Curved versus straight scissors to avoid 3rd and 4th degree perineal tears: A randomised feasibility study

BackgroundSevere perineal tears sustained during childbirth cause significant distress and morbidity amongst women. The objective of this study was to compare the use of straight scissors for cutting an episiotomy with the use of curved scissors, which are designed to curve away from the anal sphincter.MethodsWe used a single-centre, randomised feasibility trial. The intervention was the use of curved scissors. Women were recruited during a prenatal visit and randomised in the delivery suite, when it became clear that an episiotomy was required. The feasibility outcomes were the proportion of women able to be recruited, randomised and followed up. We also calculated the incidence of obstetric anal sphincter injury when either straight or curved scissors were used to cut an episiotomy. Other outcomes assessed were pain, length of hospital stay, perineal infection and perineal dehiscence.ResultsOf the 155 patients recruited in the prenatal period, only 20 (12.9%) were eventually randomised at birth. The main reasons for the high loss were that women either did not have a vaginal delivery (38, 24.5%), or they did not need an episiotomy (72, 46.5%). Rates of obstetric anal sphincter injury and other outcomes were similar between groups.DiscussionAnal sphincter injury during childbirth remains an important problem. Although the use of curved scissors provides a theoretical solution, we found that the high attrition rate made feasibility of conducting a suitably powered, randomised trial using the current design untenable. Alternative strategies have been suggested to make any future study more viable.     

Observed and parent‐reported conscience in childhood: Relations with bullying involvement in early primary school

This exploratory study aimed to examine which components of early childhood conscience predicted bullying involvement around school entry. In the population‐based Generation R Study, teacher reports of bullying involvement and parent reports of conscience were available for 3,244 children (M age = 6.7 years). Higher levels of overall conscience predicted lower bullying perpetration scores, independently of intelligence quotient, temperamental traits and sociodemographic characteristics. Particularly, the subscales guilt, confession, and internalized conduct, and to a lesser extent empathy, predicted bullying perpetration. Conscience was not related to victimization. Similar results were found using observations during so‐called ‘cheating games’ (subsample N = 450 children). Findings suggest that improving children's understanding of moral standards and norms may be a potential target for bullying intervention programs in early primary school.     

Cytometry inference through adaptive atomic deconvolution

In this paper, we consider a statistical estimation problem known as atomic deconvolution. Introduced in reliability, this model has a direct application when considering biological data produced by flow cytometers. From a statistical point of view, we aim at inferring the percentage of cells expressing the selected molecule and the probability distribution function associated with its fluorescence emission. We propose here an adaptive estimation procedure based on a previous deconvolution procedure introduced by Es, Gugushvili, and Spreij [(2008), ‘Deconvolution for an atomic distribution’, Electronic Journal of Statistics, 2, 265–297] and Gugushvili, Es, and Spreij [(2011), ‘Deconvolution for an atomic distribution: rates of convergence’, Journal of Nonparametric Statistics, 23, 1003–1029]. For both estimating the mixing parameter and the mixing density automatically, we use the Lepskii method based on the optimal choice of a bandwidth using a bias-variance decomposition. We then derive some convergence rates that are shown to be minimax optimal (up to some log terms) in Sobolev classes. Finally, we apply our algorithm on the simulated and real biological data.     

Changing attitudes about self-injury prevention management: lessons learned

In the behavioral health environment, nurses often use continuous staff monitoring and, at times, physical restraints, to manage the severity of patients' self-injury. Both options put staff in control, are the most restrictive in nature, and can be financially draining on the hospital's budget. This can result in negative reactions by both patients and staff. It is important to develop a program that will empower patients to control their behavior and allow staff to be aware of their perceptions and attitudes toward patients who self-injure. This article describes the leadership initiative that drove the development, training, and implementation of a self-injury prevention project and the lessons learned by staff.     

Fetal movements: What are we telling women?

Problem

Information that women receive about the importance of monitoring fetal movements and what to do if there are changes is inconsistent and may not be evidence based.

Bullying and Victimization Among Young Elementary School Children: The Role of Child Ethnicity and Ethnic School Composition

School-aged children with an ethnic minority background are relatively often involved in bullying and victimization, but the role of ethnic composition of schools in this context remains unclear. This study examined the relation between ethnic minority background, ethnic school composition, and bullying behaviour around primary school entry in the Netherlands. The study was based on a 2008/2009 school survey in Rotterdam, a Dutch city where about 50 % of children have a non-Dutch background. For 8523 children, teacher reports of bullying behaviour at age 5–6 years were available. Children with a non-Dutch background had higher odds of being a victim (adjusted OR 1.41, 95 % CI 1.11, 1.80), bully (OR 1.38, 95 % CI 1.20, 1.58) or bully-victim (OR 1.38, 95 % CI 1.19, 1.62) than children of Dutch national origin. Ethnic diversity in schools increased children’s risk of bullying behaviour (e.g. OR_victim per 0.1 increase in 0–1 diversity range = 1.06, 95 % CI 1.00, 1.13), with children of both Dutch and non-Dutch national origin relatively more often involved in bullying in ethnically diverse schools. The proportion of same-ethnic peers in school reduced the risk of bullying among children of Dutch national origin (e.g. OR_victim per 10 % more same-ethnic children = 0.90, 95 % CI 0.83, 0.98), but not among non-Dutch children. In conclusion, ethnic minority background and ethnic diversity within schools are risk factors for bullying among 5–6 year olds. Plausibly, reductions in absolute numbers of bullying events may be obtained with tailor-made interventions in ethnically diverse schools. Such interventions should preferably be offered early in the school curriculum.