Optimal misoprostol dosing among patients with a body mass index greater than 30: a randomized controlled trial.

BACKGROUND: Patients with obesity experience an increased duration of labor with an increased risk for perinatal morbidity. When compared with parturients without obesity, they also experience fewer uterine contractions after administration of misoprostol. It is unclear if the same dose of misoprostol should be used for induction of labor in patients with obesity compared to non-obese patients. Therefore, we sought to investigate if a higher dose of misoprostol for patients with obesity is more effective. OBJECTIVE: This study aimed to determine if 50 µg compared with 25 µg of vaginal misoprostol reduced the time from induction start to delivery among patients with obesity. STUDY DESIGN: We performed a double-blinded, pragmatic randomized controlled trial, between June 1, 2022, and July 17, 2023. Patients with a body mass index ≥30 kg/m2 who underwent labor induction at ≥ 36 weeks' gestation, had a singleton gestation, and a cervical dilation ≤3 cm at admission were included. Patients were excluded if they had a contraindication to vaginal delivery or misoprostol administration. Patients were randomized to 25 or 50 µg of vaginal misoprostol, stratified by parity, body mass index <40 kg/m2 or ≥40 kg/m2, and provider intent to use mechanical dilation at the onset of labor induction. Usual labor management was followed at the discretion of the provider. The primary outcome was time from induction to delivery. A priori, we estimated that 90 subjects per group (N=180) were needed for an 85% power to detect a 3-hour difference between groups with a type I error of 5%. Analysis was by intention-to-treat. A 2-sample t test was used for the primary outcome, Cohen's d was used as a measure of effect, and P values were reported. RESULTS: Of the 180 patients randomized, 88 were assigned to the 25 µg group and 92 were assigned to the 50 µg group. Of those, 96.1% of patients received the designated intervention. The baseline characteristics were similar between groups. No difference was found in the primary outcome of time to delivery (21.6 hours vs 18.6 hours; d=.28; 95% confidence interval, -0.02 to 0.57). In a planned subgroup analysis, multiparous patients delivered faster in the 50 µg group (15.2 hours vs 12.0 hours; d=.51; 95% confidence interval, 0.04-0.97). The risk for tachysystole associated with fetal heart tracing changes was rare overall (2.2%) and not significantly different between groups. No differences in maternal or neonatal adverse effects were observed. CONCLUSION: Patients with obesity who underwent cervical ripening with 50 µg of vaginal misoprostol experienced a similar time to delivery when compared with those who received 25 µg of misoprostol. However, multiparous patients had a significantly reduced time to delivery when 50 µg was used. A higher dose of misoprostol may be a promising intervention for reducing time in labor, which warrants further study.

Longitudinal study of cognitive decline among women with and without urinary incontinence.

BACKGROUND: Cross-sectional and short-term cohort studies have demonstrated an association between urinary incontinence and dementia, as well as lower performance on cognitive testing. The Health and Retirement Study, a longitudinal study of community-dwelling older adults, offers an opportunity to assess the temporal association between these conditions because it included an assessment of incontinence symptoms and biennial assessments of cognitive function. OBJECTIVE: This study aimed to evaluate if urinary incontinence before the age of 70 years had an effect on changes in cognitive function among women participating in the Health and Retirement Study. STUDY DESIGN: This secondary analysis included data from female respondents in the Health and Retirement Study aged 58 to 67 years with ≥2 cognitive assessments. Urinary incontinence was defined as any involuntary loss of any urine in the preceding 12 months. A control group without incontinence was reweighted for better comparability using coarsened exact matching for age and comorbidities. Validated methods, including neuropsychological test data, estimated a memory score and dementia probability for each participant biennially. Coprimary outcomes were the changes in memory score and dementia probability. Linear regression models were used to estimate the association of urinary incontinence with change in memory score and dementia probability, adjusting for baseline demographics and comorbidities. A subgroup analysis was performed to assess the effects of urinary incontinence frequency on these outcomes. The infrequent subgroup reported <15 days of leakage per month and the frequent subgroup reported ≥15 days of leakage per month. RESULTS: Among eligible female respondents, 40.6% reported urinary incontinence between the ages of 58 and 69 years. Baseline memory scores and dementia probability were similar between those with urinary incontinence (n=1706) and controls (n=2507). Memory score declined significantly in both cohorts, indicating poorer memory over time (-0.222 among those with incontinence [95% confidence interval, -0.245 to -0.199] vs -0.207 in controls [95% confidence interval, -0.227 to -0.188]). The decline of memory score was not statistically significantly different between cases and controls (mean difference, -0.015; 95% confidence interval, -0.045 to 0.015). Dementia probability increased significantly in both groups, indicating a greater probability of developing dementia by 0.018 among those with incontinence (95% confidence interval, 0.015-0.020) and by 0.020 among controls (95% confidence interval, 0.017-0.022). The change in dementia probability was not significantly different between groups (mean difference, -0.002; 95% confidence interval, -0.006 to 0.002). Frequent urinary incontinence was reported in 105 of 1706 (6%) of those with urinary incontinence. Memory score declined and dementia probability increased with time (P<.001) in frequent and infrequent urinary incontinence subgroups. There was no dose-response relationship. CONCLUSION: Measures of cognitive performance declined during approximately 10 years of observation. The changes in performance were not associated with the presence of urinary incontinence in the participants' younger years.

The Impact of Telehealth on Obstetrical Outcomes during the COVID-19 Pandemic.

OBJECTIVE: Nationwide, obstetric clinics modified prenatal care to include telehealth visits in response to the coronavirus disease 2019 (COVID-19) pandemic, enabling the opportunity to investigate its impact on patient outcomes. We hypothesized that use of prenatal telehealth visits would increase the number of prenatal visits, decrease the frequency of urgent triage/emergency department (ED) visits, and improve perinatal outcomes. This study aimed to determine the impact of telehealth on number of obstetric prenatal visits and urgent triage/ED visits amidst the COVID-19 pandemic. STUDY DESIGN: This is a retrospective cohort of patients from a federally qualified health center in central Texas. Patients with a singleton gestation who delivered after 32 weeks were included. Comparison groups were made between those patients who delivered between May 2020 and December 2020 (presumed modified prenatal visit schedule with in-person and telehealth) and those patients delivering between June 2019 and February 2020 (the traditional care model with in-person visits only). Multivariable linear and logistic regression models were used to estimate differences in the number of prenatal visits and unscheduled triage/ED visits. RESULTS: A total of 1,654 patients were identified with 801 (48.4%) patients undergoing modified prenatal care and 853 (51.6%) patients receiving traditional care during the study period. No significant differences were seen in overall prenatal attendance or triage/ED presentations. However, when stratified by parity, multiparous patients undergoing modified prenatal care were less likely to experience an urgent triage/ED presentation (8.7 vs. 12.7%; odds ratio, 1.69; 95% confidence interval, 1.10-2.61). CONCLUSION: When compared with a traditional prenatal visitation cohort prepandemic, patients who received modified telehealth prenatal care during the COVID-19 pandemic had similar prenatal attendance and unscheduled emergency presentations. However, multiparous patients experienced a decreased rate of unscheduled emergency presentations. Supplementing prenatal care with telehealth may provide overall comparable prenatal care delivery. KEY POINTS: · Use of telehealth has the potential to improve prenatal care.. · The COVID-19 pandemic allowed for comparison to traditional prenatal care.. · Multiparous patients had a decreased frequency of ED visits.. · Similar prenatal attendance was seen between both prenatal models..

Synthesis and characterization of XeAr2 under high pressure.

The binary Xe-Ar system has been studied in a series of high pressure diamond anvil cell experiments up to 60 GPa at 300 K. In-situ x-ray powder diffraction and Raman spectroscopy indicate the formation of a van der Waals compound, XeAr2, at above 3.5 GPa. Powder x-ray diffraction analysis demonstrates that XeAr2 adopts a Laves MgZn2-type structure with space group P63/mmc and cell parameters a = 6.595 Å and c = 10.716 Å at 4 GPa. Density functional theory calculations support the structure determination, with agreement between experimental and calculated Raman spectra. Our DFT calculations suggest that XeAr2 would remain stable without a structural transformation or decomposition into elemental Xe and Ar up to at least 80 GPa.

Review article laser-induced hyperthermia on graphene oxide composites.

BACKGROUND: Hyperthermia-based therapies have shown great potential for clinical applications such as for the antitumor and antipathogenic activities. Within all strategies, the so-called photothermal therapy proposes to induce the hyperthermia by the remote laser radiation on a photothermal conversion agent, in contact with the target tissue. METHODS: This paper reviews the most relevant in vitro and in vivo studies focused on NIR laser-induced hyperthermia due to photoexcitation of graphene oxide (GO) and reduced graphene oxide (rGO). Relevant parameters such as the amount of GO/rGO, the influence of the laser wavelength and power density are considered. Moreover, the required temperature and exposure time for each antitumor/antipathogenic case are collected and unified in a thermal dose parameter: the CEM43. RESULTS: The calculated CEM43 thermal doses revealed a great variability for the same type of tumor/strain. In order to detect potential tendencies, the values were classified into four ranges, varying from CEM43 < 60 min to CEM43 ≥ 1 year. Thus, a preference for moderate thermal doses of CEM43 < 1 year was detected in antitumor activity, with temperatures ≤ 50 °C and exposure time ≤ 15 min. In case of the antipathogenic studies, the most used thermal dose was higher, CEM43 ≥ 1 year, with ablative hyperthermia (> 60ºC). CONCLUSIONS: The ability of GO/rGO as effective photothermal conversion agents to promote a controlled hyperthermia is proven. The variability found for the CEM43 thermal doses on the reviewed studies reveals the potentiality to evaluate, for each application, the use of lower temperatures, by modulating time and/or repetitions in the doses.

Formation and Stability of Dense Methane-Hydrogen Compounds.

Through a series of x-ray diffraction, optical spectroscopy diamond anvil cell experiments, combined with density functional theory calculations, we explore the dense CH_{4}-H_{2} system. We find that pressures as low as 4.8 GPa can stabilize CH_{4}(H_{2})_{2} and (CH_{4})_{2}H_{2}, with the latter exhibiting extreme hardening of the intramolecular vibrational mode of H_{2} units within the structure. On further compression, a unique structural composition, (CH_{4})_{3}(H_{2})_{25}, emerges. This novel structure holds a vast amount of molecular hydrogen and represents the first compound to surpass 50 wt % H_{2}. These compounds, stabilized by nuclear quantum effects, persist over a broad pressure regime, exceeding 160 GPa.

Dynamic Covalent Properties of a Novel Indolo[3,2-b]carbazole Diradical.

This work describes the synthesis and properties of a dicyanomethylene-substituted indolo[3,2-b]carbazole diradical ICz-CN. This quinoidal system dimerises almost completely to (ICz-CN)2 , which contains two long C(sp3 )-C(sp3 ) σ-bonds between the dicyanomethylene units. The minor open-shell ICz-CN component in the solid-state mixture was identified by EPR spectroscopy. Cyclic voltammetry and UV-visible spectroelectrochemical data, as well as comparison with reference monomer ICz-Br reveal that the nature of the one-electron oxidation of (ICz-CN)2 at ambient temperature and ICz-CN at elevated temperature is very similar in all these compounds due to the prevailing localization of their HOMO on the ICz backbone. The peculiar cathodic behaviour reflects the co-existence of (ICz-CN)2 and ICz-CN. The involvement of the dicyanomethylene groups stabilizes the close-lying LUMO and LUMO+1 of (ICz-CN)2 and especially ICz-CN compared to ICz-Br, resulting in a distinctive cathodic response at low overpotentials. Differently from neutral ICz-CN, its radical anion and dianion are remarkably stable under ambient conditions. The UV/Vis(-NIR) electronic transitions in parent (ICz-CN)2 and ICz-CN and their different redox forms have been assigned convincingly with the aid of TD-DFT calculations. The σ-bond in neutral (ICz-CN)2 is cleaved in solution and in the solid-state upon soft external stimuli (temperature, pressure), showing a strong chromism from light yellow to blue-green. Notably, in the solid state, the monomeric diradical species is predominantly formed under high hydrostatic pressure (>1 GPa).

High-temperature phase transitions in dense germanium.

Through a series of high-pressure x-ray diffraction experiments combined with in situ laser heating, we explore the pressure-temperature phase diagram of germanium (Ge) at pressures up to 110 GPa and temperatures exceeding 3000 K. In the pressure range of 64-90 GPa, we observe orthorhombic Ge-IV transforming above 1500 K to a previously unobserved high-temperature phase, which we denote as Ge-VIII. This high-temperature phase is characterized by a tetragonal crystal structure, space group I4/mmm. Density functional theory simulations confirm that Ge-IV becomes unstable at high temperatures and that Ge-VIII is highly competitive and dynamically stable at these conditions. The existence of Ge-VIII has profound implications for the pressure-temperature phase diagram, with melting conditions increasing to much higher temperatures than previous extrapolations would imply.

A Chichibabin's Hydrocarbon-Based Molecular Cage: The Impact of Structural Rigidity on Dynamics, Stability, and Electronic Properties.

A three-dimensional π-conjugated polyradicaloid molecular cage c-Ph14, consisting of three Chichibabin's hydrocarbon motifs connected by two benzene-1,3,5-triyl bridgeheads, was synthesized. Compared with its linear model compound l-Ph4, the prism-like c-Ph14 has a more rigid structure, which shows significant impact on the molecular dynamics, stability, and electronic properties. A higher rotation energy barrier for the quinoidal biphenyl units was determined in c-Ph14 (15.64 kcal/mol) than that of l-Ph4 (11.40 kcal/mol) according to variable-temperature NMR measurements, leading to improved stability, a smaller diradical character, and an increased singlet-triplet energy gap. The pressure-dependent Raman spectroscopic studies on the rigid cage c-Ph14 revealed a quinoidal-to-aromatic transformation along the biphenyl bridges. In addition, the ellipsoidal cavity in the cage allowed selective encapsulation of fullerene C70 over C60, with an associate constant of about 1.43 × 104 M-1. Moreover, c-Ph14 and l-Ph4 exhibited similar redox behavior and their cationic species (c-Ph146+ and l-Ph42+) were obtained by chemical oxidation, and the structures were identified by X-ray crystallographic analysis. The biphenyl unit showed a twisted conformation in l-Ph42+ and remained coplanarity in c-Ph146+. Notably, molecules of c-Ph146+ form a one-dimensional columnar structure via close π-π stacking between the bridgeheads.

Impact of Prevalence Ratios of Chondroitin Sulfate (CS)- 4 and -6 Isomers Derived from Marine Sources in Cell Proliferation and Chondrogenic Differentiation Processes.

Osteoarthritis is the most prevalent rheumatic disease. During disease progression, differences have been described in the prevalence of chondroitin sulfate (CS) isomers. Marine derived-CS present a higher proportion of the 6S isomer, offering therapeutic potential. Accordingly, we evaluated the effect of exogenous supplementation of CS, derived from the small spotted catshark (Scyliorhinus canicula), blue shark (Prionace glauca), thornback skate (Raja clavata) and bovine CS (reference), on the proliferation of osteochondral cell lines (MG-63 and T/C-28a2) and the chondrogenic differentiation of mesenchymal stromal cells (MSCs). MG-G3 proliferation was comparable between R. clavata (CS-6 intermediate ratio) and bovine CS (CS-4 enrichment), for concentrations below 0.5 mg/mL, defined as a toxicity threshold. T/C-28a2 proliferation was significantly improved by intermediate ratios of CS-6 and -4 isomers (S. canicula and R. clavata). A dose-dependent response was observed for S. canicula (200 µg/mL vs 50 and 10 µg/mL) and bovine CS (200 and 100 µg/mL vs 10 µg/mL). CS sulfation patterns discretely affected MSCs chondrogenesis; even though S. canicula and R. clavata CS up-regulated chondrogenic markers expression (aggrecan and collagen type II) these were not statistically significant. We demonstrate that intermediate values of CS-4 and -6 isomers improve cell proliferation and offer potential for chondrogenic promotion, although more studies are needed to elucidate its mechanism of action.

Current Stage of Marine Ceramic Grafts for 3D Bone Tissue Regeneration.

Bioceramic scaffolds are crucial in tissue engineering for bone regeneration. They usually provide hierarchical porosity, bioactivity, and mechanical support supplying osteoconductive properties and allowing for 3D cell culture. In the case of age-related diseases such as osteoarthritis and osteoporosis, or other bone alterations as alveolar bone resorption or spinal fractures, functional tissue recovery usually requires the use of grafts. These bone grafts or bone void fillers are usually based on porous calcium phosphate grains which, once disposed into the bone defect, act as scaffolds by incorporating, to their own porosity, the intergranular one. Despite their routine use in traumatology and dental applications, specific graft requirements such as osteoinductivity or balanced dissolution rate are still not completely fulfilled. Marine origin bioceramics research opens the possibility to find new sources of bone grafts given the wide diversity of marine materials still largely unexplored. The interest in this field has also been urged by the limitations of synthetic or mammalian-derived grafts already in use and broadly investigated. The present review covers the current stage of major marine origin bioceramic grafts for bone tissue regeneration and their promising properties. Both products already available on the market and those in preclinical phases are included. To understand their clear contribution to the field, the main clinical requirements and the current available biological-derived ceramic grafts with their advantages and limitations have been collected.

Linear, Non-Conjugated Cyclic and Conjugated Cyclic Paraphenylene under Pressure.

The n-paraphenylene family comprises chains of phenylene units linked together by C-C bonds that are between single- and double-bonded, and where n corresponds to the number of phenylene units. In this work, we compare the response of the optical properties of different phenylene arrangements. We study linear chains (LPP), cyclic systems (CPPs), and non-conjugated cyclic systems with two hydrogenated phenylenes (H4[n]CPP). Particularly, the systems of interest in this work are [6]LPP, [12]- and [6]CPP and H4[6]CPP. This work combines Raman and infrared spectroscopies with absorption and fluorescence (one- and two-photon excitations) measured as a function of pressure up to maximum of about 25 GPa. Unprecedented crystallographic pressure-dependent results are shown on H4[n]CPP, revealing intramolecular π-π interactions upon compression. These intramolecular interactions justify the H4[n]CPP singular optical properties with increasing fluorescence lifetime as a function of pressure.

Reactivity of Hydrogen-Helium and Hydrogen-Nitrogen Mixtures at High Pressures.

Through a series of Raman spectroscopy studies, we investigate the behavior of hydrogen-helium and hydrogen-nitrogen mixtures at high pressure across a wide range of concentrations. We find that there is no evidence of chemical association or increased miscibility of hydrogen and helium in the solid state up to pressures of 250 GPa at 300 K. In contrast, we observe the formation of concentration-dependent N_{2}-H_{2} van der Waals solids, which react to form N-H bonded compounds above 50 GPa. Through this combined study, we can demonstrate that the recently reported chemical association of H_{2}-He can be attributed to significant N_{2} contamination and subsequent formation of N_{2}-H_{2} compounds.

Mechanochemistry in [6]Cycloparaphenylene: A Combined Raman Spectroscopy and Density Functional Theory Study.

Raman spectroscopy under high pressures up to 10 GPa and density functional computations up to 30 GPa are combined to obtain insights into the behavior of a prototypical nanohoop conjugated molecule, [6]cycloparaphenylene ([6]CPP). Upon increasing pressure, the nanohoop undergoes deformations, first reversible ovalization and then at even higher pressures aggregates are formed. This irreversible aggregation is caused by the formation of new intermolecular σ-bonds. Frequencies and derivatives of the Raman frequency shifts as a function of pressure are well reproduced by the computations. The frequency behavior is tied to changes in aromatic/quinonoid character of the nanohoop. The modeling at moderate high pressures reveals the deformation of the [6]CPP molecules into oval-like and peanut-like shapes. Surprisingly the pressure derivatives of the observed Raman mode shifts undergo a sudden change around a pressure value that is common to all Raman modes, indicating an underlying geometrical change extended over the whole molecule that is interpreted by the computational modeling. Simulations predict that under even larger deformations caused by higher pressures, oligomerization reactions would be triggered. Our simulations demonstrate that these transformations would occur regardless of the solvent, however pressures at which they happen are influenced by solvent molecules encapsulated in the interior of the [6]CPP.

Structures of lithium-zinc compounds at high pressures.

Intermetallic lithium compounds have found a wide range of applications owing to their light mass and desirable electronic and mechanical properties. Here, by compressing pure lithium and zinc mixtures in a diamond-anvil cell, we observe a direct reaction forming the stoichiometric compound LiZn, at pressures below 1 GPa. On further compression above 10 GPa, we observe the formation of Li2Zn, which is the highest lithium content compound to be discovered in the Li-Zn system. Our results constrain the structures of these compounds and their evolution with pressure, furthering our understanding of potentially useful light volume-efficient energy storage materials.

High pressure synthesis and stability of cobalt hydrides.

In situ high-pressure high-temperature X-ray powder diffraction studies of the cobalt-hydrogen system reveal the direct synthesis of both the binary cobalt hydride (CoH) and a novel cobalt dihydride (CoH2). We observe the formation of fcc CoH at pressures of 4 GPa, which persists to pressures of 45 GPa. At this pressure, we see the emergence with time of a further expanded fcc lattice, which we identify as CoH2, where the hydrogen atoms occupy the tetrahedral vacancies. We have explored alternative synthesis routes of CoH2 and can lower the synthesis pressure to 35 GPa by the application of high temperature. CoH2 is stable to at least 55 GPa and decomposes into CoH below 10 GPa, releasing molecular hydrogen before further decomposing completely into its constituent elements below 3 GPa. As a first-row transition metal, cobalt has a relatively lower mass than other hydride-forming transition metals, and as a result, CoH2 has a high hydrogen content of 3.3 wt. % and a volumetric hydrogen density of 214 g/l.

Brief Intervention Among Mexican-Origin Young Adults in the Emergency Department at the USA-Mexico Border: Examining the Role of Patient's Preferred Language of Intervention in Predicting Drinking Outcomes.

AIMS: Determine if the language in which brief intervention (BI) is delivered influences drinking outcomes among Mexican-origin young adults in the emergency department when controlling for ethnic matching. SHORT SUMMARY: Aim of study was to determine if a patient's preferred language of intervention influences drinking outcomes among Mexican-origin young adults in the emergency department. Results indicate no significant differences in drinking outcomes among those who received BI in Spanish and BI in English. METHODS: This is a secondary data analysis on data from 310 patients randomized to receive a BI completed in Spanish (BI-S) or English (BI-E), with 3- and 12-month follow-up. Outcome measures of interest were drinking days per week, drinks per drinking day, maximum drinks in a day and negative consequences of drinking. RESULTS: There were no significant differences in drinking outcomes among those who received BI in Spanish and BI in English. CONCLUSIONS: Reduced drinking outcomes following BI among Mexican-origin young adults in the emergency department may not have been due to the language used to deliver intervention. Thus, our results provide evidence that language of intervention is not a crucial factor to achieve cultural congruence. In addition, our findings suggest that receiving the intervention is beneficial regardless of language, thus, facilitating real-world implementation.

[Quality of maternal mortality statistics in Cuba, 2013Qualidade das estatísticas de mortalidade materna em Cuba, 2013]. / Calidad de las estadísticas de mortalidad materna en Cuba, 2013.

OBJECTIVE: Evaluate the degree of integrity of the Cuban statistical registry of maternal deaths and the quality of the classification of the causes of death included in that registry. METHODS: We analyzed the information of all Cuban women who died in fertile age in 2013 according to the continuous mortality registry of the Directorate of Medical Records and Health Statistics of the Ministry of Public Health of Cuba (MINSAP), regardless of the main cause of death informed. Four research groups (national, expert, provincial and health units), each with defined functions, applied four forms to establish if the women had been pregnant in the year prior to death, to reassess whether the cases corresponded to a maternal death and, in that case, to review the classification. RESULTS: Deaths of 2 731 women of reproductive age notified in Cuba in 2013 were assessed. Of them, the cause of death of 2 711 (99.3%) was conclusive and, of these, 97 (3.6%) had had a pregnancy in the year prior to death. We found 50 maternal deaths (one more than in the continuous registry) for a 2% error and an adjustment factor of 1.02. Of the 97 deaths studied, only 4 cases were reclassified: 2 maternal deaths and 1 death related to pregnancy, delivery and puerperium, according to the continuous registry, which were reclassified as direct deaths; and 1 death considered non- maternal by the continuous registry that was reclassified as late maternal death, for a 95.9% concordance. CONCLUSIONS: The information on maternal deaths included in the MINSAP's continuous mortality registry has a high level of integrity. The quality of the classification of maternal deaths in this registry is high; reclassification of causes of death is uncommon.

OBJETIVOS: Avaliar o grau de integridade do registro estatístico cubano de óbitos maternos e a qualidade da classificação das causas de óbito incluídas nesse registro. MÉTODOS: Analisamos a informação de todas as mulheres cubanas que morreram em idade fértil em 2013 de acordo com o histórico de mortalidade contínua da Diretoria de Registros Médicos e Estatísticas de Saúde do Ministério da Saúde Pública de Cuba (MINSAP), independentemente da causa básica da morte consignada. Quatro grupos de pesquisa (nacional, especialistas, provincial e unidades de saúde), com funções definidas, aplicaram quatro formas para determinar se houve gravidez no ano anterior à morte, reavaliam se os casos corresponderam a uma morte materna e, em nesse caso, rever a classificação. RESULTADOS: Foram investigadas as 2 731 mulheres falecidas de idade reprodutiva notificadas em Cuba em 2013, das quais as causas de morte de 2 711 (99,3%) foram conclusivas e, destas, 97 (3,6%) tiveram gravidez no ano anterior à morte. Encontramos 50 mortes maternas (uma mais do que no registro contínuo) por erro de 2% e um fator de ajuste de 1,02. Das 97 mortes estudadas, apenas 4 casos foram reclassificados: 2 mortes maternas e 1 morte relacionada à gravidez, parto e puerpério, de acordo com o registro contínuo, que foram reclassificadas como mortes diretas, e 1 morte considerada não materna pelo registro contínuo que foi reclassificada como morte materna tardia, para uma concordância de 95,9%. CONCLUSÕES: A informação sobre mortes maternas incluída no registro de mortalidade contínua do MINSAP tem alto nível de integridade. A qualidade da classificação das mortes maternas neste registro é alta; a reclassificação das causas de morte é pouco frequente.

Fingerprints of Through-Bond and Through-Space Exciton and Charge π-Electron Delocalization in Linearly Extended [2.2]Paracyclophanes.

New stilbenoid and thiophenic compounds terminally functionalized with donor-donor, acceptor-acceptor, or donor-acceptor moieties and possessing a central [2.2]paracyclophane unit have been prepared, and their properties interpreted in terms of through-bond and through space π-electron delocalization (i.e., π-conjugations). Based on photophysical data, their excited-state properties have been described with a focus on the participation of the central [2.2]paracyclophane in competition with through-bond conjugation in the side arms. To this end, two-photon and one-photon absorption and emission spectroscopy, as a function of temperature, solvent polarity, and pressure in the solid state have been recorded. Furthermore, charge delocalization through the [2.2]paracyclophane in the neutral state and in the oxidized species (radical cations, dications and radical trications) has been investigated, allowing the elucidation of the vibrational Raman fingerprint of through-space charge delocalization. Thus, a complementary approach to both "intermolecular" excitation and charge delocalizations in [2.2]paracyclophane molecules is shown which can serve as models of charge and exciton migration in organic semiconductors.

New Multiresponsive Chromic Soft Materials: Dynamic Interconversion of Short 2,7-Dicyanomethylenecarbazole-Based Biradicaloid and the Corresponding Cyclophane Tetramer.

This work reports on a quinodimethane-type molecule, 2,7-dicyanomethylene-9-(2-ethylhexyl)carbazole (1), one of the shortest π-conjugated biradicaloids reported to be stable in solution under ambient conditions. This carbazole-based quinoidal precursor is able to form a macrocyclic σ-bonded tetramer (2). The resolved single-crystal X-ray structure of tetramer 2 shows that four molecules of 1 are linked together through four long (CN)2 C-C(CN)2 bonds (1.631 Å) resulting from coupling of the unpaired electrons in biradicaloid 1. Dynamic interconversion between monomer 1 and cyclophane tetramer 2 is achieved by reversible cleavage and recovery of the four (CN)2 C-C(CN)2 bonds upon soft external stimuli (light absorption, temperature and pressure), which is accompanied by significant color changes. These novel photo-, thermo-, and mechanochromic properties expand the versatility of π-conjugated biradicaloid compounds as novel functional materials that, in combination with spin chemistry and dynamic covalent chemistry, can be relevant in molecular machines, sensors, and switches.