Paul Hastings

To describe the relationships among patient self-advocacy, patient-centered communication, pain intensity, and opioid stigma in female breast cancer survivors aged 65 years or older. 73 women in a longitudinal study of symptoms experienced during the first year and as many as three years after breast cancer surgery. This prospective, cross-sectional study employed a descriptive, correlational design. Participants completed instrument assessments measuring self-advocacy, patient-centered communication, pain intensity, and opioid stigma. Self-advocacy correlated moderately positively with patient-centered communication. Patient-centered communication correlated moderately positively with informed decision-making. Nurses can empower patients with the necessary skills to self-advocate for their needs and facilitate a patient-centered clinical environment to improve outcomes.

Abstract This article aims at reviewing the practice of ‘initiatives’ by Intergovernmental Organizations (igo s) when responding to crises or the unforeseen needs of their respective memberships. It forms part of a broader research project on the role of igo s in international law where more than 100 initiatives were identified so far, focusing on 14 igo s. The notion of an igo’s initiative, conceptualised as activities of the Executive Heads and the secretariat’s staff that enhance the remit of an organization beyond those functions initially or formally envisaged by its constituent instrument, is examined. A descriptive analysis of over 30 initiatives indicate that they may be successful in addressing modern unforeseen challenges, whether they stem from international emergencies, climate change, dynamic technological advancements, or global health crises such as the covid-19 pandemic- especially when such initiatives are accepted and supported by igo s’ members.

We have proposed, designed, simulated and fabricated a holographic, low loss focusing lens with engineered nano-scaled features. This metastructure was designed to converge off-axis infrared (IR) radiation and created by patterning a dielectric surface. To leverage previous efforts for baseline data, we chose an array of nano-pillars which varied in widths although were fixed in both height and periodicity. We achieved the desired Gradient Index (GRIN) and resulting focus length, by engineering the effective index of refraction across the metasurface which was achieved from varying the material-to-air ratio. This allowed us to create a parabolic phase gradient, thereby generating an effective optical density that peaks in the appropriate sector of the lens while gradually degrading towards the perimeter of the lens in Figure 1. Lenslets with varying patterns, dependent upon their position in the array, were designed, simulated and fabricated.

Triage and the timing of admission of low-risk pregnant women can affect the use of augmentation, epidural, and cesarean. The purpose of this analysis was to explore these outcomes in a community hospital by the type of provider staffing triage. This was a retrospective cohort study of low-risk nulliparous women with a term, vertex fetus laboring in a community hospital. Bivariate and multivariable statistics evaluated associations between triage provider type and labor and birth outcomes. Patients in this sample (N = 335) were predominantly White (89.5%), with private insurance (77.0%), and married (71.0%) with no significant differences in these characteristics by triage provider type. Patients admitted by midwives had lower odds of oxytocin augmentation (adjusted odds ratio [aOR] = 0.50, 95% confidence interval [CI] = 0.29-0.87), epidural (aOR = 0.29, 95% CI = 0.12-0.69), and cesarean birth (aOR = 0.308, 95% CI = 0.14-0.67), compared with those triaged by physicians after controlling for patient characteristics and triage timing. This study provides additional context to midwives as labor triage providers for healthy, low-risk pregnant individuals; however, challenges persisted with measurement. More research is needed on the specific components of care during labor that support low-risk patients to avoid medical interventions and poor outcomes.

(Abstracted from Obstet Gynecol 2020;135:761–769) Between 2007 and 2010, the rate of total vaginal hysterectomy (TVH) in the United States among commercially insured patients undergoing hysterectomy decreased from 21.7% to 19.8% and by 2013 decreased to 11.5%. Between 2007 and 2010, use of robotic-assisted hysterectomy increased from 0.5% to 9.5%.