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Introduction: Research suggests that interprofessional education, bringing learners together to learn about, with, and from each other, improves health professions education and can improve health outcomes. Little research has measured outcomes of interprofessional education between midwifery students and obstetrics and gynecology residents. The purpose of this study was to examine self-assessed interprofessional and collaborative competencies among midwifery students and obstetrics and gynecology residents., Methods: Baseline self-assessed interprofessional and collaborative competencies were compared with follow-up measurements to evaluate learners' experiences over an 11-month study period. Participants were midwifery students and obstetrics and gynecology residents who experienced interprofessional learning activities. The Interprofessional Education Collaborative Competency Self-Assessment Survey (IPEC Survey) and Interprofessional Collaborative Competency Attainment Survey (ICCAS) were used., Results: Of 256 learners at 4 demonstration sites, 223 (87%) completed the baseline, and 121 of 237 eligible learners (51%) completed the follow-up surveys. The IPEC Survey total score (t = 2.31, P = .02) and interaction subscale (t = 2.85, P = .005) and ICCAS score (t = 4.04, P = .001) increased for midwifery students but not obstetrics and gynecology residents on the IPEC Survey (t = 0.32, P = .75) and ICCAS (t = -0.05, P = .96) measures. Midwifery students (87%) and residents (57%) reported improved overall ability to collaborate. Learners responding to 3 open-ended questions valued team-based experiences, including learning how to communicate with each other; appreciated learning each other's education and scope of practice; and recommended skills development including uncommon clinical events, case discussions, and direct clinical care., Discussion: This study advanced knowledge about interprofessional education between midwifery students and obstetrics and gynecology residents. Midwifery students improved in self-assessed interprofessional and collaborative competencies. Most learners reported better interprofessional collaboration skills and were positive about future interprofessional learning. This evaluation approach is available for other programs implementing or extending interprofessional education., (© 2022 The Authors. Journal of Midwifery & Women's Health published by Wiley Periodicals LLC on behalf of American College of Nurse Midwives (ACNM).)

Stress urinary incontinence (SUI), a serious condition which affects ~56% of postmenopausal women, is the involuntary leakage of urine through urethra during physical activity that causes an increase in abdominal pressure. SUI is associated with a decrease in compliance and volume of urethral tissue, likely due to a reduced proteoglycan: collagen ratio in the extracellular matrix and collagen disorganization. Here, we investigated the use of biomimetic proteoglycans (BPGs) to molecularly engineer urethral tissue of New Zealand White rabbits to examine biocompatibility in vivo. BPG concentrations of 50 mg/mL (n = 6, 1 week) and 200 mg/mL (n = 6, 1 week and n = 6, 6 weeks) dissolved in 1× phosphate-buffered saline (PBS) were injected transurethrally using a 9 French cystoscope, and were compared to PBS-injected controls (n = 3, 1 week) and non-injected controls (n = 2, 1 week). Urethral compression pressure measurements confirm BPG injections did not modify normal urethral pressure, as intended. Histological assessment demonstrated biological tolerance of BPGs in urethra and no inflammatory response was detected after 1 and 6 weeks compared to non-injected controls. Confocal imaging of fluorescently-labeled BPG injected urethral specimens demonstrated the integration of BPGs into the interstitial connective tissue and confirmed they were still present after 6 weeks. A general decrease of collagen density was exhibited near injection sites which may be due to increased hydration induced by BPGs. Injection of BPGs is a novel approach that demonstrates potential as molecular treatment for SUI and may be able to reverse some of the degenerative tissue changes of individuals affected by this condition. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: 00B: 000-000, 2019. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2409-2418, 2019., (© 2019 Wiley Periodicals, Inc.)

Using a wearable electromyography (EMG) and an accelerometer sensor, classification of subject activity state ( i.e ., walking, sitting, standing, or ankle circles) enables detection of prolonged "negative" activity states in which the calf muscles do not facilitate blood flow return via the deep veins of the leg. By employing machine learning classification on a multi-sensor wearable device, we are able to classify human subject state between "positive" and "negative" activities, and among each activity state, with greater than 95% accuracy. Some negative activity states cannot be accurately discriminated due to their similar presentation from an accelerometer ( i.e ., standing vs . sitting); however, it is desirable to separate these states to better inform the risk of developing a Deep Vein Thrombosis (DVT). Augmentation with a wearable EMG sensor improves separability of these activities by 30%.

Context: As the role of robot-assisted surgery continues to expand, development of standardised and validated training programmes is becoming increasingly important., Objective: To provide guidance on an optimised "train-the-trainer" (TTT) structured educational programme for surgical trainers, in which delegates learn a standardised approach to training candidates in skill acquisition. We aim to describe a TTT course for robotic surgery based on the current published literature and to define the key elements within a TTT course by seeking consensus from an expert committee formed of key opinion leaders in training., Evidence Acquisition: The project was carried out in phases: a systematic review of the current evidence was conducted, a face-to-face meeting was held in Philadelphia, and then an initial survey was created based on the current literature and expert opinion and sent to the committee. Thirty-two experts in training, including clinicians, academics, and industry, contributed to the Delphi process. The Delphi process underwent three rounds of survey in total. Additions to the second- and third-round surveys were formulated based on the answers and comments from the previous rounds. Consensus opinion was defined as ≥80% agreement., Evidence Synthesis: There was 100% consensus that there was a need for a standardized TTT course in robotic surgery. A consensus was reached in multiple areas, including the following: (1) definitions and terminologies, (2) qualifications to attend, (3) course objectives, (4) precourse considerations, (5) requirement of e-learning, (6) theory and course content, and (7) measurement of outcomes and performance level verification. The resulting formulated curriculum showed good internal consistency among experts, with a Cronbach alpha of 0.90., Conclusions: Using the Delphi methodology, we achieved an international consensus among experts to develop and reach content validation for a standardised TTT curriculum for robotic surgery training. This defined content lays the foundation for developing a proficiency-based progression model for trainers in robotic surgery. This TTT curriculum will require further validation., Patient Summary: As the role of robot-assisted surgery continues to expand, development of standardised and validated training programmes is becoming increasingly important. There is currently a lack of high-level evidence on how best to train trainers in robot-assisted surgery. We report a consensus view on a standardised "train-the trainer" curriculum focused on robotic surgery. It was formulated by training experts from the USA and Europe, combining current evidence for training with experts' knowledge of surgical training., (Copyright © 2019 European Association of Urology. All rights reserved.)

Functional neuroimaging studies have implicated regions of both ventrolateral prefrontal cortex (VLPFC) and angular gyrus in processes associated with retrieving goal-relevant information, which increases the fidelity and richness of long-term memory (LTM). To further investigate the roles of these cortical regions as nodes in functional networks with memory regions of the medial temporal lobe (MTL), we used fMRI-guided, 1 Hz repetitive transcranial magnetic stimulation (rTMS) to perturb normal neuronal function. The aim was to test the causal roles of left mid-VLPFC and left angular gyrus (AG) in MTL-VLPFC-parietal networks that have been associated with high-fidelity memory retrieval. rTMS treatments were administered immediately before blocks in an old/new recognition test, which was based on a mnemonic similarity task requiring discrimination of previously studied pictures of common objects. Capability for mnemonic discrimination was evaluated after each of three conditions: placebo control (rTMS at somatosensory cortex), mid-VLPFC target (rTMS at left pars triangularis) and parietal target (rTMS at left AG). The results showed the effect of rTMS perturbation of mid-VLPFC diminished subsequent discrimination-based memory performance, relative to placebo control, and no significant effect of perturbation of AG. These findings show a causal role for functional networks with left mid-VLPFC in high-fidelity retrieval.

Background: Autism spectrum disorder (ASD) affects more than 1% of children in the USA. The male-to-female prevalence ratio of roughly 4:1 in ASD is a well-recognized but poorly understood phenomenon. An explicit focus on potential etiologic pathways consistent with this sex difference, such as those involving prenatal androgen exposure, may help elucidate causes of ASD. Furthermore, the multi-threshold liability model suggests that the genetic mechanisms in females with ASD may be distinct and may modulate ASD risk in families with female ASD in the pedigree., Methods: We examined umbilical cord blood from 137 children in the Early Autism Risk Longitudinal Investigation (EARLI) cohort. EARLI is an ASD-enriched risk cohort with all children having an older sibling already diagnosed with ASD. Fetal testosterone (T), androstenedione (A4), and dehyroepiandrosterone (DHEA) levels were measured in cord blood using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Robust linear regression models were used to determine associations between cord blood androgen levels and 12-month Autism Observation Scales for Infants (AOSI) scores and 36-month Social Responsiveness Scale (SRS) scores adjusting for potential confounders., Results: Increasing androgens were not associated with increasing 12-month AOSI score or 36-month total SRS score in either boys or girls. However, the association between T and autistic traits among subjects with a female older affected sibling was greater at 12 months (test of interaction, P  = 0.008) and deficits in reciprocal social behavior at 36 months were also greater (test of interaction, P  = 0.006) than in subjects whose older affected sibling was male., Conclusions: While increased prenatal testosterone levels were not associated with autistic traits at 12 or 36 months, our findings of a positive association in infants whose older ASD-affected siblings were female suggests an androgen-related mechanism that may be dependent on, or related to, genetic liability factors present more often in families containing female ASD cases. However, this initial finding, based on a small subgroup of our sample, should be interpreted with considerable caution.

Female genital cosmetic surgery is surgery performed on a woman within a normal range of variation of human anatomy. The issues are heightened by a lack of long-term and substantive evidence-based literature, conflict of interest from personal financial gain through performing these procedures, and confusion around macroethical and microethical domains. It is a source of conflict and controversy globally because the benefit and harm of offering these procedures raise concerns about harmful cultural views, education, and social vulnerability of women with regard to both ethics and human rights. The rights issues of who is defining normal female anatomy and function, as well as the economic vulnerability of women globally, bequeath the profession a greater responsibility to ensure that there is adequate health and general education-not just among patients but broadly in society-that there is neither limitation nor interference in the decision being made, and that there are no psychological disorders that could be influencing such choices., (Copyright © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.)

The Institute of Medicine, partnering with national private foundations, has challenged existing approaches to health care delivery and patient safety by suggesting a sweeping redesign of the entire U.S. health care system. This article explores the historical and philosophic imperative to change health care education to a seamless transdisciplinary model to foster interprofessional communication and collaboration during the formative training years. To improve patient safety and quality of care and reduce medical error, students in health care disciplines will need to be educated together to practice together effectively., (Copyright © 2012 Elsevier Inc. All rights reserved.)

The American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives (ACNM) asked ACNM member midwives and ACOG Fellows with successful and sustainable collaborative practices between obstetricians and midwives to describe their care models in jointly written articles. This review analyzes 12 of the 60 articles submitted. Five main themes were identified: impetus for new collaboration, basic foundations of collaborative care, commitment to successful partnership, care integration, and health professions education in an interprofessional practice environment. The analysis provides evidence of the extent to which committed clinicians are working together to provide excellent, women-centered maternity care., (Copyright © 2012. Published by Elsevier Inc.)

Background: Little is known about factors contributing to nursing home-associated infections (NHAIs). We conducted a survey of residents in 133 Department of Veterans Affairs community living centers to determine the roles of indwelling device use, bed locations, and treatment codes on NHAIs., Methods: A Web-based point prevalence survey of NHAIs using modified Centers for Disease Control and Prevention definitions for health care-associated infections was conducted on November 14, 2007., Results: Among 10,939 residents, 575 had at least one NHAI, for a point prevalence rate of 5.3%. Urinary tract infection, skin infection, asymptomatic bacteriuria, and pneumonia were the most prevalent NHAIs. A total of 2687 residents had one or more indwelling devices; 290 of these also had an NHAI, for a prevalence of 10.8%. In contrast, the prevalence of NHAIs in residents without indwelling devices was 3.5% (P < .0001). Indwelling urinary catheters, percutaneous gastrostomy tubes, peripherally inserted central catheters, and suprapubic urinary catheters were the most commonly used devices. There were 4027 residents in designated units and 6912 residents in dispersed units. The rate of device use was 21.4% in the designated units and 26.4% in the dispersed units (P < .0001). The prevalence of NHAIs was 4.5% in the designated units and 5.7% in the dispersed units (P < .001). Rates of NHAIs and device use varied greatly among the various treatment codes; however, there was a positive correlation between the rates of NHAIs and device use. Stepwise logistic regression analysis of data from long-stay and short-stay skilled nursing care residents revealed that only the presence of an indwelling device, not length of stay or bed location, affected the rate of NHAIs., Conclusion: Indwelling device use, but not bed location or treatment code, was found to be associated with increased rate of NHAIs., (Copyright 2010. Published by Mosby, Inc.)

Objective: To explore knowledge of Human Papillomavirus (HPV) and cervical cancer, health beliefs, and preventative practices in women 40 to 70 years., Design: Cross-sectional descriptive., Setting: Three urban ambulatory Obstetrics and Gynecology offices connected with a teaching hospital's Department of Obstetrics and Gynecology in the Mid-Atlantic section of the United States., Participants: A convenience sample of 149 women age 40 to 70., Methods: To assess HPV and cervical cancer knowledge, health beliefs, and preventative practices a self-administered survey, the Awareness of HPV and Cervical Cancer Questionnaire was distributed to women as they waited for their well-woman gynecologic exam., Results: The mean knowledge score was 7.39 (SD=3.42) out of 15. One third of the questions about the relationship of HPV and risks for cervical cancer were answered incorrectly by more than 75% of these women. Although most appreciate the seriousness of cervical cancer, they believed themselves not particularly susceptible., Conclusion: There is a need for HPV and cervical cancer awareness and education for women older than age 40. Women's health care professionals are well positioned to act as a catalyst to improve HPV and cervical cancer knowledge, health beliefs, and preventative practice to ensure optimum health promotion for all women.

Background: The Department of Veterans Affairs (VA) is the largest single provider of long-term care in the United States. The prevalence of nursing home-associated infections (NHAIs) among residents of VA nursing home care units (NHCUs) is not known., Methods: A Web-based point prevalence survey of NHAIs using modified Centers for Disease Control and Prevention definitions for health care-associated infections was conducted in the VA's 133 NHCUs on November 9, 2005., Results: From a total population of 11,475 NHCU residents, 591 had at least 1 NHAI for a point prevalence rate of 5.2%. Urinary tract infection, asymptomatic bacteriuria, pneumonia, skin infection, gastroenteritis, and soft tissue infection were most prevalent, constituting 72% of all NHAIs. A total of 2817 residents (24.5%) had 1 or more indwelling device. Of these 2817 residents with an indwelling device(s), 309 (11.0%) had 1 or more NHAI. In contrast, the prevalence of NHAIs in residents without an indwelling device was 3.3%. Indwelling urinary catheter, percutaneous gastrostomy tube, intravenous peripheral line, peripherally inserted central catheter, and suprapubic urinary catheter were most common, accounting for 79.3% of all devices used., Conclusion: There are effective infection surveillance and control programs in VA NHCUs with a point prevalence of NHAIs of 5.2%.

A survey was conducted to assess the capacity and current practices of the infection surveillance and control programs at the Department of Veterans Affairs' 130 nursing home care units (VA NHCUs) covering a total of 15,006 beds in 2003. All 130 VA NHCUs responded to the survey, although not all NHCUs answered every question. The majority of the VA NHCUs provided specialized services that might pose increased risks of infection. For every 8 to 10 VA NHCU beds, there was 1 regular-pressure or negative-pressure infection control room available. Each VA NHCU had an active ongoing infection surveillance and control program managed by highly educated infection control personnel (ICP), of which 96% had a minimum of a bachelor degree. A median of 12 hours per week of these ICP efforts was devoted to the infection surveillance and control activities. The most frequently used surveillance methods were targeted surveillance for specific infections and for specific organisms. Most VA NHCUs conducted surveillance for antibiotic-resistant organisms. However, VA NHCUs did not use a uniform set of definitions for nosocomial infections for their infection surveillance and control purposes. We conclude that VA NHCUs have a considerable infrastructure and capacity for infection surveillance and control. This information can be used to develop a nationwide VA NHCU nosocomial infection surveillance system.

We sought to determine the sensitivity of maternal history as a predictor of varicella immune status during pregnancy. A total of 514 women were prospectively questioned about history of varicella infection at the time of their first prenatal visit. Eighty-one patients who gave either negative or uncertain histories of prior infection had blood drawn and analyzed for presence of varicella antibodies. Women with negative histories had a significantly lower rate of serologic varicella immunity than women with uncertain histories (46.9% vs 93.8%, p < 0.001); these women were also significantly younger than those with either uncertain or positive histories. Patient payer status and number of children were also analyzed; neither was significantly associated with varicella seropositivity. The certainty of a pregnant woman's varicella infection history was the strongest single predictor of her actual immune status. These results should be helpful both for patient counseling and for possible development of prenatal varicella screening protocols.

We report the first known case of chronic, massive fetomaternal hemorrhage managed by serial fetal intravascular transfusions. Timing of transfusions was guided by fetal heart rate patterns and fetal movement evaluation. Despite severe anemia and a sinusoidal heart rate pattern, the fetus demonstrated normal blood gases and no sign of hydrops.

The preventative effect of low-dose aspirin in the development of stress ulcer induced by cold restraint were examined in Sprague-Dawley rats. The bleeding and ulceration scores in the control group were 2.14 and 13.50, respectively. The bleeding score in the 1 mg/kg aspirin group was 1.32 and the ulceration score was 6.89. The scores in 50 mg/kg aspirin group were 2.86 and 38.74, respectively. A significant decrease of ulceration in low-dose aspirin and significant increase in high-dose aspirin were demonstrated. A significant decrease in gastric acid secretion in the low-dose aspirin group was recognized. However, the inhibition of platelet aggregation induced by low-dose aspirin was thought to play a major role in the prevention of stress ulcer.

The methods of daily routine analysis of urinary stones in one laboratory, employing a combination of microscopy, spectroscopy, chemistry, and X-ray diffractometry, are described. A methodologic study indicates that these methods are complementary and no one method is sufficient. Quantitative estimates are in general best obtained by X-ray diffraction, whereas qualitative identification of depositional sequence and the quantitative determination of minor constituents must depend on microscopic and chemical methods. Components at a concentration of 1 per cent may be identified whereas those in excess of 5 per cent are rarely overlooked. Concentrations are correct within +/- 10 per cent of stone mass.