Risk assessment of preterm birth through identification and stratification of pregnancies using a real-time scoring algorithm.

INTRODUCTION: Preterm birth poses a significant challenge. This study evaluated a real-time scoring algorithm to identify and stratify pregnancies to indicate preterm birth. METHODS: All claims data of pregnant women were reviewed between 1 January 2014 and 31 October 2018 in Kentucky. RESULTS: A total of 29,166 unique women who were matched to a live newborn were documented, with the pregnancy identified during the first trimester in 54.1% of women. Negative predictive values, sensitivity, and positive likelihood ratios increased from the first to third trimesters as pregnant women who were matched to a live newborn had more visits with their physicians. The area under the receiving-operating characteristics curve on test data classifying preterm birth was 0.59 for pregnancies identified during the first trimester, 0.62 for pregnancies identified in the second trimester, and 0.73 for pregnancies identified in the third trimester. CONCLUSIONS: This study presents a real-time scoring algorithm of indicating preterm birth in the first trimester of gestation which permits stratification of pregnancies to provide more efficient early care management.

Targeting CD137 enhances the efficacy of cetuximab.

Treatment with cetuximab, an EGFR-targeting IgG1 mAb, results in beneficial, yet limited, clinical improvement for patients with head and neck (HN) cancer as well as colorectal cancer (CRC) patients with WT KRAS tumors. Antibody-dependent cell-mediated cytotoxicity (ADCC) by NK cells contributes to the efficacy of cetuximab. The costimulatory molecule CD137 (4-1BB) is expressed following NK and memory T cell activation. We found that isolated human NK cells substantially increased expression of CD137 when exposed to cetuximab-coated, EGFR-expressing HN and CRC cell lines. Furthermore, activation of CD137 with an agonistic mAb enhanced NK cell degranulation and cytotoxicity. In multiple murine xenograft models, including EGFR-expressing cancer cells, HN cells, and KRAS-WT and KRAS-mutant CRC, combined cetuximab and anti-CD137 mAb administration was synergistic and led to complete tumor resolution and prolonged survival, which was dependent on the presence of NK cells. In patients receiving cetuximab, the level of CD137 on circulating and intratumoral NK cells was dependent on postcetuximab time and host FcyRIIIa polymorphism. Interestingly, the increase in CD137-expressing NK cells directly correlated to an increase in EGFR-specific CD8+ T cells. These results support development of a sequential antibody approach against EGFR-expressing malignancies that first targets the tumor and then the host immune system.

How caregivers manage pain and distress in second-stage labor.

Innovative care interactions are needed when helping a woman who exhibits severe pain or distress during the second stage of labor. We describe how caregivers and laboring women interacted during second-stage labor, with particular attention to how caregivers managed pain and distress. We used observational methods to perform a microanalysis of behaviors from video-recorded data. Pain occurred during labor contractions, and distress (an emotional response to pain) manifested primarily between contractions. Four patterns of women's behavior were identified: 1) no pain or distress, 2) low-level pain and/or distress, 3) focused working, and 4) severe pain and/or distress. Successful care was identified as enabling the woman to maintain herself in any state other than severe pain and/or distress. Particular modes of speech used by the caregiver enabled the attainment of successful care when the woman was not in severe pain or distress. When severe pain or distress existed, innovative caregiving transitioned the woman to another state. Successful intervention strategies included 1) giving innovative directions and 2) "talking down." Ordinary modes of "birth talk" can be used when severe pain or distress is not manifested and when the primary care problem is to assist women with bearing down. Innovative care interactions are needed when faced with severe pain or distress. Managing labor pain is an ongoing focus of clinicians who provide care to women in labor. In addition to pain, women might also experience distress, an emotional response to the labor experience. Whether from choice or necessity, caregivers for laboring women need nonpharmacologic interventions and interpersonal skills that can help women endure labor and give birth. Labor is hard work, and even in precipitous labors most women require assistance. Care given to a laboring woman consists of employing comforting strategies that help her cope with the pain of uterine contractions. The purpose of these comfort strategies is to help the woman find needed resilience during labor. Most cultures have mechanisms for providing this kind of support. In this article, we identify patterns of behavior used by laboring women and describe successful and unsuccessful strategies used by caregivers to help these women deal with pain and distress during the second stage of labor.

Birth talk in second stage labor.

In this secondary analysis of videotape data, we describe birth talk demonstrated by caregivers to women during the second stage of labor. Birth talk is a distinctive verbal register or a set of linguistic features that are used with particular behaviors during specific situations, has a particular communication purpose, and is characterized by distinctive language features. Birth talk is found cross-culturally among speakers of diverse languages. Our findings show that birth talk occurred mainly during contractions and co-occurred with two general styles of caregiving: "directed toward forced bearing down" and "supportive of physiologic bearing down." We also describe talk that occurred during rest periods, which was similar across the two styles. Caregivers' use of language tended to be either procedural (giving directions, instructions) or comfort related (encouraging and supporting). Linguistic features of the talk consisted of utterances of short duration, level pitch patterns with no sudden pitch shifts, and a restricted pitch range.