Twin Births Research Articles

CHARACTERISTICS OF RETINOPATHY OF PREMATURITY IN MAKASSAR BETWEEN JANUARY 2020 AND DECEMBER 2022

Introduction & Objectives : Introduction: Retinopathy of Prematurity (ROP) is one of the leading causes of irreversible visual impairment in infants, especially in premature infants. Preterm birth leads to incomplete development of retina that will cause ROP. ROP screening is an early strategy to prevent irreversible blindness in ROP. Objective: The purpose of this study was to describe the characteristics of ROP in Makassar between January 2020 and December 2022.
 Methods : A multi-center observational descriptive study at ten hospitals in Makassar.
 Results : The total patients in this study were 168 infants (336 eyes) included 53.25% male and 46.15% female. The incidence of ROP in Makassar between January 2020 and December 2022 was 14.87%. Most of the patients had history of preterm birth with gestational age ranged from 28 to 33 weeks and low birth weight less than 1500 gram in 50% patients. Majority of patients had history of oxygen therapy (77.98%), and other risk factors such as sepsis, twin birth, history of transfusion, or apnea. About 98.81% patients had bilateral ROP and 33.93% were diagnosed with stage 3 at first screening. Photocoagulation laser was done in 41 patients (24.40%).
 Conclusion : The ROP screening in Makassar had a good outcome in managing the premature infants, so they can be diagnosed and got treated earlier. A sustainable screening program is required to prevent the irreversible blindness due to ROP.

Digital Twin Prototypes for Supporting Automated Integration Testing of Smart Farming Applications

Industry 4.0 marks a major technological shift, revolutionizing manufacturing with increased efficiency, productivity, and sustainability. This transformation is paralleled in agriculture through smart farming, employing similar advanced technologies to enhance agricultural practices. Both fields demonstrate a symmetry in their technological approaches. Recent advancements in software engineering and the digital twin paradigm are addressing the challenge of creating embedded software systems for these technologies. Digital twins allow full development of software systems before physical prototypes are made, exemplifying a cost-effective method for Industry 4.0 software development. Our digital twin prototype approach mirrors software operations within a virtual environment, integrating all sensor interfaces to ensure accuracy between emulated and real hardware. In essence, the digital twin prototype acts as a prototype of its physical counterpart, effectively substituting it for automated testing of physical twin software. This paper discusses a case study applying this approach to smart farming, specifically enhancing silage production. We also provide a lab study for independent replication of this approach. The source code for a digital twin prototype of a PiCar-X by SunFounder is available open-source on GitHub, illustrating how digital twins can bridge the gap between virtual simulations and physical operations, highlighting the symmetry between physical and digital twins.

Digital Twins to Predict Crack Propagation of Sustainable Engineering Materials under Different Loads

Computer-aided engineering (CAE) is an essential tool in a digital twin not only to verify and validate a virtual twin before it is transformed into a physical twin, but also to monitor the use of the physical twin for enhanced sustainability. This paper aims to develop a CAE model for a digital twin to predict the fatigue life of materials. Fatigue damage is represented by the size of a macro-crack that grows with a cluster of micro-cracks subjected to three different loads. The growth angle is related to the maximum circumferential tensile stress, and the growth rate is determined by the stress intensity factor (SIF) at the crack tip. The prediction model takes into consideration the main factors, including micro-cracks, crack closures, and initial configurations. Simulations are developed for the growth of macro-cracks with radially distributed micro-cracks and randomly distributed micro-cracks, and we find that (1) the macro-crack in the second case grows faster than that in the first case; (2) a pure shear load affects the macro-crack propagation more than a combined shear and tensile load or a tensional load; (3) the external stresses required to propagate are reduced when the inclination angle of the micro-crack is small and within (−25° < β < 25°); (4) micro-cracks affect the propagating path of the macro-crack and generally guide the direction of propagation. The developed model has been verified and validated experimentally for its effectiveness in predicting the fracture or fatigue damage of a structure.

Maternal and perinatal risks for monozygotic twins conceived following frozen-thawed embryo transfer: a retrospective cohort study

BackgroundThe present study aimed to explore the maternal and perinatal risks in cases of monozygotic twins (MZT) following frozen-thawed embryo transfer (FET).MethodsAll twin births that were conceived following FET from 2007 to 2021 at Shanghai Ninth People’s Hospital in Shanghai, China were retrospectively reviewed. The exposure variable was twin type (monozygotic and dizygotic). The primary outcome was the incidence of neonatal death while secondary outcomes included hypertensive disorders of pregnancy, gestational diabetes, intrahepatic cholestasis of pregnancy, placenta previa, placental abruption, preterm premature rupture of the membranes, Cesarean delivery, gestational age, birth weight, weight discordance, stillbirth, birth defects, pneumonia, respiratory distress syndrome, necrotizing enterocolitis, and neonatal jaundice. Analysis of the outcomes was performed using logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs). The causal mediation analysis was conducted. A doubly robust estimation model was used to validate the results. Kaplan-Meier method was used to calculate survival probability. The sensitivity analysis was performed with a propensity score-based patient-matching model.ResultsOf 6101 dizygotic twin (DZT) and 164 MZT births conceived by FET, MZT showed an increased risk of neonatal death based on the multivariate logistic regression models (partially adjusted OR: 4.19; 95% CI, 1.23–10.8; fully adjusted OR: 4.95; 95% CI, 1.41–13.2). Similar results were obtained with the doubly robust estimation. Comparing MZT with DZT, the neonatal survival probability was lower for MZT (P < 0.05). The results were robust in the sensitivity analysis. Females with MZT pregnancies exhibited an elevated risk of preterm premature rupture of the membranes (adjusted OR: 2.42; 95% CI, 1.54–3.70). MZT were also associated with higher odds of preterm birth (prior to 37 weeks) (adjusted OR: 2.31; 95% CI, 1.48–3.67), low birth weight (adjusted OR: 1.92; 95% CI, 1.27–2.93), and small for gestational age (adjusted OR: 2.18; 95% CI, 1.21–3.69) in the fully adjusted analyses. The effect of MZT on neonatal death was partially mediated by preterm birth and low birth weight (P < 0.05).ConclusionsThis study indicates that MZT conceived by FET are related to an increased risk of neonatal death, emphasizing a potential need for comprehensive antenatal surveillance in these at-risk pregnancies.

An intelligent digital twinning approach for complex circuits

The digital twinning process is essential for transferring real-world objects to the Metaverse by creating accurate digital versions, known as digital twins. However, complex systems pose challenges in this process. With the increasing utilization of microwave components and circuits in telecommunication systems such as IoT, 5 G, and 6 G, the need for digital twins of these components arises. Nevertheless, high-frequency components exhibit intricate behavior, requiring advanced modeling techniques. Artificial intelligence (AI) provides a powerful tool for enhancing the reliability and accuracy of estimated models in such cases. In this study, a microstrip lowpass filter (LPF) is designed, fabricated, and measured as the physical twin. An intelligent digital twinning approach is employed using a machine learning method based on an adaptive neuro-fuzzy inference system (ANFIS), trained by a subtractive clustering algorithm. The resulting digital twin of the LPF proves valuable for communication networks and IoT applications. Moreover, this research showcases the applicability and accessibility of machine learning in creating digital twins of electromagnetic components for communication cyber-physical systems (CPSs) and the Metaverse. Furthermore, the proposed method exhibits adaptability to various passive and active electrical or electronic circuits. By harnessing the potential of AI and digital twinning, this study presents a robust and accurate approach for modeling and analyzing complex circuits, specifically in the context of communication systems and their integration into the Metaverse. The findings highlight the advantages of an intelligent digital twinning approach and its potential for advancing various domains involving complex circuitry.

Familial congenital laryngotracheal stenosis: A systematic review

BackgroundCongenital laryngotracheal stenosis (CLS) is a rare cause of stridor among newborns. Evidence has shown that several family members can be affected by CLS. Knowledge of the pathophysiology of familial congenital laryngotracheal stenosis (FCLS) will enable more effective therapeutic strategies. ObjectiveTo determine the clinical course and outcome of familial congenital laryngotracheal stenosis (FCLS). MethodsA literature search was conducted over a period of one month (September 2023) by searching several databases to identify studies published from inception to 31st August 2023. ResultsOf 256 papers identified, five articles met the inclusion criteria. A total of 17 patients with slight female predominance (59 %) were identified. Familial congenital tracheal stenosis was reported in female twins (100 %). A variety of clinical presentations were listed. An endoscopic airway study was performed on all patients. 64.8 % of the included children were managed surgically. Genetic studies performed on 41 % of children could not locate genetic abnormalities. ConclusionConsanguinity, twin births, and female gender could be predisposing factors for FCLS, although the quality of evidence is low due to the rarity of the condition.

Interpregnancy interval and adverse birth outcomes: a population-based cohort study of twins

BackgroundTo investigate associations between interpregnancy intervals (IPIs) and adverse birth outcomes in twin pregnancies.MethodsThis retrospective cohort study of 9,867 twin pregnancies in Western Australia from 1980–2015. Relative Risks (RRs) were estimated for the interval prior to the pregnancy (IPI) as the exposure and after the pregnancy as a negative control exposure for preterm birth (< 37 weeks), early preterm birth (< 34 weeks), small for gestational age (SGA: < 10th percentile of birth weight by sex and gestational age) and low birth weight (LBW: birthweight < 2,500 g).ResultsRelative to IPIs of 18–23 months, IPIs of < 6 months were associated with a higher risk of early preterm birth (aRR 1.41, 95% CI 1.08–1.83) and LBW for at least one twin (aRR 1.16, 95% CI 1.06–1.28). IPIs of 6–11 months were associated with a higher risk of SGA (aRR 1.24, 95% CI 1.01–1.54) and LBW for at least one twin (aRR 1.09, 95% CI 1.01–1.19). IPIs of 60–119 months and ≥ 120 months were associated with an increased risk of preterm birth (RR 1.12, 95% CI 1.03–1.22; and (aRR 1.25, 95% CI 1.10–1.41, respectively), and LBW for at least one twin (aRR 1.17, 95% CI 1.08–1.28; and aRR 1.20, 95% CI 1.05–1.36, respectively). IPIs of ≥ 120 months were also associated with an increased risk of early preterm birth (aRR 1.42, 95% CI 1.01–2.00). After negative control analysis, IPIs ≥ 120 months remained associated with early preterm birth and LBW.ConclusionEvidence for adverse associations with twin birth outcomes was strongest for long IPIs.

Clinical and neonatal outcomes of complete zona pellucida removal by laser-assisted hatching after single vitrified-warmed blastocyst transfer.

Laser-assisted hatching (LAH) is a widely used and unavoidable technique in assisted reproductive technology after frozen embryo transfer (FET). We aimed to investigate the safety and efficacy of completely ZP (zona pellucida) removed by an assisted laser group compared to an intact group after FET. This retrospective study involved 320 SVBT single vitrified-warmed blastocyst transfers of 213 patients who underwent clomiphene citrate (CC) based minimal stimulation protocol. This study compared 160 SVBT with ZP that were completely removed using laser-assisted (laser beams of 10-15, a wavelength of 1.48μm, and duration of 1.8-2.2ms) to 160 cases of intact SVBT. Fisher's exact test, chi-squared test, and logistic regression are used for statistical analysis. The women's age, cause of infertility, BMI, transferred embryo day, insemination methods, and blastocyst grade were not significantly different between two groups. The implantation rate (66.2% vs. 51.2%, P < 0.01), the clinical pregnancy rate (CPR, 52.5% vs. 39.3%, P = 0.01), and the live birth rate (LBR, 43.7% vs. 29.3%, P < 0.01) were significantly higher in the completely ZP removed than the intact group. In logistic regression analysis, the laser-assisted hatching group showed about 2 times higher implantation rate and CPR and LBR than the control group. But miscarriage, gestational weeks, gender, birth weight, and twin births were insignificant between two groups. Our study suggests ZP free embryo transfer by assisted laser is more effective and safer than intact embryo transfer.

Assessment of the prevalence of meningitis in clinically suspected cases of early and late onset neonatal sepsis

Background: Meningitis is more common in the neonatal period than any other time in life and is an important cause of morbidity and mortality globally. In India, rate of neonatal sepsis is reported 0.5 per 1000 live births. The major burden of neonatal sepsis and meningitis occurs in the developing world. According to WHO estimates there are approximately 5 million neonatal deaths in a year. The objective of the study is to assess the prevalence of meningitis in neonates with clinical suspicion of sepsis. Methods: The study was conducted among suspected cases of neonatal septicemia in neonatal intensive care unit (NICU), department of pediatrics, VPIMS, Lucknow. It is a prospective observational study. A total of 180 neonates were included in the study. Results: Out of 180 neonates, CSF examination of 131 (72.78%) neonates was normal, of 37 (20.56%) was suggestive of meningitis. Prevalence of meningitis in neonatal sepsis was 20.0%. It was 18.0% in early neonatal sepsis and 32.6% in late neonatal sepsis cases. Conclusions: The findings of present study suggested that there is a high risk of meningitis among neonatal sepsis cases. Cases with risk factors like twin birth, anemia, low TLC, low platelet count, acid-base imbalance and X-ray findings suggestive of pneumonitis should be kept in a high-risk category.

Prenatal exposure to poly- and perfluoroalkyl substances and postpartum depression in women with twin pregnancies

BackgroundWomen with multiple pregnancies are vulnerable to experience postpartum depression (PPD). Emerging evidence indicates an association between poly- and perfluoroalkyl substances (PFAS) exposure and PPD in women delivering singletons. The health risks of PFAS may also be present in women delivering twins. ObjectiveTo estimate the impacts of prenatal PFAS exposure on the risk of PPD in women with twin pregnancies. MethodsOur study included 150 mothers who gave birth to twins and were enrolled in the Wuhan Twin Birth Cohort. The concentrations of maternal plasma PFAS were measured in each trimester and averaged. Eight individual PFAS were included in analyses. We used Edinburgh Postnatal Depression Scale to evaluate maternal depression at early pregnancy and 1 and 6 months after childbirth. The outcome was dichotomized using a cutoff value of ≥10 for main analyses. Associations were examined using multiple informant models and modified Poisson regressions. PFAS mixture effects were estimated using quantile g-computation. ResultsUsing quantile g-computation models, a quartile increase in the PFAS mixture during the first, second, third, and average pregnancy was significantly associated with a relative risk (RR) of 1.73 (95% CI: 1.42, 2.12), 1.54 (95% CI: 1.27, 1.84), 1.75 (95% CI: 1.49, 2.08), and 1.63 (95% CI: 1.35, 1.97) for PPD at 6 months after childbirth, respectively. The results of the single-PFAS models also indicated significant positive associations between individual PFAS and PPD at both 1 and 6 months. ConclusionsThe first study of women with twin pregnancies suggests that prenatal exposure to PFAS increases PPD risk up to 6 months postpartum. Twin pregnant women should receive long-term follow-up after delivery and extensive social support.

Iatrogenic and demographic determinants of the national plural birth increase

ObjectiveTo study the contribution of ovulation induction and ovarian stimulation, in vitro fertilization (IVF) and unassisted conception to the increase in national plural births in the U.S., a significant contributor to adverse maternal and infant health outcomes. DesignNational and IVF-assisted plural birth data were derived from the Centers for Disease Control and Prevention’s National Vital Statistics System (1967-2021, after introduction of Clomiphene Citrate in the U.S.) and the National Assisted Reproductive Technology Surveillance System (1997-2021), respectively. Main Outcome MeasuresIn addition to IVF-assisted plural births, the contributions of unassisted conception to plural births among women aged <35 and ≥35 years were estimated using plural birth rates from 1949-1966, and a Bayesian logistic model with race and age as independent variables. The contribution of ovulation induction and ovarian stimulation was estimated as the difference between national plural births and IVF-assisted and unassisted counterparts. ResultsFrom 1967-2021, the national twin birth rate increased 1.7-fold to a 2014 high (33.9/1000 live births), then declined to 31.2/1000 live births; the triplet and higher-order birth rate increased 6.7-fold to a 1998 high (1.9/1000 live births), then declined to 0.8/1000 live births. In 2021, the contribution of unassisted conception among women <35 to the national plural births was 56.1%, followed by ovulation induction and ovarian stimulation (19.5%), unassisted conception among women ≥35 (16.8%) and IVF (7.6%). During 2009-2021, the contribution of ovulation induction and ovarian stimulation has remained stable, the contribution of unassisted conception among women <35 and women ≥35 has increased, and the contribution of IVF has decreased. ConclusionOvulation induction and ovarian stimulation are leading iatrogenic contributors to plural births. They are, therefore, targets for intervention to reduce the adverse maternal and infant health outcomes associated with plural births. Maternal age ≥35 is a significant contributor to the national plural birth increase.

Birth Outcomes of Twin’s Pregnancy and Associated Factors in Selected Public Hospitals of Addis Ababa, Ethiopia, 2022

Background: Twin birth is a type of multiple births when the mother gives birth to two offspring from the same pregnancy. The prevalence rates range from less than 8 twin pregnancies per 1,000 births in the East and Southern Asia, India, and Oceania to 17 or more per 1,000 births in Africa. There are factors to increase the negative birth outcome of twin delivery; from these, some of them are associated with increased maternal age, prim parity, low birth weight, chronic disease, low ANC follow-up, and PROM. Adverse birth outcome for twin delivery is a critical health issue in developing countries such as Ethiopia. It resulted in many bad consequences, neonatal and infant morbidity and mortality. Objective: The objective of this study was to assess birth out come and associated factors of twin’s pregnancy in selected public Hospitals, Addis Ababa, Ethiopia. Methods: Facility based cross sectional study was conducted on 246 maternal records of twin delivery in selected public hospitals of Addis Ababa to assess birth out come and associated factors of twin’s pregnancy from December, 2020-June, 2021.A pretested questionnaire which will be analyzed by SPSS and result will be reported in tables, bivariate and multivariate regression will be done to show correlations by Crude and adjusted odds ratio. A confidence limit of 95% and p- value less than 0.05 will be used as cut of point to see presence of statistical significance. Result: The prevalence of adverse birth outcome (Both maternal and fetal) among twin delivery in the three selected public hospitals of Addis Ababa is 234 (95%). majority, 156(63.4%) were in the age group 18-28 years, with the mean age of 29.78 and Standard deviation of±6.53.Most of the mothers 227(92%) were married. Mothers who had Pregnancy induced hypertension (AOR= 10.465, 95% CI (2.922-37.474)), Mothers who had ruptured membrane before the onset of Labor (AOR= 3.577, 95% CI (1.198-10.682)) and Mothers who labor for more than 12 hours were (AOR= 3.324, 95% CI (1.101-10.034)) were significantly associated with adverse maternal birth outcome. While mothers who had ANC follow up at private clinic (AOR= 0.252, 95% CI (0.098-0.649)) and Mothers who live outside Addis Ababa were unlikely to have adverse fetal outcome (AOR= 0.343, 95% CI (0.143-0.826)). Conclusion: Adverse birth outcome of Twins pregnancy is relatively higher when compared to similar studies conducted in Ethiopia. The Health facilities should have effective risk assessment in Antenatal care unit and labor ward. It is also recommended to have guidelines and protocols for the management of twin’s pregnancy. Since the Prevalence of Adverse twin’s Birth outcome is higher greater attention should be given on both Antepartum and Intrapartum care.

Obesity, Twin Pregnancy, and the Role of Assisted Reproductive Technology

The prevalence of overweight and obesity (body mass index [BMI] ≥25) has increased globally, and high BMI has been linked to higher rates of twin birth. However, evidence from large population-based studies is lacking; the issue needs careful study, as women with obesity are also more likely to use assisted reproductive technology (ART), which frequently results in twin pregnancy. To examine the association between BMI and twin birth and the role of ART as a potential mediator in this association. This retrospective cohort study included all live births and stillbirths with gestational age of 20 weeks or longer in British Columbia, Canada, from 2008 to 2020, using data from the British Columbia Perinatal Database Registry. Data analysis was conducted from November 2022 to June 2023. Prepregnancy BMI, calculated as weight in kilograms divided by height in meters squared, and use of ART. The study assessed whether prepregnancy BMI is associated with the rate of twin vs singleton delivery and whether this association is explained by the differential use of ART in women with obesity. A total of 524 845 deliveries at 20 weeks' or longer gestation occurred in British Columbia during the study period, and 392 046 women had complete data on prepregnancy BMI. The median (IQR) age was 31.4 (27.7-35.0) years, approximately half were nulliparous (243 443 [46.4%]) and less than 10% smoked during pregnancy (36 894 [7.1%]). Overall, 8295 women had a twin delivery (15.8 per 1000 deliveries), and rates per 1000 deliveries by prepregnancy BMI categories were 11.9 (underweight), 15.1 (normal), 16.0 (overweight), 16.0 (obesity class I), 16.7 (obesity class II), and 18.9 (obesity class III). After adjustment for other covariates, women with underweight had relatively 16% fewer twins compared with women with normal BMI (adjusted risk ratio [aRR], 0.84; 95% CI, 0.74-0.95), while women with overweight, class I obesity, class II obesity, and class III obesity had 14% (aRR, 1.14; 95% CI, 1.07-1.21), 16% (aRR, 1.16; 95% CI, 1.06-1.27), 17% (aRR, 1.17; 95% CI, 1.02-1.34), and 41% higher rates (aRR, 1.41; 95% CI, 1.19-1.66), respectively. The proportion of women who conceived by ART increased with increasing BMI, and ART was associated with nearly a 12-fold higher rate of twin delivery (aRR, 11.80; 95% CI 11.10-12.54). ART explained about a quarter of the association between obesity class I and II and twin delivery (eg, obesity class I, 23% mediated; 95% CI, 7%-39% mediated), but none of this association was mediated by ART in women with class III obesity. In this cohort study of 524 845 births, the rate of twin birth increased with increasing prepregnancy BMI. In women with a BMI between 30 and 40, approximately one-quarter of this association was explained by higher use of ART; however, there was no evidence of such mediation in women with BMI of 40 or greater.

Advancements in Precision Trajectory Generation: A Synergistic Approach to Design and Implementation for the 5-DOF Alpha-II Robot's Digital and Physical Twins

This research paper explores the comprehensive design and verification process of a 5-DOF articulated robotic arm, named the Alpha-II. Leveraging SolidWorks and CoppeliaSim, the digital twin is meticulously developed, with kinematics and working envelope computations verified on CoppeliaSim and MATLAB. The transition to CoppeliaSim for testing involvesthe implementation of diverse control strategies, such as position control, velocity control, and torque control, to rigorously evaluate the manipulator's movements. Highlighting the synergy between SolidWorks and CoppeliaSim, this literature emphasizes the versatility of SolidWorks in digital twin design and the effectiveness of CoppeliaSim's virtual environment. The research culminatesin the creation of a physical twin, aligning with the meticulously crafted digital counterpart. This study not only advances the understanding of trajectory generation for 5-DOF robotic arms but also underscores the pivotal role of cohesive digital and physical twin methodologies in cutting-edge robotics research. The rigorous verification, testing, and synthesis process contribute to the development of a refined and thoroughly validated end product, showcasing the significance of integrating simulation toolsin the design and analysis of robotic systems.

Twin births in Yucatan, Mexico during 2008–2020: trends in maternal sociodemographic factors and differences in birth weight and length according to sex of co-twin

Background: Over the years, there has been a noticeable increase in the incidence of multiple pregnancies, due in part to the increased use of assisted reproductive technologies in recent years. The increase in twin pregnancies constitutes a public health challenge due to the adverse outcomes sometimes they entail. Twin pregnancies inherently carry a higher risk of complications, and one of the critical associated factors is the risk of low birth weight. Twin birth weight discordance among different populations can be attributed to differences in non-shared environmental influences. The presence of two or more fetuses in the uterus may lead to an unequal distribution of nutritional and oxygen resources, increasing the likelihood that at least one of the twins will experience insufficient fetal development. Other factors, such as ethnicity, genetics, sociodemographic characteristics, gestational age, parity, and chorion type, have also been related to the birth weight discordance in twin pregnancies. However, it is unclear to what extent the associations between these factors can explain the differences in birth and length size. The frequency of twin births varies among populations and over time, so it is crucial to gain a deeper understanding of the factors contributing to the rise in the twinning rate. The official records of twins continue to make significant contributions to our understanding of the causes of individual differences, and new twin registries are still being created. The recent availability of data from developing countries allows the analysis of trends in regions with sociodemographic and reproductive profiles. Obtaining a more comprehensive understanding of the epidemiology, as well as the related morbidity and mortality, is clinically crucial. Objectives: The aim of the study was to describe the trends of twin births in Yucatan, Mexico during 2008–2021, analyze their association with maternal sociodemographic factors, and compare birth outcomes between types of twin pairs: female-female, male-male, and female-male. Methods: A retrospective cohort analysis was conducted using data from the Mexican Ministry of Health, encompassing information on all births registered in the State of Yucatán, Mexico, from 2008 through 2021. The data was obtained from both public and private hospitals. The variables, including date of birth, sex, gestational age, birth weight and length of newborns, mother´s date of birth, educational level, and number of previous live offspring, were extracted from each dataset. Multiple births (three or more) were excluded from the study. We graphically analyzed the rates (per 1000 births) and percentages of twins according to maternal age, education level, and parity during the study period. A multiple logistic regression model was used to analyze the association between maternal sociodemographic factors and the occurrence of twin births. Comparisons of the gestational age and birth weight and length between types of twin pairs were performed using analysis of variance. Results: A total of 478,118 live births, including 1.4% twins (accounting 6,766 twin births), were analyzed. The rates increased from 11.21 during 2008–2011 to 13.34 during 2012–2017 and reached 20.08 in 2019. The percentages increased in women aged ≥30 years and those with higher educational levels. Older maternal age (coefficient = 0.03; OR = 1.03, per each year), greater education level (coefficient = 0.55 and OR= 1.74 for medium and coefficient = 1.05; OR = 2.57 for high level, compared with no education) and higher parity (coefficient= 0.26; OR = 1.30 per each previous offspring) increased the odds for having twins. Twins’ male-male showed a slightly increased of preterm birth than a co-twin female. Opposite-sex twins showed measurable but small increases in birth weight and length compared with same-sex twins. Conclusion: The rate of twins in Yucatan increased substantially during 2008–2020 in specific sociodemographic groups. Opposite-sex twins were slightly larger than same-sex twins at birth.

Intelligent wireless resource management in industrial camera systems: Reinforcement Learning-based AI-extension for efficient network utilization

In this paper, we present an innovative method for replacing wired communication within an operational agile production cell with wireless communication, using a minimal number of access points. Our approach utilizes Reinforcement Learning (RL) to optimize the layout and minimize the required number of access points. We introduce an Artificial Intelligence (AI) agent that facilitates cooperative interaction between cameras and access points, optimizing camera stream utilization and radio coverage. This solution benefits from the recent standardization of The fifth generation of mobile communications (5G) Network Resource Management (NRM) features of the User Equipment (UE) attached to the cameras. To accommodate the dynamic nature of the production cell, our optimization algorithms run during cell operation, necessitating extended training times.Our contributions extend beyond the state-of-the-art by offering a Digital Twin (DT) environment equipped with physics and radio propagation capabilities, fast raytracing for radio propagation modeling, curriculum-learning-based reinforcement learning, and a Physical Twin (PT) of the radio-connected camera with self-adjusting scene setup capabilities. This comprehensive proposal combines the efficiency of 5G radio utilization with precise modeling and high-resolution simulations, while also significantly improving training speed.In the Agile Robotics for Industrial Automation Competition (ARIAC) 2020 environment, our methods showed compelling results, with curriculum learning achieving a remarkable 3x speed-up compared to non-curriculum approaches. We also demonstrated that high Quality of Service (QoS) demands can be reduced to just 2% of total time while maintaining consistent productivity Key Performance Indicators (KPIs). Furthermore, we explored the integration of these methods into Internet of Things (IoT) devices with limited performance capabilities. In conclusion, our approach offers significant benefits and savings for IoT devices, networks, edge clouds, and industry players.

Maternal and fetal outcomes after planned cesarean or vaginal delivery in twin pregnancy: a comparison between 2 third level birth centers

Background Twin pregnancy is associated with higher risks of adverse perinatal outcomes for both the mother and the babies. Among the many challenges in the follow-up of twin pregnancies, the mode of delivery is the last but not the least decision to be made, with the main influencing factors being amnionicity and fetal presentation. The aim of the study was to compare perinatal outcomes in two European centers using different protocols for twin birth in case of non-cephalic second twin; the Italian patients being delivered mainly by cesarean section with those in Belgium being routinely offered the choice of vaginal delivery (VD). Methods This was a dual center international retrospective observational study. The population included 843 women with a twin pregnancy ≥ 32 weeks (dichorionic or monochorionic diamniotic pregnancies) and a known pregnancy outcome. The population was stratified according to chorionicity. Demographic and pregnancy data were reported per pregnancy, whereas neonatal outcomes were reported per fetus. We used multiple logistic regression models to adjust for possible confounding variables and to compute the adjusted odds ratio (adjOR) for each maternal or neonatal outcome. Results The observed rate of cesarean delivery was significantly higher in the Italian cohort: 85% for dichorionic pregnancies and 94.4% for the monochorionic vs 45.2% and 54.4% respectively in the Belgian center (p-value < 0.001). We found that Belgian cohort showed significantly higher rates of NICU admission, respiratory distress at birth and Apgar score of < 7 after 5 min. Despite these differences, the composite severe adverse outcome was similar between the two groups. Conclusion In this study, neither the presentation of the second twin nor the chorionicity affected maternal and severe neonatal outcomes, regardless of the mode of delivery in two tertiary care centers, but VD was associated to a poorer short-term neonatal outcome.

Randomised placebo-controlled trial of antenatal corticosteroids for planned birth in twins (STOPPIT-3): study protocol

IntroductionThe aim of the STOPPIT-3 study is to determine the clinical and cost effectiveness of antenatal corticosteroids (ACS) prior to planned birth of twins in a multicentre placebo-controlled trial with...

Is postpartum depression related to total weight gain during pregnancy and maternal anemia?

This study aimed to investigate the effects of weight gain and maternal anemia on postpartum depression. This is a prospective, single-center, case-control study. We recorded the demographic characteristics, blood ferritin level, and weight gain during the pregnancy. This study was planned between April 2023 and June 2023 in the Obstetrics and Gynecology Clinic of Ankara Etlik City Hospital. A total of 109 patients were enrolled in the study. Patients were assessed with the Edinburgh Postpartum Depression Scale. Weight gain, nutritional education, educational level, mode of delivery, and pregnancy history were asked in person. Ferritin levels at the onset of labor were determined to detect anemia. Twin births, births due to fetal anomalies or intrauterine stillbirths, patients with systemic infections, and patients diagnosed with a psychiatric disorder in the past 6 months whose records were not accessible were excluded from the study. Pregnancy weight gain and percentage of pregnancy weight gain were higher. Serum ferritin levels and nutritional education during pregnancy were lower in the postpartum depression group (p<0.001). These parameters with statistical significance were identified as risk factors in the regression analysis for postpartum depression (p<0.05). In receiver operating characteristics analysis, >15 kg for weight gain, >28.8 for percentage of weight gain in pregnancy, and <19 ng/dL for serum ferritin level were identified as cutoff values (p<0.001). Nutritional education and vitamin supplementation should be recommended to pregnant women during routine examinations.

Spatial variations and determinants of bottle feeding among children aged 0-23 months in Ethiopia in 2019: A spatial and multi-level analysis.

Bottle feeding should be avoided since it interferes with optimal breastfeeding and it causes diarrheal-related morbidity and mortality. Despite the WHO's recommendation that children to avoid bottle feeding, it is still widely practiced in developing countries including our country, Ethiopia. Therefore, this study aimed to assess the spatial variations, and determinants of bottle feeding among children aged 0-23 months using the recent demographic and health survey data for Ethiopia. A secondary data analysis was conducted using the 2019 Ethiopian mini demographic and health survey data. The total weighted sample of 2067 children aged 0-23 months was included in this study. Spatial analysis was done to identify the hotspot areas of bottle feeding among children in Ethiopia. Multivariable multilevel logistic regression was used to identify predictors of bottle feeding. The spatial analysis was done using ArcGIS 10.7 and Sat Scan 9.6 software. The prevalence of bottle feeding among children aged 0-23 months was 21.52% with 95% CI(19.80%, 23.34%). Age of the child from 6-11 months, and 12-23 months age, having secondary and above education [AOR = 2.09; 95%CI; 1.31, 3.32], being from middle and rich household [AOR = 2.14; 95%CI; 1.37, 3.34] and [AOR = 2.30; 95%CI; 1.46, 3.63], and twin birth [AOR = 8.06; 95%CI; 2.87, 22.58] were significant predictors of bottle feeding. Hotspot areas of bottle feeding were observed in Addis Ababa, Dire Dawa, Harari, and Afar regions of Ethiopia. Bottle feeding practice was found to be spatially clustered in Ethiopia. Education, wealth index, parity, and child's age were significant predictors of bottle feeding. Hotspot areas of bottle feeding were observed in Addis Ababa, Dire Dawa, Harari, and Afar regions. Special attention should be directed towards mothers residing in hotspot areas, educated mothers, mothers of multiple births, and mothers from rich households through community education programs focused on child feeding practices to reduce the practice of bottle-feeding in Ethiopia.