Community Mercy Health Partners

BACKGROUND: Preterm birth and low birthweight contribute substantially to the disproportionately high infant mortality rates experienced by Puerto Ricans in the United States. The purpose of this study was to examine whether the timing and pattern of prenatal psychosocial stress increased risk of adverse birth outcomes in this high-risk population. MATERIALS AND METHODS: Proyecto Buena Salud was a prospective cohort study conducted from 2006 to 2011 among predominantly Puerto Rican women. Participants (n = 1,267) were interviewed in early, mid-, and late pregnancy. We evaluated associations between early and mid-pregnancy stress (Perceived Stress Scale) and preterm birth and low birthweight, and stress at each pregnancy time point and small for gestational age (SGA). RESULTS: = 0.01). Women in the highest quartile of stress experienced three times the risk for preterm birth (odds ratio [OR] = 3.50, confidence interval [95% CI]: 1.38-8.87) and low birthweight (OR = 3.53, 95% CI = 1.27-9.86) compared with women in the lowest quartile. Early pregnancy stress was not associated with preterm birth or low birthweight. Increase in stress from early to late pregnancy increased risk for SGA (OR = 1.90, 95% CI = 1.01-3.59); no associations were found between stress at any timepoint and SGA. CONCLUSION: Elevated levels of mid-pregnancy perceived stress increased risk for preterm birth and low birthweight, and an increase in stress over the course of pregnancy increased risk for SGA in a population of predominantly Puerto Rican women.

This paper presents a method of calculating polyphase induction motor performance which eliminates a large amount of detail work without making use of approximations which sacrifice accuracy. In any rigorous system for calculating induction motor performance, the determination of the relation between input and current values makes the greater part of the work. By the procedure here presented, the relation of watts to amperes for all cases likely to be encountered in ordinary design work may be accurately calculated once for all and recorded in a set of curves. When making practical calculations tedious detail work may be eliminated by taking the necessary values from the curves, in much the same way that sines are taken from sine tables. The calculation begins with the torque, from which the corresponding secondary input is obtained by a simple formula. Then, by reference to the appropriate curves and a few simple slide rule operations, the primary and secondary currents are determined. With the secondary input and the current values known, the completion of the calculation requires nothing more than a few operations of simple arithmetic. The entire process for one load point may be completed in from five to seven minutes.

A curious gap exists in the technical literature dealing with electrical-design methods. Procedures for determining performance by various analyses and for various testing methods can be found on nearly all of the more common machines. Yet the novice or the intelligently curious, interested in the field of design, finds but few references in the technical literature concerning the procedure whereby the machine dimensions were first determined and the completed design made. While it is true that a comparatively small group of engineers may be concerned with such design work, the philosophy and technique of approach could be of interest to an entire profession which is so profoundly influenced by the designer's work.

When color pattern variation is co-adapted with other biological features, distinct color morphs may be separated along divergent niche axes, and data on niche partitioning can provide insight into how distinct color morphs are maintained over spatiotemporal scales. The Eastern Red-backed Salamander, Plethodon cinereus, contains two common color morphs (striped and unstriped) that differ along several trait axes in addition to coloration. Previous studies from a single population have suggested that dietary composition represents an important axis of ecological differentiation between morphs of P. cinereus. To determine if morphs partition prey resources over space and time, we collected stomach contents from morphs across six populations that ranged in color morph frequency from 100% striped to >99% unstriped, and sampled each population in a spring and a fall season. From each population and season, we also sampled leaf litter invertebrates to quantify morph differences in prey selection. Based on previous studies, we predicted striped morph diet would consist of higher quality prey in polymorphic populations, whereas in monomorphic populations, we predicted both morphs would have a more variable diet due to ecological release from intermorph competition. In the two polymorphic populations we examined, one showed no evidence of diet differences and the other mirrored differences reported from previous studies. There was no change in dietary breadth between polymorphic and monomorphic populations, and thus no signature of dietary release. Our results show there is a high degree of overlap between dietary and leaf litter invertebrates, suggesting both morphs of P. cinereus are generalist predators. Finally, we found dietary composition varied across seasons and populations, which demonstrates the importance of examining morph traits over spatial and temporal scales.

Left untreated, peripheral arterial disease can lead to chronic leg ischaemia, causing pain, foot ulcers and gangrene, and increasing the risk of amputation. The ulcers of two patients treated with cilostazol after revascularisation healed completely

According to the National Assessment of Adult Literacy (2003), only 12% of U.S. adults have a proficient level of health literacy, with adults 65 years and older more likely to have a below basic or a basic health literacy level. An estimated 5.8 million individuals in the United States have heart failure (HF) and it is one of the most common reasons for those aged 65 and over to be hospitalized. Many patients with HF are at risk for poor health outcomes due to low health literacy. This article reviews the literature with regard to the effectiveness of methods used to address low health literacy among HF patients and describes a pilot study implemented by a home care agency in the northeast to address high HF readmission rates.

Although split-phase induction motors are built annually in millions of units, involving thousands of designs, little can be found in the technical literature concerning the design processes.

Abstract Insect populations are experiencing ongoing declines in abundance and diversity, but their dynamics are often complex and trends are difficult to identify. Butterflies are an important, convenient, and useful insect group to monitor. They are a well‐recorded group of insects and play important ecological roles as both pollinators and herbivores, and there is a large community of amateur lepidopterists that contribute to citizen science butterfly monitoring programs. In the present study, we analyzed 27 years of citizen science butterfly monitoring data collected across four sites in Cuyahoga Valley National Park, Ohio. We aimed to investigate patterns of species richness and abundance across years and sites and elucidate potential climatic variables that influence the butterfly community. We found similar levels of estimated butterfly species richness at three sites, yet one site had noticeably higher estimated species richness. Abundance fluctuated annually and was relatively consistent across sites. Further, we found that the butterfly communities changed directionally over time across all sites. Additionally, we identified degree days and average daily precipitation as drivers of butterfly community variability. Overall, this work identified patterns of richness and abundance in a unique national park and identified potential climatic drivers of butterfly community variability.

BACKGROUND: The nose is a common site for the development of skin cancers. Mohs micrographic surgery (MMS) is a highly curative treatment for skin cancer of the nose. Reconstruction of MMS defects on the nose, especially on the distal aspect, can be challenging given the proximity of multiple subunits and limited adjacent tissue reservoirs. Our goal was to describe our experience using a nasal tip rotation flap (NTRF) for MMS defects on the distal nose. METHODS: A retrospective review of all MMS cases at multiple institutions between June 2018 and June 2022 was undertaken. Cases that used an NTRF to repair the MMS defect(s) were selected, and data were collected on patient demographics, tumor type, anatomical location of the tumor, preoperative and postoperative size, number of stages needed to clear the tumor, repair dimensions, and any postoperative complications. RESULTS: A total of 66 cases that utilized an NTRF for reconstruction were included. The mean preoperative tumor size was 0.8 cm (range: 0.3-1.6 cm), and the mean defect size was 1.2 cm (range: 0.7-1.9 cm). The defects were most commonly on the nasal tip. There were no significant complications observed. CONCLUSIONS: The nasal tip rotation flap is a reliable reconstruction option for MMS defects of the distal nose. This flap can be used for defects that involve the nasal tip, soft triangle, and/or portions of the ala, including the alar rim.

Medical innovation awards stand out as an important means to focus public attention on what matters in medical advancement. Traditional awards typically focus on celebrating medical innovators with either a track record of proven successes in new treatments or promising basic science breakthroughs still years away from reaching patients. Perhaps one of the greatest challenges for medical innovation that is not sufficiently addressed by these traditional awards is celebrating translational research efforts on the cusp of major advancements where medical innovators are demonstrating success in bringing emerging transformative medical innovations to patients. As a part of its award process, the Sanford Lorraine Cross Award has developed a unique method to fill this gap in the landscape of medical innovation awards for ongoing translational research efforts by identifying promising medical innovations within a narrow spectrum of the research pipeline on the verge of having transformative impact for patients in the near term. The Sanford Lorraine Cross Award addresses the challenges of identifying emerging transformative medical innovations making their way through development by deploying a rigorous, analytically-based "early signals analysis" to identify emerging transformative medical innovations in its selection process independent of the medical innovators who are succeeding in bringing them forward. It also stands apart from traditional medical innovation awards in focusing on identifying award candidates that have significant roles in bringing the emerging transformative medical innovation across the finish line to patients, and their efforts in overcoming challenges, forging collaborations, and ensuring a successful outcome. The data-driven award selection process used for the Lorraine Cross award ultimately inverts the standard medical award selection paradigm - truly innovative areas of discovery and breakthrough science are identified independently of candidates and used to then focus candidate selection on the areas with the most promising transformative potential for patients. This article sets out the details of how the Sanford Award makes use of leading tools and methods in identifying transformative innovations currently in translational research to provide another important focus of what matters in medical innovation. RELEVANCE FOR PATIENTS: The Sanford Lorraine Cross Award identifies the most successful application of translational research that ultimately expedited the development of a treatment or cure of a disease.

Knowing and understanding the values that organizations hold dear actually requires rigorous analysis. Elements of a Catholic presence in this case study went beyond religious symbols and the Directives. Five years after the merger, the Springfield Regional Medical Center operating board concluded that a Catholic presence indeed supports the continued healing ministry intended by the sponsors of the Community Hospital-Mercy Medical Center merger.

As both live loading and impact have been recent subjects discussed by the American Railway Engineering Association, the work of the Special Committee on Specifications for Bridge Design and Construction of the Society, was greatly simplified, and, in general, consisted of a careful review of the publication8 of that Association and the consideration of new material or new aspects that may have appear ed since that time.