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Children with learning disabilities (LD) are more likely to have health conditions that require hospital attendance than children without LD. Like all children, they can experience fear and distress related to procedural anxiety. Parents play a key role in managing procedural anxiety in children with LD. No previous published qualitative studies have explored parental experiences of caring for a child with LD and procedural anxiety in hospital.To explore how parents experienced caring for their child with LD and procedural anxiety in hospital.A purposive sample of six participants were recruited through a Facebook group for parents of children with LD. Remote semi-structured interviews were conducted via telephone, Microsoft Teams or Whatsapp. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis.Five key themes were generated: (1) Emotional toll: parents characterized their experiences as highly emotional; reporting feeling stressed, anxious and worried. (2) Restraint and holding: parents spoke of their experiences of restraint which was largely viewed as negative and sometimes inappropriate. (3) Advocacy: parents articulated their responsibility as advocates for their children. (4) Going it alone: parents were extremely proactive in managing their child's anxieties but some also felt highly-pressurized and isolated. (5) Inconsistency and uncertainty: parents experienced inconsistency and uncertainty in their children's care from healthcare professionals which led to anxiety and frustration.Parents of children with both LD and procedural anxiety experienced many challenges. Parents' expertise must be utilized by clinicians when caring for children with LD and procedural anxiety whilst ensuring appropriate support for parents. Nurses require specific training in psychosocial interventions to enhance care for children with LD and procedural anxiety. Further research identifying effective nursing strategies to enhance parental experiences would be beneficial to improve care to this patient group.

ProblemThere has been little focus on women’s views of care and recovery following pregnancy complicated by hypertensive disorders of pregnancy [HDP] despite long-term implications for maternal health.BackgroundIncreasingly in clinical research, areas of interest include the extent to which women are involved in postnatal care planning, perceived value of routine postnatal contacts, lifestyle behaviour advice, and extent to which ongoing concerns about HDP could be discussed with healthcare professionals.AimThis study explored women’s experiences of birth-recovery up to 12 months following HDP.MethodsA longitudinal qualitative study using semi-structured interviews at four and 12 months postpartum. Twenty-four women who each had a form of HDP, were recruited using a maximum variation, purposive sampling strategy from four National Health Service maternity units in London, 21 of whom were interviewed at both time points. Data were collected and analysed by timepoint following a recurrent, cross-sectional cohort approach using template analysis methodology.FindingsFour main themes and ten sub-themes were identified. Main themes included: assumptions about blood pressure; perinatal experiences; postnatal care pathways; and managing complex health conditions.DiscussionPostnatal care needs to be tailored to women’s individual needs following HDP, with ongoing review by relevant clinicians during and beyond the first six weeks. Many women with HDP have ongoing information needs about hypertensive status, treatment and prognoses, and future birth planning.ConclusionPolicy makers, health providers and funders cannot continue to ignore the need to ensure postnatal services meet the needs of women who have experienced medically complex pregnancies.

Background: Female genital mutilation (FGM) is a cultural practice with numerous negative health consequences. Due to migration from countries where FGM is prevalent into high-income countries, there is increased awareness within non-practising communities, with emphasis on FGM's illegal nature and the negative impacts on women. It is therefore vital for health professionals to be knowledgeable to provide adequate patient care. Aim: This review aimed to synthesise literature to report the understanding and experiences of health professionals caring for females affected by FGM in high-income countries. Methods: A systematic search was conducted on three databases: Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). Inclusion and exclusion criteria were applied to select the papers. Findings from included papers were synthesised using thematic synthesis. Findings: Eight articles met the criteria. Four themes were generated: FGM knowledge, training, attitudes and caring for FGM patients. Conclusion: Health professionals' knowledge and experiences of FGM tend to be varied. This review highlights the need of training for health professionals in high-income countries to strengthen their FGM knowledge.

Due to the global warming crisis, the spread of various infectious diseases is worsening, with mosquito-borne contagious diseases posing a significant threat. While many residential and public spaces contain plants, often for greening the environment and improving mental and physical well-being, the carbon dioxide released by these plants produces ideal habitats for mosquitoes. Considering the quality of life of urban residents and the development of health-related products simultaneously is an important topic. This study used diverse complementary techniques, such as energy-storing rare-earth luminescent materials, sustainable power generation using plant energy, blue light–emitting diodes, and environmentally friendly fermentation formula, to develop planting products with potential mosquito control functionality. The prototype design for this mosquito-trapping potted plant has been patented. The aim of this paper is to discuss the design principles adopted to improve the defects of existing mosquito-trapping designs, the green energy materials and techniques employed, the architecture configuration of the product prototype, and the test results. By integrating green materials and technology, the prototype can be self-powered without being plugged in to yield conspicuous energy savings. The results showed that the developed multi-function products, combined with the concept of energy sustainability, can improve global public health as well as individuals’ physical and mental health.

BackgroundStudies regarding the impact of COVID-19 on breastfeeding have mostly used single- country samples or a qualitative design.AimThe objective of this study was to examine breastfeeding intention during pregnancy and breastfeeding behaviour among postpartum women in five countries during the COVID-19 pandemic and the associated factors.MethodsAn online questionnaire survey was conducted in Thailand, the United Kingdom, South Korea, Taiwan, and Brazil from July through November 2021. The study participants included 3253 mothers within six months of birth.FindingsAbout 90% of participants intended to breastfeed during pregnancy and 85.7% reported breastfeeding in the past 24 h. More than half reported their breastfeeding duration being as planned or longer despite COVID-19. Multivariate logistic regression models showed that being multiparous, ever tested COVID-19 positive, and having positive breastfeeding beliefs were associated with increased odds for intention to breastfeed during pregnancy. Lower maternal educational level, being primiparous, ever tested COVID-19 positive, and experiencing food insecurity were associated with decreased odds for breastfeeding duration being as planned or longer. Vaginal birth, currently working or on maternity leave, breastfeeding beliefs, breastfeeding support from spouse/partner/friend/relative, online support groups, and in-person or telephone contact with healthcare professionals were associated with increased odds for breastfeeding duration being as planned or longer.ConclusionBreastfeeding intention and behaviour remained high during the COVID-19 pandemic. Online support groups and telephone contact with health professionals were effective during the pandemic.

Background: Women who are obese have lower rates of breastfeeding initiation and duration and are less likely to breastfeed exclusively compared with women who are not obese. To develop programs to improve breastfeeding practices among this group of women, we investigated the association between maternal obesity and breastfeeding practices and problems in the first days postpartum. Methods: We analyzed medical records from postpartum women at a rooming-in maternity ward in State of São Paulo, Brazil, between 2016 and 2018. We included those who had intended to exclusively breastfeed, had given birth to a singleton and were admitted to rooming-in. We analyzed exclusive breastfeeding and nonexclusive breastfeeding each day of hospitalization and the presence of breastfeeding problems, comparing women in the obese category (body mass index [BMI] ≥30 kg/m2) to normal and overweight women (≥18.6 to ≤29.9 kg/m2). Results: Two hundred and twenty-four postpartum women participated, including 86 women in the obese category. More than 50% of women with obesity reported a breastfeeding problem in the first and second postpartum days (p = 0.026 and p = 0.017, respectively) compared with the 41% and 38% nonobese group. Children of obese women were 2.8 times more likely to have poor latch during breastfeeding (95% confidence interval [CI]: 1.29-6.10) compared with the nonobese group on the third day. Conclusion: Maternal obesity increased the probability of breastfeeding difficulties and nonexclusive breastfeeding at discharge. Professionals need to support breastfeeding techniques in the days immediate after delivery to improve breastfeeding outcomes for mothers with obesity.

With a median survival time of 15 months, glioblastoma multiforme is one of the most aggressive primary brain cancers. The crucial roles played by the extracellular matrix (ECM) stiffness in glioma progression and treatment resistance have been reported in numerous studies. However, the association between ECM-stiffness-regulated genes and the prognosis of glioma patients remains to be explored. Thus, using bioinformatics analysis, we first identified 180 stiffness-dependent genes from an RNA-Seq dataset, and then evaluated their prognosis in The Cancer Genome Atlas (TCGA) glioma dataset. Our results showed that 11 stiffness-dependent genes common between low- and high-grade gliomas were prognostic. After validation using the Chinese Glioma Genome Atlas (CGGA) database, we further identified four stiffness-dependent prognostic genes: FN1, ITGA5, OSMR, and NGFR. In addition to high-grade glioma, overexpression of the four-gene signature also showed poor prognosis in low-grade glioma patients. Moreover, our analysis confirmed that the expression levels of stiffness-dependent prognostic genes in high-grade glioma were significantly higher than in low-grade glioma, suggesting that these genes were associated with glioma progression. Based on a pathophysiology-inspired approach, our findings illuminate the link between ECM stiffness and the prognosis of glioma patients and suggest a signature of four stiffness-dependent genes as potential therapeutic targets.

The impacts of caregivers' perception of child weight on their non-responsive feeding practices are inconclusive. This systematic review aimed to examine their relationships.A systematic search of five databases was conducted from inception to March 2022, following PRISMA guidelines. Data synthesis was performed using semi-quantitative approach and meta-analysis.Twenty-two studies with 12005 respondents were included for semi-quantitative analyses. Eighteen studies examined 26 associations between caregivers' perception of child weight and food restriction with 12 statistically significant associations being observed. A total of 22 relationships between caregivers' perception of child weight and pressure to eat were investigated, with 13 being statistically significant. The statistically significant associations consistently reported that caregivers' visual and self-reported perception of child weight was positively associated with their restrictive feeding and negatively associated with pressure to eat. The pooled odds ratios (ORs) indicated that caregivers who perceived their child as overweight were found to apply pressure to eat less frequently (OR = 0.61; 95%CI: 0.44, 0.84) compared with those who did not. However, caregivers' perception of child weight was not statistically significantly associated with restrictive feeding (OR = 1.37; 95%CI: 0.74, 2.55).Caregivers' self-reported and visual perception of child weight may be important risk factors for non-responsive feeding practices, particularly food restriction and pressure to eat. Thus, interventions need to consider the role of caregivers' perception of child weight, which may optimize feeding practices. Furthermore, longitudinal and intervention-based studies using validated measurements while controlling for potential covariates are needed to provide more evidence on their causal relationships.

Background: SGLT2i and GLP1-RA improve cardiovascular (CV) and renal outcomes in patients with T2D who are at elevated cardiac or renal risk; however, prescription rates are low despite guidelines recommending their use. We aimed to evaluate the eligibility for and utilization of SGLT2i and GLP-1 in a large health system (HS) . Methods: The electronic health record (EHR) at a quaternary HS in the Northeastern US was queried to identify patients with T2D with CV, renal disease, or at high CV risk based on comorbidities and 10-year atherosclerotic CV disease (ASCVD) risk score. Demographics, medications, comorbidities, indications, and contraindications for SGLT2i and/or GLP1-RA therapy were assessed. Results: The population of individuals with T2D on metformin therapy consists of 122,537 patients: 55% male, 8% Black, 13% non-English speaking. Of patients eligible for SGLT2i, 12% were prescribed an SGLT2i. Of patients eligible for GLP1-RA therapy, 17% were prescribed GLP1-RA. Of patients eligible for either SGLT2i or GLP1-RA therapy not currently receiving either therapy, 41% had 10-year ASCVD risk >10%, 56% had ASCVD, 29% had chronic kidney disease (CKD) , and 18% had heart failure. Conclusion: While advantages of novel therapies have demonstrated benefits, opportunities from provider, patient, and systems to eliminate barriers to uptake and dissemination of therapy to improve outcomes for patients exist. Disclosure A.Blood: None. D.J.Wexler: Other Relationship; Elsevier, Novo Nordisk, UpToDate. B.M.Scirica: Consultant; Allergan, Boehringer Ingelheim International GmbH, ESPERION Therapeutics, Inc., Hanmi Pharm. Co., Ltd., Novo Nordisk, Research Support; Better Therapeutics, Eisai Co., Ltd., Merck & Co., Inc., Novo Nordisk, Pfizer Inc., Stock/Shareholder; Heath At Scale. F.Waterman: Employee; Novo Nordisk. G.Stern: None. D.Zelle: None. L.Chang: Consultant; Alosa Health, Pri-Med LLC, Other Relationship; Applied Therapeutics, Better Therapeutics, Eli Lilly and Company, Fractyl Health, Inc., Sanofi, Research Support; Boehringer Ingelheim International GmbH, Novo Nordisk. C.A.Colling: None. D.Gabovitch: None. C.M.Hamersky: Employee; Novo Nordisk. E.Durden: Employee; Novo Nordisk A/S. C.Holt: Employee; Novo Nordisk. J.Noone: Employee; Novo Nordisk. C.P.Cannon: Advisory Panel; Alnylam Pharmaceuticals, Inc., Amarin Corporation, Amgen Inc., Amryt Pharma Plc, Applied Therapeutics, Ascendis Pharma A/S, Boehringer Ingelheim International GmbH, Bristol-Myers Squibb Company, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Merck & Co., Inc., Pfizer Inc., Rhoshan, Sanofi, Research Support; Amgen Inc., Better Therapeutics, Boehringer Ingelheim International GmbH, Bristol-Myers Squibb Company, Daiichi Sankyo, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk, Pfizer Inc. Funding Novo Nordisk

The postnatal period is an underserved aspect of maternity care, potentially worsened by the COVID-19 pandemic. This study aims to identify postnatal care (PNC) use by health personnel within the 42 days of childbirth among postpartum mothers in Thailand. This web-based, cross-sectional study was conducted from July to October 2021 (n = 840). Multiple binary and ordinal logistic regressions were conducted to predict three outcome variables (≥2 times, ≥3 times, or level of PNC use). Women who received PNC were in low numbers (≥2: 30.7% and (≥3: 12.9%), while 54.4% of women reported no barriers to access PNC, and 31.9% reported barriers, including worries over COVID-19 infection, followed by movement restrictions imposed by the government (11.7%) and the closure of healthcare centers (10%). Women working in a self-employed capacity, living in urban areas, and undergoing a Caesarean section with no/less worry about COVID-19 infection were more likely to utilize postnatal care (≥2 or number of PNC). This study provides timely information, revealing that a relatively low percentage of postpartum women received PNC, particularly among the socially deprived group. Since the fear of COVID infection is listed as a major barrier, the provision of PNC services, including a telehealth program should be considered.

Background: Post-traumatic stress disorder (PTSD) affects approximately 3% of women in the postnatal period, but less is known about risk factors for PTSD than other postnatal mental illnesses. This review aimed to analyze the literature on the impact of mode of birth on postnatal PTSD. Methods: Searches were undertaken of CINAHL, the Cochrane Library, MEDLINE, PsycINFO, and Scopus for studies investigating the link between mode of birth and postnatal PTSD in high-resource countries from January 1990 to February 2021. Quantitative and qualitative data were collected and synthesized. Meta-analysis was performed with four of the studies, and the rest were analyzed narratively. Results: Twelve quantitative studies, presenting data on 5567 women, and two qualitative studies, with 92 women, were included in the review. Most studies found a significant relationship between mode of birth and maternal PTSD symptoms. Meta-analysis found cesarean birth was more closely associated with PTSD than vaginal delivery (VD) (P = 0.005), emergency cesarean birth (EmCB) more than elective cesarean birth (ElCB) (P < 0.001), instrumental vaginal delivery (IVD) more than spontaneous vaginal delivery (SVD) (P < 0.001), and EmCB more than SVD (P < 0.001). Women who developed PTSD after EmCB felt less in control and less supported than those who did not develop it after the same procedure. Request for repeat ElCB appeared more common among women with pre-existing postnatal PTSD, but this may subsequently leave them feeling dissatisfied and their fears of childbirth unresolved. Conclusions: Modes of birth involving emergency intervention may be risk factors for the development of postnatal PTSD. Ensuring that women feel supported and in control during emergency obstetric interventions may mediate against this risk.

While many new applications prefer manycore processor with a large number of cores, the exploding communications among multiple cores, caches, and off-chip memories is posing a fundamental challenge on manycore designs. Silicon photonics-based interconnection network promises high bandwidth, low latency, and high energy efficiency, and can potentially meet the communication requirements of manycore processors. In this paper, we propose CAMON, a small low-cost silicon photonic chiplet integrated into the manycore processor package. CAMON chiplet can effectively alleviate the communication bottlenecks of manycore processors and improve the energy efficiency of data movement, especially for large-scale systems. We develop a distributed arbitration system, a low-power low-latency optical interface, and an off-chip laser preactivation mechanism for CAMON. The experimental results show that compared with the electrical network, CAMON can improve the full-system performance per energy by $4.6\times $ , speedup the manycore processor by $2.7\times $ , and save the area of the processor die by 3%, in a 512-core system.

Silicon photonic networks are revolutionizing computing systems by improving the energy efficiency, bandwidth, and latency of data movements. Optical modulators, such as microresonators (MRs) and Mach–Zehnder interferometers (MZIs), are the basic building blocks of silicon photonic networks. This paper proposes a SPICE-compatible electro-optical co-simulation model, basic optical switch integration model (BOSIM), to systematically study optical modulators using PN, PIN, and metal–insulator–silicon (MIS) capacitor device technologies. BOSIM holistically models both transient and steady state properties, such as switching speed, power, transmission spectrum, area, and carrier distribution. BOSIM is validated by the measured data from eight research groups and companies. Compared to MRs, BOSIM shows MZIs are fast, with a high extinction ratio and large bandwidth but in the sacrifice of loss, energy, and area. Using a PIN diode over a PN diode can save area, but retain the loss and energy, while an MIS capacitor has the shock response of carrier distribution in a narrow range and is marginalized gradually. For instance, an MZI can achieve a $2.5 {\times }$ bit rate, $6.06{\times }$ extinction ratio, $71.04 {\times }\,\,3$ -dB bandwidth, but costs at least $1.93 {\times }$ passing loss, $1.46 {\times }$ energy consumption, and $16.67 {\times }$ area, compared with MR.

Rack-scale computing systems are promising to undertake the emerging large-scale applications by distributing massive tasks to processing cores. The communication and coordination efficiency of these tasks and resources directly affect the system performance and energy consumption. Silicon photonic interconnects are expected to address the communication and system power consumption challenges imposed on rack-scale systems. However, the control for optical interconnects can cause server performance degradation if not properly designed, especially for the complicated and time-consuming multidomain networks. In this paper, we study the optical interconnects for rack-scale computing systems and propose a new communication flow and control scheme for the efficient coordination of distributed resources. Particularly, we first propose a forward propagation strategy that parallels the path reservation process with the distributed tasks connection setup. Second, we develop a pre-emptive chain feedback (PCF) scheme to optimize multidomain path reservation. The PCF scheme pre-emptively allocates network resources with the help of multicell reservation window and quickly releases resources with a feedback mechanism. This solution increases the network resources utilization and task coordination efficiency while minimizing path reservation overheads. Comparing to the baseline InfiniBand network fabric and handshake scheme, PCF can improve network throughput greatly under uniform and hotspot traffic patterns. Realistic benchmark results show that the PCF scheme on average reduces 52% and 60% energy consumption per unit system performance than InfiniBand and the handshake scheme for a 256-node rack system.

The advancement of silicon photonics promises integrated optical switches to provide high-bandwidth, low-latency, and low-power communications in data centers. An optical switch’s loss limits its scale and affects the energy efficiency of the switch system. In this paper, we present cross-layer optical switch optimization (CLOSO), a cross-layer optimization (CLO) framework, based on not only photonic device models at the physical layer but also optical switch models at the fabric layer. With the proposed framework, optimal losses of optical switches can be evaluated efficiently, and the corresponding losses and design parameters of photonic devices can be obtained. Using CLOSO, we optimize four categories of integrated optical switches, Crossbar, PILOSS, DRAGON, and FODON, and compare them regarding their optimal worst-case loss with variation of the switch scale and data rate of signals. Furthermore, system-level evaluations of the optimized optical switches are performed, demonstrating a significant improvement of energy efficiency from the CLO. For instance, CLOSO helps to reduce the energy consumption of a 64-port DRAGON and FODON to as low as 6 pJ/bit and that of a 128-port DRAGON and FODON to as low as 10 pJ/bit. The investigation of 128-port switches also shows the necessity of adaptive power control on lasers for high-radix integrated optical switches. Through quantitative analyses and comparisons, CLOSO shows the capability of facilitating initial design exploration of optical switches and paves the way to fair evaluations and comparisons of switch systems in data centers.

Background: Parental non-responsive feeding practices and child eating behaviors both play significant roles in childhood obesity. However, their longitudinal relationships are less clear. This systematic review aimed to examine their bidirectional associations. Methods: A systematic search of five databases was conducted from inception to February 2022. Data synthesis was performed using a semi-quantitative and quantitative approach. Results: A total of 14 studies with 15348 respondents were included. A total of 94 longitudinal effects from 14 studies of parental non-responsive feeding practices on child eating behaviors were investigated, and 19 statistically significant effects were discovered. Seventy-seven longitudinal effects from nine studies of child eating behaviors on parental feeding practices were examined, with fifteen being statistically significant. The pooled results of meta-analysis showed five statistically significant associations: parental restrictive feeding positively predicted child enjoyment of food (β = 0.044; 95% CI: 0.004, 0.085); use of food as a reward positively predicted child emotional eating (β = 0.09; 95% CI: 0.04, 0.15); child food responsiveness positively predicted restrictive feeding (β = 0.04; 95% CI: 0.02, 0.06); use food as a reward (β = 0.06; 95% CI: 0.03, 0.10). In addition, the pooled effects showed that child satiety responsiveness negatively predicted restrictive feeding (β = −0.05; 95% CI: −0.08, −0.01). Conclusions: The bidirectional relationships between parental non-responsive feeding practices and child eating behaviors are inconsistent and a few showed statistical significance. Theory-driven longitudinal studies using validated instruments and controlling for potential confounders are needed to unveil their relationships and provide evidence for obesity prevention interventions.

ImportanceMany patients at high cardiovascular risk—women more commonly than men—are not receiving statins. Anecdotally, it is common for patients to not accept statin therapy recommendations by their clinicians. However, population-based data on nonacceptance of statin therapy by patients are lacking.ObjectivesTo evaluate sex disparities in nonacceptance of statin therapy and assess their association with low-density lipoprotein (LDL) cholesterol control.Design, Setting, and ParticipantsA retrospective cohort study was conducted from January 1, 2019, to December 31, 2022, of statin-naive patients with atherosclerotic cardiovascular disease, diabetes, or LDL cholesterol levels of 190 mg/dL (to convert to millimoles per liter, multiply by 0.0259) or more who were treated at Mass General Brigham between January 1, 2000, and December 31, 2018.ExposureRecommendation of statin therapy by the patient’s clinician, ascertained from the combination of electronic health record prescription data and natural language processing of electronic clinician notes.Main Outcomes and MeasuresTime to achieve an LDL cholesterol level of less than 100 mg/dL.ResultsOf 24 212 study patients (mean [SD] age, 58.8 [13.0] years; 12 294 women [50.8%]), 5308 (21.9%) did not accept the initial recommendation of statin therapy. Nonacceptance of statin therapy was more common among women than men (24.1% [2957 of 12 294] vs 19.7% [2351 of 11 918]; P P Conclusions and RelevanceThis cohort study suggests that nonacceptance of a statin therapy recommendation was common among patients at high cardiovascular risk and was particularly common among women. It was associated with significantly higher LDL cholesterol levels, potentially increasing the risk for cardiovascular events. Further research is needed to understand the reasons for nonacceptance of statin therapy by patients and to develop methods to ensure that all patients receive optimal therapy in accordance with their preferences and priorities.

Introduction\ud Returning to paid employment is one of the reasons women stop breastfeeding earlier than they planned to. This systematic review aimed to provide insight into the experiences and views of women and employers on breastfeeding and returning to paid employment, with findings used to inform practice and policy.\ud \ud Methods\ud The review was guided by the Joanna Briggs Institute (JBI) methodology for systematic reviews of qualitative evidence. Medline, CINAHL, PsycINFO, and Web of Science databases were searched for studies published in English. JBI's meta-aggregative approach informed data analysis. The studies in this analysis included women who stopped breastfeeding before, and those who continued breastfeeding after, returning to paid employment and the employers, work managers, or supervisors of women who continued breastfeeding after returning to paid employment.\ud \ud Results\ud Twenty-six articles presenting findings from 25 studies were included and critically appraised. Synthesized findings showed that women experienced physical and emotional difficulties and described gender and employment inequalities in accessing and receiving the support they needed. Women reported that the importance of their own motivation and having workplace legislation in place facilitated breastfeeding during employment. Support from employers, colleagues, and family members, as well as access to convenient child care, helped women continue breastfeeding on return to paid employment. Employers’ personal experiences influenced their views on breastfeeding and working, and the need for more education and communication between employers and employers on breastfeeding in the workplace was recognized.\ud \ud Discussion\ud Support from family, work colleagues, and employers was important to reduce the physical and emotional challenges women experienced when combing breastfeeding with return to paid employment. Gender inequalities, especially in low- and middle-income countries, in accessing support exacerbated the difficulties women experienced. Limited data were identified regarding employers’ experiences and views, suggesting an urgent need for further research to explore employers’ and work colleagues’ experiences and views.

Evidence for the health benefits of breastfeeding is well substantiated but breastfeeding uptake and duration remains low worldwide. Individual level breastfeeding promotion programmes are behavioural interventions, targeting malleable social-psychological processes to change behaviour. This systematic review aimed to investigate whether such interventions are effective at improving breastfeeding initiation, duration and exclusivity, and breastfeeding support. A three-stage search strategy identified eligible articles from six databases. Nine controlled-clinical trials and 11 quasi-experimental trials were included. Random-effects meta-analyses identified significant improvements in rates of breastfeeding initiation (N = 2,213; OR = 2.32, 95% CI [1.33, 4.03], p = .003; I2 = 0%, p = .966) and suggested improved exclusive breastfeeding rates up to six months postpartum (N = 3,671; OR = 1.84, 95% CI [1.38, 2.45], p

Background Due to the limited number of studies in low- and middle-income countries (LMICs), this study aimed to identify the prevalence and determinants of postpartum poor maternal sleep and depression. Methods This cross-sectional study was conducted with 380 women who were 2–12 months postpartum in March and April 2017 in Ramechhap district, Nepal. Multiple logistic regression was used to identify the associated factors. Results The prevalence of poor sleep quality and depression was 28.2% and 18.7%, respectively. Poor sleep quality was associated with having an occupation (in government or business, odds ratio [OR] 6.69; in agriculture/labour, OR 15.5), a male infant (OR 2.37), home delivery (OR 2.17), mental illness during pregnancy (OR 5.87), complications after delivery (OR 5.58) and postpartum depression (OR 2.86). Meanwhile, postpartum depression was associated with having no post-natal care (OR 98.7), living in a nuclear family (OR 48.5), living in a rural area (OR 26.6), having a male infant (OR 4.61), having complications after delivery (OR 21.9), introducing complementary foods before 6 months of age (OR 4.71) and having poor sleep quality (OR 3.20). Conclusions A relatively high prevalence of depression and poor sleep quality were found. The close positive association between poor sleep quality and depression suggests the need for early identification and support for women at risk of poor sleep quality and depression in Nepal.

This paper presents the electromagnetic interface (EMI) impact on the current transformer with amorphous HB1-M core, printed circuit board (PCB) power transformer and the filter of inductor for Internet of Things (IoTs) device. According to the antenna principle, the radiation emission power responses of PCB transformer and current transformer are estimated and found to be negligible due to the EMI experimental report. Based on this reason, consideration of the amorphous core in design manufacturing and EMI filter development is indispensable. Thus, the current transformer of amorphous HB1-M core is annealed at 350°C and soaked for 1.5 h. The simulation results of electromagnetic field show an EMI impact on filter performance. EMI frequency between 50 to 400 MHz for filter is found to be suitable for PCB. Experimental results have confirmed that the application of PCB transformer with HB1-M would be performed as well in high permeability and sensitivity. Key words: Internet of things (IoTs), electromagnetic interface (EMI), soft magnetic sensor.

Human immunodeficiency virus (HIV)‐positive women can breastfeed with minimal risk of mother‐to‐child transmission if taking antiretrovirals. Guidelines surrounding infant feeding for HIV‐positive women have evolved several times over the last two decades. Our review aimed to explore perspectives of breastfeeding with antiretrovirals from HIV‐positive women since the World Health Organization (2010) infant feeding and antiretroviral guidelines. HIV‐positive pregnant and postnatal women from all countries/settings were eligible. HIV‐positive women were either on an antiretroviral regimen at the time of the study, previously on an antiretroviral regimen, not initiated on a regimen yet, or enrolled in prevention of mother‐to‐child transmission (PMTCT) care. Quality assessment of all included studies were conducted. Four databases (CINAHL, EMBASE, MEDLINE and PsycINFO) were searched for studies conducted from January 2010 to October 2020. Nine papers were included in the review, of which two presented findings from the same study. Five analytical themes were developed via thematic synthesis: (1) awareness of breastfeeding with antiretrovirals, (2) turmoil of emotions, (3) coping mechanisms, (4) the intertwining of secret, stigma and support and (5) support needed. Support from family and health care professionals and coping approaches were important to overcome stigma and the emotional challenges of breastfeeding with antiretrovirals. Health care professionals should be familiar with the most updated national and local guidance surrounding infant feeding and antiretrovirals. Further research into interventions to encourage HIV‐positive women to adhere and commit to lifelong antiretroviral treatment (Option B+) for breastfeeding is required.

This review aimed to synthesize qualitative evidence of views and experiences of partners and other family members who provided breastfeeding support for a relative. The Joanna Briggs Institute (JBI) methodology for systematic reviews of qualitative evidence was followed. Seven databases: CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Maternal and Infant Care, and Web of Science were searched. Partners and other family members (e.g. grandmothers, siblings) of women in any countries were included. Included papers were critically appraised. The JBI meta-aggregative approach was used to analyze data and form synthesized findings. Seventy-six papers from 74 studies were included. Five synthesized findings were: (i) spectrum of family members' breastfeeding knowledge, experiences and roles; (ii) the complexity of infant feeding decision making; (iii) the controversy of breastfeeding in front of others; (iv) impact of breastfeeding on family; and (v) it takes more than just family members: support for family members. Partners' and family members’ views and experiences of breastfeeding support reflected multi-faceted personal, social, financial, cultural, religious, emotional, psychological, and societal factors of the support they provided (or not). Healthcare professionals should engage them in breastfeeding discussions with the woman, and offer tailored and practical guidance relevant to help them to appropriately support the woman. This article is part of the theme issue ‘Multidisciplinary perspectives on social support and maternal–child health’.

Autoimmune diabetes is a rare but severe endocrine toxicity induced by immune checkpoint inhibitor (ICI) treatment. It is unclear if ICI causes selective islet toxicity or non-selective pancreas toxicity. We analyzed 11 patients treated with ICI who developed ICI-related autoimmune diabetes. Eight patients had lipase and/or amylase tested on the same day of diagnosis of autoimmune diabetes. Among them, 75% (6/8) had normal lipase and 100% (6/6) had normal amylase. There was no correlation between glucose level at onset and biochemical pancreatitis. We characterized the clinical features of ICI-induced autoimmune diabetes. Fifty-five percent (6/11) of patients tested positive for GAD65 autoantibodies, and 55% (6/11) developed diabetic ketoacidosis at manifestation of hyperglycemia. In all 11 patients, C-peptide levels were low in the presence of hyperglycemia. ICI-induced thyroiditis was found in 64% (7/11), of which 36% (4/11) were newly diagnosed with thyroiditis while the remaining 27% (3/11) had pre-existing hypothyroidism followed by ICI-induced thyroiditis. Additionally, 27% (3/11), developed ICI-induced hypophysitis. Thyroiditis and autoimmune diabetes coexisted in all patients with ICI-induced hypophysitis. The median time from ICI treatment to the onset of autoimmune diabetes was 11 weeks. Our data suggest that few patients had coexistent ICI-induced autoimmune diabetes and pancreatitis, suggesting ICI mainly caused selective islet toxicity.

Background As suggested by the World Health Organization, breastfeeding peer support is being introduced worldwide to support women’s breastfeeding needs. Evidence has shown that when such support is offered to women, the duration and exclusivity of breastfeeding is increased. We developed an innovative home-based intervention to sustain exclusive breastfeeding in Hong Kong. However, potential barriers must be addressed before a full randomised controlled trial (RCT) is conducted. The aim of this study was to determine the feasibility of a breastfeeding support programme with home-based visits from peer supporters over a six month period among postpartum Chinese women in Hong Kong. Methods We conducted a feasibility and pilot randomised controlled trial. Twenty primiparous women intending to breastfeed their healthy term singleton infant were recruited from a hospital in Kowloon, Hong Kong between February and March 2019. Participants were randomly allocated to the intervention or control group. Participants in the intervention group received five home-based visits with a peer supporter over a six month period, as well as standard care, whereas participants in the control group received standard care only. We assessed feasibility, compliance, and acceptability of the breastfeeding peer support programme. Other outcomes assessed were breastfeeding self-efficacy, duration, and exclusivity. Results It was feasible to recruit and train existing peer supporters, and peer supporters were able to deliver the intervention, which was acceptable to women, but rates of stopping the intervention and loss to follow-up were high. There was higher retention seen within the first month. Women interviewed at the end of the study reported that the intervention was positive. The cessation risk of any, and exclusive breastfeeding were not statistically different between the intervention and control groups. Conclusions This study provided valuable information on feasibility of the trial design and intervention. Modifications to the intervention, such as targeting women with lower breastfeeding self-efficacy, or combining home visits with technology and telephone follow-up may be more appropriate in a larger trial. Implementing the programme early during the antenatal phase and tailoring peer support to most appropriately sustain exclusive breastfeeding and other feeding modes should be incorporated in a future home-based peer support arm. Trial registration NCT03705494 on 15 Oct 2018.

OBJECTIVE The purpose of this study was to determine whether patients who discuss bariatric surgery with their providers are more likely to undergo the procedure and to lose weight. METHODS A retrospective cohort study of adults with BMI ≥ 35 kg/m2 treated between 2000 and 2015 was conducted to analyze the relationship between a discussion of bariatric surgery in the first year after study entry and weight changes (primary outcome) and receipt of bariatric surgery (secondary outcome) over 2 years after study entry. Natural language processing was used to identify the documentation of bariatric surgery discussion in electronic provider notes. RESULTS Out of 30,560 study patients, a total of 2,659 (8.7%) discussed bariatric surgery with their providers. The BMI of patients who discussed bariatric surgery decreased by 2.18 versus 0.21 for patients who did not (p < 0.001). In a multivariable analysis, patients who discussed bariatric surgery with their providers lost more weight (by 1.43 [change in BMI]; 95% CI: 1.29-1.57) and had greater odds (10.2; 95% CI: 9.0-11.6; p < 0.001) of undergoing bariatric surgery. CONCLUSIONS Clinicians rarely discussed bariatric surgery with their patients. Patients who did have this discussion were more likely to lose weight and to undergo bariatric surgery.

Background: It is unclear whether caregivers’ concern about child weight impacts their non-responsive feeding practices. This systematic review aimed to examine their relationships. Methods: A systematic search of PubMed, Embase, PsycINFO, Web of Science core collection, CINAHL and grey literature was conducted from inception to March 2022, following PRISMA guidelines. Data synthesis was performed using a semi-quantitative approach and a meta-analysis. Results: A total of 35 studies with 22,933 respondents were included in the review for semi-quantitative analyses. Thirty-four studies examined 52 associations between concern about child weight and restriction with 40 statistically significant associations being observed. A total of 34 relationships between concern about child weight and pressure to eat were investigated, with 12 being statistically significant. The pooled regression coefficients (β) demonstrated that caregivers’ concern about child overweight was positively associated with restriction (β = 0.22; 95%CI: 0.12, 0.31), negatively associated with use of food as a reward (β = −0.06; 95%CI: −0.11, −0.01), and not statistically associated with pressure to eat (β = −0.05; 95%CI: −0.13, 0.04). The pooled odds ratios (ORs) indicated that caregivers who were concerned about child overweight were found to use restrictive feeding more often (OR = 2.34; 95%CI: 1.69, 3.23), while less frequently adopting pressure to eat (OR = 0.76; 95%CI: 0.59, 0.98) compared with those without concerns. The results also showed that caregivers who were concerned about child underweight were more likely to force their children to eat (OR = 1.83; 95%CI: 1.44, 2.33) than those without concerns. Conclusion: Caregivers’ concern about child weight may be an important risk factor for non-responsive feeding practices. Thus, interventions are needed to focus on managing and relieving caregivers’ excessive concern about child weight, especially overweight, which may optimize feeding practices and subsequently contribute to child health.

To examine and synthesise qualitative evidence of women's, peer supporters' and healthcare professionals' views and experiences of breastfeeding peer support.The Joanna Briggs Institute (JBI) approach to systematic reviews of qualitative studies was followed. Seven databases: CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, MaternalInfant Care, and Web of Science were searched. Included papers were critically appraised using the JBI Critical Appraisal Checklist for Qualitative Research. JBI's meta-aggregation approach was used to synthesise findings. JBI's ConQual process was followed to assess confidence of evidence.Primiparous and multiparous women, lay breastfeeding peer supporters, and healthcare professionals based in high, middle, and low income countries.Twenty-three papers presenting findings from 22 studies were included. The synthesised findings included: (1) Positive characteristics, approaches and benefits of peer support(ers); (2) Relationships between healthcare professionals and peer supporters; (3) Improving women's access to peer support services; (4) Barriers and enablers to provide peer support.Breastfeeding peer support increased women's self-esteem and confidence in breastfeeding while reducing social isolation. Peer supporters valued the experience, which gave them a sense of purpose and confidence, and felt good about helping the women they supported. Women appreciated peer supporters who were caring, spent time with them, shared experiences, provided realistic information, practical and emotional support. Although there were tensions between some healthcare professionals and peer supporters, many valued the mutual support offered. Embedding peer supporters in healthcare systems for them to work alongside healthcare professionals, combined with good communications and building trusty relationships could be a useful strategy to reduce tensions between them.

Background This paper reports the development of a co-produced e-resource to support those who have experienced childhood sexual abuse through pregnancy, birth, and parenthood. These are times of major transition for any woman but can present particular challenges for those who have experienced childhood sexual abuse. Re-traumatisation during the perinatal period is common and can occur in ways that may not be anticipated by those involved. Survivors often do not disclose their abuse and the childbearing journey can be lonely. Methods The work was conducted in collaboration with The Survivors Trust and in keeping with the Survivor’s Charter. A participatory approach was used. There were two phases: the generation of new qualitative data and development of the resource. To encourage participation from this hidden population, data were collected by a variety of means including focus groups, telephone interviews and an on-line survey. Survivors who had children and those who hoped to one day participated. Resource development was facilitated by two workshops and email feedback. Results Overall, 37 women participated, all of whom were positive about development of the resource. Although many issues identified during data collection were specific to the participants’ history of abuse other areas of concern would be relevant for any woman contemplating the journey to parenthood. Women often assumed that they were alone in their concerns and were reassured to discover that others shared their experiences. The final resource is hosted on The Survivors Trust Website and is accessible from all electronic devices. It follows the journey from deciding to have a baby, pregnancy, labour, birth, and the postnatal period through to parenthood. Links are provided to further information and sources of support. The process of developing the resource used trauma-informed principles and it speaks with women’s words in a peer-to-peer voice. Conclusions This paper describes the development of an innovative and accessible e-resource that is based on the words and experiences of survivors of childhood sexual abuse. It recognises the importance of control and feeling safe and aims to empower those who use the resource as they embark on pregnancy, birth, and parenthood.

Recent data have shown significant benefit from SGLT2 inhibitors (SGLT2i) in patients with diabetes (DM) and cardiovascular disease (CVD) but experience with use in the acute care setting is limited and feasibility of initiating in the hospital is unclear. A multidisciplinary team of cardiology, endocrinology, and pharmacy developed a pilot to assess the feasibility of initiating SGLT2i in the hospital and subsequent transition of care. From 5/4/19 to 10/6/19, patients with DM on the cardiology service were identified and initiated on therapy with an SGLT2i if there were no contraindications. All patients were offered education via fact sheet, video, and/or focused consultation from the inpatient diabetes team. All prescriptions were either filled or verified as covered by insurance prior to discharge. An electronic communication was sent to notify the PCP and recommend basic metabolic labs be done at 2 weeks after initiation. 24 patients were eligible and 23 (96%) filled the prescription at discharge. 54.2% had CAD while 75% had CHF: 45.8% HFrEF and 29.2% HFpEF. The median GFR was 54 mL/min (44-64) and mean A1c was 8.1%. At 1 month, 71% remained on SGLT2i (n=17) and 63% completed recommended labs (n=15). 79% had outpatient follow up by 30 days (N=24) and 91% by 90 days (N=12). One patient died of respiratory failure within 30 days. 33% were readmitted within 90 days due to non-CHF cardiac illness (50%), respiratory problem (25%), lightheadedness (13%, n=1), or urinary tract infection (13%, n=1), and none for diabetes or CHF. There were no cases of metabolic acidosis or electrolyte disturbance. There was both a significant decrease in estimated GFR at 1 month (-6.95 mL/min, p= 30% reduced GFR and 1 advanced from CKD stage 4 to 5. In conclusion, initiation of SGLT2i therapy in select patients with CVD and DM in the acute care setting appears to be feasible. Guidance is needed to ensure appropriate patient selection and medication adjustment in these patients. Disclosure N.E. Palermo: None. M. Goodberlet: None. G. Cromwell: None. C.M. Smith: None. L. Chang: Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Other Relationship; Self; Applied Therapeutics, Fractyl Laboratories, Inc., Novo Nordisk Inc., Sanofi. A. Bilodeau: None. J. Plutzky: Consultant; Self; Amgen, AstraZeneca, Janssen Pharmaceuticals, Inc., Novo Nordisk A/S. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc. P.M. Szumita: None. O. Hulme: None. C. Cannon: None. M.E. McDonnell: None.

In recent years, optical interconnection networks have been proposed in order to achieve the ultrahigh bandwidth and low latency requirements for inter/intra-chip communication. In these optical interconection networks, series of basic optical elements are employed. Via these series of optical elements, the intrinsic crosstalk noise is generated. With a large scale of these optical elements, the signal-to-noise ratio (SNR) of an optical interconnect can be reduced by this crosstalk noise. In this paper, we utilize the adaptive power control (APC) to enhance the SNR under the crosstalk noise constraints. APC has been known to save energy and reduce power consumption. We apply this technique in one of the inter/intra-chip optical interconnect called I2CON. A new cluster design, namely the Beam cluster, is also introduced. Results have demonstrated that the APC can help to reduce crosstalk noise, hence, the overall SNR is improved. Comparison results have also indicated the further improvement of SNR in I2CON using Beam cluster when APC is applied.

Postpartum weight retention (PWR) is a risk factor for future obesity. The role of breastfeeding in reducing PWR is not fully understood. We examined the relationship between PWR and the duration of exclusive/partial breastfeeding in 52,367 postpartum women from 2012&ndash, 2016 Taiwan national breastfeeding surveys. The women were interviewed at 7&ndash, 14 months postpartum. Non-linear models were fit to examine the association between PWR and breastfeeding duration. PWR adjusted means and 95% confidence intervals were plotted and compared for the duration of exclusive/partial breastfeeding in the total sample and between pre-pregnancy body-mass index (BMI) groups (underweight, normal, overweight, and obese). Women who breastfed exclusively for &gt, 30 days showed significantly lower PWR than those who did not breastfeed and those who breastfed partially for the same duration, thereafter each additional duration of 30 days being associated with an average of 0.1&ndash, 0.2 kg less PWR. Women who breastfed partially for 120 days showed lower PWR than those who did not or those who ceased to breastfeed, thereafter each additional duration of 30 days being associated with an average of 0.1 kg less PWR. Duration of breastfeeding needed to achieve significantly less PWR differed between pre-pregnancy BMI groups, but the effect of exclusive breastfeeding appeared earlier in the normal weight group. Women with obesity who breastfed exclusively for &gt, 30 or partially for &gt, 180 days, had lower PWR than non-obese groups. The observed dose&ndash, response relationship between breastfeeding duration and PWR supports the &ldquo, every feeding matters&rdquo, approach in breastfeeding promotion. The larger effect of exclusive and partial breastfeeding on PWR in women with obesity may draw special attention of breastfeeding promotion.

Cardiometabolic conditions span overlapping systemic disease states including obesity, diabetes mellitus (DM), dyslipidemia, nonalcoholic fatty liver disease, and chronic kidney disease. These entities are highly prevalent, share common core pathological drivers, and are associated with an excess