Demographic and pregnancy‐related predictors of postnatal contraception uptake: A cross‐sectional study

Objective: To examine the uptake of postnatal contraception (PNC) and experiences of PNC care across a geographical region of England. Design: Cross‐sectional online survey. Setting: The North East and North Cumbria Integrated Care System (ICS). Population: Women who had completed a pregnancy in the previous 3 years. Methods: The uptake of PNC by accessed method(s) and the availability of preferred method(s) is described, and adjusted odds ratios are reported for group differences in uptake by characteristics of interest. Main outcome measures: Uptake of medically prescribed/administered contraception and uptake of long‐acting reversible contraception (LARC) during the postnatal period, and access to preferred PNC methods. Results: Although almost half of respondents (47.1%; n = 1178) reinitiated some form of sexual activity during the postnatal period, only 38.7% (n = 969) of respondents accessed a medically prescribed/administered contraceptive method postnatally, and only 15.5% (n = 389) of respondents accessed a LARC. It is a matter of concern that 18.8% (n = 451) of respondents indicated that they were unable to access their preferred PNC. In multivariate analysis, younger age, lower household income, higher multiparity, operative delivery, unplanned pregnancy and not breastfeeding were significant predictors of higher PNC uptake. Conclusions: The uptake of PNC in this cohort was low, with almost a fifth of women unable to access their preferred method. However, there was some evidence that women belonging to groups perceived to be at risk of rapid repeat pregnancy were more likely to access reliable PNC methods

Varying alpha and black hole entropy

Recently it has been suggested that an increase in the fine structure constant alpha with time would decrease the entropy of a Reissner-Nordstrom black hole, thereby violating the second law of thermodynamics. In this note we point out that, at least for a certain class of charged dilaton black holes related to string theory, the entropy does not change under adiabatic variations of alpha and one might expect it to increase for non-adiabatic changes.Comment: 5 pages, matches version accepted in JHE

Ocean warming drives rapid dynamic activation of a marine-terminating glacier on the west Antarctic Peninsula

Ice dynamic change is the primary cause of mass loss from the Antarctic Ice Sheet, thus it is important to understand the processes driving ice-ocean interactions and the timescale on which major change can occur. Here we use satellite observations to measure a rapid increase in speed and collapse of the ice shelf fronting Cadman Glacier in the absence of surface meltwater ponding. Between November 2018 and December 2019 ice speed increased by 94 ± 4% (1.47 ± 0.6 km/yr), ice discharge increased by 0.52 ± 0.21 Gt/yr, and the calving front retreated by 8 km with dynamic thinning on grounded ice of 20.1 ± 2.6 m/yr. This change was concurrent with a positive temperature anomaly in the upper ocean, where a 400 m deep channel allowed warm water to reach Cadman Glacier driving the dynamic activation, while neighbouring Funk and Lever Glaciers were protected by bathymetric sills across their fjords. Our results show that forcing by warm ocean water can cause the rapid onset of dynamic imbalance and increased ice discharge from glaciers on the Antarctic Peninsula, highlighting the region’s sensitivity to future climate variability

Effectiveness and implementation of lower-intensity weight management interventions delivered by the non-specialist workforce in postnatal women: a mixed-methods systematic review

Lower-intensity interventions delivered in primary and community care contacts could provide more equitable and scalable weight management support for postnatal women. This mixed-methods systematic review aimed to explore the effectiveness, implementation, and experiences of lower-intensity weight management support delivered by the non-specialist workforce. We included quantitative and qualitative studies of any design that evaluated a lower-intensity weight management intervention delivered by non-specialist workforce in women up to 5 years post-natal, and where intervention effectiveness (weight-related and/or behavioural outcomes), implementation and/or acceptability were reported. PRISMA guidelines were followed, and the review was prospectively registered on PROSPERO (CRD42022371828). Nine electronic databases were searched to identify literature published between database inception to January 2023. This was supplemented with grey literature searches and citation chaining for all included studies and related reviews (completed June 2023). Screening, data extraction and risk of bias assessments were performed in duplicate. Risk of bias was assessed using the Joanna Briggs Institute appraisal tools. Narrative methods were used to synthesise outcomes. Seven unique studies described in 11 reports were included from the Netherlands (n = 2), and the United Kingdom, Germany, Taiwan, Finland, and the United States (n = 1 each). All studies reported weight-related outcomes; four reported diet; four reported physical activity; four reported intervention implementation and process outcomes; and two reported intervention acceptability and experiences. The longest follow-up was 13-months postnatal. Interventions had mixed effects on weight-related outcomes: three studies reported greater weight reduction and/or lower postnatal weight retention in the intervention group, whereas four found no difference or mixed effects. Most studies reporting physical activity or diet outcomes showed no intervention effect, or mixed effects. Interventions were generally perceived as acceptable by women and care providers, although providers had concerns about translation into routine practice. The main limitations of the review were the limited volume of evidence available, and significant heterogeneity in interventions and outcome reporting which limited meaningful comparisons across studies. There is a need for more intervention studies, including process evaluations, with longer follow-up in the postnatal period to understand the role of primary and community care in supporting women’s weight management. Public Health Wales was the primary funder of this review

Predictors of loss to follow up among patients with type 2 diabetes mellitus attending a private not for profit urban diabetes clinic in Uganda : a descriptive retrospective study

BACKGROUND: Although the prevalence of type 2 diabetes mellitus is increasing in Uganda, data on loss to follow up (LTFU) of patients in care is scanty. We aimed to estimate proportions of patients LTFU and document associated factors among patients attending a private not for profit urban diabetes clinic in Uganda. METHODS: We conducted a descriptive retrospective study between March and May 2017. We reviewed 1818 out-patient medical records of adults diagnosed with type 2 diabetes mellitus registered between July 2003 and September 2016 at St. Francis Hospital - Nsambya Diabetes clinic in Uganda. Data was extracted on: patients' registration dates, demographics, socioeconomic status, smoking, glycaemic control, type of treatment, diabetes mellitus complications and last follow-up clinic visit. LTFU was defined as missing collecting medication for six months or more from the date of last clinic visit, excluding situations of death or referral to another clinic. We used Kaplan-Meier technique to estimate time to defaulting medical care after initial registration, log-rank test to test the significance of observed differences between groups. Cox proportional hazards regression model was used to determine predictors of patients' LTFU rates in hazard ratios (HRs). RESULTS: Between July 2003 and September 2016, one thousand eight hundred eighteen patients with type 2 diabetes mellitus were followed for 4847.1 person-years. Majority of patients were female 1066/1818 (59%) and 1317/1818 (72%) had poor glycaemic control. Over the 13 years, 1690/1818 (93%) patients were LTFU, giving a LTFU rate of 34.9 patients per 100 person-years (95%CI: 33.2-36.6). LTFU was significantly higher among males, younger patients (< 45 years), smokers, patients on dual therapy, lower socioeconomic status, and those with diabetes complications like neuropathy and nephropathy. CONCLUSION: We found high proportions of patients LTFU in this diabetes clinic which warrants intervention studies targeting the identified risk factors and strengthening follow up of patients

Urological cancer care pathways: development and use in the context of systematic reviews and clinical practice guidelines

Background: Making healthcare treatment decisions is a complex process involving a broad stakeholder base including patients, their families, health professionals, clinical practice guideline developers and funders of healthcare. Methods: This paper presents a review of a methodology for the development of urological cancer care pathways (UCAN care pathways), which reflects an appreciation of this broad stakeholder base. The methods section includes an overview of the steps in the development of the UCAN care pathways and engagement with clinical content experts and patient groups. Results: The development process is outlined, the uses of the urological cancer care pathways discussed and the implications for clinical practice highlighted. The full set of UCAN care pathways is published in this paper. These include care pathways on localised prostate cancer, locally advanced prostate cancer, metastatic prostate cancer, hormone-resistant prostate cancer, localised renal cell cancer, advanced renal cell cancer, testicular cancer, penile cancer, muscle invasive and metastatic bladder cancer and non-muscle invasive bladder cancer. Conclusion: The process provides a useful framework for improving urological cancer care through evidence synthesis, research prioritisation, stakeholder involvement and international collaboration. Although the focus of this work is urological cancers, the methodology can be applied to all aspects of urology and is transferable to other clinical specialties.11 page(s

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

Overcoming the obstacles of harvesting and searching digital repositories from federated searching toolkits, and embedding them in VLEs

This paper addresses two important needs. The first one is the need to alleviate the resource discovery task across digital repositories by subject, which includes the ability of searching heterogeneous sources that apply to a specific audience (e.g. engineering academics) or purpose (e.g. research, teaching) from one access point. The second need is to provide toolkits for federated searching which are able to be embedded in electronic learning environments used by lecturers, students and researchers. Most of these environments are institutional Virtual Learning Environments (VLEs) and Portals. Our study will show that the satisfaction of both needs faces important obstacles. On one side, standard exchange formats such as Z39.50 or OAI, developed precisely to facilitate the transfer or sharing of data between computer systems, present obstacles that make the harvesting and searching of data from digital repositories a challenging process. On the other side, VLEs are often restricted in their ability to allow the sharing and re-use of external e-learning sources discovered by federated searching toolkits. A solution for these obstacles, based on a service-oriented architecture approach, is suggested and explored on a pilot system. The aim of our research is the realisation of the concept of flexible federated searching. The intention is that the VLE user should be able to use whatever search tool he/she likes for whatever repositories he/she needs to search, without concern for how the tool and the repositories manage to communicate, or how the tool makes search results available to other VLE components. The pilot system attempts to demonstrate that most of the flexible federated searching concept can be achieved by making proper use of current interoperability standards for digital repositories and e-learning systems