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(BJOG. 2022;129:9–20)Although ~3.8 million people have children per year, few people have researched postpartum recovery. This may be because tools developed to measure postpartum recovery, such as the Obstetric Quality of Recovery instrument, have not been used, validated, or developed sufficiently. The authors of this study previously created a list of domains they considered valuable to postpartum recovery, but had not determined which are important to stakeholders, postpartum individuals, obstetricians, maternal and fetal medicine specialists, nurses, and obstetric anesthetists. This study aimed to identify and propose a list of domains, rank these domains based on perspectives and feedback from stakeholders, identify factors that positively and negatively impact postpartum recovery, and establish the greatest difficulties individuals face after childbirth through concept elicitation interviews and focus group meetings.

Health researchers and policy-makers increasingly urge both patient and clinician engagement in shared decision making (SDM) to promote patient-centered care. Although SDM has been examined in numerous clinical settings, it has received little attention in solid organ transplantation. This paper describes the application of SDM to the kidney transplantation context. Several distinctive features of kidney transplantation present challenges to SDM including fragmented patient–provider relationships, the time-sensitive and unpredictable nature of deceased organ offers, decision-making processes by transplant providers serving as both organ guardians (given the organ scarcity) versus advocates for specific patients seeking transplantation, variable clinical practices and policies among transplant centers, and patients’ potentially compromised cognitive status and literacy levels. We describe potential barriers to and opportunities for SDM, and posit that SDM is feasible, warranting encouragement in kidney transplantation. We propose strategies to promote and overcome obstacles to SDM in kidney transplantation. We contend that engagement in SDM can be facilitated by re-organization of clinical care, communication and education of providers and patients.

We report theory and observations of paramagnetic resonance in a measured field gradient of 44,000 T per meter by the technique of magnetic resonance force microscopy (MRFM). Resonance was induced in a dilute solid solution of diphenylpicrylhydrazyl in polystyrene at 77 and 10 K by an amplitude-modulated microwave field. This modulated the force between resonant sample spins and a micrometer-scale SmCo magnetic tip on a force microscope cantilever. The force signals were typically of order 10 fN, and were detected above a thermal noise floor of 80 aN per root hertz at 10 K, equivalent to a magnetic moment noise of 200 μBper root hertz of bandwidth. Resonance saturation was readily observed. Starting with the Bloch equations, we derived simple analytic expressions for the predicted cantilever signal amplitudes and T1-dependent phase lags, valid at low microwave power levels. For power levels below saturation, the data were in good agreement with the Bloch equation predictions, while above saturation the measured force increased more slowly with power than predicted. Several ESR mechanisms which might lead to non-Bloch dynamics in the MRFM environment are reviewed. Spin-relaxation mechanisms are also reviewed. A detailed description of the experimental apparatus is offered.

Background Left ventricular (LV) systolic and diastolic function are known to be affected in the wake of a myocardial infarction (MI). @b-Adrenergic blocking agents have demonstrated improvement of LV systolic and diastolic function in patients with dilated cardiomyopathy and theoretically would have same beneficial effects in MI. @b-Adrenergic blocking agents are widely used in MI; however only few reports on changes of LV systolic and diastolic function during long-term treatment after acute MI are available. Methods Two-dimensional and Doppler echocardiography were used to evaluate LV diastolic filling in 77 patients randomly assigned to placebo (n = 38) or metoprolol (n = 39). The patients were randomly assigned at day 5 to 7 (baseline) after acute MI and were treated for 12 months. LV diastolic filling was assessed by pulsed Doppler measurements of transmitral and pulmonary venous flow. Results Mitral E-wave deceleration time was prolonged in the metoprolol group (baseline vs 12 months: 167 +/- 51 ms to 218 +/- 36 ms; P = .01) versus the placebo group (baseline vs 12 months: placebo 174 +/- 46 ms to 189 +/- 41 ms), which implies a less restrictive filling of the LV in the metoprolol group. This was supported by a decrease of E/A ratio (baseline vs 12 months: placebo, 1.06 +/- 0.40 to 0.96 +/- 0.29; metoprolol, 1.09 +/- 0.33 to 0.80 +/- 0.21; P = .05) and prolongation of the isovolumetric relaxation time in the metoprolol treated group (baseline vs 12 months: placebo, 83 +/- 19 ms to 95 +/- 20 ms; metoprolol, 82 +/- 23 ms to 117 +/- 22 ms; P = .01). The difference between mitral A wave and pulmonary venous flow reversal duration was significantly changed during follow-up (baseline vs 12 months: placebo, 22 +/- 11 ms to 24 +/- 11; metoprolol, 11 +/- 21 to 32 +/- 17 ms; P = .02). Patients with normal LV filling pattern at baseline in the metoprolol group preserved a normal LV filling pattern during the study, and patients with restrictive LV filling pattern in the metoprolol group had a nonrestrictive LV filling pattern develop. Maximal or near maximal changes of the diastolic Doppler measurements occurred by 3 months of follow-up, whereas a significant increase in LV ejection fraction was noted after 12 months treatment with metoprolol. Conclusions Long-term treatment with the @b-blocking agent metoprolol seems to improve LV diastolic filling after acute MI. Less restrictive LV filling was noted during @b-blockade indicated by a significant prolongation of the mitral E deceleration time, which was predominantly noted in patients with restrictive LV filling. This observation might have prognostic implications because this LV filling pattern is known to be associated with poor outcome. The changes of LV diastolic filling occurred during the first 3 months, whereas systolic recovery was seen at up to 12 months of treatment. (Am Heart J 1999;138:710-20.)

The structure of the plasmid-mediated β-lactamase TEM-1 has been solved in complex with a designed boronic acid inhibitor (1R)-1-acetamido-2-(3-carboxyphenyl)ethane boronic acid at 1.7 Å resolution. The boronate inhibitor was designed based on the crystallographic coordinates of the acyl-enzyme intermediate of TEM-1 bound to the substrate penicillin G. The boronate–TEM-1 complex is highly ordered and defines a novel transition state analogue of the deacylation step in the β-lactamase reaction pathway. The design principles of this highly effective inhibitor (Ki=110 nM) and the resulting structural and mechanistic implications are presented.

In this paper we have described some aspects of the LSD-25 treatment given to alcoholics in Weyburn, Saskatchewan. The three main therapeutic reactions discussed are (1) abreaction, (2) the transcendental experience and (3) break-down of inappropriate defence mechanisms. Some case histories are given to illustrate these therapeutic reactions and to give an idea of the kind of person who can be helped by this type of therapy. Some results of the work done at Weyburn are quoted and it is considered that they are quite encouraging. It is stressed that although only the LSD-25 therapy is discussed here, the total therapeutic situation contributed to the results.