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The U.S. Supreme Court's Dobbs v. Jackson Women's Health Organization decision on June 24, 2022 effectively overturned federal constitutional protections for abortion that have existed since 1973 and returned jurisdiction to the states. Several states implemented abortion bans, some of which banned abortion after 6 weeks and others that permit abortion under limited exceptions, such as if the health or the life of the woman is in danger. Other states introduced bills that define life as beginning at fertilization. As a result of these new and proposed laws, the future availability of mifepristone, one of two drugs used for medical abortion in the United States, has become the topic of intense debate and speculation.Although its safety and effectiveness has been confirmed by many studies, the use of mifepristone has been politicized regularly since its approval. Areas of future study include mifepristone for induction termination and fetal demise in the third trimester and the management of leiomyoma.PubMed, Society of Family Planning, American College of Obstetricians and Gynecologists, the World Health Organization.The use of no-touch medical abortion, which entails providing a medical abortion via a telehealth platform without a screening ultrasound or bloodwork, expanded during the COVID-19 pandemic, and studies have confirmed its safety. With the Dobbs decision, legal abortion will be less accessible and, consequently, self-managed abortion with mifepristone and misoprostol will become more prevalent.Mifepristone and misoprostol are extremely safe medications with many applications. In the current changing political climate, physicians and pregnancy-capable individuals must have access to these medications.

Anger is an emotional state that occurs when unexpected things happen to or around oneself and is “an emotional state that varies in intensity from mild irritation to intense fury and rage.” It is defined as “a strong feeling of displeasure and usually of antagonism,” an emotion characterized by tension and hostility arising from frustration, real or imagined injury by another, or perceived injustice. It can manifest itself in behaviors designed to remove the object of the anger (e.g., determined action) or behaviors designed merely to express the emotion. For the Roman philosopher Seneca anger is not an uncontrollable, impulsive, or instinctive reaction. It is, rather, the cognitive assent that such initial reactions to the offending action or words are in fact unjustified. It is, rather, the cognitive assent that such initial reactions to the offending action or words are in fact unjustified. It seems that the year 2022 was a year when many Americans were plainly angry. “Why is everyone so angry?” the New York Times asked in the article “The Year We Lost It.” We believe that Seneca is correct in that anger is unacceptable. Anger is a negative emotion that must be controlled, and Seneca provides us with the tools to avoid and destroy anger. Health care professionals will be more effective, content, and happier if they learn more about Seneca’s writings about anger and implement his wisdom on anger from over 2000 years ago.

On 24 June 2022, the US Supreme Court overturned Roe v. Wade, a 49-year-old precedent that provided federal constitutional protection for abortions up to the point of foetal viability, returning jurisdiction to the individual states. Restrictions that came into effect automatically in several states, and are anticipated in others, will severely limit access to abortions in approximately half of the US. Even though every state allows for exceptions to the abortion bans, in some instances these exceptions can be used to preserve the health of a pregnant patient, while in other instances, only to preserve their life. The vague and confusing nature of the abortion ban exceptions threatens to compromise the standard of care for patients with pregnancy complications that are distinct from abortions, such as nonviable pregnancies, miscarriages, and ectopic pregnancies. Additionally, we envision challenges for the treatment of women with certain autoimmune conditions, pregnant cancer patients, and patients contemplating preimplantation genetic diagnosis as part of assisted reproductive technologies. The abortion ban exceptions will impact and interfere with the medical care of pregnant and non-pregnant patient populations alike and are poised to create a medical and public health crisis unlike any other one from the recent past.

One of the immediate consequences of Covid-19 is that educational institutions all over the world had to make a rapid transition from frontal classroom learning to distance learning. The present study focuses on higher education and examines the implications of the transition from in-class learning to learning via the Zoom platform in an academic institute of engineering. Specifically, we focus on how the transition affected interpersonal communication. We examined the manifestation of the four media richness theory (MRT) dimensions as reported in the subjective evaluations of the lecturers and students. We gathered information from various formal and informal oral and textual sources and found that shifting away from in-class learning was detrimental to all four dimensions of interpersonal communication. Using Te’eni’s cognitive-affective model of communication, we examined whether successful educators used communication strategies to overcome potential harm to the learning process. We found a diverse use of six communication strategies to maintain mutual understanding and positive emotions. We recommend that educators apply these communicational strategies to compensate for the forced distance from the richest media, thus promoting a high level of effective learning in cognitive and affective terms. © 2021 The Author(s). Published with license by Taylor & Francis Group, LLC.

This study addresses the effectiveness of learning via educational software. Recent decades have seen the integration of technologies, which are changing teaching and transforming teachers into mediating, facilitating, and guiding figures by means of digital learning methods that serve as a major tool in schools, colleges, and universities. The current study focuses on instruction provided within the Israeli Air Force and examined the effectiveness of instruction provided via educational software in terms of learning products: Bloom’s revised taxonomy, Te’eni’s affective-cognitive model of organizational communication and the STEM model. We randomly divided the learners into three groups who studied the same topic: one group studied with the educational software only, the second with the educational software together with an instructor, and the third with an instructor who used a presentation. The learners took a test and four months later they took another test to examine the effectiveness of the instruction over time. The research results show that the recall levels and performance levels on the tests were almost identical in all groups, but in the categories of understanding and applying the addition of an instructor strongly contributed to achievements: Those who received instruction via educational software achieved the best results in the understanding category, while those who studied with an instructor who used a presentation achieved the best results on the test with regard to application of the studied material. The findings of this study can illuminate the effectiveness of using educational software in learning processes in all educational systems.

To identify specific characteristics of women diagnosed with gestational diabetes who failed to achieve good glycemic control by lifestyle modifications only. Retrospective analysis of women carrying a singleton pregnancy diagnosed with gestational diabetes. The cohort included 314 women who achieved good glycemic control by lifestyle modifications and 328 women who required anti-diabetic medications. Lifestyle modifications included medical nutrition therapy and physical exercise recommendations. Anti-diabetic medications included either oral treatment with metformin or glyburide and\or insulin. Women in the lifestyle modifications group were younger (32.87 vs. 33.79 years, p = 0.012) and had lower pre-pregnancy body-mass-index (25.86 vs. 27.93 kg/m2, p

Births in freestanding birth centers have more than doubled between 2007 and 2019. Although birthing centers, which are defined by the American College of Obstetricians and Gynecologists as ". . . freestanding facilities that are not hospitals," are being promoted as offering women fewer interventions than hospitals, there are limited recent data available on neonatal outcomes in these settings.To compare several important measures of neonatal safety between 2 United States birth settings and birth attendants: deliveries in freestanding birth centers and hospital deliveries by midwives and physicians.This is a retrospective cohort study using the United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, and Division of Vital Statistics natality online database for the years 2016 to 2019. All term, singleton, low-risk births were eligible for inclusion. The study outcomes were several neonatal outcomes including neonatal death, neonatal seizures, 5-minute Apgar scores of4 and7, and neonatal death in nulliparous and in multiparous women. Outcomes were compared between the following 3 groups: births in freestanding birth centers, in-hospital births by a physician, and in-hospital births by a midwife. The prevalence of each neonatal outcome among the different groups was compared using Pearson chi-squared test, with the in-hospital midwife births being the reference group. Multivariate logistic regression models were performed to account for several potential confounding factors such as maternal prepregnancy body mass index, maternal weight gain, parity, gestational weeks, and neonatal birthweight and calculated as adjusted odds ratio.The study population consisted of 9,894,978 births; 8,689,467 births (87.82%) were in-hospital births by MDs and DOs, 1,131,398 (11.43%) were in-hospital births by midwives, and 74,113 (0.75%) were births in freestanding birth centers. Freestanding birth center deliveries were less likely to be to non-Hispanic Black or Hispanic, less likely to women with public insurance, less likely to be women with their first pregnancy, and more likely to be women with advanced education and to have pregnancies at ≥40 weeks' gestation. Births in freestanding birth center had a 4-fold increase in neonatal deaths (3.64 vs 0.95 per 10,000 births: adjusted odds ratio, 4.00; 95% confidence interval, 2.62-6.1), a more than 7-fold increase in neonatal deaths for nulliparous patients (6.8 vs 0.92 per 10,000 births: adjusted odds ratio, 7.7; 95% confidence interval, 4.42-13.76), a more than 2-fold increase in neonatal seizures (3.91 vs 1.94 per 10,000 births: adjusted odds ratio, 2.19; 95% confidence interval, 1.48-3.22), and a more than 7-fold increase of a 5-minute Apgar score of4 (194.84 vs 28.5 per 10,000 births: adjusted odds ratio, 7.46; 95% confidence interval, 7-7.95). Compared with hospital midwife deliveries, hospital physician deliveries had significantly higher adverse neonatal outcomes (P0.001).Births in United States freestanding birth centers are associated with an increased risk of adverse neonatal outcomes such as neonatal deaths, seizures, and low 5-minute Apgar scores. Therefore, when counseling women about the location of birth, it should be conveyed that births in freestanding birth centers are not among the safest birth settings for neonates compared with hospital births attended by either midwives or physicians.

(1) Background: Social distancing became a central strategy employed to limit the spread of the SARS-CoV-2 virus. We explore self-reported adherence (SRA) and factors associated with SRA among Israeli adults at the end of the first national lockdown in Israel. (2) Methods: We conducted a cross-sectional consumer panel survey of 820 Israeli adults aged 18 to 70 in May and June 2020. We collected data on the SRA to the social distancing measures, sociodemographic variables, perceptions of pandemic-related danger and of protection provided by the social distancing measures, as well as Sense of Coherence (SoC). (3) Results: 60% of respondents reported complying with 7 measures. Higher SoC was associated with higher SRA (p = 0.04), and was related to income, marital status, age, profession, and education. The SRA was higher among Jews than Arabs (Jews: Mean = 10.5, SD = 4.5; Arabs: Mean = 9.1, SD = 4.1, p < 0.001) and among males (Males: Mean = 10.8, SD = 4.7; Females: Mean = 9, SD = 4.1; p = 0.003). SoC, perception of protection and perception of danger were associated with higher SRA (p = 0.42, p < 0.001 and p = 0.005 respectively). Single people reported higher levels of SRA than people in relationships (Partnered: Mean = 9.7, SD = 4.2, Non-partnered: Mean = 10.9, SD = 4.7, p = 0.033). (4) Conclusions: At the time of exit from the first lockdown, compliance with social distancing measures was high, with Jewish, single and male Israelis more likely to adhere to the guidelines. We identified the populations at risk for non-adherence and associated factors, reporting for the first time the correlation between SoC and SRA. Further research is needed to assess the role of these factors in Jewish and Arab populations.

The COVID-19 pandemic has abruptly affected every aspect of people's daily lives worldwide. Just like every other area, the medical field has been dramatically impacted by the need to care for a large number of patients while at the same time protecting staff, patients, and their families. Changes in the wake of the pandemic called for the prompt and extensive rechanneling and re-organization of resources. The pandemic has opened challenges and concerns for patient safety, starting with the early recognition that individuals, including medical staff, may spread the virus during the asymptomatic phase. Many healthcare facilities faced resource-limited settings, including challenges in the availability of personal protective equipment for healthcare providers. Additionally, the pandemic has disrupted medical education, both at the undergraduate and at the graduate levels, and according to many predictions, its effects may forever transform the ways medical education is delivered. In this chapter, we are exploring the history of medical education, describe changes in medical education experienced during the COVID-19 pandemic, and predict some of the considerations worth taking into account when envisioning the future of medical education.

The development of coronavirus disease 2019 vaccines in the current and planned clinical trials is essential for the success of a public health response. This paper focuses on how physicians should implement the results of these clinical trials when counseling patients who are pregnant, planning to become pregnant, breastfeeding or planning to breastfeed about vaccines with government authorization for clinical use. Determining the most effective approach to counsel patients about coronavirus disease 2019 vaccination is challenging. We address the professionally responsible counseling of 3 groups of patients-those who are pregnant, those planning to become pregnant, and those breastfeeding or planning to breastfeed. We begin with an evidence-based account of the following 5 major challenges: the limited evidence base, the documented increased risk for severe disease among pregnant coronavirus disease 2019-infected patients, conflicting guidance from government agencies and professional associations, false information about coronavirus disease 2019 vaccines, and maternal mistrust and vaccine hesitancy. We subsequently provide evidence-based, ethically justified, practical guidance for meeting these challenges in the professionally responsible counseling of patients about coronavirus disease 2019 vaccination. To guide the professionally responsible counseling of patients who are pregnant, planning to become pregnant, and breastfeeding or planning to breastfeed, we explain how obstetrician-gynecologists should evaluate the current clinical information, why a recommendation of coronavirus disease 2019 vaccination should be made, and how this assessment should be presented to patients during the informed consent process with the goal of empowering them to make informed decisions. We also present a proactive account of how to respond when patients refuse the recommended vaccination, including the elements of the legal obligation of informed refusal and the ethical obligation to ask patients to reconsider. During this process, the physician should be alert to vaccine hesitancy, ask patients to express their hesitation and reasons for it, and respectfully address them. In contrast to the conflicting guidance from government agencies and professional associations, evidence-based professional ethics in obstetrics and gynecology provides unequivocal and clear guidance: Physicians should recommend coronavirus disease 2019 vaccination to patients who are pregnant, planning to become pregnant, and breastfeeding or planning to breastfeed. To prevent widening of the health inequities, build trust in the health benefits of vaccination, and encourage coronavirus disease 2019 vaccine and treatment uptake, in addition to recommending coronavirus disease 2019 vaccinations, physicians should engage with communities to tailor strategies to overcome mistrust and deliver evidence-based information, robust educational campaigns, and novel approaches to immunization.

BACKGROUND Noncommunicable diseases (NCDs) are the leading global health problem in this century and are the principal causes of death and health care spending worldwide. Mobile health (mHealth) apps can help manage and prevent NCDs if people are willing to use them as supportive tools. Still, many people are reluctant to adopt these technologies. Implementing new apps could result in earlier intervention for many health conditions, preventing more serious complications. OBJECTIVE This research project aimed to test the factors that facilitate the adoption of mHealth apps by users with NCDs. We focused on determining, first, what user interface (UI) qualities and complexity levels appeal to users in evaluating mHealth apps. We also wanted to determine whether people prefer that the data collected by an mHealth app be analyzed using a physician or an artificial intelligence (AI) algorithm. The contribution of this work is both theoretical and practical. We examined users’ considerations when adopting mHealth apps that promote healthy lifestyles and helped them manage their NCDs. Our results can also help direct mHealth app UI designers to focus on the most appealing aspects of our findings. METHODS A total of 347 respondents volunteered to rate 3 models of mHealth apps based on 16 items that measured instrumentality, aesthetics, and symbolism. Respondents rated each model after reading 1 of 2 different scenarios. In one scenario, a physician analyzed the data, whereas, in the other, the data were analyzed by an AI algorithm. These scenarios tested the degree of trust people placed in AI algorithms versus the “human touch” of a human physician regarding analyzing data collected by an mHealth app. RESULTS As shown by the responses, the involvement of a human physician in the application had a significant effect (PP=.03). CONCLUSIONS Generally, when participants found a human touch in the mHealth app (connection to a human physician who they assumed would analyze their data), they judged the app more favorably. Simple models were evaluated more positively than complex ones, and aesthetics and symbolism were salient predictors of preference. These trends suggest that designers and developers of mHealth apps should keep the designs simple and pay special attention to aesthetics and symbolic value.

The COVID-19 pandemic has abruptly affected every aspect of people's daily lives worldwide. Just like every other area, the medical field has been dramatically impacted by the need to care for a large number of patients while at the same time protecting staff, patients, and their families. Changes in the wake of the pandemic called for the prompt and extensive rechanneling and re-organization of resources. The pandemic has opened challenges and concerns for patient safety, starting with the early recognition that individuals, including medical staff, may spread the virus during the asymptomatic phase. Many healthcare facilities faced resource-limited settings, including challenges in the availability of personal protective equipment for healthcare providers. Additionally, the pandemic has disrupted medical education, both at the undergraduate and at the graduate levels, and according to many predictions, its effects may forever transform the ways medical education is delivered. In this chapter, we are exploring the history of medical education, describe changes in medical education experienced during the COVID-19 pandemic, and predict some of the considerations worth taking into account when envisioning the future of medical education.

Robotic assistance in laparoscopy has increasingly been adopted for many surgical procedures; and as a result, in recent years, robotic-assisted laparoscopic hysterectomy has seen more acceptance for both benign and malignant gynecologic diseases. The approach is safe and feasible and has been facilitated by advances in both operative and equipment techniques. For women with endometrial cancer, robotic approaches facilitate the completion of minimally invasive hysterectomy and have been associated with improved outcomes compared to open surgery. In comparison with vaginal or abdominal hysterectomy, some of the advantages of minimally invasive surgical techniques include less pain, a shorter hospital stay, a lower risk of infection, less blood loss, and superior cosmetic results. However, the use of robotic devices is associated with significant increases in costs and investment in educational resources.

Background Noncommunicable diseases (NCDs) are the leading global health problem in this century and are the principal causes of death and health care spending worldwide. Mobile health (mHealth) apps can help manage and prevent NCDs if people are willing to use them as supportive tools. Still, many people are reluctant to adopt these technologies. Implementing new apps could result in earlier intervention for many health conditions, preventing more serious complications. Objective This research project aimed to test the factors that facilitate the adoption of mHealth apps by users with NCDs. We focused on determining, first, what user interface (UI) qualities and complexity levels appeal to users in evaluating mHealth apps. We also wanted to determine whether people prefer that the data collected by an mHealth app be analyzed using a physician or an artificial intelligence (AI) algorithm. The contribution of this work is both theoretical and practical. We examined users’ considerations when adopting mHealth apps that promote healthy lifestyles and helped them manage their NCDs. Our results can also help direct mHealth app UI designers to focus on the most appealing aspects of our findings. Methods A total of 347 respondents volunteered to rate 3 models of mHealth apps based on 16 items that measured instrumentality, aesthetics, and symbolism. Respondents rated each model after reading 1 of 2 different scenarios. In one scenario, a physician analyzed the data, whereas, in the other, the data were analyzed by an AI algorithm. These scenarios tested the degree of trust people placed in AI algorithms versus the “human touch” of a human physician regarding analyzing data collected by an mHealth app. Results As shown by the responses, the involvement of a human physician in the application had a significant effect (P Conclusions Generally, when participants found a human touch in the mHealth app (connection to a human physician who they assumed would analyze their data), they judged the app more favorably. Simple models were evaluated more positively than complex ones, and aesthetics and symbolism were salient predictors of preference. These trends suggest that designers and developers of mHealth apps should keep the designs simple and pay special attention to aesthetics and symbolic value.

The coronavirus disease 2019 (COVID-19) pandemic has placed great demands on many hospitals to maximize their capacity to care for affected patients. The requirement to reassign space has created challenges for obstetric services. We describe the nature of that challenge for an obstetric service in New York City. This experience raised an ethical challenge: whether it would be consistent with professional integrity to respond to a public health emergency with a plan for obstetric services that would create an increased risk of rare maternal mortality. We answered this question using the conceptual tools of professional ethics in obstetrics, especially the professional virtue of integrity. A public health emergency requires frameshifting from an individual-patient perspective to a population-based perspective. We show that an individual-patient-based, beneficence-based deliberative clinical judgment is not an adequate basis for organizational policy in response to a public health emergency. Instead, physicians, especially those in leadership positions, must frameshift to population-based clinical ethical judgment that focuses on reduction of mortality as much as possible in the entire population of patients served by a healthcare organization.

(A leading cause of several nontransmissible chronic medical conditions and of disability-adjusted life years globally, overweight and obesity have reached pandemic proportions. Their worldwide trend is compounded by the existence of marked social, ethnic, and environmental disparities and by an incomplete understanding of the most helpful and effective interventions that could control or reverse the course of the pandemic. To a great extent, these challenges stem from the contribution of many individual, socioeconomic, nutritional, and environmental factors that determine the risk of obesity and overweight and shape the disparities. This chapter provides a glimpse into a few of these factors; there are many more, and some of them were perhaps not even identified yet. If we contemplate these factors as a group, one of their most salient features is their diversity. Racism and discrimination, social capital, food environments, social networks, access to recreational facilities, and exposure to obesogens are the topics that historically belonged to distinct disciplines yet are now merging into an intricate and dynamic interdisciplinary and cross-disciplinary network of acute medical, public health, and economic relevance. Adding to the present impact of the pandemic, emerging evidence points toward the potential of some of the contributing factors to exert transgenerational effects, indicating that in all likelihood, we have only witnessed the tip of the iceberg for what is increasingly being recognized as one of the biggest medical and public health challenges of our time.

This study involves e-learning skills via educational software, compared to instruction via educational software with the mediation of an instructor. In the last two decades, the role of the teacher-lecturer has changed, from teaching to guidance and instruction. The technological tools have changed the nature of the learning space and the manner in which the teacher interacts with his students. Educational software is a collection of digital pages, packaged as a learning unit, and is a common tool for delivering self-instruction in academia on a range of issues. This is despite the fact that the effectiveness of this tool in academia has not yet been tested. In addition, the educational software is a technological tool but it is not being updated regularly, therefore the development of the topics in educational software is low. The key motif of technological advancement is to enable constant updates, and therefore, the effectiveness of this learning tool, which has the potential of countering the need for the dynamics of content transfer with its static nature, must be examined. The current study aims to examine the use of this tool in teaching and instruction, and to examine the ways to bridge over this gap of a "static" tool and a "dynamic" learning world. The study focuses on a case study in the Israeli Air Force and integrates instruction with technologies means. We have looked into the skills of e-learning through educational software, as well as the contribution of the instructor to the teaching process. The study's literature reveals that e-learning focuses on the cognitive aspect of learning and on the knowledge of the instruction field. Yet there are studies that engage in reinforcing the in-person communication, meaning, the significance of a “face-to-face” encounter between the student and his instructor. We examined the probability and the extent of the added value of the teacher/instructor in e-learning through educational software. An examination of e-learning through educational software is conducted by a test that consists of questions broken down into levels according to the STEM Model. The findings of the study demonstrate the contribution of educational software as a means of instruction, when it is combined with an in-person encounters between the students and their instructor. We found that combining the in-person meetings with the educational software practice has vastly improved the motivation of the technicians in training, their learning experience and the learner’s ability to understand the learning material.The results of our study shed a spotlight on the instruction, which are a major part of the teaching process in general, as well as the use of educational software as a relevant and applicable mean in the training process in particular. The case study, conducted in the Israeli Air Force, which guides the training processes that are held in the army, is the first case study of its kind, which tracks the use of educational software as a means of instructional work. Our assumption is that training work using educational software has a high influence in the context of teaching and training in different and diverse institutions and organizations, such as in academia.

Ovarian cysts and specifically ovarian teratomas are a common finding in young patients. These cysts display histological cell types from all three cells lines: endodermal, ectodermal and mesodermal origins. A 22-year-old woman who displayed classic signs of cortisol excess – excessive weight gain, difficultly losing weight and abdominal striae – was found to have a 10 cm mature teratoma cyst. This patient presented with ovarian torsion, a common complication of ovarian cysts, and was treated surgically. Pathology was significant for an ovarian teratoma with pituitary secreting cells, most significantly cells secreting adrenocorticotropic hormone (ACTH)., Highlights • Ovarian torsion is a common gynecologic emergency occurring with a variety of ovarian cysts. • Ovarian dermoid cysts are benign mature cystic teratomas that are composed of ectodermal, endodermal and mesodermal elements. • Rarely these dermoid tumors will secrete hormones. • Pituitary cells within an ovarian dermoid can increase systemic adrenocorticotropic hormone (ACTH) levels. • ACTH-secreting ovarian dermoid cysts can cause a Cushing-like syndrome.

This paper describes the design of a prototype for an emotionally enhanced computer mediated communication system which is aimed at compensating for the emotional distance between communicators. The prototype system encourages the sender to take the emotional perspective of the message receiver by giving the sender a sense of how his message may affect the intended receiver, and by allowing the sender to reconsider sending the message or revise it. The objective of an emotionally enhanced communication system is to raise awareness to the ease in which a written word might be misinterpreted since emotions are too often unseen due to the nature of lean communication media. In order to show the receiver’s assumed emotion, the written text would be parsed before sending the message. An algorithm, for demonstrating the prediction of the emotion a written message might evoke, will choose a facial expression from a pool of 7 expressions, according to the words and phrases inserted in the message. We conducted a user test to evaluate the acceptance and attitudes toward such an emotionally enhanced communication system and received a high level of acceptance and favorable attitudes towards using it.

To evaluate the yield of work-up in intrauterine growth restriction (IUGR) pregnancies and their outcomes.Retrospective data regarding prenatal work-up (serology, genetic testing and imaging), and neonatal outcomes of 198 IUGR pregnancies (estimated fetal weight10th percentile) were analyzed.IUGR was isolated in 72 cases. Work-up performed in 158 (80%) cases was positive in 4 (2.5%). No abnormalities were detected in prenatal genetic testing. Echocardiogram performed in 27 cases was abnormal in 3 (11.1%). Serological testing performed in 150 pregnancies (75.8%) detected 1 case (0.7%) of cytomegalovirus (CMV) infection. Thirteen neonates (6.5%) were diagnosed with significant health problems. A positive work-up and significant postnatal health problems were not correlated with IUGR severity, symmetry or additional concurrent findings.The yield of IUGR work-up is not clear and is probably highest for fetal echocardiography. The rate of significant adverse outcomes after birth is increased in IUGR pregnancies.

Research problem: Adding contextual information to a core message has been shown to be critical in improving communication quality, especially in computer mediated communication. This paper models how people contextualize messages in the face of changing communication complexity. Research question: Can changes in communication complexity that occur during the communication process explain and predict contextualization? Literature review: Theories of human communication and studies of computer supported collaboration suggest that communication complexity reflects potentially problematic conditions resulting from 1) the difference in perspective and context held by the collaborators; 2) the incompatibility between the message representation and the way it is interpreted and used by the receiver; and 3) the intensity of information exchanged between communicators. We use this definition as a basis of for developing a measure of cognitive communication complexity. The literature further suggests that higher communication complexity induces higher contextualization. Methodology: First, we conducted a pilot study to develop and validate measures of communication complexity. Second, we conducted a laboratory experiment, in which 258 participants working in pairs collaborated on a sixteen-step assembly task. They used a tailored system that structured each message as core (the essence of the message) and context (additional information that explains the core and the sender's perspective). We used unbalanced panel data analysis to examine the repeated measures of contextualization and communication complexity associated with each step of the task. Results and discussion: We found that collaborators respond to changes in communication complexity at the expense of higher collaborative effort. We offer a cost-benefit framework in which, at the step level, people contextualize to reduce the communication complexity, and at the task level, they additionally consider the impact of contextualization on task performance. The main limitation of this study was the need to structure the communication between collaborators, to control and measure contextualization. Future research can adapt and extend our measure of communication complexity to less structured communication.

We apply a pedagogic approach named learning from errors (LFE) to the area of relational database modeling. Database modeling is a complex cognitive process characterized by a high level of element interactivity. Finding an appropriate pedagogy to teach database modeling is a challenge for information systems educators. One of the challenges that practitioners meet is the need to help database students shift between different levels of abstraction. We metaphorically treat the LFE approach as a bridge over the gulf of abstraction levels. Errors have a powerful potential in education, to encourage students to move to a deeper processing level of the course material. We use Rasmussen’s three levels of human performance model to explain and demonstrate the promising potential of the LFE approach in database modeling.