Prognostic prediction models for pregnancy complications in women with gestational diabetes: a protocol for systematic review, critical appraisal and meta-analysis

Background: Gestational diabetes (GDM) is increasingly common and has significant implications during pregnancy and for the long-term health of the mother and offspring. However, it is a heterogeneous condition with inter-related factors including ethnicity, body mass index and gestational weight gain significantly modifying the absolute risk of complications at an individual level. Predicting the risk of pregnancy complications for an individual woman with GDM presents a useful adjunct to therapeutic decision-making and patient education. Diagnostic prediction models for GDM are prevalent. In contrast, prediction models for risk of complications in those with GDM are relatively novel. This study will systematically review published prognostic prediction models for pregnancy complications in women with GDM, describe their characteristics, compare performance and assess methodological quality and applicability. Methods: Studies will be identified by searching MEDLINE and Embase electronic databases. Title and abstract screening, full-text review and data extraction will be completed independently by two reviewers. The included studies will be systematically assessed for risk of bias and applicability using appropriate tools designed for prediction modelling studies. Extracted data will be tabulated to facilitate qualitative comparison of published prediction models. Quantitative data on predictive performance of these models will be synthesised with meta-analyses if appropriate. Discussion: This review will identify and summarise all published prognostic prediction models for pregnancy complications in women with GDM. We will compare model performance across different settings and populations with meta-analysis if appropriate. This work will guide subsequent phases in the prognosis research framework: further model development, external validation and model updating, and impact assessment. The ultimate model will estimate the absolute risk of pregnancy complications for women with GDM and will be implemented into routine care as an evidence-based GDM complication risk prediction model. It is anticipated to offer value to women and their clinicians with individualised risk assessment and may assist decision-making. Ultimately, this systematic review is an important step towards a personalised risk-stratified model-of-care for GDM to allow preventative and therapeutic interventions for the maximal benefit to women and their offspring, whilst sparing expense and harm for those at low risk.Shamil D. Cooray, Jacqueline A. Boyle, Georgia Soldatos, Lihini A. Wijeyaratne and Helena J. Teed

On the anomalous large-scale flows in the Universe

Recent combined analyses of the CMB and galaxy cluster data reveal unexpectedly large and anisotropic peculiar velocity fields at large scales. We study cosmic models with included vorticity, acceleration and total angular momentum of the Universe in order to understand the phenomenon. The Zeldovich model is used to mimic the low redshift evolution of the angular momentum. Solving coupled evolution equations of the second kind for density-contrast in corrected Ellis-Bruni covariant and gauge-invariant formalism one can properly normalize and evaluate integrated Sachs-Wolfe effect and peculiar velocity field. The theoretical results compared to the observations favor a much larger matter content of the Universe than that of the concordance model. Large-scale flows appear anisotropic with dominant components placed in the plane perpendicular to the axis of vorticity(rotation). The integrated Sachs-Wolfe term has negative contribution to the CMB fluctuations for the negative cosmological constant and it can explain the observed small power of the CMB TT spectrum at large scales. The rate of the expansion of the Universe can be substantially affected by the angular momentum if its magnitude is large enough.Comment: 13 pages, 6 tables, 4 figures, 36 references; version to appear in Eur. Phys. J.

Cosmological constraints from galaxy clustering

In this manuscript I review the mathematics and physics that underpins recent work using the clustering of galaxies to derive cosmological model constraints. I start by describing the basic concepts, and gradually move on to some of the complexities involved in analysing galaxy redshift surveys, focusing on the 2dF Galaxy Redshift Survey (2dFGRS) and the Sloan Digital Sky survey (SDSS). Difficulties within such an analysis, particularly dealing with redshift space distortions and galaxy bias are highlighted. I then describe current observations of the CMB fluctuation power spectrum, and consider the importance of measurements of the clustering of galaxies in light of recent experiments. Finally, I provide an example joint analysis of the latest CMB and large-scale structure data, leading to a set of parameter constraints.Comment: 30 pages, 13 figures. Lecture given at Third Aegean Summer School, The invisible universe: Dark matter and Dark energ

A single fast radio burst localized to a massive galaxy at cosmological distance

Fast radio bursts (FRBs) are brief radio emissions from distant astronomical sources. Some are known to repeat, but most are single bursts. Nonrepeating FRB observations have had insufficient positional accuracy to localize them to an individual host galaxy. We report the interferometric localization of the single-pulse FRB 180924 to a position 4 kiloparsecs from the center of a luminous galaxy at redshift 0.3214. The burst has not been observed to repeat. The properties of the burst and its host are markedly different from those of the only other accurately localized FRB source. The integrated electron column density along the line of sight closely matches models of the intergalactic medium, indicating that some FRBs are clean probes of the baryonic component of the cosmic web

Clay-biochar composites for sorptive removal of tetracycline antibiotic in aqueous media

The focus of this research was to synthesize novel clay-biochar composites by incorporating montmorillonite (MMT) and red earth (RE) clay materials in a municipal solid waste (MSW) biochar for the adsorptive removal of tetracycline (TC) from aqueous media. X-ray Fluorescence Analysis (XRF), Fourier Transform Infrared Spectroscopy (FTIR), Powder X-ray Diffraction (PXRD) and Scanning Electron Microscopy (SEM) were used for the characterization of the synthesized raw biochar (MSW-BC) and clay-biochar composites (MSW-MMT and MSW-RE). Results showed that minute clay particles were dispersed on biochar surfaces. The FTIR bands due to Si-O functional group vibrations in the spectra of the clay-biochar composites provided further evidence for successful composite formation. The kinetic TC adsorption data of MSW-MMT were well fitted to the Elovich model expressing high surface activity of biochar and involvement of multiple mechanisms in the adsorption. The kinetic TC adsorption data of MSW-BC and MSW-RE were fitted to the pseudo second order model indicating dominant contribution of chemisorption mechanism during the adsorption. The adsorption differentiation obtained in the kinetic studies was mainly due to the structure of the combined clay material. The adsorption isotherm data of all the adsorbents were well fitted to the Freundlich model suggesting that the adsorption of TC onto the materials occurred via both physisorption and chemisorption mechanisms. In comparison to the raw biochar and MSW-RE, MSW-MMT exhibited higher TC adsorption capacity. Therefore, MSW-MMT clay-biochar composite could be applied in the remediation of TC antibiotic residues in contaminated aqueous media

Effect of QT interval prolongation on cardiac arrest following liver transplantation and derivation of a risk index

Liver transplantation (LT) has a 4-fold higher risk of periprocedural cardiac arrest and ventricular arrhythmias (CA/VAs) compared with other noncardiac surgeries. Prolongation of the corrected QT interval (QTc) is common in patients with liver cirrhosis. Whether it is associated with an increased risk of CA/VAs following LT is unclear. Rates of 30-day CA/VAs post-LT were assessed in consecutive adults undergoing LT between 2010 and 2017. Pretransplant QTc was measured by a cardiologist blinded to clinical outcomes. Among 408 patients included, CA/VAs occurred in 26 patients (6.4%). QTc was significantly longer in CA/VA patients (475 ± 34 vs 450 ± 34 ms, P < .001). Optimal QTc cut-off for prediction of CA/VAs was ≥480 ms. After adjustment, QTc ≥480 ms remained the strongest predictor for the occurrence of CA/VAs (odds ratio [OR] 5.2, 95% confidence interval [CI] 2.2-12.6). A point-based cardiac arrest risk index (CARI) was derived with the bootstrap method for yielding optimism-corrected coefficients (2 points: QTc ≥480, 1 point: Model for End-Stage Liver Disease [MELD] ≥30, 1 point: age ≥65, and 1 point: male). CARI score ≥3 demonstrated moderate discrimination (c-statistic 0.79, optimism-corrected c-statistic 0.77) with appropriate calibration. QTc ≥480 ms was associated with a 5-fold increase in the risk of CA/VAs. The CARI score may identify patients at higher risk of these events. Whether heightened perioperative cardiac surveillance, avoidance of QT prolonging medications, or beta blockers could mitigate the risk of CA/VAs in this population merits further study.Anoop N. Koshy, Jefferson Ko, Omar Farouque, Shamil D. Cooray, Hui‐Chen Han ... Han S. Li