"They're Doing Their Job": Women's Acceptance of Emergency Department Contraception Counseling.

STUDY OBJECTIVE: We explore reproductive-aged women's acceptance of contraception counseling in the emergency department (ED). METHODS: This study is phase 1 of an exploratory sequential mixed methods study. We purposively interviewed 31 participants with the following criteria: black, white, or Latina race/ethnicity; nonpregnant; aged 15 to 44 years; receiving nonemergency care; not using highly effective contraception; and did not intend to become pregnant. We conducted semistructured interviews with a piloted interview guide until reaching thematic saturation. We coded transcripts with an iteratively developed codebook, maintaining intercoder agreement greater than 80%. Qualitative acceptance of ED contraception counseling was grouped into 3 categories: acceptable, unacceptable, and equivocal. We conducted a thematic text analysis to assess themes expressing support and concern for ED contraception counseling. Qualitative findings were stratified by age, race, and frequency of ED use. Using components of grounded theory, we developed a conceptual model. RESULTS: Most participants (81%) accepted ED contraception counseling. Themes expressing support and concern for ED contraception counseling included opportunity to address women's unmet contraception needs, contraception is within the scope of ED practice, the ED is a convenient setting with competent providers, contraception is a sensitive topic, and the ED may be an inappropriate setting for some women. Latina participants had lower acceptance of ED contraception counseling. Dominant subthemes varied slightly by race, age, and frequency of ED use. CONCLUSION: Diverse women had high acceptance of contraception counseling in the ED. Perspectives expressing both support and concern in regard to ED contraception counseling were explored in detail.

ICD-ON Registry for Perioperative Management of CIEDs: Most Require No Change.

BACKGROUND: There is significant variability in the perioperative management of patients with cardiac implanted electronic devices (CIEDs) undergoing procedures requiring electrosurgery. METHODS: We performed a multicenter registry from February 2014 to August 2015 at three suburban Chicago hospitals. Patients with transvenous CIEDs undergoing procedures requiring electrosurgery were assigned to one of three groups: (1) reprogram, (2) magnet, or (3) no change. Subjects with implantable cardioverter defibrillators (ICDs) or those pacemaker dependent having surgical procedures within 6 inches of their CIED were assigned to the reprogram group, whereby ICD therapies were programmed off with asynchronous pacing if pacemaker dependent. Subjects with ICDs ≥ 6 inches from their surgical site but above the iliac crest were assigned to the magnet group. All others were in the no change group. We evaluated electromagnetic interference (EMI) and postoperative device reset based on surgical location. RESULTS: All patients (n = 331) had pectoral CIEDs with mean age 73 years, 65% male, ejection fraction 56% for pacemaker subjects, 35% for ICD subjects with 22% pacemaker dependent. Assignments were n = 52 (16%) reprogram group, n = 51 (15%) magnet group, and n = 228 (69%) no change. There was EMI in 45% of thoracic cases, 35% of head/neck, 15% of upper extremity, and 3% of abdominal cases above iliac crest. There was no EMI in procedures below the iliac crest. There were no inappropriate therapies or device reset. CONCLUSION: Results of the ICD-ON protocol demonstrate safe and efficient management of patients with CIEDs based on electrosurgery location, with 69% requiring no reprogramming or magnet application.

Description of Thalassospira lohafexi sp. nov., isolated from Southern Ocean, Antarctica.

A gram-negative, aerobic, obligatory halophilic, curved-to-spiral rod-shaped, uni- or bi-polar flagellated motile bacterium 139Z-12(T) was isolated from water samples collected from Southern Ocean surrounding Antarctica as part of the Indo-German iron fertilization experiment "LOHAFEX." The bacterium was positive for catalase, oxidase, and gelatinase, with C18:1ω7c (20.1 %), C16:0 (7.3 %), C16:1ω7c (28.9 %), and C12:0 (19.0 %) as the predominant fatty acids, phosphatidylglycerol, and phosphatidylethanolamine as major lipids and Q-10 as the major respiratory quinone. DNA G + C content (mol%) of strain 139Z-12(T) was 53.0. Both BLAST and EzTaxon identified strain 139Z-12(T) as affiliated species of the genus Thalassospira with 16S rRNA gene sequence similarities ranging from 97.9 to 99.9 %. Based on above characteristics, strain 139Z-12(T) was assigned to the genus Thalassospira. Since strain 139Z-12(T) shared a DNA-DNA similarity of <70.0 % with members of the genus Thalassospira, 139Z-12(T) was identified as a novel species of the genus and named as Thalassospira lohafexi sp. nov. In addition to this, strain 139Z-12(T), based on REP-PCR, delineated at a similarity coefficient of <0.67 from other species of the genus Thalassospira and also exhibited a MLSA distance of <95.5 %, a value less than the interspecies distance determined previously for the genus Thalassospira, further supporting the species status. In addition, species rank was further confirmed by other polyphasic characteristics. The type strain of Thalassospira lohafexi sp. nov. is 139Z-12(T) (KCTC 32347(T) = LMG 27449(T) = MCC 2233(T) = NBRC 110402(T)).

Randomized controlled trial of perioperative ICD management: magnet application versus reprogramming.

BACKGROUND: There are insufficient data to guide perioperative implantable cardioverter-defibrillator (ICD) management for patients undergoing surgical procedures using electrocautery. METHODS: We conducted a multicenter randomized controlled trial of patients with ICDs undergoing surgery with monopolar electrocautery. Subjects were randomized to an "Off" group (ICD therapy programmed off, then postoperatively programmed on) or a "Magnet" group (ICD therapy suspended with a magnet and no immediate postoperative ICD interrogation). Also, a registry was maintained of ICD patients with procedures within 6 inches of the ICD (all programmed off). The primary endpoint was ICD off time with secondary endpoints being caregiver handoffs and incidence of electromagnetic interference (EMI). RESULTS: All patients (n = 80) had pectoral ICDs. Subject demographics were well matched in each group, and duration of electrocautery was similar (80 minutes vs 64 minutes, P = 0.58). The mean "excess" ICD off time (ICD off time - electrocautery time) was significantly higher in the Off group than the Magnet group (115 minutes vs 28 minutes, P < 0.001). Mean number of caregiver handoffs were higher in the Off group (6.6 vs 5.5, P < 0.001). There was no EMI in any lower abdominal or lower extremity procedures. Neither group had arrhythmic events or device reset. CONCLUSION: A magnet protocol simplifies perioperative ICD management for procedures using electrocautery more than 6 inches from the ICD. This protocol results in significantly shorter time with ICD therapy off, fewer provider handoffs, no risk of inadvertently discharging patients home with ICD therapies off, and no device reset.