Development and validation of a Spanish version of the Obstetric Quality of Recovery-10 item score (ObsQoR-10-Spanish).

Background: Spanish is the second most spoken language globally with around 475 million native speakers. We aimed to validate a Spanish version of the Obstetric Quality of Recovery-10 item (ObsQoR-10) patient-reported outcome measure. Methods: ObsQoR-10-Spanish was developed using EuroQoL methodology. ObsQoR-10-Spanish was assessed in 100 Spanish-speaking patients undergoing elective Caesarean or vaginal delivery. Patients <38 weeks, undergoing an intrapartum Caesarean delivery, intrauterine death, or maternal admission to the intensive care unit (ICU) were excluded. Validity was assessed by evaluating (i) convergent validity-correlation with 24-h EuroQoL and global health visual analogue scale (GHVAS) scores (0-100); (ii) discriminant validity-difference in ObsQoR-10-Spanish score for patients with GHVAS scores >70 vs <70; (iii) hypothesis testing-correlation of ObsQoR score with maternal and neonatal factors; and (iv) cross-cultural validity assessed using differential item functioning analysis. Reliability was assessed by evaluating: (i) internal consistency; (ii) split-half reliability and (iii) test-retest reliability; and (iv) floor and ceiling effects. Results: One hundred patients were approached, recruited, and completed surveys. Validity: (i) convergent validity: the ObsQoR 24-h score correlated moderately with the 24-h EuroQoL (r=-0.632) and GHVAS scores (r=0.590); (ii) discriminant validity: the ObsQoR-10-Spanish 24-h scores were higher in women who delivered vaginally compared to via Caesarean delivery, (mean [standard deviation] scores were 89 [9] vs 81 [12]; P<0.001). The 24-h ObsQoR-Spanish scores were lower in patients experiencing a poor vs a good recovery (mean [standard deviation] scores were 76 [12.3] vs 87.1 [10.6]; P=0.001); (iii) hypothesis testing: the ObsQoR-10 score correlated negatively with age (r=-0.207) and positively with 5-min (r=0.204) and 10-min (r=0.243) Apgar scores. Remaining correlations were not significant; and (iv) differential item functioning analysis suggested no potential bias among the 10 items. Reliability: (i) internal consistency was good (Cronbach alpha=0.763); (ii) split-half reliability was good (Spearman-Brown prophesy reliability estimate of 0.866); (iii) test-retest reliability was excellent with an intra-class correlation coefficient of 0.90; and (iv) floor and ceiling effects: six patients scored a maximum total ObsQoR-10 score. Conclusions: The ObsQoR-10-Spanish patient-reported outcome measure is valid, reliable, and clinically feasible, and should be considered for use in Spanish-speaking women to assess quality of inpatient postpartum recovery.

Size-dependent colouration balances conspicuous aposematism and camouflage.

Colour is an important component of many different defensive strategies, but signal efficacy and detectability will also depend on the size of the coloured structures, and how pattern size interacts with the background. Consequently, size-dependent changes in colouration are common among many different species as juveniles and adults frequently use colour for different purposes in different environmental contexts. A widespread strategy in many species is switching from crypsis to conspicuous aposematic signalling as increasing body size can reduce the efficacy of camouflage, while other antipredator defences may strengthen. Curiously, despite being chemically defended, the gold-striped frog (Lithodytes lineatus, Leptodactylidae) appears to do the opposite, with bright yellow stripes found in smaller individuals, whereas larger frogs exhibit dull brown stripes. Here, we investigated whether size-dependent differences in colour support distinct defensive strategies. We first used visual modelling of potential predators to assess how colour contrast varied among frogs of different sizes. We found that contrast peaked in mid-sized individuals while the largest individuals had the least contrasting patterns. We then used two detection experiments with human participants to evaluate how colour and body size affected overall detectability. These experiments revealed that larger body sizes were easier to detect, but that the colours of smaller frogs were more detectable than those of larger frogs. Taken together our data support the hypothesis that the primary defensive strategy changes from conspicuous aposematism to camouflage with increasing size, implying size-dependent differences in the efficacy of defensive colouration. We discuss our data in relation to theories of size-dependent aposematism and evaluate the evidence for and against a possible size-dependent mimicry complex with sympatric poison frogs (Dendrobatidae).

Multiple Fragmentations: A Subnational Analysis of the Early Childhood Education and Care Workforce in Argentina.

The divided nature of the ECEC workforce is widely acknowledged. While scholarship has focused primarily on the consequences of the education-care divide, few studies have examined the workforce's fragmentation from a subnational perspective, particularly in the Global South. This article explores multiple fragmentations in the workforce, drawing on three provincial case studies in Argentina. The study included 17 interviews with national and subnational policy makers and three focus groups with ECEC workers. We explore ECEC workers' heterogeneous conditions and experiences across three provinces and demonstrate how vertical and horizontal fragmentation combine to create multiple fragmentations. We argue that subnational approaches are critical for better understanding the ECEC workforce's complexities and, ultimately, ECEC systems.

La nature diverse du personnel de l'éducation et des soins aux enfants (ECEC pour son single en anglais) est largement reconnue. Cette recherche s'est principalement centrée sur les conséquences du clivage entre l'éducation et les soins. Peu d'études ont examiné la fragmentation du personnel ECEC avec un point de vue infranational, en particulier dans les pays du Sud. L'article explore les multiples fragmentations des travailleurs de l'éducation et des soins aux enfants à partir de trois études dans trois provinces en Argentine. L'étude s'est appuyée sur l'information obtenue dans 17 entretiens avec des décideurs politiques nationaux et infranationaux et dans 3 focus groups avec des travailleurs de l'ECEC. Nous explorons les conditions de travail et les expériences hétérogènes du personnel de l'ECEC dans trois provinces et montrons comment la fragmentation verticale et horizontale se combine pour créer des fragmentations multiples. Nous soutenons que les approches infranationales sont essentielles pour mieux comprendre les complexités du personnel d'ECEC et les systèmes d'ECEC en général.

Modalidades en Terapia Física para el Manejo del Dolor de la Cicatriz Post Cesárea No Mayor a 6 Meses de Evolución. Scoping Review / Physical Therapy Modalities for the Management of Post Cesarean Section Scar Pain not more than 6 Months Old. Scoping Review.

Introducción. El manejo del dolor y cicatrización post cesárea es diferente a los otros manejos post operatorios debido a que la madre debe recuperarse lo más pronto posible para el cuidado del recién nacido. La evidencia referente al impacto de las intervenciones en terapia física para el manejo del dolor en este tipo de cicatriz es limitada. Objetivo. Identificar las modalidades en fisioterapia disponibles para el manejo del dolor sobre la cicatriz de la cesárea, con una evolución menor a 6 meses. Metodología. Se realizó un scoping review según la metodología propuesta de Arskey y O'Malley, y PRISMA-Scr. Las bases de datos empleadas para la búsqueda fueron PubMed, ScienceDirect, Scopus, Scielo y Google Scholar, incluyendo artículos en el idioma inglés y español publicados entre enero de 2012 y abril de 2022. Resultados. Se incluyeron 6 estudios de tipo prospectivo. Identificando 4 modalidades de intervención en terapia física para el alivio del dolor de la cicatriz post cesárea en un periodo de evolución menor a 6 meses, entre las cuales se encuentran: TENS, Láser, Infrarrojo y Ejercicio Terapéutico. Siendo el TENS la modalidad más empleada en los estudios. Conclusión. Existe una escasa evidencia de intervenciones de terapia física en el manejo de la cicatriz durante el proceso de cicatrización post cesárea en los primeros 6 meses de evolución. La modalidad más relevante es el TENS garantizando una herramienta terapéutica con respuesta efectiva sin efectos adversos y coadyuvante a la disminución de uso de medicación analgésica.

Background. Post cesarean scar pain management is different from other postoperative management because the mother must recover as soon as possible to care for the newborn. Evidence regarding the impact of physical therapy interventions for c-section scar pain management is limited. Objetive. To identify the physical therapy modalities available for pain management of the c-section scar within the first 6 months since the procedure. Methods. A scoping review was performed according to the methodology proposed by Arskey and O'Malley PRISMA-Scr. The databases used for the search were PubMed, ScienceDirect, Scopus, Scielo and Google Scholar, including articles in English and Spanish published between January 2012 and April 2022. Results. 6 prospective studies were included. Four physical therapy modalities were identified post cesarean scar pain relief in a period of evolution less than 6 months, among which are: TENS, Laser, Infrared and Therapeutic Exercise. TENS being the most used modality in the studies. Conclusion. There is scarce evidence of physical therapy interventions in scar management during the post cesarean healing process in the first 6 months of evolution. The most relevant modality is TENS, guaranteeing a therapeutic tool with effective response without adverse effects and contributing to the decrease in the use of analgesic medication.

Predicting pain after Cesarean delivery: pressure algometry, temporal summation, three-item questionnaire.

PURPOSE: Approximately one in five women will experience severe postoperative pain after Cesarean delivery (CD). Previously, a bedside three-item questionnaire (3-IQ) has shown to predict women experiencing higher evoked pain intensity after CD, with an area under the receiver operator characteristics (ROC) curve of 0.72. We hypothesized that the addition of psychophysical pain tests to the existing 3-IQ would improve the ability to predict severe pain in women undergoing elective CD under spinal anesthesia METHODS: This was a prospective cohort study on women undergoing elective CD under spinal anesthesia. Women were assessed preoperatively using the 3-IQ, pressure algometry (PA) and mechanical temporal summation (TS) response. All women received standard perioperative care, including a multimodal analgesia regimen that included intrathecal fentanyl and morphine. A 0-100 mm visual analogue scale (VAS) was used to assess the severity of pain at rest (VASr) and on movement (VASm) at 24 and 48 hr after surgery. Patient satisfaction and opioid consumption were also recorded. We performed ROC curve analyses to assess whether we could improve the ability to predict our primary outcome of severe pain on movement at 24 hr (VASm24 ≥ 70). RESULTS: We studied 195 women. Median [interquartile range] VASm24 was 53 [32-72] and 28% of patients experienced a VASm24 ≥ 70. The ability to predict a VASm24 ≥ 70 assessed by the area under the ROC curve was 0.64 using the 3-IQ and 0.67 using the 3-IQ combined with TS and PA. CONCLUSION: The addition of PA and TS to the 3-IQ model resulted in a predictive model that performed similarly to the 3-IQ model alone. Further research is warranted in this area to better predict women at risk of severe pain post CD.

RéSUMé: OBJECTIF: Environ une femme sur cinq souffrira de douleur postopératoire sévère après un accouchement par césarienne. Un questionnaire à trois critères (Q3C) administré au chevet de la patiente a déjà été utilisé pour prédire quelles femmes éprouveraient une intensité de douleur évoquée plus élevée après une césarienne, avec une aire sous la courbe ROC de 0,72. Nous avons émis l'hypothèse que l'ajout de tests psychophysiques de douleur au Q3C existant améliorerait notre capacité à prédire la douleur sévère chez les femmes bénéficiant d'une césarienne élective sous rachianesthésie. MéTHODE: Il s'agissait d'une étude de cohorte prospective auprès de femmes bénéficiant d'une césarienne élective sous rachianesthésie. Les femmes ont été évaluées en préopératoire à l'aide du Q3C, de l'algométrie par pression (AP) et de la réponse à une sommation temporale (ST) mécanique. Toutes les femmes ont bénéficié des soins périopératoires standard, ainsi que d'un régime d'analgésie multimodal incluant fentanyl et morphine intrathécaux. Une échelle visuelle analogique (EVA) de 0 à 100 mm a été utilisée pour évaluer la sévérité de la douleur au repos (EVAr) et en mouvement (EVAm) à 24 et 48 heures après la chirurgie. La satisfaction des patientes et la consommation d'opioïdes ont également été enregistrées. Nous avons effectué des analyses de la courbe ROC pour déterminer s'il nous était possible d'améliorer notre capacité à prédire notre critère d'évaluation principal, soit la douleur sévère à la mobilisation à 24 heures (EVAm24 ≥ 70). RéSULTATS: Nous avons étudié 195 femmes. L'EVAm 24 médiane [écart interquartile] était de 53 [32-72] et 28 % des patientes ont noté un score sur l'EVAm24 ≥ 70. La capacité à prédire un score sur l'EVAm24 ≥ 70 tel qu'évalué par la surface sous la courbe ROC était de 0,64 en utilisant le Q3C et de 0,67 en utilisant le Q3C combiné à la ST et l'AP. CONCLUSION: L'ajout de l'AP et de la ST au modèle de Q3C a résulté en un modèle prédictif présentant une performance similaire au modèle de Q3C seul. D'autres recherches sont nécessaires dans ce domaine pour mieux prédire les femmes à risque de douleur sévères après une césarienne.

Respuesta ecológica multitaxón a la pérdida de hábitat y fragmentación del paisaje en la Amazonía occidental reveladas por evaluaciones de biodiversidad RAPELD / Multi-taxa ecological responses to habitat loss and fragmentation in western Amazonia as revealed by RAPELD biodiversity surveys

La pérdida y fragmentación del hábitat causada por la deforestación es un importante impulsor antropogénico de cambios sobre la biodiversidad en la selva amazónica. Sin embargo, la magnitud y dirección de los efectos sobre la composición y distribución de las especies aún es incomprendida. Evaluamos las respuestas de cuatro grupos taxonómicos - aves, anfibios, abejas de orquídeas y escarabajos peloteros - a la pérdida y fragmentación del hábitat, tanto a nivel de especies como de ensamblaje, en la Amazonía norte ecuatoriana. Tomamos muestras de quince parcelas de 250 m de largo en remanentes de bosque de tierra firme. Calculamos un índice de fragmentación del paisaje (fragindex), que considera la cobertura forestal continua, densidad del borde y el aislamiento en el paisaje, y nueve métricas de configuración del paisaje para analizar las respuestas de especies y ensamblajes. Más del 80% de las especies de aves, anfibios o abejas de orquídeas y el 60% de los escarabajos peloteros se vieron afectados negativamente por la pérdida y fragmentación del hábitat. La composición por especies se vio significativamente afectada por las diferencias en la cobertura forestal y la conectividad, mientras que la forma y el área de los parches de bosque determinaron la magnitud y la dirección del efecto en las respuestas de las especies. Por lo tanto, los cambios en la configuración del paisaje de la Amazonía ecuatoriana deben minimizarse para disminuir los efectos de la pérdida y fragmentación del hábitat sobre la presencia de especies y la composición de los ensambles. (AU)

Intubation Using C-MAC Video Laryngoscope During Ex Utero Intrapartum Treatment Featuring Upper Airway Neck Mass: A Case Report.

Ex utero intrapartum treatment procedures are mainly indicated to secure the airways of fetuses featuring a risk of obstruction at birth while ensuring uteroplacental circulation. This report documents a successful intubation case with a C-MAC video laryngoscope during an ex utero intrapartum treatment procedure in a newborn featuring an infiltrative neck mass. Despite technical challenges faced in this procedure, the C-MAC video laryngoscope allowed an optimal view of airway structures. This novel approach, where laryngoscopy relies on the usage of C-MAC to optimize intubation conditions, may lead to increased chances of success in this particular scenario.

Comparison of Intermittent Intravenous Boluses of Phenylephrine and Norepinephrine to Prevent and Treat Spinal-Induced Hypotension in Cesarean Deliveries: Randomized Controlled Trial.

BACKGROUND: Phenylephrine (PE) is currently the vasopressor of choice to prevent and treat spinal-induced hypotension at cesarean delivery (CD). However, its use is often associated with reflex bradycardia. Norepinephrine (NE) has been put forward as an alternative vasopressor during CD due to its ability to treat hypotension while maintaining heart rate (HR). Recent studies have focused on the role of NE used as an infusion with favorable results compared to PE. No studies have compared equipotent bolus doses of PE and NE at CD. We hypothesized that when used in equipotent doses as an intermittent bolus regimen to prevent and treat spinal-induced hypotension, NE would result in a reduction in the incidence of bradycardia compared to PE. METHODS: This was a double-blind, randomized clinical trial of women undergoing elective CD under spinal anesthesia. Women were randomized to receive either PE 100 µg or NE 6 µg when the systolic blood pressure (SBP) was below baseline. In addition to the randomized treatment, ephedrine was given intravenously to both groups if the SBP was below baseline and the HR <60 bpm or if the SBP was <80% of baseline for 2 consecutive readings. The primary outcome was bradycardia (HR <50 bpm) in the predelivery period. Secondary outcomes included hypotension (SBP <80% of baseline), hypertension (SBP >120% of baseline), tachycardia (HR >120% of baseline), ≥2 episodes of bradycardia, nausea, vomiting, umbilical artery and vein blood gases, and Apgar scores. RESULTS: One hundred twelve patients were randomized. The incidence of bradycardia was lower in the NE group compared to the PE group (10.7% vs 37.5%; P < .001; difference [95% confidence interval {CI}], -26.8% [-41.8% to -11.7%]), implying an estimated 71% relative reduction (95% CI, 35%-88%). The distribution of the number of bradycardia episodes was also different between the 2 groups (P = .007). Further testing showed that the patients in the PE group had a higher risk of multiple bradycardia episodes (≥2 episodes) compared to the NE group (19.6% for PE versus 3.6% for NE; P = .008). The proportion of patients requiring rescue boluses of ephedrine was lower in the NE group compared to the PE group (7.2% for NE versus 21.4% for PE; P < .03; difference [95% CI], -14.3% [-27.0% to -1.6%]). No differences were observed between the 2 groups in the incidence of other secondary outcomes. CONCLUSIONS: When used as an intermittent bolus regimen to prevent and treat spinal-induced hypotension during CD, NE resulted in a significant reduction in the incidence of bradycardia as compared to an equipotent bolus regimen of PE. We conclude that the hemodynamic profile offered by NE during CD is superior to that of PE due to less fluctuations in HR and possibly cardiac output.

Caught in the web: Spider web architecture affects prey specialization and spider-prey stoichiometric relationships.

Quantitative approaches to predator-prey interactions are central to understanding the structure of food webs and their dynamics. Different predatory strategies may influence the occurrence and strength of trophic interactions likely affecting the rates and magnitudes of energy and nutrient transfer between trophic levels and stoichiometry of predator-prey interactions. Here, we used spider-prey interactions as a model system to investigate whether different spider web architectures-orb, tangle, and sheet-tangle-affect the composition and diet breadth of spiders and whether these, in turn, influence stoichiometric relationships between spiders and their prey. Our results showed that web architecture partially affects the richness and composition of the prey captured by spiders. Tangle-web spiders were specialists, capturing a restricted subset of the prey community (primarily Diptera), whereas orb and sheet-tangle web spiders were generalists, capturing a broader range of prey types. We also observed elemental imbalances between spiders and their prey. In general, spiders had higher requirements for both nitrogen (N) and phosphorus (P) than those provided by their prey even after accounting for prey biomass. Larger P imbalances for tangle-web spiders than for orb and sheet-tangle web spiders suggest that trophic specialization may impose strong elemental constraints for these predators unless they display behavioral or physiological mechanisms to cope with nutrient limitation. Our findings suggest that integrating quantitative analysis of species interactions with elemental stoichiometry can help to better understand the occurrence of stoichiometric imbalances in predator-prey interactions.

Trait overdispersion and the role of sociality in the assembly of social spider communities across the Americas.

Among the factors that may lead to differences in resource use among closely related species, body size and morphology have been traditionally considered to play a role in community assembly. Here we argue that for animals that live and forage in groups, level of sociality, reflecting differences in group size and cooperative tendencies, can be an additional and powerful dimension separating species in niche space. We compare 50+ communities of the social spider genus Anelosimus across the Americas against a null model that accounts for known effects of biotic and abiotic factors on the distribution of social systems in the genus. We show that these communities are more overdispersed than expected by chance in either or both body size and level of sociality, traits we have previously shown to be associated with differences in resource utilization (prey size, microhabitat, and phenology). We further show that the contribution of sociality to differences in the size of the prey captured is two to three times greater than that of body size, suggesting that changes in group size and cooperative tendencies may be more effective than changes in body size at separating species in niche space.

Fibrinógeno y hemorragia posparto - ¿Asociación o causalidad? / Fibrinogn and postpartum hemorrhage - Association or causality?

Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide, accounting for one in four maternal deaths. Despite efforts in public health policy, the incidence of massive PPH has increased in recent years even in first world countries. In Colombia, PPH is the second leading cause of maternal death. Multiple observational studies have provided evidence about the association between the concentration levels of fibrinogen in blood plasma and the severity of PPH, proposing the systematic use of fibrinogen concentrates as a prophylactic or therapeutic measure in patients with obstetric hemorrhage. However, the statistical relationship demonstrated in such studies should not necessarily be interpreted as a cause-effect relationship. Traditionally, we have used the criteria postulated by Sir Arthur Bradford Hill to establish a causal relationship. Therefore, the most pragmatic way to evaluate a possible causal relationship is through a randomized placebo-controlled experiment. Experiments of this kind available to date have methodological deficiencies or have been criticized for internal validity. As a result, the statistical relationship (association) between low levels of fibrinogen and PPH cannot be certainly interpreted as a cause-effect relationship and the use of fibrinogen concentrates may only be justified in the context of new clinical trials.

La hemorragia posparto (HPP) es la primera causa de muerte materna en el mundo, siendo responsable de una de cuatro muertes maternas. A pesar de los esfuerzos en políticas de salud pública, la incidencia de la HPP masiva ha aumentado en los últimos años incluso en países del primer mundo. En Colombia, la HPP es la segunda causa de muerte materna. Múltiples estudios observacionales han proporcionado evidencia sobre la asociación entre la concentración plasmática de fibrinógeno y la severidad de la HPP, por lo que se ha planteado el uso sistemático de concentrados de fibrinógeno como medida profiláctica o terapéutica en pacientes con hemorragia obstétrica. Sin embargo, la relación estadística demostrada en este tipo de estudios no necesariamente se debe interpretar como una relación causa-efecto. Tradicionalmente, se han usado los criterios postulados por Sir Arthur Bradford Hill para establecer una relación causal, a la luz de los cuales la manera más pragmática para evaluar una eventual relación causal sea a través de un experimento aleatorizado controlado con placebo. Los experimentos de esto tipo disponibles a la fecha poseen deficiencias metodológicas o se ha criticado su validez interna. Por lo pronto, la relación estadística (asociación) entre los niveles bajos de fibrinógeno y la HPP no se puede interpretar como una certeza de relación causa-efecto y el uso de concentrados de fibrinógeno solo estará justificado en el contexto de nuevos experimentos clínicos.

Community-wide body size differences between nocturnal and diurnal insects.

Examining community-wide patterns for the most diverse animal group, insects, is fundamental to our understanding of the ecological and evolutionary factors that maintain tropical diversity. Using several sampling techniques (malaise traps, pitfall traps, visual searches, and social spider nest captures), we investigated the day-night community composition of active insects to reveal differences in body size at three elevations in eastern Ecuador. We show that insects active at night are, on average, larger than those active during the day. Even though insect size decreased with increasing elevation, the observed diel pattern was consistent across elevations, and for most insect orders. All sampling techniques consistently detected day--night differences in insect size, except for social spider captures at the two higher elevations, probably due to the reduced range of colony sizes at the higher elevations and possibly lower spider activity at night. We suggest that the observed diel patterns in insect size may be driven by a combination of factors, including increased risk imposed on large insects by diurnal visual predators, mainly insectivorous birds, and physiological responses to diel changes in abiotic conditions.

Multiple techniques confirm elevational differences in insect size that may influence spider sociality.

Social and subsocial spiders of the genus Anelosimus exhibit an altitudinal pattern in their geographic distribution at tropical latitudes in the Americas. Social species, which capture prey cooperatively, occur primarily in the lowland rain forest and are absent from higher elevations, whereas subsocial species are common at higher elevations but absent from the lowland rain forest. Previous studies have suggested that differences in the size of potential insect prey along altitudinal gradients may explain this pattern as insects were found to be, on average, larger in lowland rain forests than at higher elevations. These studies, however, may have under-sampled the insect size composition of each habitat because only one sampling technique was used. Using a number of collection methods we sampled the insect size composition in the environments of social and subsocial spiders in this genus. We found that the average insect size in lowland rain forest habitats was indeed larger than at high-elevation cloud forests in eastern Ecuador. We also found that, even though the various techniques differed in the size of the insects they captured (visual searching and blacklighting yielding larger insects than beating, sweeping, or malaise trapping), they all caught, on average, larger insects in the lowlands. Overall, spider colonies in the lowlands caught larger prey than did spider colonies at higher elevations, paralleling differences in insect size distribution obtained by the various techniques in their respective environments.