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Black soldier fly larvae (BSFL) waste processing has proven to be a promising approach, which can be applied in centralised or decentralised settings. Financial considerations however still remain undisclosed given business secrecy. Building on the experiences of a facility and operational setup in Indonesia, this study conducted an indepth cost analysis using methods such as time motion studies, activity based costing and a mass flow balance to evaluate business models. Thereafter followed an analysis of different scenarios on how to integrate the approach into the solid waste management system of Surabaya, Indonesia assuming different degrees of decentralisation with market rates and prices from 2020. Results show that a centralised plant, managing all steps of the BSFL process ( Scenario 1), achieves the highest net present value (NPV), mainly through the economy of scale. When BSFL waste treatment is conducted using a decentralised approach, close to the waste sources, and the nursery and postprocessing of larvae remains at a central location (Scenario 3), other benefits besides the still positive NPV can be shown. Such a scenario for instance would reduce the spatial footprint of the central facility, create jobs within the communities and reduce the transport costs and total costs for the municipality. Another scenario (Scenario 2) hypothesises a decentralised waste treatment as well as post-processing of larvae at the same decentralised location increasing storability and the value of products. Although this achieves higher NPV values compared to Scenario 3, it requires larger scale units to achieve financial viability. Coordination and facilitation by local government can further strengthen a network of decentralised BSFL treatment plants, as the city authorities could focus on operating a centralised nursery (Scenario 2), supplying young larvae at low cost or free of charge to increase the financial viability of the decentralised plants treating the waste., Journal of Insects as Food and Feed, 9 (3), ISSN:2352-4588

In early triple-negative breast cancer (eTNBC), platinum-based chemotherapy has been shown to improve pathological complete response, but recommendations to include platinum chemotherapy are not consistent in international guidelines. We performed a systematic review of published randomized control trials to assess to assess survival outcomes and quality of life for people with early TNBC. The results presented in this abstract have not yet been peer-reviewed by Cochrane. If the final version of the review meets the necessary standards, the review is expected to be published in the Cochrane Database of Systematic Reviews. Methods: Randomized controlled trials examining neoadjuvant or adjuvant platinum chemotherapy for eTNBC were included. We searched for published and unpublished data using standard Cochrane search strategies. The primary outcomes assessed were disease free survival (DFS) and overall survival (OS). Secondary outcomes included rate of pathological complete response (pCR), dose intensity and completion of regimens, grade III or IV toxicity related to chemotherapy, and quality of life. Prespecified subgroups included BRCA mutation status, HRD status, lymph node status, frequency of chemotherapy, type of platinum agent used, and the presence or absence of anthracycline chemotherapy. Results: From 3972 records, 19 published studies were eligible. Twenty six ongoing studies were identified. Risk of bias was judged low for most trials. There were 14 neoadjuvant chemotherapy trials, 4 adjuvant chemotherapy trials, and one trial of neoadjuvant and adjuvant therapy. Most trials used carboplatin (16 trials) followed by cisplatin (2), and lobaplatin (1). Eight trials had an anthracycline free intervention arm, 5 of which had a carboplatin-taxane intervention compared to an anthracycline-taxane control. All studies reporting DFS and OS used carboplatin. Twelve of 19 studies with a total of 3347 participants reported DFS data. Inclusion of platinum chemotherapy improved DFS in neoadjuvant and adjuvant setting (HR 0.63, 95% confidence interval (CI) 0.53-0.75; HR 0.69, 95% CI 0.54-0.88 respectively)). Eleven studies collected OS data, with a total of 3229 participants and 460 deaths reported. Inclusion of platinum chemotherapy in the regimen improved OS (neoadjuvant: HR 0.69, 95% CI 0.69, 0.55-0.86; adjuvant: 0.70, 95% CI 0.50 to 0.96). Median follow up for survival outcomes ranged from 36 – 97.6 months. Our analysis confirmed platinum chemotherapy increased pCR rates (RR 1.46 [1.33-1.61], p< 0.00001). Subgroup analysis revealed that survival outcome benefits were seen regardless of BRCA mutation status, HRD status, lymph node status, or whether the intervention arm contained anthracycline chemotherapy or not. Platinum chemotherapy was associated with reduced dose intensity, with participants more likely to require chemotherapy delays (RR 2.23 [1.70-2.94], 4 studies), dose reductions (RR 1.77 [1.56-2.02], 6 studies) and early cessation of treatment (RR 1.20 [1.04-1.38], 16 studies). Increased hematological toxicity occurred in the platinum group who were more likely to experience grade III/IV neutropenia (RR 1.55 [1.45-1.66]), anemia (RR 10.12 [6.61-15.50]) and thrombocytopenia (RR 7.59 [5.10-11.29]). There was no increase in febrile neutropenia (RR 1.16 [0.89-1.49]). Treatment-related death was very rare (7 events in 3094 patients) and similar across treatment groups (RR 0.58 [0.14-2.33]). Five studies collected quality of life data but did not report it. Conclusion: Platinum-based chemotherapy using carboplatin in the adjuvant or neoadjuvant setting improves long-term outcomes in eTNBC, regardless of the examined subgroups. This was at the cost of more frequent chemotherapy delays and dose reductions, and greater haematological toxicity. Benefit from platinum was seen both when platinum agents were added to anthracycline containing regimens, as well as in anthracycline-free regimens. Citation Format: Sofia Mason, Melina Willson, Annabel Goodwin, Jane Beith, Sam J. Egger, Rachel F. Dear. Platinum-based chemotherapy for early triple-negative breast cancer: A Cochrane systematic review and meta-analysis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-06-01.

Background Funded grant proposals provide biomedical researchers with the resources needed to build their research programs, support trainees, and advance public health. Studies using National Institutes of Health (NIH) data have found that investigators from underrepresented groups in the biomedical workforce are awarded NIH research grants at disproportionately lower rates. Grant writing training initiatives are available, but there is a dearth of rigorous research to determine the effectiveness of such interventions and to discern their essential features. Methods This 2 × 2, unblinded, group-randomized study compares the effectiveness of variations of an NIH-focused, grant writing, group coaching intervention for biomedical postdoctoral fellows and early-career faculty. The key study outcomes are proposal submission rates and funding rates. Participants, drawn from across the United States, are enrolled as dyads with a self-selected scientific advisor in their content area, then placed into coaching groups led by senior NIH-funded investigators who are trained in the intervention’s coaching practices. Target enrollment is 72 coaching groups of 4–5 dyads each. Groups are randomized to one of four intervention arms that differ on two factors: [1] duration of coaching support (regular dose = 5 months of group coaching, versus extended dose = regular dose plus an additional 18 months of one-on-one coaching); and [2] mode of engaging scientific advisors with the regular dose group coaching process (unstructured versus structured engagement). Intervention variations were informed by programs previously offered by the NIH National Research Mentoring Network. Participant data are collected via written surveys (baseline and 6, 12, 18, and 24 months after start of the regular dose) and semi-structured interviews (end of regular dose and 24 months). Quantitative analyses will be intention-to-treat, using a 2-sided test of equality of the effects of each factor. An inductive, constant comparison analysis of interview transcripts will be used to identify contextual factors -- associated with individual participants, their engagement with the coaching intervention, and their institutional setting – that influence intervention effectiveness. Discussion Results of this study will provide an empirical basis for a readily translatable coaching approach to supporting the essential grant writing activities of faculty, fellows, and other research trainees, including those from underrepresented groups.

Little is known about early postpartum physical activity (PA). Objectives: We aimed to describe PA amount and types and compare moderate-vigorous PA (MVPA) at 12-25 (T1) and 33-46 days (T2) postpartum. Design: Cross-sectional study. Methods: Participants, primiparas delivered vaginally, wore wrist accelerometers and completed questionnaires. Median and interquartile range (IQR) describe minutes/day of PA intensities in total minutes, 5- and 10-minute bouts. Wilcoxon Signed Rank test compared MVPA. Results: 577 (age: 28.3 (SD: 5.1)) had accelerometry or questionnaire at either time-point. 405 had accelerometry at both timepoints. Median (IQR) total minutes/day for light, moderate, vigorous and MVPA were 295.8 (256.1-331.7), 54.6 (40-72.7), 0.4 (0.2-0.8), and 55.5 (40.4-74.3), respectively, at T1 and 329 (289.4-367.1), 63.6 (46.9-82.2), 0.6 (0.3-1.3), and 64.5 (47-84.8), respectively, at T2. Median (IQR) minutes/day for MVPA in 5- and 10-minute bouts were 1.6 (0-5.5) and 0 (0-3.8) at T1, and 3 (0-9.2) and 0 (0-5.5) at T2. At T1, 75% (406/541) and at T2, 72.4% (397/548) reported non-impact activities. At T1, 4% and at T2, 13% reported impact/straining activities. MVPA was greater at T2 than T1 (p< 0.0001) with medians (IQR) of: total: 64.7 (47-84.6) vs 56.5 (41-74.9) minutes; 5-minute bouts: 3 (0-9.8) vs 1.7 (0-5.6) minutes; and 10-minute bouts: 1.3(0-6) vs 0(0-3.8) minutes. Conclusion: Women had high daily MVPA, though MVPA in bouts remained low. Significant increases in MVPA from T1 to T2 were small, few women reported impact/straining activities. Realistic return to pre-pregnancy PA levels should recognize the relative lack of sustained/strenuous activity in early postpartum.

BACKGROUND Human and vehicle resource management indicates a good emergency medical system (EMS). Frequently, an emergency medical technician (EMT) is the first responder to the emergency, which negates the necessity for an emergency physician (EP) and is just as sensible as handing over a stable patient to the EMT for transport to the hospital. The Austrian EMS is utilized by EMTs, in cases of potential life-threatening emergencies the dispatch center dispatches an additional team with an on-board EP. During the years 2017-2018 nearly every fifth EP mission in Innsbruck (including surrounding areas) ended in a cancellation. The numbers of patient handovers from EP to EMT are slightly lower with mission cancellations resulting in every fourth patient. Therefore, due to the high number of cancellations and handovers evaluated in this study, the findings suggest that there is a potential need to re-evaluate procedures. The re-evaluation of these procedures could determine whether these cancellations/handovers were justified or if an over hasty decision making was at fault. All cases considered in this study were from the Innsbruck and Telfs EP bases between 1 January 2017 and 13 December 2018. METHODS Out of a total of 96,908 emergency dispatches, there were 2470 cancellation/handover occurrences. These occurrences consisted of 1190 cancellations and 1280 patient handovers from the EP to the EMT. Patients who were transferred to the University Hospital Innsbruck were included in these figures. The protocols of the emergency dispatches have been filtered from the so-called CarPC. They have subsequently been grouped into cancellation and handover categories. The clinical diagnoses of the patients with inpatient treatment were evaluated from the hospital information system (KIS) of the University Hospital Innsbruck. This was done with the help of the so-called emergency physician indications catalogue of the German Medical Council. The diagnosis was documented in the hospital information system. The emergency protocols from the EMTs were also evaluated retrospectively. The Innsbruck based EP patients are hospitalized in the Innsbruck Hospital due their geographical position. When there is no need for a specific intervention the patients of the EPs based in Telfs are transferred to a local hospital. When a specific intervention is necessary, patient care must be provided by the University Hospital Innsbruck. Due to the privacy practices of the Innsbruck Medical University "vote of ethics" only the data of patients transferred to the Innsbruck Clinic can be evaluated. The information provided from the EPs based in Innsbruck was exclusively from the University Hospital Innsbruck's anesthesiologists. The physicians from the Telfs EP base are of mixed medical specialities. All of them, however, have an emergency medical physician diploma, in addition to the ius practicandi. Lastly, there are no EPs in Innsbruck or Telfs, who have any special obligations during their duty. RESULTS The results show that in 210 cases (8.5%) the indications for the EP, based on the emergency physician indications catalogue of the German Medical Council were given. Also, 8.7% of all cancellations and 8.4% of patient handovers were not justified. Patients with emergency indications had a longer hospitalization. The EP base EMS Innsbruck had more cancellations than the EP base EMS Telfs. The EMS Innsbruck also had more cancellations than patient handovers. Conversely, the EMS Telfs had more patient handovers than cancellations. On the weekends between 6:00 pm and 6:00 am there were less cancellations and handovers from both EP bases. The documentation from the EMT protocols was incomplete in 284 cancellations (23.9% of the cancellations) and 339 handovers (26.5% of the handovers), 35 patients after cancellations (2.9%), 35 patients after handovers (2.7%) needed intensive care treatment, 20 patients after cancellations (1.7% of all cancellations), and 24 patients after handovers (1.9% of all handovers) who needed intensive care treatment had a critical diagnosis. In 40 cases of patient handovers, the EP was alerted to another emergency follow-up within 10 min. CONCLUSION In Austria, the introduction of a standardized emergency indication checklist might help dispatch centers to provide a more accurate dispatch as well as all EMS team members. Furthermore, a better traceability system (according to EP cancellations and patient handovers from the EP to the EMT) could be achieved. The documentation requirements should be more precise by all members of the EMT staff, not only for the legal aspects but also for improving the overall management quality. Intense education and training as well as diagnosis feedbacks could help to reduce the number of risky cancellations/patient handovers.

Objectives The objectives of this study were to describe trajectories of pelvic floor symptoms and support from the third trimester to 1 year postpartum in primiparous women after vaginal delivery and to explore factors associated with their resolution between 8 weeks postpartum and 1 year postpartum. Methods Five hundred ninety-seven nulliparous women 18 years or older who gave birth vaginally at term completed the Epidemiology of Prolapse and Incontinence Questionnaire and the Pelvic Organ Prolapse Quantification examination at the third trimester, 8 weeks postpartum, and 1 year postpartum. Results At 1 year postpartum, 41%, 32%, and 23% of participants reported stress urinary incontinence, nocturia, and flatus incontinence, respectively, and 9% demonstrated maximal vaginal descent (MVD) ≥ 0 cm. For more common symptoms, incidence rates between the third trimester and 8 weeks postpartum ranged from 6% for urinary frequency to 22% for difficult bowel movements, and resolution rates between 8 weeks postpartum and 1 year postpartum ranged from 23% for stress urinary incontinence to 73% for pain. Between the third trimester and 8 weeks postpartum, 13% demonstrated de novo MVD ≥ 0 cm. For most symptoms, the presence of the same symptom before delivery decreased the probability of resolution between 8 weeks postpartum and 1 year. However, the sensitivities of predelivery vaginal bulge and MVD of 0 cm or greater for those outcomes at 1 year postpartum was overall low (10-12%). Conclusions One year postpartum, urinary and bowel symptoms are common in primiparous women who gave birth vaginally. A substantial portion of this burden is represented by symptoms present before delivery, while most of the prevalence of worse anatomic support is accounted for by de novo changes after delivery.

OBJECTIVE: To determine whether oxytocin for induction or augmentation of labor impacts the incidence or persistence of pelvic floor symptoms and support 5–10 weeks after first vaginal delivery. METHODS: Participants in this prospective cohort study were nulliparous women ≥ 18 years that delivered vaginally at ≥ 37 weeks gestation, completed the Epidemiology of Prolapse and Incontinence Questionnaire (EPIQ) and the Pelvic Organ Prolapse Quantification examination (POP-Q) in third trimester and 5–10 weeks postpartum. We compared the incidence and persistence of symptomatic EPIQ domains and worse vaginal support (maximal vaginal descent ≥ 0 cm) between women who received oxytocin to those that did not (with or without prostaglandin or mechanical methods in both groups). We performed modified binomial regression to calculate adjusted relative risks of each outcome with 95% confidence intervals. RESULTS: Mean age of the 722 participants was 28.3 (SD 5.2) years; 20% were Hispanic. There were no significant differences according to oxytocin exposure in either incidence or persistence of symptomatic EPIQ domains or worse vaginal support. We found similar results in sensitivity analyses comparing women who received oxytocin as the sole pharmacologic agent to women who received no pharmacologic agent. After adjusting for demographic and obstetric factors associated with incidence and persistence of symptoms and support, oxytocin exposure continued to have no effect. CONCLUSIONS: Oxytocin during labor does not significantly increase the risks for the incidence or persistence of pelvic floor symptoms or worse vaginal support in the early postpartum period, though power for less frequent outcomes was limited. SINGLE SENTENCE SUMMARY: Oxytocin during labor does not significantly increase the risks for the incidence or persistence of pelvic floor symptoms or worse vaginal support in the early postpartum period.

This article employs the six tenets of intersectional research to examine the interconnections of oppression, relationality, complexity, context, deconstruction, and comparison that shape study participants’ experiences. This study was conducted at an after-school STEM program in a poverty-demographic through the lens of intersectionality. This is important because present literature that examines urban demographics and underserved students does not take into consideration the intersections of gender, race, ethnicity, socioeconomic status, and citizenship as this study reveals. Digital badges, individually awarded to students upon successful completion of 28 small-skill videos while programming in MIT App Inventor, yielded data about persistence through increasingly difficult coding techniques which is a desirable trait for individuals interested in pursuing STEM-focused high schools or professional careers. The results of this study reveal that the intersections of gender, race, ethnicity, socioeconomic status, and citizenship create a void of power such that children living in this poverty demographic have diminished access to authentic STEM environments and opportunities.

STUDY QUESTION Does sexual intercourse enhance the cycle fecundability in women without known subfertility? SUMMARY ANSWER Sexual intercourse (regardless of timing during the cycle) was associated with cycle characteristics suggesting higher fecundability, including longer luteal phase, less premenstrual spotting and more than 2 days of cervical fluid with estrogen-stimulated qualities. WHAT IS KNOWN ALREADY Human females are spontaneous ovulators, experiencing an LH surge and ovulation cyclically, independent of copulation. Natural conception requires intercourse to occur during the fertile window of a woman’s menstrual cycle, i.e. the 6-day interval ending on the day of ovulation. However, most women with normal fecundity do not ovulate on Day 14, thus the timing of the hypothetical fertile window varies within and between women. This variability is influenced by age and parity and other known or unknown elements. While the impact of sexual intercourse around the time of implantation on the probability of achieving a pregnancy has been discussed by some researchers, there are limited data regarding how sexual intercourse may influence ovulation occurrence and menstrual cycle characteristics in humans. STUDY DESIGN, SIZE, DURATION This study is a pooled analysis of three cohorts of women, enrolled at Creighton Model FertilityCare centers in the USA and Canada: ‘Creighton Model MultiCenter Fecundability Study’ (CMFS: retrospective cohort, 1990–1996), ‘Time to Pregnancy in Normal Fertility’ (TTP: randomized trial, 2003–2006) and ‘Creighton Model Effectiveness, Intentions, and Behaviors Assessment’ (CEIBA: prospective cohort, 2009–2013). We evaluated cycle phase lengths, bleeding and cervical mucus patterns and estimated the fertile window in 2564 cycles of 530 women, followed for up to 1 year. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were US or Canadian women aged 18–40 and not pregnant, who were heterosexually active, without known subfertility and not taking exogenous hormones. Most of the women were intending to avoid pregnancy at the start of follow-up. Women recorded daily vaginal bleeding, mucus discharge and sexual intercourse using a standardized protocol and recording system for up to 1 year, yielding 2564 cycles available for analysis. The peak day of mucus discharge (generally the last day of cervical fluid with estrogen-stimulated qualities of being clear, stretchy or slippery) was used to identify the estimated day of ovulation, which we considered the last day of the follicular phase in ovulatory cycles. We used linear mixed models to assess continuous cycle parameters including cycle, menses and cycle phase lengths, and generalized linear models using Poisson regression with robust variance to assess dichotomous outcomes such as ovulatory function, short luteal phases and presence or absence of follicular or luteal bleeding. Cycles were stratified by the presence or absence of any sexual intercourse, while adjusting for women’s parity, age, recent oral contraceptive use and breast feeding. MAIN RESULTS AND THE ROLE OF CHANCE Most women were LIMITATIONS, REASONS FOR CAUTION Our study participants were geographically dispersed but relatively homogeneous in regard to race, ethnicity, income and educational levels, and all had male partners, which may limit the generalizability of the findings. We cannot exclude the possibility of undetected subfertility or related gynecologic disorders among some of the women, such as undetected endometriosis or polycystic ovary syndrome, which would impact the generalizability of our findings. Acute illness or stressful events might have reduced the likelihood of any intercourse during a cycle, while also altering cycle characteristics. Some cycles in the no intercourse group may have actually had undocumented intercourse or other sexual activity, but this would bias our results toward the null. The Creighton Model FertilityCare System (CrM) discourages use of barrier methods, so we believe that most instances of intercourse involved exposure to semen; however, condoms may have been used in some cycles. Our dataset lacks any information about the occurrence of female orgasm, precluding our ability to evaluate the independent or combined impact of female orgasm on cycle characteristics. WIDER IMPLICATIONS OF THE FINDINGS Sexual activity may change reproductive hormonal patterns, and/or levels of reproductive hormones may influence the likelihood of sexual activity. Future work may help with understanding the extent to which exposure to seminal fluid, and/or female orgasm and/or timing of intercourse could impact menstrual cycle function. In theory, large data sets from women using menstrual and fertility tracking apps could be informative if women can be appropriately incentivized to record intercourse completely. It is also of interest to understand how cycle characteristics may differ in women with gynecological problems or subfertility. STUDY FUNDING/COMPETING INTEREST(S) Funding for the research on the three cohorts analyzed in this study was provided by the Robert Wood Johnson Foundation #029258 (Creighton Model MultiCenter Fecundability Study), the Eunice Kennedy Shriver National Institute of Child Health and Human Development 1K23 HD0147901-01A1 (Time to Pregnancy in Normal Fertility) and the Office of Family Planning, Office of Population Affairs, Health and Human Services 1FPRPA006035 (Creighton Model Effectiveness, Intentions, and Behaviors Assessment). The authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A.

The performance of a quantum processor depends on the characteristics of the device and the quality of the control pulses. Characterizing cloud-based quantum computers and calibrating the pulses that control them is necessary for high-fidelity operations. However, this time-intensive task eats into the availability of the device. Here, we show restless measurements with a dynamic repetition rate that speed-up calibration and characterization tasks. Randomized benchmarking is performed 5.3 times faster on the quantum device than when an active reset is used and without discarding any data. In addition, we calibrate a qubit with parameter scans and error-amplifying gate sequences and show speed-ups of up to a factor of 40 on the quantum device over active reset. Finally, we present a methodology to perform restless quantum process tomography that mitigates restless state preparation errors. These results reduce the footprint of characterization and calibration tasks. Quantum computers can thus either spend more time running applications or run calibrations more often to maintain gate fidelity., Physical Review Applied, 17 (6), ISSN:2331-7019

In circuit-based quantum computing the available gate set typically consists of single-qubit gates acting on each individual qubit and at least one entangling gate between pairs of qubits. In certain physical architectures, however, some qubits may be “hidden” and lacking direct addressability through dedicated control and readout lines, for instance, because of limited on-chip routing capabilities, or because the number of control lines becomes a limiting factor for many-qubit systems. In this case, no single-qubit operations can be applied to the hidden qubits and their state cannot be measured directly. Instead, they may be controlled and read out only via single-qubit operations on connected “control” qubits and a suitable set of two-qubit gates. We first discuss the impact of such restricted control capabilities on the performance of specific qubit coupling networks. We then experimentally demonstrate full control and measurement capabilities in a superconducting two-qubit device with local single-qubit control and iswap and controlled-phase two-qubit interactions enabled by a tunable coupler. We further introduce an iterative tune-up process required to completely characterize the gate set used for quantum process tomography and evaluate the resulting gate fidelities., Physical Review X, 11 (4), ISSN:2160-3308

Background: Few electronic resources are available for new mothers with concerns about changes in their pelvic floorfollowing childbirth. Patients may struggle when seeking authoritative information regarding pelvic floor conditions online given the sensitivity of the topic as well as the inadvertent connection to obscene or demeaning content found online. A health sciences librarian partnered with the Motherhood and Pelvic Health Study, an interdisciplinary research group, to provide expert searching skills for a particularly challenging health condition that patients struggle to find useful information on. Case Presentation: A custom rubric was developed to evaluate existing information products, which included criteria for cultural sensitivity, conflicts of interest, and other red flags. This evaluation process enabled the research team to identify top-tier evidence-based materials that were culturally congruent. This collaborative evaluation process led to the creation of a web-based toolkit resource for new mothers concerned about changes in their pelvic floor. The toolkit connects women to pertinent information on a national health organization’s patient portal, supplemented by videos created by the team to serve as models of communication for women and health care providers. Conclusion: When developing a web-based resource, health sciences libraries can partner with research teams to find, evaluate, and disseminate information. Culturally congruent toolkits such as this one can improve access to health information and lead to improved health outcomes. To ensure that the information highlighted in toolkits is both culturally congruent and authoritative, research teams should form advisory committees and partner with relevant professional medical associations.

STUDY QUESTION What is the normal range of cervical mucus patterns and number of days with high or moderate day-specific probability of pregnancy (if intercourse occurs on a specific day) based on cervical mucus secretion, in women without known subfertility, and how are these patterns related to parity and age? SUMMARY ANSWER The mean days of peak type (estrogenic) mucus per cycle was 6.4, the mean number of potentially fertile days was 12.1; parous versus nulliparous, and younger nulliparous ( WHAT IS KNOWN ALREADY The rise in estrogen prior to ovulation supports the secretion of increasing quantity and estrogenic quality of cervical mucus, and the subsequent rise in progesterone after ovulation causes an abrupt decrease in mucus secretion. Cervical mucus secretion on each day correlates highly with the probability of pregnancy if intercourse occurs on that day, and overall cervical mucus quality for the cycle correlates with cycle fecundability. No prior studies have described parity and age jointly in relation to cervical mucus patterns. STUDY DESIGN, SIZE, DURATION This study is a secondary data analysis, combining data from three cohorts of women: ‘Creighton Model MultiCenter Fecundability Study’ (CMFS: retrospective cohort, 1990–1996), ‘Time to Pregnancy in Normal Fertility’ (TTP: randomized trial, 2003–2006), and ‘Creighton Model Effectiveness, Intentions, and Behaviors Assessment’ (CEIBA: prospective cohort, 2009–2013). We evaluated cervical mucus patterns and estimated fertile window in 2488 ovulatory cycles of 528 women, followed for up to 1 year. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were US or Canadian women age 18–40 years, not pregnant, and without any known subfertility. Women were trained to use a standardized protocol (the Creighton Model) for daily vulvar observation, description, and recording of cervical mucus. The mucus peak day (the last day of estrogenic quality mucus) was used as the estimated day of ovulation. We conducted dichotomous stratified analyses for cervical mucus patterns by age, parity, race, recent oral contraceptive use (within 60 days), partial breast feeding, alcohol, and smoking. Focusing on the clinical characteristics most correlated to cervical mucus patterns, linear mixed models were used to assess continuous cervical mucus parameters and generalized linear models using Poisson regression with robust variance were used to assess dichotomous outcomes, stratifying by women’s parity and age, while adjusting for recent oral contraceptive use and breast feeding. MAIN RESULTS AND THE ROLE OF CHANCE The majority of women were 3 days (exceeded by 72% of women), most minus fewest days of non-peak type mucus >4 days (exceeded by 54% of women), greatest minus least cervical mucus cycle score >4.0 (exceeded by 73% of women), and most minus fewest potentially fertile days >8 days (found in 50% of women). Race did not have any association with cervical mucus parameters. Recent oral contraceptive use was associated with reduced cervical mucus cycle score and partial breast feeding was associated with a higher number of days of mucus (both peak type and non-peak type), consistent with prior research. Among the women for whom data were available (CEIBA and TTP), alcohol and tobacco use had minimal impact on cervical mucus parameters. LIMITATIONS, REASONS FOR CAUTION We did not have data on some factors that may impact ovulation, hormone levels, and mucus secretion, such as physical activity and body mass index. We cannot exclude the possibility that some women had unknown subfertility or undiagnosed gynecologic disorders. Only 27 women were age 35 or older. Our study participants were geographically dispersed but relatively homogeneous with regard to race, ethnicity, income, and educational level, which may limit the generalizability of the findings. WIDER IMPLICATIONS OF THE FINDINGS Patterns of cervical mucus secretion observed by women are an indicator of fecundity and the fertile window that are consistent with the known associations of age and parity with fecundity. The number of potentially fertile days (12 days) is likely greater than commonly assumed, while the number of days of highly estrogenic mucus (and higher probability of pregnancy) correlates with prior identifications of the fertile window (6 days). There may be substantial variability in fecundability between cycles for the same woman. Future work can use cervical mucus secretion as an indicator of fecundity and should investigate the distribution of similar cycle parameters in women with various reproductive or gynecologic pathologies. STUDY FUNDING/COMPETING INTEREST(S) Funding for the three cohorts analyzed was provided by the Robert Wood Johnson Foundation (CMFS), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (TTP), and the Office of Family Planning, Office of Population Affairs, Health and Human Services (CEIBA). The authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A

Human and vehicle resource management indicates a good emergency medical system (EMS). Frequently, an emergency medical technician (EMT) is the first responder to the emergency, which negates the necessity for an emergency physician (EP) and is just as sensible as handing over a stable patient to the EMT for transport to the hospital. The Austrian EMS is utilized by EMTs, in cases of potential life-threatening emergencies the dispatch center dispatches an additional team with an on-board EP. During the years 2017-2018 nearly every fifth EP mission in Innsbruck (including surrounding areas) ended in a cancellation. The numbers of patient handovers from EP to EMT are slightly lower with mission cancellations resulting in every fourth patient. Therefore, due to the high number of cancellations and handovers evaluated in this study, the findings suggest that there is a potential need to re-evaluate procedures. The re-evaluation of these procedures could determine whether these cancellations/handovers were justified or if an over hasty decision making was at fault. All cases considered in this study were from the Innsbruck and Telfs EP bases between 1 January 2017 and 13 December 2018.Out of a total of 96,908 emergency dispatches, there were 2470 cancellation/handover occurrences. These occurrences consisted of 1190 cancellations and 1280 patient handovers from the EP to the EMT. Patients who were transferred to the University Hospital Innsbruck were included in these figures. The protocols of the emergency dispatches have been filtered from the so-called CarPC. They have subsequently been grouped into cancellation and handover categories. The clinical diagnoses of the patients with inpatient treatment were evaluated from the hospital information system (KIS) of the University Hospital Innsbruck. This was done with the help of the so-called emergency physician indications catalogue of the German Medical Council. The diagnosis was documented in the hospital information system. The emergency protocols from the EMTs were also evaluated retrospectively. The Innsbruck based EP patients are hospitalized in the Innsbruck Hospital due their geographical position. When there is no need for a specific intervention the patients of the EPs based in Telfs are transferred to a local hospital. When a specific intervention is necessary, patient care must be provided by the University Hospital Innsbruck. Due to the privacy practices of the Innsbruck Medical University "vote of ethics" only the data of patients transferred to the Innsbruck Clinic can be evaluated. The information provided from the EPs based in Innsbruck was exclusively from the University Hospital Innsbruck's anesthesiologists. The physicians from the Telfs EP base are of mixed medical specialities. All of them, however, have an emergency medical physician diploma, in addition to the ius practicandi. Lastly, there are no EPs in Innsbruck or Telfs, who have any special obligations during their duty.The results show that in 210 cases (8.5%) the indications for the EP, based on the emergency physician indications catalogue of the German Medical Council were given. Also, 8.7% of all cancellations and 8.4% of patient handovers were not justified. Patients with emergency indications had a longer hospitalization. The EP base EMS Innsbruck had more cancellations than the EP base EMS Telfs. The EMS Innsbruck also had more cancellations than patient handovers. Conversely, the EMS Telfs had more patient handovers than cancellations. On the weekends between 6:00 pm and 6:00 am there were less cancellations and handovers from both EP bases. The documentation from the EMT protocols was incomplete in 284 cancellations (23.9% of the cancellations) and 339 handovers (26.5% of the handovers), 35 patients after cancellations (2.9%), 35 patients after handovers (2.7%) needed intensive care treatment, 20 patients after cancellations (1.7% of all cancellations), and 24 patients after handovers (1.9% of all handovers) who needed intensive care treatment had a critical diagnosis. In 40 cases of patient handovers, the EP was alerted to another emergency follow-up within 10 min.In Austria, the introduction of a standardized emergency indication checklist might help dispatch centers to provide a more accurate dispatch as well as all EMS team members. Furthermore, a better traceability system (according to EP cancellations and patient handovers from the EP to the EMT) could be achieved. The documentation requirements should be more precise by all members of the EMT staff, not only for the legal aspects but also for improving the overall management quality. Intense education and training as well as diagnosis feedbacks could help to reduce the number of risky cancellations/patient handovers.HINTERGRUND: Die Qualität eines Rettungssystems zeichnet sich auch durch den effizienten Einsatz seiner personellen und Fahrzeugressourcen aus. So können im berechtigten Fall Stornierungen des anfahrenden Notarztes durch den Rettungsdienst (RD) ebenso sinnvoll sein wie Übergaben des stabilen Patienten an den RD. Aufgrund der hohen Zahlen solcher Storno- und Übergabeeinsätze evaluiert diese Studie diese Entscheidungen retrospektiv und zeigt evtl. Auffälligkeiten auf. Studienkollektiv waren die 10.278 Notarztalarmierungen der beiden Notarzteinsatzfahrzeuge (NEF) Innsbruck Stadt (städtisch) und Telfs (ländlich) der Jahre 2017 und 2018.Der Patientenzustand sowie die Rettungsdienstdokumentation wurden beurteilt und die Notarztindikation retrospektiv anhand der klinischen Aufnahmediagnosen im Abgleich mit dem Notarztindikationskataloges der Deutschen Bundesärztekammer (NIKDBÄK) anhand vorgegebener Kriterien wie eingegebener Vitalparameter und/oder des Notfallgeschehens bewertet.Im zweijährigen Studienzeitraum ergaben sich 2470 relevante Datensätze, davon 1190 Storno- und 1280 Übergabeeinsätze mit gesamt 210 Einsätzen (8,5 %) mit Notarztindikation laut NIKDBÄK. Am NEF Innsbruck fanden mehr Stornierungen statt, und es kam zu mehr Storno- als Übergabeeinsätzen, umgekehrt dazu am NEF Telfs zu mehr Übergabe- als Stornoeinsätzen. An Wochenenden fanden nachts weniger Storno- und Übergabeeinsätze statt. In 284 Protokollen bei Stornierungen (23,9 %) und 339 Protokollen bei Übergaben (26,5 %) war die Dokumentation der Sanitäterprotokolle unvollständig. Patienten mit gegebener Notarztindikation laut NIKDBÄK mussten länger stationär behandelt werden. 35 Patienten nach Storno- (2,9 %) und 35 Patienten nach Übergabeeinsätzen (2,7 %) mussten auf einer Intensivstation aufgenommen werden. Bei den Intensivbehandlungen wurde bei 20 Patienten (1,7 % der Stornoeinsätze) nach einem Stornoeinsatz eine kritische Aufnahmediagnose festgestellt bzw. bei 24 Patienten (1,9 % der Übergabeeinsätze) nach einem Übergabeeinsatz. Bei 40 (3,1 %) Übergabeeinsätzen vom Notarzt an den Rettungsdienst kam es innerhalb von 10 min nach Eintreffen des Notarztes zu einem Folgeeinsatz.Die Einführung eines eigenen standardisierten Notfallindikationskataloges für Österreich erscheint als Vorgabe für Leitstellen und Rettungsdienstpersonal sinnvoll. Storno- und Übergabeentscheidungen müssen sorgsam getroffen werden und sollten QM-gesichert evaluiert werden. Der Dokumentationspflicht im Rettungswesen muss vermehrte Aufmerksamkeit gewidmet werden. Durch intensivere Aus- und Fortbildungen sowie Diagnosefeedbacks könnte die Anzahl an unberechtigten bzw. risikobehafteten Storno‑/Übergabeeinsätzen vermindert werden.

We show a pulse-efficient circuit transpilation framework for noisy quantum hardware. This is achieved by scaling cross-resonance pulses and exposing each pulse as a gate to remove redundant single-qubit operations with the transpiler. Crucially, no additional calibration is needed to yield better results than a CNOT-based transpilation. This pulse-efficient circuit transpilation therefore enables a better usage of the finite coherence time without requiring knowledge of pulse-level details from the user. As demonstration, we realize a continuous family of cross-resonance-based gates for SU(4) by leveraging Cartan's decomposition. We measure the benefits of a pulse-efficient circuit transpilation with process tomography and observe up to a 50% error reduction in the fidelity of RZZ(θ) and arbitrary SU(4) gates on IBM Quantum devices. We apply this framework for quantum applications by running circuits of the quantum approximate optimization algorithm applied to MAXCUT. For an 11-qubit nonhardware native graph, our methodology reduces the overall schedule duration by up to 52% and errors by up to 38%., Physical Review Research, 3 (4), ISSN:2643-1564

We preform dynamic state evolution on an IBM quantum computer using a simulation of braiding Majorana zero modes as a benchmark for success. We find the native quantum gates introduce too much noise to observe braiding. Instead, we use Qiskit Pulse to develop scaled 2-qubit quantum gates that better match the unitary time evolution operator and enable us to observe braiding. This paper demonstrates that quantum computers can be used for simulation, and highlights the use of pulse-level control for programming quantum computers and constitutes the first experimental evidence of braiding via dynamical Hamiltonian evolution.

Background: Exercise increases intra-abdominal pressure (IAP) acutely, which may impact the pelvic floor of women. IAP during exercise demonstrates high variability among women but is not routinely assessed. Assessing less invasive measures related to IAP during exercise may facilitate study of how IAP impacts the pelvic floor. Methods: The objective of this study was to investigate the relationship of heart rate and rating of perceived exertion (RPE) with IAP during a standard treadmill test. We describe the trend of IAP by predicted aerobic fitness during incremental exercise. IAP was measured using a validated transducer placed in the upper vagina. Heart rate and RPE were collected during the first 3 stages of the standard Bruce treadmill protocol. Relationships of heart rate and RPE with IAP were determined by Pearson correlation coefficients. Predicted aerobic fitness values for each participant were ranked in tertiles with IAP by treadmill stage. Results: Twenty-four women participated in this study (mean age: 24.7 ± 5.4 years; body mass index: 22.5 ± 2.2 kg·m−2). There were significant relationships between heart rate and IAP (r = 0.67, P < 0.001) and RPE and IAP (r = 0.60, P < 0.001) across treadmill stages. Tertiles of predicted aerobic fitness and IAP displayed similar trends as other exercise measures such as heart rate and ventilation during incremental exercise. Conclusion: Heart rate and RPE could be used as proxy measures of IAP during incremental exercise. Aerobic fitness may help explain IAP variability in women and provide context for future research on IAP and pelvic floor health.

Risks of pelvic organ prolapse and urinary incontinence increase after the first vaginal delivery. During the early postpartum period, a time of active regeneration and healing of the pelvic floor, women may be particularly vulnerable to greater pelvic floor loading.This prospective cohort study aimed to determine whether objectively measured moderate to vigorous physical activity in the early postpartum period predicts pelvic floor support and symptoms 1 year after the first vaginal birth.We enrolled nulliparous women in the third trimester, later excluding those who had a cesarean or preterm delivery. Participants wore triaxial wrist accelerometers at 2 to 3 weeks and 5 to 6 weeks postpartum for ≥4 days. Primary outcomes, assessed 1 year postpartum, included (1) pelvic floor support on Pelvic Organ Prolapse Quantification examination, dichotomized as maximal vaginal descent of0 cm (better support) vs ≥0 cm (worse support); and (2) pelvic floor symptom burden, considered positive with report of ≥1 bothersome symptom in ≥2 of 6 domains, assessed using the Epidemiology of Prolapse and Incontinence Questionnaire. The primary predictor was average daily moderate to vigorous physical activity. Because we could not eliminate women with pelvic floor changes before pregnancy, we modeled prevalence, rather than risk, ratios for each outcome using modified Poisson regression.Of 825 participants eligible after delivery, 611 completed accelerometry and 1-year follow-up; 562 completed in-person visits, and 609 completed questionnaires. The mean age was 28.9 years (standard deviation, 5.01). The mean for moderate to vigorous physical activity measured in minutes per day was 57.3 (standard deviation, 25.4) and 68.1 (standard deviation, 28.9) at 2 to 3 weeks and 5 to 6 weeks, respectively. One year postpartum, 53 of 562 participants (9.4%) demonstrated worse vaginal support and 330 of 609 participants (54.2%) met criteria for pelvic floor symptom burden. In addition, 324 (53.1%), 284 (46.6%), 144 (23.6%), and 25 (4.1%) reported secondary outcomes of stress urinary incontinence, overactive bladder, anal incontinence, and constipation, respectively, and 264 (43.4%), 250 (41.0%), and 89 (14.6%) reported no, mild, or moderate to severe urinary incontinence, respectively. The relationship between moderate to vigorous physical activity and outcomes was not linear. On the basis of plots, we grouped quintiles of moderate to vigorous physical activity into 3 categories: first and second quintiles combined, third and fourth quintiles combined, and fifth quintile. In final multivariable models, compared with women in moderate to vigorous physical activity quintiles 3 and 4, those in the lower 2 (prevalence ratio, 0.55; 95% confidence interval, 0.31-1.00) and upper quintile (prevalence ratio, 0.70; 95% confidence interval, 0.35-1.38)) trended toward lower prevalence of worse support. However, we observed the reverse for symptom burden: compared with women in quintiles 3 and 4, those in the lower 2 (prevalence ratio, 1.20; 95% confidence interval, 1.02-1.41) and upper quintile prevalence ratio 1.34 (95% confidence interval, 1.11-1.61) demonstrated higher prevalence of symptom burden. Moderate to vigorous physical activity did not predict any of the secondary outcomes. The presence of a delivery factor with potential to increase risk for levator ani muscle injury did not modify the effect of moderate to vigorous physical activity on outcomes.Except for support, which was worse in women with moderately high levels of activity, early postpartum moderate to vigorous physical activity was either protective or had no effect on other parameters of pelvic floor health. Few women performed substantial vigorous activity, and thus, these results do not apply to women performing strenuous exercise shortly after delivery.

Reaching high-speed, high-fidelity qubit operations requires precise control over the shape of the underlying pulses. For weakly anharmonic systems, such as superconducting transmon qubits, short gates lead to leakage to states outside of the computational subspace. Control pulses designed with open-loop optimal control may reduce such leakage. However, model inaccuracies can severely limit the usability of such pulses. We implemented a closed-loop optimization that simultaneously adapts all control parameters based on measurements of a cost function built from Clifford gates. We directly optimize the amplitude and phase of each sample point of the digitized control pulse. We thereby fully exploit the capabilities of the pulse generation electronics and create a 4.16 ns single-qubit pulse with 99.76 % fidelity and 0.044 % leakage. This is a sevenfold reduction of the leakage rate and a threefold reduction in standard errors of the best DRAG pulse we have calibrated at such short durations on the same system.

Assurance of transcript accuracy and quality in interview-based qualitative research is foundational for data accuracy and study validity. Based on our experience in a cross-cultural ethnographic study of women’s pelvic organ prolapse, we provide practical guidance to set up step-by-step interview transcription and translation protocols for team-based research on sensitive topics. Beginning with team decisions about level of detail in transcription, completeness, and accuracy, we operationalize the process of securing vendors to deliver the required quality of transcription and translation. We also share rubrics for assessing transcript quality and the team protocol for managing transcripts (assuring consistency of format, insertion of metadata, anonymization, and file labeling conventions) and procuring an acceptable initial translation of Spanish-language interviews. Accurate, complete, and systematically constructed transcripts in both source and target languages respond to the call for more transparency and reproducibility of scientific methods.

This article outlines our point of view regarding the applicability, state-of-the-art, and potential of quantum computing for problems in finance. We provide an introduction to quantum computing as well as a survey on problem classes in finance that are computationally challenging classically and for which quantum computing algorithms are promising. In the main part, we describe in detail quantum algorithms for specific applications arising in financial services, such as those involving simulation, optimization, and machine learning problems. In addition, we include demonstrations of quantum algorithms on IBM Quantum back-ends and discuss the potential benefits of quantum algorithms for problems in financial services. We conclude with a summary of technical challenges and future prospects., Comment: 24 pages

To Characterize and calibrate quantum processing devices a large amount of measurement data has to be collected. Active qubit reset increases the speed at which data can be gathered but requires additional hardware and/or calibration. The experimental apparatus can, however, be operated at elevated repetition rates without reset. In this case, the outcome of a first measurement serves as the initial state for the next experiment. Rol. $\textit{et al.}$ used this restless operation mode to accelerate the calibration of a single-qubit gate by measuring fixed-length sequences of Clifford gates which compose to $X$ gates [Phys. Rev. Appl. $7$, 041001 (2017)]. However, we find that, when measuring pulse sequences which compose to arbitrary operations, a distortion appears in the measured data. Here, we extend the restless methodology by showing how to efficiently analyze restless measurements and correct distortions to achieve an identical outcome and accuracy as compared to measurements in which the superconducting qubits are reset. This allows us to rapidly characterize and calibrate qubits. We illustrate our data collection and analysis method by measuring a Rabi oscillation at a $250~\rm{kHz}$ repetition rate without any reset, for a qubit with a decay rate of $1/2\pi T_1=3~\rm{kHz}$. We also show that we can measure a single- and a two-qubit average gate fidelity with Randomized Benchmarking 20 and 8 times faster, respectively, than measurements that reset the qubits through $T_1$-decay.