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Objective This study aimed to examine whether there are racial disparities in severe maternal morbidity (SMM) in patients with hypertensive disorders of pregnancy (HDP). Study Design Secondary analysis of an observational study of 115,502 patients who had a live birth at ≥20 weeks in 25 hospitals in the United States from 2008 to 2011. Only patients with HDP were included in this analysis. Race and ethnicity were categorized as non-Hispanic White, non-Hispanic Black (NHB), and Hispanic and were abstracted from the medical charts. Patients of other races and ethnicities were excluded. Associations were estimated between race and ethnicity, and the primary outcome of SMM, defined as any of the following, was estimated by unadjusted logistic and multivariable backward logistic regressions: blood transfusion ≥4 units, unexpected surgical procedure, need for a ventilator ≥12 hours, intensive care unit (ICU) admission, or failure of ≥1 organ system. Multivariable models were run classifying HDP into three levels as follows: (1) gestational hypertension; (2) preeclampsia (mild, severe, or superimposed); and (3) eclampsia or HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Results A total of 9,612 individuals with HDP met inclusion criteria. No maternal deaths occurred in this cohort. In univariable analysis, non-Hispanic White patients were more likely to present with gestational hypertension whereas NHB and Hispanic patients were more likely to present with preeclampsia. The frequency of the primary outcome, composite SMM, was higher in NHB patients compared with that in non-Hispanic White or Hispanic patients (11.8 vs. 4.5% in non-Hispanic White and 4.8% in Hispanic, p Conclusion NHB patients with HDP had higher rates of the composite SMM compared with non-Hispanic White patients, driven mainly by a higher frequency of blood transfusions and ICU admissions. However, once severity and other confounding factors were taken into account, the differences did not persist. Key Points

The prevalence of opioid use disorder (OUD) in the United States has more than quadrupled over the past two decades. This patient population presents a number of challenges to clinicians, including difficult pain management after surgical procedures due to the development of opioid tolerance. Significantly greater opioid consumption and pain scores after cesarean delivery have been reported in patients with OUD compared to other obstetric patients. A multi-modal analgesic regimen is generally recommended, but there are few well-established pain management strategies after cesarean delivery specific to patients with OUD. We present the case of a patient with OUD maintained on daily methadone that received a continuous epidural hydromorphone infusion for post-cesarean analgesia, a technique not previously reported in obstetric patients and only rarely described for patients undergoing other surgical procedures. The patient received epidural anesthesia for cesarean delivery, and after surgery, the epidural catheter was left in place for the epidural hydromorphone infusion, initiated at 140 mcg/hr and continued for approximately 40 hrs. This strategy reduced her average daily oral opioid consumption by 97%, reduced self-reported pain scores, shortened the length of hospitalization and improved ability to ambulate compared to her previous cesarean delivery. The use of continuous epidural hydromorphone infusion was effective in this case, and this analgesic technique may also be applicable to other types of surgical procedures with the potential for significant post-operative pain, particularly in patients with OUD.

Following the cessation of hostilities in May 2009, the Government of Sri Lanka has announced a suitably ambitious macroeconomic vision to capitalize on the peace dividend. Its goals include growing at 8 percent or more per year and lowering government indebtedness from around 80 to 60 percent of GDP by 2015. This paper's main finding is that while some post-conflict bounce is only to be expected, sustaining high growth presents significant challenges. A substantial rise in the national investment and savings rates will be needed to sustain growth rates of 8 percent even when accompanied by a significant rise in total factor productivity growth. With the government's balance sheet constrained by its desire to lower public indebtedness, private investment will need to become the engine of growth. This places high priority on better infrastructure, clear signals about the relative roles of the public and private sectors, and hard budget constraints and competition both to strengthen the investment climate and spur technological upgrading in pursuit of faster productivity growth.

This paper takes a hard look at the experience with official intervention in sovereign debt crises, focusing on debt crises of the 1980s, Russia in 1998, Argentina in 2001, and Greece in 2010. Based on the track record, the authors argue that in situations where countries face a solvency problem, official intervention is more likely to succeed if official money is lent at the risk-free rate reflecting its seniority and private creditors receive an upfront haircut. Such an approach would limit the costs associated with procrastination and increase the chances of success by enabling a more realistic fiscal program to restore solvency. They examine the moral hazard implications for debtor countries of this proposal and find that these are unlikely to be severe. In fact, after their crises of 1997-2001, emerging market countries embarked on an aggressive and comprehensive program of self-insurance, indicating that they are weary of debt crises and their costs. However, the prospect of an upfront haircut for private creditors in the event of insolvency is likely to make them more diligent in their sovereign lending decisions.

Hypoxic chemotransmission in the rat carotid body (CB) is mediated in part by ATP acting on P2X urinoceptors. Here we use RT-PCR, cloning, and sequencing techniques to show P2X2 and P2X3 receptor expression in petrosal neurons (PN). Confocal immunofluorescence indicated co-localization of P2X2 and P2X3 protein in many petrosal neurons and CB afferent terminals in situ. Petrosal and nodose neurons share a similar developmental origin (i.e. the ectodermal placodes) and GDNF is a required survival factor for both the neuronal groups. However, in the present study the profiles of P2X receptor subunit expression in the petrosal and nodose neurons differed from each other. The PNs showed a slight increase in the expression of P2X2 and P2X3 mRNA by P-21, whereas in nodose neurons the corresponding expression levels peaked by P-9, but fell significantly by P-21. However, in both cases the expression levels for the P2X2 mRNA were higher than those of P2X3 mRNA and the expression profile for both the P2X subunits developed along a parallel time course. Previous developmental studies have indicated that expression levels of various autoreceptors on type I cells (e.g. DA D2-receptors, A2a and A2b adenosine receptors) change during the first week of postnatal life, as the animal breathes normoxic air. In the present study, the possibility that oxygen tension might regulate P2X receptor expression on type I cells was examined. RT-PCR was employed to compare expression levels of the P2X subunits in isolated type I cells grown under different 0₂ tensions. Compared to nonnoxic (20% 02) cell clusters grown under chronic hypoxia ( 6% O₂). Immunofluorescence studies cells grown under CHox. Thus, ATP and P2X2/P2X3 purinoceptors play an important role under normal conditions and following exposure to chronic hypoxia. Thesis Master of Science (MSc)

The purpose of this study was to investigate the effects of exercise and dietary iron on various components of iron metabolism in 13 month old female rats. Fifty-six 13 month old female Sprague-Dawley rats were randomly assigned to one of five groups of treatment: baseline (BL); 40ppm iron, exercise (40 E); 9ppm iron, exercise (9 E); 40ppm iron, non- exercise (40 NE); 9ppm iron, non-exercise (9 NE). The exercise protocol involved swimming the exercise groups for a period of six weeks, starting with 10 minutes/day until the rats were swimming for 1 hour/day, 5 days/ week, at the sixth week. Results indicated no significant differences in food intake and body weight among the groups. Hematocrit values were similar among groups and did not show significant effects of diet, activity or interaction. Hemoglobin values demonstrated significant effects of activity with values being elevated in the exercise groups (p ≤0.05). No significant effects of diet and interaction on hemoglobin concentrations were observed. Serum iron levels were significantly affected by dietary intake of iron, with levels being lower in the groups consuming the moderately-deficient diet (p≤0.05). Serum iron levels were not significantly affected by activity or interaction of diet and activity. TIBC levels did not demonstrate significant effects of diet, activity or interaction (p