Postpartum acute stress disorder symptoms, social support, and quality of couple’s relationship associations with childbirth PTSD

BackgroundWe aimed to examine the hypothesized negative associations between childbirth post-traumatic stress disorder (PTSD) symptoms (using the two-factor model of birth-related and general symptoms), social support, and a couple’s relationship quality at 8–12 weeks postpartum. This analysis considered the longitudinal positive shared variance with acute stress disorder (ASD) symptoms measured shortly after birth, while accounting for obstetric and demographic variables.MethodsParticipants included 246 mothers who gave birth at the maternity ward of a tertiary healthcare center. Self-report questionnaires were used 1–4 days postpartum (T1): Demographic information, the Birth Satisfaction Scale-Revised (BSS-R), and the National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS). At T2 (8–12 weeks postpartum), the Multidimensional Scale of Perceived Social Support (MSPSS), the Dyadic Adjustment Scale (DAS-7), and the City Birth Trauma Scale (BiTS).ResultsIn partial support of our hypotheses, three hierarchical regression analyses revealed a significant positive contribution of ASD symptoms to childbirth PTSD general symptoms (β = .33, p <.001) and the total score (β = .29, p <.001), but not to birth-related symptoms. Social support (β = -.21, p = .003) and the quality of the couple’s relationship (β=-.20, p = .003) showed negative associations with the BiTS general symptoms.ConclusionOur study enhances understanding of the shared variance between childbirth ASD and PTSD, supporting the factor structure of general and birth-related symptoms as different aspects of childbirth PTSD and highlighting the negative association of social support and the quality of a couple’s relationship with PTSD general symptoms, suggesting potential avenues for targeted interventions

CaImAn an open source tool for scalable calcium imaging data analysis

Advances in fluorescence microscopy enable monitoring larger brain areas in-vivo with finer time resolution. The resulting data rates require reproducible analysis pipelines that are reliable, fully automated, and scalable to datasets generated over the course of months. We present CaImAn, an open-source library for calcium imaging data analysis. CaImAn provides automatic and scalable methods to address problems common to pre-processing, including motion correction, neural activity identification, and registration across different sessions of data collection. It does this while requiring minimal user intervention, with good scalability on computers ranging from laptops to high-performance computing clusters. CaImAn is suitable for two-photon and one-photon imaging, and also enables real-time analysis on streaming data. To benchmark the performance of CaImAn we collected and combined a corpus of manual annotations from multiple labelers on nine mouse two-photon datasets. We demonstrate that CaImAn achieves near-human performance in detecting locations of active neurons

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome

BACKGROUND: The efficacy of venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome (ARDS) remains controversial. METHODS: In an international clinical trial, we randomly assigned patients with very severe ARDS, as indicated by one of three criteria - a ratio of partial pressure of arterial oxygen (Pao) to the fraction of inspired oxygen (Fio) of less than 50 mm Hg for more than 3 hours; a Pao:Fio of less than 80 mm Hg for more than 6 hours; or an arterial blood pH of less than 7.25 with a partial pressure of arterial carbon dioxide of at least 60 mm Hg for more than 6 hours - to receive immediate venovenous ECMO (ECMO group) or continued conventional treatment (control group). Crossover to ECMO was possible for patients in the control group who had refractory hypoxemia. The primary end point was mortality at 60 days. RESULTS: At 60 days, 44 of 124 patients (35%) in the ECMO group and 57 of 125 (46%) in the control group had died (relative risk, 0.76; 95% confidence interval [CI], 0.55 to 1.04; P=0.09). Crossover to ECMO occurred a mean (±SD) of 6.5±9.7 days after randomization in 35 patients (28%) in the control group, with 20 of these patients (57%) dying. The frequency of complications did not differ significantly between groups, except that there were more bleeding events leading to transfusion in the ECMO group than in the control group (in 46% vs. 28% of patients; absolute risk difference, 18 percentage points; 95% CI, 6 to 30) as well as more cases of severe thrombocytopenia (in 27% vs. 16%; absolute risk difference, 11 percentage points; 95% CI, 0 to 21) and fewer cases of ischemic stroke (in no patients vs. 5%; absolute risk difference, -5 percentage points; 95% CI, -10 to -2). CONCLUSIONS: Among patients with very severe ARDS, 60-day mortality was not significantly lower with ECMO than with a strategy of conventional mechanical ventilation that included ECMO as rescue therapy. (Funded by the Direction de la Recherche Clinique et du Développement and the French Ministry of Health; EOLIA ClinicalTrials.gov number, NCT01470703 .)

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Risk of pocket hematoma in patients on chronic anticoagulation with warfarin undergoing electrophysiological device implantation: a comparison of different peri-operative management strategies

OBJECTIVE: Periprocedural management of warfarin remains challenging in patients requiring electrophysiological device surgery. For patients at high risk of thromboembolic events, guidelines recommend bridging therapy with heparin; however, this strategy is associated with a high risk of pocket hematoma. This paper systematically reviews studies appraising the risk of pocket hematoma with different perioperative anticoagulation strategies. METHODS: All relevant studies identified in MEDLINE/PubMed, The Cochrane Collaboration CENTRAL, clinicaltrials.org and in bibliographies of key articles. Estimates were combined using a fixed effects model. Heterogeneity was assessed by p values of chi(2) statistics and I-2. Publication bias was assessed by visual examination of funnel plots and by Egger test. Fifteen studies enrolling 5911 patients met all inclusion criteria and were included in this review. RESULTS: Heparin bridging compared with no heparin was associated with increased risk of pocket hematoma (OR = 4.47, 95% CI 3.21-6.23, p < 0.00001), and prolonged hospital stay (9.13 +/- 1.9 days vs. 5.11 +/- 1.39 days, p < 0.00001). Warfarin continuation was not associated with increased pocket hematoma compared to warfarin discontinuation (p = 0.38), but was associated with reduced risk of pocket hematoma compared with heparin bridging (OR = 0.37, 95% CI 0.2-0.69, p = 0.002). Thromboembolic complications were reduced with heparin bridging vs. no heparin (0.50% vs.1.07%, p = 0.02), and no significant differences were reported between heparin bridging vs. warfarin continuation (p = 0.83). CONCLUSIONS: Heparin bridging is associated with a higher risk of pocket hematoma and a prolonged hospital stay. Perioperative continuation of warfarin reduces the occurence of pocket hematoma compared with heparin bridging without any significant differences in thromboembolic complications