Twin-Twin Transfusion Syndrome: study protocol for developing, disseminating, and implementing a core outcome set.

BACKGROUND: Twin-Twin Transfusion Syndrome (TTTS) is associated with an increased risk of perinatal mortality and morbidity. Several treatment interventions have been described for TTTS, including fetoscopic laser surgery, amnioreduction, septostomy, expectant management, and pregnancy termination. Over the last decade, fetoscopic laser surgery has become the primary treatment. The literature to date reports on many different outcomes, making it difficult to compare results or combine data from individual studies, limiting the value of research to guide clinical practice. With the advent and ongoing development of new therapeutic techniques, this is more important than ever. The development and use of a core outcome set has been proposed to address these issues, prioritising outcomes important to the key stakeholders, including patients. We aim to produce, disseminate, and implement a core outcome set for TTTS. METHODS: An international steering group has been established to oversee the development of this core outcome set. This group includes healthcare professionals, researchers and patients. A systematic review is planned to identify previously reported outcomes following treatment for TTTS. Following completion, the identified outcomes will be evaluated by stakeholders using an international, multi-perspective online modified Delphi method to build consensus on core outcomes. This method encourages the participants towards consensus 'core' outcomes. All key stakeholders will be invited to participate. The steering group will then hold a consensus meeting to discuss results and form a core outcome set to be introduced and measured. Once core outcomes have been agreed, the next step will be to determine how they should be measured, disseminated, and implemented within an international context. DISCUSSION: The development, dissemination, and implementation of a core outcome set in TTTS will enable its use in future clinical trials, systematic reviews and clinical practice guidelines. This is likely to advance the quality of research studies and their effective use in order to guide clinical practice and improve patient care, maternal, short-term perinatal outcomes and long-term neurodevelopmental outcomes. TRIAL REGISTRATION: Core Outcome Measures in Effectiveness Trials (COMET), 921 Registered on July 2016. International Prospective Register of Systematic Reviews (PROSPERO), CRD42016043999 . Registered on 2 August 2016

Superdeformed Band in ^{36}Ar Described by Projected Shell Model

The projected shell model implements shell model configuration mixing in the projected deformed basis. Our analysis on the recently observed superdeformed band in $^{36}$Ar suggests that the neutron and proton 2-quasiparticle and the 4-quasiparticle bands cross the superdeformed ground band at the same angular momentum. This constitutes a picture of band disturbance in which the first and the second band-crossing, commonly seen at separate rotation frequencies in heavy nuclei, occur simultaneously. We also attempt to understand the assumptions of two previous theoretical calculations which interpreted this band. Electromagnetic properties of the band are predicted.Comment: 4 pages and 2 figures, accepted by Phys. Rev. C as a Rapid Communicatio

Planned Cesarean or planned vaginal delivery for twins : secondary analysis of randomized controlled trial

ACKNOWLEDGMENTS We thank all the participants in the Twin Birth Study and the staff at the Centre for Mother, Infant, and Child Research for their hard work and dedication. The Twin Birth Study was supported by a grant (63164) from the Canadian Institute of Health Research. P.T. and M.H.Z. were supported by a grant from The Netherlands Organization for Scientific Research (NWO ‐ grant number 401.16.080). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

High Prevalence of Antibiotic-Resistant Mycoplasma genitalium in Nongonococcal Urethritis: The Need for Routine Testing and the Inadequacy of Current Treatment Options.

Background. Empirical antibiotic therapy for nongonococcal urethritis (NGU) and cervicitis is aimed at Chlamydia trachomatis, but Mycoplasma genitalium, which also commonly causes undiagnosed NGU, necessitates treatment with macrolides or fluoroquinolones rather than doxycycline, the preferred chlamydia treatment. Prevalence of M. genitalium and associated genotypic markers of macrolide and fluoroquinolone resistance among men symptomatic of urethritis were investigated. Genetic diversity of M. genitalium populations was determined to infer whether findings were applicable beyond our setting. Methods. Mycoplasma genitalium and other NGU pathogens were detected using nucleic acid amplification methods, and DNA sequencing was used to detect genotypic resistance markers of macrolide and fluoroquinolone antibiotics in 23S ribosomal RNA, gyrA, gyrB, and parC genes. MG191 single-nucleotide polymorphism typing and MG309 variable number tandem analysis were combined to assign a dual locus sequence type (DLST) to each positive sample. Results. Among 217 men, M. genitalium prevalence was 16.7% (95% confidence interval [CI], 9.5%-24.0%) and C. trachomatis prevalence was 14.7% (95% CI, 7.8%-21.6%) in NGU cases. Nine of 22 (41%; 95% CI, 20%-62%) patients with M. genitalium were infected with DLSTs possessing genotypic macrolide resistance and 1 patient was infected with a DLST having genotypic fluoroquinolone resistance. Typing assigned M. genitalium DLSTs to 2 major clusters, broadly distributed among previously typed international strains. Genotypic macrolide resistance was spread within these 2 clusters. Conclusions. Mycoplasma genitalium is a frequent undiagnosed cause of NGU in this population with rates of macrolide resistance higher than those previously documented. Current guidelines for routine testing and empirical treatment of NGU should be modified to reduce treatment failure of NGU and the development of further resistance

ΔI=4\Delta I=4 and ΔI=8\Delta I=8 bifurcations in rotational bands of diatomic molecules

It is shown that the recently observed $\Delta I=4$ bifurcation seen in superdeformed nuclear bands is also occurring in rotational bands of diatomic molecules. In addition, signs of a $\Delta I=8$ bifurcation, of the same order of magnitude as the $\Delta I=4$ one, are observed both in superdeformed nuclear bands and rotational bands of diatomic molecules.Comment: LaTex twice, 10 pages and 5 PS figures provided upon demand by the Author

Determining the Energy Barrier for Decay out of Superdeformed Bands

An asymptotically exact quantum mechanical calculation of the matrix elements for tunneling through an asymmetric barrier is combined with the two-state statistical model for decay out of superdeformed bands to determine the energy barrier (as a function of spin) separating the superdeformed and normal-deformed wells for several nuclei in the 190 and 150 mass regions. The spin-dependence of the barrier leading to sudden decay out is shown to be consistent with the decrease of a centrifugal barrier with decreasing angular momentum. Values of the barrier frequency in the two mass regions are predicted.Comment: v1: 4 pages, 1 figure, 1 table. v2: 5 pages, 1 figure, 1 table; minor corrections and clarification

Maternal outcomes at 3 months after planned caesarean section versus planned vaginal birth for twin pregnancies in the Twin Birth Study: a randomised controlled trial

OBJECTIVE: To compare outcomes at 3 months post partum for women randomised to give birth by planned caesarean section (CS) or by planned vaginal birth (VB) in the Twin Birth Study (TBS). DESIGN: We invited women in the TBS to complete a 3-month follow-up questionnaire. SETTING: Two thousand and eight hundred and four women from 25 countries. POPULATION: Two thousand and five hundred and seventy women (92% response rate). METHODS: Women randomised between 13 December 2003 and 4 April 2011 in the TBS completed a questionnaire and outcomes were compared using an intention-to-treat approach. MAIN OUTCOME AND MEASURES: Breastfeeding, quality of life, depression, fatigue and urinary incontinence. RESULTS: We found no clinically important differences between groups in any outcome. In the planned CS versus planned VB groups, breastfeeding at any time after birth was reported by 84.4% versus 86.4% (P = 0.13); the mean physical and mental Short Form (36) Health Survey (SF-36) quality of life scores were 51.8 versus 51.6 (P = 0.65) and 46.7 versus 46.0 (P = 0.09), respectively; the mean Multidimensional Assessment of Fatigue score was 20.3 versus 20.8 (P = 0.14); the frequency of probable depression on the Edinburgh Postnatal Depression Scale was 14.0% versus 14.8% (P = 0.57); the rate of problematic urinary incontinence was 5.5% versus 6.4% (P = 0.31); and the mean Incontinence Impact Questionnaire-7 score was 20.5 versus 20.4 (P = 0.99). Partner relationships, including painful intercourse, were similar between the groups. CONCLUSION: For women with twin pregnancies randomised to planned CS compared with planned VB, outcomes at 3 months post partum did not differ. The mode of birth was not associated with problematic urinary incontinence or urinary incontinence that affected the quality of life. Contrary to previous studies, breastfeeding at 3 months was not increased with planned VB. TWEETABLE ABSTRACT: Planned mode of birth for twins doesn't affect maternal depression, wellbeing, incontinence or breastfeeding

Staggering effects in nuclear and molecular spectra

It is shown that the recently observed Delta J = 2 staggering effect (i.e. the relative displacement of the levels with angular momenta J, J+4, J+8, ..., relatively to the levels with angular momenta J+2, J+6, J+10, ...) seen in superdeformed nuclear bands is also occurring in certain electronically excited rotational bands of diatomic molecules (YD, CrD, CrH, CoH), in which it is attributed to interband interactions (bandcrossings). In addition, the Delta J = 1 staggering effect (i.e. the relative displacement of the levels with even angular momentum J with respect to the levels of the same band with odd J) is studied in molecular bands free from Delta J = 2 staggering (i.e. free from interband interactions/bandcrossings). Bands of YD offer evidence for the absence of any Delta J = 1 staggering effect due to the disparity of nuclear masses, while bands of sextet electronic states of CrD demonstrate that Delta J = 1 staggering is a sensitive probe of deviations from rotational behaviour, due in this particular case to the spin-rotation and spin-spin interactions.Comment: LaTeX, 16 pages plus 30 figures given in separate .ps files. To appear in the proceedings of the 4th European Workshop on Quantum Systems in Chemistry and Physics (Marly-le-Roi, France, 1999), ed. J. Maruani et al. (Kluwer, Dordrecht

Cranked Relativistic Hartree-Bogoliubov Theory: Formalism and Application to the Superdeformed Bands in the A∼190A\sim 190 region

Cranked Relativistic Hartree-Bogoliubov theory without and with approximate particle number projection by means of the Lipkin-Nogami method is presented in detail as an extension of Relativistic Mean Field theory with pairing correlations to the rotating frame. Pairing correlations are taken into account by a finite range two-body force of Gogny type. The applicability of this theory to the description of rotating nuclei is studied in detail on the example of superdeformed bands in even-even nuclei of the $A\sim 190$ mass region. Different aspects such as the importance of pairing and particle number projection, the dependence of the results on the parametrization of the RMF Lagrangian and Gogny force etc. are investigated in detail. It is shown that without any adjustment of new parameters the best description of experimental data is obtained by using the well established parameter sets NL1 for the Lagrangian and D1S for the pairing force. Contrary to previous studies at spin zero it is found that the increase of the strength of the Gogny force is not necessary in the framework of Relativistic Hartree-Bogoliubov theory provided that particle number projection is performed.Comment: 34 pages, 24 figures, 3 tables, uses Revtex and epsf.sty, submitted to Nuclear Physics