Twin chorionicity-specific population birth-weight charts adjusted for estimated fetal weight

OBJECTIVE: To construct chorionicity-specific birthweight reference charts for dichorionic diamniotic (DCDA) and monchorionic diamniotic (MCDA) twin pregnancies incorporating estimated fetal weight (EFW) data in order to adjust for the relationship between suboptimal growth and premature delivery. An additional aim of this study was to determine if the inclusion of complicated twin pregnancies impacts the reference charts produced. METHODS: The Inclusion criteria were twin pregnancy of known chorionicity, known pregnancy outcome, last ultrasound scan within 14 days of birth which took place between 25 and 38 weeks (Analysis A). An analysis was also conducted excluding any pregnancies with complications recorded (Analysis B). The analysis makes use of previously published twin EFW reference ranges. A joint statistical model for EFW and observed birthweight for each pregnancy was created in order to estimate population birthweight reference ranges corresponding to the distribution expected were all pregnancies to deliver at any given gestation. It was not assumed that the median EFW was equal for any given gestation. The models were fitted using a Bayesian approach. RESULTS: We retrieved data on 1664 twin pregnancies, of which 707 DCDA and 241 MCDA pregnancies met the inclusion criteria. The estimate population median birthweight was similar to median EFW around 27 weeks but fell below the EFW values with increasing gestation to 156g lower in both DCDA and MCDA pregnancies at 35 weeks; this finding was confirmed by direct comparison of last EFW and birthweight values in each pregnancy. When the analysis was repeated after excluding the complicated twin pregnancies, there was very little difference between the results obtained when comparing the median EFW across gestations, in Analysis A and those in Analysis B. The largest absolute difference in DCDA twins being a decreased median birthweight of 9g in the Analysis A cohort at 31, 32- and 33-weeks, when compared to Analysis B. The largest absolute difference in MCDA was greater showing an increased median birthweight of 25.3g in the Analysis B cohort at 25 weeks, when compared to Analysis A. CONCLUSION: We established population reference chorionicity-specific birthweight charts for all twin pregnancies, corresponding to the range expected were all pregnancies to deliver at any given gestational age. In this population the median birthweight for twins is consistently lower than singletons and there is a variation in the median birthweight at different gestational ages for chorionicity. This article is protected by copyright. All rights reserved

Editorial

© 2014, Mediterranean Center of Social and Educational Research. All right reserved. This article is devoted to analysis of production concentration processes at modern stage which indicates evolutional origin of this phenomenon, which requires the use of different approaches to managing and evaluation of their efficiency at all economic levels. It deals with characteristic features of production concentration management at the branch level taking into account existing approaches to the branch development; managing changes in the interaction of individual sectors’ agents caused by globalization processes in the economy; methods to solve problems of production concentration management, in particular, to form a network configuration and evaluate its efficiency

Performance of Anal Cytology Compared With High-Resolution Anoscopy and Histology in Women With Lower Anogenital Tract Neoplasia

Background: Information on the performance of anal cytology in women who are high-risk for human papillomavirus-related lesions and the factors that might influence it are largely lacking. Aims: Evaluate the performance of anal cytology in women with lower anogenital tract neoplasia. Methods: retrospective study including all new referrals of women with a previous history of anogenital neoplasia, from January 2012 to July 2017, with concomitant anal cytology and high-resolution anoscopy with or without biopsies. Results: 636 anal cytology samples and 323 biopsies were obtained from 278 women. Overall sensitivity and specificity of 'any abnormality' on anal cytology to predict 'any abnormality' in histology was 47% (95% CI 41-54%) and 84% (95% CI 73-91%), respectively. For detecting high-grade squamous intraepithelial lesions (HSIL)/cancer, sensitivity was 71% (95% CI 61-79%) and specificity was 73% (95% CI 66-79%). There was a poor concordance between cytological and histological grades (κ=0.147). Cytology had a higher sensitivity to predict HSIL/cancer in immunosuppressed vs. non-immunosuppressed patients (92% vs. 60%, P=0.002). The sensitivity for HSIL detection was higher when two or more quadrants were affected in comparison with only one (86% vs. 57%, P=0.006). A previous history of vulvar HSIL/cancer (OR 1.71, 1.08-2.73; P=0.023), immunosuppression (OR 1.88, 1.17-3.03; P=0.009) and concomitant genital HSIL/cancer (OR 2.51, 1.47-4.29; P=0.001) were risk factors for abnormal cytology. Conclusions: Patient characteristics can influence the performance of anal cytology in women. The sensitivity for detecting anal HSIL/cancer was higher in those immunosuppressed and with more extensive disease

Effectiveness of conditional cash transfers (Afya credits incentive) to retain women in the continuum of care during pregnancy, birth and the postnatal period in Kenya: a cluster-randomised trial

OBJECTIVES: Given high maternal and child mortality rates, we assessed the impact of conditional cash transfers (CCTs) to retain women in the continuum of care (antenatal care (ANC), delivery at facility, postnatal care (PNC) and child immunisation). DESIGN: We conducted an unblinded 1:1 cluster-randomised controlled trial. SETTING: 48 health facilities in Siaya County, Kenya were randomised. The trial ran from May 2017 to December 2019. PARTICIPANTS: 2922 women were recruited to the control and 2522 to the intervention arm. INTERVENTIONS: An electronic system recorded attendance and triggered payments to the participant's mobile for the intervention arm (US$4.5), and phone credit for the control arm (US$0.5). Eligibility criteria were resident in the catchment area and access to a mobile phone. PRIMARY OUTCOMES: Primary outcomes were any ANC, delivery, any PNC between 4 and 12 months after delivery, childhood immunisation and referral attendance to other facilities for ANC or PNC. Given problems with the electronic system, primary outcomes were obtained from maternal clinic books if participants brought them to data extraction meetings (1257 (50%) of intervention and 1053 (36%) control arm participants). Attendance at referrals to other facilities is not reported because of limited data. RESULTS: We found a significantly higher proportion of appointments attended for ANC (67% vs 60%, adjusted OR (aOR) 1.90; 95% CI 1.36 to 2.66) and child immunisation (88% vs 85%; aOR 1.74; 95% CI 1.10 to 2.77) in intervention than control arm. No intervention effect was seen considering delivery at the facility (90% vs 92%; aOR 0.58; 95% CI 0.25 to 1.33) and any PNC attendance (82% vs 81%; aOR 1.25; 95% CI 0.74 to 2.10) separately. The pooled OR across all attendance types was 1.64 (1.28 to 2.10). CONCLUSIONS: Demand-side financing incentives, such as CCTs, can improve attendance for appointments. However, attention needs to be paid to the technology, the barriers that remain for delivery at facility and PNC visits and encouraging women to attend ANC visits within the recommended WHO timeframe. TRIAL REGISTRATION: NCT03021070

Fractional Brownian motion and multivariate-t models for longitudinal biomedical data, with application to CD4 counts in HIV-positive patients.

Longitudinal data are widely analysed using linear mixed models, with 'random slopes' models particularly common. However, when modelling, for example, longitudinal pre-treatment CD4 cell counts in HIV-positive patients, the incorporation of non-stationary stochastic processes such as Brownian motion has been shown to lead to a more biologically plausible model and a substantial improvement in model fit. In this article, we propose two further extensions. Firstly, we propose the addition of a fractional Brownian motion component, and secondly, we generalise the model to follow a multivariate-t distribution. These extensions are biologically plausible, and each demonstrated substantially improved fit on application to example data from the Concerted Action on SeroConversion to AIDS and Death in Europe study. We also propose novel procedures for residual diagnostic plots that allow such models to be assessed. Cohorts of patients were simulated from the previously reported and newly developed models in order to evaluate differences in predictions made for the timing of treatment initiation under different clinical management strategies. A further simulation study was performed to demonstrate the substantial biases in parameter estimates of the mean slope of CD4 decline with time that can occur when random slopes models are applied in the presence of censoring because of treatment initiation, with the degree of bias found to depend strongly on the treatment initiation rule applied. Our findings indicate that researchers should consider more complex and flexible models for the analysis of longitudinal biomarker data, particularly when there are substantial missing data, and that the parameter estimates from random slopes models must be interpreted with caution

Protocol for the COG-UK hospital onset COVID-19 infection (HOCI) multicentre interventional clinical study: evaluating the efficacy of rapid genome sequencing of SARS-CoV-2 in limiting the spread of COVID-19 in United Kingdom NHS hospitals

Introduction: Nosocomial transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a significant cause of mortality in National Health Service (NHS) hospitals during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study is to evaluate the impact of rapid whole genome sequencing of SARS-CoV-2, supported by a novel probabilistic reporting methodology, to inform infection prevention and control (IPC) practice within NHS hospital settings. / Methods and analysis: COG-UK HOCI (COG-UK Consortium Hospital-Onset COVID-19 Infections study) is a multicentre, prospective, interventional, superiority study. Eligible patients must be admitted to hospital with first confirmed SARS-CoV-2 PCR positive test result >48h from time of admission, where COVID-19 diagnosis was not suspected upon admission. The projected sample size for 14 participating sites covering all study phases over winter-spring 2020/2021 in the United Kingdom is 2,380 patients. The intervention is the return of a sequence report, within 48 hours in one phase (rapid local lab) and within 5-10 days in a second phase (mimicking central lab use), comparing the viral genome from an eligible study participant with others within and outside the hospital site. The primary outcomes are the incidence of Public Health England (PHE)/IPC-defined SARS-CoV-2 hospital-acquired infection during the baseline and two interventional phases, and proportion of hospital-onset cases with genomic evidence of transmission linkage following implementation of the intervention where such linkage was not suspected by initial IPC investigation. Secondary outcomes include incidence of hospital outbreaks, with and without sequencing data; actual and desirable changes to IPC actions; periods of healthcare worker (HCW) absence. A process evaluation using qualitative interviews with HCWs will be conducted alongside the study and analysis, underpinned by iterative programme theory of the sequence report. Health economic analysis will be conducted to determine cost-benefit of the intervention, and whether this leads to economic advantages within the NHS setting. / Ethics and dissemination: The protocol has been approved by the National Research Ethics Service Committee (Cambridge South 20/EE/0118). This manuscript is based on version 5.0 of the protocol. The study findings will be disseminated through peer-reviewed publications