695 research outputs found
The annual course of precipitation over much of the United States: observed versus GCM simulation
General Circulation Models (GCMs) may be useful in estimating the ecological impacts of global climatic change. We analyzed seasonal weather patterns over the conterminous United States and determined that regional patterns of rainfall seasonality appear to control the distributions of the Nation's major biomes. These regional patterns were compared to the output from three GCMs for validation. The models appear to simulate the appropriate seasonal climates in the northern tier of states. However, the spatial extent of these regions is distorted. None of the models accurately portrayed rainfall seasonalities in the southern tier of states, where biomes are primarily influenced by the Bermuda High
Understanding complex magnetic order in disordered cobalt hydroxides through analysis of the local structure
In many ostensibly crystalline materials, unit-cell-based descriptions do not
always capture the complete physics of the system due to disruption in
long-range order. In the series of cobalt hydroxides studied here,
Co(OH)(Cl)(HO), magnetic Bragg diffraction reveals a
fully compensated N\'eel state, yet the materials show significant and open
magnetization loops. A detailed analysis of the local structure defines the
aperiodic arrangement of cobalt coordination polyhedra. Representation of the
structure as a combination of distinct polyhedral motifs explains the existence
of locally uncompensated moments and provides a quantitative agreement with
bulk magnetic measurements and magnetic Bragg diffraction
Second trimester serum tests for Down's Syndrome screening
Background
Down's syndrome occurs when a person has three copies of chromosome 21 - or the specific area of chromosome 21 implicated in causing Down's syndrome - rather than two. It is the commonest congenital cause of mental retardation. Noninvasive screening based on biochemical analysis of maternal serum or urine, or fetal ultrasound measurements, allows estimates of the risk of a pregnancy being affected and provides information to guide decisions about definitive testing.
Objectives
To estimate and compare the accuracy of second trimester serum markers for the detection of Down’s syndrome.
Search methods
We carried out a sensitive and comprehensive literature search of MEDLINE (1980 to May 2007), EMBASE (1980 to 18 May 2007), BIOSIS via EDINA (1985 to 18 May 2007), CINAHL via OVID (1982 to 18 May 2007), The Database of Abstracts of Reviews of Effectiveness (The Cochrane Library 2007, Issue 1), MEDION (May 2007), The Database of Systematic Reviews and Meta-Analyses in Laboratory Medicine (May 2007), The National Research Register (May 2007), Health Services Research Projects in Progress database (May 2007). We studied reference lists and published review articles.
Selection criteria
Studies evaluating tests of maternal serum in women at 14-24 weeks of gestation for Down's syndrome, compared with a reference standard, either chromosomal verification or macroscopic postnatal inspection.
Data collection and analysis
Data were extracted as test positive/test negative results for Down's and non-Down's pregnancies allowing estimation of detection rates (sensitivity) and false positive rates (1-specificity). We performed quality assessment according to QUADAS criteria. We used hierarchical summary ROC meta-analytical methods to analyse test performance and compare test accuracy. Analysis of studies allowing direct comparison between tests was undertaken. We investigated the impact of maternal age on test performance in subgroup analyses.
Main results
Fifty-nine studies involving 341,261 pregnancies (including 1,994 with Down's syndrome) were included. Studies were generally high quality, although differential verification was common with invasive testing of only high-risk pregnancies. Seventeen studies made direct comparisons between tests. Fifty-four test combinations were evaluated formed from combinations of 12 different tests and maternal age; alpha-fetoprotein (AFP), unconjugated oestriol (uE3), total human chorionic gonadotrophin (hCG), free beta human chorionic gonadotrophin (βhCG), free alpha human chorionic gonadotrophin (αhCG), Inhibin A, SP2, CA125, troponin, pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PGF) and proform of eosinophil major basic protein (ProMBP).
Meta-analysis of 12 best performing or frequently evaluated test combinations showed double and triple tests (involving AFP, uE3, total hCG, free βhCG) significantly outperform individual markers, detecting six to seven out of every 10 Down's syndrome pregnancies at a 5% false positive rate. Tests additionally involving inhibin performed best (eight out of every 10 Down's syndrome pregnancies) but were not shown to be significantly better than standard triple tests in direct comparisons. Significantly lower sensitivity occurred in women over the age of 35 years. Women who miscarried in the over 35 group were more likely to have been offered an invasive test to verify a negative screening results, whereas those under 35 were usually not offered invasive testing for a negative screening result. Pregnancy loss in women under 35 therefore leads to under ascertainment of screening results, potentially missing a proportion of affected pregnancies and affecting the accuracy of the sensitivity.
Authors' conclusions
Tests involving two or more markers in combination with maternal age are significantly more sensitive than those involving one marker. The value of combining four or more tests or including inhibin have not been proven to show statistically significant improvement. Further study is required to investigate reduced test performance in women aged over 35 and the impact of differential pregnancy loss on study findings
First trimester ultrasound tests alone or in combination with first trimester serum tests for Down's syndrome screening
First and second trimester serumtests with and without first trimester ultrasound tests for Down's syndrome screening
The APPLe Study: A Randomized, Community-Based, Placebo-Controlled Trial of Azithromycin for the Prevention of Preterm Birth, with Meta-Analysis
Abstract Background: Premature birth is the major cause of perinatal mortality and morbidity in both high-and low-income countries. The causes of preterm labour are multiple but infection is important. We have previously described an unusually high incidence of preterm birth (20%) in an ultrasound-dated, rural, pregnant population in Southern Malawi with high burdens of infective morbidity. We have now studied the impact of routine prophylaxis with azithromycin as directly observed, single-dose therapy at two gestational windows to try to decrease the incidence of preterm birth
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