Avery Pace (masschange70)

Pre-existing diabetes in pregnancy is associated with an increased risk of complications. Likewise, living in rural, regional and remote Victoria, Australia, is also associated with poorer health outcomes. There is a gap in the literature with regard to whether Victorian women with pre-existing diabetes experience a greater risk of adverse pregnancy outcomes compared to their metropolitan counterparts. Our objective is to compare obstetric and perinatal outcomes for women with pre-existing diabetes delivering in rural vs metropolitan hospitals in Victoria, Australia. Retrospective population-based study using routinely collected state-based data of singleton births to women with type 1 and type 2 diabetes who delivered in metropolitan (n=3233) and rural hospitals (n=693) in Victoria, Australia, between 2006-2015. Pearson's χ test, Fisher's exact test and MannWhitney U-test were used to compare obstetric and perinatal outcomes between metropolitan and rural locations. Delivery in a rural hospital was associated with higher rates of stillbirth (2.3% vs 1.1%, P=0.027), macrosomia (25.9% vs 16.9%, P<0.001), shoulder dystocia (8.4% vs 3.5%, P<0.001) and admission to the neonatal intensive care unit/special care nursery (73.2% vs 59.3%, P<0.001). Smoking (18.0% vs 8.9%, P<0.001), overweight/obesity (P=0.047) and socioeconomic disadvantage (P<0.001) were more common in rural women. Women with pre-existing diabetes who deliver in rural hospitals experience a greater risk of adverse perinatal outcomes and present with increased maternal risk factors. These results suggest a need to improve care for women with pre-existing diabetes in rural Victoria. Women with pre-existing diabetes who deliver in rural hospitals experience a greater risk of adverse perinatal outcomes and present with increased maternal risk factors. These results suggest a need to improve care for women with pre-existing diabetes in rural Victoria. Nitrous oxide (N O) is an important and persistent greenhouse gas making a significant contribution to global climate change. Deep fertilization has been demonstrated to increase crop yield and nutrient use efficiency by decreasing losses of volatilization and surface runoff. However, N O emissions from croplands induced by deep fertilization are variable and mitigation strategies remain uncertain. This study aimed to (i) quantify the response of area-scaled (N O emissions) and yield-scaled N O emissions (N O intensity) from croplands to deep fertilization, and (ii) identify the soil, climate, and management factors that mitigate N O emissions and N O intensity under deep fertilization. Compared with the control, deep fertilization increased N O emissions by 18.6% (P < 0.001) but decreased N O intensity by 20.1% (P = 0.018). By adopting deep fertilization, N O emissions could be significantly mitigated in rice-paddies soils (-48.8%), with fertilizer depth > 10 cm (-33.0%), and with fertilizer N amount > 200 kg N ha (-8.2%). N O intensity following deep fertilization significantly decreased in soils with pH ≤6 (-22.5%), at sites with precipitation of 500-1000 mm (-25.5%), in rice-paddies soils (-53.0%), with the method of mixed fertilizer in the control (-21.2%), and with fertilizer depth > 10 cm (-33.6%). This study provides a basis for assessing the effect of deep fertilization on N O emissions and provides potential measures to mitigate N O emissions associated with deep fertilization practices. This study provides a basis for assessing the effect of deep fertilization on N2 O emissions and provides potential measures to mitigate N2 O emissions associated with deep fertilization practices. Spontaneous aneurysmal subarachnoid hemorrhage (SAH) is a common neurosurgical emergency with a high case fatality rate. The