A review of the methodological features of systematic reviews in maternal medicine

Background In maternal medicine, research evidence is scattered making it difficult to access information for clinical decision making. Systematic reviews of good methodological quality are essential to provide valid inferences and to produce usable evidence summaries to guide management. This review assesses the methodological features of existing systematic reviews in maternal medicine, comparing Cochrane and non-Cochrane reviews in maternal medicine. Methods Medline, Embase, Database of Reviews of Effectiveness (DARE) and Cochrane Database of Systematic Reviews (CDSR) were searched for relevant reviews published between 2001 and 2006. We selected those reviews in which a minimum of two databases were searched and the primary outcome was related to the maternal condition. The selected reviews were assessed for information on framing of question, literature search and methods of review. Results Out of 2846 citations, 68 reviews were selected. Among these, 39 (57%) were Cochrane reviews. Most of the reviews (50/68, 74%) evaluated therapeutic interventions. Overall, 54/68 (79%) addressed a focussed question. Although 64/68 (94%) reviews had a detailed search description, only 17/68 (25%) searched without language restriction. 32/68 (47%) attempted to include unpublished data and 11/68 (16%) assessed for the risk of missing studies quantitatively. The reviews had deficiencies in the assessment of validity of studies and exploration for heterogeneity. When compared to Cochrane reviews, other reviews were significantly inferior in specifying questions (OR 20.3, 95% CI 1.1–381.3, p = 0.04), framing focussed questions (OR 30.9, 95% CI 3.7- 256.2, p = 0.001), use of unpublished data (OR 5.6, 95% CI 1.9–16.4, p = 0.002), assessment for heterogeneity (OR 38.1, 95%CI 2.1, 688.2, p = 0.01) and use of meta-analyses (OR 3.7, 95% CI 1.3–10.8, p = 0.02). Conclusion This study identifies areas which have a strong influence on maternal morbidity and mortality but lack good quality systematic reviews. Overall quality of the existing systematic reviews was variable. Cochrane reviews were of better quality as compared to other reviews. There is a need for good quality systematic reviews to inform practice in maternal medicine

Length of stay for mental and behavioural disorders postpartum in primiparous mothers: A cohort study

Background: Previous research showed that there was a significant increase in psychiatric hospital admission of postpartum mothers. The aim of the current study is to describe the length of hospital stays and patient days for mental and behavioural disorders (MBD) of new mothers in the first year after birth. Method: This was a cohort study based on linked population data between the New South Wales (NSW) Midwives Data Collection (MDC) and the NSW Admitted Patients Data Collection (APDC). The study population included primiparous mothers aged from 18 to 44 who gave birth between 1 July 2000 and 31 December 2005. The Kaplan-Meier method was used to describe the length of hospital stay for MBD. Results: For principal diagnoses of MBD, the entire length of hospital stay in the first year postpartum was 11.38 days (95% CI: 10.70-12.06) for mean and 6 days (95% CI: 5.87-6.13) for median. The length of hospital stay per admission was 8.47 days (95% CI: 8.03-8.90) for mean and 5 days (95% CI: 4.90-5.10) for median. There were 5,129 patient days of hospital stay per year for principal diagnoses of postpartum MBD in new mothers between 1 July 2000 and 31 December 2005 in NSW, Australia. Conclusions: MBD, especially unipolar depressions, adjustment disorders, acute psychotic episodes, and schizophrenia, or schizophrenia-like disorders during the first year after birth, placed a significant burden on hospital services due to long hospital stays and large number of admissions. © 2014 by the authors; licensee MDPI, Basel, Switzerland

The application of predictive modelling for determining bio-environmental factors affecting the distribution of blackflies (Diptera: Simuliidae) in the Gilgel Gibe watershed in Southwest Ethiopia

Blackflies are important macroinvertebrate groups from a public health as well as ecological point of view. Determining the biological and environmental factors favouring or inhibiting the existence of blackflies could facilitate biomonitoring of rivers as well as control of disease vectors. The combined use of different predictive modelling techniques is known to improve identification of presence/absence and abundance of taxa in a given habitat. This approach enables better identification of the suitable habitat conditions or environmental constraints of a given taxon. Simuliidae larvae are important biological indicators as they are abundant in tropical aquatic ecosystems. Some of the blackfly groups are also important disease vectors in poor tropical countries. Our investigations aim to establish a combination of models able to identify the environmental factors and macroinvertebrate organisms that are favourable or inhibiting blackfly larvae existence in aquatic ecosystems. The models developed using macroinvertebrate predictors showed better performance than those based on environmental predictors. The identified environmental and macroinvertebrate parameters can be used to determine the distribution of blackflies, which in turn can help control river blindness in endemic tropical places. Through a combination of modelling techniques, a reliable method has been developed that explains environmental and biological relationships with the target organism, and, thus, can serve as a decision support tool for ecological management strategies

Pharmacists in Pharmacovigilance: Can Increased Diagnostic Opportunity in Community Settings Translate to Better Vigilance?

The pharmacy profession has undergone substantial change over the last two to three decades. Whilst medicine supply still remains a central function, pharmacist’s roles and responsibilities have become more clinic and patient focused. In the community (primary care), pharmacists have become important providers of healthcare as Western healthcare policy advocates patient self-care. This has resulted in pharmacists taking on greater responsibility in managing minor illness and the delivery of public health interventions. These roles require pharmacists to more fully use their clinical skills, and often involve diagnosis and therapeutic management. Community pharmacists are now, more than ever before, in a position to identify, record and report medication safety incidents. However, current research suggests that diagnostic ability of community pharmacists is questionable and they infrequently report to local or national schemes. The aim of this paper is to highlight current practice and suggest ways in which community pharmacy can more fully contribute to patient safety

Do psychosocial interventions have an impact on maternal perception of perinatal depression?

YesPoor perinatal mental health, in particular depression, affects at least 10% of new mothers in the UK. Current best practice recommends the use of talking therapies or medication, however, many women choose not to use medication or are deterred from accessing NHS services for example due to immigration status. Those who can access NHS treatment often face a long waiting list to see a clinician or therapist. Untreated perinatal depression impacts on the health and wellbeing of mothers and babies, consequently it is essential that alternative psychosocial interventions delivered by non-clinicians are considered. A systematic review was conducted on seven quantitative studies examining the effect of psychosocial interventions in reducing maternal symptoms of depression. Interventions focused either on physical activity or peer support, measuring depression scores on a validated screening tool. The review concludes that antenatal group peer support may benefit women in the antenatal period and that postnatal peer telephone support may be helpful for primiparous women but further large scale research is required

Measurement of the inclusive and dijet cross-sections of b-jets in pp collisions at sqrt(s) = 7 TeV with the ATLAS detector

The inclusive and dijet production cross-sections have been measured for jets containing b-hadrons (b-jets) in proton-proton collisions at a centre-of-mass energy of sqrt(s) = 7 TeV, using the ATLAS detector at the LHC. The measurements use data corresponding to an integrated luminosity of 34 pb^-1. The b-jets are identified using either a lifetime-based method, where secondary decay vertices of b-hadrons in jets are reconstructed using information from the tracking detectors, or a muon-based method where the presence of a muon is used to identify semileptonic decays of b-hadrons inside jets. The inclusive b-jet cross-section is measured as a function of transverse momentum in the range 20 < pT < 400 GeV and rapidity in the range |y| < 2.1. The bbbar-dijet cross-section is measured as a function of the dijet invariant mass in the range 110 < m_jj < 760 GeV, the azimuthal angle difference between the two jets and the angular variable chi in two dijet mass regions. The results are compared with next-to-leading-order QCD predictions. Good agreement is observed between the measured cross-sections and the predictions obtained using POWHEG + Pythia. MC@NLO + Herwig shows good agreement with the measured bbbar-dijet cross-section. However, it does not reproduce the measured inclusive cross-section well, particularly for central b-jets with large transverse momenta.Comment: 10 pages plus author list (21 pages total), 8 figures, 1 table, final version published in European Physical Journal

TDP-43 stabilises the processing intermediates of mitochondrial transcripts

The 43-kDa trans-activating response region DNA-binding protein 43 (TDP-43) is a product of a causative gene for amyotrophic lateral sclerosis (ALS). Despite of accumulating evidence that mitochondrial dysfunction underlies the pathogenesis of TDP-43–related ALS, the roles of wild-type TDP-43 in mitochondria are unknown. Here, we show that the small TDP-43 population present in mitochondria binds directly to a subset of mitochondrial tRNAs and precursor RNA encoded in L-strand mtDNA. Upregulated expression of TDP-43 stabilised the processing intermediates of mitochondrial polycistronic transcripts and their products including the components of electron transport and 16S mt-rRNA, similar to the phenotype observed in cells deficient for mitochondrial RNase P. Conversely, TDP-43 deficiency reduced the population of processing intermediates and impaired mitochondrial function. We propose that TDP-43 has a novel role in maintaining mitochondrial homeostasis by regulating the processing of mitochondrial transcripts

Over-Selectivity is Related to Autism Quotient and Empathizing, But not to Systematizing

The relationships of autism quotient (AQ), systematizing (SQ), and empathizing (EQ), with over-selectivity were explored to assess whether over-selectivity is implicated in complex social skills, which has been assumed, but not experimentally examined. Eighty participants (aged 18–60) were trained on a simultaneous discrimination task (AB+CD−), and tested in extinction on the degree to which they had learned about both elements of the reinforced (AB) compound. Higher AQ and lower EQ scorers demonstrated greater over-selectivity, but there was no relationship between SQ and over-selectivity. These results imply that high AQ scorers perform similarly to individuals with ASD on this cognitive task, and that over-selectivity may be related to some complex social skills, like empathy

Development and implementation of rapid metabolic engineering tools for chemical and fuel production in Geobacillus thermoglucosidasius NCIMB 11955

Background The thermophile Geobacillus thermoglucosidasius has considerable attraction as a chassis for the production of chemicals and fuels. It utilises a wide range of sugars and oligosaccharides typical of those derived from lignocellulose and grows at elevated temperatures. The latter improves the rate of feed conversion, reduces fermentation cooling costs and minimises the risks of contamination. Full exploitation of its potential has been hindered by a dearth of effective gene tools. Results Here we designed and tested a collection of vectors (pMTL60000 series) in G. thermoglucosidasius NCIMB 11955 equivalent to the widely used clostridial pMTL80000 modular plasmid series. By combining a temperature-sensitive replicon and a heterologous pyrE gene from Geobacillus kaustophilus as a counter-selection marker, a highly effective and rapid gene knock-out/knock-in system was established. Its use required the initial creation of uracil auxotroph through deletion of pyrE using allele-coupled exchange (ACE) and selection for resistance to 5-fluoroorotic acid. The turnaround time for the construction of further mutants in this pyrE minus strain was typically 5 days. Following the creation of the desired mutant, the pyrE allele was restored to wild type, within 3 days, using ACE and selection for uracil prototrophy. Concomitant with this process, cargo DNA (pheB) could be readily integrated at the pyrE locus. The system’s utility was demonstrated through the generation in just 30 days of three independently engineered strains equivalent to a previously constructed ethanol production strain, TM242. This involved the creation of two in-frame deletions (ldh and pfl) and the replacement of a promoter region of a third gene (pdh) with an up-regulated variant. In no case did the production of ethanol match that of TM242. Genome sequencing of the parental strain, TM242, and constructed mutant derivatives suggested that NCIMB 11955 is prone to the emergence of random mutations which can dramatically affect phenotype. Conclusions The procedures and principles developed for clostridia, based on the use of pyrE alleles and ACE, may be readily deployed in G. thermoglucosidasius. Marker-less, in-frame deletion mutants can be rapidly generated in 5 days. However, ancillary mutations frequently arise, which can influence phenotype. This observation emphasises the need for improved screening and selection procedures at each step of the engineering processes, based on the generation of multiple, independent strains and whole-genome sequencing