GP-initiated preconception counselling in a randomised controlled trial does not induce anxiety

BACKGROUND: Preconception counselling (PCC) can reduce adverse pregnancy outcome by addressing risk factors prior to pregnancy. This study explores whether anxiety is induced in women either by the offer of PCC or by participation with GP-initiated PCC. METHODS: Randomised trial of usual care versus GP-initiated PCC for women aged 18–40, in 54 GP practices in the Netherlands. Women completed the six-item Spielberger State Trait Anxiety Inventory (STAI) before PCC (STAI-1) and after (STAI-2). After pregnancy women completed a STAI focusing on the first trimester of pregnancy (STAI-3). RESULTS: The mean STAI-1-score (n = 466) was 36.4 (95% CI 35.4 – 37.3). Following PCC there was an average decrease of 3.6 points in anxiety-levels (95% CI, 2.4 – 4.8). Mean scores of the STAI-3 were 38.5 (95% CI 37.7 – 39.3) in the control group (n = 1090) and 38.7 (95% CI 37.9 – 39.5) in the intervention group (n = 1186). CONCLUSION: PCC from one's own GP reduced anxiety after participation, without leading to an increase in anxiety among the intervention group during pregnancy. We therefore conclude that GPs can offer PCC to the general population without fear of causing anxiety. Trial Registration: ISRCTN5394291

Climate Change and the Future of California's Endemic Flora

The flora of California, a global biodiversity hotspot, includes 2387 endemic plant taxa. With anticipated climate change, we project that up to 66% will experience >80% reductions in range size within a century. These results are comparable with other studies of fewer species or just samples of a region's endemics. Projected reductions depend on the magnitude of future emissions and on the ability of species to disperse from their current locations. California's varied terrain could cause species to move in very different directions, breaking up present-day floras. However, our projections also identify regions where species undergoing severe range reductions may persist. Protecting these potential future refugia and facilitating species dispersal will be essential to maintain biodiversity in the face of climate change

Mega-heatwave temperatures due to combined soil desiccation and atmospheric heat accumulation

The recent European mega-heatwaves of 2003 and 2010 broke temperature records across Europe(1-5). Although events of this magnitude were unprecedented from a historical perspective, they are expected to become common by the end of the century(6,7). However, our understanding of extreme heatwave events is limited and their representation in climate models remains imperfect(8). Here we investigate the physical processes underlying recent mega-heatwaves using satellite and balloon measurements of land and atmospheric conditions from the summers of 2003 in France and 2010 in Russia, in combination with a soil-water-atmosphere model. We find that, in both events, persistent atmospheric pressure patterns induced land-atmosphere feedbacks that led to extreme temperatures. During daytime, heat was supplied by large-scale horizontal advection, warming of an increasingly desiccated land surface and enhanced entrainment of warm air into the atmospheric boundary layer. Overnight, the heat generated during the day was preserved in an anomalous kilometres-deep atmospheric layer located several hundred metres above the surface, available to re-enter the atmospheric boundary layer during the next diurnal cycle. This resulted in a progressive accumulation of heat over several days, which enhanced soil desiccation and led to further escalation in air temperatures. Our findings suggest that the extreme temperatures in mega-heatwaves can be explained by the combined multi-day memory of the land surface and the atmospheric boundary layer