Perinatal Telehealth: Meeting Patients Where They Are.

INTRODUCTION: Prior to the coronavirus disease 2019 (COVID-19) pandemic, studies of innovative telehealth perinatal care models showed similar clinical outcomes and perceived quality of care between groups receiving a combination of virtual video and in-person visits. However, these studies included primarily White, English-speaking participants, excluding those who were economically disenfranchised or did not speak English. The purpose of this qualitative study was to describe perinatal patients' and providers' experiences with telehealth during and after the acute phase of the COVID-19 pandemic to inform future utilization of telehealth to drive the delivery of high-quality, accessible, and equitable perinatal care to diverse communities. METHODS: This descriptive qualitative study included a purposive sample of 14 patients and 17 providers who received or provided perinatal care via telehealth in either a certified nurse-midwifery practice or the nurse-family partnership care model between March 2020 and April 2022. Maximum variation sampling offered a diverse population based on race, ethnicity, and rurality. Researchers conducted 2 rounds of semistructured interviews with a focus on understanding social and geographic context. RESULTS: Six themes were identified through inductive analysis: (1) unexpected advantages of telehealth, (2) patient empowerment, (3) providers' fear of adverse outcomes, (4) concern for equitable care, (5) strategies to enhance the telehealth experience, and (6) strategies to address access to perinatal telehealth. Patients appreciated the increased ease and reduced cost of accessing visits, which led to fewer missed appointments. Health care providers saw great opportunity in telehealth but expressed concerns about accessibility for patients with language barriers or limited resources. DISCUSSION: This study provides insight into priorities for continued telehealth utilization focused on providing equitable access to perinatal care. Rather than returning to practices from before the COVID-19 pandemic formed from longstanding routines and perceived limitations, providers are encouraged to capitalize on the rapid innovations in telehealth to build a more effective, equitable, and patient-centered approach to perinatal care.

Evaluation of nutrient assimilative capacity in waterfowl impoundments: The role of environmental stressors.

The effectiveness of wetlands in sequestering nutrients and improving water quality relies on a suite of abiotic and biotic conditions. To more fully understand the restraints on nutrient removal, especially salinity and plant cover, we created field-scale mesocosms and monitored nutrient sequestration with nutrient additions and isotopic pool dilutions over 2 years in two wetlands near the Great Salt Lake in Utah. Surprisingly, we found no differences in nutrient removal with plant removal, increased salinity, and altered ambient nutrient concentrations, suggesting functional redundancy in associated primary producers. When submerged aquatic vegetation was removed, chlorophyll α concentration (0.1-9.0 µg/L) increased while nitrogen (N) and phosphorus (P) assimilation remained the same as phytoplankton occupied the open niche space. We did find ammonium concentrations to be inversely related to nitrate assimilation-as the ammonium concentration increased, nitrate assimilation decreased, suggesting preferential uptake of ammonium. Last, in our high N and P treatment mesocosms, the nitrate dramatically declined from 43.9 mg/L to background levels (<0.1 mg/L) within 1 week, showing a high potential for N remediation in these wetlands.

Extinction of eastern Sahul megafauna coincides with sustained environmental deterioration.

Explanations for the Upper Pleistocene extinction of megafauna from Sahul (Australia and New Guinea) remain unresolved. Extinction hypotheses have advanced climate or human-driven scenarios, in spite of over three quarters of Sahul lacking reliable biogeographic or chronologic data. Here we present new megafauna from north-eastern Australia that suffered extinction sometime after 40,100 (±1700) years ago. Megafauna fossils preserved alongside leaves, seeds, pollen and insects, indicate a sclerophyllous forest with heathy understorey that was home to aquatic and terrestrial carnivorous reptiles and megaherbivores, including the world's largest kangaroo. Megafauna species diversity is greater compared to southern sites of similar age, which is contrary to expectations if extinctions followed proposed migration routes for people across Sahul. Our results do not support rapid or synchronous human-mediated continental-wide extinction, or the proposed timing of peak extinction events. Instead, megafauna extinctions coincide with regionally staggered spatio-temporal deterioration in hydroclimate coupled with sustained environmental change.

On the chronology of the Uluzzian.

The Uluzzian, one of Europe's 'transitional' technocomplexes, has gained particular significance over the past three years when the only human remains associated with it were attributed to modern humans, instead of Neanderthals as previously thought. The position of the Uluzzian at stratified sequences, always overlying late Mousterian layers and underlying early Upper Palaeolithic ones, highlights its significance in understanding the passage from the Middle to Upper Palaeolithic, as well as the replacement of Neanderthals by modern humans in southeastern Mediterranean Europe. Despite several studies investigating aspects of its lithic techno-typology, taxonomy and material culture, the Uluzzian chronology has remained extremely poorly-known, based on a handful of dubious chronometric determinations. Here we aim to elucidate the chronological aspect of the technocomplex by presenting an integrated synthesis of new radiocarbon results and a Bayesian statistical approach from four stratified Uluzzian cave sequences in Italy and Greece (Cavallo, Fumane, Castelcivita and Klissoura 1). In addition to building a reliable chronological framework for the Uluzzian, we examine its appearance, tempo-spatial spread and correlation to previous and later Palaeolithic assemblages (Mousterian, Protoaurignacian) at the relevant regions. We conclude that the Uluzzian arrived in Italy and Greece shortly before 45,000 years ago and its final stages are placed at ∼39,500 years ago, its end synchronous (if not slightly earlier) with the Campanian Ignimbrite eruption.

U-series and radiocarbon analyses of human and faunal remains from Wajak, Indonesia.

Laser ablation U-series dating results on human and faunal bone fragments from Wajak, Indonesia, indicate a minimum age of between 37.4 and 28.5 ka (thousands of years ago) for the whole assemblage. These are significantly older than previously published radiocarbon estimates on bone carbonate, which suggested a Holocene age for a human bone fragment and a late Pleistocene age for a faunal bone. The analysis of the organic components in the faunal material show severe degradation and a positive δ(13)C ratio indicate a high degree of secondary carbonatisation. This may explain why the thermal release method used for the original age assessments yielded such young ages. While the older U-series ages are not in contradiction with the morphology of the Wajak human fossils or Javanese biostratigraphy, they will require a reassessment of the evolutionary relationships of modern human remains in Southeast Asia and Oceania. It can be expected that systematic direct dating of human fossils from this area will lead to further revisions of our understanding of modern human evolution.

Low bone mineral density and nutritional vitamin D deficiency in pediatric renal transplant recipients: Assessment of risk factors and response to oral vitamin D therapy.

VitD deficiency and bone disease are common after Tx. Prevalence and risk factors for low VitD and BMD and response to VitD therapy were investigated in pediatric renal Tx recipients. 25-hydroxy VitD levels of 71 Tx were compared to 54 healthy AA children. DXA of 44 Tx were compared to 47 AA controls. Of Tx, 59% were AA. Majority (59.1%) of Tx were VitD deficient (23.9%) or insufficient (35.2%). Prevalence of low VitD levels was double in AA (73.9%) vs. non-AA Tx (37.7%), (p = 0.003). Low VitD among Tx was associated with AA ethnicity (p < 0.01), winter (p < 0.05), older age (p < 0.05), males (p < 0.05) and time <6 months post Tx (p < 0.05). Tx with low VitD were treated with oral ergocalciferol or cholecalciferol (23 each); 13% treated with ergocalciferol vs. 82.6% treated with cholecalciferol achieved repletion (p < 0.0001). Of 36 Tx with whole body DXA, 19.5% had BMD (z < -1) after height adjustment. AA Tx had 3.4-fold higher risk of low BMD vs. controls (p < 0.05). Low VitD and BMD are prevalent in children after renal Tx. Better repletion of VitD is achieved with cholecalciferol.