A randomised clinical trial of intrapartum fetal monitoring with computer analysis and alerts versus previously available monitoring

Background

It has been shown that plasma carnitine concentrations decrease markedly during gestation. A recent study performed with a low number of subjects suggested that this effect could be due to a low iron status which leads to an impairment of carnitine synthesis. The present study aimed to confirm this finding in a greater number of subjects. It was moreover intended to find out whether low carnitine concentrations during pregnancy could be due to a reduced availability of precursors of carnitine synthesis, namely trimethyllysine (TML) and γ-butyrobetaine (BB).

Methods

Blood samples of 79 healthy pregnant women collected at delivery were used for this study.

Results

There was only a weak, non-significant (P > 0.05), correlation between plasma concentration of ferritin and those of free and total carnitine. There was no correlation between other parameters of iron status (plasma iron concentration, hemoglobin, MCV, MCH) and plasma concentration of free and total carnitine. There were, however, significant (P < 0.05) positive correlations between concentrations of TML and BB and those of free and total carnitine in plasma.

Conclusions

The results of this study suggest that an insufficient iron status is not the reason for low plasma carnitine concentrations observed in pregnant women. It is rather indicated that low plasma carnitine concentrations are caused by a low availability of precursors for carnitine synthesis during gestation.     

Supporting patient safety: Examining communication within delivery suite teams through contrasting approaches to research observation

Objective

to explore the nature of intra- and interprofessional communication on delivery suites, with a particular focus on patient safety.

Design

longitudinal study using contrasting forms of observation: ethnographic methods alongside the highly structured Interaction Process Analysis (IPA) framework.

Setting

four contrasting delivery suites offering different models of care and serving different populations: two in the north of England and two in London.

Participants

the multidisciplinary delivery suite teams and visiting professionals from related areas.

Key findings

the ethnographic observations and quantitative findings combine to highlight four principal areas relating to communication: communication underpinning collaboration; effects of workload pressures on communication practices; interprofessional communication; and the influence of architecture on communication. Contextual factors (e.g. case acuity, client throughput, model of care) underscore some inter site differences and attention is drawn to implications for safety.

Conclusions and implications for practice

the use of complementary methods aided exploration of communication in the complex environment of the delivery suite. The findings reflect the complexity of communication patterns and the multiple influences on patterns and norms. Interprofessional tensions, workload pressures and the design of the environment can restrict communication, with implications for safety. As such, these findings have implications for policy in that safety solutions which focus efforts on standardising communication need to be located within wider strategies that also address structural and organisational networks and influences.     

Localization of phosphodiesterase-4 isoforms in the medulla and nodose ganglion of the squirrel monkey

Pre-clinical and clinical studies are currently underway to evaluate the potential of phosphodiesterase-4 (PDE4) inhibitors for the treatment of chronic obstructive pulmonary disease and other inflammatory conditions of the airways. The most common side effect associated with this class of compounds is emesis. The squirrel monkey provides a model for evaluating the efficacy of PDE4 inhibitors and their emetic potential. The distribution of three PDE4 isoforms (A, C and D) has been investigated in the squirrel monkey medulla and nodose ganglion to determine which isoform(s) could be responsible for the emetic adverse effects. The distribution of PDE4 isoforms was delineated using immunohistochemistry with antibodies specific for PDE4A, PDE4C and PDE4D and by in situ hybridization with isoform-selective riboprobes. PDE4A was present in the medulla where expression was mostly restricted to glial cells and the vasculature. PDE4C was not detected in either the medulla or nodose ganglion. Finally, the PDE4D isoform was localized to neurons in the nodose ganglion and found through many structures of medulla including the area postrema, neurons of the nucleus tractus solitarius and locus coeruleus. These data are consistent with a role for PDE4D in the emetic response.     

Effect of Individual Nutrition Therapy and Exercise Regime on Gait Speed,Physical Function,Strength and Balance,Body Composition,Energy and Protein,in Injured,Vulnerable Elderly: A Multisite Randomized Controlled Trial (INTERACTIVE)

It is imperative that the surgical treatment of hip fractures is followed up with rehabilitation to enhance recovery and quality of life. This randomized controlled trial aimed to determine if an individualised, combined exercise–nutrition intervention significantly improved health outcomes in older adults, after proximal femoral fracture. We commenced the community extended therapy while in hospital, within two weeks post-surgery. The primary outcome was gait speed and secondary outcomes included physical function, strength and balance, body composition, energy and protein intake. Eighty-six and 89 participants were randomized into six months individualised exercise and nutrition intervention and attention-control groups, respectively. There were no statistically significant differences in gait speed between the groups at six and 12 months. There were no major differences between groups with respect to the secondary outcomes, except estimated energy and protein intake. This may be explained by the sample size achieved. Participants in the intervention group had greater increment in energy (235 kcal; 95% CI, 95 to 375; p = 0.01) and protein intake (9.1 g; 95% CI, 1.5 to 16.8; p = 0.02), compared with those in the control group at six months but not significant at 12 months. This study has demonstrated that providing early, combined exercise and nutrition therapy can improve dietary energy and protein intake in older adults with hip fractures.     

Corrosion Properties of Mn-Based Alloys Obtained by Aluminothermic Reduction of Deep-Sea Nodules

Deep-sea manganese nodules are polymetallic oxidic ores that can be found on a seabed. Aluminothermic reduction is one of the possibilities of manganese nodules processing. This process obtains the polymetallic alloy with a high content of Mn and a varying content of Al, depending on the ratio between aluminum and nodules. The corrosion behaviors of three experimental Mn-based alloys produced by aluminothermic reduction with a content of Mn > 50 wt % were studied. The electrochemical testing in potable water and model seawater was used to explain the corrosion mechanism of Mn-based alloys. The results showed that the corrosion rate of experimental Mn-based alloy decreases with the increase in aluminum content in both potable water and model seawater. It was observed that the uniform corrosion of experimental Mn-based alloys is changed with an increase in aluminum content in alloy to localized corrosion, which was caused by microcells in an environment of model seawater. In contrast, the formation of a semi-protective layer of corrosion products was observed on the surface of Mn-based alloys with a higher content of aluminum in potable water. Moreover, the pitting corrosion of tested Mn-based alloys was observed neither in potable water nor in model seawater.     

Anthropometric factors in differentiated thyroid cancer in French Polynesia: a case–control study

Objectives  French Polynesia has one of the world’s highest thyroid cancer incidence rates. A case–control study among native residents of French Polynesia included 219 cases of differentiated thyroid cancers diagnosed between 1979 and 2004 (195 women/24 men) matched with 359 population controls (315 women/44 men) on the date of birth. Methods  Anthropometric factors were analyzed by conditional logistic regression. Results  The risk of thyroid cancer for women in the highest quartile of body mass index (BMI) before diagnosis and at age 18 was 2.3-fold higher (95% CI, 1.1–4.7 p = 0.04) and 2.3-fold higher (95% CI, 1.2–4.4 p < 0.01), respectively, compared with the lowest. Women who were overweight (BMI = 25–29.9 kg/m²) or obese (BMI ≥ 30 kg/m²) at age 18 and before diagnosis had an increased risk compared with those with a normal lifelong weight (OR = 6.2; 95% CI, 2.5–15.5 p < 0.01). Results for excess weight appeared in similar directions for men, although the number of cases was too small to provide reliable estimates. Height was positively associated with thyroid cancer among men and women. Conclusion  This study shows the role of excess body weight, especially if the onset is during early adulthood, and elevated height in the risk of differentiated thyroid cancer in populations born in French Polynesia.     

Predicting breast cancer risk: implications of a “weak” family history

Published guidelines adopted in many countries recommend that women whose family history of breast cancer places them at a risk ≥1.7 times that of the age-matched general population, should be considered for inclusion in special surveillance programmes. However validation of risk assessment models has been called for as a matter of urgency. The databases of the four Scottish Familial Breast Cancer clinics and the Scottish Cancer Registry have been searched to identify breast cancers occurring among 1,125 women aged 40–56, with family histories placing them below the “moderate” level of genetic risk. The observed incidence over 6 years was compared with age-specific data for the Scottish population. Our findings confirm that when there are two affected relatives (one first degree) the relative risk (RR) exceeds 1.7 regardless of their ages at diagnosis. When only one (first degree) relative was affected at any age from 40 to 55, the RR does not reach 1.7 if that relative was a mother but exceeds it if the relative was a sister. The probable explanation is that sisters are more likely than mother/daughter pairs to share homozygosity for a risk allele. Surveillance programmes might therefore accommodate sisters of women affected before age 55. Evidence that “low penetrance” alleles contributing to breast cancer risk may be recessive should be taken into account in strategies for identifying them. All the authors are from the Scottish Cancer Family Clinical Centres.