Organ-specific learning curves of sonographers performing first-trimester anatomical screening and impact of score-based evaluation on ultrasound image quality.

INTRODUCTION: First-trimester anatomical screening (FTAS) by ultrasound has been introduced in many countries as screening for aneuploidies, but also as early screening for fetal structural abnormalities. While a lot of emphasis has been put on the detection rates of FTAS, little is known about the performance of quality control programs and the sonographers' learning curve for FTAS. The aims of the study were to evaluate the performance of a score-based quality control system for the FTAS and to assess the learning curves of sonographers by evaluating the images of the anatomical planes that were part of the FTAS protocol. METHODS: Between 2012-2015, pregnant women opting for the combined test in the North-Netherlands were also invited to participate in a prospective cohort study extending the ultrasound investigation to include a first-trimester ultrasound performed according to a protocol. All anatomical planes included in the protocol were documented by pictures stored for each examination in logbooks. The logbooks of six sonographers were independently assessed by two fetal medicine experts. For each sonographer, logbooks of examination 25-50-75 and 100 plus four additional randomly selected logbooks were scored for correct visualization of 12 organ-system planes. A plane specific score of at least 70% was considered sufficient. The intra-class correlation coefficient (ICC), was used to measure inter-assessor agreement for the cut-off scores. Organ-specific learning curves were defined by single-cumulative sum (CUSUM) analysis. RESULTS: Sixty-four logbooks were assessed. Mean duration of the scan was 22 ± 6 minutes and mean gestational age was 12+6 weeks. In total 57% of the logbooks graded as sufficient. Most sufficient scores were obtained for the fetal skull (88%) and brain (70%), while the lowest scores were for the face (29%) and spine (38%). Five sonographers showed a learning curve for the skull and the stomach, four for the brain and limbs, three for the bladder and kidneys, two for the diaphragm and abdominal wall and one for the heart and spine and none for the face and neck. CONCLUSION: Learning curves for FTAS differ per organ system and per sonographer. Although score-based evaluation can validly assess image quality, more dynamic approaches may better reflect clinical performance.

Longitudinal pathways of numerical abilities in preschool: Cognitive and environmental correlates and relation to primary school mathematics achievement.

Children start preschool with large individual differences in their early numerical abilities. Little is known about the importance of heterogeneous patterns that exist within these individual differences. A person-centered analytic approach might be helpful to unravel these patterns and the cognitive and environmental factors that are associated with them. We applied a person-centered approach to a 5-year longitudinal study (N = 410, 213 boys) conducted in Belgium from preschool to grade 3. Preschoolers (Mage = 58.14 months, SDage = 3.51) were selected to represent the full range of socioeconomic backgrounds. We examined via Latent Profile Analysis the heterogeneous patterns that exist in preschoolers' early numerical development using measures of counting, numeral identification, comparison, ordering, and arithmetic abilities. We investigated the association between the derived numerical ability pathways, general cognitive factors (working memory, language, spatial ability) and the home math environment. We also evaluated the relation of these early numerical ability pathways to later mathematics achievement in grade 1 and 3. Four longitudinal pathways emerged: a low (15%), below-average (28%), above-average (44%), and a high numerical ability pathway (13%). Differences between the four pathways were mostly quantitative. Most of the general cognitive factors contributed to pathway membership, whereas the home math environment and socioeconomic status (SES) did not. The pathways differed in mathematics achievement in grade 1 and 3, and most of these differences remained when the covariates were considered. The results highlight the heterogeneity that is already present in preschoolers' numerical abilities and their predictive value for subsequent mathematics achievement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychological outcomes, knowledge and preferences of pregnant women on first-trimester screening for fetal structural abnormalities: A prospective cohort study.

INTRODUCTION: The primary aim of this study is to investigate the impact of a 13-week anomaly scan on the experienced levels of maternal anxiety and well-being. Secondly, to explore women's knowledge on the possibilities and limitations of the scan and the preferred timing of screening for structural abnormalities. MATERIAL AND METHODS: In a prospective-cohort study conducted between 2013-2015, pregnant women in the North-Netherlands underwent a 13-week anomaly scan. Four online-questionnaires (Q1, Q2, Q3 and Q4) were completed before and after the 13- and the 20-week anomaly scans. In total, 1512 women consented to participate in the study and 1118 (74%) completed the questionnaires at Q1, 941 (64%) at Q2, 807 (55%) at Q3 and 535 (37%) at Q4. Psychological outcomes were measured by the state-trait inventory-scale (STAI), the patient's positive-negative affect (PANAS) and ad-hoc designed questionnaires. RESULTS: Nine-nine percent of women wished to be informed as early as possible in pregnancy about the absence/presence of structural abnormalities. In 87% of women levels of knowledge on the goals and limitations of the 13-week anomaly scan were moderate-to-high. In women with a normal 13-week scan result, anxiety levels decreased (P < .001) and well-being increased over time (P < .001). In women with false-positive results (n = 26), anxiety levels initially increased (STAI-Q1: 39.8 vs. STAI-Q2: 48.6, P = 0.025), but later decreased around the 20-week anomaly scan (STAI-Q3: 36.4 vs. STAI-Q4: 34.2, P = 0.36). CONCLUSIONS: The 13-week scan did not negatively impact the psychological well-being of pregnant women. The small number of women with screen-positive results temporarily experienced higher anxiety after the scan but, in false-positive cases, anxiety levels normalized again when the abnormality was not confirmed at follow-up scans. Finally, most pregnant women have moderate-to-high levels of knowledge and strongly prefer early screening for fetal structural abnormalities.

No Association Between the Home Math Environment and Numerical and Patterning Skills in a Large and Diverse Sample of 5- to 6-year-olds.

Selecting a large and diverse sample of 5-6-year-old preschool children (179 boys and 174 girls; M age = 70.03 months, SD age = 3.43), we aimed to extend previous findings on variability in children's home math environment (i.e., home math activities, parental expectations, and attitudes) and its association with children's mathematical skills. We operationalized mathematics in a broader way than in previous studies, by considering not only children's numerical skills but also their patterning skills as integral components of early mathematical development. We investigated the effects of children's gender and socioeconomic status (SES) on their home math environment, examined the associations between children's home math environment and their mathematical skills, and verified whether these associations were moderated by children's gender and/or SES. Parents of 353 children completed a home math environment questionnaire and all children completed measures of their numerical (e.g., object counting) and patterning skills (e.g., extending repeating patterns). Results indicated no effect of children's gender on their home math environment. There was no effect of SES on the performed home math activities, but small SES differences existed in parents' math-related expectations and their attitudes. We found no evidence for associations between children's home math environment and their mathematical skills. Furthermore, there were no moderating effects of gender or SES on these associations. One explanation for these findings might relate to the characteristics of the general preschool system in the country of the present study (Belgium). Future studies should consider the effect of the preschool learning environment because it might explain differences between studies and countries with regard to the home math environment and its association with mathematical skills.

Gender equality in 4- to 5-year-old preschoolers' early numerical competencies.

Numerical competencies acquired in preschool are foundational and predictive for children's later mathematical development. It remains to be determined whether there are gender differences in these early numerical competencies which could explain the often-reported gender differences in later mathematics and STEM-related abilities. Using a Bayesian approach, we quantified the evidence in favor of the alternative hypothesis of gender differences versus the null hypothesis of gender equality. Participants were 402 4- to 5-year-old children attending preschool in Flanders (Belgium). Children were selected via stratified cluster sampling to represent the full range of socioeconomic backgrounds. All children completed eight numerical tasks (verbal counting, object counting, numeral recognition, symbolic comparison, nonsymbolic comparison, nonverbal calculation, number order, dot enumeration). Results supported the gender equality hypothesis, and this evidence was substantial for seven of the eight numerical tasks. Preschoolers' early numerical competencies are characterized by gender equality. They probably do not explain later-reported gender differences.

Prenasal Thickness, Prefrontal Space Ratio and Other Facial Profile Markers in First-Trimester Fetuses with Aneuploidies, Cleft Palate, and Micrognathia.

OBJECTIVE: To investigate the feasibility and reproducibility of the prenasal thickness (PNT)/nasal bone length (NBL) ratio, maxilla-nasion-mandible (MNM) angle, facial profile line, profile line distance, and prefrontal space ratio (PFSR) in the first trimester of pregnancy, develop normal ranges, and evaluate these markers in abnormal fetuses. METHODS: All measurements were performed on stored images by two operators. Feasibility, interoperator agreement, and prediction intervals were calculated for all measurements. RESULTS: Feasibility was the highest for the NBL (74.3-79.7%) and the MNM angle (75.7-79.05%). Correlation was good for the NBL, the PNT, and the MNM angle (intraclass correlation coefficient 0.706-0.835). Mean difference between operators was the lowest for the PNT and PFSR (0.03-0.08). Measurements in abnormal fetuses showed that the majority of trisomy 21 fetuses had either an absent nasal bone or a shorter NBL. The PNT and PNT/NBL ratio were above the 97.5th centile in one third of the cases. Fetuses with facial clefts or micrognathia showed on average a large MNM angle (multiple of the median 0.96-5.15). CONCLUSION: First-trimester facial markers are feasible. The PNT and PNT/NBL ratio were increased in one third of the trisomic fetuses, and the MNM angle in the majority of fetuses with micrognathia and facial clefts.

Progression paths in children's problem solving: The influence of dynamic testing, initial variability, and working memory.

The current study investigated developmental trajectories of analogical reasoning performance of 104 7- and 8-year-old children. We employed a microgenetic research method and multilevel analysis to examine the influence of several background variables and experimental treatment on the children's developmental trajectories. Our participants were divided into two treatment groups: repeated practice alone and repeated practice with training. Each child received an initial working memory assessment and was subsequently asked to solve figural analogies on each of several sessions. We examined children's analogical problem-solving behavior and their subsequent verbal accounts of their employed solving processes. We also investigated the influence of verbal and visual-spatial working memory capacity and initial variability in strategy use on analogical reasoning development. Results indicated that children in both treatment groups improved but that gains were greater for those who had received training. Training also reduced the influence of children's initial variability in the use of analogical strategies with the degree of improvement in reasoning largely unrelated to working memory capacity. Findings from this study demonstrate the value of a microgenetic research method and the use of multilevel analysis to examine inter- and intra-individual change in problem-solving processes.

Dynamic testing and test anxiety amongst gifted and average-ability children.

BACKGROUND: Dynamic testing has been proposed as a testing approach that is less disadvantageous for children who may be potentially subject to bias when undertaking conventional assessments. For example, those who encounter high levels of test anxiety, or who are unfamiliar with standardized test procedures, may fail to demonstrate their true potential or capabilities. While dynamic testing has proven particularly useful for special groups of children, it has rarely been used with gifted children. AIM: We investigated whether it would be useful to conduct a dynamic test to measure the cognitive abilities of intellectually gifted children. We also investigated whether test anxiety scores would be related to a progression in the children's test scores after dynamic training. SAMPLE: Participants were 113 children aged between 7 and 8 years from several schools in the western part of the Netherlands. The children were categorized as either gifted or average-ability and split into an unguided practice or a dynamic testing condition. METHODS: The study employed a pre-test-training-post-test design. Using linear mixed modelling analysis with a multilevel approach, we inspected the growth trajectories of children in the various conditions and examined the impact of ability and test anxiety on progression and training benefits. RESULTS AND CONCLUSIONS: Dynamic testing proved to be successful in improving the scores of the children, although no differences in training benefits were found between gifted and average-ability children. Test anxiety was shown to influence the children's rate of change across all test sessions and their improvement in performance accuracy after dynamic training.

Increased nuchal translucency with normal karyotype and anomaly scan: what next?

Over the years, it has become clear that increased nuchal translucency is a marker for chromosomal abnormalities, and it is also associated with a wide spectrum of structural anomalies, genetic syndromes, a higher risk of miscarriage, and intrauterine fetal death. These risks are all proportionally related to the degree of nuchal translucency enlargement. After the initial assessment of increased nuchal translucency, parents should be counselled by the fetal medicine specialist about the possible outcomes and the value of additional karyotyping and array comparative genomic hybridisation. A detailed late first-trimester and subsequent 20-week scan should aim at identifying structural anomalies, with special focus on the fetal heart and subtle dysmorphic features. In the absence of structural anomalies or markers, the chance of a favourable outcome is high.

Low uptake of the combined test in The Netherlands--which factors contribute?

OBJECTIVE: The aim of this study was to evaluate which of the following factors affect the uptake of the combined test (CT) in The Netherlands: women's socio-demographic background, attitude towards Down syndrome, attitude towards termination of pregnancy, counseling process, reimbursement policy, and knowledge on the aim of the CT. METHODS: Cross-sectional survey in the Northwest (NW) and the Northeast (NE) region of The Netherlands. RESULTS: Analyses were based on 820 questionnaires (73% response rate). Women from the NW region opted more often for the CT than women from the NE region (52.1% and 16.5%, respectively, p < 0.001). Women of 36 years and older opted more often for the CT than younger women (59.4% and 28.2%, respectively, p < 0.001). Women's socio-demographic background and their attitude towards Down syndrome and termination of pregnancy (TOP) had contributed independently on CT choice. CONCLUSION: The uptake of the CT in this study is low. The main reason for the low uptake is the relatively positive attitude towards Down syndrome and a negative attitude towards TOP. Moreover, the perception of maternal age as strong predictor of Down syndrome risk and the inequality of access to care, due to the financial threshold for younger women, are likely to affect participation in screening.