Estimating the risk of adverse birth outcomes in pregnant women undergoing non-obstetric surgery using routinely collected NHS data: an observational study

Background: Previous research suggests that non-obstetric surgery is carried out in 1 – 2% of all pregnancies. However, there is limited evidence quantifying the associated risks. Furthermore, of the evidence available, none relates directly to outcomes in the UK, and there are no current NHS guidelines regarding non-obstetric surgery in pregnant women. Objectives: To estimate the risk of adverse birth outcomes of pregnancies in which non-obstetric surgery was or was not carried out. To further analyse common procedure groups. Data Source: Hospital Episode Statistics (HES) maternity data collected between 2002 – 3 and 2011 – 12. Main outcomes: Spontaneous abortion, preterm delivery, maternal death, caesarean delivery, long inpatient stay, stillbirth and low birthweight. Methods: We utilised HES, an administrative database that includes records of all patient admissions and day cases in all English NHS hospitals. We analysed HES maternity data collected between 2002 – 3 and 2011 – 12, and identified pregnancies in which non-obstetric surgery was carried out. We used logistic regression models to determine the adjusted relative risk and attributable risk of non-obstetric surgical procedures for adverse birth outcomes and the number needed to harm. Results: We identified 6,486,280 pregnancies, in 47,628 of which non-obstetric surgery was carried out. In comparison with pregnancies in which surgery was not carried out, we found that non-obstetric surgery was associated with a higher risk of adverse birth outcomes, although the attributable risk was generally low. We estimated that for every 287 pregnancies in which a surgical operation was carried out there was one additional stillbirth; for every 31 operations there was one additional preterm delivery; for every 25 operations there was one additional caesarean section; for every 50 operations there was one additional long inpatient stay; and for every 39 operations there was one additional low-birthweight baby. Limitations: We have no means of disentangling the effect of the surgery from the effect of the underlying condition itself. Many spontaneous abortions will not be associated with a hospital admission and, therefore, will not be included in our analysis. A spontaneous abortion may be more likely to be reported if it occurs during the same hospital admission as the procedure, and this could account for the associated increased risk with surgery during pregnancy. There are missing values of key data items to determine parity, gestational age, birthweight and stillbirth. Conclusions: This is the first study to report the risk of adverse birth outcomes following non-obstetric surgery during pregnancy across NHS hospitals in England. We have no means of disentangling the effect of the surgery from the effect of the underlying condition itself. Our observational study can never attribute a causal relationship between surgery and adverse birth outcomes, and we were unable to determine the risk of not undergoing surgery where surgery was clinically indicated. We have some reservations over associations of risk factors with spontaneous abortion because of potential ascertainment bias. However, we believe that our findings and, in particular, the numbers needed to harm improve on previous research, utilise a more recent and larger data set based on UK practices, and are useful reference points for any discussion of risk with prospective patients. The risk of adverse birth outcomes in pregnant women undergoing non-obstetric surgery is relatively low, confirming that surgical procedures during pregnancy are generally safe. Future work: Further evaluation of the association of non-obstetric surgery and spontaneous abortion. Evaluation of the impact of non-obstetric surgery on the newborn (e.g. neonatal intensive care unit admission, prolonged length of neonatal stay, neonatal death). Funding: The National Institute for Health Research Health Services and Delivery Research programme

Generation of mice harbouring a conditional loss-of-function allele of Gata6

The zinc finger transcription factor GATA6 is believed to have important roles in the development of several organs including the liver, gastrointestinal tract and heart. However, analyses of the contribution of GATA6 toward organogenesis have been hampered because Gata6(-/- )mice fail to develop beyond gastrulation due to defects in extraembryonic endoderm function. We have therefore generated a mouse line harbouring a conditional loss-of-function allele of Gata6 using Cre/loxP technology. LoxP elements were introduced into introns flanking exon 2 of the Gata6 gene by homologous recombination in ES cells. Mice containing this altered allele were bred to homozygosity and were found to be viable and fertile. To assess the functional integrity of the loxP sites and to confirm that we had generated a Gata6 loss-of-function allele, we bred Gata6 'floxed' mice to EIIa-Cre mice in which Cre is ubiquitously expressed, and to Villin-Cre mice that express Cre in the epithelial cells of the intestine. We conclude that we have generated a line of mice in which GATA6 activity can be ablated in a cell type specific manner by expression of Cre recombinase. This line of mice can be used to establish the role of GATA6 in regulating embryonic development and various aspects of mammalian physiology

Engineering design tropisms: Utilization of a bamboo-resin joint for voxelized network geometries

We propose the combination of the traditional construction material bamboo with a novel epoxy-resin joint. The joint forms a bending-resisting connection that eliminates the need for diagonal members. This allows its utilization along rectangular grids as was tested with the design of a prototype structure that occupies a voxelized space. The design process used an agent-based simulation to mediate between design intent, site and structural considerations. The prototype was constructed with a robotic milling of the components and forms a successful application of the joints and design methodology

Estimating the risk of adverse birth outcomes in pregnant women undergoing non-obstetric surgery using routinely collected NHS data: an observational study

Background: Previous research suggests that non-obstetric surgery is carried out in 1 – 2% of all pregnancies. However, there is limited evidence quantifying the associated risks. Furthermore, of the evidence available, none relates directly to outcomes in the UK, and there are no current NHS guidelines regarding non-obstetric surgery in pregnant women. Objectives: To estimate the risk of adverse birth outcomes of pregnancies in which non-obstetric surgery was or was not carried out. To further analyse common procedure groups. Data Source: Hospital Episode Statistics (HES) maternity data collected between 2002 – 3 and 2011 – 12. Main outcomes: Spontaneous abortion, preterm delivery, maternal death, caesarean delivery, long inpatient stay, stillbirth and low birthweight. Methods: We utilised HES, an administrative database that includes records of all patient admissions and day cases in all English NHS hospitals. We analysed HES maternity data collected between 2002 – 3 and 2011 – 12, and identified pregnancies in which non-obstetric surgery was carried out. We used logistic regression models to determine the adjusted relative risk and attributable risk of non-obstetric surgical procedures for adverse birth outcomes and the number needed to harm. Results: We identified 6,486,280 pregnancies, in 47,628 of which non-obstetric surgery was carried out. In comparison with pregnancies in which surgery was not carried out, we found that non-obstetric surgery was associated with a higher risk of adverse birth outcomes, although the attributable risk was generally low. We estimated that for every 287 pregnancies in which a surgical operation was carried out there was one additional stillbirth; for every 31 operations there was one additional preterm delivery; for every 25 operations there was one additional caesarean section; for every 50 operations there was one additional long inpatient stay; and for every 39 operations there was one additional low-birthweight baby. Limitations: We have no means of disentangling the effect of the surgery from the effect of the underlying condition itself. Many spontaneous abortions will not be associated with a hospital admission and, therefore, will not be included in our analysis. A spontaneous abortion may be more likely to be reported if it occurs during the same hospital admission as the procedure, and this could account for the associated increased risk with surgery during pregnancy. There are missing values of key data items to determine parity, gestational age, birthweight and stillbirth. Conclusions: This is the first study to report the risk of adverse birth outcomes following non-obstetric surgery during pregnancy across NHS hospitals in England. We have no means of disentangling the effect of the surgery from the effect of the underlying condition itself. Our observational study can never attribute a causal relationship between surgery and adverse birth outcomes, and we were unable to determine the risk of not undergoing surgery where surgery was clinically indicated. We have some reservations over associations of risk factors with spontaneous abortion because of potential ascertainment bias. However, we believe that our findings and, in particular, the numbers needed to harm improve on previous research, utilise a more recent and larger data set based on UK practices, and are useful reference points for any discussion of risk with prospective patients. The risk of adverse birth outcomes in pregnant women undergoing non-obstetric surgery is relatively low, confirming that surgical procedures during pregnancy are generally safe. Future work: Further evaluation of the association of non-obstetric surgery and spontaneous abortion. Evaluation of the impact of non-obstetric surgery on the newborn (e.g. neonatal intensive care unit admission, prolonged length of neonatal stay, neonatal death). Funding: The National Institute for Health Research Health Services and Delivery Research programme

Determination of Antioxidant Capacity and Free Radical Scavenging Activity of Milk from Native Cows (Bos Indicus), Exotic Cows (Bos Taurus), and Riverine Buffaloes (Bubalus Bubalis) Across Different Lactation Stages

The aim of this study was to evaluate comparative changes in total antioxidant capacity and free radical scavenging activity of milk during lactation in different cattle types and buffaloes. Milk samples from a total of 96 healthy animals of Sahiwal cows (Indian native cattle), Karan Fries cows (Cross-bred), Holstein Frisian cows (exotic cattle) and Murrah buffaloes (Riverine buffaloes) were collected at different lactation stages; early lactation (5-15 days), peak (30-60 days), mid (100-140 days) and late lactation (>215 days). The total antioxidant capacity (TAC) of milk was measured by ferric reducing/antioxidant power assay (FRAP) and free radical scavenging activity was evaluated using 1,1-diphenyl-2-picrylhydrazyl (DPPH) radicals. TAC in milk was higher during early lactation. Similar results were observed for DPPH radical scavenging activity of the samples. The data suggested that milk during the early lactation period of dairy cows and buffaloes had higher content of antioxidants in comparison to other stages of lactation

A novel mutation in the Choroideremia gene in a Turkish family.

Choroideremia is an X-linked recessive genetic disorder caused by mutations in the CHM gene. It is a rare retinal dystrophy that manifests as nyctalopia and vision loss, progressing to blindness in later stages. We report a 21-year Turkish man who presented with nyctalopia for the past 4-5 years. His mother and maternal grandmother had similar, but less pronounced complaints. Fundus examination revealed pigmentary changes and retinal atrophy in both eyes. Optical coherence tomography showed outer retinal loss, with central island of preserved autofluorescence surrounded by absent autofluorescence on fundus autofluorescence examination. Goldmann visual fields were constricted. Microperimetry detected retinal sensitivity losses, and full-field electroretinogram demonstrated extinguished cone responses. Genetic analysis revealed a novel nonsense mutation in the CHM gene, namely p.E480X: c.1438G \u3eT. The mutation causes a premature stop codon in exon 12. This is the first report of a G1438T mutation resulting in an E480X premature stop in the CHM gene

DGAT1 and ABCG2 polymorphism in Indian cattle (Bos indicus) and buffalo (Bubalus bubalis) breeds

BACKGROUND: Indian cattle (Bos indicus) and riverine buffalo (Bubalus bubalis) give a poor yield of milk but it has a high fat and protein percentage compared to taurine cattle. The identification of QTLs (Quantitative Trait Loci) on BTA14 and BTA6 and its subsequent fine mapping has led to identification of two non conservative mutations affecting milk production and composition. Our objective was to estimate the frequency of K232A (DGAT1 – diacylglycerol – acyltransferase 1) and Y581S (ABCG2 – ATP binding cassette sub family G member 2) polymorphisms in diverse cattle and buffalo breeds of India having large variation in terms of milk production. RESULTS: We screened the reported missense mutations in six cattle and five buffalo breeds. The DGAT1(K )and ABCG2(Y )alleles were found to be fixed in Indian cattle and buffalo breeds studied. CONCLUSION: This study provides an indirect evidence that all the Indian cattle and buffalo breeds have fixed alleles with respect to DGAT1 and ABCG2 genes reported to be responsible for higher milk fat yield, higher fat and protein percent

Elastic moduli of sea ice and lake ice calculated from in-situ and laboratory experiments

The effective elastic modulus of ice is an important physical parameter for the calculation of ice stresses in different situations when ice deformations are small. In the present paper the review of methods used for the calculation of the elastic modulus of ice is performed, new tests for the calculation of the elastic modulus are described, and their results are discussed. Field experiments with floating vibrating ice beams with fixed ends were performed in March and November 2019 on sea ice of the Van Mijen Fjord and fresh-water ice of a lake near Longyearbyen. Laboratory experiments with vibrating cantilever beams were performed in the cold laboratory of UNIS in November 2019. The results are compared with the values of the effective elastic modulus obtained in quasi-static tests with floating cantilever beams, and with in-situ dynamic tests where the effective elastic modulus was measured by the speed of sound waves

The relative emphasis on supply-chain/logistics topics by UK industry in hiring postgraduates and by UK universities in teaching and research

We examine how UK universities view different topics within supply-chain management as seen in their research output and their postgraduate curricula and whether this view matches the relative emphasis on these aspects by UK-based employers when hiring. Using content analysis, we analysed: (1) UK-based supply-chain/logistics job advertisements, (2) abstracts of research articles by UK academics in supply-chain/logistics journals, and (3) the description of the postgraduate-level supply-chain/logistics degrees in UK universities. Our findings show that the overall research output of UK universities is broadly in line with employers' needs with regards to the relative emphasis on different supply-chain topics. However, their relative emphasis on these topics in their teaching programmes is quite different. We suggest that universities need to look into their provision of academic programmes in relation to employers' needs and need to look into how to leverage their research output better for this purpose