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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.

The aim was to evaluate the feasibility of protective measures for infants of low-income SARS-CoV-2 positive breastfeeding mothers.Breastfeeding mothers with SARS-CoV-2 positive should avoid exposing the infant through protective measures (PM), but it could be challenging in a low-income population.A prospective, multicenter study was conducted between July and October 2020 (BRACOVID). The participants were recruited at birth and interviewed through a structured questionnaire at seven and 14 days in the home environment. The feasibility of PM during breastfeeding at home was defined by guidelines recommendations (mask using, handwashing, and distancing from newborn when not breastfeeding). Three groups according to the feasibility of guidelines: complete guidelines feasibility (CG): all PM; partial guidelines feasibility (PG): at least one PM feasible; no guidelines (NG): infeasibility to all of PM. Flu-like neonatal symptoms, mothers' breastfeeding practices. We evaluated the association between PM feasibility and socioeconomic factors.117 infected mothers from 17 Brazilian hospitals were enrolled. 47 (40%) mothers followed all recommendations, 14 (11.9%) could not practice at least one recommendation, and 50 (42.7%) did not execute any of them. The breastfeeding rate was 98%. Factors associated with infeasibility were monthly family income92.7 dollars/person, high housing density (1 inhabitant/room), teenage mothers, responsive feeding, and poor schooling. Regarding infants' flu-like symptoms, 5% presented symptoms at fourteen days (NG group).The guidelines were not applied to infants of SARs-CoV-positive mothers in 54.6% of the dyads since the recommendations were unviable in their environments. During pandemics, we should look for feasible and effective guidelines to protect neonates from low-income populations.Poor socioeconomic conditions lead to the unfeasibility of protective measures for infants of low-income SARS-CoV-2 positive breastfeeding mothers during the isolation period in the pandemics. The orientations and the support provided to dyad should consider the socioeconomic factors to guide feasible measures in the home environment and promote adequate protections; only an individual approach will allow a safe environment for low-income infants.

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.

To investigate the connection between the Arctic and East Asia cold events, we categorize the continuum of Eurasian circulation patterns using self-organizing maps (SOMs). The analysis identifies several circulation patterns associated with East Asian extreme temperature occurrences during winter months from November to January (NDJ) 1979-2020, including the warm Arctic-cold Siberia-like pattern (WACS).The SOM-derived trend pattern of geopotential height at 500 hPa illuminates a zonal wave train of wavenumber 4 extending from central Eurasia to eastern Pacific. The analysis shows that the observed trend is a result of competing influences from the change of frequency of several different SOM patterns. SOMs reveals that some patterns undergo statistically significant trend over certain time periods, notably a positive trend of WACS-like pattern since late 1990s that has resulted in more frequent cold events in East Asia. The composites based on the WACS-like SOM pattern show that an anomalous Siberia High leads to cold surface air temperature over a broad region in East Asia, which can provide potential sources of predictability.In the associated SST composite, a cold tongue of SST emerges in the southeast Pacific centered around 15o stretching offshore from the coast of Peru, which corresponds closely to the observed NDJ SST trend pattern. We explore the relationship between the WACS-like SOM pattern and El Niño-Southern Oscillation (ENSO). We also evaluate the subseasonal impacts of WACS on East Asian cold events in winter using a probabilistic forecast model determined through multiple linear regression with WACS index, ENSO, and long-term trend as predictors.

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.