The role of healthcare professionals in encouraging parents to see and hold their stillborn baby: a meta-synthesis of qualitative studies.

Background: Globally, during 2013 there were three million recorded stillbirths. Where clinical guidelines exist some recommend that professionals do not encourage parental contact. The guidance is based on quantitative evidence that seeing and holding the baby is not beneficial for everyone, but has been challenged by bereaved parents' organisations. We aim to inform future guideline development through a synthesis of qualitative studies reporting data relevant to the research question; how does the approach of healthcare professionals to seeing and holding the baby following stillbirth impact parents views and experiences? Methods/Findings: Using a predetermined search strategy of PubMed and PsychINFO we identified robust qualitative studies reporting bereaved parental views and/or experiences relating to seeing and holding their stillborn baby (final search 24 February, 2014). Eligible studies were English language, reporting parental views, with gestational loss >20weeks. Quality was independently assessed by three authors using a validated tool. We used meta-ethnographic techniques to identify key themes and a line of argument synthesis. We included 12 papers, representing the views of 333 parents (156 mothers, 150 fathers, and 27 couples) from six countries. The final themes were: "[Still]birth: Nature of care is paramount", "Real babies: Perfect beauties, monsters and spectres", and "Opportunity of a lifetime lost." Our line-of-argument synthesis highlights the contrast between all parents need to know their baby, with the time around birth being the only time memories can be made, and the variable ability that parents have to articulate their preferences at that time. Thus, we hypothesised that how health professionals approach contact between parents and their stillborn baby demands a degree of active management. An important limitation of this paper is all included studies originated from high income, westernised countries raising questions about the findings transferability to other cultural contexts. We do not offer new evidence to answer the question "Should parents see and hold their stillborn baby?", instead our findings advance understanding of how professionals can support parents to make appropriate decisions in a novel, highly charged and dynamic situation. Conclusions: Guidelines could be more specific in their recommendations regarding parental contact. The role of healthcare professionals in encouraging parents to see and hold their stillborn baby is paramount. Parental choice not to see their baby, apprehension, or uncertainty should be continuously revisited in the hours after birth as the opportunity for contact is fleeting and final

Enhanced flexibility of the O2 + N2 interaction and Its effect on collisional vibrational energy exchange

12 págs.; 8 figs.; 1 app. This article is part of the Piergiorgio Casavecchia and Antonio Lagana Festschrift special issue.Prompted by a comparison of measured and computed rate coefficients of Vibration-to-Vibration and Vibration-to-Translation energy transfer in O2 + N2 nonreactive collisions, extended semiclassical calculations of the related cross sections were performed to rationalize the role played by attractive and repulsive components of the interaction on two different potential energy surfaces. By exploiting the distributed concurrent scheme of the Grid Empowered Molecular Simulator we extended the computational work to quasiclassical techniques, investigated in this way more in detail the underlying microscopic mechanisms, singled out the interaction components facilitating the energy transfer, improved the formulation of the potential, and performed additional calculations that confirmed the effectiveness of the improvement introduced.The authors acknowledge financial support from the Phys4entry FP7/2007-2013 project (Contract No. 242311), ARPA Umbria, INSTM, the EGI-Inspire project (Contract No. 261323), MIUR PRIN 2008 (2008KJX4SN 003) and 2010/2011 (2010ERFKXL_002), the ESA-ESTEC Contract No. 21790/ 08/NL/HE and the Spanish CTQ2012-37404 and FIS2013- 48275-C2-1-P projects. Computations have been supported by the use of Grid resources and services provided by the European Grid Infrastructure (EGI) and the Italian Grid Infrastructure (IGI) through the COMPCHEM Virtual Organization. Thanks are also due to the COST CMST European Cooperative Project CHEMGRID (Action D37) EGI Inspire.Peer reviewe

Efficiency of Collisional O2 + N2 Vibrational Energy Exchange

10 pags.; 6 figs.; 5 tabs. In press.By following the scheme of the Grid Empowered Molecular Simulator (GEMS), a new O2 + N2 intermolecular potential, built on ab initio calculations and experimental (scattering and second virial coefficient) data, has been coupled with an appropriate intramolecular one. On the resulting potential energy surface detailed rate coefficients for collision induced vibrational energy exchanges have been computed using a semiclassical method. A cross comparison of the computed rate coefficients with the outcomes of previous semiclassical calculations and kinetic experiments has provided a foundation for characterizing the main features of the vibrational energy transfer processes of the title system as well as a critical reading of the trajectory outcomes and kinetic data. On the implemented procedures massive trajectory runs for the proper interval of initial conditions have singled out structures of the vibrational distributions useful to formulate scaling relationships for complex molecular simulations.The authors acknowledge financial support from the Phys4- entry FP7/2007-2013 project (Contract 242311), ARPA Umbria, INSTM, the EGI-Inspire project (Contract 261323), MIUR PRIN 2008 (2008KJX4SN 003) and 2010/2011 (2010ERFKXL_002), the ESA-ESTEC contract 21790/08/ NL/HE, and the Spanish CTQ2012-37404 and FIS2013- 48275-C2-1-P projects. Computations have been supported by the use of Grid resources and services provided by the European Grid Infrastructure (EGI) and the Italian Grid Infrastructure (IGI) through the COMPCHEM Virtual Organization. Thanks are also due to the COST CMST European Cooperative Project CHEMGRID (Action D37) EGI Inspire.Peer reviewe

Balance between the reliability of classification and sampling effort: A multi-approach for thewater Framework Directive (WFD) ecological status applied to the Venice Lagoon (Italy)

The Water Framework Directive (WFD) requires Member States to assess the ecological status of water bodies and provide an estimation of the classification confidence and precision. This study tackles the issue of the uncertainty in the classification, due to the spatial variability within each water body, proposing an analysis of the reliability of classification, using the results of macrophyte WFD monitoring in the Venice Lagoon as case study. The level of classification confidence, assessed for each water body, was also used as reference to optimize the sampling effort for the subsequent monitorings. The ecological status of macrophytes was calculated by the Macrophyte Quality Index at 114 stations located in 11 water bodies. At water body scale, the level of classification confidence ranges from 54% to 100%. After application of the multi-approach (inferential statistics, spatial analyses, and expert judgment), the optimization of the sampling effort resulted in a reduction of the number of stations from 114 to 84. The decrease of sampling effort was validated by assessing the reliability of classification after the optimization process (54-99%) and by spatial interpolation of data (Kernel standard error of 22.75%). The multi-approach proposed in this study could be easily applied to any other water body and biological quality element

The interaction between vaginal microbiota, cervical length and vaginal progesterone treatment for preterm birth risk

Background: Preterm birth is the primary cause of infant death worldwide. A short cervix in the second trimester of pregnancy is a risk factor for preterm birth. In specific patient cohorts, vaginal progesterone reduces this risk. Using 16S rRNA gene sequencing we undertook a prospective study in women at risk of preterm birth (n=161) to assess 1) the relationship between vaginal microbiota and cervical length in the second trimester and preterm birth-risk, and 2) the impact of vaginal progesterone on vaginal bacterial communities in women with a short cervix. Results: Lactobacillus iners dominance at 16 weeks gestation was significantly associated with both a short cervix <25mm (n=15, P<0.05), and preterm birth <34+0 weeks (n=18, 38P<0.01; 69% PPV). In contrast, L. crispatus dominance was highly predictive of term birth (n=127, 98% PPV). Cervical shortening and preterm birth were not associated with vaginal dysbiosis. A longitudinal characterization of vaginal microbiota (<18, 22, 28 and 34 weeks) was then undertaken in women receiving vaginal progesterone (400mg/OD, n=25) versus controls (n=42). Progesterone did not alter vaginal bacterial community structure nor reduce L. iners-associated preterm birth (<34 weeks). Conclusions: L. iners dominance of the vaginal microbiota at 16 weeks gestation is a risk factor for preterm birth, whereas L. crispatus dominance is protective against preterm birth. Vaginal progesterone does not appear to impact the pregnancy vaginal microbiota. Patients and clinicians who may be concerned about ‘infection risk’ associated with use of a vaginal pessary during high-risk pregnancy can be reassured

Absence of an independent association between serum uric acid and left ventricular mass in Caucasian hypertensive women and men

Background and aim: Experimentally uric acid may induce cardiomyocyte growth and interstitial fibrosis of the heart. However, clinical studies exploring the relationship between serum uric acid (SUA) and left ventricular (LV) mass yielded conflicting results. The aim of our study was to evaluate the relationships between SUA and LV mass in a large group of Caucasian essential hypertensive subjects. Methods and results: We enrolled 534 hypertensive patients free of cardiovascular complications and without severe renal insufficiency. In all subjects routine blood chemistry, including SUA determination, echocardiographic examination and 24 h ambulatory blood pressure (BP) monitoring were obtained. In the overall population we observed no significant correlation of SUA with LV mass indexed for height2.7 (LVMH2.7) (r = 0.074). When the same relationship was analysed separately in men and women, we found a statistically significant correlation in female gender (r = 0.27; p < 0.001), but not in males (r = 0.042; p = NS). When we grouped the study population in sex-specific tertiles of SUA, an increase in LVMH2.7 was observed in the highest tertiles in women (44.5 \ub1 15.6 vs 47.5 16 vs 55.9 \ub1 22.2 g/m2.7; p < 0.001), but not in men. The association between SUA and LVMH2.7 in women lost statistical significance in multiple regression analyses, after adjustment for age, 24 h systolic BP, body mass index, serum creatinine and other potential confounders. Conclusions: Our findings do not support an independent association between SUA and LV mass in Caucasian men and women with arterial hypertension

Identification of Neural Circuits by Imaging Coherent Electrical Activity with FRET-Based Dyes

AbstractWe show that neurons that underlie rhythmic patterns of electrical output may be identified by optical imaging and frequency-domain analysis. Our contrast agent is a two-component dye system in which changes in membrane potential modulate the relative emission between a pair of fluorophores. We demonstrate our methods with the circuit responsible for fictive swimming in the isolated leech nerve cord. The output of a motor neuron provides a reference signal for the phase-sensitive detection of changes in fluorescence from individual neurons in a ganglion. We identify known and possibly novel neurons that participate in the swim rhythm and determine their phases within a cycle. A variant of this approach is used to identify the postsynaptic followers of intracellularly stimulated neurons

A New Multi-Index Method for the Eutrophication Assessment in Transitional Waters: Large-Scale Implementation in Italian Lagoons

Eutrophication represents one of the most impacting threats for the ecological status and related ecosystem services of transitional waters; hence, its assessment plays a key role in the management of these ecosystems. A new multi-index method for eutrophication assessment, based on the ecological index MaQI (Macrophyte Quality Index), the trophic index TWQI (Transitional Water Quality Index), and physicochemical quality elements (sensu Dir. 2000/60/EC), was developed including both driver and impact indicators. The study presents a large-scale implementation of the method, which included more than 100 Italian lagoon sites, covering a wide variability of lagoon typologies and conditions. Overall, 35% of sites resulted in eutrophic status, 45% in mesotrophic, and 25% in oligotrophic status

Active-treatment effects of the Forsus fatigue resistant device during comprehensive Class II correction in growing patients

Objective: To evaluate the active-treatment effects of the Forsus fatigue resistant device (Forsus) during comprehensive correction of Class II malocclusion in growing patients. Methods: Fifty-four patients (mean age, 12.5 \ub1 1.2 years) with Class II division 1 malocclusion were consecutively treated with fixed app-liances in combination with Forsus. Lateral cephalograms were analyzed at the beginning of the fixed treatment (T1), Forsus insertion (T2), its removal (T3), and end of the comprehensive therapy (T4). Statistical comparisons were carried out by repeated-measures ANOVA with Tukey's post-hoc test (p < 0.05). Results: The overall therapeutic effects were mainly dentoalveolar and occurred mostly during the active treatment with Forsus (T2-T3, mean duration = 0.5 \ub1 0.1 years). The overjet and overbite decreased significantly (-3.5 and -1.5 mm, respectively) and the molar relationship improved by 4.3 mm. These changes were associated with significant retroclination of the maxillary incisors (-3.1\ub0), proclination and intrusion of the mandibular incisors (+5.0\ub0 and -1.5 mm, respectively), and mesialization of the mandibular molars (+2.0 mm). Conclusions: Forsus had mainly dentoalveolar effects and contributed largely to the overall therapeutic outcome