First-trimester ultrasound detection of fetal heart anomalies: systematic review and meta-analysis

Objectives: To determine the diagnostic accuracy of ultrasound at 11–14 weeks' gestation in the detection of fetal cardiac abnormalities and to evaluate factors that impact the detection rate. Methods: This was a systematic review of studies evaluating the diagnostic accuracy of ultrasound in the detection of fetal cardiac anomalies at 11–14 weeks' gestation, performed by two independent reviewers. An electronic search of four databases (MEDLINE, EMBASE, Web of Science Core Collection and The Cochrane Library) was conducted for studies published between January 1998 and July 2020. Prospective and retrospective studies evaluating pregnancies at any prior level of risk and in any healthcare setting were eligible for inclusion. The reference standard used was the detection of a cardiac abnormality on postnatal or postmortem examination. Data were extracted from the included studies to populate 2 × 2 tables. Meta-analysis was performed using a random-effects model in order to determine the performance of first-trimester ultrasound in the detection of major cardiac abnormalities overall and of individual types of cardiac abnormality. Data were analyzed separately for high-risk and non-high-risk populations. Preplanned secondary analyses were conducted in order to assess factors that may impact screening performance, including the imaging protocol used for cardiac assessment (including the use of color-flow Doppler), ultrasound modality, year of publication and the index of sonographer suspicion at the time of the scan. Risk of bias and quality assessment were undertaken for all included studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Results: The electronic search yielded 4108 citations. Following review of titles and abstracts, 223 publications underwent full-text review, of which 63 studies, reporting on 328 262 fetuses, were selected for inclusion in the meta-analysis. In the non-high-risk population (45 studies, 306 872 fetuses), 1445 major cardiac anomalies were identified (prevalence, 0.41% (95% CI, 0.39–0.43%)). Of these, 767 were detected on first-trimester ultrasound examination of the heart and 678 were not detected. First-trimester ultrasound had a pooled sensitivity of 55.80% (95% CI, 45.87–65.50%), specificity of 99.98% (95% CI, 99.97–99.99%) and positive predictive value of 94.85% (95% CI, 91.63–97.32%) in the non-high-risk population. The cases diagnosed in the first trimester represented 63.67% (95% CI, 54.35–72.49%) of all antenatally diagnosed major cardiac abnormalities in the non-high-risk population. In the high-risk population (18 studies, 21 390 fetuses), 480 major cardiac anomalies were identified (prevalence, 1.36% (95% CI, 1.20–1.52%)). Of these, 338 were detected on first-trimester ultrasound examination and 142 were not detected. First-trimester ultrasound had a pooled sensitivity of 67.74% (95% CI, 55.25–79.06%), specificity of 99.75% (95% CI, 99.47–99.92%) and positive predictive value of 94.22% (95% CI, 90.22–97.22%) in the high-risk population. The cases diagnosed in the first trimester represented 79.86% (95% CI, 69.89–88.25%) of all antenatally diagnosed major cardiac abnormalities in the high-risk population. The imaging protocol used for examination was found to have an important impact on screening performance in both populations (P < 0.0001), with a significantly higher detection rate observed in studies using at least one outflow-tract view or color-flow Doppler imaging (both P < 0.0001). Different types of cardiac anomaly were not equally amenable to detection on first-trimester ultrasound. Conclusions: First-trimester ultrasound examination of the fetal heart allows identification of over half of fetuses affected by major cardiac pathology. Future first-trimester screening programs should follow structured anatomical assessment protocols and consider the introduction of outflow-tract views and color-flow Doppler imaging, as this would improve detection rates of fetal cardiac pathology. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology

O2‐01‐03: Amyloid load increase and cerebral microbleed prevalence differ as a function of the position of the mutation within the PSEN1 coding sequence

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153135/1/alzjjalz201507132.pd

IC‐P‐051: Amyloid load increase and cerebral microbleed prevalence differ as a function of the position of the mutation within the PSEN1 coding sequence

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153145/1/alzjjalz201506072.pd

Patterns of Sedentary Behaviour and Physical Activity Among Adolescents in the United Kingdom: Project STIL

The purpose of this study was to use ecological momentary assessment to investigate the patterning of physical activity and sedentary behaviours in UK adolescents and to examine if different lifestyle groups differ on key explanatory variables. A total of 1,371 (38% boys, mean age 14.7 years) adolescents completed diaries every 15 min for 3 weekdays outside of school hours and 1 weekend day. Cluster analysis yielded five-cluster solutions for both boys and girls to explain the grouping of sedentary behaviours and physical activity. The clusters demonstrated that adolescents engage in many leisure time behaviours but have one activity that predominates. Active adolescents spend more time outside and more time with their friends. Few demographic and environmental variables distinguished between clusters. The findings suggest a potential need for different behavioural targets in interventions to reduce sedentary behaviour in sub groups of the adolescent population. Further research is required to examine the modifiable determinants of different sedentary lifestyles among young people

Can spirituality be taught to health care professionals?

Although people with life-limiting conditions report a desire to have spiritual concerns addressed, there is evidence that these issues are often avoided by health care professionals in palliative care. This study reports on the longitudinal outcomes of four workshops purpose-designed to improve the spiritual knowledge and confidence of 120 palliative care staff in Australia. Findings revealed significant increases in Spirituality, Spiritual Care, Personalised Care, and Confidence in this field immediately following the workshops. Improvements in Spiritual Care and Confidence were maintained 3 month later, with Confidence continuing to grow. These findings suggest that attendance at a custom-designed workshop can significantly improve knowledge and confidence to provide spiritual care

Public expenditures and growth

The article explores the effects of public expenditures on growth among 73 countries over the 1970-89 period. While much of the literature attributes weak growth to public investment and social expenditures which inhibit growth through crowding-out and rent-seeking, the article highlights the contributions that public investment and social expenditures may make to growth. The article's econometric analysis suggests that crowding-out and rent-seeking concerns may have been overstated in the literature.