Perinatal loss is often a traumatic outcome for families. While there are limited data about depressive outcomes in small populations, information about depression and posttraumatic stress disorder ...among large racially and economically diverse populations is sparse.
We collaborated with the Michigan Department of Community Health to conduct a longitudinal survey of bereaved mothers with stillbirth or infant death under 28 days of life and live-birth (control) mothers in Michigan. The study assessed 9-month mental health outcomes including self-reported symptoms of depression and posttraumatic stress disorder along with information about demographics, pregnancy and loss experience, social support, and past and present mental health and treatment.
Of 1400 women contacted by the State of Michigan, 609 completed surveys and were eligible to participate for a 44% response rate (377 bereaved mothers and 232 control mothers with live births). In multivariable analysis, bereaved women had nearly 4-fold higher odds of having a positive screen for depression and 7-fold higher odds of a positive screen for post-traumatic stress disorder after controlling for demographic and personal risk variables. A minority of screen-positive women were receiving any type of psychiatric treatment.
This is the largest epidemiologically based study to date to measure the psychological impact of perinatal loss. Nine months after a loss, bereaved women showed high levels of distress with limited rates of treatment. Symptoms need to be monitored over time for persisting disorder and further research should identify women at highest risk for poor outcomes.
Objective: Depression among pregnant women is a prevalent public health problem associated with poor maternal and offspring development. Behavioral activation (BA) is a scalable intervention aligned ...with pregnant women's preference for nonpharmacological depression care. This is the first test of the effectiveness of BA for depression among pregnant women, which aimed to evaluate the effectiveness of BA as compared with treatment as usual (TAU). Method: Pregnant women (mean age = 28.75 years; SD = 5.67) with depression symptoms were randomly assigned to BA (n = 86) or TAU (n = 77). Exclusion criteria included known bipolar or psychotic disorder or immediate self-harm risk. Follow-up assessment occurred 5 and 10 weeks postrandomization and 3 months postpartum using self-report measures of primary and secondary outcomes and putative targets. Results: Compared with TAU, BA was associated with significantly lower depressive symptoms (d = 0.34, p = .04) and higher remission (56.3% vs. 30.3%, p = .003). BA also demonstrated significant advantage on anxiety and perceived stress. Participants attended most BA sessions and reported high satisfaction. Participants in BA reported significantly higher levels of activation (d = 0.69, p < .0002) and environmental reward (d = 0.54, p < .003) than those who received TAU, and early change in both of these putative targets significantly mediated subsequent depression outcomes. Conclusions: BA is effective for pregnant women, offering significant depression, anxiety, and stress benefits, with mediation analyses supporting the importance of putative targets of activation and environmental reward.
What is the public health significance of this article?
This study suggests that behavioral activation (BA) is an effective treatment for pregnant women with elevated depressive symptoms. Compared with usual care, women receiving BA reported clinically significant improvements in depressive, anxiety, and stress symptoms.
ABSTRACT We present spectral analyses of five Nuclear Spectroscopic Telescope Array and Swift observations of GX 339-4 taken during a failed outburst during the summer of 2013. These observations ...cover Eddington luminosity fractions in the range 0.9%-6%. Throughout this outburst GX 339-4 stayed in the hard state and all five observations show similar X-ray spectra, with a hard power law with a photon index near 1.6, and significant contribution from reflection. Using simple reflection models we find unrealistically high iron abundances. Allowing for different photon indices for the continuum incident on the reflector relative to the underlying observed continuum results in a statistically better fit and reduced iron abundances. With a photon index around 1.3, the input power law on the reflector is significantly harder than that which is directly observed. We study the influence of different emissivity profiles and geometries and consistently find an improvement when using separate photon indices. The inferred inner accretion disk radius is strongly model dependent, but we do not find evidence for a truncation radius larger than in any model. The data do not allow independent spin constraints, but the results are consistent with the literature (i.e., ). Our best-fit models indicate an inclination angle in the range 40°-60°, consistent with limits on the orbital inclination but higher than reported in the literature using standard reflection models. The iron line around 6.4 keV is clearly broadened, and we detect a superimposed narrow core as well. This core originates from a fluorescent region outside the influence of the strong gravity of the black hole. Additionally, we discuss possible geometries.
ABSTRACT Recently, unresolved hard (20-40 keV) X-ray emission has been discovered within the central 10 pc of the Galaxy, possibly indicating a large population of intermediate polars (IPs). Chandra ...and XMM-Newton measurements in the surrounding ∼50 pc imply a much lighter population of IPs with . Here we use broadband NuSTAR observations of two IPs: TV Columbae, which has a fairly typical but widely varying reported mass of - , and IGR J17303-0601, with a heavy reported mass of - . We investigate how varying spectral models and observed energy ranges influences estimated white dwarf mass. Observations of the inner 10 pc can be accounted for by IPs with , consistent with that of the CV population in general and the X-ray observed field IPs in particular. The lower mass derived by Chandra and XMM-Newton appears to be an artifact of narrow energy-band fitting. To explain the (unresolved) central hard X-ray emission (CHXE) by IPs requires an X-ray (2-8 keV) luminosity function (XLF) extending down to at least 5 × 1031 erg s−1. The CHXE XLF, if extended to the surrounding ∼50 pc observed by Chandra and XMM-Newton, requires that at least ∼20%-40% of the ∼9000 point sources are IPs. If the XLF extends just a factor of a few lower in luminosity, then the vast majority of these sources are IPs. This is in contrast to recent observations of the Galactic ridge, where the bulk of the 2-8 keV emission is ascribed to non-magnetic CVs.
A long duration gamma-ray burst, GRB 160530A, was detected by the Compton Spectrometer and Imager (COSI) during the 2016 COSI Super Pressure Balloon campaign. As a Compton telescope, COSI is ...inherently sensitive to the polarization of gamma-ray sources in the energy range 0.2-5.0 MeV. We measured the polarization of GRB 160530A using (1) a standard method (SM) based on fitting the distribution of azimuthal scattering angles with a modulation curve and (2) an unbinned, maximum likelihood method (MLM). In both cases, the measured polarization level was below the 99% confidence minimum detectable polarization levels of 72.3% 0.8% (SM) and 57.5% 0.8% (MLM). Therefore, COSI did not detect polarized gamma-ray emission from this burst. Our most constraining 90% confidence upper limit on the polarization level was 46% (MLM).
In this work, we have applied a statistical method by computing statistical nucleus-independent chemical shifts (SNICS) in point of probes motions within a spatial shielding and de-shielding spaces ...around the OH groups of some amino acids. NMR contour maps as a new parameter have been created for amino-acyl-tRNA conjugation, by using a computational method to identify this model theoretically, it is critical to understand the reasons for tRNA–amino acid conjugation. DFT, NMR, 3D Gaussian distribution and Monte Carlo methods have been applied for Methionine, Serine, Histidine, Glycine and Glutamine to investigate the structural stability in the active parts of the amino acid–tRNA linkage by chemical shielding effects.
In this work we have exhibited the dielectric effect in an incorrect tRNA–amino acid conjugation.
The narrow-line Seyfert I galaxy, 1H0707−495, has been well observed in the 0.3–10 keV band, revealing a dramatic drop in flux in the iron Kα band, a strong soft excess, and short time-scale ...reverberation lags associated with these spectral features. In this paper, we present the first results of a deep 250-ks NuSTAR (Nuclear Spectroscopic Telescope Array) observation of 1H0707−495, which includes the first sensitive observations above 10 keV. Even though the NuSTAR observations caught the source in an extreme low-flux state, the Compton hump is still significantly detected. NuSTAR, with its high effective area above 7 keV, clearly detects the drop in flux in the iron Kα band, and by comparing these observations with archival XMM–Newton observations, we find that the energy of this drop increases with increasing flux. We discuss possible explanations for this, the most likely of which is that the drop in flux is the blue wing of the relativistically broadened iron Kα emission line. When the flux is low, the coronal source height is low, thus enhancing the most gravitationally redshifted emission.
Two modern methods of reirradiation, intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT), are established for patients with recurrent or second primary ...squamous cell carcinoma of the head and neck (rSCCHN). We performed a retrospective multi-institutional analysis to compare methods.
Data from patients with unresectable rSCCHN previously irradiated to ≥40 Gy who underwent reirradiation with IMRT or SBRT were collected from 8 institutions. First, the prognostic value of our IMRT-based recursive partitioning analysis (RPA) separating those patients with unresectable tumors with an intertreatment interval >2 years or those with ≤2 years and without feeding tube or tracheostomy dependence (class II) from other patients with unresected tumors (class III) was investigated among SBRT patients. Overall survival (OS) and locoregional failure were then compared between IMRT and SBRT by use of 2 methods to control for baseline differences: Cox regression weighted by the inverse probability of treatment and subset analysis by RPA classification.
The study included 414 patients with unresectable rSCCHN: 217 with IMRT and 197 with SBRT. The unadjusted 2-year OS rate was 35.4% for IMRT and 16.3% for SBRT (P<.01). Among SBRT patients, RPA classification retained an independent association with OS. On Cox regression weighted by the inverse probability of treatment, no significant differences in OS or locoregional failure between IMRT and SBRT were demonstrated. Analysis by RPA class showed similar OS between IMRT and SBRT for class III patients. In all class II patients, IMRT was associated with improved OS (P<.001). Further subset analysis demonstrated comparable OS when ≥35 Gy was delivered with SBRT to small tumor volumes. Acute grade ≥4 toxicity was greater in the IMRT group than in the SBRT group (5.1% vs 0.5%, P<.01), with no significant difference in late toxicity.
Reirradiation both with SBRT and with IMRT appear relatively safe with favorable toxicity compared with historical studies. Outcomes vary by RPA class, which informs clinical trial design. Survival is poor in class III patients, and alternative strategies are needed.
The therapeutic ratio of reirradiation for recurrent or second primary (RSP) squamous carcinoma of the head and neck may be improved in the intensity modulated radiation therapy (IMRT) era. However, ...patient selection for reirradiation remains challenging. We performed a multi-institution cohort study to investigate modern outcomes after IMRT-based reirradiation and to identify prognostic subgroups.
Patients with RSP squamous carcinoma originating in a previously irradiated field (≥40 Gy) who underwent reirradiation with IMRT (≥40 Gy re-IMRT) were included. Locoregional failure and late toxicity were calculated using the Gray competing risk method. Cox proportional hazards regression was used to identify factors associated with overall survival (OS). Factors associated with OS were entered into a recursive partitioning analysis (RPA) for OS.
From 7 institutions, 412 patients were included. The median dose of re-IMRT was 60 Gy, and the median time between RT courses was 2.4 years. Chemotherapy was used in 76% of patients. The rates of grade ≥3, grade ≥4, and grade 5 acute toxicities were 19%, 4.4%, and 1.2%, respectively. The 2-year cumulative incidence of grade ≥3 late toxicity adjusted for the competing risks of recurrence or death was 14.2%. RPA identified 3 prognostic subgroups with distinct and homogenous OS (P<.001): class I included patients >2 years from their initial course of RT with resected tumors (2-year OS, 61.9%); class II included patients >2 years with unresected tumors or those ≤2 years and without feeding tube or tracheostomy dependence (2-year OS, 40.0%), and the remaining patients formed class III (2-year OS, 16.8%). Fifty-nine percent of class III patients underwent postoperative re-irradiation.
This study informs outcomes and expectations with IMRT-based reirradiation. The RPA classification identifies 3 distinct subgroups, which can guide patient selection for therapy and clinical trial design. RPA class III patients are not ideal candidates for protracted chemoradiation regardless of resection status.
Mechanical signals regulate a multitude of cell functions and ultimately govern fibrous tissue growth, maintenance and repair. Such mechanotransduction processes often involve modulation of ...intracellular calcium concentration (Ca2+i). However, most studies interrogate these responses in cells in simplified culture systems, thereby removing potentially important inputs from the native extracellular microenvironment. The objective of this study was to test the hypothesis that the intracellular calcium response of meniscus fibrochondrocytes (MFCs) is dependent on both the microenvironmental context in which this perturbation is applied and on the tensile deformation. Using a custom micro-mechanical tester mounted on a confocal microscope, intracellular calcium activity in MFCs in response to incremental tissue strains (0, 3, 6 and 9 %) was monitored in situ (i.e., in the native tissues) on MFC-seeded aligned scaffolds and MFC-seeded silicone membranes. The Ca2+i regulation by MFCs within the native meniscus tissue microenvironment was considerably different from Ca2+i regulation by MFCs on either aligned nanofibrous scaffolds or flat silicone membranes. Additionally, increasing levels of tensile deformation resulted in a greater number of responding cells, both in situ and in vitro, while having no effects on temporal characteristics of Ca2+i signalling. Collectively, these findings have significant implications for mechanobiology of load-bearing fibrous tissues and their responses to injury and degeneration. In addition, from a tissue engineering perspective, the findings establish cellular benchmarks for maturing engineered constructs, where native tissue-like calcium mechano-regulation may be an important outcome parameter to achieve mechanical functionality comparable to native tissue.
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