Prenatal determination of human platelet antigen type using DNA amplification following amniocentesis

OBJECTIVE: To assess the effectiveness of a newly developed individualised birthweight ratio (IBR), which corrects for physiological birthweight determinants, in identifying infants at risk from the complications of macrosomia. DESIGN: Prospective observational study. SETTING: Obstetric unit, Nottingham City Hospital. SUBJECTS: 2835 women delivered between December 1991 and July 1992 and the infants of 624 of these, selected by virtue of their birthweight for gestation and IBR centile positions. MAIN OUTCOME MEASURES: Skinfold thickness and ponderal index measurements, operative delivery, shoulder dystocia, fetal trauma, impaired glucose tolerance. RESULTS: Using an IBR above the 90th centile as a cut off results in 2.4% of infants being reclassified as normally grown and 3.1% are reclassified as large. The IBR does not result in the identification of any more infants with abnormal ponderal indices or skinfold thicknesses than birthweight for gestation. It does, however, identify more of the infants at risk of operative delivery, shoulder dystocia, fetal trauma and impaired glucose tolerance. CONCLUSION: The IBR significantly improves upon birthweight for gestation in identifying infants who suffer from the complications of relative macrosomia.     

Randomised trial of educational visits to enhance use of systematic reviews in 25 obstetric units

OBJECTIVE: To evaluate the effectiveness of an educational visit to help obstetricians and midwives select and use evidence from a Cochrane database containing 600 systematic reviews. DESIGN: Randomised single blind controlled trial with obstetric units allocated to an educational visit or control group. SETTING: 25 of the 26 district general obstetric units in two former NHS regions. SUBJECTS: The senior obstetrician and midwife from each intervention unit participated in educational visits. Clinical practices of all staff were assessed in 4508 pregnancies. INTERVENTION: Single informal educational visit by a respected obstetrician including discussion of evidence based obstetrics, guidance on implementation, and donation of Cochrane database and other materials. MAIN OUTCOME MEASURES: Rates of perineal suturing with polyglycolic acid, ventouse delivery, prophylactic antibiotics in caesarean section, and steroids in preterm delivery, before and 9 months after visits, and concordance of guidelines with review evidence for same marker practices before and after visits. RESULTS: Rates varied greatly, but the overall baseline mean of 43% (986/2312) increased to 54% (1189/2196) 9 months later. Rates of ventouse delivery increased significantly in intervention units but not in control units; there was no difference between the two types of units in uptake of other practices. Pooling rates from all 25 units, use of antibiotics in caesarean section and use of polyglycolic acid sutures increased significantly over the period, but use of steroids in preterm delivery was unchanged. Labour ward guidelines seldom agreed with evidence at baseline; this hardly improved after visits. Educational visits cost pound860 each (at 1995 prices). CONCLUSIONS: There was considerable uptake of evidence into practice in both control and intervention units between 1994 and 1995. Our educational visits added little to this, despite the informal setting, targeting of senior staff from two disciplines, and donation of educational materials. Further work is needed to define cost effective methods to enhance the uptake of evidence from systematic reviews and to clarify leadership and roles of senior obstetric staff in implementing the evidence.     

The Effects of Experience and Strategy on Visual Attention Allocation in an Automated Multiple-Task Environment

Operators and users interacting with computer environments often have to deal with multiple tasks at once, responding to each in series. Diagnostic automation, that is, automation that alerts users when and where to look, has been suggested to support the unique challenges of multiple task environments: activating tasks, switching between tasks, and tasks interfering with each other. Automation is not always reliable, however. Because of the common interaction with novel systems and the importance of training, the Simultaneous Task Environment Platform program—a multiple-task environment—was developed to understand the effects of experience on interaction with these automation-supported systems, as well as what strategies were developed. It was found that participants became more efficient with experience only when they interacted with higher reliability automation. Furthermore, the strategies participants developed focused on the differences between tasks and patterns across those tasks. Automated systems training should be sure to employ these findings.     

Measurement of thrombus formation on intravascular catheters

War is a complex social situation due to the interplay of multiple factors. Economical and political ones are of utmost importance, but human attitudes and motivations must be also taken into account. Being desirable to modify human transactions in such a way that they do not interfere with the basic right of everyone to a condition of physical and mental well-being, war must be abolished. The author contends that an understanding of behaviour through Psychology can be helpful in that aim. Aggression is considered the principal psychological cause of war. It is worth while to differentiate between aggression as an instrument for attaining a special end, and as pure hostility. Only in the first form, it is held here, does it play an important role in war. Psychogists must deal also with a wide range of states of mind that can be "served" by aggression: feelings of inferiority or insecurity, fear, greed, projections, compensations, rationalizations, etc. Scientific approach is not the only one Physiology brings to war prevention. It is equally important the wide dissemination of its conclusions among the general public. Information on the dynamics that prompt people to decide war would make it easier to control. This applies not only to political or military leaders, but also to civil populations. Concerning those two possible contributions of psychologists, scientific and educative, it is suggested the extensive use of psychodramatic techniques. Their richness lie in the lifelike experiences they convey to the participants, and particular aptitude to promote changes of attitudes. Investigation and information on the psychological processes related to war should be undertaken by international organizations of social scientists, acting simultaneously in several countries. Some of the initial steps they could further: 1) that prevention of war be a current subject matter in psychological courses; 2) that the World Health Organization take interest in this subject; 3) that psychologists participate in international political and economical bodies in order to clarify the psychological factors leading to war.     

Health benefits and costs of filtration interventions that reduce indoor exposure to PM2.5 during wildfires

Increases in hospital admissions and deaths are associated with increases in outdoor air particles during wildfires. This analysis estimates the health benefits expected if interventions had improved particle filtration in homes in Southern California during a 10‐day period of wildfire smoke exposure. Economic benefits and intervention costs are also estimated. The six interventions implemented in all affected houses are projected to prevent 11% to 63% of the hospital admissions and 7% to 39% of the deaths attributable to wildfire particles. The fraction of the population with an admission attributable to wildfire smoke is small, thus, the costs of interventions in all homes far exceeds the economic benefits of reduced hospital admissions. However, the estimated economic value of the prevented deaths exceed or far exceed intervention costs for interventions that do not use portable air cleaners. For the interventions with portable air cleaner use, mortality‐related economic benefits exceed intervention costs as long as the cost of the air cleaners, which have a multi‐year life, are not attributed to the short wildfire period. Cost effectiveness is improved by intervening only in the homes of the elderly who experience most of the health effects of particles from wildfires.     

Real-time quality authentication of honey using atmospheric pressure chemical ionisation mass spectrometry (APCI-MS)

The aim of this study was to use gas chromatography-mass spectrometry (GC-MS) and APCI-MS techniques to detect adulteration in honey. The key volatile compounds in the headspace of the adulterated honey were marked by GC-MS and their representative fragment ions were utilised in scanning honey samples using the real-time APCI-MS system. The PLS models validated using independent data sets resulted in coefficient of the determination () of 0.97 and 0.96 and root mean square error in prediction (RMSEP) of 2.62 and 2.45 for the GC-MS and APCI-MS data sets respectively. The most efficient volatiles from GC-MS analysis and their corresponding fragment ions m/z from APCI-MS data analysis were then identified and used to develop new PLS models to predict the level of adulteration. The best PLS model gave of 0.95 and RMEP of 2.60% in the independent validation set indicating that the model was very accurate in predicting the level of adulteration.