Impact of violence against women on severe acute maternal morbidity in the intensive care unit, including neonatal outcomes: a case–control study protocol in a tertiary healthcare facility in Lima, Peru

Introduction Preventing and reducing violence against women (VAW) and maternal mortality are Sustainable Development Goals. Worldwide, the maternal mortality ratio has fallen about 44% in the last 25 years, and for one maternal death there are many women affected by severe acute maternal morbidity (SAMM) requiring management in the intensive care unit (ICU). These women represent the most critically ill obstetric patients of the maternal morbidity spectrum and should be studied to complement the review of maternal mortality. VAW has been associated with all-cause maternal deaths, and since many women (30%) endure violence usually exerted by their intimate partners and this abuse can be severe during pregnancy, it is important to determine whether it impacts SAMM. Thus, this study aims to investigate the impact of VAW on SAMM in the ICU. Methods and analysis This will be a prospective case-control study undertaken in a tertiary healthcare facility in Lima-Peru, with a sample size of 109 cases (obstetric patients admitted to the ICU) and 109 controls (obstetric patients not admitted to the ICU selected by systematic random sampling). Data on social determinants, medical and obstetric characteristics, VAW, pregnancy and neonatal outcome will be collected through interviews and by extracting information from the medical records using a pretested form. Main outcome will be VAW rate and neonatal mortality rate between cases and controls. VAW will be assessed by using the WHO instrument. Binary logistic followed by stepwise multivariate regression and goodness of fit test will assess any association between VAW and SAMM. Ethics and dissemination Ethical approval has been granted by the La Trobe University, Melbourne-Australia and the tertiary healthcare facility in Lima-Peru. This research follows the WHO ethical and safety recommendations for research on VAW. Findings will be presented at conferences and published in peer-reviewed journals

Frontal Gray Matter Reduction After Breast Cancer Chemotherapy and Association With Executive Symptoms: A Replication and Extension Study

poster abstractCognitive changes related to cancer and its treatment have been intensely studied, and neuroimaging has begun to demonstrate brain correlates of these changes. We recently reported structural brain changes in a prospective longitudinal cohort of breast cancer patients. Decreased gray matter density, particularly in frontal regions, was detected one month after completion of chemotherapy and partially recovered over the next year. These findings helped confirm a neural basis for the cognitive symptoms reported by many prior studies, which most commonly involve executive and memory processes in which the frontal lobes are a critical component of underlying neural circuitry. Here we present data from an independent, larger and more demographically diverse cohort that is more generalizable to the breast cancer population. 3.0T MP-RAGE structural MRI scans were acquired on 27 breast cancer patients treated with chemotherapy, 28 breast cancer patients not treated with chemotherapy, and 24 matched healthy controls (all participants were female). Study measures were completed at baseline (after surgery but before radiation, chemotherapy, and/or anti-estrogen treatment) and one month following the completion of chemotherapy, or yoked intervals for the non-chemotherapy and control groups. Gray matter density was examined using optimized voxel-based morphometry (VBM) methods. Results showed decreased frontal gray matter after chemotherapy, as observed in our initial cohort, which was accompanied by self-reported difficulties in executive functioning. These findings provide confirmatory evidence of frontal morphometric changes that may be a pathophysiological basis for cancer and treatment-related cognitive dysfunction. Ongoing research into individual risk factors for such changes will be critical for development of treatment and prevention strategies

Chemotherapy-induced amenorrhea: a prospective study of brain activation changes and neurocognitive correlates

Chemotherapy-induced amenorrhea (CIA) often occurs in pre- and peri-menopausal BC patients, and while cancer/chemotherapy and abrupt estrogen loss have separately been shown to affect cognition and brain function, studies of the cognitive effects of CIA are equivocal, and its effects on brain function are unknown. Functional MRI (fMRI) during a working memory task was used to prospectively assess the pattern of brain activation and deactivation prior to and one month after chemotherapy in BC patients who experienced CIA (n=9), post-menopausal BC patients undergoing chemotherapy (n=9), and pre- and post-menopausal healthy controls (n=6 each). Neurocognitive testing was also performed at both time points. Repeated measures general linear models were used to assess statistical significance, and age was a covariate in all analyses. We observed a group-by-time interaction in the combined magnitudes of brain activation and deactivation (p = 0.006): the CIA group increased in magnitude from baseline to post-treatment while other groups maintained similar levels over time. Further, the change in brain activity magnitude in CIA was strongly correlated with change in processing speed neurocognitive testing score (r=0.837 p=0.005), suggesting this increase in brain activity reflects effective cognitive compensation. Our results demonstrate prospectively that the pattern of change in brain activity from pre- to post-chemotherapy varies according to pre-treatment menopausal status. Cognitive correlates add to the potential clinical significance of these findings. These findings have implications for risk appraisal and development of prevention or treatment strategies for cognitive changes in CIA

Novel Approach to Mass Tort Class Actions: The Billion Dollar Settlement in the Sulzer Artificial Hip and Knee Litigation: A Symposium

This is a transcript of a two hour symposium which deals with the Sulzer knee and hip replacement class action. A copy of the settlement is included as an appendix. The settlement in the U.S. District Court for the N.D. Ohio was unique and creative approach to resolving a mass tort class action. In a novel move, Sulzer agreed to open its books to an independent review firm to determine how much the firm could pay without going bankrupt. The number was $1 billion. As negotiated by the parties and approved by the court, the final settlement provides compensation for each member of the class based on a variety of factors, such as whether the member has undergone - or is likely to undergo - a revision to replace the defective part. Professor Susan Becker made the introductory remarks. The panel members were all involved in the Sulzer knee and hip replacement class action. R. Eric Kennedy served as lead plaintiffs\u27 counsel. The Honorable Kathleen McDonald O\u27Malley of the U.S. District Court for the Northern District of Ohio presided over the Sulzer class action litigation and settlement. Sidney A. Backstrom and Richard F. Scruggs were the defense counsel. James J. McMonagle served as the Claims Administrator overseeing distribution of the Sulzer class action settlement funds

Novel Approach to Mass Tort Class Actions: The Billion Dollar Settlement in the Sulzer Artificial Hip and Knee Litigation: A Symposium

This is a transcript of a two hour symposium which deals with the Sulzer knee and hip replacement class action. A copy of the settlement is included as an appendix. The settlement in the U.S. District Court for the N.D. Ohio was unique and creative approach to resolving a mass tort class action. In a novel move, Sulzer agreed to open its books to an independent review firm to determine how much the firm could pay without going bankrupt. The number was $1 billion. As negotiated by the parties and approved by the court, the final settlement provides compensation for each member of the class based on a variety of factors, such as whether the member has undergone - or is likely to undergo - a revision to replace the defective part. Professor Susan Becker made the introductory remarks. The panel members were all involved in the Sulzer knee and hip replacement class action. R. Eric Kennedy served as lead plaintiffs\u27 counsel. The Honorable Kathleen McDonald O\u27Malley of the U.S. District Court for the Northern District of Ohio presided over the Sulzer class action litigation and settlement. Sidney A. Backstrom and Richard F. Scruggs were the defense counsel. James J. McMonagle served as the Claims Administrator overseeing distribution of the Sulzer class action settlement funds

Teaching with Feminist Judgments: A Global Conversation

This conversational-style essay is an exchange among fourteen professors—representing thirteen universities across five countries—with experience teaching with feminist judgments. Feminist judgments are ‘shadow’ court decisions rewritten from a feminist perspective, using only the precedent in effect and the facts known at the time of the original decision. Scholars in Canada, England, the U.S., Australia, New Zealand, Scotland, Ireland, India, and Mexico have published (or are currently producing) written collections of feminist judgments that demonstrate how feminist perspectives could have changed the legal reasoning or outcome (or both) in important legal cases. This essay begins to explore the vast pedagogical potential of feminist judgments. The contributors to this conversation describe how they use feminist judgments in the classroom; how students have responded to the judgments; how the professors achieve specific learning objectives through teaching with feminist judgments; and how working with feminist judgments—whether studying them, writing them, or both—can help students excavate the multiple social, political, economic, and even personal factors that influence the development of legal rules, structures, and institutions. The primary takeaway of the essay is that feminist judgments are a uniquely enriching pedagogical tool that can broaden the learning experience. Feminist judgments invite future lawyers, and indeed any reader, to re-imagine what the law is, what the law can be, and how to make the law more responsive to the needs of all people

Poor outcomes in patients with sepsis undergoing emergency laparotomy and laparoscopy are attenuated by faster time to care measures

ACKNOWLEDGEMENTS NE received the University of Aberdeen Innes Will Endowed Research Scholarship 2022 to carry out the research. FUNDING INFORMATION The Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) is a Scottish Government initiative supported via the Modernising Patient Pathways Programme (MPPP).Peer reviewedPublisher PD

Using contractual incentives in district nursing in the English NHS: results from a qualitative study

© 2018 The author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Since 2008, health policy in England has been focusing increasingly on improving quality in healthcare services. To ensure quality improvements in community nursing, providers are required to meet several quality targets, including an incentive scheme known as Commissioning for Quality and Innovation (CQUIN). This paper reports on a study of how financial incentives are used in district nursing, an area of care which is particularly difficult to measure and monitor