‘They’re more like ordinary stroppy British women’: Attitudes and expectations of maternity care professionals to UK-born ethnic minority women

Objective To explore the attitudes and expectations of maternity care professionals to UK-born ethnic minority mothers. Methods Qualitative in-depth interviews with 30 professionals from eight NHS maternity units in England that provide services for large proportions of women of black Caribbean, black African, Indian, Pakistani and Irish descent. Results All the professionals reported providing care to both UK-born and migrant mothers from ethnic minorities. Most of them felt that they could differentiate between UK-born and migrant mothers based mainly on language fluency and accent. ‘Westernized dress’ and ‘freedom’ were also cited as indicators. Overall, professionals found it easier to provide services to UK-born mothers and felt that their needs were more like those of white English mothers than those of migrant mothers. UK-born mothers were generally thought to be assertive and expressive, and in control of care-related decision-making whereas some South Asian Muslim women were thought to be constrained by family influences. Preconceived ideas about ethnic minority mothers' tolerance of pain in labour, use of pharmacological pain relief measures and mode of delivery were recurring themes. Women's education and social class were felt to be major influences on the uptake of maternity care, regardless of ethnicity. Conclusions Professionals appeared to equate the needs of UK-born ethnic minority women with those of white English women. Overall, this has positive implications for care provision. Despite this, specific behavioural expectations and unconscious stereotypical views were evident and have the potential to affect clinical practice

Impact of the frequency of online verifications on the patient set-up accuracy and set-up margins

<p>Abstract</p> <p>Purpose</p> <p>The purpose of the study was to evaluate the patient set-up error of different anatomical sites, to estimate the effect of different frequencies of online verifications on the patient set-up accuracy, and to calculate margins to accommodate for the patient set-up error (ICRU set-up margin, SM).</p> <p>Methods and materials</p> <p>Alignment data of 148 patients treated with inversed planned intensity modulated radiotherapy (IMRT) or three-dimensional conformal radiotherapy (3D-CRT) of the head and neck (n = 31), chest (n = 72), abdomen (n = 15), and pelvis (n = 30) were evaluated. The patient set-up accuracy was assessed using orthogonal megavoltage electronic portal images of 2328 fractions of 173 planning target volumes (PTV). In 25 patients, two PTVs were analyzed where the PTVs were located in different anatomical sites and treated in two different radiotherapy courses. The patient set-up error and the corresponding SM were retrospectively determined assuming no online verification, online verification once a week and online verification every other day.</p> <p>Results</p> <p>The SM could be effectively reduced with increasing frequency of online verifications. However, a significant frequency of relevant set-up errors remained even after online verification every other day. For example, residual set-up errors larger than 5 mm were observed on average in 18% to 27% of all fractions of patients treated in the chest, abdomen and pelvis, and in 10% of fractions of patients treated in the head and neck after online verification every other day.</p> <p>Conclusion</p> <p>In patients where high set-up accuracy is desired, daily online verification is highly recommended.</p

General Practitioners' views on the provision of nicotine replacement therapy and bupropion.

BACKGROUND: Nicotine replacement therapies (NRT) and a new drug, bupropion, are licensed in several countries as aids to smoking cessation. General practitioners (GPs) play a crucial role in recommending or prescribing these medications. In the UK there has been discussion about whether the medications should be reimbursable by the National Health Service (NHS). This study assessed English GPs' attitudes towards reimbursement of NRT and bupropion. METHODS: Postal survey of a randomly selected national sample of GPs; 376 GPs completed the questionnaire after one reminder; effective response rate: 53%. There was no difference between the responses of GPs who responded to the initial request and those who responded only after a reminder suggesting minimal bias due to non-response. RESULTS: Attitudes of GPs were remarkably divided on most issues relating to the medications. Forty-three percent thought that bupropion should not be on NHS prescription while 42% thought that it should be (15% did not know); Fifty percent thought that NRT should not be on NHS prescription while 42% thought it should be (8% did not know). Requiring that smokers attend behavioural support programmes to be eligible to receive the medications on NHS prescription made no appreciable difference to the GPs' views. GPs were similarly divided on whether having the medications reimbursable would add unacceptably to their workload or offer a welcome opportunity to discuss smoking with their patients. A principal components analysis of responses to the individual questions on NRT and bupropion revealed that GPs' attitudes could be understood in terms of a single 'pro-con' dimension accounting for 53% of the total variance which made no distinction between the two medications. CONCLUSIONS: GPs in England appear to be divided in their attitudes to medications to aid smoking cessation and appear not to discriminate in their views between different types of medication or different aspects of their use. This suggests that their attitudes are generated by quite fundamental values. Addressing these values may be important in encouraging GPs to adhere more closely to national and international guidelines

Upk3b is dispensable for development and integrity of urothelium and mesothelium

The mesothelium, the lining of the coelomic cavities, and the urothelium, the inner lining of the urinary drainage system, are highly specialized epithelia that protect the underlying tissues from mechanical stress and seal them from the overlying fluid space. The development of these epithelia from simple precursors and the molecular characteristics of the mature tissues are poorly analyzed. Here, we show that uroplakin 3B (Upk3b), which encodes an integral membrane protein of the tetraspanin superfamily, is specifically expressed both in development as well as under homeostatic conditions in adult mice in the mesothelia of the body cavities, i.e., the epicardium and pericardium, the pleura and the peritoneum, and in the urothelium of the urinary tract. To analyze Upk3b function, we generated a creERT2 knock-in allele by homologous recombination in embryonic stem cells. We show that Upk3bcreERT2 represents a null allele despite the lack of creERT2 expression from the mutated locus. Morphological, histological and molecular analyses of Upk3b-deficient mice did not detect changes in differentiation or integrity of the urothelium and the mesothelia that cover internal organs. Upk3b is coexpressed with the closely related Upk3a gene in the urothelium but not in the mesothelium, leaving the possibility of a functional redundancy between the two genes in the urothelium only

TOI-858 B b: A hot Jupiter on a polar orbit in a loose binary

We report the discovery of a hot Jupiter on a 3.28-day orbit around a 1.08 M$_{Sun}$ G0 star that is the secondary component in a loose binary system. Based on follow-up radial velocity observations of TOI-858 B with CORALIE on the Swiss 1.2 m telescope and CHIRON on the 1.5 m telescope at the Cerro Tololo Inter-American Observatory (CTIO), we measured the planet mass to be $1.10\pm 0.08$ M$_{J}$ . Two transits were further observed with CORALIE to determine the alignment of TOI-858 B b with respect to its host star. Analysis of the Rossiter-McLaughlin signal from the planet shows that the sky-projected obliquity is $\lambda = 99.3\pm 3.8$. Numerical simulations show that the neighbour star TOI-858 A is too distant to have trapped the planet in a Kozai-Lidov resonance, suggesting a different dynamical evolution or a primordial origin to explain this misalignment. The 1.15 Msun primary F9 star of the system (TYC 8501-01597-1, at $\rho$ ~11") was also observed with CORALIE in order to provide upper limits for the presence of a planetary companion orbiting that star.Comment: Accepted for publication in A&

TOI-2257 b: A highly eccentric long-period sub-Neptune transiting a nearby M dwarf

N.S., R.W. and B.-O.D. acknowledge support from the Swiss National Science Foundation (PP00P2-163967 and PP00P2-190080). M.N.G. acknowledges support from MIT's Kavli Institute as a Juan Carlos Torres Fellow and from the European Space Agency (ESA) as an ESA Research Fellow. A.A.B., B.S.S.and I.A.S. acknowledge the support of the Ministry of Science and Higher Education of the Russian Federation under the grant 075-15-2020-780 (N13.1902.21.0039). L.D. is an F.R.S.-FNRS Postdoctoral Researcher. B.V.R. thanks the Heising-Simons Foundation for support. This publication benefits from the support of the French Community of Belgium in the context of the FRIA Doctoral Grant awarded to M.T. and E.J. acknowledges DGAPA for his postdoctoral fellowship. Y.G.M.C. acknowledges support from UNAM-DGAPA PAPIIT BG-101321. D.D. acknowledges support from the TESS Guest Investigator Program grant 80NSSC19K1727 and NASA Exoplanet Research Program grant 18-2XRP18_2-0136. We acknowledge support from the Centre for Space and Habitability (CSH) of the University of Bern. Part of this work received support from the National Centre for Competence in Research PlanetS, supported by the Swiss National Science Foundation (SNSF). Funding for the TESS mission is provided by NASA's Science Mission Directorate. We acknowledge the use of public TESS data from pipelines at the TESS Science Office and at the TESS Science Processing Operations Center. This research has made use of the Exoplanet Follow-up Observation Program website, which is operated by the California Institute of Technology, under contract with the National Aeronautics and Space Administration under the Exoplanet Exploration Program. Resources supporting this work were provided by the NASA High-End Computing (HEC) Program through the NASA Advanced Supercomputing (NAS) Division at Ames Research Center for the production of the SPOC data products. This paper includes data collected by the TESS mission that are publicly available from the Mikulski Archive for Space Telescopes (MAST). This work is based upon observations carried out at the Observatorio Astronomico Nacional on the Sierra de San Pedro Martir (OAN-SPM), Baja California, Mexico. We warmly thank the entire technical staff of the Observatorio Astronomico Nacional at San Pedro Martir in Mexico for their unfailing support to SAINT-EX operations, namely: E. Cadena, T. Calvario, E. Colorado, F. Diaz, A. Franco, B. Garcia, C. Guerrero, G. Guisa, F. Guillen, A. Landa, L. Figueroa, B. Hernandez, J. Herrera, E. Lopez, E. Lugo, B. Martinez, G. Melgoza, F. Montalvo, J.M. Nunez, J.L. Ochoa, I. Plauchu, F. Quiroz, H. Riesgo, H. Serrano, T. Verdugo, I. Zavala. The research leading to these results has received funding from the European Research Council (ERC) under the FP/2007-2013 ERC grant agreement nffi 336480, and under the European Union's Horizon 2020 research and innovation programme (grants agreements nffi 679030 and 803193/BEBOP); from an Actions de Recherche Concertee (ARC) grant, financed by the Wallonia-Brussels Federation, from the Balzan Prize Foundation, from the BEL-SPO/BRAIN2.0 research program (PORTAL project), from the Science and Technology Facilities Council (STFC; grant nffi ST/S00193X/1), and from F.R.S-FNRS (Research Project ID T010920F). This work was also partially supported by a grant from the Simons Foundation (PI: Queloz, grant number 327127), as well as by the MERAC foundation (PI: Triaud). PI: Gillon is F.R.S.-FNRS Senior Research Associate. TRAPPIST is funded by the Belgian Fund for Scientific Research (Fond National de la Recherche Scientifique, FNRS) under the grant PDR T.0120.21, with the participation of the Swiss National Science Fundation (SNF). M.G. and E.J. are F.R.S.-FNRS Senior Research Associate. This work makes use of observations from the LCOGT network. Part of the LCOGT telescope time was granted by NOIRLab through the Mid-Scale Innovations Program (MSIP). M.S.I.P. is funded by NSF. Some of the observations in the paper made use of the High-Resolution Imaging instrument(s) `Alopeke (and/or Zorro). `Alopeke (and/or Zorro) was funded by the NASA Exoplanet Exploration Program and built at the NASA Ames Research Center by Steve B. Howell, Nic Scott, Elliott P. Horch, and Emmett Quigley. Data were reduced using a software pipeline originally written by Elliott Horch and Mark Everett. `Alopeke (and/or Zorro) was mounted on the Gemini North (and/or South) telescope of the international Gemini Observatory, a program of NSF's OIR Lab, which is managed by the Association of Universities for Research in Astronomy (AURA) under a cooperative agreement with the National Science Foundation, on behalf of the Gemini partnership: the National Science Foundation (United States), National Research Council (Canada), Agencia Nacional de Investigacion y Desarrollo (Chile), Ministerio de Ciencia, Tecnologia e Innovacion (Argentina), Ministerio da Ciencia, Tecnologia, Inovacoes e Comunicacoes (Brazil), and Korea Astronomy and Space Science Institute (Republic of Korea). This research has made use of the NASA Exoplanet Archive, which is operated by the California Institute of Technology, under contract with the National Aeronautics and Space Administration under the Exoplanet Exploration Program. This research made use of exoplanet (Foreman-Mackey et al. 2021a,b) and its dependencies (Agol et al. 2020; Kumar et al. 2019; Astropy Collaboration 2013, 2018; Kipping 2013; Luger et al. 2019; Salvatier et al. 2016; Theano Development Team 2016). Additional use of software packages AstroImageJ (Collins et al. 2017) and TAPIR (Jensen 2013).Context. Thanks to the relative ease of finding and characterizing small planets around M-dwarf stars, these objects have become cornerstones in the field of exoplanet studies. The current paucity of planets in long-period orbits around M dwarfs makes such objects particularly compelling as they provide clues about the formation and evolution of these systems. Aims. In this study we present the discovery of TOI-2257 b (TIC 198485881), a long-period (35 d) sub-Neptune orbiting an M3 star at 57.8 pc. Its transit depth is about 0.4%, large enough to be detected with medium-size, ground-based telescopes. The long transit duration suggests the planet is in a highly eccentric orbit (e similar to 0.5), which would make it the most eccentric planet known to be transiting an M-dwarf star. Methods. We combined TESS and ground-based data obtained with the 1.0-meter SAINT-EX, 0.60-meter TRAPPIST-North, and 1.2-meter FLWO telescopes to find a planetary size of 2.2 R-circle plus and an orbital period of 35.19 days. In addition, we make use of archival data, high-resolution imaging, and vetting packages to support our planetary interpretation. Results. With its long period and high eccentricity, TOI-2257 b falls into a novel slice of parameter space. Despite the planet's low equilibrium temperature (similar to 256 K), its host star's small size (R-* = 0.311 +/- 0.015) and relative infrared brightness (K-mag = 10.7) make it a suitable candidate for atmospheric exploration via transmission spectroscopy.Swiss National Science Foundation (SNSF)European Commission PP00P2-163967 PP00P2-190080MIT's Kavli InstituteEuropean Space Agency European CommissionMinistry of Science and Higher Education of the Russian Federation 075-15-2020-780 (N13.1902.21.0039)Heising-Simons FoundationFrench Community of BelgiumDGAPAPrograma de Apoyo a Proyectos de Investigacion e Innovacion Tecnologica (PAPIIT) Universidad Nacional Autonoma de Mexico BG-101321TESS Guest Investigator Program 80NSSC19K1727NASA Exoplanet Research Program 18-2XRP18_2-0136Centre for Space and Habitability (CSH) of the University of BernSwiss National Science Foundation (SNSF)European Research Council (ERC) 336480Actions de Recherche Concertee (ARC) grant - Wallonia-Brussels FederationUK Research & Innovation (UKRI)Science & Technology Facilities Council (STFC)Science and Technology Development Fund (STDF) ST/S00193X/1Fonds de la Recherche Scientifique - FNRS T010920FSimons Foundation 327127MERAC foundationFonds de la Recherche Scientifique - FNRS PDR T.0120.21Swiss National Science Foundation (SNSF)National Science Foundation (NSF)NASA Exoplanet Exploration Program NASA's Science Mission DirectorateEuropean Research Council (ERC) 679030 803193/BEBOPBalzan Prize Foundation BEL-SPO/BRAIN2.0 research program (PORTAL project

Prognostic value of gross tumor volume delineated by FDG-PET-CT based radiotherapy treatment planning in patients with locally advanced pancreatic cancer treated with chemoradiotherapy

<p>Abstract</p> <p>Background</p> <p>We aimed to assess whether gross tumor volume (GTV) determined by fusion of contrast-enhanced computerized tomography (CT) and 18F-fluoro-deoxy-D-glucose positron emission tomography-CT (FDG-PET-CT) based radiotherapy planning could predict outcomes, namely overall survival (OS), local-regional progression-free survival (LRPFS), and progression-free survival (PFS) in cases with locally advanced pancreas cancer (LAPC) treated with definitive concurrent chemoradiotherapy.</p> <p>Methods</p> <p>A total of 30 patients with histological proof of LAPC underwent 50.4 Gy (1.8 Gy/28 fractions) of radiotherapy concurrent with continuously infused 5-FU followed by 4 to 6 courses of maintenance gemcitabine. Target volume delineations were performed on FDG-PET-CT-based RTP. Patients were stratified into 2 groups: GTV lesser (GTV_L) versus greater (GTV_G) than cut off value determined by receiver operating characteristic (ROC) analysis, and compared in terms of OS, LRPFS and PFS.</p> <p>Results</p> <p>Median GTV delineated according to the FDG-PET-CT data was 100.0 cm³. Cut off GTV value determined from ROC curves was 91.1 cm³. At a median follow up of 11.2 months, median OS, LRPFS and PFS for the entire population were 10.3, 7.8 and 5.7 months, respectively. Median OS, LRPFS and PFS for GTV_Land GTV_Gcohorts were 16.3 vs. 9.5 (<it>p </it>= 0.005), 11.0 vs. 6.0 (<it>p </it>= 0.013), and 9.0 vs. 4.8 months (<it>p </it>= 0.008), respectively.</p> <p>Conclusions</p> <p>The superior OS, LRPFS and PFS observed in GTV_Lpatients over GTV_Gones suggests a potential for FDG-PET-CT-defined GTV size in predicting outcomes of LAPC patients treated with definitive C-CRT, which needs to be validated by further studies with larger cohorts.</p

The young mini-Neptune HD 207496b that is either a naked core or on the verge of becoming one

We report the discovery and characterisation of the transiting mini-Neptune HD~207496~b (TOI-1099) as part of a large programme that aims to characterise naked core planets. We obtained HARPS spectroscopic observations, one ground-based transit, and high-resolution imaging which we combined with the TESS photometry to confirm and characterise the TESS candidate and its host star. The host star is an active early K dwarf with a mass of $0.80 \pm 0.04\,$M$_\odot$, a radius of $0.769 \pm 0.026\,$R$_\odot$, and a G magnitude of 8. We found that the host star is young, $\sim 0.52\,$ Myr, allowing us to gain insight into planetary evolution. We derived a planetary mass of $6.1 \pm 1.6\,\mathrm{M}_E$,\, a planetary radius of $2.25 \pm 0.12\,\mathrm{R}_E$,\ and a planetary density of $\rho_p = 3.27_{-0.91}^{+0.97}\,\mathrm{g.cm^{-3}}$. From internal structure modelling of the planet, we conclude that the planet has either a water-rich envelope, a gas-rich envelope, or a mixture of both. We have performed evaporation modelling of the planet. If we assume the planet has a gas-rich envelope, we find that the planet has lost a significant fraction of its envelope and its radius has shrunk. Furthermore, we estimate it will lose all its remaining gaseous envelope in $\sim 0.52\,$ Gyr. Otherwise, the planet could have already lost all its primordial gas and is now a bare ocean planet. Further observations of its possible atmosphere and/or mass-loss rate would allow us to distinguish between these two hypotheses. Such observations would determine if the planet remains above the radius gap or if it will shrink and be below the gap.Comment: 20 pages, 18 figures, 4 tables, A&A accepte