The midwife factor in obstetric procedures and neonatal outcome

Aims. In the face of major tendency towards midwiferyled-care it was our purpose to investigate the extent of the influence of the midwife on the rates of obstetric procedures and perinatal outcome. Methods. 5384 consecutive deliveries at the Department of Obstetrics and Gynecology. University of Graz, were enrolled in the study. The following data were collected: mode of delivery, pH of umbilical artery, Apgar score. Firstly, data were investigated for interindividual differences and, secondly, for relationship with age of the midwife as a measure of experience. Results. Interindividual differences were significant for episiotomy rates (minimum: 31.6%; maximum 76.9%; p<0.001), forceps rates (minimum: 1.7%; maximum 11.1%;p=0.002) and pH of umbilical arteries (minimum: 7.21:maxinium: 7.28 p=0.001) but not for cesarean section rates and Apgar scores. Linear regression analysis was significant between age of midwives and pH of umbilical arteries (p<0.001: r=0.055) and for one-minute Apgar score (p=0.009; r=0.050) but not for episiotomy rates, cesarean section rates, forceps rates and five-minutes Apgar score. Conclusions. There are large interindividual differences in obstetric intervention rates which cannot be explained by the midwives' age. Provision of health care should be primarily determined by need and not by the personal characteristics of the health care provider, thus interindividual differences should be reduced and more often taken into account when analyzing any kind of data

Comparing seed production and regeneration of Carapa guianensis (Aublet.) in two forest types in Acre, Brazil from 2004 to 2007.

Carapa guianensis is a tropical tree valuable for its seed oil and timber. This study compared Carapa seed production and regeneration density in two forest types: upland and occasionally inundated

Control of Carapa guianensis phenology and seed production at multiple scales: a five-year study exploring the influences of tree attributes, habitat heterogeneity and climate cues.

During 5 y, we monitored reproductive activity and seed production of Carapa guianensis in two forest types to test the hypothesis that seed production is influenced by multiple factors across scales (regional climatic cues, local habitat heterogeneity and individual tree attributes). Variability in seed production was moderate at the population (CVp =1.25) and individual level (xCVi =1.24). Amixed modelwith a Poisson regression revealed that seed production was explained by variables at all scales. Total seed production was significantly higher in occasionally inundated forests. Diameter at breast height, dbh2, crown cross-sectional area, liana load, density, dry-season rainfall and mean maximum temperature were also significant in explaining seed production variation. Seed production increased with dbh until 40?50 cm, then decreased. Liana load demonstrated a negative relationship with seed production, but only in terra firme forests. Climatic cues (rainfall and temperature parameters) were central to setting overall patterns in reproductive activity and seemed to best explain why years with high seed production were consistent across the two forest types (habitats) examined. Dry-season rainfall was positively correlated with seed production

An easily accessible technology to increase Brazil nut stand productivity: a case study in Chico Mendes Extractive Reserve.

Brazil nut (Bertholletia excelsa) is central to many Amazonian protected area reserves and resident extractivist livelihoods therein. Extractivists tend to concentrate nut harvests on trails worked by their ancestors and/or previous landholders, rather than integrate off-trail trees that may have more recently entered reproductive maturity. We tested an easily accessible mapping technology to potentially increase productivity simply by including more extant trees in collection routines. In a 145-ha landholding, we accompanied the resident harvester, tracking trails used and trees annually harvested to estimate current stand utilization. We also conducted a parallel 100% inventory of all B. excelsa trees ≥ 10 cm DBH, using linear transects 50 m apart. Results showed that the extractivist collected from 70% of all reproductive trees. The systematic mapping identified 54 new trees, some of which the extractivist had already identified as negligible producers. Still 32 of the 54 (59%) had good or tolerable crown forms and no vines, suggesting that they would be good producers. In 2013, this extractivist collected an estimated 3586 kg of nuts, visiting 125 trees. By incorporating 32 more trees, he could potentially increase his production by 27% (an additional ~USD 600 at 2013 prices) based on average diameter-informed production levels.Editado por: John A. Parrota; Cynthia F. Moser; Amy J. Scherzer; Nancy E. Koerth; Daryl R. Lederle

Manejo madeireiro comunitário em áreas protegidas da Amazônia: aprendizados e recomendações de como facilitar a troca de experiências entre comunidades e organizações.

Este documento apresenta um histórico do manejo madeireiro comunitário na Amazônia brasileira e a motivação para promover a troca de experiências; descreve o percurso metodológico adotado para a realização do encontro; e analisa os aprendizados do processo de organização do evento e dos casos de manejo madeireiro comunitário. Espera-se que possa contribuir com as iniciativas de uso sustentável das florestas por comunidades locais da Amazônia.bitstream/item/222907/1/27125.pd

Prenatal diagnosis of Neu-Laxova syndrome: a case report

BACKGROUND: Neu-Laxova syndrome is a rare congenital abnormality involving multiple systems. We report a case of Neu-Laxova syndrome (NLS) diagnosed prenatally by ultrasound examination. CASE PRESENTATION: A 29-year-old gravida 3, para 2 woman was first seen in our antenatal clinic at 38 weeks' pregnancy. Except for the consanguinity and two previous abnormal stillborn babies her medical history was unremarkable. On ultrasound examination microcephaly, flat forehead, micrognathia, intrauterine growth restriction, generalized edema of the skin, hypoplastic chest, excessive soft tissue deposition of hands and feet, joint contractures and a penis without scrotal sacs were detected. She delivered a 2000 g male fetus. He died five minutes after delivery. Postmortem examination confirmed the diagnosis of Neu-Laxova syndrome. CONCLUSION: Because of the autosomal recessive inheritance of Neu-Laxova syndrome genetic counseling and early-serial ultrasound examination should be performed at risk families. Early diagnosis of the disease may offer termination of the pregnancy as an option

Response to Emerging Infection Leading to Outbreak of Linezolid-Resistant Enterococci

These bacteria have emerged as a hospital problem that appears to be caused by both linezolid exposure and patient-to-patient transmission

Manejo da castanheira (Bertholletia excelsa) para produção de Castanha-do-Brasil.

Devido às exigências sanitárias cada vez mais rígidas por parte tanto do mercado nacional quanto internacional, o Ministério da Agricultura, Pecuária e Abastecimento (Mapa)incentivou, em 2003, várias instituições a estudarem e definirem práticas de produção e pós-colheita que garantam a qualidade do produto e também seu mercado. Assim, este documento tem por objetivo fornecer subsídios para o manejo da castanheira e de seu produto visando a uma produção sustentável e de boa qualidade

Seasonal differences in leaf-level physiology give lianas a competitive advantage over trees in a tropical seasonal forest

Lianas are an important component of most tropical forests, where they vary in abundance from high in seasonal forests to low in aseasonal forests. We tested the hypothesis that the physiological ability of lianas to fix carbon (and thus grow) during seasonal drought may confer a distinct advantage in seasonal tropical forests, which may explain pan-tropical liana distributions. We compared a range of leaf-level physiological attributes of 18 co-occurring liana and 16 tree species during the wet and dry seasons in a tropical seasonal forest in Xishuangbanna, China. We found that, during the wet season, lianas had significantly higher CO2 assimilation per unit mass (Amass), nitrogen concentration (Nmass), and δ13C values, and lower leaf mass per unit area (LMA) than trees, indicating that lianas have higher assimilation rates per unit leaf mass and higher integrated water-use efficiency (WUE), but lower leaf structural investments. Seasonal variation in CO2 assimilation per unit area (Aarea), phosphorus concentration per unit mass (Pmass), and photosynthetic N-use efficiency (PNUE), however, was significantly lower in lianas than in trees. For instance, mean tree Aarea decreased by 30.1% from wet to dry season, compared with only 12.8% for lianas. In contrast, from the wet to dry season mean liana δ13C increased four times more than tree δ13C, with no reduction in PNUE, whereas trees had a significant reduction in PNUE. Lianas had higher Amass than trees throughout the year, regardless of season. Collectively, our findings indicate that lianas fix more carbon and use water and nitrogen more efficiently than trees, particularly during seasonal drought, which may confer a competitive advantage to lianas during the dry season, and thus may explain their high relative abundance in seasonal tropical forests