Regional differences in the quality of maternal and neonatal care during the COVID-19 pandemic in Portugal: Results from the IMAgiNE EURO study

Objective: To compare women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth across Nomenclature of Territorial Units for Statistics 2 (NUTS-II) regions in Portugal during the COVID-19 pandemic. Methods: Women participating in the cross-sectional IMAgiNE EURO study who gave birth in Portugal from March 1, 2020, to October 28, 2021, completed a structured questionnaire with 40 key WHO standards-based quality measures. Four domains of QMNC were assessed: (1) provision of care; (2) experience of care; (3) availability of human and physical resources; and (4) reorganizational changes due to the COVID-19 pandemic. Frequencies for each quality measure within each QMNC domain were computed overall and by region. Results: Out of 1845 participants, one-third (33.7%) had a cesarean. Examples of high-quality care included: low frequencies of lack of early breastfeeding and rooming-in (8.0% and 7.7%, respectively) and informal payment (0.7%); adequate staff professionalism (94.6%); adequate room comfort and equipment (95.2%). However, substandard practices with large heterogeneity across regions were also reported. Among women who experienced labor, the percentage of instrumental vaginal births ranged from 22.3% in the Algarve to 33.5% in Center; among these, fundal pressure ranged from 34.8% in Lisbon to 66.7% in Center. Episiotomy was performed in 39.3% of noninstrumental vaginal births with variations between 31.8% in the North to 59.8% in Center. One in four women reported inadequate breastfeeding support (26.1%, ranging from 19.4% in Algarve to 31.5% in Lisbon). One in five reported no exclusive breastfeeding at discharge (22.1%; 19.5% in Lisbon to 28.2% in Algarve). Conclusion: Urgent actions are needed to harmonize QMNC and reduce inequities across regions in Portugal. © 2022 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.Funding text 1: This work was supported by the Ministry of Health, Rome - Italy, in collaboration with the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste - Italy. This study was supported by Portuguese fundings through FCT - Fundação para a Ciência e a Tecnologia, IP, in the scope of the projects EPIUnit - UIDB/04750/2020, ITR - LA/P/0064/2020, and HEILab - UIDB/05380/2020, and by the European Social Fund (ESF) and FCT (SFRH/BPD/117597/2016; RC postdoctoral fellowship). We are grateful to the women who dedicated their time to complete the survey, to Associação Portuguesa pelos Direitos da Mulher na Gravidez e Parto (APDMGP) for support with survey dissemination and to nurse Louise Semião for assistance provided in back-translation of the questionnaires. Special thanks to the IMAgiNE EURO study group for their contribution to the development of this project and support for this manuscript.; Funding text 2: This work was supported by the Ministry of Health, Rome ‐ Italy, in collaboration with the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste ‐ Italy. This study was supported by Portuguese fundings through FCT ‐ Fundação para a Ciência e a Tecnologia, IP, in the scope of the projects EPIUnit ‐ UIDB/04750/2020, ITR ‐ LA/P/0064/2020, and HEILab ‐ UIDB/05380/2020, and by the European Social Fund (ESF) and FCT (SFRH/BPD/117597/2016; RC postdoctoral fellowship). We are grateful to the women who dedicated their time to complete the survey, to Associação Portuguesa pelos Direitos da Mulher na Gravidez e Parto (APDMGP) for support with survey dissemination and to nurse Louise Semião for assistance provided in back‐translation of the questionnaires. Special thanks to the IMAgiNE EURO study group for their contribution to the development of this project and support for this manuscript. ; Funding text 3: IMAgiNE EURO project was supported by the Ministry of Health, Rome ‐ Italy, in collaboration with the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste ‐ Italy. This study was supported by Fundação para a Ciência e a Tecnologia; European Social Fund (ESF) Funding informatio

Ammonium Nitrogen Patterns in Soils of a Pennisetum clandestinum Pasture and its Reaction to Nitrogen Fertilizers

Soil ammonium N concentration within the profile of a Pennisetum clandestinum (kikuyu) pasture was higher at 0-10 cm and 75-100 cm than at intermediate depths. This contrasted with the pattern in the same soil from an adjacent maizeland. Here, ammonium N concentrations declined with depth, reaching their lowest concentration at 75-100 cm. Soil ammonium N concentrations increased with increasing N applications

Breeding for better clover-Rhizobium symbiosis: selection enriches for significant biomass GWAS SNP alleles

White clover (Trifolium repens L.) is an integral component of mixed pastures in temperate agriculture, providing quality feed and a sustainable source of fixed nitrogen (N) through its symbiosis with soil-dwelling Rhizobium bacteria. While there has been much focus on identifying and applying Rhizobium inoculants with improved N-fixation, there has been less attention on identifying and exploiting plant genetic factors to develop cultivars that routinely form effective Rhizobium symbioses. The complexity of the clover-Rhizobium interaction makes for a challenging but valuable breeding target and an important strategy for reducing N-fertiliser use. We investigated deployment of genomic selection (GS) for clover-Rhizobium symbiotic response by growing seedlings from 120 half-sibling (HS) families in vermiculite/McKnight’s solution where N was provided either by a commercial Rhizobium strain (TA1) or supplied mineral N (positive control). Shoot dry matter (DM) among other traits was recorded after 35 days of growth. Symbiotic potential (SP) for each HS family was calculated as DM produced in the Rhizobium treatment as a proportion of the positive control DM. The traits showed significant additive variation and narrow-sense heritabilities ranged from 0.24-0.33. A Smith-Hazel (SH) multi-trait selection index to generate the largest plants with the greatest SP was derived. The maternal parents of the 120 HS families were genotyped with 110,000 genotyping by sequencing (GBS)-derived SNPs and their phenotypes inferred from performance of their respective HS family. These data underpinned prediction modelling using KGD-GBLUP, and cross-validation of the model generated predictive abilities ranging from 0.23-0.36 depending on the trait. Crosses were made for the SH index (combined Shoot DM and SP) using i) standard Among Family selection based on family phenotype (ApHSF); and ii) Among and Within Family selection (ApWgsHSF) incorporating GS. For the GS, 40 seedlings each of the top and bottom 12 performing HS families were genotyped (GBS) and genomic estimated breeding values were calculated using KGD-GBLUP to identify predicted best individuals within families. The predicted top two individuals from each of the top 12 families were polycrossed. A divergent selection was made using the two predicted bottom performing individuals from each of the bottom 12 families. Phenotyping (see above) showed progeny of the top ApHSF cross had a mean shoot dry matter 58% greater than progeny from the bottom ApHSF cross. Incorporating GS increased this difference to 95% between progenies of the top and bottom ApWgsHSF crosses. To investigate associated markers and underlying trait mechanisms, a genome-wide association study (GWAS) of the 120 families identified a significant SNP each on Chromosomes 2 and 16 with four other SNPs approaching the Bonferroni threshold. The most significant SNP was near a pentatricopeptide repeat gene associated with regulating reactive oxygen species that influence Rhizobium symbiosis specificity. Furthermore, the GWAS SNP variants associated with increased biomass were absent or at very low frequencies in the bottom performing families. These SNPs will be assessed as markers to improve prediction models. These data highlight that clover genetics can be harnessed for increased DM in symbiosis with Rhizobia, and the next steps include field assessment

How Sequentially Changing Reward Prospect Modulates Meta-control: Increasing Reward Prospect Promotes Cognitive Flexibility

Meta-control is necessary to regulate the balance between cognitive stability and flexibility. Evidence from (voluntary) task switching studies suggests performance-contingent reward as one modulating factor. Depending on the immediate reward history, reward prospect seems to promote either cognitive stability or flexibility: Increasing reward prospect reduced switch costs and increased the voluntary switch rate, suggesting increased cognitive flexibility. In contrast, remaining high reward prospect increased switch costs and reduced the voluntary switch rate, suggesting increased cognitive stability. Recently we suggested that increasing reward prospect serves as a meta-control signal toward cognitive flexibility by lowering the updating threshold in working memory. However, in task switching paradigms with two tasks only, this could alternatively be explained by facilitated switching to the other of two tasks. To address this issue, a series of task switching experiments with uncued task switching between three univalent tasks was conducted. Results showed a reduction in reaction time (RT) switch costs to a nonsignificant difference and a high voluntary switch rate when reward prospect increased, whereas repetition RTs were faster, switch RTs slower, and voluntary switch rate was reduced when reward prospect remained high. That is, increasing reward prospect put participants in a state of equal readiness to respond to any target stimulus-be it a task repetition or a switch to one of the other two tasks. The study thus provides further evidence for the assumption that increasing reward prospect serves as a meta-control signal to increase cognitive flexibility, presumably by lowering the updating threshold in working memory

The dynamic balance between cognitive flexibility and stability: the influence of local changes in reward expectation and global task context on voluntary switch rate

Current theories describe cognitive control as a dynamic balance between two antagonistic control functions, namely cognitive stability and flexibility. Recent evidence suggests that this balance between these control modes is modulated by changing reward prospects on the one side and contextual parameters on the other. In the present study, we aim to investigate how both factors interact. In a between-subjects design, we manipulated the context by the ratio of free- to forced-choice trials (80:20, 50:50, 20:80) in a hybrid task-switching paradigm, combining forced- and free-choice task switching. In addition, two reward magnitudes changed randomly from trial to trial. Results showed an overall increase in voluntary switch rate (VSR) with increasing forced-choice frequency, demonstrating a robust context effect. Moreover, the trial-by-trial reward manipulation interacted with this global context effect: with a stability bias (80% free:20% forced), only an increase in reward expectation increased VSR, whereas with a more flexible global bias (in the 50:50 or 20:80 conditions) VSR increased when reward expectation changed and reduced when reward expectation remained high. Taken together, results suggest that the cognitive system is able to adapt to global context parameters and to respond to rapid changes in reward expectation at the same time