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The dorsoventral projection has been included in this section to show that even with fully inflated lungs, the area of lung exposed is less in this projection compared with the ventrodorsal. This effect is smaller in the cat but with this species the thoracic cavity is greatly reduced, and appears more triangular, when the front limbs are not extended forwards. The dorsoventral projection should always be used for cardiovascular evaluation as cardiac position is not altered. It also shifts pleural fluid dorsally and cranial mediastinal shadows are clearer. It must also be remembered that the ventrodorsal and/or dorsoventral projection(s) should be performed first, before the recumbent lateral projections. Hypostatic congestion/lung lobe collapse occurs rapidly in recumbent animals suffering from cardiovascular or respiratory problems. Even in clinically normal animals hypostatic congestion will develop during lateral recumbency (see Figure 432). Figure 416 Line drawing of photograph representing radiographic positioning for Figure 417. Beagle dog 2 years old, entire female (same dog as in dorsoventral projection of thorax, Figure 421). Line drawing to highlight mediastinal structures (pleura excluded and diaphragm included in respiratory system drawings). Often only one radiolucent circular shadow can be seen at this level, the endon projection of left cranial lobe bronchus at bifurcation into bronchi for cranial and caudal segments. In the dog the mediastinum is incomplete but the pleural coating is non-fenestrated. Large fat deposits can also be found in the cranial mediastinum in obese old dogs. Dogs of the smaller breeds, and especially the brachycephalic breeds, are prone to accumulate fat in the cranial mediastinum. Fat may also develop in the cranioventral mediastinum resulting in a dorsal elevation of the cardiac shadow. Fat accumulation, as referenced above, must not be misdiagnosed as a pathological condition. Knowledge of breed variation, plus radiographic opacity evaluation, is required for correct interpretation of thoracic radiographs. Right and left lie in the angle between the lateral surface of each cranial principal bronchus and the trachea. Beagle dog 2 years old, entire female (same dog as in right lateral recumbent projection of thorax, Figure 417). Drawing to highlight mediastinal structures (pleura excluded and diaphragm included in respiratory system drawings). Thoracic portion lies slightly to the right until its termination when it is midline. Ligament is a fibrous thickening in the ventral portion of the caudal mediastinum. As dog ages, lymphoid tissue reduces but in older dogs a vestigial thymus is often seen (B). Radiograph taken during general anaesthesia with endotracheal tube removed for clarity of radiographic shadows. The radiograph shows the vertical position of the hyoid bones together with a much reduced oropharynx and very large soft palate shadow. The nasopharynx is also small and the endotracheal intubation has caused the epiglottis (closed arrow) to lie ventrocranially.

Following digital amputation the cat made an uneventful recovery but within 18 months was involved in a road traffic accident. The cat was hospitalised after being presented to the emergency duty veterinary surgeon. Hindlimb bony fractures were an obvious injury but clinical examination of the thorax revealed a systolic cardiac murmur which had not previously been present. The respiration was also abnormal and thoracic radiography revealed pleural effusion. Diaphragmatic shadow appeared intact, although the shadow was lost more ventrally by the pleural effusion. No disturbance of abdominal shadows to suggest a rupture of the diaphragm was present. Cardiac failure was suspected as the cause of the effusion but neoplasia was also considered. Echocardiography using 2D and M mode imaging confirmed that hypertrophic cardiomyopathy was present. No abnormal mediastinal echoes were seen to suggest neoplastic metastasis as the cause of the obstructive effusion. In particular, the lateral projection has a rounded cardiac shadow, as demonstrated by the cranial border and apex. A degree of cardiac enlargement can also be argued although there is a small degree of positional thoracic rotation. This Burmese cat was showing no clinical signs of cardiac abnormality, radiography being undertaken as part of an investigation into possible pulmonary changes following rhinitis. Unfortunately no further thoracic radiography or clinical history is available for this particular cat and one can only speculate on whether the cardiac shadow was normal or a precursor to overt cardiac disease. British domestic short haired cat 6 years old, neutered male (same cat as in right lateral recumbent projection of thorax, Figure 699). Unlike in the dog, the right and left cranial lung lobes in the cat often extend to the same cranioventral level, as in both lateral recumbent projections of this cat, Figures 699 and 713. Pulmonary opacities can be seen in the lucent region confirming the identity of lung tissue. A recognisable bronchial and interstitial pattern in the cat indicates present or previous clinical abnormality. The position of the recess is very different to the dog and must not be mistaken for abnormality. In this radiograph the dorsal border of the caudal lung lobe is separated from the bony vertebrae by a soft tissue shadow extending from caudal 11th. Such an appearance is normal in the cat and must not be confused with lung retraction due to the presence of pleural effusion. British domestic short haired cat 10 months old, neutered female (same cat as in dorsoventral projection of thorax, Figure 702). The comments on bronchial markings and interstitial opacities made for the left lateral recumbent projection of thorax, Figure 714, also apply to this projection. Although skin folds do not usually create the same false effect of lung opacity, compared with the dog, it is worth noting that the extreme cranial, and correct, position of the forelimbs in this radiograph has caused superimposition of the bony scapulae over the cranial thoracic cavity. All bony shadows seen in a thoracic cavity radiograph must be traced to their origin to avoid misdiagnosis. The latter is extremely important for rib shadows with their associated calcified costal cartilages. Note the curvature of the right atrium (10a) created by the ventrodorsal positioning. The ventrodorsal position is the preferred projection for lung shadows but even so dorsoventral projection can show improvement by pulling the forelegs cranially. A short, triangular thoracic cavity, and hence a reduction of lung shadow, is greatest in the dorsoventral projection with the forelegs at the sides of the thorax. British domestic short haired cat 10 months old, entire female (same cat as in right and left lateral recumbent projections of thorax, Figures 705 and 706).

Blue bars denote estimated direct fiscal support packages announced by fiscal authorities between late-January 2020 and late-May. Red bars denote other economic support packages announced by fiscal authorities since the outbreaks. A relative volume of direction requests compared to a baseline volume on January 13th, 2020. Among the major economies, the largest downward revisions for 2020 are in Malaysia, the Philippines, and Thailand (7. This reflects the significant impact of domestic lockdown measures, as well as the impact from reduced tourism, disruption of trade and manufacturing sector, the spillovers from financial markets, and lower commodity prices in Malaysia (World Bank 2016, World Bank 2020c). Although all countries in the region have experienced a sharp reduction in visitors as a result of travel restrictions and risk aversion, the Pacific Islands-especially Fiji, Palau, Samoa, and Vanuatu-are particularly dependent on tourism and likely to see a massive decline in national income following the pandemic. Various indicators, including domestic flights, have rebounded, but the outlook remains uncertain amid contracting global activity. Exports contracted in 2020Q1, because of factory closures in China followed by a plunge in global demand. Total debt is estimated to have increased by about 17 percentage points in 2020Q1 reflecting fiscal and monetary policy support amid economic contraction. Year-on-year change of total real industrial value added (2005=100) and seasonally adjusted nominal retail sales. Growth in China this year is projected to slow to the lowest rate since 1976, and performance in the rest of the region is forecast to be the worst since the East Asian financial crisis of 1998. The deterioration in regional activity has been broad-based reflecting both domestic and external channels. Regional economies are vulnerable to tighter global financing conditions and financial shocks in different ways, including through elevated domestic debt, external debt, sizable fiscal deficits, or heavy reliance on volatile capital flows. The pandemic will likely further slow potential growth in the region by weakening investment and the supply chains that have been an important conduit for productivity gains over the past decade (World Bank 2020a, 2020d). The negative impact is expected to be broad-based and will add to the long-term slowdown from deteriorating demographic trends and falling growth in total factor productivity (Chapter 3). The regional outlook is predicated on major countries in the region avoiding a second wave of outbreaks. The outlook assumes that a severe contraction in 2020Q1 in China and in 2020Q2 in the rest of the region will be followed by a gradual and sustained recovery. The outlook is also predicated on the assumption that sizable fiscal and monetary policy support measures implemented by major economies are successful in averting a prolonged recession and financial crises. By the second half of 2020, these are assumed to result in a recovery in global import demand, a normalization of global financial conditions, a resumption of capital inflows to the region, and no major re-escalation in trade tensions between China and the United States. The full duration and spread of the pandemic is still unknown, as is the effectiveness of the policies implemented in response. In addition, the spillover impacts of the outbreak through global trade, financial markets, confidence, and other second round effects continue to evolve. The containment measures in major economies may last longer than three months assumed under the baseline scenario. The regional outlook will also significantly deteriorate if global trade tensions re-escalate. Foreign holdings of government bonds Source: International Monetary Fund; Institute of International Finance; World Bank. Forecasts, including those for the Pacific Island economies, are not strictly comparable because of the difference in accounting financial year periods. The main risks include the possibility that the pandemic lasts longer and has more severe effects than assumed (Chapter 1). A second wave of the outbreaks in countries with subsiding active cases remains a real possibility. Tighter financing conditions would weigh heavily on investment and consumption and further reduce regional growth. Eventually, this could exacerbate existing balance sheet weaknesses in highly leveraged banking, corporate, and household sectors, leading to defaults and financial crises (World Bank 2020b).

Counting all preterm bir ths, both live and stillbir ths, would be preferable to improve Accounting for all births the recording of births and deaths and the likelihood of active medical intervention after preterm birth are affected by perceptions of viability and social and economic factors, especially in those born close to the lower gestational age cut-off used for registration. The registration thresholds for stillbirths vary between countries from 16 to 28 weeks, and under-registration of both live and stillbirths close to the registration boundary is well documented (Froen et al. The cut-off for viability has changed over time and varies across settings, with babies born at 22 to 24 weeks receiving full intensive care and surviving in some high-income countries, whilst babies born at up to 32 weeks gestation are perceived as non-viable in many low-resource settings. An example of this reporting bias is seen in high-income settings where the increase in numbers of extremely preterm (<28 weeks) Table 2. The process is complicated by having only limited data for the majority of countries (the exception being primarily developed countries), from definitions of preterm births that may vary across countries and data sources, and from the need to develop a statistical model to account for all these issues. Inputs Preterm birth rate data were identified through a systematic search of online databases, National Statistical Offices and Ministry of Health data and assessed according to pre-specified inclusion criteria. National Registries (563 data points from 51 countries), surveys (13 Reproductive Health Surveys from 8 countries), and other studies identified through systematic searches (162 datapoints from 40 countries) were included. Additional data points identified at this stage were included for the final analysis. Each model included a set of predictors or factors associated with preterm birth rate and was used to estimate for the countries in the model. Uncertainty ranges were estimated for all countries: Model I was developed for 65 countries based on a total of 547 data inputs. Gestational age subgroups We reviewed all data that separate preterm births to gestational age subgroups: extremely preterm (<28 weeks), very preterm (28 to <32 weeks), moderate preterm (32 to <37 weeks). The distribution was remarkably similar across the 345 data points from 41 countries in the period 1990 to 2010 (Table 2. There was no evidence of differences between regions or a change in the distribution over time. Given this remarkable consistency, we applied the proportions to the estimates for 2010 for all countries without their own data for these subgroups. Few population-based data reporting preterm birth rates were identified for developing countries. Estimates for developing countries have relied on modeling using data from sub-national or facility based studies when available. An increasing proportion of all preterm infants born will be stillborn with decreasing gestational age. The pathophysiology is similar for live and stillbirths; thus, for the true public health burden, it is essential to count both preterm babies born alive and all stillbirths (Golenberg et al. The high absolute number of preterm births in Africa and Asia are related, in part, to high fertility and the large number of births in those two regions in comparison to other parts of the world. The variation in the rate of preterm birth among regions and countries Preterm births 28 to <32 weeks Preterm 32 to <37 weeks 4000 3000 2000 1000 0 Total number of births in region n=8,400 n=10,800 n=14,300 n=19,100 n=11,200 n=32,100 n=38,700 8. Source: Blencowe et al National, regional and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications Northern Latin Africa & America Western & the Asia Caribbean Developed Central & Eastern Asia SouthEastern Asia & Oceania SubSaharan Africa South Asia is substantial and yield a d i f fe r e n t p i c tu r e to other conditions in that some high-income countries have very high rates. Pakistan Preterm birth rate, year 2010 <10% 10 - <15% 15% or more Data not available Not applicable the boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Source: Blencowe et al National, regional and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. However, relatively high preterm birth rates are seen in many individual high-income countries where they contribute substantially to neonatal mortality and morbidity. The highest rates by Millennium Development Goal Regions ("Millennium Development Indicators: World and regional groupings,"Barker, 1983) are found in Southeastern and South Asia where 13. Brazil 0 1,500 2,500 5,000 kilometers the boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Note: preterm birth numbers by country are available on the accompanying wall chart. Although these data gaps are particularly great for Africa and Asia, there also are gaps in data from highincome countries.