Similarly, the double bundle augmentation had the greatest rotational stability click here while there was little advantage in ligament stress compared to those of the other reconstruction method.\n\nInterpretation: Double bundle augmentation has advantages with regard to posterior and rotational stabilities as well as ligament stress in comparison with other reconstruction methods, especially following secondary deficiencies in the reconstructed grafts. (c) 2010 Elsevier Ltd. All rights reserved.”
“S-adenosyl homocysteine hydrolase (SAHH) is a key enzyme in methylation metabolism

of eukaryotes. A 1585 bp fragment upstream to ATG of SAHH1 gene, was fused with a promoter-less P-Glucuronidase (GUS) gene and mobilized into Arabidopsis by Agrobacterium-mediated floral transformation to generate transgenic Arabidopsis. This fragment was found to drive constitutive expression of GUS in T(2) progeny of transgenic Arabidopsis. In silico analysis of the promoter region of SAHH1 suggested the presence of several cis-regulatory motifs including seed-specific motifs as well as anther-specific motifs in the 376 bp (upstream to TSS of SAHH1) promoter fragment. Based on the partial

deletion analysis carried out in the promoter region of SAHH1 (At4g13940) this 376 bp promoter fragment was found to be capable of driving GUS expression in developing seeds and in some anthers/microspores.”
“Understanding the mechanisms that control chromosome folding in the nucleus of eukaryotes and their contribution to OSI-906 nmr gene regulation is a key open issue in molecular biology. Microscopy and chromatin-capture techniques have shown that chromatin has a complex organization, which dynamically changes across organisms and cell types. The need to make sense of such a fascinating complexity has prompted

the development of quantitative models from physics, to find the principles of chromosome folding, its origin and function. Here, we concisely review recent advances in chromosome modeling, focusing on a recently proposed framework, the Strings & Binders Switch (SBS) model, which recapitulates key features of chromosome TL32711 organization in space and time.”
“The basic helix-loop-helix (bHLH) family of transcription factors orchestrates cell-fate specification, commitment and differentiation in multiple cell lineages during development. Here, we describe the role of a bHLH transcription factor, Tcf21 (epicardin/Pod1/capsulin), in specification of the cardiac fibroblast lineage. In the developing heart, the epicardium constitutes the primary source of progenitor cells that form two cell lineages: coronary vascular smooth muscle cells (cVSMCs) and cardiac fibroblasts.

\n\nMethods\n\nThe participants were randomised to 5 or 10 units of oxytocin, given as an intravenous bolus. A Holter monitor was used to record electrocardiograms and non invasive blood pressure and heart rate (HR) was monitored. A blood sample was obtained 12-hour postoperatively.\n\nMain outcome measures\n\nDepression

of CA3 price the ST segment. Secondary outcomes: symptoms, Troponon I levels, mean arterial pressure (MAP), HR and blood loss.\n\nResults\n\nThere was a significant difference in occurrence of ST depressions associated with oxytocin administration, 4 (7.7%) with 5 and 11 (21.6%) with 10 units, P < 0.05. The absolute risk reduction was 13.9% (95% confidence interval, 0.5-27.3).\n\nDecrease of mean MAP from baseline to 2 minutes differed, being 9 mmHg in the 5 unit group and

17 mmHg in the 10 unit group (P < 0.01). The increase in mean HR did not differ. Troponin I levels were increased in four subjects (3.9%). There were no differences in occurrence of symptoms, Troponin I levels, or estimated blood loss.\n\nConclusion\n\nST depressions were associated with oxytocin administration significantly more often in subjects receiving 10 units compared with 5 units. Interventions to prevent hypotension during caesarean section may reduce the occurrence of ST depressions on electrocardiograms.”
“Atypical tuberculous tenosynovitis of the foot and ankle is extremely rare. The determination of the Mycobacterium species NVP-LDE225 cell line is essential because resistance of atypical mycobacterial strains to antituberculous drugs is often encountered. We report a case of Mycobacterium chelonae paratendinous and intratendinous infection involving the Achilles tendon. Repeat aggressive irrigation and debridement

procedures, coupled with removal of foreign materials and the appropriate use of prolonged antibiotic therapy, can result in a successful long- term outcome. (C) 2014 by the American College of Foot and Ankle Surgeons. All rights reserved.”
“Angiogenesis is spatially and temporally orchestrated by a myriad of signaling pathways, including the Notch signaling pathway. Here, we identified UXT as an evolutionarily conserved and developmentally expressed protein, indispensable for intersegmental vessel (ISV) formation in zebrafish. Deficiency of UXT in zebrafish embryos results in shorter VX-809 molecular weight ISVs, loss of tip cell behavior, and impairment of endothelial cell migration and division. Significantly, UXT attenuates the expression of the Notch-responsive genes in vitro and in vivo. Mechanistically, UXT binds to the promoters of the Notch signaling target genes and specifically interacts with the transactivation region domain of the Notch intracellular domain (NICD), impairing the interaction between NICD and the transcription factor RBP-J kappa endogenously. This prevents RBP-J kappa/CSL from activation and thus inhibits the consequent gene inductions.

The polarity of the spermatozoon is clearly demonstrated by the acrosome at the apical pole of the cell and the flagellum at the opposite end. Spermatogenesis

consists of three basic phases: mitosis, meiosis and spermiogenesis. The final phase represents the period of greatest cellular change where cell-type specific organelles such as the acrosome and the flagellum form, the nucleus migrates to the plasma membrane and elongates, chromatin condenses and residual cytoplasm is removed. An important feature of spermatogenesis is the change in the cytoskeleton that occurs throughout this pathway. In this review, the author will provide an overview of these transformations and provide insight into possible modes of regulation of these rearrangements during spermatogenesis. Although primary focus will be given to the microtubule cytoskeleton, the importance of actin filaments to the cellular transformation of the male germ cell will also be discussed.”
“Developing SBE-β-CD mouse proteomic biomarkers is valuable for evaluating therapeutic effects of drugs and generating better treatment strategies. However, conventional protein analysis

is often challenging due to inadequate sample size of clinical specimens, lack of assay reproducibility, accuracy, and sensitivity. A novel capillary isoelectricfocusing (IEF) immunoassay HDAC inhibitor system (NanoPro) was used to study the dynamic phosphorylation status of signaling molecules in non-small cell lung cancer (NSCLC) cells treated with EGFR tyrosine kinase and MEK inhibitors. NanoPro showed the same dynamic ERK phosphorylation as Western blotting with good assay reproducibility using 1,000 times less protein. The IEF separation in NanoPro system enables multiple protein phosphorylation isoforms to be resolved and detected simultaneously. With NanoPro, we identified a specific on-target mitogen-activated protein/extracellular signal-regulated kinase (MEK) response pattern to MEK inhibitor PD325901, which was not detectable by Western blot analysis. We also revealed a MEK2 signal that may be associated with NSCLC cell sensitivity to the EGF receptor inhibitor erlotinib, and distinguished erlotinib-sensitive cells

from intrinsic as well as acquired resistant cells to erlotinib. Moreover, NanoPro could differentiate human ERK1 isoforms from the mouse isoforms based AS1842856 on their isoelectric point differences and showed that erlotinib effectively inhibited ERK phosphorylation in targeted human xenograft cancer cells but not in surrounding mouse stromal cells. With 8 mu g of tumor aspirates, we precisely quantified the response of 18 signaling molecules to erlotinib and MEK1 inhibitor treatments in an NSCLC patient. NanoPro’s higher sensitivity, better resolution of protein phosphorylation status, and reduced tissue requirement warrant NanoPro’s investigation for future drug development and evaluation of drug effects of targeted therapies. Mol Cancer Ther; 12(11); 2601-13. (C) 2013 AACR.

“
“Most bacterial chromosomes contain homologs of plasmid partitioning (par) loci. These loci encode ATPases called ParA that are thought to contribute to the mechanical force required

for chromosome and plasmid Metabolism inhibitor segregation. In Vibrio cholerae, the chromosome II (chrII) par locus is essential for chrII segregation. Here, we found that purified ParA2 had ATPase activities comparable to other ParA homologs, but, unlike many other ParA homologs, did not form high molecular weight complexes in the presence of ATP alone. Instead, formation of high molecular weight ParA2 polymers required DNA. Electron microscopy and three-dimensional reconstruction revealed that ParA2 formed bipolar helical filaments on double-stranded DNA in a sequence-independent manner. These

filaments had a distinct change in Bafilomycin A1 clinical trial pitch when ParA2 was polymerized in the presence of ATP versus in the absence of a nucleotide cofactor. Fitting a crystal structure of a ParA protein into our filament reconstruction showed how a dimer of ParA2 binds the DNA. The filaments formed with ATP are left-handed, but surprisingly these filaments exert no topological changes on the right-handed B-DNA to which they are bound. The stoichiometry of binding is one dimer for every eight base pairs, and this determines the geometry of the ParA2 filaments with 4.4 dimers per 120 angstrom pitch left-handed turn. Our findings will be critical for understanding how ParA proteins function in plasmid and chromosome segregation.”
“Our previous study has for the first time demonstrated that atopic dermatitis (AD) patients show enhanced plasma concentrations

of PF4 and beta-TG. In addition, it has been suggested that chemokines may be the markers of AD severity. The aim of this study was to determine whether enhanced platelet activation in active AD withdraws when the disease reaches IPI-145 Angiogenesis inhibitor the clinical remission stage. Plasma PF-4 and beta-TG concentrations were studied in 10 AD patients and in 23 healthy controls. Patients were examined twice: first, during the active period, and next, during the clinical remission lasting for at least 6 months. Plasma PF-4 and beta-TG concentrations in patients upon AD remission were significantly lower as compared to active AD and did not differ significantly from the healthy subjects. Enhanced platelet activation is a transient phenomenon accompanying active AD and disappears during clinical remission. As with earlier data, the findings point to platelet activity in AD increasing during flare, falling following therapy and normalizing upon remission.”
“This study evaluated secondary caries and periodontal conditions associated with metal (MCs) and composite resin copings (RCs) of abutment teeth for overdentures. The rates of secondary caries and periodontal problems in 70 root copings (41 MCs, 29 RCs) in 35 patients were retrospectively investigated for a period of 6.9 years.

The final analytic sample included 1,407 RNs. Descriptive statistics were used to describe the sample, analysis of variance to compare means, and chi square to compare categorical variables.\n\nFindings: RNs learn more reporting higher levels of verbal abuse from nurse colleagues were more likely to be unmarried, work in a hospital setting, or work in a nonmagnet hospital. They also had lower job satisfaction, and less

organizational commitment, autonomy, and intent to stay. Lastly, they perceived their work environments unfavorably.\n\nConclusions: Data support the hypothesis that early career RNs are vulnerable to the effects of verbal abuse from nurse colleagues. Although more verbal abuse is seen in environments with unfavorable working

conditions, and RNs working in such environments tend to have less favorable work attitudes, one cannot assume causality. It is unclear if poor working conditions create an environment where verbal abuse is tolerated or if verbal abuse creates an unfavorable work environment.\n\nClinical Relevance: There is a need to develop and test evidence-based interventions to deal with the problems inherent with verbal abuse from nurse colleagues.”
“One megastigmane derivative 1, one methyl jasmonate glycoside derivative 2, and two C-28 steroids with 3 beta,5 beta-cis-dihydroxyl conformation 3 and 4, together with eight known compounds 5-12 were isolated from the 70% ethanol extract of linseed meal (Linum usitatissimum L). Structures of 1-4 were elucidated by spectroscopic methods including NMR, HRESIMS, and Mo-2(OAc)(4)-induced selleck Alvocidib Cell Cycle inhibitor CD. The absolute configuration of I and 3 was determined by observing their induced circular dichroism after addition of Mo-2(OAc)(4) in DMSO. The absolute configuration of 2 was determined by NOESY experiment together with conformational analysis. The structure of 4a was corrected as 4 by an extensive analysis of its 1D and 2D NMR, in combination with the Mo-2(OAc)(4)-induced CD in DMSO. The effect of all the isolates on nitric oxide (NO) generation by stimulated macrophages was evaluated, and none of them showed

active. (c) 2014 Elsevier B.V. All rights reserved.”
“Non-local ethnicity or nationality and lower English proficiency have been linked with poor performance in health professional education. This study sought to compare the relative contributions of ethnicity and English proficiency, and to do so in a context where students had not been selected via interviews or some other proxy for language proficiency. Ethnicity, citizenship, and demographic data, as well as academic performance and progress were obtained for three successive cohorts (entering in 2007, 2008 and 2009) into a three-year pharmacy programme, following a common first-year. Complete data was available for all 297 students entering via this path.

(C) 2008 Wiley-Liss, Inc.”
“AIM: To determine the incidence and characteristics of intestinal and extra-intestinal cancers

among patients with inflammatory bowel disease in a Spanish hospital and to compare them with those of the local population.\n\nMETHODS: This was a prospective, observational, 7-year follow-up, cohort study. Cumulative incidence, incidence rates based on person-years of follow-up and relative risk were calculated for patients with inflammatory bowel disease and compared with the background population. The incidence of cancer was determined using a hospital-based data registry from Hospital Universitario de Fuenlabrada. Demographic data and details about time from diagnosis of inflammatory bowel disease to occurrence Lapatinib manufacturer of cancer, disease extent, inflammatory bowel disease treatment, cancer therapy and cancer evolution were also collected in Tubastatin A ic50 the inflammatory bowel disease cohort.\n\nRESULTS: Eighteen of 590 patients with inflammatory bowel disease developed cancer

[cumulative incidence = 3% (95% CI: 1.58-4.52) vs 2% (95% CI: 1.99-2.11) in the background population; RR = 1.5; 95% CI: 0.97-2.29]. The cancer incidence among inflammatory bowel disease patients was 0.53% (95% CI: 0.32-0.84) per patient-year of follow-up. Patients with inflammatory bowel disease had a significantly increased relative risk of urothelial carcinoma (RR = 5.23, 95% CI: 1.95-13.87), appendiceal mucinous cystadenoma (RR = 36.6, 95% CI: 7.92-138.4), neuroendocrine carcinoma (RR = 13.1, 95% CI: 1.82-29.7) and rectal carcinoid (RR = 8.94, 95% CI: 1.18-59.7). Colorectal

cancer cases were not found.\n\nCONCLUSION: The overall risk of cancer did not significantly increase in our inflammatory bowel disease patients. However, there was an increased risk of urinary bladder cancer and, with less statistical power, an increased risk of appendiceal mucinous cystadenoma and of neuroendocrine tumors. Colorectal cancer risk was low in our series. (C) 2013 Baishideng Publishing Group Co., Limited. All rights reserved.”
“With a mean global incidence of 1:14500, congenital adrenal hyperplasia (CAH) is the most common PND-1186 disorder of sexual differentiation (DSD). In case of female karyotype, the prenatal surplus of androgens causes virilization of the external genitalia. This includes clitoral hypertrophy and an increasing higher confluence of the urethra and normal developed proximal vagina, creating the urogenital sinus. Internal genitalia are female.\n\nUntil recently feminizing surgery was performed within the first 18 months of life, at least concerning clitoroplasty. Though the cosmetic result of this kind of surgery is quite good, functional shortcomings like clitoral hyposensibility were often reported.

Taken together, these findings suggest that CacyBP/SIP plays important roles in the proliferation of human glioma cell

which might be involved in the development of human glioma. (c) 2014 IUBMB Life, 66(4):286-291, 2014″
“Introduction: Multiple myeloma (MM) patients who relapse, or become refractory to currently available novel agents, have limited treatment options with poor outcomes. Sotrastaurin nmr The introductions of the newer proteasome inhibitor carfilzomib and the immunomodulatory agent pomalidomide have provided new treatment strategies within the relapse setting. Pomalidomide, a novel 4-amino derived from thalidomide, was recently introduced for the treatment of MM. In addition to being immune-adjuvant with anti-inflammatory properties, pomalidomide has shown several biological activities that directly and indirectly inhibit MM cells.\n\nAreas covered: Herein, the authors review the chemistry, the mechanism of action and the pharmacokinetic properties of pomalidomide. The data reviewed within this article based on the relevant literature pertaining to pomalidomide’s Phase I, II and III clinical trials.\n\nExpert opinion: Pomalidomide has shown to be a safe and active agent, both alone and in combination with dexamethasone, in heavily pretreated patients. Furthermore, pomalidomide

represents an effective treatment option for relapsed/refractory BAY 63-2521 concentration patients. Results from the ongoing trials evaluating the synergistic activity of pomalidomide combined with conventional chemotherapy or novel agents look promising and may prove to be viable treatment options in the future.”
“Human V gamma 9V delta 2 T cells are potent anti-tumor lymphocytes that specifically respond to pyrophosphate (phospho-) antigens, which constitute the basis of current gamma delta T-cell-based immunotherapy

strategies. Despite a clear buy Barasertib involvement of the TCR, the costimulation requirements of V gamma 9V delta 2 T cells remain ill-defined. Here, we show that the expression of the CD27 receptor by the vast majority of V gamma 9V delta 2 peripheral blood lymphocytes endows them with enhanced proliferative capacity upon ligation by its unique ligand CD70, a tumor necrosis factor superfamily member expressed on lymphoma B-cells but also on TCR-activated gamma delta T cells. Moreover, V gamma 9V delta 2 T-cell treatment with soluble recombinant CD70 induced calcium signals and increased transcription of anti-apoptotic Bcl2a1 and cell-cycle-promoting Cyclin D2 genes. We further demonstrate that the manipulation of CD70-CD27 interactions significantly impacted on V gamma 9V delta 2 T-cell survival, proliferation and cytokine secretion, in both loss-of-function and gain-of-function experiments.

7-7.6), and the rate of vaccination was 63.9% (95% CI: 62.1-65.8). The odds ratio (OR) for vaccination against the infection among adult patients and younger patients ( smaller than = the median age) were 0.61 (95% Cl: 0.45-0.84) and 0.62 (95% Cl: 0.42-0.90), respectively. However, OR among the older patient ( bigger than median age) were 1.38 (96%Cl: SC79 PI3K/Akt/mTOR inhibitor 0.66-2.89). The rate of infection-induced asthma exacerbation was 23.2% (95% CI: 18.6-29.6), and the OR for vaccination against the infection-induced asthma exacerbation was 1.42 (95% Cl: 0.69-2.92). Conclusions: The effectiveness of the vaccination against the H1N1 pdm09 virus was

confirmed during the first pandemic season, but it was limited. Further investigation on H1N1 pdm09 virus infection in asthmatics will be required.”
“Purpose: R406 in vivo We performed a prospective arthroscopic study to explore the variability of the posterior labrum glenoid insertion. We aimed to classify the insertions and to explore whether these insertions can be identified by pre-operative arthro-CT scan. Patients and methods: From January to December 2011, 86 patients were prospectively included in the current study. During arthroscopy, anterior labrum was evaluated and posterior labrum

was assessed in 3 different locations: superior, medial, and inferior. For each segment, the labrum was considered normally inserted (directly to the glenoid cartilage), medialized (inserted at the posterior part of the glenoid bone, without direct contact with the cartilage), torn (macroscopic degenerative changes, tears, fragments) or absent (agenesis). Imaging was analyzed segment by segment by an experienced osteoarticular radiologist, using the same classification. Results: Four types of posterior labrum

insertions were identified. Type 1, 60% of the cases, corresponded to a posterior labrum totally inserted in the glenoid, with direct contact with the cartilage. Type 2, 20% THZ1 inhibitor of the cases, represented medialized insertion of the superior segment. Type 3, 15% of the cases, represented an associated medialization of the superior and medial segment of the posterior labrum. Type 4 is a medialized insertion of the all-posterior labrum. Fifty-six shoulders were used for arthro-CT and arthroscopy correlation: for the superior segment (n = 22/56), the sensitivity of arthro-CT to identify an abnormal insertion when the labrum is medialized was 68.18%, specificity 70.59%, positive predictive value (PPV) 60%, and negative predictive value (NPV) 77.42%. For the medial segment (n = 16/56), the sensitivity of arthro-CT to identify an abnormal insertion when the labrum is medialized was 81.25%, specificity 57.50%, PPV 43.33% and NPV 88.46%. For the inferior segment (n = 5/56), the sensitivity was 100%, specificity 47.60%, PPV 15.63% and NPV 100%.

Results:

Postnatal maternal abuse-related healthcare utilization and use of medication were associated with child out-of-home care. Significant differences were in particular observed in the categories of maternal mental and behavioural disorders caused by psychoactive substance use as well as injury and poisoning. Maternal inpatient care for mental and behavioural disorders peaked at the time of child out-of-home care. Maternal abuse-related healthcare utilization was associated with early child healthcare utilization and use of medication for mental and behavioural disorders. These associations were largely explained by the association with child out-of-home care. Conclusions: Postnatal maternal abuse-related morbidity is associated with significant early child morbidity, use of medication P5091 price find more and timing of out-of-home care.”
“Obesity and type 2 diabetes are characterized by insulin resistance, and the common

basis of these events is a chronic and systemic inflammatory process marked by the activation of the c-Jun N-terminal kinase (JNK) and inhibitor-kappa B kinase (IKK beta)/nuclear factor-kappa B (NF kappa B) pathways, up-regulated cytokine synthesis, and endoplasmic reticulum dysfunction. The aim of this study was to evaluate the effects of diacerhein administration, an antiinflammatory drug that reduces the levels of inflammatory cytokines, on insulin sensitivity and signaling in diet-induced obese (DIO) mice. Swiss mice were fed with conventional PD173074 chow (control group) or a high-fat diet (DIO group). Later, DIO mice were randomly subdivided into a new subgroup (DAR) that received 20 mg/kg diacerhein for 10d. Western blotting was used to quantify the expression and phosphorylation of insulin receptor,

insulin receptor substrate 1, and Akt and of inflammatory mediators that modulate insulin signaling in a negative manner (IKK beta, JNK, and inducible nitric oxide synthase). We show here, for the first time, that the administration of diacerhein in DIO mice improved endoplasmic reticulum stress, reduced JNK and IKK beta phosphorylation, and resulted in a marked improvement in fasting glucose, a decrease in macrophage infiltration in adipose tissue, and a reduced expression and activity of proinflammatory mediators accompanied by an improvement in the insulin signaling mainly in the liver and adipose tissue. Taken together, these results indicate that diacerhein treatment improves insulin sensitivity in obesity, mediated by the reversal of subclinical inflammation, and that this drug may be an alternative therapy for insulin resistance. (Endocrinology 152: 4080-4093, 2011)”
“The genome of the gut protozoan parasite Giardia duodenalis (assemblage A) has been sequenced and compiled as contigs and scaffolds (GiardiaDB-http://GiardiaDB.org), but specific chromosome location of all scaffolds is unknown. To determine which scaffolds belong to the 3-Mb chromosome, a library of probes specific for this chromosome was constructed.

The rodent wheel lock (WL) model was adopted by our laboratory and others to study how different organ systems of juvenile rats respond to a cessation of daily physical activity. Our WL model houses rats in cages equipped with voluntary running wheels starting at 28 days of age. After a certain period of voluntary running (3 to 6 wk), the wheels GSK2879552 manufacturer are locked, thus preventing the rats’ primary source of physical activity. The studies discussed herein suggest that obesity-associated maladies including skeletal muscle insulin resistance, hypothalamic leptin resistance, fatty acid oxidation impairments in skeletal muscle and

adipose tissue, nonalcoholic fatty liver disease, and endothelial dysfunction are initiated in juvenile animals that are restrained from voluntary exercise via WL. The use of the juvenile rodent WL or other inactivity models will continue to provide a powerful clinical translational tool that can be used for primordial prevention of human childhood obesity.”
“A new Data Acquisition (DAQ) sub-system

for gamma-ray diagnostics was developed for Joint European Torus (JET). The system is based on the ATCA platform and is able to sample up to 400 MSPS with 14-bit resolution. This DAQ is used for gamma-ray diagnostics dedicated to the study of fast ions in fusion tokamak plasma experiments. The present work describes the development of pulse processing algorithms used to extract the pulse parameters from the DAQ free running ADC data selleck screening library URMC-099 supplier streams. These

algorithms are divided in three main functional blocks, namely, advanced triggering and segmentation, segmentation validation and finally, peak height analysis (PHA) and pile-up rejection (PUR).\n\nThe developed algorithms perform the pulse segmentation, shaping and validation according to the noise level and characteristics of the digitized signal. Shaping is performed through a reconfigurable trapezoidal filter in order to optimize the spectral resolution with the required throughputs and a comprehensive study of this parameterization is presented. Calibration procedures are mandatory for an efficient real time application and its implementation in the FPGA is discussed and explained.\n\nThe presented and discussed results refer to the analysis of the JET pulse files obtained during the recent campaigns where a spectral resolution of 4.5% for the Cs-137 energy peak at 662 keV was achieved through FPGA real time processing. Results of high gamma-ray reaction rates experiments performed outside JET are also presented.”
“Background: The reliable availability of health technologies, defined as equipment, medicines, and consumable supplies, is essential to ensure successful childbirth practices proven to prevent avoidable maternal and newborn mortality.