Screening for gestational diabetes : a systematic review and economic evaluation

Background Screening for gestational diabetes mellitus (GDM) has been controversial, with some expert bodies advising universal screening, others selective screening, and yet others advising against screening at all. This has partly been a result of debate about the definition of GDM, and partly because of the profusion of different tests available, both for screening and definite diagnosis. In the UK, there is no national policy on screening, and a variety of practices exist in different parts of the country. There have also been doubts about the treatment of GDM, and particularly about management of minor degrees of glucose elevation, which are better described as glucose intolerance rather than true diabetes. Objectives To provide an updated review of current knowledge, to clarify research needs, and to assist with policy making in the interim, pending future research. Methods A literature review was carried out, with a particular focus on screening methods and costs, and an appraisal of screening for GDM against the criteria for assessing screening programmes used by the UK National Screening Committee (NSC). Results There is still debate about what is meant by GDM – the threshold for diagnosis is not soundly based; the terms GDM and impaired glucose tolerance are not used in a standard fashion in pregnancy; there is almost certainly a continuum of risk to the baby, rather than there being separate normal and abnormal groups; and the key risk factor in most women may be maternal overweight, with glucose intolerance being an associate of that. In addition there are some rare genetic conditions, which affect a few women, such as glucokinase and hepatic nuclear factor disorders. GDM is usually defined according to divergence from normal glucose levels, but glucose levels are usually raised in pregnancy, and so diagnosis by normal levels in non-pregnant women may misclassify many normal pregnant women as abnormal. This may lead to anxiety and the inconvenience of extra investigations and ‘disease’ care. The Caesarean section rate appears to be increased by the diagnosis alone. Ideally, the condition should be defined by the incidence of adverse effects. However, the most common reported complication of GDM is ‘macrosomia’ in the baby. This is usually defined by arbitrary weight cut-offs (usually a birth weight of 4000 g, but sometimes 4500 g), but such neat thresholds fail to distinguish between larger than average healthy babies and those that have the abnormal growth patterns associated with high insulin levels in the womb. Screening for GDM fails to meet some of the NSC criteria. A number of screening tests have been used but some, such as glycosylated haemoglobin and fructosamine, have proved unsatisfactory and can be discarded. Others, such as urine testing or random blood glucose, are far from satisfactory, although they may be cheap to do. There is marked international variation. Risk factors such as weight, age and family history are useful for selective screening but some patients with GDM would be missed. Fasting plasma glucose (FPG) is convenient and reliable, but some pregnant women have normal fasting levels but raised levels of glucose after meals, and would be missed by screening based on FPG alone. Glucose challenge tests (GCTs) are based on glucose levels after a glucose drink, but also have shortcomings. The definitive diagnosis is usually by oral glucose tolerance test (OGTT), but the glucose load and timing vary in different countries; taking a 75 g glucose load is unnatural, makes some women sick, and the reproducibility of the test is poor. More natural methods such as test meals have been used, but not widely. Conclusions Interim conclusions There are clearly some women whose glucose levels rise sufficiently in pregnancy to cause harm to their babies. However, there are also many women with lower levels of glucose intolerance whose babies are not at risk, but who may suffer anxiety and inconvenience as a result of being classed as abnormal. On balance, the present evidence suggests that we should not have universal screening, but a highly selective policy, based on age and overweight. The best test at present, for those deemed to need testing, is probably the GCT, preferably combined with an FPG. The benefits of a follow-up OGTT are doubtful

Dr. Mary Edwards Walker: years ahead of her time.

Women phsycians in the United States were virtually nonexistent in the early to mid-1800s. Traditional medical schools still did not accept women, and few secretarian or eclectic medical schools were beginning to open their doors to female students. In 1849 at Geneva College, Elizabeth Blackwell became the first woman to achieve a medical degree in the United States.1 At the time of the Civil War, the few women who had managed to obtain medical degrees mainly served as nurses in the war, because society was not yet ready to accept the female physician.2 Dr. Mary Edwards Walker would help change the role of women physicians, becoming not only a valuable surgeon for the Union Army, but also a catalyst for the introduction and advancement of women in medicine

Software Process Assessment (SPA)

NASA's environment mirrors the changes taking place in the nation at large, i.e. workers are being asked to do more work with fewer resources. For software developers at NASA's Goddard Space Flight Center (GSFC), the effects of this change are that we must continue to produce quality code that is maintainable and reusable, but we must learn to produce it more efficiently and less expensively. To accomplish this goal, the Data Systems Technology Division (DSTD) at GSFC is trying a variety of both proven and state-of-the-art techniques for software development (e.g., object-oriented design, prototyping, designing for reuse, etc.). In order to evaluate the effectiveness of these techniques, the Software Process Assessment (SPA) program was initiated. SPA was begun under the assumption that the effects of different software development processes, techniques, and tools, on the resulting product must be evaluated in an objective manner in order to assess any benefits that may have accrued. SPA involves the collection and analysis of software product and process data. These data include metrics such as effort, code changes, size, complexity, and code readability. This paper describes the SPA data collection and analysis methodology and presents examples of benefits realized thus far by DSTD's software developers and managers

Status of Infant and Toddler Programs in Missouri

Includes bibliographical references.Early childhood is a critical period for cognitive, linguistic, and social-emotional development. Research finds that children who attend high quality infant and toddler programs are better prepared to succeed in school and in the workforce than those who did not attend. Thus, the quality of infant and toddler programs has great implications for children's development. One of the tasks of a survey was to examine infant and toddler workforce issues and program quality.Funded by HHS Child Care Bureau and the Ewing Marion Kauffman Foundation

Revealing Gender Bias: An Experiential Exercise

Stereotyping and biases continue to be a problem in many facets of society. Understanding how biases may affect recruitment and retention of employees has become a priority issue for companies, not only from an image perspective but also from a firm performance perspective, since both research and industry experience have shown that diverse teams generate better results. The need to address these issues, particularly with students who will become leaders in organizations, remains a priority in business education. In this article, we present an experiential activity that management instructors can use to help students understand and appreciate the reality and power of unconscious bias. The focus of this activity is on uncovering gender bias, yet the basic framework of the activity can easily be adapted to focus on other types of unconscious bias and stereotyping

Tinker, tailor, policy-maker: can the UK government’s teaching excellence framework deliver its objectives?

The Teaching Excellence Framework (TEF), originally proposed in the UK government’s Higher Education White Paper, now the Higher Education and Research Act 2017, is a national mechanism to assess teaching quality in universities. This article provides a critical account of the TEF, underpinned by an overview of the policy context and marketisation and employability agendas exploring the rationale for implementing TEF within universities. We argue, first, that the White Paper’s narrative, the rhetoric of the TEF, seems positive but its implementation appears to be conceptually flawed. Second, its complex quality metrics system demands yet another layer of bureaucracy in an already micro-managed system of higher education. Third, claims made by the White Paper must be supported by evidence-based research to ensure that the objectives are clear. We conclude by questioning whether the quality of the student experience can be improved by the TEF reforms

Agricultural Water Management in the Missippi Delta Region of Arkansas

Agriculture is the largest use of soil and water resources in eastern Arkansas. This bulletin summarized the recent historical use of soil and water by agriculture and the impact of irrigation on yields of rice, soybeans and cotton. The experiments conducted in the field to quantitatively schedule irrigations of crops are summarized. The results show the close relationship between the irrigation of crops and the extraction of water from the Alluvial Aquifer. The implications of this relationaship for the future are discussed

Little Creek Naval Amphibious Base Chesapeake Bay Shoreline

Little Creek Naval Amphibious Base (NAB) is located in Virginia Beach, Virginia. It’s shoreline along the southern Chesapeake Bay extends from Little Creek Inlet eastward approximately 1.5 miles to the NAB’s eastern boundary. In 1997, a study and report entitled “LITTLE CREEK NAVAL AMPHIBIOUS BASE, CHESAPEAKE BAY SHORELINE, SHORELINE MANAGEMENT PLAN and OFFICER’S BEACH SHORE PROTECTION EVALUATION” was produced by VIMS’s Shoreline Studies Program (Hardaway et al., 1997). The purpose of that report was to assess the rates and patterns of beach change along the Chesapeake Bay shoreline at Little Creek NAB in order to develop a shoreline management plan, particularly for the Officer’s Beach (“O” Beach). Field surveys, historical aerial imagery, empirical models and computer models were used to address these objectives. Plan recommendations resulted in the construction of a headland breakwater system and revetments at the “O” Beach as well as a series of proposed breakwaters along the length of the Little Creek NAB coast. In 2002, an update to the shoreline management plan was performed (Hardaway et al., 2004). The purposes of that effort were to update the Hardaway et al. (1997) study and to determine if additional management strategies should be implemented. Elements of the previous report were presented to provide the background perspective and bring the reader up-to-date. Generally, the shoreline subreach just west of the “O” Beach has continued to erode from the existing revetment westward toward the Enlisted Beach (“E” Beach). This trend was prevalent prior to 1997 and was predicted to continue in the previous study. The question is how long will this trend continue and what impact will it have on the Base’s shoreline, particularly the Bayfronting primary dune system which is eroding along much of the coast? This report attempts to detail the potential impacts to Little Creek NAB Chesapeake Bay coast if the updated management plan is implemented. It was determine that the impact will be to the shoreline position and consequently to the associated beach/dune system. The management recommendations of the updated plan are to create headland features with large stone breakwaters and to allow the adjacent coast to continue to recede toward dynamic equilibrium. Dynamic equilibrium is a concept whereby shoreline embayments, whether natural or man-made, will attain a state where the shore planform is stable given the input and output of littoral sands. In the case of Little Creek NAB, the input of sand from ongoing beach nourishment efforts west of Lynnhaven Inlet is a significant factor