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Summary: Background: Planned birth by induction of labour in low-risk, nulliparous women at 39+0–39+6 weeks gestation is associated with fewer caesarean sections, adverse maternal and neonatal outcomes and perinatal deaths compared with expectant management. However, the consequences of scheduled caesarean section in these women at this gestation are unclear. We compared outcomes following planned birth at 39+0–39+6 weeks gestation (either by induction of labour or scheduled caesarean section) to expectant management. Methods: The population included low-risk, singleton pregnancies between 2000 and 2021 in Queensland, Australia. Study outcomes were perinatal mortality (antepartum or intrapartum stillbirth and neonatal death), severe neonatal neurological morbidity and non-neurological morbidity, severe maternal outcome, maternal-infant separation, perineal trauma, shoulder dystocia, and caesarean birth. Multivariable models were built to determine risks of adverse outcomes for planned birth compared to expectant management. Subgroup analyses according to parity and birthweight were also performed. We calculated the number of planned births required that were associated with one less adverse outcome. Findings: In 472,520 low-risk pregnancies, planned birth at 39+0–39+6 weeks occurred in 97,438 (20.6%) women, of whom 39,697 (40.7%) underwent induction of labour and 57,741 (59.3%) had scheduled caesarean delivery. Planned birth was associated with 52% lower odds of perinatal mortality (adjusted Odds Ratio (aOR) 0.48; 95% CI 0.30, 0.76, p = 0.002), 62% lower odds of antepartum stillbirth (aOR 0.38; 95% CI 0.15, 0.97, p = 0.04), and 84% lower odds of intrapartum stillbirth by (aOR 0.16; 95% CI 0.04, 0.66, p = 0.01). It was also associated with reduction in the odds of severe neurological morbidity (aOR 0.46; 95% CI 0.39, 0.53, p = 0.00004), severe non-neurological morbidity (aOR 0.65; 95% CI 0.62, 0.68, p = 0.00004), and severe maternal outcome (aOR 0.95; 95% CI 0.92, 0.99, p = 0.008) but not maternal-infant separation (aOR 1.04; 95% CI 1.00, 1.08, p = 0.08). The reduction in odds for perinatal mortality, severe neurological, and non-neurological morbidity was greatest for birth by scheduled caesarean section. Compared to expectant management, planned birth by induction of labour was associated with reduced odds of caesarean delivery (aOR 0.54; 95% CI 0.51, 0.58, p = 0.00004), severe perineal trauma (aOR 0.53; 95% CI 0.45, 0.63, p = 0.00004), and shoulder dystocia (aOR 0.73; 95% CI 0.64, 0.84, p = 0.00004). Planned delivery of 2278 (95% CI 1760, 3231) women is associated with a reduction in one case of perinatal death, however significantly lower numbers are required for the other outcomes. Interpretation: Planned birth at 39+0–39+6 weeks in low-risk women was associated with lower odds of perinatal mortality and other adverse outcomes. Reductions in odds of adverse outcome were greater following scheduled caesarean section than induction of labour. Compared to expectant management, induction of labour was associated with lower odds of severe perineal trauma, shoulder dystocia, and caesarean birth. These findings generate further hypotheses that need to be tested in adequately powered randomised controlled trials. Funding: This study was supported by funds from the National Health and Medical Research Council and Mater Foundation.

Objective To predict birth weight at various potential gestational ages of delivery based on data routinely available at the first antenatal visit.Design Individual participant data meta-analysis.Data sources Individual participant data of four cohorts (237 228 pregnancies) from the International Prediction of Pregnancy Complications (IPPIC) network dataset.Eligibility criteria for selecting studies Studies in the IPPIC network were identified by searching major databases for studies reporting risk factors for adverse pregnancy outcomes, such as pre-eclampsia, fetal growth restriction, and stillbirth, from database inception to August 2019. Data of four IPPIC cohorts (237 228 pregnancies) from the US (National Institute of Child Health and Human Development, 2018; 233 483 pregnancies), UK (Allen et al, 2017; 1045 pregnancies), Norway (STORK Groruddalen research programme, 2010; 823 pregnancies), and Australia (Rumbold et al, 2006; 1877 pregnancies) were included in the development of the model.Results The IPPIC birth weight model was developed with random intercept regression models with backward elimination for variable selection. Internal-external cross validation was performed to assess the study specific and pooled performance of the model, reported as calibration slope, calibration-in-the-large, and observed versus expected average birth weight ratio. Meta-analysis showed that the apparent performance of the model had good calibration (calibration slope 0.99, 95% confidence interval (CI) 0.88 to 1.10; calibration-in-the-large 44.5 g, −18.4 to 107.3) with an observed versus expected average birth weight ratio of 1.02 (95% CI 0.97 to 1.07). The proportion of variation in birth weight explained by the model (R2) was 46.9% (range 32.7-56.1% in each cohort). On internal-external cross validation, the model showed good calibration and predictive performance when validated in three cohorts with a calibration slope of 0.90 (Allen cohort), 1.04 (STORK Groruddalen cohort), and 1.07 (Rumbold cohort), calibration-in-the-large of −22.3 g (Allen cohort), −33.42 (Rumbold cohort), and 86.4 g (STORK Groruddalen cohort), and observed versus expected ratio of 0.99 (Rumbold cohort), 1.00 (Allen cohort), and 1.03 (STORK Groruddalen cohort); respective pooled estimates were 1.00 (95% CI 0.78 to 1.23; calibration slope), 9.7 g (−154.3 to 173.8; calibration-in-the-large), and 1.00 (0.94 to 1.07; observed v expected ratio). The model predictions were more accurate (smaller mean square error) in the lower end of predicted birth weight, which is important in informing clinical decision making.Conclusions The IPPIC birth weight model allowed birth weight predictions for a range of possible gestational ages. The model explained about 50% of individual variation in birth weights, was well calibrated (especially in babies at high risk of fetal growth restriction and its complications), and showed promising performance in four different populations included in the individual participant data meta-analysis. Further research to examine the generalisability of performance in other countries, settings, and subgroups is required.Trial registration PROSPERO CRD42019135045

Objective: To compare the accuracy of four published reference standards for the umbilical artery pulsatility index (UA‐PI) in predicting small‐for‐gestational age (SGA), adverse neonatal outcomes and obstetric complications in pregnancies at risk for fetal growth restriction. Methods: This was a secondary analysis of a prospective study of singleton pregnancies that underwent fetal growth assessment by ultrasound between 26 and 36 weeks' gestation. Pregnancies with estimated fetal weight or abdominal circumference < 20th percentile with UA‐PI measurements available were included. We excluded fetuses with chromosomal anomaly or congenital malformation and those without delivery information. The predictive ability of UA‐PI > 95th percentile according to the reference standards of Acharya et al., the INTERGROWTH‐21st Project, the Fetal Medicine Foundation and Parra‐Cordero et al. for SGA, a composite of adverse neonatal outcomes and a composite of obstetric complications was compared using the area under the receiver‐operating‐characteristics curve (AUC). Sensitivity, specificity and positive and negative predictive values were calculated. Results: Of the 1054 pregnancies that underwent fetal growth evaluation by ultrasound, 207 were included in our analysis. SGA, adverse neonatal outcomes and obstetric complications were diagnosed in 94 (45.4%), 50 (24.2%) and 69 (33.3%) cases, respectively. All reference standards had similar and statistically significant but poor predictive accuracy for SGA (AUC of 0.55 to 0.56), adverse neonatal outcomes (AUC of 0.57 to 0.60) and obstetric complications (AUC of 0.55 for all). Conclusions: The reference standards for UA‐PI evaluated herein have poor predictive ability for SGA, adverse neonatal outcomes and obstetric complications. At present, no particular UA‐PI reference standard can be recommended over others. Larger trials are needed to answer this research question. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

The article discusses the establishment of trustworthiness criteria for meta-analyses of randomized controlled trials (RCTs) in obstetrics and gynecology (OBGYN) journals. The criteria aim to ensure the exclusion of low-quality or fabricated studies from meta-analyses by assessing various aspects such as governance, ethics, registration, and methodology. Authors conducting meta-analyses are encouraged to adhere to these criteria, which are divided into 'absolute' and 'other quality' criteria, to enhance the integrity and reliability of their research. The guidelines also emphasize the importance of prospective registration, adherence to CONSORT guidelines, and risk-of-bias assessment to promote transparency and reproducibility in research. [Extracted from the article]

The editorial discusses the role of genetic and epigenetic factors in pregnancy-related complications, focusing on placental dysfunction and its impact on maternal and fetal health. It highlights the importance of understanding epigenetic mechanisms in regulating gene expression for pregnancy outcomes. Various studies explore topics such as fetal reprogramming, placental abnormalities in diabetic pregnancies, spiral artery remodeling, hypoxic injury in the fetal brain, recurrent pregnancy loss, paralogous genes in embryonic development, and advancements in placental drug and gene delivery technologies. The research aims to improve our understanding of these complex processes to develop effective treatments and interventions for better maternal and fetal health outcomes. [Extracted from the article]

Background: This study was undertaken to determine the antimicrobial susceptibility profile and plasmid analysis of micro-organisms associated with ocular infections. Methods: Ocular specimens were collected from 500 patients. Subsequent identification was done based on morphology and biochemical tests. Susceptibility pattern of the isolates was done using the disk diffusion method. The presence of plasmids was determined using the agar gel electrophoresis technique. Plasmid curing was carried out by treating the MAR isolates with sodium dodecyl sulfate at concentration of 10%. Results: Conjunctivitis was the most prevalent ocular infection of 105 (39.8%). S. aureus was the most prevalent pathogen 63 (23.9%) followed by CoNS 36 (13.6%). S. aureus was 100% sensitive to vancomycin and chloramphenicol. CoNS was also 100% sensitive to ciprofloxacin, vancomycin, and chloramphenicol. K pneumoniae was 100% sensitive to gentamicin and amoxicillin-clavulanic acid while N. gonorrhoeae was 100% sensitive to gentamicin, ciprofloxacin, ceftriaxone, amoxicillin-clavulanic acid, and cefotaxime. The overall MAR bacteria was 38 (16.2%). Plasmid analysis revealed the presence of 1–3 plasmid bands of sizes 6.21–16.22 Kbp from the MAR isolates. Plasmid curing revealed that the gene coding for resistant seen in this study was plasmid mediated. Conclusions: The prevalence of ocular infection was high with conjunctivitis being the dominant. The dominant bacteria species were S. aureus and CoNS. The overall MAR bacteria proportion was relatively high. The presence of plasmids was responsible for the resistance of the isolates to antibiotics.

This paper present the investigation of the possible causes of the incessant road failure associated with subgrade soils of the Niger delta using mineralogical and geotechnical properties assessment. Geotechnical investigation revealed clayey sand form the bulk of the subgrade soils composed generally of fine to medium grains with low to intermediate plasticity. Based on AASHTO the soil classifies as A-2 and A-6 with the granular soils being dominant. The average values obtained for California Bearing Ratio (CBR), maximum dry density (MDD), optimum-moisture-content (OMC) and shear strength are 19%, 1726 kg/m3, 15.70% and 286 KPA respectively. The angle of friction ranged from 180 to 250 indicates high presence of sand. X-ray diffraction analyses reveal the absence of expandable clay mineral. Collapse potential ranged from 1.3 to 10.8% indicating slight to severe collapse. High amount of settlement and field observation of intense failure revealed the soils as collapsible, particularly when inundated under poor drainage conditions. Thus, the road failures observed in the study are as a result of the soil inherent properties and the failure of design relative to the Region peculiar geomorphological and climatic conditions.

Keratinases are enzymes that catalyze the degradation of keratin, a resilient protein found in various biological materials such as: feathers, hair, and fish scales. Two isolates identified from previous work as Alcaligenes faecalis (SCA A1) and Pseudomonas aeruginosa (FSA A2) was used for keratinase production. The enzyme produced were purified using dialysis, ion exchange chromatography and gel filtration chromatography and the purified enzyme was characterized and used to check for keratin substrate specificity. Fermentation studies revealed that A. faecalis (SCA A1) displayed optimal growth at pH 9.5 and 10.5, particularly at higher temperatures (48°C, 58°C, and 68°C) when using Mackerel fish scales as the substrate. In contrast, P. aeruginosa (FSA A2) demonstrated better growth at pH 7.5 and 8.5, with the highest growth observed at 28°C and 38°C using both Mackerel and Elephant fish scales. Enzyme activity profiles showed that A. faecalis exhibited higher activity with Mackerel scales (65.7 U/ml), while P. aeruginosa showed greater activity using Elephant scales (68.1 U/ml). Purification of the keratinase enzymes from both isolates resulted in a 7-fold increase in specific activity, reaching 35.16 U/mg for A. faecalis and 37.80 U/mg for P. aeruginosa. Characterization of the purified enzymes revealed that both exhibited optimal activity at 70°C, with P. aeruginosa displaying slightly higher activity. The enzymes also shows good activity over a wide pH range, with optima at pH 7.3 and 6.3 for A. faecalis and P. aeruginosa, respectively. Substrate specificity analysis indicated that both enzymes had the highest activity towards Mackerel fish scales, followed by Casein, Human Hair, Chicken feathers, and Elephant fish scales. These findings highlight the potential of A. faecalis and P. aeruginosa for the biodegradation of fish scale waste, offering a sustainable solution for waste management and the production of valuable bioproducts. These results suggest that these keratinolytic bacteria could be utilized in the development of bioremediation strategies for fish processing waste. Additionally, the keratinase enzymes produced by these isolates could be utilized in various industrial applications, such as the production of animal feed supplements, leather processing, and the development of cosmetic and pharmaceutical products. [ABSTRACT FROM AUTHOR]

Objectives: Estimated fetal weight (EFW) is an important metric at delivery as neonates with abnormal birthweight and their mothers are at higher risk of birth complications. Data regarding optimal EFW assessment in gravidas with obesity is inconsistent, and with the increasing incidence of obesity, clarification of this question is crucial. We aimed to compare accuracy of ultrasound (US)‐derived EFW and clinical assessments of EFW in predicting neonatal birthweight among gravidas with obesity. Methods: This prospective cohort study enrolled gravidas with obesity and a singleton pregnancy admitted for delivery at term. EFW was determined using either US biometry or clinical assessment (Leopold's maneuvers, Johnson's formula, and Insler's formula) at time of admission. Our primary outcome was accurate EFW, defined as EFW within 500 g of birthweight. Secondary outcomes included ability to predict small‐for‐gestational age (SGA) and large‐for‐gestational age (LGA) birthweights. These outcomes were compared between all EFW methods. Results: A total of 250 gravidas with a median body mass index of 36.4 kg/m2 were enrolled. Admission US outperformed Leopold's maneuvers in obtaining accurate EFW (81.6% versus 74.5%, P =.03). When comparing all methods, Johnson's and Insler's formulae performed the worst, accurately predicting EFW in only 27.4% and 14.3% of cases, respectively. Likewise, US‐derived EFW outperformed Leopold's maneuvers and fundal height in the prediction of SGA and LGA neonates. Conclusions: US is more accurate than clinical assessment of EFW in gravidas with obesity both for estimation of actual birthweight and prediction of abnormal birthweight. Universal late third‐trimester or peripartum US for EFW should be considered in gravidas with obesity. [ABSTRACT FROM AUTHOR]

Godwin Avwioro,1 Andy Egwunyenga,2 Collins Adjekuko,3 Osaro Mgbere,4,5 Ewomazino Odibo,2 Sina Iyiola,6 Seyi Samson Enitan,7 Ekere James Essien4,5 1Faculty of Science, Delta State University, Abraka, Nigeria; 2Department of Animal and Environmental Biology, Faculty of Science, Delta State University, Abraka, Nigeria; 3Department of Medical Laboratory Services, General Hospital, Asaba, Delta State, Nigeria; 4Institute of Community Health, University of Houston College of Pharmacy, Houston, TX, USA; 5Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA; 6Department of Histopathology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria; 7Department of Medical Laboratory Science, Babcock University, Ilisan-Remo, Ogun State, NigeriaCorrespondence: Osaro MgbereInstitute of Community Health, University of Houston College of Pharmacy, Houston, TX, USAEmail omgbere@uh.eduBackground: Sex workers, like others, are facing economic hardships and anxiety about their health and safety due to coronavirus disease-2019 (COVID-19), an infectious disease caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Universally, most sex work has largely reduced, moved online, or undertaken covertly because of lockdown measures and need for social distancing to break the transmission of SARS-CoV-2. However, the ability of sex workers to protect themselves against COVID-19 depends on their individual and interpersonal behaviors and work environment. In this study, we sought to determine the relationships between COVID-19 knowledge, awareness and prevention practice (KAP) among female commercial sex workers (FCSW) in the Niger Delta region of Nigeria to inform the development of prevention interventions for this vulnerable population.Methods: Data used in this study were obtained from a cross-sectional survey of 604 FCSW operating in the Niger Delta region of Nigeria. We used descriptive and inferential statistics to assess their socio-demographic characteristics and COVID-19 KAP adopted against the novel coronavirus. Latent class analysis was used to systematically classify participants’ attributes and behaviors into the most likely distinct clusters or risk groups.Results: The majority of the FCSW were singles (86.8%) of childbearing ages, 21– 35 years (86.2%), with almost three quarters (73.2%) of them having sex with 3– 4 clients per day during the COVID-19 pandemic. Overall, almost three quarters of the participants had both good knowledge and awareness about COVID-19 but less than half of them (41.1%) implemented good practice to prevent the spread of the disease. However, a highly significant and positive relationship was recorded between COVID-19 knowledge (r=0.90, p< 0.0001) and awareness (r=0.65, p< 0.0001), and preventive practice of FCSW, respectively. About 89.1% of the participants were not very familiar with the symptoms of COVID-19 (p< 0.0001). Only 10.9% of the FCSW indicated that they wear facemask at all times, while 45.2% of them do not wear facemask during sexual intercourse with their clients (p< 0.0001). Based on the FCSW attributes and behaviors, we identified three distinct clusters or risk groups (p< 0.0001), namely, low-risk takers (Cluster 1), high-risk takers (Cluster 2) and very high-risk takers (Cluster 3) with latent class prevalence rates (γc) of 41.13% (95% CI: 37.26– 45.10), 33.17% (95% CI: 29.53– 37.02) and 25.71% (95% CI: 22.38– 29.34), respectively.Conclusion: Sex work has high transmission potentials for SARS-CoV-2 because of its operational nature, which does not permit social distancing, and thus, renders certain preventive measures practically ineffective. This is a major challenge in the fight against COVID-19 in this high-risk group and calls for the development of operational guidelines and targeted intervention strategies to help reduce the spread of COVID-19 in the Niger Delta region.Keywords: SARS-CoV-2, COVID-19, commercial sex workers, social distancing, transmission, Niger Delta region

The impact of globalization on multinational enterprises was examined from the years 1980 to 2020. A scoping literature review was conducted for a total of 141 articles. Qualitative, quantitative, and mixed typologies were categorized and conclusions were drawn regarding the influence and performance (i.e., positive or negative effects) of globalization. Developed countries show more saturated markets than developing countries that favor developing country multinational enterprises to rely heavily on foreign sales for revenue growth. Developed country multinationals are likely to use more advanced factors of production to create revenue, whereas developing country multinationals are more likely to use less advanced forms. A number of common trends and issues showed corporate social responsibility, emerging markets, political issues, and economic matters as key to global market production. Recommendations signal a strong need for more research that addresses contributive effects in the different economies, starting with the emerging to the developed. Limitations of data availability and inconsistency posed a challenge for this review, yet the use of operationalization, techniques, and analyses from the business literature enabled this study to be an excellent starting point for additional work in the field.

Abstract Background Pre-eclampsia is a leading cause of maternal and perinatal mortality and morbidity. Early identification of women at risk during pregnancy is required to plan management. Although there are many published prediction models for pre-eclampsia, few have been validated in external data. Our objective was to externally validate published prediction models for pre-eclampsia using individual participant data (IPD) from UK studies, to evaluate whether any of the models can accurately predict the condition when used within the UK healthcare setting. Methods IPD from 11 UK cohort studies (217,415 pregnant women) within the International Prediction of Pregnancy Complications (IPPIC) pre-eclampsia network contributed to external validation of published prediction models, identified by systematic review. Cohorts that measured all predictor variables in at least one of the identified models and reported pre-eclampsia as an outcome were included for validation. We reported the model predictive performance as discrimination (C-statistic), calibration (calibration plots, calibration slope, calibration-in-the-large), and net benefit. Performance measures were estimated separately in each available study and then, where possible, combined across studies in a random-effects meta-analysis. Results Of 131 published models, 67 provided the full model equation and 24 could be validated in 11 UK cohorts. Most of the models showed modest discrimination with summary C-statistics between 0.6 and 0.7. The calibration of the predicted compared to observed risk was generally poor for most models with observed calibration slopes less than 1, indicating that predictions were generally too extreme, although confidence intervals were wide. There was large between-study heterogeneity in each model’s calibration-in-the-large, suggesting poor calibration of the predicted overall risk across populations. In a subset of models, the net benefit of using the models to inform clinical decisions appeared small and limited to probability thresholds between 5 and 7%. Conclusions The evaluated models had modest predictive performance, with key limitations such as poor calibration (likely due to overfitting in the original development datasets), substantial heterogeneity, and small net benefit across settings. The evidence to support the use of these prediction models for pre-eclampsia in clinical decision-making is limited. Any models that we could not validate should be examined in terms of their predictive performance, net benefit, and heterogeneity across multiple UK settings before consideration for use in practice. Trial registration PROSPERO ID: CRD42015029349 .

Among several interleukin (IL)-6 family members, only IL-6 and IL-11 require a gp130 protein homodimer for intracellular signaling due to lack of intracellular signaling domain in the IL-6 receptor (IL-6R) and IL-11R. We previously reported enhanced decidual IL-6 and IL-11 levels at the maternal-fetal interface with significantly higher peri-membranous IL-6 immunostaining in adjacent interstitial trophoblasts in preeclampsia (PE) vs. gestational age (GA)-matched controls. This led us to hypothesize that competitive binding of these cytokines to the gp130 impairs extravillous trophoblast (EVT) differentiation, proliferation and/or invasion. Using global microarray analysis, the current study identified inhibition of interferon-stimulated gene 15 (ISG15) as the only gene affected by both IL-6 plus IL-11 vs. control or IL-6 or IL-11 treatment of primary human cytotrophoblast cultures. ISG15 immunostaining was specific to EVTs among other trophoblast types in the first and third trimester placental specimens, and significantly lower ISG15 levels were observed in EVT from PE vs. GA-matched control placentae (p = 0.006). Induction of primary trophoblastic stem cell cultures toward EVT linage increased ISG15 mRNA levels by 7.8-fold (p = 0.004). ISG15 silencing in HTR8/SVneo cultures, a first trimester EVT cell line, inhibited invasion, proliferation, expression of ITGB1 (a cell migration receptor) and filamentous actin while increasing expression of ITGB4 (a receptor for hemi-desmosomal adhesion). Moreover, ISG15 silencing further enhanced levels of IL-1β-induced pro-inflammatory cytokines (CXCL8, IL-6 and CCL2) in HTR8/SVneo cells. Collectively, these results indicate that ISG15 acts as a critical regulator of EVT morphology and function and that diminished ISG15 expression is associated with PE, potentially mediating reduced interstitial trophoblast invasion and enhancing local inflammation at the maternal-fetal interface. Thus, agents inducing ISG15 expression may provide a novel therapeutic approach in PE.

Meckel's diverticulum is a congenital anomaly involving a true diverticulum of the ileum. These diverticula can present in a variety of ways. They can be asymptomatic and discovered incidentally or can present with symptoms of infection, bleeding or obstruction. Typically, patients present around age 2. We present a case of an in utero perforation of a Meckel's diverticulum causing a small bowel obstruction diagnosed on prenatal imaging.