Pre-term or full-term childbirth can be experienced as physically or psychologically traumatic. Cumulative and trans-generational effects of traumatic stress on both psychological and physical health ...indicate the ethical requirement to investigate appropriate preventative treatment for stress symptoms in women following a routine traumatic experience such as childbirth.
The objective of this review was to investigate the effectiveness of early psychological interventions in reducing or preventing post-traumatic stress symptoms and post-traumatic stress disorder in post-partum women within twelve weeks of a traumatic birth.
Randomised controlled trials and pilot studies of psychological interventions preventing or reducing post-traumatic stress symptoms or PTSD, that included women who had experienced a traumatic birth, were identified in a search of Cochrane Central Register of Randomised Controlled Trials, MEDLINE, Embase, Psychinfo, PILOTS, CINAHL and Proquest Dissertations databases. One author performed database searches, verified results with a subject librarian, extracted study details and data. Five authors appraised extracted data and agreed upon risk of bias. Analysis was completed with Rev Man 5 software and quality of findings were rated according to Grading of Recommendation, Assessment, Development, and Evaluation.
Eleven studies were identified that evaluated the effectiveness of a range of early psychological interventions. There was firm evidence to suggest that midwifery or clinician led early psychological interventions administered within 72 hours following traumatic childbirth are more effective than usual care in reducing traumatic stress symptoms in women at 4-6 weeks. Further studies of high methodological quality that include longer follow up of 6-12 months are required in order to substantiate the evidence of the effectiveness of specific face to face and online early psychological intervention modalities in preventing the effects of stress symptoms and PTSD in women following a traumatic birth before introduction to routine care and practice.
CRD42020202576, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=202576.
We report on deep, coordinated radio and X-ray observations of the black hole X-ray binary XTE J1118+480 in quiescence. The source was observed with the Karl G. Jansky Very Large Array for a total of ...17.5 h at 5.3 GHz, yielding a 4.8 ± 1.4 μJy radio source at a position consistent with the binary system. At a distance of 1.7 kpc, this corresponds to an integrated radio luminosity between 4 and 8 × 1025 erg s−1, depending on the spectral index. This is the lowest radio luminosity measured for any accreting black hole to date. Simultaneous observations with the Chandra X-ray Telescope detected XTE J1118+480 at 1.2 × 10−14 erg s−1 cm−2 (1–10 keV), corresponding to an Eddington ratio of ∼4 × 10−9 for a 7.5 M⊙ black hole. Combining these new measurements with data from the 2005 and 2000 outbursts available in the literature, we find evidence for a relationship of the form ℓr = α+βℓX (where ℓ denotes logarithmic luminosities), with β = 0.72 ± 0.09. XTE J1118+480 is thus the third system – together with GX339-4 and V404 Cyg – for which a tight, non-linear radio/X-ray correlation has been reported over more than 5 dex in ℓX. Confirming previous results, we find no evidence for a dependence of the correlation normalization of an individual system on orbital parameters, relativistic boosting, reported black hole spin and/or black hole mass. We then perform a clustering and linear regression analysis on what is arguably the most up-to-date collection of coordinated radio and X-ray luminosity measurements from quiescent and hard-state black hole X-ray binaries, including 24 systems. At variance with previous results, a two-cluster description is statistically preferred only for random errors ≲0.3 dex in both ℓr and ℓX, a level which we argue can be easily reached when the known spectral shape/distance uncertainties and intrinsic variability are accounted for. A linear regression analysis performed on the whole data set returns a best-fitting slope β = 0.61 ± 0.03 and intrinsic scatter σ0 = 0.31 ± 0.03 dex.
This study examines the effects of financial reporting complexity on investors' trading behavior. I find that more complex (longer and less readable) filings are associated with lower overall ...trading, and that this relationship appears due to a reduction in small investors' trading activity. Additional evidence suggests that the association between report complexity and lower abnormal trading is driven by both cross-sectional variation in firms' disclosure attributes and variations in disclosure complexity over time. Given regulatory concerns over plain English disclosures and the trend toward more disclosure, my investigation into the effects of reporting complexity on small and large investors should be of interest to regulators concerned with reporting clarity and leveling the playing field across classes of investors.
With advances in neonatal care, preterm neonates are surviving with an evolving constellation of motor and cognitive disabilities that appear to be related to widespread cellular maturational ...disturbances that target cerebral gray and white matter. Whereas preterm infants were previously at high risk for destructive brain lesions that resulted in cystic white matter injury and secondary cortical and subcortical gray matter degeneration, contemporary cohorts of preterm survivors commonly display less severe injury that does not appear to involve pronounced glial or neuronal loss. Nevertheless, these milder forms of injury are also associated with reduced cerebral growth. Recent human and experimental studies support that impaired cerebral growth is related to disparate responses in gray and white matter. Myelination disturbances in cerebral white matter are related to aberrant regeneration and repair responses to acute death of premyelinating late oligodendrocyte progenitors (preOLs). In response to preOL death, early oligodendrocyte progenitors rapidly proliferate and differentiate, but the regenerated preOLs fail to normally mature to myelinating cells required for white matter growth. Although immature neurons appear to be more resistant to cell death from hypoxia–ischemia than glia, they display widespread disturbances in maturation of their dendritic arbors, which further contribute to impaired cerebral growth. These complex and disparate responses of neurons and preOLs thus result in large numbers of cells that fail to fully mature during a critical window in development of neural circuitry. These recently recognized forms of cerebral gray and white matter dysmaturation raise new diagnostic challenges and suggest new therapeutic directions centered on reversal of the processes that promote dysmaturation. Ann Neurol 2014;75:469–486
Although Arctic tundra has been estimated to cover only 8% of the global land surface, the large and potentially labile carbon pools currently stored in tundra soils have the potential for large ...emissions of carbon (C) under a warming climate. These emissions as radiatively active greenhouse gases in the form of both CO2 and CH4 could amplify global warming. Given the potential sensitivity of these ecosystems to climate change and the expectation that the Arctic will experience appreciable warming over the next century, it is important to assess whether responses of C exchange in tundra regions are likely to enhance or mitigate warming. In this study we compared analyses of C exchange of Arctic tundra between 1990 and 2006 among observations, regional and global applications of process-based terrestrial biosphere models, and atmospheric inversion models. Syntheses of flux observations and inversion models indicate that the annual exchange of CO2 between Arctic tundra and the atmosphere has large uncertainties that cannot be distinguished from neutral balance. The mean estimate from an ensemble of process-based model simulations suggests that Arctic tundra has acted as a sink for atmospheric CO2 in recent decades, but based on the uncertainty estimates it cannot be determined with confidence whether these ecosystems represent a weak or a strong sink. Tundra was 0.6 °C warmer in the 2000s compared to the 1990s. The central estimates of the observations, process-based models, and inversion models each identify stronger sinks in the 2000s compared with the 1990s. Some of the process models indicate that this occurred because net primary production increased more in response to warming than heterotrophic respiration. Similarly, the observations and the applications of regional process-based models suggest that CH4 emissions from Arctic tundra have increased from the 1990s to 2000s because of the sensitivity of CH4 emissions to warmer temperatures. Based on our analyses of the estimates from observations, process-based models, and inversion models, we estimate that Arctic tundra was a sink for atmospheric CO2 of 110 Tg C yr−1 (uncertainty between a sink of 291 Tg C yr−1 and a source of 80 Tg C yr−1) and a source of CH4 to the atmosphere of 19 Tg C yr−1 (uncertainty between sources of 8 and 29 Tg C yr−1). The suite of analyses conducted in this study indicate that it is important to reduce uncertainties in the observations, process-based models, and inversions in order to better understand the degree to which Arctic tundra is influencing atmospheric CO2 and CH4 concentrations. The reduction of uncertainties can be accomplished through (1) the strategic placement of more CO2 and CH4 monitoring stations to reduce uncertainties in inversions, (2) improved observation networks of ground-based measurements of CO2 and CH4 exchange to understand exchange in response to disturbance and across gradients of climatic and hydrological variability, and (3) the effective transfer of information from enhanced observation networks into process-based models to improve the simulation of CO2 and CH4 exchange from Arctic tundra to the atmosphere.
Alleles In Space software performs a number of different analyses that can be used to detect or characterize patterns of spatial genetic structure. Alleles In Space also implements a novel procedure ...based on the statistical concept of aggregation.
While cities are well documented to enhance precipitation through the urban rainfall effect (URE), the distinguishing characteristics of urban‐influenced storms that help establish the URE are poorly ...understood. The purpose of this study is to examine the morphological traits (i.e., size, duration, intensity, etc.) and near‐storm environmental conditions of weakly forced thunderstorms (WFTs) occurring near urban areas in the Southeast US relative to storms forming in surrounding rural areas. Urban WFTs are found to have higher reflectivities, are more likely to contain hail, and produce more lightning than nearby non‐urban storms, but their sizes and shapes are statistically indistinguishable. When disaggregated across individual urban areas, the increase in maximum composite reflectivity among urban storms is the most pervasive morphological difference, with 24 of the 31 cities displaying elevated reflectivities. Urban WFTs also benefit from near‐storm environments with greater instability and higher precipitation efficiency, which may further contribute to the URE.
Plain Language Summary
Research has shown that cities can generate extra precipitation in areas downwind, but the exact causes for the extra rainfall have not been definitively established. While cities can cause additional thunderstorms, they may also cause thunderstorms to look, move, or grow differently, ultimately leading to the precipitation boost. In this study, we find that weakly forced thunderstorms forming closest to cities are stronger, more hail‐prone, and bigger lightning‐producers than otherwise similar storms forming outside the city.
Key Points
Weakly forced thunderstorms near cities are associated with higher composite reflectivities than storms in adjacent outlying areas
Total lightning flash density and radar‐based hail indicators are also larger among storms forming closer to the urban centers
Urban storms formed in environments with greater instability and higher precipitable water than nearby non‐urban storms
Access to health care based on need rather than ability to pay was the founding principle of the Canadian health-care system. Medicare was born in one province in 1947. It spread across the country ...through federal cost sharing, and eventually was harmonised through standards in a federal law, the Canada Health Act of 1984. The health-care system is less a true national system than a decentralised collection of provincial and territorial insurance plans covering a narrow basket of services, which are free at the point of care. Administration and service delivery are highly decentralised, although coverage is portable across the country. In the setting of geographical and population diversity, long waits for elective care demand the capacity and commitment to scale up effective and sustainable models of care delivery across the country. Profound health inequities experienced by Indigenous populations and some vulnerable groups also require coordinated action on the social determinants of health if these inequities are to be effectively addressed. Achievement of the high aspirations of Medicare's founders requires a renewal of the tripartite social contract between governments, health-care providers, and the public. Expansion of the publicly funded basket of services and coordinated effort to reduce variation in outcomes will hinge on more engaged roles for the federal government and the physician community than have existed in previous decades. Public engagement in system stewardship will also be crucial to achieve a high-quality system grounded in both evidence and the Canadian values of equity and solidarity.
During summer and fall 2023, Louisiana experienced a historic local drought while dry conditions elsewhere in the central US withheld vital runoff from the Mississippi River, leading to below‐normal ...discharge into the Gulf of Mexico. Thus, by late October 2023, Louisiana was gripped by two super‐imposed water crises: a severe local drought and saltwater contamination in the Mississippi River channel. This study frames the development of the water emergency through the lens of flash drought using the Evaporative Demand Drought Index (EDDI). The EDDI shows south Louisiana experience a flash drought during June 2023, while the Mississippi River basin was subsequently characterized by large expanses of high‐percentile EDDI in August‐September 2023 shortly before the saltwater intrusion episode along the lower Mississippi River. Over the last 15 years, MRB‐wide EDDI percentile has oscillated between years‐long elevated and depressed states, accounting for 23.7% of the monthly discharge anomaly near New Orleans.
Plain Language Summary
In 2023, Louisiana experienced one of its driest and hottest summers on record. While drought developed across the state, rain shortfalls further north led to low water levels in the Mississippi River, a major navigation corridor and drinking water source for the state. As river levels fell, seawater moved into the channel, threatening to contaminate the water supply with salt. The statewide drought, particularly in coastal Louisiana, is shown to have developed rapidly during June 2023 through a process called flash drought. Meanwhile, high evaporation rates and low rainfall upriver exacerbated Louisiana's water shortage by limiting runoff into the Mississippi River. Over the last 15 years, evaporative demand over the Mississippi River watershed varies closely with river discharge near New Orleans, and even corresponds to river conditions more closely than rainfall itself.
Key Points
Louisiana experienced 5 months of exceptional evaporative demand and low precipitation, including a flash drought during June 2023
Historically low flows on the lower Mississippi River in fall 2023 were accompanied by several episodes of high evaporative demand upbasin
Basin‐wide high evaporative demand coincides with low discharge near New Orleans, with a trend toward this combination since the 2019 flood
The United States government is encouraging physicians to adopt patient portals-secure websites that allow patients to access their health information. For patient portals to recognize their full ...potential and improve patient care, health care providers' acceptance and encouragement of their use will be essential. However, little is known about provider concerns or views of patient portals.
We conducted this qualitative study to determine how administrators, clinic staff, and health care providers at practices serving a lower income adult population viewed patient portals in terms of their potential benefit, areas of concern, and hopes for the future.
We performed in-depth interviews between October 2013 and June 2014 with 20 clinic personnel recruited from health centers in four North Carolina counties. Trained study personnel conducted individual interviews following an interviewer guide to elicit perceptions of the benefits and disadvantages of patient portals. Interviews were recorded and transcribed. Research team members reviewed transcribed interviews for major themes to construct a coding dictionary. Two researchers then coded each transcript with any coding discrepancies resolved through discussion.
The interviews revealed that clinic personnel viewed patient portals as a mandated product that had potential to improve communication and enhance information sharing. However, they expressed many concerns including portals' potential to generate more work, confuse patients, alienate non-users, and increase health disparities. Clinic personnel expected few older and disadvantaged patients to use a portal.
Given that clinic personnel have significant concerns about portals' unintended consequences, their uptake and impact on care may be limited. Future studies should examine ways portals can be implemented in practices to address providers' concerns and meet the needs of vulnerable populations.
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