Pregnancy and neonatal outcomes of COVID-19: The PAN-COVID study

Objective To assess perinatal outcomes for pregnancies affected by suspected or confirmed SARS-CoV-2 infection. Methods Prospective, web-based registry. Pregnant women were invited to participate if they had suspected or confirmed SARS-CoV-2 infection between 1st January 2020 and 31st March 2021 to assess the impact of infection on maternal and perinatal outcomes including miscarriage, stillbirth, fetal growth restriction, pre-term birth and transmission to the infant. Results Between April 2020 and March 2021, the study recruited 8239 participants who had suspected or confirmed SARs-CoV-2 infection episodes in pregnancy between January 2020 and March 2021. Maternal death affected 14/8197 (0.2%) participants, 176/8187 (2.2%) of participants required ventilatory support. Pre-eclampsia affected 389/8189 (4.8%) participants, eclampsia was reported in 40/ 8024 (0.5%) of all participants. Stillbirth affected 35/8187 (0.4 %) participants. In participants delivering within 2 weeks of delivery 21/2686 (0.8 %) were affected by stillbirth compared with 8/4596 (0.2 %) delivering ≥ 2 weeks after infection (95 % CI 0.3–1.0). SGA affected 744/7696 (9.3 %) of livebirths, FGR affected 360/8175 (4.4 %) of all pregnancies. Pre-term birth occurred in 922/8066 (11.5%), the majority of these were indicated pre-term births, 220/7987 (2.8%) participants experienced spontaneous pre-term births. Early neonatal deaths affected 11/8050 livebirths. Of all neonates, 80/7993 (1.0%) tested positive for SARS-CoV-2. Conclusions Infection was associated with indicated pre-term birth, most commonly for fetal compromise. The overall proportions of women affected by SGA and FGR were not higher than expected, however there was the proportion affected by stillbirth in participants delivering within 2 weeks of infection was significantly higher than those delivering ≥ 2 weeks after infection. We suggest that clinicians’ threshold for delivery should be low if there are concerns with fetal movements or fetal heart rate monitoring in the time around infection

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease

Greenwell, William (1820-1918)

Process controls on water, sediment, nutrient, and organic carbon exports from the landscape through runoff are not fully understood. This paper provides analyses from 446 sites worldwide to evaluate the impact of environmental factors (MAP and MAT: mean annual precipitation and temperature; CLAY and BD: soil clay content and bulk density; S: slope gradient; LU: land use) on annual exports (RC: runoff coefficients; SL: sediment loads; TOCL: organic carbon losses; TNL: nitrogen losses; TPL: phosphorus losses) from different spatial scales. RC was found to increase, on average, from 18% at local scale (in headwaters), 25% at microcatchment and subcatchment scale (midreaches) to 41% at catchment scale (lower reaches of river basins) in response to multiple factors. SL increased from microplots (468 g m?2 yr?1) to plots (901 g m?2 yr?1), accompanied by decreasing TOCL and TNL. Climate was a major control masking the effects of other factors. For example, RC, SL, TOCL, TNL, and TPL tended to increase with MAP at all spatial scales. These variables, however, decreased with MAT. The impact of CLAY, BD, LU, and S on erosion variables was largely confined to the hillslope scale, where RC, SL, and TOCL decreased with CLAY, while TNL and TPL increased. The results contribute to better understanding of water, nutrient, and carbon cycles in terrestrial ecosystems and should inform river basin modeling and ecosystem management. The important role of spatial climate variability points to a need for comparative research in specific environments at nested spatiotemporal scales

Conservation agriculture in Sub-Saharan Africa

Specific practices of conservation agriculture (CA) in sub-Saharan Africa are diverse and vary according to local farming conditions. However, despite more than two decades of investment in its development and dissemination, adoption of CA is low. Crop responses to CA are highly variable, and not always positive, which is an important hindrance for adoption, especially for resource-poor farmers who need immediate returns with their investments in CA in order to be able to feed their families. In contrast with commercial farms such as in Brazil, reduced costs with CA on smallholder farms in sub-Saharan Africa are not always observed. Another major challenge with the practice of CA is the use of crop residues for mulching since crop residues are a major source of feed for livestock, especially in semiarid regions, where biomass production is limited and livestock plays a crucial role in farming systems. Studies indicate that the three principles of CA, including mulching, are needed to increase crop yields compared with conventional tillage (CT)-based practices. Among the three principles of CA, mulching is certainly the one that is least observed in past and current cropping practices in Africa. CA has a potential to improve the soil water balance and increase soil fertility, and it is undoubtedly a cropping practice that can result in substantial benefits for certain farmers in Africa. The question is when and how it is the best approach for smallholder farmers in sub-Saharan Africa. In general, CA is more likely to be attractive for farmers with a strategy of intensification than for farmers who struggle to produce food for their family. The latter too often face multiple constraints that limit the possibilities to engage in technological innovations. Some farmers may not be interested in new technologies because they earn their income from off-farm activities. Good markets of input supply and sale of extra produce are a prerequisite condition for adoption of CA as they are for any other new agricultural technology that aims at intensification. In sub-Saharan Africa, there is certainly a need to better target CA to potential end users and adapt the CA practices to their local circumstances and specific farming contexts. (Résumé d'auteur