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Background Antenatal corticosteroids (ACS) have long been regarded as a cornerstone intervention in mitigating the adverse effects of a preterm birth. However, the safety and efficacy of ACS in hospitals in low-resource countries has not been established in an efficacy trial despite their widespread use. Findings of a large cluster-randomized trial in six low- and middle-income countries showed that efforts to scale up ACS use in low-resource settings can lead to harm. There is equipoise regarding the benefits and harms of ACS use in hospitals in low-resource countries. This randomized controlled trial aims to determine whether ACS are safe and efficacious when given to women at risk of imminent birth in the early preterm period, in hospitals in low-resource countries. Methods/design The trial design is a parallel, two-arm, double-blind, individually randomized, placebo-controlled trial of ACS (dexamethasone) for women at risk of imminent preterm birth. The trial will recruit 6018 women in participating hospitals across five low-resource countries (Bangladesh, India, Kenya, Nigeria and Pakistan). The primary objectives are to compare the efficacy of dexamethasone with placebo on survival of the baby and maternal infectious morbidity. The primary outcomes are: 1) neonatal death (to 28 completed days of life); 2) any baby death (any stillbirth postrandomization or neonatal death); and 3) a composite outcome to assess possible maternal bacterial infections. The trial will recruit eligible, consenting pregnant women from 26 weeks 0 days to 33 weeks 6 days gestation with confirmed live fetuses, in whom birth is planned or expected within 48 h. The intervention comprises a regimen of intramuscular dexamethasone sodium phosphate. The comparison is an identical placebo regimen (normal saline). A total of 6018 women will be recruited to detect a reduction of 15% or more in neonatal deaths in a two-sided 5% significance test with 90% power (including 10% loss to follow-up). Discussion Findings of this trial will guide clinicians, programme managers and policymakers on the safety and efficacy of ACS in hospitals in low-resource countries. The trial findings will inform updating of the World Health Organization’s global recommendations on ACS use. Trial registration ACTRN12617000476336. Registered on 31 March 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3488-z) contains supplementary material, which is available to authorized users.

Optimal maternal nutrition, including adequate intake of essential vitamins and minerals, is important for fetal development and longer term impacts on the child’s health. Although pregnant women are considered to be at increased risk of micronutrient deficiencies due to increased maternal and fetal nutritional needs, there is some debate around how best to achieve an optimal diet with adequate and balanced intakes of the necessary nutrients during the antenatal period and before pregnancy.1 The most common micronutrient deficiency in pregnancy that is known to impact maternal health is iron deficiency, due to increased iron demands. Iron deficiency is a common cause of anaemia, which is estimated to affect 40% of pregnancies globally, highest in South-East Asia (49%), Africa (46%) and the Eastern Mediterranean (41%) and lower prevalence in Western Pacific (33%), the Americas (26%) and Europe (27%).2 Thus, iron supplementation has been recommended by WHO for all women during pregnancy since the 1950s. Current global nutrition targets call for a 50% reduction in anaemia among women of reproductive age by 2025, and the prevalence of anaemia in women aged 15–49 years, by pregnancy status, has now been proposed as an indicator for Sustainable Development Goal 2.3 In addition to routine iron and folic acid (IFA) supplementation, various other interventions have been proposed to increase the micronutrient intake before and during pregnancy, including food-based approaches. The 2016 WHO recommendations on routine antenatal care (ANC) for pregnant women and adolescent girls provide comprehensive guidance on the practice, organisation and delivery of ANC and prioritise woman-centred care to facilitate a positive pregnancy experience.4 Recognising that ANC provides a strategic platform for important healthcare functions including health promotion and disease prevention, 14 out of the 49 recommendations in the WHO ANC guideline relate to nutrition. Antenatal micronutrient interventions recommended in …

Background Postpartum hemorrhage is the most common cause of maternal death. Oxytocin is the standard therapy for the prevention of postpartum hemorrhage, but it requires cold storage, which is not available in many countries. In a large trial, we compared a novel formulation of heat-stable carbetocin with oxytocin. Methods We enrolled women across 23 sites in 10 countries in a randomized, double-blind, noninferiority trial comparing intramuscular injections of heat-stable carbetocin (at a dose of 100 μg) with oxytocin (at a dose of 10 IU) administered immediately after vaginal birth. Both drugs were kept in cold storage (2 to 8°C) to maintain double-blinding. There were two primary outcomes: the proportion of women with blood loss of at least 500 ml or the use of additional uterotonic agents, and the proportion of women with blood loss of at least 1000 ml. The noninferiority margins for the relative risks of these outcomes were 1.16 and 1.23, respectively. Results A total of 29,645 women underwe...

The mapW gene of Staphylococcus aureus strain N315 contains a poly(A) tract which truncates translation of the protein. This study demonstrates that mapW is an allelic variant of the map/eap genes found in other strains and that the variation in the length of this poly(A) tract suggests that it is a contingency locus.

Background Policies for timing of cord clamping vary, with early cord clamping generally carried out in the first 60 seconds after birth, whereas later cord clamping usually involves clamping the umbilical cord greater than one minute after the birth or when cord pulsation has ceased. Objectives To determine the effects of different policies of timing of cord clamping at delivery of the placenta on maternal and neonatal outcomes. Search strategy We searched the Cochrane Pregnancy and Child Birth Group's Trials Register (December 2007). Selection criteria Randomized controlled trials comparing early and late cord clamping. Data collection and analysis Two review authors independently assessed trial eligibility and quality and extracted data. Main results We included 11 trials of 2,989 mothers and their babies. No significant differences between early and late cord clamping were seen for postpartum hemorrhage or severe postpartum hemorrhage in any of the five trials (2236 women) which measured this outcome (relative risk (RR) for postpartum hemorrhage 500 mls or more 1.22, 95% (CI) 0.96 to 1.55). For neonatal outcomes, our review showed both benefits and harms for late cord clamping. Following birth, there was a significant increase in infants needing phototherapy for jaundice (RR 0.59, 95% CI 0.38 to 0.92; five trials of 1,762 infants) in the late compared with early clamping group. This was accompanied by significant increases in newborn hemoglobin levels in the late cord clamping group compared with early cord clamping (weighted mean difference 2.17 g/dL; 95% CI 0.28 to 4.06; three trials of 671 infants), although this effect did not persist past six months. Infant ferritin levels remained higher in the late clamping group than the early clamping group at six months. Authors' conclusion One definition of active management includes directions to administer an uterotonic with birth of the anterior shoulder of the baby and to clamp the umbilical cord within 30-60 seconds of birth of the baby (which is not always feasible in practice). In this review delaying clamping of the cord for at least two to three minutes seems not to increase the risk of postpartum hemorrhage. In addition, late cord clamping can be advantageous for the infant by improving iron status which may be of clinical value particularly in infants where access to good nutrition is poor, although delaying clamping increases the risk of jaundice requiring phototherapy.

If there is one canon in gsology more firmly established than another, it is that fossils indicate a certain definite time in the earth's history, that the various species which they represent appeared, lived, and died out at certain definite times, and that, therefore, fossil evidence has come to be considered the most trustworthy of all evidence as an index to the age and succession of the various rock-formations. In fact, that, as Dr. Mantell put it, fossils are the “Medals of Creation.” Associated with this there is another belief, viz., that the various formations succeeded each other in a certain distinct order, one at a time; that each formation was newer than that below, and older than that overlying it, but was contemporaneous with neither. With these beliefs, it appears, however, that Sir Archibald Geikie does not agree, at least, judging from the third edition of his “Text Book of Geology,” 1893, according to which fossils cannot be depended on as indications of the age of rocks, as they may be found in formations to which they do not really belong; and that the difference between two formations may be geographical rather than geological, as two entirely separate formations may have been formed contemporaneously in different, though possibly neighbouring, geographical areas. Thus, at page 665, it is stated that in Bohemia and Russia some of the most characteristic Upper Silurian organisms are found beneath strata full of Lower Silurian life forms. At page 760, when speaking of the close This 250-word extract was created in the absence of an abstract

The drain in question runs parallel to the road which leads from the west end of Thornliebank to Clarkston, and about 50 yards south of the same. It was pointed out to us during an excursion of the Glasgow Geological Society in November, 1903. The specimens referred to were taken from a point about 200 yards east of the boundary of the Rouken Glen Park. Unfortunately it was dusk ere we arrived, and we could only secure a few specimens. I made another trip a few days later, only to find that the drain was being filled up, and, what between the slush and the men working in the hole, I was unable to get the proper section or to secure enough specimens to piece together what I consider one of the most interesting bits of local history that has turned up of late years. The best section I saw was something like the following: — Most of our Marine Limestones have a bed of coal lying at a short distance underneath, and the Arden is no exception to this rule, although it was not seen in this section. The Arden Limestone has been extensively wrought in this district for many years, but as the work ceases at the bottom of the Limestone I have never before seen these shales exposed. Our late respected Vice-President, John Young, LL.D., however, recorded the finding of these shales in a drain at Arden Old Limestone Quarry, about a mile west from here. This This 250-word extract was created in the absence of an abstract

Introductory. During the late summer the Geological Survey issued a map of the Glasgow district which will prove a boon not only to the members of this Society, but also to the increasing number of those who, although not members, still take an interest in geology as a branch of liberal education. The present map differs from its predecessors in that it is colour-printed, and the printing and general details are brought out more clearly than was possible in the hand-coloured maps. This fact has been taken advantage of to add an enormous amount of detail, which is often of such a minute character that after study one feels inclined to wish that he were gifted with microscopic eyes or that the map had been drawn to a larger scale. Not the least of its benefits is the low price at which it is sold (2s. on paper, and 3s. on cloth), the price of the previous maps having lately become prohibitive (19s. 3d. on paper). It will be observed that the long way of the map is from north to south. This has doubtless been adopted for good and sufficient reasons, if we only knew them; but I, at least, would have preferred that the long way should have been east and west, with Glasgow in the centre. The map is accompanied by an extensive memoir of the geology of the district, and the more one reads of it the more one is impressed with the This 250-word extract was created in the absence of an abstract

These sections are situated about seven miles south of Glasgow, a little to the north-east of the Eaglesham Road Station, on the Busby and East Kilbride Railway, and at a height of from five to six hundred feet above the level of the sea. At this place we are near the south-western edge of the Lanarkshire coalfield, and a good idea may be formed of its transverse extent by ascending any of the hills in the district; as, for instance, that to the east of Thornton farm-house. In the distance to the west we descry the Bowling hills and the range of mountains from Ben Voirlich to Ben Ledi, while on the north the Clyde basin is bounded by the trap hills of Campsie and Kilsyth. A corresponding range of trap hills runs behind us on the south. The strata here dip under all the intermediate strata and reappear near the base of the Campsie hills, as we shall afterwards have occasion to notice. Between these points the strata are overlaid by part of the lower limestones, the middle ironstones, and the upper limestones, as well as by strata corresponding to the millstone grit, and the whole, or nearly the whole, of the upper coal measures. The surface of the ground is of an undulating character, rising gradually towards the south. The sections to be described occur at four quarries, viz.,—Thornton, Thornton Hall, Braehead, and Phillipshill—the first being on the southern, the second on the western, and the third and This 250-word extract was created in the absence of an abstract

Introduction.—After some hesitation I have decided to call this paper by the above title, as it owes its origin to the problem of the geological conditions which existed about the time when Crannogs were being built, though many of the questions raised have much wider issues than those affecting the first erection of those interesting structures. The Dumbuck “Crannog” has been brought very prominently before the public of late by a long series of letters and articles (probably not far short of two hundred) which, during a period of about four years, have appeared in the Glasgow Herald and the Glasgow Evening Times . Many of these were very bitter and personal, and some even contained what almost amounted to charges of forgery or fraud against persons known or unknown in connection with the Dumbuie and Dumbuck investigations. Believing that these attributions and accusations arose very much from the fact that the Dumbuck “Crannog” and all its contents were largely unique, therefore to some extent incomprehensible, my intention in writing the present paper has been to try to offer a scientific explanation of some of the difficulties which have been advanced by the different writers on the subject.* The Langbank “Crannog,” which is placed on the south bank of the river, was only discovered some years later than the Dumbuck one. [It has to a considerable extent been investigated by a Committee of the Glasgow Archaeological Society, and a Report by Mr. John Bruce, F.S.A.Scot., is given in that Society's Transactions This 250-word extract was created in the absence of an abstract

In the third edition of his Text-Book of Geology, Sir Archibald Geikie has discussed the question whether fossils can be wholly depended upon to indicate the age of rocks when similar or representative species are found in areas wide apart. Thus he tells us (p. 665) that in Bohemia and Russia some of the most characteristic Upper Silurian organisms are found beneath strata replete with Lower Silurian life. Again, speaking of the close of the Silurian period, he says (p. 760): “There is every reason to believe that for a long time the marine sedimentation of Upper Silurian type continued to prevail in some areas, while the probably lacustrine type of the Old Red Sandstone had already been established in others.” He also tells us (p. 828) that “In the West of Scotland there occur among the red sandstones (some of which contain Old Red Sandstone fishes) bands of limestone full of true Carboniferous Limestone corals and brachiopods.” Again (p. 665), he draws our attention to the statement that “In Australia a flora with Jurassic affinities and a Carboniferous Limestone fauna were contemporaneous” while we may conclude our extracts by one which says: “At the present day the higher fauna of Australia is more nearly akin to that which flourished in Europe far back in Mesozoic time, than to the living fauna of any other region of the globe.”

Although the Island of Little Cumbrae must be perfectly familiar—by sight at least—to every member of the Society, I am afraid that only a few have ever set foot on its lonely shores. This arises not so much from its comparative inaccessibility as from a mistaken notion that, amid so much surrounding beauty, the “Wee Cumra” is hardly worth a visit. It will, however, be found that the rocky island has charms all its own, and differs so much in almost every respect from the other Clyde islands and from the neighbouring mainland that it may, as a whole, be described as unique. The lover of the lonely who walks its shores or glens may here indulge to the full his feeling of monarch-of-all-I-survey-ishness . For the archaeologist there are prehistoric remains — early Christian church ruins and graves; the foundations of what is said to have been a round tower; cairns supposed to have been raised over Norse warriors slain in the battle of Largs; an old castle of historic times; and an old lighthouse perched on the summit of the hill. Several of the caves are believed to have been at one time inhabited, and in a rocky recess on the shore near the northern point is what I take to be the remains of an ancient kitchen-midden yet awaiting exploration. Nor is the interest afforded by the Little Cumbrae less to the geologist. Its terraces present possibly one of the best examples of that stair-like appearance from which This 250-word extract was created in the absence of an abstract

Travelling from Cairo in Egypt, via Port Said, the author landed in Beyrout. Of the mountains of Lebanon he remarked that, although they reached an altitude of nearly 10,000 feet, they were new, compared with our own Grampians, or even the Stirlingshire or Renfrewshire Hills, some of their rocks containing fossil fish of Tertiary age. He had been deeply impressed by the beauty and magnitude of the ruins of Baalbec, and the carving was magnificent. Some of the stones in the Temple buildings were so large that the question arose as to the appliances used for getting them into position. Three, known as “trilithons,” are supposed to be the largest stones ever used for building purposes, their weight being computed at 770 tons each. They are built into one of the walls, and their bases are over 20 feet above the ground. One still larger, but never removed from the quarry, about half a mile distant, is said by Baedeker to weigh about 1500 tons, but the author thought 900 would be nearer the reality. From this to Damascus, through Anti-Lebanon, the railway passes along several deep, narrow gorges, where great contortions and faultings in the light-coloured, thin-bedded limestones were noticed. Taking steamer from Beyrout, a call was made at Saida (the ancient Sidon), apparently a prosperous little place, while Tyre (passed in the night) seemed much less thriving. Landing at Haifa, at the foot of Mount Carmel a great ridge of Cretaceous limestone, about 1700 feet high, which from This 250-word extract was created in the absence of an abstract

The Auld Wives’ Lifts have—from time immemorial—been looked on as an ancient monument. This, however, did not (and there was no reason why it should) prevent geologists from inquiring as to the origin of these stones—whether they had come to their present position through natural or human agency. Although certain of our members considered that the stones may have come there through natural causes, yet until the present year of grace only one (Mr. Renwick) had the hardihood to read a paper advocating this view, and his courage seems to have oozed away, as he has never published it. Our old and esteemed member, the late Dugald Bell, who was our foremost authority on glacial geology, just touches the subject in his charming little book, “Among the Rocks Round Glasgow” (1885, p. 66), thus— “The ‘glacial’ or ‘iceberg’ theory, which some geologists favour, is not without its difficulties, such as the improbability of a glacier or iceberg placing three stones so similar in size in such a position, and the likelihood that, if transported by such an agency, they would be brought from a greater distance and be of different kinds. These and other considerations . . . an observer interested in the subject must weigh for himself.” It seems strange to find Mr. Bell, a man of very strong views, thus halting between two opinions, although it seems to me that his summing up is rather against the glacial origin. Mr. Renwick has kindly sent me part of his This 250-word extract was created in the absence of an abstract

The subject of Carboniferous Brachiopoda has lately been of very special interest to a number of the members of this Society, from the fact that Dr. Thomas Davidson, of Brighton, has been revising his great work on the group, published by the Palaeontographical Society, and is now engaged in preparing a supplement, with figures of all recent discoveries [since published, 1881]. There has therefore been a general searching for new points, and, amongst others, I have been in correspondence with Dr. Davidson regarding various matters, some of which, being quite new, I thought would be of interest to the members, more especially as, during the coming summer, there might be an opportunity of elucidating various questions not yet cleared up. Amongst the specimens I have brought for exhibition this evening you will find representatives of nearly all the species of Brachiopoda hitherto found in Scotland, there being only seven or eight not in the collection; but I need not now speak of more than the new or rarer forms. In the first place, I may direct your attention to a remarkable series of minute Brachiopods from weathered limestone at Dockra, near Beith, and which I had the good fortune to discover some six years ago. The decomposed rock is found, after washing, to abound with examples of various minute species, many of them being no larger than the dot of an i in the present type. Some of them have been hitherto regarded as very rare, while one species and This 250-word extract was created in the absence of an abstract

On two occasions last year business took me to the north of Ireland, where I utilised my spare time by visiting the Giant's Causeway and the district adjoining. On the first occasion I went by rail from Londonderry to Portrush, an enjoyable ride, during which most interesting views were obtained of the Antrim chalk cliffs with their basaltic caps. This most characteristic feature of the coast line of N.E. Ulster was best seen at Downhill and Castlerock, while the great Atlantic breakers, from a recent storm, rushing shorewards and bursting in snowy whiteness on the sandy beach, presented a scene of beauty hardly surpassable. At Portrush we were transferred to the electric tramway car, having 8 miles still to go before reaching our destination. For the first 2 miles we skirt hills of blown sand, and then reach the exposure of strata known as the “White Rocks,” the equivalent of the English chalk, and overlaid by basalt which has burnt them nearly as hard as itself. These “White Rocks” form a continuous series of sea-cliff for some miles, and appear to be from 60 to 100 feet in height. The action of the sea has worn them into extraordinary shapes, and a Scotchman may here see in a couple of hours as many rock arches as he would in a lifetime in his own country. On a black cavernous rock, adjoining a fault which cuts off the chalk, stand the picturesque ruins of Dunluce Castle, with its narrow approach, and This 250-word extract was created in the absence of an abstract

The Boulder-clay has always been more or less of a puzzle; and although an enormous amount of research and ingenuity—not to speak of imagination—has been expended on its elucidation, there yet remain as many points in dispute as will probably outlast the present generation of geologists and leave a considerable legacy to its successors. There are various theories regarding its origin, each defended by its advocates with an amount of heat quite sufficient, had it been evolved at the proper time, to have accounted for any number of mild interglacial periods, if not even for the disappearance of the glacial period itself. The one most generally held is that the Boulder-clay was accumulated as a moraine profonde , under a great sheet of land-ice—an enormous mass, 3000 to 4000 feet thick—bearing resemblance rather to the present accumulations of ice over Greenland and the Antarctic Continent than to the glaciers of Switzerland and Norway. Now, while it is no part of my design to draw attention to the objections to this or any other theory, but rather to concentrate interest on the new evidence now to be brought forward in favour of the marine origin of the Boulder-clay, I cannot but express a feeling that the moraine profonde theory has been arrived at from negative rather than from positive evidence—not so much on account of its own inherent evidence, as from the objections entertained by its promoters to all rival ones. Another theory is that the great ice-sheet, which covered the country This 250-word extract was created in the absence of an abstract