Objective
To compare outcomes before and after implementation of medical abortion (termination of pregnancy) without ultrasound via telemedicine.
Design
Cohort analysis.
Setting
The three main ...abortion providers.
Population or sample
Medical abortions at home at ≤69 days’ gestation in two cohorts: traditional model (in‐person with ultrasound, n = 22 158) from January to March 2020 versus telemedicine‐hybrid model (either in person or via telemedicine without ultrasound, n = 29 984, of whom 18 435 had no‐test telemedicine) between April and June 2020. Sample (n = 52 142) comprises 85% of all medical abortions provided nationally.
Methods
Data from electronic records and incident databases were used to compare outcomes between cohorts, adjusted for baseline differences.
Main outcome measures
Treatment success, serious adverse events, waiting times, gestation at treatment, acceptability.
Results
Mean waiting time from referral to treatment was 4.2 days shorter in the telemedicine‐hybrid model and more abortions were provided at ≤6 weeks’ gestation (40% versus 25%, P < 0.001). Treatment success (98.8% versus 98.2%, P > 0.999), serious adverse events (0.02% versus 0.04%, P = 0.557) and incidence of ectopic pregnancy (0.2% versus 0.2%, P = 0.796) were not different between models. In the telemedicine‐hybrid model, 0.04% were estimated to be over 10 weeks’ gestation at the time of the abortion; all were completed safely at home. Within the telemedicine‐hybrid model, effectiveness was higher with telemedicine than in‐person care (99.2% versus 98.1%, P < 0.001). Acceptability of telemedicine was high (96% satisfied) and 80% reported a future preference for telemedicine.
Conclusions
A telemedicine‐hybrid model for medical abortion that includes no‐test telemedicine and treatment without an ultrasound is effective, safe, acceptable and improves access to care.
Tweetable
Compelling evidence from 52 142 women shows no‐test telemedicine abortion is safe, effective and improves care.
Tweetable
Compelling evidence from 52 142 women shows no‐test telemedicine abortion is safe, effective and improves care.
This article includes Author Insights, a video available at https://vimeo.com/bjog/authorinsights16668
Roadmap of optical communications Agrell, Erik; Karlsson, Magnus; Chraplyvy, A R ...
Journal of optics (2010),
06/2016, Letnik:
18, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Lightwave communications is a necessity for the information age. Optical links provide enormous bandwidth, and the optical fiber is the only medium that can meet the modern society's needs for ...transporting massive amounts of data over long distances. Applications range from global high-capacity networks, which constitute the backbone of the internet, to the massively parallel interconnects that provide data connectivity inside datacenters and supercomputers. Optical communications is a diverse and rapidly changing field, where experts in photonics, communications, electronics, and signal processing work side by side to meet the ever-increasing demands for higher capacity, lower cost, and lower energy consumption, while adapting the system design to novel services and technologies. Due to the interdisciplinary nature of this rich research field, Journal of Optics has invited 16 researchers, each a world-leading expert in their respective subfields, to contribute a section to this invited review article, summarizing their views on state-of-the-art and future developments in optical communications.
Partial melting in the Earth's mantle plays an important part in generating the geochemical and isotopic diversity observed in volcanic rocks at the surface. Identifying the composition of these ...primary melts in the mantle is crucial for establishing links between mantle geochemical 'reservoirs' and fundamental geodynamic processes. Mineral inclusions in natural diamonds have provided a unique window into such deep mantle processes. Here we provide experimental and geochemical evidence that silicate mineral inclusions in diamonds from Juina, Brazil, crystallized from primary and evolved carbonatite melts in the mantle transition zone and deep upper mantle. The incompatible trace element abundances calculated for a melt coexisting with a calcium-titanium-silicate perovskite inclusion indicate deep melting of carbonated oceanic crust, probably at transition-zone depths. Further to perovskite, calcic-majorite garnet inclusions record crystallization in the deep upper mantle from an evolved melt that closely resembles estimates of primitive carbonatite on the basis of volcanic rocks. Small-degree melts of subducted crust can be viewed as agents of chemical mass-transfer in the upper mantle and transition zone, leaving a chemical imprint of ocean crust that can possibly endure for billions of years.
No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors ...associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.
The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.
2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7–9). The proportion of patients reporting full recovery was unchanged between 5 months (501 25·5% of 1965) and 1 year (232 28·9% of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 95% CI 0·46–0·99), obesity (0·50 0·34–0·74) and invasive mechanical ventilation (0·42 0·23–0·76). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 IQR 0·74–1·00), at 5 months (0·74 0·64–0·88) to 1 year (0·75 0·62–0·88), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.
The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.
UK Research and Innovation and National Institute for Health Research.
To quantify developmental abnormalities in cerebral and cerebellar volume in autism.
The authors studied 60 autistic and 52 normal boys (age, 2 to 16 years) using MRI. Thirty autistic boys were ...diagnosed and scanned when 5 years or older. The other 30 were scanned when 2 through 4 years of age and then diagnosed with autism at least 2.5 years later, at an age when the diagnosis of autism is more reliable.
Neonatal head circumferences from clinical records were available for 14 of 15 autistic 2- to 5-year-olds and, on average, were normal (35.1 +/- 1.3 cm versus clinical norms: 34.6 +/- 1.6 cm), indicative of normal overall brain volume at birth; one measure was above the 95th percentile. By ages 2 to 4 years, 90% of autistic boys had a brain volume larger than normal average, and 37% met criteria for developmental macrencephaly. Autistic 2- to 3-year-olds had more cerebral (18%) and cerebellar (39%) white matter, and more cerebral cortical gray matter (12%) than normal, whereas older autistic children and adolescents did not have such enlarged gray and white matter volumes. In the cerebellum, autistic boys had less gray matter, smaller ratio of gray to white matter, and smaller vermis lobules VI-VII than normal controls.
Abnormal regulation of brain growth in autism results in early overgrowth followed by abnormally slowed growth. Hyperplasia was present in cerebral gray matter and cerebral and cerebellar white matter in early life in patients with autism.
The Galactic Centre contains a supermassive black hole with a mass of four million Suns
within an environment that differs markedly from that of the Galactic disk. Although the black hole is ...essentially quiescent in the broader context of active galactic nuclei, X-ray observations have provided evidence for energetic outbursts from its surroundings
. Also, although the levels of star formation in the Galactic Centre have been approximately constant over the past few hundred million years, there is evidence of increased short-duration bursts
, strongly influenced by the interaction of the black hole with the enhanced gas density present within the ring-like central molecular zone
at Galactic longitude |l| < 0.7 degrees and latitude |b| < 0.2 degrees. The inner 200-parsec region is characterized by large amounts of warm molecular gas
, a high cosmic-ray ionization rate
, unusual gas chemistry, enhanced synchrotron emission
, and a multitude of radio-emitting magnetized filaments
, the origin of which has not been established. Here we report radio imaging that reveals a bipolar bubble structure, with an overall span of 1 degree by 3 degrees (140 parsecs × 430 parsecs), extending above and below the Galactic plane and apparently associated with the Galactic Centre. The structure is edge-brightened and bounded, with symmetry implying creation by an energetic event in the Galactic Centre. We estimate the age of the bubbles to be a few million years, with a total energy of 7 × 10
ergs. We postulate that the progenitor event was a major contributor to the increased cosmic-ray density in the Galactic Centre, and is in turn the principal source of the relativistic particles required to power the synchrotron emission of the radio filaments within and in the vicinity of the bubble cavities.
We performed laser-heated diamond anvil cell experiments on bulk compositions in the systems MgO–SiO2–H2O (MSH) and MgO–Al2O3–SiO2–H2O (MASH) that constrain the stability of hydrous phases in Earth's ...lower mantle. Phase identification by synchrotron powder diffraction reveals a consistent set of stability relations for the high-pressure, dense hydrous silicate phases D and H. In the MSH system phase D is stable to ~50GPa, independent of temperature from ~1300 to 1700K. Phase H becomes stable between 35 and 40GPa, and the phase H out reaction occurs at ~55GPa at 1600K with a negative dT/dP slope of ~−75K/GPa. Between ~30 and 50GPa dehydration melting occurs at ~1800K with a flat dT/dP slope. A cusp along the solidus at ~50GPa corresponds with the intersection of the subsolidus phase H out reaction, and the dT/dP melting slope steepens to ~15K/GPa up to ~85GPa.
In the MASH system phase H is stable in experiments between ~45 and 115GPa in all bulk compositions studied, and we expect aluminous phase H to be stable throughout the lower mantle depth range beneath ~1200km in both peridotitic and basaltic lithologies. In the subsolidus, aluminous phase D is stable to ~55GPa, whereas at higher pressures aluminous phase H is the stable hydrous phase. The presence of hydrogen may sharpen the bridgmanite to post-perovskite transition. The ambient unit cell volume of bridgmanite increases systematically with pressure above ~55GPa, possibly representing an increase in alumina content, and potentially hydrogen content, with depth. Bridgmanite in equilibrium with phases D and H has a relatively low alumina content, and alumina partitions preferentially into the hydrous phases. The melting curves of MASH compositions are shallower than in the MSH system, with dT/dP of ~6K/GPa. Phase D and H solid solutions are stable in cold, hydrated subducting slabs and can deliver water to the deepest lower mantle. However, hydrated lithologies in the lower mantle are likely to be partially molten at all depths along an ambient mantle geotherm.
•Along a cold subduction geotherm an aluminous hydrous phase, either D or H, will be stable throughout the lower mantle.•Aluminous phase H can be stable in lower mantle lithologies at depths from ~1200km to the core–mantle boundary.•Along a lower mantle adiabat a hydrous melt will be stable once the storage capacity of the mantle has been exceeded.
We compared the presence of autistic and comorbid psychopathology and functional impairments in young adults who received a clinical diagnosis of Pervasive Developmental Disorders Not Otherwise ...Specified or Asperger’s Disorder during childhood to that of a referred comparison group. While the Autism Spectrum Disorder group on average scored higher on a dimensional ASD self- and other-report measure than clinical controls, the majority did not exceed the ASD cutoff according to the Autism Diagnostic Observation Schedule. Part of the individuals with an ASD diagnosis in their youth no longer show behaviors that underscribe a clinical ASD diagnosis in adulthood, but have subtle difficulties in social functioning and a vulnerability for a range of other psychiatric disorders.
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