The Social Context of Pregnancy, Respectful Maternity Care, Biomarkers of Weathering, and Postpartum Mental Health Inequities: A Scoping Review

Background: Mental health disorders are the number one cause of maternal mortality and a significant maternal morbidity. This scoping review sought to understand the associations between social context and experiences during pregnancy and birth, biological indicators of stress and weathering, and perinatal mood and anxiety disorders (PMADs). Methods: A scoping review was performed using PRISMA-ScR guidance and JBI scoping review methodology. The search was conducted in OVID Medline and Embase. Results: This review identified 74 eligible English-language peer-reviewed original research articles. A majority of studies reported significant associations between social context, negative and stressful experiences in the prenatal period, and a higher incidence of diagnosis and symptoms of PMADs. Included studies reported significant associations between postpartum depression and prenatal stressors (n = 17), socioeconomic disadvantage (n = 14), negative birth experiences (n = 9), obstetric violence (n = 3), and mistreatment by maternity care providers (n = 3). Birth-related post-traumatic stress disorder (PTSD) was positively associated with negative birth experiences (n = 11), obstetric violence (n = 1), mistreatment by the maternity care team (n = 1), socioeconomic disadvantage (n = 2), and prenatal stress (n = 1); and inverse association with supportiveness of the maternity care team (n = 5) and presence of a birth companion or doula (n = 4). Postpartum anxiety was significantly associated with negative birth experiences (n = 2) and prenatal stress (n = 3). Findings related to associations between biomarkers of stress and weathering, perinatal exposures, and PMADs (n = 14) had mixed significance. Conclusions: Postpartum mental health outcomes are linked with the prenatal social context and interactions with the maternity care team during pregnancy and birth. Respectful maternity care has the potential to reduce adverse postpartum mental health outcomes, especially for persons affected by systemic oppression.

A-44 Experiences of Adversity and Validity of Baseline Concussion Testing

Purpose: This study examined the relationship between individual-level experiences of social adversity and baseline computerized concussion testing validity (Immediate Post-Concussion Assessment and Cognitive Testing; ImPACT). Methods: This study involved 6495 student-athletes born between 1995 and 2005 who completed a baseline ImPACT test between 10 and 18 years old and could be identified in the Child-Household Integrated Longitudinal Data (CHILD) System, a continuously updated integrated and comprehensive data system that captures detailed individual-level demographic, social service usage, and educational outcomes on every child born or living in Cuyahoga County, Ohio from 1989 to present. Multivariable logistic regression models were conducted with experiences of SNAP/TANF enrollment, substantiated abuse or neglect incidents, and extreme neighborhood deprivation occurring in the sensitive developmental periods of early childhood and adolescence as key predictors of baseline test validity. Results: Our findings suggest that social mobility may play an important role in baseline validity. Youth with upward social mobility (poverty or neighborhood deprivation in early childhood only) were not significantly different than youth without such experiences (OR = 0.91, p = 0.74). Youth with persistent adversity across childhood or downward social mobility (poverty or high neighborhood deprivation in adolescence only) had 50–72% lower odds of achieving a valid baseline test (persistent poverty: OR = 0.59, p = 0.05; adolescent poverty only: OR = 0.50, p = 0.004; adolescent neighborhood deprivation only: OR = 0.28, p < 0.0001). Conclusions: These findings suggest certain patterns of social adversity may predispose youth to invalid computerized concussion baseline testing scores, potentially increasing their risk of inaccurate injury management and poor outcomes.

Dosimetry of very high energy electrons (VHEE) for radiotherapy applications: using radiochromic film measurements and Monte Carlo simulations

Very high energy electrons (VHEE) in the range from 100-250 MeV have the potential of becoming an alternative modality in radiotherapy because of their improved dosimetry properties compared with MV photons from contemporary medical linear accelerators. Due to the need for accurate dosimetry of small field size VHEE beams we have performed dose measurements using EBT2 Gafchromic® film. Calibration of the film has been carried out for beams of two different energy ranges: 20 MeV and 165 MeV from conventional radio frequency linear accelerators. In addition, EBT2 film has been used for dose measurements with 135 MeV electron beams produced by a laser-plasma wakefield accelerator. The dose response measurements and percentage depth dose profiles have been compared with calculations carried out using the general-purpose FLUKA Monte Carlo (MC) radiation transport code. The impact of induced radioactivity on film response for VHEEs has been evaluated using the MC simulations. A neutron yield of the order of 10(-5) neutrons cm(-2) per incident electron has been estimated and induced activity due to radionuclide production is found to have a negligible effect on total dose deposition and film response. Neutron and proton contribution to the equivalent doses are negligible for VHEE. The study demonstrates that EBT2 Gafchromic film is a reliable dosimeter that can be used for dosimetry of VHEE. The results indicate an energy-independent response of the dosimeter for 20 MeV and 165 MeV electron beams and has been found to be suitable for dosimetry of VHEE.

Changes in Cisternal Udder Compartment Induced by Milking Interval in Dairy Goats Milked Once or Twice Daily

Fourteen Murciano-Granadina dairy goats were used to evaluate udder compartments (cisternal and alveolar) and cisternal recoil after an oxytocin (OT) challenge at different milking intervals (8, 16, and 24 h) during wk 7 of lactation. Goats were milked once (1x; n = 7) or twice (2x; n = 7) daily from wk 2 of lactation. Average milk yields for wk 4 and 8 were 1.76 and 2.24 L/d, for goats milked 1x and 2x, respectively. For each half udder, cisternal area was measured by ultrasonography and cisternal milk was measured by machine milking after i.v. injection of an OT receptor blocking agent. Alveolar milk was then obtained after i.v. injection of OT. Regardless of milking frequency, alveolar milk increased from 8 to 16 h after milking, but did not change thereafter. Cisternal area and cisternal milk increased linearly (R2 = 0.96 to 0.99) up to 24 h, indicating continuous milk storage in the cistern at any alveoli filling degree. Cisternal to alveolar ratio increased with milking interval (from 57:43 to 75:25), but differences between milking intervals were significant at 8 h only, at which time goats milked 2x showed a greater ratio (1x = 51:49; 2x = 62:38). Despite extended milking intervals, cisterns of goats milked 1x did not become larger than cisterns of goats milked 2x after 5 wk of treatment. The highest correlation between cisternal area and cisternal milk was detected at 8 h after milking (r = 0.74). Primiparous goats had smaller cisternal areas and less cisternal milk than multiparous goats at all milking intervals. Cisternal recoil was studied in a sample of multiparous goats milked 1x (n = 4) and 2x (n = 4) by scanning cisterns by ultrasonography at 0, 5, 15, and 30 min after an OT challenge for each milking interval. Cisternal area increased after OT injection for the 8- and 16-h milking intervals, but no differences were observed for the 24-h interval. Unlike cows, no changes in cisternal area were observed after OT injection, indicating the absence of cisternal recoil in goats. We conclude that goats show a large cisternal compartment that increases linearly after milking. Nevertheless, cisternal size did not increased after 1x milking, probably because of lesser milk yield. Multiparous goats had larger cisterns than primiparous goats and were able to store more milk in their cisterns at all milking intervals. Because of the high capacity of goat cisterns, no milk return from cistern to alveoli is expected if milking is delayed after milk letdown.

Leptin and the adaptations of lactation in rodents and ruminants

Lactation markedly increases nutrient requirements in both rodents and ruminants. This is met mostly by increased food intake, but there are also adaptations to increase metabolic efficiency. Despite such changes, lactating animals usually experience periods of negative energy balance. This is not due to a physical constraint on food intake, at least in the rat. Leptin, a hormone secreted by adipocytes, plays an important role in the regulation of appetite and energy balance. During lactation, serum leptin concentration is decreased in both rodents and ruminants, and the nocturnal rise in concentration is lost in rats. Hypoleptinaemia in lactation is primarily a result of negative energy balance. There is also increased clearance of serum leptin, and the attenuation of the nocturnal rise in leptin in rats is at least partly due to the suckling stimulus. Hypoleptinaemia is not the major factor driving hyperphagia in lactating rats, but it probably facilitates the increased food intake. Leptin may play a more important role in this respect in lactating ruminants. Leptin is probably involved in other adaptations that increase metabolic efficiency during lactation. The ability of hypothalamic neuropeptides to respond to leptin does not appear to be altered by lactation in either rodents or ruminants. The reason why lactating animals do not respond to hypoleptinaemia with a further increase in appetite, thereby achieving energy balance, appears to be due to a failure to respond to changes in neuropeptides which mediate the effects of leptin.

Endocrine profiles of cows undergoing extended lactation in relation to the control of lactation persistency

We conducted an experiment in dairy cows investigating the effects of calving season, milking frequency and nutrition on lactation persistency. Cows calved in the Spring (n=12) or Winter (n=12). Commencing in lactation week 9 one udder-half of each cow was milked thrice-daily and half of each calving group received additional concentrate at a fixed rate of 3kg per day above that of the control cows. As reported elsewhere, between lactation weeks 9 and 33 persistency (measured as the slope of decline in milk yield) was significantly improved by frequent milking (P<0.001), by calving in the Winter (P<0.001) and by additional concentrate (P<0.05). The cows were rebred after week 33. When analysis of persistency was extended up to week 20 of the recurring pregnancy only the frequency effect remained significant. Persistency was unaffected by the pregnancy up until pregnancy week 20 but was then greatly reduced (P<0.001). In this paper we report hormone concentrations. GH was unaffected by nutrition but was consistently elevated in the Winter calving group relative to the Spring. IGF1 and prolactin were both unaffected by nutrition and calving season, IGF1 tended to increase as lactation progressed but changes in prolactin were related to time of year more than stage of lactation. Insulin was not affected by nutrition and was lower in Winter calvers, but only during early lactation. Prior to rebreeding, lactation persistency was correlated (slightly) with [GH] but not with [IGF1] or [insulin] and was correlated significantly with changes in GH, IGF1 (both positive) and insulin (negative). In conclusion, whilst bovine lactation persistency is plastic and amenable to beneficial manipulation, the details of its endocrine control remain to be elucidated.

A novel extinction screen in Arabidopsis thaliana identifies mutant plants defective in early microsporangial development

Few Arabidopsis mutants defective in early male or female germline development have been reported. A novel extinction screen has been devised which permits the identification of mutants deficient in the earliest stages of anther development. Using mutagenized plants carrying GUS reporter constructs driven by tapetal-specific promoters originally derived from Brassica genes, a wide spectrum of mutants have been identified in Arabidopsis, ranging from those defective in archesporial cell differentiation to others expressed later in development. Crosses between these lines and known anther development mutants have enabled the identification of lines carrying mutations in genes expressed during very early anther formation. Initial characterization reveals these early mutants fall into two classes, gne (GUS-negative) 1-like, and gne2-like. Members of the gne1 mutant class initiate all four layers of the anther wall and an appropriate number of sporogenous cells; however, as development proceeds the tapetal and middle-layer cells enlarge, eventually crushing the sporogenous cells. The gne2 class anthers are disrupted at an earlier stage, with the middle and tapetal layers failing to form, and an excess of sporogenous cells developing until the germline aborts late in meiosis II. Analysis of these mutants has already raised questions about the accuracy of current models of angiosperm anther development.

Symptom recognition in advanced cancer. A comparison of nursing records against patient self-rating

The aim of the study was to investigate the extent to which the symptoms experienced by advanced cancer patients were covered by the nursing records. On the day of the first contact with our palliative care department, a nursing record was taken, and on this or the following day, 56 patients filled in the questionnaires EORTC Quality of Life Questionnaire (EORTC QLQ-C30), Edmonton Symptom Assessment System (ESAS), and Hospital Anxiety and Depression Scale (HADS). In each patient, the symptomatology reported in the patient-completed questionnaires was compared with the symptomatology mentioned by the nurse in the nursing record. The analysis revealed good concordance concerning pain and poor physical functioning, but patients reported other symptoms or problems much more often than their nurses. Reasons for these discrepancies are discussed. It is suggested that the nurse's knowledge of the patient's symptomatology might gain from more systematic screening or from transfer of information from patient self-assessment questionnaires to the nursing records.

Windows in early mammary development: critical or not?

Two critical windows in mammary development have been proposed. The first arises from observations in rodents that nutrition during fetal and neonatal periods can affect mammary ductular outgrowth, subsequent proliferative activity and, eventually, tumorigenesis, that is, potentially it could have a long-term effect on pathological outcome (breast cancer) in women. The second similarly involves early diet, but in this case the outcome is phenotypic, in that dairy heifers reared too quickly during the peripubertal period subsequently show impaired udder development and reduced milk yield persisting throughout life. Most mammary development occurs during pregnancy, but this period is usually thought of only in terms of the immediate outcome for the subsequent lactation; it is not believed to be a critical window, at least in terms of lifetime mammary productivity. This review examines the evidence underlying these various claims and attempts to define the mechanisms involved, and also considers whether derangements occurring earlier in life (prenatally) could also have long-term consequences for physiological or pathological mammary development.

Familial non-specific dementia maps to chromosome 3

A significant minority of degenerative dementias lack distinctive inclusion bodies, plagues or tangles on pathological examination. Half of these cases have a positive family history of dementia. We have studied the largest published family with such a dementia and mapped the disease locus to a 12 cM region of chromosome 3 spanning the centromere. Haplotype analysis demonstrates a common region shared between all affected individuals between the markers D3S1284 and D3S1603. Like a number of other late onset neurodegenerative diseases, the disease presents at an earlier age when paternally inherited.

Mapping quantitative trait loci controlling milk production in dairy cattle by exploiting progeny testing

We have exploited "progeny testing" to map quantitative trait loci (QTL) underlying the genetic variation of milk production in a selected dairy cattle population. A total of 1,518 sires, with progeny tests based on the milking performances of > 150,000 daughters jointly, was genotyped for 159 autosomal microsatellites bracketing 1645 centimorgan or approximately two thirds of the bovine genome. Using a maximum likelihood multilocus linkage analysis accounting for variance heterogeneity of the phenotypes, we identified five chromosomes giving very strong evidence (LOD score > or = 3) for the presence of a QTL controlling milk production: chromosomes 1, 6, 9, 10 and 20. These findings demonstrate that loci with considerable effects on milk production are still segregating in highly selected populations and pave the way toward marker-assisted selection in dairy cattle breeding.

Microsatellite mapping of a gene affecting horn development in Bos taurus

The presence or absence of horns in Bos taurus is thought to be under the genetic control of the autosomal polled locus, characterized by two alleles: P dominant over p, and causing the polled or hornless phenotype. We have demonstrated genetic linkage between the polled locus and two microsatellite markers, GMPOLL-1 and GMPOLL-2, and have assigned the corresponding linkage group to bovine chromosome 1. This confirms the existence of the postulated polled locus and the hypothesized inheritance pattern. It will allow marker assisted selection for the polledness trait in breeding programs and is a first step towards positional cloning and molecular study of a gene that has been subjected to both natural and artificial selection.

Characterization of a new class of oleosins suggests a male gametophyte-specific lipid storage pathway

The expression and sequences of two related antherspecific cDNAs (I3 and C98) of Brassica napus (oilseed rape) were examined. These cDNAs were found to exhibit significant predicted amino acid sequence similarity with a group of seed-specific proteins, the oleosins, which are involved in oil body membrane structure. Pollen of B. napus also contains oil bodies, and the synthesis and accumulation of these organelles correlates with expression of the I3 and C98 transcripts. The protein content of purified pollen oil bodies was therefore examined in order to determine the presence or absence of possible oleosins. One major protein species of 14 kDa was identified and subjected to N-terminal amino acid sequence determination. The sequence of this pollen oil body associated protein is homologous to the predicted sequence of one of the anther-specific cDNs, I3, implying that this cDNA represents an anther-specific oleosin gene expressed in developing pollen. The expression of other genes active during seed oil body formation was also examined, and these were found to be specific to the sporophyte, inferring the existence of specific components of the pathway of lipid synthesis and storage in the male gametophyte. These possibilities and the relationship between different oleosin genes are discussed.

Microsatellite mapping of the gene causing weaver disease in cattle will allow the study of an associated quantitative trait locus

A genetic disease in cattle, progressive degenerative myeloencephalopathy (weaver disease), is associated with increased milk production. This association could result from population stratification, from a pleiotropic effect of a single gene, or from linkage disequilibrium between the gene causing weaver disease and a quantitative trait locus (QTL) for milk production. To test these hypotheses, we performed an extensive linkage study in a bovine pedigree segregating for the weaver condition and identified a microsatellite locus (TGLA116) closely linked to the weaver gene (zmax, 8.15; theta, 0.03). TGLA116 and, by extension, the weaver locus were assigned to bovine synteny group 13. This microsatellite can be used to identify weaver carriers, to select against this genetic defect, and to study the effect of the corresponding chromosomal region on milk production in Brown Swiss and other breeds of cattle.

Dietary modification with dairy products for preventing vertebral bone loss in premenopausal women: a three-year prospective study

The effect of dietary calcium on vertebral bone mass in women is controversial. In a randomized study we have investigated the effect of dietary modification in the form of dairy products on vertebral bone mass in 30- to 42-yr-old premenopausal women over a 3-yr period. Twenty women increased their dietary calcium intake by an average of 610 mg/day (P less than 0.03) for 3 yr, while 17 age- and weight-matched women served as controls. Calcium intake was monitored by 3-day diet histories and 24-h urinary calcium excretion. The consumption of the dairy products did not alter serum calcium or PTH levels or the fasting urinary calcium to creatinine ratio. Twenty-four-hour urinary calcium excretion increased by 28% (P less than 0.03) in the supplemented women. Dairy product intake was accompanied by increased dietary fat intake, but there were no statistically significant changes in serum cholesterol, low density lipoprotein cholesterol, or high density lipoprotein cholesterol levels. The vertebral bone density in the women consuming increased calcium did not change over the 3-yr period (-0.4 +/- 0.9%). In contrast, the vertebral bone density in the control women declined (-2.9 +/- 0.8%; P less than 0.001) and was significantly lower than that in the supplemented group at 30 and 36 months. The study suggests that dietary modification in the form of dairy products retards vertebral bone loss in premenopausal women. Therefore, increased calcium intake in estrogen-replete premenopausal women may prevent age-related bone loss.

Digoxin-prescribing. Mostly good news

We examined digoxin-prescribing in 47,000 prescriptions written predominantly by physicians in a large family medicine practice. Two hundred fifty-four patients received 511 digoxin prescriptions. Dose adjustments for age (16% decrease in patients older than 64 years), for renal disease (33% decrease), and for atrial fibrillation (39% increase) followed good prescribing practices. Appropriately lower loading doses were used for digitalization. However, despite continuing concern over the bioavailability of generic digoxin tablets, less than 40% of digoxin prescriptions in this study were written for the innovator's brand-name product (Lanoxin).

Pseudoblocks and portal localization

A new method of rapid simulation including design, verification and patient marking for shaped fields is described. This system utilizes a "pseudoblock" constructed from the Styrofoam components of the Cerrobend blocking system. The procedure is precise; errors in block aperture or patient positioning can readily be seen and corrected before the block is cast. In addition, the use of the pseudoblock does not significantly increase the time the patient spends in the simulator on his initial visit.

Simple design for a Styrofoam cutter

The design and construction of a Styrofoam cutter used in the fabrication of custom shielding blocks is described.