Using Prophylactic Antihemorrhagic Medications in Second-Trimester Surgical Abortions.

We aimed to estimate the association of prophylactic antihemorrhagic medication use during dilation and evacuation (D&E) with operative hemorrhage and estimated blood loss (EBL). Records for all pregnant patients between 14 and less than 22 weeks of gestation who had a D&E procedure from January 2012 to December 2019 were retrospectively reviewed. Prophylactic antihemorrhagic medication use was defined as receiving vasoconstrictors, uterotonics, or both before identification of hemorrhage during a D&E procedure. Overall, 147 D&E procedures were completed at a mean of 16.4 (±2.2) weeks of gestation. Prophylactic medications were used in 72.1% (n=106) of D&E procedures. Prophylactic medication use was associated with lower operative hemorrhage (21.7% vs 51.2%, P <.01) and lower EBL (336.9 mL vs 551.3 mL, P <.01).

Guilt and Burnout in Medical Students.

THEORY: Burnout is prevalent among medical students and is correlated with negative feelings, behaviors, and outcomes. Empathy is a desired trait for medical students that has been correlated with reduced burnout. The concept of guilt is closely related to concern about the well-being of others; therefore, feelings of guilt may be associated with empathy. Excessive guilt poses an increased risk for internalized distress, symptoms such as anhedonia, and may be related to burnout. The relationship between pathogenic guilt and burnout in medical students is unknown. HYPOTHESIS: We hypothesize that pathogenic guilt is present and related to both burnout and empathy in medical students. METHODS: We conducted a cross-sectional survey study of all students in one medical school. Data were collected in February 2020. The Oldenburg Burnout Inventory (OBLI), Toronto Empathy Questionnaire (TEQ), and Interpersonal Guilt Questionaire-67 (IGQ-67) were used. A modified version of IGQ-67 was used to measure four subscales of pathogenic guilt: survival guilt, separation guilt, omnipotence guilt, and self-hate guilt. Data analyses for this study including screening, evaluation of assumptions, descriptive statistics, reliabilities, one-way ANOVA, and correlation coefficients, were conducted using SPSS version 26. RESULTS: Of 300, 168 (56.0%) students participated in the study. Survival, omnipotence, and self-hate classes of pathogenic guilt were positively correlated with burnout. Empathy was correlated with two classes of pathogenic guilt: survival and omnipotence. Empathy was inversely related to burnout (disengagement). CONCLUSIONS: Pathogenic guilt may be a contributor to burnout in medical students. Guilt should be a target of prevention and treatment in burnout in medical students.Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1891544.

Single sheets of graphene for fabrication of fibers with enhanced mechanical properties.

This paper reports the fabrication and mechanical properties of macroscale graphene fibers (diameters of 10 to 100 µm with lengths upwards of 2 cm) prepared from a single sheet of single-layer graphene grown via chemical vapor deposition (CVD). The breaking strength of these graphene fibers increased with consecutive tensile test measurements on a single fiber, where fiber fragments produced from a prior test exhibited larger breaking strengths. Additionally, we observed an overall reduction of surface folds and wrinkles, and an increase in their alignment parallel to the tensile direction. We propose that a foundation of this property is the plastic deformations within the fiber that accumulate through sequential tensile testing. Through this cyclic method, our best fiber produced a strength of 2.67 GPa with a 1 mm gauge length.

Family-centered cesarean delivery: a randomized controlled trial.

BACKGROUND: Women who undergo cesarean delivery report that they are less satisfied with their child birthing experience and have a later skin-to-skin contact. Because cesarean deliveries account for nearly one-fifth of all births globally, improving the child birthing experience is imperative. One delivery technique that may improve the child birthing experience, termed the family-centered cesarean, allows the mother to view the birth of her baby and to have the baby immediately placed on her chest following delivery. OBJECTIVE: Our primary outcome was to compare satisfaction with birthing experiences between women who underwent either a family-centered or traditional cesarean delivery. Our secondary outcomes compared timing of skin-to-skin contact, and maternal and neonatal outcomes between the 2 methods of cesarean delivery. STUDY DESIGN: Pregnant women aged ≥18 years who had been admitted to Labor and Delivery with a planned cesarean delivery at 1 of 2 delivery units were prospectively enrolled. Women were randomized 1:1, but not blinded, to either the family-centered cesarean (Method 1; N=68) or traditional cesarean (Method 2; N=61). Time to skin-to-skin interactions and newborn vitals were recorded by a nurse at time of delivery. A self-administered questionnaire was provided to participants in the hospital on postpartum to obtain satisfaction with the birthing experience using a modified Likert scale, ranging from 1 (lowest) to 5 (highest). Baseline characteristics and all other variables of interest were abstracted from the electronic medical record. Baseline characteristics, maternal satisfaction, and maternal or neonatal outcomes between methods of delivery were compared using t tests and Pearson chi-squared (or Fisher exact), as appropriate. RESULTS: Between June 2016 and July 2018, women who were randomized to either Method 1 or Method 2 did not significantly differ by baseline characteristics. This study was unable to detect a difference in satisfaction (4.6 Method 1 vs 4.4 Method 2; P=.27). However, mean time to skin-to-skin contact was significantly different. Patients in Method 1 established skin-to-skin contact on average 11.2 minutes earlier than those in Method 2 (5.1 vs 16.3; P<.01). No other differences in maternal and neonatal outcomes were identified. CONCLUSION: Although our study did not find statistical differences in maternal or newborn outcomes, including maternal satisfaction, the family-centered cesarean was significantly associated with earlier skin-to-skin contact. Given the known benefits of earlier skin-to-skin contact without associated harm, women should be allowed to choose either method of cesarean delivery based on their personal preference.

Early Enteral Nutrition in Mechanically Ventilated Patients With COVID-19 Infection.

BACKGROUND: Nutrition therapy is essential in critically ill adults. Little is known about appropriate nutrition therapy in patients with severe coronavirus disease 2019 (COVID-19) infection. METHODS: This was a retrospective, observational study in adult patients with confirmed COVID-19 infection receiving mechanical ventilation. Data regarding patient demographics and nutrition therapy were collected. Patients that received enteral nutrition within 24 hours of starting mechanical ventilation were compared with patients starting enteral nutrition later. The primary outcome was inpatient length of stay. Propensity score matching was conducted to control for baseline differences in patient groups. RESULTS: One hundred fifty-five patients were included in final analysis. Patients who received enteral nutrition within 24 hours received a significantly greater daily amount of calories (17.5 vs 15.2 kcal/kg, P = .015) and protein (1.04 vs 0.85 g/kg, P = .003). There was no difference in length of stay (18.5 vs 23.5 days, P = .37). The propensity score analysis included 100 patients. Following propensity scoring, significant differences in daily calorie (17.7 [4.6] vs 15.1 [5.1] kcal/kg/d, P = .009) and protein (1.03 [0.35] vs 0.86 [0.38] g/kg/d, P = .014) provision remained. No differences in length of stay or other outcomes were noted in the propensity score analysis. CONCLUSION: Initiation of enteral nutrition within 24 hours was not associated with improved outcomes in mechanically ventilated adults with COVID-19. No harm was detected either. Future research should seek to clarify optimal timing of enteral nutrition initiation in patients with COVID-19 who require mechanical ventilation.

Laboratory Evaluation of Egg White and Milk External Biomarkers for Wasmannia auropunctata (Hymenoptera: Formicidae).

Acquisition and retention of two protein markers were tested on little fire ants, Wasmannia auropunctata Roger. Pure (100%) cow's milk and a dilution (10%) of chicken egg whites were applied to W. auropunctata directly by contact spray plus residue or indirectly via residual contact only with protein-marked plant debris. Protein-marked ants were held in plastic shoe-box-sized containers, collected at 0, 24, and 48 h after exposure to their respective marks, and then examined for the presence of the marks by a chicken egg albumin and milk casein-specific enzyme-linked immunosorbent assay. Cross-contamination rates were assessed by allowing ants marked with egg whites to interact with an equal number marked milk for 24 and 48 h, and then collected either individually or in bulk. Results indicated that the egg white biomarker was retained longer than milk and that more ants were successfully marked when the direct spray application method was employed. Cross-contamination rates were highest among bulk-collected ants and lowest among ants collected individually after 24 h. However, the rates of cross-contamination among individually collected ants increased and were similar to that of bulk-collected ants after 48 h. On the basis of our results, external protein marking may not be suitable if mass trapping is required or if the study extends beyond 24 h due to high cross-contamination rates among specimens collected in bulk and reduced marker detection rates.

A longitudinal analysis of albendazole treatment effect on neurocysticercosis cyst evolution using multistate models.

BACKGROUND: In neurocysticercosis, the larval form of the pork tapeworm Taenia solium appears to evolve through three phases-active, degenerative and sometimes calcification-before disappearance. The antihelmintic drug, albendazole, has been shown to hasten the resolution of active cysts in neurocysticercosis. Little is known about the time cysts take to progress through each phase, with or without treatment. METHODS: We reconfigured brain imaging data from patient level to cyst level for 117 patients in a randomized clinical trial of albendazole in which images were taken at baseline, 1, 6, 12 and 24 mo. Applying a multistate model, we modelled the hazard of a cyst evolving to subsequent cyst phases before the next imaging (vs no change). We examined the impact of albendazole treatment overall and by patient and cyst characteristics on the hazard. RESULTS: Albendazole accelerated the evolution from the active to degenerative phase (HR=2.7, 95% CI 1.3 to 6.5) and from the degenerative phase to disappearance (HR=1.9, 95% CI 1.1 to 3.9). Albendazole's impact was stronger for patients who were male, did not have calcified cysts at baseline and who had multiple cysts in different locations. CONCLUSIONS: This research provides a better understanding of where in the cyst trajectory albendazole has the greatest impact.

The surprisingly facile formation of Pd(i)-phosphido complexes from ortho-biphenylphosphines and palladium acetate.

The widely-used ortho-biphenylphosphine ligands SPhos and RuPhos not only undergo facile orthometallation with palladium acetate, yielding strained, four-membered dimeric palladacycles but more surprisingly, in the presence of alcoholic solvents, along with the less encumbered analogue MePhos, yield unusual dinuclear Pd(i) complexes, in which the Pd-centers are bridged by both a phosphide ligand and by the arene of a coordinated phosphine donor.

Palladium-Catalyzed Ortho-Arylation of Carbamate-Protected Estrogens.

The palladium-catalyzed ortho-arylation of diethyl carbamate-protected estrone and estriol with aryl iodides gives the 2-arylated analogues. Subsequent removal of the carbamate directing group furnishes 2-arylated estrone, estradiol, or estriol depending on the method used.

Catalyst-Switchable Regiocontrol in the Direct Arylation of Remote C-H Groups in Pyrazolo[1,5-a]pyrimidines.

The regiodivergent palladium-catalyzed C-H arylation of pyrazolo[1,5-a]pyrimidine has been achieved, wherein the switch in regioselectivity between positions C3 and C7 is under complete catalyst control. A phosphine-containing palladium catalyst promotes the direct arylation at the most acidic position (C7), whereas a phosphine-free catalyst targets the most electron-rich position (C3).

Premigration harm and depression: findings from the new immigrant survey, 2003.

Studies examining refugees from conflict areas have found that persecution in the place of origin is a risk factor for depression. No studies have looked at this association between mental health and the experience of premigration harm due to race, gender or religion in the general population of United States immigrants. The New Immigrant Survey baseline questionnaire was administered to a random sample of adults receiving legal permanent residency in the U.S. in 2003 (n = 8,573), including refugees, asylees and other immigrants. In multivariate analysis controlling for visa type, premigration harm was a predictor of general depression of borderline statistical significance [odds ratio (OR), 1.33; 95 % CI 0.98-1.80, p = 0.068] and a significant predictor of major depression with dysphoria (OR, 2.24; 95 % CI 1.48-3.38, p = 0.0001). These findings suggest that premigration harm is a risk factor for depression in the general immigrant population and not just among refugees.

Dominant-negative effect of truncated mannose 6-phosphate/insulin-like growth factor II receptor species in cancer.

Oligomerization of the mannose 6-phosphate/insulin-like growth factor II receptor (M6P/IGF2R) is important for optimal ligand binding and internalization. M6P/IGF2R is a tumor suppressor gene that exhibits loss of heterozygosity and is mutated in several cancers. We tested the potential dominant-negative effects of two cancer-associated mutations that truncate M6P/IGF2R in ectodomain repeats 9 and 14. Our hypothesis was that co-expression of the truncated receptors with the wild-type/endogenous full-length M6P/IGF2R would interfere with M6P/IGF2R function by heterodimer interference. Immunoprecipitation confirmed formation of heterodimeric complexes between full-length M6P/IGF2Rs and the truncated receptors, termed Rep9F and Rep14F. Remarkably, increasing expression of either Rep9F or Rep14F provoked decreased levels of full-length M6P/IGF2Rs in both cell lysates and plasma membranes, indicating a dominant-negative effect on receptor availability. Loss of full-length M6P/IGF2R was not due to increased proteasomal or lysosomal degradation, but instead arose from increased proteolytic cleavage of cell-surface M6P/IGF2Rs, resulting in ectodomain release, by a mechanism that was inhibited by metal ion chelators. These data suggest that M6P/IGF2R truncation mutants may contribute to the cancer phenotype by decreasing the availability of full-length M6P/IGF2Rs to perform tumor-suppressive functions such as binding/internalization of receptor ligands such as insulin-like growth factor II.

The Native Comic Book Project: native youth making comics and healthy decisions.

BACKGROUND: American Indians and Alaska Natives have traditionally used stories and drawings to positively influence the well-being of their communities. OBJECTIVES: The objective of this study was to describe the development of a curriculum that trains Native youth leaders to plan, write, and design original comic books to enhance healthy decision making. METHODS: Project staff developed the Native Comic Book Project by adapting Dr. Michael Bitz's Comic Book Project to incorporate Native comic book art, Native storytelling, and decision-making skills. After conducting five train-the-trainer sessions for Native youth, staff were invited by youth participants to implement the full curriculum as a pilot test at one tribal community site in the Pacific Northwest. Implementation was accompanied by surveys and weekly participant observations and was followed by an interactive meeting to assess youth engagement, determine project acceptability, and solicit suggestions for curriculum changes. RESULTS: Six youths aged 12 to 15 (average age = 14) participated in the Native Comic Book Project. Youth participants stated that they liked the project and gained knowledge of the harmful effects of commercial tobacco use but wanted better integration of comic book creation, decision making, and Native storytelling themes. CONCLUSION: Previous health-related comic book projects did not recruit youth as active producers of content. This curriculum shows promise as a culturally appropriate intervention to help Native youth adopt healthy decision-making skills and healthy behaviors by creating their own comic books.