The Two Front War on Reproductive Rights-When the Right to Abortion is Banned, Can the Right to Refuse Obstetrical Interventions Be Far behind?

The loss of the federally protected constitutional right to an abortion is a threat to the already tenuous autonomy of pregnant people, and may augur future challenges to their right to refuse unwanted obstetric interventions. Even before Roe's demise, pregnancy led to constraints on autonomy evidenced by clinician-led legal incursions against patients who refused obstetric interventions. In Dobbs v. Jackson Women's Health Organization, the Supreme Court found that the right to liberty espoused in the Constitution does not extend to a pregnant person's right to an abortion. With Roe's demise, the right to request specific types of care has been vitiated. The same argument underpinning that holding may now become ballast for attacks on the traditionally more robust right, the right to refuse. Here we discuss how the elevation of fetal and embryonic rights may lead to a cascade of medical intrusions and deprivations of liberty against pregnant persons, and offer an argument opposing these improprieties.

Sexual & reproductive health information on minor consent forms for pubertal suppression and gender affirming hormones.

Introduction: Transgender and Nonbinary (TNB) youth need specialized sexual and reproductive health (SRH) information and counseling. One avenue for providing this information is the use of informed consent documents before initiating pubertal suppression (PS) and/or gender-affirming hormones (GAHs). This study aims to compare the type and amount of SRH information included on informed consent documents used across clinical sites providing PS and GAH to youth. Methods: As part of a larger, IRB-approved survey on informed consent, providers of gender-related care to youth uploaded informed consent forms used in clinical practice. Publicly available forms were also included in analysis. Content analysis of these forms was undertaken using published clinical guidelines to inform coding and reflect the SRH implications of starting PS and GAH. Results: 21 unique consent documents were included in the content analysis (PS = 7, Masculinizing = 7, Feminizing = 7). SRH information on consent documents fell into 4 broad categories: (1) changes in sexual organs and functioning; (2) pregnancy and fertility information; (3) cancer risk; and (4) sexually transmitted infections. Forms varied considerably in the level of detail included about these SRH topics and most forms included implicit or explicit acknowledgement of the uncertainty that exists around certain SRH outcomes for TNB youth. Conclusions: There was substantial variability in both SRH content and context across consent forms. The role of consent forms in fostering TNB youth's understanding of complex SHR information when initiating PS and GAHs needs further clarification and development. Future research should focus on ways to ensure provision of adequate SRH information for TNB youth.

Spontaneous Reduction by One Electron on Water Microdroplets Facilitates Direct Carboxylation with CO2.

Recent advances in microdroplet chemistry have shown that chemical reactions in water microdroplets can be accelerated by several orders of magnitude compared to the same reactions in bulk water. Among the large plethora of unique properties of microdroplets, an especially intriguing one is the strong reducing power that can be sometimes as high as alkali metals as a result of the spontaneously generated electrons. In this study, we design a catalyst-free strategy that takes advantage of the reducing ability of water microdroplets to reduce a certain molecule, and the reduced form of that molecule can convert CO2 into value-added products. By spraying the water solution of C6F5I into microdroplets, an exotic and fragile radical anion, C6F5I•-, is observed, where the excess electron counter-intuitively locates on the σ* antibonding orbital of the C-I bond as evidenced by anion photoelectron spectroscopy. This electron weakens the C-I bond and causes the formation of C6F5-, and the latter attacks the carbon atom on CO2, forming the pentafluorobenzoate product, C6F5CO2-. This study provides a good example of strategically making use of the spontaneous properties of water microdroplets, and we anticipate that microdroplet chemistry will be a green avenue rich in new opportunities in CO2 utilization.

Effect of a Moral Distress Consultation Service on Moral Distress, Empowerment, and a Healthy Work Environment.

BACKGROUND:  Healthcare providers who are accountable for patient care safety and quality but who are not empowered to actualize them experience moral distress. Interventions to mitigate moral distress in the healthcare organization are needed. OBJECTIVE:  To evaluate the effect on moral distress and clinician empowerment of an established, health-system-wide intervention, Moral Distress Consultation. METHODS:  A quasi-experimental, mixed methods study using pre/post surveys, structured interviews, and evaluation of consult themes was used. Consults were requested by staff when moral distress was present. The purpose of consultation is to identify the causes of moral distress, barriers to action, and strategies to improve the situation. Intervention participants were those who attended a moral distress consult. Control participants were staff surveyed prior to the consult. Interviews were conducted after the consult with willing participants and unit managers. Moral distress was measured using the Moral Distress Thermometer. Empowerment was measured using the Global Empowerment Scale. RESULTS:  Twenty-one consults were conducted. Analysis included 116 intervention and 30 control surveys, and 11 interviews. A small but significant decrease was found among intervention participants, especially intensive care staff. Empowerment was unchanged. Interview themes support the consult service as an effective mode for open discussion of difficult circumstances and an important aspect of a healthy work environment. CONCLUSIONS:  Moral distress consultation is an organization-wide mechanism for addressing moral distress. Consultation does not resolve moral distress but helps staff identify strategies to improve the situation. Further studies including follow up may elucidate consultation effectiveness.

Beyond Abortion: The Consequences of Overturning Roe.

The upcoming U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization has the potential to eliminate or severely restrict access to legal abortion care in the United States. We address the impact that the decision could have on abortion access and its consequences beyond abortion care. We posit that an abortion ban would, in effect, mean that anyone who becomes pregnant, including those who continue a pregnancy and give birth to healthy newborns and those with pregnancy complications or adverse pregnancy outcomes will become newly vulnerable to legal surveillance, civil detentions, forced interventions, and criminal prosecution. The harms imposed by banning or severely restricting abortion access will disproportionately affect persons of color and perpetuate structural racism. We caution that focusing on Roe as a decision that only protects ending a pregnancy ignores the protection that the decision also affords people who want to continue their pregnancies. It overlooks the ways in which overturning Roe will curtail fundamental rights for all those who become pregnant and will undermine their status as full persons meriting Constitutional protections. Such a singular focus inevitably obscures the common ground that people across the ideological spectrum might inhabit to ensure the safety, health, humanity, and rights of all people who experience pregnancy.

Experimental and Computational Description of the Interaction of H and H- with U.

The results of ab initio correlated molecular orbital theory electronic structure calculations for low-lying electronic states are presented for UH and UH- and compared to photoelectron spectroscopy measurements. The calculations were performed at the CCSD(T)/CBS and multireference CASPT2 including spin-orbit effects by the state interacting approach levels. The ground states of UH and UH- are predicted to be 4Ι9/2 and 5Λ6, respectively. The spectroscopic parameters Te, re, ωe, ωexe, and Be were obtained, and potential energy curves were calculated for the low energy Ω states of UH. The calculated adiabatic electron affinity is 0.468 eV in excellent agreement with an experimental value of 0.462 ± 0.013 eV. The lowest vertical detachment energy was predicted to be 0.506 eV for the ground state, and the adiabatic ionization energy (IE) is predicted to be 6.116 eV. The bond dissociation energy (BDE) and heat of formation values of UH were obtained using the IE calculated at the Feller-Peterson-Dixon level. For UH, UH-, and UH+, the BDEs were predicted to be 225.5, 197.9, and 235.5 kJ/mol, respectively. The BDE for UH is predicted to be ∼20% lower in energy than that for ThH. The analysis of the natural bond orbitals shows a significant U+H- ionic component in the bond of UH.

Molecular Properties of Thorium Hydrides: Electron Affinities and Thermochemistry.

High-level electronic structure calculations of the ground and low-lying energy electronic states for ThHx and ThHx- for x = 2-5 are reported and compared to available anion photoelectron detachment experiments. The adiabatic electron affinities (EAs) are predicted to be 0.82, 0.88, 0.51, and 2.36 eV for x = 2 to 5, respectively, at the Feller-Peterson-Dixon (FPD) level. The vertical detachment energies (VDEs) are predicted to be 0.84, 0.88, 0.81, and 4.38 eV for x = 2-5, respectively. The corresponding experimental VDEs are 0.871 eV for x = 2, 0.88 eV for x = 3, and 4.09 eV for x = 5. As for ThH, there is a significant spin-orbit (SO) correction for the EA of ThH2, and this correction decreases substantially for x > 2. The observed ThH2- photoelectron spectrum has many transitions as predicted at the CASPT2-SO level. The FPD bond dissociation energies (BDEs) increase from 67 to 75 kcal/mol for x = 2 to x = 4 at the FPD level. The BDE for ThH5 is much lower as it is a complex of H2 with ThH3. The hydride affinities for x = 2 to 4 are all comparable and near 70 kcal/mol. A natural bond orbital analysis is consistent with a significant Th+-H- ionic contribution to the Th-H bonds. There is very little participation of the 5f orbitals in the bonding and the valence electrons on the Th are dominated by 7s and 6d for the neutrals and anions except for ThH2- where there is a significant contribution from the 7p.

Photoelectron Spectroscopic and Computational Study of the Deprotonated Gallic Acid and Propyl Gallate Anions.

Antioxidants play important roles in eliminating reactive oxygen species (ROS), which have been associated with various degenerative diseases, such as cancer, aging, and inflammatory diseases. Gallic acid (GA) and propyl gallate (PG) are well-known antioxidants and have been widely studied in vitro and in vivo. The biological antioxidant abilities of GA and PG are related to the electronic structure of their dehydro-radicals. In this work, we report a combined photoelectron spectroscopic and computational study of the deprotonated gallic acid anion, [GA - H]-, and deprotonated propyl gallate anion, [PG - H]-. Adiabatic electron affinities of the dehydro-gallic acid radical, [GA - H]· and of the dehydro-propyl gallate radical, [PG - H]·, are measured to be 2.90 ± 0.05 eV and 2.85 ± 0.05 eV, respectively, and compared to computational results.

ThAu2 -, ThAu2O-, and ThAuOH- anions: Photoelectron spectroscopic and theoretical characterization.

The thorium-gold negative ions ThAu2 -, ThAu2O-, and ThAuOH- have been observed and experimentally characterized by anion photoelectron spectroscopy. These experiments are accompanied by extensive ab initio electronic structure calculations using a relativistic composite methodology based primarily on coupled cluster singles and doubles with perturbative triples calculations. The theoretical electron affinities (EAs) at 0 K agree with the experimental adiabatic EAs to within 0.02 eV for all species. Two separate isomers were located in the calculations for ThAuOH-, and detachment from both of these appears to be present in the photoelectron spectrum. Excited electronic states of the neutral molecules are reported at the equation of motion-coupled cluster singles and doubles level of theory. Atomization energies and heats of formation are also calculated for each neutral species and have expected uncertainties of 3 and 4 kcal/mol, respectively. The σ bonds between Th and Au are determined by natural bond orbital analysis to consist of predominately sd hybrids on Th bonding with the Au 6s orbital. In order to investigate the correspondence between the bonding in Th-Au and Th-F molecules, a limited number of calculations were also carried out on most of the F-analogs of this study. These results demonstrate that Au does behave like F in these cases, although the Th-F σ bonds are much more ionic compared to Th-Au. This results in an EA for ThF2 that is 10 kcal/mol smaller than that of ThAu2. The EA values for the Th(IV) species, i.e., ThX2O and ThXOH, only differed, however, by 3-4 kcal/mol.

Interaction of Th with H0/-/+: Combined Experimental and Theoretical Thermodynamic Properties.

High-level electronic structure calculations of the low-lying energy electronic states for ThH, ThH-, and ThH+ are reported and compared to experimental measurements. The inclusion of spin-orbit coupling is critical to predict the ground-state ordering as inclusion of spin-orbit switches the coupled-cluster CCSD(T) ordering of the two lowest energy states for ThH and ThH+. At the multireference spin-orbit SO-CASPT2 level, the ground states of ThH, ThH-, and ThH+ are predicted to be the 2Δ3/2, 3Φ2, and 3Δ1 states, respectively. The adiabatic electron affinity is calculated to be 0.820 eV, and the vertical detachment energy is calculated to be 0.832 eV in comparison to an experimental value of 0.87 ± 0.02 eV. The observed ThH- photoelectron spectrum has many transitions, which approximately correlate with excitations of Th+ and/or Th. The adiabatic ionization energy of ThH including spin-orbit corrections is calculated to be 6.181 eV. The natural bond orbital results are consistent with a significant contribution of the Th+H- ionic configuration to the bonding in ThH. The bond dissociation energies for ThH, ThH-, and ThH+ using the Feller-Peterson-Dixon approach were calculated to be similar for all three molecules and lie between 259 and 280 kJ/mol.

Responding to patient requests for women obstetrician-gynecologists.

Patients may request care from a woman obstetrician-gynecologist for various reasons, including privacy concerns, religious or cultural reasons, and in some cases, a history of abuse. They should be given the opportunity to voice their reasons for requesting a woman obstetrician-gynecologist but should not be compelled to do so. Respect for patient autonomy is a compelling reason to consider honoring a patient's gender-based request. When a patient requests a woman obstetrician-gynecologist, efforts should be made to accommodate the request if possible. However, medical professionals and institutions are not ethically obligated to have a woman obstetrician-gynecologist on call or to make one available at all times. If it is not feasible for a woman obstetrician-gynecologist to provide care because of staffing or other system constraints or patient safety concerns, accommodation is not required, and physicians do not have an overriding responsibility to ensure that patients receive gender-concordant care. Patients have the right to decline care and may choose to seek care elsewhere if their requested healthcare provider type is not available. Institutions and medical clinics should have policies and procedures in place for managing patient requests for women obstetrician-gynecologists, and patients should be made aware of these policies preemptively. These policies and procedures should include information about whom to contact for assistance and how to document the encounter. They should also be accessible and familiar to physicians and trainees. Care should be taken to ensure that adequate educational opportunities in obstetrics and gynecology are available for all medical trainees, regardless of gender.

An Intentionally Designed Walking Program for Seniors Results in Enhanced Community Connection.

Social connection is vital for older adults' physical and psychological well-being, yet nearly one third of them report feeling lonely. The purpose of this study was to evaluate the influence of a monthly walking program (walking once a month for 8 months) on older adults' community connection. Older adults (Mage = 78.06 ± 5.98 years) completed a focus group at the completion of the program (n = 15). Qualitative findings indicate that participation in the walking program led to enhanced social connection. Researchers developed six major themes: (1) frequent and engaging walking programs, (2) benefits of group activity, (3) enhanced social connections, (4) connection to the community, (5) knowledge about transit, and (6) personal well-being, and 10 subthemes. Implications from this study highlight the importance of designing a walking program with older adults' needs and desires in mind.

"Do You Smoke?" Physician-Patient Conversations About Smoking and Lung Cancer.

This study examined how physicians initiated and navigated conversations about smoking with patients with lung cancer. While there are numerous health benefits associated with smoking cessation in patients with advanced lung cancer, conversations about smoking cessation are infrequent and often lack tangible cessation support. We conducted a qualitative inductive content analysis on transcripts of conversations (n = 58) recorded during an initial appointment between a physician and a standardized patient (SP). SPs portrayed a 62-year-old male with lung cancer completing an initial visit with a new physician. Qualitative analysis focused on examining how physicians discussed smoking with a new patient. We found that a majority of physicians initiated conversations about smoking, often during the medical history charting process or during conversations about the lung cancer diagnosis. The content of conversations about smoking generally fits within six categories: assesses smoking status, builds smoking history profile, praises smoking cessation, connects smoking behaviors to diagnosis or treatment, provides empathy or understanding, and presents a negative bias about smoking. We found that while a majority of physicians asked patients about smoking, most physicians aimed for these conversations to be short, routine, and medically driven. Conversations about smoking were not tailored to meet the specific needs of patients with lung cancer, which might include additional provision of support for smoking cessation and recognition of smoking-related stigma.

Is physician implicit bias associated with differences in care by patient race for metastatic cancer-related pain?

RATIONALE: Implicit racial bias affects many human interactions including patient-physician encounters. Its impact, however, varies between studies. We assessed the effects of physician implicit, racial bias on their management of cancer-related pain using a randomized field experiment. METHODS: We conducted an analysis of a randomized field experiment between 2012 and 2016 with 96 primary care physicians and oncologists using unannounced, Black and White standardized patients (SPs)who reported uncontrolled bone pain from metastatic lung cancer. We assessed implicit bias using a pain-adaptation of the race Implicit Association Test. We assessed clinical care by reviewing medical records and prescriptions, and we assessed communication from coded transcripts and covert audiotapes of the unannounced standardized patient office visits. We assessed effects of interactions of physicians' implicit bias and SP race with clinical care and communication outcomes. We conducted a slopes analysis to examine the nature of significant interactions. RESULTS: As hypothesized, physicians with greater implicit bias provided lower quality care to Black SPs, including fewer renewals for an indicated opioid prescription and less patient-centered pain communication, but similar routine pain assessment. In contrast to our other hypotheses, physician implicit bias did not interact with SP race for prognostic communication or verbal dominance. Analysis of the slopes for the cross-over interactions showed that greater physician bias was manifested by more frequent opioid prescribing and greater discussion of pain for White SPs and slightly less frequent prescribing and pain talk for Black SPs with the opposite effect among physicians with lower implicit bias. Findings are limited by use of an unvalidated, pain-adapted IAT. CONCLUSION: Using SP methodology, physicians' implicit bias was associated with clinically meaningful, racial differences in management of uncontrolled pain related to metastatic lung cancer. There is favorable treatment of White or Black SPs, depending on the level of implicit bias.

Photoelectron Spectroscopic Study of Ascorbate and Deprotonated Ascorbate Anions Using an Electrospray Ion Source and a Cryogenically Cooled Ion Trap.

Reactive oxygen species (ROS) in biological systems are formed through a variety of mechanisms. These species are very reactive and have been associated with many diseases, including cancer and cardiovascular disease. One way of removing ROS from the body is through the use of radical scavengers, which are compounds capable of giving up an electron to neutralize the ROS yet form a stable radical species themselves. A common radical scavenger is ascorbic acid, also known as vitamin C. At physiological pH, ascorbic acid is predominately present as the ascorbate anion, C6H7O6-. The ascorbate anion, as well as the dianion (C6H6O62-), is an effective antioxidant due to its ability to donate an electron from a lone pair generated by deprotonation. An electrospray ionization source was added to our pulsed anion photoelectron spectrometer to study ascorbate anions and deprotonated ascorbate dianions via photoelectron spectroscopy. The antioxidant behavior of the ascorbate anion and the deprotonated ascorbate dianion was confirmed based on the experimental vertical detachment energy (VDE), and, therefore, the ionization energy of the anions, 3.85 and 2.68 eV, respectively.

The electron affinity of the uranium atom.

The results of a combined experimental and computational study of the uranium atom are presented with the aim of determining its electron affinity. Experimentally, the electron affinity of uranium was measured via negative ion photoelectron spectroscopy of the uranium atomic anion, U-. Computationally, the electron affinities of both thorium and uranium were calculated by conducting relativistic coupled-cluster and multi-reference configuration interaction calculations. The experimentally determined value of the electron affinity of the uranium atom was determined to be 0.309 ± 0.025 eV. The computationally predicted electron affinity of uranium based on composite coupled cluster calculations and full four-component spin-orbit coupling was found to be 0.232 eV. Predominately due to a better convergence of the coupled cluster sequence for Th and Th-, the final calculated electron affinity of Th, 0.565 eV, was in much better agreement with the accurate experimental value of 0.608 eV. In both cases, the ground state of the anion corresponds to electron attachment to the 6d orbital.

Clofazimine for treatment of multidrug-resistant non-tuberculous mycobacteria.

BACKGROUND: /QUESTION: Nontuberculous mycobacteria (NTM) infections are increasingly detected but difficult to cure given complex drug-resistance patterns. Select U.S. centers have incorporated clofazimine in the treatment of NTM but experience is limited as procurement restrictions hamper widespread use. METHODS: A prospective cohort study was performed in patients diagnosed with pulmonary or extrapulmonary NTM infection and treated with clofazimine between February 2015 and April 2019 at a tertiary referral hospital. Treatment success was defined by a combined outcome of clinical stabilization, microbiologic cure and radiologic improvement. Secondary outcomes included all-cause mortality and time to sputum culture conversion. Uni/multi-variate regression were used to define associations between pre-determined predictor variables and overall treatment outcome. RESULTS: Of 44 patients enrolled, 39 (89 %) received clofazimine along with a median of 3 concomitant antibiotics. Thirty-one (80 %) of patients had pulmonary NTM infection, with Mycobacterium abscessus group and Mycobacterium avium complex being the most common species groups identified. Of 36 people with evaluable outcomes, 35 (97 %) survived and 22 (58 %) had treatment success, including 12 of 19 (63 %) with Mycobacterium abscessus group. In multivariate analysis, patients with Mycobacterium abscessus group were more likely to experience treatment success (OR 18.22, 95%CI 0.972-341.43, p = 0.052), while macrolide resistance predicted a lack of treatment success (OR 0.053, 95%CI 0.003-0.841, p = 0.037). Clofazimine was well-tolerated. CONCLUSION: Adding clofazimine to multi-class antibiotic regimens for drug-resistant NTM infection led to treatment success in the majority treated. Randomized controlled studies are needed to determine the individual impact of clofazimine within an otherwise optimized drug regimen.