The influence of hours worked prior to delivery on maternal and neonatal outcomes: a retrospective cohort study.

BACKGROUND: Long continuous periods of working contribute to fatigue, which is an established risk factor for adverse patient outcomes in many clinical specialties. The total number of hours worked by delivering clinicians before delivery therefore may be an important predictor of adverse maternal and neonatal outcomes. OBJECTIVE: We aimed to examine how rates of adverse delivery outcomes vary with the number of hours worked by the delivering clinician before delivery during both day and night shifts. STUDY DESIGN: We conducted a retrospective cohort study of 24,506 unscheduled deliveries at an obstetrics center in the United Kingdom from 2008-2013. We compared adverse outcomes between day shifts and night shifts using random-effects logistic regression to account for interoperator variability. Adverse outcomes were estimated blood loss of ≥1.5 L, arterial cord pH of ≤7.1, failed instrumental delivery, delayed neonatal respiration, severe perineal trauma, and any critical incident. Additive dynamic regression was used to examine the association between hours worked before delivery (up to 12 hours) and risk of adverse outcomes. Models were controlled for maternal age, maternal body mass index, parity, birthweight, gestation, obstetrician experience, and delivery type. RESULTS: We found no difference in the risk of any adverse outcome that was studied between day vs night shifts. Yet, risk of estimated blood loss of ≥1.5 L and arterial cord pH of ≤7.1 both varied by 30-40% within 12-hour shifts (P<.05). The highest risk of adverse outcomes occurred after 9-10 hours from the beginning of the shift for both day and night shifts. The risk of other adverse outcomes did not vary significantly by hours worked or by day vs night shift. CONCLUSION: Number of hours already worked before undertaking unscheduled deliveries significantly influences the risk of certain adverse outcomes. Our findings suggest that fatigue may play a role in increasing the risk of adverse delivery outcomes later in shifts and that obstetric work patterns could be better designed to minimize the risk of adverse delivery outcomes.ARA is supported by grant P2CHD047879, awarded to the Office of Population Research at Princeton University by The Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health. JGS is supported by a CAREER grant from the U.S. National Science Foundation (DMS-1255187).This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.ajog.2016.06.02

Weekend working: a retrospective cohort study of maternal and neonatal outcomes in a large NHS delivery unit.

OBJECTIVES: Mandatory weekend working for NHS consultants is currently the subject of intense political debate. The Secretary of State for Health's proposed 7-day contract policy is based on the claim that such working patterns will improve patient outcomes. We evaluate this claim by taking advantage of as-if-at-random presentation of women for non-elective deliveries throughout the week. We examine (i) whether consultants currently perform fewer deliveries during weekends versus weekdays, and (ii) whether adverse outcomes increase during weekends. STUDY DESIGN: We conducted a retrospective cohort study using data on all non-elective deliveries from January 2008 to December 2013 in a large UK obstetrics centre (n=27,466). We used Pearson's chi-squared tests to make direct comparisons of adverse outcome rates during weekdays versus weekends. Outcomes included: estimated maternal blood loss ≥1.5l; severe perineal trauma; delayed neonatal respiration; umbilical arterial pH <7.1; and critical incidents at delivery. RESULTS: Consultants currently perform the same proportion of non-elective deliveries on weekends and weekdays (2.3% versus 2.6%, p=0.25). We found no increase in any adverse maternal or neonatal outcomes during weekends versus weekdays, despite high statistical power to detect such differences. Moreover, adverse outcomes are no higher during periods of the weekend when consultants are not routinely present compared to equivalent periods during weekdays. CONCLUSIONS: Under current working arrangements, women who would benefit from consultant-led delivery are equally likely to receive one on weekends compared to weekdays. Weekend delivery has no effect on maternal or neonatal morbidity. Adopting mandatory 7-day contracts is unlikely to make any difference to either consultant-led delivery during weekends or to patient outcomes.The Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (Grant ID: P2CHD047879)This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.ejogrb.2016.01.03

Management of fetal malposition in the second stage of labor: a propensity score analysis.

OBJECTIVE: We sought to determine the factors associated with selection of rotational instrumental vs cesarean delivery to manage persistent fetal malposition, and to assess differences in adverse neonatal and maternal outcomes following delivery by rotational instruments vs cesarean delivery. STUDY DESIGN: We conducted a retrospective cohort study over a 5-year period in a tertiary United Kingdom obstetrics center. In all, 868 women with vertex-presenting, single, liveborn infants at term with persistent malposition in the second stage of labor were included. Propensity score stratification was used to control for selection bias: the possibility that obstetricians may systematically select more difficult cases for cesarean delivery. Linear and logistic regression models were used to compare maternal and neonatal outcomes for delivery by rotational forceps or ventouse vs cesarean delivery, adjusting for propensity scores. RESULTS: Increased likelihood of rotational instrumental delivery was associated with lower maternal age (odds ratio [OR], 0.95; P < .01), lower body mass index (OR, 0.94; P < .001), lower birthweight (OR, 0.95; P < .01), no evidence of fetal compromise at the time of delivery (OR, 0.31; P < .001), delivery during the daytime (OR, 1.45; P < .05), and delivery by a more experienced obstetrician (OR, 7.21; P < .001). Following propensity score stratification, there was no difference by delivery method in the rates of delayed neonatal respiration, reported critical incidents, or low fetal arterial pH. Maternal blood loss was higher in the cesarean group (295.8 ± 48 mL, P < .001). CONCLUSION: Rotational instrumental delivery is often regarded as unsafe. However, we find that neonatal outcomes are no worse once selection bias is accounted for, and that the likelihood of severe obstetric hemorrhage is reduced. More widespread training of obstetricians in rotational instrumental delivery should be considered, particularly in light of rising cesarean delivery rates.During data analysis, A.R.A. was supported by an NICHD Predoctoral Fellowship under grant number F31HD079182 and by grant R24HD042849, awarded to the Population Research Center at The University of Texas at Austin. She is currently supported by grant R24HD047879 for Population Research at Princeton University. J.G.S. is partially funded by a CAREER grant from the National Science Foundation (DMS-1255187).This is the accepted version. It will be embargoed until 12 months after the final version is published by Elsevier. The final version is available from Elsevier at http://www.sciencedirect.com/science/article/pii/S000293781401078

In the beginning: Role of autonomy support on the motivation, mental health and intentions of participants entering an exercise referral scheme

Self-determination theory (Deci & Ryan, 2000, Intrinsic motivation and self-determination in human behaviour. New York: Plenum Publishing) highlights the impact autonomy supportive environments can have on exercise motivation and positive health outcomes. Yet little is known about whether differential effects occur as a function of which significant other is providing this support. Further, no research has examined the relationship between motivation and the social environment with participants’ mental health and intentions to be physically active before entering an exercise intervention. Study participants were 347 British adults who were about to start an exercise referral scheme. Regression analyses revealed that the effects of autonomy support on mental health and physical activity intentions differed as a function of who provided the support (offspring, partner or physician), with the offspring having the weakest effects. A structural model was supported, indicating that autonomy support and more autonomous regulations led to more positive mental health outcomes and stronger intentions to be physically active. Knowledge of the social environmental and personal motivation of those about to commence an exercise programme can provide important insights for professionals supporting such efforts

Primary and secondary contributions to aerosol light scattering and absorption in Mexico City during the MILAGRO 2006 campaign

A photoacoustic spectrometer, a nephelometer, an aethalometer, and an aerosol mass spectrometer were used to measure at ground level real-time aerosol light absorption, scattering, and chemistry at an urban site located in North East Mexico City (Instituto Mexicano del Petroleo, Mexican Petroleum Institute, denoted by IMP), as part of the Megacity Impact on Regional and Global Environments field experiment, MILAGRO, in March 2006. Photoacoustic and reciprocal nephelometer measurements at 532 nm accomplished with a single instrument compare favorably with conventional measurements made with an aethalometer and a TSI nephelometer. The diurnally averaged single scattering albedo at 532 nm was found to vary from 0.60 to 0.85 with the peak value at midday and the minimum value at 07:00 a.m. local time, indicating that the Mexico City plume is likely to have a net warming effect on local climate. The peak value is associated with strong photochemical generation of secondary aerosol. It is estimated that the photochemical production of secondary aerosol (inorganic and organic) is approximately 75% of the aerosol mass concentration and light scattering in association with the peak single scattering albedo. A strong correlation of aerosol scattering at 532 nm and total aerosol mass concentration was found, and an average mass scattering efficiency factor of 3.8 m&lt;sup&gt;2&lt;/sup&gt;/g was determined. Comparisons of photoacoustic and aethalometer light absorption with oxygenated organic aerosol concentration (OOA) indicate a very small systematic bias of the filter based measurement associated with OOA and the peak aerosol single scattering albedo

Brain oscillatory activity as a biomarker of motor recovery in chronic stroke

In the present work, we investigated the relationship of oscillatory sensorimotor brain activity to motor recovery. The neurophysiological data of 30 chronic stroke patients with severe upper‐limb paralysis are the basis of the observational study presented here. These patients underwent an intervention including movement training based on combined brain–machine interfaces and physiotherapy of several weeks recorded in a double‐blinded randomized clinical trial. We analyzed the alpha oscillations over the motor cortex of 22 of these patients employing multilevel linear predictive modeling. We identified a significant correlation between the evolution of the alpha desynchronization during rehabilitative intervention and clinical improvement. Moreover, we observed that the initial alpha desynchronization conditions its modulation during intervention: Patients showing a strong alpha desynchronization at the beginning of the training improved if they increased their alpha desynchronization. Patients showing a small alpha desynchronization at initial training stages improved if they decreased it further on both hemispheres. In all patients, a progressive shift of desynchronization toward the ipsilesional hemisphere correlates significantly with clinical improvement regardless of lesion location. The results indicate that initial alpha desynchronization might be key for stratification of patients undergoing BMI interventions and that its interhemispheric balance plays an important role in motor recovery.Bundesministerium für Bildung und Forschung, Grant/Award Numbers: 13GW0053, 16SV7754; Deutsche Forschungsgemeinschaft; Deutscher Akademischer Austauschdienst, Grant/Award Number: 9156335

Belief in a Just World: Consumer Intentions and Behaviors Toward Ethical Products

Although consumers report positive attitudes toward ethical goods, their intentions and behaviors often do not follow suit. Just-world theory highlights the conditions under which consumers are most likely to prefer fair-trade products. This theory proposes that people are motivated to construe the world as a just place where people get what they deserve. In the current research, when people are confronted with high levels of injustice (communicated need is high) and avenues for justice restoration seem uncertain or unavailable, assisting others by supporting fair trade decreases. However, highlighting how injustice can be redressed through purchases enhances fair-trade support under conditions of high need. The effects are moderated by justice sensitivity factors, such as just-world beliefs and whether the product type (indulgence vs. necessity) makes the injustice of consumer privilege salient. The results suggest that communicating high need when requesting consumer prosocial actions can sometimes backfire. Marketers employing high need appeals should heighten perceptions of justice restoration potential and activate fairness-related thoughts through product positioning to encourage fair-trade purchases

Scientific Verification of Faraday Rotation Modulators: Detection of Diffuse Polarized Galactic Emission

The design and performance of a wide bandwidth linear polarization modulator based on the Faraday effect is described. Faraday Rotation Modulators (FRMs) are solid-state polarization switches that are capable of modulation up to 10 kHz. Six FRMs were utilized during the 2006 observing season in the Background Imaging of Cosmic Extragalactic Polarization (BICEP) experiment; three FRMs were used at each of BICEP's 100 and 150 GHz frequency bands. The technology was verified through high signal-to-noise detection of Galactic polarization using two of the six FRMs during four observing runs in 2006. The features exhibit strong agreement with BICEP's measurements of the Galaxy using non-FRM pixels and with the Galactic polarization models. This marks the first detection of high signal-to-noise mm-wave celestial polarization using fast, active optical modulation. The performance of the FRMs during periods when they were not modulated was also analyzed and compared to results from BICEP's 43 pixels without FRMs

Creating Virtual 3-D Outcrop

Because of the high precision of present-day GPS and reflectorless laser technology, geologic information and remotely sensed data (i.e., seismic and GPR grids, wells) can be positioned accurately in 3-D and reconstructed as a virtual image. Hence, we have developed the “virtual outcrop” for applications that require knowledge about the 3-D spatial arrangements of rock types