Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Food system value-chain adaptability - can new opportunities increase food security and food safety in Kibera? Linking aquaculture to urban food systems : Workshop Report - Discussing new opportunities with the aquaculture value-chains between Nyeri - Kibera

New business opportunities for aquaculture farmers in Nyeri and Kibera fish vendors – with potentials for real impact on food security in Kiber

Measurement of the ratio of the B0→D∗−τ+ντB^0 \to D^{*-} \tau^+ \nu_{\tau} and B0→D∗−μ+νμB^0 \to D^{*-} \mu^+ \nu_{\mu} branching fractions using three-prong τ\tau-lepton decays

International audienceThe ratio of branching fractions R(D*-)≡B(B0→D*-τ+ντ)/B(B0→D*-μ+νμ) is measured using a data sample of proton-proton collisions collected with the LHCb detector at center-of-mass energies of 7 and 8 TeV, corresponding to an integrated luminosity of 3  fb-1. For the first time, R(D*-) is determined using the τ-lepton decays with three charged pions in the final state. The B0→D*-τ+ντ yield is normalized to that of the B0→D*-π+π-π+ mode, providing a measurement of B(B0→D*-τ+ντ)/B(B0→D*-π+π-π+)=1.97±0.13±0.18, where the first uncertainty is statistical and the second systematic. The value of B(B0→D*-τ+ντ)=(1.42±0.094±0.129±0.054)% is obtained, where the third uncertainty is due to the limited knowledge of the branching fraction of the normalization mode. Using the well-measured branching fraction of the B0→D*-μ+νμ decay, a value of R(D*-)=0.291±0.019±0.026±0.013 is established, where the third uncertainty is due to the limited knowledge of the branching fractions of the normalization and B0→D*-μ+νμ modes. This measurement is in agreement with the standard model prediction and with previous results

First observation of B+→Ds+K+K−B^{+} \to D_s^{+}K^{+}K^{-} decays and a search for B+→Ds+ϕB^{+} \to D_s^{+}\phi decays

International audienceA search for B$^{+}$ → D$_{s}^{+}$ K$^{+}$K$^{−}$ decays is performed using pp collision data corresponding to an integrated luminosity of 4.8 fb$^{−1}$, collected at centre-of-mass energies of 7, 8 and 13 TeV with the LHCb experiment. A significant signal is observed for the first time and the branching fraction is determined to b

Geomechanical substantiation of reuse feasibility of development workings for coal mines

Дисертація на здобуття наукового ступеня кандидата технічних наук за спеціальністю 05.15.09 – «Геотехнічна і гірнича механіка». Державний вищий навчальний заклад «Національний гірничий університет», Дніпропетровськ, 2016.В дисертації обґрунтувані такі параметри комбінованої системи кріплення і охоронної конструкції на сполученні «штрек–лава», при яких можлива економічно доцільна повторна експлуатація підготовчих виробок в гірничо–геологічних умовах шахт ДП «Селідіввугілля». В результаті натурних вимірювань встановлено, що величина залишкового перерізу може виступати критерієм, що характеризує доцільність для повторного використання конвеєрного штреку на суміжній лаві. Такою величиною є залишкова площа в світлі, що дорівнює 8,5 м2. На основі обґрунтованого критерію вирішена чисельна задача про вплив різних систем охорони на НДС геомеханічної системи «кріплення – охоронна конструкція – масив». Встановлено, що при використанні охоронної конструкції у вигляді накатного костра зі шпального бруса в сукупності з дворівневою системою рамно–анкерного кріплення за лавою забезпечується збереження перерізу підготовчої виробки, що призначена для повторного використання. Досліджено вплив куту нахилу пласта на параметри прийнятої геомеханічної системи. Розробки були успішно реалізовані в промисловості з економічним ефектом 2 422 грн./м виробки.Цель работы состоит в геомеханическом обосновании таких параметров комбинированной системы крепи и охранной конструкции на сопряжении «штрек – лава», при которых возможна экономически целесообразная повторная эксплуатация подготовительных выработок в горно - геологических условиях шахт ГП «Селидовуголь». В качестве основного объекта исследований выбрана шахта «1/3 Новогродовская» ГП «Селидовуголь», где были выполнены комплексные исследования, заключавшиеся в визуальном обследовании ряда горных выработок, организации инструментальных наблюдений на замерных станциях, решении аналитических задач, а также проведении экспертной оценки состояния выемочных штреков и анализе архивных данных. В результате выполнения комплекса натурных измерений определены основные виды проявлений горного давления и ремонтных работ в подготовительных выработках, построены зависимости развития геомеханических процессов в их окрестности во времени и установлено, что величина остаточного сечения может выступать тем критерием, который характеризует целесообразность для повторного использования конвейерного штрека на смежной лаве. Критериальной величиной экономической рациональности повторного использования штрека является остаточная площадь в свету, равная 8,5 м2. На основе обоснованного критерия решена численная задача о влияние различных систем охраны на НДС геомеханической системы «крепь – охранная конструкция – массив». Установлено, что при использовании охранных конструкции в виде накатного костра из шпального бруса, выбраной по комплексу критериев «геомеханическая эффективность», «стоимость», «технологичность», в совокупности с двухуровневой системой рамно - анкерной крепи на основе сталеполимерных и канатных анкеров, за лавой обеспечивается сохранение сечения подготовительной выработки, применяемой для повторного использования. Такая система «крепь – охранная конструкция» принята как базовая. В горно–геологических условиях шахт Красноармейского промышленного района величина остаточного сечения конвейерного штрека, принятая в качестве критерия повторного использования подготовительных выработок, уменьшается при увеличении угла падения угольных пластов по линейному закону, что позволяет на этой основе корректировать базовый вариант системы крепи и охранной конструкции. Результаты внедрены в виде Рекомендации по геомеханическому обоснованию параметров рамно - анкерной крепи подготовительных выработок угольных шахт при отработке выемочного участка 18 южной лавы пл. l1 шахты «1/3 Новогродовская» и «Методики численного моделирования рамно –анкерной крепи подготовительных и капитальных выработок угольных шахт ГП «Селидовуголь», а также использованы в учебном процессе ГВУЗ «НГУ» при подготовке студентов ступеней «бакалавр» и «магистр» и образовательно–квалификационного уровня «специалист». Выполненная оценка экономической эффективности предложенных тех-нических решений, обеспечивающих повторное использование штрека показала, что ожидаемый экономический эффект, составляет 2422 грн./м выработки.The research purpose is geomechanical substantiation of such parameters of combined system of lining and support on the roadhead of roadway and longwall through which is possible and economically feasible to ensure the reuse of development workings under the mining and geological conditions of "Selidovugol" mines. As a result of the in–situ measurements revealed that the value of the remaining area can be a criteria that characterizes the feasibility for belt road reusing to adjacent longwall. Such value is the remaining area in the light that equal to 8.5 m2. On the basis of justified criteria the influence of various support systems on stress–deformed state of the geomechanical system "lining – support – array" was solved. It is established that a residual inside half–timbers of roadway can act the criteria that characterize suitable for reuse in development workings adjacent to the longwall. Economic rationality criteria for reuse roadway is a residual inside half–timbers, equal to 8.5 m2. It was found that by using a support system in the form of sawed stick crib, with the two – tier system of frame – bolt lining the criteria for development workings reuse was performed over the longwall. The influence of the angle of the bed at the geomechanical system parameters was adopted. The developments were successfully implemented and approbated. Economic effect is 2422 UAH on 1m

Measurement of the ratio of branching fractions B(Bc+ → J/ψτ+ντ)\mathcal{B}(B_c^+\,\to\,J/\psi\tau^+\nu_\tau)/B(Bc+ → J/ψμ+νμ)\mathcal{B}(B_c^+\,\to\,J/\psi\mu^+\nu_\mu)

International audienceA measurement is reported of the ratio of branching fractions R(J/ψ)=B(Bc+→J/ψτ+ντ)/B(Bc+→J/ψμ+νμ), where the τ+ lepton is identified in the decay mode τ+→μ+νμν¯τ. This analysis uses a sample of proton-proton collision data corresponding to 3.0  fb-1 of integrated luminosity recorded with the LHCb experiment at center-of-mass energies of 7 and 8 TeV. A signal is found for the decay Bc+→J/ψτ+ντ at a significance of 3 standard deviations corrected for systematic uncertainty, and the ratio of the branching fractions is measured to be R(J/ψ)=0.71±0.17(stat)±0.18(syst). This result lies within 2 standard deviations above the range of central values currently predicted by the standard model

Measurements of the branching fractions of Λc+→pπ−π+\Lambda_{c}^{+} \rightarrow p \pi^{-} \pi^{+}, Λc+→pK−K+\Lambda_{c}^{+} \rightarrow p K^{-} K^{+}, and Λc+→pπ−K+\Lambda_{c}^{+} \rightarrow p \pi^{-} K^{+}

International audienceThe ratios of the branching fractions of the decays Λ$_{c}^{+}$  → pπ$^{−}$π$^{+}$, Λ$_{c}^{+}$  → pK$^{−}$K$^{+}$, and Λ$_{c}^{+}$  → pπ$^{−}$K$^{+}$ with respect to the Cabibbo-favoured Λ$_{c}^{+}$  → pK$^{−}$π$^{+}$ decay are measured using proton-proton collision data collected with the LHCb experiment at a 7 TeV centre-of-mass energy and corresponding to an integrated luminosity of 1.0 fb$^{−1}$: \begin{array}{l}\frac{\mathrm{\mathcal{B}}\left({\varLambda}_c^{+}\to p{\pi}^{-}{\pi}^{+}\right)}{\mathrm{\mathcal{B}}\left({\varLambda}_c^{+}\to p{K}^{-}{\pi}^{+}\right)}=\left(7.44\pm 0.08\pm 0.18\right)\%,\hfill \\ {}\frac{\mathrm{\mathcal{B}}\left({\varLambda}_c^{+}\to p{K}^{-}{K}^{+}\right)}{\mathrm{\mathcal{B}}\left({\varLambda}_c^{+}\to p{K}^{-}{\pi}^{+}\right)}=\left(1.70\pm 0.03\pm 0.03\right)\%\hfill \\ {}\frac{\mathrm{\mathcal{B}}\left({\varLambda}_c^{+}\to p{\pi}^{-}{K}^{+}\right)}{\mathrm{\mathcal{B}}\left({\varLambda}_c^{+}\to p{K}^{-}{\pi}^{+}\right)}=\left(0.165\pm 0.015\pm 0.005\right)\%,\hfill \end{array} where the uncertainties are statistical and systematic, respectively. These results are the most precise measurements of these quantities to date. When multiplied by the world-average value for $\mathrm{\mathcal{B}}\left({\varLambda}_c^{+}\to p{K}^{-}{\pi}^{+}\right)$ , the corresponding branching fractions are \begin{array}{l}\mathrm{\mathcal{B}}\left({\varLambda}_c^{+}\to p{\pi}^{-}{\pi}^{+}\right)=\left(4.72\pm 0.05\pm 0.11\pm 0.25\right)\times {10}^{-3},\hfill \\ {}\mathrm{\mathcal{B}}\left({\varLambda}_c^{+}\to p{K}^{-}{K}^{+}\right)=\left(1.08\pm 0.02\pm 0.02\pm 0.06\right)\times {10}^{-3},\hfill \\ {}\mathrm{\mathcal{B}}\left({\varLambda}_c^{+}\to p{\pi}^{-}{K}^{+}\right)=\left(1.04\pm 0.09\pm 0.03\pm 0.05\right)\times {10}^{-4},\hfill \end{array} where the final uncertainty is due to $\mathrm{\mathcal{B}}\left({\varLambda}_c^{+}\to p{K}^{-}{\pi}^{+}\right)$