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The paper explores the potential of a low-cost advanced video-based technique for the assessment of structural damage induced to buildings by seismic loading. A low-cost high-speed video camera was utilized for motion magnification (MM) processing of footages of a two-story reinforced concrete frame building subjected to shaking table tests. The damage after seismic loading was estimated by analyzing the dynamic behavior (i.e. in terms of modal parameters) and the structural deformations of the building in the MM videos. The results by MM were compared for method validation to damage assessment obtained by the analyses of conventional accelerometers and high-precision optical markers tracked by a passive 3D motion capture system. Also, 3D laser scanning to obtain an accurate survey of the building geometry before and after the seismic tests was carried out. In particular, accelerometers were also processed and analyzed by using several stationary and non-stationary techniques with the aim to analyze the linear behavior of the undamaged structure and the nonlinear structural behavior during damaging shaking table tests. The proposed MM-based procedure provided accurate estimate of the main modal frequency and the damage location through the analysis of modal shapes, which were confirmed by advanced analyses of accelerometric data.

The deployment of Structural Health Monitoring (SHM) systems is a natively interdisciplinary task that involves joint research contributions from sensing technologies, data science and civil engineering. The capability to assess, also from remote stations, the working conditions of industrial plants or the structural integrity of civil buildings is widely requested in many application fields. The technological development aims to continuously provide innovative tools and approaches to satisfy these demands. As a first instance, reliable monitoring strategies are needed to detect structural damages while filtering out environmental noise. Ongoing solutions to tackle these topics are based on the exploitation of highly customized sensing technologies, such as shaped transducers for Acoustic Emission (AE) testing or Micro-Electro-Mechanical System (MEMS) accelerometers for Operational Modal Analysis (OMA) [1]. On the other hand, effective data acquisition and storage techniques must be employed to cope with the heterogeneity of the sensing devices and with the amount of data produced by collecting raw measured signals. Finally, damage detection and prediction tasks should be computed via data-driven algorithms that can complement the model-based alternatives traditionally used in civil engineering. Layered SHM architectures [2] represent straightforward approaches to address the system complexity originated by this interdisciplinary design; however, few real-world implementations have been presented so far in the literature. In this paper, we overcome these limitations by presenting an Internet of Things (IoT)-based SHM architecture for the predictive maintenance of industrial sites and civil engineering structures and infrastructures. The proposed cyber-physical system includes a monitoring layer, that consists of accelerometer-based sensor networks, a data acquisition layer, built on the recent W3C Web of Things standard [3], and a data storage and analytics layer, which leverages distributed database and Machine Learning tools. We extensively discuss the hardware/software components of the proposed SHM architecture, by stressing its advantages in terms of device versatility, data scalability and interoperability support. Finally, the effectiveness of the system is validated on a real-world use-case, i.e., the monitoring of a metallic frame structure located at the SHM research labs of the University of Bologna, Italy, within the MAC4PRO project [4].

Background: in France, 14.5% of women and 3.9% of men aged 20–69 years have experienced sexual violence. Of these, 40% will go on to develop posttraumatic stress disorder. Sexual violence is therefore a major public health issue. In the present study, we tested a life skills development tool (Selflife) designed to prevent sexual violence in a population of healthcare students. Methods: a total of 225 French healthcare students were randomly divided into a control group using case studies (n = 114) and a group using Selflife (n = 111) to discuss the topic of sexual violence. After the session, they completed self-report questionnaires collecting sociodemographic data and probing their feelings about their participation, their life skills, and their verdict on the intervention. Results: compared with controls, participants in the Selflife group reported gaining more knowledge about sexual violence, a greater sense of improving their life skills, and greater satisfaction with the intervention. Conclusions: these results suggest that, in addition to providing information about sexual violence, Selflife helped students develop their life skills, thereby empowering them to act when confronted with sexual violence. Its impact on prevalence and on the psychological and psychiatric consequences remains to be assessed.

The acoustic emission (AE) method is well studied for its capability to detect and locate discontinuity that evolve in time, when a pressure tank is charged with a greater load than the usual one. When the discontinuity is a crack the AE is able to follow the nucleation and the propagation of the defect in the material. For this paper, experiment on pre-cracked samples with different notch shape are presented. The samples have been loaded with fatigue cycles and the acoustic activity during the tests has been recorded. The stress was always positive to keep the notched side in traction during the test. During the test AE signals become relevant when the load leads plastic strain near the notch. We noticed an increase of activity when the plasticity advances with a stepped shape. This stepped shape of the number of the events versus time agrees very well with the crack nucleation and its evolution to a fully developed crack. We applied the fractal analysis method to these experiments, to verify the correlation between the fractal dimension (Dt), the applied stress and the order/disorder of the material of the sample. The fractal analysis method is capable to follow the damage status of the sample, while fatigue test.

Acoustic Emissions (AE) are at the basis of extremely accurate and reliable monitoring systems. Within the SmartBench project, data regarding structural health of components are gathered in a database in order to make safety integrated, operative and smart. An accurate modelling of wave propagation is a necessary requirement for a proper design of sensor networks as well as for data interpretation. Numerical simulations of the transient behavior of structural systems are well-established in this field but, on the minus side, they are very expensive in terms of computational time and resources. This paper reports different instances of AE propagation through metallic media. Bulk waves and guided waves are both investigated by means of 2D and 3D models and resorting to different software. Obtained results are cross-checked and computational times are compared as well. As a last point, High Performance Computing is applied to the case of waves simulation in order to get a significant reduction of the required computational time.

The paper discusses a software application aiming at the dynamic assessment of the remaining useful life (RUL) of critical equipment in process plants. A number of advanced integrity sensors, including ultrasound thickness (UT) and acoustic emissions (AE) systems, are installed on vessels and pipe throughout the plant. They are able to detect in advance cracks and corrosion and gather continuous data, which feed a simple prognostic model and, in turn, is able to continuously update the information about the expected RUL, in order to support reasonable decisions about equipment life extension as well as inspection scheduling and stops planning. The software exploits an existing platform for communication, database and user interface. The prognosis module uses an easy model, which could be replaced by a more sophisticated algorithm, keeping the other modules.

The AT-rich repeat on chromosome 22q11.2 is known to be involved in the recurrent constitutional t(11;22)(q23;q11.2). Segregation of this translocation has been reported in several hundred families, but a de novo translocation event has been identified in only 8 cases, and everytime the translocation originated in paternal germ-line chromosomes. Further, de novo t(11;22) rearrangements have been detected in the sperm of healthy males, leading to the hypothesis that it occurs somewhere along the meiosis-spermatogenesis pathway. This report describes a woman whose constitutional karyotype revealed mosaicism for the recurrent t(11;22) and the subsequent testing performed to determine the origin of the translocation event. Karyotype analysis, translocation-specific PCR, human identity testing, and a SNP genotyping array were performed to detect mosaicism and/or chimerism. As a result, the SNP genotyping array revealed no evidence for mosaicism in genomic DNA beyond mosaicism for the balanced t(11;22). Human identity testing and the SNP genotyping array ruled out chimerism. PCR of the translocation breakpoint followed by sequencing confirmed that the translocation had occurred at the typical t(11;22) breakpoints. In conclusion, these results indicate that the translocation occurred post-fertilization, providing the first evidence of a de novo t(11;22)(q23;q11.2) occurring in a maternal mitotic environment.

Cell-free DNA testing is increasingly being used to screen pregnant women for fetal aneuploidy. This technology may also identify microdeletion syndromes, including 22q11.2 deletion syndrome, the most common microdeletion syndrome, and the 22q11.2 duplication syndrome. The purpose of this paper is to provide an overview of the 22q11.2 deletion syndrome, to review the early experience with cell-free DNA screening for this deletion and to consider the potential benefits that may be associated with prenatal detection of the deletion. © 2016 John Wiley & Sons, Ltd.

The Loeys-Dietz syndrome (LDS) is a connective tissue disorder that is associated with vascular abnormalities, including aggressive aortic aneurysms, as well as skeletal and craniofacial malformations. The molecular mechanism of this syndrome remains to be fully elucidated. In this case, we describe a 29-year-old woman, gravida 2 para 1, who was referred for consultation after urinary tract malformations were observed during her mid-gestation anatomic survey. Following referral to our unit, ultrasound examination of the 21-week fetus was repeated. The fetus was observed to have a dilated aortic root and a poorly ossified sternum with mild pectus deformity. After elective termination, single nucleotide polymorphism microarray testing identified a novel 204 kb microdeletion involving the short arm of chromosome 3. The deleted genetic material included 4 exons of the TGFBR2 gene. Although the phenotype of LDS may be caused by haploinsufficiency of the TGFBR1 or TGFBR2 gene, our experience suggests a more complex picture of LDS. The study of such cases might further elucidate its pathogenesis.

In this paper a wireless sensor node for Acoustic Emission (AE) analysis has been proposed. This node can be used to simplify the in-force procedures for the structural integrity verification of pressure tanks. This procedure is currently based on periodic checks and consequently does not allow a real-time monitoring. The proposed wireless sensor node is compatible with commonly used AE sensors available on market and can be integrated in a wireless sensor network for real time monitoring increasing the security of the plant.

Cell-free DNA (cfDNA) testing is increasingly being used to screen pregnant women for fetal aneuploidies. This technology may also identify fetal sex and can be used to screen for sex chromosome aneuploidies (SCAs). Physicians offering this screening will need to be prepared to offer comprehensive prenatal counseling about these disorders to an increasing number of patients. The purpose of this article is to consider the source of information to use for counseling, factors in parental decision-making, and the performance characteristics of cfDNA testing in screening for SCAs. Discordance between ultrasound examination and cfDNA results regarding fetal sex is also discussed.

Beare–Stevenson syndrome (BSS) is a rare FGFR2-associated craniosynostosis syndrome with a higher rate of sudden unexplained death than related conditions such as Apert, Pfeiffer, and Crouzon syndromes. BSS presents with craniosynostosis, cutis gyrata, and significant developmental delay in most patients who survive infancy. There have only been 21 reported patients with BSS, which limits prognostication for clinicians and likely does not capture the full extent of the phenotype. Here we report on two additional patients with molecularly confirmed BSS, one each with p.Ser372Tyr and p.Tyr375Cys mutations in FGFR2. Cloverleaf skull was identified prenatally in one patient, with initial concern for Crouzon syndrome. Prenatal 3D ultrasound was performed, but cutis gyrata was only visible on retrospective examination following the clinical diagnosis of BSS after birth. Due to phenotypic overlap with Crouzon syndrome, but worse prognosis, we recommend consideration of prenatal 3D ultrasound and mutation testing for patients with suspected Crouzon to allow for prenatal diagnosis of BSS and to enable appropriate genetic counseling and postnatal care. One of our patients was noted to have a tracheal cartilaginous sleeve, which if present could explain sudden death. Of note, tracheal cartilaginous sleeves have been reported in other FGFR2-related craniosynostosis syndromes, and are associated with 90% risk of death by two years of age without tracheostomy. Tracheal cartilaginous sleeves are often only found incidentally at autopsy as they are difficult to diagnose without direct visualization of the trachea. This association and our experience suggests that BSS patients be evaluated for tracheal cartilaginous sleeve to prevent airway compromise. © 2015 Wiley Periodicals, Inc.

Objectives The objective of this study was to identify maternal characteristics associated with a failed cell-free DNA (cfDNA) test due to a low fetal fraction (FF). Method Retrospective cohort study of women with singleton pregnancies who had cfDNA screening at 10-25 weeks gestation between October 2011 and January 2016. cfDNA screening was performed using methylation techniques until October 2013; thereafter, samples were run with massively parallel sequencing. Multivariable logistic regression was performed to identify maternal characteristics associated with no cell free DNA result secondary to low FF. Results Thirty-three (1.2%) of 2890 eligible women had a failed cfDNA test, including 18 (0.6%) cases with a low FF. A failed cfDNA test due to a low FF was associated with obesity (aOR 1.11, CI 1.05-1.18, p = 0.0003) and treatment with enoxaparin (aOR 37.5, 11.19 – 125.87, p

ASTM A 297 grade HP steels are widely employed for radiant tubes in reforming furnaces: this class of heat resistant alloys shows high creep and corrosion resistance, ensuring good performances in extreme pressure and temperature conditions. The typical microstructure of such materials is an austenitic matrix surrounded by a network of interdendritic carbides, which contain chromium and other carbide forming elements, namely Nb, Ti, W, Zr and Y. During long service life, these high strength materials may suffer aging or even severe damage, especially when process conditions allow coke deposition, or maintenance procedures are not carried properly. Service aging can be summarized, for HP steels, in terms of microstructure degradation: coalescence and coarsening of interdendritic precipitates, precipitation of secondary carbides in the austenite matrix and transformation of niobium-rich carbides in the G-phase silicide are the typical phenomena occurring on the microstructure of these alloys during service. Carburization can also occur in radiant tubes, since their inner wall side is exposed to hydrocarbon-rich process fluids: carbon diffuses into the metal matrix, causing massive precipitation of chromium-rich carbides. The alloy corrosion resistance is then reduced, resulting in surface attack, cracks development and a general wastage of the material. Furthermore, the high temperatures, which tubes are exposed to, can also induce creep, especially if a local tube overheating occurs: cavities and microcracks, mainly localized at precipitates, are the typical evidences of creep damage on HP steels. The present work is aimed on the damage characterization of several radiant tubes in HP alloys, after long term service aging in reforming plants. We employed optical and electron microscopy, EDX elements mapping and mechanical tests, in order to characterize and evaluate the various damages affecting the alloys. Microstructure evolution has been detected in all the analyzed tubes, but we found that such a phenomenon was strictly influenced by the chemical composition of each alloy, so that in presence of small amounts of titanium and tungsten, the chemical evolution of the secondary phases was appreciably contained. Creep also was observed in all the investigated tubes and its extent was found to be related to both alloy composition and process conditions. These latter have assumed to be the main driving factor for carburization, since we observed that slight differences in temperature, pressure, chemical composition of the process fluid and tube maintenance dramatically conditioned the performances of each tube. Massive precipitation and material degradation, in fact, were found in some cases, but, on the other side, no appreciable evidence of carburization damage was observed on other cases.

Cell-free DNA testing is increasingly being used to screen pregnant women for fetal aneuploidy. This technology may also identify microdeletion syndromes, including 22q11.2 deletion syndrome, the most common microdeletion syndrome, and the 22q11.2 duplication syndrome. The purpose of this paper is to provide an overview of the 22q11.2 deletion syndrome, to review the early experience with cell-free DNA screening for this deletion and to consider the potential benefits that may be associated with prenatal detection of the deletion. © 2016 John WileySons, Ltd.

Studies performed in selected populations have shown a poor utilization of triptans for migraine. Our study was aimed at establishing patterns of triptans utilization in a large community using the pharmaceutical prescriptions database of two consecutive years in a regional Health Authority in Italy. About 0.5% of the population observed received triptans prescriptions in a year, but > 50% of the cases received only one prescription. On the other hand, 46% of triptan users did not receive a triptan prescription in the following year (past users): in 80% of cases, patients received only 1–2 triptan packages. The evaluation of the discontinued triptan type has shown percentages varying between 30 and 70%. The percentage of triptan users who received a triptan prescription for the first time in the successive year of study (new users) was 52%. These findings together highlight a high turnover in triptans utilization. Less than 15% of subjects received more than one triptan product in the 2 years. In conclusion, we observed a low percentage of triptan users and a low rate of utilization, associated with a high percentage of discontinuation and new utilization (high turnover), without any substantial increase in triptans utilization during the years. All these data probably do not support optimal satisfaction with triptan therapy.

A normocephalic, severely retarded boy with a family history suggesting aqueductal stenosis was found by computerized tomography to have aqueductal stenosis. His parents' concurrent pregnancy was monitored by ultrasonography and amniocentesis; these disclosed a male fetus which developed marked hydrocephalus after the 20th week. The pregnancy was terminated and an autopsy of the fetus demonstrated several major CNS malformations in addition to a very narrowed aqueduct. This case illustrates the diffuse CNS disease present in at least some cases of X-linked aqueductal stenosis (XLAS) and the importance of considering this variable syndrome in normocephalic, non-dysmorphic mentally retarded males. Important aspects of the prenatal diagnosis of XLAS are also illustrated.

Objective To provide an evidence-based review of measures of psychosocial adjustment and psychopathology, with a specific focus on their use in the field of pediatric psychology. Methods As part of a larger survey of pediatric psychologists from the Society of Pediatric Psychology e-mail listserv (American Psychological Association, APA, Division 54), 37 measures were selected for this psychometric review. Measures that qualified for the review fell into one of the following three categories: (a) internalizing or externalizing rating scales, (b) broad-band rating scales, and (c) self-related rating scales. Results Psychometric characteristics (i.e., three types of reliability, two types of validity) were strong for the majority of measures reviewed, with 34 of the 37 measures meeting “well-established” evidence-based assessment (EBA) criteria. Strengths and weaknesses of existing measures were noted. Conclusions Recommendations for future work in this area of assessment are presented, including suggestions that more fine-grained EBA criteria be developed and that evidence-based “profiles” be devised for each measure.

Genetic screening is used to identify individuals who have genetic variations or mutations that are associated with a particular disorder. Genetic screening may be useful to plan for periodic evaluation, implementation of preventive strategies, or initiation of therapeutic interventions. Current practice is to offer carrier screening for certain genetic diseases during the preconception encounter or more commonly as part of early prenatal care.

The National Institute of Child Health and Human Development (NICHD), the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists (ACOG), cosponsored a workshop on December 16-17, 2004, to discuss the evidence for first-trimester Down syndrome screening and to explore the effects of combining first- and second-trimester screening, given the results of recent U.S. trials. The experts evaluated the evidence for offering first-trimester screening to provide individual risk assessment for Down syndrome. First-trimester screening has been demonstrated to provide efficient Down syndrome risk assessment, with a detection rate of 84% (95% confidence interval 80-87%), which is clinically comparable to the second-trimester quadruple screen at a fixed false-positive rate of 5%. The participants at the workshop concluded that at this time there is sufficient evidence to support implementing first-trimester Down syndrome risk assessment in obstetric practice in the United States, provided that certain requirements can be met. These requirements include training and quality control standards for first-trimester nuchal translucency measurement and laboratory assays, access to chorionic villus sampling, and appropriate counseling regarding screening options.

With the convergence of mobile and fixed communication networks, mobile users are increasingly demanding applications offering the same quality of service (QoS) as provided by wired access. High-speed time division duplex access mode is typical of high-speed mobile communication systems in order to simultaneously handle real-time, interactive, and best effort traffic classes. This paper proposes a medium access control (MAC) protocol that makes efficient use of radio resources for access. The proposed protocol, named dynamic-time division duplexing (D-TDD), is based on a multiple-access TDD air interface capable of supporting uplink and downlink traffic asymmetries. Validation of the D-TDD good performance was achieved by comparison with an ideal scheme and a different MAC protocol recently proposed in the literature on this subject.

Background. Myocardial stunning has recently been demonstrated by use of stress gated technetium 99m sestamibi single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy. However, its prognostic value is less well determined. The aim of this study was to investigate the prognostic value of reversible regional wall motion abnormalities (RWMAs). Methods and Results. We studied 303 consecutive subjects with known or suspected coronary artery disease who underwent 2-day stress-rest gated Tc-99m sestamibi SPECT and were followed up for 19 ± 16 months. Clinical and test-derived variables were evaluated to predict cardiac death, nonfatal myocardial infarction (MI), unstable angina, and early or late coronary revascularization. Reversible RWMAs were identified in 102 patients. On Cox analysis, the presence, site, degree, and extent of reversible RWMAs did not identify an adverse outcome, except in patients without prior ML After adjustment for prescan data, the strongest predictors of hard events and all cardiac events were poststress RWMAs and the amount of ischemia. The addition of poststress RWMAs to the combined model of prescan and perfusion data yielded incremental prognostic value. Conclusion. Poststress RWMAs and ischemia by perfusion were the most powerful predictive parameters of cardiac events. However, myocardial stunning should always be considered, particularly in patients without prior MI and in the referral of patients for early revascularization. (J Nucl Cardiol 2005;12:20-31.)

SUMMARY Previous research has documented the beneficial effects of expressive narrative writing, and especially the inclusion of cognitive processing and emotion words, for alleviating stress. In this study, 65 mostly white Emory University undergraduates of Judeo-Christian backgrounds recalled their emotional reaction upon hearing the news of 9/11 within 2 months of the event, and again one month and 6 months later. Between the initial and one month assessment, participants engaged in expressive writing for 20 minutes a day for 5 consecutive days. Individuals who had higher personal involvement in the events of 9/11, through knowing someone who was killed or having lived in the affected areas, recalled being more shocked and upset upon hearing the news across time, and used fewer cognitive processing and positive emotion words in their narratives, than those with no direct involvement. Individuals who used more cognitive processing and emotion words in their narratives subsequently recalled being less shocked and upset upon hearing the news. Implications of these finding for emotional memory and emotional regulation are discussed. Copyright # 2003 John Wiley & Sons, Ltd.

Parent-child reminiscing about negative experiences influences children's developing "emotional self-concept", which comprises three interrelated functions: self-defining (this is the kind of emotional person I am), self-in-relation (this is how I express and share my emotions with others), and coping (this is how I cope with and resolve negative emotion). In this study, we examined how 70 mostly white, middle-class mothers discuss three negative experiences (fear, anger, and sadness) with their 4-year-old children. Conversations about fear elaborate on the facts of the event and emotional resolutions, thus focusing on coping. Conversations about sadness contain evaluative feedback and emotional resolutions, thus focusing on self-in-relation and coping. Finally, conversations about anger highlight the emotional state itself, thus focusing on self-definition. Mothers are also more elaborative and more evaluative with daughters than with sons, and place emotional events in a more interpersonal context with daughters than sons. Thus girls may be forming a more elaborated and more interpersonal emotional self-concept than boys.

The simultaneous assessment of perfusion and function with the use of technetium 99m sestamibi gated single photon emission computed tomography (SPECT) is helpful for the detection of myocardial viability, but its value in comparison with more established methods is not yet defined. This study compared low-dose dobutamine (LDD) nitrate-enhanced gated SPECT with LDD echocardiography for predicting recovery of regional ventricular function after revascularization in 25 patients with ischemic cardiomyopathy. In both studies, regional function (wall motion and thickening) at rest, during inotropic stimulation, and after revascularization was scored by a 4-point scale. In LDD echocardiography, the prediction of reversible dysfunction was based on the recognition of contractile reserve in asynergic (hypokinetic or a-dyskinetic) segments. In LDD gated sestamibi SPECT, reversible dysfunction was predicted on the basis of perfusion quantification (sestamibi uptake > 50%) in a-dyskinetic segments and on the basis of contractile reserve in hypokinetic segments. LDD echocardiography predicted reversible dysfunction with sensitivity, specificity, and global accuracy of 57%, 85%, and 75%, respectively. The sensitivity and specificity of LDD gated SPECT for identifying dysfunctional segments capable of functional recovery were 77% and 88%, respectively, with a diagnostic accuracy of 84% (P < .02 vs LDD echocardiography). The combined use of 2 different markers of viability, such as cellular integrity in a-dyskinetic segments and contractile reserve in hypokinetic segments, as permitted by LDD gated sestamibi SPECT, showed higher predictive accuracy for reversible dysfunction than the assessment of contractile reserve in all asynergic segments with LDD echocardiography. (J Nucl Cardiol 2002;9:402-6.)

Cell-free DNA (cfDNA) testing is increasingly being used to screen pregnant women for fetal aneuploidies. This technology may also identify fetal sex and can be used to screen for sex chromosome aneuploidies (SCAs). Physicians offering this screening will need to be prepared to offer comprehensive prenatal counseling about these disorders to an increasing number of patients. The purpose of this article is to consider the source of information to use for counseling, factors in parental decision-making, and the performance characteristics of cfDNA testing in screening for SCAs. Discordance between ultrasound examination and cfDNA results regarding fetal sex is also discussed.

The value of gated single photon emission computed tomography (SPECT) in the assessment of wall motion (WM) in patients with severe perfusion defects and in the evaluation of low-dose dobutamine (LDD)-induced changes is not yet established. In patients with chronic coronary artery disease who have left ventricular (LV) dysfunction, the results of nitrate-enhanced technetium 99m sestamibi (sestamibi) gated SPECT for the evaluation of resting and LDD WM were compared with those of baseline and LDD echocardiography (LDDE).Thirty-seven patients underwent echocardiography and nitrate-enhanced sestamibi gated SPECT within 1 week at rest and during LDD infusion. WM was scored from 1 (normal) to 4 (dyskinetic) by using a 16-segment model. Segments with sestamibi uptake less than 30% were considered unsuitable for WM analysis (36 of 592 segments). Echocardiography was technically unreliable in 10 of 592 segments. The precise agreement between echocardiography and gated SPECT for baseline regional WM was 68.4% (kappa = 0.54), without significant differences for the involved coronary artery territory. The agreement for +/- 1 WM scoring was 96.5% (kappa = 0.94). Contractile reserve during LDD was detected by means of echocardiography in 36% and by means of sestamibi gated SPECT in 33% of baseline asynergic segments. Agreement for detection of WM improvement in response to LDD was 74% (kappa = 0.41). The overall and +/-1 WM score agreement for LDD WM was 67.5% (kappa = 0.50) and 94.7% (kappa = 0.91), respectively. A significant correlation between echocardiography and gated SPECT was observed for both baseline (p = 0.78) and LDD (p = 0.74) WM score index.In patients with coronary artery disease who have LV dysfunction, nitrate-enhanced sestamibi gated SPECT allows a reliable WM evaluation, both at rest and during LDD infusion, in almost all segments and provides results in agreement with LDDE.

We describe monozygotic twins with partially discordant phenotypes who were found to have a duplication of chromosome region 4q28.3-qter. The duplicated region of chromosome 4 resulted from an unbalanced segregation of a balanced maternal (4;22)(q28.3;p13) translocation. Duplication of the long arm of chromosome 4 has been described in >60 patients; however, it usually results from the unbalanced segregation of a parental balanced translocation and has an associated monosomy. Twenty cases of dup 4q without an associated monosomy have been reported, and this is the only case of dup 4q28.3-qter. All cases of dup 4q are reviewed, and phenotypic aspects are analyzed. Issues of monozygotic twinning and other birth defects also are addressed. Am. J. Med. Genet. 94:125–140, 2000. © 2000 Wiley-Liss, Inc.

Carrier screening for cystic fibrosis as part of reproductive health care, including prenatal care, is not the standard of practice at this time. However, a recent National Institutes of Health Consensus Development Conference recommended that cystic fibrosis carrier screening should be offered to adults with a family history of cystic fibrosis, partners of individuals with cystic fibrosis, couples planning a pregnancy, and couples seeking prenatal testing. A workshop convened to discuss the implementation of these recommendations concluded that several issues must be resolved before these recommendations can be implemented. This commentary reviews the discussions that occurred and the conclusions that were reached at this workshop. Some of the subjects considered by the workshop participants were: the goals and outcomes of carrier screening; the continuum from making a test available to offering that test; to whom, when, and how cystic fibrosis testing should be offered; laboratory practice and quality assurance; provider and patient education; and insurance issues. The workshop participants concluded that those populations to whom carrier screening should be offered might include individuals and couples in high-risk groups who seek preconception counseling, infertility care, or prenatal care. High-risk groups include individuals of white northern European or of Ashkenazi-Jewish descent, those whose partners have cystic fibrosis, and those with a family history of cystic fibrosis. Before screening can be offered systematically to these individuals or couples, practice guidelines, educational materials for providers and patients, informed-consent protocols, and laboratory standards for testing must be developed.

The paper proposes an adaptive admission control (AC) policy, that reduces call dropping probability, resorting to rate adaptation in accordance with the instantaneous connection configurations. We describe the philosophy of the proposed adaptive scheme and analyze the effective call dropping probability when considering a single cell UMTS scenario with an additive white Gaussian noise (AWGN) channel. Our simulations demonstrate that, by employing the proposed scheme, the network performance can be extremely increased while the quality of service (QoS) requested is respected.

Future wireless systems need higher support in terms of QoS support. In particular, when several connections with different QoS attributes are allowed, a prioritization system has to be foreseen. In UMTS and other systems that exploit the WCDMA approach, the problem of mitigating multiple access interference arises, too. Admission control algorithms have been introduced in the literature in order to prevent any congestion status in the network. An admission control algorithm that works by exploiting the current interference level is presented; moreover, each type of traffic is managed in order to respect its QoS in terms of priority.

This paper deals with an advanced admission control (AC) scheme that estimates the requesting connections signal-to-noise plus interference ratio (SINR) by means of accurate multiple access interference (MAI) analysis results. This algorithm verifies the possibility of a new call admission by valuating if a power configuration exists, whose predicted SINR values satisfy each QoS constraints. Numerical simulations, closely related to the UMTS system, underline a remarkable number of active users increase up to four times traditional AC policies, together with the maximisation of QoS requirements.

The purpose of this study was to evaluate the prenatal characteristics of congenital nephrosis of the Finnish type (CNF). Patients presenting with elevated maternal serum and/or amniotic fluid α-fetoprotein levels, normal ultrasound examinations and normal fetal karyotypes were included. A retrospective cohort study was conducted using questionnaires sent to all board certified clinical geneticists. Perinatal outcome, including histologic verification of CNF, was obtained. Forty index cases met the above criteria. Ten cases ultimately did not have the diagnosis of CNF, with a median MSAFP level of 7.59 MoM (range 2.7–27.64 MoM) and a median AFAFP level of 10.99 MoM (range 1.47–128.6 MoM). In the affected cohort of index pregnancies, the initial median MSAFP level was 14.49 MoM (range 3.1–38.0 MoM); the median AFAFP level was 40.0 MoM (range 2.4–80.9). MSAFP and AFAFP levels may be lower than previously recognized in patients carrying fetuses with CNF. There is significant overlap between the affected and unaffected patients. J. Matern.-Fetal Med. 6:164–167, 1997. © 1997 Wiley-Liss, Inc.

National strategies to control health care costs have resulted in earlier hospital discharge of many patient groups. Earlier discharge may reduce hospital charges and return patients to their families sooner. However, complications after discharge may go undetected and require readmittance to the hospital and more acute care visits (Britton & Britton, 1984; Jansson, 1985; Rogers et al., 1990; Schwartzberg, 1982). To maintain good patient outcomes while lowering hospital charges, a number of programs of early hospital discharge and home follow-up have been developed for groups of patients at high risk who use a high volume of services (Brooten et al., 1986; McCorkle et al., 1989). Women delivering by unplanned cesarean birth represent such a group. Almost one in four women who give birth in the United States do so by cesarean birth (Taffel, Placek, & Korsary, 1992). The hospital stay after cesarean birth has decreased from a mean of 6.1 days in 1982 to 4.0 days in 1992 (Commission on Professional & Hospital Activities, 1991; 1993). One recent report suggested a 2-day length of stay for women after delivery by cesarean birth, provided they had no complications during pregnancy and delivery and after delivery (Strong, Brown, Brown, & Curry, 1993). Many early discharge programs for high-risk groups have home follow-up services that differ in length, services, and provider (Meissier, 1993). Data are needed on the nurse's time required for home follow-up of childbearing women at high risk when care is based on patient need and provider judgment rather than the reimbursement plan. For women delivering by cesarean birth, most follow-up services have' included one or more home visits by a nurse. The number and length of visits often are dictated by reimbursement systems (Brooten, 1995). Institutions or agencies providing these services usually have a standard fee and maximum time for the visit based on the projected needs of that patient population. However, home visits of varying lengths of time may be necessary, depending on the needs of individual patients and the complexity of their care. Currently, little data are available on the following: (a) the time required by nurses to provide home care to different patient groups; (b) differences in nursing time required within those groups, depending on patient morbidity; and (c) the number and length of home visits or other contacts when dictated by patient need and provider judgment rather than patterns of reimbursement. The purpose of this study was to examine the average time nurses spent planning for early hospital discharge and providing home care to women who delivered by unplanned cesarean birth. It also examined differences in nursing care time required for patients with and without morbidity when dictated by patient need and provider judgment.

Dr Daley : Mrs J, a 35-year-old married attorney and mother of 2 preschool-aged children, is in her first trimester of pregnancy. She is considering maternal serum screening and/or amniocentesis for the detection of neural tube defects and chromosomal abnormalities. She is insured with a managed care organization through her husband's medical insurance. Mrs J is healthy and has had 3 previous pregnancies. Her first pregnancy was uncomplicated during gestation, with a 40-hour labor, ending in a cesarean delivery of a healthy boy at term. Her second pregnancy ended in a spontaneous miscarriage during the first trimester. In the first trimester of her third pregnancy, Mrs J's obstetrician, Dr O, offered her serum screening and/or amniocentesis. She and her husband declined both, feeling that the risks of neural tube defects and chromosomal abnormalities were low and that they would not be willing to terminate a pregnancy in the second trimester if

Among 179,663 prenatal diagnosis cases collected from ten institutions and two publications, 555 (0.3 per cent) were diagnosed as having chromosome mosaicism. Of these, 57 (10.3 per cent) were mosaic for an autosomal structural abnormality, 28 (5 per cent) for a sex chromosome structural abnormality, and 85 (15.3 per cent) were mosaic for a marker chromosome. Ninety-five cases of prenatally diagnosed mosaicism with a structural abnormality in an autosome and a normal cell line, and with a known phenotypic outcome, were collected for karyotype-phenotype correlations through our collaboration (40 cases), a prior survey (26 cases), and published reports (29 cases). They included 13 balanced reciprocal translocations, one unbalanced reciprocal translocation, four balanced Robertsonian translocations, four unbalanced Robertsonian translocations, four inversions, 17 deletions, three ring chromosomes, 19 i(20q), seven +i(12p), six other isochromosomes, and 17 partial trisomies resulting from a duplication or other rearrangement. All cases mosaic for a balanced structural rearrangement resulted in a normal phenotype. All cases of 46/46,i(20q) resulted in normal liveborns. Five of seven cases with 46/47,+i(12p) had an abnormal phenotype compatible with Killian-Pallister syndrome. The overall risk for an abnormal outcome for a mosaic case with an unbalanced structural abnormality, excluding 46/46,i(20q) and 46/47,+i(12p), is 40.4 per cent. In the same category, the study also suggested a correlation between the percentage of abnormal cells and an abnormal phenotype. For mosaicism involving a terminal deletion, the possibility of a familial fragile site should be considered.