Secular Trends in Preterm Birth: A Hospital-Based Cohort Study

Context.— Canada and the United States have reported a recent increase in the incidence of preterm birth, but the reasons for this increase are unknown. Objective.— To assess secular trends in preterm birth and its potential determinants. Design.— Hospital-based cohort study. Setting.— Canadian tertiary care university teaching hospital, 1978-1996. Participants.— A total of 65,574 nonreferred live births and stillbirths. Main Outcome Measures.— Changes in occurrence of preterm birth, before and after adjustment for changes in method of gestational age assessment, obstetric intervention, registration of births weighing less than 500 g, and sociodemographic, behavioral, and clinical determinants. Results.— A crude secular increase in preterm births was seen for births less than 37, 34, and 32 completed weeks using 3 alternative gestational age estimation methods. Based on an algorithm incorporating both menstrual and early ultrasound gestational age estimates, rates increased from 6.6% to 9.8% for births at less than 37 weeks' gestation, 1.7% to 2.3% at less than 34 weeks, and 1.0% to 1.2% at less than 32 weeks. Exclusion of births weighing less than 500 g and those with induction or preterm cesarean delivery without labor before each of the corresponding gestational age cutoffs eliminated the secular trends for births before 34 and 32 weeks and attenuated the trend for births before 37 weeks. Nearly half of the remaining trend for births before 37 weeks was accounted for by the increasing use of early ultrasound dating. The residual trend was eliminated after controlling for secular increases in unmarried status and the proportion of women aged 35 years or older. These factors, combined with a decrease in alcohol consumption and increases in histological chorioamnionitis and cocaine use, appear to have counteracted a reduction in preterm birth since the mid-1980s that otherwise would have been observed. Conclusions.— This hospital's increase in preterm births since 1978 parallels increases reported in population-based national studies from the United States and Canada. This trend appears largely attributable to the increasing use of early ultrasound dating, preterm induction and preterm cesarean delivery without labor, and changes in sociodemographic and behavioral factors.      

Biophysical characterization of recombinant human ameloblastin

Ameloblastin (AMBN) is a protein expressed mainly during dental hard tissue development. Biochemically, it is classified as an intrinsically disordered protein (IDP). Its biological role remains largely unknown; however, the question of AMBN function will undoubtedly be connected to its structural properties and its potential for protein-protein and protein-cell interactions. A basic biophysical characterization of human recombinant ameloblastin (hrAMBN) and its N- and C-terminal domains by means of circular dichroism spectroscopy and dynamic light scattering showed that under physiological conditions ameloblastin is an IDP with a prevalent polyproline-II (PPII) conformation. Both the N- and C-terminal polypeptides, when expressed independently, showed different structural preferences upon heating as well as different behaviour in the presence of trifluoroethanol and CaCl(2) salt. The N-terminal peptide showed a more ordered structure with a strong tendency to adopt a helical conformation upon the addition of trifluorethanol, whereas the C-terminal domain seemed to be primarily responsible for the structural disorder of the entire AMBN molecule.     

Contextualism adds realism: nursing students' perceptions of and performance in numeracy skills tests

This project investigated nursing students' perceptions of and performance in a de-contextualised diagnostic maths paper (i.e. questions only) and a contextualised diagnostic maths paper (i.e. visual pictures along with questions). Sampling was purposive, the criteria being that participants would be from the population of student nurses (n=700) in their second year, of a three-year Bachelor of Nursing course, undertaking a Unit 'Medical-Surgical Nursing 1' (MSN1) at one of four campuses across the University of Western Sydney (UWS), NSW, Australia. The numerical test scores for both papers were analysed with the assistance of SPSS software and a Professional Development Officer. The survey data were analysed manually and thematically by the researcher. There was a substantive improvement in scores from Test 1 (de-contextualised) to Test 2 (contextualised). It is uncertain whether the change occurred because Test 2 is a genuinely better presentation than Test 1 or just a practice effect. Nevertheless, the contextualised paper was preferred by the majority of students (80%). Students preferred the visual images and revealed that it led to a "deeper learning" of numeracy skills, reduced stress and anxiety levels and simulated 'the real life' clinical setting, thus adding "an element of realism" to the situation.     

Degradation-induced changes of mechanical properties of an electro-spun polyester-urethane scaffold for soft tissue regeneration

The aim of this study was the in vitro investigation of the change in mechanical properties of a fast-degrading electro-spun polymeric scaffold for the use in soft tissue regenerative implants. Tubular scaffolds were electro-spun from a DegraPol? D30 polyesther-urethane solution (target outer diameter: 5.0 mm; scaffold wall thickness: 0.99 ± 0.18 mm). Scaffold samples were subjected to hydrolytic in vitro degradation for up to 34 days. The fiber network structure and fiber surfaces were inspected on scanning electron micrographs. Following vacuum drying and determination of mass, flat samples (9.69 ± 0.21 × 18.47 ± 2.62 mm, n = 5) underwent uni-axial tensile testing (5 load cycles, strain ε = 0 to 20%; final extension to failure) in circumferential scaffold direction after 5, 10, 14, 18, 22, 26, 30, and 34 days of degradation. Scaffold mass did not change with degradation. Maximum elastic modulus, maximum stress and associated strain were E(max) = 1.14 ± 0.23 MPa, σ(max) = 0.52 ± 0.12 MPa and ε(max) = 176.8 ± 21.9% before degradation and E(max) = 0.43 ± 0.26 MPa, σ(max) = 0.033 ± 0.028 MPa and ε(max) = 24.6 ± 3.0% after 34 days of degradation. The deterioration of mechanical properties was not reflected in the ultrastructural surface morphology of the fibers. The current exploratory study provides a basis for the development of constitutive computational models of biodegradable scaffolds with future extension of the investigation most importantly to capture mechanical effects of regenerating tissue. Future studies will include degradation in biological fluids and assessment of molecular weight for an advanced understanding of the material changes during degradation.