Client experiences of virtual energy healing.

CONTEXT: During the COVID-19 pandemic medical and holistic health practitioners turned to utilizing virtual healthcare. As energy healing practitioners and educators who shifted to an online format, it seemed important to document descriptions of client experiences of virtual energy healing. OBJECTIVE: To describe client experiences of virtual energy healing sessions. DESIGN: Descriptive pre-post intervention design. SETTING AND INTERVENTIONS: Two experienced and eclectic energy healing practitioners developed a protocol and conducted energy healing sessions via Zoom. PARTICIPANTS: A convenience sample of Sisters of St. Joseph of Carondelet (CSJ) Consociates, people of diverse life-styles and spiritual traditions who are committed to living the mission of the CSJs in the St. Paul Province. MAIN OUTCOME MEASURES: Pre-post 10-point Likert scale rating of relaxation, well-being, and pain. Pre-post primarily qualitative questionnaires. RESULTS: Results indicated significant pre-post differences: pre-session relaxation (M=5.036, SD = 2.9) and post-session relaxation (M=7.86, SD = 6.4): t(13)=2.16, p=.0017*; pre-session well-being (M=5.86, SD = 4.29); post-session well-being (M=8, SD = 2.31), t(13), p=.0001*; pre-session pain (M=4.0, SD = 6.15) and post-session pain (M=2.25, SD = 3.41), t(13)=2.16, p=.004*. Thematic analysis revealed six themes related to client experiences of virtual energy healing: 1) embodied sensations, 2) relaxation, 3) release - a letting go of tasks/anxieties/worries, 4) sense of peace/joy/calm, 5) connection to themselves, others, and something larger, and 6) surprise that virtual energy healing works. LIMITATIONS: This was a descriptive study using a convenience sample, therefore, there was not a control group, a large sample size, and the sample might be more prone to report better results than the general population because of their spiritual perspectives. Results were not generalizable. IMPLICATIONS: Clients reported positive descriptions of virtual energy healing and say they would do it again. However more research is needed to understand the variables that influenced the results and the underlying mechanisms of action.

Characteristics associated with antenatally unidentified small-for-gestational-age fetuses: prospective cohort study nested within DESiGN randomized controlled trial.

OBJECTIVE: To identify the clinical characteristics and patterns of ultrasound use amongst pregnancies with an antenatally unidentified small-for-gestational-age (SGA) fetus, compared with those in which SGA is identified, to understand how to design interventions that improve antenatal SGA identification. METHODS: This was a prospective cohort study of singleton, non-anomalous SGA (birth weight < 10th centile) neonates born after 24 + 0 gestational weeks at 13 UK sites, recruited for the baseline period and control arm of the DESiGN trial. Pregnancy with antenatally unidentified SGA was defined if there was no scan or if the final scan showed estimated fetal weight (EFW) at the 10th centile or above. Identified SGA was defined if EFW was below the 10th centile at the last scan. Maternal and fetal sociodemographic and clinical characteristics were studied for associations with unidentified SGA using unadjusted and adjusted logistic regression models. Ultrasound parameters (gestational age at first growth scan, number and frequency of ultrasound scans) were described, stratified by presence of indication for serial ultrasound. Associations of unidentified SGA with absolute centile and percentage weight difference between the last scan and birth were also studied on unadjusted and adjusted logistic regression, according to time between the last scan and birth. RESULTS: Of the 15 784 SGA babies included, SGA was not identified antenatally in 78.7% of cases. Of pregnancies with unidentified SGA, 47.1% had no recorded growth scan. Amongst 9410 pregnancies with complete data on key maternal comorbidities and antenatal complications, the risk of unidentified SGA was lower for women with any indication for serial scans (adjusted odds ratio (aOR), 0.56 (95% CI, 0.49-0.64)), for Asian compared with white women (aOR, 0.80 (95% CI, 0.69-0.93)) and for those with non-cephalic presentation at birth (aOR, 0.58 (95% CI, 0.46-0.73)). The risk of unidentified SGA was highest among women with a body mass index (BMI) of 25.0-29.9 kg/m2 (aOR, 1.15 (95% CI, 1.01-1.32)) and lowest in those with underweight BMI (aOR, 0.61 (95% CI, 0.48-0.76)) compared to women with BMI of 18.5-24.9 kg/m2 . Compared to women with identified SGA, those with unidentified SGA had fetuses of higher SGA birth-weight centile (adjusted odds for unidentified SGA increased by 1.21 (95% CI, 1.18-1.23) per one-centile increase between the 0th and 10th centiles). Duration between the last scan and birth increased with advancing gestation in pregnancies with unidentified SGA. SGA babies born within a week of the last growth scan had a mean difference between EFW and birth-weight centiles of 19.5 (SD, 13.8) centiles for the unidentified-SGA group and 0.2 (SD, 3.3) centiles for the identified-SGA group (adjusted mean difference between groups, 19.0 (95% CI, 17.8-20.1) centiles). CONCLUSIONS: Unidentified SGA was more common amongst women without an indication for serial ultrasound, and in those with cephalic presentation at birth, BMI of 25.0-29.9 kg/m2 and less severe SGA. Ultrasound EFW was overestimated in women with unidentified SGA. This demonstrates the importance of improving the accuracy of SGA screening strategies in low-risk populations and continuing performance of ultrasound scans for term pregnancies. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Improving antenatal detection of small-for-gestational-age fetus: economic evaluation of Growth Assessment Protocol.

OBJECTIVE: To determine whether the Growth Assessment Protocol (GAP), as implemented in the DESiGN trial, is cost-effective in terms of antenatal detection of small-for-gestational-age (SGA) neonate, when compared with standard care. METHODS: This was an incremental cost-effectiveness analysis undertaken from the perspective of a UK National Health Service hospital provider. Thirteen maternity units from England, UK, were recruited to the DESiGN (DEtection of Small for GestatioNal age fetus) trial, a cluster randomized controlled trial. Singleton, non-anomalous pregnancies which delivered after 24 + 0 gestational weeks between November 2015 and February 2019 were analyzed. Probabilistic decision modeling using clinical trial data was undertaken. The main outcomes of the study were the expected incremental cost, the additional number of SGA neonates identified antenatally and the incremental cost-effectiveness ratio (ICER) (cost per additional SGA neonate identified) of implementing GAP. Secondary analysis focused on the ICER per infant quality-adjusted life year (QALY) gained. RESULTS: The expected incremental cost (including hospital care and implementation costs) of GAP over standard care was £34 559 per 1000 births, with a 68% probability that implementation of GAP would be associated with increased costs to sustain program delivery. GAP identified an additional 1.77 SGA neonates per 1000 births (55% probability of it being more clinically effective). The ICER for GAP was £19 525 per additional SGA neonate identified, with a 44% probability that GAP would both increase cost and identify more SGA neonates compared with standard care. The probability of GAP being the dominant clinical strategy was low (11%). The expected incremental cost per infant QALY gained ranged from £68 242 to £545 940, depending on assumptions regarding the QALY value of detection of SGA. CONCLUSION: The economic case for replacing standard care with GAP is weak based on the analysis reported in our study. However, this conclusion should be viewed taking into account that cost-effectiveness analyses are always limited by the assumptions made. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Randomized controlled pilot trial with ion-exchange water softeners to prevent eczema (SOFTER trial).

BACKGROUND: Observational studies suggest an increased risk of eczema in children living in hard versus soft water areas, and there is, therefore, an interest in knowing whether softening water may prevent eczema. We evaluated the feasibility of a parallel-group assessor-blinded pilot randomized controlled trial to test whether installing a domestic ion-exchange water softener before birth in hard water areas reduces the risk of eczema in infants with a family history of atopy. METHODS: Pregnant women living in hard water areas (>250 mg/L calcium carbonate) in and around London UK, were randomized 1:1 antenatally to either have an ion-exchange water softener installed in their home or not (ie to continue to receive usual domestic hard water). Infants were assessed at birth and followed up for 6 months. The main end-points were around feasibility, the primary end-point being the proportion of eligible families screened who were willing and able to be randomized. Clinical end-points were evaluated including frequency of parent-reported doctor-diagnosed eczema and visible eczema on skin examination. Descriptive analyses were conducted, and no statistical testing was performed as this was a pilot study. RESULTS: One hundred and forty-nine families screened were eligible antenatally and 28% (41/149) could not have a water softener installed due to technical reasons or lack of landlord approval. Eighty of 149 (54%) were randomized, the primary end-point. Two participants withdrew immediately after randomization, leaving 39 participants in each arm (78 total). Attrition was 15% (12/78) by 6 months postpartum. All respondents (n = 69) to the study acceptability questionnaire reported that the study was acceptable. Fifty-six of 708 (7.9%) water samples in the water softener arm were above the hard water threshold of 20 mg/L CaCO3 . At 6 months of age 27/67 infants (40%) developed visible eczema, 12/36 (33%) vs. 15/31 (48%) in the water softener and control groups, respectively, difference -15% (95% CI -38, 8.3%), with most assessments (≥96%) remaining blinded. Similarly, a lower proportion of infants in the water softener arm had parent-reported, doctor-diagnosed eczema by 6 months compared to the control arm, 6/17 (35%) versus 9/19 (47%), difference -12% (95% CI -44, 20%). CONCLUSION: A randomized controlled trial of water softeners for the prevention of atopic eczema in high-risk infants is feasible and acceptable. TRIAL REGISTRATION: NCT03270566 (clinicaltrials.gov).

POPPIE: protocol for a randomised controlled pilot trial of continuity of midwifery care for women at increased risk of preterm birth.

BACKGROUND: High rates of preterm births remain a UK public health concern. Preterm birth is a major determinant of adverse infant and longer-term outcomes, including survival, quality of life, psychosocial effects on the family and health care costs. We aim to test whether a model of care combining continuity of midwife care with rapid referral to a specialist obstetric clinic throughout pregnancy, intrapartum and the postpartum period is feasible and improves experience and outcomes for women at increased risk of preterm birth. METHODS: This pilot, hybrid, type 2 randomised controlled implementation trial will recruit 350 pregnant women at increased risk of preterm birth to a midwifery continuity of care intervention or standard care. The intervention will be provided from recruitment (antenatal), labour, birth and the postnatal period, in hospital and community settings and in collaboration with specialist obstetric clinic care, when required. Standard care will be the current maternity care provision by NHS midwives and obstetricians at the study site. Participants will be followed up until 6-8 weeks postpartum. The composite primary outcome is the appropriate initiation of any specified interventions related to the prevention and/or management of preterm labour and birth. Secondary outcomes are related to: recruitment and attrition rates; implementation; acceptability to women, health care professionals and stakeholders; health in pregnancy and other complications; intrapartum outcomes; maternal and neonatal postnatal outcomes; psycho-social health; quality of care; women's experiences and health economic analysis. The trial has 80% power to detect a 15% increase in the rate of appropriate interventions (40 to 55%). The analysis will be by 'intention to treat' analysis. DISCUSSION: Little is known about the underlying reasons why and how models of midwifery continuity of care are associated with fewer preterm births, better maternal and infant outcomes and more positive experiences; nor how these models of care can be implemented successfully in the health services. This will be the first study to provide direct evidence regarding the effectiveness, implementation and evaluation of a midwifery continuity of care model and rapid access to specialist obstetric services for women at increased risk of preterm birth. TRIAL REGISTRATION: ISRCTN37733900 . Retrospectively registered on 21 August 2017.

The schizophrenia- and autism-associated gene, transcription factor 4 regulates the columnar distribution of layer 2/3 prefrontal pyramidal neurons in an activity-dependent manner.

Disruption of the laminar and columnar organization of the brain is implicated in several psychiatric disorders. Here, we show in utero gain-of-function of the psychiatric risk gene transcription factor 4 (TCF4) severely disrupts the columnar organization of medial prefrontal cortex (mPFC) in a transcription- and activity-dependent manner. This morphological phenotype was rescued by co-expression of TCF4 plus calmodulin in a calcium-dependent manner and by dampening neuronal excitability through co-expression of an inwardly rectifying potassium channel (Kir2.1). For we believe the first time, we show that N-methyl-d-aspartate (NMDA) receptor-dependent Ca2+ transients are instructive to minicolumn organization because Crispr/Cas9-mediated mutation of NMDA receptors rescued TCF4-dependent morphological phenotypes. Furthermore, we demonstrate that the transcriptional regulation by the psychiatric risk gene TCF4 enhances NMDA receptor-dependent early network oscillations. Our novel findings indicate that TCF4-dependent transcription directs the proper formation of prefrontal cortical minicolumns by regulating the expression of genes involved in early spontaneous neuronal activity, and thus our results provides insights into potential pathophysiological mechanisms of TCF4-associated psychiatric disorders.

Application Efficacy of Vectobac WDG Against Larval Aedes aegypti Using Thermal Fog Technology.

The effectiveness of thermal fog application of Bacillus thuringiensis israelensis (Vectobac® WDG) against larval Aedes aegypti was evaluated in open and forest canopied environments in northeastern Florida, using a handheld IGEBA® TF34 thermal fogger (with water conversion kit). The product was applied at the maximum label rate of 1 kg/ha to linear transects, in each environment, containing empty 0.5-liter cups. After application, late-2nd to early-3rd instars of Ae. aegypti were added to each cup. Complete larval mortality occurred 48 h after treatment, 8 m away from the spray line in the open field while 63.4% larval mortality was achieved at this same distance in the forest canopy at 72 h posttreatment. Operational efficacy was then evaluated in an urban tropical environment in Key West, FL. In this study, empty plastic cups were placed in cryptic areas of a commercial lobster and crab trap yard. The 0.1-ha area was treated with Vectobac WDG at the maximum label rate using the same equipment. Aedes aegypti larval mortality from treated cups was >99% at 24 h posttreatment, whereas complete mortality was achieved at 48 h after application.

Infant adiposity following a randomised controlled trial of a behavioural intervention in obese pregnancy.

OBJECTIVES: Randomised controlled trials are required to address causality in the reported associations between maternal influences and offspring adiposity. The aim of this study was to determine whether an antenatal lifestyle intervention, associated with improvements in maternal diet and reduced gestational weight gain (GWG) in obese pregnant women leads to a reduction in infant adiposity and sustained improvements in maternal lifestyle behaviours at 6 months postpartum. SUBJECTS AND METHODS: We conducted a planned postnatal follow-up of a randomised controlled trial (UK Pregnancies Better Eating and Activity Trial (UPBEAT)) of a complex behavioural intervention targeting maternal diet (glycaemic load (GL) and saturated fat intake) and physical activity in 1555 obese pregnant women. The main outcome measure was infant adiposity, assessed by subscapular and triceps skinfold thicknesses. Maternal diet and physical activity, indices of the familial lifestyle environment, were assessed by questionnaire. RESULTS: A total of 698 (45.9%) infants (342 intervention and 356 standard antenatal care) were followed up at a mean age of 5.92 months. There was no difference in triceps skinfold thickness z-scores between the intervention vs standard care arms (difference -0.14 s.d., 95% confidence interval -0.38 to 0.10, P=0.246), but subscapular skinfold thickness z-score was 0.26 s.d. (-0.49 to -0.02; P=0.03) lower in the intervention arm. Maternal dietary GL (-35.34; -48.0 to -22.67; P<0.001) and saturated fat intake (-1.93% energy; -2.64 to -1.22; P<0.001) were reduced in the intervention arm at 6 months postpartum. Causal mediation analysis suggested that lower infant subscapular skinfold thickness was partially mediated by changes in antenatal maternal diet and GWG rather than postnatal diet. CONCLUSIONS: This study provides evidence from follow-up of a randomised controlled trial that a maternal behavioural intervention in obese pregnant women has the potential to reduce infant adiposity and to produce a sustained improvement in maternal diet at 6 months postpartum.

A Small-Scale Investigation Into the Effect of A Larvicidal Oil On Oviposition Site Preference By Aedes aegypti.

Larvicidal oils can be used to control immature Aedes aegypti and other pestiferous mosquitoes. To test whether oil-based larvicides also act as oviposition deterrents, indoor and semi-field trials were conducted at the Navy Entomology Center of Excellence in Jacksonville, FL. In both studies, treatment cages consisted of oviposition cups lined with seed germination paper as an oviposition substrate and filled with 1-wk-old southern live oak ( Quercus virginiana) leaf litter-infused water. Treatment cages consisted of 2 cups treated with CocoBear™ Mosquito Larvicidal Oil, while 2 cups were untreated. Control cages contained oviposition cups with only oak leaf litter-infused water. Gravid Ae. aegypti were released into cages and allowed to oviposit for 24 h, after which eggs were counted. The number of eggs deposited in treatment and control cages was not significantly different (indoor P = 0.0865; outdoor P = 0.9765). However, the number of eggs deposited in untreated cups was significantly greater than that deposited in treated cups within treatment cages (indoor P < 0.0001; outdoor P = 0.0050). These results suggest that the presence of the larvicidal oil CocoBear may cause gravid female Ae. aegypti to seek alternative oviposition sites.

Shock index: an effective predictor of outcome in postpartum haemorrhage?

OBJECTIVES: To compare the predictive value of the shock index (SI) with conventional vital signs in postpartum haemorrhage (PPH), and to establish 'alert' thresholds for use in low-resource settings. DESIGN: Retrospective cohort study. SETTING: UK tertiary centre. POPULATION: Women with PPH ≥ 1500 ml (n = 233). METHODS: Systolic blood pressure (BP), diastolic BP, mean arterial pressure, pulse pressure, heart rate (HR) and SI (HR/systolic BP) were measured within the first hour following PPH. Values measured at the time of highest SI were selected for analysis. The area under the receiver operating characteristic curve (AUROC) for each parameter, used to predict admission to an intensive care unit and other adverse outcomes, was calculated. Sensitivity, specificity and negative/positive predictive values determined thresholds of the best predictor. MAIN OUTCOME MEASURES: Intensive care unit (ICU) admission, blood transfusion ≥ 4 iu, haemoglobin level <7 g/dl, and invasive surgical procedures. RESULTS: Shock index has the highest AUROC to predict ICU admissions (0.75 for SI [95% CI 0.63-0.87] compared with 0.64 [95% CI 0.44-0.83] for systolic BP). SI compared favourably for other outcomes: SI ≥ 0.9 had 100% sensitivity (95% CI 73.5-100) and 43.4% specificity (95% CI 36.8-50.3), and SI ≥ 1.7 had 25.0% sensitivity (95% CI 5.5-57.2) and 97.7% specificity (CI 94.8-99.3), for predicting ICU admission. CONCLUSIONS: Shock index compared favourably with conventional vital signs in predicting ICU admission and other outcomes in PPH, even after adjusting for confounding; SI <0.9 provides reassurance, whereas SI ≥ 1.7 indicates a need for urgent attention. In low-resource settings this simple parameter could improve outcomes. It was not possible to adjust for resuscitative measures administered following vital sign measurement that may have influenced the outcome.

Prediction of gestational diabetes in obese pregnant women from the UK Pregnancies Better Eating and Activity (UPBEAT) pilot trial.

AIM: To examine the prediction of gestational diabetes in obese women using routine clinical measures and measurement of biomarkers related to insulin resistance in the early second trimester. METHODS: A total of 117 obese pregnant women participating in a pilot trial of a complex intervention of dietary advice and physical activity were studied. Blood samples were obtained at recruitment (15⁺°-17⁺6 weeks' gestation) and demographic, clinical history and anthropometric measures recorded. The biomarkers analysed were plasma lipids (HDL cholesterol, LDL cholesterol, triglycerides), high-sensitivity C-reactive protein, alanine transaminase, aspartate transaminase, ferritin, fructosamine, insulin, adiponectin, tissue plasminogen activator, interleukin-6, visfatin and leptin. Univariate and logistic regression analyses were performed to determine independent predictors and area under the receiver-operating curve was calculated for the model. RESULTS: Of the 106 participants included in the analysis, 29 (27.4%) developed gestational diabetes. Participants with gestational diabetes were older (P = 0.002), more often of parity ≥ 2, had higher systolic (P = 0.02) and diastolic blood pressure (P = 0.02) and were more likely to be black (P = 0.009). Amongst the blood biomarkers measured, plasma adiponectin alone remained independently associated with gestational diabetes in adjusted models (P = 0.002). The area under the receiver-operating curve for clinical factors alone (0.760) increased significantly (area under the curve 0.834, chi-square statistic (1) = 4.00, P = 0.046) with the addition of adiponectin. CONCLUSIONS: A combination of routinely measured clinical factors and adiponectin measured in the early second trimester in obese women may provide a useful approach to the prediction of gestational diabetes. Validation in a large prospective study is required to determine the usefulness of this algorithm in clinical practice.

Reporting errors, incidence and risk factors for postpartum haemorrhage and progression to severe PPH: a prospective observational study.

OBJECTIVE: To quantify reporting errors, measure incidence of postpartum haemorrhage (PPH) and define risk factors for PPH (≥500 ml) and progression to severe PPH (≥1500 ml). DESIGN: Prospective observational study. SETTING: Two UK maternity services. POPULATION: Women giving birth between 1 August 2008 and 31 July 2009 (n = 10 213). METHODS: Weighted sampling with sequential adjustment by multivariate analysis. MAIN OUTCOME MEASURES: Incidence and risk factors for PPH and progression to severe PPH. RESULTS: Errors in transcribing blood volume were frequent (14%) with evidence of threshold preference and avoidance. The incidences of PPH ≥500, ≥1500 and ≥2500 ml were 33.7% (95% CI 31.2-36.2), 3.9% (95% CI 3.3-4.6) and 0.8% (95% CI 0.6-1.0). New independent risk factors predicting PPH ≥ 500 ml included Black African ethnicity (adjusted odds ratio [aOR] 1.77, 95% CI 1.31-2.39) and assisted conception (aOR 2.93, 95% CI 1.30-6.59). Modelling demonstrated how prepregnancy- and pregnancy-acquired factors may be mediated through intrapartum events, including caesarean section, elective (aOR 24.4, 95% CI 5.53-108.00) or emergency (aOR 40.5, 95% CI 16.30-101.00), and retained placenta (aOR 21.3, 95% CI 8.31-54.7). New risk factors were identified for progression to severe PPH, including index of multiple deprivation (education, skills and training) (aOR 1.75, 95% CI 1.11-2.74), multiparity without caesarean section (aOR 1.65, 95% CI 1.20-2.28) and administration of steroids for fetal reasons (aOR 2.00, 95% CI 1.24-3.22). CONCLUSIONS: Sequential, interacting, traditional and new risk factors explain the highest rates of PPH and severe PPH reported to date.

Psychological predictors of dietary intentions in pregnancy.

BACKGROUND: Consuming a healthy diet in pregnancy has the potential to improve obstetric outcome, including minimising the risk of macrosomia. Effective promotion of dietary change depends on identifying and targeting determinants of gestational diet. The present study aimed to model psychological predictors of intentions to reduce intake of high-fat and high-sugar foods, and increase fruit and vegetable consumption, among pregnant women. METHODS: One hundred and three pregnant women completed questionnaire measures of intentions to modify the consumption of the target foods, current intake, perceived vulnerability to and severity of adverse outcomes of unhealthful consumption of these foods (i.e. 'threat'), benefits of dietary change to mother and baby, barriers to dietary changes, and social approval for dietary change ('subjective norms'). A cross-sectional design was used. Logistic regression analyses were undertaken to model dietary change intentions. RESULTS: Participants who reported excessive current intake of high-fat and high-sugar foods were more likely to intend to reduce the intake of these foods. Perceived benefits for mother and baby enhanced intentions to eat more fruit and vegetables and eat less high-fat, and marginally significantly increased high-sugar reduction intentions. There were no effects of threat, barriers or subjective norms. CONCLUSIONS: Lack of effects for barriers, threat and subjective norms may indicate that pregnant women discount barriers to health-promoting behaviour, understand the threat posed by unhealthy eating and perceive social approval from others. Dietary change interventions for pregnant women should emphasise likely positive outcomes for both mother and child.

Clinical and geographical variation in prophylactic and therapeutic treatments for pre-eclampsia in the UK.

OBJECTIVE: To evaluate the clinical and geographical variation in the use of aspirin in women at high risk of pre-eclampsia, and in the use of antihypertensive drugs and magnesium sulphate in women with established pre-eclampsia. DESIGN: Analysis of vitamins in pre-eclampsia (VIP) trial database. SAMPLE: A total of 2399 women at increased risk of pre-eclampsia in 25 UK hospitals. METHODS: An analysis of a large prospectively validated database of high-risk women in the UK was undertaken to assess aspirin use across different risk groups and to evaluate the use of antihypertensives and magnesium sulphate in 370 women who developed pre-eclampsia. Logistic regression was employed to compare drug use between region and by recognised clinical indicators. MAIN OUTCOME MEASURES: Usage of aspirin, antihypertensive drugs and magnesium sulphate. RESULTS: Of the women with known risk factors at trial entry, 24% (569/2399) received low-dose aspirin. Aspirin usage varied widely between risk groups [from 5% (19/378) in women with multiple pregnancy to 94% (50/53) in women with antiphospholipid syndrome] and between geographical regions [from 8% (20/248) to 49% (95/193)]. Three hundred and seventy women developed pre-eclampsia, 52% (n = 193) of whom received new or additional antihypertensives after 20 weeks of gestation; 34% (77/224) with a maximum recorded systolic blood pressure of >OR=160 mmHg in the second half of pregnancy did not receive antihypertensive treatment; 17% (62/370) of women with pre-eclampsia received magnesium sulphate prophylactically. CONCLUSIONS: Prophylactic and treatment regimes for pre-eclampsia in the UK vary by region and risk group.

Low saliva progesterone concentrations are associated with spontaneous early preterm labour (before 34 weeks of gestation) in women at increased risk of preterm delivery.

Saliva progesterone and oestriol concentrations were determined weekly from 24 weeks of gestation in women at increased risk of preterm delivery. Samples were analysed from 28 women with spontaneous onset of labour and delivery before 37 weeks of gestation, and 64 who delivered at term. Saliva progesterone was lower in the 12 women delivering before 34 weeks than in those delivering later, between 34 and 37 weeks (P = 0.007) or at term (P = 0.009). Measurement of saliva progesterone may be of value in the prediction of early preterm labour and in determining which women might benefit from progesterone supplementation.

Fetal fibronectin as a predictor of spontaneous preterm labour in asymptomatic women with a cervical cerclage.

OBJECTIVE: To assess the accuracy of fetal fibronectin (fFN) testing for prediction of preterm labour in asymptomatic high-risk women with a cervical cerclage. DESIGN: Retrospective observational study. SETTING: United Kingdom. POPULATION: Nine hundred and ten asymptomatic women at high-risk of Preterm birth referred to specialist antenatal clinics and undergoing fFN testing between November 1997 and December 2007. METHODS: Women had fFN tests taken between 23(+0) and 27(+6) weeks' gestation, on one or more occasions. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive predictive values and negative predictive values of fFN testing for predicting delivery <30 and <37 weeks were compared in those with and without cerclage. RESULTS: For delivery <30 weeks' gestation, the specificity of fFN testing was significantly lower in women with cervical cerclage (77% vs 90%; P < or = 0.00001). The sensitivity of the test was similar between the groups (78.6 (no-cerclage) vs 60% (cerclage); P > 0.4). The negative predictive value of the fFN test for delivery <30 weeks was high in both groups (>98%). CONCLUSIONS: Asymptomatic high-risk women with cerclage in situ are more likely to have a false positive fFN test. The negative predictive value is similar.

Prospective cohort study investigating the reliability of the AmnioSense method for detection of spontaneous rupture of membranes.

OBJECTIVE: This study investigated the reliability, sensitivity and specificity of a commercially available absorbent pad, AmnioSense, compared with speculum examination for detection of spontaneous ruptured membranes (SRM). DESIGN: Prospective cohort study. SETTING: Antenatal Day Unit (ADU) of a UK inner-city teaching hospital. POPULATION: Women attending the ADU with a history of suspected ruptured membranes between 18 and 42 weeks of gestation. METHODS: Eligible women were asked to use the absorbent pad in accordance with the manufacturer's instructions. A midwife recorded the result. A second midwife performed a speculum examination according to unit protocol. Results were entered onto a password-protected study-specific database. Both midwives were blind to the other test result. MAIN OUTCOME MEASURES: Comparability between the index test (AmnioSense) and reference standard (speculum). RESULTS: A total of 157 women were recruited and results were analysed in 139 cases. Median gestational age at recruitment was 37(+2) weeks. The prevalence of SRM was 42% (59/139) with AmnioSense giving a sensitivity of 98% (58/59) and specificity of 65% (52/80). CONCLUSIONS: Thirty-eight percent (53/139 women) with SRM would have been correctly identified as having intact membranes without the need for a speculum examination. Twenty-five percent of AmnioSense false-positive results were associated with positive high vaginal swab results (7/28). These data suggest that a negative AmnioSense result can provide reassurance of intact membranes. Use of the AmnioSense test before considering speculum examination could reduce the number of speculum examinations undertaken, with benefit to women and concomitant health resource savings.

Vitamin C and vitamin E in pregnant women at risk for pre-eclampsia (VIP trial): randomised placebo-controlled trial.

BACKGROUND: Oxidative stress could play a part in pre-eclampsia, and there is some evidence to suggest that vitamin C and vitamin E supplements could reduce the risk of the disorder. Our aim was to investigate the potential benefit of these antioxidants in a cohort of women with a range of clinical risk factors. METHODS: We did a randomised, placebo-controlled trial to which we enrolled 2410 women identified as at increased risk of pre-eclampsia from 25 hospitals. We assigned the women 1000 mg vitamin C and 400 IU vitamin E (RRR alpha tocopherol; n=1199) or matched placebo (n=1205) daily from the second trimester of pregnancy until delivery. Our primary endpoint was pre-eclampsia, and our main secondary endpoints were low birthweight (<2.5 kg) and small size for gestational age (<5th customised birthweight centile). Analyses were by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN 62368611 . FINDINGS: Of 2404 patients treated, we analysed 2395 (99.6%). The incidence of pre-eclampsia was similar in treatment placebo groups (15% [n=181] vs 16% [n=187], RR 0.97 [95% CI 0.80-1.17]). More low birthweight babies were born to women who took antioxidants than to controls (28% [n=387] vs 24% [n=335], 1.15 [1.02-1.30]), but small size for gestational age did not differ between groups (21% [n=294] vs 19% [n=259], 1.12 [0.96-1.31]). INTERPRETATION: Concomitant supplementation with vitamin C and vitamin E does not prevent pre-eclampsia in women at risk, but does increase the rate of babies born with a low birthweight. As such, use of these high-dose antioxidants is not justified in pregnancy.

Physical map of a conditionally dispensable chromosome in Nectria haematococca mating population VI and location of chromosome breakpoints.

Certain isolates of the plant pathogenic fungus Nectria haematococca mating population (MP) VI contain a 1.6-Mb conditionally dispensable (CD) chromosome carrying the phytoalexin detoxification genes MAK1 and PDA6-1. This chromosome is structurally unstable during sexual reproduction. As a first step in our analysis of the mechanisms underlying this chromosomal instability, hybridization between overlapping cosmid clones was used to construct a map of the MAK1 PDA6-1 chromosome. The map consists of 33 probes that are linked by 199 cosmid clones. The polymerase chain reaction and Southern analysis of N. haematococca MP VI DNA digested with infrequently cutting restriction enzymes were used to close gaps and order the hybridization-derived contigs. Hybridization to a probe extended from telomeric repeats was used to anchor the ends of the map to the actual chromosome ends. The resulting map is estimated to cover 95% of the MAK1 PDA6-1 chromosome and is composed of two ordered contigs. Thirty-eight percent of the clones in the minimal map are known to contain repeated DNA sequences. Three dispersed repeats were cloned during map construction; each is present in five to seven copies on the chromosome. The cosmid clones representing the map were probed with deleted forms of the CD chromosome and the results were integrated into the map. This allowed the identification of chromosome breakpoints and deletions.

Partial MAT-2 gene structure and the influence of temperature on mating success in Gibberella circinata.

Genetic analysis of Gibberella circinata, the causative agent of pitch canker disease of pines, historically has been thwarted by a low frequency of mating success in the laboratory. We describe two findings that should facilitate genetic analysis of this fungus and related species. First, we determined that previously described degenerate primers could be used to amplify a portion of the MAT-2 mating type gene from G. circinata. This led to the cloning and sequencing of a fragment of the MAT-2 gene, which in turn made it possible to distinguish between G. circinata isolates of opposite mating types. Second, we discovered that of the 18 G. circinata field isolates in our collection, the 1 female fertile isolate expressed its fertility at 15 and 20 degrees C but not at 25 degrees C, the temperature used for crossing many Gibberella species. It is evident, therefore, that when sexual reproduction in other closely related species is initially being investigated, the crosses should be established at a variety of temperatures. Once we learned that female fertility in this G. circinata isolate was expressed at 20 degrees C, a high frequency of mating success was achieved.