Effectiveness of contingent screening for placenta accreta spectrum disorders based on persistent low‐lying placenta and previous uterine surgery

Objectives Maternal mortality related to placenta accreta spectrum (PAS) disorders remains substantial when diagnosed unexpectedly at delivery. The aim of this study was to evaluate the effectiveness of a routine contingent ultrasound screening program for PAS. Methods This was a retrospective study of data obtained between 2009 and 2019, involving two groups: a screening cohort of unselected women attending for routine mid‐trimester ultrasound assessment and a diagnostic cohort consisting of women referred to the PAS diagnostic service with a suspected diagnosis of PAS. In the screening cohort, women with a low‐lying placenta at the mid‐trimester assessment were followed up in the third trimester, and those with a persistent low‐lying placenta (i.e. placenta previa) and previous uterine surgery were referred to the PAS diagnostic service. Ultrasound assessment by the PAS diagnostic service consisted of two‐dimensional grayscale and color Doppler ultrasonography, and women with a diagnosis of PAS were usually managed with conservative myometrial resection. The final diagnosis of PAS was based on a combination of intraoperative clinical findings and histopathological examination of the surgical specimen. Results In total, 57 179 women underwent routine mid‐trimester fetal anatomy assessment, of whom 220 (0.4%) had a third‐trimester diagnosis of placenta previa. Seventy‐five of these women were referred to the PAS diagnostic service because of a history of uterine surgery, and 21 of 22 cases of PAS were diagnosed correctly (sensitivity, 95.45% (95% CI, 77.16–99.88%) and specificity, 100% (95% CI, 99.07–100%)). Univariate analysis demonstrated that parity ≥ 2 (odds ratio (OR), 35.50 (95% CI, 6.90–649.00)), two or more previous Cesarean sections (OR, 94.20 (95% CI, 22.00–656.00)) and placenta previa (OR, 20.50 (95% CI, 4.22–369.00)) were the strongest risk factors for PAS. In the diagnostic cohort, there were 173 referrals, with one false‐positive and three false‐negative diagnoses, resulting in a sensitivity of 96.63% (95% CI, 90.46–99.30%) and a specificity of 98.81% (95% CI, 93.54–99.97%). Conclusions A contingent screening strategy for PAS is both feasible and effective in a routine healthcare setting. When linked to a PAS diagnostic and surgical management service, adoption of such a screening strategy has the potential to reduce the maternal morbidity and mortality associated with this condition. However, larger prospective studies are necessary before implementing this screening strategy into routine clinical practice

Possible Challenges and Appropriate Measures for a Resilient WMN-Based Disaster Network

A wireless mesh network (WMN)-based disaster network shall provide an emergency communication infrastructure in case of a catastrophe destroyed any existing communication infrastructure. Since the hardware of the disaster network is deployed in an environment affected by the outcome of a catastrophe, events such as aftershocks and/or outbreaking fires are likely to occur and may destroy the hardware of the disaster network. To maintain its provided functionality and thus its usability, the network requires to be resilient to these and other events which are affecting the network infrastructure. To achieve a resilient network, the normal state of the network as well as possible challenges affecting the normal state need to be defined in prior. This scientific work deals with the derivation and definition of the required normal state of the WMN-based disaster network, as well as the definition of possible challenges resulting from environmental-based events. Since each possible challenge is influencing the network infrastructure of the WMN-based disaster network, possible measures for preventing and/or reducing the impact of each challenge are defined. In addition, emergency corrections capable of resolving the influences of an occurring challenge are defined

High Throughput WMN for the Communication in Disaster Scenario

The Wireless mesh network (WMN) is a popular network architecture used to support disaster recovery operations. However, few research works have addressed the capacity problem of such a network. This is due to the assumption that the communication network in disaster scenario is built to support services with a low rate requirement like delay tolerant messages. At the same time, the demand for higher data rates has increased in recent years due to the digitalisation of rescue operations and the use of new services (e.g. VoIP, drones and robots). Therefore, the capacity of the WMN is becoming a central issue in the design of future WMNs. This paper proposes a Layer 1 cluster-based network to solve the throughput bottleneck in the WMN. The proposed architecture is evaluated by several real world measurements. The obtained results are compared with the theory. The proposed solution shows a throughput improvement compared to a single-radio WMN and a multi-radio WMN using the CoMTaC channel allocation strategy

Conduct Disorder and the specifier callous and unemotional traits in the DSM-5

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Cognitive and affective perspective-taking in conduct-disordered children high and low on callous-unemotional traits

<p>Abstract</p> <p>Background</p> <p>Deficits in cognitive and/or affective perspective-taking have been implicated in Conduct-Disorder (CD), but empirical investigations produced equivocal results. Two factors may be implicated: (a) distinct deficits underlying the antisocial conduct of CD subgroups, (b) plausible disjunction between cognitive and affective perspective-taking with subgroups presenting either cognitive or affective-specific deficits.</p> <p>Method</p> <p>This study employed a second-order false-belief paradigm in which the cognitive perspective-taking questions tapped the character's thoughts and the affective perspective-taking questions tapped the emotions generated by these thoughts. Affective and cognitive perspective-taking was compared across three groups of children: (a) CD elevated on Callous-Unemotional traits (<it>CD-high-CU</it>, <it>n </it>= 30), (b) CD low on CU traits (<it>CD-low-CU</it>, <it>n </it>= 42), and (c) a 'typically-developing' comparison group (<it>n </it>= 50), matched in age (7.5 – 10.8), gender and socioeconomic background.</p> <p>Results</p> <p>The results revealed deficits in <it>CD-low-CU </it>children for both affective and cognitive perspective-taking. In contrast <it>CD-high-CU </it>children showed relative competency in cognitive, but deficits in affective-perspective taking, a finding that suggests an affective-specific defect and a plausible dissociation of affective and cognitive perspective-taking in <it>CD-high-CU </it>children.</p> <p>Conclusion</p> <p>Present findings indicate that deficits in cognitive perspective-taking that have long been implicated in CD appear to be characteristic of a subset of CD children. In contrast affective perspective-taking deficits characterise both CD subgroups, but these defects seem to be following diverse developmental paths that warrant further investigation.</p

The economics of vision impairment and its leading causes: A systematic review

Vision impairment (VI) can have wide ranging economic impact on individuals, households, and health systems. The aim of this systematic review was to describe and summarise the costs associated with VI and its major causes. We searched MEDLINE (16 November 2019), National Health Service Economic Evaluation Database, the Database of Abstracts of Reviews of Effects and the Health Technology Assessment database (12 December 2019) for partial or full economic evaluation studies, published between 1 January 2000 and the search dates, reporting cost data for participants with VI due to an unspecified cause or one of the seven leading causes globally: cataract, uncorrected refractive error, diabetic retinopathy, glaucoma, age-related macular degeneration, corneal opacity, trachoma. The search was repeated on 20 January 2022 to identify studies published since our initial search. Included studies were quality appraised using the British Medical Journal Checklist for economic submissions adapted for cost of illness studies. Results were synthesized in a structured narrative. Of the 138 included studies, 38 reported cost estimates for VI due to an unspecified cause and 100 reported costs for one of the leading causes. These 138 studies provided 155 regional cost estimates. Fourteen studies reported global data; 103/155 (66%) regional estimates were from high-income countries. Costs were most commonly reported using a societal (n = 48) or healthcare system perspective (n = 25). Most studies included only a limited number of cost components. Large variations in methodology and reporting across studies meant cost estimates varied considerably. The average quality assessment score was 78% (range 35–100%); the most common weaknesses were the lack of sensitivity analysis and insufficient disaggregation of costs. There was substantial variation across studies in average treatment costs per patient for most conditions, including refractive error correction (range $12–$201 ppp), cataract surgery (range $54–$3654 ppp), glaucoma (range $351–$1354 ppp) and AMD (range $2209–$7524 ppp). Future cost estimates of the economic burden of VI and its major causes will be improved by the development and adoption of a reference case for eye health. This could then be used in regular studies, particularly in countries with data gaps, including low- and middle-income countries in Asia, Eastern Europe, Oceania, Latin America and sub-Saharan Africa

A practical conservation tool to combine diverse types of evidence for transparent evidence-based decision-making

Funder: Arcadia Fund; Id: http://dx.doi.org/10.13039/100012088Funder: MAVA Foundation; Id: http://dx.doi.org/10.13039/100013324Funder: The David and Claudia Harding FoundationFunder: University of Cambridge, Department of Zoology; Id: http://dx.doi.org/10.13039/501100000735Making the reasoning and evidence behind conservation management decisions clear and transparent is a key challenge for the conservation community. Similarly, combining evidence from diverse sources (e.g., scientific and local knowledge) into decision-making is also difficult. Our group of conservation researchers and practitioners has co-produced an intuitive tool and template (Evidence-to-Decision [E2D] tool: www.evidence2decisiontool.com) to guide practitioners through a structured process to transparently document and report the evidence and reasoning behind decisions. The tool has three major steps: (1). Define the Decision Context; (2). Gather Evidence; and (3). Make an Evidence-Based Decision. In each step, practitioners enter information (e.g., from the scientific literature, practitioner knowledge and experience, and costs) to inform their decision-making and document their reasoning. The tool packages this information into a customized downloadable report (or is documented if using the offline template), which we hope can stimulate the exchange of information on decisions within and between organizations. By enabling practitioners to revisit how and why past decisions were made, and integrate diverse forms of evidence, we believe our open-access tool's template can help increase the transparency and quality of decision-making in conservation.William J. Sutherland and Harriet Downey were supported by Arcadia, The David and Claudia Harding Foundation, and MAVA. Alec P. Christie was supported by the Natural Environment Research Council as part of the Cambridge Earth System Science NERC DTP (NE/L002507/1) and The David and Claudia Harding Foundation. Thomas B. White was supported by the Balfour Studentship awarded by the Department of Zoology, Cambridge University

Genetics of callous-unemotional behavior in children

Callous-unemotional behavior (CU) is currently under consideration as a subtyping index for conduct disorder diagnosis. Twin studies routinely estimate the heritability of CU as greater than 50%. It is now possible to estimate genetic influence using DNA alone from samples of unrelated individuals, not relying on the assumptions of the twin method. Here we use this new DNA method (implemented in a software package called Genome-wide Complex Trait Analysis, GCTA) for the first time to estimate genetic influence on CU. We also report the first genome-wide association (GWA) study of CU as a quantitative trait. We compare these DNA results to those from twin analyses using the same measure and the same community sample of 2,930 children rated by their teachers at ages 7, 9 and 12. GCTA estimates of heritability were near zero, even though twin analysis of CU in this sample confirmed the high heritability of CU reported in the literature, and even though GCTA estimates of heritability were substantial for cognitive and anthropological traits in this sample. No significant associations were found in GWA analysis, which, like GCTA, only detects additive effects of common DNA variants. The phrase ‘missing heritability’ was coined to refer to the gap between variance associated with DNA variants identified in GWA studies versus twin study heritability. However, GCTA heritability, not twin study heritability, is the ceiling for GWA studies because both GCTA and GWA are limited to the overall additive effects of common DNA variants, whereas twin studies are not. This GCTA ceiling is very low for CU in our study, despite its high twin study heritability estimate. The gap between GCTA and twin study heritabilities will make it challenging to identify genes responsible for the heritability of CU