Rethinking our approach to postpartum haemorrhage and uterotonics

Analysis Rethinking our approach to postpartum haemorrhage and uterotonics BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3251 (Published 08 July 2015) Cite this as: BMJ 2015;351:h3251 Article Related content Metrics Responses Peer review Andrew D Weeks, professor of international maternal health1, James P Neilson, professor of obstetrics and gynaecology1 Author affiliations Correspondence to: AD Weeks [email protected] Accepted 30 March 2015 Andrew Weeks and James Neilson suggest that we have inappropriately generalised evidence on the use of uterotonics from uncomplicated births to all births. They call for stronger focus on women with complex births to reduce deaths from postpartum haemorrhage Postpartum haemorrhage (defined as a bleed >500 mL) is estimated to affect 1-15% of vaginal births, depending on the definition used, the method of assessing blood loss, the setting, and the population studied. Risk factors include Asian ethnicity, obesity, previous postpartum haemorrhage, multiple pregnancy, anaemia, large baby, age over 40, induction of labour, prolonged labour, placental abruption, and caesarean delivery.1 Although global mortality from postpartum haemorrhage is falling, its incidence is increasing in high resource settings, the reasons for which are unclear.2 3 4 Many of those who survive have severe anaemia, renal failure, or psychological trauma, and the offspring may have difficulties in breast feeding and bonding. Current best practice globally is for all pregnant women to receive a uterotonic drug at the time of childbirth to prevent postpartum haemorrhage. This recommendation has been in place since the 1980s when randomised trials showed that routine prophylaxis with oxytocin based uterotonic drugs reduced the rate of postpartum haemorrhage.5 The assumption that this would translate into fewer maternal deaths—based on the understanding that atony was the most common cause of haemorrhage related deaths—led to the promotion of active management of the third stage of labour, which comprises a prophylactic uterotonic drug, early cord clamping, and controlled cord traction. Here we discuss the problems with generalising data from spontaneous vaginal (“normal”) births to complex births, and call for a change in global strategy on postpartum haemorrhage

Fragility of Fermi arcs in Dirac semimetals

We use tunable, vacuum ultraviolet laser-based angle-resolved photoemission spectroscopy and density functional theory calculations to study the electronic properties of Dirac semimetal candidate cubic PtBi${}_{2}$. In addition to bulk electronic states we also find surface states in PtBi${}_{2}$ which is expected as PtBi${}_{2}$ was theoretical predicated to be a candidate Dirac semimetal. The surface states are also well reproduced from DFT band calculations. Interestingly, the topological surface states form Fermi contours rather than double Fermi arcs that were observed in Na$_3$Bi. The surface bands forming the Fermi contours merge with bulk bands in proximity of the Dirac points projections, as expected. Our data confirms existence of Dirac states in PtBi${}_{2}$ and reveals the fragility of the Fermi arcs in Dirac semimetals. Because the Fermi arcs are not topologically protected in general, they can be deformed into Fermi contours, as proposed by [Kargarian {\it et al.}, PNAS \textbf{113}, 8648 (2016)]. Our results demonstrate validity of this theory in PtBi${}_{2}$.Comment: 6 pages, 4 figure

Polarization simulations of stellar wind bow shock nebulae. II. The case of dust scattering

We study the polarization produced by scattering from dust in a bow shock-shaped region of enhanced density surrounding a stellar source, using the Monte Carlo radiative transfer code SLIP. Bow shocks are structures formed by the interaction of the winds of fast-moving stars with the interstellar medium. Our previous study focused on the polarization produced in these structures by electron scattering; we showed that polarization is highly dependent on inclination angle and that multiple scattering changes the shape and degree of polarization. In contrast to electron scattering, dust scattering is wavelength-dependent, which changes the polarization behaviour. Here we explore different dust particle sizes and compositions and generate polarized spectral energy distributions for each case. We find that the polarization SED behaviour depends on the dust composition and grain size. Including dust emission leads to polarization changes with temperature at higher optical depth in ways that are sensitive to the orientation of the bow shock. In various scenarios and under certain assumptions, our simulations can constrain the optical depth and dust properties of resolved and unresolved bow shock-shaped scattering regions.Constraints on optical depth can provide estimates of local ISM density for observed bow shocks. We also study the impact of dust grains filling the region between the star and bow shock. We see that as the density of dust between the star and bow shock increases, the resulting polarization is suppressed for all the optical depth regimes.Comment: 21 pages, accepted for publication in MNRA

The role of Magnetic Resonance Images (MRIs) in coping for patients with brain tumours and their parents:a qualitative study

Abstract Background When children and young people (CYP) are diagnosed with a brain tumour, Magnetic Resonance Imaging (MRI) is key to the clinical management of this condition. This can produce hundreds, and often thousands, of Magnetic Resonance Images (MRIs). Methods Semi-structured interviews were undertaken with 14 families (15 parents and 8 patients), and analysed using Grounded Theory. Analysis was supported by the Framework Method. Results Although the focus of the research was whether paediatric patients and their families find viewing MRIs beneficial, all patients and parents discussed difficult times during the illness and using various strategies to cope. This article explores the identified coping strategies that involved MRIs, and the role that MRIs can play in coping. Coping strategies were classified under the aim of the strategy when used: ‘Normalising’; ‘Maintaining hope and a sense of the future’; ‘Dealing with an uncertain future’; and ‘Seeking Support’. Conclusions Coping and finding ways to cope are clearly used by patients and their families and are something that they wish to discuss, as they were raised in conversations that were not necessarily about coping. This suggests clinicians should always allow time and space (in appointments, consultations, or impromptu conversations on the ward) for patient families to discuss ways of coping. MRIs were found to be used in various ways: to maintain or adapt normal; maintain hope and a sense of the future; deal with an uncertain future; and seek support from others. Clinicians should recognise the potential for MRIs to aid coping and if appropriate, suggest that families take copies of scans (MRIs) home. Professional coaches or counsellors may also find MRIs beneficial as a way to remind families that the child is in a more stable or ‘better’ place than they have been previously

The initiator methionine tRNA drives cell migration and invasion leading to increased metastatic potential in melanoma

The cell's repertoire of transfer RNAs (tRNAs) has been linked to cancer. Recently, levels of the initiator methionine tRNA (tRNAiMet) in stromal fibroblasts have been shown to influence extracellular matrix (ECM) secretion to drive tumour growth and angiogenesis. Here we show that increased tRNAiMet within cancer cells does not influence tumour growth, but drives cell migration and invasion via a mechanism that is independent from ECM synthesis and dependent on α5β1 integrin and levels of the translation initiation ternary complex. In vivo and ex vivo migration (but not proliferation) of melanoblasts is significantly enhanced in transgenic mice which express additional copies of the tRNAiMet gene. We show that increased tRNAiMet in melanoma drives migratory, invasive behaviour and metastatic potential without affecting cell proliferation and primary tumour growth, and that expression of RNA polymerase III-associated genes (which drive tRNA expression) are elevated in metastases by comparison with primary tumours. Thus specific alterations to the cancer cell tRNA repertoire drive a migration/invasion programme that may lead to metastasis

Active acoustic tracking suggests that soft sediment fishes can show site attachment: a preliminary assessment of the movement patterns of the blue-spotted flathead (Platycephalus caeruleopunctatus)

Background It is generally considered that on relatively homogenous marine soft sediment habitats, such as sand, fish are unlikely to show site attachment. This poses challenges for management and the evaluation of the efficacy of marine protected areas, in which soft sediments often make up more than 70 % of habitats. The blue-spotted flathead is a commercially and recreationally targeted species found on soft sediments in coastal marine waters of south-eastern Australia. There are no published data on its movement patterns. Here, using active acoustic telemetry, we aim to (a) quantify movement and habitat use of blue-spotted flathead, (b) compare area usage to no-take sanctuary zone size and (c) obtain data to aid in the design of a large passive receiver array to be used in long-term comprehensive tracking of soft sediment fish. Results Three of five blue-spotted flathead that were tagged exhibited strong site attachment and were detected close to their release points for the entire 60-day study period. The two other fish were not detected after 4 and 25 days and were likely to have moved out of the study area (search radius ≈ 3 km). For the three fish tracked over 60 days, the area used was compact (mean ± SE = 0.021 km2 ± 0.037) and two patterns of movement were apparent: (1) a small activity space used in its entirety each day (two fish) and (2) a larger activity space in which a separate area is utilised each day (one fish). Conclusions Our study is the first to document the movement of blue-spotted flathead, and these preliminary results demonstrate two broad movement patterns shown by this species on soft sediments in Jervis Bay. Over the course of 60 days, a majority of fish in this study showed strong site attachment; however, a number of fish also made larger-scale movements. Finally, our study suggests that a tightly spaced, passive acoustic array would provide meaningful results for this species, although strategically placed receivers outside this array would be required to detect any longer range movements

Empirical array quality weights in the analysis of microarray data

BACKGROUND: Assessment of array quality is an essential step in the analysis of data from microarray experiments. Once detected, less reliable arrays are typically excluded or "filtered" from further analysis to avoid misleading results. RESULTS: In this article, a graduated approach to array quality is considered based on empirical reproducibility of the gene expression measures from replicate arrays. Weights are assigned to each microarray by fitting a heteroscedastic linear model with shared array variance terms. A novel gene-by-gene update algorithm is used to efficiently estimate the array variances. The inverse variances are used as weights in the linear model analysis to identify differentially expressed genes. The method successfully assigns lower weights to less reproducible arrays from different experiments. Down-weighting the observations from suspect arrays increases the power to detect differential expression. In smaller experiments, this approach outperforms the usual method of filtering the data. The method is available in the limma software package which is implemented in the R software environment. CONCLUSION: This method complements existing normalisation and spot quality procedures, and allows poorer quality arrays, which would otherwise be discarded, to be included in an analysis. It is applicable to microarray data from experiments with some level of replication

Experimental conditions for observation of electron-hole superfluidity in GaAs heterostructures

The experimental parameter ranges needed to generate superfluidity in optical and drag experiments in GaAs double quantum wells are determined, using a formalism that includes self-consistent screening of the Coulomb pairing interaction in the presence of the superfluid. The very different electron and hole masses in GaAs make this a particularly interesting system for superfluidity, with exotic superfluid phases predicted in the BCS-BEC crossover regime. We find that the density and temperature ranges for superfluidity cover the range for which optical experiments have observed indications of superfluidity, but that existing drag experiments lie outside the superfluid range. However we also show that for samples with low mobility with no macroscopically connected superfluidity, if the superfluidity survived in randomly distributed localized pockets, standard quantum capacitance measurements could detect these pockets.Comment: 7 pages, 4 figure

Non-destructive identification of fibre orientation in multi-ply biaxial laminates using contact temperature sensors

Fibre orientation within composite structures dictates the material properties of the laminate once cured. The ability to accurately and automatically assess fibre orientation of composite parts is a significant enabler in the goal to optimise the established processes within aftermarket aerospace industries. Incorrect ply lay-up results in a structure with undesirable material properties and as such, has the potential to fail under safe working loads. Since it is necessary to assure structural integrity during re-manufacture and repair assessment, the paper demonstrates a novel method of readily and non-destructively determining fibre orientation throughout multi-ply Biaxial woven composite laminates using point temperature contact sensors and data analysis techniques. Once cured, only the outermost laminates are visible to assess orientation. The inspection method is conducted visually, with reference guides to allow for rapid adoption with minimum training, as well as harnessing established temperature sensors within the Maintenance Repair and Overhaul (MRO) environment. The system is amenable to integration within existing repair/re-manufacture processes without significant impact to process flow. The method is able to identify noisy samples with an accuracy, precision and recall of 0.9, and for synthetically created samples of double the cure ply thickness, a precision of 0.75, a recall of 0.7 and an accuracy of 0.87