A retrospective cohort study of the anesthetic management of postpartum tubal ligation.

BACKGROUND: Neuraxial anesthesia with reactivation of a labor epidural catheter is commonly utilized for postpartum tubal ligations (PPTL), although the optimal anesthetic approach is unknown. We assessed institutional anesthesia practices for PPTL, and evaluated the failure rates of reactivation of labor epidural catheters, de novo spinal anesthesia, and spinal anesthesia after failed blocks. METHODS: We conducted a single-center retrospective cohort analysis of 300 consecutive patients who underwent a PPTL and 100 having spinal anesthesia for cesarean delivery. Anesthetic management data (existing labor epidural catheter reactivation, de novo spinal anesthesia or general anesthesia) were collected from electronic medical records. Anesthetic block failure rates were determined for each anesthetic technique. RESULTS: The failure rate was 15% for de novo spinal anesthesia and 23% after failed reactivation of a labor epidural catheter or spinal anesthesia. The epidural catheter reactivation failure rate was 35%. The failure rate of spinal anesthesia for cesarean delivery was 4%. Drug dosage, epidural catheter use in labor, time since epidural catheter placement or delivery, labor neuraxial technique (combined spinal-epidural, epidural), supplemental top-up doses during labor, and anesthesiologist experience did not predict neuraxial anesthesia failures. CONCLUSIONS: Our analysis revealed an unexpectedly high neuraxial anesthesia failure rate even when de novo spinal anesthesia was used for PPTL. The results are consistent with other institutions' recent findings, and are higher than spinal anesthesia failure rates associated with cesarean delivery. Further studies are required to determine optimal anesthesia dosing strategies, and to understand the mechanisms behind high neuraxial anesthesia failures for PPTL.

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.

Outcomes and outcome measures utilised in randomised controlled trials of postoperative caesarean delivery pain: a scoping review.

BACKGROUND: Inadequately treated postoperative pain following caesarean delivery can delay recovery and the ability to care for a newborn. Effectiveness studies of interventions to treat postoperative caesarean delivery pain measure different outcomes, limiting data pooling for meta-analysis. We performed a comprehensive review of existing outcomes with the aim of recommending core outcomes for future research. METHODS: A scoping review to identify all outcomes reported in randomised controlled trials (RCTs) and clinical trial registries of interventions to treat or prevent postoperative caesarean delivery pain, with postoperative pain as a primary outcome measure. We searched PubMed, Web of Science, CINAHL, LILACS, Embase, CDSR and CRCT for studies from May 2016 to 2021. Outcomes were extracted and frequencies tabulated. RESULTS: Ninety RCTs and 11 trial registries were included. In total, 392 outcomes (375 inpatient and 17 outpatient) were identified and categorised. The most reported outcome domain was analgesia (n = 242/375, 64.5%), reported in 96% of inpatient studies, with analgesic consumption accounting for 108/375, 28.8% of analgesia outcomes. The second most common domain was pain intensity (n = 120/375, 32%), reported in 97% of inpatient studies, using the visual analogue scale (68/120, 59%) and the numerical reporting scale (37/120, 25%). Maternal and neonatal adverse effects accounted for 65/375 (17.3%) and 19/375 (5.1%) of inpatient outcomes, respectively. CONCLUSIONS: Outcomes reported in RCTs for postoperative caesarean delivery pain vary widely. The results of this review suggest that standardisation is needed to promote research efficiency and aid future meta-analyses to identify optimal postoperative caesarean delivery pain management.

Diversity and probiotic characterisation of yeast isolates in the bovine gastrointestinal tract.

The use of yeasts as a feed supplement for cattle can promote animal development and performance. However, for the positive results to be consistent, strains with probiotic properties must be selected. The objective of this study was to isolate and identify yeasts present in the bovine feces and evaluate their probiotic potential together with strains previously isolated from the rumen (preliminary study). A total of 193 isolates were studied, including 139 isolates (19 species) from fecal samples from 11 different animals (Bos taurus and Bos indicus) and 54 strains previously isolated from rumen fluid (Bos taurus). The yeast population in the feces ranged from 3.51 to 4.99 log CFU/g, with Candida pararugosa being the most abundant (isolated from the feces of six samples analysed). Isolates were selected that had negative results in the safety tests (hemolytic activity, DNAse, and gelatinase) and had percentages greater than 35 and 70% for hydrophobicity and auto-aggregation, respectively. In addition, selected isolates had percentages greater than 77.7 and 74.7% for coaggregation with pathogenic strains of Escherichia coli and Clostridium perfringens, respectively. The isolates with percentage growth at 39 °C greater than 64.6% and viability greater than 96.7% were selected for survival testing under bovine gastrointestinal conditions. After the tests, the seven best isolates were selected, belonging to the species Candida pararugosa (L60, CCMA 928 and CCMA 930) and Pichia kudriavzevii (L97, L100, CCMA904, CCMA 907). The selected isolates were exopolysaccharide producers. Based on the results of the evaluated properties, the seven selected isolates were classified as potential probiotics for cattle.

Cytotoxic screening of plants from the Brazilian Atlantic Forest has led to the identification of Casearia arborea and Sorocea hilarii as sources of antitumor compounds.

In the present study, we have evaluated the cytotoxic activity of 282 extracts from 72 native plant species of the Brazilian Atlantic Forest biome. As a result, Casearia arborea and Sorocea hilarii leaves extracts showed cytotoxic activity against three tumour cell lines tested (B16F10, SW480 and Jurkat). After bioassay-guided fractionation, the bioactive fractions were submitted to the dereplication study via High-performance Liquid Chromatography, connected to High-resolution Mass Spectrometry (HPLC-ESI-QTOF/MS) analysis, combined with a Global Natural Products Social Molecular Networking (GNPS) tool. A combination of bioactivity-guided and dereplication approaches resulted in the putative annotation of 27 clerodane diterpenes and 9 flavonoids as main compounds present in the cytotoxic fractions of C. arborea. Regarding the active fraction of S. hilarii, 10 megastigmans, 17 spirostane steroids derivatives and 2 lignans were putatively identified. In conclusion, Casearia arborea and Sorocea hilarii are potential sources of antitumor compounds.

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.

Absence of aluminium compromises root integrity, reduces leaf hydration and Rubisco performance in Qualea grandiflora, an Al-accumulating species.

Aluminium (Al) is toxic to most plants. Nevertheless, some species accumulate Al without showing toxicity symptoms. Previous studies have evidenced Al in chloroplasts of Al-accumulating species from the Cerrado vegetation in South America. We ask whether Al increases carbon assimilation through enhanced apparent efficiency of Rubisco. Seedlings of the Al-accumulator Qualea grandiflora (Vochysiaceae) were grown in nutrient solution with 0, 740, and 1480 µm Al. Growth parameters, relative leaf water content, Al concentration in organs, gas exchange and apparent carboxylation efficiency (measured from A/Ci curves) were evaluated for 60 days. Plants without Al showed no root growth, necrotic roots, low gas exchange rates, and decreased apparent carboxylation efficiency. Al-treated plants, however, showed new white roots and increased root biomass leading to higher leaf hydration, and apparent carboxylation efficiency was higher in these plants. Increased Al available in the nutrient solution increased Al accumulation in plant organs. Absence of Al compromised root integrity in Q. grandiflora, thus limiting leaf hydration. No positive direct effect of Al on Rubisco was evidenced in Al-treated plants.

Prevalence and predictors for postpartum sleep disorders: a nationwide analysis.

OBJECTIVE: To describe the prevalence and predictors of postpartum sleep disorders. DESIGN: A retrospective cohort study. SETTING: Postpartum. POPULATION: Commercially insured women delivering in California (USA) between 2011 and 2014. METHODS: Using the Optum Clinformatics Datamart Database. MAIN OUTCOME MEASURES: Prevalence of a postpartum sleep disorder diagnosis with and without a depression diagnosis up to 12 months following hospital discharge for inpatient delivery. We also identified predictors of a postpartum sleep disorder diagnosis using multivariable logistic regression. RESULTS: We identified 3535 (1.9%) women with a postpartum sleep disorder diagnosis. The prevalence of sleep disorder diagnoses was insomnia (1.3%), sleep apnea (0.25%), and other sleep disorder (0.25%). The odds of a postpartum sleep disorder were highest among women with a history of drug abuse (adjusted odds ratio (aOR): 2.70, 95% confidence interval (CI): 1.79-4.09); a stillbirth delivery (aOR: 2.15, 95% CI: 1.53-3.01); and chronic hypertension (aOR: 1.82; 95% CI: 1.57-2.11). A comorbid diagnosis of a postpartum sleep disorder and depression occurred in 1182 women (0.6%). These women accounted for 33.4% of all women with a postpartum sleep disorder. The strongest predictors of a comorbid diagnosis were a history of drug abuse (aOR: 4.13; 95% CI: 2.37-7.21) and a stillbirth delivery (aOR: 2.93; 95% CI: 1.74-4.92). CONCLUSIONS: Postpartum sleep disorders are underdiagnosed conditions, with only 2% of postpartum women in this cohort receiving a sleep diagnosis using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Insomnia was the most common disorder and one-third of women diagnosed with a postpartum sleep disorder had a co-morbid diagnosis of depression. Future studies are needed to improve the screening and diagnostic accuracy of postpartum sleep disorders.

The multitarget fecal immunochemical test versus the fecal immunochemical test for programmatic colorectal cancer screening: a cross-sectional intervention study with paired design.

BACKGROUND: Many screening programs for colorectal cancer (CRC) use the fecal immunochemical test (FIT) to triage individuals for colonoscopy. Although these programs reduce CRC incidence and CRC-related mortality, the detection of advanced precursor lesions (advanced adenomas and advanced serrated polyps) by FIT could be improved. As an alternative for FIT, the antibody-based multitargetFIT (mtFIT) has been proposed. The mtFIT measures three protein markers: hemoglobin, calprotectin, and serpin family F member 2. In a retrospective diagnostic accuracy study in a large colonoscopy-controlled series (n = 1284), mtFIT showed increased sensitivity for advanced neoplasia (AN), at equal specificity, compared to FIT (42.9% versus 37.3%; p = 0.025). This increase was mainly due to a higher sensitivity of mtFIT for advanced adenomas (37.8% versus 28.1% for FIT; p = 0.006). The present mtFIT study aims to prospectively validate these findings in the context of the Dutch national CRC screening program. METHOD: The mtFIT study is a cross-sectional intervention study with a paired design. Eligible subjects for the Dutch FIT-based national CRC screening program are invited to perform mtFIT in addition to FIT. Samples are collected at home, from the same bowel movement, and are shipped to a central laboratory by postal mail. If either one or both tests are positive, participants are referred for colonoscopy. Detailed colonoscopy and pathology data are centrally stored in a national screening database (ScreenIT; Topicus, Deventer, the Netherlands) that is managed by the screening organization, and will be retrieved for this study. We aim to determine the relative sensitivity for AN, comprising of CRC, advanced adenomas and advanced serrated polyps, of mtFIT compared to FIT at an equal positivity rate. Additionally, we will use the Adenoma and Serrated Pathway to Colorectal CAncer model to predict lifetime health effects and costs for programmatic mtFIT- versus FIT-based screening. The target sample size is 13,131 participants. DISCUSSION: The outcome of this study will inform on the comparative clinical utility of mtFIT versus FIT in the Dutch national CRC screening program and is an important step forward in the development of a new non-invasive stool test for CRC screening. TRIAL REGISTRATION: Clinicaltrials.gov ; NCT05314309, registered April 6th 2022, first inclusions March 25th 2022 https://clinicaltrials.gov/ct2/results?cond=&term=NCT05314309&cntry=&state=&city=&dist =.

Quantitative blood loss after vaginal delivery: a retrospective analysis of 104 079 measurements at 41 institutions.

BACKGROUND: Peripartum quantitative blood loss (QBL) measurement is recommended over visual estimation. However, QBL measurement after vaginal delivery has been inadequately evaluated. The primary aim of this study was to determine the characteristics of QBL measurements from a large, multicenter cohort of patients having vaginal deliveries. We also determined the incidence of postpartum hemorrhage (PPH) and the relationship between gravimetric QBL from weighed sponges vs. volumetric QBL from liquid drape or suction cannister contents. METHODS: Data were collected from 41 institutions in the United States of America that use an automated QBL device after vaginal delivery as part of routine care. The QBL device tracks cumulative blood loss based on gravimetry and volumetric V-drape assessment, automatically subtracting the dry weights of all blood-containing sponges, towels, pads and other supplies as well as the amniotic fluid volume. RESULTS: Between January 2017 and April 2020, 104 079 QBL values were obtained from patients having vaginal deliveries. Total median [IQR] QBL was 171 [61-362] mL. The PPH incidence, stratified by QBL, was 15.2% (>500 mL), 3.4% (>1000 mL), and 1.0% (>1500 mL). The contribution of QBL from V-drapes was 60.6±26.3% of total QBL. CONCLUSION: Results from this large set of QBL measurements and the PPH incidence provide normative "real-world" clinical care values that can be expected as hospitals transition from estimated blood loss to QBL to assess the blood loss at vaginal delivery.

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.

Accuracy of visual estimation of blood loss in obstetrics using clinical reconstructions: an observational simulation cohort study.

INTRODUCTION: Postpartum hemorrhage is the leading cause of maternal mortality worldwide, and optimal management requires accurate blood loss estimations. The aim of this study was to assess whether differences exist between visually estimated blood loss vs. actual blood loss based on delivery mode, blood volume or distribution/location and knowledge of patient's current cardiovascular status. METHODS: For this observational cohort study, photographs were taken of 18 blood loss scenarios for vaginal delivery and cesarean delivery, and six photographs were duplicated and annotated with maternal vital signs. Scenarios were categorized into 50% (500 mL), 100% (1000 mL) and 200% (2000 mL) of the defined blood loss volume for postpartum hemorrhage and the photographs were shown to participants to visually estimate blood loss volumes. RESULTS: The mean ±â€¯standard deviation estimates of actual 500 mL, 1000 mL and 2000 mL blood loss volumes were 1208 ±â€¯438 mL, 1676 ±â€¯630 mL and 2637 ±â€¯1123 mL, respectively (P <0.001 among groups). The difference was significantly greater in vaginal delivery than cesarean delivery scenarios (1064 ±â€¯849 mL vs. 284 ±â€¯456 mL; P <0.001). Estimated blood loss volume was not influenced by blood loss distribution/location, or by provider group or experience. The cardiovascular status of the patient impacted estimations only if tachycardia and hypotension were present. CONCLUSIONS: Most providers significantly overestimated blood loss volumes (by nearly 700 mL). Provider and scenario factors that impact inaccuracies in visual estimated blood loss identified in this study can be used to guide education and training.

Proposed domains for assessing postpartum recovery: a concept elicitation study.

OBJECTIVE: To propose postpartum recovery domains. DESIGN: Concept elicitation study. SETTING: Semi-structured interviews. POPULATION: Ten writing committee members and 50 stakeholder interviews (23 postpartum women, nine general obstetricians, five maternal and fetal medicine specialists, eight nurses and five obstetric anaesthetists). METHODS: Alternating interviews and focus group meetings until concept saturation was achieved (no new themes discussed in three consecutive interviews). Interviews were digitally recorded and transcribed, and an iterative coding process was used to identify domains. MAIN OUTCOME MEASURES: The primary outcome was to identify recovery domains. We also report key symptoms and concerns. Discussion frequency and importance scores (0-100; 0 = not important; 100 = vitally important to recovery) were used to rank domains. Discussion frequency was used to rank factors helping and hindering recovery, and to determine the greatest challenges experienced postpartum. RESULTS: Thirty-four interviews and two focus group meetings were performed. The 13 postpartum recovery domains identified, (ranked highest to lowest) were: psychosocial distress, surgical/medical factors, infant feeding and breast health, psychosocial support, pain, physical function, sleep, motherhood experience, infant health, fatigue, appearance, sexual function and cognition. The most frequently discussed factors facilitating postpartum recovery were: family support, lactation/breastfeeding support and partner support. The most frequently discussed factor hindering recovery was inadequate social support. The most frequent challenges reported were: breastfeeding (week 1), breastfeeding (week 3) and sleep (week 6). CONCLUSIONS: We propose 13 domains that comprehensively describe recovery in women delivering in a single centre within the USA. This provides a novel framework to study the postpartum recovery process. TWEETABLE ABSTRACT: We propose 13 postpartum recovery domains that provide a framework to study the recovery process following childbirth.

A randomized trial to investigate needle redirections/re-insertions using a handheld ultrasound device versus traditional palpation for spinal anesthesia in obese women undergoing cesarean delivery.

BACKGROUND: Ultrasound may be useful to identify the spinal anesthesia insertion point, particularly when landmarks are not palpable. We tested the hypothesis that the number of needle redirections/re-insertions is lower when using a handheld ultrasound device compared with palpation in obese women undergoing spinal anesthesia for cesarean delivery. METHODS: Study recruits were obese (body mass index (BMI) >30 kg/m2) women with impalpable bony landmarks who were undergoing spinal anesthesia for elective cesarean delivery. Women were randomized to ultrasound or palpation. The primary study outcome was a composite between-group comparison of total number of needle redirections (any withdrawal and re-advancement of the needle and/or introducer within the intervertebral space) or re-insertions (any new skin puncture in the same or different intervertebral space) per patient. Secondary outcomes included insertion site identification time and patient verbal numerical pain score (0-10) for comfort during surgical skin incision. RESULTS: Forty women completed the study. The mean BMI (standard deviation) for the ultrasound group was 39.8 (5.5) kg/m2 and for the palpation group 37.3 (5.2) kg/m2. There was no difference in the composite primary outcome (median (interquartile range) [range]) between the ultrasound group (4 (2-13) [2-22]) and the palpation group (6 (4-10) [1-17]) (P=0.22), with the 95% confidence interval of the difference 2 (-1.7 to 5.7). There were no differences in the secondary outcomes. CONCLUSIONS: Handheld ultrasound did not demonstrate any advantages over traditional palpation techniques for spinal anesthesia in an obese population undergoing cesarean delivery, although the study was underpowered to show a difference.

Tillering dynamics in spring and summer of marandu palisade grass pastures previously used under deferred grazing / [Dinâmica de perfilhamento na primavera e no verão de pastagens de capim-marandu previamente utilizadas sob pastejo diferido]

This work was conducted to evaluate the effect of deferred pasture condition of Brachiaria brizantha cv. Marandu in the late winter on tillering during the growing season. The treatments were three pasture conditions at late winter: short pasture, tall pasture and tall/mown pasture. In September and October, tiller appearance rate (TApR) and tiller mortality rate (TMoR) were greater in the tall/mown pasture. In November and December, tall pasture presented greater TApR. From November to January the TMoR was greater in the tall pasture. The tiller stability index of short and tall/mown pastures were greater in October. The short pasture presented a greater tiller number than the tall and tall/mown pastures during the entire experimental period. Deferred and short pasture of marandu palisade grass at late winter presents in general lower tiller mortality and higher population density of tillers from the early spring onwards, in comparison to tall pasture. The mowing of marandu palisade grass with high forage mass at the late winter, although it only temporarily compromises the population stability of tillers, also stimulates its fast tillering from spring on.(AU)

Este trabalho foi conduzido com o objetivo de avaliar o efeito da condição da pastagem diferida de Brachiaria brizantha cv. Marandu ao final do inverno sobre o perfilhamento durante a estação de crescimento. Os tratamentos foram três condições de pastagem no final do inverno: pasto baixo, pasto alto e pasto alto/roçado. Nos meses de setembro e outubro, a taxa de aparecimento de perfilhos (TApP) e a taxa de mortalidade de perfilhos (TMoP) foram maiores na pastagem alta/roçada. Nos meses de novembro e dezembro, a pastagem alta apresentou maior TApP. De novembro a janeiro, a TMoP foi maior na pastagem alta. Os índices de estabilidade de perfilhos das pastagens baixas e altas/roçadas foram maiores em outubro. A pastagem baixa apresentou maior número de perfilhos do que as pastagens altas e altas/roçadas durante todo o período experimental. A pastagem diferida e baixa de capim-marandu no final do inverno apresenta, em geral, menor mortalidade de perfilhos e maior densidade populacional de perfilhos no início da primavera, em comparação com a pastagem alta. A roçada do capim-marandu com alta massa de forragem ao final do inverno, embora comprometa apenas temporariamente a estabilidade populacional dos perfilhos, também estimula o perfilhamento rápido a partir da primavera.(AU)

Morphogenesis of stockpiled Marandu, Piatã, Xaraés and Paiaguás brachiaria grass cultivars / [Morfogênese de cultivares de capins marandu piatã, xaraés e paiaguás diferidos]

The objective this study was to identify differences in the morphogenic patterns of four Urochloa brizantha cultivars (marandu, piatã, xaraés and paiaguás grasses) during the stockpiling period. A completely randomized design was used, with three replications, in experimental plots of 9m². The evaluations took place over 2 years. The grasses were stockpiled for 92 (Year 1) and 95 (Year 2) days. The leaf appearance rate of paiaguás grass was higher, compared to other grasses. In Year 1, the stem elongation rate of xaraés grass was higher than other grasses. At the end of stockpiling period of Year 1, the tiller population density (TPD) was higher in the paiaguás grass, intermediate in the xaraés and marandu grasses and lower in the piatã grass. At the end of the stockpiling period in Year 2, TPD was higher in the paiaguás grass canopy, intermediate in the marandu and piatã grasses canopies, and lower in the xaraés grass canopy. Paiaguás grass has greater leaf growth during the stockpiling period and is therefore suitable for use under stockpiled grazing. Xaraés grass has high stem elongation during the stockpiling period, which is why its use under stockpiled grazing must be accompanied by adjustments in pasture management.(AU)

O objetivo deste estudo foi identificar diferenças nos padrões morfogênicos de quatro cultivares de Urochloa brizantha (marandu, piatã, xaraés e paiaguás) durante o período de diferimento. Foi utilizado o delineamento inteiramente ao acaso, com três repetições, em parcelas experimentais de 9m². As avaliações ocorreram por dois anos. Os capins foram diferidos por 92 (Ano 1) e 95 (Ano 2) dias. A taxa de aparecimento foliar do capim-paiaguás foi maior, em comparação aos demais capins. No Ano 1, a taxa de alongamento do colmo do capim-xaraés foi superior aos demais capins. No final do diferimento do Ano 1, a densidade populacional de perfilho (DPP) foi maior no capim-paiaguás, intermediária nos capins xaraés e marandu e inferior no capim-piatã. No fim do período de diferimento do Ano 2, a DPP foi superior no dossel de capim-paiaguás, intermediária nos dosséis dos capins marandu e piatã, e menor no dossel de capim-xaraés. O capim-paiaguás tem maior crescimento foliar durante o período de diferimento, sendo, portanto, apropriado para uso sob pastejo diferido. O capim-xaraés apresenta elevado alongamento de colmo durante o período de diferimento, razão pela qual seu uso sob pastejo diferido deve vir acompanhado de ajustes no manejo da pastagem.(AU)

Does the lowering strategy before the stockpiling period modify the marandu palisade grass production and structure? / [A estratégia de desfolhação prévia ao período de diferimento modifica a produção e a estrutura do capim-marandu?]

The objective was to identify lowering strategies for Urochloa brizantha cv. Marandu in the beginning of the stockpiling period that increase forage production and improve the structure of stockpiled canopies. Three lowering strategies were evaluated: maintenance of marandu palisade grass with 15cm four months before the stockpiling period; maintenance of palisade grass with 30cm for four months, and lowering to 15cm before the stockpiling period; and maintaining of palisade grass at 45cm for four months, and lowering to 15cm before the stockpiling period. The experimental design was completely randomized, with four replications. At the end of stockpiling, the number of reproductive tillers and forage mass were higher in the canopy under 15/15cm than in the others; the percentage of live leaf was higher in the canopy under 45/15cm than under 15/15cm. Forage production during the stockpiling period was higher in the canopy under 15/15cm and lower in the under 45/15cm. Maintaining 15cm marandu palisadegrass for four months before the stockpiling period increases forage production during this period. The lowering of the marandu palisadegrass from 45 to 15cm at the beginning of the stockpiling period improves the structure of the stockpiled canopy.(AU)

Objetivou-se identificar estratégias de rebaixamento da Urochloa brizantha cv. Marandu no início do diferimento, as quais resultem em aumento da produção e em melhoria da estrutura do dossel diferido. Foram avaliadas três estratégias de rebaixamento no início do diferimento: manutenção do capim-marandu com 15cm por quatro meses antes do início do diferimento; manutenção do capim-marandu com 30cm por quatro mese, e rebaixamento para 15cm no início do diferimento; e manutenção do capim com 45cm por quatro meses e rebaixamento para 15cm no início do diferimento. O delineamento foi inteiramente ao acaso, com quatro repetições. No fim do diferimento, o número de perfilho reprodutivo e a massa de forragem foram superiores no dossel sob 15/15cm do que nos demais; a percentagem de folha viva foi maior no dossel sob 45/15cm do que sob 15/15cm. A produção de forragem durante o diferimento foi superior no dossel sob 15/15cm e inferior no sob 45/15cm. A manutenção do capim-marandu com 15cm por quatro meses antes do período de diferimento aumenta a produção de forragem neste período. O rebaixamento do capim-marandu de 45 para 15cm no início do diferimento melhora a estrutura do dossel diferido.(AU)

A systematic review of patient-reported outcome measures used to assess sleep in postpartum women using Consensus Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines.

STUDY OBJECTIVES: We performed a systematic review to identify the best patient-reported outcome measure (PROM) of postpartum sleep in women. METHODS: We searched four databases for validated PROMs used to assess postpartum sleep. Studies were considered if they evaluated at least one psychometric measurement property of a PROM. An overall performance rating was assigned for each psychometric measurement property of each PROM based upon COSMIN criteria. A modified GRADE approach was used to assess the level of evidence and recommendations were then made for each PROM. RESULTS: We identified 15 validation studies of eight PROMs, in 9,070 postpartum women. An adequate number of sleep domains was assessed by five PROMs: Bergen Insomnia Scale (BIS), Pittsburgh Sleep Quality Index (PSQI), General Sleep Disturbance Scale (GSDS), Athens Insomnia Scale (AIS), and the Sleep Symptom Checklist (SSC). BIS and GSDS were the only PROMs to demonstrate adequate content validity and at least a low level of evidence of sufficient internal consistency, resulting in Class A recommendations. The BIS was the only PROM, which is easily accessible and free to use for noncommercial research, that achieved a Class A recommendation. CONCLUSION: The BIS is the best currently available PROM of postpartum sleep. However, this PROM fails to assess several important domains such as sleep duration (and efficiency), chronotype, sleep-disordered breathing and medication usage. Future studies should focus on evaluating the psychometric measurement properties of BIS in the North American setting and in different cultural groups, or to develop a more specific PROM of postpartum sleep.