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Travels in Transylvania : the greater Tمarnava Valley
\"A visitor's handbook to the valley of the Greater Tمarnava river in the heart of Transylvania. This is a land of ancient fortified churches and rolling wildflower meadows, towering steep-roofed citadels and stately noble castles, suspended in time, with an intricate history and a complex diversity of peoples.\" -- back cover.
Book
Perinatal management of extreme preterm birth before 27 weeks of gestation: a framework for practice
In 2006, the Nuffield Council on Bioethics convened a working group to explore the ethical, social, economic and legal issues around clinical decisions made in fetal and neonatal medicine1; in response to their report, the British Association of Perinatal Medicine (BAPM), in conjunction with other professional groups, developed a Framework for Clinical Practice for the management of babies born extremely preterm at less than 26 weeks of gestation. In the current era, the outcomes for babies actively managed at 22 weeks of gestation appear similar to those of babies at 23 weeks of gestation at the time of the 2008 BAPM Framework for Clinical Practice.5–8 Reports from other countries confirm increasing survival and improving neurodevelopmental outcome for babies born before 27 weeks of gestation.9–12 Although internationally there remain differences in practice, there is increasing willingness to consider stabilisation at birth and subsequent intensive care for the most extremely preterm babies,13–15 accompanied by greater acknowledgement of the importance of involving parents in perinatal decision-making.16 Reported outcomes are, of course, impacted by willingness to consider active interventions before and after birth.17 This updated Framework for Practice has been developed by consensus, taking into account the most recent available outcome data both from the UK and internationally, and follows wide consultation. The scope has been extended to include births up to 26+6 weeks of gestation, better to align with national recommendations and published data, and we refer to new RCPCH and other national guidance on palliative care of babies as well as guidance on bereavement care for parents who experience loss of a baby.18 19 Prevention of preterm birth is now a national priority and all maternity services should ensure that measures are in place to realise this ambition. Risk-based approach to decision-making A key ethical consideration for decisions about instituting life-sustaining treatment for an extremely preterm baby is the baby’s prognosis—the risk of an acceptable (or unacceptable) outcome if active (survival focused) management is undertaken.
Journal Article
The plant messiah : adventures in search of the world's rarest species
A scientist discusses saving extraordinary plants on the brink of extinction, describing his search for exotic plants in remote locations and his laboratory efforts to encourage vulnerable plants to propagate and thrive.
Book
Neurodevelopmental outcomes following late and moderate prematurity: a population-based cohort study
ObjectiveThere is a paucity of data relating to neurodevelopmental outcomes in infants born late and moderately preterm (LMPT; 32+0–36+6 weeks). This paper present the results of a prospective, population-based study of 2-year outcomes following LMPT birth.Design1130 LMPT and 1255 term-born children were recruited at birth. At 2 years corrected age, parents completed a questionnaire to assess neurosensory (vision, hearing, motor) impairments and the Parent Report of Children's Abilities-Revised to identify cognitive impairment. Relative risks for adverse outcomes were adjusted for sex, socio-economic status and small for gestational age, and weighted to account for over-sampling of term-born multiples. Risk factors for cognitive impairment were explored using multivariable analyses.ResultsParents of 638 (57%) LMPT infants and 765 (62%) controls completed questionnaires. Among LMPT infants, 1.6% had neurosensory impairment compared with 0.3% of controls (RR 4.89, 95% CI 1.07 to 22.25). Cognitive impairments were the most common adverse outcome: LMPT 6.3%; controls 2.4% (RR 2.09, 95% CI 1.19 to 3.64). LMPT infants were at twice the risk for neurodevelopmental disability (RR 2.19, 95% CI 1.27 to 3.75). Independent risk factors for cognitive impairment in LMPT infants were male sex, socio-economic disadvantage, non-white ethnicity, preeclampsia and not receiving breast milk at discharge.ConclusionsCompared with term-born peers, LMPT infants are at double the risk for neurodevelopmental disability at 2 years of age, with the majority of impairments observed in the cognitive domain. Male sex, socio-economic disadvantage and preeclampsia are independent predictors of low cognitive scores following LMPT birth.
Journal Article
The feminism book
\"Combines authoritative text with graphics and quotes from leading contributors in an introduction to more than eighty-five of the most important ideas, movements, and events that have defined feminism and feminist thought throughout history. Using the Big Ideas series' trademark combination of authoritative, accessible text and bold graphics, this book traces feminism and the feminist movement from its origins, through the suffragette movement of the 19th century, to recent developments such as the Everyday Sexism Project and the #MeToo movement. Entries explore and explain each idea, placing them in their social and cultural context. Packed with inspirational quotations, profiles of key individuals and turning points, and flowcharts and infographics explaining the most significant concepts clearly and simply, The Feminism Book is perfect for anyone with an interest in female empowerment.\" -- (Source of summary not specified)
Book
An evidence-based study mapping the decline in freshwater ponds in the Severn Vale catchment in the UK between 1900 and 2019
Freshwater ponds have long been an overlooked biodiversity store and changing types of land use and the land management practices has led to a steady decline in pond numbers. Establishing the regional extent of pond loss is the first step in identifying key areas for conservation action. This study calculated pond loss in the Severn Vale catchment UK since 1900. Identification of pond location and surrounding land use on historic and contemporary maps enabled a comparison of total number, density and distance between present day and historic ponds. 57.7% of ponds present in 1900 were lost and pond density declined from 7.3 to 4.5 ponds km−2 between 1900 and 2019. This resulted in a 24.6 m increase in the average distance between contemporary ponds. Land use was an important factor in determining pond loss. Although in 2019 the highest density of ponds are in rural areas, 62.3% of ponds lost were from agricultural settings (arable or pasture). Our results highlight the significant pond loss experienced in the Severn Vale since 1900 and provide a valuable baseline for pondscape restoration. The methods described are widely applicable to other regions either with a history of ponds or an environment that could sustain them.
Journal Article
Occurrence patterns of sympatric forest wallabies: assessing the influence of structural habitat attributes on the coexistence of Thylogale thetis and T. stigmatica
We studied the occurrence of two sympatric wallabies, the red-necked pademelon (
) and the red-legged pademelon (
) in northeastern New South Wales, Australia in relation to structural habitat attributes. At our study site, both species inhabit closed forest environments and have overlapping distributions, but
leaves the forest at night to graze adjacent grassy forest edges whereas
remains within the forest and browses forest vegetation. The objectives of the study were to investigate how structural attributes of two forest types, wet sclerophyll forest and rainforest, relate to the fine-scale occurrence of these two wallaby species within the forested environment.
We gathered occurrence data from 48 camera trap stations divided equally between rainforest and wet sclerophyll forest. At each camera point, we also measured a range of structural habitat attributes to determine habitat affiliations for the two
species. Principal component analyses were used to describe major trends in habitat, and generalised linear models were used to describe the efficacy of the variables in predicting habitat occurrence of each species.
The number of occurrences of
was significantly greater than occurrences of
, which was driven by significantly greater occurrences of
in wet sclerophyll forest. There was both spatial and temporal partitioning between the two species; there was a significant difference in the occurrences of the two species at individual cameras and
had a different activity schedule than
in wet sclerophyll forest, where the latter reached its greatest rate of occurrence. At a finer (camera station) scale, occurrences of
increased with proximity to roads and grassy edges and at sites that were less rocky and less steep.
occurrence increased in the presence of rainforest elements like vines, palms and ferns, more ground-level cover and tree-fall gaps and at sites with fewer emergent eucalypts.
Our findings have implications for managing these pademelons and their habitats.
is a common species that was encountered more often than
, and it responded positively to human disturbance like roadsides and grassy edges, presumably because these areas provided good grazing opportunities. By comparison,
is a threatened species, and it responded to natural disturbance like tree-fall gaps where lateral cover was greater, and where rainforest food plants may be more abundant. Our results suggest, therefore, that conservation of the threatened
requires the preservation of intact rainforest.
Journal Article
Diagnosis of a severe congenital anomaly: A qualitative analysis of parental decision making and the implications for healthcare encounters
Objective To explore parental decision making following diagnosis of a severe congenital anomaly, and implications for healthcare encounters. Design Qualitative semi‐structured interviews with 38 parents‐to‐be were collated and triangulated with data generated from consultation recordings. Analysis Data were analysed using a constant comparative‐based approach. Setting Recruitment was undertaken across four fetal medicine sites in two tertiary referral trusts. Participants Parents‐to‐be whose pregnancy was suspected or diagnosed as being affected by a severe congenital anomaly. This sample was purposive to include known factors affecting the decision to terminate or continue the affected pregnancy. Findings In trying to make a decision about how to proceed with their pregnancy, parents‐to‐be typically had to work hard to negotiate multiple uncertainties around the diagnosis and prognosis of the suspected anomaly. This was influenced by parents’ capacity to cope with uncertainty and the way in which uncertainty was managed by the clinical team. This negotiation of uncertainty was enacted within a fluid, nonlinear three‐phase process: “information seeking,” reflecting the way parents‐to‐be face the uncertainty associated with a fetal diagnosis and associated prognosis; “implications,” where consideration is given to future consequences of the decision; and “decision making,” which reflects the way in which the decision is made (head‐ or heart‐led). Spectrums of responses were apparent within each phase. Conclusions This study provides important insights into how parents‐to‐be make decisions following diagnosis or suspicion of a severe congenital anomaly. The impact of these on healthcare encounters is discussed, alongside recommendations for clinical practice.
Journal Article
Quantifying the burden of stillbirths before 28 weeks of completed gestational age in high-income countries: a population-based study of 19 European countries
International comparisons of stillbirth allow assessment of variations in clinical practice to reduce mortality. Currently, such comparisons include only stillbirths from 28 or more completed weeks of gestational age, which underestimates the true burden of stillbirth. With increased registration of early stillbirths in high-income countries, we assessed the reliability of including stillbirths before 28 completed weeks in such comparisons.
In this population-based study, we used national cohort data from 19 European countries participating in the Euro-Peristat project on livebirths and stillbirths from 22 completed weeks of gestation in 2004, 2010, and 2015. We excluded countries without national data for stillbirths by gestational age in these periods, or where data available were not comparable between 2004 and 2015. We also excluded those countries with fewer than 10 000 births per year because the proportion of stillbirths at 22 weeks to less than 28 weeks of gestation is small. We calculated pooled stillbirth rates using a random-effects model and changes in rates between 2004 and 2015 using risk ratios (RR) by gestational age and country.
Stillbirths at 22 weeks to less than 28 weeks of gestation accounted for 32% of all stillbirths in 2015. The pooled stillbirth rate at 24 weeks to less than 28 weeks declined from 0·97 to 0·70 per 1000 births from 2004 to 2015, a reduction of 25% (RR 0·75, 95% CI 0·65–0·85). The pooled stillbirth rate at 22 weeks to less than 24 weeks of gestation in 2015 was 0·53 per 1000 births and did not significantly changed over time (RR 0·97, 95% CI 0·80–1·16) although changes varied widely between countries (RRs 0·62–2·09). Wide variation in the percentage of all births occurring at 22 weeks to less than 24 weeks of gestation suggest international differences in ascertainment.
Present definitions used for international comparisons exclude a third of stillbirths. International consistency of reporting stillbirths at 24 weeks to less than 28 weeks suggests these deaths should be included in routinely reported comparisons. This addition would have a major impact, acknowledging the burden of perinatal death to families, and making international assessments more informative for clinical practice and policy. Ascertainment of fetal deaths at 22 weeks to less than 24 weeks should be stabilised so that all stillbirths from 22 completed weeks of gestation onwards can be reliably compared.
EU Union under the framework of the Health Programme and the Bridge Health Project.
Journal Article
Neonatal outcomes and delivery of care for infants born late preterm or moderately preterm: a prospective population-based study
ObjectiveTo describe neonatal outcomes and explore variation in delivery of care for infants born late (34–36 weeks) and moderately (32–33 weeks) preterm (LMPT).Design/settingProspective population-based study comprising births in four major maternity centres, one midwifery-led unit and at home between September 2009 and December 2010. Data were obtained from maternal and neonatal records.ParticipantsAll LMPT infants were eligible. A random sample of term-born infants (≥37 weeks) acted as controls.Outcome measuresNeonatal unit (NNU) admission, respiratory and nutritional support, neonatal morbidities, investigations, length of stay and postnatal ward care were measured. Differences between centres were explored.Results1146 (83%) LMPT and 1258 (79% of eligible) term-born infants were recruited. LMPT infants were significantly more likely to receive resuscitation at birth (17.5% vs 7.4%), respiratory (11.8% vs 0.9%) and nutritional support (3.5% vs 0.3%) and were less likely to be fed breast milk (64.2% vs 72.2%) than term infants. For all interventions and morbidities, a gradient of increasing risk with decreasing gestation was evident. Although 60% of late preterm infants were never admitted to a NNU, 83% required medical input on postnatal wards. Clinical management differed significantly between services.ConclusionsLMPT infants place high demands on specialist neonatal services. A substantial amount of previously unreported specialist input is provided in postnatal wards, beyond normal newborn care. Appropriate expertise and planning of early care are essential if such infants are managed away from specialised neonatal settings. Further research is required to clarify optimal and cost-effective postnatal management for LMPT babies.
Journal Article