Major obstetric haemorrhage of 2000 ml or greater: a clinical audit.

Haemorrhage remains a leading cause of maternal death. We conducted an audit to identify strategies to improve the management at our local NHS Trust. A data collection form was based on our local guideline. A coded database search was conducted for all deliveries where the estimated blood loss was ≥2000 ml (from June 1 2015 to December 31 2015), returning 68 search results (13.7/1000 births). Fifty-six records were included. Poor compliance (<75%) was seen in some key areas including the major obstetric haemorrhage (MOH) call activation (52%), the presence of an anaesthetic consultant (63%) and tranexamic acid administration (46%). Thirty out of 56 cases (54%) were acutely transfused. Women, who were not transfused acutely, appeared to be more likely to need a secondary transfusion if no MOH call had been activated (9/27 (33%) versus 3/29 (10%), p = .052). A key area for improvement was the activation of MOH calls. Following this audit, we adjusted our guideline to make it more clinically useful and staff training sessions were held, including simulation training. Impact statement What is already known on this subject? A postpartum haemorrhage (PPH) is an obstetric emergency. A structured approach is important to optimise the care of the mothers during this dangerous time, and has been shown to reduce the transfusion requirements. However, clinical practice may not adhere to the guideline recommendations. What the results of this study add? With the objective evidence of increased rates of PPH ≥2000 ml at our institution, our work identifying the flaws in management was a critical component of the work to improve the outcomes. This study gives impetus to find innovative ways to improve adherence to guidelines, and inspired an update of our local guideline to improve the applicability and utility. This project suggests a new marker for the adequacy of an acute management (a requirement for secondary blood transfusion without having received an acute transfusion), and raises questions about what constitutes optimum PPH management. What the implications are of these findings for clinical practice and/or further research? The primary and secondary transfusion data raised new questions to investigate in the future: does the involvement of consultants and the escalation of care via the instigation of major haemorrhage protocols improve decision-making and patient outcomes? Does the necessity for a secondary transfusion indicate a suboptimal acute care?

Atmospheric peroxyacetyl nitrate (PAN): a global budget and source attribution.

Peroxyacetyl nitrate (PAN) formed in the atmospheric oxidation of non-methane volatile organic compounds (NMVOCs) is the principal tropospheric reservoir for nitrogen oxide radicals (NOx = NO + NO2). PAN enables the transport and release of NOx to the remote troposphere with major implications for the global distributions of ozone and OH, the main tropospheric oxidants. Simulation of PAN is a challenge for global models because of the dependence of PAN on vertical transport as well as complex and uncertain NMVOC sources and chemistry. Here we use an improved representation of NMVOCs in a global 3-D chemical transport model (GEOS-Chem) and show that it can simulate PAN observations from aircraft campaigns worldwide. The immediate carbonyl precursors for PAN formation include acetaldehyde (44% of the global source), methylglyoxal (30 %), acetone (7 %), and a suite of other isoprene and terpene oxidation products (19 %). A diversity of NMVOC emissions is responsible for PAN formation globally including isoprene (37 %) and alkanes (14 %). Anthropogenic sources are dominant in the extratropical Northern Hemisphere outside the growing season. Open fires appear to play little role except at high northern latitudes in spring, although results are very sensitive to plume chemistry and plume rise. Lightning NOx is the dominant contributor to the observed PAN maximum in the free troposphere over the South Atlantic.

Changes in plasma gonadotrophins, 17ß-oestradiol, progesterone, prolactin, thyroxine and triiodothyronine concentrations in female Japanese quail (Coturnix coturnix japonica) of a heavy body weight line during photo-induced ovarian growth and regression.

1. Simultaneous changes of the width of the cloacal opening and plasma luteinising hormone (LH), follicle stimulating hormone (FSH), 17ß-oestradiol, progesterone, prolactin, thyroxine (T(4)) and triiodothyronine (T(3)) during photo-induced ovarian growth and regression were measured in commercially bred Japanese quail from a heavy body weight line. 2. Somatically mature female Japanese quail were transferred from short days (light:dark 8L:16D) at 10°C to long days (16L:8D) at 20°C, and sexually mature female Japanese quail were transferred from long to short days. All variables were measured at transfer and every five days thereafter (except for a measurement at 12 instead of 10 d) for 35 d. 3. Transfer from short to long days caused significant increases in LH, FSH, 17ß-oestradiol, ovary weights and oviduct weights after five days, and in the cloacal opening after 12 d. T(3) decreased after five days, whereas no significant changes were observed in T(4) concentrations. Progesterone and prolactin both decreased after 25 long days. 4. The transfer of quail from long to short days caused significant decreases in LH, FSH, 17ß-oestradiol, progesterone, prolactin, ovary and oviduct weights after 12 d and an increase in T(3). There was no significant change in T(4) concentrations. The cloacal opening decreased after 25 short days. 5. These results are the first to show simultaneous changes in gonadotrophins, sex steroids, thyroid hormones and prolactin during photo-induced gonadal growth and regression in female Japanese quail.

Long-term retention of injected aluminium-26.

Data previously reported on the whole-body retention of aluminium-26 ((26)Al) in a male volunteer are extended to 8 years after intravenous administration as citrate, when only ~2% of the injected tracer remained. The extended data, combined with a report elsewhere of the late urinary and faecal excretion of (26)Al by this subject, reinforce indications that transdermal losses contribute to the clearance of systemic aluminium and mitigate its long-term accumulation from chronic exposure.

The fallacy of the two-minute acid phosphatase cut off.

Research was carried out to determine whether the likelihood of obtaining a positive Acid Phosphatase (AP) test result is affected by the make and type of paper used. Also, we aimed to investigate the frequency of AP positive reactions occurring after 2min using a series of known semen dilutions and to determine whether spermatozoa transfer onto the paper during the act of AP screening. In this research, most brands of paper tested were able to detect a 1 in 40 semen dilution within 2min. Leaving AP test papers for longer will allow the detection of greater dilutions of semen and as the amount of ejaculation is not reliably known in most casework situations and levels of AP activity can vary in different men, this will increase the seminal detection rate in sexual offence allegations.

Complex traits analysis of chicken growth using targeted genetical genomics.

Dissecting the genetic control of complex trait variation remains very challenging, despite many advances in technology. The aim of this study was to use a major growth quantitative trait locus (QTL) in chickens mapped to chromosome 4 as a model for a targeted approach to dissect the QTL. We applied a variant of the genetical genomics approach to investigate genome-wide gene expression differences between two contrasting genotypes of a marked QTL. This targeted approach allows the direct quantification of the link between the genotypes and the genetic responses, thus narrowing the QTL-phenotype gap using fewer samples (i.e. microarrays) compared with the genome-wide genetical genomics studies. Four differentially expressed genes were localized under the region of the QTL. One of these genes is a potential positional candidate gene (AADAT) that affects lysine and tryptophan metabolism and has alternative splicing variants between the two genotypes. In addition, the lysine and glycolysis metabolism pathways were significantly enriched for differentially expressed genes across the genome. The targeted approach provided a complementary route to fine mapping of QTL by characterizing the local and the global downstream effects of the QTL and thus generating further hypotheses about the action of that QTL.

Transfer of take-home messages in graduate ICU education.

PURPOSE: Teaching by lecture (lecture format) is widely used at congresses and in medical educational programmes. The process involves the transfer of take-home messages. The aim of this study was to assess the number of take-home messages identified by postgraduate critical care junior doctors (juniors) during lectures. METHODS: This was a prospective observational study of 13 lectures. Lecturers were not informed in advance of the study. At the end of the lecture (30 or 50 min), the lecturer (senior doctor) and juniors listed the three main take-home messages on a form. Subjective elements of the juniors' appraisal (quality of the presentation, explanation of the topic's relevance, enthusiasm of the lecturer, background, case-based, delivery and personality, comprehensibility, practical applicability of information given, prioritization, presence of raw data, references, overall satisfaction) and objective elements (length of lecture, number of take-home messages written on the slides) of the lectures were recorded. Successful knowledge transfer was assessed by matching lecturers' and juniors' take-home messages. RESULTS: In total, 367 forms completed by 367 juniors were analysed. A match equal to 3 (highest match), 2, 1 or 0 was observed in 3.8, 26.7, 48.2 and 21.2% of the forms, respectively. No single subjective or objective element of the lecture was associated with the number of identified take-home messages. CONCLUSIONS: Two-thirds of critical care junior doctors identified at best only one of the three main take-home messages of a lecture, suggesting that knowledge transfer is poor during passive format learning. These results suggest that there is a need to develop strategies to improve the performance of lecture-based learning.

Changes in plasma gonadotrophins, testosterone, prolactin, thyroxine and triiodothyronine concentrations in male Japanese quail (Coturnix coturnix japonica) of a heavy body weight line during photo-induced testicular growth and regression.

1. Simultaneous changes of cloacal gland area (CGA) and plasma luteinising hormone (LH), follicle stimulating hormone (FSH), testosterone (T), prolactin (PRL), thyroxine (T(4)) and triiodothyronine (T(3)) during photo-induced testicular growth and regression were measured in commercially bred Japanese quail from a heavy body weight line. 2. Somatically mature male Japanese quail were transferred from short days (light:dark 8L:16D) at 10°C, to long days (16L:8D) at 20°C; and sexually mature male Japanese quail were transferred from long to short days. All variables were measured at transfer and every 5 d thereafter for 35 d. 3. Transfer from short to long days caused significant increases in LH, FSH, T and testis weight (TW) after 5 d, and in CGA after 10 d. T(3) decreased after 5 d, whereas T(4) increased significantly after 25 long days and PRL did not undergo any consistent change. The testicular growth rate was k = 0·1146. 4. Transferring quail from long to short days caused significant decreases in LH and FSH after 5 d, and decreases in T, TW and CGA after 10 d. T(4) decreased after 5 d whilst T(3) increased significantly by day 15. PRL decreased significantly after 10 d then rose before declining again. The testicular regression rate was k = 0·0582. 5. The rates of photo-induced testicular development and regression in a strain of large Japanese quail did not differ from rates reported for other strains of quail. CGA was a better indicator of TW than plasma T concentrations during growth and regression. The role of PRL in photo-induced reproductive cycles in male Japanese quail remains to be determined. 6. The photoperiod-induced changes in gonad size and hormone concentrations, together provide valuable information that can be used in future studies of the endocrinology and neuroendocrinology of photoperiodism in birds.

New hypotheses on the function of the avian shell gland derived from microarray analysis comparing tissue from juvenile and sexually mature hens.

Activation of the shell gland region of the avian oviduct is mediated by ovarian steroids. To understand more extensively how shell glands are maintained and function, we have compared gene expression in the shell glands from juvenile and laying hens using a chicken cDNA microarray. Average expression profiles of juvenile and sexually mature shell glands were compared resulting in the identification of 266 differentially regulated genes. Reverse transcription quantitative polymerase chain reaction confirmed expression differences. The differentially expressed genes included several with known involvement in shell gland function, including ion transport and shell matrix proteins. There were also many unpredicted differentially expressed genes, and for some we propose hypotheses for their functions. These include those encoding (a) osteoprotegerin, a decoy death receptor for receptor activator of nuclear factor NFkB ligand (RANKL) and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), that in the shell gland, may prevent apoptosis and/or may have an endocrine effect by preventing RANKL's action on bone osteoclasts that mobilize stored calcium; (b) prostatic acid phosphatase (ACPP) and prostate stem cell antigen (PSCA) that could play a role in sperm physiology within the shell gland; (c) urea transporter (SLC14A2) that could provide a novel anti-microbial defence; (d) bactericidal/permeability-increasing protein-like 2 (BPIL2), and other potential anti-microbials that have not previously been documented in the chicken. These new hypotheses, if borne out experimentally, will lead to a greater understanding of shell gland function including the processes involved in eggshell formation and anti-microbial activity.