An obstetric sphincter injury risk identification system (OSIRIS): is this a clinically useful tool?

INTRODUCTION AND HYPOTHESIS: To establish the contribution of maternal, fetal and intrapartum factors to the risk of incidence of obstetric anal sphincter injuries (OASIS) and assess the feasibility of an OASIS risk prediction model based on variables available to clinicians prior to birth. METHODS: This was a population-based, retrospective cohort study using single-site data from the birth database of Aarhus University Hospital, Denmark. The participants were all women who had a singleton vaginal birth during the period 1989 to 2006. Univariate and multivariate logistic regression analyses were performed using multiple imputations for missing data and internally validated using bootstrap methods. The main outcome measures were the contributions of maternal, fetal and intrapartum events to the incidence of OASIS. RESULTS: A total of 71,469 women met the inclusion criteria, of whom 1,754 (2.45 %) sustained OASIS. In the multivariate analysis of variables known prior to birth, maternal age 20 – 30 years (OR 1.65, 95 % CI 1.44 – 1.89) and ≥30 years (OR 1.60, 95 % CI 1.39 – 1.85), occipitoposterior fetal position (OR 1.34, 95 % CI 1.06 – 1.70), induction/augmentation of labour (OR 1.46, 95 % CI 1.32 – 1.62), and suspected macrosomia (OR 2.20, 95 % CI 1.97 – 2.45) were independent significant predictors of OASIS, with increasing parity conferring a significant protective effect. The ‘prebirth variable’ model showed a 95 % sensitivity and a 24 % specificity in predicting OASIS with 1 % probability, and a 3 % sensitivity and a 99 % specificity in predicting OASIS with a 10 % probability. CONCLUSIONS: Our model identified several significant OASIS risk factors that are known prior to actual birth. The prognostic model shows potential for ruling out OASIS (high sensitivity with a low risk cut-off value), but is not useful for ruling in the event. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00192-016-3125-2) contains supplementary material, which is available to authorized users

Forest changes due to prescribed burns and windstorms in Itasca State Park, Minnesota: A preliminary report.

This report explores how the forests of Itasca State Park, Minnesota, have changed over a 35-year period, with particular emphasis on responses to management burns that were begun in 1995 with the goal of restoring the natural disturbance regime of the region over the next 50 years. The consequences of windstorms, a second natural element of the disturbance regime, were also examined, in the aftermath of a catastrophic storm in 1995. A network of permanently marked plots have been sampled periodically since 1965 by now-emeritus Professor Vilis Kurmis of the University of Minnesota's Department of Forest Resources. Now with post-fire and post-windstorm resampling conducted in 2000 and 2001, the changes over time at these sites can be interpreted in context of large disturbance events. Of great concern is the conservation of old growth pine ecosystems within the park. The dependence of the region's three species of pine upon fire was a major motivation for the new controlled burn program. We found that red pine, white pine, and jack pine populations have been declining throughout the 35 year period of study but that fire caused no further damage; burned plots had no more pine mortality than unburned plots. Moreover, in both burned and undisturbed plots, those pines that continued to survive were adding girth and biomass even as their populations thinned. However, windstorms are plucking out the tallest and oldest red and white pines where they extend above the main canopy. Fires have not yet triggered new pine regeneration, and repeated burns as well as herbivore controls may be necessary to achieve this goal. Fires thinned out some understory shrubs and trees, including the ubiquitous hazel and the scattered thickets of shade-tolerant balsam fir found in the spruce-fir forest type. In the maple-basswood forest type, fire correlated with a dip in sugar maple seedlings from superabundant to abundant, but also with a pulse of sprouting by ironwood, an understory tree. Prescribed burns did not damage the richness of the vascular flora. Those forests treated with controlled, spring-season fires did not differ significantly from unburned forests in their trajectories of plant species richness. This resistance to fire was seen in the diversity data for trees, tree seedlings, shrubs, and forbs (wildflowers and ferns). Unlike fire, windstorms did influence diversity in at least one cover type, the maple-basswood forest, where forb richness dropped after wind damage. Richness has varied greatly over time and amongst different forest types, with a general downward trend for shrub richness and an upward trend for forbs. Thus the current regime of management burns appears to be meeting objectives related to ecosystem restoration: favoring canopy pines, whose preservation and perpetuation is of primary concern, while thinning understory shrubs and shade-tolerant saplings without damaging the diversity of vascular plant species, although not yet generating new pine reproduction

Cuidado de las lesiones posparto en la consulta perineal

El objetivo de este artículo fue revisar bibliográficamente los principales problemas que se derivan de las lesiones perineales, así como dar a conocer el trabajo de la matrona en una consulta perineal y el modo en que se está implementando esta consulta en el Hospital General de Granollers. Para cumplir con la primera parte del objetivo, se realizó una revisión bibliográfica sobre las complicaciones derivadas de las lesiones perineales que ocurren durante el parto. Los resultados obtenidos se han estructurado en los siguientes apartados: dolor perineal y dispareunia, infección y dehiscencia, incontinencia urinaria y prolapso genital (lesión del músculo elevador del ano) e incontinencia fecal y de gases (lesión del esfínter anal). En la segunda parte del artículo se explica la experiencia que se realizó en el Servicio de Obstetricia del Hospital de Granollers para disminuir la morbilidad posparto derivada de las lesiones perineales. Se implementaron diversas medidas de prevención, y se creó una consulta perineal para dar continuidad a los cuidados especializados para las mujeres que han sufrido alguna complicación perineal tras el parto vaginal. La matrona, integrada en el equipo multidisciplinario especialista en suelo pélvico, es la profesional que realiza este seguimiento y proporciona apoyo a la mujer

A Strategy for LSST to Unveil a Population of Kilonovae without Gravitational-wave Triggers

We present a cadence optimization strategy to unveil a large population of kilonovae using optical imaging alone. These transients are generated during binary neutron star and potentially neutron star–black hole mergers and are electromagnetic counterparts to gravitational-wave signals detectable in nearby events with Advanced LIGO, Advanced Virgo, and other interferometers that will be online in the near future. Discovering a large population of kilonovae will allow us to determine how heavy-element production varies with the intrinsic parameters of the merger and across cosmic time. The rate of binary neutron star mergers is still uncertain, but only few (≾ 15) events with associated kilonovae may be detectable per year within the horizon of next-generation ground-based interferometers. The rapid evolution (~days) at optical/infrared wavelengths, relatively low luminosity, and the low volumetric rate of kilonovae makes their discovery difficult, especially during blind surveys of the sky. We propose future large surveys to adopt a rolling cadence in which g-i observations are taken nightly for blocks of 10 consecutive nights. With the current baseline2018a cadence designed for the Large Synoptic Survey Telescope (LSST), l≾ 7.5 poorly sampled kilonovae are expected to be detected in both the Wide Fast Deep (WFD) and Deep Drilling Fields (DDF) surveys per year, under optimistic assumptions on their rate, duration, and luminosity. We estimate the proposed strategy to return up to ~272 GW170817-like kilonovae throughout the LSST WFD survey, discovered independently from gravitational-wave triggers

The relationship between early neural responses to emotional faces at age 3 and later autism and anxiety symptoms in adolescents with autism

Both autism spectrum (ASD) and anxiety disorders are associated with atypical neural and attentional responses to emotional faces, differing in affective face processing from typically developing peers. Within a longitudinal study of children with ASD (23 male, 3 female), we hypothesized that early ERPs to emotional faces would predict concurrent and later ASD and anxiety symptoms. Greater response amplitude to fearful faces corresponded to greater social communication difficulties at age 3, and less improvement by age 14. Faster ERPs to neutral faces predicted greater ASD symptom improvement over time, lower ASD severity in adolescence, and lower anxiety in adolescence. Early individual differences in processing of emotional stimuli likely reflect a unique predictive contribution from social brain circuitry early in life

GROWTH on S190510g: DECam Observation Planning and Follow-Up of a Distant Binary Neutron Star Merger Candidate

The first two months of the third Advanced LIGO and Virgo observing run (2019 April–May) showed that distant gravitational-wave (GW) events can now be readily detected. Three candidate mergers containing neutron stars (NS) were reported in a span of 15 days, all likely located more than 100 Mpc away. However, distant events such as the three new NS mergers are likely to be coarsely localized, which highlights the importance of facilities and scheduling systems that enable deep observations over hundreds to thousands of square degrees to detect the electromagnetic counterparts. On 2019 May 10 02:59:39.292 UT the GW candidate S190510g was discovered and initially classified as a binary neutron star (BNS) merger with 98% probability. The GW event was localized within an area of 3462 deg^2, later refined to 1166 deg^2 (90%) at a distance of 227 ± 92 Mpc. We triggered Target-of-Opportunity observations with the Dark Energy Camera (DECam), a wide-field optical imager mounted at the prime focus of the 4 m Blanco Telescope at Cerro Tololo Inter-American Observatory in Chile. This Letter describes our DECam observations and our real-time analysis results, focusing in particular on the design and implementation of the observing strategy. Within 24 hr of the merger time, we observed 65% of the total enclosed probability of the final skymap with an observing efficiency of 94%. We identified and publicly announced 13 candidate counterparts. S190510g was reclassified 1.7 days after the merger, after our observations were completed, with a "BNS merger" probability reduced from 98% to 42% in favor of a "terrestrial classification

A Strategy for LSST to Unveil a Population of Kilonovae without Gravitational-wave Triggers

We present a cadence optimization strategy to unveil a large population of kilonovae using optical imaging alone. These transients are generated during binary neutron star and potentially neutron star–black hole mergers and are electromagnetic counterparts to gravitational-wave signals detectable in nearby events with Advanced LIGO, Advanced Virgo, and other interferometers that will be online in the near future. Discovering a large population of kilonovae will allow us to determine how heavy-element production varies with the intrinsic parameters of the merger and across cosmic time. The rate of binary neutron star mergers is still uncertain, but only few (≾ 15) events with associated kilonovae may be detectable per year within the horizon of next-generation ground-based interferometers. The rapid evolution (~days) at optical/infrared wavelengths, relatively low luminosity, and the low volumetric rate of kilonovae makes their discovery difficult, especially during blind surveys of the sky. We propose future large surveys to adopt a rolling cadence in which g-i observations are taken nightly for blocks of 10 consecutive nights. With the current baseline2018a cadence designed for the Large Synoptic Survey Telescope (LSST), l≾ 7.5 poorly sampled kilonovae are expected to be detected in both the Wide Fast Deep (WFD) and Deep Drilling Fields (DDF) surveys per year, under optimistic assumptions on their rate, duration, and luminosity. We estimate the proposed strategy to return up to ~272 GW170817-like kilonovae throughout the LSST WFD survey, discovered independently from gravitational-wave triggers

A population of gamma-ray emitting globular clusters seen with the Fermi Large Area Telescope

Globular clusters with their large populations of millisecond pulsars (MSPs) are believed to be potential emitters of high-energy gamma-ray emission. Our goal is to constrain the millisecond pulsar populations in globular clusters from analysis of gamma-ray observations. We use 546 days of continuous sky-survey observations obtained with the Large Area Telescope aboard the Fermi Gamma-ray Space Telescope to study the gamma-ray emission towards 13 globular clusters. Steady point-like high-energy gamma-ray emission has been significantly detected towards 8 globular clusters. Five of them (47 Tucanae, Omega Cen, NGC 6388, Terzan 5, and M 28) show hard spectral power indices $(0.7 < \Gamma <1.4)$ and clear evidence for an exponential cut-off in the range 1.0-2.6 GeV, which is the characteristic signature of magnetospheric emission from MSPs. Three of them (M 62, NGC 6440 and NGC 6652) also show hard spectral indices $(1.0 < \Gamma < 1.7)$, however the presence of an exponential cut-off can not be unambiguously established. Three of them (Omega Cen, NGC 6388, NGC 6652) have no known radio or X-ray MSPs yet still exhibit MSP spectral properties. From the observed gamma-ray luminosities, we estimate the total number of MSPs that is expected to be present in these globular clusters. We show that our estimates of the MSP population correlate with the stellar encounter rate and we estimate 2600-4700 MSPs in Galactic globular clusters, commensurate with previous estimates. The observation of high-energy gamma-ray emission from a globular cluster thus provides a reliable independent method to assess their millisecond pulsar populations that can be used to make constraints on the original neutron star X-ray binary population, essential for understanding the importance of binary systems in slowing the inevitable core collapse of globular clusters.Comment: Accepted for publication in A&A. Corresponding authors: J. Kn\"odlseder, N. Webb, B. Pancraz