Haemoglobin-based oxygen carriers can undergo oxidation of ferrous haemoglobin into a non-functional ferric form with enhanced rates of haem loss. A recently developed human haemoglobin conjugated to maleimide-activated poly(ethylene glycol), termed MP4, has unique physicochemical properties (increased molecular radius, high oxygen affinity and low cooperativity) and lacks the typical hypertensive response observed with most cell-free haemoglobin solutions. The rate of in vitro MP4 autoxidation is higher compared with the rate for unmodified SFHb (stroma-free haemoglobin), both at room temperature (20-22 degrees C) and at 37 degrees C (P<0.001). This appears to be attributable to residual catalase activity in SFHb but not MP4. In contrast, MP4 and SFHb showed the same susceptibility to oxidation by reactive oxygen species generated by a xanthine-xanthine oxidase system. Once fully oxidized to methaemoglobin, the rate of in vitro haem loss was five times higher in MP4 compared with SFHb in the fast phase, which we assign to the beta subunits, whereas the slow phase (i.e. haem loss from alpha chains) showed similar rates for the two haemoglobins. Formation of MP4 methaemoglobin in vivo following transfusion in rats and humans was slower than predicted by its first-order in vitro autoxidation rate, and there was no appreciable accumulation of MP4 methaemoglobin in plasma before disappearing from the circulation. These results show that MP4 oxidation and haem loss characteristics observed in vitro provide information regarding the effect of poly(ethylene glycol) conjugation on the stability of the haemoglobin molecule, but do not correspond to the oxidation behaviour of MP4 in vivo.

Although the overall incidence of short cervical length is low (1%-2%), women with at least 1 prior uterine evacuation have at least a 2-fold increased risk of a short second-trimester cervical length compared to women without a prior uterine evacuation.

Most women with prior sPTB received progesterone and CL screening. Those at highest risk for PTB based on obstetric history are more likely to utilize recommended interventions.

Purpose This research aimed to explore individuals’ willingness to pay (WTP) and studied the role of family decision makers in WTP for COVID-19 vaccines. Methods A self-administered online questionnaire evaluating the willingness of community residents to pay for booster vaccination of COVID-19 vaccine was conducted among families in a community in Taizhou, China. The logistic regression model was performed to identify the factors associated with WTP for the COVID-19 vaccines, and all data were analysed by R software, version 4.1.0. Results 44.2% and 43.7% of 824 community residents were willing to pay for the first two doses and the booster dose of the COVID-19 vaccine, respectively. Decision-makers were more willing to pay for both the first two doses and the boost dose of the COVID-19 vaccines, with OR (95%CI) being 1.75 (1.25–2.47) and 1.89 (1.34–2.67), respectively. Besides, participants’ WTP for COVID-19 vaccines were also associated with their occupation and monthly household income. Conclusion This study found that family decision-makers were more willing to pay for both the first two doses and the booster dose of COVID-19 vaccines in Taizhou, China. To improve the WTP for COVID-19 vaccines, public policy programs need to conduct a comprehensive cost-benefit analysis and focus on the role of family decision makers in vaccination. Key Messages A study evaluating the willingness of community residents to pay for booster vaccination of COVID-19 vaccine was conducted among families in a community in Taizhou, China. Family decision-makers were more willing to pay for both the first two doses and the booster dose of COVID-19 vaccines. To improve the WTP for COVID-19 vaccines, public policy programs need to conduct a comprehensive cost-benefit analysis and focus on the role of family decision-makers in vaccination.

INTRODUCTION: The purpose is to identify risk factors for early preterm birth (PTB), defined as less than 34 weeks, in otherwise low risk women who have a short cervix (less than or equal to 20mm) and prescribed vaginal progesterone. METHODS: Retrospective cohort study from 1/2012-12/2014 of singleton gestations without a history of prior spontaneous preterm birth who underwent cervical length (CL) screening between 18 0/7-23 6/7 weeks. Women with a short cervix who took vaginal progesterone were included. RESULTS: 3,678 women were screened, 38 women (1.0%) were diagnosed with a short cervix, 31 accepted and were started on vaginal progesterone. Of the 31 women included, 11 women (36%) had an early PTB. Among women who had an early PTB, demographic characteristics and obstetric history were similar, however mean CL was significantly lower (11.9 ±4.0 vs 16.5 ±4.1, p=0.005) and the percent of women with a CL less than 15mm was significantly higher (82% vs 15%, p < 0.001) compared to those who delivered after 34 weeks. ROC curve demonstrated that CL was predictive of a PTB < 34 weeks with an area under the curve of 0.81 (p=0.005). CL less than 15mm was associated with an increased risk of PTB < 34 weeks with an odds ratio of 25.5 (95%CI 3.6-181.6). CONCLUSION: A cervical length less than 15mm is highly predictive of an early PTB in women with a short cervix, despite vaginal progesterone therapy. Further studies should be done in this subgroup of women to see if they would benefit from additional interventions.