Obstetric Surgical Procedures

For the anthrax infection experiment, B10.D2-Hc⁰ mice were randomly divided into five groups (10 mice per group) that were infected with different doses of B. anthracis Pasteur II spores using i.t. delivery. The operation of i.t. delivery of the spores was the same as i.t. immunization. Observations continued for 14 days, and deaths recorded daily for LD₅₀ calculation.
In the vaccine effectiveness evaluation experiment, at 63 dppi, B. anthracis (Pasteur II strain) spores were enumerated and diluted for aerosolized challenge. Mice immunized with rPA, CpG or PBS were challenged intratracheally with 5×10⁴ CFU (20× LD₅₀) or 1×10⁵ CFU (40× LD₅₀) B. anthracis spores in 50 uL of PBS. Animals were closely monitored for signs of weakness and survival for 14 days.
At days 2, 14 and 28 post-challenge, three mice per group were sacrificed and their lungs, spleens, livers and blood were collected individually. The tissue homogenates (in 800 uL of sterile PBS) and whole blood were serially diluted and plated on tryptic soy agar (TSA) plates, followed by incubation at 37°C for 8 h. Bacterial colonies were enumerated, and the corresponding concentration (CFU/g or CFU/mL) calculated.

Eligibility of articles was determined independently by two investigators (KS and OV). Using a standardised data-extraction form (KS and BH) independently extracted data on study characteristics and outcomes, with input from OV. Any disagreements were resolved by consensus. Potential citations (published articles and conference papers after removal of duplicates) which were identified from the search strategy were reviewed for suitability. Citations which were on conference abstracts or were unrelated to community approaches of HIV testing in sub-Saharan Africa—for instance studies from other countries, laboratory studies or articles which were not reporting primary research—were excluded. Titles and abstracts were then examined and excluded if they did not report HIV testing, linkage to care or were on facility based HIV testing. Full text articles were then reviewed for full inclusion and exclusion criteria as detailed above.
Markers of study quality were examined [9 (link)] and strengths and limitations of the studies are presented along with propensity for bias. The latter was examined using a modified Cochrane Collaboration approach for assessing risk of bias.[10 ] We focused on three main domains in relation to our study objectives—selection bias (eg whether those who were already in care were excluded from linkage to care outcome calculations), outcome ascertainment (eg whether objective measures such as clinic records were sought to determine LTC) and attrition (with a cut-off of ≥20% loss-to-follow up as high attrition)—before summarising if the risk of bias in a study was low, medium or high overall. Studies were not excluded for quality reasons using formal criteria for reporting scientific data, not least because a large proportion of the available data came from operational delivery of HTC services and authors presented data as were available from the programmes.
Ethical approval was not required as only published literature was included for review.

The setting for this research was the Western Cape province where existing public–private contracting for caesarean delivery services was occurring due to human resource shortages in rural district hospitals. Five rural district hospitals within one rural district were chosen following engagement with provincial managers and obstetric clinical managers.
In SA, women with low-risk pregnancies receive antenatal care at primary care clinics and community health centres. District hospitals provide level 1 (generalist) services to inpatients and outpatients including obstetric care for women with low-risk pregnancies. District hospitals have between 30 and 200 beds, a 24-hour emergency service and an operating theatre. Generalists (medical officers) provide the services together with nursing staff and allied health professionals; some district hospitals have specialist family physicians serving as clinical managers but there are no obstetric or anaesthetic specialists at district hospital level. Most district hospitals also have community service doctors. These are doctors who have completed a 2-year internship and are required to complete a further 1 year of community service.13 None of the five hospitals had newly qualified intern medical doctors who are generally not placed within district hospitals.
For obstetric services at district hospital level, normal vaginal deliveries are performed by midwives, assisted vaginal deliveries are performed by advanced midwives or medical officers and caesarean deliveries (surgery and anaesthesia) are performed by medical officers. Pregnant women with pre-existing morbidities such as diabetes, autoimmune disorders, thyroid disease, and cardiac disease or obstetric complications such as anticipated preterm delivery, suspected intrauterine growth restrictions, pre-eclampsia, placenta praevia, abruptio placentae, multiple pregnancy, two previous caesarean sections, body mass index over 35–40 kg/m², and severe anaemia are referred for delivery to a secondary or tertiary level hospital.
Public health facilities are permitted to contract the services of private providers where needed. There are three mechanisms by which private providers can be contracted to the public service: through a locum agency, through a sessional contract which is limited to a maximum of 39 hours per month or as a service provider in response to a tender for specific services. In all three contracting models, the remuneration is time based and not related to the number of patients or theatre cases performed. In the case of obstetric services, private providers are mainly used for theatre services either as a GP surgeon or GP anaesthetist to undertake caesarean deliveries or for obstetric surgery including ectopic pregnancy, termination of pregnancy and dilatation and curettage following spontaneous miscarriage. They may also be called for an assisted delivery if the establishment doctor is unable to manage a complicated delivery. For GPs contracted through a sessional contract, medicolegal indemnity is provided by the state but for those contracted as locums or through a service provider tender, they are required to have their own medicolegal indemnity cover. In these five hospitals, the private GPs did not have medical indemnity for private obstetric practice and only performed caesarean deliveries during their public sector contracted time.

To retrospectively analyse the clinical data of patients with advanced EOC with tumour platinum-drug resistance and recurrence who were admitted to the Affiliated Tumour Hospital of Guangxi Medical University, Liuzhou Workers’ Hospital and Liuzhou People’s Hospital from January 2014 to June 2018. The inclusion criteria were as follows: (1) patients with EOC diagnosed by pathology; (2) patients with at least one lesion for imaging measurement such as computed tomography (CT), or magnetic resonance imaging (MRI) p; (3) patients with advanced tumour recurrence, stage IIIc-IV according to International Federation of Gynecology and Obstetrics (FIGO) surgery-pathological staging; (4) patients who underwent ovarian tumour cytoreduction surgery or standard first-line platinum-based chemotherapy and now have uncontrolled or relapsed platinum-resistant disease after second-line or n-line chemotherapy; and (5) patients treated with oral apatinib who met the ethical requirements and signed the relevant informed consent form. The exclusion criteria were as follows: (1) patients with severe cardiovascular and cerebrovascular events in the past 6 months; (2) patients with irreversible liver and kidney damage; and (3) patients with hypertension who cannot be controlled by drugs. According to the inclusion and exclusion criteria, 144 patients were finally included in the study group. According to different treatment plans, the patients were divided into the apatinib group (44 patients) and the control group (100 patients). The apatinib group was treated with apatinib combined with chemotherapy, and the control group was treated with second-line and above conventional chemotherapy drugs after recurrence.