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Wendelstein 7-X, the world’s largest superconducting stellarator in Greifswald (Germany), started plasma experiments with a water-cooled plasma-facing wall in 2022, allowing for long pulse operation. In parallel, a project was launched in 2021 to develop a W based divertor, replacing the current CFC divertor, to demonstrate plasma performance of a stellarator with a reactor relevant plasma facing materials with low tritium retention. The project consists of two tasks: Based on experience from the previous experimental campaigns and improved physics modelling, the geometry of the plasma-facing surface of the divertor and baffles is optimized to prevent overloads and to improve exhaust. In parallel, the manufacturing technology for a W based target module is qualified.This paper gives a status update of project. It focusses on the conceptual design of a W based target module, the manufacturing technology and its qualification, which is conducted in the framework of the EUROfusion funded WPDIV program. A flat tile design in which a target module is made of a single target element is pursued. The technology must allow for moderate curvatures of the plasma-facing surface to follow the magnetic field lines. The target element is designed for steady state heat loads of 10 MW/m2 (as for the CFC divertor). Target modules of a similar size and weight as for the CFC divertor are assumed (approx.

After a long device enhancement phase, scientific operation resumed in 2022. The main new device components are the water cooling of all plasma facing components and the new water-cooled high heat flux divertor units. Water cooling allowed for the first long-pulse operation campaign. A maximum discharge length of 8 min was achieved with a total heating energy of 1.3 GJ. Safe divertor operation was demonstrated in attached and detached mode. Stable detachment is readily achieved in some magnetic configurations but requires impurity seeding in configurations with small magnetic pitch angle within the edge islands. Progress was made in the characterization of transport mechanisms across edge magnetic islands: Measurement of the potential distribution and flow pattern reveals that the islands are associated with a strong poloidal drift, which leads to rapid convection of energy and particles from the last closed flux surface into the scrape-off layer. Using the upgraded plasma heating systems, advanced heating scenarios were developed, which provide improved energy confinement comparable to the scenario, in which the record triple product for stellarators was achieved in the previous operation campaign. However, a magnetic configuration-dependent critical heating power limit of the electron cyclotron resonance heating was observed. Exceeding the respective power limit leads to a degradation of the confinement.

We present a method to geometrically quantify the three magnetic island chains with the poloidal mode numbers m = 4, 5, and 6 (referred to in this paper as high-iota, standard, and low-iota islands, respectively), on which the W7-X divertor relies. The focus is on a comparative study of their detachment performance using a series of models of different physical and geometrical complexity, ranging from one- to three-dimensional (1D to 3D). In particular, it aims to identify the key physical elements behind the correlation between impurity radiation and island geometry and the associated detachment stability. Assuming intrinsic carbon as a radiator, we scan the three island chains with the EMC3-Eirene code based on otherwise identical code inputs. We find that the three islands behave differently in the radiation distribution, in the development of the radiation zones during detachment, and in the ‘radiation costs’, defined as the product of impurity and electron density near the last closed flux surface. While the radiation costs for the iota = 5/4 and 5/5 island chains linearly increase with the total radiation, the low-iota island with iota = 5/6 shows a bifurcation behavior in the sense that the radiation costs initially increase and then decrease when the total radiation exceeds a critical level. Consistent with the numerical trends, stable detachment, which is experimentally easy and robust to achieve with the standard iota = 5/5 island chain, remains an experimental challenge with the low-iota configuration. Dedicated numerical experiments show that the recycling neutrals and the ratio of parallel to perpendicular heat transport, which depends closely on the field line pitch, play a significant role in the formation and evolution of the radiation layer. A deeper understanding of the underlying physics relies on simpler models that explain why and how flux expansion can reduce the radiation costs. From these insights, we derive the conditions in which detached plasmas can benefit from the expansion of flux surfaces around the X-point. We show and explain why the current divertor design limits the actual capability of the high-iota configuration and propose solutions. The work is presented within a theoretical/numerical framework but cites relevant experimental evidence to emphasize its practical significance.

In the last experimental campaign (OP1.2b) of the stellarator Wendelstein 7-X (W7-X), boronisation as a mean for first wall conditioning was applied for the first time which led to strongly reduced impurity fluxes from plasma-facing components. Thermal detachment at the uncooled target plates of the test divertor unit (TDU) was reached at higher plasma densities and was accompanied by high recycling of neutrals at the target plate [1], [2]. A feedback control system was established in W7-X to actively control the gas injection (actuator) for plasma fuelling and impurity seeding [3] through the divertors. It allowed very successful stabilisation of the detached plasma condition state as well as mitigation of thermal overloads to some baffle tiles. Different routinely available diagnostic signals were used as input parameters (sensors). We describe the setup of the feedback control system, its performance and provide some example results with the main focus on the development of the control scheme which led to the detachment stabilisation over the entire longest (30 s) high-power discharge at W7-X so far. In view of the achieved very successful detachment stabilisation and the necessity to include simultaneous optimisation of the core performance in the future, the feedback control system is being upgraded for the upcoming campaign (OP2.1) in which the water cooled and hereby inherently steady-state capable divertor has been currently installed. The prospects and some experiment ideas for active detachment control are discussed.

Abstract Background The availability of modern contraception including long-acting reversible contraceptives (LARC), is a fundamental component of postabortion care. Findings from a recent randomized controlled trial (RCT) in South Africa comparing immediate to delayed insertion of the copper intrauterine device (IUD) after medical abortion (MA) at 17-20 gestational weeks showed that immediate insertion resulted in higher IUD use at 6 weeks postabortion, but that expulsion rates were significantly higher than for delayed insertion. This study aims to explore barriers, facilitators, and context-specific factors relevant to the implementation of immediate IUD provision after second trimester medical abortion. Methods We performed a qualitative study alongside the RCT in which we conducted in-depth interviews with 14 staff providing healthcare to study participants and 24 study participants. Research questions explored barriers and facilitators to implementation of immediate IUD insertion, contraceptive decision-making, and the impact of context and supplementary trial activities on service provision. Interviews were recorded and transcribed, with translation into English if needed. We performed a triangulated thematic analysis at the level of the transcribed interview text. Results Contraceptive counselling at the abortion facility by a study nurse improved knowledge, corrected misconceptions, and increased demand for the IUD postabortion. Women expressed a clear preference for immediate insertion. Convenience, protection from pregnancy and privacy issues were paramount and women expressed preference for engagement with staff who knew their abortion history, and with whom they had an established connection. Doctors and nurses were generally in favour of immediate insertion and said it could be incorporated into standard care if women wanted this. This contrasted with the need for interventions by the research team to reinforce adherence by staff to provide contraception as allocated during the trial. Conclusions Women and staff favour immediate IUD insertion after second trimester medical abortion, but service delivery may require structures that ensure timely insertion postabortion, continuity of care, communication that mitigates loss to follow-up and training of staff to ensure competence.

During its second operational campaign (OP 1.2a) W7-X operated with an edge island divertor. Much higher densities (1020m−3) than in to the previous, limiter campaign were achieved. In order to asses this improved performance and the nature of transport with regard to the expected higher densities and other parameters such as the electron and ion temperature, the electric field and plasma flow, measurements at the plasma edge were conducted with reciprocating probe, mounted on a Manipulator. The probe contains a set of Langmuir pins, Mach probes, compensation coils and a set of 3D pick up coils for the measurement of the local magnetic field and fluctuations, and an ion sensitive probe. It has been observed, in addition to differences due to the magnetic configurations, that the magnetic topology is sensitive to the plasma conditions, especially to changes due to a evolving toroidal plasma current. Measurements from divertor cameras showed that an increasing toroidal current in the standard configuration broadened the heat flux and shifted the strike line considerably. These down-stream observation can be complemented with the measurements at the mid-plane with the manipulator mounted probes. During the experiments the edge island remnant was identified with the measured edge plasma profiles and compared with the predictions from the field line tracing code. Those electron densities and temperatures have been used as an input for understanding edge transport with the EMC3-EIRENE modeling. The results from EMC3-EIRENE also help improve the caculated density profiles, since the modelling provides a profile of the effective charge Zeff. Keywords: W7-X, Langmuir probes, Magnetic islands, Plasma edge transport

Wendelstein 7-X is a low-shear stellarator with an island divertor, formed by natural magnetic islands at the plasma edge and ten modular divertor units for particle and energy exhaust. For the island divertor concept to work properly, the device is optimized for small internal currents. In particular, the bootstrap current is minimized. Previous studies predicted a thermal overload of the targets at a particular location, due to the slow evolution of the toroidal net current in the initial phase of certain otherwise desirable high-power discharges. The present numerical study explores the neoclassical predictions for the bootstrap current in more detail and demonstrates, as a proof of principle, that a path from low density and low heating power to high density and full heating power exists, on which the bootstrap current remains constant. This offers the possibility to reach the predetermined toroidal net current at low heating power, where no overload will occur in the transient phase. [ABSTRACT FROM AUTHOR]

Classical particle drifts are known to have substantial impacts on fluxes of particles and heat through the edge plasmas in both tokamaks and stellarators. Here we present results from the first dedicated investigation of drift effects in the W7-X stellarator. By comparing similar plasma discharges conducted with a forward- and reverse-directed magnetic field, the impacts of drifts could be isolated through the observation of up-down asymmetries in flux profiles on the divertor targets. In low-density plasmas, the radial locations of the strike lines (i.e. peaks in the target heat flux profiles) exhibited discrepancies of up to 3 cm that reversed upon magnetic field reversal. In addition, asymmetric heat loads were observed in regions of the target that are shadowed by other targets from parallel flux from the core plasma. A comparison of these asymmetric features with the footprints of key topological regions of the edge magnetic field on the divertor suggests that the main driver of the asymmetries at low density is poloidal E × B drift due to radial electric fields in the scrape-off layer and private flux region. In higher-density plasmas, upper and lower targets collected non-ambipolar currents with opposite signs that also inverted upon field reversal. Overall, in these experiments, almost all up-down asymmetry could be attributed to the field reversal and, therefore, field-dependent drifts. [ABSTRACT FROM AUTHOR]

Divertor target plates of magnetic confinement experiments are usually intersected by the magnetic field under a shallow angle. If steps are present in the target surface, the resulting leading edges will receive a strongly increased heat load as compared with the surrounding target surface. A very precise alignment of the target components is required to limit the height of leading edges in all magnetic configurations. In preparation of the initial divertor operation phase of the Wendelstein 7-X stellarator, we combined a model calculating the thermal load pattern on the targets for each magnetic configuration with a time-dependent model for heat transport within the targets, with a model for carbon sublimation and with measurements of step heights between target components to estimate the carbon sublimation rates to be expected. In a few locations of the as-built and as-installed divertor, these were found to be critically high, such that a limitation of plasma performance might have resulted. By re-aligning one type of target component according to the results of our modelling, the expected carbon sublimation rates were strongly reduced to uncritical levels. [ABSTRACT FROM AUTHOR]

The magnetic diagnostic system at the Wendelstein 7-X stellarator includes three diamagnetic loops to measure magnetic flux changes in the plasma. Their signals are directly related to the plasma energy. The diagnostic design with respect to materials, component cooling and data acquisition is built to be fully steady-state capable within the harsh environment of a fusion plasma device. During the first operational phase, two diamagnetic loops have been put into operation, each of them close to one of the up-down symmetric main planes of the plasma column with a bean-shaped and triangular-shaped cross-section, respectively. Both loops measured reliable energies in accordance to theoretical expectations. The triangular-shaped diamagnetic loop is equipped with four compensation coils. They are used to compensate errors during the energy measurement due to small fluctuations of externally driven currents in the main superconducting magnetic field coils and eddy currents in the adjacent vacuum vessel and thereby increase the time-resolution allowing to measure fast changes of the plasma energy. The diamagnetic flux measurements agree well with corresponding estimations of diamagnetic signals using three-dimensional Biot–Savart calculations. A consistency check for the diamagnetic energy is performed by a reconstruction of the associated Pfirsch–Schlüter current distribution and a comparison of predicted signals with measurements of an arrangement of eight plasma encircling Rogowski coil segments. Additionally, the measured diamagnetic energy is compared to kinetic energy calculations based on density and temperature measurements performed by the Thomson scattering diagnostic and the x-ray imaging crystal spectrometer diagnostic. The resulting energy confinement times are similar to predictions of empirical scaling laws, like ISS04. For upcoming operational periods of Wendelstein 7-X, the diamagnetic energy measurement will be used to generate an interlock signal, which will turn off the main plasma heating systems in case of a sudden, unwanted plasma collapse. [ABSTRACT FROM AUTHOR]

Observations on confinement in the first experimental campaign on the optimized Stellarator Wendelstein 7-X are summarized. In this phase W7-X was equipped with five inboard limiters only and thus the discharge length restricted to avoid local overheating. Stationary plasmas are limited to low densities  <2–3 · 1019 m−3. With the available 4.3 MW ECR Heating core Te ~ 8 keV, Ti ~ 1–2 keV are achieved routinely resulting in energy confinement time τE between 80 ms to 150 ms. For these conditions the plasmas show characteristics of core electron root confinement with peaked Te-profiles and positive Er up to about half of the minor radius. Profiles and plasma currents respond to on- and off-axis heating and co- and counter ECCD respectively. [ABSTRACT FROM AUTHOR]

Wendelstein 7-X (W7-X) is currently under commissioning in preparation for its initial plasma operation phase, operation phase 1.1 (OP1.1). This first phase serves primarily to provide an integral commissioning of all major systems needed for plasma operation, as well as systems, such as diagnostics, that need plasma operation to verify their foreseen functions. In OP1.1, W7-X will have a reduced set of in-vessel components. In particular, five graphite limiter stripes replace the later foreseen divertor. This paper describes the expected machine capabilities in OP1.1, as well as a selection of physics topics that can be addressed in OP1.1, despite the simplified configuration and the reduced machine capabilities. Physics topics include the verification and adjustment of the magnetic topology, the testing of the foreseen plasma start-up scenarios and the feed-forward control of plasma density and temperature evolution, as well as more advanced topics such as scrape-off layer (SOL) studies at short connection lengths and transport studies. Plasma operation in OP1.1 will primarily be performed in helium, with a hydrogen plasma phase at the end. [ABSTRACT FROM AUTHOR]

Wendelstein 7-X, currently under commissioning at the Max-Planck-Institut für Plasmaphysik in Greifswald, Germany, is a modular advanced stellarator, combining the modular coil concept with optimized properties of the plasma. Most of the envisaged magnetic configurations of the machine are rather sensitive to symmetry breaking perturbations which are the consequence of unavoidable manufacturing and assembly tolerances. This overview describes the successive tracking of the Wendelstein 7-X magnet system geometry starting from the manufacturing of the winding packs up to the modelling of the influence of operation loads. The deviations found were used to calculate the resulting error fields and to compare them with the compensation capacity of the trim coils. [ABSTRACT FROM AUTHOR]

Wendelstein 7-AS was the first modular stellarator device to test some basic elements of stellarator optimization: a reduced Shafranov shift and improved stability properties resulted in b-values up to 3.4% (at 0.9 T). This operational limit was determined by power balance and impurity radiation without noticeable degradation of stability or a violent collapse. The partial reduction of neoclassical transport could be verified in agreement with calculations indicating the feasibility of the concept of drift optimization. A full neoclassical optimization, in particular a minimization of the bootstrap current was beyond the scope of this project. A variety of non-ohmic heating and current drive scenarios by ICRH, NBI and in particular, ECRH were tested and compared successfully with their theoretical predictions. Besides, new heating schemes of overdense plasmas were developed such as RF mode conversion heating--Ordinary mode, Extraordinary mode, Bernstein-wave (OXB) heating--or 2nd harmonic O-mode (O2) heating. The energy confinement was about a factor of 2 above ISS95 without degradation near operational boundaries. A number of improved confinement regimes such as core electron-root confinement with central Te [?] 7 keV and regimes with strongly sheared radial electric field at the plasma edge resulting in Ti [?] 1.7 keV were obtained. As the first non-tokamak device, W7-AS achieved the H-mode and moreover developed a high density H-mode regime (HDH) with strongly reduced impurity confinement that allowed quasi-steady-state operation (t [?] 65 · tE) at densities \bar {n}_{\rme} \cong 4 \times 10^{20}\,\mbox{m}^{-3} (at 2.5 T). The first island divertor was tested successfully and operated with stable partial detachment in agreement with numerical simulations. With these results W7-AS laid the physics background for operation of an optimized low-shear steady-state stellarator. [ABSTRACT FROM AUTHOR]

Objectives: To quantify and qualify the experience of workplace violence (WPV) in a global sample of providers in obstetrics and gynecology (OBGYN)., Methods: We performed a mixed-methods analysis on data from a global survey. Survey content was designed around categorical and open-ended questions in relation to WPV; the occurrence and character, the physical and psychological consequences, training and support structures, and perceived triggers of the experience of WPV. Quantitative data were analyzed using descriptive statistics and text data using mixed deductive-inductive content analysis. These data were integrated using convergent joint display., Results: Between October 2023 and January 2024, survey responses were collected from 77 individual countries. Among the final sample, 764/1016 (75.2%) had experienced WPV, 699/1016 (68.8%) verbal, and 123/1016 (12.1%) physical violence. The violence affected physical health, psychological health, or job satisfaction for 106/764 (13.9%), 36/7642 (47.4%), and 222/764 (29.1%) of individuals respectively; 216/764 (28.3%) received support. Main WPV triggers were staff shortages, lack of security personnel, and long waiting times, identified by 38.8%, 37.5%, and 37.3% of respondents respectively. Qualitative data indicated that violence caused severe and long-lasting suffering. Catalysts for WPV were often reported as complex interplays between unmet or unrealistic expectations and insufficient resources. Lack of support for WPV was explained as violence being "part of the job" and a culture of assumed resilience among providers., Conclusion: WPV against OBGYN providers seems to be ubiquitous, arises from a complex interplay of factors, and causes significant injury while receiving insufficient mitigation and support., (© 2024 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Purpose of Review: The last decade has seen a cascade of different telemedicine models for medical abortion (MA) being tested and implemented. Among these service delivery models is the 'no-test' MA model, in which care is provided remotely and eligibility for the MA is based on history alone. The purpose of this review is to provide an overview of the existing evidence for no-test MA., Recent Findings: The evidence base for no-test MA relies heavily on cohort and noncomparative studies predominantly from high resource settings. Recent findings indicate that no-test MA is safe, effective, and highly acceptable. Diagnoses of ectopic pregnancy and underestimation of gestational age were rare. Identified advantages included shortening time to access MA and mitigating access barriers such as cost, and geographical barriers. Abortion seekers valued omitting the ultrasound citing reasons such as privacy concerns, costs, more flexibility, and control. The impacts of no-test MA on unscheduled postabortion contacts and visits and on contraceptive use were unclear due to limited evidence., Summary: No-test MA can be provided to complement other care pathways including those with some or no in-person care. Further research is needed to allow for widespread adoption of no-test MA and scale-up in a variety of contexts, including low-resource settings., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The design, development, and successful implementation of pop-up Langmuir probes installed in the water-cooled divertor of W7-X are described. The probes are controlled by drive coils (actuators) installed behind the divertor plates. These drive coils make use of the magnetic field in W7-X to move the probe tips into and out of the plasma. The drive coils were installed in the vacuum vessel after extensively testing the durability of the coils and analyzing the criteria for safe operation. The probe design is carefully tailored for each of the 36 probe tips in order to be suitable for the different magnetic field configurations used in W7-X and ensure that the probes do not present leading edges to the magnetic flux tubes. An electronic bridge circuit is used for measurement to compensate for the effects of signal propagation time on the long cable lengths used. The diagnostic is integrated with the segment control of W7-X for automated operation and control of the diagnostic. The evaluation of the results from the plasma operation is presented after accounting for appropriate sheath expansion for negative bias voltage on the probes., (© 2024 Author(s). All article content, except where otherwise noted, is licensed under a Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).)

Objective: To assess current access to essential sexual and reproductive health (SRHR) services in Afghanistan and how access has changed with the transition of power., Methods: This is a cross-sectional study based on data from an anonymous survey among doctors in Afghanistan in May 2022, analyzed using descriptive statistics. The survey recorded subjective estimates of access to SRHR services, barriers to access, extent of maternal mortality or near miss due to preventable factors, and the effect of the regime change on access., Results: The data collection was interrupted after 60 responses. A majority of providers responded that their population went hungry often or always. According to our criteria for "access", that 75% or more of the population was estimated to have it, no respondents (0%) assessed that access existed for services for gender-based violence. The corresponding proportion responding that access existed was 3.4% for services after rape, 12.6% for legal abortion, 13.3% for antenatal care, and 20% for labor care. According to 41.7% of respondents, untreated postpartum hemorrhage accounted for a large or very large proportion of preventable maternal mortality or near miss. Almost half of respondents (47.4%) reported the same for lack of skilled providers, 66.2% reported it for the concept "too many pregnancies", and 55% reported it for malnutrition and poor health. According to 43.3% of respondents, the regime change had reduced access to labor care to a large extent, 33.9% of respondents said this in relation to access to contraceptives, and 43.1% for overall access for internally displaced persons., Conclusion: Interim data suggest that women in some settings in Afghanistan have no access to SRHR services, that preventable factors account for a large portion of maternal deaths or near miss, and that access has deteriorated since the transition of power., (© 2023 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Our aim was to investigate the inclusion of sexual and reproductive health and rights (SRHR) topics in medical curricula and the perceived need for, feasibility of, and barriers to teaching SRHR. We distributed a survey with questions on SRHR content, and factors regulating SRHR content, to medical universities worldwide using chain referral. Associations between high SRHR content and independent variables were analyzed using unconditional linear regression or χ 2 test. Text data were analyzed by thematic analysis. We collected data from 219 respondents, 143 universities and 54 countries. Clinical SRHR topics such as safe pregnancy and childbirth (95.7%) and contraceptive methods (97.2%) were more frequently reported as taught compared with complex SRHR topics such as sexual violence (63.8%), unsafe abortion (65.7%), and the vulnerability of LGBTQIA persons (23.2%). High SRHR content was associated with high-income level (P = 0.003) and low abortion restriction (P = 0.042) but varied within settings. Most respondents described teaching SRHR as essential to the health of society. Complexity was cited as a barrier, as were cultural taboos, lack of stakeholder recognition, and dependency on fees and ranking., (© 2022 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Introduction: The COVID-19 pandemic has negatively impacted health systems globally and widened preexisting disparities. We conducted a scoping review on the impact of the COVID-19 pandemic on women and girls' access to and utilisation of sexual and reproductive health (SRH) services for contraception, abortion, gender-based and intimate partner violence (GBV/IPV) and sexually transmitted infections (STIs)., Methods: We systematically searched peer reviewed literature and quantitative reports, published between December 2019 and July 2021, focused on women and girls' (15-49 years old) access to and utilisation of selected SRH services during the COVID-19 pandemic. Included studies were grouped based on setting, SRH service area, study design, population and reported impact. Qualitative data were coded, organised thematically and grouped by major findings., Results: We included 83 of 3067 identified studies and found that access to contraception, in-person safe abortion services, in-person services for GBV/IPV and STI/HIV testing, prevention and treatment decreased. The geographical distribution of this body of research was uneven and significantly less representative of countries where COVID-19 restrictions were very strict. Access was limited by demand and supply side barriers including transportation disruptions, financial hardships, limited resources and legal restrictions. Few studies focused on marginalised groups with distinct SRH needs., Conclusion: Reports indicated negative impacts on access to and utilisation of SRH services globally, especially for marginalised populations during the pandemic. Our findings call for strengthening of health systems preparedness and resilience to safeguard global access to essential SRH services in ongoing and future emergencies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Telemedicine for medical abortion increases access to safe abortion but its use has not been described in a controlled trial. We aimed to investigate the effectiveness, adherence, safety, and acceptability of a modified telemedicine protocol for abortion compared with standard care in a low-resource setting., Methods: In this randomised, controlled, non-inferiority trial we recruited women seeking medical abortion at or before 9 gestational weeks at four public health clinics in South Africa. Participants were randomly allocated (1:1) by computer-generated blocks of varying sizes to telemedicine or standard care. The telemedicine group received asynchronous online abortion consultation and instruction, self-assessed gestational duration, and had a uterine palpation as a safety measure. Participants in this group took 200 mg mifepristone and 800 μg misoprostol at home. The standard care group received in-person consultation and instruction together with an ultrasound, took 200 mg mifepristone in clinic and 800 μg misoprostol at home. Our primary outcome was complete abortion after initial treatment, assessed at a 6-week interview. Our non-inferiority margin was 4%. Group differences were assessed by modified intention-to-treat (mITT) analysis and per protocol. The trial is registered at ClinicalTrials.gov, NCT04336358, and the Pan African Clinical Trials Registry, PACTR202004661941593., Findings: Between Feb 28, 2020, and Oct 5, 2021, we enrolled 900 women, 153 (17·0%) of whom were discontinued before the abortion and were not included in the analysis. By mITT analysis, 355 (95·4%) of 372 women in the telemedicine group had a complete abortion compared with 338 (96·6%) of 350 in the standard care group (odds ratio 0·74 [95% CI 0·35 to 1·57]). The risk difference was -1·1% (-4·0 to 1·7). Among women who completed treatment as allocated (per protocol), 327 (95·6%) of 342 women in telemedicine group had complete abortion, compared with 338 (96·6%) of 350 in the standard care group (0·77 [0·36 to 1·68]), with a risk difference of -1·0% (-3·8 to 1·9). One participant (in the telemedicine group) had a ruptured ectopic pregnancy, and a further four participants were admitted to hospital (two in each group), of whom two had blood transfusions (one in each group)., Interpretation: Asynchronous online consultation and instruction for medical abortion and home self-medication, with uterine palpation as the only in-person component, was non-inferior to standard care with respect to rates of complete abortion, and did not affect safety, adherence, or satisfaction., Funding: Grand Challenges Canada and the Swedish Research Council., Competing Interests: Declaration of interests RG is founder and director of WoW, the telemedicine service platform used in the study. All other authors declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Purpose: Levonorgestrel-only emergency contraception (EC) inhibits ovulation to prevent fertilization. Misconceptions regarding its mechanism of action contribute to low use in some settings. We aimed to review the mechanism of action of Levonorgestrel EC and assess the evidence for a postovulatory effect on viable pregnancy development in the exposed and subsequent cycles., Basic Procedures: We searched Pubmed, Embase, Web of Science, clinicaltrials.gov, the Cochrane database, and the US FDA Adverse Event Reporting System. We included studies reporting on the effect of Levonorgestrel EC exposure on (1) ovulation, (2) conception, (3) implantation, (4) ectopic pregnancy, (5) pregnancy viability, and (6) fertility in subsequent cycles. Data were extracted and tabulated from included studies by two researchers. The results were analyzed and summarized in narrative form., Main Findings: We included 33 studies. Women exposed to Levonorgestrel EC at or after the LH (luteinizing hormone) surge had similar rates of inhibited ovulation (3 studies) and conception rates (2 studies) as controls. Nine out of ten studies found no difference in endometrial receptivity to implantation after exposure to Levonorgestrel EC compared to controls. The evidence for an association between Levonorgestrel EC and reduced fallopian tube motility or ectopic pregnancy was conflicting. We found no evidence of increased miscarriage or teratogenicity (3 studies) or disrupted menstrual cycle (3 studies) after Levonorgestrel EC exposure compared to controls., Principal Conclusions: This review supports that Levonorgestrel EC taken after ovulation does not affect implantation and results in similar conception rates compared to placebo. There is no evidence that exposure to Levonorgestrel EC affects fetal development, miscarriage, stillbirth, or subsequent menstruations., Competing Interests: Declaration of Competing Interest ME received a partial salary for the research involved in performing the systematic review from Foundation Consumer Healthcare. She has no other conflicts of interest to report. KGD has served as ad hoc invited speaker or on advisory meetings for Gedeon Richter, Bayer AG, MSD, Exelgyn, Exeltis, Azanta, HRA Pharma, and Ferring. RHWL has received research support from HRA Pharma and Ferring and served as an ad hoc invited speaker for Ferring., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Due to the COVID-19 pandemic, health services around the globe are struggling. An effective system for monitoring patients can improve healthcare delivery by avoiding in-person contacts, enabling early-detection of severe cases, and remotely assessing patients' status. Internet of Things (IoT) technologies have been used for monitoring patients' health with wireless wearable sensors in different scenarios and medical conditions, such as noncommunicable and infectious diseases. Combining IoT-related technologies with early-warning scores (EWS) commonly utilized in infirmaries has the potential to enhance health services delivery significantly. Specifically, the NEWS-2 has been showing remarkable results in detecting the health deterioration of COVID-19 patients. Although the literature presents several approaches for remote monitoring, none of these studies proposes a customized, complete, and integrated architecture that uses an effective early-detection mechanism for COVID-19 and that is flexible enough to be used in hospital wards and at home. Therefore, this article's objective is to present a comprehensive IoT-based conceptual architecture that addresses the key requirements of scalability, interoperability, network dynamics, context discovery, reliability, and privacy in the context of remote health monitoring of COVID-19 patients in hospitals and at home. Since remote monitoring of patients at home (essential during a pandemic) can engender trust issues regarding secure and ethical data collection, a consent management module was incorporated into our architecture to provide transparency and ensure data privacy. Further, the article details mechanisms for supporting a configurable and adaptable scoring system embedded in wearable devices to increase usefulness and flexibility for health care professions working with EWS., Competing Interests: The authors declare no conflict of interest., (© 2021 The Authors. Published by Elsevier B.V.)

Health monitoring systems (HMSs) capture physiological measurements through biosensors (sensing), obtain significant properties and measures from the output signal (perceiving), use algorithms for data analysis (reasoning), and trigger warnings or alarms (acting) when an emergency occurs. These systems have the potential to enhance health care delivery in different application domains, showing promising benefits for health diagnosis, early symptom detection, disease prediction, among others. However, the implementation of HMS presents challenges for sensing, perceiving, reasoning, and acting based on monitored data, mainly when data processing should be performed in real time. Thus, the quality of these diagnoses relies heavily on the data and data analysis methods applied. Data mining techniques have been broadly investigated in health systems; however, it is not clear what real-time data analysis techniques are best suited for each context. This work carries out a search in five scientific electronic databases to identify recent studies that investigated HMS using real-time data analysis techniques. Thirty-six research studies were selected after screening 2,822 works. Applied data analysis methods, application domains, utilized sensors, physiological parameters, extracted features, claimed benefits, limitations, datasets used, and published results were described, compared and analyzed. The findings indicate that machine learning methods are trending in such studies. There is no universal solution for all health domains; however, support vector machines are a predominant method. Among the application domains, cardiovascular disease is the most investigated. Most reviewed studies reported improvements in performing data mining tasks or operational modes of solutions. Although studies tested algorithms and presented promising results, those are particular for each experiment. This review gives a comprehensive overview of HMS real-time data analysis and points to directions for future research., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: Women on Web (WoW) is a global medical abortion telemedicine service operating outside the formal health sector. In April 2019 they opened their helpdesk to Germany. Our aim was to understand the motivations, and perceived barriers to access, for women who choose telemedicine abortion outside the formal health sector in Germany., Methods: We conducted a parallel convergent mixed-methods study among 1090 women consulting WoW from Germany between 1 January and 31 December 2019. We performed a cross-sectional study of data contained in online consultations and a content analysis of 108 email texts. Analysis was done until saturation; results were merged and triangulation used to validate results., Results: The quantitative analysis found that the need for secrecy (n=502, 48%) and the wish for privacy (n=500, 48%) were frequent reasons for choosing telemedicine abortion. Adolescents were more likely to report secrecy, cost, stigma and legal restrictions as reasons for using telemedicine abortion compared with older women. The content analysis developed two main themes and seven subsidiary categories, (1) internal motivations for seeking telemedicine abortion encompassing (i) autonomy, (ii) perception of external threat and (iii) shame and stigma, and (2) external barriers to formal abortion care encompassing (iv) financial stress, (v) logistic barriers to access, (vi) provider attitudes and (vii) vulnerability of foreigners., Conclusions: Women in Germany who choose telemedicine abortion outside the formal health sector do so both from a place of empowerment and a place of disempowerment. Numerous barriers to abortion access exist in the formal sector which are of special relevance to vulnerable groups such as adolescents and undocumented immigrants., Competing Interests: Competing interests: Coauthors RG, SG and HA work for or are affiliated with Women on Web., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: This trial reports on use of the copper intrauterine device (IUD) after immediate compared with delayed insertion following medical abortion at 17-20 gestational weeks (GW)., Methods: This randomised controlled trial was conducted at one tertiary hospital and five community healthcare centres in Cape Town, South Africa. Eligible consenting women were randomised to immediate (within 24 hours) or delayed (3 weeks post-abortion) insertion of the copper IUD. Follow-up was at 6 weeks, 3 months and 6 months. Main outcomes were use of the original IUD and use of any IUD, including replacement IUDs at 6 weeks post-abortion. Secondary outcomes included rates of expulsion and malposition at 6 weeks, use of any IUD at 3 and 6 months, and acceptability of the IUD., Results: We recruited and randomised 114 women admitted for elective medical abortion between August 2018 and June 2019. In the immediate and delayed study arms, respectively, 45/55 (82%) and 12/57 (21%) women received the IUD as planned. By intention-to-treat, 56% in the immediate and 19% in the delayed arms were using the original IUD at 6 weeks (p<0.001), and 76% in the immediate and 40% in the delayed arms were using any IUD (p<0.001). Complete expulsion or removal occurred in 32% in the immediate and 7% in the delayed arms (p=0.044)., Conclusions: Insertion of an IUD immediately after medical abortion at 17-20 GW results in increased use after 6 weeks compared with delayed insertion, however expulsion rates are higher than with interval insertion., Clinical Trials Registration: NCT03505047), Pan African Trials Registry (www.pactr.org), 201804003324963., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The availability of modern contraception including long-acting reversible contraceptives (LARC), is a fundamental component of postabortion care. Findings from a recent randomized controlled trial (RCT) in South Africa comparing immediate to delayed insertion of the copper intrauterine device (IUD) after medical abortion (MA) at 17-20 gestational weeks showed that immediate insertion resulted in higher IUD use at 6 weeks postabortion, but that expulsion rates were significantly higher than for delayed insertion. This study aims to explore barriers, facilitators, and context-specific factors relevant to the implementation of immediate IUD provision after second trimester medical abortion., Methods: We performed a qualitative study alongside the RCT in which we conducted in-depth interviews with 14 staff providing healthcare to study participants and 24 study participants. Research questions explored barriers and facilitators to implementation of immediate IUD insertion, contraceptive decision-making, and the impact of context and supplementary trial activities on service provision. Interviews were recorded and transcribed, with translation into English if needed. We performed a triangulated thematic analysis at the level of the transcribed interview text., Results: Contraceptive counselling at the abortion facility by a study nurse improved knowledge, corrected misconceptions, and increased demand for the IUD postabortion. Women expressed a clear preference for immediate insertion. Convenience, protection from pregnancy and privacy issues were paramount and women expressed preference for engagement with staff who knew their abortion history, and with whom they had an established connection. Doctors and nurses were generally in favour of immediate insertion and said it could be incorporated into standard care if women wanted this. This contrasted with the need for interventions by the research team to reinforce adherence by staff to provide contraception as allocated during the trial., Conclusions: Women and staff favour immediate IUD insertion after second trimester medical abortion, but service delivery may require structures that ensure timely insertion postabortion, continuity of care, communication that mitigates loss to follow-up and training of staff to ensure competence., (© 2021. The Author(s).)

Background: The World Health Organization's "Coordinated Global Research Roadmap: 2019 Novel Coronavirus" outlined the need for research that focuses on the impact of COVID-19 on pregnant women and children. More than one year after the first reported case significant knowledge gaps remain, highlighting the need for a coordinated approach. To address this need, the Maternal, Newborn and Child Health Working Group (MNCH WG) of the COVID-19 Clinical Research Coalition conducted an international survey to identify global research priorities for COVID-19 in maternal, reproductive and child health., Method: This project was undertaken using a modified Delphi method. An electronic questionnaire was disseminated to clinicians and researchers in three different languages (English, French and Spanish) via MNCH WG affiliated networks. Respondents were asked to select the five most urgent research priorities among a list of 17 identified by the MNCH WG. Analysis of questionnaire data was undertaken to identify key similarities and differences among respondents according to questionnaire language, location and specialty. Following elimination of the seven lowest ranking priorities, the questionnaire was recirculated to the original pool of respondents. Thematic analysis of final questionnaire data was undertaken by the MNCH WG from which four priority research themes emerged., Results: Questionnaire 1 was completed by 225 respondents from 29 countries. Questionnaire 2 was returned by 49 respondents. The four priority research themes which emerged from the analysis were 1) access to healthcare during the COVID-19 pandemic, 2) the direct and 3) indirect effects of COVID-19 on pregnant and breastfeeding women and children and 4) the transmission of COVID-19 and protection from infection., Conclusion: The results of these questionnaires indicated a high level of concordance among continents and specialties regarding priority research themes. This prioritized list of research uncertainties, developed to specifically highlight the most urgent clinical needs as perceived by healthcare professionals and researchers, could help funding organizations and researchers to answer the most pressing questions for clinicians and public health professionals during the pandemic. It is hoped that these identified priority research themes can help focus the discussion regarding the allocation of limited resources to enhance COVID-19 research in MNCH globally., Competing Interests: The authors have declared that no competing interests exist.

Introduction: We aimed to give a global overview of trends in access to sexual and reproductive health and rights (SRHR) during the coronavirus disease 2019 (COVID-19) pandemic and what is being done to mitigate its impact., Material and Methods: We performed a descriptive analysis and content analysis based on an online survey among clinicians, researchers, and organizations. Our data were extracted from multiple-choice questions on access to SRHR services and risk of SRHR violations, and written responses to open-ended questions on threats to access and required response., Results: The survey was answered by 51 people representing 29 countries. Eighty-six percent reported that access to contraceptive services was less or much less because of COVID-19, corresponding figures for surgical and medical abortion were 62% and 46%. The increased risk of gender-based and sexual violence was assessed as moderate or severe by 79%. Among countries with mildly restrictive abortion policies, 69% had implemented changes to facilitate access to abortion during the pandemic, compared with none among countries with severe restrictions (P < .001), 87.5% compared with 46% had implemented changes to facilitate access to contraception (P = .023). The content analysis showed that (a) prioritizations in health service delivery at the expense of SRHR, (b) lack of political will, (c) the detrimental effect of lockdown, and (d) the suspension of sexual education, were threats to SRHR access (theme 1). Requirements to mitigate these threats (theme 2) were (a) political will and support of universal access to SRH services, (b) the sensitization of providers, (c) free public transport, and (d) physical protective equipment. A contrasting third theme was the state of exception of the COVID-19 pandemic as a window of opportunity to push forward women's health and rights., Conclusions: Many countries have seen decreased access to and increased violations of SRHR during the COVID-19 pandemic. Countries with severe restrictions on abortion seem less likely to have implemented changes to SRHR delivery to mitigate this impact. Political will to support the advancement of SRHR is often lacking, which is fundamental to ensuring both continued access and, in a minority of cases, the solidification of gains made to SRHR during the pandemic., (© 2020 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Traditionally, mental health specialists monitor their patients' social behavior by applying subjective self-report questionnaires in face-to-face meetings. Usually, the application of the self-report questionnaire is limited by cognitive biases (e.g., memory bias and social desirability). As an alternative, we present a solution to detect context-aware sociability patterns and behavioral changes based on social situations inferred from ubiquitous device data. This solution does not focus on the diagnosis of mental states, but works on identifying situations of interest to specialized professionals. The proposed solution consists of an algorithm based on frequent pattern mining and complex event processing to detect periods of the day in which the individual usually socializes. Social routine recognition is performed under different context conditions to differentiate abnormal social behaviors from the variation of usual social habits. The proposed solution also can detect abnormal behavior and routine changes. This solution uses fuzzy logic to model the knowledge of the mental health specialist necessary to identify the occurrence of behavioral change. Evaluation results show that the prediction performance of the identified context-aware sociability patterns has strong positive relation (Pearson's correlation coefficient >70%) with individuals' social routine. Finally, the evaluation conducted recognized that the proposed solution leading to the identification of abnormal social behaviors and social routine changes consistently.

We performed a country case study using thematic analysis of interviews and existing grey and published literature to identify facilitators and barriers to the implementation of midwife-provided abortion care in Sweden. Identified facilitating factors were: (1) the historical role and high status of Swedish midwives; (2) Swedish research and development of medical abortion that enabled an enlarged clinical role for midwives; (3) collaborations between individual clinicians and researchers within the professional associations, and the autonomy of clinical units to implement changes in clinical practice; (4) a historic precedent of changes in abortion policy occurring without prior official or legal sanction; (5) a context of liberal abortion laws, secularity, gender equality, public support for abortion, trust in public institutions; and (6) an increasing global interest in task-shifting to increase access and reduce costs. Identified barriers/risks were: (1) the lack of systems for monitoring and evaluation; and (2) a loss of physician competence in abortion care., (© 2020 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Traditionally, the process of monitoring and evaluating social behavior related to mental health has based on self-reported information, which is limited by the subjective character of responses and various cognitive biases. Today, however, there is a growing amount of studies that have provided methods to objectively monitor social behavior through ubiquitous devices and have used this information to support mental health services. In this paper, we present a Systematic Literature Review (SLR) to identify, analyze and characterize the state of the art about the use of ubiquitous devices to monitor users' social behavior focused on mental health. For this purpose, we performed an exhaustive literature search on the six main digital libraries. A screening process was conducted on 160 peer-reviewed publications by applying suitable selection criteria to define the appropriate studies to the scope of this SLR. Next, 20 selected studies were forwarded to the data extraction phase. From an analysis of the selected studies, we recognized the types of social situations identified, the process of transforming contextual data into social situations, the use of social situation awareness to support mental health monitoring, and the methods used to evaluate proposed solutions. Additionally, we identified the main trends presented by this research area, as well as open questions and perspectives for future research. Results of this SLR showed that social situation-aware ubiquitous systems represent promising assistance tools for patients and mental health professionals. However, studies still present limitations in methodological rigor and restrictions in experiments, and solutions proposed by them have limitations to be overcome., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Equilibrium analysis in fusion devices usually relies on plasma pressure profiles and magnetic measurements outside the plasma. The kinetic profiles can give indirect information about the equilibrium magnetic field, while the stationary magnetic diagnostics cannot resolve current distributions on a smaller scale. This work presents a reciprocating magnetic probe, designed to provide direct plasma response measurements of the magnetic field in the scrape-off layer of Wendelstein 7-X. Hardware design and frequency characteristics are discussed, and a post-processing technique for extending the lower frequency cutoff of the integration scheme is presented.

The design and evaluation of the Langmuir probe system used in the first divertor operation phase of Wendelstein 7-X is described. The probes are integrated into the target plates and have individually facetted surfaces to keep the angle of incidence of the magnetic field within an appropriate range for different magnetic configurations. Multiple models for the derivation of plasma parameters from current-voltage characteristics are introduced. These are analyzed with regard to their assumptions and limitations, generalized, and adapted to our use case. A detailed comparison is made to determine the most suitable model. It is found that the choice of model has a large impact, for example, resulting in a change in the inferred temperatures of up to a factor two. This evaluation is implemented in a Bayesian modeling framework and automated to allow for joint analysis with other diagnostics and a replacement of ad hoc assumptions. We rigorously treat parameter uncertainties, revealing strong correlations between them. General and flexible model formulations permit an expansion to additional effects.

Ensuring universal access to sexual and reproductive healthcare services is Target 3.7 of the United Nations Sustainable Development Goals (SDG). Refugee and migrant women and children are at particular risk of being forgotten in the global momentum to achieve this target. In this article we discuss the violations of sexual and reproductive health and rights (SRHR) of particular relevance to the refugee and migrant reality. We give context-specific examples of denial of health services to vulnerable groups; lack of dignity as a barrier to care; the vulnerability of adolescents; child marriage; weaponized rape; gender-based violence; and sexual trafficking. We discuss rights frameworks and models that are being used in response to these situations, as well as what remains to be done. Specifically, we call for obstetricians and gynecologists to act as individual providers and through their FIGO member societies to protect women's health and rights in these exposed settings., (© 2020 International Federation of Gynecology and Obstetrics.)

We performed a search in PubMed and Web of Science on the self-use of abortion medication after online access. Studies published between January 1, 1995, and March 31, 2019, were considered. We included studies of online services that were (i) led by healthcare staff (n = 14), (ii) led by non-healthcare staff (n = 4), and (iii) providing noninteractive access (n = 17). Our outcomes were utilization (frequency and demand for services), acceptability for women, safety, and success rate. Key findings: Women are increasingly using the Internet to access abortion medication. Available services are of varying quality. Women accessing noninteractive services report feelings of distress related to the lack of medical guidance, and the demand for interactive guidance through the abortion process is high. Women using services led by healthcare staff report high rates of satisfaction and similar rates of clinical outcomes as those of in-person abortion care., (Copyright © 2019. Published by Elsevier Ltd.)

Background: Telemedicine is increasingly being used to access abortion services., Objective: To assess the success rate, safety, and acceptability for women and providers of medical abortion using telemedicine., Search Strategy: We searched PubMed, EMBASE, ClinicalTrials.gov, and Web of Science up until 10 November 2017., Study Criteria: We selected studies where telemedicine was used for comprehensive medical abortion services, i.e. assessment/counselling, treatment, and follow up, reporting on success rate (continuing pregnancy, complete abortion, and surgical evacuation), safety (rate of blood transfusion and hospitalisation) or acceptability (satisfaction, dissatisfaction, and recommendation of the service)., Data Collection and Analysis: Quantitative outcomes were summarised as a range of median rates. Qualitative data were summarised in a narrative synthesis., Main Results: Rates relevant to success rate, safety, and acceptability outcomes for women ≤10 +0 weeks' gestation (GW) ranged from 0 to 1.9% for continuing pregnancy, 93.8 to 96.4% for complete abortion, 0.9 to 19.3% for surgical evacuation, 0 to 0.7% for blood transfusion, 0.07 to 2.8% for hospitalisation, 64 to 100% for satisfaction, 0.2 to 2.3% for dissatisfaction, and 90 to 98% for recommendation of the service. Rates in studies also including women >10 +0 GW ranged from 1.3 to 2.3% for continuing pregnancy, 8.5 to 20.9% for surgical evacuation, and 90 to 100% for satisfaction. Qualitative studies on acceptability showed no negative impacts for women or providers., Conclusion: Based on a synthesis of mainly self-reported data, medical abortion through telemedicine seems to be highly acceptable to women and providers, success rate and safety outcomes are similar to those reported in literature for in-person abortion care, and surgical evacuation rates are higher., Tweetable Abstract: A systematic review of medical abortion through telemedicine shows outcome rates similar to in-person care., (© 2019 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.)

Introduction: The impact of placenta previa on pregnancy, delivery and infant outcomes has been extensively studied. However, less is known about the possible association of placental location other than previa with pregnancy outcomes. The aim of this study was to investigate if placental location other than previa is associated with adverse pregnancy, delivery and infant outcomes., Material and Methods: This is a population-based cohort study, with data from the regional population-based Stockholm-Gotland Obstetric Cohort, Sweden, from 2008 to 2014. The study population included 74 087 nulliparous women with singleton pregnancies resulting in live-born infants, with information about placental location from the second-trimester ultrasound screening. The association between placental location (fundal, lateral, anterior or posterior) and pregnancy outcomes was estimated using logistic regression analysis. Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated, and adjustments were made for maternal age, height, country of birth, smoking in early pregnancy, sex of the infant and in vitro fertilization. Main outcome measures were pregnancy, delivery and infant outcomes., Results: Compared with posterior placental location, fundal and lateral placental locations were associated with a number of adverse pregnancy outcomes, the most important being: very preterm birth (<32 weeks of gestation) (adjusted OR [aOR] 1.78, 95% CI 1.18-2.63 and aOR 2.12, 95% CI 1.39-2.25, respectively), moderate preterm birth (32-36 weeks of gestation) (aOR 1.23, 95% CI 1.001-1.51 and aOR 1.62, 95% CI 1.32-2.00, respectively), small-for-gestational-age birth (aOR 1.67, 95% CI 1.34-2.07 and aOR 1.77, 95% CI 1.39-2.25, respectively) and manual removal of the placenta in vaginal births (aOR 3.27, 95% CI 2.68-3.99 and aOR 3.27, 95% CI 2.60-4.10, respectively). Additionally, lateral placental location was associated with preeclampsia (aOR 1.30, 95% CI 1.03-1.65) and severe postpartum hemorrhage (aOR 1.42, 95% CI 1.27-1.82)., Conclusions: Compared with posterior placental location, fundal and lateral placental locations are associated with a number of adverse pregnancy, delivery and infant outcomes., (© 2019 Nordic Federation of Societies of Obstetrics and Gynecology.)

Objective: To assess the safety and acceptability of abortion through telemedicine at >9 +0  weeks of gestation., Design: Cohort study., Setting: Poland., Population: Six hundred and fifteen women who requested and underwent a abortion through telemedicine from 1 June to 31 December 2016., Methods: Risks of adverse outcomes were calculated as adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) by unconditional logistic regression according to gestational age at abortion: ≤9 or >9 weeks of gestation., Main Outcome Measures: Self-reported clinical visits for complaints related to the abortion within 0-1 days of the treatment, heavy bleeding, pain or bleeding more than expected, and low satisfaction., Results: Among women undergoing a abortion at ≤9 or >9 weeks of gestation, 3.3 versus 11.7% went to hospital with concerns within 0-1 days of the termination (aOR 3.82, 95% CI 1.90-7.69). Among women undergoing a abortion from 11 +1 to 14 +2  weeks of gestation, the rate was 22.5% (aOR 9.20, 95% CI 3.58-23.60). Among women undergoing a abortion at ≤9 or >9 weeks of gestation, the rate of heavy bleeding was 6.8 versus 10.1% (aOR 1.65, 95% CI 0.90-3.04), the rate of low satisfaction was 2.4 versus 1.6% (aOR 0.69, 95% CI 0.14-3.36), the rate of bleeding more than expected was 45.6 versus 57.8% (aOR 1.26, 95% CI 0.78-2.02), and the rate of pain more than expected was 35.6 versus 38.8% (aOR 1.11, 95% CI 0.71-1.71)., Conclusions: Medical abortion through telemedicine at >9 weeks of gestation is associated with a higher risk of same-day or day-after clinical visits for concerns related to the procedure, and this risk increases with gestational age. Self-reported rates of heavy bleeding, low satisfaction, or unmet expectations with medical abortion do not increase with gestational age., Tweetable Abstract: A cohort study shows that abortion through telemedicine at >9 weeks of gestation is associated with more hospital visits but not with increased bleeding., (© 2018 Royal College of Obstetricians and Gynaecologists.)

Objective: To investigate whether retained placenta in the first generation is associated with an increased risk of retained placenta in the second generation., Design: Population-based cohort study., Setting: Sweden., Population: Using linked generational data from the Swedish Medical Birth Register 1973-2012, we identified 494 000 second-generation births with information on the birth of the mother (first-generation index birth). For 292 897 of these births there was information also on the birth of the father., Methods: Risk of retained placenta in the second generation was calculated as adjusted odds ratios (aOR) by unconditional logistic regression with 95% confidence intervals (95% CI) according to whether retained placenta occurred in a first generation birth or not., Main Outcome: Retained placenta in the second generation., Results: The risk of retained placenta in a second-generation birth was increased if retained placenta had occurred at the mother's own birth (aOR 1.66, 95% CI 1.52-1.82), at the birth of one of her siblings (aOR 1.58, 95% CI 1.43-1.76) or both (aOR 2.75, 95% CI 2.18-3.46). The risk was slightly increased if retained placenta had occurred at the birth of the father (aOR 1.23, 95% CI 1.07-1.41). For preterm births in both generations, the risk of retained placenta in the second generation was increased six-fold if retained placenta had occurred at the mother's birth (OR 6.55, 95% CI 2.68-16.02)., Conclusion: There is an intergenerational recurrence of retained placenta on the maternal and most likely also on the paternal side. The recurrence risk seems strongest in preterm pregnancies., Tweetable Abstract: A population-based cohort study suggests that there is an intergenerational recurrence of retained placenta., (© 2017 Royal College of Obstetricians and Gynaecologists.)

Context aware systems are able to adapt their behavior according to the environment in which the user is. They can be integrated into an Internet of Things (IoT) infrastructure, allowing a better perception of the user's physical environment by collecting context data from sensors embedded in devices known as smart objects. An IoT extension called the Internet of Mobile Things (IoMT) suggests new scenarios in which smart objects and IoT gateways can move autonomously or be moved easily. In a comprehensive view, Quality of Context (QoC) is a term that can express quality requirements of context aware applications. These requirements can be those related to the quality of information provided by the sensors (e.g., accuracy, resolution, age, validity time) or those referring to the quality of the data distribution service (e.g, reliability, delay, delivery time). Some functionalities of context aware applications and/or decision-making processes of these applications and their users depend on the level of quality of context available, which tend to vary over time for various reasons. Reviewing the literature, it is possible to verify that the quality of context support provided by IoT-oriented middleware systems still has limitations in relation to at least four relevant aspects: (i) quality of context provisioning; (ii) quality of context monitoring; (iii) support for heterogeneous device and technology management; (iv) support for reliable data delivery in mobility scenarios. This paper presents two main contributions: (i) a state-of-the-art survey specifically aimed at analyzing the middleware with quality of context support and; (ii) a new middleware with comprehensive quality of context support for Internet of Things Applications. The proposed middleware was evaluated and the results are presented and discussed in this article, which also shows a case study involving the development of a mobile remote patient monitoring application that was developed using the proposed middleware. This case study highlights how middleware components were used to meet the quality of context requirements of the application. In addition, the proposed middleware was compared to other solutions in the literature., Competing Interests: The authors declare no conflict of interest.

Current mobile devices allow the execution of sophisticated applications with the capacity for identifying the user situation, which can be helpful in treatments of mental disorders. In this paper, we present SituMan , a solution that provides situation awareness to MoodBuster , an ecological momentary assessment and intervention mobile application used to request self-assessments from patients in depression treatments. SituMan has a fuzzy inference engine to identify patient situations using context data gathered from the sensors embedded in mobile devices. Situations are specified jointly by the patient and mental health professional, and they can represent the patient's daily routine (e.g., "studying", "at work", "working out"). MoodBuster requests mental status self-assessments from patients at adequate moments using situation awareness. In addition, SituMan saves and displays patient situations in a summary, delivering them for consultation by mental health professionals. A first experimental evaluation was performed to assess the user satisfaction with the approaches to define and identify situations. This experiment showed that SituMan was well evaluated in both criteria. A second experiment was performed to assess the accuracy of the fuzzy engine to infer situations. Results from the second experiment showed that the fuzzy inference engine has a good accuracy to identify situations., Competing Interests: The authors declare no conflict of interest.

Background: Retained placenta is associated with severe postpartum hemorrhage. Its etiology is unknown and its biochemistry has not been studied. We aimed to assess whether levels of the antioxidative enzyme Glutathione Peroxidase 1 (GPX1) and the transcription factor Nuclear Factor κβ (NFκβ), as markers of oxidative stress and inflammation, were affected in retained placentas compared to spontaneously released placentas from otherwise normal full term pregnancies., Methods: In a pilot study we assessed concentrations of GPX1 by ELISA and gene (mRNA) expression of GPX1, NFκβ and its inhibitor Iκβα, by quantitative real-time-PCR in periumbilical and peripheral samples from retained (n = 29) and non-retained (n = 31) placental tissue., Results: Median periumbilical GPX1 concentrations were 13.32 ng/ml in retained placentas and 17.96 ng/ml in non-retained placentas (p = 0.22), peripheral concentrations were 13.27 ng/ml and 19.09 ng/ml (p = 0.08). Retained placental tissue was more likely to have a low GPX1 protein concentration (OR 3.82, p = 0.02 for periumbilical and OR 3.95, p = 0.02 for peripheral samples). Median periumbilical GPX1 gene expressions were 1.13 for retained placentas and 0.88 for non-retained placentas (p = 0.08), peripheral expression was 1.32 and 1.18 (p = 0.46). Gene expressions of NFκβ and Iκβα were not significantly different between retained and non-retained placental tissue., Conclusions: Women with retained placenta were more likely to have a low level of GPX1 protein concentration in placental tissue compared to women without retained placenta and retained placental tissue showed a tendency of lower median concentrations of GPX1 protein expression. This may indicate decreased antioxidative capacity as a component in this disorder but requires a larger sample to corroborate results.

Wendelstein 7-X, a superconducting optimized stellarator built in Greifswald/Germany, started its first plasmas with the last closed flux surface (LCFS) defined by 5 uncooled graphite limiters in December 2015. At the end of the 10 weeks long experimental campaign (OP1.1) more than 20 independent diagnostic systems were in operation, allowing detailed studies of many interesting plasma phenomena. For example, fast neutral gas manometers supported by video cameras (including one fast-frame camera with frame rates of tens of kHz) as well as visible cameras with different interference filters, with field of views covering all ten half-modules of the stellarator, discovered a MARFE-like radiation zone on the inboard side of machine module 4. This structure is presumably triggered by an inadvertent plasma-wall interaction in module 4 resulting in a high impurity influx that terminates some discharges by radiation cooling. The main plasma parameters achieved in OP1.1 exceeded predicted values in discharges of a length reaching 6 s. Although OP1.1 is characterized by short pulses, many of the diagnostics are already designed for quasi-steady state operation of 30 min discharges heated at 10 MW of ECRH. An overview of diagnostic performance for OP1.1 is given, including some highlights from the physics campaigns.

Introduction: Retained placenta is a potentially fatal obstetric disorder due to postpartum hemorrhage, its pathophysiology is however unknown. We aimed to assess if retained placenta was associated with increased macroscopic and histological signs of placental maternal underperfusion, a pattern otherwise seen in preeclampsia and other disorders of defective placentation., Methods: This was a case-control study of retained (n = 49) and non-retained (n = 47) placentas, collected from full-term singleton and otherwise healthy pregnancies, carried out at a tertiary level obstetric department. Macroscopic and histological analysis was performed. Signs of maternal placental underperfusion and signs of placental inflammation, fetal vascular thrombo-occlusive disease and increased placental attachment were recorded in a primary and secondary analysis respectively. Variables were compared groupwise using unconditional logistic regression or comparison of median or mean values., Results: Compared to non-retained placentas retained placentas had a significantly smaller surface area (p = 0.05), were more oblong in shape (OR 5.24 95% CI:1.34-20.21) and showed overall more signs of maternal underperfusion (OR 2.52 95% CI: 1.07-5.87). There was no significant difference in signs of placental inflammation, fetal vascular thrombo-occlusive disease or placenta accreta but basal plate myometrial fibers were more common among retained placentas., Conclusion: In regard to shape, surface area and histological signs of maternal placental underperfusion, retained placentas showed a histological pattern similar to that seen in preeclamptic placentas., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Nosema ceranae causes a widespread disease that reduces honey bee health but is only thought to infect adult honey bees, not larvae, a critical life stage. We reared honey bee (Apis mellifera) larvae in vitro and provide the first demonstration that N. ceranae can infect larvae and decrease subsequent adult longevity. We exposed three-day-old larvae to a single dose of 40,000 (40K), 10,000 (10K), zero (control), or 40K autoclaved (control) N. ceranae spores in larval food. Spores developed intracellularly in midgut cells at the pre-pupal stage (8 days after egg hatching) of 41% of bees exposed as larvae. We counted the number of N. ceranae spores in dissected bee midguts of pre-pupae and, in a separate group, upon adult death. Pre-pupae exposed to the 10K or 40K spore treatments as larvae had significantly elevated spore counts as compared to controls. Adults exposed as larvae had significantly elevated spore counts as compared to controls. Larval spore exposure decreased longevity: a 40K treatment decreased the age by which 75% of adult bees died by 28%. Unexpectedly, the low dose (10K) led to significantly greater infection (1.3 fold more spores and 1.5 fold more infected bees) than the high dose (40K) upon adult death. Differential immune activation may be involved if the higher dose triggered a stronger larval immune response that resulted in fewer adult spores but imposed a cost, reducing lifespan. The impact of N. ceranae on honey bee larval development and the larvae of naturally infected colonies therefore deserve further study.

Objective: To evaluate whether defective placentation disorders, i.e. pre-eclampsia, stillbirth, small for gestational age (SGA), and spontaneous preterm birth, are associated with risk of retained placenta., Design: Population-based cohort study., Setting: Sweden., Population: Primiparous women in Sweden with singleton vaginal deliveries between 1997 and 2009 at 32-41 weeks of gestation (n = 386,607), without placental abruption or infants with congenital malformations., Methods: Risks were calculated as odds ratios (ORs) by unconditional logistic regression with 95% confidence intervals (95% CIs) after adjustments for maternal, delivery, and infant characteristics., Main Outcome Measure: Retained placenta, defined by the presence of both a diagnostic code (of retained placenta) and a procedure code (for the manual removal of the placenta)., Results: The overall rate of retained placenta was 2.17%. The risk of retained placenta was increased for women with pre-eclampsia (adjusted OR, aOR, 1.37, 95% CI 1.21-1.54), stillbirth (aOR 1.71, 95% CI 1.28-2.29), SGA birth (aOR 1.47, 95% CI 1.28-1.70), and spontaneous preterm birth (32-34 weeks of gestation, aOR 2.35, 95% CI 1.97-2.81; 35-36 weeks of gestation, aOR 1.55, 95% CI 1.37-1.75). The risk was further increased for women with preterm pre-eclampsia (aOR 1.69, 95% CI 1.25-2.28) and preterm SGA birth (aOR 2.19, 95% CI 1.42-3.38). There was no association between preterm stillbirth (aOR 1.10, 95% CI 0.63-1.92) and retained placenta, but the exposed group comprised only 15 cases., Conclusions: Defective placentation disorders are associated with an increased risk of retained placenta. Whether these relationships indicate a common pathophysiology remains to be investigated., (© 2014 Royal College of Obstetricians and Gynaecologists.)

An overview of the diagnostics which are essential for the first operational phase of Wendelstein 7-X and the set of diagnostics expected to be ready for operation at this time are presented. The ongoing investigations of how to cope with high levels of stray Electron Cyclotron Resonance Heating (ECRH) radiation in the ultraviolet (UV)/visible/infrared (IR) optical diagnostics are described.