Persistent urinary incontinence and delivery mode history: a six-year longitudinal study.

Objective: To investigate the prevalence of persistent and long term postpartum urinary incontinence and associations with mode of first and subsequent delivery. Setting: Maternity units in Aberdeen (Scotland), Birmingham (England) and Dunedin (New Zealand). Design: Longitudinal study Population: 4214 women who returned postal questionnaires 3 months and 6 years after the index birth. Methods: Symptom data were obtained from both questionnaires and obstetric data from case-notes for the index birth and the second questionnaire for subsequent births. Logistic regression investigated the independent effects of mode of first delivery and delivery mode history. Main outcome measures: Urinary incontinence – persistent (at 3 months and 6 years after index birth) and long-term (at 6 years after index birth). Results: The prevalence of persistent urinary incontinence was 24%. Delivering exclusively by Caesarean section was associated with both less persistent (OR= 0.46, 95% CI 0.32 to 0.68) and long term urinary incontinence (OR=0.50, 95% CI 0.40 to 0.63). Caesarean section birth in addition to vaginal delivery however was not associated with significantly less persistent incontinence (OR 0.93, 95%CI 0.67 to 1.29). There were no significant associations between persistent or long-term urinary incontinence and forceps or vacuum extraction delivery. Other significantly associated factors were increasing number of births and older maternal age. Conclusions: The risk of persistent and long term urinary incontinence is significantly lower following Caesarean section deliveries but not if there is another vaginal birth. Even when delivering exclusively by Caesarean section, the prevalence of persistent symptoms (14%) is still high

The association among diet, dietary fiber, and bowel preparation at colonoscopy

BACKGROUND AND AIMS: Pre-colonoscopy dietary restrictions vary widely and lack evidence-based guidance. We investigated whether fiber and various other foods/macronutrients consumed during the 3 days before colonoscopy are associated with bowel preparation quality. METHODS: This was a prospective observational study among patients scheduled for outpatient colonoscopy. Patients received instructions including split-dose polyethylene glycol, avoidance of vegetables/beans 2 days before colonoscopy, and a clear liquid diet the day before colonoscopy. Two 24-hour dietary recall interviews and 1 patient-recorded food log measured dietary intake on the 3 days before colonoscopy. The Nutrition Data System for Research was used to estimate dietary exposures. Our primary outcome was the quality of bowel preparation measured by the Boston Bowel Preparation Scale (BBPS). RESULTS: We enrolled 201 patients from November 2015 to September 2016 with complete data for 168. The mean age was 59 years (standard deviation, 7 years), and 90% of colonoscopies were conducted for screening/surveillance. Only 17% and 77% of patients complied with diet restrictions 2 and 1 day(s) before colonoscopy, respectively. We found no association between foods consumed 2 and 3 days before colonoscopy and BBPS scores. However, BPPS was positively associated with intake of gelatin, and inversely associated with intake of red meat, poultry, and vegetables on the day before colonoscopy. CONCLUSIONS: Our findings support recent guidelines encouraging unrestricted diets >1 day before colonoscopy if using a split-dose bowel regimen. Furthermore, we found no evidence to restrict dietary fiber 1 day before colonoscopy. We also found evidence to promote consumption of gelatin and avoidance of red meat, poultry, and vegetables 1 day before colonoscopy.Dr Jacobson has acted as a consultant for MOTUS GI and Remedy Partners. All other authors disclosed no financial relationships relevant to this publication. Supported by NIH/NIDDK R21DK105476. (R21DK105476 - NIH/NIDDK)Accepted manuscrip

Twelve-year follow-up of conservative management of postnatal urinary and faecal incontinence and prolapse outcomes : randomised controlled trial

© 2013 Royal College of Obstetricians and Gynaecologists. Funded by Royal College of Obstetricians and Gynaecologists, London, UK; Health Research Council of New Zealand. Grant Number: RG 819/06 New Zealand Lottery Grant Board Health Services Research Unit, University of Aberdeen Chief Scientist Office of the Scottish Government Health DirectoratesPeer reviewedPostprin

Sample size calculations for cluster randomised controlled trials with a fixed number of clusters

Background\ud Cluster randomised controlled trials (CRCTs) are frequently used in health service evaluation. Assuming an average cluster size, required sample sizes are readily computed for both binary and continuous outcomes, by estimating a design effect or inflation factor. However, where the number of clusters are fixed in advance, but where it is possible to increase the number of individuals within each cluster, as is frequently the case in health service evaluation, sample size formulae have been less well studied. \ud \ud Methods\ud We systematically outline sample size formulae (including required number of randomisation units, detectable difference and power) for CRCTs with a fixed number of clusters, to provide a concise summary for both binary and continuous outcomes. Extensions to the case of unequal cluster sizes are provided. \ud \ud Results\ud For trials with a fixed number of equal sized clusters (k), the trial will be feasible provided the number of clusters is greater than the product of the number of individuals required under individual randomisation ($n_i$) and the estimated intra-cluster correlation ($\rho$). So, a simple rule is that the number of clusters ($\kappa$) will be sufficient provided: \ud \ud $\kappa$ > $n_i$ x $\rho$\ud \ud Where this is not the case, investigators can determine the maximum available power to detect the pre-specified difference, or the minimum detectable difference under the pre-specified value for power. \ud \ud Conclusions\ud Designing a CRCT with a fixed number of clusters might mean that the study will not be feasible, leading to the notion of a minimum detectable difference (or a maximum achievable power), irrespective of how many individuals are included within each cluster. \ud \u

Faecal incontinence persisting after childbirth : a 12 year longitudinal study

© 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.Peer reviewedPostprin

M31's Heavy Element Distribution and Outer Disk

Hubble Space Telescope imaging of 11 fields in M31 were reduced to color-magnitude diagrams. The fields were chosen to sample all galactocentric radii to 50 kpc. Assuming that the bulk of the sampled stellar populations are older than a few Gyr, the colors of the red giants map to an abundance distribution with errors of order 0.1 dex in abundance. The radially sampled abundance distributions are all about the same width, but show a mild abundance gradient that flattens outside ~20 kpc. The various distributions were weighted and summed with the aid of new surface brightness profile fits to obtain an abundance distribution representative of the entirety of M31. M31 is a system near chemical maturity. This ``observed closed box'' is compared to analytical closed box models. M31 suffers from a lack of metal-poor stars and metal-rich stars relative to the simplest closed-box model in the same way as the solar neighborhood.Comparing to several simple chemical evolution models, neither complete mixing of gas at all times nor zero mixing, inhomogeneous models give the most convincing match to the data. As noted elsewhere, the outer disk of M31 is a factor of ten more metal-rich than the Milky Way halo, ten times more metal-rich than the dwarf spheroidals cospatial with it, and more metal-rich than most of the globular clusters at the same galactocentric radius. Difficulties of interpretation are greatly eased if we posit that the M31 disk dominates over the halo at all radii out to 50 kpc. In fact, scaling from current density models of the Milky Way, one should not expect to see halo stars dominating over disk stars until beyond our 50 kpc limit. A corollary conclusion is that most published studies of the M31 "halo" are actually studies of its disk.Comment: 28 pages, 11 black-and-white figures, in press, Astrophysical Journa

Stages of development and injury: an epidemiological survey of young children presenting to an emergency department

<p><b>Background:</b> The aim of our study was to use a local (Glasgow, west of Scotland) version of a Canadian injury surveillance programme (CHIRPP) to investigate the relationship between the developmental stage of young (pre-school) children, using age as a proxy, and the occurrence (incidence, nature, mechanism and location) of injuries presenting to a Scottish hospital emergency department, in an attempt to replicate the findings of a recent study in Kingston, Canada.</p> <p><b>Methods:</b> We used the Glasgow CHIRPP data to perform two types of analyses. First, we calculated injury rates for that part of the hospital catchment area for which reasonably accurate population denominators were available. Second, we examined detailed injury patterns, in terms of the circumstances, mechanisms, location and types of injury. We compared our findings with those of the Kingston researchers.</p> <p><b>Results:</b> A total of 17,793 injury records for children aged up to 7 years were identified over the period 1997–99. For 1997–2001, 6,188 were used to calculate rates in the west of the city only. Average annual age specific rates per 1000 children were highest in both males and females aged 12–35 months. Apart from the higher rates in Glasgow, the pattern of injuries, in terms of breakdown factors, mechanism, location, context, and nature of injury, were similar in Glasgow and Kingston.</p> <p><b>Conclusion:</b> We replicated in Glasgow, UK, the findings of a Canadian study demonstrating a correlation between the pattern of childhood injuries and developmental stage. Future research should take account of the need to enhance statistical power and explore the interaction between age and potential confounding variables such as socio-economic deprivation. Our findings highlight the importance of designing injury prevention interventions that are appropriate for specific stages of development in children.</p&gt

Experimental test of higher-order Laguerre–Gauss modes in the 10 m Glasgow prototype interferometer

Brownian noise of dielectric mirror coatings is expected to be one of the limiting noise sources, at the peak sensitivity, of next generation ground based interferometric gravitational wave (GW) detectors. The use of higher-order Laguerre–Gauss (LG) beams has been suggested to reduce the effect of coating thermal noise in future generations of gravitational wave detectors. In this paper we describe the first test of interferometry with higher-order LG beams in an environment similar to a full-scale gravitational wave detector. We compare the interferometric performance of higher-order LG modes and the fundamental mode beams, injected into a 10 m long suspended cavity that features a finesse of 612, a value chosen to be typical of future gravitational wave detectors. We found that the expected mode degeneracy of the injected LG3, 3 beam was resolved into a multiple peak structure, and that the cavity length control signal featured several nearby zero crossings. The break up of the mode degeneracy is due to an astigmatism (defined as |Rcy − Rcx|) of 5.25 ± 0.5 cm on one of our cavity mirrors with a radius of curvature (Rc) of 15 m. This observation agrees well with numerical simulations developed with the FINESSE software. We also report on how these higher-order mode beams respond to the misalignment and mode mismatch present in our 10 m cavity. In general we found the LG3, 3 beam to be considerably more susceptible to astigmatism and mode mismatch than a conventional fundamental mode beam. Therefore the potential application of higher-order Laguerre–Gauss beams in future gravitational wave detectors will impose much more stringent requirements on both mode matching and mirror astigmatism

School Playground Surfacing and Arm Fractures in Children: A Cluster Randomized Trial Comparing Sand to Wood Chip Surfaces

In a randomized trial of elementary schools in Toronto, Andrew Howard and colleagues show that granitic sand playground surfaces reduce the risk of arm fractures from playground falls when compared with wood fiber surfaces