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

Getting Beneath the Veil of Effective Schools: Evidence from New York City

Charter schools were developed, in part, to serve as an R&D engine for traditional public schools, resulting in a wide variety of school strategies and outcomes. In this paper, we collect unparalleled data on the inner-workings of 35 charter schools and correlate these data with credible estimates of each school's effectiveness. We find that traditionally collected input measures -- class size, per pupil expenditure, the fraction of teachers with no certification, and the fraction of teachers with an advanced degree -- are not correlated with school effectiveness. In stark contrast, we show that an index of five policies suggested by over forty years of qualitative research -- frequent teacher feedback, the use of data to guide instruction, high-dosage tutoring, increased instructional time, and high expectations -- explains approximately 50 percent of the variation in school effectiveness. Our results are robust to controls for three alternative theories of schooling: a model emphasizing the provision of wrap-around services, a model focused on teacher selection and retention, and the "No Excuses'' model of education. We conclude by showing that our index provides similar results in a separate sample of charter schools.

Design of a monitor for the debugging and development of multiprocessing process control systems : a thesis presented in partial fulfilment of the requirements for the degree of Master of Technology in Computing Technology at Massey University

This thesis describes the design of a general purpose tool for debugging and developing multimicroprocessor process control systems. With the decreasing pnce of computers, multimicroprocessors are increasingly being used for process control. However, the lack of published information on multiprocessing systems and distributed systems has meant that methodologies and tools for debugging and developing such systems have been slow to develop. The monitor designed here is system independent, a considerable advantage over other such tools that are currently available

Red Giants in the Small Magellanic Cloud. II. Metallicity Gradient and Age-Metallicity Relation

We present results from the largest CaII triplet line metallicity study of Small Magellanic Cloud (SMC) field red giant stars to date, involving 3037 objects spread across approximately 37.5 sq. deg., centred on this galaxy. We find a median metallicity of [Fe/H]=-0.99+/-0.01, with clear evidence for an abundance gradient of -0.075+/-0.011 dex / deg. over the inner 5 deg. We interpret the abundance gradient to be the result of an increasing fraction of young stars with decreasing galacto-centric radius, coupled with a uniform global age-metallicity relation. We also demonstrate that the age-metallicity relation for an intermediate age population located 10kpc in front of the NE of the Cloud is indistinguishable from that of the main body of the galaxy, supporting a prior conjecture that this is a stellar analogue of the Magellanic Bridge. The metal poor and metal rich quartiles of our RGB star sample (with complementary optical photometry from the Magellanic Clouds Photometric Survey) are predominantly older and younger than approximately 6Gyr, respectively. Consequently, we draw a link between a kinematical signature, tentatively associated by us with a disk-like structure, and the upsurges in stellar genesis imprinted on the star formation history of the central regions of the SMC. We conclude that the increase in the star formation rate around 5-6Gyr ago was most likely triggered by an interaction between the SMC and LMC.Comment: To appear in MNRA

Professional Materials

Farr, Rodger. Tone, Bruce. (1994). Portfolio and Performance Assessment: Helping Students Evaluate Their Progress as Readers and Writers