Exploring Pyroelectricity, Thermal and Photochemical Switching in a Hybrid Organic-Inorganic Crystal by In Situ X-Ray Diffraction.

The switching behavior of the novel hybrid material (FA)Na[Fe(CN)5(NO)].H2O (1) in response to temperature (T), light irradiation and electric field (E) is studied using in situ X-ray diffraction (XRD). Crystals of 1 display piezoelectricity, pyroelectricity, second and third harmonic generation. XRD shows that the FA+ are disordered at room-temperature, but stepwise cooling from 273-100 K induces gradual ordering, while cooling under an applied field (E=+40 kVcm-1) induces a sudden phase change at 140 K. Structural-dynamics calculations suggest the field pushes the system into a region of the structural potential-energy surface that is otherwise inaccessible, demonstrating that application of T and E offers an effective route to manipulating the crystal chemistry of these materials. Photocrystallography also reveals photoinduced linkage isomerism, which coexists with but is not correlated to other switching behaviors. These experiments highlight a new approach to in situ studies of hybrid materials, providing insight into the structure-property relationships that underpin their functionality.

Characterization of an unanticipated indium-sulfur metallocycle complex.

We have produced a novel indium-based metallocycle complex (In-MeSH), which we initially observed as an unanticipated side-product in metal-organic framework (MOF) syntheses. The serendipitously synthesized metallocycle forms via the acid-catalysed decomposition of dimethyl sulfoxide (DMSO) during solvothermal reactions in the presence of indium nitrate, dimethylformamide and nitric acid. A search through the Cambridge Structural Database revealed isostructural zinc, ruthenium and palladium metallocycle complexes formed by other routes. The ruthenium analogue is catalytically active and the In-MeSH structure similarly displays accessible open metal sites around the outside of the ring. Furthermore, this study also gives access to the relatively uncommon oxidation state of In(II), the targeted synthesis of which can be challenging. In(II) complexes have been reported as having potentially important applications in areas such as catalytic water splitting.

Light scattering in a three-phase photosensitive system via Monte Carlo approach.

Digital light processing (DLP)-based additive manufacturing has emerged as a powerful technique for fabricating structures from filled resin systems, in which the light scattering behavior is critical to the dimensional fidelity of the cured part. Recently created low density filled resins that incorporate hollow microspheres introduce a third optically active phase, producing yet more complex scattering and cure behaviours that existing empirical relationships cannot predict. This study simulates light scattering in these systems via Mie theory and a novel Monte Carlo model, providing insight into the relationship between filler volume fraction and cured dimensions, and proposes an inversion parameter for predicting film dimensions. Cured resin geometry dimensions such as cured depth (CD) and cured width (CW) are predicted using the developed model for 10, 30, and 50 vol% hollow glass microsphere filled resin systems. In contrast to standard two-phase models, our three-phase model predicts a positive relationship between cured depths and half-widths and the filler volume fraction, consistent with experimental data. By elucidating the intricacies of light scattering in three-phase systems, this work provides valuable insights for advancing DLP-based additive manufacturing and designing filled resin formulations to achieve the desired cured dimensions.

Influencing factors on women's attitudes toward hormone therapy acceptance for menopause treatment: a systematic review.

IMPORTANCE: There is a paucity of data on recent attitudes and perceptions toward hormone therapy use, especially subsequent reanalysis and follow-up of Women's Health Initiative data. OBJECTIVE: The aim of this systematic review was to assess the factors influencing women's attitudes and perceptions toward hormone therapy use for menopausal symptoms. EVIDENCE REVIEW: We conducted a comprehensive search of several medical databases including PubMed, Web of Science, Google Scholar, and Scopus. Quality assessment was performed using the Strengthening the Reporting of Observational Studies in Epidemiology Statement for cross-sectional studies. A search was conducted for cross-sectional articles published from January 2012 to March 2023 in English medical databases (PubMed, Web of Science, Scopus, and Google Scholar). Search keywords included "hormone therapy," "acceptance," "menopause," "attitudes," "influence," "factor," "estrogen," "perimenopause," "postmenopause," and "climacteric." Studies evaluating factors that influenced women's attitudes toward hormone therapy were identified. FINDINGS: A total of 1,280 articles were initially identified. Twenty-one articles were ultimately included in the review after screening studies based on inclusion and exclusion criteria. The studies were conducted between 2012 and 2023 and included a total of 40,226 participants. The most common positive factor included awareness of the existence and efficacy of hormone therapy. The most common negative factors included concern for general adverse effects and negative perception of hormone therapy from family and friends. The factors assessed in this review on women's attitudes toward hormone therapy acceptance for menopause treatment were categorized into three main themes: (1) demographic factors, (2) environmental/contextual factors, and (3) health care-related factors. CONCLUSIONS AND RELEVANCE: Hormone therapy can be a safe and effective tool to improve the quality of life in perimenopausal and postmenopausal women with vasomotor and genitourinary symptoms. However, there are many complex factors that shape women's perceptions of the efficacy, safety, and accessibility of hormone therapy. Healthcare providers should seek to understand these factors to better discuss the benefits and risks with women and assist with decision making based on cultural, personal, and environmental factors.

Telehealth Utilization in High-Risk Pregnancies During COVID-19.

Purpose: To determine how telehealth has influenced outcomes in high-risk obstetrics patients during the Coronavirus disease 2019 (COVID-19) pandemic. Methods: A retrospective chart review was conducted to identify patterns in both telehealth and in-person clinic visits among patients of a Maternal Fetal Medicine (MFM) department from the onset of the COVID-19 pandemic from March 2020 until October 2021. For the descriptive analysis, p-values were calculated using Wilcoxon rank sum for continuous variables and chi-square or Fisher exact (where cell n < 5) for categorical variables. Variables of interest were then tested for their univariate association with telehealth utilization using logistic regression. Variables found to meet the criterion of p < 0.2 in the univariate case were introduced into a multivariable logistic model with a backward elimination for determining variable retention. We aimed to analyze whether telehealth visits significantly impacted pregnancy outcomes. Results: Four hundred nineteen high-risk patients visited the clinic via in-person and/or telehealth appointments during the study period: 320 patients without telehealth visits and 99 patients with telehealth visits. Care provided by telehealth visits was not found to be related to self-reported race (p = 0.81), maternal body mass index (p = 1.0), or maternal age (p = 0.53). Patients with private insurance were more likely to have telehealth visits than patients with public insurance (79.9% vs. 65.5%, p < 0.01). In univariate logistic analyses, patients with diagnoses of anxiety (p < 0.01), asthma (p = 0.03), and depression (p < 0.01), at the time care was established, were more likely to have telehealth visits. Those patients with telehealth visits did not have any statistical differences in mode of delivery (p = 0.2) or pregnancy outcomes (p = 0.12), including fetal demise, preterm delivery, or delivery at term as compared with patients with all in-office visits. In multivariable analysis, patient conditions of anxiety (p < 0.01), maternal obesity (p < 0.01), and twin pregnancy (p = 0.04) were associated with higher rates of telehealth visits. Conclusion: Patients with certain pregnancy complications elected to have more telehealth visits. Patients with private insurance were more likely to have telehealth visits than patients with public insurance. There are benefits for patients with certain pregnancy complications to incorporate telehealth visits in addition to regularly scheduled in-person clinic visits and may be suitable in a post-pandemic setting as well. Further research in this field is needed to better understand the impact of implementing telehealth in high-risk obstetrics patients.

Tailoring recommendation algorithms to ideal preferences makes users better off.

People often struggle to do what they ideally want because of a conflict between their actual and ideal preferences. ​​​By focusing on maximizing engagement, recommendation algorithms appear to be exacerbating this struggle. However, this need not be the case. Here we show that tailoring recommendation algorithms to ideal (vs. actual) preferences would provide meaningful benefits to both users and companies. To examine this, we built algorithmic recommendation systems that generated real-time, personalized recommendations tailored to either a person's actual or ideal preferences. Then, in a high-powered, pre-registered experiment (n = 6488), we measured the effects of these recommendation algorithms. We found that targeting ideal rather than actual preferences resulted in somewhat fewer clicks, but it also increased the extent to which people felt better off and that their time was well spent. Moreover, of note to companies, targeting ideal preferences increased users' willingness to pay for the service, the extent to which they felt the company had their best interest at heart, and their likelihood of using the service again. Our results suggest that users and companies would be better off if recommendation algorithms learned what each person was striving for and nudged individuals toward their own unique ideals.

A Systematic Review of Minimally Invasive Approaches to Uterine Fibroid Treatment for Improving Quality of Life and Fibroid-Associated Symptoms.

Improvement in symptom severity and quality of life (QoL) are critical concerns for women with fibroids as they evaluate treatment options. This systematic review analyzed available evidence regarding minimally invasive approaches to fibroid treatment and compared validated QoL and fibroid-associated symptom scores before and after treatment. A comprehensive search was conducted using PubMed, Embase, Cochrane Library, and Scopus from January 1990 to July 2020. English-language publications were included if they evaluated associations between minimally invasive approaches to fibroid treatment and QoL or fibroid-associated symptoms, and they used validated questionnaires before and after treatment. QoL or fibroid-associated symptom scores were compared and summarized for each minimally invasive approach. Thirty-seven studies were ultimately included in this review: 26 evaluating individual approaches and 11 which were comparative studies of minimally invasive approaches and surgical interventions. Radiofrequency ablation (RFA) and ultrasound-guided sclerotherapy (USGS) significantly improved overall QoL. Uterine artery embolization (UAE) and ultrasound-guided high-intensity frequency ultrasound (US-HIFU) improved overall QoL to a similar extent as surgical interventions. Twenty-eight studies assessed fibroid-associated symptoms with the Uterine Fibroid Symptoms Quality of Life Questionnaire (UFS-QoL). UAE, magnetic resonance imaging-guided high-intensity frequency ultrasound (MR-HIFU), US-HIFU, RFA, and percutaneous microwave ablation (PMWA) significantly decreased Symptom Severity Score by a range of 21 to 39 points (out of 100) at 6 months. Minimally invasive approaches to treat fibroids were effective alternatives to surgical interventions for improving quality of life, fibroid-associated symptoms, and pain. Outcomes among minimally invasive approaches were similar, presenting patients with numerous options for fibroid treatment.

Nernst-Planck-Gaussian modelling of electrodiffusional recovery from ephaptic excitation between mammalian cardiomyocytes.

Introduction: In addition to gap junction conduction, recent reports implicate possible ephaptic coupling contributions to action potential (AP) propagation between successive adjacent cardiomyocytes. Here, AP generation in an active cell, withdraws Na+ from, creating a negative potential within, ephaptic spaces between the participating membranes, activating the initially quiescent neighbouring cardiomyocyte. However, sustainable ephaptic transmission requires subsequent complete recovery of the ephaptic charge difference. We explore physical contributions of passive electrodiffusive ion exchange with the remaining extracellular space to this recovery for the first time. Materials and Methods: Computational, finite element, analysis examined limiting, temporal and spatial, ephaptic [Na+], [Cl-], and the consequent Gaussian charge differences and membrane potential recovery patterns following a ΔV∼130 mV AP upstroke at physiological (37°C) temperatures. This incorporated Nernst-Planck formalisms into equations for the time-dependent spatial concentration gradient profiles. Results: Mammalian atrial, ventricular and purkinje cardiomyocyte ephaptic junctions were modelled by closely apposed circularly symmetric membranes, specific capacitance 1 µF cm-2, experimentally reported radii a = 8,000, 12,000 and 40,000 nm respectively and ephaptic axial distance w = 20 nm. This enclosed an ephaptic space containing principal ions initially at normal extracellular [Na+] = 153.1 mM and [Cl-] = 145.8 mM, respective diffusion coefficients D Na = 1.3 × 109 and D Cl = 2 × 109 nm2s-1. Stable, concordant computational solutions were confirmed exploring ≤1,600 nm mesh sizes and Δt≤0.08 ms stepsize intervals. The corresponding membrane voltage profile changes across the initially quiescent membrane were obtainable from computed, graphically represented a and w-dependent ionic concentration differences adapting Gauss's flux theorem. Further simulations explored biological variations in ephaptic dimensions, membrane anatomy, and diffusion restrictions within the ephaptic space. Atrial, ventricular and Purkinje cardiomyocytes gave 40, 180 and 2000 ms 99.9% recovery times, with 720 or 360 ms high limits from doubling ventricular radius or halving diffusion coefficient. Varying a, and D Na and D Cl markedly affected recovery time-courses with logarithmic and double-logarithmic relationships, Varying w exerted minimal effects. Conclusion: We thereby characterise the properties of, and through comparing atrial, ventricular and purkinje recovery times with interspecies in vivo background cardiac cycle duration data, (blue whale ∼2000, human∼90, Etruscan shrew, ∼40 ms) can determine physical limits to, electrodiffusive contributions to ephaptic recovery.

Racial disparities in menopausal hormone therapy acceptance: a pilot study.

OBJECTIVE: Previous studies provide little data on the role of race in acceptance and utilization of hormone therapy. Our primary objective was to examine differences in hormone therapy acceptance between self-reported racial groups, whereas our secondary objective was to assess patient comorbidities and reported symptom frequency at presentation in these cohorts in a menopause-focused care clinic. METHODS: We conducted a retrospective medical record review of patients presenting to a menopause clinic at an urban university-affiliated academic medical center in the Midsouth between July 2018 and July 2021. Statistical analysis was performed with Student t tests and odds ratios and P values ≤ 0.05 were considered statistically significant. During the 3-year study period, 113 patients presented with menopausal symptoms and were included in the study. RESULTS: The cohort's self-reported racial composition was 51% Black (58 patients), and 42% White (47), and 7% unknown/declined to answer (8). Of the 42 patients who presented to the clinic with a primary complaint of vasomotor symptoms, 55% (23 patients) accepted lifestyle modification therapy, and 45% (19 patients) accepted hormone therapy. Of 34 patients who presented with a primary complaint of vaginal dryness, 85% (29 patients) accepted the recommendation of moisturizers or lubricants, whereas only 15% (5) accepted vaginal hormone therapy. Of patients with vasomotor symptoms, 10 (25%) were excluded from eligibility for systemic hormone therapy due to medical comorbidities. Thirty-seven individuals were eligible for systemic hormone therapy; 18 (49%) White patients accepted hormone therapy; however, only 9 (24%) Black patients accepted with similar clinical criteria ( P = 0.01). Black patients were 24% less likely to accept hormones for menopausal symptom management. The odds ratio was 0.24 (95% confidence interval, 0.09-0.64). CONCLUSIONS: Our pilot study suggests a racial disparity in acceptance of both systemic and local hormonal therapy among perimenopausal and postmenopausal patients. The presence of racial disparity in acceptance of these treatment modalities can inform clinicians about patient factors affecting treatment choice for menopausal symptoms and opportunities to explore racial differences in quality of care.

Intergenerational gestational surrogacy in a patient with ovarian dysgerminocarcinoma.

A 20-year-old woman was diagnosed with an ovarian dysgerminoma on the right ovary and underwent fertility-preserving right salpingo-oophorectomy and staging. Eight months later she was found to have a left ovarian solid mass. She underwent controlled ovarian hyperstimulation and oocyte cryopreservation before total abdominal hysterectomy, left salpingo-oophorectomy, and exploratory surgery were performed. The patient was optimally debulked, with no recurrent cancer to date. Thirty-six oocytes were mature and cryopreserved using vitrification. Now, the patient's mother has undergone embryo transfer that resulted in a clinical pregnancy, acting as a gestational carrier, for her daughter. To our knowledge, this is the first case describing the uterine transfer of embryos into a gestational carrier where the embryos were generated using oocytes obtained through controlled ovarian hyperstimulation in the context of active ovarian cancer. In the appropriate clinical setting, women desiring future fertility with a diagnosis of ovarian cancer without the option of ovarian-sparing surgery may be candidates for controlled ovarian hyperstimulation for the purposes of fertility preservation, especially if altruistic gestational carriers are available and willing.

Healthcare provider knowledge, attitudes, and preferences in management of genitourinary syndrome of menopause in the Mid-South.

OBJECTIVE: This study explored the clinical management practices of healthcare providers who treat menopausal women in an urban Mid-South area. The study specifically examined their knowledge of prescribing and counseling related to the care of women who present with complaints or clinical findings of genitourinary syndrome of menopause. METHODS: An electronic questionnaire was distributed to healthcare providers involved in the care of women undergoing menopausal transition spanning a variety of medical specialties. The questionnaire was distributed to academic program directors, coordinators, and ListServ administrators to forward to targeted respondents. Items included demographic questions, clinical knowledge, management practices, and preferences. Statistical analysis for associations between demographics was performed using Chi-squared tests and between age groups with Kruskal Wallis tests. RESULTS: The final sample contained 106 healthcare providers. Respondents were demographically diverse and encompassed multiple levels of professional training including Attendings, Trainees (Residents and Fellows), as well as Advanced Practice Registered Nurses. Significant differences were noted in many areas examined in our questionnaire, comprising knowledge, management, counseling, and prescribing practices surrounding the treatment of genitourinary syndrome of menopause when accounting for training level, specialty, and years in practice. Among all respondents, 10.4% reported rarely or never discussing menopausal symptoms with their patients. Most respondents (76.4%) stated they had prescribed topical therapies for genitourinary syndrome of menopause, with over 90% of practitioners prescribing lubricants/moisturizers and estradiol cream; however, only 55% reported being familiar with the US Food and Drug Administration's boxed warning on low-dose vaginal estrogen. Nearly half of the respondents (49%) reported being uncomfortable counseling about the boxed warning on low-dose vaginal estrogen. CONCLUSION: This study identifies gaps in Mid-South healthcare providers' awareness of the boxed warning on low-dose vaginal estrogen as well as their comfort level in providing counseling regarding the risks, benefits, and alternatives to vaginal estrogen. Integrated practice between physicians and Advanced Practice Registered Nurses can lead to a significant benefit to patients experiencing menopause as shared experience and knowledge are shared between each group. Our survey does reveal gaps in knowledge and practice for optimal outcomes for patients experiencing genitourinary syndrome of menopause. These results will be useful in providing continuing education to providers and more effective communication, evaluation, and treatment to patients.

Early detection of velamentous cord insertion at the eighth week of gestation.

Velamentous cord insertion can be diagnosed at 8 weeks of gestation, earlier than previously reported. Fetal surveillance may be informed and prognosis may be impacted by early diagnosis once viability is reached.

Sympathetic blocks for complex regional pain syndrome: a survey of pain physicians.

BACKGROUND: Sympathetic blocks (SB) are commonly used to treat pain from complex regional pain syndrome (CRPS). However, there are currently no guidelines to assist pain physicians in determining the best practices when using and performing these procedures. METHODS: A 32-question survey was developed on how SBs are used and performed to treat CRPS. The survey was conducted online via SurveyMonkey. The responses were statistically analyzed using descriptive statistics, and comparing academic versus non-academic, and fellowship versus non-fellowship-trained physicians. RESULTS: A total of 248 pain physicians responded with a response rate of 37%. Forty-four percent of respondents schedule the first SB at the first clinic visit; 73% perform one to three consecutive blocks; over 50% will repeat the block if a patient receives at least 50% pain relief from the previous one lasting 1-7 days.Fifty-four percent of respondents perform stellate ganglion blocks (SGB) at the C6 vertebral level, 41% at C7; 53% perform lumbar sympathetic blocks (LSB) at L3 level, 39% at L2; 50% use fluoroscopy to guide SGB, 47% use ultrasound. More respondents from academic than non-academic centers use ultrasound for SGB. About 75% of respondents use a total volume of 5-10 mL for SGB and 10-20 mL for LSB. The most commonly used local anesthetic is 0.25% bupivacaine. About 50% of respondents add other medications, mostly steroids, for these blocks. CONCLUSION: Our study showed a wide variation in current practice among pain physicians in treating CRPS with SBs. There is a clear need for evidence-based guidelines on when and how to perform SBs for CRPS.

Microscopy and Cell Biology: New Methods and New Questions.

Understanding the cellular basis of human health and disease requires the spatial resolution of microscopy and the molecular-level details provided by spectroscopy. This review highlights imaging methods at the intersection of microscopy and spectroscopy with applications in cell biology. Imaging methods are divided into three broad categories: fluorescence microscopy, label-free approaches, and imaging tools that can be applied to multiple imaging modalities. Just as these imaging methods allow researchers to address new biological questions, progress in biological sciences will drive the development of new imaging methods. We highlight four topics in cell biology that illustrate the need for new imaging tools: nanoparticle-cell interactions, intracellular redox chemistry, neuroscience, and the increasing use of spheroids and organoids. Overall, our goal is to provide a brief overview of individual imaging methods and highlight recent advances in the use of microscopy for cell biology.

Advances in materials for cellular applications (Review).

The goal of this review is to highlight materials that show exciting promise for either entirely new cellular-level applications or new approaches to long-standing biological challenges. The authors start with two more established materials, graphene and carbon nanotubes, and then progress to conducting polymers, followed by an overview of the microresonators, nanowires, and spasers used as intracellular lasers. These materials provide new approaches to gene and drug delivery, cellular regeneration, mechanical sensing, imaging, and the modulation and recording of cellular activity. Of specific interest is the comparison of these materials with existing technologies, the method of cellular delivery, and the all-encompassing challenge of biocompatibility. Concluding remarks examine the extension of these materials from cellular-level experiments to in vivo applications, including the method of activation: light, electricity, and ultrasound. Overall, these materials and their associated applications illustrate the most recent advances in material-cell interactions.

Choosing an expanded carrier screening panel: comparing two panels at a single fertility centre.

RESEARCH QUESTION: What are the factors contributing to similarities and differences in carrier rates between two expanded carrier screening (ECS) panels? DESIGN: Retrospective cross-sectional study. A total of 7700 infertility patients who underwent ECS from one of two genetic testing laboratories (Panel A or Panel B) using a genotyping microarray were included in the study. Individuals presenting to the Centre between June 2013 and July 2015 underwent screening via Panel A. Those presenting between August 2015 and April 2017 underwent screening via Panel B. Self-reported ethnicity was recorded. Panel content, carrier rates for the overall study population and for comparable self-reported ethnicities, carrier couple rates, and the top 10 identified disorders were compared. RESULTS: Of 4232 individuals screened by Panel A, 1243 were identified as carriers (29.4%). Panel B identified 1503 carriers among the 3468 (43.3%) participants (P < 0.0001). Carrier couple rate also varied between panels (1.2% versus 3.1%; P = 0.0017). A total of 311 disorders covering 2746 mutations were observed across the two ECS panels, with 372 (13.5%) shared mutations. Carrier rates did not differ for the shared mutations overall and across ethnicities. Significant differences were observed when comparing unique content in the overall population (P < 2 .2 × 10-16) and across ethnicities (P < 2.2 × 10-16 to 0.0010). CONCLUSIONS: Carrier rates in the overall population and across ethnicities vary widely based on panel content, and highlight the need to expand panel content as well as incorporate preconception carrier screening coupled with genetic counselling into routine assisted reproduction practice.

Indications for and use of long-acting injectable antipsychotics: consideration from an inpatient setting.

Studies have examined the differences in sociodemographic/clinical characteristics between patients on long-acting injectable (LAI) versus oral medications. However, most studies did not focus specifically on patients for whom LAIs would clearly be indicated. We performed a chart review of patients with schizophrenia or schizoaffective disorder. Patients were categorized as having an 'indication for an LAI' or not on the basis of their adherence history. Patients for whom an LAI was indicated and prescribed on discharge were then compared with similar patients for whom an LAI was not prescribed. Of 305 charts reviewed, consisting of 279 unique patients, 27.2% were judged to have an indication for an LAI (n=76), but only 32.9% of these (n=25) were discharged on an LAI. In the multiregression model, being African American, residing in a psychiatric residence, having a previous history of an LAI trial, and being treated with a higher antipsychotic dose were predictive of LAI prescription. It is important to focus on the population who are not likely to receive an LAI, but who have such indications for treatment.

Conducting polymer nanowires for control of local protein concentration in solution.

Interfacing devices with cells and tissues requires new nanoscale tools that are both flexible and electrically active. We demonstrate the use of PEDOT:PSS conducting polymer nanowires for the local control of protein concentration in water and biological media. We use fluorescence microscopy to compare the localization of serum albumin in response to electric fields generated by narrow (760 nm) and wide (1.5 µm) nanowires. We show that proteins in deionized water can be manipulated over a surprisingly large micron length scale and that this distance is a function of nanowire diameter. In addition, white noise can be introduced during the electrochemical synthesis of the nanowire to induce branches into the nanowire allowing a single device to control multiple nanowires. An analysis of growth speed and current density suggests that branching is due to the Mullins-Sekerka instability, ultimately controlled by the roughness of the nanowire surface. These small, flexible, conductive, and biologically compatible PEDOT:PSS nanowires provide a new tool for the electrical control of biological systems.