Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: individual participant data meta-analysis

OBJECTIVE: To estimate the associations between gestational weight gain (GWG) during pregnancy and neonatal outcomes in low and middle income countries. DESIGN: Individual participant data meta-analysis. SETTING: Prospective pregnancy studies from 24 low and middle income countries. MAIN OUTCOME MEASURES: Nine neonatal outcomes related to timing (preterm birth) and anthropometry (weight, length, and head circumference) at birth, stillbirths, and neonatal death. ANALYSIS METHODS: A systematic search was conducted in PubMed, Embase, and Web of Science which identified 53 prospective pregnancy studies published after the year 2000 with data on GWG, timing and anthropometry at birth, and neonatal mortality. GWG adequacy was defined as the ratio of the observed maternal weight gain over the recommended weight gain based on the Institute of Medicine body mass index specific guidelines, which are derived from data in high income settings, and the INTERGROWTH-21st GWG standards. Study specific estimates, adjusted for confounders, were generated and then pooled using random effects meta-analysis models. Maternal age and body mass index before pregnancy were examined as potential modifiers of the associations between GWG adequacy and neonatal outcomes. RESULTS: Overall, 55% of participants had severely inadequate (<70%) or moderately inadequate (70% to <90%) GWG, 22% had adequate GWG (90-125%), and 23% had excessive GWG (≥125%). Severely inadequate GWG was associated with a higher risk of low birthweight (adjusted relative risk 1.62, 95% confidence interval 1.51 to 1.72; 48 studies, 93 337 participants; τ2=0.006), small for gestational age (1.44, 1.36 to 1.54; 51 studies, 93 191 participants; τ2=0.016), short for gestational age (1.47, 1.29 to 1.69; 40 studies, 83 827 participants; τ2=0.074), and microcephaly (1.57, 1.31 to 1.88; 31 studies, 80 046 participants; τ2=0.145) compared with adequate GWG. Excessive GWG was associated with a higher risk of preterm birth (1.22, 1.13 to 1.31; 48 studies, 103 762 participants; τ2=0.008), large for gestational age (1.44, 1.33 to 1.57; 47 studies, 90 044 participants; τ2=0.009), and macrosomia (1.52, 1.33 to 1.73; 29 studies, 68 138 participants; τ2=0) compared with adequate GWG. The direction and magnitude of the associations between GWG adequacy and several neonatal outcomes were modified by maternal age and body mass index before pregnancy. CONCLUSIONS: Inadequate and excessive GWG are associated with a higher risk of adverse neonatal outcomes across settings. Interventions to promote optimal GWG during pregnancy are likely to reduce the burden of adverse neonatal outcomes, however further research is needed to assess optimal ranges of GWG based on data from low and middle income countries

Open education and critical pedagogy

This paper argues for a revaluation of the potential of open education to support more critical forms of pedagogy. Section I examines contemporary discourses around open education, offering a commentary on the perception of openness as both a disruptive force in education, and a potential solution to contemporary challenges. Section II examines the implications of the lack of consensus around what it means to be open, focusing on the example of commercial and proprietary claims to openness commonly known as ‘openwashing’. Section III uses Raymond’s influential essay on open source software ‘The Cathedral and the Bazaar’ as a framework for thinking through these issues, and about alternative power structures in open education. In Section IV an explicit link is drawn between more equal or democratic power structures and the possibility for developing pedagogies which are critical and reflexive, providing examples which show how certain interpretations of openness can raise opportunities to support critical approaches to pedagogy

Sports psychiatry and medical views on mild traumatic brain injury in competitive sport: a current review and recommendations

Head injuries are common in competitive and recreational sport. Nomenclature, though inconsistent, identifies mild traumatic brain injury (mTBI) based on acute diagnostic criteria, whereas a sport-related concussion (SRC) is event-related and specific to mTBI experienced while participating in athletic activity. The effects of SRC are often neurological, neuropsychological and/or psychiatric with a variety of symptoms. Different organizations categorize these symptoms differently and this variance demonstrates that no uniform clinical classification system has been agreed upon. Diagnosis of SRC is based on clinical examination. Numerous symptom checklists and assessments are available for clinical diagnosis, but their validity is somewhat limited. There is increasing awareness regarding the psychiatric deficits associated with SRC and the potential for developing post-concussion syndrome (PCS). In addition to complex, causal SRC-associated symptoms, reactive psychological complaints may also occur, as well as social mistreatment on recovery from SRC. Pre-existing mental health conditions are associated with an increased risk for developing PCS. This often necessitates the implementation of psychiatric or psychotherapeutic care after SRC. As with mTBI and SRC, no standardized classification has been established for PCS. Multi-stage rehabilitation strategies can help injured athletes navigate a successful recovery and prevent premature return to play. Further research on the utility of psychotherapy, psychopharmacotherapy, and exercise therapy of PCS is needed. Key Words: Concussion, Mental Health, Post-Concussion Syndrome, Interdisciplinarit

Reduction of claustrophobia during magnetic resonance imaging: methods and design of the "CLAUSTRO" randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Magnetic resonance (MR) imaging has been described as the most important medical innovation in the last 25 years. Over 80 million MR procedures are now performed each year and on average 2.3% (95% confidence interval: 2.0 to 2.5%) of all patients scheduled for MR imaging suffer from claustrophobia. Thus, prevention of MR imaging by claustrophobia is a common problem and approximately 2,000,000 MR procedures worldwide cannot be completed due to this situation. Patients with claustrophobic anxiety are more likely to be frightened and experience a feeling of confinement or being closed in during MR imaging. In these patients, conscious sedation and additional sequences (after sedation) may be necessary to complete the examinations. Further improvements in MR design appear to be essential to alleviate this situation and broaden the applicability of MR imaging. A more open scanner configuration might help reduce claustrophobic reactions while maintaining image quality and diagnostic accuracy.</p> <p>Methods/Design</p> <p>We propose to analyze the rate of claustrophobic reactions, clinical utility, image quality, patient acceptance, and cost-effectiveness of an open MR scanner in a randomized comparison with a recently designed short-bore but closed scanner with 97% noise reduction. The primary aim of this study is thus to determine whether an open MR scanner can reduce claustrophobic reactions, thereby enabling more examinations of claustrophobic patients without incurring the safety issues associated with conscious sedation. In this manuscript we detail the methods and design of the prospective "CLAUSTRO" trial.</p> <p>Discussion</p> <p>This randomized controlled trial will be the first direct comparison of open vertical and closed short-bore MR systems in regards to claustrophobia and image quality as well as diagnostic utility.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00715806">NCT00715806</a></p

Maternal hemoglobin depletion in a settled Northern Kenyan pastoral population

Objectives: This study examines maternal hemoglobin depletion in a cross-sectional sample of Ariaal women living in northern Kenya. Maternal hemoglobin depletion occurs when women do not have enough dietary iron to replace the high levels of iron allocated to the fetus during pregnancy. Methods: To study this phenomenon, reproductive histories, socioeconomic status, anthropometry, and hemoglobin levels were collected from a cross-section of 200 lactating Ariaal women in northern Kenya. Results: Ariaal women show increasing levels of hemoglobin with increasing time since birth and lower hemoglobin levels with increasing parity, indicating an incomplete repletion of dietary iron over women's reproductive lifetime. Women who lived in a more livestock-dependent village had higher hemoglobin levels and lower prevalence of clinical anemia than women who lived in villages more dependent on agriculture, indicating that differences in diet may alleviate the effects of iron depletion. Conclusions: These data demonstrate that Ariaal women are iron depleted due to pregnancy, incompletely replete hemoglobin during the course of lactation, and show depletion of hemoglobin with increasing parity. Women in this community may be able to improve their iron status through a greater reliance on food sources rich in dietary iron. Am. J. Hum. Biol., 2010. © 2010 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78218/1/21078_ftp.pd

Nonlinear effects in random lasers

Recent numerical and theoretical studies have demonstrated that the modes at threshold of a random laser are in direct correspondence with the resonances of the same system without gain, a feature which is well known in a conventional laser but which was not known until recently for a random laser. This paper presents numerical results, which extend such studies to the multimode regime that takes place when the pumping rate is progressively increased above threshold. Behavior that is already known in standard lasers, such as mode competition and nonlinear wave-mixing, are shown to also take place in random lasers thus reinforcing their recent modal description. However, due to the complexity of the laser modes and to the openness of such lasers, which requires large external pumping to compensate for strong loss, one observes that these effects are more pronounced than in a conventional laser