Better care for babies: the added value of a modified reverse syphilis testing algorithm for the treatment of congenital syphilis in a maternity Hospital in Central African Republic.

BACKGROUND: In high syphilis prevalence settings, the syphilis testing and treatment strategy for mothers and newborns must be tailored to balance the risk of over treatment against the risk of missing infants at high-risk for congenital syphilis. Adding a non-treponemal test (Rapid Plasma Reagin - RPR) to a routine rapid treponemal test (SD Bioline Syphilis 3.0) for women giving birth can help distinguish between neonates at high and low-risk for congenital syphilis to tailor their treatment. Treatment for neonates born to RPR-reactive mothers (high-risk) is 10?days of intravenous penicillin, while one dose of intramuscular penicillin is sufficient for those born to RPR non-reactive mothers (low-risk). This strategy was adopted in March 2017 in a Médecins Sans Frontières supported hospital in Bangui, Central African Republic. This study examined the operational consequences of this algorithm on the treatment of newborns. METHODS: The study was a retrospective cohort study. Routine programmatic data were analysed. Descriptive statistical analysis was done. Total antibiotic days, hospitalization days and estimated costs were compared to scenarios without RPR testing and another where syphilis treatment was the sole reason for hospitalization. RESULTS: Of 202 babies born to SD Bioline positive mothers 89 (44%) and 111(55%) were RPR-reactive and non-reactive respectively (2 were unrecorded) of whom 80% and 88% of the neonates received appropriate antibiotic treatment respectively. Neonates born to RPR non-reactive mothers were 80% less likely to have sepsis [Relative risk (RR)?=?0.20; 95% Confidence interval (CI)?=?0.04-0.92] and 9% more likely to be discharged [RR?=?1.09; 95% CI?=?1.00-1.18] compared to those of RPR-reactive mothers. There was a 52%, and 49% reduction in antibiotic and hospitalization days respectively compared to a scenario with SD-Bioline testing only. Total hospitalization costs were also 52% lower compared to a scenario without RPR testing. CONCLUSIONS: This testing strategy can help identify infants at high and low risk for congenital syphilis and treat them accordingly at substantial cost savings. It is especially appropriate for settings with high syphilis endemicity, limited resources and overcrowded maternities. The babies additionally benefit from lower risks of exposure to unnecessary antibiotics and nosocomial infections

Attribution of the heavy rainfall events leading to severe flooding in Western Europe during July 2021

In July 2021 extreme rainfall across Western Europe caused severe flooding and substantial impacts, including over 200 fatalities and extensive infrastructure damage within Germany and the Benelux countries. After the event, a hydrological assessment and a probabilistic event attribution analysis of rainfall data were initiated and complemented by discussing the vulnerability and exposure context. The global mean surface temperature (GMST) served as a covariate in a generalised extreme value distribution fitted to observational and model data, exploiting the dependence on GMST to estimate how anthropogenic climate change affects the likelihood and severity of extreme events. Rainfall accumulations in Ahr/Erft and the Belgian Meuse catchment vastly exceeded previous observed records. In regions of that limited size the robust estimation of return values and the detection and attribution of rainfall trends are challenging. However, for the larger Western European region it was found that, under current climate conditions, on average one rainfall event of this magnitude can be expected every 400 years at any given location. Consequently, within the entire region, events of similar magnitude are expected to occur more frequently than once in 400 years. Anthropogenic climate change has already increased the intensity of the maximum 1-day rainfall event in the summer season by 3–19 %. The likelihood of such an event to occur today compared to a 1.2 ∘ C cooler climate has increased by a factor of 1.2–9. Models indicate that intensity and frequency of such events will further increase with future global warming. While attribution of small-scale events remains challenging, this study shows that there is a robust increase in the likelihood and severity of rainfall events such as the ones causing extreme impacts in July 2021 when considering a larger region

Attribution of the heavy rainfall events leading to severe flooding in Western Europe during July 2021

In July 2021 extreme rainfall across Western Europe caused severe flooding and substantial impacts, including over 200 fatalities and extensive infrastructure damage within Germany and the Benelux countries. After the event, a hydrological assessment and a probabilistic event attribution analysis of rainfall data were initiated and complemented by discussing the vulnerability and exposure context. The global mean surface temperature (GMST) served as a covariate in a generalised extreme value distribution fitted to observational and model data, exploiting the dependence on GMST to estimate how anthropogenic climate change affects the likelihood and severity of extreme events. Rainfall accumulations in Ahr/Erft and the Belgian Meuse catchment vastly exceeded previous observed records. In regions of that limited size the robust estimation of return values and the detection and attribution of rainfall trends are challenging. However, for the larger Western European region it was found that, under current climate conditions, on average one rainfall event of this magnitude can be expected every 400 years at any given location. Consequently, within the entire region, events of similar magnitude are expected to occur more frequently than once in 400 years. Anthropogenic climate change has already increased the intensity of the maximum 1-day rainfall event in the summer season by 3–19 %. The likelihood of such an event to occur today compared to a 1.2 $$^{\circ }$$C cooler climate has increased by a factor of 1.2–9. Models indicate that intensity and frequency of such events will further increase with future global warming. While attribution of small-scale events remains challenging, this study shows that there is a robust increase in the likelihood and severity of rainfall events such as the ones causing extreme impacts in July 2021 when considering a larger region

Adverse Fetal and Neonatal Outcomes Associated with a Life-Long High Fat Diet: Role of Altered Development of the Placental Vasculature

Maternal obesity results in a number of obstetrical and fetal complications with both immediate and long-term consequences. The increased prevalence of obesity has resulted in increasing numbers of women of reproductive age in this high-risk group. Since many of these obese women have been subjected to hypercaloric diets from early childhood we have developed a rodent model of life-long maternal obesity to more clearly understand the mechanisms that contribute to adverse pregnancy outcomes in obese women. Female Sprague Dawley rats were fed a control diet (CON - 16% of calories from fat) or high fat diet (HF - 45% of calories from fat) from 3 to 19 weeks of age. Prior to pregnancy HF-fed dams exhibited significant increases in body fat, serum leptin and triglycerides. A subset of dams was sacrificed at gestational day 15 to evaluate fetal and placental development. The remaining animals were allowed to deliver normally. HF-fed dams exhibited a more than 3-fold increase in fetal death and decreased neonatal survival. These outcomes were associated with altered vascular development in the placenta, as well as increased hypoxia in the labyrinth. We propose that the altered placental vasculature may result in reduced oxygenation of the fetal tissues contributing to premature demise and poor neonatal survival

Reimagining Engagement between Citizens and Parliament

This chapter reimagines the relationship between citizens and parliament. Five core principles of public engagement – inclusivity, relevance, relatability, continuity and sustainability – drive the process of reimagining; and result in a reimagined parliamentary public engagement that would be welcoming and inclusive, consequential and future generations aware. In reflecting upon how far the UK parliament is from this reimagined future, core features of parliament – such as its collective and hierarchical nature, and its dependency on electoral cycles – are identified as inhibitors of a principled reimagining of parliamentary public engagement. The chapter concludes by calling for a far more institutionalised approach to engagement, to make it more meaningful, consequential and better resourced

HPV infection, cervical abnormalities, and cancer in HIV-infected women in Mumbai, India: 12-month follow-up.

HIV-infected women are at a higher risk of cervical intraepithelial neoplasia (CIN) and cancer than women in the general population, partly due to a high prevalence of persistent human papillomavirus (HPV) infection. The aim of the study was to assess the burden of HPV infection, cervical abnormalities, and cervical cancer among a cohort of HIV-infected women as part of a routine screening in an urban overpopulated slum setting in Mumbai, India