Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study.

BACKGROUND: Fetal growth restriction is a major determinant of adverse perinatal outcome. Screening procedures for fetal growth restriction need to identify small babies and then differentiate between those that are healthy and those that are pathologically small. We sought to determine the diagnostic effectiveness of universal ultrasonic fetal biometry in the third trimester as a screening test for small-for-gestational-age (SGA) infants, and whether the risk of morbidity associated with being small differed in the presence or absence of ultrasonic markers of fetal growth restriction. METHODS: The Pregnancy Outcome Prediction (POP) study was a prospective cohort study of nulliparous women with a viable singleton pregnancy at the time of the dating ultrasound scan. Women participating had clinically indicated ultrasonography in the third trimester as per routine clinical care and these results were reported as usual (selective ultrasonography). Additionally, all participants had research ultrasonography, including fetal biometry at 28 and 36 weeks' gestational age. These results were not made available to participants or treating clinicians (universal ultrasonography). We regarded SGA as a birthweight of less than the 10th percentile for gestational age and screen positive for SGA an ultrasonographic estimated fetal weight of less than the 10th percentile for gestational age. Markers of fetal growth restriction included biometric ratios, utero-placental Doppler, and fetal growth velocity. We assessed outcomes for consenting participants who attended research scans and had a livebirth at the Rosie Hospital (Cambridge, UK) after the 28 weeks' research scan. FINDINGS: Between Jan 14, 2008, and July 31, 2012, 4512 women provided written informed consent of whom 3977 (88%) were eligible for analysis. Sensitivity for detection of SGA infants was 20% (95% CI 15-24; 69 of 352 fetuses) for selective ultrasonography and 57% (51-62; 199 of 352 fetuses) for universal ultrasonography (relative sensitivity 2·9, 95% CI 2·4-3·5, p<0·0001). Of the 3977 fetuses, 562 (14·1%) were identified by universal ultrasonography with an estimated fetal weight of less than the 10th percentile and were at an increased risk of neonatal morbidity (relative risk [RR] 1·60, 95% CI 1·22-2·09, p=0·0012). However, estimated fetal weight of less than the 10th percentile was only associated with the risk of neonatal morbidity (pinteraction=0·005) if the fetal abdominal circumference growth velocity was in the lowest decile (RR 3·9, 95% CI 1·9-8·1, p=0·0001). 172 (4%) of 3977 pregnancies had both an estimated fetal weight of less than the 10th percentile and abdominal circumference growth velocity in the lowest decile, and had a relative risk of delivering an SGA infant with neonatal morbidity of 17·6 (9·2-34·0, p<0·0001). INTERPRETATION: Screening of nulliparous women with universal third trimester fetal biometry roughly tripled detection of SGA infants. Combined analysis of fetal biometry and fetal growth velocity identified a subset of SGA fetuses that were at increased risk of neonatal morbidity. FUNDING: National Institute for Health Research, Medical Research Council, Sands, and GE Healthcare.This work was supported by the National Institute for Health Research (NIHR) Cambridge Comprehensive Biomedical Research Centre and the Stillbirth and Neonatal Death Society. DP was supported by a Medical Research Council (MRC) Clinical Training Fellowship. IRW is supported by a MRC Unit Programme (number U105260558). GE Healthcare (Fairfield, CT, USA) donated two Voluson i ultrasound systems for this study. This study was also supported by the NIHR Cambridge Clinical Research Facility, where all visits at about 20, 28, and 36 weeks took place. No direct or indirectly supporting bodies for the project were involved in any aspect of preparation of this paper for publication. We thank the Perinatal Institute for providing a bulk calculator for customised percentiles of estimated fetal weight. We thank all the women who participated in the study, and all the staff in the Rosie Hospital (Cambridge, UK) and NIHR Cambridge Clinical Research Facility who provided direct or indirect assistance for the study.This is the final published version of the article. It was originally published in The Lancet (Sovio U, White IR, Dacey A, Pasupathy D, Smith GCS, The Lancet, 2015, doi:10.1016/S0140-6736(15)00131-2). The final version is available at http://dx.doi.org/10.1016/S0140-6736(15)00131-2

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Planning a large‐scale tabletop exercise to test Qatar's healthcare system readiness to respond to a major incident during the 2022 FIFA World Cup

© 2023 The Authors, This is an open access article distributed under the Creative Commons Attribution License (CC BY), to view a copy of the license, see: https://creativecommons.org/licenses/by/4.0/This article is an illustration of ‘Lessons from the Field’. The Journal of Contingencies and Crisis Management has begun to present lessons coming from professionals engaged in crisis management. ‘Lessons for the Field’ provides insights that can be useful to other professionals. Moreover, ‘Lessons from the Field’ can stimulate ideas for researchers and provide resources for educators. Hosting a mega‐sporting event such as the International Federation of Football Associations (FIFA) World Cup presents many healthcare challenges, especially when organized over a small geographical area with many international supporters potentially increasing the country's normal population by 50%. This article presents how a system‐wide tabletop simulation exercise was planned to test Qatar's healthcare system's readiness to respond to a potential major incident during the FIFA World Cup. The healthcare system‐wide tabletop exercise lasted about 4 h with participants engaging in all the various facilities as expected. It provided opportunities for everyone to put their knowledge of major incident response and mass casualty management into practice. The exercise preparation ensured it ran smoothly for all participants who quickly understood how to engage in the activity. It enabled organizers and participants to identify potential gaps in systems and processes, but also in their own ability to manage such situation.Peer reviewe

Study protocol. A prospective cohort study of unselected primiparous women: the pregnancy outcome prediction study.

BACKGROUND: There have been dramatic changes in the approach to screening for aneuploidy over the last 20 years. However, the approach to screening for other complications of pregnancy such as intra-uterine growth restriction, pre-eclampsia and stillbirth remains largely unchanged. Randomised controlled trials of routine application of high tech screening methods to the general population have generally failed to show improvement in outcome. We have previously reviewed this and concluded it was due, in large part, to poor performance of screening tests. Here, we report a study design where the primary aim is to generate clinically useful methods to screen women to assess their risk of adverse pregnancy outcome. METHODS/DESIGN: We report the design of a prospective cohort study of unselected primiparous women recruited at the time of their first ultrasound scan. Participation involves serial phlebotomy and obstetric ultrasound at the dating ultrasound scan (typically 10-14 weeks), 20 weeks, 28 weeks and 36 weeks gestation. In addition, maternal demographic details are obtained; maternal and paternal height are measured and maternal weight is serially measured during the pregnancy; maternal, paternal and offspring DNA are collected; and, samples of placenta and membranes are collected at birth. Data will be analysed as a prospective cohort study, a case-cohort study, and a nested case-control study. DISCUSSION: The study is expected to provide a resource for the identification of novel biomarkers for adverse pregnancy outcome and to evaluate the performance of biomarkers and serial ultrasonography in providing clinically useful prediction of risk

Revising upper-ocean sulfur dynamics near Bermuda : new lessons from 3 years of concentration and rate measurements

© The Author(s), 2015. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Environmental Chemistry 13 (2016): 302-313, doi:10.1071/EN15045.Oceanic biogeochemical cycling of dimethylsulfide (DMS), and its precursor dimethylsulfoniopropionate (DMSP), has gained considerable attention over the past three decades because of the potential role of DMS in climate mediation. Here we report 3 years of monthly vertical profiles of organic sulfur cycle concentrations (DMS, particulate DMSP (DMSPp) and dissolved DMSP (DMSPd)) and rates (DMSPd consumption, biological DMS consumption and DMS photolysis) from the Bermuda Atlantic Time-series Study (BATS) site taken between 2005 and 2008. Concentrations confirm the summer paradox with mixed layer DMS peaking ~90 days after peak DMSPp and ~50 days after peak DMSPp : Chl. A small decline in mixed layer DMS was observed relative to those measured during a previous study at BATS (1992–1994), potentially driven by long-term climate shifts at the site. On average, DMS cycling occurred on longer timescales than DMSPd (0.43 ± 0.35 v. 1.39 ± 0.76 day–1) with DMSPd consumption rates remaining elevated throughout the year despite significant seasonal variability in the bacterial DMSP degrader community. DMSPp was estimated to account for 4–5 % of mixed layer primary production and turned over at a significantly slower rate (~0.2 day–1). Photolysis drove DMS loss in the mixed layer during the summer, whereas biological consumption of DMS was the dominant loss process in the winter and at depth. These findings offer new insight into the underlying mechanisms driving DMS(P) cycling in the oligotrophic ocean, provide an extended dataset for future model evaluation and hypothesis testing and highlight the need for a reexamination of past modelling results and conclusions drawn from data collected with old methodologies.The authors acknowledge funding from the National Science Foundation (NSF) (OCE-0425166) and the Center for Microbial Oceanography Research and Education (CMORE) a NSF Science and Technology Center (EF-0424599)

Sea-to-air fluxes from measurements of the atmospheric gradient of dimethylsulfide and comparison with simultaneous relaxed eddy accumulation measurements

We measured vertical profiles of dimethylsulfide (DMS) in the atmospheric marine boundary layer from R/P FLIP during the 2000 FAIRS cruise. Applying Monin-Obukhov similarity theory to the DMS gradients and simultaneous micrometeorological data, we calculated sea-to-air DMS fluxes for 34 profiles. From the fluxes and measured seawater DMS concentrations, we calculated the waterside gas transfer velocity, kw. Gas transfer velocities from the gradient flux approach are within the range of previous commonly used parameterizations of kw as a function of wind speed but are a factor of 2 smaller than simultaneous determinations of transfer velocity using the relaxed eddy accumulation technique. This is the first field comparison of these different techniques for measuring DMS flux from the ocean; the accuracy of the techniques and possible reasons for the discrepancy are discussed

Fluxes and gas transfer rates of the biogenic trace gas DMS derived from atmospheric gradients

Author Posting. © American Geophysical Union, 2004. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research 109 (2004): C08S10, doi:10.1029/2003JC001795.Gas transfer rates were determined from vertical profile measurements of atmospheric dimethylsulfide (DMS) gradients over the equatorial Pacific Ocean obtained during the GasEx-2001 cruise. A quadratic relationship between gas transfer velocity and wind speed was derived from the DMS flux measurements; this relationship was in close agreement with a parameterization derived from relaxed eddy accumulation measurements of DMS over the northeastern Pacific Ocean. However, the GasEx-2001 relationship results in gas transfer rates that are a factor 2 higher than gas transfer rates calculated from a parameterization that is based on coincident eddy correlation measurements of CO2 flux. The measurement precision of both the profiling and eddy correlation techniques applied during GasEx-2001 is comparable; the two gas transfer data sets are in agreement within their uncertainty. Differences in the number of samples and the wind speed range over which CO2 and DMS fluxes were measured are likely causes for the observed discrepancy.Funding for this work came from the Netherlands Organization for Scientific Research (NWO) and from the NOP project 951203: ‘‘Micrometeorology of air/sea fluxes of carbon dioxide. This work was supported by the Global Carbon Cycle project of the NOAA Office of Global Programs grant NA17RJ1223, National Science Foundation grant OCE-9986724, and NSF grant ATM-0120569

Influence of rain on air-sea gas exchange : lessons from a model ocean

Author Posting. © American Geophysical Union, 2004. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research 109 (2004): C08S18, doi:10.1029/2003JC001806.Rain has been shown to significantly enhance the rate of air-water gas exchange in fresh water environments, and the mechanism behind this enhancement has been studied in laboratory experiments. In the ocean, the effects of rain are complicated by the potential influence of density stratification at the water surface. Since it is difficult to perform controlled rain-induced gas exchange experiments in the open ocean, an SF6 evasion experiment was conducted in the artificial ocean at Biosphere 2. The measurements show a rapid depletion of SF6 in the surface layer due to rain enhancement of air-sea gas exchange, and the gas transfer velocity was similar to that predicted from the relationship established from freshwater laboratory experiments. However, because vertical mixing is reduced by stratification, the overall gas flux is lower than that found during freshwater experiments. Physical measurements of various properties of the ocean during the rain events further elucidate the mechanisms behind the observed response. The findings suggest that short, intense rain events accelerate gas exchange in oceanic environments.Funding was provided by a generous grant from the David and Lucile Packard Foundation

Environmental turbulent mixing controls on air-water gas exchange in marine and aquatic systems

Air-water gas transfer influences CO2 and other climatically important trace gas fluxes on regional and global scales, yet the magnitude of the transfer is not well known. Widely used models of gas exchange rates are based on empirical relationships linked to wind speed, even though physical processes other than wind are known to play important roles. Here the first field investigations are described supporting a new mechanistic model based on surface water turbulence that predicts gas exchange for a range of aquatic and marine processes. Findings indicate that the gas transfer rate varies linearly with the turbulent dissipation rate to the equation image power in a range of systems with different types of forcing - in the coastal ocean, in a macro-tidal river estuary, in a large tidal freshwater river, and in a model (i.e., artificial) ocean. These results have important implications for understanding carbon cycling