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To understand the relationship between birth weight and altitude to improve health outcomes in high-altitude populations, to systematically assess the impact of altitude on the likelihood of low birth weight (LBW), small for gestational age (SGA), and spontaneous preterm birth (sPTB), and to estimate the magnitude of reduced birth weight associated with altitude.

PubMed, OvidEMBASE, Cochrane Library, Medline, Web of Science, and clinicaltrials.gov were searched (from inception to November 11, 2020). Observational, cohort, or case-control studies were included if they reported a high altitude (>2500m) and appropriate control population.

Of 2524studies identified, 59 were included (n=1604770 pregnancies). Data were abstracted according to PRISMA guidelines, and were pooled using random-effects models. There are greater odds of LBW (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.33-1.62, P<0.001), SGA (OR 1.88, 95% CI 1.08-3.28, P=0.026), and sPTB (OR 1.23, 95% CI 1.04-1.47, P=0.016) in high- versus low-altitude pregnancies. Birth weight decreases by 54.7g (±13.0g, P<0.0001) per 1000 m increase in altitude. Average gestational age at delivery was not significantly different.

Globally, the likelihood of adverse perinatal outcomes, including LBW, SGA, and sPTB, increases in high-altitude pregnancies. There is an inverse relationship between birth weight and altitude. These findings have important implications for the increasing global population living at altitudes above 2500m.

Globally, the likelihood of adverse perinatal outcomes, including LBW, SGA, and sPTB, increases in high-altitude pregnancies. There is an inverse relationship between birth weight and altitude. These findings have important implications for the increasing global population living at altitudes above 2500 m.We examined variations in age at seaward migration and sea age for the anadromous form of red-spotted masu salmon (Oncorhynchus masou ishikawae) in two Japanese rivers. The anadromous form of red-spotted masu salmon expressed only two sea migration patterns in the two rivers (a) the majority of the salmon (95%, n = 81) were of age-0, and age-1 migrants were rare (n = 4); and (b) all the salmon examined (n = 22) made a return migration within a year, with 23% of the salmon exhibiting potamodromy in the river. Dooku1 Owing to low variation in their sea migratory patterns, the anadromous form of red-spotted masu salmon is likely vulnerable to environmental fluctuations.The self-esteem Questionnaire-based Implicit Association Test (SE-qIAT) provides an indirect assessment of general self-worth that is based on the items of the well-validated Rosenberg Self-Esteem Scale (RSES), and the structure of this variant of the IAT enables a clearer interpretation, compared with the conventional self-esteem IAT. Study 1 (N = 224) provided support for the internal consistency, test-retest reliability, and implicit-explicit convergent validity of the SE-qIAT. In Study 2 (N = 305), the correlation of the SE-qIAT with the explicit RSES was replicated, and it was larger than the correlations of the SE-qIAT with other self-reports. As to criterion validity, the SE-qIAT moderated the effect of a mild social threat (being excluded in the Cyberball game) on participants' performance in a subsequent anagram task, and this effect was incremental to the explicit self-esteem assessment. In Study 3 (N = 334), the SE-qIAT correlated positively with the self-esteem IAT and negatively with a measure of depression. The two implicit tasks correlated uniquely with each other, above and beyond the variance they each shared with the explicit RSES. Taken together, these findings provide initial support for the reliability and validity of the SE-qIAT.

The value of in-hospital systems-based interventions in streamlining treatment delays associated with reperfusion therapy delivery in acute ischaemic stroke (AIS), in the emergency department (ED), is poorly understood. This systematic review and meta-analysis aimed to assess and quantify the value of in-hospital systems-based interventions in streamlining reperfusion therapy delivery following AIS.

Articles from the following databases were retrieved Medline, Embase and Cochrane Central Register of Controlled Trials. The primary endpoint was in-hospital time metrics between the intervention and control group. The secondary endpoint included the rate of good functional outcome at 90days.

393 Systems intervention studies published after 2015 were screened, and 231 full articles were then read. In total, 35 studies with 35,815 patients were included in the final systematic review and 26 studies with 7,089 patients were used in the meta-analysis. The greatest time reductions from in-hospital system interventions were achieved in door-to-needle (DTN) time (SMD -2.696, 95% CI -2.976, -2.416, z = 3.03, p = 0.002). Systems interventions were also associated with a statistically significant improvement in mortality (RR 0.25, 95% CI 0.18, 0.38), rate of symptomatic intracerebral haemorrhage (RR 0.07, 95% CI 0.04, 0.1) and ≤60-minute reperfusion rates (RR 0.63, 95% CI 0.51, 0.79).

The use of in-hospital workflow optimization is imperative to expedite reperfusion therapy delivery and improving patient outcomes. To reduce the morbidity and mortality of stroke globally, in-hospital workflow guidelines should be adhered to and incorporated including the optimal elements identified in this study.

The use of in-hospital workflow optimization is imperative to expedite reperfusion therapy delivery and improving patient outcomes. To reduce the morbidity and mortality of stroke globally, in-hospital workflow guidelines should be adhered to and incorporated including the optimal elements identified in this study.The evidence for pharmacogenetics has grown rapidly in recent decades. However, the strength of evidence required for the clinical implementation of pharmacogenetics is highly debated. Therefore, the purpose of this review is to summarize different perspectives on the evidence required for the clinical implementation of pharmacogenetics. First, we present two patient cases that demonstrate how knowledge of pharmacogenetic evidence affected their care. Then we summarize resources that curate pharmacogenetic evidence, types of evidence (with an emphasis on randomized controlled trials [RCT]) and their limitations, and different perspectives from implementers, clinicians, and patients. We compare pharmacogenetics to a historical example (i.e., the evidence required for the clinical implementation of pharmacokinetics/therapeutic drug monitoring), and we provide future perspectives on the evidence for pharmacogenetic panels and the need for more education in addition to evidence. Although there are differences in the interpretation of pharmacogenetic evidence across resources, efforts for standardization are underway.