Does an educational video for aneuploidy screening improve informed choice among pregnant women? A randomised controlled trial

Background

Poor knowledge and the lack of deliberation have been cited as reasons for women making uninformed choices about aneuploidy screening. Adequate pre-test counselling is of particular importance where non-invasive prenatal screening (NIPS) is being increasingly offered as a primary screening test.

Design

Women attending the antenatal clinic with a singleton pregnancy below 14 weeks were randomised to receive routine counselling or the intervention—a 16-min educational video on aneuploidy screening before their consult. The primary outcome, rate of informed choice, was assessed using an adapted multidimensional measure of informed choice questionnaire, where informed choice was defined as good knowledge and value-consistent behaviour. Secondary outcomes included informed choice with deliberation, decisional conflict and anxiety.

Results

Two hundred and eighty-six women were recruited. 69.8% of women in the intervention group made an informed choice compared with 53.6% in the control group (Risk Ratio [RR] 1.30, p = 0.014). A significantly higher number of women in the intervention group had good knowledge compared to controls (81% vs. 60.9%; RR 1.33, p = 0.001). Decisional conflict did not differ between groups, but women in the intervention group had higher anxiety scores (p < 0.001).

Conclusion

The study intervention was effective in helping women make informed choice. Qualitative studies to determine the reason for increased anxiety are needed.

Trial registration

Trial registry: ClinicalTrials.gov ; Identifier: NCT05492981.     

Early reproductive stages in the crustose coralline alga Phymatolithon lenormandii are strongly affected by mild ocean acidification

Coralline algae (Corallinales, Rhodophyta) are predicted to be negatively impacted by near-future ocean acidification. The effect of low pH/high pCO₂ on early life stages of Phymatolithon lenormandii (Areschoug) Adey was studied in a perturbation experiment. Several parameters including mortality, calcification (calcein staining) and development (growth and abnormalities) have been monitored for a month under experimental conditions ranging from pH_T = 8.00 (pCO₂ = 398 μatm) and pH_T = 7.55 (pCO₂ = 1,261 μatm). Our results demonstrate that survival and development of P. lenormandii early life stages can be impacted by small pH changes (ΔpH < ?0.1 pH unit). A negative impact of decreasing pH was observed including an increased mortality and a higher rate of abnormalities. Growth and calcification were still observed at the lowest pH (ΔpH = ?0.45). Growth rate was similar at all tested pH, but the maintenance of the skeleton under low pH was only possible through a persistent dynamic dissolution/calcification process, an energetically costly mechanism potentially draining resources from other vital processes.     

Couples experiences of receiving uncertain results following prenatal microarray or exome sequencing: A mixed-methods systematic review

Background

Tests in pregnancy such as chromosomal microarray analysis and exome sequencing are increasing diagnostic yield for fetal structural anomalies, but have greater potential to result in uncertain findings. This systematic review investigated the experiences of prospective parents about receiving uncertain results from these tests.

Methods

A systematic search of three electronic databases was conducted. Data extraction was performed for studies that met the eligibility and quality criteria. Results were synthesised following the principles of thematic analysis.

Results

Fourteen studies (10 qualitative, 4 quantitative) were included. Findings were grouped into three overarching themes. Sources of uncertainty included the testing procedure, the diagnosis and prognosis, and health professionals' own uncertainty. The clinical impact of the uncertainty included parents struggling to make clinical decisions with the information available, the emotional impact included decisional-regret, shock, worry and feeling overwhelmed. To manage the uncertainty, parents sought support from healthcare professionals, friends, family, the internet and other parents as well as remaining hopeful.

Conclusions

Prospective parents experience a myriad of uncertainties in the prenatal setting, which must be handled sensitively. Future research should explore optimal ways of managing uncertainty to minimise harm. Recommendations are made for discussing uncertainty during pre- and post-test counseling.     

Maternity health care professionals' views and experiences of fetal genomic uncertainty: A review

The field of prenatal screening and diagnosis for fetal anomalies has been marked by a rapid succession of technological advances, including most notably, chromosomal microarray analysis, and next generation sequencing. Despite the diagnostic advantages of these technologies, their incorporation into prenatal testing has created additional challenges of revealing genomic variants of unknown or uncertain significance, and secondary findings. While detailed posttest counseling about uncertain variants is best performed by medical geneticists, many of the screening and diagnostic tests that lead to this information are actually ordered by general maternity health care professionals (HCPs), such as obstetricians, midwives, and family physicians. Maternity HCPs support pregnant women through to the conclusion of their pregnancy and the postpartum period, and thus are close observers of the psychosocial impart of fetal genomic uncertainty on women and their families. While there have been many studies exploring the handling of genomic uncertainty by genetics HCPs, there has been relatively less attention paid to maternity HCPs without speciality training in genetics. This review explores the current literature surrounding nongenetic maternity HCPs' views and experiences of genomic uncertainty and returning uncertain results in the prenatal setting.     

Avoidance of low doses of naphthalene by Collembola

The introduction of behavioural aspects of soil animals in ecological risk assessment would allow us to better assess soil quality, all the more if a range of animal populations are considered. We compared the avoidance behaviour of several strains of springtails (Arthropoda: Collembola) obtained from different soils. Naphthalene, a polycyclic aromatic hydrocarbon (PAH), widely represented in soils polluted with hydrocarbons, was tested in aqueous solutions on nine springtail species issuing from four sites. Fine quartz sand saturated with an aqueous solution of naphthalene was avoided by most of the tested species, avoidance being, however, detected down to a concentration of 0.030 mg L(-1). Folsomia candida (Isotomidae) was shown to be relatively tolerant to pollutants compared to other Collembola such as Mesaphorura macrochaeta, Mesaphorura yosii (Onychiuridae), Parisotoma notabilis (Isotomidae) and Arrhopalites caecus (Arrhopalitidae). Differences between strains could not be explained by properties of the original soils.     

Measuring the violence of dust explosions with the “20 l sphere” and with the standard “ISO 1 m vessel”: Systematic comparison and analysis of the discrepancies

On the basis of a systematic testwork with a number of different dusts, the explosion indices as determined within the 20 l sphere and with the ISO-VDI 1 m³ vessel have been compared. The repeatability has been assessed and since some systematic deviations appear a refined physical analysis of the explosion processes is developed. It appears in particular that the cube root law supposed to link both vessels is not verified. A striking illustration of this appears when a dust with a significant explosion severity inside the 20 l sphere is not even explosible in the larger vessel. It is strongly suggested that the ignition energy is forcing very significantly the explosion in the smaller vessel inducing several tens of Celsius degrees of preheating. It is shown also that the inner level of turbulence is decreasing very fast in the 20 l sphere during the flame development so that difficult-to-ignite mixtures would tend to burn at a lower combustion rate. It is further demonstrated that the major bias between the chambers can be explained and quantified with these elements. A correlation with the standard 1 m³ vessel and a grid of interpretation of the data is proposed.     

对加拿大东南部湖泊从酸沉降效应中恢复的评价

北美洲SO2排放量的减少激起了人们对加拿大东南部的水生态系统能迅速摆脱酸化的状态的期待.但是只有那些明显减少了排放量的冶炼厂附近的湖泊达到了这种期望值.在临近大西洋的省份魁北克和安大略,受远程污染源影响的湖泊的硫酸根离子(SO2- 4)浓度都有一定降低,但pH和碱度则仅有较少量的提高.对于这种延迟的酸度响应,有如下几种因素可以解释:碱基阳离子含量的下降,干旱加速SO2- 4的迁移,水体内部碱性物质生成机制遭到破坏;同时硝酸盐和有机阴离子含量的提高也可能是其中的原因.对加拿大东南部生物恢复的监测资料非常有限,即使有的话,在萨德伯里(Sudbury)和基拉尼(Killarney)地区以外也很难找到恢复的证据.比如,尽管除了酸化作用外其他因素也对上述现象有一定影响,新思科舍河中的大西洋鲑鱼出现率和安大略湖潜鸟的繁殖成功率实际上正在下降.化学和生物学模型预测,只有比目前法规要求严格的多的SO2排放削减额才能促进广泛的化学恢复和其后的生物恢复,而在加拿大东南部的众多湖泊中重建工业化前的化学与生物学条件或许很难实现.     

Rates and processes affecting As speciation and mobility in lake sediments during aging

Sediments from an arsenic(As) contaminated groundwater vent site were used to investigate As( Ⅲ) binding, transformation and redistribution in native and iron oxide amended lake sediments using aging spiked batch reactions and a sequential extraction procedure that maintains As(V) and As( Ⅲ) speciation. In the native sediments, fractionation analysis revealed that 10% of the spiked As( Ⅲ) remained intact after a 32-day aging experiment and was predominantly adsorbed to the strongly sorbed(NH_4H_2PO_4 extractable) and amorphous Fe oxide bound(H_3PO_4 extractable) fractions. Kinetic modelling of the experimental results allowed identifying the dominant reaction path for depletion of dissolved As( Ⅲ) to As( Ⅲ)absorbed on to the solid phase, followed by oxidation in the solid phase. Arsenite was initially adsorbed primarily to the easily exchangeable fraction((NH_4)_2SO_4 extractable), then rapidly transformed into As(V) and redistributed to the strongly sorbed and amorphous Fe oxide bound fractions. Oxidation of As( Ⅲ) in recalcitrant fractions was less efficient. The iron oxide amendments illustrated the controls that iron oxides can have on As( Ⅲ) binding and transformation rates. In goethite amended samples As( Ⅲ) oxidation was faster and primarily occurred in the strongly sorbed and amorphous Fe oxide bound fractions. In these samples,19.3 μg Mn was redistributed(compared to the native sediment) from the easily exchangeable and crystalline Fe oxide bound fractions to the strongly sorbed and amorphous Fe oxide bound fractions, indicating that goethite may act as a catalyst for Mn(Ⅱ) oxidation, thereby producing sorbed Mn( Ⅲ/Ⅳ ), which then appears to be involved in rapidly oxidizing As( Ⅲ).