WRISK voices: A mixed-methods study of women's experiences of pregnancy-related public health advice and risk messages in the UK

Background Women receive many public health messages relating to pregnancy which are intended to improve outcomes for babies and mothers. However, negotiating the risk landscape and maternity care system can feel confusing and disempowering. Relationships between women and their healthcare providers are paramount, but they can be adversely affected by issues of trust and autonomy. Methods We used a nested study design including an online survey and qualitative interviews to gain an understanding of women's experiences of risk messages during pregnancy. We purposively sampled survey participants to ensure the interview population included women whose voices are seldom heard and are disproportionately impacted by poor risk communication. Results A total of 7,009 women responded to the survey, and 34 women participated in interviews. Participants received public health and risk messages from a range of sources. Data showed that women wanted a balance between a “better safe than sorry” approach and evidence-based information and advice. Women reported a discrepancy between the topics they received a lot of information on and areas in which they felt they needed more advice. Many participants said they were given conflicting advice, and the way information was delivered sometimes challenged their autonomy. We identified that younger women (<20 years old) and women with higher BMIs experienced stigmatisation in their maternity care. Conclusions Our research shows the importance of risk communication that respects women's autonomy and trusts them to make decisions about their own pregnancy. We identified a need for a layered approach to risk communication. Whilst some women are happy to adopt precautionary behaviour without discussion, others will want a thorough examination of the evidence-base. Our findings suggest that more individualised care, continuity, and less judgement and stigmatisation from HCPs will improve experiences for women and may lead to better engagement with services

Women's experiences of over-the-counter and prescription medication during pregnancy in the UK: findings from survey free-text responses and narrative interviews

Objectives To explore women’s experiences of over-the-counter and prescription medication advice and use during pregnancy. Design A study design consisting of an online survey and nested in-depth interviews with a subsample of participants. We analysed data from survey free-text responses and in-depth interviews using thematic analysis. Quantitative survey data is published elsewhere. Setting The UK. Participants Women were eligible if living in the UK, aged 16–45 years, were pregnant or had been pregnant in the last 5 years regardless of pregnancy outcome. A total of 7090 women completed the survey, and 34 women who collectively had experienced 68 pregnancies were subsequently interviewed. Results Medication prescribing and use during pregnancy was common. The prescribing, dispensing and taking of some advised medications were restricted through women’s or prescribers’ fear of fetal harm. Lack of adherence to national prescribing guidance, conflicting professional opinion and poor communication resulted in maternal anxiety, avoidable morbidity and women negotiating complex and distressing pathways to obtain recommended medications. In contrast, some women felt overmedicated and that pharmacological treatments were used without exploring other options first. Conclusion Increased translation of national guidance into practice and greater personalisation of antenatal care are needed to improve the safety, efficacy and personalisation of prescribing in pregnancy

Cell-Mediated Immunity Generated in Response to a Purified Inactivated Vaccine for Dengue Virus Type 1

Dengue is the most prevalent arboviral disease afflicting humans, and a vaccine appears to be the most rational means of control. Dengue vaccine development is in a critical phase, with the first vaccine licensed in some countries where dengue is endemic but demonstrating insufficient efficacy in immunologically naive populations. Since virus-neutralizing antibodies do not invariably correlate with vaccine efficacy, other markers that may predict protection, including cell-mediated immunity, are urgently needed. Previously, the Walter Reed Army Institute of Research developed a monovalent purified inactivated virus (PIV) vaccine candidate against dengue virus serotype 1 (DENV-1) adjuvanted with alum. The PIV vaccine was safe and immunogenic in a phase I dose escalation trial in healthy, flavivirus-naive adults in the United States. From that trial, peripheral blood mononuclear cells obtained at various time points pre- and postvaccination were used to measure DENV-1-specific T cell responses. After vaccination, a predominant CD4+ T cell-mediated response to peptide pools covering the DENV-1 structural proteins was observed. Over half (13/20) of the subjects produced interleukin-2 (IL-2) in response to DENV peptides, and the majority (17/20) demonstrated peptide-specific CD4+ T cell proliferation. In addition, analysis of postvaccination cell culture supernatants demonstrated an increased rate of production of cytokines, including gamma interferon (IFN-γ), IL-5, and granulocyte-macrophage colony-stimulating factor (GM-CSF). Overall, the vaccine was found to have elicited DENV-specific CD4+ T cell responses as measured by enzyme-linked immunosorbent spot (ELISpot), intracellular cytokine staining (ICS), lymphocyte proliferation, and cytokine production assays. Thus, together with antibody readouts, the use of a multifaceted measurement of cell-mediated immune responses after vaccination is a useful strategy for more comprehensively characterizing immunity generated by dengue vaccines

Diamond Line - Fall 2020

In following up the premier issue of The Diamond Line, the fall 2020 editorial staff had big shoes to fill. We took on the challenge of creating something that would uphold the framework of Issue 1 while simultaneously branching out from its margins. Like the editors before us, we had a vision, but ours took a new form — bright, warm colors. Sunset colors. Moons. Playful lines. Isolation and introspection. A stroll through an art gallery. A coming-of-age story bound between two groovy orange bookends. While Issue 2 does not have an overarching theme, we chose the cover art, “Pandemic Prom” by Autumn Blaylock, because it beautifully encompassed the pages within and the vision we were working toward

Diamond Line - Fall 2020

In following up the premier issue of The Diamond Line, the fall 2020 editorial staff had big shoes to fill. We took on the challenge of creating something that would uphold the framework of Issue 1 while simultaneously branching out from its margins. Like the editors before us, we had a vision, but ours took a new form — bright, warm colors. Sunset colors. Moons. Playful lines. Isolation and introspection. A stroll through an art gallery. A coming-of-age story bound between two groovy orange bookends. While Issue 2 does not have an overarching theme, we chose the cover art, “Pandemic Prom” by Autumn Blaylock, because it beautifully encompassed the pages within and the vision we were working toward

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Introducing WRISK: drawing on women’s experiences to develop recommendations for public health messaging in pregnancy

The WRISK project is a Wellcome-funded collaboration between the British Pregnancy Advisory Service (bpas) and the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer) at Cardiff University. WRISK engages expert stakeholders and draws directly on women’s experiences to develop recommendations to ensure effective and respectful public health messages for women in pregnancy

The Use of Marine Aquaculture Solid Waste For Nursery Production of the Salt Marsh Plants \u3ci\u3eSpartina alterniflora\u3c/i\u3e and \u3ci\u3eJuncus roemerianus\u3c/i\u3e

Recent technological advances in marine shrimp and finfish aquaculture alleviate many of the environmental risks associated with traditional aquaculture, but challenges remain in cost-effective waste management. Liquid effluent from freshwater aquaculture systems has been shown to be effective in agricultural crop production (i.e., aquaponics), but few studies have explored the potential for reuse of marine aquaculture effluent, particularly the solid fraction. The purpose of this study was to investigate the use of marine aquaculture solid waste as a nutrient source for the nursery production of two salt tolerant plants commonly used in coastal salt marsh restoration, Spartina alterniflora (smooth cordgrass) and Juncus roemerianus (black needlerush). Specifically, measurements of plant biomass and tissue nitrogen and phosphorus allocation were compared between plants fertilized with dried shrimp biofloc solids and unfertilized controls, as well as between plants fertilized with dried fish solids and unfertilized controls. In both experiments, S. alterniflora plants fertilized with marine aquaculture solids showed few significant differences from unfertilized controls, whereas fertilized J. roemerianus plants had significantly greater biomass and absorbed and incorporated more nutrients in plant tissue compared to unfertilized controls. These results suggest that J. roemerianus may be a suitable plant species for the remediation of marine aquaculture solid waste