The impact of family physicians in rural maternity care

BACKGROUND

Reduced access to maternity care in rural areas of the United States presents a significant burden to pregnant persons and infants. The objective of this study was to estimate the impact of family physicians (FPs) on access to maternity care in rural United States hospitals, especially where other providers may not be available.

METHODS

We administered a survey to 216 rural hospitals in 10 US states inquiring about the number of babies delivered from 2013 to 2017, the types of delivering physicians, and the maternity services offered. We calculated the percentage of rural hospitals in our sample where FPs performed vaginal deliveries, cesareans, and vaginal births after cesarean (VBACs), and the percentage of all babies delivered by FPs. We estimated the distance patients would have to travel for care if FPs were not providing care locally.

RESULTS

The final study population consisted of 185 rural hospitals. FPs delivered babies in 67% of these hospitals and were the only physicians who delivered babies in 27% of these hospitals. FPs provided VBAC at 18% and cesarean birth services at 46% of the rural hospitals, but with wide geographic differences. Many patients would have to drive an average of 86 miles round-trip to access care if those FPs were to stop delivering.

CONCLUSIONS

Family physicians are essential providers of maternity care in the rural United States. Family Medicine residency programs should ensure that trainees who intend to practice in rural locations have adequate maternity care training to maintain and expand access to maternity care for rural patients and their families.

Contact angles on surfaces using mean field theory: nanodroplets vs. nanoroughness

With emerging systems and applications accessing features within the nanoregime, whether due to droplet size or feature size, understanding the wetting behaviours of these materials is an area of ongoing interest. Theoretical studies, providing a fundamental understanding of how contact angle behaviour changes at these length scales, are important to further such work. This study provides a comprehensive examination of the application of lattice density functional theory (LDFT) to a pillared surface to confirm the suitability of LDFT for studying more complex surfaces. Incorporation of the correct level of details for the fluid-wall interaction was found to produce all of the qualitative changes that have been observed in off-lattice theories. Though previous reports have provided apparently conflicting results, the more comprehensive examination of feature sizes provided here demonstrates that those behaviours are consistent with one another. The well-studied failure of macroscopic models that results from non-negligible line tension contributions and small droplets to feature size ratios was demonstrated using LDFT. Furthermore, the failure of macroscopic models resulting upon reduction in feature size, which has been considered less often, is clearly demonstrated. A key assumption of the macroscopic models is the consistent interaction between surface and fluid regardless of the flatness or roughness of the surface. The density functional results presented here show that, for the smallest features, this is not the case and demonstrate that macroscopic models do not predict the correct contact angle for droplets of any size on nanorough surfaces.

Monte Carlo simulations on the effect of substrate geometry on adsorption and compression

Canonical Monte Carlo simulations were used to study the adsorption and compression of fluid layers on model substrates with cubic, (111) fcc, and graphite geometries. The effect of the relative size of the fluid and substrate molecules on adsorption was considered for strong molecule-surface interactions. In the case of monolayer formation, it was found that the surface geometry and the size of the adsorbate molecules had a significant effect on the structure of the adsorbed layer. These structures varied from well-ordered, commensurate layers to liquid-like structures. Lateral compression was observed for certain fluid to substrate molecule sizes. For the interactions studied in this work, it was found that maximum lateral compression occurred on the cubic surface when adsorbate molecules had a diameter approximately 15% larger than the substrate diameter. In the case of multilayer formation, it was found that second and higher adsorbed layers could compress into the adsorbed layers below them. For cubic substrates, the interlayer compression was predicted analytically with reasonable accuracy, with maximum interlayer compression found for fluid diameters approximately 90% the size of substrate molecule diameters.

Lattice gas 2D/3D equilibria: Chemical potentials and adsorption isotherms with correct critical points

A priori information is used to derive the chemical potential as a function of density and temperature for 2D and 3D lattice systems. The functional form of this equation of state is general in terms of lattice type and dimensionality, though it contains critical temperature and critical density as parameters which depend on lattice type and dimensionality. The adsorption isotherm is derived from equilibrium between two-dimensional and three-dimensional phases. Theoretical predictions are in excellent agreement with grand canonical Monte Carlo simulations.

Intracoronary urokinase for intracoronary thrombus accumulation complicating percutaneous transluminal coronary angioplasty in acute ischemic syndromes

Intracoronary urokinase was used to treat flow-limiting intracoronary thrombus accumulation that complicated successful percutaneous transluminal coronary angioplasty (PTCA) during acute ischemic syndromes in 48 patients who were followed up through the acute phase of their illness. The study group comprised 10 patients with unstable angina pectoris, 18 patients with an evolving acute myocardial infarction, and 20 patients with postinfarction angina. The initial mean percent coronary diameter stenosis for the entire population was 95 +/- 7% and decreased with initial PTCA to 41 +/- 20% (p less than 0.001), with improved corresponding coronary flow by Thrombolysis in Myocardial Infarction trial (TIMI) grade. However, thrombus accumulation then resulted in a significant increase in percent diameter stenosis to 83 +/- 17% (p less than 0.001); a corresponding significant reduction in coronary flow also occurred by TIMI grade. After administration of intracoronary urokinase (mean dose, 141,000 units; range, 100,000-250,000 units during an average period of 34 minutes), with additional PTCA, mean percent diameter stenosis significantly decreased to 34 +/- 17% (p less than 0.001); a correspondingly significant improvement in mean coronary flow by TIMI grade occurred to 2.9 +/- 0.2. Overall, the angiographic success rate was 90%. There were no ischemic events requiring repeat PTCA and no procedure-related myocardial infarctions or deaths before hospital discharge. One patient was referred for urgent coronary artery bypass graft surgery after a successful PTCA. Plasma fibrinogen levels were obtained in 15 patients, and in no patient was the level below normal for our laboratory.(ABSTRACT TRUNCATED AT 250 WORDS)

Echocardiographic and clinical predictors for outcome of elective cardioversion of atrial fibrillation

Previous studies have suggested that success of elective direct-current cardioversion for atrial fibrillation (AF) can be predicted from clinical features and M-mode echocardiographic left atrial diameter. We evaluated clinical variables as well as M-mode and 2-dimensional echocardiographic measurements of atrial size in 85 patients undergoing electrical cardioversion for AF. Of 65 patients who were initially converted to sinus rhythm, 45 (69%) and 38 (58%) remained in sinus rhythm at 1 and 6 months, respectively. No historical feature predicted initial success, although patients with cardiomyopathy or pulmonary disease underlying their AF had significantly lower success rates compared with those having other etiologies. Furthermore, no M-mode or 2-dimensional echocardiographic measurements of atrial size predicted initial success of cardioversion. Maintenance of sinus rhythm at 1 month was related to short duration of AF before cardioversion (less than 3 months vs greater than 12 months, p less than 0.05). Left atrial area and long axis dimension by 2-dimensional echocardiography were significantly larger in patients remaining in sinus rhythm than in those who had reverted to AF at 1 month (28 +/- 7 vs 24 +/- 5 cm2 and 65 +/- 9 vs 59 +/- 8 mm, respectively, both p less than 0.05), but overlap was great. No significant difference in atrial dimensions was noted at 6-month follow-up. It appears that, although no clinical or echocardiographic variable predicts initial success for cardioversion of AF, duration of AF does predict maintenance of sinus rhythm 1 month after initial success.(ABSTRACT TRUNCATED AT 250 WORDS)

Biological properties of human interferon fractions obtained by blue sepharose chromatography

Human interferons of lymphoid and nonlymphoid origins were segregated into several fractions by virtue of their elution properties from Blue Sepharose. According to desorption of the main portion of antiviral activity, three major classes could be discerned: 1. Leukocyte interferons eluting predominantly in 0.5 M NaCl buffer, 2. Lymphoblastoid interferons eluting mostly in 1 M NaCl buffer, and 3. Cell culture-derived fibroblast and bladder carcinoma interferons requiring ethylene glycol in addition to 1 M NaCl for elution. Desorption behavior from Blue Sepharose did not necessarily correlate with the presence of specific antigenic markers and no consistent segregation of Le and F antigens in individual fractions was observed. All fractions exhibited comparable activity in heterologous sheep and homologous human cells. Therefore, no distinctive biological features could be associated with multiple interferon species isolated by Blue Sepharose chromatography.

Molecular species of interferon induced in mouse L cells by Newcastle disease virus and polyriboinosinic-polyribocytidylic acid

Interferons were stimulated in mouse L cells by Newcastle disease virus (NDV) or by polyriboinosinic-polyribocytidylic acid poly(rI).poly(rC). These were fractionated by sequential affinity chromatography on bovine plasma albumin (BPA)-Sepharose and on omega-carboxypentyl (CH)-Sepharose. Based on their interaction with CH-Sepharose, interferon induced by NDV was resolved into three major bands of activity (L/NDV-1,2,3) and poly(rI).poly(rC)-interferon into two (L/rI:rC-1,2). These interferon components were purified to a specific activity of 3 X 10(7) to 4 X 10(7) units/mg protein by antibody affinity chromatography and examined by electrophoresis in SDS-polyacrylamide gels. A total of five molecular species was thus identified for NDV-induced interferon and three for poly(rI).poly(rC) induced interferon, as summarized in Table 1. We conclude from our observations that mouse interferons can be produced by L cells in multiple forms with specific physiochemical properties and in proportions determined by the type of agent employed for induction.

N-hexyl-O-glucosyl sphingosine, an inhibitor of glucosyl ceramide -glucosidase

A synthetic analog of glucocerebroside, N-hexyl-O-glucosyl sphingosine, was found to inhibit the glucosidase in rat spleen that hydrolyzes glucocerebroside. At a concentration of 1 micro m, the analog inhibited the enzyme by 48%. The mode of action appeared to be competitive, probably aided by tight binding of the amine group to a carboxyl group near the enzyme's active site. Increasing or decreasing the chain length of the n-alkyl group attached to the nitrogen atom led to decreased effectiveness. The inhibitory effect was maximal at pH 7.0, but it was still considerable at the enzyme's optimal pH, 5.0. It is suggested that the compound may be useful for inducing an animal model of Gaucher's disease.

Glucocerebrosidase: reconstitution of activity from macromolecular components

Glucocerebrosidase activity was reconstituted in vitro from a soluble glycoprotein factor (P) and a particle-bound factor (C). The physiological significance of the system is discussed.