Peer review of third trimester abdominal circumference measurements.

BACKGROUND: Third trimester growth scans represent a significant proportion of the workload in obstetric ultrasound departments. The objective of these serial growth scans is to improve the antenatal detection of babies with fetal growth restriction. The aim of this paper is to describe a method of peer review for third trimester abdominal circumference measurements which is realistic within busy obstetric ultrasound departments in the UK. METHOD: Twenty-two, third trimester, measured abdominal circumference images were randomly selected. Images were assessed subjectively by 12 sonographers using the image Criteria Achieved Score. For quantitative assessment, termed the Inter-operator Variability Score, three of the abdominal circumference (AC) images were blindly remeasured. Following this, a questionnaire was used to ascertain which image criteria sonographers considered most important and to reach an agreement on correct caliper placement. RESULTS: The least frequently met image criteria with the lowest Criteria Achieved Score related to an oblique abdominal circumference section. These included fetal kidney present (Criteria Achieved Score 24.6%), multiple oblique ribs (Criteria Achieved Score 39.4%) and oblique spine (Criteria Achieved Score 37.5%). Caliper placement was also identified as inconsistent. DISCUSSION: This study demonstrates that the perfect AC section is not always possible and sonographers use their professional judgement to determine whether an image is acceptable. Seventy-three percent of the images reviewed were of an acceptable standard. There can be inconsistencies in sonographer opinion regarding what is an acceptable third trimester abdominal circumference image. These differences need to be addressed to maximise the effectiveness of the third trimester ultrasound examination. CONCLUSION: Peer review can be used to monitor scan quality and identify areas of inconsistency.

Potential predictability of the Ethiopian summer rains: Understanding local variations and their implications for water management decisions.

Understanding the influence of large-scale oceanic and atmospheric variability on rainfall over Ethiopia has huge potential to improve seasonal forecasting and inform crucial water management decisions at local levels, where data is available at appropriate scales for decision makers. In this study, drivers of Ethiopia's main rainy season, July-September (JAS), are investigated using correlation analysis with sea surface temperature (SST). The analysis showed local spatial variations in the drivers of JAS rainfall. Moreover, the analysis revealed strong correlation between March to May (MAM) SST and JAS rainfall in particular regions. In addition to the influence of SSTs, we highlighted one of the mechanisms explaining the regional pattern of SST influence on Ethiopian rainfall, the East African Low-Level Jet. Moreover, examining the occurrence of large-scale phenomena provided additional information, with very strong ENSO and positive IOD events associated with drier conditions in most part of Ethiopia. A sub-national analysis, focused at a scale relevant for water managers, on the Awash basin, highlighted two distinct climate zones with different relationships to SSTs. June was not included as part of the rainy season as in some areas June is a hot, dry month between rainy seasons and in others it can be used to update sub-seasonal forecasts with lead time of one month for JAS rainfall. This highlights the importance of understanding locally relevant climate systems and ensuing sub-seasonal to seasonal forecasts are done at the appropriate scale for water management in the complex topography and climatology of Ethiopia.

Could masking gestational age estimation during scanning improve detection of small-for-gestational-age fetuses? A controlled pre-post evaluation.

BACKGROUND: Antenatal detection of small-for-gestational-age fetuses improves outcomes and reduces perinatal mortality rates. However, ultrasonographic estimation of fetal weight is subject to several potential sources of error. One potential source of error is subconscious operator bias towards "normal" measurement values for gestational age (observer-expectancy bias). OBJECTIVE: We aimed to determine whether the sensitivity of small-for-gestational-age detection is improved by removing real-time display of estimated gestational age during measurement of the abdominal circumference in the third trimester. STUDY DESIGN: This retrospective evaluation (November 2014-May 2018 inclusive) included all singleton infants liveborn at ≥28 weeks gestation in a single United Kingdom obstetrics center. In the preintervention phase, real-time estimated gestational age was displayed to sonographers as they measured fetal abdominal circumference (the key determinant of estimated fetal weight with the use of the INTERGROWTH 21st fetal weight equation) in the third trimester. In the postintervention phase, real-time gestational age information was removed on selected ultrasound machines. Accuracy of birthweight percentile estimation was assessed before and after intervention, both in the full cohort comprising all eligible scans and in a subcohort that was scanned within 4 weeks of delivery. We assessed the accuracy of small-for-gestational-age detection using the sensitivity, positive likelihood ratio, and area under the receiver-operator curve. RESULTS: Of the 18,342 eligible pregnancies, 9342 (51%) had a third-trimester growth scan. The sensitivity of ultrasonographic estimation of fetal weight for antenatal detection of small-for-gestational-age babies did not change significantly between the before and after intervention phases (31.5% confidence interval, 27.1-36.2 vs 31.7% confidence interval, 20.2-45.0). Although the sensitivity for small-for-gestational-age detection was higher in the subcohort that was scanned within 4 weeks of delivery than in the full cohort (P<.001), there was no significant difference between the before and after intervention phases (58% confidence interval, 50-66 vs 65% confidence interval, 43-84). With the use of an estimation of the abdominal circumference percentile rather than estimated fetal weight percentile significantly decreased the sensitivity for small-for-gestational-age detection in all groups (P<.01), but there was no difference between the before and after intervention phases. CONCLUSION: Blinding operators to the estimated gestation of the fetus during abdominal circumference measurement does not significantly alter the antenatal detection rate of small-for-gestational-age babies. The observer-expectancy effect is therefore unlikely to be a significant contributor to the error that is associated with ultrasonographic estimation of fetal weight.

Evidence for a curriculum review for secondary schools in Fiji.

This pilot study aimed to gather information about knowledge of and attitudes towards a range of health and dietary issues, with a focus on obesity and NCDs. It involved 967 children equally distributed between Form 3 (age range 13-14) and form 5 (age range 16-17) from three schools, one from each of the health divisions in Fiji. It was found that almost half of the sample group were of "normal" weight, whilst 18% were classified as "overweight" and 16% as "obese". Half the children took an inactive mode of transport (bus/car) to school and a higher percentage of those who went by bus/car were overweight. The average daily consumption of fruit and vegetables was very low and the consumption of fried foods was high, particularly in urban-based schools. The majority of students did not know the full and correct definition of "balanced meals". Despite the majority of children (83.7%) recognizing the importance of PA and 75% of children reporting that they exercised "for health", only 14% of boys and 10% of girls said they looked forward to PE classes as it was good for their health. Ninety percent of children indicated that being overweight is not healthy and that 75% of children think that being underweight is not healthy. Overall, the children recognized the importance of good diet and exercise for health. However, gaps existed in the curriculum--particularly regarding the importance of engaging in PE for health, the role of obesity in increasing the risks of NCDs and the specific meanings of terms such as "health" and "balanced meals". Modification of the curriculum to enforce knowledge of the importance of PE/PA and the way they impact upon health, may improve the dietary and PA trends seen in schools in Fiji.