Understanding coping and adaptation behaviour of different population groups in the context of global environmental change has become increasingly important, especially in regions with high ...vulnerability such as Sub-Saharan drylands. In this regard, household strategies tend to be dependent on local and context-specific conditions. However, the strategic development of climate change adaptation measures, as well as natural resource and migration management on national and international level require transferable results and recommendations. In this paper, a first attempt is made to address the lack of meta-knowledge and to create a bigger trans-regional picture on the topic. It provides an exploratory and systematic synthesis of quantitative and qualitative data from 63 studies covering more than 9700 rural households from Sub-Saharan African drylands. Relevant household coping and adaptation strategies under different types of environmental change are assessed with a particular focus on the role and relative significance of migration. The results demonstrate that strategies related to crop, livestock, soil and water management are, by far, the most common. Yet, various forms of migration are reported as strategy by about 23% of the households. Corroborated by qualitative findings, this emphasises the importance of migration for responding to unfavourable environmental conditions at the household level. Based on the synthesised literature, future directions for research needed to support socially and ecologically sustainable coping and adaptation are provided.
Most current research on land‐use intensification addresses its potential to either threaten biodiversity or to boost agricultural production. However, little is known about the simultaneous effects ...of intensification on biodiversity and yield. To determine the responses of species richness and yield to conventional intensification, we conducted a global meta‐analysis synthesizing 115 studies which collected data for both variables at the same locations. We extracted 449 cases that cover a variety of areas used for agricultural (crops, fodder) and silvicultural (wood) production. We found that, across all production systems and species groups, conventional intensification is successful in increasing yield (grand mean + 20.3%), but it also results in a loss of species richness (−8.9%). However, analysis of sub‐groups revealed inconsistent results. For example, small intensification steps within low intensity systems did not affect yield or species richness. Within high‐intensity systems species losses were non‐significant but yield gains were substantial (+15.2%). Conventional intensification within medium intensity systems revealed the highest yield increase (+84.9%) and showed the largest loss in species richness (−22.9%). Production systems differed in their magnitude of richness response, with insignificant changes in silvicultural systems and substantial losses in crop systems (−21.2%). In addition, this meta‐analysis identifies a lack of studies that collect robust biodiversity (i.e. beyond species richness) and yield data at the same sites and that provide quantitative information on land‐use intensity. Our findings suggest that, in many cases, conventional land‐use intensification drives a trade‐off between species richness and production. However, species richness losses were often not significantly different from zero, suggesting even conventional intensification can result in yield increases without coming at the expense of biodiversity loss. These results should guide future research to close existing research gaps and to understand the circumstances required to achieve such win‐win or win‐no‐harm situations in conventional agriculture.
To determine the responses of species richness and yield to conventional land‐use intensification, we conducted a global meta‐analysis. Across all production systems (food, fodder, wood), intensification increases yield (+20.3%), but also leads to a loss of species (−8.9%). Within low intensity systems, intensification did not affect yield or richness, while within medium intensity systems, the highest yield increase (+84.9%) and largest richness loss (−22.9%) were found. Conventional intensification often drives a trade‐off between richness and production. However, this meta‐analysis also highlights that—even conventional—intensification can result in yield increases without coming at the expense of biodiversity loss.
Background
Perineal trauma following vaginal birth can be associated with significant short‐term and long‐term morbidity. Antenatal perineal massage has been proposed as one method of decreasing the ...incidence of perineal trauma.
Objectives
To assess the effect of antenatal digital perineal massage on the incidence of perineal trauma at birth and subsequent morbidity.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (22 October 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2012, Issue 10), PubMed (1966 to October 2012), EMBASE (1980 to October 2012) and reference lists of relevant articles.
Selection criteria
Randomised and quasi‐randomised controlled trials evaluating any described method of antenatal digital perineal massage undertaken for at least the last four weeks of pregnancy.
Data collection and analysis
Both review authors independently applied the selection criteria, extracted data from the included studies and assessed study quality. We contacted study authors for additional information.
Main results
We included four trials (2497 women) comparing digital perineal massage with control. All were of good quality. Antenatal digital perineal massage was associated with an overall reduction in the incidence of trauma requiring suturing (four trials, 2480 women, risk ratio (RR) 0.91 (95% confidence interval (CI) 0.86 to 0.96), number needed to treat to benefit (NNTB) 15 (10 to 36)) and women practicing perineal massage were less likely to have an episiotomy (four trials, 2480 women, RR 0.84 (95% CI 0.74 to 0.95), NNTB 21 (12 to 75)). These findings were significant for women without previous vaginal birth only. No differences were seen in the incidence of first‐ or second‐degree perineal tears or third‐/fourth‐degree perineal trauma. Only women who have previously birthed vaginally reported a statistically significant reduction in the incidence of pain at three months postpartum (one trial, 376 women, RR 0.45 (95% CI 0.24 to 0.87) NNTB 13 (7 to 60)). No significant differences were observed in the incidence of instrumental deliveries, sexual satisfaction, or incontinence of urine, faeces or flatus for any women who practised perineal massage compared with those who did not massage.
Authors' conclusions
Antenatal digital perineal massage reduces the likelihood of perineal trauma (mainly episiotomies) and the reporting of ongoing perineal pain, and is generally well accepted by women. As such, women should be made aware of the likely benefit of perineal massage and provided with information on how to massage.
Abstract
The United Nations has declared 2021–2030 the decade on ecosystem restoration with the aim of preventing, stopping and reversing the degradation of the ecosystems of the world, often caused ...by the fragmentation of natural landscapes. Human activities separate and surround habitats, making them too small to sustain viable animal populations or too far apart to enable foraging and gene flow. Despite the need for strategies to solve fragmentation, it remains unclear how to efficiently reconnect nature. In this paper, we illustrate the potential of deep reinforcement learning (DRL) to tackle the spatial optimisation aspect of connectivity conservation planning.
The propensity of spatial optimisation problems to explode in complexity depending on the number of input variables and their states is and will continue to be one of its most serious obstacles. DRL is an emerging class of methods focused on training deep neural networks to solve decision‐making tasks and has been used to learn good heuristics for complex optimisation problems. While the potential of DRL to optimise conservation decisions seems huge, only few examples of its application exist.
We applied DRL to two real‐world raster datasets in a connectivity planning setting, targeting graph‐based connectivity indices for optimisation. We show that DRL converges to the known optimums in a small example where the objective is the overall improvement of the Integral Index of Connectivity and the only constraint is the budget. We also show that DRL approximates high‐quality solutions on a large example with additional cost and spatial configuration constraints where the more complex Probability of Connectivity Index is targeted. To the best of our knowledge, there is no software that can target this index for optimisation on raster data of this size.
DRL can be used to approximate good solutions in complex spatial optimisation problems even when the conservation feature is non‐linear like graph‐based indices. Furthermore, our methodology decouples the optimisation process and the index calculation, so it can potentially target any other conservation feature implemented in current or future software.
Resumen
Las Naciones Unidas han declarado 2021–2030 la década para la restauración ecológica, con el objetivo de prevenir, detener e incluso revertir la degradación de los ecosistemas del mundo. Esta alteración es causada a menudo por la fragmentación de los paisajes naturales. Las actividades humanas dividen y aíslan los hábitats, haciéndolos demasiado pequeños para sustentar poblaciones animales viables o demasiado separados para permitir el forrajeo y el flujo genético. A pesar de la necesidad de estrategias para resolver la fragmentación, sigue sin ser claro cómo reconectar eficazmente a la naturaleza. En este artículo, ilustramos el potencial del Aprendizaje Profundo por Refuerzo (APR) para abordar el aspecto de optimización espacial en la planificación de la conservación de la conectividad.
La propensión de los problemas de optimización espacial a crecer exponencialmente en complejidad en función del número de variables y sus estados es, y seguirá siendo, uno de sus obstáculos más serios. El APR es una clase de métodos para el entrenamiento de redes neuronales profundas con el fin de resolver tareas de toma de decisiones y se ha utilizado para diseñar buenas heurísticas para problemas de optimización complejos. Si bien el potencial de el APR para optimizar las decisiones de conservación parece enorme, actualmente sólo existen unos pocos ejemplos de su aplicación.
En este estudio, aplicamos APR a dos rásteres de cobertura del suelo del mundo real en un entorno de planificación de conectividad, apuntando a la optimización de índices de conectividad basados en grafos. Mostramos que APR converge a los óptimos conocidos en un ejemplo pequeño donde el objetivo es la mejora del Índice Integral de Conectividad y la única restricción es el presupuesto. También, mostramos que APR se aproxima a soluciones de alta calidad en un ejemplo mayor, con restricciones adicionales de costos y de configuración espacial y donde el objetivo es la mejora del Índice de Probabilidad de Conectividad. Hasta donde sabemos, no existe ningún software que pueda optimizar este índice sobre datos ráster del tamaño que nosotros procesamos.
El APR puede utilizarse para aproximar buenas soluciones en problemas complejos de optimización espacial, incluso cuando el objetivo de conservación es no lineal, como lo son los índices basados en grafos. Además, nuestra metodología desvincula el proceso de optimización y el cálculo del índice, por lo que potencialmente puede incorporar cualquier otro objetivo de conservación implementado en el software actual o futuro.
Abstract
STUDY QUESTION
In women with threatened miscarriage, does progesterone supplementation until the completion of the first trimester of pregnancy increase the probability of live birth?
...SUMMARY ANSWER
In women with threatened miscarriage, 400 mg vaginal progesterone nightly, from onset of bleeding until 12 weeks, did not increase live birth rates.
WHAT IS KNOWN ALREADY
Limited evidence has indicated that vaginal micronized progesterone may make little or no difference to the live birth rate when compared with placebo in women with threatened miscarriage. Subgroup analysis of one recent randomized trial reported that in women with bleeding and at least one previous miscarriage, progesterone might be of benefit.
STUDY DESIGN, SIZE, DURATION
We performed a randomized, double-blinded, placebo-controlled trial between February 2012 and April 2019. Eligible pregnant women under 10 weeks gestation, experiencing a threatened miscarriage as apparent from vaginal bleeding were randomized into two groups in a 1:1 ratio: the intervention group received 400 mg progesterone as vaginal pessaries, the control group received placebo vaginal pessaries, both until 12 weeks gestation. The primary endpoint was live birth. We planned to randomize 386 women (193 per group). The study was stopped at a planned interim analysis for futility after randomization of 278 women.
PARTICIPANTS/MATERIALS, SETTING, METHODS
This trial was conducted at the Mater Mothers’ Hospital, a tertiary centre for maternity care in South Brisbane, Queensland, Australia. We randomized 139 women to the intervention group and 139 women to the placebo group. Primary outcome data were available for 136 women in the intervention group and 133 women in the placebo group.
MAIN RESULTS AND THE ROLE OF CHANCE
The live birth rates were 82.4% (112/136) and 84.2% (112/133) in the intervention group and placebo group, respectively (risk ratio (RR) 0.98, 95% CI 0.88 to 1.09; risk difference −0.02, 95% CI −0.11 to 0.07; P = 0.683). Among women with at least one previous miscarriage, live birth rates were 80.6% (54/67) and 84.4% (65/77) (RR 0.95, 95% CI 0.82–1.11; P = 0.550). No significant effect was seen from progesterone in women with two (RR 1.28, 95% CI 0.96–1.72; P = 0.096) or more (RR 0.79, 95% CI 0.53–1.19; P = 0.267) previous miscarriages. Preterm birth rates were 12.9% and 9.3%, respectively (RR 1.38; 95% CI 0.69 to 2.78; P = 0.361). Median birth weight was 3310 vs 3300 g (P = 0.992). There were also no other significant differences in obstetric and perinatal outcomes.
LIMITATIONS, REASONS FOR CAUTION
Our study was single centre and did not reach the planned sample size because it was stopped prematurely at an interim analysis.
WIDER IMPLICATIONS OF THE FINDINGS
We did not find evidence supporting the treatment effect of vaginal progesterone in women with threatened miscarriage. Progesterone in this setting should not be routinely used for threatened miscarriage. The treatment effect in women with threatened miscarriage after previous miscarriages warrants further research.
STUDY FUNDING/COMPETING INTEREST(S)
Mothers’ and babies Golden Casket Clinical Fellowship (L.A.M.). Progesterone and placebo pessaries were provided by Perrigo Australia.
B.W.J.M. reports grants from NHMRC, personal fees from ObsEva, personal fees from Merck KGaA, personal fees from Guerbet, personal fees from iGenomix, outside the submitted work.
TRIAL REGISTRATION NUMBER
ACTRN12611000405910
TRIAL REGISTRATION DATE
19 April 2011
DATE OF FIRST PATIENT’S ENROLMENT
06 February 2012
Background
Postnatal depression is a medical condition that affects many women and the development of their infants. There is a lack of evidence for treatment and prevention strategies that are safe ...for mothers and infants. Certain dietary deficiencies in a pregnant or postnatal woman's diet may cause postnatal depression. By correcting these deficiencies postnatal depression could be prevented in some women. Specific examples of dietary supplements aimed at preventing postnatal depression include: omega‐3 fatty acids, iron, folate, s‐adenosyl‐L‐methionine, cobalamin, pyridoxine, riboflavin, vitamin D and calcium.
Objectives
To assess the benefits of dietary supplements for preventing postnatal depression either in the antenatal period, postnatal period, or both.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2013).
Selection criteria
Randomised controlled trials, involving women who were pregnant or who had given birth in the previous six weeks, who were not depressed or taking antidepressants at the commencement of the trials. The trials could use as intervention any dietary supplementation alone or in combination with another treatment compared with any other preventive treatment, or placebo, or standard clinical care.
Data collection and analysis
Two review authors independently assessed trials for inclusion and assessed the risk of bias for the two included studies. Two review authors extracted data and the data were checked for accuracy.
Main results
We included two randomised controlled trials.
One trial compared oral 100 microgram (µg) selenium yeast tablets with placebo, taken from the first trimester until birth. The trial randomised 179 women but outcome data were only provided for 85 women. Eighty‐three women were randomised to each arm of the trial. Sixty‐one women completed the selenium arm, 44 of whom completed an Edinburgh Postnatal Depression Scale (EPDS). In the placebo arm, 64 women completed the trial, 41 of whom completed an EPDS. This included study (n = 85) found selenium had an effect on EPDS scores but did not reach statistical significance (P = 0.07). There was a mean difference (MD) of ‐1.90 (95% confidence interval (CI) ‐3.92 to 0.12) of the self‐reported EPDS completed by participants within eight weeks of delivery. There was a high risk of attrition bias due to a large proportion of women withdrawing from the study or not completing an EPDS. This included study did not report on any of the secondary outcomes of this review.
The other trial compared docosahexanoic acid (DHA) and eicosapentaenoic acid (EPA) with placebo. The trial randomised 126 women at risk of postpartum depression to three arms: 42 were allocated to EPA, 42 to DHA, and 42 to placebo. Three women in the EPA arm, four in the DHA arm, and one woman in the placebo arm were lost to follow‐up. Women who were found to have major depressive disorder, bipolar disorder, current substance abuse or dependence, suicidal ideation or schizophrenia at recruitment were excluded from the study. The women who discontinued the intervention (five in the EPA arm, four in the DHA arm and seven in the placebo arm) were included in the intention‐to‐treat analysis, while those who were lost to follow‐up were not. Women received supplements or placebo from recruitment at a gestational age of 12 to 20 weeks until their final review visit six to eight weeks postpartum. The primary outcome measure was the Beck Depression Inventory (BDI) score at the fifth visit (six to eight weeks postpartum). No benefit was found for EPA‐rich fish oil (MD 0.70, 95% CI ‐1.78 to 3.18) or DHA‐rich fish oil supplementation (MD 0.90, 95% CI ‐1.33 to 3.13) in preventing postpartum depression. No difference was found in the effect on postnatal depression comparing EPA with DHA (MD ‐0.20, 95% CI ‐2.61 to 2.21). No benefit or significant effect was found in terms of the secondary outcomes of the presence of major depressive disorder at six to eight weeks postpartum, the number of women who commenced antidepressants, maternal estimated blood loss at delivery or admission of neonates to the neonatal intensive care unit.
Authors' conclusions
There is insufficient evidence to conclude that selenium, DHA or EPA prevent postnatal depression. There is currently no evidence to recommend any other dietary supplement for prevention of postnatal depression.
Biodiversity studies are sensitive to well‐recognised temporal and spatial scale dependencies. Cross‐study syntheses may inflate these influences by collating studies that vary widely in the numbers ...and sizes of sampling plots. Here we evaluate sources of inaccuracy and imprecision in study‐level and cross‐study estimates of biodiversity differences, caused by within‐study grain and sample sizes, biodiversity measure, and choice of effect‐size metric. Samples from simulated communities of old‐growth and secondary forests demonstrated influences of all these parameters on the accuracy and precision of cross‐study effect sizes. In cross‐study synthesis by formal meta‐analysis, the metric of log response ratio applied to measures of species richness yielded better accuracy than the commonly used Hedges' g metric on species density, which dangerously combined higher precision with persistent bias. Full‐data analyses of the raw plot‐scale data using multilevel models were also susceptible to scale‐dependent bias. We demonstrate the challenge of detecting scale dependence in cross‐study synthesis, due to ubiquitous covariation between replication, variance and plot size. We propose solutions for diagnosing and minimising bias. We urge that empirical studies publish raw data to allow evaluation of covariation in cross‐study syntheses, and we recommend against using Hedges' g in biodiversity meta‐analyses.
Biodiversity studies are sensitive to well‐recognised temporal and spatial scale dependencies. Here we demonstrate by simulation and empirical examination that cross‐study syntheses amplify within‐study scale bias when they incorporate scale‐dependent measures of within‐study variance. We provide guidance for treating scale dependence in cross‐study syntheses of biodiversity differences, and for appraising existing syntheses.
Postpartum urinary retention (PPUR) (also known as voiding dysfunction) is a common problem, defined as the inability to completely void after giving birth. If voiding dysfunction is not recognised, ...bladder overdistension can lead to denervation, detrusor atony and prolonged voiding dysfunction.
To describe the incidence of PPUR amongst postpartum women undergoing routine bladder scanning and to identify the factors that lead to postpartum voiding dysfunction.
A retrospective analysis of all postpartum women at Mater Health Services, Brisbane between February and December 2012 was undertaken. Routinely collected postvoid residual bladder volumes (PVRBV) were reported using a bladder scanner at four and six hours and two to three days postbirth or following removal of an indwelling catheter (IDC). The characteristics of women with or without increased PVRBV were analysed.
Postvoid residual bladder volumes at four-hours postbirth/removal of IDC were available for 5558 women of whom 281 (5.1%) had a residual volume measured >150 mL. Obstetric factors explored included mode of birth, method of analgesia or anaesthesia, duration of labour, degree of perineal trauma, birth weight, gestation, parity, maternal age and body mass index. After controlling for confounders, nulliparity (aOR 1.53; 95% CI 1.05-2.26), birth by caesarean section (aOR 2.21; 95% CI 1.10-4.41) and 3rd/4th degree perineal trauma (aOR 2.01; 95% CI 1.09-3.72) were significant independent predictors of PPUR.
Following the introduction of a protocol of timed voiding and routine measurement of PVRBV after birth/removal of IDC, PPUR is uncommon. Adopting a risk-factor-based approach to PVRBV screening is not supported by these data.
The share of renewables in the primary energy demand of Germany has increased from 1.3% in 1990 to 11.7% in 2013. The plans are to increase it further, by the year 2050, to 50% or even 100%, by ...carrying out the national Energiewende (energy change/switch) programme. In this paper we analyze the current energy scenario and recall goals of the Energiewende programme. We also identify infrastructural and technological bottlenecks which are likely to affect the programme execution. By doing so, the enormous scale of this national venture becomes apparent and it is clear that its execution will last for several generations and perhaps even for a century or two. Additionally, we introduce an idea of Exclusively Green Energy Communities (EGECs) as an Energiewende mile-stone. Due to the dimensions of the tasks, the energy change/switch programme will last for several generations and perhaps even for a century or two. Realization of this overwhelming national venture has to proceed through milestones and demonstration projects. We propose demo-projects, called Green Energy Communities (GECs), to examine with what efforts and under what constraints such communities can operate using exclusively renewable forms of energy.
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