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Background Antenatal steroid (ANS) therapy is given to women at risk of preterm delivery to accelerate fetal lung maturation. However, the benefit of ANS therapy is variable and how maternal and fetal factors contribute to this observed variability is unknown. We aimed to test the degree of concordance in preterm lung function, and correlate this with genomic, transcriptomic, and pharmacokinetic variables in preterm dizygotic twin ovine fetuses. Methods Thirty-one date-mated ewes carrying twin fetuses at 123 ± 1 days’ gestation received maternal intramuscular injections of either (i) 1 × 0.25 mg/kg betamethasone phosphate and acetate (CS1, n  = 11 twin pairs) or (ii) 2 × 0.25 mg/kg betamethasone phosphate and acetate, 24 h apart (CS2, n  = 10 twin pairs) or (iii) 2 × saline, 24 h apart (negative control, n  = 10 twin pairs). Fetuses were surgically delivered 24 h after their final treatment and ventilated for 30 min. Results ANS-exposed female fetuses had lower arterial partial pressure of carbon dioxide (PaCO 2 ) values than male fetuses (76.5 ± 38.0 vs. 97.2 ± 42.5 mmHg), although the observed difference was not statistically significant ( p  = 0.1). Only 52% of ANS-treated twins were concordant for lung maturation responses. There was no difference in fetal lung tissue or plasma steroid concentrations within or between twin pairs. Genomic analysis identified 13 single-nucleotide polymorphisms (SNPs) statistically associated with ANS-responsiveness, including in the proto-oncogene MET and the transcription activator STAT1. Conclusions Twin fetal responses and ANS tissue levels were comparable with those from singleton fetuses in earlier studies. Twin ovine fetuses thus benefit from ANS in a similar manner to singleton fetuses, and a larger dose of betamethasone is not required. Assuming no difference in input from the placental or maternal compartments, fetal lung responses to ANS therapy in dizygotic twin preterm lambs are dependent on the fetus itself. These data suggest a potential heritable role in determining ANS responsiveness.

The aim of this study was to document the haematological profile of pregnant ewes throughout gestation. Sheep were divided into three groups (n = 8 per group): non-pregnant, singleton, or twin pregnancy. Blood samples were collected every 14 days from day 55 of gestation for haemoglobin concentration; packed cell volume; total protein; and albumin concentration. On days 55 and 125 of gestation blood was collected for trace element estimation: soluble copper and zinc; glutathione peroxidase (GSHPx); and methylmalonic acid (MMA). Pooled faecal samples were collected on days 55, 97, and 139 of gestation. Pasture cuts were collected on days 97 and 153 of gestation. The haematology and protein concentrations were not different between groups throughout the study. Copper concentration increased in all animals during the study (p < 0.0001). Zinc concentration was lowest in the singleton and twin pregnant sheep on day 55 of gestation (p = 0.04). GSHPx was not different between groups during the study. MMA decreased in all animals during the study (p < 0.0001), but was not different between groups. Faecal samples were consistently negative for strongyle and nematode eggs, and coccidian oocysts. The pasture was good quality. Pregnant sheep in a farm environment with normal trace element status, no parasites, and an adequate diet, did not develop anaemia (PCV < 0.27).

Background Patients living with chronic pain are typically resource intensive, their care requirements are long term and referral to secondary care is not always expeditious. To provide more appropriate, accessible and cost-effective care, Tower Hamlets Primary Care Trust reviewed the needs of the patients, their current care and the numbers requiring treatment for non-malignant chronic pain, initially starting with musculoskeletal pain. Method We estimated the number of people with chronic pain being treated outside general practice by the NHS in Tower Hamlets. A working group established set criteria to define a chronic pain patient. We surveyed appropriate clinicians to determine the approximate number of patients who fitted our inclusion criteria, the approximate number of follow-up appointments they required and their care pathways. Secondly, we estimated the cost of care for chronic pain patients using NHS national tariff and reference cost data. We also took a convenience sample of chronic pain patients and recorded their history of care. Findings The routes and pathways of care are complex and multiple. We estimate between 4.0% and 5.5% of new patients in rheumatology, orthopaedics, occupational therapy and musculoskeletal physiotherapy and up to 90% in the pain clinic are people living with chronic pain. The cost of this care ranged from £296 for a course of physiotherapy to £1911 for a patient seen in physiotherapy, orthopaedic and the pain clinics. Conclusion There is no facility in current management information services that identifies people being treated for non-specific chronic pain; therefore, estimating both the numbers and costs for treating these people is difficult. National tariff and notional cost data provide estimates only, of an 'average patient'; the real cost of these patients is unknown.

[...] most importantly - to quote Ingrid Bergman - \"Be yourself, the world worships an original.\"

Why? Because he spent all of his time - when not handling customers - studying.

While having a crisis plan is the first step to ensuring your organization will be in a good position to survive the initial turmoil, the Toyota situation emphasizes the necessity of ensuring your plan covers all potential disasters, is clear and concise and most importantly is available and explained to all employees all the way from senior management to front-line staff.

Furthermore, if a rewards system has so many nominees, like the Oscars, instead of showcasing the value that an employee brings to the organization, it can inadvertently publicize those individuals who may be struggling. Because the Oscars are voted on by people who work in the industry, thus a peer award, it's often the high profile movies that tend to get nominated.

[...] the morale for her team has been gradually improving and she recognizes it's a slow jog uphill, but at least her team now has a clear plan to see where they are, where they want to be, and provides everyone - managers and employees - with accountability in realizing their success.

[...] sometimes, my friend will ask a colleague for information and they will purposely (or so it seems to her), provide her with inaccurate information to push her in the wrong direction so that they can make themselves look better to the senior manager.