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Severe postpartum haemorrhage at a large referral hospital in Uganda: A prospective observational pilot study

Background Postpartum haemorrhage (PPH) is a leading cause of maternal mortality, near-misses and morbidity in Uganda and globally. Kawempe National Referral Hospital (KNRH), Uganda’s largest obstetric referral hospital, receives many obstetric emergencies, including PPH, from lower-level health facilities. Little is known about the outcomes and management of severe PPH at KNRH. This study aimed to map the occurrence, profile and management challenges of severe PPH at KNRH. Methods A prospective hospital-based observational pilot study was conducted between 5th April and 30th May 2023 at KNRH. Sixty women with severe PPH, both in-house and referrals, were enrolled. Data collection was done by research assistants on day 0–3 and 42 of inclusion, capturing characteristics, management and outcomes of the participants. Descriptive statistics were used for analysis. Results Of the 60 participants, 47 were referrals. There were 3 maternal deaths, 56 maternal near-misses (hysterectomy, cardiovascular dysfunction, uterine rupture or massive blood loss, and 46 underwent critical interventions (intensive care, laparotomy or blood transfusions). All the participants with uterine ruptures and 12 out of the 13 participants with stillbirths and hysterectomies, respectively, were among referrals. Only referrals had an initial systolic blood pressure ≤ 60 mm Hg and received ≥ 5 units of blood. In both groups approximately two thirds received tranexamic acid and oxytocin/misoprostol while few of the participants (23.3%) received uterine massage. Nine women had surgical site infections (8 were referrals), and 15 had suboptimal (fair/poor) wellbeing at 6 weeks postpartum (13 were referrals). None of the comparisons were statistically significant due to too few observations. Conclusions Referrals were more critically ill and disproportionally affected by adverse outcomes and substandard care. While drugs and fluids were often timely administered according to national guidelines and did not differ greatly between the groups, gaps remained particularly non-pharmaceutical interventions. Bettered implementation of evidence-based PPH management and strengthening of the referral system could improve quality of care and maternal outcomes.

Unveiling the Switchable Chemoselectivity Mechanism in Electrochemical Nickel-Catalyzed C(sp²)–O Coupling of Phenols and Aliphatic Alcohols

Hybrid feature-based machine vision method for objective evaluation of textile pilling and fuzzing

The degree of pilling and fuzzing in textile fabrics is a crucial indicator of textile product quality. Current evaluation methods predominantly rely on subjective judgments, leading to issues such as rating errors and inefficiency. To achieve objective assessment of pilling and fuzzing grades, this study proposes a Hybrid Feature-Based Machine Vision Method for Objective Evaluation of Textile Pilling and Fuzzing. The method incorporates a Hybrid Feature-based Depthwise Separable Attention Network for Objective Evaluation of Textile Pilling and Fuzzing (HDAN-PF), which effectively extracts and fuses frequency and Space domain features. A Channel Attention mechanism enhances the model’s ability to capture subtle features, while Depthwise Separable Convolutions reduce computational complexity, improving evaluation speed while maintaining high accuracy.The model size is approximately 327.37 MB with a total parameter count of 135,115,512. Experimental results demonstrate that the proposed method achieves a classification accuracy of 96.26% on diverse fabric images, showcasing robust generalization and practical utility.By leveraging this machine vision approach, the proposed method offers a transformative solution for achieving objective, consistent, and efficient assessments of pilling and fuzzing grades, advancing textile quality evaluation practices.

Radical Propagation via σ-Cleavage Mediates Radical SAM Catalyzed Sulfur-for-Oxygen Swapping Reaction during the Biosynthesis of Albomycin δ₂

Arsenic bioaccumulation in fish of the lower meghna river: Seasonal dynamics, species sensitivity, and public health implications

The Lower Meghna River (LMR), located in one of Bangladesh’s most arsenic-contaminated regions, is essential for local fisheries and provides water for drinking, irrigation, and daily use. Consequently, this study investigates arsenic accumulation in ten edible, small indigenous species (SIS) of fish, considering their morphology, habitats, diets, and water and sediment conditions. Samples were analysed across three distinct river segments during three seasons. The arsenic levels in water and sediment fell within non-polluting limits; however, certain fish species, including Mystus vittatus, Glossogobius giuris, Lepidocephalichthys guntea, Neotropius atherinoides, and Apocryptes bato, surpassed the WHO’s safe consumption threshold (1 mg/kg). Arsenic levels in water, sediment, and fish show significant seasonal variations (p < 0.05) but no notable spatial differences (p > 0.05). Strong correlations exist between arsenic in fish and both water and sediment (R2 > 0.5). Fish body shape and the presence of scales notably influence arsenic accumulation. Benthic carnivores accumulate more arsenic than pelagic and benthic-pelagic omnivores. Children are especially vulnerable to health risks. While Hazard Indices (HI) and Hazard Quotients (HQ) for water and sediment remain within safe limits, fish consumption presents a risk. Furthermore, the cancer risk associated with fish consumption is higher than that from water and sediment pathways. These results highlight a significant food safety concern and emphasize the need for integrated arsenic risk management strategies in the Lower Meghna River region.

Enantioselective Total Synthesis of (−)-Novofumigatonin

Constraints to sustainable energy technology implementation: Insights from an emerging economy using ISM-MICMAC analysis

The growing environmental, economic, and social challenges have compelled governments and policymakers to incorporate sustainable energy technologies. However, the development of sustainable energy technologies is hindered by various barriers in emerging economies like China. Although, previous studies attempted to investigate these barriers but there is dearth of studies determining the hierarchy ranking of the barriers. ISM based approach has been developed to fill this research gap by presenting the barriers on the basis of importance level. Through literature survey, fourteen barriers have been identified which were confirmed from expert’s panel. These fourteen barriers are displayed in six layers of ISM hierarchy form from bottom to top which exhibits their ranking on priority base. Findings revealed that high initial cost, longer payback period, and lack of proper financing facilities are major barriers in adopting sustainable energy technologies. However, lack of social acceptance is the least important barrier in sustainable energy technologies. This work will assist companies to better understand the relationships between the barriers which is useful to reduce the barriers strength by implementing effective strategies.

Catalytic Asymmetric Ionic Hydrogenation of α-Alkyl Styrenes

Uncovering key biomarkers, potential therapeutic targets and development of deep learning model in heart failure

Heart failure (HF) represents a significant public health concern, characterized by elevated rates of mortality and morbidity. Recent advancements in gene sequencing technologies have led to the identification of numerous genes associated with heart failure. By utilizing available gene expression data from the Gene Expression Omnibus (GEO) database, we conducted a screening for differentially expressed genes (DEGs) related to heart failure. Key genes were identified through intersection analysis in conjunction with weighted gene co-expression network analysis (WGCNA). Following this, we pinpointed four essential genes (ITIH5, ISLR, ASPN, and FNDC1) by employing functional enrichment analyses, machine learning approaches, protein-protein interaction (PPI) assessments, gene set enrichment analysis (GSEA), and immune infiltration evaluations. Additionally, a novel diagnostic model for heart failure was successfully developed using a deep learning convolutional neural network (CNN), and its diagnostic performance was validated within public datasets. Analysis via single-cell RNA sequencing further indicated stable up-regulation patterns of these genes across various cardiomyocyte types in HF patients. Moreover, the exploration of drug-protein interactions revealed two potential therapeutic drugs targeting the identified key genes, with molecular docking offering a feasible pathway for this connection. In conclusion, we identified four potential key biomarkers closely related to HF and two possibly effective small molecules, which provide significant insights into the molecular mechanisms underlying heart failure and the search for new therapeutic targets.

Entropy-Regulated Selective Synthesis of Cyclic Polymers and Polycatenanes by Lewis Pair Polymerization

Fracture fixation in the hand and wrist: A 16-year population-based study of 56 163 patients from the Swedish National Patient Register

Hand and wrist fractures are among the most common orthopaedic injuries, with a growing trend toward surgical treatment. However, large-scale data on regional variations and treatment trends remain limited. This population-based study analyses the incidence, trends, and regional variations in hand and wrist fracture fixation with plates and screws in Sweden from 2008 to 2023, with predictive modelling for future trends. A total of 56,163 patients aged ≥15 years underwent fixation (code NDJ69). Southern regions, including Skåne and Halland, had the highest fixation rates (>100/100,000), while northern areas like Norrbotten had significantly lower rates (<20/100,000). Women ≥65 years had the highest incidence. Predictive models indicate a continued increase in procedures, particularly among women aged ≥65, through 2035. These findings highlight regional disparities and the ongoing shift towards surgical treatment in older populations, emphasizing the need for optimized treatment strategies to ensure equitable access to care.

Late-Stage Aromatic C–H Bond Functionalization for Cysteine/Selenocysteine Bioconjugation

Understanding Anomalous Cage-Escape Dynamics in Photoredox Processes Driven by a Fe(III) N-Heterocyclic Carbene Complex

Developing a high-quality patient-centric integrated model for emergency care system in selected districts of India: An implementation research protocol (INDIA-EMS Study)

Introduction Integrated emergency care systems are essential for achieving universal health coverage and managing time-sensitive conditions. In India, emergency care remains fragmented, with limited resources and coordination across healthcare tiers. The INDIA-EMS study aims to develop and evaluate a patient-centric, high-quality integrated emergency care model in diverse Indian districts. Methodology The proposed implementation research is designed as a mixed methods study to be conducted over a 3-year period in selected districts of the states of Punjab, Gujarat, Madhya Pradesh, Odisha and Puducherry. The public/private medical college hospital/ tertiary care hospital in the district will serve as a hub and primary health care services as spokes. The health facilities will be graded according to the availability of resources for their readiness and preparedness to provide care for handling a particular emergency condition. The steps to build and implement the model are: 1. a gap analysis related to emergency care at both pre-hospital and health facility level; 2. a community-based survey in a sample of 30,000 in 5 districts for EMD burden estimates and health-seeking behaviour at baseline and endline; 3. use a consolidated framework for implementation research to develop, optimise and implement hub and spoke model through three cycles of iterative processes; and; 4.evaluation for feasibility, acceptability, cost, effectiveness and coverage. Discussion A high-quality patient-centric integrated emergency care model may be able to ensure efficient delivery of care to patients experiencing time-sensitive emergencies and advance towards the coveted target under Sustainable Development Goals (SDGs). Ethics and dissemination Ethics approval was obtained in all the project sites. The results of the project will be submitted to a peer-reviewed journal for publication, in addition to national and state-level dissemination. Trial registration The trial is registered with CTRI (Clinical Trial Registry of India; CTRI/2024/01/061304).

Highly Porous, Electrically Conductive Two-Dimensional Nickel–Hexaaminodehydrobenzoannulene Frameworks

Medical associations’ guidance on caring for patients experiencing incarceration in the United States

The United States has one of the highest incarceration rates in the world. Carceral status can complicate clinical encounters in community and academic settings for an already medically vulnerable population. While it is likely physicians will encounter patients experiencing incarceration in their practice, there are few educational opportunities dedicated to ensuring delivery of healthcare that protects patient dignity, autonomy, and privacy. Professional medical associations can play a role in filling this physician knowledge gap. The goal of this analysis is to catalogue and analyze the current landscape of official medical association documents addressing healthcare of people experiencing incarceration. A systematic Internet search was conducted of American Medical Association House of Delegates associations and their existing documents. Out of 116 associations included in the systematic search, 16 groups published materials on incarceration. From these 16 associations, 44 documents were identified and coded thematically. Documents served four main purposes: education on incarceration (28/44), clinical guidance (25/44), logistical guidance (27/44), and policy advocacy (30/44). Common topics included medical conditions of people experiencing incarceration, patient factors antecedent to incarceration, and specialty or population-specific information. Few medical associations have published material on incarceration and the paucity of pragmatic clinical guidance was particularly pronounced. A lack of resources from medical associations can lead to variability and lapses in best healthcare practices when treating patients experiencing incarceration. Medical associations should consider developing guidance for clinicians to maximize this patient population’s autonomy and dignity.

Magneto-optical Effect of Dark State in 0D Metal Halides through HT/FC Vibrational Coupling

Investigating the use of a one-page infographic to improve recruitment and retention to the BASIL+ randomised controlled trial: A Study Within a Trial (SWAT)

Background Low participant recruitment and retention rates are a significant barrier to successful Randomised Controlled Trials (RCTs). A Study Within A Trial (SWAT) is an effective way to explore which trial delivery methods may be useful for improving participant recruitment and retention rates. Infographics are a useful information delivery tool that may improve participants’ understanding of the trial and thus improve recruitment or retention rates. This SWAT was embedded within the Behavioural Activation in Social Isolation (BASIL+) RCT. BASIL+ was delivered during the Covid-19 pandemic and evaluated the clinical and cost-effectiveness of a brief psychological intervention (Behavioural Activation) to mitigate depression and loneliness in older adults with multiple long-term health conditions. Methods Twelve research sites were randomly allocated 1:1 to either the SWAT intervention group (participant information included a one-page infographic) or the SWAT control group (participant information did not include a one-page infographic). The primary outcome was the recruitment rate to the BASIL+ trial. The secondary outcomes were the number of expressions of interest in the trial and the follow-up retention rate at 3 months post-randomisation. Results were compared for each group using a mixed-effect logistic regression model with trial site as a random effect. The cost-effectiveness of the SWAT intervention was also evaluated. Results Despite a small additional cost (£0.13) per participant, there was no evidence that participant recruitment, expressions of interest or retention was significantly affected by the inclusion of the one-page infographic. Conclusion Our results suggest that the inclusion of an infographic alongside the participant information sheet may not be the best way to improve recruitment and retention rates for RCTs. However, infographics continue to be effective tools for information delivery in healthcare settings, and further research is needed to explore their use in RCTs.

Photoelectrocatalytic Upgrading of Biomass Derivatives for Efficient C–N Coupling with Formamide

Exploring the coupling dynamics between accessibility of tourist attractions and tourism demand in Anhui Province

Tourist attractions, as core components of tourism product supply, play a crucial role in regional tourism development. Investigating the spatial relationship between the supply and demand of tourist attractions contributes to optimizing the spatial structure of regional tourism and promoting high-quality, balanced, and coordinated growth of the tourism industry. Taking high-grade tourist attractions in Anhui Province as the research object, this paper first analyzes the characteristics of accessibility using the time cost distance method and the standard deviational ellipse. Subsequently, it constructs a set of tourism demand indicators and employs the coupling coordination model and Markov chain method to evaluate the spatial coupling coordination between accessibility of tourist attractions and tourism demand. The results show a significant improvement in accessibility of tourist attractions from 2015 to 2024, with average travel time to tourist attractions at the county level decreasing from 65 to 41 minutes, and the proportion of areas reachable within 60 minutes rising from 62.5% to 92.3%. However, spatial disparities persist, particularly exhibiting persistent low accessibility in mountainous and peripheral areas. The coupling coordination levels between the accessibility of tourist attractions and tourism demand remained generally stable, with most counties classified into the moderate and high coordination categories. Spatial Markov analysis indicates that neighboring regions exert strong spatial spillover effects, influencing both the direction and magnitude of coordination level transitions. Notably, leap-level transitions were rare, while adjacent-level shifts dominated the dynamics. These findings underscore the importance of spatial context and infrastructure in shaping the interaction between tourism supply and demand. This study provides empirical evidence to support spatially differentiated planning and transportation investment strategies aimed at promoting balanced tourism development.