Ethnicity, socio-economic deprivation and postpartum outcomes following caesarean delivery: a multicentre cohort study.

Disparities relating to postpartum recovery outcomes in different socio-economic and racial ethnic groups are underexplored. We conducted a planned analysis of a large prospective caesarean delivery cohort to explore the relationship between ethnicity, socio-economic status and postpartum recovery. Eligible patients were enrolled and baseline demographic, obstetric and medical history data were collected 18 h and 30 h following delivery. Patients completed postpartum quality of life and recovery measures in person on day 1 (EuroQoL EQ-5D-5L, including global health visual analogue scale; Obstetric Quality of Recovery-10 item score; and pain scores) and by telephone between day 28 and day 32 postpartum (EQ-5D-5L and pain scores). Socio-economic group was determined according to the Index of Multiple Deprivation quintile of each patient's usual place of residence. Data from 1000 patients who underwent caesarean delivery were included. There were more patients of Asian, Black and mixed ethnicity in the more deprived quintiles. Patients of White ethnicities had shorter postpartum duration of hospital stay compared with patients of Asian and Black ethnicities (35 (28-56 [18-513]) h vs. 44 (31-71 [19-465]) h vs. 49 (33-75 [23-189]) h, respectively. In adjusted models at day 30, patients of Asian ethnicity had a significantly greater risk of moderate to severe pain (numerical rating scale ≥ 4) at rest and on movement (odds ratio (95%CI) 2.42 (1.24-4.74) and 2.32 (1.40-3.87)), respectively). There were no differences in readmission rates or incidence of complications between groups. Patients from White ethnic backgrounds experience shorter postpartum duration of stay compared with patients from Asian and Black ethnic groups. Ethnic background impacts pain scores and recovery at day 1 postpartum and following hospital discharge, even after adjusting for socio-economic group. Further work is required to understand the underlying factors driving differences in pain and recovery and to develop strategies to reduce disparities in obstetric patients.

Quality of recovery following childbirth: a prospective, multicentre cohort study.

To better understand outcomes in postpartum patients who receive peripartum anaesthetic interventions, we aimed to assess quality of recovery metrics following childbirth in a UK-based multicentre cohort study. This study was performed during a 2-week period in October 2021 to assess in- and outpatient post-delivery recovery at 1 and 30 days postpartum. The following outcomes were reported: obstetric quality of recovery 10-item measure (ObsQoR-10); EuroQoL (EQ-5D-5L) survey; global health visual analogue scale; postpartum pain scores at rest and movement; length of hospital stay; readmission rates; and self-reported complications. In total, 1638 patients were recruited and responses analysed from 1631 (99.6%) and 1282 patients (80%) at one and 30 days postpartum, respectively. Median (IQR [range]) length of stay postpartum was 39.3 (28.5-61.0 [17.7-513.4]), 40.3 (28.5-59.1 [17.8-220.9]), and 35.9 (27.1-54.1 [17.9-188.4]) h following caesarean, instrumental and vaginal deliveries, respectively. Median (IQR [range]) ObsQoR-10 score was 75 ([62-86] 4-100) on day 1, with the lowest ObsQoR-10 scores (worst recovery) reported by patients undergoing caesarean delivery. Of the 1282 patients, complications within the first 30 days postpartum were reported by 252 (19.7%) of all patients. Readmission to hospital within 30 days of discharge occurred in 69 patients (5.4%), with 49 (3%) for maternal reasons. These data can be used to inform patients regarding expected recovery trajectories; facilitate optimal discharge planning; and identify populations that may benefit most from targeted interventions to improve postpartum recovery experience.

Collaboration between the military and a charity: delivering care to patients, training to defence medical staff and defence engagement overseas.

The Royal College of Anaesthetists Military Anaesthesia higher training module was approved in 2008. The opportunities for trainee deployments to operational environments are limited, and while the need to ensure training and demonstrate the unique military skill set remains, these may not be consistently attainable within NHS posts. This paper proposes a template for the successful integration of military training with a charity mission by describing experiences in Addis Ababa over the two weeks of Project Harar's 2020 Complex Surgery Mission. This model not only benefits patients and military trainees by providing opportunities to gain the skills and attributes required by the Armed Services Consultant Appointment Board, but also by projecting the Defence Medical Services on the global stage.

Development and validation of a Portuguese version of Obstetric Quality of Recovery-10 (ObsQoR-10-Portuguese).

BACKGROUND: We aimed to develop and validate a Portuguese version of the Obstetric Quality of Recovery-10 (ObsQoR-10-Portuguese) patient-reported outcome measure and evaluate its psychometric properties. METHODS: After ethical approval, we recruited term pregnant women undergoing uncomplicated elective cesarean delivery in a single Brazilian institution. Women were invited to complete the translated ObsQoR-10-Portuguese and EuroQoL (EQ-5D) questionnaires (including a global health visual analog scale [GHVAS]) at 24 h (±6 h) following delivery, and a subset of women an hour later. We assessed validity and reliability of ObsQoR-10-Portuguese. RESULTS: One hundred thirteen enrolled women completed the surveys at 24 h and 29 women at 25 h (100% response rate). VALIDITY: (i) convergent validity: ObsQoR-10-Portuguese correlated moderately with EuroQoL score (r = -0.587) and GHVAS score (r = 0.568) at 24 h. (ii) Discriminant validity: ObsQoR-10 discriminated well between good versus poor recovery (GHVAS score ≥ 70 versus < 70; difference in mean scores 14.2; p < 0.001). (iii) Hypothesis testing: 24-h ObsQoR-10-Portuguese scores correlated with gestational age (r = 0.191; p = 0.043). (iv) Cross-cultural validity: differential item functioning analysis suggested bias in 2 items. Reliability: (i) internal consistency was good (Cronbach's alpha = 0.82 and inter-item correlation = 0.31). (ii) Split-half reliability was very good (Spearman-Brown Prophesy Reliability Estimate = 0.80). (iii) Test re-test reliability was excellent (intra-class correlation coefficient = 0.87). (iv) Floor and ceiling effects: < 5% women scored either 0 or 100 (lowest and highest scores, respectively). CONCLUSION: ObsQoR-10-Portuguese is valid and reliable, and should be considered for use in Portuguese-speaking women to assess their quality of inpatient recovery following cesarean delivery.

Sea lice Lepeophtheirus spinifer, Tuxophorus sp. and Caligus sp. infections on wild-caught queenfish Scomberoides commersonnianus from northern Australia.

Studies of ectoparasites of wild-caught queenfish Scomberoides commersonnianus from several areas in northern Australia were reviewed to investigate relationships between parasite burdens, environmental conditions and external lesions. A sample of 27 queenfish captured near a dredge spoil disposal site in Gladstone Harbour, Queensland, Australia, in January 2012 was anomalous, with a high percentage of fish (66.6%) exhibiting grossly visible skin lesions including foci of erythema and petechial haemorrhages, particularly on the pectoral girdle and ventrolateral surfaces. Microscopically, lesions comprised acute epidermal erosion, ulceration and/or perivascular dermatitis with dermal oedema and depigmentation. Skin lesions were associated with high prevalence (100%) and intensity (mean = 21.2 copepods fish-1, range 4-46) of infection by sea lice Lepeophtheirus spinifer. Only queenfish infected with >10 L. spinifer presented with skin lesions. This is the first record of L. spinifer from Australia. In contrast, grossly visible skin lesions were not reported from queenfish (n = 152) sampled from other sites in the Northern Territory and Queensland, where the sampled fish had a much lower prevalence (51.3%) and intensity (mean = 3.54, range 0-26) of copepod (L. spinifer, Caligus spp. and Tuxophorus sp.) infections. Copepods from queenfish in studies undertaken outside Gladstone Harbour exhibited an over-dispersed pattern of infection, with the vast majority (n = 137, or 90.1%) of fish infected with <5 copepods. These data demonstrate that heavy L. spinifer infections, combined with poor water quality and/or direct exposure to contaminated dredge spoil and blooms of the cyanobacterium Lyngbya majuscula, can be associated with cutaneous disease in wild-caught queenfish.

Tidal Energy: The benthic effects of an operational tidal stream turbine.

The effect of modified flow on epifaunal boulder reef communities adjacent to the SeaGen, the world's first grid-compliant tidal stream turbine, were assessed. The wake of the SeaGen was modelled and the outputs were used in conjunction with positional and substrate descriptor variables, to relate variation in epifaunal community structure to the modified physical environment. An Artificial Neural Network (ANN) and Generalised Linear Model (GLM) were used to make predictions on the distribution of Ecological Status (ES) of epifaunal communities in relation to the turbulent wake of the SeaGen. ES was assigned using the High Energy Hard Substrate (HEHS) index. ES was largely High throughout the survey area and it was not possible to make predictions on the spatial distribution of ES using an ANN or GLM. Spatial pattern in epifaunal community structure was detected when the study area was partitioned into three treatment areas: area D1; within one rotor diameter (16 m) of the centre of SeaGen, area D2; between one and three rotor diameters, and area D3; outside of three rotor diameters. Area D1 was found to be significantly more variable than D2 and D3 in terms of epifaunal community structure, bare rock distributions and ES.

Dense WDM transmission at 2 µm enabled by an arrayed waveguide grating.

We show, for the first time, dense WDM (8×20 Gbit/s) transmission at 2 µm enabled by advanced modulation formats (4-ASK Fast-OFDM) and the development of key components, including a new arrayed waveguide grating (AWGr) at 2 µm. The AWGr shows -12.8±1.78 dB of excess loss with an 18-dB extinction ratio and a thermal tunability of 0.108 nm/°C.

100 Gbit/s WDM transmission at 2 µm: transmission studies in both low-loss hollow core photonic bandgap fiber and solid core fiber.

We show for the first time 100 Gbit/s total capacity at 2 µm waveband, using 4 × 9.3 Gbit/s 4-ASK Fast-OFDM direct modulation and 4 × 15.7 Gbit/s NRZ-OOK external modulation, spanning a 36.3 nm wide wavelength range. WDM transmission was successfully demonstrated over 1.15 km of low-loss hollow core photonic bandgap fiber (HC-PBGF) and over 1 km of solid core fiber (SCF). We conclude that the OSNR penalty associated with the SCF is minimal, while a ~1-2 dB penalty was observed after the HC-PBGF probably due to mode coupling to higher-order modes.

Effects of sample storage and delayed secondary enrichment on detection of Salmonella spp in swine feces.

OBJECTIVE: To determine effects of fecal sample storage and delayed secondary enrichment (DSE) on detection of Salmonella spp in swine feces. Sample Population-Fecal samples obtained from 84 pigs in a commercial herd. PROCEDURE: Each fecal sample underwent 3 storage treatments: no storage (ie, processed on the day of collection), storage at 4 C for 6 days, and storage at -15 C for 14 days. After assigned storage treatments, all samples were enriched in Rappaport-Vassiladias (RV) broth (single enrichment) and plated on XLT4 agar. Delayed secondary enrichment was performed, using single enrichment broths that were stored for 4 days at room temperature. RESULTS: Of 504 cultures, 186 (36.9%) were Salmonella positive. A difference in proportions of samples with positive results was not found between same-day processing and storage at 4 C for 6 days. Compared with use of single enrichment for 24 hours (34% positive), use of DSE resulted in a greater proportion (40%; P < 0.001) of samples with positive results. Estimated relative sensitivities for the storage methods were 0.90, 0.85, and 0.71 for same-day processing, storage at 4 C for 6 days, and storage at -15 C for 14 days, respectively. CONCLUSIONS: Where practical, processing of fecal samples on the day of collection is recommended, although storage at 4 C for several days does not result in marked loss of sensitivity. Improved detection associated with DSE warrants further investigation and optimization.

Detection of milk antibiotic residues by use of screening tests and liquid chromatography after intramammary administration of amoxicillin or penicillin G in cows with clinical mastitis.

OBJECTIVE: To compare results of 6 commercially available milk antimicrobial screening tests with results of liquid chromatography (LC) when testing milk samples from individual cows treated for mild clinical mastitis by intramammary (IMM) infusion with amoxicillin or penicillin G. ANIMALS: 6 cows with noninduced clinical mastitis: 3 treated by IMM infusion with amoxicillin and 3 treated by IMM infusion with penicillin G. PROCEDURE: Composite milk samples were collected before, during, and after treatment. Samples were assayed by use of the screening tests and their results and those of LC were compared. The LC results were assumed to represent the true result. RESULTS: Results of screening tests compared well with results of LC, with agreement of 94%. Positive screening test results for samples containing drug values below the established tolerance or safe level, as evaluated by LC, were obtained from 2 cows in which abnormal milk, as well as marked increases in composite milk somatic cell count, were observed. With the exception of 1 test in 1 cow, all screening tests had negative results at the end of the labeled milk-withholding time. CONCLUSIONS AND CLINICAL IMPLICATIONS: On the basis of results of the limited sample reported, the screening tests appeared to provide good agreement overall, compared with LC results, when testing milk of individual cows treated by IMM infusion with amoxicillin or penicillin G. Positive screening test results for milk samples containing amoxicillin or penicillin G at values below the established tolerance or safe level, as evaluated by LC, may occasionally be obtained.