The 'conspectus' technique is applied to large libraries: how suitable is it for smaller libraries? A study taking place in the medical libraries of Leicester Royal Infirmary, Leicester General Hospital, Glenfield General Hospital, Charles Frears College of Nursing and Midwifery and the Towers Hospital

The 'conspectus' technique is applied to large libraries: how suitable is it for smaller libraries? A study taking place in the medical libraries of Leicester Royal Infirmary, Leicester General Hospital, Glenfield General Hospital, Charles Frears College of Nursing and Midwifery and the Towers Hospita

Identification of a core, distinct placental microbiome.

<p>(A) Rank abundance curve showing the 25 most common organisms recovered from participants’ placental tissue (n = 476) and fetal membranes (n = 738) that were positive for bacterial DNA. (B) Principal coordinate analysis of unweighted UniFrac distances computed for matched participant placenta (n = 445), fetal membrane (n = 719), oral (n = 725) and vaginal (n = 747) samples from 1107 participants. PC1 and PC2 refer to principal coordinate two and principal coordinate three respectively. Each individual point refers to a single participant’s microbiome for that body site, with samples in similar positions on each axis assumed to have similar microbiomes and samples further apart in the plot are assumed to have more divergent microbiomes. (C) Principal coordinate analysis of unweighted UniFrac distances using the same participants as (B) but plotting axes PC2 and PC3.</p

High bacterial load in placental tissues associated with a restricted number of phylogenetically diverse organisms.

<p>Multivariate plot of participant’s (A) placental and (B) fetal membrane bacterial load, observed number of OTUs and median intra-individual unweighted UniFrac distances.</p

OTUs identified in placental tissues are also identified in participant’s mouth and vagina.

<p>(A) The mean ± SEM estimated proportion of OTUs in placenta and fetal membranes sourced from vaginal, oral cavity or an unknown source. (B) Comparison between the proportion of OTUs found in placenta and fetal membranes sourced from the vagina stratified by participants who delivered vaginally or by caesarean section.</p

OTUs isolated from fetal membranes significantly associated with differences in head circumference-for-age Z-score.

<p>OTUs isolated from fetal membranes significantly associated with differences in head circumference-for-age Z-score.</p

Baseline characteristics of included and excluded participants (n = 1391).

<p>Baseline characteristics of included and excluded participants (n = 1391).</p

Presence of OTUs in both vagina and placental tissue associated with a lower length-for-age z-score.

<p>(A) Heat map showing presence of vaginal organisms in all individuals’ vaginal and placental samples. Hierarchical clustering was computed using average linkage of Euclidean distances. (B) Mean ± 95%CI LAZ score for participants with individual bacterium not present in their vagina, present in their vagina only and present in both vagina and placental tissue (*q<0.05).</p

Specific combinations of bacteria found in fetal membranes that associate with each other, severe chorioamnionitis and adverse birth outcomes.

<p>Heat map of Spearman’s correlations between the 6 most abundant bacterial phyla with each other (A) and 20 most abundant bacterial families with each other (B) recovered from fetal membranes. Hierarchical clustering was computed by complete linkage of Euclidean distances. Heat map is annotated with mean difference in bacterial load between participants with and without severe chorioamnionitis, preterm birth (<37 weeks), low birth weight (<2500g) and neonatal stunting (LAZ < -2) and small head circumference (HCZ < -2) for each bacterial phyla or family. Asterisks indicate p<0·05 association between higher load of that bacterial phyla or family and prevalence of severe chorioamnionitis, preterm birth, low birth weight, neonatal stunting or small head circumference. The mean different and confidence intervals of these associations can be found in the main results text. Adjusted model <i>P</i> values were calculated using linear regression adjusting for the nutritional intervention, maternal BMI at enrolment, maternal age, proxy for socioeconomic status, number of previous pregnancies, anaemia, site of enrolment, mode of delivery and time between delivery and placenta sampling.</p

Placental examination of chorioamnionitis and sever chorioamnionitis (n = 989).

<p>Placental examination of chorioamnionitis and sever chorioamnionitis (n = 989).</p

The effect of sample collection on detection of bacterial DNA.

<p>(A) Histogram of the number of hours between delivery and the placenta being sampled. (B) Box-and-whisker plot showing the association between the number of hours after delivery sampling took place and whether the placental tissue had detectable levels of bacterial DNA. Correlation between the number of hours after delivery the placenta was sampled (C), and the observed number of OTUs and median inter-individual unweighted UniFrac distance (D).</p