Doula Decisions: A Mental Models Approach to UnderstandingLack of Doula Use Despite the Benefits

Research Question: Despite the proven benefits of utilizing a doula, only 6% of United States women choose to have a doula present at birth. What explains this lack of doula utilization? Methods:This research employed the mental models approach, an in-depth interviewing and analysis method deriving from decision science, to examine the decision making process of expectant mothers with regard to the use of doulas. The process included 5 interviews with experts including OBGYNs, midwifes, and doulas,and 11 interviews with pregnant women.Analysis:A gap analysis compares the mental models of experts versus pregnant women.Results:Pregnant women have difficulty predicting what labor will be like, and thus how much continuous labor support they will need and want(a hot cold empathy gap). They also lack essential knowledge about what a doula is and does. They report not receiving information about doulas from their health care providers, which contributes to this gap in knowledge and is interpreted as a signal that the provider does not support the choice to use a doula. Lastly, pregnant women anticipate potentially negative relationship consequences when they imagine using a doula—both with their health care provider as well as with their partner. Conclusions/Implications: Health care providers can provide preliminary information about doulas to their patients via methods such as a poster or pamphlet. This would not only give pregnant women basic information on the benefits of doulas but also signal that they support the decision. Doula communications can better address women’s knowledge needs and relationship fears by including information about their role in supporting both women and partners in the child birth experience.</div

Tales of diversity: Genomic and morphological characteristics of forty-six <i>Arthrobacter</i> phages

<div><p>The vast bacteriophage population harbors an immense reservoir of genetic information. Almost 2000 phage genomes have been sequenced from phages infecting hosts in the phylum Actinobacteria, and analysis of these genomes reveals substantial diversity, pervasive mosaicism, and novel mechanisms for phage replication and lysogeny. Here, we describe the isolation and genomic characterization of 46 phages from environmental samples at various geographic locations in the U.S. infecting a single <i>Arthrobacter</i> sp. strain. These phages include representatives of all three virion morphologies, and Jasmine is the first sequenced podovirus of an actinobacterial host. The phages also span considerable sequence diversity, and can be grouped into 10 clusters according to their nucleotide diversity, and two singletons each with no close relatives. However, the clusters/singletons appear to be genomically well separated from each other, and relatively few genes are shared between clusters. Genome size varies from among the smallest of siphoviral phages (15,319 bp) to over 70 kbp, and G+C contents range from 45–68%, compared to 63.4% for the host genome. Although temperate phages are common among other actinobacterial hosts, these <i>Arthrobacter</i> phages are primarily lytic, and only the singleton Galaxy is likely temperate.</p></div

Genome organization of <i>Arthrobacter</i> phage Jawnski, Cluster AO.

<p>See <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0180517#pone.0180517.g005" target="_blank">Fig 5</a> for details.</p

Genome organization of <i>Arthrobacter</i> phage Maggie, Cluster AN.

<p>See <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0180517#pone.0180517.g005" target="_blank">Fig 5</a> for details.</p

Genome organization of <i>Arthrobacter</i> phage Circum, Cluster AM.

<p>See <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0180517#pone.0180517.g005" target="_blank">Fig 5</a> for details.</p

Genome organization of <i>Arthrobacter</i> phage Amigo, Cluster AQ.

<p>See <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0180517#pone.0180517.g005" target="_blank">Fig 5</a> for details.</p

Genome organization of <i>Arthrobacter</i> phage KellEzio, Cluster AT.

<p>See <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0180517#pone.0180517.g005" target="_blank">Fig 5</a> for details.</p

Pairwise alignment of clustered <i>Arthrobacter</i> phages.

<p>The genomes of 23 <i>Arthrobacter</i> phages are shown. Pairwise nucleotide sequence similarity is displayed by color-spectrum coloring between the genomes, with violet as most similar and red as least similar. Genes are shown as boxes above (transcribed rightwards) and below (transcribed leftwards) each genome line; boxes are colored according to the gene phamilies they are assigned [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0180517#pone.0180517.ref029" target="_blank">29</a>]. Maps were generated using Phamerator and its database Actinobacteriophage_692.</p

Nucleotide sequence comparison of <i>Arthrobacter</i> phages.

<p>Dot Plot of <i>Arthrobacter</i> phage genomes displayed using Gepard [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0180517#pone.0180517.ref035" target="_blank">35</a>]. Individual genome sequences were concatenated into a single file arranged such that related genomes were adjacent to each other. The assignment of clusters is shown along both the left and bottom.</p

Splitstree representation of <i>Arthrobacter</i> phages and average nucleotide comparisons of Cluster AO <i>Arthrobacter</i> phages.

<p>All <i>Arthrobacter</i> phage predicted proteins were assorted into 1052 phams according to shared amino acid sequence similarities. Each genome was then assigned a value reflecting the presence or absence of a pham member, and the genomes were compared and displayed using Splitstree [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0180517#pone.0180517.ref036" target="_blank">36</a>]. Cluster and subcluster assignments derived from the dot plot and ANI analyses are annotated. The scale bar indicates 0.001 substitutions/site.</p