Society for Maternal-Fetal Medicine Special Statement: Maternal-fetal medicine subspecialist survey on abortion training and service provision.

Following a collaborative workshop at the 39th Annual Pregnancy Meeting, the Society for Maternal-Fetal Medicine Reproductive Health Advisory Group identified a need to assess the attitudes of maternal-fetal medicine subspecialists about abortion services and the available resources at the local and regional levels. The purpose of this study was to identify trends in attitudes, beliefs, and behaviors of practicing maternal-fetal medicine subspecialists in the United States regarding abortion. An online survey was distributed to associate and regular members of the Society for Maternal-Fetal Medicine to assess their personal training experience, abortion practice patterns, factors that influence their decision to provide abortion care, and their responses to a series of scenarios about high-risk maternal or fetal medical conditions. Frequencies were analyzed and univariable and multivariable analyses were conducted on the survey responses. Of the 2751 members contacted, 546 Society for Maternal-Fetal Medicine members completed all (448 of 546, 82.1%) or some (98 of 546, 17.9%) of the survey. More than 80% of the respondents reported availability of abortion services in their state, 70% reported availability at their primary institution, and 44% reported provision as part of their personal medical practice. Ease of referral to family planning subspecialists or other abortion providers, institutional restrictions, and the lack of training or continuing education were identified as the most significant factors contributing to the respondents' limited scope of abortion services or lack of any abortion services offered. In the univariable analysis, exposure to formal family planning training programs, fewer years since the completion of residency, current practice setting not being religiously affiliated, and current state categorized as supportive by the Guttmacher Institute's abortion policy landscape were factors associated with abortion provision (all P values <.01). After controlling for these factors in a multivariable regression, exposure to formal family planning training programs was no longer associated with current abortion provision (P=.20; adjusted odds ratio, 1.34; 95% confidence interval, 0.85-2.10), whereas a favorable state policy environment and fewer years since the completion of residency remained associated with abortion provision. The results of this survey suggest that factors at the individual, institutional, and state levels affect the provision of abortion care by maternal-fetal medicine subspecialists. The subspecialty of maternal-fetal medicine should be active in ensuring adequate training and education to create a community of maternal-fetal medicine physicians able to provide comprehensive reproductive healthcare services.

Observations of lightning in relation to transitions in volcanic activity during the 3 June 2018 Fuego Eruption.

Satellite and ground-based remote sensing are combined to characterize lightning occurrence during the 3 June 2018 Volcán de Fuego eruption in Guatemala. The combination of the space-based Geostationary Lightning Mapper (GLM) and ground-based Earth Networks Total Lightning Network observed two distinct periods of lightning during this eruption totaling 75 unique lightning flash occurrences over five hours (57 in cloud, 18 cloud-to-ground). The first period of lightning coincided with the rapid growth of the ash cloud, while the second maxima occurred near the time of a deadly pyroclastic density current (PDC) and thunderstorm. Ninety-one percent of the lightning during the event was observed by only one of the lightning sensors, thus showing the importance of combining lightning datasets across multiple frequencies to characterize electrical activity in volcanic eruptions. GLM flashes during the event had a median total optical energy and flash length of 16 fJ, and 12 km, respectively. These median GLM flash energies and lengths observed in the volcanic plume are on the lower end of the flash spectrum because flashes observed in surrounding thunderstorms on 3 June had larger median total optical energy values (130 fJ) and longer median flash lengths (20 km). All 18 cloud-to-ground flashes were negative polarity, supportive of net negative charge within the plume. Mechanisms for the generation of the secondary lightning maxima are discussed based on the presence and potential interaction between ash plume, thunderstorm, and PDC transport during this secondary period of observed lightning.

Engaging African American Parents to Develop a Mobile Health Technology for Breastfeeding: KULEA-NET.

BACKGROUND: African Americans breastfeed less than other groups, which has implications for health throughout the life course. Little is known about mobile health technologies to support breastfeeding. RESEARCH AIMS: This study proceeded in two phases. The aim of Phase 1 was to identify ideal technological components and content of a mobile health intervention. The aim of Phase 2 was to determine the usability of a prototype, KULEA-NET, based on the Phase 1 findings. METHODS: For this mixed-methods study, we used community-based participatory research methods and user-centered technology design methods. We used open coding in NVivo 11 to organize data from focus groups and in-depth interviews, then we analyzed the data. We then developed a prototype and tested the prototype's usability with the System Usability Scale. Fifty pregnant and postpartum African Americans from the District of Columbia participated. RESULTS: Participants preferred an app with text messaging technology and identified areas for intervention: self-efficacy, parent-child attachment beliefs, social support, public breastfeeding and social desirability, and returning to work. Desired features included local resources, support person access, baby care logs, identification of public breastfeeding venues, and peer discussions. The System Usability Scale score was 73.8, which indicates above average usability. CONCLUSIONS: A mobile health technology like KULEA-NET can be used to meet the breastfeeding needs of African Americans, build social desirability, and complement traditional health care. The appeal of an African American-specific intervention is unclear. Responding to mixed feeding practices is challenging. KULEA-NET is a mobile breastfeeding intervention guided by the preferences of African American parents and offers promising usability metrics.