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Infertility is a critical late toxicity that impacts adolescent and young adult (AYA, ages 15-39 years) cancer survivors. International oncology societies recommend discussing fertility preservation (FP) for all AYA patients, regardless of stage or prognosis. We aim to understand Canadian medical oncologists' perceptions, attitudes, and knowledge toward FP and pregnancy in patients with cancer, including advanced stages and high risk for recurrence.An anonymous electronic survey utilizing hypothetical scenarios was sent to medical oncologists in the province of Ontario, Canada. Descriptive statistics were used to summarize all data. Logistic regression models were constructed to identify factors that predicted FP discussions and referrals.The survey was received by 91 medical oncologists, and the response rate was 44%. Fifty-eight percent of respondents offer FP for all patients. Physicians are more likely to refer patients for FP before curative intent therapy than before palliative chemotherapy (95% vs. 39.5%, p 0.001). Most respondents (86%) are comfortable discussing FP; however, only 31% self-reported feeling up-to-date on knowledge of current FP methods. Female physicians were more likely to report up-to-date knowledge and confidence discussing FP with patients. Forty percent of respondents identified that concerns about the welfare of the resulting offspring should not be a cause for denying patients assistance in reproduction.There is a significant difference in physician attitude toward offering FP based on the cancer stage. Increased awareness of standard of care guidelines and resources for difficult situations may improve the frequency of discussions about FP in motivated cancer patients.

How do children learn about the structure of the social world? We tested whether children would extract patterns from an agent's social choices to make inferences about multiple groups' relative social standing. In Experiment 1, 4- to 6-year-old children (N = 36; tested in Central New York) saw an agent and three groups (Group-A, Group-B, and Group-C) and observed the agent choose between pairs of individuals from different groups. Across pairwise selections, a pattern emerged: The agent chose individuals from Group-AGroup-BGroup-C. Children tracked the agent's choices to predict that Group-A was "most-preferred" and the "leader" and that Group-C was "least-preferred" and the "helper." In Experiments 2 and 3, we examined children's reasoning about a more complex pattern involving four groups and tested a wider age range. In Experiment 2, 5- to 10-year-old children (N = 98; tested in Central New York) used the agent's pattern of pairwise choices to infer that the agent liked Group-AGroup-BGroup-CGroup-D and to make predictions about which groups were likely to be "leaders" and "helpers." In Experiment 3, we found evidence for social specificity in children's reasoning: 5- to 10-year-old children (N = 96; from 26 U.S. States) made inferences about groups' relative social but not physical power from the agent's pattern of affiliative choices across the four groups. These findings showcase a mechanism through which children may learn about societal-level hierarchies through the patterns they observe over time in people's group-based social choices. This article is protected by copyright. All rights reserved.

Although reproductive factors have been repeatedly associated with lung cancer risk, no study to date has directly evaluated the relationship with endogenous sex hormones nor with aromatase activity in postmenopausal never-smoking women. A case-control study of 397 incident lung cancer cases and their individually matched controls, nested within the Shanghai Women's Health Study, was conducted among postmenopausal women who were lifetime never smokers. Prediagnostic concentrations of sex hormones was quantitated using LC-MS/MS assays in plasma. The product-substrate molar ratio of estrone to androstenedione was used as an index of aromatase activity (IAA). Multivariable conditional logistic regression models were used to calculate odds ratios (ORs) for lung cancer. Baseline concentrations of estradiol, free testosterone and IAA were inversely associated with subsequent risk of lung cancer in multivariable-adjusted models. When further adjusted for body mass index, the inverse association with estradiol was attenuated and no longer statistically significant, but the association with free testosterone and IAA remained. In analyses confined to participants having never used menopausal hormone therapy in 376 case-control pairs, the inverse association with free testosterone and IAA was slightly strengthened. OR for the highest vs the lowest quartile of free testosterone was 0.55 (95% CI = 0.34-0.90; P

In 2017, the European Union (EU) initiated the development of the European Education Area (EEA). The referentiality approach frames an original and timely inquiry into how EU policymakers explain the reasons for the development of the EEA. This inquiry relies on thematic analysis of relevant key policy materials, produced by the European Commission and the Council of the EU. The findings highlight a range of internal and external referentiality mechanisms that EU policymakers use to justify the development of the EEA. Internal references are related mainly to education traditions in the EU as a strong foundation for the EEA and the source of its ideas; the beliefs that the EEA can help overcome the interlocking crises the EU has faced in its recent past in the area of education as well as more generally; as well as the organisation of the EEA as part of the functioning of the EU, with both mutually shaping each other. External references are used to build on this and boost the competitiveness of EU's education sector and the EU as a region in the world. These findings address important gaps in our knowledge about EU policymakers' reasons for the development of the EEA. They enrich the limited literature about the EEA, make a theoretical contribution by extending the application of the referentiality approach and call policy actors at all levels of the EEA to facilitate a shared understanding of the reasons for the development of the EEA to ensure that their work serves EEA's purpose.

Objective Identify placental pathology-related complications, labor and neonatal outcomes in pregnancies complicated by pathological nuchal translucency (NT) with normal microarray analysis. Methods A retrospective study in which all women with singleton pregnancy who demonstrated NT above 3 mm and a normal microarray analysis were matched to women with normal NT and a normal microarray analysis (2013-2019) in a single tertiary academic center. The following placental pathology-related parameters were measured: preeclampsia, oligohydramnios, suspected intrauterine growth restriction, abnormal Doppler studies or small for gestational age (SGA) neonates. The primary outcome was defined as a composite of complications related to placental pathology including preeclampsia and SGA neonate. Secondary outcomes were labor complications and neonatal morbidity. Results A total of 185 women were included in the study: of them, 47 presented an abnormal NT (study group) and 138 presented normal NT (controls). Groups did not significantly differ in baseline characteristics. Regarding primary outcome, all placental-related complications frequencies were higher in the study group, with a composite rate of 17.02% versus 6.52% in controls (p = 0.042%). Secondary outcomes did not differ between groups. Conclusions Abnormal NT measurement presented in pregnancies with normal fetal microarray analysis is associated with higher rates of placental-related complications.

People value those who act with others in mind even as they pursue their own goals. Across three studies (N = 566; 4- to 6-year-olds), we investigated children's developing understanding of such considerate, socially-mindful actions. By age 6, both U.S. and Chinese children positively evaluate a character who takes a snack for herself in a way that leaves a snack choice for others over a character who leaves no choice (Study 1), but only when the actors had alternative possible actions (Study 2) and when a clear beneficiary was present (Study 3). These results suggest an emerging ability to infer underlying social intentions from self-oriented actions, providing insights into the role of social-cognitive capacities versus culture-specific norms in children's moral evaluations.

Recent work (Starmans & Bloom, 2016) identified a shift in judgments of moral praiseworthiness that occurs late in development: adults recognize the virtue of moral actions that involve resolving an inner conflict between moral desires and selfish desires. Children, in contrast, praise agents who do the right thing in the absence of inner conflict. This finding stands in contrast with other work showing that children incorporate notions of cost and effort into their social reasoning. Using a modified version of Starmans & Bloom’s (2016) vignettes, we show that understanding the virtue of costly moral action precedes understanding the virtue of resolving inner conflict. In two studies (N=192 children, Range=4.00-9.95 years; and N=193 adults), we contrasted a character who paid a personal cost (psychological in Study 1, physical in Study 2) to perform a moral action with another who acted morally without paying a cost. We found a developmental progression; 8- and 9-year-old children and adults recognized the praiseworthiness of moral actions that are psychologically or physically costly. Six- and 7-year-old children only recognized the praiseworthiness of moral actions that are physically costly, but not actions that are psychologically costly. Moreover, neither adults nor children inferred that paying a cost to act morally required having a moral desire or resolving inner conflict. These results suggest that both adults and children conceptualize obligation as a direct motivational force on actions. They further suggest that costly choice – a hallmark of moral agency – is implicated in judgments of praiseworthiness early in development.

Perovskite oxides are at the forefront of the race to develop catalysts/electrodes for fuel cells and electrolyzers. This work presents trifunctional properties of the double-perovskite oxide PrBa0.5 Sr0.5 Co1.5 Fe0.5 O5+δ and the PrBa0.5 Sr0.5 Co1.5 Fe0.5 O5+δ -Ag composite prepared by the glycine nitrate process. The electrocatalytic studies reveal that the Ag-based composite is an excellent catalyst for both oxygen evolution (OER) and hydrogen evolution reactions (HER) in alkaline solution. The electrochemical impedance spectroscopy analysis through distribution function of relaxation times (DFRT) suggests that the improved activity originates from the suppression of resistance contributed by various relaxation processes. The oxygen reduction reaction (ORR) kinetics in these oxide-based cathodes has been studied by performing symmetric-cell measurements at high temperatures using both oxygen-ion and proton-conducting cells. DC bias dependence of charge-transfer processes, oxygen-surface kinetics, polarization resistances, and activation energies are revealed by DFRT studies. Ag addition in PrBa0.5 Sr0.5 Co1.5 Fe0.5 O5+δ leads to enhanced kinetics of OER, HER, and ORR.

OBJECTIVE Esophageal atresia with/without tracheo-esophageal fistula (EA/TEF) is more common among twins. The detection of polyhydramnios might be altered in twins, leading to EA/TEF underdiagnosis, prenatally. The aim of the study was to compare the prenatal manifestation of EA/TEF between twins and singletons. METHODS A 12-year study of EA/TEF cases was performed at a tertiary center. Cases exhibiting (a) small/absent stomach or (b) polyhydramnios were considered "suspected"; cases with (c) esophageal pouch were considered "detected." We compared the rate and timing of appearance of these signs between the groups. RESULTS There were 76 cases of EA/TEF, of which 17 were a co-twin. All twin pairs were EA/TEF discordant. The prevalence of EA/TEF at our center was 1:750 for twins (1:319 monochorionic and 1:1133 dichorionic) and 1:2399 for singletons. The rate of small/absent stomach, polyhydramnios and pouch in twins vs singletons was 23.5%, 47.1%, 29.4% and 39.7%, 72.4%,34.5%, respectively (P = .2, P = .09 and P = .7). Esophageal pouch was detected earlier in twins (P = .03). Twins were scanned more frequently (×1.8 times, P = .01). CONCLUSION EA/TEF is more prevalent in twins. Despite lower rate of polyhydramnios, twins were similarly detected prenatally as singletons, and this was accomplished earlier in pregnancy; perhaps reflecting more frequent scans.

The targeted manipulation of polyketide synthases has in recent years led to numerous new-to-nature polyketides. For type I polyketide synthases the response of post-polyketide synthases (PKS) processing enzymes onto the most frequently polyketide backbone manipulations is so far insufficiently studied. In particular, complex processes such as the polyether cyclisation in the biosynthesis of ionophores such as monensin pose interesting objects of research. We present here a study of the substrate promiscuity of the polyether cyclisation cascade enzymes in monensin biosynthesis in the conversion of redox derivatives of the nascent polyketide chain. LC-HRMS/MS2 -based studies revealed a remarkable flexibility of the post-PKS enzymes. They acted on derivatized polyketide backbones based on the three possible polyketide redox states within two different modules and gave rise to an altered polyether structure. One of these monensin derivatives was isolated and characterized by 2D-NMR spectroscopy, crystallography, and bioactivity studies.

Aims and objective To examine whether nurses' assessment of their relationships and communication with lesbian women seeking perinatal care is associated with their personal and professional characteristics and knowledge of homosexuality. Background Recently, there has been a growing incidence of same-sex parenthood. Nurses administer health care to lesbian women from pregnancy planning through birth, providing consultation. Although there has been a shift in attitudes towards homosexuality, discrimination is still quite common. Design This research is part of a larger cross-sectional study carried out at women's healthcare centres, concerning nurses' perceived quality of perinatal care provided to lesbian women. Methods The study was conducted from December 2015-April 2016 at women's health centres in Israel encompassing 184 registered nurses who completed self-report questionnaires. They were assessed as to their knowledge of homosexuality and nurse-patient relationships and communication. The Squire checklist was used. Results Most (73.4%) had prior acquaintance with lesbian women; only 17.9% had been educated as to lesbian women's unique health needs; of these, 66.7% thought that they had been given professional tools for working with lesbian women; 60.4% were unaware of the importance of knowing the patient's sexual orientation. The average score on a homosexuality knowledge questionnaire was 10.4 on a scale of 0-17, indicating moderate levels of factual knowledge about homosexuality. A significant positive correlation was found between nurses' knowledge of homosexuality and assessment of their relationships and communication with lesbian women seeking perinatal care. In addition, nurses' personal and professional characteristics, such as place of birth, religiosity and familiarity with lesbian women, were related to their assessment of their relationships and communication. Conclusion Nurses' knowledge of homosexuality and personal and professional characteristics were associated with their perceptions regarding relationships and communication with lesbian women seeking perinatal care. Relevance to clinical practice Further training might broaden, refine rigid perceptions and contribute to advancing equal perinatal nursing care of lesbian women.

This New York City Panel on Climate Change (NPCC3) chapter builds on the projections developed by the second New York City Panel on Climate Change (NPCC2) (Horton et al., 2015). It confirms NPCC2 projections as those of record for the City of New York, presents new methodology related to climate extremes, and describes new methods for developing the next generation of climate projections for the New York metropolitan region. These may be used by the City of New York as it continues to develop flexible adaptation pathways to cope with climate change. The main topics of the climate science chapter are: (1) Comparison of observed temperature and precipitation trends to NPCC2 2015 projections. (2) New methodology for analysis of historical and future projections of heatwaves, humidity, and cold snaps. (3) Improved characterization of observed heavy downpours. (4) Characterization of observed drought using paleoclimate data. (5) Suggested methods for next generation climate risk information.