Prevalence and main outcomes of placenta accreta spectrum: a systematic review and metaanalysis

OBJECTIVE: The objective of this study was to evaluate the prevalence of placenta accreta spectrum in general population studies and the main maternal outcomes at delivery. STUDY DESIGN: Data sources: We searched PubMed, Google Scholar, clinicalTrials.gov and MEDLINE between 1982 and 2018. STUDY ELIGIBILITY CRITERIA: Articles providing data on the number of cases of placenta accreta spectrum per pregnancies, births or deliveries in a defined population. STUDY APPRAISAL AND SYNTHESIS METHODS: Study characteristics were evaluated by two independent reviewers using a predesigned protocol. Primary outcomes were the prevalence of placenta accreta spectrum and clinical diagnostic at birth and pathologic criteria used to confirm the diagnosis. Secondary outcomes included cases requiring transfusion, incidence of peripartum hysterectomy and maternal mortality rates. Heterogeneity between studies was analysed with the Cochran's Q-test and the I2 statistics. RESULTS: Of the 98 full-text studies identified, 29 articles met the defined criteria including 22 retrospective and 7 prospective studies comprising 7,001 cases of placenta accreta spectrum out 5,719,992 births. Prevalence rates ranged between 0.01 and 0.1% with an overall pooled prevalence of 0.17% (95% CI 0.14-0.19). Only 10 studies provided with detailed histopathologic data. The pool prevalence for the adherent versus the invasive grades was 0.5 (95% CI 0.3-0.36) and 0.3 (95% CI 0.2-0.4) per 1000 births, respectively. The pooled incidence for peripartum hysterectomy was 52.2% (95% CI 38.3-66.4; I2= 99.8%) and 46.9% (95 % CI 34-59.9, I2= 98.8%) for haemorrhage requiring transfusion. The pooled estimate of maternal death was 0.05% (95% CI 0.06-0.69, I2=73%). We found large amounts of heterogeneity between studies for all parameters and further quantifying was limited because of methodological inconsistencies between studies with regards to clinical criteria used for the diagnosis of the condition at birth and the histopathologic confirmation of the diagnosis and differential diagnosis between adherent and invasive accreta placentation. CONCLUSIONS: This meta-analysis indicates wide variation between studies for the prevalence rate of placenta accreta spectrum and for the different grades of accreta placentation, highlighting the need for consistency in definitions used to describe placenta accreta spectrum at birth and in reporting on this increasing common obstetric complication

The Relationship Between Empathy and Reading Fiction: Separate Roles for Cognitive and Affective Components

Research suggests that both life-time experience of reading fiction and the extent to which a reader feels ‘transported’ by the narrative are associated with empathy. This study examined these relationships further by delineating empathy into cognitive and affective components. Thirty-three participants were tested on prior exposure to fiction, transportation, and different measures of cognitive empathy, affective empathy and helping tendency. The results revealed that exposure to fiction was associated with trait cognitive, but not affective, empathy, while the experience of being transported was associated with story-induced affective empathy. Story-induced affective empathy was also associated with helping tendency. The results are discussed by considering implications for relationships between reactions to fictional worlds and reactions to real-world behaviours

Epidemiology of placenta previa accreta: a systematic review and meta-analysis

Objective To estimate the prevalence and incidence of placenta previa complicated by placenta accreta spectrum (PAS) and to examine the different criteria being used for the diagnosis. Design Systematic review and meta-analysis. Data sources PubMed, Google Scholar, ClinicalTrials.gov and MEDLINE were searched between August 1982 and September 2018. Eligibility criteria Studies reporting on placenta previa complicated by PAS diagnosed in a defined obstetric population. Data extraction and synthesis Two independent reviewers performed the data extraction using a predefined protocol and assessed the risk of bias using the Newcastle-Ottawa scale for observational studies, with difference agreed by consensus. The primary outcomes were overall prevalence of placenta previa, incidence of PAS according to the type of placenta previa and the reported clinical outcomes, including the number of peripartum hysterectomies and direct maternal mortality. The secondary outcomes included the criteria used for the prenatal ultrasound diagnosis of placenta previa and the criteria used to diagnose and grade PAS at birth. Results A total of 258 articles were reviewed and 13 retrospective and 7 prospective studies were included in the analysis, which reported on 587 women with placenta previa and PAS. The meta-analysis indicated a significant (p<0.001) heterogeneity between study estimates for the prevalence of placenta previa, the prevalence of placenta previa with PAS and the incidence of PAS in the placenta previa cohort. The median prevalence of placenta previa was 0.56% (IQR 0.39–1.24) whereas the median prevalence of placenta previa with PAS was 0.07% (IQR 0.05–0.16). The incidence of PAS in women with a placenta previa was 11.10% (IQR 7.65–17.35). Conclusions The high heterogeneity in qualitative and diagnostic data between studies emphasises the need to implement standardised protocols for the diagnoses of both placenta previa and PAS, including the type of placenta previa and grade of villous invasiveness. PROSPERO registration number CRD4201706858

Effective role of unpolarized nonvalence partons in Drell-Yan single spin asymmetries

We perform numerical simulations of the Sivers effect from single spin asymmetries in Drell-Yan processes on transversely polarized protons. We consider colliding antiprotons and pions at different kinematic conditions of interest for the future planned experiments. We conventionally name "framework I" the results obtained when properly accounting for the various flavor dependent polarized valence contributions in the numerator of the asymmetry, and for the unpolarized nonvalence contribution in its denominator. We name "framework II" the results obtained when taking a suitable flavor average of the valence contributions and neglecting the nonvalence ones. We compare the two methods, also with respect to the input parametrization of the Sivers function which is extracted from data with approximations sometimes intermediate between frameworks I and II. Deviations between the two approaches are found to be small except for dilepton masses below 3 GeV. The Sivers effect is used as a test case; the arguments can be generalized to other interesting azimuthal asymmetries in Drell-Yan processes, such as the Boer-Mulders effect.Comment: 13 pages, 9 figures in eps forma

Transverse Double-Spin Asymmetries for Muon Pair Production in pp-Collisions

We calculate the rapidity dependence of the transverse double-spin asymmetry for the Drell-Yan process to next-to-leading order in the strong coupling. Input transversity distributions are obtained by saturating the Soffer inequality at a low hadronic mass scale. Results for the polarized BNL-RHIC proton-proton collider and the proposed HERA-N fixed-target experiment are presented, and the influence of the limited muon acceptance of the detectors on measurements of the asymmetry is studied in detail.Comment: 7 pages including 5 figures; significantly shortened, to be published in Phys. Rev.

Narrative of Chain cruise #43 : February - August 1964

Originally issued as Reference No. 65-9, series later renamed WHOI-.On CHAIN Cruise 43, 15 February to 21 August 1964, geophysical and geological observations were made in the North Atlantic Ocean, the Mediterranean and Red Seas, and the Western part of the Indian Ocean, along the track Woods Hole - Ceuta (Spanish Africa) - La Spezia - Port Said - Aden - Victoria (Seychelles Islands) - Port Louis (Mauritius) - Victoria (Seychelles Islands) - Port Said - Beirut - La Spezia - Monaco - Plymouth (England) - Woods Hole. This report contains (1) a narrative of the cruise, (2) a list of stations, (3) statements of the scientific objectives of the cruise, (4) a summary of the geological and geophysical observations, (5) end-of-cruise reports on equipment and some phases of the research program, and (6) a selection of bottom photographs. WHOI Ref. No. 64-51 contains a detailed navigational plot of the entire cruise, including soundings and the locations of other observations.This cruise was supported by the National Science Foundation under Grant GP-2370 and Submitted to the Office of Naval Research under Contract Nonr-4029(00) NR 260-101

Detecting respiratory bacterial communities of wild dolphins: Implications for animal health

Infectious diseases contribute to the vulnerable status of marine mammals, including respiratory illnesses. This study aimed to capture exhaled breath condensate (blow) for microbial identification from wild Indo-Pacific bottlenose dolphins Tursiops aduncus. Individual dolphins were sampled by holding a funnel connected to a 50 ml centrifuge tube over the blowhole of the animal near shore in Shark Bay (SB), Western Australia. Four individuals were sampled on 2 occasions along with seawater samples. Comparative blow and pool water samples were collected from 4 individual common bottlenose dolphins Tursiops truncatus housed in the National Aquarium (NA), Baltimore, Maryland, USA. Bacteria were identified using the V4 region of the 16S rRNA gene from extracted DNA. We identified bacteria independent of seawater in SB dolphins, which included the classes Alphaproteobacteria (26.1%) and Gammaproteobacteria (25.8%); the phyla Bacteroidetes (15.6%) and Fusobacteria (7.2%); and the genera Pseudomonas (11.5%), Pedomicrobium (4.5%), Streptobacillus (3.7%), Phenylobacterium (2.2%) and Sphingomonas (2.1%). There were broad similarities in phyla between SB and NA dolphins yet there were differences between lower taxonomic groups. A number of operational taxonomic units (OTUs) were shared between dolphin individuals, which may be a result of their genetic lineage (siblings or parentage), shared living and social interactions. A number of genera were observed in SB dolphins which have species known to be infectious in marine mammals such as Pseudomonas, Mycoplasma and Streptococcus. This study successfully characterised bacteria from DNA captured in blow from wild dolphins. The ability to capture these communities from individuals in the wild provides a novel health indicator

Application of robotics In the clinical laboratory

The basic types of robot are explained, and the performances and costs of some commercial examples are given. The potential advantages and problems of introducing robots into clinical laboratories are identified and the specifcation of a suitable robot is developed. None of the commercially available robots meets all aspects of the specificalion, and currently the purchase of a robot is considered premature for most clinical laboratories

Ophthalmic statistics note 5: diagnostic tests-sensitivity and specificity

This is the fifth statistics note produced by the Ophthalmic Statistics Group (OSG) which is designed to be a simple guide to ophthalmic researchers on a statistical issue with an applied ophthalmic example. The OSG is a collaborative group of statisticians who have come together with a desire to raise the statistical standards of ophthalmic researcher by increasing statistical awareness of common issues