The chloroplast and mitochondrial genomes of two Gomphonema parvulum (Bacillariophyta) environmental isolates from South Carolina (United States) and Virginia (United States).

Gomphonema parvulum is a cosmopolitan freshwater diatom that is used as an indicator in water quality biomonitoring. In this study, we report the culturing of two geographically separated isolates from southeastern North America, their morphology, and the sequencing and assembly of their mitochondrial and chloroplast genomes. Morphologically, both strains fit G. parvulum sensu lato, but the frustules from a protected habitat in South Carolina were smaller than those cited in the historic data of this species from the same location as well as a second culture from Virginia. Phylogenetic analyses using the rbcL gene placed both within a clade with G. parvulum. Genetic markers, including full chloroplast and mitochondrial genomes and the nuclear small subunit rRNA gene region were assembled from each isolate. The organellar genomes of the two strains varied slightly in size due to small differences in intergenic regions with chloroplast genomes of 121,035 bp and 121,482 bp and mitochondrial genomes of 34,639 bp and 34,654 bp. The intraspecific pairwise identities of the chloroplast and mitochondrial genomes of these two isolates were 97.9% and 95.4%, respectively. Multigene phylogenetic analysis demonstrated a close relationship between G. parvulum, Gomphoneis minuta, and Didymosphenia geminata.

'A profound effect on how I see myself and the world around me': what students found meaningful about taking an academic course intended to reduce campus sexual violence.

Sexual violence is common on US college campuses and can result in negative health and academic outcomes. Credit-bearing courses are a possible innovative intervention, but few have been studied, and little is known about enrolled students' experiences. Our institution, located in the Southern United States, developed a semester-long class as a curricular intervention after our institutional climate survey results showed high rates of sexual violence among undergraduate students. Students enrolled in the course wrote a final reflection paper on what they found meaningful about the class (N = 62). Qualitative conventional content analysis was used to examine what students found most salient. Three overarching categories emerged: course content, course delivery and course impact, each with multiple themes. For course content, students wrote about 22 different topics from the class. For course delivery, students discussed the open forum to discuss sexuality, the importance of taking the course in their first year of college and the course structure. For course impact, students discussed gaining new knowledge, questioning prior assumptions, experiencing personal transformation and feeling empowered to act. Results indicated that students had a powerful class experience and that this kind of educational intervention has the potential to positively impact enrolled students.

"It feels like you have to choose one or the other": a qualitative analysis of obstetrician focus groups on periviability counseling.

OBJECTIVES: The objective of this study was to gain knowledge and ascertain challenges about periviability counseling among obstetricians to inform curricular development. METHODS: Focus groups were utilized. A series of open-ended questions was posed to each group of obstetricians; responses were audio recorded and transcribed. Transcriptions were analyzed by two coders using thematic analysis. RESULTS: Four focus groups were convened. Prominent themes included: (1) Obstetrician knowledge about neonatal outcomes is limited, (2) Periviability counseling is both time intensive and time-challenged, (3) Patient processing of information relies on the content, delivery and patient readiness, and (4) Obstetrician bias is toward advocating for maternal safety, which may run counter to parental instinct to "do everything." The last theme was specifically focused on the role of cesarean delivery. CONCLUSIONS: Curricula focused on improving obstetrician periviability counseling should focus on neonatal outcomes, the role of cesarean delivery, and utilization of shared decision-making.

Cerclage plus Adjuvant Vaginal Progesterone for Preterm Birth Prevention in Patients with a Short or Dilated Cervix without Prior Preterm Birth.

OBJECTIVE: The primary objective was to determine if vaginal progesterone following cerclage for cervical length <10 mm or cervical dilation in patients without a history of spontaneous preterm birth (sPTB) decreased the risk of preterm birth at <34 weeks' gestation compared with cerclage alone. Secondary objectives were to determine if vaginal progesterone following cerclage (1) decreased the risk of preterm birth at <24, <28, and <37 weeks' gestation and (2) increased the latency period from cerclage placement to delivery compared with treatment with cerclage alone. STUDY DESIGN: Multicenter retrospective cohort study from 2015 to 2020 of singleton pregnancies, without prior sPTB, who had cerclage placement <24 weeks' gestation for cervical length <10 mm or cervical dilation. Exposure defined as cerclage plus vaginal progesterone postoperatively (dual therapy) and unexposed as cerclage alone (monotherapy), based on surgeon preference. RESULTS: We included 122 patients, 78 (64%) treated with dual therapy and 44 (36%) treated with monotherapy. In the crude analysis, dual therapy was associated with a lower risk of delivery at <28 weeks' gestation (13%) compared with monotherapy (34%; crude risk ratio: 0.38 [95% confidence interval, CI: 0.19-0.75]). When adjusted for preoperative vaginal progesterone, results were attenuated (adjusted risk ratio: 0.45 [95% CI: 0.20-1.01]). In both the crude and adjusted analyses, the risk of sPTB was not statistically different at <24, <34 or <37 weeks' gestation. Dual therapy was associated with a greater pregnancy latency from cerclage to delivery (16.3 vs. 14.4 weeks; p = 0.04), and greater gestational age at delivery (37.3 vs. 35.8 weeks' gestation; p = 0.02) compared with monotherapy. CONCLUSION: While not statistically significant, the risk of sPTB was lower at all gestational ages studied in patients treated with dual therapy compared with monotherapy. Dual therapy was associated with longer pregnancy latency and greater gestational age at delivery compared with monotherapy. KEY POINTS: · Dual therapy did not decrease preterm birth risk compared with monotherapy.. · Dual therapy prolonged pregnancy compared with monotherapy.. · Dual therapy can be considered but further studies are needed..

Direct lysosome-based autophagy of lipid droplets in hepatocytes.

Hepatocytes metabolize energy-rich cytoplasmic lipid droplets (LDs) in the lysosome-directed process of autophagy. An organelle-selective form of this process (macrolipophagy) results in the engulfment of LDs within double-membrane delimited structures (autophagosomes) before lysosomal fusion. Whether this is an exclusive autophagic mechanism used by hepatocytes to catabolize LDs is unclear. It is also unknown whether lysosomes alone might be sufficient to mediate LD turnover in the absence of an autophagosomal intermediate. We performed live-cell microscopy of hepatocytes to monitor the dynamic interactions between lysosomes and LDs in real-time. We additionally used a fluorescent variant of the LD-specific protein (PLIN2) that exhibits altered fluorescence in response to LD interactions with the lysosome. We find that mammalian lysosomes and LDs undergo interactions during which proteins and lipids can be transferred from LDs directly into lysosomes. Electron microscopy (EM) of primary hepatocytes or hepatocyte-derived cell lines supports the existence of these interactions. It reveals a dramatic process whereby the lipid contents of the LD can be "extruded" directly into the lysosomal lumen under nutrient-limited conditions. Significantly, these interactions are not affected by perturbations to crucial components of the canonical macroautophagy machinery and can occur in the absence of double-membrane lipoautophagosomes. These findings implicate the existence of an autophagic mechanism used by mammalian cells for the direct transfer of LD components into the lysosome for breakdown. This process further emphasizes the critical role of lysosomes in hepatic LD catabolism and provides insights into the mechanisms underlying lipid homeostasis in the liver.

The Multimethod Evaluation of a Curricular Intervention Intended to Reduce Sexual Violence on a College Campus: A Synthesis of Findings and Lessons Learned.

Sexual violence is a major problem on college campuses, and innovative solutions are needed. Our university created a semester-long, credit-bearing, academic course as a curricular intervention intended to reduce sexual violence on campus. In this article, we describe the multiple methods used to evaluate the course, including a pre-post online survey with a quasi-experimental design, a qualitative content analysis of student reflection papers, and semistructured interviews with previously enrolled students conducted by a peer interviewer 3 months after course completion. The synthesis of evaluation findings indicated that an academic course has the potential to positively affect campus climate around sexual violence. Furthermore, using multiple methods enabled us to create a theory of change that illustrates how key course components shaped students' knowledge, attitudes, and behaviors about sexual violence, thereby ideally generating campus change. Results have been used by various stakeholders for both practice-based and scholarly purposes. We provide lessons learned and implications for practice that are transferable to other multimethod curricular intervention evaluations regardless of topical focus, including the many ways in which using multiple methods added value to the study; the considerable investment of time and resources needed when using multiple methods; the challenges that can arise when integrating findings across methods; the major benefits of having a multidisciplinary research team consisting of faculty and students; and the need to engage in critical reflexivity.

PCOS and the risk of pre-eclampsia.

RESEARCH QUESTION: What is the association between polycystic ovary syndrome (PCOS) and pre-eclampsia? Data suggest that patients with PCOS are at increased risk of developing pre-eclampsia; however, several studies have not found an independent association between the two. DESIGN: A retrospective case-control study of singleton deliveries at a tertiary care hospital from 2011 to 2015. Patients with pre-eclampsia (cases) were matched to the next delivery without pre-eclampsia (controls) on gestational age week. Medical history data, a diagnosis or clinical features of PCOS and obstetric data, including pre-eclampsia, were abstracted from the medical record. Groups were compared with the chi-squared test, and conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (95% CI). OR were adjusted for maternal age at delivery and race/ethnicity. RESULTS: This study included 435 cases and 435 controls. Cases were more likely to be Black compared with controls. Age, comorbidities, features of PCOS and use of IVF were similar between groups. Patients with pre-eclampsia were not more likely to have PCOS (8.3%) than those without pre-eclampsia (6.2%, adjusted OR 1.40, 95% CI 0.81-2.30). Sensitivity analyses for body mass index and parity suggested an increased pre-eclampsia risk for patients with PCOS and these additional factors, however no group showed a statistically significant association between PCOS and pre-eclampsia. CONCLUSIONS: In this study, a history of PCOS was not associated with the risk of pre-eclampsia. Further investigation is necessary to determine whether there are subgroups of PCOS patients who are at increased risk of pre-eclampsia.

The enduring impact of birth: Women's birth perceptions, postpartum depressive symptoms, and postpartum depression risk.

BACKGROUND: Postpartum depression (PPD) and related maternal mood disorders affect anywhere from 7% to 19% of postpartum women. Although historically a neglected issue, there has been a strong impetus in the past few decades to implement routine, universal screening and to address PPD as a major public health concern. Still, there has been relatively little analysis of how the quality of the birth experience influences subsequent maternal mental health. We examine the relationship between perceived birth experience and two PPD screeners (Edinburgh Postnatal Depression Scale and Postpartum Depression Screening Scale). METHODS: Data came from waves I and II of the Listening to Mothers data set. This is the only national survey of US women's childbirth and postpartum experiences. In logistic and linear regression models, we used a 12-item "feeling" index (perceived birth experience) to predict (a) overall PPD screener scores, and (b) likelihood of meeting the clinical cutoff for depression risk. We also controlled for other known socio-demographic and obstetric risk factors. RESULTS: Perceived birth experience strongly and consistently predicted both PPD screener measures, and in both forms-raw scores and clinical cutoffs. By contrast, other known risk factors had inconsistent results across the two screeners. DISCUSSION: Perceived birth experience should be considered more central in assessing PPD. It may also be more robust than the PPD screeners used in practice, and therefore, could be a more reliable predictor of PPD. Providers should consider how the improved social-psychological quality of women's birth experience can act as a buffer to PPD and other postpartum concerns.

Risk-Factor Based Lead Screening and Correlation with Blood Lead Levels in Pregnancy.

OBJECTIVES: Lead exposure has devastating neurologic consequences for children and may begin in utero. The American College of Obstetricians and Gynecologists recommends prenatal lead screening using a risk factor-based approach rather than universal blood testing. The clinical utility of this approach has not been studied. We evaluated a risk-factor based questionnaire to detect elevated blood lead levels in pregnancy. METHODS: We performed a secondary analysis of a cohort of parturients enrolled to evaluate the association of lead with hypertensive disorders of pregnancy. We included participants in this analysis if they had a singleton pregnancy ≥ 34 weeks' gestation with blood lead levels recorded. Participants completed a lead risk factor survey modified for pregnancy. We defined elevated blood lead as ≥ 2 µg/dL, as this was the clinically reportable level. RESULTS: Of 102 participants enrolled in the cohort, 92 had blood lead measured as part of the study. The vast majority (78%) had 1 or more risk factor for elevated lead using the questionnaire yet none had clinical blood lead testing during routine visits. Only two participants (2.2%) had elevated blood lead levels. The questionnaire had high sensitivity but poor specificity for predicting detectable lead levels (sensitivity 100%, specificity 22%). CONCLUSIONS FOR PRACTICE: Prenatal risk-factor based lead screening appears underutilized in practice and does not adequately discriminate between those with and without elevated blood levels. Given the complexity of the risk factor-based approach and underutilization, the benefit and cost-effectiveness of universal lead testing should be further explored.

Relationship between Perceived Quality of Prenatal Care and Maternal/Infant Health Outcomes.

OBJECTIVES: Studies have shown that quality of care affects patient health outcomes and well-being. In this study, we examine the relationship between perceived quality of prenatal care, birth outcomes, and postpartum depression (PPD). METHODS: We use data from the third wave of the Listening to Mothers dataset (2013). After removing missing data, the analytic sample size included 2168 women. Through linear and logistic regression analyses, we test the following hypotheses: higher perceived quality of prenatal care will have a positive association with a likelihood of vaginal delivery and normal birth weight outcomes, and a negative association with a likelihood of preterm birth; and higher perceived quality of prenatal care will have a negative association with a likelihood of PPD risk. RESULTS: Women who perceived higher quality of prenatal care were significantly less likely to have a preterm birth relative to women who reported lower quality care. Women who reported (any) medical jargon during their prenatal visits were less likely to have a normal birth weight baby. Women who reported provider use of medical jargon, lower perceived quality of interaction with a prenatal care provider, and lower perceived quality of US maternity care in general were more likely to be at risk for PPD. CONCLUSIONS: Negative prenatal care experiences may exacerbate adverse patient outcomes. Positive prenatal care experiences may buffer/improve adverse outcomes. Quality of care measures were most consistently predictive of PPD outcomes. Providers should focus on improving the quality of prenatal care as one of the means to improve maternal and infant health and well-being.

Special Report of the Society for Maternal-Fetal Medicine Placenta Accreta Spectrum Ultrasound Marker Task Force: Consensus on definition of markers and approach to the ultrasound examination in pregnancies at risk for placenta accreta spectrum.

Placenta accreta spectrum includes the full range of abnormal placental attachment to the uterus or other structures, encompassing placenta accreta, placenta increta, placenta percreta, morbidly adherent placenta, and invasive placentation. The incidence of placenta accreta spectrum has increased in recent years, largely driven by increasing rates of cesarean delivery. Prenatal detection of placenta accreta spectrum is primarily made by ultrasound and is important to reduce maternal morbidity associated with the condition. Despite a large body of research on various placenta accreta spectrum ultrasound markers and their screening performance, inconsistencies in the literature persist. In response to the need for standardizing the definitions of placenta accreta spectrum markers and the approach to the ultrasound examination, the Society for Maternal-Fetal Medicine convened a task force with representatives from the American Institute of Ultrasound in Medicine, the American College of Obstetricians and Gynecologists, the American College of Radiology, the International Society of Ultrasound in Obstetrics and Gynecology, the Society for Radiologists in Ultrasound, the American Registry for Diagnostic Medical Sonography, and the Gottesfeld-Hohler Memorial Ultrasound Foundation. The goals of the task force were to assess placenta accreta spectrum sonographic markers on the basis of available data and expert consensus, provide a standardized approach to the prenatal ultrasound evaluation of the uterus and placenta in pregnancies at risk of placenta accreta spectrum, and identify research gaps in the field. This manuscript provides information on the Placenta Accreta Spectrum Task Force process and findings.

Placenta Accreta Spectrum: In Vitro Fertilization and Non-In Vitro Fertilization and Placenta Accreta Spectrum in a Massachusetts Cohort.

OBJECTIVE: The incidence of placenta accreta spectrum (PAS) has been increasing in the United States. In addition, there has also been an increase in the utilization of in vitro fertilization (IVF). The IVF pregnancies confer an increased risk of adverse obstetric and neonatal outcomes, but there is limited data on whether IVF is associated with PAS. The aim of this study is to assess the association between IVF and the risk of PAS. STUDY DESIGN: This was a retrospective cohort study of deliveries from January 1, 2013 to August 1, 2018 at a tertiary hospital in the Massachusetts. IVF pregnancies were compared with non-IVF pregnancies, and PAS diagnosis was confirmed by histopathology reports. Hospital administrative data and medical record review were used, and supplemented with data from birth certificates from the Massachusetts Department of Public Health. RESULTS: We identified 28,344 pregnancies that met inclusion criteria, of which 1,418 (5.0%) were IVF pregnancies. The overall incidence of PAS was 0.4% (2.2% in the IVF group and 0.3% in the non-IVF group). Women who underwent IVF had 5.5 times the risk of PAS (95% confidence interval [CI]: 3.4-8.7) compared with women in the non-IVF group, adjusted for maternal age, nulliparity, and year of delivery (Table 5). Compared with women in the non-IVF group, the IVF group had fewer prior cesarean deliveries (22.6 vs. 64.2%) and a lower prevalence of placenta previa (19.4 vs. 44.4%). CONCLUSION: Women with an IVF pregnancy carry an increased risk of PAS compared with non-IVF. Among women who underwent IVF, there was a lower prevalence of prior cesarean deliveries and placenta previa. Future work is needed to identify the mechanism of association for this increased risk as well as a reliable tool for antenatal detection in this cohort of women. KEY POINTS: · IVF pregnancies have higher risk of PAS than non-IVF pregnancies.. · IVF pregnancies with PAS do not exhibit common risk factors.. · IVF may be an independent risk factor for PAS..

Degrees of Medicalization: The Case of Infertility Health-Seeking.

We examine responses to infertility among a sample of 2,361 women with infertility from the National Survey of Fertility Barriers. Latent class analysis uncovered seven latent classes of behavioral response which can be arranged in a rough continuum from least medicalized to most medicalized response. We then aggregated these seven categories into three schemas representing various degrees of medicalization. Women in each class combine treatment-seeking, knowledge-seeking, socio-emotional support seeking, and non-medical solution-seeking strategies. Even women pursuing the greatest degree of medicalization in their health-seeking (e.g., fertility treatments, assisted reproduction) made use of a variety of medical and non-medical health-seeking resources.

Risk of ischemic placental disease is increased following in vitro fertilization with oocyte donation: a retrospective cohort study.

PURPOSE: Assess the risk of ischemic placental disease (IPD) among in vitro fertilization (IVF; donor and autologous) pregnancies compared with non-IVF pregnancies. METHODS: This was a retrospective cohort study of deliveries from 2000 to 2015 at a tertiary hospital. The exposures, donor, and autologous IVF, were compared with non-IVF pregnancies and donor IVF pregnancies were also compared with autologous IVF pregnancies. The outcome was IPD (preeclampsia, placental abruption, small for gestational age (SGA), or intrauterine fetal demise due to placental insufficiency). We defined SGA as birthweight < 10th percentiles for gestational age and sex. A secondary analysis restricted SGA to < 3rd percentile. RESULTS: Of 69,084 deliveries in this cohort, 262 resulted from donor IVF and 3,501 from autologous IVF. Compared with non-IVF pregnancies, IPD was more common among donor IVF pregnancies (risk ratio (RR) = 2.9; 95% CI 2.5-3.4) and autologous IVF pregnancies (RR = 2.0; 95% CI 1.9-2.1), adjusted for age and parity. IVF pregnancies were more likely to be complicated by preeclampsia (donor RR = 3.8; 95% CI 2.8-5.0 and autologous RR = 2.2; 95% CI 2.0-2.5, adjusted for age, parity, and marital status), placental abruption (donor RR = 3.8; 95% CI 2.1-6.7 and autologous RR = 2.5; 95% CI 2.1-3.1, adjusted for age), and SGA (donor RR = 2.7; 95% CI 2.1-3.4 and autologous RR = 2.0; 95% CI 1.9-2.2, adjusted for age and parity). Results were similar when restricting SGA to < 3rd percentile. CONCLUSION: Pregnancies conceived using donor IVF and autologous IVF were at higher risk of IPD and its associated conditions than non-IVF pregnancies and associations were consistently stronger for donor IVF pregnancies.

'Just because a doctor says something, doesn't mean that [it] will happen': self-perception as having a Fertility Problem among Infertility Patients.

Only some individuals who have the medically defined condition 'infertility' adopt a self-definition as having a fertility problem, which has implications for social and behavioural responses, yet there is no clear consensus on why some people and not others adopt a medical label. We use interview data from 28 women and men who sought medical infertility treatment to understand variations in self-identification. Results highlight the importance of identity disruption for understanding the dialectical relationship between medical contact and self-identification, as well as how diagnosis acts both as a category and a process. Simultaneously integrating new medical knowledge from testing and treatment with previous fertility self-perceptions created difficulty for settling on an infertility self-perception. Four response categories emerged for adopting a self-perception of having a fertility problem: (i) the non-adopters - never adopting the self-perception pre- or post-medical contact; (ii) uncertain - not being fully committed to the self-perception pre- or post-medical contact; (iii) assuming the label - not having prior fertility concerns but adopting the self-perception post-medical contact; and (iv) solidifying a tentative identity - not being fully committed to a self-perception pre-medical contact, but fully committed post-medical contact. (A virtual abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA).

Contingent maternities? Maternal claims-making in third party reproduction.

The new reproductive technologies have significantly impacted definitions of motherhood. Historically, mothers were defined through the act of giving birth, but egg donation, embryo donation, and surrogacy disrupt this. Now multiple women can potentially claim maternity through gestational, genetic, legal, and social ties. Although there is some legal precedent for designating parentage, there is no simple solution to identify the 'true' mother. I address maternal claims-making in third party reproduction via a content analysis of US patient literature for infertile women. Major tensions arise over which link to privilege, especially regarding genetic versus gestational ties in egg donation versus surrogacy; however, adding embryo donation to the analysis illuminates another crucial dimension previously overlooked - that heterosexual women's maternal claims are supported by their partner's paternity claims. Ultimately, I argue that although reproductive organisational discourse carefully constructs credible options for maternal claims-making, contemporary reproductive medicine does not define maternity through assisted reproduction as a truly autonomous connection. Rather, maternity is highly contingent and thus potentially discreditable.

Amount, Source, and Quality of Support as Predictors of Women's Birth Evaluations.

BACKGROUND: This paper examines the separate effects of the perceived amount, source, and quality of support during labor and delivery on women's positive and negative evaluations of their birth experiences. METHODS: Data come from the Listening to Mothers I and II (LTM) surveys (n = 2,765). Women's perception of support was regressed separately onto indices of positive and negative words that women associated with their labor and delivery. RESULTS: The total number of support sources, type of support person, and quality of support all impacted women's birth evaluations across different regression models, controlling for demographics, birth interventions, and other birth characteristics. Support overall had a greater effect on increasing women's positive evaluations, but was not as protective against negative evaluations. Support from medical and birth professionals (doctors, nurses, doulas) had the greatest effect on women's positive evaluations. Good partner support was complexly related: it was associated with less positive evaluations but also appeared to have a protective effect against negative birth evaluations. DISCUSSION: Support in childbirth is a complex concept with multiple dimensions that matter for women's birth evaluations. Support from nursing staff, doctors, and doulas is important for enabling positive evaluations while support from partners is more complexly related to women's evaluations. Research on support for laboring women should more extensively address the division of labor between different sources of support.

Research on Black Women and Breastfeeding: Assessing Publication Trends (1980-2020).

Background: Research on race/ethnicity and breastfeeding has consistently found lower rates for Black mothers compared with other U.S. women, due to various social, cultural, and historical factors. Aggregate analyses illuminate racial/ethnic differences, but they only provide partial insight into the factors contextualizing breastfeeding decisions and rates. We examined articles addressing Black women and breastfeeding (1980-2020) to assess publication trends. Materials and Methods: A targeted literature search in PubMed for research on Black women and breastfeeding (1980-2020). The search used nine different keyword combinations: ("breastfeeding" OR "lactation" OR "infant feeding,") AND ("rac*" OR "African American" OR "Black"). After removing duplicates, non-U.S. research, and irrelevant articles, 221 articles were reviewed. Articles were coded for year, type (quantitative, qualitative, mixed method, conceptual/literature review, commentary/editorial), and journal target audience (e.g., nursing). Results: More than 50% of all articles were published after 2013. The period of 2018-2020 accounts for 25% of all published articles. The research is also mostly quantitative (60.2%). Qualitative studies made up only 16.7% of articles. A few studies used mixed methods (5%). More than half of all qualitative studies were published after 2014. Conclusions: Research on Black women and breastfeeding has slowly increased since 1980, but much of the work has only been done post-2000. Research is also mostly quantitative analyses. Quantitative and qualitative methods rely on different research aims, styles, and objectives. To provide a fuller understanding of Black women's relationship to and experience of breastfeeding, we suggest that scholars cultivate a stronger focus on qualitative and mixed methods for future research.

Clinician communication after discovery of a soft marker of aneuploidy during pregnancy: A mixed methods assessment of a communication workshop.

BACKGROUND: Soft markers of aneuploidy are common findings on obstetric ultrasounds but disclosure often increases patient anxiety. It is unknown whether communication training affects patient experience of soft marker disclosure. Our objective was to evaluate clinician experience of a simulation-based communication workshop and assess workshop influence on patient anxiety, understanding, and perception of communication quality. METHODS: We implemented a communication workshop for clinicians at an academic institution in 2019, and assessed clinician anxiety and confidence with counseling before and after. To assess effect of the workshop on patients, we surveyed pregnant people before and after workshop implementation for whom an echogenic intracardiac focus, choroid plexus cyst, or urinary tract dilation was identified. The primary outcome was anxiety. Some respondents completed a semi-structured interview. Interviews were analyzed using thematic analysis. RESULTS: Twelve clinicians participated. Twenty-one out of 49 eligible patients (43%) completed a survey before the workshop and 40 out of 90 eligible patients (44%) completed a survey after. The risk of high anxiety after was similar to before the workshop (aRR 1.7, 95% CI 0.6-4.2). Twenty patients were recruited for an interview. Qualitative analysis revealed that patients' backgrounds, emotional impact of the conversation and clinician manner influenced perception of communication quality. CONCLUSION: While a single clinician workshop did not affect patient anxiety, clinician manner and personalization play a large role in perception of counseling about soft markers of aneuploidy.

Ectopic expression of DOCK8 regulates lysosome-mediated pancreatic tumor cell invasion.

Amplified lysosome activity is a hallmark of pancreatic ductal adenocarcinoma (PDAC) orchestrated by oncogenic KRAS that mediates tumor growth and metastasis, though the mechanisms underlying this phenomenon remain unclear. Using comparative proteomics, we found that oncogenic KRAS significantly enriches levels of the guanine nucleotide exchange factor (GEF) dedicator of cytokinesis 8 (DOCK8) on lysosomes. Surprisingly, DOCK8 is aberrantly expressed in a subset of PDAC, where it promotes cell invasion in vitro and in vivo. DOCK8 associates with lysosomes and regulates lysosomal morphology and motility, with loss of DOCK8 leading to increased lysosome size. DOCK8 promotes actin polymerization at the surface of lysosomes while also increasing the proteolytic activity of the lysosomal protease cathepsin B. Critically, depletion of DOCK8 significantly reduces cathepsin-dependent extracellular matrix degradation and impairs the invasive capacity of PDAC cells. These findings implicate ectopic expression of DOCK8 as a key driver of KRAS-driven lysosomal regulation and invasion in pancreatic cancer cells.