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A history of psychologically traumatic experiences can impact health outcomes for pregnant people and their infants. The perception and prevalence of traumatic experiences during pregnancy may differ by geographical region. To better understand trends in how and what kinds of psychological trauma are assessed globally, we conducted a secondary analysis on a larger systematic review examining psychological trauma measurement in pregnancy. Through a systematic literature review conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, completed between July 2021 and September 2023 using Ovid MEDLINE, Ovid EMBASE, Scopus, Web of Science, PsycInfo and Cochrane, we identified 576 research studies assessing psychological trauma during pregnancy that were conducted across nine geopolitical regions. Most of these studies took place in North America, followed by sub-Saharan Africa, Europe, Asia, the Middle East or Northern Africa, Oceania, South America, and Central America. The fewest number of studies was conducted across multiple regions. We found that most studies measuring psychological trauma in pregnancy across the nine geopolitical regions assessed interpersonal trauma, and the fewest number of studies assessed healthcare trauma. Moreover, for each type of psychological trauma assessed, the greatest number of studies was conducted in North America. We also found that Central America, Oceania, sub-Saharan Africa, Asia, Middle East or Northern Africa, Europe, and studies conducted across multiple regions had one-third or more studies that only used in-house assessments, rather than previously validated assessments of psychological trauma. The results of this review emphasize the need for regionally specific and culturally appropriate measures of psychological trauma for pregnant people, which prioritize the types of psychological trauma that are most common in a given region. Newly developed measures can be used for screening and treatment of patients using trauma-informed obstetric care.
The relevance of education and outreach (E&O) activities about the Antarctic Treaty has been recognized at the Antarctic Treaty Consultative Meetings (ATCM) and at the Committee for Environmental Protection (CEP). This study examines the key topics and the target audiences detailed in papers submitted to the ATCM on E&O. Since the Antarctic Treaty entered into force in 1961, a total of 216 ATCM papers on E&O have been produced. The number of papers has increased substantially since the mid-1990s. ‘Science’ (76.9%) and ‘Wildlife/Biodiversity/Environment’ (75.5%) were the most addressed topics in these papers, while the ‘Public’ (81.0%) and those attending ‘Schools’ (69.0%) are the main target audiences. ‘Science’ in ATCM papers increased ~120-fold from 1961–1997 to 2015–2023, while ATCM papers discussing engagement with the ‘Public’ increased ~40-fold during the same period. ‘Climate change’ was first mentioned in 2006, and the number of papers per year increased fourfold by 2015–2023. This study shows the increasing interest in E&O through time, addressing key topics to relevant audiences related to the Antarctic region. From an educational perspective, attention should be paid to emerging topics (e.g. equity, diversity and inclusion), and the engagement of early-career professionals and educators should be made a priority.
This study investigates the interaction between a freely rising, deformable bubble and a freely settling particle of the same size due to gravity. Initially, an in-line configuration is considered while varying the Bond, Galilei and Archimedes numbers. The study shows that as the bubble and particle approach each other, a liquid film forms between them that undergoes drainage. The formation of the liquid film leads to dissipation of kinetic energy, and for sufficiently large bubble velocities, particle flotation takes place. Increasing the Bond number causes the bubble to deform more severely, which may allow the particle to pass through the bubble as it ruptures. This work also considers an offset configuration, which shows that the bubble slides away from the particle, affecting its settling trajectory.
A surveillance system for measuring patient-level antimicrobial adverse drug events (ADE) may support stewardship activities, however, design and implementation questions remain. In this national survey, stewardship experts favored simple, laboratory-based ADE definitions although there were tensions between feasibility, ability to identify attribution without chart review, and importance of specific ADE.
Metabolic and inflammatory dysfunction is prevalent in middle-aged people with major mood disorders, but less is known about young people. We investigated the trajectories of sensitive metabolic (Homeostatic Model Assessment for Insulin Resistance [HOMA2-IR]) and inflammatory markers (C-reactive protein [CRP]) in 155 young people (26.9 ± 5.6 years) accessing mental health services. We examined demographic and clinical correlates, longitudinal trajectories and relationships with specific illness subtypes. Additionally, we compared the HOMA2-IR with fasting blood glucose (FBG) for sensitivity. We observed a significant increase in HOMA2-IR and CRP over time with higher baseline levels predicting greater increases, although the rate of increase diminished in those with higher baseline levels. Body mass index predicted increases in HOMA2-IR (p < 0.001), but not CRP (p = 0.135). Multinomial logistic regression revealed that higher HOMA2-IR levels were associated with 2.3-fold increased odds of the “circadian-bipolar spectrum” subtype (p = 0.033), while higher CRP levels were associated with a reduced risk of the “neurodevelopmental psychosis” subtype (p = 0.033). Standard FBG measures were insensitive in detecting early metabolic dysregulation in young people with depression. The study supports the use of more sensitive markers of metabolic dysfunction to address the longitudinal relationships between immune-metabolic dysregulation and mood disorders in young people.
Faecal examinations for helminth eggs were performed on 1869 people from two riverside localities, Vientiane Municipality and Saravane Province, along the Mekong River, Laos. To obtain adult flukes, 42 people positive for small trematode eggs (Opisthorchis viverrini, heterophyid, or lecithodendriid eggs) were treated with a 20–30 mg kg−1 single dose of praziquantel and purged. Diarrhoeic stools were then collected from 36 people (18 in each area) and searched for helminth parasites using stereomicroscopes. Faecal examinations revealed positive rates for small trematode eggs of 53.3% and 70.8% (average 65.2%) in Vientiane and Saravane Province, respectively. Infections with O. viverrini and six species of intestinal flukes were found, namely, Haplorchistaichui, H. pumilio, H. yokogawai, Centrocestus caninus,Prosthodendrium molenkampi, and Phaneropsolus bonnei. The total number of flukes collected and the proportion of fluke species recovered were markedly different in the two localities; in Vientiane, 1041 O. viverrini (57.8 per person) and 615 others (34.2 per person), whereas in Saravane, 395 O. viverrini (21.9 per person) and 155207 others (8622.6 per person). Five people from Saravane harboured no O. viverrini but numerous heterophyid and/or lecithodendriid flukes. The results indicate that O. viverrini and several species of heterophyid and lecithodendriid flukes are endemic in these two riverside localities, and suggest that the intensity of infection and the relative proportion of fluke species vary by locality along the Mekong River basin.
To examine the feasibility of implementing a cardiorespiratory exercise stimulus during functional Magnetic Resonance Imaging (fMRI).
Participants and Methods:
12 young adults (age: 18-22 years) completed progressive maximal exercise testing and a brain MRI scan. During scanning, participants completed three runs of functional MRI (volumes = 619; TR = 800 ms; multiband = 4; voxel size = 3 mm3). During each 8 minute fMRI run, participants completed an exercise challenge consisting of alternating blocks of exercise and rest. Exercise was implemented with a cardiostepper, an MRI-compatible device (similar to a Stairmaster) capable of generating a cardiorespiratory exercise stimulus. During exercise blocks, participants stepped at a rate of 60 Hz with pedal resistance determined by participants' fitness level. Heart rate and respiration data were collected during MRI. fMRI data were processed and analyzed using FMRIB Software Library (FSL). The ARtifact Detection Toolbox (ART) software was also used to identify volumes with significant artifact, and ICA-AROMA was used to remove motion-related BOLD signal components.
Results:
During exercise blocks, heart rate increased (mean = 131 beats per minute) compared to rest (mean = 87 beats per minute; t(34) = 4.3; p < .001). The mean heart rate during exercise blocks corresponds to an exercise intensity in the light to moderate intensity range for this age group. Motion (median framewise displacement) was significantly higher during exercise (mean = .53 mm) than rest (mean = .36 mm). Across all blocks, ART classified 19.8% of brain volumes as artifact-containing outliers, with 69% of the outliers occurring during exercise blocks. Although greater head motion was observed during exercise, the use of ICA-AROMA reduced the impact of motion considerably, recovering an additional 25% of the task-related signal, relative to noise. Comparison of fMRI activity during exercise versus rest revealed significant associations with primary and supplementary motor cortices, hippocampus, and the insula, among other regions.
Conclusions:
The current study demonstrates the feasibility of eliciting light to moderate intensity cardiorespiratory exercise (using a lower body stepping exercise) during functional MRI. Although increased head motion was observed during exercise compared to rest, the degree of head motion was roughly approximate to the values published in previous fMRI studies and post image acquisition processing improved task-related signal. During exercise, increased brain activation was observed in regions associated with the central command network, which regulates autonomic nervous system and musculoskeletal function during exercise.
We identify a set of essential recent advances in climate change research with high policy relevance, across natural and social sciences: (1) looming inevitability and implications of overshooting the 1.5°C warming limit, (2) urgent need for a rapid and managed fossil fuel phase-out, (3) challenges for scaling carbon dioxide removal, (4) uncertainties regarding the future contribution of natural carbon sinks, (5) intertwinedness of the crises of biodiversity loss and climate change, (6) compound events, (7) mountain glacier loss, (8) human immobility in the face of climate risks, (9) adaptation justice, and (10) just transitions in food systems.
Technical summary
The Intergovernmental Panel on Climate Change Assessment Reports provides the scientific foundation for international climate negotiations and constitutes an unmatched resource for researchers. However, the assessment cycles take multiple years. As a contribution to cross- and interdisciplinary understanding of climate change across diverse research communities, we have streamlined an annual process to identify and synthesize significant research advances. We collected input from experts on various fields using an online questionnaire and prioritized a set of 10 key research insights with high policy relevance. This year, we focus on: (1) the looming overshoot of the 1.5°C warming limit, (2) the urgency of fossil fuel phase-out, (3) challenges to scale-up carbon dioxide removal, (4) uncertainties regarding future natural carbon sinks, (5) the need for joint governance of biodiversity loss and climate change, (6) advances in understanding compound events, (7) accelerated mountain glacier loss, (8) human immobility amidst climate risks, (9) adaptation justice, and (10) just transitions in food systems. We present a succinct account of these insights, reflect on their policy implications, and offer an integrated set of policy-relevant messages. This science synthesis and science communication effort is also the basis for a policy report contributing to elevate climate science every year in time for the United Nations Climate Change Conference.
Social media summary
We highlight recent and policy-relevant advances in climate change research – with input from more than 200 experts.
Clinical guidelines recommend device removal for cardiovascular implantable electronic device (CIED) infection management. In this retrospective, nationwide cohort, 60.8% of CIED infections received guideline-concordant care. One-year mortality was higher among those without procedural management (25% vs 16%). Factors associated with receipt of device procedures included pocket infections and positive microbiology.
Much attention in recent years has focused on the extent to which the risk of metabolic disturbances, and most fundamentally of glucose and insulin, are prevalent among those treated for depressive and other mood disorders (Osimo et al., 2021; Scott et al., 2019; Tickell et al., 2022). Public concern has also focused on the increased rates of premature mortality in those with chronic depression and other major mental disorders, with a significant proportion of that risk being due to early-onset cardiovascular disease (particularly among women). A common assumption is that much of this risk is a consequence of medical treatments for depression, and their possible adverse effects such as increased risk of diabetes, presumably mediated by long-term weight gain.
This meta-analysis aimed to consolidate existing data from randomised controlled trials on hypoplastic left heart syndrome.
Methods:
Hypoplastic left heart syndrome specific randomised controlled trials published between January 2005 and September 2021 in MEDLINE, EMBASE, and Cochrane databases were included. Regardless of clinical outcomes, we included all randomised controlled trials about hypoplastic left heart syndrome and categorised them according to their results. Two reviewers independently assessed for eligibility, relevance, and data extraction. The primary outcome was mortality after Norwood surgery. Study quality and heterogeneity were assessed. A random-effects model was used for analysis.
Results:
Of the 33 included randomised controlled trials, 21 compared right ventricle-to-pulmonary artery shunt and modified Blalock–Taussig-Thomas shunt during the Norwood procedure, and 12 regarded medication, surgical strategy, cardiopulmonary bypass tactics, and ICU management. Survival rates up to 1 year were superior in the right ventricle-to-pulmonary artery shunt group; this difference began to disappear at 3 years and remained unchanged until 6 years. The right ventricle-to-pulmonary artery shunt group had a significantly higher reintervention rate from the interstage to the 6-year follow-up period. Right ventricular function was better in the modified Blalock–Taussig-Thomas shunt group 1–3 years after the Norwood procedure, but its superiority diminished in the 6-year follow-up. Randomised controlled trials regarding medical treatment, surgical strategy during cardiopulmonary bypass, and ICU management yielded insignificant results.
Conclusions:
Although right ventricle-to-pulmonary artery shunt appeared to be superior in the early period, the two shunts applied during the Norwood procedure demonstrated comparable long-term prognosis despite high reintervention rates in right ventricle-to-pulmonary artery shunt due to pulmonary artery stenosis. For medical/perioperative management of hypoplastic left heart syndrome, further randomised controlled trials are needed to deliver specific evidence-based recommendations.
Despite their documented efficacy, substantial proportions of patients discontinue antidepressant medication (ADM) without a doctor's recommendation. The current report integrates data on patient-reported reasons into an investigation of patterns and predictors of ADM discontinuation.
Methods
Face-to-face interviews with community samples from 13 countries (n = 30 697) in the World Mental Health (WMH) Surveys included n = 1890 respondents who used ADMs within the past 12 months.
Results
10.9% of 12-month ADM users reported discontinuation-based on recommendation of the prescriber while 15.7% discontinued in the absence of prescriber recommendation. The main patient-reported reason for discontinuation was feeling better (46.6%), which was reported by a higher proportion of patients who discontinued within the first 2 weeks of treatment than later. Perceived ineffectiveness (18.5%), predisposing factors (e.g. fear of dependence) (20.0%), and enabling factors (e.g. inability to afford treatment cost) (5.0%) were much less commonly reported reasons. Discontinuation in the absence of prescriber recommendation was associated with low country income level, being employed, and having above average personal income. Age, prior history of psychotropic medication use, and being prescribed treatment from a psychiatrist rather than from a general medical practitioner, in comparison, were associated with a lower probability of this type of discontinuation. However, these predictors varied substantially depending on patient-reported reasons for discontinuation.
Conclusion
Dropping out early is not necessarily negative with almost half of individuals noting they felt better. The study underscores the diverse reasons given for dropping out and the need to evaluate how and whether dropping out influences short- or long-term functioning.
The effect of surfactants on the flow characteristics during rapid drop formation in a microchannel is investigated using high-speed imaging, micro-particle image velocimetry and numerical simulations; the latter are performed using a three- dimensional multiphase solver that accounts for the transport of soluble surfactants in the bulk and at the interface. Drops are generated in a flow-focusing microchannel, using silicone oil ($4.6$ mPa s) as the continuous phase and a 52 % w/w glycerol solution as the dispersed phase. A non-ionic surfactant (Triton X-100) is dissolved in the dispersed phase at concentrations below and above the critical micelle concentration. Good agreement is found between experimental and numerical data for the drop size, drop formation time and circulation patterns. The results reveal strong circulation patterns in the forming drop in the absence of surfactants, whose intensity decreases with increasing surfactant concentration. The surfactant concentration profiles in the bulk and at the interface are shown for all stages of drop formation. The surfactant interfacial concentration is large at the front and the back of the forming drop, while the neck region is almost surfactant free. Marangoni stresses develop away from the neck, contributing to changes in the velocity profile inside the drop.
We study the effect of insoluble surfactants on the impact of surfactant-free droplets onto surfactant-laden thin liquid films via a fully three-dimensional direct numerical simulation approach that employs a hybrid interface-tracking/level-set method, and by taking into account surfactant-induced Marangoni stresses due to gradients in interfacial surfactant concentration. Our numerical predictions for the temporal evolution of the surfactant-free crown are validated against the experimental work by Che & Matar (Langmuir, vol. 33, 2017, pp. 12140–12148). We focus on the ‘crown-splash regime’, and we observe that the crown dynamics evolves through various stages: from the growth of linear modes (through a Rayleigh–Plateau instability) to the development of nonlinearities leading to primary and secondary breakup events (through droplet shedding modulated by an end-pinching mechanism). We show that the addition of surfactants does not affect the wave selection via the Rayleigh–Plateau instability. However, the presence of surfactants plays a key role in the late stages of the dynamics as soon as the ligaments are driven out from the rim. Surfactant-induced Marangoni stresses delay the end-pinching mechanisms to result in longer ligaments prior to their capillary singularity. Our results indicate that Marangoni stresses bridge the gap between adjacent protrusions promoting the adjacent protrusions' collision and the merging of ligaments. Finally, we demonstrate that the addition of surfactants leads to surface rigidification and consequently to the retardation of the flow dynamics.
This chapter describes the grammar of groups and phrases in Korean – covering nominal groups, verbal groups, adverbial groups and co-verbal phrases. The function structure of each unit is introduced and their meaning potential is formalised in system networks. The realisation of systems by function structures and their realisation in turn by words and morphemes or by embedded groups or clauses is outlined. Korean morphology is brought into the picture to clarify the realisation of choices for meaning at group/phrase rank.
This chapter focuses on grammatical resources for construing experience – transitivity. It begins with a basic introduction to experiential clause structure, covering participants, processes and circumstances. It then presents the distinctive structures of material, mental, relational and verbal clauses. The meaning potential of each clause type is consolidated in a system network whose realisation in structure is specified. Following a discussion of diathesis (covering voice and causatives), a range of types of circumstance are surveyed.