Perceived stress and emotional social support among women who are denied or receive abortions in the United States: a prospective cohort study.

BackgroundExamining women's stress and social support following denial and receipt of abortion furthers understanding of the effects of unwanted childbearing and abortion on women's well-being. This study investigated perceived stress and emotional social support over time among women who were denied wanted abortions and who received abortions, and compared outcomes between the groups.MethodsThe Turnaway Study is a prospective cohort study of women who sought abortions at 30 abortion facilities across the United States, and follows women via semiannual phone interviews for five years. Participants include 956 English or Spanish speaking women aged 15 and over who sought abortions between 2008 and 2010 and whose gestation in pregnancy fit one of three groups: women who presented up to three weeks beyond a facility's gestational age limit and were denied an abortion; women presenting within two weeks below the limit who received an abortion; and women who received a first trimester abortion. The outcomes were modified versions of the Perceived Stress Scale and the Multidimensional Scale of Perceived Social Support. Longitudinal mixed effects models were used to assess differences in outcomes between study groups over 30 months.ResultsWomen denied abortions initially had higher perceived stress than women receiving abortions near gestational age limits (1.0 unit difference on 0-16 scale, P = 0.003). Women receiving first-trimester abortions initially had lower perceived stress than women receiving abortions near gestational age limits (0.6 difference, P = 0.045). By six months, all groups' levels of perceived stress were similar, and levels remained similar through 30 months. Emotional social support scores did not differ among women receiving abortions near gestational limits versus women denied abortions or women having first trimester abortions initially or over time.ConclusionsSoon after being denied abortions, women experienced higher perceived stress than women who received abortions. The study found no longer-term differences in perceived stress or emotional social support between women who received versus were denied abortions

Risk of violence from the man involved in the pregnancy after receiving or being denied an abortion.

BackgroundIntimate partner violence is common among women having abortions, with between 6% and 22% reporting recent violence from an intimate partner. Concern about violence is a reason some pregnant women decide to terminate their pregnancies. Whether risk of violence decreases after having an abortion, remains unknown.MethodsData are from the Turnaway Study, a prospective cohort study of women seeking abortions at 30 facilities across the U.S. Participants included women who: presented just prior to a facility's gestational age limit and received abortions (Near Limit Abortion Group, n = 452), presented just beyond the gestational limit and were denied abortions (Turnaways, n = 231), and received first trimester abortions (First Trimester Abortion Group, n = 273). Mixed effects logistic regression was used to assess the relationship between receiving versus being denied abortion and subsequent violence from the man involved in the pregnancy over 2.5 years.ResultsPhysical violence decreased for Near Limits (adjusted odds ratios (aOR), 0.93 per month; 95% Confidence Interval (CI) 0.90, 0.96), but not Turnaways who gave birth (P < .05 versus Near Limits). The decrease for First Trimesters was similar to Near Limits (P = .324). Psychological violence decreased for all groups (aOR, 0.97; CI 0.94, 1.00), with no differential change across groups.ConclusionsPolicies restricting abortion provision may result in more women being unable to terminate unwanted pregnancies, potentially keeping them in contact with violent partners, and putting women and their children at risk

Refining the M_BH-V_c scaling relation with HI rotation curves of water megamaser galaxies

Black hole - galaxy scaling relations provide information about the coevolution of supermassive black holes and their host galaxies. We compare the black hole mass - circular velocity (MBH - Vc) relation with the black hole mass - bulge stellar velocity dispersion (MBH - sigma) relation, to see whether the scaling relations can passively emerge from a large number of mergers, or require a physical mechanism, such as feedback from an active nucleus. We present VLA H I observations of five galaxies, including three water megamaser galaxies, to measure the circular velocity. Using twenty-two galaxies with dynamical MBH measurements and Vc measurements extending to large radius, our best-fit MBH - Vc relation, log MBH = alpha + beta log(Vc /200 km s^-1), yields alpha = 7.43+/-0.13, beta = 3.68+1.23/-1.20, and intrinsic scatter epsilon_int = 0.51+0.11/-0.09. The intrinsic scatter may well be higher than 0.51, as we take great care to ascribe conservatively large observational errors. We find comparable scatter in the MBH - sigma relations, epsilon_int = 0.48+0.10/-0.08, while pure merging scenarios would likely result in a tighter scaling with the dark halo (as traced by Vc) than baryonic (sigma) properties. Instead, feedback from the active nucleus may act on bulge scales to tighten the MBH - sigma relation with respect to the MBH - Vc relation, as observed.Comment: 27 pages, 15 figures, ApJ accepte

Advancing Learning Health Systems Through Embedded Research: The 23rd Annual Conference of the Health Care Systems Research Network

The 23rd annual conference of the Health Care Systems Research Network (HCSRN, formerly the HMO Research Network) was held in San Diego, California, March 21–23, 2017, attracting 387 attendees. As a consortium of 20 research organizations embedded in or affiliated with large health care delivery organizations, the HCSRN has held annual research conferences since 1994. The overall aim of the conferences is to bring researchers, project staff, research funders and other stakeholders together to share latest scientific findings and foster new research ideas and collaborations. The 2017 conference was hosted by the Palo Alto Medical Foundation Research Institute. Each host site takes responsibility for the content and structure of the conference, and the 2017 team introduced several new features. In particular, past conferences used concurrent sessions to present research results in different topical areas, such as chronic disease, cancer, health informatics, mental health or precision medicine. This year, concurrent sessions shifted to panel discussions about how research results were achieved, including the use of methods, partnerships and analytic approaches. The 35 panels were organized into tracks such as engagement, data and informatics, partnerships and research implementation. Scientific results from HCSRN projects were presented via 120 posters in two poster sessions. Plenary sessions included a town hall-style panel with different funding agency representatives, an opening presentation on the range of opportunities and benefits to studying health systems, and a concluding presentation on how researchers can apply design thinking in their work

Clostridium difficile infection in the United States: A national study assessing preventive practices used and perceptions of practice evidence

We surveyed 571 US hospitals about practices used to prevent Clostridium difficile infection (CDI). Most hospitals reported regularly using key CDI prevention practices, and perceived their strength of evidence as high. The largest discrepancy between regular use and perceived evidence strength occurred with antimicrobial stewardship programs.Infect. Control Hosp. Epidemiol. 2015;36(8):969–971</jats:p

Peripartum hysterectomy incidence, risk factors and clinical characteristics in Ireland

Background: The incidence of peripartum hysterectomy (PH) shows fifty-fold variation worldwide (0.2–10.5/1000 deliveries) and risk factors include advancing maternal age and parity, previous caesarean section (CS) and abnormal placentation. Objectives: In this first national study of PH in Ireland, our objectives were threefold: to describe the national trend in PH incidence over 15 years since 1999; to assess risk of PH associated with morbidly adherent placenta (MAP), placenta praevia and postpartum haemorrhage (PPH) during 2005–2013; and to describe the causes, interventions and outcomes of PH cases during 2011–2013. Study design: For the 15-year time-trend analysis, PH cases and denominator data were extracted from Ireland’s Hospital In-Patient Enquiry database. Multivariate Poisson regression analysis assessed risk of PH associated with MAP, placenta praevia and PPH. In collaboration with the 20 Irish maternity units we carried out a three-year national clinical audit of severe maternity morbidity. PH was a notifiable morbidity and the audit included detailed review of MOH cases. Results: In 1999–2013 there were 298 PH cases, a rate of 0.32/1000 deliveries. During the period 2005–2013, the PH rate was 50 times higher in deliveries involving PPH, 100 times higher with placenta praevia and 1000 times higher with MAP. During the clinical audit (2011–2013) there were 65 PH cases, a rate of 0.33/1000 deliveries, increasing with advancing age and parity. The reporting of abnormal placentation, primarily the co-occurrence of placenta praevia and MAP, was linked with previous CS. Fifty-six of the 65 cases suffered MOH, most commonly associated with placenta praevia, MAP and uterine atony. Prophylactic and therapeutic uterotonic agents were appropriately used in the majority of cases. Conclusions: The incidence of PH in Ireland has been consistently low over 15 years, averaging one case every 3000 deliveries. The recognised risk factors of MAP, placenta praevia and PPH were independently associated with PH, with MAP being by far the strongest predictor. The vast majority of PH cases in our clinical audit were associated with MOH. Some deficiencies were noted in antenatal care, in certain elements of treatment and clinical governance protocols but adherence to guidelines was generally high

Leadership and Gender: School Counselors’ Experiences of Girls’ Leadership in Secondary Schools

There has been a proliferation of girls’ leadership programs to stymie the leaking pipeline of women’s leadership and resulting gender leadership gap. School counselors are advocates and change agents in the schools and play a key role in student development and leadership programming. School counselors’ training in their counseling programs may impact their support and assessment of girls’ leadership programming. This phenomenological research utilized the open-ended questions of an online survey to understand school counselors’ experiences of girls’ leadership. The themes, (a) Formal Approach to Girls’ Leadership, (b) Informal Approach to Girls’ Leadership, (c) No Girls’ Leadership, and (d) Non-Gender Specific Approach to Girls’ Leadership were discovered. Themes are discussed and suggestions for school counselors and counselor educators are offered

Leadership and Gender: School Counselors’ Experiences of Girls’ Leadership in Secondary Schools

There has been a proliferation of girls’ leadership programs to stymie the leaking pipeline of women’s leadership and resulting gender leadership gap. School counselors are advocates and change agents in the schools and play a key role in student development and leadership programming. School counselors’ training in their counseling programs may impact their support and assessment of girls’ leadership programming. This phenomenological research utilized the open-ended questions of an online survey to understand school counselors’ experiences of girls’ leadership. The themes, (a) Formal Approach to Girls’ Leadership, (b) Informal Approach to Girls’ Leadership, (c) No Girls’ Leadership, and (d) Non-Gender Specific Approach to Girls’ Leadership were discovered. Themes are discussed and suggestions for school counselors and counselor educators are offered

The Local Nanohertz Gravitational-Wave Landscape From Supermassive Black Hole Binaries

Supermassive black hole binaries (SMBHBs) in the 10 million to 10 billion $M_\odot$ range form in galaxy mergers, and live in galactic nuclei with large and poorly constrained concentrations of gas and stars. There are currently no observations of merging SMBHBs--- it is in fact possible that they stall at their final parsec of separation and never merge. While LIGO has detected high frequency GWs, SMBHBs emit GWs in the nanohertz to millihertz band. This is inaccessible to ground-based interferometers, but possible with Pulsar Timing Arrays (PTAs). Using data from local galaxies in the 2 Micron All-Sky Survey, together with galaxy merger rates from Illustris, we find that there are on average $91\pm7$ sources emitting GWs in the PTA band, and $7\pm2$ binaries which will never merge. Local unresolved SMBHBs can contribute to GW background anisotropy at a level of $\sim20\%$, and if the GW background can be successfully isolated, GWs from at least one local SMBHB can be detected in 10 years.Comment: submitted to Nature Astronomy (reformatted for arXiv