Complex interventions in midwifery care: Reflections on the design and evaluation of an algorithm for the diagnosis of labour

Randomised controlled trials are the ‘gold standard’ for evaluating the effectiveness of interventions in health-care settings. However, in midwifery care, many interventions are ‘complex’, comprising a number of different elements which may have an effect on the impact of the intervention in health-care settings. In this paper we reflect on our experience of designing and evaluating a complex intervention (a decision tool to assist with the diagnosis of labour in midwifery care), examining some of the issues that our study raises for future research in complex interventions

Critical phenomena from the two-particle irreducible 1/N expansion

The 1/N expansion of the two-particle irreducible (2PI) effective action is employed to compute universal properties at the second-order phase transition of an O(N)-symmetric N-vector model directly in three dimensions. At next-to-leading order the approach cures the spurious small-N divergence of the standard (1PI) 1/N expansion for a computation of the critical anomalous dimension eta(N), and leads to improved estimates already for moderate values of N.Comment: 18 pages, 3 figure

Best Practice Guidelines for Responsible Images of Non-Human Primates

Photos or videos (hereafter images) can draw the attention of millions of people to non-human primate (hereafter primate) conservation and welfare. However, if the context of the images is inappropriate, unclear, or lost, people may draw mistaken conclusions about the content. These mistaken conclusions can have unintended, negative consequences for primate welfare and conservation (Aldrich 2018; Wallis 2018; Norconk et al. 2019). The potential for the dissemination of images without appropriate context is a particular concern on social media

Fast field-cycling magnetic resonance detection of intracellular ultra-small iron oxide particles in vitro: Proof-of-concept.

PurposeInflammation is central in disease pathophysiology and accurate methods for its detection and quantification are increasingly required to guide diagnosis and therapy. Here we explored the ability of Fast Field-Cycling Magnetic Resonance (FFC-MR) in quantifying the signal of ultra-small superparamagnetic iron oxide particles (USPIO) phagocytosed by J774 macrophage-like cells as a proof-of-principle.MethodsRelaxation rates were measured in suspensions of J774 macrophage-like cells loaded with USPIO (0-200 μg/ml Fe as ferumoxytol), using a 0.25 T FFC benchtop relaxometer and a human whole-body, in-house built 0.2 T FFC-MR prototype system with a custom test tube coil. Identical non-imaging, saturation recovery pulse sequence with 90° flip angle and 20 different evolution fields selected logarithmically between 80 μT and 0.2 T (3.4 kHz and 8.51 MHz proton Larmor frequency [PLF] respectively). Results were compared with imaging flow cytometry quantification of side scatter intensity and USPIO-occupied cell area. A reference colorimetric iron assay was used.ResultsThe T1 dispersion curves derived from FFC-MR were excellent in detecting USPIO at all concentrations examined (0-200 μg/ml Fe as ferumoxytol) vs. control cells, p ≤ 0.001. FFC-NMR was capable of reliably detecting cellular iron content as low as 1.12 ng/µg cell protein, validated using a colorimetric assay. FFC-MR was comparable to imaging flow cytometry quantification of side scatter intensity but superior to USPIO-occupied cell area, the latter being only sensitive at exposures ≥ 10 µg/ml USPIO.ConclusionsWe demonstrated for the first time that FFC-MR is capable of quantitative assessment of intra-cellular iron which will have important implications for the use of USPIO in a variety of biological applications, including the study of inflammation

Hippocampal sequencing mechanisms are disrupted in a maternal immune activation model of schizophrenia risk

Episodic memory requires information to be stored and recalled in sequential order, and these processes are disrupted in schizophrenia. Hippocampal phase precession and theta sequences are thought to provide a biological mechanism for sequential ordering of experience at timescales suitable for plasticity. These phenomena have not previously been examined in any models of schizophrenia risk. Here, we examine these phenomena in a maternal immune activation (MIA) rodent model. We show that while individual pyramidal cells in the CA1 region continue to precess normally in MIA animals, the starting phase of precession as an animal enters a new place field is considerably more variable in MIA animals than in controls. A critical consequence of this change is a disorganization of the ordered representation of experience via theta sequences. These results provide the first evidence of a biological-level mechanism that, if it occurs in schizophrenia, may explain aspects of disorganized sequential processing that contribute to the cognitive symptoms of the disorder

Four patients with a history of acute exacerbations of COPD: implementing the CHEST/Canadian Thoracic Society guidelines for preventing exacerbations

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Comparison of ultra-low, low and high concentration local anaesthetic for labour epidural analgesia: a systematic review and network meta-analysis

Lumbar epidural is the gold standard for labour analgesia. Low concentrations of local anaesthetic are recommended. This network meta-analysis investigated whether further reducing the concentration of local anaesthetic can improve maternal and neonatal outcomes without compromising analgesia. We conducted a systematic search of relevant databases for randomised controlled trials comparing high (>0.1%), low (>0.08% to ≤0.1%) or ultra-low (≤0.08%) concentration local anaesthetic (bupivacaine or equivalent) for labour epidural. Outcomes included mode of delivery, duration of labour and maternal/neonatal outcomes. Bayesian network meta-analysis with random-effects modelling was used to calculate odds ratios or weighted mean differences and 95% credible intervals. A total of 32 studies met inclusion criteria (3665 women). The total dose of local anaesthetic received increased as the concentration increased; ultra-low compared with low (weighted mean difference −14.96 mg, 95% credible interval [−28.38 to −1.00]) and low compared with high groups (weighted mean difference −14.99 [−28.79 to −2.04]), though there was no difference in the number of rescue top-ups administered between the groups. Compared with high concentration, ultra-low concentration local anaesthetic was associated with increased likelihood of spontaneous vaginal delivery (OR 1.46 [1.18 to 1.86]), reduced motor block (Bromage score >0; OR 0.32 [0.18 to 0.54]) and reduced duration of second stage of labour (weighted mean difference −13.02 min [−21.54 to −4.77]). Compared with low, ultra-low concentration local anaesthetic had similar estimates for duration of second stage of labour (weighted mean difference −1.92 min [−14.35 to 10.20]); spontaneous vaginal delivery (OR 1.07 [0.75 to 1.56]; assisted vaginal delivery (OR 1.35 [0.75 to 2.26]); caesarean section (OR 0.76 [0.49 to 1.22]); pain (scale 1–100, weighted mean difference −5.44 [−16.75 to 5.93]); and maternal satisfaction. Although a lower risk of an Apgar score < 7 at 1 min (OR 0.43 [0.15 to 0.79]) was reported for ultra-low compared with low concentration, this was not sustained at 5 min (OR 0.12 [0.00 to 2.10]). Ultra-low concentration local anaesthetic for labour epidural achieves similar or better maternal and neonatal outcomes as low and high concentration, but with reduced local anaesthetic consumption

A Feasibility Study of Quantifying Longitudinal Brain Changes in Herpes Simplex Virus (HSV) Encephalitis Using Magnetic Resonance Imaging (MRI) and Stereology.

OBJECTIVES: To assess whether it is feasible to quantify acute change in temporal lobe volume and total oedema volumes in herpes simplex virus (HSV) encephalitis as a preliminary to a trial of corticosteroid therapy. METHODS: The study analysed serially acquired magnetic resonance images (MRI), of patients with acute HSV encephalitis who had neuroimaging repeated within four weeks of the first scan. We performed volumetric measurements of the left and right temporal lobes and of cerebral oedema visible on T2 weighted Fluid Attenuated Inversion Recovery (FLAIR) images using stereology in conjunction with point counting. RESULTS: Temporal lobe volumes increased on average by 1.6% (standard deviation (SD 11%) in five patients who had not received corticosteroid therapy and decreased in two patients who had received corticosteroids by 8.5%. FLAIR hyperintensity volumes increased by 9% in patients not receiving treatment with corticosteroids and decreased by 29% in the two patients that had received corticosteroids. CONCLUSIONS: This study has shown it is feasible to quantify acute change in temporal lobe and total oedema volumes in HSV encephalitis and suggests a potential resolution of swelling in response to corticosteroid therapy. These techniques could be used as part of a randomized control trial to investigate the efficacy of corticosteroids for treating HSV encephalitis in conjunction with assessing clinical outcomes and could be of potential value in helping to predict the clinical outcomes of patients with HSV encephalitis

Conservation of long-tailed macaques: Implications of the updated IUCN status and the CoVID-19 pandemic

The often synanthropic long-tailed macaque (Macaca fascicularis) is listed in Appendix II of CITES and was recently updated to Vulnerable on the IUCN Red List. The update was highly anticipated, as it can have wide-reaching implications for long-tailed macaque conservation and trade. Long-tailed macaques have suffered from intensive capture for biomedical research since the 1960s. From 2008–2019, at least 450,000 live long-tailed macaques, and over 700,000 “specimens” from an unknown number of individuals were part of this trade, with over 50,000 termed as wild-caught. These official trade numbers exclude laundering of wild-caught individuals as captive bred, harvesting for breeding center upkeep, their capture for the pet trade, hunting for consumption, and culling due to human-macaque conflicts. With Fooden’s population estimate of 3 million long-tailed macaques in Southeast Asia in 2006, this is likely not sustainable. In some areas, they have already been extirpated because of this trade, as detected by a survey of 200 km of suitable habitat in Cambodia in 2008. Long-tailed macaques are one of the most geographically widely dispersed and adaptable primate species. However, their flexibility and preference for the forest edge draws them to anthropogenic habitats, where their visibility results in assumptions of overabundance, as was demonstrated on Java in 2009 and 2017. Long-tailed macaques face many threats, and there is an urgent need for systematic demographic and range surveys across Southeast Asia, as well as investigation into local, regional and national perceptions of long-tailed macaques. Current conservation foci should include dynamic widespread synanthropic species, such as long-tailed macaques, which are often targets of intensive trade and other threats. Insights from such studies may be critical for effective conservation and management in the 21st century