Mindfulness in antenatal classes: A quasi-experimental pilot study

Pregnancy is a major life transition, and entails high levels of change and uncertainty which, for some parents, can elicit anxiety and distress. Mindfulness practices may help people to cope with uncertainty and change. This study explores whether adding mindfulness to antenatal classes is acceptable and helpful for mothers and fathers, and whether participants use these skills during pregnancy, birth, and the early postnatal period. It also explores whether it is feasible to incorporate mindfulness into an existing comprehensive antenatal education curriculum. The study compared the experiences of participants in two sets of antenatal classes with the same curriculum, except for the addition of a brief weekly mindfulness exercise and associated handout for one of the two groups. The two-hour classes were run over six weeks for pregnant women in their third trimester and their partners. Two separate trials were carried out consecutively – Trial A and Trial B. Trial A included 23 participants in the intervention group and 15 in the comparison group. Thirty-eight people were in the Trial B intervention group and 32 in the comparison group. However, practical barriers led to the Trial B intervention being minimally delivered and therefore data from Trial B were not analysed. Pre-intervention and post-intervention questionnaires measured pregnancy-related anxiety, psychological distress, and mindfulness. Acceptability of the mindfulness intervention and satisfaction with the antenatal classes was measured post-intervention. Psychological distress, mindfulness, and overall birth experience were measured one-month postnatally. Findings showed no statistically significant reductions in psychological distress or pregnancy-related anxiety for either group. There were also no significant increases in mindfulness. Although not statistically significant, participants in the mindfulness group may have had a slightly better birth experience; however, this is difficult to establish with certainty. People in the mindfulness group generally enjoyed the classes overall and reported having learned some useful skills; however, most did not practice mindfulness outside of class. The results of this pilot study suggest that it may be feasible to incorporate mindfulness into typical antenatal classes if adaptations are made so that it can be more smoothly integrated into the existing curriculum. Further research is needed into the feasibility of mindfulness in antenatal classes using a mindfulness programme which addresses the challenges identified in this study. This may have implications for the potential inclusion of brief mindfulness interventions across a variety of health and social settings

The Complexity of Approximately Counting Stable Roommate Assignments

We investigate the complexity of approximately counting stable roommate assignments in two models: (i) the $k$-attribute model, in which the preference lists are determined by dot products of "preference vectors" with "attribute vectors" and (ii) the $k$-Euclidean model, in which the preference lists are determined by the closeness of the "positions" of the people to their "preferred positions". Exactly counting the number of assignments is #P-complete, since Irving and Leather demonstrated #P-completeness for the special case of the stable marriage problem. We show that counting the number of stable roommate assignments in the $k$-attribute model ($k \geq 4$) and the 3-Euclidean model($k \geq 3$) is interreducible, in an approximation-preserving sense, with counting independent sets (of all sizes) (#IS) in a graph, or counting the number of satisfying assignments of a Boolean formula (#SAT). This means that there can be no FPRAS for any of these problems unless NP=RP. As a consequence, we infer that there is no FPRAS for counting stable roommate assignments (#SR) unless NP=RP. Utilizing previous results by the authors, we give an approximation-preserving reduction from counting the number of independent sets in a bipartite graph (#BIS) to counting the number of stable roommate assignments both in the 3-attribute model and in the 2-Euclidean model. #BIS is complete with respect to approximation-preserving reductions in the logically-defined complexity class #RH\Pi_1. Hence, our result shows that an FPRAS for counting stable roommate assignments in the 3-attribute model would give an FPRAS for all of #RH\Pi_1. We also show that the 1-attribute stable roommate problem always has either one or two stable roommate assignments, so the number of assignments can be determined exactly in polynomial time

Social structure, activity budgets and spatial relationships of the British & Irish captive population of lion-tailed macaques (Macaca silenus)

Less than 2500 mature lion-tailed macaques (Macaca silenus) are left in the wild in the Western Ghats, India. It is important to manage and sustain the captive populations to gain an insight into this species and how to manage the wild fragmented populations. The European captive population suffers from high infant mortality, large birth intervals and a low reproductive success amongst females. Thus the aim of this study was to assess possible causes of these three factors by investigating the social structure, activity budgets and spatial relationships in the captive British and Irish population of lion-tailed macaques. Observations were carried out at all zoos housing this species in the U.K. and Ireland. Observations were made over 12 days per zoo at 09:00h, 12:00h and 15:00h. The average distance between individuals within a group was determined using Animal Tracker® computer software. Activity budgets were constructed for each zoo. Enclosure size, enclosure complexity, feeding regimes and visitor numbers were investigated to determine any influence on spatial separation distances and activity budgets. The social structure varied between groups due to age, sex and number of individuals and the facilities surrounding each of the groups. The degree of relatedness between females, as well as the size of enclosure, appeared to influence the spatial separation distances between individuals, although not significantly. The activity budgets varied between zoos, with autogrooming and foraging showing significant differences throughout all sampling periods. Significant differences in behaviour were also found between adult and juvenile lion-tailed macaques and in relation to time of day. Visitor numbers and feeding regimes appeared to have no effect on the macaques' behaviour. However, enclosure size and enclosure complexity did appear to influence behaviour. In conclusion, this study of captive lion-tailed macaques gives an insight into how wild fragmented populations may be influenced by a reduced and isolated habitat. This study will also provide information regarding the welfare of captive lion-tailed macaques

Gastrointestinal Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

CONTEXT Prior criteria to define pediatric multiple organ dysfunction syndrome (MODS) did not include gastrointestinal dysfunction. OBJECTIVES Our objective was to evaluate current evidence and to develop consensus criteria for gastrointestinal dysfunction in critically ill children. DATA SOURCES Electronic searches of PubMed and EMBASE were conducted from January 1992 to January 2020, using medical subject heading terms and text words to define gastrointestinal dysfunction, pediatric critical illness, and outcomes. STUDY SELECTION Studies were included if they evaluated critically ill children with gastrointestinal dysfunction, performance characteristics of assessment/scoring tools to screen for gastrointestinal dysfunction, and assessed outcomes related to mortality, functional status, organ-specific outcomes, or other patient-centered outcomes. Studies of adults or premature infants, animal studies, reviews/commentaries, case series with sample size ≤10, and non-English language studies with inability to determine eligibility criteria were excluded. DATA EXTRACTION Data were abstracted from each eligible study into a standard data extraction form along with risk of bias assessment by a task force member. RESULTS The systematic review supports the following criteria for severe gastrointestinal dysfunction: 1a) bowel perforation, 1b) pneumatosis intestinalis, or 1c) bowel ischemia, present on plain abdominal radiograph, computed tomography (CT) scan, magnetic resonance imaging (MRI), or gross surgical inspection, or 2) rectal sloughing of gut mucosa. LIMITATIONS The validity of the consensus criteria for gastrointestinal dysfunction are limited by the quantity and quality of current evidence. CONCLUSIONS Understanding the role of gastrointestinal dysfunction in the pathophysiology and outcomes of MODS is important in pediatric critical illness

Increasing uptake of hepatitis C virus infection case- finding, testing, and treatment in primary care: evaluation of the HepCATT (Hepatitis C Assessment Through to Treatment) trial

Background Hepatitis C virus (HCV) infection is a key cause of liver disease but can be cured in more than 95% of patients. Around 70 000 people in England may have undiagnosed HCV infection and many more will not have been treated. Interventions to increase case-finding in primary care are likely to be cost-effective; however, evidence of effective interventions is lacking. The Hepatitis C Assessment Through to Treatment (HepCATT) trial assessed whether a complex intervention in primary care could increase case-finding, testing, and treatment of HCV.Aim To investigate the feasibility and acceptability of the HepCATT intervention.Design and setting A qualitative study with primary care practice staff from practices in the south west of England taking part in the HepCATT trial.Method Semi-structured interviews were carried out with GPs, nurses, and practice staff to ascertain their views of the HepCATT intervention at least 1 month after implementing the intervention in their practice. Normalisation process theory, which outlines the social processes involved in intervention implementation, informed thematic data analysis.Results Participants appreciated the HepCATT intervention for increasing knowledge and awareness of HCV. Although some initial technical difficulties were reported, participants saw the benefits of using the audit tool to systematically identify patients with HCV infection risk factors and found it straightforward to use. Participants valued the opportunity to discuss HCV testing with patients, especially those who may not have been previously aware of HCV risk. Future implementation should consider fully integrating software systems and additional resources to screen patient lists and conduct tests.Conclusion When supported by a complex intervention, primary care can play a crucial role in identifying and caring for patients with HCV infection, to help stem the HCV epidemic, and prevent HCV-related illnes

Increasing uptake of Hepatitis C virus infection case-finding, testing and treatment in primary care:HepCATT (Hepatitis C Assessment Through to Treatment Trial) qualitative evaluation

Hepatitis C virus (HCV) infection is a key cause of liver disease but can be cured in more than 95% of patients. Around 70 000 people in England may have undiagnosed HCV infection and many more will not have been treated. Interventions to increase case-finding in primary care are likely to be cost-effective; however, evidence of effective interventions is lacking. The Hepatitis C Assessment Through to Treatment (HepCATT) trial assessed whether a complex intervention in primary care could increase case-finding, testing, and treatment of HCV