'Only for the white'. A qualitative exploration of the lived experiences of Black, Asian and Minority Ethnic midwifery students.

BACKGROUND: An ethnically diverse workforce has been identified as a key component of safe, compassionate maternity care, and yet midwifery remains a predominantly White profession across the Global North. Understanding the experiences of Black, Asian and Minority Ethnic midwifery students is key to addressing this disparity. OBJECTIVE: To capture the university and placement experiences of Black, Asian and Minority Ethnic midwifery students in a culturally White environment. METHODS: A qualitative approach underpinned by a feminist, inductive, interpretivist paradigm informed a study undertaken with student midwives studying at three separate universities in South East England. Five virtual focus groups and two semi-structured interviews were conducted with thirteen current student midwives and one preceptee (recently graduated) midwife self-identifying as Black, Asian or Minority Ethnic. Analysis was inductive, data-driven and thematic. Standards for Reporting Qualitative Research recommendations have been used to formulate this report. FINDINGS: Although some participants reported positive experiences and felt well-supported, an overarching narrative emerged of midwifery as an exclusive and White profession. Institutionalised Whiteness was experienced in university, in placement and within individual student cohorts. Four themes were identified: 'being an outsider', 'prejudice, discrimination and racism', 'nowhere to turn' and 'positive forces'. CONCLUSIONS: Racist and discriminatory beliefs and practices in some midwifery education and placement settings negatively impact student experience and are likely to result in poorer care being provided to Global Ethnic Majority women and families. An unwillingness among some White educators and students to recognise the presence and impact of inequitable and racist environments, and a lack of clear, acceptable, and effective pathways for students to use to raise and discuss concerns, makes it difficult to challenge and change this injustice.

Choosing Midwifery - The perceptions and experiences of Black, Asian and Minority Ethnic applicants to midwifery programmes: A mixed methods study.

AIM: to explore recruitment to UK midwifery programmes from the perspective of applicants from Black, Asian and Minority Ethnic (BAME) groups and describe the perceptions and experiences of the application process for these applicants and those from white backgrounds. BACKGROUND: Midwifery in the Global North is an overwhelmingly white profession. This lack of diversity has been cited as a factor in the poorer outcomes experienced by women from non-white backgrounds. There is a need for midwifery programmes to recruit and support more ethnically and racially diverse cohorts if this situation is to be addressed. Very little is currently known about the recruitment experiences of midwifery applicants. DESIGN: A mixed methods study comprising a survey and individual interview or focus group. The study was conducted between September 2020 and March 2021 in three universities in South East England. Participants comprised 440 applicants to midwifery programmes and 13 current or recently qualified BAME midwifery students. FINDINGS: Although many survey findings in respect to choosing a midwifery programme were broadly similar between candidates from BAME and non-BAME backgrounds, some trends were noted. More BAME applicants cited school/college rather than family as encouraging. More BAME applicants also indicated that they would consider issues of diversity when selecting a place of study, and BAME respondents appeared less likely to consider location and university life. Survey and focus group findings combined may indicate deficits in social capital available to BAME midwifery applicants. Focus group findings in particular suggest multiple experiences of challenge and inequity at all stages of the application process, together with a perception that midwifery is a niche and white profession. Applicants value proactive support from universities and would appreciate increased diversity, opportunities for mentorship and an individualised approach to recruitment. CONCLUSIONS: BAME applicants to midwifery can face additional challenges which have an impact on their ability to secure a place. There is a need to reposition midwifery as an inclusive and welcoming option for people from all backgrounds and to develop equitable recruitment processes that value a range of skills and life experiences.

Circadian clock function does not require the histone methyltransferase MLL3.

The circadian clock controls the physiological function of tissues through the regulation of thousands of genes in a cell-type-specific manner. The core cellular circadian clock is a transcription-translation negative feedback loop, which can recruit epigenetic regulators to facilitate temporal control of gene expression. Histone methyltransferase, mixed lineage leukemia gene 3 (MLL3) was reported to be required for the maintenance of circadian oscillations in cultured cells. Here, we test the role of MLL3 in circadian organization in whole animals. Using mice expressing catalytically inactive MLL3, we show that MLL3 methyltransferase activity is in fact not required for circadian oscillations in vitro in a range of tissues, nor for the maintenance of circadian behavioral rhythms in vivo. In contrast to a previous report, loss of MLL3-dependent methylation did not affect the global levels of H3K4 methylation in liver, indicating substantial compensation from other methyltransferases. Furthermore, we found little evidence of genomic repositioning of H3K4me3 marks. We did, however, observe repositioning of H3K4me1 from intronic regions to intergenic regions and gene promoters; however, there were no changes in H3K4me1 mark abundance around core circadian clock genes. Output functions of the circadian clock, such as control of inflammation, were largely intact in MLL3-methyltransferase-deficient mice, although some gene-specific changes were observed, with sexually dimorphic loss of circadian regulation of specific cytokines. Taken together, these observations indicate that MLL3-directed histone methylation is not essential for core circadian clock function; however, it may influence the inflammatory response.

The Influence of Social Relationships on Men's Weight.

OBJECTIVE: To explore how men's social relationships influence their dietary, physical activity, and weight loss intentions and behaviors. DESIGN: Qualitative study using semistructured interviews. SETTING: One county in the southwest of England. PARTICIPANTS: Men (n = 19) aged 18-60 years with a body mass index ≥24 kg/m2 who were otherwise healthy. PHENOMENON OF INTEREST: Men's perceptions of dieting, physical activity and weight loss, and how social relationships influence these behaviors. ANALYSIS: Interviews were audiorecorded and transcribed verbatim. Transcripts were coded line by line using NVivo software. Themes and subthemes were inductively generated using thematic analysis. RESULTS: Four themes were derived: (1) how experiences shape beliefs, (2) being a proper bloke, (3) adapting to family life, and (4) support from outside the home. Men discussed how partners were a greater influence on diet than physical activity. Attitudes toward diet and physical activity were influenced by life events such as becoming a father. It was framed as acceptable for men to talk to their friends about exercise and food intake in general, but they emphasized that this was not for "support." CONCLUSIONS AND IMPLICATIONS: Family members were key influences on men's behaviors. Future qualitative research could include interviews with men's families. Findings may inform family weight loss interventions.

Genome-wide effect of pulmonary airway epithelial cell-specific Bmal1 deletion.

Pulmonary airway epithelial cells (AECs) form a critical interface between host and environment. We investigated the role of the circadian clock using mice bearing targeted deletion of the circadian gene brain and muscle ARNT-like 1 (Bmal1) in AECs. Pulmonary neutrophil infiltration, biomechanical function, and responses to influenza infection were all disrupted. A circadian time-series RNA sequencing study of laser-captured AECs revealed widespread disruption in genes of the core circadian clock and output pathways regulating cell metabolism (lipids and xenobiotics), extracellular matrix, and chemokine signaling, but strikingly also the gain of a novel rhythmic transcriptome in Bmal1-targeted cells. Many of the rhythmic components were replicated in primary AECs cultured in air-liquid interface, indicating significant cell autonomy for control of pulmonary circadian physiology. Finally, we found that metabolic cues dictate phasing of the pulmonary clock and circadian responses to immunologic challenges. Thus, the local circadian clock in AECs is vital in lung health by coordinating major cell processes such as metabolism and immunity.-Zhang, Z. Hunter, L., Wu, G., Maidstone, R., Mizoro, Y., Vonslow, R., Fife, M., Hopwood, T., Begley, N., Saer, B., Wang, P., Cunningham, P., Baxter, M., Durrington, H., Blaikley, J. F., Hussell, T., Rattray, M., Hogenesch, J. B., Gibbs, J., Ray, D. W., Loudon, A. S. I. Genome-wide effect of pulmonary airway epithelial cell-specific Bmal1 deletion.

Better together: A qualitative exploration of women's perceptions and experiences of group antenatal care.

PROBLEM: Childbearing women from socio-economically disadvantaged communities and minority ethnic groups are less likely to access antenatal care and experience more adverse pregnancy outcomes. BACKGROUND: Group antenatal care aims to facilitate information sharing and social support. It is associated with higher rates of attendance and improved health outcomes. AIMS: To assess the acceptability of a bespoke model of group antenatal care (Pregnancy Circles) in an inner city community in England, understand how the model affects women's experiences of pregnancy and antenatal care, and inform further development and testing of the model. METHODS: A two-stage qualitative study comprising focus groups with twenty six local women, followed by the implementation of four Pregnancy Circles attended by twenty four women, which were evaluated using observations, focus groups and semi-structured interviews with participants. Data were analysed thematically. FINDINGS: Pregnancy Circles offered an appealing alternative to standard antenatal care and functioned as an instrument of empowerment, mediated through increased learning and knowledge sharing, active participation in care and peer and professional relationship building. Multiparous women and women from diverse cultures sharing their experiences during Circle sessions was particularly valued. Participants had mixed views about including partners in the sessions. CONCLUSIONS: Group antenatal care, in the form of Pregnancy Circles, is acceptable to women and appears to enhance their experiences of pregnancy. Further work needs to be done both to test the findings in larger, quantitative studies and to find a model of care that is acceptable to women and their partners.

Developing and evaluating an online learning tool to improve midwives' accuracy of visual estimation of blood loss during waterbirth: An experimental study.

OBJECTIVE: The principal objective was to test the effectiveness of an online learning tool to improve midwives' accuracy of blood loss estimations in a birthing pool environment. The secondary objective was to assess the acceptability of the online learning tool to the midwives using it. DESIGN: A one group pre-test, post-test experiment with immediate and six weeks follow-up to test ability together with an online questionnaire to assess perceived usefulness of an online learning tool. SETTING: A large NHS maternity hospital comprising an acute care obstetric unit, a small district unit labour ward, one alongside midwifery-led unit and three freestanding midwifery-led units. PARTICIPANTS: Volunteer NHS employed midwives who had experience in caring for women labouring and giving birth in water (n = 24). INTERVENTION: An online learning tool comprising six randomly ordered short video simulations of blood loss in a birthing pool in real time, and a tutorial giving verbal and pictorial guidance on making accurate blood loss estimations in water was developed then piloted. Midwives' accuracy scores for estimating blood loss in each of the videos were calculated at three timepoints; pre and immediately post the learning component, and six weeks later. The estimated blood loss volume was subtracted from the actual blood loss volume, to give the difference between estimated and real blood loss in millilitres (ml) which was then converted to percentage difference to standardise comparison across the six volumes. The differences between pre- and post-learning for each of the six blood volumes was analysed using a repeated measures ANOVA. Statistical significance was set at p < 0.05. An online questionnaire incorporated questions using Likert scales to gauge confidence and competence and free text. Free text responses were analysed using a modified form of inductive content analysis. FINDINGS: Twenty-two midwives completed the online learning and immediate post-test, 14 completed a post-test after six weeks, and 15 responded to the online questionnaire. Pre-test results showed under-estimation of all blood loss volumes and particularly for the two largest volumes (1000 and 1100 ml). Across all volumes, accuracy of estimation was significantly improved at post-test 1. Accuracy diminished slightly, but overall improvement remained, at post-test 2. Participants rated the online tool positively and made suggestions for refining it. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This is the first study measuring the accuracy of midwives' blood loss estimations in a birthing pool using real-time simulations and testing the effectiveness of an online learning tool to improve this important skill. Our findings indicate a need to develop interventions to improve midwives' accuracy at visually estimating blood loss in water, and the potential of an online approach. Most women who labour and/or give birth in water do so in midwifery-led settings without immediate access to medical support. Accuracy in blood loss estimations is an essential core skill.

REVERBa couples the circadian clock to hepatic glucocorticoid action.

The glucocorticoid receptor (GR) is a major drug target in inflammatory disease. However, chronic glucocorticoid (GC) treatment leads to disordered energy metabolism, including increased weight gain, adiposity, and hepatosteatosis - all programs modulated by the circadian clock. We demonstrated that while antiinflammatory GC actions were maintained irrespective of dosing time, the liver was significantly more GC sensitive during the day. Temporal segregation of GC action was underpinned by a physical interaction of GR with the circadian transcription factor REVERBa and co-binding with liver-specific hepatocyte nuclear transcription factors (HNFs) on chromatin. REVERBa promoted efficient GR recruitment to chromatin during the day, acting in part by maintaining histone acetylation, with REVERBa-dependent GC responses providing segregation of carbohydrate and lipid metabolism. Importantly, deletion of Reverba inverted circadian liver GC sensitivity and protected mice from hepatosteatosis induced by chronic GC administration. Our results reveal a mechanism by which the circadian clock acts through REVERBa in liver on elements bound by HNF4A/HNF6 to direct GR action on energy metabolism.

`It makes sense and it works': Maternity care providers' perspectives on the feasibility of a group antenatal care model (Pregnancy Circles).

AIM: To test the feasibility of introducing a group antenatal care initiative (Pregnancy Circles) in an area with high levels of social deprivation and cultural diversity by exploring the views and experiences of midwives and other maternity care providers in the locality before and after the implementation of a test run of the group model. DESIGN: (i) Pre-implementation semi-structured interviews with local stakeholders. (ii) Post-implementation informal and semi-structured interviews and a reflective workshop with facilitating midwives, and semi-structured interviews with maternity managers and commissioners. Data were organised around three core themes of organisational readiness, the acceptability of the model, and its impact on midwifery practice, and analyzed thematically. SETTING: A large inner-city National Health Service Trust in the United Kingdom. PARTICIPANTS: Sixteen stakeholders were interviewed prior to, and ten after, the group model was implemented. Feedback was also obtained from a further nine midwives and one student midwife who facilitated the Pregnancy Circles. INTERVENTION: Four Pregnancy Circles in community settings. Women with pregnancies of similar gestation were brought together for antenatal care incorporating information sharing and peer support. Women undertook their own blood pressure and urine checks, and had brief individual midwifery checks in the group space. FINDINGS: Dissatisfaction with current practice fuelled organisational readiness and the intervention was both possible and acceptable in the host setting. A perceived lack of privacy in a group setting, the ramifications of devolving blood pressure and urine checks to women, and the involvement of partners in sessions were identified as sticking points. Facilitating midwives need to be adequately supported and trained in group facilitation. Midwives derived accomplishment and job satisfaction from working in this way, and considered that it empowered women and enhanced care. KEY CONCLUSIONS: Participants reported widespread dissatisfaction with current care provision. Pregnancy Circles were experienced as a safe environment in which to provide care, and one that enabled midwives to build meaningful relationships with women. IMPLICATIONS FOR PRACTICE: Pre-registration education inadequately prepared midwives for group care. Addressing sticking points and securing management support for Pregnancy Circles is vital to sustain participation in this model of care.

Being there and reconnecting: Midwives' perceptions of the impact of Mindfulness training on their practice.

OBJECTIVE: To ascertain how midwives perceived attending a mindfulness course impacted on their professional practice, particularly in regard to any stress they experienced at work. DESIGN: A qualitative study using Interpretive Phenomenological Analysis. Semi-structured interviews were conducted with nine midwives. SETTING: A large maternity Trust in the United Kingdom. INTERVENTION: An eight-week mindfulness course, adapted from mindfulness-based cognitive therapy. FINDINGS: Four superordinate themes were identified as follows: "being challenged and committing," "containing the self," "reconnecting" and "moving forward with confidence." Focusing on the present moment enabled participants better to identify the boundary between self and other. This led to an increased sense of control and a reconnection with and reframing of relationships with colleagues and the women in their care. KEY CONCLUSIONS: Mindfulness may provide an effective way to address the high levels of stress, role dissatisfaction and workplace bullying found in midwifery, by improving both the working environment and patient care. The pivotal role of positive workplace relationships in this process resonates with other nursing research and with contemporary philosophical thought. RELEVANCE TO CLINICAL PRACTICE: This study adds to a body of evidence which suggests investing in the well-being of midwifery staff improves both job satisfaction and women's experiences of care.

Real-Time Measurement of the Tool-Tissue Interaction in Minimally Invasive Abdominal Surgery: The First Step to Developing the Next Generation of Smart Laparoscopic Instruments.

Introduction Analysis of force application in laparoscopic surgery is critical to understanding the nature of the tool-tissue interaction. The aim of this study is to provide real-time data about manipulations to abdominal organs. Methods An instrumented short fenestrated grasper was used in an in vivo porcine model, measuring force at the grasper handle. Grasping force and duration over 5 small bowel manipulation tasks were analyzed. Forces required to retract gallbladder, bladder, small bowel, large bowel, and rectum were measured over 30 seconds. Four parameters were calculated-T(hold), the grasp time; T(close), time taken for the jaws to close; F(max), maximum force reached; and F(rms), root mean square force (representing the average force across the grasp time). Results Mean F(max) to manipulate the small bowel was 20.5 N (±7.2) and F(rms) was 13.7 N (±5.4). Mean T(close) was 0.52 seconds (±0.26) and T(hold) was 3.87 seconds (±1.5). In individual organs, mean F(max) was 49 N (±15) to manipulate the rectum and 59 N (±13.4) for the colon. The mean F(max) for bladder and gallbladder retraction was 28.8 N (±7.4) and 50.7 N (±3.8), respectively. All organs exhibited force relaxation, the F(rms) reduced to below 25 N for all organs except the small bowel, with a mean F(rms) of less than 10 N. Conclusion This study has commenced the process of quantifying tool-tissue interaction. The static measurements discussed here should evolve to include dynamic measurements such as shear, torque, and retraction forces, and be correlated with evidence of histological damage to tissue.

Making time and space: the impact of mindfulness training on nursing and midwifery practice. A critical interpretative synthesis.

AIMS AND OBJECTIVES: To explore qualitative literature to ascertain whether and how nurses and midwives perceive that mindfulness impacts on their practice, particularly their interactions with patients. BACKGROUND: Stress and burnout, which negatively impact patient care, are widely reported among nurses and midwives, who face unique stressors as professionals who often hold little organisational power, but are expected to shoulder the burden of resource cuts and an increasingly complex workload. Mindfulness is recommended as a tool to decrease stress and burnout in health professionals, and may also increase practitioner compassion and improve patient interactions. DESIGN: A critical interpretative synthesis. METHODS: A systematic search was undertaken to identify qualitative studies where the majority of participants were qualified nurses and/or midwives who had attended mindfulness training. Retrieved literature was read and reread to identify relevant material, which was then coded into themes. Related themes were grouped into synthetic constructs, and a synthetic argument was produced to illustrate the relationships between these. RESULTS: Five relevant papers were identified. Findings indicate that mindfulness training enables nurses and midwives to gain some control over their thoughts and stress levels. This then creates a quiet mental space giving them agency and perspective and leading to improved caring, including a more patient-centred focus and increased presence and listening. Mindfulness appears to alter the way nurses and midwives operate within a stressful work environment, thereby changing the way the environment is experienced by themselves and, potentially, the people in their care. CONCLUSIONS: Further research is needed, but current qualitative research suggests mindfulness may enable nurses and midwives to work with compassion in stressful and demanding work environments. RELEVANCE TO CLINICAL PRACTICE: Mindfulness may offer an enabling way of coping with stress, in contrast to long-standing strategies such as task-orientation and depersonalisation.

Being with woman: claiming midwifery space.

Being 'with woman' is characterised as presence, a spiritual concept which is nevertheless bound up with physical space. In this article, the work of the American philosopher Judith Butler is used to explore the interplay between space and relationships in midwifery practice. Butler argues that relationships based on mutual recognition and respect define the actions possible within physical space. In midwifery, being with woman creates a therapeutic space necessary for the wellbeing and empowerment of women and midwives alike.

'Oh no, no, no, we haven׳t got time to be doing that': Challenges encountered introducing a breast-feeding support intervention on a postnatal ward.

OBJECTIVE: to identify elements in the environment of a postnatal ward which impacted on the introduction of a breast-feeding support intervention. DESIGN: a concurrent, realist evaluation including practice observations and semi-structured interviews. SETTING: a typical British maternity ward. PARTICIPANTS: five midwives and two maternity support workers were observed. Seven midwives and three maternity support workers were interviewed. Informed consent was obtained from all participants. Ethical approval was granted by the relevant authorities. FINDINGS: a high level of non-compliance with the intervention was driven by a lack of time and staff, and the ward staffs׳ lack of control of the organisation of their time and space. This was compounded by a propensity towards task orientation, workload reduction and resistance to change - all of which supported the existing medical approach to care. Limited support for the intervention was underpinned by staff willingness to reconsider their views and a widespread frustration with current ways of working. KEY CONCLUSIONS: this small, local study suggests that the environment and working conditions on a typical British postnatal ward present significant barriers to the introduction of breast-feeding support interventions requiring a relational approach to care. IMPLICATIONS FOR PRACTICE: midwives and maternity support workers need to be able to control their time and space, and feel able to provide the relational care they perceive that women need, before breast-feeding support interventions can be successfully implemented in practice. Frustration with current ways of working, and a willingness to consider other approaches, could be harnessed to initiate change that would benefit health professionals and the women and families in their care. However, without appropriate leadership or facilitation for change, this could alternatively encourage learned helplessness and passive resistance.

Disempowered, passive and isolated: how teenage mothers' postnatal inpatient experiences in the UK impact on the initiation and continuation of breastfeeding.

Teenage mothers in the UK and other developed English-speaking nations are among those least likely to breastfeed. Evidence suggests more young mothers intend to breastfeed than actually start, indicating that their post-birth experiences militate against initiating breastfeeding. We aimed to explore how the inpatient experiences of a group of young women who gave birth as teenagers influenced their feeding decisions and experiences, and ascertain their ideals for breastfeeding support. Six focus groups or interviews were conducted with 15 women aged 16-20 who had intended to breastfeed or breastfed. Women were recruited from teenage parent groups in Oxfordshire, UK. Ethical approval was obtained from the relevant authorities. Data were analysed inductively using a thematic approach. Three overriding themes of 'postbirth experience on Labour Ward: disempowered and passive'; 'the postnatal ward: alien, alone and exposed'; and 'being there: a need for relational support' were identified. Sub-themes on Labour Ward were 'feelings at birth: 'so tired and so dazed'; 'deliver, stitch, dress'; and 'initiating feeding'. Participants described care that followed set routines, discouraging their initiating breastfeeding by compounding feelings of dependence and encouraging a passive role as midwives took control, often deciding when and how babies should be fed. Sub-themes on the postnatal ward were 'an alien environment'; 'feeling exposed and judged'; and 'miscommunications'. The young mothers' breastfeeding support requirements reflected those known to be desired by older women, but they particularly wanted guidance and esteem support to be provided by a health professional, while looking to their peers for emotional support.

Challenging the reported disadvantages of e-questionnaires and addressing methodological issues of online data collection.

AIM: To review the advantages and disadvantages of e-questionnaires, and question whether or not reported disadvantages remain valid or can be limited or circumvented. BACKGROUND: The internet is likely to become the dominant medium for survey distribution, yet nurses and midwives have been slow to use online technology for research involving questionnaires. Relatively little is known about optimal methods of harnessing the internet's potential in health studies. DATA SOURCE: A small e-questionnaire of health workers. REVIEW METHODS: The Medline and Maternity and Infant Care databases were searched for articles containing the words 'web', 'online', or 'internet' and 'survey' or 'questionnaire'. The search was restricted to articles in English published since 2000. The reference lists of retrieved articles were also searched. DISCUSSION: Reported disadvantages of online data collection, such as sample bias, psychometric distortions, 'technophobia' and lower response rates are discussed and challenged. The author reports her experience of conducting a survey with an e-questionnaire to contribute to the limited body of knowledge in this area, and suggests how to maximise the quantity and quality of responses to e-questionnaires. CONCLUSION: E-questionnaires offer the researcher an inexpensive, quick and convenient way to collect data. Many of the reported disadvantages of the medium are no longer valid. The science of conducting the perfect e-survey is emerging. However, the lessons learned in the author's study, together with other research, seem to suggest that satisfactory response rates and data quality can be achieved in a relatively short time if certain tactics are used. IMPLICATIONS FOR RESEARCH/PRACTICE: To get the best results from e-questionnaires, it is suggested that the questionnaire recipients should be targeted carefully and that the value of their potential contribution to the project should be emphasised. E-questionnaires should be convenient, quick and easy to access, and be set out in a way that encourages full and complete responses.

ProExC triage of atypical glandular cells on liquid-based cervical cytology specimens.

OBJECTIVE: Morphologic distinction between atypical glandular cells not otherwise specified (AGC-NOS) and AGC-favor neoplasia (AGC-FN) can be difficult. Distinction between these entities is important as the American Society for Colposcopy and Cervical Pathology 2006 consensus guidelines state that management of AGC-NOS differs from that of AGC-FN. The objective of this study was to determine the potential role of ProExC immunocytochemical triage of AGC-NOS. MATERIALS AND METHODS: Cytopathology records from a pathology practice were reviewed from January 2006 to December 2009 to identify AGC-NOS liquid-based Pap smears with subsequent biopsy correlation. Archival slides were examined, and ProExC immunocytochemistry was performed. The AGC groups were assessed for nuclear staining, and results were correlated with subsequent biopsy findings. RESULTS: Twenty-eight AGC-NOS cases with biopsy correlation were identified: 13 with subsequent high-grade neoplastic or malignant (positive) diagnoses and 15 with benign diagnoses. Of 13 AGC-NOS cases with positive diagnosis, 10 were ProExC-positive and 3 were ProExC-negative (metastatic tumors from distant sites). Of 15 AGC cases with benign follow-up, 13 were ProExC-negative and 2 were ProExC-positive (sensitivity, 77%; specificity, 87%). For patients with cervical intraepithelial neoplasia or carcinoma originating from the female genital tract, 100% (10/10) were ProExC-positive (sensitivity, 100%; specificity, 87%). CONCLUSIONS: Results suggest that ProExC-positive AGC-NOS may be classified as AGC-FN. Although positive immunocytochemical staining for ProExC requires management similar to AGC-FN, negative staining does not rule out malignancy such as metastatic tumor. Management for ProExC-negative AGC-NOS cases should proceed according to the current guidelines for AGC-NOS.