploratory laparotomy was performed due to multiple bloody bowel movements, ruling out mesenteric ischemia. He underwent re-exploration and chest closure on POD 2. Postoperative complications included transient delirium, dysphagia, and right diaphragm elevation. He progressed well and was discharged on day 17.
Discussion: Acute TAAD is life-threatening and requires immediate intervention. Organ malperfusion and ischemia can rapidly lead to acidosis, with in-hospital mortality exceeding 85% when more than two organ systems are involved. This patient had malperfusion to five organ systems and a lactate of 7.4, indicating severe metabolic derangement. Although base excess was not measured on presentation, lactate strongly correlates with acidosis, the strongest validated predictor of operative mortality. In this case, a dynamic intimal flap caused intermittent obstruction of branch vessels and coronary flow, worsening ischemia. An anomalous RCA, present in \u3c 1% of the population, further complicated the operation. The anomalous origin made surgical manipulation difficult and has been rarely described in the setting of TAAD.
This case was challenging due to multiorgan malperfusion with metabolic acidosis and anatomical complexity. Successful repair and recovery reflect the importance of rapid diagnosis and appropriate management of malperfusion
Artificial Intelligence in Cancer-Related Malnutrition and Cachexia: A Transformative Tool in Clinical Nutrition
No full text[Introduction] Malnutrition and cachexia are common complications in cancer patients, and they negatively influence prognosis, treatment efficacy, and tolerability as well as quality of life [[1], [2], [3]]. Accurately identifying and effectively managing malnutrition and cachexia in this population remains a clinical challenge. Conventional validated screening tools may lack the sensitivity and specificity required for early detection and personalized intervention in diverse cancer types and treatment settings [4,5]. Over the last decade, the use of artificial intelligence (AI), including machine learning (ML) and deep learning (DL) strategies, has shown promising results in clinical nutrition, with the potential to revolutionize nutritional care by providing more precise and scalable tools [6].
In the recent issue of the Journal, Sguanci et al. [7] investigated the role of AI in identifying and managing malnutrition and cachexia in cancer patients. The authors conducted a systematic review involving over 52,000 individuals to investigate AI’s potential for nutritional assessment, body composition monitoring, dietary adherence, and clinical outcomes in patients with cancer
Scholarly Inquiry and Practice in Mathematics Teacher Education Through Intimate Scholarship
No full textHistorically scholarly inquiry and practice in mathematics education has responded to societal values and questions. Drawing from the Journal of Mathematics Teacher Education’s description of mathematics teacher educator (MTE) work as in solidarity with and alongside mathematics teachers, we turn to mathematics teacher education research as a series of paradigm shifts. MTEs committed to supporting teachers and transferring knowledge attempted to influence mathematics teachers’ work by exploring and understanding teachers’ behaviors. MTEs have also used insider’s perspectives to report the particular of MTEs’ work by describing it beyond behavior and knowledge. These scholars fulfill the call for theoretical eclecticism and facilitate a turn to ontology. Authors in this book answered the call and joined colleagues in teacher education by using self-based methodologies and insider perspective to study their practices and report findings using intimate scholarship. Chapters offer characterizations of MTE work that complement existing findings, illustrate how self-based methodologies support the continued development of MTEs, and evidence how dissemination using intimate scholarship unearths MTEs’ philosophical considerations. This introductory chapter provides an overview of mathematics teacher education research to situate this volume historically and methodologically. The book’s chapters are then introduced in four sections highlighting chapters’ evidence of being, knowing, ethics, and the interrelatedness of these three philosophical perspectives. We conclude by arguing that using self-based methodologies and writing intimate scholarship reports is a transformative professional learning experience that provides readers with opportunities to consider their own practice activated by stories of others
New Onset Heart Failure of Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors in Patients with End-Stage Renal Disease (ESRD) and Dialysis
No full textIntroduction: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated cardioprotective and renoprotective benefits in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). However, the effects of these agents in patients with end-stage renal disease (ESRD) or on dialysis remain underexplored, as previous clinical trials often excluded this population. With the recent removal of ESRD as a contraindication by the U.S. Food and Drug Administration, understanding the cardiovascular risks of SGLT2 inhibitors in this group is imperative. This study aimed to assess the incidence of new onset heart failure (HF), including HF with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF), among patients with ESRD or on dialysis treated with SGLT2 inhibitors compared to matched controls.
Materials and Methods: We conducted a retrospective cohort study using the TriNetX U.S. Collaborative Network, which includes de-identified electronic medical records from 50 healthcare organizations. Patients aged 18–85 with a diagnosis of ESRD or CKD stage 5, glomerular filtration rate \u3c 15 ml/min, or undergoing dialysis were included. Those with prior diagnoses of HF or type 1 diabetes mellitus were excluded. SGLT2 inhibitor use was identified using Anatomical Therapeutic Chemical (ATC) classification code A10BK. Propensity score matching was used to balance cohorts based on demographics, comorbidities, and medication usage. The primary outcome was new onset HF (ICD-10 codes I50, I11.0), with secondary outcomes including HFrEF (I50.2) and HFpEF (I50.3). Additional comparative analyses were run with exclusion criteria of prior history of type 2 diabetes mellitus (T2DM) or dialysis. Statistical analyses included relative risk calculations and Kaplan-Meier survival analysis, with significance defined as P \u3c 0.05.
Results: After propensity score matching, 47,894 patients were included in both the SGLT2 inhibitor and control cohorts. The incidence of new-onset HF was higher in the SGLT2 inhibitor group compared with controls (2.96% vs. 1.32%), with increased risk for both HFrEF (2.27% vs. 0.57%) and HFpEF (1.86% vs. 0.88%). Relative risks for new-onset HF, HFrEF, and HFpEF were 2.25 (95% CI), 3.96 (95% CI), and 2.11 (95% CI), respectively. In a subgroup excluding patients with prior T2DM (n=8,657), relative risks further increased to 8.73, 14.39, and 5.55, respectively.
Discussion: Our findings suggest that SGLT2 inhibitors may not confer the same cardioprotective effects in patients with ESRD or those undergoing dialysis as seen in earlier-stage CKD populations. This reduced efficacy may be attributed to diminished glomerular filtration rate and tubular function, both of which are essential for the diuretic and natriuretic mechanisms that contribute to SGLT2 inhibitors’ benefits. Prior studies, including DAPA-CKD and EMPA-KIDNEY, demonstrated mixed results on HF outcomes in patients with advanced kidney disease. These results raise caution regarding the generalized use of SGLT2 inhibitors in patients with advanced kidney dysfunction.
Conclusion: This study demonstrates a higher incidence of new onset heart failure, HFrEF, and HFpEF in patients with ESRD or on dialysis who are treated with SGLT2 inhibitors compared to matched controls
High Temporal Resolution Gene Expression Analysis of Acute Heat Stress Response in Acropora cervicornis and Porites astreoides
No full textWidespread coral bleaching and mortality events are becoming increasingly frequent due to rising ocean temperatures, though certain coral species and populations have displayed higher tolerance to elevated emperatures than others. As such, it is of high research priority to identify thermally tolerant coral populations for research and conservation and assess the biological mechanisms allowing these populations to survive exposure to higher temperatures. This research utilized the Coral Bleaching Automated Stress System (CBASS), a portable experimental aquaria system with precise temperature manipulation, to assess the thermal thresholds and heat stress response of two coral species from Summerland Key, FL, USA. Seven genotypes of Acropora cervicornis from Mote Marine Laboratory’s offshore nursery and five Porites astreoides genotypes (wild) each from a documented thermally tolerant and a thermally sensitive population were collected for thermal stress experiments. Fragments from each coral genet were exposed to an 18-hour heat stress assay reaching maximum temperatures ranging from 30–38°C with RNA-seq samples and photosynthetic efficiency (Fv/Fm) measurements collected at multiple time points throughout. The stress response gene regulation was compared between the two coral species to analyze interspecies gene expression pathways and within populations to examine the regulation of gene expression in tolerant vs sensitive individuals. This research provides vital insight into coral thermal vulnerability, examining the time course of molecular pathways of heat stress response and bleaching through a high-resolution genetic analysis to better understand how corals can survive in a warming climate
Two Analytic Issues Arising from Models in Probability and Materials Science
No full textThis dissertation explores two distinct topics centered on mathematical models in probability theory and materials science. The first part investigates a series of functions derived from an adaptive algorithm designed to address the score-based secretary problem, a classic challenge in probability theory. This problem involves making immediate decisions to select the best candidate from a sequence of interviews. The algorithm aims to maximize the probability of selecting the optimal candidate based on observed scores. We prove two fundamental analytic properties of this sequence of functions as a theoretic support of the algorithm: first, the functions in the sequence each possess a unique maximum point, ensuring a well-defined optimal decision at every step; and second, the sequence of maximum points increases monotonically to infinity as n tends to infinity, suggesting that the algorithm becomes increasingly effective as the process improves. Although only single-variable calculus is used in the proofs, the argument is non-trivial and the results provide fresh insights into this adaptive approach for solving the classical problem.
The second part revisits the 2-dimensional Smoluchowski equation, a mathematical model widely used to describe the orientational distribution of nematic liquid crystalline polymers, which are characterized by their ability to transition between isotropic and nematic phases and play a vital role in advanced applications such as liquid crystal displays, sensors, and other technologies. Focusing on the steady-state solutions, we present a simplified proof to characterize these solutions based on the intensity parameter. Specifically, if the intensity constant is less than or equal to 4, there exists a unique, trivial solution corresponding to the isotropic state. If the intensity constant is greater than 4, there are exactly two solutions -trivial and nontrivial- representing two distinct physical states: the isotropic and nematic phases of liquid crystals. This new proof relies on elementary calculus, making it more intuitive and accessible
Peace Engagement and Non-Negotiable Commitment Through an In-Depth Lens [PENCIL Theory]: A Film Perspective on UN’s Conflict Resolution
No full textThe research addresses the effectiveness of the United Nations concerning conflict resolution and peacekeeping, seen from the perspective of film culture. Applying the PENCIL Theory (Peace Engagement through an in-depth lens), the UN study along with its structural dynamics would be considered herein: a pencil comprising the Security Council as its lead, world as the eraser, and filmmakers as the ferrule that is representative of that significant link between public awareness and policy impact, and the UN General Assembly and Secretariat as its body in support of the decision-making processes. It brings to the fore the critical impacts on the view of the UN through cinematic representations: case studies of failures within Rwanda, Bosnia, and the Democratic Republic of Congo, analyses of films such as Hotel Rwanda and Ghosts of Rwanda, reveal systemic issues and incite calls for reform. Drawing on Constructivist theory, the paper assesses how films, as a cultural artifact, influence international norms, public opinion, and institutional accountability, and conversely, how this shapes UN work on promoting peace and justice worldwide. It contributes to knowledge on how film can facilitate critical discourse on matters pertinent to the United Nations\u27 agenda, subsequently demanding better international governance. By critiquing the UN’s structural weaknesses and advocating for reform, the PENCIL theory aligns with social justice ideals, calling for accountability, inclusivity, and moral courage in international governance. It urges a shift from bureaucratic inertia to decisive, people-centered action that prioritizes human dignity and equitable solutions
Assessing Porosity Limit in Freeze-Cast Sintered Lithium Titanate (Li₄Ti₅O₁₂) Materials
Get PDFThis study aims to assess the lower limit of porosity that can be achieved in freeze-cast sintered lithium titanate (LTO) materials while maintaining the characteristic pore directionality. LTO materials were fabricated with solid loading varying in the range of 30–37 vol.%. Sucrose and cationic dispersant were used to vary viscosity and total solute concentration in the aqueous LTO suspensions. Two series of suspension compositions were selected for freeze-casting. In one series, aqueous suspensions were prepared by mixing deionized (DI) water, sucrose, and LTO powder, while in the other series, aqueous suspensions were prepared by mixing DI water, sucrose, cationic dispersant (1-hexadecyl)trimethylammonium bromide (CTAB), and LTO powder. With increasing solid loading from 30 to 37 vol.%, porosity in the sintered materials decreased from about 50 to 36 vol.%. LTO materials fabricated from suspensions containing sucrose exhibited well-developed characteristic freeze-cast microstructure. Unexpectedly, LTO materials fabricated from suspensions containing sucrose and dispersant exhibited cellular pore morphology irrespective of the solid loading. Sample height had an impact on microstructure evolution in the transition zone and zone length. With the increasing solid loading from 30 to 37 vol.%, the compressive strength of sintered LTO materials having the characteristic freeze-cast microstructure increased from about 110 to 240 MPa