Fetal Care Nursing-The Birth of a Specialty.

With the rapid growth of specialized fetal care centers (FCCs) across the United States, a new area of nursing practice has emerged. Fetal care nurses provide care in FCCs to pregnant persons experiencing complex fetal conditions. This article describes the unique practice of fetal care nurses necessitated by the complexity of perinatal care and the provision of maternal-fetal surgery in FCCs. The Fetal Therapy Nurse Network has played a significant role in the evolution of this nursing practice and will serve as a platform for the generation of core competencies and the development of a potential specialty certification for fetal care nurses.

Evidence of Biological Self-Organization in Spatial Patterns of a Common Tropical Alga.

AbstractTropical reef communities contain spatial patterns at multiple scales, observable from microscope and satellite alike. Many of the smaller-scale patterns are generated physiologically (e.g., skeletal structures of corals at <1-m scale), while some of the larger patterns have been attributed to scale-dependent feedbacks (e.g., spur and groove reefs at 10-100-m scales). In describing the spatial patterning of reef benthic communities at landscape levels, we uncovered unique spatial patterning among living marine algae. Populations of the calcifying green alga Halimeda were observed to form a consistent polygonal pattern at a characteristic scale of 3-4 m. The pattern showed no clear evidence of having been formed through biologically created shifts in hydrodynamical conditions or related mechanisms. In considering the specifics of Halimeda growth patterns, a model of self-organization involving separation and patterned extension is proposed, a mechanism revealed in some geological pattern formation. This observation reinforces the diversity of pathways by which striking spatial patterns can occur in ecosystems.

Perinatal outcomes of pregnancies with twin-anemia polycythemia sequence complicating twin-to-twin transfusion syndrome using different twin-anemia polycythemia sequence diagnostic criteria.

OBJECTIVE: To investigate whether the presence of twin-anemia polycythemia sequence (TAPS) with twin-to-twin transfusion syndrome (TTTS) or post-laser TAPS would change outcomes using different TAPS diagnostic criteria. METHODS: TTTS cases undergoing laser surgery between 2012 and 2020 were included. Groups included pre-laser TTTS-only compared to TTTS + TAPS, and no post-laser TAPS compared to post-laser TAPS. Three prenatal TAPS diagnostic criteria were used: group A: middle cerebral artery-peak systolic velocity (MCA-PSV) > 1.5 MoM in one twin and <1 MoM in the other twin, group B: inter-twin MCA-PSV difference >1 MoM, and group C: inter-twin MCA-PSV difference >0.5 MoM. Perinatal outcomes including survival and severe cerebral injury were investigated. RESULTS: 174 laser procedures were included. TTTS + TAPS cases were 16 in group A, 17 in group B, and 29 in group C. Post-laser TAPS cases were 11 in group A, 6 in group B, and 12 in group C. There were no differences in preoperative, operative variables and outcomes including survival and severe cerebral injury between groups using all three TAPS diagnostic criteria. The incidence of TTTS + TAPS was highest in group C (16.7%), then group B (9.8%), followed by group A (9.2%). The incidence of post-laser TAPS was highest in group C (9%), then group A (8.3%), followed by group B (4.5%). CONCLUSION: Presence of TAPS complicating TTTS and presence of post-laser TAPS do not seem to be associated with worse perinatal outcomes including postnatal-ultrasound detected cerebral injury using three different TAPS criteria. Collaborative studies are needed to investigate the validity and the performance of different TAPS criteria.

Post-settlement demographics of reef building corals suggest prolonged recruitment bottlenecks.

For many organisms, early life stages experience significantly higher rates of mortality relative to adults. However, tracking early life stage individuals through time in natural settings is difficult, limiting our understanding of the duration of these 'mortality bottlenecks', and the time required for survivorship to match that of adults. Here, we track a cohort of juvenile corals (1-5 cm maximum diameter) from 12 taxa at a remote atoll in the Central Pacific from 2013 to 2017 and describe patterns of annual survivorship. Of the 537 juveniles initially detected, 219 (41%) were alive 4 years later, 163 (30%) died via complete loss of live tissue from the skeleton, and the remaining 155 (29%) died via dislodgement. The differing mortality patterns suggest that habitat characteristics, as well as species-specific features, may influence early life stage survival. Across most taxa, survival fit a logistic model, reaching > 90% annual survival within 4 years. These data suggest that mortality bottlenecks characteristic of 'recruitment' extend up to 5 years after individuals can be visually detected. Ultimately, replenishment of adult coral populations via sexual reproduction is needed to maintain both coral cover and genetic diversity. This study provides key insights into the dynamics and time scales that characterize these critical early life stages.

Automated 2D, 2.5D, and 3D Segmentation of Coral Reef Pointclouds and Orthoprojections.

Enabled by advancing technology, coral reef researchers increasingly prefer use of image-based surveys over approaches depending solely upon in situ observations, interpretations, and recordings of divers. The images collected, and derivative products such as orthographic projections and 3D models, allow researchers to study a comprehensive digital twin of their field sites. Spatio-temporally located twins can be compared and annotated, enabling researchers to virtually return to sites long after they have left them. While these new data expand the variety and specificity of biological investigation that can be pursued, they have introduced the much-discussed Big Data Problem: research labs lack the human and computational resources required to process and analyze imagery at the rate it can be collected. The rapid development of unmanned underwater vehicles suggests researchers will soon have access to an even greater volume of imagery and other sensor measurements than can be collected by diver-piloted platforms, further exacerbating data handling limitations. Thoroughly segmenting (tracing the extent of and taxonomically identifying) organisms enables researchers to extract the information image products contain, but is very time-consuming. Analytic techniques driven by neural networks offer the possibility that the segmentation process can be greatly accelerated through automation. In this study, we examine the efficacy of automated segmentation on three different image-derived data products: 3D models, and 2D and 2.5D orthographic projections thereof; we also contrast their relative accessibility and utility to different avenues of biological inquiry. The variety of network architectures and parameters tested performed similarly, ∼80% IoU for the genus Porites, suggesting that the primary limitations to an automated workflow are 1) the current capabilities of neural network technology, and 2) consistency and quality control in image product collection and human training/testing dataset generation.

Proximate Cord Insertion in Twin-to-Twin Transfusion Syndrome: Case Series and PRISMA Compliant Systematic Review and Meta-Analysis.

OBJECTIVE: We aimed to investigate the prevalence and clinical outcomes of twin-to-twin transfusion syndrome (TTTS) with proximate cord insertions. METHODS: This was retrospective cohort study of TTTS cases managed at single fetal center between 2012 and 2020. Presence of proximate cord insertions was defined as a distance of equal or less than 4 cm between placental cord insertions that was recorded based on sonographic and fetoscopic examinations. Clinical outcomes were investigated compared to unmatched cohort and to 1:2 matched controls using preoperative variables including Quintero staging, selective fetal growth restriction, anterior placenta, preoperative cervical length, and gestational age at fetal intervention. Systematic review and meta-analysis were conducted following PRSMA guidelines through searching PubMed, Scopus, CINAHL, and Medline databases from inception until January 2021. RESULTS: The prevalence of proximate cord insertions in monochorionic placentas with TTTS was 2% (5/246). All 5 cases were managed by fetoscopic laser surgery (FLS). Procedure time was significantly longer (mean: 61.4 min in proximate cord vs. 37.5 min in nonproximate cord, p < 0.001), and amnioinfusion was significantly more common (100% in proximate cord vs. 43% in nonproximate cord, p = 0.01). Perinatal survival and neonatal outcomes were not different between groups. Similar findings were seen following 1:2 control matching. Systematic review yielded total of 19 case reports of which different management options were applied including FLS (n = 13), amniodrainage (n = 3), and selective reduction (n = 3). Clinical outcomes results were mixed and inconsistent. FLS was described as technically challenging and residual anastomosis was common. Overall fetal and neonatal survival following FLS was 85% and 80%, respectively. CONCLUSION: Presence of proximate cords in TTTS cases poses serious technical challenges even for highly experienced surgeons. Feasibility should be only determined by fetoscopic examination.

Considering the rates of growth in two taxa of coral across Pacific islands.

Reef-building coral taxa demonstrate considerable flexibility and diversity in reproduction and growth mechanisms. Corals take advantage of this flexibility to increase or decrease size through clonal expansion and loss of live tissue area (i.e. via reproduction and mortality of constituent polyps). The biological lability of reef-building corals may be expected to map onto varying patterns of demography across environmental contexts which can contribute to geographic variation in population dynamics. Here we explore the patterns of growth of two common coral taxa, corymbose Pocillopora and massive Porites, across seven islands in the central and south Pacific. The islands span a natural gradient of environmental conditions, including a range of pelagic primary production, a metric linked to the relative availability of inorganic nutrients and heterotrophic resources for mixotrophic corals, and sea surface temperature and thermal histories. Over a multi-year sampling interval, most coral colonies experienced positive growth (greater planar area of live tissue in second relative to first time point), though the distributions of growth varied across islands. Island-level median growth did not relate simply to estimated pelagic primary productivity or temperature. However, at locations that experienced an extreme warm-water event during the sampling interval, most Porites colonies experienced net losses of live tissue and nearly all Pocillopora colonies experienced complete mortality. While descriptive statistics of demographics offer valuable insights into trends and variability in colony change through time, simplified models predicting growth patterns based on summarized oceanographic metrics appear inadequate for robust demographic prediction. We propose that the complexity of life history strategies among colonial reef-building corals introduces unique demographic flexibility for colonies to respond to a wide breadth of environmental conditions.

Outcome after fetoscopic selective laser ablation of placental anastomoses vs equatorial laser dichorionization for the treatment of twin-to-twin transfusion syndrome.

OBJECTIVE: The objective of the study was to compare the outcome in women with twin-twin transfusion syndrome (TTTS) who were managed by selective laser ablation of placental anastomoses (S-LASER) vs equatorial dichorionization of the anastomoses and chorionic plate (ED-LASER). STUDY DESIGN: We conducted an analysis of 2 consecutive cohorts with TTTS treated with S-LASER and ED-LASER. Preoperative, procedural, delivery, and outcome details were compared between treatment groups. RESULTS: A total of 147 twin pregnancies had laser (S-LASER, n = 71; ED-LASER, n = 76). Obstetric history, Quintero stage, placental location, individual arterial and venous Doppler parameters, and gestational age at laser and delivery did not differ. Use of lens fetoscope (96.1% vs 50.7%), coagulated anastomosis count (11 vs 15, P < .001), complete equatorial plate visualization (77.5% vs 92.1%, P = .019), and amniotic fluid transparency (80.3% vs 94.7%, P = .011) was greater during ED-LASER. Procedure-related complications, gestational age at delivery, and perinatal details were comparable between groups. ED-LASER was associated with significantly lower recurrence of TTTS (3.9% vs 8.5%), twin anemia polycythemia sequence (2.6% vs 4.2%), and amniotic fluid abnormalities (0% vs 5.6%, P < .05 for all comparisons). Logistic regression identified complete visualization of the equator as the primary determinant for successful TTTS treatment and coagulation of the chorionic plate as an independent cofactor. Double survival at age 6 months was significantly higher after ED-LASER (68.4% vs 50.7%, P < .05), attributable to a lower postlaser and neonatal mortality rates. CONCLUSION: In patients with TTTS, photocoagulation of causative anastomoses and the chorionic plate along the vascular equator decreases recurrence without increasing adverse outcome and improves survival compared with the selective technique.