Background Various methods are used for cervical ripening during the induction of labour. It is still debatable which of these methods of treatment is optimal.Objective To compare treatment techniques for cervical ripening in the induction of labour.Search strategy Medline, Embase, and the Cochrane Collaboration databases were searched using the keywords 'cervical ripening', 'labour induced', 'misoprostol', 'dinoprostone', and 'Foley catheter'.Selection criteria Randomised controlled trials (RCTs) of cervical ripening during the induction of labour, evaluating rates of failure to achieve vaginal delivery within 24 hours, incidence of uterine hyperstimulation with fetal heart rate (FHR) changes, and rates of caesarean section. Studies including women with prelabour rupture of membranes were excluded.Data collection and analysis Outcome data were collected and analysed through pairwise meta-analysis and network metaanalysis within a Bayesian framework.Main results A total of 96 RCTs (17 387 women) were included in the meta-analysis. Vaginal misoprostol was the most effective cervical ripening method to achieve vaginal delivery within 24 hours, but had the highest incidence of uterine hyperstimulation with FHR changes. The use of a Foley catheter to induce labour was associated with the lowest rate of uterine hyperstimulation accompanied by FHR changes. The caesarean section rate was lowest using oral misoprostol for the induction of labour.Author's conclusions No method of labour induction demonstrated overall superiority when considering all three clinical outcomes. Decisions regarding the choice of induction method will depend upon the relative preference for effecting vaginal delivery within 24 hours, minimising the incidence of uterine hyperstimulation with adverse FHR changes and avoiding caesarean section.Keywords Cervical ripening, dinoprostone, Foley catheter, induction of labour, misoprostol.Tweetable abstract Oral misoprostol for the induction of labour is safer than vaginal misoprostol and has the lowest rate of caesarean section.

It has been conclusively established that folic acid supplementation prior to and during early pregnancy (up to 12 weeks of gestation) can prevent neural tube defects (NTDs). We hypothesized that folate effects may extend from neuro-structural defects to alterations in neuro-behavioural and emotional skills including autism spectrum disorders (ASDs) and other developmental disorders. The objective of this review was to comprehensively evaluate evidence on the impact of folic acid on neurodevelopment other than NTDs. We conducted an online search of relevant literature compiled by the National Library of Medicine from Medline and EMBASE (searched on Dec 31, 2014: http://www.ncbi.nlm.nih.gov/entrez/query/fcgi and http://www.elsevier.com/online-tools/embase). We first created 3 files (search restricted to English literature) using the following key words: 1) folate or folic acid (171322 papers identified by this search); 2) maternal or pregnancy or pregnant or gestation or gestational or prenatal or antenatal or periconception or periconceptional (1349219 papers identified by this search); and 3) autism or autism spectrum disorders or developmental delay or development or neurodevelopment or mental or cognitive or language or personal-social or gross motor or fine motor or behaviour or intellectual or intelligence or Bayley Scale (8268145 papers identified by this search). We then merged the 3 files and reviewed the papers that addressed these three issues simultaneously. A total of 22 original papers that examined the association between folic acid supplementation in human pregnancy and neurodevelopment/autism were identified after the screening, with 15 studies showing a beneficial effect of folic acid supplementation on neurodevelopment/autism, 6 studies showed no statistically significant difference, while one study showed a harmful effect in > 5 mg folic acid supplementation/day during pregnancy. Folic acid supplementation in pregnancy may have beneficial effects on the neurodevelopment of children beyond its proven effect on NTDs.

Ceiling fans provide cooling to indoor occupants and improve their thermal comfort in warm environments at very low energy consumption. Understanding indoor air distribution associated with ceiling fans helps designs when ceiling fans are used. In this study, we systematically investigate the air movement distribution in an unoccupied office room installed with a ceiling fan, as influenced by (1) fan rotational speed, (2) fan blade geometry, (3) ceiling-to-fan depth, and (4) ceiling height. We both measured and simulated air speeds at four heights in the occupied zone according to ANSI/ASHRAE/IES Standard 55 (2013) for seated and standing occupants. CFD predictions were validated by experimental results. In general, numerical results show that for an unoccupied space, the fan blade geometry, ceiling-to-fan depth, and ceiling height only influence air speed profiles within a cylindrical zone directly under a ceiling fan whose diameter is identical to that of the ceiling fan. However, the average speeds within the cylindrical zone at each height are very similar (< 10% in difference) for the different blade shapes studied, indicating a minor influence of blade geometries on occupants' perception of the thermal environment. The results also indicate that the velocity profile remains similar in the main jet zone (the tapered high-velocity zone under the fan blade) for various rotational speeds. The jet impingement on the floor creates radial airflow at the ankle level (0.1 m) across the room, which is not the most effective airflow distribution for cooling occupants.

Ceiling fans may cool room occupants very efficiently, but the air speeds experienced in the occupied zone are inherently non-uniform. Designers should be aware of several generic flow patterns when positioning ceiling fans in a room. Key to these are the fan jet itself and lateral spreading near the floor. Adding workstation furniture redirects the jet's airflow laterally in a deeper spreading zone, making room air flows more complex but potentially increasing the cooling experienced by the occupants. This paper presents the first evaluation of the effects of tables and workstation partitions on a room's generic air flow and comfort profiles. In a test room with a ceiling fan, we moved five anemometers mounted in a "tree" at heights of 0.1, 0.6, 0.75, 1.1, and 1.7 m to sample a dense measurement grid of 7 rows and 6 columns. We tested five different table and partition configurations and compared them to the empty room base case. From the results we propose a simplified model of room airflow under ceiling fans, useful for positioning fans and workstation furniture. We also present comfort contours measured in two ways that have comfort standards implications. The measured data are publicly available on the internet. Keywords: Ceiling fan; air speed; furniture; comfort cooling; corrective power Highlights 1. We performed high resolution measurements of ceiling-fan-induced air flow in an empty room; 2. We compare this reference case to air flow profiles measured in the room with five different table and partition configurations. The data are included as publicly available supplementary material; 4. The initial ceiling fan flow in the room could be modeled as a free jet; 5. The subsequent room circulation, with and without tables and partitions, may be represented by an intuitive model for designers who are placing fans and furniture; 6. The extent of comfort cooling provided by the fan air flow can be represented by the metric 'corrective power'. Corrective power equates the cooling effect of the fan as an ambient temperature reduction, ºC. We present the corrective power distribution in the room in two ways--with and without the air speed at ankle level--to evaluate air speed cooling effect. This evaluation is significant for thermal comfort standards.

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Background and Aims: The World Health Organization (WHO) Western Pacific Region set a target of eliminating mother-to-child transmission (MTCT) of hepatitis B virus (HBV) by 2030. To assess the feasibility of this target in China, we carried out an epidemiological study to investigate the status quo of MTCT in the real-world setting. Methods: One thousand and eight hepatitis B surface antigen-positive pregnant women were enrolled at 10 hospitals. Immunoprophylaxis was administered to infants. In addition, mothers with HBV DNA level >2,000,000 IU/mL were advised to initiate antiviral therapy during late pregnancy. A health application called SHIELD was used to manage the study. Results: Nine hundred and five of the enrolled mothers, with 924 infants, completed the follow-up. Birth-dose hepatitis B vaccine and hepatitis B immunoglobulin were received by 99.7% and 99.7% of infants, respectively, within 24 h after birth. There were 446 mothers who received antiviral therapy, including 72.3% of the mothers with HBV DNA level >2,000,000 IU/mL and 21.0% of the mothers with HBV DNA level <2,000,000 IU/mL. Eight infants were infected with HBV. The overall rate of MTCT was 0.9%. Birth defects were rare (0.5% among infants with maternal antiviral exposure versus 0.7% among infants without exposure; p=1.00). Conclusions:The MTCT rate was lower than the WHO Western Pacific Region elimination MTCT target in this real-world study, indicating that a comprehensive management composed of immunoprophylaxis to infants and antiviral prophylaxis to mothers may be a feasible strategy to achieve the 2030 WHO elimination goal.

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Preeclampsia is believed to be caused by impaired placentation with insufficient trophoblast invasion, leading to impaired uterine spiral artery remodeling and angiogenesis. However, the underlying molecular mechanism remains unknown. We recently carried out transcriptome profiling of placental long noncoding RNAs (lncRNAs) and identified 383 differentially expressed lncRNAs in early-onset severe preeclampsia. Here, we are reporting our identification of lncRNA INHBA-AS1 as a potential causal factor of preeclampsia and its downstream pathways that may be involved in placentation. We found that INHBA-AS1 was upregulated in patients and positively correlated with clinical severity. We systematically searched for potential INHBA-AS1 -binding transcription factors and their targets in databases and found that the targets were enriched with differentially expressed genes in the placentae of patients. We further demonstrated that the lncRNA INHBA-AS1 inhibited the invasion and migration of trophoblast cells through restraining the transcription factor CENPB from binding to the promoter of TNF receptor-associated factor 1 ( TRAF1 ). Therefore, we have identified the dysregulated pathway “ INHBA-AS1 -CENPB-TRAF1” as a contributor to the pathogenesis of preeclampsia through prohibiting the proliferation, invasion, and migration of trophoblasts during placentation.