2,495 research outputs found

    Recognising Stakeholder Conflict and Encouraging Consensus of ‘Science-Based Management’ Approaches for Marine Biodiversity Beyond National Jurisdiction (BBNJ)

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    Areas beyond national jurisdiction (ABNJ) encompass the seabed, subsoil and water column beyond coastal State jurisdiction and marine biodiversity beyond national jurisdiction (BBNJ) is rich and varied. From providing sustenance and supporting livelihoods, to absorbing anthropogenic carbon dioxide emissions, ABNJ ecosystems are vital to the wellbeing of humankind. However, an enhanced understanding of BBNJ and its significance has not equated to its successful conservation and sustainable use. Negotiations for a new international legally binding instrument for the conservation and sustainable use of BBNJ have scoped applicable principles for a future agreement, including the use of best available science and science-based approaches. But there remains a lack of convergence on what science-based approaches would look like, or how they would be operationalised. In order to negotiate and implement a meaningful BBNJ treaty that can meet conservation and sustainable use objectives, stakeholder perceptions must be identified, and areas of divergence must be overcome. Thisstudy uses Q-methodology to reveal and analyse the diversity of perceptions that exist amongst key stakeholders regarding what it means to operationalise science-based approaches for the conservation and sustainable use of BBNJ. The Q-study features 25 stakeholder interviews and 30 Q-study participants revealing four different perceptions, each of which represent a different interpretation of what science-based management means in the context of BBNJ. Across these perceptions, there were areas of stakeholder consensus (e.g., regarding the benefits of integrative management, the application of precautionary approaches when data are insufficient, and the issuespertaining to the trustworthiness and credibility of science) and areas of stakeholder conflict (e.g., regarding the definition, function and authority of science within current and future BBNJ governance processes). Key implications of this study include the evidencing of fundamental tensions between differing perceptions of the authority of science and between conservation and sustainable use objectives, that may be fueling stakeholder conflict, and the subsequent proposal of integrative and highly participatory management approaches to operationalise science-based management of BBNJ

    Incidence and outcomes of pregnancy-associated cancer in Australia, 1994?2008: a population-based linkage study

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    OBJECTIVE: To determine trends in pregnancy-associated cancer and associations between maternal cancer and pregnancy outcomes. DESIGN: Population-based cohort study. SETTING: New South Wales, Australia, 1994–2008. POPULATION: A total of 781 907 women and their 1 309 501 maternities. METHODS: Cancer and maternal information were obtained from linked cancer registry, birth and hospital records for the entire population. Generalised estimating equations with a logit link were used to examine associations between cancer risk factors and pregnancy outcomes. MAIN OUTCOME MEASURES: Incidence of pregnancy-associated cancer (diagnosis during pregnancy or within 12 months of delivery), maternal morbidities, preterm birth, and small- and large-for-gestational-age (LGA). RESULTS: A total of 1798 new cancer diagnoses were identified, including 499 during pregnancy and 1299 postpartum. From 1994 to 2007, the crude incidence rate of pregnancy-associated cancer increased from 112.3 to 191.5 per 100 000 maternities (P < 0.001), and only 14% of the increase was explained by increasing maternal age. Cancer diagnosis was more common than expected in women aged 15–44 years (observed-to-expected ratio 1.49; 95% CI 1.42–1.56). Cancers were predominantly melanoma (33.3%) and breast cancer (21.0%). Women with cancer diagnosed during pregnancy had high rates of labour induction (28.5%), caesarean section (40.0%) and planned preterm birth (19.7%). Novel findings included a cancer association with multiple pregnancies (adjusted odds ratio 1.52, 95% CI 1.13–2.05) and LGA (aOR 1.47, 95% CI 1.14–1.89). CONCLUSIONS: Pregnancy-associated cancers have increased, and this increase is only partially explained by increasing maternal age. Pregnancy increases women’s interaction with health services and the possibility for diagnosis, but may also influence tumour growth

    High maternal serum ferritin in early pregnancy and risk of spontaneous preterm birth

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    Previous studies have reported inconsistent associations between maternal serum ferritin concentrations and risk of preterm birth. The aim of this study was to examine the association between iron biomarkers, including serum ferritin and risk of total, early and moderate-to-late spontaneous preterm birth (sPTB). This cohort study included women with singleton pregnancies who were attending first-trimester screening in New South Wales, Australia. sPTB births included births 75th percentile (≥43 μg/L) (OR: 1.49, 95% CI: 1.06, 2.10) and >90th percentile (≥68 μg/L) (OR: 1.92, 95% CI: 1.25, 2.96). Increased odds of early and moderate-to late sPTB were associated with ferritin levels >90th (OR: 2.50, 95% CI: 1.32, 4.73) and >75th (OR: 1.56, 95% CI: 1.03, 2.37) percentiles, respectively. No association was found between sPTB, and elevated sTfR levels or iron deficiency. In conclusion, elevated early pregnancy maternal serum ferritin levels are associated with increased risk of sPTB from 34 weeks gestation. The usefulness of early pregnancy ferritin levels in identifying women at risk of sPTB warrants further investigation.NHMR

    Iron deficiency in early pregnancy using serum ferritin and soluble transferrin receptor concentrations are associated with pregnancy and birth outcomes.

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    Background: There are several biomarkers for measuring iron deficiency (ID) in pregnancy, but evidence of their prevalence in association with inflammation and adverse pregnancy outcomes is inconclusive. Objectives: To describe the prevalence and determinants of ID in women in the first trimester of pregnancy and associations with pregnancy and birth outcomes. Design: A record-linkage cohort study of archived serum samples of women attending first trimester screening and birth and hospital data to ascertain maternal characteristics and pregnancy outcomes. Sera were analysed for iron stores (ferritin; μg/L), tissue iron (soluble transferrin receptor, sTfR; nmol/L) and inflammatory (C-reactive protein, CRP; mg/L) biomarkers. Total body iron (TBI) was calculated from serum ferritin and sTfR concentrations. Multivariate logistic regression analyzed risk factors and pregnancy outcomes associated with ID using the definitions: serum ferritin <12 μg/L, TfR ≥21.0 nmol/L and TBI<0 mg/kg. Results: Of 4,420 women, the prevalence of ID based on ferritin, sTfR and TBI was 19.6%, 15.3% and 15.7%, respectively. Risk factors of ID varied depending on which iron parameter was used and included maternal age <25 years, multiparity, socioeconomic disadvantage, high maternal body weight and inflammation. ID was associated with reduced risk of gestational diabetes (GDM) defined using serum ferritin and TBI, but not sTfR and increased risk of large for gestation age (LGA) infants defined using TBI only. Conclusions: Nearly 1 in 5 Australian women begin pregnancy with ID. Evidence suggests excess maternal weight and inflammation play a role in the relationships between ID and GDM and LGA infants.NHMR

    Nurses\u27 Alumnae Association Bulletin, June 1970

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    Alumnae President\u27s Message Congratulations Alumni Association Portrait of Samuel D. Gross Officers and Chairmen of Committees Financial Report Progress of Jefferson 1969-1970 School of Nursing Annual Report School of Practical Nursing Report Emergency Department Patient Services Department Annual Luncheon Pictures Committee Reports Progress of the Alumnae Association Crossword Puzzle Missing Graduates Resume of Alumnae Meetings Minutes Class News Student Nurses Section Crossword Puzzle Answers Notice

    Serum Creatinine and Tacrolimus Assessment With VAMS Finger-Prick Microsampling: A Diagnostic Test Study

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    Rationale & Objective: Kidney transplant recipients require frequent venipunctures. Microsampling methods that use a finger-prick draw of capillary blood, like volumetric absorptive microsamplers (VAMS), have the potential to reduce the pain, inconvenience, and volume of blood loss associated with venipuncture. This study aimed to provide diagnostic accuracy using VAMS for measurement of tacrolimus and creatinine compared to gold standard venous blood in adult kidney transplant recipients. Study Design: Diagnostic test study. Prospective blood samples for measurement of tacrolimus and creatinine were collected using Mitra VAMS and venipuncture immediately before and 2 hours after tacrolimus dosing. Setting & Participants: A convenience sample of 40 adult kidney transplant participants in the outpatient setting. Tests Compared: Method comparison was assessed by Passing-Bablok regression and Bland-Altman analysis. The predictive performance of VAMS measurement compared to venipuncture was also assessed through estimation of the median prediction error and median absolute percentage prediction error. Results: A total of 74 tacrolimus samples and 70 creatinine samples were analyzed from 40 participants. Passing-Bablok regression showed a systematic difference between VAMS and venipuncture when measuring tacrolimus and creatinine with a slope of 1.08 (95% CI, 1.03-1.13) and a slope of 0.65 (95% CI, 0.6-0.7), respectively. These values were then corrected for the systematic difference. When used for Bland-Altman analysis, corrected values of tacrolimus and creatinine showed a bias of -0.1 μg/L and 0.04 mg/dL, respectively. Tacrolimus (corrected) and creatinine (corrected) microsampling values when compared to corresponding venipuncture values met median prediction error and median absolute percentage prediction error predefined acceptability limits of <15%. Limitations: This study was conducted in a controlled environment using a trained nurse to collect VAMS samples. Conclusions: In this study, VAMS was used to reliably measured tacrolimus and creatinine. This represents a clear opportunity for more frequent and less invasive sampling for patients

    Scalability of digital psychological innovations for refugees: A comparative analysis in Egypt, Germany, and Sweden

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    E-mental health interventions may offer innovative means to increase access to psychological support and improve the mental health of refugees. However, there is limited knowledge about how these innovations can be scaled up and integrated sustainably into routine services. This study examined the scalability of a digital psychological intervention called Step-by-Step (SbS) for refugees in Egypt, Germany, and Sweden. We conducted semi-structured interviews (n = 88) with Syrian refugees, and experts in SbS or refugee' mental health systems in the three countries. Data collection and analysis were guided by a system innovation perspective. Interviewees identified three contextual factors that influenced scalability of SbS in each country: increasing use of e-health, the COVID-19 pandemic, and political instability. Nine factors lay at the interface between the innovation and potential delivery systems, and these were categorised by culture (ways of thinking), structure (ways of organising), and practice (ways of doing). Factors related to culture included: perceived need and acceptability of the innovation. Acceptability was influenced by mental health stigma and awareness, digital trust, perceived novelty of self-help interventions, and attitudes towards non-specialist (e-helper) support. Factors related to structure included financing, regulations, accessibility, competencies of e-helpers, and quality control. Factors related to practice were barriers in the initial and continued engagement of end-users. Many actors with a potential stake in the integration of SbS across the three countries were identified, with nineteen stakeholders deemed most powerful. Several context-specific integration scenarios were developed, which need to be tested. We conclude that integrating novel e-mental health interventions for refugees into routine services will be a complex task due to the many interrelated factors and actors involved. Multi-stakeholder collaboration, including the involvement of end-users, will be essential. Previous article in issu

    Amniotic fluid embolism incidence, risk factors and outcomes: a review and recommendations

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    <p>Abstract</p> <p>Background</p> <p>Amniotic fluid embolism (AFE) is a rare but severe complication of pregnancy. A recent systematic review highlighted apparent differences in the incidence, with studies estimating the incidence of AFE to be more than three times higher in North America than Europe. The aim of this study was to examine population-based regional or national data from five high-resource countries in order to investigate incidence, risk factors and outcomes of AFE and to investigate whether any variation identified could be ascribed to methodological differences between the studies.</p> <p>Methods</p> <p>We reviewed available data sources on the incidence of AFE in Australia, Canada, the Netherlands, the United Kingdom and the USA. Where information was available, the risk factors and outcomes of AFE were examined.</p> <p>Results</p> <p>The reported incidence of AFE ranged from 1.9 cases per 100 000 maternities (UK) to 6.1 per 100 000 maternities (Australia). There was a clear distinction between rates estimated using different methodologies. The lowest estimated incidence rates were obtained through validated case identification (range 1.9-2.5 cases per 100 000 maternities); rates obtained from retrospective analysis of population discharge databases were significantly higher (range 5.5-6.1 per 100 000 admissions with delivery diagnosis). Older maternal age and induction of labour were consistently associated with AFE.</p> <p>Conclusions</p> <p>Recommendation 1: Comparisons of AFE incidence estimates should be restricted to studies using similar methodology. The recommended approaches would be either population-based database studies using additional criteria to exclude false positive cases, or tailored data collection using existing specific population-based systems.</p> <p>Recommendation 2: Comparisons of AFE incidence between and within countries would be facilitated by development of an agreed case definition and an agreed set of criteria to minimise inclusion of false positive cases for database studies.</p> <p>Recommendation 3: Groups conducting detailed population-based studies on AFE should develop an agreed strategy to allow combined analysis of data obtained using consistent methodologies in order to identify potentially modifiable risk factors.</p> <p>Recommendation 4: Future specific studies on AFE should aim to collect information on management and longer-term outcomes for both mothers and infants in order to guide best practice, counselling and service planning.</p
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