Audit of antenatal clinic for high-risk obstetric patients; activity and outcomes

A specialised clinic for the antenatal care of high-risk patients was established in Cork in January 2004. It is led by 2 specialists in materno-fetal medicine and provides care for patients from a large catchment area. Small clinic numbers, specialised midwives, ready access to medical experts and fetal assessment facilities, facilitate an efficient use of resources. We report on the experience and outcomes of this clinic after the first year in operation. A database was set up to store relevant information on patients who attended the clinic in 2004. 143 patients attended. Risk categories included maternal medical disease (62%); multiple pregnancy (11%); previous poor obstetric history (10%); fetal anomaly (8%). Average gestation; 35.9 weeks, average birth weight; 2598g. Caesarean section rate; 41%. Perinatal mortality rate 67 per 1000 (uncorrected); and 20% neonates required NICU care. This approach to highrisk obstetric care resulted in favourable outcomes. The management strategy applied in Cork may be a suitable prototype for comparable areas throughout Ireland

Periodontal Disease in Five and Six Year Old Children

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141478/1/jper0019.pd

Poor uptake of reproductive health screening services by female renal transplant recipients.

Women with functioning renal transplants are a high-risk group for de novo malignancies and other gynaecological health problems. The objective of this study was to assess patients awareness of gynaecological issues, and to assess uptake of cervical and breast cancer screening services. A structured questionnaire on family planning, menopausal issues and knowledge/use of cervical and breast cancer screening was administered to 64 female renal transplant recipients. 58 (91%) responded to the questionnaire. Mean age at first transplantation was 35 years (range 11 - 69). 84% were aware as to why they should have regular cervical smears. 15 (26%) had, however, never had a smear and only 9 (16%) were having yearly smears. 12 of 28 postmenopausal women entered the menopause under the age of 41 years, but only 5 of these had received Hormone Replacement Therapy. Breast self examination is practiced by 71%, but only 26% have had mammograms. These figures suggest that female renal transplant patients are not adequately screened for cervical and breast cancer. The results also indicate a need for further education regarding family planning issues and menopausal health concerns. We conclude that formal gynaecological review should be routinely available for women with renal transplants

Cenozoic global cooling and increased seawater Mg/Ca via reduced reverse weathering

© The Author(s), 2017. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Nature Communications 8 (2017): 844, doi:10.1038/s41467-017-00853-5.Authigenic clay minerals formed on or in the seafloor occur in every type of marine sediment. They are recognized to be a major sink of many elements in the ocean but are difficult to study directly due to dilution by detrital clay minerals. The extremely low dust fluxes and marine sedimentation rates in the South Pacific Gyre (SPG) provide a unique opportunity to examine relatively undiluted authigenic clay. Here, using Mg isotopes and element concentrations combined with multivariate statistical modeling, we fingerprint and quantify the abundance of authigenic clay within SPG sediment. Key reactants include volcanic ash (source of reactive aluminium) and reactive biogenic silica on or shallowly buried within the seafloor. Our results, together with previous studies, suggest that global reorganizations of biogenic silica burial over the Cenozoic reduced marine authigenic clay formation, contributing to the rise in seawater Mg/Ca and decline in atmospheric CO2 over the past 50 million years.Funding for this research was provided by the U.S. National Science Foundation to R.W.M. (OCE1130531) and to J.A.H. (OCE1654571)

Modeling the effects of diagenesis on carbonate clumped-isotope values in deep- and shallow-water settings

The measurement of multiply isotopically substituted (‘clumped isotope’) carbonate groups provides a way to reconstruct past mineral formation temperatures. However, dissolution-reprecipitation (i.e., recrystallization) reactions, which commonly occur during sedimentary burial, can alter a sample’s clumped-isotope composition such that it partially or wholly reflects deeper burial temperatures. Here we derive a quantitative model of diagenesis to explore how diagenesis alters carbonate clumped-isotope values. We apply the model to a new dataset from deep-sea sediments taken from Ocean Drilling Project site 807 in the equatorial Pacific. This dataset is used to ground truth the model. We demonstrate that the use of the model with accompanying carbonate clumped-isotope and carbonate δ^(18)O values provides new constraints on both the diagenetic history of deep-sea settings as well as past equatorial sea-surface temperatures. Specifically, the combination of the diagenetic model and data support previous work that indicates equatorial sea-surface temperatures were warmer in the Paleogene as compared to today. We then explore whether the model is applicable to shallow-water settings commonly preserved in the rock record. Using a previously published dataset from the Bahamas, we demonstrate that the model captures the main trends of the data as a function of burial depth and thus appears applicable to a range of depositional settings

Intensive care for extreme prematurity--moving beyond gestational age.

BACKGROUND: Decisions regarding whether to administer intensive care to extremely premature infants are often based on gestational age alone. However, other factors also affect the prognosis for these patients. METHODS: We prospectively studied a cohort of 4446 infants born at 22 to 25 weeks\u27 gestation (determined on the basis of the best obstetrical estimate) in the Neonatal Research Network of the National Institute of Child Health and Human Development to relate risk factors assessable at or before birth to the likelihood of survival, survival without profound neurodevelopmental impairment, and survival without neurodevelopmental impairment at a corrected age of 18 to 22 months. RESULTS: Among study infants, 3702 (83%) received intensive care in the form of mechanical ventilation. Among the 4192 study infants (94%) for whom outcomes were determined at 18 to 22 months, 49% died, 61% died or had profound impairment, and 73% died or had impairment. In multivariable analyses of infants who received intensive care, exposure to antenatal corticosteroids, female sex, singleton birth, and higher birth weight (per each 100-g increment) were each associated with reductions in the risk of death and the risk of death or profound or any neurodevelopmental impairment; these reductions were similar to those associated with a 1-week increase in gestational age. At the same estimated likelihood of a favorable outcome, girls were less likely than boys to receive intensive care. The outcomes for infants who underwent ventilation were better predicted with the use of the above factors than with use of gestational age alone. CONCLUSIONS: The likelihood of a favorable outcome with intensive care can be better estimated by consideration of four factors in addition to gestational age: sex, exposure or nonexposure to antenatal corticosteroids, whether single or multiple birth, and birth weight. (ClinicalTrials.gov numbers, NCT00063063 [ClinicalTrials.gov] and NCT00009633 [ClinicalTrials.gov].)

A Mg isotopic perspective on the mobility of magnesium during serpentinization and carbonation of the Oman Ophiolite

Author Posting. © American Geophysical Union, 2021. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research: Solid Earth 126(2), (2021): e2020JB020237, https://doi.org/10.1029/2020JB020237.Alteration of mantle peridotite in the Samail ophiolite forms secondary minerals, mainly serpentine and Mg‐rich carbonates. Magnesium accounts for ∼25 – 30% of peridotite mass and its mobility can be used to trace this alteration. We report the first set of Mg isotope measurements from peridotites and their alteration products in Oman. Partially serpentinized peridotites have Mg isotope ratios that are indistinguishable from estimates for the average mantle and bulk silicate earth (δ26Mg = −0.25 ± 0.04‰). However, more extensively altered peridotite samples show large shifts in Mg isotopic composition. The range of δ26Mg values for our suite of alteration products from the mantle section is ∼4.5‰ (from −3.39‰ to 1.19‰), or >60% of the total range of terrestrial variability in δ26Mg values. Serpentine veins are typically enriched in 26Mg (max δ26Mg value = 0.96‰) whereas Mg‐carbonate veins are associated with low 26Mg/24Mg ratios (magnesite δ26Mg = −3.3‰, dolomite δ26Mg = −1.91‰). Our preferred explanation for the range in δ26Mg values involves coprecipitation of serpentine and carbonates at water‐to‐rock ratios >103. The coincidence of alteration products characterized by δ26Mg values that are both lower and higher than bulk silicate Earth and the finite 14C ages of the carbonates suggest that both serpentinization and carbonation are ongoing in Oman. Rates of calcite precipitation in travertines inferred from Δ26Mgcal‐fl suggest that travertine formation in Oman sequesters a total of 106–107 kg CO2/yr, consistent with previous estimates.This work was supported through the Sloan Foundation–Deep Carbon Observatory (Grant 2014‐3‐01, Kelemen PI), the U.S.‐National Science Foundation (NSF‐EAR‐1516300, Kelemen lead PI).2021-06-0

Pegylated arginine deiminase drives arginine turnover and systemic autophagy to dictate energy metabolism

Obesity is a multi-systemic disorder of energy balance. Despite intense investigation, the determinants of energy homeostasis remain incompletely understood, and efficacious treatments against obesity and its complications are lacking. Here, we demonstrate that conferred arginine iminohydrolysis by the bacterial virulence factor and arginine deiminase