Interventions for the prevention of spontaneous preterm birth : a scoping review of systematic reviews

Background: Globally, 11% of babies are born preterm each year. Preterm birth (PTB) a leading cause of neonatal death and under-5 mortality and morbidity, with lifelong sequelae in those who survive. PTB disproportionately impacts low- and middle income countries (LMICs) where the burden is highest. Objectives: This scoping review sought to map the evidence for interventions that reduce the risk of PTB, focusing on the evidence from LMICs and describing how context is considered in evidence synthesis. Design: We conducted a scoping review, to describe this wide topic area. We searched five electronic databases (2009-2020) and contacted experts to identify relevant systematic reviews of interventions to reduce the risk of PTB. We included published systematic reviews that examined the effectiveness of interventions and their effect on reducing the risk of PTB. Data was extracted and is described narratively. Results: 139 published systematic reviews were included in the review. Interventions were categorised as primary or secondary. The interventions where the results showed a greater effect size and consistency across review findings included treatment of syphilis and vaginal candidiasis, vitamin D supplementation and cervical cerclage. Included in the 139 reviews were 1372 unique primary source studies. 28% primary studies were undertaken in LMIC contexts and only 4.5% undertaken in a low income country (LIC) Only 10.8% of the reviews sought to explore the impact of context on findings, and 19.4% reviews did not report the settings or the primary studies Conclusion: This scoping review highlights the lack of research evidence derived from contexts where the burden of PTB globally is greatest. The lack of rigour in addressing contextual applicability within systematic review methods is also highlighted. This presents a risk of inappropriate and unsafe recommendations for practice within these contexts. It also highlights a need for primary research, developing and testing interventions LIC settings

Impact of a school‐based nutrition educational intervention on knowledge related to iron deficiency anaemia in rural Karnataka, India: A mixed methods pre–post interventional study

Objective To understand the extent to which adolescent awareness about anaemia and anaemia prevention can be changed by nutrition messages received at school. Design Mixed-methods pre–post intervention study. Setting Three government schools in Bagalkot, Belagavi and Raichur districts of Karnataka, India. Population Students of grade six and seven and teachers involved in implementing the intervention. Methods An educational intervention was co-developed by school teachers and nutrition experts using locally adapted resource materials that consisted of lectures, role play and practical demonstrations. Seven half-hour educational sessions were delivered by school teachers over 7 weeks to 455 students. Pre- and post-intervention tests measured changes in adolescents' knowledge about anaemia. Semi-structured in-depth interviews with teachers and focus groups with students explored their reactions to the intervention. Main outcome measures Knowledge score related to anaemia. Results The percentage of children with correct scores increased by 7.3–49.0 percentage points for the tested questions after implementation of the intervention. The mean knowledge score increased by 3.67 ± 0.17 (p < 0.01). During interviews, teachers and students highlighted high acceptance of the intervention and materials, an increase in awareness, a positive attitude towards changing behaviour around diet, an increase in the demand for iron and folic acid supplements and improved sharing of messages learned with peers and families. Challenges expressed included need for further training, time limitations and hesitancy in teaching about menstruation and pregnancy. Conclusions Educational interventions carried out for adolescents by teachers in schools are effective in improving awareness and attitude related to anaemia and its prevention

Propuesta guía para una planeación y ejecución en proyectos de vivienda unifamiliar con enfoque Lean Construction

Trabajo de investigaciónEste trabajo contempla el desarrollo de una matriz enfocada en la metodología Lean Construction para la planeación y ejecución en proyectos de vivienda unifamiliar. Así mismo se evidencia un análisis de manera cuantitativa y cualitativamente en la adopción de la filosofía Lean Construction en procesos de la gestión de la planeación y ejecución de proyectos, que permite establecer un orden de actividades y sub actividades que componen las fases de un proyecto de vivienda unifamiliar en la relación del alcance exitoso en productividad y rendimiento.INTRODUCCIÓN 1. GENERALIDADES 2. METODOLOGÍAS EN EL MARCO DE LA PLANEACIÓN Y EJECUCIÓN DE PROYECTOS 3. LEAN CONSTRUCTION EN ACTIVIDADES DE CONSTRUCCIÓN 4. IMPLEMENTACIÓN DE LA MATRIZ EN CASO DE ESTUDIO 5. CONCLUSIONES 6. RECOMENDACIONES BIBLIOGRAFÍA ANEXOSPregradoIngeniero Civi

Routine Antenatal Anti-D Prophylaxis in Women Who Are Rh(D) Negative: Meta-Analyses Adjusted for Differences in Study Design and Quality

Background: To estimate the effectiveness of routine antenatal anti-D prophylaxis for preventing sensitisation in pregnant Rhesus negative women, and to explore whether this depends on the treatment regimen adopted. Methods: Ten studies identified in a previous systematic literature search were included. Potential sources of bias were systematically identified using bias checklists, and their impact and uncertainty were quantified using expert opinion. Study results were adjusted for biases and combined, first in a random-effects meta-analysis and then in a random-effects metaregression analysis. Results: In a conventional meta-analysis, the pooled odds ratio for sensitisation was estimated as 0.25 (95 % CI 0.18, 0.36), comparing routine antenatal anti-D prophylaxis to control, with some heterogeneity (I 2 = 19%). However, this naïve analysis ignores substantial differences in study quality and design. After adjusting for these, the pooled odds ratio for sensitisation was estimated as 0.31 (95 % CI 0.17, 0.56), with no evidence of heterogeneity (I 2 = 0%). A meta-regression analysis wa

Diagnosis and management of selective fetal growth restriction in monochorionic twin pregnancies: A cross-sectional international survey.

OBJECTIVE: To identify current practices in the management of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancies. DESIGN: Cross-sectional survey. SETTING: International. POPULATION: Clinicians involved in the management of MCDA twin pregnancies with sFGR. METHODS: A structured, self-administered survey. MAIN OUTCOME MEASURES: Clinical practices and attitudes to diagnostic criteria and management strategies. RESULTS: Overall, 62.8% (113/180) of clinicians completed the survey; of which, 66.4% (75/113) of the respondents reported that they would use an estimated fetal weight (EFW) of 25% for the diagnosis of sFGR. For early-onset type I sFGR, 79.8% (75/94) of respondents expressed that expectant management would be their routine practice. On the other hand, for early-onset type II and type III sFGR, 19.3% (17/88) and 35.7% (30/84) of respondents would manage these pregnancies expectantly, whereas 71.6% (63/88) and 57.1% (48/84) would refer these pregnancies to a fetal intervention centre or would offer fetal intervention for type II and type III cases, respectively. Moreover, 39.0% (16/41) of the respondents would consider fetoscopic laser surgery (FLS) for early-onset type I sFGR, whereas 41.5% (17/41) would offer either FLS or selective feticide, and 12.2% (5/41) would exclusively offer selective feticide. For early-onset type II and type III sFGR cases, 25.9% (21/81) and 31.4% (22/70) would exclusively offer FLS, respectively, whereas 33.3% (27/81) and 32.9% (23/70) would exclusively offer selective feticide. CONCLUSIONS: There is significant variation in clinician practices and attitudes towards the management of early-onset sFGR in MCDA twin pregnancies, especially for type II and type III cases, highlighting the need for high-level evidence to guide management

The Tommy’s Clinical Decision Tool, a device for reducing the clinical impact of placental dysfunction and preterm birth : protocol for a mixed-methods early implementation evaluation study

Background Disparities in stillbirth and preterm birth persist even after correction for ethnicity and social deprivation, demonstrating that there is wide geographical variation in the quality of care. To address this inequity, Tommy’s National Centre for Maternity Improvement developed the Tommy’s Clinical Decision Tool, which aims to support the provision of “the right care at the right time”, personalising risk assessment and care according to best evidence. This web-based clinical decision tool assesses the risk of preterm birth and placental dysfunction more accurately than current methods, and recommends best evidenced-based care pathways in a format accessible to both women and healthcare professionals. It also provides links to reliable sources of pregnancy information for women. The aim of this study is to evaluate implementation of Tommy’s Clinical Decision Tool in four early-adopter UK maternity services, to inform wider scale-up. Methods The Tommy’s Clinical Decision Tool has been developed involving maternity service users and healthcare professionals in partnership. This mixed-methods study will evaluate: maternity service user and provider acceptability and experience; barriers and facilitators to implementation; reach (whether particular groups are excluded and why), fidelity (degree to which the intervention is delivered as intended), and unintended consequences. Data will be gathered over 25 months through interviews, focus groups, questionnaires and through the Tommy’s Clinical Decision Tool itself. The NASSS framework (Non-adoption or Abandonment of technology by individuals and difficulties achieving Scale-up, Spread and Sustainability) will inform data analysis. Discussion This paper describes the intervention, Tommy’s Clinical Decision Tool, according to TiDIER guidelines, and the protocol for the early adopter implementation evaluation study. Findings will inform future scale up. Trial registration This study was prospectively registered on the ISRCTN registry no. 13498237, on 31st January 2022

E-readiness in construction: an incongruous paradigm of variables

The construction industry has witnessed unprecedented levels of technological change over the last 10 years in particular, the corollary of which has required key decision makers to fundamentally re-think the way they: (a) have undertaken business in the past; (b) are currently doing business at the moment; and, (c) will need to change their business practices in order to compete in the future. This research attempts to understand this trichotomy, with a specific emphasis on understanding key decision makers' perception of e-readiness within the context of the construction industry. Research findings highlighted the importance of People, Process and Technology, along with five core enablers that are deemed priority areas for operationalisation. The rubrics for managing these dependences are also discussed in the context of future leveraging opportunities. This research reports the significant importance of ICT to capture, store and reuse knowledge in the organisational and demonstrates the need for the organisation to be e-ready

Information Management in UK-Based Architecture and Engineering Organizations: Drivers, Constraining Factors, and Barriers

This article was published in the serial Journal of Management in Engineering [© ASCE]. The definitive version is available at: http://dx.doi.org/10.1061/(ASCE)ME.1943-5479.0000085The need to improve collaborative working, knowledge sharing, and operational effectiveness has made effective Information Management a growing priority for Architecture and Engineering (A & E) organizations in the UK construction industry. While significant research has been carried out in the construction industry on project Information Management, limited work has been carried out to understand Information Management from an organisational paradigm. This paper presents the findings of an investigation into the nature of Information Management within A & E organizations in the UK construction industry. Interviews were conducted with experts across nine large architectural and multidisciplinary consultancies, the outputs of which were analysed using thematic analysis. From this, 26 themes across three core categories classed as drivers, constraining factors, and barriers which shape Information Management practices in construction organizations emerged. The findings show that Information Management is indeed of strategic significance to organizations and an organizational dimension is necessary to better align information needs with an organisation’s operational processes. They also show that context-dependent factors exist which shape the nature of Information Management in line with the specific needs of each organizations. Therefore, the effectiveness of an organisation’s Information Management practices is not absolute, but rather relative to its level of alignment to the organisation’s chosen mode of operation. The findings provide a much needed practical view of the complexities of Information Management, highlighting that particularly within multidisciplinary organizations; a unifying approach is much more practical and appropriate than a single approach to managing information