Improved approximation and visualization of the correlation matrix.

The graphical representation of the correlation matrix by means of different multivariate statistical methods is reviewed, a comparison of the different procedures is presented with the use of an example data set, and an improved representation with better fit is proposed. Principal component analysis is widely used for making pictures of correlation structure, though as shown a weighted alternating least squares approach that avoids the fitting of the diagonal of the correlation matrix outperforms both principal component analysis and principal factor analysis in approximating a correlation matrix. Weighted alternating least squares is a very strong competitor for principal component analysis, in particular if the correlation matrix is the focus of the study, because it improves the representation of the correlation matrix, often at the expense of only a minor percentage of explained variance for the original data matrix, if the latter is mapped onto the correlation biplot by regression. In this article, we propose to combine weighted alternating least squares with an additive adjustment of the correlation matrix, and this is seen to lead to further improved approximation of the correlation matrix.

Corrigendum/Erratum to "Livestock water and land productivity in Kenya and their implications for future resource us" [].

[This corrects the article DOI: 10.1016/j.heliyon.2022.e09006.].

Livestock water and land productivity in Kenya and their implications for future resource use.

Population growth and rising affluence increase the demand for agricultural commodities. Associated growth in production increases dependency on natural resources in countries that attempt to meet part or all of the new demand locally. This study assesses the impact of changing meat and milk production on natural resource use in Kenya under three plausible scenarios of socio-economic development, namely Business-As-Usual (BAU), Sustainable Development (SDP) and Kenya Vision 2030 (V2030) scenarios. The IMPACT model is used to estimate projected cattle, sheep, goats and camel production parameters for meat and milk. The BAU and SDP represent standard scenarios for Kenya of a global economic model, IMPACT, while V2030 incorporates in the model features specific to Kenya's medium-term national development plan. We use calculations of water footprint and land footprint as resource use indicators to quantify the anticipated appropriation of water and land resources for meat and milk production and trade by 2040. Though camel dairy production numbers increase the most by quadrupling between 2005 and 2040, it is cattle dairy production that significantly determined gains in production between the scenarios. Productivity gains under the SDP scenario does not match the investments made thereby leading to only slightly better values for water and land productivity than those achieved under the BAU scenario. Relative to the BAU scenario, improvement in land productivity under the V2030 scenario is the most dramatic for shoat milk production in the arid and semi-arid systems but the least marked for cattle milk production in the humid system. By quantifying water and land productivity across heterogenous production systems, our findings can aid decision-makers in Kenya and other developing countries to understand the implications of strategies aimed at increasing domestic agricultural and livestock production on water and land resources both locally and through trade with other countries.

Global trends in grassland carrying capacity and relative stocking density of livestock.

Although the role of livestock in future food systems is debated, animal proteins are unlikely to completely disappear from our diet. Grasslands are a key source of primary productivity for livestock, and feed-food competition is often limited on such land. Previous research on the potential for sustainable grazing has focused on restricted geographical areas or does not consider inter-annual changes in grazing opportunities. Here, we developed a robust method to estimate trends and interannual variability (IV) in global livestock carrying capacity (number of grazing animals a piece of land can support) over 2001-2015, as well as relative stocking density (the reported livestock distribution relative to the estimated carrying capacity [CC]) in 2010. We first estimated the aboveground biomass that is available for grazers on global grasslands based on the MODIS Net Primary Production product. This was then used to calculate livestock carrying capacities using slopes, forest cover, and animal forage requirements as restrictions. We found that globally, CC decreased on 27% of total grasslands area, mostly in Europe and southeastern Brazil, while it increased on 15% of grasslands, particularly in Sudano-Sahel and some parts of South America. In 2010, livestock forage requirements exceeded forage availability in northwestern Europe, and southern and eastern Asia. Although our findings imply some opportunities to increase grazing pressures in cold regions, Central Africa, and Australia, the high IV or low biomass supply might prevent considerable increases in stocking densities. The approach and derived open access data sets can feed into global food system modelling, support conservation efforts to reduce land degradation associated with overgrazing, and help identify undergrazed areas for targeted sustainable intensification efforts or rewilding purposes.

Forceps and vacuum: one goal, two entities.

Damage to the pelvic floor during pregnancy and vaginal delivery is an inevitable consequence of the natural birthing process. As this damage is associated with functional and anatomical problems in later life, minimizing pelvic floor damage during pregnancy and vaginal delivery may serve as an important factor in the prevention of these unwanted sequelae. Operative vaginal delivery using forceps or vacuum extractor is common practice to achieve or expedite vaginal birth for maternal or fetal indications such as maternal exhaustion or fetal distress. However, operative vaginal delivery is associated with more extensive damage to the pelvic floor and perineal structures with forceps carrying a stronger risk compared to vacuum. The evidence on this subject is discussed with possible suggestions to minimize pelvic floor damage as much as possible.

Early plant organics increased global terrestrial mud deposition through enhanced flocculation.

An irreversible increase in alluvial mudrock occurred with the Ordovician-Silurian evolution of bryophytes, challenging a paradigm that deep-rooted plants were responsible for this landscape shift. We tested the idea that increased primary production and plant organics promoted aggregation of clay into flocs in rivers and facilitated mud deposition on floodplains. In experiments, we observed that clay readily flocculated for organic and clay concentrations common to modern rivers, yielding settling velocities three orders of magnitude larger than those without organics. Using a transport model, we found that flocculation substantially increased mud deposition, resulting in muddier floodplains. Thus, organic-induced flocculation may have been more critical than deep-rooted plants in the proliferation of muddy floodplains.

Cranberries after pelvic floor surgery for urinary tract infection prophylaxis: A randomized controlled trial.

AIMS: Urinary tract infection (UTI) is a common complication after pelvic floor surgery. Antibiotics as prophylaxis may reduce the prevalence of UTI's by 50%, but bacterial resistance may be a large disadvantage, necessitating the search for other possible prophylactic options. Recent research found a 50% reduction in the rate of UTI's with the use of cranberry capsules after elective gynecologic surgery, suggesting that cranberry capsules may serve as a good prophylaxis. The aim of this study was to assess whether perioperative cranberry prophylaxis reduces the risk of clinical overt UTI after elective pelvic floor surgery with indwelling catheter. METHODS: We conducted a single-center randomized, double-blind, placebo-controlled trial. Women were given cranberry capsules twice daily or identical placebo for 6 weeks, starting the day before surgery. The main endpoint of the trial was the incidence of UTI within 6 weeks after surgery, defined as clinical diagnosis and treatment of UTI by the medical doctor. Analyses were performed with the intention to treat. RESULTS: Two hundred ten participants were included, 105 in each arm. There was no significant difference in the prevalence of UTI between the cranberry arm (n = 13, 12.4%) and the placebo arm (n = 21, 20.0%; P = .13), but the prevalence in both arms was lower than anticipated. CONCLUSIONS: This trial shows no beneficial effect of adequately dosed cranberry prophylaxis in women undergoing pelvic floor surgery, although such effect cannot be ruled out in settings with a higher prevalence of UTI's.

Leaf cuticle analyses: implications for the existence of cutan/non-ester cutin and its biosynthetic origin.

BACKGROUND AND AIMS: The cuticle of a limited number of plant species contains cutan, a chemically highly resistant biopolymer. As yet, the biosynthesis of cutan is not fully understood. Attempting to further unravel the origin of cutan, we analysed the chemical composition of enzymatically isolated cuticular membranes of Agave americana leaves. METHODS: Cuticular waxes were extracted with organic solvents. Subsequently, the dewaxed cuticular membrane was depolymerized by acid-catalysed transesterification yielding cutin monomers and cutan, a non-hydrolysable, cuticular membrane residue. The cutan matrix was analysed by thermal extraction, flash pyrolysis and thermally assisted hydrolysis and methylation to elucidate the monomeric composition and deduce a putative biosynthetic origin. KEY RESULTS: According to gas chromatography-mass spectrometry analyses, the cuticular waxes of A. americana contained primarily very-long-chain alkanoic acids and primary alkanols dominated by C32, whereas the cutin biopolyester of A. americana mainly consisted of 9,10-epoxy ω-hydroxy and 9,10,ω-trihydroxy C18 alkanoic acids. The main aliphatic cutan monomers were alkanoic acids, primary alkanols, ω-hydroxy alkanoic acids and alkane-α,ω-diols ranging predominantly from C28 to C34 and maximizing at C32. Minor contributions of benzene-1,3,5-triol and derivatives suggested that these aromatic moieties form the polymeric core of cutan, to which the aliphatic moieties are linked via ester and possibly ether bonds. CONCLUSIONS: High similarity of aliphatic moieties in the cutan and the cuticular wax component indicated a common biosynthetic origin. In order to exclude species-specific peculiarities of A. americana and to place our results in a broader context, cuticular waxes, cutin and cutan of Clivia miniata, Ficus elastica and Prunus laurocerasus leaves were also investigated. A detailed comparison showed compositional and structural differences, indicated that cutan was only found in leaves of perennial evergreen A. americana and C. miniata, and made clear that the phenomenon of cutan is possibly less present in plant species than suggested in the literature.

[Better training in perineal injury is desirable]. / Betere training over perineumletsel gewenst.

Better training in perineal injury is desirable One of the most common complaints from women following childbirth is perineal pain, caused by perineal trauma. The episiotomy technique, the suture material chosen, the suture technique, and the knowledge and skills of the care-provider all influence healing and subsequent symptoms. Evidence-based techniques are associated with fewer symptoms and complications; however, the literature reveals that care-providers are often inexperienced, not well trained or not conscientious enough in: performing an accurate episiotomy; assessing perineal trauma; diagnosing anal-sphincter injuries; and evidence-based repair techniques. The angle at which an episiotomy is performed and the suture techniques used vary considerably, while the evidence shows emphatically which techniques are optimal. We believe that the responsibility for the improvement of knowledge and skills lies with the care-providers. Despite the absence of obligation, they should attend repeated training sessions, to guarantee the optimal quality of perineal care following childbirth.

Quantitative analysis of diverse sporomorph-derived sporopollenins.

Over the years studies on sporopollenin have reported a wide variety of structures. However, the methods and techniques used to elucidate sporopollenin structures are highly diverse so that much is still unclear with respect to the nature and structural diversity of sporopollenins. In order to investigate the structural diversity in sporopollenin between different taxa, extant sporomorphs of ten different species ranging from a mushroom to a cycad were examined using a relatively simple and fast analytical procedure. Sporomorphs, before and after saponification, were analysed for sporopollenin composition by Thermally assisted Hydrolysis and Methylation (THM) using [13C]tetramethylammonium hydroxide ([13C]TMAH). The sporomorp chemical composition differed markedly between the groups of organisms analysed. Moreover, we not only identified the nature and relative quantities of the well-known sporopollenin constituents p-coumaric acid and ferulic acid but also many other phenolic moieties, such as caffeic acid, which appeared to be the most abundant phenolic constituent in spores of Equisetum palustre, Salvinia molesta, Cyrtomium falcatum and Anemia phyllitidis. Within the two Equisetum species analysed as well as in the closely related Azolla and Salvinia species the same suite of phenolic constituents were observed, but their relative distribution varied largely. We thus demonstrate the existence of a high structural diversity, both qualitatively and quantitatively in sporopollenins enabling future studies related to the evolution, phylogeny and (palaeo)environment of sporopollenin-producing organisms. Furthermore, a better knowledge of sporopollenin and its structural variety is of relevance to the rapidly growing application of spores and pollen as a drug delivery agent in medicine.

Balloon catheter for induction of labor in women with one previous cesarean and an unfavorable cervix.

INTRODUCTION: When women with a previous cesarean section and an unfavorable cervix have an indication for delivery, the choice is to induce labor or to perform a cesarean section. This study aims to assess the effectiveness and safety of a balloon catheter as a method of induction of labor in women with one previous cesarean section and an unfavorable cervix compared with an elective repeat cesarean section. MATERIAL AND METHODS: We performed a prospective cohort study in 51 hospitals in the Netherlands on term women with one previous cesarean section, a live singleton fetus in cephalic position, an unfavorable cervix and an indication for delivery. We recorded obstetric, maternal and neonatal characteristics. We compared the outcome of women who were induced with a balloon catheter with the outcome of women who delivered by elective repeat cesarean section. Main outcomes were maternal and neonatal morbidity. Mode of delivery was a secondary outcome for women who were induced. Adjusted odds ratios (aOR) were calculated using logistic regression, adjusted for potential confounders. RESULTS: Analysis was performed on 993 women who were induced and 321 women who had a repeat cesarean section (August 2011 until September 2012). Among the women who were induced, 560 (56.4%) delivered vaginally and 11 (1.1%) sustained a uterine rupture. Composite adverse maternal outcome (uterine rupture, severe postpartum hemorrhage or postpartum infection) occurred in 73 (7.4%) in the balloon and 14 (4.5%) women in the repeat cesarean section group (aOR 1.58, 95% confidence interval [CI] 0.85-2.96). Composite adverse neonatal outcome (Apgar score <7 at 5 minutes or umbilical pH <7.10) occurred in 57 (5.7%) and 10 (3.2%) neonates, respectively (aOR 1.40, 95% CI 0.87-3.48). Women who were induced had a shorter postpartum admission time (2.0 vs 3.0 days (P < 0.0001)). CONCLUSIONS: In women with a previous cesarean section and a need for delivery, induction of labor with a balloon catheter does not result in a significant increase in adverse maternal and neonatal outcomes as compared with planned cesarean section.

Implementation of a perineal support programme for reduction of the incidence of obstetric anal sphincter injuries and the effect of non-compliance.

OBJECTIVE: Obstetric anal sphincter injury (OASI) is a serious complication of a vaginal delivery. In 2005, a Norwegian nation-wide training programme to reduce the OASI rate was successfully implemented. The aim of the present study was to assess the impact of a perineal support programme, inspired by the Norwegian programme, on the incidence of OASIs in a Dutch hospital with a low a priori rate. STUDY DESIGN: Prospective cohort study with historical comparison group. Three midwives and one obstetrician were trained on site by an expert midwife from Norway. These four trained the rest of the obstetrical staff. Data were prospectively recorded using the Dutch National Perinatal Registry, with additional recording whether the manual perineal support was actually applied in individual deliveries. OASI rates in three time periods were studied: the year preceding the training programme, the training period of 7 months and the year after the training period (respectively "control period", "training period" and "result period"). After exclusion of caesarean sections, preterm deliveries, breech and twin deliveries, a total of 4391 deliveries were recorded during the study period. RESULTS: During the training period, the OASI rate decreased significantly from 2.0 to 0.7% (aOR 0.34; 95%CI 0.15-0.76). In the result period, manual perineal support was performed in 72.7% of the deliveries and the overall OASI rate raised to 1.7% again, mainly because of non-compliance to the programme during vacuum deliveries. Nevertheless, multivariate logistic regression analysis with correction for known OASI risk factors showed that the OASI rate was 83% lower with application of perineal support (aOR 0.17; 95%CI 0.07-0.39). CONCLUSION: A perineal support programme decreases OASI rate. Continuous verification of application and repetitive training is necessary, especially during vacuum deliveries.

The effectiveness of mediolateral episiotomy in preventing obstetric anal sphincter injuries during operative vaginal delivery: a ten-year analysis of a national registry.

INTRODUCTION AND HYPOTHESIS: Obstetric anal sphincter injuries (OASIS) are associated with an increased risk of faecal incontinence after vaginal delivery. The aim of this retrospective population-based cohort study was to assess whether mediolateral episiotomy is associated with a reduction in the rate of OASIS during operative vaginal delivery. METHODS: We used data from the Dutch Perinatal Registry (Perined) that includes records of almost all births between 2000 and 2010 in The Netherlands. In a cohort of 170,969 primiparous and multiparous women whose delivery was recorded, we estimated the association between mediolateral episiotomy and OASIS following both vacuum and forceps deliveries using univariate and multivariate logistic regression analysis. RESULTS: The incidences of OASIS following vacuum delivery in 130,157 primiparous women were 2.5% and 14% in those with and without a mediolateral episiotomy, respectively (adjusted OR 0.14, 95% CI 0.13-0.15), and in 29,183 multiparous women were 2.0% and 7.5%, respectively (adjusted OR 0.23, 95% CI 0.21-0.27). The incidences of OASIS following forceps delivery in 9,855 primiparous women were 3.4% and 26.7% in those with and without a mediolateral episiotomy, respectively (adjusted OR 0.09, 95% CI 0.07-0.11), and in 1,774 multiparous women were 2.6% and 14.2%, respectively (adjusted OR 0.13, 95% CI 0.08-0.22). CONCLUSIONS: The use of a mediolateral episiotomy during both vacuum delivery and forceps delivery is associated with a fivefold to tenfold reduction in the rate of OASIS in primiparous and multiparous women.

The MOVE-trial: Monocryl® vs. Vicryl Rapide™ for skin repair in mediolateral episiotomies: a randomized controlled trial.

BACKGROUND: Previous studies have shown that complaints after episiotomy repair depend on the method and material used for repair. The objective of our study was to determine which of two frequently used suture materials, Monocryl® (poliglecaprone 25) and Vicryl Rapide™ (polyglactin 910), is superior for intracutaneous closure of the skin in mediolateral episiotomies. METHODS: In a randomized controlled trial performed in a teaching hospital in the Netherlands between 2010 and 2013 250 primiparous women with uncomplicated mediolateral episiotomies were randomly allocated to intracutaneous skin closure with either Monocryl® or Vicryl Rapide™. All other layers were sutured with Vicryl 2-0 and Vicryl 0 in both groups. Pain scores and complications were documented using questionnaires during the first three months post partum. The primary outcome was pain 10 days after delivery in sitting position established by Visual Analogous Scale (VAS). Secondary outcomes were pain scores at different time points and reported complications such as infections, dehiscence and dyspareunia one day, 10 days, six weeks and three months after delivery. RESULTS: Of 250 allocated women 54% returned questionnaires. No statistical difference was found between both groups for the primary outcome (VAS 2,8 (95% CI 2,18-3,44) vs. VAS 2,5 (95% CI 2,00-2,98), p = 0,43). With regard to secondary outcomes only self-reported dehiscence was significantly different, favouring Monocryl® (10% vs. 25%, p = 0.016). CONCLUSIONS: Use of Monocryl® 3-0 and Vicryl Rapide™ 3-0 for intracutaneous closure of the skin after mediolateral episiotomy leads to equal pain scores ten days after delivery and therefore both materials may be considered for this use. Monocryl® 3-0 might be favourable over Vicryl Rapide™ 3-0 due to less self-reported dehiscence after intracutaneous closure of the skin in mediolateral episiotomies. TRIAL REGISTRATION: The trial was retrospectively registered under trial nr. ISRCTN29869308 on 20-04-2016.

Choice of mode of delivery in a subsequent pregnancy after OASI: a survey among Dutch gynecologists.

INTRODUCTION AND HYPOTHESIS: National and international guidelines do not provide clear recommendations on the mode of delivery in a subsequent pregnancy after obstetric anal sphincter injury (OASI). The aim of this study was to investigate the opinion of gynecologists in The Netherlands on this choice and the extent to which this choice is affected by the gynecologist's characteristics. METHODS: Of 973 gynecologists sent a questionnaire seeking their opinion on the mode of delivery in 16 different case descriptions, 234 (24%) responded. Factors influencing the opinion of the respondents on the mode of delivery, the presence of anal symptoms, the degree of OASI and the characteristics of the respondents were analyzed by univariate and multivariate logistic regression analysis. RESULTS: Recommendations on the mode of delivery in a subsequent pregnancy after OASI showed considerable variation. The recommendations depended on (previous) symptoms and the degree of OASI. For gynecologists who based their recommendations on endoanal ultrasonography outcomes (7-20% depending on the case), the degree of OASI and severity of (previous) symptoms were less important. Gynecologists basing their recommendations on endoanal ultrasonography recommended a primary cesarean section less often. Gynecologist's characteristics (including years of experience, type of hospital and subspecialty) had a small effect on their recommendations on the mode of delivery. CONCLUSIONS: Due to lack of evidence, recommendations of gynecologists in The Netherlands on the mode of delivery in a subsequent pregnancy after OASI vary widely and depend on (previous) symptoms and the degree of OASI. Gynecologists who based their recommendations on endoanal ultrasonography outcomes recommended cesarean section less often.

Women's Experiences with and Preference for Induction of Labor with Oral Misoprostol or Foley Catheter at Term.

Objective We assessed experience and preferences among term women undergoing induction of labor with oral misoprostol or Foley catheter. Study Design In 18 of the 29 participating hospitals in the PROBAAT-II trial, women were asked to complete a questionnaire within 24 hours after delivery. We adapted a validated questionnaire about expectancy and experience of labor and asked women whether they would prefer the same method again in a future pregnancy. Results The questionnaire was completed by 502 (72%) of 695 eligible women; 273 (54%) had been randomly allocated to oral misoprostol and 229 (46%) to Foley catheter. Experience of the duration of labor, pain during labor, general satisfaction with labor, and feelings of control and fear related to their expectation were comparable between both the groups. In the oral misoprostol group, 6% of the women would prefer the other method if induction is necessary in future pregnancy, versus 12% in the Foley catheter group (risk ratio: 0.70; 95% confidence interval: 0.55-0.90; p = 0.02). Conclusion Women's experiences of labor after induction with oral misoprostol or Foley catheter are comparable. However, women in the Foley catheter group prefer more often to choose a different method for future inductions.