Impact of Deferral for Low Hemoglobin on Donor Return

Introduction. A consistent blood supply to support life-saving transfusions relies on regular and repeat volunteer blood donations. In this study, we focused on donors previously deferred for low-hemoglobin (Hb) levels to better understand the value of supplying post-deferral educational information, and the actions donors took based on their deferral. Methods. An anonymous national survey of active and inactive donor groups (10,000 each) was conducted. The survey questions assessed post-deferral donor actions, preferences regarding post deferral education, understanding of their deferral, and demographic information. Chi-square analysis was performed to compare categorical survey results between donor groups with p \u3c 0.05 denoting statistical significance. Results. The survey resulted in 722 and 103 active and inactive donor respons- es, respectively. Active donors were more likely to recall receiving educational materials post-deferral (52% vs. 35%, p=003), take iron and vitamin supplements (54% vs. 39%, p=0.009), lived within 30 min of a donor site (94% vs. 84%, p=0.006), and more likely to be older than 45 yr (62% vs. 42%, p=0.002) than their inactive donor counter- parts. Active and inactive donors were similar (p\u3e0.05) with anemia history frequency, female-gender predominance, low-prevalence of vegans, and mixed interest in receiving information about raising hemoglobin levels. Conclusion. While active donors more frequently recalled receiving educational materials for their low hemoglobin deferral, and were more likely to take action to improve their hemoglobin, an alternative method of post-deferral recruitment should be considered given the uncertain value of post-deferral information when comparing active vs. inactive donors.https://scholarworks.uvm.edu/comphp_gallery/1253/thumbnail.jp

Decision-to-delivery interval of emergency cesarean section in Uganda: a retrospective cohort study

Funder: Addenbrooke's Charitable Trust, Cambridge University Hospitals; doi: http://dx.doi.org/10.13039/501100002927Funder: Isaac Newton Trust[12.21(a)]/Wellcome Trust ISSF [105602/Z/14/Z]/ University of Cambridge Joint Research GrantAbstract: Background: In many low and medium human development index countries, the rate of maternal and neonatal morbidity and mortality is high. One factor which may influence this is the decision-to-delivery interval of emergency cesarean section. We aimed to investigate the maternal risk factors, indications and decision-to-delivery interval of emergency cesarean section in a large, under-resourced obstetric setting in Uganda. Methods: Records of 344 singleton pregnancies delivered at ≥24 weeks throughout June 2017 at Mulago National Referral Hospital were analysed using Cox proportional hazards models and multivariate logistic regression models. Results: An emergency cesarean section was performed every 104 min and the median decision-to-delivery interval was 5.5 h. Longer interval was associated with preeclampsia and premature rupture of membranes/oligohydramnios. Fetal distress was associated with a shorter interval (p 0.05). Mothers waited on average 6 h longer for deliveries between 00:00–08:00 compared to those between 12:00–20:00 (p < 0.01). The risk of perinatal death was higher in neonates where the decision to deliver was made between 20:00–02:00 compared to 08:00–12:00 (p < 0.01). Conclusion: In this setting, the average decision-to-delivery interval is longer than targets adopted in high development index countries. Decision-to-delivery interval varies diurnally, with decisions and deliveries made at night carrying a higher risk of adverse perinatal outcomes. This suggests a need for targeting the improvement of service provision overnight

Interrater Reliability of NI-RADS on Posttreatment PET/Contrast-enhanced CT Scans in Head and Neck Squamous Cell Carcinoma

Purpose: To evaluate the interrater reliability among radiologists examining posttreatment head and neck squamous cell carcinoma (HNSCC) fluorodeoxyglucose PET/contrast-enhanced CT (CECT) scans using Neck Imaging Reporting and Data System (NI-RADS). Materials and Methods: In this retrospective study, images in 80 patients with HNSCC who underwent posttreatment surveillance PET/CECT and immediate prior comparison CECT or PET/CECT (from June 2014 to July 2016) were uploaded to the American College of Radiology's cloud-based website, Cortex. Eight radiologists from seven institutions with variable NI-RADS experience independently evaluated each case and assigned an appropriate prose description and NI-RADS category for the primary site and the neck site. Five of these individuals were experienced readers (> 5 years of experience), and three were novices (< 5 years of experience). In total, 640 lexicon-based and NI-RADS categories were assigned to lesions among the 80 included patients by the eight radiologists. Light generalization of Cohen κ for interrater reliability was performed. Results: Of the 80 included patients (mean age, 63 years ± 10 [standard deviation]), there were 58 men (73%); 60 patients had stage IV HNSCC (75%), and the most common tumor location was oropharynx (n = 32; 40%). Light κ for lexicon was 0.30 (95% CI: 0.23, 0.36) at the primary site and 0.31 (95% CI: 0.24, 0.37) at the neck site. Light κ for NI-RADS category was 0.55 (95% CI: 0.46, 0.63) at the primary site and 0.60 (95% CI: 0.48, 0.69) at the neck site. Percent agreement between lexicon and correlative NI-RADS category was 84.4% (540 of 640) at the primary site and 92.6% (593 of 640) at the neck site. There was no significant difference in interobserver agreement among the experienced versus novice raters. Conclusion: Moderate agreement was achieved among eight radiologists using NI-RADS at posttreatment HNSCC surveillance imaging

Learning together for and with the Martuwarra Fitzroy River

Co-production across scientific and Indigenous knowledge systems has become a cornerstone of research to enhance knowledge, practice, ethics, and foster sustainability transformations. However, the profound differences in world views and the complex and contested histories of nation-state colonisation on Indigenous territories, highlight both opportunities and risks for Indigenous people when engaging with knowledge co-production. This paper investigates the conditions under which knowledge co-production can lead to improved Indigenous adaptive environmental planning and management among remote land-attached Indigenous peoples through a case study with ten Traditional Owner groups in the Martuwarra (Fitzroy River) Catchment in Western Australia’s Kimberley region. The research team built a 3D map of the river and used it, together with an interactive table-top projector, to bring together both scientific and Indigenous spatial knowledge. Participatory influence mapping, aligned with Traditional Owner priorities to achieve cultural governance and management planning goals set out in the Fitzroy River Declaration, investigated power relations. An analytical framework, examining underlying mechanisms of social learning, knowledge promotion and enhancing influence, based on different theories of change, was applied to unpack the immediate outcomes from these activities. The analysis identified that knowledge co-production activities improved the accessibility of the knowledge, the experiences of the knowledge users, strengthened collective identity and partnerships, and strengthened Indigenous-led institutions. The focus on cultural governance and management planning goals in the Fitzroy River Declaration enabled the activities to directly affect key drivers of Indigenous adaptive environmental planning and management—the Indigenous-led institutions. The nation-state arrangements also gave some support to local learning and decision-making through a key Indigenous institution, Martuwarra Fitzroy River Council. Knowledge co-production with remote land-attached Indigenous peoples can improve adaptive environmental planning and management where it fosters learning together, is grounded in the Indigenous-led institutions and addresses their priorities

Transmission of Mitochondrial DNA Diseases and Ways to Prevent Them

Recent reports of strong selection of mitochondrial DNA (mtDNA) during transmission in animal models of mtDNA disease, and of nuclear transfer in both animal models and humans, have important scientific implications. These are directly applicable to the genetic management of mtDNA disease. The risk that a mitochondrial disorder will be transmitted is difficult to estimate due to heteroplasmy—the existence of normal and mutant mtDNA in the same individual, tissue, or cell. In addition, the mtDNA bottleneck during oogenesis frequently results in dramatic and unpredictable inter-generational fluctuations in the proportions of mutant and wild-type mtDNA. Pre-implantation genetic diagnosis (PGD) for mtDNA disease enables embryos produced by in vitro fertilization (IVF) to be screened for mtDNA mutations. Embryos determined to be at low risk (i.e., those having low mutant mtDNA load) can be preferentially transferred to the uterus with the aim of initiating unaffected pregnancies. New evidence that some types of deleterious mtDNA mutations are eliminated within a few generations suggests that women undergoing PGD have a reasonable chance of generating embryos with a lower mutant load than their own. While nuclear transfer may become an alternative approach in future, there might be more difficulties, ethical as well as technical. This Review outlines the implications of recent advances for genetic management of these potentially devastating disorders

Future of keeping pet reptiles and amphibians:towards integrating animal welfare, human health and environmental sustainability

The keeping of exotic pets is currently under debate and governments of several countries are increasingly exploring the regulation, or even the banning, of exotic pet keeping. Major concerns are issues of public health and safety, animal welfare and biodiversity conservation. The keeping of reptiles and amphibians in captivity encompasses all the potential issues identified with keeping exotic pets, and many of those relating to traditional domestic pets. Within the context of risks posed by pets in general, the authors argue for the responsible and sustainable keeping of reptile and amphibian pets by private persons, based on scientific evidence and on the authors' own expertise (veterinary medicine, captive husbandry, conservation biology)

Preventing death following unsafe abortion: a case series from urban Uganda

Funder: Government of the United KingdomBackground: Maternal deaths from unsafe abortion continue to occur globally, with particularly high rates in Sub-Saharan Africa where the majority of abortions are classified as unsafe. Maternal death reviews have been shown to be an effective part of cohesive strategies to prevent future deaths while abortion remains illegal. Objectives: To conduct maternal death reviews for all deaths occurring following unsafe abortion during the study period. To assess preventability and to synthesise key learning points that may help to prevent future maternal deaths following unsafe abortions. Study design: Full case reviews of all maternal deaths (n=350, Jan 2016 - Dec 2018) at the study center (a national referral hospital in urban Uganda) were conducted by specially trained multidisciplinary panels of obstetricians and midwives. We extracted the reviews of women who died following unsafe abortions (n=13, 2.6%) for further analysis. Results: The majority of maternal deaths due to unsafe abortion were found to be preventable. The key recommendations that emerged from the reviews were: (i) that clinicians should maintain a high index of suspicion for delayed presentation and rapid decompensation in cases where unsafe abortion has occurred, (ii) that a low threshold for early intravenous antibiotic therapy should be applied, and (iii) that any admission with complications following an unsafe abortion merits review by an experienced clinician as soon as practicable. Conclusions: Post-abortion care is part of essential emergency medical care and should be provided to high standards, especially in areas where there is limited or no legal access to abortion care. Implementing the recommended learning points is likely to be feasible even in low resource obstetric settings and, given the high rates of preventability found in maternal deaths due to unsafe abortion, is likely to be effective.This work was supported through the DELTAS Africa programme grant # DEL15-011. The DELTAS Africa programme is an independent funding scheme of The African Academy of Sciences (The AAS) supported by Wellcome 07742/Z/15/Z and the UK government. At The AAS, DELTAS Africa is implemented through AESA (Accelerating Excellence in Science in Africa), the Academy’s agenda and programmatic platform, created in collaboration with the African Union (AUDA-NEPAD) Agency. The views expressed in this publication are those of the author(s) and not necessarily those of The AAS, the AUDA-NEPAD Agency, Wellcome or the UK government. The funders had no role in in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication