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Autopsy has been a foundation of pathology training for many years, but hospital autopsy rates are notoriously low. At the 2014 meeting of the Association of Pathology Chairs, some pathologists suggested removing autopsy from the training curriculum of pathology residents to provide additional months for training in newer disciplines, such as molecular genetics and informatics. At the same time, the American Board of Pathology received complaints that newly hired pathologists recently certified in anatomic pathology are unable to perform an autopsy when called upon to do so. In response to a call to abolish autopsy from pathology training on the one hand and for more rigorous autopsy training on the other, the Association of Pathology Chairs formed the Autopsy Working Group to examine the role of autopsy in pathology residency training. After 2 years of research and deliberation, the Autopsy Working Group recommends the following: Autopsy should remain a component of anatomic pathology training. A training program must have an autopsy service director with defined responsibilities, including accountability to the program director to record every autopsy performed by every resident. Specific entrustable activities should be defined that a resident must master in order to be deemed competent in autopsy practice, as well as criteria for gaining the trust to perform the tasks without direct supervision. Technical standardization of autopsy performance and reporting must be improved. The current minimum number of 50 autopsies should not be reduced until the changes recommended above have been implemented.

Conventional visual search tasks do not address attention directly and their core manipulation of 'set size' - the number of displayed items - introduces stimulus confounds that hinder interpretation. However, alternative approaches have not been widely adopted, perhaps reflecting their complexity, assumptions, or indirect attention-sampling. Here, a new procedure, the ATtention Location And Size ('ATLAS') task used probe displays to track attention's location, breadth, and guidance during search. Though most probe displays comprised six items, participants reported only the single item they judged themselves to have perceived most clearly - indexing the attention 'peak'. By sampling peaks across variable 'choice sets', the size and position of the attention window during search was profiled. These indices appeared to distinguish narrow- from broad attention, signalled attention to pairs of items where it arose and tracked evolving attention-guidance over time. ATLAS is designed to discriminate five key search modes: serial-unguided, sequential-guided, unguided attention to 'clumps' with local guidance, and broad parallel-attention with or without guidance. This initial investigation used only an example set of highly regular stimuli, but its broader potential should be investigated., (© 2024. The Author(s).)

Introduction: As one of the most common medical conditions for which patients seek medical care, chronic pain can be debilitating. The relationship between chronic pain and sleep is thought to be bidirectional, suggesting that treatment of one can be beneficial to the other. There is mounting evidence that spinal cord stimulation (SCS) improves aspects of sleep. How meaningful that is to patients' lives has not been ascertained., Objective: The aim of the current study was to further elucidate the effect of SCS on sleep by examining the relationship between pain outcome measures with the insomnia severity index (ISI) and to establish the minimally clinical important difference (MCID), which is defined as the smallest noticeable change that an individual perceives as clinically significant., Materials and Methods: We prospectively collected ISI, Epworth sleepiness scale (ESS), Numerical Rating Scale, McGill Pain Questionnaire-Short Form, Oswestry Disability Index, Beck Depression Inventory, and Pain Catastrophizing Scale data both pre- and postoperatively for chronic pain patients who underwent SCS placement and had long-term outcomes. The ISI is a well-studied questionnaire used to assess an individual's level of insomnia., Results: We correlated the ESS and ISI with pain outcome measures in sixty-four patients at a mean follow-up of 9.8 ± 2.9 months. The ISI showed correlations with disability as measured through the Oswestry Disability Index (p = 0.014) and depression as measured through the Beck Depression Inventory (p = 0.024). MCID values for the ISI were calculated using both anchor- and distribution-based methods. The minimal detectable change method resulted in an MCID of 2.4 points, standard error of measurement resulted in an MCID of 2.6 points, and the change difference resulted in an MCID of 2.45. The receiver operating characteristic method yielded an MCID of 0.5-point change with an area under the curve of 0.61., Conclusion: This study successfully established MCID ranges for the ISI outcome measure to help gauge improvement in insomnia after SCS. The ISI has ample evidence of its validity in assessment of insomnia, and MCID values of 2.4-2.6 correlate with improvement in disability and depression in our patients., (© 2022 S. Karger AG, Basel.)

Background and Objectives: Preeclampsia is a serious multisystem blood pressure disorder during pregnancy that is associated with increased long-term risk of cardiovascular disease to the mother and offspring. We investigated the vascular health of children exposed to intrauterine preeclampsia., Materials and Methods: This was a cross-sectional study of offspring in a prospective cohort of women with complications during pregnancy. Children aged between 2 and 5 years [median age 4.7 (2.8, 5.1) years] exposed to intrauterine preeclampsia ( n = 26) or normotensive controls ( n = 34), were recruited between July 2020 and April 2021. Vascular health was assessed by measuring aortic intima-media thickness and pulse wave velocity. Univariate generalized linear regression models were used to explore associations between vascular measurements and explanatory variables., Results: Children exposed to preeclampsia had a lower body mass index at assessment (15.5 vs. 16.2 kg/m 2 , p = 0.04), birth weight (2.90 vs. 3.34 kg, p = 0.004), gestational age at birth (37.5 vs. 39.4 weeks, p < 0.001) and higher frequency of preterm birth (27% vs. 6%, p = 0.02). There were no differences in vascular health between children exposed to preeclampsia vs. controls (mean aortic intima-media thickness 0.575 mm vs. 0.563 mm, p = 0.51, pulse wave velocity 4.09 vs. 4.18 m/s, p = 0.54) and there were no significant associations in univariate analyses., Conclusions: There were no major adverse differences in vascular health which contrasts with existing studies. This suggests exposure to intrauterine preeclampsia may result in a less severe cardiovascular phenotype in young children. While reassuring, longitudinal studies are required to determine if and when exposure to intrauterine preeclampsia affects vascular health in children., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Varley, Henry, Roberts, Davis, Skilton, Craig and Gow.)

In ice hockey, the butterfly style/stance is a technique distinguished by the goalkeepers (goalie) dropping to their knees to block attempts to score. Although this goalie style has been around for many years, comparisons between on and off-ice attire has not been undertaken. Therefore, this preliminary study compared differences in torso acceleration and energy expenditure by way of the Metabolic Equivalent of Task (MET) during off-ice and on-ice butterfly stances/saves. Seven participants each performed 8 on-ice butterfly saves/stances whilst wearing full hockey attire followed by 8 off-ice butterfly stances without wearing full hockey attire whilst torso acceleration was collected. The off-ice movement significantly increased vertical torso acceleration (p < 0.01, d > 0.90) with increased MET, compared to on-ice motion. Despite no significant difference in anteroposterior and mediolateral torso kinematics, vector magnitudes were significantly greater (p < 0.01, d > 0.90) when the stance was performed off-ice. The increased vertical acceleration observed when goalies performed the movement off-ice could be due to a failure to maintain adequate posture without the support of the external load. The results of this study may help inform off-ice training interventions for ice hockey goalkeeping.

Alcohol use disorder is a medical condition that impacts millions of individuals worldwide. Although there are a few pharmacotherapeutic options for alcohol-dependent individuals; there is a need for the development of novel and more effective therapeutic approaches. Alcohol and nicotine are commonly co-abused, and there is evidence that neuronal nicotinic acetylcholine receptors (nAChRs) play a role in both alcohol and nicotine dependence. Desformylflustrabromine (dFBr), a positive allosteric modulator of the α4β2 nAChRs has been shown to reduce nicotine intake, compulsive-like behavior and neuropathic pain in animal models. dFBr has also been previously shown to cross the blood-brain-barrier. We have recently shown that dFBr can attenuate the response to an acute, hypnotic dose of ethanol, via β2 nAchR. Here, we have investigated the effect of dFBr in modulating ethanol consumption using the intermittent access two-bottle choice (IA2BC) model of voluntary ethanol consumption in male and female Sprague Dawley rats. We show that dFBr selectively reduced ethanol but not sucrose consumption in the IA2BC model. Furthermore, dFBr decreased preference for ethanol in both male and female rats. No rebound increase in ethanol intake was observed after the washout period after dFBr treatment. The ability of dFBr to decrease ethanol consumption, along with its previously demonstrated ability to decrease nicotine self-administration in rodents, suggest that dFBr is an attractive therapeutic candidate to target both nicotine and alcohol abuse., Competing Interests: The authors have declared that no competing interests exist.

Intrauterine preeclampsia exposure affects the lifelong cardiometabolic health of the child. Our study aimed to compare the growth (from birth to 6 months) of infants exposed to either a normotensive pregnancy or preeclampsia and explore the influence of being born small for gestational age (SGA). Participants were children of women participating in the Post-partum, Physiology, Psychology and Paediatric follow-up cohort study. Birth and 6-month weight and length z-scores were calculated for term and preterm (<37 weeks) babies, and change in weight z-score, rapid weight gain (≥0.67 increase in weight z-score) and conditional weight gain z-score were calculated. Compared with normotensive exposed infants (n = 298), preeclampsia exposed infants (n = 84) were more likely to be born SGA (7% versus 23%; P < 0.001), but weight gain from birth to 6 months, by any measure, did not differ between groups. Infants born SGA, irrespective of pregnancy exposure, were more likely to have rapid weight gain and had greater increases in weight z-score compared with those not born SGA. Preeclampsia exposed infants born SGA may benefit from interventions designed to prevent future cardiometabolic disease.

Approximately 100 million adults in the United States have chronic pain, though only a subset utilizes the vast majority of healthcare resources. Multidisciplinary care has been shown to improve outcomes in a variety of clinical conditions. There is concern that multidisciplinary care of chronic pain patients may overwhelm existing resources and increase healthcare utilization due to the volume of patients and the complexity of care. We report our findings on the use of multidisciplinary conferences (MDC) to facilitate care for the most complex patients seen at our tertiary center. Thirty-two of nearly 2,000 patients seen per year were discussed at the MDC, making up the top 2% of complex patients in our practice. We evaluated patients' numeric rating score (NRS) of pain, medication use, hospitalizations, emergency department visits, and visits to pain specialists prior to their enrollment in MDC and 1 year later. Matched samples were compared using Wilcoxon's signed rank test. Patients' NRS scores significantly decreased from 7.64 to 5.54 after inclusion in MDC ( p < 0.001). A significant decrease in clinic visits ( p < 0.001) and healthcare utilization ( p < 0.05) was also observed. Opioid and non-opioid prescriptions did not change significantly ( p = 0.43). 83% of providers agreed that MDC improved patient care. While previous studies have shown the effect of multi-disciplinary care, we show notable improvements with a team established around a once-a-month MDC., Competing Interests: JP is a consultant for Boston Scientific, Nevro, Medtronic, Saluda and Abbott and receives grant support from Medtronic, Boston Scientific, Abbott, Nevro, NIH R01CA166379 and NIH U44NS115111. She is the medical advisor for Aim Medical Robotics and Karuna and has stock equity. CA is a consultant for Teva, Lilly, Allergan, Amgen, Novartis, and Flowonix. He provides research support to Teva and Allergan. He has stock in Pfizer. He is part of the Speaker's Bureau for Theranica, Tercera, Teva, Lilly, Allergan, Amgen, Novartis, and Flowonix. GD receives fellowship support from Medtronic, Boston Scientific, and Abbott. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflictof interest., (Copyright © 2021 Campwala, Davis, Khazen, Trowbridge, Nabage, Bagchi, Argoff and Pilitsis.)

The ubiquitin-proteasome system (UPS) and autophagy-lysosomal pathway (ALP) are two major protein degradation pathways in eukaryotic cells. Initially considered as two independent pathways, there is emerging evidence that they can work in concert. As alterations of UPS and ALP function can contribute to neurodegenerative disorders, cancer and cardiac disease, there is great interest in finding targets that modulate these catabolic processes. We undertook an unbiased, total genome high-throughput screen to identify novel effectors that regulate both the UPS and ALP. We generated a stable HEK293 cell line expressing a UPS reporter (Ub G76V -mCherry) and an ALP reporter (GFP-LC3) and screened for genes for which knockdown increased both Ub G76V -mCherry intensity and GFP-LC3 puncta. With stringent selection, we isolated 80 candidates, including the transcription factor ZNF418 (ZFP418 in rodents). After screen validation with Zfp418 overexpression in HEK293 cells, we evaluated Zfp418 knockdown and overexpression in neonatal rat ventricular myocytes (NRVMs). Endogenous and overexpressed ZFP418 were localized in the nucleus. Subsequent experiments showed that ZFP418 negatively regulates UPS and positively regulates ALP activity in NRVMs. RNA-seq from Zfp418 knockdown revealed altered gene expression of numerous ubiquitinating and deubiquitinating enzymes, decreased expression of autophagy activators and initiators and increased expression of autophagy inhibitors. We found that ZPF418 activated the promoters of Dapk2 and Fyco1 , which are involved in autophagy. RNA-seq from Zfp418 knockdown revealed accumulation of several genes involved in cardiac development and/or hypertrophy. In conclusion, our study provides evidence that ZNF418 activates the ALP, inhibits the UPS and regulates genes associated with cardiomyocyte structure/function. Abbreviations: ACTN2, actinin alpha 2; ALP, autophagy-lysosomal pathway; COPB1, COPI coat complex subunit beta 1; DAPK2, death associated protein kinase 2; FYCO1, FYVE and coiled-coil domain autophagy adaptor 1; HEK293, human embryonic kidney cells 293; HTS, high-throughput screen; LC3, microtubule associated protein 1 light chain 3; NRVMs, neonatal rat ventricular myocytes; RNA-seq, RNA sequencing; RPS6, ribosomal protein S6; TNNI3, troponin I, cardiac 3; UPS, ubiquitin-proteasome system; shRNA, short hairpin RNA; SQSTM1/p62, sequestosome 1; VPS28, VPS28 subunit of ESCRT-I; ZNF418/ZFP418, zinc finger protein 418.

Objectives: Women who had hypertensive disorders of pregnancy (HDP) are twice as likely to experience maternal cardiovascular disease later in life. The primary aim of this study (BP 2 ) is to compare outcomes of 3 different management strategies, including lifestyle behaviour change (LBC), in the first 12 months postpartum in women who had HDP in their preceding pregnancy. Secondary aims include assessing the effects on other cardiometabolic parameters., Study Design: Three-arm multicentre randomised trial in metropolitan Australian hospitals, (registration: ACTRN12618002004246) target sample size 480. Participants are randomised to one of three groups: 1) Optimised usual care: information package and family doctor follow-up 6 months postpartum 2) Brief intervention: information package as per group 1, plus assessment and brief LBC counselling at a specialised clinic with an obstetric physician and dietitian 6 months postpartum 3) Extended intervention: as per group 2 plus enrolment into a 6 month telephone-based LBC program from 6 to 12 months postpartum. All women have an outcome assessment at 12 months., Main Outcome Measures: Primary outcomes: (a) BP change or (b) weight change and/or waist circumference change., Secondary Outcomes: maternal health-related quality of life, engagement and retention in LBC program, biochemical markers, vascular function testing, infant weight trajectory, incremental cost-effectiveness ratios. The study is powered to detect a 4 mmHg difference in systolic BP between groups, or a 4 kg weight loss difference/2cm waist circumference change., Conclusions: BP 2 will provide evidence regarding the feasibility and effectiveness of postpartum LBC interventions and structured clinical follow-up in improving cardiovascular health markers after HDP., (Copyright © 2020 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.)

Introduction: Pregnancy induces significant physiological and cardiometabolic changes, and is associated with alterations in the maternal microbiota. Increasing rates of prepregnancy obesity, metabolic abnormalities and reduced physical activity, all impact negatively on the microbiota causing an imbalance between the commensal microorganisms (termed dysbiosis), which may drive complications, such as gestational diabetes or hypertensive disorders. Considerable work is needed to define the inter-relationships between the microbiome, nutrition, physical activity and pregnancy outcomes. The role of the microbiota during pregnancy remains unclear. The aim of the study is to define microbiota signatures longitudinally throughout pregnancy and the first year post birth, and to identify key clinical and environmental variables that shape the female microbiota profile during and following pregnancy., Methods and Analysis: The Microbiome Understanding in Maternity Study (MUMS) is an Australian prospective longitudinal cohort study involving 100 mother-infant pairs. Women are enrolled in their first trimester and followed longitudinally. Assessment occurs at <13+0, 20+0-24+6 and 32+0-36+6 weeks gestation, birth and 6 weeks, 6 months and 12 months postpartum. At each assessment, self-collected oral, vaginal and faecal samples are collected with an additional postpartum skin swab and breastmilk sample. Each infant will have oral, faecal and skin swab samples collected. Measurements include anthropometrics, body composition, blood pressure, serum hormonal and metabolic parameters and vaginal pH. Dietary intake, physical activity and psychological state will be assessed using validated self-report questionnaires, and pregnancy and infant outcomes recorded. Parametric and non-parametric hypothesis tests will be used to test the association between high-risk and low-risk pregnancies and their outcomes., Ethics and Dissemination: The study received the following approval: South Eastern Sydney Local Health District Research Ethics Committee (17/293 (HREC/17/POWH/605). Results will be made available to the participants of MUMS, their families and the funding bodies; in the form of a summary document. Results for the greater maternity care community and other researchers will be disseminated through conferences, local, national and international presentations and peer-reviewed publications., Trial Registration Number: ACTRN12618000471280 (prospectively registered)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Rationale: Postmitotic cells, such as cardiomyocytes, seem to be particularly susceptible to proteotoxic stimuli, and large, proteinaceous deposits are characteristic of the desmin-related cardiomyopathies and crystallin cardiomyopathic diseases. Increased activity of protein clearance pathways in the cardiomyocyte, such as proteasomal degradation and autophagy, has proven to be beneficial in maintaining cellular and cardiac function in the face of multiple proteotoxic insults, holding open the possibility of targeting these processes for the development of effective therapeutics., Objective: Here, we undertake an unbiased, total genome screen for RNA transcripts and their protein products that affect aggregate accumulations in the cardiomyocytes., Methods and Results: Primary mouse cardiomyocytes that accumulate aggregates as a result of a mutant CryAB (αB-crystallin) causative for human desmin-related cardiomyopathy were used for a total genome-wide screen to identify gene products that affected aggregate formation. We infected cardiomyocytes using a short hairpin RNA lentivirus library in which the mouse genome was represented. The screen identified multiple candidates in many cell signaling pathways that were able to mediate significant decreases in aggregate levels., Conclusions: Subsequent validation of one of these candidates, Jak1 (Janus kinase 1), a tyrosine kinase of the nonreceptor type, confirmed the usefulness of this approach in identifying previously unsuspected players in proteotoxic processes., (© 2017 American Heart Association, Inc.)

This manuscript discusses the current surgical management of glioblastoma. This paper highlights the common pathophysiology attributes of glioblastoma, surgical options for diagnosis/treatment, current thoughts of extent of resection (EOR) of tumor, and post-operative (neo)adjuvant treatment. Glioblastoma is not a disease that can be cured with surgery alone, however safely performed maximal surgical resection is shown to significantly increase progression free and overall survival while maximizing quality of life. Upon invariable tumor recurrence, re-resection also is shown to impact survival in a select group of patients. As adjuvant therapy continues to improve survival, the role of surgical resection in the treatment of glioblastoma looks to be further defined.

Background: Recent events in our hospital, combined with international recommendations, catalyzed the need to move from mercury sphygmomanometry to automated blood pressure (BP) recording in pregnancy., Aim: To test the accuracy of the Omron T9P automated BP recorder in pregnant women, using mercury sphygmomanometry as the gold standard., Setting: Antenatal clinics and obstetric day assessment unit, St George Hospital, Sydney., Participants: Eighty-five pregnant women, 11% of whom were receiving antihypertensives., Methods: Differences in both systolic and diastolic BP between the T9P Omron device and mercury sphygmomanometer were obtained for each woman, using sequential automated and mercury BP recordings, as required by a modified British Hypertension Society (BHS) protocol. The accuracy of the device was graded according to the BHS and the Association for the Advancement of Medical Instrumentation (AAMI) standards., Results: The Omron T9P device received an A/A grade according to this modified BHS and AAMI testing process, though the range of the 255 differences was 1-13 for systolic BP and 1-10 for diastolic BP., Conclusions: The Omron T9P device is an accurate device for use predominantly in an outpatient antenatal clinical setting. Further studies are required solely within hypertensive pregnant women before its use can be recommended with certainty in this group.

Objectives: To determine the prevalence of vitamin D deficiency in pregnant women and their neonates and to examine factors associated with vitamin D deficiency., Design and Patients: Population-based study of pregnant women and their neonates from South-eastern Sydney, Australia., Measurements: Serum 25 hydroxy-vitamin D (25-OHD), PTH, calcium, albumin, phosphate and alkaline phosphatase were measured in women at 23-32 weeks gestation and on cord blood at delivery. Maternal skin phototype was recorded using the Fitzpatrick scale., Results: Vitamin D deficiency (defined as 25-OHD

The objective of this study was to determine whether AJCC staging, supplemented by additional clinical and pathologic variables could identify a subpopulation of pathologically staged NSCLC patients who had been resected for cure with a low risk (<20%) of 5-year disease specific mortality. The Surveillance, Epidemiology, and End Results (SEER) registry was analyzed to identify and evaluate the disease specific 5-year mortality of 17,130 patients with resected and pathologically defined Stage I-IIIA disease initially diagnosed from 1988 to 1997. The analyses showed that American Joint Commission on Cancer (AJCC) T and N defined stage Stage I-IIIA subgroups had approximately a 30, 60, and 75% 5-year disease specific mortality, respectively. The 5,366 Stage IA patients were identified as having a 5-year disease specific mortality of 25%. Further multivariate analyses of Stage IA cases showed predictors of favorable outcome to be tumor size (< 10 mm), histologic grade (well differentiated), and histologic subtype (bronchoalveolar cell). Subgroups identified with two or all three of these additional features had an approximately 10% 5-year lung cancer specific mortality. Although nearly all patient subgroups with Stages I-IIIA resected and pathologically staged NSCLC have substantial (>20%) risk of death from their cancer within 5 years of diagnosis, for Stage IA patients additional information (tumor size, histologic grade, and histologic subtype) allows additional refinement in prognostic estimates and identification of some low risk subgroups.

Abstract The induction of labour of women with an unfavourable cervix who have had a previous Caesarean section, is challenging. Eight women who had a Caesarean section in a previous pregnancy had labour induced with an Atad catheter. Six out of eight women achieved labour, and two out of these six women had a vaginal delivery. An Atad catheter is an option for women needing induction of labour with an unfavourable cervix who have had a Caesarean section previously and are motivated to have a vaginal delivery.

Objective: To determine, in women with proteinuric pre-eclampsia, whether a discriminant value of proteinuria at the time of diagnosis predicts the presence or absence of subsequent adverse maternal and fetal outcomes., Design: Retrospective cohort study., Setting: One teaching hospital and two primary referral hospitals in Sydney, Australia., Sample: Three hundred and twenty-one pregnant women with proteinuric pre-eclampsia, managed according to a uniform management protocol., Methods: All women with the diagnosis of proteinuric pre-eclampsia in the years 1998-2001 were studied. After exclusion of women with pre-eclampsia superimposed on pre-existing hypertension, a twin pair, unavailable spot urine results, 353 women were analysed using logistic regression to determine separately the predictors of any adverse maternal or fetal outcomes at the time of delivery. Receiver operating characteristic (ROC) curves, sensitivity and specificity were then calculated from the data., Main Outcome Measures: Adverse maternal outcomes: severe maternal hypertension (BP > or = 170/110 mmHg), renal insufficiency, liver disease, cerebral irritation, haematological disturbances. Adverse fetal outcomes: small for gestational age, perinatal mortality., Results: There were 108 (34%) adverse maternal outcomes and 60 (19%) adverse fetal outcomes including two stillbirths. In multivariate analysis, an adverse maternal outcome was significantly associated with higher spot urine protein/creatinine ratio at diagnosis (P < 0.0001) with an odds ratio (OR) of 1.003 per mg/mmol (95% confidence interval [CI] 1.002-1.004) and with older maternal age (P= 0.014) with OR 1.06 per year (95% CI 1.01-1.11). An increased risk of adverse fetal outcome was associated with higher spot urine protein/creatinine (P= 0.013; OR 1.44 per log [mg/mmol], 95% CI 1.08-1.92), gestation at diagnosis <34 weeks (P < 0.0001; OR 3.60, 95% CI 1.90-6.82) and early pregnancy systolic blood pressure < or =115 mmHg (P= 0.0002; OR 3.41, 95% CI 1.77-6.57). The area under the receiver operating characteristic (ROC) curve was 0.67 for adverse maternal outcomes and 0.72 for adverse fetal outcomes., Conclusions: With increasing proteinuria, there is increased risk of adverse maternal and fetal outcomes. Although we did not identify a specific spot protein/creatinine ratio that could be used as a definitive screening value for adverse outcomes, it is possible to utilise data from this study to predict the likelihood of adverse maternal and fetal outcomes. A high spot urine protein/creatinine ratio in pre-eclamptic women of greater than 900 mg/mmol ( approximately 9 g/day), or greater than 500 mg/mmol (approximately 5 g/day) in women over 35 years, is associated with a greatly increased likelihood of adverse maternal outcomes.

This study compared data from death certificates (DC), medical examiner (ME) reports, and Uniform Crime Reporting (UCR) Program for homicides among children age 5 years or younger in Jefferson County, Alabama between 1988 and 1998. Records from each source were matched independently to records from the other two sources. Kappa coefficients measured the chance-corrected agreement between sources. The strongest correlations were for victim's gender and race. Correlations were weakest for victim's relationship to the offender and offender's gender. DC and ME data demonstrated excellent agreement and provided a comprehensive count of homicides in Jefferson County, whereas UCR comparisons had lower correlations. However, the UCR is a valuable source of child homicide data in the United States that is underutilized in public health research.

Objective: The purpose of this study was to present the epidemiology of homicide among children younger than 6 years of age in Jefferson County, Alabama. This study focused on obtaining great detail on homicides and suspicious deaths occurring within a fixed population., Methods: For purposes of this study, cases included Jefferson County deaths attributed to "homicide" or that were "undetermined" as noted in the coroner files among children younger than 6 years of age who were born and died between January 1, 1988 and December, 31, 1998. Victim and offender characteristics were obtained from the Jefferson County Coroner/Medical Examiner Office records. Environmental factors and circumstances surrounding the death were noted as well., Results: The 53 study subjects were mainly female (55%), Black (69%), younger than 2 years of age (85%), had single mothers (38%), and a history of abuse (53%). Offenders were more likely to be male (64%), Black (73%), and a parent of the victim (53%). Homicides primarily resulted from an angry impulse (61%), with hands the most common weapon (61%)., Conclusions: The majority of deaths in this study occurred among children younger than age 2, with a high proportion of fatalities among Black children of unmarried mothers. The offender most often knew the victim, with half of all homicides and two-thirds of all infant homicides involving a parent. More than half of the homicides resulted from an angry impulse, while the most common scenario for deaths with undetermined intent involved the caretaker finding the child unresponsive.