Severe maternal morbidity following stillbirth in Western Australia 2000–2015: a population-based study

Purpose There is scant literature about the management of stillbirth and the subsequent risk of severe maternal morbidity (SMM). We aimed to assess the risk of SMM associated with stillbirths compared with live births and whether this differed by the presence of maternal comorbidities. Methods In this retrospective cohort study, we used a population-based dataset of all stillbirths and live births ≥ 20 weeks’ gestation in Western Australia between 2000 and 2015. SMM was identified using a published Australian composite for use with routinely collected hospital morbidity data. Maternal comorbidities were identified in the Hospital Morbidity Data Collection or the Midwives Notification System using a modified Australian chronic disease composite. Multivariable Poisson regression was used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for factors associated with SMM in analyses stratified by the presence of maternal comorbidities. Singleton and multiple pregnancies were examined separately. Results This study included 458,639 singleton births (2319 stillbirths and 456,320 live births). The adjusted RRs for SMM among stillbirths were 2.30 (95% CI 1.77, 3.00) for those without comorbidities and 4.80 (95% CI 4.11, 5.59) (Interaction P value < 0.0001) for those with comorbidities compared to live births without and with comorbidities, respectively. Conclusion In Western Australia between 2000 and 2015, mothers of stillbirths both with and without any maternal comorbidities had an increased risk of SMM compared with live births. Further investigation into why women who have had a stillbirth without any existing conditions or pregnancy complications develop SMM is warranted

Trends and burden of diabetes in pregnancy among Aboriginal and non-Aboriginal mothers in Western Australia, 1998–2015

Background Diabetes in pregnancy (DIP), which includes pre-gestational and gestational diabetes, is more prevalent among Aboriginal women. DIP and its adverse neonatal outcomes are associated with diabetes and cardiovascular disease in the offspring. This study investigated the impact of DIP on trends of large for gestational age (LGA) in Aboriginal and non-Aboriginal populations, and added to the limited evidence on temporal trends of DIP burden in these populations. Methods We conducted a retrospective cohort study that included all births in Western Australia between 1998 and 2015 using linked population health datasets. Time trends of age-standardised and crude rates of pre-gestational and gestational diabetes were estimated in Aboriginal and non-Aboriginal mothers. Mixed-effects multivariable logistic regression was used to estimate the association between DIP and population LGA trends over time. Results Over the study period, there were 526,319 births in Western Australia, of which 6.4% were to Aboriginal mothers. The age-standardised annual rates of pre-gestational diabetes among Aboriginal mothers rose from 4.3% in 1998 to 5.4% in 2015 and remained below 1% in non-Aboriginal women. The comparable rates for gestational diabetes increased from 6.7 to 11.5% over the study period in Aboriginal women, and from 3.5 to 10.2% among non-Aboriginal mothers. LGA rates in Aboriginal babies remained high with inconsistent and no improvement in pregnancies complicated by gestational diabetes and pre-gestational diabetes, respectively. Regression analyses showed that DIP explained a large part of the increasing LGA rates over time in Aboriginal babies. Conclusions There has been a substantial increase in the burden of pre-gestational diabetes (Aboriginal women) and gestational diabetes (Aboriginal and non-Aboriginal) in recent decades. DIP appears to substantially contribute to increasing trends in LGA among Aboriginal babies

CE19004

The 2019 Irish Anglerfish and Megrim Survey (IAMS) took place from 1-25th March (area 7bcjk) and 16-25th April 2019 (area 6a) on RV Celtic Explorer. The main objective of the survey is to obtain biomass and abundance indices for anglerfish (Lophius piscatorius and L. budegassa) and megrim (Lepidorhombus whiffiagonis and L. boscii) in areas 6a (south of 58°N) and 7 (west of 8°W). Secondary objectives are to collect data on the distribution, relative abundance and biology of other commercially exploited species. This year, additional sampling took place in deep water (up to 1,500m) in order to monitor the recovery of exploited deep-water species following the decline of the deep-water fisheries in Irish waters. The IAMS survey is coordinated with the Scottish Anglerfish and Megrim Survey (SIAMISS) and uses the same gear and fishing practices

Direct observation by resonant tunneling of the B^+ level in a delta-doped silicon barrier

We observe a resonance in the conductance of silicon tunneling devices with a delta-doped barrier. The position of the resonance indicates that it arises from tunneling through the B^+ state of the boron atoms of the delta-layer. Since the emitter Fermi level in our devices is a field-independent reference energy, we are able to directly observe the diamagnetic shift of the B^+ level. This is contrary to the situation in magneto-optical spectroscopy, where the shift is absorbed in the measured ionization energy.Comment: submitted to PR

A rapid review of variation in the use of dental general anaesthetics in children

Introduction: The use of dental general anaesthetics (DGAs) remains a cause for concern due to additional strains placed on health services. There are numerous factors influencing the prevalence and use of DGAs, and understanding these is an important first step in addressing the issue. Aim: Conduct a rapid review of current peer-reviewed and grey literature on the variation in the use of DGAs in children. Methods: Electronic searching using Medline via Ovid covering DGA articles from 1998 onwards, written in English. Publication types included primary and secondary sources from peer-reviewed journals and reports, as well as grey literature. Results: From 935 results, 171 articles were included in the final review. Themes emerging from the literature included discussions of DGA variation, variations in standards of service provision by health services, and the socio-demographic and geographical characteristics of children. Prominent socio-demographic and geographical characteristics included age, other health conditions, ethnic and cultural background, socioeconomic status and deprivation, and geographical location. Conclusions: This review identified numerous variations in the patterns associated with DGA provision and uptake at both a health service and individual level. The findings demonstrate the complicated and multifaceted nature of DGA practices worldwide

Risk Factors for In-hospital Nonhemorrhagic Stroke in Patients With Acute Myocardial Infarction Treated With Thrombolysis: Results from GUSTO-I

BACKGROUND: Nonhemorrhagic stroke occurs in 0.1% to 1.3% of patients with acute myocardial infarction who are treated with thrombolysis, with substantial associated mortality and morbidity. Little is known about the risk factors for its occurrence. METHODS AND RESULTS: We studied the 247 patients with nonhemorrhagic stroke who were randomly assigned to one of four thrombolytic regimens within 6 hours of symptom onset in the GUSTO-I trial. We assessed the univariable and multivariable baseline risk factors for nonhemorrhagic stroke and created a scoring nomogram from the baseline multivariable modeling. We used time-dependent Cox modeling to determine multivariable in-hospital predictors of nonhemorrhagic stroke. Baseline and in-hospital predictors were then combined to determine the overall predictors of nonhemorrhagic stroke. Of the 247 patients, 42 (17%) died and another 98 (40%) were disabled by 30-day follow-up. Older age was the most important baseline clinical predictor of nonhemorrhagic stroke, followed by higher heart rate, history of stroke or transient ischemic attack, diabetes, previous angina, and history of hypertension. These factors remained statistically significant predictors in the combined model, along with worse Killip class, coronary angiography, bypass surgery, and atrial fibrillation/flutter. CONCLUSIONS: Nonhemorrhagic stroke is a serious event in patients with acute myocardial infarction who are treated with thrombolytic, antithrombin, and antiplatelet therapy. We developed a simple nomogram that can predict the risk of nonhemorrhagic stroke on the basis of baseline clinical characteristics. Prophylactic anticoagulation may be an important treatment strategy for patients with high probability for nonhemorrhagic stroke, but further study is needed

Checkerboard local density of states in striped domains pinned by vortices

Within a Green's function formalism we calculate the electronic structure around static extended magnetic and non-magnetic perturbations in a d-wave superconductor. In partucular, we discuss recent elastic neutron scattering and scanning tunneling experiments on High-T_c cuprates exposed to an applied magnetic field. A physical picture consisting of antiferromagnetic vortex cores operating as pinning centers for surrounding stripes is qualitatively consistent with the neutron data provided the stripes have the usual antiphase modulation. The low energy electronic structure in such a region reveals a checkerboard interference pattern consistent with recent scanning tunneling experiments.Comment: 5 pages, 4 figure

Economic vs. juristic thinking in Carl Menger’s principles of economics

Austrian Economic School is increasingly being treated as one of the most significant and ever more influential bodies of ideas affecting the contemporary economic science. It is well known that Carl Menger, the founder of the Austrian School, was a lawyer by education. The paper is devoted to the degree to which his legal education influenced his economic theorizing. After a close examination of the Menger’s conceptual apparatus and the epistemological ramifications of the key notions underlying his thinking, the paper concludes that the juristic background of the far-reaching theoretical contributions contained in Menger’s Principles was truly decisive. That holds true despite the fact that Menger only exceptionally utilized the juristic vocabulary. The key ingredients of his theoretical creation? such as the individual autonomy, the coincidence of the wills in concluding a contract the effective protection of property and making transactions based on the individual motivation to further one’s own interests to the utmost? are clearly inspired and in many ways influenced by private law, particularly the doctrines underlying the Roman Law and the Austrian Civil Code

Early mortality among Aboriginal and non-Aboriginal women who had a preterm birth in Western Australia: A population-based cohort study

Background: Having a preterm (<37 weeks' gestation) birth may increase a woman's risk of early mortality. Aboriginal and Torres Strait Islander (hereafter Aboriginal) women have higher preterm birth and mortality rates compared with other Australian women. Objectives: We investigated whether a history of having a preterm birth was associated with early mortality in women and whether these associations differed by Aboriginal status. Methods: This retrospective cohort study used population-based perinatal records of women who had a singleton birth between 1980 and 2015 in Western Australia linked to Death Registry data until June 2018. The primary and secondary outcomes were all-cause and cause-specific mortality respectively. After stratification by Aboriginal status, rate differences were calculated, and Cox proportional hazard regression was used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for allcause and cause-specific mortality. Results: There were 20,244 Aboriginal mothers (1349 deaths) and 457,357 nonAboriginal mothers (7646 deaths) with 8.6 million person-years of follow-up. The all-cause mortality rates for Aboriginal mothers who had preterm births and term births were 529.5 and 344.0 (rate difference 185.5, 95% CI 135.5, 238.5) per 100,000 person-years respectively. Among non-Aboriginal mothers, the corresponding figures were 125.5 and 88.6 (rate difference 37.0, 95% CI 29.4, 44.9) per 100,000 personyears. The HR for all-cause mortality for Aboriginal and non-Aboriginal mothers associated with preterm birth were 1.48 (95% CI 1.32, 1.66) and 1.35 (95% CI 1.26, 1.44), respectively, compared with term birth. Compared with mothers who had term births, mothers of preterm births had higher relative risks of mortality from diabetes, cardiovascular, digestive and external causes. Conclusions: Both Aboriginal and non-Aboriginal women who had a preterm birth had a moderately increased risk of mortality up to 38 years after the birth, reinforcing the importance of primary prevention and ongoing screening.Helen D. Bailey, Caitlin Gray, Akilew A. Adane, Natalie A. Strobel, Scott W. White, Rhonda Marriott, Gizachew A. Tessema, Carrington C. J. Shepherd, Mary Shar