We examined the extent to which differences in hospital-level cesarean delivery rates in Massachusetts were attributable to hospital-level, rather than maternal, characteristics.
Methods
Birth certificate and maternal in-patient hospital discharge records for 2004–06 in Massachusetts were linked. The study population was nulliparous, term, singleton, and vertex births (NTSV) (n = 80,371) in 49 hospitals. Covariates included mother''s age, race/ethnicity, education, infant birth weight, gestational age, labor induction (yes/no), hospital shift at time of birth, and preexisting health conditions. We estimated multilevel logistic regression models to assess the likelihood of a cesarean delivery
Results
Overall, among women with NTSV births, 26.5% births were cesarean, with a range of 14% to 38.3% across hospitals. In unadjusted models, the between-hospital variance was 0.103 (SE 0.022); adjusting for demographic, socioeconomic and preexisting medical conditions did not reduce any hospital-level variation 0.108 (SE 0.023).
Conclusion
Even after adjusting for both socio-demographic and clinical factors, the chance of a cesarean delivery for NTSV pregnancies varied according to hospital, suggesting the importance of hospital practices and culture in determining a hospital''s cesarean rate. 相似文献
Phylogeographic studies of animals with low vagility and restricted to patchy habitats of the supralittoral zone, can uncover unknown diversity and shed light on processes that shaped evolution along a continent’s edge. The Pacific coast between southern California and central Mexico, including the megadiverse Gulf of California, offers a remarkable setting to study biological diversification in the supralittoral. A complex geological history coupled with cyclical fluctuations in temperature and sea level provided ample opportunities for diversification of supralittoral organisms. Indeed, a previous phylogeographic study of Ligia, a supralittoral isopod that has limited dispersal abilities and is restricted to rocky patches, revealed high levels of morphologically cryptic diversity. Herein, we examined phylogeographic patterns of Tylos, another supralittoral isopod with limited dispersal potential, but whose habitat (i.e., sandy shores) appears to be more extensive and connected than that of Ligia. We conducted Maximum Likelihood and Bayesian phylogenetic analyses on mitochondrial and nuclear DNA sequences. These analyses revealed multiple highly divergent lineages with discrete regional distributions, despite the recognition of a single valid species for this region. A traditional species-diagnostic morphological trait distinguished several of these lineages. The phylogeographic patterns of Tylos inside the Gulf of California show a deep and complex history. In contrast, patterns along the Pacific region between southern California and the Baja Peninsula indicate a recent range expansion, probably postglacial and related to changes in sea surface temperature (SST). In general, the phylogeographic patterns of Tylos differed from those of Ligia. Differences in the extension and connectivity of the habitats occupied by Tylos and Ligia may account for the different degrees of population isolation experienced by these two isopods and their contrasting phylogeographic patterns. Identification of divergent lineages of Tylos in the study area is important for conservation, as some populations are threatened by human activities. 相似文献
Histopathologic interpretation of dermoscopic and reflectance confocal microscopy (RCM) features of cutaneous melanoma was timidly carried out using perpendicular histologic sections, which does not mimic the same plane of the image achieved at both techniques (horizontal plane). The aim of this study was to describe the transverse histologic sections research technique and correlate main dermoscopic features characteristic of cutaneous melanoma (atypical network, irregular globules and pseudopods) with RCM and histopathology in perpendicular and transverse sections in order to offer a more precise interpretation of in vivo detectable features. Four melanomas and 2 nevi with different dermoscopic clues have been studied. Lesion areas that showed characteristic dermoscopic features were imaged by dermoscopy and confocal microscopy and directly correlated with histopathology in perpendicular and transverse sections. We presented the possibility to perform transverse sections as a new approach to understand RCM features. Atypical network showed different aspects in the 2 melanomas: in one case it was characterized by pleomorphic malignant melanocytes with tendency to form aggregates, whereas in the other elongated dendritic cells crowded around dermal papillae, some of them forming bridges that resembled the mitochondrial aspect at confocal and histopathology transversal sections. Pigment globules in melanomas and nevi differed for the presence of large atypical cells in the former, and pseudopods showed up as elongated nests protruded toward the periphery of the lesion. Transverse histologic research sections have a consistent dermoscopic and confocal correlate, and it may represent an help in confocal feature interpretation and an advance in improving melanoma diagnosis and knowledge of the biology of melanocytic lesions. 相似文献
The early stages of diabetic retinopathy (DR) are characterized by alterations similar to neurodegenerative and inflammatory conditions such as increased neural apoptosis, microglial cell activation and amplified production of pro-inflammatory cytokines. Adenosine regulates several physiological functions by stimulating four subtypes of receptors, A1AR, A2AAR, A2BAR, and A3AR. Although the adenosinergic signaling system is affected by diabetes in several tissues, it is unknown whether diabetic conditions in the retina can also affect it. Adenosine delivers potent suppressive effects on virtually all cells of the immune system, but its potential role in the context of DR has yet to be studied in full. In this study, we used primary mixed cultures of rat retinal cells exposed to high glucose conditions, to mimic hyperglycemia, and a streptozotocin rat model of type 1 diabetes to determine the effect diabetes/hyperglycemia have on the expression and protein levels of adenosine receptors and of the enzymes adenosine deaminase and adenosine kinase. We found elevated mRNA and protein levels of A1AR and A2AAR, in retinal cell cultures under high glucose conditions and a transient increase in the levels of the same receptors in diabetic retinas. Adenosine deaminase and adenosine kinase expression and protein levels showed a significant decrease in diabetic retinas 30 days after diabetes induction. An enzymatic assay performed in retinal cell cultures revealed a marked decrease in the activity of adenosine deaminase under high glucose conditions. We also found an increase in extracellular adenosine levels accompanied by a decrease in intracellular levels when retinal cells were subjected to high glucose conditions. In conclusion, this study shows that several components of the retinal adenosinergic system are affected by diabetes and high glucose conditions, and the modulation observed may uncover a possible mechanism for the alleviation of the inflammatory and excitotoxic conditions observed in diabetic retinas. 相似文献
Systematic Parasitology - The ergasilid copepod Acusicola margulisae n. sp. is described based on material from three species of cichlid, Amphilophus citrinellus (Günther), Parachromis... 相似文献
Systematic Parasitology - Isospora parnaitatiaiensis Silva, Rodrigues, Lopes, Berto, Luz, Ferreira & Lopes, 2015 was identified from a new host, the plain antvireo Dysithamnus mentalis... 相似文献
Elevated temperatures and nutrients are degrading coral reef ecosystems, but the understanding of how early life stages of reef corals respond to these stressors remains limited. Here, we test the impact of temperature (mean ~ 27 °C vs. ~ 29 °C) and nitrate and phosphate enrichment (ambient, + 5 µM nitrate, + 1 µM phosphate and combined + 5 µM nitrate with 1 µM phosphate) on coral larvae using three Hawaiian coral species with different modes of symbiont transmission and reproduction: Lobactis scutaria (horizontal, gonochoric broadcast spawner), Pocillopora acuta (vertical, hermaphroditic brooder) and Montipora capitata (vertical, hermaphroditic broadcast spawner). Temperature and nutrient effects were species specific and appear antagonistic for L. scutaria and M. capitata, but not for P. acuta. Larvae survivorship in all species was lowest under nitrate enrichment at 27 °C. M. capitata and L. scutaria survivorship increased at 29 °C. However, positive effects of warming on survivorship were lost under high nitrate, but phosphate attenuated nitrate effects when N/P ratios were balanced. P. acuta larvae exhibited high survivorship (> 91%) in all treatments and showed little change in larval size, but lower respiration rates at 29 °C. Elevated nutrients (+N+P) led to the greatest loss in larvae size for aposymbiotic L. scutaria, while positive growth in symbiotic M. capitata larvae was reduced under warming and highest in +N+P treatments. Overall, we report a greater sensitivity of broadcast spawners to warming and nutrient changes compared to a brooding coral species. These results suggest variability in biological responses to warming and nutrient enrichment is influenced by life-history traits, including the presence of symbionts (vertical transmission), in addition to nutrient type and nutrient stoichiometry.
Scedosporium species are filamentous fungi usually found in sewage and soil from human-impacted areas. They cause a wide range of diseases in humans, from superficial infections, such as mycetoma, to invasive and disseminated cases, especially associated in immunocompromised patients. Scedosporium species are also related to lung colonization in individuals presenting cystic fibrosis and are considered one of the most frequent fungal pathogens associated to this pathology. Scedosporium cell wall contains glycosylated molecules involved in important biological events related to virulence and pathogenicity and represents a significant source of antigens. Polysaccharides, peptidopolysaccharides, O-linked oligosaccharides and glycosphingolipids have been identified on the Scedosporium surface. Their primary structures were determined based on a combination of techniques including gas chromatography, ESI-MS, and 1H and 13C nuclear magnetic resonance. Peptidorhamnnomannans are common cell wall components among Scedosporium species. Comparing different species, minor structural differences in the carbohydrate portions were detected which could be useful to understand variations in virulence observed among the species. N- and O-linked peptidorhamnomannans are major pathogen-associated molecular patterns and, along with α-glucans, play important roles in triggering host innate immunity. Glycosphingolipids, such as glucosylceramides, have highly conserved structures in Scedosporium species and are crucial for fungal growth and virulence. The present review presents current knowledge on structural and functional aspects of Scedosporium glycoconjugates that are relevant for understanding pathogenicity mechanisms and could contribute to the design of new agents capable of inhibiting growth and differentiation of Scedosporium species. Other cell components such as melanin and ectophosphatases will be also included.