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Validated screening tools to identify common mental disorders in perinatal and postpartum women in India: a systematic review and meta-analysis
No full textBackground
Perinatal common mental disorders are associated with significant adverse outcomes for women and their families, particularly in low- and middle-income settings. Early detection through screening with locally-validated tools can improve outcomes.
Methods
We searched MEDLINE, Embase, PsycINFO, Global Health, Cochrane Library, Web of Science and Google Scholar for articles on the validation of screening tools for common mental disorders in perinatal women in India, with no language or date restrictions. Quality was assessed using the QUADAS-2 tool. We used bivariate and hierarchical summary receiver operating characteristic models to calculate pooled summary estimates of sensitivity and specificity. Heterogeneity was assessed by visualising the distance of individual studies from the summary curve.
Results
Seven studies involving 1003 women were analysed. All studies assessed the validity of the Edinburgh Postnatal Depression Scale (EPDS) in identifying perinatal depression. No validation studies of any other screening tools were identified. Using a common threshold of ≥13 the EPDS had a pooled sensitivity and specificity of 88·9% (95%CI 77·4–94·9) and 93·4 (95%CI 81·5–97·8), respectively. Using optimal thresholds (range ≥ 9 to ≥13) the EPDS had a pooled sensitivity and specificity of 94·4% (95%CI 81·7–98·4) and 90·8 (95%CI 83·7–95·0), respectively.
Conclusion
The EPDS is psychometrically valid in diverse Indian settings and its use in routine maternity care could improve detection of perinatal depression. Further research is required to validate screening tools for other perinatal common mental disorders in India
Risk factors for death in Welsh infants with a congenital anomaly
No full textObjectives To investigate risk factors associated with death of infants with a congenital anomaly in Wales, UK.
Design A population-based cohort study.
Setting Data from the Welsh Congenital Anomaly Register and Information Service (CARIS) linked to live births and deaths from the Office for National Statistics.
Patients All live births between 1998 and 2016 with a diagnosis of a congenital anomaly, which was defined as a structural, metabolic, endocrine or genetic defect, as well as rare disease of hereditary origin.
Main outcome measures Adjusted ORs (aORs) were estimated for socio-demographic, maternal, infant and intervention factors associated with death in infancy, using logistic regression for all, isolated, multiple and cardiovascular anomalies.
Results 30 424 live births affected by congenital anomalies were identified, including 1044 infants who died by the age of 1 year (infant mortality rate: 16.5 per 10 000 live births, case fatality: 3.4%, 30.3% of all infant deaths). Risk factors for infant death were non-white versus white ethnicity (aOR: 2.25; 95% CI: 1.77–2.86); parous versus nulliparous (aOR: 1.24; 95% CI: 1.08–1.41); smoking during pregnancy versus non-smokers/ex-smokers (aOR: 1.20; 95% CI: 1.02–1.40); preterm versus term birth (aOR: 4.38; 95% CI 3.86–4.98); female versus male infants (aOR: 1.28; 95% CI: 1.13–1.46) and the earlier years of the birth cohort (aOR: 0.96; 95% CI: 0.95–0.98 per yearly increase). Infants with a cardiovascular anomaly who received surgery had a lower odds of death than those who did not (aOR: 0.34; 95% CI: 0.15–0.75). Preterm birth was a significant factor for death for all anomalies but the effect of the other characteristics varied according to anomaly group.
Conclusions Nearly a third of all infant deaths had an associated anomaly. Improving access to prenatal care, smoking cessation advice, optimising care for preterm infants and surgery may help lower the risk of infant death
A home-based rehabilitation programme compared with traditional physiotherapy for patients at risk of poor outcome after knee arthroplasty: the CORKA randomised controlled trial
No full textObjectives To evaluate whether a home-based rehabilitation programme for people assessed as being at risk of a poor outcome after knee arthroplasty offers superior outcomes to traditional outpatient physiotherapy.
Design A prospective, single-blind, two-arm randomised controlled superiority trial.
Setting 14 National Health Service physiotherapy departments in the UK.
Participants 621 participants identified at high risk of a poor outcome after knee arthroplasty using a bespoke screening tool.
Interventions A multicomponent home-based rehabilitation programme delivered by rehabilitation assistants with supervision from qualified therapists versus usual care outpatient physiotherapy.
Main outcome measures The primary outcome was the Late-Life Function and Disability Instrument (LLFDI) at 12 months. Secondary outcomes were the Oxford Knee Score (a disease-specific measure of function), Knee injury and Osteoarthritis Outcome Score Quality of Life subscale, Physical Activity Scale for the Elderly, 5 dimension, 5 level version of Euroqol (EQ-5D-5L) and physical function assessed using the Figure of 8 Walk test, 30 s Chair Stand Test and Single Leg Stance.
Results 621 participants were randomised between March 2015 and January 2018. 309 were assigned to CORKA (Community Rehabilitation after Knee Arthroplasty) home-based rehabilitation, receiving a median five treatment sessions (IQR 4–7). 312 were assigned to usual care, receiving a median 4 sessions (IQR 2–6). The primary outcome, LLFDI function total score at 12 months, was collected for 279 participants (89%) in the home-based CORKA group and 287 participants (92%) in the usual care group. No clinically or statistically significant difference was found between the groups (intention-to-treat adjusted difference=0.49 points; 95% CI −0.89 to 1.88; p=0.48). There were no statistically significant differences between the groups on any of the patient-reported or physical secondary outcome measures at 6 or 12 months.
There were 18 participants in the intervention group reporting a serious adverse event (5.8%), only one directly related to the intervention, all other adverse events recorded throughout the trial related to underlying chronic medical conditions.
Conclusions The CORKA intervention was not superior to usual care. The trial detected no significant differences, clinical or statistical, between the two groups on either primary or secondary outcomes. CORKA offers an evaluation of an intervention utilising a different service delivery model for this patient group.
Trial registration number ISRCTN13517704
Universal hybrid quantum computing in trapped ions
No full textUsing discrete and continuous variable subsystems, hybrid approaches to quantum information could enable more quantum computational power for the same physical resources. Here, we propose a hybrid scheme that can be used to generate the necessary Gaussian and non-Gaussian operations for universal continuous variable quantum computing in trapped ions. This scheme utilizes two linear spin-motion interactions to generate a broad set of nonlinear effective spin-motion interactions including one- and two-mode squeezing, beam splitter, and trisqueezing operations in trapped ion systems. We discuss possible experimental implementations using laser-based and laser-free approaches
The investigation of viscous and structural damping for piezoelectric energy harvesters using only time-domain voltage measurements
No full textKnowing the nature of damping in piezoelectric energy harvesters can lead to proper damping and electromechanical models and designing highly efficient harvesters with less damping. As an attempt toward a better understanding of damping in piezoelectric energy harvesters, this paper presents experimental results for structural and viscous air damping coefficients extracted directly from voltage measurements under shock-induced tests. Free-vibration excitations are analyzed using the modified Short-Term Fourier Transform and Resampling method. Seven cases are studied, namely Macro Fiber Composite with different substrate shims, different bonding layers, and with or without a tip mass. The damping coefficients can be reliably extracted using an up-chirp driving signal and analyzing the system's decay curve, without the need for full measurement of harmonic response over a wide frequency range. The results also indicate that the damping coefficient is not independent of the base excitation amplitude and can increase up to 30%. The relative significance of viscous air damping and structural damping mechanisms is identified in each case. The dependency of viscous air damping on the base excitation amplitude is also evaluated. The experimental results highlight the significance of the bonding layer in structural damping, which can account for approximately 60% of the total damping. In the absence of a substrate shim and bonding layer, the main contribution to energy dissipation is viscous air damping. While an added tip mass increases the output power, it also escalates the viscous air damping to approximately 40% due to increased beam tip deflection
Sex- and age-specific associations between cardiometabolic risk and white matter brain age in the UK Biobank cohort
No full textCardiometabolic risk factors (CMRs) are associated with accelerated brain aging and increased risk for sex-dimorphic illnesses such as Alzheimer’s Disease (AD). Yet, it is unknown how CMRs interact with sex and apolipoprotein E-ε4 (APOE4), a known genetic risk factor for AD, to influence brain age across different life stages. Using age prediction based on multi-shell diffusion-weighted imaging data in 21,308 UK Biobank participants, we investigated whether associations between white matter Brain Age Gap (BAG) and body mass index (BMI), waist-to-hip ratio (WHR), body fat percentage (BF%), and APOE4 status varied i) between males and females, ii) according to age at menopause in females, and iii) across different age groups in males and females. We report sex differences in associations between BAG and all three CMRs, with stronger positive associations among males com- pared to females. Higher BAG (older brain age relative to chronological age) was associated with greater BMI, WHR, and BF% in males, whereas in females, higher BAG was associated with greater WHR, but not BMI and BF%. These divergent associations were most prominent within the oldest group of females (66-81yrs), where higher BF% was linked to lower BAG (younger brain age relative to chronological age). Earlier menopause transition was associated with higher BAG, but no interactions were found with CMRs. APOE4 status was not significantly associated with BAG, and no significant interactions with CMRs were found. In conclusion, the findings point to sex- and age-specific associations between body fat composition and brain age. Incorporating sex as a factor of interest in studies addressing cardiometabolic risk may promote sex-specific precision medicine, consequently improving health care for both males and females
Communicative perspectives on strategic organization
No full textWhile in the past, perspectives that focus on language and communication have perhaps not received the attention they deserve in the mainstream literature in strategy and organization, interest in this area has been growing in recent years. The present essay serves to introduce a collection of insightful papers (independently submitted and reviewed, but brought together in this themed issue) that offer an opportunity to reflect on the contributions of a rich variety of research perspectives on communication to research in strategic organization. Building on the seven contributions featured in this issue, we show how communicative perspectives speak to questions of the who, how, what, and what then, of strategy. We then discuss dualisms that underpin research on strategic organization adopting a communicative lens and propose directions for future work that might bridge these divides
CryoET structures of immature HIV Gag reveal six-helix bundle
No full textGag is the HIV structural precursor protein which is cleaved by viral protease to produce mature infectious viruses. Gag is a polyprotein composed of MA (matrix), CA (capsid), SP1, NC (nucleocapsid), SP2 and p6 domains. SP1, together with the last eight residues of CA, have been hypothesized to form a six-helix bundle responsible for the higher-order multimerization of Gag necessary for HIV particle assembly. However, the structure of the complete six-helix bundle has been elusive. Here, we determined the structures of both Gag in vitro assemblies and Gag viral-like particles (VLPs) to 4.2 Å and 4.5 Å resolutions using cryo-electron tomography and subtomogram averaging by emClarity. A single amino acid mutation (T8I) in SP1 stabilizes the six-helix bundle, allowing to discern the entire CA-SP1 helix connecting to the NC domain. These structures provide a blueprint for future development of small molecule inhibitors that can lock SP1 in a stable helical conformation, interfere with virus maturation, and thus block HIV-1 infection