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Examines the risks of an acute myocardial infarction on patients with thrombophilia in Great Britain. Increase on the level of mortality rate; Description on the physical condition of the patients; Level of survival.

Abstract: Management of fisheries directed at a particular species (the target) is often complicated by the capture of other species (the bycatch), each of which may be subject to competing management objectives. Optimal management depends upon a good understanding of how catches of the target species vary in relation to bycatch of other species of commercial and conservation concern. This paper considers the composition of trawl catches taken on a Norway lobster (Nephrops norvegicus) ground off the NE coast of England, examining the factors that determine catch rates of Nephrops and various commercial finfish species taken as bycatch. We describe the results of a trawl survey undertaken using four commercial vessels deploying standard commercial gear. Only about 19% of the variance in Nephrops catch rates could be accounted for by variations in local density, as measured independently by underwater television survey of Nephrops burrows. Variations in Nephrops catch rates were dominated by changes over time, particularly in relation to tidal state. Five commercial bycatch species were taken alongside Nephrops in significant quantities. Catch rates of haddock (Melanogrammus aeglefinus), whiting (Merlangius merlangus) and lemon sole (Microstomus kitt) varied independently of Nephrops, whereas catches of cod (Gadus morhua) and plaice (Pleuronectes platessa) were inversely related to Nephrops. We conclude that it is possible for the commercial Nephrops fishery to use spatial and temporal targeting to maximise catches of N. norvegicus whilst minimising the bycatch of some fish species. If catch statistics are used to identify Nephrops-directed fishing métiers for fishery management purposes it is vital that data are examined at the level of individual hauls or fishing trips. Aggregation of data at a higher level risks obscuring the effectiveness with which the fishery is targeted at Nephrops. [Copyright &y& Elsevier]

Objectives: To estimate the potential impact of the addition of culture-based screening for group B streptococcus (GBS) carriage in pregnancy to a risk-based prevention policy in the UK. We aimed to establish agreement within a multidisciplinary group of key stakeholders on the model input parameters., Design: Deterministic model using a consensus approach for the selection of input parameters., Setting and Participants: A theoretical annual cohort of 711 999 live births in the UK (excluding births by elective caesarean section)., Interventions: Culture-based screening for GBS at 35-37 weeks of pregnancy added to the recommended risk-based prevention policy in place on the date of modelling., Outcome Measures: Outcomes assessed included use of intrapartum antibiotic prophylaxis (IAP), early onset GBS (EOGBS), EOGBS mortality, severe EOGBS-related morbidity and maternal penicillin anaphylaxis., Results: With no prophylaxis strategy, the model estimated that there would be 421 cases of culture positive EOGBS in a year (0.59/1000 live births). In the risk-based prophylaxis scenario, 30 666 women were estimated to receive IAP and 70 cases of EOGBS were prevented. Addition of screening resulted in a further 96 260 women receiving IAP and the prevention of an additional 52 to 57 cases of EOGBS. This resulted in the prevention of three EOGBS deaths and four cases of severe disability. With screening, an additional 1675 to 1854 women receive IAP to prevent one EOGBS case and 24 065 to 32 087 receive IAP to prevent one EOGBS death., Conclusions: The evidence base available for a broad range of model input parameters was limited, leading to uncertainty in the estimates produced by the model. Where data was limited, the model input parameters were agreed with the multidisciplinary stakeholder group, the first time this has been done to our knowledge. The main impact of screening is likely to be on the large group of low-risk women where the clinical impact of EOGBS tends to be less severe. This model suggests that the reduction in mortality and severe disability due to EOGBS with antenatal GBS screening is likely to be very limited, with a high rate of overdetection and overuse of antibiotics., Competing Interests: Competing interests: CP chaired the expert group. JM and DB were both employees of the UK National Screening Committee at the time of preparation of the model. AW is an employee of Bazian Ltd. who received payment to develop the model and write up the project through contracts with the UK National Screening Committee. Bazian Ltd. have also been paid to carry out other literature searches, reviews and models for the National Screening Committee, including reviews of the evidence on antenatal GBS screening. Bazian Ltd. is part of The Economist Group, and holds contracts with public and private organisations within the healthcare industry., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)