Reproductive decision making in women with medical comorbidities: A qualitative study

BACKGROUND: A growing number of reproductive-age women in the U.S. have chronic medical conditions, increasing their risk of perinatal morbidity and mortality. Still, they experience unintended pregnancies at similar rates to low-risk mothers. We have limited understanding of how these individuals consider decisions about pregnancy and contraceptive use. The purpose of this study was to understand factors that influence reproductive decision-making among pregnant women with chronic medical conditions. METHODS: We conducted 28 semi-structured interviews with pregnant women with pre-existing medical conditions admitted to a tertiary maternal hospital to examine factors influencing reproductive decision making. Maternal demographic characteristics, medical history, and pregnancy outcome data were obtained through participant surveys and abstraction from electronic health records. Interview transcripts were coded and analyzed using Dedoose® with both deductive and inductive content analysis. RESULTS: Out of 33 eligible participants, 30 consented to participate and 28 completed interviews. The majority of participants identified as black, Christian, made less than $23,000 yearly, and had a variety of preexisting medical conditions. Overarching themes included: 1) Perceived risks-benefits of pregnancy, 2) Perceived risks-benefits of birth control, 3) Determinants of contraceptive utilization, and 4) Perceived reproductive self-agency. Contraception was viewed as acceptable, but with concerning physical and psychological side effects. Although some considered pregnancy as a health threat, more experienced pregnancy as positive and empowering. Few planned their pregnancies. CONCLUSIONS: Preexisting health conditions did not significantly influence reproductive decision-making. Barriers to birth control use were generally based in patient value-systems instead of external factors. Interventions to improve uptake and use of birth control in this cohort should focus on improving care for chronic health conditions and influencing patient knowledge and attitudes toward contraception

Evolutionary fine-tuning of conformational ensembles in FimH during host-pathogen interactions

Positive selection in the two-domain type 1 pilus adhesin FimH enhances Escherichia coli fitness in urinary tract infection (UTI). We report a comprehensive atomic-level view of FimH in two-state conformational ensembles in solution, composed of one low-affinity tense (T) and multiple high-affinity relaxed (R) conformations. Positively selected residues allosterically modulate the equilibrium between these two conformational states, each of which engages mannose through distinct binding orientations. A FimH variant that only adopts the R state is severely attenuated early in a mouse model of uncomplicated UTI but is proficient at colonizing catheterized bladders in vivo or bladder transitional-like epithelial cells in vitro. Thus, the bladder habitat has barrier(s) to R state–mediated colonization possibly conferred by the terminally differentiated bladder epithelium and/or decoy receptors in urine. Together, our studies reveal the conformational landscape in solution, binding mechanisms, and adhesive strength of an allosteric two-domain adhesin that evolved “moderate” affinity to optimize persistence in the bladder during UTI

Bidirectional Barbed Suture: An Evaluation of Safety and Clinical Outcomes

The use of bidirectional barbed suture appears to be safe for closing the vaginal cuff in a total laparoscopic hysterectomy and for closing the hysterotomy site during laparoscopic myomectomy

Introducing a Concise Formulation of the Jacobian Matrix for Newton-Raphson Power Flow Solution in the Engineering Curriculum

The power flow computer program is fundamentally important for power system analysis and design. Many textbooks teach the Newton-Raphson method of power flow solution. The typical formulation of the Jacobian matrix in the NR method is cumbersome, inelegant, and laborious to program. Recent papers have introduced a method for calculating the Jacobian matrix that is concise, elegant, and simple to program. The concise formulation of the Jacobian matrix makes writing a power flow program more accessible to students. However, its derivation in the research literature involves advanced manipulations using higher dimensional derivatives, which are challenging for dual level students. This paper presents alternative derivations of the concise formulation that are suitable for undergraduate students, where some cases can be presented in lecture while other cases are assigned as exercises. These derivations have been successfully taught in a dual level course on computational methods for power systems for about ten years

Unlocking Construction Digital Future: assessing the affordance of remote working in construction

The advancement of digital technology within the construction industry has created greater flexibility that goes beyond simply working from home. As remote working becomes increasingly popular, it could potentially unlock the construction’s digital future with new ways of working and operating. However, the sector has been slow to adopt digitisation in its processes, making it difficult to assess whether this affordance may be well received and the current capabilities of digitisation to achieve this practically. The purpose of this paper is to investigate the interest in remote working among construction professionals and to examine the factors affecting remote working. Data were collected from 125 construction professionals in a questionnaire survey. The findings show that there is a general appetite for remote working on a flexible basis where a mix of “on-site” and “off-site” arrangement was deemed practical. This could potentially unlock significant time and cost savings as well as productivity gains. The main factors affecting remote working were the availability of interconnected systems allowing efficient communication and digital infrastructure that enable automated processes. The findings may benefit organisations to evaluate the practical needs of ensuring effective remote working in the construction industry and unlocking efficiencies

Endoscopic Retrograde Cholangiopancreatography-Related Early Perforations: A Study of Effects of Procedure Duration, Complexity, and Endoscopist Experience

BACKGROUND: Perforations (Perf) during endoscopic retrograde cholangiopancreatography (ERCP) are rare (\u3c 1%) but potentially fatal events (up to 20% mortality). Given its rarity, most data is through case series studies from centers or analysis of large databases. Although a meta-analysis has shown fewer adverse events as a composite (bleeding, pancreatitis, Perf) during ERCP performed at high-volume centers, there is very little real-world data on endoscopist and center procedural volumes, ERCP duration and complexity on the occurrence of Perf. AIM: To study the profile of Perf related to ERCP by center and endoscopist procedure volume, ERCP time, and complexity from a national endoscopic repository. METHODS: Patients from clinical outcomes research initiative-national endoscopic database (2000-2012) who underwent ERCP were stratified based on the endoscopist and center volume (quartiles), and total procedure duration and complexity grade of the ERCP based on procedure details. The effects of these variables on the Perf that occurred were studied. Continuous variables were compared between Perf and no perforations (NoPerf) using the Mann-Whitney U test as the data demonstrated significant skewness and kurtosis. RESULTS: A total of 14153 ERCPs were performed by 258 endoscopists, with 20 reported Perf (0.14%) among 16 endoscopists. Mean patient age in years 61.6 ± 14.8 CONCLUSION: Overall adverse events as a composite during ERCP are known to occur at a lower rate with higher volume endoscopists and centers. However, Perf studied from the national database show prolonged and more complex procedures performed by high-volume endoscopists at high-volume centers contribute to Perf

Formation of Super-Earths

Super-Earths are the most abundant planets known to date and are characterized by having sizes between that of Earth and Neptune, typical orbital periods of less than 100 days and gaseous envelopes that are often massive enough to significantly contribute to the planet's overall radius. Furthermore, super-Earths regularly appear in tightly-packed multiple-planet systems, but resonant configurations in such systems are rare. This chapters summarizes current super-Earth formation theories. It starts from the formation of rocky cores and subsequent accretion of gaseous envelopes. We follow the thermal evolution of newly formed super-Earths and discuss their atmospheric mass loss due to disk dispersal, photoevaporation, core-cooling and collisions. We conclude with a comparison of observations and theoretical predictions, highlighting that even super-Earths that appear as barren rocky cores today likely formed with primordial hydrogen and helium envelopes and discuss some paths forward for the future.Comment: Invited review accepted for publication in the 'Handbook of Exoplanets,' Planet Formation section, Springer Reference Works, Juan Antonio Belmonte and Hans Deeg, Ed

Best practice for the selection, design and implementation of UK Kidney Association guidelines: a modified Delphi consensus approach

Background: Despite research into how to effectively implement evidence-based recommendations into clinical practice, a lack of standardisation in the commissioning and development of clinical practice guidelines can lead to inconsistencies and gaps in implementation. This research aimed to ascertain how topics in kidney care worthy of guideline development within the UK should be chosen, prioritised, designed and implemented. Methods: Following a modified Delphi methodology, a multi-disciplinary panel of experts in kidney healthcare from across the UK developed 35 statements on the issues surrounding the selection, development and implementation of nephrology guidelines. Consensus with these statements was determined by agreement using an online survey; the consensus threshold was defined as 75% agreement. Results: 419 responses were received. Of the 364 healthcare practitioners (HCPs), the majority had over 20 years of experience in their role (n=123) and most respondents were nephrologists (n=95). Of the 55 non-clinical respondents, the majority were people with kidney disease (n=41) and the rest were their carers or family. Participants were from across England, Northern Ireland, Scotland and Wales. Consensus between HCPs was achieved in 32/35 statements, with 28 statements reaching ≥90% agreement. Consensus between patients and patient representatives was achieved across all 20 statements, with 13/20 reaching ≥90% agreement. Conclusions: The current results have provided the basis for six recommendations to improve the selection, design and implementation of guidelines. Actioning these recommendations will help improve the accessibility of, and engagement with, clinical guidelines, contributing to the continuing development of best practice in UK kidney care

Unprecedented reduction in air pollution and corresponding short-term premature mortality associated with COVID-19 lockdown in Delhi, India

Countries around the world introduced strict restrictions on movement and activities known as ‘lockdowns’ to restrict the spread of the novel coronavirus disease (COVID-19) from the end of 2019. A sudden improvement in air quality was observed globally as a result of these lockdowns. To provide insight into the changes in air pollution levels in response to the COVID-19 restrictions we have compared surface air quality data in Delhi during four phases of lockdown and the first phase of the restriction easing period (25 March to 30 June 2020) with data from a baseline period (2018–2019). Simultaneously, short-term exposure of PM and O attributed premature mortality were calculated to understand the health benefit of the change in air quality. Ground–level observations in Delhi showed that concentrations of PM , PM and NO dropped substantially in 2020 during the overall study period compared with the same period in previous years, with average reductions of ~49%, ~39%, and ~39%, respectively. An overall lower reduction in O of ~19% was observed for Delhi. A slight increase in O was found in Delhi’s industrial and traffic regions. The highest peak of the diurnal variation decreased substantially for all the pollutants at every phase. The decrease in PM and O concentrations in 2020, prevented 904 total premature deaths, a 60% improvement when compared to the figures for 2018–2019. The restrictions on human activities during the lockdown have reduced anthropogenic emissions and subsequently improved air quality and human health in one of the most polluted cities in the world. Implications: I am submitting herewith the manuscript entitled “Unprecedented Reduction in Air Pollution and Corresponding Short-term Premature Mortality Associated with COVID-19 Forced Confinement in Delhi, India” for potential publishing in your journal. The novelty of this research lies in: (1) we utilized ground-level air quality data in Delhi during four phases of lockdown and the first phase of unlocking period (25 March to 30 June) for 2020 as well as data from the baseline period (2018–2019) to provide an early insight into the changes in air pollution levels in response to the COVID-19 pandemic, (2) Chatarize the change of diurnal variation of the pollutants and (3) we assess the health risk due to PM and O . Results from ground-level observations in Delhi showed that concentrations of PM , PM and NO substantially dropped in 2020 during the overall study period compared to the similar period in previous years, with an average reduction of ~49%, ~39%, and ~39%, respectively. In the case of O , the overall reduction was observed as ~19% in Delhi, while a slight increase was found in industrial and traffic regions. And consequently, the highest peak of the diurnal variation decreased substantially for all the pollutants. The health impact assessment of the changes in air quality indicated that 904 short-term premature deaths (~60%) were prevented due to the decline in PM and O concentrations in the study period. The restrictions on human activities during the lockdown have reduced the anthropogenic emissions and subsequently improved air quality and human health in one of the most polluted cities in the world