NHS maternity care response to human trafficking in the UK: Views of women and clinicians

NHS clinicians have a key role in the identification, referral and care of people trafficked in the UK. However, little is known about clinicians’ response to trafficking or their training needs in this area. In addition the views and experiences of trafficked individuals who accessed NHS services or which NHS services they were likely to access were unknown. We aimed to provide evidence to inform the NHS response to human trafficking, specifically the identification and safe referral of trafficked people and provision of appropriate care to meet their health needs. Data relevant to maternity are presented

Pre-analytical stability of sorbitol dehydrogenase in equine heparinized plasma.

Sorbitol dehydrogenase (SDH) activity is one of the most sensitive and specific markers for hepatocellular injury in horses, but its reported lability makes it impractical for use in many clinical settings. To date, stability of SDH in equine samples has only been evaluated in a limited number of studies in serum samples of horses with activities within reference intervals. The objective of the study was to determine pre-analytical stability of equine SDH activity in heparinized plasma stored at different temperatures for up to 72 h. Twenty client-owned horses admitted to a veterinary teaching hospital for any reason were included in the study. Blood samples collected in lithium-heparin tubes were immediately centrifuged and SDH activity was analyzed within 1 h of collection (T0). Aliquots of plasma were stored at room temperature, 4 °C and -20 °C and SDH activity was re-analyzed after 4 h (T4), 24 h (T24) and 72 h (T72). A significant difference from values measured at T0 was found for samples stored at room temperature (P = 0.022) and -20 °C (P < 0.001), but not at 4 °C. The activity of SDH was within ±20% of that measured at T0 for all samples under all temperature conditions stored for 4 h, and for all samples stored at 4 °C for 24 h. Bland-Altman plots revealed narrow limits of agreement at T4 for all storage temperatures and at T24 for samples stored at 4 °C. The mean absolute percentage error and 95th percentile of the absolute percentage error were lower for samples stored at 4 °C than those stored at room temperature or -20 °C. The activity of SDH has adequate stability for 4 h regardless of storage temperature and 24 h if stored at 4 °C across a wide range of values. Knowledge of the pre-analytical stability of SDH may permit its broader use in assessing hepatic disorders in horses

The prevalence and correlates of self-harm in pregnant women with psychotic disorder and bipolar disorder

Women with severe mental illness are at increased risk of suicide in the perinatal period, and these suicides are often preceded by self-harm, but little is known about self-harm and its correlates in this population. This study aimed to investigate the prevalence of suicidal ideation and self-harm, and its correlates, in women with psychotic disorders and bipolar disorder during pregnancy. Historical cohort study using de-identified secondary mental healthcare records linked with national maternity data. Women pregnant from 2007 to 2011, with ICD-10 diagnoses of schizophrenia and related disorders, bipolar disorder or other affective psychoses were identified. Data were extracted from structured fields, natural language processing applications and free text. Logistic regression was used to examine the correlates of self-harm in pregnancy. Of 420 women, 103 (24.5 %) had a record of suicidal ideation during the first index pregnancy, with self-harm recorded in 33 (7.9 %). Self-harm was independently associated with younger age (adjusted odds ratio (aOR) 0.91, 95 % CI 0.85–0.98), self-harm in the previous 2 years (aOR 2.55; 1.05–6.50) and smoking (aOR 3.64; 1.30–10.19). A higher prevalence of self-harm was observed in women with non-affective psychosis, those who discontinued or switched medication and in women on no medication at the start of pregnancy, but these findings were not statistically significant in multivariable analyses. Suicidal thoughts and self-harm occur in a significant proportion of pregnant women with severe mental illness, particularly younger women and those with a history of self-harm; these women need particularly close monitoring for suicidality

Going Beyond Rote Auditory Learning: Neural Patterns of Generalized Auditory Learning

The ability to generalize across specific experiences is vital for the recognition of new patterns, especially in speech perception considering acoustic–phonetic pattern variability. Indeed, behavioral research has demonstrated that listeners are able via a process of generalized learning to leverage their experiences of past words said by difficult-to-understand talker to improve their understanding for new words said by that talker. Here, we examine differences in neural responses to generalized versus rote learning in auditory cortical processing by training listeners to understand a novel synthetic talker. Using a pretest–posttest design with EEG, participants were trained using either (1) a large inventory of words where no words were repeated across the experiment (generalized learning) or (2) a small inventory of words where words were repeated (rote learning). Analysis of long-latency auditory evoked potentials at pretest and posttest revealed that rote and generalized learning both produced rapid changes in auditory processing, yet the nature of these changes differed. Generalized learning was marked by an amplitude reduction in the N1–P2 complex and by the presence of a late negativity wave in the auditory evoked potential following training; rote learning was marked only by temporally later scalp topography differences. The early N1–P2 change, found only for generalized learning, is consistent with an active processing account of speech perception, which proposes that the ability to rapidly adjust to the specific vocal characteristics of a new talker (for which rote learning is rare) relies on attentional mechanisms to selectively modify early auditory processing sensitivity

Forced Stratified Turbulence: Successive Transitions with Reynolds Number

Numerical simulations are made for forced turbulence at a sequence of increasing values of Reynolds number, R, keeping fixed a strongly stable, volume-mean density stratification. At smaller values of R, the turbulent velocity is mainly horizontal, and the momentum balance is approximately cyclostrophic and hydrostatic. This is a regime dominated by so-called pancake vortices, with only a weak excitation of internal gravity waves and large values of the local Richardson number, Ri, everywhere. At higher values of R there are successive transitions to (a) overturning motions with local reversals in the density stratification and small or negative values of Ri; (b) growth of a horizontally uniform vertical shear flow component; and (c) growth of a large-scale vertical flow component. Throughout these transitions, pancake vortices continue to dominate the large-scale part of the turbulence, and the gravity wave component remains weak except at small scales.Comment: 8 pages, 5 figures (submitted to Phys. Rev. E

Intervention for children with word-finding difficulties: a parallel group randomised control trial

Purpose: The study investigated the outcome of a word-web intervention for children diagnosed with word-finding difficulties (WFDs). Method: Twenty children age 6–8 years with WFDs confirmed by a discrepancy between comprehension and production on the Test of Word Finding-2, were randomly assigned to intervention (n = 11) and waiting control (n = 9) groups. The intervention group had six sessions of intervention which used word-webs and targeted children’s meta-cognitive awareness and word-retrieval. Result: On the treated experimental set (n = 25 items) the intervention group gained on average four times as many items as the waiting control group (d = 2.30). There were also gains on personally chosen items for the intervention group. There was little change on untreated items for either group. Conclusion: The study is the first randomised control trial to demonstrate an effect of word-finding therapy with children with language difficulties in mainstream school. The improvement in word-finding for treated items was obtained following a clinically realistic intervention in terms of approach, intensity and duration

Young pregnant women and risk for mental disorders: findings from an early pregnancy cohort

BACKGROUND:Young women aged 16-24 are at high risk of common mental disorders (CMDs), but the risk during pregnancy is unclear.AimsTo compare the population prevalence of CMDs in pregnant women aged 16-24 with pregnant women ≥25 years in a representative cohort, hypothesising that younger women are at higher risk of CMDs (depression, anxiety disorders, post-traumatic stress disorder, obsessive-compulsive disorder), and that this is associated with low social support, higher rates of lifetime abuse and unemployment. METHOD:Analysis of cross-sectional baseline data from a cohort of 545 women (of whom 57 were aged 16-24 years), attending a South London maternity service, with recruitment stratified by endorsement of questions on low mood, interviewed with the Structured Clinical Interview DSM-IV-TR. RESULTS:Population prevalence estimates of CMDs were 45.1% (95% CI 23.5-68.7) in young women and 15.5% (95% CI 12.0-19.8) in women ≥25, and for 'any mental disorder' 67.2% (95% CI 41.7-85.4) and 21.2% (95% CI 17.0-26.1), respectively. Young women had greater odds of having a CMD (adjusted odds ratio (aOR) = 5.8, 95% CI 1.8-18.6) and CMDs were associated with living alone (aOR = 3.0, 95% CI 1.1-8.0) and abuse (aOR = 1.5, 95% CI 0.8-2.8). CONCLUSIONS:Pregnant women between 16 and 24 years are at very high risk of mental disorders; services need to target resources for pregnant women under 25, including those in their early 20s. Interventions enhancing social networks, addressing abuse and providing adequate mental health treatment may minimise adverse outcomes for young women and their children.Declaration of interestNone

A Parametric Study of Erupting Flux Rope Rotation. Modeling the "Cartwheel CME" on 9 April 2008

The rotation of erupting filaments in the solar corona is addressed through a parametric simulation study of unstable, rotating flux ropes in bipolar force-free initial equilibrium. The Lorentz force due to the external shear field component and the relaxation of tension in the twisted field are the major contributors to the rotation in this model, while reconnection with the ambient field is of minor importance. Both major mechanisms writhe the flux rope axis, converting part of the initial twist helicity, and produce rotation profiles which, to a large part, are very similar in a range of shear-twist combinations. A difference lies in the tendency of twist-driven rotation to saturate at lower heights than shear-driven rotation. For parameters characteristic of the source regions of erupting filaments and coronal mass ejections, the shear field is found to be the dominant origin of rotations in the corona and to be required if the rotation reaches angles of order 90 degrees and higher; it dominates even if the twist exceeds the threshold of the helical kink instability. The contributions by shear and twist to the total rotation can be disentangled in the analysis of observations if the rotation and rise profiles are simultaneously compared with model calculations. The resulting twist estimate allows one to judge whether the helical kink instability occurred. This is demonstrated for the erupting prominence in the "Cartwheel CME" on 9 April 2008, which has shown a rotation of \approx 115 degrees up to a height of 1.5 R_sun above the photosphere. Out of a range of initial equilibria which include strongly kink-unstable (twist Phi=5pi), weakly kink-unstable (Phi=3.5pi), and kink-stable (Phi=2.5pi) configurations, only the evolution of the weakly kink-unstable flux rope matches the observations in their entirety.Comment: Solar Physics, submitte