Cardiac Physiology and Pathophysiology in Pregnancy.

Cardiovascular disease is the leading indirect cause of maternal morbidity and mortality, accounting for nearly one third of maternal deaths during pregnancy. The burden of cardiovascular disease in pregnancy is increasing, as are the incidence of maternal morbidity and mortality. Normal physiologic adaptations to pregnancy, including increased cardiac output and plasma volume, may unmask cardiac conditions, exacerbate previously existing conditions or create de novo complications. It is important for care providers to understand the normal physiologic changes of pregnancy and how they may impact the care of patients with cardiovascular disease. This review outlines the physiologic adaptions during pregnancy and their pathologic implications for some of the more common cardiovascular conditions in pregnancy.

Improving bereavement outcomes in Zimbabwe: results of a feasibility cluster trial of the 9-cell bereavement tool.

CONTEXT: Despite high mortality rates from both communicable and non-communicable diseases, bereavement is under-researched in African countries. The 9-cell bereavement tool was designed to assist individuals to reflect on their feelings about bereavement and identify resources in families and communities to manage bereavement. This study aimed to determine the feasibility of implementing the 9-cell bereavement tool and recruitment to experimental evaluation. METHODS: A feasibility cluster randomized trial with embedded qualitative interviews was conducted in two comparable neighbourhoods in Chitungwiza, Zimbabwe. Community leaders identified potential community lay bereavement supporters (interventionists). Each community lay bereavement supporter recruited two to three recently bereaved community members (trial participants). Following baseline data collection, the communities were randomly allocated to intervention or wait-list control. Self-administered questionnaires were completed at T0 (month 0), T1 (3 months) and T2 (6 months). Grief, mental health and social support were assessed. Focus group discussions with selected interventionists described training impact and intervention processes. Quantitative and qualitative analyses were performed. RESULTS: Implementation of the nine-cell bereavement tool and recruitment to experimental evaluation were successful. Implementation of the tool and the recruitment of study participants were conducted within the intended timeframe of 3 weeks. In line with the suggested sample size, the study was able to recruit and retain at least 75% of the trial participants for the total duration of the study. CONCLUSION: The feasibility cluster trial was successfully implemented and assessed. Through the published protocol, the literature review and the results of this study, it has been noted that there is an urgent need to carry out a full trial in this subject matter, not only as a contribution to the currently sparse literature in this regard, but for the enormous potential public health benefit in supporting and saving lives in many more under-resourced and under-supported countries. TRIAL REGISTRATION: Protocol registration: http://www.isrctn.com/ISRCTN16484746 . Protocol publication: https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-019-0450-5.

Racial justice in psycholegal research and forensic psychology practice: Current advances and a framework for future progress.

Police killings of Black civilians have brought unprecedented attention to racial and ethnic discrimination in the criminal justice and legal systems. However, these topics have been underexamined in the field of law-psychology, both in research and forensic-clinical practice. We discuss how a racial justice framework can provide guidance for advancing psycholegal research and forensic-clinical practice related to race, ethnicity, culture, and their intersections. A racial justice framework centers the goal of increasing fair and responsive treatment and just outcomes for the most vulnerable populations involved with the criminal justice, legal, and carceral systems and ending existing disparities. We argue that the framework should include the use of transparent nonobjectivity, in which racial justice is an explicit and acknowledged goal of research and practice that exists alongside a commitment to open and rigorous science and evidence-based practice. We then use the racial justice framework as a backdrop for discussing the articles and broader themes that appear in the special issue, which include racial biases in policing, public views of the police and use of force, expanding research on racial bias in lay judgments, understanding disparities in sentencing and corrections, and improving forensic practice. Finally, we look to the future, discussing practices and perspectives that can facilitate a racial justice approach in psycholegal research and forensic-clinical practice. Our recommendations include engaging in reflexivity and addressing positionality; expanding research questions and methods, especially qualitative and community-based participatory action research; centering and engaging with communities of color; greater emphasis on intersectionality; shifting toward structural and adaptive interventions; and greater integration of work from other fields. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Further action toward valid science in Law and Human Behavior: Requiring open data, analytic code, and research materials.

In 2019, the inaugural editorial of Law and Human Behavior promised a measured approach to increasing transparency, openness, and replicability practices in the journal. Now, 3 years later, and on the brink of the present authors' last year as the editorial team, it seems only fitting that they take further action to bolster the validity of science published in the journal by requiring that authors openly report data, analytic code, and research materials. The purpose of this editorial is to briefly outline Law and Human Behavior's new requirements. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Clinical presentation and maternal-fetal outcomes of Mirror Syndrome: A case series of 10 affected pregnancies.

Background: Mirror Syndrome, also known as Ballantyne syndrome, is a rare condition with fewer than 120 cases described in the literature. A simultaneous edematous state of the mother, fetus and placenta is pathognomonic, with the maternal condition frequently presenting with signs and symptoms similar to that of preeclampsia. Objective: Our aim was to add to the international body of literature through identification of all cases of Mirror Syndrome at two Canadian tertiary obstetric centres and characterize the maternal presentation, laboratory findings, and perinatal outcomes. Methodology: We performed a retrospective chart review of all cases of fetal hydrops from two tertiary centres in Winnipeg (Manitoba, Canada) between 2000 and 2019. There were 276 cases of fetal hydrops during this period, of which 10 cases satisfied the diagnostic criteria for Mirror Syndrome where maternal and perinatal outcomes were analysed. Results: The median gestational age at diagnosis with Mirror Syndrome was 23 weeks and 3 days of gestation and at birth was 25 weeks and 0 days of gestation. The majority of women were multiparous (80%) and had elevated maternal body mass index (median 33 kg/m2). The most common maternal clinical findings included weight gain (100%) and hypertension (90%). The most common laboratory findings included low hematocrit (100%), hypoalbuminemia (80%), anemia (70%) and hyperuricemia (70%). Structural anomalies were observed in 50% of cases, over half of the fetuses were stillborn (66.7%) and one quarter of pregnancies resulted in neonatal deaths (25%). The median time until maternal improvement of Mirror Syndrome was 2 days postpartum. Conclusion: Mirror Syndrome affected 3.6% of all cases of fetal hydrops in our cohort, and showed associations with multiparity, elevated BMI, hemodilution, hypoalbuminemia, anemia and hyperuricemia. Delivery is frequently required for fetal and/or maternal indications and symptoms usually improved rapidly after delivery.

Medical treatment of seafarers in the Southern Indian Ocean - interaction between the French Telemedical Maritime Assistance Service (TMAS) and the medical bases of the French Southern and Antarctic Lands (TAAF).

BACKGROUND: The waters surrounding the French Southern Lands are a fishing zone, accessible only by sailing for several days in a region where weather conditions are often difficult. The scientific bases of the region have medical staff whose services can be called upon if seafarers require assessment and rapid medical treatment. We conducted an epidemiological study of the maritime teleconsultations carried out by the French Telemedical Maritime Assistance Service (TMAS), where patients navigating in the Southern Indian Ocean zone were advised to disembark on the medical bases in the French Southern Lands, between 2015 and 2020, to receive medical treatment. MATERIALS AND METHODS: We extracted data from all of the maritime records from 1 January 2015 to 31 December 2020 relating to patients who attended a maritime teleconsultation with a French TMAS doctor in the Southern Indian Ocean zone and who had been redirected to the medical bases in the French Southern Lands. Data were collected on the patients' age, gender, nationality, rank, type of vessel, teleconsultation diagnosis, patient management on board and in the French Southern Lands medical bases, as well as the medical outcome. We carried out a descriptive data analysis. RESULTS: French TMAS doctors managed 11,908 cases including 76 in the Southern Indian Ocean zone (0.6%). Nineteen (25%) patients were redirected to the French Southern Lands over the study period. Eighteen patients were men with an average age of 45 ± 10 years. Eighteen patients were on board a trawler and 11 of them were sailors. Nine patients were treated for a trauma-related condition, 8 for a medical condition and 2 for a surgical disease. Eleven (58%) patients were evacuated to Reunion Island and 8 (42%) patients received medical treatment and were able to re-embark aboard their vessel. CONCLUSIONS: Relatively few patients are redirected to the French Southern Lands for medical assistance, but referrals occur on a regular basis. The presence of these medical bases is unusual in a maritime setting, but they can be a valuable asset when maritime medical assistance is required in this region. The type of condition encountered, and the patient profile, were typical of the fishing community. The presence of these bases and communication between the various stakeholders delivering maritime medical assistance provided these patients with optimal care despite their isolated location.

Promoting Adaptation in Female Inmates to Reduce Risk of Opioid Overdose Post-Release Through HOPE.

The purpose of the project was to develop a sustainable pre-release education program to reduce the risk of opioid overdose post-release in female inmates in a rural county jail in Middle Tennessee. The project was supported and guided using Roy's adaptation model. Content analysis resulted in common themes (initiation, moral failure, ineffective strategies, supportive environment, new beginnings, and adaptive domains), identified within the pre- and post-implementation surveys. The implementation of a successful reentry program for the vulnerable female incarcerated population has the potential to reduce the risk of opioid overdose death and negative health outcomes post-release.

The epidemiology of bacterial zoonoses in pastoral and dairy cattle in Cameroon, Central Africa.

Previous work identified that bacterial zoonoses (Brucella species, Coxiella burnetii and Leptospira hardjo) were present in Cameroonian pastoral cattle. To assess the characteristics of this zoonotic risk, we analyse seroprevalence of each pathogen and the associated management, herd and environmental factors in Cameroonian pastoral and dairy cattle. Cross-sectional samples included pastoralist herds in the Northwest Region (NWR n = 750) and Vina Division (VD n = 748) and small holder dairy herds in the NWR (n = 60). Exposure to Brucella spp., C. burnetii and L. hardjo were screened for using commercial ELISAs and population adjusted estimates made. In addition, individual, herd and ecological metadata were collected and used to identify risk factors associated with animal-level seropositivity. In the pastoral cattle, seroprevalence to Brucella spp. was relatively low but was higher in the NWR (4.2%, CI: 2.5%-7.0%) than the VD (1.1%: CI 0.5%-2.4%), while L. hardjo seroprevalence was much higher though similar in the NWR (30.7%, CI 26.3%-35.5%) and VD (35.9%, CI 31.3%-40.7%). No differences were noted in C. burnetii seroprevalence between the two study sites (NWR: 14.6%, CI 11.8%-18.0%. VD: 12.4%, 9.6%-15.9%). Compared to pastoral, dairy cattle had lower seroprevalences for L. hardjo (1.7%, CI: 0.0%-4.9%), C. burnetii (0.0%, CI 0.0%-6.0%) but similar for Brucella spp. (5.0%, CI 0.0%-10.6%). Increased odds of Brucella spp. seropositivity were associated with owning sheep or rearing sheep and fencing cattle in at night. Adult cattle had increased odds of being seropositive for both C. burnetii and L. hardjo. Additionally, exposure to C. burnetii was associated with local ecological conditions and L. hardjo was negatively associated with cattle undertaking transhumance. This work highlights that exposure to these 3 important production diseases and occupational zoonoses are widespread in Cameroonian cattle. Further work is required to understand transmission dynamics between humans and livestock to inform implementation of effective control measures.

Sympathetic Nervous System and Exercise Affects Cognition in Youth (SNEACY): study protocol for a randomized crossover trial.

BACKGROUND: There is an increasing prevalence of physical inactivity during childhood, which is associated with a variety of health problems. However, the mechanisms by which acute exercise benefits cognition in childhood remains unknown. Here we describe the protocol for a randomized crossover trial called SNEACY (Sympathetic Nervous System & Exercise Affects Cognition in Youth), a study designed to better understand mechanisms linking acute exercise and cognition in 9-10-year-old healthy, cognitively normal children. METHODS: Children from the Greater Boston, MA region will be recruited to participate in this single center study. A randomized crossover design will be utilized, such that participants will act as their own controls, through initial randomization to condition assignment and condition counterbalancing across participants. One hundred three children will participate in three randomized acute interventions: moderate intensity treadmill exercise (20 min, 70-75% of their maximal heart rate), seated rest (20 min), and a Trier Social Stress Test for Children (14 min). These visits will occur on 3 three separate days, approximately 5-8 days apart. Before and after each intervention, children complete a variety of cognitive tasks measuring attentional inhibition while their neuroelectric activity is recorded. Variables of interest include EEG data, accuracy and reaction time, academic achievement, and salivary alpha amylase. Academic achievement is also assessed following interventions. In addition, children provide passive drool samples throughout the interventions to measure various biomarkers that may explain the acute exercise benefit on cognition. DISCUSSION: The results from this study could influence educational and public health recommendations to enhance cognition and learning in pre-adolescent children. TRIAL REGISTRATION: ClinicalTrials.gov NCT03592238 . Registered on 19 July 2018.

The role of BMI on cognition following acute physical activity in preadolescent children.

BACKGROUND: There is an increasing prevalence of physical inactivity during childhood, concurrent with a rise in obesity rates, which is associated with a variety of health problems. However, the extent to which increased body mass index (BMI) influences acute physical activity (PA) benefits on cognition in childhood remains unknown. The aim of this study was to examine whether BMI influences the effects of acute PA on inhibitory control task performance. METHODS: In a sample of 116 children pooled from four prior studies (ages 8-11; 51 females), demographic measures of age, sex, IQ, socioeconomic status, and aerobic fitness were considered along with BMI. Children participated in a counterbalanced, randomized crossover study, whereby they completed two different interventions; 20 minutes of treadmill walking (60-70% heart rate max) and restful reading (non-exercise control). Following each intervention, children performed a modified flanker task that manipulates inhibitory control demands. Correlations were conducted to determine the influence of demographic variables, fitness, and BMI on inhibitory control following each intervention. Subsequent hierarchical regression analyses were performed with significant demographic factors in the first step, aerobic fitness in the second step when significant, and BMI in the final step. RESULTS: Analyses indicated that children exhibited improved task performance (p's ≤ 0.001) and decreased interference (p = 0.04) following the walking intervention compared to the restful reading control condition, indicating greater benefits following acute PA across task condition, with selectively greater benefits for the task condition requiring greater inhibitory control. Regression analyses revealed that greater BMI was related to decreased performance following acute PA (p = 0.001); an association not observed following restful reading (p's ≥ 0.11). These results suggest that BMI negatively influences the effect of acute exercise on performance. CONCLUSION: Confirming previous studies, these findings indicate beneficial effects of acute PA on a flanker task that modulates inhibitory control requirements, but the effects are significantly greater for task conditions requiring greater amounts of inhibitory control. Further, these beneficial effects of PA appear to be blunted in children with higher BMI. These findings suggest that the acute benefits of PA on cognition may not be fully realized in children with higher BMI.

Streptococcus mitis Chorioamnionitis after Dental Scaling and Oral Sex.

BACKGROUND: Oral sex is postulated to be a risk factor for the introduction of bacteria into the amniotic cavity. Common oropharyngeal bacteria have been implicated in reports of second trimester chorioamnionitis via ascending vaginal transmission following oral sex. Dental scaling can also introduce these pathogens into the blood stream, allowing hematogenous spread of oral pathogens to the fetoplacental unit in pregnant patients. CASE: We report a case of Streptococcus mitis chorioamnionitis at 21 weeks and 5 days' gestation in a patient whose only risk factors were recent dental scaling and recent oral sex with a partner known to have periodontal disease. CONCLUSION: Bacterial chorioamnionitis should be considered in the differential diagnosis of preterm labour. Oral sex and dental procedures may be risk factors for chorioamnionitis.

Grief and Bereavement in Parents After the Death of a Child in Low- and Middle-Income Countries.

While great strides have been made in improving childhood mortality, millions of children die each year with significant health-related suffering. More than 98% of these children live in low- and middle-income countries (LMICs). Efforts have been made to increase access to pediatric palliative care (PPC) services to address this suffering in LMICs through policy measures, educational initiatives, and access to essential medicines. However, a core component of high-quality PPC that has been relatively neglected in LMICs is grief and bereavement support for parents after the death of their child. This paper reviews the current literature on parental grief and bereavement in LMICs. This includes describing bereavement research in high-income countries (HICs), including its definition, adverse effect upon parents, and supportive interventions, followed by a review of the literature on health-related grief and bereavement in LMICs, specifically around: perinatal death, infant mortality, infectious disease, interventions used, and perceived need. More research is needed in grief and bereavement of parents in LMICs to provide them with the support they deserve within their specific cultural, social, and religious context. Additionally, these efforts in LMICs will help advance the field of parental grief and bereavement research as a whole.

Improving bereavement outcomes in Zimbabwe: protocol for a feasibility cluster trial of the 9-cell bereavement tool.

BACKGROUND: The high burden of bereavement in sub-Saharan Africa is largely attributable to HIV, cancer, and other non-communicable diseases. However, interventions to improve grief and bereavement are rare. Given high rates of mortality in the context of weak health systems, community lay members are well placed to provide peer bereavement support. The 9-cell bereavement tool was developed in Zimbabwe to improve community members' capacity to support the bereaved. This study aims to determine the feasibility of implementing the 9-cell bereavement tool and recruitment to experimental evaluation. METHODS/DESIGN: This feasibility cluster randomized trial with embedded qualitative interviews will be conducted in two comparable neighborhoods in Zimbabwe. Community leaders from each neighborhood will identify 25 potential community lay bereavement supporters, each of whom will recruit 2-3 bereaved community members into the trial. The intervention will be randomly allocated to one community, and the second community will form a wait-list control (n ≥ 75 in each community cluster). Recruitment is estimated to take place over 3 weeks. Measures at T0 (baseline, i.e., week 0), T1 (midline, i.e., week 14 or 3 months post-baseline) and T2 (endline, i.e., week 27 or 3 months post-midline) will address mental health, social support, and levels of grief per individual. Qualitative data will describe lay supporters' views of intervention training and delivery, and participants' experience of bereavement support. DISCUSSION: This is the first documented trial evaluating a bereavement intervention in sub-Saharan Africa. Recruitment, retention, and measurement data will determine the feasibility of a full trial. TRIAL REGISTRATION: ISRCTN, ISRCTN16484746. Registered 6 February 2018.

Some Considerations on the WHO Histological Classification of Laryngeal Neoplasms.

A new edition of the World Health Organization (WHO) Histological classification of tumours of the hypopharynx, larynx, trachea and parapharyngeal space was published in 2017. We have considered this classification regarding laryngeal neoplasms and discuss the grounds for said revision. Many of the laryngeal neoplasms described in the literature and in the previous WHO edition from 2005 have been omitted from this current revision. Many are described elsewhere in the book but it may give the new generation of pathologists/surgeons/oncologists the false impression that these tumour entities do not exist in the larynx.

Well-differentiated Neuroendocrine Carcinoma of the Larynx: Confusion of Terminology and Uncertainty of Early Studies.

Well-differentiated neuroendocrine carcinoma (also known as "carcinoid") of the larynx is an exceedingly rare tumor that has an epithelial origin. These tumors are malignant and have a low, but definite, risk of metastasis. Although it can be challenging, this tumor should be differentiated from moderately differentiated neuroendocrine carcinoma (also known as "atypical carcinoid"). The clinical and pathologic features of this tumor, as well as treatment and prognosis, are reviewed in detail.

Taking the next steps: Promoting open science and expanding diversity in Law and Human Behavior.

In this editorial, the authors note that steady submission rate and a rejection rate that hovers at 80%, indicates the journal is flourishing and provides them with the fortunate opportunity to make an excellent journal even better. To that end, they describe three initiatives they are working on and explain the changes readers can expect as they begin to implement them in the journal. Specifically, these initiatives include: (1) promoting transparency, openness, and reproducibility in published research; (2) improving author-reviewer fit; and (3) expanding the diversity of journal content and decision makers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Social networks and quitting in a national cohort of Australian Aboriginal and Torres Strait Islander smokers.

INTRODUCTION AND AIMS: Health behaviours, such as smoking and quitting, spread person-to-person through social networks. We explore how social networks are associated with making and sustaining quit attempts for at least 1 month among Aboriginal and Torres Strait Islander smokers. DESIGN AND METHODS: We analysed data from the nationally representative quota sample of 759 Aboriginal and Torres Strait Islander adults who reported smoking at least weekly in Talking About The Smokes baseline survey (April 2012-October 2013) who completed a follow-up survey a year later (August 2013-August 2014). RESULTS: At baseline, 41% of smokers reported that all of their five closest family or friends smoked, but 62% reported that family or friends had provided encouragement to quit. Fewer smokers with other adult smokers in their household at baseline made a quit attempt between surveys (OR 0.63, 95% CI 0.45-0.87). Fewer smokers who had made an attempt between surveys sustained abstinence for at least 1 month if all of their five closest friends smoked (OR 0.60, 95% CI 0.37-0.97). Perceived support to quit in your social network was associated with making and sustaining a quit attempt. DISCUSSION AND CONCLUSIONS: Exposure to smoking in the social networks of Aboriginal and Torres Strait Islander smokers is an obstacle to quitting, but there is also considerable support for quitting from within these same social networks. Health staff could consider encouraging smokers to draw on the few non-smokers within their social networks as role models to increase their confidence in quitting.

Using Lean to Enhance Heart Failure Patient Identification Processes and Increase Core Measure Scores.

BACKGROUND: Heart failure (HF) is the leading cause of hospitalization among older adults in the United States. Health systems target readmission rates for quality improvement and cost reduction. LOCAL PROBLEM: Heart failure core measure (CM) scores at our medical center were lower than the national average, and methods for capturing the appropriate documentation on HF patients to ensure CM compliance were not clear. METHODS: An interdisciplinary team determined barriers to increasing CM scores, gathered baseline data, and identified gaps in the existing process. INTERVENTIONS: The team implemented an accurate reporting system and error-proofing process, redesigned the process for identifying patients admitted with a HF diagnosis, and developed a patient appointment section before discharge in the electronic medical record. RESULTS: There was a decrease in readmissions within 30 days of implementation from 12% to 8%, and HF CM compliance score increased from 88% to 100%. The percentage of HF patients not identified during hospitalization decreased from 17% to 0%. Heart failure patients discharged with a 7-day follow-up appointment increased from 88% to 98%. CONCLUSION: Through implementation of an interdisciplinary-led process improvement and lean methodologies, metrics and CMs were achieved.