Search

Oceanic and coastal fronts are well-documented as accumulators of microplastic debris; however the impact of estuarine fronts and their associated secondary flows on microplastic concentrations are less well-known. An investigation into the dynamics of microplastic behaviour within estuarine systems will allow for a greater understanding of plastic retention and exportation to coastal and offshore environments. This study combines high resolution modelling of estuarine processes with realistically parameterized microplastic particles to determine local exposure levels, residence times and temporal variability. We present a validated, three-dimensional, D-Flow Flexible mesh (D-Flow FM) model of a well-mixed estuary (Conwy Estuary, Wales, UK), demonstrating the regular development of an axial convergent front following high tide. A Lagrangian particle tracking model has been applied to simulate the behaviour of microplastic in these frontal systems and analyse how this behaviour may change as a response to various river discharge levels and tidal phases. The results of the ocean model and Lagrangian particle tracking model will be presented. Understanding how estuarine fronts impact microplastic concentration and dispersal within estuaries will increase the accuracy of modelling and in-situ estuarine microplastic studies alike, helping to quantify the contribution of well-mixed estuaries to regional and global microplastic budgets, and bridging the gap between terrestrial and marine environments.

Objective(s)\ud To understand current practice, expertise and training requirements for management of an impacted fetal head (IFH) at caesarean section (CS) in the UK, and whether a clinical trial of techniques to manage an IFH is acceptable.\ud \ud Study design\ud Five hundred and thirty-eight online surveys were completed by obstetricians (n = 206), obstetric anaesthetists (n = 38), midwives (n = 35) and parents (n = 259). Data was collected on incidences of CS and IFH, current use of techniques, and acceptability of a clinical trial to manage an IFH from health care professionals. Information on incidences of CS and recollection of an IFH, acceptability of techniques, and likelihood of taking part in a clinical trial were sought from parents.\ud \ud Results\ud The most common technique used by obstetricians (84%) and midwives (69%) was the ‘push technique’. Eighty-seven percent of health care professionals would be willing to participate in a clinical trial, with 89% confirming that results would guide their clinical practice. Most parents expressed reluctance regarding participation in a clinical trial during labour (62%), due to preferring a doctor to adopt the technique they felt most comfortable with (63%).\ud \ud Conclusion(s)\ud Given the lack of national guidance on appropriate techniques, no formal training, and no consensus on best practice for the management of an IFH during emergency CS, it is perhaps not surprising that the majority of heath care professionals would be willing to participate in a clinical trial, where results will guide their clinical practice. The future development of clinical trials, involving relevant stakeholders in the design of such trials, is crucial to improve upon the guidance and training provided to staff who may encounter an IFH.

IntroductionFollowing the detection of fetal growth restriction, there is no consensus about the criteria that should trigger delivery in the late preterm period. The consequences of inappropriate early or late delivery are potentially important yet practice varies widely around the world, with abnormal findings from fetal heart rate monitoring invariably leading to delivery. Indices derived from fetal cerebral Doppler examination may guide such decisions although there are few studies in this area. We propose a randomised, controlled trial to establish the optimum method of timing delivery between 32 weeks and 36 weeks 6 days of gestation. We hypothesise that delivery on evidence of cerebral blood flow redistribution reduces a composite of perinatal poor outcome, death and short-term hypoxia-related morbidity, with no worsening of neurodevelopmental outcome at 2 years.Methods and analysisWomen with non-anomalous singleton pregnancies 32+0 to 36+6 weeks of gestation in whom the estimated fetal weight or abdominal circumference is Ethics and disseminationThe Study Coordination Centre has obtained approval from London-Riverside Research Ethics Committee (REC) and Health Regulatory Authority (HRA). Publication will be in line with NIHR Open Access policy.Trial registration numberMain sponsor: Imperial College London, Reference: 19QC5491. Funders: NIHR HTA, Reference: 127 976. Study coordination centre: Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS with Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University. IRAS Project ID: 266 400. REC reference: 20/LO/0031. ISRCTN registry: 76 016 200.

Rivers and estuaries act as conduits of microplastic transport, linking terrestrial and marine environments: however, it is unclear to what extent estuaries act as sources or sinks for marine plastic waste. In densely populated catchments, microplastic pollution could impact human populations and natural ecosystems including through industry, domestic activities or direct exposure. An investigation into the physical behaviour of microplastic within estuarine systems will allow for a greater understanding of plastic retention and exportation to coastal and offshore environments. A high resolution 3D model (Delft D-Flow FM) of the Conwy Estuary (UK) is under development, with current and future projections of microplastic concentrations used to determine local exposure levels, residence times and temporal variability.The Conwy Estuary (UK) is a well-mixed macro-tidal, embayment type system connecting the Conwy catchment to the North Wales coast and Irish Sea – where waters are used for leisure and aquaculture. Microplastics derived from the catchment population, industry and agriculture are thought to flow into the estuary primarily from the Conwy river network. Because of this, this study will incorporate in-situ samples of microplastic concentrations in river water to be able to predict microplastic levels in the estuary with greater accuracy. Plastic dispersal simulations through particle tracking and water quality monitoring will be undertaken using known concentrations and future projections of microplastic.The results of the model validation as well as application to plastic dispersal simulations will be presented.

Background: Patient education should be integral to the care of people with inflammatory arthritis [1]. Research suggests that the majority of patients with Psoriatic Arthritis (PsA) would like to receive education about their condition [2]. There are limited studies in PsA but randomised controlled trials in rheumatoid arthritis have demonstrated that patient education improves compliance to medication [3], disease specific knowledge [4] and coping mechanisms [5]. In our department, patient education in PsA was recognised as an unmet need. Objectives: To pilot an educational session for PsA patients, to assess whether this improved patients’ understanding of their condition, and to determine whether an education programme would be a useful adjunct to patient care. Methods: Adult PsA patients attending their rheumatology clinic appointments were asked to complete a short survey on whether they would be interested in attending an education session and the aspects they would like to have covered. Those who expressed interest were invited to attend a 2.5 hour multidisciplinary team (MDT) session which covered 1) a general overview of PsA; 2) medications used in PsA; 3) the role of physiotherapy and occupational therapy; 4) flares and self management. Patients were asked to evaluate their knowledge or understanding before and after each topic covered, on the same day, using a series of 1-10 Likert scales. They were specifically asked whether they found the education session helpful; whether they would recommend it to other PsA patients; whether they would be interested in developing a PsA patient support group. Results: 25 patients were invited to the session and 9 patients attended. There were 5 males and 4 females, across a wide range of age categories. There were statistically significant improvements in all topics covered, including a mean improvement of 120% in how well informed patients felt about PsA in general (p Conclusion: All PsA patients demonstrated a greater awareness and understanding of their condition following a 2.5 hour education session. This study indicates that an education programme is a useful and important adjunct to patient care and supports extending this to the wider PsA patient population. References [1] Zangi HA, Ndosi M, Adams J, Andersen L, Bode C, Bostrom C, et al. EULAR recommendations for patient education for people with inflammatory arthritis. Ann Rheum Dis. 2015; 74(6):954-62 [2] Dragoi RG, Ndosi M, Sadlonova M, Hill J, Duer M, Graninger W, et al. Patient education, disease activity and physical function: can we be more targeted? A cross sectional study among people with rheumatoid arthritis, psoriatic arthritis and hand osteoarthritis. Arthritis Res Ther. 2013;15(5):R156 [3] Ravindran V & Jadhav R. The effect of rheumatoid arthritis disease education on adherence to medications and follow up in Kerala, India. J Rheumatol. 2013;40(8):1460-61 [4] Lovisi Neto BE, Jennings F, Barros Ohashi C, Silva PG & Natour J. Evaluation of the efficacy of an educational programme for rheumatoid arthritis patients. Clin Exp Rheumatol. 2009;27(1):28-34 [5] Giraudet-Le Quintrec J, Mayoux-Benhamou A, Ravaud P, Champion K, Dernis E, Zerkak, et al. Effect of a collective educational program for patients with rheumatoid arthritis: a prospective 12-month randomized controlled trial. J Rheumatol. 2007;34(8):1684–91. Disclosure of Interests: Keziah Austin: None declared, Nia Jones: None declared, Roopa Prasad Consultant for: Was on an Advisory Board for a pharmaceutical company meeting several years ago (unrelated to current abstract submission)., Speakers bureau: Speaker fees for a national psoriatic arthritis meeting in 2017 (unrelated to current abstract submission).

For hypertensive women in CHIPS (Control of Hypertension in Pregnancy Study), we assessed whether the maternal benefits of tight control could be achieved, while minimizing any potentially negative effect on fetal growth, by delaying initiation of antihypertensive therapy until later in pregnancy. For the 981 women with nonsevere, chronic or gestational hypertension randomized to less-tight (target diastolic blood pressure, 100 mm Hg), or tight (target, 85 mm Hg) control, we used mixed-effects logistic regression to examine whether the effect of less-tight (versus tight) control on major outcomes was dependent on gestational age at randomization, adjusting for baseline factors as in the primary analysis and including an interaction term between gestational age at randomization and treatment allocation. Gestational age was considered categorically (quartiles) and continuously (linear or quadratic form), and the optimal functional form selected to provide the best fit to the data based on the Akaike information criterion. Randomization before (but not after) 24 weeks to less-tight (versus tight) control was associated with fewer babies with birth weight P interaction =0.005), but more preterm birth ( P interaction =0.043), and no effect on perinatal death or high-level neonatal care >48 hours ( P interaction =0.354). For the mother, less-tight (versus tight) control was associated with more severe hypertension at all gestational ages but particularly so before 28 weeks ( P interaction =0.076). In women with nonsevere, chronic, or gestational hypertension, there seems to be no gestational age at which less-tight (versus tight) control is the preferred management strategy to optimize maternal or perinatal outcomes. Clinical Trial Registration— URL: https://www.isrctn.com . Unique identifier: ISRCTN71416914.

Background: Pregnant women with type 1 diabetes are a high-risk population who are recommended to strive for optimal glucose control, but neonatal outcomes attributed to maternal hyperglycaemia remain suboptimal. Our aim was to examine the effectiveness of continuous glucose monitoring (CGM) on maternal glucose control and obstetric and neonatal health outcomes. Methods: In this multicentre, open-label, randomised controlled trial, we recruited women aged 18-40 years with type 1 diabetes for a minimum of 12 months who were receiving intensive insulin therapy. Participants were pregnant (≤13 weeks and 6 days' gestation) or planning pregnancy from 31 hospitals in Canada, England, Scotland, Spain, Italy, Ireland, and the USA. We ran two trials in parallel for pregnant participants and for participants planning pregnancy. In both trials, participants were randomly assigned to either CGM in addition to capillary glucose monitoring or capillary glucose monitoring alone. Randomisation was stratified by insulin delivery (pump or injections) and baseline glycated haemoglobin (HbA1c). The primary outcome was change in HbA1c from randomisation to 34 weeks' gestation in pregnant women and to 24 weeks or conception in women planning pregnancy, and was assessed in all randomised participants with baseline assessments. Secondary outcomes included obstetric and neonatal health outcomes, assessed with all available data without imputation. This trial is registered with ClinicalTrials.gov, number NCT01788527. Findings: Between March 25, 2013, and March 22, 2016, we randomly assigned 325 women (215 pregnant, 110 planning pregnancy) to capillary glucose monitoring with CGM (108 pregnant and 53 planning pregnancy) or without (107 pregnant and 57 planning pregnancy). We found a small difference in HbA1c in pregnant women using CGM (mean difference -0·19%; 95% CI -0·34 to -0·03; p=0·0207). Pregnant CGM users spent more time in target (68% vs 61%; p=0·0034) and less time hyperglycaemic (27% vs 32%; p=0·0279) than did pregnant control participants, with comparable severe hypoglycaemia episodes (18 CGM and 21 control) and time spent hypoglycaemic (3% vs 4%; p=0·10). Neonatal health outcomes were significantly improved, with lower incidence of large for gestational age (odds ratio 0·51, 95% CI 0·28 to 0·90; p=0·0210), fewer neonatal intensive care admissions lasting more than 24 h (0·48; 0·26 to 0·86; p=0·0157), fewer incidences of neonatal hypoglycaemia (0·45; 0·22 to 0·89; p=0·0250), and 1-day shorter length of hospital stay (p=0·0091). We found no apparent benefit of CGM in women planning pregnancy. Adverse events occurred in 51 (48%) of CGM participants and 43 (40%) of control participants in the pregnancy trial, and in 12 (27%) of CGM participants and 21 (37%) of control participants in the planning pregnancy trial. Serious adverse events occurred in 13 (6%) participants in the pregnancy trial (eight [7%] CGM, five [5%] control) and in three (3%) participants in the planning pregnancy trial (two [4%] CGM and one [2%] control). The most common adverse events were skin reactions occurring in 49 (48%) of 103 CGM participants and eight (8%) of 104 control participants during pregnancy and in 23 (44%) of 52 CGM participants and five (9%) of 57 control participants in the planning pregnancy trial. The most common serious adverse events were gastrointestinal (nausea and vomiting in four participants during pregnancy and three participants planning pregnancy). Interpretation: Use of CGM during pregnancy in patients with type 1 diabetes is associated with improved neonatal outcomes, which are likely to be attributed to reduced exposure to maternal hyperglycaemia. CGM should be offered to all pregnant women with type 1 diabetes using intensive insulin therapy. This study is the first to indicate potential for improvements in non-glycaemic health outcomes from CGM use. Funding: Juvenile Diabetes Research Foundation, Canadian Clinical Trials Network, and National Institute for Health Research.