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ObjectiveTo examine rates of postpartum hemorrhagic (PPH) morbidity among patients who did and did not have immediate skin-to-skin contact (SSC).MethodsThis study was a retrospective cohort of all non-anomalous, term singleton vaginal births at a Level IV center over 2 years. Exclusion criteria included COVID-19. Immediate SSC was defined as at least 60 min of direct contact initiated between parturient and neonate within 10 min of birth. The primary outcome was a composite of maternal morbidity related to PPH compared among those with and without immediate SSC. We used multivariable Poisson regression adjusted for possible confounders with robust error variance to determine the strength of the association.ResultsOf 8623 deliveries during the study period, 3520 (40.8%) deliveries were included; of which 2428 (55.5%) had immediate SSC and 1028 (31.0%) did not. Immediate SSC reduced the overall rate of composite morbidity (adjusted relative risk 0.78, 95% confidence interval 0.65-0.92), and rate of blood loss 1000 mL or greater, use of additional uterotonics, and use of mechanical tamponade. Blood loss and third stage of labor duration were significantly less for immediate SSC. Transfusion rate and hematocrit change after delivery, did not differ.ConclusionImmediate SSC among term vaginal deliveries was associated with a significant reduction in PPH. Emphasis on early contact for maternal benefit may increase uptake of SSC and provide an accessible intervention for PPH in high- and low-resource settings.

Abstract Background The Oakland Score predicts risk of 30-day adverse events among hospitalized patients with lower gastrointestinal bleeding (LGIB) possibly identifying patients who may be safe for discharge. The Oakland Score has not been studied among emergency department (ED) patients with LGIB. The Oakland Score composite outcome includes re-bleeding, defined as additional blood transfusion requirements and/or a further decrease in hematocrit (Hct) >/= 20% after 24 h in clinical stability; red blood cell transfusion; therapeutic intervention to control bleeding, including surgery, mesenteric embolization, or endoscopic hemostasis; in-hospital death, all cause; and re-admission with further LGIB within 28 days. Prediction variables include age, sex, previous LGIB admission, systolic blood pressure, heart rate, and hemoglobin concentration, and scores range from 0 to 35 points, with higher scores indicating greater risk. Methods Retrospective cohort study of adult (≥ 18 years old) patients with a primary ED diagnosis of LGIB across 21 EDs from March 1st, 2018, through March 1st, 2020. We excluded patients who were more likely to have upper gastrointestinal bleeding (esophago-gastroduodenoscopy without LGIB evaluation), patients who left against medical advice or prior to ED provider evaluation, ED patients without active health plan membership, and patients with incomplete Oakland Score variables. We assessed predictive accuracy by reporting the area under the receiver operator curve (AUROC) and sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios at multiple clinically relevant thresholds. Results We identified 8,283 patients with LGIB, 52% were female, mean age was 68, 49% were non-White, and 27% had an adverse event. The AUROC for predicting an adverse event was 0.85 (95% CI 0.84–0.86). There were 1,358 patients with an Oakland Score of

South Africa is among the world's top eight tuberculosis (TB) burden countries, and despite a focus on HIV-TB co-infection, most of the population living with TB are not HIV co-infected. The disease is endemic across the country, with 80-90% exposure by adulthood. We investigated epidemiological risk factors for (TB) in the Northern Cape Province, South Africa: an understudied TB endemic region with extreme TB incidence (926/100,000). We leveraged the population's high TB incidence and community transmission to design a case-control study with similar mechanisms of exposure between the groups. We recruited 1,126 participants with suspected TB from 12 community health clinics and generated a cohort of 774 individuals (cases = 374, controls = 400) after implementing our enrollment criteria. All participants were GeneXpert Ultra tested for active TB by a local clinic. We assessed important risk factors for active TB using logistic regression and random forest modeling. We find that factors commonly identified in other global populations tend to replicate in our study, e.g. male gender and residence in a town had significant effects on TB risk (OR: 3.02 [95% CI: 2.30-4.71]; OR: 3.20 [95% CI: 2.26-4.55]). We also tested for demographic factors that may uniquely reflect historical changes in health conditions in South Africa. We find that socioeconomic status (SES) significantly interacts with an individual's age (p = 0.0005) indicating that protective effect of higher SES changed across age cohorts. We further find that being born in a rural area and moving to a town strongly increases TB risk, while town birthplace and current rural residence is protective. These interaction effects reflect rapid demographic changes, specifically SES over recent generations and mobility, in South Africa. Our models show that such risk factors combined explain 19-21% of the variance (r2) in TB case/control status.

Abstract Aims Emergency department (ED) providers play an important role in the management of patients with acute heart failure (AHF). We present findings from a pilot study of an electronic decision support that includes personalized risk estimates using the STRIDE‐HF risk tool and tailored recommendations for initiating guideline directed medical therapy (GDMT) among appropriate patients. Methods Among ED patients treated for AHF who were discharged from the ED or the ED‐based observation unit in two EDs from 1 January 2023 to 31 July 2023, we assess prescriptions to the four classes of GDMT at two intervals: (1) ED arrival and (2) ED discharge. Specifically, we report active prescriptions for beta‐blockers (BBs), renin–angiotensin receptor system inhibitors (RASis), sodium‐glucose transport protein 2 inhibitors (SGLT2is) and mineralocorticoid receptor antagonists (MRA) among patients with reduced ejection fraction (HFrEF) and mildly reduced (HFmrEF). Second, we describe rates of 30‐day serious adverse events (SAE) (death, cardiopulmonary resuscitation, balloon‐pump insertion, intubation, new dialysis, myocardial infarction or coronary revascularization) among patients predicted to be very low risk by STRIDE‐HF and discharged home. Results Among 234 discharged patients, 55% were female and 76% were non‐White. We found 51 (21.8%), 21 (9.0%) and 126 (53.8%) had HFrEF, HFmEF and HFpEF, respectively, while 36 (15.4%) were missing EF, and 51 (22%) were very low risk, 82 (35%) were low risk, 60 (26%) were medium risk and 41 (18%) were high risk. Among HFrEF patients, 68.6%, 66.7%, 25.5% and 19.6% were on a RASi, BB, SGLT2i and MRA, respectively, at ED arrival, while 42.9%, 66.7%, 14.3% and 4.8% of HFmrEF patients were on a RASi, BB, SGLT2i and MRA, respectively. Among patients with HFpEF, only 6 (4.8%) were on an SGLT2i at ED arrival. The most prescribed new medication at ED discharge was an SGLT2i, with a nearly 10% increase in the proportion of patients with an active prescription for SGLT2i at ED discharge among HFrEF and HFmEF patients. We observed no 30‐day SAE among the 51 patients predicted to be very low risk and discharged home. Conclusions Ongoing treatment with GDMT at ED arrival was sub‐optimal. Initiation among appropriate patients at discharge may be feasible and safe.

Background: While clinical practice habits vary by patient, physician and clinic factors in primary care, limited research has examined whether differences exist in obesity medicine. Our objective was to compare practice habits by such factors among obesity medicine physicians certified by the American Board of Obesity Medicine (ABOM). Methods: We conducted secondary analyses of cross-sectional data from the 2023 ABOM Practice Analysis Validation Survey. We included three obesity medicine practice habits – prescribing anti-obesity medications (AOMs), off-label prescribing of medications for weight reduction, and obesity medicine clinical practice hours (4–20 h/week versus >20 h/week). We included patient (patient population), physician (primary medical specialty, years of obesity medicine experience) and clinic factors (practice setting, geographic catchment, accepts insurance for obesity care). We conducted bivariate analyses using Χ2 tests. Results: Among 565 ABOM-certified physicians, 71.5 % had primary medical specialties within primary care and 9.2 % predominantly treated children/adolescents with obesity. Overall, 97.5 % prescribed AOMs and 85.1 % prescribed off-label medications for weight reduction. Fewer physicians who predominantly treated children/adolescents prescribed AOMs compared to physicians with no or limited treatment of children (88.5 % versus 98.4 % and 98.5 %, respectively; p 20 h/week, which was more likely to occur as years of obesity medicine experience increased (i.e., 21.9 ​% among physicians with 1–2 years of experience versus 58.5 ​% with 10+ years; p ​

Political elites express their ideological positions on contentious issues across various arenas in the public sphere. Social science research often relies on data extracted from various media or political and administrative sources, as well as surveys that are administered directly with the political actor. Although some studies compare ideology across different sources, few systematically analyze how political actors adjust their ideological messaging to the audiences in the respective communication arenas and how such changes are associated with systematic bias in data sources. This paper uses a unique dataset combining climate policy belief observations from three arenas—social media, Congressional testimony, and surveys—on identical ideological variables and during the same time period. We apply item response theory to understand how responses differ by arena and find that ideological communication on Twitter is most left-leaning, Congressional testimony is most right-leaning, and surveys, the data source with the smallest potential arena effect, is in the middle. We also find that actors with strong ideological leaning moderate their positions on social media and in Congress. These findings enhance our understanding of strategic communication depending on audience context and inform social research on biases when analyzing specific data sources.

ObjectivesEfficient and accurate emergency department (ED) triage is critical to prioritize the sickest patients and manage department flow. We explored the use of electronic health record data and advanced predictive analytics to improve triage performance.MethodsUsing a data set of over 5 million ED encounters of patients 18 years and older across 21 EDs from 2016 to 2020, we derived triage models using deep learning to predict 2 outcomes: hospitalization (primary outcome) and fast-track eligibility (exploratory outcome), defined as ED discharge with

Background: Preterm inductions may be necessary for maternal comorbidities or fetal abnormalities. Previous studies have identified risk factors for undergoing a cesarean delivery (CD). Our study examined the insertion-to-expulsion time (IET) of cervical ripening balloons (CRB) in preterm inductions that achieved vaginal delivery (VD) compared to CD. Methods: This was a retrospective cohort study of preterm inductions with CRB between 2010 and 2021. Primary outcome was IET of CRB. IRB approval was obtained. Results: The study included 82 women. IET for cesarean patients was significantly greater, and required more removal of CRB at the allotted 12 h. Dilation before and after CRB was significantly greater in the vaginal cohort. There was no significant difference in maternal comorbidities, indication for induction or neonatal complications. Conclusions: Maternal comorbidities, induction indication and neonatal complications were similar between cohorts, making trial of induction with CRB in preterm women a reasonable option. Spontaneous expulsion of CRB and greater dilation may be predictors of vaginal delivery.

Factors such as subsistence turnover, warfare, or interaction between different groups can be major sources of cultural change in human populations. Global demographic shifts such as the transition to agriculture during the Neolithic and more recently the urbanization and globalization of the twentieth century have been major catalysts for cultural change. Here, we test whether cultural traits such as patri/matrilocality and postmarital migration persist in the face of social upheaval and gene flow during the past 150 years in postcolonial South Africa. The recent history of South Africa has seen major demographic shifts that resulted in the displacement and forced sedentism of indigenous Khoekhoe and San populations. During the expansion of the colonial frontier, the Khoe-San admixed with European colonists and enslaved individuals from West/Central Africa, Indonesia, and South Asia, introducing novel cultural norms. We conducted demographic interviews among Nama and Cederberg communities representing nearly 3,000 individuals across three generations. Despite the history of colonial expansion, and the subsequent incorporation of Khoe-San and Khoe-San-descendant communities into a colonial society with strong patrilocal norms, patrilocality is the least common postmarital residence pattern in our study populations today. Our results suggest that more recent forces of integration into the market economy are likely the primary drivers of change in the cultural traits examined in our study. Birthplace had a strong effect on an individual's odds of migration, distance moved, and postmarital residence form. These effects are at least partially explained by the population size of the birthplace. Our results suggest that market factors local to birthplaces are important drivers of residence decisions, although the frequency of matrilocal residence and a geographic and temporal cline in migration and residence patterns also indicate the persistence of some historic Khoe-San cultural traits in contemporary groups.

Science is under attack and scientists are becoming more involved in efforts to defend it. The rise in science advocacy raises important questions regarding how science mobilization can both defend science and promote its use for the public good while also including the communities that benefit from science. This article begins with a discussion of the relevance of science advocacy. It then reviews research pointing to how scientists can sustain, diversify, and increase the political impact of their mobilization. Scientists, we argue, can build and maintain politically impactful coalitions by engaging with and addressing social group differences and diversity instead of suppressing them. The article concludes with a reflection on how the study of science-related mobilization would benefit from further research.

Background: Given the evolving nature of obesity medicine, periodic evaluation of its clinical practice is needed to ensure that certification requirements address real-world experience. Practice analysis is a systematic approach to define a field's body of knowledge, and its results can inform the content outline and examination blueprint for a certification examination. This study describes the 2023 practice analysis conducted by the American Board of Obesity Medicine (ABOM). Methods: Initially, 14 obesity medicine physicians participated in a practice analysis panel, resulting in 3 duties and 30 tasks required for competent practice of obesity medicine physicians. Each task included steps, knowledge, skills, and abilities needed to perform the task. ABOM then recruited 645 certified obesity medicine physicians from its database to participate in a validation survey to rate the frequency [scale: never (0) to very frequently (5)] and importance [scale: not important (0) to very important (3)] of each task. Survey participants could also provide open-ended comments. Results: Among validation survey participants (n = 645), the most common primary medical specialties reported were internal medicine (46.0 %), family medicine (33.8 %), and pediatrics (11.2 %). Years practicing obesity medicine varied with 45.3 % reporting 1–4 years, 26.0 % 5–9 years, and 28.7 % ≥ 10 years in practice. Most tasks were performed frequently (mean score ≥4.0) and rated as important (mean score ≥2.0). All tasks were retained based on the frequency and importance ratings. Survey results informed the weighting in the examination blueprint. Conclusion: There was consensus among practicing ABOM-certified physicians who participated in the validation survey in the tasks required for competent obesity medicine practice. Our practice analysis approach was a structured process that engaged obesity medicine physicians and captured the breadth and depth of knowledge required for obesity medicine. The new content outline and examination blueprint developed will be implemented with the 2025 ABOM certification exam administration.

The present study examined university students’ perceptions of a campus sexual violence scenario, and specifically determined whether the presence of known risk factors for sexual perpetration would influence their views of an individual who caused harm. Two hundred and seventy-five student participants read a vignette that either included the present or absence of the following three risk factors: Frequent alcohol use, attitudes supportive of rape, and negative peer influence. The findings indicated that the risk factors did not have a significant relationship with students' risk perceptions, indicating that students’ perceptions of risk may not be influenced by the presence of known risk factors. The results suggest that students may use intuition or other non-scientific approaches when assessing instances of interpersonal violence, at least in campus settings. Implications for students, post-secondary institutional safety, and prevention of campus sexual violence are discussed.

BackgroundManagement of adults with atrial fibrillation (AF) or atrial flutter in the emergency department (ED) includes rate reduction, cardioversion, and stroke prevention. Different approaches to these components of care may lead to variation in frequency of hospitalization and stroke prevention actions, with significant implications for patient experience, cost of care, and risk of complications. Standardization using evidence-based recommendations could reduce variation in management, preventable hospitalizations, and stroke risk.MethodsWe describe the rationale for our ED-based AF treatment recommendations. We also describe the development of an electronic clinical decision support system (CDSS) to deliver these recommendations to emergency physicians at the point of care. We implemented the CDSS at three pilot sites to assess feasibility and solicit user feedback. We will evaluate the impact of the CDSS on hospitalization and stroke prevention actions using a stepped-wedge cluster randomized pragmatic clinical trial across 13 community EDs in Northern California.DiscussionWe hypothesize that the CDSS intervention will reduce hospitalization of adults with isolated AF or atrial flutter presenting to the ED and increase anticoagulation prescription in eligible patients at the time of ED discharge and within 30 days. If our hypotheses are confirmed, the treatment protocol and CDSS could be recommended to other EDs to improve management of adults with AF or atrial flutter.Trial registrationClinicalTrials.gov NCT05009225 .  Registered on 17 August 2021.

Data4HumanRights’ training materials have been developed as open-source and tailored to limited-resource settings, where community data collectors often live and work. Access to training on data collection, analysis, and visualisation to support the advocacy of vulnerable groups is essential, particularly in the context of increasing human rights challenges such as land rights, adequate housing, conflicts, and climate justice. This paper provides an overview of how the training materials were co-developed with community data collectors in Nigeria and Kenya, offering insights into the fundamental principles (i.e., inclusiveness, adaptive, limited resources, and being gender- and incentive-sensitive) and the structure of the open-access training materials. The development process resulted in 28 modules, each designed to be delivered in a face-to-face format in less than one day by a local trainer. To maximize adaptivity, the training modules can be mixed and matched (e.g., as individual modules or a learning path of several modules around a specific training need). The individual modules cover a range of methods and tools that are useful to human rights work and community advocacy, e.g., documenting evictions, performing rapid needs assessments after acute crises, community profiling, and monitoring community development indicators. The training materials contain instructions for the training facilitator(s) and all necessary training materials. To ensure inclusivity, the training covers both basic and advanced topics, with most modules designed to address basic needs that can be followed using a mobile phone, thereby avoiding the need for computers or printed handouts. The training results in Nigeria and Kenya showcase applications, including mapping waste problems and addressing forced evictions. Trained community groups produced maps of waste piles to prioritize community actions, such as finding space for urban agriculture, and conducted rapid needs assessments during a massive eviction. This approach helps reduce power imbalances and empowers community groups to effectively manage and utilise their own data.

We present the first emission spectrum of the hot Jupiter WASP-17 b using one eclipse observation from the JWST Near Infrared Imager and Slitless Spectrograph (NIRISS) Single Object Slitless Spectroscopy (SOSS) mode. Covering a wavelength range of 0.6–2.8 μ m, our retrieval analysis reveals a strong detection of H _2 O in WASP-17 b’s dayside atmosphere (6.4 σ ). Our retrievals consistently favor a supersolar dayside H _2 O abundance and a noninverted temperature–pressure profile over a large pressure range. Additionally, our examination of the brightness temperature reveals excess emission below 1 μ m, suggesting the possibility of a high internal temperature (600–700 K) and/or contributions from reflected light. We highlight that JWST emission spectroscopy retrieval results can be sensitive to whether negative eclipse depths are allowed at optical wavelengths during light-curve fitting. Our findings deepen our understanding of WASP-17 b’s atmospheric composition while also highlighting the sensitivity of our results to pressure–temperature profile parameterizations. This work is part of a series of studies by our JWST Telescope Scientist Team (TST), in which we will use Guaranteed Time Observations to perform Deep Reconnaissance of Exoplanet Atmospheres through Multi-instrument Spectroscopy (DREAMS).

Background: Rapid advances in prenatal genetic testing highlight the need for technology-based tools to assist in informed decision-making. Purpose: This study evaluates the feasibility, acceptability, and efficacy of a Computer-Aided Genetics Education Module (CAGEM) as an e-counseling tool and decision aid in a busy obstetric clinic among a socially disadvantaged patient population. Methods: A randomized controlled trial with patients randomized (1:1) to receive the intervention in addition to standard of care or standard of care only. Participants responded to pre- and posttest questionnaires. Results: Although limited in recruitment by the COVID-19 pandemic, this tool scored 81.0% acceptability and 91.0% feasibility among 88 participants. No statistically significant difference was detected between the overall improvement in knowledge scores and the total posttest knowledge scores among the intervention and control groups. However, the intervention group scored significantly higher on the posttest questions regarding NIPT interpretation (61.7 ± 49.1 vs 80.9 ± 39.8, p = 0.049), Down syndrome (78.7 ± 41.4 vs 93.6 ± 24.7, p = 0.016), and inheritance of recessive conditions (59.6 ± 49.6 vs 91.4 ± 28.2, p < 0.001). The intervention group also showed a greater improvement in knowledge scores for inheritance of recessive conditions (31.9 ± 8.1 vs 0 ± 7.8, p = 0.006) and a protective effect in knowledge scores for Down syndrome (0 ± 6.1 vs -17.1 ± 6.0, p = 0.049). Discussion: CAGEM may be a feasible and acceptable e-counseling tool and decision aid, especially when compared to standard of care prenatal counseling. Although overall knowledge did not show significant improvement, CAGEM showed promise in enhancing knowledge acquisition for certain genetic education topics, showing that technology-based tools may be beneficial in informed consent. Future iterations may be revised to improve clarity, especially around invasive testing methods, race congruency, and insurance coverage. Translation to Health Education Practice: This study's method creates a model for Health Educators to design and evaluate technology-based tools for improving informed decision-making around prenatal genetic testing. Tools like CAGEM may be utilized to improve patient education prior to prenatal appointments and thus serve as an adjunct to provider counseling. Specifically, CAGEM addresses multiple NCHEC Responsibilities and Competencies including #1.1.2, 1.3.2, 1.3.4, 4.2.9, and 6.4.3. Translation to Health Education Practice

Abstract Nutrient‐rich waters along the Pacific coast of North America support diverse fish communities that have helped sustain coastal peoples for millennia. Five Nuu‐chah‐nulth First Nations on the west coast of what is now known as Vancouver Island, Canada, hold constitutional Indigenous rights to conduct a multispecies community fishery, which includes Pacific Halibut (Hippoglossus stenolepis). A 2009 court decision defined the extent of these Indigenous rights to be within 9 nm of the coast, thereby not fully recognizing the knowledge and authority of the traditional leadership and raising concerns about the potential for an increase in rockfish bycatch. Yelloweye Rockfish (Sebastes ruberrimus) are a potential ‘choke’ species for this fishery because the two species occupy similar depth ranges. A choke species is one that is caught incidentally while targeting other species and, if caught in excess of its quota limits, can trigger a halt to fishing on the target species. Guided by the insights of local Indigenous peoples and using both fishery‐independent survey and commercial longline catch data, we investigated the effects of fishing depth and spatial restriction on the relative catch weights of these two species using spatiotemporal models. We find evidence that a confined fishing area can limit opportunities for avoiding choke species. Specifically, fishing at depths deeper than 175 m, which occur outside the court defined area (CDA), would provide more opportunities for catching halibut while avoiding Yelloweye Rockfish than are currently available within the CDA. This Indigenous‐informed, analytical approach to a management problem is just one example of how Western scientists can engage in coproduction of knowledge with Indigenous peoples to transition from the ‘status quo’ towards a practice of ‘Two‐Eyed Seeing’ that more effectively balances Indigenous rights and species conservation. Policy implications: Our study highlights (1) the importance of considering choke species distributions and opportunities for their avoidance when implementing spatial harvest restrictions and (2) how related analytical and management decisions can benefit from being guided by the advice of Indigenous knowledge holders. Read the free Plain Language Summary for this article on the Journal blog.