In Vivo Evaluation of Cervical Stiffness Evolution during Induced Ripening Using Shear Wave Elastography, Histology and 2 Photon Excitation Microscopy: Insight from an Animal Model

Prematurity affects 11% of the births and is the main cause of infant mortality. On the opposite case, the failure of induction of parturition in the case of delayed spontaneous birth is associated with fetal suffering. Both conditions are associated with precocious and/or delayed cervical ripening. Quantitative and objective information about the temporal evolution of the cervical ripening may provide a complementary method to identify cases at risk of preterm delivery and to assess the likelihood of successful induction of labour. In this study, the cervical stiffness was measured in vivo in pregnant sheep by using Shear Wave Elastography (SWE). This technique assesses the stiffness of tissue through the measurement of shear waves speed (SWS). In the present study, 9 pregnant ewes were used. Cervical ripening was induced at 127 days of pregnancy (term: 145 days) by dexamethasone injection in 5 animals, while 4 animals were used as control. Elastographic images of the cervix were obtained by two independent operators every 4 hours during 24 hours after injection to monitor the cervical maturation induced by the dexamethasone. Based on the measurements of SWS during vaginal ultrasound examination, the stiffness in the second ring of the cervix was quantified over a circular region of interest of 5 mm diameter. SWS was found to decrease significantly in the first 4–8 hours after dexamethasone compared to controls, which was associated with cervical ripening induced by dexamethasone (from 1.779 m/s ± 0.548 m/s, p < 0.0005, to 1.291 m/s ± 0.516 m/s, p < 0.000). Consequently a drop in the cervical elasticity was quantified too (from 9.5 kPa ± 0.9 kPa, p < 0.0005, to 5.0 kPa ± 0.8 kPa, p < 0.000). Moreover, SWE measurements were highly reproducible between both operators at all times. Cervical ripening induced by dexamethasone was confirmed by the significant increase in maternal plasma Prostaglandin E2 (PGE2), as evidenced by the assay of its metabolite PGEM. Histological analyses and two-photon excitation microscopy, combining both Second Harmonic Generation (SHG) and Two-photon Fluorescence microscopy (2PF) contrasts, were used to investigate, at the microscopic scale, the structure of cervical tissue. Results show that both collagen and 2PF-active fibrillar structures could be closely related to the mechanical properties of cervical tissue that are perceptible in elastography. In conclusion, SWE may be a valuable method to objectively quantify the cervical stiffness and as a complementary diagnostic tool for preterm birth and for labour induction success

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase&nbsp;1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation&nbsp;disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age&nbsp; 6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score&nbsp; 652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc&nbsp;= 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N&nbsp;= 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in&nbsp;Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in&nbsp;Asia&nbsp;and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Sharing and community curation of mass spectrometry data with Global Natural Products Social Molecular Networking

The potential of the diverse chemistries present in natural products (NP) for biotechnology and medicine remains untapped because NP databases are not searchable with raw data and the NP community has no way to share data other than in published papers. Although mass spectrometry techniques are well-suited to high-throughput characterization of natural products, there is a pressing need for an infrastructure to enable sharing and curation of data. We present Global Natural Products Social molecular networking (GNPS, http://gnps.ucsd.edu), an open-access knowledge base for community wide organization and sharing of raw, processed or identified tandem mass (MS/MS) spectrometry data. In GNPS crowdsourced curation of freely available community-wide reference MS libraries will underpin improved annotations. Data-driven social-networking should facilitate identification of spectra and foster collaborations. We also introduce the concept of ‘living data’ through continuous reanalysis of deposited data

Integrating research on dissociation and hypnotizability: are there two pathways to hynotizability?

p. 032-038Attention to the relationship between hypnotizability and dissociation has been limited to date. A few studies have examined instances of dissociation in the context of hypnosis. Only recently have researchers begun to ask questions about the relationship between an individual's hypnotizability and his or her tendency to dissociate on a day-to-day basis. A review of the literature and recent research in this area invites reconsideration of J. Hilgard 's theory of two developmental pathways to hypnotizability. The parallel question is also raised of whether the different pathways result in the experience of qualitatively different hypnotic states

Acute Stress Disorder Revisited

Acute stress disorder (ASD) was introduced into the Diagnostic and Statistical Manual (DSM) taxonomy in 1994 to address the lack of a specific diagnosis for acute pathological reactions to trauma and the role that dissociative phenomena play both in the short- and long-term reactions to trauma. In this review, we discuss the history and goals of the diagnosis and compare it with the diagnoses of acute stress reaction, combat stress reaction, and posttraumatic stress disorder (PTSD). We also evaluate the research on the validity and limitations of ASD as a diagnosis, the relationship between peritraumatic dissociation and other symptomatology, the extent to which PTSD is predicted by previous ASD or peritraumatic dissociation, and other important issues such as impairment and risk factors related to ASD. We conclude with our recommendations for changes in DSM-5 criteria and the development of more sophisticated research that considers ASD as but one of two or possibly three common acute posttraumatic syndromes. Expected final online publication date for the Annual Review of Clinical Psychology Volume 7 is March 27, 2011. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates

Iraq War Clinician Guide 108 Appendix D Appendix D. Assessment of Iraq War Veterans: Selecting Assessment Instruments and Interpreting Results

The Assessment section of this Guide discussed general challenges to assessment of veterans returning from Iraq and delineated suggested domains to assess and issues to consider in assessing those domains. This section will focus on suggested instruments to use as part of an assessment to decide what services to offer veterans and to plan psychological treatment. As indicated in the previous section, responses in the days and weeks following exposure to highly stressful events are highly variable across individuals and high levels of distress in the days and weeks following exposure do not reliably predict longer-term posttraumatic symptoms. Some, but not all, who meet criteria for Acute Stress Disorder two weeks after and event will later have PTSD, but some who do not meet criteria for ASD will also develop PTSD (Bryant &amp; Harvey, 2002). Since no measures of early responses have been found to reliably predict longer-term responses and since most of those exposed to extreme stressors recover within a month, assessment with measures of specific domains is not recommended during this period. This section will make suggestions, therefore, about selecting measures to assess veterans who have been home one month or more. Many of the domains discussed in the previous section can be adequately assessed during a

Reliability and validity of the adolescent dissociative experiences scale

p. 125-129The Adolescent Dissociative Experiences Scale (A-DES) is designed to measure dissociation in adolescents (ages 11-17). The A-DES measures dissociation in four areas: dissociative amnesia, absorption and imaginative involvement, depersonalization and derealization, and passive influence. The present study was designed to establish A-DES norms for general population adolescents and to study aspects of the reliability and validity of the A-DES. Test-retest reliability was studied by testing one group of subjects twice, with a two-week interval between test administrations. Internal consistency was assessed by measuring the split-half reliability of the A-DES. Cronbach's alphas were calculated for the A-DES global score and four subscales. Results of these three analyses provide evidence for the reliability of the ADES. The concurrent validity of the A-DES was studied by correlating scores on the A-DES with scores on the Dissociative Experiences Scale (DES) in a college sample. Results showed a high correlation between scores on these two measures. Overall, results indicate that the A-DES appears to have promise as a measure of dissociation in adolescents

An update on the Dissociative Experience Scale

p. 016-027The authors review a wide range of studies that relate to the norms, reliability, and validity of the Dissociative Experiences Scale (DES). Appropriate clinical and research use of the scale are discussed together with factor analytic studies and fruitful statistical analysis methods. Current research with the DES is described and promising new research questions are highlighted. Suggestions are made for translating and using the DES in other cultures. A second version of the DES, which is easier to score, is included as an appendix

Evaluating the Facilitating Attuned Interactions (FAN) Approach: Vicarious Trauma, Professional Burnout, and Reflective Practice

Background: This evaluation examined the use of the Facilitated Attuned Interaction (FAN) approach to reflective practice among child welfare and early childhood professionals working with vulnerable children and families. Objective: The aims of the current evaluation were to test (a) the role of vicarious trauma in predicting professional burnout, (b) the effect of reflective practice quality in decreasing professional burnout, and (c) the ability of reflective practice quality to lessen the relationship between vicarious trauma and professional burnout. Participants and Setting: The sample included sixty-three professionals across diverse professions including child welfare social workers, early childhood educators, and child welfare attorneys. Methods: Child welfare and early childhood professionals participating in reflective practice with consultants trained in the FAN approach to reflective practice completed surveys measuring their vicarious trauma, burnout, and the quality of reflective practice pre-intervention as well as nine months post-intervention. Results: Results indicated that pre-intervention vicarious trauma directly and significantly increased child welfare and early childhood professionals’ post-intervention reports of professional burnout, β = 0.42, [95% CI: 0.08, 0.76]. Post-intervention reflective practice quality did not directly nor significantly reduce professionals’ post-intervention reports of professional burnout, β = −0.06, [95% CI: −0.46, 0.36]; however, the relationship between pre-intervention vicarious trauma and post-intervention burnout was significantly diminished by positive perceptions of reflective practice quality, β = −0.36, [95% CI: −0.69, −0.02]. Conclusion: Vicarious trauma was associated with increased rates of professional burnout among child welf essionals. The current evaluation indicates the potential benefit of receiving high quality reflective practice with the FAN approach