Birth after emergency caesarean section: Women’s perspectives on the factors influencing their decision making

The study explored the decisions women made in relation to mode of birth following a previous emergency lower segment caesarean section (emLSCS), particularly focusing on what different factors influenced women to choose a particular mode of birth and what they described as the rationale underpinning that decision. Participants were recruited from a population of students and staff within the School of Human and Health Sciences at a university in the north of England. Sixteen individuals were selected using convenience sampling, who then completed open-ended questionnaires. The questions were non-leading and asked the women to identify and expand upon factors that influenced their decision on mode of birth. Data were analysed using a basic thematic framework analysis. Many of the identified themes mirrored those well recognised in existing research: the woman’s previous birth, her perception of risks, the influence of professionals and the influence of peers were all apparent. One factor not explored in existing literature, namely a sense of duty to existing children, appeared to be strongly influential in this data set. Interestingly, it was observed that each woman’s philosophical framework and her relationship with the element of control substantially underpinned her consideration of key factors, leading her to an individual decision. This article provides an interesting insight into the complexity of individual decision making in maternity care. The findings highlight the fact that professional guidelines may fail to meet the personal and individual needs of their subjects. This is a thought-provoking topic for policy and guideline authors, as well as for the professionals who counsel patients through decision-making processes in maternity care and wider fields of healthcare

The Use of E-Textiles in Ontario Education

The purpose of this iterative design-based research study was to determine best practices when using e-textiles for learning in four diverse contexts. We employed a qualitative, ethnographic case study approach, and used interviews, observations, journals, and audiovisual materials in our data collection to explore student engagement with e-textile materials over a two-year period. The data from each iteration were coded using a thematic coding system. Results indicated that collaboration, choice, and making with purpose were the most important factors for student engagement and learning. Importantly, we found that different demographics of students require different supports in the learning process with e-textiles, and that student-driven making is critical when using e-textiles for learning

Implementation and evaluation of the VA DPP clinical demonstration: protocol for a multi-site non-randomized hybrid effectiveness-implementation type III trial.

BackgroundThe Diabetes Prevention Program (DPP) study showed that lifestyle intervention resulted in a 58% reduction in incidence of type 2 diabetes among individuals with prediabetes. Additional large randomized controlled trials have confirmed these results, and long-term follow-up has shown sustained benefit 10-20 years after the interventions ended. Diabetes is a common and costly disease, especially among Veterans, and despite strong evidence supporting the feasibility of type 2 diabetes prevention, the DPP has not been widely implemented. The first aim of this study will evaluate implementation of the Veterans Affairs (VA) DPP in three VA medical centers. The second aim will assess weight and hemoglobin A1c (A1c) outcomes, and the third aim will determine the cost-effectiveness and budget impact of implementation of the VA DPP from a health system perspective.Methods/designThis partnered multi-site non-randomized systematic assignment study will use a highly pragmatic hybrid effectiveness-implementation type III mixed methods study design. The implementation and administration of the VA DPP will be funded by clinical operations while the evaluation of the VA DPP will be funded by research grants. Seven hundred twenty eligible Veterans will be systematically assigned to the VA DPP clinical demonstration or the usual care VA MOVE!® weight management program. A multi-phase formative evaluation of the VA DPP implementation will be conducted. A theoretical program change model will be used to guide the implementation process and assess applicability and feasibility of the DPP for VA. The Consolidated Framework for Implementation Research (CFIR) will be used to guide qualitative data collection, analysis, and interpretation of barriers and facilitators to implementation. The RE-AIM framework will be used to assess Reach, Effectiveness, Adoption, Implementation, and Maintenance of the VA DPP. Twelve-month weight and A1c change will be evaluated for the VA DPP compared to the VA MOVE!ProgramMediation analyses will be conducted to identify whether program design differences impact outcomes.DiscussionFindings from this pragmatic evaluation will be highly applicable to practitioners who are tasked with implementing the DPP in clinical settings. In addition, findings will determine the effectiveness and cost-effectiveness of the VA DPP in the Veteran population

Characterization of IgA response among women with incident HPV 16 infection

AbstractPrevious studies have characterized the prevalence and duration of serum IgG antibodies to human papillomavirus type 16 (HPV 16) in a well-studied cohort of college women, using viruslike particle- (VLP) based ELISAs. In this study IgA antibodies in cervical secretions and sera were examined using a newly developed capsomer-based ELISA and the patterns observed for serum IgG, serum IgA, and cervical IgA antibodies were compared. The median time to antibody detection from the first detection of HPV 16 DNA was 10.5 months for IgA in cervical secretions and 19.1 months for serum IgA. Serum IgA antibody conversion was observed less frequently and occurred later than IgA conversion in cervical secretions (P = 0.011) or serum IgG conversion (P = 0.051). The median time to antibody reversion, following seroconversion, was 12.0 months for IgA in cervical secretions and 13.6 months for serum IgA, whereas approximately 20% of women with serum IgG antibodies reverted within 36 months. Thus, the duration of IgA in cervical secretions and sera was shorter than the duration of serum IgG (P = 0.007 and 0.001)

The Disk Substructures at High Angular Resolution Project (DSHARP). III. Spiral Structures in the Millimeter Continuum of the Elias 27, IM Lup, and WaOph 6 Disks

We present an analysis of Atacama Large Millimeter/submillimeter Array 1.25 mm continuum observations of spiral structures in three protoplanetary disks from the Disk Substructures at High Angular Resolution Project. See full text for full abstract

The Disk Substructures at High Angular Resolution Project (DSHARP). II. Characteristics of Annular Substructures

The Disk Substructures at High Angular Resolution Project (DSHARP) used ALMA to map the 1.25 mm continuum of protoplanetary disks at a spatial resolution of ~5 au. We present a systematic analysis of annular substructures in the 18 single-disk systems targeted in this survey. No dominant architecture emerges from this sample; instead, remarkably diverse morphologies are observed. Annular substructures can occur at virtually any radius where millimeter continuum emission is detected and range in widths from a few astronomical units to tens of astronomical units. Intensity ratios between gaps and adjacent rings range from near-unity to just a few percent. In a minority of cases, annular substructures coexist with other types of substructures, including spiral arms (3/18) and crescent-like azimuthal asymmetries (2/18). No clear trend is observed between the positions of the substructures and stellar host properties. In particular, the absence of an obvious association with stellar host luminosity (and hence the disk thermal structure) suggests that substructures do not occur preferentially near major molecular snowlines. Annular substructures like those observed in DSHARP have long been hypothesized to be due to planet–disk interactions. A few disks exhibit characteristics particularly suggestive of this scenario, including substructures in possible mean-motion resonance and double gap features reminiscent of hydrodynamical simulations of multiple gaps opened by a planet in a low-viscosity disk

CO and dust properties in the TW Hya disk from high-resolution ALMA observations

We analyze high angular resolution ALMA observations of the TW Hya disk to place constraints on the CO and dust properties. We present new, sensitive observations of the $^{12}$CO $J = 3-2$ line at a spatial resolution of 8 AU (0\farcs14). The CO emission exhibits a bright inner core, a shoulder at $r\approx70$ AU, and a prominent break in slope at $r\approx90$ AU. Radiative transfer modeling is used to demonstrate that the emission morphology can be reasonably reproduced with a $^{12}$CO column density profile featuring a steep decrease at $r\approx15$ AU and a secondary bump peaking at $r\approx70$ AU. Similar features have been identified in observations of rarer CO isotopologues, which trace heights closer to the midplane. Substructure in the underlying gas distribution or radially varying CO depletion that affects much of the disk's vertical extent may explain the shared emission features of the main CO isotopologues. We also combine archival 1.3 mm and 870 $\mu$m continuum observations to produce a spectral index map at a spatial resolution of 2 AU. The spectral index rises sharply at the continuum emission gaps at radii of 25, 41, and 47 AU. This behavior suggests that the grains within the gaps are no larger than a few millimeters. Outside the continuum gaps, the low spectral index values of $\alpha\approx 2$ indicate either that grains up to centimeter size are present, or that the bright continuum rings are marginally optically thick at millimeter wavelengths.Comment: 27 pages, 11 figures, accepted by ApJ; FITS image files available at https://dataverse.harvard.edu/dataset.xhtml?persistentId=doi:10.7910/DVN/PXDKB

The UK Coronavirus Job Retention Scheme and diet, physical activity, and sleep during the COVID-19 pandemic: evidence from eight longitudinal population surveys

BACKGROUND: In March 2020, the UK implemented the Coronavirus Job Retention Scheme (furlough) to minimise job losses. Our aim was to investigate associations between furlough and diet, physical activity, and sleep during the early stages of the COVID-19 pandemic. METHODS: We analysed data on 25,092 participants aged 16-66 years from eight UK longitudinal studies. Changes in employment, including being furloughed, were based on employment status before and during the first lockdown. Health behaviours included fruit and vegetable consumption, physical activity, and sleep. Study-specific estimates obtained using modified Poisson regression, adjusting for socio-demographic characteristics and pre-pandemic health and health behaviours, were statistically pooled using random effects meta-analysis. Associations were also stratified by sex, age, and education. RESULTS: Across studies, between 8 and 25% of participants were furloughed. Compared to those who remained working, furloughed workers were slightly less likely to be physically inactive (RR = 0.85; [95% CI 0.75-0.97]; I 2 = 59%) and did not differ overall with respect to low fruit and vegetable consumption or atypical sleep, although findings for sleep were heterogenous (I 2 = 85%). In stratified analyses, furlough was associated with lower fruit and vegetable consumption among males (RR = 1.11; [1.01-1.22]; I 2 = 0%) but not females (RR = 0.84; [0.68-1.04]; I 2 = 65%). Considering changes in quantity, furloughed workers were more likely than those who remained working to report increases in fruit and vegetable consumption, exercise, and hours of sleep. CONCLUSIONS: Those furloughed exhibited similar health behaviours to those who remained in employment during the initial stages of the pandemic. There was little evidence to suggest that adoption of such social protection policies in the post-pandemic recovery period and during future economic crises had adverse effects on population health behaviours

Baseline characteristics of people experiencing homelessness with a recent drug overdose in the PHOENIx pilot randomised controlled trial

Background: Drug-related deaths in Scotland are the highest in Europe. Half of all deaths in people experiencing homelessness are drug related, yet we know little about the unmet health needs of people experiencing homelessness with recent non-fatal overdose, limiting a tailored practice and policy response to a public health crisis. Methods: People experiencing homelessness with at least one non-fatal street drug overdose in the previous 6 months were recruited from 20 venues in Glasgow, Scotland, and randomised into PHOENIx plus usual care, or usual care. PHOENIx is a collaborative assertive outreach intervention by independent prescriber NHS Pharmacists and third sector homelessness workers, offering repeated integrated, holistic physical, mental and addictions health and social care support including prescribing. We describe comprehensive baseline characteristics of randomised participants. Results: One hundred and twenty-eight participants had a mean age of 42 years (SD 8.4); 71% male, homelessness for a median of 24 years (IQR 12–30). One hundred and eighteen (92%) lived in large, congregate city centre temporary accommodation. A quarter (25%) were not registered with a General Practitioner. Participants had overdosed a mean of 3.2 (SD 3.2) times in the preceding 6 months, using a median of 3 (IQR 2–4) non-prescription drugs concurrently: 112 (87.5%) street valium (benzodiazepine-type new psychoactive substances); 77 (60%) heroin; and 76 (59%) cocaine. Half (50%) were injecting, 50% into their groins. 90% were receiving care from Alcohol and Drug Recovery Services (ADRS), and in addition to using street drugs, 90% received opioid substitution therapy (OST), 10% diazepam for street valium use and one participant received heroin-assisted treatment. Participants had a mean of 2.2 (SD 1.3) mental health problems and 5.4 (SD 2.5) physical health problems; 50% received treatment for physical or mental health problems. Ninety-one per cent had at least one mental health problem; 66% had no specialist mental health support. Participants were frail (70%) or pre-frail (28%), with maximal levels of psychological distress, 44% received one or no daily meal, and 58% had previously attempted suicide. Conclusions: People at high risk of drug-related death continue to overdose repeatedly despite receiving OST. High levels of frailty, multimorbidity, unsuitable accommodation and unmet mental and physical health care needs require a reorientation of services informed by evidence of effectiveness and cost-effectiveness. Trial registration UK Clinical Trials Registry identifier: ISRCTN 10585019