Birth order, gestational age, and risk of delivery related perinatal death in twins: retrospective cohort study

Objective: To determine whether twins born second are at increased risk of perinatal death because of complications during labour and delivery. Design: Retrospective cohort study. Setting: Scotland, 1992 and 1997. Participants: All twin births at or after 24 weeks' gestation, excluding twin pairs in which either twin died before labour or delivery or died during or after labour and delivery because of congenital abnormality, non-immune hydrops, or twin to twin transfusion syndrome. Main outcome measure: Delivery related perinatal deaths (deaths during labour or the neonatal period). Results: Overall, delivery related perinatal deaths were recorded for 23 first twins only and 23 second twins only of 1438 twin pairs born before 36 weeks (preterm) by means other than planned caesarean section (P>0.99). No deaths of first twins and nine deaths of second twins (P=0.004) were recorded among the 2436 twin pairs born at or after 36 weeks (term). Discordance between first and second twins differed significantly in preterm and term births (P=0.007). Seven of nine deaths of second twins at term were due to anoxia during the birth (2.9 (95% confidence interval 1.2 to 5.9) per 1000); five of these deaths were associated with mechanical problems with the second delivery following vaginal delivery of the first twin. No deaths were recorded among 454 second twins delivered at term by planned caesarean section. Conclusions: Second twins born at term are at higher risk than first twins of death due to complications of delivery. Previous studies may not have shown an increased risk because of inadequate categorisation of deaths, lack of statistical power, inappropriate analyses, and pooling of data about preterm births and term births

Predicting cesarean section and uterine rupture among women attempting vaginal birth after prior cesarean section

<p><b>Background:</b> There is currently no validated method for antepartum prediction of the risk of failed vaginal birth after cesarean section and no information on the relationship between the risk of emergency cesarean delivery and the risk of uterine rupture.</p> <p><b>Methods and Findings:</b> We linked a national maternity hospital discharge database and a national registry of perinatal deaths. We studied 23,286 women with one prior cesarean delivery who attempted vaginal birth at or after 40-wk gestation. The population was randomly split into model development and validation groups. The factors associated with emergency cesarean section were maternal age (adjusted odds ratio [OR] = 1.22 per 5-y increase, 95% confidence interval [CI]: 1.16 to 1.28), maternal height (adjusted OR = 0.75 per 5-cm increase, 95% CI: 0.73 to 0.78), male fetus (adjusted OR = 1.18, 95% CI: 1.08 to 1.29), no previous vaginal birth (adjusted OR = 5.08, 95% CI: 4.52 to 5.72), prostaglandin induction of labor (adjusted OR = 1.42, 95% CI: 1.26 to 1.60), and birth at 41-wk (adjusted OR = 1.30, 95% CI: 1.18 to 1.42) or 42-wk (adjusted OR = 1.38, 95% CI: 1.17 to 1.62) gestation compared with 40-wk. In the validation group, 36% of the women had a low predicted risk of caesarean section (<20%) and 16.5% of women had a high predicted risk (>40%); 10.9% and 47.7% of these women, respectively, actually had deliveries by caesarean section. The predicted risk of caesarean section was also associated with the risk of all uterine rupture (OR for a 5% increase in predicted risk = 1.22, 95% CI: 1.14 to 1.31) and uterine rupture associated with perinatal death (OR for a 5% increase in predicted risk = 1.32, 95% CI: 1.02 to 1.73). The observed incidence of uterine rupture was 2.0 per 1,000 among women at low risk of cesarean section and 9.1 per 1,000 among those at high risk (relative risk = 4.5, 95% CI: 2.6 to 8.1). We present the model in a simple-to-use format.</p> <p><b>Conclusions:</b> We present, to our knowledge, the first validated model for antepartum prediction of the risk of failed vaginal birth after prior cesarean section. Women at increased risk of emergency caesarean section are also at increased risk of uterine rupture, including catastrophic rupture leading to perinatal death.</p&gt

SimHealth: Estimating Small Area Populations Using Deterministic Spatial Microsimulation in Leeds and Bradford.

The increasing prevalence of obesity and type 2 diabetes in recent decades is often cited as a serious public health concern, lowering life expectancy and costing the National Health Service (NHS) billions of pounds each year. However, measuring diabetes prevalence proves challenging; the best estimates are based on the annual Health Survey for England (HSE) and little is currently available at the small area level. Simulation models are increasingly used in health research to predict future prevalence, cost of treatment, provision of care and the possible outcomes of policy intervention. Previous research shows the relevance of this technique in modelling the outcomes of changes in taxation and child benefit policy, or analysing health inequalities. This paper introduces SimHealth, a small-area diabetes prevalence model for Leeds and Bradford, West Yorkshire created as part of a generic model framework. The process of configuring an optimal spatial microsimulation model, building on earlier research, is detailed with the aim of improving and extending existing simulation models

Parental height in relation to offspring coronary heart disease: examining transgenerational influences on health using the west of Scotland Midspan Family Study

<b>Background </b>Adult height is known to be inversely related to coronary heart disease (CHD) risk. We sought to investigate transgenerational influence of parental height on offspring’s CHD risk. <p></p> <b>Methods </b>Parents took part in a cardiorespiratory disease survey in two Scottish towns during the 1970s, in which their physical stature was measured. In 1996, their offspring were invited to participate in a similar survey, which included an electrocardiogram recording and risk factor assessment.<p></p> <b>Results </b>A total of 2306 natural offspring aged 30–59 years from 1456 couples were subsequently flagged for notification of mortality and followed for CHD-related hospitalizations. Taller paternal and/or maternal height was associated with socio-economic advantage, heavier birthweight and increased high-density lipoprotein cholesterol in offspring. Increased height in fathers, but more strongly in mothers (risk ratio for 1 SD change in maternal height = 0.85; 95% confidence interval: 0.76 to 0.95), was associated with a lower risk of offspring CHD, adjusting for age, sex, other parental height and CHD risk factors. <p></p> <b>Conclusion </b>There is evidence of an association between taller parental, particularly maternal, height and lower offspring CHD risk. This may reflect an influence of early maternal growth on the intrauterine environment provided for her offspring

Ad libitum suckling by a foster calf in the presence or absence of the cow\u27s own calf prolongs postpartum anestrus to first ovarian cycle

Five treatments were initiated approximately 15 days after calving: 1) calf was weaned from its dam (CW); 2) calf was present continually with its own dam (CP-O); 3) calf was present continually with its own dam but contact with the udder was restricted (CR); 4) foster calf was pre sent continually but the cow\u27s own calf was absent (CP-F); and 5) foster calf was present continually, and the dam\u27s own calf was present but restricted (CR+F). Cows weaned at 15 days (CW) cycled in about 2 weeks, whereas cows in the CR treatment cycled 1 week later, and cows in the CP-O treatment did not cycle for about 5 weeks. Cows fostering calves in the presence (CR+F) or absence (CP-F) of their own calves had extended anestrus periods similar to those in cows nursing their own calve s (CP-O). If a cow bonds with a foster calf (as in the CP-F treatment), then the duration of anestrus is lengthened. We conclude that anestrus is prolonged only when milk is removed by a calf (her own or a foster calf) to which the cow is bonded

FcγRIIb Balances Efficient Pathogen Clearance and the Cytokine-mediated Consequences of Sepsis

The immune response to infection must be controlled to ensure it is optimal for defense while avoiding the consequences of excessive inflammation, which include fatal septic shock. Mice deficient in FcγRIIb, an inhibitory immunoglobulin G Fc receptor, have enhanced immune responses. Therefore, we examined whether FcγRIIb controls the response to Streptococcus pneumoniae. Macrophages from FcγRIIb-deficient mice showed increased antibody-dependent phagocytosis of pneumococci in vitro, and consistent with this infected FcγRIIb-deficient mice demonstrated increased bacterial clearance and survival. In contrast, previously immunized FcγRIIb-deficient mice challenged with large inocula showed reduced survival. This correlated with increased production of the sepsis-associated cytokines tumor necrosis factor α and interleukin 6. We propose that FcγRIIb controls the balance between efficient pathogen clearance and the cytokine-mediated consequences of sepsis, with potential therapeutic implications

Optical properties of tissue measured using terahertz pulsed imaging.

The first demonstrations of terahertz imaging in biomedicine were made several years ago, but few data are available on the optical properties of human tissue at terahertz frequencies. A catalogue of these properties has been established to estimate variability and determine the practicality of proposed medical applications in terms of penetration depth, image contrast and reflection at boundaries. A pulsed terahertz imaging system with a useful bandwidth 0.5-2.5 THz was used. Local ethical committee approval was obtained. Transmission measurements were made through tissue slices of thickness 0.08 to 1 mm, including tooth enamel and dentine, cortical bone, skin, adipose tissue and striated muscle. The mean and standard deviation for refractive index and linear attenuation coefficient, both broadband and as a function of frequency, were calculated. The measurements were used in simple models of the transmission, reflection and propagation of terahertz radiation in potential medical applications. Refractive indices ranged from 1.5 ± 0.5 for adipose tissue to 3.06 ± 0.09 for tooth enamel. Significant differences (P<0.05) were found between the broadband refractive indices of a number of tissues. Terahertz radiation is strongly absorbed in tissue so reflection imaging, which has lower penetration requirements than transmission, shows promise for dental or dermatological applications

Catalytic Chan–Lam coupling using a ‘tube-in-tube’ reactor to deliver molecular oxygen as an oxidant

A flow system to perform Chan–Lam coupling reactions of various amines and arylboronic acids has been realised employing molecular oxygen as an oxidant for the re-oxidation of the copper catalyst enabling a catalytic process. A tube-in-tube gas reactor has been used to simplify the delivery of the oxygen accelerating the optimisation phase and allowing easy access to elevated pressures. A small exemplification library of heteroaromatic products has been prepared and the process has been shown to be robust over extended reaction times

Characterization of an INVS Model IV Neutron Counter for High Precision (γ,n\gamma,n) Cross-Section Measurements

A neutron counter designed for assay of radioactive materials has been adapted for beam experiments at TUNL. The cylindrical geometry and 60% maximum efficiency make it well suited for ($\gamma,n$) cross-section measurements near the neutron emission threshold. A high precision characterization of the counter has been made using neutrons from several sources. Using a combination of measurements and simulations, the absolute detection efficiency of the neutron counter was determined to an accuracy of $\pm$ 3% in the neutron energy range between 0.1 and 1 MeV. It is shown that this efficiency characterization is generally valid for a wide range of targets.Comment: 22 pages, 13 figure