Effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes in low risk pregnancy (the IRIS study): nationwide, pragmatic, multicentre, stepped wedge cluster randomised trial

Objectives To investigate the effectiveness of routine ultrasonography in the third trimester in reducing adverse perinatal outcomes in low risk pregnancies compared with usual care and the effect of this policy on maternal outcomes and obstetric interventions. Design Pragmatic, multicentre, stepped wedge cluster randomised trial. Setting 60 midwifery practices in the Netherlands. Participants 13 046 women aged 16 years or older with a low risk singleton pregnancy. Interventions 60 midwifery practices offered usual care (serial fundal height measurements with clinically indicated ultrasonography). After 3, 7, and 10 months, a third of the practices were randomised to the intervention strategy. As well as receiving usual care, women in the intervention strategy were offered two routine biometry scans at 28-30 and 34-36 weeks’ gestation. The same multidisciplinary protocol for detecting and managing fetal growth restriction was used in both strategies. Main outcome measures The primary outcome measure was a composite of severe adverse perinatal outcomes: perinatal death, Apgar score <4, impaired consciousness, asphyxia, seizures, assisted ventilation, septicaemia, meningitis, bronchopulmonary dysplasia, intraventricular haemorrhage, periventricular leucomalacia, or necrotising enterocolitis. Secondary outcomes were two composite measures of severe maternal morbidity, and spontaneous labour and birth. Results Between 1 February 2015 and 29 February 2016, 60 midwifery practices enrolled 13 520 women in mid-pregnancy (mean 22.8 (SD 2.4) weeks’ gestation). 13 046 women (intervention n=7067, usual care n=5979) with data based on the national Dutch perinatal registry or hospital records were included in the analyses. Small for gestational age at birth was significantly more often detected in the intervention group than in the usual care group (179 of 556 (32%) v 78 of 407 (19%), P<0.001). The incidence of severe adverse perinatal outcomes was 1.7% (n=118) for the intervention strategy and 1.8% (n=106) for usual care. After adjustment for confounders, the difference between the groups was not significant (odds ratio 0.88, 95% confidence interval 0.70 to 1.20). The intervention strategy showed a higher incidence of induction of labour (1.16, 1.04 to 1.30) and a lower incidence of augmentation of labour (0.78, 0.71 to 0.85). Maternal outcomes and other obstetric interventions did not differ between the strategies. Conclusion In low risk pregnancies, routine ultrasonography in the third trimester along with clinically indicated ultrasonography was associated with higher antenatal detection of small for gestational age fetuses but not with a reduced incidence of severe adverse perinatal outcomes compared with usual care alone. The findings do not support routine ultrasonography in the third trimester for low risk pregnancies. Trial registration Netherlands Trial Register NTR4367

Social Media - a primer

A short online guide to social media.

The effect of social transfers in Europe An empirical analysis using Generalised Lorenz Curves

'This paper aims at examining the impact of different transfers on the income distribution in European countries. Therefore an empirical analysis using generalised Lorenz curve comparisons is carried out. The obtained results are investigated by relating them to a classification of European social transfer systems.' (author's abstract)Gegenstand der Untersuchung sind die Auswirkungen unterschiedlicher Transferzahlungen auf die Einkommensverteilung in europaeischen Laendern. Die vorgelegte empirische Untersuchung arbeitet mit generalisierten Lorenz-Kurven. Die Verfasserin setzt die Ergebnisse dieser Untersuchung in Beziehung zu einer Klassifikation von sozialen Transfersystemen in Europa. (ICEUebers)German title: Die Auswirkungen sozialer Transfers in Europa: eine empirische Analyse mit Hilfe generalisierter Lorenz-KurvenAvailable from http://www.ceps.lu/iriss/documents/irisswp25.pdf / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

The counter-terrorist campus: Securitisation theory and university securitisation – Three Models

With intensified threats to global security from international terrorism, universities have become a focus for security concerns and marked as locus of special interest for the monitoring of extremism and counter-terrorism efforts by intelligence agencies worldwide. Drawing on initiatives in the United Kingdom and United States, I re-frame three – covert, overt and covert–overt – intersections of education, security and intelligence studies as a theoretical milieu by which to understand such counter-terrorism efforts. Against the backdrop of new legislative guidance for universities in an era of global terrorism and counter-terrorism efforts by security and intelligence agencies and their Governments, and through a review of Open-Source security/intelligence concerning universities in the United Kingdom and the United States, I show how this interstitial (covert, overt and covert– overt) complexity can be further understood by the overarching relationship between securitisation theory and university securitisation. An emergent securitised concept of university life is important because de facto it will potentially effect radical change upon the nature and purposes of the university itself. A current-day situation replete with anxiety and uncertainty, the article frames not only a sharply contested and still unfolding political agenda for universities but a challenge to the very nature and purposes of the university in the face of a potentially existential threat. Terrorism and counterterrorism, as manifest today, may well thus be altering the aims and purposes of the university in ways we as yet do not fully know or understand. This article advances that knowledge and understanding through a theoretical conceptualisation: the counter-terrorist campus