Brief Report: Sedatives for Mothers of Stillborn Infants: Views from a National Survey of Obstetricians

Abstract Although no guidelines support the use of benzodiazepines in bereavement care, clinicians continue to use this medication for surviving family members. An anonymous survey about perinatal death was sent to 1500 United States obstetricians. One question assessed beliefs about prescribing sedatives to bereaved mothers. Almost half (49%) of 804 obstetricians endorsed the use of sedatives, such as benzodiazepines, for acute bereavement. Grieving families may experience mental and physical anguish after a death; however, benzodiazepines are not part of recommended care for bereavement. The surprisingly high support from physicians for the use of sedatives in the case of maternal grief raises important questions about how physicians can best support bereaved mothers and what effect benzodiazepines may have in the grieving process.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63275/1/jwh.2008.0868.pd

On what scales can GOSAT flux inversions constrain anomalies in terrestrial ecosystems?

This is the final version. Available on open access from European Geosciences Union via the DOI in this recordData availability. CarbonTracker CT2016 results were provided by NOAA ESRL, Boulder, Colorado, USA, from the website at https://www.esrl.noaa.gov/gmd/ccgg/carbontracker/ (National Oceanic and Atmospheric Administration (NOAA) Earth System Laboratory (ESRL), 2019a). CASA GFED 4.1 and CASA CMS NEE fluxes were also downloaded from the CT2016 website. The GOSAT L4 product and VISIT NEE were downloaded from the GOSAT Data Archive Service (https://data2.gosat.nies.go.jp; NIES, 2019). The Dai Global Palmer Drought Severity Index was downloaded from the Research Data Archive at the National Center for Atmospheric Research, Computational and Information Systems Laboratory (https://doi.org/10.5065/D6QF8R93; Dai, 2017). NASA GOME-2 SIF products were obtained from the Aura Validation Data Center (https://avdc.gsfc.nasa.gov/; Aura Validation Data Center, 2019). FLUXCOM products were obtained from the data portal of the Max Planck Institute for Biochemistry (https://www.bgc-jena.mpg.de/geodb/projects/Home.php.; Max Plank Institue for Biogeochemistry, 2019). MERRA-2 products were downloaded from MDISC (https://gmao.gsfc.nasa.gov/reanalysis/MERRA-2/; Global Modeling and Assimilation Office, 2019), managed by the NASA Goddard Earth Sciences (GES) Data and Information Services Center (DISC). The GEOS-Chem forward and adjoint models are freely available to the public. Instructions for downloading and running the models can be found at http://wiki.seas.harvard.edu/geos-chem (Atmospheric Chemistry Modeling Group at Harvard University , 2019). ACOS GOSAT lite files were obtained from the CO2 Virtual Science Data Environment (https://co2.jpl.nasa.gov/; Jet Propulsion Laboratory, California Institute of Technology, 2019). The SST anomalies were downloaded from the National Oceanic and Atmospheric Administration (NOAA) Earth System Research Laboratory (ESRL) website (https://www.esrl.noaa.gov; National Oceanic and Atmospheric Administration (NOAA) Earth System Laboratory (ESRL), 2019b).Interannual variations in temperature and precipitation impact the carbon balance of terrestrial ecosystems, leaving an imprint in atmospheric CO2. Quantifying the impact of climate anomalies on the net ecosystem exchange (NEE) of terrestrial ecosystems can provide a constraint to evaluate terrestrial biosphere models against and may provide an emergent constraint on the response of terrestrial ecosystems to climate change. We investigate the spatial scales over which interannual variability in NEE can be constrained using atmospheric CO2 observations from the Greenhouse Gases Observing Satellite (GOSAT). NEE anomalies are calculated by performing a series of inversion analyses using the GEOS-Chem adjoint model to assimilate GOSAT observations. Monthly NEE anomalies are compared to "proxies", variables that are associated with anomalies in the terrestrial carbon cycle, and to upscaled NEE estimates from FLUXCOM. Statistically significant correlations (P<0.05) are obtained between posterior NEE anomalies and anomalies in soil temperature and FLUXCOM NEE on continental and larger scales in the tropics, as well as in the northern extratropics on subcontinental scales during the summer (R2≥0.49), suggesting that GOSAT measurements provide a constraint on NEE interannual variability (IAV) on these spatial scales. Furthermore, we show that GOSAT flux inversions are generally better correlated with the environmental proxies and FLUXCOM NEE than NEE anomalies produced by a set of terrestrial biosphere models (TBMs), suggesting that GOSAT flux inversions could be used to evaluate TBM NEE fluxes.Environment and Climate Change CanadaNatural Sciences and Engineering Research Council of CanadaCanadian Space Agenc

Surface-Atmosphere Coupling Scale, the Fate of Water, and Ecophysiological Function in a Brazilian Forest

This is the final verison. Available from American Geophysical Union (AGU) via the DOI in this record.The K83 observational data are available from AmeriFlux (ameriflux.lbl.gov), NCEP Reanalysis data provided by NOAA/ESRL/PSD, Boulder, Colorado, USA, from the http://www.cdc.noaa.gov/ website. Model code and output is stored at GitLab (gitlab.com). This project is password protected, and the password can be obtained from the corresponding author at [email protected] upon request.Tropical South America plays a central role in global climate. Bowen ratio teleconnects to circulation and precipitation processes far afield, and the global CO2 growth rate is strongly influenced by carbon cycle processes in South America. However, quantification of basin-wide seasonality of flux partitioning between latent and sensible heat, the response to anomalies around climatic norms, and understanding of the processes and mechanisms that control the carbon cycle remains elusive. Here, we investigate simulated surface-atmosphere interaction at a single site in Brazil, using models with different representations of precipitation and cloud processes, as well as differences in scale of coupling between the surface and atmosphere. We find that the model with parameterized clouds/precipitation has a tendency toward unrealistic perpetual light precipitation, while models with explicit treatment of clouds produce more intense and less frequent rain. Models that couple the surface to the atmosphere on the scale of kilometers, as opposed to tens or hundreds of kilometers, produce even more realistic distributions of rainfall. Rainfall intensity has direct consequences for the “fate of water,” or the pathway that a hydrometeor follows once it interacts with the surface. We find that the model with explicit treatment of cloud processes, coupled to the surface at small scales, is the most realistic when compared to observations. These results have implications for simulations of global climate, as the use of models with explicit (as opposed to parameterized) cloud representations becomes more widespread.National Aeronautics and Space Administration (NASA)National Science Foundation (NSF)National Science Foundation (NSF)U.S. Department of Energy (DOE

Sub-Sets of Cancer Stem Cells Differ Intrinsically in Their Patterns of Oxygen Metabolism

PMCID: PMC3640080This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Increasing condom use in heterosexual men: development of a theory-based interactive digital intervention

Increasing condom use to prevent sexually transmitted infections is a key public health goal. Interventions are more likely to be effective if they are theory- and evidence-based. The Behaviour Change Wheel (BCW) provides a framework for intervention development. To provide an example of how the BCW was used to develop an intervention to increase condom use in heterosexual men (the MenSS website), the steps of the BCW intervention development process were followed, incorporating evidence from the research literature and views of experts and the target population. Capability (e.g. knowledge) and motivation (e.g. beliefs about pleasure) were identified as important targets of the intervention. We devised ways to address each intervention target, including selecting interactive features and behaviour change techniques. The BCW provides a useful framework for integrating sources of evidence to inform intervention content and deciding which influences on behaviour to target

Yoga programme for type-2 diabetes prevention (YOGA-DP) among high risk people in India: a multicentre feasibility randomised controlled trial protocol.

INTRODUCTION: A huge population in India is at high risk of type-2 diabetes (T2DM). Physical activity and a healthy diet (healthy lifestyle) improve blood glucose levels in people at high risk of T2DM. However, an unhealthy lifestyle is common among Indians. Yoga covers physical activity and a healthy diet and can help to prevent T2DM. The research question to be addressed by the main randomised controlled trial (RCT) is whether a Yoga programme for T2DM prevention (YOGA-DP) is effective in preventing T2DM among high risk people in India as compared with enhanced standard care. In this current study, we are determining the feasibility of undertaking the main RCT. INTERVENTION: YOGA-DP is a structured lifestyle education and exercise programme. The exercise part is based on Yoga and includes Shithilikarana Vyayama (loosening exercises), Surya Namaskar (sun salutation exercises), Asana (Yogic poses), Pranayama (breathing practices) and Dhyana (meditation) and relaxation practices. METHODS AND ANALYSIS: This is a multicentre, two-arm, parallel-group, feasibility RCT with blinded outcome assessment and integrated mixed-methods process evaluation. Eligible participants should be aged 18-74 years, at high risk of T2DM (fasting plasma glucose level 5.6-6.9 mmol/L) and safe to participate in physical activities. At least 64 participants will be randomised to intervention or control group with final follow-up at 6 months. Important parameters, needed to design the main RCT, will be estimated, such as SD of the outcome measure (fasting plasma glucose level at 6-month follow-up), recruitment, intervention adherence, follow-up, potential contamination and time needed to conduct the study. Semistructured qualitative interviews will be conducted with up to 20-30 participants, a sample of those declining to participate, four YOGA-DP instructors and around eight study staff to explore their perceptions and experiences of taking part in the study and of the intervention, reasons behind non-participation, experiences of delivering the intervention and running the study, respectively. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the following Research Ethics Committees: Faculty of Medicine and Health Sciences, University of Nottingham (UK); Centre for Chronic Disease Control (CCDC, India); Bapu Nature Cure Hospital and Yogashram (BNCHY, India) and Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA, India). The results will be widely disseminated among key stakeholders through various avenues. TRIAL REGISTRATION NUMBER: CTRI/2019/05/018893

Efficacy and Safety of Prophylactic Vaccines against Cervical HPV Infection and Diseases among Women: A Systematic Review & Meta-Analysis

<p>Abstract</p> <p>Background</p> <p>We conducted a systematic review and meta-analysis to assess efficacy and safety of prophylactic HPV vaccines against cervical cancer precursor events in women.</p> <p>Methods</p> <p>Randomized-controlled trials of HPV vaccines were identified from MEDLINE, Cochrane Central Register of Controlled Trials, conference abstracts and references of identified studies, and assessed by two independent reviewers. Efficacy data were synthesized using fixed-effect models, and evaluated for heterogeneity using I²statistic.</p> <p>Results</p> <p>Seven unique trials enrolling 44,142 females were included. The fixed-effect Relative Risk (RR) and 95% confidence intervals were 0.04 (0.01-0.11) and 0.10 (0.03-0.38) for HPV-16 and HPV 18-related CIN2+ in the per-protocol populations (PPP). The corresponding RR was 0.47 (0.36-0.61) and 0.16 (0.08-0.34) in the intention-to-treat populations (ITT). Efficacy against CIN1+ was similar in scale in favor of vaccine. Overall vaccines were highly efficacious against 6-month persistent infection with HPV 16 and 18, both in the PPP cohort (RR: 0.06 [0.04-0.09] and 0.05 [0.03-0.09], respectively), and the ITT cohorts (RR: 0.15 [0.10-0.23] and 0.24 [0.14-0.42], respectively). There was limited prophylactic effect against CIN2+ and 6-month persistent infections associated with non-vaccine oncogenic HPV types. The risk of serious adverse events (RR: 1.00, 0.91-1.09) or vaccine-related serious adverse events (RR: 1.82; 0.79-4.20) did not differ significantly between vaccine and control groups. Data on abnormal pregnancy outcomes were underreported.</p> <p>Conclusions</p> <p>Prophylactic HPV vaccines are safe, well tolerated, and highly efficacious in preventing persistent infections and cervical diseases associated with vaccine-HPV types among young females. However, long-term efficacy and safety needs to be addressed in future trials.</p

Impact of treatment on damage and hospitalization in elderly patients with microscopic polyangiitis and granulomatosis with polyangiitis

OBJECTIVE: Age is a risk factor for organ damage, adverse events, and mortality in microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA). However, the relationship between treatment and damage, hospitalizations, and causes of death in elderly patients is largely unknown. METHODS: Consecutive patients from Sweden, England, and the Czech Republic diagnosed between 1997 and 2013 were included. Inclusion criteria were a diagnosis of MPA or GPA and age 75 years or more at diagnosis. Treatment with cyclophosphamide, rituximab, and corticosteroids the first three months was registered. Outcomes up to two years from diagnosis included vasculitis damage index (VDI), hospitalization, and cause of death. RESULTS: Treatment data was available for 167 of 202 patients. At two years, 4% had no items of damage. There was a positive association between VDI score at two years and Birmingham Vasculitis Activity Score at onset, and a negative association with treatment using cyclophosphamide or rituximab. Intravenous methylprednisolone dose was associated with treatment-related damage. During the first year, 69% of patients were readmitted to hospital. MPO-ANCA positivity and lower creatinine levels decreased the odds for readmission. The most common cause of death was infection, and this was associated with cumulative oral prednisolone dose. CONCLUSION: Immunosuppressive treatment with cyclophosphamide or rituximab in elderly patients with MPA and GPA was associated with development of less permanent organ damage and was not associated with hospitalization. However, higher doses of corticosteroids during the first three months was associated with treatment-related damage and fatal infections

Creating comprehensive, youth-centered culturally appropriate sex education: What do young gay, bisexual and questioning men want?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106604/1/Creating comprehensive, youth-centered culturally appropriate sex education What do young gay, bisexual and questioning men want.pd