Impact of COVID-19 pandemic restrictions on pregnancy duration and outcome in Melbourne, Australia.

OBJECTIVE: To investigate the effect of restriction measures implemented to mitigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission during the coronavirus disease 2019 (COVID-19) pandemic on pregnancy duration and outcome. METHODS: A before-and-after study was conducted with cohort sampling in three maternity hospitals in Melbourne, Australia, including women who were pregnant when restriction measures were in place during the COVID-19 pandemic (estimated conception date between 1 November 2019 and 29 February 2020) and women who were pregnant before the restrictions (estimated conception date between 1 November 2018 and 28 February 2019). The primary outcome was delivery before 34 weeks' gestation or stillbirth. The main secondary outcome was a composite of adverse perinatal outcomes. Pregnancy outcomes were compared between women exposed to restriction measures and unexposed controls using the χ-square test and modified Poisson regression models, and duration of pregnancy was compared between the groups using survival analysis. RESULTS: In total, 3150 women who were exposed to restriction measures during pregnancy and 3175 unexposed controls were included. Preterm birth before 34 weeks or stillbirth occurred in 95 (3.0%) exposed pregnancies and in 130 (4.1%) controls (risk ratio (RR), 0.74 (95% CI, 0.57-0.96); P = 0.021). Preterm birth before 34 weeks occurred in 2.4% of women in the exposed group and in 3.4% of women in the control group (RR, 0.71 (95% CI, 0.53-0.95); P = 0.022), without evidence of an increase in the rate of stillbirth in the exposed group (0.7% vs 0.9%; RR, 0.83 (95% CI, 0.48-1.44); P = 0.515). Competing-risks regression analysis showed that the effect of the restriction measures on spontaneous preterm birth was stronger and started earlier (subdistribution hazard ratio (HR), 0.81 (95% CI, 0.64-1.03); P = 0.087) than the effect on medically indicated preterm birth (subdistribution HR, 0.89 (95% CI, 0.70-1.12); P = 0.305). The effect was stronger in women with a previous preterm birth (RR, 0.42 (95% CI, 0.21-0.82); P = 0.008) than in parous women without a previous preterm birth (RR, 0.93 (95% CI, 0.63-1.38); P = 0.714) (P for interaction = 0.044). Composite adverse perinatal outcome was less frequent in the exposed group than in controls (all women: 2.1% vs 2.9%; RR, 0.73 (95% CI, 0.54-0.99); P = 0.042); women with a previous preterm birth: 4.5% vs 8.4%; RR, 0.54 (95% CI, 0.25-1.18); P = 0.116). CONCLUSIONS: Restriction measures implemented to mitigate SARS-CoV-2 transmission during the COVID-19 pandemic were associated with a reduced rate of preterm birth before 34 weeks. This reduction was mainly due to a lower rate of spontaneous prematurity. The effect was more substantial in women with a previous preterm birth and was not associated with an increased stillbirth rate. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Social contributors to cardiometabolic diseases in indigenous populations: an international Delphi study.

OBJECTIVE: The objective of this study was to identify priority social factors contributing to indigenous cardiometabolic diseases. STUDY DESIGN: A three-round Delphi process was used to consolidate and compare the opinions of 60 experts in indigenous cardiometabolic health from Australia, New Zealand and the United States. METHODS: Round one: three open-ended questions: (i) historical, (ii) economic and (iii) sociocultural factor contributors to cardiometabolic disease risk. Round two: a structured questionnaire based on the results from the first round; items were ranked according to perceived importance. Final round: the items were reranked after receiving the summary feedback. RESULTS: Several key findings were identified: (i) an important historical factor is marginalisation and disempowerment; (ii) in terms of economic and sociocultural factors, the panellists came to the consensus that the socio-economic status and educational inequalities are important; and (iii) while consensus was not reached, economic and educational factors were also perceived to be historically influential. CONCLUSION: These findings support the need for multilevel health promotion policy. For example, tackling financial barriers that limit the access to health-promoting resources, combined with improving literacy skills to permit understanding of health education.

Phytosterol-based edible oleogels: A novel way of replacing saturated fat in food.

This article presents a summary of recent results relating to phytosterol oleogels. Oleogels represent a novel way of replacing saturated fat in food, whilst phytosterols have been shown to actively lower low-density lipoprotein (LDL)- cholesterol levels. There are a number of technical challenges to exploiting phytosterol oleogels, including a high sensitivity to water. To facilitate their incorporation into food, the fundamental physiochemical processes which mediate the formation of these gels and two different approaches to produce phytosterol oleogels that are stable in the presence of water were explored as part of the recent Biotechnology and Biological Sciences Research Council (BBSRC)-Diet and Health Research Industry Club (DRINC)-funded Edible Oleogels for Reduction of Saturated Fat project. This report summarises the findings, which will support the development of healthier food products that are lower in saturated fat and acceptable to consumers.

An assessment of data quality in a multi-site electronic medical record system in Haiti.

OBJECTIVES: Strong data quality (DQ) is a precursor to strong data use. In resource limited settings, routine DQ assessment (DQA) within electronic medical record (EMR) systems can be resource-intensive using manual methods such as audit and chart review; automated queries offer an efficient alternative. This DQA focused on Haiti's national EMR - iSanté - and included longitudinal data for over 100,000 persons living with HIV (PLHIV) enrolled in HIV care and treatment services at 95 health care facilities (HCF). METHODS: This mixed-methods evaluation used a qualitative Delphi process to identify DQ priorities among local stakeholders, followed by a quantitative DQA on these priority areas. The quantitative DQA examined 13 indicators of completeness, accuracy, and timeliness of retrospective data collected from 2005 to 2013. We described levels of DQ for each indicator over time, and examined the consistency of within-HCF performance and associations between DQ and HCF and EMR system characteristics. RESULTS: Over all iSanté data, age was incomplete in <1% of cases, while height, pregnancy status, TB status, and ART eligibility were more incomplete (approximately 20-40%). Suspicious data flags were present for <3% of cases of male sex, ART dispenses, CD4 values, and visit dates, but for 26% of cases of age. Discontinuation forms were available for about half of all patients without visits for 180 or more days, and >60% of encounter forms were entered late. For most indicators, DQ tended to improve over time. DQ was highly variable across HCF, and within HCFs DQ was variable across indicators. In adjusted analyses, HCF and system factors with generally favorable and statistically significant associations with DQ were University hospital category, private sector governance, presence of local iSante server, greater HCF experience with the EMR, greater maturity of the EMR itself, and having more system users but fewer new users. In qualitative feedback, local stakeholders emphasized lack of stable power supply as a key challenge to data quality and use of the iSanté EMR. CONCLUSIONS: Variable performance on key DQ indicators across HCF suggests that excellent DQ is achievable in Haiti, but further effort is needed to systematize and routinize DQ approaches within HCFs. A dynamic, interactive "DQ dashboard" within iSanté could bring transparency and motivate improvement. While the results of the study are specific to Haiti's iSanté data system, the study's methods and thematic lessons learned holdgeneralized relevance for other large-scale EMR systems in resource-limited countries.

Transcranial orbital decompression for progressive compressive optic neuropathy after 3-wall decompression in severe graves' orbitopathy.

PURPOSE: To determine surgical outcomes after transcranial decompression of the superior orbit in patients with progressive compressive optic neuropathy (CON) secondary to Graves' orbitopathy (GO) who had previously been treated with 3-wall decompression. METHODS: Approval from the West Virginia University Institution Review Board was obtained. A retrospective review of 4 patients with GO who received bilateral transcranial decompression of the orbits for progressive compressive optic neuropathy after bilateral maximal extracranial 3-wall decompression was performed. The patients were treated by the Multidisciplinary Orbit and Skull Base Services at West Virginia University and the University of Michigan. RESULTS: Bilateral transcranial decompression of the orbit for GO was performed on 8 orbits in 4 patients. All 8 orbits had radiographic evidence of compression of the orbital apex, and all patients had been treated with steroids, orbital radiation, and bilateral 3-wall decompression. Preoperative vision ranged from 20/25 to 20/100, which improved to 20/25 or better in all eyes. The visual field mean deviation improved from a mean of -13.05 to -1.67 dB. Hertel measurements improved from a mean of 19.25 to 15.25 mm. Extraocular motility was essentially unchanged. Two patients were noted to have asymptomatic ocular pulsations. There were no other complications, and all patients remained stable during a follow-up period of 5 years (range 2-8 years). CONCLUSIONS: Transcranial decompression is an effective and safe method of salvaging vision when standard treatments fail. This is only the second report of transcranial decompression for refractory compressive optic neuropathy after decompression from a standard approach.

Calculated computed tomography volumes of lacrimal glands and comparison to clinical findings in patients with thyroid eye disease.

PURPOSE: To describe the range of lacrimal gland volumes on CT in Caucasian patients with thyroid eye disease (TED) and to correlate with clinical findings. METHODS: With institutional review board approval, 125 orbital CT scans for TED were reviewed. OsiriX software was used to calculate the volume of the lacrimal gland. Comparison of the volumes was made with previously published results of the normal population. Patient race, gender, smoking status, diplopia, tearing, exophthalmometry, superficial punctate keratitis (SPK), lagophthalmos, restriction in motility, and VISA score were collected. RESULTS: The mean volume of the lacrimal gland in patients with TED was 0.890 cm in right orbits (standard deviation [SD] 0.348), 0.851 cm in left orbits (SD 0.350), with no significant difference between right and left (p = 0.311). The mean volume was 0.811 cm in right male orbits (SD 0.386) and 0.911 cm in right female orbits (SD 0.335), with no significant difference between men and women (p = 0.774). These findings were confirmed in an analysis of left orbits. The volume of right and left orbits correlated well (r = 0.777, p < 0.0001). The lacrimal gland volume in patients with TED was greater compared with the normal population using a 2-sample t test (p < 0.0001). Exophthalmometry (right: r = 0.225, p = 0.0115; left: r = 0.267, p = 0.0026) and subjective tearing (right: r = 0.226, p = 0.0138; left: r = 0.197, p = 0.0322) correlated with lacrimal gland volume. CONCLUSIONS: This study is the first to report the volume of the lacrimal gland calculated on CT scan for patients with TED. The lacrimal gland is larger in patients with TED and correlates with subjective tearing and exophthalmometry.

An invisible enemy: Panton-Valentine leukocidin Staphylococcus aureus on deployed troops.

Over the last seven years Primary Care establishments in the Royal Navy and Royal Marines have dealt with a number of severe and fatal infections caused by Panton-Valentine leukocidin (PVL) producing Staphylococcus aureus, and appear to be seeing these infections more commonly than their civilian colleagues. This retrospective study looked at the levels of PVL S. aureus isolated in deployed personnel during Op HERRICK 14 to determine if the levels seen in British military troops are higher than the national average. We found that the percentage of PVL positive S. aureus isolates sent to the UK HPA reference laboratory from the Camp Bastion laboratory during OP Herrick 14 was 41%, considerably higher rate than the UK civilian rate. Future research, including a larger study into the carriage levels of PVL S. aureus in the military will hopefully shed more light on the spread and transmission of this potentially deadly bacterium.

Bilateral diffuse orbital myositis in a patient with relapsing ulcerative colitis.

Ophthalmic manifestations of inflammatory bowel disease are common, but orbital inflammatory disease is rare with most cases associated with Crohn disease. We describe the first case of bilateral, diffuse, orbital myositis associated with ulcerative colitis in a patient taking infliximab. Within 72 hours of intravenous methylprednisolone treatment, the orbital inflammation dramatically improved. After 8 weeks of prednisone, it completely resolved and has remained quiet for 13 months. This is only the third report of ulcerative colitis-associated orbital inflammatory disease.

CT dimensions of the lacrimal gland in Graves orbitopathy.

PURPOSE: To determine if lacrimal dimensions are enlarged in Graves orbitopathy on CT and to correlate size with clinical data. METHODS: One hundred and twenty-eight adult Caucasian patients with Graves orbitopathy who had CT at initial presentation to the authors' clinic were identified. The lacrimal gland width and length were measured on axial and coronal scans using the OsiriX software according to an established protocol. Comparison of dimensions with a published normal population was made. Clinical data near the time of CT were collected, including gender, age, smoking, subjective diplopia, exophthalmometry, intraocular pressure, corneal staining, and the VISA activity score for correlation with gland size. RESULTS: The lacrimal glands in Graves orbitopathy were significantly larger in all measured dimensions (p = 0.0001 for each dimension). There were no differences between the genders (p values ranged between 0.3855 and 0.8699). Exophthalmometry showed weak correlation with gland size in all dimensions (p value range, 0.0058 to <0.0001; r value range, -0.2616 to 0.4181). Smoking correlated significantly with gland enlargement in right coronal and axial width dimensions (p = 0.0150 and p = 0.0232, respectively). VISA inflammatory score was borderline correlated with right axial width. Lacrimal gland size did not correlate with diplopia, intraocular pressure, or corneal staining. CONCLUSIONS: The lacrimal gland is statistically significantly enlarged in Graves orbitopathy. Only weak correlation was found between gland enlargement and smoking, proptosis, and inflammatory activity. Future research will address the causal changes of enlargement and their effect on lacrimal function.

Cutaneous leishmaniasis in Royal Marines from Oruzgan, Afghanistan.

Leishmaniasis is an infectious disease caused by Leishmania protozoa and occurs as a spectrum of clinical syndromes ranging from various forms of cutaneous leishmaniasis (CL) to mucosal leishmaniasis (ML) and visceral leishmaniasis (VL). CL in Afghanistan is either zoonotic (ZCL) due to L. major or anthroponotic (ACL) due to L. tropica and there has been a prolonged epidemic of ACL in eastern Afghanistan since 1987. However, there have been remarkably few reports of CL due to L. tropica amongst foreign troops serving in Afghanistan since 2001. We describe two such cases in Royal Marines deployed to Oruzgan Province in Afghanistan from 2008-9. These patients illustrate important issues regarding the clinical features, referral, diagnosis, treatment and epidemiology of CL amongst foreign troops in Afghanistan. This disease has the potential to cause significant disruption to military personnel and units and so requires efficient management in order to maintain operational effectiveness.

Delayed Eikenella corrodens orbital infection after fracture repair.

Orbital cellulitis and abscess after fracture repair are rare. Ophthalmic infection with Eikenella species is even more unusual, but can be severe. We report a case of Eikenella corrodens infection in a 28-year-old man who underwent zygomaticomaxillary and orbital floor blowout fracture surgery 4 years before presentation. Eikenella species are often resistant to frequently used empiric antibiotics, and because of specific growth conditions, easily missed on standard cultures. Appropriate efforts should be made to identify and treat E. corrodens in atypical orbital and periocular infections.

Universal screening for meticillin-resistant Staphylococcus aureus in acute care: risk factors and outcome from a multicentre study.

BACKGROUND: A Health Technology Assessment (HTA) model on effectiveness of meticillin-resistant Staphylococcus aureus (MRSA) screening in Scotland suggested that universal screening using chromogenic agar was the preferred option in terms of effectiveness and cost. AIM: To test the model's validity through a one-year pilot-study. METHOD: A large one-year prospective cohort study of MRSA screening was carried out in six acute hospitals in NHS Scotland, incorporating 81,438 admissions. Outcomes (MRSA colonization and infection rates) were subjected to multivariable analyses, and trends before and after implementation of screening were compared. FINDINGS: The initial colonization prevalence of 5.5% decreased to 3.5% by month 12 of the study (P < 0.0001). Colonization was associated with the number of admissions per patient, specialty of admission, age, and source of admission (home, other hospital or care home). Around 2% of all admissions with no prior history of MRSA infection or colonization tested positive. Those who were screen positive on admission and not previously known positive were 12 times more likely than those who screened negative to develop infection, increasing to 18 times if they were both screen positive and previously known positive. MRSA infections (7.5 per 1000 inpatient-days overall) also reduced significantly over the study year (P = 0.0209). CONCLUSION: The risk factors identified for colonization and infection indicate that a universal clinical risk assessment may have a role in MRSA screening.

Computed tomography dimensions of the lacrimal gland in normal Caucasian orbits.

INTRODUCTION: CT is frequently used to assess the lacrimal gland, yet no published reports exist of normal dimensions using this modality. We retrospectively evaluated CT data from normal orbits and measured the lacrimal gland dimensions. METHODS: Two-hundred ninety-three consecutive orbital CT scans (586 orbits) of 282 patients were identified. Caucasian patients aged 18 years and older without known orbital disease were included. Traumatized orbits were excluded. All repeated scans were excluded. Length and width of the lacrimal gland were measured in axial and coronal sections with GE Centricity Software. The primary outcome was a descriptive analysis of the distribution of dimensions in normal orbits. A random subset of patient scans was measured independently by observers at different levels of training, and intraclass correlation coefficients (ICCs) were established. RESULTS: Three hundred orbits (150 right orbits and 150 left orbits) of 282 patients were included. Normal distributions occurred with axial and coronal length measurements. Mean (10th and 90th percentiles) lacrimal gland axial length in right orbits was 14.7 mm (10.9 mm and 18.3 mm) and 14.5 mm in left orbits (10.3 mm and 18.3 mm). Coronal length averaged 17.7 mm in right eyes (13.9 mm and 21.8 mm) and 16.9 mm in left eyes (12.8 mm and 20.8 mm). Axial and coronal width showed non-normal distributions. No statistically significant difference in dimensions was found between genders, and a significant inverse linear relation occurred between gland size and age. Agreement was significant among the observers (ICC >0.7). CONCLUSION: This study presents a normal range of Caucasian lacrimal gland dimensions seen on CT. Lacrimal gland size decreases with age, and no gender difference exists. This range can aid in differentiating diseased and nondiseased lacrimal glands, especially when correlated with physical examination. This may be useful in clinical trials that involve lacrimal gland size.

Amniotic membrane in medial canthal reconstruction.

PURPOSE: To describe the use of amniotic membrane for reconstruction of large medial canthal defects. METHODS: Four cases of medial canthus resection of cutaneous malignancies were reconstructed using amniotic membrane to cover exposed sclera and orbital fat, combined with other reconstructive techniques including titanium plating and myocutaneous flaps. RESULTS: Complete epithelialization of the scleral defect covered with amniotic membrane was seen within 6 weeks in all 4 patients. CONCLUSIONS: Amniotic membrane is useful for complex reconstructions of the medial canthus, and can be combined with other techniques such as myocutaneous flaps. This technique results in good functional and cosmetic results.

Surgery in an Afghan population: is pictorial consent and injury pattern recognition identification of patients appropriate?

OBJECTIVE: The aim of this study was to develop a safe way to obtain informed consent and ensure the correct patient was operated on in a generally poorly educated, non-English speaking Afghan patient population admitted to a military role 2 (enhanced) hospital facility. SUMMARY BACKGROUND DATA: Prior to Herrick 9, surgical consent for Afghan patients was obtained via an interpreter in the traditional manner and documented on a U.K. formatted consent form (MOD form 660) (group 1) with patient identification largely being the responsibility of the interpreter. Patient agreement was documented by placing a thumbprint on the form. During Herrick 9, pictorial consent and injury pattern recognition (IPR) identification of patients was introduced. The consent was written as part of the case note narrative with diagrammatic representation of the injuries and the proposed surgery, which was explained by the interpreter (Group 2). METHODS: We compared the consent and identification process for ten consecutive patients from each group. Each method of consent was examined for documentary evidence of the procedure, patient identification and method of patient agreement. The senior Afghan interpreter was asked for his personal views on the benefit or otherwise of the pictorial consent. RESULTS: For group 1, each of the nine MOD form 660s were completed in English by the operating surgeon and included details of the procedure. Seven had been signed by the interpreter. Each had a thumbprint on the form but there was no name or date alongside it. There was no way of confirming that the thumbprint was that of a particular patient. For group 2, pictorial consent was documented in the narrative with specific documentation of the injury pattern of that patient. Confirmation of consent and patient identification by IPR was by the operating surgeon. CONCLUSIONS: When possible, informed consent is required for all patients undergoing surgery in line with Department of Health guidelines. The use of pictorial consent and IPR identification, as part of patient documentation, would appear to be superior in this particular environment.

Striated muscle hamartoma of the eyelid in an adult woman.

A 57-year-old woman presented with a recurrent lower eyelid growth that was found to be a striated muscle hamartoma on surgical biopsy. This is a rare entity in adults with no history of congenital abnormality. Several other rare, benign lesions may be clinically similar and should be considered in the differential diagnosis of an eyelid lesion containing striated muscle.

Retrofitting houses with insulation to reduce health inequalities: aims and methods of a clustered, randomised community-based trial.

This paper describes the purpose and methods of a single-blinded, clustered and randomised trial of the health impacts of insulating existing houses. The key research question was whether this intervention increased the indoor temperature and lowered the relative humidity, energy consumption and mould growth in the houses, as well as improved the health and well-being of the occupants and thereby lowered their utilisation of health care. Households in which at least one person had symptoms of respiratory disease were recruited from seven predominantly low-income communities in New Zealand. These households were then randomised within communities to receive retrofitted insulation either during or after the study. Measures at baseline (2001) and follow-up (2002) included subjective measures of health, comfort and well-being and objective measures of house condition, temperature, relative humidity, mould (speciation and mass), endotoxin, beta glucans, house dust mite allergens, general practitioner and hospital visits, and energy or fuel usage. All measurements referred to the three coldest winter months, June, July and August. From the 1352 households that were initially recruited, baseline information was obtained from 1310 households and 4413 people. At follow-up, 3312 people and 1110 households remained, an 84% household retention rate and a 75% individual retention rate. Final outcome results will be reported in a subsequent paper. The study showed that large trials of complex environmental interventions can be conducted in a robust manner with high participation rates. Critical success factors are effective community involvement and an intervention that is valued by the participants.

General and specific combining ability from partial diallels of radiata pine: implications for utility of SCA in breeding and deployment populations.

Variances for general combining ability (GCA) and specific combining ability (SCA) and the relationship between mid-parental GCA and SCA effects were estimated for tree diameter (DBH) from a series of 20 sets of 6x6 half-diallel mating experiments in radiata pine, planted at ten sites across Australia. Significant SCA variance for DBH was almost equal to GCA variance for the combined analysis of all ten sites. The importance of SCA variance varied among sites, from non-significant to SCA variance accounting for all genetic variation among full-sib families. Significant SCA x site interaction was detected among the ten sites. A significant and positive correlation between mid-parental breeding values and best linear unbiased predictions of the SCA effects was observed. About a quarter of extra genetic gain is achievable through use of SCA variance if selection is based on the best breeding values. To fully exploit genetic gain from SCA variance in a deployment population, positive assortative matings are required for the best parents. It is estimated that the additional deployment gain of 46.0% for ten sites combined, or 52.9% for four sites combined that had significant GCA as well as SCA effects, were achievable relative to gain from GCA only, if all SCA variance within this breeding population was exploited. For a breeding population, selection for breeding values may be sufficient due to positive correlations between breeding values and SCA values. For a deployment population to capture more SCA genetic gain, it is preferable to make more pair-wise mating for parents with higher breeding values.

Detection and verification of quantitative trait loci for resistance to Dothistroma needle blight in Pinus radiata.

Six related radiata pine ( Pinus radiata) full-sib families were used to detect and independently verify quantitative trait loci (QTLs) for resistance to Dothistroma needle blight, caused by Dothistroma septospora. The detection families had from 26 to 30 individuals each, and had either a common maternal (31053) or paternal (31032) parent; one family (cross 4) consisted of progeny from both parents, 31053 x 31032. Approximately 200 additional progeny from cross 4 were clonally replicated and planted at two sites, with at least five to seven ramets of each individual per site. Marker segregation data were collected from a total of 250 RFLP and microsatellite markers, and single factor ANOVAs were conducted separately for each family and marker. A number of putative associations were observed, some across more than one family. Permutation tests were used to confirm expected probabilities of multiple associations based on chance alone. Seven markers representing at least four QTLs for resistance to Dothistroma were identified as being significant in more than one family; one of these was significant at P<0.05 in three families and highly significant at P<0.01 in a fourth. Further confirmation was obtained by testing those markers that were significant in more than one of the detection families (or highly significant in cross 4) in the clonally replicated progeny from cross 4. Four QTL positions were verified in the clonal populations, with a total percent variation accounted for of 12.5.