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The postpartum period is marked by radical changes in the maternal brain. Seeking to explore the mechanisms that underlie these changes, this article focuses on the relevant hormonal, inflammatory, and behavioral factors. Longitudinal imaging studies have shed valuable light on both short- and long-term alterations in postpartum brain structure and connectivity, particularly in the regions that play key roles in emotion regulation and stress response. It is plausible that these peripartum changes contribute to the mental health challenges new mothers face, including postpartum depression. Adding to our understanding of postpartum neurobiology, this insight highlights the importance of personalized intervention in the promotion of maternal well-being.

BackgroundTraditional approaches for surgical site infection (SSI) surveillance have deficiencies that delay detection of SSI outbreaks and other clinically important increases in SSI rates. We investigated whether use of optimised statistical process control (SPC) methods and feedback for SSI surveillance would decrease rates of SSI in a network of US community hospitals.MethodsWe conducted a stepped wedge cluster randomised trial of patients who underwent any of 13 types of common surgical procedures across 29 community hospitals in the Southeastern United States. We divided the 13 procedures into six clusters; a cluster of procedures at a single hospital was the unit of randomisation and analysis. In total, 105 clusters were randomised to 12 groups of 8-10 clusters. All participating clusters began the trial in a 12-month baseline period of control or "traditional" SSI surveillance, including prospective analysis of SSI rates and consultative support for SSI outbreaks and investigations. Thereafter, a group of clusters transitioned from control to intervention surveillance every three months until all clusters received the intervention. Electronic randomisation by the study statistician determined the sequence by which clusters crossed over from control to intervention surveillance. The intervention was the addition of weekly application of optimised SPC methods and feedback to existing traditional SSI surveillance methods. Epidemiologists were blinded to hospital identity and randomisation status while adjudicating SPC signals of increased SSI rates, but blinding was not possible during SSI investigations. The primary outcome was the overall SSI prevalence rate (PR=SSIs/100 procedures), evaluated via generalised estimating equations with a Poisson regression model. Secondary outcomes compared traditional and optimised SPC signals that identified SSI rate increases, including the number of formal SSI investigations generated and deficiencies identified in best practices for SSI prevention. This trial was registered at ClinicalTrials.gov, NCT03075813.FindingsBetween Mar 1, 2016, and Feb 29, 2020, 204,233 unique patients underwent 237,704 surgical procedures. 148,365 procedures received traditional SSI surveillance and feedback alone, and 89,339 procedures additionally received the intervention of optimised SPC surveillance. The primary outcome of SSI was assessed for all procedures performed within participating clusters. SSIs occurred after 1171 procedures assigned control surveillance (prevalence rate [PR] 0.79 per 100 procedures), compared to 781 procedures that received the intervention (PR 0·87 per 100 procedures; model-based PR ratio 1.10, 95% CI 0.94-1.30, p=0.25). Traditional surveillance generated 24 formal SSI investigations that identified 120 SSIs with deficiencies in two or more perioperative best practices for SSI prevention. In comparison, optimised SPC surveillance generated 74 formal investigations that identified 458 SSIs with multiple best practice deficiencies.InterpretationThe addition of optimised SPC methods and feedback to traditional methods for SSI surveillance led to greater detection of important SSI rate increases and best practice deficiencies but did not decrease SSI rates. Additional research is needed to determine how to best utilise SPC methods and feedback to improve adherence to SSI quality measures and prevent SSIs.FundingAgency for Healthcare Research and Quality.

Background and Aims: Data on the prevalence and characteristics of so-called rare HCV genotypes (GTs) in larger cohorts is limited. This study investigates the frequency of rare GT and resistance-associated substitutions and the efficacy of retreatment in a European cohort. Methods: A total of 129 patients with rare GT1-6 were included from the European resistance database. NS3, NS5A, and NS5B were sequenced and clinical parameters and retreatment efficacies were collected retrospectively. Results: Overall 1.5% (69/4,656) of direct-acting antiviral (DAA)-naive and 4.4% (60/1,376) of DAA-failure patients were infected with rare GT. Although rare GTs were almost equally distributed throughout GT1-6 in DAA-naive patients, we detected mainly rare GT4 (47%, 28/60 GT4; of these n = 17, subtype 4r) and GT3 (25%, 15/60 GT3, of these n = 8, subtype 3b) among DAA-failures. A total of 62% (37/60) of DAA failures had not responded to first-generation regimes and the majority was infected with rare GT4 (57%, 21/37). In contrast, among patients with failure to pangenotypic DAA regimens (38%, 23/60), infections with rare GT3 were overrepresented (57%, 13/23). Although NS5A RASs were uncommon in rare GT2, GT5a, and GT6, we observed combined RASs in rare GT1, GT3, and GT4 at positions 28, 30, 31, which can be considered as inherent. DAA failures with completed follow-up of retreatment, achieved a high SVR rate (94%, 45/48 modified intention-to-treat analysis; 92%, 45/49 intention-to-treat). Three patients with GT4f, 4r, or 3b, respectively, had virological treatment failure. Conclusions: In this European cohort, rare HCV GT were uncommon. Accumulation of specific rare GT in DAA-failure patients suggests reduced antiviral activities of DAA regimens. The limited global availability of pangenotypic regimens for first line therapy as well as multiple targeted regimens for retreatment could result in HCV elimination targets being delayed. Impact and implications: Data on the prevalence and characteristics of rare HCV genotypes (GT) in larger cohorts are still scarce. This study found low rates of rare HCV GTs among European HCV-infected patients. In direct-acting antiviral (DAA)-failure patients, rare GT3 subtypes accumulated after pangenotypic DAA treatment and rare GT4 after first generation DAA failure and viral resistance was detected at NS5A positions 28, 30, and 31. The limited global availability of pangenotypic DAA regimens for first line therapy as well as multiple targeted regimens for retreatment could result in HCV elimination targets being delayed.

In the Wadden Sea, intertidal mussel beds of the blue mussel (Mytilus edulis) and the Pacific oyster (Magallana gigas) form distinct epibenthic communities and local hotspots of high biomass and biodiversity. To detect and evaluate natural and anthropogenic processes, a ground-based monitoring program started over 25 years ago in the German Wadden Sea. In this study, we describe the potential of drones and machine learning approaches for a remote sensing-based integration into an existing monitoring program of intertidal mussel beds. A fixed wing drone was used to cover an area of up to 39ha in a single flight, with an overall time saving potential of 50%. Applying machine learning approaches, a detailed extraction of the intertidal blue mussel bed coverage with an overall accuracy (OA) up to 95.6% was reached, applying a Support Vector Machine (SVM). The application of a multispectral sensor improved the classification performance. Compared to ground-based monitoring, the drone-based method provided significantly more information on the area extension, coverage, and associated algae of the mussel beds. The results show that drones can provide a non-invasive way to survey large and difficult to access areas providing detailed maps of mussel beds and their internal structures.

Abstract Background The current paper analyzed the effect of the pandemic-induced lockdown on maternal mental health during the first 12 postpartum weeks in Germany. Methods In this cohort study, we compared the participants’ anamnestic backgrounds and the results of psychological tests, measuring stress levels, depressive symptoms and attachment. The 327 participants were divided into two groups with one representing the “pre-COVID” sample and the other the “lockdown” sample. We performed multiple comparisons, investigating the distribution of diagnoses and the correlating risk profiles between the two cohorts. Results Our analysis showed a significant difference between the two cohorts, with a 13.2% increase in the prevalence of adjustment disorders (AD), but not postpartum depression (PPD), in the first 12 weeks postpartum. However, during the pandemic, women with AD had fewer risk factors compared to their pre-pandemic counterparts. In the “lockdown” cohort, a tendency toward higher stress and lower mother-child attachment was observed in AD. Conclusions In sum, we observed some negative impact of the pandemic on maternal mental health. The lockdown might have contributed to an increase in the number of cases involving AD in the postpartum period. The prevalence of PPD (ca. 6–10%), on the other hand, was not affected by the lockdown. Thus, the effect of COVID-19 on maternal mental health might not, after all, have been as severe as assumed at the beginning of the pandemic.

Constructed Technosols are an important means of substituting natural soil material, such as peat and geogenic material, for use in urban green infrastructure. One characteristic of Technosols important to their role in urban green infrastructure, specifically with respect to urban water management, is their soil hydraulic properties (SHPs). The SHPs depend on the composition of the constructed Technosols (e.g. their components and their mixing ratio). The diversity of possible components and the infinite number of mixing ratios practically prohibit the experimental identification of the composition needed to achieve suitable soil hydrological functions. In this study, we propose a compositional model for predicting the water retention curves (WRCs) of any binary mixture based on the measured WRCs of its two pure components only (basic scheme) or with one additional mixture (extended scheme). The unsaturated hydraulic conductivity curves (HCCs) are predicted based on the modelled WRCs. The compositional model is developed from existing methods for estimating the porosity of binary mixtures. The model was tested on four data sets of measured WRCs of different binary mixtures. The distribution of water and air in 50 cm high soil columns filled with these mixtures was predicted under hydrostatic conditions in order to assess their suitability for typical urban applications. The difference between the maxima of the pore size distributions ΔPSDmax (m) of the components indicates the applicability of the compositional approach. For binary mixtures with small ΔPSDmax, the water content deviations between the predicted and the measured WRCs range from 0.004 to 0.039 cm3 cm−3. For mixtures with a large ΔPSDmax, the compositional model is not applicable. The prediction of the soil hydraulic properties of any mixing ratio facilitates the simulation of flow and transport processes in constructed Technosols before they are produced (e.g. for specific urban water management purposes).

AimsThe present study was conducted to examine the association between dietary acid load (DAL) and markers of inflammation, oxidative stress, and malnutrition in a group of Iranian hemodialysis (HD) patients.MethodsThis cross-sectional study was performed on individuals aged ≥18 years who were on HD at least 6 months before their enrollment in the study. A 4-day dietary recall was used for the evaluation of dietary intake. DAL was calculated using two methods including potential renal acid load (PRAL) and net endogenous acid production (NEAP). For assessing the malnutrition status, we used the subjective global assessment (SGA), dialysis malnutrition score (DMS), and malnutrition inflammation score (MIS). Fasting blood samples were collected from each participant to assess serum levels of high-sensitivity C-reactive protein (hs-CRP), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular adhesion molecule-1 (sVCAM-1), sE-selectin, malondialdehyde (MDA), nitric oxide (NO), and endothelin-1.ResultsIn total, 291 patients with a mean age of 57.73 ± 0.88 years and HD vintage of 4.27 ± 0.25 months were enrolled in the current study. Significant positive associations were observed between PRAL and hs-CRP (β = 1.77, 95% CI: 0.88, 2.65), sICAM-1 (β = 83.21, 95% CI: 10.39, 156.04), sVCAM-1 (β = 194.63, 95% CI: 74.68, 314.58), and sE-selectin (β = 6.66, 95% CI: 1.81, 11.50) among participants with the highest PRAL scores, compared to those with the lowest PRAL scores. NEAP was positively correlated with hs-CRP (β = 1.34, 95% CI: 0.46, 2.22), sICAM-1 (β = 88.83, 95% CI: 16.99, 160.67), and MDA (β = 0.35, 95% CI: 0.005, 0.71). Additionally, marginally significant higher odds of SGA (OR = 1.98, 95% CI: 0.95, 4.11) and DMS (OR = 1.94, 95% CI: 0.92, 4.05) were observed in individuals in the third tertile of PRAL vs. the first tertile of PRAL. NEAP had also a marginally significant positive correlation with DMS (OR = 2.01, 95% CI: 0.93, 4.31).ConclusionThis study illustrates that higher consumption of acidic foods is correlated with markers of inflammation, oxidative stress, and malnutrition in HD patients.

Abstract Objective This study investigates whether psychological well‐being in post‐bariatric patients seeking body contouring procedures differs from those who do not seek body contouring procedures, those who have already undergone body contouring procedures, and those who are unsure about body contouring procedures. Methods An anonymous, nonrandomized, cross‐sectional survey study was designed. Psychological well‐being of four groups of post‐bariatric‐patients (undergone body contouring procedures, seeking body contouring procedures, not seeking body contouring procedures, unsure about body contouring procedures) were compared. Results A total of 345 patients were included in this study. No significant difference between patients seeking body contouring procedures and those not seeking body contouring procedures was found with regard to depressive symptoms, self‐esteem, and body image. Patients who had already undergone body contouring procedures scored lower on depressive symptoms (p = 0.035) and reported feeling more attractive (p

Background The aetiology and consequences of ‘baby blues’ (lower mood following childbirth) are yet to be sufficiently investigated with respect to an individual's clinical history. Aims The primary aim of the study was to assess the symptoms of baby blues and the relevant risk factors, their associations with clinical history and premenstrual syndrome (PMS), and their possible contribution to the early recognition of postpartum depression (PPD). Method Beginning shortly after childbirth, 369 mothers were followed up for 12 weeks. Information related to their clinical history, PMS, depression, stress and mother–child attachment was collected. At 12 weeks, mothers were classified as non-depressed, or with either PPD or adjustment disorder. Results A correlation was found between the severity of baby blues and PMS (r = 0.397, P < 0.001), with both conditions increasing the possibility of adjustment disorder and PPD (baby blues: OR = 6.72, 95% CI 3.69–12.25; PMS: OR = 3.29, 95% CI 2.01–5.39). Baby blues and PMS independently predicted whether a mother would develop adjustment disorder or PPD after childbirth (χ2(64) = 198.16, P < 0.001). Among the non-depressed participants, baby blues were found to be associated with primiparity (P = 0.012), family psychiatric history (P = 0.001), PMS (P < 0.001) and childhood trauma (P = 0.017). Conclusions Baby blues are linked to a number of risk factors and a history of PMS, with both conditions adding to the risk of PPD. The neuroendocrine effects on mood need be understood in the context of individual risk factors. The assessment of both baby blues and PMS symptoms within the first postpartum days may contribute to an early identification of PPD.

The United States continues to become more racially and ethnically diverse, and the nation's colleges and universities' demographics are commensurate with that growth. Between 1976 and 2017, the percentage of White students enrolled in postsecondary institutions fell from 84% to 56%, while the percentage of American college students who identify as Hispanic, Asian, Black, and American Indian/Alaskan Native increased during the same time frame. As a result of diversity growth among college students, the U.S. Department of Education designated approximately 600 colleges and universities as Minority Serving Institutions (MSIs). Today, one in five college students attends an MSI, and 40% of students currently enrolled in an MSI are from historically underrepresented groups. As more institutions receive Hispanic Serving Institution (HSI) and Asian American Native American and Pacific Islander Institution (AANAPISI) designations, it becomes paramount to understand how the changing demographics affect campus climate. Understanding perceptions of those working in student affairs during the time of such a transition is an important step in determining how institutions of higher education may be better able to meet the needs of their students. The research question that guided this inquiry was: What are the campus climate perceptions of student affairs staff as the institution emerges as an MSI? The study focused on University of Nevada, Las Vegas (UNLV), a large public, doctoral-granting institution in an urban setting. The institution recently emerged as an MSI in the last five years, so data were collected simultaneously as the institution was emerging as minority serving. The findings of this study indicate that newly diverse campuses need to focus on leaders increasing communication about diversity efforts and fashioning the overall intentionality of MSI as a priority.