Associations between introduction and withdrawal of a financial incentive and timing of attendance for antenatal care and incidence of small for gestational age: natural experimental evaluation using interrupted time series methods.

OBJECTIVES: To determine whether introduction or withdrawal of a maternal financial incentive was associated with changes in timing of first attendance for antenatal care ('booking'), or incidence of small for gestational age. DESIGN: A natural experimental evaluation using interrupted time series analysis. SETTING: A hospital-based maternity unit in the north of England. PARTICIPANTS: 34 589 women (and their live-born babies) who delivered at the study hospital and completed the 25th week of pregnancy in the 75 months before (January 2003 to March 2009), 21 months during (April 2009 to December 2010) and 36 months after (January 2011 to December 2013) the incentive was available. INTERVENTION: The Health in Pregnancy Grant was a financial incentive of £190 ($235; €211) payable to pregnant women in the UK from the 25th week of pregnancy, contingent on them receiving routine antenatal care. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was mean gestational age at booking. Secondary outcomes were proportion of women booking by 10, 18 and 25 weeks' gestation; and proportion of babies that were small for gestational age. RESULTS: By 21 months after introduction of the grant (ie, immediately prior to withdrawal), compared with what was predicted given prior trends, there was an reduction in mean gestational age at booking of 4.8 days (95% CI 2.3 to 8.2). The comparable figure for 24 months after withdrawal was an increase of 14.0 days (95% CI 2.8 to 16.8). No changes in incidence of small for gestational age babies were seen. CONCLUSIONS: The introduction of a universal financial incentive for timely attendance at antenatal care was associated with a reduction in mean gestational age at first attendance, but not the proportion of babies that were small for gestational age. Future research should explore the effects of incentives offered at different times in pregnancy and of differing values; and how stakeholders view such incentives

Spatial risk factors for Pillar 1 COVID-19 excess cases and mortality in rural eastern England, UK

Understanding is still developing about spatial risk factors for COVID-19 infection or mortality. This is a secondary analysis of patient records in a confined area of eastern England, covering persons who tested positive for SARS-CoV-2 through end May 2020, including dates of death and residence area. We obtained residence area data on air quality, deprivation levels, care home bed capacity, age distribution, rurality, access to employment centers, and population density. We considered these covariates as risk factors for excess cases and excess deaths in the 28 days after confirmation of positive Covid status relative to the overall case load and death recorded for the study area as a whole. We used the conditional autoregressive Besag—York–Mollie model to investigate the spatial dependency of cases and deaths allowing for a Poisson error structure. Structural equation models were applied to clarify relationships between predictors and outcomes. Excess case counts or excess deaths were both predicted by the percentage of population age 65 years, care home bed capacity and less rurality: older population and more urban areas saw excess cases. Greater deprivation did not correlate with excess case counts but was significantly linked to higher mortality rates after infection. Neither excess cases nor excess deaths were predicted by population density, travel time to local employment centers, or air quality indicators. Only 66% of mortality was explained by locally high case counts. Higher deprivation clearly linked to higher COVID-19 mortality separate from wider community prevalence and other spatial risk factors

Site-selective and rewritable labeling of DNA through enzymatic, reversible, and click chemistries

International audienc

Particulate matter exposure during pregnancy is associated with birth weight, but not gestational age, 1962-1992: a cohort study

<p>Abstract</p> <p>Background</p> <p>Exposure to air pollutants is suggested to adversely affect fetal growth, but the evidence remains inconsistent in relation to specific outcomes and exposure windows.</p> <p>Methods</p> <p>Using birth records from the two major maternity hospitals in Newcastle upon Tyne in northern England between 1961 and 1992, we constructed a database of all births to mothers resident within the city. Weekly black smoke exposure levels from routine data recorded at 20 air pollution monitoring stations were obtained and individual exposures were estimated via a two-stage modeling strategy, incorporating temporally and spatially varying covariates. Regression analyses, including 88,679 births, assessed potential associations between exposure to black smoke and birth weight, gestational age and birth weight standardized for gestational age and sex.</p> <p>Results</p> <p>Significant associations were seen between black smoke and both standardized and unstandardized birth weight, but not for gestational age when adjusted for potential confounders. Not all associations were linear. For an increase in whole pregnancy black smoke exposure, from the 1^st(7.4 μg/m³) to the 25^th(17.2 μg/m³), 50^th(33.8 μg/m³), 75^th(108.3 μg/m³), and 90^th(180.8 μg/m³) percentiles, the adjusted estimated decreases in birth weight were 33 g (SE 1.05), 62 g (1.63), 98 g (2.26) and 109 g (2.44) respectively. A significant interaction was observed between socio-economic deprivation and black smoke on both standardized and unstandardized birth weight with increasing effects of black smoke in reducing birth weight seen with increasing socio-economic disadvantage.</p> <p>Conclusions</p> <p>The findings of this study progress the hypothesis that the association between black smoke and birth weight may be mediated through intrauterine growth restriction. The associations between black smoke and birth weight were of the same order of magnitude as those reported for passive smoking. These findings add to the growing evidence of the harmful effects of air pollution on birth outcomes.</p

Impact of non-pharmaceutical interventions against COVID-19 in Europe in 2020:a quasi-experimental non-equivalent group and time series design study

IntroductionThe current pandemic of coronavirus disease (COVID-19) is unparalleled in recent history as are the social distancing interventions that have led to a considerable halt on the economic and social life of so many countries.AimWe aimed to generate empirical evidence about which social distancing measures had the most impact in reducing case counts and mortality.MethodsWe report a quasi-experimental (observational) study of the impact of various interventions for control of the outbreak through 24 April 2020. Chronological data on case numbers and deaths were taken from the daily published figures by the European Centre for Disease Prevention and Control and dates of initiation of various control strategies from the Institute of Health Metrics and Evaluation website and published sources. Our complementary analyses were modelled in R using Bayesian generalised additive mixed models and in STATA using multilevel mixed-effects regression models.ResultsFrom both sets of modelling, we found that closure of education facilities, prohibiting mass gatherings and closure of some non-essential businesses were associated with reduced incidence whereas stay-at-home orders and closure of additional non-essential businesses was not associated with any independent additional impact.ConclusionsOur findings are that schools and some non-essential businesses operating 'as normal' as well as allowing mass gatherings were incompatible with suppressing disease spread. Closure of all businesses and stay at home orders are less likely to be required to keep disease incidence low. Our results help identify what were the most effective non-pharmaceutical interventions in this period

Relationship between soil fungal diversity and temperature in the maritime Antarctic

Soil fungi have pivotal ecological roles as decomposers, pathogens and symbionts1, 2. Alterations to their diversity arising from climate change could have substantial effects on ecosystems, particularly those undergoing rapid warming that contain few species3, 4. Here, we report a study using pyrosequencing to assess fungal diversity in 29 soils sampled from a 1,650 km climatic gradient through the maritime Antarctic, the most rapidly warming region in the Southern Hemisphere5, 6. Using a ‘space-for-time’ substitution approach, we show that soil fungal diversity is higher in warmer habitats, with increases of 4.7 (observed) and 11.3 (predicted) fungal taxa per degree Celsius rise in surface temperature along the transect. Among 22 predictor variables, air temperature was the strongest and most consistent predictor of diversity. We propose that the current rapid warming in the maritime Antarctic (0.34 °C per decade6) will facilitate the colonization of soil by a wider diversity of fungi than at present, with data from regression models suggesting 20–27% increases in fungal species richness in the southernmost soils by 2100. Such increases in diversity, which provide a sentinel for changes at lower latitudes, are likely to have substantial effects on nutrient cycling and, ultimately, productivity in the species-poor soils of maritime Antarctica

No association between ambient particulate matter exposure during pregnancy and stillbirth risk in the north of England, 1962–1992

Objectives: Research evidence suggests that exposure to ambient air pollutants can adversely affect the growth and development of the foetus and infant survival. Much less is known regarding the potential for an association between black smoke air pollution and stillbirth risk. This potential association was examined using data from the historical cohort UK Particulate Matter and Perinatal Events Research (PAMPER) study. Methods: Using data from paper-based neonatal records from the two major maternity hospitals in Newcastle upon Tyne (UK), a birth record database of all singletons born during 1961–1992 to mothers resident in the city was constructed. Weekly black smoke levels were obtained from routine data recorded at 20 air pollution monitoring stations over the study period. A two-stage statistical modelling strategy was used, incorporating temporally and spatially varying covariates to estimate black smoke exposure during each trimester and for the whole pregnancy period for each individual pregnancy. Conditional logistic regression models, with stratification on year of birth, were used to assess potential associations between black smoke exposures in pregnancy and stillbirth risk. Results: The PAMPER database consists of 90,537 births, between 1962 and 1992, with complete gestational age and residential address information, of which 812 were stillborn. There was no association between black smoke exposures in any trimester or across whole pregnancy and risk of stillbirth. Adjustment for potential confounders did not alter these results. Conclusions: While black smoke in pregnancy is likely to be related to other pregnancy outcomes, our findings do not suggest that black smoke air pollution exposure during pregnancy increases the risk of stillbirth

Evaluation of a complex healthcare intervention to increase smoking cessation in pregnant women: interrupted time series analysis with economic evaluation

Objectives To evaluate the effectiveness of a complex intervention to improve referral and treatment of pregnant smokers in routine practice, and to assess the incremental costs to the National Health Service (NHS) per additional woman quitting smoking. Design Interrupted time series analysis of routine data before and after introducing the intervention, within-study economic evaluation. Setting Eight acute NHS hospital trusts and 12 local authority areas in North East England. Participants 37 726 records of singleton delivery including 10 594 to mothers classified as smoking during pregnancy. Interventions A package of measures implemented in trusts and smoking cessation services, aimed at increasing the proportion of pregnant smokers quitting during pregnancy, comprising skills training for healthcare and smoking cessation staff; universal carbon monoxide monitoring with routine opt-out referral for smoking cessation support; provision of carbon monoxide monitors and supporting materials; and an explicit referral pathway and follow-up protocol. Main outcome measures Referrals to smoking cessation services; probability of quitting smoking during pregnancy; additional costs to health services; incremental cost per additional woman quitting. Results After introduction of the intervention, the referral rate increased more than twofold (incidence rate ratio=2.47, 95% CI 2.16 to 2.81) and the probability of quitting by delivery increased (adjusted OR=1.81, 95% CI 1.54 to 2.12). The additional cost per delivery was £31 and the incremental cost per additional quit was £952; 31 pregnant women needed to be treated for each additional quitter. Conclusions The implementation of a system-wide complex healthcare intervention was associated with significant increase in rates of quitting by delivery

A synopsis of the Ordovician System in its birthplace - Britain and Ireland

Rock successions in Britain and Ireland, and more especially those in North Wales, were instrumental in the founding and naming of the Ordovician System, and the Anglo-Welsh series established both initially and subsequently were used widely as a standard for Ordovician chronostratigraphy. Although now largely superseded in the global scheme of series and stages, they retain their local and regional importance. The Ordovician System in Britain and Ireland documents the history of a segment of the Earth's crust that incorporated opposing peri-Gondwanan and peri-Laurentian/Laurentian margins of the Iapetus Ocean during its closure, and is accordingly complex. The complexity arises from the volcanic and tectonic processes that accompanied oceanic closure coupled with the effects of eustatic sea-level changes, including the far-field effects of the Late Ordovician glaciation. For the past three decades, Ordovician successions in Britain and Ireland have been discussed in terms of terranes. Here we review Ordovician successions in each terrane, incorporating the results of recent research and correlating those successions via biostratigraphical schemes and radiometric dates to the global Ordovician series and stages

Age and geochemistry of the Charlestown Group, Ireland:Implications for the Grampian orogeny, its mineral potential and the Ordovician timescale

Accurately reconstructing the growth of continental margins during episodes of ocean closure has important implications for understanding the formation, preservation and location of mineral deposits in ancient orogens. The Charlestown Group of county Mayo, Ireland, forms an important yet understudied link in the Caledonian-Appalachian orogenic belt located between the well documented sectors of western Ireland and Northern Ireland. We have reassessed its role in the Ordovician Grampian orogeny, based on new fieldwork, high-resolution airborne geophysics, graptolite biostratigraphy, U–Pb zircon dating, whole rock geochemistry, and an examination of historic drillcore from across the volcanic inlier. The Charlestown Group can be divided into three formations: Horan, Carracastle, and Tawnyinah. The Horan Formation comprises a mixed sequence of tholeiitic to calc-alkaline basalt, crystal tuff and sedimentary rocks (e.g. black shale, chert), forming within an evolving peri-Laurentian affinity island arc. The presence of graptolites Pseudisograptus of the manubriatus group and the discovery of Exigraptus uniformis and Skiagraptus gnomonicus favour a latest Dapingian (i.e. Yapeenian Ya 2/late Arenig) age for the Horan Formation (equivalent to c. 471.2–470.5 Ma according to the timescale of Sadler et al., 2009). Together with three new U–Pb zircon ages of 471.95–470.82 Ma from enclosing felsic tuffs and volcanic breccias, this fauna provides an important new constraint for calibrating the Middle Ordovician timescale. Overlying deposits of the Carracastle and Tawnyinah formations are dominated by LILE- and LREE-enriched calc-alkaline andesitic tuffs and flows, coarse volcanic breccias and quartz-feldspar porphyritic intrusive rocks, overlain by more silicic tuffs and volcanic breccias with rare occurrences of sedimentary rocks. The relatively young age for the Charlestown Group in the Grampian orogeny, coupled with high Th/Yb and zircon inheritance (c. 2.7 Ga) in intrusive rocks indicate that the arc was founded upon continental crust (either composite Laurentian margin or microcontinental block). Regional correlation is best fitted to an association with the post-subduction flip volcanic/intrusive rocks of the Irish Caledonides, specifically the late-stage development of the Tyrone Igneous Complex, intrusive rocks of Connemara (western Ireland) and the Slishwood Division (Co. Sligo). Examination of breccia textures and mineralization across the volcanic inlier questions the previous porphyry hypothesis for the genesis of the Charlestown Cu deposit, which are more consistent with a volcanogenic massive sulfide (VMS) deposit.</p