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Photo-elicitation interview techniques, a method in which researchers incorporate images to enrich the interview experience, have been gaining traction in numerous spheres of research over the last two decades. Little is, however, written about the utility of the technique in studies involving vulnerable populations in clinical contexts. Drawing on research where researcher-generated photographs were used to elicit mothers’ experiences of pain and perceptions about use of pain-relieving strategies in critically ill infants, we aim to demonstrate (a) how the method can be used to generate harmonized and detailed accounts of experiences from diverse groups of participants of limited literacy levels, (b) the ethical and methodological consideration when employing photo-elicitation interview techniques and the (c) possible limitations of employing photo-elicitation interview techniques in clinical research.

Background: Family planning (FP) is a key intervention in improving maternal and child health. Hence, we assessed the factors associated with utilisation and unmet need for modern contraceptives among urban women in Kenya.Methods: The study used pooled data on 10,474 women 15–49 years from the seven rounds of the performance monitoring for accountability surveys collected between 2014 and 2018. The surveys were conducted in 11 of the 47 counties of Kenya using a multistage cluster design. Sample characteristics were described using frequencies and percentages while factors associated with utilisation and unmet need for modern contraceptives were assessed using multivariable logistic regressions.Results: The prevalence of modern contraceptives use and unmet need for FP among urban women in Kenya was 53.7% [95% confidence interval (CI) 52.1–55.3%] and 16.9% (15.8–18.1%), respectively. The use of modern contraceptive was associated with the county of residence, age, marital status, parity, education, household wealth quintile, exposure to media, and survey year. Teenagers, poorest urban women, women with no formal or primary level of education and those who seek services at a dispensary or health centres had higher odds of unmet need for FP while women who resided in Kitui and Nyamira counties had reduced odds of unmet need for FP. The odds of unmet need decreased with the survey year while that of modern contraceptive use had an inverse trend.Conclusion: Overall modern contraceptive use in urban areas is lower than the national average while the unmet need for FP is higher than national average, highlighting a potential urban-rural disparity in FP indicators in Kenya. Individual sociodemographic and socioeconomic and contextual factors are associated with the use of modern contraceptive and unmet need for FP among urban women in Kenya. Urban family planning policies and programmes in Kenya need to focus on strengthening urban healthcare systems to provide equal and accessible FP services, especially targeted towards teenagers and young women and those of low socioeconomic status.

Marlene O'Brien, Ankur Chandra Department of Surgery, Division of Vascular Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA Abstract: Despite a decline during the recent decades in stroke-related death, the incidence of stroke has remained unchanged or slightly increased, and extracranial carotid artery stenosis is implicated in 20%–30% of all strokes. Medical therapy and risk factor modification are first-line therapies for all patients with carotid occlusive disease. Evidence for the treatment of patients with symptomatic carotid stenosis greater than 70% with either carotid artery stenting (CAS) or carotid endarterectomy (CEA) is compelling, and several trials have demonstrated a benefit to carotid revascularization in the symptomatic patient population. Asymptomatic carotid stenosis is more controversial, with the largest trials only demonstrating a 1% per year risk stroke reduction with CEA. Although there are sufficient data to advocate for aggressive medical therapy as the primary mode of treatment for asymptomatic carotid stenosis, there are also data to suggest that certain patient populations will benefit from a stroke risk reduction with carotid revascularization. In the United States, consensus and practice guidelines dictate that CEA is reasonable in patients with high-grade asymptomatic stenosis, a reasonable life expectancy, and perioperative risk of less than 3%. Regarding CAS versus CEA, the best-available evidence demonstrates no difference between the two procedures in early perioperative stroke, myocardial infarction, or death, and no difference in 4-year ipsilateral stroke risk. However, because of the higher perioperative risks of stroke in patients undergoing CAS, particularly in symptomatic, female, or elderly patients, it is difficult to recommend CAS over CEA except in populations with prohibitive cardiac risk, previous carotid surgery, or prior neck radiation. Current treatment paradigms are based on identifying the magnitude of perioperative risk in patient subsets and on using predictive factors to stratify patients with high-risk asymptomatic stenosis. Keywords: carotid stenosis, carotid endarterectomy, carotid stent

We report our analysis of the stability of pulsation periods in the DAV star (pulsating hydrogen atmosphere white dwarf) ZZ Ceti, also called R548. Based on observations that span 31 years, we conclude that the period 213.132605 s observed in ZZ Ceti drifts at a rate dP/dt≤(5.5±1.9)×10−15 s/s, after correcting for proper motion. Our results are consistent with previous Ṗ values for this mode and an improvement over them due to the larger time-base. The characteristic stability timescale implied for the pulsation period is |P/ Ṗ|≥1.2 Gyr, comparable to the theoretical cooling timescale for the star. Our current stability limit for the period 213.132605 s is only slightly less than the present measurement for G117-B15A for the period 215.2 s, another DAV, establishing this mode in ZZ Ceti as the second most stable optical clock known, more stable than atomic clocks and most pulsars.

Full-wave simulations are performed in order to investigate the interaction of plasma density perturbations and microwaves. The perturbations are divided into two cases: A single blob-like structure and a fully turbulent density profile. The resulting scattering of a microwave beam and the effect on the O–X mode conversion are presented for both cases. Quantitative analyses are performed as a function of the average size and position of the perturbations. The usage of spatial coordinates normalized to the vacuum wavelength of the microwave allows to easily adopt the results to a specific problem.

Abstract Background There is a rapid decline in moderate-to-vigorous physical activity (MVPA) during middle childhood and adolescence. Information on the environmental factors implicated in this decline is limited. This study focuses on family factors associated with the rate of decline in objectively measured physical activity during middle childhood and adolescence. Methods Longitudinal analysis of 801 participants from 10 US sites in the NICHD Study of Early Child Care and Youth Development whose data included accelerometer-determined levels of moderate-to-vigorous physical activity (MVPA) between ages 9 and 15 years, as well as family process, BMI and demographic information. The sample included an even split of boys (49%) and girls (51%), was predominantly white (77%), and contained about 26% low income and 19% single parent families. The outcome measure was mean MVPA. It was based on 4 to 7 days of monitored physical activity. Results Boys with lower parental monitoring scores and more days of parental encouragement had significantly more minutes of MVPA at age 9 years. The effect of parental monitoring, however, was moderated by early puberty. High parental monitoring was associated with decreased activity levels for boys experiencing later puberty and increased activity for boy experiencing early puberty. Minutes of MVPA for boys living in the Midwest decreased at significantly faster rates than boys living in any other region; and boys in the South declined faster than boys in the West. Girls in the Midwest and South declined faster than girls in the West and Northeast. Among girls, more days of parental exercise and transportation to activities were associated with more MVPA per day at age 9. However, more parental transportation to activities and less monitoring was associated with faster linear declines in daughters' MVPA between the ages of 9 and 15 years. For girls who experienced puberty early, parental encouragement was associated with more MVPA. Conclusions Parenting processes, such as monitoring and encouragement, as well as the parents' own level of physical activity, showed significant, but small, gender-specific associations with MVPA levels at age nine and the linear rate of decline in MVPA between ages 9 and 15.

Abstract Introduction The term "intracystic papillary ductal carcinoma in situ" has recently changed and is now more appropriately referred to "intracystic papillary carcinoma". Intracystic papillary carcinoma in men is an extremely rare disease with only a few case presentations published in the literature so far. Case presentation We discuss a case of a 44-year-old Caucasian man with an intracystic papillary carcinoma treated with simple mastectomy, sentinel lymph-node biopsy and contralateral risk-reducing mastectomy. These were followed by adjuvant radiotherapy of the breast. Conclusion Triple assessment (i.e. clinical examination and radiological and histological assessment) with a high level of clinical suspicion is necessary to diagnose intracystic papillary carcinoma in men due to its rarity. Furthermore, genetic testing and risk-reducing mastectomy should also be considered in cases of a strong family history for male breast cancer.

Background: Within Europe, Roma, Gypsy, and Traveller groups have been marginalized and discriminated against by larger society. Persecution and displacement have resulted in high rates of unemployment, reduced access to education, and poorer health, with significantly increased risk of poverty compared with the general population. In pregnancy, there appears to be a gap in the literature surrounding the experiences and outcomes of pregnant people within these ethnic groups. Objectives: The aim of this study was therefore to scope published research, specifically questioning "What is the experience of Roma Gypsy and Traveller pregnant people who access maternity care?" and "What are the obstetric outcomes within these groups?" Search Strategy: This review followed frameworks proposed by Arksey and O'Malley, Levac, and the Joanna Brigg's Institute. The PRISMA extension for Scoping Reviews (PRISMA‐ScR) tool was used. The search strategy and specific terms were chosen using the population–concepts–context framework. Selection Criteria: Titles and abstracts were reviewed independently by two reviewers. Inclusion and exclusion criteria were defined to set clear guidance for reviewers to identify appropriate studies. Data Collection and Analysis: Five electronic databases were searched (CINAHL, EMBASE, MEDLINE [OVID] Web of Science and SCOPUS). A charting form was developed to record key characteristics systematically and uniformly from the studies. Main Results: Five themes were identified: systemic issues, antenatal care, complications of pregnancy, birth experience, and postnatal care. Systemic issues included racism, barriers to care, and adapted antenatal care. Antenatal issues included teenage pregnancy, smoking, risk of venous thrombus embolism, dietary issues, risk of communicable diseases, domestic violence, and mental health concerns. Increased risks of congenital abnormalities, growth restriction, premature labor, and perinatal and early childhood mortality were identified. For Roma women, negative birth experiences were reported, whereas the experiences of Traveller women varied. Conclusions: The findings identified in this study serve to create a framework upon which healthcare providers can tailor the way in which pregnant people from a Roma, Gypsy, or Irish Traveller background are cared for. Using such a framework would hopefully begin to reduce the systematic marginalization and discrimination of these minorities. Synopsis: Gypsy, Roma, and Traveller pregnant people suffer poor outcomes in pregnancy. The true extent of this is not known as they are underrepresented in research. [ABSTRACT FROM AUTHOR]

In this visionary conversation, Alexis Pauline Gumbs and M.E. O'Brien explore collective relations, liberatory practices and radical futures. Engaging with Black feminist theory, insurgent utopias, psychoanalytic insights, communist visions and poetic expressions, they connect the fields of race, symbolic exchange, social dreaming, speaking and listening, accountability, maternal practice, the family, poetic interventions, and envisioning through struggle. Together, they invite us all to conjure a world of shared imaginations and collective liberation. [ABSTRACT FROM AUTHOR]

Introduction: Psychological and psychosocial impacts of major trauma, defined as any injury that has the potential to be life-threatening and/or life changing, are common, far-reaching and often enduring. There is evidence that these aspects of major trauma care are often underserved. The aim of this research was to gain insight into the current provision and operationalisation of psychological and psychosocial aspects of major trauma care across the UK and Ireland. Methods: A cross-sectional online survey, open to health professionals working in major trauma network hospitals was undertaken. The survey had 69 questions across six sections: Participant Demographics, Psychological First Aid, Psychosocial Assessment and Care, Assessing and Responding to Distress, Clinical Psychology Services, and Major Trauma Keyworker (Coordinator) Role. Results: There were 102 respondents from across the regions and from a range of professional groups. Survey findings indicate a lack of formalised systems to assess, respond and evaluate psychological and psychosocial aspects of major trauma care, most notably for patients with lower-level distress and psychosocial support needs, and for trauma populations that don't reach threshold for serious injury or complex health need. The findings highlight the role of major trauma keyworkers (coordinators) in psychosocial aspects of care and that although major trauma clinical psychology services are increasingly embedded, many lack the capacity to meet demand. Conclusion: Neglecting psychological and psychosocial aspects of major trauma care may extend peritraumatic distress, result in preventable Years Lived with Disability and widen post-trauma health inequalities. A stepped psychological and psychosocial care pathway for major trauma patients and their families from the point of injury and continuing as they move through services towards recovery is needed. Research to fulfil knowledge gaps to develop and implement such a model for major trauma populations should be prioritised along with the development of corresponding service specifications for providers. [ABSTRACT FROM AUTHOR]

Abstract Background There is a rapid decline in moderate-to-vigorous physical activity (MVPA) during middle childhood and adolescence. Information on the environmental factors implicated in this decline is limited. This study focuses on family factors associated with the rate of decline in objectively measured physical activity during middle childhood and adolescence. Methods Longitudinal analysis of 801 participants from 10 US sites in the NICHD Study of Early Child Care and Youth Development whose data included accelerometer-determined levels of moderate-to-vigorous physical activity (MVPA) between ages 9 and 15 years, as well as family process, BMI and demographic information. The sample included an even split of boys (49%) and girls (51%), was predominantly white (77%), and contained about 26% low income and 19% single parent families. The outcome measure was mean MVPA. It was based on 4 to 7 days of monitored physical activity. Results Boys with lower parental monitoring scores and more days of parental encouragement had significantly more minutes of MVPA at age 9 years. The effect of parental monitoring, however, was moderated by early puberty. High parental monitoring was associated with decreased activity levels for boys experiencing later puberty and increased activity for boy experiencing early puberty. Minutes of MVPA for boys living in the Midwest decreased at significantly faster rates than boys living in any other region; and boys in the South declined faster than boys in the West. Girls in the Midwest and South declined faster than girls in the West and Northeast. Among girls, more days of parental exercise and transportation to activities were associated with more MVPA per day at age 9. However, more parental transportation to activities and less monitoring was associated with faster linear declines in daughters' MVPA between the ages of 9 and 15 years. For girls who experienced puberty early, parental encouragement was associated with more MVPA. Conclusions Parenting processes, such as monitoring and encouragement, as well as the parents' own level of physical activity, showed significant, but small, gender-specific associations with MVPA levels at age nine and the linear rate of decline in MVPA between ages 9 and 15.

We derive the local stellar formation history from the Gaia -defined 40 pc white dwarf sample. This is currently the largest volume-complete sample of white dwarfs for which spectroscopy is available, allowing for classification of the chemical abundances at the photosphere, and subsequently accurate determination of the atmospheric parameters. We create a population synthesis model and show that a uniform stellar formation history for the last ≈10.5 Gyr provides a satisfactory fit to the observed distribution of absolute Gaia G magnitudes. To test the robustness of our derivation, we vary various assumptions in the population synthesis model, including the initial mass function, initial-to-final mass relation, kinematic evolution, binary fraction, and white dwarf cooling time-scales. From these tests, we conclude that the assumptions in our model have an insignificant effect on the derived relative stellar formation rate as a function of look-back time. However, the onset of stellar formation (age of Galactic disc) is sensitive to a variety of input parameters including the white dwarf cooling models. Our derived stellar formation history gives a much better fit to the absolute Gaia G magnitudes than most previous studies. [ABSTRACT FROM AUTHOR]

Hydrogen-induced cracking (HIC) occurs in pipeline steels used in oil and gas applications that are rich in hydrogen sulfide gas also known as sour service environments. In this study, an experimental X65 steel was produced by intercritically finish rolling, accelerated cooling, then air-cooling to room temperature. This thermo-mechanical processing scheme resulted in a mixture of quasi-polygonal ferrite and martensite/austenite (M/A) microconstituents, also known as granular bainite. Sections from the steel were also tempered at 300 °C, 400 °C, 500 °C, and 600 °C for 40 min, which resulted in a significant increase in HIC resistance and impact toughness, along with a marginal increase in yield strength and maintenance of untempered hardness. The evolution of HIC resistance, tensile properties, and impact toughness is discussed in the context of phase fraction, dislocation density, and microstructural evolution. The current work demonstrates the potential for tempering after thermo-mechanical processing to reduce HIC susceptibility and increase impact toughness while nominally maintaining yield strength and hardness in microalloyed pipeline steels. [ABSTRACT FROM AUTHOR]