Readiness to Implement a Doula-Hospital Partnership Program.

OBJECTIVE: To assess obstetric clinicians' and leaders' baseline knowledge, attitudes, and experience with doulas and their readiness to implement a novel doula-hospital partnership program. DESIGN: Survey of obstetric clinicians and leaders before implementation of the doula program. SETTING/LOCAL PROBLEM: Academic medical center in Western Massachusetts that was preparing to pilot a doula-hospital partnership program with Black doulas for Black women to address racial disparities in maternal morbidity and mortality. PARTICIPANTS: Obstetric clinicians and leaders (N = 48). INTERVENTION/MEASUREMENTS: We used established questions from the Organizational Readiness for Implementing Change (ORIC) scale and original questions to assess participants' knowledge, attitudes, and experiences with doulas and their readiness to implement the planned doula program. We distributed the questionnaire to 103 potential respondents. We conducted descriptive and bivariate analyses and analyzed open-ended responses using content analysis. RESULTS: Forty-eight participants responded to the survey. Of those who provided intrapartum care (n = 45), all were familiar with doula roles. Respondents who reported having experience working with a doula, 47.3% (n = 18/38) had at least one prior negative experience with a doula and 76.3% (n = 29/38) reported positive experiences with doulas. However, there was a mean score of 12.62 on the attitude toward doulas (scale range: 3-15). The mean score on the ORIC change commitment subscale was 20.65 (range: 15-25) and on the ORIC change efficacy subscale, mean score was 29.31 (range: 19-35). Results did not differ by participants characteristics. CONCLUSION: Our findings suggested strong support for and readiness to implement the doula-hospital partnership program.

Comparing municipal progress in implementing temporary cycle lanes during the Covid-19 pandemic.

This study investigates whether the Covid-19 pandemic opened a policy window of opportunity for the implementation of temporary cycle lanes, and how German municipalities differed in their implementation progress. The Multiple Streams Framework is used to guide the data analysis and interpretation of the results. A survey of staff working in German municipalities is conducted. The extent to which municipal administrations progressed in the implementation of temporary cycle lanes is estimated using a Bayesian sequential logit model. Our results show that of the administrations who responded to the survey most did not consider implementing temporary cycle lanes. The Covid-19 pandemic positively affected implementation progress of temporary cycle lanes, but only the first implementation stage, which was the decision to consider implementing this type of measure. Administrations are more likely to report progress if they already had plans for and experience with implementing active transport infrastructure and were located in areas with high population density.

Lipase-Mediated Mechanoenzymatic Synthesis of Sugar Esters in Dissolved Unconventional and Neat Reaction Systems.

Mechanochemical and biocatalytic approaches in modern research are two major assets to develop greener processes. In the present study, these modular tools of sustainability are pointed toward the production of versatile and daily employed compounds such as surfactants. Toward this aim, glycolipids, a class of nonionic surfactants composed of ubiquitous and primary metabolites such as sugar and fatty acid moieties, represent a promising alternative to petroleum-derived surface-active agents. Therefore, the combination of biocatalysis with mechanochemistry aiming at glycolipid synthesis seemed a logical step that was taken in this study for the first time. The monoacylated model compound glucose-6-O-decanoate was synthesized with the help of a bead mill apparatus using two different unconventional dissolved reaction systems, namely, menthol-based hydrophobic deep eutectic solvents and 2-methyl-2-butanol, thus reaching up to 12% yield in the latter based on the conversion of vinyl decanoate, after only 90 min of reaction. In addition, a neat reaction system using an excess of vinylated fatty ester as an adjuvant allowed a 27 mM/h space-time yield. The overall significant increase in productivities, up to 6 times, compared to standard heating and shaking methods, shows the tremendous potential of mechanoenzymatic synthesis.

Learning and attention problems among children with pediatric primary hypertension.

OBJECTIVE: The objective was to determine whether children with sustained primary hypertension are at increased risk for learning disabilities (LDs), as a school-related manifestation of neurocognitive problems. METHODS: A total of 201 children 10 to 18 years of age who were referred because of elevated blood pressure (BP) were included. Patients were categorized as having or not having hypertension, on the basis of BP evaluation at the initial hypertension clinic visit and subsequent confirmation of sustained elevated BP outside the clinic setting. Parents reported whether their child had a provider-confirmed LD or attention-deficit/hyperactivity disorder (ADHD). RESULTS: A total of 101 children without hypertension and 100 children with hypertension were evaluated; 18% of the children (n = 37) had LDs. In comparison with children without hypertension, children with hypertension were significantly more likely to have LDs (18% vs 9%; P < .001), irrespective of comorbid ADHD. With adjustment for demographic variables and obesity, the odds of having LDs were elevated for subjects with hypertension, in comparison with subjects without hypertension (odds ratio: 4.1 [95% confidence interval: 1.8-9.4]). CONCLUSIONS: The rate of LDs, with or without ADHD treatment, was significantly higher for children with sustained primary hypertension, compared with children without hypertension. These findings add to the growing evidence for an association between primary hypertension and cognitive function and may inform treatment and monitoring decisions for these children who may be at risk for learning problems.

Time to resumption of driving after implantation of an automatic defibrillator (from the Dual chamber and VVI Implantable Defibrillator [DAVID] trial).

The time to resumption of driving after insertion of an implantable cardioverter-defibrillator (ICD) was evaluated in the Dual Chamber And VVI Implantable Defibrillator trial. Most patients were advised not to drive for 3 to 6 months after the ICD was implanted. Patients were surveyed at 3-, 6-, or 9-month intervals to characterize their driving habits, with 101 of 137 (73.7%), 98 of 146 (67.1%), and 79 of 135 (58.5%) responding. Of respondents, 82% recalled being told not to drive for a specified time after ICD implantation. These patients generally obeyed recommendations (association between recommended time and time of resumption, p <0.001) from medical personnel.

Comparison of perception of health status by physicians, nurses, and patients in the Dual-chamber And VVI Implantable Defibrillator (DAVID) trial.

Previous studies have shown a poor correlation between health and quality-of-life assessments by patients, physicians, and nurses. Some have argued that patients are treated impersonally in clinical trials. Because one would expect that patient care would be compromised if this were the case, we used the Dual-chamber And VVI Implantable Defibrillator (DAVID) clinical trial setting to see if these assertions truly reflect the assessments of quality of life by health care professionals. Physicians, nurses, and patients in the DAVID trial had concordant assessments of the patients' perception of health status. The findings dispel assertions that patient concerns are not reliably assessed.