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Background. The Center for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) recommend influenza vaccination for all pregnant women during the influenza season. However, the actual rate of vaccination is substantially below the target levels. Given the recent emergence of novel influenza strains, there is an important need to address knowledge gaps in women and their healthcare providers to improve vaccination coverage for pregnant women during inter-pandemic and pandemic periods. This study attempted to identify potentially remediable attitudinal factors among women and their physicians that may present barriers to influenza vaccination and then assess the impact of interventions to increase the influenza vaccination rate in pregnant women. Methods. This prospective study initially analyzed patient and physician knowledge regarding the influenza vaccine in pregnancy and then examined the impact of several interventions aimed to increase immunization rates implemented over the following year. Influenza vaccination rates were assessed before and after the interventions. Results. Five hundred twenty patients were enrolled in the study during the influenza season 2007/2008. Only 19%% of those patients reported receiving the influenza vaccination and only 28%% recalled that the vaccine was offered. Following this, in the summer and fall of 2008, we performed a physician education program and distributed posters advertising the influenza vaccine to all offices offering prenatal care in our area in order to increase patient awareness of the need for the vaccine. In the following influenza season, we again reassessed the vaccination rate and patient's knowledge and awareness of the vaccine in 480 postpartum women. Influenza vaccination rates increased from 19%% to 31%%. After the intervention, 51%% of patients recalled that the vaccine was offered to them during the pregnancy as opposed to only 28%% the year prior. Conclusion. Understanding the specific barriers to vaccination that our population faced was helpful in designing the interventions to improve knowledge and acceptance of influenza vaccination in pregnancy, which led to an increased vaccination rates in women. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite the acceptance of protocols for the prevention of group B streptococcal (GBS) sepsis for the newborn, protocol violations, with subsequent failure to initiate intrapartum antibiotic therapy, occur at many institutions. The causes for GBS prophylaxis protocol violations are not well understood. CASES: We report two cases of indicated preterm birth in which appropriate antibiotic prophylaxis for GBS sepsis was not initiated. CONCLUSION: In the setting of indicated preterm birth, GBS prophylaxis may be overlooked. We suspect that the attention given to the medical or fetal complications of indicated preterm birth may contribute to the omission of GBS sepsis prophylaxis in these situations. [ABSTRACT FROM AUTHOR]

We developed and tested a theoretically-based pamphlet entitled 'Influenza in Pregnancy,' specifically designed to increase pregnant women's knowledge, reduce barriers to maternal vaccination, and subsequently improve vaccine uptake. A randomized control trial was conducted on pregnant women (n = 135) at three locations in Connecticut during the 2011-2012 season to evaluate the impact of the patient-centered pamphlet. The women were randomized to one of three groups: the pamphlet; pamphlet/benefit statement (vaccinating the pregnant woman also benefits the young infant); or control. A Chi square analysis compared the intervention with control using the primary outcome of vaccination. A secondary outcome of the perceptions of health beliefs of maternal vaccination were measured through General Linear Model/ANOVA model for repeated measures. Overall 66.9 % (89/133) were vaccinated. Both the pamphlet group 72.9 % (35/48) (χ² = 6.81, df = 1 p = .009), and the pamphlet/benefit statement group 86.1 % (31/36) (χ² = 13.74, df = 1, p < .001), had significantly higher vaccine uptake than the control group 46.9 % (23/49). The potential barrier, perception of vaccine safety (F = 4.973, df = 2, p < .01), and benefit of vaccination to mother and infant (F = 6.690, df = 2, p < .01) significantly improved for the intervention groups compared to control group. The pamphlet significantly increased the pregnant women's perceptions of the safety and benefit of the vaccine, and the overall uptake. [ABSTRACT FROM AUTHOR]

Objectives. We sought to determine the prevalence of group B streptococcus (GBS) colonisation and to characterise antibiotic resistance patterns. Methods. Vaginal and ano-rectal cultures were evaluated for GBS colonisation, and antibiotic susceptibility profiles were determined to 15 antibiotics according to the guidelines of the National Committee for Clinical Laboratory Standards. Results. Our GBS prevalence was 30%. All isolates were sensitive to amoxicillin/clavulanic acid, ampicillin, ampicillin/sulbactam, cefotaxime, ceftriaxone, cefuroxime-sodium, imipenem, linezolid, penicillin G and vancomycin. Thirty-two percent of the isolates were resistant to azithromycin, 21% to clindamycin, 25% to erythromycin and 23% to tetracycline. Conclusions. The relatively high rates of resistance to four of the 15 antibiotics tested confirm that for women allergic to penicillin and colonised with GBS, antibiotic sensitivities should be determined. We noticed increasing resistance to clindamycin over a 7-year period. Ongoing surveillance of local antibiotic resistance patterns at the institutional level is important in determining optimal prophylaxis as resistance patterns differ between institutions and are increasing. [ABSTRACT FROM AUTHOR]

The intermediate polar FO Aquarii (FO Aqr) experienced its first reported low-accretion states in 2016, 2017, and 2018, and, using newly available photographic plates, we identify prediscovery low states in 1965, 1966, and 1974. The primary focus of our analysis, however, is an extensive set of time-series photometry obtained between 2002 and 2018, with particularly intensive coverage of the 2016–2018 low states. After computing an updated spin ephemeris for the white dwarf (WD), we show that its spin period began to increase in 2014 after having spent 27 yr decreasing; no other intermediate polar has experienced a sign change of its period derivative, but FO Aqr has now done so twice. Our central finding is that the recent low states all occurred shortly after the WD began to spin down, even though no low states were reported in the preceding quarter-century, when it was spinning up. Additionally, the system's mode of accretion is extremely sensitive to the mass-transfer rate, with accretion being almost exclusively disk-fed when FO Aqr is brighter than V ∼ 14 and substantially stream-fed when it is not. Even in the low states, a grazing eclipse remains detectable, confirming the presence of a disklike structure (but not necessarily a Keplerian accretion disk). We relate these various observations to theoretical predictions that during the low state, the system's accretion disk dissipates into a non-Keplerian ring of diamagnetic blobs. Finally, a new XMM-Newton observation from a high state in 2017 reveals an anomalously soft X-ray spectrum and diminished X-ray luminosity compared to pre-2016 observations. [ABSTRACT FROM AUTHOR]

The aim of the study was to gain an in-depth understanding of the reasons why pregnant women accept or reject the seasonal influenza vaccine. The qualitative descriptive design used a face-to-face semi-structured interview format. Sixty pregnant and postpartum women at two hospitals in the Northeastern United States participated. Content analysis was the inductive method used to code the data and identify emergent themes. Six themes emerged from the data: differing degrees of influence affect action to vaccinate; two-for-one benefit is a pivotal piece of knowledge that influences future vaccination; fear if I do (vaccinate), fear if I don't; women who verbalize 'no need' for the vaccine also fear the vaccine; a conveniently located venue for vaccination reduces barriers to uptake; H1N1-a benefit and barrier to the seasonal vaccine. Our study supports previous findings and reveals a deeper understanding and interpretation of the behavior and decision-making to accept or reject the influenza vaccine. Understanding the reasons behind the behavior of vaccine rejection gives us the chance to change it. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the previously published article "Professional Liability Payments in Obstetrics and Gynecology," by Dr. Barbieri.