First-trimester or second-trimester screening, or both, for Down's syndrome

BACKGROUND: It is uncertain how best to screen pregnant women for the presence of fetal Down's syndrome: to perform first-trimester screening, to perform second-trimester screening, or to use strategies incorporating measurements in both trimesters.METHODS: Women with singleton pregnancies underwent first-trimester combined screening (measurement of nuchal translucency, pregnancy-associated plasma protein A [PAPP-A], and the free beta subunit of human chorionic gonadotropin at 10 weeks 3 days through 13 weeks 6 days of gestation) and second-trimester quadruple screening (measurement of alpha-fetoprotein, total human chorionic gonadotropin, unconjugated estriol, and inhibin A at 15 through 18 weeks of gestation). We compared the results of stepwise sequential screening (risk results provided after each test), fully integrated screening (single risk result provided), and serum integrated screening (identical to fully integrated screening, but without nuchal translucency).RESULTS: First-trimester screening was performed in 38,167 patients; 117 had a fetus with Down's syndrome. At a 5 percent false positive rate, the rates of detection of Down's syndrome were as follows: with first-trimester combined screening, 87 percent, 85 percent, and 82 percent for measurements performed at 11, 12, and 13 weeks, respectively; with second-trimester quadruple screening, 81 percent; with stepwise sequential screening, 95 percent; with serum integrated screening, 88 percent; and with fully integrated screening with first-trimester measurements performed at 11 weeks, 96 percent. Paired comparisons found significant differences between the tests, except for the comparison between serum integrated screening and combined screening.CONCLUSIONS: First-trimester combined screening at 11 weeks of gestation is better than second-trimester quadruple screening but at 13 weeks has results similar to second-trimester quadruple screening. Both stepwise sequential screening and fully integrated screening have high rates of detection of Down's syndrome, with low false positive rates

Transition to parenthood and quality of parenting among gay, lesbian and heterosexual couples who conceived through assisted reproduction

Little research has focused on the emotions felt during pregnancy and early parenthood as well as the initial quality of parenting displayed by first-time parents who conceived using assisted reproduction technologies (surrogacy, donor insemination, and in vitro fertilization). Research on primary and secondary caregivers in gay, lesbian, and heterosexual families is especially sparse. The current study examined 35 gay-father families, 58 lesbian-mother families and 41 heterosexual-parent families with their infants. Families were assessed at home when their infants were 4 months old (±14 days), and each parent participated in an audio-recorded standardized semi-structured interview in which we explored parental feelings during pregnancy, feelings about the parental role, perceived parental competence, the enjoyment of parenthood, expressed warmth and emotional over-involvement of parents. 13 Heterosexual parents reported less positive feelings in early pregnancy than lesbian parents, while gay parents reported less positive feelings at the end of pregnancy than lesbian mothers and more positive feelings about parenthood during the first post-partum weeks than heterosexual parents. There was no interaction between family type and caregiver role on reported feelings, or on perceived competence, enjoyment, warmth, and involvement. The present findings elucidate the transition to parenthood among first-time parents conceiving through assisted reproductive technologies, and especially contribute to our knowledge about gay fathers who became parents through surrogacy

Three-loop \beta-functions for top-Yukawa and the Higgs self-interaction in the Standard Model

We analytically compute the dominant contributions to the \beta-functions for the top-Yukawa coupling, the strong coupling and the Higgs self-coupling as well as the anomalous dimensions of the scalar, gluon and quark fields in the unbroken phase of the Standard Model at three-loop level. These are mainly the QCD and top-Yukawa corrections. The contributions from the Higgs self-interaction which are negligible for the running of the top-Yukawa and the strong coupling but important for the running of the Higgs self-coupling are also evaluated.Comment: 22 pages, 7 figures. Few extra citations are added; the plots are improved. Results in computer readable form can be retrieved from http://www-ttp.particle.uni-karlsruhe.de/Progdata/ttp12/ttp12-012

Theorems for asymptotic safety of gauge theories

We classify the weakly interacting fixed points of general gauge theories coupled to matter and explain how the competition between gauge and matter fluctuations gives rise to a rich spectrum of high- and low-energy fixed points. The pivotal role played by Yukawa couplings is emphasised. Necessary and sufficient conditions for asymptotic safety of gauge theories are also derived, in conjunction with strict no go theorems. Implications for phase diagrams of gauge theories and physics beyond the Standard Model are indicated

Size Matters: Microservices Research and Applications

In this chapter we offer an overview of microservices providing the introductory information that a reader should know before continuing reading this book. We introduce the idea of microservices and we discuss some of the current research challenges and real-life software applications where the microservice paradigm play a key role. We have identified a set of areas where both researcher and developer can propose new ideas and technical solutions.Comment: arXiv admin note: text overlap with arXiv:1706.0735

Searching for plasticity in dissociated cortical cultures on multi-electrode arrays

We attempted to induce functional plasticity in dense cultures of cortical cells using stimulation through extracellular electrodes embedded in the culture dish substrate (multi-electrode arrays, or MEAs). We looked for plasticity expressed in changes in spontaneous burst patterns, and in array-wide response patterns to electrical stimuli, following several induction protocols related to those used in the literature, as well as some novel ones. Experiments were performed with spontaneous culture-wide bursting suppressed by either distributed electrical stimulation or by elevated extracellular magnesium concentrations as well as with spontaneous bursting untreated. Changes concomitant with induction were no larger in magnitude than changes that occurred spontaneously, except in one novel protocol in which spontaneous bursts were quieted using distributed electrical stimulation

Delivering at Home or in a Health Facility? Health-Seeking Behaviour of Women and the Role of Traditional birth attendants in Tanzania.

Traditional birth attendants retain an important role in reproductive and maternal health in Tanzania. The Tanzanian Government promotes TBAs in order to provide maternal and neonatal health counselling and initiating timely referral, however, their role officially does not include delivery attendance. Yet, experience illustrates that most TBAs still often handle complicated deliveries. Therefore, the objectives of this research were to describe (1) women's health-seeking behaviour and experiences regarding their use of antenatal (ANC) and postnatal care (PNC); (2) their rationale behind the choice of place and delivery; and to learn (3) about the use of traditional practices and resources applied by traditional birth attendants (TBAs) and how they can be linked to the bio-medical health system. Qualitative and quantitative interviews were conducted with over 270 individuals in Masasi District, Mtwara Region and Ilala Municipality, Dar es Salaam, Tanzania. The results from the urban site show that significant achievements have been made in terms of promoting pregnancy- and delivery-related services through skilled health workers. Pregnant women have a high level of awareness and clearly prefer to deliver at a health facility. The scenario is different in the rural site (Masasi District), where an adequately trained health workforce and well-equipped health facilities are not yet a reality, resulting in home deliveries with the assistance of either a TBA or a relative. Instead of focusing on the traditional sector, it is argued that more attention should be paid towards (1) improving access to as well as strengthening the health system to guarantee delivery by skilled health personnel; and (2) bridging the gaps between communities and the formal health sector through community-based counselling and health education, which is provided by well-trained and supervised village health workers who inform villagers about promotive and preventive health services, including maternal and neonatal health

Mirroring everyday clinical practice in clinical trial design: a new concept to improve the external validity of randomized double-blind placebo-controlled trials in the pharmacological treatment of major depression

Background: Randomized, double-blind, placebo-controlled trials constitute the gold standard in clinical research when testing the efficacy of new psychopharmacological interventions in the treatment of major depression. However, the blinded use of placebo has been found to influence clinical trial outcomes and may bias patient selection. Discussion: To improve clinical trial design in major depression so as to reflect clinical practice more closely we propose to present patients with a balanced view of the benefits of study participation irrespective of their assignment to placebo or active treatment. In addition every participant should be given the option to finally receive the active medication. A research agenda is outlined to evaluate the impact of the proposed changes on the efficacy of the drug to be evaluated and on the demographic and clinical characteristics of the enrollment fraction with regard to its representativeness of the eligible population. Summary: We propose a list of measures to be taken to improve the external validity of double-blind, placebocontrolled trials in major depression. The recommended changes to clinical trial design may also be relevant for other psychiatric as well as medical disorders in which expectations regarding treatment outcome may affect the outcome itself

Three-loop HTL QCD thermodynamics

The hard-thermal-loop perturbation theory (HTLpt) framework is used to calculate the thermodynamic functions of a quark-gluon plasma to three-loop order. This is the highest order accessible by finite temperature perturbation theory applied to a non-Abelian gauge theory before the high-temperature infrared catastrophe. All ultraviolet divergences are eliminated by renormalization of the vacuum, the HTL mass parameters, and the strong coupling constant. After choosing a prescription for the mass parameters, the three-loop results for the pressure and trace anomaly are found to be in very good agreement with recent lattice data down to $T \sim 2-3\,T_c$, which are temperatures accessible by current and forthcoming heavy-ion collision experiments.Comment: 27 pages, 11 figures; corresponds with published version in JHE