UWOMJ Volume 33

Schulich School of Medicine & Dentistryhttps://ir.lib.uwo.ca/uwomj/1006/thumbnail.jp

Very preterm birth and fetal growth restriction in adolescence - Cardiovascular and renal aspects

This thesis applied magnetic resonance imaging (MRI) to investigate to what extent very preterm birth due to early onset fetal growth restriction (FGR) impacts the cardiovascular system and kidneys in adolescence. The thesis further investigated whether FGR exacerbates the organ-specific effects of very preterm birth.Study I validated a widely available non-contrast enhanced MRI method for quantification of renal cortical and medullary parenchymal volumes and showed that kidney volumes can be quantified with high accuracy and precision.Study II validated an MRI method for pulse wave velocity (PWV) acquisition in neonates and adolescents and showed how the acquired PWV was influenced by commonly used MRI methods. The study proposed the use of 3D angiography images and the time-to-foot method for accurate and precise PWV acquisition.Study III implemented the proposed PWV method from Study II and 24-hour ambulatory blood pressure measurements and showed that very preterm birth due to early onset FGR was associated with higher, yet normal, blood pressure in adolescent boys while very preterm birth was associated with higher arterial stiffness in girls.Study IV showed that very preterm birth was associated with smaller ventricular volumes without alterations in left or right longitudinal and radial pumping. Early onset FGR did not exacerbate the effects of very preterm birth.Study V implemented the newly validated non-contrast enhanced MRI method from Study I together with biomarkers of kidney function. Very preterm birth due to FGR was associated with smaller total kidney and medullary kidneyvolumes, but not with markers of kidney dysfunction or renin-angiontensin-aldosterone system activation in adolescence.This thesis concludes that adolescents born very preterm with and without preceding fetal growth restriction show alterations in cardiovascular and renal morphology. Changes were more pronounced in girls. Cardiovascular andkidney function were however normal, possibly indicating a decreased long-term effect of very preterm birth and fetal growth restriction on these organ systems compared to earlier studies, where clear signs of increased risk were observed already in childhood and adolescence. As indicated by increases in blood pressure, male sex and fetal growth restriction might increase cardiovascular risk in those born preterm. Morphological changes in the heart and in the kidneys may still precede functional decline in this population, and the alterations observed could potentially be used as prognostic markers in the future

Informing the design of a trial of kangaroo mother care initiated before stabilisation amongst small and sick newborns in a sub-Saharan African context using mixed methods

An estimated 2.5 million neonates die every year, with preterm birth being the leading cause. Sub-Saharan Africa and southern Asia account for 78% of neonatal deaths. The WHO recommends kangaroo mother care (KMC) for stabilised newborns ≤2000g; however, most deaths occur before stabilisation. An evidence gap exists regarding KMC for this population. The overall aim of this PhD was to inform the design of a trial of KMC initiated before stabilisation in a sub-Saharan African context. The first part focused on assessing facility readiness and quantifying neonatal mortality risk. Cascade models were developed and used to assess 23 East African facilities. A logistic model was derived and validated using data from 187 UK hospitals and one Gambian hospital. The final model, including three parameters, demonstrated very good performance. The score requires further validation in low-resource contexts, but has potential to improve neonatal resource allocation. The second part of this PhD focused on evaluating the feasibility of initiating KMC before stabilisation and designing the trial. This study showed it was feasible to monitor and provide care in the KMC position, and found the intervention was acceptable to parents and providers. Launched in 2020, the OMWaNA trial will determine the mortality impact of this intervention within 7 days relative to standard care at four Ugandan hospitals. Process and economic evaluations will explore causal pathways for clinical effects, estimate incremental cost and costeffectiveness, and examine barriers and facilitators to inform uptake and sustainability. This PhD has developed a cascade model to assess facility readiness, validated a score to assess individual risk, and demonstrated the feasibility of initiating KMC before stabilisation. These studies have informed the design of a trial evaluating the mortality impact of this intervention in Uganda. The findings are expected to have broad applicability to low-resource hospitals and important policy implications

The transmission of music into the human uterus and the response to music of the human fetus and neonate

The aim of this study was to investigate whether music influences human life before birth. In order to determine the existence and character of music in the uterine acoustic environment, a study was conducted involving the insertion of a hydrophone through the cervix, next to the fetal head. The investigation was conducted on eight women in early labour. The average residual uterine sound of the eight subjects was measured at 65 dBA (A-weighted) re 20 µ.Pa in a 1 O KHz band, RMS averaged over 32-second records. Above this emerged the maternal voice, an external female voice and a male voice presented at approximately 65 dB (linear weighted). Pure tones between 50 Hz and 1 O KHz and orchestral music, all presented at 80 dB (linear weighted), were also shown to emerge above the residual uterine sound. Attenuation of external sound was observed to vary as a function of frequency, with less attenuation of lower frequencies. It was determined that the music was transmitted into the uterus without sufficient distortion to significantly alter the recognisable characteristics of the music. The fetal heart rate (FHA) response to a music stimulus (MS) and a vibroacoustic stimulus (VS) was measured in 40 subjects. Gestational age of the fetuses ranged from 32 to 42 weeks. The study included a control period with no acoustic stimulation; a period with the presentation of 5 music stimuli; and a period with the presentation of 5 vibroacoustic stimuli. A change in the FHA of 15 beats per minute or greater, lasting 15 seconds and occurring within 15 seconds of at least 2 of the 5 stimuli (or a tachycardia of greater than 15 beats per minute above the resting baseline, sustained for one minute or longer) was considered to be a positive response. The MS elicited a positive response in 35 of the fetuses (the 5 non-responses occurring in a period of low FHA variability) and all 40 fetuses responded to the VS (regardless of arousal state). In the third study, mothers attending childbirth education classes volunteered to listen to a prescribed music excerpt twice daily from the 34th week of pregnancy. Ten neonates (all clinically normal) were tested betw~en the 2nd and 5th day after birth. Investigators observed the effect of two music sti:Tiuli, the prescribed stimulus and a non-prescribed stimulus, on neonatal sucking of a non-nutritive nipple. A five-minute control period with no stimulation was compared with a ten-minute period during which two music stimuli were presented. By random allocation, either the prescribed music stimulus (PM) or the nonprescribed music (NM) was presented contingent upon sucking pressure. If a sucking burst was initiated, the PM stimulus was activated. On cessation of sucking, the NM stimulus was activated. Randomly, the procedure would be reversed for some of the subjects, where initiation of sucking activated the NM stimulus and cessation of sucking activated the PM stimulus. It was determined that the inter-burst intervals during the music period were significantly extended when coinciding with the PM stimulus and significantly shortened when coinciding with the NM stimulus.The studies indicated that music is transmitted into the uterus with insufficient distortion to alter the character of the music; that the normal fetus responds to a music stimulus from at least the 32nd week of gestation; and that the neonate alters the normal sucking pattern to activate longer periods of a music stimulus which has been repeatedly presented during the intrauterine stage and shorter periods of a novel music stimulus

Women in Artificial intelligence (AI)

This Special Issue, entitled "Women in Artificial Intelligence" includes 17 papers from leading women scientists. The papers cover a broad scope of research areas within Artificial Intelligence, including machine learning, perception, reasoning or planning, among others. The papers have applications to relevant fields, such as human health, finance, or education. It is worth noting that the Issue includes three papers that deal with different aspects of gender bias in Artificial Intelligence. All the papers have a woman as the first author. We can proudly say that these women are from countries worldwide, such as France, Czech Republic, United Kingdom, Australia, Bangladesh, Yemen, Romania, India, Cuba, Bangladesh and Spain. In conclusion, apart from its intrinsic scientific value as a Special Issue, combining interesting research works, this Special Issue intends to increase the invisibility of women in AI, showing where they are, what they do, and how they contribute to developments in Artificial Intelligence from their different places, positions, research branches and application fields. We planned to issue this book on the on Ada Lovelace Day (11/10/2022), a date internationally dedicated to the first computer programmer, a woman who had to fight the gender difficulties of her times, in the XIX century. We also thank the publisher for making this possible, thus allowing for this book to become a part of the international activities dedicated to celebrating the value of women in ICT all over the world. With this book, we want to pay homage to all the women that contributed over the years to the field of AI