Value of maternal serum unconjugated oestriol measurement in prenatal screening for Down's syndrome

We compared the medical and financial cost-effectiveness of prenatal serum screening for Down's syndrome using maternal age, serum alpha-fetoprotein and human chorionic gonadotrophin with and without the use of unconjugated oestriol. The use of unconjugated oestriol is medically more cost-effective than screening without it at all levels of detection. The actual performance depends on whether gestational age is estimated using ‘dates’ or an ultrasound scan. At a detection rate of 60 per cent, the proportion of unaffected fetal losses per case diagnosed at amniocentesis is about 22 per cent less if gestational age is estimated using dates (time since the first day of the last menstrual period) and about 47 per cent less if it is based on an ultrasound scan examination. At this detection rate, the inclusion of unconjugated oestriol increases costs by about £2k per case diagnosed (£36k instead of £34k) if gestational age is estimated using dates, but it is no more expensive if gestational age is measured from an ultrasound scan examination (indeed, it is more cost-effective at detection rates above 60 per cent). Since there is little change in the financial cost with the inclusion of unconjugated oestriol, for the improved medical performance of screening, it is worthwhile including it in the screening test.     

Visualization of fetal intra-abdominal organs in second-trimester severe oligohydramnios by intraperitoneal infusion

Fetal intraperitoneal infusion of saline was performed in two patients with severe oligohydramnios at 24 and 25 weeks' gestation in order to enhance visualization of intra-abdominal organs. Renal agenesis was easily diagnosed. The technique can be considered as an alternative to artificial instillation of amniotic fluid in the differential diagnosis of conditions associated with severe oligohydramnios.     

Habitat-induced morphological variation influences photosynthesis and drag on the marine macroalga <Emphasis Type="Italic">Pachydictyon coriaceum</Emphasis>

Photosynthesis, growth, distribution, and persistence of macroalgae are determined in part by the physical environment in which they live. Therefore, discerning how macroalgae interact with their physical environment is necessary to better understand their physiological performance. The purpose of this study was to examine what photosynthetic and hydrodynamic costs and benefits the morphology of Pachydictyon coriaceum (Phaeophyta) confers on the thallus in a given environment. Principal components analysis of morphometric measurements of Pachydictyon coriaceum from different flow habitats and depths separated thalli into three distinct morphs: shallow wave-exposed, shallow wave-protected, and deep. To test the hypothesis that thallus morphology affects net photosynthesis (NP), thalli of three morphotypes of P. coriaceum were incubated in an enclosed recirculating flume under three simulated light/water flow environments representing conditions from which the three morphotypes were collected. The wave-protected and deep morphs had significantly higher rates of photosynthesis than the wave-exposed morph for all three simulated environments. The dense, compact shape of the wave-exposed morph readily streamlines with flow and in doing so, potentially shades many of its internal blades likely accounting for its lower biomass-specific NP. Drag coefficients (C _d) were estimated for the three morphotypes over a range of flow velocities between 0.08 and 0.47 m s⁻¹. At lower water flow velocities (0.08–0.21 m s⁻¹), wave-exposed morphs had the lowest C _d among the three morphotypes. But drag coefficients of the three morphotypes converged with increasing flow velocities, and at velocities >0.31 m s⁻¹ there were no differences in C _d among the three morphotypes. The results of this study indicate that the environmentally-shaped morphs influence photosynthesis and, to a lesser degree, hydrodynamic forces acting on P. coriaceum.     

The reflection method of line intercept sampling to eliminate boundary bias

When a line transect overlaps the boundary of the sampled region, it can be reflected back on top of itself into the region, thereby making it possible to include elements near the edge twice from the same transect. A practical advantage of doing so is the reduction of field time and effort compared to the customary procedure of folding the transect back into another part of the region. An estimator is presented which accounts for this procedure in a way that preserves design-unbiased estimation.     

Risk-based prenatal screening for trisomy 18 using alpha-fetoprotein,unconjugated oestriol and human chorionic gonadotropin

Nine centres collaborated to examine the feasibility of a screening method for trisomy 18 that was based on assigning individual risk, using a combination of maternal age and measurements of alpha-fetoprotein (AFP), unconjugated oestriol (uE3), and human chorionic gonadotropin (hCG). Second-trimester measurements of these analytes were obtained from 94 trisomy 18 pregnancies. In the 89 pregnancies without an associated open defect, the median levels for AFP, uE3, and hCG were 0.65, 0.43 and 0.36 multiples of the unaffected population median, respectively. The strongest individual predictor of risk for trisomy 18 was uE3, followed by hCG, AFP, and maternal age, in that order. Using a method of individual risk estimation that is based on the three markers and maternal age, 60 per cent of pregnancies associated with trisomy 18 would be detected at a risk cut-off level of 1:100, with a false-positive rate of about 0.2 per cent. One in nine pregnancies identified as being at increased risk for trisomy 18 would be expected to have an affected pregnancy. This risk-based screening method is more efficient than an existing method that is based on fixed analyte cut-off levels. Even though the birth prevalence of trisomy 18 is low, prenatal screening can be justified when performed in conjunction with Down syndrome screening and when a high proportion of women offered amniocentesis have an affected fetus.     

Artisanal gold and transformational exchange: toward a public–private partnership in Tanzania

Human rights abuses, environmental predations and governance failures plague artisanal gold mining in Tanzania. Gold's exchange value and the illegality of most artisanal gold product challenge the traditional fair trade model, a potential solution. Additionally, memories of the government's earlier failed effort to serve as a sole purchaser of artisanal gold undercut enthusiasm for statist interventions. This paper presents an alternative: a public–private partnership (PPP) that would engage one or more private banks, an agency within the Ministry of Energy and Minerals and NGOs or international initiatives specifically aimed at improving conditions for artisanal mine operators. The concept of transformational exchange, wherein a set of business transactions substantially affects societal expectations, modifies behavior and promotes sustainable mechanisms, frames the proposal.