Do first-trimester screening algorithms for preeclampsia aligned to use of preventative therapies reduce the prevalence of pre-term preeclampsia: A systematic review and meta-analysis

Objective

Traditional obstetric practice relies upon history-based assessment to screen for preeclampsia and guide preventative therapies but is hampered by low sensitivity, high false-positive rates and low treatment rates. First-trimester screening algorithms represent the most efficacious approach for risk prediction and could target early initiation of aspirin to well-defined high-risk populations. A large randomised controlled trial has demonstrated the clinical benefits of this approach, but widespread practice implementation has remained elusive.

Methods

We performed a systematic review and meta-analysis summarising studies linking first-trimester preeclampsia screening algorithms with the initiation of preventative therapy and examined their effect on pre-term preeclampsia rates compared with standard maternity care. Odds ratios were calculated together with 95% confidence intervals.

Results

7 studies with a total of 377,790 participants were included. Within singleton populations, early initiation of aspirin in response to a high-risk screening algorithm result reduced the prevalence of pre-term preeclampsia by 39% compared with routine antenatal care (odds ratio 0.61; 95% CI: 0.52–0.70). There were significant reductions in the prevalence of preeclampsia at <32–34 weeks, preeclampsia at any gestation and stillbirth.

Conclusion

First-trimester screening algorithms for preeclampsia aligned with early initiation of preventative therapy with aspirin reduce the prevalence of pre-term preeclampsia.     

Directional changes in the species composition of a tropical forest

Long-term studies have revealed that the structure and dynamics of many tropical forests are changing, but the causes and consequences of these changes remain debated. To learn more about the forces driving changes within tropical forests, we investigated shifts in tree species composition over the past 25 years within the 50-ha Forest Dynamics Plot on Barro Colorado Island (BCI), Panama, and examined how observed patterns relate to predictions of (1) random population fluctuations, (2) carbon fertilization, (3) succession from past disturbance, (4) recovery from an extreme El Ni?o drought at the start of the study period, and (5) long-term climate change. We found that there have been consistent and directional changes in the tree species composition. These shifts have led to increased relative representations of drought-tolerant species as determined by the species' occurrence both across a gradient of soil moisture within BCI and across a wider precipitation gradient from a dry forest near the Pacific coast of Panama to a wet forest near its Caribbean coast. These nonrandom changes cannot be explained by stochastic fluctuations or carbon fertilization. They may be the legacy of the El Ni?o drought, or alternatively, potentially reflect increased aridity due to long-term climate change. By investigating compositional changes, we increased not only our understanding of the ecology of tropical forests and their responses to large-scale disturbances, but also our ability to predict how future global change will impact some of the critical services provided by these important ecosystems.     

Responses of Some Terrestrial Invertebrates to Catchment Treatments Applied at Loch Fleet

The impact of liming and heather-burning on the beetle and spider faunas of open and afforested moorland was studied by use of pitfall traps. of the 168 species identified, the catch of only one species, the ground beetle Trechus obtusus Erichson, increased in a way that could be related to intervention treatments. No species obviously declined as a result of the intervention treatments.     

Storage stability of biocrude oils from fast pyrolysis of poultry litter

The unstable nature of biocrude oils produced from conventional pyrolysis of biomass is one of the properties that limits its application. In the disposal of poultry litter via pyrolysis technology, the biocrude oil produced as a value-added product can be used for on farm applications. In this study, we investigated the influence of bedding material (wood shavings) on the storage stability of biocrude oils produced from the fast pyrolysis of poultry litter. The biocrude oils produced from manure, wood (pine and oak), and mixtures of manure and wood in proportions (75:25 50:50, and 25:75 w/w%) were stored under ambient conditions in sealed glass vials for a period of 6 months and their stability were monitored by measuring the changes in viscosity over time. The manure oil had the lowest rate of viscosity change and thus was relatively the most stable and the oils from the 50:50 w/w% litter mixtures were the least stable. The rate of viscosity change of the manure biocrude oil was 1.33 cP/day and that of the 50/50 litter mixture was 7.6 cP/day for pine and 4.17 cP/day for oak.The spectrometric analyses of the biocrude oils showed that the presence of highly reactive oxygenated functionalities in the oil were responsible for the instability characteristic of the litter biocrude oils. The poor stability of the biocrude oil from the 50:50 w/w% litter mixtures was attributed to reactions between nitrogenous compounds (amides) from protein degradation and oxygenated compounds from the decomposition of polysaccharides and lignin. The addition of 10% methanol and 10% ethanol to the oil from 50% manure and 50% pine reduced the initial viscosity of the oil and was also beneficial in slowing down the rate of viscosity change during storage.     

Evidence for Ph Insensitivity in Some Insects Inhabiting Peat Pools in the Loch Fleet Catchment

The impact of liming on the insects associated with peat pools was studied in the Loch Fleet catchment in 1991 and 1992. Fifty-six taxa were identified from 121 timed samples. Despite the raised pH associated with liming in 1986, the population densities of Odonata, Hemiptera and Coleoptera appeared to be unaffected when compared with those of untreated peat pools in the same area. the study demonstrated the existence of two main types of community, that of the steep-sided edges of pools, dominated by odonate nymphs and large species of beetles, and that of the shallower pools, dominated by Hydroporus species (Col., Dytiscidae).     

Registrars,Accreditation, and ISO 14001

The International Standardization Organization (ISO) will be publishing the first international environmental management system standard: ISO 14001. The ultimate impact of this standard is subject to heated debate throughout the industrial and environmental communities. This article focuses on one aspect of the standard: the process of certification/registration. ISO 14001 is a voluntary initiative. Companies will need to decide for themselves whether or not to pursue certification. As indicated in Section 1 of ISO 14001, ?This International Standard is applicable to any organization that wishes to

• a) implement, maintain and improve an environmental management system;
• b) assure itself of its conformance with its stated environmental policy;
• c) demonstrate such conformance to others;
• d) seek certification/registration of its environmental management system by an external organization;
• e) make a self determination and declaration of conformance with the standard.”?

As the introduction to ISO 14001 makes clear, ?the specification contains only those requirements that may be objectively audited for certification/registration and/or self declaration purposes.”? Any additional ?guidance…will be contained in other international standards.”? To avoid confusion, these other international standards tend to be called ?guidelines”?. Of particular interest to those associated with the certification and registration of systems to ISO 14001 are the three guidelines for environmental auditing. Officially these are referred to as:

• ISO 14010 - Guidelines for Environmental Auditing - General Principles,
• ISO 14011 - Guidelines for Environmental Auditing - Audit Procedures - Auditing of Environmental Management Systems, and
• ISO 14012 - Guidelines for Environmental Auditing - Qualification Criteria for Environmental Auditors.

     

Adequacy of Wildlife Habitat Relation Models for Estimating Spatial Distributions of Terrestrial Vertebrates

In the U.S. National Biological Service's gap analysis, potential distributions of terrestrial vertebrate species are based on the synthesis of wildlife habitat relation data and then modeled using a vegetation cover map derived from Landsat Thematic Mapper imagery. Using long-term species lists from eight National Parks in Utah, we evaluated the adequacy of the wildlife habitat relations data generated by gap analysis in predicting species distributions at landscape scales. Omission and commission error rates were estimated for major taxonomic groups and for each national park. Depending on the taxonomic group, omission error ranged from 0 to 25%, whereas commission error ranged from 4 to 33%. Error rates were highest in amphibians and reptiles and lowest for birds and mammals. In general, the error rate declined as the size of the park increased. The Utah wildlife habitat relation models performed well when used to predict the presence or absence of terrestrial vertebrates in eight national parks in Utah and should provide valuable information for making conservation decisions. They also provide a measure of support for the use of these models within the gap analysis framework. Although it is likely that accuracy of wildlife habitat relation models will vary from state to state, and even considerably within a state, the modeling process seems robust enough to provide a reasonably high level of accuracy for use in conservation planning at the ecoregion level.