Can gestational dates routinely derived from very early ultrasound be used to interpret maternal serum alpha-fetoprotein measurements?

This study assesses the reliability of estimating gestational age via crown-rump or gestational sac measurements obtained at 8 weeks' gestation or earlier as part of routine physician office practice. To accomplish this, we studied 88 pregnancies managed at 45 different sites in which both an early first-trimester ultrasonically-derived gestational age estimate and a second-trimester biparietal diameter (BPD) estimate were available. The first-and second-trimester determinations were highly correlated, but the first-trimester determinations were, on average, 0.43 weeks earlier than the second. The first-trimester estimates were satisfactory for use in interpreting maternal serum alpha-fetoprotein (MSAFP) screening measurements, but second-trimester BPD measurements obtained prior to MSAFP screening should be the method of choice for interpreting MSAFP values, due to the increased sensitivity for detecting open spina bifida.     

Prevention of neural tube defects in curly-tail mice by maternal administration of vitamin A

Various doses of vitamin A were administered on day 9 of pregnancy to the pregnant curly-tail mouse, a mutant, 60 per cent of which have neural tube defects (NTD). There was a reduction in the incidence of NTD in the fetuses with all doses used. The effect was maximal with 5 mg/kg; it was also marked, but to a lesser degree, with 10 and 20 mg/kg and minimal with 1 mg/kg. The implications of these findings in the mouse to the prevention of NTD in humans by preconception vitamin supplementation are discussed.     

Contaminant Exposure and Effects—Terrestrial Vertebrates Database: Trends and Data Gaps for Atlantic Coast Estuaries

In order to examine the condition of biota in Atlantic coast estuaries, "Contaminant Exposure and Effects—Terrestrial Vertebrates" database (CEE-TV) has been compiled through computerized search of published literature, review of existing databases, and solicitation of unpublished reports from conservation agencies, private groups, and universities. Summary information has been entered into the database, including species, collection date (1965–present), site coordinates, estuary name, hydrologic unit code, sample matrix, contaminant concentrations, biomarker and bioindicator responses, and reference source, utilizing a 98-field character and numeric format. Currently, the CEE-TV database contains 3699 geo-referenced records representing 190 vertebrate species and >140,000 individuals residing in estuaries from Maine through Florida. This relational database can be directly queried or imported into a Geographic Information System to examine spatial patterns, identify data gaps and areas of concern, generate hypotheses, and focus ecotoxicological field assessments. Information on birds made up the vast majority (83%) of the database, with only a modicum of data on amphibians (<0.1%). Of the >75,000 chemical compounds in commerce, only 118 commonly measured environmental contaminants were quantified in tissues of terrestrial vertebrates. There were no CEE-TV data records in 15 of the 67 estuaries located along the Atlantic coast and Florida Gulf coast. The CEE-TV database has a number of potential applications including focusing biomonitoring efforts to generate critically needed ecotoxicological data in the numerous "gaps" along the coast, reducing uncertainty about contaminant risk, identifying areas for mitigation, restoration or special management, and ranking ecological conditions of estuaries.     

Drowsy drivers: The effect of light and circadian rhythm on crash occurrence

Drowsiness has been recognized as a pervasive problem for drivers, with effects comparable to alcohol. Alcohol, however, has a clear legal limit for impairment; there are no comparable criteria to suggest sleepiness. Drowsiness has been associated with light and circadian rhythm. To investigate the joint effects of these factors on crash occurrence, along with other factors, single vehicle crashes reported in Ontario (1999–2004) were analyzed. Crashes occurring at four times of day, when light varies and circadian rhythm is low (2–5 a.m. and 2–4 p.m.) and with similar light conditions and higher circadian rhythm (9–11 p.m. and 10 a.m.–12 noon). Logistic regression was used to see how light and other factors are associated with single vehicle crashes occurring at times of low circadian rhythm, when drowsiness is more likely.Initial results indicated many circumstances associated with occurrence at these times: the age and sex of the driver and reported driver condition as well as weather. There is, however, an interaction between light and presumed alertness. In separate analyses for daytime and night time crashes most variables were significant for nighttime crashes but not for daytime events. The effects of alcohol and youth remained. A lack of light may exacerbate the effects of other factors at times of low alertness; this should be further investigated in controlled environments such as sleep laboratories and/or driving simulators.     

Commitment,procedural fairness,and organizational citizenship behavior: a multifoci analysis

Research on commitment, procedural fairness, and organizational citizenship behavior (OCB) suggests that employees maintain distinct beliefs about, and direct behaviors towards, multiple targets in the workplace (e.g., the organization as a whole, their supervisor, and fellow workgroup members). The present studies were designed to test for “target similarity effects,” in which the relationships between commitment, procedural fairness, and OCB were expected to be stronger when they referred to the same target than when they referred to different targets. As predicted, we found that: (1) the positive relationship between commitment and OCB, and (2) the mediating effect of commitment on the positive relationship between procedural fairness and OCB, was particularly likely to emerge when the constructs were in reference to the same target. Support for these target similarity effects was found among layoff survivors (Study 1) and student project teams (Study 2). Theoretical and practical implications are discussed, as are limitations of the studies and suggestions for future research. Copyright © 2008 John Wiley & Sons, Ltd.     

Improving fetal congenital heart disease screening using a checklist-based approach

To determine if using a checklist of specific ultrasound image criteria to screen the fetal heart improves the cardiac exam completion rate, defined as the ability to classify the heart as normal or abnormal. This is a retrospective cohort study of patients with singleton pregnancies who underwent a fetal anatomy survey between 18 and 28 weeks' gestation. A checklist was used from 1 September 2015 to 31 March 2016 to categorize exams as complete-normal, complete-abnormal, or incomplete. Performance was compared with a 7-month period prior to checklist introduction (1 December 2014 to 30 June 2015). Checklist utilization improved the cardiac exam completion rate by 8.9%. With the checklist, 1083 of 1202 exams (90.1%) were completed compared to 987 of 1193 (82.7%) pre-checklist, P < .001. We did not detect a change in cases classified as abnormal and referred for echocardiography: 25 (2.1%) with the checklist and 16 (1.3%) pre-checklist, P = .16. We did not detect more congenital heart disease (CHD), 12 (1.0%) with checklist screening, 5 (0.4%) pre-checklist, P = .14. Critical CHD was not missed in either group. Using the checklist improved the cardiac exam completion rate. There was no change in congenital heart disease detection.     

Klinefelter Syndrome: What should we tell prospective parents?

Klinefelter syndrome (KS) or 47,XXY is the most common sex chromosome aneuploidy (SCA), occurring at a prevalence of 1 in 600 male pregnancies. Historically, only 25% of individuals with KS came to medical attention, for a range of issues across the life course including under-virilisation at birth, developmental and social concerns in childhood, absence, delay or arrest of puberty in adolescence or infertility in adulthood. Our understanding of the phenotypic spectrum of KS has been largely influenced by this ascertainment bias. With increasing uptake of antenatal noninvasive prenatal testing (NIPT), a corresponding increase in identification of KS has been documented. Population-based longitudinal data from infancy to adulthood on these individuals is lacking, which impedes balanced antenatal genetic counselling and raises issues for prospective parents and clinicians alike.