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Introduction Outpatient cervical ripening and induction of labor might offer potential benefits. There are a few randomized controlled trials (RCTs) comparing outpatient balloon catheters with inpatient vaginal dinoprostone, but the reported outcomes among these trials were inconsistent, justifying the need for a meta‐analysis. We aimed to evaluate the effectiveness and safety of inpatient vaginal dinoprostone compared to outpatient balloon catheters for cervical ripening in labor induction. Material and Methods Eligible RCTs were identified using MEDLINE, Emcare, Embase, Scopus, CINAHL Plus, Cochrane Pregnancy and Childbirth Group's Trials Register, WHO International Clinical Trials Registry Platform, and clinicaltrials.gov from inception to July 2024. Women with live singleton pregnancies at 34 or more weeks of gestation were eligible. The authors of eligible trials were invited to share their de‐identified data. The main outcomes were vaginal birth and a composite adverse perinatal and maternal outcome. All analyses were adjusted for age and parity. Two‐stage random effects meta‐analysis was the main analysis strategy with the intention‐to‐treat principle. This meta‐analysis was registered with PROSPERO (CRD42022313183) on 27‐04‐2022. Results We identified three eligible RCTs, and all three shared data (N = 1636); inpatient vaginal dinoprostone (n = 832), outpatient balloon catheter (n = 804). The odds of vaginal birth were higher after inpatient vaginal dinoprostone than outpatient balloon catheter (67.8% vs 61.7%, adjusted odds ratio [aOR] 1.30, 95% CI 1.05–1.62, I2 = 0%). There was no significant difference in the composite adverse perinatal outcome (13.7% vs 13.1%, aOR 1.09, 95% CI 0.75–1.58, I2 = 28.7%) or the composite adverse maternal outcome (16.6% vs 19.8%, aOR 0.81, 95% CI 0.61–1.07, I2 = 11.5%). The difference in effect on vaginal birth rate varied according to body mass index. Overweight and obese women had a lower vaginal birth rate after outpatient induction, whereas for those with underweight/normal weight, the rates of vaginal birth were similar. Conclusions Balloon catheter used in an outpatient labor induction setting probably leads to fewer vaginal births compared to vaginal dinoprostone in an inpatient setting. In pre‐planned subgroup analysis, for pregnant women with underweight/normal weight, both inpatient vaginal dinoprostone and outpatient balloon catheter methods are viable options, but balloon catheter has a lower vaginal birth rate in women with overweight and obesity during pregnancy. The perinatal and maternal safety profiles are comparable. Cervical ripening in the induction of labor with outpatient balloon catheters is probably less effective than inpatient vaginal dinoprostone, specifically in maternal overweight and obesity during pregnancy. The perinatal and maternal safety profiles are comparable.

Bacteria are becoming increasingly resistant to currently used antibiotics. At the same time, little progress has been made in discovering new antibacterial drugs to combat resistant organisms. History teaches us that ‘high tech’ target-based complex methods are not synonymous with success and a return to simple, systematic screening of natural products against bacteria from traditional and novel resources holds our greatest hope of success. A simple, systematic approach to antibacterial drug discovery with a focus on natural products led to our greatest achievements and likely holds the key for future success.

Induction of labour is one of the most common obstetric interventions globally. Balloon catheters and vaginal prostaglandins are widely used to ripen the cervix in labour induction. We aimed to compare the effectiveness and safety profiles of these two induction methods. We did an individual participant data meta-analysis comparing balloon catheters and vaginal prostaglandins for cervical ripening before labour induction. We systematically identified published and unpublished randomised controlled trials that completed data collection between March 19, 2019, and May 1, 2021, by searching the Cochrane Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and PubMed. Further trials done before March 19, 2019, were identified through a recent Cochrane review. Data relating to the combined use of the two methods were not included, only data from women with a viable, singleton pregnancy were analysed, and no exclusion was made based on parity or membrane status. We contacted authors of individuals trials and participant-level data were harmonised and recoded according to predefined definitions of variables. Risk of bias was assessed with the ROB2 tool. The primary outcomes were caesarean delivery, indication for caesarean delivery, a composite adverse perinatal outcome, and a composite adverse maternal outcome. We followed the intention-to-treat principle for the main analysis. The primary meta-analysis used two-stage random-effects models and the sensitivity analysis used one-stage mixed models. All models were adjusted for maternal age and parity. This meta-analysis is registered with PROSPERO (CRD42020179924). Individual participant data were available from 12 studies with a total of 5460 participants. Balloon catheters, compared with vaginal prostaglandins, did not lead to a significantly different rate of caesarean delivery (12 trials, 5414 women; crude incidence 27·0%; adjusted OR [aOR] 1·09, 95% CI 0·95–1·24; I2=0%), caesarean delivery for failure to progress (11 trials, 4601 women; aOR 1·20, 95% CI 0·91–1·58; I2=39%), or caesarean delivery for fetal distress (10 trials, 4441 women; aOR 0·86, 95% CI 0·71–1·04; I2=0%). The composite adverse perinatal outcome was lower in women who were allocated to balloon catheters than in those allocated to vaginal prostaglandins (ten trials, 4452 neonates, crude incidence 13·6%; aOR 0·80, 95% CI 0·70–0·92; I2=0%). There was no significant difference in the composite adverse maternal outcome (ten trials, 4326 women, crude incidence 22·7%; aOR 1·02, 95% CI 0·89–1·18; I2=0%). In induction of labour, balloon catheters and vaginal prostaglandins have comparable caesarean delivery rates and maternal safety profiles, but balloon catheters lead to fewer adverse perinatal events. Australian National Health and Medical Research Council and Monash Health Emerging Researcher Fellowship.

Introduction Melatonin has been suggested to have a biological role in the onset and progress of labor. We tested the hypothesis that the addition of melatonin during an induction of labor will reduce the need for a cesarean birth. Material and Methods This trial underwent protocol amendments that are detailed in the main text of the article. This trial is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12616000311459). At a multi‐center health service including secondary and tertiary obstetric hospitals, we performed a randomized, double‐blind, placebo‐controlled trial in women with a singleton cephalic pregnancy, free of significant maternal or perinatal complications who were undergoing induction of labor (with or without cervical ripening). Women were randomized to 10 mg melatonin vs placebo, with cervical ripening as required, and then 6‐h during their induction of labor to a maximum of four doses or until birth. The primary outcome was cesarean birth. Secondary outcomes included labor, maternal, and neonatal outcomes. Data were analyzed using intention to treat. Sub‐group analyses based on mode of ripening and parity were also performed. Results Between 2019 and 2021 we randomized 189 women (103 to melatonin and 86 to placebo). The study was prematurely terminated due to logistical complications resulting from the COVID‐19 pandemic. Cesarean rates were 28/103 (27.2%) in the melatonin group vs 20/84 (23.3%) in the placebo group (RR 1.17 95% CI 0.71–1.92). There were no significant differences in rate of cesarean birth between the melatonin and placebo groups for failure to progress (13.4% and 9.3%, respectively, RR 1.46; 95% CI 0.64–3.32) or suspected fetal distress (10.7% and 10.5%, respectively, RR 1.02; 95% CI 0.44–2.34). The melatonin group had significantly lower rates of spontaneous vaginal birth within 24 h (35.0% vs. 50.0%; RR 0.70 95% CI 0.50–0.98). The rates of secondary outcomes such as total length of labor, rate of postpartum hemorrhage, and instrumental birth were comparable. Babies born in the melatonin group were more likely to need admission to the special care nursery, namely for hypoglycemic monitoring (18.5% vs. 8.1% RR 2.26; 95% CI 1.00–5.10). Conclusions In women undergoing induction of labor, melatonin does not reduce the cesarean section rate. Melatonin use intrapartum may also be associated with neonatal hypoglycemia. Melatonin was tested in a randomized control trial against placebo as an adjuvant to oxytocin for induction of labor. It was not shown to reduce cesarean section rates and may be related to neonatal hypoglycemia.

Folic acid (FA) food fortification in Australia has resulted in a higher-than-expected intake of FA during pregnancy. High FA intake is associated with increased insulin resistance and gestational diabetes. We aimed to establish whether maternal one-carbon metabolism and hormones that regulate glucose homeostasis change in healthy pregnancies post-FA food fortification. Circulating folate, B12, homocysteine, prolactin (PRL), human placental lactogen (hPL) and placental growth hormone (GH2) were measured in early pregnancy maternal blood in women with uncomplicated pregnancies prior to (SCOPE: N = 604) and post (STOP: N = 711)-FA food fortification. FA food fortification resulted in 63% higher maternal folate. STOP women had lower hPL (33%) and GH2 (43%) after 10 weeks of gestation, but they had higher PRL (29%) and hPL (28%) after 16 weeks. FA supplementation during pregnancy increased maternal folate and reduced homocysteine but only in the SCOPE group, and it was associated with 54% higher PRL in SCOPE but 28% lower PRL in STOP. FA food fortification increased maternal folate status, but supplements no longer had an effect, thereby calling into question their utility. An altered secretion of hormones that regulate glucose homeostasis in pregnancy could place women post-fortification at an increased risk of insulin resistance and gestational diabetes, particularly for older women and those with obesity.

Manual wheelchairs promote independence among older adult users. However, the user's level of disability, strength, and stamina, and the environmental conditions in which the wheelchair is used, may limit the functionality of manual wheelchairs and their impact on independence and active aging. The use of power-assist add-ons may mitigate these limitations and allow an individual to age in place. We propose to conduct a scoping review of scientific and gray literature to examine the use of power-assist add-ons by older adults who use manual wheelchairs, as well as their advantages, limitations, and potential benefits in promoting independence and active aging. The review will be guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist, and we will use the Arksey and O'Malley scoping review methodology. The literature search will use a comprehensive approach and will be carried out in two phases: (1) a keyword and Medical Subject Headings search of electronic databases, proceedings, and symposia for relevant titles and abstracts and (2) a search of Google and Google Scholar. Articles will be selected based on predefined inclusion and exclusion criteria. We will include studies of power-assist add-ons for older manual wheelchair users (aged ≥65 years) across any health condition or setting. We will exclude studies not focused on power-assist add-ons or older adults. Data will be synthesized through thematic analysis (attitudes and efficacy) and directed content analysis (limitations and gaps). Results will be summarized narratively and in tables. The findings will be disseminated in peer-reviewed publications and conferences focused on rehabilitation or gerontology. We will synthesize data on power-assist add-ons by compiling a list of devices, analyzing attitudes toward their use, identifying limitations, and highlighting gaps in the literature. We expect to publish the results in 2025. The information obtained through this review could inform future research involving wheelchair producers, suppliers, and prescribers. PRR1-10.2196/56375.

The highly aromatic Australian mint bushes from the genus Prostanthera Labill. produce a high yield of essential oil on hydrodistillation. Together with its rich history, horticultural potential, iconic flowers, and aromatic leaves, it achieves high ornamental and culinary value. Species in the genus express highly diverse and chemically unique essential oils that demonstrate intra- and inter-specific patterns that have inspired taxonomic reinterpretation for over a hundred years. Previous studies have conveyed that phenoplastic expression of volatiles creates chemotypes within taxa, adding complexity to chemophenetic exploration. The current study chemically characterised essential oils from 64 highly aromatic specimens, representative of 25 taxa, giving yields as high as >2% g/g. The chemical profiles of essential oils are diverse, but generally include 1,8-cineole and signatory compounds such as sesquiterpene oxides, caryophyllene oxide, kessane and cis-dihydroagarofuran; sesquiterpene alcohols, globulol, epiglobulol, maaliol, prostantherol, spathulenol and ledol; and monoterpene derivatives of common scaffolds, borneol, bornyl acetate, bornanone, linalool and linalyl acetate. As in previous studies, analysis of chemical data confirms that the chemistry strongly agrees with taxonomic classifications. Importantly, as in classical taxonomy, the current chemical study complemented morphological analysis but conveys chemovariation, obscuring the taxonomic agreement. Nevertheless, variation within taxa may be due to environmental factors, meaning that cultivation of species in gardens will create different chemical profiles as compared to those published here.

Australia’s endemic desert shrubs are commonly aromatic, with chemically diverse terpenes and phenylpropanoids in their headspace profiles. Species from the genus Eremophila (Scrophulariaceae ex. Myoporaceae) are the most common, with 215 recognised taxa and many more that have not yet been described, widely spread across the arid parts of the Australian continent. Over the years, our research team has collected multiple specimens as part of a survey to investigate the chemical diversity of the genus and create leads for further scientific enquiry. In the current study, the diversity of volatile compounds is studied using hydrodistilled essential oils and leaf solvent extracts from 30 taxa. Several rare terpenes and iridoids were detected in chemical profiles widely across the genus, and three previously undescribed sesquiterpenes were isolated and are assigned by 2D NMR—E-11(12)-dehydroisodendrolasin, Z-11-hydroxyisodendrolasin and 10-hydroxydihydro-α-humulene acetate. Multiple sampling from Eremophila longifolia, Eremophila arbuscular, Eremophila latrobei, Eremophila deserti, Eremophila sturtii, Eremophila oppositifolia and Eremophila alternifolia coneys that species in Eremophila are highly chemovariable. However, taxa are generally grouped according to the expression of (1) furanosesquiterpenes, (2) iridoids or oxides, (3) mixtures of 1 and 2, (4) phenylpropanoids, (5) non-furanoid terpenes, (6) mixtures of 4 and 5, and less commonly (7) mixtures of 1 and 5. Furthermore, GC–MS analysis of solvent-extracted leaves taken from cultivated specimens conveys that many heavier ‘volatiles’ with lower vapour pressure are not detected in hydrodistilled essential oils and have therefore been neglected in past chemical studies. Hence, our data reiterate that chemical studies of the genus Eremophila will continue to describe new metabolites and that taxon determination has limited predictive value for the chemical composition.

Bringing together prominent Africanist scholars from a variety of disciplines, this book offers a comprehensive treatment of the social, cultural and political impact of Pentecostal-Charismatic Christianity in postcolonial sub Saharan Africa.