Objective To explore and describe what women who have given birth in Norway emphasise as important aspects of care during childbirth. Design The study is based on data from the Babies Born Better survey, version 2, a mixed-method online survey. Setting The maternity care system in Norway. Study population Women who gave birth in Norway between 2013 and 2018. Method Descriptive statistics were used to describe sample characteristics and to compare data from the B3 survey with national data from the MBRN, using SPSS® software (version 20). The open-ended questions were analysed with an inductive thematic analysis, using NVIVO 12® software. Main outcome measures Themes developed from two open-ended questions. Results The final sample included 8,401 women. There were no important differences between the sample population and the national population with respect to maternal age, marital status, parity, mode of birth and place of birth, except for the proportion of planned homebirths. Four themes and one overarching theme were identified; Compassionate and Respectful Care, A Family Focus, Continuity and Consistency, and Sense of Security, and the overarching theme Coherence in Childbearing. Conclusions Socio-cultural and psychological aspects of care are significant for women in childbirth, alongside physical and clinical factors. Caring for the woman implies caring for her partner and having a baby is about ‘becoming a family or expanding the family’. Childbirth is a continuous experience in women’s lives and continuity and consistency are important for women to maintain and promote a coherent experience.

L’elaborato ha il compito di descrivere come l’ossigeno disciolto nei corsi d’acqua sia un parametro estremamente rilevante per la caratterizzazione qualitativa del comparto idrico. Dopo aver fatto una panoramica dal punto di vista normativo che contraddistingue tale comparto e aver descritto brevemente le tipologie di analisi che lo caratterizzano, ci si è focalizzati sulla caratterizzazione qualitativa dell’acqua. Tale caratterizzazione è stata effettuata descrivendola in primis dal punto di vista normativo, sia europeo che nazionale e successivamente individuando un indicatore, l'ossigeno disciolto, per determinare la qualità. Infine, utilizzando sempre come punto di riferimento l’ossigeno si è descritto brevemente due modelli utilizzati per la modellazione qualitativa dei corsi d’acqua: il Modello Streeter & Phelps e il Modello Qual2k.

A document by Hamada Masaaki. Click on the document to view its contents.

Consumption of Japanese cuisine, such as sushi and sashimi, is accompanied by the risk of food poisoning through various pathogens. Kudoa hexapunctata, detected in both adult and juvenile Pacific bluefin tuna, causes foodborne diseases. Here, we report cases of food poisoning after Kudoa hexapunctata-infected PBT consumption.

Sexual dysfunction (SD) is a common side effect of antipsychotics. The community pharmacist assessed a patient with SD and suggested a change in prescription from risperidone and haloperidol to aripiprazole that improved SD. This is the first report on amelioration of antipsychotic-induced SD by early intervention by community pharmacists.

New-onset DM or unmasking existing one, with or without metabolic complications, has been reported in SARS CoV-2 infection. New-onset DM in association with HHS alone or combination with DKA is uncommon but a possible manifestation of SARS CoV-2 infection that poses management challenges where the outcome may be worst.

A document by Angel Mazon. Click on the document to view its contents.

Rapidly expanding thyroid lesions with tracheal invasion are typical characteristics of anaplastic and high-grade thyroid carcinomas. However, primary thyroid lymphoma (PTL) must also be considered as a differential. We present a rare case of PTL with direct invasion and compression of the trachea resulting in pulmonary oedema and cardiomyopathy.

Differentiation of hypertrophic cardiomyopathy phenotypes is challenging but crucial for appropriate management. We report a case of myocardial oxalate deposition as an unfrequent cause of infiltrative cardiomyopathy.

Relatedness (rxy) measures are useful in molecular ecology studies as they can provide a means to answer biological hypotheses where pedigree information is valuable. Our understanding of the reproductive ecology of the threatened amphibian Litoria aurea is not complete where applying rxy measurements may provide further elucidation. Here we use SNPs to identify which rxy estimators (or combination of) most precisely assign relationships in L. aurea tadpoles to determine how many breeding pairs contribute to producing propagules in explosive breeding events. We aimed to (1) use simulated L. aurea genotype data to determine the precision of six rxy estimators, (2) compare the precision of relationship assignment thresholds between rxy estimators computed by discriminant function analysis (DFA) and test if using multiple estimators improved precision, and (3) Apply the best performing DFA model to assign relationships in wild tadpoles to quantify how many mating pairs reproduced in explosive breeding events. We hypothesised that each tadpole cohort produced during explosive breeding events would be conceived by >|2| mating pairs. The triadic maximum likelihood estimator had the highest Pearson’s R2 (0.92) and the lowest amount of misclassifications in the DFA (16.00%). A multi-variate DFA that included three rxy estimators further reduced the misclassifications down to 11.88%. There was evidence that more than one mating pair contributed to each explosive breeding event (n = 11). We show that the multi-variate DFA enabled precise relationship classification of free-living tadpoles which improved knowledge on amphibian reproductive ecology. We recommend this method for relationship assignments in SNP genotyped datasets.

The main strategy for animal diversity conservation is to increase the territory size but little consideration is given to habitat characteristics requirement, which lead to a decrease in effectiveness for protected areas. Marginal of protected areas are considered to have higher species richness due to the edge effect. Strategy in these sites are still adopts to increase territory size or pay no attention to needs of specific habitat characteristics that is an important topic for the planner and manager. In this study, camera traps was used to estimate composition, diversity and habitat characteristics of mammals in a non-protected area near Huangshan Mountains in Anhui Province, China. We ran 49 liner models with the relative abundance index and 13 habitat characteristic factors of 11 mammals. To answer the question of habitat characteristics or territory size: which is more important to composition and diversity of mammals in non-protect area? We hypothesized that: (1) Non-protected areas have more mammal species than protected areas with the edge effect. (2) Non-protected areas have more species associated with habitat characteristics. We predicted that the habitat characteristics should be firstly considered, territory size secondly in non-protected areas, would provide a last refuge for mammals. Cameras were operated from June 2017 to October 2019, for a total of 29 months, 2,212 independent photos, 9,485 trap-days, recorded 18 species of mammals more than any other protected areas confirmed first hypothesis 1. The model analysis results showed that, habitat characteristics of mammals were different and showed a significant correlation, supported hypothesis 2. In addition, most species are related to vegetation characteristics except to primates (Macaca. thibetana) and rodent (Leopoldamys edwardsi) confirmed our prediction. We suggested conservation policies in non-protected areas: Habitat characteristics should be concerned at first and then increasing protected areas to provide the last refuge for species conservation.

Introduction: Many children and adolescents who were vaccinated prior to cancer treatment lose humoral immunity after completion of therapy. Pediatricians and pediatric oncologists often recommend re-immunization, although there is little consensus on timing and approach to serologic testing. However, vaccine hesitancy in the U.S. is a growing problem. It is not known whether parents who initially permitted vaccination might demonstrate secondary hesitancy regarding re-immunization. Methods: We conducted a qualitative study to explore parental attitudes toward re-immunization after completion of cancer therapy. Twenty primary caregivers of current pediatric cancer patients participated in structured interviews exploring knowledge and understanding of immunity and vaccination; previous experiences with vaccines; and attitudes toward vaccines and revaccination. Results: Of those interviewed, 80% were female and 90% were White Non-Hispanic. Of interviewees’ children with cancer, 60% were male, 75% had been diagnosed within the past 6 months, and 45% had leukemia or lymphoma. All caregivers demonstrated a basic understanding of vaccination, but only 65% understood that it was possible to lose immunity even with previous vaccination. All caregivers were willing to have their children immunized if tests showed lack of humoral immunity, with 85% expressing a preference for testing prior to revaccination. Conclusions: Primary caregivers of children with cancer are willing to consider re-immunization interest but do express some secondary hesitancy and strongly prefer that the need for re-immunization be established via serologic testing, rather than performed empirically. Caregivers’ beliefs and preferences regarding re-immunization in pediatric oncology should be considered in the development of post-treatment guidelines.

Background: Low Grade Gliomas(LGG) account for about 50% of childhood brain tumors. Elevated citrate levels have previously been shown to be markers for aggressive behavior in LGGs and the H3K27M and G34R/V mutations have emerged as molecular drivers for pediatric high-grade gliomas(HGG). Procedure: We retrospectively analyzed data from 25 patients with midline gliomas to determine whether citrate levels measured through magnetic resonance spectroscopy(MRS) were associated with histone mutations identified by immunohistochemistry. Results: Median age was 6 years (range:0-16 years) with 13 males and 12 females. Most of the patients 14(56%) had a LGG with the most common locations being the thalamus 13(52%) and brainstem 7(28%). The majority had undergone a biopsy 16(65%) or a partial resection 8(32%). Gross total resection was achieved in only one patient(4%). The majority of the patients received adjuvant chemotherapy and/or radiotherapy. Median citrate levels trended higher in patients with HGG compared to those with LGG (1.49vs0.93mmol/kg, p-value=0.16) and in patients with the H3K27M mutation compared to those without (2.30vs0.80mmol/kg, p-value 0.26). Histological grading (LGGvsHGG) (OR: 3.96, 95% confidence interval (CI):1.32-11.94), H3K27M mutation (OR:3.77, 95% CI:1.05-13.61), and age (OR:1.12, 95%CI:1.00-1.25) were significant adverse prognostic factors in univariate analysis but only the histological grading remained significant in multivariate analysis. Conclusion: We determined that H3K27M mutations and elevated citrate levels were adverse prognostic factors in both patients with LGG and HGG. Exploring the relation between these two markers in larger studies could lead to a noninvasive way of predicting high risk behavior prior to biopsy.

AIM To explore the admission process to our Neonatal Intensive Care Unit. METHODS A first phase quality improvement initiative was conducted. We utilised observational video recording of a convenience sample of inborn admissions. Two remote GoPro cameras were placed, one giving an overview of activity and the other focussed on the infant. Recordings captured the first hour after admission including transfer to the NICU by the birthing team. The video footage of each case study was reviewed by a multidisciplinary panel using an agreed semi quantitative analysis of events. RESULTS Ten admissions to the NICU were video recorded between June and October 2018. Gestational age 282- 401. A focus on maintaining airway support was inconsistent as was the ability to provide continuous monitoring of vital signs. Overall leadership of the process was lacking, and handover often appeared fragmented. Median temperature on admission was 362 (354-373) oC. Vascular access and fluid management occurred at a median of 36 (13 – 67) minutes. CONCLUSIONS Planning and approval for this study was protracted, particularly negotiating the use of video recording. Anecdotally, this delay is thought to have contributed to an improvement in managing admissions, particularly when maintaining airway support and monitoring. However, our baseline data has highlighted a lack of leadership, fragmented handover, low admission temperatures and broad time frames to achieve vascular access. A guideline to streamline handover and nursery transition is currently being implemented, a subsequent evaluation cycle is planned.

A document by Gabriel Revon-Riviere. Click on the document to view its contents.

Complex lymphatic anomalies are congenital diseases of the lymphatic circulation system that are associated with significant morbidity and early mortality. While guidelines for the comprehensive evaluation of the complex lymphatic anomalies were recently published, the diagnostic approach and medical management are not standardized. The current manuscript presents the clinical features of 4 complex lymphatic anomalies: Gorham-Stout disease, generalized lymphatic anomaly, kaposiform lymphangiomatosis, and central collecting lymphatic anomaly. We also offer three cases from the authors’ practice and our views on diagnostic testing and disease management including supportive care, medical therapies and other interventions.

High-dose glucocorticoids are commonly used for a wide variety of childhood diseases. They are known to cause several side-effects by oral administration; nonetheless, side-effects associated with intravenous bolus are not well known1. Whereas a rise in blood pressure is a well-known side-effect of corticosteroid treatment, sinus bradycardia has been reported as another adverse effect of high-dose glucocorticoid therapy2. This effect mainly occurs in adults and few cases have been described in children. We report two cases of sinus bradycardia due to intravenous methylprednisolone administration in paediatric oncology patients and the approach we adopted for their resolution.

We report the electronic, elastic, mechanical, optical and magnetic properties of Rh2MnX (X=Ti, Hf, Sc, Zr, Zn) Heusler alloys performed within density functional theory (DFT). The generalized gradient approximation (GGA) was used for calculations in the context of the Perdew-Burke-Ernzerhof (PBE) exchange-correlation energy treatment. The computed elastic constants and elastic moduli show that all investigated alloys are mechanically stable and ductile. It has been found that the magnitudes of the theoretical Vickers hardness values of these alloys are in the range of Ti> Sc> Zr> Hf> Zn. Also, a typical metallic behavior is obtained for all alloys after agreement of mechanical, electronic and optical data. On the other side, all alloys show strong ferromagnetic ordering following the magnetic moment (B) rank of Ti > Zr > Hf > Sc > Zn. Our calculated B data also agree well with the former theoretical results of Rh2MnX (X=Ti, Hf, Sc, Zr, Zn) Heusler alloys.

The rapid evolution of Next Generation Sequencing in clinical settings and the resulting challenge of variants interpretation in the light of constantly updated information, requires robust data management systems and organized approaches to variant reinterpretation. In this paper, we present iVar: a freely available and highly customizable tool provided with a user-friendly web interface. It represents a platform for the unified management of variants identified by different sequencing technologies. iVar accepts, as input, VCF files and text annotation files and elaborates them, optimizing data organization and avoiding redundancies. Updated annotations can be periodically re-uploaded and associated to variants as historicize attributes. Data can be visualized through variant-centered and sample-centered interfaces. A customizable search functionality can be exploited to periodically check if pathogenicity related data of a variant are changed over time. Patient recontacting ensuing from variant reinterpretation is made easier by iVar through the effective identification of all patients present in the database and carrying a specific variant. We tested iVar by uploading 4171 VCF files and 1463 annotation files, obtaining a database of 4166 samples and 22569 unique variants. iVar has proven to be a useful tool with good performances for collecting and managing data from medium-throughput

Wiskott-Aldrich Syndrome (WAS) is an inherited disorder characterized by classical triad of eczema, micro-thrombocytopenia, and immune-deficiency. This disease affects all the three hematopoietic lineages to a variable extent. The spectrum of clinical and laboratory data for WAS has been well described in the literature though there is paucity of its histopathologic correlates. The current case describes the autopsy findings of a case of WAS with specific recognition of altered histology noticed in the lympho-reticular tissues- ‘the follicular dendritic cell (FDC)-only lymphoid follicles.’ The possible mechanisms of this altered histology has been discussed.

Neurologic complications after hematopoietic stem cell transplant (HSCT) in children are poorly described, but may contribute to morbidity and mortality. We retrospectively reviewed 261 patients who underwent allogeneic or autologous HSCT, of whom 57 had brain magnetic resonance imaging (MRI) post-transplant, and subsequently identified indications for imaging and determined correlation of findings with neurologic symptoms. Approximately half of imaging studies were done to investigate new neurologic symptoms; of those, 1/3 had acute findings on MRI that correlated with symptoms. Imaging done in patients at risk for neurologic processes but without active neurologic symptoms did not demonstrate acute or actionable findings.

Ataxia telangiectasia (A-T) is a rare childhood autosomal recessive neurodegenerative chromosomal instability disorder. It is characterized by high risk of hematological malignancies with T-cell phenotype being the most common, which can present first before the diagnosis of A-T made. The chromosomal instability in A-T increases the toxicity to radio- chemotherapeutic agents, creating the treatment modification challenges and the deviation from the optimal management protocols. In this case report we present a 14-month-old boy diagnosed as T cell –ALL. Based on his early presentation, family history of childhood lymphoma, and high AFP, inherited predisposition was suspected, and genetic testing confirm A-T. This report represents the crucial part of clinical suspicion of A-T in similar cases as well as highlighting the importance of an early A-T diagnosis that prevents toxic death due to the extensive regimen of radio- chemotherapeutic agents. The report summarizes the toxicity and modification challenges during management with literature review for the chemotherapy modification experience in such cases.

BACKGROUND: Medulloblastoma (MB), the most malignant brain tumor of childhood has survival outcomes exceeding 80% for standard risk and 60% for high risk patients in high-income countries (HIC). These results have not been replicated in low-to-middle income countries (LMIC), where 80% of children with cancer live. METHODS: Retrospective review of 114 children (3-18 years) diagnosed with MB from 1997 to 2016 at INCA. Data on patients, disease characteristics and treatment information were retrieved from the charts and summarized descriptively. Overall survival (OS) and event-free survival (EFS) were calculated using the Kaplan-Meier Method. RESULTS: The male/female ratio was 1.32 and the median age at diagnosis was 8.2 years. Headache (83%) and nausea/vomiting (78%) were the most common presenting symptoms. Overall survival (5y) was 59,1% and EFS (5y) was 58,4%. The OS for standard-risk patients was 69% and 53% for high-risk patients. Forty-five patients (35%) had metastatic disease at admission. Lower maternal education correlated with lower OS (71.3% versus 49% p=0.25). Patients who lived >40km from INCA fared better (OS= 68.2% versus 51.1% p=0.032). Almost 20% of families lived below the Brazilian minimum wage. CONCLUSIONS: The epidemiological characteristics of this series possibly explain the differences in survival that medulloblastoma patients have in Brazil. Issues related to limited health care resources, poverty, delayed diagnosis, treatment abandonment, and malnutrition are reflected in inferior survival outcomes when compared to high-income countries. Despite the difficulties encountered in an upper-middle income country, it was possible to deliver treatment with good results.

Microwave (MW) can selectively interact with polar molecules in homogeneous mixture liquid solution and therefore change their relative volatility, which has been previously observed in experimental results for various binary mixtures. However, the lack of theoretical analysis and quantitative modeling hinders the further development of novel MW-assisted separation techniques. Hence, this study derived a novel dimensionless number ZMW based on the assumption of molecular irradiation to explore the effect of the dielectric and thermodynamic properties of materials as well as MW field intensity on the microwave-induced relative volatility change (MIRVC). Furthermore, a quantitative correlation between MIRVC and ZMW was established, whose model parameters were determined by fitting experimental data under MW irradiation. The correlation was also utilized to predict MIRVC in the previously published literature and the error range between predictive values and experimental values was within ± 6%, indicating great validity of the proposed quantitative correlation.