Vasa praevia (VP) is a rare but potentially devastating obstetric complication. Indeed, if undiagnosed it is associated with up to a 60% rate of perinatal mortality, typically near term in an ...otherwise healthy infant. The rarity of the condition and lack of recognition of risk factors has inhibited systematic prenatal diagnosis. Sonographic diagnosis of VP is possible and quite accurate.
Placenta accreta spectrum (PAS) is among the most feared causes of maternal morbidity worldwide, and yet few prospective data are available to inform best practice. PAS is rare enough that rigorous ...study in a single center is difficult, but common enough that most obstetric hospitals now encounter PAS. Management and outcomes vary strikingly between hospitals and best practice, regrettably, is guided more by expert consensus than by level I evidence.
Traditional police culture (TPC) is a set of attitudes and values, developed as coping mechanisms for police work's unique and inherent strains, that fosters distrust toward, and isolation from, ...citizens. An online survey of 781 American police officers from 48 U.S. states is used to assess: first, the individual, organizational, and contextual correlates of endorsement of TPC, and second, whether endorsement of TPC relates to support for the use of force and support for procedurally just tactics. Results indicate that, apart from supervisor status and supervisor race, individual-level officer characteristics are not related to endorsement of TPC. By contrast, organizational factors-agency size and type-relate to endorsement of TPC among line officers, but not supervisors. Results also indicate that support for use of force and support for procedural justice are strongly linked to TPC endorsement among both line officers and managers.
Depression and anxiety impact up to 1 in 5 pregnant and postpartum women worldwide. Yet, as few as 20% of these women are treated with frontline interventions such as evidence-based psychological ...treatments. Major barriers to uptake are the limited number of specialized mental health treatment providers in most settings, and problems with accessing in-person care, such as childcare or transportation. Task sharing of treatment to non-specialist providers with delivery on telemedicine platforms could address such barriers. However, the equivalence of these strategies to specialist and in-person models remains unproven.
This study protocol outlines the Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) randomized trial. SUMMIT is a pragmatic, non-inferiority test of the comparable effectiveness of two types of providers (specialist vs. non-specialist) and delivery modes (telemedicine vs. in-person) of a brief, behavioral activation (BA) treatment for perinatal depressive and anxiety symptoms. Specialists (psychologists, psychiatrists, and social workers with ≥ 5 years of therapy experience) and non-specialists (nurses and midwives with no formal training in mental health care) were trained in the BA protocol, with the latter supervised by a BA expert during treatment delivery. Consenting pregnant and postpartum women with Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 10 (N = 1368) will be randomized to one of four arms (telemedicine specialist, telemedicine non-specialist, in-person specialist, in-person non-specialist), stratified by pregnancy status (antenatal/postnatal) and study site. The primary outcome is participant-reported depressive symptoms (EPDS) at 3 months post-randomization. Secondary outcomes are maternal symptoms of anxiety and trauma symptoms, perceived social support, activation levels and quality of life at 3-, 6-, and 12-month post-randomization, and depressive symptoms at 6- and 12-month post-randomization. Primary analyses are per-protocol and intent-to-treat. The study has successfully continued despite the COVID-19 pandemic, with needed adaptations, including temporary suspension of the in-person arms and ongoing randomization to telemedicine arms.
The SUMMIT trial is expected to generate evidence on the non-inferiority of BA delivered by a non-specialist provider compared to specialist and telemedicine compared to in-person. If confirmed, results could pave the way to a dramatic increase in access to treatment for perinatal depression and anxiety.
ClinicalTrials.gov NCT04153864 . Registered on November 6, 2019.
This study explores the moralization of purity and perceptions of harm as constraints on sex buying among men. Purchasing sex has long been considered an offense against public morality. While ...personal morality provides a powerful constraint on offending, and people may vary in the extent to which they experience moral intuitions about bodily and spiritual purity, research has so far neglected the role of purity moralization in understanding sex buying behavior. We hypothesize specifically that moral intuitions about purity constrain sex buying by leading people to perceive it as inherently wrong and by eliciting perceptions that sex buying is harmful to prostitutes. We test these hypotheses in a nationally representative survey of U.S. men (N = 2,525). Results indicate that purity moralization is associated with reduced sex buying, and that this relationship is mediated fully by perceptions of sex buying as harming prostitutes.
Sustained rate-coded signals encode many types of sensory modalities. Some sensory synapses possess specialized ribbon structures, which tether vesicles, to enable high-frequency signaling. However, ...central synapses lack these structures, yet some can maintain signaling over a wide bandwidth. To analyze the underlying molecular mechanisms, we investigated the function of the active zone core component Bassoon in cerebellar mossy fiber to granule cell synapses. We show that short-term synaptic depression is enhanced in Bassoon knockout mice during sustained high-frequency trains but basal synaptic transmission is unaffected. Fluctuation and quantal analysis as well as quantification with constrained short-term plasticity models revealed that the vesicle reloading rate was halved in the absence of Bassoon. Thus, our data show that the cytomatrix protein Bassoon speeds the reloading of vesicles to release sites at a central excitatory synapse.
► Generation of a transgenic mouse line that lacks Bassoon ► Normal basal transmission at mossy fiber to granule cell synapses in Bassoon mutants ► Enhanced synaptic depression within milliseconds during high-frequency transmission ► Halved rate of vesicle reloading at active zones in Bassoon knockout mice
In vivo, cortical pyramidal cells are bombarded by asynchronous synaptic input arising from ongoing network activity. However, little is known about how such 'background' synaptic input interacts ...with nonlinear dendritic mechanisms. We have modified an existing model of a layer 5 (L5) pyramidal cell to explore how dendritic integration in the apical dendritic tuft could be altered by the levels of network activity observed in vivo. Here we show that asynchronous background excitatory input increases neuronal gain and extends both temporal and spatial integration of stimulus-evoked synaptic input onto the dendritic tuft. Addition of fast and slow inhibitory synaptic conductances, with properties similar to those from dendritic targeting interneurons, that provided a 'balanced' background configuration, partially counteracted these effects, suggesting that inhibition can tune spatio-temporal integration in the tuft. Excitatory background input lowered the threshold for NMDA receptor-mediated dendritic spikes, extended their duration and increased the probability of additional regenerative events occurring in neighbouring branches. These effects were also observed in a passive model where all the non-synaptic voltage-gated conductances were removed. Our results show that glutamate-bound NMDA receptors arising from ongoing network activity can provide a powerful spatially distributed nonlinear dendritic conductance. This may enable L5 pyramidal cells to change their integrative properties as a function of local network activity, potentially allowing both clustered and spatially distributed synaptic inputs to be integrated over extended timescales.
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