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In a randomized trial comparing induction of labor with expectant management at 39 weeks in low-risk nulliparous women, induction did not result in a significantly lower frequency of adverse perinatal outcomes, but it did result in a lower frequency of cesarean delivery.

Gestational diabetes mellitus, which is defined as the onset or first recognition of carbohydrate intolerance during pregnancy, is estimated to affect between 6 and 9% of pregnant women in the United States. 1,2 Associated perinatal outcomes include excessive fetal growth that can lead to maternal or fetal birth trauma, hypertensive disorders of pregnancy, and neonatal hypoglycemia. 3 Trials have shown that the treatment of women with gestational diabetes can reduce many of these immediate outcomes, 4,5 and these trials led the U.S. Preventive Services Task Force to conclude that there is a net benefit to routinely screening for and treating gestational diabetes. 6 Despite . . .

Two placebo-controlled trials involving pregnant women with subclinical hypothyroidism or hypothyroxinemia showed that levothyroxine beginning between 8 and 20 weeks of gestation did not significantly improve cognitive outcomes in children through 5 years of age. Observational studies spanning almost three decades suggest that subclinical thyroid disease during pregnancy is associated with adverse outcomes. 1 – 5 In 1999, interest in undiagnosed maternal thyroid dysfunction was heightened by studies suggesting an association between subclinical thyroid hypofunction and impaired fetal neuropsychological development. 6 , 7 In one report, children of women whose serum thyrotropin levels during pregnancy were greater than the 98th percentile had a lower IQ than children of matched controls who had a normal thyrotropin level. 6 In another study, children whose mothers had a serum free thyroxine (T 4 ) level of less than the 10th percentile in early . . .

In this randomized trial of treatment versus no treatment for mild gestational diabetes mellitus, rates of the primary outcome (a composite of stillbirth or perinatal death and neonatal hyperbilirubinemia, hypoglycemia, hyperinsulinemia, or birth trauma) did not differ significantly between groups. However, there were significant reductions with treatment in several secondary outcomes, including the frequency of large-for-gestational-age infants, shoulder dystocia, cesarean delivery, and hypertension in pregnancy. In this randomized trial of treatment versus no treatment for mild gestational diabetes mellitus, rates of the primary outcome (a composite of stillbirth or perinatal death and neonatal hyperbilirubinemia, hypoglycemia, hyperinsulinemia, or birth trauma) did not differ significantly between groups. However, there were significant reductions with treatment in several secondary outcomes. Gestational diabetes mellitus is defined as glucose intolerance that first occurs or is first identified during pregnancy. 1 The frequency of this condition is rising in the United States and occurs in 1 to 14% of all pregnancies, depending on varying characteristics of the population. 2 More than 40 years ago, O'Sullivan and Mahan developed glucose-tolerance-test criteria for the diagnosis of gestational diabetes mellitus. 3 The diagnostic thresholds that they developed were based on the subsequent development of adult-onset diabetes and were not predicated on any association between carbohydrate intolerance discovered during gestation and adverse pregnancy outcomes. Although gestational diabetes mellitus is a . . .

In this multicenter, randomized trial involving women at high risk for late preterm delivery, administration of betamethasone significantly reduced the rate of neonatal respiratory complications. Antenatal glucocorticoids are widely used in obstetrics for pregnancies at risk for early preterm delivery. Their use increased especially after a consensus conference held by the National Institutes of Health in 1994, which concluded that there was strong evidence that glucocorticoids reduce adverse neonatal outcomes, including death, the respiratory distress syndrome, and other complications, when administered to women who are likely to deliver before 34 weeks of gestation. 1 – 3 The recommendation was not extended to women at risk for preterm delivery after 34 weeks because of both a lack of data 4 , 5 and the belief that at a threshold of . . .

The manufacture of load-bearing prosthetic lower limb sockets is traditionally reliant on skilled technicians working with qualified clinicians to create bespoke solutions. While this approach is effective and, in some situations, necessary, the appeal of a sustainable, efficient, and digitalized production solution cannot be ignored. The focus of additive manufacturing (AM) is typically on low-weight-bearing prostheses, which can be misleading for clinics attempting to adopt AM solutions for clientele with weight-bearing or activity-level needs. This review aims to offer readers a way to approach AM for load-bearing requirements as opposed to non-load-bearing counterparts. The use cases of AM for the production of load-bearing transtibial prosthetic sockets and components are reviewed to highlight current trends, protocols, and standings. By reviewing publications from the past 25 years, this state-of-the-art review highlights the key requirements and technologies relevant for load-bearing transtibial prosthetic sockets specifically. The most commonly used AM solutions for commercial use, such as selective laser sintering and binder jetting through Multi Jet Fusion, are outlined. As these solutions are most often paired with the structural testing standard International Organization for Standardization 10328, their relevance for evaluating the strength and durability of lower limb sockets is also discussed. Clinician and technician experiences of digitalized ways of working within the prosthetic industry for load-bearing applications are outlined. Observations of adoption barriers of AM solutions are brought to light, focusing on clinician and technician education, skill set, exposure to innovative technologies, and trust in the regulation of digital processes in a clinical and technical environment.

In this follow-up report of a trial of CMV hyperimmune globulin in pregnant women with primary CMV infection, hyperimmune globulin did not improve hearing or developmental outcomes in children at the age of 2 years.

In 1952, Virginia Apgar proposed the Apgar score as a means of evaluating the physical condition of infants shortly after delivery. 1 This scoring system, which encouraged delivery-room personnel to pay close attention to the newborn, was rapidly adopted in delivery rooms throughout the United States and elsewhere. Indeed, it has been said that “every baby born in a modern hospital anywhere in the world is looked at first through the eyes of Virginia Apgar.” 2 Each of five easily identifiable characteristics — heart rate, respiratory effort, muscle tone, reflex irritability, and color — is assessed and assigned a value of 0 . . .

Introduction: Co-design has been cited as playing a major role in the future of effective integrated care, however, there is a lack of reporting and reflection on the methods used. Information sharing is fundamental when working in integrated care, however sharing across professions, service settings and localities can be complex. Through co-design, we seek to establish a shared understanding of information needs within a newly formed integrated care team. In doing so we aim to inform future practice in the understanding of co-design.Description: Co-design Workshop 1 (N = 24 participants, plus 6 facilitators), collected ‘Current Position’ understanding of service information needs. Co-design Workshop 2 (N = 18 participants, plus 6 facilitators) sought a ‘Future Position’ understanding, identifying solutions and next steps for establishing information-need solutions. Reflection on the co-design process was conducted to inform future co-design practices.Conclusion: Identified was a wide range of future service information needs under the themes of Culture Building, Health System Needs, and Processes. We conclude with 4 key learning points on co-designing. 1. Ensure simplicity in format. 2. Interdisciplinary co-design and co-facilitation of workshops are beneficial. 3. Planning and preparation are key. 4. Co-designing can enhance communication for service improvement.

The Franciscan Missionaries of the Divine Motherhood (FMDM) arrived in Ireland in 1942, to establish and run Portiuncula Hospital in Ballinasloe, county Galway. This was not without its challenges and this article explores many of those challenges in the context of the construction and management of the hospital between 1942 and 1970. FMDM sisters were women in a patriarchal church and needed to also negotiate their place within the similar frameworks of the medical profession, civil service, and government, while being subject to gossip as to the work they were doing. The article is a revealing case-study of some of the global changes in medicine that had been taking place since the 1920s. It is also an example of how modern methods of healthcare were having an impact on the Irish healthcare system, with medically trained Catholic religious sisters at the forefront. The story of women religious in twentieth-century global Catholicism is a relatively unattended one. This case-study allows historians of religion to better understand the internationality of Catholic religious congregations, examining concepts of unity and disharmony, and the various efforts they made to confront but also comply with the patriarchal structures in which they found themselves.