Consent practices in midwifery: A survey of UK midwives.

OBJECTIVE: To explore midwives' knowledge and understanding of the law and practice of consent in the post-Montgomery world. DESIGN: Cross-sectional online survey. Descriptive statistical analysis of midwives' survey responses. SETTINGS: Social media: Instagram, Facebook and Twitter. Survey distribution was via the UCL Opinio survey platform. PARTICIPANTS: A total of 402 midwives, surveyed over a four month period between 2nd March and 2nd July 2021. MEASUREMENTS: Knowledge of legal consent, 'sureness' of meeting current legal requirements and competence to gain consent. FINDINGS: 91% of participants acknowledged correctly that consent must be voluntary. 91% reported that women must be informed of all the risks associated with their care, although 26% reported that women should be informed of some of the risks associated with their care. Most participants were 'sure' that their discussions of consent meet current legal requirements (91%). 21% rated their competence to gain consent as 'excellent', 71% rated themselves as 'very good', whilst 1% rated their competence as 'poor'. Deficiencies in fundamental knowledge of consent were noted in some participants rating themselves highest in 'sureness' of meeting legal requirements and competence to consent. KEY CONCLUSIONS: Fundamental gaps in midwives' knowledge of legal consent were identified. Participants demonstrated uncertainty regarding the extent of risk disclosure and discussion of alternative care options. Participants generally rated themselves highly in their consenting practices, despite lacking in basic knowledge of legal consent, revealing a discrepancy between midwives' self-perceptions and their actual knowledge. IMPLICATIONS FOR PRACTICE: The overconfidence displayed by some participants is concerning for clinical midwifery practice. Professional education and guidance for midwives on legal consent in keeping with Montgomery is urgently required to ensure that midwives are legally compliant in their consenting practices.

Phosphorus is the key soil indicator controlling productivity in planted Masson pine forests across subtropical China.

Soil physiochemical properties are critical to understanding forest productivity and carbon (C) finance schemes in terrestrial ecosystems. However, few studies have focused on the effects of the soil physiochemical properties on the productivity in planted forests. This study was therefore conducted at 113 sampling plots located in planted Masson pine forests across subtropical China to test what and how the aboveground net primary productivity (ANPP) would be explained by the soil physiochemical properties, stand attributes, and functional traits using regression analysis and structural equation modelling (SEM). Across subtropical China, the ANPP ranged from 1.79 to 14.04 Mg ha-1 year-1 among the plots, with an average value of 6.05 Mg ha-1 year-1. The variations in ANPP were positively related to the stand density, root phosphorus (P) content and soil total P content but were negatively related to the stand age, root C:P and N:P ratios. Among these factors, the combined effects of stand density, stand age and soil total P content explained 35% of the ANPP variations. The SEM results showed the indirect effect of the soil total P content via the root P content and C:P ratio on the ANPP and indirect effects of other soil properties (e.g., pH, clay, and bulk density) via the soil total P content and root functional traits (e.g., root P, C:P, and N:P) on the ANPP. By considering all possible variables and paths, the best-fitting SEM explained only 11-13% of the ANPP variations, which suggested that other factors may be more important in determining the productivity in planted forests. Overall, this study highlights that soil total P content should be used as a key soil indicator for determining the ANPP in planted Masson pine forests across subtropical China, and suggests that the root functional traits mediate the effects of soil properties on the ANPP.

Intravenous immunoglobulin G in the treatment of ABO hemolytic disease of the newborn during the early neonatal period at a tertiary academic hospital: a retrospective study.

OBJECTIVE: To evaluate the efficacy and safety of intravenous immunoglobulin G (IVIG) in infants with ABO hemolytic disease of the newborn (HDN). METHODS: Infants with moderate-to-severe ABO HDN during early neonatal period (<7 days) at our hospital in 2017 were included in this retrospective study. Patients treated with IVIG and phototherapy were classified as the IVIG group, and those who only received phototherapy were classified as the phototherapy only group. RESULTS: Forty-six patients were classified into the IVIG group and 68 other patients were classified into the phototherapy only group. There was no significant difference in duration of phototherapy, hospitalization periods, needs for exchange transfusion, transfusions, and incidence of bilirubin-induced neurological sequelae between these two groups (P = 0.20, 0.27, 0.65, 0.47, 0.78, respectively). CONCLUSION: It seems unnecessary to expose neonates to IVIG in moderate-to-severe ABO HDN when the available data show no appreciable benefits.

Defense pattern of Chinese cork oak across latitudinal gradients: influences of ontogeny, herbivory, climate and soil nutrients.

Knowledge of latitudinal patterns in plant defense and herbivory is crucial for understanding the mechanisms that govern ecosystem functioning and for predicting their responses to climate change. Using a widely distributed species in East Asia, Quercus variabilis, we aim to reveal defense patterns of trees with respect to ontogeny along latitudinal gradients. Six leaf chemical (total phenolics and total condensed tannin concentrations) and physical (cellulose, hemicellulose, lignin and dry mass concentration) defensive traits as well as leaf herbivory (% leaf area loss) were investigated in natural Chinese cork oak (Q. variabilis) forests across two ontogenetic stages (juvenile and mature trees) along a ~14°-latitudinal gradient. Our results showed that juveniles had higher herbivory values and a higher concentration of leaf chemical defense substances compared with mature trees across the latitudinal gradient. In addition, chemical defense and herbivory in both ontogenetic stages decreased with increasing latitude, which supports the latitudinal herbivory-defense hypothesis and optimal defense theory. The identified trade-offs between chemical and physical defense were primarily determined by environmental variation associated with the latitudinal gradient, with the climatic factors (annual precipitation, minimum temperature of the coldest month) largely contributing to the latitudinal defense pattern in both juvenile and mature oak trees.