Exploring perceptions of vulnerability among women facing psychosocial adversity before, during and after pregnancy:A qualitative interview-study using thematic analysis

Objective: The term ‘vulnerable’ is often used to describe women facing psychosocial adversity during pregnancy, implying a heightened risk of experiencing suboptimal pregnancy outcomes. While this label might facilitate the pathway to appropriate care, it can be perceived as stigmatizing by the women it intends to help, which could deter their interaction with healthcare services. This study explores how women facing psychosocial adversity before, during and after pregnancy perceive the concept of vulnerability and experience being labeled as such. Methods: We conducted a thematic analysis of semi-structured, in-depth interviews. Through purposive sampling targeting maximum variation, ten women of diverse backgrounds were included. Results: Three central themes emerged: defining vulnerability, embracing vulnerability and the feeling of being stigmatized. Women perceived vulnerability as an inability to adequately care for themselves or their children, necessitating additional support alongside routine antenatal care. Acceptance of the ’vulnerable’ label came when it also acknowledged their proactive efforts and strengths to improve their situation. Conversely, if discussions surrounding vulnerability failed to recognize women's agency – specifically, their personal journeys and the courage needed to seek support – the label was perceived as stigmatizing. Conclusions: Addressing vulnerability effectively in maternity care requires a nuanced, patient-centered approach, acknowledging both the challenges and strengths of women facing psychosocial adversities. Emphasizing personal narratives and their courage in seeking support can mitigate the stigmatizing effects of the ’vulnerable’ label. Integrating these narratives into maternal healthcare practices can foster deeper connections with the women involved, enhancing the overall quality of care.</p

Resilient Parameter-Invariant Control With Application to Vehicle Cruise Control

This work addresses the general problem of resilient control of unknown stochastic linear time-invariant (LTI) systems in the presence of sensor attacks. Motivated by a vehicle cruise control application, this work considers a first order system with multiple measurements, of which a bounded subset may be corrupted. A frequency-domain-designed resilient parameter-invariant controller is introduced that simultaneously minimizes the effect of corrupted sensors, while maintaining a desired closed-loop performance, invariant to unknown model parameters. Simulated results illustrate that the resilient parameter-invariant controller is capable of stabilizing unknown state disturbances and can perform state trajectory tracking

Current lifestyles in the context of future climate targets: analysis of long-term scenarios and consumer segments for residential and transport

The carbon emissions of individuals strongly depend on their lifestyle, both between and within regions. Therefore, lifestyle changes could have a significant potential for climate change mitigation. This potential is not fully explored in long-term scenarios, as the representation of behaviour change and consumer heterogeneity in these scenarios is limited. We explore the impact and feasibility of lifestyle and behaviour changes in achieving climate targets by analysing current per-capita emissions of transport and residential sectors for different regions and consumer segments within one of the regions, namely Japan. We compare these static snapshots to changes in per-capita emissions from consumption and technology changes in long-term mitigation scenarios. The analysis shows less need for reliance on technological solutions if consumption patterns become more sustainable. Furthermore, a large share of Japanese consumers is characterised by consumption patterns consistent with those in scenarios that achieve ambitious climate targets, especially regarding transport. The varied lifestyles highlight the importance of representing consumer heterogeneity in models and further analyses

(Path)ways to sustainable living: The impact of the SLIM scenarios on long-term emissions

Sustainable lifestyles and behaviour changes can be vital in climate change mitigation. Various disciplines analyse the potential for such changes – but without much interaction. Qualitative studies look into the change process (e.g. social practice theory), while quantitative studies often focus on their impact in stylised cases (e.g. energy modelling). A more holistic approach can provide insightful scenarios with diverse lifestyle changes based on informed narratives for quantifying long-term impacts. This research explores how comprehensive sustainable lifestyle scenarios, coined SLIM (Sustainable Living in Models) scenarios, could contribute to transport and residential emission reductions. By translating and quantifying lifestyle scenario narratives through engagements with advisors and policymakers, we modelled two distinct lifestyle scenarios which differ in their degree of access to structural support. In one scenario, governments, corporations and cities leverage existing values and market systems to shape citizen and consumer preferences and everyday practices. In the other scenario, people adopt ambitious sustainable lifestyle behaviours and practices through peer-to-peer interaction and digital technology. We quantified the scenarios based on motivations, contextual factors, extent, and speed of lifestyle adoptions with regional differentiation. Furthermore, we applied heterogenous adopter groups to determine the model inputs. We present the resulting pathways in per capita emissions and more detailed changes in total emissions via decomposition analyses. We conclude that regional differentiation of the scenario narratives and modelling of intra-regional differences allows accounting for equity in lifestyle changes to a certain extent. Furthermore, new technologies are more important for enabling lifestyle change in a scenario with than a scenario without strong structural support. With strong structural support, lifestyle changes reduce transport and residential emissions to a larger degree (about 39% for Global North and 27% for Global South overall in 2050 relative to a “Middle-of-the-Road” SSP2 reference scenario in 2050). Thus, lifestyle changes in larger systems change are essential for effective climate change mitigation

Antithrombotic therapy in patients undergoing TAVI: an overview of Dutch hospitals

To assess current antithrombotic treatment strategies in the Netherlands in patients undergoing transcatheter aortic valve implantation (TAVI). For every Dutch hospital performing TAVI (n = 14) an interventional cardiologist experienced in performing TAVI was interviewed concerning heparin, aspirin, thienopyridine and oral anticoagulation treatment in patients undergoing TAVI. The response rate was 100 %. In every centre, a protocol for antithrombotic treatment after TAVI was available. Aspirin was prescribed in all centres, concomitant clopidogrel was prescribed 13 of the 14 centres. Duration of concomitant clopidogrel was 3 months in over two-thirds of cases. In 2 centres, duration of concomitant clopidogrel was based upon type of prosthesis: 6 months versus 3 months for supra-annular and intra-annular prostheses, respectively. Leaning on a small basis of evidence and recommendations, the antithrombotic policy for patients undergoing TAVI is highly variable in the Netherlands. As a standardised regimen might further reduce haemorrhagic complications, large randomised clinical trials may help to establish the most appropriate approac

Bivalirudin started during emergency transport for primary PCI.

BACKGROUND: Bivalirudin, as compared with heparin and glycoprotein IIb/IIIa inhibitors, has been shown to reduce rates of bleeding and death in patients undergoing primary percutaneous coronary intervention (PCI). Whether these benefits persist in contemporary practice characterized by prehospital initiation of treatment, optional use of glycoprotein IIb/IIIa inhibitors and novel P2Y12 inhibitors, and radial-artery PCI access use is unknown. METHODS: We randomly assigned 2218 patients with ST-segment elevation myocardial infarction (STEMI) who were being transported for primary PCI to receive either bivalirudin or unfractionated or low-molecular-weight heparin with optional glycoprotein IIb/IIIa inhibitors (control group). The primary outcome at 30 days was a composite of death or major bleeding not associated with coronary-artery bypass grafting (CABG), and the principal secondary outcome was a composite of death, reinfarction, or non-CABG major bleeding. RESULTS: Bivalirudin, as compared with the control intervention, reduced the risk of the primary outcome (5.1% vs. 8.5%; relative risk, 0.60; 95% confidence interval [CI], 0.43 to 0.82; P=0.001) and the principal secondary outcome (6.6% vs. 9.2%; relative risk, 0.72; 95% CI, 0.54 to 0.96; P=0.02). Bivalirudin also reduced the risk of major bleeding (2.6% vs. 6.0%; relative risk, 0.43; 95% CI, 0.28 to 0.66; P<0.001). The risk of acute stent thrombosis was higher with bivalirudin (1.1% vs. 0.2%; relative risk, 6.11; 95% CI, 1.37 to 27.24; P=0.007). There was no significant difference in rates of death (2.9% vs. 3.1%) or reinfarction (1.7% vs. 0.9%). Results were consistent across subgroups of patients. CONCLUSIONS: Bivalirudin, started during transport for primary PCI, improved 30-day clinical outcomes with a reduction in major bleeding but with an increase in acute stent thrombosis. (Funded by the Medicines Company; EUROMAX ClinicalTrials.gov number, NCT01087723.)

Decomposition analysis of per capita emissions : a tool for assessing consumption changes and technology changes within scenarios

Recent studies show that behaviour changes can provide an essential contribution to achieving the Paris climate targets. Existing climate change mitigation scenarios primarily focus on technological change and underrepresent the possible contribution of behaviour change. This paper presents and applies a methodology to decompose the factors contributing to changes in per capita emissions in scenarios. With this approach, we determine the relative contribution to total emissions from changes in activity, the way activities are carried out, the intensity of activities, as well as fuel choice. The decomposition tool breaks down per capita emissions loosely following the Kaya Identity, allowing a comparison between the contributions of technology and consumption changes among regions and between various scenarios. We illustrate the use of the tool by applying it to three previously-published scenarios; a baseline scenario, a scenario with a selection of behaviour changes, and a 2 degrees C scenario with the same selection of behaviour changes. Within these scenarios, we explore the contribution of technology and consumption changes to total emission changes in the transport and residential sector, for a selection of both developed and developing regions. In doing so, the tool helps identify where specifically (i.e. via consumption or technology factors) different measures play a role in mitigating emissions and expose opportunities for improved representation of behaviour changes in integrated assessment models. This research shows the value of the decomposition tool and how the approach could be flexibly replicated for different global models based on available variables and aims. The application of the tool to previously-published scenarios shows substantial differences in consumption and technology changes from CO2 price and behaviour changes, in transport and residential per capita emissions and between developing and developed regions. Furthermore, the tool's application can highlight opportunities for future scenario development of a more nuanced and heterogeneous representation of behaviour and lifestyle changes in global models.Peer reviewe

Loss of Endothelial Glycocalyx During Normothermic Machine Perfusion of Porcine Kidneys Irrespective of Pressure and Hematocrit

BACKGROUND: Normothermic machine perfusion (NMP) is a promising modality for marginal donor kidneys. However, little is known about the effects of NMP on causing endothelial glycocalyx (eGC) injury. This study aims to evaluate the effects of NMP on eGC injury in marginal donor kidneys and whether this is affected by perfusion pressures and hematocrits.METHODS: Porcine slaughterhouse kidneys (n = 6/group) underwent 35 min of warm ischemia. Thereafter, the kidneys were preserved with oxygenated hypothermic machine perfusion for 3 h. Subsequently, 4 h of NMP was applied using pressure-controlled perfusion with an autologous blood-based solution containing either 12%, 24%, or 36% hematocrit. Pressures of 55, 75, and 95 mm Hg were applied in the 24% group. Perfusate, urine, and biopsy samples were collected to determine both injury and functional parameters.RESULTS: During NMP, hyaluronan levels in the perfusate increased significantly ( P &lt; 0.0001). In addition, the positivity of glyco-stained glycocalyx decreased significantly over time, both in the glomeruli ( P = 0.024) and peritubular capillaries ( P = 0.003). The number of endothelial cells did not change during NMP ( P = 0.157), whereas glomerular endothelial expression of vascular endothelial growth factor receptor-2 decreased significantly ( P &lt; 0.001). Microthrombi formation was significantly increased after NMP. The use of different pressures and hematocrits did not affect functional parameters during perfusion. CONCLUSIONS: NMP is accompanied with eGC and vascular endothelial growth factor receptor-2 loss, without significant loss of endothelial cells. eGC loss was not affected by the different pressures and hematocrits used. It remains unclear whether endothelial injury during NMP has harmful consequences for the transplanted kidney.</p