Maternal mental health in the first 3-week postpartum: the impact of caregiver support and the subjective experience of childbirth - a longitudinal path model

Acute stress reactions (ASR) and postpartum depressive symptoms (PDS) are frequent after childbirth. The present study addresses the change and overlap of ASR and PDS from the 1- to 3-week postpartum and examines the interplay of caregiver support and subjective birth experience with regard to the development of ASR/PDS within a longitudinal path model.

Labor induction in preeclampsia: is misoprostol more effective than dinoprostone?

OBJECTIVE: To compare the efficacy of vaginal misoprostol versus dinoprostone for induction of labor (IOL) in patients with preeclampsia according to the WHO criteria. STUDY DESIGN: Ninety-eight patients were retrospectively analyzed. A total of 47 patients received 3 mg dinoprostone suppositories every 6 h (max. 6 mg/24 h) whereas 51 patients in the misoprostol group received either 50 mug misoprostol vaginally every 12 h, or 25 mug every 6 h (max. 100 mug/24 h). Primary outcomes were vaginal delivery within 24 and 48 h, respectively. RESULTS: The probability of delivering within 48 h was more than three-fold higher in the misoprostol than in the dinoprostone group: odds ratio (OR)=3.48; 95% confidence interval (CI) 1.24, 10.30, whereas no significant difference was observed within 24 h (P=0.34). No correlation was seen between a ripe cervix prior to IOL and delivery within 24/48 h (P=0.33 and P=1.0, respectively). More cesarean sections were performed in the dinoprostone group due to failed IOL (P=0.0009). No significant differences in adverse maternal outcome were observed between both study groups, whereas more neonates (12 vs. 6) of the dinoprostone group were admitted to the NICU (P=0.068). CONCLUSION: This study suggests that misoprostol may have some advantages compared to dinoprostone, including improved efficacy and lower cost of the drug, even in cases of preeclampsia.

Oral misoprostol for third stage of labor: a randomized placebo-controlled trial

OBJECTIVE: To investigate whether orally administered misoprostol during the third stage of labor is efficient in reducing postpartum blood loss. METHODS: In a double-masked trial, during vaginal delivery women were randomly assigned to receive a single oral dose of misoprostol (600 microg) or placebo in third stage of labor, immediately after cord clamping. The third stage of labor was managed routinely by early cord clamping and controlled cord traction; oxytocin was administered only if blood loss seemed more than usual. Blood loss was estimated by the delivering physician and differences in hematocrit were measured before and after delivery. RESULTS: Mean (+/- standard error of the mean) estimated blood loss (345 +/- 19.5 mL versus 417 +/- 25.9 mL, P = .031) and hematocrit difference (4.5 +/- 0.9% versus 7.9 +/- 1.2%, P = .014) were significantly lower in women who received misoprostol than those who received placebo. Fewer women in the misoprostol group had postpartum hemorrhage (blood loss of at least 500 mL), but that difference was not statistically significant (7% versus 15%, P = .43). Additional oxytocin before or after placental separation was used less often in the misoprostol group (16% versus 38%, P = .047). There were no differences in the length of third stage of labor (8 +/- 0.9 minutes versus 9 +/- 1 minutes, P = .947). There were no differences in pain during third stage of labor, postpartum fever, or diarrhea, but shivering was more frequent in the misoprostol group. CONCLUSION: Oral misoprostol administered in the third stage of labor reduced postpartum blood loss and might be effective in reducing incidence of postpartum hemorrhage.

ON THE MERITS OF VOXEL-BASED MORPHOMETRIC PATH-ANALYSIS FOR INVESTIGATING VOLUMETRIC MEDIATION OF A TOXICANT'S INFLUENCE ON COGNITIVE FUNCTION

We previously showed that lifetime cumulative lead dose, measured as lead concentration in the tibia bone by X-ray fluorescence, was associated with persistent and progressive declines in cognitive function and with decreases in MRI-based brain volumes in former lead workers. Moreover, larger region-specific brain volumes were associated with better cognitive function. These findings motivated us to explore a novel application of path analysis to evaluate effect mediation. Voxel-wise path analysis, at face value, represents the natural evolution of voxel-based morphometry methods to answer questions of mediation. Application of these methods to the former lead worker data demonstrated potential limitations in this approach where there was a tendency for results to be strongly biased towards the null hypothesis (lack of mediation). Moreover, a complimentary analysis using anatomically-derived regions of interest volumes yielded opposing results, suggesting evidence of mediation. Specifically, in the ROI-based approach, there was evidence that the association of tibia lead with function in three cognitive domains was mediated through the volumes of total brain, frontal gray matter, and/or possibly cingulate. A simulation study was conducted to investigate whether the voxel-wise results arose from an absence of localized mediation, or more subtle defects in the methodology. The simulation results showed the same null bias evidenced as seen in the lead workers data. Both the lead worker data results and the simulation study suggest that a null-bias in voxel-wise path analysis limits its inferential utility for producing confirmatory results.

Gunshot-related displacement of skin particles and bacteria from the exit region back into the bullet path

In previous studies, it was shown that there is a gunshot-related transport of skin particles and microorganisms from the entrance region into the depth of the bullet path. The present study deals with the question of whether gunshots may also cause a retrograde transport of skin particles and microorganisms from the bullet exit region back into the bullet path. For this purpose, we used a composite model consisting of rectangular gelatin blocks and pig skin. The skin pieces were firmly attached to the gelatin blocks on the side where the bullet was to exit. Prior to the test shots, the outer surface of the pig skin was contaminated with a thin layer of a defined bacterial suspension. After drying the skin, test shots were fired from a distance of 10 m using cartridges calibre .38 spec. with different bullet types. Subsequent analyses showed that in all shots with full penetration of the composite model, the bullet path contained displaced skin particles and microorganisms from the skin surface at the exit site. These could be regularly detected in the distal 6-8 cm of the track, occasionally up to a distance of 18 cm from the exit hole. The distribution of skin particles and microorganisms is presented and the possible mechanism of this retrograde transport is discussed.

High precision range estimation techniques for multi-path wireless environments

Range estimation is the core of many positioning systems such as radar, and Wireless Local Positioning Systems (WLPS). The estimation of range is achieved by estimating Time-of-Arrival (TOA). TOA represents the signal propagation delay between a transmitter and a receiver. Thus, error in TOA estimation causes degradation in range estimation performance. In wireless environments, noise, multipath, and limited bandwidth reduce TOA estimation performance. TOA estimation algorithms that are designed for wireless environments aim to improve the TOA estimation performance by mitigating the effect of closely spaced paths in practical (positive) signal-to-noise ratio (SNR) regions. Limited bandwidth avoids the discrimination of closely spaced paths. This reduces TOA estimation performance. TOA estimation methods are evaluated as a function of SNR, bandwidth, and the number of reflections in multipath wireless environments, as well as their complexity. In this research, a TOA estimation technique based on Blind signal Separation (BSS) is proposed. This frequency domain method estimates TOA in wireless multipath environments for a given signal bandwidth. The structure of the proposed technique is presented and its complexity and performance are theoretically evaluated. It is depicted that the proposed method is not sensitive to SNR, number of reflections, and bandwidth. In general, as bandwidth increases, TOA estimation performance improves. However, spectrum is the most valuable resource in wireless systems and usually a large portion of spectrum to support high performance TOA estimation is not available. In addition, the radio frequency (RF) components of wideband systems suffer from high cost and complexity. Thus, a novel, multiband positioning structure is proposed. The proposed technique uses the available (non-contiguous) bands to support high performance TOA estimation. This system incorporates the capabilities of cognitive radio (CR) systems to sense the available spectrum (also called white spaces) and to incorporate white spaces for high-performance localization. First, contiguous bands that are divided into several non-equal, narrow sub-bands that possess the same SNR are concatenated to attain an accuracy corresponding to the equivalent full band. Two radio architectures are proposed and investigated: the signal is transmitted over available spectrum either simultaneously (parallel concatenation) or sequentially (serial concatenation). Low complexity radio designs that handle the concatenation process sequentially and in parallel are introduced. Different TOA estimation algorithms that are applicable to multiband scenarios are studied and their performance is theoretically evaluated and compared to simulations. Next, the results are extended to non-contiguous, non-equal sub-bands with the same SNR. These are more realistic assumptions in practical systems. The performance and complexity of the proposed technique is investigated as well. This study’s results show that selecting bandwidth, center frequency, and SNR levels for each sub-band can adapt positioning accuracy.

DIFFERENTIATING PATH AND SOURCE PROCESSES IN COMPLEX GEOLOGIC STRUCTURE THROUGH PASSIVE SEISMIC STUDIES: BERING GLACIER, ALASKA AND VILLARRICA VOLCANO, CHILE

Measuring shallow seismic sources provides a way to reveal processes that cannot be directly observed, but the correct interpretation and value of these signals depend on the ability to distinguish source from propagation effects. Furthermore, seismic signals produced by a resonating source can look almost identical to those produced by impulsive sources, but modified along the path. Distinguishing these two phenomena can be accomplished by examining the wavefield with small aperture arrays or by recording seismicity near to the source when possible. We examine source and path effects in two different environments: Bering Glacier, Alaska and Villarrica Volcano, Chile. Using three 3-element seismic arrays near the terminus of the Bering Glacier, we have identified and located both terminus calving and iceberg breakup events. We show that automated array analysis provided a robust way to locate icequake events using P waves. This analysis also showed that arrivals within the long-period codas were incoherent within the small aperture arrays, demonstrating that these codas previously attributed to crack resonance were in fact a result of a complicated path rather than a source effect. At Villarrica Volcano, seismometers deployed from near the vent to ~10 km revealed that a several cycle long-period source signal recorded at the vent appeared elongated in the far-field. We used data collected from the stations nearest to the vent to invert for the repetitive seismic source, and found it corresponded to a shallow force within the lava lake oriented N75°E and dipping 7° from horizontal. We also used this repetitive signal to search the data for additional seismic and infrasonic properties which included calculating seismic-acoustic delay times, volcano acoustic-seismic ratios and energies, event frequency, and real-time seismic amplitude measurements. These calculations revealed lava lake level and activity fluctuations consistent with lava lake level changes inferred from the persistent infrasonic tremor.