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Accurate wildfire forecasting can inform regional management and mitigation strategies in advance of fire occurrence. Existing systems typically use fire danger indices to predict landscape flammability, based on meteorological forecasts alone, often using little or no direct information on land surface or vegetation state. Here, we use a vegetation characteristic model, weather forecasts and a data‐driven machine learning approach to construct a global daily ∼9 km resolution Probability of Fire (PoF) model operating at multiple lead times. The PoF model outperforms existing indices, providing accurate forecasts of fire activity up to 10 days in advance, and in some cases up to 30 days. The model can also be used to investigate historical shifts in regional fire patterns. Furthermore, the underlying data driven approach allows PoF to be used for fire attribution, isolating key variables for specific fire events or for looking at the relationships between variables and fire occurrence. Plain Language Summary: Wildfires have widespread effects on local ecosystems, communities, air quality, and global atmospheric conditions. Accurate wildfire forecasts can be used by local communities and agencies to manage and respond to wildfires effectively. As such, it is essential these predictions are not only accurate but are accessible in real‐time and provide sufficient advanced notice to ensure successful actions can be taken. To achieve this we have developed a forecasting system that combines satellite observations, weather forecasting, and vegetation characteristics using machine learning. Tested on historical data and operated in real‐time, our model provides a global daily wildfire forecast with a 9 km resolution, predicting the likelihood of fires up to 30 days in advance. The model outperforms existing fire danger forecasts when evaluated against satellite observations of active fires. It can also identify key drivers which result in the occurrence of fire. Finally, it not only offers real‐time forecasts but can be used to help investigate past fire events, understand their causes, and predict wildfire activity over longer climate timescales. Key Points: A data‐driven model informed by satellite observations and an Earth System Model provides accurate fire forecasts upto 10 days in advanceThe probability of fire forecast is implemented operationally in a numerical weather prediction model to provide real‐time forecastsFire attribution is demonstrated and can be used for specific fire events or historical analysis [ABSTRACT FROM AUTHOR]

WeatherBench 2 is an update to the global, medium‐range (1–14 days) weather forecasting benchmark proposed by (Rasp et al., 2020, https://doi.org/10.1029/2020ms002203), designed with the aim to accelerate progress in data‐driven weather modeling. WeatherBench 2 consists of an open‐source evaluation framework, publicly available training, ground truth and baseline data as well as a continuously updated website with the latest metrics and state‐of‐the‐art models: https://sites.research.google/weatherbench. This paper describes the design principles of the evaluation framework and presents results for current state‐of‐the‐art physical and data‐driven weather models. The metrics are based on established practices for evaluating weather forecasts at leading operational weather centers. We define a set of headline scores to provide an overview of model performance. In addition, we also discuss caveats in the current evaluation setup and challenges for the future of data‐driven weather forecasting. Plain Language Summary: Traditionally, weather forecasts are made by models that attempt to replicate the physical processes of the atmosphere. This has been very successful over the last few decades as better computers, better observations and model upgrades have lead to steadily improving weather forecasts. However, with rapid advances in artificial intelligence (AI), the question can be asked whether one can simply learn a weather model from past observations or reanalyzes. In the last couple of years, we have seen tremendous progress with state‐of‐the‐art AI models rivaling the best "traditional" weather models in skill. WeatherBench 2 is a benchmark data set designed to evaluate and compare the quality of AI and traditional models. By setting a standard for evaluation, alongside providing open‐source data and code, this project aims to accelerate this research direction and lead to better weather prediction. Key Points: WeatherBench 2 is a framework for evaluating and comparing data‐driven and traditional numerical weather forecasting modelsIt provides an evaluation framework, publicly available data sets and a website to assess the state‐of‐the‐art weather modelsThe evaluation protocol has been designed following best practices established in the operational weather forecasting community [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To assess the frequency and determinants of medical interventions during childbirth without women's consent at the population level.The nationwide cross‐sectional Enquête Nationale Périnatale 2021 provided a representative sample of women who delivered in metropolitan France with a 2‐month postpartum follow‐up (n = 7394). Rates and 95% confidence intervals (CI) of interventions during childbirth (oxytocin administration, episiotomy or emergency cesarean section) without consent were calculated. Associations with maternal, obstetric, and organizational characteristics were assessed using robust variance Poisson regressions, after multiple imputation for missing covariates, and weighted to account for 2‐month attrition.Women reporting failure to seek consent were 44.7% (CI: 42.6–47.0) for oxytocin administration, 60.2% (CI: 55.4–65.0) for episiotomy, and 36.6% (CI: 33.3–40.0) for emergency cesarean birth. Lack of consent for oxytocin was associated with maternal birth abroad (adjusted prevalence ratio [aPR] 1.20; 95% CI: 1.06–1.36), low education level, and increased cervical dilation at oxytocin initiation, whereas women with a birth plan reported less frequently lack of consent (aPR 0.79; 95% CI: 0.68–0.92). Delivery assisted by an obstetrician was more often associated with lack of consent for episiotomy (aPR 1.46; 95% CI: 1.11–1.94 for spontaneous delivery and aPR 1.39; 95% CI: 1.13–1.72 for instrumental delivery, reference: spontaneous delivery with a midwife). Cesarean for fetal distress was associated with failure to ask for consent for emergency cesarean delivery (aPR 1.58; 95% CI: 1.28–1.96).Women frequently reported that perinatal professionals failed to seek consent for interventions during childbirth. Reorganization of care, particularly in emergency contexts, training focusing on adequate communication and promotion of birth plans are necessary to improve women's involvement in decision making during childbirth. [ABSTRACT FROM AUTHOR]

Background: Shared decision‐making is an important component of a patient‐centered healthcare system. We assessed the prevalence of parturients with preferences for their labor and childbirth, expressed verbally in the birthing room or as a written birth plan, and studied maternal, obstetric, and organizational factors associated with their expression. Methods: Data came from the 2016 National Perinatal Survey, a cross‐sectional nationwide population‐based survey conducted in France. Preferences for labor and childbirth were studied in three categories: expressed verbally, in writing (birth plan), or unexpressed or nonexistent. Analyses used multinomial multilevel logistic regression. Results: The analysis included 11,633 parturients: 3.7% had written a birth plan, 17.3% expressed their preferences verbally, and 79.0% either did not have or did not express any preferences. Compared with the latter group, written or verbal preferences were both significantly associated with prenatal care by independent midwives (respectively, adjusted odds ratio (aOR) 2.19; 95% confidence interval (CI), [1.59–3.03], and aOR 1.43; 95% CI [1.19–1.71]) and with attendance at childbirth education classes (respectively, aOR 4.99; 95% CI [3.49–7.15], and aOR 2.27; 95% CI [1.98–2.62]). As years in traditional schooling increased, so did its association with preferences. Conversely, parturients from African countries were significantly less likely than French mothers to express preferences. A written birth plan was also associated with characteristics of maternity unit organization. Conclusion: Only one in five parturients reported having expressed preferences for labor and childbirth to healthcare professionals in the birthing room. This expression of preferences was associated with maternal characteristics and the organization of care. [ABSTRACT FROM AUTHOR]

Reduced‐precision floating‐point arithmetic is now deployed routinely in numerical weather forecasting over short timescales. However, the applicability of these reduced‐precision techniques to longer‐timescale climate simulations—especially those that seek to describe a dynamical, changing climate—remains unclear. We investigate this question by deploying a global atmospheric, coarse‐resolution model known as Simplified Parameterizations PrimitivE Equation DYnamics (SPEEDY) to simulate a changing climate system subject to increased CO2$$ {\mathrm{CO}}_2 $$ concentrations, over a 100‐year timescale. Whilst double precision is typically the operational standard for climate modelling, we find that reduced‐precision solutions are sufficiently accurate. Rounding the floating‐point numbers stochastically, rather than using the more common "round‐to‐nearest" technique, improves the performance of the reduced‐precision solutions notably. Over 100 years, the mean bias error (MBE) in the global mean surface temperature (precipitation) relative to the double‐precision solution is +1.8 ×10−2$$ \times 1{0}^{-2} $$ K (−8×10−4$$ -8\times 1{0}^{-4} $$ mm·$$ \cdotp $$(6 hr)−1$$ {}^{-1} $$) when integrating numerically at half precision (10 significant bits) with stochastic rounding. By examining the resultant climatic distributions that arise after 100 years, the difference in the expected value of the global surface temperature relative to the double‐precision solution is ≤5×10−3$$ \le 5\times 1{0}^{-3} $$ K and that for precipitation is 8×10−4$$ 8\times 1{0}^{-4} $$ mm·$$ \cdotp $$(6 hr)−1$$ {}^{-1} $$. Whilst further research is necessary to extended these results to more complex and higher‐resolution models, they indicate that reduced‐precision techniques and stochastic rounding could be suitable for the next generation of climate models and motivate the use of low‐precision hardware to this end. [ABSTRACT FROM AUTHOR]

We assess the value of machine learning as an accelerator for the parameterization schemes of operational weather forecasting systems, specifically the parameterization of nonorographic gravity wave drag. Emulators of this scheme can be trained to produce stable and accurate results up to seasonal forecasting timescales. Generally, networks that are more complex produce emulators that are more accurate. By training on an increased complexity version of the existing parameterization scheme, we build emulators that produce more accurate forecasts. For medium range forecasting, we have found evidence that our emulators are more accurate than the version of the parametrization scheme that is used for operational predictions. Using the current operational CPU hardware, our emulators have a similar computational cost to the existing scheme, but are heavily limited by data movement. On GPU hardware, our emulators perform 10 times faster than the existing scheme on a CPU. Plain Language Summary: The ability of computers to construct models from data (machine learning) has had significant impacts on many areas of science. Here, we use this ability to construct a model of an element of a numerical weather forecasting system. This element captures one physical process in the model, a part of the model that describes the propagation of large‐scale waves through the atmosphere, but the long‐term aim would be to make many models each capturing a process. The goal is that the computer‐generated model will perform the task more efficiently than the existing model. Testing is then carried out to ensure that our computer model performs as accurately as the existing model. This is a challenging step, as learning is carried out over short time periods (seconds), but forecasts need to be accurate over years. Our computer‐generated models produce accurate forecasts on all tested timescales. On current computers, they are not faster, but will be if weather forecasting centers invest in computers with graphics processing units. Key Points: Nonorographic gravity wave drag parametrization can be accurately emulated with a neural networkThese emulators produce accurate and stable forecasts over long timescalesNeural networks can reduce the cost of an increased complexity scheme [ABSTRACT FROM AUTHOR]

This article discusses a new bioinformatics research tool that is being developed to identify genes involved in prenatal syndromes based on ultrasound phenotypes. The tool uses an internal database that links ultrasound fetal phenotypes to genes curated by experts in prenatal diagnosis of rare diseases. The tool was tested on 10 cases of CHARGE Syndrome and accurately identified the gene and syndrome in 90% of the cases. Comparative analyses with other available solutions showed that the research tool outperformed other apps in finding the correct gene and/or syndrome. The article concludes that early gene detection of rare syndromes can be significantly improved using research tools specifically designed for prenatal phenotypes. [Extracted from the article]

Despite continuous improvements, precipitation forecasts are still not as accurate and reliable as those of other meteorological variables. A major contributing factor to this is that several key processes affecting precipitation distribution and intensity occur below the resolved scale of global weather models. Generative adversarial networks (GANs) have been demonstrated by the computer vision community to be successful at super‐resolution problems, that is, learning to add fine‐scale structure to coarse images. Leinonen et al. (2020, https://doi.org/10.1109/TGRS.2020.3032790) previously applied a GAN to produce ensembles of reconstructed high‐resolution atmospheric fields, given coarsened input data. In this paper, we demonstrate this approach can be extended to the more challenging problem of increasing the accuracy and resolution of comparatively low‐resolution input from a weather forecasting model, using high‐resolution radar measurements as a "ground truth." The neural network must learn to add resolution and structure whilst accounting for non‐negligible forecast error. We show that GANs and VAE‐GANs can match the statistical properties of state‐of‐the‐art pointwise post‐processing methods whilst creating high‐resolution, spatially coherent precipitation maps. Our model compares favorably to the best existing downscaling methods in both pixel‐wise and pooled CRPS scores, power spectrum information and rank histograms (used to assess calibration). We test our models and show that they perform in a range of scenarios, including heavy rainfall. Plain Language Summary: The processes that lead to precipitation (rainfall) happen on a very small scale. Weather forecast computer models work on much larger scales, so rainfall is often poorly predicted. In this paper, we develop a method that enhances the resolution of rainfall forecasts by a factor of 10, and makes the forecasts more accurate. We generate many samples of what the rainfall pattern could be, which gives an idea of the uncertainty in the forecast. Our method is based on machine learning and neural networks, which means that we use many past examples of weather forecasts, together with the rainfall that actually happened, and our method "automatically" learns how the forecasts can be improved. We use an existing idea called "Generative Adversarial Networks," which has been used very successfully in image‐related tasks, such as producing realistic higher‐resolution images from low‐resolution ones. Our task is similar to producing a high‐resolution image from a low‐resolution one, hence this approach is promising. Our method outperforms a variety of existing approaches, and even produces good predictions for the most extreme rainfall situations in our data set. These are the scenarios that cause the most real‐world disruption, the most useful events to produce good forecasts for. Key Points: We use generative adversarial neural networks to post‐process global weather forecast model output over the UKWe produce more realistic precipitation forecasts than the input forecast data, at 10X resolution, with excellent statistical propertiesWe match or outperform a state‐of‐the‐art pointwise downscaling scheme, while also producing spatially coherent images [ABSTRACT FROM AUTHOR]

We assess the ability of neural network emulators of physical parametrization schemes in numerical weather prediction models to aid in the construction of linearized models required by four‐dimensional variational (4D‐Var) data assimilation. Neural networks can be differentiated trivially, and so if a physical parametrization scheme can be accurately emulated by a neural network then its tangent‐linear and adjoint versions can be obtained with minimal effort, compared with the standard paradigms of manual or automatic differentiation of the model code. Here we apply this idea by emulating the non‐orographic gravity wave drag parametrization scheme in an atmospheric model with a neural network, and deriving its tangent‐linear and adjoint models. We demonstrate that these neural network‐derived tangent‐linear and adjoint models not only pass the standard consistency tests but also can be used successfully to do 4D‐Var data assimilation. This technique holds the promise of significantly easing maintenance of tangent‐linear and adjoint codes in weather forecasting centers, if accurate neural network emulators can be constructed. Plain Language Summary: The neural network is an algorithm developed in the field of artificial intelligence that can in principle learn the relationship between any two variables, provided you give it enough real‐world data. There are countless applications for such an algorithm in the field of weather and climate simulation. The application that we focus on here is to use the neural network as a replacement for one component of a weather simulation. Essentially, you train the neural network so that it can accurately emulate the component that it replaces. For expensive components, using the neural network emulator instead of the original can provide a significant computational saving. Other studies have already demonstrated that this technique can be applied in weather simulations. What we show here, however, is that neural networks can also be used to easily and automatically calculate the slope of the line relating the two variables in question, through a slight modification of the network. This is an essential procedure for constructing the initial conditions for weather forecasts through a process known as data assimilation. Key Points: Neural network emulators of physical parametrization schemes can be used to easily construct tangent‐linear and adjoint modelsThese neural network‐based linear models are potentially much easier to maintain compared with the traditional approachWe test these tangent‐linear and adjoint models in data assimilation experiments in a state‐of‐the‐art weather forecasting model [ABSTRACT FROM AUTHOR]

The SARS-CoV-2 pandemic exposed multiple shortcomings in national and international capacity to respond to an outbreak of infectious disease. See Table S1 for data by country. gl Some countries reported disruptions or changes of data procedures related to the pandemic that may impact on quality or completeness, particularly for preliminary data. In these cases, we asked for information about the availability of data to generate stillbirth, preterm birth, low birthweight and caesarean rates, as they are often available earlier than data on neonatal or infant deaths. When several sources were used to generate Euro-Peristat data, we requested information on birth data that could be used to generate stillbirth, preterm and low birthweight rates (as opposed to neonatal or infant deaths, which may become available later). [Extracted from the article]

Objectives: To compare knowledge, attitudes and risk perception related to blood donation and transfusion in Trinidad and Tobago and Bahamas. Background: Trinidad and Tobago and the Bahamas are two Caribbean countries whose national blood transfusion systems are heavily reliant (76.2% and 76%) on family replacement donors. The Pan American Health Organisation/World Health Organisation recommends blood collection from exclusively voluntary nonremunerated donors on the grounds that family replacement donor‐based blood systems are unsafe and inadequate compared to those based on voluntary nonremunerated blood donors. Methods/Materials: A 23‐item questionnaire was distributed online by snowball sampling in these two countries to assess knowledge, attitudes, risk perception and behaviour. SPSS version 24 was used for interpretative and descriptive data analysis, chi‐square to measure significance and linear regression the strength of associations. p < 0.05 was used to define statistical significance. Results: Four hundred and fifty three (453) responses were obtained from Trinidad and Tobago and 101 from the Bahamas. Knowledge and positive attitudes were high in both countries (75.5% vs. 80.2%, p < 0.001 and 96.6% vs. 100%, p < 0.001). A substantial proportion of respondents held the perception that the local blood donation system was safe or very safe (26.4 and 61.4%, p < 0.001) that was linked to the misconception that the prevalent method of blood donation was voluntary nonremunerated (27.8 and 51.4%, p < 0.001). Concerns about receiving blood were underpinned by mistrust of transfusion‐related procedures. Conclusion: A social interface to transfer information between blood transfusion services and the community could encourage voluntary nonremunerated blood donation and reduce concerns about receiving transfusion. [ABSTRACT FROM AUTHOR]

In continuation of the annual national surveys of winter wheat, which began in 1970, samples from between 250 and 350 randomly selected wheat crops in England and Wales between 1999 to 2019 were visually assessed for disease symptoms during the milky ripe development stages (GS 73–75). Septoria tritici blotch was the most prevalent and severe foliar disease each year, although annual levels fluctuated considerably and there was no overall significant change over the two decades. Incidence of brown rust, yellow rust, take‐all, and barley yellow dwarf virus also showed no significant overall change during the survey period, whereas glume blotch, powdery mildew, eyespot, and sharp eyespot all showed significant decline. Fusarium ear blight has significantly increased in both incidence and severity, causing a serious epidemic in 2012, when 96% of crops were affected. Tan spot has been the third most prevalent foliar disease since 2009 although severity is still very low. Regional disease levels were consistent over the two decades, providing reliable baselines to measure changes in seasonal disease severity. There were significant changes in agronomic practice with a rise to predominance of minimum tillage over the use of ploughing, decreases in overall disease susceptibility of cultivars grown, a major increase in the use of oilseed rape in the rotation and a long‐term trend towards earlier sowing. Fungicide use increased considerably, with over 98% crops sprayed and an average of 3.5 applications made per crop each year since 2014. Implications of changes over the last 21 years are discussed. [ABSTRACT FROM AUTHOR]

Summary: Anaemia is frequently diagnosed during pregnancy. However, there are few data regarding its incidence, and the association with severe maternal morbidity remains uncertain and potentially biased in high‐resource countries. The purpose of this study was to explore the association between gestational anaemia and severe acute maternal morbidity during and after delivery. We performed a cohort‐nested case‐control analysis from the epidemiology of severe maternal mortality (EPIMOMS) prospective study conducted in six French regions (2012–2013, n = 182,309 deliveries). There were 1669 women with severe acute maternal morbidity during or after delivery, according to a standardised definition obtained by expert consensus. The control group were randomly selected among women without severe morbidity who delivered in the same health centres (n = 3234). We studied the association between gestational anaemia and severe acute maternal morbidity during or after delivery overall, by cause, and by mode of delivery, using multivariable logistic regression and multiple imputation. Gestational anaemia was significantly more frequent in women with severe acute maternal morbidity (25.3%) than in controls (16.3%), p < 0.001, and mostly mild in both groups. After adjustment for confounders, women with gestational anaemia were at increased risk of overall severe acute maternal morbidity during and after delivery (adjusted OR (95%CI) 1.8 (1.5–2.1)). This association was also found for severe postpartum haemorrhage (adjusted OR (95%CI) 1.7 (1.5–2.0)), even after omitting the transfusion criterion (adjusted OR (95%CI) 1.9 (1.6–2.3)), and for severe acute maternal morbidity secondary to causes other than haemorrhage or pregnancy‐related hypertensive disorders (adjusted OR (95%CI) 2.7 (1.9–4.0)). These results highlight the importance of optimising the diagnosis and management of anaemia during pregnancy. [ABSTRACT FROM AUTHOR]

Background: Monitoring severe acute maternal morbidity (SAMM) appears essential for optimising care and informing health care policies, especially given changes in obstetric practices and mother profiles. International comparisons can identify areas where improvement is needed, but the comparability of indicators must be evaluated.Objective: To assess the feasibility of monitoring SAMM using common definitions from hospital discharge databases across Europe.Methods: We used hospital discharge data in eight countries (2 826 868 deliveries) to identify women with SAMM among all hospitalisations of women of reproductive age admitted for antenatal or delivery care. Five SAMM indicators were investigated: eclampsia, septicaemia, hysterectomy, hysterectomy associated with a diagnosis of obstetric haemorrhage, and red blood cell (RBC) transfusion associated with a diagnosis of obstetric haemorrhage. Between-country variation was described, by the ratio of the highest to lowest rates, while external validation was assessed by comparing with population-based studies on maternal morbidity.Results: Ratios for hysterectomy and red blood cell (RBC) transfusion in the context of obstetric haemorrhage were 1:2.1 and 1:3.5, respectively. High values of hysterectomy and low values of transfusion were both consistent with high maternal mortality from haemorrhage (France, Italy, Portugal). Ratios across countries were relatively low for eclampsia (1:3.4) but very high for septicaemia (1:22.5). Compared to population-based morbidity estimates, eclampsia was over-reported in hospital databases whereas the two indicators of severe haemorrhage had good external validity.Conclusions: In association with diagnosis codes indicating obstetric haemorrhage, hysterectomy and RBC transfusion appear to be good candidates for surveillance of maternal morbidity in Europe. [ABSTRACT FROM AUTHOR]

Background and objectives: For many developing countries, achieving exclusive voluntary non‐remunerated blood donation requires converting an existing pool of family replacement donors consisting of individuals recruited by health professionals and persons they recruited. This study was done to evaluate emotions and beliefs in these two groups and their effect on future blood donor intentions. Materials and methods: Cross‐sectional, descriptive, questionnaire‐based surveys were administered by two medical student research groups. Survey 1 assessed persons recruited by health professionals to serve as or recruit replacement donors and Survey 2, individuals recruited by patients or their relatives to be replacement donors. Results: The majority of Survey 1 participants experienced negative emotional reactions to being asked to solicit and actually asking persons to serve as family replacement donors (72·3% and 50·2%, respectively). The proportion that would serve as a replacement donor increased from 55·9% to 74·1% (P < 0·001). Among Survey 2 participants, 61% (P < 0·001) would more willingly donate blood if directly approached by the person in need. Conclusion: Emotions and beliefs arising from family replacement donation encouraged future replacement donation intention. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between in vitro fertilisation IVF and severe maternal morbidity (SMM) and to explore the role of multiple pregnancy as an intermediate factor.Design: Population-based cohort-nested case-control study.Setting: Six French regions in 2012/13.Population: Cases were 2540 women with SMM according to the EPIMOMS definition; controls were 3651 randomly selected women who gave birth without SMM.Methods: Analysis of the associations between IVF and SMM with multivariable logistic regression models, differentiating IVF with autologous oocytes (IVF-AO) from IVF with oocyte donation (IVF-OD). The contribution of multiple pregnancy as an intermediate factor was assessed by path analysis.Main Outcome Measures: Severe maternal morbidity overall and SMM according to its main underlying causal condition and by severity (near misses).Results: The risk of SMM was significantly higher in women with IVF (adjusted OR = 2.5, 95% CI 1.8-3.3). The risk of SMM was significantly higher with IVF-AO, for all-cause SMM (aOR = 2.0, 95% CI 1.5-2.7), for near misses (aOR = 1.9, 95% CI 1.3-2.8), and for intra/postpartum haemorrhages (aOR = 2.3, 95% CI 1.6-3.2). The risk of SMM was significantly higher with IVF-OD, for all-cause SMM (aOR = 18.6, 95% CI 4.4-78.5), for near misses (aOR = 18.1, 95% CI 4.0-82.3), for SMM due to hypertensive disorders (aOR = 16.7, 95% CI 3.3-85.4) and due to intra/postpartum haemorrhages (aOR = 18.0, 95% CI 4.2-77.8). Path-analysis estimated that 21.6% (95% CI 10.1-33.0) of the risk associated with IVF-OD was mediated by multiple pregnancy, and 49.6% (95% CI 24.0-75.1) of the SMM risk associated with IVF-AO.Conclusion: The risk of SMM is higher in IVF pregnancies after adjustment for confounders. Exploratory results suggest higher risks among women with IVF-OD; however, confidence intervals were wide, so this finding needs to be confirmed. A large part of the association between IVF-AO and SMM appears to be mediated by multiple pregnancy.Tweetable Abstract: The risk of severe maternal morbidity is higher in IVF-conceived pregnancies than in pregnancies conceived by other means. [ABSTRACT FROM AUTHOR]

Background and objectives: Trinidad and Tobago is a developing country with a hospital‐based, replacement blood donation system, low annual donation rate and high frequency of donor transfusion transmissible infections. Previous studies suggest a need for more information to improve total donations and encourage conversion to voluntary non‐remunerated blood donation. The aim of this study was to investigate public knowledge and perceptions about receiving blood to derive information for designing a safe blood donation campaign. Materials and methods: A cross‐sectional, questionnaire‐based survey was administered to a non‐randomly selected sample of adults at seven health centres. Participants were surveyed for demographics, knowledge of the local transfusion service, confidence in safety checks and attitudes to blood receipt. Results: Of 400 respondents, a substantial proportion (38·2%) was unaware of inadequate blood bank stock. Only 18·4% correctly identified the method of blood donor recruitment in the country. Only 1·2% of participants were able to identify all from a list of six scenarios, in which blood is transfused. Although 86% would accept transfusion, most (84%) of these had concerns about acquiring infections and hospital‐related activities. Young persons and females had higher risk perception (P = 0·026 and P = 0·041). There was a positive association between confidence in the safety of blood donation processes and willingness to accept transfusion. Conclusion: A blood donor education programme should include all processes from donor recruitment to component administration to reduce the perceived risk of receiving blood in Trinidad and Tobago. [ABSTRACT FROM AUTHOR]

Background: Maternal obesity is increasing. There is growing evidence of its effect on severe maternal morbidity. We assessed prepregnancy obesity as an independent risk factor for severe maternal morbidity by timing and cause.Methods: We designed a case-control analysis within the EPIMOMS prospective population-based study conducted in six French regions in 2012-2013 (182 309 women who delivered at ≥22 weeks). Cases were all women who experienced severe maternal morbidity during pregnancy to 42 days postpartum as per a multicriteria definition derived by national expert consensus (n = 2540, severe maternal morbidity prevalence 1.4%). Controls were randomly selected from the same health centres (n = 3651). The association between obesity and severe maternal morbidity was assessed from fitting multivariable logistic regression models: overall, by timing (antepartum and intrapartum/ postpartum), and by cause.Results: Prepregnancy obesity was associated with overall severe maternal morbidity (adjusted odds ratio [OR] 1.34, 95% confidence interval [CI] 1.14, 1.59) and antepartum severe maternal morbidity (OR 2.07, 95% CI 1.61, 2.65), but not with intra/postpartum severe maternal morbidity (OR 1.15, 95% CI 0.96, 1.38). Among antepartum severe maternal morbidity, severe hypertensive disorders were most strongly associated with obesity (OR 2.50, 95% CI 1.85, 3.40) but the risk of antepartum severe maternal morbidity due to other causes was also increased among obese women (OR 1.64, 95% CI 1.13, 2.37). Obesity was not associated with severe postpartum haemorrhage (OR 1.12, 95% CI 0.92, 1.37).Conclusion: Obesity is associated with an increased risk of antepartum, but not intra/ postpartum, severe maternal morbidity. [ABSTRACT FROM AUTHOR]

We have screened small molecule libraries specifically for inhibitors that target WWP2, an E3 ubiquitin ligase associated with tumour outgrowth and spread. Selected hits demonstrated dose‐dependent WWP2 inhibition, low micromolar IC50 values, and inhibition of PTEN substrate‐specific ubiquitination. Binding to WWP2 was confirmed by ligand‐based NMR spectroscopy. Furthermore, we used a combination of STD NMR, the recently developed DEEP‐STD NMR approach, and docking calculations, to propose for the first time an NMR‐validated 3D molecular model of a WWP2‐inhibitor complex. These first generation WWP2 inhibitors provide a molecular framework for informing organic synthetic approaches to improve activity and selectivity. HTS screen and DEEP‐STD NMR validation of a 3D structural model was used to discover a new class of WWP2 ubiquitin ligase inhibitors. [ABSTRACT FROM AUTHOR]

The use of reduced numerical precision within an atmospheric data assimilation system is investigated. An atmospheric model with a spectral dynamical core is used to generate synthetic observations, which are then assimilated back into the same model using an ensemble Kalman filter. The effect on the analysis error of reducing precision from 64 bits to only 22 bits is measured and found to depend strongly on the degree of model uncertainty within the system. When the model used to generate the observations is identical to the model used to assimilate observations, the reduced‐precision results suffer substantially. However, when model error is introduced by changing the diffusion scheme in the assimilation model or by using a higher‐resolution model to generate observations, the difference in analysis quality between the two levels of precision is almost eliminated. Lower‐precision arithmetic has a lower computational cost, so lowering precision could free up computational resources in operational data assimilation and allow an increase in ensemble size or grid resolution. Plain Language Summary: In order to produce a weather forecast, we must have a good estimate of the current state of the atmosphere. We can observe the atmosphere using satellites and other instruments, but observations alone do not tell the whole picture. We must combine observational data with computational models in order to estimate the atmospheric state comprehensively. This process is known as data assimilation. Data assimilation is a very computationally expensive process as it requires the atmospheric model to be run many times over. This paper proposes a novel method to reduce the computational cost of data assimilation: reduced‐precision calculations. Reducing the precision of the calculations inside the atmospheric model might be expected to degrade the data assimilation process. However, our atmospheric models are inherently imperfect because they do not capture all of the important scales of atmospheric motion. Therefore, the degradation from reducing precision is not actually significant when compared with this unavoidable error. The computational savings that we make by reducing precision could be reinvested to actually improve the data assimilation system and therefore the skill of weather forecasts. For example, we could run more simulations (i.e., use a larger ensemble) for no extra cost. Key Points: Lowering precision could accelerate an ensemble Kalman filterThe level of precision used should fit the level of model errorWe perform tests with a spectral dynamical core [ABSTRACT FROM AUTHOR]

Extracorporeal Photopheresis (ECP) is a cellular immunotherapy frequently used for steroid-refractory graft-versus-host disease (GVHD). Chronic GVHD (cGVHD), response to ECP is associated with survival benefit. The UVAR-XTSTM system and the more recently developed CELLEXTM device (both TherakosTM) are the mainstay for ECP-delivery in the UK and US. No comparison of treatment outcomes has been reported. We retrospectively compared cGVHD response and steroid reduction and withdrawal in patients treated exclusively over 12 months with either the XTS ( n = 51) or CELLEX ( n = 50). Our hypothesis was that there would be no difference in clinical outcome or steroid changes in the 2 matched cohorts. We also compared infection incidence, infection-related death (IRD), and treatment time. Significant clinical improvement and regular capacity to reduce or cease steroids was encountered in both cohorts; at 6 months of ECP 70% of cutaneous cGvHD patients had partial or complete responses and 85% of patients receiving steroids pre-ECP had reduced dosage. In the XTS group we unexpectedly encountered both superior steroid reduction (86% dose at least halved vs. 61% for CELLEX, P = 0.01) and withdrawal (15 vs. 5 CELLEX, P = 0.01) and a trend for superior skin disease response in the CELLEX-treated cohort at 3 months. No inter-relationship was evident. Halving or greater reduction of steroid dose by 3 or 6 months was associated with reduced risk of IRD in the XTS cohort as was withdrawal at 6 months for the combined cohorts. By 6 months, XTS-treated patients had experienced fewer antibiotic-requiring infections (mean 1.9 vs. 2.8, P = 0.025). Origins for the disparities are unclear and warrant investigation. [ABSTRACT FROM AUTHOR]

Measurement of BCR activator of RhoGEF and GTPase -ABL proto-oncogene 1, non-receptor tyrosine kinase (BCR-ABL1) mRNA levels by reverse transcription quantitative polymerase chain reaction (RTqPCR) has been critical to treatment protocols and clinical trials in chronic myeloid leukaemia; however, interlaboratory variation remains a significant issue. Reverse transcriptase droplet digital PCR (RTddPCR) has shown potential to improve testing but a large-scale interlaboratory study is required to definitively establish this. In the present study, 10 BCR-ABL1-positive samples with levels ranging from molecular response (MR) 1·0 -MR 5·0 were tested by 23 laboratories using RTddPCR with the QXDX BCR-ABL %IS kit. A subset of participants tested the samples using RTqPCR. All 23 participants using RTddPCR detected BCR-ABL1 in all samples to MR 4·0 . Detection rates for deep-response samples were 95·7% at MR 4·5 , 78·3% at MR 4·7 and 87·0% at MR 5·0 . Interlaboratory coefficient of variation was indirectly proportional to BCR-ABL1 level ranging from 29·3% to 69·0%. Linearity ranged from 0·9330 to 1·000 (average 0·9936). When results were compared for the 11 participants who performed both RTddPCR and RTqPCR, RTddPCR showed a similar limit of detection to RTqPCR with reduced interlaboratory variation and better assay linearity. The ability to detect deep responses with RTddPCR, matched with an improved linearity and reduced interlaboratory variation will allow improved patient management, and is of particular importance for future clinical trials focussed on achieving and maintaining treatment-free remission., (© 2021 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.)

Monocytes infiltrating scar tissue are predominantly viewed as progenitor cells. Here, we show that tissue CCR2+ monocytes have specific immunosuppressive and profibrotic functions. CCR2+ monocytic cells are acutely recruited to the lung before the onset of silica-induced fibrosis in mice. These tissue monocytes are defined as monocytic myeloid-derived suppressor cells (M-MDSCs) because they significantly suppress T-lymphocyte proliferation in vitro. M-MDSCs collected from silica-treated mice also express transforming growth factor (TGF)-β1, which stimulates lung fibroblasts to release tissue inhibitor of metalloproteinase (TIMP)-1, an inhibitor of metalloproteinase collagenolytic activity. By using LysMCreCCR2 loxP/ loxP mice, we show that limiting CCR2+ M-MDSC accumulation reduces the pulmonary contents of TGF-β1, TIMP-1 and collagen after silica treatment. M-MDSCs do not differentiate into lung macrophages, granulocytes or fibrocytes during pulmonary fibrogenesis. Collectively, our data indicate that M-MDSCs contribute to lung fibrosis by specifically promoting a non-degrading collagen microenvironment. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

We examined the effect of iron-containing prenatal vitamin-mineral supplements taken postpartum on biomarkers of iron status and oxidative stress. Lactating women ( n = 114) were randomly assigned to consume daily one iron-free prenatal vitamin-mineral supplement plus either 27 mg of iron or placebo for approximately 3.5 months. The placebo group took the tablets between meals, while those given iron took the tablets either with (Fe-W) or between meals (Fe-B). Blood and urine samples were collected before and after the supplementation period to analyze hemoglobin (Hb), ferritin, hepcidin, transferrin saturation (TfSat), total plasma iron, and biomarkers of oxidative stress (isoprostane and 8-hydroxy-2-deoxyguanosine (8-OHdG)) and inflammation (C-reactive protein (CRP) and alpha-1-acid glycoprotein (AGP)). There was a trend toward a greater change in Hb among women in the Fe-B group compared to placebo (+2.5 vs. −3.7 g/L, respectively, p = 0.063). When the iron groups were combined, there was a greater change in Hb (+1.4 g/L) compared to placebo ( p = 0.010). There were trends toward greater changes in TfSat ( p = 0.087) and total plasma iron ( p = 0.065) in the iron groups compared to placebo, yet no significant differences between the three groups in change in hepcidin ( p = 0.291), isoprostane ( p = 0.319), or 8-OHdG ( p = 0.659), nor in change in ferritin among those with elevated CRP at baseline (60% of women; p = 0.946); among those without elevated CRP (40% of women), ferritin increased more in the iron groups compared to placebo ( p = 0.001). Iron consumption during lactation moderately increased iron status, particularly among women without elevated CRP, and increased Hb, but did not significantly increase oxidative stress. [ABSTRACT FROM AUTHOR]

SUMMARY Objectives To assess the attitude towards voluntary non-remunerated blood donation among blood donors in Trinidad and Tobago ( TRT). Background Blood donors in TRT are either family replacement (F/R, 87%) or remunerated (13%). There is chronic blood shortage and high seroreactivity for transfusion-transmissible infections ( TTI) in donors. Converting existing to voluntary non-remunerated donors ( VNRD) reduces the need to recruit news donors in achieving 100% VNRD. Methods A questionnaire-based, cross-sectional survey was conducted at two blood collection centres at an interval of 8 years. Donors were surveyed for sociodemographic characteristics, awareness of the blood shortage, previous donation behaviour, donor-beneficiary linkage if F/R, willingness to become VNRD and choice of motivators for converting to VNRD. Results A total of 400 and 595 donors respectively participated in Surveys 1 and 2, of whom 92·8 and 86·3% were F/R ( P < 0·001), respectively. In both surveys, 52% of participants were unaware of an existing blood shortage ( P = 0·983). Only 9·8 and 9·1% of participants expressed unwillingness to become VNRD ( P = 0·720). The main motivators to convert to VNRD were reminders from the centre (84%) and extended opening hours (78%) in Survey 1 as compared to confidence that donated blood was used properly (73%) and shortened waiting times to donate (73%) in Survey 2. Conclusion Despite low awareness of blood shortage, willingness to become VNRD was high among existing donors. Accountability and donor convenience underpinned the main motivators for converting to VNRD. [ABSTRACT FROM AUTHOR]

The role of imaging in myeloma has gained increasing importance over the past few years. The recently revised definition of myeloma from the International Myeloma Working Group ( IMWG) includes cross sectional imaging as a method to define bone disease and also incorporates its use in the disease definition for patients with suspected smouldering myeloma. The National Institute for Health and Care Excellence myeloma guidelines also recommend cross sectional imaging for patients with suspected myeloma. There is also increasing use of imaging in disease assessments and the International Myeloma Working Group has recently incorporated imaging in defining new response categories of minimal residual disease negativity, with or without imaging-based evidence of disease. Plain X-rays have previously been the standard imaging modality included in a myeloma work up at presentation but evidence is mounting for use of cross-sectional modalities such as computed tomography ( CT), magnetic resonance imaging ( MRI) and 18fluoro-deoxyglucose (18F- FDG) positron emission tomography ( PET)/ CT. Funding and therefore availability of newer imaging techniques remains a barrier. Here, we propose an evidence-based approach to the use and technical application of the latest imaging modalities at diagnosis and in the follow-up of patients with myeloma and plasmacytoma. [ABSTRACT FROM AUTHOR]

SUMMARY: Objectives: To assess blood usage for elective surgery in a developing country as a first step towards developing a maximum surgical blood‐ordering schedule (MSBOS). Background: Cross‐match:transfusion (C/T) ratio, transfusion index (Ti) and transfusion ratio (T%) are standard indices of efficient blood usage for elective surgical procedures. The MSBOS assigns surgical procedures to Group and Cross Match (GXM) and Group and Save (G&S) categories. Non‐use probability (NUP) is the percentage of blood that is requested but not used. Trinidad and Tobago (TTO) has a transfusion service that predominantly uses family replacement (F/R) donors. Materials/Methods: C/T ratio, Ti, T% and NUP were retrospectively calculated for 304 elective surgical procedures performed at a tertiary medical institution in TTO between 1st January and 15th May 2013. Results: For 17 types of surgical procedure, C/T ratio was <2·5 for 10, T% ≥ 30 for 10 and Ti ≥ 0·5 for 12, suggesting efficiency, significant blood use and a requirement for GXM for most operations. However, the majority of these procedures qualify for G&S when performed under conditions that guarantee ready access to blood in an emergency. A substantial proportion of issued blood was returned unused to the blood bank, giving an NUP of 39·7%. Conclusion: NUP was the most sensitive measure of efficiency. C/T ratio, T% and Ti must be interpreted in the context of the blood donation system. An internationally accepted value of NUP that equates to efficient blood use should be adopted. [ABSTRACT FROM AUTHOR]

Myeloma bone disease results from an uncoupling of osteoclastic resorption and osteoblastic bone formation, but early changes in osteogenic function remain poorly defined. We used the KMS12BM xenograft model to investigate cellular and molecular events at early and late stages of disease. Lytic lesions and changes in osteoblast and osteoclast numbers occur late (8 weeks), however, micro-computed tomography of femora revealed significant reduction in bone volume at earlier disease stages (3 weeks) when tumour burden is low. Calcein labelling demonstrated reduced mineralization and bone formation at 3 weeks, suggesting functional impairment despite preserved osteoblast numbers. Osteo-progenitors from compact bone increased early (1 week), but fell at 3 weeks and were profoundly suppressed by 8 weeks. Exposure of osteoblast progenitors to multiple myeloma (MM) cells in vitro induced cell cycling, suggesting a mechanistic basis for early expansion of osteo-progenitors. We observed temporal changes in chemokine, osteogenic and osteoclastogenic genes in the stromal compartment. Notably, an early rise in CCL3 may underlie functional changes in mature osteoblasts at 3 weeks. Our data indicate that MM has distinct effects on mature osteoblasts and immature osteo-progenitors. Our findings argue for early clinical intervention to prevent bone changes that ultimately lead to the development of osteolytic disease. [ABSTRACT FROM AUTHOR]

The article presents a review that focuses on the ubiquitination pathway regulation and the significance of a group of NEDD4 E3-ubiquitin ligase isoforms in the context of transforming growth factor-beta (TFG-β) pathway regulation. The authors also incorporate protein isoforms within the ubiquitin ligase superfamily as a whole into the observations, and discusses its relevance in the definition of a new iso-ubiquitinome.

Objectives The aim of the study was to describe growth and body composition changes in HIV-positive children after they had initiated or changed antiretroviral therapy (ART) and to correlate these with viral, immune and treatment parameters. Methods Ninety-seven prepubertal HIV-positive children were observed over 48 weeks upon beginning or changing ART. Anthropometry and bioelectrical impedance analysis results were compared with results from the National Health and Nutrition Examination Survey 1999–2002 (NHANES) to generate z-scores and with results for HIV-exposed, uninfected children from the Women and Infants Transmission Study (WITS). Multivariate analysis was used to evaluate associations between growth and body composition and disease parameters. Results All baseline lean and fat mass measures were below those of controls from NHANES. Weight, height and fat free mass (FFM) index (FFM/height2) z-scores increased over time ( P=0.004, 0.037 and 0.027, respectively) and the waist:height ratio z-score decreased ( P=0.045), but body mass index and per cent body fat z-scores did not change. Measures did not increase more than in uninfected WITS controls. In multivariate analysis, baseline height, mid-thigh circumference and FFM z-scores related to CD4 percentage ( P=0.029, P=0.008 and 0.020, respectively) and change in FFM and FFM index z-scores to CD4 percentage increase ( P=0.010 and 0.011, respectively). Compared with WITS controls, baseline differences in height and mid-thigh muscle circumference were also associated with CD4 percentage. Case–control differences in change in both subscapular skinfold (SSF) thickness and the SSF:triceps skinfold ratio were inversely associated with viral suppression. No measures related to ART class(es) at baseline or over time. Conclusions In these HIV-positive children, beginning or changing ART was associated with improved growth and lean body mass (LBM), as indicated by FFM index. Height and LBM related to CD4 percentage at baseline and over time. Altered fat distribution and greater central adiposity were associated with detectable virus but not ART class(es) received. [ABSTRACT FROM AUTHOR]

Aim: To determine if videotapes about newborn circumcision would be superior to traditional physician ‘informed consent’ discussion for maternal knowledge, satisfaction and perception of provider bias. Design/methods: A convenience sample of mothers interested in or undecided about circumcision was randomized to watch a video on: (i) circumcision risks/benefits (‘Video-Plus’ n = 168); or (ii) unrelated material followed by traditional physician risk/benefit discussion (‘Standard-MD’ n = 136). Questionnaires were administered during hospitalization and subsequent telephone interviews. Statistical differences were analysed by chi-square and Wilcoxon signed rank test. Results: Most mothers (82%) decided about circumcision prenatally. Fewer mothers perceived bias from the video vs. physicians [1.1% vs. 6.8%, p = 0.04]. Composite knowledge (correct of 10 answers) [ (SD) 6.5 (2.1) vs. 6.4 (2.1), p = 0.78] or satisfaction [5-point Likert scale, 3.98 (1.50) vs. 3.75 (1.58), p = 0.16] did not differ by group, although more highly educated mothers preferred the video [satisfaction 4.08 (1.01) vs. 2.63 (0.99), p = 0.04]. Significant knowledge gaps existed in both groups. Conclusion: In this setting, no difference in maternal knowledge was found between ‘Video-Plus’ and traditional informed consent although more highly educated mothers preferred the video. Better ways to achieve understanding of risks and benefits for this elective procedure should be sought. [ABSTRACT FROM AUTHOR]

In November 2014 the International Myeloma Working Group ( IMWG) revised the definition of multiple myeloma, such that asymptomatic patients with newly diagnosed multiple myeloma without any of the traditional ' CRAB' (hyper calcaemia, renal impairment, anaemia, bone disease) end organ damage criteria but with one of three new criteria would be recommended to start treatment. Previously, the standard of care for such patients was expectant management. These three new criteria are: greater than 60% clonal plasma cells on bone marrow biopsy, a serum free light chain ( sFLC) ratio of >100 (the involved sFLC must be >100 mg/l) and greater than one unequivocal focal lesion on advanced imaging (low dose whole body computerized tomography, magnetic resonance imaging, 18F fluorodeoxyglucose positron emission tomography). Although this would appear to affect a small number of patients, the impact of these changes are broad, leading to an increased use of advanced imaging, a debate around the management of patients previously diagnosed with smouldering myeloma, changed terminology and clinical trial design and an extension of the use of biomarkers. For the first time the philosophy of treatment in myeloma will change from treatment initiation only being triggered by overt end organ damage to an era where sub clinical risk factors will also be taken into account. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between in vitro fertilisation IVF and severe maternal morbidity (SMM) and to explore the role of multiple pregnancy as an intermediate factor., Design: Population-based cohort-nested case-control study., Setting: Six French regions in 2012/13., Population: Cases were 2540 women with SMM according to the EPIMOMS definition; controls were 3651 randomly selected women who gave birth without SMM., Methods: Analysis of the associations between IVF and SMM with multivariable logistic regression models, differentiating IVF with autologous oocytes (IVF-AO) from IVF with oocyte donation (IVF-OD). The contribution of multiple pregnancy as an intermediate factor was assessed by path analysis., Main Outcome Measures: Severe maternal morbidity overall and SMM according to its main underlying causal condition and by severity (near misses)., Results: The risk of SMM was significantly higher in women with IVF (adjusted OR = 2.5, 95% CI 1.8-3.3). The risk of SMM was significantly higher with IVF-AO, for all-cause SMM (aOR = 2.0, 95% CI 1.5-2.7), for near misses (aOR = 1.9, 95% CI 1.3-2.8), and for intra/postpartum haemorrhages (aOR = 2.3, 95% CI 1.6-3.2). The risk of SMM was significantly higher with IVF-OD, for all-cause SMM (aOR = 18.6, 95% CI 4.4-78.5), for near misses (aOR = 18.1, 95% CI 4.0-82.3), for SMM due to hypertensive disorders (aOR = 16.7, 95% CI 3.3-85.4) and due to intra/postpartum haemorrhages (aOR = 18.0, 95% CI 4.2-77.8). Path-analysis estimated that 21.6% (95% CI 10.1-33.0) of the risk associated with IVF-OD was mediated by multiple pregnancy, and 49.6% (95% CI 24.0-75.1) of the SMM risk associated with IVF-AO., Conclusion: The risk of SMM is higher in IVF pregnancies after adjustment for confounders. Exploratory results suggest higher risks among women with IVF-OD; however, confidence intervals were wide, so this finding needs to be confirmed. A large part of the association between IVF-AO and SMM appears to be mediated by multiple pregnancy., Tweetable Abstract: The risk of severe maternal morbidity is higher in IVF-conceived pregnancies than in pregnancies conceived by other means., (© 2019 Royal College of Obstetricians and Gynaecologists.)

Background The lessons learned from the study of maternal deaths depend on the accuracy of data. Our objective was to assess time trends in the underestimation of maternal mortality ( MM) in the national routine death statistics in France and to evaluate their current accuracy for the selection and causes of maternal deaths. Methods National data obtained by enhanced methods in 1989, 1999, and 2007-09 were used as the gold standard to assess time trends in the underestimation of MM ratios ( MMRs) in death statistics. Enhanced data and death statistics for 2007-09 were further compared by characterising false negatives ( FNs) and false positives ( FPs). The distribution of cause-specific MMRs, as assessed by each system, was described. Results Underestimation of MM in death statistics decreased from 55.6% in 1989 to 11.4% in 2007-09 ( P < 0.001). In 2007-09, of 787 pregnancy-associated deaths, 254 were classified as maternal by the enhanced system and 211 by the death statistics; 34% of maternal deaths in the enhanced system were FNs in the death statistics, and 20% of maternal deaths in the death statistics were FPs. The hierarchy of causes of MM differed between the two systems. The discordances were mainly explained by the lack of precision in the drafting of death certificates by clinicians. Conclusion Although the underestimation of MM in routine death statistics has decreased substantially over time, one third of maternal deaths remain unidentified, and the main causes of death are incorrectly identified in these data. Defining relevant priorities in maternal health requires the use of enhanced methods for MM study. [ABSTRACT FROM AUTHOR]

Background and objectives Trinidad and Tobago is a multi-ethnic, multicultural country with an annual blood donation rate of 17 per 1000 and predominantly (87%) family/replacement (F/R) donors. A knowledge, attitudes and practice ( KAP) community survey in 2003 revealed lack of information and poor access to donation centres as barriers to voluntary non-remunerated donors ( VNRD). The survey was repeated in 2013 after a national intervention to increase VNRD failed. Materials and methods The second cross-sectional, questionnaire-based survey was administered to 816 adults in the same community. The variables assessed were sociodemographics, knowledge, attitudes and blood donation behaviour. Data analysis was performed using SPSS statistical software and Minitab 17. Chi-square was used to assign significance and logistic regression to analyse correlation between variables. Results of the two surveys were compared. Results There was no difference in the overall percentage of donors (18·8 vs. 21·1%, P = 0·337), and a low donor percentage was observed in all sociodemographic groups (7·7-31·6% vs. 10·2-31·7%). The main reason for donating blood was replacement for a relative or friend (86·0 vs. 86·9% P = 0·851). Willingness to repeat donation was high (90·6% vs. 86·4%, P = 0·006). Motivators and demotivators to donation varied among sociodemographic groups. Conclusion There was no significant change in community KAP between surveys. Anthropological studies into blood donation are needed to plan an effective revised and targeted blood donation campaign. Legal and regulatory changes must facilitate VNRD. [ABSTRACT FROM AUTHOR]

The monocytic tumour, THP-1, expresses many of the properties of monocytes, both by cell surface staining and its capacity to produce monokines. It was used as a source of homogenous monocytic cells as a model to determine whether a variety of highly purified or recombinant cytokines could induce HLA-DR expression and the production of interleukin-1 (IL-1). Interferon-gamma (IFN-γ) alone induced HLA-DR. Tumour necrosis factor (TNF), lymphotoxin (LT) and granulocytemacrophage colony-stimulating factor (GM-CSF) alone were able to induce IL-1 but not HLA-DR. When IFN-γ was combined with TNF, induction of HLA-DR and IL-1 was enhanced in a synergistic manner. These effects were detectable at a pretranslational level as synergistic effects were observed on DRα mRNA and IL-1β mRNA levels. The results demonstrate the specificity of IFN-γas the inductive stimulus for HLA-DR expression by THP-1 cells. As IFN-γ and TNF are products of activated T cells, the synergistic role for these molecules in macrophage activation is discussed. [ABSTRACT FROM AUTHOR]

Aim Adolescence is the final opportunity for a large-scale immunisation programme before adulthood. The Western Australian ( WA) school-based vaccination programme provides Year 7 students with free vaccination against hepatitis B virus ( HBV); diphtheria, tetanus and pertussis ( dTpa); varicella zoster virus ( VZV); and human papilloma virus ( HPV). We aimed to identify factors determining consent form return and vaccination uptake. Methods Data were collected via a statewide, web-based database in 2009 and 2010. Proportions of students who returned a vaccine consent form, and completed HBV and HPV multi-dose courses and dTpa and VZV vaccination were determined. Factors associated with these outcomes were identified with multivariate analysis using logistic regression, accounting for clustering by school. Results In 2010, 92.8% of WA Year 7 students returned a vaccination consent form and 85.3%, 74.3%, 66.7.0% and 26.4% completed their adolescent vaccination(s) against dTpa, HPV (females only), HBV and VZV, respectively. Consent form return and dTpa vaccination uptake improved between 2009 and 2010. Independent and consistently negative associations were observed between outcome variables (consent form return and vaccine uptake) and male gender, geographically remote schools, government schools and schools in the most socio-economically disadvantaged areas. Both HBV and HPV course completion were higher in Catholic than government schools, and the same in government and independent schools. Conclusion To effectively maximise vaccination coverage, the WA school-based adolescent vaccination programme must specifically target male students and schools in the most disadvantaged and remote areas. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To identify routine clinical, ultrasound, and biologic criteria to assess the volume of hemoperitoneum in women with ectopic pregnancy (EP). Methods: Except for patients with hemodynamic shock, all women assigned to surgical laparoscopic treatment for confirmed EP at Poissy Saint Germain en Laye Hospital between January 2004 and December 2007 were included in the study. The patients underwent abdominal and digital pelvic examination, and standardized ultrasonography. Ordered logistic regression analysis was performed to select criteria associated with an increase in hemoperitoneum. The diagnostic accuracy of each variable was then calculated for different hemoperitoneum cut-off values. Results: The study included 215 patients. Pelvic pain of 4 or above on a numeric rating scale (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.3–4.1), abdominal guarding or rebound tenderness (OR, 4.6; 95% CI, 2.0–10.8), hemoglobin under 10g/dL (OR, 12.2; 95% CI, 4.2–35.8), presence of fluid at transvaginal ultrasound (OR, 3.6; 95% CI, 1.4–9.2), and fluid in Morison pouch at abdominal ultrasound (OR, 5.6; 95% CI, 2.0–15.9) were found to be independently associated with hemoperitoneum. Conclusion: Both clinical examination and standardized ultrasonography were found to be useful for accurate evaluation of hemoperitoneum in patients presenting with EP. [Copyright &y& Elsevier]

Linking community knowledge with modern techniques to record and analyse risk related data is one way of engaging and mobilising community capacity. This paper discusses the use of the Geographic Information System (GIS) at the local level and the need for integrating modern technology and indigenous knowledge into disaster management. It suggests a way to mobilise available human and technical resources in order to strengthen a good partnership between local communities and local and national institutions. The paper also analyses the current vulnerability of two communes by correlating hazard risk and loss/damage caused by disasters and the contribution that domestic risk maps in the community can make to reduce this risk. The disadvantages, advantages and lessons learned from the GIS flood risk mapping project are presented through the case study of the Quang Tho Commune in Thua Thien Hue province, central Viet Nam. [ABSTRACT FROM AUTHOR]

Although the European rabbit ( Oryctolagus cuniculus) is used both in agronomics and in research, genomic resources for this species are still limited and no microsatellite-based genetic map has been reported. Our aim was to construct a rabbit genetic map with cytogenetically mapped microsatellites so as to build an integrated genetic and cytogenetic map. A reference population of 187 rabbits comprising eight three-generation families with 10–25 offspring per family was produced. One hundred and ninety-four of 305 previously identified microsatellites were included in this study. Of these, 158 were polymorphic with two to seven alleles. The map reported here comprises 111 markers, including 104 INRA microsatellites, five microsatellites from another source and two phenotypic markers ( angora and albino). Ninety markers were integrated into 20 linkage groups. The remaining 21 microsatellites mapped to separate linkage groups, 19 with a precise cytogenetic position and two with only a chromosomal assignment. The genetic map spans 2766.6 cM and covers 20 rabbit chromosomes, excluding chromosomes 20, 21 and X. The density of this map is limited, but we used it to verify the location of angora and albino on chromosomes 15q and 1q, respectively, in agreement with previously published data. This first generation genetic/cytogenetic map will help gene identification and quantitative trait loci mapping projects in rabbit. [ABSTRACT FROM AUTHOR]

Abstract Two dogs were treated with a hypofractionated course of radiotherapy following surgical excision of an intermediate grade mast cell tumour and a round cell tumour, respectively. Both dogs developed a sarcoma of the bone, within the irradiated site, several years after the initial radiotherapy treatment. Bone tumours arising within a previously irradiated area are well-recognized late radiotherapy side-effect in humans but have been reported infrequently in dogs. These are the first case reports to describe bone sarcomas in the appendicular skeleton at a site, which had been previously treated by a hypofractionated course of radiotherapy for an unrelated tumour. [ABSTRACT FROM AUTHOR]