Screening for abnormal placentation and adverse pregnancy outcomes with maternal serum biomarkers in the second trimester

Second trimester biomarkers were initially introduced with the intent of screening for neural tube defects and then subsequently for Down syndrome. It was soon realized that these markers can be indirect evidence of abnormal placentation and, therefore, can be used for screening for adverse pregnancy outcomes. Several new biomarkers have subsequently been described with conflicting findings regarding their efficiency for screening for adverse pregnancy outcomes. Although a biologically feasible mechanism has been proposed for the role of these biomarkers, they still fall short of an ideal screening test to be clinically useful. © 2014 John Wiley & Sons, Ltd.     

International Society for Prenatal Diagnosis 2022 DEBATE: There should be formal accreditation and ongoing quality assurance/review for units offering fetal therapy that includes public reporting of outcomes

The field of fetal therapy has so far escaped from formal accreditation and quality control. Despite that, current published evidence shows that outcomes of interventions in younger fetal therapy centers are similar to what is achieved in more experienced centers and outcomes of interventions have improved over time. The question however remains what is not being published and what should be the standard of care, given the lack of level 1 evidence from randomized controlled trials for many interventions. Formal collaborative networks such as NAFTnet and others allow for anonymized benchmarking of center outcomes, without publicly shaming (and financially punishing) underperforming centers. Large registries also allow for tracking of rare complications and may result in improved patient outcomes over time. Core outcome sets, which could serve as a basis for outcome reporting, are available for some conditions, but certainly not for all, resulting in communication difficulties between centers. Formal accreditation, quality control, and outcome reporting are hard to implement, expensive, and may result in decreasing access to care by pushing smaller centers out of the market. Despite the existing difficulties, international societies have committed to quality improvement, and fetal therapy programs are strongly recommended to participate in voluntary outcome tracking.     

Demography and interannual variability of salp swarms (Thalia democratica)

Swarms of the pelagic tunicate, Thalia democratica, form during spring, but the causes of the large interannual variability in the magnitude of salp swarms are unclear. Changes in asexual reproduction (buds per chain) of T. democratica populations in the coastal waters of south-east Australia (32–35°S) were observed in three austral springs (October 2008–2010). T. democratica abundance was significantly higher in 2008 (1,312 individuals m^?3) than 2009 and 2010 (210 and 92 individuals m^?3, respectively). There was a significant negative relationship (linear regression, r ² = 0.61, F _1,22 = 33.83, P < 0.001) between abundance and asexual reproduction. Similarly, relative growth rates declined with decreasing abundance. Generalised additive mixed modelling showed that T. democratica abundance was significantly positively related to preferred food >2 μm in size (P < 0.05) and negatively related to the proportion of non-salp zooplankton (P < 0.001). Salp swarm magnitude, growth, and asexual reproduction may depend on the abundance of larger phytoplankton (prymnesiophytes and diatoms) and competition with other zooplankton.     

Numerical simulation of water mixing and renewals in the Barcelona harbour area: the winter season

In the present paper, we use numerical simulation to investigate currents, mixing and water renewal in Barcelona harbour under typical conditions of wind forcing for the winter season. This site is of particular importance due to the interplay between touristic and commercial activities, requiring detailed and high-definition studies of water quality within the harbour. We use Large Eddy Simulation (LES) which directly resolves the anisotropic and energetic large scales of motion and parametrizes the small, dissipative, ones. Small-scale turbulence is modelled by the anisotropic Smagorinsky model (ASM) to be employed in presence of large cell anisotropy. The complexity of the harbour is modelled using a combination of curvilinear, structured, non-staggered grid and the immersed boundary method. Boundary conditions for wind and currents at the inlets of the port are obtained from in-situ measurements. Analysis of the numerical results is carried out based on both instantaneous and time-averaged velocity fields. First- and second-order statistics, such as turbulent kinetic energy and horizontal and vertical eddy viscosities, are calculated and their spatial distribution is discussed. The study shows the presence of intense current in the narrow and elongated part of the harbour together with sub-surface along-shore elongated rolling structures (with a time scale of a few hours), and they contribute to the vertical water mixing. Time-averaged velocity field reveals intense upwelling and downwelling zones along the walls of the harbour. The analysis of second-order statistics shows strong inhomogeneity of turbulent kinetic energy and horizontal and vertical eddy viscosities in the horizontal plane, with larger values in the regions characterized by stronger currents. The water renewal within the port is quantified for particular sub-domain regions, showing that the complexity of the harbour is such that certain in-harbour basins have a water renewal of over five days, including the yacht marina area. The LES solution compares favourably with available current-meter data. The LES solution is also compared with a RANS solution obtained in literature for the same site under the same forcing conditions, the comparison demonstrating a large sensitivity of properties to model resolution and frictional parametrization.