Experiences of intimate partner violence among partners during the perinatal period and the COVID-19 pandemic

Background: Intimate partner violence (IPV) is not only considered a serious public health issue and a cause of human suffering (National Center for Injury Prevention of the Centers for Disease Control and Prevention, 2015), IPV can be a barrier to utilization of care in vital life phases (Bonomi et al, 2009; Snow Jones, Dienemann, & Schollenberger, 2006), and a determinant of many serious negative health outcomes for affected individuals and their families (Silverman et al, 2020). As a significant contributor to health, social, and economic disparities, violence jeopardizes the fabric of families and transcends all levels of socioeconomic status (Rhodes, 2012). Among those who suffer serious to fatal consequences as a direct result of IPV, the perinatal period has only recently received special attention in research and is extremely scarce (WHO, 2011). This is particularly the case as the exposure/context of IPV may be further complicated by societal crises such as natural disasters and pandemics, where the threat of violence and its health consequences may be heightened (Yehuda et al, 2008). Objectives: The objectives of this dissertation were to address the knowledge gaps pertaining to perinatal IPV and violence experiences during the COVID-19 pandemic. It had three specialist articles, two of which were reviews of the literature, and one was a population-based empirical study. The objectives of the dissertation were as follows: 1) To explore uni- and bi-directional IPV prevalence estimates and associated factors during the perinatal period (Paper I) (Mojahed et al, 2021a); 2) To investigate a broader range of pre- pandemic contexts of social and geographical isolation and their associations with IPV, as well as to provide reliable, preliminary knowledge of their potential impact during the COVID- 19 pandemic (Paper II) (Mojahed et al, 2021b; 3) To explore the 12-month prevalence of psychological, physical, and sexual IPV within an existing cohort, which consists of women and men, as well as to detect any possible changes during the COVID-19 pandemic in the experienced IPV behaviors as opposed to pre-pandemic times (Paper III) (Mojahed et al, 2023); 4) To explore factors that could prospectively predict IPV victimization (Paper III). Materials and Methods: Paper I involved a qualitative synthesis of the literature. Due to the heterogeneity of prevalence studies and varying violence definitions, quantitative analyses were not feasible for this review. The paper investigated prevalence estimates of perinatal IPV among intimate partners and explored associated factors. Information such as author, year of publication, recruitment setting, study design, sample size, directionality of IPV, prevalence estimates, and types of violence were extracted and tabulated. The integrative ecological model was used to consider population characteristics and (gender-based) associated factors relevant to IPV prevalence. Paper II was a rapid review conducted following Cochrane guidelines to address the urgency of studying IPV in the context of the COVID-19 pandemic. The review focused on the correlation between social and geographical isolation and IPV. Paper III utilized data from the population-based longitudinal study DREAMCORONA. Descriptive analyses were performed to determine the prevalence of IPV victimization among women and men, examining changes during the pandemic. Pearson correlation analyses and multiple logistic regression analysis were conducted to identify associations and potential predictors of IPV. The results were presented as odds ratios with confidence intervals. Results: In Paper I, several key findings were reported. Psychological uni-directional IPV against female partners was most prevalent during pregnancy. Studies comparing IPV prevalence before and after childbirth showed mixed results, with some reporting a decrease and others reporting an increase in IPV after birth. Risk factors at the individual, family, community, and societal levels were identified, including socioeconomic status, substance use, insufficient prenatal care utilization, low self-esteem, unplanned pregnancy, lack of support, and certain social and ethnic identities. Paper II found that lack of social support increased the risk of IPV victimization, and the compounding effect of social and geographical isolation heightened this risk. It also revealed that social isolation correlated with physical and sexual IPV among female drug users and predicted various forms of IPV among immigrant women. In Paper III, it was found that around 50% of women and 40% of men experienced some form of IPV in the last 12 months. Psychological aggression was the most prevalent form of violence reported. The majority of women and men reported no change in victimization by psychological and physical violence during the pandemic. On the other hand, about a quarter of (expectant) mothers (27%) and fathers (22-24%) reported an increase in psychological and physical IPV. With regard to sexual violence, neither mothers nor fathers reported any changes during the pandemic. Higher partnership satisfaction reduced the likelihood of IPV victimization, while symptoms of anger-hostility increased this probability. Conclusions: Considering the burden of perinatal IPV and the impact of the COVID-19 pandemic on IPV, this dissertation highlights the urgent need for effective preventive interventions. The findings suggest the importance of initiating antenatal care and delivering in clinical settings, as these factors were associated with a lower risk of perinatal IPV. Routine screening for IPV in obstetric care is crucial, and healthcare providers should be aware of the elevated risk for mental health distress among perinatal partners exposed to IPV. As experiences of IPV remained largely unchanged during the pandemic, there is a strong recommendation to strengthen and improve access to support services. Alternative support measures such as messenger services and telemedicine should be accessible and reliable for victims of severe IPV who may face increased isolation. Raising awareness about IPV is essential for individuals in informal and formal sectors, as well as family and friends within the immediate social network of those at risk. The findings also support the use of programs targeting adverse interaction patterns, particularly psychological aggression. Future research should focus on associated factors of IPV during the peripartum period and other critical life phases or societal events. It is crucial to adopt ecological and intersectional perspectives to gain a comprehensive understanding of IPV. Furthermore, including the perspective of the other partner in IPV research can provide valuable context for better prevention and intervention strategies

Generalised Decision Level Ensemble Method for Classifying Multi-media Data

In recent decades, multimedia data have been commonly generated and used in various domains, such as in healthcare and social media due to their ability of capturing rich information. But as they are unstructured and separated, how to fuse and integrate multimedia datasets and then learn from them eectively have been a main challenge to machine learning. We present a novel generalised decision level ensemble method (GDLEM) that combines the multimedia datasets at decision level. After extracting features from each of multimedia datasets separately, the method trains models independently on each media dataset and then employs a generalised selection function to choose the appropriate models to construct a heterogeneous ensemble. The selection function is dened as a weighted combination of two criteria: the accuracy of individual models and the diversity among the models. The framework is tested on multimedia data and compared with other heterogeneous ensembles. The results show that the GDLEM is more exible and eective

Condensates and pressure of two-flavor chiral perturbation theory at nonzero isospin and temperature

We consider two-flavor chiral perturbation theory ($\chi$PT) at finite isospin chemical potential $\mu_I$ and finite temperature $T$. We calculate the effective potential and the quark and pion condensates as functions of $T$ and $\mu_I$ to next-to-leading order in the low-energy expansion in the presence of a pionic source. We map out the phase diagram in the $\mu_I$--$T$ plane. Numerically, we find that the transition to the pion-condensed phase is second order in the region of validity of $\chi$PT, which is in agreement with model calculations and lattice simulations. Finally, we calculate the pressure to two-loop order in the symmetric phase for nonzero $\mu_I$ and find that $\chi$PT seems to be converging very well.Comment: 11 pages and 6 figures, LaTeX; typos corrected, references adde

Assessing the Dissipative Capacity of Particle Impact Dampers Based on their Nonlinear Bandwidth Characteristics

The dissipative capacity as quantified by the nonlinear bandwidth measure of impulsively loaded primary structures (PSs) coupled to particle impact dampers (PIDs) is assessed. The considered PIDs are designed by initially placing different numbers of spherical, linearly viscoelastic granules at different 2D initial topologies and clearances. The strongly nonlinear and highly discontinuous dynamics of the PIDs are simulated via the discrete element method taking Hertzian interactions, slipping friction and granular rotations into account. The general definition of nonlinear bandwidth is used to evaluate the energy dissipation capacity of the integrated PS-PID systems. Moreover, the effect of the dynamics of the PIDs on the time-bandwidth product of these systems is studied, as a measure of their capacity to store or dissipate vibration energy. It is found that the initial topologies of the granules in the PID drastically affect the time-bandwidth product, which, depending on shock intensity, may break the classical limit of unity which holds for linear time-invariant dissipative resonators. The optimal PS-PID systems composed of multiple granules produce large nonlinear bandwidths, indicating strong dissipative capacity of broadband input energy by the PIDs. Additionally, in the optimal configurations, the time-bandwidth product, i.e., the measure of the frequency bandwidth of the input shock that is stored in the PS-PID system, in tandem with the amount of time it takes for the system to dissipate (1/e) of the initial energy, can be tuned either above or below unity by varying the applied shock intensity. The implications of these findings on the dissipative capacity of the system considered are discussed, showing that it can be predictively assessed so that PIDs can act as highly effective nonlinear energy sinks capable of rapid and efficient suppression of vibration induced by shocks

Decision level ensemble method for classifying multi-media data

In the digital era, the data, for a given analytical task, can be collected in different formats, such as text, images and audio etc. The data with multiple formats are called multimedia data. Integrating and fusing multimedia datasets has become a challenging task in machine learning and data mining. In this paper, we present heterogeneous ensemble method that combines multi-media datasets at the decision level. Our method consists of several components, including extracting the features from multimedia datasets that are not represented by features, modelling independently on each of multimedia datasets, selecting models based on their accuracy and diversity and building the ensemble at the decision level. Hence our method is called decision level ensemble method (DLEM). The method is tested on multimedia data and compared with other heterogeneous ensemble based methods. The results show that the DLEM outperformed these methods significantly

Renal primitive neuroectodermal tumor: does age at diagnosis impact outcomes?

Primitive neuroectodermal tumor (PNET) of the kidney is a rare and highly malignant neoplasm. The median age for renal PNET is 27 years but it can be seen also in a wide age range between 3 and 78 years. We performed a Medline search for the term renal PNET and identified 79 cases up till December of 2010. We report here a new case of renal PNET and a literature review for published data for evaluation of clinicopathological prognostic factors, with an emphasis on prognosis in two groups of adults and children-adolescents: 18 years of age or under and over 18 years

An adaptive version of k-medoids to deal with the uncertainty in clustering heterogeneous data using an intermediary fusion approach

This paper introduces Hk-medoids, a modified version of the standard k-medoids algorithm. The modification extends the algorithm for the problem of clustering complex heterogeneous objects that are described by a diversity of data types, e.g. text, images, structured data and time series. We first proposed an intermediary fusion approach to calculate fused similarities between objects, SMF, taking into account the similarities between the component elements of the objects using appropriate similarity measures. The fused approach entails uncertainty for incomplete objects or for objects which have diverging distances according to the different component. Our implementation of Hk-medoids proposed here works with the fused distances and deals with the uncertainty in the fusion process. We experimentally evaluate the potential of our proposed algorithm using five datasets with different combinations of data types that define the objects. Our results show the feasibility of the our algorithm, and also they show a performance enhancement when comparing to the application of the original SMF approach in combination with a standard k-medoids that does not take uncertainty into account. In addition, from a theoretical point of view, our proposed algorithm has lower computation complexity than the popular PAM implementation

Visualisation of Integrated Patient-Centric Data as Pathways: Enhancing Electronic Medical Records in Clinical Practice

Routinely collected data in hospital Electronic Medical Records (EMR) is rich and abundant but often not linked or analysed for purposes other than direct patient care. We have created a methodology to integrate patient-centric data from different EMR systems into clinical pathways that represent the history of all patient interactions with the hospital during the course of a disease and beyond. In this paper, the literature in the area of data visualisation in healthcare is reviewed and a method for visualising the journeys that patients take through care is discussed. Examples of the hidden knowledge that could be discovered using this approach are explored and the main application areas of visualisation tools are identified. This paper also highlights the challenges of collecting and analysing such data and making the visualisations extensively used in the medical domain. This paper starts by presenting the state-of-the-art in visualisation of clinical and other health related data. Then, it describes an example clinical problem and discusses the visualisation tools and techniques created for the utilisation of these data by clinicians and researchers. Finally, we look at the open problems in this area of research and discuss future challenges

Experiences of intimate partner violence among partners during the perinatal period and the COVID-19 pandemic

Background: Intimate partner violence (IPV) is not only considered a serious public health issue and a cause of human suffering (National Center for Injury Prevention of the Centers for Disease Control and Prevention, 2015), IPV can be a barrier to utilization of care in vital life phases (Bonomi et al, 2009; Snow Jones, Dienemann, & Schollenberger, 2006), and a determinant of many serious negative health outcomes for affected individuals and their families (Silverman et al, 2020). As a significant contributor to health, social, and economic disparities, violence jeopardizes the fabric of families and transcends all levels of socioeconomic status (Rhodes, 2012). Among those who suffer serious to fatal consequences as a direct result of IPV, the perinatal period has only recently received special attention in research and is extremely scarce (WHO, 2011). This is particularly the case as the exposure/context of IPV may be further complicated by societal crises such as natural disasters and pandemics, where the threat of violence and its health consequences may be heightened (Yehuda et al, 2008). Objectives: The objectives of this dissertation were to address the knowledge gaps pertaining to perinatal IPV and violence experiences during the COVID-19 pandemic. It had three specialist articles, two of which were reviews of the literature, and one was a population-based empirical study. The objectives of the dissertation were as follows: 1) To explore uni- and bi-directional IPV prevalence estimates and associated factors during the perinatal period (Paper I) (Mojahed et al, 2021a); 2) To investigate a broader range of pre- pandemic contexts of social and geographical isolation and their associations with IPV, as well as to provide reliable, preliminary knowledge of their potential impact during the COVID- 19 pandemic (Paper II) (Mojahed et al, 2021b; 3) To explore the 12-month prevalence of psychological, physical, and sexual IPV within an existing cohort, which consists of women and men, as well as to detect any possible changes during the COVID-19 pandemic in the experienced IPV behaviors as opposed to pre-pandemic times (Paper III) (Mojahed et al, 2023); 4) To explore factors that could prospectively predict IPV victimization (Paper III). Materials and Methods: Paper I involved a qualitative synthesis of the literature. Due to the heterogeneity of prevalence studies and varying violence definitions, quantitative analyses were not feasible for this review. The paper investigated prevalence estimates of perinatal IPV among intimate partners and explored associated factors. Information such as author, year of publication, recruitment setting, study design, sample size, directionality of IPV, prevalence estimates, and types of violence were extracted and tabulated. The integrative ecological model was used to consider population characteristics and (gender-based) associated factors relevant to IPV prevalence. Paper II was a rapid review conducted following Cochrane guidelines to address the urgency of studying IPV in the context of the COVID-19 pandemic. The review focused on the correlation between social and geographical isolation and IPV. Paper III utilized data from the population-based longitudinal study DREAMCORONA. Descriptive analyses were performed to determine the prevalence of IPV victimization among women and men, examining changes during the pandemic. Pearson correlation analyses and multiple logistic regression analysis were conducted to identify associations and potential predictors of IPV. The results were presented as odds ratios with confidence intervals. Results: In Paper I, several key findings were reported. Psychological uni-directional IPV against female partners was most prevalent during pregnancy. Studies comparing IPV prevalence before and after childbirth showed mixed results, with some reporting a decrease and others reporting an increase in IPV after birth. Risk factors at the individual, family, community, and societal levels were identified, including socioeconomic status, substance use, insufficient prenatal care utilization, low self-esteem, unplanned pregnancy, lack of support, and certain social and ethnic identities. Paper II found that lack of social support increased the risk of IPV victimization, and the compounding effect of social and geographical isolation heightened this risk. It also revealed that social isolation correlated with physical and sexual IPV among female drug users and predicted various forms of IPV among immigrant women. In Paper III, it was found that around 50% of women and 40% of men experienced some form of IPV in the last 12 months. Psychological aggression was the most prevalent form of violence reported. The majority of women and men reported no change in victimization by psychological and physical violence during the pandemic. On the other hand, about a quarter of (expectant) mothers (27%) and fathers (22-24%) reported an increase in psychological and physical IPV. With regard to sexual violence, neither mothers nor fathers reported any changes during the pandemic. Higher partnership satisfaction reduced the likelihood of IPV victimization, while symptoms of anger-hostility increased this probability. Conclusions: Considering the burden of perinatal IPV and the impact of the COVID-19 pandemic on IPV, this dissertation highlights the urgent need for effective preventive interventions. The findings suggest the importance of initiating antenatal care and delivering in clinical settings, as these factors were associated with a lower risk of perinatal IPV. Routine screening for IPV in obstetric care is crucial, and healthcare providers should be aware of the elevated risk for mental health distress among perinatal partners exposed to IPV. As experiences of IPV remained largely unchanged during the pandemic, there is a strong recommendation to strengthen and improve access to support services. Alternative support measures such as messenger services and telemedicine should be accessible and reliable for victims of severe IPV who may face increased isolation. Raising awareness about IPV is essential for individuals in informal and formal sectors, as well as family and friends within the immediate social network of those at risk. The findings also support the use of programs targeting adverse interaction patterns, particularly psychological aggression. Future research should focus on associated factors of IPV during the peripartum period and other critical life phases or societal events. It is crucial to adopt ecological and intersectional perspectives to gain a comprehensive understanding of IPV. Furthermore, including the perspective of the other partner in IPV research can provide valuable context for better prevention and intervention strategies