Preeclampsia is a systemic syndrome that occurs in 3 to 5% of pregnant women and classically manifests as new-onset hypertension and proteinuria after 20 weeks of gestation. Preeclampsia is a leading cause of maternal and neonatal morbidity and mortality. The only known cure is delivery of the placenta. Recent discoveries, however, have led to important advances in understanding the pathogenesis of the condition. Placental antiangiogenic factors are upregulated and disrupt the maternal endothelium. This change in the normal angiogenic balance toward an antiangiogenic state can result in hypertension, proteinuria, glomerular endotheliosis, HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, and cerebral edema-the clinical signs of preeclampsia and eclampsia. The regulation of these antiangiogenic factors in the placenta is unknown. The recent discoveries of upregulated antiangiogenic factors provide promise for future testing to predict and diagnose preeclampsia as well as therapeutic targets for amelioration of the clinical disease.
Preeclampsia, a hypertensive disorder of pregnancy, affects 5–8% of women. Large studies demonstrate a strong association between preeclampsia and future cardiovascular disease. Despite cardiovascular disease being the leading cause of mortality for women, there has been little education for internal medicine physicians or obstetrician-gynecologists about this association, and published guidelines do not include preeclampsia as a risk factor for future cardiovascular disease. Therefore, women with a history of preeclampsia may not receive adequate risk reduction counseling for cardiovascular disease. It is unclear whether primary care physicians are aware of the association; thus, we sought to determine whether primary care providers at our institution were aware of preeclampsia’s association with future cardiovascular disease and whether they were providing appropriate counseling. An anonymous on-line survey was sent to all internists and obstetrician-gynecologists at our hospital. Although most internists (95%) and obstetrician-gynecologists (70%) provide routine cardiovascular risk reduction counseling, a substantial proportion of them were unaware of any health risk associated with a history of preeclampsia. Many internists were unsure or did not know if preeclampsia is associated with ischemic heart disease (56%), stroke (48%) and decreased life expectancy (79%). The corresponding proportions for obstetrician-gynecologists were 23%, 38% and 77%. A majority of internists (88%) and obstetrician-gynecologists (79%) were incorrect about or unaware whether preeclampsia was included as a risk factor in the American Heart Association guidelines for prevention of ischemic heart disease. Only 9% of internists and 38% of obstetrician-gynecologists were providing cardiovascular risk reduction counseling to women with a history of preeclampsia.
Integrating research on the social construction of technology and social cognitive processes in organizations, technology frame of reference (TFR) theory has helped researchers investigate how stakeholder groups perceive information systems practices and opportunities, how these perceptions shift over time, and, how stakeholders may impact or leverage them to facilitate change. Such insights are particularly important in dynamic environments where individuals, groups, and organizations face a constant challenge to make sense of and respond to how industries undergo change, information technologies (IT) evolve, and new opportunities to transform processes and products emerge. Still, although extant research provides detailed accounts of TFR dynamics between groups, we know little about TFR dynamics in groups and about how intra-and inter-group TFRs interact during IT-enabled change. Accordingly, we report on an action research project in which we relied on TFR theory to assist organizational innovators in a rapidly growing mobile phone company, VoiceTech, during a sales force automation (SFA) project. Consistent with current TFR studies, our analyses reveal how the SFA project implicated frame incongruences between different stakeholder groups. In addition, our analyses reveal important inconsistencies in how individual groups framed the SFA project and consequential interactions between the observed inconsistencies and incongruences over time. Based on these findings, we argue that inconsistencies and incongruences in stakeholders' technological frames play equally important but quite distinct and interacting roles during IT-enabled change. As a result, we extend current TFR theory with a nuanced account of how IT-enabled change efforts implicate these two fundamental characteristics of framing processes. In conclusion, we discuss the empirical and theoretical contributions to TFR theory and highlight implications for future research and for the management of IT-enabled change in dynamic contexts.
Although our general knowledge about open source communities is extensive, we are only beginning to understand the increasingly common practices by which corporations design software through engagement with these communities. In response, we combine design theorizing with field-study research (1) to analyze rich qualitative data from over 40 corporations participating in the Linux open source community and (2) to synthesize the observed corporate-open source community engagements into a new type of information systems design theory that we call responsive design. Empirically, we document how corporate participants in these contexts respond to market decisions, interdependent ideologies, and distributed relationships by continuously establishing and maintaining connections with community members; connections that stem from the social and material rules inherent in the open source community. Based on these observations, we create the theory of responsive design as a particular form of corporate software design which, beyond the inclusion of external participants, distinguishes itself from traditional monocentric design in which one corporation controls a dedicated team of software designers focused on solving an isolated and singular organizational problem. Guided by the principles of interconnection, opportunism, and domestication, we define responsive design as the kind of design approach that enables corporate participants to create and maintain productive design practices in response to the complex and dynamic landscapes of activities that are the foundation of corporate-communal engagements. We conclude with a discussion of the theoretical and practical implications of this new form of corporate software design.
OBJECTIVE To evaluate an intrapartum nucleic acid amplification test (NAAT) for Group B streptococcus (GBS). STUDY DESIGN Prospective cohort study of 559 women comparing intrapartum GBS culture with antepartum culture and intrapartum NAAT. RESULTS GBS prevalence was 19.5% by antepartum culture and 23.8% by intrapartum culture. Compared with intrapartum culture, antepartum culture had 69.2% sensitivity (60.6–76.9) and 96.0% specificity (93.7–97.7). The NAAT demonstrated sensitivity of 90.8% (84.6–95.2), specificity of 97.6% (95.6–98.8), and predictive values exceeding 92%. The incidence of discordant cultures was 10.4%. Of the women with negative antepartum and positive intrapartum cultures, only 1 (2.4%) received intrapartum antibiotics. Compared with white women, black (P=0.02) and Hispanic (P=0.02) women were more likely to have discordant cultures. CONCLUSION This intrapartum NAAT has excellent characteristics. It may be superior to antepartum culture for detecting intrapartum GBS—allowing more accurate management of laboring mothers and reducing neonatal GBS sepsis.
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