Abrasive, Silica Phytoliths and the Evolution of Thick Molar Enamel in Primates, with Implications for the Diet of Paranthropus boisei

Background: Primates—including fossil species of apes and hominins—show variation in their degree of molar enamel thickness, a trait long thought to reflect a diet of hard or tough foods. The early hominins demonstrated molar enamel thickness of moderate to extreme degrees, which suggested to most researchers that they ate hard foods obtained on or near the ground, such as nuts, seeds, tubers, and roots. We propose an alternative hypothesis—that the amount of phytoliths in foods correlates with the evolution of thick molar enamel in primates, although this effect is constrained by a species ’ degree of folivory. Methodology/Principal Findings: From a combination of dietary data and evidence for the levels of phytoliths in plant families in the literature, we calculated the percentage of plant foods rich in phytoliths in the diets of twelve extant primates with wide variation in their molar enamel thickness. Additional dietary data from the literature provided the percentage of each primate’s diet made up of plants and of leaves. A statistical analysis of these variables showed that the amount of abrasive silica phytoliths in the diets of our sample primates correlated positively with the thickness of their molar enamel, constrained by the amount of leaves in their diet (R 2 = 0.875; p,.0006). Conclusions/Significance: The need to resist abrasion from phytoliths appears to be a key selective force behind the evolution of thick molar enamel in primates. The extreme molar enamel thickness of the teeth of the East African homini

Freqüência e critérios para indicar a episiotomia Frecuencia y criterios para indicar la episiotomía Frequency and criteria for the indication of episiotomy

Trata-se de estudo exploratório com o objetivo de identificar a freqüência, os tipos e os critérios adotados para indicar a episiotomia. Foram entrevistados 12 médicos e 12 enfermeiras que prestam assistência à parturiente no Hospital Universitário da Universidade de São Paulo. A episiotomia ocorreu em 76,2% dos partos normais; as indicações mais freqüentes foram: rigidez perineal (28,7%), primiparidade (23,7%), feto macrossômico (11,9%), prematuridade (10,2%). O tipo mais citado foi médio-lateral direito (92,0%), justificado por: aprendizado durante a formação acadêmica (25,9%), ser adotada rotineiramente (19,4%), menor chance de lesar o esfíncter anal (16,1%), menor risco de complicações (16,1%). É necessário rever as práticas de atendimento à parturiente, considerando as evidências científicas e condutas individualizadas.<br>Trata-se de estudo exploratório com o objetivo de identificar a freqüência, os tipos e os critérios adotados para indicar a episiotomia. Foram entrevistados 12 médicos e 12 enfermeiras que prestam assistência à parturiente no Hospital Universitário da Universidade de São Paulo. A episiotomia ocorreu em 76,2% dos partos normais; as indicações mais freqüentes foram: rigidez perineal (28,7%), primiparidade (23,7%), feto macrossômico (11,9%), prematuridade (10,2%). O tipo mais citado foi médio-lateral direito (92,0%), justificado por: aprendizado durante a formação acadêmica (25,9%), ser adotada rotineiramente (19,4%), menor chance de lesar o esfíncter anal (16,1%), menor risco de complicações (16,1%). É necessário rever as práticas de atendimento à parturiente, considerando as evidências científicas e condutas individualizadas.<br>This is an exploratory study aimed at identifying the frequency, the types and the criteria adopted to recommend episiotomy. Twelve doctors and 12 nurses who attend women giving birth at the University of São Paulo's Hospital Universitário were interviewed. Episiotomy was performed in 76.2 percent of the normal births; the most frequent indications were: perineal rigidity (28.7 percent), primiparity (23.7 percent), macrossomic infant (11.9 percent) and prematurity (10.2 percent). The most mentioned type was the right medium-lateral (92.0 percent), and the justifications were: it was learned during academic formation (25.9 percent); it is adopted routinely (19.4 percent); with it there is a lesser chance for causing lesions to the anal sphincter (16.1 percent); with it there is a lesser risk of complications (16.1 percent). The practices for attending women giving birth must be revised taking into account scientific evidences and individualized conducts

Delivering a quality-assured fracture liaison service in a UK teaching hospital—is it achievable?

SummaryTo determine whether new national guidance on the specifications of a fracture liaison service are realistically deliverable, 1 year of data on the performance of such a service were audited. Audit targets were mostly met. This audit demonstrates that these standards are deliverable in a real world setting.IntroductionUK service specifications for a fracture liaison service (FLS) have been produced (National Osteoporosis Society, NOS) to promote effective commissioning and delivery of the highest quality care to patients with fragility fractures. How deliverable these standards are has not as yet been methodically reported. Our FLS was modelled on the ten NOS standards; performance was audited after 1 year to determine whether these standards could be delivered and to describe the lessons learnt.MethodsPerformance was audited against the NOS FLS Service Standards, with management based on the Fracture Risk Assessment Tool (FRAX®), the four-item Falls Risk Assessment Tool (FRAT), National Institute for Health and Care Excellence (NICE) and the National Osteoporosis Guideline Groups (NOGG) guidance. Data were recorded prospectively on a database. The FLS commenced in May 2014, was fully operational in August 2014 and data were captured from 1 September 2014 to 1 September 2015.ResultsThe FLS detected 1773 patients and standards were largely achieved. Most, 94 %, patients were seen within 6 weeks, 533 DXA requests were generated, 804 outpatient FRAT assessments were recorded (134 required falls intervention) and 773 patients had bone treatments started. On follow-up at 3 months, between 78–79 % were still taking medication.ConclusionsPreliminary evaluation of a FLS implemented according to UK NOS standards demonstrates that the model is practical to apply to a large teaching hospital population. Collection and review of outcome and cost effectiveness data is required to determine the performance of this model in comparison with existing models

Fatores relacionados ao trauma perineal no parto normal em nulíparas Factores relacionados al trauma perineal en el parto normal en nulíparas Factors related to perineal trauma in normal births in nulliparous

Inúmeros estudos têm sido realizados com a finalidade de contribuir para a prevenção do trauma perineal no parto normal. O objetivo do presente estudo foi relacionar a altura do períneo, duração do período expulsivo, variedade de posição no desprendimento cefálico, tipo de puxo, presença de circular de cordão, peso do recém-nascido e ardor na vulva ao urinar com a ocorrência de lacerações perineais. A pesquisa foi realizada em 2003, no Centro de Parto Normal do Amparo Maternal, com uma amostra de 67 parturientes sem partos vaginais anteriores. Os resultados mostraram que não houve diferença estatisticamente significante em relação às variáveis analisadas.<br>Innumerables estudios han sido realizados con la finalidad de contribuir en la prevención del trauma perineal, en el parto normal. El objetivo del presente estudio fue relacionar la altura del perineo, duración del período expulsivo, variedad de posición en el desprendimiento cefálico, tipo de pujo, presencia de circular de cordón, peso del recién nacido y ardor en la vulva al orinar con la ocurrencia de laceraciones perineales. La investigación fue realizada en el 2003, en el Centro de Parto Normal do Amparo Maternal, con una muestra de 67 parturientas sin partos vaginales anteriores. Los resultados mostraron que no hubo diferencia estadísticamente significativa en relación a las variables analizadas.<br>Many studies have been undertaken with the purpose of contributing towards the prevention of perineal trauma in normal birth. The objective of this study was to relate height of the perineum, duration of the second stage of labor, variation of the position of the head detaching, kind of effort, presence of the umbilical cord around the babies' neck, birth weight and vulva's ardor to urinate with the occurrence of perineal laceration. The study was undertaken in 2003 at the Normal Birth Center of the Amparo Maternal, with a sample consisting of 67 women in labor without previous vaginal births. The results demonstrated that there were no significant statistical differences between the variables verified