Ten women's decision-making experiences in threatened preterm labour: Qualitative findings from the EQUIPTT trial.

BACKGROUND: Clinical triage of women in threatened preterm labour (TPTL) could be improved through utilising the QUiPP App, as symptoms alone are poor predictors of early delivery. As most women in TPTL ultimately deliver at term, they must weigh this likelihood with their own personal considerations, and responsibilities. The importance of personal considerations was highlighted by the 2015 Montgomery ruling, and the significance of shared decision-making. AIMS: Through qualitative interviews, the primary aim was to explore women's decision-making experiences in TPTL through onset of symptoms, triage, clinical assessment, and discharge. METHODS: Qualitative interviews were undertaken as part of the EQUIPTT study (REC: 17/LO/1802) using a semi-structured interview schedule. Descriptive labels of the coding scheme were applied to the raw transcript data. This coding scheme was then increasingly refined into key themes and allowed parallels to be made within and between cases. RESULTS: Ten ethnically diverse women who presented at six different London hospitals sites in TPTL were interviewed. Three final themes emerged from the data incorporating 10 sub-themes, 'Seeking help', 'Being "assessed" vs making clinical decisions together', and 'End result.' CONCLUSION: Women described their busy lives and the need to juggle their commitments. Participants drew comparisons between their TPTL symptoms and 'period pain,' contrasting to typical medical terminology. Shared decision-making and the clinician-patient relationship could be improved through clinicians utilizing terminology women understand and relate to. Women used language that highlighted the clinician-patient power balance. While not fully involved in shared decision-making, women were overall satisfied with their care

Clinicians' experiences of using and implementing a medical mobile phone app (QUiPP V2) designed to predict the risk of preterm birth and aid clinical decision making.

BACKGROUND: As the vast majority of women who present in threatened preterm labour (TPTL) will not deliver early, clinicians need to balance the risks of over-medicalising the majority of women, against the potential risk of preterm delivery for those discharged home. The QUiPP app is a free, validated app which can support clinical decision-making as it produces individualised risks of delivery within relevant timeframes. Recent evidence has highlighted that clinicians would welcome a decision-support tool that accurately predicts preterm birth. METHODS: Qualitative interviews were undertaken as part of the EQUIPTT study (The Evaluation of the QUiPP app for Triage and Transfer) (REC: 17/LO/1802) which aimed to evaluate the impact of the QUiPP app on management of TPTL. Individual semi-structured telephone interviews were used to explore clinicians' (obstetricians' and midwives') experiences of using the QUiPP app and how it was implemented at their hospital sites. Thematic analysis was chosen to explore the meaning of the data, through a framework approach. RESULTS: Nineteen participants from 10 hospital sites in England took part. Data analysis revealed three overarching themes which were: 'experience of using the app', 'how QUiPP risk changes practice' and 'successfully adopting QUiPP: context is everything'. With these final themes we appeared to have achieved our aim of exploring the clinicians' experiences of using and implementing the QUiPP app. CONCLUSION: This study explored different clinician's experiences of implementing the app. The organizational and cultural context at different sites appeared to have a large impact on how well the QUiPP app was implemented. Future work needs to be undertaken to understand how best to embed the intervention within different settings. This will inform scale up of QUiPP app use across the UK and ensure that clinicians have access to this free, easy-to-use tool which can positively aid clinical decision making when caring for women in TPTL. CLINICAL TRIAL REGISTRY AND REGISTRATION NUMBER: ISRCTN 17846337, registered 08th January 2018, https://doi.org/10.1186/ISRCTN17846337

Neurofibromatosis 1 (NF1) mutation results in impaired function of human induced pluripotent stem cell-derived microglia

Neurofibromatosis type 1 (NF1) is an autosomal dominant condition caused by germline mutations in the NF1 gene. Children with NF1 are prone to the development of multiple nervous system abnormalities, including autism and brain tumors, which could reflect the effect of NF1 mutation on microglia function. Using heterozygous Nf1-mutant mice, we previously demonstrated that impaired purinergic signaling underlies deficits in microglia process extension and phagocytosis in situ. To determine whether these abnormalities are also observed in human microglia in the setting of NF1, we leveraged an engineered isogenic series of human induced pluripotent stem cells to generate human microglia-like (hiMGL) cells heterozygous for three different NF1 patient-derived NF1 gene mutations. While all NF1-mutant and isogenic control hiMGL cells expressed classical microglia markers and exhibited similar transcriptomes and cytokine/chemokine release profiles, only NF1-mutant hiMGL cells had defects in P2X receptor activation, phagocytosis and motility. Taken together, heterozygous NF1 mutation impairs a subset of human microglia functional properties, which could contribute to the neurological abnormalities seen in children with NF1

Microglia/macrophage derived human CCL18 promotes glioma progression via CCR8-ACP5 axis analyzed in humanized slice model

Factors released from glioma-associated microglia/macrophages (GAMs) play a crucial role in glioblastoma multiforme (GBM) progression. Here, we study the importance of CCL18, a cytokine expressed in human but not in rodent GAMs, as a modulator of glioma growth. Since CCL18 signaling could not be studied in classical mouse glioma models, we developed an approach by transplanting induced pluripotent stem cell-derived human microglia and human glioma cells into mouse brain slices depleted of their intrinsic microglia. We observe that CCL18 promotes glioma cell growth and invasion. Chemokine (C-C motif) receptor 8 (CCR8) is identified as a functional receptor for CCL18 on glioma cells, and ACP5 (acid phosphatase 5) is revealed as an important part of the downstream signaling cascade for mediating glioma growth. We conclude, based on the results from an in vitro, ex vivo humanized glioma model and an in vivo GBM model that microglia/macrophage-derived CCL18 promotes glioma growth

Characterization of OSIRIS NAC filters for the interpretation of multispectral data of comet 67P/Churyumov-Gerasimenko

We interpret multicolor data from OSIRISNAC for the remote-sensing exploration of comet 67P/Churyumov-Gerasimenko. We determine the most meaningful definition of color maps for the characterization of surface variegation with filters available on OSIRIS NAC. Methods. We analyzed laboratory spectra of selected minerals and olivine-pyroxene mixtures seen through OSIRIS NAC filters, with spectral methods existing in the literature: reflectance ratios, minimum band wavelength, spectral slopes, band tilt, band curvature, and visible tilt. Results. We emphasize the importance of reflectance ratios and particularly the relation of visible tilt vs. band tilt. This technique provides a reliable diagnostic of the presence of silicates. Color maps constructed by red-green-blue colors defined with the green, orange, red, IR, and Fe2O3 filters let us define regions that may significantly differ in composition

Exposed bright features on the comet 67P/Churyumov-Gerasimenko: Distribution and evolution

Context. Since its arrival at the comet 67P/Churyumov-Gerasimenko in August 2014, the Rosetta spacecraft followed the comet as it went past the perihelion and beyond until September 2016. During this time there were many scientific instruments operating on board Rosetta to study the comet and its evolution in unprecedented detail. In this context, our study focusses on the distribution and evolution of exposed bright features that have been observed by OSIRIS, which is the scientific imaging instrument aboard Rosetta. Aims. We envisage investigating various morphologies of exposed bright features and the mechanisms that triggered their appearance. Methods. We co-registered multi-filter observations of OSIRIS images that are available in reflectance. The Lommel-Seeliger disk function was used to correct for the illumination conditions and the resulting colour cubes were used to perform spectrophotometric analyses on regions of interest. Results. We present a catalogue of 57 exposed bright features observed on the nucleus of the comet, all of which are attributed to the presence of H2O ice on the comet. Furthermore, we categorise these patches under four different morphologies and present geometric albedos for each category. Conclusions. Although the nucleus of 67P/Churyumov-Gerasimenko appears to be dark in general, there are localised H2O ice sources on the comet. Cometary activity escalates towards the perihelion passage and reveals such volatile ices. We propose that isolated H2O ice patches found in smooth terrains in regions, such as Imhotep, Bes, and Hapi, result from frost as an aftermath of the cessation of the diurnal water cycle on the comet as it recedes from perihelion. Upon the comet's return to perihelion, such patches are revealed when sublimation-driven erosion removes the thin dust layers that got deposited earlier. More powerful activity sources such as cometary outbursts are capable of revealing much fresher, less contaminated H2O ice that is preserved with consolidated cometary material, as observed on exposed patches resting on boulders. This is corroborated by our albedo calculations that attribute higher albedos for bright features with formations related to outbursts

Acceleration of individual, decimetre-sized aggregates in the lower coma of comet 67P/Churyumov-Gerasimenko

We present observations of decimetre-sized, likely ice-containing aggregates ejected from a confined region on the surface of comet 67P/Churyumov-Gerasimenko. The images were obtained with the narrow angle camera of the Optical, Spectroscopic, and Infrared Remote Imaging System on board the Rosetta spacecraft in 2016 January when the comet was at 2 au from the Sun outbound from perihelion.We measure the acceleration of individual aggregates through a 2 h image series. Approximately 50 per cent of the aggregates are accelerated away from the nucleus, and 50 per cent towards it, and likewise towards either horizontal direction. The accelerations are up to one order of magnitude stronger than local gravity, and are most simply explained by the combined effect of gas drag accelerating all aggregates upwards, and the recoil force from asymmetric outgassing, either from rotating aggregates with randomly oriented spin axes and sufficient thermal inertia to shift the temperature maximum away from an aggregate's subsolar region, or from aggregates with variable ice content. At least 10 per cent of the aggregates will escape the gravity field of the nucleus and feed the comet's debris trail, while others may fall back to the surface and contribute to the deposits covering parts of the Northern hemisphere. The rocket force plays a crucial role in pushing these aggregates back towards the surface. Our observations show the future back fall material in the process of ejection, and provide the first direct measurement of the acceleration of aggregates in the innermost coma (<2 km) of a comet, where gas drag is still significant

A mini outburst from the nightside of comet 67P/Churyumov-Gerasimenko observed by the OSIRIS camera on Rosetta

Context. On 12 March 2015 the OSIRIS WAC camera onboard the ESA Rosetta spacecraft orbiting comet 67P/Churyumov-Gerasimenko observed a small outburst originating from the Imhotep region at the foot of the big lobe of the comet. These measurements are unique since it was the first time that the initial phase of a transient outburst event could be directly observed. Aims. We investigate the evolution of the dust jet in order to derive clues about the outburst source mechanism and the ejected dust particles, in particular the dust mass, dust-to-gas ratio and the particle size distribution. Methods. Analysis of the images and of the observation geometry using comet shape models in combination with gasdynamic modeling of the transient dust jet were the main tools used in this study. Synthetic images were computed for comparison with the observations. Results. Analysis of the geometry revealed that the source region was not illuminated until 1.5 h after the event implying true nightside activity was observed. The outburst lasted for less than one hour and the average dust production rate during the initial four minutes was of the order of 1 kg/s. During this time the outburst dust production rate was approximately constant, no sign for an initial explosion could be detected. For dust grains between 0.01-1 mm a power law size distribution characterized by an index of about 2.6 provides the best fit to the observed radiance profiles. The dust-to-gas ratio of the outburst jet is in the range 0.6-1.8

Opposition effect on comet 67P/Churyumov-Gerasimenko using Rosetta-OSIRIS images

Aims. We aim to explore the behavior of the opposition effect as an important tool in optical remote sensing on the nucleus of comet 67P/Churyumov-Gerasimenko (67P), using Rosetta-OSIRIS images acquired in different filters during the approach phase, July-August 2014 and the close flyby images on 14 of February 2015, which contain the spacecraft shadow. Methods. We based our investigation on the global and local brightness from the surface of 67P with respect to the phase angle, also known as phase curve. The local phase curve corresponds to a region that is located at the Imhotep-Ash boundary of 67P. Assuming that the region at the Imhotep-Ash boundary and the entire nucleus have similar albedo, we combined the global and local phase curves to study the opposition-surge morphology and constrain the structure and properties of 67P. The model parameters were furthermore compared with other bodies in the solar system and existing laboratory study. Results. We found that the morphological parameters of the opposition surge decrease monotonically with wavelength, whereas in the case of coherent backscattering this behavior should be the reverse. The results from comparative analysis place 67P in the same category as the two Mars satellites, Phobos and Deimos, which are notably different from all airless bodies in the solar system. The similarity between the surface phase function of 67P and a carbon soot sample at extremely small angles is identified, introducing regolith at the boundary of the Imhotep-Ash region of 67P as a very dark and fluffy layer

The rotation state of 67P/Churyumov-Gerasimenko from approach observations with the OSIRIS cameras on Rosetta

Aims. Approach observations with the Optical, Spectroscopic, and Infrared Remote Imaging System (OSIRIS) experiment onboard Rosetta are used to determine the rotation period, the direction of the spin axis, and the state of rotation of comet 67P's nucleus. Methods. Photometric time series of 67P have been acquired by OSIRIS since the post wake-up commissioning of the payload in March 2014. Fourier analysis and convex shape inversion methods have been applied to the Rosetta data as well to the available ground-based observations. Results. Evidence is found that the rotation rate of 67P has significantly changed near the time of its 2009 perihelion passage, probably due to sublimation-induced torque. We find that the sidereal rotation periods P1 = 12.76129 ± 0.00005 h and P2 = 12.4043 ± 0.0007 h for the apparitions before and after the 2009 perihelion, respectively, provide the best fit to the observations. No signs of multiple periodicity are found in the light curves down to the noise level, which implies that the comet is presently in a simple rotation state around its axis of largest moment of inertia. We derive a prograde rotation model with spin vector J2000 ecliptic coordinates λ = 65° ± 15°, β = + 59° ± 15°, corresponding to equatorial coordinates RA = 22°, Dec = + 76°. However, we find that the mirror solution, also prograde, at λ = 275° ± 15°, β = + 50° ± 15° (or RA = 274°, Dec = + 27°), is also possible at the same confidence level, due to the intrinsic ambiguity of the photometric problem for observations performed close to the ecliptic plane