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Abstract Background Studies have demonstrated that standardizing labor induction (IOL), often with the use of protocols, may reduce racial inequities in obstetrics. IOL protocols are complex, multi-component interventions. To target identified implementation barriers, audit and feedback (A&F) was selected as an implementation strategy. Here, we aimed to understand the acceptability and effect of A&F on fidelity to this complex intervention through quantitative and qualitative approaches. Methods This secondary analysis of a type I hybrid effectiveness-implementation trial (10/2018–12/2022) compared 2 years before (PRE) to 2 years after (POST) implementation of an IOL protocol at two sites. Fidelity to each of 8 specific protocol components was collected via chart review. During the POST period, unit-aggregated A&F reports were distributed via email every 3 months to site clinicians. Reports tracked fidelity to protocol components over time. For this analysis, we compared component fidelity PRE to POST-implementation. Additionally, during the POST period, we compared fidelity by month after each A&F (Month#1 v. Month#2/3) to evaluate the effect of A&F over time. Acceptability of A&F reports was evaluated using qualitative interviews. Results 8509 labor inductions were included (PRE = 4214, POST = 4295). A&F reports were successfully distributed every 3 months for the 2-year POST period. PRE to POST-implementation, fidelity to 4 of the 8 components increased significantly (cervical Foley utilization, latent labor examination frequency, amniotomy timing, and intrauterine pressure catheter utilization), without change in the other 4 components. For 2 of those 4 components where improvement was noted, there was no difference in fidelity by month after A&F report; rather, there was sustained improvement across the POST-implementation period. On the other hand, for the remaining 2 components, fidelity peaked in the first month after each A&F report, with some decline in the following 2 months prior to the next A&F report. Qualitative analysis (n = 24) supported A&F acceptability, with A&F described as “motivating” and “helpful.” Conclusions A&F was an effective implementation strategy to promote fidelity to certain components of this labor induction protocol. With some decline in effect after the first month POST-A&F report, increased A&F frequency should be considered in future work targeting obstetric outcomes, as well as health inequities.

Summary: Background: Cesarean delivery remains the most common obstetrical procedure with more than 250,000 patients in the US undergoing cesarean following labor induction annually. Here, we evaluated the impact of prospectively implementing a standardized labor induction protocol on cesarean delivery rates. Methods: This multi-site type I hybrid effectiveness-implementation study compared 2 years before (PRE) and 2 years after (POST) implementation of a standardized labor induction protocol at two hospitals within the University of Pennsylvania Health System (2018–2022). The protocol included multiple components and recommended active management of labor induction, including frequent cervical examinations, amniotomy if cervical exam ≥4 cm, and interventions for labor dystocia. The primary effectiveness outcome was cesarean delivery. Secondary effectiveness outcomes included labor length, chorioamnionitis, and maternal and neonatal morbidity. The primary implementation outcome was fidelity, defined as adherence to ≥75% of the protocol components among 8 individual components that could be evaluated discretely. All data was collected via individual chart review. Findings: 8509 patients were included (PRE: n = 4214, POST: n = 4295). Our population was of median age of 31 years interquartile range (IQR) [26–35], and 44.6% identified as Black, 40.1% as white, 6.9% as Asian, and 8.4% as other or unknown; 7.4% of the population identified as Latinx. There was no significant difference in cesarean delivery rate between the two time periods overall (PRE: 21.6% vs. POST: 21.8%, p = 0.85; adjusted relative risk (aRR) 0.99 95% confidence interval (CI) [0.90–1.09]). There were no significant differences in labor length, chorioamnionitis, or composite neonatal morbidity. Maternal morbidity decreased PRE to POST (PRE: 9.3% vs. POST: 6.5%, p

A novel Eu(tta)3([4,4′-(t-bu)2-2,2′-bpy)] complex (tta-thenoyltrifluoroacetone), a ratiometric luminescent-based optical sensor for the quantitative determination of aluminum ion, is synthesized and characterized using XRD and 1H NMR. The XRD data reveal the slightly distorted octahedral structure. The complex displays a bright red emission at 613 nm in methanol which is characteristic of europium (III) complexes. Upon the addition of Al3+ ions, the red emission disappears, and a new blue emission at 398 nm emerges, manifesting the ratiometric nature of the complex. The turn-off of the red emission and turn-on of the blue emission are attributed to Eu-Al trans-metalation, as supported by Raman data that show the emergence of Al-O vibrations at 418, 495, and 608 cm−1 concomitant with the disappearance of Eu-O and Eu-N bond vibrations. Most aluminum sensors are known to suffer from interferences from other metals including Cu2+, Co2+, and Cd2+. However, the sensor reported here is tested for 11 common cations and shows no interference on sensitivity. To the best of our knowledge, this is the first known Eu-based luminescence sensor that successfully exhibited the ability to detect aluminum ions in ppb levels in aqueous environments. The calculated Al3+ binding constant is 2.496 × 103 ± 172. The complex shows a linear relationship in the range of 0–47.6 ppb (1.76 × 10−6 M) Al3+ and the limit of detection (LOD) is 4.79 ppb (1.77 × 10−7 M) in MeOH. ICP-OES is used for validation of the sensor complex in water and then it was used for quantitative detection of Al3+ ions in water as a real-life application. The complex can accurately detect Al3+ ions in the range of 4.97–24.9 ppb (1.84 × 10−7 M–9.2 × 10−7 M) with an LOD of 8.11 ppb (2.99 × 10−7 M). Considering that the aluminum ion serves no recognized function within the human body, its accumulation can lead to severe neurological disorders, including Parkinson’s and Alzheimer’s diseases. With the LOD value significantly lower than the WHO-recommended maximum permissible level of 200 ppb for aluminum in drinking water, even without high-power laser-aided signal enhancement, the sensor shows promise for detecting trace amounts of aluminum contamination in water. Therefore, it can significantly aid in the monitoring of even the smallest aluminum ion contamination in drinking water, industrial effluents, and natural water bodies.

An incomplete right bundle branch block (RBBB) associated with coagulation disturbance in mitral valvular disease was diagnosed in a five-year-old female Dachshund. Morphologically moderate mitral valvular thickening and nodularity could be noticed on echocardiography. Prolonged activated partial thromboplastin time and thrombocytopaenia supported the probable underlying mechanism for myocardial infarction and RBBB. The animal showed clinical improvement after one month of therapy with enalapril and torasemide for mitral valve insufficiency.

Abstract Background Implementation outcomes, including acceptability, are of critical importance in both implementation research and practice. The gold standard measure of acceptability, Acceptability of Intervention Measure (AIM), skews positively with a limited range. In an ongoing hybrid effectiveness-implementation trial, we aimed to evaluate clinician acceptability of induction standardization. Here, we describe an innovative mixed-methods approach to maximize the interpretability of the AIM using a case study in maternal health. Methods In this explanatory sequential mixed methods study, we distributed the validated, 4-question AIM (total 4–20) to labor and delivery clinicians 6 months post-implementation at 2 sites (Site 1: 3/2021; Site 2: 6/2021). Respondents were grouped by total score into tertiles. The top (“High” Acceptability) and bottom (“Low” Acceptability) tertiles were invited to participate in a 30-minute semi-structured qualitative interview from 6/2021 to 10/2021 until thematic saturation was reached in each acceptability group. Participants were purposively sampled by role and site. Interviews were coded using an integrated approach, incorporating a priori attributes (Consolidated Framework for Implementation Research constructs) into a modified content analysis approach. Results 104 clinicians completed the initial survey; 24 were interviewed (12 “High” and 12 “Low” Acceptability). Median total AIM scores were 20/20 IQR[20–20] in the High and 12.5/20 IQR[11–14] in the Low Acceptability groups. In both groups, clinicians were enthusiastic about efforts to standardize labor induction, believing it reduces inter-clinician variability and improves equitable, evidence-based care. In the Low Acceptability group, clinicians stated the need for flexibility and consideration for patient uniqueness. Rarely, clinicians felt labor induction could not or should not be standardized, citing discomfort with medicalization of labor, and concerns with “bulldozing” the patient with interventions. Suggested strategies for overcoming negative sentiment included comprehensive clinician education, as well as involving patients as active participants in the protocol prenatally. Conclusions This study utilized AIM in an innovative sequential mixed-methods approach to characterize clinician acceptability, which may be generalizable across implementation endeavors. By performing this work during a hybrid trial, implementation strategies to improve acceptability emerged (clinician education focusing on respect for flexibility; involving patients as active participants prenatally) for year 2, which will inform future multi-site work.

Lymphangioleiomyomatosis is a rare cystic lung disease primarily affecting premenopausal females and may be exacerbated by pregnancy. We conducted a literature review of lymphangioleiomyomatosis during pregnancy with a specific focus on related maternal morbidity and obstetrical outcomes. We also report a case of lymphangioleiomyomatosis that presented as an acute spontaneous pneumothorax in the third trimester of pregnancy, followed by significant maternal morbidity. A 37-year-old primigravid woman who presented at 29 weeks 5 days gestation with chest pain was diagnosed with spontaneous pneumothorax. Further imaging demonstrated cystic lung lesions and renal angiomyolipomas. She developed severe abdominal pain concerning for placental abruption that led to an urgent cesarean delivery at 30 weeks 2 days gestation. Her course was complicated by recurrent pneumothorax, superimposed preeclampsia, and significant ileus and bowel dilation complicated by bowel perforation. For patients with a clinical suspicion of lymphangioleiomyomatosis in pregnancy, prompt recognition, diagnosis, and referral to appropriate multidisciplinary subspecialists is critical to mitigate complications and optimize outcomes both during and after pregnancy.

The present study was carried out with the objective of evaluating the response to a combination therapy of enalapril and torasemide in dogs with mitral valve disease (MVD). Dogs diagnosed with stage C of MVD as per the American College of Veterinary Internal Medicine guidelines were included in the study. Treatment was initiated with enalapril at 0.5 mg/kg BID and torasemide at 0.2 mg/kg OD orally on 0th day. Detailed clinical examination with special reference to the cardiovascular system including measurement of blood pressure, radiographic, electrocardiographic and echocardiographic parameters of the animals were performed on 0th and 30th day of treatment. The treatment was well tolerated by all the animals. Amelioration of clinical signs with a noticeable reduction in cough was noticed in all the animals. On 30th day of treatment, a significant decrease was noticed in the vertebral heart score and left ventricular internal diameter during diastole and a non-significant decrease was noticed in left atrium to aortic root ratio, left ventricular internal diameter during systole, with a considerable reduction in severity of mitral regurgitation. Post- treatment clearing of lung fields was noticed in dogs with radiographic evidence of pulmonary oedema on 0th day. In addition to this, ventricular premature complexes noticed in three animals pre- treatment was not noticed post treatment.

The present study was conducted to investigate electrocardiographical (ECG) and haemato-biochemical changes in arrhythmia associated with renal diseases in dogs. The dogs with renal affections confirmed through appropriate diagnostic methods were selected and screened for arrhythmia. The ECG and haemato-biochemical parameters of twenty dogs with arrhythmia were compared with that of the control group and ECG parameters were statistically correlated with the haemato-biochemical parameters for correlation studies. It was found that the occurrence of arrhythmia was 51.2 per cent in renal diseases. Arrhythmia was more predominant in dogs with chronic kidney disease (CKD) followed by acute kidney injury (AKI). Sinus arrhythmia followed by first-degree AV block and wandering pacemaker were the common types of arrhythmias observed. A significant increase in R-R interval and a decrease in heart rate was noticed in comparison. The haemato-biochemical analysis revealed anaemia, leukocytosis with neutrophilia, elevated blood urea nitrogen (BUN), creatinine and magnesium level. A significant positive correlation was noticed between haemoglobin, volume of packed red cells (VPRC) and red blood cell count (RBC) with T amplitude and, creatinine and BUN levels with corrected Q-T interval. A significant negative correlation was noticed between VPRC, RBC and haemoglobin with the corrected QT interval. The present study revealed ECG and haemato-biochemical parameters had a significant role in renal diseases in dogs which might help in the early diagnosis and proper management of arrhythmia associated with renal diseases.

Objective. The red rhizome of Angiopteris helferiana has been used widely to treat muscle fatigue, bone pain, and skin infection in Nepal. However, scientific evidence for its bioactive compounds and their bioactivities was lacking till January, 2024. Therefore, we investigated to validate and advance the further use and development. Methods. Column chromatography, including MCI gel CHP20P, Sephadex LH-20, ODS, and Silica gel, was used for the isolation of compounds from 70% methanol extract of A. helferiana rhizomes. The isolated compounds were evaluated for their TLC-based antioxidant and antibacterial activity against Staphylococcus aureus, Klebsiella pneumonia, Escherichia coli, and Pseudomonas aeruginosa by adopting the agar well diffusion protocol. Furthermore, in silico molecular docking against the penicillin binding protein of E. coli (PBP1b, PBP2, and PBP3 TPd) and ADME toxicity of the isolated compounds was predicted. Results and Discussion. Angiopteroside (1) and osmundalactone (2) were isolated for the first time from the red rhizomes of A. helferiana. The structure of the isolated compounds was elucidated on the basis of spectroscopic (1H-, 13C-, and 13C/DEPT-NMR) and spectrometric (LC MS/ESI and IR) analyses and comparison with reported literature. Both compounds were inactive towards DPPH scavenging activity. Compound 1 showed poor inhibitory activity against E. coli, with inhibition zone range of 2–7 mm. However, both isolated compounds were found to be resistant against S. aureus, K. pneumonia, and P. aeruginosa. Based on in silico molecular docking forecasting, compound 1 revealed the good binding affinity with PBP1b (−6.5 kcal/mol), PBP2 (−5.8 kcal/mol) and PBP3 TPd (−6.1 kcal/mol) compared to positive control meropenem with PBP1b (−6.6 kcal/mol), PBP2 (−6.9 kcal/mol), and PBP3 TPd (−6.6 kcal/mol). Similarly, compound 2 showed weak preference for PBP1b (−4.3 kcal/mol), PBP2 (−4.4 kcal/mol), and PBP TPd (−4.5 kcal/mol). Compounds 1 and 2 were predicted to be safe in terms of hepatotoxicity, cytotoxicity, mutagenicity, and carcinogenicity, with a potential to induce nephrotoxicity similar to that of meropenem. Conclusion. This study successfully isolates two lactones with antibacterial properties and inspires the researcher to further research, development, and formulation.

The present study was conducted to evaluate the alterations in oxidative stress parameters in dogs suffering from haemorrhagic gastroenteritis (HGE). Dogs presented with vomiting and diarrhoea were screened and fifteen animals with signs suggestive of HGE were included in the study. The oxidative stress parameters, serummalondialdehyde (MDA) level, total antioxidant status (TAS) and plasma glutathione peroxidase (GSH-Px) activity were studied. The values were compared with the values from six apparently healthy dogs. A significant increase was noticed in the mean values of serum MDA and TAS of diseased animals at the time of presentation when compared to healthy animals whereas the activity of plasma GSH-Px was found to be lower than in healthy dogs. Supplementation with N-acetyl cysteine @ 70 mg/kg or five days was found effective in managing the oxidative injury in the affected animals.

The present study was carried out with the objective of assessment of haematobiochemical and trichographic features of mucocutaneous lesions in dogs. Dogs presented with mucocutaneous lesions associated with various dermatological conditions were included in the study. Mange, atopic dermatitis, dermatophytosis, juvenile cellulitis, pyoderma and hypothyroidism with secondary Malassezia dermatitis were presented with mucocutaneous lesions in the perioral, periorbital and in the nostrils with least involvement of anogenital region. Haemato-biochemical analysis revealed anaemia, non-significant increase in total leucocyte count, neutrophilia, eosinophilia, elevated platelet count, hyperproteinaemia and hypoalbuminaemia. Elevated serum C-reactive protein was evident in all cases. Trichographic features revealed that highest number of hairs were included in the telogen phase of hair cycle with greater number of primary hairs. Hair fractures were evident in 20.8 per cent of hairs and trichoptilosis of hair tip was observed in 50.8 per cent of hairs studied. Demodex mites could be detected by hair pluck examination in all cases of demodicosis.

BackgroundPrenatal care, one of the most common preventive care services in the United States, endeavors to improve pregnancy outcomes through evidence-based screenings and interventions. Despite the prevalence of prenatal care and its importance to maternal and infant health, there are several debates about the best methods of prenatal care delivery, including the most appropriate schedule frequency and content of prenatal visits. Current US national guidelines recommend that low-risk individuals receive a standard schedule of 12 to 14 in-office visits, a care delivery model that has remained unchanged for almost a century. ObjectiveIn early 2020, to mitigate individuals’ exposure to the SARS-CoV-2 virus, prenatal care providers implemented new paradigms that altered the schedule frequency, interval, and modality (eg, telemedicine) of how prenatal care services were offered. In this paper, we describe the development of a core outcome set (COS) that can be used to evaluate the effect of the frequency of prenatal care schedules on maternal and infant outcomes. MethodsWe will systematically review the literature to identify previously reported outcomes important to individuals who receive prenatal care and the people who care for them. Stakeholders with expertise in prenatal care delivery (ie, patients or family members, health care providers, and public health professionals and policy makers) will rate the importance of identified outcomes in a web-based survey using a 3-round Delphi process. A digital consensus meeting will be held for a group of stakeholder representatives to discuss and vote on the outcomes to include in the final COS. ResultsThe Delphi survey was initiated in July 2022 with invited 71 stakeholders. A digital consensus conference was conducted on October 11, 2022. Data are currently under analysis with plans to submit them in a subsequent manuscript. ConclusionsMore research about the optimal schedule frequency and modality for prenatal care delivery is needed. Standardizing outcomes that are measured and reported in evaluations of the recommended prenatal care schedules will assist evidence synthesis and results reported in systematic reviews and meta-analyses. Overall, this COS will expand the consistency and patient-centeredness of reported outcomes for various prenatal care delivery schedules and modalities, hopefully improving the overall efficacy of recommended care delivery for pregnant people and their families. International Registered Report Identifier (IRRID)DERR1-10.2196/43962

The purpose of this study was to conduct a systematic review on reproductive health problems and health seeking behaviour among adolescent girls in India. Literature search was conducted by pubmed, scholar and google search. A total of 407 articles were searched through data bases at the first stage, and 11 articles met the eligibility criteria were selected and analyzed. The findings of the study showed that reproductive health problems such as menstrual problems and reproductive tract infections are common among adolescent girls and the related health seeking behaviour was not satisfactory.

Background: Studies have demonstrated that standardizing labor induction (IOL), often with the use of protocols, may reduce racial inequities in obstetrics. IOL protocols are complex, multi-component interventions. To target identified implementation barriers, audit and feedback (A&F) was selected as an implementation strategy. Here, we aimed to understand the acceptability and effect of A&F on fidelity to this complex intervention through quantitative and qualitative approaches. Methods: This secondary analysis of a type I hybrid effectiveness-implementation trial (10/2018–12/2022) compared 2 years before (PRE) to 2 years after (POST) implementation of an IOL protocol at two sites. Fidelity to each of 8 specific protocol components was collected via chart review. During the POST period, unit-aggregated A&F reports were distributed via email every 3 months to site clinicians. Reports tracked fidelity to protocol components over time. For this analysis, we compared component fidelity PRE to POST-implementation. Additionally, during the POST period, we compared fidelity by month after each A&F (Month#1 v. Month#2/3) to evaluate the effect of A&F over time. Acceptability of A&F reports was evaluated using qualitative interviews. Results: 8509 labor inductions were included (PRE = 4214, POST = 4295). A&F reports were successfully distributed every 3 months for the 2-year POST period. PRE to POST-implementation, fidelity to 4 of the 8 components increased significantly (cervical Foley utilization, latent labor examination frequency, amniotomy timing, and intrauterine pressure catheter utilization), without change in the other 4 components. For 2 of those 4 components where improvement was noted, there was no difference in fidelity by month after A&F report; rather, there was sustained improvement across the POST-implementation period. On the other hand, for the remaining 2 components, fidelity peaked in the first month after each A&F report, with some decline in the following 2 months prior to the next A&F report. Qualitative analysis (n = 24) supported A&F acceptability, with A&F described as "motivating" and "helpful." Conclusions: A&F was an effective implementation strategy to promote fidelity to certain components of this labor induction protocol. With some decline in effect after the first month POST-A&F report, increased A&F frequency should be considered in future work targeting obstetric outcomes, as well as health inequities. [ABSTRACT FROM AUTHOR]

Objective In response to the unacceptable racial disparities in US obstetric outcomes, our health system established a formal goal to reduce maternal morbidity for black women. Here, we describe our process for meeting this equity-focused goal in the context of diverse implementation climates at 5 inpatient sites.Study design To meet the system goal, we established a collaborative of multidisciplinary, site-based teams. The validated 18-question Implementation Climate Scale (ICS) was distributed to site clinicians at baseline. Sites focused on haemorrhage, performing case reviews of black women meeting morbidity criteria. Comparing cases by site, site-specific areas for improvement in haemorrhage risk assessment, prevention and management emerged. Evidence-based practices (EBPs) were then selected, tailored and implemented by site. Monthly system-wide team meetings included (1) metric tracking and (2) site presentations with discussions around barriers/facilitators to EBP implementation. Maternal morbidity rates among black women were compared the year before goal development (1 July 2019–30 June 2020) to the year after (1 July 2020–30 June 2021).Results Mean ICS scores for inpatient obstetric units differed by site (p=0.005), with climates more supportive of implementation at urban/academic hospitals. In response to case reviews, sites reported implementing 2 to 8 EBPs to meet the goal. Despite different ICS scores, this process was associated with significant reductions in maternal morbidity for black women from pregoal to postgoal development overall and at sites 1, 2 and 3, with non-statistically significant reductions at sites 4 and 5 (overall: −29.4% reduction, p

Abstract Background The goal of regionalized perinatal care, specifically levels of maternal care, is to improve maternal outcomes through risk-appropriate obstetric care. Studies of levels of maternal care are limited by current approaches to identify a hospital’s level of care, often relying on hospital self-reported data, which is expensive and challenging to collect and validate. The study objective was to develop an empiric approach to determine a hospital’s level of maternal care using administrative data reflective of the patient care provided and apply this approach to describe the levels of maternal care available over time. Methods Retrospective cohort study of mother-infant dyads who delivered in California, Missouri, and Pennsylvania hospitals from 2000 to 2009. Linked mother-infant administrative records with an infant born at 24–44 weeks’ gestation and a birth weight of 400–8000 g were included. Using the American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine descriptions of levels of maternal care, four levels were classified based on the appropriate location of care for patients with specific medical or pregnancy conditions. Individual hospitals were assigned a level of maternal care annually based on the volume of patients who delivered reflective of the four classified levels as determined by International Classification of Diseases and Current Procedural Terminology. Results Based on the included 6,895,000 mother-infant dyads, the obstetric hospital levels of maternal care I, II, III and IV were identified. High-risk patients more frequently delivered in hospitals with higher level maternal care, accounting for 8.9, 10.9, 13.8, and 16.9% of deliveries in level I, II, III and IV hospitals, respectively. The total number of obstetric hospitals decreased over the study period, while the proportion of hospitals with high-level (level III or IV) maternal care increased. High-level hospitals were located in more densely populated areas. Conclusion Identification of the level of maternal care, independent of hospital self-reported variables, is feasible using administrative data. This empiric approach, which accounts for changes in hospitals over time, is a valuable framework for perinatal researchers and other stakeholders to inexpensively identify measurable benefits of levels of maternal care and characterize where specific patient populations receive care.

BackgroundThe quality of care in labor and delivery is traditionally measured through the Hospital Consumer Assessment of Healthcare Providers and Systems but less is known about the experiences of care reported by patients and caregivers on online sites that are more easily accessed by the public. ObjectiveThe aim of this study was to generate insight into the labor and delivery experience using hospital reviews on Yelp. MethodsWe identified all Yelp reviews of US hospitals posted online from May 2005 to March 2017. We used a machine learning tool, latent Dirichlet allocation, to identify 100 topics or themes within these reviews and used Pearson r to identify statistically significant correlations between topics and high (5-star) and low (1-star) ratings. ResultsA total of 1569 hospitals listed in the American Hospital Association directory had at least one Yelp posting, contributing a total of 41,095 Yelp reviews. Among those hospitals, 919 (59%) had at least one Yelp rating for labor and delivery services (median of 9 reviews), contributing a total of 6523 labor and delivery reviews. Reviews concentrated among 5-star (n=2643, 41%) and 1-star reviews (n=1934, 30%). Themes strongly associated with favorable ratings included the following: top-notch care (r=0.45, P