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Non-immune fetal hydrops: etiology and outcome according to gestational age at diagnosis.

OBJECTIVE: Fetal hydrops is associated with increased perinatal morbidity and mortality. The etiology and outcome of fetal hydrops may differ according to the gestational age at diagnosis. The aim of this study was to evaluate the cause, evolution and outcome of non-immune fetal hydrops (NIFH), according to the gestational age at diagnosis. METHODS: This was a retrospective cohort study of all singleton pregnancies complicated by NIFH, at the Fetal Medicine Unit at St George's University Hospital, London, UK, between 2000 and 2018. All fetuses had detailed anomaly and cardiac ultrasound scans, karyotyping and infection screening. Prenatal diagnostic and therapeutic intervention, gestational age at diagnosis and delivery, as well as pregnancy outcome, were recorded. Regression analysis was used to test for potential association between possible risk factors and perinatal mortality. RESULTS: We included 273 fetuses with NIFH. The etiology of the condition varied significantly in the three trimesters. Excluding 30 women who declined invasive testing, the cause of NIFH was defined as unknown in 62 of the remaining 243 cases (25.5%). Chromosomal aneuploidy was the most common cause of NIFH in the first trimester. It continued to be a significant etiologic factor in the second trimester, along with congenital infection. In the third trimester, the most common etiology was cardiovascular abnormality. Among the 152 (55.7%) women continuing the pregnancy, 48 (31.6%) underwent fetal intervention, including the insertion of pleuroamniotic shunts, fetal blood transfusion and thoracentesis. Fetal intervention was associated significantly with lower perinatal mortality (odds ratio (OR), 0.30 (95% CI, 0.14-0.61); P  0.05). CONCLUSIONS: An earlier gestational age at diagnosis of NIFH was associated with an increased risk of aneuploidy and worse pregnancy outcome, including a higher risk of perinatal loss. Fetal therapy was associated significantly with lower perinatal mortality. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology

Schizotypy in an online sample: Associations with functioning, wellbeing, and stigma toward psychological treatment

poster abstractBackground: Social functioning and positive attitudes toward treatment have been strongly linked with recovery in people with schizophrenia, yet less is known for schizotypy – traits that are associated with risk for schizophrenia. Previous studies of schizotypy have used primarily undergraduate or small community samples. The aim of the current study was to investigate correlates of schizotypy in a large online sample. We hypothesized that people with schizotypy traits would report lower functioning, well-being, and greater stigmatizing attitudes regarding treatment. Methods: In a sample (N=856) recruited using Amazon’s Mechanical Turk (MTurk), participants were dichotomized into non-schizotypy or schizotypy groups based on their endorsement of schizotypal traits on the Schizotypal Personality Questionnaire – Brief Revised (SPQ-BR; schizotypy group n=101; non-schizotypy group n=431). Participants completed a demographic survey and several measures related to functioning, well-being, and stigma, including the Romantic Relationship Functioning Scale (RRFS), the Social Adjustment Scale – Self-Report: Screener (SAS-SR: Screener), the SPQ-BR, the Short Form-12 Health Survey (SF-12), and the Stigma Scale for Receiving Psychological Help (SSRPH). Independent-samples t-tests were conducted to compare schizotypy groups on these variables. Results: Those who reported high levels of schizotypy reported significantly poorer social functioning, t(122.74)=-10.66, p<.001; poorer romantic relationship functioning, t(129.01)=12.00, p<.001; poorer mental wellbeing ,t(132.58)=13.42, p=.001; and greater stigma toward receiving psychological treatment, t(137.06)=-3.89, p=.037. There was no significant difference in physical wellbeing. Discussion: These findings support the use of online samples and suggest schizotypy is associated with poorer functioning and wellbeing and increased stigma toward seeking treatment. Results support the emergence of deficits in key social domains among those at risk for developing greater psychosis symptoms. Given the links between these deficits and attitudes and poorer functioning in clinical samples, these findings suggest social functioning and help-seeking attitudes may be important targets of early intervention services

Visit complexity, diagnostic uncertainty, and antibiotic prescribing for acute cough in primary care: a retrospective study

Background: Guidelines and performance measures recommend avoiding antibiotics for acute cough/acute bronchitis and presume visits are straightforward with simple diagnostic decision-making. We evaluated clinician-assigned diagnoses, diagnostic uncertainty, and antibiotic prescribing for acute cough visits in primary care. Methods: We conducted a retrospective analysis of acute cough visits – cough lasting ≤21 days in adults 18–64 years old without chronic lung disease – in a primary care practice from March 2011 through June 2012. Results: Of 56,301 visits, 962 (2%) were for acute cough. Clinicians diagnosed patients with 1, 2, or ≥ 3 cough-related diagnoses in 54%, 35%, and 11% of visits, respectively. The most common principal diagnoses were upper respiratory infection (46%), sinusitis (10%), acute bronchitis (9%), and pneumonia (8%). Clinicians prescribed antibiotics in 22% of all visits: 65% of visits with antibiotic-appropriate diagnoses and 4% of visits with non-antibiotic-appropriate diagnoses. Clinicians expressed diagnostic uncertainty in 16% of all visits: 43% of visits with antibiotic-appropriate diagnoses and 5% of visits with non-antibiotic-appropriate diagnoses. Clinicians expressed uncertainty more often when prescribing antibiotics than when not prescribing antibiotics (30% vs. 12%; p < 0.001). As the number of visit diagnoses increased from 1 to 2 to ≥ 3, clinicians were more likely to express diagnostic uncertainty (5%, 25%, 40%, respectively; p < 0.001) and prescribe antibiotics (16%, 25%, 41%, respectively; p < 0.001). Conclusions: Acute cough may be more complex and have more diagnostic uncertainty than guidelines and performance measures presume. Efforts to reduce antibiotic prescribing for acute cough should address diagnostic complexity and uncertainty that clinicians face

Investment Opportunities Forecasting: Extending the Grammar of a GP-based Tool

In this paper we present a new version of a GP financial forecasting tool, called EDDIE 8. The novelty of this version is that it allows the GP to search in the space of indicators, instead of using pre-specified ones. We compare EDDIE 8 with its predecessor, EDDIE 7, and find that new and improved solutions can be found. Analysis also shows that, on average, EDDIE 8's best tree performs better than the one of EDDIE 7. The above allows us to characterize EDDIE 8 as a valuable forecasting tool

Eclogites and basement terrane tectonics in the northern arm of the Grenville orogen, NW Scotland

The presence of eclogites within continental crust is a key indicator of collisional orogenesis. Eclogites within the Eastern Glenelg basement inlier of the Northern Highland Terrane (NHT) have been re-dated in order to provide more accurate constraints on the timing of collision within the northern arm of the Grenville Orogen. The eclog-ites yield dates of ca.1200 Ma which are interpreted to record the onset of continent-continent interaction, and the NHT as a whole is thought to represent the lower plate in successive 1200-1000 Ma collision events. The Eastern Glenelg basement inlier is viewed as a fragment of the leading edge of the NHT continental basement that was partially subducted along a suture and then exhumed back up the subduction channel. Differences in ages of igneous protoliths and intrusive histories, and metamorphic events (this paper) between the NHT basement and the Laurentian foreland, suggests that they were separate crustal blocks until after ca. 1600 Ma. We therefore suggest that: (1) the NHT represents a fragment of Archean-Paleoproterozoic crust that was reworked within the ca. 1.7-1.6 Ga Labradorian-Gothian belt, although whether it was derived from Laurentia or Baltica is uncertain, and (2) amalgamation of the NHT with the Laurentian foreland did not occur until the terminal stages of the Grenville collision at ca. 1000 Ma

Identification of Seismo-Volcanic Regimes at Whakaari/White Island (New Zealand) Via Systematic Tuning of an Unsupervised Classifier

We present an algorithm based on Self-Organizing Maps (SOM) and k-means clustering to recognize patterns in a continuous 12.5-year tremor time series recorded at Whakaari/White Island volcano, New Zealand (hereafter referred to as Whakaari). The approach is extendable to a variety of volcanic settings through systematic tuning of the classifier. Hyperparameters are evaluated by statistical means, yielding a combination of “ideal” SOM parameters for the given data set. Extending from this, we applied a Kernel Density Estimation approach to automatically detect changes within the observed seismicity. We categorize the Whakaari seismic time series into regimes representing distinct volcano-seismic states during recent unrest episodes at Whakaari (2012/2013, 2016, and 2019). There is a clear separation in classification results between background regimes and those representing elevated levels of unrest. Onset of unrest is detected by the classifier 6 weeks before the August 2012 eruption, and ca. 3.5 months before the December 2019 eruption, respectively. Regime changes are corroborated by changes in commonly monitored tremor proxies as well as with reported volcanic activity. The regimes are hypothesized to represent diverse mechanisms including: system pressurization and depressurization, degassing, and elevated surface activity. Labeling these regimes improves visualization of the 2012/2013 and 2019 unrest and eruptive episodes. The pre-eruptive 2016 unrest showed a contrasting shape and nature of seismic regimes, suggesting differing onset and driving processes. The 2016 episode is proposed to result from rapid destabilization of the shallow hydrothermal system, while rising magmatic gases from new injections of magma better explain the 2012/2013 and 2019 episodes

Hydrodynamic theory of an electron gas

The generalised hydrodynamic theory of an electron gas, which does not rely on an assumption of a local equilibrium, is derived as the long-wave limit of a kinetic equation. Apart from the common hydrodynamics variables the theory includes the tensor fields of the higher moments of the distribution function. In contrast to the Bloch hydrodynamics, the theory leads to the correct plasmon dispersion and in the low frequency limit recovers the Navies-Stocks hydrodynamics. The linear approximation to the generalised hydrodynamics is closely related to the theory of highly viscous fluids.Comment: 4 pages, revte

Primary care clinicians’ perceptions about antibiotic prescribing for acute bronchitis: a qualitative study

Background: Clinicians prescribe antibiotics to over 65% of adults with acute bronchitis despite guidelines stating that antibiotics are not indicated. Methods: To identify and understand primary care clinician perceptions about antibiotic prescribing for acute bronchitis, we conducted semi-structured interviews with 13 primary care clinicians in Boston, Massachusetts and used thematic content analysis. Results: All the participants agreed with guidelines that antibiotics are not indicated for acute bronchitis and felt that clinicians other than themselves were responsible for overprescribing. Barriers to guideline adherence included 6 themes: (1) perceived patient demand, which was the main barrier, although some clinicians perceived a recent decrease; (2) lack of accountability for antibiotic prescribing; (3) saving time and money; (4) other clinicians’ misconceptions about acute bronchitis; (5) diagnostic uncertainty; and (6) clinician dissatisfaction in failing to meet patient expectations. Strategies to decrease inappropriate antibiotic prescribing included 5 themes: (1) patient educational materials; (2) quality reporting; (3) clinical decision support; (4) use of an over-the-counter prescription pad; and (5) pre-visit triage and education by nurses to prevent visits. Conclusions: Clinicians continued to cite patient demand as the main reason for antibiotic prescribing for acute bronchitis, though some clinicians perceived a recent decrease. Clinicians felt that other clinicians were responsible for inappropriate antibiotic prescribing and that better pre-visit triage by nurses could prevent visits and change patients’ expectations. Electronic supplementary material The online version of this article (doi:10.1186/s12875-014-0194-5) contains supplementary material, which is available to authorized users