Preterm birth after loop electrosurgical excision procedure (LEEP). how cone features and microbiota could influence the pregnancy outcome

OBJECTIVE: In the last years, the mean age of women who underwent cervical treatment for high-grade cervical intraepithelial neoplasia (CIN 2-3) is similar to the age of women having their first pregnancy. The aim of this study was to evaluate the risk of preterm birth in subsequent pregnancies after loop electrosurgical excision procedure (LEEP). PATIENTS AND METHODS: From January 2013 to January 2016 the study identified a total of 1435 women, nulliparous, who underwent LEEP for CIN 2-3, and who wished to have their first pregnancy. Before surgery, the lengths of the cervix were calculated by transvaginal sonography. After the treatment, the dimension of the removed tissue was evaluated. During the pregnancy, all women carried out periodic transvaginal sonography and vaginal-cervical swabs. RESULTS: The average age of patients was 31.96±5.24 years; the interval between the surgical procedure and pregnancy was 12.04±4.67 months; the gestational age at births was 37.53±2.91 weeks. The first vaginal and cervical swab performed during pregnancy was negative in 81.8% of patients. The most prevalent infections were related to C. Albicans, G. Vaginalis, and Group B Streptococcus (GBS). The rate of preterm delivery was significantly higher in women with a minor cervical length. CONCLUSIONS: The length and the volume of cervical tissue excised have been shown to be directly related to the risk for preterm birth. Furthermore, vaginal infections and their persistence during pregnancy in women with a history of LEEP may be associated with an increased risk for preterm birth, compared with women with no history of LEEP

Interruptions to intensive care nurses and clinical errors and procedural failures: A controlled study of causal connection

Objectives. Interruptions occur frequently in the Intensive Care Unit (ICU) and are associated with errors. To date, no causal connection has been established between interruptions and errors in healthcare. It is important to know if interruptions directly cause errors before implementing interventions designed to reduce interruptions in ICUs. Our objective was to investigate whether ICU nurses who receive a higher number of workplace interruptions commit more clinical errors and procedural failures than those who receive a lower number of interruptions. Methods. We conducted a prospective controlled trial in a high -fidelity ICU simulator. A volunteer sample of ICU nurses from a single unit prepare d and administered intravenous medications for a patient manikin. Nurses received either 3 (n=35) or 12 (n=35) scenario - relevant interruptions and were allocated to either condition in an alternating fashion. Primary outcomes were the number of clinica l errors and procedural failures committed by each nurse. Results . The rate ratio of clinical errors committed by nurses who received 12 interruptions compared to nurses who received 3 interruptions was 2.0 (95% CI [1.41, 2.83]), p < .001. The rate ratio of procedural failures committed by nurses who received 12 interruptions compared to nurses who were interrupted 3 times was 1.2 (95% CI [1.05, 1.37]), p = .006. Conclusions. More workplace interruptions during medication preparation and administration le ad to more clinical errors and procedural failures. Reducing the frequency of interruptions may reduce the number of errors committed; however, this should be balanced against important information that interruptions communicat

Localized holes and delocalized electrons in photoexcited inorganic perovskites: Watching each atomic actor by picosecond X-ray absorption spectroscopy

We report on an element-selective study of the fate of charge carriers in photoexcited inorganic CsPbBr3 and CsPb(ClBr)3 perovskite nanocrystals (NCs) in toluene solutions using time-resolved X-ray absorption spectroscopy with 80 ps time resolution. Probing the Br K-edge, the Pb L3-edge and the Cs L2-edge, we find that holes in the valence band are localized at Br atoms, forming small polarons, while electrons appear as delocalized in the conduction band. No signature of either electronic or structural changes are observed at the Cs L2-edge. The results at the Br and Pb edges suggest the existence of a weakly localized exciton, while the absence of signatures at the Cs edge indicates that the Cs+ cation plays no role in the charge transport, at least beyond 80 ps. These results can explain the rather modest charge carrier mobilities in these materials.Comment: 19 pages, 3 figure

Assessing hydrothermal liquefaction for the production of bio-oil and enhanced metal recovery from microalgae cultivated on acid mine drainage

The hydrothermal liquefaction (HTL) of algal biomass is a promising route to viable second generation biofuels. In this investigation HTL was assessed for the valorisation of algae used in the remediation of acid mine drainage (AMD). Initially the HTL process was evaluated using Arthrospira platensis (Spirulina) with additional metal sulphates to simulate metal remediation. Optimised conditions were then used to process a natural algal community (predominantly Chlamydomonas sp.) cultivated under two scenarios: high uptake and low uptake of metals from AMD. High metal concentrations appear to catalyse the conversion to bio-oil, and do not significantly affect the heteroatom content or higher heating value of the bio-oil produced. The associated metals were found to partition almost exclusively into the solid residue, favourable for potential metal recovery. High metal loadings also caused partitioning of phosphates from the aqueous phase to the solid phase, potentially compromising attempts to recycle process water as a growth supplement. HTL was therefore found to be a suitable method of processing algae used in AMD remediation, producing a crude oil suitable for upgrading into hydrocarbon fuels, an aqueous and gas stream suitable for supplementing the algal growth and the partitioning of most contaminant metals to the solid residue where they would be readily amenable for recovery and/or disposal

Knowledge Integration, Complex Adaptive Systems, and the Choice of Foreign Entry Mode: Internationalization From a Knowledge-Based Perspective

Knowledge is the most critical strategic asset that a firm possesses, and the ability to integrate knowledge is among the most essential determinants of competitive advantage. However, the multiple characteristics of knowledge result in inconsistent definitions, leading to a wide range of constructs and studies that yield conflicting results, reducing generalizability. Limited empirical evidence supports the proposition that knowledge integration is a function of the changing knowledge structures of firms. In this study, complex adaptive systems theory was leveraged to develop an empirical examination of the influence of knowledge complexity on foreign entry mode (FEM) choices and the subsequent ability of firms in the chemical industry to integrate knowledge. The examination of changes in the knowledge structure of a firm showed that a significant curvilinear relationship existed between the ability to integrate knowledge and its knowledge complexity and that its knowledge complexity influenced its FEM choices. The choice of FEM was also shown to exert a weak indirect influence on the relationship between knowledge complexity and knowledge integration in the period of the FEM activity. Ultimately, the study supported the notion that firms behave in a manner congruent with complex adaptive systems theory and provided empirical support for the assertions of the knowledge-based view

Friendly Facts: program to help children explore the complexities of friendship

For children with ASD, making and keeping friends is often not a simple process. These children need to be intentionally taught in developmentally appropriate, respectful and supportive environments how to be a friend and how to make and keep friends. This presentation focuses on children ages 7-11, a period when friendships become increasingly complex and a lack of peer acceptance is all the more obvious and challenging. Through a variety of educational activities that appeal to different learning styles, children are scaffolded in their learning about making and keeping friends

Your Special Student: a book for educators of children diagnosed with Asperger syndrome

'Your Special Student' is written for professionals and paraprofessionals aspiring to create class programs based upon inclusive teaching practices. It offers practical assistance, direction, and concrete strategies for professionals and paraprofessionals- that are challenged, to establish class programs inclusive of the diverse and often complex needs of individual students. Professionals and paraprofessionals working in these communities are challenged to act as facilitators of learning. They are encouraged - to be flexible in attitude and approach, supporting all students to develop as independent, responsible, interested, active and engaged lifelong learners. They endeavor to structure teaching- and learning environments that foster a sense of belonging-, acceptance, respect, competence, achievement, success, and a genuine interest in learning. Professionals and paraprofessionals are continually challenged to work in collaborating, genuinely appreciate, nurture, embrace, respect, and celebrate student diversity. 'Your Special Student' provides down-to-earth, hands on strategies and frameworks for professionals- and paraprofessionals working in the field of education

Detailed phytochemical analysis of high- and low artemisinin-producing chemotypes of Artemisia annua

Chemical derivatives of artemisinin, a sesquiterpene lactone produced by Artemisia annua, are the active ingredient in the most effective treatment for malaria. Comprehensive phytochemical analysis of two contrasting chemotypes of A. annua resulted in the characterization of over 80 natural products by NMR, more than 20 of which are novel and described here for the first time. Analysis of high- and low-artemisinin producing (HAP and LAP) chemotypes of A. annua confirmed the latter to have a low level of DBR2 (artemisinic aldehyde Δ11(13) reductase) gene expression. Here we show that the LAP chemotype accumulates high levels of artemisinic acid, arteannuin B, epi-deoxyarteannuin B and other amorpha-4,11-diene derived sesquiterpenes which are unsaturated at the 11,13-position. By contrast, the HAP chemotype is rich in sesquiterpenes saturated at the 11,13-position (dihydroartemisinic acid, artemisinin and dihydro-epi-deoxyarteannunin B), which is consistent with higher expression levels of DBR2, and also with the presence of a HAP-chemotype version of CYP71AV1 (amorpha-4,11-diene C-12 oxidase). Our results indicate that the conversion steps from artemisinic acid to arteannuin B, epi-deoxyarteannuin B and artemisitene in the LAP chemotype are non-enzymatic and parallel the non-enzymatic conversion of DHAA to artemisinin and dihyro-epi-deoxyarteannuin B in the HAP chemotype. Interestingly, artemisinic acid in the LAP chemotype preferentially converts to arteannuin B rather than the endoperoxide bridge containing artemisitene. In contrast, in the HAP chemotype, DHAA preferentially converts to artemisinin. Broader metabolomic and transcriptomic profiling revealed significantly different terpenoid profiles and related terpenoid gene expression in these two morphologically distinct chemotypes

Pirates: an early-years group program for developing social understanding and social competence for children with autism spectrum disorders and related challenges

Using a pirate theme popular among young children, this social understanding program is designed for children, ages preschool to third grade, who have social cognitive challenges, including autism spectrum disorders. Through fun and engaging activities, the program helps children learn constructive social interaction skills related to friendship making, social problem solving and emotional expression. This eight-adventure pirate voyage includes the following focus areas: social understanding, friendship making, emotional literacy and emotional expression, relaxing, social problem solving and responding to bullying incidents

Creative ways to promote cognitive thinking

Children with ASD often experience negative self-talk. The starting point of stopping such negative dialogues inside your head is to be aware of it, challenge it, and replace it with helpful thinking. The objective of this session is to portray Cool Comics as a vehicle that assists children in recognising negative self talk. By working through the comic scenarios, children develop an awareness of negative self-talk and practice replacing it with more positive self-talk