The comparative efficacy of comprehensive self-care interventions in chronic illness: An updated meta-analysis of randomized controlled trials.

Pelvic floor symptoms, such as vaginal bulge and stress urinary incontinence, are closely linked to vaginal delivery, especially assisted vaginal delivery. In addition, levator ani muscle avulsion, which may occur during vaginal delivery, increases the risk of pelvic floor dysfunction. However, the isolated effect of forceps or vacuum delivery in women with and without avulsion remains unclear. This study aimed to determine whether the presence of vaginal bulge symptoms and urinary incontinence 1 year after delivery differed between different vaginal delivery modes, accounting for levator ani muscle avulsion. In addition, this study aimed to assess the overall presence and bother of pelvic floor dysfunction across different delivery modes. This was a cross-sectional analysis of the Bergen Birth Study, a prospective observational cohort study comparing maternal and neonatal outcomes after forceps, vacuum, and spontaneous vaginal deliveries. Primiparous women with a singleton vaginal delivery at term between June 2021 and April 2023 were eligible. Exposure was defined as the delivery mode (spontaneous vaginal, vacuum, or forceps delivery). The women later underwent a transperineal ultrasound examination to assess levator ani muscle avulsion and answered the Pelvic Floor Distress Inventory-20 for grading of pelvic floor symptoms 9 to 12 months after delivery. The primary outcomes were the presence of vaginal bulge symptoms, stress urinary incontinence, and urge urinary incontinence on the Pelvic Floor Distress Inventory-20 questionnaire, with the degree of bother graded as "somewhat" or higher. Multiple logistic regression analysis was performed to compare the odds of vaginal bulge symptoms, stress urinary incontinence, and urge urinary incontinence between different modes of delivery. Age, body mass index, and self-reported prepregnancy urinary dysfunction were adjusted for as potential confounders. Nonparametric tests were used to compare the Pelvic Floor Distress Inventory-20 sum score between different delivery modes. In this study, 699 women were available for analysis, 238 had forceps delivery, 238 had vacuum delivery, and 223 had spontaneous vaginal delivery. Moreover, 142 of 699 women (20.3%) had levator ani muscle avulsion. Vaginal bulge symptoms were present in 10 (4.5%), 19 (8.0%), and 37 (15.6%) women after spontaneous, vacuum-assisted, and forceps-assisted deliveries, respectively. Women who underwent forceps delivery had an adjusted odds ratio of 3.21 (95% confidence interval, 1.56-7.14) of reporting bulge symptoms 1 year after delivery compared with those who underwent spontaneous delivery and an adjusted odds ratio of 1.87 (95% confidence interval, 1.02-3.49) compared with those who underwent vacuum delivery. In contrast, vacuum delivery was not associated with bulge symptoms compared with spontaneous delivery (adjusted odds ratio, 1.74 [95% confidence interval, 0.80-4.02]). In the subgroup analysis of women with intact levator ani muscle, the difference between forceps delivery and vacuum delivery was not significant (adjusted odds ratio, 1.59 [95% confidence interval, 0.74-3.47]). No association was found between mode of delivery and stress or urge urinary incontinence. Levator ani muscle avulsion was associated with more bulge symptoms (adjusted odds ratio, 3.58 [95% confidence interval, 2.06-6.18]) and urge urinary incontinence (adjusted odds ratio, 2.00 [95% confidence interval, 1.11-3.51]). The median Pelvic Floor Distress Inventory-20 score was statistically higher in the forceps delivery group than in the vacuum delivery and spontaneous vaginal delivery groups (25.0 in the forceps delivery group vs 18.2 in the vacuum delivery group [P=.03] and 25.0 in the forceps delivery group vs 16.7 in the spontaneous vaginal delivery group [P=.02]). Forceps delivery increased the odds of vaginal bulge symptoms 1 year after delivery compared with both vacuum and spontaneous vaginal deliveries. In women with no levator ani muscle avulsion, no difference was observed between the instruments. A higher Pelvic Floor Distress Inventory-20 score indicates greater symptom burden after forceps delivery, which seems to be mediated by the presence of levator ani muscle avulsion.

Balancing anatomical limits and dynamic adaptation: Understanding the determinants of successful vaginal breech delivery.

Determinants of neonatal morbidity in Rajshahi Division of Bangladesh.

University courses with hundreds of students have become common, particularly during early years of university studies. The sheer scale of these courses limits traditional instruction, shifting it towards a one-to-many mode of delivery. This shift reduces student–instructor interaction and tailored instructor feedback which are crucial for student success. Automated feedback systems allow scaling feedback, but they often reduce instructor contributions to student learning. This paper investigates how emerging technologies can support, rather than replace, instructors in tailoring their teaching and feedback to identify and correct student knowledge gaps at scale. To address this challenge, the paper introduces a novel technological solution: the Knowledge Gaps to Mastery (KG2M) approach. KG2M combines discussion forum data with course-specific content and leverages large language models (LLMs) and Retrieval-Augmented Generation (RAG) for the dual purpose of identifying prevalent class-level knowledge gaps and transforming them into targeted learning activities and formative assessments. The approach was deployed across three computer science courses with a combined enrollment of 1,355 students and evaluated through semi-structured interviews with five instructors. Results indicate that instructors found the tool intuitive and pedagogically valuable, particularly for surfacing knowledge gaps and generating actionable teaching insights. The paper reports on the tool, the evaluation, and the current limitations of the approach that emerged during instructor evaluation. • Large classrooms are prevalent at universities, but they hinder instructors’ ability to provide feedback tailored to students’ needs. • The rise of GenAI shows promise in providing automated feedback at scale; however, it often lacks the nuanced guidance of instructor-led feedback. • Leveraging discussion forums with appropriate design and tech innovation could minimize instructor workload and address students’ learning needs. • We introduce an approach (KG2M) using LLMs and RAG to spot class-wide knowledge gaps and generate learning activities. • Evaluation via case studies in 3 CS courses (1355 students and 2878 unique posts) and with 5 instructors emphasizes pedagogical value.

Maternal type 1 diabetes mellitus and atopic dermatitis in offspring: A nationwide cohort study.

A predictive model for birth delivery mode utilizing shape characteristics of uterine contractions from electrohysterographic signals and obstetric parameters

More explicit is not always better: Boundary conditions for action guidance in hazard notifications across traffic complexity.

Optimizing remote access to Urinary Incontinence Treatments for Women Veterans: Identifying salient features of participants’ experiences with two delivery modalities

The art and science of providing patients with helpful information.

• Carbonic anhydrase reliably enhances carbon capture under eco-friendly conditions • Textile contactors promote liquid wicking for efficient CO 2 reactive absorption • Bifunctional reactive dyes offer a scalable enzyme immobilization approach • Enzyme catalysis shows potential to enhance ex situ mineralization • Biocatalytic textiles offer a diverse and practical platform for CO 2 mitigation Biocatalytic textiles were developed and tested as high-efficiency gas-liquid contactors for reactive CO 2 absorption using eco-friendly solvents catalyzed by carbonic anhydrase. The testing in lab to bench-scale systems with various configurations showed that biocatalytic textiles are durable and compatible with multiple different alkaline CO 2 absorption solvents across wide working concentrations, including secondary amines, carbonates, amino acids, and abundant natural water sources like pH-adjusted seawater and spring water. Biocatalytic textile contactors proved to be remarkably robust across diverse conditions, delivering similar percent CO 2 capture regardless of inlet CO 2 concentrations. By controlling gas and liquid flows, packing height and mode of enzyme delivery, single-pass CO 2 absorption efficiencies up to 95% were achieved at lab scale. Biocatalytic textiles were able to withstand repeated washing and drying, immersion and shaking in heated solvents, ambient dry storage for many months, and continuous solvent flow testing for hundreds of hours without performance reduction. Integrated bench unit testing with aqueous MDEA solvent and biocatalytic textile packing modules achieved a CO 2 adsorption rate increase of over 200% at low 1.8 L/G when compared to traditional steel structured packing. A straightforward enzyme crosslinking technology based on fiber reactive dyes developed in the course of this work makes fabrication and scale up possible using established textile manufacturing infrastructure, and a solvent composition based on seawater and wood ash extract offers potential for ex-situ mineralization of CO 2 to permanent solid carbonates for utilization or storage.

Predictive value of uterine artery pulsatility index for cesarean delivery in late-onset fetal growth restriction.

Online learning has become a central mode of delivery in higher education worldwide, offering new opportunities for non-traditional students such as working professionals, caregivers, and mature-age learners. However, in developing countries such as Uganda, online education faces significant challenges, including limited digital infrastructure, high data costs, and inadequate institutional policies. While previous research has examined online learning, little is known about how instructors in Ugandan higher education institutions adapt their strategies to support non-traditional students. This study seeks to address this gap by exploring the instructional and institutional practices that enable student persistence in resource-constrained environments. Using a qualitative research design, semi-structured interviews were conducted with 52 online instructors from 12 institutions between January and March 2025. Data were transcribed, coded, and analysed thematically, revealing six interrelated themes: flexibility, institutional support services, community building and engagement, balancing multiple roles, perceptions of success, and institutional policies and practices. Findings highlight the importance of flexibility, including extended deadlines, asynchronous learning, and mobile-friendly materials, given students’ competing responsibilities and technological barriers. Instructors emphasised the critical role of support services, particularly digital literacy guidance and mental health counselling. They stressed the value of informal engagement strategies, such as WhatsApp study groups and personal check-ins, for fostering a sense of belonging. Notably, instructors defined success holistically, focusing on persistence, skill acquisition, and workplace application rather than solely degree completion. The study concludes that institutional policies must be reformed to address digital inequities, support informal engagement, and recognise diverse definitions of success. Recommendations include affordable internet initiatives, community-based learning hubs, and context-sensitive student support systems.

Triplet pregnancies are increasingly leaning toward planned cesarean deliveries (CD), yet data on determining factors and outcomes remain limited. To assess the success of vaginal delivery (VD) in triplet pregnancies and compare neonatal and maternal outcomes with those of CD. A retrospective cohort study included triplet pregnancies from 26 weeks' gestation onward in a tertiary center between 2000 and 2020. The primary outcome was the actual mode of delivery (successful VD, planned CD, or unplanned CD). Secondary outcomes included indications for CD, as well as neonatal and maternal outcomes. Seventy-one women were included. Of these, 41% attempted VD, with 90% successfully delivering vaginally. Planned CD was chosen by 59%, mainly for fetal (64%) or maternal (19%) indications, or patient preference (17%). Neonatal mortality did not differ significantly between planned VD and CD (aOR: 0.29; 95% CI: 0.06-1.50; p = 0.14). However, neonates born via VD compared to CD had lower risks for sepsis (aOR: 0.19; 95% CI: 0.04-0.94; p = 0.04) and retinopathy of prematurity (aOR: 0.17; 95% CI: 0.03-0.93; p = 0.04). Neonates born after VD had higher risks of infant respiratory distress syndrome (OR: 2.70; 95% CI: 1.03-7.08; p = 0.04) and interventricular hemorrhage (OR: 4.00; 95% CI: 1.20-13.35; p = 0.02), though these associations were not significant after adjusting for gestational age (p = 0.92 and p = 0.32, respectively). Women opting for VD in triplet pregnancies had a 90% success rate. VD can be safe after careful case selection and access to highly trained personnel at a tertiary center. Centralization might enhance safety and outcomes, offering essential insights for clinicians.

Application of 3D reconstruction software and MRI measurements in predicting delivery Mode: A comparative study

Unmeasured confounding remains a fundamental challenge permeating contemporary causal inference, substantially impeding the valid estimation of treatment effects. A rigorous identification strategy is presented for estimating average causal effects with unmeasured confounding by exploiting the information contained in primary and secondary outcomes. In contrast to existing literature, our approach is intended to construct the proxy confounder for inverse probability weighting-type estimation. Formal identification results and the asymptotic distribution theory for the proposed estimator are established. Through extensive simulation studies, it is demonstrated that the method achieves marked reduction in confounding bias and offers refinements to causal effect estimation. In practical applications, by integrating secondary outcomes that characterize cognitive aspects, we successfully supplemented information not captured by the covariates, enabling us to draw significant inferences regarding the effects of maternal delivery mode on child's test scores. This approach provides a promising methodology for data sets with multiple secondaryoutcomes.

Tai Chi and wellness for Gulf War Illness: Combined analysis of in-person and remote randomized controlled trials.

Precise delivery of medical gases by engineered nanomedicine for enhanced liver fibrosis therapy.

Healthy aging as Black adults, in it together (HABIT): Protocol for a comparative effectiveness trial to address comorbid chronic pain and early cognitive decline among older, community-based Black adults.

The safety and efficacy of peripartum transfusion support depends on a comprehensive risk analysis, the provision of substantiated criteria for ordering blood products, and surveillance of outcomes over time. We aimed to determine bleeding frequencies and volumes of blood loss, associated patient risk factors, and the effectiveness of our transfusion support scheme. Birth records of 12,255 pregnant women who gave birth at our hospital were screened for haemorrhage volumes, mode of delivery, bleeding aetiology, accompanying risk factors as well as outcome. Transfusion related data was extracted from the electronic blood product database. A total of 204 (1.6 %) women who gave birth within the 5-year study period received at least one RBC transfusion within 48 h after delivery. Differences in haemorrhage volumes in all women compared to those receiving RBC transfusion confirmed an increased probability of RBC transfusion with larger haemorrhage volumes. Uterus atony bleeding (UAB) was the most common cause associated with transfusions. Six risk factors for RBC transfusion among transfused patients were identified that showed a probability of >10 %: Adherent placenta (31.4 %), preterm rupture of membranes (PROM) (25.5 %), age over 35 (25.0 %), a previous caesarean section (19.6 %), gestational diabetes mellitus (15.2 %), and a twin pregnancy (11.8 %). An overall crossmatch-to-transfusion (C/T) ratio of 2.75:1 was reached and no patient with major haemorrhage-related morbidity or mortality was recorded. Evaluation of peripartum haemorrhage and associated RBC transfusion using the described methodology revealed RBC transfusions in 1.6 % of all women who gave birth within the study period. The described blood ordering scheme demonstrates a safe and efficient utilisation of blood products.