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Background Women who enter pregnancy with a Body Mass Index above 30 kg/m2 face an increased risk of complications during pregnancy and birth. National and local practice recommendations in the UK exist to guide healthcare professionals in supporting women to manage their weight. Despite this, women report inconsistent and confusing advice and healthcare professionals report a lack of confidence and skill in providing evidence-based guidance. A qualitative evidence synthesis was conducted to examine how local clinical guidelines interpret national recommendations to deliver weight management care to people who are pregnant or in the postnatal period. Methods A qualitative evidence synthesis of local NHS clinical practice guidelines in England was conducted. National Institute for Health and Care Excellence and Royal College of Obstetricians and Gynaecologists guidelines for weight management during pregnancy constructed the framework used for thematic synthesis. Data was interpreted within the embedded discourse of risk and the synthesis was informed by the Birth Territory Theory of Fahy and Parrat. Results A representative sample of twenty-eight NHS Trusts provided guidelines that included weight management care recommendations. Local recommendations were largely reflective of national guidance. Consistent recommendations included obtaining a weight at booking and informing women of the risks associated with being obese during pregnancy. There was variation in the adoption of routine weighing practices and referral pathways were ambiguous. Three interpretive themes were constructed, exposing a disconnect between the risk dominated discourse evident in the local guidelines and the individualised, partnership approach emphasised in national level maternity policy. Conclusions Local NHS weight management guidelines are rooted in a medical model rather than the model advocated in national maternity policy that promotes a partnership approach to care. This synthesis exposes the challenges faced by healthcare professionals and the experiences of pregnant women who are in receipt of weight management care. Future research should target the tools utilised by maternity care providers to achieve weight management care that harnesses a partnership approach empowering pregnant and postnatal people in their journey through motherhood.

Background Pregnant people with chronic hypertension, pre-existing diabetes or both are at high risk of developing cardiovascular disease. Lifestyle interventions play an important role in disease management in non-pregnant populations. Aim To review the existing evidence of randomised controlled trials (RCTs) that examine lifestyle interventions in pregnant people with chronic hypertension and/or pre-existing diabetes. Methods A systematic review and narrative synthesis was conducted. Five electronic databases were searched from inception to April 2021 for RCTs evaluating antenatal lifestyle interventions in people with chronic hypertension and/or pre-existing diabetes with outcomes to include weight or blood pressure change. Results Nine randomised controlled trials including 7438 pregnant women were eligible. Eight studies were mixed pregnant populations that included women with chronic hypertension and/or pre-existing diabetes. One study included only pregnant women with pre-existing diabetes. Intervention characteristics and procedures varied and targeted diet, physical activity and/or gestational weight. All studies reported weight and one study reported blood pressure change. Outcome data were frequently unavailable for the subset of women of interest, including subgroup data on important pregnancy and birth complications. Eligibility criteria were often ambiguous and baseline data on chronic hypertension was often omitted. Conclusion A lack of primary interventional trials examining the effect of lifestyle interventions on weight and blood pressure outcomes in pregnant populations with chronic hypertension and/or pre-existing diabetes was evident. Lifestyle modification has the potential to alter disease progression. Future trials should address the ambiguity and frequent exclusion of these important populations.

Plant competition belowground is a crucial factor that determines plant fitness and shapes plant communities. It has been shown that roots possess the ability to recognize between self and non-self individuals and modify their growth patterns accordingly. Roots may also be further able to discriminate between kin and non-kin roots. Competition is stronger with non-kin than kin neighbors, but whether root growth patterns determined by kin interactions are modified in stressful environments is largely unexplored. In this study we used two different experimental set-ups to confirm whether the clonal species Glechoma hederacea exhibits kin recognition between roots, and 88 89 how water limitation modifies this response. A split-root design was conducted using a focal clonal fragment of G. hederacea placed onto the ridge that separated two adjacent containers: either square petri-dishes boxes with 200 ml of soil or 400 ml clear pots. Focal plants were randomly allocated to either growing alone or in competition with another G. hederacea ramet (of similar size taken from the same stolon as the focal plant) or a non-kin individual (a ramet selected from a different population). A water limitation treatment was applied to both experiments. Five root parameters were measured during the experiment using boxes: the maximum depth and the maximum width of the deepest root, the depth and the maximum width of the widest root, and the total number of roots visible. All plants were harvested after 36 days and several final root measurements were taken and analyzed using GiaRoots. Our results show that G. hederacea roots have kin recognition mechanisms, showing a significant tendency to avoid growing toward a non-kin neighbor but not avoiding the roots of a kin plant, even though the presence of a kin plant modifies root distribution within the soil. As expected, water limitation significantly affected plant growth and root parameters, but this effect was not related to neighbor kin identity. Taken together, our results confirm the existence of root recognition in this species and suggest that the mechanisms of kin recognition are probably related to a root-derived chemical cues, as recognition took place before physical contact occurred.

This paper provides an update on research in the relatively new and fast-moving field of decadal climate prediction, and addresses the use of decadal climate predictions not only for potential users of such information but also for improving our understanding of processes in the climate system. External forcing influences the predictions throughout, but their contributions to predictive skill become dominant after most of the improved skill from initialization with observations vanishes after about 6–9 years. Recent multimodel results suggest that there is relatively more decadal predictive skill in the North Atlantic, western Pacific, and Indian Oceans than in other regions of the world oceans. Aspects of decadal variability of SSTs, like the mid-1970s shift in the Pacific, the mid-1990s shift in the northern North Atlantic and western Pacific, and the early-2000s hiatus, are better represented in initialized hindcasts compared to uninitialized simulations. There is evidence of higher skill in initialized multimodel ensemble decadal hindcasts than in single model results, with multimodel initialized predictions for near-term climate showing somewhat less global warming than uninitialized simulations. Some decadal hindcasts have shown statistically reliable predictions of surface temperature over various land and ocean regions for lead times of up to 6–9 years, but this needs to be investigated in a wider set of models. As in the early days of El Niño–Southern Oscillation (ENSO) prediction, improvements to models will reduce the need for bias adjustment, and increase the reliability, and thus usefulness, of decadal climate predictions in the future.

Xeroderma pigmentosum (XP) is a genodermatosis that results in increased sensitivity to UV-radiation, resulting in early onset of photodamage and skin cancers. There are eight XP subtypes, seven due to variable defects in the nucleotide excision repair pathway and one due to a defect in translesion synthesis.