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Psychosocial factors have been implicated as both a cause and consequence of hypertension in the general population but are less understood in relation to hypertensive disorders of pregnancy (HDP). The aims of this review were to (1) synthesize the existing literature examining associations between depression and/or anxiety in pregnancy and HDP and (2) assess if depression and/or anxiety in early pregnancy was a risk factor for HDP.
A comprehensive search of Medline, Embase, CINAHL, and PsycINFO was conducted from inception to March 2020 using terms related to ‘pregnancy’, ‘anxiety’, ‘depression’, and ‘hypertensive disorders’. English-language cohort and case-control studies were included if they reported: (a) the presence or absence of clinically significant symptoms of depression/anxiety, or a medical record diagnosis of depression or an anxiety disorder in pregnancy; (b) diagnosis of HDP; and/or (c) data comparing the depressed/anxious group to the non-depressed/anxious group on HDP. Data related to depression/anxiety, HDP, study characteristics, and aspects related to study quality were extracted independently by two reviewers. Random-effects meta-analyses of estimated pooled relative risks (RRs) were conducted for depression/anxiety in pregnancy and HDP.
In total, 6291 citations were retrieved, and 44 studies were included across 61.2 million pregnancies. Depression and/or anxiety were associated with HDP [RR = 1.39; 95% confidence interval (CI) 1.25–1.54].
When measurement of anxiety or depression preceded diagnosis of hypertension, the association remained (RR = 1.27; 95% CI 1.07–1.50). Women experiencing depression or anxiety in pregnancy have an increased prevalence of HDP compared to their non-depressed or non-anxious counterparts.
Cognitive behavior therapy (CBT) is effective for most patients with a social anxiety disorder (SAD) but a substantial proportion fails to remit. Experimental and clinical research suggests that enhancing CBT using imagery-based techniques could improve outcomes. It was hypothesized that imagery-enhanced CBT (IE-CBT) would be superior to verbally-based CBT (VB-CBT) on pre-registered outcomes.
A randomized controlled trial of IE-CBT v. VB-CBT for social anxiety was completed in a community mental health clinic setting. Participants were randomized to IE (n = 53) or VB (n = 54) CBT, with 1-month (primary end point) and 6-month follow-up assessments. Participants completed 12, 2-hour, weekly sessions of IE-CBT or VB-CBT plus 1-month follow-up.
Intention to treat analyses showed very large within-treatment effect sizes on the social interaction anxiety at all time points (ds = 2.09–2.62), with no between-treatment differences on this outcome or clinician-rated severity [1-month OR = 1.45 (0.45, 4.62), p = 0.53; 6-month OR = 1.31 (0.42, 4.08), p = 0.65], SAD remission (1-month: IE = 61.04%, VB = 55.09%, p = 0.59); 6-month: IE = 58.73%, VB = 61.89%, p = 0.77), or secondary outcomes. Three adverse events were noted (substance abuse, n = 1 in IE-CBT; temporary increase in suicide risk, n = 1 in each condition, with one being withdrawn at 1-month follow-up).
Group IE-CBT and VB-CBT were safe and there were no significant differences in outcomes. Both treatments were associated with very large within-group effect sizes and the majority of patients remitted following treatment.
It is a point of some controversy whether we can call the Ireland of the nineteenth-century ‘Victorian’, for all that Victoria was its head of state within the United Kingdom. While not a state in itself, Ireland was certainly going through what William Carleton called in 1842 a ‘transition state’. There is much that is preliminary, provisional or even experimental about the writing of nineteenth-century Ireland, caught between Romanticism and Revival and never fully accounted for in the mainstream of Victorian literary history. The writing, too, was not located solely in Ireland: famine and mass emigration meant that the Irish found themselves in the United States, Australia or India, both as participants in decolonising movements or as servants of Empire. This chapter surveys the twin location of Irish literature, nationalist and diasporic. It focuses on the work of Carleton and Jane Elgee (Speranza) while also introducing many of the themes and authors which are the subject matter of the pages that follow.
The Irish poetry of the romantic age is dominated by its best-known figure, Thomas Moore. While Moore claimed that his songs were responsible for saving the national literary and musical culture, there were, of course, many other writers producing poetry in differing modes, languages, and registers. This chapter begins and ends with Moore’s considerable achievements, but it also deals with three issues that preoccupied Irish poetic and cultural debate in the period and after: translation, authenticity, and quality. The debate gains its first focus in the work of Charlotte Brooke, but continues through Moore’s contact with music in the collections of Edward Bunting. This period was also one of considerable historical moment, and the chapter also addresses poetry written out of the contact with French revolutionary ideas, the United Irishmen, 1798, and Union. Among poets considered are also William Drennan, Mary Tighe, James Orr, and Thomas Dermody, writing in English and Ulster Scots as well as in contact with the Irish-language tradition, mock-epic, and the oriental.
Ireland's experience in the nineteenth century was quite different from that of Victorian Britain. Its fictions were written in differing forms – like the gothic or historical novel – and its poetry and drama were populated with ballad and song. Its writers were by turns nationalist or unionist, anglophile or de-anglicising. If the effects of famine and emigration were catastrophic for mid-nineteenth-century Irish culture, they initiated a literary story that spread across the diaspora. Despite the decline of spoken Irish, literature continued to be published, while scholarly endeavours such as translation or the Ordnance Survey preserved much from the Gaelic past. This rich volume examines the many forms of new writing that thrived throughout this period. Utilizing a thematic and historical approach, it addresses a broad anglophone readership in Victorian literature. Essays consider the Irish authors in America and India, women's writing, and the resilience of Irish literature before the revival.
In a 2017 article, Holen and colleagues reported evidence for a 130 000-year-old archaeological site in California. Acceptance of the site would overturn current understanding of global human migrations. The authors here consider Holen et al.’s conclusions through critical evaluation of their replicative experiments. Drawing on best practice in experimental archaeology, and paying particular attention to the authors’ chain of inference, Magnani et al. suggest that to argue convincingly for an early human presence at the Cerutti Mastodon site, Holen et al. must improve their analogical foundations, test alternative hypotheses, increase experimental control and quantify their results.
Although we do not know the cause of death of most fossil animals, mortality is often associated with ecological stress due to seasonality and other stochastic events (droughts, storms, volcanism) that may have caused shifts in feeding ecology preceding death. In these instances, dental microwear, which reflects feeding ecology in a narrow window of time, may provide a biased view of diet. Mesowear, another dental-wear proxy based on the morphology of worn cusps, requires macroscopic amounts of dental wear and reflects diet for a longer interval and may be less prone to bias from near-death ecological stress. We compared congruence between microwear and mesowear of North American, fossil rhinocerotid mass-death assemblages and collections of hunted modern rhinocerotids to test the hypothesis that fossil assemblages yield more incongruous microwear and mesowear data as a result of near-death ecological disturbances. In extant rhinos, both mesowear and microwear are associated with diet and height of the feeding environment. Mesowear and microwear in the modern rhinocerotid collections are statistically correlated, with strong relationships between average mesowear scores and labially distributed dental microwear. In contrast, a relationship between mesowear and microwear was not observed among the fossil rhinocerotid assemblages. Mesowear suggests that the fossil rhinos had low-abrasion diets, suggesting that they fed from clean, possibly tall vegetation. Some, but not all, mass-death assemblages produce microwear data with excessive scratches and/or pits compared with expectations based on mesowear results, suggesting that dental microwear was altered shortly before death in some but not all of the fossil assemblages. The dental-wear proxies available to paleoecologists provide a mosaic of dietary evidence reflecting diet over long (mesowear) and more abbreviated (microwear) periods of time that, together, provide a richer understanding of feeding ecology and its relationship to environment, seasonal change, and other ecological disturbances.