Evaluating patient experience to improve care in a specialist antenatal clinic for pregnancy after loss.

In the United Kingdom, roughly 1 in 250 babies are stillborn each year. Most women who experience stillbirth become pregnant again - 80% within a year of loss. Presently, obstetric-led care is recommended; though there is a growing body of evidence to support provision of specialist services. The Rainbow Clinic is a specialist antenatal service providing care for pregnancies after loss incorporating clinical and psychological care. This study aimed to assess patient experience at the Rainbow Clinic and identify areas for clinical improvement. A 13-item questionnaire was distributed to pregnant women who attended the Rainbow Clinics at the Oxford Road and Wythenshawe sites of Saint Mary's Hospital, Manchester, UK between July 2016 and June 2021. Descriptive statistics and unpaired t-test were used for quantitative data and summative content analysis for qualitative data. Four-hundred and fifty-six women completed the questionnaire. The mean patient experience score per quarter was stable with an average of 21.1 (± 3.0) for the five years, with a maximum attainable score of 25. The COVID-19 pandemic had no effect on patient experience at the Rainbow Clinic (pre-pandemic vs. during-pandemic: mean 21.2 v 21.3; p = 0.75). Free-text responses demonstrated women felt positively about the antenatal care received. Identified areas for improvement included "more awareness of the [Rainbow] sticker" to ensure women with previous loss are identified; increased publicity of the Rainbow Clinic services; developing more clinics at different locations to improve accessibility; and continuing specialist input into intrapartum care. Specialist antenatal care provided by the Rainbow Clinic was rated as of a high standard. Potential future improvements include sticker alterations (or other mechanisms to identify women who have experienced a previous loss) and develop increased awareness of the clinic in other institutions.

Evaluating antenatal risk in twin pregnancies-A feasibility study to identify modifiable factors associated with adverse pregnancy outcomes.

INTRODUCTION: Twin pregnancies have significantly higher rates of perinatal morbidity and mortality compared to singleton pregnancies; current attempts to reduce perinatal mortality have been less successful in twin pregnancies. The paucity of information about modifiable risk factors for adverse neonatal outcomes in twin pregnancies, as well as independent effects of chorionicity may have contributed to this outcome. This study aimed to explore the feasibility of an observational study to identify modifiable factors associated with adverse neonatal outcomes in twin pregnancies. MATERIAL AND METHODS: Patients pregnant with twins at six UK hospitals between December 2019-March 2021 completed researcher-administered questionnaires at approximately 20-, 28- and 36-weeks' gestation, recording a wide range of self-reported social, lifestyle and demographic factors, alongside prospectively recorded clinical data from maternity records. Descriptive statistics were used to describe frequencies of exposures; logistic regression was used to determine whether factors were associated with a composite measure of adverse neonatal outcome. RESULTS: Data were collected from 65% (181/277) of eligible participants. A total of 98% (175) of participants had positive views about their participation. Some exposures, including cigarette smoking, supine sleep position and reduced fetal movements were less frequent in twin pregnancies compared to singletons, whereas fertility treatment was more common. Furthermore, different patterns of exposure were seen between monochorionic and dichorionic twins. This pilot study found some associations with adverse neonatal outcomes including: low BMI (OR 8.36, 95% CI: 1.02-68.87), maternal age ≥41 years (OR 9.0 95% CI: 1.07-75.84), maternally perceived high-stress levels (OR 1.96, 95% CI: 1.03-3.75) and inadequate antenatal screening (OR 1.44, 95% CI: 1.01-2.06). Sleep duration ≥9 h and right-sided going to sleep position were more frequent among pregnancies with adverse outcomes. Participants who reported receiving no information on fetal movement and reduced maternal perception of movements were more likely to have an adverse outcome, but sample size prohibited analysis based upon chorionicity. CONCLUSIONS: An observational study of modifiable factors in twin pregnancy is feasible. Differences in the frequencies of exposures between twin and singleton pregnancies highlight the need for twin-specific studies to identify modifiable factors and develop preventative strategies for morbidity and mortality in twin pregnancies.

Deep, ultra-hot-melting residues as cradles of mantle diamond.

The ancient stable continents are up to 250 km deep, with roots extending into the diamond stability field1. These cratons owe their mechanical strength to being cool and rigid2, features inherited from extensive melt extraction1,3. The most prominent model for craton formation anticipates dominant melting at relatively shallow depth (50-100 km) above diamond stability4-7, followed by later imbrication to form the deeper roots8,9. Here we present results from thermodynamic and geochemical modelling of melting at sufficiently high temperatures to produce the very magnesian olivine of cratonic roots10. The new closed-system and open-system modelling reproduces the observed cratonic mantle mineral compositions by deep (about 200 km) and very hot melting (≥1,800 °C), obviating the need for shallow melting and stacking. The modelled highly magnesian liquids (komatiites) evolve to Al-enriched and Ti-depleted forms, as observed in the greenstone belts at the fossil surface of cratons11. The paucity of Ti-depleted komatiite12 implies that advanced closed-system isochemical melting (>1,825 °C) was much less common than open-system interaction between deeper liquids and melting of existing refractory mantle. The highly refractory compositions of diamond inclusion minerals could imply preferential diamond growth in the more reducing parts of the cratonic root, depleted by ultra-hot melting in response to heat plumes from a deeper former boundary layer that vanished at the end of the Archaean13.

Community established best practice recommendations for tephra studies-from collection through analysis.

Tephra is a unique volcanic product with an unparalleled role in understanding past eruptions, long-term behavior of volcanoes, and the effects of volcanism on climate and the environment. Tephra deposits also provide spatially widespread, high-resolution time-stratigraphic markers across a range of sedimentary settings and thus are used in numerous disciplines (e.g., volcanology, climate science, archaeology). Nonetheless, the study of tephra deposits is challenged by a lack of standardization that inhibits data integration across geographic regions and disciplines. We present comprehensive recommendations for tephra data gathering and reporting that were developed by the tephra science community to guide future investigators and to ensure that sufficient data are gathered for interoperability. Recommendations include standardized field and laboratory data collection, reporting and correlation guidance. These are organized as tabulated lists of key metadata with their definition and purpose. They are system independent and usable for template, tool, and database development. This standardized framework promotes consistent documentation and archiving, fosters interdisciplinary communication, and improves effectiveness of data sharing among diverse communities of researchers.

Age of the oldest known Homo sapiens from eastern Africa.

Efforts to date the oldest modern human fossils in eastern Africa, from Omo-Kibish1-3 and Herto4,5 in Ethiopia, have drawn on a variety of chronometric evidence, including 40Ar/39Ar ages of stratigraphically associated tuffs. The ages that are generally reported for these fossils are around 197 thousand years (kyr) for the Kibish Omo I3,6,7, and around 160-155 kyr for the Herto hominins5,8. However, the stratigraphic relationships and tephra correlations that underpin these estimates have been challenged6,8. Here we report geochemical analyses that link the Kamoya's Hominid Site (KHS) Tuff9, which conclusively overlies the member of the Omo-Kibish Formation that contains Omo I, with a major explosive eruption of Shala volcano in the Main Ethiopian Rift. By dating the proximal deposits of this eruption, we obtain a new minimum age for the Omo fossils of 233 ± 22 kyr. Contrary to previous arguments6,8, we also show that the KHS Tuff does not correlate with another widespread tephra layer, the Waidedo Vitric Tuff, and therefore cannot anchor a minimum age for the Herto fossils. Shifting the age of the oldest known Homo sapiens fossils in eastern Africa to before around 200 thousand years ago is consistent with independent evidence for greater antiquity of the modern human lineage10.

Lake Ohrid's tephrochronological dataset reveals 1.36 Ma of Mediterranean explosive volcanic activity.

Tephrochronology relies on the availability of the stratigraphical, geochemical and geochronological datasets of volcanic deposits, three preconditions which are both often only fragmentary accessible. This study presents the tephrochronological dataset from the Lake Ohrid (Balkans) sediment succession continuously reaching back to 1.36 Ma. 57 tephra layers were investigated for their morphological appearance, geochemical fingerprint, and (chrono-)stratigraphic position. Glass fragments of tephra layers were analyzed for their major element composition using Energy-Dispersive-Spectroscopy and Wavelength-Dispersive Spectroscopy and for their trace element composition by Laser Ablation-Inductively Coupled Plasma-Mass Spectrometry. Radiometric dated equivalents of 16 tephra layers and orbital tuning of geochemical proxy data provided the basis for the age-depth model of the Lake Ohrid sediment succession. The age-depth model, in turn, provides ages for unknown or undated tephra layers. This dataset forms the basis for a regional stratigraphic framework and provides insights into the central Mediterranean explosive volcanic activity during the last 1.36 Ma.

Depth-dependent peridotite-melt interaction and the origin of variable silica in the cratonic mantle.

Peridotites from the thick roots of Archaean cratons are known for their compositional diversity, whose origin remains debated. We report thermodynamic modelling results for reactions between peridotite and ascending mantle melts. Reaction between highly magnesian melt (komatiite) and peridotite leads to orthopyroxene crystallisation, yielding silica-rich harzburgite. By contrast, shallow basalt-peridotite reaction leads to olivine enrichment, producing magnesium-rich dunites that cannot be generated by simple melting. Komatiite is spatially and temporally associated with basalt within Archaean terranes indicating that modest-degree melting co-existed with advanced melting. We envisage a relatively cool mantle that experienced episodic hot upwellings, the two settings could have coexisted if roots of nascent cratons became locally strongly extended. Alternatively, deep refractory silica-rich residues could have been detached from shallower dunitic lithosphere prior to cratonic amalgamation. Regardless, the distinct Archaean melting-reaction environments collectively produced skewed and multi-modal olivine distributions in the cratonic lithosphere and bimodal mafic-ultramafic volcanism at surface.

Combined zinc-lead isotope and trace-metal assessment of recent atmospheric pollution sources recorded in Irish peatlands.

Atmospherically-fed Earth surface archives such as ombrotrophic peatlands, lake sediments, and ice consistently show an upward increase in Zn concentrations of hitherto unclear origin. Here, we present a combined stable Zn isotope and trace element (Zn, Cd, Ni, Cu, Cr, V, Ta, Pb) dataset for a historically polluted, near-urban bog (Liffey Head) from the east coast of Ireland. This peat record is compared to an archive from a rural site at the west coast of Ireland (Brackloon Wood). Both archives show a clear near-surface increase in Zn deposition, accompanied by periodic deposition in Cr, Ni, Mo, and V suggesting a co-genetic origin of these elements. In the Liffey Head site, biologic upward distillation of nutrients can be excluded as the origin of the elemental enrichments. The differences in the excess metal ratios between the two sites (e.g., Zn/Cd of 426-1564, east, and 77-106, west) are attributed to a higher contribution from traffic emissions (diesel, petrol) and oil-burning at the near-urban site, and dominant atmospheric influence from solid fossil fuel combustion emissions (e.g., mixed fuel, coal and wood) at the rural site. The Zn isotope composition in the historically-polluted Liffey Head bog evolved from δ66/64ZnJMC-Lyon values of 0.72 ±â€¯0.03‰ in the peat accumulated during the 19th century to lighter ratios (0.18 ±â€¯0.03‰) towards the top of the monolith (i.e., recent). Zinc-isotope ratios are positively correlated with excess metal/Cd ratios and also with 206Pb/207Pb, collectively fingerprinting the gradual change from a mining-dominated to a traffic-dominated atmospheric pollution at the east coast over the past century. A prevalent input, interpreted to represent combustion emissions from diesel engines, is observed for the past 15 years. Combined with trace elements and radiogenic Pb isotopes, the information obtained with the Zn isotope systematics adds towards an in-depth characterisation of the pollution signals.

The chronostratigraphy of the Haua Fteah cave (Cyrenaica, northeast Libya).

The 1950s excavations by Charles McBurney in the Haua Fteah, a large karstic cave on the coast of northeast Libya, revealed a deep sequence of human occupation. Most subsequent research on North African prehistory refers to his discoveries and interpretations, but the chronology of its archaeological and geological sequences has been based on very early age determinations. This paper reports on the initial results of a comprehensive multi-method dating program undertaken as part of new work at the site, involving radiocarbon dating of charcoal, land snails and marine shell, cryptotephra investigations, optically stimulated luminescence (OSL) dating of sediments, and electron spin resonance (ESR) dating of tooth enamel. The dating samples were collected from the newly exposed and cleaned faces of the upper 7.5 m of the ∼14.0 m-deep McBurney trench, which contain six of the seven major cultural phases that he identified. Despite problems of sediment transport and reworking, using a Bayesian statistical model the new dating program establishes a robust framework for the five major lithostratigraphic units identified in the stratigraphic succession, and for the major cultural units. The age of two anatomically modern human mandibles found by McBurney in Layer XXXIII near the base of his Levalloiso-Mousterian phase can now be estimated to between 73 and 65 ka (thousands of years ago) at the 95.4% confidence level, within Marine Isotope Stage (MIS) 4. McBurney's Layer XXV, associated with Upper Palaeolithic Dabban blade industries, has a clear stratigraphic relationship with Campanian Ignimbrite tephra. Microlithic Oranian technologies developed following the climax of the Last Glacial Maximum and the more microlithic Capsian in the Younger Dryas. Neolithic pottery and perhaps domestic livestock were used in the cave from the mid Holocene but there is no certain evidence for plant cultivation until the Graeco-Roman period.

Volcanic ash layers illuminate the resilience of Neanderthals and early modern humans to natural hazards.

Marked changes in human dispersal and development during the Middle to Upper Paleolithic transition have been attributed to massive volcanic eruption and/or severe climatic deterioration. We test this concept using records of volcanic ash layers of the Campanian Ignimbrite eruption dated to ca. 40,000 y ago (40 ka B.P.). The distribution of the Campanian Ignimbrite has been enhanced by the discovery of cryptotephra deposits (volcanic ash layers that are not visible to the naked eye) in archaeological cave sequences. They enable us to synchronize archaeological and paleoclimatic records through the period of transition from Neanderthal to the earliest anatomically modern human populations in Europe. Our results confirm that the combined effects of a major volcanic eruption and severe climatic cooling failed to have lasting impacts on Neanderthals or early modern humans in Europe. We infer that modern humans proved a greater competitive threat to indigenous populations than natural disasters.

Methods for the purification of ubiquitinated proteins.

Post-translational protein modification by the covalent conjugation of ubiquitin, originally implicated as a signal for proteolytic degradation by 26S proteasome, has now been realised to play important roles in the regulation of almost all biological processes in eukaryotes. In order to understand these processes in greater detail there is a requirement for techniques that can purify mixtures of ubiquitin-conjugated proteins, as a prerequisite to their identification and characterisation. Here we review the methods that have been applied to the bulk purification of ubiquitinated proteins and discuss their applications in proteomic analyses of the 'ubiquitome'.