Provider Perception and Office Practices of the Initial Prenatal Visit Pre – Coronavirus 2019 Pandemic

Background Prenatal Care is a critical aspect of women’s health and current literature shows adequate care significantly reduces risk of adverse outcomes. With scientific advancement, the initial prenatal visit is increasingly tasked with more objectives that leave providers with barriers to provide appropriate and adequate care. Purpose The aim of this survey study was to determine clinical practices of the initial prenatal visit – regarding history taking, counseling, lab work and screening prior to the onset of COVID-19 Pandemic. Methods A one-time anonymous provider survey was distributed electronically to all obstetrics providers in the Tampa Bay Region in Florida. Descriptive statistics and bivariate analyses were performed for data analysis. Results A total of 67 responses were completed, and 58 responses analyzed after vetting for greater than 75% completion. Providers reported the initial visit most commonly occurring in the 1st trimester, and 90.2% reported the initial visit was completed via in-office visits. One provider reported completing this visit via nursing phone call. 32.5% of providers allocated 30-minutes and 34.1% reported allocating 45-minutes for an office visit. 50% of providers felt there were able to appropriately counsel patients in visits that lasted up to 1 hour. All providers reported collecting a patient’s history themselves for the majority of topics (90% or more). Discussion Providers reported the initial prenatal visit occurring most commonly in the 1st trimester as an in-office visit. Providers utilized routine blood work, and genetic screening per guidelines. Medical doctors reported the lowest rates of direct discussion and review of prenatal counseling topics when compared to mid-level practitioners. Given the onset and ongoing COVID-2019 pandemic since this survey study was completed, future studies should see how the implementation of telehealth medicine has impacted practices

Evaluation of Virtual Prenatal Care for Obstetric Care Delivery During the COVID-19 Pandemic: A Mixed Method Research Study Using the Consolidated Framework in Implementation Research

Background and Objective: Coronavirus 2 (SARS-CoV-2), a novel respiratory virus, rapidly spread, and placed patients at increased risk for short and potentially long-standing medical illnesses. The pandemic necessitated the rapid implementation of virtual prenatal care via telemedicine in obstetrics to maintain social distancing measures. The aim of this study was to assess and understand the patient perspectives of the rapidly implemented virtual prenatal care via a telemedicine model during the Coronavirus disease 2019 (COVID-19) pandemic utilizing the Consolidated Framework in Implementation Research (CFIR). Methods: Following the implementation of virtual prenatal care in March 2020, pregnant patients at a large urban clinic in the southeastern United States completed a 19-question anonymous survey that included open and closed-ended questions on their experience receiving virtual prenatal care via telemedicine or in-person prenatal care from May to December 2020. The survey and mixed-methods data analysis was guided by the CFIR framework. Results: A total of 59 patients completed the survey. One-third (31%, n=18) of the patients found virtual prenatal care to be an acceptable alternative model, and half (53%, n=31) found it acceptable only during a pandemic, preferring to return to in-person visits. Qualitative analysis found that some patients were deterred by limited in-person examinations and uncertainty with the virtual platform, while others appreciated the reduced need for transportation, childcare, and time spent. Conclusion and Global Health Implications: Most patients found virtual prenatal care to be easy to access and an acceptable alternative during the pandemic; however, most would prefer to return to in-person prenatal care visits. Future comparative research studies should examine how, among others, virtual prenatal care versus in-person prenatal care impacts specific maternal and fetal outcomes.   Copyright © 2023 Delgado et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0

Exploring Patients’ Needs and Desires for Quality Prenatal Care in Florida, United States

Background and Objective: High-quality prenatal care promotes adequate care throughout pregnancy by increasing patients’ desires to return for follow-up visits. Almost 15% of women in the United States receive inadequate prenatal care, with 6% receiving late or no prenatal care. Only 63% of pregnant women in Florida receive adequate prenatal care, and little is known about their perceptions of high-quality prenatal care.Therefore, the objective of this study was to assess women’s perceptions of the quality of their prenatal care and to describe their preferences for seeking prenatal care that meets their needs. Methods: From April to December 2019, a qualitative study was conducted with postpartum women (n = 55) who received no or late prenatal care and delivered in Tampa, Florida, USA. Eligible women completed an open-ended qualitative survey and a semi-structured in-depth interview. The interview contextualized the factors influencing prenatal care quality perceptions.The qualitative data analysis was based on Donabedian’s quality of care model. Results: The qualitative data analysis revealed three key themes about women’s perceptions and preferences for prenatal care that meets their needs. First, clinical care processes included provision of health education and medical assessments. Second, structural conditions included language preferences, clinic availability, and the presence of ancillary staff. Finally, interpersonal communication encompassed interactions with providers and continuity of care. Overall, participants desired patient-centered care and care that was informative, tailored to their needs, and worked within the constraints of their daily lives. Conclusion and Global Health Implications: Women seeking and receiving prenatal care prefer a welcoming, patient-centered health care environment. These findings should prompt health care providers and organizations to improve existing prenatal care models and develop new prenatal care models that provide early, accessible, and high-quality prenatal care to a diverse population of maternity patients.   Copyright © 2023 Fryer et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0

Associations of prenatal maternal depressive symptoms with cord blood glucocorticoids and child hair cortisol levels in the project viva and the generation R cohorts:a prospective cohort study

Background: Prior studies have reported conflicting results regarding the association of prenatal maternal depression with offspring cortisol levels. We examined associations of high levels of prenatal depressive symptoms with child cortisol biomarkers. Methods:In Project Viva (n = 925, Massachusetts USA), mothers reported their depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) during pregnancy, cord blood glucocorticoids were measured at delivery, and child hair cortisol levels were measured in mid-childhood (mean (SD) age: 7.8 (0.8) years) and early adolescence (mean (SD) age: 13.2 (0.9) years). In the Generation R Study (n = 1644, Rotterdam, The Netherlands), mothers reported depressive symptoms using the Brief Symptom Inventory (BSI) during pregnancy, and child hair cortisol was measured at a mean (SD) age of 6.0 (0.5) years. We used cutoffs of ≥ 13 for the EPDS and &gt; 0.75 for the BSI to indicate high levels of prenatal depressive symptoms. We used multivariable linear regression models adjusted for child sex and age (at outcome), and maternal pre-pregnancy BMI, education, social support from friends/family, pregnancy smoking status, marital status, and household income to assess associations separately in each cohort. We also meta-analyzed childhood hair cortisol results from both cohorts. Results: 8.0% and 5.1% of women respectively experienced high levels of prenatal depressive symptoms in Project Viva and the Generation R Study. We found no associations between high levels of maternal depressive symptoms during pregnancy and child cortisol biomarkers in either cohort. Conclusions: The present study does not find support for the direct link between high levels of maternal depressive symptoms and offspring cortisol levels.</p

Gamma-Secretase Represents a Therapeutic Target for the Treatment of Invasive Glioma Mediated by the p75 Neurotrophin Receptor

The multifunctional signaling protein p75 neurotrophin receptor (p75NTR) is a central regulator and major contributor to the highly invasive nature of malignant gliomas. Here, we show that neurotrophin-dependent regulated intramembrane proteolysis (RIP) of p75NTR is required for p75NTR-mediated glioma invasion, and identify a previously unnamed process for targeted glioma therapy. Expression of cleavage-resistant chimeras of p75NTR or treatment of animals bearing p75NTR-positive intracranial tumors with clinically applicable γ-secretase inhibitors resulted in dramatically decreased glioma invasion and prolonged survival. Importantly, proteolytic processing of p75NTR was observed in p75NTR-positive patient tumor specimens and brain tumor initiating cells. This work highlights the importance of p75NTR as a therapeutic target, suggesting that γ-secretase inhibitors may have direct clinical application for the treatment of malignant glioma

Heterozygous Variants in KMT2E Cause a Spectrum of Neurodevelopmental Disorders and Epilepsy.

We delineate a KMT2E-related neurodevelopmental disorder on the basis of 38 individuals in 36 families. This study includes 31 distinct heterozygous variants in KMT2E (28 ascertained from Matchmaker Exchange and three previously reported), and four individuals with chromosome 7q22.2-22.23 microdeletions encompassing KMT2E (one previously reported). Almost all variants occurred de novo, and most were truncating. Most affected individuals with protein-truncating variants presented with mild intellectual disability. One-quarter of individuals met criteria for autism. Additional common features include macrocephaly, hypotonia, functional gastrointestinal abnormalities, and a subtle facial gestalt. Epilepsy was present in about one-fifth of individuals with truncating variants and was responsive to treatment with anti-epileptic medications in almost all. More than 70% of the individuals were male, and expressivity was variable by sex; epilepsy was more common in females and autism more common in males. The four individuals with microdeletions encompassing KMT2E generally presented similarly to those with truncating variants, but the degree of developmental delay was greater. The group of four individuals with missense variants in KMT2E presented with the most severe developmental delays. Epilepsy was present in all individuals with missense variants, often manifesting as treatment-resistant infantile epileptic encephalopathy. Microcephaly was also common in this group. Haploinsufficiency versus gain-of-function or dominant-negative effects specific to these missense variants in KMT2E might explain this divergence in phenotype, but requires independent validation. Disruptive variants in KMT2E are an under-recognized cause of neurodevelopmental abnormalities

Abstracts from the 8th International Conference on cGMP Generators, Effectors and Therapeutic Implications

This work was supported by a restricted research grant of Bayer AG

Gravitational Waves from Gravitational Collapse

Gravitational-wave emission from stellar collapse has been studied for nearly four decades. Current state-of-the-art numerical investigations of collapse include those that use progenitors with more realistic angular momentum profiles, properly treat microphysics issues, account for general relativity, and examine non-axisymmetric effects in three dimensions. Such simulations predict that gravitational waves from various phenomena associated with gravitational collapse could be detectable with ground-based and space-based interferometric observatories. This review covers the entire range of stellar collapse sources of gravitational waves: from the accretion-induced collapse of a white dwarf through the collapse down to neutron stars or black holes of massive stars to the collapse of supermassive stars

Tubo-ovarian abscess caused by Edwardsiella tarda: A case report

Tubo-ovarian abscesses (TOAs) are a complicated form of pelvic inflammatory disease (PID). They are usually caused by Bacteroides species or Escherichia coli. A 35-year-old woman presented with TOA caused by an infection with the rare pathogen Edwardsiella tarda. Thus, in a suspected case of a TOA in a patient with PID, we recommend obtaining a culture to test for a wide variety of bacterial organisms. By identifying less common pathogenic causes of TOA earlier, more conservative treatments can be used to mitigate the negative consequences of TOA and the need for surgical intervention