The Active Management of Impending Cephalopelvic Disproportion in Nulliparous Women at Term: A Case Series

Background. The Active Management of Risk in Pregnancy at Term (AMOR-IPAT) protocol has been associated in several studies with significant reductions of group cesarean delivery rate. Present within each of these studies were nulliparous women with risk factors for cephalopelvic disproportion. Risk factors for cephalopelvic disproportion in nulliparous women are especially important because they represent the precursors for the most common indication for primary cesarean delivery. Cases. Three examples of exposure of urban nulliparous women to the AMOR-IPAT protocol are presented. Each woman's risk factor profile for Cephalopelvic Disproportion (CPD) was used to estimate her Upper Limit of Optimal Time of Vaginal Delivery for CPD (UL-OTDcpd). Labor management and clinical outcomes for each case are presented. A simple table summarizing induction rates and birth outcome rates of exposed versus nonexposed nulliparous women is also presented. Conclusion. Because the mode of delivery of the first birth substantially impacts birth options in later pregnancies, the impact of AMOR-IPAT on nulliparous patients is particularly important. Determining the UL-OTDcpd in nulliparous patients, and carefully inducing each patient who has not entered labor by her UL-OTDcpd, may be an effective way of lowering rates of cesarean delivery in nulliparous women

Dust emission at 8-mic and 24-mic as Diagnostics of HII Region Radiative Transfer

We use the Spitzer SAGE survey of the Magellanic Clouds to evaluate the relationship between the 8-mic PAH emission, 24-mic hot dust emission, and HII region radiative transfer. We confirm that in the higher-metallicity Large Magellanic Cloud, PAH destruction is sensitive to optically thin conditions in the nebular Lyman continuum: objects identified as optically thin candidates based on nebular ionization structure show 6 times lower median 8-mic surface brightness (0.18 mJy arcsec^-2) than their optically thick counterparts (1.2 mJy arcsec^-2). The 24-mic surface brightness also shows a factor of 3 offset between the two classes of objects (0.13 vs 0.44 mJy arcsec^-2, respectively), which is driven by the association between the very small dust grains and higher density gas found at higher nebular optical depths. In contrast, PAH and dust formation in the low-metallicity Small Magellanic Cloud is strongly inhibited such that we find no variation in either 8-mic or 24-mic emission between our optically thick and thin samples. This is attributable to extremely low PAH and dust production together with high, corrosive UV photon fluxes in this low-metallicity environment. The dust mass surface densities and gas-to-dust ratios determined from dust maps using Herschel HERITAGE survey data support this interpretation.Comment: Accepted to ApJ, May 15, 2017. 10 pages, 9 figure

Demographic and physiological signals of reproductive events in humpback whales on a southwest pacific breeding ground

The field of marine mammal conservation has dramatically benefited from the rapid advancement of methods to assess the reproductive physiology of individuals and populations from steroid hormones isolated from minimally invasive skin-blubber biopsy samples. Historically, this vital information was only available from complete anatomical and physiological investigations of samples collected during commercial or indigenous whaling. Humpback whales (Megaptera novaeangliae) are a migratory, cosmopolitan species that reproduce in warm, low-latitude breeding grounds. New Caledonia is seasonally visited by a small breeding sub-stock of humpback whales, forming part of the endangered Oceania subpopulation. To better understand the demographic and seasonal patterns of reproductive physiology in humpback whales, we quantified baseline measurements of reproductive hormones (progesterone – P4, testosterone - T, and 17β-estradiol – E2) using an extensive archive of skin-blubber biopsy samples collected from female humpback whales in New Caledonia waters between 2016-2019 (n = 194). We observed significant differences in the P4, T, and E2 concentrations across different demographic groups of female humpback whales, and we described some of the first evidence of the endocrine patterns of estrus in live free-ranging baleen whales. This study is fundamental in its methodological approach to a wild species that has a global distribution, with seasonally distinct life histories. This information will assist in monitoring, managing, and conserving this population as global ecological changes continue to occur unhindered.Peer reviewe

Electron-Like Fermi Surface and Remnant (pi,0) Feature in Overdoped La1.78Sr0.22CuO4

We have performed an angle-resolved photoemission study of overdoped La1.78Sr0.22CuO4, and have observed sharp nodal quasiparticle peaks in the second Brillouin zone that are comparable to data from Bi2Sr2CaCu2O8+d. The data analysis using energy distribution curves, momentum distribution curves and intensity maps all show evidence of an electron-like Fermi surface, which is well explained by band structure calculations. Evidence for many-body effects are also found in the substantial spectral weight remaining below the Fermi level around (pi,0), where the band is predicted to lie above EF.Comment: 4 pages, 4 figure

Effectiveness of interventions to support the early detection of skin cancer through skin self-examination: a systematic review and meta-analysis.

BACKGROUND: As skin cancer incidence rises, there is a need to evaluate early detection interventions by the public using skin self-examination (SSE); however, the literature focuses on primary prevention. No systematic reviews have evaluated the effectiveness of such SSE interventions. OBJECTIVES: To systematically examine, map, appraise and synthesize, qualitatively and quantitatively, studies evaluating the early detection of skin cancer, using SSE interventions. METHODS: This is a systematic review (narrative synthesis and meta-analysis) examining randomized controlled trials (RCTs) and quasiexperimental, observational and qualitative studies, published in English, using PRISMA and National Institute for Health and Care Excellence guidance. The MEDLINE, Embase and PsycINFO databases were searched through to April 2015 (updated in April 2018 using MEDLINE). Risk-of-bias assessment was conducted. RESULTS: Included studies (n = 18), totalling 6836 participants, were derived from 22 papers; these included 12 RCTs and five quasiexperiments and one complex-intervention development. More studies (n = 10) focused on targeting high-risk groups (surveillance) than those at no higher risk (screening) (n = 8). Ten (45%) study interventions were theoretically underpinned. All of the study outcomes were self-reported, behaviour related and nonclinical in nature. Meta-analysis demonstrated the impact of the intervention on the degree of SSE activity from five studies, especially in the short term (up to 4 months) (odds ratio 2·31, 95% confidence interval 1·90-2·82), but with small effect sizes. Risk-of-bias assessment indicated that 61% of the studies (n = 11) were of weak quality. CONCLUSIONS: Four RCTs and a quasiexperimental study indicate that some interventions can enhance SSE activity and so are more likely to aid early detection of skin cancer. However, the actual clinical impact remains unclear, and this is based on overall weak study (evidence) quality

Behaviour change intervention for smokeless tobacco cessation: its development, feasibility and fidelity testing in Pakistan and in the UK

Background: People of South Asian-origin are responsible for more than three-quarters of all the smokeless tobacco (SLT) consumption worldwide; yet there is little evidence on the effect of SLT cessation interventions in this population. South Asians use highly addictive and hazardous SLT products that have a strong socio-cultural dimension. We designed a bespoke behaviour change intervention (BCI) to support South Asians in quitting SLT and then evaluated its feasibility in Pakistan and in the UK. Methods: We conducted two literature reviews to identify determinants of SLT use among South Asians and behaviour change techniques (BCTs) likely to modify these, respectively. Iterative consensus development workshops helped in selecting potent BCTs for BCI and designing activities and materials to deliver these. We piloted the BCI in 32 SLT users. All BCI sessions were audiotaped and analysed for adherence to intervention content and the quality of interaction (fidelity index). In-depth interviews with16 participants and five advisors assessed acceptability and feasibility of delivering the BCI, respectively. Quit success was assessed at 6 months by saliva/urine cotinine. Results: The BCI included 23 activities and an interactive pictorial resource that supported these. Activities included raising awareness of the harms of SLT use and benefits of quitting, boosting clients’ motivation and self-efficacy, and developing strategies to manage their triggers, withdrawal symptoms, and relapse should that occur. Betel quid and Guthka were the common forms of SLT used. Pakistani clients were more SLT dependent than those in the UK. Out of 32, four participants had undetectable cotinine at 6 months. Fidelity scores for each site varied between 11.2 and 42.6 for adherence to content – maximum score achievable 44; and between 1.4 and 14 for the quality of interaction - maximum score achievable was 14. Interviews with advisors highlighted the need for additional training on BCTs, integrating nicotine replacement and reducing duration of the pre-quit session. Clients were receptive to health messages but most reported SLT reduction rather than complete cessation. Conclusion: We developed a theory-based BCI that was also acceptable and feasible to deliver with moderate fidelity scores. It now needs to be evaluated in an effectiveness trial

Nomenclature of the symptoms of head and neck cancer: a systematic scoping review

Copyright \ua9 2024 Bradley, Lee, Albutt, Hardman, Kellar, Odo, Randell, Rousseau, Tikka, Patterson and Paleri.Introduction: Evolution of a patient-reported symptom-based risk stratification system to redesign the suspected head and neck cancer (HNC) referral pathway (EVEREST-HN) will use a broad and open approach to the nomenclature and symptomatology. It aims to capture and utilise the patient reported symptoms in a modern way to identify patients’ clinical problems more effectively and risk stratify the patient. Method: The review followed the PRISMA checklist for scoping reviews. A search strategy was carried out using Medline, Embase and Web of Science between January 1st 2012 and October 31st 2023. All titles, abstracts and full paper were screened for eligibility, papers were assessed for inclusion using predetermined criteria. Data was extracted pertaining to the aims, type of study, cancer type, numbers of patients included and symptoms, presenting complaints or signs and symptoms. Results: There were 9,331 publications identified in the searches, following title screening 350 abstracts were reviewed for inclusion and 120 were considered for eligibility for the review. 48 publications met the eligibility criteria and were included in the final review. Data from almost 11,000 HNC patients was included. Twenty-one of the publications were from the UK, most were retrospective examination of patient records. Data was extracted and charted according to the anatomical area of the head and neck where the symptoms are subjectively and objectively found, and presented according to lay terms for symptoms, clinical terms for symptoms and the language of objective clinical findings. Discussion: Symptoms of HNC are common presenting complaints, interpreting these along with clinical history, examination and risk factors will inform a clinician’s decision to refer as suspected cancer. UK Head and Neck specialists believe a different way of triaging the referrals is needed to assess the clinical risk of an undiagnosed HNC. EVEREST-HN aims to achieve this using the patient history of their symptoms. This review has highlighted issues in terms of what is considered a symptom, a presenting complaint and a clinical finding or sign

ADAPTIVE PATTERNING FOR PANELIZED PACKAGING

ABSTRACT Fan-Out Wafer-Level Packaging (FOWLP) or fan-out technology has held promise for a number of years; primarily as a means of packaging semiconductor devices with interconnect densities exceeding the capabilities of standard Wafer Level Chip Scale Packaging (WLCSP). With FOWLP technology, die are embedded in a molded panel, and I/Os are then redistributed over the larger effective surface area using conventional WLCSP techniques. The packages are then singulated and attached directly to a printed circuit board (PCB) or lowcost substrate. This technology provides one of the smallest and lightest possible package form factors; enables more I/Os for a given pitch with excellent electrical properties; and eliminates the need for custom substrates used in flip chip or wirebond Ball Grid Array (BGA) packages. Despite its promise, widespread adoption of FOWLP packaging has been limited largely by cost and yield issues. The requirement for high die placement accuracy when forming the molded panel restricts throughput at the die pick-and-place operation, leading to high process costs. Die drift, or movement during panel molding, limits via and RDL design rules and ultimately can result in yield loss when the drift is excessive. Managing or overcoming die offset is one of the keys to making FOWLP competitive with other package formats. This paper describes an approach to FOWLP that allows die offset to increase by an order of magnitude compared with conventional methods. Using a novel Adaptive Patterning* technology, real-time designs are created for each package within each panel during the manufacturing process. After panelization, the position of each die within each molded panel is precisely measured. Information is fed into a proprietary auto-routing design tool on a per panel basis. The resulting pattern layers are then issued to a lithography system which dynamically implements the unique design on a per panel basis. Dynamic layers include various design features such as vias or redistribution layers (RDL). The ability of adaptive patterning to correct for deviations in die location can result in both improved yield and higher panelization throughput, thereby enabling the industry to finally realize the cost, flexibility, and form factor benefits of FOWLP. In the paper, adaptive patterning examples will be presented and the benefits and limitations of the technology will be discussed