The effect of an educational video on the immediate insertion of postpartum contraceptive implants: A randomized controlled trial.

OBJECTIVE: To assess the impact of an educational video on immediate postpartum contraceptive implant utilization. METHODS: This was a randomized controlled study conducted in a university hospital. Postpartum women aged over 18 years were recruited and divided into two groups: the intervention group, which viewed a 7-min educational video about contraceptive implants; and the control group, which did not. We evaluated the uptake of contraceptive implants immediately and during a 12-week period postpartum, in addition to the reasons for not selecting this method. RESULTS: A total of 202 participants were included in the study, 101 in each group. Viewing the educational video was associated with higher immediate postpartum contraceptive implant usage (22.77% vs 10.89%; relative risk [RR] 2.09, 95% confidence interval [CI] 1.08-4.06). However, no significant difference was observed at the postpartum follow-up visit (29.9% vs 25.74%; RR 1.61, 95% CI 0.74-1.82). The primary reasons for not selecting contraceptive implants were concerns about potential side effects and discomfort associated with the insertion procedure. CONCLUSION: The inclusion of an animated educational video significantly improved immediate postpartum contraceptive implant uptake, making it a potentially viable strategy in settings with high rates of loss to follow-up. However, further research into how to address patients' fears regarding the implant is required.

Photoluminescent Multicolor Carbon Dots for UV Detection and Dynamic Anticounterfeiting.

Carbon dots (CDs) are an emerging type of fluorescent carbon nanomaterial with broad application prospects. Among them, photochromic CDs have been widely used in the field of optoelectronic devices but rarely in ultraviolet (UV) detection. In this work, we successfully developed photochromic CDs that exhibit reversible emission under light stimulation in an amine solvent system. Notably, the CDs showed ultrafast photochromic behavior in diethylamine solvent, shifting the fluorescence color from cyan-green to orange-red after 2 s of irradiation, with the solution color changing from pale yellow to pale purple. Furthermore, this performance could recover without additional stimuli, simply by standing for several tens of seconds. Structural analysis indicated that rapid photochromism arises from changes in the surface functional group radicals of the CDs, with the reversibility attributed to fluctuation in these radicals. Leveraging the excellent photochromic properties of CDs, we further developed a device for detecting UV indices in sunlight. This opens up broad prospects for developing high-performance UV detection devices based on CDs.

Discovery of new non-covalent reversible BTK inhibitors: Synthesis, in silico studies, and in vitro evaluations.

Bruton's Tyrosine Kinase (BTK) played a key role in the B cell antigen receptor (BCR) signaling pathway, and was considered a hotspot in the treatment of B cell malignant tumors and B cell immune diseases. There were 5 covalent irreversible inhibitors launched currently on the market, but C481S mutation was detected in most patients after administration. The approval of Pirtobrutinib (Jaypirca) by FDA in 2023 aroused great interest in the development of non-covalent and reversible BTK inhibitors. In order to solve the resistance of covalent irreversible inhibitors caused by C481S mutation, 11 reversible BTK inhibitors were designed based on screening in this article. The design, synthesis, in silico studies, and in vitro evaluations were performed for further verification. Among them, compound WS-11 showed best activity with IC50 of 3.9 nM for wild type, 2.2 nM for C481S mutation BTK, which was comparable to the positive control Pirtobrutinib. Furthermore, WS-11 would have a good druglikeness properties predicted by pkCSM and SwissADME, which provided a promising lead for further optimization and development.

Febrile neutropenia induced by adjuvant radiotherapy for a patient with breast cancer accompanied with reversible splenial lesion syndrome (RESLES, TypeI): a case report.

BACKGROUND: Reversible splenial lesion syndrome (RESLES) is known as a neuro-imaging syndrome with recurrent but reversible lesion of the corpus callosum, characterized by nonspecific but usually mild encephalopathies and specific imaging manifestations.There are few published reports in the field of oncology. CASE PRESENTATION: A 33-year-old female with right breast cancer and with no particular family history was admitted to hospital with high fever and severe headache, after receiving adjuvant radiotherapy. Blood routine test upon admission suggested neutropenia, considering myelosuppression associated with radiotherapy. There were no definite findings of common pathogenic microorganism, and no imaging indication of certain infectious sites other than a likely reversible corpus callosum syndrome suggested by brain MRI, which was relieved after systemic antibiotic therapy and granulocyte colony-stimulating factor injection. CONCLUSIONS: Reversible splenial lesion syndrome is a kind of clinical-imaging syndrome with multiple clinical manifestations and etiologies. This breast cancer patient after postoperative adjuvant radiotherapy develops a complication of RESLES that rings an alarm bell to the oncologists not to easily recognize the corpus callosum lesion as infarction or metastasis. Meanwhile, the potential pathogenic mechanisms need to be explored further.

The association between socio-economic deprivation and receipt of long-acting reversible contraception at a single clinic visit.

OBJECTIVES: To determine the relationship between area deprivation index (ADI) and obtaining single-visit long-acting reversible contraception (LARC). STUDY DESIGN: We utilized Poisson regression to determine the association between area deprivation and single-visit LARC insertion within a state-wide healthcare system between 2019-2021. RESULTS: Among our cohort (N = 4417), 68.60% of patients desiring LARC obtained single-visit LARC. Participants living in high deprivation areas were less likely to receive single-visit LARC (aRR 0.72, 95% CI 0.65-0.80). CONCLUSIONS: Living in areas of high deprivation is independently negatively associated with obtaining a single-visit LARC. IMPLICATIONS: While access to single-visit LARC should be universally improved, reducing barriers for patientswith a higher ADI may help limit inequities in reproductive healthcare.

Reversible Adhesive Film with Ultralow Dielectric Loss in High Frequency via Surface Anchoring of Catechol.

Debonding of the dielectric adhesive material will make the high-frequency communication equipment unusable, leading to resource wasting and electronic waste. Reversible adhesive is an ideal strategy to realize the reuse of debonding devices, but the low dielectric loss requirement of the dielectric adhesive materials in high-frequency devices limits its development. Here, the surface anchoring design of catechol was proposed to prepare a reversible adhesive film with ultralow dielectric loss in high frequency. The catechol structure was linked to the end of polybutadiene (PB) macromolecule to synthesize catechol-terminated PB (PB-D). The PB-based adhesive film (PB-F) with ultralow dielectric loss was used as the base film, and then PB-D was sprayed on PB-F to form a thin layer. In the subsequent curing process, the catechol group on the surface of PB-F could be anchored by the cross-linking reaction between the heterogeneous PB segments. The surface modification transforms the interface debonding between PB-F and copper foil into cohesive failure within the PB-D layer, showing a strong adhesion of more than 1.1 N/mm. More importantly, relying on the reversible hydrogen bonding of catechol structures, the debonding material can regain stable bonding in a mild way. Because the catechol group is only distributed on the film surface, the reversible adhesive film kept an ultralow dielectric loss (Df = 2.5-2.9 × 10-3) at 10 GHz. In this work, an ultralow dielectric loss and reversible adhesive film with commercial prospects was prepared for the first time, which is expected to be used for simple recovery of communication substrate bonding failure.

Secondary parkinsonism associated with focal brain lesions.

Focal imaging abnormalities in patients with parkinsonism suggest secondary etiology and require a distinctive clinical approach to diagnosis and treatment. We review different entities presenting as secondary parkinsonism associated with structural brain lesions, with emphasis on the clinical course and neuroimaging findings. Secondary parkinsonism may be due to vascular causes, hydrocephalus, space-occupying lesions, metabolic causes (including acquired hepatocerebral degeneration, diabetic uremic encephalopathy, basal ganglia calcifications, osmotic demyelination syndrome), hypoxic-ischaemic brain injury, intoxications (including methanol, carbon monoxide, cyanide, carbon disulfide, manganese poisoning and illicit drugs), infections and immune causes. The onset can vary from acute to chronic. Both uni-and bilateral presentations are possible. Rigidity, bradykinesia and gait abnormalities are more common than rest tremor. Coexisting other movement disorders and additional associated neurological signs may point to the underlying diagnosis. Neuroimaging studies are an essential part in the diagnostic work-up of secondary parkinsonism and may point directly to the underlying etiology. We focus primarily on magnetic resonance imaging to illustrate how structural imaging combined with neurological assessment can lead to diagnosis. It is crucial that typical imaging abnormalities are recognized within the relevant clinical context. Many forms of secondary parkinsonism are reversible with elimination of the specific cause, while some may benefit from symptomatic treatment. This heterogeneous group of acquired disorders has also helped shape our knowledge of Parkinson's disease and basal ganglia pathophysiology, while more recent findings in the field garner support for the network perspective on brain function and neurological disorders.

Hemp Protein Isolate-Based Natural Thermal-Reversible Hydrogel as a Novel Wound Dressing Material.

Hydrogels, due to their excellent microstructure and mechanical strength, have become a novel biomaterial in wound dressing. However, plant proteins have never been considered because of their poor original gelling performances and insufficient rheological properties. Here, we reported the fabrication of a plant protein-based thermal-reversible gel using a reverse micelle-extracted hemp protein isolate (HPI). A systematic study was conducted to fully reveal their microstructure, rheological properties, and anti-inflammatory effect to lay a foundation for this newly developed plant protein hydrogel as a potential natural wound dressing. By modulating protein concentration (4% HPI) and temperature (85 °C), a thermal-reversible HPI gel appeared as a filament structure with the major molecular driving force of hydrophobic interactions and hydrogen bonds. By characterizing the rheological properties, lower gel strength and wider linear viscoelastic regime were determined in the thermal-reversible HPI gel compared with a thermal-irreversible HPI gel. Besides, large amplitude oscillatory shear data identified the thermal-reversible gel as a soft gel which demonstrated intracycle strain stiffening and shear thinning behavior. Moreover, the thermal-reversible HPI gel is nontoxic and has benefits in neutrophil growth with injectability and perfect wound coverage. This study opens a novel means to form a natural thermal-reversible hydrogel that can be a new material source for wound dressing.

A case of bilateral cortical blindness followed by generalised tonic-clonic seizure epilepsy in a patient with posterior reversible encephalopathy syndrome.

Posterior reversible encephalopathy syndrome (PRES) in end-stage kidney disease (ESKD) is rare, with ocular symptoms as the first manifestation being even rarer. Here, we report a case of PRES in a patient with ESKD, characterized by sudden binocular blurred vision followed by epilepsy, to improve the understanding of this syndrome among nephrologists and ophthalmologists. A 50-year-old female requested an ophthalmic consultation due to bilateral vision loss followed by generalised tonic-clonic seizures. One month before onset of current illness, she developed ESKD secondary to rapid progression of previous ANCA vasculitis associated renal damage. Latter magnetic resonance imaging confirmed the diagnosis of PRES. Two weeks later, the patient's vision fully recovered. Conclusion: PRES is not an etiological diagnosis but a neuroimaging sign. In addition, PRES is a danger signal that is usually reversible if recognized and treated early, and can be life-threatening if treatment is delayed.

Thioctic Acid-Based Solvent-Free and Recoverable Adhesive for Dry/Wet Environments.

Metal adhesive synthesis typically involves heating and solvents, and the resultant adhesives lack degradability and suffer from recycling and sustainable problems. Herein, we developed a solvent-free and chemically degradable biobased adhesive (p(Elp-TA)+PVP) from thioctic acid (TA), its derivative (Elp), and polyvinylpyrrolidone (PVP). Through a rapid acid-triggered cationic ring-opening polymerization of dithiolane at ambient conditions, p(Elp-TA)+PVP adhesive could build up a strong lap shear strength of 1123 kPa in air and an underwater lap shear strength of 534 kPa to the copper plate. Molecular dynamics simulations show that compared to p(Elp-TA), the presence of an appropriate amount of PVP can significantly enhance the binding energy of the adhesive molecules to the metal substrate, and the rapid adhesion of p(Elp-TA)+PVP molecules to metal substrates was achieved through a synergistically dynamic adaptive network enhanced by hydrogen bonding, reversible dynamic bonding, and metal coordination bonding at 40 ps. More importantly, the applied p(Elp-TA)+PVP adhesive could be easily degraded and reverted to its small-molecular-weight lipoic acid species. Upon exposure to dithiothreitol, a green reducing agent, the average molecular weight of the adhesive could quickly decrease from 1603 kDa to 274 Da. This green adhesive constructed by a simple method provides a promising general strategy for developing a controlled degradable and recoverable adhesive from natural resources.

Preventing recurrence of endometriosis-related pain by means of long-acting progestogen therapy: the PRE-EMPT RCT.

Background: Endometriosis affects 1 in 10 women, many of whom have surgery for persistent pain. Recurrence of symptoms following an operation is common. Although hormonal treatment can reduce this risk, there is uncertainty about the best option. Objectives: To evaluate the clinical and cost-effectiveness of long-acting progestogen therapy compared with the combined oral contraceptive pill in preventing recurrence of endometriosis-related pain and quality of life. Design: A multicentre, open, randomised trial with parallel economic evaluation. The final design was informed by a pilot study, qualitative exploration of women's lived experience of endometriosis and a pretrial economic model. Setting: Thirty-four United Kingdom hospitals. Participants: Women of reproductive age undergoing conservative surgery for endometriosis. Interventions: Long-acting progestogen reversible contraceptive (either 150 mg depot medroxyprogesterone acetate or 52 mg levonorgestrel-releasing intrauterine system) or combined oral contraceptive pill (30 µg ethinylestradiol, 150 µg levonorgestrel). Main outcome measures: The primary outcome was the pain domain of the Endometriosis Health Profile-30 questionnaire at 36 months post randomisation. The economic evaluation estimated the cost per quality-adjusted life-years gained. Results: Four hundred and five women were randomised to receive either long-acting reversible contraceptive (N = 205) or combined oral contraceptive pill (N = 200). Pain scores improved in both groups (24 and 23 points on average) compared with preoperative values but there was no difference between the two (adjusted mean difference: -0.8, 95% confidence interval -5.7 to 4.2; p = 0.76). The long-acting reversible contraceptive group underwent fewer surgical procedures or second-line treatments compared with the combined oral contraceptive group (73 vs. 97; hazard ratio 0.67, 95% confidence interval 0.44 to 1.00). The mean adjusted quality-adjusted life-year difference between two arms was 0.043 (95% confidence interval -0.069 to 0.152) in favour of the combined oral contraceptive pill, although this cost an additional £533 (95% confidence interval 52 to 983) per woman. Limitations: Limitations include the absence of a no-treatment group and the fact that many women changed treatments over the 3 years of follow-up. Use of telephone follow-up to collect primary outcome data in those who failed to return questionnaires resulted in missing data for secondary outcomes. The COVID pandemic may have affected rates of further surgical treatment. Conclusions: At 36 months, women allocated to either intervention had comparable levels of pain, with both groups showing around a 40% improvement from presurgical levels. Although the combined oral contraceptive was cost-effective at a threshold of £20,000 per quality-adjusted life-year, the difference between the two was marginal and lower rates of repeat surgery might make long-acting reversible contraceptives preferable to some women. Future work: Future research needs to focus on evaluating newer hormonal preparations, a more holistic approach to symptom suppression and identification of biomarkers to diagnose endometriosis and its recurrence. Trial registration: This trial is registered as ISRCTN97865475. https://doi.org/10.1186/ISRCTN97865475. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 11/114/01) and is published in full in Health Technology Assessment; Vol. 28, No. 55. See the NIHR Funding and Awards website for further award information. The NIHR recognises that people have diverse gender identities, and in this report, the word 'woman' is used to describe patients or individuals whose sex assigned at birth was female, whether they identify as female, male or non-binary.

Endometriosis is a condition where cells similar to ones that line the womb are found elsewhere in the body. Endometriosis affects 1 in 10 women, many of whom have surgery for persistent pain. Unfortunately, symptoms often return and some women will need repeat operations. Hormonal contraceptives can prevent the return of endometriosis-related pain: either long-acting reversible contraceptives (injections or a coil, fitted inside the womb) or the combined oral contraceptive pill (often called 'the pill'). We do not know which is the best option. The aim of this trial was to find out which of these two hormone treatments was more effective in terms of symptom relief, avoidance of further surgery and costs. Four hundred and five women with endometriosis, who were not intending to get pregnant, participated in a clinical trial. Half of the participants took long-acting reversible contraceptives, and the other half took the pill for 3 years following endometriosis surgery. The choice of treatment was made at random by a computer to ensure a fair comparison, although those allocated to the long-acting contraceptive could choose between injections or the coil. Participants completed questionnaires about their symptoms and life quality at intervals up to 3 years. Both treatments were equally good at reducing pain but more women using the pill had repeat operations. The pill was a little more costly overall but associated with a slightly higher quality of life. Both treatments are equally effective in reducing pain up to 3 years after surgery for endometriosis. The differences in costs are small and the choice of treatment should be based on personal preference.

Optimal Computational Modeling and Simulation of QCA Reversible Gates for Information Reliability in Nano-Quantum Circuits.

As the relationship between energy and information loss and reversible gates was revealed, much interest in reversible gate design arose, and as quantum-dot cellular automata (QCA) gained attention as a next-generation nano circuit design technology, various reversible gates based on QCA emerged. The proposed study optimizes the performance and design costs of existing QCA-based reversible gates including TR, RUG, PQR, and URG. According to most indicators, the proposed circuits showed significant improvement rates and outperformed existing studies. In particular, the proposed optimal TR, RUG, PQR, and URG showed performance improvements of 266%, 265%, 300%, and 144% in CostAD, respectively, compared with the best existing circuit. This shows outstanding improvement and superiority in terms of area and delay, which are the most important factors in the performance of nano-scale circuits that are becoming extremely miniaturized. Additionally, the exceptionally high-output polarization of the proposed circuits is an important indicator of the circuit's expansion and connection and increases the circuit's reliability.

Etiology and characteristics of non-aneurysmal thunderclap headache presenting to an acute setting.

OBJECTIVES: To describe the characteristics and causes of non-aneurysmal thunderclap headache (TCH) and compare serious from benign underlying causes. METHODS: Retrospective cohort study of consecutive adult patients with TCH presenting to a tertiary care academic medical center between 2010 and 2020. Aneurysmal subarachnoid hemorrhage cases were excluded. Cases were categorized into serious or benign; serious TCH was defined as any condition in which delayed diagnosis and treatment could result in neurological disability or death. Risk factors for serious TCH were analyzed. We adhere to standardized guidelines for reporting observational studies. RESULTS: A total of 932 patients presented with TCH. After exclusion of 393 patients with aneurysmal-type subarachnoid hemorrhage, 539 were included in the analysis. One-half (n = 275, 51.0 %) had a serious cause. Median age was 51 years, 69.0 % were female. Most frequent diagnoses were intracranial hemorrhage (n = 102, 18.9 %), reversible cerebral vasoconstriction syndrome (n = 97, 18.0 %), and idiopathic TCH (n = 102, 38.6 %). A multivariable logistic regression model for prediction of serious TCH included age, hypertension, migraines, recurrent TCH, level of consciousness and other clinical exam findings, and achieved an AUROC of 0.732. This score had a sensitivity of 79.9 % (95 % CI 73.5-83.5 %) for the identification of serious TCH. A 0.5-point increase in the risk score was associated with a 73 % increase in the odds of serious TCH (odds ratio 1.73, 95 % CI 1.53-1.95, p < 0.001). CONCLUSION: Our study describes the relative frequency of presentation and etiologies among patients with TCH This score can aide clinicians in recognising patients with potentially serious cause of TCH, for whom additional imaging and neurological consultation is necessary.

Immediate versus delayed postpartum insertion of long-acting reversible contraception methods: meta-analysis of randomized controlled trials.

OBJECTIVE: We aimed to conduct a meta-analysis of randomized trials comparing the immediate versus delayed provision of long-acting reversible contraceptives in postpartum subjects, focusing on short-interval pregnancies, utilization rates, and adverse events. DATA SOURCES: Cochrane Central, Embase, PubMed and ClinicalTrials.gov were systematically searched from inception up to December 19, 2023, without filters or language limitation. STUDY ELIGIBILITY CRITERIA: We selected randomized controlled trials assessing the immediate insertion of long-acting reversible contraceptives in women during postpartum period in comparison with the delayed provision. STUDY APPRAISAL AND SYNTHESIS METHODS: We calculated relative risks (RR) with 95% confidence intervals to analyze the primary outcome of utilization rates and secondary endpoints, including initiation rates, pregnancy, any breastfeeding, exclusive breastfeeding, and serious adverse events. A random effects model was employed in the R software. Moreover, we assessed the risk of bias of selected RCTs using version 2 of the Cochrane Risk of Bias Assessment Tool. RESULTS: We included 24 randomized trials comprising 2,507 participants, of whom 1,293 (51.6%) were randomized to the immediate insertion. Postpartum women in the immediate group had lower risk of pregnancy (RR 0.16; 95% CI 0.04-0.71; P = 0.02) compared with delayed group, and higher rates of long-acting reversible contraceptives at 6 months of follow-up (RR 1.23; 95% CI 1.09-1.37; P < 0.01). CONCLUSIONS: Inserting long-acting reversible contraceptives before hospital discharge was associated with a reduction in the risk of pregnancy, and increased rates of its utilization at 6 months of follow-up. This intervention may be an effective contraception strategy for postpartum women.

Magnetic resonance imaging patterns and perfusion changes of posterior reversible encephalopathy syndrome in children with clinical outcome correlation.

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) in children has a propensity towards atypical features on magnetic resonance (MR) imaging, with limited literature on perfusion changes and clinicoradiological correlation. OBJECTIVE: We aimed to comprehensively study MR imaging patterns of pediatric PRES, including cerebral blood flow variations on arterial spin labeling, and looked for any MR biomarkers of poor clinical outcome. MATERIALS AND METHODS: In this retrospective observational study conducted in a tertiary hospital setting, MR records over a 4-year period (May 2019 to May 2023) were systematically searched along with their clinical details. Patients with an age less than 18 years and a clinicoradiological constellation consistent with PRES were included. MR scans were analyzed by two neuroradiologists with 8 years' and 10 years' experience. Association was sought with poor clinical outcome (defined as modified Rankin Scale score at discharge of > 2). RESULTS: A total of 45 patients (29 boys) were included in the study, with a mean age (± standard deviation) of 11.19 (± 4.53) years. On MR imaging, 95.6% of patients (n = 43) showed atypical features and/or atypical areas of involvement. The superior frontal sulcus (n = 18) was the most predominant MR pattern, and cerebellar involvement was not uncommon (n = 15). Unilateral involvement (n = 3), isolated central pattern (n = 1), and spinal cord involvement (PRES-SCI: n = 1) were also encountered. Brainstem involvement (n = 4) showed a characteristic "V-sign" of anterior medullary hyperintensity. Patchy restricted diffusion (46.6%), punctate hemorrhages (37.7%), and leptomeningeal contrast enhancement (36%) were not uncommon. Arterial spin labeling sequence (available in 24 patients) showed increased cerebral blood flow in the involved areas in 79.2% of patients. Univariate analysis showed a significant association of the presence of hemorrhage (P = 0.003), involvement of brainstem (P = 0.007), deep white matter (P = 0.008), and thalamus (P = 0.026) with poor clinical outcome. Multivariate regression analysis found that hemorrhage on MRI (P = 0.011, odds ratio 8) was an independent factor associated with poor clinical outcome. CONCLUSIONS: The conventionally described atypical features in PRES are common in children and therefore may no longer be considered exceptions. Raised perfusion on arterial spin labeling sequence was seen in the majority of cases. Hemorrhage on MRI was an independent predictor of poor clinical outcome in pediatric PRES.

Injection Depot Medroxyprogesterone Acetate as an Early Postpartum Contraceptive Measure: Evaluation of Its Acceptability, Efficacy, and Impact on Lactation.

Introduction Through its National Family Planning Programme, India has been relentlessly working to decrease society's unmet contraception needs. The postpartum period is of paramount importance for addressing these contraceptive needs owing to alterations in fertility and coital behavior associated with childbirth. Depot medroxyprogesterone acetate (DMPA), a long-acting reversible contraceptive, is one of the safe options available in the early postpartum period. In this study, we aimed to evaluate its efficacy and acceptability among postpartum women delivering in Guru Gobind Singh Medical College and Hospital. Methodology We recruited 206 early postpartum women for the study. After thorough counseling and ensuring establishment of lactation, we administered DMPA 150mg by injection intramuscularly and repeated it at intervals of three months in willing patients. We then evaluated them for their symptoms, side effects, and lactation status using a predesigned proforma either during their follow-up visits or telephonically. Results We found DMPA to be 100% efficacious as an early postpartum contraceptive measure. The main reasons for acceptance were its ease of use, long-term effects of a single dose, and noninterference with lactation. However, the continuation rate for the second dose was only 18% in our study, highlighting the need for better counseling and improving awareness among our patients. Ninety-nine percent of our patients were satisfied with their lactation. Conclusion We found injectable DMPA used as a contraceptive in the immediate postpartum period to be a safe and effective alternate method with no deleterious effect on lactation and an acceptable side effect profile. However, more awareness programs are necessary to encourage women, especially those in low-resource areas, to continue using DMPA.

Multifunctional Interface Layer Constructed by Trace Zwitterions for Highly Reversible Zinc Anodes.

The inhomogeneous plating/stripping of Zn anode, attributed to dendrite growth and parasitic reactions at the electrode/electrolyte interface, severely restricts its cycling life-span. Here, trace zwitterions (trifluoroacetate pyridine, TFAPD) are introduced into the aqueous electrolyte to construct a multifunctional interface that enhances the reversibility of Zn anode. The TFA- anions with strong specific adsorption adhere onto the Zn surface to reconstruct the inner Helmholtz plane (IHP), preventing the hydrogen evolution and corrosion side reactions caused by free H2O. The Py+ cations accumulate on the outer Helmholtz plane (OHP) of Zn anode with the force of electric field during Zn2+ plating, forming a shielding layer to uniformize the deposition of Zn2+. Besides, the adsorbed TFA- and Py+ promote the desolvation process of Zn2+ resulting in fast reaction kinetics. Thus, the Zn||Zn cells present an outstanding cycling performance of more than 10000 hours. And even at 85% utilization rate of Zn, it can stably cycle for over 200 hours at 10 mA cm-2 and 10 mAh cm-2. The Zn||I2 full cell exhibits a capacity retention of over 95% even after 30000 cycles. Remarkably, the Zn||I2 pouch cells (95 mAh) deliver a high-capacity retention of 99% after 750 cycles.

Entropy-Driven Reversible Melting and Recrystallization of Layered Hybrid Perovskites.

Typical layered 2D A2PbX4 (A: organic ammonium cation, X: Br, I) perovskites undergo irreversible decomposition at high temperatures. Can they be designed to melt at lower temperatures without decomposition? Which thermodynamic parameter drive the melting of layered perovskites? These questions are addressed by considering the melt of A2PbX4 as a mixture of ions (like ionic liquids), and hypothesized that the increase in the structural entropy of fusion (ΔSfus) will be the driving force to decrease their melting temperature. Then to increase structural ΔSfus, A-site cations are designed that are rigid in the solid crystal, and become flexible in the molten state. Different tail groups in the A-site cations form hydrogen-, halogen- and even covalent bonding-interactions, making the cation-layer rigid in the solid form. Additionally, the rotation of ─NH3 + head group is suppressed by replacing ─H with ─CH3, further enhancing the rigidity. Six A2PbX4 crystals with high ΔSfus and low melting temperatures are prepared using this approach. For example, [I-(CH2)3-NH2(CH3)]2PbI4 reversibly melts at 388 K (decomposition temperature 500 K), and then recrystallizes back upon cooling. Consequently, melt-pressed films are grown demonstrating the solvent- and vacuum-free perovskite films for future optoelectronic devices.

Advances in reversible covalent kinase inhibitors.

Reversible covalent kinase inhibitors (RCKIs) are a class of novel kinase inhibitors attracting increasing attention because they simultaneously show the selectivity of covalent kinase inhibitors yet avoid permanent protein-modification-induced adverse effects. Over the last decade, RCKIs have been reported to target different kinases, including Atypical group of kinases. Currently, three RCKIs are undergoing clinical trials. Here, advances in RCKIs are reviewed to systematically summarize the characteristics of electrophilic groups, chemical scaffolds, nucleophilic residues, and binding modes. In so doing, we integrate key insights into privileged electrophiles, the distribution of nucleophiles, and hence effective design strategies for the development of RCKIs. Finally, we provide a further perspective on future design strategies for RCKIs, including those that target proteins other than kinases.

Mother-Daughter Dyads' Perceptions of Contraception.

STUDY OBJECTIVE: In an increasing number of states, parents must provide permission for their daughters under 18-years-old to start contraception. We sought to understand perceptions among mother-daughter dyads about sources of information, and to describe dyadic interactions when discussing contraception. METHODS: Dyads were recruited from an adolescent medicine clinic in Dallas, TX. A semi-structured joint interview was conducted with each dyad. Interviews were recorded, transcribed, and coded through an iterative approach. RESULTS: There were 11 dyadic interviews (22 participants). Sources of information about contraception included mothers, healthcare providers (HCPs), friends/family, school, and individualized learning. Dyads identified distinct purposes and limitations of each source. Mothers noted the importance of supporting their daughter's development and specific needs. Often these conversations began with a discussion of menstrual management. Information from friends/family was overwhelmingly anecdotal. Schools and HCPs were viewed as trusted sources, and the internet/social media as possibly inaccurate or misleading. Dyads described several risks and benefits of different methods. Minimal conflict was noted. CONCLUSION: These results provide rich information about how mother-daughter dyads view contraception in joint discussion. It is important to ensure that accurate stories about contraception are accessible and teaching health literacy would be helpful. Menstrual management appears to be an acceptable starting point to discuss contraception. Schools and HCPs are trusted sources and measures should be taken to ensure teaching is accurate, developmentally appropriate and teaches evaluation of online information. Regardless of parental consent laws for adolescent contraception, engaging caregivers in the process can help support adolescent contraceptive decision-making.