Desistance, Self-treatment, or Substitution: Decisions about Cannabis Use During Pregnancy

Cannabis is the most commonly used drug during pregnancy in the United States and Canada, and the American College of Obstetricians and Gynecologists recommends that all pregnant individuals be screened for cannabis use and counseled regarding potential adverse health impacts of use. However, those considering or using cannabis during pregnancy report experiencing stigma and lack of information from health care providers and, thus, frequently rely on friends, family, and the internet for information. This article describes 3 types of decisions individuals may be making about cannabis use during pregnancy and suggests approaches health care providers may take to minimize judgment and provide optimal support for informed cannabis use decisions among pregnant individuals. Desistance decisions involve consideration of whether and how to reduce or stop using during pregnancy. Self‐treatment decisions are made by those exploring cannabis to help alleviate troublesome symptoms such as nausea or anxiety. Substitution decisions entail weighing whether to use cannabis instead of another substance with greater perceived harms. Health care providers should be able to recognize the various types of cannabis use decisions that are being made in pregnancy and be ready to have a supportive conversation to provide current and evidence‐based information to individuals making desistance, self‐treatment, and substitution decisions. Individuals making desistance decisions may require support with potential adverse consequences such as withdrawal or return of symptoms for which cannabis was being used, as well as potentially navigating social situations during which cannabis use is expected. Those making self‐treatment decisions should be helped to fully explore treatment options for their symptoms, including evidence on risks and benefits. Regarding substitution decisions, health care providers should endeavor to help pregnant individuals understand the available evidence regarding risks and benefits of available options and be open to revisiting the topic over time

Relational Decision‐Making in the Context of Life‐Limiting Fetal Anomalies: Two Cases of Anencephaly Diagnosis

Life‐limiting fetal diagnoses such as anencephaly require families to make decisions in which no options offered will lead to the desired outcome of a healthy newborn. Although informed choice and shared decision‐making are important aspects of ethics regarding care choices, they have limitations. In this article, 2 cases of anencephaly diagnosis are presented, and a relational decision‐making model of care is proposed as an alternative for aiding pregnant people and their families in making challenging choices in the context of perinatal care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163826/1/jmwh13161.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163826/2/jmwh13161_am.pd

An Anthropocene Without Archaeology—Should We Care?

For more than a decade, a movement has been gathering steam among geoscientists to designate an Anthropocene Epoch and formally recognize that we have entered a new geological age in which Earth’s systems are dominated by humans. Chemists, climatologists, and other scientists have entered the discussion, and there is a growing consensus that we are living in the Anthropocene. Nobel Prize-winning atmospheric chemist Paul Crutzen (2002a, 2002b; Crutzen and Stoermer 2000) coined the term, but the idea that humans are a driver of our planet’s climate and ecosystems has much deeper roots. Italian geologist Antonio Stoppani wrote of the “anthropozoic era” in 1873 (Crutzen 2002a), and many others have proposed similar ideas, including journalist Andrew Revkin’s (1992) reference to the “Anthrocene” and Vitousek and colleagues (1997) article about human domination of earth’s ecosystems. It was not until Crutzen (2002a, 2002b) proposed that the Anthropocene began with increased atmospheric carbon levels caused by the Industrial Revolution in the late eighteenth century (including the invention of the steam engine in A.D. 1784), however, that the concept began to gain serious traction among scientists and inspire debate

The DistoX2: a methodological solution to archaeological mapping in poorly accessible environments

Spatial information is crucial to archaeological field research. From the plane-table to the total station, recent technological advances have enabled data collection to become fully digital and highly accurate. Nevertheless, the recent expansion of archaeological expeditions to novel environments often incompatible with modern mapping equipment, e.g. tropical forests or ephemeral shorelines, calls for further methodological innovations. Such projects, as well as those under logistic or financial limitations, are still largely reliant on more time consuming, less accurate, traditional approaches, e.g. offset or tape and compass methods. The DistoX2 is a digital, highly portable, and versatile hand-held instrument originally developed for speleological surveys where total stations and DGPSs are not feasible. However, the potential of the DistoX2 system as a spatial mapping tool in above-ground contexts has been surprisingly overlooked. Here, we present a first assessment of the applicability of the DistoX2 for archaeological mapping in non-speleological environments. We investigate precision and accuracy in controlled above-ground settings relative to two common methods of data collection - total station, and tape and compass. We test the relative precision of the DistoX2 when mounted on a tripod or operated in hand-held mode and discuss its applicability, and potential combined used, in the context of other increasingly popular methods - GNSS and SfM photogrammetry. With a mean error of approximate to 5.00 cm for horizontal readings and approximate to 2.00 cm for vertical readings, the DistoX2 is considerably more accurate than the tape and compass method (mu approximate to 67.00 cm horizontal; mu approximate to 3.00 cm vertical). While the DistoX2 exceeds the error thresholds of projects that require high spatial sensitivity (e.g. Palaeolithic excavations), it provides a reliable, low-cost and more accurate alternative to many projects that resort to more traditional methods. This fills an existent methodological and financial gap amongst the growing diversity of archaeological expeditions.SFRH/BD/115085/2016; UIDB/04211/2020; EC-399R-18info:eu-repo/semantics/publishedVersio

A puzzle form of a non-verbal intelligence test gives significantly higher performance measures in children with severe intellectual disability

<p>Abstract</p> <p>Background</p> <p>Assessment of 'potential intellectual ability' of children with severe intellectual disability (ID) is limited, as current tests designed for normal children do not maintain their interest. Thus a <it>manual puzzle </it>version of the Raven's Coloured Progressive Matrices (RCPM) was devised to appeal to the attentional and sensory preferences and language limitations of children with ID. It was hypothesized that performance on the book and manual puzzle forms would not differ for typically developing children but that children with ID would perform better on the puzzle form.</p> <p>Methods</p> <p>The first study assessed the validity of this puzzle form of the RCPM for 76 typically developing children in a test-retest crossover design, with a 3 week interval between tests. A second study tested performance and completion rate for the puzzle form compared to the book form in a sample of 164 children with ID.</p> <p>Results</p> <p>In the first study, no significant difference was found between performance on the puzzle and book forms in typically developing children, irrespective of the order of completion. The second study demonstrated a significantly higher performance and completion rate for the puzzle form compared to the book form in the ID population.</p> <p>Conclusion</p> <p>Similar performance on book and puzzle forms of the RCPM by typically developing children suggests that both forms measure the same construct. These findings suggest that the puzzle form does not require greater cognitive ability but demands sensory-motor attention and limits distraction in children with severe ID. Thus, we suggest the puzzle form of the RCPM is a more reliable measure of the non-verbal mentation of children with severe ID than the book form.</p

Environmental contributions to disparities in pregnancy outcomes.

One of the most persistent disparities in American health status is the pronounced difference in birth outcomes between non-Hispanic black and non-Hispanic white women. Poor pregnancy outcomes have a substantial impact on mortality, morbidity, and health care costs. Increasing evidence indicates that environmental exposures are associated with poor birth outcomes. This paper reviews the latest research on how environmental exposures affect pregnancy outcomes and then discusses how these exposures may be embedded within a context of significant social and host factor stress. The analysis suggests that environmental, social, and host factors are cumulatively stressing non-Hispanic black women and that this cumulative stress may be a cause of the persistent disparities in pregnancy outcomes

Weaned age variation in the Virunga mountain gorillas (Gorilla beringei beringei)

The final publication is available at Springer via http://dx.doi.org/10.1007/s00265-016-2066-6Weaning marks an important milestone during life history in mammals indicating nutritional independence from the mother. Age at weaning is a key measure of maternal investment and care, affecting female reproductive rates, offspring survival and ultimately the viability of a population. Factors explaining weaned age variation in the endangered mountain gorilla are not yet well understood. This study investigated the impact of group size, group type (one-male versus multi-male), offspring sex, as well as maternal age, rank, and parity on weaned age variation in the Virunga mountain gorilla population. The status of nutritional independence was established in 69 offspring using long-term suckling observations. A Cox-regression with mixed effects was applied to model weaned age and its relationship with covariates. Findings indicate that offspring in one-male groups are more likely to be weaned earlier than offspring in multi-male groups, which may reflect a female reproductive strategy to reduce higher risk of infanticide in one-male groups. Inferior milk production capacity and conflicting resource allocation between their own and offspring growth may explain later weaning in primiparous mothers compared to multiparous mothers. Sex-biased weaned age related to maternal condition defined by parity, rank, and maternal age will be discussed in the light of the Trivers-Willard hypothesis. Long-term demographic records revealed no disadvantage of early weaning for mother or offspring. Population growth and two peaks in weaned age within the Virunga population encourage future studies on the potential impact of bamboo shoots as a weaning food and other environmental factors on weaning