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The DIAMOND antenatal clinic was established to provide multidisciplinary continuity of care to pregnant women living with morbid (body mass index (BMI) ≥40 kg/mThe aim was to describe clinic processes, demographics, clinical outcomes and women's perceptions of the clinic.Women who received antenatal care in the clinic between 2016 and 2019 (n = 257) had routine data collected for retrospective analysis. A patient satisfaction survey was conducted for women who received care in 2019 (n = 89).The median BMI was 49 kg/mEstablishing a dedicated clinic for women living with high BMI provides a well-liked environment for a high-risk cohort of women. Our review identified opportunities for improvement in clinic processes. We plan to assess overall impact on perinatal outcomes.

The aim was to examine the social determinants of health on human immunodeficiency virus care quality for children in Indonesia.A qualitative design using constructivist grounded theory methods was utilized.Data were collected between 2019 and 2020 using in-depth- interviews and memo writing. In total, 23 semi-structured individual interviews with healthcare professionals, 12 with children with human immunodeficiency virus, and eight family members were conducted. Data were analysed with the two-step initial coding and focused coding, along with the constant comparative method, theoretical sensitivity and memo writing.Five themes were constructed from participants' perspectives on human immunodeficiency virus care for children: (1) living with a low-socioeconomic status, (2) lacking instrumental support, (3) experiencing complicated procedures for public health insurance, (4) limited Human Immunodeficiency Virus care services for children and (5) lacking care coordination, policies and practices.Children living with human immunodeficiency virus had poor health outcomes, due to having a low-socioeconomic status, reduced access to healthcare, coupled with a lack of social support services.This study demonstrated how the social determinants of health negatively impact the quality of care for Indonesian children with human immunodeficiency virus and their families. Understanding these determinants would benefit health professionals, in particular nurses, to consider these factors in their assessment to create a holistic care plan for children living with human immunodeficiency virus and their families. Addressing the social determinants of health would beneficially enhance outcomes and well-being of children living with human immunodeficiency virus health in Indonesia.

Thrombocytopenia in patients with myelofibrosis (MF) is prognostically detrimental and poses a therapeutic challenge. MF patients with thrombocytopenia are considered high-risk by most prognostic models and their distinct phenotype has given rise to the emerging concept of cytopenic MF. Yet, the mechanisms underlying thrombocytopenia in MF are poorly understood.This study aimed to highlight the genetic mechanisms driving low platelet counts in treatment-naive MF patients, establish their phenotypic correlates, and assess prognostic factors specific to this group of patients.The authors found that most patients presenting with low platelets had a clear thrombocytopenia-specific genetic abnormality involving a U2AF1 Q157 mutation, deletion 20q, molecular complexity (three or more mutations), or high-risk karyotype. Etiologic clustering did not correlate with prognosis; however, thrombocytopenic patients were found to have unique prognostic variables including low serum albumin and mutations of SRSF2 and TP53. This led to the proposal of a prognostic model (SRSF2, albumin, TP53 score) that stratifies thrombocytopenic patients as low, intermediate, or high-risk with corresponding median survivals of 93.5, 29.5, and 7.2 months, respectively.This study demonstrates that thrombocytopenia in MF is driven by different genetic mechanisms and is not uniformly high-risk. As novel agents with improved hematologic safety profiles enter the treatment landscape, thoughtful, risk-adapted therapeutic decisions will be required for MF patients with thrombocytopenia.A significant minority of patients with myelofibrosis (MF) present with low platelets. Historically, these patients have been viewed as having "high-risk" disease, but this may not be uniformly true. Our study shows that there are various different causes for low platelets in MF, some of which represent high-risk disease whereas others do not. Additionally, our study shows that genetic mutations affecting the genes SRSF2 and TP53 are uniquely problematic in this group, as is a low serum albumin level. This study helps to risk-stratify MF patients with thrombocytopenia, thereby providing more information to guide informed and individualized treatment decisions.

Host-specialist parasites of endangered large vertebrates are in many cases more endangered than their hosts. In particular, low population densities and reduced among-host transmission rates are expected to lead to inbreeding within parasite infrapopulations living on single host individuals. Furthermore, spatial population structures of directly-transmitted parasites should be concordant with those of their hosts. Using population genomic approaches, we investigated inbreeding and population structure in a host-specialist seal louse (Echinophthirius horridus) infesting the Saimaa ringed seal (Phoca hispida saimensis), which is endemic to Lake Saimaa in Finland, and is one of the most endangered pinnipeds in the world. We conducted genome resequencing of pairs of lice collected from 18 individual Saimaa ringed seals throughout the Lake Saimaa complex. Our analyses showed high genetic similarity and inbreeding between lice inhabiting the same individual seal host, indicating low among-host transmission rates. Across the lake, genetic differentiation among individual lice was correlated with their geographic distance, and assignment analyses revealed a marked break in the genetic variation of the lice in the middle of the lake, indicating substantial population structure. These findings indicate that movements of Saimaa ringed seals across the main breeding areas of the fragmented Lake Saimaa complex may in fact be more restricted than suggested by previous population-genetic analyses of the seals themselves.

This commentary asks anthropologists to work within communities to actively address the global mental health impact of COVID-19 and contribute to the pandemic response. Multiple social and physical losses, worsened by numerous factors, have produced syndemic traumatic stress and suffering across populations, highlighting persistent inequalities further amplified by the effects of COVID-19. Specifically, anthropologists can work to contribute to the development of mental health programs; confront the racialization of COVID-19 alongside marginalized communities; support real-time policy making with community responses; and innovate transparent collaborative research methods through open science. This pandemic can serve as an opportunity to prioritize research endeavors, public service, and teaching to better align with societal needs while providing new opportunities for synergy and collaborations between anthropologists in and outside the academy. Anthropologists collaborating directly with mental health clinicians and the public can contribute to knowledge specifically through direct program development and implementation of interventions designed to improve mental well-being. Innovating to find impactful solutions in response to the unprecedented mental health challenges exacerbated by the COVID-19 pandemic has the potential to promote more equitable recovery around the world.

Plutonium(IV) oxalate hexahydrate (Pu(C2O4)2∙6H2O; PuOx) is an important intermediate in the recovery of plutonium from used nuclear fuel. Its formation via precipitation is well studied, yet its crystal structure remains unknown. Instead, the crystal structure of PuOx is assumed to be isostructural with neptunium(IV) oxalate hexahydrate (Np(C2O4)¬2∙6H2O; NpOx) and uranium(IV) oxalate hexahydrate (U(C2O4)¬2∙6H2O; UOx) despite the high degree of unresolved disorder that exists when determining water positions in the crystal structures of the latter two compounds. Such assumptions regarding the isostructural behavior of the actinide elements have been used to predict the structure of PuOx for use in a wide range of studies. Herein, we report the first crystal structures for PuOx and Th(C2O4)2·6H2O (ThOx). This data, along with new characterization of UOx and NpOx, has resulted in the full determination of the structures and resolution of the disorder around the water molecules. Specifically, we identify the coordination of two water molecules with each metal center, which necessitates a change in oxalate coordination mode from axial to equatorial that has not been reported in the literature. The results of this work exemplify the need to revisit previous assumptions regarding fundamental actinide chemistry, which are heavily relied upon within the current nuclear field.