Postnatal debriefing: Have we thrown the baby out with the bathwater?

Postnatal debriefing is offered by 78% of maternity services in the UK despite little evidence from randomized controlled trials (RCTs) that it is effective. RCTs in this area have applied debriefing as a prophylactic to all or high risk women, rather than as a treatment for women who request it. This pragmatic trial therefore evaluated existing postnatal debriefing services that provide debriefing as a treatment for women who request it. Forty-six women who met criterion A for post-traumatic stress disorder (PTSD) and requested debriefing 1.3 to 72.2 months (median 16 weeks) postpartum completed measures of depression, PTSD, support and negative appraisals of the birth before and one month after debriefing. Women were compared with others who gave birth in the same hospitals during the same time period (n=34), who met criterion A for PTSD but had not requested debriefing. Results showed PTSD symptoms reduced over time in both groups but greater decreases were observed in women who attended debriefing. Debriefing also led to reduction in negative appraisals but did not affect symptoms of depression. Therefore, results suggest providing debriefing as a treatment to women who request or are referred to it may help to reduce symptoms of PTSD

Synoptic estimates of air-sea fluxes

Synoptic and climatological dynamic studies generally rely on bulk aerodynamic flux formulae to describe air-sea heat and momentum exchange on synoptic and climatological scales. Barometric pressure maps (which involve an intrinsic spatial and temporal averaging of the wind) and wind roses provide two sources of spatial and temporal wind information for flux calculations. Several investigators have shown that time-averaged estimates of the fluxes based on vector-averaged winds systematically underestimate the actual time-averaged fluxes.Using surface meteorological observations from 9 weatherstations in the North Atlantic Ocean and 2 weatherstations in the North Pacific Ocean, the three hourly stresses, latent heat fluxes and sensible heat fluxes were calculated. The sampled data and the calculated fluxes were then averaged over periods up to 28 days. The estimates of the averaged fluxes based on the vector-averaged winds were then compared to the directly averaged values. An upper bound for the difference in the two stresses calculations was directly proportional to the sum of the x and y component wind variances lost through the averaging process (in agreement with Fofonoff, 1960) and inversely proportional to the square of the vector-averaged wind speed. The wind-averaged and directly averaged flux estimates were grouped according to the Beaufort wind speed category and the averaging period. A multivariate regression was then performed to optimize a transformation from the wind-averaged to the directly averaged case. For all fluxes, the transformation dramatically improved the wind-averaged estimates of the climatological means and variances of the directly averaged fluxes. The residual error between the two estimates was decreased up to a factor of 5 over the uncorrected case and the correlation coefficients showed a moderate increase. The regression cofficients showed similar values for all temperate latitude stations.An empirical formula was found which interpolated the wind speed and averaging period dependences and duplicated the multivariate regression results. The data from the ten temperate latitude stations were grouped and a single formula was found which only moderately increased the errors between the wind-averaged and directly averaged estimates. The geographically averaged formula was not applicable at Station N, located at the northern extremity of the North Pacific Trade Wind region.Analysis of the 28 day wind-averaged flux spectral estimates showed that they underestimated the 28 day directly averaged flux spectral estimates. Application of the specific ship empirical formula greatly improved agreement between the two spectral densities and reduced the residual series power density at all frequencies. High latent heat flux errors at Station N were reduced by application of a seasonal correction

Spinal Cord Ischaemia Following Endovascular Repair of Abdominal Aortic Aneurysm: Result of Spinal Drain Insertion in a Rare Complication

IntroductionSpinal cord ischaemia (SCI) is a devastating complication of endovascular abdominal aortic aneurysm repair (EVAR), with a reported incidence of 0.2%. Interventions for SCI are largely derived from thoracic and thoracoabdominal aortic repairs.ReportWe report a case of acute neurological injury complicating an EVAR that was altered by spinal drain insertion and removal.DiscussionThis case highlights the need for appropriate consent of EVAR patients and the early utilisation of a spinal drain in the management of SCI

Coriolis force in Geophysics: an elementary introduction and examples

We show how Geophysics may illustrate and thus improve classical Mechanics lectures concerning the study of Coriolis force effects. We are then interested in atmospheric as well as oceanic phenomena we are familiar with, and are for that reason of pedagogical and practical interest. Our aim is to model them in a very simple way to bring out the physical phenomena that are involved.Comment: Accepted for publication in European Journal of Physic

Twenty years of anti-HER2 therapy-associated cardiotoxicity

Over the past 20...years, the prognosis of HER2-positive breast cancer has been transformed by the development of anti-HER2 targeted therapies. In early clinical trials of trastuzumab (ie, the first anti-HER2 agent to be developed) cardiotoxicity became a major concern. In the first published phase 3 trial of trastuzumab, 27% of patients receiving anthracyclines and trastuzumab experienced cardiac events and 16% suffered from severe congestive heart failure. In subsequent trials conducted in advanced and early settings, the incidence of cardiac events was reduced through changes in chemotherapy regimens, more strict patient selection and close cardiac assessment. However, cardiotoxicity remains a significant problem in clinical practice that is likely to increase as new agents are approved and exposure times increase through improved patients' survival. Though numerous trials have led to improved understanding of many aspects of anti-HER2 therapy-related cardiotoxicity, its underlying physiopathology mechanisms are not well understood. The purpose of this article is to provide an in-depth review on anti-HER2 therapy-related cardiotoxicity, including data on both trastuzumab and the recently developed anti-HER2 targeted agents

Strategic avionics technology definition studies. Subtask 3-1A: Electrical Actuation (ELA) systems

This interim report presents the preliminary results of an electrical actuation (ELA) system study (subtask TA3-1A) to support the NASA strategic avionics technology definition studies. The final report of this ELA study is scheduled for September 30, 1993. The topics are presented in viewgraph form and include the following ELA technology demonstration testing; ELA system baseline; power and energy requirements for shuttle effector systems; power efficiency and losses of ELA effector systems; and power and energy requirements for ELA power sources

Sex Differences in the Kinetic Profiles of d- and l- Methylphenidate in the Brains of Adult Rats

OBJECTIVE: Methylphenidate is commonly used in the treatment of Attention Deficit Hyperactivity Disorder and narcolepsy. Methylphenidate is administered as a racemic mixture of the d- and l- threo enantiomers; however, the d-enantiomer is primarily responsible for the pharmacologic activity. Previous studies of the behavioral effects of methylphenidate have highlighted sex differences in the responsiveness to the drug, namely an increased sensitivity of females to its stimulatory effects. These differences may be due to differences in the uptake, distribution, and elimination of methylphenidate from male and female brains. Therefore, we compared the pharmacokinetics of d- and l- threo methylphenidate in the brains of male and female rats. MATERIALS AND METHODS: Adult male and female Sprague-Dawley rats were injected with 5 mg/kg d, l- threo methylphenidate, and whole brains were collected at various time points following injection. We measured methylphenidate concentrations utilizing chiral high pressure liquid chromatography followed by mass spectrometry. RESULTS: Females exhibited consistently higher brain concentrations of both d- and l- methylphenidate and a slower clearance of methylphenidate from brain as compared to males, particularly with the active d-enantiomer. CONCLUSIONS: The increased sensitivity of females to methylphenidate may be partially explained by an increase in total brain exposure to the drug

Experimental measurement of stress at a four-domain junction in lead zirconate titanate

A junction between two lamellar bands of ferroelectric domains in a lead zirconate titanate (PZT) ceramic is analysed using Kikuchi diffraction patterns in the transmission electron microscope. Indexing of the diffraction patterns allowed the determination of the 3D relative orientation of the 4 different domains at the junction and thus the characterisation of the domain boundaries. The local c/a ratio could also be determined from the misorientations at the domain boundaries. Analysis of the data showed that large stresses were concentrated at the junction, and that this is inevitable at such band junctions. Such stress concentrations could act as nuclei for cracking of the ceramic under additional loading in service, perhaps particularly as a consequence of extended electromechanical cycling. Moreover, the stresses would increase with increasing c/a making the issues all the more serious for Ti-rich compositions having larger c/a ratios