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Respiratory diseases affect a large proportion of the population and can cause complications when associated with pregnancy. Pregnancy induces profound anatomical and functional physiological changes in the mother, and subjects the mother to pregnancy-specific respiratory conditions. Reviewing respiratory conditions both specific and non-specific to pregnancy, the book also addresses related issues such as smoking and mechanical ventilation. Basic concepts for the obstetrician are covered, including patient history, physiology and initial examinations. Topics such as physiological changes during pregnancy and placental gas exchange are discussed for the non-obstetrician. Guidance is practical, covering antenatal and post-partum care, as well as management in the delivery suite. An essential guide to respiratory diseases in pregnancy, this book is indispensable to both obstetricians and non-obstetric physicians managing pregnant patients.
A number of applications utilise the energy focussing potential of imploding shells to dynamically compress matter or magnetic fields, including magnetised target fusion schemes in which a plasma is compressed by the collapse of a liquid metal surface. This paper examines the effect of fluid rotation on the Rayleigh–Taylor (RT) driven growth of perturbations at the inner surface of an imploding cylindrical liquid shell which compresses a gas-filled cavity. The shell was formed by rotating water such that it was in solid body rotation prior to the piston-driven implosion, which was propelled by a modest external gas pressure. The fast rise in pressure in the gas-filled cavity at the point of maximum convergence results in an RT unstable configuration where the cavity surface accelerates in the direction of the density gradient at the gas–liquid interface. The experimental arrangement allowed for visualisation of the cavity surface during the implosion using high-speed videography, while offering the possibility to provide geometrically similar implosions over a wide range of initial angular velocities such that the effect of rotation on the interface stability could be quantified. A model developed for the growth of perturbations on the inner surface of a rotating shell indicated that the RT instability may be suppressed by rotating the liquid shell at a sufficient angular velocity so that the net surface acceleration remains opposite to the interface density gradient throughout the implosion. Rotational stabilisation of high-mode-number perturbation growth was examined by collapsing nominally smooth cavities and demonstrating the suppression of small spray-like perturbations that otherwise appear on RT unstable cavity surfaces. Experiments observing the evolution of low-mode-number perturbations, prescribed using a mode-6 obstacle plate, showed that the RT-driven growth was suppressed by rotation, while geometric growth remained present along with significant nonlinear distortion of the perturbations near final convergence.
Analysis of milk BHB concentration by Fourier-transform infrared (FTIR) spectrometry more frequently than regular milk testing could help dairy producers in decision making, particularly if it would be possible to use small hand-stripped samples (hereinafter simply called samples) taken between dairy herd improvement (DHI) test-samples analysed using DHI algorithms. The aim of this Research Communication was to evaluate milk BHB concentration and the prevalence of elevated milk BHB concentration analysed by FTIR spectrometry compared with flow-injection analysis (SKALAR) from samples taken at different times relative to the milking. A total of 293 early-lactation cows in 44 commercial dairy herds were involved in the study. Herds were visited once during the morning milking when a routine DHI test-sample was obtained using in-line milk samplers. Additional milk samples were taken by hand stripping as follows: (1) Just before connecting the milking machine; (2) immediately after removing the milking machine; (3) 3 h after milking and (4) 6 h after milking. Milk samples were analysed for BHB concentration by FTIR and SKALAR, the latter being the reference method. Milk BHB concentration from samples taken before milking was different between FTIR and SKALAR whereas no difference was noted for other sampling times, although milk BHB concentration rose as time after milking increased. Except for DHI test-samples for which prevalence was not different between analysis methods, prevalence of elevated milk BHB concentration (≥0.15 mmol/l) was greater for FTIR analysis. However, no difference in prevalence was observed between SKALAR and FTIR when using a threshold of ≥0.20 mmol/l. In summary, hand-stripped milk samples taken any time after removing the milking machine until 6 h after the milking can be recommended for FTIR analysis of elevated milk BHB concentration prevalence provided a threshold of 0.20 mmol/l is used.
This paper extends the scope of earlier studies of Karl Barth's relationship with Charlotte von Kirschbaum by exploring his marriage to Nelly Barth and the deterioration in their relationship in the 1920s. It traces the development and character of Barth's relationship with Kirschbaum, and the Notgemeinschaft (emergency community) they formed with Nelly. The paper makes use of Nelly Barth's unpublished letters to her family in which she accounts for her reluctance to divorce her husband in the early 1930s. The second half of the paper explores the impact of Barth's relationship with Kirschbaum on others and goes on to suggest ways in which this had consequences for his theology, particularly in his thinking in Church Dogmatics III/4 about the relation between man and woman.
Frequent standard International Normalized Ratio (INR) monitoring by health professionals is one of the major inconveniences reported by warfarin users. However, portable coagulometers are now available to reduce this burden by allowing patients to self-monitor their INR in the comfort of their home, thereby reducing their visiting frequency to a medical clinic. The aim of this work was thus to elaborate recommendations on the use of self-monitoring in the management of warfarin-treated patients in the province of Quebec.
Systematic literature reviews were conducted to retrieve the most up-to-date scientific data from primary studies and pharmacoeconomic evaluations as well as recommendations from published clinical practice guidelines. This information was then triangulated with the experiential knowledge of Quebec experts and clinicians collaborating on the project.
The scientific, contextual and experiential evidence gathered during this work provided convincing support for the use of self-monitoring for long-term warfarin-treated patients, leading to a more effective treatment than standard monitoring while being safe, cost-effective and potentially improving patients’ quality of life. However, physical and mental limitations can hinder the use of portable coagulometers, outlining the need for caution in the selection and support of self-monitoring patients.
This work led to the development of specific recommendations on the use of self-monitoring along with a clinical tool to help discussion between patients and health professionals leading to a shared decision-making. This work will be part of two optimal usage guides on oral anticoagulant therapy to be published by the Institut national d'excellence en santé et en services sociaux.
Next-generation 21cm observations will enable imaging of reionization on very large scales. These images will contain more astrophysical and cosmological information than the power spectrum, and hence providing an alternative way to constrain the contribution of different reionizing sources populations to cosmic reionization. Using Convolutional Neural Networks, we present a simple network architecture that is sufficient to discriminate between Galaxy-dominated versus AGN-dominated models, even in the presence of simulated noise from different experiments such as the HERA and SKA.
In the aftermath of the Civil War, state judges lost their long-held right to inquire into the legality of federal detentions, and habeas corpus—once almost solely the business of state courts—was largely transformed into a federal remedy. We argue that the wartime furor surrounding underage enlistees was a key factor in driving this legal change. Scholarship on the use of habeas corpus during the war generally concentrates on cases involving freedom of speech or political association, but thousands of parents and guardians also petitioned Union authorities and state courts to retrieve minor children who had enlisted without their consent. Angrily demanding that the military discharge such youths, they portrayed control over the personhood and labor of minor children as fundamental to American liberty. At the same time, state court judges fought to retrain jurisdiction over such cases as a critical check on federal and military power. We illuminate these conflicts by drawing on a rich array of sources that capture the competing perspectives of federal and state court judges, Lincoln Administration officials, elected representatives, military officers, parents and guardians, and minors themselves. In the process, we show the halting and contested transformation of habeas corpus, the outcome of which ultimately redefined the relationship between American citizens and their government, preventing aggrieved parents from using state courts to safeguard their rights against federal and military authorities, and blocking state courts from querying the legality of federal detentions of any kind.
Studies have shown that a mother's history of childhood maltreatment is associated with her child's experience of internalising and externalising difficulties.
To characterise the mediating pathways that underpin this association.
Data on a mother's history of childhood maltreatment, depression during pregnancy, postnatal depression, maladaptive parenting practices and her child's experience of maltreatment and internalising and externalising difficulties were analysed in an Avon Longitudinal Study of Parents and Children (ALSPAC) sample of 9397 mother–child dyads followed prospectively from pregnancy to age 13.
Maternal history of childhood maltreatment was significantly associated with offspring internalising and externalising difficulties. Maternal antenatal depression, postnatal depression and offspring child maltreatment were observed to significantly mediate this association independently.
Psychological and psychosocial interventions focused around treating maternal depression, particularly during pregnancy, and safeguarding against adverse childhood experiences could be offered to mothers with traumatic childhood histories to help protect against psychopathology in the next generation.
Introduction: Recruitment and retention of healthcare staff are difficult in rural communities. Poor quality of work life (QWL) may be an underling factor as rural healthcare professionals are often isolated and work with limited resources. However, QWL data on rural emergency (ED) staff is limited. We assessed QWL among nurses and physicians as part of an ongoing study on ED care in Québec. Methods: We selected EDs offering 24/7 medical coverage, with hospitalization beds, in rural or small towns (Stats Canada definition). Of Québec’s 26 rural EDs, 23 (88%) agreed to participate. The online Quality of Work Life Systemic Inventory (QWLSI, with 1 item per 34 “life domains”), was sent to all non-locum ED nurses and physicians (about 500 potential participants). The QWLSI is used for comparing QWL scores to those of a large international database. We present overall and subscale QWL scores as percentiles (PCTL) of scores in the large database, and comparisons of nurses’ and physicians’ scores (t test). Results: Thirty-three physicians and 84 nurses participated. Mean age was 39.8 years (SD=10.1): physicians=37 (7.7) and nurses=40.9 (10.7). Overall QWL scores for all were in the 32nd PCTL, i.e. low. Nurses were in the 28th PCTL and physicians in the 44nd (p>0.05). For both groups, QWL was below the 25th PCTL i.e. very low, for “sharing workload during absence of an employee”, “working equipment”, “flexibility of work schedule”, “impact of working hours on health”, “possibility of being absent for familial reasons”, “relations with employees”. The groups differed (p<0.05) on only two subscales: remuneration and career path. For remuneration, scores were similar on fringe benefits (nurses 22nd PCTL, physicians 32nd) and income security (nurses 72nd, physicians 74th), but differed on income level (nurses 74th, physicians 93rd). The groups differed on all 3 career path items: advancement possibilities (nurses 53th, physicians 91st), possibilities for transfer (nurses 51nd, physicians 84th) and continuing education (nurses 18th, physicians 49th). Conclusion: Overall QWL among rural ED staff is poor. Groups had similar QWL scores except on career path, with physicians perceiving better long-term prospects. Given difficulties in rural recruitment and retention, these findings suggest that QWL should be assessed in rural and urban EDs nationwide.
Introduction: Trauma remains the primary cause of death in people under 40 in Québec. Although trauma care has dramatically improved in the last decade, no empirical data on the effectiveness of trauma care in rural Québec are available. This study aims to establish a portrait of trauma and trauma-related mortality in rural versus urban pre-hospital and hospital settings. Methods: Data for all trauma victims treated in the 26 rural hospitals and 32 Level-1 and Level-2 urban trauma centres was obtained from Québec’s trauma registry (2009-2013). Rural hospitals were located in rural small towns (Statistics Canada definition), provided 24/7 physician coverage and admission capabilities. Study population was trauma patients who accessed eligible hospitals. Transferred patients were excluded. Descriptive statistics were used to compare rural with urban trauma case frequency, severity and mortality and descriptive data collected on emergency department (ED) characteristics. Using logistic regression analysis we compared rural to urban in-hospital mortality (pre-admission and during ED stay), adjusting for age, sex, severity (ISS), injury type and mode of transport. Results: Rural hospitals (N=26) received on average 490 000 ED visits per year and urban trauma centres (N=32), 1 550 000. Most rural hospitals had 24/7 coverage and diagnostic equipment e.g. CT scanners (74 %), intensive care units (78 %) and general surgical services (78 %), but little access to other consultants. About 40% of rural hospitals were more than 300 km from a Level-1 or Level-2 trauma centre. Of the 72 699 trauma cases, 4703 (6.5%) were treated in rural and 67 996 (93.5%) in urban hospitals. Rural versus urban case severity was similar: ISS rural: 8.6 (7.1), ISS urban: 7.2 (7.2). Trauma mortality was higher in rural than urban pre-hospital settings: 7.5% vs 2.6%. Reliable pre-hospital times were available for only a third of eligible cases. Rural mortality was significantly higher than urban mortality during ED stays (OR (95% IC): 2.14 (1.61-2.85)) but not after admission (OR (95% IC): 0.87 (0.74-1.02)). Conclusion: Rural hospitals treat equally severe trauma cases as do urban trauma centres but with fewer resources. The higher pre-hospital and in-ED mortality is of grave concern. Longer rural transport times may be a factor. Lack of reliable pre-hospital times precluded further analysis.
Studies have shown that maternal depression during pregnancy predicts offspring depression in adolescence. Child maltreatment is also a risk factor for depression.
To investigate (a) whether there is an association between offspring exposure to maternal depression in pregnancy and depression in early adulthood, and (b) whether offspring child maltreatment mediates this association.
Prospectively collected data on maternal clinical depression in pregnancy, offspring child maltreatment and offspring adulthood (18–25 years) DSM-IV depression were analysed in 103 mother–offspring dyads of the South London Child Development Study.
Adult offspring exposed to maternal depression in pregnancy were 3.4 times more likely to have a DSM-IV depressive disorder, and 2.4 times more likely to have experienced child maltreatment, compared with non-exposed offspring. Path analysis revealed that offspring experience of child maltreatment mediated the association between exposure to maternal depression in pregnancy and depression in adulthood.
Maternal depression in pregnancy is a key vulnerability factor for offspring depression in early adulthood.
THE issue of whaling has been the subject of considerable controversy in recent years, as the international community remains divided as to how the world's marine resources should be managed: some states prioritise conservation, while others favour sustainable exploitation. Against this background, Australia initiated proceedings against Japan before the International Court of Justice (ICJ) in May 2010, claiming that Japan's continuing whaling activities, carried out under the guise of scientific research, were in breach of its various obligations under the International Convention for the Regulation of Whaling (ICRW). New Zealand later intervened in the proceedings, exercising its right under Article 63 of the ICJ Statute, and oral pleadings involving the three states were held in June and July 2013. On 31 March 2014, the ICJ delivered its judgment in Whaling in the Antarctic (Australia v Japan, New Zealand Intervening), finding that Japan had violated three provisions of the ICRW – the moratorium on commercial whaling, the ban on factory ships, and the prohibition on whaling in the Southern Ocean Sanctuary – by authorising the killing of certain whale species as part of its JARPA II research programme. The decision has largely been welcomed, especially by environmental activists, for offering a measure of protection to endangered marine life, but the judgment carries broader significance for its treatment of a number of points of international law, including the standard of review exercised by international courts, the role of scientific reasoning in international dispute settlement, and the interpretation of treaties.