The environmental impacts of energetic compounds can be minimized through the design and selection of new energetic materials with favorable fate properties. Building predictive models to inform this process, however, is difficult because of uncertainties and complexities in some major fate-determining transformation reactions such as the alkaline hydrolysis of energetic nitroaromatic compounds (NACs). Prior work on the mechanisms of the reaction between NACs and OH(-) has yielded inconsistent results. In this study, the alkaline hydrolysis of 2,4,6-trinitrotoluene (TNT) and 2,4-dinitroanisole (DNAN) was investigated with coordinated experimental kinetic measurements and molecular modeling calculations. For TNT, the results suggest reversible formation of an initial product, which is likely either a Meisenheimer complex or a TNT anion formed by abstraction of a methyl proton by OH(-). For DNAN, the results suggest that a Meisenheimer complex is an intermediate in the formation of 2,4-dinitrophenolate. Despite these advances, the remaining uncertainties in the mechanisms of these reactions-and potential variability between the hydrolysis mechanisms for different NACs-mean that it is not yet possible to generalize the results into predictive models (e.g., quantitative structure-activity relationships, QSARs) for hydrolysis of other NACs.

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Fertility is often impaired in adolescents and women with cirrhosis, but it is rapidly restored after liver transplantation (LT). Early and unplanned pregnancies confer increased risks to maternal, fetal, and graft health, underscoring the need for reproductive counseling. However, data on reproductive practices or counseling in the LT setting are limited. An anonymous online Qualtrics (Provo, UT) survey was sent to transplant patients and providers to gauge knowledge and practices surrounding contraception and pregnancy. Eligible participants included transplant patients aged 14‐45 years and their transplant providers. Patient response was 50.0% (74/148), 14 of whom were pre‐LT patients and 60 of whom were post‐LT patients. Counseling occurred in 37% of patients prior to transplant and 82% after transplant. Most patients (86%) considered family planning a high priority in their transplant care. Contraception‐ and pregnancy‐specific counseling was provided by LT providers in 60% and 44% of patients, respectively. The most desired mode of counseling by patients was in‐person discussion with an LT provider (89%). Despite most post‐LT patients receiving counseling, only 41% used contraception during the first year after LT, of whom 32% relied on high failure methods. Of the 31/43 (72.1%) provider responses, 96% voiced interest in additional reproductive education. Most providers (90%) correctly advised that patients delay pregnancy during the first year after LT, although misconceptions about safety of estrogen and intrauterine devices were selected by 53% and 42%, respectively. Some favored resources by providers were educational pamphlets in clinic (88%) and automated note templates to prompt family planning inquiry (72%). Transplant patients and providers have key deficiencies in their knowledge of contraception and corresponding practices. Most post‐LT patients receive counseling, yet contraception practices are inadequate for preventing unplanned pregnancy. Discussion with transplant providers was the most favored counseling modality by patients, underscoring our critical role in optimizing post‐LT reproductive care.

Aim: Routine polypectomy is still practiced in many settings. The objective of this study was to establish the frequency of dysplasia or malignancy found in cervical polyps from a multiyear sample after abnormal specimens performed for indication were excluded. Materials & Methods: This is a retrospective study of the pathology results from 2006-2013, inclusive. Results: The study included 898 polyps from 854 nonpregnant women, after the 17 abnormal specimens from women who presented with complaints of abnormal bleeding or for evaluation of abnormal cytological tests were excluded; none of the 898 specimens showed any significant abnormalities. The results did not vary by patient age or polyp size. Conclusion: Routine removal of cervical polyps in asymptomatic women with current, normal cervical cytology testing is unwarranted because it adds little to their management and it has the potential to cause harm.

The government agenda is clear. At the highest level users are involved in policy making. We as service providers need to show evidence that users views are elicited and used to improve the quality of care. The tool bag of techniques used to elicit users views will be explored--questionnaires, structured interviews, focus groups and innovative cognitive techniques such as perception score cards. We explore the continuum of user-led qualitative techniques to provider-led quantitative approaches. Building a framework of techniques which cover the diverse needs of people using a speech and language therapy (SLT) service is a challenge. A greater challenge is using the views of users to bring about meaningful change.

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